The Health Reform Bills Would Be Great For the Business Of Health Care

Have you noticed how none of the big health care business special interests is running any negative health care reform ads? Why should they when each is poised to gain billions of dollars from it?

As President Barack Obama has said many times, any health care bill that costs about $1 trillion would be paid for, roughly half and half, with savings in the health care system and new revenues (taxes).

All told, health care providers will likely get hit by $500 billion in federal payment reductions over 10 years from what they would have received otherwise. This is their "savings" contribution to help pay for the overhaul effort. It amounts to no more than a couple of percentage points less than they would have received anyway.

But more importantly, the Congress is getting ready to spend $1 trillion over the same 10 years mostly to expand Medicaid and provide subsidies to the uninsured to help them purchase private health insurance and be able to pay their medical bills. The health industry, by giving up $500 billion, gets millions more patients armed with public and private health insurance cards. Not a bad deal—particularly when the other $500 billion needed to finance the bill comes from new levies on taxpayers, not bigger industry cuts.

The details show an even prettier picture for the business of health care.

Read the rest of this column at Kaiser Health News.

The Higher the Price the Better It Works--Placebo Drugs That Cost More Found to "Work Better"

That was the somewhat humorous--but nonetheless valuable--conclusion from a study sponsored by MIT and led by a Duke behavioral economist.

It seems that researchers told one group that a medication cost $2.50 per pill and told another group that it cost ten cents per pill. Both were identical placebos.

85% of those who took the "$2.50 pill" reported pain relief.

61% of those who took the "10 cent pill" reported pain relief.

I guess we have always known that when it comes to health care a good name and a higher price has always counted for something in the absence of hard data to the contrary.

Yesterday, in a post reporting a 7.4% increase in brand-name prescription drugs during 2007, I asked why it was necessary for these prices to rise by two-and-a-half times the rate of overall inflation.

Maybe the pharmaceutical industry knows that lots of advertising and higher prices actually help them!

Drug Prices Rise 7% For Drugs Most Commonly Prescribed For Seniors--Two-and-A-Half Times the Rate of Overall Inflation

Many health care experts point to the creation of Medicare as the time that the American health care system's costs began to explode at an unsustainable rate. Simply, they believe that a huge infusion of government money drove both the supply and the demand for services setting the stage for today's cost problems.

That has made many wonder what impact the new Medicare Part D drug benefit, which began in 2006, would have on drug prices.

That's why last week's news that drug prices for the brand-name medications most often prescribed for seniors increased by an average of 7.4% in 2007--two-and-a-half times the rate of basic inflation--caught my eye.

In the study, the senior group, AARP, tracked the wholesale drug prices for 220 different drugs. The prices increased for all but four.

In the four years prior to the advent of Part D, wholesale drug prices increased between 5.3% and 6.6% annually.

The pharmaceutical industry countered that overall drug prices have only increased by 3.7% since 2000. But that number includes the price of generic drugs that make up about half of all drug purchases.

While prices didn't spike much past prior trends, the 7.4% increase is disconcerting.

Will Part D have the kind of inflationary effect on drug prices that Medicare has been thought to have on overall health care costs?

Why did name-brand drug prices rise by a multiple of two-and-a half-times the rate of inflation in the first place?

Drug Patents and "Pay-For-Delay"--Drug Industry Payoffs That Need To End

I call your attention to a recent op-ed by a member of the Federal Trade Commission, Jon Leibowitz, in the Washington Post.

Commissioner Leibowitz writes about the growing practice of "colluding with competitors to keep lower-cost generic alternatives to prescription drugs off the market."

The Hatch-Waxman Act made it easier for generic drugs to enter the market once a name brand drug's patent has expired. Because of it, the health care system has saved many billions of dollars. For example, the generic versions of just four drugs, Prozac, Zantac, Taxol, and Platinol, will ultimately save payers $9 billion.

But that has been changing.

More recently, the patent holding drug companies have begun to payoff their potential competitors to delay bringing a generic alternative to market when the patent has expired. A case in point is drug maker Cephalon and its sleep apnea and narcolepsy drug, Provigil.

Cephalon paid its potential competitors $200 million to keep a generic version off the market for another seven years. By Cephalon's own estimate that will make the company another $4 billion--and $4 billion more in costs to health care payers.

The courts have recently supported this practice. As a result, during 2006, 14 of 28 pharmaceutical patent settlements included such arrangements. While this may yet get to the Supreme Court, there is a bill pending in the Congress to make the practice illegal.

Something as egregious as this deserves to be outlawed.

When It Comes To Drug Prices the Europeans Are Better Health Care Capitalists Than We Are!

Sometimes I think the government-run European health care systems do a better job of using market tools to control their drug prices than we do in the U.S. market.

For example, some government-run systems in Europe, France for example, are not afraid to take a drug off their official formulary if they don't get a competitive price.

In January, the Democratic House passed a bill requiring Medicare to negotiate prices with the drug industry. But for all their election-year bluster last year, the Democrats put no teeth in the measure. When the day was done, Medicare would have had no power to take a drug off the approved list if the government didn't get a good price. But being able to walk away from a vendor is how good capitalist market negotiations work. Would you go to the Chevy dealer, tell them you are going to buy the car no matter what the price, and then demand a better price and expect to get it? But, that's exactly what the Dems put in their Medicare drug price negotiation bill.

That bill later died in the Senate.

It is ironic that Part D insurance companies have the right to exclude a particular drug from their list if they can't get a good price--although they rarely do. Insurers are rightly required to include a wide range of drugs in each class--but not every drug available in a particular class.

It looks like those "sissy" Europeans have turned out to be better market capitalists once again.

This from today's Wall Street Journal:

"To overcome European state-run health-care systems' increasing stinginess about paying for new drugs, some pharmaceutical companies are taking a novel approach: pay for performance.

"Johnson & Johnson has promised to reimburse Britain's National Health Service when patients don't respond to the U.S. company's blood-cancer drug Velcade, in a deal expected to start later this month. In France, J&J has made another agreement on its schizophrenia treatment, Risperdal Consta, offering to pay back the French health-care service some of the money it spends on the drug if tests don't show the injectable medication helps patients stay on regular doses.

"And France's health-care service says it has discussed pay-for-performance contracts with GlaxoSmithKline PLC, but won't reveal details. A Glaxo spokeswoman says the company has talked with European governments about "pricing-for-value" deals, but declined to provide specifics.

"Drug companies are offering these deals instead of simply lowering prices in part because they are fearful of setting precedents that would cause insurance payers world-wide to demand price cuts.

"J&J spokeswoman Kate Purcell says J&J decided to offer a rebate on Velcade instead of lowering its price. "We know our drug works" and "don't accept that our drug wasn't cost-effective," she says. British officials had recommended late last year that the NHS not pay for Velcade because they didn't think the expensive drug was effective in enough people. A full course of Velcade can cost up to $49,000 per patient. J&J then offered to reimburse the NHS, in either cash or product, for patients who don't respond adequately to treatment.

"In the U.S., health-care payers -- which include employers and insurance companies -- have traditionally been more generous than European health-care services in paying for new drugs. Even so, Hartford, Conn.-based insurer Aetna Inc. is exploring pay-for-performance deals with drug makers..."

Let me repeat that last line: "In the U.S., health-care payers -- which include employers and insurance companies -- have traditionally been more generous than European health-care services in paying for new drugs."

Much is made about a government-run systems ability to unilaterally negotiate a price and therefore drive the cost down.

However, it has been my observation that in many European systems what they really do is go to the drug company and tell them straight out if you don't drop the price you will not be on our list. They pit one vendor against the other. Isn't that what we want the U.S. government to do when it comes to buying airplanes and tanks?

Is that government price controls or darn good capitalist negotiation?

Once again, when it comes to drug prices, some of these Europeans look to me to be better capitalists than we are!

The Senate’s Mixed Message on Drug Reimportation—They Voted For it Before They Voted Against It!

To be completely fair, they actually voted against it before they voted for it but the outcome is the same.

A whole lot of Senators now go down as voting for the ability of drug wholesalers, retailers, and consumers to bring drugs in from industrialized nations where prescription drugs are a lot cheaper. This provision was one that could have really had an impact on drug prices.

While drug reimportation from places like Canada is illegal, it goes on virtually unimpeded everyday as individuals buy small amounts for personal use from online pharmacies.

What made this provision different is that it would have allowed the big prescription drug purchasers—drug wholesalers and retailers like big chain drug stores—to import large quantities of prescription drugs from cheaper markets. That would have likely busted the market open with cheaper drugs and a new level of competition.

The pharmaceutical drug industry argues that would also have opened up a “Pandora’s box” of problems—particularly safety issues—as tons of new and cheaper drugs flooded the market from Europe and Canada.

In response to these concerns, the Senate added a provision that requires the Secretary of HHS to assure the safety of foreign drug supplies. The result is that the final bill is loaded with a "poison pill" that all but guts it.

The Senate has done this before—in fact at least once during the Clinton administration. Back then Donna Shalala wouldn’t certify the safety of drug imports (because she didn’t have the resources to do so) and Mike Leavitt isn’t going to in this administration. So, the bill is meaningless in its current form.

The vote to add the "poison pill" Cochran amendment was 49-40 with the likes of liberal Senator Ted Kennedy somewhat surprisingly voting with the majority to add the "poison pill."

Why did so many Democrats who might have been expected to vote for drug reimportation effectively vote against it?

The answer lies in the primary bill that supporters were using to attach their reimportation amendment to—a bill that would give the Food and Drug Administration (FDA) significant new regulatory powers over how drugs are used and promoted after they go to market.

This FDA bill has been a longtime in coming and is considered vital legislation and groundbreaking—particularly by its Senate cosponsors Ted Kennedy (D-MA) and Mike Enzi (R-WY).

With President Bush already saying he would veto the whole FDA bill if a strong drug reimportation provision were added, the “poison pilled” version was the only way that both the important FDA bill would become law and Senators could appear to be supporting cheaper drugs from Canada and Europe.

Of course by voting for the Cochran amendment they really weren’t supporting drug reimportation—just looking like they did.

Hence, they voted for it but not really.

Will prescription drug remimportation be back on the Senate agenda in 2007?

It likely will.

But even if we see a real up or down vote on drug reimportation there is no doubt that President Bush will veto it.

But for now the President is happy with the “poison pilled” version.

He’s for it before he has to be against it.

In Washington, DC, this all really does make a lot of sense!

Medicare Drug Negotiation Bill Fails in the Senate

Democrats fell short of the required 60-votes to pass a bill that would have allowed the Secretary of HHS the power to negotiate Medicare Part D drug prices. Democrats did get 55 votes while 42 Senators opposed the bill. The vote generally followed party lines.

The Medicare Part D drug negotiation bill was little more than a political charade anyway since the bill would not give HHS any leverage in negotiating Medicare Part D drug prices. Unless Medicare has the right to exclude a drug from coverage under Medicare, there isn't any reason for a drug manufacturer to lower their price. The lack of any negotiating leverage made this a pretty hollow bill.

If the bill had passed and been combined with a similar (and just as hollow) House bill, President Bush would have vetoed it making this a just a political exercise.

Even though this was a very weak bill, the pharmaceutical industry pulled out all of the stops to kill it. Their worry was that even this weak bill could have been manipulated by regulation into something more powerful by a future Democratic Secretary of HHS. If nothing else, it also represented the "camel's nose under the tent" since it could have served as the basis of an expansion by a more liberal Congress and President down the road.

Ironically, private Medicare Part D insurance companies have this leverage--they can exclude a particular manufacturers product (although they must include drugs from every class) or place it in a co-pay tier that puts it at a disadvantage from competitors drugs. That leverage makes it possible for insurers to get lower prices.

You can also hear my Wednesday evening comments on public radio's "Marketplace:" Medicare Drug Bill Stalls

My January comments on the House drug negotiation bill: The Democrats Hollow Part D Proposal

A Drug Reimportation Bill Continues to Receive Bipartisan Congressional Support

A drug reimportation bill that would enable consumers, drug retailers, and wholesalers to import cheaper foreign drugs from FDA-approved plants and warehouses continues to gain support. The CBO reported that the bill would generate $50 billion in savings for pharmaceutical purchasers over 10 years.

While a floor vote has not yet been scheduled in either house, we continue to believe this, or a similar drug reimportation bill, will pass both houses in this Congress.

The real question is can its supporters sustain a Bush veto? That one is too close to call.

Waxman Investigates Part D Medicare Drug Plans

When the Democrats took over the Congress I pointed out that not only would they launch a health care legislative agenda of their own but they would also focus on the oversight of existing health care policy.

Their greatest interest was always going to be the new Medicare Advantage plans and the Part D Medicare drug benefit. While the Democrats don't have the votes to repeal either of these popular programs, they do have the ability to impact them in the budget process and in their oversight activities. The House Democratic chairmen (Dingell, Rangel, Stark, and Waxman) tend to be more liberal then many of their Democratic colleagues--particularly the recently elected Dems--and have a far more cynical view of the Republican policy that has given the private markets a substantial stake in the Medicare program (see an earlier post on why the Democrats hate Medicare Advantage).

So it wasn't at all surprising when House Oversight and Government Reform Chair, Henry Waxman, held a hearing looking into the operation of the Part D Medicare Drug plan last Friday.

His specific focus was whether Part D private insurers are passing on the savings from drug price negotiations or whether too much of those savings are being taken in profit. He heard testimony arguing that if the government were in charge of negotiating drug prices it would be clear just how much of the benefit of lower drug prices was being passed on to seniors.

The subject of his first set of Medicare oversight hearings is somewhat surprising since by all accounts the cost of Part D to both the government and to consumers has been less than anyone originally thought it would be.

What will make this interesting is Waxman's promise to ask the HMOs just how profitable their Part D drug plans are.

But as I have said before, this is not so much about the details of the private market in Medicare as it is a deep philosophical concern on the part of these powerful Democratic chairmen that the privatization of Medicare is the wrong way to go.

This will be the first of many attacks on the privatization of Medicare in preparation for an even more direct assault on what was a centerpiece of Republican health care policy--using the private market to "modernize" Medicare.

Medicare Drug Negotiation Legislation and a Drug Reimportation Bill––Will They Be Merged?

Legislation to give pharmacies and drug wholesalers the ability to take advantage of lower drug prices in places like Canada, where government controls produce much lower prices, has been introduced in the new Congress.

Unlike bills that would only give consumers this ability to import drugs—something lots of people are doing anyway—this would turn the market upside-down by letting the big U.S. pharmacy companies and drug wholesalers do it.

That means that health plans and large, self-insured employer groups could directly benefit from a drug reimportation scheme.

In the last Republican Congress, the votes were likely there to pass a drug reimportation bill but Republican leaders in both houses blocked it.

Now, with both houses led by Democrats, it is very possible we will see a drug reimportation bill make it through this Congress.

A new bill introduced by Senator Byron Dorgan (D-ND) and Olympia Snowe (R-ME), as well as Representative Rahm Emanuel (D-IL) and Jo Ann Emerson (R-MO) in the House, would establish the framework for wholesalers and retailers to purchase FDA-approved drugs from FDA-approved manufacturing facilities in foreign nations. In addition, the bill would require the FDA to regulate the shipments of prescription drugs reimported (originally manufactured in the U.S.) back into the U.S for personal or commercial use.

President Bush has said he will veto such a bill.

The question is not whether there are enough votes to pass such a bill in both houses, but whether there are the two-thirds votes necessary to override a veto.

It wouldn’t surprise me to see this bill eventually merged with a compromise drug negotiation bill that focuses on the one-of-a-kind drugs the Snowe/Wyden bill is targeted on.

Earlier posts on the Medicare Part D drug negotiation issue.

Back to "Regular Order"--The House Medicare Part D Drug Bill and SCHIP Reauthorization

The debate over the House Medicare drug negotiation bill is now moving over to the Senate.

My post from last Friday (next post below) still reflects what I am seeing on this issue. The Senate will move a drug bill on "regular order" which means we will see the standard committee hearings and process that could lead to floor action later in the spring or summer. The House Medicare Part D drug negotiation bill––all three pages of it--will go nowhere. It is possible a bill focused on the most expensive drugs with no competitor in its class has a chance. See Friday's post for those details.

The other health care issue that will be getting both House and Senate time (lots of it) will be the reauthorization of SCHIP (State Children's Health Insurance Program). This is the existing Medicaid plan that covers uninsured children who are part of families not otherwise eligible for Medicaid benefits.

SCHIP was a 1997 bipartisan product of the Clinton Administration that both Democrats and Republicans will tell you has been a success. As the number of working uninsured has grown, the only thing that has kept the overall number of the uninsured from going up even further is SCHIP.

It is estimated that if the program were to end as many as 6 million kids would become uninsured.

The problem is that the program needs to be reauthorized--and soon or it will die. Even at current funding levels the program will face big deficits perhaps leading to 1.5 million kids losing coverage.

To keep the program going and fix the funding gap over the next five years would cost between $13 billion and $15 billion.

The Democrats have boxed themselves into a bit of a corner because the new House has put the Congress on a pay-as-you-go basis with their new budget rules--they say no more big deficits like the Republicans piled up. You don't spend money unless you find a spending offset or you raise taxes to pay for it.

So, Republicans and Democrats think SCHIP is a great plan--a bipartisan success. Both sides want to reauthorize it and nobody wants to see more kids uninsured.

But there isn't any money obviously available.

Right now, every one in Congress is waiting for the President to make the first move in his budget message and the upcoming State of the Union Address.

So, no "100 hours" quick fixes for SCHIP. It's also "regular order" for this challenge.

SCHIP isn't a sexy political issue but it is an important one.

And, SCHIP is the first real test of the Democrats ability to lead and keep their promise to be fiscally responsible.

When it comes to health care, SCHIP and a Part D Senate bill are the two big issues everyone in Washington will be focused on for the next few weeks.

Grassley and Baucus Key to Any Drug Negotiation Compromise

In earlier posts, I have made the point that the House bill to require the federal government to negotiate Part D prescription drug prices will not pass the Senate.

Developments in recent days have confirmed that opinion for me. The ranking Republican on the Senate Finance committee, Chuck Grassley, has said he would lead a filibuster of the House bill on the Senate floor and has said he is confident he can keep the Dems from getting the necessary 60-votes.

President Bush yesterday issued a statement formally telling us what we already knew—that he would veto the bill if it passes both houses.

Democrats are now scrambling to find a compromise that can get through the Senate.

In recent posts, I pointed out that any bill that is just three pages long wasn’t a serious proposal anyway—I called the House bill a hollow political charade.

The fact that the Senate is looking at options for what is a far more complex issue just tells us that this is where the serious work will be done.

Senate Finance Chair Baucus, with his friend Chuck Grassley, will be pivotal in any possible compromise.

Baucus has said that he will not support the House bill—put a nail in that coffin.

What is interesting is that Baucus has said that he is interested in looking at a more targeted bill. For example, looking at price negotiation for drugs that have no competition—where the drug company has a monopoly in a drug class or their particular compound is unique. Often, these will be the “blockbusters” that typically have the very high prices. It looks like he would leave the rest of the market alone and let the Part D plans continue to make competition work.

Senators Snowe (R-ME) and Wyden (D-OR), have proposed a similar structure when there is only one drug in the class or when a drug was developed with substantial assistance from the government.

This might make some sense. However, to work the feds would have to either ban the drug if the drug company didn’t negotiate in good faith—not a great solution for people who need the new drug—or be able to unilaterally set an “appropriate” price. The latter would be a kind of “eminent domain” taking of the product for a price the government deemed fair.

Just giving the government the ability to negotiate for a smaller number of drugs would do nothing unless the feds had leverage to make the drug company come to the table. That is what is lacking from the current House bill and if it is lacking from a Senate compromise any new proposal will be just as hollow.

If Baucus can bring Republican Grassley and a handful of his colleagues onside with such a compromise, something Grassley has not ruled out, we could have a bill.

Such a compromise would really put the President’s threat to veto a drug negotiation bill on the line—but this “lame duck” is stubborn enough to do it!

But we have a long way to go.

Both Grassley and Baucus have said they do not want to harm the market and the success Part D has had so far—and I believe both of them on that score. Finding a compromise that lowers prices, because it has teeth, and does not “harm” the market is a tall order.

We have a long way to go and the Senate is going to take its time.

And, big pharma is going to really turn up the heat! The House bill wasn't going to harm them. A compromise like this would be a whole new ballgame.

Big pharma didn't oppose the House bill because they were afraid of it. They opposed it because they were afraid it would turn into this!!!!

The House Part D Drug Negoatiation Debate is Heating Up!

I was quoted in the Washington Post today reiterating my concern that the House Part D drug negoatiation bill is a hollow political charade on the part of the Dems:

"The federal government can get lower prices, but only if it's willing to exclude a certain number of drugs from the formulary," said Robert Laszewski, a nonpartisan health policy consultant in Washington. "And that's a huge political leap that I would be very surprised if this Congress took. I don't think they are going to give CMS any teeth."

Even former CMS head, Mark McClellan, no enemy of the drug industry, sees it falling way short of what the Veterans Administration is able to do to control their drug costs:

"It's apples to oranges," former CMS administrator Mark B. McClellan said of the comparison. "The VA is a closed health-care system relying on mail order and a tighter formulary than Medicare beneficiaries have shown they prefer."

You can see the full story--which is very well done and balanced--in today's Washington Post (link at top of post).

I also had two more comprenhensive posts on the issue that you can read below (January 8th).

More on the Democratic Part D Drug Negotiation Debate

A friend in big pharma responded to my earlier post on Part D disagreeing with me that the Democratic proposal is not a threat to the drug industry.

He made two points:

• The Dem bill does not prevent the government from requiring each and every plan to prior authorize a medicine for which it is unable to negotiate an "acceptable" price. They see such restrictions as possible because this would not be a formulary.
• They worry that CMS might, by regulation, decide that to participate a PDP must follow a price schedule. They see this as possible because the Dem bill eliminates the prohibition against a price schedule.

My sense is that the three page Dem bill says nothing about any of this and it might be possible for a future Democratic administration to be expansive in the way it interprets any of this. And maybe not.

However, I still maintain that the real threat to pharma is from the big market share HMOs that do have the market clout and can establish a formulary as well as a co-payment structure that should scare pharma a whole lot more than what a future Democrat CMS administrator might dream up. Any interpretation of this bill falls short of what the HMOs can now do without asking.

In the end, my sense is that pharma is scared, and should be, because of the "camel's nose under the tent" this bill creates more than any short-term risk it creates.

But, pharma should be a lot more afraid of what the big HMOs can already do like the rate of generic take-up that private plans, including PDPs, have been effective in steering.

This three page House Democratic bill is little more than a hollow political proposal. If it were serious, it would be more than three pages long! I can't remember the last time I saw a three page bill (the ones that name a post office are longer).

The House will pass this, the Dems will celebrate, it will go to the Senate, and it will die. If the Dems are really lucky (and the Republicans are stupid) a Republican senator will put a "hold" on the bill and the Democrats can blame the Republicans for siding with the big drug companies and against grandma.

The Democrats' Hollow Part D Proposal

The House Democrats have announced the form their Part D prescription drug legislation will take.

Throughout the 2006 campaign, they had pledged to lower senior prescription drug prices by requiring the federal government to negotiate directly with the drug companies--something the 2003 Medicare Act specifically prohibited. The Democrats went further saying that these negotiations would make it possible to close the "donut hole," or coverage "gap," that now exists in the senior drug program.

That all had a great ring to it on the campaign trail. But guess what? The Democrats won the election and now they have to follow through on the pledge.

The problem is that when they got back to Washington they couldn't figure out a way to make their pledge work! It became clear that there weren't the savings in drug negotiation they had hoped for--so forget eliminating the gap.

More, they found out that the way you get real savings from negotiation is that you tell the drug companies if they don't give the Part D plans a great price they will be excluded from being offered--they won't be on the formulary.

All last year Democrats were critical of the Republican Part D plan for limiting benefits in one way or another. Now Democrats find out that if you really want to cut costs you have to limit benefits to do it. Yikes!!!

So what do the Democrats propose for their "first 100 hours" approach to limiting drug costs?

They propose something hollow and nothing more than a political charade.

The Democrats propose to require the Department of Health and Human Services (HHS) to negotiate drug prices with the drug companies (tough language there). BUT, they don't give the feds any leverage to get a lower price.

The Democrats would require the negotiations but they put HHS in the position of having to tell the other side that they also have no leverage--negotiate with us but you are going to get offered in all the health plans anyway.

The Democrat proposal also says that the Part D drug plans (the PDPs) are free to negotiate better prices than the government gets.

So, where are we at the end of the day?

The PDPs will do what they do now. The big guys, who have the market clout, can exclude drug companies from their formulary, and give incentives to use generic drugs, will have more clout than the the feds who have none because they can't exclude anybody.

So, the Democrats pass their hollow and meaningless Part D negotiation law in the "first 100 hours," likely watch it die in the Senate (if not incur a Bush veto), declare a political victory, and move on.

The market keeps doing what it has and the Democratic proposal, if it were to become law, wouldn't make any difference.

Being in the opposition was a lot easier than governing!

January 7 LA Times Related Story

January 7 Washington Post Related Story