Vice President Joe Biden launched the “Cancer Moonshot” — his mission to cure cancer — this week, just as Hillary Clinton was shooting it down, along with the hopes of millions of cancer patients.
Biden’s plan is to streamline decisions made by the FDA, NIH and other government agencies to both speed up drug approvals and give patients the freedom to obtain the combination of medicines that works best for them. He wants to increase tax incentives and patent protection for private companies to partner with and invest in government cancer research.
Clinton wants a vast new bureaucracy that would delay and limit such choices.
Clinton is planning to use a series of executive actions to control the price of cancer drugs, how they are used and who will get them. There is nothing Congress or the courts can do, short of replacing ObamaCare, to change that.
She strongly supports a Centers for Medicare and Medicaid Services experiment to randomly pay some doctors a lower fee when they use more expensive drugs for cancer and other complex illnesses to see if it saves money. Medicare has no provision to ensure that this arbitrary cost-cutting doesn’t cost lives. And if someone with cancer wants to opt out, tough luck. Medicare patients are forced to be lab rats in this experiment.
As former CMS official Scott Gottlieb observes, another part of the project allows Medicare to decide what drugs are “therapeutically similar” to each other and set a benchmark, or “reference price,” that it would pay for them all. But this flies in the face of Biden’s effort to use knowledge that cancer not only varies from person to person, but from tumor to tumor, to ensure patients get the best medicine possible.
Proponents of these policies claim that other health systems, such as those in Europe and Canada, reduce cancer-drug prices without hurting patients. In fact, cancer-drug spending is actually higher in Europe, but because access to new medicines is limited, mortality rates are higher, too. So is spending on cancer care.
Further, Clinton proposes letting outside, unelected entities decide which cancer drugs should be covered and who should get them.
In particular, Medicare and the Clinton campaign are relying on the Institute for Clinical and Economic Review and the Center for Health Policy and Outcomes to decide for the rest of us the price and use of drugs based on an arbitrary dollar value of how much an additional year of life is worth.
This methodology would also be used by the Independent Payment Advisory Board, which was established by ObamaCare to force Medicare spending to conform to levels predetermined by the bureaucrats. The board will limit both the uses and prices of drugs to achieve those cuts.
Hence Clinton is outsourcing life-and-death decisions about cancer care to a panel of unaccountable bureaucrats and political cronies using one-size-fits-all criteria.
She would empower a similar panel to decide which drugs are truly “innovative” and set prices accordingly. And what’s a Clinton presidency without crony capitalism? The panel would also include insurers and companies that manage prescription-drug coverage. Since both interests get a percentage of lower drug prices in the form of cash rebates (almost $125 billion a year!), there’s a self-serving incentive to ratchet them down as far as possible.
And just to ensure that drug companies comply, Clinton supports a proposal that would deem prices 20 percent higher than those set by this federal advisory committee to be unreasonable and to harm public health and to punish drug companies accordingly.
Finally, Clinton also plans to force drug companies to spend a minimum percentage of their revenue in R&D or face fines and possible federal prosecution.
Incredibly, Clinton promises that each of these steps — from restricting access to new cancer drugs to price controls, to redistributing income from biotech firms to insurers and government coffers — will increase investment in truly innovative drugs. As one Clinton adviser said: “If [a company] doesn’t invest in research and development, it won’t be a drug company anymore.”
Perhaps Clinton should ask the thousands of people participating in Biden’s summit what they think of her proposal.
Better yet, let her publicly explain in the next summit how she would vindicate hope for a cure, not crush it.
Robert Goldberg is vice president of the Center for Medicine in the Public Interest.