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Gibbons: Reconciliation Bill Hobbles Medicare, Hurts Seniors

Oped by Mark Gibbons - President /CEO RetireSafe - Boston Herald - November 16, 2021


To help pay for the massive spending bill, congressional Democrats are planning an enormous change to Medicare. The changes will curtail access to today’s advanced medicines and stifle the development of tomorrow’s new treatments and cures.

The bill seeks to remove the Medicare drug benefit’s “non-interference” clause, which bars federal health officials from meddling in the prescription drug market. Democrats are marketing this plan as “negotiations” — because few would take issue with a good-faith back-and-forth. However, the bill explicitly plans to impose price controls.

As it currently stands, the spending package would cap the prices on branded medicines and impose a financial penalty if a drug rises in price at a pace faster than inflation.

This would completely upend Medicare.

By design, Medicare’s drug benefit was set up to be administered by private insurers. This model forces insurers to compete for seniors’ business by offering a wide variety of drug plans. Additionally, it forces drug companies to negotiate with those insurers, as they all want their medicines included on insurers’ formularies.

The government subsidizes the drug plans and requires insurers to cover many critical medicines, but otherwise, it stays out on the sidelines. This “non-interference” has turned into a critical safeguard for seniors, as it protects them from the one-size-fits-all formulary that patients face in other government-run health care programs.

Consider the Veterans Affairs drug benefit. Of the 200 most popular branded drugs in Medicare, the VA covered only 52% of them. Medicare’s drug plans, though, covered 74% of them. Government-run systems abroad are even more restrictive. American patients gained immediate access to 90% of the medicines released between 2011 and 2017. British patients could access only 60% of those drugs — and Canadians could only access 44% of them.

Setting drug prices arbitrarily would also deter companies from investing in research. It costs almost $3 billion, on average, to develop a new treatment. That cost is so high because every success story must pay for the medicines that never make it out of the lab or fail in clinical trials.

If the government starts capping prices — and thus, eliminates any potential for a return — investors’ risk calculus will change. Firms will scale back research. Funding for early-stage biotechs will effectively evaporate. The number of drugs created by those small firms will plummet 90%, according to Vital Transformation, a consulting firm.

That would turn out disastrously for America’s seniors. Nearly 6 million American seniors have Alzheimer’s today, and more than two-thirds of U.S. cancer deaths are among seniors. While we don’t have cures for these diseases today, in 10 or 20 years, we might — if our leaders don’t get in scientists’ way.

I served in the Army for 10 years, both enlisted and as an officer, and was a commander in Desert Shield and Desert Storm. I know firsthand the sacrifices our veterans make, as well as the shortcomings of the VA. Additionally, as an advocate for both veterans and seniors, I cannot stand by as Congress attempts to restrict our care and curb innovation.

Several experts echo this concern.

Tomas Philipson, who chaired President Trump’s Council of Economic Advisers, has forecast that an earlier version of this bill would prevent the development of at least 167 drugs over the next two decades, and as many as 342.

Meanwhile, the director of health policy research at the Harvard Kennedy School of Government recently predicted that a similar plan could block scientists from creating “a transformational drug for Alzheimer’s.”

What’s particularly galling is the reason Democrats are proposing these misguided reforms. The changes have little, if anything, to do with lowering patients’ out-of-pocket prices. Rather, it’s a money grab to “pay-for” the spending bill.

In effect, Democrats seem willing to sacrifice seniors’ health to pay for a spending package drafted by the far-left wing of the party. That’s unacceptable.



Advisory Committee on Immunization Practices (ACIP)
September 29, 2021
Docket No. CDC-2021-0075

To the Committee:

RetireSafe is an organization whose mission is to educate and advocate on behalf of older Americans on issues including Social Security, Medicare, health, safe retirement, and financial well-being. Currently there are nearly 70 million Americans over the age of 60. Due to immune system decline as part of aging as well as the prevalence of chronic disease comorbidities, many of them are particularly vulnerable to infectious disease such as influenza, pneumococcal pneumonia and, of course COVID 19.

Vaccines for these and other conditions can truly be a matter of life or death and we are grateful for the continued work by ACIP to evaluate and approve critical vaccines for COVID 19.

RetireSafe has a long history of informing and educating American seniors of the important role vaccines play in maintaining our long-term health. Our members are committed to taking the steps necessary to protect against preventable illnesses and represent the largest sector of Americans by age to have taken the COVID-19 vaccine with 89 percent of those 65 and older having received at least one dose, compared with 68 percent for people ages 18 to 64.

While we are encouraged by the progress made toward vaccinating older Americans against COVID 19, we are increasingly concerned that experts are predicting the flu and pneumonia season to be more serious than last year, now that states across the country are relaxing COVID 19 restrictions.  

Given that older Americans are especially vulnerable to the flu and pneumonia due to the strength of the body’s immune system declining over time, we are particularly focused on what is being done to protect the most vulnerable in our population.

It was recently announced that the FDA has approved two new and improved vaccines for pneumonia. These new vaccines offer hope of even greater protection against a life-threatening disease for some of the most vulnerable in our population.

We have recently heard from several senior Americans who have reached out specifically calling for expedited access to these new vaccines. One such individual is Joe Velasquez who is a 78-year-old diabetic living in San Antonio. Joe wrote that he is not only concerned about protecting himself, but also his family members including his daughter who suffers from ALS and her husband who has severe asthma.

Jean Aratingi, also of San Antonio, wrote to us and said, “The Covid 19 cases take up enough room in Doctor’s offices and when necessary, Hospitals, to make Flu and Pneumonia victims suffer further issues without proper care. Planning ahead long before the October meeting, would make more sense and ultimately save many more lives.”

We have included below the most recent letters we have received from seniors for your reference, and we hope their voices, and those of thousands more across the country for whom we represent, will be heard.

We greatly appreciate all of the hard work by this committee to expedite access to critical COVID-19 vaccines for all Americans, but especially those most vulnerable to serious illness and death. We urge ACIP to consider expediting the vote on these new pneumonia vaccines for adults age 50+ and the at-risk community to ensure the broadest availability possible for America’s seniors ahead of this year’s flu and pneumonia season.


Click HERE to Read some of the letters from America's Seniors to the CDC


Gearing Up for Pneumonia and Flu season


While many of us may still be enjoying the summer weather and vacations spent with family, it is never too early to start preparing for flu and pneumonia season. You can start by planning your doctor’s visit now. Especially during this time when so many medical offices are still trying to handle the influx in patient visits due to COVID-19, making an appointment now will help you to avoid long wait times come fall.

It’s also worth looking into what’s new in prevention to help get you through the year in good health. The Centers for Medicare and Medicaid Services (CMS) offer several helpful resources that provide thorough overviews of the latest prevention services covered by Medicare. You can find an interactive chart broken out by key services here or a helpful guide to utilizing your Medicare benefits here. You may be surprised at all of the services that are covered including screenings, counseling, wellness visits and of course vaccinations.

Many experts are predicting the 2021/2022 flu and pneumonia season to be more active due to easing of COVID-19 restrictions across the country. Additionally, researchers are still working to understand the long-term impacts of COVID-19 on lung health and this potential impact could contribute to an increase in hospitalizations due to pneumonia.

Fortunately, the FDA recently approved two new and more effective vaccines for pneumonia. This is a promising development to help ensure we have the most effective tools we need to protect ourselves during this potentially dangerous flu and pneumonia season.

The Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP). ACIP makes recommendations for the use of the vaccines and then the CDC uses that guidance to set the U.S. adult and childhood immunization schedules based on those recommendations. That process is going on now and RetireSafe has been engaged is advocating for swift action by CDC so that these important new vaccines can be available to seniors as soon as possible.

I urge you to start planning ahead for your doctor’s visits and consider asking your doctor about when you’ll have access to the latest pneumonia vaccines. With so much attention being paid to the approval of COVID-19 vaccines, and rightly so, we must be diligent in reminding the medical community of our need to protect ourselves against one of the leading causes of death in this country – pneumonia!

We may be called upon to help ourselves and our friends and neighbors to make sure CDC knows how much we need and want access to vaccines that can protect us in the dangerous flu and pneumonia season.  Thank you for turning to RetireSafe for reliable up-to-date health policy information. It is our duty and our privilege to do this work!



Hello America's Seniors,

As you age, there is greater chance of receiving a serious medical diagnosis. This can sometimes be cancer. Thanks to an educational grant from Bristol-Myers Squibb, RetireSafe is launching a webinar series partnered with the National Grange that guides you and your family through that diagnosis. The series is split into six sessions. While we hope you and your families never have to experience this life altering diagnoses, we hope this information can make the process easier for those who may face serious medical diagnoses. On July 12th the series will be posted here on our website. Check it out!

Click to learn more...