My Common Sense Action Plan For My First Term in Congress:

 Health care:

1. I will cosponsor and work for passage of HR 676 – Congressman Kucinich's bill for the establishment of a national single-payer health program. I recently had the opportunity to discuss some of my thoughts below on health care with Congressman Kucinich, and I look forward to working with him closely in Congress.

2. I will submit a "Health Care Free Market Support Act" which would require all providers of medical services who accept federal funds to post their charges for all procedures and their reimbursement rate from Medicare for those same charges. This will force providers who charge dramatically more to cash patients than they are reimbursed by insurance companies to reduce their fees and would allow patients to actually comparison shop.

3. Also, under my “Uninsured Americans Protection Act” any uninsured patient who is in a "captive" situation (in the ER or admitted to the hospital) will not be charged more than 30% more than the Medicare payment the hospital accepts for the same procedures. These acts will become moot once HR 676 passes because all Americans will be covered equally under a national plan.

4. I will submit the Veterans Comprehensive Care Act. This creates a Medicare Part V which allows any veteran to receive medical care from any Medicare provider in the United States. Currently many veterans must travel long distances to receive health care at VA facilities. Even in the Space Coast area, veterans who receive care at our local facility must still travel to Tampa to see VA specialists. With Medicare Part V the choice will be the veteran’s. This program will also be moot once the National Health Program takes effect.

5. Each state determines how medicine is practiced within their state. Because of the seventy-year refusal of the FDA to consider the medical uses of marijuana, several states have passed laws allowing its medical use. The federal government has responded with harassment and arrests.  I will support Congressman Hinchey’s upcoming bill that would prevent the federal government from interfering with a state’s application of their medical marijuana laws or the harassment of doctors or patients legally using that or any other plant medicine under their state laws. I have studied plant medicines with Dr. James Duke (author of "The Green Pharmacy") and feel that many plant medicines have untapped potential. It is an absurd irony in our society that I can prescribe a dying patient any number of potent and addictive narcotics and even a marijuana-derived medicine that costs them $500 for 60 capsules and yet their use of a natural herb could result in prison time.

6. The Bush administration and its congressional rubber-stamp supporters set AIDS prevention and sex education back twenty years. Under their puritanical reign, information on safe sex practices was even removed from the CDC web site and international programs. "Abstinence-only" sex education was taught to populations of students in which over half were well beyond abstinence. These programs, often taught by religious-based organizations, mostly taught the dangerous and negligently incorrect message that condoms were ineffective at preventing STDs. Hundreds of millions of dollars were spent on these programs even though there is to this day no evidence that they reduce teen sexuality. I helped bring comprehensive sex education to Brevard County schools, and I will work to bring it nationally. As I testified to the School Board: "As the father of two teenaged girls, I am all in favor of abstinence - but I am NOT in favor of ignorance".

7. I will submit a "Pharmaceutical Competitiveness Act" to promote price competition where it does not exist. Three main points: First - new products in an established class of medications will get shorter patent protection unless they are priced significantly lower in price than the existing drug, and any medication that increases more in price each year than a reasonable rate determined by the FDA (based on increasing production costs only) will lose its patent protection one year earlier for each year of excessive price increase. Second: old drugs that are "reinvented" into time-release products (such as Ambien and Ambien CR), that are remarketed as a metabolite of an existing drug (Nexium is a metabolic breakdown product of Prilosec), or that are split into stereoisomers (desloratadine/Clarinex versus loratadine/Claritin) are not new agents and should receive minimal patent protection.  Third: secret kickbacks from pharmaceutical companies to health insurance companies through third-party intermediaries (“PBM’s”, or pharmacy benefit management companies) which are currently standard practice, are monopolistic, anticompetitive, and probably violations of anti-racketeering laws. I will introduce legislation that includes these arrangements in the classification of illegal kickbacks, and force the pharmaceutical companies to set one wholesale price for each product.  Pharmacies could then offer competitive prices to all customers.

See the addendum for examples of egregious anti-competitive examples of pharmaceutical company behavior.

 

The War in Iraq:

The Republicans have used the recent lull in fighting, whether or not caused by the troop surge, as an argument for staying in Iraq - perhaps indefinitely! I think it demonstrates that we need to start thinking of getting out - that perhaps with negotiation the factions there can decide to stop killing each other.  I have endorsed "A Responsible Plan to End the War in Iraq"  (www.responsibleplan.com/plan) It includes the following features:

1.      End U.S. Military Action in Iraq

2.      Use U.S. diplomatic power

3.      Address humanitarian concerns

4.      Restore our Constitution

5.      Restore our military

6.      Restore independence to the media

7.      Create a new, U.S.-centered energy policy

If security forces are needed after our exit, that would be the proper role for the UN. They would not be seen so much as an occupying force, and it would stop generating generations of anti-American hatred in the Muslim world.

 

Economy and Labor:

1. Checks in the mail to buy stuff at Wal-Mart will stimulate the economy – of China! We need jobs! I will lend my support to efforts to rebuild New Orleans and to repair old bridges and leaky school roofs. I will push for a low-interest loan program to harden homes in hurricane and flood-prone areas - this will put construction workers back to work and help mitigate damages when the next disaster strikes!

2. We need to move back towards the balanced budget that the Democrats have achieved but that has eluded Republican administrations for decades in spite of their rhetoric.

3. I will help roll back the Bush tax cuts that benefit the rich. Tax breaks for the oil companies that are extorting us will be eliminated and tax breaks for development of proven alternative energy will be offered in their place.

4. Companies that export jobs need to be denied tax breaks. Companies that lay off American workers should not be allowed to bring foreign workers here for those jobs on visa waivers.

5. I will cosponsor the Employee Free Choice Act which will allow workers to join unions with more easily and with less fear.

6. We need to reassess the free trade deals that have not helped our balance of trade.

7. On a global scale, nations need to consider putting a stop to financial speculation – buying purchase options – on necessities such as food and fuel. One estimate is that this financial speculation is responsible for about half of the current price of oil.

8. We MUST stop the war. It is bleeding us dry financially.

9. We are spending around $500 billion per year on the interest on our debt! Compare that to the federal expenditure of only $5 billion per year on cancer research. We MUST get our debt under control!

10. Social Security must be protected. The income which is subject to the Social Security Tax should be increased and the Social Security funds should not be raided by the government to fund other programs.

 

Education:

1. Resources spent on education are not expenses but investments. We need to increase funding for the GI Bill’s tuition reimbursement program, we need to increase Pell grants, and we need to increase availability of low-interest student loans. I will introduce legislation that will make both principle and interest of student loans tax-deductible, as it is for any employed American who takes a job-related educational program. These expenses generally result in the taxpayer having a higher income and paying more taxes, so these expenses benefit the nation’s economy.

2. Standardized testing should not be interpreted as defining “bad schools” or impugning educators as “bad teachers”.  Schools that score low on standardized testing are warning that this is a neighborhood that needs help with early childhood education programs such as Head Start. Working on school preparedness is vitally important in these areas.

3. I will continue the long Democratic tradition of discouraging voucher programs and supporting the strongest, best public education for ALL Americans possible!

   

NASA/Space:

1. To ensure its' long-term stability and viability, NASA needs an ongoing ten-year plan and ten-year budget from congress for long-term mission-specific planning.

2. The deep-space research, life sciences research utilizing the ISS (International Space Station), and the earth sciences research missions of NASA are vitally important and need to be supported.

3. The ongoing role of NASA in launch and support of communications, weather, navigation, and intelligence-gathering satellites must be supported.

4. NASA has a vital role in studying the science of global climate change, and extra funding for this role will be supported.

5. I have seen no cost-benefit analysis of manned lunar space stations which would justify the expense at this time. We have over $9 trillion in debt, and it is unclear that not “beating the Chinese back to the moon” poses any more risk than does borrowing the money from the Chinese to get there. However, if manned lunar missions are supported by our next president I will support that effort 100% - but only if NASA gets a rolling ten-year plan and budget so that there are NO sudden cutoffs in vital programs such as that with which we now suffer.

Only six of the past thirteen Mars landings have ended in less than disaster, so it is premature to plan manned trips to Mars.

6. Robotics science has improved dramatically and is safer and far less expensive than manned trips, and research missions to the surface of the moon, Mars, or Venus should be continued utilizing robotics. The amazing Mars Rovers are still going long after their expected lifespan.

7. We need to sign the U.N. treaty calling for a verifiable ban on weapons in space. We cannot afford the cost and world instability that will result from an arms race in space.

 

Energy:

We did more in energy conservation and alternative energy thirty years ago than we are doing now. Since Reagan removed the solar water heaters from the White House roof ("because they were ugly") we have done little.

1. We need strong federal leadership to provide incentives for solar water heating and recapturing waste heat from air conditioning to use to preheat domestic hot water. Photovoltaic and wind energy needs to be supported.

2. Do we need to start drilling for oil off the Florida coast and in the Alaska National Wildlife Refuge? Consider the following points;

A. Can we justify even thinking about drilling in environmentally pristine areas while continuing our gluttonous wasteful energy habits?

B. The U.S. has 3% of the world's oil reserves and uses 25% of the world's oil production - tapping all of our reserves wouldn't make a dent in the demand.

C. American oil refineries are operating at about 98% capacity or so and no new refineries are being built. Any newly produced oil would be shipped overseas immediately.

3. With gasoline now exceeding $4 per gallon the promotion of public transportation systems such as light rail seems more prudent and logical. The federal government can lead the way by providing several large matching fund block grants for the creation of rail systems in several busy corridors which are without such systems. Remember back to the days of the 1964 World's Fair in New York City? It had as I recall (I was a kid then) the first demonstration of a monorail in the US - it was touted as being able to provide the solution to public transportation utilizing existing interstate corridor right-of-ways. Imagine such a system running down the east coast of Florida and connecting to the busy I-4 corridor! 

 

Immigration:

I recognize the struggle of all immigrants, legal or not, who have come to this country in order to work hard to make a better life for themselves and their families. They embody the American spirit in their search for the American dream. There must be some limits to the influx of undocumented aliens for the safety and long-term economic stability of our country, though.

1. I support a guest worker program - this will allow us to know who is here - to screen those who come and to limit how many and what kind of workers come.

2. A guest worker program needs to be balanced with enforcement of laws punishing those who hire unregistered foreign workers. We do not need walls and fences if these two aspects are implemented, because unregistered jobs would dry up.

3. Jobs offered to guest workers must meet all U.S. requirements for minimum wage, worker safety, etc. These jobs should be offered with a priority to any American citizens who want them.

4. Guest workers and employers would pay a special Social Security and Medicare Tax, just as do citizens, except that these tax revenues do not provide any Social Security benefits. They go towards supporting my proposed Medicare Part G through which guest workers can obtain health care when needed, and through which hospitals and clinics can get reimbursed for the services they provide to the guest workers.

5. Guest workers would not have priority for residency or citizenship. After a certain time period they would be required to return to their native country and would be required to reapply to the program or for residency. Those who have lived here without criminal activity or who have served in our armed forces will be given some credit towards eventual residency, however. 

6. I support the DREAM Act. This is the Development, Relief, and Education for Alien Minors Act. Children should not be punished for the decisions of their parents. Hundreds of thousands – perhaps millions – of children have entered the United States illegally with their parents. Many of these children have lived here since they were young and have attended school here and have become integrated as productive members of our society. Many do not even speak the language of their legal homeland. The DREAM Act would allow alien children who have lived here for a long time and who have graduated high school to either attend college or enter the military and to obtain legal residency status after the successful completion of either.

Environment:

1. I will cosponsor HR 4238 – the Bottle Recycling Climate Protection Act of 2007. This will create a national bottle deposit. Studies consistently demonstrate that states with a bottle bill have twice the recycling rate as those without. Bottle and can recycling not only saves the resources used to make them; it saves energy and reduces landfill requirements.

2. I will continue the fight against drilling for oil in pristine places. There is no evidence that a small increase in production will lower oil prices, and we need to concentrate on using less energy.

3. Work for tight limits on the levels of mercury and other pollutants – not just “average” output but individual site output.

4. Strengthen regulations dealing with factory farms. Current efforts by Republicans supported by giant agribusiness to have manure legally declared a “non-pollutant” (preventing regulation) will be strongly challenged.

5. Work for an updated Kyoto Treaty to lower greenhouse gas emission worldwide.

6. Return the strength of the Endangered Species Act.

7. Support our National Park System and restore funding.

8. Call hearings to investigate mountaintop-removal mining.

9. Support recommendations to lower carbon monoxide standards in urban and rural areas.

10. Roll back ALL of the assaults perpetrated on our wild places and the laws that protect them during the past eight years!

 

Food and Drug Safety:

 There are currently no more FDA inspectors than there were 15 years ago! And yet there are 5,000 deaths per year from food poisoning and some 15,000 deaths from adverse drug reactions.

1. Only 7% of the Chinese factories that produce medications imported into the United States have been inspected by the FDA!  I will support legislation that denies admission into the U.S. of ANY drug from any foreign facility that has not had an annual inspection! Obviously more FDA inspectors will be needed.

2. Food production facilities need to be inspected annually, and inspections must be unannounced. This will require changes in FDA procedures and an increase in the number of FDA inspectors.

3. I will call for hearings into the safety of rBGH (recombinant Bovine Growth Hormone). Whether rBGH is safe or not, it is a consumer choice whether or not to ingest dairy products from cattle that have been treated with rBGH and the USDA should cease harassing dairies who wish to offer consumers that choice.

4. I will call for hearings to investigate the safety of GMOs (genetically modified organisms) in our food supply and in the environment. Consumers should always be informed if the food they are purchasing contains GMOs.

5. Some 85% of the antibiotics used in this nation are put in animal feed to increase weight output. Many nations have outlawed this practice which leads to the development of drug-resistant bacteria. We must follow their lead.

6. Our nation’s efforts to prevent BSE (bovine spongiform encephalopathy), or “mad cow disease” are not up to international standards. We need to improve our standards, and we must increase testing. With improved standards it should not at this time be necessary to start testing each cow for BSE, but any individual cattle grower who wishes to do so should not be stopped in this effort by the FDA and USDA, as has been the current practice.  

 

Addendum: Examples of anti-competitive tactics of the drug companies.

1.      Drugs marketed by prescription do not compete for sales by price as they would in a free market. As evidence of this claim are many examples:

a.      H2 blockers: Tagamet was the first in the class, and was a wonderful drug, first introduced at about $65 for a month’s treatment. Zantac came next. It was priced exactly the same, but gained substantial market share because it had fewer drug interactions. Pepcid and Axid came next – and were clinically equal to Zantac. They never gained much of a market share because they were never priced competitively. When I would ask the drug reps about these drugs, they would always say “they are priced comparably”. 

b.      When prescription medications have proven safety records such that they are allowed to be sold over-the-counter (without prescription), they then must compete for the consumer’s dollar with a legion of medications for similar ailment. Thus, Pepcid AC, the 10mg tablet which was cleared for OTC sales, was suddenly competing with Maalox, Zantac 75, etc. The wholesale cost to the pharmacy for a Pepcid AC 10mg tablet was $0.20 while the 40mg prescription tablet was $2.60 – which insurance companies still paid for! Other examples include Zyrtec – in early 2008 this was cleared for OTC sales. On one day it cost $85 for 30 tablets by prescription. The next day it cost $18 OTC!

2.      Long-acting formulations of an existing drug are frequently touted as “new and improved”. They do offer more convenience, often reducing a two-or three times per day regimen to a once daily one. Twenty years ago the drug companies strived to produce once-daily medications. Nowadays they tend to wait until the patent is about to expire on the short-acting medication until they develop and start promoting the longer-acting product. The price, though, can be extreme, and the rationale sometimes irrational. In the example of Ambien CR (“controlled-release”), Ambien was always promoted as better than the sleeping pills in use at the time it was released because the drug entered the system fast and wore off fairly quickly so as to not leave a hung-over feeling. As the patent life of Ambien was near its’ end, the manufacturers introduced Ambien-CR – a controlled release version “that wouldn’t wear off too quickly”.

                       

Sample Prices (generic equivalent prices listed for the earlier drug versions):                       

Drug Name:	How Taken:	Price/ Month:	New Name:	How Taken:	Price/ Month:
Oxybutinin (generic Ditropan) 5mg	Twice daily	$4	Ditropan-LA	Once daily	$105
Zolpidem (generic Ambien 10mg)	1 at bedtime	$18	Ambien-CR 12.5mg	Once daily	$126
Tramadol (generic Ultram) 50mg	1 four times daily	$64	Ultram CR	200mg once daily	$170
Diltiazem (generic Cardizem) 60mg #90	1 three times daily	$6	Cardizem CD 180mg	1 daily	$95

           

3.      Adding two generic drugs to make a “new” brand-name drug: the classic example of this was “Lotrisone”, which had a “use-patent” on combining a steroid and an antifungal cream in one. For quite a few years each separate medication could be obtained as a generic for about $3 per 45 gram tube. The Lotrisone combination was about $48 per 45 gram tube. The latest in this scam: Imitrex, the first-in-its-class migraine headache medication. A wonder drug for sure. But given that its patent will soon run out, Glaxo Smith Kline is now presenting us physicians with a “new, improved version” called “Treximet”. This pill combines Imitrex, baking soda, and some Naproxen (equal to two “Aleve”) into a single pill. It sells for $200 for nine pills, which is what Imitrex has sold for over the past sixteen years. Within the year, though, Imitrex will be selling as a generic, but Treximet will roll on at $200. The reps have already been bringing around the studies that show that Treximet is superior to either Imitrex or naproxen alone! They don’t show a study that shows whether or not it is superior to taking a generic Imitrex and a couple of Aleve….

 

4.      Mirror images: when a chemical compound is created in the lab or refinery, the chemical reactions result in two sets of compounds which are mirror images of each other. And just like your right and left hand are the same but they are not, these compounds are the same but they are not. In fact, only the “right-handed” version of the compound functions in the body. The drug companies have learned how to create a product that contains only the right-handed form. This is usually indicated with the prefix des- or levo- in front of the generic name. Hence loratadine (Claritin) 10mg is now marketed as desloratadine (Clarinex) 5mg. Zyrtec become Xyzal, and Celexa becomes Lexapro.

Old Drug Name:	Price/ Month:	Mirror-Image Name:	Price/ Month:
Loratadine (generic Claritin) 10mg	$4	Desloratadine (Clarinex) 5mg	$47
Zyrtec (citirazine) 10mg	$18	Xyzal (levocitirazne) 5mg	$79
Citalopram (generic Celexa) 20mg	$4	Lexapro (escitalopram) 10mg	$86

             

5. How a PBM works: There are laws against kickbacks in healthcare. If a drug company offered a doctor a kickback for prescribing a particular drug it would be illegal. It would probably be illegal for a drug company to offer a direct kickback to an insurance company for listing a drug on its’ “preferred” list. And it would be impractical for each insurance company to negotiate their own individual cost since the pharmacist still has to order the product for everybody. So the insurance company hires a “pharmacy benefit management company – companies like MEDCO and Ameripharm. The insurance company then negotiates with the pharmaceutical company to get a better price on a drug. Usually the pharmaceutical company will expect their product to be listed as the preferred agent in that class if they are to give the insurance company a big break. Patients are steered towards the preferred products by way of lower copayments not because they are better for treating the condition but because they came with the biggest financial incentive. So one insurance company may get a really good deal on Nexium where the other insurance company works out its best deal on Protonix.  The pharmacist still buys each for $135 or so for 30 tablets, and sells them retail for $150 or so.  A patient with insurance may get thirty tablets for a $40 copayment, and the pharmacist bills the insurance company’s PBM the difference. Meanwhile, the PBM asks the drug company for their “rebate” of $60 or whatever it is for each prescription and then bills the insurance company the $50 or so difference. Everybody is happy – except the poor shmoe who has no insurance and doesn’t realize that the “real” price of Nexium or Protonix is some lower amount he will never know, but his price is $150. So once again, the “price” for health care for those without insurance is maintained at an artificially high level.

Steve Blythe   17 June 2008