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Boehner’s exit may presage more healthcare gridlock


Observers say that the announcement by House Speaker John Boehner that he will resign the speakership and his congressional seat at the end of the next month under Tea Party pressure increases the chances of intractable partisan fights over fixes to the Affordable Care Act  and other healthcare policy from now until the 2016 election.

Boehner’s successor will be pressed by Tea Partiers to try to repeal the entire Affordable Care Act — in the face of a presidential veto. But the general  legislative gridlock following the exit of the relatively pragmatic Boehner may undermine efforts to  roll back or revise parts of the healthcare reform law that  even many Democrats don’t like either, such as the tax on high-value employer health plans, the medical-device tax and the expansion of small-group insurance rules to larger employer plans.



Healing the medical-device ‘eco-system’


Stephen Ubi and David Nexon present their case for boosting the American medical-technology industry. Some respond that the writers are, in effect, pushing for more  corporate welfare and that the  vast cost of, and, for some products, exaggerated claims of medical efficacy, require pushback in what is by far the world’s most expensive healthcare system.

Anyway, Messrs. Ubi and Nexon  assert in HealthAffairs that the medical- innovation ”eco-system” is “severely stressed” and they say that policy improvements are essential.

They  write  that the biggest problems include: reduced investment; reduced revenue growth;  flight of clinical trials and first-product introduction out of the United States; increasing difficulty in getting  public and private insurers to cover patient costs to use new medical devices and diagnostics, and disincentives for providers to adopt  new technology.

Their solutions:

*”The FDA and the Centers for Medicare and Medicaid Services (CMS) should adopt a seamless, accelerated process for approval of breakthrough products that offer the promise of significant improvements in treatment or diagnosis of serious illnesses.”

*”The FDA needs to continue to progress toward the goal articulated in the device center’s recent vision statement that patients in the U.S. will have first in the world access to new medical devices.”

*”CMS needs to view encouraging medical innovation as part of its mission and review all its policies with this goal in mind.”

* “U.S. tax policy needs to be reformed to put knowledge-based, high- value-added industries on a level playing field with competitor countries. Prior to the enactment of the medical-device tax, medical technology companies paid an effective federal tax rate of 31 percent on activities …taxed in the U.S., but an average effective rate of 14 percent on activities located and taxed abroad.”





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