Hampshire president ial primary and the iowa caucuses. Sunday night, longtime New HampshireUnion Leader Publisher and now editor at large, gee receive mcquaid, talks about his states president ial primary history and the current state of politics in New Hampshire. New hampshire is always different, i think it appreciates being first. And people turn out. Its one of the highest turnout states at least in primaries in the country. Too f it was so, you know, white, not representative of the country, then with the exception of bloomberg who has not cited that as a reason, but why are all these other candidates coming to New Hampshire . Watch sunday night at 8 00. M. Eastern on cspans q a. Congressman curlt schrader at our table this morning. Emme kraa member of the energy and commerce committee. Prescriptionabout drug pricing, what would hr 3 do . Would try to reduce drug price increases for americans. We hear again and again on the campaign trail that prices and Health Care Costs are the Biggest Issue for americans right now. This would allow the United StatesGovernment Health and Human Services to negotiate drug prices. We negotiate drug prices in our private lives, with unions, businesses, why cant seniors or americans negotiate . It is a marketbased principal. Republicans and democrats should be able to agree to that. It limits outofpocket cost. If your cost go beyond a certain point, both democrat and republican bills would limit that to 2000 or 3000. It puts transparency into the system. Energy and commerce investigating took place in increases. There are a lot of Different Actors playing to these cost increases. We need more transparency to make the right moves politically to make sure these increases dont affect what we have had so far. Side,on the business which companies will be impacted by that type of negotiation . Guest first and foremost, probably pharmaceutical companies. Benefit managers that help negotiate prices for Different Companies in different groups would be affected. Hopefully beld affected in a positive way at the end of the day. Taxpayers would not have to pay as much outofpocket. Of people that would be affected along the supply chain. Pharmacies are cop between and they have to pay back after the fact dollars to various companies that these pharmacy benefit managers negotiate with. Lots of folks will be impacted. Tot how do you respond republicans and others who argue this would kill innovation. Pharmaceutical companies are not incentivized to spend the billions they have to spend on research to find new drugs to prevent and possibly cure diseases. Guest i think that is a little bit of a bogus argument. Probably not, you have to weigh that against the decreasing cost in the american consumer. If you could reduce these increases from 15 20 a year year,o 2 , 3 , 4 per that is a huge savings. Most of the medications and drugs, theyw orphan work for very targeted types of diseases. It only affects 100,000 people. The cost could be hundreds of thousands of dollars to the taxpayer and the system. You have to weigh that back and forth. They will spend a lot of money on research anyway. That is the breadandbutter. There will be great medication coming to market. Host there was a story yesterday about a new way of paying for costs of these very expensive drugs that treat these niche diseases. One of the ways is allowing Drug Companies to pay it back. What you think about allowing the market to take care of it . We have a two fold the porch approach. This should be able to limit the inflationary increases Going Forward. As one of the leaders in health conversations, i believe it is a fair way to go as well as protecting the and sumer consumer. Host what is that . Guest if you come up with a drug that will cure Something Like hepatitis c, maybe you get the full 50,000. You could also advertise that. Instead of paying 50,000 of, which would bankrupt a lot of small coordinated Care Organizations in oregon, you take money per year over the lifespan of that individual. Orthat decreases your pain fromes the mortality rate 25 years, you get paid a little bit less than the full cost of the medication. Theres a lot of emphasis on companies to get to solving all problems with the rising cost and escalating cost of pharmaceuticals. Host what did you make of president trumps attempt so far to reduce Prescription Drug prices. One of his idea was to compare it to the International Index of what we pay versus what other countries pay. It seems that did not go into effect. Is that a good idea . Guest that is what hr three tries to get at a little bit. The president tried it on his own, why did we have to set it to european standards . We are trying to get at that in a slightly different way. Anyond hr three there is opportunity in the Senate Finance bill, Senate Health committee bill, Senate Judiciary committee bill. We have seen it on the house and bipartisan support to reduce these costs dramatically. Maybe we can get to the negotiation piece this session. It is important to bring it is important to bring up that American Consumers realized why cant we negotiate . We can limit outofpocket costs. We can do the transparency piece and make sure drug prices for existing drugs dont increase beyond inflation. Inflation is 2 inflation is 2 g prices are going up 5 , that is wrong. Host do you think any deal could address a surprise medical billing . Guest i certainly hope so. It is a big deal back home. You are trying to get insurance, you stay in your network, doctors, hospitals, you going for your surgery only to find out the anesthesiologist is an in network and you have a 20,000 bill and you oh my gosh, what is happening . That is not fair. The consumer has done the right thing. The way the arcane structure of health care is, they have this huge bill at the end of the day. With a really good approach. Is, who does pay what at the end of the day . The insurers had one idea and the doctors had another. Us rightally likes now. It is a good approach where there is a bit of an Index Benchmark we should be thinking about for the cost of these outofnetwork. If there is a lot of disagreement you could go to arbitration. New york has had great success. In oure are interested viewers joining the conversation as well, what experiences have you had with Prescription Drug pricing or surprise medical billing . Lets go to tina in virginia, democratic caller. Ler host go ahead with your question. Recently went to my physician for an annual physical. , 2019. October 29 i have been going to the same Family Practice for over 10 years. Never had to pay for a physical. This time i came out with a 254 charge. I have been in contact with the sinceal corporation november 16 when they first sent me a bill with no satisfaction. They are telling me that they are charging me jordan 64 for advanced directory counseling. It is supposed to take 30 minutes on the bill. If you have been to the doctor you know you dont spend 30 minutes therefore anything anymore. I was there 10 minutes. I did not get the service they are saying. , whatung lady asked me would you want to happen if you had an Emergency Reaction here in the office . Would you want resuscitation, i said yes. Cpr was what she said. I said yes. She handed me a form to fill out that procedure, not counseling but directives. That was handed to me. There was no discussion about what i should do with it, who should help me fill it out. I have been talking to them. They told me i am responsible for this 254. Blue cross, blue shield will not pay for it. I do not have medicare. I cant afford 254. What am i supposed to do . Off. you got ripped that is why we are trying to get people universal access to basic health care. That physical, if it is once a year, it is free. If they are trying to charge you for that, that is wrong. You could take them to court. , ithe advanced directive havent heard that game played before. Unfortunately we will probably see more of that. I would get a different doctor at the end of the day. Endoflife planning is a basic thing everyone should do to protect their family. It should be incorporated in any exam. I think that is egregious. Certainly seek some legal regress. Cross and to the blue say this was basic health care information, it should be totally covered with the annual exam. Host go ahead, for the congressman. Caller [indiscernible] good morning, thank you for taking my call. My issue is about us spending that theugs drugs we are taking now in stead of solving the problem, creating problems. Host like what . Caller theyre making you sick, getting cancer. We dont have the medical to take care of the added problem of the medication is causing. Host you have to turn on the television. It is causing confusion. Im a veterinarian. In real life i spent 30 plus years as a veterinarian. Im aware of the side effects from a lot of medications. A lot of the newer medications is more powerful. Effects thatside end up making you take other medications which are probably wrong. Will you have to do is have a conversation with your physician about side effects medication is having on you. Is there a less potent but helpful medication you could take . So it wouldnt set you up or cause the side effects. One of the things you need to do very carefully is read these labels and question your doctor on side effects for many medications they prescribed for you. They could be life saving. They keep us at home and out of the hospital. ,hey extend the quality of life thankfully for the most part. You have to make sure you have the full understanding of what those are. Host we will go to milwaukee, patricia is watching there, democratic caller. I am calling because i called on the democratic line, has no, medication party. , we might spend a lot of money on research and countries, but other doe canada and other places negotiate with the pharmaceutical countries as to how much they will pay in order to do business with them. Why this sois difficult for us to also do the same thing . Epipen. Things like the the young man who purchased the right to that, it won from one price and it skyrocketed. I want to understand, why doesnt our government prevent those kind of things from happening to our citizens for our drugs . Not democrat, it is not republican, it is not independent. People beingr of able to afford access medication. I would like you to respond to that. Thank you very much. Question, veryd thoughtful. I totally agree. AndUnited States of america americans should not subsidize the cost of drugs around the world. Everyone should pay their fair share. We should be able to negotiate prices. What will happen, the secret a lot of pharmaceutical Companies Want tell you, they will raise the prices on the folks in europe and other places. To make sure they could make a profit so they could do innovation that they want to do. We should not be subsidizing these people in a it begs the question why not negotiate for the drug prices . The department of defense negotiates drug prices, we negotiate drug prices and medicaid, why cant we do for citizens, why cant we do for everyone . There is no defensible answer for that. We need to come up with an approach to assure people it will lower the cost and get the europeans and other countries to pay a little bit more. To your point on some of these bad actors, Hedge Fund Managers that by pharmaceutical companies and check the price up like they of theepipen and some other medications. We went after them. , i work with a good friend from mine on florida on the bipartisan bill in last congress that would make that not something they would want to do because we put competition in the marketplace. If there is a drug out there, we allow Different Company that wants to make a competitor go to the head of the line, get quick approval and dried that price right back down. Host wanda, republican in florida, you are next. Caller good morning, thank you for taking my call. I agree with the former caller who said there is no party regarding prescriptions and health care i agree. I tried to call the democrat line and couldnt get through. The reason im calling is four 2010, a small amount has been deducted from my check each month for what they called late enrollment penalty. Ive tried to resolve it. I called my representative and her expert on the issue said theres nothing we could do about this. I tried to explain the logic of this. If you have a late penalty under , it isu take care of it done, you dont pay for it the rest of your life. I think this is a very unfair aspects. The notice i received last year about how much i would be getting this year, because it is information about your medicare Prescription Drug plan cost, it is no longer calling it a late penalty. This is astounding. I take a drug that has been around for decades. Hypothyroidism. It cost me 15 a month and hit his men it has been around 70 some years. Drug taking another because i do better. The brand name cost me 40. I had to cut back on expenses. This is ridiculous that these drugs that have been around for decades, the Drug Companies are still getting monumental amounts. They should be like an aspirin practically. Although aspirin is pretty expensive these days. What about those two and shoot . The cost has been around for decades. The late penalty for enrollment im not sure if it happened, it is ridiculous. Thanks for taking my call. Guest good issues. A lot of folks face those. I assume you are a senior on medicare. There is a late enrollment penalty if you dont sign up exactly when you are supposed to. It goes on for the rest of your life. I agree with you, totally unfair. You pay your fine for the mistake you made. Not when it comes to signing up for medicare. We are trying to fix that. Got a bill out there, we had a big hearing just last week about medicare and roman penalties and what we can do about it. A lot of folks think they still have coverage through their job. That ends and they cannot enroll for another year or two. What to they do about Health Coverage in the meantime . Not right, not fair. I dont think folks read the fine print. Supposed to sign up for or 67. E when you turn 65 sometimes people get wrong advice period advice. We will probably have a markup on a number of bills to address the medicare penalty. Sometimes you can get that reduced if you make your case to the federal government. You have a good reason, youre misinformed or whatever. I urge you to follow up on that. To the rest of the drug problem, the main thing is being able to have an opportunity to have that negotiation at the end of the day. Limiting price increases. As a veterinarian i prescribe a bunch of drugs, they are very inexpensive, not costly at all. They become unprofitable because they are very inexpensive. Drug Companies Want to go to the big blockbuster. There is more money in that, i get that. We are capitalist. There should be a way to still have access to key drugs. Drug shortages are a huge issue in the veterinarian field, the human field, we are trying to address that. There are Innovative Solutions coming forward. Nonprofit groups, maybe some of the manufacturers themselves. Hopefully over the next 68 issue,it is a bipartisan we will be able to get bipartisan support for reducing these costs and making sure there are suppliers when the shortages identified seek and get medication you need. Im sympathetic to the fact that you require a brandname drug. I have medications in my clinic that were forfeited and they required a brandname drug to get the results. We should make sure those costs are driven down. The most recent trade agreement helps us out a little bit in that area as well as hopefully the whole issue of getting lower drug costs. There is bipartisan support for that. The Senate Health committee has almost all of the same things we had in hr three but it would limit increases Going Forward for a lot of folks. Work has been done on increasing competition in the generic marketplace. To prevent these oneoff rates we are talking about. We have passed all of those bills out of energy and commerce on the house side. There is a lot of bipartisan support out there. Michigan, in independent. What is your comment . Caller good morning to both of you and the whole world out there. Use drugs right now, Prescription Drugs. That is because you will not be able to have to at certain points. Im on medicare now. , iot thrown off medicaid owned too many items in equity. Worked all my life or that i cant enjoy that. I will not give you the hardship case. Thought of a system that out as a bided system. It could be fair for everybody and supply and demand guest we all negotiate in our daily lives for best price, different stores, different insurance companies, auto, health, you name it. We should be able to do that on a regular basis. We shop for different insurers that offer us the best deal that cover most of our medications or health care needs. We need to be able to do that more directly with pharmaceuticals. The problem is weve got this weird chain of command, if you will, thats grown up where the Drug Companies mainly increase the price of drugs a couple Percentage Points and pharmaceutical costs have not gone up that much in recent years. What you pay at the end has gone up dramatically. Theres pharmacies and pharmacy benefit managers and hospitals and all these intermediaries that take a cut of the pie and cost a bunch of money. Like the farmers. Hes still selling the same number he did 20 years ago but your costs have gone up dramatically because of all these middle men in between. What we need to do is address the supply chain and look at where the costs are legitimate and see where people are taking an extra profit and where consumers should have more information to negotiate a better deal for them. I think thats the goal here. Were raising this issue for the first time in 20 years in the United States congress, getting a lot of play. Folks like you are paying attention, and i truly think that bidding on various drug costs is the way to go. Pharmacy benefit managers shouldnt do spread pricing and should be focused more on per unit pricing because thats what matters. A bigger discount doesnt mean you pay less. A bigger discount on a higher cost drug means you should be paying more on a lower discount on something that maybe costs 10 or tsdz 20. 10 or 20. If the Veterans Administration can negotiate prices and the d. O. D. Can, why cant medicare folks and seniors who have frankly made our country very, very a great place to live. Why cant they benefit from just negotiation, simple american marketplace principle. And live now to a conversation with pakistans foreign minister. Es expected to talk about the relationship between pakistan and the u. S. The center for strategic and International Studies is hosting event