Congress has been on recess for a week, so the nation is safe from more prolific spending for now.  Taxpayers certainly deserve a break after the House passed on November 5, H.R. 3684, a $1.2 trillion bipartisan infrastructure bill named a “New Vision for the Environment and Surface Transportation in America Act“ that only contains only $500 billion in traditional infrastructure like roads and bridges.  

A few days before passage, the legislation was in deep trouble because House Speaker Nancy Pelosi’s (D-Calif.) and the Democratic caucus could not reach agreement on whether to separate H.R. 3684 from H.R. 5376, President Biden’s Build Back Better Act (BBB Act), currently expected to cost $1.75 trillion.  The BBB Act is described as a “human infrastructure” bill and contains multiple billion-dollar social welfare programs including “free” college, childcare, paid leave, more public housing, hand-outs to unions, and the Green New Deal.  The most recent version included $550 billion, or 31 percent, for climate change programs, and only $3 billion, or 0.17 percent, to prepare the nation for a future pandemic.

Political pundits varied on whether voting on the two bills separately or together was the better strategy to pass – or kill – the bills, but this is what we do know:  the BBB Act will fundamentally change the United States if it should become law.  The Council for Citizens Against Government Waste (CCAGW) has written letters opposing both H.R. 3684 and H.R. 5376.

Currently, the Congressional Budget Office (CBO) is working on a cost estimate for H.R. 5376, but the bill is complicated and the “timing is uncertain” for getting the numbers that many members of Congress are demanding before they vote on it.  CBO scores are being released in a piecemeal fashion and while Speaker Pelosi wants to vote on it next week, likely the earliest the BBB Act could be considered is after the Thanksgiving break.  That may be optimistic, because Sen. Joe Manchin (D-W. Va.) remains opposed to the price tag of the bill due to the impact on inflation of prior spending bills and may force Congress to wait until after the New Year to vote.  There are also some “moderate” House Democrats that are hesitant, but not as vocal, about the bill’s price tag.  Nonetheless, taxpayers should remain vigilant.

CCAGW continues to express its strongest objections to including the exact provisions, or any variation thereof, from H.R. 3, the “Elijah Cummings Lower Drug Costs Now Act,” to the BBB Act.  The legislation would eventually allow the government to control the prices of pharmaceuticals, which would be disastrous for the U.S. biopharmaceutical market, the current global leader in research and development. 

Along with price controls on medicines CCAGW is concerned about the potential use of QALYs, or Quality-Adjusted Life Year metrics.  The QALY process assigns a monetary value to a life year and in doing so, lowers the worth of life for older adults and individuals who have a disability or a chronic disease.  QALYs are used in numerous countries around the world that utilize single-payer or government-run healthcare systems to keep costs down.  Along with cost-effectiveness studies, these two methods can be used to formulate the value of healthcare treatments and assign an “appropriate value.”  For example, the process would use a methodological way to compare the value of treating blindness in a teenager to treating cancer in an elderly patient.  The value to drugs intended to treat ailments of the elderly could be given a lower value than a younger person.  In other words, a person with a low-quality score should have less money spent on their healthcare, meaning their care would be rationed or restricted.

The BBB Act supposedly prevents the secretary of Health and Human Services (HHS) from using QALY assessments on the value of drugs when negotiating drug prices.  Section 1194, Negotiation and Renegotiation Process, of H.R. 5376 states, “the Secretary shall not use evidence or findings from comparative clinical effectiveness research in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill.”  But the bill does allow the HHS secretary to contract with “third parties” to carry out the requirements  established by the pricing program.  That could mean seeking recommendations from organizations that uses QALY and comparative effectiveness metrics to determine the value of therapies, like the Institute for Clinical and Economic Review (ICER).  That looks like a distinction without a difference.

CAGW has expressed concerns about ICER.  A March 2021 blog, “Bernie is Back with More Bad Bills,” discussed some of the problems with ICER, which uses analytic methods to determine the worth of drugs and other treatments and that it behaves like the British National Health Service’s advisory agency, the National Institute for Health and Care Excellence, that routinely denies patients access to innovative therapies.

A survey released in July 2021 conducted by the Healthcare Leadership Council found that a majority of seniors who use part D are concerned about the use of government price controls and the impact they could have in determining which ones are covered by Medicare.  The survey found 85 percent would prefer to keep Medicare Part D law as it currently exists if instituting government price controls led to restricted access to drugs they currently use.  And 83 percent were against the government setting prices if it meant there would be fewer choices and options for prescription drugs.

Currently Medicare does not use QALY to determine what drugs are available but if H.R. 5376 should become law, it will be only a matter of time before QALY metrics are used to determine which drugs will be available to all patients, not just those who use Medicare.

There is a lot at stake under the Build Back Better Act.  Adopting its policies will be unhealthy for the economy and individual freedom and liberty, including personal control and choices in healthcare.