Tuesday, October 12, 2021

In which the Kaiser Family Foundation moves to quell a PhRMA disinformation campaign

Subscribe to xpostfactoid

The Kaiser Family Foundation (KFF) appears to have taken steps prevent PhRMA from using its polling in a disinformation campaign. 

In response, PhRMA has accused KFF of politicizing its research. That's like Donald Trump accusing an opponent of lying to the public (or rigging the vote count).

What KFF did do -- amend its survey questions about empowering Medicare to negotiate prescription drug prices -- is interesting. Let's step back and review how KFF typically structures questions regarding public policy options.

In its questionnaires, KFF will ask whether a respondent favors an initiative -- say, subsidizing children's lemonade stands. 90% approve! It will follow up with a question that raises the possible negative effects -- say, increasing neighbors' likelihood of developing Diabetes from all that liquid sugar.  Approval will drop, a little or a lot.

In December 2008, when Democrats were flush with victory and bruiting the outlines of what would become the Affordable Care Act, KFF polling about key elements of the nascent plan provided what should have been a useful warning. 

KFF asked respondents whether they favored "requiring all Americans to have health insurance, either from their employer or from another source, with financial help for those who can't afford it." Two thirds of respondents (67%) did favor the measure (40% strongly, 27% somewhat).

Next question: "What if you heard that this could mean that some people would be required to buy health insurance that they find too expensive or did not want?" The numbers reversed:  69% would oppose the mandate if that were the case, with only 28% still in favor.

As I noted in 2014, such qualifiers are a bit open-ended: "Of course some people would find the individual mandate either a financial burden or an imposition or both; the question...is whether it imposes real hardship or forces bad options on a significant number of people." Nonetheless, the results posed a clear warning to Democrats: if you're going to impose a penalty on going uninsured, make damn sure the new insurance on offer is affordable to all who need it. That warning they did not heed: the ACA marketplace was severely undersubsidized.

Skip forward to May 2021. KFF asks respondents whether they favor "allowing the federal government to negotiate with drug companies to get a lower price on medications that would apply to both Medicare and private insurance."  88% favor the measure.

But what if "it could lead to less research and development of new drugs"? Or "it could limit people’s access to newer prescription drugs"? Support plunges to 32% (for less R&D) and 31% (for limited access).

Again, the poll can't capture the degree of potential harm. CBO has estimated that over a ten-year period, Democrats' actual plan to empower Medicare to negotiate prices for the most vital and expensive drugs for all payers and penalize price-gouging (H.R. 3, which passed the House in 2019) would reduce Medicare drug spending by $448 billion while reducing the number of new drugs approved by 8 in the first ten years and by 30 (approximately 10%) in the next ten.  How does that tradeoff sound? Too nuanced for a questionnaire.

The qualifier was crack to PhRMA, however. In healthcare media, the lobbyist group ran ads with text like this:

Why Americans reject “so-called” Medicare negotiation

Proponents of government price setting often misrepresent voter opinion on support for allowing the government to negotiate drug prices.

Independent polls have repeatedly shown once Americans understand what government negotiation is, and what the tradeoffs are, support evaporates.

The open-ended nature of KFF's caveat-question created a vulnerability. Here's how PhRMA framed the poll results in a brief that the ad links to:

Myth: Americans support government negotiation in Medicare under any circumstances.

Fact: Data shows that once Americans understand what government negotiation is, and the tradeoffs involved, they reject it. According to the Kaiser Family Foundation, 65% of Americans oppose negotiation if it leads to less research and development of new treatments or if it limits people’s access to medicines once they come to market. Additional data reveals that 72% of Americans actively oppose government negotiation if it results in fewer new medicines being developed in the future, and 76% of Americans oppose government negotiation if it causes delay in access to new prescription medicines.

That's not strictly untrue -- it exploits the vagueness of the polling. So KFF went back to the question-drawing board.

Polling from September 23 through October 4, KFF counterpoised argument and counter-argument:

Argument against: People opposed to allowing the federal government to negotiate prices with drug companies say this would have the government too involved and will lead to fewer new drugs being available in the future.

Argument in favor: People in favor of allowing the federal government to negotiate prices with drug companies say this is needed because Americans pay higher prices than people in other countries, many can’t afford their prescriptions, and drug company profits are too high.

Support softened a bit, but the topline for overall approval barely budged:

Of course, those "arguments" provide exactly no basis for assessing the effects of lower U.S. pricing on drug development.  Still, the polling provides nothing like the red flag against the individual mandate (as deployed in the ACA) for a drug pricing policy like H.R. 3. Crudely, the benefits -- capped drug pricing in Medicare Part D, lower drug prices for all -- should be clearly visible, whereas the possible downside -- pharma companies pulling the plug on more drugs at various stages of development -- will be invisible.  And people's gut reactions to the potential upside and downside are as near universal as you'll get in American politics.

So PhRMA is hopping mad. KFF, in its telling, has "abandoned the nonpartisan, objective approach it’s always used..."

Translation: PhRMA disinformation drove KFF to greater clarity in its questioning.

Subscribe to xpostfactoid

1 comment:

  1. thanks for this lucid analysis and bit of optimism at the end.