As CalWatchdog reported in April, supervisors had taken initial steps to mandate that the costs involved in collecting and disposing of unused prescription drugs and syringes be shifted from Los Angeles County to U.S. and international pharmaceutical companies.

The measure wasn’t justified with claims that these companies somehow had a moral and ethical responsibility to pay for disposal of their potentially dangerous products. Instead, officials asserted that it was a costly and difficult task that the county was ill-suited to handle. This type of trash is “one of the things we’re completely ill-equipped to take. … We just had one of our biggest days ever just a few months ago where we had almost 27 1/2 pounds of needles come through the line. The workers up there have leather gloves, but there are no gloves made that can stop a fine, little puncture from a needle,” a Burbank recylcing manager told KPCC.

Board disregards testimony of county health executive

But this week, three of five county supervisors went against the proposal, bucking the testimony of interim county Health Officer Jeffrey Gunzehauser, who linked ineffective drug disposal policies to the nation’s opiate overdose epidemic.

Instead, Supervisors Mark Ridley-Thomas, Don Knabe and Mike Antonovich accepted the pharmaceutical companies’ offer “to pay for an education and outreach program about existing take-back options and to explain how to dispose of unused medications in the trash, a method opposed by county public health officials,” the Los Angeles Times reported.

This didn’t sit well with the Sheila Kuehl and Hilda Solis, according to the Los Angeles Daily News. They wanted the program adopted and hold out hope it can be revived.

While the L.A. County plan is unusual, it has a precedent. In 2013, lawmakers and Gov. Jerry Brown enacted Senate Bill 254. The law requires mattress manufacturers “to create and manage a mattress recycling organization that will provide recycling services to municipalities for free. The program will be financed by a visible mattress recycling charge, or ‘eco-fee,’ which will be collected from consumers at the point of sale.”

Mattress manufacturers complained intensely about the law, but talk of a lawsuit was never followed up on.

The measure is unusual in that it assigns cleanup costs to the producer of a product instead of to its users. But many officials throughout Los Angeles County depict themselves as overwhelmed by the problem posed by proper disposal of the medical waste, especially items that pose health risks to trash handlers.

Burbank recycling coordinator Kreigh Hampel told KPCC that this waste is “one of the things we’re completely ill-equipped to take. … We just had one of our biggest days ever just a few months ago where we had almost 27 1/2 pounds of needles come through the line. The workers up there have leather gloves, but there are no gloves made that can stop a fine, little puncture from a needle.”

Drug companies question wisdom of approach

Santa Clara County reportedly has a similar law. But pharmaceutical companies appear ready to step up efforts to assign them a costly new task when the party involved is the most populated county in the United States:

“We agree that it’s really vital that consumers dispose of their medicines properly,” says Priscilla VanderVeer, spokeswoman for the Pharmaceutical Research and Manufacturers of America, a national trade association.

But “a mandated costly and frankly inefficient take-back program is not the way to do that,” she says. “There are cheaper, less burdensome ways to dispose of medicines.”

VanderVeer says a mandatory program would force a liability risk onto pharmacies that handle controlled substances. A better option, she says, would be to educate residents about proper disposal and to promote voluntary drug drop-off sites, such as those offered by the Los Angeles County Sheriff’s Department and some pharmacies.

That’s from KPCC’s reporting.

Mattress law set precedent for requiring help in cleanup

Forcing producers to help oversee the cleanup of the goods they make has a precedent in California. In September 2013, Gov. Jerry Brown signed Senate Bill 254. The Waste360 website reported that “the law requires mattress manufacturers to create and manage a mattress recycling organization that will provide recycling services to municipalities for free. The program will be financed by a visible mattress recycling charge, or ‘eco-fee,’ which will be collected from consumers at the point of sale.”

The mattress program, which began gearing up this January, draws criticism from mattress makers.

Ryan Trainer, president of the Mattress Recycling Council, told Capitol Public Radio earlier this year that “at the end of its useful life, a used mattress has relatively low value. It’s a very bulky product and so we don’t want to handle it multiple times before it gets to the recycler and in turn to the scrap markets where the foam and steel can be reused in making new products.”

But so far mattress companies haven’t sued over the law, as some expected when it was first discussed several years ago.

State law bans the Fresno Democrat from lobbying his former colleagues for one year following his tenure in the state Assembly. Yet, the state’s ban on influence-peddling hasn’t stopped the Pharmaceutical Research and Manufacturers of America from hiring Perea as a senior director of state advocacy. Perea, according to published reports, began talking job prospects with the industry group in September.

Beginning on January 4, Perea will direct political operations in California, Arizona and Nevada for the group known around the Capitol by the acronym PhRMA. The group represents the country’s biggest pharmaceutical and biotechnology companies, including Allergan, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, GlaxoSmithKline, Johnson & Johnson, Merck & Co., Novartis Pharmaceuticals Corporation and Pfizer.

“They innovate, they discover cures, they represent a lot of California employers,” Perea said in an interview with the Los Angeles Times. “The debate in health care, especially after the Affordable Care Act, is going to be very robust over the next decade or two and I look forward to being a part of that.”

PhRMA’s Robust Lobbying Operation

Since Perea’s first term in the state Assembly in 2010, the Pharmaceutical Research and Manufacturers of America has spent big money to lobby the governor, state lawmakers and other state government officials.

A CalWatchdog.com analysis of state lobbying disclosure forms found that Perea’s new employer has spent more than $2.59 million in state lobbying over the past five years. That half-million dollars per year in annual lobbying fees doesn’t include money spent by PhRMA’s member organizations.

Just one PhRMA member, the multinational pharmaceutical giant Pfizer, spent more than $3.18 million in lobbying over the same period, according to CalWatchdog.com’s review of disclosure reports.

Perea’s Campaign Contributions from PhRMA

The pharmaceutical industry’s robust lobbying operation in Sacramento has frequently crossed paths with Perea. Over the course of his career, Perea has accepted $157,144 in campaign contributions from the industry, according to FollowtheMoney.org’s analysis of campaign contributions. That ranks him 119th of every politician in the country and, according to FollowtheMoney.org, means he’s accepted more pharma money than Senate President Pro Tem Kevin de León, Speaker of the Assembly Toni Atkins and former Senate President Pro Tem Darrell Steinberg.

During the 2011-2012 legislative session, the pharmaceutical industry contributed more than $74,000 to Perea’s campaign accounts, making it the second largest industrywide contributor to Perea’s campaign, according to an independent analysis by the transparency group MapLight.

Perea’s multiple campaign committees also appear frequently on campaign finance disclosure reports and political action committee summaries filed by pharmaceutical companies. Earlier this year, his campaign committee for a 2018 Insurance Commissioner campaign accepted $2,000 from Amgen. In 2014, Pfizer gave Perea $3,500 and counted his re-election among its important wins.

“We continue to face significant legislative and regulatory challenges and each election cycle is critical to our industry,” Sally Susman, chair of Pfizer PAC, wrote in its 2014 Pfizer PAC annual report, a 102-page report detailing the company’s effort to build “positive public will.”

Perea’s history of luxury gifts, trips

Although Perea has refused to disclose his new salary, it’s likely to be more than the $97,197 annual salary and $33,000 in annual tax-free per diem payments he received as a member of the state Legislature.

Over the course of his career, Perea supplemented his income with tens of thousands of dollars in luxury goods, entertainment and travel, according to his economic disclosure reports.

In 2011, Perea accepted $9,397 worth of lodging, meals and transportation for a junket to Italy sponsored by the California Foundation on the Environment and the Economy, “a San Francisco-based nonprofit made up of oil companies, utilities and environmental groups.” Two years later, Perea again accompanied the group on its junket to Eastern Europe – a trip valued at $9,984.

Perea’s biggest haul came last year, when he accepted $16,090 from the group, including a $10,221 trip to Chile. He also traveled to: Maui on a $2,148 trip paid for by the Independent Voter Project, Israel on a $11,550 trip paid for by the American Israel Public Affairs Committee, and Central America on a $1,500 trip paid for by the government of El Salvador.

3rd lawmaker resignation since 2013

Perea will become the third California lawmaker in two years to quit in the middle of a term in order to take a job with a Capitol interest group. In 2013, Democrat State Senator Michael Rubio abruptly quit his position to take a job with Chevron’s government affairs unit. That same year, Republican State Senator Bill Emmerson quit mid-term for a high-paying job with the California Hospital Association.

Perea’s resignation will trigger a 2016 special election that is expected to cost Fresno taxpayers several hundred thousand dollars. The March 2014 special election to fill Emmerson’s seat cost Riverside County taxpayers $415,000, according to the Press-Enterprise.

Two candidates had already announced their intentions to run for the 31st Assembly District: Democrat Joaquin Arambula and Republican Fresno City Councilman Clint Olivier.

by WAYNE LUSVARDI

Rationing health care under Obamacare will end up politicizing and bankrupting the medical financing system, just as Medicare does.  And there will be middle-class resistance to Obamacare when it is realized that this will end the American Dream of leaving your wealth and home to your heirs.

Last week President Barack Obama signed HR 3630 to postpone nearly 30 percent cuts to Medicare physician reimbursements.  This bill, delaying budget cuts in Medicare was part of a larger package of measures that included an extension of the payroll tax cut and continued unemployment benefits.

The part of the legislation delaying cuts to fees doctors can charge under Medi-Cal is called a “doc fix.” This is because it “fixes” the problem by delaying cuts in doctors fees for another 10 months.

It should have been called a “patient fix,” because if doctors’ fees were cut about 30 percent, they might have dumped their patients covered by Medi-Cal. This would result in an even larger overload of patients that depend on hospital emergency care.

A two-tiered medical service system would result in low income persons assigned to county hospitals and the middle class and wealthy able to access private physicians. What politician in his right mind would want that coming home to roost in an election year?  It is bad enough Obama made the Catholics mad.

The legislation postpones a 27.4 percent reduction in fees originally set to begin on March 1, 2012.  The cost of the “doc fix” will be $18 billion nationally. This is just to extend the current rate of reimbursement for doctors for 10 more months.  This is to be funded by various cuts in other health-related cuts spread out over a decade:

The measure will fund:

* $18 billion in Medicare costs through 2012.

The measure will cut:

* $5 billion from the prevention and public health fund created by the federal health reform law;

* About $4.1 billion in Medicaid payments to hospitals with a disproportionate number of uninsured patients;

* Payment rates for clinical laboratory services, by 2 percent in 2013, to save an estimated $2.7 billion over a decade;

* $6.9 billion in “bad debt” payments to hospitals when Medicare beneficiaries do not pay for services; and

* $2.5 billion in Medicaid funding to Louisiana, which received increased funding from the overhaul.

Doctors will face about a 32 percent reduction in Medicare payments when the “doc fix” expires. This assumes it is more politically expedient to stick it to them then and not kick the can further down the road.

Obamacare Sees ‘Markets’ as the Problem

Many health care policy experts see the ability of private-sector model of health care and Big Pharma — large drug companies — as the primary cause of why the federal budget is running uncontrollable deficits. A long-term solution would cost $300 billion.

They believe that many treatments and drugs are ineffective, such as:

* stents for blocked arteries that can be prevented by forcing everyone to shift to a plant-based diet;

* “palliative” chemotherapy that only relieves symptoms of incurable cancers;

* removal of cataracts from eyes in the elderly;

* health care rendered in the last two years of life.

The problem to these experts is “capitalism”: too many entrepreneurial doctors making lucrative compensation with exotic treatments that often don’t work, causing Medicare to go broke. The only solution they see is punishing doctors and rationing health care services.

A problem with the Obamcare solutino is that the health care system will end up politicized and broke, just as Medicare is now. The adult children of elderly medical patients will vote for whatever politician or political party promises to provide medical services “on demand” to their elderly parents.

This would continue to protect the inheritances of the children of the elderly. To leave your children your wealth is considered to be part of the American Dream. So any health care rationing system would just end up in the same place, as Medicare is today — running huge unsustainable deficits.

Back to the Pre-WWII Future?

Says Charles B. Warren, an economic policy analyst in Pleasant Hill, California:

“I guess the important question is, ‘What are the last couple years of life worth to you?’ Anything spent 10 years or more before your probable pull date is probably worthy of consideration. But, in the present system, tons of money has been spent on the last couple years of sometimes very aged people’s lives. Death panels are one answer.”

Warren believes individual responsibility for a major cut of care, particularly end-of-life care, is another solution.  His proposed solution entails:

* medical insurance deductible by all or none. This would be something like “assigned risk” car insurance for high-risk individuals;

* major co-pays (with optional but, if insurance is deductible, tax deductible medical savings accounts to cover them);

* openly published prices and outcome rates, which implies…

* immunity from liability for the disclosure of negative outcomes.

According to Warren, we need to establish a market in medical services not dissimilar to what existed before World War II. He says employer-paid health care was an end-run around WWII wage-price controls. “Its IRS deductibility shows that everybody knew and knows that health insurance is just another wage expense,” he said.

“It is no surprise that Medicare has just made everything more costly,” he added.   He believes we lost that battle when former Republican Barry Goldwater lost the 1964 presidential race to President Lyndon Johnson. In 1965, Johnson I imposed his “Great Society” welfare systems, including Medicare and Medicaid.

California is in the process of postponing inevitable cuts to the public-funded health care system. It is not the cuts, however, that are the main issue, but how to make the cuts. Those who want Obamacare see a totalitarian rationing system as the only solution. But such a system will end up just as politicized and broke just as Medicare.

This is because the middle class will eventually catch on that Obamacare will end the “American Dream” and the “California Dream” of leaving their wealth and their homes to their children.  As Machiavelli wrote: “Men more quickly forget the death of their father than the loss of their patrimony.”