A couple weeks back, I took a deeper look at one issue on the "100 hour agenda" for House Democrats, giving the Medicare program direct authority to negotiate with pharmaceutical companies for the new prescription drug program, rather than leaving those negotiations to private sector providers of the benefit. Today, the LA Times previews the issue heading into the new Congress.

The Times article is worth a read, especially for readers who recall past coverage at this site on the Medicare drug benefit, particularly on the political arguments surrounding the program and its implementation. Specifically, the Times explores a couple themes discussed previously here (including in the comments section):

One, the VA's system of "negotiations" won't work for Medicare, particularly because of the restrictive nature of the VA's drug coverage.

Yet applying the VA approach to Medicare may prove difficult. For one thing, Medicare is much larger and more diverse.

VA officials can negotiate major price discounts because they restrict the number of drugs on their coverage list. Instead of seven or eight drugs for a given medical problem, the VA list may contain three or four. If a drug company fails to offer a hefty discount, its product may not make the cut.

For example, VA beneficiaries can get Zocor for high cholesterol, but not Lipitor. In all, the VA covers about 1,300 medications. By comparison, the most popular Medicare plan -- AARP MedicareRx -- covers about 4,300.

But VA patients who want drugs that are not on the department's list must go outside the system.

In other words, the VA offers lower drug prices, but fewer choices.

Furthermore, contrary to claims by some that "direct negotiations" by Medicare would simply utilize free-market principles, the Times coverage says this:

"The VA had to resort to a preferred drug list, but I don't think that Medicare would have to restrict its list very much because it is such a huge purchaser," said Dr. David Blumenthal, a professor of medicine and public health at Harvard University. "Medicare's power in the marketplace is such that I think every manufacturer would have to take its prices."

Translation: if it doesn't restrict patient choice, Medicare will essentially set prices, not "negotiate" for them. Bluntly, that puts Democrats in a bad situation.

"From a rhetorical perspective, Democrats may feel like they gain a lot with this issue, but there are many substantive hurdles that the government faces in trying to negotiate prices," said Dan Mendelson, president of Avalere Health, a consulting firm that tracks the Medicare prescription program.

"If you look historically at the government's experience in trying to regulate prices, it's poor."

Read the whole thing here.

UPDATE: The Washington Post had coverage on Sunday too. Here's the lede:

It sounded simple enough on the campaign trail: Free the government to negotiate lower drug prices and use the savings to plug a big gap in Medicare's new prescription-drug benefit. But as Democrats prepare to take control of Congress, they are struggling to keep that promise without wrecking a program that has proven cheaper and more popular than anyone imagined.

Oh.