thank you. guest: taxes are going to be a very controversial part of this. biden has proposed something in the area of $3 trillion on tax increases. millionaires who die with a huge unrealized capital gain and corporations, he wants to take the corporate rate not back up to the 35% it was before trump but up to 28%. he wants to increase taxes on overseas profits. every single detail will have a fleet of lobbyists. if you watch cable tv you will see some of these tax increases. if you haven't, you soon will. they have trillions of reasons

to try to defeat that part of the bill. in washington, it is always so much easier to increase spending and cut taxes. one of the things the democrats are doing in this package is cutting taxes for a lot of people. they want to permanently expend -- extend the boosted tax credit. there are millions of families who will be getting checks, direct deposits this week for the child tax credit that they increase this year. that is a big deal. people will be reminded every month when they look in their account and they got hundreds of dollars bigger that this happened. it is hard to take something like that away. the democrats will say this package overall will be a tax cut for these families. it will provide all of these benefits on childcare, free

community college, universal pre-k. there are somebody things they could say this will help your family and the people paying the bill are the corporations and the wealthy. they think that will be more politically sellable then what they were trying in 2010 when there were these various things that were unpopular. the things like individual mandate, republicans could say this will raise the price of electricity or this will raise the price of fuel at the pump. joe biden is not really opposing that stuff. when republicans were imposing the gas tax increase, joe biden said no. he said i made a promise, i will not raise taxes on people making over $400,000 a year.

public and say a lot of people who make less than $400,000 have stocks and a lot of things. you are taxing the corporate profit. that will be a fight over the next several months. host: the caller mentioned a different look because we have a guest back in the studio. a different look on capitol hill today with the security coming down around capitol hill just over the past couple of days. video of removal of that security fence. i bring it up because yesterday a story you wrote in bloomberg, senator lahey unveiling a $3.7 billion security package after the capital riots. what is the future -- future of securing capitol hill looking like? guest: republicans have proposed a $600 million package that would reimburse the national guard for their deployment, reimburse the police for their

overtime time and include some other things. it is a much smaller package. lahey has a package that is not related to capital security like public defense, over $1 billion. for the capital, it would change what it looks like, the entrances there is $100 million in entrances for the house and the senate, which would be significantly beefed up right now. you could just walk up to the door basically outside, sort of like a shack. not the most glorious thing in the world. they have hundreds of millions of additional dollars. also, a lot more money to beef up the capitol police. we are seeing a lot of capitol police retire and leave the force. many were injured.

there is money for equipment. he told me yesterday he wants to get this done in the next couple of weeks. he will be talking to the top republican and we will see if they could come to some kind of agreement between $600 million and $3.7 billion. host: let me take a couple of calls in a row. a lot of folks waiting to talk to you. caller: hi, my friend, hi mr. dennis, thank you for taking my call. i have a couple of comments and then a question. this infrastructure bill for the past weekend half we have been hearing the democrats say that the republicans are not for, not backing the blue so to speak when there is not one paragraph in this bill that gives anything to the police. as far as the security at the capitol, lahey wants to spend more money to protect himself

while american cities are begging for protection. i come from a law enforcement family and i will tell you it is not fun being from a law enforcement family right now because we have targets on our back. as far as the taxes go, this tax hike, has anybody thought about the elderly people that live off of social security and how this inflation is impacting them? some can't buy medication, some can't buy food. it is ridiculous. we need to come together as a nation. get rid of the republicans, get rid of the democrats, let's talk about being american. host: we will take your comments and hear from kenny next. good morning. caller: good morning. i love c-span. i just wish we had some fact checking on both sides.

i love it that you give both sides -- this about the infrastructure bill i would be with joe manchin if the republicans wouldn't overuse it. i don't like them changing rules of the senate. we went from 30 hours to two hours. this infrastructure, mcconnell and the republicans would not let anything pass -- just like with obama. that's why you have republicans gaetz -- states with no mask requirements. they don't want it to get better. the economy gets better and people go back to work.

republicans won't win in 22. host: let me get one more, go ahead. caller: i will try to be quick. i will use an analogy. we look at america as a living, breathing thing. it has been involved in a catastrophic accident. in the emergency room, they triage. the republican wants to give him more to easy spain and we will check in the morning. the democratic doctor says he has a collapsed lung, lacerated liver, compound fracture, chest wound. we want to put him on the morphine drip but we want to get him on the ventilator, we have to tend to his liver. we need a surgeon to fix the compound fracture. we need to give him a blood

transfusion for the chest wound. host: is the infrastructure package, is that going to be what fixes the elements? caller: it's not just -- the iv drip will not get this package, the patient will be dead in the morning. the democrats don't know what they're doing. guest: i think this is sort of like the quintessential american argument. are we going to have a significantly larger federal government or do we say we got past the pandemic, we spent a lot of money. inflation is going up. it is time to step back and let the private sector and state and local government build their way out of it. they already have a bunch of

money in the 1.9 -- $1.9 trillion rescue package. states are free to use that money for schools, they can use it for all sorts of other things as a result. now you have this debate. one of the things happening this week on capitol hill, jay powell will be testifying in the banking committee on thursday while republicans will be pressing him to put out some markers on inflation. they are trying to find any ammunition they can to defeat this $3 trillion package. democrats will be pushing in the opposite direction and pointing out a lot of economists said most of the inflation we are seeing right now is sort of transitory. it is related to reopening the

economy. people having money in their pockets. want to go out and build houses, take vacations, go to restaurants. you are seeing some imbalances in the economy that might not be here in another year. i think this will be the debate you're going to hear in the next several months as they write this reconciliation bill. it sort of sets the top line. lots of pages, lots of wrangling to do. this debate will be republican saying inflation is already bad. we have the tax increase on folks, we need to stop the spending. you'll have democrats saying this is a long-term bill that is going to put money in the pockets of millions of families who are struggling with childcare, with education costs, the whole universe of things they want to do. that will be a big fight.

taxes will be a big part of that. caller: good morning. compared to what increase in taxes? they are worried about interest rates, they are worried about everything. paying for things the american people need. it will cost us more money in the long run to deal with the effects of climate change. it is killing fish. it is fires everywhere, flooding everywhere. there is a cost to that. they don't want to vote on this because they don't want biden to succeed. they don't want the economy to do well because it does not look good for them. host: the climate change point, steve dennis, what do we know about what issues are being included in perhaps that long-term package discussion? guest: one of the things the

white house really wants is a clean energy standard. they want to transform the electric grid to a cleaner grid so that we have less emissions. that could be carbon capture, maybe you could keep some of these fossil fuel plants if you can figure a way to capture the emissions and pump them underground. it could also mean more renewable energy. they want to transform the transportation sector. tax incentives, electric vehicles and trucks. you do those two things, you are dealing with two big chunks of the climate. that will be tough to get joe manchin on board. you have to figure out how he could go back to west virginia and say we are going to be able to clean up our abandoned mines.

we will have jobs here with renewable energy. we will have better benefits, whatever it takes. what will it take to get joe manchin to agree to some of these things. host: we mention president biden is heading to philadelphia to talk about voting rights. major legislation is awaiting action, hr one is what it was in the house. what is the fate of s1? guest: it is effectively dead. it is not dead dead. i think what is really happening is they are continuing to hold hearings. they are continuing to highlight the issue. there is some bipartisan talks going on around the john lewis

voting rights act, a much narrower piece. then you have the complication of the supreme court ruling continuing to narrow the use. there is really no appetite for mitch mcconnell or his lieutenants to test this issue. they think these new voting laws are fine. people can still go out and vote. they don't want any changes. we have more people we don't need to step in and fix something that isn't broken. the democrats obviously see it very differently. they look at new voting laws and say the margins are going to holt -- hurt folks that they

need to vote for them. if you have a photo id requirement and there's an 85-year-old without an id, you'll have to go and maybe go get that id, that might be a little harder for you. there are kinds of things that might affect 1% or 2% of the vote. you could say maybe it is not that big of the deal. 1% or 2% is the difference between biden winning georgia or biden losing georgia. the difference in states like arizona and wisconsin. a lot of senate races next year as well. this is going to be a battle that is fought in the courts. something where the pressure will continue on joe manchin. it will be on raphael warnock,

the georgia senator. they have put together a version that is paired back. republicans don't like that either. the question at some point is are you going to deal with the filibuster issue. they could counter some of these state laws. host: a longtime veteran of the capitol hill press corps. you can find him on twitter at stephentdennis. we appreciate you in studio, we look forward to coming back down the road. about 30 minutes left, we will be joined by aaron trish to talk about spending on some drugs by medicare versus what the health care program could have paid at costco. stick around for that discussion, right after the break.

>> weekends on c-span two are an intellectual feast. every saturday we will have events that fill our nation's past on american history tv. on sunday, book tv brings you the latest on nonfiction books. learn, discover, explore. weekends on c-span two. >> coming up today on c-span, a house judiciary subcommittee hearing on the use of facial recognition technology by police. then at 2:30 in the afternoon a senate judiciary subcommittee examines anti-competitive practices and the prescription drug market. on c-span2 the senate is back at 10:00 a.m. eastern. to consider nominations for

deputy labor secretary. >> washington journal continues. host: headlines last week about a study out of the university of southern california found that medicare could have saved $2.6 billion if they bought generic drugs at cosco. erin trish joins us to talk about this. how did you come up with that study and how did you make the comparison to purchasing the generic drug at cosco? guest: good morning at thank you for having me. my colleagues and i were having a conversation with an executive from a generic manufacturing firm. they provided some kind of provocative anecdotes for us. they make these generic drugs. they knew how much they were selling those pills for when they made them.

those same generic drugs at the pharmacy, what were they charging them just for when the employees were selling those drugs. they share with us they were charging them about six times more than what they were selling those drugs for. that really just piqued our interest. it got interested in looking in the hood, where were those dollars going? were there examples of places where you could reduce those prices and drive on efficiency and value? host: let's talk about pharmacy benefit managers, who do they work for? why is that system in place? guest: pbm's are these large

organizations. their job is to actively negotiate prices that they will pay pharmacies. they turn around and sell their services to health plans and employers. they are basically acting and operating the prescription drug benefits. in the context of the medicare program, the medicare part b program provides coverage for about 45 million beneficiaries in america. they are the ones who are designing and actively negotiating these. turning around and selling those services to beneficiaries. host: we have about 25 minutes left in our health -- our program today to talk about this study and the issue of drug pricing. let me give you the viewer -- the number for viewers to join in. democrats, (202) 748-8000, republicans (202) 748-8001,

independents, (202) 748-8002. a special line if you are enrolled in medicare, (202) 748-8003. we are talking about that study out of the university of southern california, the schaefer center for health policy. aaron trish -- erin trish did the study. they paid more than if bought at cosco. if they paid the same price for 100 84 commonly prescribed drugs they would have saved one point $7 billion in 2017. $2.6 billion in 2018. the obvious question here is why does cosco do it better? guest: it is quite similar to paper towels and all of the other things cosco does well. they have a strong incentive to

deliver on value directly to the purchaser. they really got this streamlined distribution system and cut out some of the cushion with the intermediaries and the opaqueness that exists with the pharmaceutical supply chain. cosco pharmacies are actively negotiating the lowest possible price. turning around and having a strong incentive to deliver that best price or that value directly to the patient. instead of the medicare part b context you have the beneficiary who might have the generic drug. they are not really shopping or understanding what is the total price that their plan is playing -- paying. compare that with cosco when you see the full sticker price. there, the system is set up to

provide incentives for cosco to pass along savings directly to the patient. host: a tweet from a watcher, i'm on social security, i get one prescription from cosco, and one from canada. you look into the cost of blind drug from out of the country? caller: we did -- guest: we did not do that in the context of this study. host: have you looked at that before or is that something you could look into down the road? guest: we haven't looked at that. there are others who have looked at as a comparison. definitely an interesting idea for a future research study. host: in terms of suggestions for lawmakers, what should they take away from your study as they tried to addressed these cost issues? guest: there hasguest: been a lot of policy discussion lately that we could take to benefit

the market. it is important to recognize that medicare negotiating prices is not the kind of answer here. this is the generic market. they are large, sophisticated organizations. they require these generic drugs . these are the most common generic drugs. there are many manufacturers making them and a lot of competition in that space. there's not really a lot of space there. i don't see medicare stepping into negotiate or do any better on the pricing in this market. the key issue here is not the -- not that they can't negotiate lower prices.

as policymakers we are thinking about tackling this market. it is really important that they recognize what is going on in this supply and do what they can to interject transparency and improve incentives there where it is not the main trade-off of the branded drug space. these are generic drugs in the context of the study we are talking about. it is really just about streamlining and improving efficiency and delivering on value to the taxpayers and to the patients. host: nancy is in maryland for -- on the line for those who have medicare part d. you are on the line. caller: good morning. you may already know about this, i'm not a big pill user, thank goodness. a major warehouse in maryland have a contract with areas in

washington, verlyn, and virginia. all of the medications that are prescribed to the patients in those areas come from this major warehouse. whoever is in charge of ordering pills because up this warehouse which is 50 or 60 miles away. it is like delivering food. you take your turn and you take the pills to whatever nursing home there is. i don't do this anymore but when i did i would drive back to washington, d.c., from suburban maryland two or three times a day. why don't they just call of rite aid, walgreens, or someplace else? that is my question. why do these major warehouses have such a hold on the pill

distribution? guest: thank you so much for calling. there is a lot of complicated mist in the market. this is one of the examples of these levels of intermediaries and the complexities of what goes on here. they are related to reimbursement. we complexities just add flux to the system. that is the point of the research that we are doing. you carveout the letters of cushion. you could drive savings and you could save money here. it is about peeling back the opaqueness of the market and understanding who is benefiting

from the status quo and what could we do to move on from where we are and improve this? host: about 15 minutes left. phone numbers again, if you are enrolled in medicare part d, (202) 748-8003. otherwise lines as usual. (202) 748-8000 for democrats. republicans, (202) 748-8001. independents, (202) 748-8002. the idea of prescription drug prices will be the focus of a hearing in the senate judiciary committee today. that is starting at 2:30 p.m. eastern. we will air it on c-span. you could also hear it on the free c-span radio app and also watch it on c-span.org. the subcommittee on competitive policy with trust and consumer rights holding that hearing.

this is joan in rochester minnesota, good morning. caller: back in the 1950's and 1960's, i went to a -- in 2020 when i went to a dentist and i was prescribed a drug for $2.97. since the patent had run out, the pharmaceutical company decided to price it like it was a new drug. it was now $93. there's a lot of hanky-panky the drug company does when it re-releases things. i said i'm not going to fall for

this. they need to clean up their act. people are getting hurt. people are losing things in their lives because of drug companies, thank you. host: your thoughts? guest: generic drugs, this is an example of the markets are working quite well. we have patents. this is what drives innovation. this is an important aspect of one of the key ways that we drive improvement that we could deliver. it could provide this to patients. typically when drugs go off patent, it is common that the branded drug price might rise after that. the existence of these generics tend to offer a much lower price and really see the kind of value

of these lower-priced alternatives really increases the availability of these therapeutics even more widely. it is important to make sure when that happens we are able to make sure the market could deliver those generic drugs at the lowest possible cost to consumers. it is patients that feel this at the counter. we have to make sure patients could afford products. we want to make sure we are rewarding innovation and not just the lack of competition among you to meet -- intermediaries. host: being joined from the west coast, this is kathleen on the east coast in delaware. good morning. caller: good morning. i would like to add that i use health mart pharmacy, who automatically dispense generic drugs. host: could you explain more how that process works? caller: all of our pharmacies

dispense generic medications automatically. guest: i think this is one of the things pbm's have done really well. this is a strong role they have played in the history here. pbm's are incredibly effective getting patients to switch to them. that is one of these success stories here. we are trying to highlight with this study that in order to fully capture the benefits, we need to make sure we are not overpaying for generic products as well. host: a question on twitter saying if costco had to provide for as many patients as does medicare, could costco manage it?

guest: i think there's a lot of people that shop at costco. they have about 500 stores nationwide. they offer a mail-order pharmacy so they could ship prescriptions nationwide. our study focused on drugs that were dispensed in 30 day or 90 day quantities. we are not talking about if i need an antibiotic today. if you focus on these chronic medications, you realize it is not just cosco. many entities are starting to get more fully into the space and recognizing that we are ready for a revolution, more efficiently and more consumer friendly way getting these drugs. host: about 10 minutes left with erin trish from the usc schaefer center, the director there.

one of the lead authors on that study that we are talking about this morning, the cost of generic prescription drugs. compared to buying those i cosco. the special line for those enrolled in medicare part d is (202) 748-8003. in 10 minutes when our program ends, we will be taking you to the house judiciary subcommittee hearing looking into police use of facial recognition technology. a government accountability report on law enforcement, particularly federal law enforcement starting at 10:00 a.m. eastern here. you can also listen on the free c-span radio app. this is geraldine in massachusetts, good morning. caller: my question is -- i am a breast cancer survivor. i went to visit a sister in

england. she was on the exact same dose, same company. she was paying one third of what i was paying in the united states. why doesn't the united states pharmaceutical companies be brought to task? why am i paying -- she is paying one third. i am paying much more for the same prescription. japan and one other country in england a few years ago as to why the prices in the united states are so high and out of reach for most people. why is that? guest: absolutely. this is a lot of the focus of the policy discussion today. the prices we pay for branded drugs. i think there is a lot of differences. there are patients in america who have more access to choice

of different treatments and therapeutics. it is a very different system of how we could make available different types of care. you're absolutely right, the current system puts a lot of that, the patient could feel a lot of this in their out-of-pocket costs. it is also important to recognize some of those price differences were driven by the fact that the -- they valued innovation that pharmaceutical companies provide. it is important we maintain an incentive for the development and discovery of new products. it is important we make sure they are available for new patients as they exist. that is certainly an important aspect that we need to fix in many policy angles. there is a wide variety, the

u.k. takes a different approach as to how they decide what therapeutics what will be available. it is a very different system of what patients have access to their end in other countries as well. host: a guest on twitter would like you to explain the doughnut hole any changes to the donut hole. guest: one of the most fun things about working on medicare is the doughnut hole. back in the early days of medicare, policymakers were trying to find a compromise that was going to enable them to create the prescription drug benefit and at a particular cost to the federal government budget that would not go at their kind of target. they wanted to make sure all beneficiaries got some benefit early on but they didn't have enough money to afford generous insurance coverage for all prescription drugs after that.

essentially this started with providing insurance coverage to reduce out-of-pocket spending. after they had a couple thousand dollars in spending, they would transition to the doughnut hole where there insurance coverage went away for a few months depending on usage. they would pay the full cost of that drug until they reached a very high level when there insurance benefit would kick back in. i think everybody realized this is not what a typical insurance policy would look like. patients were really facing a high out-of-pocket spending burden. there were other types of problematic outcomes. policymakers decided over time to fill in this doughnut hole and provide insurance coverage throughout all of the phases of part b.

that has gone through a series of policy changes the last few years. host: first time it has been referred to as something fun to talk about. good morning. caller: mi on the air? host: yes. caller: i'm a little nervous. i got diagnosed with hepatitis c last year. i went to get the medicine, the prescription only to find out my carrier wouldn't take care of the medicine. i figured i would pay for the medicine myself. now i have to turn around and get the medicine from india for $400 from the hepatitis c buyers club. why can't we import drugs from other countries? $100,000 year and the company told me they would take care of me if i got sicker. i said should i start drinking

24/7 so i could damage my liver? i got the medicine from india. now it is gone. i don't understand the idea of the pricing here. it is not for innovation, it is for greed. host: thanks for story -- sharing your story. guest: i'm glad to hear you are doing well. this is an example of the kind of policies we have in place. i'm not sure the details of what they were. this is part of the discussion of the market. several years ago we didn't have a cure. there exists now multiple products. we did see a high price for those drugs when they first came to market. we have seen a significant

amount of commerce -- competition when they entered the market. this drives home one of the other key things, a thing called rebates. basically where manufacturers are negotiating this after the fact. these are also done behind the secrecy of the industry. those savings are necessarily reflected. these are called the list prices. they are increasing over time. they are after the fact rebates that are bringing down the net cost of the system of those therapeutics. there is a lot to this discussion that we are missing in terms of the pricing dynamics. one of the things they focus on now is making sure that the patients could benefit from those types of savings.

host: a few minutes before the house judiciary committee gavels in. if you want to keep calling and we will take your phone calls. sherry is in maryland, enrolled in medicare part d on that line, go ahead. caller: i appreciate erin's work . if we had a cosco here i would shop at costco. until the government rang in the drug companies and the insurance companies because they work together, the prices will never go down. i have purchased prescriptions from other companies. they are manufactured by the same company. we are the only country, maybe there is one more in the world that allows drug companies to

advertise on tv. that should not be allowed. we pay way over half, more than is necessary. that is all i will say for now. host: thanks for the call and bringing up some of those issues. as you talk about her question, did costco say anything about your report? how did they feel about it? guest: they are very happy to get the word out. , sometimes we go for the samples. it turns out costco is quite effective at delivering on low prices to patients and to the

consumers as well. i think they are interested in expanding their ability to reach more patients and deliver value more broadly to the extent that they can. host: the caller brought up advertising by pharmaceutical companies. i wonder your thoughts on that? guest: there are trade-offs to every aspect of prescription drug policy. there could be benefits to advertising. you get information out there. some of that is directly to patients. helping to diffuse these products more quickly. you get it into the hands of patients that need them.