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Well I felt a LEETLE bit guilty for photo-shopping the faces of the heads of the major healthcare lobbying groups onto the bodies of animals, after the son of one of these personages commented on the post, basically saying that I had no proof that the Advanced Medical Technology Association (AMTA) was against the public option for healthcare insurance. I mean, I am sorry for photo-shopping the head of your dad ontop of a dog, but when you are talking about the gang of four healthcare interest groups, there is room for only, well, four, which turned out to be the American Hospitals Association (AHA), American Health Insurance Plans (AHIP), American Medical Association (AMA), and the Pharmaceutical Research and Manufacturing Association (PhRMA). The AMTA signed on to a letter pledging to voluntarily reduce medical spending by a trillion over the next decade, which was clearly a crumb to get the bogey of public option insurance off their back. I can see that AMTA would not care about that, but, hey, maybe they should come out and say that, as I said in my comment.
There was an excellent article this week in the New York Times Magazine which raised the much dreaded R word, namely “rationing”, which my e-friend Rick Lippin MD has been raising for quite some time now.
The fact is that if you viewed the United States as a PERSON, it would be seen as a histrionic female draped over the arms of a much stronger male (probably a Republican), complaining that her proper needs were never fully taken care of.
In other words, the average American is not able to think rationally when it comes to questions of the economics of healthcare (or much else, for that matter).
Consider the fact that our healthcare outcomes are second to last in the industrialized world, and that we spend twice as much as any other country. As Obama adroitely pointed out this evening in his televised address, if you could get a car for six thousand less a year, and it worked just as well, wouldn’t take it? But that is exactly what we are paying extra for for healthcare that gives us no added value.
Do you want to pay $6,000 per year more for healthcare, just so your doctor can drive a Mercedes, when it does nothing to improve the health of you or your family?
I didn’t think so.
And the next time they start blabbering about socialized medicine or you don’t get to choose your own doctor, put some cotton in your ear.
Obama was talking tonight about actually getting some medical experts to tell him what does and does not work. I mean, if you had termites in your house, wouldn’t you want to know what does and does not work to eliminate them? Why should it be any different for healthcare? The British have the National Institute for Clinical Excellence, which is a body of experts who say what actually works. NICE has been villianized by those who are against rationallity in healthcare, but hey, why don’t we get some witches in here to do the job?
Rationing? The near-dead 90 year olds don’t get chemotherapy that will cost $40,000?
Rationing? People with cancers that DEFINITELY WILL KILL YOU like esophageal, certain lung cancers, or metastisized melanoma, don’t get drugs that cost $50,000 and might extend life for a month?
They talk about rationing in Europe. But the REAL rationing takes place here in the ole US of A. Those without insurance who go to the ER have a 37% increased death rate. In terms of cost, that is $5,000 that could have saved the life of a young person that would have had a lifetime of productivity and giving back to the economy.
Rationing? Don’t spout off if you don’t know what you are talking about.
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A national health plan sounds good until you look at the history of how money is siphoned away from large US Govt run programs. It is all too predictable that in a few years after a national health plan goes in effect we’ll see great sums of money taken for non-health related things like parties, trips, homes and more for the rich people who “administer” the program. “Gosh, we really should have put in safeguards against this sort of thing” our leaders will say as they struggle to hide their involvement in the corruption. I say no national health plan without safeguards against corruption by those who administer the plan.
AdvaMed is the PhRMA of the medical device industry, and has more autonomy than other health care industries with their products. Their products never get approved by the FDA- only cleared for marketing after a 90 day review. One exception being those medical devices that are potentially life-threatening.
Biologic agents are very expensive. I think Genzyme has a product for HIV infections that costs about 250,000 a year. As you mentioned, however, the quality of life and extension of the life span of a patient who is receiving such therapy is minimal- considering the unbelievably high price that is paid for these therapeutic agents.
NICE is a good health care system that combines authentic clinical guidelines with cost effectiveness. The profit motive for a health care system monetarily is not as manditory at such locations as it is here, unfortunately. Patients should be the apex of any civilized health care system. In the United States, they clearly are not. Our well being as humans should be much more important than the prosperity of others.
Private health insurance has an overhead of about 32% while public plans are about 3%. This is what has got the American healthcare status quo so nervous, I a public plan would be more competitive. But do we have any inherent reason to support private healthcare insurance, unless your cousin Jimmy has a job there? I think not! As John Dean said recently o NPR, if the bozos don’t approve a public option lets run them out of Washington!
NICE isn’t liked by the industry, in the UK (sans surprise). The UK industry lobbying body, the ABPI, regularly takes potshots in that direction, and NICE also comes under fire from the “redtop” press for rationing drugs – I wonder what interest of the gutter press is?
Now, I forget the number (tsk, tsk), but overwhelmingly the National Health Service is the UK’s biggest customer for drugs. Anything that impacts on that customer’s ability to spend infinite amounts of (taxpayer’s), dosh on (typically), new blockbuster meds that supposedly represent a breakthrough is going to be unpopular, and the requirement that generic drugs be prescribed has been one way that NICE has brought down NHS spending (just to clarify, NICE passes drugs for use on the NHS; without its say-so, a drug may not be used). Another way is the one you mention: whereby the use of a drug has a value-added element, which boils down to the cost per month/year/whatever of extending a person’s life.
In other words, as far as the industry is concerned, NICE is about as popular as a fart in a spacesuit. But all is not lost: as an example, NICE says that when it comes to depression, SSRIs should be prescribed to patients with mild depression as a last resort and that severe depression is the true indication for these drugs (I’m paraphrasing – go and read the Guidance doc for yourself). Guess what? Yep: most SSRIs are prescribed for mild depression.
Matt
As a very healthy 72 year old with private insurance, I have been treated for a rare-but-treatable cancer. The medication was very expensive, and over years of paying for insurance, I earned every dime of it.
This system you propose, where I would have paid into it my entire life and then get told to go somewhere and die because I wasn’t worth saving… shame on you.
Under a government plan I would not have qualified for treatment even if I had private insurance. This plan comes straight from Tom Daschle’s book, which in turn come stratight from existing healthcare systems in Canada and the UK. So don’t kid yourself; if they’re getting “experts” together to design a new system, it is only to figure out how to give us the minimum and skim the rest out for themselves.
I simply do not want the government making the decision on whether I lived or died. Consider a time when, sick and frightened, I have to wait for some bureaucratic approval to be treated; or worse to be be deemed worthless for treatment.
Phillip,
Before you sound of with rhetoric, you need to demonstrate that the cancer you had did in fact have a treatment that was better than nothing, and not just more throwing money out the window because someone was sick and we ‘have to do something’. Sorry, no maudlin tears here. You are going to have to be specific about your diagnosis and then fight it out.
Nerissa: Is this so called siphoning off of funds by officials involved in health care going to be anywhere near the hundreds of thousands of dollars in bonuses to CEOS of health insurance companies who have denied payment to people with cancer through ‘resciscion’ because they happened to be sick, or the huge bonuses to CEOs of so called not for profit hospitals? That makes up the 32% of bloated overhead (compared to the 3% of most plans)? Commenters on this site need to back up their airy comments with hard data, sorry.
Doug, I wouldn’t underestimate the greed of our elected and appointed officials. From http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=34477 (2005 data): “A one-year supply of the osteoporosis treatment Fosamax is $493.32 under the VA plan, compared with the lowest available Medicare prescription drug plan price of $709.68;
Acid reflux medication Protonix is $253.32 under the VA plan, compared with the lowest available Medicare prescription drug plan price of $1,080;
Cholesterol-reducing medication Lipitor is $497.16 under the VA plan, compared with the lowest available Medicare prescription drug plan price of $717.84 (Nohlgren [1], St. Petersburg Times, 12/22).”
For the three representative drugs listed the single payer VA pays 1826.76 vs. 2507.52 for Medicare. In order for our leaders to secure kickbacks from the drug companies the drug costs are 37% higher. The Medicare model is the model being pushed by our leaders at the moment.
Doug, thank you for writing this in words that even a dumb American could understand. Having been the victim of rescission, I fully understand that something needs to be done. And soon.
@ Nerissa: You are only quoting Medicare drugs as a basis to back your corruption charge. When the Medicare Part D bill was written, the Republicans made SURE that the government was unable to negotiate drug prices with the PHarmas. My mother, who was suffering with cancer, was one of the unfortunate ones who fell through the “donut hole” that was left in the bill. Medicare Part D needs to be looked at and FIXED!
Hey can we get prenatal vitamins covered by national health care? My midwife gave me a list of vitamins to take to improve immune function and prevent GBS so I would not need antibiotics during labor. We tried to get reimburursed from our own HSA but the feds would not allow us to use our own pre-tax dollars we saved to get reimbursed for this (like a tax cut on vitamins) because they were not considered medically necessary. The prenatal vitamins would have been allowed with a prescription from an OBGYN but not from a CNM. Talk about discrimination against pregnant women. Also considered not medically necessary, for “wellness.” I would like to see the feds tell me not to take prenatal vitamins. I guess because my baby was not considered medically or legally a person, prevention of spina bifida was not a medical necessity. Hey wait, this reminds me of that other case where they took away the baby for medical neglect for refusing psych drugs. Whoa!
HSA rules allow you to get reimbursed for massage, condoms, contact cleaning solution and nicotine patches but not prenatal vitamins without a prescription.
BTW there is a website called MAMA Campaign to get midwifery into health care reform. http://www.mamacampaign.org/
NPR has been talking about Max Baucus, head of the Senate Finance Committee. Turns out that only 5% of this guy’s money comes from his home state, and one of his biggest contributors is……Big Pharma: http://www.npr.org/templates/story/story.php?storyId=106655060
And they did a story yesterday on the $40 million that Big Pharma is pumping into the political machinery to influence the health care debate :http://www.npr.org/templates/story/story.php?storyId=106899074
Oh, one other word on NICE… I mentioned that it passes drugs for use on the NHS. However, in truth the only way that it can block a drug’s use is on grounds of cost, as far as I can ascertain.
That is, NICE is fully aware that in the case of the example I gave, SSRIs, the drugs have limited efficacy, but because they have been passed by the industry regulator (the Medicines and Healthcare products Regulatory Agency, or MHRA), as safe and efficacious, NICE would be laying itself open to all kinds of lawsuits if it blocked public access to a drug on the ground that it believed that a drug was either not efficacious or not safe.
The MHRA, of course, is permitted access to all clinical trials data. NICE isn’t. The MHRA hasn’t summoned the will be tell me what its assessment process amounts to – although I understand that it takes the manufacturers’ view of their own drugs on trust. But that’s another matter.
If the US adopted the NICE model, I suspect that its powers would be severely limited, or if it were given extensive powers initially, then they would be curtailed promptly. I haven’t quite got to grips with why it is that the drugs industry is permitted to dictate policy in the way it does, although that hardly seems to matter, now.
Matt
Doug:
I agree with you that corporate interests run healthcare. But if you think that the govt can run healthcare better, then you are truly drinking the koolaid.
Profit drives innovation. Innovation lowers costs. Governments do not innovate, instead they stifle new thought.
Get the govt, corporations, pharma and everyone else at the OBama table out of there. If you want a less expensive system, we need only two factions at the table. Independent doctors and patient’s. As these two are the only two who are in ivolved in any healthcare interaction.
“Do you want to pay $6,000 per year more for healthcare, just so your doctor can drive a Mercedes, when it does nothing to improve the health of you or your family?”
Your argument would be much more effective if this were revised. I suspect most Americans believe that their doctor should be reasonably compensated for their work.
However, it’s not our docs who pocket this $6K!! It’s the insurance industry executives who drive the Mercedes around town at the expense of the doctors and patients. The third party adjudicator of claims is the one rationing care. The executive’s bonus is bigger when he finds ways to avoid paying healthcare claims and instead turns a profit for the shareholders. That’s where our money is going in the US – into the pockets of the insurers who do NOT have your best interests at heart.
Doctor SH:
The government already runs a significant portion of health care in America or have you forgotten Medicare already? My mom did just fine with it, as did her doctors. Remember all those great doctors on MASH? The guys who spent all those years patching up the wounded? All government run health care (armed forces). The pharmaceutical industry does not have the largest lobby in the US because government is not intimately involved in all aspects of medicine.
It would be interesting to see that list of supplements, especially when a cost-effective ($11 for a 90 day supply), preservative-free OTC prenatal vitamin is available.
PhRMA has profited off the backs of US seniors for many years, effectively subsidizing drug costs for the rest of the developed world. Medicare Part D was dysfunctional as designed, and the members of PhRMA are still laughing all the way to the bank.
Similar to the post-Enron divestiture of consulting companies from accounting firms, UnitedHealthcare should be forced to divest itself of Ingenix, Lewin Group, and similar companies it controls. Any other health insurance company with similar subsidiaries must also be forced to divest. IMS and Millman should be prohibited from buying Rx records from PBMs and selling them to. insurance companies. Retroactive underwriting and recission are other big insurance company moneymakers that need to go. I have a hard time believing that a public option would have the enormous administrative overhead and executive compensation that exist in public insurance companies.
Tax exemptions for any “not for profit” hospital system must be based in reality. Actual cost of charity care provided might be a good starting point. Some hospital systems count employees’ wages/salaries as part of their contributions to the public good. Close, but not “good” enough. My state has had so many class actions against overly-aggressive collections practices by large NFPs (e.g. Resurrection, Advocate, et al) that the AG got a fair billing law enacted.
RVRBS needs to go, too – when a board dominated by specialists sets the piecework rate for procedures performed by members of those specialties, costs will go up. Atul Gawande’s article about the McAllan TX debacle exemplifies this situation.