2centsworth.info

The stars do seem aligned for much needed change in the US healthcare system. But the organizations with a vested interest in the status quo, their lavishly funded lobbyists, and their tame Congressmen are going to do their damndest to make sure it does not happen.

The Boston Globe has an interesting article today: Held hostage by the health system. The article starts out by mentioning that the Senate Finance Committee (chaired by Max Baucus and Chuck Grassley) held a hearing earlier this month on healthcare reform and did not allow any advocates of a single-payer healthcare system to testify. And it is not as if there weren’t single-payer advocates ready and willing to speak. The Physicians for a National Health Program (which represents 16,000 doctors) asked the Committee to invite Dr. Marcia Angell (a senior lecturer at Harvard Medical School and a former Editor of the New England Journal of Medicine) to speak but the Committee decided to invite industry lobbyists instead.

As Dr. Angel points out, nearly every other developed country (e.g. Britain, France, Germany, Switzerland, Japan, etc.) has some form of single-payer system. All pay less per capita than the US and all have better health statistics than the US. Surely, any debate on meaningful change in our healthcare system should include debate and discussion on single-payer systems. And equally surely, the only reason it isn’t being included is that it represents a financial threat to for-profit insurers, the pharmaceutical companies, and for-profit hospitals and they and their lobbyists will do whatever they can to steer debate and discussion away from single-payer options.

In addition to Dr. Angell’s Globe article (see link above), I would recommend checking out the PBS FrontLine program Sick Around the World which examines the single-payer health plans in Britain, Germany, Switzerland, Taiwan, and Japan.

I run a small business and I currently get my healthcare through the local Chamber of Commerce. Inflation in the US has been running in the single digits for the last few years but each year the health insurance premiums go up by anything from 15% to 25%. There seems to be no real competition between the insurance companies on cost or benefits, no transparency (there are pages of fine print… “Oh, you thought you were covered”), and no real incentive on the part of the insurance companies to control cost.

The irony is that our current “free market”  healthcare system is hurting the ability of US companies to compete globally. Healthcare costs are the fastest growing costs for US firms and are growing much faster than the comparable healthcare costs for their European and Asian competitors.

Just how does the Food and Drug Administration decide what drugs or devices to approve for use by the public?

These decisions are made by FDA Advisory Committees made up of experts in the field.

Today’s New York Times (22 March, 2007) has an article F.D.A. Rule Limits Role of Advisors Tied to Industry which says that advisory committee members will (for the first time) be barred from voting on approval for a company’s product if they have received money from that company or a competitor. And if they have received more than $50,000 from that company or a competitor within the last 12 months then they cannot serve on a committee judging that company’s products (less than $50k is just hunky dory ).

FDA Acting Deputy Commissioner Randall W. Lutter stated that a “signficant number” of the agency’s current advisers would be affected by this policy.

What that means, of course, is that up until now, many of the people responsible for approving drugs and medical devices have been routinely accepting tens of thousands of dollars a year from the company’s whose products they were approving. Smells a just a bit, don’t you think?

The article describes a situation in 2005 where 10 of the advisers who voted for Bextra to remain on the market and Vioxx to return to the market had accepted tens of thousands of dollars from the manufacturers. If the tainted advisors had not been allowed to vote, the products would not have been allowed back on the market since the majority of advisers who had not accepted money had voted against approval.

Other little tidbits from the article; under FDA rules an adviser cannot vote if they hold more than $100,000 in stock in the manufacturer (but holding $99,000 or less is hunky dory ).

One needs to remember that the previous FDA Commissioner, Lester Crawford, recently pleaded guilty to charges of filing false financial disclosure forms and conflicts of interest. The government had charged that Crawford and his wife owned stock in several companies that fell under FDA regulation, and failed to fully disclose that information as required by federal law. The court papers also charge that Crawford assured federal ethics officers that he and his wife had sold stock in those companies, when they had not.

Crawford’s attorney, Barbara Van Gelder, said that under a plea agreement, her client would not dispute the government’s charges, and would likely face fines and a possible prison term of up to two years.

Click here to read the Department of Justice news release on the case’s outcome.

Today’s NY Times has an article (A Health Care Plan So Simple, Even Stephen Colbert Couldn’t Simplify It by Robert H. Frank an economics professor at Cornell – New York Times, February 15, 2007; page C3) which is worth reading.

In his State of the Union address, President Bush proposed tax cuts to make health insurance more affordable to the uninsured. Apparently Stephen Colbert (of Comedy Central) had this comment on the President’s plan:

“It’s so simple. Most people who can’t afford health insurance also are too poor to owe taxes. But if you give them a deduction from the taxes they don’t owe, they can use the money they’re not getting back from what they haven’t given to buy the health care they can’t afford.”

Which does cast GW’s plan in its proper light… as a cruel joke similar to the rest of his policies.

But Professor Frank goes on to give a very well reasoned case for why a single-payer healthplan makes sense for people at all income levels and why it should save everyone money. He also outlines the underlying motivations for the forces opposing a single-payer system.

Rather than cut and paste a bunch of quotes from the article, I will post a link to the NYTimes copy of the article here.

The US healthcare system is a disaster. If you total up all the healthcare costs (government tax dollars, private insurance premiums, etc.), US healthcare costs about twice as much per person as the healthcare in any European country, Canada, or Japan. And yet we have 40 million or so uninsured and on virtually every measure of health, the US ranks close to last of all the developed countries.

So the whole system needs to be changed. But we have all sorts of powerful, enormously wealthy institutions (insurance companies, drug companies, medical diagnostic labs, medical equipment suppliers, etc.) who are making vast amounts of money under the current system. They will resist any changes that they think will threaten the gravy train. And they and their lobbyists have had Congress in their pockets for decades.

There is a growing consensus among the public that the current system is not serving anyone well, not even those of us who have healthcare coverage. So the question is what sort of system to we move to.

To me it seems obvious that we should be moving to a single-payer system that is managed by the government and that guarantees that every citizen gets the same access to care. That’s what almost every other developed country in the world has and, while their systems certainly have problems, the statistics show that their plans are both less expensive and produce better results than what we have.

The opponents of single-payer systems are quick to point out, for example, that Canadians must wait months for routine medical appointments but when US seniors are struggling to find affordable prescription drugs where do the turn… They buy the drugs from Canada. And who is trying to stop them? The US Food and Drug Administration under the influence of the pharmaceutical industry lobbyists. And why are these drugs (most manufactured in the US) cheaper in Canada? Because the Canadian healthplan used their leverage as the sole provider of prescription coverage in Canada to negotiate better prices.

When the Republican Congress created Medicare Plan D they specifically forbade Medicare from negotiating drug prices. So now the Medicare Plan D prices are significantly higher than, for example, the prices charged the Veterans Administration. Why? Because the Veterans Administration is allowed to negotiate drug prices.

So why do I say that there is going to be a battle between “Universal Coverage” and “single-payer”? Because Universal Coverage is a nice sounding name for a Rube-Goldberg mess by which private insurers will be subsidized using tax dollars to provide 2nd-class-citizen coverage for the less affluent members of US society.

We currently have two single-payer plans in this country (Medicare and the Veterans Administration) that appear to work rather well. My understanding is that they are actually more efficient in their administrative costs than private insurers. We should be studying them and the single-payer health plans in place in other countries to try and come up with a single-payer plan that is better than all of them.

The Boston Globe has an article (February 3, 2007 by Rick Klein) entitled Romney distances self from Mass. health plan. Just as GW slunk off to Washington leaving various disasters in Texas, Mitt is doing the same.

As pointed out in the Globe article:

The plan for statewide, near-universal health coverage was the centerpiece of Romney’s administration, and it has become a key part of his presidential resume.

As Democratic legislator Richard Moore pointed out in the article:

“That’s why he left [office] in a hurry,” said Moore, the chairman of the Senate Health Care Financing Committee. “He’s setting himself up so he can go either way. If it’s a success, he’ll take all the credit in the world. If it’s a failure, he’ll blame everybody else.”

Moore said Romney can’t hide the fact that he worked closely with Democrats to craft the law, and his administration was responsible for implementing its early stages. “If it doesn’t work, it’s going to be a shared responsibility,” he said.

One of the ironies of this state-mandated plan is that it will either lead to businesses dropping coverage of their employees… Or the coverage standards (deductibles, services included, etc.) are going to be reduced until you truly have a 2nd-Class-Citizen coverage plan.

According to previous Globe articles, under the current plan, about 200,000 people who are currently insured by their employers are going to be told that their coverage is insufficient and that they are going to be penalized. But are their employers going to pay to have their coverage improved??? All the employers have to do to bail out completely on insuring their employees is pay the state $200 per year per employee… Much less than they are currently paying for their employees current coverage.

To avoid that, the State will almost certainly reduce the coverage requirements (which is what the insurance industry desperately wants) and, yes, you will have true 2nd-Class-Citizen coverage… That isn’t worth the money and that you are required to buy by the State.