2centsworth.info

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.

Well the citizens of Massachusetts (and, indeed, the State Legislature) are waking up to just what a mess this so-called universal healthcare initiative actually is.

The front page of the Boston Globe (January 27, 2007) has an article talking about the bloated salaries being paid to the administers of this quasi-state agency (the official name is the Commonwealth Health Insurance Connector). The Globe article points out that average salary of the 22 employees is $111,000 and that six of them have higher salaries than the Governor. One of them gets $175k and only works a four day week.

The best spin one can put on this is that these folks are really good at their job and totally dedicated to getting the best deal possible for the State’s citizens. But, as pointed out in an earlier posting, the average cost of this program’s insurance is going to be $380 per month for an individual… This is actually higher than what most citizens could obtain on their own. So why are we paying these bloated salaries?

The answer, as usual in Massachusetts, is that these quasi-state agencies (like the Mass Turnpike Authority and Massachusetts Port Authority) provide lots of well-paid patronage jobs and are virtually unaccountable. And the Commonwealth Health Insurance Connector is turning out to be the same thing.

Just as Medicare Plan D was set up to serve the interests of the big insurers and pharmaceutical companies, the Commonwealth Health Insurance Connect was set up to serve the interests of local commercial health insurance providers. Note that under this plan citizens are going to be required to buy their insurance… And if you cannot afford to buy their coverage, the taxpayers will subsidize the cost of your inadequate coverage. It all means more money for the insurance companies (and six-figure salaries for the Connector administrators).

Not only is the mandated insurance unaffordable, but the actual coverage being offered is unknown. One would think that there should be complete transparency, that one could go to a website and get the details of the coverage being offered. Think again. Even, the 10 member board of directors are apparently in the dark. They don’t seem to have any knowledge of the coverage details, they had no say in who was hired and at what salaries, and, according to the Globe article, they are forbidden to make any public statements about the agency. And Massachusetts State Legislators are also in the dark about this program. Several have been quoted as saying that their requests for information from the agency have stonewalled.

And, remember, Massachusetts citizens are going to required to purchase this insurance. Furthermore, people are being thrown off the Federal Medicaid healthcare program and being required to get this Commonwealth Connector pig-in-a-poke.

The Massachusetts Turnpike Authority was created about 40 years ago to run the tollbooths on the Mass Turnpike and use the revenue to pay off the state bonds that funded the turnpike construction… But those bonds were paid off about 20 years ago and the Turnpike Authority should have been dissolved. But the State Legislature kept it in existence and used it to float more bonds (and then said they had to keep it running to pay off those bonds)… And, of course, it was a good place for politically well-connected folks to get a job. Famously, they had “couriers” who drove packages between various Authority offices that got paid $70k per year.

And, even more famously, it was the Turnpike Authority that was responsible for the colossal mis-management of Boston’s Big Dig; leading to billions of dollars in cost overruns and, ultimately, the death of motorist when a tunnel roof collapsed.

And the Massachusetts Port Authority has a similar track record of patronage, bloated costs, incompetence, and tragedy. Two of airliners that were hijacked on 9/11 flew out of Boston’s Logan Airport. MassPort’s chief of security at the time? It turns out that he was the driver of the previous Republican Governor, Bill Weld. How does one go from being a driver to head of security for an international airport earning a six-figure salary? Well, that’s what these quasi-state agencies have been all about.

So add the Commonwealth Health Insurance Connector to the list… We can only expect more waste, corruption, comedy, and tragedy. It was set up to provide guaranteed revenue for insurers and patronage jobs that can be doled out by the politicians on Beacon Hill.

It is noticeable that even industry lobbyists like John McDonough and key members of the legislature that were responsible for creating this agency are now trying to distance themselves from it.

I absolutely agree that we need a means of providing high quality, affordable healthcare to our citizens at all income levels but this is certainly not the answer.

I saw a very interesting program on PBS FrontLine the other night about the growing epidemic of addiction to meth-amphetamines. You can find out more at the The METH EPIDEMIC page on the pbs.org website.

The program describes how the US Drug Enforcement Agency (DEA) attempted to head off the problem of meth-amphetamine addiction 20 years ago by controlling the production and distribution of ephedrine and pseudoephedrine, the key ingredients used to manufacture meth-amphetamine. Apparently both ingredients require very sophisticated manufacturing technology and they are made by only 9 industrial plants world wide.

But when the DEA attempted to set up controls on the manufacture and distribution of ephedrine and pseudoephedrine they were repeatedly stymied by Congressional interference brought on by lobbyists from the various companies that make over-the-counter cold medicines that use ephedrine and pseudoephedrine. Even as “Meth” addiction grew to epidemic proportions during the 90’s, Congress and the pharmaceutical industry lobbyists fought every attempt to keep these key raw ingredients out of the hands of the drug cartels.

When the DEA managed to stop direct shipments from the manufacturers to the cartels, the cartels began having people buy over-the-counter cold remedies containing ephedrine and pseudoephedrine from local pharmacies. When various States tried to have pharmacies take action to control who was buying these cold medicines, the pharmaceutical industry lobbied against it. In the FrontLine program someone suggested that 75 percent of the cold pill industry sales in some States came from people buying on behalf of the Meth drug cartels.

I generally view class action suits as an excuse for lawyers to get a lot of money but they do serve a useful punitive purpose at times and given that we now have more than 1.5 million citizens addicted to Meth, and since there seems clear evidence that this was avoidable… and that it happened because of lobbying by the cold pill manufacturers… Perhaps one or more law firms might try bringing a class action suit against the manufacturers.

And given the huge costs that Meth addiction has imposed on local and State law enforcement, prison systems, and healthcare… I don’t remember the exact number but something like 80% of the prison inmates in Oregan are Meth addicts. Perhaps the various State Attorney Generals should bring suit against the manufacturers as well and recover, say, 80% of the cost of operating the prison systems.

The US healthcare system is a shambles (e.g. 44 million uninsured, the highest per-capita spending in the world but health statistics among the worst outside the Third World, etc.) but one of the bigger problems is the sky-rocketing costs of prescriptions drugs.

One of the current battles going on in the newly Democratic Congress is an attempt to control the costs of prescription drugs purchased under Medicare Plan D. The previous Republican-controlled Congress (having received $ millions from Big Pharma) had explicitly forbidden Medicare from even negotiating on price with the pharmaceutical companies.

The “so-called” ethical drug industry (the “so-called” modifier has been applied to Big Pharma since the 60’s but only now is the general public really understanding why the term was coined) has long held that any attempt to control their prices would turn off the never ending fountain of miraculous remedies that these white-coated priests of science and medicine produce. Never mind the fact that they are perpetually the most profitable industry in the world.

There was a recent headline article (Showdown Looms in Congress Over Drug Advertising on TV; January 22, 2007 by Milt Freudenheim) in the New York Times that pointed out that the pharmaceutical industry is on track to spend $4.5 billion on TV advertising directed at consumers. This is up from $1.1 billion in the late 1990’s.

I think anyone who watches prime-time TV has noticed that virtually all the ad’s are now for prescription drugs (sleep-aids, cholesterol-lowering remedies, remedies for incontinence, etc.). The focus of the New York Times was on the amount of false and misleading information is being provided in these ad’s but my feeling is this direct-to-consumer advertising represents an easy $4.5 billion in immediate savings to the consumer and taxpayer if it was outlawed. I don’t think prescription drugs should be advertised to consumers at all.

You could also save billions by eliminating all the free lunches, all-expenses-paid junkets, and gifts that the pharmaceutical industry uses to reward our more corrupt medical professionals for prescribing (or mis-prescribing) their products.

And then you could save another few billion dollars by eliminating the high-pressure pharmaceutical salesmen that infest our doctors’ offices, clinics, and hospitals. According to a recent Boston Globe article there are 6 pharmaceutical salesmen for every doctor in Massachusetts. I imagine the ratio is similar for all the other states.

And there might be a few million dollars to be saved by eliminating the stream of money that Big Pharma’s lobbyists use to corruptly influence our legislators.