INGENIOUS! ILLEGAL!
It took me a while to figure this one out, and I'm still not sure I have it 100% correct, so bear with me while I explain it step by step -- as much for my benefit as for yours:
The Drug maker Actelion recently had to pay $360 million to settle a government action alleging that it operated an illegal "kickback" scheme. Check on the New York Times article below:
I spent some time trying to understand this, and have come up with the following:
1) Companies exist to make profits.
2) The simplest way to make a profit is secure a monopoly on the product. That's essentially what drug makers get when they come up with a drug that does what no others can, or does it better. To reward the company's investment of effort and research, our government gives it a temporary patent, and while it lasts the drug maker charges as much for its medicine as it can get away with.
3) But what if there are competing products on the market? The drug maker could collude with its competitors to fix prices -- but that's illegal (though some, as we've shown, are trying it anyway). Or it could offer coupons and other discounts to needy patients, thus blunting the public outrage over the price hikes, while they pass the full cost of the medicine onto the insurer, who then passes it on to us. Thus all is well -- at least in corporate board rooms.
4) But what if that insurer is the Government, and the patient is on Medicare? Government law requires Medicare patients to pay a co-pay, partly to encourage them to choose a less expensive drug, and encourage among drug makers some Competition -- the dreaded"C" word hated by drug makers. Therefore many drug makers have come up with an ingenious plan to donate to "charities" that help with drug payments, which is legal so long as there's no collusion between the drug maker and the "charity", for if any information were shared between them, it could go to swinging business to the drug maker and thus stifle Competition -- that dreaded "C" word again -- one of the main reasons for the co-pay. Actelion however, ignored the law, got and used info from the "charity." Thus, in this scheme, Actelion got its charitable deduction, and got to pass along the full cost of the medicine to the government, which got stuck with the bill. Actelion got to have its cake and eat it, too. Neat, eh?
The government doesn't think so, and has gone after not only Actelion, but many other drug companies, including United Therapeutics (who paid $210 million), and our darling, Pfizer ($24 million). Several others have disclosed they also are under investigation. In the Times, we read that
“Pharmaceutical companies cannot have it both ways — they cannot continue to increase drug prices while engaging in conduct designed to defeat the mechanisms that Congress designed to check such prices and then expect Medicare to pay for the ballooning costs,” Joseph H. Hunt, an assistant attorney general for the Justice Department, said in a news release.
And I say, as I've said previously, that if Single-Payer is to do more than eliminate bureaucratic bloat and the obscene profits of healthcare CEO's, it's going to have to robustly address abuses such as these, together with others that we've detailed on this blog.
Healthcare workers -- including doctors and nurses, and all those assisting, such as those who produce medical devices -- need to be compensated fairly. That should go without saying, but I need to say it here so I won't be misunderstood when I state that the Profit Motive must be completely eliminated from medicine!
Dio
PS: If you'd like to comment (and I encourage you to do so), please click on the number of comments area and in the "comment box" that appears, kindly share your thoughts.
What we demand are standards involving the 'Continuity of Care' from an 'integrated system' that communicate a continuous learning network and a systemic foundation based upon researched science based evidence, directing practice from an authentic state of the art and science of comprehensive application. What we get instead is administrative institutions of business exploitation by people outside of medicine seeking, not gold standards but. gold itself from the suffering of patients in dire need without options.
ReplyDeleteThe universal national healthcare plan is one of the most favorite health insurance because it is considered as a cheap one. But is that really the objective standard? For most of us subjected to "all or none" market medicine we feel the catastrophic casualties of debilitating diseases as a matter of life and death necessity. The "market" has placed this in terms of affordability, while the original 'selling point' of health insurance was to distribute that risk of catastrophic illness. Pooling finance, however, has proven itself to be a target for privatizing revenue streams and lifting the "market" restraints against profiteering. Over time the system has become one of economic separatism and special interests. Insurance now distributes profit advantages (wealth promotion ) that are exclusively neglecting public service well being and the health of society. It is interesting to note that "evidence based medicine" (the current gold standard over outcome based best practices), has proportionately included cost and professional opinion as guidelines to define "evidence" in contrast to and at time in contradiction to purely objective consensus based upon scientific medical research alone. The conflict of interest is clear, but that is not the point. What is clear is that catastrophic cost destruction of entire families (and the lifetime savings they may have earned for security itself) is not included in that cost/rational evidence base. This is critical. You are not part of that market formula. You are the target of support for the class medical structure that has become too big to question. A healthcare cystem that has built a separate economy detached from the public services, and where the wealth of the system has become prioritized over the health of society.
ReplyDeleteFlexible Bodies: Tracking Immunity in American Culture-from the Days of Polio to the Age of AIDS (Hardcover)
by Emily Martin (Author)
Emily Martin
Emily Martin traces Americans' changing ideas about health and immunity since the 1940s. She explores the implications of our emphasis on 'flexibility' in contexts from medicine to the corporate world, warning that we may be approaching a new form of social Darwinism.
ReplyDeleteMedicare for All is a Fight to Democratize the Economy
Kelly Coogan-Gehr of National Nurses United tells Paul Jay that healthcare represents one-fifth of the US economy, and to bring that fully into the public sector would be an important step towards transferring economic power to the public interest
Story Transcript>>> https://therealnews.com/stories/medicare-for-all-is-a-fight-to-democratize-the-economy
comment pending:
BruceEWoych • a few seconds from now Hold on, this is waiting to be approved by The Real News.
The critical pivot in the internal logic of "saving" fifteen percent (and growing to 20%) of our economy by democratizing medical care is that this "return" is the "cost-effective" market incentive for Universal Health becoming the policy law of the land (Indeed: based on social justice and much more as well). The critical point unqualified in this logic is that 85% of the economy has differential access to resources, is not united by any common specific threat (like war or "terrorism"), and is diversified in interests. But the specific critical point missing is that the 15% of that economy is a separate economy of special interests and class wealth that is not only united but will fight tooth and nail to hold on to the shares they own in that unification with political capture, multi-corporate networks including media advertising, Flagship Hedge funds that have been privatizing the Medical Markets now for over two and a half decades, and other vested and nested interests that are power based opposition. In any stake holder (85%) vs shareholder (15%) conflict of interest show down, that unified front is not about to give up its ownership of their market share of the gold mine they control. And they have all the power from their possessions they seek to protect. A corollary to this concern. what happens when you do take it away to that "power elite" so dependent on its revenue stream? They are certainly not all physicians by any stretch of the imagination. The default button for Universal Health, I'm afraid, is not cost savings. The default button is how will you dismantle the wealth class that sees the current system as their survival?