VARIOUS FLAVORS OF HEALTHCARE REFORM

From VOX, recently, I received a very interesting article 

Democrats 8 Plans for Medicare for All

which attempts to spell out the eight plans for universal health care so far cooked up by Congressional Democrats.  Though there’s no chance of any one of them being adopted under the current administration, it was clarifying to read it, because it helped to identify what I wanted to see in healthcare legislation, and what I most definitely did NOT want to see there. I figured that it might do the same for you, so I thought I’d present the gist of it here. The article sums up the eight plans in the diagram I reproduce below:

Please note that all eight plans – as Vox reports them – assume the Government’s regulation of health care prices. So even if the least generous of the plans was adopted, the result – presumably – would be better than what we have now.

Plans Number 1 (the House of Representatives’ HR676),  and number 2 (the Senate’s S1804) both are paid for strictly by tax increases, and would offer broad coverage for everyone, with no co-pays, deductibles, or pre-existing conditions.  As such, they are the only true single-payer bills being considered. In fact there are only two differences between them both, which we will consider later. 

Note that insurance companies are deliberately excluded here – a consequential decision for the drafters, since traditionally, employers offering health insurance can deduct that expense from their taxes, which means, as Vox says, that “companies’ dollars stretch further when they buy workers’ health benefits than when they pay workers’ wages.”

Taking that into account is Plan Number 3, Medicare Extra for All,  proposed by the think tank, Center for American Progress. This would achieve universal coverage for all legal residents through a combination of private and public insurance – at least for the next few decades.  The plan would let employers continue to offer coverage to their workers so long as it met federal guidelines. At the same time employers would be offered a similar, tempting option: to stop offering coverage and instead pay a payroll tax equivalent to what they currently were spending on health coverage.  But how tempting that offer would be depends on how generous the Medicare Extra plan turns out to be, a crucial detail which hasn’t been specified yet. What has been specified is that every new born would automatically be enrolled in the new plan, so that ultimately the resulting healthcare plan would look a lot like the single-payer plans being sponsored in Congress.

Plans 1, 2, and 3 are designed to bring healthcare coverage to everyone.  Not so the rest of them.

Plan 4, The Urban Institute’s Healthy America Plan aims to disrupt the employer market as little as possible. Recognizing that most people with employer plans are reasonably happy with them, they would set up new insurance marketplaces for those whose insurance isn’t very good anyway – mainly the Obamacare and Medicaid populations.  The cost of their insurance would be covered partially by tax increases, and partially by the premiums they'd pay into the system.

Plans 5 through 8 are buy-in programs – paid for in no way by higher taxes, but by the subscribers only. As such they would exclude all those unable to afford it.  For that reason I'm against them.

But I’m against buy-in programs also for another reason, and for that, let me refer to an email I just received which quotes Wendell Potter, whose every word here is worth reading and taking to heart:

“I spent 20 years as a health insurance executive before leaving my job as a vice president at Cigna. I can tell you firsthand that by focusing on a half-baked measure like a Medicare buy-in, Democrats would hand a huge gift to the private insurance industry while doing less than the bare minimum to help struggling businesses, workers, families and patients.... It’s time for Democrats to stop proposing health care reform that relies on insurance companies to play fair. After two decades in the for-profit health insurance industry, I can assure you they never will. They have no interest in doing anything that might in any way jeopardize profits. Their only interest is delivering profits to their shareholders. From that perspective, the status quo is very profitable. For everyone else, not so much.

Champion dramatic reforms, not half-measures!

Business owners are struggling to provide health insurance to their employees, workers' take-home pay is shrinking as their premiums go up, patients are literally begging for their lives on fundraising platforms like GoFundMe, doctors and hospitals are drowning in paperwork dealing with insurance claims departments, and more than 80 million people lack adequate health insurance. That number is increasing every year. Reform is desperately needed.

Democrats have the chance to be the champions of that reform if they don’t waste their energy on half-measures. Instead of thinking about how they can make small tweaks to the health care system, they should start thinking about how to enact dramatic reforms that will assure universal coverage while reducing costs and encouraging economic growth. Voters and taxpayers are asking for Medicare for All. It’s time to listen.”

For all these reasons, I’ve left Vox’s description of the four “buy-in” plans for you to read in the original document (see the link). You can make up your own minds. 

Dio

PS: If you’d like to leave a comment (and I hope you will) simply click on the number of comments area. In the comment box that appears, you can share your thoughts.

This is Scary Enough

Christmas is coming, and for a belated Christmas present, we can look forward to Pfizer's raising drug prices in January, thus ending the price-hike deferment Trump had persuaded Pfizer's CEO to enact in July. But it's not all bad news. With these price raises, said the CEO, there would be increased rebates and discounts offered to insurance companies and pharmacy benefit managers, who, he said, were sure to pass along these savings to consumers. Of course they will!  Don't you feel reassured?

But what can we expect from a corporate giant who thinks its desire trumps all, and who regards its view of things as the truth? For a stunning example of this, we can revisit the infamous Nigerian Clinical Trial. Return with us now to those thrilling days of yesteryear -- to 1996, to be exact, when the African Continent was being ravaged by a Bacterial Meningitis outbreak of unusual severity. At the same time, Pfizer was testing in its laboratory a new wide-spectrum antibiotic, trovafloxacin, which they named Trovan. Pfizer needed to test it in the field, so Pfizer, according to the Washington Post, launched the biggest clinical trial in their history to that date -- an investigation involving 13,000 patients in 87 studies in 27 countries.  As part of this, the drug maker launched an experiment involving 200 children, testing the efficacy of Trovan against another drug -- ceftriaxone, in those days regarded as the gold standard of treatment.  One hundred of the kids got the Trovan, the other 100 received the ceftriaxone. After 45 days, the researchers pronounced the test a "success."

But there was more to it than met the eye -- a lot more. According to Wikipedia it turned out that the children receiving the ceftriaxone got one third the recommended dose. This was done, said those administering the drug, to "minimize injection-site pain," though critics said it was done "to skew the test in favor of its [Pfizer's] own drug." The "success" touted by Pfizer: 5 children receiving Trovan died, while 6 receiving the ceftriaxone also perished.

In the brouhaha that followed, Pfizer was accused of conducting an "illegal trial of an unregistered drug," and it was alleged that the families were not told they were part of a trial. The children, in effect, were guinea pigs. The lead investigator, one Dr. Abdulhamid Isa Dutse, produced a letter approving the human trial -- a letter which was subsequently proven to be fake. International lawsuits ensued. Though Pfizer piously protested that they came to Nigeria only to help out in an epidemic, in less than three months they were out of there.  

To anyone who has seen the excellent movie, The Constant Gardener (2005), this will seem eerily familiar. When I saw it back in the day, I remember thinking, this is terrifying, and I wouldn't put any of it past big corporations. It turned out I was more right than I knew.

It later came out, via Wikileaks, that Pfizer hired investigators to dig up dirt on Nigeria's Attorney General to get him to drop the lawsuit.   In the upshot, Pfizer settled out of court, to the tune of $75million (very little of which ever made it to the families of the victims).  Pfizer said that it settled "in good faith," and that "any notion that the company hired investigators in connection to the former Attorney General is simply preposterous." But the Wikileaks revelation not only disproved that, it quashed Pfizer's false claim that Doctors Without Borders (likewise on the scene doing their excellent work) had also dispensed Trovan during the Nigerian epidemic.

Now with the Nigerian business behind it -- they unrealistically hoped -- Pfizer focused on marketing the drug in the US, for the FDA, amazingly, had approved its use in various bacterial infections.  But an employee whistle blower, Dr. Juan Walterspiel, alleged unethical practices in the Nigeria trial.  He was fired. Pfizer reported sales of $160Million in its first year, and things were looking good (for Pfizer, if not for the rest of us), when our government got around to noticing Trovan's high toxicity to the liver, ultimately forcing Pfizer to drop the drug.

The movie, The Constant Gardener was based on a novel by John LeCarré, in turn very loosely based on the events set forth here. It won all kinds of awards. In the credits after the film, there appeared, over LeCarré's name, the following: Nobody in this story, and no outfit or corporation, thank God, is based upon an actual person or outfit in the real world, but I can tell you this, as my journey through the pharmaceutical jungle progressed, I came to realize that, by comparison with the reality, my story was as tame as a holiday postcard.  

I have a question for you: Having heard all this, does any of you think that Pfizer would give up one dollar in profits for the sake of the public good? I didn't think so. I don't either.  And horrifying as all this is, you might as well know that the Nigeria incident is not the worst such scandal to have tarnished the name of Pfizer. Don't worry: I'm not going to reveal it today.

This is scary enough.

Dio

To comment (and I encourage you to do so), just click on the number of comments area, and there will appear a "comment block"  in which you can share your thoughts. Don't be afraid of teaching me something! Your comments are teaching me all the time!