NOBODY IS COMING TO SAVE US.

A scary article appeared in the New York Times, yesterday. 

How a Chicago Woman Fell Victim to Candida Auris, a Drug-Resistant Fungus

The fungus that killed her, Candida Auris, has a frightening ability to mutate and develop resistance to any drug deployed against it. The Times wrote:  According to the Centers for Disease Control and Prevention, nearly half of people who contract the illness die within 90 days. 

This is scary enough.  Even scarier is the likelihood,  if we judge by Ezekiel J. Emanuel's  recent article in The Atlantic Monthly -- that Big Pharma doesn't intend to anything about it.

Big Pharma’s Go-To Defense of Soaring Drug Prices Doesn’t Add Up 

Why? According to Emanuel, Pharmaceutical manufacturers would rather concentrate on anti-cancer medications, which make much more money for them -- even though they may extend life only for a few weeks:

Consider antibiotics. The Centers for Disease Control and Prevention ranks antibiotic-resistant infections as one of the nation’s top health threats. An estimated 2 million Americans become infected with such bacteria each year, and 23,000 die. A superbug that is resistant to all known antibiotics is an imminent threat. Yet because antibiotics are generally cheap, for most pharmaceutical and biotechnology companies they are not a primary focus. The Pew Charitable Trusts reports that only about 41 new antibiotics with the potential to treat serious bacterial infections were in clinical development for the U.S. market in March 2017.

If disease resistant microbes do not present as rosy a profit picture as cancer drugs, what chance have we to expect development of a drug to combat a disease resistant fungus whose main victims seem to be the aged, and those with compromised immune systems?

Once again, the possibilities for big profits trump -- forgive the expression -- the public good. Big Pharma is sitting in the catbird seat -- granted monopolistic rights by our government, which has ruled that Medicare may NOT negotiate prices with drug makers. They can charge whatever they want -- and they do.  An indecent number of our legislators have been bought and paid for by the medical-industrial establishment. Do you suppose that these bought-and-paid-for lawmakers want to harm the geese that lay for them so many golden eggs? Don't hold your breath waiting.

Speaking of eggs, the time is coming for Easter and Passover, when we recall the miraculous events heralding salvation -- the Hebrew people being rescued from a cruel despot who thinks he's God, and -- millennia later -- Jesus' rising from the tomb. I know more about the former tradition, being raised in it. What interests me is that God remembered His promise to the Israelites only when they, as one person, cried out to Him because of their pain. Before that, apparently, they thought that their enslavement was the natural order of things, just as many of us today are content to put up with the chancy corporate insurance that makes us afraid to leave our current employment -- making us, in effect, wage slaves.

What can free our healthcare from the cruel tyranny of profits?  I wouldn't count on any supernatural occurrences. But if we all, every man, woman, and child, could rise up and cry out as one person: ENOUGH OF THIS SHIT -- WE WON'T TAKE IT ANY MORE! -- that would be miracle enough, and it just might do it.

I wish a sweet Passover to those for whom, like me, it is meaningful, and to my Christian friends, a happy Easter. May all our deeds bring blessing.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

WHY IS AMERICAN HEALTHCARE SO EXPENSIVE?

Part Two

In this blog’s early posts, we saw how Big Pharma exploits its near monopolistic powers by raising prices simply because it can, resulting in the shortened lives of many patients who have been priced out of living.

In the current two-part series, the first part showed the results of Physicians and other providers gaming the system by ordering unnecessary procedures – which benefits mainly them, unlike Patient Centered systems like the Mayo Clinic, where their salaried doctors have no incentive to drive up charges, and everything is focused on institution-wide teamwork in healing the patient.  The former is profit-driven, the latter patient-driven, resulting in better outcomes at lower costs.

So far, if we’ve been paying attention, we’d be justified in concluding that where patient care is concerned, considerations of profit are poison.

But what about Hospitals and Clinics, Dialysis Centers and the like? Are considerations of profit poison for them as well? The answer is a resounding YES, according to Steffie Woolhandler and David Himmelstein, the pre-eminent Physicians/Scholars, co-founders of the Physicians for a National Health Program,  the lead authors of the PNHP’s healthcare reform article published in the Journal of the American Medical Association, which in turn is the basis of H.R. 676 , the Single-Payer Bill from the House of Representatives. Woolhandler and Himmelstein are, in my opinion, the God-Parents of our movement. and are worth listening to.

They spell out their position in the article: IMPORTANCE OF ALIGNING HOUSE AND SENATE SINGLE-PAYER BILLS THE RIGHT WAY: Removing Medicare’s Profiteering Incentive is Key. I encourage you to read it:

Aligning House & Senate Versions of Single-Payer The Right Way.

Woolhandler and Himmelstein say that the Senate Bill, unlike the House Bill “...would, like Medicare, pay hospitals and other institutional providers on a per-patient basis, intermixing payments for current operating expenses with funding for future capital investments and profits. At present, hospitals’ success, and even survival, depends on generating profits (“surpluses” in non-profit facilities). Hospitals with a favorable bottom line can invest and add new buildings and programs, while unprofitable ones can’t modernize or expand, risking a downward spiral toward takeover or closure....It’s this profit imperative that drives hospitals’ financial gaming, e.g. upcoding, and concentration on the most lucrative services, such as elective cardiac and orthopedic services, rather than money losers like mental health. This payment mechanism (and S.1804 as a whole) also leaves the door open to investor-owned providers.”

The authors go on to explain why payment for performance schemes – in addition to requiring expensive bureaucratic overhead – provide “no evidence that they’ve improved patients’ outcomes in any setting.” Moreover – it should go without saying – the minute you have an investor-owned enterprise, you must compromise quality to ensure profits. Privately owned dialysis centers, for example, have far worse outcomes than community owned ones.

Contrast all this with the model provided by Scotland and several other European countries who pay these institutions the way we pay firehouses – globally – to take care of operating expenses. Our firehouses aren’t expected to make a “profit” to save for a new firetruck.  If they need one, they appeal to the local municipality to buy them one.

The House’s H.R. 676, similarly, would pay medical institutions globally, covering all operating costs, and would allow no “profits.” If new equipment or expansions are warranted, they would get them from the government, which – if it wanted to stay in office – would provide them promptly. And privately owned facilities would be made publicly owned by the government’s buying them out. This would be less expensive than  it might at first appear, partly because health facilities typically carry a debt load, and partly because it would not be done all at once, but over a period of time.

Everyone agrees that once established, Single-Payer would save money if for no other reason than obscene profits and bloated bureaucratic overhead would be eliminated (contrast Medicare’s 2% overhead with conventional insurance’s 12%).  While that is not small potatoes, it might well not be enough to meaningfully lighten the burden of healthcare on our economy.  As our authors point out:
“In sum, the financial viability of a single-payer reform turns on cutting administrative costs and minimizing incentives for financial gaming. Maintaining Medicare’s current payment strategies, as under S.1804, would be substantially costlier than adopting the non-profit global-budgeting strategy used in several other nations.”

Atul Gawande, physician/author of the article on which the previous post is based, is more blunt:

“When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.”

To me this means that setting up Single-Payer – by itself – will not be enough, unless it removes the profit motive, regulates  greed, minimizes the incentives to game the system, and unless it requires healthcare providers to meet carefully fashioned public standards . If this happens, the cost savings and improvements in care will be very great.

There will be plenty of arguments, pro and con, for everything that’s been said in all my posts. Our job is to stay on top of them, making sure that when reform is done, it’s done right.

Dio

PS: To leave a comment (and I encourage you to do  so) just click on the number of comments area, and share your thoughts in the “comment box” that appears.

WHY IS HEALTHCARE SO EXPENSIVE IN THE USA?

Part One

A few days ago I came across a video entitled, The Real Reason American Healthcare is So Expensive. Almost 3 million people have watched it, You really should, too.

The Real Reason American Healthcare is So Expensive

In typing this just now, I couldn't help watching it again -- which made it my fourth time viewing it (it's that good).  What it shows is that the high cost of healthcare in this country is NOT because of what we spend on Medicare, Medicaid, and VA healthcare -- our versions of socialized medicine in this country. In those public expenditures, our costs are right in line with other countries. Where we exceed them is what we spend privately. That's where we go through the roof.

I love the enthusiasm of the young man in the video, who says he's "obsessed" with this data. He points out that we hear all the time that the government "can't say no, it's corrupt, it's inefficient, it's slow; if you want something done right you give it to the private sector. That is what we hear in America all the time," he says, "yet here we are, with the biggest private sector, spending the most."  And it's not because we Americans go to the doctor more, he says, showing that if anything, we go less. He goes on to state the obvious, that the capitalist free-market model, while it may be great for selling things, simply cannot work when providing healthcare to people, who, when they need it, are in no position to comparison shop for the best value, even if they knew the best thing to shop for. And when presented with a sky-high cost , they are in no position to say "no." We are left with a graphic of our healthcare system -- symbolized by a huge hospital building with many lines of "influence" running from it to the Capitol Building in Washington, DC,  Although there are no arrows to show in which direction the lines of "influence" are flowing, and the young man doesn't say so explicitly, I gather that they are flowing not from the Capitol, but to the Capitol, and that influence is in the form of dollars. Our healthcare system has grown so powerfully wealthy, he says, that it's going to be very hard to trim the cost of doctors and the services and medicines they prescribe. 

It's almost as if there has descended on us, like a poisonous fog, a culture of money, a phrase I borrowed from Atul Gawande's famous New Yorker article, The Cost Conundrum. You should read it: 

The Cost Conundrum

Here Gawande describes the medical goings-on in the small, not-very-prosperous McAllen Texas, which had -- at the time of Gawande's writing (2009) -- the most expensive healthcare market in the country. Many healthcare markets -- such as El Paso -- were far more prosperous yet spent on medical costs only half the money spent in McAllen. With all this money spent in McAllen, one might suppose that the healthcare delivered there was superior. Not so -- in fact, Gawande reports the reverse: 

"Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care."

Why then? Gawande quotes a general surgeon: "'We all know....there is overutilization here, pure and simple.' Doctors, he said. were racking up charges with extra tests, services and procedures."  It got to the point, he said, where “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?”

Gawande contrasts all this with the practice at Mayo clinic, where doctors are not paid by procedure, but are salaried. The time they spend with patients is not a predetermined slot of 15 minutes,but is determined by the patient's need. And they regularly consult with other doctors in the practice, so that the outcome is a joint effort. Gawande writes that "No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs." 

It's no accident that in my recent posting [Good News ... Sort Of], Mayo is one of the hospitals cited for combining with others to establish CIVICA RX, a company which will produce generic medicines that the current cartel has attempted to price out of reach of many people. Intermountain Healthcare, also cited by Gawande for good practice, is another co-founder of Civica. Are they exceptions? As far back as 2009, Gawande pessimistically predicted that the Mayo Model seemed to be losing traction, whereas the McAllen model seemed to be winning.

Despite the remarkable surge in demand for Single-Payer, it may be too soon to tell which model will win. As we saw in the video above, Bernie Sanders proposes a transition plan to ease us into a full scale Single-Payer, but from my point of view, the crucial question will be whether or not Bernie or anyone else can succeed in putting price controls on Big Pharma. That is the epic struggle to come. Meanwhile, NYHA has such controls written into it, and it behooves us to push for it, publicize it, and do everything we can to hasten the day when Single-Payer will be the law -- if not of our country, then of our State.

PS: If you'd like to leave a comment -- and I hope you will -- just click on the number of comments area and share your thoughts in the "comment box" that appears.

PPS: My surgery went well, and I'm doing fine. But an amusing thing happened. I heard one nurse comment to another that the downside for working for an eye surgeon is that while before surgery, some patients mention how nice looking they are,  they hear no such remarks after surgery, when the patients can see. And on a more serious note, both doctors present said Single-Payer was "inevitable."  More on that later, perhaps.

NOW COMES THE HARD -- AND MOST EXCITING PART!

Today -- Dec. 11. at 9:27 AM -- The Gothamist published an article titled  Powerful NY Unions Could Complicate Push For Single Payer Health Care. The link for it is below:

Possible Complications for Single Payer Healthcare

According to the article, there are two complications, actually: (1) Some unions, who have their own vested interests and concerns, and (2) A newly mobilized healthcare industry, which is now in overdrive spreading distortions and outright lies, which say that so-called "realities" of  Single-Payer are to be dreaded as causes of catastrophe.

For me, these developments are very exciting, because the growing intensity of Single-Payer's opposition indicates the increasing possibility of its enactment!

These two complications -- the diffidence of some unions, and the propaganda of the healthcare industry -- are too much to cover in one blog post. So I propose, in this post, first to deal with the unions:

The good news is that, as The Gothamist says,  The most powerful healthcare union in the state, 1199 Service Employees International Union (SEIU) is a backer, as is the New York State Nurse Association (NYSNA), BUT two other pivotal statewide unions, New York State United Teachers (NYSUT) and the Civil Service Employees Association (CSEA) have yet to endorse it.

Why this diffidence? In an article in Politico/New York, 

City unions say they dread impact of Single Payer in Albany

we read that the city unions fear that the coverage for their workers would be reduced, a concern that NYHA sponsors, Assemblyman Richard Gottfried and State Sen. Gustavo Rivera, say the bill is being revised to address. This concern is sensible and to be expected. But there's a second concern, which, from my point of view is much more fascinating: Up to now the union's membership has relied on their unions to negotiate healthcare benefits that are better than some others enjoy. But if all these benefits will be furnished by the NYHA, the importance of the unions would be diminished,  their collective bargaining leverage around health plans nullified, wiping out the city's roughly $1500-per-employee contribution to individual union funds.

As I see it, these unions' point of view seems to be that the more employees receive benefits outside the unions,  the less they need the unions. To union leaders this prospect may well seem  frightening.  These leaders may be struggling with the question: Which is more important -- prosperity of the workers, or prosperity of the unions?  For me the answer is embodied in what Gottfried says,
“As Gustavo and I keep telling them, this is what our parents raised us to do. We were not raised to screw city workers. Or any workers,” Gottfried said.

Another union leadership objection to NYHA, according to the Gothamist, is how will the Act treat Union members who work out of state? NYHA, as currently drafted, covers only people who make their dwelling in New York State. What happens to, say,  a member of a New York Electrical Union who does half his work in New York State, and the other half in New Jersey? The unions make a big deal of this. but one of the readers of the article had a simple answer: If you live or work in New York State, you pay taxes to it, because you receive benefits from it.  For this worker. as for many, the issues were simple, and what I found interesting was that virtually all the scores of comments were in favor of single-payer; the difficulties seem to be only in minds of the union leadership.

My take on all this? Let me just say that a few months ago, I had an email conversation with a congressional  candidate who was subsequently elected to the House. He said that he wasn't necessarily opposed to Single-Payer if, and only if, all the "stake-holders" could negotiate the required compromises. Since this was email, he couldn't see my snorting reaction: If by "stake-holders" he meant Big Insurance and Big Pharma, I could only retort that they had NO PLACE at the table! None whatever! Among my circle of friends, (all progressive Democrats), this Representative is what we call a "Corporate Democrat,"  and there is no doubt in my mind that the stake-holders he had in mind did indeed include Big Pharma and Big Insurance. But now, after reading this Gothamist article, I see that my Corporate Democrat was, in a sense, right!  The reality seems to be that we cannot move forward with NYHA unless we take into account the interests not only of the individual worker, but also of his or her union -- corporate-like though it may seem in the worker's eyes.  In this light we may view the comment of a reader:
Of course CSEA has yet to endorse it. They are the most corporation-like of all the unions that operate here in NYS.

Be that as it may, I wouldn't be surprised if there are many other perfectly legitimate entities who have a place at the negotiating table (and by legitimate, I mean NOT Big Pharma, and NOT Big Insurance)! 

Is all this getting complicated? Yes!

Should we therefore drop it? NO, NO, and NO!  (Did I remember to say no?)  Again, no. Rather, to strengthen our resolve, all we must do is think of the Hell which is our healthcare distribution system now. True, in our healthcare reform, the devil WILL BE in the details, and we must stay on top of them to make sure they're sorted right! 

And always, we must continue to show the Insurance and Pharmaceutical execs as the blood sucking Ghouls of Greed that they are, so that the public may be revolted by them! That's why I keep at this.

Dio

PS: I welcome comments. Just click on the number of  commnts area, and there will appear a "comment box" in which you can share your thoughts. Don't be afraid to teach me! From your comments, I'm learning all the time.

GOOD NEWS! ... SORT OF

Today I read some very positive sounding news: The on-line journal VOX reports that "A group of hospitals is banding together to produce cheap generic drugs to fight off egregious price hikes and drug shortages. The not-for-profit venture is called Civica Rx, and the company announced itself last month. A collection of 22 hospitals in the Salt Lake City area called Intermountain Healthcare, the Mayo Clinic, the for-profit health care facilities company HCA Healthcare, and some philanthropic foundations are pulling together to form the firm."

Wonderful!  They're looking to produce drugs generic drugs that are in short supply, or whose prices have skyrocketed  -- or both. For example, IV bags, injections for sundry anemic problems, tissue numbing agents, have been reported in very short supply, not to mention drugs that treat Parkinson's disease, chemotherapy drugs, and a tablet to treat C.O.P.D.  -- chronic obstructive pulmonary disease.

All this, Vox reminds us, is happening against the backdrop of the Justice Department and 45 states being  "currently in court accusing generic drug makers of price fixing and costing Americans more than $1 billion for their medicines."  Vox goes on to say that  "We spend a lot of time on new brand-name drugs, but some of the most egregious examples of price hikes have been for generic drugs."

Amazing! No less than Jeff Bezos, chief of Amazon, had tried to go up against the behemoth of Big Pharma but had to back down, lacking the infrastructure and the complex network of customer relationships that Big Pharma has built up over the years. Yet now, these folks think they can do what Bezos couldn't? 

They have a very good chance. Part of Big Pharma's network of customer relationships was with hospitals, but a good part of the new group are themselves hospitals! They're not trying to develop any new drugs, but simply to make old ones that the drug industry, doubtless for monopolistic reasons, had allowed to get very scarce. Yes, the FDA will have to give its approval, but with the collective bona fides of  the new venture, that may not be at all impossible. The new firm will start off with 14 drugs yet to be named. "Experts," says Vox, "are cautiously optimistic." 

And you thought that Big Pharma was unassailable!  But don't start dancing quite yet. Yesterday I read of a study which proved that doctors who were given free meals were much more likely to prescribe the new, branded, proprietary drug pitched by the rep who was paying for the meal!  Researchers had already established that doctors who had been set up with speaking engagements would be far friendlier to the folks who set them up -- and the drugs they were selling -- than they otherwise would have been.

Let me tell you something: For years and years, the Health Industry has been wallowing in their own private Capitalistic heaven, enjoying obscene profits untrammeled by the regulations they would face in any other country. And do you think they are going to give all that up with out a fight? Do you think they won't pull out every trick in the book, to threaten,  lie, distort, suborn, seduce -- whatever it takes for them to hold on to their cushy situation? Ladies and Gentlemen, what we're up against here is class war.  Actually, we've been it it for a long time, but not many knew it.

But now, as the Bible says, it's time for us to "gird our loins with strength," and fight for our lives -- literally. I'm not talking pitchforks; it hasn't come to that yet, thank God. What I am talking about is linking arms, for unity is our strength. Our job is to form a unified front and show our state lawmakers that if they don't pass the New York Health Act (Single Payer for New York) we'll vote them out. Period. Many of them were very happy to vote for it when they were sure that the Republicans in the Senate would shoot it down.  But since that's now far less likely to happen, these so-called progressives may remember the money that got them elected,  and where it came from. They'll have a change of heart and reconsider, UNLESS WE HOLD THEIR FEET TO THE FIRE. What fire?  Why do you think I've been sharing these tales of  rapacious capitalists whose stupendous salaries we've been paying for with our blood -- to fuel the the fire of our outrage, our determination.  There'll be more of the same, God willing, together with some sense of what Single Payer is, and why I can think of no  other cure for the sick morass that is healthcare in our country.

Dio

PS: If you'd like to comment, (and I hope you will) simply click on the number of comments  area, and share your thoughts in the comment box that appears. Don't be afraid to teach me something -- your comments have already taught me a lot, and I love it!