Single Payer Health Care

Has Obama Already Vetoed Single-Payer Health Care?

Consensus on Universal Health Care

The AARP (American Association of Retired Persons) held a rally today across Lake Washington from Seattle in the town of Bellevue. The AARP was attempting to draw attention to the fact that the elderly are all heading towards financial disaster as health care costs continue to rise.

800,000 Washingtonians are with out insurance. More than 43 million Americans are uninsured. Even those insured cannot pay the expense not covered by their policies.

Many physicians were in attendance and they all called for drastic change in the way America deals with health care. One physician on a speaking panel was even quoted by the Seattle Post-Intelligencer (P-I ) on May 22, 2008 as saying “Do not resuscitate the system”. I’ll agree with that. The private health care system is dead. It needs to be replaced with a new and vibrant single-payer health insurance system.

In the same issue of the P-I Dr. Edward Langston discusses the bleak future of Medicare. Physicians are getting pay cuts for services rendered and it is getting more difficult for persons receiving Medicare and Medicaid to find a doctor who will see them. The Republican Medicare coverage reductions and the resulting lower payments to physicians don’t cover the expenses the doctors incur. If a lab tests cost more than Medicare will pay, the doctor isn’t likely to be able to provide the needed test.

Another guest columnist in this issue of the P-I is concerned about the regulation of biotechnology and genetics. Some of these new technologies will work wonders for the future of medicine. However, my genetic code belongs to me. No technological firm should be allowed to patent my genetic lines or any living creature’s genes for that matter. Life belongs to the commons and cultured cell lines ought to belong to the public domain. Science would progress much more rapidly that way.

I’ve been on a brief sabbatical and a lot has happened in the two weeks since I’ve last written for this web log.

A patient suffering from Hepatitis - C recently died because he wasn’t placed on the organ transplant list. One reason given was his use of medical marijuana. The doctor used his pot smoking as one of her reasons for declining to enroll him. If it was a moral decision it was wrong. If it was a medical decision the doctor had to make a choice. Who should have access to the limited supply of donor organs? The discussion about the morality of drug use and the socially destructive ‘war on drugs’ is not the purview of this web site but I do have an opinion I wish to share about transplants in general.
There are very few organ donors even though many people die with perfectly good working organs. (If they die of head trauma, their heart, lungs, kidneys, and liver are still alive and functional.) Unless these people have given their advance permission to use their organs, or unless the person with power of attorney for the deceased person’s estate gives permission, these organs die with the individual. Far more organs and organ tissue is wasted than donated. Organ donation should be automatic. There would be less, if any organ shortage for those requiring transplants and the cost would drop measurably. It would lower the prices for transplants, thus giving insurance companies less of a reason to decline covering transplants. (I knew there was a tie in to universal health coverage here.) Any one with religious objections such as Christian Scientists or worshipers of ancient Egyptian gods could opt out of the donation program but they would have to carry a card saying “I am not an organ donor….”

A May 4th story in the New York Times explains that it is not only the growing numbers of uninsured feeling the pinch of health care but the insured also cannot afford to be ill. Insurance was supposed to absorb the cost of illness so as to not destroy the finances of the individual who becomes sick or their family. Employers too are feeling an economic impact. Private insurers seem to be covering a smaller and smaller percentage of medical expenses while making increasing profits. People are paying obscene amounts of money in order to stay well. I am convinced the rash of medical bankruptcies has hurt the overall economy nearly as much as has the mortgage crisis and will continue to damage the economy until we have a national single payer health insurance system.

The next bizarre story is about a gentleman who kept getting billed for a service performed after the death of his wife. This relates to the transplant issue that opened this story. The Seattle Cancer Care Alliance had continued to look for bone marrow to transplant into the woman who had leukemia. She died as a result of a reaction to chemotherapy. They were unaware of her death and the insurance company refused to pay for the services rendered since the patient was deceased.

There were two stories about insurance companies abuse of the Medicare system.
States have requested Congress to allow them to regulate the insurance industry. Many people are buying into private Medicare plans that provide less overall coverage than the government run Medicare plans. The states can currently do little to regulate the industry or mediate insurance disputes between HMO and other insurance  providers and individuals.
With the above lack of regulation in mind the second story is about aggressive marketing. Insurance salesmen deceive the elderly or disabled into believing they are better off joining a private plan. they are using their access to the Medicare lists to cold call Medicare recipients and sell them on privately run Medicare programs. I know of people who have received Pfizer drug marketing pamphlets in government Medicare statements. This is using tax money to provide private enterprise free access to our homes. All the evidence shows that privately run programs are less efficient than publicly run programs. Check out the book Bleeding the Patient by Dr. David Himmelstein, et al, for details on this phenomena.

There have been stories comparing the health plans of the candidates. I’ve written some on that before so I won’t go into too much detail. However, the Seattle Post-Intelligencer (P-I) headline “Democrats’ health care plans follow U.S. tradition” demonstrated the need to bring the discussion about a national single-payer health insurance system into the mainstream. Americans need to know there is a better alternative to privately run health insurance. we need to demand that the candidates support HR676 as the only viable health care option.

There was a Seattle P-I story on the growing number of chronic pharmaceutical users in the USA. Although much of the increase in people using medicine is due to the worsening public health resulting from the American diet, a vast part of the problem is direct to the public advertising by the pharmaceutical companies. Combined with deceptive marketing to physicians, people are being over prescribed medications of dubious value. Melody Petersen’s book Our Daily Meds goes into detail on the subject of the big drug advertising blitz. Petersen and her book were featured on Bill Moyers recently and is discussed by Alison Rose Levy on the HuffingtonPost blog.

David Myers, who has the blog Discuss Race, sent me this story; Ethel Long-Scott, is the Executive Director of the Women’s Economic Agenda Project and wrote in the Black Commentator web log that, “Our nation is being presented with an amazing opportunity right now.”
It is a worthwhile read.

Dr. David McLanahan, Dr. Donald Mitchell, and Dr. Hugh Foy together have written an opinion published in the Seattle Post-Intelligencer, on May Day, 2008. It explains the situation with American health care and advocates a single-payer system. They are far more qualified than I to make a case for a universal single-payer health insurance system. Read the Doctors’ Opinion Piece.

The doctors are members of Physicians for a National Health Program.

P.N.H.P. Washington State Chapter

John McCain’s market approach to health care is a fiasco waiting to happen. We already know from Nixon’s White House recordings (after the tone) that discloses the original concept that Health Management Organizations will be to collect payments from employers and individuals without providing benefits to those insured. It is the primary method by which HMOs make a profit as presented to John Erlichman by Edgar Kaiser founder of the infamous Kaiser Permanente HMO. The marketplace provides this incentive. The idea that shifting the burden of insurance cost from the employer to the employee “to foster competition” is irrelevant with such a business plan in place. What will the private insurers compete for?

McCain plans to provide a $5000 tax credit to families in order to pay for insurance. This does a whole lot of good for those people who make $5.85 per hour minimum wage. Since $5000 is nearly half the yearly wages of $12168 for a 40 hour work week, these people won’t receive more than what their current tax refund already is. The tax credits don’t help them one iota.

McCain plans to help the poor by providing some money to the states to administer. However, his plan calls for state administered insurance “pools” so that chronically ill, injured, and older people can be covered. Basically, the states will be “contracting” with insurance companies who will then administer the state programs. This smacks of privatizing Medicare and Medicaid. It has been demonstrated time and again that privately run programs cost more and provide less than non-profits or Medicare.

The McCain plan is like a wolf in sheeps clothing. The wolves are the HMOs. The rest of us are being fleeced.

(Read Bleeding the Patient for a great analysis of the private health care industry.)

The Association of American Medical Colleges has recommended that medical colleges and universities ban receiving money from pharmaceutical companies and medical equipment manufacturers. They claim that conflict of interest problems inevitably ensue once a college starts relying on corporate money. When individuals start to receive perks from these companies it clouds their judgement. I couldn’t agree more.

Pharmaceutical companies spend billions of dollars marketing to physicians. They spend more in this way than they even spend on direct marketing to consumers. Marketing to consumers costs more than any drug company’s research and development expenses yet we are told the exorbitant prices for otherwise cheap drugs (IE; AZT) is due to the money spent on research.

The idea that the drug companies, many which have falsified data to be presented to the Food and Drug Administration, create the content of many of the lectures being given to students, is frightening to me. A generation of graduates is leaving school with an educational bias that is flawed.

I can never mention Melody Petersen’s book, Our Daily Meds, enough as it does a great job describing the influence of the drug companies on the medical profession.

Here is an article on the proposed ban on med schools and staff accepting  big business money in the New York Times.

Here’s an intersting story from the Seattle Times.

Life spans falling for least-healthy Americans, study by Harvard, UW finds

By Kyung M. Song

Seattle Times health reporter

For the first time in generations, life expectancy for large numbers of Americans is stagnating or falling as more people pay for obesity, high blood pressure and other chronic conditions with shortened lives.

The findings, published Monday by researchers at Harvard University and the University of Washington, show that while Americans are living longer than ever on average, life expectancy is changing at increasingly unequal rates among the population….

This last Saturday I read in the news how a Benefits Management Company raised the rates of a drug that treats a rare epilepsy in children to nearly 15 times its previous cost. It had cost $1600 before (which is not cheap) the price increase and now was up to $23,000. Express Scripts, the company in question, is the sole distributor of this drug. They claim the price increase was a decision of the pharmaceutical company that makes it. Express Scripts uses the health management model to keep prices low (right, $23,000 is low) for employers who are actually providing their employees a health plan. The question is, what would cause the cost of a drug to raise to this level? Questcor Pharmaceuticals, the company that produces the epilepsy drug H.P. Acthar Gel, changed from regular wholesale distribution of this pharmaceutical to “Specialty Pharmacy Distribution” the First of August 2007. That is when the price went up. Rates also rise for employers providing employee health care coverage using Express Scripts and they have no choice but to pay.

Yes, I suppose it’s OK for Questcor to hold a patent on H.P. Acthar Gel and make a fair profit based upon their research expense. I question how a drug could suddenly become 15 times more expensive once it has already been on the market. What I see here is monopoly practice.

Drug companies have always used the excuse, “The price of drugs is due to the expense of research and development (R & D).” However, the cost of marketing drugs is twice as much as the cost of R & D. Marketing directly to consumers has caused people to ask for drugs they don’t need, according to Melody Peterson, author of
Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs. Direct to consumer marketing has caused people to request anti-depressants even when someone is clearly going through a period of healthy grief over a loss, states Peter Breggin, who wrote Toxic Psychiatry: Why Therapy, Empathy and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the “New Psychiatry”. (It must be mentioned it is cheaper to treat symptoms than it is to give therapy and make a person well. HMOs won’t pay for much treatment but gladly pays for the cheaper drugs.) Pharmaceutical advertising has increased unnecessary medical treatment of frightened patients, claims Dr. Nortin M. Hadler in his forthcoming book Worried Sick: A Prescription for Health in an Overtreated America. (I don’t always agree with the good doctor but he makes many valid points such as the one above.)

Other Benefits Management Companies, such as CVS and Caremark also have acquired exclusivity agreements with pharmaceuticals, thus limiting distribution of the drugs in the marketplace. Maybe this is why drug prices have risen so high. A supply side system means that a limited supply will cost more than a supply that is plentiful. The basic premise of supply and demand will raise the cost. This is a flimsy excuse since the limitations are arbitrary and benefit the management companies rather than the consumer while the supply of pharmaceuticals is controlled by the manufacturers. It seems to me the private sector is simply taking advantage of a captive and helpless group of Americans.

So the question is, “What is the price of a child’s health?”

The Seattle Times and Seattle Post Intelligencer have both reported that Doctor Bruce Psaty and biostatistician Dr. Richard Kronmal, PhD, of the University of Washington have written an article for the Journal of the American Medical Association (JAMA) describing how Merck Pharmaceuticals has misrepresented data regarding its pain relieving drug Vioxx. Vioxx is a COX-2 inhibitor which was supposed to cause less harm to the stomach lining than a more generalized anti-inflammatory COX inhibitor like aspirin or ibuprofen. The study in question showed Vioxx increasing the death rate of Alzheimer’s patients as well as increasing dementia in those patients. Other in-company studies showed an increase in cardiovascular problems in Vioxx users. Merck was aware of this cardiovascular side-effect a full two years before the Food and Drug Administration (FDA) approved the drug.

Merck and Company, the largest pharmaceutical company in the world, spent a huge number of dollars promoting Vioxx. Melody Petersen, in her book Our Daily Meds, describes “The Age of Blockbusters” and “the most expensive and aggressive pharmaceutical marketing battle at the turn of the century.” Advertising for Vioxx was starting to emerge in the late 90s even before Vioxx and Celebrex, a similar drug created by Merck competitors Pfizer and Pharmacia, had gained FDA approval in May of 1999.

Many doctors receive money from Merck and other prescription drug companies for consultations and participation in drug studies. Doctors give these studies credibility even when the data from clinical trials show that a new drug is little better than a placebo. Negative side effects have been understated or ignored. In the case of Vioxx, only patients without heart conditions were allowed in the effectiveness studies after an earlier study showed increased heart problems and even then, four out of one-thousand patients had cardiovascular problems as a result of the drug’s mechanism. That is four times the number as those who were receiving naproxen as part of a control group. That data was disregarded.

Merck has been found guilty of some other unsavory practices. A Friday, February 8, 2008 Washington Post article reports Merck was required to pay a settlement to Medicaid for unfair pricing practices. Merck would give drugs to hospitals and their patients for nothing or next to nothing. Once those patients left the hospital and were dependent on these drugs, Merck would jack up the price and these same drugs would become extremely expensive.

Peterson’s book documents case after case of pharmaceutical companies unduly influencing clinical trials and cherry picking the studies it offers to the FDA. Merck is only the largest of these companies. Recently, the FDA has been remiss in its duty as the agency in charge of regulating the prescription drug industry.

Insurance companies and HMO’s prefer using drugs that regulate symptoms rather than providing therapies that cure a disease. Therapy can be time consuming, difficult, and expensive. Drugs are cheap to make, (only a small percentage of the total retail cost for most drugs), and easy to administer, thus saving doctors time and HMOs money while making drug companies billions. This is also another reason we need to look at removing the profit motive from the health care industry. America needs a single-payer insurance, health care system.

A JAMA editorial by Catherine D. DeAngelis, MD, MPH, and Phil B. Fontanarosa, MD, MBA, about the negative effects of pharmaceutical company influence on the way doctors conduct studies and prescribe drugs offers some suggestions as to how to remove industry influence.

Several ethical doctors are starting to refuse payment from drug companies and they are working pro-bono for their consultations so as to avoid any conflict of interest. This is a start.

This is a video of a 60 Minutes story from February 28th, 2008. Sorry about the opening ad but this story is worth viewing.