Single Payer 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.

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.

The Huffington Post has a multi-part posting by Miles Mogulescu describing the Democratic distancing from a single-payer system. Miles does a good job of describing the political environment. He states that any plan that involves private insurers is doomed to failure. He also points out that about 30% of current health care costs is administrative due to billing paperwork.

What wasn’t mentioned is that the insurance companies and HMOs are also corrupt. The folowing excerpt from a proposed platform plank in Washington State say it all.

The Washington Post reported on February 8th 2008 that Merck Pharmaceutical paid a $650 million fine for defrauding the Medicaid system. Carrie Johnson, Washington Post staff writer, states, “Prosecutors say the drug maker gave pills to hospitals at virtually no cost to hook poor patients on expensive medicine. When the patients left the hospital, they often continued taking the drugs, but with the government footing the higher bill.”
On January 16th 2007, Premera Blue Cross asked a judge to seal documents that disclosed it defrauded Medicare by using it to pay insurance claims. On August 26th 2006, the New York Times reported that the California State Attorney General filed charges against 39 drug companies suspected of defrauding the state by overcharging for medicines.
When former Republican President Richard M. Nixon first introduced HMOs to the American people in the 1970s, those who had developed the business structures knew they were taking client funds and profiting by not providing services. It is obvious that private insurers or Health Management Organizations cannot be involved in any successful health care system. The current United States health care system, using private insurers, is not only ineffectual and inefficient but it is corrupt, as well.

Links to Miles Mogulescu’s posts are below.

Part 1: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-a_b_67836.html
Part 2: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_70848.html
Part 3: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_75070.html
Part 4: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_84862.html

Part 5:

http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_94239.html

In case you are curious as to why Medicare is “going broke”. We know it is because the surplus once in the Trust Fund was squandered but this is what happens to the rest.

http://www.nytimes.com/2008/04/01/business/01disabled.html?_r=1&oref=slogin&pagewanted=print

April 1, 2008

Insurers Faulted as Overloading Social Security

By MARY WILLIAMS WALSH

The Social Security system is choking on paperwork and spending millions of dollars a year screening dubious applications for disability benefits, according to lawsuits filed by whistle-blowers.

Insurance companies are the source of the problem, the lawsuits say. The insurers are forcing many people who file disability claims with them to also apply to Social Security — even people who clearly do not qualify for the government program….