Follow The Money

Look beneath the purported story theme of testing ADHD meds to protect the lives of those taking them--http://online.wsj.com/article/SB10001424052970204336104577094624185636102.html?KEYWORDS=adderall--and you will find one explanation for why some drugs cost more than others and how the big pharma companies stand to profit while disposable income of medication users goes down. The FDA should not be practicing medicine. Yet, the FDA is doing just that when it arbitrarily halts the production of entire classes of drugs because there is a suspicion that some of those taking these medicines could be harmed by them. It is up to the physicians treating these people & prescribing these medicines to decide which people might be at risk. But wait--they ALREADY DID THAT when they took a history before prescribing these or any other meds as part of the patients' treatment plans. So, why is the government taking its usual "one-size-fits-all" approach in shutting down supply of these drugs? In the case of Adderall XR, for example, it appears to be a case of "nobody goes there anymore--it's too crowded." In other words, because students and others needing to improve alertness and concentration (how they got scripts is another question) have been taking Adderall in increasing numbers, Adderall XR's popularity grew to the point where the Feds decided that too many people were benefitting from it. So, in their infinite wisdom, they left the supply of regular Adderall intact on drugstore shelves but choked off the supply of Adderall XR so no one could get it. Guess what happened. Patients lobbied their doctors to prescribe them the closest real (as opposed to generic) medication, in this case a newer (a.k.a. still under patent protection) drug called Vyvanse. The dosing is different as is its absorption--it's smoother in than Adderall by a tad less efficacious. What no doubt interested the drug companies manufacturing these drugs is that Adderall XR, an older drug no longer patent protected, costs patients a copay of $30. However, Vyvanse, a newer drug, costs users a $50 copay as a Class III medication. Neither the government or big pharma acknowledge that doctors prescribe these drugs based on the needs of individuals, not with a "take-two-of-these-and-call-me-in-the-morning" approach. Illness is routinely measured in large patient groups, but, if you have a disease, it's YOUR disease. Your response to it and subsequent treatment is for YOU, not an anonymous large patient population. Offering this nuanced approach to prescribing is one reason doctors go to school for all those years. So, until at least 2012, Adderall and other medicines in its and related classes will not be available to anyone who was using them. And, if you follow the money in the way I suggest, you will understand why.

The problem--and the solution--remain.

Got a letter from my dentist last week. What did she want? I'm all paid up, haven't missed any appointments, so why send postal mail? Here's what she wanted to tell me: Use you remaining benefits before the end of the year or lose them! Just one more example of how convoluted, how constipated, our current system is. The principles remain simple: UNIVERSAL. CRADLE-TO-GRAVE. SINGLE-PAYER. Of course, you'll hear the opponents say, "It'll never fly. It's socialism! No one wants the government to control their healthcare. We've got to cut expenses, not increase revenues or taxes! It's too hard!" Sure, it's hard! If it were easy, we would have done it already! Confront the problem and solve it! No guts, no glory! Or--and I like this variation better--"No pressure. No diamond." It's a weird situation: Everyone, in their heart of hearts, knows that the principles above are the answer. It's been the same for the past 20+ years. For the same span of time, though, since many legislators are in the pockets of big pharma and the medical establishment, politics--and, of course, lack of courage--stops them from acting in the best interests of the people who elected them. Time for a change, no?

As I've written before, when healthcare availability and delivery are controlled by people who know the price of everything but the value of nothing, stories like the one below occur. We'll be hearing about similar situations all too often in the near future and beyond: Clinic Rejects Immigrants After Impasse With Hospital By KEVIN SACK ATLANTA — After the collapse of negotiations between Atlanta’s public hospital and the world’s largest dialysis provider, a dozen immigrants suffering from renal failure were refused treatment at an Atlanta clinic on Thursday and advised to wait until their conditions deteriorated enough to justify life-saving care in an emergency room. Unless the deadlock is broken, 22 patients, most of them illegal immigrants, face a debilitating cycle. Rather than receiving dialysis three times a week, as is standard protocol for cleansing their blood of toxins, they must wait until they are in sufficiently serious jeopardy to trigger the federal law that requires hospital care. Dialysis patients said that typically means placing themselves at risk of serious impairment or death. “Trust me, it is just like dying,” said Bineet Kaur, 28, an illegal immigrant from India who was turned away on Thursday morning from the clinic, operated by Fresenius Medical Care. “You are almost unconscious, you know. Even if you are talking, your brain is not working. Sometimes you have to be hospitalized for days or weeks.” As was said in a different context in the 1950s, "Have you no sense of decency, sir?" My mother was on dialysis for several years, and, while she would occasionally skip one of the three required weekly treatments, she knew, as we all did, that to stop dialysis meant death. These illegal immigrants know it, too. Yes, they should have become citizens, but, for whatever reasons, they didn't or couldn't. And, because they have a medical condition that requires three-times-a-week treatment for life, they get an additional penalty imposed. Not only do some folks want to deport them (which, if they were healthy, might be an option), these same people want to withhold the dialysis keeping the immigrants alive. This act would cause cruel and unusual punishment for a somewhat victimless crime: Self poisoning followed by death. You know that old saying: Every 4th house in America will be burgled. So, look out your front door and count down three houses. In other words, withholding medical treatment for cost reasons could happen to anyone in this country. Here's a specific example--from 20 years ago! A doctor told me about a patient of his who went for a routine mammogram. As sometimes happened, the film's resolution was marred, so the facility asked her to return the following week to repeat the scan. The second scan showed no disease. However, when the patient applied for life insurance, the potential insurer saw that she'd had two mammograms in two weeks, and, "reasoning" that she all but had breast cancer, refused to insure her! The doctor went to bat for his patient, and, eventually, the insurance company relented, making a Solomon-like decision. It insured the woman, BUT NOT HER BREASTS!!! And so, the pattern goes in America. We are the only industrialized country that apportions health insurance and healthcare delivery on the basis of whether an applicant can afford it, rather than as a basic right of citizenship. Oddly enough, this rationing drives healthcare costs up much more than insuring the entire population by virtue of citizenship would. Let me know your thoughts.

Here is an important piece of the puzzle about why health care costs (for both delivery and insurance) rise year after year: " . . . a fundamental reason that private-plan costs have outpaced Medicare fee-for-service spending: 160 million Americans with employer-sponsored coverage are quietly subsidizing seniors’ coverage through cost-shifting. When confronted with inadequate Medicare reimbursements, doctors, hospitals and other providers learned long ago to shift costs to the under-65 population by demanding higher payments from private insurers. This cost-shift, in turn, has fueled premium increases and rising medical costs for working families. Meanwhile, traditional Medicare fails to provide seniors with a comprehensive benefit akin to what working Americans currently have. If Medicare “as we know it” is such a good deal for seniors, why is it that nearly 90 percent of beneficiaries supplement their traditional Medicare plan with Medicare Advantage, employer-sponsored retiree coverage or Medigap policies?" The latter is a good question, but the answer is self evident: MediGAP (my emphasis) fills the coverage "donut hole" in Medicare.

But, we may well ask, why do these kludges, patches, tweaks, and other "baby steps" exist? Everyone knows how to fix health care insurance and delivery so everyone receives insurance and treatment cost effectively. Just apply the formula: Universal. Cradle-to-grave. Single-payer. Problem solved. Of course, everyone also knows that the moneyed and powerful strive mightily to prevent implementation of these principles. Perhaps the best explanation, though, comes from an observation by Winston Churchill on the American character: "America will always do the right thing, but only after exhausting all other options."

Another result of the abysmal U.S. healthcare "system"

More Pregnant Women Dying in CA, Says Study

By Jen Phillips | Wed Apr. 27, 2011 3:14 PM PDT

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Despite what the protesters at your local Planned Parenthood may say, abortion is not unsafe. In fact, you're about 20 times more likely to die from childbirth-related ailments than you are from getting an abortion.* In California, a disturbing new report [1] shows that more pregnant women are dying than before, due to increased obesity rates, more Cesarean sections, older mothers, and limited health care access. Part of the rise is also attributed to better data reporting methods.

The study (PDF [2]) says that the maternal mortality rate in California is about 14 out of 100,000 live births. In 2005, it was around 12 and in 2002 it was around 10. The rate (and increase) may not sound high, but take into consideration that more than half a million women give birth in California each year, and the state accounts for 1 of 8 births in the US.

In 2004, 82% had insurance that covered maternity services. Today, only 22% do.

The rise in mortality seen in California also reflects national trends, the report says, which is bad news for moms, especially moms of color. African-American women suffer maternal mortality rates far higher than any other ethnic group: about 46 of 100,000 African-American mothers die due to childbirth, as compared to much lower rates in Whites (12.4), Hispanics (12.8), and Asians (9.3). The authors of the report are still not sure exactly why African-American women are four times as likely to die than women of other races, but they suspect a combination of higher obesity rates, lower use of prenatal health care, less adequate care, and various risk factors as a result of lower socioeconomic status (e.g. higher stress). But the authors still seemed to be scratching their heads about how one ethnic group could make up only 6% of all California births, but 22% of maternal deaths.

Another anomaly: although Hispanics overall account for 51% of all California births, foreign-born Hispanics had much better health than those born in the US. "Immigrant Hispanics tend to have better health than the average American population, in spite of what their aggregate socioeconomic indicators would predict," write the study's authors. It could be because foreign-born women give birth at younger ages, when they are less likely to encounter complications. Or it could simply be that the American lifestyle, and health care system, is so unhealthy that it's actually a liability. The high Cesarean rate, which accounts for a third of all births, in particular, is directly related to maternal mortality. And then there's the question of care, and of cost. Only 22% of people with health insurance in California (the report says) have coverage for maternity services: In 2004, 82% of them did. For those who can't get, or can't afford, private health insurance, there's Medi-Cal, which paid for 47% of all prenatal and pregnancy-related costs in 2008. An especially interesting tidbit found in the report is that 7% of women in Medi-Cal's maternity program actually HAVE private insurance: their insurance just doesn't cover maternal services.

There's something seriously wrong when your health insurer doesn't cover your prenatal care. Maybe this could be a new torch for the pro-life movement, or a larger one for the pro-choicers. It seems like a perfect platform for a "family values" Republican, no?

*This is provided your abortion is in the first trimester, as 90% of all abortions are. The risk goes up for later abortions.

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Source URL: http://motherjones.com/blue-marble/2011/04/new-study-shows-more-pregnant-women-dying

Links:
[1] http://www.cdph.ca.gov/data/statistics/Pages/CaliforniaPregnancy-AssociatedMortalityReview.aspx
[2] http://www.cdph.ca.gov/data/statistics/Documents/MO-CA-PAMR-MaternalDeathReview-2002-03.pdf

Making an offer employees can't refuse

I never thought I would find a reason to relate to Sarah Palin's phrase "death panels," but a headline in the Boston Globe made me revise that position: "Plans steer patients to lower-cost hospitals" (you can read the full article at http://www.boston.com/business/healthcare/articles/2011/02/10/plans_steer_patients_to_lower_cost_hospitals/). The reporter, Liz Kowalczyk, writes that Blue Cross/Blue Shield (BC/BS) of MA lauched a new "product" purportedly to help small businesses continue to offer health insurance to their employees.

Once again, the health insurance establishment shows itself to know the price of everything but the value of nothing. This cost shifting by BC/BS reflects the belief that patients won't mind going to a community hospital instead of a teaching hospital because doing so will save money for themselves and, wink-wink, their insurers (Three guesses: What will the insurers do with the money saved?). After all, a hospital is a hospital and a specialist is a specialist, right?

Here's the tenor of the deal offered: "The Blue Cross Hospital Choice plan, which went on sale last month, charges members, for example, an extra $1,000 for an inpatient stay or outpatient surgery, and $450 more for an MRI, at 15 higher-cost hospitals, including Massachusetts General and Brigham and Women’s hospitals, Children’s Hospital Boston, and UMass Memorial Medical Center in Worcester. Companies and workers that sign up get a significant break on their health insurance premiums: a 4.5 percent increase for the first quarter of the year instead of a 10 percent increase."

What a deal! You can pay $1,000 more in your choice of ways: Either stay in the hospital following surgery or go home the same day as the surgery. In other words, you will pay $1,000 more no matter which choice you make! And, to sweeten the deal, BC/BS says that, while everyone pays an increase every year, if you choose this new plan, your increase will be less--but only for the first three months of the first year. To seal the deal, the state will pay each employee's three-month share of the premium when the employer enrolls. With choices like these, how could anyone refuse to enroll?

Wait until employees referred for medical treatment to a hospital find out they can't choose the hospital. For "those" people not affected by price--I guess you can call them "price inelastic"--it's no big deal. They will continue to go where they want for the services they need, regardless of cost. But, for the working-class guy or gal and their families, the new plan means they've been "price triaged"--they have less money to spend on their treatment, so the system sends them to the lowest-cost provider. As Stevie Wonder put it: "Livin' just enough for the city." Or, rather, dyin'.

To add insult to injury (pun intended), the reporter quotes the head of an insurance agency on why this plan is such a good idea: "These plans 'really help the employer and the employee start to understand what is driving health care premiums higher', said Paul Pietro, chairman of Mid-State Insurance Agency Inc., an insurance broker in Worcester. 'Simple things, like MRIs and CAT scans, if you’re just able to stay out of those hospital settings, that can save money. It helps everybody'." If you can't believe an insurance broker about what is good for your health, who can you believe?

So, while I don't want to encourage use of Sarah Palin's "death panel" phrase, the BC/BS MA plan comes closer to what Ms. Palin meant than President Obama's initiative.

What do you think?

I read the following today in the New York Times medicine section: "Republicans recalled, however, that they secured approval of two huge changes in domestic social policy that worked much better than Democrats had predicted. They remade welfare programs in 1996 and added a prescription drug benefit to Medicare in 2003. 'The idea that Republicans are just not interested in health care and won't do anything is belied by history', said Stuart M. Butler, director of the Center for Policy Innovation at the conservative Heritage Foundation." My interest lies in the second observation, that adding the prescription drug benefit to Medicare in 2003 demonstrates Republican in health care.

If you recall the phrase "donut hole," you understand why I question the facts behind Mr. Butler's superficially true statement. Here's how Reason magazine wrote about it at the time: "The cost is also likely to rise because of demands to close the drug plan's weird gap in coverage: After a $250 deductible, it will pay 75 percent of prescription drug expenses, up to $2,250 a year; but between $2,250 and $5,100, the point at which the plan starts paying 95 percent of costs, there will be no coverage at all." When one runs the numbers, one realizes that (a) Medicare enrollees are reimbursed up to $2,250 per year and (b) at that point, Medicare enrollees reimburse insurance companies for the same amount, up to $5,100. How did this come about?

As you might guess, the insurance industry had a lot to do with it. In fact, it was an insurance industry lobbyist who wrote the bill! Only in America.

What everyone forgets but should remember: The bulk of the new health insurance law won't kick in until 2014. No one knows how all those changes will affect care, cost, universality, etc. Of course, that hasn't stopped those who throw slings and arrows about ObamaCare, death panels, and other points on the right-hand side of the Sane<------>Lunacy scale from turning the dark sides of their imaginations loose:

• It will bankrupt the country
• It's a socialist plot
• "I don't want no gummint messin' with my healthcare!" (often heard from those ignorocrats who don't know that Medicare, Medicaid, etc. are government-run programs)

It will be a long time before the populace and those elected to govern them acknowledge that the real solutions--universal, cradle-to-grave, single payer--will take the concerns about who get what and how much and at what cost off the table. Then, we can focus on more important problems:

• Food
• Water
• Education
• Industry & jobs
• Security

Let me know your thoughts.