US Not Number 1……in murder rate, we’re only number 3 in the world

Graphic presentation of the murder rate around the world.  While we are number 3 in the world with 52/100,000 we can, however, take pride (sic) in that we do lead the industrialized world, in homicides, by a wide wide margin.

Medicynical note:  Think the number of guns in the U.S. has anything to do with it?  Is this collateral damage from our “freedom” to bear arms?   Has this anything to do with the wide disparity of wealth in our country?  Our failing educational system?  Our long standing institutional racism?  Take your pick.  The question is where we go from here and how to get ourselves out of this mess? 

Corporate Cheaters in Health Care? Shocking!

It becoming increasingly apparent that Big Pharma and other medical suppliers game the “system.”  Consider:

The past decade has seen a relatively constant rate of newly approved drugs every year. The number has even jumped in the past few years. Yet, despite such encouraging trends, we are actually facing a crisis in drug innovation today. That is because many of these new products do not offer substantial improvements over already available alternatives.

And:

At the same time, novel and effective treatments for many diseases—both rare and common—remain elusive. For example, there is widespread concern over the lack of development of new antibiotics aimed at multidrug-resistant infections. Therapeutic innovation for central nervous system disorders such as dementia and psychoses, which affect almost 100 million Americans, has likewise stagnated.

In this climate, pharmaceutical manufacturers have nonetheless continued to thrive. The top eleven drug manufacturers made $711 billion from 2003 to 2012, including $68 billion in 2012 alone, translating to an industry profit margin on par with the banking sector.

Yet some of these profits have been acquired through illegal marketing practices that lead to unnecessary over-prescribing of their products, including issuing kickbacks to physicians, making false claims about their products, and marketing drugs for unapproved uses for which there is no evidence of efficacy despite important risks potentially leading to adverse patient outcomes. In the past five years alone, pharmaceutical companies have been required to pay over $13 billion for such violations.

Read the rest of the article here.

Medicynical Note:  Health Care in the U.S. is all about money.  Value, affordability, efficacy, whatever is not their first priority, maybe not even their second or third.

Big Pharma Manipulates the System to Increase Drug Prices—Anyone Surprised?

A drug company’s goal is to increase revenue.  Cost efficiency, value for the money?  Not their department. 

On Feb. 10, Valeant Pharmaceuticals International Inc.bought the rights to a pair of life-saving heart drugs. The same day, their list prices rose by 525% and 212%.

Medicynical Note:  Health care in case you didn’t notice is a perfect set up for blackmail.  The companies have something you think you want, something that you have been told you must have in order to survive.  Insurers are a buffer and in part delay the effects of price increases on drugs and pay the increased prices.  So companies raise prices whenever and however they can.  They think they can get away with it so they do it.

How else to explain the above increases?  How else to explain the fact that today we are paying in multiples of our median and average incomes for a single medications which  most often are  of modest value.  Panaceas?  Cures?  Not these.  But cash cows for Big Pharma and investors, yes.

What about regulations on prices?  What about some pay back for government funded research?  Both were given away by congressmen/women who guess what, receive lots of money from drug companies.  It’s a corrupt vile system.  But really it’s just business…….as usual.

Drug Costs Outstripping the Ability to Pay

Health Affairs’ blog had an interesting discussion of the problems of our drug patent system and it’s costly consequences.

One critical incentive for ongoing drug discovery and development is the temporary monopoly pricing that manufacturers can command for novel drugs. Yet this incentive, embedded in current patent and regulatory policy, does not guarantee that manufacturers will deliver novel products with clinically meaningful benefits. Indeed there are many diseases—including Alzheimer’s disease and Amyotrophic lateral sclerosis (ALS)—that pose significant patient, family, and societal burden but have not benefited from meaningful treatment advances.

Meanwhile, the American public appears increasingly wary of the unintended consequences of these market-based incentives. Since the early 2000s, regulatory actions have focused increasing public attention on shortfalls in the efficacy and safety of already marketed drugs — including the withdrawal of celebrated “blockbusters.” Recently, patient and insurer attention has focused on the list prices of novel specialty drugs, including those to treat cancer, that commonly exceed $50,000 per treatment course — these drug prices have also grown faster than all other medical spending.

Medicynical Note:  In the U.S. the medium and average family incomes are about $50-60,000/year.  So we are talking drugs that cost multiples of the annual incomes of families.  A few of these drugs have miraculous effects but most offer slight improvement in patint’s outcomes. 

Other countries try to control these expenditures by providing strong guidelines on expensive medications use; negotiating prices with the manufacturers and suggesting equally or more effective alternatives.   Their costs are significantly less than ours.  The Affordable Care Act has started this process but whether or not it’s political overseers (under the influence of  drug companies contributions)  will allow a rational implementation remains to be seen. 

Value in Health Care: Not Our Concern

Another in the series on health care costs by Elizabeth Rosenthal in the New York Times—The Odd Math of Medical Tests.

Over use and over charge seem to be the watchwords of American healthcare.  Why?  read below.

Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue — especially because the equipment to perform them has generally become far cheaper, smaller and more highly mechanized in the past two decades.

Read the article for more details.

Medicynical note:  There are interesting contrasts between the U.S. approach and the experience elsewhere in the article.  The end result is that we pay much much more for the same services….that are done many many more time/unit of population.  Our costs are double most other industrialized countries.  Sustainable?  No.

Why?  In the U.S. there are no restraints on gouging the “system.”  Everyone is in the business to make money for themselves and stockholders—its their “fiduciary” responsibility.  Quality patient care and appropriate use of technology and medical care is really not their concern. 

America Lags Behind: Even with Medicare

Even with Medicare the U.S. lags behind other countries in healthcare access,  costs and quality.  This graph from the Commonwealth Fund survey of older adults says it all.

Among American seniors, 21 percent had out-of-pocket medical expenses that topped $2,000 and 11 percent had problems paying their medical bills. In Norway and Sweden, 1 percent had problems paying; in Germany, 3 percent.

“As good as Medicare is – it provides excellent coverage over all – it still isn’t as protective as the coverage people get in other countries,” Ms. Osborn said. Its deductibles and cost-sharing requirements still leave many Americans scrambling to afford drugs and doctors – which also cost more here.

Read the article for more.

Medicynical Note:  The basic premise of those involved in healthcare in the U.S. is different than in other countries.  Instead of assuring   value, quality and access, our system is devoted to assuring excessive financial returns to providers, insurers, drug companies and hospitals.  Protections are in place not to assure good quality affordable health care but rather to guarantee profits.

Some examples of this include congress forbidding the government from negotiating price of drugs purchased by Medicare part D; the generation long monopoly afforded new drugs without assuring reasonable pricing (one of the requirements of the Dole-Bayh law that is not enforced); the obscured price of services at medical facilities–insurers pay half of what an individual would pay for the same service.  It’s worse than buying a used car. And so on.

American Exceptionlism, Again: 42.9 million Americans have unpaid medical bills

Another only in American moment. 

Nearly 20 percent of U.S. consumers with credit records — 42.9 million people — have unpaid medical debts, according to a new report by the Consumer Financial Protection Bureau.

The findings suggest that many Americans are being trapped by debt because they are confused by the notices they get from hospitals and insurance companies about the cost of treatment. As a result, millions of Americans may be surprised to find they are stuck with lower credit scores, making it harder for them to borrow to buy a home or an automobile.

Medicynical Note:  Not only do we have the most expensive, inefficient health care non-system in the world, but we also lead the world in medical debt and bankruptcy (a category of bankruptcy unknown in other industrialized countries).  Even with the Affordable Care Act, this problem persists. 

Instead of doing something about it our new republican congress wants to make it worse by doing away with the Affordable Care Act (the only progress in 30 years) and replacing it with …………….nothing.  Amazing. 

America isn’t fit to lead the world until it gets it’s own house in order.