Consider, for example, the proliferation of for-profit schools, hospitals, and prisons, and the outsourcing of war to private military contractors. (In Iraq and Afghanistan, private contractors have actually outnumbered U.S. military troops.) Consider the eclipse of public police forces by private security firms—especially in the U.S. and the U.K., where the number of private guards is almost twice the number of public police officers.

Or consider the pharmaceutical companies’ aggressive marketing of prescription drugs directly to consumers, a practice now prevalent in the U.S. but prohibited in most other countries. (If you’ve ever seen the television commercials on the evening news, you could be forgiven for thinking that the greatest health crisis in the world is not malaria or river blindness or sleeping sickness but an epidemic of erectile dysfunction.)

Medicynical Note:  Some would say that our dalliance with “market” based health care has led us to and/or exacerbated our cost/quality/access issues. 

It’s my contention that we don’t have the best system of health care but rather we have the best system of revenue generation for suppliers.  Consider drug prices:

Companies like Pfizer Inc and AstraZeneca have grown dependent on higher U.S. prices to generate profits as generic rivals to their best-selling medicines enter the world market, Europe’s government-run health plans clamp down on spending and sales growth in emerging markets stutters.

And:

The price variations become clearer when studying individual drugs. Switzerland’s Roche sells a month’s supply of cancer medication Avastin at about $8,800 in the United States, compared with 2,577 pounds ($3,978) in the U.K. and 6,800 Swiss francs ($7,177) in Switzerland.

Read the article for more.

Medicynical Note:  Why is this?  Consider that drug companies spend more on lobbying and campaign contributions per year than any other business group in the country.  It’s not even close.

In both cases, you’d be wrong. It’s actually the pharmaceutical industry that spends the most each year to influence our lawmakers, forking over a total of $2.6 billion on lobbying activities from 1998 through 2012, according to OpenSecrets.org. To get some perspective on just how big that number is, consider that oil and gas companies and their trade associations spent $1.4 billion lobbying Congress over the same time frame while the defense and aerospace industry spent $662 million, a fourth of Big Pharma’s total.

Interesting, they spend more on influencing Washington so that we can pay more.  And it works beautifully for big PHarma.  It is the best congress money can buy. 

U.S. Worst Place in Industrialized World for Babies

These are the facts:

The United States has the highest first-day death rate in the industrialized world. More than 11,000 babies in this country die on the day they are born, which is 50 percent more first-day deaths than in all other industrialized countries combined. One reason is that the U.S. has a high preterm birth rate. It also has more teenagers giving birth than any other industrialized country. Babies born to teens are more likely to be premature and weigh less. The solutions involve everything from keeping young women in school longer to making sure every mom and baby has access to healthcare.

Read the article:

Medicynical Note:  The article also points out that “ it takes governments, nonprofits and citizens all working together to make such solutions a reality. There are daunting obstacles, from abject poverty to pure gender discrimination, that hamper their implementation. “

The findings in the Save the Children paper support MSNBC’s  Melissa Harris-Perry’s contention that raising healthy educated children is everyone’s (the community as well as the parent’s) responsibility.    Fox news once again blew it. 

This adds to data on hospitals.

A hospital in Livingston, N.J., charged $70,712 on average to implant a pacemaker, while a hospital in nearby Rahway, N.J., charged $101,945.

In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000.

Read the article for more.

Medicynical Note:  Of course insurers and Medicare don’t pay those prices.  No, the inflated charges are for those least able to afford the bill, the uninsured.  Rather than have an up-front price for services, hospitals, like the proverbial used care salesmen (no disrespect meant) have an asking price from which patients can try to “negotiate” a settlement or as most do simply pay the inflated amount. 

It’s a little like the proverbial shell game.  What’s the price? This? or This? or This?

Hospital’s when the bill is challenged, traditionally do a review of a person’s  financial circumstances and may or may not adjust the amount due based on the hospital’s biased conclusions.  They then claim the reduction, if any, is “charity care.”  This is true for private for-profit and so-called “non-profit religious charitable” institutions as well. 

In all the world, except maybe in some third world situations,  ours is the only “system” that asks the least informed, most desperate customer to negotiate a price for a vital service, healthcare.  It’s part of the reason we pay more than any other country in the world for healthcare. 

Parenthetically, I recently had a procedure for which the hospital bill was $26,000.  The insurer paid $13,000.  What a farce. 

Prices for cancer drugs have been part of the debate over health care costs for several years — and recently led to a public protest from doctors at a major cancer center in New York. But the decision by so many specialists, from more than 15 countries on five continents, to join the effort is a sign that doctors, who are on the front lines of caring for patients, are now taking a more active role in resisting high prices. In this case, some of the specialists even include researchers with close ties to the pharmaceutical industry.

And:

Gleevec entered the market in 2001 at a price of about $30,000 a year in the United States, the doctors wrote. Since then, the price has tripled, it said, even as Gleevec has faced competition from five newer drugs. And those drugs are even more expensive.

The prices have been the subject of intense debate elsewhere as well. The Supreme Court in India ruled recently that the drug could not be patented, clearing the way for use of far less expensive generic alternatives.

Read the article for more.

Medicynical Note:  The article emphasizes the cost inflation of the most successful of the new targeted agents.  As noted above since it’s introduction Gleevac has tripled in cost.  It is the most profitable drug marketed by Novartis.  Oh yes you remember Novartis the company that in the news the past few days for bribing doctors and pharmacists, yes that “ethical” company Novartis.

What’s not discussed in the article is that many of these super expensive drugs do very little to improve patient outcomes (i.e. patients don’ t live longer) but still cost in the range of $100,000/year.

As Marcia Angell observed 10 years or so ago, in today’s medical business it’s your money or life or in the case of drugs that don’t work, both.

Authorities said the Basel-based company for a decade lavished healthy speaking fees and “opulent” meals, including a nearly $10,000 dinner for three at the Japanese restaurant, Nobu, to induce doctors to prescribe its drugs.

They said this led to the Medicare and Medicaid programs paying millions of dollars in reimbursements based on kickback-tainted claims for medication such as hypertension drugs Lotrel and Valturna and the diabetes drug Starlix.

Read the article for more.

Medicynical Note:  The US leads the world in drug costs, spending on health care/capita and bankruptcy due to medical expenses.  We have a highly developed sophisticated system not of health care but rather of revenue generation.  For companies like Novartis and many others health care is not really their main interest.

The point of sequestration was to force congress and the executive into making difficult budget choices in a budget.  Republicans in congress decided it was easier and in a perverse way better for them to simply accept the 10% across the board cuts in the sequestration than negotiate with a Democratic president.  .  The  executive branch warned of the impact both before and after it’s passage. .  Republicans in Congress ignored the warnings and now are claiming ignorance…and they are right.

This is frankly embarrassing in the leader of the free world…..it’s more like what happens in those “socialist” countries in Europe.  Actually it’s worse because of the wilful stupidity.

He said that he and others at the Transportation Department had been warning since February, before the sequester took effect, that it would cause layoffs that would create air traffic delays, adding that the agency had done everything it could to limit the impact.

And:

But Mr. Rogers insisted, “You didn’t forewarn us that this was coming; you didn’t ask advice about how we should handle it.”

Medicynical note: I wouldn’t trust a repub congressman to drive a car, much less run the country.  Too bad they can’t be sued for malpractice.

The U.S. government sued Novartis Pharmaceuticals Corp. Tuesday, claiming it gave kickbacks to pharmacies to switch kidney transplant patients from competitors’ drugs to its own.

And

The government said Novartis offered one pharmacist in Los Angeles a “bonus” rebate amounting to several hundred thousand dollars to induce the pharmacist to “shoulder the burden” of switching 700 to 1,000 transplant patients to Myfortic.

Medicynical Note:  Unbelievable but true.

What’s doubly distressing is that this is not unique or unprecedented behavior by these companies which formerly called themselves “ethical.  When money is involved apparently another form of ethics emerge, i.e. greed—and it’s not good…. for patients or health care or costs.

Patients believe that they need to do everything to maximize their care, no matter the cost or efficacy of the intervention.     Moreover most believe they are entitled to do everything and have someone else (insurance/Medicare/the VA whatever) pay for it.  Providers and hospitals figured out a long time ago that doing more means more income.  Insurers learned that they could simply pass through the costs without affecting their 20% or share of premiums–check out insurance executives salaries.  Suppliers understand that there is no real price competition in health care and if they charge more, someone will pay.

Adding insult to injury Congress in it’s infinite (well lobbied and paid for) wisdom protects manufacturers and suppliers by not allowing the largest purchaser of health care in the country (Medicare) to bargain on price.

So it’s encouraging to find a model that puts in place a braking system  to slow expenditures.

For most health care providers, that would be cause for alarm. But not for Advocate Health Care, based in Oak Brook, Ill., a pioneer in an approach known as “accountable care” that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services. Under the agreement, hospital admissions are down 6 percent. Days spent in the hospital are down nearly 9 percent. The average length of a stay has declined, and many other measures show doctors providing less care, too.

And

Under Advocate’s deal with Blue Cross Blue Shield, certain patients are assigned to the accountable care framework — about 380,000 — and their health costs are projected. If Advocate achieves savings below that amount while meeting explicit quality targets, it splits the money with the insurer. If not, its revenue is at risk.

Read the article for more.

Medicynical Note:  It will be fascinating to see whether this “innovation” is effective, and if patients and the other players in the health care game allow it to work.  Previously you will recall, a very similar system of cost containment ran into patient and industry opposition in the 90′s. 

Just so you know I am covered by a HMO/medicare advantage program and like it.

Ted Kamp wanted to make sure his daughter received the medical treatment she needed. That was his first priority.

nHis second was making sure his insurance would cover things and that he’d pay a fair price for any procedures.

The fact that this proved so difficult highlights one of the crazier aspects of the U.S. healthcare system: the inability of patients to know how much their treatment really costs.

Cigna’s  preapproval procedure required an evaluation of the indication for the MRI by  a third party contractor.  In this case the insurer paid nothing for the procedure as the family had not yet paid their $5000/year deductible.  When approved, the patient was expected to accept whatever was charged by the “approved” provider, and not afforded the opportunity to shop for the best price. 

The price paid was several times the cost of other providers in the area and  multiples (my estimate) of the amount charged if the insurer was paying the bill directly—this patient has a $5000 deductible and the bill came to $4700. 

Medicynical Note:  We have the most expensive health care costs in the world, no one else is even close.  

Insurers get the best prices for care through their negotiating leverage.  The uninsured, or in this case those still paying off their deductible are charged more, multiple of the insurance payment.   This is a system designed to assure profits not quality affordable care.