Category Archives: General Cynicism

It’s fascinating to watch our flawed legislative system “work.” Buy offs, illegitimate martinets demanding their 15 minutes, deals with money hungry corporate entities, bribery at every level, compromises until it’s hard to recognize what’s really been accomplished and complexity that violates the KISS principle. It’s certainly not pretty, efficient or effective.

Despite all that the resulting bill improves the current dysfunctional non-system and should be passed. This conclusion is more a comment on the current pathetic state of health care in America than an unqualified endorsement.

In a “two party” democracy one would have thought the opposition would have something to offer. But in this case the best they could do was maintain that free emergency room care was the answer to our health care problems. Incredible.

The bill allows insurers to rate on age but appears to stop the practice of varying rates according to illness.

‘‘(a) IN GENERAL.—With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or group market—
‘‘(1) such rate shall vary only by— ‘‘(A) family structure; ‘‘(B) community rating area; ‘‘(C) the actuarial value of the benefit; ‘‘(D) age, except that such rate shall not
vary by more than 2 to 1; and
‘‘(2) such rate shall not vary by health status- related factors, gender, class of business, claims ex- perience, or any other factor not described in paragraph (1).

The publicity on the bill claims no one can be denied coverage and that rates will not be increased (presumably after issuance) for a pre existing illness. It does sanction a 3:1 increase based on increasing age, hardly a people friendly policy. Considering that the average cost of insurance for a family is in the range of $10,000, such variation in charges are prohibitive. If this is so it’s hardly a benevolent system or one in which the health and well-being of those covered is the primary objective.

See this in LA Times

Companies in the exchanges would have to offer policies to all customers, regardless of their health status. Insurers could not charge older people more than three times what they charge their youngest customers, an unprecedented national restriction on what is known as age-rating.

It’s also unclear what the bill will do to decrease costs to a more reasonable level; to rein in corporate profits; or whether it will provide objective evaluations of the effectiveness of outrageously expensive therapies and improve efficiency.

Until we are more concerned with patients than corporate profits our health care will be costly and, for the amount spent, mediocre.

Medicynical Note: I’m in awe of a health care system that can charge $20 for a flu vaccine and then add $38 to the bill as a fee for the injection–as I was recently billed. We need to put the health care reform ball in play and make changes in its trajectory as we go.

The maybe in the title is because no one knows whether this new $30,000/month drug (Folotyn) works to prolong life.

And Folotyn has not even been shown to prolong lives — only to shrink tumors. The drug was approved by the Food and Drug Administration in late September as a treatment for peripheral T-cell lymphoma, a rare and usually aggressive blood cancer that strikes an estimated 5,600 Americans each year.

and later in the article:

But Dr. Newcomer said insurers would be obligated to pay for Folotyn because there were no alternatives.

Medicynical note: Even if this new drug worked perfectly in 100% of cases can any health care system afford such pricing? Think of it as sophisticated blackmail rather than health care and you get the idea.

Of course this is simply the most egregious example of drug company gouging. Pricing drugs proportional not to costs or benefit but on how desperate the patient is. A more cynical approach is hard to imagine.

This drug is a poster child for patent reform. We’ve argued that patent length (government sanctioned monopolies) should be dependent to some extent on responsible pricing. If a drug is priced ridiculously the patent should be of shorter duration. The more reasonably priced the advance, the longer the patent–a market solution to price gouging.

Nice article at TPM on pharmaceutical manufacturers manipulating the market. After all money is what it’s all about. Health care, pshaw!

Congress is thinking of doing something about it. PhARMA’s memorable response:.

• “Patent settlements between brand-name and generics companies can resolve expensive patent disputes to help foster innovation and improve access to medicines so that patients can live healthier, more productive lives.” Medicynic: Huh? Improve access by charging more?
• “Law and public policy have always favored settlements, including patent settlements. PhRMA continues to believe that legislation that would impose a blanket ban on certain types of patent settlements or otherwise prevent them could decrease the value of patents and reduce incentives for future innovation of new medicines. This is also unnecessary because the Federal Trade Commission (FTC) and others already have the authority to review and evaluate any patent settlement agreement between a brand name company and a generic company. The courts and enforcement agencies like the FTC are in the best position to review these settlements on a case-by-case basis to ensure that they are not harmful to competition. By imposing a general ban or imposing harsh disincentives, pending legislation would effectively remove the decision-making process from this appropriate venue.”

Medicynical note: So call “ethical” (they used to call themselves this) pharmaceutical manufacturers pay off generic companies, some would say bribe, to not market generics that compete with their branded drug. It’s apparently legal but highly disadvantageous to consumers. A free market, no! Guess who pays?