The Medical Industrial Complex: It’s the Money Stupid!

Posted on September 16, 2012 | Leave a comment

In health care, we’ve developed a system of money making that’s unprecedented.  What once was a profession that at least gave lip service to patients and health care–remember the “sacred patient doctor relationship?” or the “ethical” pharmaceutical industry?–has evolved into a money grubbing borderline ethical business.

Gaming the billing system has become the norm.  When our local “non-profit” hospital (run by a Catholic hospital conglomerate) bought out medical practices in our area, costs dramatically increased.  Coding for visits moved to more expensive levels.  The hospital  billed an additional facility fee even while the practices remained in the same location as before.   Procedures previously done out of the hospital were moved into their facility.  Instead of finding ways to provide efficient economical care, providers (and suppliers) even so-called non-profits seek to maximize revenue.  This is happening at every level of our health care mess and is one of the major causes of our  ridiculous cost inflation over the past 20 years.

More on gaming our non-system here:

Between 2001 and 2010, doctors increasingly moved to higher-paying codes for billing Medicare for office visits while cutting back on lower-paying ones, according to a year-long examination of about 362 million claims. In 2001, the two highest codes were listed on about 25 percent of the doctor-visit claims; in 2010, they were on 40 percent.

 

 

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Posted in Ethics, General Cynicism, Health Economics

9/11 Cancer Compensation: Says a Lot About our Corrupt Non-Health Care System

Posted on September 15, 2012 | Leave a comment

Sad story of the immorality of our health care non-system.  Jevon Thomas apparently worked the Trade Center site for a year and subsequently developed a sarcoma.  His disease and required treatment was costly and disabling.   He died impoverished and destitute.

He didn’t hesitate to say yes when his boss asked him to set up toilets at ground zero for the emergency workers. He told CNN in an interview two years ago that he worked there without a mask for 10 hours a day, seven days a week, for about 14 months.

Around the time he stopped working at ground zero, he noticed a lump on his hand. It turned out to be a rare cancer called epithelioid sarcoma.

Thomas had several surgeries and rounds of chemotherapy and had to quit his $65,000-a-year job.

His physician, Dr. Iris Udasin at Rutgers University, found him as much charity care as possible, but his family suffered financially as Thomas’ wife is disabled and couldn’t work to support their two

Medicynical Note:  It’s irrelevant whether or not his cancer came from his exposure at the Trade Center.  What’s relevant is that in our country, the “wealthiest” in the world, we have problems providing health care. 

To repeat the litany:  60% of bankruptcies in the U.S. are related one way or another to health care expenses; we lead the world in health care costs (1.5-2X as much spent per capita); we have 50 million uninsured; care is compromised because of lack of coverage and fear of the expense. 

We are unique in the world and it’s shameful. 

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That Sucking Sound: Soaring Medical Insurance Costs

Posted on September 12, 2012 | Leave a comment

Insurance coverage for a family nears $16,000/year, about 1/3 of the median income in the U.S.  More than housing costs, more than food……hardly sustainable. 

Average annual premiums for family coverage rose 4 percent and individual premiums rose an average of 3 percent in 2012, increasing faster than employee wages and overall inflation for the 13th straight year, according to a nationwide survey of businesses released Tuesday from the Kaiser Family Foundation and the Health Research & Educational Trust.

Medicynical Note:  The Romney un-plan is to undo health reform and allow the private sector control expenditures and care.  This is shorthand for economic rationing of health care.  If you can’t afford the insurance or medical intervention than you are out of luck.  His “plan” will do nothing for the 50 million people without insurance, do nothing for those will serious illness who are priced out of the insurance market, nothing for those with “pre-existing illness.”  (as clearly enunciated by his campaign earlier this week). 

I would remind you that the fiduciary responsibility of the private insurance industry is to maximize profits not health health care.

Stark choices this November.  In the end we’ll get what we deserve. 

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Big Pharma in Full Spin

Posted on August 25, 2012 | 1 comment

The headline reads “Alzheimer’s Drug Misses Goal, but Offers Hint of Potential”.  It’s clear the drug didn’t work, but Lilly is spinning the results like mad—it’s stock actually rose.

An Alzheimer’s drug being tested by Eli Lilly failed in its main goal of halting progress of the disease, the company said Friday, but there were some signs it could slow cognitive decline in patients with mild cases.

The study found:

The two clinical trials involved a total of more than 2,000 patients with mild or moderate Alzheimer’s disease who received either solanezumab or a placebo for 18 months. In both trials, those treated with the drug were not better off at the end of the trial than those who received the placebo, either in terms of cognition or daily functioning.

Sounds conclusive to me, but through manipulation of data Lilly found that

there was a statistically significant slowing of the decline in cognition. When the data was further broken down, it was found that this beneficial effect was found in the patients with mild disease but not those with moderate disease.

Medicynical Note:  It would be nice if we could suspend reality and say that this drug had benefit but it’s hard to ignore the first part of the findings.  The discussion notes that “It is also not clear whether a slowing of cognitive decline, without an improvement of the ability of a patient to perform daily activities, would be sufficient for approval.”

Kind of pathetic.   It seems clear that the drug didn’t work and that Lilly is grasping at the straw of a subgroup without revealing the extent of the “benefit,” or the number of patients out of 2000 who “benefitted.”  

The press report and presumably Lilly’s press release reeks of a (Medi)cynical statistical manipulation designed to boost Lilly’s stock, not to improve the care and outcomes of these patients

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Posted in General Cynicism

The Ryan/Romney Health Plan: A Faustian Bargain!

Posted on August 25, 2012 | Leave a comment

To fully understand what’s happening in the health debate you  need to keep in mind that the repubs opposed Medicare (as well as Medicaid and Social Security) from it’s inception and have done everything in their power to cripple it (them).  They’ve prevented Medicare from assessing efficacy of treatments and interventions, prevented Medicare from negotiating prices with the drug companies, and have worked to “privatize” it.

Now they try to sell privatization as an improved program when it would appear to be a rather cynical effort to undermine affordable coverage to both the elderly and younger populations.  How else to interpret this:

He wanted to reassure the seniors in the crowd about the Republican presidential ticket’s plans for Medicare, the government health insurance program serving 39 million seniors.

“Our solution to preserve, protect and save Medicare does not affect your benefits,” Ryan, Romney’s vice presidential pick, said during an Aug. 18, 2012, stop at The Villages.  “Let me repeat that — our plan does not affect the benefits for people who are in or near retirement

Medicynical Note:  Guess who gets to pay for the continued benefits of the elderly under Romney/Ryan?  Our children and grandchildren! Guess who will get lower benefits and higher costs now and when they retire?  Our children and grandchildren!  This is a greed is good deal. 

In plainer terms “Romney/Ryan is a Faustian bargain with the payoff being the wealth, health and well-being of our children and grandchildren.    The Romney promises are empty as he has a track record of flip-flopping on health care and many other issues, depending solely on his political ambition. 

Romney has no apparent heart felt core issues, except to protect the interests of the wealthy.   Accepting his assurances  on health care provides no certainty that he actually will maintain the policy.  Adding to the uncertainty are the beliefs of his radical conservative tea party backers who want to completely gut Medicare, Medicaid as well as Social Security. 

Supporting Romney/Ryan is Faustian, there will come a time when we/you will be called upon to pay!

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Why the ACA (Obamacare) is Essential to Healthcare in the U.S.

Posted on August 25, 2012 | Leave a comment

A Tennessee doctor’s views on health reform–It’s a no-brainer:

He notes:

The ultimate expense of health care is tied to quality and access. The state with the worst health care costs a third more than the states with the best. The state with the best access costs half as much as the worst. The best combination of access and quality is found in Massachusetts, the state whose plan was the blueprint for ACA.

And:

The ultimate expense of health care is tied to quality and access. The state with the worst health care costs a third more than the states with the best. The state with the best access costs half as much as the worst. The best combination of access and quality is found in Massachusetts, the state whose plan was the blueprint for ACA.

And finally:

Germany, Switzerland and the Netherlands have more privatized health systems than the U.S. They have almost universal coverage with better health outcomes and spend a lot less. Their private insurers are prohibited by law from making profit on the basic coverage packages but can profit on additional coverage.

Every country rations health care. Other rich nations do this by multidisciplinary committees. The U.S. rations like a Third World nation, allowing 50,000 people to die each year from easily treatable and preventable conditions because they do not have access to the system.

 

Medicynical Note:  Read the article.

 

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Why Drugs are Expensive: Marketing Costs

Posted on August 10, 2012 | Leave a comment

Drug companies spend as much or more on marketing than they do on research.  In the first quarter of 2012 direct to consumer advertising approached 1 billion dollars.

The costs of marketing to doctors,  and this is admittedly old data, is reflected in this graph.

  Capture

Today one would expect at least a 100% increment paralleling the increase in health care costs over the same period of time. 

Aggressive marketing has been shown to effect doctor’s decisions and increase patient expenditures, and overall costs.  Guess who pays?

Medicynical Note:  Read the links for more details.

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It’s all about the money: Dermatologic Drug Price Inflation

Posted on August 9, 2012 | Leave a comment

Health care at one time was a altruistic endeavour.  Yes you earned a living and companies made profits but most providers were individuals and most institutions, non-profits.   The pharmaceutical industry at the time had the moniker, “ethical.”

Since the mid eighties there has been a unceasing inflation in costs.  Individual providers are anachronisms today and non-profits for the most part have converted into to for-profit entities.  As a matter of fact, because of a lack of concern about costs, even the non-profits that survive charge the same or more.

The report today in the Times on the rapid increase in generic dermatologic drugs re-emphasizes the point the prices in health care have nothing to do with costs of “development” or production.  It’s simply whatever drug companies choose to charge.  Since the number of suppliers and producers are few they are not inclined to compete on price.  So prices sky-rocket:

They are the staples of most dermatology practices: generic creams and ointments that treat everything from skin rashes to athlete’s foot to scabies. Many doctors prescribe the drugs without a second thought. But increasingly, some dermatologists say, patients are complaining about a recent, mysterious and rapid rise in price.

Take betamethasone dipropionate, a cream used to relieve itchy skin. In 2008, a tube cost $18.17. The medicine now costs $71.28, according to Red Book, which tracks wholesale drug prices. Permethrin cream, which kills scabies mites, cost $29.25 in 2008 but has jumped to $71.08 today.

Medicynical Note:  There’s no rational reason for this except that companies charge what insurers will pay.  Since Medicare is forbidden from negotiating prices and private insurers simply pass through the higher prices by adding to co-pays and deductibles, there is no strong countervailing force to control the gouging, particularly for these relatively inexpensive agents. 

In other countries the governments  negotiate prices and control price increases.  In our country our congress, under republican control at the time, forbade Medicare to negotiate. 

Is it any wonder that we pay more, double in some cases, for health care than anywhere else in the world….and I’d hazard a guess that we pay more for these drugs as well. 

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Posted in General Cynicism, Health Economics

American Health Care and Pizza (Papa Johns)

Posted on August 9, 2012 | Leave a comment

In addition to having the most expensive and by inference the most inefficient health care on earth, ours is the most heartless.  As noted in the experiences of this young woman, when you are desperately ill you are forced to spend an inordinate amount of time figuring our your coverage, worrying about life time maximums, finances, and copays and deductibles.

If you have a chronic illness in America, there’s a good chance you also hold a degree in Health Insurance 101, whether you want to or not. The first thing I learned was how lucky I was to have health insurance at all. (An estimated 49 million Americans, and nearly one-third of Americans 18 to 24 years old, are uninsured.) I was on my parents’ insurance, a plan provided through my father’s employer. It’s a comprehensive plan that will cover me until age 26 — two years from now.

I’ve been fortunate to be treated by excellent doctors at world-class hospitals. In the last year alone, my insurance has covered over a million dollars in medical expenses, including a bone marrow transplant and 10 hospitalizations amounting to a combined five months of inpatient care. It all sounds straightforward when I explain it like that. But even if you have insurance, the cost of health care — in dollars as well as in time and stress — is incredibly high.

Read the rest of the article for more.

Medicynical Note:  If Mitt gets his way insurers will be free to discriminate against this young woman and others with serious and debilitating illness and not offer them insurance or price it out of their range.  She is a poster person for health reform in that her coverage through her parents was not allowed prior to the  passage of that act.

Regarding the millionaire owner of Papa John’s Pizza moaning about increasing the cost of an order .15-.20 cents, he should be thankful to be able to offer such coverage to his employees.  Who, but for their good luck, could be facing similar catastrophic illnesses. Would he have preferred no coverage for his valued workers and the government paying directly through Medicaid for their care or having them become financially bankrupt or even worse not having access to care because of lack of insurance or funds.  Apparently Mr. Schatter is a Romney supporter, so who knows what he thinks.

The U.S.is the only industrialized country in the world without a national health plan assuring coverage to all citizens.   How exceptional is that?!

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Posted in General Cynicism, Health Economics, Uncategorized

America’s Olympic Salute to Health Care: Pay More for Less Coverage

Posted on August 8, 2012 | Leave a comment

People in the U.S. were stunned that the Brits should honor it’s health system at the opening of the Olympics.  Of course they expend half or less than what we do on health care/capita, and get comparable outcomes……and the people are quite pleased.  Visualize a similar salute to American Health Care at the next Olympics in the U.S.  from the Columbus dispatch: 

The spotlight widens to show 94 primary-care doctors, in multi-colored scrub suits, forming a ring around David Cordani, the CEO of Cigna Health Care, bowing and scraping to honor the fact that at $19.1 million, Cordani made more in 2011 than all 94 of them combined.

Medicynical Note:  Read the article and weep.  The current tea party and it’s repub echo chamber is pressuring states to torpedo any progressive change in health care in an attempt to maintain the status quo—a money grubbing  dangerous non-system.   Good ole American exceptionalism, or is this a form of cultural self immolation, or are they the same thing? 

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