Profit Rules

The NIght Pills - Year 2 - 33/365

Image by Amarand Agasi via Flickr

Judging by ads one would think that the drug companies are all about saving lives and improving the health of all human beings. One would be wrong. While it’s true that drug discoveries have greatly improved the effectiveness of treating many conditions, it is not altruism that motivates how drug companies run their businesses. It is profit, pure and simple. As some will know, I have posted on this subject before. In that post I made the point that most R&D investment in what is the world’s most profitable industry is not in drugs intended for cures, i.e., not for antibiotics or vaccines, or fixes for malaria, dengue fever, or even chemotherapy. No, they concentrate on things like statins and drugs for chronic conditions like GERD, high triglyceride levels, psychiatric conditions, and male impotence because that’s where the profits are.

The use of expensive psychoactive drugs alone deserves special mention. Consider this from an article in Psychology Today:

yoga time at the nursing home

Image by Susan NYC via Flickr

Kirsch’s research reveals that psychoactive drugs are not nearly as effective as the pharmaceutical industry would lead us to believe. In fact, of the 42 studies cited above, placebos were found to be 82 percent as effective as the drugs being tested. According to Kirsch, the average difference between the reviewed drugs and placebos was 1.8 points, which, according to Angell, may be “statistically significant,” but “clinically unimpressive.” In light of this information, why do psychiatrists continue to prescribe antidepressants so frequently to their patients? The answer, suggests Angell, has more to do with the pharmaceutical industry’s success at marketing to psychiatrist than the actual clinical effectiveness of such drugs.

I can add from personal experience that I have seen psychoactive drugs routinely prescribed, and indefinitely renewed, to residents of nursing homes and residents of houses for the mentally handicapped with virtually zero evidence of efficacy.  The above referenced article convinces me that my experience is far from unique.

Now comes a revelation in USA Today newspaper that,
Doctors, hospitals and patients across the USA are grappling with a record number of drug shortages, causing them to delay treatment, postpone surgery or make do with costlier and less effective substitutes.  The article says,

Hospitals are running out of drugs used in everything from cancer to surgery, anesthesia and intravenous feeding, according to the Food and Drug Administration.
So far this year, 180 drugs have been in short supply. Virtually all U.S. hospitals say they’ve been affected, and 82% say the problem has delayed care for patients, says the American Hospital Association.
Although drugmakers say they’re doing everything they can to relieve the shortages, some health care experts say they see no end in sight.
“It’s a crisis situation,” says Joseph Hill of the American Society of Health-System Pharmacists.

Why this is happening is admittedly complex, one factor being that many of these drugs are generics and some come from sources with faulty quality control. Generics, of course, are not as profitable as those still under patent. In reading the article there is only one conclusion I can draw: profit drives every business decision and the health of their clientele is only an afterthought and an advertising line for Big Pharma. Now the health of the country is beginning to suffer and some people are in danger of actually dying.

What we are seeing is avarice. Read through the explanations and the arguments and it is all about money. To fix the problem? More money. But wait a minute on that. This is, as I posted before, the most profitable industry in the world. What’s wrong with this picture? What’s wrong is the same thing that’s wrong with the entire medical industry in America. The Medical Industrial Complex has been on a tear for decades to wring maximum profit from its business and it has been so successful that it is now threatening the very livelihood of its client base. Those who tout capitalism as the answer to solve this problem are missing a huge point – when business becomes so big that it can manipulate its own government regulation, true competition evaporates, tacit market sharing enters the picture, and the industry becomes a threat to the very society it says it serves, and in my opinion that is exactly what is happening.

In the meantime, if you get cancer or another serious condition, just hope the right medicine will be available. But if it’s not, Canada and Sweden probably won’t have it either.  Big Pharma has a global reach now, and they do have their priorities.

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About Jim Wheeler

U. S. Naval Academy, BS, Engineering, 1959; Naval line officer and submariner, 1959 -1981, Commander, USN; The George Washington U., MSA, Management Eng.; Aerospace Engineer, 1981-1999; Resident Gadfly, 1999 - present. Political affiliation: Independent, tending progressive as the GOP recedes from its Eisenhower roots.
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31 Responses to Profit Rules

  1. John Erickson says:

    oh, the battles I’ve had with doctors about which drugs to take! Despite the repeated evidence that I am VIOLENTLY allergic to any of the “triptan” migraine drugs, every doctor I’ve had to go through has tried to force them on me – except my current doc, which is WHY he’s my doctor, and has been for 3 years now. He also took me off a number of drugs my Illinois doctor had me on (via the insurance I USED to have) – drugs that included anti-seizure drugs and anti-depression drugs. (Anti-depression? I have PAIN, not depression. Relieve my pain, you make me happy. Simple! 😀 ) I’m feeling better, have lost weight, and am more active as a result. Yes, I realise this is unique to me – but going from a drug-company shill to a free-thinking MD has been a blessing. Now If I could just clone him, I’d make a mint! 😉

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  2. ansonburlingame says:

    To all,

    The situation is indeed complex but yet somewhat simple to me. I would suggest that our standards of medical care are the best in the world for those that can pay for it. But it costs too much to sustain such standards for everyone. The reason it costs too much is the market demands such costs. Drugs cost to much money. Doctors charge too much money for services. Hospitals charge too much money to provide their services.

    So the question, for drugs, for doctors for hospitals, for the cost of a wheel chair, etc. is how to control such costs? Jim chooses to again go after the Big Pharma companies but an argument could well be made for other segments of the Medical “complex” in its individual segments or its entirety.

    The sum total of those costs today in America is somewhere in the range of $2.5 Trillion and EVERYONE wants to see that figure come down (except the communities receiving the $2.5 Trillion). But how to do so, control HC costs, is a great unknown in reality without affecting the standards of care demanded by anyone going for treatment. Take an asprin and soak it will not in any way satisfy Americans even if all it really takes is an “asprin” and a hot bath.

    I remember long ago on TV that liquor was advertised, hard liquor. We finally outlawed that practice it seems. Same for cigarettes but not yet beer. Why not do the same for any medical advertisement I wonder? Let all that propaganda go back into research or even into the pockets of shareholders to be fed back into the economy? I HATE those medical ads with “Talk to your doctor about….!” Hell drug reps already “talk to my doctor” why should I?

    But I only feel very convinced about one thing in terms of government controls over services of almost any sort other than national defense. Government cannot provide goods and services better than a market driven approach in almost any instance. And when it tries to do so out of concerns for fairness or equality, well, just look at deficit spending today to show the results.

    Take away the moral argument for equality and govenment has few legs left to stand upon to take over what was in the past a private and market driven good or service. Sure the moral argument can be overpowering up to a point. But when it leads to an overall degradation in the human condition of ALL Americans, to the point of bankruptcy, well which is worse. Some inequality or lower standards of living for ALL Americans, with something akin to or even worse than the Great Depression becoming the new “standards” for most Americans..

    Seems to me that is the great debate today. We used to make those choices individually and with liberty. Now many argue that liberty must step aside out of concerns for equality. I know where I come down in such a debate. And I totally ignore the ads from Big Pharma and don’t need government to outlaw them. I would do the same if a cold martini was shown on my TV screen as well.

    Anson

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    • John Erickson says:

      I won’t speak for others, but in my case, the doctors I went to were “encouraged” to prescribe the latest by drug company sales hacks. One of my doctors actually walked out of an exam to go chat with the rep, explaining that it was very important in keeping his practice running!
      I’ve also found a strong resistance among doctors to prescribe generics. While some is the unforgivable “latest and greatest” pushed by media and unknowledgeable patients, I did have some problems on my cholesterol meds. Most everything was a “name brand” still “on schedule” (I think that’s what they called it – no generic). It took a list from my pharmacist, and a half-hour going through the “Physician’s Desk Reference” with my current doctor to finally locate a cholesterol that did what I needed AND was a generic. While it was worth it to me, I can see why people wouldn’t want to put such a huge effort into finding drugs – I’m also blessed with VERY friendly (small-town AND Amish) pharmacies.
      No real point, I guess, other than it is certainly not easy to find affordable medications. Just some more personal observations from the front lines. 😉

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      • Jim Wheeler says:

        John, your story is entirely consistent with my reading and my own experience with my wife’s hypertension meds. We are fortunate to have a good family doctor who prefers some older meds over the newer ones. I was later to hear of a large study on the national news that her generic had been found superior, and having fewer side effects, to a supposedly better “new” one in common use. You are to be commended for taking responsibility for understanding your own healthcare. I think very few people do that.

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  3. PiedType says:

    Jim, you’re so right about Big Pharma. There’s not an altruistic bone in their bodies. It’s all about profit, and only profit. I’ve had quite a thread going over at my place (hope I did that link right) about the shortage of triamterene, which actually does look like a self-reported manufacturing problem. But in general Big Pharma’s attitude and professional ethics are reprehensible. I don’t see it changing until we start treating corporations like the people they insist they are, and jail a few CEOs.

    Healthcare reform was such a gutted mess by the time it passed that very little of it is going to work as intended and it will increase costs overall, not reduce them. Obama promised Big Pharma before the talks even began that he wouldn’t touch their profits — and right there a chance at huge savings went out the window. That’s two presidents in a row who dropped the ball on a chance to negotiate lower prices by buying in bulk for Medicare patients.

    Anyway, I have some real bones to pick with Big Pharma, since my dad was a doctor and I was an editor for the medical association for 15 years. It was rather like working in the sausage factory and seeing how it was made. I’d probably have been happier not knowing. Especially as I get into those years when I’m going to be having more medical problems. It is not reassuring to know the entire healthcare industry has feet of clay. All of you are very wise to be asking questions, doing your own readying and research (bless the Internet), and standing up for yourselves.

    Somebody once opined on my blog that it was immoral for the healthcare industry to be profiting off people’s illness and infirmity. I’m torn between that position and thinking that free enterprise is the American way — or used to be, back when a fair to middlin’ profit margin was all anyone asked.

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    • Jim Wheeler says:

      I too am of two minds about Big Pharma’s profits, PiedType. I am a strong believer in capitalism and the profit motive, but there’s something seriously wrong with an industry that spends millions and millions on advertising to influence people who are unqualified to make technical judgements about what medicine they should be on, especially when that advice is often wrong. But, I am not so naive as to expect an industry not to pursue profit aggressively either.

      With your background perhaps you can help unravel the conundrum. I see a major part of the problem to be bias on the part of prescribing doctors. While I have little evidence of overt financial fraud (13 doctors in FL arrested recently in Oxycontin scheme), the pressure to prescribe the latest and most expensive drugs seems relentless. I visit our doctor more often now than I used to and I don’t recall a single visit during which I didn’t see a well-dressed, attractive drug rep either arriving or departing, sample case in tow. That must work or they wouldn’t be paying those people to do that!

      Anyway, thanks for your comments.

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      • John Erickson says:

        It’s not just the rep or the sample case. Look around your doctor’s office. Every pen, every pa of paper, every Kleenex box, every clock, every stapler has some drug company’s name on it. As good as my current doc is, about the only thing without a drug company label is the toilet paper in the head! (And my doc in Illinois actually had toilet paper with a “Big Pharma” name on the wrapper – can’t a guy do his business in private? I always suspected one nurse of having tattoos from one of the big companies, as well, but for some reason, she would never take her clothes off to show me – and me sitting there in a paper gown! 😀 )

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      • PiedType says:

        You bet it works! Those drug reps pass out oodles of free samples, knickknacks like note pads, pens, pencil cups, calendars, etc. (all with conspicuous brand names, of course), and free meals. I once cooled my heels in the waiting room for an hour while the entire staff enjoyed a pizza lunch brought in by a drug rep. Thoughtful doctors will at least schedule the reps in at the end of the day (and have them use the back door) so as not to disrupt patient visits.

        Doctors are very busy and unfortunately too many of them rely on drug reps to keep them up to date on what’s new on the market. The reps, under orders from their employers, often promote off-label uses (not specifically approved by the FDA) in order to sell more of the drug. They may also cite studies affirming the efficacy of the drug, but neglect to mention those studies were financed by the drug’s manufacturer. The studies themselves may be written up by ghost writers, not the researchers who did the work.

        The direct-to-consumer advertising should be illegal. It used to be, but if you grease enough palms in Washington, anything is possible. The point of the ads, of course, is to get consumers to inquire about the drugs and perhaps pressure their doctors into prescribing them. Conscientious doctors do their homework and won’t be moved by these tactics, but some patients, if not given a prescription, will feel they’ve been ill-served by that doctor and may go shopping for another one.

        Sorry to ramble on so. Big Pharma is one of my pet peeves and I could rant about them for hours.

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  4. PiedType says:

    Oops, sincere apologies. Looks like I really mess up that link. 😦

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  5. ansonburlingame says:

    To all,.

    The elephant in this case (or the herd of elephants) is the Medical community. The issue is how much does the profit motive dictate treatment of disease? How does any patient or oversight organization know when that line of profit over patient is crossed? Frankly, I have no idea how to measure such a situation accurately.

    Along the same lines, how do we know that our tax dollars for entitlements are going to people that really need the entitilements and are not just gaming the system for “profit”.

    Considering the money involved in both health care and federal entitlements, it is a question with huge consequences. Dr. Cox a local physician writes frequently calling for more and more federal money for health care but NEVER writes about how such money might be used improperly or even illegally. Two of you are homing in on Big Pharma and demanding reform.

    So I wonder why you two and Dr. Cox don’t write a JOINT blog or column calling for more federal money for health care while at the same time showing how to reform the industry such that the money is not going to illegal or immoral purposes?

    I on the other hand call for more consumer controls on health care money, out of pocket money. If I think that I am being scammed it would be up to me to go find a non-scamming doctor, etc. And my incentive is “profit” or less money coming out of my own pocket. Yet some on the left call me all sorts of “names” for calling for such a resolution for what I admit is a huge societal problem today.

    Pied type said about Big Pharma, “There’s not an altruistic bone in their bodies. It’s all about profit, and only profit.” Well to me that literally jumps off the page as hyperbole, pure and absolute resentment of an entire industry and a gross exaggeration as well. It is that kind of sweeping claim that shows ones “bloomers” of resentment and antagonism that makes me come close to ignoring what one says. Call it a “radical” accusation which simply CANNOT be proven and almost assuredly at least partially false.

    I take one pill a day that is “life saving” in my case and view. For three years it was not a generic drug and cost TriCare about $300 per 90 day supply with me paying $3 copay each 90 days. Then just the other day my refill was a generic drug. My copay remainded at $3 but the cost to Tricare went down by at least 2/3rds or more.

    Because the drug is so important to me I immediately called the phamacy to be sure I would not receive any adverse impacts from the change and was assured all is well. Probably will be the case but I am watching my health more closely as I make the transition.

    That particular drug in my case is a psycho-pharmaceutical one which recently had huge criticism for abuse in these pages. Such drugs and their use by physicans were strongly criticized as an example of an industry run amoke. Well when that same industry literally saved my life, I am not nearly as critical as others. But I also acknowledge abuse therein as well.

    So tough issue needing careful and real insight and correction, along with entitlement reform.

    Somewhere is that short anecdote is a seed for reform I suspect. But at the same time some pharmaceutical company in fact developed a new drug that is a life saver to me. I don’t want to kill that goose with the reform for sure.

    Anson

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    • PiedType says:

      I won’t argue that the drug companies produce life-saving medications. But you can bet you aren’t getting them at the lowest possible cost. Even if you factor in R&D costs, the drug companies make huge profits. In some of the recent reports about nationwide drug shortages, it’s been noted that in the last year before a drug goes off-patent, the manufacturer often will hike the price of the drug to maximize profits before the drug goes generic and the price drops. Other reports have noted that in tough economic times like these, drug companies may cease production of their less profitable and/or generic drugs and concentrate on those that are still profitable. Doesn’t show much concern for patients using those generic drugs, does it?

      While you may think my comment about their altruism is hyperbole, I contend that without profit, these companies would not exist at all. They don’t exist to serve the consumer; they exist to profit from the consumer.

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      • Jim Wheeler says:

        PiedType,

        What you say in this and the prior comment confirms what I have read elsewhere, and I thank you for sharing it, especially since your background includes personal familiarity with the industry. But lest others think I am condemning the concept of capitalism in this post, (nor do I think you are), let me again emphasize the contrary. What I decry is the lack of a remedy to what amounts to monopolies plying their wares through manipulation of the patent system and manipulation of the public through gullibility. This is one of the items on my list to consider before I vote a year from now. One party is anti-regulation and the other is pro-. Something to consider, is it not?

        BTW, I didn’t recall that direct marketing of prescription drugs had been unlawful. Just off the top of my head that sounds like something that should be reversed. It was probably a free-speech issue similar to the Citizens United decision, the one that gave corporate boards the same rights as people. If so, I think there would be little hope of changing that now under the present conservative majority, but I submit it is an issue that we can hope is discussed in the campaigning to come.

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  6. PiedType says:

    Allow me to correct my statement and poor memory. It was a change in FDA regulations, not the law, that unleashed the torrent of DTC advertising. The most succinct history I could find was in an internal AMA report:
    “Pharmaceutical companies began marketing prescription drugs directly to consumers in the early 1980s. In 1983 the Food and Drug Administration (FDA) imposed a moratorium on direct-to-consumer advertising, then lifted it in 1985. Since then, the industry has increased its activities in this area. In 1997, the FDA acted to facilitate DTCA via broadcast media (e.g., television) when the Agency issued a “Draft Guidance for Industry: Consumer-Directed Broadcast Advertisements.” As a result, both the extent and frequency of appearance of DTC advertisements for prescription drugs have significantly increased in both print and broadcast media. To date, 34 prescription drugs have been advertised on television alone. In 1998, approximately $1.3 billion was spent on DTCA, and monthly expenditures on DTCA were five-fold greater than they were just three years earlier. Every indication is that DTCA will continue to expand.”

    http://www.ama-assn.org/meetings/public/annual99/reports/onsite/…/bot38.doc

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  7. PiedType says:

    Doh. I give up on creating live links. This takes you to the document: http://www.ama-assn.org/meetings/public/annual99/reports/onsite/bot/word7/bot38.doc

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    • Jim Wheeler says:

      Thanks, Pied.

      I immediately find three things interesting about the document.

      1. It is not dated. (Why is such a fundamental practice omitted here, if the intent is to clarify?)
      2. It is not identified as to authority, i.e., an FDA document.
      3. The document said,

      ” Whether such advertisements also provide useful information to consumers about treatments for diseases and conditions, encourage consumers to seek medical advice from their physicians, enhance the patient-physician relationship, and potentially result in better health outcomes is at the core of the controversy about DTCA.”

      But, the document’s author did nothing to resolve such questions, and therefore they linger these 2? 3? decades later. Given the sad state of education, about which many of us seem to agree, the regrettable answer, IMHO, is that DTCA of prescription drugs is harmful to society and should be stopped.

      Thanks for the update.

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      • PiedType says:

        As I noted, this is an internal AMA report, not an FDA document. It is dated; A-99 means it was presented during the 1999 Annual Meeting (usually June). It was from the
        AMA Board of Trustees to AMA Committee E. The AMA has no authority over the FDA; this document simply states the AMA position. I quoted it only because it was shortest summary of the history of DTCA that I could find. The 1997 FDA document is out there, but I was going cross-eyed trying to read it and extract the relevant information.

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  8. ansonburlingame says:

    To both,.

    The problem is profit at the expense of adequate treatment. Call it greed if you like.

    The Hypocratic Oath was an early effort to reduce that motive in the practice of the “healing arts”.

    Now show me any government program that accomplishes the abolishment of greed over the service or goods provided? We have “welfare” that promotes “greed” to receive the benefits. We have Wall Street that promotes “greed” to make more money. We have Big Pharma that in some cases promotes greed over health care and we have doctors that do the same thing, sometimes.

    Your call is for government to “fix” that problem through regulations. In 1965 we used government to “fix” racial discrimination and health care costs for people over 65.

    Now listen to the screams of many that say both racial discrimination and health care for those over 65 needs more, more and more government, government, government to fix our situation in those areas today.

    Well, I simply ask today, at what cost to government and how effective might further “fixes” become. Then I will ask is the cost worth the effort on the part of government.

    I KNOW, personally, how to control costs. It starts with “don’t buy it”. But if I HAVE to buy it I “shop” for the “best deals available”. Put government in the driving seat and I can’t shop or won’t do so because I have no motive to shop around for cost effectiveness.

    In that sense, government promotes that which we try, through regulations, to control, greed. But in this case it is greed on the part of the receipent, not the producer. I have my “rights” thus government must GIVE it to me.

    Anson

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    • Jim Wheeler says:

      See, Anson, I was afraid you would take this tack. Your argument above, to me, boils down to the notion that you are given two choices. One, that you will have to endure healthcare as Big Brother government dictates. Two, that you can decide healthcare choices for yourself by shopping for the “best deals available”. You are buying into myths.

      First, a transparent single-payer government system doesn’t have to be dictatorial any more than the Post Office is dictatorial. Second, under the present healthcare system, your freedom of choice is largely an illusion. Big Pharma manipulates the system badly, as has been described, and your shopping, like that of most other Americans’, is presently devoid of any price considerations, as has been described in these pages repeatedly. If there were true competition and patients had skin in the game, as we have agreed, it would be a different matter. But please don’t base your arguments on the illusion that such has been achieved. You know it hasn’t.

      Jim

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  9. ansonburlingame says:

    Of course, Jim,.

    We do not and never will have an ideal system. As mention before in another of your blogs, we are “between” the two extremes of government does all or pure market forces doing it all. It is where do we go from “here” TODAY that involves the debate.

    Do we move towards a government does “more” today or a government does “less” today. You want to, seemingly, go one way towards more government (but certainly not all the way to all government) and I want the exact opposite, more market controls but again not all the way to all market controls.

    We cannot remain at the status quo today simply because we cannot afford the status quo system given our current revenues. We either have to reduce costs of health care (thus change the status quo of how we provide HC to current beneficiaries) or increase government revenues to pay for those costs.

    So what did we actually “do” now two years ago? We expanded the pool of beneficiaries using government power but did nothing with the costs of such HC. We expanded government mandated HC (such as no pre-existing conditions constraints for private providers) and did nothing to reduce the cost of HC. In other words we compounded the problem of the status quo pre-Obamacare, not reduce the pre-Obamacare dilemma.

    Now you and yours seem to encourage (or demand for some) a single payer system. Great, if it reduces the cost of HC AND maintains the quality of service demanded by most Americans, be my guest. BUT you and yours have in no way convinced me that the cost of status quo goods and services will remain as is. In my view the quality and access MUST go down, rather dramatically, for HC before you will have any chance of moving the status quo of HC to the “left”, towards single payer.

    I have never experienced HC in socialized Europe and thus have no direct experience in such. But we have both heard the “horror stories” simply of Canandians flooding across the border to seek our services in HC. Well if you do as proposed, we will have no borders to seek as a resolution for our own perceived needs and must live with a one size fits all system.

    ONE, I am convinced that we cannot afford such a system. TWO I don’t think the majority of Americans WANT such a system. In my case you have a very long road to go to change my mind. For the other Americans that have doubts, I don’t think you have done much to convince them as well, particularly with moral arguments.

    Might I suggest that you and yours call for a single pay system with no reference whatsoever to the “poor”. Stop the moral arguments if you can and show why it is in the best interest of ALL (or at least a very substantial majority like 70% or so of Americans) Americans to go single payer.

    Right now the odds are around 70% OPPOSED to your single payer call. So you have your work cut out for you and yours, politically. And when you make your arguments so very significan financial arguments MUST be included. No smoke and mirrors or Europe does it why can’t we do the same. Europe in fact does not “do it” except for the very small and homogenous countries and even they cannot afford it now and are backing off to the extent that they can do so it seems.

    Remember the “bottom line” for today. We in America spend $2.8 or so Trillion per year for HC. To go single payer you must in my view reduce that cost to around $1.+ Trillion overall. I see no way to achieve such a low cost system and satisfy most Americans today. Something has to “give” and most Americans don’t want it to be their money that they have to “give”, moral arguments aside.

    Anson

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    • Jim Wheeler says:

      Anson,

      The notion that healthcare costs can be reduced with a single payer system rests on demonstrated systems like Canada’s and Scandinavia’s where equal or better outcomes cost half what ours do. Your argument ignores this. You say “we cannot afford such a system”. That is illogical. Are you saying that we couldn’t achieve what they have achieved? QED.

      You also ignore the fact, now firmly established, that the present system is unsustainable with the retirement of the Boomers, the obesity epidemic, and the reality of EMTALA (which nobody, including you, is inclined to change). Your argument also ignores, as it always does, the fact that some 40% of the population is evading the responsibility of health insurance by relying on ER’s.). You disdainfully accuse me of “moralizing”, but you offer nothing as a solution but Ryan vouchers that leave at least a third of the population without adequate healthcare. Are you saying that a national healthcare system should be amoral?

      I wonder why you keep referring to me as “you and yours”? Is this some attempt to lump me with your political liberal antagonists? By doing this you are engaging in name calling as far as I am concerned. But if you are calling me a liberal simply because I want a healthcare system that serves everybody and not just the prosperous and the well-retired pensioners, then you are making a mistake. My ideas are my own, not those of any particular political clique, and if they happen to coincide with liberal ideas, then so be it.

      As far as healthcare goes I have said repeatedly that I would prefer a system where everyone had skin in the game, just as you say you would, a system that would effectively reduce costs through competition that would halve the excessive profits of the Medical Industrial Complex and Big Pharma through competition. But “you and yours” (how do you like it?) apparently find it anathema that profits should be reduced. In any case, you apparently concede you don’t know how to do that.

      What evidence do you have that Europe is backing off of the model? I know that some Canadians occasionally have a scheduling problem and come here for care, but I am unaware of any “flood” of them. And if “70% are opposed to a single payer system”, pray tell me how many people who were polled were under any pressure to change when the current system hasn’t crumbled yet? The ones with employee insurance? No. The prosperous ones with private or self insurance? No, why would they want to pay for others? The ones with Medicare? No. The 40% or so who rely on ER’s? No – they are mostly young and/or healthy and don’t want to pay anything now. The ones who have Tricare? Nope. So, who are the crybabies? They are people like John Erickson who struggles with serious problems and pays as much of the inflated costs as he can. They have fallen between the cracks. Just tough darts, eh?

      But I suppose we could struggle on as we are. Oops. Except for the aging Boomers and their increasing drain on the limited caregiver pool, obesity (with its diabetes, glaucoma, hypertension and other complications), burgeoning dementia, increasingly antibiotic-resistant strains of disease vectors, and the encroaching spread of tropical diseases like dengue fever as the planet warms. (Hey, Big Pharma, how about some new antibiotics to cure some of this stuff? Sorry, the pipeline is full of Viagra right now!) Just to mention a few. Also a stagnant birth rate and diminishing immigration to do the grunt work. And radical climate changes that imperil agricultural prices, not to mention Ethanol and its effect. (Less money for meds, get it?) But what, me worry? Hell, we took care of the world and now we’re retired. We’ve got ours, right? Let’em get their own. Darn those liberals. They and theirs want to wreck every good system we’ve got. Right.

      Jim

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  10. PiedType says:

    Anson, doctors are probably the least profit-driven elements in our healthcare system. There are far faster, easier ways to get rich than by becoming a doctor. Four years of college, fours years of medical school, a year of internship, up to four years of residency, all while working incredibly long hours and piling up hundreds of thousands of dollars in debt. That’s before even starting a practice. In my experience, most doctors become doctors because they are altruists at heart and want to help others. It isn’t they who will deny you care or procedures in order to make a profit; it’s the insurance companies.

    Frankly, I miss the good old days, when a doctor and patient worked out a fair payment between them. (My dad was sometimes paid in chickens, or handicrafts.) The insurance companies, if they were involved at all, only came in after the fact to reimburse the patient directly if the patient filed a claim. Now they often dictate which doctor to see and which treatment you can have. It’s the tail wagging the dog, for profit.

    I don’t read the Hippocratic Oath as you do. I see it as an appeal to high ethical standards and a concern for the patient above all else, not a direct effort to suppress the profit motive. If you’d like to read it again, it’s on my blog: http://piedtype.com/2011/08/15/first-do-no-harm-is-not-in-the-hippocratic-oath/

    As for a single-payer system, Jim … health care reform had a chance to be good, as it was originally proposed. I might almost have gone along with it. But by the time the politicians got through hacking, chopping, and compromising, and finally dropping the public option, it was a hopeless mess. You can’t add 32 million people to the health rolls in the face of an unaddressed national shortage of health care providers and facilities, and expect it to work. It isn’t logical (or even Constitutional) to require those 32 million to buy health insurance when the legislators failed to include the cheap public option that was supposed to accompany that mandate. Nor did the bill repeal the McCarran-Ferguson Act, which exempts health insurance companies from federal antitrust laws and would have forced them to operate in a competitive open market (thus lowering the cost of insurance). As passed, it was a seriously flawed piece of legislation that’s going to increase, not reduce, costs.

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  11. ansonburlingame says:

    Thanks Pied,

    Now we have a good debate going. Jim and I get “stale” throwing our preconceived ideas around at each other many times.

    As noted by Pied, Obamacare has about a 70% “rejection rate” from the general public today. That was the source of my figure above. And Obamacare does NOT come close to a single payer system though it was envisioned as a BIG step in that direction when it was first proposed. Politics made it what it is today, an Obamamess, not better care for ALL Americans. And if the SC does not declare it unconstitutional we will see the costs of Obamcare “tear us apart” come 2014 without strong Congressional correction to the current law.

    Now Jim, you keep accusing me of arguing for the status quo in HC which is just not true. Means testing, raising the cap on SS taxes, even raising Medicare taxes have all been part of my agenda. But those “fixes” will not do ANYTHING to lower the $2.8 Trillion spent today on HC for all Americans.

    The only way to lower that cost is to force patients to put more “skin in the game” for the cost of HC. But I hear NOTHING of substance from the left to achieve that goal, patients paying more (other than the “rich” patients). And as with recinding the Bush “cuts” on the “rich” (meaning raise income taxes on the “rich”) taxing the rich and forcing only the rich to pay more will just be a drop in a much larger bucket. It will not be nearly enough to solve our cost problem with HC while maintaining at least the status quo in goods and services provided.

    One last note for Pied,

    Yes Doctors go through hell to become good doctors. But as I look around town (and the country) I see no “poor” doctors. And if I get sick at night or on a weekend my only option is to go to the emergency room which costs about $4000 just to walk in the door with something wrong. As a child my dad paid “chickens” for the doctor to treat me anytime that I broke an arm or became ill enough that home remedies failed to “lower my temperature” or make me stop crying in pain.

    Anson

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    • Jim Wheeler says:

      OK, Anson, let’s see if we are closing in on it.

      1. Why do you not comment on my reasoning of my previous comment (8/29, 1:33p) for why the “rejection rate” is 70%? Instead you proceed as if it meant something. It was a meaningless poll IMO.
      2. Agreed, that ACA, a.k.a Obamacare, does not handle costs adequately, and yes, it was politics- GOP politics – that gutted it of such provisions.
      3. Admitted, you have indeed “offered” means testing and raising taxes to support Social Security and Medicare, respectively. I do recall it, I agree with it, and that is much to your credit. Mea culpa.
      4. You criticize the “left” for not offering a way to get patients to get “skin in the game”, but you have NEVER offered a way yourself. I have, but they weren’t very good ideas. THAT is why I have RELUCTANTLY come to the conclusion that a government system is the only viable answer. Unless you can come up with one, you should concede the point, should you not?
      5. Agreed – repealing the Bush II tax breaks is not the answer to the HC dilemma because it is much too small. (But it is PART of the answer to restoring a sensible and fair budget.)

      Jim

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  12. PiedType says:

    Anson, that $4000 for your emergency room visit goes mostly to the hospitals and insurance companies to help cover their costs for treating all the non-paying people who crowd the ERs with their non-emergency problems. Those people should have insurance coverage, but why buy it when they can get care for free at the ER? It’s a broken system that’s causing ERs all over the country to close because they are too expensive for the hospitals to maintain. That’s no good for anyone.

    Oh, yes, the doctors get their cut of the $4000, of course. Many if not most of them are emergency medicine specialists who only work ERs and are on staff and paid by the hospitals where they work. I suspect they don’t get terribly wealthy compared to doctors with private practices. It’s a matter of perspective, I suppose. How much does it take to be “rich”?

    Urgent care clinics, where one can get treated for sniffles, fever, a simple broken arm, etc., without an appointment, take some of the pressure off the ERs and help free them up for truly life-threatening emergencies. If only people would use them instead of the ERs.

    I really don’t know what the fix is. My knee-jerk reaction is if your life is not in danger, you don’t go to an ER. You go to a walk-in clinic or wait to see your doctor. I know some people think ERs are their only option because they can’t or won’t pay cash or buy insurance, and they know ERs have to treat them regardless (required by law now; not sure that was necessary or a good idea). But it’s destroying our ERs.

    As for ways to pay for our spiraling HC costs … economics have never been my strong suit. But for starters, I’d be willing to pay a little more than I am now for healthcare. It’s certainly worth it. I also see nothing wrong with bumping up the minimum age for Medicare and Social Security benefits; it happened at least once during my working years and since I wasn’t right on the eve of retirement, it didn’t bother me a bit. I would most definitely let the Bush tax cuts expire. They were supposed to be temporary; the legislation had a specific expiration date written into it. No one should have been surprised or upset or claimed “tax hike!” when that date was reached. They all knew it was coming; they should have prepared for it.

    I haven’t tried it yet, and hope I never have to, but I keep thinking if push comes to shove one day, and the insurance company is telling me they won’t pay for and I can’t have a certain treatment — my doctor and I will work out a payment plan between us that will get me treated. Screw the insurance companies. A bunch of bureaucrats who don’t even know me don’t dictate my health decisions; my doctor and I decide that. (Well, it works that way in my dreams, anyway.)

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  13. PiedType says:

    Jim, what finally got passed as the healthcare reform act was but a shadow of the original proposal. Whether you put much faith in polls or not, Anson’s does seem to show that most Americans, whatever their personal situations might be, realize the bill has serious shortcomings.

    The two parties tore the bill to ribbons in the course of their negotiations. Neither side was blameless. The GOP was determined to deal Obama a mortal blow, no matter what. The Democrats were equally determined to get something — anything — passed because it was to be Obama’s landmark achievement. In the end it had little to do with the bill itself; it was about beating the other party. Period. Eleventh-hour negotiations saw amendments added, clauses stricken, pork added, pork cut. And then everyone voted on the patchwork result, more than 2,000 pages that not one of them had time to read through. Talk about negligent and irresponsible. Stay tuned for clauses no one knew were there, offsets that were supposed to be included but weren’t, oversights, mistakes, omissions, and years of unintended, unforeseen consequences — not the least of which will be layers and layers of new bureaucracy to administer all the changes.

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    • Jim Wheeler says:

      Your analysis makes sense, Type, except I don’t share your opinion that both parties are equally to blame. The truth is in your own analysis when you said,

      The GOP was determined to deal Obama a mortal blow, no matter what.

      Wouldn’t you think that concern for the welfare of the country would over-ride thirst for power? 😆 😆 😆 😆

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      • PiedType says:

        I used to believe the welfare of the country was uppermost in our lawmakers’ minds. The battle over health care reform and the subsequent battle over the budget/debt ceiling have convinced me that for now at least, the two parties would rather beat each other into the ground than work together to do what’s best for the country.

        I think the Democrats are equally to blame because rather than admit HCR had become a 2,000-page fish wrapper and give the GOP a huge victory, they insisted on ramming it through. Had they cared more for the country and less about Obama’s legacy, they’d have backed off and tried again some other time, when the result could have been something well thought out and well written.

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  14. Jim Wheeler says:

    I must admit, Pied, you have a point there.

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