PNHP

Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care

Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care

Annals of Internal Medicine
August 17, 2004
Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study
By Eve A. Kerr, MD, MPH, et al

We believe that this is the first study to use equivalent instruments and methods to compare quality of diabetes care for patients treated in the VA system with quality for those in commercial managed care systems. We should note that the average results for diabetes quality among the commercial managed care plans participating in this study are at or near the top of diabetes performance when compared with national results for commercial plans participating in the National Committee for Quality Assurance accreditation process. Despite this relatively high level of performance in the commercial plans, we found that the processes of care and 2 intermediate outcomes for VA study participants were better than or as good as those for commercial managed care participants. In many cases, the observed differences in quality of care between VA and commercial managed care were large.

…as an integrated health care system, the VA system has implemented several simultaneous, national-level strategies, such as an integrated electronic medical record, unified nationwide guidelines, service integration, alignment of payment incentives, and effective performance monitoring. While almost all commercial managed care plans also had established diabetes quality improvement and monitoring systems, the Chronic Care Model suggests that changes in several domains of care and investment in quality by organizational leaders are necessary to move the quality needle effectively.

Our results suggest that a federally sponsored national health care organization can provide care that is equivalent to or better than that provided by high-performing commercial managed care plans.

http://www.annals.org/cgi/content/full/141/4/272

Comment: So much for “the government can’t do anything right.”

Canada's vacillating solidarity

The Globe and Mail
August 20, 2004
Then they came for health care
By Rick Salutin

It has been a summer of dire warning about eroding health care, leading doomfully toward a health summit in September. This is not new. For a decade, virtually the entire political class and opinion elites have said our health care is not “sustainable,” as if it is a coastline faced by a weather system. The sole public voice (aside from the public) to reject this fatalism has been Roy Romanow. This week, he noted that tax cuts have cost $250-billion in revenue since 1996 while health costs have risen just $108-billion. In other words, the decline in health care is a result of free human choice.

The reason public opinion has resisted elite wisdom about our hopeless health care is not that people adore those “free” doctor visits, but that they have come to see it as a basic right. It may not have begun that way,but it soon took on that air. This sense of health care as a right makes it resistant to fiscal fear-mongering. What would you say if you were told we cannot afford free speech, or democracy, due to current economic conditions? Health care is different and similar. But rights can be lost, as well as gained. To shed light on how that happens, let me take another case: the right to be free of destitution, known disparagingly as welfare.(Welfare is not just about being poor but being destitute. Welfare incomes are often about 15 per cent of average income and miles below the poverty line.)

The sense of welfare as a human right emerged in the 1960s, like health care. It, too, occurred by stealth. Till then, welfare had been akin to charity, bestowed by their betters on the poor, who were seen as partially or wholly responsible for their plight. But during the Depression, the destitute started being seen as victims of market forces largely outside of their control. The token of this change was the 1966 Canada Assistance Plan (CAP), which offered federal funding for welfare as long as the provinces made it universally available, provided a decent living standard and removed distinctions between the worthy and unworthy poor. It was a kind of informal acceptance of the right not to be destitute.

The retraction of this right — one of the “givebacks” of the 1990s — was the work of then-finance minister Paul Martin. His 1995 budget abolished the CAP, replacing it with the Canada Health and Social Transfer, a pot of money the provinces were handed with far fewer conditions attached. Ontario and B.C. swiftly brought in the old divisions between the worthy and unworthy poor, plus programs such as workfare. The right of Canadians not to be destitute was effectively repealed. It’s striking that this did not extend to the health component of federal funding. There, standards stayed in place and the right to health care stood. The ill as a class were now treated as more fully human, as mirrored by their rights, than the poor — surely due to calculating the votes involved.

This was bad news for the poor. But I’d say it was also bad news for the rest of us. The loss of the right not to be destitute makes the poor less fully human. The non-poor, meanwhile, become more fully human, and they get to show it by lording it over the poor, deciding their fate by giving or withholding welfare. This kind of social breakup is the essence of charity,which was defined in 1825, for instance, as something that exists “to signify the promoting of the happiness of our inferiors.” Welcome to the 19th century. Less human solidarity, more division and strife.

The accumulation of human rights is a social, historical process. It isn’t handed down once and for all. It can move ahead and fall back. If you can find a reason to deny the rights of the destitute, you can do the same for those of the ill. Why not give health care only to those who deserve it, who exercise, don’t smoke etc. It is not inherently illogical. The same for free speech. You can find reasons to withdraw it: terror, moral decay . . . The right to vote? At one time, it went only to those with property or other virtues.

When they came to take away the rights of the destitute, I was not destitute, so I did not speak out. Then they came to take the rights of the ill.

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040820/COSALU20/TPHealth/

Comment: Whether in the United States or Canada, is it solidarity that is vacillating? Or is it merely due to our all too feeble efforts to involve ourselves in the political process?

Canada’s vacillating solidarity

The Globe and Mail
August 20, 2004
Then they came for health care
By Rick Salutin

It has been a summer of dire warning about eroding health care, leading doomfully toward a health summit in September. This is not new. For a decade, virtually the entire political class and opinion elites have said our health care is not “sustainable,” as if it is a coastline faced by a weather system. The sole public voice (aside from the public) to reject this fatalism has been Roy Romanow. This week, he noted that tax cuts have cost $250-billion in revenue since 1996 while health costs have risen just $108-billion. In other words, the decline in health care is a result of free human choice.

The reason public opinion has resisted elite wisdom about our hopeless health care is not that people adore those “free” doctor visits, but that they have come to see it as a basic right. It may not have begun that way,but it soon took on that air. This sense of health care as a right makes it resistant to fiscal fear-mongering. What would you say if you were told we cannot afford free speech, or democracy, due to current economic conditions? Health care is different and similar. But rights can be lost, as well as gained. To shed light on how that happens, let me take another case: the right to be free of destitution, known disparagingly as welfare.(Welfare is not just about being poor but being destitute. Welfare incomes are often about 15 per cent of average income and miles below the poverty line.)

The sense of welfare as a human right emerged in the 1960s, like health care. It, too, occurred by stealth. Till then, welfare had been akin to charity, bestowed by their betters on the poor, who were seen as partially or wholly responsible for their plight. But during the Depression, the destitute started being seen as victims of market forces largely outside of their control. The token of this change was the 1966 Canada Assistance Plan (CAP), which offered federal funding for welfare as long as the provinces made it universally available, provided a decent living standard and removed distinctions between the worthy and unworthy poor. It was a kind of informal acceptance of the right not to be destitute.

The retraction of this right — one of the “givebacks” of the 1990s — was the work of then-finance minister Paul Martin. His 1995 budget abolished the CAP, replacing it with the Canada Health and Social Transfer, a pot of money the provinces were handed with far fewer conditions attached. Ontario and B.C. swiftly brought in the old divisions between the worthy and unworthy poor, plus programs such as workfare. The right of Canadians not to be destitute was effectively repealed. It’s striking that this did not extend to the health component of federal funding. There, standards stayed in place and the right to health care stood. The ill as a class were now treated as more fully human, as mirrored by their rights, than the poor — surely due to calculating the votes involved.

This was bad news for the poor. But I’d say it was also bad news for the rest of us. The loss of the right not to be destitute makes the poor less fully human. The non-poor, meanwhile, become more fully human, and they get to show it by lording it over the poor, deciding their fate by giving or withholding welfare. This kind of social breakup is the essence of charity,which was defined in 1825, for instance, as something that exists “to signify the promoting of the happiness of our inferiors.” Welcome to the 19th century. Less human solidarity, more division and strife.

The accumulation of human rights is a social, historical process. It isn’t handed down once and for all. It can move ahead and fall back. If you can find a reason to deny the rights of the destitute, you can do the same for those of the ill. Why not give health care only to those who deserve it, who exercise, don’t smoke etc. It is not inherently illogical. The same for free speech. You can find reasons to withdraw it: terror, moral decay . . . The right to vote? At one time, it went only to those with property or other virtues.

When they came to take away the rights of the destitute, I was not destitute, so I did not speak out. Then they came to take the rights of the ill.

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040820/COSALU20/TPHealth/

Comment: Whether in the United States or Canada, is it solidarity that is vacillating? Or is it merely due to our all too feeble efforts to involve ourselves in the political process?

New Hampshire uses market reform to cover the healthy

New Hampshire uses market reform to cover the healthy

The Union Leader
August 18, 2004
State health insurance ‘reform’ is making matters worse
By Burt Cohen

I know I’m not the only one whose health insurance premium has long since surpassed my mortgage. This is crazy.

But hang on to your seat. Thanks to a bill sponsored by Sen. Russell Prescott, R-Kingston, it’s going to get much worse. Prescott’s infamous Senate Bill 110, with Gov. Craig Benson’s active support, became law despite overwhelming evidence it would do great harm.

The simple premise of SB 110 was that, by allowing market forces free rein,more health insurance companies would be drawn to New Hampshire, and health insurance costs would drop. My goodness, it didn’t turn out that way.The actual results are that insurance will now be cheaper for the young and healthy (who generally don’t even buy health insurance), but more expensive for the old and sick. Premiums are skyrocketing from 25 percent to 75 percent, or more, for small businesses and families across New Hampshire.

It was obvious at the time that SB 110 was about cherry picking. It enables insurance companies to make more money by being more selective in who they underwrite. They can now charge higher rates for small groups according to
geographic region, as well as age or health.

The public good is served when the healthy help pay the costs of caring for the sick. And it’s not like we have a choice in getting sick. While it is certainly fair to have bad drivers pay more for insurance, is it fair to charge the sick more for their unchosen predicament? Yet that’s exactly how SB 110 works.

It’s hard to imagine, but thanks to Sen. Prescott’s bill, today our New Hampshire government is prying deep into private personal information.You must list every health problem, and every medication taken by anyone in your family during the past five years. So here we have it: The state of New Hampshire, through SB 110, is now serving the interests of the health insurance industry against the interests of the citizens.

Yes, we have to do something. More and more health care providers are coming to the conclusion that it’s time to create a national solution,something like an expanded Medicare system.

http://www.theunionleader.com/articles_showfast.html?article=42473

New Hampshire’s Chapter 420-G: Portability, Availability, and Renewability of Health Coverage:
http://www.gencourt.state.nh.us/rsa/html/indexes/420-G.html

Comment: The splitting of insurance coverage into high risk and low risk pools is not some theoretical policy proposal by advocates of “consumer directed” health coverage. It is already here. Health coverage is being made affordable for the larger sector of our population that is relatively healthy. Those with higher health care needs are being shoved into unaffordable high cost pools.

We desperately need to establish one single universal risk pool that spreads the costs equitably. Is this concept really so complex that we should remain frozen in inaction?

McKinney, Texas, drugstore offers prescriptions at no profit for needy

The Dallas Morning News
July 31, 2004, Saturday

McKinney, Texas, drugstore offers prescriptions at no profit for needy
By Paul Meyer

To order prescription drugs for less, please visit:
http://cheapdrugsforall.com

McKINNEY, Texas — As pill prices rise, politicians wrangle and some customers search north of the border for help, one of Texas’ oldest drugstores is offering a novel remedy grounded in old-fashioned values.

Last month, Smith Drug Co. began selling prescriptions at no profit for underinsured and uninsured customers a move some doctors and industry observers call unprecedented in their experience.

“It’s really not fair to the customers to take advantage of them,” said Kaylei Mosier, owner of the 145-year-old store in McKinney’s historic downtown.

Take the drug ciprofloxacin, a generic medication commonly prescribed to treat infections. For 20 500-milligram pills, customers spend $ 84.59 at a Walgreens.com. CanadaPharmacy.com charges $ 36 for the same amount, based on a 100-pill order.

At Smith Drug, it costs $ 10.22, including a $ 7 charge for labor and overhead, according to a letter sent to doctors this month.

“Generic drugs are the ones that are marked up the most, have the greatest variation [in cost] and make the pharmacies the most money,” said Devon M. Herrick, research manager for the National Center for Policy Analysis.

Both the Texas Pharmacy Association and American Pharmacists Association said Friday that they haven’t heard of another pharmacy with a similar program.

“This is the first experience I’ve heard of somebody willing to sell at cost,” said David Gonzales, director of public affairs for the Texas Pharmacy Association.

“You have other pharmacies that would question the wisdom of doing that from a profit standpoint, but that would be a business question.”

Carla Chandler, 42, has insurance that covers three of her five medications. For one of the others, she called every pharmacy in the area and says she was quoted about $ 240 at one store. At Smith, the bill was $ 16.68. Drug delivery was free.

“My mouth dropped open. I said, ‘Excuse me, that can’t be right,’ ” Ms. Chandler said when she learned the cost of her medication at Smith Drug.

“If it wasn’t for them, it would mean we would have to go without paying one of our major bills.”

The same applies to Marjorie J. Washington, 76, who became uninsured after moving here from Missouri.

Ms. Washington, with six prescriptions, said prices she pays at Smith Drug are less than her co-payments under her old insurance.

“I wouldn’t have any money if it wasn’t for them,” she said. “I couldn’t do anything but eat and buy drugs.”

McKinney urologist Jerry Frankel, a member of Physicians for a National Health Program, said he tries to send all his patients, insured or not, to the pharmacy after learning of the new policy.

“You can’t make a living just taking care of uninsured people,” he said.

“I’m trying to direct people with open minds and good insurance to go there as well.”

Excluding preganancy from insurance risk pools

Excluding preganancy from insurance risk pools

Los Angeles Times
August 18, 2004
State Bill Mandates Maternity Coverage
By Marc Lifsher

The measure by Sen. Jackie Speier (D-Hillsborough) would affect a relatively small number of Californians: the 354,000 who get their health insurance outside of employer-provided group plans and don’t buy maternity coverage.

Kaiser Permanente, the state’s largest healthcare provider, thinks maternity care should be part of any basic health service. Slightly smaller rival Blue Cross of California, a subsidiary of WellPoint Health Networks Inc., contends that getting pregnant is a choice and that outlawing the exclusion would drive up insurance costs.

Speier and her supporters say they want to protect women against discrimination and prevent insurance companies from exploiting a legal loophole by covering only certain medical conditions – a practice known as cherry-picking. (Federal law prohibits insurers from excluding maternity benefits from employer health plans, which cover 97% of Californians who have health insurance.)

“If you’re going to tailor healthcare to the individual . everybody’s costs would skyrocket,” Speier said. “The reason that healthcare works now is because we spread the risks over the entire population.”

Although (Gov. Schwarzenegger) hasn’t taken an official position, his insurance advisor, Scott K. Reid, wrote a letter to Speier opposing the bill. “This bill would limit choice in the marketplace and increase costs for consumers who desire a lower-cost insurance product that excludes maternity coverage,” he said.

http://www.latimes.com/business/la-fi-maternity18aug18,1,2163960.story?coll=la-home-business

Comment: Customizing insurance coverage by allowing shoppers to choose from a menu of options for coverage would reduce costs for those who likely would not need the services declined. But for those who are clustered with individuals who have greater specific needs, the costs of the segregated pools would be significantly higher and unaffordable for many. An equitable insurance pool shifts costs from those with greater needs and dilutes those costs amongst the greater number of individuals with much more modest needs.

Segregating higher cost individuals into separate pools is irrational, but assessing financial penalties on pregnant women is inhumane. We should establish our own equitably-funded universal insurance pool and tell Blue Cross/WellPoint to get lost.

State health insurance 'reform' is making matters worse

Another View: State health insurance ‘reform’ is making matters worse
By BURT COHEN
Guest Commentary

WHICH COSTS you more: your mortgage or your health insurance? From talking to many neighbors, I know I’m not the only one whose health insurance premium has long since surpassed my mortgage. This is crazy.

But hang on to your seat. Thanks to a bill sponsored by Sen. Russell Prescott, R-Kingston, it’s going to get much worse. Prescott’s infamous Senate Bill 110, with Gov. Craig Benson’s active support, became law despite overwhelming evidence it would do great harm. Citizens of all political stripes are up in arms, as they should be.

The simple premise of SB 110 was that, by allowing market forces free rein, more health insurance companies would be drawn to New Hampshire, and health insurance costs would drop. My goodness, it didn’t turn out that way. The actual results are that insurance will now be cheaper for the young and healthy (who generally don’t even buy health insurance), but more expensive for the old and sick. Premiums are skyrocketing from 25 percent to 75 percent, or more, for small businesses and families across New Hampshire.

The argument for passing SB 110 was that insurance costs are high, so we’ve got to do something — anything. Well, actually no, not if it makes matters worse. I am reminded of Barbara Tuchman’s perceptive book “The March of Folly,” in which folly is defined as “government pursuit of a policy contrary to the self-interest of the constituency involved . . . a policy which is perceived to be counter-productive in its own time, not merely by hindsight.” SB 110 clearly fits that definition.

It was obvious at the time that SB 110 was about cherry picking. It enables insurance companies to make more money by being more selective in who they underwrite. They can now charge higher rates for small groups according to geographic region, as well as age or health. Any legislation that forces employers in the economically depressed North Country to pay more, shift costs to employees or drop health insurance altogether is completely counter-productive. It is not in our state’s best interest.

The public good is served when the healthy help pay the costs of caring for the sick. And it’s not like we have a choice in getting sick. While it is certainly fair to have bad drivers pay more for insurance, is it fair to charge the sick more for their unchosen predicament? Yet that’s exactly how SB 110 works.

Another odious part of the new law requires employees to fill out the “New Hampshire Family Health Statement” questionnaire. I’ve talked to many employers who hate being forced to ask these invasive questions of their loyal employees. It’s hard to imagine, but thanks to Sen. Prescott’s bill, today our New Hampshire government is prying deep into private personal information. You must list every health problem, and every medication taken by anyone in your family during the past five years. So here we have it: The state of New Hampshire, through SB 110, is now serving the interests of the health insurance industry against the interests of the citizens.

And what about Sen. Prescott’s claim that insurance companies would flood into New Hampshire? According to the Insurance Commission, since the bill became law in January, just one insurance company has come to this state, period. The three or four others who may come had signaled their intent to enter the market prior to SB 110’s passage.

And it’s not just patients who are getting whacked by our insurance mess. Ask your physician what he or she thinks of SB 110. To them it means a huge amount of new paperwork, with no benefit to anybody. Except, of course, the insurers.

Yes, we have to do something. More and more health care providers are coming to the conclusion that it’s time to create a national solution, something like an expanded Medicare system.

New Hampshire’s new experiment is not a solution. It’s a big problem, and it’s getting worse. The fact is that people across America are struggling with health care costs that are out of reach. Allowing cherry picking by the insurers does not help; it causes harm. Prescott’s puzzling plan is no fix at all. It merely makes a bad problem worse. Voters can take this matter into their own hands. Before you cast a vote in November, it would serve you well to ask your Senate or House candidate how he or she feels about repealing SB 110.

Burt Cohen is a Democratic state senator from New Castle.

State health insurance ‘reform’ is making matters worse

Another View: State health insurance ‘reform’ is making matters worse
By BURT COHEN
Guest Commentary

WHICH COSTS you more: your mortgage or your health insurance? From talking to many neighbors, I know I’m not the only one whose health insurance premium has long since surpassed my mortgage. This is crazy.

But hang on to your seat. Thanks to a bill sponsored by Sen. Russell Prescott, R-Kingston, it’s going to get much worse. Prescott’s infamous Senate Bill 110, with Gov. Craig Benson’s active support, became law despite overwhelming evidence it would do great harm. Citizens of all political stripes are up in arms, as they should be.

The simple premise of SB 110 was that, by allowing market forces free rein, more health insurance companies would be drawn to New Hampshire, and health insurance costs would drop. My goodness, it didn’t turn out that way. The actual results are that insurance will now be cheaper for the young and healthy (who generally don’t even buy health insurance), but more expensive for the old and sick. Premiums are skyrocketing from 25 percent to 75 percent, or more, for small businesses and families across New Hampshire.

The argument for passing SB 110 was that insurance costs are high, so we’ve got to do something — anything. Well, actually no, not if it makes matters worse. I am reminded of Barbara Tuchman’s perceptive book “The March of Folly,” in which folly is defined as “government pursuit of a policy contrary to the self-interest of the constituency involved . . . a policy which is perceived to be counter-productive in its own time, not merely by hindsight.” SB 110 clearly fits that definition.

It was obvious at the time that SB 110 was about cherry picking. It enables insurance companies to make more money by being more selective in who they underwrite. They can now charge higher rates for small groups according to geographic region, as well as age or health. Any legislation that forces employers in the economically depressed North Country to pay more, shift costs to employees or drop health insurance altogether is completely counter-productive. It is not in our state’s best interest.

The public good is served when the healthy help pay the costs of caring for the sick. And it’s not like we have a choice in getting sick. While it is certainly fair to have bad drivers pay more for insurance, is it fair to charge the sick more for their unchosen predicament? Yet that’s exactly how SB 110 works.

Another odious part of the new law requires employees to fill out the “New Hampshire Family Health Statement” questionnaire. I’ve talked to many employers who hate being forced to ask these invasive questions of their loyal employees. It’s hard to imagine, but thanks to Sen. Prescott’s bill, today our New Hampshire government is prying deep into private personal information. You must list every health problem, and every medication taken by anyone in your family during the past five years. So here we have it: The state of New Hampshire, through SB 110, is now serving the interests of the health insurance industry against the interests of the citizens.

And what about Sen. Prescott’s claim that insurance companies would flood into New Hampshire? According to the Insurance Commission, since the bill became law in January, just one insurance company has come to this state, period. The three or four others who may come had signaled their intent to enter the market prior to SB 110’s passage.

And it’s not just patients who are getting whacked by our insurance mess. Ask your physician what he or she thinks of SB 110. To them it means a huge amount of new paperwork, with no benefit to anybody. Except, of course, the insurers.

Yes, we have to do something. More and more health care providers are coming to the conclusion that it’s time to create a national solution, something like an expanded Medicare system.

New Hampshire’s new experiment is not a solution. It’s a big problem, and it’s getting worse. The fact is that people across America are struggling with health care costs that are out of reach. Allowing cherry picking by the insurers does not help; it causes harm. Prescott’s puzzling plan is no fix at all. It merely makes a bad problem worse. Voters can take this matter into their own hands. Before you cast a vote in November, it would serve you well to ask your Senate or House candidate how he or she feels about repealing SB 110.

Burt Cohen is a Democratic state senator from New Castle.

A brief history of disease, science and medicine

From the ice age to the genome project
by Michael Kennedy
(Asklepiad Press, 2004)

Discovery of beneficial drugs or other therapy requires some capability for scientific analysis, studying the effects of administration to sick patients and recognizing evidence of improvement. Before such analysis is possible, the natural history of disease and the diagnosis of different maladies must be known. Greek physicians were capable of scientific observation and ancient medicine was mostly a matter of diagnosis and prognostication since useful remedies were few. The physician who was successful was a good observer and able to predict the outcome of the illness. He often took credit for successful outcomes that he had nothing to do with, a characteristic that makes him seem only more modern.

Asklepiad Press:
http://www.asklepiadpress.com/order.htm

Borders/Amazon reviews:
http://www.amazon.com/exec/obidos/tg/detail/-/0974946648/qid=1092759272/sr=1-1/ref=sr_1_1/103-0155879-1115008?v=glance&s=books

Comment: What does a book on the history of disease and medicine have to do with health care reform? The simple answer is the well acknowledged concept that those who fail to understand the errors of history are doomed to repeat them. But an even greater value of this book is that it provides a clear perspective of the historical basis of our existing health care system.

Understanding that perspective is essential if we expect to design a truly rational system of reform. As a transition into our contemplation of reform, Dr. Kennedy ends his book with a chapter on the economics of medicine.

There is another quality of this book that I should mention. It is truly enjoyable reading. I read it within view of Old Faithful in Yellowstone. I actually missed several eruptions of the geyser because I was so deeply absorbed in the story that Dr. Kennedy has to tell.

The next time that you are looking for some escape literature, make it worth your while. Read Mike Kennedy’s book. It will be fun, and it will recharge your enthusiasm for reform.

Canadian drugs aren't the cure

Canadian drugs aren’t the cure
By Robert Kuttner  |  August 18, 2004

THERE IS something quite lunatic about the entire debate on whether to permit imports of drugs from Canada. It’s not as if Canada manufactures drugs more cheaply. Nor are drugs like trees, or bauxite, or hydro power, which just happen to be naturally plentiful in Canada.

No, the cheaper Canadian drugs are the same ones sold at higher prices in the United States, and either exported or licensed for manufacture in Canada.

Why are they cheaper up north? Because Canada has a policy of controlling drug prices through its national health insurance system. As Deborah Stone, a health policy expert at Dartmouth, has observed, it’s not the drugs we should be importing, it’s the policy.

But the pharmaceutical lobby has so much power in the United States that cheaper drug prices are off the political radar screen. In fact, the recent Medicare bill pushed through Congress by the Bush administration explicitly prohibits Medicare, the largest bulk purchaser of pharmaceutical drugs, from negotiating cut-rate bulk prices. A consequence of these sky-high drug prices is that seniors who elect to take the new Medicare drug coverage must pay thousands of dollars out of pocket each year before the coverage fully kicks in. (Senator Kerry, to his credit, would reverse this policy.)

Instead of debating head-on whether the United States should have a national health program like Canada’s, or at least controlled drug prices, the news media have generally accepted the nonsensical premise that the battle is about imports and that the issue is the safety of drugs from Canada. This is the drug industry line, and it’s a complete red herring. In fact, there is no documented case of an American getting sick because of tainted or adulterated drugs brought in from Canada. On the contrary, Canadian safety standards are at least as strict as our own. But Bush appointees at the FDA, as a service to their allies in the pharmaceutical industry, have tried to make the public focus on safety. Why? Because if drug imports from Canada became widespread, the domestic structure of drug overpricing would collapse. Everyone would buy from Canada.

If the administration were not hostile to the idea of drug imports or cheaper drug prices, it would be easy to set up safety spot checks. Indeed, in areas where the administration promotes free trade, it satisfies its safety concerns with spot checks of raw agricultural products imported from countries whose rudimentary sanitary standards are far less sophisticated than Canada’s. To add insult to injury, the administration is actually pressing America’s trading partners who have lower drug prices to raise those prices so that our high prices won’t stick out like a sore thumb and tempt Americans to seek cheaper drugs from abroad.

The drug industry and its friends in the administration contend that the exorbitant prices are necessary to pay for research. You’ve probably seen the TV ads in which an idealistic research scientist at a drug company vows to find a cure for Parkinson’s or Alzheimer’s, mentioning in passing that it costs $800 million to “bring a new drug to market.”

But as author Merrill Goozner documents in his book, “The $800 Million Pill,” much of the money attributed to “research” goes to advertising and copy-cat drugs rather than true breakthroughs, and much of the actual research is financed by taxpayers through the National Institutes of Health). Economist Dean Baker has calculated that only about one dollar in five that US consumers spend on inflated drug prices go to finance drug research. Baker adds up all the money contributed by taxpayers to drug companies through Medicare, Medicare, the Veterans Administration, and NIH. He concludes that it would be more cost-effective to pay for all drug research through government grants and then put the results in the public domain. Manufacturers, as in the case of aspirin, doxycycline, and other off-patent drugs, would then earn only a normal profit, and all drugs would be far cheaper.

Scientists would still innovate. The pioneers of antibiotics weren’t in it to get rich. Nor was Dr. Jonas Salk. Their breakthroughs quickly went into the public domain to help the greatest number at the lowest cost.

It’s charming that the Republican governor of New Hampshire, Craig Benson, is suing the FDA to allow Canadian pharmacies to fill US prescriptions and that congressmen of both parties have sponsored bills to legalize imports. But these worthies are fighting the wrong fight and ducking the real one. Forget Canada. We need a national policy to lower drug prices right here in the USA.

A Medical Emergency in Ireland Shows Strengths of National Health Service

Jerry
Laura&Jerry

A Medical Emergency in Ireland Shows Strengths of National Health Service
By Laura Zimmermann, second year medical student,
Northwestern University Feinberg School of Medicine.

While gingerly treading among the limestone slabs of the Burren in County Clare, Ireland, my 71-year old grandmother fell and broke her hip. While my father retrieved the rented minibus, my siblings and I carried my grandmother, moaning in pain, past grazing cows to the main road. We raced to the ER of the local hospital in Galway, where the staff immediately took her back to the examining area. We waited anxiously in the lobby, worried about her injury, but relieved that she was receiving emergency attention.

As a second-year medical student at Northwestern University, I look back on this traumatic family vacation in the summer of 2000 and recognize a lesson in health care systems. In the United States, where tens of millions of people go without needed care because of the cost, opponents of national health insurance often claim that patients will end up waiting in long lines for sub-par care. However, this is not what happened to my grandmother when she was treated by the Irish national health service.

My grandmother was diagnosed with a complete fracture of the femur. Her leg was, in effect, detached from her body. Less than twenty-four hours later, we greeted my grandmother, fresh out of surgery. Both she and my entire family were relieved when told she would need ten days to recover before she could leave Galway hospital. My grandmother stayed in a pleasant hospital room called “the Sun Room,” and quickly made friends with her roommates and nurses. Her doctor was “just the nicest man.” Altogether, the hospital provided my Grandmother with emergency care, orthopedic surgery, physical therapy, nursing care, and a lovely hospital room for ten days. Within a few months of arriving home, my Grandmother’s recovery was complete, and she walked without assistance.

Given the amount and quality of the care my grandmother received, the entire family was shocked when the bill arrived. The Irish health service charged my grandmother’s insurance company $6,100 for all the care she received in Ireland. According to Blue Cross/Blue Shield, a U.S. hospital would charge about $35,000, including only four days of hospitalization, and not including emergency treatment.

My grandmother’s care in the Irish national health service was swift, compassionate, high-quality, and effective. “The experience was as good as it could have been considering I broke a bone,” my grandmother says. Unfortunately, my grandmother broke her other femur three years later. That hip still hurts her, while her “Irish hip,” she likes to note, is just fine. Her share of the bill for her care, at a hospital in Illinois, despite having extra coverage on top of her Medicare coverage, was not only more than the entire bill in Ireland, but the bills were so very confusing, they took a lot of my parents’ time to straighten out.

I hope to provide the best care for all of my future patients, not just the wealthy and well-insured ones. Also, patients should not have to face financial ruin in addition to illness. Over a million Americans go bankrupt over medical bills every year, despite the fact that 75 percent of them have health insurance.
The United States has a lot to learn about health care from County Galway, Ireland. Just ask my grandmother, “Jerry.”

Canadian drugs aren’t the cure

Canadian drugs aren’t the cure
By Robert Kuttner  |  August 18, 2004

THERE IS something quite lunatic about the entire debate on whether to permit imports of drugs from Canada. It’s not as if Canada manufactures drugs more cheaply. Nor are drugs like trees, or bauxite, or hydro power, which just happen to be naturally plentiful in Canada.

No, the cheaper Canadian drugs are the same ones sold at higher prices in the United States, and either exported or licensed for manufacture in Canada.

Why are they cheaper up north? Because Canada has a policy of controlling drug prices through its national health insurance system. As Deborah Stone, a health policy expert at Dartmouth, has observed, it’s not the drugs we should be importing, it’s the policy.

But the pharmaceutical lobby has so much power in the United States that cheaper drug prices are off the political radar screen. In fact, the recent Medicare bill pushed through Congress by the Bush administration explicitly prohibits Medicare, the largest bulk purchaser of pharmaceutical drugs, from negotiating cut-rate bulk prices. A consequence of these sky-high drug prices is that seniors who elect to take the new Medicare drug coverage must pay thousands of dollars out of pocket each year before the coverage fully kicks in. (Senator Kerry, to his credit, would reverse this policy.)

Instead of debating head-on whether the United States should have a national health program like Canada’s, or at least controlled drug prices, the news media have generally accepted the nonsensical premise that the battle is about imports and that the issue is the safety of drugs from Canada. This is the drug industry line, and it’s a complete red herring. In fact, there is no documented case of an American getting sick because of tainted or adulterated drugs brought in from Canada. On the contrary, Canadian safety standards are at least as strict as our own. But Bush appointees at the FDA, as a service to their allies in the pharmaceutical industry, have tried to make the public focus on safety. Why? Because if drug imports from Canada became widespread, the domestic structure of drug overpricing would collapse. Everyone would buy from Canada.

If the administration were not hostile to the idea of drug imports or cheaper drug prices, it would be easy to set up safety spot checks. Indeed, in areas where the administration promotes free trade, it satisfies its safety concerns with spot checks of raw agricultural products imported from countries whose rudimentary sanitary standards are far less sophisticated than Canada’s. To add insult to injury, the administration is actually pressing America’s trading partners who have lower drug prices to raise those prices so that our high prices won’t stick out like a sore thumb and tempt Americans to seek cheaper drugs from abroad.

The drug industry and its friends in the administration contend that the exorbitant prices are necessary to pay for research. You’ve probably seen the TV ads in which an idealistic research scientist at a drug company vows to find a cure for Parkinson’s or Alzheimer’s, mentioning in passing that it costs $800 million to “bring a new drug to market.”

But as author Merrill Goozner documents in his book, “The $800 Million Pill,” much of the money attributed to “research” goes to advertising and copy-cat drugs rather than true breakthroughs, and much of the actual research is financed by taxpayers through the National Institutes of Health). Economist Dean Baker has calculated that only about one dollar in five that US consumers spend on inflated drug prices go to finance drug research. Baker adds up all the money contributed by taxpayers to drug companies through Medicare, Medicare, the Veterans Administration, and NIH. He concludes that it would be more cost-effective to pay for all drug research through government grants and then put the results in the public domain. Manufacturers, as in the case of aspirin, doxycycline, and other off-patent drugs, would then earn only a normal profit, and all drugs would be far cheaper.

Scientists would still innovate. The pioneers of antibiotics weren’t in it to get rich. Nor was Dr. Jonas Salk. Their breakthroughs quickly went into the public domain to help the greatest number at the lowest cost.

It’s charming that the Republican governor of New Hampshire, Craig Benson, is suing the FDA to allow Canadian pharmacies to fill US prescriptions and that congressmen of both parties have sponsored bills to legalize imports. But these worthies are fighting the wrong fight and ducking the real one. Forget Canada. We need a national policy to lower drug prices right here in the USA.