PNHP

Doctors Without Borders: TPP a threat to global health

Doctors Without Borders: TPP a threat to global health

The Trans-Pacific Partnership: A Threat To Global Health?

By Deane Marchbein, President of the Doctors Without Borders USA Board of Directors
Health Affairs Blog, May 8, 2015

Lost in the political discussions over the passage of the Trans-Pacific Partnership (TPP)—a trade agreement currently being negotiated in secret between the U.S. and 11 other Pacific-Rim nations—is the very real negative impact it would have on global health.

Doctors Without Borders/Médecins Sans Frontières (MSF) works in over 60 countries, and our medical teams rely on access to affordable medicines and vaccines. We are deeply concerned that the TPP, in its current form, will lock-in high, unsustainable drug prices, block or delay the availability of affordable generic medicines, and price millions of people out of much-needed medical care.

The public health repercussions of this deal could be massive. The negotiating countries represent at least 700 million people, and U.S. negotiators refer to the TPP as a “blueprint” for future trade deals. The TPP attempts to rewrite existing global trade rules and would dismantle legal flexibilities and protections afforded for public health.

Problematic Provisions

We have concerns with several U.S. government demands in the TPP. For example, the TPP would lower the standard for patentability of medicines. It would force TPP governments to grant pharmaceutical companies additional patents for changes to existing medicines, even when the changes provide no therapeutic benefit to patients. These provisions would facilitate “evergreening” and other forms of abuse of the patent system by lengthening monopolies and delaying access to generic competition.

Another concerning provision in the TPP involves so-called “data exclusivity” for biologics, a new class of medicines that includes vaccines and drugs used for cancer and multiple sclerosis treatment. Data exclusivity blocks competing firms from using previously generated clinical trial data to gain approval for generic versions of these drugs and vaccines. If pharmaceutical companies have their way, the TPP will block generic producers of biologics from entering the market for at least 12 years, during which patients would be forced to endure astronomical prices.

Twelve years of data exclusivity is not only unprecedented in any trade agreement, it is not the law in any of the TPP negotiating countries outside of the U.S., and it would keep lifesaving medicines out of reach of millions of people.

Research And Development

As an organization caring for patients worldwide, Doctors Without Borders understands that there should be incentives to recover research and development investments and to promote innovation. Unfortunately, the public is in the dark on what this research and development truly costs. We are told that it costs billions to research and develop a new medicine, although a significant amount of early research and development actually happens at publicly funded centers and universities.

We are told that the only way to ensure that people receive the medicines they need is by increasing intellectual property provisions, such as those encapsulated in the TPP. In reality, the existing monopoly-based innovation system that the TPP is attempting to standardize has left us with more patents and fewer medical breakthroughs.

As TPP countries aim to conclude negotiations in the next few months, it is essential that the United States and other negotiating countries work to protect existing access to medicines’ safeguards and to promote a public-health driven biomedical innovation system.

http://healthaffairs.org/blog/2015/05/08/the-trans-pacific-partnership-a-threat-to-global-health/

Doctors Without Borders/Médecins Sans Frontières website, “TPP: A Bad Deal for Medicine”: http://www.doctorswithoutborders.org/help-us-fix-tpp

Coalition letter to President Obama: http://www.msfaccess.org/sites/default/files/MSF_assets/IP/Docs/TPP-Joint-Letter-Dec-17-2014-FINAL.pdf

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Comment:

By Don McCanne, MD

Doctors Without Borders/Médecins Sans Frontières, recipients of the Nobel Peace Prize, are warning us of an imminent threat to global health.

The U.S. Senate is expected to act as soon as tomorrow on granting President Obama fast track authority to approve the Trans-Pacific Partnership Agreement (TPP) – an international trade agreement. Fast track approval would prevent the agreement from being modified by Congress, as it would limit their role to an up-or-down vote.

Although the TPP agreement is still secret, it is known that there are many provisions that should be modified or removed. Amongst the more important are the provisions that would allow the pharmaceutical and biomedical industries to lock in high prices for their products, which would price millions of people out of much needed medical care. Blanket approval of TPP would precipitate a series of expensive and unnecessary global medical crises.

This issue should be of direct concern for advocates of single payer reform. A state or national program would have to comply with international agreements, even if that meant perpetuating the outrageous pricing policies of the pharmaceutical and biomedical industries – policies that would impair access to much needed treatments.

President Obama is currently campaigning heavily for fast track authority on behalf of the industries that would profit, while criticizing advocates of social justice for their opposition. Sorry, but we have to work with those who place the people first, including Doctors Without Borders/Médecins Sans Frontières.

The most urgent task: Contact your Senators today and tell them to REJECT fast track authority that would allow the President to unilaterally set the terms for TPP.

NOTE:  The issues are complex. Sen. Elizabeth Warren was specifically cited by Pres. Obama as being “absolutely wrong” in her opposition to fast track authority. Today she fired back at the President.

Public campaign needed for national health service in Ireland

By Caoilfhionn Ní Dhonnabháin
Slugger O’Toole blog, May 10, 2015

In the South we often look enviously at the British National Health Service.

From the injustice and inequality of our two tier system, from our GP waiting rooms where we will have paid €50 or €60 to see a doctor, we see how the NHS was at the center of the debate in the British General election campaign.

As efforts to push citizens in the South into the private health market are ratcheted up we see the growth of grassroots campaigns in support of the NHS. We have heard the emotive words of campaigners such as Harry Leslie Smith who called on the British people to stand up and defend the NHS.

Yes, we recognise that the NHS has its own problems. Under the Tories it has suffered from cut backs and attempts to pursue a privatisation agenda. And with the election of a majority Conservative government the future for the NHS is far from secure.

But for now the debate is quantitatively different.

NHS campaigners are fighting to keep what they already have – to retain something which many British people feel great pride in.

Here those of us who want to see a universal health system are fighting for something we have never had.

And the odds are stacked against us.

Against us stand the vested interests. The private health profiteers. The proponents of neoliberalism. The EU rules on spending and borrowing brought in by way of the Fiscal (Austerity) Treaty.

But there is too much at stake to let that stop us.

We all know people who have been let down and failed by the two tier health system.

We know people who cannot afford health insurance but have borrowed money to have a cancer test privately because the time they are expected to wait in the public system could put their lives at risk.

And we know people who can neither afford insurance nor to borrow for healthcare but who have to wait. Sometimes in pain. Sometimes in fear.

We have seen public patients with late diagnosis die where private patients survive.

An example of this was the high profile case of health campaigner Susie Long.

Her story of her seven month wait for a colonoscopy in the public health system in 2005.

Her late diagnosis.

Her encounter while undergoing chemotherapy with a private patient who had been referred for a colonoscopy at the same time as her but got it after 3 days.

His survival.

Her death.

There have been many other cases just like this.

So many ordinary people whose stories will never be told.

This is an inequality and injustice which many of us are simply not prepared to accept.

So how is it then that we do not have a more vocal public campaign for a national health service in Ireland?

It is back to how this debate is framed and how the dominant political ideology over recent years has seen a greater focus on putting money back in people’s pockets than on strengthening public services.

But for most people on low and middle incomes the pennies they put back in your pocket won’t buy you the healthcare you need.   Remember Susie Long’s case occurred in the boom years of the Celtic Tiger.

We need to start discussing how we build a public health system and how we pay for it. And why a progressive tax system that asks those who have more to pay more is the fairest way to do this.

People’s greatest fears around paying more taxes are what that money will be used for. Sometimes the record has not been good – waste and excessive pay have undermined public confidence. But for many they are open to paying more tax if they are genuinely getting a better service for it.

A public health system would mean many people would not have to pay the exorbitant private health insurance costs which they feel they have to pay for at present.

Healthcare and the choice between public and private is a debate that goes to the heart of what kind of society we want to live in.

It is a debate between those who clearly see that the state must stand by the responsibilities which it has progressively adopted over the last two centuries and those who want to minimise the role of the state – a battle between those of us who believe the in the essential value of solidarity between citizens and those who don’t.

For many the United States stands as a forewarning on what you get when you go down the private health route. Gross inequality. Crippling healthcare costs. Healthcare costs pushing up the costs of living.

But it is worth looking to developing countries to understand how bad it can get when governments cut back on healthcare spending at the behest of those pursuing a neoliberal agenda.

In developing states we have seen how the absence of a developed public health service has impeded the ability to control epidemics such as Ebola with consequences for both citizens in those countries and globally.

The question of the IMF’s role in the Ebola outbreak in Sierra Leone is illustrative of the moral bankruptcy of that organization and neoliberalism as a whole. It is illustrative of its incompatibility with social justice. Structural adjustment programmes created the conditions that made it inevitable that the health system of Sierra Leone would not be able to cope with an outbreak of a contagious disease. Sierra Leone along with Liberia and Guinea were engaged in IMF structural adjustment programmes at the time of the Ebola outbreak – the constraints on public spending meant quiet incredibly that Liberia had only 60 doctors before the Ebola outbreak while Sierra Leone had only 136 with populations of four million and six million respectively. For more on this it is worth reading the Lancet Medical Journal’s article of February 2015 entitled “The International Monetary Fund and the Ebola Outbreak”.

While the experience of the countries affected by Ebola is extreme it is ultimately where the neoliberal and anti-public services agenda brings us.

Neoliberalism may seek to make us individually responsible for our well-being but it cannot change the essence of our interdependence.

In working for a universal health system the challenge now is to promote solidarity as a core value, essential to building a fairer society.

We need to counter individualism and consumerism and false freedoms (such as putting the money in your pocket to pay for your own healthcare) that have done so much to destroy societies, communities, lives and the environment.

It is time to recognise that public healthcare provision is a cornerstone of what a progressive state does for its citizens.

As Britain stands on the verge of discarding the great legacy of Aneurin Bevan and the post war Labour Government, in Ireland it is time to build an alliance of ordinary people, patients, healthcare professionals and political representatives to work towards building a universal public health system for all of Ireland.

http://sluggerotoole.com/2015/05/10/public-campaign-needed-for-national-health-service-in-ireland/

Will we allow our police and firefighters to lose their retiree health benefits?

San Bernardino to slash retiree health care in bankruptcy plan

By Tim Reid
Reuters, May 7, 2015

The southern California city of San Bernardino has proposed virtually eliminating retiree health insurance costs under a bankruptcy exit plan it must produce by May 31, according to an attorney involved in negotiations with city officials.

Steven Katzman, who represents a committee of retirees in talks with the bankrupt city, says a tentative deal has been struck under which retirees would sacrifice the city subsidies they currently receive for health care coverage in exchange for a guarantee that San Bernardino continues to fund and not cut current pension benefits.

The deal would follow an approach taken in the recent bankruptcies of Detroit, Michigan and Stockton, California, where retiree health care was slashed or eliminated, while pensions emerged relatively unscathed.

Retirees, including former police, firefighters and other city workers, can choose to stay with the city health plan, while paying all costs, or they can quit the city health plan and look for coverage in a health exchange, or if eligible, apply for Medicare, the government-funded healthcare program for the elderly.

http://www.reuters.com/article/2015/05/07/usa-bankruptcy-bernardino-idUSL1N0XY3SL20150507

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Comment:

By Don McCanne, MD

In designing the Affordable Care Act, one of the highest priorities was to protect employer-sponsored health plans since they were source of health care coverage for the majority of us. Certainly amongst the most reliable coverage are the plans provided for our police officers and firefighters. No.

As these and other public employees in San Bernardino and other bankrupt cities discovered, their coverage is vulnerable. These workers were forced into a deal wherein they had to give up the ironclad guarantee of retiree health benefits in exchange for protecting their pensions.

At least Medicare would be there for them once they became eligible, though they might face significant financial hardships in the interim. In fact, if we had an improved Medicare that covered everyone, it would always be there, not just for them but for all of us, and we would not have to rely on our employment as a source of health care coverage.

So the best – employer-sponsored health plans – do not provide the stability in health care coverage that we need, and these plans do not even cover over forty percent of us. Besides, the federal government is not subject to bankruptcy. With a single payer national health program, the government would always be there for us.

Almost 17 Million Gained Coverage Under Obamacare

But many Americans still can’t afford medical care, expert says

By Steven Reinberg
HealthDay, May 6, 2015

As a result of the landmark health-reform law known as the Affordable Care Act, nearly 17 million previously uninsured Americans now have health coverage, a new analysis reveals.

The Rand Corporation’s 2013-2015 report said increases were observed across all types of insurance, from employer-provided health plans to Medicaid.

“The Affordable Care Act has really changed the number of people who have access to health insurance,” said lead author Katherine Carman, an economist at Rand Corp. 

Employer-sponsored health plans showed the biggest gain, with 9.6 million newly enrolled as a result of the health care legislation, sometimes called Obamacare.

Another 6.5 million were newly enrolled in Medicaid, the publicly financed health plan for the poor, and 4.1 million were covered through newly created insurance marketplaces. The report also said 2.7 million were insured through non-marketplace plans and other sources.

The findings, published online May 6 in the journal Health Affairs, are based on a survey of about 1,600 Americans aged 18 to 64.

But not everyone is impressed with the findings, among them Dr. Ida Hellander, director of health policy and programs at Physicians for a National Health Program. 

“These findings hide some larger problems in our health care system,” Hellander said.

By Rand’s own measure, about 33 million people remain uninsured in 2015, the fifth year after passage of the Affordable Care Act when about 50 million Americans lacked insurance, she said.

Hellander also pointed to a Congressional Budget Office prediction that at least 27 million will remain uninsured over the next 10 years.

Many others are under-insured, she added.

According to the report, 22.8 million uninsured people became insured and 5.9 million lost coverage from September 2013 to February 2015, when the second open enrollment period ended for Obamacare. This translates to a gain of 16.9 million newly insured Americans.

Growth of employer-sponsored coverage proves fears that employers would drop insurance plans were unfounded, Carman said. This also suggests employer-based coverage will remain the primary source of health insurance, she added.

Among the other findings:

  • 11.2 million people are insured through state and federal marketplaces, including 4.1 million who are newly covered. 
  • Among the 12.6 million people newly enrolled in Medicaid, 6.5 million were not insured previously.
  • Overall, the vast majority of Americans under age 65 experienced no change in insurance provider over the study period, while 24.6 million people changed insurance.
  • Most insurance gains since the rollout of Obamacare occurred during the first open enrollment period — between September 2013 and May 2014.

Despite some insurance gains, Hellander is concerned that many people are under-insured in the wake of the Affordable Care Act, which was enacted in 2010

“While this study found a slight uptick in the proportion of workers with coverage, the long-term trend has been less coverage and a shift in benefits towards skimpier policies or so-called high-deductible health plans requiring large co-pays and deductibles,” she said. “Instead of spreading risk, companies shift it to patients.”

This is also true of private plans sold on the health exchanges, Hellander said. “About 20 percent of the plans are so-called bronze plans that only cover 60 percent of health costs and have deductibles as high as $5,000. Some don’t even cover a prescription until the deductible is met,” she said. 

“People have insurance but can’t afford care,” Hellander said. “We need to eliminate cost-sharing and adopt an improved Medicare for all.”

Meanwhile, Obamacare — the centerpiece domestic legislation of President Barack Obama’s presidency — remains controversial. Republicans have consistently vowed to repeal the law.

SOURCES: Katherine Carman, Ph.D., economist, Rand Corp., Santa Monica, Calif.; Ida Hellander, M.D., director, health policy and programs, Physicians for a National Health Program; May 6, 2015, Health Affairs, online 

http://consumer.healthday.com/public-health-information-30/lack-of-insurance-news-418/almost-17-million-gained-coverage-under-obamacare-699176.html

What does NDP’s landslide victory in Alberta say about single payer?

Alberta’s health care system needs new prescription, NDP leader Rachel Notley tells Calgary crowd

By Dave Dormer
Calgary Sun, April 29, 2015

Restoring a $1 billion cut to funding and eliminating personal levies is the prescription to fixing an ailing health care system, NDP leader Rachel Notley said Wednesday.

“That is a private clinic behind me and that is what Jim Prentice has in mind for you and your family,” she said while campaigning in southwest Calgary.

“That is what a billion-dollar health care cutback leads to and I have a fundamental problem with private clinic health care.

“Private clinic health care is about building a two-tier system where the wealthy, the people who Jim Prentice and his friends represent, can pay to jump to the head of the line instead of treating people on the basis of need.”

Notley said private clinics draw resources away from the public health care system, ultimately undermining it.

“Instead of more of these clinics, I’m proposing we reverse the billion-dollar cutback to health care Mr. Prentice is asking you to vote for in this election and I’m also proposing that we get rid of the regressive health levy,” she said.

“And I’m proposing that we improve our public system with better diagnostics, better long-term care, better mental health care and just plain better health care overall, including better cancer care here in Calgary.

“On this issue, there’s a stark contrast between the vision I’m putting forward and what Mr. Prentice has to offer.”

http://www.calgarysun.com/2015/04/29/albertas-health-care-system-needs-new-prescription-ndp-leader-rachel-notley-tells-calgary-crowd

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Alberta election 2015 results: NDP wave sweeps across province in historic win

CBC News, May 6, 2015

It’s a massive shock that turns Canadian politics on its head: the NDP has won a majority government in Alberta.  

“I think we might have made a little bit of history tonight,” (NDP) leader Rachel Notley told her supporters Tuesday night. “Friends, I believe, that change has finally come to Alberta. New people, new ideas and a fresh start for our great province.”

The long-governing PC Party dropped to third place. The outgoing premier Jim Prentice told his supporters late Tuesday that he had resigned as party leader and had resigned his seat.

The NDP won just over 41 per cent of the popular vote, the Wildrose got 24 per cent and the PCs were at about 28 per cent.

Prime Minister Stephen Harper congratulated Notley on her win.

“I look forward to working with future Premier Notley on issues of importance for Albertans and all Canadians, including creating jobs, economic growth and long-term prosperity across the province and country,” Harper said in a statement issued Wednesday. He also offered thanks to Prentice, a former minister in his cabinet, and wished him well in his future endeavours.

2015 results – Number of seats won (Number of seats at prior dissolution in parentheses)

10 (70) – Progressive Conservatives
1 (5) – Liberal Party
53 (4) – New Democratic Party
21 (5) – Wildrose Alliance Party
1 (0) – Alberta Party
1 – Undecided

http://www.cbc.ca/news/elections/alberta-votes/alberta-election-2015-results-ndp-wave-sweeps-across-province-in-historic-win-1.3062605

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Comment:

By Don McCanne, MD

The landslide victory for the New Democratic Party (NDP) in Alberta appears to represent not only a shift to supporting progressive values and away from Prime Minister Stephen Harper’s conservative politics, but it also appears to be an endorsement of NDP’s strong support of Alberta’s single payer health program, with a rejection of recent trends in privatization of their system.

Lest the victors not become too smug and complacent, it should be pointed out that the progressives (New Democratic Party) received 41 percent of the popular vote, whereas the conservatives (Progressive Conservatives and Wildrose Alliance Party) received a combined 52 percent of the vote. (This may represent an oversimplification since some would label Harper’s PC party as “neoliberal.”)

Nevertheless it is reassuring to see a vote in one of Canada’s most conservative provinces that seems to support their single payer public health system, while rejecting privatized two-tier health care.

What lessons might there be here for the United States?

Privatization isn’t the solution

By F. Douglas Stephenson
The Gainesville (Fla.) Sun, May 4, 2015

Privatization by predatory corporations and the local and state authorities that cooperate with them use state underfunding to sabotage public mental health and social services, “proving” that government is incompetent and unable to deliver services.

The latest idea for privatizing mental health services was first proposed by Florida Gov. Rick Scott, who included it in the proposed proviso language of his 2015-16 budget, a budget that also included further cuts in state funding for mental health services. Among the private, for-profit companies that could qualify to bid on the projects are some of the largest contributors to the governor’s campaign, making a mockery of ethics and conflict-of-interest standards.

We should expect nothing less from Gov. Rick Scott, however, a billionaire businessman who formerly was the infamous “unaware” CEO of Columbia/HCA. Columbia/HCA was fined $1.7 billion for falsified patient billing and giving kickbacks to doctors, perpetrating the largest Medicare fraud in the entire history of the Medicare program.

Sunshine Health, a Miami-based company that is the largest HMO provider under the long-term care portion of the state’s Medicaid managed care program, could be among the companies that competes. It is owned by Centene Corp., which spent $762,000 in campaign contributions in the last election cycle, including nearly $300,000 to the Republican Party of Florida. The company gave another $175,000 to the Republican Governor’s Association, which spent more than $20 million to re-elect Scott.

The standard technique of privatization: defund government services to make sure things don’t work and people get angry, then hand it over to private capital. By continuing to defund state mental health services, the Florida Legislature allows the for-profit, private sector to appear to “rescue” mental health services programs via self-serving profit-driven programs. It won’t be long until privatization falls short in quality service to the patient, but not until the private corporations raid the meager Florida treasury, getting their take going out the door.

Shockingly, we let the Republican Scott administration get away with this. The state of Minnesota learned that adding a profiteering middleman to manage health care delivery has always added costs, not lowered them. Without evidence, private HMOs always claim this will save the state millions annually.

We should remove private corporate insurance and HMOs from the administration of our public programs in Florida. Privatization of Florida’s mental health services will increase costs without any corresponding increase in quality or access to care.

As long as the general Florida population remains passive, apathetic and seemingly unable to advocate for its best interests, the powerful such as Scott and his corporate sponsors will continue privatizing as they please — and laugh all the way to the bank.

F. Douglas Stephenson, LCSW, BCD, is a former president of the Florida Society for Clinical Social Work. He lives in Inglis.

http://www.gainesville.com/article/2015150509901

Gilead and the hedge fund managers

Activists Target Hedge Fund Managers Cashing In on Predatory Drug Pricing Schemes from Gilead Sciences

Vocal New York, May 5, 2015

On the eve of Gilead Science’s annual shareholder meeting, activists criticized the pharmaceutical giant’s decision to price its Hepatitis C Virus (HCV) cure out of reach for millions of sick people by targeting three major hedge fund investors in the company. The groups released a new report charging Julian Robertson of Tiger Management, Steve Cohen of Point72 Asset Management, and other hedge fund managers of profiting from extortionate drug prices on the backs of 3.5 million Americans and 175 million people worldwide who are living with the virus.

Gilead charges as much as $1,125 per pill and $94,500 for a course of its lifesaving treatments, forcing health care systems to limit access, robbing patients of a decent quality of life, and forcing many into serious health problems and complications.

Hedge fund managers are laughing all the way to the bank. A pack of hedge fund managers bet big on Gilead price-gouging schemes in 2014, increasing the number of shares they held by a factor of 12. The bet turned out well for the hedge fund managers – Gilead’s stock rose 84%. But things haven’t worked so well for HCV patients who still can’t get access to Gilead’s overpriced drugs.

“The hedge fund industry directly supports Gilead’s decision to put astronomical profits over people’s lives,” said Fred Wright of the grassroots political group VOCAL New York. “Hedge fund managers, including those we’re protesting today, have unapologetically attacked any effort to control drug costs for the good of the public. They’re parasites feeding off of people’s desperation.”

“While Gilead reports, once again, exorbitant profits from their HCV cures, the majority of the people with chronic HCV infection cannot afford them and are not being cured,” said Luis Santiago of ACT UP New York.  “Millions of people will see their HCV disease progress, with horrendous yet avoidable health results. Gilead’s profiteering is letting people get sicker, knowing there is a cure. Gilead must substantially lower these outrageous prices so the rationing is lifted and we can cure everyone with HCV.”

http://www.vocal-ny.org/blog/press-release-activists-target-hedge-fund-managers-cashing-in-on-predatory-drug-pricing-schemes-from-gilead-sciences/

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Hedgepapers No. 13 – Hepatitis C and Hedge Fund Profiteers

Hedge Clippers, May 4, 2015

A pack of hedge fund managers bet big on Gilead price-gouging schemes in 2014:

Julian Robertson of Tiger Management: “I love Gilead right now. I think it’s fabulous…They’re going to get inundated with cash from the profits on the Hepatitis C drug”

Steve Cohen, Chairman and CEO of Point72 Asset Management, whose firm’s schemes to game drug trials resulted in extensive insider trading investigations and almost landed him in prison

Cliff Asness of AQR Capital Management, who has published extensive rants against Obamacare, and who sits on the board of the Manhattan Institute, which opposes Medicare drug price negotiations

Robert Mercer of Renaissance Technologies, a major backer of key players in the fight against Obamacare, including the Heartland Institute and presidential candidate Ted Cruz

Joel Greenblatt of Gotham Asset Management and Glenn Dubin of Highbridge Capital, also significantly increased their stakes in Gilead Sciences over the course of 2014

These six hedge fund managers increased their shares of Gilead by twelve times during this period. The stock price rose 84% over this period, and the value of their collective holdings in Gilead went from $45 million to $844 million.

That’s a lot of interest in curing Hepatitis C victims – or rather, in squeezing them for profit.

#HedgePapers No. 13 – Hepatitis C and Hedge Fund Profiteers

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Pharmaceutical firms contribute to wealth inequity

Quote of the Day, April 27, 2015

Pharmaceutical firms are buying the rights to the products of other firms, often buying the firms themselves, paying very high prices for these rights. …an even more egregious example is the action of Gilead Sciences in buying up the rights to the newer, more effective Hepatitis C drugs, again paying outrageous prices for those rights. They are recovering this capital cost by charging $1,000 or more for each pill sold, when a course of treatment may be 84 pills.

A massive amount of capital is paid out, requiring the purchasing firm to charge much higher prices for those drugs to recover the funds paid to acquire the drug rights. Who receives the capital paid out? The wealthiest tier – the tier that holds by far the largest percentage of shares in public and private corporations.

https://www.pnhp.org/news/2015/april/pharmaceutical-firms-contribute-to-wealth-inequity

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Comment:

By Don McCanne, MD

Last week in a Quote of the Day it was described how pharmaceutical firms such as Gilead were paying outrageous amounts for drug rights and then passing these extra costs onto patients through much, much higher drug prices, while tacking on exorbitant profits.

Today’s report shows where much of these profits are going: to the hedge funds! The pharmaceutical industry has become a tool of Wall Street in extracting funds from patients and passing them on up to the very wealthiest, including the fund managers themselves – compounding our problem with wealth inequity.

This screams out for government intervention. With this and all of the other abuses, how could we not support moving control of health care financing to our own public program – a single payer improved Medicare for all?

(For those who plead that hedge funds serve not only the wealthiest individual investors, but they also serve institutional investors such as university foundations and union retirement funds, then you should ask yourself if it is proper for these institutions to expand their assets with tainted money. An important role of government should be to ensure that their money is clean.)

To Understand Medical Bills

By James Webster, M.D.
The New York Times, Letters, May 6, 2015

“The Medical Bill Mystery,” by Elisabeth Rosenthal (news analysis, Sunday Review, May 3), is simply another piece of evidence why we need a single-payer (Medicare for all) system.

The waste involved in employing workers to input and follow all the billing and coding minutiae is incalculable, to say nothing of the errors and angst that Dr. Rosenthal described so well.

How long can we afford such nonsense?

The writer is professor emeritus of medicine at the Feinberg School of Medicine of Northwestern University. He resides in Santa Fe, N.M.

HHS moving forward with Pioneer ACO model

Affordable Care Act payment model saves more than $384 million in two years, meets criteria for first-ever expansion

HHS.gov, May 4, 2015

Today, an independent evaluation report released by the Department of Health and Human Services showed that an innovative payment model created as a pilot project by the Affordable Care Act generated substantial savings to Medicare in just two years. Additionally, the independent Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) has certified that this patient care model is the first to meet the stringent criteria for expansion to a larger population of Medicare beneficiaries.

The independent evaluation report for CMS found that the Pioneer Accountable Care Organization (ACO) Model generated over $384 million in savings to Medicare over its first two years – an average of approximately $300 per participating beneficiary per year – while continuing to deliver high-quality patient care. The Actuary’s certification that expansion of Pioneer ACOs would reduce net Medicare spending, coupled with Secretary Sylvia Mathews Burwell’s determination that expansion would maintain or improve patient care without limiting coverage or benefits, means that HHS will consider ways to scale the Pioneer ACO Model into other Medicare programs.

“This is a crucial milestone in our efforts to build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people,” said HHS Secretary Sylvia M. Burwell. “The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier. The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large.”

Pioneer ACOs are part of the innovative framework established by the Affordable Care Act to move our health care system toward one that rewards doctors based on the quality, not quantity, of care they give patients. HHS earlier this year announced the ambitious goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018.

http://www.hhs.gov/news/press/2015pres/05/20150504a.html

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Association of Pioneer Accountable Care Organizations vs Traditional Medicare Fee for Service With Spending, Utilization, and Patient Experience

By David J. Nyweide, PhD; Woolton Lee, PhD; Timothy T. Cuerdon, PhD; Hoangmai H. Pham, MD, MPH; Megan Cox, MHA; Rahul Rajkumar, MD, JD; Patrick H. Conway, MD, MSc
JAMA, May 4, 2015

During Pioneer ACOs’ first 2 performance years, total spending for 1 481 970 aligned beneficiaries increased approximately $385 million ($280 million in year 1; $105 million in year 2) less than spending of similar FFS beneficiaries. A large portion of the smaller increase in spending was from decreases in inpatient utilization among ACO-aligned beneficiaries, although greater decreases in primary care evaluation and management office visits, and smaller increases in the use of tests, procedures, and imaging services, also were related to the observed differential changes in spending. There was no difference in all-cause readmissions within 30 days of discharge, but follow-up visits after hospital discharge increased more for ACO-aligned beneficiaries. Beneficiary reports of care experiences were similar to both the general FFS and Medicare Advantage populations in the first performance year and may have been better in terms of timely care and clinician communication.

Although such success may be replicable in regions with varying market characteristics, not all ACOs did well fiscally—one-third of Pioneer ACOs did not generate lower expenditure growth relative to their comparison populations in their first 2 years, and 2 generated significantly higher expenditure growth their second year. Multiple factors may contribute to these findings. It may take more time for some ACOs to redesign care delivery and learn how to effectively manage the care of a population of FFS Medicare beneficiaries to realize smaller increases in spending. CMS may also need to reexamine specific design elements to facilitate better performance, such as expenditure benchmarking methodologies that are more predictable to the ACO or enhanced benefits and other tools to engage beneficiaries. Reducing Medicare spending through the Pioneer ACO model, then, likely depends on an array of market, organizational, programmatic, and physician-related factors that should be better understood in future implementation and research.

For individual Pioneer ACOs, the results of this difference-in-differences analysis differ from the results that determine whether they share in savings with CMS. The latter results were derived from reconciling the ACO’s projected and actual spending levels as part of their financial incentive to participate in the model, whereas the primary goal of this analysis was to assess the performance of Pioneer ACOs on a set of key spending and utilization outcomes compared with such outcomes in the absence of the intervention. This study does not address other important concerns such as the degree to which the Pioneer ACO model can sustain small increases in spending and high quality performance over longer periods or whether Pioneer ACOs can achieve a meaningful return on investment for the resources they devote to improving care. These results are also limited to Pioneer ACOs and do not include other types of Medicare ACOs.

http://jama.jamanetwork.com/article.aspx?articleid=2290608

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Accountable Care Organizations and Evidence-Based Payment Reform

By Mark McClellan, MD, PhD
JAMA, May 4, 2015

The study by Nyweide et al in this issue of JAMA is the most comprehensive to date on the association of Medicare’s Pioneer ACO program with spending and beneficiary experience with care. Because beneficiaries cannot be randomized to a Pioneer ACO, the authors compared annual changes among beneficiaries assigned to the ACOs with changes among beneficiaries in the same region who were not in an ACO or a Medicare Advantage plan.

In the first year, the spending difference was largely attributable to fewer physician encounters and hospital admissions; in the second year, reductions in “preventable” hospitalizations for complications that may be affected by ambulatory care were more important.

These early results may be viewed as modest. The smaller increase in spending amounted to 4% in year 1 and less than 1.5% in year 2 (though the 2 estimates do not appear statistically different). The estimates do not account for the shared-savings payments to the ACOs, which totaled $77 million in 2012. Nor do they account for the investments of time and money made by the health care organizations.

http://jama.jamanetwork.com/article.aspx?articleID=2290607

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Pioneer ACO Evaluation Findings from Performance Years One and Two

L&M Policy Research, March 19, 2015

From “Results at a Glance”

  • Pioneer ACOs saved a total of $384 million over the first two performance years; most of these savings accrued in the first performance year ($279.7 million in the first performance year [2012]; $104.5 million in the second performance year [2013]).
  • Total spending relative to local markets varied for the 32 individual Pioneer ACOs:
    •   Ten Pioneers had statistically significant savings in both performance years.
    •   Ten Pioneers had statistically significant savings in only one of the two performance years; two of these Pioneers had significant losses the other year.
    •   Twelve Pioneers had no statistically distinguishable savings or losses.
  • Pioneer ACO features explored to date—including hospital relationships, ability to follow beneficiaries across the care continuum, and ACO leadership—do not appear to explain the differences in Pioneer ACOs’ spending performance in the first two years of the model. Provider engagement activities suggest some relationship with Pioneer ACOs’ performance. These findings may be attributable, in part, to the somewhat limited variation in observed structural characteristics that can be measured consistently from available qualitative data across all Pioneer ACOs.
  • Overall spending performance was mainly accompanied by utilization reductions in acute inpatient settings. As a group, Pioneer ACO results showed lower-than-expected utilization in acute inpatient stays and physician services in the first and second performance years compared to local markets. The 10 Pioneers with savings in both performance years had particularly steep reductions in acute inpatient stays.
  • Pioneer ACOs collectively had per-beneficiary-per-month savings in 2012 relative to near markets on physician services, inpatient hospital, hospital outpatient, skilled nursing facility, home health, hospice, and durable medical equipment services. However, the magnitude of savings in these settings was lower in 2013.
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys of aligned Pioneer beneficiaries found that Pioneer ACOs exhibited few changes in patient experience between the first and second performance year. In addition, most ACOs have similar levels of performance to one another in the domains we examined. There appears to be little relationship between savings and high or low CAHPS scores.
  • Pioneer ACOs continue to rely largely on internal sources of learning. Although ACO leadership report gaining insights from consultants, commercial payers, and self-insured employers, they find that as innovators, they have more experience within their organizations that they can draw on than from external sources. Pioneers ACOs had the greatest participation in learning system topics related to cost savings, financial data analysis, and quality results/quality reporting/quality improvement.

From “Conclusions”

Descriptive examination of key ACO features did not reveal measured characteristics that appear to be related to ACOs’ two-year spending results. This finding may be attributable, in part, to the somewhat limited variation in observed structural characteristics that can be measured consistently from available qualitative data across all Pioneer ACOs. For those features where we do observe variation, such as relationship with a hospital or whether ACO providers use a single EHR, it appears that they do not explain Pioneer ACOs’ two-year spending results. One suggestive finding is around provider engagement, where ACOs that place more emphasis on engaging providers through incentives and referral management activities may be better positioned to achieve savings. Ongoing collection and analysis of qualitative data may provide additional insights into key operational features or may reveal that other factors, such as market characteristics, are bigger drivers of spending.

http://innovation.cms.gov/Files/reports/PioneerACOEvalRpt2.pdf

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Comment:

By Don McCanne, MD

Although most reports about the initial experiences with the Pioneer ACO model have been relatively disappointing, nevertheless HHS Secretary Sylvia Burwell in a press release states, “The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large.”

The release further states, “this patient care model is the first to meet the stringent criteria for expansion to a larger population of Medicare beneficiaries.” HHS intends that, by 2018, 50 percent of Medicare payments will be tied to quality and value through such “alternative payment models.”

This study was done with highly select “Pioneer” organizations that were already geared up to put into place policies intended to accomplish the goal of lower costs without impairing quality. The first year reductions in spending were quite modest and not achieved by many of the ACOs, and the second year savings were only one-third of the first year, questioning whether savings could be sustained. Also a portion of the savings was returned as shared savings rewards, plus the calculated savings did not include the offset of investment of time and money by the health care organizations. A savings for Medicare does not necessarily equate with a savings in health care spending.

The mechanisms of the savings are not clear. With the successful Pioneer ACOs there were fewer hospitalizations and fewer physician visits, but this could represent the fact that the Pioneer organizations were caring for healthier patients. Also it is not clear if the ACOs were truly effective in reducing unnecessary physician visits and hospitalizations, or if they were denying beneficial health care services because of incentives provided for reducing spending.

The JAMA authors write, “Reducing Medicare spending through the Pioneer ACO model, then, likely depends on an array of market, organizational, programmatic, and physician-related factors that should be better understood in future implementation and research.” So we do not know what we are doing, yet HHS is going to shove us into an ill-defined and unproven program which will determine 50 percent of Medicare payments in less than three years from now. And doctors thought SGR was bad!

Oregon advocates testify for universal health care

By Saerom Yoo
Statesman Journal (Salem, Ore.), May 4, 2015

Advocates for a universal state health system urged legislators Monday to consider how Oregon could create a publicly funded, single-payer health system.

The Senate health care committee heard testimony on Senate Bill 631, which would establish such a system, but the proponents weren’t asking the panel to pass the bill. They acknowledged Oregon wasn’t ready to enact the policy.

Instead, they used the hearing as a platform to voice why they thought pursuing universal health care as a long-term goal was important. They asked for funding for a study to examine how Oregon could finance such a system.

Charlie Swanson, of Eugene, said the rising cost of health care in the U.S. creates hardships for individuals who cannot afford medical care (even with insurance), for employers that lose their competitive edge and for the state government that struggles to invest in other important programs.

Universal health care would cut administrative costs through simplification, he said. Ultimately, all Oregon residents and workers would have equal access to necessary health care, and providers would not have to worry about whether a particular patient can afford his or her co-pay, or whether his or her payer would reimburse their services.

Sen. Michael Dembrow, D-Portland, a chief sponsor of the bill, said, “We need to take Medicare and improve it and extend it to the entire population. This is the way health care is delivered in virtually all industrialized nations in the world.”

Dr. Paul Hochfeld told the committee that taxpayers already pay for a significant portion of the population’s health care — but that they’re getting a bad deal. The current system splits people in risk pools, and tax dollars either subsidize or fully pay for the highest risk patients — the elderly, disabled and the poor.

Instead, universal health care would put everyone in the risk pool and spread out tax money and the risk over the entire state population, he said.

“There’s a lot of fear of more government involvement in health care, but I think we need to get over it and admit that we’re all paying for everybody anyway,” Hochfeld said. “And we need to design a system that reflects that reality and puts everybody in the same risk pool.”

Sen. Laurie Monnes Anderson, D-Gresham, chairwoman of the committee said she was concerned about how high income taxes would need to be to finance a single-payer system.

http://www.statesmanjournal.com/story/news/health/2015/05/04/oregon-advocates-testify-universal-health-care/26904907/

Single-Payer Activists Outline Possible 2016 Ballot Measure

By Chris Gray
The Lund Report (Portland, Ore.), May 5, 2015

While a legislative effort for single-payer does not have enough support to pass, particularly in the Senate, Sen. Michael Dembrow believes a ballot measure could bring universal healthcare to Oregonians before the end of the decade, using a template to be decided by a comprehensive study.

Single-payer advocates came to the Capitol on Monday to air their passions on behalf of a bill that’s not going anywhere, but a pair of efforts on the horizon may bolster their ideas for replacing private health insurance with a single-payer health plan for everyone.

Charlie Swanson of Health Care of All Oregon told The Lund Report that his organization has submitted three potential ballot measures to the Secretary of State’s office, to put before the voters in 2016. His organization will decide later this month whether to begin collecting signatures.

“The most ideal time would be on the 2016 ballot, and that’d be great if that could happen,” said Sen. Michael Dembrow, D-Portland, Oregon’s longtime champion of single-payer health insurance. “We don’t want to go to the ballot until the organizers could guarantee us a million votes,” he added, reserving the possibility to delay the vote to 2018 or 2020.

Swanson explained that none of the ballot initiatives include details about how the system would actually work. One measure says that healthcare is a human right, and would require the state to guarantee healthcare to everyone. Another calls upon the Legislature to enact a universal healthcare system based on the outcome of House Bill 2828, which funds a comprehensive study, on another ballot measure.

HB 2828 does not call specifically for a single-payer system, but asks health researchers to weigh its merits against other models, including a public option, and then develop a system that meets the goals of affordable, comprehensive healthcare for all Oregonians. Because HB 2828 would involve multiple options, it has a Republican sponsor, Rep. Andy Olson of Albany. A previous, unfunded study attracted nine Republican supporters, including Sen. Jeff Kruse, R-Roseburg.

Dembrow has asked for an unspecified amount of money — potentially $100,000 to $250,000 — from the general fund — after the unfunded study was unable to attract private funding. It’s too early to tell how much money will actually become available, however Sen. Alan Bates, D-Medford, who oversees the health and human services budgets, has co-sponsored the study bill, even though he hasn’t signed onto single payer.

The single-payer bill, Senate Bill 631, is similar to previous legislation that would initiate a single, streamlined health financing system for Oregonians. Championed in the Senate by Dembrow and Sen. Chip Shields, D-Portland, it drew a few more sponsors this time — five in the Senate and 22 in the House, but still stands short of a majority, and the hearing Monday was a courtesy from Sen. Laurie Monnes Anderson, D-Gresham, since it occurred after the filing deadline.

“Even under the Affordable Care Act, many people will remain left out,” said Dembrow. “Second for most people, insurance will still be tied to employment and that has distorted how employment works in this state.”

Obamacare has slowed the rise in healthcare costs, which remain a burden for the business community. And, the high costs of health insurance may deter businesses from hiring sufficient employees, and make existing employees work longer hours, even though they’re less productive. Employers can also reduce the hours of employees to avoid paying for health insurance.

Monnes Anderson is numbered among the Democrats on the fence about a single-payer system, and told activists she questioned the comparisons with other countries since some  face higher tax burdens than the United States.

“They have such a high tax, 50 to 60 percent of income going to the government,” Monnes Anderson said. “That’s why I get nervous when it comes to a funding mechanism.”

But as Professor Chunhuei Chi of Oregon State University pointed out to The Lund Report, the United States already spends more tax money on healthcare than many industrialized countries without a universal healthcare system. In addition to Medicare, Medicaid, Veteran’s Affairs and the Indian Health Service, state, federal and local governments spend an enormous amount of money on public employee health costs. The government also loses revenue from tax expenditures given to businesses that provide healthcare for their employees.

A single-payer system would supplant many if not all of these disparate funding streams.

Beyond government funding, the overall costs of the U.S. healthcare system as a percentage of gross domestic product is 50 percent higher than the next-highest country, The Netherlands.

Chi lamented in the hearing that despite its high costs, the U.S. system lags well behind other industrialized countries when it comes to access, efficiency, and outcomes. Patients also have much longer wait times in the United States than in Britain or France, where about 60 percent of the population is assured of next-day service, compared to 43 percent of Americans and 80 percent for those living in The Netherlands.

In his testimony, SEIU Local 503 president Rob Sisk laid the reasons for high healthcare costs at the feet of a profit-driven troika: the health insurance, pharmaceutical and hospital industries, all angling separately to increase their bottom line and fatten executive salaries at the expense of everyone else, including each other. These are the same entities that oppose single-payer.

“Tragically, for what should be a humanitarian-driven system, healthcare services continue to be exploited by those using it for their own financial interest,” Sisk said. “Executive compensation and profits in all these industries are outrageously – and immorally – high as these industries have spent nearly $3 billion in the last 15 years lobbying for more tax breaks, tax loopholes, exemptions, protections and other special privileges enabling monopolies on high-cost drugs and procedures, excessive fees and other profit drivers.”

In Oregon, all but two hospitals are non-profit, while nearly two dozen hospitals pay their top executives in excess of $1 million, and their official “non-profit” status seems like little more than a means to avoid paying taxes and sharing net revenue with stockholders.

Health insurers, hospitals and the pharmaceutical industry have helped ensure their dominance over both federal and state politics through heavy spending on political campaigns of both major political parties. In Oregon, SEIU, which represents state workers as well as many healthcare workers, and also spends generously on political campaigns, provides one of the few counterweights to their heft.

https://www.thelundreport.org/content/single-payer-activists-outline-possible-2016-ballot-measure

Should Massachusetts adopt a single payer healthcare system?

By Jim Bennett
The Boston Globe, April 26, 2015

From 2007 to 2008, I enjoyed the best health insurance plan I have ever known. I was allowed to choose any primary care physician in my neighborhood who had room for new patients. My prescriptions all came with the same negligible copay, and I could have them filled at any pharmacy. I never received a single bill for a doctor’s appointment or emergency room visit. In fact, the only paperwork I ever handled were my prescriptions and the reminder card for my next appointment.

My mystery insurer? It was the British National Health Service.

While my description of life on NHS may sound like an impossible dream to many people in Massachusetts, it is the daily reality known to millions in dozens of prosperous countries across the developed world. Some of them, such as the UK, opt for healthcare that is entirely government-run. Others, such as Canada and Australia, opt for a single-payer system, whereby hospitals and medical practices are privately managed, but a single government agency handles medical payments. In other words, it’s much like Medicare, but for everyone.

Many arguments for a single-payer system start from a moral premise. I would appeal to rational self-interest. We now spend far more money on healthcare than any nation with a single-payer system, about twice as much per capita than Canadians, for example. In Canada, rather than having private insurers work out payment plans with hospitals and pharmaceuticals that create inflated profits, provincial governments act as consumer advocates to ensure that prices remain at market rates. Moreover, because everyone is insured and there are no financial incentives for costly procedures, treatable conditions receive attention early on and do not reach crisis phase. Finally, in what may sound like irony to some, government management of healthcare significantly reduces the costly and stress-inducing red tape and bureaucracy that characterizes our current system.

Imagine a world where businesses would raise up their part-time workers to full-time status without worrying about the cost to their company health plan; where individuals would not have to wade through an ocean of paperwork after a brief stay in the hospital; and where no one would ever again face medical bankruptcy just to remain alive. All that is possible in Massachusetts if we decide to follow the successful lead of so many other nations, and lead our own nation into a more healthy and cost-effective future by adopting a single-payer system.

Jim Bennett is a member of the Melrose Democratic City Committee.

https://www.bostonglobe.com/metro/regionals/north/2015/04/25/the-argument-should-massachusetts-adopt-single-payer-healthcare-system/2s0DQWU8iRCcvGwzDK9C9O/story.html

Restating the facts on health care

By G. Richard Dundas, M.D.
Bennington Banner, Letters, April 28, 2015

I recently attended a meeting at St. Peter’s Episcopal Church at which we discussed Green Mountain Care and the Affordable Care Act. Subsequently, a Banner reporter wrote an article in which he misidentified a member of the audience as Rep. Alice Miller. The participant had some negative things to say about the Canadian health care system and its costs. Miller was not at this meeting as she was busy doing her job in Montpelier. Furthermore, I know that Alice favors a health care system in the United States which, like the Canadian system, features universal health care.

It might be useful to restate the facts and compare the Canadian system to ours. Even better would be to compare the U.S. system to that of 11 other wealthy industrialized nations. Last year, the Commonwealth Fund did just that in their report “Mirror, Mirror on the Wall, 2014 Update.” They studied Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S. The U.S. ranks dead last. It turns out that the United Kingdom ranks first, Switzerland is second, and Canada next to the last. Other nations that were not included in this study (Singapore, Hong Kong, Italy, Japan, South Korea, etc) also have excellent health care systems.

Each of the other nations insures all residents (universal care). The U.S. does not. Before Obamacare there were 50 million people in our country who had no health insurance; currently there are about 37 million. Without insurance, people tend to put off needed health care. It is estimated that about 40,000 people died in 2013 because they had no insurance, couldn’t afford care, and didn’t go for care until it was too late.

The other nations in the study lead the U.S. in such important things as life expectancy and infant mortality. We ranked last in efficiency, equity (the rich get better care than the poor), and healthy lives. We ranked ninth in access to care and seventh in safety of care.

Even though we rank last among these nations, we rank first in a single area — the cost of care. The health care cost per capita in 2014 was $3,647 in the United Kingdom but was $8,895 in the U.S. The health care cost as a percentage of the GDP in 2014 was 9.4 percent in the United Kingdom but was 17.2 percent in the U.S. The extra 7.8 percent of our GDP amounts to about $1 trillion per year. Some of these dollars could reduce our national debt or pay for other things such as housing or infrastructure.

The U.S. provides relatively poor care at an excessive cost. The solution is to implement a better system.

A better system would include universal health care and a single payer. Universal care would help our problems with access and equity. Single payer would help our problems with efficiency and would lower costs.

The hurdle is that we must first wrest power away from the corporations (mainly insurance companies and pharmaceutical companies) who now control our health care and who have disproportionate influence on our federal government.

Dr. G. Richard Dundas resides in Bennington.

http://www.benningtonbanner.com/letters/ci_28007095/letter-restating-facts