PNHP

America’s health-care famine is slowly killing us

America’s health-care famine is slowly killing us

By Clark Newhall
Editorial columnist
The Salt Lake Tribune
01/03/2009

We don’t have a health-care problem. We don’t have a health-care crisis. What we have is a health-care famine.

I realized this when a friend told me that she was not in favor of universal health insurance. She was opposed to paying for health care for all. She has a little boy with cancer. She was afraid that universal health care would mean her little boy would not be able to get an appointment with the oncologist.

“But all those other children with cancer deserve treatment, too, don’t they?” I asked. “I guess so,” she grudgingly admitted, “but I have to worry about my little boy.”

Too many other people’s children would be trying to get appointments and treatment. Too many other people would be competing for a scarce resource — the time of a doctor.

It is a health-care famine.

Perhaps you know the story of Jacob, who predicted seven years of plenty and seven years of famine. When famine came, he was prepared with full granaries. His brothers, who had sold him into slavery, begged him for grain for their starving families and he gave them grain. We are like Jacob’s brothers in the famine, begging for health care. But for us, there is no Jacob. There is only the for-profit medical-industrial complex, gate-keeping us out of the health-care system.

When too many people are fighting to get the scarce stuff to stay alive, whether the scarce stuff is food or health care, that is a famine.

When those of us who have barely enough are willing to sacrifice those others of us who have too little or none at all, that is a famine.

When our own situation is so desperate that we turn a blind eye to the more desperate situation of others, that is a famine.

When dog-eat-dog surpasses “do unto others” as the Golden Rule, that is a famine.

A famine never strikes everyone equally. In a famine, the have-nots become the have-nothings while the haves become the have-barely-enoughs. And, as always, the wealthy survive, even thrive, even profit, from the shortages that are killing others.

This famine is not new — it has been slowly building for years.

The price of our privately run, profit-driven medical-industrial complex has caused this famine. About one-third of every dollar going to health care pays for administrative costs — for utilization reviewers, for computer programmers, for advertising, for sales managers, for executives of all kinds, for billing clerks, for coding clerks, for CEO bonuses in the millions and hundreds of million — and for profits.

We are not talking about government waste. We are not talking about the cost of actually treating the sick and nurturing the healthy. We are talking only about the cost of running our profit-making health insurance industry.

One third of the health-care dollar — that amount is far more than enough to give excellent medical care to everyone in the nation. It is far more than enough to fund the (privately-owned) surgical centers and imaging centers and Lasik centers that sprout up on every corner. It is even more than the amount we have given to Wall Street to bail out financiers and bankers from their hubristic near-demise.

The famine has grown while insurance companies charge higher premiums and reduce coverage, while employers cut their contributions and increase deductibles, while legislators reduce Medicaid and Children’s Health Insurance Program budgets, and on and on.

We are in a health-care famine. Millions of us are suffering and millions more will suffer soon. More than 20,000 people die each year in this famine because they cannot afford the price of for-profit health insurance.

The famine will not end until, like Jacob, we open the granaries and give aid to the starving. The health-care famine will not end until we end the money-hoarding that health insurance companies call “reserves” and “administrative costs” and “profits.”

It will not end until we open our blind eye and see the plight of our neighbor. It will not end until we learn that tolerating a profit-making middleman in the health-care system builds a wall between patient and doctor. It will not end until we learn that good things for everyone can only be accomplished by the will of everyone.

It will not end until we pay for health care in the same way that we pay for everything else that we value highly — our security, our freedom, our laws. It will not end until we have a national health-care system that covers everyone equally and is paid for by everyone equitably.

It is time for national single-payer health insurance. It is time to remove the profit-making middleman from medical care. It is time to see health care for the public good that it is and not for the profitable business it has become. Support Medicare for all.

Clark Newhall is a physician and attorney in Salt Lake City.

http://www.sltrib.com/opinion/ci_11357007

Student Debt, Resident Hours, and Primary Care

Student Debt, Resident Hours, and Primary Care Redux

By Josh Freeman
Medicine and Social Justice (A Blog)
January 2, 2009
The December 18, 2008 issue of the New England Journal of Medicine includes Perspectives on 3 topics that have been previously addressed on this blog: Medical student debt (Dec 14), resident duty-hours (Dec 3, 9), and the future of primary care (Dec 11).
The piece on “Medical Student Debt — Is there a Limit?” by Robert Steinbrook presents data on the extraordinary rise in tuition, and debt, among medical students, most surprisingly in the public medical schools. “For the current academic year, tuition, fees, and health insurance at private medical schools range from $15,278 (for Texas residents) or $28,378 (for non-residents) at Baylor University to $51,969 at Tufts University in Massachusetts and $52,236 at Temple University (for nonresidents of Pennsylvania — state residents are charged at $43,232.” While tuition rates at private medical schools are generally higher than at public, the non-resident tuition at public schools is about the same as that of the privates, and the rate of rise (percent change) in the last 10 years at public schools has far exceeded that at private schools (100% vs 50% increase). Indebtedness ranged from an average (high is different) of $80,000 to $163,000 at public schools, and $70,000 to $182,000 at private schools. Some schools give significant tuition scholarships, but others are more challenged: Stanford’s endowment allows it to give a far larger number of scholarships relative to loans than does, say Drexel. More important, the article points out that the high debt burden may discourage lower-income students from applying to medical school, and to enter specialties with higher income potentials. “It is not surprising that a recent analysis showed a ‘strong direct correlation’ between higher mean salary in a specialty, such as orthopedic surgery or radiology, and the percentage of residency positions filled by US graduates.” The piece says that there is no easy solution, and probably there is not. But most countries have very low medical school tuitions, but require national service of their graduates.
“Revisiting Duty Hour Limits — IOM Recommendations for patient safety and resident education” by John Iglehart, discusses that topic in a balanced way. It points out the acknowledgment in the IOM report that “Although some might propose further reductions in total duty hours, the report notes, ‘evidence suggests it is an indirect and inefficient approach given the moderate correlation that exists between resident duty hours and sleep time.'” Igelhart also notes that “the 2003 limits on duty hours have resulted in an increase in handoffs of patient care between physicians — transitions associated with increased risks to patient safety.” I have discussed this at length, but I did note that this article includes a table with a recommendation I had missed — that internal and external moonlight be counted against the 80-hour per week limits. I have no difficulty with that conceptually, as it makes perfect sense — what is the point of limiting work hours in the residency if residents can moonlight for extra money in an unrestricted fashion? — but I wonder about the legal ability of program directors to restrict the moonlighting activities of their residents in their off hours.
“The Future of Primary Care — the Community Responds” involves a followup to a series of opinion pieces and a roundtable discussion with Drs. Thomas Bodenheimer, Barbara Starfield, Katharine Treadway, Allan Goroll, and Thomas H. Lee that appeared in the November 13, 2008 issue. The comments, and responses from the roundtable participants, are salient and generally useful. Several writers noted the role of physician assistants, and one (Paul Lombardo) states that “Patients, and the U.S. health care system as a whole, would be better served if the content of and level of primary care education were better matched to the needs of patients. The physician assistant (PA) model of medical education, with its emphasis on physician-physician assistant teams, needs to be expanded.”
These are all thorny, and not unrelated, issues. What is the relationship between resident work hours and physician’s assistants? Well, someone has to do the work. Since residents, even with the 80-hour restriction, work twice as many hours as do physician’s assistants, for about half the salary, and have a greater scope of practice, it would be incredibly expensive for hospitals to replace resident labor with that of physician’s assistants, not to mention physicians. As hospitals complain about the “cost” of resident education, this needs to be kept in mind; they are much better at accounting the cost than the benefit. Even if a hospital closes its residencies because it assesses the costs are greater than the benefit, this usually includes the fact that the residents care for many medically indigent patients, and you can be sure that the hospitals are planning to no longer care for them at all, not to pay someone else to do it. This, of course, again decreases access for the most needy.
I have repeatedly said that the nucleus of a solution is a comprehensive national health program, which includes a single-payer and a system that is tasked with ensuring the health and access to quality health care of all Americans. With such a system, addressing issues such as resident work hours, medical student debt, and the composition of the physician (and NP and physician assistant) workforce could be feasible; without it, they all remain insoluble because they all depend upon each other.
(Joshua Freeman, M.D. is Professor and Chair of the Department of Family Medicine at the University of Kansas School of Medicine, though the comments in this blog are his own. He does understand his topic: http://www2.kumc.edu/fammed/Chairman.htm)
http://medicinesocialjustice.blogspot.com/2009/01/student-debt-resident-hours-and-primary.html

Josh Freeman’s comments were selected to start off this year of reform (hopefully) because they set the theme that reform should not be simply about tweaking private and public insurance options; reform needs to be about fundamental restructuring of our health care financing and delivery systems.
Single payer is frequently conceived of as simply an administrative system of collecting funds for health care through an equitable system that is designed to include everyone. Well, it is that, and that would be a great improvement over the dysfunctional, fragmented, inequitable, and inadequate system that we have.
But there is the other side to single payer: spending. Imagine having two and a half trillion dollars under the control of our own single, public purchaser of health care – a monopsony. Scary? Well, yes, but not when you compare it to the horrendously frightening system that we now have – a system which the policy makers in Washington unbelievably wish to expand.
Our current system bankrupts and even kills people. With our own public single payer system the funds would be used to save lives, preserve health, and prevent financial hardship in the face of medical need. Professor Freeman is right on target when he says, “the nucleus of a solution is a comprehensive national health program, which includes a single-payer and a system that is tasked with ensuring the health and access to quality health care of all Americans.” Otherwise our problems “all remain insoluble because they all depend upon each other.”
If we expect someday to have an efficient, high-performance health care system for all of us, repairing and expanding our primary care infrastructure is not an option; it’s an absolute necessity.

Student Debt, Resident Hours, and Primary Care

Student Debt, Resident Hours, and Primary Care Redux

By Josh Freeman
Medicine and Social Justice (A Blog)
January 2, 2009

The December 18, 2008 issue of the New England Journal of Medicine includes Perspectives on 3 topics that have been previously addressed on this blog: Medical student debt (Dec 14), resident duty-hours (Dec 3, 9), and the future of primary care (Dec 11).

The piece on “Medical Student Debt — Is there a Limit?” by Robert Steinbrook presents data on the extraordinary rise in tuition, and debt, among medical students, most surprisingly in the public medical schools. “For the current academic year, tuition, fees, and health insurance at private medical schools range from $15,278 (for Texas residents) or $28,378 (for non-residents) at Baylor University to $51,969 at Tufts University in Massachusetts and $52,236 at Temple University (for nonresidents of Pennsylvania — state residents are charged at $43,232.” While tuition rates at private medical schools are generally higher than at public, the non-resident tuition at public schools is about the same as that of the privates, and the rate of rise (percent change) in the last 10 years at public schools has far exceeded that at private schools (100% vs 50% increase). Indebtedness ranged from an average (high is different) of $80,000 to $163,000 at public schools, and $70,000 to $182,000 at private schools. Some schools give significant tuition scholarships, but others are more challenged: Stanford’s endowment allows it to give a far larger number of scholarships relative to loans than does, say Drexel. More important, the article points out that the high debt burden may discourage lower-income students from applying to medical school, and to enter specialties with higher income potentials. “It is not surprising that a recent analysis showed a ‘strong direct correlation’ between higher mean salary in a specialty, such as orthopedic surgery or radiology, and the percentage of residency positions filled by US graduates.” The piece says that there is no easy solution, and probably there is not. But most countries have very low medical school tuitions, but require national service of their graduates.

“Revisiting Duty Hour Limits — IOM Recommendations for patient safety and resident education” by John Iglehart, discusses that topic in a balanced way. It points out the acknowledgment in the IOM report that “Although some might propose further reductions in total duty hours, the report notes, ‘evidence suggests it is an indirect and inefficient approach given the moderate correlation that exists between resident duty hours and sleep time.'” Igelhart also notes that “the 2003 limits on duty hours have resulted in an increase in handoffs of patient care between physicians — transitions associated with increased risks to patient safety.” I have discussed this at length, but I did note that this article includes a table with a recommendation I had missed — that internal and external moonlight be counted against the 80-hour per week limits. I have no difficulty with that conceptually, as it makes perfect sense — what is the point of limiting work hours in the residency if residents can moonlight for extra money in an unrestricted fashion? — but I wonder about the legal ability of program directors to restrict the moonlighting activities of their residents in their off hours.

“The Future of Primary Care — the Community Responds” involves a followup to a series of opinion pieces and a roundtable discussion with Drs. Thomas Bodenheimer, Barbara Starfield, Katharine Treadway, Allan Goroll, and Thomas H. Lee that appeared in the November 13, 2008 issue. The comments, and responses from the roundtable participants, are salient and generally useful. Several writers noted the role of physician assistants, and one (Paul Lombardo) states that “Patients, and the U.S. health care system as a whole, would be better served if the content of and level of primary care education were better matched to the needs of patients. The physician assistant (PA) model of medical education, with its emphasis on physician-physician assistant teams, needs to be expanded.”

These are all thorny, and not unrelated, issues. What is the relationship between resident work hours and physician’s assistants? Well, someone has to do the work. Since residents, even with the 80-hour restriction, work twice as many hours as do physician’s assistants, for about half the salary, and have a greater scope of practice, it would be incredibly expensive for hospitals to replace resident labor with that of physician’s assistants, not to mention physicians. As hospitals complain about the “cost” of resident education, this needs to be kept in mind; they are much better at accounting the cost than the benefit. Even if a hospital closes its residencies because it assesses the costs are greater than the benefit, this usually includes the fact that the residents care for many medically indigent patients, and you can be sure that the hospitals are planning to no longer care for them at all, not to pay someone else to do it. This, of course, again decreases access for the most needy.

I have repeatedly said that the nucleus of a solution is a comprehensive national health program, which includes a single-payer and a system that is tasked with ensuring the health and access to quality health care of all Americans. With such a system, addressing issues such as resident work hours, medical student debt, and the composition of the physician (and NP and physician assistant) workforce could be feasible; without it, they all remain insoluble because they all depend upon each other.

(Joshua Freeman, M.D. is Professor and Chair of the Department of Family Medicine at the University of Kansas School of Medicine, though the comments in this blog are his own. He does understand his topic: http://www2.kumc.edu/fammed/Chairman.htm)

http://medicinesocialjustice.blogspot.com/2009/01/student-debt-resident-hours-and-primary.html

Comment:

By Don McCanne, MD

Josh Freeman’s comments were selected to start off this year of reform (hopefully) because they set the theme that reform should not be simply about tweaking private and public insurance options; reform needs to be about fundamental restructuring of our health care financing and delivery systems.

Single payer is frequently conceived of as simply an administrative system of collecting funds for health care through an equitable system that is designed to include everyone. Well, it is that, and that would be a great improvement over the dysfunctional, fragmented, inequitable, and inadequate system that we have.

But there is the other side to single payer: spending. Imagine having two and a half trillion dollars under the control of our own single, public purchaser of health care – a monopsony. Scary? Well, yes, but not when you compare it to the horrendously frightening system that we now have – a system which the policy makers in Washington unbelievably wish to expand.

Our current system bankrupts and even kills people. With our own public single payer system the funds would be used to save lives, preserve health, and prevent financial hardship in the face of medical need. Professor Freeman is right on target when he says, “the nucleus of a solution is a comprehensive national health program, which includes a single-payer and a system that is tasked with ensuring the health and access to quality health care of all Americans.” Otherwise our problems “all remain insoluble because they all depend upon each other.”

If we expect someday to have an efficient, high-performance health care system for all of us, repairing and expanding our primary care infrastructure is not an option; it’s an absolute necessity.

Health economists: Their facts, but our values

Health Economists’ Views of Health Policy

By Michael A. Morrisey and John Cawley
Journal of Health Politics, Policy and Law
August 2008
This article reports the views of a national survey of U.S. health economists on a series of questions ranging from mergers among health care providers to the profits of pharmaceutical manufacturers to fundamental health care reform. We find a high degree of agreement on issues of fact but considerable disagreement on issues that depend on values.
Issues of Fundamental Disagreement
Arguably the most divisive statement in our entire survey was, “The United States should adopt a Canadian-style system of universal and compulsory health insurance.” Of U.S. health economists, 47 percent agreed that the United States should adopt such a system. What makes the responses to this question so divided is the fact that the entire range of answers is used; 22 percent strongly agreed, 25 percent agreed, 21 percent disagreed, and 22 percent strongly disagreed. The nearly uniform spread of answers is unique; for all other issues reported, answers tend to be concentrated around the middle (agree or disagree) with few responses in the extreme tails (strongly agree, strongly disagree). Moreover, only 10 percent responded that they didn’t know, which is among the smallest response in that category to any question.
http://jhppl.dukejournals.org/cgi/content/abstract/33/4/707

Almost all of us want 2009 to be the Year of Health Care Reform. Almost all of us agree on the facts. We agree not only on what the deficiencies are in our health care financing and delivery systems, but we also largely agree on what the impact would be of various public policies that might be enacted during the reform process.
But the debate isn’t about facts; it’s about values! Just think about the strongly held values on the two sides of the debate over whether or not “the United States should adopt a Canadian-style system of universal and compulsory health insurance.”
Many of us can speak to one side of that debate. We want a health care system that can provide high-quality care for everyone at a cost that we can afford, both individually and collectively. An improved Canadian-style single payer system would do that. Those strongly opposed to single payer have not provided us with any model that would come close to all of those goals.
If the other side doesn’t share our specific goals, then what values do they support? Perhaps it’s unfair to try to describe their values since there is such an intense disagreement, but we can parrot some of their published statements on their values.
Many support the concept of individual responsibility. Each individual should be responsible for acquiring the means to obtain whatever products or services they desire, including health care. For those who are truly incapable, minimal basic services can be provided by private charity or by public safety-net welfare programs. For average-income individuals who can no longer afford health care, it is their responsibility to make choices – either a choice to advance themselves so they can afford care, or a choice to reduce other spending such as on rent, transportation, education or other less essential products or services, or simply to do without health care.
Many oppose wealth transfer, especially in the form of progressive taxes. They believe that those who have achieved great wealth should be allowed to keep it, and those who haven’t should simply make do. Wealth should not be confiscated by the government simply because tens of millions of individuals are not capable of paying for health care that they might need. In their view it is morally just that society be stratified, richly rewarding the producers.
Many passionately support the concept of freedom, meaning “free exercise of the natural right of sole dominion over their own lives, liberty and property,” relegating government to a minimal, custodial role. They specifically reject the United Nations Universal Declaration of Human Rights, which states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”
They value greatly the entrepreneurial spirit of the private marketplace that brings us wealth-creating insurance company middlemen, and an abundance of expensive technologies that shift the profit/benefit ratios ever upward. To them, private business success has a priority over public social policies.
Freedom, entrepreneurialism, and individual responsibility are values that are not the exclusive domain of the opponents of single payer, for we all share them. The disagreement is in how we value public policies that make these concepts work for all of us. We need freedom – freedom to chose our health care professionals – a freedom that the insurers have taken away from us. We need entrepreneurialism to provide us with better technology – but technology that meets the test of value. We need to exercise our individual responsibility to take care of ourselves – but along with our responsibility to support public policies that will enhance the health of all of us.
Princeton health economist Uwe Reinhardt has said that we can do this. The facts are easy. You tell us your values and then we can design a health care system that matches them. The question is, whose values will Congress and the Obama administration honor?

Health economists: Their facts, but our values

Health Economists' Views of Health Policy

By Michael A. Morrisey and John Cawley
Journal of Health Politics, Policy and Law
August 2008

This article reports the views of a national survey of U.S. health economists on a series of questions ranging from mergers among health care providers to the profits of pharmaceutical manufacturers to fundamental health care reform. We find a high degree of agreement on issues of fact but considerable disagreement on issues that depend on values.

Issues of Fundamental Disagreement

Arguably the most divisive statement in our entire survey was, “The United States should adopt a Canadian-style system of universal and compulsory health insurance.” Of U.S. health economists, 47 percent agreed that the United States should adopt such a system. What makes the responses to this question so divided is the fact that the entire range of answers is used; 22 percent strongly agreed, 25 percent agreed, 21 percent disagreed, and 22 percent strongly disagreed. The nearly uniform spread of answers is unique; for all other issues reported, answers tend to be concentrated around the middle (agree or disagree) with few responses in the extreme tails (strongly agree, strongly disagree). Moreover, only 10 percent responded that they didn’t know, which is among the smallest response in that category to any question.

http://jhppl.dukejournals.org/cgi/content/abstract/33/4/707

Comment:

By Don McCanne, MD

Almost all of us want 2009 to be the Year of Health Care Reform. Almost all of us agree on the facts. We agree not only on what the deficiencies are in our health care financing and delivery systems, but we also largely agree on what the impact would be of various public policies that might be enacted during the reform process.

But the debate isn’t about facts; it’s about values! Just think about the strongly held values on the two sides of the debate over whether or not “the United States should adopt a Canadian-style system of universal and compulsory health insurance.”

Many of us can speak to one side of that debate. We want a health care system that can provide high-quality care for everyone at a cost that we can afford, both individually and collectively. An improved Canadian-style single payer system would do that. Those strongly opposed to single payer have not provided us with any model that would come close to all of those goals.

If the other side doesn’t share our specific goals, then what values do they support? Perhaps it’s unfair to try to describe their values since there is such an intense disagreement, but we can parrot some of their published statements on their values.

Many support the concept of individual responsibility. Each individual should be responsible for acquiring the means to obtain whatever products or services they desire, including health care. For those who are truly incapable, minimal basic services can be provided by private charity or by public safety-net welfare programs. For average-income individuals who can no longer afford health care, it is their responsibility to make choices – either a choice to advance themselves so they can afford care, or a choice to reduce other spending such as on rent, transportation, education or other less essential products or services, or simply to do without health care.

Many oppose wealth transfer, especially in the form of progressive taxes. They believe that those who have achieved great wealth should be allowed to keep it, and those who haven’t should simply make do. Wealth should not be confiscated by the government simply because tens of millions of individuals are not capable of paying for health care that they might need. In their view it is morally just that society be stratified, richly rewarding the producers.

Many passionately support the concept of freedom, meaning “free exercise of the natural right of sole dominion over their own lives, liberty and property,” relegating government to a minimal, custodial role. They specifically reject the United Nations Universal Declaration of Human Rights, which states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”

They value greatly the entrepreneurial spirit of the private marketplace that brings us wealth-creating insurance company middlemen, and an abundance of expensive technologies that shift the profit/benefit ratios ever upward. To them, private business success has a priority over public social policies.

Freedom, entrepreneurialism, and individual responsibility are values that are not the exclusive domain of the opponents of single payer, for we all share them. The disagreement is in how we value public policies that make these concepts work for all of us. We need freedom – freedom to chose our health care professionals – a freedom that the insurers have taken away from us. We need entrepreneurialism to provide us with better technology – but technology that meets the test of value. We need to exercise our individual responsibility to take care of ourselves – but along with our responsibility to support public policies that will enhance the health of all of us.

Princeton health economist Uwe Reinhardt has said that we can do this. The facts are easy. You tell us your values and then we can design a health care system that matches them. The question is, whose values will Congress and the Obama administration honor?

House party attendees in agreement

At House Party on Health Care, the Diagnosis Is It’s Broken

By Robert Pear
The New York Times
December 22, 2008
When a dozen consumers gathered over the weekend to discuss health care at the behest of President-elect Barack Obama, they quickly agreed on one point: they despise health insurance companies.
http://www.nytimes.com/2008/12/23/health/23health.html?_r=1&hp

And for reform, our nation’s political leaders are going to bring us… even more of the same?

House party attendees in agreement

At House Party on Health Care, the Diagnosis Is It's Broken

By Robert Pear
The New York Times
December 22, 2008

When a dozen consumers gathered over the weekend to discuss health care at the behest of President-elect Barack Obama, they quickly agreed on one point: they despise health insurance companies.

http://www.nytimes.com/2008/12/23/health/23health.html?_r=1&hp

Comment:

By Don McCanne, MD

And for reform, our nation’s political leaders are going to bring us… even more of the same?

Ovation extorts innocent premature babies

FTC accuses firm of drug monopoly

By James Rowley
The Seattle Times
December 17, 2008

Antitrust enforcers accused Ovation Pharmaceuticals of cornering the U.S. market on a drug for a congenital heart defect in premature infants and asked a court to break up the company’s monopoly on the medication.

Ovation, based in Deerfield, Ill., purchased the rights to Indocin from Merck in August 2005. The FTC said Ovation then bought the rights to NeoProfen from Abbott Laboratories in January 2006.

As soon as it acquired NeoProfen, Ovation raised the $36 price it had been charging hospitals for each vial of Indocin to about $500, the FTC alleged in its complaint. Ovation set a price of $483 a vial for NeoProfen when it started selling the drug in July 2006, the FTC said.

The two drugs are the only alternative to risky surgery to treat a condition known as patent ductus arteriosus in which a blood vessel connecting two heart arteries fails to close.

http://seattletimes.nwsource.com/html/nationworld/2008528981_ftc17.html

Comment:

By Don McCanne, MD

Imagine if we had a publicly-financed and publicly-administered national health program covering everyone that included a comprehensive drug benefit. Would we be reading this story? Of course not. This does not mean that pharmaceutical firms will not engage in other criminal activities, but this one would have been prevented if we had a rational system of financing health care.

This one isn’t only about money; it’s about the soul of our health care system. It is about a pharmaceutical company that merely bought rights to products developed by others and then used those rights to egregiously extort innocent premature infants who had the misfortune of being born with a patent ductus arteriosus.

Depending on antitrust enforcers to establish health policy doesn’t seem like a smart way to run a health care system. With a single payer national health program we’d be able to eliminate many of the causes of excessive spending that often brings us only mediocrity in health care. Leaving the middlemen money managers in place will never allow us to achieve a high-performance system at a reasonable cost. Yet our national policy makers are determined to protect these middlemen no matter how much it costs us both in dollars and in tradeoffs in beneficial health policies.

Atlanta physicians on curing faulty system

Letters to the Editor
Atlanta Journal-Constitution
Dec. 21, 2008

Responses to “Health care reform: We can’t afford to wait to fix this broken system” and “There is a cure available,” by Dr. Oliver Fein,” Dec. 14.

Stabilize primary care

I agree with the AJC editorial that pooling all our children in one consolidated system of health financing could solve many problems.

Even among families with insurance, children must often defer needed care when their health plan changes rules, raises costs, drops a physician or terminates the employer’s contract.

Effective primary care needs stability and continuity in the patient-doctor relationship, and it functions best when the families have freedom to choose their doctor or clinic.

A universal, single-payer system would — for less money — bring us closer to these goals for children.

Why not extend a universal single-payer system to all Americans?

Dr. Oliver Fein’s commentary provided good reasons why the National Health Insurance Act offers a sensible way forward.

Dr. HENRY S. KAHN
Kahn is a professor emeritus at Emory University School of Medicine.

Single-payer system works

As a board-certified internist, I concur with Dr. Oliver Fein’s idea of a single-payer system.

I have seen many Georgia patients with strokes and myocardial infarctions that could have been prevented if they had access to good primary care. Helping these victims fit into a broken health care system has been frustrating to say the least.

Although born and raised in the United States, my medical education at McGill University in Montreal gave me a chance to observe the Canadian single-payer health care system.

While it is not perfect, it is far better overall (and less expensive) than what we have here.

Let’s put the dollars that would otherwise be spent paying administrators back into the health care system and enact a single-payer system.

Dr. SUSAN HENDERSON
Henderson is a physician at Grady Health System.

And the downside is …

Dr. Oliver Fein, in arguing for a single-payer health care system, states that eliminating the $400 billion private health insurance industry would enable us to cover the uninsured and do away with co-pays and deductibles for most Americans. But think of what we would lose if that industry vanished!

Hmmmm … can’t seem to think of anything.

Dr. ANNETTE BERNARD
Bernard is an Atlanta physician.

Seize opportunity to fix health care system

by Bob Balhiser
Queen City News, Helena, Montana
Wednesday, December 17, 2008

Like the old saying, “Too many cooks spoil the broth”, it can likewise be said that too many fingers in the till ruin a health care system. Dr. Putsch has recently done an excellent job of outlining just how much of our health care dollar is spent on administrative costs by citing studies that peg the range between 31 to 38 cents. I think everyone can agree that either amount is out of line and serves to explain why our health care costs have grown exponentially.

To reinforce Dr. Putsch’s assertions, it may be instructive to enumerate just a few of the non-medical costs built into U.S. health care that could be significantly reduced or eliminated with a well-designed system to provide Medicare for all U.S. citizens. They are: 1) Insurance agent sales commissions; 2) Insurance company overhead costs five times those of Medicare; 3) Costs for doctors to deal with delays, denials, and complex rules of myriad private insurers and plans; 4) Unproductive costs of practicing defensive medicine; 5) Excessive costs of malpractice insurance; 6) Disproportionately high compensation of medical specialists; 6) Expensive advertising and “me, too” drug development costs incurred and passed on by pharmaceutical companies, and finally, 7) The obscene example Dr. Putsch used to illustrate the apparent necessity for “one billing clerk per bed” to sort out costs at Duke University Hospital.

Quoting a recent e-mail I received from Senator Baucus’s office: “The U.S. spends twice as much per person on health care as any other nation in the world, but our spending does not translate into higher quality. The U.S. ranks 19th out of 19 countries in preventable deaths”. I find it unimaginable Max can look at these statistics and not want to throw out the whole health care payer system and rebuild it from the ground up. Perhaps he would like to start over, but considers it politically impractical.

Similarly, a Montana reporter asked Barack Obama when he was in Butte why he didn’t support a single-payer health care system despite the fact that a majority of voters support the idea. To paraphrase Obama, he said it would be too difficult and disruptive to deep-six most of the health insurance industry that employs three million people nationwide.

I supported Obama, but I must say he made a pretty lame argument in this instance! If these folks do not add value to our health care system, then they should find something useful to do. Many with claims-processing experience would likely find positions in a single-payer system, while many highly (over)compensated executives might be forced to discover their true worth in a real world job market.

I would not be at all surprised if an impartial, in-depth audit of our current health care system were to reveal that the portion of our health care dollar devoted to non-medical costs was actually as high as 50 percent. Considering all the “slippage” in our current health care system, I suggest that we should be able to root out the waste, provide basic health care for all U.S. citizens, and still have money left over.

We can fix our broken health care system, and with Max Baucus and Denny Rehberg in influential congressional seats, Montanans are uniquely positioned to get the ball rolling. Surely there are powerful lobbyists who will resist meaningful change, but just remember this: those of us who pay the bills far outnumber those with fingers in the tills. We could start by persuading Denny to promote a hearing on H.R. 676 to examine the merits of a single-payer national health insurance system in an open forum.

To fix our health care system, we need only embolden politicians to do the right thing, then support them when they do. We can bring about meaningful health care reform, but if we have become too lazy or complacent to seize this golden opportunity, then we deserve to live with a failed health care system that will ultimately bankrupt the country.

Bob Balhiser is a retired engineer who lives in Helena

Real Health Care

Letter to the Editor
New York Times
Published: December 22, 2008

To the Editor:

Re “Necessary Medicine?” (Week in Review, Dec. 14):

The problem with President-elect Barack Obama’s supposed emphasis on the costs of health care is that his proposals fail to deal with the biggest source of wasteful expenditures, our dependence upon private health insurance.

Mr. Obama’s plans, by continuing to embrace a role for private health insurance in our system, wed us to the waste, profiteering and venality of an industry that exists only to take our money and spend as little of it as possible on the objective.

The private insurance industry seeks to increase the proportion of its revenue reserved for profits by spending as little as possible on health care, instead directing its expenditures to marketing, underwriting, “product development” and executive compensation.

I’d prefer my health care dollars to be spent — surprise! — on health care. Only a move toward “Medicare for all” can do that.

Aaron M. Roland
San Francisco, Dec.

The writer is a practicing family physician and clinical associate professor of medicine at the University of California San Francisco.

Our plea: No more Natalines

By Hilda Sarkisyan
Los Angeles Daily News
Article Launched: 12/22/2008

One year ago, my beautiful daughter Nataline lost her long struggle with leukemia. Our insurance company, Cigna Healthcare, closed the door on us. Now we need to make sure that other families can have the security that our daughter didn’t.

It was one year ago that the California Nurses Association, bloggers from coast to coast, and our Armenian community mounted a massive national protest that forced the hand of our insurance company to reverse their decision to deny a lifesaving liver transplant for our 17-year-old daughter.

Tragically, Nataline slipped into a coma and died two hours after Cigna Healthcare relented and approved the procedure.

Nataline was first diagnosed with leukemia at age 14. She was in remission for only one short year before her relapse. After her sweet 16 birthday, which was a huge celebration with her friends and family, she had several months of chemotherapy. She then developed complications following a bone-marrow transplant from her brother, Bedig, which led to liver failure.

Cigna refused to pay for treatment, citing policy provisions which didn’t cover “services considered experimental, investigational and/or unproven to be safe and/or effective for the patient.”

Four prominent doctors, including the surgical director of the Pediatric Liver Transplant Program at UCLA, wrote to Cigna urging it to reverse its denial. They said that Nataline “currently meets criteria to be listed as Status 1A” for

a transplant. They also challenged Cigna Healthcare’s denial that the company said occurred because their benefit plan “does not cover experimental, investigational and unproven services,” to which the doctors replied, “Nataline’s case is in fact none of the above.”

Why didn’t they listen to the doctors and nurses at her bedside and approve the transplant the week before, when there were two healthy livers that were a match and could have saved my sweet Nataline?

We were told that the cost of a liver transplant and one year of follow-up care was $450,000 in 2007 and UCLA turned down two livers while waiting for approval from Cigna Healthcare. It took a huge outpouring of protest and Cigna Healthcare’s public humiliation to force their hand.

We agree with President-elect Obama, who is talking about the need to bring down spiraling health-care costs, but it won’t happen as long as the insurance industry is minding the till.

Having insurance is not the same as receiving needed care. We need a fundamental change in our health-care system that takes control away from the insurance companies and places it where it belongs – in the hands of the caregivers, the patients and their families.

We have a rare opening, a historic opportunity, and piecemeal solutions that keep the insurance industry open for business will only stoke the fires of financial hardship and unnecessary heartbreak for America’s working families.

My family’s New Year’s wish is to see an end to the suffering caused by insurance industry greed and misguided priorities.

We believe that the only way to guarantee all Americans health care, and assure that another young life is not sacrificed, is through a single-payer system, which is like improved Medicare for all.

Hilda Sarkisyan, of Northridge, and her husband filed a lawsuit against Cigna Healthcare of California last week.