Eclectic commentary from a progressive voice in the red state

Thursday, November 21, 2013

Why health reform won’t work — a historical perspective - Part 3

Technology, aided by the information revolution and faster and cheaper computers, has exploded. Newer and more powerful imaging devices, moving cardiac cath labs out of the hospital, enhanced lab analyses and creating a completely new flow of information are making medical decisions easier and faster. For some physicians, they can be on call and never leave their homes. An orthopedic surgeon can have a huge LCD screen in his living room. The hospital and some of the clinics where he works can route digitized X-ray images to that screen and he can then decide the next step.

Rural America has benefited by having high-speed information flow to and from major medical centers.

But it’s not clear whether all this new technology is helping the bigger picture. Are we a healthier nation? Are our mortality rates dropping? Are we better off now than X-number of years ago?

And, the cost of health care in the aggregate for the nation soared some more.

The pharmaceutical revolution also played a role in the high cost of medical care. With a “free market” and a compliant Federal Drug Administration, Big Pharma began pumping drugs into the public’s minds through massive direct-to-consumer advertising campaigns — huge ad campaigns on TV and, since women make many of a family’s health decision, women’s magazine. It’s massive, but only part of the sales job.

Pharmaceutical representatives called on doctors to “educate” them on the latest and greatest therapy. Some of these drugs have not proven to perform better than cheaper and older generic stand-bys, but writing the prescription for the brand name drug earned the doctors’ privileges — like being asked to tear himself away from his Minnesota practice in February to present company-authored research at the Maui Hilton. The firms covered the air fare, hotel and greens fees.

Then, of course, the pharmaceutical industry told the American people three other things it hoped the public would believe.

The first is that it costs millions of dollars to bring a new and drug to market. And yet the industry had to contend with problems with drugs like Vioxx that was pulled from the market for being tied to heart attacks. It doesn’t take much research to see the problem. About twice a month we read about the need to pull a drug from the market or to change the labeling because of nasty side effects. Until either a lawsuit or congressional probe, the public may never know how much it will cost to bring a new drug to market.

Second, BigPharma invented drugs and found a disease it would treat, filling the public’s mind with made up problems in direct-to-consumer ads. An example? Restless leg syndrome. Effexor found generalized anxiety disorder (GAD); and, a patient’s depression about Effexor’s cost can mean a prescription for Prozac.

Third, by tweaking a formula, drug companies tried to convince the ethical physicians that the older formula won’t work as well or it’s not designed for the therapy. An example: Genentech makes Avastin and Lucentis. Both are ranibizumab. It marketed Avastin for treating colorectal and lung cancers and Lucentis for macular degeneration and some other rare conditions. Avastin is about $75 a dose; Lucentis is about $2,500. Genentech argues that using Avastin for eye treatments is “off-label” and shouldn’t be done. But a reputable retina specialist will tell you that Avastin is just as good, if not better, for treating certain eye diseases. And, the recent ruling against Johnson & Johnson over Risperdal, which it marketed “off label” pretty much tells the story of BigPharma’s hypocrisy as it contradicts itself.

These massive and multi-million dollar efforts to convince Americans a little pill will do you had to be paid for by someone and those costs, too, were passed on to the consumer or the insurance company.

But insurers noticed how their drug costs were rising, and those brand name drugs are costly. Now, they set limits on which drugs doctors can use and the costs. If the drugs don’t meet the profit criteria for the drug company after insurance firms cut costs, then the consumer has to pay the difference. Or the consumer has to forgo taking the drug.

The reason that the current approaches to health care reform will not work are because neither the politicians nor the public wishes to educate itself on the history of health care in the United States. Further, by ignoring the history public policy makers are ignoring solutions that may work. But, clearly the other reason the public won't benefit from health care reform are:

• The medical community shot itself in the foot by loosing control of the medical decisions and will have a hard time getting control back;

• The institutional part of the health care industry has betrayed its charitable history, its decency and its doctors and patients by accepting the free market model without a fight. Leaders of the industry and the medical profession need to decide what the system should look like, curb any greed, which is not good, and stand up for what’s right — show some courage; as a former hospital administrator, I can say I’ve never met a group with less backbone.

• The insurance industry became the more powerful player in the system, taking away choices from patients and doctors alike. Congress needs to regulate it, treating health care insurers including all forms of HMOs as public utilities; but, it won’t.

• Congress has been useless, lacking the will to tackle the problem. They are, almost to a person, bought and owned by the corrupt corporate interests and don’t want to give up the bribes, both blatant and subtle that go with protecting the system;

• The media have failed our nation. Corporate media will not offend the advertisers. And, it would rather report on celebrities than do a good job of explaining our failing systems. Media leaders need to accept a lower rate of return and recognize that with press freedom comes press responsibility and change the business model to do so. And it needs help foster a renewed appreciation for education; and,

• Consumers and patients have failed themselves, tolerating politicians who pander and line their pockets from a corrupt system. And they too would rather read about Britney and Paris, rich ne’er do wells, than serious stuff that actually affects their lives. Parents and older people should also engender an appreciation for education and knowledge and should assist in boycotting those businesses that continue to foster the problems outline above.