Health Care

[Samirol]

Health Care in America as it Stands

Right now, we have a health care crisis in the United States. We have about 47 million uninsured people, and being uninsured means that you can be paying debt for years to come. About half of the bankruptcies in the United States are due in at least part to medical emergencies. Unless you are rich, if you lose your job and get hurt, then your finances can quickly go into ruin.

Comparisons to Other Countries

http://img180.imageshack.us/img180/53/healthcarenw4.jpg

Solutions

The Beveridge Model

Named after William Beveridge, the daring social reformer who designed Britain's National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.

Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.

Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world's purest example of total government control.

The Bismarck Model

Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system -- the insurers are called "sickness funds" -- usually financed jointly by employers and employees through payroll deduction.

Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don't make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model -- Germany has about 240 different funds -- tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.

The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

The National Health Insurance Model

This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there's no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

The single payer tends to have considerable market power to negotiate for lower prices; Canada's system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

The classic NHI system is found in Canada, but some newly industrialized countries -- Taiwan and South Korea, for example -- have also adopted the NHI model.

The Out-of-Pocket Model

Only the developed, industrialized countries -- perhaps 40 of the world's 200 countries -- have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.

In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.

In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat's milk or child care or whatever else they may have to give. If they have nothing, they don't get medical care.

These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany.

For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital.

The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it's fairer and cheaper, too.

Terminology

Universal Health Care - All citizens have health care provided, not necessarily socialized.

Socialized Health Care - Entirely or nearly entirely public-based health care.

The Presidential Candidates

Barack Obama - Health care plan offered by the government for those that want it, also help make it cheaper for the poor and the middle class. (more information here: http://www.barackobama.com/issues/healthcare/)

John McCain - $2500 to help offset the costs (more info here http://www.johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm)



For me, as a Social Democrat, the overriding factor when considering the health care system is making sure that nobody is forced to choose between eating and getting treated, but the concerns of many Americans have to be taken into account. Countries with universal health care overwhelmingly support their systems. The insurance companies in Germany are non-profit, regulated, and efficient. Efficient CEOs and managers are paid more, and there is healthy competition within the market as companies work to cut costs to deliver the lowest rates.

[DirtyDog]

This is an interesting post and I plan on reading it (beer in hand) later. I can tell you that the fact that my health insurance premiums have been going up about 25% per year is a load of crap. Having a for-profit industry working as a middleman between citizens and health care organizations is just plain dumb.

[jimmydean]

This is an interesting post and I plan on reading it (beer in hand) later. I can tell you that the fact that my health insurance premiums have been going up about 25% per year is a load of crap. Having a for-profit industry working as a middleman between citizens and health care organizations is just plain dumb.

In the 6 months I have had my new insurance, I have paid more out of pocket than I have in the previous 7 years combined. Not to mention the hoops I had to jump though to get a "pre-existing clause" lifted because I had a 32 day laps in coverage.

Not like I've been to the doctor a whole lot this year or anything. But I have between $500 and $1000 per person deductible (primary care is different than chiropractic, so the deductible is separate for each) per doctor. So far I have spent about $3400 in uncovered and/or deductibles.

What a scam.

[SPINTECK]

We Americans are too stupid and greedy to change our system. PLEASE PROVE ME WRONG.

I keep my evil corporate job mostly for the healthcare. I could live on less money in a funner environment, but I hate knowing my kids wouldn't have good coverage. It's all about enslaving americans for profit, but we kind of do it to ourselves through voting, lack of unions and buying stuff made by people with a lower standard of living.

There is a major point in your article that makes it a tough fight- apparently taking profits out of medicine is better for the people, but not for wealthy dividend holders. It will be tough to pry their greedy little hands off our system.

Great post. Thanks for the data, solution proposals and personal opinion (I'm getting tired of fishing posts w/no search for truth/answers).

[BurlyShirley]

Excellent post.

My only concerns with socialized healthcare are, #1.) that Im afraid Americans will cease to be seen as customers any longer by providers, and that general care could decrease as an effect of that. I think about the general productivity/initiative/work ethic (or lack thereof actually) of most government run agencies or programs and it's a bit unnerving to think my health would be in the hands of such people.
#2.) Is that I'm afraid of stifling research by large medical/pharm companies; that they won't be so inclined to invest huge money intp research anymore because the windfall profits they used to be able to count on after a breakthrough will be no longer.

Ultimately though, I think the idea that a culture as socially advanced as ours in the US is, which will simply let people die every year by the thousands because they can't afford health care is ridiculous... especially considering every other advanced nation on the planet has found a way around the problem. And anyone who thinks that isn't a problem isn't someone I'd really care to know. How selfish can you be?

[DirtyDog]

My girlfriend and a lot of my friends are in health care. The number one complaint in that industry is HMO's. Its so bad, that almost unanimously they are all sorry they got into health care at all. So much for windfall profits improving the system.

[blue]

#1.) that Im afraid Americans will cease to be seen as customers any longer by providers, and that general care could decrease as an effect of that. I think about the general productivity/initiative/work ethic (or lack thereof actually) of most government run agencies or programs and it's a bit unnerving to think my health would be in the hands of such people.



This isn't the case in other countries, if you look at the chart.


#2.) Is that I'm afraid of stifling research by large medical/pharm companies; that they won't be so inclined to invest huge money intp research anymore because the windfall profits they used to be able to count on after a breakthrough will be no longer.



What, you'd be sad if there weren't more anti-depressants and strains of Botox out on the market? It seems like the vast majority of R&D development from pharma companies is on designer drugs that are easily marketed to the unwashed horde, instead of life-saving breakthroughs and cures. Removing vast profit sums (and marketing) from the equation may do quite the opposite of what you're saying.

[Defenestrated]

blue makes good points

[BurlyShirley]

This isn't the case in other countries, if you look at the chart.

Exactly what does that chart tell us about the US government's abilities to manage large programs effectively? Wouldn't a more accurate projection of what they'd be able to accomplish be gained from knowledge of how other US gov't programs are managed? How's that VA healthcare been working out for the vets?

What, you'd be sad if there weren't more anti-depressants and strains of Botox out on the market? It seems like the vast majority of R&D development from pharma companies is on designer drugs that are easily marketed to the unwashed horde, instead of life-saving breakthroughs and cures. Removing vast profit sums (and marketing) from the equation may do quite the opposite of what you're saying.


It seems like that because you watch too much TV and are constantly inundated with such "breakthroughs," but in reality alot of the advances in healthcare worldwide come from the research of American companies, whether you want to admit it or not. Save the hyperbole next time.

[Toshi]

blue makes good points

no, he makes a shallow point. Botox has many non-cosmetic uses, for the record, and there are many lower profile workhorse drugs and procedures out there that genuinely save a ton of lives: aspirin for one, beta blockers, statins, ACE inhibitors, ANTIBIOTICS, etc.

when's the last time you saw an advertisement for heparin? :twitch: yet it may well be what keeps you from having a pulmonary embolism after surgery.

[DirtyDog]

no, he makes a shallow point. Botox has many non-cosmetic uses, for the record, and there are many lower profile workhorse drugs and procedures out there that genuinely save a ton of lives: aspirin for one, beta blockers, statins, ACE inhibitors, ANTIBIOTICS, etc.

when's the last time you saw an advertisement for heparin? :twitch: yet it may well be what keeps you from having a pulmonary embolism after surgery.

Blue's points still aren't valid? Were hundreds of millions spent on the development of Aspirin? Have there been breakthroughs in Antibiotics related to the research budgets at big pharma?

Would not a better solution be for government to sponsor preventative medicine and education into healthy living? Do you really think the drug arms race is needed to keep up with our ridiculous life choices?

[Toshi]

Blue's points still aren't valid? Were hundreds of millions spent on the development of Aspirin? Have there been breakthroughs in Antibiotics related to the research budgets at big pharma?

Would not a better solution be for government to sponsor preventative medicine and education into healthy living? Do you really think the drug arms race is really needed to keep up with our ridiculous life choices?

my point is that condensing the pharmaceutical industry into botox and antidepressants is dense.

[Samirol]

no, he makes a shallow point. Botox has many non-cosmetic uses, for the record, and there are many lower profile workhorse drugs and procedures out there that genuinely save a ton of lives: aspirin for one, beta blockers, statins, ACE inhibitors, ANTIBIOTICS, etc.

when's the last time you saw an advertisement for heparin? :twitch: yet it may well be what keeps you from having a pulmonary embolism after surgery.

Aspirin was discovered by a French scientist in the mid-1800s
Beta blockers were discovered by a Scottish doctor
Statins were discovered by Japanese doctors
Heparin was discovered by a university student

None of the specific drugs you listed came from U.S drug companies, beta blockers and statins were discovered under a universal health care system. Drug companies still profit under a Bismarckian health care system, insurance companies don't.

[SPINTECK]

It seems like that because you watch too much TV and are constantly inundated with such "breakthroughs," but in reality alot of the advances in healthcare worldwide come from the research of American companies, whether you want to admit it or not. Save the hyperbole next time.

There are just as many european and japanese advances. Just look at the annual report of any pharmaceutical company and you'll see they spend 2 to 3 times as much on marketing as they do on research. Americans' pay for that marketing.

Many companies just buy-up smaller companies that have already done the work, or they put a smaller company out of business by having a stronger legal fund.So the super rich stock holders that own the mega corporations just keep their revenue streams and still rip off americans. You are kidding yourself if you think just b/c you own 200K to 2 million$$ of stock your a major share holder. My point is the super rich will always fund any research or buy any company that will make money.

Toshi, you know pharmaceutical companies make more money off treating a disease than curing it. You are probably also aware that these companies don't fund projects that CAN cure disease if it doesn't make enough money b/c then they have to continue to make that product.

Genital warts (HPV) and herpes (valtrex), the biggest blockbuster drugs in the recent years. Those drugs make the money.

SO yeah, our system allows big pharma to spend millions to market drugs many don't need and manufacture drugs that only make more money even though other diseases could be cured. They make the stuff in Puerto Rico or Ireland and sell it to us for more than any other country.

Please prove me wrong b/c I'm getting depressed justing thinking about it.

[Toshi]

spinteck, interesting you bring up the whole cure vs. treat deal. do your tinfoil hat sources have any actual examples of a potential curative mechanism that's been suppressed thanks to the big bad wolf, er, pharma? the pathophysiology of disease is not simple.

[SPINTECK]

spinteck, interesting you bring up the whole cure vs. treat deal. do your tinfoil hat sources have any actual examples of a potential curative mechanism that's been suppressed thanks to the big bad wolf, er, pharma? the pathophysiology of disease is not simple.

Yeah, you're right- no projects that could help a small percent of the population have ever been taken off the budget. We should just work for medicine and doctors and be happy that we're still breathing in this country. I admire your MD, but I see the barbi sales reps have already stroked your ego with the promise of lots of ssssssssssssssss.................................s amples.

So for the record, you advocate our current healthcare system Toshi?

[stevew]

spinteck, interesting you bring up the whole cure vs. treat deal. do your tinfoil hat sources have any actual examples of a potential curative mechanism that's been suppressed thanks to the big bad wolf, er, pharma? the pathophysiology of disease is not simple.



Yeah, you're right- no projects that could help a small percent of the population have ever been taken off the budget. We should just work for medicine and doctors and be happy that we're still breathing in this country. I admire your MD, but I see the barbi sales reps have already stroked your ego with the promise of lots of ssssssssssssssss.................................s amples.

So for the record, you advocate our current healthcare system Toshi?

So I guess your answer was no, I do not have any proof.

[SPINTECK]

So I guess your answer was no, I do not have any proof.

Thought I covered that in "yeah, you're right" ;)

[Silver]

That first post looks like an astroturf job to me...

[blue]

Would not a better solution be for government to sponsor preventative medicine and education into healthy living? Do you really think the drug arms race is really needed to keep up with our ridiculous life choices?

Damn skippy on that. It's like not ever changing the oil in your car, and then putting in a new engine at 50,000 miles when the old one finally seized. It just doesn't make any sense.

my point is that condensing the pharmaceutical industry into botox and antidepressants is dense.

I could just condense it into "pharmaceutical companies=evil" :brows:

But really, the marketing budgets of these companies ALONE speak volumes about where their priorities lie.

[Defenestrated]

so is there any evidence that the American system facilitates the development of life saving drugs better than the systems of other industrialized nations?

or is the discussion mostly based on principle instead of evidence at this point?

[DirtyDog]

I think this is the first discussion I have seen where Toshi wasn't out front with some insightful statements. You better become an advocate for change in health care Toshi, or your new job is going to ****ing suck :D

[valve bouncer]

Japan figures are interesting. Take all the other things out of the equation and it comes down to a very simple fact. If the food you are eating is mostly healthy then you're going to live longer and have to worry about health care less. I taught 3 classes of high school kids today (80 kids) and although they're bastards they're not fat little bastards. There were maybe half a dozen kids who you might classify as a bit over-weight, there are no porkers. Compare that to a high school in the US, UK or Australia.

[Toshi]

I think this is the first discussion I have seen where Toshi wasn't out front with some insightful statements. You better become an advocate for change in health care Toshi, or your new job is going to ****ing suck :D

please note that i'm not going into primary care. i'm going to be doing radiology... y'all can eat yourselves to death, but as long as you fit within the MRI scanner then i'm ok.

:pirate2:

[Samirol]

That first post looks like an astroturf job to me...

I took the solution explanation from frontline, PBS's investigatory journalism program, because it explains the four options incredibly well. The rest I wrote up.

You can find their program here (http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/main.html), it does an excellent job of explaining the pros and cons of each system.

Edit: I would have included the video in the OP, but asking people to watch a documentary before posting is a lost cause

[ohio]

Need to clear up some facts:

- Pharma companies spend about the SAME on marketing as R&D, and about half as much as on R&D if you subtract free samples (at fair market value) from the equation. The vast majority of this spend is on getting the knowledge to doctors. Doctors can't use treatments they don't know about. It is unfortunate that they seem to find out more about it when it's sold to them by The Girls Next Door, but hey, it's called retention. The rare commercial you see on TV is a small proportion of the marketing. You are not being indoctrinated.


- Big companies buying up small companies is a GOOD thing. It's the whole raison d'etre for a small pharma startup. If big ones don't buy up small ones, you won't have small ones.

- It is not the pharma companies' interest to unprofitably cure diseases, but that's not a problem because cures are profitable. HPV vaccine anyone? Do you know what a cure for AIDS would be worth? You aren't seeing cures because they are really hard to find. Diseases mutate. Even treatments are hard to find, but they CAN be found and they work. You're right however that pharma companies have no interest in prevention...

- ...that isn't an issue because prevention IS in insurance companies' and governments' interest. The system isn't doing much prevention because it is ****ed, not because of a conspiracy. Competition is fierce and providers are doing everything they can to lower costs despite the ****itude of our system, and that includes a tremendous surge recently in wellness programs and alternative sources of care and advice.

- Doctors prescribe known pharmaceutical treatments because A) we know they work and B) we'll sue their ****ing shirts off their backs if they don't. I'm sure they agree with you that a healthy lifestyle is great, but faced with a sick patient, do you really think it's even possible for them to prescribe yoga and char? Doctors aren't broken, our legal system is.

I'll think of more later, but yes we need a new HC system; no, the evil corporations are not purposefully trying to keep you sick.

[SPINTECK]

I can't really answer this stuff from work because I'm part of the pharm machine and I need my job right now. We do more good than bad, but companies need to be kept honest.

I enjoy making vaccines because most are noble and cure a disease instead of just treat it. With that said, there are politics and profits at hand and a constant struggle to balance due to the high profits.

I'm not going to air all our dirty laundry, just read a paper. Look at the Heprin label issue with Quad's kids or the Viox studies. Profits and greed can kill people through poorly run systems. For the last five years the corporate motto has been "it's a business". Well, after some issues we have a new motto, "focus on compliance". So these companies do a lot of good, but still need to be kept honest. Some of the other country inspections actually get companies into better shape through different inspection styles than our FDA.

As far as marketing vs. research, here is the standard pfizer annual report. go to consolidated statements of income (page 40 of 84) and see for yourself.
http://www.pfizer.com/investors/financial_reports/financial_report_2007.jsp

costs of sales 11, 239
selling information and administrative expenses 15 626
research and development expenses 8 089

So I guess all that prime time/super bowl advertising really adds up. Where does that money come from?? I don't know what company Ohio is thinking of. This is pretty standard in the industry so you can compare to jnj and such. I really don't think big corporations buying the technology or a smaller company is good unless they can keep the brain power and ethics that found the technology.

My general practitioner says the system is flawed b/c it's driven by profit. My kids pediatrician, older than dirt, thinks the consumer advertising is out of hand. So when I hear experienced doctors I respect say this in combination to our corporations politics, I can't help but admire other countries like Britian. On my honeymoon in italy and france we met so many people, one couple from Britian, that loved their healthcare system.

So I'm for a system like Britians, even if I make less and have to pay more in taxes. I'd like to see any doctor that doesn't work for a pharm company or the gov't defend our current system.

[SPINTECK]

Japan figures are interesting. Take all the other things out of the equation and it comes down to a very simple fact. If the food you are eating is mostly healthy then you're going to live longer and have to worry about health care less. I taught 3 classes of high school kids today (80 kids) and although they're bastards they're not fat little bastards. There were maybe half a dozen kids who you might classify as a bit over-weight, there are no porkers. Compare that to a high school in the US, UK or Australia.


funny you say that b/c your company gets fined if you're too fat. please tell me this is not true and just stupid american journalism

http://www.cnn.com/video/#/video/health/2008/06/23/kyung.fat.busters.cnn

[valve bouncer]

funny you say that b/c your company gets fined if you're too fat. please tell me this is not true and just stupid american journalism

http://www.cnn.com/video/#/video/health/2008/06/23/kyung.fat.busters.cnn
Seems true from the minor bit of digging I've looked at. I doubt firms are going to be fined for not meeting targets. Properly run this could be a good thing.

[Silver]

I took the solution explanation from frontline, PBS's investigatory journalism program, because it explains the four options incredibly well. The rest I wrote up.

You can find their program here (http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/main.html), it does an excellent job of explaining the pros and cons of each system.

Edit: I would have included the video in the OP, but asking people to watch a documentary before posting is a lost cause

I need to apologize to you.

You have a low post count, and you threw out a fairly comprehensive post. I've seen that before, and that usually means it's a cut and paste job.

Those don't stick around to answer follow ups though...:)

[Silver]

My general practitioner says the system is flawed b/c it's driven by profit. My kids pediatrician, older than dirt, thinks the consumer advertising is out of hand. So when I hear experienced doctors I respect say this in combination to our corporations politics, I can't help but admire other countries like Britian. On my honeymoon in italy and france we met so many people, one couple from Britian, that loved their healthcare system.

So I'm for a system like Britians, even if I make less and have to pay more in taxes. I'd like to see any doctor that doesn't work for a pharm company or the gov't defend our current system.

MY GP is about 35 years old, I think, and she knows that I'm from Canada. The last couple times I've been in to the doctor, she turns it into a bitch session about the American healthcare system and how stupidly it's being run.

The thing about paying more in taxes that most people don't remind you about is this: Sure, you're paying more in taxes. However, you also get to subtract that chunk a month that you're paying to United Healthcare so that Willaim McGuire could afford the new Gulfstream and not get stuck with the slightly older model.

[ohio]

SPINTECK, my numbers are from the industry as a whole, so the big pharm (higher marketing expenses) and the small startups (almost 100% R&D) average out. Realizing that at this stage, you NEED a distribution network (small pharm is somewhat subsidized by big pharm in that they don't need that huge network) I still don't find the spend reprehensible. Less than ideal, yes, but not outrageous.

We're in agreement that the system is very broken. I just take issue with the idea that it's "evil." Thinking about it in moral terms won't get you to a solution.

[kidwoo]

Need to clear up some facts:

- Pharma companies spend about the SAME on marketing as R&D, and about half as much as on R&D if you subtract free samples (at fair market value) from the equation. The vast majority of this spend is on getting the knowledge to doctors. Doctors can't use treatments they don't know about. It is unfortunate that they seem to find out more about it when it's sold to them by The Girls Next Door, but hey, it's called retention. The rare commercial you see on TV is a small proportion of the marketing. You are not being indoctrinated.


- Big companies buying up small companies is a GOOD thing. It's the whole raison d'etre for a small pharma startup. If big ones don't buy up small ones, you won't have small ones.

- It is not the pharma companies' interest to unprofitably cure diseases, but that's not a problem because cures are profitable. HPV vaccine anyone? Do you know what a cure for AIDS would be worth? You aren't seeing cures because they are really hard to find. Diseases mutate. Even treatments are hard to find, but they CAN be found and they work. You're right however that pharma companies have no interest in prevention...

- ...that isn't an issue because prevention IS in insurance companies' and governments' interest. The system isn't doing much prevention because it is ****ed, not because of a conspiracy. Competition is fierce and providers are doing everything they can to lower costs despite the ****itude of our system, and that includes a tremendous surge recently in wellness programs and alternative sources of care and advice.

- Doctors prescribe known pharmaceutical treatments because A) we know they work and B) we'll sue their ****ing shirts off their backs if they don't. I'm sure they agree with you that a healthy lifestyle is great, but faced with a sick patient, do you really think it's even possible for them to prescribe yoga and char? Doctors aren't broken, our legal system is.

I'll think of more later, but yes we need a new HC system; no, the evil corporations are not purposefully trying to keep you sick.


I feel so much differently now about these noble organizations.

The fabrication of such legitimate ailments as 'acid reflux DISEASE' are just their ways of showing us they care.*







*side effects of treatment may include complete shutdown of the central nervous system. Consult with your doctor if you currently have a fully functional nervous system and don't shlt your brains out at regular 5 minute intervals

[splat]

Reading this article, Makes one think , I would like to know how true is it all.


HOW 'LIBERAL' CARE WOULD KILL TED
By ROBERT M. GOLDBERG
Kennedy: Getting care denied by 'liberal' health regimes.
Kennedy: Getting care denied by 'liberal' health regimes.

June 5, 2008 -- IRONICALLY enough, the dangers of the lib eral health-care agenda are being made clear by the care that a liberal icon, Sen. Ted Kennedy, has received since his brain seizure last month.

One day after an MRI detected a tumor, Kennedy was quickly diagnosed with a malignant glioma - a rare and often-fatal form of brain cancer. Less than two weeks later, his tumor was being removed by one of the world's experts in brain cancer at Duke Univeristy Medical Center. He'll follow up with chemo and radiation therapy tailored to the genetic makeup of his cancer to keep the cancer from spreading.

He'll likely take Avastin, a drug that in experiments with brain cancer has extended survival by months. A new cancer vaccine being developed in partnership with Pfizer could extend his life by six years.

Of course, with his wealth and power, Kennedy would get good treatment anywhere. But the same care is available to every American.

Not so - if we make the health "reforms" called for by Kennedy and other liberals.

Filmmaker Michael Moore gives their standard line when he says: "There are problems in all health-care systems, but at least Europeans and Canadians have a health-care system that covers everyone."

Problem is, governments that promise to "cover everyone" always wind up cutting corners simply to save money. People with Kennedy's condition are dying or dead as a result.

Consider Jennifer Bell of Norwich, England. In 2006, the 22-year-old complained of headaches for months - but Britain's National Health Service made her wait a year to see a neurologist.

Then she had to wait more than three months before should could get what the NHS decided was only a "relatively urgent" MRI scan. Three days before the MRI appointment, she died.

Consider, too, the chemo drug Kennedy is receiving: Temodar, the first oral medicine for brain tumors in 25 years.

Temodar has been widely used in this country since the FDA approved it in 2000. But a British health-care rationing agency, the National Institute for Comparative Effectiveness, ruled that, while the drug helps people live longer, it wasn't worth the money - and denied coverage for it.

Barack Obama - and other Democrats - have been pushing a Senate bill to set up a similar US "review board" for Medicare and any future government health-care plan.

After denying this treatment completely for seven years, the NICE (did whoever named it intend the irony?) relented - partly. Even today, only a handful of Brits with brain tumors can get Temodar.

And if you want to pay for Temodar out of your own pocket, the British system forces you to pay for all of your cancer care - about $30,000 a month.

Things are no different in Canada, where the wait for an MRI (once you finally get a referral) has grown to 10 weeks. For Canadians relying on their government health care, the average wait time from diagnosis of cancer to surgery is beyond the guideline set by both the US and European societies for surgical oncology.

And HealthCanada, the government system, similar refuses to pay for treatments that are often covered in America.

Chad Curley, a 37-year-old auto worker from Windsor, Ontario, had a brain tumor like Kennedy's but can't have surgery because his is too large to be operable.

His tumor didn't respond to Temodar and the same doctors now treating Sen. Kennedy told him and his wife that the Avastin combination could stop his tumor from growing and add months to his life. But HealthCanada wouldn't pay to use Avastin to treat his tumor.

Chad's family and friends scraped together the $5,000 for the first round of treatment in mid-November; they later saw Chad's left-side paralysis start to subside. But the money ran out - and he died on Feb. 21.

In pushing for government-run health care, liberals are pushing for a system where only the Ted Kennedys of the world can get cutting-edge - and life-saving - care.

[Inclag]

Excellent post.

My only concerns with socialized healthcare are, #1.) that Im afraid Americans will cease to be seen as customers any longer by providers, and that general care could decrease as an effect of that. I think about the general productivity/initiative/work ethic (or lack thereof actually) of most government run agencies or programs and it's a bit unnerving to think my health would be in the hands of such people.
#2.) Is that I'm afraid of stifling research by large medical/pharm companies; that they won't be so inclined to invest huge money intp research anymore because the windfall profits they used to be able to count on after a breakthrough will be no longer.

Ultimately though, I think the idea that a culture as socially advanced as ours in the US is, which will simply let people die every year by the thousands because they can't afford health care is ridiculous... especially considering every other advanced nation on the planet has found a way around the problem. And anyone who thinks that isn't a problem isn't someone I'd really care to know. How selfish can you be?

The amount of true drug breakthroughs in the last in 20 years that have come from big pharma has been steadily dropping as most of the research and such has been handed over to academia and other research institutes. I don't think that we would see any stifle in Big Pharma's initiative.

[BurlyShirley]

The amount of true drug breakthroughs in the last in 20 years that have come from big pharma has been steadily dropping as most of the research and such has been handed over to academia and other research institutes. I don't think that we would see any stifle in Big Pharma's initiative.

Do grants given to academia come solely from the government, or from these private pharmaceutical companies as well?

My point in this thread isn't to lash out against socialized healthcare...overall I am in favor of it, but I think my points/concerns are still valid, whether or not people want to recognize them.
We've seen what happens to other American industries when their profits are cut for one reason or another. Look at the motor vehicle industry in the US...nothing exactly groundbreaking lately. Production is moving overseas, etc.
It seems pretty obvious that pharm. companies would indeed take a hit if socialized healthcare were adopted here. Why should we assume that everything else would remain would remain the same?

[Samirol]

"Of course, with his wealth and power, Kennedy would get good treatment anywhere. But the same care is available to every American."

Only the super rich Americans.

"He'll likely take Avastin, a drug that in experiments with brain cancer has extended survival by months. A new cancer vaccine being developed in partnership with Pfizer could extend his life by six years."

Insurance does not cover things considered "experimental", like liver transplants.

"Things are no different in Canada..."

Except that things are hugely different in Canada since they are different systems, the article highlights the worst situations possible in a universal system, but shows that the super rich can get amazing care in our system. It doesn't highlight how 50% of the bankruptcies in the U.S are due partly to medical costs. It doesn't highlight how insurance companies in the United States are allowed to effectively kill someone by claiming liver transplants as experimental.

Do grants given to academia come solely from the government, or from these private pharmaceutical companies as well?

My point in this thread isn't to lash out against socialized healthcare...overall I am in favor of it, but I think my points/concerns are still valid, whether or not people want to recognize them.
We've seen what happens to other American industries when their profits are cut for one reason or another. Look at the motor vehicle industry in the US...nothing exactly groundbreaking lately. Production is moving overseas, etc.
It seems pretty obvious that pharm. companies would indeed take a hit if socialized healthcare were adopted here. Why should we assume that everything else would remain would remain the same?

As it stands, research in new drugs may take a hit, but the trade-off is that lives are saved and people aren't going bankrupt and losing their homes because they got cancer.

[ohio]

I feel so much differently now about these noble organizations.


Look I'm no cheerleader of these guys, but they are no worse or more evil than any large, for-profit organization. Sony wants us all to purchase TVs we don't need. Are they evil because of that?

Fix the system, but don't expect that large, for-profit pharmas (which we need, whether we want them or not) to suddenly become charitable organizations or to stop selling designer drugs to people that can afford them (e.g. viagra).

[Inclag]

Do grants given to academia come solely from the government, or from these private pharmaceutical companies as well?

My point in this thread isn't to lash out against socialized healthcare...overall I am in favor of it, but I think my points/concerns are still valid, whether or not people want to recognize them.
We've seen what happens to other American industries when their profits are cut for one reason or another. Look at the motor vehicle industry in the US...nothing exactly groundbreaking lately. Production is moving overseas, etc.
It seems pretty obvious that pharm. companies would indeed take a hit if socialized healthcare were adopted here. Why should we assume that everything else would remain would remain the same?

Not sure about your above question, would be interesting to know however. It is probably like most research done though academia that I saw as an engineering student. Government awards contracts/money to corporation. Corporation uses students (and I maybe this isn't coming out with the right tonality) as what is effectively cheap labor and after a breakthrough is made, the corporation and school profit from it.

I don't know what your trying to analogous with, with respect to the automotive industry. Could you be more elaborate? I thought that the overseas manufacturers were moving production stateside? There have been a number of Japanese manufactures opening plants in the South where union laws differ from their Detroit counterparts. The US automotive industry is more or less a fiasco however.

[kidwoo]

Look I'm no cheerleader of these guys, but they are no worse or more evil than any large, for-profit organization. Sony wants us all to purchase TVs we don't need. Are they evil because of that?

No they're just cocksuckers for using their resources to produce and market complete bullshlt under the guise of health and well being. Given they're allowed to do so because of the market environment we've given them......they just suck for choosing to proceed in an area as serious as health :)

What it's done for me (and I'm damn sure not alone on this) is when I see the words 'new' and 'recently approved by the FDA' I want to run for my life. Sure it could be another jesus holy son of god (my little nickname for advil), or it could be the next viox. There have been some wonderful things to come out of merck phizer etc........it would be great if that's ALL that came from them. Yes they're just like every other profit based, board directed, publicly traded company. And that's EXACTLY the problem.


Fix the system, but don't expect that large, for-profit pharmas (which we need, whether we want them or not) to suddenly become charitable organizations or to stop selling designer drugs to people that can afford them (e.g. viagra).

You mean like quit making pills for things that don't exist and live off the government teat just like northrop grumman, lockheed etc.........?

Government just needs to grow that extra titty. That's right. I said it.

[SPINTECK]

Here's something I thought about. If the gov't enables a form of healthcare, you can hold them accountable through elections and even call your representative up. In the current system, when my healthcare gets changed I have no control and can't reach anyone- they don't care anyway because what can I do, buy a better plan from an insurer my company doesn't use?? For what, 900$ /month family plan??

Many older people want to retire, but can't because they won't have healthcare until medicare kicks in. If I manage my finances properly, it would be nice that I don't have to work just for healthcare. Not relying on your employer for healthcare will also enable workers to change jobs w/out worrying about healthcare.

Just some random thoughts. I'm sure by now everyone has strong opinions either way.

[BurlyShirley]

You mean like quit making pills for things that don't exist and live off the government teat just like northrop grumman, lockheed etc.........?


Apparently you've been praying enough that our loving god hasn't yet seen fit to burden you with the intolerable agony that is "Restless Leg Syndrome." Consider yourself blessed that a cure exists.

[BurlyShirley]

This:
http://www.obesitylapbandsurgery.com/tecmain.html

The "Lap Band" is actually my favorite medical breakthrough yet. If you're too fat a piece of sh*t to stop eating, get a "Lap Band" implanted around the top of your stomach, which you can, by remote, close off ... to stop yourself from gorging down any more pork rinds.

[Samirol]

something that trial lawyers can cash in on in about 5 years.

The contracts they probably make you sign are airtight, so they can't get sued if something bad happens.

Although the lap bands and gastric bypass surgery may seem lazy to us, to some people, it is critical that they lose weight fast and reliably, and those procedures do it. They save and improve lives.

[Samirol]

http://www.huffingtonpost.com/rob-kall/libertarian-legacy-ron-pa_b_111079.html

I found this extremely ironic

What a testament to the Libertarian creed, which abhors the idea of universal health care. This loyal, passionate man who died too young left his family a debt of $400,000 in medical bills. And who knows whether he put off getting treatment for the pneumonia that killed him because he was uninsured.

Kent Snyder did some amazing work on the Ron Paul Campaign and as remembered as a "libertarian giant"- by Lew Rockwell, on libertarian site, Lew Rockwell.com.


Ron Paul's campaign manager leaves his family with $400,000 of debt because of his illness, and was vehemently against universal health care.

[Silver]

http://www.huffingtonpost.com/rob-kall/libertarian-legacy-ron-pa_b_111079.html

I found this extremely ironic



Ron Paul's campaign manager leaves his family with $400,000 of debt because of his illness, and was vehemently against universal health care.

Libertarians have zero sense of irony...it will be totally lost on them.

[Samirol]

http://www.washingtonpost.com/wp-dyn/content/article/2008/08/03/AR2008080302077_pf.html

Health and life insurance companies have access to a powerful new tool for evaluating whether to cover individual consumers: a health "credit report" drawn from databases containing prescription drug records on more than 200 million Americans.

Collecting and analyzing personal health information in commercial databases is a fledgling industry, but one poised to take off as the nation enters the age of electronic medical records. While lawmakers debate how best to oversee the shift to computerized records, some insurers have already begun testing systems that tap into not only prescription drug information, but also data about patients held by clinical and pathological laboratories.

Traditionally, insurance companies have judged an applicant's risk by gathering medical records from physicians' offices. But the new tools offer the advantage of being "electronic, fast and cheap," said Mark Franzen, managing director of Milliman IntelliScript, which provides consumers' personal drug profiles to insurers.

The trend holds promise for improved health care and cost savings, but privacy and consumer advocates fear it is taking place largely outside the scrutiny of federal health regulators and lawmakers.

Ingenix, a Minnesota-based health information services company that had $1.3 billion in sales last year -- and Wisconsin-based rival Milliman -- say the drug profiles are an accurate, less expensive alternative to seeking physician records, which can take months and hundreds of dollars to obtain. They note that consumers authorize the data release and that the services can save insurance companies millions of dollars and benefit consumers anxious for a decision.

"Some insurers can make a decision in the same day, or right on the spot," Franzen said. "That's the real 'value-add.' "

But the practice also illustrates how electronic data gathered for one purpose can be used and marketed for another -- often without consumers' knowledge, privacy advocates say. And they argue that although consumers sign consent forms, they effectively have to authorize the data release if they want insurance.

"As health care moves into the digital age, there are more and more companies holding vast amounts of patients' health information," said Joy Pritts, research professor at Georgetown University's Health Policy Institute. "Most people don't even know these organizations exist. Unfortunately the federal health privacy rule does not cover many of them. . . . The lack of transparency with how all of this works is disturbing."

Ingenix and Milliman create the profiles by plumbing rich databases of prescription drug histories kept by pharmacy benefit managers (PBMs), which help insurers process drug claims. Ingenix, for instance, has servers in the PBM data centers, updating the drug files as frequently as once a day, said John Stenson, senior vice president of consulting for Ingenix, which is a division of UnitedHealth Group. The corporation also owns UnitedHealthcare, the nation's second-largest insurer.

When an insurer makes an online query about an applicant, Ingenix or Milliman's servers scour the data and within minutes or less return reports to a central server at the company. The server aggregates the information going back as far as five years, including the drugs and dosages prescribed, dates filled and refilled, the therapeutic class and the name and address of the prescribing doctor.

Then comes the analysis.

Ingenix's MedPoint tool provides insurers a "pharmacy risk score," or a number that represents an "expected risk" for a group of people, such as 30- to 35-year-old women who have taken prescription drugs, Stenson said. Higher scores imply higher medical costs.

Milliman's IntelliScript codes drugs red, yellow or green, according to the insurer's instructions, with red signaling the greatest risk, Franzen said. Red codes could include the so-called AIDS cocktail drugs and cancer medications, he said.

The companies receive data only on individuals who are in clients in PBMs' databases, generally excluding, say, people who pay for drugs in cash. The profiles cost insurers about $15 a search. IntelliScript gets about 1 million queries from insurers a year, largely individual health insurers.

The system can save money for insurers, said Richard Dick, an entrepreneur who built the database system that Ingenix acquired in 2002.

For instance, if MedPoint produces a report that an individual has been on the highest dose of the cholesterol-reducing drug Zocor for 18 months, the insurer "would be able to know that you have a very high, near-intractable cholesterol problem," Dick said, and could avoid a costly blood test.

From a business standpoint, it makes no sense for an insurer to sell a plan with a $200 monthly premium if the company knows that the consumer is taking medications that cost $400 every six months, industry experts said. That is why having access to an "objective" source of third-party information is valuable, said Tia Goss Sawhney, a Chicago area health insurance actuary who has used both companies' tools. "Though most people tell the truth most of the time, there are people out there who don't, who leave out something that's incredibly relevant, who may even be able to defraud a company," she said. "That's important because ultimately the people who tell the truth have to pay for those who don't."

Franzen, whose firm expects revenue of $575 million this year, said his clients tell him that about 10 percent of applicants do not disclose pertinent medical conditions in their applications that are later revealed by prescription drug history.

Some health experts worry that insurance companies can make faulty assumptions by looking at prescription drug records, because many drugs have multiple uses. "I had a patient on Amitriptyline for migraines and they were denied life insurance because it's also an antidepressant," said physician Kate Atkinson of Amherst, Mass. "I had to explain it wasn't being used for depression." Another patient was on Prozac -- not for depression, but for menopausal hot flashes. "I wrote an appeal letter, and they still wouldn't give it to her," Atkinson said.

Services such as MedPoint are just "one of many tools" underwriters use to make coverage decisions, said Tyler Mason, a spokesman for UnitedHealthcare, which uses MedPoint. A high-risk score on a profile will often lead to requests for more information from the applicant, he said.

Ingenix and Milliman officials stress that they provide data only with the patient's consent, as required by the Health Insurance Portability and Accountability Act (HIPAA), a 1996 law that governs personal health records information. But HIPAA does not give the Department of Health and Human Services the ability to directly investigate or hold accountable entities, such as pharmacy benefit managers or companies such as Ingenix and Milliman, who are not covered by HIPAA.

A health privacy proposal pending in Congress would expand federal officials' ability to regulate such "downstream" organizations, audit their activities and impose civil fines. The bill also includes a prohibition on the sale of electronic medical records.

Tim Sparapani, senior legislative counsel at the American Civil Liberties Union, said that the products that Ingenix and Milliman are marketing represent the "commodification" of electronic medical records by third parties. "We've got to stop these practices before the marketplace is fully developed and patients lose all control over their medical information," he said.

The field is growing rapidly. Realtime Solutions Group, a company in Woodridge, Ill., is testing whether lab data can be aggregated with prescription and other data for underwriting purposes. The firm is working with two major commercial labs and three large insurers, using thousands of real applicants. Initial results are promising enough that the company plans to proceed to the data-analysis stage, company co-founder Tedd Determan said.

"A lot of insurance companies are starting to use this type of data," said Determan, who co-founded IntelRx, a company that mined prescription databases and was sold to Milliman in 2005. "They said, 'All right. Prescription data is working, let's go and look at other types of data, too.' It's because of the success of one, that we're going after others."

In February, the Federal Trade Commission issued an order saying that MedPoint and IntelliScript are consumer reports under the Fair Credit Reporting Act, so the companies must notify insurers that consumers denied insurance on the basis of these reports have the right to request a copy of the report and that errors be corrected. The FTC's order followed a settlement of allegations that the companies violated the credit-reporting law by failing to provide such notice to insurers.

Bob Gellman, an independent privacy consultant in Washington, said the FTC's decision not to fine the companies sends "the message that it is okay to ignore the law." That, he said, "is absolutely outrageous."

As more health records become electronic, he said, more parties will compete to sell more comprehensive patient data to insurers, driving down data prices. "It will all likely be lawful," Gellman said, "but consumers will likely continue to have no real meaningful choices if they want insurance."

Dick, who conceived the idea of linking the pharmacy databases for underwriting purposes a decade ago, said the pharmacy benefit managers understood the system's privacy implications. He said their attitude seemed one of, " 'Ooh, this is a 60 Minutes' story in the making.' Generally, they wanted to make it a super-secret database, restricted to underwriting."

But now, he said, "there's a huge case for it being opened up for all legitimate access," whether for a patient in an emergency room or for federal government purposes. The key, he said, is full transparency.

He said he has created a privacy tool that requires users to consent before specific data, such as prescription histories, can be released. To work, he said, the tool must be independent of all who hold the data.

"Otherwise," he said, "you have the fox in charge of the henhouse."

[drkenan]

Samirol - beat you to it by 6 months... :D

http://www.ridemonkey.com/forums/showthread.php?t=195741

...but strangely no one really seemed to care that much. I think this is huge news.

[Samirol]

Samirol - beat you to it by 6 months... :D

http://www.ridemonkey.com/forums/showthread.php?t=195741

...but strangely no one really seemed to care that much. I think this is huge news.

Slightly different, this uses prescriptions to determine life insurance and health insurance rates, that uses past payment history from hospital stays (which can be used by insurance companies to risk, aka raise rates). At one point, I was taking asthma medication for my allergies when it was a horrible summer, when I don't have asthma at all. That could be used to say "Hey, this person has a history of asthma, jack up his rates".

[drkenan]

Ha ha...guess I should've read the article. :D

But both situations are extremely fvcked up.

[Defenestrated]

thats verging on evil