[Dialogue] [Oe List ...] some proposals for real health care reform

[Jack Gilles]

Susan,

Just a small input to your point.  Speaking as a former research  
chemist and as a consultant to 4-5 pharma companies in India I would  
question your assumption that the incentive for invention is profit.   
No, in most cases, for those doing the inventing the incentive is to  
make a difference in caring for the world.  Profit is often the  
determining factor in a company's willingness to finance the  
research.  But even in that case I know of pharma companies that  
sponsor research on drugs because they truly want to make a difference  
and if it makes money for them that's a bonus.  There is a famous  
example where Merck developed a drug that was affective for river  
blindness but couldn't profitably sell it.  But they ended up giving  
it away.  Why?  Because they knew that the chemists who invented it  
would have quit had they not.  Sure there are companies pouring vast  
sums into finding drugs for many of our current problems, Alzheimer's  
for instance, knowing that a breakthrough will mean huge profits.  But  
I know for a fact that most, not all, of the scientists working on  
these problems are doing so because they care, not to make their  
companies rich.  I know personally the Managing Director of one of the  
pharmaceutical companies, Cipla, in India that developed the low cost  
AIDS cocktail of drugs distributed by Bill Clinton at a "cost plus"  
basis.  Meaning that essentially they produced them almost at cost so  
that they would be available to the poor.  He told me they don't worry  
about profit and it isn't the reason they are in business, rather it  
is the reason they can STAY in business.

Peace,

Jack
On Sep 11, 2009, at 3:23 PM, Susan Fertig wrote:

> I like a lot of what you say in this message Marshall (I know -  
> can't remember when I ever agreed with you about anything!!).  I am  
> particularly interested in your first set re: Congress.  I worry a  
> little about your second set, because the incentive for invention  
> (i.e. new cures) is profit -- those pharmaceutical companies just  
> need better oversight to break the link between doctors and  
> pharmaceutical companies (why isn't it a conflict of interest for  
> doctors to own pharna stock --and then prescribe from those  
> companies' products?).  I'm curious about your comments on Medicare  
> Part D -- I opted not to sign up for it, for instance, because I  
> couldn't see how it would be better than what was available  
> commercially.  And why 2E?  Again, I want those pharmaceutical  
> companies doing research and finding new drugs and new cures. If  
> there is no profit, who will do the research?  Taxpayer funds are  
> not a bottomless resource or a tree that just grows money.
>
> On your third point: I recently found out that Blue Cross Blue  
> Shield is a non-profit.  I was quite surprised, because they compete  
> with Aetna and all the others.  (Actually, BCBS is my carrier). Why  
> do you want to force everyone to use a non-profit, though?  Oh well,  
> I guess we'll never agree on socialism vs. capitalism. (And i don't  
> mean that having non-profits vs. commercial companies = socialism,  
> just that requiring everybody to be non-profit = socialism).
>
> And finally, on your fourth section, what is excessive?  Who defines  
> that?
>
> Susan
>
>
> From: oe-bounces at wedgeblade.net [mailto:oe-bounces at wedgeblade.net]  
> On Behalf Of W. J.
> Sent: Thursday, September 10, 2009 12:39 AM
> To: oe at wedgeblade.net; dialogue at wedgeblade.net
> Subject: [Oe List ...] some proposals for real health care reform
>
> OK, so I waited to hear Obama's speech. Not much new there. So now's  
> my turn.
>
> Here are some fairly radical proposals for bringing the cost of  
> health care down from one sixth of GNP to maybe as little as one  
> tenth, while moving toward universal coverage (excepting, of course,  
> those pesky undocumented workers).
>
> 1. Start with Congress itself, which is captive to 'special  
> interests' who provide generous campaign and lobbying issues funding.
>
> a. Cap corporate contributions to Congress @ $1,000 total per year  
> per candidate/officeholder for all corporations and their  
> executives. Ban all corporate perks such as free flights on  
> corporate jets, etc.
> b. Drastically reduce the cost of political campaigns by banning  
> paid television advertising on commercial networks. Unpaid news  
> coverage and public affairs television exposure would be encouraged.
> c. Substitute extensive free political issues exposure on the PBS  
> system for all candidates/officeholders with massive coverage of  
> debates, town meetings, speeches, position papers, books, articles,  
> proposals, etc.
>
> 2. Squeeze both marketing costs and profits out of the major  
> pharmaceutical companies.
>
> a. Ban all commercial television advertising of medical devices and  
> prescription drugs ("Ask your doctor about . . . ").
> b. Change Medicare Part D to mandate federally negotiated drug  
> pricing (the Republicans won't stand for this, 'cause they're  
> protecting these special interests with a massive give-away program).
> c. Require pharmaceuticals to offer the Medicare negotiated drug  
> pricing through all insurance companies.
> d. Encourage all prescription drug users to seek the lowest cost  
> options outside the USA, for example from Canadian sources.
> e. Require Medicare and all other payers of prescription drugs to  
> use the lowest cost approved suppliers of generic drugs in the  
> global marketplace.
> f. Require FDA oversight of all approved foreign drug manufacturers.
>
> 3. Take the health insurance companies out of the 'for profit'  
> insurance business and place them in competitive positions to lower  
> the costs of health insurance.
>
> a. Place all health insurance in not-for-profit spin-offs, breaking  
> the hold of consolidation in the insurance industry.
> b. Force competition among insurers by making insurance available  
> across state lines.
> c. Place private insurance companies under federal, as opposed to  
> state, regulation.
> d. Set up federally sponsored alternative insurance programs.
> e. Give federations of small businesses the same negotiating  
> leverage to drive down group insurance rates enjoyed by large  
> corporations.
> f. Require licensed insurance companies to offer individual health  
> insurance at a rate that is the average of all their group health  
> plans.
> g. Make health insurance a right, not a privilege that can be denied  
> to the 'undesirable.'
> h. Lower all monthly Medicare payments to Medicare Advantage plan  
> insurers to an annually negotiated rate (the Republicans won't stand  
> for this, 'cause they're protecting these special interests with a  
> massive give-away program).
> i. Require Medicare Advantage plans to offer dental insurance in  
> their benefits package @ zero premium to the policyholder.
>
> 4. Wring excessive costs and huge profits out of for-profit medical  
> practices and hospitals.
>
> a. Set up alternative medical practices like the Cleveland Clinic  
> model based on salaried personnel, rather than fee for service  
> payments, and give preference to these providers based on lower  
> costs and higher quality of services.
> b. Set up alternative specialty hospitals, clinics, and medical  
> services companies with lower operating costs to compete with  
> outdated and underperforming institutions.
> c. Set up an alternative form of liability insurance with federal  
> panels of physicians to sift real malpractice from spurious/inflated  
> claims, and severely punish those who violate medical norms.
> d. Put an end to defensive medicine, duplicative testing, and the  
> 'anything goes' mindset by making physicians annually accountable to  
> review boards for substantially inappropriate, wasteful  
> 'overtreatment' of patients, with significant penalties for patterns  
> of abuse.
> e. Study systemic regional differences in cost and practice patterns  
> with control mechanisms to rectify exaggerated distortions in the  
> costs of medical care.
> f. Offer standard fee-for-service procedures at Medicare approved  
> rates throughout the nation through all insurers.
>
> That's just a few of the things you probably won't get in Obamacare.
>
> Marshall
>
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