[Dialogue] [Oe List ...] some proposals for real health carereform

[Jack Gilles]

Susan,

My comment was about the profit motive on invention and creativity.   
It is not an endorsement of Pharma companies, especially the global  
giants.  Many, if not most, are interested in but one thing, how to be  
as profitable as possible, even if it means doing unethical and even  
illegal actions.  I know, in my consulting work I saw many examples of  
this.  The same is true by the way for the giant food companies.

For instance most companies advertise on TV to get people to ask their  
doctors for certain drugs even though they have NO IDEA if they are  
what they should be taking.  Such advertising should be banned.   
Pharma companies get doctors to write articles promoting their drugs,  
but hide the fact that they are paying the doctors for the articles,  
many of which have "cooked" data.  Companies will "tweek" a drug so  
that it can be marketed as a new drug, but in reality it has no better  
affect than the old one, but protects the high price against it  
becoming available as a generic.  Much of the "high cost of research"  
is paid for by government grants, but the company gets to profit from  
the results.  Companies often build into the pricing the high penalty  
costs that will come from discovered side affects, many of which are  
know before hand, but deemed worth the risk because the profit is so  
high.  And as for giving away those drugs you mentioned, I'm afraid in  
most cases that is just a clever PR gimmick, not unlike we "liberals"  
who brought turkeys to the inner city so that for one day people would  
have a nice meal, but never got involved in the structural changes  
needed to enable food availability to all.

No, I have no love for most pharma companies actions, but I have hope  
that business people can and do find "making a difference" their  
reason for existence and work and that we are in a trend, albeit an  
early one, that is leading in this direction.  I take courage in the  
Cigna health executive who, after visiting a free health clinic and  
seeing the vast needs, awoke to his own participation in stopping  
genuine reform, did as Neibhur suggested on that Sunday morning paper  
in RS-I, turned his back on it and is leading the charge towards a  
redeeming change.

Peace,

Jack
On Sep 11, 2009, at 3:58 PM, Susan Fertig wrote:

> And a lot of those "bad" pharmaceutical companies who make those  
> nasty "profits" have plans to provide drugs free of charge to people  
> who cannot afford them.  Again, that is not legislated; that is  
> voluntary.
>
> Susan
>
>
> From: oe-bounces at wedgeblade.net [mailto:oe-bounces at wedgeblade.net]  
> On Behalf Of Jack Gilles
> Sent: Friday, September 11, 2009 4:49 PM
> To: Colleague Dialogue; Order Ecumenical Community
> Subject: Re: [Oe List ...] [Dialogue] some proposals for real health  
> carereform
>
> 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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