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PHARMA/POLICY/POLITICS: McKinnell’s friends turn and bitch-slap him, by The Industry Veteran

The Industry Veteran is back. He notes a piece I’d missed in which the oh-so-rational editorial board of the Wall Street Journal declared Part D to be a future political liability for their desire to drown the government in a bath-tub. And it’s all or mostly the fault of poor Hank McKinnell. The Veteran’s not too impressed with their analysis:

In its May 19 editorial, the Wall Street Journal bitch slapped Pfizer’s CEO, Hank McKinnell, for strongly advocating the 2003 Medicare Modernization Act (i.e., Part D) before the legislation passed and since.  In the week preceding the May 19 cuffing, McKinnell apparently did a panegyric for Medicare Part D in front of the Journal’s editorial board that the Goebbels Gang considered less than persuasive.  Before writing their Night of the Long Knives editorial, the Journal’s editors knew that McKinnell’s partisanship for Part D was more than mere flack work, sycophancy or a simple affirmation of sound, eighteenth century economics.  In his role as president of Big Pharma’s trade group, the Pharmaceutical Research and Manufacturers Association (PhRMA), McKinnell was a driving force behind the Medicare Modernization Act.  Never more than six months behind the news, the Journal is finally reflecting some of the sotto voce criticism that McKinnell is receiving from within Pfizer itself.The Journal’s criticism of Medicare Part D and its advocates combines boilerplate, right wing economics with Monday morning political quarterbacking and crypto-fascist scare threats about single-payer health systems.  The patellar reflex economics faults Part D for contributing to the federal deficit.  In this respect the Journal aligns with Reaganite and other conservatives who label Bush a fraud for posing as a conservative when he is actually a big deficit spender who obtains Congressional acquiescence for his military Keynesianism by declining to veto porkbarrel legislation.  The Wall Street Journal’s reproval of Bush’s spending, however, is less credible than Claude Rains’s declaration of shock at learning that there is gambling at Rick’s Cafe.  Bush is only opposed to federal spending if it benefits the middle class and the poor.  He doesn’t have the slightest problem with a fiscal deficit policy as long as the spending benefits his cronies and benefactors who run multi-billion dollar corporations.  It is for this reason, rather than some fixation on 1960’s vocabulary, that I call George Bush a fascist.  In siding with the stopped-clock conservatives who favor a balanced budget, the Wall Street Journal’s editors merely seek a cloak of principle for their Hjalmar Schacht economics.The Journal’s Monday morning quarterbacking faults Republicans for thinking that the Medicare Modernization Act would turn Medicare from a Democratic into a Republican issue.  Instead the MMA gives Democrats a reason to call for constant improvements to the program that will require more federal spending.  In the Journal’s horror scenario, the out of control spending will lead to calls for Medicare to act as a single purchaser that can constrain costs.  The Journal holds some smelly socks and underwear between its thumb and forefinger to admonish thoughts of price constraint by claiming that the pharmaceutical industry will fail to discover new remedies if it can no longer gouge a cancer patient $300,000 a year for his medication.  (I mean, is this a great country or what?)  If a rejoinder to the Journal’s herring-stained fright-wig is necessary, it is the fact that the development of new molecular entities constitutes the sole reason for the existence and capital investment of branded pharma companies and biotechs.  The aging demographics of the developed world, and our commitment to health and longevity, virtually guarantee a fair return on this investment for a biopharmaceutical industry.  Not content with a fair rate of return, the Wall Street Journal, Hank McKinnell and George Bush take a unconscionable rate as their entitlement and that is where I want to see them bent, broken and humiliated.  Is Medicare Part D turning out badly?  If so, that’s good.  When it comes to George Bush and all his constituencies, worse is better.

QUALITY/INDUSTRY: Healthways buys Lifemasters

Over in the disease management world, a little piece of consolidation late yesterday. Healthways is buying Lifemasters for some $307m. Healthways is running at a $400m annual revenue rate and has a $1.75 billion market cap, so that suggests that Lifemasters is less than one fifth of its size, even though it’s apparently been growing fast the last couple of years. (It’s private so there are no official numbers). It’s also been around a long long time (I met the first founder in 1995!) waiting for DM as a market to take off. You can tell that in part from its funders:

LifeMasters Supported SelfCare, Inc. is privately held. Financial backing is provided in part by Intel Corporation, Lightspeed Venture Partners, Pacific Venture Group, Knotty & Co., VantagePoint Venture Partners, SightLine Partners, National Healthcare Services, The Northwestern Mutual Life Insurance Co., J. and W. Seligman & Co., Landmark Partners, ORIX Venture Partners, Siemens, Pacific Life Insurance Company, Cove Investments, Comerica Bank and Lion Investments Limited.

Sixteen different venture investors suggests that a lot of money has gone in over the years, and most of those investors must be tired enough that they are taking the rather thin bird in the hand than the fatter one which apparently was not hiding behind the IPO bush. Still with Medicare getting interested in DM, and the whole market belatedly taking off (Lifemasters is advertising over 60 vacancies on its website), it’s a little curious that they decided to take the offer rather than soldier on alone. Still Healthways stock is down some 5% on the news, so its investors aren’t exactly thrilled.

Anyone know more or have any thoughts?

 

POLICY/INDUSTRY: Money-driven Medicine, a sorta review

I must be getting vaguely famous as I was sent (unsolicited) a copy of a new book by Maggie Mahar called Money-Driven Medicine. On Sunday it was reviewed in the Boston Globe, which fairly accurately portrayed it as an indictment of 30 years of corporate medicine. Here’s the Globe’s conclusion:

The core message of "Money-Driven Medicine" is that the quintessential doctor-patient relationship has been transformed by the requirements of corporate medicine into a retailer-consumer relationship, and every sector of the system is trying to sell its products and services to that consumer and reap profits for its stockholders.This market-driven system, Mahar shows, turns the law of supply and demand on its head. The competition generates excess supply, but that does not lead to less costly medical care. It is the cost of replicated facilities, equipment, products, and services, along with millions spent on marketing and advertising, that keep the cost of medical care in this country soaring

So unlike many others, as this was a book looking at my core topic, I read it cover to cover. It’s a good read and broadly accurate as a narrative. If I had to nitpick I’d complain that Mahar spends too much time quoting other people rather than telling the story herself. I got the impression that being a financial journalist who came to health care as a fresh topic, she was a little over-wowed by what she found — although I guess that means that old middle-aged fogeys like me are too cynical about how badly people in the system behave. But at least the people she quotes at length like Jamie Robinson and Sheryl Scholnick are pretty sensible.

There were also one or two minor gems. I didn’t know that the AMA had a televised presentation opposing Medicare in 1962 immediately after JFK had a rally promoting it in Madison Square Garden—although it’s worth remembering that the AMA (and by extension most doctors) opposed Medicare and universal health insurance basically all through the 20th century. I also missed the fact that the SEC dropped an investigation into Bill Frist’s brothers conduct in the Columbia/HCA scandal immediately before the 2002 elections under pressure from the Administration—but that’s not exactly surprising.

Overall it’s a pretty comprehensive review of the corporatization of the health care system, and probably a pretty good introduction for people who don’t understand health care much. Although I remember another other book very like it written in the 1980s (which I can’t remember the title of) which also decried the new world of the for-profit hospital chains and that was before the most recent round of Columbia/HCA and Tenet undertakings.

Where I disagree with Mahan is that the perversion of medicine by money is somehow a recent thing caused by Wall Street & corporate incentives — sure you could argue that it’s worse now, but the manipulation of the health care system for the ends of power and profit is as old as the economy. And the impact that has had on the quality and cost of medical care is just as crucial, as whatever Tenet, HCA or HealthSouth has been up to. Paul Starr and Michael Millenson wrote much better books about that in the 80s and 90s. On the human issues involved Jonathan Cohn has what promises to be an even more interesting book coming up (although I’ve only seen two chapters)

Meanwhile I’ve given the book to John Irvine, who’s a more recent arrival in health care than I am…so I hope that he’ll be able to do an interesting review later unclouded by my biased perspective.

OFF-TOPIC: The most important world news

Iraq? Terrorism? Middle East? Health Care? IT?

None of that is in the least importance compared to what the English nation is fixated on. Will Wayne Rooney’s right foot be better in time for the world cup? The answer appears to be that a Scan rules Rooney out for six weeks. So he should be fit for the latter stages, provided we sneak past Trinidad, Sweden and Paraguay.

Policy: The LA Times on Kaiser Permanente By John Irvine

The smoke appears to be clearing around Kaiser Permanente’s headquarters, where the management is no doubt wondering if the worst is over after this week’s decision
  to close the HMO’s Northern California kidney
  transplant center
. Patients enrolled in the program have been transferred
  to UCSF and to UC Davis. Embarrasingly for Kaiser, there were a few Medicare Part D style snafus with the transition (apparently nobody was picking up at the toll-free number set up for patients.) But all in all, the consensus
  seems to be that Kaiser did the right thing by moving quickly to shut down the
  operation once the extent of the problems became clear.

What happens next? The answer to that question is probably best known by the
  reporters at the Los Angeles Times, who may or may not have something else up
  their sleeves, after the first wave of stories uncovering the scandal. Historically,
  the Times has been tenacious when it comes to pieces like this (For a good example see: the transplant story at UCI
  Medical Center
). The paper won a Pulitzer for
  outstanding public service journalism in 2005 for its series on King/Drew and might well have won another last year if it hadn’t been
  for the Times-Picayune’s
  brilliant coverage of Hurricane Katrina.

The problem for Kaiser is that once a story like this one breaks, a chain reaction
  starts. People get mad. People come forward. E-mails start flying. For reporters,
  the threads begin to unravel. It should go without saying that for a large health
  management organization with a long and varied history, this is not exactly
  an ideal scenario …

The whole emerging Kaiser story of course, has been the topic of lively debate  in the THCB comments section, where the company is far from as unpopular as  one might assume. (Matthew, you’ll note from earlier posts in this thread, is
  a fairly sympathetic observer.) Up from the comments to make life more interesting
  comes a former Kaiser transplant patient who did not particularly care for the
  detached and academic tone of the discussion between some of the posters. Sarah 
  had this to say:

I hate 70% of you. You have no CLUE what you are saying. I am one of those
  patients in the Kaiser Nor/Cal Transplant Program, having had a kidney transplant
  17 years ago. What is coming out about this program is utterly horrifying, and
  how any of you can defend Kaiser or debate the merits of transplants makes me
  ILL. You should be ashamed of yourselves. And I know none of this is coming
  from UCSF or Davis. And I know Dr. Inokuchi personally (she was one of my docs
  at CPMC). And I know the program has been crap since it started (good luck getting
  a call back for a simple question about dental pre-meds).This scandal is far bigger than y’all seem to realize. A lot of people died 
for no reason.

And for my surgery, Kaiser saved a fortune. $40k a year for 17
  years plus health care costs related to dialysis would have been far more than
  the transplant cost plus rejection meds."

POLICY: Do No Evil, Part II.

Here’s my editorial in today’s issue of FH.

This week saw more controversy regarding some of the bad boys of healthcare past
and strong hints that some of the healthcare market stars of the present may
have adopted their bad habits. Criminal investigations into United HealthGroup
and ACS are now following The Wall Street Journal story about their
stock option pricing and Bill McGuire’s huge fortune. Now Caremark has been
subpoenaed, too. Those of you with very long memories may remember Caremark in a
previous life getting into legal trouble as a home infusion operation in the
1980s and being a financial disaster as a physician group roll-up in the
1990s.

Meanwhile, Tenet accepts a death penalty on one hospital and is still
struggling to get out from the malfeasance and its appalling, if not outright
criminal behavior, in Redding, CA, and probably elsewhere. Not that this is the
first time that appalling criminal behavior has been seen from that company,
although it was called NME back when it was kidnapping children into its
psychiatric hospitals.

We won’t do more than mention the name HealthSouth. While they’ve been off
the news lately, it’s worth remembering that the other big hospital chain, HCA,
has paid two of the biggest fines ever for defrauding Medicare, and that the
Senate majority leader’s brother, who happened to be the chairman, had an SEC
investigation mysteriously end in 2002.

So it’s worth asking the question again. Is it just a few bad apples? Or is
the pressure for stock growth from Wall Street incompatible with running a
responsible healthcare company?

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