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POLICY: Unrealistic, unfair mercatilism in health care.

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I like Don Johnson’s blog Businessword but sadly when you really push him, as I’ve done in his comments over the last couple of years, he either won’t answer or his answers reveal a political philosophy that is downright mean. So in his criticism of Krugman’s analysis on his blog and in comments at THCB here, Don essentially says that if you’re poor or sick in America, well that’s just tough titties. And, as a by product, it’s OK for the insurance market to screw over those who really need individual insurance because, well, because it’s a "market". Same way it’s OK for Enron to defraud the California rate payer, or same way it’s OK for Healthsouth to defraud its shareholders. After all they’re operating in "markets" too.  But Don misses the wider point. Because of the way the US system is set up  — because we’re a richer country than any in Europe, and because the majority of people can afford to pay way too much for our health care —  we systematically overpay for things that no rational market would value. That does not help our economy, it hurts it as most health care spending is non-productive to the overall economy.

The other point that pro-unrestrained booty capitalists in health care, or those Krugman was criticizing, go on about is the huge waiting lists in Canada and the UK.  Well as I mentioned in the UK the wealthy can trade up with their own money while the less well-off get a decent standard of care. Meanwhile single payer advocate Don McCanne found this just excellent chart from Stats  Canada which shows that median waiting times for non-emergency surgeries in Canada  are just over 4 weeks! I’m more than prepared to wait 4 weeks for non-emergency surgery if it means that poor people wont be crushed by their medical bills and can get access to basic health care. (For far more details on this see my "Oh Canada" piece).  And anyone who doesn’t think that’s a fair equation is just mean in my viewpoint. Not to mention that such a system would cost me as a tax payer and a premium payer less money! Money I could spend on other, more productive things, like Frappuchinos.

POLICY: Ezra Klein on Health Care in France

Ezra Klein is a nauseatingly over-achieving student at UCLA who, at an age when I was trying to pick sufficient 10p pieces out of the gutter to buy myself a half of ale at the college bar (and usually end up back in the gutter), has a successful blog and is on the way to becoming a writing star of the liberal ilk. Ezra’s blog goes all over the map in a fascinating way.  This week he’s featuring a whole series on health care systems in other countries.  Dangerous work, Ezra — that’s where I started.  The first one is about Health Care in France and it’s really good.

Policy: A Break in the Florida HIV case By John Pluenneke

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It sounded a lot like one of those stories from Florida we keep hearing about. A mystery like the chads. Or the anthrax case, which started not far away in Boca Raton.   

Two months ago a worker at the Palm Beach Department of Health (DOH)
accidentally sent out an email containing a list with the names of
6,500 people with HIV/AIDS. Officials thought the problem had been
contained. It turned out it had not. About thirty days after the incident mysterious letters started
appearing at the homes of people named on the list. "Your name appears
on a list of people with HIV/AIDS", the letters began.

Somebody had apparently gotten their hands on the list. That somebody
was using it to target people with HIV/AIDS. The head of the Palm Beach
Health Department called the case "terrorism."  Speculation immediately
focused on the e-mail leak.

Had a copy of the list somehow escaped and found its way into unfriendly hands?  It seemed unlikely we’d ever know exactly what happened. After all, the
anthrax case showed how difficult it is to track down somebody who
wants to go around using the U.S. postal service to mail things to
people.

There has however been a break in the case. Late last week, the Palm Beach Health Department said it has fired an analyst
in its HIV/AIDS program. It also said it had discovered another
security breach. There is suspicion that Dr. Shireesh Patel was the
person responsible for the disappearance of 15 pages of the paper copy of the Palm/Beach HIV/AIDS list. 

According to documents obtained by the Palm Beach Post, the internal
investigation into the matter found that Patel lied to investigators
about the incident. It also found that he asked fellow employees to
help him cover up the mistake. 

There are also new details about the number of letters sent. According
to the report, which was filed by inspectors Jerome Worley and Paladin
Henderson (a solid name for law enforcement, if ever there was one), 36
letters were sent to people with HIV/AIDS in the Palm Beach area.

Case closed?  Perhaps not. The Orlando Sentinel
has a piece which ran over the weekend, which strongly suggests that
things are far from settled.  According to Department spokesman Tim O’Connor the
paper copy of the list could not be the source of the leak because the
missing pages do not include any of the names of patients who received
letters.  Very mysterious. Very mysterious, indeed.

It would be interesting to know what Dr. Patel has to say for himself, wouldn’t it?

PHARMA: Why is Crawford’s FDA nomination stalled?

Good salacious stuff for a Friday.  Apparently the scuttlebut inside the FDA is that reason that the FDA acting commissioner Crawford’s nomination is being held up is because he’s favoring an FDA staffer. What this means, according to a much more frank article in FDA Webview is that he’s hoofing his secretary and taking her on lots of "business" trips.

FDA Webview has learned that the investigation into FDA commissioner-nominee Lester M. Crawford requested by Senate HELP Committee chairman Mike Enzi (R-WY) involves an anonymous allegation that Crawford has been having an affair with his special assistant, Susan Bond. A close confidant has denied any affair exists, however. According to well-placed sources, the investigation Enzi asked FDA’s Office of Internal Affairs (OIA) to conduct involves allegations of waste of government resources in unnecessary travel expense and irregular promotion of Bond to her present position. OIA, which has a long history of ineptness, secrecy and bullying, reports directly to Crawford, raising questions as to why Enzi turned to it instead of the HHS Office of the Inspector General, which has a much better record. Personnel issues, however, especially those involving improper use of government resources, are within OIA’s charter.

I’m of the opinion that what you do with your private parts in your private life is private, and that so long as you’re doing your job well who cares? But I suspect several of the Republican Senators on the confirmation committee don’t agree with me, and I suppose a government official shouldn’t play favorites (although of course they all do).  What with holding back on Plan B, it does appear that Mr Crawford’s "family values" planning is a little awry.

HOSPITALS: Hospitals on the verge of a nervous breakdown

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Sorry, so the title is another bad attempt to be imitate an old Spanish movie but the problem is real enough. If the formula is, increase the number of jobs available without insurance, add more people moving into a county without regular  access to physicians, reduce the number of community clinics, and limit the amount of services at county hospitals, then the result will be more and more people showing up in the ER at other local hospitals. And of course if this is in LA County, all those problems are going to be magnified. The study claims that at "40 private hospitals reporting jumps in
emergency room visits by the uninsured, the cost of caring for them
rose from $63 million in 2000 to $77.5 million in 2004." So amazingly enough, the health care system for the people at the bottom appears to be connected to the one for the rest of us? Who’d have thought it, in this day and age when there are no social problems, no issues with inequality, and we’re all happy in Arnie’s golden state?

POLICY: Krugman on the international health care context

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Paul Krugman has a great column out about the international health care context, called The Medical Money Pit. There’s nothing new or original that THCB readers or Health Affairs readers won’t already know. We spend more and basically get less, but we lead the league in surgeons driving Porsches. But it’s very good that someone is raising this issue outside of pure policy wonk circles. Even Krugman seems stunned that our government spends so much more per head than other governments which cover all their people, and all we get for it is Medicare for seniors and crappy coverage for the very poor. And by the way those numbers don’t count the role of the Feds and states as employers paying for health care coverage for 10 million government workers–if you add that in, the government share of spending is higher (although that math doesn’t really matter as we don’t cover any more people because of which column you put the spending in).

What Krugman doesn’t say is that, in general, government spending in those other countries guarantees a basic level of care for everyone, and that the rich (even in the UK, but not in Canada) can trade up with their own money for a nicer class of waiting room or to jump the line. And they do, and there’s not only nothing wrong with that.  It doesn’t destroy the basic fabric of the social system.  And if we had universal health care here, it would be true here too, and there would be nothing for those in the upper social tiers here to be afraid about.  But you won’t find that rumor getting out when this gets discussed politically.

PBM: Caremark apparently about to face fraud charges?

Writing in The Street Melissa David says that a 6 year-long investigation of Caremark receiving overpayments for Texas Medicaid is about to result in indictments.  Caremark stock reacted poorly to the rumors.

Caremark

Of course indictments and charges are nothing new in the PBM industry, and will only become more common when Medicare Part D is introduced next year.  Why?  Well the whole industry runs on secrets, and no-one really understands what’s going on, despite the attempt to develop "transparent PBMs".

PHARMA: Patients are stil “complieant”

Patients don’t take their pills properly. Some estimates are that 30% of written scripts are never filled.  Now there’s a new Harris study out showing that 33% of patients are actively non-compliant. Of course if all these patients took all the pills that they were supposed to, then pharma costs would be much higher — Datamonitor is quoted as saying that’s $30 billion a year higher (or 15-ish percent).  And of course if they all took all their pills properly overall health costs would be much lower, right? Right? (Where is the echo from PhRMA when you need it?).  Still the cost impact of non-compliance is something to ponder.

PS "Complieant" was my add to the "just-off" definitions list run on THCB a few weeks back.

POLICY: Super Size This! By John Pluenneke

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Supersizeposte200_1 As if the US fast food industry didn’t have enough worries with new labeling rules under discussion at the FDA and the campaign for healthy school foods being led in California by the Governator, there is more bad news on the way. Morgan Spurlock’s Super Size Me has been edited down and re-released so that it can be shown to middle school and high school audiences.  The film, which shows Spurlock’s physical deterioration over the course of a month as he consumes a steady diet of Big Macs, fries and sodas, has won praise from nutritionists for its depiction of the health problems junk food can lead to.  Perhaps objectionable segments, like the moment where Spurlock’s vegan chef girlfriend discusses the impact of his fast food diet on his penis with almost eery clinical detachment have been edited
out.   What sort of impact could the film have? According to a
report in Newsday, students in New York went on strike last week after watching the film, demanding healthier food. Could this mean a wave of radical civil disobedience might follow at school cafeterias and vending machines across the country? 

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