The ongoing healthcare debate and my own braindump

October 17, 2008 – 2:24 pm

Yes, I watched the final Barack Obama/John McCain debate on Wednesday night. Thankfully, the election will be over soon, and my dad will stop forwarding me “interesting” e-mails (he’s a conservative ex-cop; just one guess who he supports). U.S. presidential politics have made some headway into the pharmaceutical blogosphere; John Mack reported the results of his poll at the Pharma Marketing Blog; apparently pharma favors Mr. Obama. But there are other things to talk about other than politics and the shaky economy. For example, the NIH suspended a large grant at Emory University after Sen. Charles Grassley questioned the payments received by the former chair of the school’s psychiatry department; the Wall Street Journal reports that eight companies will be studying blood clot occurrence in stent patients; Genentech and Johnson & Johnson reported great third-quarter earnings; and Pfizer reached an agreement in principle to settle lawsuits about Celebrex and Bextra for $894 million.

The true costs of healthcare?

Jacob Goldstein at the Wall Street Journal Health Blog reviews the stances Mr. Obama and Mr. McCain took on health care at the debate.

At DTC in Perspective, Bob Ehrlich says it’s time to take stock in some new realities. “First, Obama is probably no worse for pharmaceutical companies than McCain,” he says. “Both blame big drug companies for high prices and reduced innovation. Both would try to significantly change the health insurance industry. In either case we should expect more price negotiation and re-importation.”

Here’s a question I’d love to hear answered: Under Mr. McCain’s plan, if the tax credit for health care is eliminated, and my employer winds up dropping my coverage because it’s now too expensive, will he also require insurance companies to take anyone, regardless of pre-existing conditions? Because I have to tell you, with my husband having epilepsy, I’m pretty sure that I will not be able to find a policy for him. If my husband has a seizure and needs to brought to the emergency room, that’s at least $8,000 we’d have to pay, folks – and even on epilepsy meds, he still has the chance of having a seizure. Also to consider are the costs of occasional visits to a neurologist, regular blood tests to make sure the medicine isn’t causing liver damage, the occasional MRI … would any individual policy I could possibly afford (even if a plan would take him) cover all this?

Over at DrugWonks, Peter Pitts and Dr. Robert Goldberg have continued to write about the threat of universal health care. CMPI (which Mr. Pitts is the president of) did a survey of millennials (people ages 18 to 28) and their attitudes about healthcare. Apparently this group supports healthcare reform, but is less supportive of any reforms that could raise their tax burden or increase their wait times for treatment (you can download the press release here).

Hmmmm.

OK, time to put a proactive plan into place. If I lose my health insurance for any reason, and can’t get a private policy for Thom, and we’re out somewhere and he has a seizure, I’ll be very, very insistent about him not being taken to the nearest emergency room – don’t call an ambulance (a ride can cost from $350 to $500), just leave him alone, he can walk it off – but if he has a seizure and I am not there, they’re going to transport him. That’s happened before, folks. Without insurance, what is a minor worry and inconvenience will become a full-blown financial nightmare.

I’ll be suggesting things like, “Honey, you have to start wearing your medical alert bracelet again, because then if you are brought to a hospital, maybe they won’t do those very expensive tests for controlled substances in your bloodstream!” (When I spotted that item in one of the bills, and saw the cost, my eyebrows shot up so far they almost flew off my face - they tested him for just about EVERYTHING, heroin, cocaine, meth, even though the ER personnel had been told he has epilepsy. I guess they were just being cautious. Or maybe hospital policy required them to.)

But I digress. Fard Johnmar, at Envisioning 2.0, says with capitalism is under siege, the anti-single payer crowd needs new rhetoric. “Currently, the economic crisis is causing increasing numbers of Americans to forgo much-needed medical care,” he says. “In addition, with unemployment steadily increasing, many more people are going to be without health insurance. Given these trends, the term ’socialized medicine’ becomes a lot less scary. People – especially those with young children – will want access to health care, even if it is subsidized and more heavily regulated by the government. As a communicator, I make it my business to understand when a message is either ineffective or beginning to ring false. Arguing against single-payer health care because it will be akin to socialized medicine no longer works in the current environment. Free marketers need to come up with some new rhetoric.” Thank you, Mr. Johnmar.

E. Michael D. Scott of Vox Medica, who blogs at Health + Vision, wonders if it “could be possible that we are finally deciding to grasp the vicious health care cost nettle that is set to sting us all if we do nothing.”

“Perhaps we actually have something to thank the financial ‘gurus’ for!” Mr. Scott says. “If they hadn’t made such a mess of the long-term value of the investment marketplace, we might not have received the kick in the pants that we certainly need to address the the health care problem.”

He goes on to say that if we all are going to address what is going on with healthcare costs, we need to undergo what he calls an expectation cut.

“For some, that expectation cut needs to come in the form of lower financial remuneration,” Mr. Scott says. “Administrators who do a ‘decent’ job shouldn’t be earning millions of dollars a year, and nor should doctors who obtain certain specialty qualifications unless they are very, very good at what they do. For others (you and me), that expectation cut should come via the understanding that we are not entitled to live in perfect health for ever and ever. We are all going to get sick at least occasionally, most of us will get old, and we are all going to die. We should be allowed (and indeed helped) to do these things with dignity, but we should also appreciate that perhaps as much as 50 percent of what is currently being done to us medically is a waste of time and money.”

Hmmmm, like running blood tests for contraband substances when the patient has a history of epilepsy and not drug abuse?

Mr. Scott also calls for standardized costs for every medical product and procedure, the fixed costs that government or private insurance should pay for basic health care. “Should you choose to go and get your health care at a center that wants to charge more for delivery of those products or procedures, no one should stop you,” he says. “You should be able to obtain supplementary insurance coverage or pay the difference out of your pocket, but we should all be starting from the same place, and we should provide coverage for every American starting at that basic level. It might not be beautiful, but it should be ‘enough.’”

At Shearlings Got Plowed, Condor posts the discussion draft by Senator Chuck Grassley, Max Baucus, Ron Wyden, Mike Enzi, and Ben Nelson about legislation that would provide for a greater disclosure of health insurance costs to workers.

Here’s some perspective of what could happen if there isn’t a radical overhaul of the healthcare system. Over at MedPage Today, Dr. Rob says if there are any more cuts to state Medicaid programs, he’s going to have stop accepting Medicaid patients. “What is the result of decreased access to PCP’s? ER visits,” he says. ” A rise in the number of ER visits would be inevitable (especially as the patients are not themselves financially penalized for using the more expensive ER over a PCP). This would significantly raise the cost to the system and worsen the financial shortfall for the Medicaid program. Cutting reimbursement would be the equivalent of biting the cyanide capsule – it would result in sure collapse of the system.”

Although a poll taken by MedPage Today says if the election were today, 59% of physicians would vote for Mr. Obama, compared with 35% for Mr. McCain. But there are commenters who expressed some very telling statements. “Socialism is not my bag,” says Dr. J. Pervis Milnor III. “I have always heard that docs make more money under Democrats, BUT I would have to give more back in taxes to support the non-working crew that is so enthralled by Obama.”

At his blog Repairing the Healthcare System, Dr. Stanley Feld cautions what could happen if Mr. Obama’s healthcare plan, which is much like Massachusetts’, is adopted. …”the Massachusetts healthcare plan was not thought out,” he says. “Massachusetts did not control the premiums costs they promised to subsidize while putting a ceiling and floor on premiums to the consumers. They did not set appropriate incentives for employers to continue to provide healthcare to employees. The number of enrollees was underestimated. The premiums the healthcare insurance industry was demanding increased and is inflated. Rather than the normal laws of insurance cost prevailing (the more lives insured the lower the premium cost) the opposite is happening. The cost of the healthcare system is rising in Massachusetts at a more rapid rate than in other parts of the country.” He adds that this is because overbooked primary care physicians have to refer their patients to emergency rooms.

Dr. Edwin Leap at his blog asks, “Medicine and money; why is it such a problem?” I agree with him that medical care should not be provided for free. My friend Stacey the florist, however, never saw a doctor for that persistent sinus infection because she doesn’t have insurance of any kind (her small-business-owning boss doesn’t provide any) and couldn’t afford even the office fee. She wound up having to go to the local emergency room, where she found out that the infection damaged her sinuses so much that to really unblock them and drain them, she needs surgery. Of course, she can’t afford the surgery, so she is making do with antibiotics. A basic primary-care visit and some antibiotics months before her ER visit could have headed all of this off.

Mr. McCain’s plan for the $2,500 credit sounds like it would be great for her … but she also found out in that ER visit that she has Grave’s disease. Again, what private insurance plan would take her?

But here’s another thing to consider: turns out Hawaii is dropping its children’s healthcare plan, says Jacob Goldstein at the Wall Street Journal Health Blog. Parents were apparently dropping private coverage to enroll their kids in the state plan to save some money. This should be a cautionary tale for Mr. Obama if he is elected, since he would mandate healthcare for all children.

In what may be a harbinger of things to come, Merrill Goozner at GoozNews looks at Sen. Hillary Clinton’s proposed legislation to set up a Wellness Trust. “New legislation dropped in the final days of a Congressional session obviously isn’t going anywhere,” Mr. Goozner says. “But it does signal what that legislator thinks is important and plans to push next year.”

Around and about …

Ed Silverman at Pharmalot and Scott Hensley at the Wall Street Journal Health Blog give the breakdowns of Pfizer’s settlements for its cox-2 drugs.

Initially, a prominent Democratic fundraiser was not going to receive Tysabri to treat his multiple myeloma — but now he is, Mr. Silverman reports.

A former Pfizer executive was sentenced for child pornography, writes Jacob Goldstein at the Wall Street Journal Health Blog.

The Senate continues to probe the relationships between industry and academia, this time, a Columbia professor and a non-profit that runs a conference highlighting cardiac device technologies, Mr. Silverman reports.

An Amgen sales representative can pursue a wrongful firing suit, Mr. Silverman says.

Over at In the Pipeline, Dr. Derek Lowe wonders where all of the CNS drugs are. “My take, having worked in the field, is that there is still so much unmet need in that area because we just don’t understand what’s going on,” he says. “It’s hard to come up with disease-altering therapies when you don’t really understand a single disease in the whole field.”

Chris Morrison at the InVivo Blog looks at the many failures of Phase III drugs this year. Mr. Morrison also posts about what the ultimate goal of the big stent trial is (predictability of results, apparently).

Also at the InVivo Blog, Ramsey Baghdadi explains why Wall Street finds the delay of prasugrel important.

John Mack at the Pharma Marketing Blog says e-marketers have made a comeback inside pharma.

At World of DTC Marketing, Rich Meyer predicts a major shakeout of social media sites, and “although pharma marketers need to join in the conversation, they also need to ensure that there are clear and concise objectives and measurement parameters before attempting any social media engagement.”

Dr. Daniel Carlat at the Carlat Psychiatry Blog takes a look at a new initiative from the Alliance for CME to teach CME faculty how to tell the difference between CME and drug promotion. He also rips into a “sham journal” published by a medical education company, and gets into a discussion about ghostwriting, which he vehemently opposes.

Dr. Adam J. Fein at Drug Channels looks at whether the economy will hurt drug stores. He predicts yes, but not by much.

At Patent Baristas, guest blogger Kelly Kilpatrick examines a speech by Yale University’s Thomas Pogge that attacks the current patent system in the pharmaceutical industry. Although Mr. Pogge proposes an alternative system, Ms. Kilpatrick does not believe it will work. “While this is an altruistic model that also has the potential to be profitable for drug manufacturers, there’s just one major drawback — the assumption that drug companies are willing to even consider that there’s a moral aspect to their trade,” she says. “All they seem to be looking for is instant and immense profits, and the larger their monopoly, the more the money they make before any side effects are found and a public outcry and subsequent pull-out ensue.”

Here’s a fun new online game, Biologicsland, points out Patent Baristas’ main blogger, Stephen Albainy-Jenei. The game, about generic biologics, was set up by Teva. “Wherever you stand on approval of generic biologics, the game does provide some facts that surprise you,” Mr. Albainy-Jenei says. (That obsessive clicking noise you just heard is me being distracted for half an hour, at least).

At Policy and Medicine, Thomas Sullivan examines the effect that Washington, D.C.’s requirement to license all pharmaceutical representatives would have on medical meetings and conventions. “We expect this law to have a chilling effect on the convention and meetings businesses in the District of Columbia,” he says. “Many conventions will have no choice but to move the location of their meetings to avoid registration and penalties for the sales reps brought in to handle exhibits. Or perhaps a simpler solution will be to put up a ‘DC Docs not allowed’ sign in front of the exhibit hall and promotional meetings venues. Washington has been an anti-business city for quite some time, this regulation just adds to the many reasons to do business elsewhere. I am not sure how this will help the city, but then again it is DC.”