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Sunday, October 25, 2015

Health Care Reform Articles - October 25, 2015

Justin Trudeau: Low Expectations, High Relief
By HEATHER MALLICK
Toronto — THE Monday night election defeat of Stephen Harper, the Conservative prime minister of Canada, and the triumph of his most hated rival, the Liberal leader Justin Trudeau, gave many Canadians that rush of feeling they so rarely enjoy: “It’s a girl.” “The lab says it’s benign.” “Your long national nightmare is over.”
But after what was seen here as a painfully protracted 11-week campaign, we are more relieved than triumphant. (It’s a different high than Americans might have after an election: How do you tolerate an almost permanent level of high-cortisol stress?)
It’s not that Canada has the same impossibly high expectations of Mr. Trudeau that Americans had of President Obama. At the risk of sounding like a broken human after almost 10 years of Harper rule, I suspect that Canadians simply ask that Mr. Trudeau, a centrist, not be like his predecessor. Behold, we are already pleased!
For Mr. Harper began turning Canada into a place we didn’t recognize. It wasn’t Trudeaumania, it was Harper-phobia, as one writer said the morning after.
It’s too simple to say that Mr. Harper was trying to Americanize Canada. That is rather insulting to Americans, and anyway Mr. Harper, no internationalist, seemed bored by Americans, although he tagged along with them on their pointless bombing wars.
In the United States, divisions between, say, regions or parties seem reasonably matched. Mr. Harper was doing something different. He was enabling bullying on a national scale. He won three elections because he relied on his full right-wing base but also pressed buttons Canadians don’t like to admit they have: lowering taxes, deploring immigrants, sidelining women and hyping militarism.
Ultimately Mr. Harper’s problem in this election was that he couldn’t win nationally with just an older, white male, rural base. He had to extend his reach, was weirdly unwilling to do that and ended up holding tiny rallies of Conservative voters, while Mr. Trudeau was meeting everyone, anyone. Two days before the election, a desperate Mr. Harper was reduced to appearing in public with Rob Ford, the notorious ex-mayor of Toronto. The photos were excruciating.
Mr. Harper’s bullying was extreme, and it was high schoolish. In 2011, his government barred women from wearing niqabs, the face-covering scarves, during citizenship ceremonies. The problem was that there appeared to be only one or two women trying to do this. The one giving interviews seemed quite nice. Then, more recently, women in niqabs began to be tormented on the streets. This shocked us.
The scroll of what Mr. Harper didn’t like grew longer as the years passed. It comprised scientists, environmentalists, returning veterans, urbanites, immigrants, then immigrants with accents, refugee claimants, then claimants needing health care, and so on. Bubbles of despised people began popping up. At some point the bubbles would have joined up and made Canada a vast blister for Mr. Harper to target. It was becoming absurd.
For Canadians are different from Americans, and we like it that way. We don’t think we’re exceptional; in fact, it’s rather important to us that we’re not, because that would imply that other nations are below par, which would be quite rude. We are a vast, cold country with a small population of about 36 million (Mr. Harper canceled the mandatory census, so we’re not sure about the number), and it is essential for Canadians to connect with and help one another. Mr. Trudeau understands that; Mr. Harper did not.
Mr. Harper fatally referred to “old-stock Canadians,” which was taken to mean “white” in a young country that has been peopled by immigrants, with many more being welcomed to come here. In his victory speech, Mr. Trudeau said definitively “a Canadian is a Canadian is a Canadian,” a charming contrast to Mr. Harper’s classifications of lesser citizens.
It’s also too easy to say that Mr. Harper was dour and that the younger Mr. Trudeau was cheerful. Mr. Harper spent government money on a grand scale while cutting business and personal taxes. But money doesn’t come first here. We’re ambitious. We pay healthy taxes to support a national single-payer health care system, the jewel of our country.
We want more. As drug prices soar, we need a universal drug plan, too. It will have to be paid for, and a national plan will provide it in the cheapest and most efficient way. Mr. Harper wouldn’t do that. While handing out a great deal of pork, it sometimes seemed he killed more useful spending out of doctrinaire spite.
Take guns, and you may. We have rifles and other long guns but spend time alone with them in the woods to kill wild animals. What other purpose would there be for rifles? Our gun control included a national long-gun registry that assisted battered women and local police forces; Mr. Harper killed it, saying it was an invasion of privacy.
Mr. Trudeau is different. He is a better match for Canadians’ vision of themselves: peaceable, educated, emotionally stable, multicultural.
Mr. Harper always seemed like the unpopular kid standing on the sidelines planning his revenge on a nation. He wasn’t brilliant, he was cunning. He took his revenge. We’re done.
“It’s not about me,” Mr. Harper said bleakly as the campaign neared its end, knowing that it was in fact all about him.
We are not seeking grandeur with Mr. Trudeau. What we want is an honest repairman, and we’ll take it from there. Americans, thank you for your patience.




Former Hedge Fund Manager Won’t Lower Price of $750 AIDS Drug Anytime Soon


  • The most hated man in medicine will not cede that title anytime soon. Former hedge fund manager Martin Shkreli drew ire last month when he increased the price of an AIDS drug by more than 5,000%. After bearing the brunt of Internet outrage, he promised to lower the price. But now, three weeks after that vow, the CEO of Turing Pharmaceuticals now says it will take a “long time” for him to determine the new price of the drug.
    Th 62-year-old drug. Daraprim, used to cost just $13.50 per pill. Shkreli changed the price to $750. Doctors use Daraprim to treat infants and others with weakened immune systems, often AIDS patients. It is one of the most common drugs prescribed to combat life-threatening parasite infections.
    “Until we figure out demand, we won’t lower the price.” Shkreli told Business Insider. “We have to find a safe price to lower it to.”
    Turing Pharmaceuticals is not the only pharma company to recently raise the price of a life-saving drug—though his hike was by far the biggest. Pfizer, Merck and Valent have all increased their prices and come under fire for doing so.
    “There have been hundreds of companies that have raised [their drug prices] higher, and they’re not rolling back their prices, so why should we?” Shkreli said in the interview.


    The Feds Finally Make a Move Soaring Drug Prices

    By 

    Federal and state prosecutors delivered an unmistakable shot across the bow of the U.S. pharmaceutical industry this week amid mounting concern that soaring drug prices are posing risks to the health of many Americans and blowing a hole in the budgets of federal and state health care programs.
    Two of the worst offenders, Valeant Pharmaceuticals International and Turing Pharmaceuticals, were presented with subpoenas or letters by prosecutors investigating their pricing practices and other aspects of how they do business
    During a Senate hearing last summer, Sen. Claire McCaskill (D-MO) questioned former Valeant CFO Howard Schiller about the company’s February 2015 decision to increase the price per vial of Isuprel, a drug used to treat cardiac arrest, from $215 to $1,346. That same month, Valeant boosted the price of the Nitropress, a blood pressure medicine, from $257 to $805 per vial.   
    Last month, Hillary Clinton called out Turing for boosting the cost of Daraprim, an older drug used to treat infections, from $13.50 to $750 a pill. Donald Trump called the company’s 32-year-old CEO, Martin Shkreli, a “spoiled brat.”
    Now the eye-popping markups in the price of both old and new drugs is drawing intense interest from federal and state prosecutors. The controversy is turning into a perfect storm for the drug industry, with both politicians and state and federal prosecutors demanding justification for their drug pricing policies.
    “I think what’s happened is that some of these companies … in a remarkable feat of poor political timing stuck their heads way, way out of the foxhole and raised prices seemingly unaware that we’re in the midst of a presidential election where there’s a lot more sensitivity about all of these things,” Joseph Antos, a health care specialist with the American Enterprise Institute, said in an interview on Thursday.
    “And if you would like to be made a subject of an investigation, this would be a great year to do that,” he added.
    Few have done more to arouse public and government hostility to the pharmaceutical industry than Shkreli, a cocky former Wall Street hedge fund manager who purchased Turing and then jacked up the price of Daraprim by more than 5,000 percent after acquiring the rights from Impax Laboratory. Shkreli, who once worked as an intern for TV personality Jim Cramer, exuded arrogance and a healthy disregard for the well-being of sick Americans in numerous tweets on social media and appearances on television.

    The life-saving pill ‘pharma bro’ increased to $750 now has a $1 competitor

     

    Fareed Zakaria: Health IT is no magic bullet

    ORLANDO, FL | October 21, 2015
    As Fareed Zakaria sees it, the remedy for America's ailing and expensive health system is clear.

    It might be hard for some to swallow, but, in his view, it is sure and proven.

    "There's absolutely no question that when we look at the ability to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provision, a single government payer and multiple private providers is the answer. It's absolutely clear that is the only way you can achieve that goal," Zakaria said. "The revolution that's needed here is not an information revolution, it's a political revolution."

    Zakaria is a journalist, author and host of Fareed Zakaria GPS, a Sunday morning staple on CNN that delves into global issues and ways to solve them. For purposes of his broadcast "GPS" stands for Global Public Square.

    Zakaria spoke to a crowd of more than 600 healthcare CIOs at the annual CHIME Fall Forum, October. 16 in Orlando, Fla.

    "There's absolutely no question that when we look at the ability to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provision, a single government payer and multiple private providers is the answer," he asserted. "It's absolutely clear that is the only way you can achieve that goal."
    His remark about a single payer healthcare system drew a ripple of applause from some in the audience.

    It wasn't until halfway through his hour-long talk that Zakaria even mentioned healthcare. First he set the global stage, explained what was happening in the world before technology changed so much and seemed to become the answer for all that ails healthcare and other industries today.

    Zakaria, an immigrant, grew up in India in the 1960s and 1970s. India was one of the poorest countries and it was cut off from the rest of the world. It was very technologically backward, he said. His version of the American dream then was the opening credits of the TV show "Dallas." The appeal was the opulence, the sense of dynamism.

    By the time he was studying at Yale University in the 1980s, the seeds for both a globalization revolution and a technological revolution were yet to be sown. There were no satellite networks, no smart phones, no iPhones, no laptops. Hospitals were still mired in paper.

    Today, many are looking to technology to improve the healthcare system and perhaps even to drive down costs.

    "The fundamental point, I think, that you have to understand about healthcare is information technology, globalization are not magical solutions," Zakaria told the audience.
    This is especially so, because the fundamental structure of healthcare "makes it very difficult to achieve certain economies of scale."

    "What I'm always struck by when I look at healthcare," Zakaria said,  "is the fundamental accuracy, impressions of the1961 or 1962 article written by Kenneth Arrow, a Nobel Prize winning economist, who said healthcare is not going to operate like any other market."

    Indeed, noted economist, New York Times columnist and author Paul Krugman also references Arrow's work.

    "One of the most influential economic papers of the postwar era was Kenneth Arrow's Uncertainty and the welfare economics of health care, which demonstrated – decisively, I and many others believe – that health care can't be marketed like bread or TVs," Krugman wrote in a 2009 column.

    Exactly Zakaria's point.

    Healthcare "is all non-tradable work," he explained. Yet, "people look at healthcare and they ask themselves, 'Why aren't you getting more and more productivity?'"

    That approach works in most industries.

    "We have wrung inflation out of literally every industry," Zakaria noted. "In most cases you've seen enormous price deflation. Think about computers; think about technology."

    Higher education and healthcare have been elusive when it comes to controlling spiraling costs. In fact inflation rates have been two to three times higher than the national average, he said.

    "In both cases, you have the consumer not paying, very complicated government regulation that involves lots of third parties that pay and reimburse on very complicated schedules," Zakaria said.  "So all the normal price mechanisms that are at work that allow supply and demand to find equilibrium do not exist. "

    As Zakaria sees it, the answer does not lie in technology – at least not in technology alone, but rather in the structure of the health system itself and leaders should be prepared to unravel the structure.

    "The fundamental point, I think, that you have to understand about healthcare is information technology are globalization are not magical solutions," Zakaria said. "I don't mean to be the bearer of bad news. What I mean is you have a very complicated job ahead of you, which is the structure. In addition to that you have a Democratic system, which makes it very hard to change the structure."

    "The hope in America has always been that we find a technological solution that magically gets around all these problems," he concluded. "I think, more likely we're going to have to do the hard work of unraveling the system that we have in place and figuring out how you actually make some hard political decisions that force you to choose, you know, when you're 80 years old, are double hip replacements covered."


    Blue Shield may be heading to showdown with regulators over executive pay

    In response to mounting criticism, Blue Shield of California's chief executive is vowing to improve the nonprofit insurer's poor ratings from patients and to disclose more about executive compensation.
    But CEO Paul Markovich warned that certain details on executive pay will remain secret, portending a potential showdown with regulators.
    Markovich has been dogged by questions for months surrounding the insurance giant's nonprofit status, lack of transparency and repeated rate increases despite holding $4.2 billion in reserve.
    The 48-year-old CEO cleared one major hurdle this month when state officials approved his $1.2-billion acquisition of Care1st Health Plan, a Medicaid insurer based in Monterey Park.
    The deal attracted more scrutiny than usual after The Times reported in March that the California Franchise Tax Board had revoked the tax exemption Blue Shield held since its founding in 1939.
    Auditors said the company didn't deserve the lucrative tax break because of its excessive surplus and the failure to provide lower-cost coverage or other substantial community benefits.
    Echoing those concerns, consumer advocates and a former company official argued against Blue Shield's deal and said the nonprofit's money should be used to reduce premiums or bolster the state's healthcare safety net.
    The state's managed-care regulator sided with Blue Shield and said the company didn't hold public assets or have a charitable trust obligation.
    On executive pay, the San Francisco insurer faces more questions.
    The Times reported last month that Blue Shield boosted executive pay by $24 million in 2012 — a 64% jump over the previous year — according to a confidential tax audit. Some of that money probably went to former CEO Bruce Bodaken as part of his retirement package.
    The company won't say who got the money, and Markovich said his plans for increased disclosure don't include revisiting the past. In general, he said, the company may be ready to share more information by March.
    "Just to satisfy idle curiosity about what happened in the past about a particular person is not something we will run around to satisfy," said Markovich, who became CEO in 2013 and made $2.5 million that year, the most recent data available. "It's not necessary to hold us accountable for living our nonprofit mission."


    By Judy Harrison, BDN Staff
    Kaci Hickox, the nurse who lived in Fort Kent and was quarantined in New Jersey after returning last year from treating patients suffering from the Ebola virus in Africa, on Thursday sued Gov. Chris Christie and other New Jersey public health officials in federal court.
    The American Civil Liberties Union of New Jersey is working with two New York law firms to represent her, according to a news release issued by the ACLU of New Jersey.
    Alison Beyea, executive director of the ACLU of Maine, said, “The ACLU of Maine supports the efforts of Kaci Hickox and our sister affiliate in New Jersey to fight back against draconian quarantine laws. As we said when Ms. Hickox faced the threat of involuntary quarantine in Maine, extreme measures like mandatory quarantines raise serious concerns about government overreach, not to mention frighten the public. Our response to public health situations should be guided by sound medical science, not by fear.”
    Hickox’s private attorney, Steven Hyman of New York City, said Thursday that no legal action was planned against Gov. Paul LePage or any Maine officials, since a District Court judge refused to confine her to her Fort Kent home.
    “One of the reasons we are filing now is we had all the documents from New Jersey that we needed,” Hickox said by phone Thursday evening from her home in Springfield, Oregon. “Honestly, in Maine the judge ruled in my favor, [and] this is about policy and how the quarantine [in New Jersey] was enacted and how that was done.”
    The lawsuit claims that Hickox was held illegally and unconstitutionally against her will as part of a mandatory quarantine for anyone returning from certain West African countries who treated patients with Ebola. Her attorneys claim that Christie, then-Commissioner of Health Mary O’Dowd, and other New Jersey health officials imprisoned her illegally through the quarantine. The complaint also said that Christie made false statements about Hickox’s health and implied she had symptoms of Ebola.
    “In-home quarantine still remains in place in many states,” Hickox said. “This [lawsuit] is not just about Chris Christie, though it is in part about him; but again, it is about setting a higher precedent so decisions are made in a more just and fair way.”
    Brian Murray, a spokesman for Christie, declined Thursday to comment on the lawsuit because it is a pending legal matter.
    In addition, the lawsuit alleged that the quarantine violated her constitutional rights to due process and illegally deprived her of her liberty.
    Hickox is seeking a minimum of $250,000 in compensatory and punitive damages, according to the complaint, along with legal fees and costs.
    The lawsuit also asked that New Jersey’s quarantine policy, which is still in effect, be declared unconstitutional.
    “While this lawsuit has been filed to vindicate Kaci’s constitutional rights, an important corollary of this action is to change the existing New Jersey quarantine policy so that what happened to Kaci will not happen to another health care worker on their return,” Hyman said in the news release.
    Norm Siegel, another attorney on Hickox’s legal team, said Thursday at a news conference that because Christie and officials in his administration are being sued as individuals, any judgment against them would come out of their own pockets, NJ.com reported. That would provide a strong deterrent to other officials who wanted to come up with health policies that were not rooted in medical science, the attorney said.

    Doctors take to the streets to learn from patients

    By Felice J. Freyer
    Hae Kyung Chung encountered a surprising sight on Boston Common the other day: two guys in white coats, holding notepads, regaling passersby.
    “We’re collecting stories about health care,” Dr. Aaron Stupple called out to each person walking the diagonal path to the State House.
    Chung stopped. The embroidered titles on the pair’s coats confirmed they were real doctors: Stupple, hospital medicine, and Vikas Saini, cardiology.
    “I felt like I might as well make use of their time,” Chung said, noting that a typical medical visit leaves little time for chitchat. She told Saini about a recent frustrating encounter with the health care system. He scribbled notes.
    And so Chung joined the dozens of people contributing to an unusual project: a series of “listening booths” sponsored by the Lown Institute, a Brookline nonprofit that wants to transform health care — and that this week sought impromptu input from those who know it best: patients.
    Saini, the Lown Institute’s president, and Stupple, a young activist with the group, took their mobile complaint department to Cambridge, Chelsea, Everett, Somerville, and several Boston neighborhoods.
    Patients gave only their first names, and their comments were taken by hand, not recorded. The results will be compiled to inform the institute’s future actions.
    Saini described the effort as “a fact-finding mission.”
    “It’s not scientific,” he said. “It’s to get a sense of, experientially, what people are going through.”
    Although described as a “booth,” Wednesday’s enterprise on the Common was decidedly minimalist: two folding chairs and a poster board positioned in the open air, avoiding any barriers to the public on a mild day.
    Several people stepped up. One told of an elderly relative whose doctor pushed him to undergo an unwanted and ultimately fatal procedure. Another said her father couldn’t afford his medication.
    Betsy Powers complained that her primary care doctors keep leaving, with several setting up high-priced “concierge” practices. She barely knows her current doctor, her seventh. Powers, a 57-year-old decorator who lives in Wellesley, said she’s healthy, but the turnover in physicians is disconcerting. “Internists aren’t getting enough money,” she said.
    Chung, who is 50 and lives in Cambridge, is a home health physical therapist who works in the health care system but rarely uses it. A recent encounter, however, left her yearning for the simplicity of the single-payer system she enjoyed while living in Spain years ago.
    After a visit to an urgent care center, Chung was advised to see a specialist. But the center’s referral got lost in its computer system. Her calls to the urgent care center were routed to a call center in Texas. When she finally got an appointment, it was with a gastroenterologist — but Chung needed a gynecologist. She’s still waiting to see the right doctor.
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