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Monday, December 28, 2015

Health Care Reform Articles - December 28, 2015

Maine Voices: ‘Medicare for all’ system makes so much sense on so many levels

EDITOR’S NOTE: David L. Adams, M.D., lived with his wife and family on Cousins Island in Yarmouth for almost 40 years.
He retired in 1998 after 30 years in active practice with Maine Cardiology in Portland. He was a dedicated volunteer after retirement, winning several awards for his activities.
A passionate advocate for single-payer health care, Adams was one of the organizers of a celebration of Medicare’s 50th birthday in Monument Square in Portland on July 30.
As he became cognizant of his approaching death from cancer this fall, he wrote the following column as an act of devotion to his patients and his belief in the importance of affordable health care for all.
Adams died Dec. 6, the day before the end of open enrollment for Medicare in 2015.
COUSINS ISLAND — It is open enrollment time for Medicare. Many people are finding themselves totally perplexed by the need to evaluate the competing offerings of the different Medicare supplement plans and Part D drug plans they have to choose from before the Dec. 7 deadline for enrollment.
The problem is the choices are so complicated that comparisons of apples to oranges don’t begin to describe the difficulties.
So why not simplify things by going to a single-payer, Medicare-for-all system, as many industrialized countries around the world have done with striking success? That success can be measured by their administrative costs, which are less than half the costs of our system of private health insurance.
Another measure of success is that there are better outcomes of care in countries with universal coverage, such as those with single-payer health care. There were 15 countries around the world with single-payer systems as of 2009, and all but four had higher-rated health care systems (by the World Health Organization) than the United States.
We pay considerably more for our health care, per person, than do people in any other country. Thanks to Congress, our current system prohibits negotiating about drug pricing, which is another source of cost savings in many countries. But our system does allow inflated salaries to the CEOs and administrators whose main function seems to be to refuse care whenever it will enhance their profit margin.
So, what are the drawbacks to single-payer Medicare for all, which have been cited by conservative Congresses since the 1960s?
• It’s socialized medicine: “Socialized medicine” refers to government-controlled medicine. Medicare for all is certainly not socialized medicine. The people providing your health care would not all work for the government. The decisions you and your health care provider make would continue to be private, without “death panels” or other suggested forms of government interference;
• It would lead to higher taxes: Because of potential savings on administrative costs and on negotiated drug prices, a recent study by economist Gerald Friedman showed that Medicare for all could save $592 billion per year in health care costs. These savings come from $476 billion saved if administrative costs were limited to the percentage spent on administration by Medicare, along with the $116 billion saved by negotiating pharmaceutical prices down to the levels charged in Europe.
This would be enough to offset cost increases for universal coverage. Gerald Friedman’s research shows that 95 percent of U.S. households would save money overall with Medicare for all.
Most importantly, by providing access to care for everyone, our health outcomes such as infant and maternal mortality, life expectancy and care for chronic illnesses, which now lag behind many developed countries, would improve.
Universal coverage and better outcomes at lower cost! So why not Medicare for all?


Rubio’s inaccurate claim that he ‘inserted’ a provision restricting Obamacare ‘bailout’ funds

by Glen Kessler

 Super PAC supporting Republican presidential candidate Marco Rubio released an ad claiming Sen. Rubio (R-Fla.) created "a plan that will all but kill Obamacare." (Conservative Solutions PAC)
“On Obamacare, some Republicans gave up. Some talked tough but got nowhere. For all the Republican talk about dismantling the Affordable Care Act, one Republican hopeful has actually done something.”
— voiceover of new ad by pro-Sen. Marco Rubio group, Conservative Solutions PAC
“I’m the only one running for president that’s ever scored a victory against Obamacare. And I didn’t do it with a lot of fanfare, I just did it.… Last year, these companies lost money and they came to the government and said, where’s the bailout money you promised us in the law? It would’ve been about two and half billion dollars. And the government said, ‘We don’t have that money because Marco Rubio inserted, in the end-of-the-year budget, a provision. He was able to work to ensure this provision got in, that took away the bailout money.’”
— Rubio, speech in Muscatine, Iowa, Dec. 17, 2015
This is a story about a media narrative, abetted by a presidential campaign, that has unfairly misdirected the credit for one of the most important blows against the Affordable Care Act.
Indeed, the second part of the voiceover in the Super PAC ad comes directly from a New York Times article that, in its first sentence, said that Rubio had “slipped into a giant spending bill” in 2014 a “little-noticed health care provision” that had undermined confidence in Obamacare. The ad quotes other news reports as well.
Meanwhile, Rubio also has claimed that he inserted key language in the budget bill.
In reality, in the sausage making of the law, Rubio didn’t make the sausage that has wounded the law. He had wanted to make a different sausage. But through deft marketing, he managed to slap his name on this one.
So far, with the exception of a careful report in the Associated Press, much of the media have gotten this story wrong.


Patients Fear Spike in Price of Old Drugs

By 


Fred Kellerman, a retired car salesman from Los Angeles, was bedridden with a rare neuromuscular disease when he started taking a drug in the 1990s at Duke University in North Carolina. It changed his life.
“I had to have a wheelchair to get onto the airplane, but by the time I left, I could walk on,” he said.
Mr. Kellerman has been using the drug ever since, paying nothing but postage. In an unusual act of charity, a small family-run drug company in Plainsboro, N.J., has been giving it away. The drug was never formally approved by the Food and Drug Administration, but was provided under an obscure federal drug provision.
But one company’s generosity is another’s opportunity. Catalyst Pharmaceuticals, a Wall Street-traded company, last week completed an application to the F.D.A. for formal approval of a slightly modified version of the drug that does not need refrigeration. In a presentation to investors last spring, Catalyst estimated that it could make $300 million to $900 million a year from the drug, named Firdapse, that could eventually benefit as many as 8,000 patients. That works out to possibly more than $100,000 per patient.
Catalyst’s move has brought fears among patients of a punishing price increase and led to a recent call from more than 100 neuromuscular doctors for “ethical and just pricing.” Catalyst says it has not yet chosen a price and that patients’ fears are misplaced. Jacobus Pharmaceutical, the private company that has been giving away the drug, says it will also seek F.D.A. approval. The winner is likely to receive seven years of exclusive rights to sell the drug. The F.D.A. does not consider price in its evaluations, though the doctors argue that perhaps it should.
The showdown between the companies powerfully illustrates the growing tension in the United States over the rising prices of drugs. The issue has drawn increased scrutiny from policy makers and prompted rising public outrage, much of it directed at Martin Shkreli, a former hedge fund manager who has become a symbol for pharmaceutical price gouging. Turing Pharmaceuticals, the company he formerly headed, and others have been harshly criticized for abruptly raising the prices of medicines after acquiring them — without having taken the risks involved in research and development.

For Martin Shkreli and Others, ‘No Comment’ Is Not in the Script

By  and 


It used to be that money managers and entrepreneurs charged with a crime or civil securities fraud would keep their mouths shut and routinely refer any questions to their lawyers.
But in the age of social media, those days are gone. For some media-savvy defendants there is a new script: They jump on Twitter to tell the world they are innocent, even though lawyers think doing so is a terrible — and legally risky — idea.
Two days after the pharmaceutical executive Martin Shkreli was arraigned on federal securities fraud charges, which accused him of defrauding investors in his former hedge funds and looting a drug company he once ran, he proclaimed his innocence in a Twitter post after pleading not guilty in court.
“I am confident I will prevail,” Mr. Shkreli, 32, wrote to Twitter followers on Saturday. On Tuesday, he wrote, “I’m not a criminal,” in response to a comment on Twitter.
Mr. Shkreli, best known for raising the price of a decades-old drug by 5,000 percent and later paying $2 million to buy the only known copy of an album by the rap group Wu-Tang Clan, has tried to present a carefree attitude online since his arrest on Thursday.
He has also posted streaming videos of himself on YouTube sitting at his computer — combing his hair, playing chess and strumming a guitar — and responding to comments from his supporters as if the possibility of going to prison were just a bump in the road.
Last spring, Lynn Tilton, a private equity executive, embarked on a similar public relations strategy after federal securities regulators filed a civil lawsuit that charged her with defrauding investors in distressed-debt securities managed by her firm, Patriarch Partners.
Ms. Tilton, 56, posted a video online defending herself and denying the charges and later used Twitter to attack the Securities and Exchange Commission’s decision to bring her case before an administrative law judge, as opposed to filing the matter in federal court.
And in a twist on the strategy, Charlie Shrem, an early proponent of the digital currency Bitcoin and chief of the money exchange service BitInstant, gave a speech via Skype to a Bitcoin conference while under house arrest before he pleaded guiltyin 2014 to aiding and abetting the operation of an unlicensed money transmitting business. Mr. Shrem, 26, has continued to post on Twitter, with the assistance of some friends, from federal prison.
His Twitter profile describes him as “Bitcoin pioneer & first felon.” In April, shortly after beginning to serve his two-year sentence, Mr. Shrem posted, “I’m in prison for a victimless crime” and invited people to write to him.

Hospitals With Monopolies Are Way More Expensive

  •  @DenverNicks

    Bad news if your region is served by one hospital.



    A new survey of hospital pricesacross the United States found massive price hikes in markets in which one hospital enjoys a monopoly. 
    Analyzing insurance claims from 2007 to 2011 covering more than a quarter of individuals with private employer-sponsored health insurance in the United States, researchers from a consortium of universities found that prices in hospitals that have a monopoly on hospital care in their market are 15.4 percent higher than prices in markets with four or more hospitals. 
    Hospital pricing schemes are notoriously opaque, with rates negotiated privately between insurers and hospitals and held as closely guarded trade secrets. “As a result,” the authors write, “there is a great deal that is unknown about how and why health care providers’ prices vary across the nation and the extent to which providers’ negotiated prices influence overall health spending for the privately insured.” 
    The report also finds a wide disparity and little correlation between the prices charged to Medicare patients—which are public—and those charged to the privately insured, contradicting the widely accepted belief that prices charged to Medicare patients across the U.S. are a useful approximation of healthcare prices overall. Grand Junction, Colo., for instance, has been held up by President Obama as a model healthcare market due to the city’s low Medicare costs, but the report found significantly higher prices charged to the privately insured. Grand Junction and the western Colorado region around it are served primarily by a single hospital.
    http://time.com/money/4159131/hospital-prices-competition-monopoly/

    On Medicare-for-All, Clinton Reminds Us That She's Part of the Problem

    by Tom Gallagher
    If the Hillary Clinton campaign had its way, supporters of Bernie Sanders –  whose backing she will obviously want in November should she win the Democratic nomination – would feel that, while Clinton might not be all that they want in a president, she would at least go part of the way there.  But if you followed the third debate deep enough into the night, you witnessed, in what stands as the most disingenuous moment of the Democratic race thus far, Clinton not simply disagreeing with Sanders on his Medicare For All, single payer health insurance plan, but knowingly distorting it. This was not Hillary Clinton offering a more moderate version of a solution, this was Hillary Clinton acting as part of the problem.  
    Clinton argued that the Sanders plan “really does transfer every bit of our health care system including private health care, to the states to have the states run. And I think we've got to be really thoughtful about how we're going to afford what we proposed.”  Between that and Sanders’s public university free tuition plan, she said “we’re looking at 18 to $20 trillion.”  And indeed, the single-payer bill Sanders introduced in 2013 called for a 2.2 percent tax on individual incomes up to $200,000 and couples up to $250,000 (and higher rates for higher brackets), a group she pledges would see no tax increases under a Clinton administration.  But the reason that a recent Kaiser Family Foundation poll found 52 percent of Democrats strongly backing a Medicare For All plan, and another 29 percent somewhat favoring it, is that they understand that there is a payback for that tax increase.  And so does Hillary Clinton.
    In ignoring the fact that a single payer plan would, as Sanders quickly pointed out, do “away with the cost of private insurance,” meaning that “the middle class will be paying substantially less for health care,” not only was Clinton wrong on the claim that the Sanders plan would cost the middle class more, but she knew it.  As Sanders said of her, “I know you know a lot about health care.”  Hillary Clinton, let’s remember, was the point person for Bill Clinton’s unsuccessful 1993 health insurance reform, to the point where it was sometimes called “Hillarycare.”  People have applied a lot of negative labels to Hillary Clinton over the years, but “stupid” is not one you hear very often.  This was not an actor like Ronald Reagan, delivering lines he may or may not have understood.  This was not George W. Bush, struggling over words and concepts.  It was a telling, cynical moment. 

    State-Level Brawls Over Medicaid Reflect Wider War in G.O.P.

    By 
    WASHINGTON — This month, John Thune of South Dakota, the No. 3 Republican in the Senate, voted to repeal major provisions of the Affordable Care Act and to end its expansion of Medicaid, arguing that the health law was “unpopular and unaffordable.”
    A week later, his state’s Republican governor, Dennis Daugaard, announced that he wanted to make 55,000 additional South Dakota residents eligible for Medicaid under the law.
    “I know many South Dakotans are skeptical about expanding Medicaid, and I share some of those sentiments,” Mr. Daugaard said. “It bothers me that some people who can work will become more dependent on government.”
    “But,” Mr. Daugaard said, “we also have to remember those who would benefit, such as the single mother of three who simply cannot work enough hours to exceed the poverty line for her family.”
    In state after state, a gulf is opening between Republican governors willing to expand Medicaid coverage through the Affordable Care Act and Republican members of Congress convinced the law is collapsing and determined to help it fail. In recent months, insurers have increased premiums and deductibles for many policies sold online, and a dozen nonprofit insurance co-ops are shutting down, forcing consumers to seek other coverage.
    But in Arizona, Arkansas, Indiana, Iowa, Michigan, New Jersey, Nevada and Ohio, Republican governors have expanded Medicaid under the health care law or defended past expansions. In South Dakota, Tennessee and Utah, Republican governors are pressing for wider Medicaid coverage. And Republican governors in a few other states, including Alabama, have indicated that they are looking anew at their options after rejecting the idea in the past.
    That has created tension with Washington that some lawmakers can no longer ignore.

    Baby Boomers are more likely to spend their last years in worse health than past generations

    By Lisa Gillespie, Kaiser Health News
    Posted Dec. 26, 2015

    After the last of the baby boomers become fully eligible for Medicare, the federal health program can expect significantly higher costs in 2030 both because of the high number of beneficiaries and because many are expected to be significantly less healthy than previous generations.
    The typical Medicare beneficiary who is 65 or older then will more likely be obese, disabled and suffering from chronic conditions such as heart disease and high blood pressure than those in 2010, according to a report by the University for Southern California’s Schaeffer Center of Health Policy and Economics.
    Adjusted for inflation, overall Medicare spending is projected to more than double between 2010 and 2030 to about $1.2 trillion. A massive influx of baby boomers into Medicare will be the main driver. With the last baby boomers turning 65 in 2029, Medicare rolls are expected to number 67 million Americans in 2030, the Schaeffer Center said.
    But costs per beneficiary could grow by 50 percent over the same time due to longer life expectancies, shifting health trends and medical cost inflation, the report said. In inflation-adjusted dollars, Medicare is projected to spend 72 percent more for the remaining lifetime of a typical 65-year-old beneficiary in 2030 than a 65-year-old in 2010.
    “It’d be one thing if there was an increase in life expectancy while maintaining health, but this is different. If you have more people that are disabled, it’s more costly, and we’re paying more because they’re living longer,” said lead researcher Dana Goldman at the University of Southern California.
    “In some ways, we are victims of our success” in extending lives and preventing mortality, he said. “We’ve done such a good job of preventing cardiovascular disease that now we have more cancer and Alzheimer’s.”
    The average life expectancy for 65-year-olds is projected to rise by almost a year from the 2010 norm, to 20.1 years in 2030. People with disabilities at 65 will extend their old ages, too – by more than a full year, to 8.6 years in 2030, the Schaeffer Center said.
    Obesity is likely to surge, affecting 47 percent of Medicare elderly beneficiaries by 2030, up from 28 percent in 2010, according to the report.


    Republican senators again propose MaineCare expansion

    By tying expansion of the program to treatment for the state's heroin epidemic, supporters hope to overcome resistance by Gov. Paul LePage and many Republican legislators.
    by Joe Lawlor - PPH
    Two moderate Republican state senators are gearing up for another run at expanding Medicaid, this time tying the effort to Maine’s heroin epidemic. The uninsured have a difficult time entering substance abuse treatment programs, and Medicaid expansion would greatly increase options for those with newly acquired health benefits, they say.
    “The landscape has changed,” said Sen. Roger Katz, R-Augusta. “Everyone realizes that we need to be putting more money into treatment resources. Why not have the federal government pay for most of it?”
    Substance abuse counselors would no longer have to try to squeeze a limited number of uninsured patients into programs, because they would instead be reimbursed for treating patients, Katz said.
    Heroin overdose deaths in Maine surged from seven in 2009 to 57 in 2014, and the number of people seeking treatment for opiate abuse jumped from 1,115 in 2010 to 3,463 in 2014.
    Katz said he hopes a new coalition of lawmakers concerned about the heroin crisis will rally around a modified version of Medicaid expansion. Katz is collaborating with Sen. Thomas Saviello, R-Wilton, on the effort.
    “Heroin is a terrible epidemic,” Saviello said. “Just give me a chance to present my case.”
    Since 2013, efforts by Democrats and some moderate Republicans to expand Medicaid to more than 60,000 Mainers have been opposed by most Republicans lawmakers and vetoed by Gov. Paul LePage, a staunch opponent of expansion. Under LePage, Maine has tightened eligibility for MaineCare, the state’s name for Medicaid, reducing the number of Mainers who can obtain the free health insurance. The number of MaineCare patients has declined from 355,000 in 2011 to 287,000 this year, due to tightening eligibility requirements and the improved economy.
    Saviello and Katz have at times been at odds with LePage on various issues.
    Saviello is taking the lead on next year’s compromise expansion effort, with a placeholder bill that was carried over from the last session. Saviello said the bill, which was not formally considered in 2015 but introduced so it could be considered in the 2016 session, would be similar to compromise plans approved in other states with divided government or under Republican control.

    Why Preventing Cancer Is Not the Priority in Drug Development

    by Austin Frat

    Most people would agree that it would be better to prevent cancer, if we could, than to treat it once it developed. Yet economic incentives encourage researchers to focus on treatment rather than prevention.
    The way the patent system interacts with the Food and Drug Administration’s drug approval process skews what kinds of cancer clinical trials are run. There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place.
    That’s one of the findings from the work of Heidi Williams, an M.I.T. economics professor and recent MacArthur Foundation “genius” grant winner, who studied the problem along with Eric Budish, a University of Chicago economics professor, and Ben Roin, assistant professor of technological innovation, entrepreneurship and strategic management at M.I.T.
    “R & D on cancer prevention and treatment of early-stage cancer is very socially valuable,” the authors told me in an email, “yet our work shows that society provides private firms — perhaps inadvertently — with surprisingly few incentives to conduct this kind of research.”
    To secure F.D.A. approval, after patenting a drug, drug companies race the clock to show that their product is safe and effective. The more quickly they can complete those studies, the longer they have until the patent runs out, which is the period of time during which profit margins are highest. Developing drugs to treat late-stage disease is usually much faster than developing drugs to treat early-stage disease or prevention, because late-stage disease is aggressive and progresses rapidly. This allows companies to see results in clinical trials more quickly, even if those results are only small improvements in survival.
    This very lesson is taught in some medicinal chemistry textbooks. For instance, one notes that “some compounds are never developed [into drugs] because the patent protected production time available to recoup the cost of development is too short.”
    The clinical trials necessary for the F.D.A. to approve drugs for commercialization take years. Though a patent lasts 20 years (before any extensions), a typical drug comes to market with about 12.5 years of patent life remaining. But would-be innovators have some control over the length of time between receipt of a patent and F.D.A. approval — the “commercialization lag.” By studying patients in whom safety and efficacy can be demonstrated more quickly, innovators can reduce this lag. (Recent studies suggest that commercialization lag times may be decreasing for some types of drugs.)
    Many more cancer trials focused on treatments for patients with late-stage cancers than for early-stage cancers, according to the study. Between 1973 and 2011, there were about 12,000 trials for relatively later-stage patients with a 90 percent chance of dying in five years. But there were only about 6,000 focused on earlier-stage patients with a 30 percent chance of dying. And there were over 17,000 trials of patients with the lowest chance of survival (those with recurrent cancers) but only 500 for cancer prevention, which confer the longest survival gains. The bias toward studies focused on patients with shorter survival duration is more prevalent among privately financed trials than for publicly financed ones.


    Capitalists should listen to Bernie Sanders

    by E.J. Dionne- Washington Post

    There is an irony to the presidential candidacy of Bernie Sanders: The senator from Vermont is often cast as exotic because he calls himself a “democratic socialist.” Yet the most important issue in politics throughout the Western democracies is whether the economic and social world that social democrats built can survive the coming decades.
    Let’s deal first with the tyranny of labels. “Socialist” has long been an unacceptable word in the United States, yet our country once had a vibrant socialist movement; its history has been well recounted by John Nichols and James Weinstein. Socialists had a major impact on the mainstream conversation. Reforming liberals, including Franklin D. Roosevelt, co-opted many of their best ideas, and it’s one reason they were marginalized.
    Moreover, the vast majority of “democratic socialists” are now properly described more modestly as “social democrats” because most on the left believe in a successful private sector. But they also favor a government that achieves broad public objectives, from a clean environment to wide access to education, and regulates and redistributes in ways that strengthen the bargaining power of those who don’t own much capital.
    When Sanders defined his own brand of socialism this year in a speech at Georgetown University, he made clear he’s in this camp. “The next time you hear me attacked as a socialist, remember this,” he said. “I don’t believe government should own the means of production, but I do believe that the middle class and the working families who produce the wealth of America deserve a fair deal.”
    Honestly, Bernie, you’re really a social democrat.
    But there is great honor in this. The bargain between government and the market that allowed the United States and the other Western democracies to share growing prosperity from the end of World War II until recent years was essentially a social democratic achievement.



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