The Progressive Ensign

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Category: Health (Page 1 of 2)

Administration Drug Price Reduction Plan – Good Start

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab. Click on the Index Topic Name at the beginning of each post to see more posts on that topic on PC or Laptop.)

Image: blog.medicareright.org

The GOP Administration has announced a new drug price reduction program that will use a basket of prices that 16 nations pay for certain drugs in the Medicare Part B Plan (hospital and health services plans) to determine the price the federal government will pay.  Biotech drugs which are extremely expensive, yet have high efficacy are to be targeted.  The price reductions will be phased in over a 5 year period.

The difference between what the U.S. pays for many often prescribed medicines is huge as the following chart shows:

Sources: Bloomberg, The Washington Post – 10/26/18

How did U.S. prices get so much higher than other nations?  Simply, the other countries negotiated  tougher than we did. The pharma industry lobby in Washington spends tens of millions of dollars every year to persuade lawmakers and the White House to give drug makers complete pricing freedom.  In effect, Americans are paying for the low prices other countries receive where the drugs are being sold with low margins or below margin.  Pharma companies do not have a problem with this inequitable situation as long as they make money.

For example, in the U.S. Genentech, a division of Roche, prices a single dose macular degeneration drug Lucentis at $1000 while the same exact bio medicine – Avastin costs 10 times less.  The firm says that the extra testing for the eye version requires a higher price.  This premise disputed by scientists who worked in the Lucentis division and left in part due to the greed of management.

The administration is also planning on developing ways to give the private sector more leverage in negotiating prices with drug makers.  Plus, HHS wants to create new policies that would reduce incentives for doctors to prescribe expensive drugs.

Next Steps:

We applaud the GOP Administration for taking on the drug companies and their money making over all else approach to drug pricing.  The pharma companies most affected are stung by the plan and charged it with ‘socializing medicine’.  We don’t see their gouging prices to Americans as fair and equitable, so controlling prices to reasonable margins is common sense not a value shift of the health industry.

A good place to start cutting costs is to end prescription drug TV advertising like over 100 countries worldwide ban – that would allow the firms to cut billions off prices each year.  Next, they need to end stock buybacks which take shares off the market to increase share price.

Sources: Leerink Group, Market Watch – 10/30/18

These are the top 6 of all pharma firms wasting money on goosing their stock price with stock buybacks to increase stock compensation to executives while patients get hit with soaring drug prices.  Nearly $100 billion dollars spent in the last year would go a long way to bringing down the price of drugs.  When the industry cries it does not have funding for research it needs to start here and drug advertising if they tried harder to find the money they could.  The executives just don’ want to take a pay cut and run their firm with reasonable margins, yet are fine with driving patients into bankruptcy or adding thousands of dollars of debt to patient accounts.

The GOP plan does not go far enough, all medicines purchased by Medicare and HHS should be negotiated.  The negotiating authorization for HHS has been in numerous bills in Congress repeatedly defeated in by the drug lobby.  Congress needs to pass the bill, and get moving with a fair drug pricing model, with complete transparency from insurers and pharmacies to patients.  The federal government can learn from the assertive approaches many states are taking by looking a efficacy based pricing to bring prices within reason as well.

It is time the pharma industry took a hard look at its financial engineering and redesign a more equitable pricing and reasonable profit model for patients, hospitals and suppliers.

Millennials Demand Virtual Health Services – Upending the Present System

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab. Click on the Index Topic Name at the beginning of each post to see more posts on that topic on PC or Laptop.)

Image: meddeviceonline.com

By 2020 there will be 83 million millennials in our country becoming the largest generational group.  As they take ever more powerful positions in our society their demands on the healthcare system will focus on virtual services. They grew up using the Internet, with its culture of immediate access, virtual relationships and convenience.  Millennials expect their healthcare services to provide the same types of services as they regularly use on the Internet – Internet healthcare.  For them the baseline is using technology as the platform for accessing, using and paying for services.

Harris Survey for Salesforce – 2015

The millennial generation want to use as their framework for health services all the Internet services they enjoy now: patient reviews, online appointments (including specialists), using mobile phones for services, use apps to manage their wellness, use wearables for monitoring health, 3D printing of devices ie hearing aids, teleservices like video chat with a doctor, and pills that monitor internal organs that are swallowed.

The present system is organized around a primary care physician (PCP) who is the gatekeeper and co-manager of the patient’s health program. All patient records are with the PCP and the healthcare provider, records are not accessible from anywhere in the ‘cloud’.  The core guiding principle being that all medical services need to be integrated, not disconnected for increased efficiency, effectiveness and safety.

Artificial Intelligence adds another innovation level to delivery of health services. The AI industry is looking to serve the needs of millennials in healthcare by offering ‘neural network’ based medicine of expert databases and access to the ‘right treatments’ at the click of a button or the swipe of a phone app.

Next Steps:

The implications for changing the present PCP, doctor oriented system toward an on-demand patient based system are revolutionary.  One challenge will be how to maintain continuity of care when the patient is using virtual services from multiple providers, while ensuring effective care and safety.  The human body is one complex entity made up of multiple systems, all integrated tightly to work together. If one system is off balance or damaged other systems maybe impacted, which is why the PCP based system was established.  Doctors, not patients are trained to see the interactions of various human body systems, and to know when and how to bring in a specialist to treat a condition.  Yet, how will placing tests, treatments and services at the touch of an app by a patient change the doctor – patient relationship? Will quality of care be maintained?   Will high quality care only go to the technology savvy patient who knows how access all the health services to obtain a complete health solution? Are we going to be comfortable with AI – a physician advisor robot prescribing medications, treatments, surgery? In this virtual world of services who is responsible for maintaining continuity in care?

The virtual world of medicine does offer ways for reducing the cost of healthcare dramatically to thousands of patients. The U.S. spends 41 % more as a percentage of GDP than OECD countries while life expectancy is 4 years less.  Yet how will the present system of layered providers, drug – pharmacy managers and hospitals respond to Internet based healthcare?  Will they just use this myriad of disconnected services to charge even more because it will be difficult for the patient to manage costs the same way a health care provider does today. Do we want to place the patient in the center of healthcare delivery of services?  The economic dislocation of every health care service provider will be profound and huge. How will we make sure that all our citizens are included and not just those with Internet access?  So, what will our health sector plan be?

A few salient points need to be kept in mind in developing a sound policy.  The patient does not have the expertise of a physician who has attended years of training, internship and practice before treating patients.  Replacing the physicians role in the delivery of healthcare needs to be done carefully and in some cases certain conditions are off limits. Ensuring the safety of medicines, treatments and invasive procedures needs to be paramount in any system change.  Patients need to be given options, for example the patient may not want a robo physician advisor and wants a human doctor of his or her choice.

The other major point is our political processes are way behind what technology innovators are creating today, dramatically impacting what our healthcare choices will be tomorrow.  Our political processes need to be brought up to date, and forward looking if we are to have any chance at making intelligent decisions about our healthcare delivery system.  We need to take this opportunity of a shift to Internet based health care to ensure that everyone receives good quality health care, at a reasonable price and will not go bankrupt in the process.

Rethinking How We Get From Home to the Grocery Store

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab. Click on the Index Topic Name at the beginning of each post to see more posts on that topic on PC or Laptop.)

Photo: texastribune.org

In a recent seminar by Climate One, an environmental conversation group, sponsored in San Francisco, one participant pointed out “the greenhouse gas reduction potential is huge.  Greenhouse gases from transportation are about 28% of all greenhouse gases in this country. “  Certainly changing how we get from home to the grocery store and everywhere will have a significant impact on climate change and greenhouse gas diffusion into the atmosphere.

While a few of us walk to the market bringing home our groceries in a cart with a basket, 99 % of all grocery trips are made by one person in a two-ton car, spewing out carbon gases.  Of course, most Americans still live in suburbs, sprawled out with single family homes connected by streets and freeways to shopping centers where the grocery store is located.  We buy a house in the suburb, buy a car to get around and that’s about all the thought we put into it.

We need to start thinking beyond the present urban map and transportation model centered on the single passenger car.  How about electric scooters?  They are shareable, we setup a logon on our smartphone, pick up a scooter left by a previous user and head on our way. Just leave the scooter there on the sidewalk when we arrive for the next person to use it.  In a minute or two, they are riding and are off on their trip.  Bikes are being shared in cities all over the U.S. with some bikes motorized to handle longer trips.

A short trip in a car on average costs about $8 one way, while an electric assisted bike costs just $2 per trip. There are cargo bikes available as well that can handle larger loads.  Of course, weather is an issue as these sharable scooter and bike solutions are growing popular in the Southwest and West.  Public transit, a bus or subway maybe the answer for rainy or snowy days.

Uber and Lyft are rethinking their business models to include electric scooters, and bikes. A customer logs on to their app for all personal transportation needs is their vision. They already offer shareable rides at a discount. Instead of buying a car, people are living closer to work and shopping in densely populated cities where owning a car is actually a costly liability.

New sharable transportation models combined with driverless cars would not only change transportation but our city maps as well.  Urban planners are already building denser housing near transportation hubs, providing bike lanes off away from parked cars and more bike pathways used exclusively by bikers.  The economic consequences are significant, the new car and used car markets would begin to shrink,  financing and insurance businesses for auto loans would decline.  New businesses using sharable transportation system would spring up for delivery, assisted transportation for doctor appoints or dropping off kids a practice.

Most importantly, using sharable transportation vehicles, bikes and scooters would make a significant impact to reduce carbon gases across the planet.  We may be able to finally, get ahead of the climate change curve and return our planet to more livable temperatures

Thinking creatively to solve our major problems like Climate One does in conversation mode with all points of view represented is refreshing.  The dialog during this seminar was focused on ‘can do’  and ‘make it happen’ while being sensitive to safety issues, city regulators and other businesses.  If we could have more of this civil solution oriented tone in our national dialog we could solve the big problems in front of us, as we always have the past two hundred and forty years.

U.S. Healthcare Spending 41 % More Than OECD Countries

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab. Click on the Index Topic Name at the beginning of each post to see more posts on that topic on PC or Laptop.)

Image: consumersunion.org

The United States healthcare system is an expensive healthcare system compared to the OECD countries that spend 41 % less per person as a percent of GDP with a 4 year higher life expectancy rate.

Sources: The Daily Shot, The Wall Street Journal – 10/1/18

As U.S. spending continues to increase life expectancy rates are stagnant, simply not improving.  Note that while OECD spending continues to grow at a much slower pace the life expectancy rate continues to climb. Americans are not getting the health care system performance that our European sister countries are achieving.

Sources: OECD, CMS – US, Moody’s Investors Services, The Daily Shot, The Wall Street Journal – 10/1/18

Even when looking at similar income level countries the cost difference is highly apparent in cost per capita.

What are OECD countries doing that the U.S. is not doing?   For starters they do not have a private health insurance system which adds a profit motive to treatment, triages services to the higher income people and increases drug prices to consumers.   Administrative costs in the U.S. are 8 % of the total healthcare spending versus the OECD countries which range from 1 to 3 %. One reason for the high administrative burden is administrative hiring was 650 % more than hiring of health services workers since 1970. Generalist physician salaries are significantly higher in the U.S. by 50% compared to developed countries. Drugs in America cost twice the average prices in comparable developed countries.  The drug costs are distorted in the U.S. largely due to price controls in European countries so drug manufacturers charge as much as they can to U.S. providers and patients to make up the difference. Finally, another key reason is about 10 % of the U.S. patients are not covered by insurance.  Which means they do not receive care from birth, let medical issues fester and go to emergency rooms for all their care (as U.S. law requires hospitals to serve all who come regardless of insurance). A study of the healthcare delivery system in Philadelphia showed that overall healthcare costs in the city could be reduced by 20 % if patients that needed care had services offered in doctor offices covered by insurance.

Next Steps: 

We have recommended in previous posts that we have one insurance system in the U.S. as other developed countries.  Administered by the Health and Human Services department, a health account would start as soon as a baby was born.  Contributions by individuals, their employer and the government would go into one account.  Private insurance could continue in those years where a worker is on the payroll of a company with benefits.  In the event the worker is between jobs he or she would be covered by the government supported part of the plan.  There would be only one formulary  for drugs, and schedule for treatments and procedures.  The administrative overhead could be cut to the 1 to 3 % range that other countries enjoy.  Staffs in providers offices dealing with insurance idiosyncrasies and byzantine rules could be cut by 75 %.  Drug companies would be prohibited from implementing stock buybacks which would make billions of dollars available to cut prices and innovate new medicines instead of lining the pockets of executives.

Phoenix Gyms Backed By Koch Brothers Help Addicts Become Sober

(Editor Note: Insight Bytes focus on key economic issues and solutions for all of us, on Thursdays we spotlight in more depth Solutions to issues we have identified. Fridays we focus on how to build the Common Good. Please right click on images to see them larger in a separate tab. Click on the Index Topic Name at the beginning of each post to see more posts on that topic on PC or Laptop.)

Photo: npr.org

The opioid crisis is continuing to grow worse with deaths from fatal drug overdoses up 10 % this past year reports the U.S. Centers for Disease Control.  The opioid crisis targets mostly young people in city centers and many rural regions across the country.  The wave of addictions through our working age people is damaging our ability to grow our work force to support a robust economy.

Sources: Deutsche Bank, The Wall Street Journal, The Daily Shot – 9/19/18

The Koch Brothers, known for their backing conservative candidates and policy programs have a foundation arm called Stand Together which has invested $2 million to $3 million in “The Phoenix” gyms of Denver.  Recovering addicts can come to the gym free, to work out, receive coaching and support during their recovery.  Peter Thanos, an addiction researcher at the University of Buffalo, told the Wall Street Journal that persistent exercise has shown to be effective in drug rehabilitation. Drugs hijack the reward system in the brain, Thanos observed. Physical exercise can re direct that reward system.  He commented ‘in theory, you should be able to have an effect on drug-seeking” through exercise.

The political advocacy arm of the Koch network, Americans for Prosperity, is working to cut the funding for Medicaid in Utah and Nebraska.  Yet, Medicaid is the main source of mental health services funding in the U.S.

We applaud the support of the Koch brothers through their foundation of this innovative effort to attack the opioid crisis.  It seems that they need to look at what their advocacy group is doing to undermine the work of the foundation.  Does it not make sense to invest in returning thousands of our young people to become sober, taking jobs, raising families, buying houses and buying or using Koch brothers company products?  Let’s think about the opioid crisis from a long range point of view by investing in addicted people, bringing them back to productive lives.  It does not make sense to hurt this effort, instead we should all be working together to solve all facets of this problem resulting in a higher quality of life and a thriving economy.  We need all the workers we can get to be productive in the declining labor force 25- 55 year age group, otherwise we shall go deeper into debt to support our seniors.

Hospitals Cut Non-Compete Deals With Insurers

Image: wbur.org

Hospitals are the number one cost in health care nationwide at $1 trillion per year.  Healthcare is close to 20 % of the U.S. annual GDP.  Physician and clinical services are second followed by prescription drugs.

Sources: Centers for Medicare and Medicaid Services, The Wall Street Journal – 9/19/18

Hospitals are at the center of the most intense and high care treatments for surgeries, interventions, procedures and emergency care.  Most must take Medicare payments if they are to have a wide enough patient population to support their business. Yet, Medicare reimbursements often don’t cover the actual costs of treatment.  Hospitals look to employer – insurer plans and cash customers to make up the difference.

The Wall Street Journal investigated a number of hospital – insurer contracts and found in some cases the hospitals and insurers were cutting contracts which included non-compete clauses.  Thus, if a hospital had a dominant position in a patient market, it would require that the insurer not insure patients of their competitor.  Clearly, a restraint of trade, causing employer plans to pick up the balance, and in some cases where doctors were affiliated with hospitals employees were having to pick up the extra cost. Employers have seen premiums from insurers going up to handle the extra cost of these sweetheart deals.

These close partnership deals between hospitals and insurers create higher costs where services are much cheaper outside of the hospital in a doctor’s office.

Sources: Health Care Cost Institute, The Wall Street Journal – 9/19/18

Instead of hospitals steering patients to their doctors for many services, they provide the services on an outpatient basis at a much more expensive price. Insurers pick up the outpatient cost and then charge employers and patients higher premiums than necessary.

Next Steps:

 We have supported the Affordable Health Care Act provisions requiring insurers to insure all patients with existing conditions, and other patient oriented options.  However, this law is only the first step in reforming the healthcare industry, rigorous enforcement of anti-trust laws needs to take place to eliminate practices like these non-compete agreements.  We call for transparency in pricing of all drugs, and the relationship between drug manufacturers and pharmacies. We recommended in earlier posts that all Americans should have access to good quality health care, beginning with a healthcare account at birth. Then, as the patient takes a job, employer plans can be used, but always between jobs or disability the patient is covered.  Medicare should be the first line of insurance for all from birth with employer plans supplementing the main plan.  Medicare should have complete negotiating rights with drug manufacturers to get the best price for all patients.  All health care for profit companies should be barred from buying back stock and wasting money on executives which is better spent reducing prices and increasing the quality of care.

Driver Connects Patients with Cancer Treatments

Image: wahospitality.org

Cancer treatment in the U.S. cost $87.8 billion in 2014, with 1.7 million new cases being diagnosed each year.  In a analysis by the American Cancer Society, patients paid $3.8 billion in out of pocket expenses for their care in 2014.

Source: American Cancer Society – 4/2017

One of the major problems in cancer care is the physician centric model the U.S. has today, which can create major delays in treatment and sometimes mismatches the patient with a specific type of cancer with the correct care program.

Driver, a startup with over $100 million in venture backing has developed an application on the Internet to help patients correctly identify the type of cancer they have and match them to clinical trials and treatment programs. The software allows the patient to be proactive about managing the course of treatment without being totally dependent the treatment processes of their healthcare provider. Driver has partnered with the National Cancer Institute (NCI) to provide access to the latest information on cancer treatment trials. NCI has also validated the matching process that Driver employs.

“There is an air gap between knowledge and patients that has existed in cancer care since the 1850s,” said Driver co-founder Will Polkinghorn. “We want to close that space, “ in a recent Bloomberg interview.

The Driver app puts the patient in the driver’s seat so they are empowered to take command of their care.  As time is of the essence in cancer care, educating patients and giving them access to the information to initiate their care is crucial.  While the target is to provide the application and cancer identification workup at low cost, the initial trial starting this month in the U.S. and China will cost patients $3,000.

We have been an advocate of innovative ways to provide health care to patients.  Empowering patients to take direct management of their care instead of being dependent on a bureaucracy in a health provider network is an interesting approach.  Providing updated information, access to clinical trials with direct identification of the specific cancer the patient has, will possibly ensure greater accuracy and speed in the treatment process, thus saving more lives and reducing costs. Innovative solutions that disrupt the present status quo of extremely expensive health insurance, provider, drug manufacturers and federal government complex need to shift if we are to see a lower cost, higher quality healthcare system.  In particular, our Heartland healthcare providers are falling behind in providing standard health care to our people.  We need to turn this spiraling down in care with soaring prices, now.

Health Providers Not Paying Care Workers Enough, Administrators Too Much

 

Photo: aarp.org

There are 3.5 million direct health care workers in the workforce today. The Bureau of Labor Statistics estimates that another 1 million direct health care workers will be hired by 2024.  Direct healthcare workers include mostly all the assistant positions except a registered nurse: personal care workers, home health aides, and nursing assistants.

Sources: Bureau of Labor Statistics, Vox – 7/3/2017

Direct care workers often receive a wage below $15.00@hr.  About 90 % of  personal assistants receive $30,000 or less per year in income.  One reason wages are so low is that 70 % of all long term care costs are paid by Medicare and Medicaid.  These agencies reimburse care providers on a fixed cost basis. There is another reason. A high number of administrators are being hired rather than physicians, nurses or direct care workers.

Sources: Bureau of Labor Statistics, National Center for Health Statistics – 2010

When viewed from the perspective of healthcare spending per capita, administrator hiring was about 650 % more than overall per capita services.  Healthcare is a lucrative sector for business, so they focus on hiring more administrators and managers rather than nurses and direct care workers. Healthcare providers can take the wages they pay too many administrators and give caregivers the wages they need to take are of themselves and their families. The byzantine way the healthcare industry is structured with insurance companies between the providers and workers when we only need one government agency to manage insurance is a good example.  Most providers have who departments devoted to interacting with insurers and Medicare staff, which expensive to staff with specialized expertise due the idiosyncrasies of insurance policies.

Next Steps:

We clearly need to use computer systems and software to reduce the number of administrators and overhead in the system to the norm of per capita costs.  End the use of private insurers except as contractors to a single government agency, use a standard reimbursement procedure with no middle layers of pharmacy benefit managers and end go to middle managers for insurance companies.

In previous posts we have recommended:

The core need is to provide low cost effective health insurance for all people (like all developed countries do), so when illness strikes patients receive high quality care and become healthy again. Why do we need multiple insurance payers – private and the federal government?  If we were running a corporation we would not have two accounts payable departments?  We need to transition to individual health accounts that stay with the patient regardless of employment status beginning at birth.  Here are ideas on how this transition could work.

Complete Analysis of ACA – We need to learn from the public exchanges that work – California’s public exchange has been quite successful covering new patients, and keeping costs reasonable for low income patients.   Yet, we also need to look at why those exchanges like Oregon are not working well and expensive. Let’s summarize the analysis and publish the results so we can build a consensus around the solution, extending what works and recommendations for changes.

Priority One Cover the 9 Million Uninsured – those not covered by insurance need insurance now, we need to figure out how to cover 100 % of our citizens immediately. Offering a public option on the exchanges for basic health services and drug coverage would be a good start.

End State by State Coverage – state pools not large enough to make insurance work for all.  With 360 million people in the US we can make our health insurance pool work to reduce costs. Plus, legislation needs to be passed to reverse the Supreme Court decision to allow states to opt out of subsidies.  For example, Texas opted out on $10 billion subsidies leaving many low income families without insurance or very high premiums they cannot afford.  Interestingly, a few months ago I talked with a small business office manager in Texas, she complained that ACA was not working (her firm did not offer health insurance), for her hourly staff. Obviously, one reason is that Texas opted out of the subsidy program. Using a national pool would help to spread out the disparities between regions in terms of the rising cost of insurance versus stagnant wage increases.

Create Individual Health Accounts – funding can be setup via a payroll tax, accrued to a personal national health insurance account when working (if they don’t have employer options – to be transitioned later). For individuals or families below the regional poverty level they would pay no health payroll tax. For those individuals who are not contributing to their health account, the federal government would fund a basic health and drug account by progressive taxes on wealthy individuals over $250k and the increase taxes on corporate profits. Corporations can offset the increased tax, by offering lower cost insurance, medigap plans or encouraging their employees to move to the basic national health insurance program.

End COBRA – by setting up health accounts regardless of being employed, there is no need for COBRA plans.  Otherwise, for those unemployed to continue coverage often they have to pay soaring COBRA premiums up to 400 % of their employed premium rate.  For this author, two major illnesses occurred when I was unemployed, often with the stress of being unemployed is the time we need health insurance.  COBRA is another example where health insurers are charging outrageous rates to those who need the insurance badly but can least afford it. For the unemployed they could rely on basic health coverage in their individual health account.

Transition Employer Plans – convert employer plans over 4 years into a national personal health care account. Rollovers can be accomplished in a similar way to 401K to IRA rollovers (without the penalty for early withdrawal).  Ending employer programs will cut a layer of administration in benefits departments that more rightly belongs to the individual regardless of employment status.

End Penalties For No Insurance – we want to to tax behavior we don’t want and support or subsidize behavior we do want.  All Americans who have Social Security numbers should be able to enroll in a personal health insurance account, if they do not have a employer sponsored program.  Parents can apply for a SSN for their child to be covered.  A public insurance option should be offered to all those families not in employer sponsored programs. The public option run by Medicare is a basic health insurance program run similar to basic Medicare for seniors with medigap plans to cover the other 80 % of coverage needed.

Use the Medicare Drug Formulary – we don’t need multiple formularies and tiers of drug coverage. Medicare already provides one formulary which should be used as the industry formulary.  We need to empower Medicare to negotiate all drug prices and health procedures with providers with provision for regional differences on procedures.  A critical medication list can be created by Medicare for life threatening (Epipens) or serious chronic conditions (diabetes) capped at 5% profit for drug manufacturers.

End Stock Buybacks by Insurers – insurers need to end stock manipulation and the waste of stock buybacks. Companies like Aetna have spent billions of dollars on stock buybacks which would go a long way to reducing premiums and costs to patients.

Pricing needs to be transparent – similar to a mortgage disclosure statement. The explanation of benefits and drug claim form needs to be clear about the provider or drug price, any discounts and rebates, the price the insurer is paying, the price the provider is actually requiring, the price the pharmacy is paying and the exact out of pocket cost to the patient, with patient accruals in out of pocket and co pays toward insurance coverage.

Do it Without Waiting – let’s get progressive investors to back drug manufacturers that adhere to drug cost reasonable, critical med list, transparent pricing innovative insurance, publicize get more investors on board. Work with Wall Street to setup an ETF stock to focus on companies adhering to the progressive national health programs demonstrating good returns.

Awareness of What Works – A media campaign with surrogates, leadership in Congress, interest groups like the AMA, and the insurers to bring the American people along on the solution journey and to put pressure on Congress to pass the necessary legislation.

Health insurers would focus on medigap plans, taking risk out of innovative drugs to help speed them to market, vision and integrative medicine, personalized medicine, telemedicine – taking their layer out with reduce costs dramatically. They can be contractors to Medicare for transition to health accts. Or insurers can be contract administrators to Medicare, keeping costs low and utilizing their expertise.

Lets establish a lifetime health insurance program that provides good quality care, and low cost medications for all Americans.”

EPA Relaxes Coal Burning Regulations Endangering People and Economies

 

Image: agriland.ie

The day after that EPA announces relaxation of coal burning regulations scientists announced the first time in all recorded history the ‘last ice sea’ north of Greenland has thawed twice!  ­This assumption that ‘last ice sea’ would not thaw due to climate warming is no longer proving to be true. One scientist described the iconic ice thawing discovery as ‘scary’.

Sources: The Polar Science Center, The Guardian – 8/21/18

At the same time, global warming is causing the seas to rise by 8 inches since 1900 of which 3 inches was since 1993.  Scientists predict the sea level will rise another 3 to 7 inches by 2030. Today, rising sea levels are sending property values in low tidal areas spiraling down. University of Colorado and Penn State University researchers found that homes within just one foot of being flooded from a sea level rise were selling at a 14.7 % discount compared to homes on higher ground. Analysts have totaled property price losses since 2005 for Charleston at $265 million and Miami- Dade County at $465 million. Of course this is just the tip of the iceberg when considering all the coastal properties in the U.S. – losses are in the billions of dollars.

California has experienced the highest number and most acreage of wildfires in its history. Japan sweltered under hot July summer temperatures making new records. During the summer large areas of heat pressure or heat domes scattered around the hemisphere led to the sweltering temperatures. The Canadian Broadcasting Corporation notes the heat is to blame for at least 54 deaths in southern Quebec, near Montreal, which sweated under record high temperatures. The worldwide list of new high temperatures goes on and on.  The chart below shows extremely hot temperatures worldwide in a model at 2 meters above ground.

Sources: University of Maine, The Washington Post – 7/5/18

The relaxation of Obama administration clean air restrictions would possibly kill from 470 to 1,400 people per year the EPA admits.  The policy shift would move enforcement responsibility to the states, and allow them to relax regulations on coal burning plants even when installing new equipment.  Utilities would be allowed to use old standards when installing new equipment without having to meet higher air quality regulations.  The Obama era policies were never enforced because the Supreme Court found in favor of the states who sued to overturn the tighter regulations.

Next Steps: 

Enough is enough, the federal government is here to protect American lives not kill more people as a result of policy.  The government’s position makes no sense, it’s time we as citizens take a stand.

As we have said in a previous post:

“we may need to look to how to make duty more of a core value in our culture and in particular business culture.  As we have observed our country is essentially run by Corporate Nation States, they must change their attitude, behavior and operating practices focused on their duty to all the people not just their executives and customers. Everything a corporation does in some way impacts the Common Good. We are the people these corporations serve, and we should expect nothing less than socially responsible behavior from the executives running these huge Corporate Nation States.”

We would like the executives of these coal companies to think about the people that will get ill or die because they wanted to make more money and be ‘efficient and affordable’.  What if their daughter died?  How would they feel.  It seems that we are back to the point we made in last week’s Common Good post we ‘use people, and love things (money)’. This policy is dead wrong, and should never be implemented.  Instead, these corporations should be coming to us with proposals on how to save people’s lives and speed up the process of reducing climate warming. Maybe, these executives need to look themselves in the mirror and ask ‘who am I serving?’.  Time is running out, people are being killed in the heat, economies are being destroyed.  All these forces will cause civil conflict unless we act now to reverse the course of climate warming, before it is too late. 

GOP Administration Panders to Infant Formula Companies

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Photo: elle

Last May, the U.S. attended a multi-lateral World Health Assembly meeting held in Ecuador to finalize the language for promotion of breast feeding to developing countries with poor regions.  The policy recommended mothers breast feed their babies to promote better health than using possibly contaminated water with dry formula.  The risks of mixing infant formula with polluted water outweighed the possibly less breast milk that some mothers give their infants.

Source: Down to Earth – 3/22/18

About 11 % of the world’s population and 19 % of people in India alone do not have access to clean water.  For developing nations developing sources of clean water is crucial for their long term economic, and societal development. People drinking contaminated water suffer from multiple GI diseases, growth deformities and death.

U.S. representatives dropped long time support of over 40 years of research and other investigations in poor regions of the world noting the good health practice of breast feeding. Instead, the administration wanted all language recommending breast milk over infant formula deleted, including language focused on monitoring infant formula companies overly promoting their formula products.

Taking the corporate side is not new. In 1981, during the Reagan Administration  U.S. representatives at a WHO conference took the only position out of 118 countries against promoting the use of the breast milk over infant formula.

Breast milk provides anti-bodies, nutrients and other substances not available in infant formulas which are synthesized.  Obviously, when breast milk is not available infant formula maybe a good substitute temporarily when using clean water.

Next Steps:

The infant formula market is estimated to be $26 billion in 2017 growing to $66 billion by 2027. The industry is adding GMOs to its formula, offering organic versions and other approaches focused particularly on emerging countries where birth rates are much higher offering greater sales opportunities than in developed countries.  It is clear the infant formula industry has successfully lobbied the GOP Administration when it shifts policy that has been settled for decades promoting breast milk is best for babies to promote good health and longevity. Plus, other studies show the nurturing relationship of the mother with her baby during breast feeding is beneficial  to the social, and psychological health of the child.

The infant formula industry ought to understand their products depend on access to clean water to be effective as a compliment to breast feeding. The industry should shift  its resources from blind product promotion and lobbying efforts and instead help to increase access to clean water worldwide.  The infant formula industry needs to recognize their responsibility to support the common good promoting clean water and good health overall.

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