8/6/08
THE EXPENSE OF FREE SPEECH
By
Richard Davis
GUILFORD-. Last week a case played out in Federal Court in Brattleboro that revolved around the free speech rights of the pharmaceutical industry. The big boys are crying foul and saying that a new Vermont law, Act 80, will drive up drug prices and stifle innovation. It’s hard to have a lot of sympathy for an industry that is perhaps the most profitable on the planet (neck and neck with the oil companies), an industry that profits from the sickest and most vulnerable people in our society.
The Vermont legislature passed Act 80 this year and it has a provision that allows the state to prevent drug companies and data companies from using what is called “prescriber identifiable data”. The drug and data companies contend that this information is speech and, as such, they have a constitutional right to that information. Their premise is that by not having free access to that information their free speech rights are being violated.
Similar laws in New Hampshire and Maine were struck down on those grounds. But the Vermont law has an opt-out provision for prescribers and that means they can simply indicate they do not want their information shared. Prescribers who do not opt out will have their information bought and sold at obscenely high prices. None of the prescribers will profit from transactions that push already ridiculously inflated drug prices to new heights .
Issues in this case revolve, in large measure, around the activities of drug detailers. They are the sales people employed by the drug manufacturers who go to doctors’ offices, hospitals and other health care locations to try to persuade prescribers to use their products. Their bosses will tell you they provide a valuable educational service to doctors who don’t have the time to learn about new drugs.
Their bosses also contend that the best way for these detailers to do their job is to have access to all of the prescribing information of doctors. Here’s how it works. Data mining companies such as IMS, one of the plaintiffs in this case, develop contracts with pharmacies and buy information that tells them what prescriptions doctors are writing. That information is then sold to the drug manufacturers who use it to target their sales pitches to doctors.
There was testimony from Scott Tierney, Director of Managed Care Operations for CVS/Caremark, the largest provider of prescriptions in the U.S. CVS provides data to IMS and Verispan and that is a source of revenue for CVS. CVS does not tell MDs that CVS is selling the prescriber identifiable data, but Tierney said they do tell customers of CVS. You can bet your last dose of Prilosec that all of these activities drive up the cost of the drugs we all struggle to pay for.
Testimony from Mr. Robertson, the Assistant VP for Sales, Planning and Inserts for Wyeth, one of the world’s largest pharmaceutical manufacturers, provided insight into how drug detailers are trained and how they operate.
Here’s a breakdown of Wyeth’s U.S. field sales force:
1500 for family practice and internal medicine
300 for psychiatrists
400 for institutions (hospitals and teaching hospitals)
80 for rheumatology
85 for oncology
17 for Hemophilia
Sales reps receive 9-12 months of training which is a combination of home study, online work and classroom training. Most training is geared to having them know what is on the medication package inserts.
According to Robertson, Wyeth uses prescriber identifiable data purchased from IMS to “know which physicians it is effective for sales reps to call on, to see which products in our portfolio physicians may have the most interest in.”
It was revealed that the average length of face-to-face interaction between MDs and sales reps is 2 to 2.5 minutes. When asked what purpose giving samples to MDs serves Robertson said that it is to see if MDs can get the desired therapeutic effect and to titrate dosage. If you willingly swallow that bitter pill then you probably believe we are fighting a war in Iraq because weapons of mass destruction are a threat to the United States.
The Vermont defense attorney asked Robertson if he considered the drug industry to be competitive. He danced around the question and wouldn’t explicitly state that it was competitive. Good coaching by the plaintiffs no doubt, or just a lot of experience bending the truth.
Sales reps receive a salary and they “make more money if they achieve or exceed their goals”, according to Robertson. Goals are the number of prescriptions in their territory. Supervisors make more money if the sales reps make more money.
Perhaps one of the most revealing questions that I heard was asked by the Vermont attorney. “Couldn’t sales reps get the prescriber information they are looking for during a visit to a doctor?” Robertson answered “Yes” but said it would be more “efficient” to buy the prescriber identifiable data.
Draw your own conclusions. I will be writing more about this trial in the coming weeks. Judge Murtha will be deliberating over this case so public discussion is important.
Thursday, August 7, 2008
IMS. v. Sorrell, August 1, 2008
August 1, 2008
IMS V. SORRELL
FEDERAL COURT, BRATTLEBORO
August 1 was the final day of the trial. I did not stay for closing arguments but here are some bits and pieces.
There was testimony from Dr. Kesselheim, a lawyer and MD who practices in Boston and also does work on drug policy research and prescription drug practices and development. He provided a statement of support to the Vermont legislature for Act 80 because he said it would, “positively impact patient health and safety.” He went on to say that, “It is a good law that will improve patient safety and lower costs. This law will prevent overuse and inappropriate use of prescription drugs.
Kesselheim got into the alternative practice of academic detailing whereby academic medical centers train people to educate doctors about drugs rather than drug company sales reps. His institution has a pilot academic detailing project ongoing in Pennsylvania.
Kesselheim gave an example of the cost of overprescribing using the example of hydrochlorothiazide(HCTZ) in the 1990’s. HCTZ is an effective, generic first line treatment for high blood pressure but drug companies pushed the use of more expensive calcium channel blockers. He noted that this, “led to billions of dollars in excess cost to government programs and increased the cost of co-pays to people in government supported programs.”
Attorney Weiner for PhRMA began his closing argument with a predictable defense saying, “The State of Vermont has directly infringed on the free speech of PhRMA members and that there is no compelling state interest.” In a statement that could cut both ways he said, “Center stage is the doctor/patient relationship.”
Judge Murtha will deliberate and it could take 4-6 weeks before a decision is rendered.
IMS V. SORRELL
FEDERAL COURT, BRATTLEBORO
August 1 was the final day of the trial. I did not stay for closing arguments but here are some bits and pieces.
There was testimony from Dr. Kesselheim, a lawyer and MD who practices in Boston and also does work on drug policy research and prescription drug practices and development. He provided a statement of support to the Vermont legislature for Act 80 because he said it would, “positively impact patient health and safety.” He went on to say that, “It is a good law that will improve patient safety and lower costs. This law will prevent overuse and inappropriate use of prescription drugs.
Kesselheim got into the alternative practice of academic detailing whereby academic medical centers train people to educate doctors about drugs rather than drug company sales reps. His institution has a pilot academic detailing project ongoing in Pennsylvania.
Kesselheim gave an example of the cost of overprescribing using the example of hydrochlorothiazide(HCTZ) in the 1990’s. HCTZ is an effective, generic first line treatment for high blood pressure but drug companies pushed the use of more expensive calcium channel blockers. He noted that this, “led to billions of dollars in excess cost to government programs and increased the cost of co-pays to people in government supported programs.”
Attorney Weiner for PhRMA began his closing argument with a predictable defense saying, “The State of Vermont has directly infringed on the free speech of PhRMA members and that there is no compelling state interest.” In a statement that could cut both ways he said, “Center stage is the doctor/patient relationship.”
Judge Murtha will deliberate and it could take 4-6 weeks before a decision is rendered.
IMS v. Sorrell , July 30, 2008
July 30, 2008
IMS V. SORRELL
FEDERAL COURT, BRATTLEBORO
The State of Vermont seemed to do a better job of rebutting some of the “expert witness” testimony that was carefully crafted by the plaintiff team of lawyers. Mr. Robertson, the Assistant VP for Sales, Planning and Insights for Wyeth provided a lot of insight into how drug detailers are trained and how they operate.
Here’s the number of Wyeth’s sales force in the field- the cover the entire U.S.:
1500 for family practice and internal medicine
300 for psychiatrists
400 for institutions (hospitals and teaching hospitals)
80 for rheumatology
85 for oncology
17 for Hemophilia
Sales reps receive 9-12 months of training which is a combination of home study, online work and classroom training. Most training is geared to having them know what is on the medication package inserts.
According to Robertson Wyeth uses prescriber identifiable data purchased from IMS to “know which physicians it is effective for sales reps to call on, to see which products in our portfolio physicians may have the most interest in.”
It was revealed that the average length of face-to-face interaction between MDs and sales reps is 2 to 2.5 minutes. When asked what purpose giving samples to MDs serves Robertson
said that it is to see if MDs can get the desired therapeutic effect and to titrate dosage.
The Vermont attorney asked Robertson if he considered the drug industry to be competitive. He danced around the question and wouldn’t explicitly state that it was competitive.
Sales reps receive a salary and they “make more money if they achieve or exceed their goals”. Goals are the number of prescriptions in their territory. Supervisors make more money if the sales reps make more money.
Perhaps the most important question asked by the Vermont attorney in relation to the issue of the case “Couldn’t sales reps get the prescriber information they are looking for during a visit to a doctor?” Robertson answered “Yes” but said it would be more “efficient” to buy the prescriber identifiable data.
There was testimony from Scott Tierney, Director of Managed Care Operations for CVS/Caremark, the largest provider of prescriptions in the U.S. CVS provides data to IMS and Verispan and that is a source of revenue for CVS. CVS does not tell MDs that CVS is selling their data but Tierney said they do tell customers of CVS.
There was testimony from Michael Turner, President of the Political and Economic Research Council. He said that the State of Vermont should have followed his recommended procedures to validate reasons for not allowing the use of identifiable data, basically the premise of the section in contention in Act 80. He said the state made unsubstantiated assertions. In order to do what Turner said the state should do would require 9-12 months of work at a cost of $700,000-$900,000. I did not stay for the state’s cross examination of Turner.
IMS V. SORRELL
FEDERAL COURT, BRATTLEBORO
The State of Vermont seemed to do a better job of rebutting some of the “expert witness” testimony that was carefully crafted by the plaintiff team of lawyers. Mr. Robertson, the Assistant VP for Sales, Planning and Insights for Wyeth provided a lot of insight into how drug detailers are trained and how they operate.
Here’s the number of Wyeth’s sales force in the field- the cover the entire U.S.:
1500 for family practice and internal medicine
300 for psychiatrists
400 for institutions (hospitals and teaching hospitals)
80 for rheumatology
85 for oncology
17 for Hemophilia
Sales reps receive 9-12 months of training which is a combination of home study, online work and classroom training. Most training is geared to having them know what is on the medication package inserts.
According to Robertson Wyeth uses prescriber identifiable data purchased from IMS to “know which physicians it is effective for sales reps to call on, to see which products in our portfolio physicians may have the most interest in.”
It was revealed that the average length of face-to-face interaction between MDs and sales reps is 2 to 2.5 minutes. When asked what purpose giving samples to MDs serves Robertson
said that it is to see if MDs can get the desired therapeutic effect and to titrate dosage.
The Vermont attorney asked Robertson if he considered the drug industry to be competitive. He danced around the question and wouldn’t explicitly state that it was competitive.
Sales reps receive a salary and they “make more money if they achieve or exceed their goals”. Goals are the number of prescriptions in their territory. Supervisors make more money if the sales reps make more money.
Perhaps the most important question asked by the Vermont attorney in relation to the issue of the case “Couldn’t sales reps get the prescriber information they are looking for during a visit to a doctor?” Robertson answered “Yes” but said it would be more “efficient” to buy the prescriber identifiable data.
There was testimony from Scott Tierney, Director of Managed Care Operations for CVS/Caremark, the largest provider of prescriptions in the U.S. CVS provides data to IMS and Verispan and that is a source of revenue for CVS. CVS does not tell MDs that CVS is selling their data but Tierney said they do tell customers of CVS.
There was testimony from Michael Turner, President of the Political and Economic Research Council. He said that the State of Vermont should have followed his recommended procedures to validate reasons for not allowing the use of identifiable data, basically the premise of the section in contention in Act 80. He said the state made unsubstantiated assertions. In order to do what Turner said the state should do would require 9-12 months of work at a cost of $700,000-$900,000. I did not stay for the state’s cross examination of Turner.
IMS v. Sorrell, July 29, 2008
July 29, 2008
IMS V. SORRELL
FEDERAL COURT, BRATTLEBORO
It is clear that the State of Vermont is outgunned and outclassed at every turn. I listened to the testimony of Peter Hutt who is a strong defender of drug companies. Clearly a smart legal scholar and Washington insider. His personal story makes it clear why the drug industry continues to call the shots.
Hutt worked for the FDA for 5 years as Chief Counsel then joined a DC law firm representing PHRMA and he lobbied for drug companies. He boasted how he has served on the board of 20 biotech companies. Quotes from Hutt tell it all.
“Profits are essential to fuel the discovery of new drugs to help all of us.”
“The pharmaceutical industry can only exist if it makes a profit. A shift to generics will cause the price of drugs to go up or development will decrease.”
“Act 80 will harm patient health because patients who need new drugs will be denied those drugs when they could be tremendously helpful.”
“You get what you pay for. We must have high enough drug prices to fuel drug development. If we start hindering the marketing and sales of drug companies it will decrease development of new drugs.”
Cross examination of Hutt by the state was weak at best. He opened the door to show how the profits are excessive and how they result in the deaths of people. They could have made a more compelling case for the use of generic drugs as something in the best interest of Vermonters thereby negating the contention that brand drugs are best for everyone.
One can only hope that Judge Murtha will see through the drug industry smokescreen and render a decision that is truly in the best interest of Vermonters.
Hutt had the chutzpa to say that the studies contending that thiazide-type diuretics provide just as good treatment of hypertension as newer more expensive drugs as flawed. He then said thiazides are no safer than new drugs. That was a simple lie. Following his statement he then made more statements in defense of profits and trashing widespread use of generics as something harmful to drug company profits.
IMS V. SORRELL
FEDERAL COURT, BRATTLEBORO
It is clear that the State of Vermont is outgunned and outclassed at every turn. I listened to the testimony of Peter Hutt who is a strong defender of drug companies. Clearly a smart legal scholar and Washington insider. His personal story makes it clear why the drug industry continues to call the shots.
Hutt worked for the FDA for 5 years as Chief Counsel then joined a DC law firm representing PHRMA and he lobbied for drug companies. He boasted how he has served on the board of 20 biotech companies. Quotes from Hutt tell it all.
“Profits are essential to fuel the discovery of new drugs to help all of us.”
“The pharmaceutical industry can only exist if it makes a profit. A shift to generics will cause the price of drugs to go up or development will decrease.”
“Act 80 will harm patient health because patients who need new drugs will be denied those drugs when they could be tremendously helpful.”
“You get what you pay for. We must have high enough drug prices to fuel drug development. If we start hindering the marketing and sales of drug companies it will decrease development of new drugs.”
Cross examination of Hutt by the state was weak at best. He opened the door to show how the profits are excessive and how they result in the deaths of people. They could have made a more compelling case for the use of generic drugs as something in the best interest of Vermonters thereby negating the contention that brand drugs are best for everyone.
One can only hope that Judge Murtha will see through the drug industry smokescreen and render a decision that is truly in the best interest of Vermonters.
Hutt had the chutzpa to say that the studies contending that thiazide-type diuretics provide just as good treatment of hypertension as newer more expensive drugs as flawed. He then said thiazides are no safer than new drugs. That was a simple lie. Following his statement he then made more statements in defense of profits and trashing widespread use of generics as something harmful to drug company profits.
IMS v. Sorrell July 28, 2008
IMS v. Sorrell
Federal Court Brattleboro
July 28, 2008
Today in Federal court in Brattleboro a trial dealing with the Vermont prescription drug law, Act 80, began. Plaintiffs are IMS* and our dear friends PHARMA. The State of Vermont is the defendant. The big issue is whether or not drug companies and information sellers have a right to the information about the prescribing practices of doctors. A similar law was struck down in NH and Maine. The Vermont law differs a little in that MDs can opt out of information sharing.
I am not a lawyer. I will be attending some of the proceedings and will provide my personal biased summaries.
There were 7 lawyers from the dark side and two techies with 4 laptops. The state had, I think, 4 lawyers. The state is clearly outclassed and it is truly a David versus Goliath trial. I did not see any media in the courtroom.
The IMS and Pharma argument is based on constitutional free speech issues. They claim that not allowing to have the information is the same as restricting free speech. They claim IMS is the same as the New York Times (major stretch but perhaps legally defensible) and that they are just another publisher.
The state used a lot of quotes from Marcia Angell and others about obscene pharmaceutical profits and the state tried to lay out an argument that they are acting in the interest of all Vermonters when they do things to try to control the price of drugs.
But, the case will be decided on the merits of specific legal points. If more members identifiable as the public were in the courtroom it might provide an interesting perspective for Judge Murtha.
I did not stay for the afternoon. I left during testimony by an IMS operative.
*IMS is a company that gathers data and then sells it to mostly drug companies.
Federal Court Brattleboro
July 28, 2008
Today in Federal court in Brattleboro a trial dealing with the Vermont prescription drug law, Act 80, began. Plaintiffs are IMS* and our dear friends PHARMA. The State of Vermont is the defendant. The big issue is whether or not drug companies and information sellers have a right to the information about the prescribing practices of doctors. A similar law was struck down in NH and Maine. The Vermont law differs a little in that MDs can opt out of information sharing.
I am not a lawyer. I will be attending some of the proceedings and will provide my personal biased summaries.
There were 7 lawyers from the dark side and two techies with 4 laptops. The state had, I think, 4 lawyers. The state is clearly outclassed and it is truly a David versus Goliath trial. I did not see any media in the courtroom.
The IMS and Pharma argument is based on constitutional free speech issues. They claim that not allowing to have the information is the same as restricting free speech. They claim IMS is the same as the New York Times (major stretch but perhaps legally defensible) and that they are just another publisher.
The state used a lot of quotes from Marcia Angell and others about obscene pharmaceutical profits and the state tried to lay out an argument that they are acting in the interest of all Vermonters when they do things to try to control the price of drugs.
But, the case will be decided on the merits of specific legal points. If more members identifiable as the public were in the courtroom it might provide an interesting perspective for Judge Murtha.
I did not stay for the afternoon. I left during testimony by an IMS operative.
*IMS is a company that gathers data and then sells it to mostly drug companies.
Sunday, December 23, 2007
THE VERMONT HOSPITAL SECURITY PLAN
THE VERMONT HOSPITAL SECURITY PLAN
By
Richard Davis
GUILFORD- Once in awhile a piece of proposed legislation comes along that seems so right, so sensible in many ways, that one almost begins to believe that it will pass on the first try. A bill introduced by Francis “Topper” McFaun-R- Barre Town with sponsors Michael Obuchowski-D- Rockingham and Hilda Ojibway-D-Hartford, The Vermont Hospital Security Plan, is such a bill.
Then political reality sets in. That is why this bill, H.304 has barely seen the light of day in three years. Things may be about to change. Thanks to the hard work of McFaun, who is perhaps the most non-partisan politician I have ever met, the bill may get a fair hearing when the new legislative session begins in January.
A fair hearing means that the chair of the House Health Care Committee, Steve Maier-D- Middlebury will schedule committee discussion and solicit public testimony early in the session when there is time to act. Then it will be up to the public to put pressure on their legislators to push the bill forward. Things can actually happen that way in Vermont if a critical mass comes together.
If there ever was a time for a critical mass to get results then it should happen with McFaun’s bill. The usual political barriers are still operational and that means that partisan politics, budget constraints and the art of perception over reality may win the day.
So what would this bill do? It would guarantee that all Vermonters have access to and payment for inpatient and outpatient hospital services. This would mean that whether or not you were insured, you would not have to worry about co-pays and deductibles if you needed hospital care.
McFaun got the state’s Joint Fiscal Office (JFO) to run some numbers and they have determined that insurance premiums could be cut by 43% if they allowed this new bill’s plan to take over. The tab for this plan would be $700 million, but we already need to raise $760 million in premiums, property taxes and out of pocket payments just to provide the current level of hospital care for Vermonters.
Estimates also indicate that if every Vermonter paid about $1300 a year they would have complete hospital coverage. Not everyone can afford that level of cost-sharing but even if people paid according to their ability this program could also be funded from other sources and still cost most people less than they pay now for hospital care.
Let’s say you have a decent insurance policy now and you pay $10,000 a year for two people with minimal out of pocket costs. That premium would be reduced to $5700 and you would pay an additional $2600 for hospital care. A couple would save $1700 a year and have even more financial security than most insurance policies provide. Anyone with a high deductible policy would save more and no longer live in fear of actually having to use their health insurance.
The bill doesn’t get into funding specifics but options include a payroll tax, income tax, cost-sharing measures, a value added tax, consumption taxes or an annual hospital fee. Most people would spend less than they do now for health care and health insurance. If things were set up well, then the hospital plan could dovetail with existing coverage.
Of course, all is not as simple as it sounds. This would be an incredibly complex undertaking and it would eliminate a few hospital jobs in billing departments because there would be a new and simpler system of financial administration.
The genius of this bill is that it could work financially if everyone pays according to their ability. My bias is toward an income tax dedicated to hospital care. Money needed but not raised in that way could be supplemented through some of the other measures already mentioned.
Consider some facts. The biggest chunk of health care cost is for hospital care. Half of all bankruptcies occur because of medical bills and 75% of those people who go bankrupt already have health insurance. More and more people, whether insured or not, are living in fear of what the next illness will do to them financially.
Imagine living in world that allowed us to think about dealing with our illness first instead of having to be consumed with how we will pay for our treatment. The hospital bill wouldn’t be a perfect cure for this problem, but it would be a good first step and we are still crawling when it comes to these issues.
By
Richard Davis
GUILFORD- Once in awhile a piece of proposed legislation comes along that seems so right, so sensible in many ways, that one almost begins to believe that it will pass on the first try. A bill introduced by Francis “Topper” McFaun-R- Barre Town with sponsors Michael Obuchowski-D- Rockingham and Hilda Ojibway-D-Hartford, The Vermont Hospital Security Plan, is such a bill.
Then political reality sets in. That is why this bill, H.304 has barely seen the light of day in three years. Things may be about to change. Thanks to the hard work of McFaun, who is perhaps the most non-partisan politician I have ever met, the bill may get a fair hearing when the new legislative session begins in January.
A fair hearing means that the chair of the House Health Care Committee, Steve Maier-D- Middlebury will schedule committee discussion and solicit public testimony early in the session when there is time to act. Then it will be up to the public to put pressure on their legislators to push the bill forward. Things can actually happen that way in Vermont if a critical mass comes together.
If there ever was a time for a critical mass to get results then it should happen with McFaun’s bill. The usual political barriers are still operational and that means that partisan politics, budget constraints and the art of perception over reality may win the day.
So what would this bill do? It would guarantee that all Vermonters have access to and payment for inpatient and outpatient hospital services. This would mean that whether or not you were insured, you would not have to worry about co-pays and deductibles if you needed hospital care.
McFaun got the state’s Joint Fiscal Office (JFO) to run some numbers and they have determined that insurance premiums could be cut by 43% if they allowed this new bill’s plan to take over. The tab for this plan would be $700 million, but we already need to raise $760 million in premiums, property taxes and out of pocket payments just to provide the current level of hospital care for Vermonters.
Estimates also indicate that if every Vermonter paid about $1300 a year they would have complete hospital coverage. Not everyone can afford that level of cost-sharing but even if people paid according to their ability this program could also be funded from other sources and still cost most people less than they pay now for hospital care.
Let’s say you have a decent insurance policy now and you pay $10,000 a year for two people with minimal out of pocket costs. That premium would be reduced to $5700 and you would pay an additional $2600 for hospital care. A couple would save $1700 a year and have even more financial security than most insurance policies provide. Anyone with a high deductible policy would save more and no longer live in fear of actually having to use their health insurance.
The bill doesn’t get into funding specifics but options include a payroll tax, income tax, cost-sharing measures, a value added tax, consumption taxes or an annual hospital fee. Most people would spend less than they do now for health care and health insurance. If things were set up well, then the hospital plan could dovetail with existing coverage.
Of course, all is not as simple as it sounds. This would be an incredibly complex undertaking and it would eliminate a few hospital jobs in billing departments because there would be a new and simpler system of financial administration.
The genius of this bill is that it could work financially if everyone pays according to their ability. My bias is toward an income tax dedicated to hospital care. Money needed but not raised in that way could be supplemented through some of the other measures already mentioned.
Consider some facts. The biggest chunk of health care cost is for hospital care. Half of all bankruptcies occur because of medical bills and 75% of those people who go bankrupt already have health insurance. More and more people, whether insured or not, are living in fear of what the next illness will do to them financially.
Imagine living in world that allowed us to think about dealing with our illness first instead of having to be consumed with how we will pay for our treatment. The hospital bill wouldn’t be a perfect cure for this problem, but it would be a good first step and we are still crawling when it comes to these issues.
Monday, July 9, 2007
An Update on Canadian Health Care
An Update on Canadian Health Care
Mimi Morton
I lived in Canada from 1970 until 1999 and had the benefits of its health care system. As a cancer survivor, I credit the Canadian system with saving my life. I can’t dredge up even one memory of bad care. Nonetheless, I know the system is flawed. As I was leaving Canada for the U.S., my Montreal surgeon, David Owen, told me, “Our system is broken.” He was referring to increased restrictions on his professional autonomy. The American health care system experiences restrictions of a different kind. U.S. insurance providers attempt to keep costs down by limiting patients’ claims rather than doctors’ protocols.
If Americans are ever to develop a truly universal, publicly-funded system, it will not be any more perfect than the Canadian one. To preview conditions we might face if we make health care a right rather than a privilege, I wanted to check in with the Canadian system now.
World Health Organization statistics have consistently shown that health outcomes are better in countries that cover all their citizens rather than in countries that do not. But most Americans have also heard horror stories about Canada, the same ones we tell about our own system: big city emergency room chaos, long waits for referrals, overworked general practitioners. I wanted to transcend hyperbole and talk to Canadians themselves.
The system that I left in 1999 was overworked and fraying around the edges but it still delivered quality care. As Canadians like to say, when you have it bad, the system is good to you. Call it triage if you wish, but when everyone is served, the worst cases must be seen first. I experienced this preferential treatment when I had cancer.
I’d heard that the 21st century was bringing Canada closer to a two-tiered system: the original public system is still in place but private insurance policies are increasingly utilized, principally to expedite care. In fact, private insurance companies have never gone out of business in Canada. From the 70s until the ‘90s, I paid into and received supplemental insurance through my Montreal teachers union that covered such amendments as high-priced specialty medicines and private hospital rooms.
Beyond such add-on insurance, full-service private group insurance is available for those who can pay. Michael Bantey, a corporate lawyer in his 40s, told me he stopped using the public system when he joined his firm and now pays into their private group policy which he considers superior to what he could get publicly. “I pay to have an MRI or whatever to avoid the six-month wait.” For my interviewees, the wait for access is the single biggest drawback of the public system.
Leila Basen, a Montreal screenwriter, told me a variation on this theme. When her daughter suffered a painful sports injury to her knee, she opted for a private MRI because she assumed the wait “might be ten months if we went through normal channels.” Because her daughter was in great pain, an orthopedic surgeon saw her immediately and her surgery took place within a month. Basen has supplemental insurance through her writers’ union which covered drugs but not MRIs. While she was happy with the timeliness of her daughter’s care, she acknowledges that the system can be difficult to access.
“’Did you have to give them an envelope?’ That’s an expression you hear from older people in Montreal.” Basen explained that this mild form of bribery is sometimes used in order to “jump the queue.” (I had never heard of the practice.)
However, when Hanford Woods, a former colleague of mine in Montreal, decided on hip replacement surgery in 2006, he found the wait reasonable and he was able to schedule the surgery at his convenience, during his vacation.
Perhaps the most caustic story came from the youngest person I interviewed, Alex Fellows, a thirty year old artist and writer. “I was hit by a car in 1999 (when he was 22). I crashed the front windshield and dented the roof as I rolled over the top. Some old lady had run a stop sign. The impact knocked both my shoes right off and shattered my front teeth. In the hospital I waited on a stretcher for about half an hour in a hallway next to other people moaning on stretchers. Eventually they took my x-rays real fast and everything checked out o.k. I was ready to go home, even though I was having trouble walking. I wasn’t offered to sit down anywhere or what to do when I got home. I asked if I could borrow a slipper because I had no shoe and it was raining outside. They gave me a bunch of doctor hair caps to use as shoes and showed me to the door, where I had to call a cab. At home, I passed out with a crazy headache. (This experience was) nothing that would shock any African, but it’s bad seeing I pay all these taxes and it’s such a fast-food health system.”
Harold Rich, a sixty year old pediatrician at the Montreal Children’s Hospital would dispute Fellows’ story as representative of emergency room care. “We try to provide the best care for everyone,” he said. “Without concern for money. “ He acknowledged that budgeting issues are chronic but that overall, both children and their parents are happy with the level of care. He added, “We offer excellent intensive ambulatory care.”
While Rich admires his hospital’s clinical practices, he is critical of what he describes as the “unfriendly” hospital ambiance: unaesthetic waiting rooms, poor food. He thinks that creature comforts could be improved. “It’s just a matter of will.” Nonetheless, hospital budgeting also must work on a triage principle in which funding for drapes and furniture comes at the bottom of the list.
Susie Gruber, a fifty-seven year old Montrealer who worked for many years as a receptionist at a CLSC, Quebec’s system of neighborhood clinics, tells me that the system is crowded. CLSCs no longer accept walk-ins. “It’s getting harder to be seen by a g.p. if you don’t have one,” she told me. “And, yes, the office waits can be long.”
In spite of their honest impressions of the system’s limitations, all of the people I interviewed, with the exception of the corporate lawyer, said they thought the system’s benefits far outweighed its problems.
Leila Basin told me the story of her other daughter who suffers from a rare congenital heart condition and has undergone multiple surgeries. She currently is seen by a comprehensive heart unit at the Royal Victoria Hospital where all her health needs are treated in one place by a team of specialists. Basen is impressed with the level of care and the innovative holistic approach.
Canada and the U.S. share more than just a common border. There is a great deal of professional interface between Canadian and American doctors. Many Canadians (such as the heart specialist Basen’s daughter works with) have studied in the U.S. just as American doctors study and work in Canada . As we struggle to reform our chaotic non-system, Canada provides us with valuable experience.
Granted, my interviewees were all urban residents of one province. Different Canadian regions may experience different challenges. Overall, my interviews did not uncover evidence of poor care but they did show the stresses a system withstands, particularly in access to primary care and expensive screenings, when patient volume is increased.
We already know that the American primary care system is over-utilized and understaffed as more medical students opt for lucrative specializations rather than family medicine/preventive care. American medical schools will need to encourage a more humanistic ethos if we are to train doctors to enter our own version of a universal public system in which medicine is more than just a business.
Mimi Morton
I lived in Canada from 1970 until 1999 and had the benefits of its health care system. As a cancer survivor, I credit the Canadian system with saving my life. I can’t dredge up even one memory of bad care. Nonetheless, I know the system is flawed. As I was leaving Canada for the U.S., my Montreal surgeon, David Owen, told me, “Our system is broken.” He was referring to increased restrictions on his professional autonomy. The American health care system experiences restrictions of a different kind. U.S. insurance providers attempt to keep costs down by limiting patients’ claims rather than doctors’ protocols.
If Americans are ever to develop a truly universal, publicly-funded system, it will not be any more perfect than the Canadian one. To preview conditions we might face if we make health care a right rather than a privilege, I wanted to check in with the Canadian system now.
World Health Organization statistics have consistently shown that health outcomes are better in countries that cover all their citizens rather than in countries that do not. But most Americans have also heard horror stories about Canada, the same ones we tell about our own system: big city emergency room chaos, long waits for referrals, overworked general practitioners. I wanted to transcend hyperbole and talk to Canadians themselves.
The system that I left in 1999 was overworked and fraying around the edges but it still delivered quality care. As Canadians like to say, when you have it bad, the system is good to you. Call it triage if you wish, but when everyone is served, the worst cases must be seen first. I experienced this preferential treatment when I had cancer.
I’d heard that the 21st century was bringing Canada closer to a two-tiered system: the original public system is still in place but private insurance policies are increasingly utilized, principally to expedite care. In fact, private insurance companies have never gone out of business in Canada. From the 70s until the ‘90s, I paid into and received supplemental insurance through my Montreal teachers union that covered such amendments as high-priced specialty medicines and private hospital rooms.
Beyond such add-on insurance, full-service private group insurance is available for those who can pay. Michael Bantey, a corporate lawyer in his 40s, told me he stopped using the public system when he joined his firm and now pays into their private group policy which he considers superior to what he could get publicly. “I pay to have an MRI or whatever to avoid the six-month wait.” For my interviewees, the wait for access is the single biggest drawback of the public system.
Leila Basen, a Montreal screenwriter, told me a variation on this theme. When her daughter suffered a painful sports injury to her knee, she opted for a private MRI because she assumed the wait “might be ten months if we went through normal channels.” Because her daughter was in great pain, an orthopedic surgeon saw her immediately and her surgery took place within a month. Basen has supplemental insurance through her writers’ union which covered drugs but not MRIs. While she was happy with the timeliness of her daughter’s care, she acknowledges that the system can be difficult to access.
“’Did you have to give them an envelope?’ That’s an expression you hear from older people in Montreal.” Basen explained that this mild form of bribery is sometimes used in order to “jump the queue.” (I had never heard of the practice.)
However, when Hanford Woods, a former colleague of mine in Montreal, decided on hip replacement surgery in 2006, he found the wait reasonable and he was able to schedule the surgery at his convenience, during his vacation.
Perhaps the most caustic story came from the youngest person I interviewed, Alex Fellows, a thirty year old artist and writer. “I was hit by a car in 1999 (when he was 22). I crashed the front windshield and dented the roof as I rolled over the top. Some old lady had run a stop sign. The impact knocked both my shoes right off and shattered my front teeth. In the hospital I waited on a stretcher for about half an hour in a hallway next to other people moaning on stretchers. Eventually they took my x-rays real fast and everything checked out o.k. I was ready to go home, even though I was having trouble walking. I wasn’t offered to sit down anywhere or what to do when I got home. I asked if I could borrow a slipper because I had no shoe and it was raining outside. They gave me a bunch of doctor hair caps to use as shoes and showed me to the door, where I had to call a cab. At home, I passed out with a crazy headache. (This experience was) nothing that would shock any African, but it’s bad seeing I pay all these taxes and it’s such a fast-food health system.”
Harold Rich, a sixty year old pediatrician at the Montreal Children’s Hospital would dispute Fellows’ story as representative of emergency room care. “We try to provide the best care for everyone,” he said. “Without concern for money. “ He acknowledged that budgeting issues are chronic but that overall, both children and their parents are happy with the level of care. He added, “We offer excellent intensive ambulatory care.”
While Rich admires his hospital’s clinical practices, he is critical of what he describes as the “unfriendly” hospital ambiance: unaesthetic waiting rooms, poor food. He thinks that creature comforts could be improved. “It’s just a matter of will.” Nonetheless, hospital budgeting also must work on a triage principle in which funding for drapes and furniture comes at the bottom of the list.
Susie Gruber, a fifty-seven year old Montrealer who worked for many years as a receptionist at a CLSC, Quebec’s system of neighborhood clinics, tells me that the system is crowded. CLSCs no longer accept walk-ins. “It’s getting harder to be seen by a g.p. if you don’t have one,” she told me. “And, yes, the office waits can be long.”
In spite of their honest impressions of the system’s limitations, all of the people I interviewed, with the exception of the corporate lawyer, said they thought the system’s benefits far outweighed its problems.
Leila Basin told me the story of her other daughter who suffers from a rare congenital heart condition and has undergone multiple surgeries. She currently is seen by a comprehensive heart unit at the Royal Victoria Hospital where all her health needs are treated in one place by a team of specialists. Basen is impressed with the level of care and the innovative holistic approach.
Canada and the U.S. share more than just a common border. There is a great deal of professional interface between Canadian and American doctors. Many Canadians (such as the heart specialist Basen’s daughter works with) have studied in the U.S. just as American doctors study and work in Canada . As we struggle to reform our chaotic non-system, Canada provides us with valuable experience.
Granted, my interviewees were all urban residents of one province. Different Canadian regions may experience different challenges. Overall, my interviews did not uncover evidence of poor care but they did show the stresses a system withstands, particularly in access to primary care and expensive screenings, when patient volume is increased.
We already know that the American primary care system is over-utilized and understaffed as more medical students opt for lucrative specializations rather than family medicine/preventive care. American medical schools will need to encourage a more humanistic ethos if we are to train doctors to enter our own version of a universal public system in which medicine is more than just a business.
Monday, June 11, 2007
New York Times June 11 Business of Health Care Section
??Worth the read???
The New York Times has published a special section on the business of health care on June 11.
The New York Times has published a special section on the business of health care on June 11.
Thursday, May 24, 2007
Sicko
Michael Moore's new film "Sicko" is due for release on June 29. This can be an important tool for getting the word out about real universal health care and the need for single payer. Organize events around the showing of the film, leaflet outside movie theaters. Many of the organization involved with the HR 676 campaign with Healthcare Now are planning events around the country. Opportunities like this don't happen very often.
Here's a link to a recent Bill Maher interview with Michael Moore:
http://www.alternet.org/blogs/video/#52438
Here's a link to a recent Bill Maher interview with Michael Moore:
http://www.alternet.org/blogs/video/#52438
Monday, May 7, 2007
Welch Signs on to HR 676
Rep. Peter Welch has signed on as a co-sponsor to HR 676, Rep. John Conyers-D-Michigan, Expanded and Improved Medicare for All Act. In addition, Welch has also signed on to three other bills aiming to promote universal health care. They are HR 1841, HR 15 and HR 506.
Wednesday, May 2, 2007
Legislative Update
The first year of this legislative biennium will be coming to an end soon. The big question is, “What happened to move health care reform forward?”. The simple answer, “Not much.”
Health care committees dealt with bills to fine tune the Catamount health bill that passed last year. It was their belief that the best they could do this year was to set the stage so that the plan has a chance to work.
Susan Besio, the state director of implementation for the plan, is doing a superhuman job of coordinating and executing all of the pieces. If you want to keep updated check out the web site: www.hcr.vt.gov.
Jim Hester, former Vermont boss for MVP health insurance, was appointed director of the Health Care Commission. He is a consummate list maker and detail person. Hester seems to have a solid grip on things and he has a vision of how things should play out. He is making an effort to reach out to all the players in the Catamount drama. Stay tuned.
As a side note, as of this writing, it is not clear if the pharmaceutical bill making its way through the legislature will pass. Even if it passes, I suspect the Governor will veto it. The bill is a remake of the comprehensive bill that many of us worked on a few years ago; the bill to control drug prices and the practices of pharmaceutical companies. If it passes it would be landmark legislation. Sadly, the press has pretty much ignored this critical piece of health care reform.
The Catamount insurance product is slated to go into effect on October 1 and the timeframe for enrollment will begin about 4-6 weeks prior to that. The cost of the policy is still a moving target but we do know that the full cost of an unsubsidized policy will be very close to $400 a month per person.
Benefit details have not been revealed but we do know they have to be at least as good as what Medicaid offers. That is good coverage.
Even though coverage may be good it won’t help all of those Vermonters who still won’t be able to afford insurance under Catamount. That is why VCCH and others are pushing for changes to the plan. We want to see the one year waiting period eliminated. The plan forces you to be uninsured for a year before you are eligible. We also want to allow self-employed people such as farmers and artists to be able to buy in or be subsidized.
Will we get what we want? Maybe. Here’s where the hope lies. The Health Care Commission held a public meeting on April 24 to hear what the public wants for next steps for Catamount. About 50 people attended the hearing and the usual spectrum of opinion was aired, but with a twist. VCCH brought two of the people it featured in its newspaper ads (view them on our web site: www.universalhealthvt.org). It was a refreshing wake up call for legislators to hear from “real people”.
The Commission plans to hold similar hearings around the state this summer and fall to hear what Vermonters want changed in the Catamount plan. We will keep you updated with schedules and information on our web site.
The best case scenario is that all of the information gathered at these hearings will be turned into legislation to expand Catamount. That legislation will be introduced at the start of the 2008 session and be ready for implementation by the end of the first year of the life of Catamount.
Don’t forget that we still have a formidable obstacle to expanding Catamount and making it work. For all of his rhetoric, Governor Douglas will only support measures that conform to his right wing ideology. Catamount expansion will not make him happy. That means we may have to wait until the next election before Catamount will be able to fulfill its promise to become more than what it is now.
Your voice will be important in the process. VCCH hopes we can help your voice become strong by all of us working together.
Health care committees dealt with bills to fine tune the Catamount health bill that passed last year. It was their belief that the best they could do this year was to set the stage so that the plan has a chance to work.
Susan Besio, the state director of implementation for the plan, is doing a superhuman job of coordinating and executing all of the pieces. If you want to keep updated check out the web site: www.hcr.vt.gov.
Jim Hester, former Vermont boss for MVP health insurance, was appointed director of the Health Care Commission. He is a consummate list maker and detail person. Hester seems to have a solid grip on things and he has a vision of how things should play out. He is making an effort to reach out to all the players in the Catamount drama. Stay tuned.
As a side note, as of this writing, it is not clear if the pharmaceutical bill making its way through the legislature will pass. Even if it passes, I suspect the Governor will veto it. The bill is a remake of the comprehensive bill that many of us worked on a few years ago; the bill to control drug prices and the practices of pharmaceutical companies. If it passes it would be landmark legislation. Sadly, the press has pretty much ignored this critical piece of health care reform.
The Catamount insurance product is slated to go into effect on October 1 and the timeframe for enrollment will begin about 4-6 weeks prior to that. The cost of the policy is still a moving target but we do know that the full cost of an unsubsidized policy will be very close to $400 a month per person.
Benefit details have not been revealed but we do know they have to be at least as good as what Medicaid offers. That is good coverage.
Even though coverage may be good it won’t help all of those Vermonters who still won’t be able to afford insurance under Catamount. That is why VCCH and others are pushing for changes to the plan. We want to see the one year waiting period eliminated. The plan forces you to be uninsured for a year before you are eligible. We also want to allow self-employed people such as farmers and artists to be able to buy in or be subsidized.
Will we get what we want? Maybe. Here’s where the hope lies. The Health Care Commission held a public meeting on April 24 to hear what the public wants for next steps for Catamount. About 50 people attended the hearing and the usual spectrum of opinion was aired, but with a twist. VCCH brought two of the people it featured in its newspaper ads (view them on our web site: www.universalhealthvt.org). It was a refreshing wake up call for legislators to hear from “real people”.
The Commission plans to hold similar hearings around the state this summer and fall to hear what Vermonters want changed in the Catamount plan. We will keep you updated with schedules and information on our web site.
The best case scenario is that all of the information gathered at these hearings will be turned into legislation to expand Catamount. That legislation will be introduced at the start of the 2008 session and be ready for implementation by the end of the first year of the life of Catamount.
Don’t forget that we still have a formidable obstacle to expanding Catamount and making it work. For all of his rhetoric, Governor Douglas will only support measures that conform to his right wing ideology. Catamount expansion will not make him happy. That means we may have to wait until the next election before Catamount will be able to fulfill its promise to become more than what it is now.
Your voice will be important in the process. VCCH hopes we can help your voice become strong by all of us working together.
Thursday, April 26, 2007
From Rep. John Conyers
From Rep. John Conyers Blog:
We Need Real Universal Health Care Coverage
Submitted by JC on April 23, 2007 - 11:54pm.
The health care crisis we face today affects everyone, overwhelming America's workers and businesses. Many low-wage earners do not receive health benefits and cannot afford insurance. Higher salaried workers know that the cost of their health insurance may lead to the next round of layoffs.
More than 46 million Americans lack basic health care coverage. Millions more face high deductibles and staggering costs leaving essential care out of reach.
We can no longer seek gradual reforms or provide insurance companies with financial incentives to solve the problem. The time has come for a single payer national health care system that provides complete care to all Americans.
Since the 2006 elections, we have heard plenty of new voices calling for universal health care. Unfortunately, many of these claim to be universal health care, but are merely bandaids to the problem.
One proposal has the federal government giving billions of dollars to insurance companies to cover the uninsured. Other proposals only cover children or shift the entire burden of healthcare to employees in the form of health savings accounts.
Unfortunately, patchwork fixes like these will not work. The only way to provide a lasting solution to our health care crisis is through single payer universal health care. We must not let the movement toward universal health care be co-opted by proposals that serve to enrich those seeking to extend the status quo at the expense of true reform.
To address this need, I have introduced H.R. 676, the United States National Health Insurance Act. My bill would create a single payer universal health care system by strengthening and extending the Medicare program to cover all Americans.
Please help me enact this important legislation by signing this statement of support. We must have real reform through a single payer universal health care program if we are to solve our nation's health care crisis.
We Need Real Universal Health Care Coverage
Submitted by JC on April 23, 2007 - 11:54pm.
The health care crisis we face today affects everyone, overwhelming America's workers and businesses. Many low-wage earners do not receive health benefits and cannot afford insurance. Higher salaried workers know that the cost of their health insurance may lead to the next round of layoffs.
More than 46 million Americans lack basic health care coverage. Millions more face high deductibles and staggering costs leaving essential care out of reach.
We can no longer seek gradual reforms or provide insurance companies with financial incentives to solve the problem. The time has come for a single payer national health care system that provides complete care to all Americans.
Since the 2006 elections, we have heard plenty of new voices calling for universal health care. Unfortunately, many of these claim to be universal health care, but are merely bandaids to the problem.
One proposal has the federal government giving billions of dollars to insurance companies to cover the uninsured. Other proposals only cover children or shift the entire burden of healthcare to employees in the form of health savings accounts.
Unfortunately, patchwork fixes like these will not work. The only way to provide a lasting solution to our health care crisis is through single payer universal health care. We must not let the movement toward universal health care be co-opted by proposals that serve to enrich those seeking to extend the status quo at the expense of true reform.
To address this need, I have introduced H.R. 676, the United States National Health Insurance Act. My bill would create a single payer universal health care system by strengthening and extending the Medicare program to cover all Americans.
Please help me enact this important legislation by signing this statement of support. We must have real reform through a single payer universal health care program if we are to solve our nation's health care crisis.
Thursday, April 19, 2007
Health Care Financing Study
A health care financing study was published in early March as part of the mandate for studies in the health care bill related to Catamount. It is dense, boring and not worth a lot but it does offer some very interesting statistics relating to health care finanacing and to a single payer plan specifically. This is the study that Gov Douglas refused to participate in and there is a letter in the documents confirming that. The report is at the Health Care Commission web site: http://www.leg.state.vt.us/CommissionOnHealthCareReform/Memo-Health%20Care%20Financing%20Review%20-%20Final%20Draft%20031307.pdf
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