You missed the drug lobby. They are more influential and funded by a far more profitable industry than either insurance or healthcare. Insurance and healthcare tend to lose money. Pharmaceuticals has been one of the most profitable industry segments for decades. And a really non-trivial fraction of our high prices are due to us paying more for the same damn drugs that everyone else uses.
Yes, earlier I referred to the fact that “today the combined health care interests as a whole are the most powerful aggregate lobby group in Washington”, which is the combined insurance, medical, hospital association, and other lobbies that have traditionally been obstacles to health care reform. Here, I’m not ascribing any particular ranking to the size or influence of insurance or medical lobbies, just saying that they’re significant obstacles to health care reform. The insurance lobby does it to protect their business interests, and the medical lobby tends to do it more for imaginary and ideological reasons.
Doctors in Saskatchewan had the same fears in the early 60s when plans were discussed to extend the public hospitalization plan to a full universal health care system. Doctors were so up in arms about it that they staged a strike, and who should come up from down south to help them out and stir the pot even more than the AMA itself, in a rather brazen act of international shit-disturbing. In the end, the fear-mongering by all parties turned out to be a pack of lies. The UHC system was so successful that it was soon adopted in the rest of the country, and Tommy Douglas, the Saskatchewan premier who laid the foundation for these reforms, has long been regarded as “the Greatest Canadian” and “the father of Canadian health care”.
Yeah, speaking as someone who works in the property casualty (not health) insurance industry, i think you are vastly overestimating the influence of the insurance industry, and vastly underestimating the influence of the pharmaceutical industry. You keep pointing a finger at money-losing industry that has proven itself to be mediocre at buying congressmen, and ignoring an incredibly profitable industry that has proven itself to be really really successful at buying influence. That has created an opioid epidemic in the US. That has prevented anything like cost limitations on its products. That has driven insulin to be unaffordable to many.
Maybe you don’t care. It’s just “those bad people” to you, and you don’t much care which people you are pointing at. But I’m close enough to those people that i do care. And you are pointing at the wrong people.
I will point out that the Opioid epidemic is world-wide.
I absolutely do care. I care very much about the fact that powerful interests are screwing ordinary Americans on health care. I care as a matter of a visceral sense of basic fairness and justice, the same way that I frequently check the news to see if various notorious criminals like the latest Texas shooter have been captured, even if they’re far away in a different country.
I agree with you about the pharmaceutical industry. I’m familiar with the enormous price gaps between the US and the rest of the world. I’ve read the CBC news stories about desperate Americans crossing over into Canada to buy insulin, because they can’t afford it at home. And, incidentally, in terms of the opioid epidemic, I don’t know if you’ve seen the miniseries Dopesick, a very highly rated dramatization of how Purdue Pharma precipitated the opioid crisis through the development and aggressive marketing of Oxycontin and related opioids. I’ve seen it twice. It’s deeply disturbing, but also very moving and very informative.
But I think the problem with your accusation here is that pharma and health insurance are two different and distinct problems, albeit with some overlap. The fundamental structural issues I’ve mentioned with private health insurance as a means of funding medically necessary health care are quite a different issue from the way that pharma is ALSO screwing the American public. The only major area of commonality is that both industries own corrupt Congresscritters who will do their bidding. But they are very different problems with very different solutions.
No, they are closely related problems. Because if taxes paid for a larger fraction of drugs, there’d be a lot more pressure to reduce the cost of drugs. The drug industry has killed bills that would inch us closer to universal healthcare because they include cost-saving measures that would affect pharma. They’ve killed several bills.
I haven’t watched the video you describe, but I’ve followed the oxycontin and fentanyl stories closely in a number of different sources. In part, i have a professional interest. My industry (which includes workers compensation insurance) has found that injured workers who take more opioids earlier are significantly less likely to recover and return to work. That’s obviously a tiny slice of the opioid epidemic, but we were among the first to raise the alarm about excessive prescription of opioids, before the opioid epidemic made the national news.
My position is that they’re distinct because medical procedures are distinct from drug prescriptions, and while the latter are far more common, they are also far less financially onerous for most people (though certainly not for all). Major surgeries costs can add up to hundreds of thousands of dollars, and even minor ones many thousands.
Thus the big breakthrough in universal health care in Canada was the unconditional, no-pay eligibility for any citizen to have access to any necessary health care, while pharmaceuticals remained funded by employer supplementary insurance or out-of-pocket. Because in the large scheme of things, it was no big deal. But, to be fair, the cost of prescriptions drugs is regulated in Canada and is far less than in the US, and they’re covered for seniors, anyway.
You’re fixated on drug costs but they’re just a relatively small part of a very big problem.
I.m sure you’d appreciate it – it’s excellent.
OK, but it’s been a very good thing for America, and very strong incremental progress. Maybe it’s not “50%” of what we needed, but it was damn sure alot more than what we usually get out of anything in Washington. When you’re dealing with the dysfunction Obama inherited and the entrenched political interests, it’s amazing what he accomplished with the ACA.
Also, I don’t think you give enough credit to the ACA for the progress it’s made in holding down the growth in healthcare costs. Has it been enough? Well of course not. No one is saying it is. But it has helped on not only the access front, but also the cost front.
Honestly, I’ve seen the material, and don’t want to watch it again. It’s depressing as hell. Donuts spelling out the name of the drug. You can’t make this stuff up.
They can be quite large. A lot of healthcare these days is drugs. A lot of the increase in medical costs in the last decade have been pharmaceuticals. It’s crazy to separate procedures from drugs.
Seems those getting healthcare from the Federal government like it.
Sounds like we just need to make everyone an employee of the US Government.
And THAT is something that many employers do not want. They like it when employees feel “locked into” a shitty job because if they quit, they will have no health insurance. It keeps the plebs in line.
Eh, it cuts both ways. Employers don’t like being stuck with employees who have expensive insurance. I think real UHC that wasn’t employer-based would be a boon for employers.
My employers have piously favored UHC in public and privately funded campaigns against it.
As far as i can tell, my employer hasn’t lobbied either way.
I’m not sure what you mean by “I’ve seen the material” in relation to also saying that you’ve never seen the miniseries Dopesick. Anyway, this is a side issue, but I just wanted to point out that it’s a very well done series in every respect – production, acting – everything. Yes, it’s a very sad story, but based on true facts and it’s informative and emotionally moving. Highly recommended.
I followed the news story about drug companies pushing opioids in real time, as it was reported on. The WSJ and Reuters both did several stories about it, as did several regional newspapers. It also made the (insurance) industry press, and continuing-ed seminars as we will end up paying a lot of liability coverage for those companies. As someone who has helped develop reserve estimates for what my employer will pay for that liability, I’ve also done some deep dives into the underlying information.
It’s depressing as hell. The only more depressing story I’ve researched as an insurance professional is the story about how the drug companies that made factor 8 for hemophiliacs knew that their blood-based product was killing people because it was contaminated with HIV, and knew they could fix it by “cooking” the product, and decided to sell the “raw” batches they’d produced anyway. None of the executives who made that decision were criminally prosecuted. Instead, their employers’ liability insurance paid some pittance to the many many hemophiliacs who died of AIDS.
And i only just now noticed that the two worst insurance stories i know both involve the pharmaceutical industry as the bad guys. Hmm.
There’s no shortage of bad guys where there’s big money to be made, and health care is it. I agree with you that the pharma industry engages in horrific abuses and profiteering, but I respectfully disagree that they’re the biggest problem compared to health insurers. Just a few random examples …
https://www.cnn.com/2017/12/11/health/aetna-surgery-denied-for-girl/index.html
That last one, the death of a young teenage girl denied coverage by Cigna, finally assailed the conscience of their VP, Wendell Potter, who resigned and wrote a whistleblower book about the systematic abuses in the industry:
This is the crazy one to me. According to the article:
The insurance company did approve her for the more invasive and more expensive open brain surgery, called a temporal lobectomy, even though her medical team never sought approval for the procedure.
“This technology is much less invasive than the alternative, which involves removing a sizeable piece of brain, at a substantially higher monetary and personal cost,” French said. “This path should be available, if the treating epilepsy physician has recommended it, without delay or barriers.”
So they denied a less invasive and cheaper treatment, while approving a more expensive one that involves removing part of the brain. They’re not even saving money here. To me, that’s not the usual story of corporate greed, it’s just incompetence.
This situation strikes me as one in which decisions about medical procedures are being made by paper pushers who have NO IDEA WHATSOEVER about medical procedures. Likely the paper pusher had a list of covered procedures in front of them, and just “followed the manual” without much (any) knowledge of medicine. They may as well have been adjusters on a home flood insurance case.
This is why the bullshit being spread about UHC in Canada being run by "government bureaucrats always infuriated me, because in large part, the opposite is true.
“Every accusation is a confession”
Just FYI, in my province, decisions about what medical procedures are covered under the MSP (Medical Services Plan) is done by the medical services commission. (All provinces have something like this)
The commission is a nine-member statutory body made up of three representatives from government, three representatives from the Doctors of BC and three members from the public. They are advised by the The Guidelines and Protocols Advisory Committee (GPAC). This is an advisory committee to the Medical Services Commission and has representatives from both the Doctors of BC and the Ministry of Health.
GPAC’s mandate supports both the effective utilization of medical services and high quality, appropriate patient care. This mandate is achieved through the development, publication and promotion of clinical practice guidelines and protocols. This is who makes advisory decisions about clinical practice.
Interestingly, of the $2.5 billion health budget for the province, about 99 per cent go directly for payment of medical and supplementary health-care services insured under the Medical Services Plan (MSP). The other one per cent covers administrative and operational costs of MSP, including salaries of MSP employees.
One. Percent.