American Pharmaceutical Company Keeps HIV Risk High

One of the reasons for America's sky high health care costs is the daily gauging of consumers by large pharmaceutical companies.  Americans pay in some cases, thousands of times more for crucial drugs that cost a relative pittance in other countries.  A prime example is Truvada, the brand name for a type of HIV pre-exposure prophylaxis, or PrEP, which is up to 99 percent effective at preventing HIV infection.  The cost in America?  Thanks to the monopoly of Gilead Sciences, over $20,000 per year, far outside the reach of even many affluent individuals even with insurance (assuming carriers do not deny coverage).  The cost elsewhere?  In other countries, a one-month supply of generic Truvada costs less than $6.00. If widely administered, PrEP could largely eliminate HIV/AIDS in America.  But just like the opioid manufacturers behind the crisis in many parts of America, money is Gilead Science's god.  Human lives mean little.  A piece in the New York Times looks at this shocking example of corporate greed.  Here are excerpts:

On July 3, 1981, this newspaper wrote about a “rare cancer” killing gay men in New York and California. . . . Today, after 37 years, we finally have a proven pathway to ending the AIDS epidemic in this country.

The only catch? Poor policy and pharmaceutical price-gouging have blocked the way, making critical drugs a luxury rather than an imperative.

The solution comes in a pill: Taken daily, Truvada, the brand name for a type of pre-exposure prophylaxis, or PrEP, is up to 99 percent effective at preventing H.I.V. infection; it also lowers the amount of H.I.V. circulating in infected patients' blood streams. Used as directed, it’s one of the most effective methods of preventing a viral infection ever discovered, as good as the polio vaccine, the miracle of modern medicine. When you combine that protection with the discovery that people with H.I.V. cannot transmit the virus to others once Truvada has suppressed it to undetectable levels, we could be on the verge of a swift end to the epidemic.

Truvada was approved by the Food and Drug Administration in 2012. But over six years later, the United States is failing miserably in expanding its use. Less than 10 percent of the 1.2 million Americans who might benefit from PrEP are actually getting it. The major reason is quite clear: pricing. With a list price over $20,000 a year, Truvada, the only PrEP drug available in the United States, is simply too expensive to become the public health tool it should be. Gilead Sciences, the company that makes Truvada, maintains a monopoly on the drug domestically. In other countries, a one-month supply of generic Truvada costs less than $6, but Gilead charges Americans, on average, more than $1,600, a markup from the generic of 25,000 percent. Infuriatingly, American taxpayers and private charities — not Gilead — paid for almost all of the clinical research used to develop Truvada as PrEP. Yet the price stays out of reach for millions, and will for at least several more years.

The disparities in PrEP access are astounding: Its use in black and Hispanic populations is a small fraction of that among whites. In the South, where a majority of H.I.V. infections occur, use is half what it is in the Northeast. Women use PrEP at drastically lower rates than men . . .

The ability of PrEP to greatly reduce new H.I.V. infections is no longer in question. In New South Wales, Australia, a program providing free access to PrEP led to a drop in H.I.V. diagnoses in the most vulnerable communities by a third in just six months, one of the fastest declines recorded since the global AIDS crisis began.

So how can we import such progress into the United States? Faced with more than half a decade of inaction by the federal government, activists have developed their own national strategy to begin the end of the H.I.V. epidemic. At the International AIDS Conference later this month, our organization, the PrEP4All Collaboration, will release its plan for a national PrEP program to ensure all Americans who need PrEP can get it.

A critical component of this plan is insisting that federal agencies use their statutory authority to break Gilead’s undeserved monopoly. With low-price, generic Truvada, the cost to cover every American who needs PrEP — including both drug costs and clinical care — would be less than a tenth the amount that the federal government already spends on H.I.V. care. The billions saved could pay for vital services to ensure those who need PrEP the most can get it and those living with H.I.V. can keep the virus suppressed. If the patent on Truvada remains, the plan will cost over $20 billion. Science has delivered answers, but Gilead’s greed and the government’s inaction are keeping it from those who need it most. There’s a pill that stops H.I.V. We can make it possible for everyone who needs that pill to get it.

Gilead's greed is replicated across the medical spectrum and is a prime reason why Americans pay far, far more for healthcare than in any other nation in the world.  We need a single payer system with government negotiation of drug prices. 

Virginia Hospital & Healthcare Association Launches Campaign for Medicaid Expansion

Here in Virginia, the Virginia GOP - like the national party - opposes anything related to Barack Obama, including Medicaid expansion which would extend healthcare coverage to roughly 400,000 working Virginians and give desperately needed financial relief to many of Virginia's hospitals.  Perhaps such racist inspired conduct against America's first non-white president should not be surprising in the state that pioneered "Massive Resistance" and the closure of public schools rather than allow black children attend school with withe children.  But what is amazing is the fact that the Virginia GOP is willing to threaten the continued existence of many hospitals, especially in rural areas where the GOP retains power by playing on voter racism, homophobia and anti-immigrant bigotry.  To fight back, the Virginia Hospital & Healthcare Association (VHHA), has launched  a statewide public awareness campaign to "alert Virginians to the financial challenges confronting Virginia hospitals" and indirectly to alert Virginians to the damage being done to health care in Virginia by the Virginia GOP obstructionism and willingness to kick working families into the gutter.  Blue Virginia has highlighted some top points of the campaign's message:

*Virginia hospitals are vital both to people's health and to the economy; they generate $35.8 billion in economic activity, employ 115,026 people with a payroll of $7.9 billion and rank among the top five employers in 60% of Virginia counties.

*Virginia hospitals are facing significant economic headwinds. This is one of the most heavily regulated industries in the country, receiving over 60% of its revenue from either Medicaid or Medicare. In Virginia, Medicaid pays about two thirds of what it costs hospitals to provide care, and more cuts in reimbursements are likely. "This is a non-sustainable situation."

* One-third (31 of 88) of Virginia’s acute care hospitals operated in the red in 2013.

*"We're here today to begin a dialogue to try to bring to the public's attention that there's a problem, that we are facing serious headwinds, and that there are a lot of health systems and hospitals in the state that are bailing water pretty seriously."

*The goal is to engage "all parts of the political spectrum" to come up with a "Virginia solution that will be sustainable for the long term."

*Virginia hospitals contribute to the overall health and well being of the Commonwealth, so "the ripple effects of policies that harm hospitals reach much farther and wider than hospitals or health care systems."

*"This isn't a partisan issue at all, this is truly a health care issue and a community issue."

*Today, there are "challenges that we've never faced before in the health care system, and it's becoming more and more difficult to meet the needs of the underserved while keeping our hospitals fiscally sound, and that's sometimes especially true in rural areas."

*Hospitals "want to start a dialogue about the real problems that exist and the need for resolution to preserve Virginia's vitally important work of health care...and the significant economic contributions we make."

*Rural hospitals are typically the largest employers in their area. Just about half of rural hospitals operate in the red in Virginia...and they're all very much challenged in terms of their sustainability, their ability to continue to be there for their communities..."

 I've written on this issue before and it is one of the issues addressed in my September, 2015, column in VEER Magazine which is on the shelf now.  Sadly, supporting the Commonwealth's hospital system should not be a partisan issue, but given the intransigence of the Virginia GOP, it has become one.  The one irony is that many GOP dominated rural areas will end up losing not only easily accessible health care, but will also see their region's largest employers close down.  Their stupidity, racism and overall bigotry will ultimately be the root of their own undoing.  Karma can indeed be a bitch.

Why America Needs a Single Payer Heathcare Plan

Perhaps because of my former legal representation of a non-profit health care system with multiple hospitals, I find it difficult to trust the healthcare industry.  What I witnessed was a mindset focused on making money - lots of it - and monopoly like wars with other healthcare providers.  The delivery of quality, cost effective healthcare for all was nowhere on the radar screen.  And little has changed.  And far too little will change even with the advent of the Affordable Health Care Act, a/k/a Obamacare.  Why?  Because the basic plan keeps the existing flawed structure largely in place.  Yes, potentially many more Americans will have access to healthcare coverage.  But the same flawed and highly inefficient system that puts little value on patient care despite claims to the contrary will remain.  An op-ed in the New York Times acknowledges this reality and argues for a single payer system which would focus on the delivery of patient services rather than the enrichment of private sector corporations and individuals.  Here are excerpts:

TODAY marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful. 

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president’s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it. 

I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it. 

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.

For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke. . . .

And yet — I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month. 

Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care. 

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment. 

In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.) 

All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it.

America's Out of Control Health Care Costs: A Single Stitch Tops $500

This blog often looks at America's broken health care system which is the most costly in the world and least efficient in delivery of services of any developed nation.  Yet the Republican Party would repeal the Affordable Health Care Act and condemn Americans to remain victims of this broken system.  How bad has America's system become?  A piece in the New York Times looks at the soaring costs where a single stitch for a cut can cost $500.00.  It's beyond ridiculous, yet that's the system preferred by the GOP, especially those in the House of Representatives.  Here are story excerpts:

SAN FRANCISCO — With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center’s tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.

On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. “It was great — they had good DVDs, the staff couldn’t have been nicer,” said Emer Duffy, Orla’s mother. 

Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11. Orla’s forehead was sealed with a dab of skin glue for $1,696. “When I first saw the charge, I said, ‘What could possibly have cost that much?’ ” recalled Ms. Singh. “They billed for everything, every pill.” 

In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.

A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more. 

At Lenox Hill Hospital in New York City, Daniel Diaz, 29, a public relations executive, was billed $3,355.96 for five stitches on his finger after cutting himself while peeling an avocado. At a hospital in Jacksonville, Fla., Arch Roberts Jr., 56, a former government employee, was charged more than $2,000 for three stitches after being bitten by a dog. At Mercy Hospital in Port Huron, Mich., Chelsea Manning, 22, a student, received bills for close to $3,000 for six stitches after she tripped running up a path. Insurers and patients negotiated lower prices, but those charges were a starting point. 

In other countries, the price of a day in the hospital often includes many basic services. Not here. The “chargemaster,” the price list created by each hospital, typically has more than ten thousand entries, and almost nothing — even an aspirin, a bag of IV fluid, or a visit from a physical therapist to help a patient get out of bed — is free. Those lists are usually secret, but California requires them to be filed with health regulators and disclosed. 

"Obamacare" Shock - They System May Work Despite GOP Efforts to Destroy It

I have noted frequently the juxtaposition - dare we say hypocrisy? - of the Republican Party and its Christofascist party base when it comes to claiming to honor Christian values while in the very next breath displaying an utter contempt for the Gospel directive to feed the hungry, clothe the naked and care for the sick.  There doesn't seem to be a single social welfare program that the GOP and its base doesn't want to slash or eliminate.   Particularly those that work to feed the hungry, clothe the naked and care for the sick.  As Paul Krugman notes in a New York Times column, few programs have drawn the wrath of the GOP and far right more than the Affordable Health Care Act, a/k/a "Obamacare."  And now, there are signs that Obamacare may actually deliver much needed healthcare coverage to those most in need.  It's a stunning contrast to the GOP/Christofascist approach of throwing American citizens on the trash heap like garbage.    Here are highlights from Krugman's column:

The Affordable Care Act, a k a Obamacare, goes fully into effect at the beginning of next year, and predictions of disaster are being heard far and wide. There will be an administrative “train wreck,” we’re told; consumers will face a terrible shock. Republicans, one hears, are already counting on the law’s troubles to give them a big electoral advantage. 

Yet important new evidence — especially from California, the law’s most important test case — suggests that the real Obamacare shock will be one of unexpected success. Before I can explain what the news means, I need to make a crucial point: Obamacare is a deeply conservative reform, not in a political sense (although it was originally a Republican proposal) but in terms of leaving most people’s health care unaffected.  

[T]he California bids are in — that is, insurers have submitted the prices at which they are willing to offer coverage on the state’s newly created Obamacare exchange. And the prices, it turns out, are surprisingly low. A handful of healthy people may find themselves paying more for coverage, but it looks as if Obamacare’s first year in California is going to be an overwhelmingly positive experience.

What can still go wrong? Well, Obamacare is a complicated program, basically because simpler options, like Medicare for all, weren’t considered politically feasible. So there will probably be a lot of administrative confusion as the law goes into effect, again especially in states where Republicans have been doing their best to sabotage the process. 

Also, some people are too poor to afford coverage even with the subsidies. These Americans were supposed to be covered by a federally financed expansion of Medicaid, but in states where Republicans have blocked Medicaid expansion, such unfortunates will be left out in the cold. 

Still, here’s what it seems is about to happen: millions of Americans will suddenly gain health coverage, and millions more will feel much more secure knowing that such coverage is available if they lose their jobs or suffer other misfortunes. Only a relative handful of people will be hurt at all. And as contrasts emerge between the experience of states like California that are making the most of the new policy and that of states like Texas whose politicians are doing their best to undermine it, the sheer meanspiritedness of the Obamacare opponents will become ever more obvious. 

So yes, it does look as if there’s an Obamacare shock coming: the shock of learning that a public program designed to help a lot of people can, strange to say, end up helping a lot of people — especially when government officials actually try to make it work.

My principle complaint with Obamacare is that it did not go far enough.  We need a national health care system like France.  Back when I was with a law firm that represented a hospital system, our client cared nothing about the delivery of quality, cost effective medical care.  It was instead all about monopoly wars with other systems and making as much money as possible.  And this was a "non-profit" hospital system.  At the wedding this weekend one of the guests was a friend I have known from high school who just retired from a major healthcare system.  From our conversation, my experience and observations were the norm, not the exception. Cost effective health care for all is the last thing that America's big health care systems want to provide.  And who are these people in bed with?  The GOP and the "godly Christian" folk.

The Republican Party’s Refusal to Make Meaningful Changesings

In the wake of the RNC's report on the reasons why the GOP did disastrously in the 2012 elections, there have been all kinds of recriminations and a denial that the GOP's policies themselves as opposed to "poor messaging" are the root cause of the party's inability to win voters, especially at the national level.  Conservative columnist Michael Gerson at the Washington Post looks at the GOP's shortcomings.  Here are some excerpts:

Recent brutal attacks on the GOP have claimed that minorities often think that “Republicans do not like them or want them in the country.” That younger voters are “rolling their eyes at what the party represents.” That former Republicans view the party as “scary,” “narrow-minded,” “out of touch” and populated by “stuffy old men.”

But these were not Democratic attacks. The quotes come from the Republican National Committee’s “Growth & Opportunity Project” report, which, as far as I can tell, is unique in the history of party-sponsored self-reflection. Losing parties generally look in the mirror and see the need for cosmetics. This report calls for reconstructive surgery. In the aftermath of the 2012 election, it describes a party unpopular with the public, fading in must-win states and progressively marginalized at the national level.

The report, inevitably, set off an internal GOP conflict. This is not so much a matter of ideology; a number of politicians with tea party roots, such as Sen. Marco Rubio of Florida, have fully internalized these political realities. The emerging argument is between political realists and ideological entrepreneurs. 

The RNC report engages this divergence of purposes in a forthright manner: “We have become expert in how to provide ideological reinforcement to like-minded people, but devastatingly we have lost the ability to be persuasive with, or welcoming to, those who do not agree with us on every issue.” The role of a political party, the report insists, is different from the pursuit of “universal purity.” 

But the report recognizes that Republicans require more than changed tone or technique; they need relevant, appealing policies. 

The 2012 election revealed insufficient GOP enthusiasm among working-class Americans and plummeting support among rising demographic groups, particularly Asians and Latinos. Appealing to these voters will require more than repetition of the Republican economic message circa 1980. They want the reassurance of a modern, functioning safety net and the realistic hope of economic and social mobility. Republicans have yet to effectively address either priority. 

This is partly an institutional problem. A smattering of conservative policy experts is working on these issues — conservative alternatives on health and education reform or promoting social capital and family stability. But the major conservative think tanks tend to be driven by ideological and donor priorities. Few conservative institutions operate effectively at the confluence of policy and politics.

Major Republican donors seem perfectly willing to support the presidential races of quixotic candidates. They foot the bill for television attack ads. They seem less interested in funding the revival of ideas and policy that is a prerequisite to reestablishing a GOP majority. It is a strategic failure of the first order. 

Those concerned about the Republican future hope for the arrival of a transformational candidate. But he or she will need something compelling to say. 

Another Indictment of America's Faux Exceptionalism

Many, especially on the far right and among Christofascist/Tea Party circles, like to bloviate about American exceptionalism.  American exceptionalism is, of course, a myth used by the ignorant and xenophobic to make themselves feel good about themselves and superior to others much as the Christofascists focus on condemning others rather than face the reality of their own hypocrisy filled, miserable lives.   But, as this blog has looked previously, there is one area in which America is exceptional, but in a very negative and unflattering way:  we have the shortest life expectancy of any developed nation and we have the least efficient health care system as well despite spending more on health care than any other nation.  The irony is that the policies that lead to this horrible distinction are those championed by those who most wrap themselves in patriotism and feign worship of Christianity.  A column in the Washington Post looks at this ignominious distinct held by America and offers an indictment of the nation's failing health care system and those responsible for the true "culture of death."  Here are excerpts:

January has turned out to be a banner month for fans of American exceptionalism. As documented in voluminous detail in a 404-page report released last week by the National Research Council and the Institute of Medicine, Americans lead shorter lives than Western Europeans, Australians, Japanese and Canadians. Of the 17 countries measured, the United States placed dead last in life expectancy, even though we lead the planet in the amount we spend on health care (17.6 percent of gross domestic product in 2010 vs. 11.6 percent each for France and Germany). We get radically less bang for the buck than comparable nations. If that’s not exceptionalism, I don’t know what is.

Americans die young. The death rate for Americans younger than 50, the report showed, is almost off the comparative charts. A range of exceptionally American factors — car usage and lack of exercise, junk-food diets, violent deaths from guns, high numbers of uninsured and a concomitant lack of treatment, the high rate of poverty — all contribute to this grim distinction.  

The study enumerates other key, if unsurprising, factors in our shortness of life. “Americans are more likely to find their health care inaccessible or unaffordable,” it concludes. “Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.”

But a funny thing happens to Americans’ life expectancy when they age. The U.S. mortality rate is the highest of the 17 nations until Americans hit 50 and the second-highest until they hit 70. Then our mortality ranking precipitously shifts: By the time American seniors hit 80, they have some of the longest life expectancies in the world.

What gives? .  .  .  .   the larger part of the answer is that at age 65, Americans enter a health-care system that ceases to be exceptional when compared with the systems in the other 16 nations studied. They leave behind the private provision of medical coverage, forsake the genius of the market and avail themselves of universal medical insurance. For the first time, they are beneficiaries of the same kind of social policy that their counterparts in other lands enjoy. And presto, change-o: Their life expectancy catches up with and eventually surpasses those of the French, Germans, Britons and Canadians.

The big question raised by the data in this study is how Americans have allowed themselves to sink to the bottom of so many indexes that measure the quality and duration of our lives. What’s truly exceptional about America, it turns out, is the indifference we show to our compatriots, the absence of the kind of national solidarity more evident in the nations that surpass us on all these lists. Mitt Romney may have lost the election — thankfully — but his relegation of 47 percent of his fellow Americans to history’s scrap heap evinces a spirit that suffuses all too many of our institutional arrangements and social relations. 

Yes, it is damning and all too accurate.  Even more damning is that the policies that are the root cause of this disgrace track directly back to the GOP and its supposedly :godly Christian" base.  They are indeed modern day Pharisees.  They most certainly are not true followers of the Gospel message.