Single Payer Healthcare - Effect on Medical Industry

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HEALTH INC.
Prescription Drug Costs Driven By Manufacturer Price Hikes, Not Innovation

January 7, 20195:04 PM ET




While some new drugs entering the market are driving up prices for consumers, drug companies are also hiking prices on older drugs.
Sigrid Olsson/PhotoAlto/Getty Images
The skyrocketing cost of many prescription drugs in the U.S. can be blamed primarily on price increases, not expensive new therapies or improvements in existing medications as drug companies frequently claim, a new study shows.

The report, published Monday in the journal Health Affairs, found that the cost of brand-name oral prescription drugs rose more than 9 percent a year from 2008 and 2016, while the annual cost of injectable drugs rose more than 15 percent.

"The main takeaway of our study should be that increases in prices of brand-name drugs were largely driven by year-over-year price increases of drugs that were already in the market," says Immaculata Hernandez, an assistant professor of pharmacy at the University of Pittsburgh, and the lead author of the study.

Trump Aims To Lower Some U.S. Drug Spending By Factoring In What Other Countries Pay
SHOTS - HEALTH NEWS
Trump Aims To Lower Some U.S. Drug Spending By Factoring In What Other Countries Pay
The price of insulin, for example, doubled between 2012 and 2016, according to the Health Care Cost Institute. And the price of Lantus, an insulin made by Sanofi, rose 49 percent in 2014 alone, according to the University of Pittsburgh.

The researchers used the wholesale acquisition cost data for more than 27,000 prescription drugs from First Databank, a company that collects prescription drug sales data. It then compared that data to claims data from the University of Pittsburgh Medical Center's health plan, which the researchers say is a sample that mirrors the population as a whole.

They then compared new and existing drugs and separated the data into brand-name, generic and specialty categories to come up with cost increase estimates.

Brand-name drugs like Lantus and others account for an average 44 percent of total prescription drug spending, Hernandez says. That share is declining as drugmakers focus more on developing high-priced specialty medications, she says.

Gerard Anderson, professor of health policy and management at Johns Hopkins University, says price increases on existing drugs not only benefit drug makers, but also insurers, who can make more money through rebates on higher priced drugs.

Why The U.S. Remains The Most Expensive Market For 'Biologic' Drugs In The World
SHOTS - HEALTH NEWS
Why The U.S. Remains The Most Expensive Market For 'Biologic' Drugs In The World
"Research and development is only about 17 percent of total spending in most large drug companies," he says. "Once a drug has been approved by the FDA, there are minimal additional research and development costs so drug companies cannot justify price increases by claiming research and development costs."

The study did find that innovation was behind price increases for certain types of drugs. Hernandez and her team found that from 2008 to 2016, the price of so-called specialty drugs rose 21 percent for oral medications and 13 percent for injectable drugs. These increases were driven by new, innovative drugs like Sovaldi and Harvoni, two medications made by Gilead Sciences, Inc. that can cure Hepatitis C. Both drugs were initially priced at over $80,000 for a course of treatment.

Total spending by the government, consumers and insurers on prescription drugs was $333 billion in 2017, according to National Health Expenditure data. That was an increase of just 0.4 percent from the previous year. But that spending rose more than 41 percent over the previous decade, from $236 billion in 2007.

The researchers say their study is based on the list prices of medications and doesn't take into account the discounts most insurance companies get for prescription drugs because those discounts are kept secret.

The study also showed big cost increases in generic drugs, with oral generics rising 4 percent a year and injectables increasing 7 percent annually. But Hernandez says that spike can be attributed to what she calls a "patent cliff" that hit the drug market during the study period in which several blockbuster drugs, including several anti-depressants and anti-psychotics, lost their patent protection and became generics.

"We're talking here about highly used drugs," Hernandez says. "And it takes some time to file generic applications and therefore in the first years after a patent expiration there's less competition in the market." So at first, prices are set very close to the brand name price.

So those high-volume, expensive generics drove up prices in the generic market overall. But, as more generic competitors hit the market, the prices begin to fall more, she says.

Since rising costs aren't paying for improved treatments, policy makers may want to take action, says Dr. William Shrank, chief medical officer of the UPMC Health Plan, who is also an author on the study.

"This observation supports policy efforts designed to control health care spending by capping price inflation to some reasonable level," he says.

https://www.npr.org/sections/health-shots/2019/01/07/682986630/prescription-drug-costs-driven-by-manufacturer-price-hikes-not-innovation

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Hospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007–14

The Issue
Are hospitals or physicians more responsible for driving up the price of hospital-based care? Tracking provider spending growth — and identifying the underlying forces at play — is an important issue for policymakers. Using data on actual prices paid by health insurers, Commonwealth Fund–supported researchers analyzed hospital and physician prices for inpatient and hospital-based outpatient services as well as for four high-volume services: cesarean section, vaginal delivery, hospital-based outpatient colonoscopy, and knee replacement. The study, published in Health Affairs, offers an analysis of price trends that can guide future cost-containment efforts.

What the Study Found
--From 2007 to 2014, prices for hospital inpatient care grew 42 percent, compared to 18 percent for physician prices for inpatient hospital-based care.
--For hospital-based outpatient care, hospital prices rose 25 percent, compared to 6 percent for physician prices.
--There were no differences in results between hospitals that directly employed physicians and those that had outside physicians work in their facilities.
--Hospital prices typically accounted for over 60 percent of the total price of hospital-based care.
--Hospital prices accounted for most of the cost of the four high-volume services included in the study. When the costs of physician and hospital care were combined, the hospital component ranged from 61 percent for vaginal deliveries to 84 percent for knee replacements.


Share
The Big Picture
Growth in hospital prices, not physician payments, is largely responsible for rising costs for inpatient and hospital-based outpatient care. During the study period, hospital prices grew more than twice as much as physician prices for inpatient care, and four times as much for hospital-based outpatient care. Efforts to control health spending therefore will likely need to address hospital costs rather than physician prices, which have roughly kept pace with inflation.

Policymakers could consider a range of strategies that address hospital price growth: reviewing proposed mergers for the potential impact on hospital costs; regulating hospital payment; and reference pricing (where patient cost-sharing payments depend not only on the price of a drug but on the price of alternatives therapies, like generic versions). For their part, payers could provide physicians with data on cost-efficient hospitals and offer incentives to refer patients to these facilities.

The Bottom Line
From 2007 to 2014, hospital prices grew faster than physician costs, and drove most of the growth in payments for inpatient and hospital-based outpatient care.

https://www.commonwealthfund.org/publications/journal-article/2019/feb/hospital-care-prices-rose-faster-cost-physician-services

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The Biggest Lies from New Insurance Industry Ads


We’ve finally seen the first ad from the new healthcare industry front group “Partnership for America’s Healthcare Future”. Watch BIHP president Wendell Potter dismantle their biggest lies.

https://businessinitiative.org/thebiggestliesfromnewinsuranceindustryads/

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New Report: It’s Actually Easy to Pay for Medicare for All


A new report from Gerald Friedman PhD, a professor of economics at the University of Massachusetts Amherst and the Director of the Hopbrook Institute, has found that Medicare for All could save anywhere from $5.5 to $12.5 trillion over the next 10 years, saving us 12-25% when compared to our current healthcare spending.

Even better, it would significantly reduce the expenses of American businesses and workers.

You can read the full report here, and I encourage you to watch the video that summarizes it below, but let’s run through a few of the basics.

.....
No matter how you slice it, business, workers, and patients will be paying less.

With estimates as low as 8.4% of payroll, new taxes on employers would be significantly lower than what they currently pay for commercial insurance. Businesses will be able to invest in raising wages, new jobs, new technologies, or staying competitive in the global market.

Workers will see their take home pay increase, as their portion of premium costs would be significantly reduced, and they’d no longer have to pay out of pocket costs to access health care.

Most importantly, we’ll all have access to healthcare, and no one would ever be afraid of being one serious illness away from bankruptcy.

Link to full article:
https://businessinitiative.org/new-report-its-actually-easy-to-pay-for-medicare-for-all/


Video:

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Katy Votava, president of Goodcare.com and a Medicare expert, cautions against using the word Medicare to describe a public single-payer system.

That is because most of the current Medicare system is actually private insurance, though it is regulated by the government, Votava said. And the coverage people get from Medicare typically comes after they have paid into that system for 40 or 50 years.

Once they are covered by Medicare, patients are often confronted by high costs and confusing rules, Votava said.

"We can provide more reasonable health insurance for all and health services for all," Votava said. "I know we can.

"But it involves breaking down some old ways."

https://www.cnbc.com/2019/02/05/medicare-for-all-will-take-center-stage-in-the-2020-election-heres-what-it-means.html

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Excerpt from a New Yorker article on fraud in Medicare Adavantage.

The False Claims Act was strengthened in 1986, after a push by Senator Charles Grassley, of Iowa. Whistle-blowers can now share between fifteen and twenty-five per cent of the recovery, depending on such factors as the importance of their contribution. This change was an effort to recognize the financial toll of being a whistle-blower, both in lost employment and in legal fees incurred during the arduous process of building a case. The law effectively turned average citizens into a fleet of amateur federal agents, and it helped to reveal the staggering amount of money wrongfully extracted from government programs. A recent government report indicated that in 2017 alone almost $2.6 billion was recovered in health-care-fraud judgments and settlements. Two hundred and sixty-two million dollars of that was awarded to whistle-blowers.

Medicare Advantage, the program that Sewell believed Freedom was abusing, is at the center of a growing number of fraud cases, some of which involve the biggest names in the health-insurance industry. The regulations around the issue are complicated, however, and legal questions about what constitutes prosecutable fraud are still the subject of debate. In 2017, the Department of Justice joined a multimillion-dollar case against the nation’s largest insurer, UnitedHealth Group, alleging widespread fraud dating back to 2006. The Justice Department is also investigating several other health insurers, including Anthem, Humana, Cigna, Health Net, and Aetna. An analysis co-authored by Fred Schulte, at the Center for Public Integrity, estimated that insurance companies had received nearly seventy billion dollars in undeserved Medicare Advantage payments between 2008 and 2013.

https://www.newyorker.com/magazine/2019/02/04/the-personal-toll-of-whistle-blowing

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A comprehensive read on socio-economic status and its impact on healthcare.

https://www.irp.wisc.edu/publications/focus/pdfs/foc331a.pdf

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You may want to consider researching the subject with an open mind rather than swallowing the party line, hook and all.

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A detailed look at rising healthcare costs -

"Most of the recent health spending growth is in insurance programs, both private and public. Private insurance expenditures now represent 34% of total health spending (up from 21% in 1970), and public insurance (which includes Medicare, Medicaid, CHIP, and the Veterans Administration and Department of Defense), represented 41% of overall health spending in 2017 (up from 22% in 1970). Although Out-of-pocket costs per capita have also been rising, compared to previous decades, now makes up a smaller share of total health expenditures."

https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-per-enrollee-spending-growth-has-slowed-recently-for-all-major-payers_2017

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Ralph Nader: Canada's Health Care System Puts America's to Shame

Ralph Nader: Canada's Health Care System Puts America's to Shame



Dear America:

Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian-style single-payer— full Medicare for all— is simple, affordable, comprehensive and universal.

In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!

Below please find 25 ways the Canadian health care system is better than the chaotic U.S. system.

Replace it with the much more efficient Medicare-for-all: everybody in, nobody out, free choice of doctor and hospital. It will produce far less anxiety, dread, and fear.

Love, Canada

Number 25:

In Canada, everyone is covered automatically at birth – everybody in, nobody out.

In the United States, under Obamacare, 28 million Americans (9 percent) are still uninsured and 85 million Americans (26 percent) are underinsured.

Number 24:

In Canada, the health system is designed to put people, not profits, first.

In the United States, Obamacare has done little to curb insurance industry profits and in fact has increased the concentrated insurance industry’s massive profits.

Number 23:

In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality.

In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.

Number 22:

In Canada, health care coverage stays with you for your entire life.

In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your insurance.

Number 21:

In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of “in-network” vendors and no extra hidden charges for going “out of network.”

In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking – thus restricting freedom of choice – and if you want to go out of network, you pay dearly for it.

Number 20:

In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in insurance premiums directly and indirectly per employer.

In the United States, under Obamacare, for thousands of Americans, it’s pay or die – if you can’t pay, you die. That’s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.

Number 19:

In Canada, there are no complex hospital or doctor bills. In fact, usually you don’t even see a bill.

In the United States, under Obamacare, hospital and doctor bills are terribly complex, making it very difficult to discover the many costly overcharges or massive billing fraud.

Number 18:

In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.

In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 17.9 percent of its GDP and still doesn’t cover tens of millions of people.

Number 17:

In Canada, it is unheard of for anyone to go bankrupt due to health care costs.

In the United States, health-care-driven bankruptcy will continue to plague Americans.

Number 16:

In Canada, simplicity leads to major savings in administrative costs and overhead.

In the United States, under Obamacare, often staggering complexity leads to ratcheting up huge administrative costs and overhead.

Number 15:

In Canada, when you go to a doctor or hospital the first thing they ask you is: “What’s wrong?”

In the United States, the first thing they ask you is: “What kind of insurance do you have?”

Number 14:

In Canada, the government negotiates drug prices so they are more affordable.

In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable and skyrocketing.

Number 13:

In Canada, the government health care funds are not profitably diverted to the top one percent.

In the United States, under Obamacare, health care funds will continue to flow to the top. In 2017, the CEO of Aetna alone made a whopping $59 million.

Number 12:

In Canada, there are no required co-pays or deductibles in inscrutable contracts.

In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.

Number 11:

In Canada, the health care system contributes to social solidarity and national pride.

In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.

Number 10:

In Canada, delays in health care are not due to the cost of insurance.

In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.

Number 9:

In Canada, nobody dies due to lack of health insurance.

In the United States, tens of thousands of Americans will continue to die every year due to lack of health insurance and much higher prices for drugs, medical devices, and health care itself.

Number 8:

In Canada, health care on average costs half as much, per person, as in the United States. And in Canada, everyone is covered.

In the United States, a majority support Medicare-for-all.

Number 7:

In Canada, the tax payments to fund the health care system are modestly progressive – the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.

In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.

Number 6:

In Canada, people use GoFundMe to start new businesses.

In the United States, fully one in three GoFundMe fundraisers are now to raise money to pay medical bills. Recently, one American was rejected for a heart transplant because she couldn’t afford the follow-up care. Her insurance company suggested she raise the money through GoFundMe.

Number 5:

In Canada, people avoid prison at all costs.

In the United States, some Americans commit minor crimes so that they can get to prison and get free health care.

Number 4:

In Canada, people look forward to the benefits of early retirement.

In the United States, people delay retirement to 65 to avoid being uninsured.

Number 3:

In Canada, Nobel Prize winners hold on to their medal and pass it down to their children and grandchildren.

In the United States, Nobel Prize winners sell their medals to pay for their medical bills.

Leon Lederman won a Nobel Prize in 1988 for his pioneering physics research. But in 2015, the physicist, who passed away in November 2018, sold his Nobel Prize medal for $765,000 to pay his mounting medical bills. According to a report in Vox, the University of Chicago professor began to suffer from memory loss in 2011, and died in an Idaho nursing home.

Number 2:

In Canada, the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.

In the United States, Obamacare’s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage “we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.”

Number 1:

In Canada, the majority of citizens love their health care system.

In the United States, a growing majority of citizens, physicians, and nurses prefer the Canadian type system – Medicare-for-all, free choice of doctor and hospital , everybody in, nobody out and far less expensive.

https://www.truthdig.com/articles/ralph-nader-canadas-health-care-puts-americas-to-shame/

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The U.S. pay for play system puts politics over mission.

This is a 1995 paper predicting loss of U.S. credibility in drug approval:

IV. DETRIMENTAL EFFECT ON SMALL BIOTECHNOLOGY COMPANIES

The approximate 1300 small biotechnology companies in the United States, all less than 20 years old, [47] seeking to use cutting edge genetic or other technologies to create new drugs and health products, perform a substantial amount of the United States' drug research. [48] Approximately two dozen biotechnology-derived drugs have entered the United States market. [49] About 150 more are in the Investigational stage. [50] According to the Boston Consulting Group, an average of one-third of all pharmaceutical research is based on molecular biology. [51]

Nearly all of these biotechnology companies have no current profits nor products. Funding of biotechnology companies is based on the belief that these companies will produce the world's future drugs which in turn will generate millions of dollars. However, the current drug regulatory scheme threatens the existence of these small biotechnology companies. First, the extreme cost of FDA drug approval increases the funding requirements of small biotechnology companies and decreases investor's willingness to invest in these companies. Second, the FDA's politically conservative approach to drug approval decreases the chance that safe and effective drugs will be approved effectively penalizing small biotechnology companies. These two problems have created a cash crunch for small biotechnology companies which likely will result in a reduction in the number of such companies in the future.

A. Extreme Cost of FDA Drug Approval

The extreme cost of the FDA drug approval process has created a perpetual cycle of capitalization problems for small biotechnology companies: (1) The high cost of drug approval combined with a small biotechnology company's limited financial resources limits the number of products that a biotechnology company can develop and decreases the probability that a biotechnology company will be able to survive the lengthy drug approval process; (2) Investors will not invest because of the substantial risk associated with biotechnology companies due to their reliance on a few products and due to the likelihood that a product will never be approved; and (3) Investor's unwillingness to invest in biotechnology increases the financing problems of biotechnology companies.

The process of drug development takes approximately 10 to 12 years and costs approximately $350 million. [52] Biotechnology companies burn considerable amounts of cash each month and generate no profits.. For example, in 1992, the average biotechnology company burned $664,000 a month. [53] This enormous "burn rate," attributable to each drug run through the FDA drug approval process, limits the amount of potential new drugs that may be pursued in the laboratory and in clinical trials by these small biotechnology companies. Therefore, small biotechnology companies base their success or failure on a few drugs getting to market. Consequently, a failure of a drug in clinical tests greatly devalues the company resulting in a substantial loss to investors. [54] As a result, investors have become unwilling to invest in such risky ventures [55] which has left biotechnology companies scrambling for precious financing for drug research. B. Politically Conservative FDA

Political influence on the FDA has caused the FDA to take an extremely conservative approach to drug approval. The FDA does not base new drug approval decisions by objectively weighing the benefits of a new drug against its potential costs. Rather, the FDA has taken the position that when the slightest doubt exists about a drug's potential harm the drug should not be approved even in the face of substantial evidence of the new drug's potential benefits. Business Week in its January 30, 1995 issue illustrated the FDA's conservative approach to drug approval by reviewing Merck & Co.'s lack of success in getting Varivax, a chicken pox vaccine, approved.

To some critics, nothing demonstrates FDA foot-dragging better than the chicken pox vaccine Varivax. Since 1981, this vaccine has been tested safely on more than 10,000 people in the U.S. Since 1984, 2 million children in Europe and Asia have had versions of it. Yet Varivax is still lumbering through the FDA. An FDA advisory committee first recommended approval in January, 1990, a year after Merck & Co. sought the OK. Early last year, a second panel pronounced Varivax safe and effective. The Centers for Disease Control (CDC) and the American Academy of Pediatrics both urge universal use

.

Yet the FDA is unapologetic about its tough stance. Data from 20 years' experience in Japan and elsewhere show that as many as 2% of inoculated children develop mild cases of chicken pox, a higher failure rate than other childhood inoculations. Regulators also worry that -- years later -- Varivax might spawn adult cases of the disease or trigger related viral conditions, such as shingles. [56] Two reasons lie behind the FDA's conservative approach to drug approval. First, Congress controls the FDA through various devices and therefore controls U.S. drug policy. Second, forces opposed to the introduction of new drugs have a greater influence on Congress than those that favor the introduction of new drugs.

Congress mandates FDA drug approval policy through the use of Congressional oversight committees which conduct rigorous hearings regarding FDA policy. Since the passage of the Kefauver-Harris Amendment, the FDA has been subject to almost continuous hearings from a number of well known Congressmen, including Representatives Fountain and Rodgers and Senators Kefauver, Kennedy and Nelson. [57] Thus, the Commissioner of the FDA is subject to hostile Congressional hearings when the FDA deviates from Congressionally acceptable drug approval policy. [58] Such pressure from Congress inevitably shapes the FDA's drug policy.

Forces that oppose less drug regulation have more influence on Congress than forces in favor of less regulation. Consumer groups opposed to less regulation of new drugs have engineered a considerable following and maintain substantial influence in Congress. [59] These groups have used past drug tragedies as their rallying cry. Deaths and deformities are vivid tangible results of less regulation. These images compel membership by generating a fear of less regulation and by creating a sense of moral duty to oppose less regulation. No Congressman wants to say to his constituents that he was a responsible participant in a governmental system that approved a thalidomide-type drug which causes 1000's of birth defects.

Forces in favor of less regulation have had a tougher time generating support for their cause. [60] First, drug consumers have little incentive to join groups to petition for less regulation. The drug lag does not result in vivid harms which can be used as a source of an emotional rallying cry. Also, the benefits derived from less regulation are dispersed throughout country and therefore a free rider problem exists. [61] Second, while the biotechnology industry has pushed hard for less regulations, the drug industry as a whole does not share the same interests with regard to the drug review process. Large drug companies benefit from a stringent drug approval process because it serves as a barrier to entry to the small firms. Less regulation simply means more competition for the large firms.

Congressional control of the FDA and public sentiment against less regulation have lead to the FDA's conservative approach to drug approval. Congressional pressure on the FDA discouraging approval of potentially harmful drugs may be described as intense. [62] Countless Congressional hearings have been conducted to criticize the approval of new drugs. [63] Meanwhile, no hearing has been conducted to investigate the failure of the FDA to approve new drugs. [64] Former FDA Commissioner Alexander Schmidt summarized the current influence of Congress on the FDA:

When it comes to pure unadulterated and directly applied pressure on the FDA, the industry can't hold a candle to Congress. . . By far the greatest pressure that the Bureau of Drugs or the Food and Drug Administration receives with respect to the new drug approval process is brought to bear through Congressional hearings... The message to the FDA could not be clearer. Whenever a controversy over a new drug is resolved by its approval, the Agency and the individuals involved likely will be investigated. Whenever such a drug is disapproved, no inquiry will be made. The Congressional pressure for our negative action is.

intense. [65]

As a result, the FDA is obsessed with minimizing risk keeping products off of the market for years.

Not only has the FDA refused to approve drugs due to over caution against the potential harms produced by new drugs. The FDA has also refused to approve drugs based on politically motivated moral judgments. For example, RU-486, a drug used as an abortifacient, is scientifically beneficial in that its benefits outweigh its risks. [66] However, while countries such as Great Britain have approved RU-486, the FDA has banned its importation. The reason for such a ban appears to be purely political -- the drug is used to cause abortions. In other words, the FDA has played policy maker rather than the scientific evaluator of new drugs. [67] Such a systematic bias against the approval of drugs compounds the problems faced by biotechnology companies. This bias reduces the likelihood that a drug will be approved even if the product is scientifically beneficial. [68] This is problematic because the value of a biotechnology company to investors is based on the present value of expected future earnings of the biotechnology company. Expected future earnings of a biotechnology company equal the expected revenues derived from sales of the company's drugs if approved multiplied by the probability that the drugs will be approved. The true value of a biotechnology company equals the present value of the expected revenues derived from sales of the company's drugs if scientifically beneficial multiplied by the probability that the drugs developed will be scientifically beneficial. Therefore, the FDA's refusal to approve scientifically beneficial drugs reduces the investment value of a biotechnology company to a level below its true value. A reduction in the value of biotechnology companies reduces their attractiveness as investments resulting in less dollars being available for biotechnology companies.

C. Results: Cash Crunch for Small Biotechnology Companies

Robert T. Abbott, President and C.E.O. of Viagene, Inc. has best summarized the cash crunch faced by small biotechnology companies:

Most second and third tier biotechnology companies have less than 18 months of funding, many have less than 12 months, and dozens have funding for less than six months. According to a recent report by Dr. Robert Goldberg of the Gordon Public Policy Center at Brandeis University, fully 75 percent of biotechnology companies have 2 or less years of capital left. Ernst & Young reports that biotechnology companies are raising capital now at 25 percent of their burn rate (the rate at which capital is being expended.) As has already been mentioned, there are approximately 1300 U.S. biotechnology companies. That means that a staggering 975 companies will need to go to the market in the next two years or face going out of business, merging or selling rights to a larger firm. The seriousness of this situation cannot be overstated. The financing climate for biotechnology companies is, frankly, hostile. Public offerings are essentially impossible to undertake because of the depressed value of most companies' stock. This effect is indiscriminate. Virtually all companies are affected, regardless of company performance. [69]

This cash crunch in the biotechnology industry will lead to fewer biotechnology companies in the United States with a resulting decrease in biotechnology-derived drug innovation. The search for financing is driving many of the small biotechnology companies to trade precious technology for capital to foreign competitors and large domestic pharmaceutical firms. [70] Foreign competitors and large domestic pharmaceutical companies are the recipients of small biotechnology companies' financing troubles because these larger companies are able to acquire the technology for cheep. In addition, the failure to raise cash may cause a biotechnology company to scale back or cease operations. Companies which scale back or cease operations generally abandon potentially promising research resulting in less biopharmaceutical innovation.

Several experts agree with the theory that current government regulation will lead to a decline in small biotechnology companies making the current industry unrecognizable by the year 2000. George Rathman, founder of Amgen, the nation's leading biotechnology company and now head of ICOS Corp., stated in January 1995 that the biotechnology industry "is now seriously threatened by the performance" of the FDA and the "incredibly slow pace of approvals." [71] Several other experts agree with Rathman but vary by the degree to which they feel small biotechnology companies are threatened. Steven Burrill, general partner at biotechnology investment banker Burrill & Craves predicts that the number of biotechnology companies may drop by almost a quarter to 1000 by the year 2000. [72] John Sterling, managing editor of Genetic Engineering News has said that biotechnology companies may drop to 750 by the year 2000. [73] An article in the September 26, 1994 issue of Business Week predicts that perhaps three quarters of United States biotechnology firms are destined to fold or merge. [74]

Robert Abbott also foresees a dramatically different biotechnology industry in the United States in the future:

The industry is now beginning to see significant layoffs . . . I believe these layoffs will forever impact our industry because of the psychological damage that is occurring. Entrepreneurial companies are staffed by people in the early, energetic part of their careers because of the long working hours and dedication required. Salaried employees often work 60 to 70 hours per week without additional compensation.

They are motivated to do this because they share in the company's vision and identify with the entrepreneurial spirit of the workplace. When, and if, such a company has its first lay-off, an irreparable break in trust occurs between the company and its employees. Sadly, it is usually the survivors of the lay-off who are the most affected. From that point forward, the work ethic is never the same. I believe that the layoffs that are now occurring, because of this longest-ever hostile financing environment, will forever change the productivity of our biotech industry, dulling it from what it has been previously. [75] V. DETRIMENTAL EFFECTS ON THE UNITED STATES

Given that the current FDA drug approval process has created a self perpetuating cycle of capitalization problems for small biotechnology companies, it is important to evaluate the effect that a decline in the number of small biotechnology companies will have on the United States. I believe that unless the FDA reduces the cost of drug approval for biotechnology companies and removes politics from its drug approval decisions, the potential decline of small biotechnology companies will result in the following adverse effects on the United States: (1) the substantial reduction in the introduction of innovative new drugs; (2) the decline of the United States as a world leader in biotechnology; and (3) the loss of an opportunity to pursue a potential economic gold mine.

A. The Substantial Reduction in the Introduction of Innovative New Drugs

1. The demise of small biotechnology companies will reduce the introduction of innovative biotechnology-derived drugs . The demise of small biotechnology companies will decrease the number of innovative new drugs introduced in the United States. A substantial proportion of the novel and innovative research in the biopharmaceutical area is performed by the approximate 1300 small biotechnology companies. The increasing number of partnerships between small biotechnology companies and large drug companies whereby the large drug companies purchase the small biotechnology companies' technology serves as evidence of the substantial role small biotechs play in novel scientific experimentation. [76] Given the substantial role small biotechs play in biotechnology research and given the importance of biotechnology in the development of new drugs, a decline in these small biotechnology companies will decrease new drug development substantially.

There are several possible explanations for why a large share of the novel research in biotechnology takes place in the small biotechnology companies. First, financial incentives exist for scientists who engage in innovative biotechnology research to either start up their own biotechnology company or perform research for a small biotechnology company. Well known and highly respected scientists probably hold a somewhat inflated sense of confidence in their ability to produce a workable product. The successful introduction of a new drug may generate hundreds of millions of dollars for a small biotech. Therefore, a large equity stake in a small biotechnology company may be more appealing to a highly skilled scientist than a salary paid by a large pharmaceutical company. However, large pharmaceutical companies provide greater assurance to their scientists that projects will not be cut off due to lack of funds. Nevertheless, this fact is mitigated somewhat because a small biotechnology company is more likely than a large pharmaceutical company to remain faithfully committed to a particular research project because unlike the large pharmaceutical company who has several other products in research, the small biotech's success or failure is based on a small number of research projects.

Second, much of the current drug experimentation and innovation is based on potential cost advantages of new products over existing products. Small biotechnology companies have a greater incentive than large pharmaceutical companies to innovate based on cost advantages of new drugs over drugs already on the market because the drugs on the market are manufactured by the large pharmaceutical companies. [77] Third, large pharmaceutical companies are constrained by their shareholders who prefer a consistent return on their investments. To the extent biotechnology research is viewed as risky without the potential for consistent returns, large pharmaceutical companies will be limited in how many resources may be allocated to biotechnology research. Unlike the shareholders of large pharmaceutical companies, shareholders of biotechnology companies do not expect consistent returns on their investment. Shareholders of biotechnology companies invest with the hope that novel biotechnology experimentation will lead to large profits in the future but at the risk of large losses.

Finally, large pharmaceutical companies have limited resources to devote to biotechnology research and have limited expertise in biotechnology. Large pharmaceutical companies, unlike most of the small biotechnology companies, already have drug products on the market. Therefore, a substantial amount of a large pharmaceutical company's resources must be devoted to manufacturing and marketing activities. Large pharmaceutical companies devote approximately 15 percent of their sales revenues to research and development while small biotechnology companies devote approximately 80 percent of their resources to research and development. [78]

Furthermore, pharmaceutical companies devote a limited proportion of their research and development budget to biotechnology-derived drug development. Most drugs produced by large pharmaceutical companies have historically been derived from molecular chemistry, not biology. Therefore, over time, large drug companies have developed considerable expertise in molecular chemistry rather than in molecular biology. Any biotechnology experimentation by large pharmaceutical companies

24

entails shifting resources away from this area of expertise to molecular biology. In a large corporation, such a shift is undoubtedly slow and met with considerable protest.

2. The results of a reduction in innovative drug production on the United Slaks. A reduction in U.S. drug innovation will lead to two results. First, less innovation will lead to continuing increases in health care costs. Biopharmaceutical experimentation is based on creating products with some form of a cost advantage. Biotechnology companies are working on developing cures and treatments for diseases which ultimately will reduce the cost of health care. By attacking life-threatening diseases, new biotechnology drugs will reduce the average stay in hospitals, cut the need for operations and decrease the frequency of the usage of many medicines.

Several commentators, including the Clinton administration, have argued that drug companies contribute to the rise in health care costs because of high drug prices. However, this argument fails as applied to small biotechnology companies for several reasons. First, large drug companies factor into their drug prices expenses other than research and development such as marketing costs. Since small biotechnology companies devote almost all of their resources to research and development, the prices for drugs introduced by these small biotechs will better reflect the actual cost of developing the drug. Second, the escalation in drug prices has slowed substantially. After rising at nearly double-digit rates in 1990 and 1991, average drug prices rose 5.7 percent in 1992 and 3.4 percent in 1993. [79] Third, drug prices simply reflect the cost of developing a new drug. Therefore, the FDA is partly to blame for high drug prices and a reduction in the cost of drug approval will lead to a decline in drug prices. [80] Finally, new drugs will be marketed successfully only if they cost less than existing therapies. For example, if surgery is less costly than a new drug treatment, surgery will be preferred and the new drug will not sell.

Reduced innovation also will lead to many Americans being denied biotechnology-derived drugs which could have been developed to prevent, cure or treat their ailments. The costly FDA drug approval process inhibits advancements against diseases and prolongs victims' suffering. Many commentators criticize the FDA's drug approval process as creating a drug lag in the United States. [81] Patients in the United States receive approved drugs later than their foreign counterparts. The decline in biotechnology companies due to the FDA drug approval process leads to an even more serious result: large numbers of innovative biotechnology-derived drug therapies that would have been developed under a less stringent regulatory regime may never be developed. For example, if penicillin had not been discovered and a small biotechnology company with financing troubles was developing penicillin today, a strong possibility exists that penicillin would never be developed. The loss of even one drug like penicillin would harm more people than all of the drug toxicity in the history of modern drug development. [82] B. The Decline of the United States as a World Leader in Biotechnology

https://dash.harvard.edu/bitstream/handle/1/8889452/dmcwilli.html?sequence=2&isAllowed=y

[XenaLives]

Investigation of generic ‘cartel’ expands to 300 drugs

Workers check pharmaceutical products during the production process at Teva Pharmaceutical Industries factory in Petah Tikva, Israel. In a court filing, Teva said allegations of a price-fixing conspiracy “conclusory and devoid of any facts.” (Ahikam Seri/Bloomberg News)
By Christopher Rowland December 9
Executives at more than a dozen generic-drug companies had a form of shorthand to describe how they conducted business, insider lingo worked out over steak dinners, cocktail receptions and rounds of golf.

The “sandbox,” according to investigators, was the market for generic prescription drugs, where everyone was expected to play nice.

“Fair share” described dividing up the sales pie to ensure that each company reaped continued profits. “Trashing the market” was used when a competitor ignored these unwritten rules and sold drugs for less than agreed-upon prices.


The terminology reflected more than just the clubbiness of a powerful industry, according to authorities and several lawsuits. Officials from multiple states say these practices were central to illegal price-fixing schemes of massive proportion.


The lawsuit and related cases picked up steam last month when a federal judge ruled that more than 1 million emails, cellphone texts and other documents cited as evidence could be shared among all plaintiffs.

HHS Sec. Alex Azar on 'complete rewiring' of the drug pricing system in America
Health and Human Services Secretary Alex Azar on June 20 discussed his department's proposals to reduce drug prices. (Washington Post Live)

What started as an antitrust lawsuit brought by states over just two drugs in 2016 has exploded into an investigation of alleged price-fixing involving at least 16 companies and 300 drugs, Joseph Nielsen, an assistant attorney general and antitrust investigator in Connecticut who has been a leading force in the probe, said in an interview. His comments in an interview with The Washington Post represent the first public disclosure of the dramatically expanded scale of the investigation.

The unfolding case is rattling an industry that is portrayed in Washington as the white knight of American health care.

“This is most likely the largest cartel in the history of the United States,” Nielsen said. He cited the volume of drugs in the schemes, that they took place on American soil and the “total number of companies involved, and individuals.”

The alleged victims were American health-care consumers and taxpayers, who foot the bills for overcharges on common antibiotics, blood-pressure medications, arthritis treatments, anxiety pills and more, authorities say. The costs flowed throughout the system, hitting hospitals, pharmacists and health insurance companies. They hit consumers who lack prescription drug coverage and even those with insurance, because many plans have high deductibles and gaps on prescription drug benefits.

(more...)

https://www.washingtonpost.com/business/economy/investigation-of-generic-cartel-expands-to-300-drugs/2018/12/09/fb900e80-f708-11e8-863c-9e2f864d47e7_story.html?

[XenaLives]

Do you have statistic on these "many women" you allege?

This says you are wrong:

https://www.pbs.org/newshour/politics/what-the-data-says-about-birthright-citizenship

The articles I found on "Birth Tourism" indicated that it was middle to upper class Chinese and Russians that were engaging in this activity. I hardly think that these women would cause the U.S. to have a 50% higher maternal mortality rate.

CONCLUSION: Despite the United Nations Millennium Development Goal for a 75% reduction in maternal mortality by 2015, the estimated maternal mortality rate for 48 states and Washington, DC, increased from 2000 to 2014; the international trend was in the opposite direction.

https://www.ncbi.nlm.nih.gov/pubmed/27500333

[Aero-man]

Do your statistics take into consideration that there are many women, from outside this country, who come into this country to have their babies – further burdening the government-subsidized medical system in the US. Their individual health may not be very good in the first place.

[XenaLives]

Maternal healthcare in the U.S. is a FAIL.
- (repost because of error in the replied to post)



The maternal mortality rate in the U.S. if 50% higher than Libya. The U.S. and China are about the same.

But it is going DOWN in China:

In 2014, the maternal mortality rate was 21.7 per 100,000 which was 76 per cent lower than in 1990

http://www.wpro.who.int/china/mediacentre/releases/2015/20151026/en/

BEIJING - China's maternal mortality rate contracted to 19.6 per 100,000 in 2017 from 19.9 per 100,000 the previous year, the National Health and Family Planning Commission said Thursday.

Moreover, the rate of infant mortality also dropped last year from 7.5 per thousand to 6.8, narrowing the gap between China and the developed world.

Attributing the achievements to the maternal risk screening and treatment system, the commission called for improved maternal and child health care services by allocating more resources to the grassroots level.

There should be at least one public maternal and child health care institution in each county by 2020, said the commission.

China plans to further reduce the maternal mortality rate to 12 per 100,000 and the infant mortality rate to five per thousand by 2030, according to an official guideline titled Healthy China 2030.

http://www.chinadaily.com.cn/a/201802/01/WS5a731de1a3106e7dcc13a43b.html

CONCLUSION: Despite the United Nations Millennium Development Goal for a 75% reduction in maternal mortality by 2015, the estimated maternal mortality rate for 48 states and Washington, DC, increased from 2000 to 2014; the international trend was in the opposite direction.

https://www.ncbi.nlm.nih.gov/pubmed/27500333

Although considered mainly as problems of the developing world, maternal mortality and morbidity remain a challenge in the United States of America (USA).1 Between 1990 and 2013, the maternal mortality ratio for the USA more than doubled from an estimated 12 to 28 maternal deaths per 100 000 births1 and the country has now a higher ratio than those reported for most high-income countries and the Islamic Republic of Iran, Libya and Turkey.2 About half of all maternal deaths in the USA are preventable.2

Each year an estimated 12001 women in the USA suffer complications during pregnancy or childbirth that prove fatal and 60 0003 suffer complications that are near-fatal – even though costs of maternity care in the USA in 2012 exceeded 60 billion United States dollars.4

Three factors are probably contributing to the upward trend in maternal mortality and morbidity in the USA. First, there is inconsistent obstetric practice. Hospitals across the USA lack a standard approach to managing obstetric emergencies and the complications of pregnancy and childbirth are often identified too late. Nationally endorsed plans to manage obstetric emergencies and updated training and guidance on implementing these plans is a serious and ongoing need.5

A second factor is the increasing number of women who present at antenatal clinics with chronic conditions, such as hypertension, diabetes and obesity, which contribute to pregnancy-related complications. Many of these women could benefit from the closer coordination of antenatal and primary care – including case management and other community-based services that help them access care and overcome cost and other obstacles. In the USA, women who lack health insurance are three to four times more likely to die of pregnancy-related complications than their insured counterparts.6

Another factor is the general lack of good data – and related analysis – on maternal health outcomes. Only half the USA’s states have maternal mortality review boards and the data that are collected are not systematically used to guide changes that could reduce maternal mortality and morbidity. There is no national forum for the states to share either their best practices for reviewing maternal deaths or the relevant lessons that they may have learned.

There is a growing effort by physicians, nurses and community organizations to address these three factors. Hospitals are beginning to implement standard approaches to managing obstetric emergencies so that, wherever a woman gives birth, she receives appropriate evidence-based care. Community initiatives are coordinating care for high-risk women to ensure good health and management of chronic conditions during and beyond pregnancy. More states are establishing or strengthening maternal mortality review boards.

Recent changes to national policies should also help improve maternal health outcomes. In 2010 the Affordable Care Act included antenatal and maternal care as essential health benefits that insurance plans must cover. By extending insurance coverage to pregnant women with low incomes, many states have lowered the economic hurdles that limit access to antenatal care for millions of women. As the health community solidifies the post-2015 agenda to end preventable maternal mortality, the USA needs to be brought into the global dialogue on maternal health. Although maternal mortality is relatively rare in the USA, one preventable maternal death is one too many. All states need to mobilize health providers, policy-makers and communities to make maternal health a priority. With increased awareness of maternal mortality and life-threatening events – and concrete actions to ensure that pregnant women get the quality care they need – many fatal and near-fatal complications could be prevented.

https://www.who.int/bulletin/volumes/93/3/14-148627/en/

On that March day, she joined one of the US’s most shameful statistics. With an estimated 26.4 deaths for every 100,000 live births in 2015, America has the highest maternal mortality rate of all industrialized countries—by several times over. In Canada, the rate is 7.3; in Western Europe, the average is 7.2, with many countries including Italy, Norway, Sweden, and Austria showing rates around 4. More women die of childbirth-related causes in the US than they do in Iran (20.8), Lebanon (15.3), Turkey (15.8), Puerto Rico (15.1), China (17.7), and many more.

https://qz.com/1108193/whats-killing-americas-new-mothers/

Ethinic based stats available here:
https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/maternal_mortality/state/ALL

[XenaLives]

MUST READ - Comprehensive article on rising healthcare costs.. compare to the chart below.

The article is full of supporting links. It clearly shows how our current path is unsustainable.

Excerpt:

Between 1983 and 1992, health care costs rose by an average of 9.9 percent each year. Home health care prices increased by 18.3 percent per year. In 1986, Congress passed the Emergency Medical Treatment and Labor Act. It forced hospitals to accept anyone who showed up at the emergency room. If the patient couldn't pay, Medicaid covered it. Prescription drug costs rose by 12.1 percent a year. One reason is that Congress allowed prescription drug companies to advertise on television.

Between 1993 and 2010, prices rose by an average of 6.4 percent a year. In the early 1990s, health insurance companies tried to control costs by spreading the use of HMOs once again. Congress then tried to control costs with the Balanced Budget Act in 1997. Instead, it forced many health care providers out of business. Because of this, Congress relented on payment restrictions in the Balanced Budget Refinement Act in 1999 and the Benefits Improvement and Protection Act of 2000. The Act also extended coverage to children through the Children's Health Insurance Program.

After 1998, people rebelled and demanded more choice in providers. As demand increased again, so did prices. Between 1997 and 2007, drug prices tripled, according to a study in Health Affairs.

One reason is that pharmaceutical companies invented new types of prescription drugs. They advertised straight to consumers and created additional demand. The number of drugs with sales that topped $1 billion increased to 52 in 2006 from six in 1997. The U.S. government approved expensive drugs even if they were not much better than existing remedies. Other developed countries were more cost-conscious, according to The New York Times.



In 2003, the Medicare Modernization Act added Medicare Part D to cover prescription drug coverage. It also changed the name of Medicare Part C to the Medicare Advantage program. The number of people using those plans tripled to 17.6 million by 2016. Those costs rose faster than the cost of Medicare itself.

The nation’s reliance on the health insurance model increased administration costs. A 2003 study found that administration made up 30 percent of U.S. health care costs. It's twice the administrative costs in Canada. About half of that is due to the complexity of billing.

For example, U.S. private doctors' offices need seven people to do billing for every 10 physicians. A big reason is that there are so many types of payers. In addition to Medicare and Medicaid, there are thousands of different private insurers. Each has its own requirements, forms, and procedures. Hospitals and doctors must also chase down people who don't pay their portion of the bill. That doesn't happen in countries with universal health care.

The reliance on corporate private insurance created health care inequality. Those without insurance often couldn't afford visits to a primary care physician. By 2009, half of the people (46.3 percent) who used a hospital said they went because they had no other place to go for health care. The Emergency Medical Treatment and Active Labor Act required hospitals to treat anyone who showed up in the emergency room. These uninsured patients cost hospitals a staggering $10 billion a year. The hospitals passed this cost along to Medicaid.

Preventable Chronic Diseases
The second cause of rising health care costs is an epidemic of preventable diseases. The four leading causes of death are heart disease, cancer, chronic obstructive pulmonary disorder, and stroke. Chronic diseases cause all of them. They can either be prevented or would cost less to treat if caught in time. Risk factors for heart disease and strokes are poor nutrition and obesity. Smoking is a risk factor for lung cancer (the most common type) and COPD. Obesity is also a risk factor for the other common forms of cancer.

These diseases cost an extra $7,900 per person. That’s five times more than the health care costs for a healthy person. The average cost of treating diabetes, for example, is $26,971 per family. These diseases are difficult to manage because patients get tired of taking the various medications. Those who cut back find themselves in the emergency room with heart attacks, strokes, and other complications. (Source: “The Impact of Chronic Diseases on Health Care,” For a Healthier America, 2014.)

Recent research found that even Alzheimer's disease might be preventable. The study, called SPRINT MIND, found that high blood pressure could worsen dementia caused by Alzheimer's.

https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878

[XenaLives]

How politics affects your healthcare:

With Power to Kneecap Bold Demand, Incoming Democratic Tax Committee Chair Says Medicare for All 'Not Realistic'
"Two decades of generous donations apparently gets you a powerful congressman willing to throw up roadblocks in front of universal healthcare."

byJake Johnson, staff writer
112 Comments

Ranking member of the House Ways and Means Committee Rep. Richard Neal (D-Mass.) speaks during a news conference on Republican plans to end the state and local tax deduction, on Capitol Hill, October 12, 2017 in Washington, D.C. (Photo: Drew Angerer/Getty Images)

As progressive House Democrats strategize and push for a vote on Medicare for All legislation as soon as possible, surging congressional and grassroots momentum for single-payer could soon run into a serious obstacle in the form of incoming Ways and Means Committee chair Rep. Richard Neal (D-Mass.), who has denounced Medicare for All as "not realistic" and will soon be in a position to tank healthcare plans that are unacceptable to his insurance industry donors.

"Over his two-decade career in the House, Neal has relied on support from the health care industry, receiving $950,000 from health professionals and associations and $750,000 from the pharmaceutical industry."

—Eoin Higgins"Neal will have near total control over what tax-related policies come to the House floor, including legislation that would create a Medicare for All healthcare system," noted investigative reporter Eoin Higgins in a piece for Sludge on Wednesday. "Having Neal at the helm of the committee, rather than a more progressive member, makes it much less likely that the House of Representatives will vote on universal healthcare measures."

As Higgins documents, Neal—who has served as the top Ways and Means Democrat since 2016—has received more insurance industry cash throughout his career than any other member of the incoming Congress, including Republicans.

This fact may help explain his recent attacks on supporters of Medicare for All, who he recently called on to be more "calm" in their pursuit of bold solutions to America's deadly healthcare status quo.

"I think that there is an approach that is a little more incremental in nature," Neal said of his position on Medicare for All during an interview in August. "I understand aspiration... but the idea that overnight you're going to take 20 percent of the American economy and transform it is not realistic."

Neal neglected to mention research showing that Medicare for All would cost trillions of dollars less than the current for-profit system while providing decent healthcare for everyone.



Neal's negative view of Medicare for All pits him against many of his House Democratic colleagues, a growing number of whom have co-sponsored single-payer legislation. It also places him completely out of touch with the 84 percent of Democratic voters—and 70 percent of Americans overall—who support Medicare for All.

Further fueling speculation that he will use his position as Ways and Means chair to squash any Medicare for All legislation, Neal is also backing a proposed rule that would "require a three-fifths supermajority to raise individual income taxes on the lowest-earning 80 percent of taxpayers"—a measure progressives have condemned as an absurd restriction that would make it impossible to fund single-payer, a Green New Deal, and other agenda items.

"It's incredibly important to get progressives on committees like Ways and Means, especially fighters like Alexandria Ocasio-Cortez."
—Stephanie Taylor, Progressive Change Campaign Committee"Supermajority tax increase rules, which can be traced back to model bills from the conservative American Legislative Exchange Council (ALEC), have been used in state legislatures across the country to stymie progressive change," Higgins pointed out. "Neal's push to use House rules to constrain change means that even before the 116th Congress is seated in January, the congressman is already flexing his legislative muscle in a way that will benefit his donors."

With Neal positioned to serve as an insurance industry-friendly bulwark against Medicare for All, Rep.-elect Alexandria Ocasio-Cortez (D-N.Y.) is vying for a seat on the Ways and Means Committee for precisely the opposite reason—to advance an ambitious progressive agenda over the objections of corporate Democrats, who have helped kill progressive healthcare solutions in the recent past.

As The Intercept first reported on Wednesday, Ocasio-Cortez is taking on self-described "fiscally conservative" Rep. Tom Suozzi (D-N.Y.) for a spot on the Ways and Means committee—part of a broader effort by progressive members to seize committee positions as a first step in moving toward Medicare for All and a Green New Deal.

"Everything that progressives care about goes through those committees," Alex Lawson, executive director of Social Security Works, said of the Ways and Means and Energy committees.

For this reason, progressive groups are mobilizing aggressively in support of Ocasio-Cortez's bid for a Ways and Means seat and against Sen. Joe Manchin's (D-W.Va.) potential rise to the top spot on the Senate Energy and National Resources Committee.

"It's incredibly important to get progressives on committees like Ways and Means, especially fighters like Alexandria Ocasio-Cortez," Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, told Vice. "It's unthinkable that Nancy Pelosi would choose someone like Tom Suozzi instead."

https://www.commondreams.org/news/2018/12/06/power-kneecap-bold-demand-incoming-democratic-tax-committee-chair-says-medicare-all

[XenaLives]

How do we pay for Medicare 4 All?

[XenaLives]

Definitely a possible source of funding, the ColoradoCare model that got overwhelmed by H.I.C. propaganda in 2016 used a simple payroll tax.

It still would have created a net savings in heathcare costs and the savings in workmans comp costs netted significant savings to businesses and local governments.

The system is so messed up right now that any ethically run Single Payer system would provide better care and save everyone money.

Still, I have issues with both of the Medicare 4 All bills now before the house because they leave the running of the plan in the hands of the head of HHS - who is a political appointee and currently also an alumnus of Big Pharma.

In order for Single Payer to work it must serve the people, not the politicians and the health care industry.

[BWIS]

Not to mention the savings public and private pensions would see if they didn't have to cover health insurance.

We could experience cost savings all over the place. Imagine if all public sector workforce current and past paid taxes to cover their own costs and the tax savings by not providing it as part of their labor costs.

Wow! Savings everywhere!

[BWIS]

Hey Xena, just read this from the NWBO board. Anyways, I'd love to see the reduction in long term care costs and automobile health insurance coverage savings provided by an all-in taxpayer funded system.

[XenaLives]

Anavex NOW!! ... because it ain't gettin' any better!

The decline in U.S. life expectancy is unlike anything we've seen in a century

The CDC identified three things shortening American lives.

By Sara Chodosh November 29, 2018


More Americans are dying by their own hands and by overdoses.
Pexels


For a nation that spends more on healthcare per citizen than almost any other, America isn’t exactly reaping the rewards. Life expectancy has been steadily climbing for decades now, but in the last few years it’s taken a troubling turn in the other direction.

A new report from the Centers for Disease Control shows that a small decrease in life expectancy, from 78.7 to 78.6 years, is part of a continuing trend. Even as we make progress treating cancer, heart disease, and stroke—three of the biggest killers—we’re losing ground on other fronts and have been since 2014. That makes this continuous decline unlike anything we've seen since World War I and the Spanish influenza, which both happened between 1915 and 1918.

In its report, the CDC highlighted three things that have contributed to American's shrinking life expectancy in recent years: drug overdoses, chronic liver disease, and suicide. “Increased death rates for unintentional drug overdoses in particular—a subset of unintentional injuries—contributed to the negative change in life expectancy observed in recent years," the report reads.

But the changes aren’t affecting everyone equally. Take a look at these charts:


These are the three main factors the CDC identified as being behind the drop in life expectancy. Infographic by Sara Chodosh

Health and life expectancy varies geographically. Worldwide variation is enormous, but even within the United States you can expect to live 6.6 years longer if you live in Hawaii, the top-ranked state, than in Mississippi, which comes in last. With its 81.3 year life expectancy, Hawaii looks more like the Netherlands than the United States. Mississippi's 74.7 year projection looks more like Kuwa


Americans living in much of the South have much shorter lives than those in the rest of the country. Infographic by Sara Chodosh

Tackling the various problems that contribute to the recent upticks in suicide, liver disease, and drug overdoses won’t be easy. They’re multifaceted issues—often complicated by economics—that we’ve only just begun to parse. But if we want Americans to lead long and healthy lives, it looks like we’re going to have to change what we’re doing. If these charts tell us anything, it's that our current methods aren’t working.

https://www.popsci.com/life-expectancy-declining


Additional statistical info here:
https://investorshub.advfn.com/boards/read_msg.aspx?message_id=145076878

[XenaLives]

Cancer kills, physically and financially.

Excerpt:

Financial toxicity led Fumiko Chino to co-write a research letter in JAMA Oncology last November. After her husband surpassed his insurance policy's $500,000 lifetime limit, Chino drained her savings to pay for his treatment. When he died, she was left hundreds of thousands of dollars in debt.

In her study of 300 cancer patients, Chino and team discovered that over one-third of them had to pay more than expected for their care, which put a strain on their decision-making process.

Facing unexpected treatment costs was associated with lower willingness to pay for care, even when adjusting for financial burden. This suggests that unpreparedness for treatment-related expenses may impact future cost-conscious decision making.

A 2016 systematic review of 45 studies, published in Journal of the National Cancer Institute, found that up to 62 percent of patients report being in debt due to treatment. Another study of over 4,700 patients from that year discovered that 55 percent accrued at least $10,000 in debt, while 3 percent filed for bankruptcy.

Cancer costs exceed $80 billion in America each year. Over half of all cancer patients "experienced house repossession, bankruptcy, loss of independence, and relationship breakdowns." Up to 85 percent of patients have to stop working for up to six months, putting further strain on their finances.

https://bigthink.com/politics-current-affairs/how-much-does-cancer-cost?rebelltitem=2#rebelltitem2

[XenaLives]

Maternal healthcare in the U.S. is a FAIL.

investorshub.advfn.com/uimage/uploads/2018/11/25/wdnxqx.JPG

The maternal mortality rate in the U.S. if 50% higher than Libya. The U.S. and China are about the same.

But it is going DOWN in China:

In 2014, the maternal mortality rate was 21.7 per 100,000 which was 76 per cent lower than in 1990

http://www.wpro.who.int/china/mediacentre/releases/2015/20151026/en/

BEIJING - China's maternal mortality rate contracted to 19.6 per 100,000 in 2017 from 19.9 per 100,000 the previous year, the National Health and Family Planning Commission said Thursday.

Moreover, the rate of infant mortality also dropped last year from 7.5 per thousand to 6.8, narrowing the gap between China and the developed world.

Attributing the achievements to the maternal risk screening and treatment system, the commission called for improved maternal and child health care services by allocating more resources to the grassroots level.

There should be at least one public maternal and child health care institution in each county by 2020, said the commission.

China plans to further reduce the maternal mortality rate to 12 per 100,000 and the infant mortality rate to five per thousand by 2030, according to an official guideline titled Healthy China 2030.

http://www.chinadaily.com.cn/a/201802/01/WS5a731de1a3106e7dcc13a43b.html

CONCLUSION: Despite the United Nations Millennium Development Goal for a 75% reduction in maternal mortality by 2015, the estimated maternal mortality rate for 48 states and Washington, DC, increased from 2000 to 2014; the international trend was in the opposite direction.

https://www.ncbi.nlm.nih.gov/pubmed/27500333

Although considered mainly as problems of the developing world, maternal mortality and morbidity remain a challenge in the United States of America (USA).1 Between 1990 and 2013, the maternal mortality ratio for the USA more than doubled from an estimated 12 to 28 maternal deaths per 100 000 births1 and the country has now a higher ratio than those reported for most high-income countries and the Islamic Republic of Iran, Libya and Turkey.2 About half of all maternal deaths in the USA are preventable.2

Each year an estimated 12001 women in the USA suffer complications during pregnancy or childbirth that prove fatal and 60 0003 suffer complications that are near-fatal – even though costs of maternity care in the USA in 2012 exceeded 60 billion United States dollars.4

Three factors are probably contributing to the upward trend in maternal mortality and morbidity in the USA. First, there is inconsistent obstetric practice. Hospitals across the USA lack a standard approach to managing obstetric emergencies and the complications of pregnancy and childbirth are often identified too late. Nationally endorsed plans to manage obstetric emergencies and updated training and guidance on implementing these plans is a serious and ongoing need.5

A second factor is the increasing number of women who present at antenatal clinics with chronic conditions, such as hypertension, diabetes and obesity, which contribute to pregnancy-related complications. Many of these women could benefit from the closer coordination of antenatal and primary care – including case management and other community-based services that help them access care and overcome cost and other obstacles. In the USA, women who lack health insurance are three to four times more likely to die of pregnancy-related complications than their insured counterparts.6

Another factor is the general lack of good data – and related analysis – on maternal health outcomes. Only half the USA’s states have maternal mortality review boards and the data that are collected are not systematically used to guide changes that could reduce maternal mortality and morbidity. There is no national forum for the states to share either their best practices for reviewing maternal deaths or the relevant lessons that they may have learned.

There is a growing effort by physicians, nurses and community organizations to address these three factors. Hospitals are beginning to implement standard approaches to managing obstetric emergencies so that, wherever a woman gives birth, she receives appropriate evidence-based care. Community initiatives are coordinating care for high-risk women to ensure good health and management of chronic conditions during and beyond pregnancy. More states are establishing or strengthening maternal mortality review boards.

Recent changes to national policies should also help improve maternal health outcomes. In 2010 the Affordable Care Act included antenatal and maternal care as essential health benefits that insurance plans must cover. By extending insurance coverage to pregnant women with low incomes, many states have lowered the economic hurdles that limit access to antenatal care for millions of women. As the health community solidifies the post-2015 agenda to end preventable maternal mortality, the USA needs to be brought into the global dialogue on maternal health. Although maternal mortality is relatively rare in the USA, one preventable maternal death is one too many. All states need to mobilize health providers, policy-makers and communities to make maternal health a priority. With increased awareness of maternal mortality and life-threatening events – and concrete actions to ensure that pregnant women get the quality care they need – many fatal and near-fatal complications could be prevented.

https://www.who.int/bulletin/volumes/93/3/14-148627/en/

On that March day, she joined one of the US’s most shameful statistics. With an estimated 26.4 deaths for every 100,000 live births in 2015, America has the highest maternal mortality rate of all industrialized countries—by several times over. In Canada, the rate is 7.3; in Western Europe, the average is 7.2, with many countries including Italy, Norway, Sweden, and Austria showing rates around 4. More women die of childbirth-related causes in the US than they do in Iran (20.8), Lebanon (15.3), Turkey (15.8), Puerto Rico (15.1), China (17.7), and many more.

https://qz.com/1108193/whats-killing-americas-new-mothers/

Ethinic based stats available here:
https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/maternal_mortality/state/ALL

[XenaLives]

A good article on how China is using technology to improve healthcare in rural areas. This is also a serious problem in the U.S. and these solutions can not be implemented under the current pay for play system.


https://www.scmp.com/tech/article/2135880/look-how-china-using-technology-improve-rural-access-quality-health-care

[XenaLives]

"Would a Single-Payer System Require Painful Sacrifices From Doctors?"

NY Times article on physician reimbursement under Single Payer:

Excerpt:

In sum, although the switch to a single-payer system would entail lower payments to service providers like doctors, it would also affect their frames of reference and conditions of employment in offsetting ways. International happiness studies offer no reason to conclude that, once it has been fully implemented and absorbed, the switch would require truly significant sacrifices by most American health care providers.

There would of course be exceptions.

As Atul Gawande described in a much-cited New Yorker article, current reimbursement arrangements have encouraged some physicians to view their practices less as centers for healing than as revenue streams. Some have invested in image centers and clinics to which they refer patients for scans and treatment, capturing insurance reimbursements for themselves directly.

Others demand kickbacks for referring patients to home-health agencies. And because most insurers don’t reimburse for phone calls, patients who call with questions that could easily be answered by phone are often told to schedule reimbursable office visits. Physicians who adopt these practices may earn seven- or even eight-figure annual incomes.

Because meaningful health reform would eliminate the incentives for these abuses, we can be sure that at a small number of doctors would suffer steep income declines. These few might scream bloody murder. And, as many Californians may discover, moving immediately to single-payer health care will require a host of trade-offs, some of them painful over the short-term.

https://www.nytimes.com/2018/06/08/business/would-a-single-payer-system-require-painful-sacrifices-from-doctors.html

[XenaLives]

A 1982 study dealt with cost sharing and use of services:

Key findings:

- In a large-scale, multiyear experiment,participants who paid for a share of theirhealth care used fewer health servicesthan a comparison group given free care.

- Cost sharing reduced the use of both highly effective and less effective servicesin roughly equal proportions. Cost sharing did not significantly affect the quality of care received by participants.

- Cost sharing in general had no adverse effects on participant health, but there were exceptions: free care led to improvements in hypertension, dental health, vision, and selected serious symptoms. These improvements were concentrated among the sickest and poorest patients.

https://www.rand.org/content/dam/rand/pubs/research_briefs/2006/RAND_RB9174.pdf

[XenaLives]

We are America’s future doctors. We support a Medicare-for-all health system

By AUGIE LINDMARK, VANESSA VAN DOREN, BRYANT SHUEY, and ANDY HYATT OCTOBER 25, 2017

Underneath a heap of hospital blankets, Stephen seemed small for a 7-year-old. His chest rose and fell rapidly, a frightening rhythm given his history of asthma. His parents stood nearby as veteran witnesses — Stephen had been admitted to a Cleveland safety net hospital for asthma four times already this year — but familiarity offers little comfort when your child struggles to breathe. When asked if their son used his asthma inhalers, they replied, “It depends. When we can afford them, he takes them. But when we can’t, it could be a few weeks.”

Stephen represents one of more than 430,000 hospitalizations each year due to asthma. At a cost of $56 billion annually, complications from asthma can be prevented with regular medications (inhalers), avoidance of triggers like dust and mold, and access to health care, which usually means access to health insurance. Stephen didn’t have the latter.

Of the diseases we are taught in medical school, a sudden worsening of asthma, known as an exacerbation, is a relatively common cause of illness in children and adults. To identify the cause of a disease, doctors are trained in the differential diagnosis. This bedrock of medical education encourages doctors — those in training, like us, as well as those with years of experience — to compile a list of causes that match a patient’s symptoms. In a way, the differential is half medicine, half Sherlock Holmes.

Chest pain, for example, might include differential diagnoses that range from heart attack to having eaten too many buffalo wings. Yet there’s a particular cause of illness — in Stephen’s case, a nonpulmonary culprit — that is unique to American health care: America’s private health insurance system.


Recent months provide ample context. As the latest Obamacare repeal efforts took the form of Graham-Cassidy 1.0 and 2.0, the GOP bill would have kicked 32 million Americans off their health insurance. Patients with preexisting conditions like asthma would have seen sharp increases in their health insurance premiums (in the case of metastatic cancer, to the tune of six digits), and Medicaid reimbursements to Planned Parenthood would have been banned, effectively barring millions of women from reproductive and preventive health care.

Both Republican and Democratic efforts have done little to change the fact that thousands of Americans die from lack of health coverage. America’s fragmented and inequitable health system is a sinking ship and recent fixes — often in the form of private health insurance industry bailouts or shutouts — are like placing tissue paper over the leaks in this doomed vessel.

No bacteria or viruses harm health more than policies that effectively prevent millions of individuals from access to affordable health insurance to pay for life-altering health care, including the recent ill-conceived executive order. As American health care maintains its appalling position as a leading cause of financial burden and bankruptcy, an equitable response is essential. That means creating a system in which access to health care is based on need, not the ability to pay. As future doctors, we are being trained to identify root causes of disease. That’s why we support Medicare for all.

Momentum toward an improved and expanded Medicare for all health system is at historic highs. The majority of American physicians now support single-payer health care, and 60 percent of Americans believe that the federal government has a responsibility to ensure health care for all citizens.


Last month, the Medicare for All Act was rolled out with fanfare as Sen. Bernie Sanders — joined by 16 co-sponsors — offered a blueprint for universal health care in America. Its sister bill in the House of Representatives, the Expanded and Improved Medicare For All Act, has 120 Democratic co-sponsors, making it the first single-payer bill in history to have a majority of Democratic support.

The overwhelmingly popular Medicare and Medicaid programs have saved millions of lives and offer strong, supportive health care to millions of Americans. Why not offer that to all Americans? As the life expectancy gap between rich and poor increases, the only path forward is to ensure that all Americans have affordable health care, regardless of socioeconomic background.

President Trump recently declared his desire to “stabilize markets” which, historically, has meant diverting funds to private insurers who have done an outstanding job of shrinking coverage and fattening corporate profits. Trump’s latest executive order, which eliminates select private insurance subsidies, will ironically dampen private profits at the expense of escalating premiums for the middle class.

Private insurance subsidies are Band-Aids on an already oozing wound, an inefficient private industry that prioritizes the depth of shareholder pockets over patient health. And while subsidies are short-term fixes inadequate for a long-term solution, removing them altogether, as has been the procedure in the latest GOP bills, would further limit patient access to affordable, comprehensive care. This worse-worst situation could be healed with an improved Medicare-for-all system that eliminates profit motives and preferentially places health above all else.

Augie Lindmark, Vanessa Van Doren, Bryant Shuey, and Andy Hyatt are medical students the University of Minnesota, Case Western Reserve University, University of New Mexico, and Boston University, respectively, as well as board members of Physicians for a National Health Program, an organization that advocates for an improved and expanded Medicare for All health system

https://www.statnews.com/2017/10/25/medicare-health-insurance-asthma/

[XenaLives]

The AMA is no longer opposed to Single Payer:

http://pnhp.org/news/medical-students-bring-the-ama-into-the-single-payer-dialogue/

By SHEFALI LUTHRA/KAISER HEALTH NEWS August 8, 2018

When the American Medical Association — one of the nation’s most powerful health care groups — met in Chicago this June, its medical student caucus seized an opportunity for change.

Though they had tried for years to advance a resolution calling on the organization to drop its decades-long opposition to single-payer health care, this was the first time it got a full hearing. The debate grew heated — older physicians warned their pay would decrease, calling younger advocates naïve to single-payer’s consequences. But this time, by the meeting’s end, the AMA’s older members had agreed to at least study the possibility of changing its stance.

“We believe health care is a human right, maybe more so than past generations,” said Dr. Brad Zehr, a 29-year-old pathology resident at Ohio State University, who was part of the debate. “There’s a generational shift happening, where we see universal health care as a requirement.”


The ins and outs of the AMA’s policymaking may sound like inside baseball. But this year’s youth uprising at the nexus of the medical establishment speaks to a cultural shift in the medical profession, and one with big political implications.

Amid Republican attacks on the Affordable Care Act, an increasing number of Democrats — ranging from candidates to established Congress members — are putting forth proposals that would vastly increase the government’s role in running the health system. These include single-payer, Medicare-for-all or an option for anyone to buy in to the Medicare program. At least 70 House Democrats have signed on to the new “Medicare-for-all” caucus.

Organized medicine, and previous generations of doctors, had for the most part staunchly opposed to any such plan. The AMA has thwarted public health insurance proposals since the 1930s and long been considered one of the policy’s most powerful opponents.

But the battle lines are shifting as younger doctors flip their views, a change that will likely assume greater significance as the next generation of physicians takes on leadership roles. The AMA did not make anyone available for comment.

Many younger physicians are “accepting of single-payer,” said Dr. Christian Pean, 30, a third-year orthopedic surgery resident at New York University.

In prior generations, “intelligent, motivated, quantitative” students pursued medicine, both for the income and because of the workplace independence — running practices with minimal government interference, said Dr. Steven Schroeder, 79, a longtime medical professor at the University of California-San Francisco.

In his 50 years of teaching, students’ attitudes have changed: “The ‘Oh, keep government out of my work’ feeling is not as strong as it was with maybe older cohorts,” said Schroeder. “Students come in saying, ‘We want to make a difference through social justice. That’s why we’re here.’”

Though “single-payer” health care was long dismissed as a left-wing pipe dream, polling suggests a slim majority of Americans now support the idea — though it is not clear people know what the term means.

A full single-payer system means everyone gets coverage from the same insurance plan, usually sponsored by the government. Medicare-for-all, a phrase that gained currency with the presidential campaign of Sen. Bernie Sanders (I-Vt.), means everyone gets Medicare, but, depending on the proposal, it may or may not allow private insurers to offer Medicare as well. (Sanders’ plan, which eliminates deductibles and expands benefits, would get rid of private insurers.)

Meanwhile, lots of countries achieve universal health care — everyone is covered somehow — but the method can vary. For example, France requires all citizens purchase coverage, which is sold through nonprofits. In Germany, most people get insurance from a government-run “public option,” while others purchase private plans. In England, health care is provided through the tax-funded National Health System.

American skeptics often use the phrase “socialized medicine” pejoratively to describe all of these models.

“Few really understand what you mean when you say single-payer,” said Dr. Frank Opelka, the medical director of quality and health policy for the American College of Surgeons, which opposes such a policy. “What they mean is, ‘I don’t think the current system is working.’”

But the willingness to explore previously unthinkable ideas is evident in young doctors’ ranks.

Recent surveys through LinkedIn, recruiting firm Merritt Hawkins and trade publication NEJM Catalyst indicate growing support. In the March NEJM survey, 61 percent of 607 respondents said single-payer would make it easier to deliver cost-effective, quality health care.

http://time.com/money/5360985/doctors-single-payer-healthcare/

[XenaLives]

Research done by PNHP (Physicians for a National Health Plan) on how Single Payer would change Healthcare in the U.S.:

http://pnhp.org/resource/pnhp-research-the-case-for-a-national-health-program/

[XenaLives]

How the U.S. is failing in healthcare:

The historical notes are mine:



Here is the same chart at visualcapitalist.com..

http://www.visualcapitalist.com/u-s-spends-public-money-healthcare-sweden-canada/

Washington Post article that uses this chart:

Is the money we're spending on health care keeping us alive?

On a certain level, that's the big test of any health-care system — and the United States is failing.

According to above chart, U.S. life expectancy continues to lag far behind other developed countries, despite spending way more on medical treatments aimed at keeping us alive.

The chart, courtesy of Oxford economist Max Roser, plots per-capita health-care spending against life expectancy for the world's wealthiest countries over the past 40-plus years. Each country gets one line, which plots its trajectory on those measures over time.

https://www.washingtonpost.com/news/wonk/wp/2017/03/08/this-chart-is-a-powerful-indictment-of-our-current-healthcare-system/?noredirect=on&utm_term=.1d778c926f32

The chart was tweeted by Eric Topol:
er.com/erictopol/status/968602204377460736

Eric Topol
American cardiologist
Eric Jeffrey Topol is an American cardiologist, geneticist, and digital medicine researcher. Before moving to Scripps in 2006, Topol served as chairman of cardiovascular medicine at Cleveland Clinic and founded the Cleveland Clinic Lerner College of Medicine. Wikipedia
Born: June 26, 1954 (age 64 years), Queens, New York City, NY
Spouse: Susan Merriman Topol (m. 1979)
Education: University of Rochester, University of Virginia, University of Rochester School of Medicine and Dentistry
Fields: Genetics, Cardiology
Organization founded: Cleveland Clinic Lerner College of Medicine

About Our World in Data:

Our World in Data is an online publication that shows how living conditions are changing. The aim is to give a global overview and to show changes over the very long run, so that we can see where we are coming from and where we are today. We need to understand why living conditions improved so that we can seek more of what works.

We cover a wide range of topics across many academic disciplines: Trends in health, food provision, the growth and distribution of incomes, violence, rights, wars, culture, energy use, education, and environmental changes are empirically analyzed and visualized in this web publication. For each topic the quality of the data is discussed and, by pointing the visitor to the sources, this website is also a database of databases. Covering all of these aspects in one resource makes it possible to understand how the observed long-run trends are interlinked.

The project is produced by the Oxford Martin Programme on Global Development at the University of Oxford, and is made available in its entirety as a public good. Visualizations are licensed under CC BY-SA and may be freely adapted for any purpose. Data is available for download in CSV format. Code we write is open-sourced under the MIT license and can be found on GitHub. Feel free to make use of anything you find here!

https://ourworldindata.org/about

Another chart from the same site:


This chart shows very clearly where the Silver Tsunami will hit first:


Above charts located here:
https://ourworldindata.org/life-expectancy#median-age-by-country

The U.S. has a 50% higher maternal mortality rate than freekin' LIBYA!


Why Single Payer in the U.S. should cost any more tax dollars than the current system:

How quickly can healthcare coverage expand?
As noted above, european countries pioneered the expansion of healthcare systems in the first half of the twentieth century. The following visualization, from the Human Development Report (2014), places the achievements of these countries in perspective. Specifically, the following graph plots healthcare protection coverage for a selection of countries during the period 1920-2010. As we can see, France, Austria and Germany increased healthcare coverage in the years 1920-1960, while Spain, Portugal and Greece did it later, in the years 1960-1980. Interestingly, however, this graph also shows some notable examples of countries that expanded healthcare coverage much later, but much more quickly. In particular, China, Rwanda and Vietnam built health protection systems in the 21st century, almost from scratch, achieving near universal coverage in only a decade. These examples show that healthcare protection can be expanded very quickly, and not only at low baseline levels of coverage. (chart below)

This is obscene -


This is even more obscene, the government spends more and the people spend more:


Above charts located here:
https://ourworldindata.org/health-meta

And finally - the source of the chart in question:

Link between health spending and life expectancy: US is an outlier
May 26, 2017 by Max Roser
This post was originally published on August 3, 2016. It was updated on 26 May 2017.

Our World in Data presents the empirical evidence on global development in entries dedicated to specific topics.

This blog post draws on data and research discussed in our entry on how healthcare is financed.

The graph below shows the relationship between what a country spends on health per person and life expectancy in that country between 1970 and 2015 for a number of rich countries.

The US stands out as an outlier: it spends far more on health than any other country, yet the life expectancy of the American population is not longer, but actually shorter than in other countries that spend far less.

If we look at the time trend for each country, we first notice that all countries have followed an upward trajectory—the population lives increasingly long lives as health expenditure increases. But again, the US stands out by following a much flatter trajectory: gains in life expectancy from additional health spending in the U.S. are much smaller than in the other high-income countries, particularly since the mid-1980s.

This development has led to a large inequality between the US and other rich countries. In the US health spending per capita is often more than three times higher than in other rich countries, yet the populations of countries with much lower health spending than the US enjoy considerably longer lives. In the most extreme case, we see that Americans spend more than 5-times what Chileans spend, yet the population of Chile actually lives longer than Americans.

What things looked like in 1970:



What they look like now... how the mighty have fallen...



The updated version of the chart I posted earlier today:




https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus

III. Main data sources
The World Development Indicators (WDI), published by the World Bank, are the main source of up-to-date cross-country data on life expectancy, child mortality and maternal mortality. Other more specialised data sources are listed and discussed in our entries on Life Expectancy and Child Mortality.

The main source of data on international healthcare expenditure is the World Health Organisation (WHO), more specifically the global health expenditure database. This is the same data published by the World Bank (World Development Indicators) and Gapminder. It is also the source of the health expenditure tables in the World Health Statistics Report and the WHO Global Health Observatory; and it is used as an input to the Development Assistance for Health Database from the IHME.23 You can read more about measurement, data quality and further details about available sources in the last two sections of our entry on Financing Healthcare.

https://ourworldindata.org/health-meta#main-data-sources

About Max Roser:

Max Roser
Economist
Image result for Oxford economist Max Roser,
Max Roser is an economist and media critic. He is known for his research on global trends of living conditions and his visualisations of these trends. He is currently a research fellow in economics at the University of Oxford. Roser was born in Kirchheimbolanden, Germany. Wikipedia
Born: 1983 (age 35 years), Kirchheimbolanden, Germany
Influenced by: Tony Atkinson, Amartya Sen, Steven Pinker, Angus Deaton
Institutions: Nuffield College, Oxford, Oxford Martin School

https://ourworldindata.org/

[XenaLives]

The dangers of Medical Tourism.

Some doctors put money first...

In Canada alternative therapies are discussed with the "MS team" giving treatment. In the U.S. very few physicians will consider or discuss these therapies because it is not part of official or insurer sanctioned protocol.

https://mssociety.ca/managing-ms/treatments/complementary-and-alternative-medicine-cam

It didn't take much research to figure out why your anecdotal account is unrelated to Single Payer.

One fourth of the patients at the MS center in Buffalo, NY are Canadian.

Ocrevus was just approved in Canada, about a year later than in the U.S. This is most likely the reason why MS patients are going to the U.S. and it has nothing to do with Single Payer, Ocrevus was approved in the U.S. eight months earlier.

Patients that could afford it probably went to the U.S. to get the drug early:
https://globalnews.ca/news/4028767/ppms-suffers-celebrating-approval-of-new-drug/

Some people seek experimental treatments or procedures that may not be approved or available in Canada. Some are used off-label (using a treatment for an indication that has not been approved by Health Canada), are considered exploratory, or have been scientifically proven to be ineffective in treating MS. A person may seek experimental treatments because medications and/or other therapies have not been effective in managing their MS, or because of a desire to explore treatments that are on their way to becoming commercially available. It is important to note that all experimental treatments and procedures come with a level of risk, and sound clinical trials are required to understand the risks and benefits. Health Canada’s approval regimen ensures that the benefits of a given treatment or procedure outweigh its risks.

https://mssociety.ca/managing-ms/treatments/experimental-treatments-treatments-in-development

This is how medical tourism works, and in some cases it's just exploitation of desperate patients:

U.S. specialists in competition for Canadian MS patients


BY SHARON KIRKEY, POSTMEDIA NEWS FEBRUARY 9, 2011

U.S. specialists in competition for Canadian MS patients

Multiple Sclerosis patients and supporters rally in front of the Alberta legislature in November, calling on the province to cover liberation treatment.
Photograph by: Ed Kaiser , edmontonjournal.com
American doctors are clamouring for Canadian multiple sclerosis patients who are travelling abroad for a controversial treatment they can't get at home, a U.S. neurologist says.

"Every IR (interventional radiologist) in every town is competing with each other, 'Who can see more Canadians?' " Dr. David Hubbard, head of the Hubbard Foundation in San Diego, said in an interview with Postmedia News Tuesday.

Canadians are travelling to Bulgaria, Poland, Mexico and other countries for the procedure known as "liberation therapy," which involves opening blocked veins in the neck.

"I'm actually more worried about some of these American doctors who are doing it," Hubbard said.

"In the States, every IR is doing it. If anything, we have the opposite problem. I actually think it's happening too quickly in the United States."

Developed by Italian physician Paolo Zamboni, the procedure is based on a theory that MS is not an autoimmune condition but a vascular disease that can be treated with surgery.

Canada has among the highest MS rates in the world. There is no known cure.

An expert panel convened by the federal government to review Zamboni's theory, and his treatment, recently concluded that there is insufficient evidence to justify clinical trials and that MS research already underway should be concluded first.

Major projects studying liberation therapy and the theory behind it are being conducted in British Columbia, Alberta and Saskatchewan. Newfoundland and Labrador is funding a study of patients who go abroad for liberation therapy. Local neurologists will examine patients before and after treatment, and they'll be matched with other MS patients, who have not undergone liberation treatment, in order to evaluate its effectiveness.

Hubbard and two other experts in CCSVI, or chronic cerebro-spinal venous insufficiency, met with members of Parliament and senators Tuesday to discuss the latest science on MS "and to advocate on behalf of Canadian patients," said Liberal MP Kirsty Duncan.

Zamboni theorizes that abnormal blood flow from the brain contributes to MS; his technique involves opening veins with a balloon or stent.

Duncan said 12,500 "liberation" procedures have been performed worldwide in more than 50 countries, and that "80 to 97 per cent of MS patients show one or more venous abnormalities."

"If you talk to the interventional radiologists — the people who actually do the liberation procedure — about one-third of MS patients seem to respond very well," she said.

"This is significantly better than the outcomes for the drugs that exist today."

Duncan said Canadian MS patients who go abroad for treatment need proper followup care and that a registry needs to be put in place to track those who have been treated.

Hubbard's son was diagnosed with MS in May of 2009. He discovered then that "really nothing much had changed since I was a resident 30 years ago.

"The theory then was that MS was caused by a virus, or possibly an autoimmune theory. Basically 40 years later, billions of dollars of research later, every article in the journals started with, 'The cause of MS is unknown.' Current articles are still beginning that way."

He says the theory that the immune system is attacking myelin, the lining of the nerve cells, "has not been validated."

He said doctors discovered severe obstructions to his son's jugular veins in his neck. "They were dilated with a simple catheter that's put in the femoral vein in the thigh. Almost immediately his symptoms improved," said Hubbard, whose foundation tests and treats CCSVI in MS patients. So far, 209 patients have been treated.

"Half of our patients in southern California are coming from Canada," Hubbard said. "That's just not right, especially when it's being prevented by a very small number of angry neurologists in Canada."

Mark Haacke, a medical physicist and MRI expert at Hamilton's McMaster University who directs the MRI imaging research centre at Wayne State University, said that he has "probably personally reviewed over 1,000 cases (of MS patients) so far, and there are venous abnormalities everywhere."

Dr. Sandy MacDonald, a cardiovascular thoracic surgeon from Barrie, Ont., who was trained in liberation therapy by Zamboni, said that of 298 patients treated at a clinic in Cabos San Lucas, Mexico, "96 per cent were Canadians.

"I personally don't believe in medical tourism," he said. "I think it behooves us to actually look after Canadians and treat them in Canada."

"My plea is that the Canadian researchers actually do the trials. We need the support of the federal government for funding and we need to do a randomized, controlled multi-centre trial to actually prove that this therapy works, or doesn't work," he said.

"If it doesn't work, then it needs to be abandoned. If it does work, then it needs to be endorsed and paid for" by the provinces and territories, he said.

Last year, an Ontario man died after undergoing the treatment in Costa Rica. Mahir Mostic had surgery in June. Blood clots formed around the stent that was inserted in his neck; his friends said he couldn't find a doctor willing to treat him in Canada.

The Niagara Falls man returned to Costa Rica in October, where he died soon after he was given medication to dissolve the clots, which may have triggered internal bleeding.

"I think it's unethical and unconscionable that when people come back and they're looking for help, they have medical appointments cancelled, they have tests cancelled," Duncan said. "They go to the emergency and they're sent home."

[e-mail]

twitter.com/sharon_kirkey

With files from Meagan Fitzpatrick, Postmedia News

© Copyright (c) Postmedia Network Inc.

http://www.canada.com/health/specialists+competition+Canadian+patients/4246308/story.html

*** Note - those trials failed in the U.S.

View on the News
A STEP IN THE RIGHT DIRECTION
SAN DIEGO -- Percutaneous transluminal venous angioplasty – also known as "liberation therapy" -- doesn't help people with multiple sclerosis and may increase MS brain activity in the short term, according to a small, randomized, sham-controlled trial from the State University of New York at Buffalo, the first randomized trial to investigate the procedure.

The technique "was ineffective in correcting" chronic cerebrospinal venous insufficiency (CCSVI), the recently described condition it targets. "The results ... caution against widespread adoption of venous angioplasty in the management of patients with MS outside of rigorous clinical trials," the investigators concluded.

The findings follow a recent Food and Drug Administration warning that PTVA (percutaneous transluminal venous angioplasty) can cause deaths and injuries, including strokes, damage to the treated vein, blood clots, cranial nerve damage, abdominal bleeding, and detachment and migration of stents.
More..


https://www.mdedge.com/vascularspecialistonline/article/83988/venous-diseases/use-liberation-therapy-may-make-ms-worse

Canada is doing groundbreaking work in stem cell research:
http://www.ohri.ca/newsroom/story/view/959?l=en
https://mssociety.ca/hot-topics/stem-cells

Stem cell therappy is cheaper in the U.S. and not yet approved for MS in Canada. They are doing trials first.

https://www.cbc.ca/news/health/more-canadian-clinics-unproven-stem-cell-therapies-1.4838985

http://www.ohri.ca/newsroom/story/view/959?l=en

[XenaLives]

The U.S. Health Care System: An International Perspective
Fact Sheet 2016

https://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/

Thank you to the IHUB poster who first posted this..

Note that healthcare premiums skyrocketed at the end of 2016 so the state of U.S. healthcare is much worse than shown in this report.

[XenaLives]

Why is the U.S. always at the bottom of the heap?

Here are some statistics from the Canadian government:

Canadians worry about money for rent or the mortgage, particularly younger age groups People who are usually or always worried or stressed about having enough money to pay rent or the mortgage (over the past 12 months):
Country results from highest to lowest
United States, 16%; Switzerland, 12%; Canada, 12% (below average); Netherlands, 11%;
Australia, 9%; Commonwealth Fund average, 9%; Sweden, 8%; New Zealand, 7%;
United Kingdom, 7%; Norway, 6%; France, 4%; Germany, 3%

Few Canadians face cost barriers to care covered under Canada Health Act Within last year, had a medical problem but did not visit a doctor because of the cost:
Country results from highest to lowest
United States, 22%; Switzerland, 16%; New Zealand, 14%; Australia, 9%; France, 9%;
Commonwealth Fund average, 9%; Canada, 6% (above average); Norway, 5%;
United Kingdom, 4%; Netherlands, 3%; Sweden, 3%; Germany, 3%
Within last year, skipped a medical test, treatment or follow-up because of the cost:
Country results from highest to lowest
United States, 19%; France, 12%; Switzerland, 10%; New Zealand, 10%; Commonwealth
Fund average, 7%; Australia, 7%; Canada, 6% (above average); Germany, 5%; Norway, 4%;
Netherlands, 4%; Sweden, 3%; United Kingdom, 3%

More Canadians face cost barriers to dental care and prescription drugs
Within last year, did not fill prescription for medicine or skipped doses of medicine because of the cost:
Country results from highest to lowest
United States, 18%; Canada, 10% (below average); Switzerland, 9%; Commonwealth Fund
average, 6%; Australia, 6%; New Zealand, 6%; Sweden, 6%; Netherlands, 4%; France, 4%;
Norway, 3%; Germany, 3%; United Kingdom, 2%

Within last year, skipped dental care or dental checkups because of the cost:
Country results from highest to lowest
United States, 32%; Canada, 28% (below average); France, 23%; New Zealand, 22%;
Australia, 21%; Switzerland, 21%; Norway, 20%; Commonwealth Fund average, 20%;
Sweden, 19%; Germany, 14%; United Kingdom, 11%; Netherlands, 11%

People who report having one doctor they usually go to for their medical care:
Country results from lowest to highest
Sweden, 42%; United States, 77%; United Kingdom, 81%; Canada, 85% (same as average);
Switzerland, 85%; Commonwealth Fund average, 85%; Australia, 86%; New Zealand, 89%;
Norway, 95%; Germany, 98%; Netherlands, 99%; France, 99%

Canadians like their usual physician but don’t think the system works well
Overall, how do you rate the medical care that you have received in the past 12 months
from your regular doctor’s practice or clinic?
“Excellent or very good” country results from lowest to highest
Sweden, 39%; Germany, 54%; France, 60%; Netherlands, 62%; Norway, 63%;
Switzerland, 64%; Commonwealth Fund average, 65%; United Kingdom, 70%; Australia, 72%;
United States, 73%; Canada, 74% (above average); New Zealand, 79%

How would you rate the overall quality of medical care in your country? “Excellent or very good”
country results from lowest to highest
United States, 26%; Sweden, 39%; Canada, 45% (below average); Germany, 49%;
Norway, 50%; Commonwealth Fund average, 51%; Netherlands, 51%; France, 52%;
New Zealand, 58%; Australia, 59%; United Kingdom, 63%; Switzerland, 66%

Overall view of the health care system — It works well and only minor changes are necessary to make it better:
Country results from lowest to highest
United States, 19%; Sweden, 31%; Canada, 35% (below average); New Zealand, 41%;
Netherlands, 43%; Commonwealth Fund average, 44%; Australia, 44%; United Kingdom, 44%;
France, 54%; Switzerland, 58%; Norway, 59%; Germany, 60%

https://www.cihi.ca/sites/default/files/document/text-alternative-version-2016-cmwf-en-web.pdf

[XenaLives]

Canadian single payer - why the wait?

Timely Access to Care
Canada continues to perform below the international average for timely access to patient
care. Most Canadians (93%) have a regular doctor or place of care, but they generally report
longer wait times for medical care than adults in comparable countries. One possible reason
for longer waits here is that Canadians consult with physicians more often than people in
other countries.
• Only 43% of Canadians report that they were able to get a same- or next-day appointment
at their regular place of care the last time they needed medical attention — the lowest
percentage of all countries.
• Only 34% of Canadians report that they could get care on evenings or weekends
without going to an emergency department. However, after-hours access is closer to the
international average (43%) in some provinces (Ontario and Alberta).
• Canadian patients are generally not seeing improvements in timely access to primary care
over time. This is contrary to what primary care physicians reported in The Commonwealth
Fund’s 2015 survey.
• Canadians visit emergency departments more often than people in other countries and
wait longer for emergency care; Canada has the highest proportion of patients waiting
4 or more hours during a visit.
• Reported wait times for specialists and non-emergency surgeries in Canada are also
the highest among the 11 countries, with all provinces showing significantly longer waits
for specialists.

Person-Centred Care
Once they do get in for a visit, Canadians are generally happy with the medical care they
receive from their regular doctor or place of care. However, their overall views about their
health care system are less positive.
• Nearly 3 in 4 Canadians rate the quality of care they receive from their regular doctor as
very good or excellent; however, 55% also believe the health care system overall requires
fundamental changes.
• Canadians report better experiences than the international average when it comes to
their regular doctor knowing their medical history, involving them in medical decisions
and explaining things in a way that is easy to understand.
• When it comes to health promotion and disease prevention, Canadians have more
discussions with their primary care providers about healthy lifestyle choices than patients
in most other countries, with Alberta, Manitoba and Ontario leading the way.
• With regard to hospital stays, patients report results that are similar to the international
average overall. Most Canadians also report good hospital discharge planning, with staff
arranging follow-up care and providing written instructions for symptoms to watch for
at home.
• Results suggest that coordination of patient care between regular providers and specialists
could be improved in all countries. Similar to the international average, 1 in 5 Canadians
report that their regular doctor did not seem up to date about the care they received from
a specialist.

These issues do not appear to be a function of Single Payer:

Timely Access to Care
Most Canadians (93%) have a regular doctor or place of care, but they have trouble accessing
their health care system in a timely manner.
Same- or next-day appointments are difficult
to get in Canada?i
Last time you were sick or needed medical attention, how quickly could you get a
same- or next-day appointment to see a doctor or a nurse? Country results from
lowest to highest
Canada, 43% (below average); Norway, 43%; Sweden, 49%; United States, 51%;
Germany, 53%; France, 56%; Switzerland, 57%; United Kingdom, 57%; Commonwealth
Fund average, 57%; Australia, 67%; New Zealand, 76%; Netherlands, 77%

Access to after-hours care continues to be
below average in Canada?ii
Is it very/somewhat easy to get medical care in the evenings, on weekends or on
holidays without going to the hospital emergency department? Country results from
lowest to highest
Sweden, 24%; Canada, 34% (below average); France, 35%; Germany, 36%; Switzerland, 41%;
United States, 42%; United Kingdom, 43%; Commonwealth Fund average, 43%; Norway, 49%;
Australia, 49%; New Zealand, 53%; Netherlands, 72%

Some of the issues faced in Canada are related to population density. In the U.S. rural hospitals and healthcare must be subsidized and it is in crisis mode because of the current healthcare for profit system.

Timely access to primary care varies across
the country
While results are below the international average in most parts of the country, some provinces
report timelier access to regular care.
Able to get same- or next-day appointment to see a doctor or a nurse: Province results
from east to west
Newfoundland and Labrador, 34% (below average); Prince Edward Island, 30% (below average);
Nova Scotia, 34% (below average); New Brunswick, 33% (below average); Quebec, 39% (below
average); Ontario, 44% (below average); Manitoba, 47% (below average); Saskatchewan, 49%
(same as average); Alberta, 48% (below average); British Columbia, 44% (below average);
Canada, 43% (below average); Commonwealth Fund average, 57%

Very/somewhat easy to get medical care in the evenings, on weekends or on holidays
without going to the hospital emergency department: Province results from east to west
Newfoundland and Labrador, 16% (below average); Prince Edward Island, 25% (below average);
Nova Scotia, 26% (below average); New Brunswick, 35% (below average); Quebec, 27%
(below average); Ontario, 40% (same as average); Manitoba, 34% (below average);
Saskatchewan, 32% (below average); Alberta, 42% (same as average); British Columbia, 27%
(below average); Canada, 34% (below average); Commonwealth Fund average, 43%
Always/often receive an answer the same day when they contact their regular doctor’s
office with a medical concern: Province results from east to west
Newfoundland and Labrador, 61% (below average); Prince Edward Island, 70% (same as
average); Nova Scotia, 64% (same as average); New Brunswick, 50% (below average);
Quebec, 54% (below average); Ontario, 62% (below average); Manitoba, 57% (below average);
Saskatchewan, 51% (below average); Alberta, 58% (below average); British Columbia, 64%
(same as average); Canada, 59% (below average); Commonwealth Fund average, 72%

Good report on mental health care:

Canadians report more timely access to mental
health care than those in other countries
1 in 4 surveyed Canadians say they experienced emotional distress, such as anxiety or
great sadness, in the past 2 years, which they found difficult to cope with by themselves
(below average).
More Canadians — 59% — who experienced emotional distress were able to get professional
help when they needed it (above average compared with the international average of 54%).

Again, Single Payer does not seem to be the determining variable here:

Canadians are high users of
emergency departments
Adults who used an emergency department in the past 2 years: Country results from
highest to lowest
Canada, 41% (below average); Sweden, 37%; United States, 35%; France, 33%;
Switzerland, 30%; Commonwealth Fund average, 27%; Norway, 26%; United Kingdom, 24%;
New Zealand, 23%; Australia, 22%; Netherlands, 20%; Germany, 11%

....

Emergency department wait times are longest
in Canada
29% of Canadians report waiting 4 or more hours the last time they went to the hospital
emergency department.
Patients who reported waiting 4 or more hours: Country results from highest to lowest
Canada, 29% (below average); Sweden, 20%; Norway, 13%; United States, 11%;
Commonwealth Fund average, 11%; Australia, 10%; New Zealand, 10%; United Kingdom, 8%;
Switzerland, 7%; Netherlands, 4%; Germany, 3%; France, 1%

Yes, wait times for specialists and elective surgeries are longer:

Wait times for specialists are longest in Canada
and not improving
Patients who waited 4 weeks or longer to see a specialist, after they were advised
or decided to see one in the last 2 years: Country results from highest to lowest
Canada, 56% (below average); Norway, 52%; New Zealand, 44%; Sweden, 42%;
United Kingdom, 37%; Commonwealth Fund average, 36%; France, 36%; Australia, 35%;
Germany, 25%; United States, 24%; Netherlands, 23%; Switzerland, 22%

...

Wait times are longer than average in Canada
for all elective surgeries
Patients who waited 4 months or longer for elective surgery in last 2 years: Country
results from highest to lowest
Canada, 18% (below average); New Zealand, 15%; Norway, 15%; United Kingdom, 12%;
Sweden, 12%; Commonwealth Fund average, 9%; Australia, 8%; Switzerland, 6%;
Netherlands, 4%; United States, 3%; France, 2%; Germany, 0%
Median wait times in days for priority procedures in 2014
Cataract surgery: Canada, 48 days; Commonwealth Fund average, 73 days
Hip replacement: Canada, 87 days; Commonwealth Fund average, 100 days
Knee replacement: Canada, 98 days; Commonwealth Fund average, 126 days
Note: The Commonwealth Fund average median wait time is calculated using the following countries: Australia, Canada, New Zealand, Norway and the United Kingdom.
While Canada performs better when it comes to wait times for priority procedures (cataract, hip and knee), these procedures account for less than half of elective surgeries in Canada9
(unpublished data, National Ambulatory Care Reporting System and Hospital Morbidity Database, CIHI).

Note that these "elective surgeries" are often just skipped by U.S. citizens with high deductible insurance plans.

https://www.cihi.ca/sites/default/files/document/text-alternative-version-2016-cmwf-en-web.pdf

[XenaLives]

This article outlines the need for evidence based healthcare protocols in detail.. hint, that ain't what we got now....

https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/

[XenaLives]

Our current pay for play system is not evidence based, it is dogma based.

This article explains why. Excerpt follows, much more info in the article:

What the patients in both stories had in common was that neither needed a stent. By dint of an inquiring mind and a smartphone, one escaped with his life intact. The greater concern is: How can a procedure so contraindicated by research be so common?

When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?

For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.

....

A separate but similarly themed study in 2012 funded by the Australian Department of Health and Ageing, which sought to reduce spending on needless procedures, looked across the same decade and identified 156 active medical practices that are probably unsafe or ineffective. The list goes on: A brand new review of 48 separate studies—comprising more than 13,000 clinicians—looked at how doctors perceive disease-screening tests and found that they tend to underestimate the potential harms of screening and overestimate the potential benefits; an editorial in American Family Physician, co-written by one of the journal’s editors, noted that a “striking feature” of recent research is how much of it contradicts traditional medical opinion.

That isn’t likely to change any time soon. The 21st Century Cures Act—a rare bipartisan bill, pushed by more than 1,400 lobbyists and signed into law in December—lowers evidentiary standards for new uses of drugs and for marketing and approval of some medical devices. Furthermore, last month President Donald Trump scolded the FDA for what he characterized as withholding drugs from dying patients. He promised to slash regulations “big league. … It could even be up to 80 percent” of current FDA regulations, he said. To that end, one of the president’s top candidates to head the FDA, tech investor Jim O’Neill, has openly advocated for drugs to be approved before they’re shown to work. “Let people start using them at their own risk,” O’Neill has argued.

So, while Americans can expect to see more drugs and devices sped to those who need them, they should also expect the problem of therapies based on flimsy evidence to accelerate. In a recent Stat op-ed, two Johns Hopkins University physician-researchers wrote that the new 21st Century Cures Act will turn the label “FDA approved” into “a shadow of its former self.” In 1962, Congress famously raised the evidentiary bar for drug approvals after thousands of babies were born with malformed limbs to mothers who had taken the sleep aid thalidomide. Steven Galson, a retired rear admiral and former acting surgeon general under both President George W. Bush and President Barack Obama, has called the strengthened approval process created in 1962 the FDA’s “biggest contribution to health.” Before that, he said, “many marketed drugs were ineffective for their labeled uses.”

Striking the right balance between innovation and regulation is incredibly difficult, but once remedies are in use—even in the face of contrary evidence—they tend to persist. A 2007 Journal of the American Medical Association paper coauthored by John Ioannidis—a Stanford University medical researcher and statistician who rose to prominence exposing poor-quality medical science—found that it took 10 years for large swaths of the medical community to stop referencing popular practices after their efficacy was unequivocally vanquished by science.

https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/

[XenaLives]

Lobbyists should not have more influence than people.

Documented political obstruction of Single Payer:


A slide from Partnership for America’s Health Care Future presentation.

An excerpt:

In several competitive races, the Partnership pressed candidates to use industry-crafted talking points when speaking about health care. In one internal planning document circulated with health care lobbyists, the Partnership touted its influence over Danny O’Connor, the Columbus, Ohio-area Democrat who ran for the 12th Congressional District, claiming that O’Connor used Partnership talking points “in national news interviews.” (O’Connor’s campaign did not respond to a request for comment.)

Several of the candidates who agreed to embrace the Partnership’s messaging and policy ideas, including Donnelly and O’Connor, came up short on Election Day. A recount ending on November 18 confirmed that Nelson received fewer votes than Republican challenger Rick Scott. But soon after Election Day results came in, the Partnership went on the offensive, informing reporters that candidates who embraced “Medicare for All” had also lost, pointing to the defeat of progressives such as Kara Eastman in Nebraska. The group also relied on research from the business-friendly Democratic think tank Third Way to argue that victorious pro-“Medicare for All” candidates couldn’t attribute their success to having supported “Medicare for All” because few Democrats explicitly mentioned the policy in their campaign advertisements.

“’Medicare for All’ didn’t win,” said Joel Kopperud, the vice president of government affairs at the Council of Insurance Agents and Brokers, one of the industry groups backing the Partnership. “I don’t think that the Bernie Sanders $32 trillion solution that’s going to eviscerate the insurance for 156 million Americans is really something that’s going to be helpful to the party in critical states,” he added in an interview with The Intercept.

Kopperud represents insurance brokers who sell employer-based health insurance coverage. He noted that his organization has a vested interest in backing the Partnership. “Medicare for All,” as some envision the policy, would eventually eliminate the need for most health insurance plans — a death knell for companies represented by the CIAB.

https://theintercept.com/2018/11/20/medicare-for-all-healthcare-industry/

[XenaLives]

A comprehensive article on Single Payer:

Excerpt:

What a Single-Payer System Is (and Is Not)
By its strictest definition, single-payer refers solely to the mechanism for financing health care. With a single-payer system, only the government is responsible for reimbursing care providers. Its purported advantage: by unifying the financing in one entity, the buyer of services functions as what economists call a “monopsony,” which can drive hard bargains on behalf of patients.

A corresponding feature is the pooling of risk. By creating a single insurance pool with no option for households to drop or expand coverage, the insurer (here, the government) has no need to match the risk characteristics (such as age, gender, pre-existing conditions, etc.) of the insured with likely costs. Everybody’s in it together.

As a practical matter, a number of other features go with single-payer financing. For one, the system is generally financed with taxes rather than premiums charged to individuals or their employers. The taxes are generally progressive, effectively subsidizing lower-income households by delivering the same benefits for less money.

In some single-payer systems, the monopsony is absolute — no health care services can legally be purchased for cash. This feature isn’t needed to make single-payer functional, however. For example, a limited single-payer system might be confined to providing catastrophic coverage, leaving households to buy supplemental private coverage or go it alone for the first thousands of medical bills. But there’s a trade-off: if medical providers ranging from doctors to hospitals to drug companies can sell services to other buyers, the government loses some of its price leverage.

Note some distinctions here. There are “all-payer” systems, like the one in Germany, where multiple private insurers band together (with government permission) to assert monopsony power over providers. Single-payer systems should also not be confused with hybrid systems that include a “public option,” in which households can buy coverage from what amounts to a government-owned insurer operating in a market with private insurers. Finally, in some single-payer systems (like the UK), the government also owns the hospitals and employs the doctors. In others (like Canada) only the financing component is socialized.

Cost Savings and Then Some
Single-payer health care systems have operated successfully in a variety of advanced economies. Indeed, even in the convoluted patchwork that is the U.S. health care system, Medicare functions as a Canadian-style health insurer, while the Veterans Health Administrations provide the care as well as the financing (a la Britain’s National Health Service). Of course, Medicare and the VHA serve only limited populations — and hardly anybody acknowledges the resemblance to foreign systems.

Single-payer systems have some well-documented advantages. While some of these can be achieved through regulation in multi-payer or all-payer systems, the frameworks are necessarily complex and subject to unintended work-arounds.

Most prominently, single-payer systems offer the chance to control costs with minimal sacrifice in quality. Consider the one-two punch of global budgeting and monopsony bargaining power. While the former creates an overall spending limit that gives administrators some political cover to say no to patients, the latter gives them my-way-or-the-highway leverage over provider prices. Additional savings follow from the reduced complexity of insurance with a single payer — Medicare’s administrative costs are a small fraction of those of private insurers.

Most importantly, enrollment is automatic and universal, which eliminates the need for eligibility determination and maintenance, two costly features of the current system. Additional savings are realized because there are no private insurance companies seeking supernormal profits, and there are little to no marketing costs.

Single-payer systems also create significant benefits for insured individuals beyond the health care itself. Benefits are portable, eliminating job-lock and reducing the risk of leaving a job to start a business. Many employers stand to gain, too, since they shed the cost of health insurance or the hassle of gaming their hiring practices to weed out high medical cost employees without breaking the law.

Finally, don’t forget the intangible benefits associated with single-payer health care systems ranging from social solidarity to preventing free-riding by individuals who refuse to buy health insurance, yet use the health care system when they become ill.

Federalism and Single-Payer Don’t Mix Well
Supporters of federalism see the federal structure as crucial for the preservation of democracy. The system limits the power of individual state governments because they can’t easily control the flow of people or property between the states. One consequence: interstate competition in combination with open borders drives states to give priority to economic development, sometimes at the expense of redistribution of income and wealth through tax policy or social welfare programs.

The problems encountered with efforts to expand health coverage in general, and to expand it with single-payer programs in particular, illustrate the constraints on states in a federal system. States would be forced to raise taxes, significantly so, to replace private funding. And higher taxes might push residents to relocate to other states — a problem that may be especially serious in metro areas that sprawl across state borders. Indeed, other states may use the lure of lower taxes to encourage migration.

Even if a state can manage to raise revenue to pay for expanded health care without losing businesses or workers, there may be negative economic consequences. Higher taxes almost inevitably lead to inefficiencies by driving production in the direction of less-taxed output and by outright tax evasion. This is always an issue for states that must compete for business and labor. But it could be especially problematic for health care expansion because the revenues needed would be very large.

Consider, too, that revenues from most taxes are volatile, fluctuating with the national business cycle. The federal government, for its part, can easily buffer deficit spending by borrowing. But states are often constrained by statute or constitution from borrowing to cover deficits — and even if they aren’t, the need to maintain their credit ratings limits borrowing. Many states are also required to maintain rainy-day funds to buffer tax shortfalls in hard times.

Enrollment is automatic and universal, which eliminates the need for eligibility determination and maintenance, two costly features of the current system. Additional savings are realized because there are no private insurance companies seeking supernormal profits, and there are little to no marketing costs.

Then, there’s the issue of monopsony power. One of the great appeals of a single-payer system is the bargaining power it gives the representative of consumers with respect to providers. But federalism limits that bargaining power to the degree that providers (health care professionals, drug companies) can move out of state or country or, in the case of medical equipment and pharmaceutical suppliers, afford to abandon the market. Big rich states like California are relatively safe, albeit not fully immune, in this regard. But smaller, poorer states plainly are not.

http://www.milkenreview.org/articles/would-state-based-single-payer-health-insurance-cure-what-ails?fbclid=IwAR0cyLgDpc9ENv8cJXcypxwUNNhk9dFzuy2uNGXEJW80PAtXDCxE-IUcnKk

My response to the objection in bold: Healthier workers are better workers. Single Payer will take away the need for workman's comp medical insurance and reduce the overall cost of healthcare. I don't believe that state based single payer will be a disadvantage to states that provide it, it is likely to be the opposite.

A payroll tax is the best means of funding Single Payer IMO.

[Buddy P Hart]

Thanks for the information..
https://www.alliancepublicadjusters.com/public-adjuster-orange-county

[dia76ca]

This is a very good resource. http://canadiandoctorsformedicare.ca/Who-We-Are/

[REECE2017]

Consumer and Provider Costs
As hospital, doctor, and health coverage markets merge and modify in retort to health care transformation, a few analysts have called for forceful implementation of the federal antitrust regulations to avert the attainment and application of market control. In health care, though, firmer antitrust implementation will help consumers merely if it accounts for the competitive biases triggered by the sector's extensive history of government rules. As a result, this leads legislators to an abandoned facet of health care competition that has remained changed by policy: the commodity. Competition may have been unsuccessful to decrease prices considerably, surge access, or enhance quality in health care for the reason that we have continued to purchase and vendor erroneous items. Competition legislators-including both antitrust implementers and regulators -must make the health care business delineate and market commodities that can be gathered and merited to consumers while keeping developing segments including mHealth apart from extreme directive, inappropriate funding, and annexation by reputable insurer and provider interests (Sage, 2014). On the other hand, the federal exchanges have newly added a calculator to streamline copayments, coinsurance, deductibles, and out-of-pocket maximums. Still, less than nine percent of uninsured individuals have numeracy aptitude that would facilitate them to accomplish such intricate tasks without assistance (Greene, Hibbard, & Sacks, 2016).
Healthcare Competition Influences Consumers
Furthermore, the possible remuneration is better efficacy by amalgamation and merging. The threat is expanding market control that can be utilized to surge costs and then damage consumers. The stakes are considerable: The United States throws away roughly $1 trillion annually for the reason that its health care system is ineffective: Currency is not expended on items that individuals value the most, and those items are not generated at the least possible price (Sage, 2014)
Conclusion
Firmer implementation of antitrust regulation has come to be a prevalent remedy for expensive health care prices. The lack of cautious preparation, though, aiming for "consolidation" will be considered as an illogical procedural approach for enhancing health system presentation as confronting "waste, fraud, and abuse" was a generation in the past (Sage, 2014). Moreover, research shows the related projected out-of-pocket expenditure for care and premiums, along with the financial afflictions they inflict, for the families of adults under two model synopses: attaining coverage through a silver plan with funded cost distribution and registering in expanded Medicaid (Hill, 2015).


References
Greene, J., Hibbard, J. H., & Sacks, R. M. (2016). Summarized costs, placement of quality stars, and other online displays can help consumers select high-value health plans. Health Affairs (Project Hope), 35(4), 671. doi:10.1377/hlthaff.2015.1367

Hill, S. C. (2015). Medicaid expansion in opt-out states would produce consumer savings and less financial burden than exchange coverage. Health Affairs (Project Hope), 34(2), 340-349. doi:10.1377/hlthaff.2014.1058

Sage, W. M. (2014). Getting the product right: How competition policy can improve health care markets. Health Affairs (Project Hope), 33(6), 1076-1082. doi:10.1377/hlthaff.2013.1183

[XenaLives]

Why doctors are supporting Single Payer in the U.S.:

One of many reasons discussed in the article:



https://www.linkedin.com/pulse/insurance-driving-physicians-mad-nearly-half-now-say-theyd-kutscher

[XenaLives]

To begin with - Universal Healthcare comes in many forms.

It is not necessarily Nationalized Healthcare or Socialized medicine.

The Single payer proposals most popular in the U.S. leave the healthcare infrastructure intact. Principle savings are realized from the elimination of insurance company overhead, additional paperwork, better control over fraud, and being able to track the quality of provider care. None of these things will affect your relationship with your current healthcare provider (unless of course, he's doing unnecessary surgeries or a quack).

True socialism is defined as ownership of the means of production by the state. In Colorado the University hospital system is expanding rapidly and even threatening the existence of the local hospital that has served my community for years. This is a real matter of concern because if this trend continues we may be depending on the government for our healthcare and private physicians may be forced to quit practice or join the system.

Additional savings will come from being able to negotiate with pharmaceutical companies and hospitals for fair pricing.

Families will be able to afford to take their children to the doctor when they get sick, not wait until they are seriously ill.

With an aging population, I believe it is the only sustainable option for the U.S. healthcare system.

This is not a discussion that can be brushed aside with a few partisan memes or anecdotes of failures in other countries. It deserves serious, open minded discussion and that is what I would like to see on this board.