Saturday, August 29, 2009

Money-Driven Medicine

"Dying is not a big deal to me, but people have got to go through a lot to get there." What people have to get through is the preventable pain that comes from having an illness or a series of medical problems that they cannot afford to treat. What people go through is a system which has not been conceived to make people healthy, but to produce income for companies, CEOs and shareholders.

Watch Money-Driven Medicine, part 1 and part 2, which aired last night on Bill Moyers Journal.

Here's how Moyers closed last night's broadcast (from the transcript on the Journal's website:
BILL MOYERS: MONEY-DRIVEN MEDICINE, a film produced by Alex Gibney, Peter Bull and Chris Matonti; directed by Andy Fredericks; and based on Maggie Mahar's book of the same name.

Log on to and click on BILL MOYERS JOURNAL - Maggie Mahar will be there to answer your questions online. We'll link you to the Money-Driven Medicine website where there's more info about the book and the film. We'll also link you to some analysis of what advocates of reform are up against in taking on the health insurance industry, the drug lobby, and the Wall Street equity firms.

Take a look at this recent cover of BUSINESS WEEK. Reporters Chad Terhune and Keith Epstein write that the CEO's of the giant insurance companies should be smiling - their lobbyists have already won. Quote: "no matter what specifics emerge in the voluminous bill Congress may send to President Obama this fall, the insurance industry will emerge more profitable."

And remember that television ad Barack Obama made as a candidate for president?

BARACK OBAMA: The pharmaceutical industry wrote into the prescription drug plan that Medicare could not negotiate with drug companies. And you know what, the chairman of the committee who pushed the law through went to work for the pharmaceutical industry making $2 million a year. Imagine that. That's an example of the same old game-playing in Washington. I don't want to learn how to play the game better. I want to put an end to the game-playing.

BILL MOYERS: Now look at this recent story in the LOS ANGELES TIMES. Lo and behold, since the election, the pharmaceutical industry's $2 million dollars a year superstar lobbyist Billy Tauzin has morphed into President Obama's pal. Tauzin says the President has promised not to pressure the drug companies to negotiate with the government for lower drug prices and has agreed not to allow cheaper drugs to be imported from Canada or Europe - contrary to the position taken by candidate Obama…

Each of these stories illuminates the scarlet thread that runs through Maggie Mahar's book - the story of how today's market-driven medical system gives Wall Street investors life and death control over our health care, turning medicine into a profit machine instead of a social service to meet human need. That's the conflict at the heart of next month's showdown in Washington.

I'm Bill Moyers. See you next time.

One day, we're gonna wake up and find out that we don't have Bill Moyers any more. What a hopeless day it will be.


Tom said...

Hey Fab,

Nice to see you're blogging again. I have a quick, probably ignorant, question about the health care reform debate. It's clear that the Republicans wont' accept a bill that doesn't include tort reform. Now I can see why liberals might initially oppose this (I think) and certainly why they think it won't do much to fix the current system. But it seems plausible to me that tort reform would help control costs and that is surely one of the goals of reform. So if you're a Democratic congressperson why not, for example, propose a bill that has both a public option and tort reform? In short, I guess my question is, why isn't that on the table for the Democrats? (Or is my premise--that it's not on the table--false?)

Sirfab said...

Thanks Tom, it's good to have the time to blog again.

My short answer to your question (why ignorant?): It's clear Republicans won't accept any bill, period.

The long answer is, Republicans are betting that killing any bill that will them an edge over Democrats in the 2010 mid-term elections. Will it?

Rachel Maddow drew a somewhat convoluted analogy, using basketball, to explain what Republicans are doing and how ridiculous the idea is that they are looking for Democrats to work with them. You can see it here.

Democrats, on the other hand, seem to be handling things like a scorned but relentless suitor does after the umpteenth rejection by the object of their desire. Every time Republicans raise the bar for compromise, Democrats seem to delude themselves: "if we make this one extra concession, she will yield to our entreats." It's really pathetic, when you think about it. As Maddow rightly points out, there is nothing Democrats will do that will convince even one lonely Republican to go along with them.

As far as malpratice suits go, they account for but a sliver of the total cost of health care in this country (can you say 0.5%?).

Also, consider this excerpt from Maggie Mahar's Money-Driven Medicine: "While Americans file 50 percent more malpractice claims than patients in the United Kingdom and Australia, and 350 percent more than in Canada, malpractice payments--including both awards and settlements--are significantly lower, on average, in the United States than in either Canada or the United Kingdom.

Moreover, while the size of malpractice payments has been growing at a stiff pace in the United States--rising by an average annual rate of 5 percent over inflation from 1996 to 2001--over the same span, malpractice awards in Australia, Canada, and the United Kingdom were outstripping inflation by a whopping 10 to 28 percent."

So, you see, the issue of tort reform is overplayed, simply because--much as people are angry with insurance companies--lawsuit manufacturers make even better scapegoats. And Republicans, god bless them, will do anything to misrepresent issues to their advantage. And why shouldn't they, as long as the American people don't bother to check the facts?

In essence, if I were a Democratic Party leader, I would stop the kabuki dance and tell Republicans to go to hell. And then I would try to pass a bill that will meaningfully reform health care with the votes I already have, whipping blue dog Democrats into their place and threatening to run against them with all the resources the party has if they don't. If a bill does not pass, and costs remain on the run, Republicans will pay for it sooner than later. But that's only my opinion.

Tom said...

Hey SirFab, thanks for the interesting and informative answer. But I guess I still think that, politically, it would make a lot of sense for Democrats to add tort reform to what they are doing, even if such reform wouldn't do a lot to control costs. If nothing else, it would give them a kind of leverage with independent voters and show a willingness to compromise. Not including it is to not include the main kind of reform that more conservative types want.

I grant that the Democrats and particularly the President, have done a lot to show they are willing to compromise--in fact, maybe they've done too much. But as far as I can tell, the kind of compromise they've done is to back off some of what they'd like to do but they've not been compromising by incorporating things conservatives want done (of course part of the problem is that conservatives don't want to do much to reform the health care system). Why not say, "We'll give you tort reform in the form of limits to punitive (not compensatory) damages but we'll also insist on a public option"? I just don't see that they'd have anything to lose with such a gesture.

Sirfab said...

Hi Tom. I see where you are coming from on tort reform and independent voters. However, I'd consider a couple of things:

Under Bush The Stupid's Administration, the power of regulatory and enforcement agencies has been gutted, their staff reduced, their budgets slashed. That has been a theme with Republican administrations and Congresses, of late, and I think it will continue in the future. Absent strong regulation and oversight, lawsuits are the only way to get corporations to play the rules that are not being enforced.

Don't get me wrong, I believe that there is much wrong with the way American society handles lawsuits. Especially compared to Europe, where I come from, America is an overly litigious society. But I am afraid, very afraid of losing the ability to keep in check not doctors per se but hospitals, insurance companies, and the pharmaceutical industry, because regulations are weakened or eliminated and tort reform will prevent punitive damages which, sometimes, are the only language companies understand.

On the issue of compromise, I would make a distinction between conservative politicians and conservative voters: any move Democrats make at this point toward compromise should be clearly and unmistakably aimed at showing goodwill toward conservative voters, not toward conservative politicians, the latter having shown over and over again that there is nothing Democrats can do to soften thei opposition to any reform. In that sense, some form of tort reform might play well with the conservative audience (at the risk, may I add, of alienating some progressive voters, so really a long term cost-benefit analysis would be in order.)

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