Are we getting ready for universal health care Clinton style?

Doctor Dave,
Who , in your opinion, is the most Pharma friendly presidential candidate? And who is the least friendly one?
Thank you.

[DrDave]

Take this with a huge grain of salt, as I am not an expert. This is my humble opinion. Of the two so-called major parties:

Most pharma friendly: Guiliani
Least pharma friendly: Edwards

That said, I'm skeptical that either are truly contenders for President. In terms of the other candidates from these two parties (Obama, McCain, Clinton, Huckabee, Romney), I'm not convinced that there is really THAT much difference in terms of pharma's interests.

But once again, I am no expert, so I'm looking forward to hearing your opinions and the rationale behind them.

Originally Posted by DrDave

Take this with a huge grain of salt, as I am not an expert. This is my humble opinion. Of the two so-called major parties:

Most pharma friendly: Guiliani
Least pharma friendly: Edwards

That said, I'm skeptical that either are truly contenders for President. In terms of the other candidates from these two parties (Obama, McCain, Clinton, Huckabee, Romney), I'm not convinced that there is really THAT much difference in terms of pharma's interests.

But once again, I am no expert, so I'm looking forward to hearing your opinions and the rationale behind them.

Not the op here but I think the most pharma friendly candidate is the one that does nothing with health care. Because of this I think the only one to worry about is Clinton but she has no chance of winning. America isn't ready yet even in the 21st century. Edwards has no shot either in my opinion.

The short answer: I don't know.
Conventional thinking is that republicans are Pharma and doctors friendly. But has it helped?
Just a quick look at the outcomes of the last few years of the republican reign indicates some evil trends for both the pharmaceutical industry and the doctors. There is an active war for redistribution of wealth and influence. Parties ( HMOs, PBMs, bureaucracy, lawyers, etc) that produce nothing but panic and fear in public, and invest nowhere but in our demise seem to be putting everyone else on the knees. Public opinion, well manipulated by mass media, is growing against the cause of all problems in life - big Pharma. The only other industry that is made look as bad is Big Oil.
Forget about years of R&D, forget about taking risks of investing billions in hope, forget about cure for cardiovascular diseases, cancers and such. The public chooses to think that it's all done "for the money". And hence the foundation of the free market is questioned on the example of Pharma.
Those candidates who blame rich, successfully capitalize on the public opinion. They call for fairness but mean socialism. Even though I am not impressed with the outcomes of the GOP era, I believe that Clinton, Edwards, Obama will be more aggressive in redistribution of wealth and power. Of the republicans Romney and Giuliani are likely to be less hungry to take away from Pharma.

i hope there is a change, the truth is we are miss using funds (over billing, lack of care and over meds) this system needs change people need better care and access to care. docs need to be in this profession for the people not the cash and reps need to xed out no need for them. Docs need to search out best treatment on thier own or by attending courses not dinners. I was a women health rep for 4 years went to med school = now OB res and pt advocate. Both sides have not self regulated, so let goverment do their job.

i hope there is a change, the truth is we are miss using funds (over billing, lack of care and over meds) this system needs change people need better care and access to care. docs need to be in this profession for the people not the cash and reps need to xed out no need for them. Docs need to search out best treatment on thier own or by attending courses not dinners. I was a women health rep for 4 years went to med school = now OB res and pt advocate. Both sides have not self regulated, so let goverment do their job.

Originally Posted by DrDave

Take this with a huge grain of salt, as I am not an expert. This is my humble opinion. Of the two so-called major parties:

Most pharma friendly: Guiliani
Least pharma friendly: Edwards

That said, I'm skeptical that either are truly contenders for President. In terms of the other candidates from these two parties (Obama, McCain, Clinton, Huckabee, Romney), I'm not convinced that there is really THAT much difference in terms of pharma's interests.

But once again, I am no expert, so I'm looking forward to hearing your opinions and the rationale behind them.

Late on this thread. Thanks for the honest opinion Dr.D. I believe if/when UHC comes it will be an irreversible disaster. The government will become the primary payer (without a close second). They will dictate what procedures are approved, create huge backlogs to see a specialist (first come, first serve) and choke off reimbursement rates for practitioners. The low reimbursement rates for physicians will be huge, because most employers will drop coverage for employees due to the available UHC. In order for physicians to make money, they will have to see a huge volume of patients. Veteran physicians will smarten up and close their practice to UHC patients and have a limited number of managed care (anthem, cigna...etc) patients that provide adequate revenues. Those patients (the elderly and the poor) who are left behind will more than likely end up at the new in-house medical care centers popping up at walmart and other pharmacies. So, instead of having a veteran MD or DO provide treatment for them-they'll have some newbie PA or NP. That sucks for them and is bad for our country. Also, with the voiding of patents going on, we can look to a short term generic bonanza followed by the death of new pharmaceutical products. Those with alzhemiers, cancer, als and other chronic diseases sorry. We just cut the revenue sources out from the pharma companies so they got out of the business. Ask your friendly foreign generic manufacturer to create a new compound. They don't do that. Scary times indeed!

If you want to see what a single-payer system will look like in this country, just look at how well the V.A. and Medicare systems work. If that doesn't scare you, nothing will.

Just because we need health care for those who are currently uninsured, doesn't mean we need a single government payer to control it. There has got to be a better way.

Dr. Dave, your thoughts please:

Discussions about universal health care begin with the premise that the question is whether or not we should have it. But the reality is that in a manner of speaking we already have "universal health care." The problem is that is is ineffective clinically and very inefficient.

Consider: Most people are covered through their employer, some people are self-insured, and everybody else either goes without proper medical care or goes to the emergency room of public hospitals for routine care. Going to the E.R. for routine medical care is like doing all your Christmas shopping at the airport gift shop: very expensive and limited choices. And going without attention to medical conditions due to inability to pay makes the eventual treatment even more expensive later.

So we're already paying for those without insurance. Wouldn't it be better medically and economically to have a structured approach than to operate on the scramble system?

Thanks

[DrDave]

So we're already paying for those without insurance. Wouldn't it be better medically and economically to have a structured approach than to operate on the scramble system?

You make a great point about the built-in inefficiencies in our current system. For example: I'm simultaneously fascinated and appalled that our business is the only one I know that penalizes customers for paying cash. We are contractually obligated to most insurance carriers to give discounts on our fees to their patients, and we may have to wait as long as 3-4 months for payment. Cash payers pay full price, often up front. It just seems ludicrous.

The philosophical bias that I bring to the discussion is that I generally believe smaller government is better. However, I also believe that lasting change usually occurs incrementally rather than all at once. Consequently, there probably is some system that would be more streamlined and efficient (simpler and smaller) that would still provide health care for more people. In order for this to occur, though, the American patient would have to get very comfortable with systematic rationing.

I don't want to put words in your mouth, but I think we agree that we already ration: just in a crazy, haphazard way that increases our costs and strains non-profit health care institutions and government programs. If a single payer system is implemented, it should cover a basic level of health/medical care for all with covered interventions (meds, procedures, tests) well supported by evidence. In other words, if you want services over and above the basics, you will need to figure out a way to pay for them. Therefore, I believe there could and probably would still be a medical marketplace, so to speak, with a single payer system. I might even go so far as to say that such a marketplace would be more "real" than the one we have now, since the patient would be more directly involved in the cost-benefit analysis for certain interventions if they come directly out of pocket.

At any rate, I agree that our system is broken, and it definitely needs fixing. Thanks for your post!

What is insurance in short terms...spreading risk and cost across a great number. I am not completely against health care for the currently uninsured but think there has got to be a free market fix to it. Actuarial science people should be able to evaluate out of the mix of uninsured patients now, who would pay for a policy. After that, look at the avg. age of subscriber, and create different levels of insurance for the person to chose from. Something like this would come from a private insurer, kind of makes sense to me for someone to develop a plan like this. However, don't know much about it, what does anyone else think?

Originally Posted by Doctor Max

Doctor Dave,
Who , in your opinion, is the most Pharma friendly presidential candidate? And who is the least friendly one?
Thank you.

"Dr" Max, why would a "doctor" care if a presidential candidate is pharma friendly?

Hi, Doctor Dave:
Here is your quote from earlier this year: ".... In terms of the other candidates from these two parties (Obama, McCain, Clinton, Huckabee, Romney), I'm not convinced that there is really THAT much difference in terms of pharma's interests...."
I am wondering if you feel any different with just a few days left before the elections.
Thanks for your answer.

[DrDave]

As a disenfranchised Libertarian (IE, not supporting Bob Barr), my views remain the same.

Originally Posted by DrDave

As a disenfranchised Libertarian (IE, not supporting Bob Barr), my views remain the same.

Thank you. I always enjoy your opinion. Please allow me to quote from my blog DrugReptime.com on this topic:

Obama brand is a great example of an outstanding branding strategy and execution. Him and his campaign deserve standing ovation for bonding with consumers. It is unparalleled in the recent history. His brand became bigger that Lipitor, Advair, Nexium and Plavix (world’s top pharmaceutical brands) combined. He is like a drug that everybody wants to take without ever reading the package insert. No reason to read the indications, cautions, or side effects. Just take it because “it’s good for you”. You will experience “the change you need”. In what areas? Just about everywhere. He is a Percocet for pain, a Xanax for anxiety, an Ambien for sleep, a Viagra for erection and a fish oil for coolness. You might guess that I share conservative values of republicans. Maybe. But I gotta tell you, that it is on the republican watch that such detrimental changes to pharmaceutical companies as the Pharma guidelines and the death of free marketing and next to viral proliferation of regulatory and legal departments in your companies actually happened. Go figure. So, what’s ahead for you? As it stands right now, after BIG OIL the second enemy of happiness for Americans is BIG PHARMA. Get ready and tighten your seat belts, folks. You thought it was tough, but you haven’t seen nothing yet. The socialization of health care means that pharmaceutical companies, formerly free dogs, who now walk on leashes, will be placed in cages. Their ability to grow and to generate revenues will be so dramatically impacted that before you know the layoffs will start. And with that, how can one explain why pharma gives Obama’s campaign more contributions than to McCain’s? Probably they are hedging their bets, hoping for liberal mercy.

O.K. this is my advice for the 2008-2009 political season: update your resume today, put yourself on LinkedIn or go work for legal and regulatory departments of your esteemed companies.

Doctor Max

Take a look at the stimulus package for yourself 650+ pages and over 1/3 devoted to electronic health records and the rationing of healthcare or "everyone in America". A panel will dictate "appropriate" healthcare and reward/penalize those providers that do not subscribe to the "panels" recommendations.

http://www.rules.house.gov/111/LegText/111_hr1_text.pdf

What is of greatest interest is NO ONE is talking about this. Tom Daschle wrote in his book- the best and easiest way to pass national healthcare would to place it in a stimulus package "undercover" where it would not have same debate problems as a social reform bill.

Click on the above link and search for the word "health" or words "electronic health record"

It is also amazing that the candidates did not want to release personal medical records but want everyone in America to have their personal medical records available for anyone to see. Yes they will try to keep them private but we all know of the leaks that happen and records of all kinds are lost/stolen daily.

I do not want my personal medical information available to anyone without my consent. Under this bill many would have access to all health related info. Health Ins. / Life Ins., employers, government agencies, marketing companies, researchers, etc. The implications are huge. Link a family history of fatal or costly diseases and no job, no insurance, no procedure, etc.

The bill also states that procedures and meds will undergo clinical/cost evaluations for "cost effectiveness". Connect the dots. They won't have to show equal effectiveness just cost less alternative. So we have "dumbed down" our education now we plan to choose our healthcare based on lowest cost? Lowest cost could mean NO CARE. If we ration healthcare (only way to reduce costs to include "everyone in America) a med or proc. that is effective in >90%, >70%, 50%, 30% will it be paid for because the "panel" does not recommend it.

I chose my physician for a reason and I want him to be able to continue to practice medicine. If this bill passes as is healthcare will devolve into "check the box" for can and can't(s) based on whole populations not individualized medicine.

Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey
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Commentary by Betsy McCaughey


Feb. 9 (Bloomberg) -- Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.
Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.
Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).
The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.
But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”
Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.
New Penalties
Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)
What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.
The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.
Elderly Hardest Hit
Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.
Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).
The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.
In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.
Hidden Provisions
If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.
The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181).
Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration’s health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.”
More Scrutiny Needed
On Friday, President Obama called it “inexcusable and irresponsible” for senators to delay passing the stimulus bill. In truth, this bill needs more scrutiny.
The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.
(Betsy McCaughey is former lieutenant governor of New York and is an adjunct senior fellow at the Hudson Institute. The opinions expressed are her own.)
To contact the writer of this column: Betsy McCaughey at Betsymross@aol.com
Last Updated: February 9, 2009 00:01 EST