The K.F. Stone Weekly

LIFE is a Pre-existing Condition

 

LIFE Is a Pre-existing Condition Audio

 

This past Thursday, '45 and a couple of dozen Republican House members gathered in the White House Rose Garden to celebrate passage (by a single vote) of their greedy, sadistic and dangerously sophomoric "American Healthcare Act." To call their celebration premature or overblown would be kind, for in truth, it was tantamount to breaking open a case of champagne because your team scored a run on an inning-ending double play in the top of the first of the first game of the season. But then again, '45 does relish victories, no matter how small or pyrrhic. And if there is a God in the heavens, this 217-213 vote victory will be of the pyrrhic sort – the definition of which is  "Coming at far too great a cost to have been worth it all."  There's no question that the Democrats – none of whom voted in favor of this atrocity – fully understand the meaning of "pyrrhic victory." Moments after the vote tally was announced many of them began singing Steam's "Na Na Hey Hey Kiss Him Goodbye" to their colleagues across the aisle.  They were, of course, referring to the 2018 mid-term election . . .

One wonders how many of the 217 Republicans who voted for this bill (20 voted against it) had read – let alone –understood just how nasty, misguided and hardhearted a piece of legislation their party gurus had crafted. For indeed, the American Healthcare Act guts some of the most widely supported aspects of Obama care, such as:

• Denying insurance companies the right to charge significantly higher rates to people with pre-existing conditions; 
• Eliminating lifetime caps on insurance coverage, and
• Creating a system in which enhancing and fostering wellness is just as important as treating illness.  

Who knows? Perhaps a lot of the Republicans voting in favor of this bill really didn't support it, were betting that the Senate version would eliminate its most egregious clauses, but nonetheless felt they had to walk in lockstep with their wealthiest donors, most of whom are more concerned with the enormous tax advantages coming their way than with the health of the American public.

For make no mistake about it, the House version of this bill has as much to do with putting hundreds of billions of dollars into the pockets of the wealthiest Americans than with making sure that all Americans can afford health insurance. The Republicans were in such a hurry to keep '45's campaign promise to "repeal and replace" Obamacare that they couldn't even wait for the Congressional Budget Office's cost analysis - which would have provided an estimate of how much the bloody thing will cost and how many millions of people will likely be losing their insurance.  According to the Tax Policy Center, the bill would cut taxes by about $765 billion over the next decade.  The lion's share of the tax savings would go to the wealthy and hyper-wealthy.  The top 20 percent of earners would receive 64% of the savings and the top 1% of earners (those making more than $772,000 in 2022) would receive 40% of the savings. Additionally, this bill would allow insurance companies to charge older customers up to five times more than younger customers — up from a maximum 3-to-1 ratio under the current health law.

And yet, '45 and his merry band continue to proclaim that the AHCA will provide better coverage for all at a greatly reduced cost (unless one is poor, un- or under-employed or has a pre-existing condition).  Truth to tell, most all of us have some sort of pre-existing condition.  For under terms of the AHCA, pre-existing conditions include - to name but a few -  Acne, allergies, anxiety, asthma, basal cell skin cancer (a type of skin cancer that doesn't tend to spread), depression, ear infections, fractures, high cholesterol, hypertension, incontinence, joint injuries, kidney stones, menstrual irregularities, migraine headaches, being overweight, restless leg syndrome, tonsillitis, urinary tract infections, varicose veins, and vertigo. 

In other words, life itself is a pre-existing condition, which means that an awful lot of people are either going to be without affordable health insurance, or else shoved into into pricey (and grossly underfunded) "high-risk pools" where coverage will be beyond their means.  And then hospital emergency rooms will return to being the healthcare destination of first - and last - resort for the un- and under insured.  By law, emergency rooms must tend to anyone who walks through the door.  This fact has long served as both a talking point and rationalization for anti-Obamacare conservatives. "No one is denied medical attention," they declare; "all they have to do is get themselves to an E. R." While this is technically true, an E.R. can do next to nothing for an uninsured person walking in, telling a nurse or doctor they simply don't feel well, going through a battery of tests, and then being diagnosed with, say, Crohn's disease, glioblastoma (an incredibly aggressive cancer) or Multiple sclerosis, all of which require rigorous long-term care. For those without insurance, the diagnosis is tantamount to a death sentence. 

So now the American Healthcare Act act goes over to the Senate, where it's most politically lethal aspects will be amputated, rewritten and likely rehabilitated. This is going to take weeks, if not months. And then, following the vote on whatever the Senate comes up with, it goes back to the House of Representatives. Whether or not that House and Senate can reach a rapprochement is anyone's guess.

Unquestionably, healthcare is going to be the central issue in the 2018 midterm election. Those House members who voted in favor of the AHCA will be wearing a bull's-eye on their political backsides. If the Democrats play it smart (and frequently they do not) they will not only aim their arrows at these bull's-eyes, but make a clear-cut and audacious case for universal health insurance. Moreover they should continually make the case that affordable healthcare is not a privilege, but a right. Yes, the Republicans will continually and breathlessly brand this audacious proposal with a label reading "Socialist" . . . But so what? Isn't it time that America stop being the only developed nation on earth (there are 33 of them) without some sort of universal healthcare - whether it be Single-Payer, Two-Tier, or Insurance Mandate?  

President Theodore Roosevelt started pushing for universal healthcare way back in 1912 – the same year Norway instituted their system. FDR, Truman, JFK, LBJ, Carter, Clinton, and even Richard Nixon all pushed for some form of national healthcare. After 105 years, isn't it about time? The American Healthcare Act – whatever its final form may be – must be rejected by the American people. For if life itself is a pre-existing condition, it must be covered.

After all, doesn't the Declaration of Independence affirm that we are all endowed by our Creator with "certain unalienable, Rights, that among them are Life, Liberty, and the Pursuit of Happiness."

Note well that "Life" comes before both "Liberty," and "the Pursuit of Happiness."

109 days down, 1,348 to go.

 Copyright©2017 Kurt F. Stone

An Obsession (un)Worthy of Munchausen, Griffith or Palissy

 

"An Obsession (un)Worthy of Munchausen Griffith or Palissy" Audio

This coming Saturday, April 29, 2017, marks a dubious historic milestone: '45's first One Hundred Days in office.  And unlike the first One Hundred Days of FDR - or JFK, LBJ, GWB or the rest of the presidential gang - '45 will have next to nothing to show for it -- save the confirmation of a new Supreme Court  Justice which is, in his inimical terminology, simply yuuuge.  Absenting this one achievement - which never would have happened without a historic, ill-considered change in Senate rules - absenting this, what do '45 and his administration really, truly have to show for their first One Hundred Days?

A humiliating withdrawal of their signature "repeal-and-replace" health care proposal? An abysmal fracturing of the GOP? A passel of Executive Orders - the lion's share of which are meant to bend, fold, spindle and mutilate   Obama's legacy? Picking fights with the very people whose support he needs? A whole bunch of policy about-faces? A series of incomprehensible phone conversations with various world leaders? A record number of weekends playing golf in Palm Beach? The telling of more fables, lies and outright bullsh*t than ever attributed to the real or fictional Baron Munchausen (that's him above, as imagined by Gustave Doré)? Not precisely the kind of First One Hundred Days historians are going to remember favorably.

In the midst of all this wibble-wobble, there are precisely two things '45 has maintained a rock-solid, obsessive consistency about:  increasing the nation's military budget  by no less than 10%  and building his cockamamie wall on America's southern border. Of course, where he originally promised ad nauseum that Mexico would pay for that piece of useless architecture, '45 is now pruning every last dime he can out of the federal budget so that we, the taxpayers, can pick up the tab . . . until the time when he, Mr. "Art of the Deal" can finally, finally convince our neighbors to the south that it is in their best interest to pay back the $12 - or $20 or $50 billion - this monster will wind up costing. And of course, '45 is obsessively, compulsively constant in his insistence that the purpose of this wall is to preserve American lives, protect American jobs and defend American honor. 

Two of the most egregious and dangerous cuts being made in order to pay for '45's Maginot Line are those aimed at the National Institutes of Health (NIH), and the Food and Drug Administration (FDA). The proposed N.I.H. cuts amount to 20% of the agency's $30 billion budget, while the proposed FDA cuts amount to 21%. The N.I.H. helps fund breakthrough medical research, creating new drug treatments, medical devices, and therapies for an unbelievably wide range of diseases and medical conditions. Without adequate financial backing from NIH, projects  researching various forms of  cancer, Multiple Sclerosis, heart disease, autism, diabetes, infertility and tens of dozens of other potentially fatal medical issues and conditions - including so-called "orphan diseases" (such as Acromegaly, Tourette Syndrome and Job Syndrome - will have the scientific carpet pulled out from underneath them. This doesn't even begin to take into account all the scientists, doctors, statisticians and bio-engineers who would be out of jobs.  This is a horrifying prospect - especially in light of just how close the medical community is to discovering actual cures for many heretofore fatal diseases, syndromes and conditions.

Without adequate FDA funding, that agency will have to cut hundreds - if not thousands - of positions, which will inevitably lead to a severe lessening of regulatory oversight. In truth, this is precisely what '45 and his billionaire buds want; a  "streamlining" of the regulatory process for new drug applications. This streamlining, they argue, will "prove to be beneficial in reducing the end consumer price point on new therapeutics and drugs, decrease the cost of research, thereby effectively bringing new products to market much sooner."

The question is, at what price? Writing as one who has spent nearly a quarter century vetting somewhere between 1,000 and 1,200 medical research proposals, I wish to state a truism learned through experience: that while FDA rules and regulations may tend to slow down progress a bit, it is both well and good. Jumping through FDA "regs and hoops"  helps insure that the risks-versus-benefits ratio inherent in any clinical trial puts the safety, efficacy and tolerability of new medications  and therapeutics ahead of  the  needs and perquisites of industry.  Simply put, it places people and patients ahead of profits.

For the past many years I have spent, on average, two days a week vetting medical research proposals -- that is, making sure that the research in question is ethical and then turning medical terminology into understandable English.  The goal is to insure that those who become test subjects in various medical research programs fully understand what they are agreeing to. This is the process known as "informed consent."  Its origins go back to the "Doctors Trials" held in Nuremberg in 1946. This trial considered the fate of twenty-three German physicians who either participated in the Nazi program to euthanize persons deemed "unworthy of life" (the mentally ill, mentally retarded, or physically disabled) or who conducted experiments on concentration camp prisoners without their consent.  As a result of the trial's findings, it was determined that from that date forth, no one would ever again participate in medical experiments without their knowledge and written consent.  For the past 70 years, those who practice medical ethics (myself included) take this very, very seriously.  A significant cut in the FDA budget puts this process - informed consent - in serious jeopardy.

And for what? To insure putting aside several billion dollars with  which '45 can fulfill his  obsession with increasing the military budget and constructing his own Great Wall? History records the exploits of any number of obsessive-compulsives who went to insane lengths in order to fulfill their dreams. Back in the 16th century, French Huguenot  potter Bernard Palissy became so obsessively committed to recreating ancient Chinese porcelain that he burned his furniture and even, it is said, the floor boards of his house in order to feed the fires of his furnaces (That's him, depicted burning his furniture above). Then too, 102 years ago, movie director D(avid) W(ark) Griffith spent, borrowed and mortgaged every dime he could find in order to create a film called The Birth of a Nation. Although it did earn tens of millions, it eventually bankrupted him. (n.b.:  That movie's star, Lillian Gish, would become  my mother's mentor. That's a newspaper photo of mom and Miss Lillian from 1939 or 40 at left).

Griffth's and Pallisay's  obsessive compulsive manias may have been considered both insane and excessive in their own time, but at least led to immortal works of artistic brilliance; the products of their obsessions have a place of honor to this very day.  One wonders whether '45's obsession - denuding the federal budget in order to build a wall between Mexico and the United States - will be applauded a century from now . . . not to mention in the midterm elections of 2018.  

'45 really, really ought not  to defund the NIH or FDA.  If he really, truly wants to preserve American lives, protect American jobs and defend American honor, he couldn't do better than fully funding ethical medical research.  Erecting a wall of medical research between fatal diseases and good health will save many more lives than building one constructed of concrete.

And who knows: perhaps one day medical science will discover cures for Obsessive Compulsive Disorder and Pseudologia fantastica (also known as "Munchausen's Syndrome").

94 days down, 1,366 to go

Copyright©2017 Kurt F. Stone

 

You Break It You Buy It

 

Audio Link to You Break It You Buy It

The Affordable Care Act - better known as Obamacare -  was originally, in part, the brainchild of the conservative Heritage Foundation. That flawed, though game-changing legislation was passed without the support of a single Congressional Republican . . . despite the fact that included among its original cosponsors were Senators Orrin Hatch and Chuck Grassley. That bill, by the way, came in at just about 2,700 pages, and took more than two decades to come to fruition.  Now 2,700 pages sounds like an awful lot - until you start looking at some of the other legislation Congress routinely deals with. That said, the Affordable Care Act was larger than most bills to begin with, but considering the scope of healthcare reform, that was quite understandable.

From almost the moment of its birth, Obamacare became both an epithet and a vile symbol of all that was diabolic and treasonous among Democrats. To Republicans, Obamacare became the Wolfsbane they hoped and prayed would destroy the werewolves of the left.  History records that during the Obama years, the Republican-controlled House - and eventually Senate - voted no fewer than 5 dozen times to eliminate it, all the while scaring the pants off a segment of the American public with talk of  "death panels," "socialized medicine," and "government making decisions about your health." During the 2016 election, the alliterative "Repeal and Replace" became a rallying cry - despite the fact that no one, including Donald Trump - had the slightest idea what the replacement would look like.  Just that it would be better.  And just last week, the so-called "American Health Care Act" - coming in at a sleek 67 pages - was unveiled.  Within 24 hours, Freedom Caucus members started calling it "Obamacare Lite," "RINO Care," and "D.O.A," while a handful of Republican heavyweights said they would not vote for it.  Turns out, what took Democrats 20 years and 2,700 pages, took Republicans a couple of weeks and less than 6 dozen pages . . .  of which nearly 10% took up the question of what to do about a Medicaid recipient who receives a lump sum or large payment from winning the lottery. (Answer: they are to be kicked off of Medicaid.)  Imagine that: 10% of the American Health Care Act took up an issue that affects at most about 100 people a year!

Although the AHCA does keep many aspects of the ACA (children being able to remain on their parents' policy until age 26; no penalty for preexisting conditions; no lifetime caps), it relies heavily on tax credits and ultimately would take upwards of $400 billion away from state Medicaid programs in the first  10 years.  No wonder both the American Hospital Association and the American Medical Association have come out against the plan.  Sure, with lots of people no longer having insurance, hospitals and doctors will see fewer and fewer patients, which means a drop in income.  Then again, hospitals and physicians take an oath to "first, do no harm'; fewer insured Americans means fewer healthy Americans and far more Americans using emergency rooms as their only source of healthcare. Additionally, hospitals employ lots and lots of people; the smaller the town, the higher the percentage of those gainfully employed.  In other words, with fewer and fewer dollars going into Medicaid on a state-by-state basis, the fewer employed.  And do remember, the American Hospital Association and AMA have ginormous lobbying operations on Capitol Hill that are going to do everything in their power to see that AHCA never sees the light of day.

The use of tax credits and health savings accounts is something near and dear to the hearts of most Republicans.  It assumes, of course, that individuals and/or families making, say $16,000, $25,000 or $40,000 actually have dollars they can put into these accounts or will benefit from being able to write a certain amount off on their federal tax bill.  It is often in these kinds of debates that we find out just how far out of touch legislators can be:

Take House Oversight Chair Jason Chaffetz as an example.  A couple of days ago, Chaffetz (R-Utah) said the Republicans' new healthcare proposal will offer Americans at all income levels the opportunity to afford health insurance.  Said Chaffetz: “Well, we're getting rid of the individual mandate. We're getting rid of those things that people said that they don't want. And you know what? Americans have choices. And they've got to make a choice, and so maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care. They've got to make those decisions themselves." Mr. Chairman: while iPhones do cost a couple of hundred dollars, that's just a drop in the bucket when it comes to paying for health insurance.  And giving people a $2,000-$3,000 tax credit won't come close to doing what the ACA did for poorer, younger and older Americans who now are insured.

Then there was Speaker Ryan's complaint that "The fatal conceit of Obamacare" is that young and healthy people are subsidizing care for sick people. Well, yeah . . . that's the way insurance works.  Think about automobile insurance - which is mandatory: the vast majority of those insured never need use their policies, because they don't get into accidents.  Their unspent premiums are used to pay the bills of those folks who do get into accidents.  Mr. Speaker: you really should take a 101 course in insurance.

How's about Rep. John Shimkus (R-IL) who, during a committee discussion with Democratic Representative Mike Doyle, laid out some of his problems with the Affordable Care Act, including the requirement that health-insurance plans cover certain basic health benefits like hospital and doctor visits. “What mandate in the Obamacare bill does he take issue with?” Doyle asked Shimkus. To which Shimkus replied, “What about men having to purchase prenatal care?” As the room started to buzz, Shimkus added, “I’m just … is that not correct? And should they?” Tell me Rep. Shimkus: do you think women should help fund men's prostate exams or ability to purchase Viagra?

And of course, virtually no one engaged in the healthcare debate - whether on Capitol Hill, the White House or K Street - are without first-class health insurance . . .

Even without a cost estimate from the  Congressional Budget Office (which President Trump and Congressional Republicans have preemptively rejected as being biased), it seems clear that the AHCA will lead to millions of Americans losing their insurance coverage  - especially older people living in rural America . . . a huge chunk of whom are devout "Trumpeters." Makes one wonder how all these folks are  going to react when they wake up to discover that once again,  they're uninsured and must, once again, resort of emergency room care.  I don't think they're going to jump up and wave "Trump: Make America Great Again!" signs.

Many of us remember going into toy stores as kids and seeing an ominous sign which read "You break it you buy it."  Well, the same goes for healthcare, President Trump. Those of us on the opposite side of the political aisle are going to make sure that people get used to hashtagging this proposal #TrumpCare.  In that way, when (God forbid) you dismantle Obamacare, you will have to take complete ownership of its disastrous, heartless  replacement. And that won't be good for you, for Republican governors (many of whom have already come out against it) and for Republican members of Congress . . . all of whom have gotten a taste of what it's like to face angry, angry constituents out there in the American heartland. 

You may well want to heed the words of Texas Senator Tom Cotton (R-Arkansas) President Trump. For just the other day, in announcing his decision to withhold support for t he AHCA, Senator Cotton said, Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote. If they vote for this bill, they're going to put the House majority at risk next year."

You break it you buy it; you buy it you own it!

51days down, 1,409 to go . . .

Copyright©2017 Kurt F. Stone

Give Me Imbruvica or Give Me Death

 

Audio Link to Give Me Imbruvica or Give Me Death

 

(Los Angeles): First the good news: Back on September 28, 2015 (the day on which our newest granddaughter, Claire Emily greeted the world), I posted a piece entitled Cat Crap and Capitalism. To remind those suffering from junior moments, this essay dealt with Martin Shkreli, the odious 31-year old founder and CEO of Turing Pharmaceuticals, which had recently raised the per-pill price of the drug  Daraprim from $13.50 to $750.00 . . . yes, that Martin Shkreli. My essay, in addition to dealing with the rapacious Master Shkreli, sought to voice the shock and utter revulsion most have for big pharma.  So what's the good news?  Only that Martin Shkreli got his:  a couple of days ago, Shkreli, the fellow G.Q's Max Williams labeled "The frat boy CEO" was arrested by the FBI for alleged investment fraud and duly lost his chief executive role at both Turing and his newly acquired company KaloBios Pharmaceuticals. Shkreli quickly blamed his arrest on the blaze of negative publicity ignited by the Daraprim controversy. While the price increase was technically legal, the subsequent backlash was most likely responsible for putting Shkreli on the federal radar.

In announcing the indictment, an F.B.I. official called Shkreli's business schemes. Rather, the federal case centers on Shkreli's time as CEO of Retrophin (RTRX), another biotech company that ousted him last year. According to U.S. Attorney Robert Capers, Shkreli "ensnared investors through a web of lies and deceit" and ran Retrophin like a Ponzi scheme, where he used the assets of the new entity to pay off debts from the old entity."  Although presumed innocent until proven guilty, one can only hope that Shkreli gets what is coming to him.

That's the good news.

Now for the bad . . .

Last year, the Food and Drug Administration (FDA) approved 41 new drugs, many of which produce more innovative treatments for serious diseases that can extend life and often have fewer side effects than older treatments.  This represented the highest number of new drugs approved in the past two decades.  Among them was a drug called Imbruvica ( known generically as Ibrutinib), which blocks proteins that cause malignant cells to multiply and stay alive. Originally approved for a rare illness called mantle-cell lymphoma, the medication, was later approved to treat some patients with chronic lymphocytic leukemia - a  type of cancer in which the bone marrow makes too many lymphocytes, a type of white blood cell.  So far, Imbruvica has proven to be a champ at bringing down the number of these cells - with far fewer adverse events (side effects) than previously-used drugs.

"So where's the bad news?" you rightfully ask.

Only this: the cost of Imbruvica - even for those with great health insurance coverage or Medicare - will set you back nearly $700.00 a month.  Without decent health insurance, the monthly cost can easily be ten times that amount.  For those who cannot afford even $700.00 a month - which is an awful lot of people - the consequence of stopping Imbruvica could be death.  And its not just this drug. Newly marketed treatments  for hepatitis C, cancer and multiple sclerosis that cost from $50,000 annually to well over $100,000 helped drive up total U.S. prescription-drug spending an astounding 12.2% in 2014, five times the prior year’s growth rate,  According to the Centers for Medicare and Medicaid Services,  out-of-pocket drug costs rose nearly 3% in 2014 only. 

For many of the poorest Americans, medicines are covered by government programs or financial-assistance funds paid for by drug companies. For those in the middle class, it's quite a different story. Though many patients can get their out-of-pocket costs paid by drug companies or drug-company-funded foundations, some patients make too much money to qualify for assistance. Others are unaware the programs exist. Medicare patients, who represent nearly a third of U.S. retail drug spending, can’t receive direct aid from drug companies.  Frighteningly, what we have is a huge segment of the public plagued by treatable diseases finding themselves caught between the Scylla of high drug prices and the Charybdis of death.  

A lot of people explain these sky-high prices as being the inevitable result of the multi-billion dollar costs for bringing a drug to market. And yes, it does cost a boatload of time and money to go from animal research to phase I, II, III and post-marketing studies.  One is left thinking that the profits big pharma make are both small and uncertain.  While the second issue - uncertainty - may be true, the first - profits - definitely is not.  As Richard Anderson, business reporter for BBC News has noted, pharmaceutical companies have shown greater profit growth than banks, carmakers, media and the oil and gas industry. 

 
Now while it is certainly true that research and development (R&D) costs are huge and that on average only three in ten drugs launched are profitable, the three that do make it can be worth billions in annual sales.  But the truth is that big pharma spends far more gelt - in some cases twice as much - on advertising and marketing drugs  as on developing them.  Ever wonder how much it costs for all those television ads which urge us to tell our physician to prescribe this or that drug?  (Silly me, I always thought it was supposed to be the other way around: that the doctor did the prescribing based on his or her knowledge . . .)

  No one is demanding - let alone expecting - drug manufacturers to create new drugs and then not make a profit.  But how much is enough? Lost in all this is the fact that people's lives are at stake.  Real people living real lives.  Until the day comes when America - like virtually every other industrialized country on the planet - goes to a single-payer system, good people are going to have to make the choice between paying for their prescriptions or their rent, utilities and food; between living and dying.

It doesn't seem like such a difficult choice.

Give me Imbruvica or give me death . . .

Copyright©2016 Kurt F. Stone

Cat Crap & Capitalism

 

Audio Link to "Cat Crap and Capitalism"

 

Up until a couple of days ago, few people - outside of his family, his classmates from Baruch College and perhaps a handful of vulture (uh, venture) capitalists - had ever heard of Martin Shkreli.  Then too, up until a couple of days ago, few people - outside of Infectious Disease specialists, pharmacologists and perhaps a handful of biomedical researchers and ethicists - could tell you what  Toxoplasmosis was  or identify for what conditions Daraprim, Cycloserine or Doxycycline are prescribed.

Well now we can.  Martin Shkreli (photo at left) is the 31-year old multi-millionaire founder and chief executive of a start-up called Turing Pharmaceuticals, which recently acquired the rights to sell the drug Daraprim -- and then overnight raised the per-pill price  from $13.50 to $750.00.  For those with a calculator handy, that's an astounding 5,456% price hike.  In a letter to Shkreli’s company, the Infectious Diseases Society of America — which represents more than 10,000 medical and scientific experts — said, “This cost is unjustifiable for the medically vulnerable patient population in need of this medication and unsustainable for the health care system.” In response, Shkreli told CBS News "At this price it's a reasonable profit.  Not excessive at all."

If this doesn't raise the old diastolic well past the danger level, it's likely because you've already shuffled off this mortal coil . . .

Daraprim (Pyrimethamine) is a 62-year old drug that has long been the standard of care for treating, among other serious medical conditions, Toxoplasmosis, a life-threatening parasitic infection.  (n.b.: If you are a reasonably healthy person, don't worry about contracting the Toxoplasma parasite.  However, if you have an impaired immune system, you could be in jeopardy - especially if you come into contact with cat feces which are a major host for the parasite.  In other words, if you have a crummy immune system, stay the hell away from cat crap.  And oh yes, one can also contract the parasite by eating or drinking contaminated food or water.)

While one might suggest that physicians respond to this unconscionable price hike by simply prescribing alternate, less expensive therapies, the fact is that those "alternate, less expensive therapies" either do not exist or may be far less efficacious.  And, to make matters even worse, while Martin Shkreli and Daraprim are getting all the press coverage, this is by no means an isolated example of capitalism conquering compassion.  There is a growing concern about huge price increases on older drugs - some of them generic - that have, like Daraprim, long been mainstays of treatment. And although some price increases have undoubtedly been caused by shortages, others have resulted from a predatory business strategy of old and often neglected drugs, and turning them into high-priced "specialty" drugs.

This is where Cycloserine and Doxycycline enter the story.  Cycloserine, a drug used to treat dangerous multidrug-resistant tuberculosis, was recently acquired by Rodelis Therapeutics, which then increased the price for 30 pills from $500.00 to $10,800.  Doxycycline, a tetracycline antibiotic used to treat a range of different conditions, saw its per bottle price jump from $20 in October 2013 to an unbelievable $1,849 in April 2014. These and other horror stories are finally beginning to be covered by the media, which in turn has elicited concern from the likes Senator Bernie Sanders, Maryland Representative Elijah Cummings, former Secretary of State Hillary Clinton and at least six state legislatures. It is possible -- just possible -- that shining a bright light into capitalism's murkier corners is beginning to have an effect.  Just the other day Rodelis Therapeutics, reeling from the intense negative publicity it has attracted from having raised the price of Cycloserine by more than 2,600%, decided to return the patent to its original owner,  the nonprofit Chao Center for Industrial Pharmacy and Contract Manufacturing, which is affiliated with the Purdue Research Foundation.  Then too, young Mr. Shkreli has just announced that he will be reducing the per pill price of Daraprim . . . by how much, he did not say.

Lest anyone think this is some mindless rant against rapacious capitalism, guess again.  I fully accept and understand just how many hundreds of millions of dollars it takes to bring a single new drug or device to market.  Corporations certainly deserve a reasonable return on investment.  The reality is that for every Viagra, Nexium or Crestor which bring in tens of billions in profits, there are dozens if not hundreds of drugs that either never make it or barely break even.  As a decades-long member of an Institutional Review Board who has vetted more than 1,000 medical protocols, I have closely followed the trail of research, testing and placebo-controlled double-blinded studies.  On the scientific side of the equation, the United States has the tightest, most ethically rigorous standards on the planet when it comes to the creation and marketing of pharmaceuticals and medical devices.  Corporations invest billions; they should be able to turn a tidy profit.

However .  .  .

What we have been experiencing of late is a level of greed and rapacity far, far beyond the bounds of the free market or Adam Smith's "invisible hand."  The fact that Martin Shkreli saw fit to increase the price of a life-saving drug (which costs less than $1.00 per pill to manufacture) from $13.50 to $750 puts him in league with the most heartless venture capitalists of modern times.  And the worst part of it is, as reprehensible as Shkreli’s actions are, what is even more harrowing is that they are not illegal. With his social media swagger, Shkreli makes an easy target for a problem that extends far beyond the confines of his ego: the rampant overpricing of life-saving medicine. 

An FAQ page on the FDA’s website asks, “What can the FDA do about the cost of drugs?” and the answer is, essentially, nothing: “We understand that drug prices have a direct impact on the ability of people to cope with their illnesses as well as meet other expenses. However, FDA has no legal authority to investigate or control the prices charged for marketed drugs.”

If we learned anything from the unspeakable horrors unleashed by Dr. Mengele during World War II it is this: that medicine and science must be bound by both moral and ethical principles.  That "first do no harm" will always come first  . . . even before excessive profit.

The fact that a Martin Shkreli can sleep at night bothers me greatly.  What encourages me is the thought that what he has done may serve as a tipping point which puts medical research and medical sales on the same moral plane. That a growing cadre of political leaders and legislatures are looking into this issue is both good and great.  However, it won't take long for even the best-intentioned to run head-long into the unlimited power of "Big Pharma," the  nickname given to the world's vast and influential pharmaceutical industry and its trade and lobbying group, the Pharmaceutical Research and Manufacturers of America or PhRMA.  With the help of staggering profits and more than 1,100 highly-paid lobbyists, the industry has unlimited power on Capitol Hill.  No matter what individual members of the House and Senate -- or the White House -- may propose or suggest in order to deal with the moral havoc Martin Shkreli and his colleagues are wreaking, PhRMA can buy enough support to keep the wolves of reform from their golden door.

Unless and until we revolutionize the manner in which campaigns are bought and paid for in this country, nothing of significance will get done.  We must once and for all overturn the decision which states that money is speech. Changing the tide of public opinion is, without question, a good and positive thing.  However, no amount of public opinion can ever hope to withstand the power of an industry that just this past year topped $1 trillion in worldwide sales. 

Martin Shkreli and his ilk must be stopped from putting a healthy existence out of the reach of those who though they may appreciate capitalism, are working stiffs who still must deal with everyday aches, pains and cat crap.

Copyright©2015 Kurt F. Stone

Everyone Hates Obamacare: Just Ask Ted Cruz and Cathy Rogers

 

Audio Link to "Everyone Hates Obamacare: Just Ask Ted Cruz and Cathy Rogers"

 

Its now been more two years since the Affordable Care Act (Obamacare) got off to a less than stellar start.  One will recall that during its first several days, the ACA website was beset with a series of embarrassing technical glitches which wound up frustrating the bejesus out of those seeking health coverage, let alone costing taxpayers somewhere in the neighborhood of $840 million dollars. When these frustrating glitches were appended on to all those frightful claims about the ACA enslaving America let alone driving a stake through its economic heart, Republicans began salivating over what they presumed would be a gift-wrapped issue for the future all but guaranteeing their future electoral success.  And while it is certainly -- and from where I stand lamentably -- true that the GOP had a field day in the 2014 off-year election, it had little to do with any overarching aversion to Obamacare.

And yet, there are still those who tirelessly point out its weak technical start, its "similarity to Socialism," its need to be utterly extirpated from the pages of history and replaced with . . . with . . . what?  Just what would they replace the A.C.C. with? To date, whether they know it or not, those who rip up Obamacare and urge starting all over again, answer  in the name of silent clown Buster Keaton's boat: "Damfino."  Among Republicans who have managed to break away from the anonymity of the Washington Congressional pack, Texas Senator Ted Cruz and Washington State Representative Cathy McMorris Rogers have, each in their own way, been making recent headlines about Obamacare . . . but for widely different reasons.  Now make no mistake about it: both are viscerally, fundamentally against the A.C.A. and all it stands for and would gladly replace it in a minute if only they had an idea of what they'd put in its place. 

Speaking at the late Reverend Jerry Fallwell's Liberty University the other day, Texas Senator Ted Cruz became the first Republican to announce his candidacy for the White House.  In announcing that his wife would be taking a leave from her position with Goldman Sachs, Cruz mentioned that he and his family -- which includes two young daughters -- would now be needing health insurance: "We'll be getting new health insurance and we'll presumably do it through my job with the Senate, and so we'll be on the federal exchange with millions of others on the federal exchange," Cruz said.  Asked whether he would accept the government contribution available to lawmakers and congressional staffers for their health care coverage through the ACA, Cruz said he will "follow the text of the law." 

Quite an admission from the man who led a 21-hour filibuster against the president's healthcare plan on the senate floor back in 2013.  This is the tactic which first brought Senator Cruz to public attention: as the man who, more than seemingly anyone, was blamed for the government shutdown which lasted 16 days.  And now, the same man who is going onto Obamacare for himself and his family, has the baytzim to tell all those students forced to attend (or be fined) his announcement at Liberty that under his presidency "Instead of the joblessness, instead of the millions forced into part-time work, instead of the millions who've lost their health insurance, lost their doctors, have faced skyrocketing health insurance premiums, imagine in 2017 a new president signing legislation repealing every word of Obamacare."

Am I missing something here?  Oh yes, were he to be elected President of the United States, he and his family could then go off Obamacare and start getting covered by whatever Rolls Royce policy covers 1600 Pennsylvania Avenue . . . and to Hell with everyone else who is un- or under-employed, has a preexisting condition or simply cannot afford a policy which runs $1,000, $2,000 or more per month.  Sounds fair, no?

Then there is Washington Representative Cathy McMorris Rogers.  Readers of this column will no doubt remember that the GOP chose Representative Rogers to deliver the party's State of the Union response this past January. In that address, Ms. Rogers -- a winsome Republican from Central Casting -- spoke about Obamacare, averring that "We've all talked to too many people who have received cancellation notices they didn't expect, or who can no longer see the doctors they always have.  No," she said, "we shouldn't go back to the way things were, but the president's healthcare law isn't working." 

Oh really?

The other day, Representative Rogers, who serves as House Republican Conference Chair, took to her Facebook page and posted the following: "This week marks the 5th anniversary of Obamacare being signed into law. Whether it's turned your tax filing into a nightmare, you’re facing skyrocketing premiums, or your employer has reduced your work hours, I want to hear about it.  Please share your story with me so that I can better understand the challenges you're facing,."  She then attached a link to her congressional office website where folks could tell what the Congresswoman presumed would be tales of horror and gloom.

Surprise, surprise. 

Instead of the final teary act of some lachrymose soap opera, what Ms. Rogers did receive were thousands -- thousands -- of Facebook entries from just plain folks, the vast majority of whom said that the ACA was a lifesaver for themselves and their families:

 

• The Republican solution to th Afordable Care Act? Let people drown in debt, clutter our emergency rooms, and die from lack of coverage due to pre-existing conditions. No thanks, "Congresswoman". Some of us care more about our fellow Americans than trying to bash the President. Keep trying to scare your followers with phony horror stories.
• I think we should repeal Obamacare, and replace it … with universal socialized medicine - like the rest of the industrialized nations of the world.
• My sister, a breast cancer survivor, couldn't get health insurance, and now she has it. Thanks, Obama!
• With Obamacare, my child with Type 1 diabetes can not be denied insurance.

Now, this is certainly not to say that we cannot improve upon Obamacare, for we certainly can.  It's called Universal Care.  But that's a subject for another time.

Until then, it might do well to keep reminding all those in Congress who want to strip the Affordable Care Act past its most basic foundation, that if they do, they are going to get a raucous earful from the millions who have been finally been able to afford even minimal coverage.  From where I stand -- one who spent years paying between $2,500 and $3,000 a month for insurance -- providing for the health of a nation is just as important as providing for a nation's defense perimeter.  For a country with secure borders and ailing people is an unsafe nation.  

On this issue -- not to mention many others -- I refuse to follow the lead of folks like Ted Cruz and Cathy McMorris Rogers -- politicians who stand foursquarely against progress unless it can somehow benefit them.  How can they justify such glaring hypocrisy?

We'll let Buster Keaton answer that one:

Damfino . . .

Copyright©2015 Kurt F. Stone

Eventually, Everything Gets Outsourced -- Even Ethics

 

Audio Link to "Eventually Everything Gets Outsoured -- Even Ethics"

 

According to Merriam Webster, the transitive verb "outsource" first entered the English vocabulary in 1979 -- a scant 35 years ago.  It's hard to believe that the term -- if not the business strategy it describes and defines -- is of such recent vintage.  For by now, it seems like everything in our cabinets, closets, garages and medicine chests is the product of cheap labor doing its thing in places like China, Bangladesh, Vietnam, India, Malaysia or Honduras. Precisely why American manufacturers move millions of jobs offshore isn't too difficult to figure out: lower production costs equal higher profits which equal much, much happier stockholders.  Why Congress has not -- and apparently will not -- do something about it is even easier to understand: American manufacturers kick back a percentage of their increased profits in the form of campaign contributions.

As a result, almost everyone and everything is the product of outsourcing these days:

• Johnson & Johnson gauze pads and Purina dog treats are made in China (along with just about everything else);
• Rawlings baseballs are stitched in Costa Rica; Mattel's iconic Barbie doll is manufactured in Hong Kong;
• Converse Allstars hail from Thailand;
• Levis are made in Lesotho, Cambodia, Turkmenistan and the Philippines;
• Even my beloved Brooks Brothers shirts are manufactured in Malaysia. 

And of course, this doesn't include what might be termed "Call Center Purgatory -- all those Indians, Pakistanis, Malaysians and Filipinos named "Mark" or "Betty" who handle our questions, requests and complaints about defective products we've purchased at Wall Mart, Best Buy or Big Lots.  

Although both maddening and occasionally stupefying, none of the above-referenced forms of outsourcing are illegal and heretofore rarely -- except in the case of our pets -- lethal.

One form of outsourcing that has been flying well beneath the radar for the past several years is lethal: this involves the outsourcing of medical ethics.  According to federal law all clinical trials -- medical research trials involving human subjects -- must first be brought before an Institutional Review Board (I.R.B.) which both oversees and protects the rights of these human subjects.  The creation of I.R.B.s finds its genesis in the post-war Nuremberg Doctors' Trial, which considered the fate of 23 German physicians who either participated in the Nazi program to euthanize persons deemed "unworthy of life" or who conducted experiments on concentration camp prisoners without their consent.  The need for such review boards -- peopled by physicians, scientists and public representatives -- was given even greater impetus when the truth of the "Tuskegee Syphilis Study" was made public.  This "experiment" was an infamous clinical study conducted between 1932 and 1972 by the U.S. Public Health Service to study the natural progression of untreated syphilis in rural African American men who thought they were receiving free health care from the U.S. government.  

Today, by law, anyone participating in a clinical trial -- whether it be for the creation of a new drug or medical device or the collecting of medical data -- must be fully cognizant of what they are signing up for. They must be apprised in easily understandable lay terms (in their native language) what they are about to undergo, what the possible risks and benefits (if any) are, and then give what is called "informed consent."  If the subject is a minor or an individual otherwise unable to give consent, they must be represented by a "legally appointed representative" (LAR). 

(Note: Over the past 19 years, I have served as a public representative on two different IRBs; from 1995-2012 with Cleveland Clinic, Florida, and since May 2013 with Schulman Associates IRB.  It is the most intellectually challenging -- and rewarding -- position I have ever held.  Over nearly 2 decades, I have poured through, sought to understand, edited (when necessary) and voted on more than 1,000 research protocols. Yes, it's a lot of work, but protecting human beings in the name of medical advancement is terribly worthwhile . . .)

Bringing new pharmaceuticals and medical devices to market is a lengthy, exhaustive, incredibly expensive proposition. It involves reams and reams of reports filed at virtually every step along the way, and an unbelievable amount of clinical and federal oversight.  However, if and when a new drug or device is granted Food and Drug Administration (FDA) approval, it can earn literally billions for companies like Bristol- Meyers Squibb (Abilify), Astra Zenica (Nexium), Perdue Pharma (OxyContin) or Pfizer (Celebrex). 

This last drug, Celebrex, is a non-steroidal anti-inflammatory drug that has been aggressively promoted in television commercials for a decade. Its manufacturer, Pfizer, the world’s largest drug company, has spent more than a billion dollars promoting its use as a pain remedy for arthritis and other conditions, including menstrual cramps.  Without getting into too much boring detail, it turns out that many of the clinical trials Pfizer ran during the creation of this incredibly profitable drug were held in places like Estonia, Croatia, Ukraine and Lithuania -- places where the F.D.A., due to financial and staffing limitations, simply  could not monitor research trials. In many cases, doctors were paid hundreds of dollars for each test subject they enrolled, while the subjects, many of whom had little or no knowledge of what they were about to undergo, were paid as little as $3.50 for their participation.  This is precisely the sort of unethical behavior an IRB is on the lookout for.  Turns out that Celebrex ran into a world of difficulty.

First, it was disclosed that patients taking the drug were more likely to suffer heart attacks and strokes than those who took older and cheaper painkillers. Then it was alleged that Pfizer had suppressed a study calling attention to these very problems. Meanwhile, Pfizer was promoting Celebrex for use with Alzheimer’s patients, holding out the possibility that the drug would slow the progression of dementia. It didn’t.   And yet, Celebrex is still on the market, still making a fortune for Pfizer (more than half-a-billion dollars in sale in the first quarter of FY 2013 alone).

Believe me, this is just the tip of the iceberg . . . the tip of the tip of the iceberg.

It has become frighteningly commonplace for big pharmaceutical companies to engage in test protocols in third world countries.  By outsourcing trials, they not only save millions upon millions of dollars; they evade the long arm of an already overworked and understaffed FDA. Frequently they take advantage of poor, illiterate men, women and children -- some reportedly as young as 6 months.  Besides being thoroughly unethical, this creates an intolerably dangerous situation.  A pair of Levis or Converse Allstars made by cheap labor won't kill you; a drug created under less than pristine clinical conditions can. 

It is horrifying to note that in 2009, the American death toll from prescription drugs considered "safe" was in excess of 200,000.  According to an exhaustive investigative piece by Vanity Fair's Donald L. Bartlett and James B. Steele, ". . . [this] is three times the number of people who die every year from diabetes, four times the number who die from kidney disease. Overall, deaths from F.D.A.-approved prescription drugs dwarf the number of people who die from street drugs such as cocaine and heroin. They dwarf the number who die every year in automobile accidents."

On the bright side, the budget passed by Congress last week did increase FDA funding: $85 million in industry-provided user fees, and an additional $91 million above FY 2013 funding levels.  What is truly needed above and beyond increased funding and the beefing up of the FDA are hearings; hearings in which the heads of big pharma will be forced to answer two straightforward questions:

Why in the world are you outsourcing medical ethics? 

Have you no shame? 

Hopefully, Congress won't accept additional campaign contributions in lieu of answers . . .

 

©2014 Kurt F. Stone

 

 

Have a Heart?

 

Audio Link to "Have a Heart?"

 

On April 23, 1951, actor John Garfield (The Postman Always Rings Twice, Body and Soul, Gentleman's Agreement, Force of Evil) spent the better part of the day being grilled by the House Un-American Activities Committee (HUAC). Heartless committee members put Garfield's past memberships, political associations and financial contributions under the microscope, seeking to trip him up and get him to admit that he was a member of the Communist Party. By 1951, members of HUAC firmly believed that there were communists under every bed, and that Hollywood was doing everything in its power to inject Marxist ideology into motion pictures.  Somewhat prior to Garfield's all-day testimony, members of HUAC had learned from "expert" witness Adolphe Menjou that a "communist actor" like Garfield could add subversive elements to a film through a “look, an inflection, or a change in voice.”  Committee members browbeat Garfield -- a not particularly well-educated or worldly man --  to such an extent that he became unemployable.  (Note: Garfield would succumb to a massive heart attack a year later at age 39. To this day, many believe his death was due in large measure to the ordeal HUAC put him through.)

When Garfield's hearing concluded and the cameras shut down, HUAC members -- the very men who had heartlessly subjected the man born Jacob Julius Garfinkle to hour upon hour of contumelious accusations -- actually stood in line seeking the actor's autograph, shaking his hand, and quarreling over who was going get the honor of taking take him out to dinner. 

In other words, Garfield, a man the committee sought to portray as a dangerous subversive bent on the destruction of America when the cameras were on, was a most welcome dinner companion at day's end; too evil to be seen on the screen, but just fine for a feast.  I guess all's fair in love and war . . . and political grandstanding.

Talk about heartlessness.

In doing research on Garfield -- as well as Edward G. Robinson, Danny Kaye, Judy Holliday and scores of other Hollywood icons -- for a new book tentatively entitled In the Land of Mink-Lined Pools, I can't help but shudder at the heartless hypocrisy, the affected dishonesty visited upon poor "Julie" Garfinkle by his HUAC accusers.  It also brings to mind so many others in the political arena whose public posture is at stunning odds with their private predilections -- those who publicly decry a lack of  morality or self-sufficiency in American society and culture while privately engaging in -- or benefiting from -- the very activities they revile.      

When it comes to this degree of heartlessness, former Vice President Dick Cheney takes the cake.  Cheney, a conservative's conservative, is one of our country's all-time "chicken hawks."  He has long found war to be both totally correct and personally profitable.  And yet, between 1959 (when he first became eligible for the draft) and 1967, he gladly accepted 5 deferments: 4 because he was a student and 1 because he was a new father. How different is this from the heartless HUAC members who, after thoroughly sliming John Garfield, then stood in line begging for his autograph and a chance to grab a bite at the Hawk 'n Dove?

In addition to lacking a heart when it comes to war, Cheney is also one of those who is fervently anti-union and hyper free market; one who believes with every fiber of his being that government is not meant to provide a social safety net -- whether it be Social Security, Medicaid, Medicare or Obamacare.  In a recent interview on NBC's "Today Show," Cheney called the Tea Party and its fierce opposition to government spending a "good thing." He also noted how the Tea Party made possible the insurgent Wyoming Senate campaign of his daughter Liz because she was "partly motivated" by the same concerns about high taxes, high national debt and the cost of the Affordable Care Act.

Out of that zeal to repeal Obamacare, the Tea Party and its congressional adherents provoked this month's government shutdown and near credit default. Yet, Cheney declared, "I've got a lot of respect for what the people are doing."

Where's the heart?  Dick Cheney's family would never have escaped the financial ravages of the Depression if it were not for the Federal Government, for which his father worked for more than 30 years.  Indeed, the Cheney family was so indebted to Franklin Roosevelt and the New Deal that, according to Dick, "When I was born [on Jan. 30, 1941] my Granddad wanted to send a telegram to the president. Both sides of my family were staunch New Deal Democrats, and Granddad was sure that FDR would want to know about the 'little stranger' with whom he now had a birthday in common."

Somewhere along the way, Dick Cheney decided to stand in staunch opposition to much of that which helped make his family solidly middle-class.  It would seem that as his physical heart weakened and his health became severely compromised -- he's had at least 5 heart attacks since age 37 and underwent a successful heart transplant less than 2 years ago --  that Dick Cheney's figurative heart turned to stone.  How in the world can anyone who has repeatedly come back from the brink of death thanks to government provided health insurance and care, also stand foursquarely against healthcare for others?  If it were not for Dick Cheney's government insurance -- or the cadillac coverage he received during his years with Halliburton -- he would likely have become a member of the celestial choir years ago.  Goodness knows, were it not for government health insurance -- or the vast wealth he acquired from his brief tenure in the private sector -- Dick Cheney would have been denied coverage due to a preexisting condition.  And as for paying for a heart transplant out of his own pocket, even with his vast wealth (he's worth a minimum of $50 million) the very costly procedure would likely have been denied due to his age -- 71. According to recent figures, a heart transplant costs a minimum of $1 million.

Most anti-Obamacare folks have flatly concluded that as of January 2014 (when the Affordable Care Act goes into effect), heart transplants will either become a thing of the past or will bankrupt an already bankrupt government.  How so many people know so much about what a program-yet-to-begin will be is beyond comprehension.  Suffice it to say, many of those most fervently against government programs like Obamacare (which is in no way "socialized medicine" as Dick Cheney as his friends constantly claim) they are denying to millions the benefits they have gladly received for oh so many years.

It is reminiscent of those HUAC members who, once having destroyed the "evil" John Garfield, wanted nothing more than to shake his hand, get his autograph and take him to dinner.

Heartless is as heartless does. 

How much the more so when you have to get a new one . . .

©2013 Kurt F. Stone

Many thanks to my lifelong friend Alad Wald for bringing this topic to my attention.

Health Insurance in America: Legalized Extortion

 

Audio Link to Health Insurance in America: Legalized Extortion

 

Included in yesterday's mail were two ominous envelopes, one addressed to me, the other to my wife.  They were from our health insurance company.  Being that this is mid-May, I knew what the contents of the envelopes would be: one-page letters informing us what our insurance premiums are going to run in the coming year.  With sweaty palms and racing heart, I began operating on the envelopes, terrified by the news that would be contained therein. Last year at this time, our premiums rose 14.6%; the year before that slightly under 13%; the year before that 15.8%.  Envelopes open, I gingerly removed the one-page form letters addressed to "Dear Member."  Reading the twin missives of doom took less than 30 seconds.  My worst fears had actually been bested by the reality of it all; beginning July 1st, our premiums would be going up an additional 25% . . . 25% . . . 25%! 

Yes indeed; as of July 1st, we will be paying the princely sum of $34,934.88 for a year's worth of "coverage" that includes neither dental nor vision nor podiatry, carries a $10,000 deductible, and is regularly refused by many doctors because the company doles out payment with a costive eyedropper.  And, to add mortal insult to lethal injury, this outrage comes fast on the heels of my wife being denied -- once again -- coverage for a crucial pain-reducing procedure because, in the opinion of some company stooge she ". . . does not present sufficient pain to warrant said procedure."   And just last month, they denied my doctor's order for an MRI because, once again, they deemed it "unnecessary."

Now mind you, my wife and I are both reasonably health-conscious people.  We don't smoke or drink, stick to healthy diets (keeping kosher in a largely non-kosher world forces one to eat lot of salad, fruit and fish) and get a reasonable amount of exercise. (I for one am a long-time inveterate gym rat.) We are healthy people who live active lives despite having conditions that might lay others low. In other words, we do everything in our power to be as healthy as is humanly possible.  And yet, we are about to begin paying nearly $35,000.00 for a year's worth of what is truly substandard health insurance coverage.

To put the rate of increase into perspective, two years ago, my wife's monthly take home pay from her part time position as an instructor at a local community college covered our monthly premium.  With this newest spike (and a concomitant cutback in her teaching hours), it now will take nearly 3 month's take home pay to cover but a single month's premium. Our annual insurance premium will be about 50% more than what we pay for the mortgage on our home and a rental property.  

So why not just change carriers? Because the last time we tried, we were turned down flat because of pre-existing conditions. (Starting next year, under terms of the Affordable Care Act, this will be illegal.) Moreover, we had to report the insurance agents (who all but guaranteed us "better coverage for less") to the state attorney general's Office of Investigations; they had signed us up (and were already billing us) for a couple of "savers' club" groups without our knowledge or consent.  

Now mind you, I am not in any way kvetching about the quality of medical care we receive.  Our doctors at Cleveland Clinic Florida are first-rate; indeed, some are galaxy-class. The problem is, that in order for these first-rate and galaxy-class physicians to provide us care, it costs an arm, a leg and a pancreas gland . . . and starting in July a clavicle and a hyoid bone. 

So what can be done?  Next to nothing, I am afraid to say.  Oh sure, we could simply drop our healthy insurance and pray that we remain healthy until age 65 and can begin being covered by Medicare . . . provided that Paul Ryan and the GOP don't have their way and voucherize it before then.  Then too, perhaps we could sit down with a supervisor or representative of the company that so willingly takes in our dollars and try to work something out.  No dice.  From prior painful experience, when given the choice between compromising and simply losing us as paying customers, they simply respond "Well, that would have to be your choice . . . to drop coverage." Even waiting for the rest of the Affordable Care Act to take effect won't do any good; while carriers may be debarred from denying coverage due to pre-existing conditions, there is nothing that says they have to make it affordable.  You see, the affordable care act isn't about health care; it's about health insurance.  Far from being "socialized medicine" as so many argue, it is a gigantic beribboned gift to the health insurance industry which, if properly and rigorously monitored, could eventually slow down the unconscionable increases in all aspects of health care.   Don't get me wrong. I have no problem with corporations making a profit; that's why they're in business.  What I do have a huge problem with -- and here I know I'm not alone -- is facing the prospect of going broke just to be covered by a company that loves saying "REFUSED!" 

According to a recent poll from the Kaiser Family Foundation, 42% of the American public don't know or aren't sure whether the Affordable Care Act is the Law of the Land.  It is.  How do I know?  Well, just yesterday, the House of Representatives tried to kill it . . . for the 37th time in two years.  Even the House wouldn't be so dense as to try destroying something that does not exist. (Oops . . . I take that back, maybe they are that dense!) And yet, because they are forever railing against Obamacare, forever trying to scare people with talk of "death squads," loss of liberty and the looming communist/socialist/fascist takeover of America, lots of Americans are against it . . . or are they?  When queried, people who say they wanted Obamacare repealed, still say they like aspects of it . . . like keeping children on their parents' policies until age 26; like not being denied coverage due to pre-existing conditions; like no lifetime caps on coverage.  And yet, they are against it.  

Despite the fact that the Affordable Care Act likely won't affect our personal situation, I am all for it -- until we get smart and one day enact universal coverage.  Likely the only way that will ever be accomplished is if enough people find themselves in our position -- of being priced out of health insurance coverage because it costs more than two mortgages and two car payments combined -- and demanding change; real, tangible, intelligent change.

Anybody out there know of a company that can provide us coverage without resorting to extortion?  Any suggestions?

Please? 

©2013 Kurt F. Stone

Eat Me

    By now, most folks are aware of New York Mayor Michael Bloomberg's intention to ban the sale of large sodas in New York City. Bloomberg's proposed ban -- which  must first be approved by the City Board of Health -- would prohibit NYC  restaurants, theaters, sports venues and street cart vendors from selling sweetened drinks in cups over sixteen ounces that contain more than fifty calories. Not surprisingly, Hizzonor's announcement drew hearty cheers from the health-conscious and hellacious catcalls from the "Don't Tread on Me" crowd as well as the folks at Coca-Cola and McDonalds who, in addition to selling billions of gallons of Coke and other heavily sugared drinks is, without question, the globe's leading purveyor of grossly unhealthy cuisine. 

   "New Yorkers expect and deserve better than this. They can make their own choices about the beverages they purchase," Coca-Cola said in their official statement to the press.  It also noted that "Coca-Cola already puts calorie counts on the front of every bottle and can we sell."  Not to be outdone in indigence, McDonald's spokeswoman Heather Oldani huffed that "Public health issues cannot be effectively addressed through a narrowly focused and misguided ban.  This is a complex topic . . . one that requires a more collaborative and comprehensive approach."

   Putting calorie counts on the front of every bottle and can or on the overhead menu may make for good p.r.  What it doesn't do, however, is counter the mind-numbing amount of advertising that got billions of men, women and children into the mood for a Whopper, Fries and a Large Coke in the first place.  Its in the same league as those incredibly wordy unreadable disclaimers that run for a second or two on television commercials -- or are intoned by an announcer speaking at Mach Three.  A minute disclaimer may keep the advertiser on the side of the angels when it comes to Truth in Advertising; but truth to tell, when advertisers make the commercials so alluring -- and run them with such frequency -- nothing but the sales pitch hits home.  Among my favorites are those for -- ironically, in view of this essay's subject matter -- weight loss products.  The ad shows "before-and-after" photos of people who go from beached whale to body beautiful by simply taking a new, revolutionary, doctor-tested pill . . . no diet, no exercise, no lifestyle changes.  And what is more, said pills are free (just pay shipping and handling) and guaranteed to work (results may vary) . . .

   While Bloomberg's supporters sadly note that his proposed soft drink ban has enough exemptions and holes to drive a Mack truck through, his detractors angrily accuse him of seeking to further the so-called "Nanny State's" pernicious reach.  "How dare government tell people what we may or may not drink?" they argue.  What's next? they ask:  "Forbidding French Fries?  Pizza?  Burritos? Bacon Sundaes?"

   Indeed, what is next?  Although it is quite possible that Bloomberg's ban will never see the light of day, he has already performed an invaluable public service in directing a megawatt spotlight on one of modern America's most vexatious problems: obesity. Facts and statistics about obesity in America are simply staggering.  According to the Centers for Disease Control and Prevention during the past twenty years, there has been a dramatic increase in obesity in the United States.  More than one-third (35.7%) and approximateley 17% (or 12.5 million) of children and adolescents age 2-19 are obese. (One is considered "Obese" when their Body Mass Index -- BMI -- is higher than 30, and "Overweight" when BMI is 25.0 -- 29.9) Anyone wishing to determine their BMI can go to a site provided by the CDC.  I just did mine and learned that my BMI is 21.1).

  Several years ago, the CDC created a program called "Healthy People 2010."  Its goal was "to lower obesity propensity to 15%" -- meaning no more than 15% of any state population with BMIs over 30. Where in 2000 there wasn't a single state with an "obesity propensity," today, there are 12 states above this mark.  In 2010, Colorado, at 21% had the lowest percentage of people with BMIs over 30, followed by the District of Columbia (22.2%), Nevada (22.4%) Utah (22.5%), and Hawaii (22.7%).  Conversely, Mississippi, at 34%, had the highest percentage of obese citizens, followed by West Virginia (32.5%), Alabama (32.2%), South Carolina (31.5%) and Kentucky (31.3%).  Florida, by the way, was right in the middle -- 26.6%.  According to the CDC, while  there is no significant relationship between obesity and education among men, among women there is a trend -- those with college degrees are less likely to be obese or overweight compared to less educated women.  The CDC also noted that in the years between 1988 and 1994, and again 2007-2008, the prevalence of obesity increased in adults at all income and education levels.

  Not only does being overweight or obese pose a serious health issue -- diabetes, heart disease, cancer -- it is a source of concern in both the areas of national economy and national security.  A recent study by the Society of Actuaries (SOA) looked at the increased economic costs of an overweight/obese America.  Their study came up with the following figures:

• $127 billion: Total cost of excess medical care caused by overweight and obesity.
• $49 billion: Economic loss of productivity caused by excess mortality.
• $43 billion: Economic loss of productivity caused by disability of active workers.
• $72 billion: Economic loss of productivity caused by totally disabled workers.

   SOA researchers found that when queried through an online survey, 83% said they would be willing to follow a healthy lifestyle, such as participating in a health and wellness program, if incentivized  through their health plan.  In all the sturm und drang over the Affordable Care Act few have noticed that it does cover obesity screening and counseling for both children and adults, and provides $16 million  to "Advance activities to improve nutrition and increase physical activity to promote healthy lifestyles and reduce obesity related conditions and costs." These activities are intended to be a part of First Lady Michelle Obama's “Let’s Move!” initiative and help implement recommendations of the President’s Childhood Obesity Task Force.

   Overweight and obesity also presents a clear-and-present danger where National Security is concerned.  Napoleon Bonaparte famously said that "An army travels on its stomach."  Increasingly though, the military stomach is getting too big to drag.  In 2008, when 684  military personnel were discharged for transgressing "don't ask, don't tell," 4,555 were discharged for failing to meet military weight standards.  Even relaxing their standard to a BMI of 26 (the low end of "overweight"), more than 9 million Americans between the ages of 18 and 25 are too heavy to enlist.  And if, as many are currently suggesting, America were to reinstitute a universal military draft, we would hard pressed to fill the ranks with people who are physically fit and ready to serve.

   Those who argue that proposals such as Mayor Bloomberg's violate the inalienable right to eat ourselves into oblivion forget what government -- from municipal to state to federal -- has accomplished over the past half-century to bring down the percentage of those who smoke cigarettes.  In 1965, 42.4% of  the American public smoked.  By 1980, that figure had been reduced to 33.2%.  Today, less than 20% (19.3% to be precise) of the American public lights up.   This dramatic decrease occurred despite the protests of an industry which still spends $29 million a day, 365 days a year to promote its deadly product. By comparison, the fast food industry spends $11.5 million a day and Coca Cola alone spends $8 million a day, as compared to Microsoft and Apple, which spend, respectively, just $4.4 million and a paltry $1.9 million. 

   Long before Mayor Bloomberg's campaign to ban sugary drinks, there was an army of health conscious people trying to get Americans to live healthier lifestyles -- and not just by switching to no-calorie sodas to go along with their 840 calorie Baconaters.  Shortly before his inauguration in January 1961, John F. Kennedy published "The Soft American" in Sports Illustrated.  His article established the need for Americans to get in better shape; toward that end he created a "White House Committee on Health and Fitness," and influenced a lot of young Americans to go out on 50  mile hikes.  I remember how in the early '60s, the 8th and 9th grade at our junior high school demanded that the lone candy machine be replaced by one that sold fresh fruit.  It was so popular that it had to be restocked a couple of times a day.  Of course that was back in the day when McDonalds measured their burgers sold in the tens of thousands.  Then again, there weren't any fast food establishments between the neighborhoods where we resided and the school we attended.  Perhaps one day we can use municipal zoning authority to keep these  establishments from setting up shop within, say, two miles of any school . . .

   I for one applaud Mayor Michael Bloomberg and hope that even if his ban on sodas doesn't pass muster, the very proposal will spark a nation-wide debate about our national waistline, cholesterol and BMI.  

  This is something we should all truly sink our teeth into. 

©2012 Kurt F. Stone