Thursday, August 6, 2009

Cigna Executive becomes "Whistleblower"

Think about this:

Government agencies and universities research diseases and come up with innovative medicines and treatments in parallel to the private research from the pharmaceutical industry. The drugs and innovations are then negotiated over to for profit business, i.e. the pharmaceutical industry, who expertly mass produce them and bring them to the public. Sometimes as direct distributions, but more often than not, through distribution chains, which jack up the costs, as they stock up their for profit owned pharmacies who tack on their profits as well. Depending on the drug, the consumer may wind up paying double the price than that at which it left the Pharmaceutical manufacturing plant. Then we have the insurance companies, as the article notes " Confusing customers and dumping the sick: all to appease the investors on Wall Street". In short doing what they can to not pay the bill.

But what happens to the sick patient?

Glad Wendell Potter has had enough - many of us have....


  1. Former

    Thanks for the very sobering link to the catastophe that is American Healthcare.
    However, I hate to admit it, but I am one of the skeptics about any proposed Healthcare Reform legislation that comes out of Washington, particularly if the proposed "Reform" is endorsed by both the AMA and the Pharmaceutical Industry.
    Unfortunately it is a very complex problem and thus far Obama and Reform supporters have not convinced me that Healthcare reform is in my best interests.

  2. James--May I ask, is there a particular aspect of a proposed plan that you have most trouble with?

  3. Excellent article, Former.

    Re: James's comment, it's a little unclear (at least to me) where AMA stands. They certainly want to limited anything resembling comparative efficacy with consequences, as does Pharma, as I understand it.

    Oddly, comparative efficacy could be in the interest of insurance companies, but now they do it "on their own"--that is, to the degree the traffic will allow and the powerless must endure.

    There will be a day, I predict, when we look back on these industry practices the way we look at the Robber Barons and the Mob.

  4. Good comments by all!
    I agree with James’ concern about the Healthcare Reform (excuse me - Health Insurance Reform) proposal, especially after seeing this article in the New York Times – HERE. This might in a way answer George’s question.

    Quoting the article
    "Pressed by industry lobbyists, White House officials on Wednesday assured drug makers that the administration stood by a behind-the-scenes deal to block any Congressional effort to extract cost savings from them beyond an agreed-upon $80 billion."

    Nothing good can come from having the American mega-powers (Insurance, Pharmaceutical Industry, AMA and all of their supporting organizations) muscling to the front of the Congressional lobbying line intent on getting their piece of the American pie. We can only hope that our Congress people will stand up for us rather than grab their own piece and leave us begging. We can only hope.

  5. I will admit that my "gut" is to agree with David above. It was precisely such "deals" that got us PDUFA, the FDAAA, and other "reforms" that perhaps were not.

    On the other hand, there are those that argue that, without PDUFA, the FDA would have been dissolved entirely via Gingrich's attack in the mid-90s. And some of the FDAAA changes have been worthwhile, in my view, even when there is much more to be done. (Some of that "more" is happening via further legislative efforts.)

    So the question becomes--what core principles are "non-negotiable" in this arena?

  6. The link made me think of “The Grapes of Wrath.”
    The folks waiting for medical attention were, most likely, the working poor. Folks who earn too much to qualify for Medicaid but not enough to buy insurance or healthcare. They don’t have any power. They are hoping the government will come to their aid. God bless them. God bless America.

  7. David thanks for the backup and the link. As to George's question, there have been numerous articles in the NYT regarding the issue of Health Insurance Reform, as David correctly described by David and these articles are what raised my concerns.
    For example, one of the articles included the hypothetical situation of a family of four with an income of 88K year; it is at this point the family becomes ineligible for Federal subsidies. Under the hypothetical scenario, the family's premium is maxed out at 12.5% of their total gross income and out of pocket expenses would be capped at 10K, not including the cost of the premium. One of the stated purposes of reform was to help families avoid bankruptcy. I do not see that proposal as offering much assistance in this area.
    Another aspect of the plan is mandatory coverage. I agree that this should be included but I do not see any provisions for enforcement of this mandate. The only viable means to ensure enforcement would be through the collection of a payroll tax and even here many of the uninsured would need to receive the above stated subsidies so that they would be able to afford the premiums. In addition, although I do not have the statistics to prove it, many of the uninsured work "off the books" and thus even if a payroll tax was implemented these workers would avoid the payroll tax.
    Additionally, without a viable means of ensuring participation in mandatory coverage and unless there are changes made to the Emergency Room Medical Treatment Act (EMTALA), current premium payers will still endure most of these costs.
    Further, as to the AMA and Pharmaceutical endorsements of Health reform, I was remiss in pointing out the fact that these groups oppose Comparative Efficacy and continue to endorse the Fee for Service Plans currently in place. While Comparative Efficacy would probably reduce the number of unnecessary procedures the fact is this is in essence the very same practice that Insurance companies are criticized for when they fail to a approve a specific procedure. However, this is really the only realistic proposal to control medical costs, which in the end is the real reason behind inreased costs.
    Finally, many supporters of Health Reform point to the Canadian model as an example of how National Healthcare could work here. In Canada the individual Provinces control the Healthcare program and until recently certain Provinces prohibited the sale of private insurance. This is an important point because when you have only one insurance provider the rates are set by that provider and every doctor, even though they do not officially work for the Government, must participate in that plan. If a plethora of plans is allowed there is nothing to prevent medical providers from dropping out of any individual plan. The way I see the current plan universal coverage will just further the difference between the qualities of healthcare each individual American will receive. If you can afford better coverage and live in an affluent area, it is more likely then not that doctors will only opt to participate in the higher quality plans.
    In closing, due to limitations on time I wrote this rather rambling reply rather quickly so I did not include any links to substantiate my points. In addition, as I stated this is a complex issue and some of my concerns may be misplaced, however I will try to provide a more detailed statement with relevant links in a future post which hopefully will further clarify my opposition.

  8. A couple of related items. In today's NYT, House Dems push back against the administration's deal with Pharma:

    Meanwhile, if anyone watches Lou Dobbs (not sure why you would), they have a series which is mostly aimed at trashing the Dem healthcare plan. Even more than Fox, which is saying something. Last night, they featured Peter Pitts as representing a "non-partisan" research group. No one from another perspective.

    Pittiful, indeed.


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