It’s been quite a week for health care in the US, with the Supreme Court providing validation for yet another facet of the Affordable Care Act, and health care behemoths gobbling up leviathans. Aetna is slurping down Humana and at $37 billion that’s a pretty bug gulp. Anthem, meanwhile has been trying to get a fork into Cigna and Cigna has so far wriggled away. UnitedHealth had been looking to swallow up HealthNet but they got beat to the bite by Centene. How can any of this foster competition, better rates, and ultimately better care? There is plenty of of talk of efficiency and improved service but that’s just a lot of flatulence. This is about money. The new Aetna will bill over $60 billion dollars to government-funded programs this year! That’s just one company and not even the biggest of them all!

There is big money in health care in this country despite all the crying from CEOs about slim margins and bonuses shrinking to six figures. Not True!

The newly strengthened ACA has been a windfall for those in the business of healthcare , particularly for those controlling coverage and commodities. Yes, I’m talking about giant health care companies like Aetna, Anthem, CVS Health that are prominent on the Fortune 500 and have paid their CEOs extraordinary annual compensation.

Here are some examples from 2012:

  • Stephen Hemsley of UnitedHealth, $48.8 million!
  • David Snow of Medco, $22.2 million!
  • Allen Wise of Coventry Health Care, $20.8 million!
  • Hold on! Didn’t Unitedhealth Group used to be called United Health Care? I guess they just stopped caring.

    Those are some of the companies that are raking in big money from our ever expanding health care costs. And we should not forget these companies either:

  • John Hammergren of McKesson, $131.9 million!!!
  • George Paz of Express Scripts, $51.5 million!
  • John Martin of Gilead Sciences, $43.3 million!
  • David Pyott of Allergan, $33.8 million!
  • Health insurance, pharmaceutical manufacturing, and benefit management companies are clearly taking billions of dollars as their slice of the health care pie. That pie, by the way, is quickly approaching $4 trillion annually. $4,000,000,000,000!!! The federal government is likely to spend over $1 trillion on subsidies and incentives related to the ACA over the next decade.

    I’m not leaving out retail or hospital pharmacy just because I am a pharmacist, I’ll get to those in due time. For now, looking at the big picture, I started looking into things at the top. By now I’ve probably read more of the ACA than my Congressmen and I’ve been on the front lines as all these changes came swiftly into my world, changing my practice and my patients.

    I’ve seen death panels. Not the ones over-hyped as being part of Obamacare’s drive to kill grandma, but folks dying as people with a master’s degree in business or political science (SCIENCE? Really, now!) decided which patients would be eligible for life-saving procedures or treatments. Here in Arizona, people waiting for liver transplants were allowed to die. In 2010, our clever legislature made cuts to our Medicaid program, AHCCCS, of about $5.3 million (losing $20 million in matching federal money) which excluded a variety of transplants and other services.

    Listen, I’ve said it before, we cannot possibly have enough money to pay for every available treatment for every patients that comes along. I am trying to point out that our system is flawed. We have put profits and politics ahead of medical science and compassion. So when it comes to death panels, would you rather have your mom’s end of life decisions be made by a group of bean counters and politicians or a group of medical professionals AND financial advisers that will include mom and her family in those decisions? The latter is closer to what was in the ACA that got twisted into death panel madness.

    Obviously, if we are to have a reasonable and sustainable system of health care, some very difficult decisions will need to be made. Many of these decisions will have a ripple effect that require further thought, discussion and decisions in other areas of our society.

    What if YOU were on the death panel? What decision would you make?

    A grandma is dying, but with aggressive treatment and mechanical support we can extend her life another 6 to 12 months. She states she is “ready to die,” but various family members agree or disagree. Medicare would pay all the costs involved, possibly approaching a million dollars with up to $10,000 out of pocket. Who decides?

    Keep in mind, “Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives. That’s more than the budget for the Department of Homeland Security, or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked.” – CBS News

    What if your spouse, with private insurance, has advanced lung cancer and has been battling valiantly, with significant out of pocket expenses despite “good” coverage. Now the doctor wants to add a new lung cancer drug, Opdivo, that has an overall survival of 12.2 months compared with 9.4 months for patients treated with docetaxel (about $16K, under $4K out of pocket). The cost of 12 months of Opdivo is about $143K with about $29,000 out of pocket, if you can get a “prior auth” for the drug. Understand that you are rolling the dice here, simply playing the odds, while undergoing toxic drug therapy and so a poor quality of life. Who decides?

    Medicare will pay about 50 grand to put a defibrillator into the chest of a 93-year-old patient with terminal cancer, even though he may not survive the surgery. Who decides?

    Our prison system drug costs are astronomical, with high concentrations of patients that are HIV positive or have hepatitis C. A recent new drug for hep C, Soldavi, costs about $84,000 per patient treated. Our state prisons are currently wrestling with this very dilemma. Which prisoners, if any, do we treat with this drug? Who decides?

    Are we headed toward a health care system where the wealthy will get the best treatments available and the less fortunate get the bare minimum? With only so many dollars available for government-funded care, who will decide how to allocate these funds? Is personal responsibility part of the equation? Is a person who lived an irresponsible life of personal neglect, drinking, and drugging, entitled to anything beyond the most basic care? Do you want to pay for that person’s Solvadi?

    I can only hope that we can get all the cards on the table and figure out a way to have a fair, affordable, sustainable health care system in this country. So far, we do not. It will probably take an effort much like the quest to put a man on the moon. That took the leadership and charisma of John F. Kennedy to energize a nation toward a clear goal. Where do we find such a leader now? Is our goal clear?

    Health care is only one of the challenges facing this country. Having a healthy economy, educational system, infrastructure and national security all have a bearing on the health care system. I wonder if we can make progress while we are so busy pushing our own agendas that we rarely compromise or even have the ability to see a middle ground, or better yet, a higher ground. Maybe we are doomed to keep chasing the ghost of old Tom Joad…

    CKL July 4, 2015

    money rain

    “Men walkin’ ‘long the railroad tracks
    Goin’ someplace there’s no goin’ back
    Highway patrol choppers comin’ up over the bridge
    Hot soup on a campfire under the bridge
    Shelter line stretchin’ ’round the corner
    Welcome to the new world order
    Families sleepin’ in their cars in the Southwest
    No home no job no peace no rest
    The highway is alive tonight
    But nobody’s kiddin’ nobody about where it goes
    I’m sittin’ down here in the campfire light
    Searchin’ for the ghost of Tom Joad

    He pulls a prayer book out of his sleeping bag
    Preacher lights up a butt and takes a drag
    Waitin’ for when the last shall be first and the first shall be last
    In a cardboard box ‘neath the underpass
    Got a one-way ticket to the promised land
    You got a hole in your belly and gun in your hand
    Sleepin’ on a pillow of solid rock
    Bathin’ in the city aqueduct

    The highway is alive tonight
    Where it’s headed everybody knows
    I’m sittin’ down here in the campfire light
    Waitin’ on the ghost of Tom Joad

    Now Tom said “Mom, wherever there’s a cop beatin’ a guy
    Wherever a hungry newborn baby cries
    Where there’s a fight against the blood and hatred in the air
    Look for me mom I’ll be there
    Wherever there’s somebody fightin’ for a place to stand
    Or a decent job or a helpin’ hand
    Wherever somebody’s strugglin’ to be free
    Look in their eyes Mom you’ll see me. “

    Well the highway is alive tonight
    But nobody’s kiddin’ nobody about where it goes
    I’m sittin’ down here in the campfire light
    With the ghost of old Tom Joad”

    – Bruce Springsteen