RALPH NADER
Was ist uns unsere Gesundheit wert?
Viele halten Ralph
Nader für den einflussreichsten Amerikaner. Fast sein ganzes Leben
lang hat er sich unermüdlich für die Belange der einfachen
Leute eingesetzt und für Verbraucherschutz und Arbeitnehmerrechte
gekämpft. Berühmt machte ihn 1965 sein Buch „Unsafe at
Any Speed“ in dem er die mangelnde Sicherheit vor allem der
Cabrios von General Motors anprangerte und so eine Wende in Fragen der
Autosicherheit herbeiführte. Umweltprobleme, Misswirtschaft,
Korruption und ungleiche Handelsbedingungen sind bis heute die
Arbeitsschwerpunkte des viermaligen Präsidentschaftskandidaten der
Grünen. In seiner Rede an der University of Colorado vom 16. April
2009, deren kurze Zusammenfassung Sie jetzt hören werden, geht es
jedoch hauptsächlich um die Reform des amerikanischen
Gesundheitswesens, also um die Einführung einer allgemeinen
staatlichen Krankenversicherung.
Legen Sie bitte nur
für einen Augenblick alle politischen und ideologischen
Scheuklappen ab und Sie werden erkennen, wie viele Menschen unter dem
bisherigen Gesundheitssystem leiden. Nur einem knallharten Kapitalisten
kann es entgehen, dass in diesem Land Jahr für Jahr mindestens
18.000 Menschen sterben müssen, weil sie sich keine
Krankenversicherung leisten können. Diese Zahl stammt nicht von
irgendwelchen Freizeit-Marxisten oder Werbefuzzis, sondern vom durch
und durch konservativen Institute of Medicine. In den 59 Jahren
seit Harry Trumans vergeblichem Versuch, eine allgemeine
Krankenversicherung einzuführen, macht dies mehr als 1 Million
toter Amerikaner.
Auch wenn Politiker es nicht gerne hören, wir brauchen nicht nur
eine Krankenversicherung für Alle, sondern eine Reform unseres
gesamten Gesundheits- und Pflegesystems.
Zunächst muss man natürlich dafür sorgen, dass in
Zukunft niemand mehr sterben muss oder ohne medizinische Versorgung
bleibt. Doch als zweitem Schritt muss das Abrechnungswesen reformiert
werden. Durch Abrechnungsschwindel in Arztpraxen, Krankenhäusern
und Pharmafirmen gehen jährlich mindestens 225 Milliarden Dollar
verloren, für die man fast alle bisher Nichtversicherten spielend
versichern könnte.
Ebenso reformbedürftig ist die Bürokratie. Das
Abrechnungswirrwarr mit zahllosen privaten Krankenkassen verschlingt
Zeit und viel Geld und produziert darüber hinaus massenhaft
persönliche Daten, die beliebig missbraucht werden können.
Eine Reform des Gesundheitswesens würde die Versicherungsindustrie
keineswegs überflüssig machen. Als 1965 Medicare, die
allgemeine Krankenversicherung für über-65-Jährige und
behinderte Menschen eingeführt wurde, standen die Versicherungen
nicht plötzlich vor dem Aus, sondern verdienten weiterhin recht
ordentlich an mehr oder minder notwendigen Zusatzleistungen.
- 2 -
Pharmafirmen dürfen in den USA - völlig legal - kostenlos die
an Universitäten und Kliniken mit Steuergeldern entwickelten und
erprobten Medikamente zu horrenden Preisen vermarkten und sie so
für den normalen Steuerzahler unerschwinglich werden lassen. Mit
dem Auslaufen von Patentrechten versiegt jedoch der warme Geldregen und
man beginnt, nach neuen, möglichst einträglichen, aber oft
völlig überflüssigen Medikamenten Ausschau zu halten.
Um die Soldaten nicht länger einer solchen ausschließlich
profitorientierten Medizin auszusetzen, gründete das Militär
während des Vietnamkrieges eigene Forschungsstätten.
Die Entwicklung eines neuen Medikamentes kostet in der Regel 800
Millionen Dollar. Dem Militärkrankenhaus Walter Reed stehen
jährlich lediglich 75 Millionen Dollar für Forschungszwecke
zur Verfügung, und trotzdem ist es ihnen gelungen, viele
Medikamente gegen Malaria, Hepatitis und zahlreiche auch tödliche
Tropenkrankheiten zu entwickeln, die der Pharmaindustrie
selbstverständlich kostenlos zur Vermarktung überlassen
werden. Wobei die Konzerne nur an solchen Erfindungen interessiert
sind, die hohe Gewinne versprechen – das Wohl der Patienten
spielt dabei überhaupt keine Rolle. Und unsere Regierung macht 175
Milliarden Dollar für die Rettung des kriminellen
Versicherungskonzerns AIG locker, hat aber keine 50 Milliarden, um die
Armen in der Dritten Welt vor Krankheit, Obdachlosigkeit, Hunger und
verseuchtem Trinkwasser zu retten.
In der Pharmaindustrie wird viel zu wenig wirklich Neues, Innovatives,
entwickelt, die Erprobungsphasen sind zu kurz, die Laufzeit der Patente
zu lang. Der Einfluss der Pharmaindustrie auf Universitäten und
Arztpraxen hätte längst eingeschränkt werden
müssen, es muss auch endlich Schluss sein mit bezahlten
Gefälligkeitsgutachten. Patienten müssen informiert, nicht
manipuliert werden. Ärzte und Pflegekräfte dürfen nicht
länger Sklaven der Abrechnungsbürokratie der
Versicherungskonzerne sein. Die Behandlung und Pflege kranker Menschen
ist eine soziale Aufgabe und kein Geschäft mit dem Ziel maximaler
Gewinne.
Mit 7.300 Dollar pro Kopf der Bevölkerung, einschließlich
der fast 50 Millionen Nichtversicherten und der 50 Millionen
Unterversicherten, geben die USA doppelt soviel Geld für das
Gesundheitswesen aus wie Kanada oder die Schweiz. Wir geben das
Doppelte aus und trotzdem sind 50 Millionen Amerikaner nicht
krankenversichert, müssen Versicherte immer höhere
Zuzahlungen leisten und sind immer weniger Leistungen in den
Versicherungen eingeschlossen. Schwangerschaften waren lange wie
Vorerkrankungen nicht versichert. Nach dem 2. Weltkrieg strotzten die
USA nur so vor Kraft, sie waren die reichste Wirtschaftsmacht der Welt,
es herrschte nahezu Vollbeschäftigung, während Europa in
Trümmern lag. Doch dort gelang es, mit Hilfe des Marshallplans,
der Gewerkschaften, eines Mehrparteiensystems und durch
„konzertierte Aktionen“ ein Gesundheitswesen mit
Mutterschutz, Kinderbetreuung, Altenpflege und sogar mit freien Tagen
zur Pflege von kranken Eltern und Familienangehörigen
einzuführen.
- 3 -
.
In unserem Land der Freien und Tapferen sterben vor den Augen hilfloser
Ärzte und Pfleger täglich viele Menschen, weil sie sich keine
Krankenversicherung leisten können, während Unsummen für
die Entwicklung von Lifestyle Pillen und unnötiger Medikamente aus
dem Fenster geworfen werden. Bei der Kindersterblichkeit rangieren wir
auf Platz 28!
Die Regierung unterstützt die Pharmaindustrie mit Hunderten von
Milliarden, aber die Schwächsten - die Kranken – haben keine
Möglichkeit, sich zusammenzutun. um gemeinsam für ihre Rechte
zu kämpfen. Nach ärztlichen Kunstfehlern - wenn sie einen
Arm, ein Bein, einen Angehörigen oder gar ihr Leben verloren
haben, speist man sie oder ihre Familie einfach mit Schmerzensgeld ab.
Für die Managerfehler bei Goldmann Sachs und Citygroup zahlten
nicht die Manager, sondern die Sparer, die Kleinanleger und die
Rentner.
Die Universität von Harvard spricht von jährlich 100 000
Opfern ärztlicher Kunstfehler. Das sind mehr als die Opfer von
Verkehrsunfällen, Bränden und Aids zusammengenommen. Hinzu
kommen weitere 100 000 Opfer von zuviel oder zuwenig oder falschen
Medikamenten. Ich kenne 15 Menschen, die in den letzten 15 Jahren Opfer
falscher Medikamente, von Nebenwirkungen oder von unfähigen
Ärzten wurden. Laut der amerikanischen Ärztevereinigung AMA
sollen 5-10% aller Ärzte alkohol- oder drogenabhängig oder
anderweitig beeinträchtigt sein.
Obwohl laut einer Umfrage vom April 2009 59% der amerikanischen
Ärzte für die Einführung einer gesetzlichen staatlichen
Krankenversicherung sind, befinden sich unter den 120
Gesundheits-Beratern von Präsident Obama nur zwei Befürworter
einer solchen Reform. Der Präsident glaubt, dass eine staatliche
Krankenversicherung nur in einer perfekten Welt politisch durchsetzbar
wäre. Und er beharrt auf diesem Standpunkt, obwohl sich die
meisten Bürger, die meisten Ärzte und die meisten
Pflegekräfte eine allgemeine Krankenversicherung wünschen!
Könnte es sein, dass sich die Regierung den Wünschen der
Lobbyisten beugt?
Es gibt bereits u.a. in Harvard ausgearbeitete Pläne für die
Überführung des bestehenden Systems des
medizinisch-industriellen Komplexes in ein staatliches
Versicherungssystem. Danach gingen 2-3 Millionen Arbeitsplätze in
der Versicherungsindustrie verloren, gleichzeitig jedoch würde die
Versicherung der bisher 50 Millionen Nichtversicherten viele neue
Arbeitsplätze schaffen. Durch eine Reform könnten 300 bis 500
Milliarden Dollar an Verwaltungskosten eingespart werden und mindestens
weitere zwei Milliarden für überhöhte, fehlerhafte
Abrechnungen – all dieses schöne Geld könnte dann in
die Gesundheitsvorsorge fließen.
Sollte die Reform gelingen und ein staatliches
Krankenversicherungssystem eingeführt werden, so wäre dies
jedoch erst nur ein Anfang. Wir benötigen dringend mehr
Allgemeinärzte oder noch besser lokale Gesundheitszentren mit
festangestellten Ärzten mit menschenwürdigen
Arbeitsbedingungen und größere, regionale
Spezialkrankenhäuser.
Präsident Obama verspricht uns eine Gesundheitsreform, aber er
sagt nicht, um welche Art von Reform es sich handeln wird, ob um eine
Krankenversicherung nach dem Muster der westlichen Staaten, wie sie von
vielen Bürgern und Experten gewünscht wird, oder um eine
Reform mehr nach den Wünschen der Mächtigen der Gesundheits-
und Pharmaindustrie.
Weitere Informationen erhalten Sie über die Ärzte Web Site pnhp.org (Physicians for National Health Program).
Vielen Dank für Ihre Geduld
RALPH NADER
The Politics of Health Care
University of Colorado, Boulder 16 April 2009
Ralph Nader has spent a
lifetime fighting on behalf of ordinary people. Life magazine ranks him
as one of the most influential Americans of the twentieth century.
Founder of Public Citizen, he is a long-time advocate for consumer
safety and workers' rights. He rose to fame in the 1960s when he took
on General Motors and its unsafe Corvair car. His 1965 book "Unsafe At
Any Speed" not only created a sensation but was instrumental in the
enactment of the Motor Vehicle Safety Act. His efforts helped create
the Environmental Protection Agency. He has exposed the misdeeds of the
corporate sector as well as of the political system. In recent years he
has led the struggles around NAFTA, the WTO, corporate welfare, and
single payer health care. He has run for president four times.
The politics of health care reform is the topic. This is a massive
subject, obviously, and depending on your predilection, if you're
ideological about this, you will screen out certain realities. Either
left or right, you will screen out certain realities. If you're
empirical about this, you will screen out fewer realities when you look
at the whole health care business and Medicare and Medicaid. If, on the
other hand, number three, you're neither ideological nor just empirical
but you're empirical and you take your cue from the people who are
suffering because of the deficiencies of the health care business, then
you embrace the greatest amount of reality on the ground.
So if you're a knee-jerk free-market conservative, you will never talk
about the fact that according to the Institute of Medicine of the
National Academy of Sciences, 18,000 people die every year in this
country because they can't afford health insurance. Never mind health
care-health insurance. The Urban Institute has it at 22,000. That's
more than six 9/11s every year. They die silently, nobody plays taps,
they're not recognized. And you probably know some of them, because
over some 59 years since Harry Truman first proposed universal health
insurance, over a million Americans, by that figure, well over, have
died because they can't afford health insurance-not health care; that's
even worse-health insurance. Then, of course, you have hundreds of
thousands who are sick, stay sick, injuries not treated, in addition to
the 22,000 or 18,000. Look, nobody has all the answers, obviously. I
can tell, in a way, where someone is coming from ideologically,
empirically, and if you take your cue from the people who suffer and
are excluded and denied and dying and so on. I can tell within 10 or 15
minutes by what they mention and what they don't mention.
The first confusion is that when you say, "What's your position on
health care, Senator this, President that?" the real question that's
asked is, "What is your position on health insurance?" Health insurance
is not health care. Health insurance pays for health care. So we have
to be very careful about drawing that distinction. You can have health
insurance and come up against a lousy hospital or a lousy doctor. They
will pay your bills if you get out alive, or maybe if you don't get out
alive. In fact, I didn't hear either Obama or McCain in their
discussion, which went on for months, on health care ever use that
figure, 18,000 people die. This is a very prestigious group, if you're
not familiar with the Institute of Medicine. They're a very
conservative group, scientists and-that's a lowball estimate. These are
not people who read Karl Marx on their lunch break. This is not like
some commercial health consulting firm coming up with a figure out of
thin air.
The second area that is almost excluded from any discussion are billing
practices. I've always told reformers, start with the deaths and
injuries, that are preventable, and start with the billing practices
and start with comparative examples. No one, no one, in Canada,
Luxembourg, Germany, Finland, Sweden, Switzerland, Italy die because
they can't afford health insurance, not one person, because they're
insured from the moment they're born, to begin with.Take the billing
practices.
There is a fellow at the Kennedy School at Harvard University. He's an
applied mathematician who came over from England, where he was a sleuth
for, like, Scotland Yard. He decided he was going to become an expert
on health care billing practices. He starts putting out these books,
and he consults for some governments and so on. But largely he's not
known. His name is Malcolm Sparrow. Malcolm Sparrow reacted to a
General Accounting Office study, which came out in 1992. They were
asked by some member of Congress, what is the extent of billing fraud
by hospitals and doctors, drug companies, you name it, in America? They
came up with a 10% figure. One out of every ten dollars goes down the
drain that we're billed for due to fraud and abuse, crime, fraud,
inflated bills, phantom entries, and so on. That amounts this year to
$225 billion. Those are big figures, even by AIG executive standards.
When I went up to Harvard to talk with him, there is a little
cubbyhole. You don't have a line of reporters coming up. You can't get
anybody to cover this man's findings, not even 60 Minutes. I said,
"What do you think of these figures?" He said, "Look, the problem is
very complex in the way these bills are designed, in switching
codes"-that's the way they can switch the codes and get higher payments
for certain procedures-"but my guess is that that $225 billion is too
low, that it could be between $300 and $500 billion. The $250 billion
level will cover most of the uninsured, just from that saving alone.
And when you have 1500 insurance companies and all kind of
cross-billings and all kinds of consulting firms designing deliberately
these billing practices in order to achieve maximum yield, is the word,
you're going to get a lot more billing fraud than if there is a single
payer in charge. A lot more billing fraud.
The third area that is very underdiscussed are the administrative
costs. The best studies I've seen on this, they've been published in
the New England Journal of Medicine, Harvard Medical School professors,
estimate now about $300 to $350 billion a year in administrative costs
that would be eliminated if we had a single-payer system, because you
don't have all the cross-billings-you don't have to have one secretary
to every doctor just to deal with the paperwork. They practice paper,
doctors. They don't like the system. One reason they envy doctors in
single payer, where they might not make quite as much money but a very
comfortable income, is that these people can practice medicine. They
don't get overwhelmed with bill collecting and paperwork of that kind.
You've seen your own bills, printouts, page after page. BIC razor, 10
bucks. Just every little thing put down. It's good that they itemize
it, but they're very rarely studied. You don't see much effort at that.
Just a case that happened last week. A woman in California was having
dizzy spells. She gets into an ambulance, goes 3 miles to the hospital.
The doctor admits her, a very nice doctor, and refers her to a
cardiologist. The cardiologist determines that she needs a pacemaker to
deal with the conduction. Not a defibrillator or something more
complex, just a pacemaker. She was in the hospital for three days, and
not a private room, a double room, and she was brought back home by her
friends. So she called me up the other day. I get these from all over
the country. She calls me up the other day, and she says, "Guess how
much?" I said, "What are other people guessing?" Well, there is a Ph.D.
in infectious diseases, and she guessed $10,000. I called up a
well-known doctor in Washington, who is a reformer, "What do you
think?" "$10,000 to $20,000." I guessed $30,000. It was $100,000. Is
she going to pay that or is the insurer going to pay that? No, they're
going to haggle. That's part of the administrative cost. They're going
to haggle over every item, get it down to 40, maybe, maybe 30. These
are basically bills as a prelude to negotiation. But even what they get
it down to is staggeringly greater than the same type of procedure in a
country like Switzerland or France or Canada. So the billing practices,
the paperwork, the deaths and injuries.
Then the other thing that people often screen out is outcomes. When you
have one insurer-and I'll get to that more in a moment-you have one
body of data. It's not 1500 insurance companies who have proprietary
data and are using it in ways you never know anymore through the
electronic systems, privacy issues and so forth. One source of data can
develop and detect patterns: oh, there are too many of this kind of
operation, and it's not a proper operation, these kinds of drugs are
being overprescribed and people are dying. So you have an early alert
system in terms of the outcomes.
Those are just a few of the differences that we have to explore when we
consider whether we want to keep the health insurance industry intact
or replace it. When Medicare came in the mid-1960s, it displaced the
insurance industry, but because it didn't have totally comprehensive
coverage, the insurance industry came back for supplementary policies,
which people have. If they're on Medicare, they will get AARP
supplementary or whatever. So there is nothing new about displacing a
health insurance industry. That's what Medicare did, within the range
of its coverage.
The drug companies are also often screened out by ideologists. The drug
companies really need to be given a psychiatric drug themselves,
because they have lost all perspective. They are a mental health
problem. I once spoke to a convention of psychologists, and I said,
"I've got some more business for you people. You're always talking
about the mental health of individuals. Why don't you try the mental
health of institutions, like corporations, like the Pentagon, like
General Motors, like drug companies? You can even use conventional
language. You can examine the kleptomaniac traits of the drug
companies. You can go to the HMOs, who are always in a rush to get
women through hospitals after they've given birth, in and out, and they
can be charged and analyzed with attention deficit disorder. And
General Motors, my favorite company, can be accused of failing to
toilet-train itself and its automobiles in terms of pollution. They
were not amused, by the way, when I said this to them. But we really
should ask about the mental health of an industry.
Look at the problems in the drug companies. Number one, they brag about
drugs that they did not discover and did not clinically test as if they
were their own. Who discovered them? Who clinically tested them? The
NIH, the National Institutes of Health, tax dollars, your tax
dollars-like Taxol and AZT-and the scientists at various universities
and clinics. So about three-quarters of all effective anti-cancer drugs
have very heavy, if not full, taxpayer dollars behind their discovery
and their testing, but under federal policy the clinical results of
these new drugs are given free under CRADA, Cooperate Research and
Development Agreements, by NIH to a selected company that has
experience in marketing this drug. So Taxol went to Bristol-Myers
Squibb because it sells anti-cancer drugs. It really takes brilliant
marketing to sell an anti-cancer drug that works. Only Bristol-Myers.
A woman in 2000 wrote me, with ovarian cancer. She had lost her
$19,000-a-year job and her health insurance. She went to a doctor who
said, "It's very serious. All I can prescribe is Taxol." She said "How
much?" He said, "$14,000 for six treatments." He didn't say the $31
million of taxpayer money through the National Cancer Institute, that
discovered and clinically tested Taxol. It was discovered from the weed
tree in Oregon, and Washington State, in case anybody thinks weeds
should be exterminated.
You can see the following pattern with the drug companies. First of
all, they produce too many me-too drugs, and that's very expensive,
especially when they pump in $3 billion a year advertising them. Most
countries prohibit advertising drugs because it's too emotional, it's
too short, you can't really get anything across, and it has a peculiar
influence, because when they immediately rat-tat-tat the side effects,
like that should scare the hell out of us, people are completely
numbed. It's almost like the list of horrific side effects which ends
"and consult with your doctor" is an anesthetic all by itself, because
anybody who took seriously those side effects would never want to
pronounce the name of the drug much less ask it to be prescribed. But
they have to do that under law.
A lot of me-too drugs and very few innovative ones. In fact, that's the
problem now. A lot of these drug companies are suffering declining
sales because they're off patent. They can't send their lawyers to
extend the patent or to bribe the generic companies to withhold
competition in return for a cash advance, which is being investigated
by the Justice Department. So there are very few innovative ones. It
turns out the real innovator is the dreaded government: the National
Institutes of Health and Walter Reed Army Hospital and Bethesda Naval
Hospital. The latter two got fed up with the drug industry during the
Vietnam War because the second cause of hospitalization for our
soldiers after injury was malaria. And the drug companies are not
interested in vaccine development. They want something you take every
day, like a blood-pressure drug, like a painkiller, maybe like Viagra.
They want something that's very recurrent. They don't want something
that's good for six months, for two years, for five years. And the
military said, "The heck with you. We're going to start our own drug
development and testing facility. We're going to have Ph.D.'s, we're
going to have M.D.'s, there are going to be colonels, captains in the
navy, brigadier generals, and we're going to supply them with the money
to do the work."
The latest estimate to develop a new drug, which includes failures, by
the drug industry, a very phony figure, is now about $800 million for a
drug. Now compare it with the dreaded government. I went over to Walter
Reed-very few people know about this. The Secretary of Defense doesn't
know about this. They are prohibited from going to Congress unless
members of Congress invite them, unless they go through OSD, the Office
of the Secretary of Defense. This is one of the great achievements of
the military in the modern age, because out of this little tiny group
came three out of the leading four anti-malarial drugs, came an
assortment of other drugs, drugs dealing with hepatitis, for example,
and tropical disease drugs. And they also run laboratories in key
places around the world to catch potential Ebola or other deadly
outbreaks.
So I'm sitting at this big table and I've got all these naval officers
and Army officers, all the ones I had to salute when I was in the Army,
and cook for, by the way. And I said to them, "What's your budget?"
They said, "Including the laboratories, it's $75 million a year." I
said, "What's your estimate as to what it's cost you to develop and
test a drug, which then you're obliged to give away to a drug company?"
No royalties, by the way. No royalties back on Taxol and AZT. It's a
give-away. He said, "Not counting salaries"-and they're not
multimillion-dollar executive bonuses-"of the M.D.'s and so on, between
$5 and $10 million." Remember that, $5 and $10 million. I said, "What
have you got in the pipeline?" He said, "Well, we're very excited.
We've got a six-month malaria drug." Have any of you had malaria, by
the way? Anybody? That makes two of us. It's not fun, is it? It doesn't
last very long, an anti-malarial drug. You have to take it regularly.
They had one for six months. He said, "But we don't have the
appropriations to fund it from Congress."
Of course, they never get any publicity. Members of Congress have never
heard of them. I had to take them over to the special assistants to
Clinton in the White House and have then Congressman Sherrod Brown from
Ohio invite them for a meeting in his office. This is ridiculous. Even
more is his answer. I said, "Before you tell me what it is in order to
clinically test this promising six-month anti-malarial drug, let me ask
you to answer it in another way. How much of a B-2 bomber would it
cost?" This was a time when the Air Force didn't want any more B-2
bombers but Lockheed Martin and Boeing, all these people, did. And they
had the grease on Capitol Hill to make it happen. Without a beat, he
answered, "A wheel," because a B-2 bomber was then going for almost $2
billion. A wheel. I blushed with shame. What kind of society have we
become? We can spend $175 billion on a criminal corporation and still
not take it over, the AIG, and a U.N Development Program estimates that
for $50 billion, that money will provide minimal health care and clean
drinking water, minimal shelter, and minimal nutrition for all the
world's poor in the Third World. You can make your own comparisons on
how we spend money and how we don't spend money from Capitol Hill and
OMB in the White House.
What does this tell us about the drug companies? One, there are too
many me-too drugs. Two, they don't innovate very well; they're
freeloaders. The Food and Drug Administration is paid by the drug
companies for testing drugs. That's called a user fee. But the Food and
Drug Administration, FDA, is not there to be used, it's there to serve
patients. The faster drug-approval decisions are made, the more money
they get from the drug companies and the more people they can hire.
It's not the proper incentive. Three, the drug companies keep secret
too much clinical research about how the drugs are working once they're
approved in the field. If they have bad clinical results and we don't
know about it, you know what happens. Four, the patent life is too
long. This is an 18th century system. They don't need to have 20 years
or so, and whatever they can extend. Therefore, a shorter patent life
or just giving them a cash incentive instead of a monopoly, which is
what a patent is, there would be more generic competition and the price
of pharmaceuticals would plummet, as we have seen. Five, the drug
companies have far too much influence over medical schools. Too many
freebees, too many junkets, too many freebees to the students, to the
professors.
And a lot of professors write articles on drugs in medical journals and
don't disclose that they're consultants or somehow economically tied.
That's a nice scandal these days, which I think is on the way to being
corrected. The Journal of the American Medical Association and the New
England Journal of Medicine are getting very tough on that. They've
been embarrassed in recent years by subsequent disclosures. And, of
course, the prices are too high and they're too variable. Claritin, for
example, the price increased 50% in one year before it went off patent.
It's the brand name. People remember brand names. That's why they spend
so much time advertising. They go to the doctors and they insist on the
brand name, and the doctors often give in.
There is another aspect of the present system that's very troubling,
and that is that doctors and nurses cannot exercise their professional
judgment on the ground, patient by patient. They have to obey these
protocols by the HMOs, the insurance companies, by somebody on the
tenth story of an office building whose principal interest is denial of
care. The insurance companies' perverse incentive is that they deny
care. The more they deny care, the more they restrict access, which can
lead to more costs, because people don't get treated in time and so
forth-it's not a freebee for the society-the more money they make. A
single-payer system, everybody in, nobody out, does not have to spend
tons of money and time trying to figure out who is to be left out. That
takes a lot of paperwork and a lot of agony and a lot of
back-and-forth, and the doctors object, and the nurses object to the
doctors. And they say, "Who is practicing medicine?" Is it the
insurance industry remotely or is it the doctors and the nurses, who
are not without their failures, but they're the ones on the front line,
they're the ones you can hold accountable, they're the ones who are
part of a profession that has certain ethical standards. The insurance
companies are not a profession, they're a business.
What's the scene in Congress? You have a present system that spends
twice as much per capita. It's up to $7,300 per person on health care
in the United States. That includes the 50 million who aren't covered
and the 50 more million who are insured but undercovered. Switzerland
and Canada spend about half that, and they are high-wage countries. The
doctors don't make as much, the drug companies don't make as much, the
drug company executives certainly don't make as much, if they're
operating under their jurisdiction. But they do get good pay. There are
nurses and orderlies, and so on.
So here we are. We have twice the amount per capita that we're
spending, about 50 million not covered, 50 million undercovered, and
many of the people who are covered comprehensively find that there are
increasing co-payments, deductions, exclusions and pre-existing
conditions. For years pregnancy was considered a pre-existing condition
and excluded.
In Western Europe and Canada-I don't want to idealize them, but you
have to compare them-in 1945, Western Europe, cities devastated,
countryside destitute, hunger, poverty. It was horrible. We came out of
1945, the end of World War II, the colossus of the world, the most
prosperous economy in the world, as close to full employment as we've
ever come. Look at the difference. Starting in 1946, with a little help
from our Marshall Plan, the people in Western Europe, through their
trade unions, their multiparty system-not two parties-and proportional
representation, and through their extensive system of cooperatives,
demanded and received universal health care, demanded and received paid
maternity leave, demanded and received universal daycare, demanded and
received very decent, humane care for the elderly. For example, a year
of pay to take care of your ailing parents in the Netherlands. Never
mind 12 days a year of unpaid family sick leave, which is as far as
we've gotten in this country.
So in the land of the free and the home of the brave this is where we
are: People dying every day because they can't afford health insurance,
enormous waste of resources, billing fraud at epidemic levels,
restricting the professional judgment of the only people who have
hands-on work every day, doctors and nurses, and spending enormous
amounts on promoting me-too drugs and drugs that deal with lifestyle.
The outcomes are better in Western Europe and Canada. We are 28th in
infant mortality in the countries of the world. Taiwan has universal
health care. Israel, which gets over $3 billion in aid from the U.S.,
has universal health care. Maybe they ought to reverse it: give us
foreign aid. These two countries have universal health care. We don't
have universal health care. So it's not just the industrial West.
Above all, the patients have no facilities to organize themselves. The
U.S. government has subsidized the drug industry hundreds of billions
of dollars over last generation, but they've never gotten around to a
simple principle of governance, which is, if you want any regulatory or
subsidy system to work, corporate subsidy system or regulatory system
on corporations, like the health industry, you must provide easy ways
for the ultimate victims, the ultimate payers, or the ultimate
beneficiaries to organize themselves. Those are the patients. And the
way to do that is not simply to give patients rights, it's not simply
to give them remedies to sue when they lose a limb or they die or their
next of kin because of medical malpractice. You have to give them
rights, remedies, and a way easily to find each other and join
nonprofit consumer oversight groups funded by consumers. Whoever joins
sends 25 bucks in. They hire their own vigilant investigators to
oversee government health care practice, policy, and, of course, HMOs
and hospitals.
No, it's not done. It's not even discussed. It's like the financial
bailouts of Wall Street. They're discussing everything but organizing
investors. Who's paying the bill? It's not Goldman Sachs, it's not
Citigroup. These guys have golden parachutes. They're doing very well.
It's the investors, the mutual fund people, the savers, the pension
holders. And there is no facility to make it easy. What is the
facility? Mailings. Mail out several times a year. Make these
subsidized companies, in their own mailings to you or otherwise, invite
you to join your own nonprofit health consumer action groups. And
unlike the drug industry or the HMOs, they're not subsidized. They use
their own money; voluntarily joined with their own money. If they don't
want to join, they don't have to. That's the important thing that is so
often overlooked.
Medical malpractice. They say there is a serious medical malpractice
crisis. Again, ambiguity in the words. You know what that usually
means? That doesn't mean that over 100,000 people a year die from
hospital malpractice, which is Harvard School of Public Health and
other estimates. That is more than all the people who died in motor
vehicle crashes, in fire, and from AIDS in the United States. And there
is another 100,000 or so who die from the side effects of
pharmaceuticals, poorly prescribed or overprescribed, combinations and
so forth. No, when they say there is a medical malpractice crisis,
here's what the insurance companies mean. They mean that the lawyers
are litigating too much, they're too litigious. Well, the studies from
places lake RAND, which can't be accused of radicalism, say that less
than 10% of the people who are victims of malpractice even go to a
lawyer, never mind file a claim. That's even a smaller percentage.
So what we're dealing with here is a malpractice situation which is
costly, a lot of people die, a lot of people get injured. I can just
think of 15 people I've known in the last 15 years-flat-out malpractice
fatalities. They were prescribed distinctly the wrong drug, with a
terrible side effect, distinctly incompetent physician attention. Five
to 10 percent of all physicians, according to the AMA years ago-they
don't like to make studies on it now-are either alcoholics, drug
addicts, or physically incapacitated to practice medicine. 5% to 10% of
the physicians. They handle a lot of patients.
In a single-payer system, half of the money that people get in verdicts
and settlements from malpractice comes because of health care expenses.
The single-payer system eliminates that. They're already covered. It
also allows for a much more tailored focus on the 10-15% of the
physicians who are recidivists. They really shouldn't have licenses.
They cut up their patients far, far more than the 85 other percent,
even taking into account different specialties, like neurosurgery.
By now you must have a sneaking suspicion that I'm for a single-payer
system. Here's what's interesting. A majority of the American people,
in poll after poll, favor a single-payer system. Last April a very good
poll found that 59% of physicians favor a single-payer system, and some
of the big organizations of physicians-not the AMA-either favor a
single-payer system or have it as one of their two or three preferred
reforms. Isn't it interesting that President Obama three weeks ago had
120 people in the White House to discuss health care and reform, until
one little reporter discovered that not one of those 120 people were
single-payer advocates, the majority-supported reform in America, and
blew the whistle before the meeting. The White House quickly invited
Congressman John Conyers, who is the chief sponsor of H.R. 676, which
had 95 sponsors in the last Congress-it's up to about 75 House members
who have signed on to it-and the head of the Physicians for a National
Health Plan, the president M.D. Two out of the 120 for the
majority-supported proposal. In other words, it's off the table. It was
never discussed by McCain, never discussed by the reporters who asked
questions during the debates, so-called debates-parallel press
conferences, I call them-it was never discussed by Obama, except once
he was asked and he said, well, in a perfect world he would be for
single payer, but it's not politically practical. When you start out
with the majority of the people and the majority of the doctors and a
majority of the nurses for single payer and you say it's not
politically practical, how are you defining politically practical?
Corporate power and lobbying, that's the definition, who don't make up
a very large number of the American population, do they? That's what
they're reacting to.
There have been very detailed plans worked out on how to make a
transition from the present medical-industrial complex system to a
single payer. There are certain technical transitions that have been
worked out by people at Harvard and elsewhere. There are going to be 2
to 3 million people out of jobs: bookkeepers, accountants, protocol
setters; all the people who fill those office buildings of Aetna and
Safeco and Cigna and so forth. They will be unemployed. However, a lot
of them can transfer into the expansion of health care coverage for the
50 million people who aren't covered, because there is going to be an
expansion in utilization. But you cut out $300 to $350 billion in
administrative costs, two and some billion dollars in overbilling. You
have better outcomes, so that you have a bigger focus on prevention.
Tommy Douglas, who initiated the Canadian health care system as a
premier of Saskatchewan, back, I guess, in the 1960s, said that health
insurance, single payer is just the first stage. The second stage is
community health care, it's clinics that work on prevention, it's
nutrition, it's exercise. It's all the things that reduce the
horrendous costs when people's health fails seriously.
I'm going to leave it at that for the time being. I'm not going to go
into the $10 million packages that some of the heads of these HMOs have
been pulling down. Or how can you quantify the anxiety of people? Think
of the lack of anxiety in a place like Canada about losing their entire
life savings, not having enough to save their relatives, this roller
coaster people are on. Even when they're treated properly, then the
bills come, and then you've got to spend the time figuring out the
bills from the anesthesiologist and the cardiologist and this and that.
You can't figure out the bills, because they're written in code. People
are spending hours on these forms. So even after it's over, even after
it's a good outcome, there is all this trouble and all this waste. And
when you know the company that has to take the humidifier or the
breather apparatus, "Well, it's Friday; run it over into a Monday," and
they get three more days, who's to know the difference? The
overbilling, the racketeering. You've seen some of this on 60 Minutes,
on 20/20, in The Wall Street Journal. And it goes on year after year
after year.
The two parties have not dealt with this fundamentally. They didn't do
it in the 1950s, '60s, '70s, '80s, '90s, and they're not going to do it
with the plans that are up before Congress. Because all of them have
one uniform trait, even though they have little differences here and
there: they leave the health insurance companies intact. As long as
they're there, you will have the perverse incentives and the
consequences that I have been describing.
How do we begin to get a movement behind health care, that the majority
of the people want, health care insurance? There is a little group that
started up in West Virginia, and I think it may have the formula. It's
called singlepayeraction.org. Look it up. Singlepayeraction.org.
They've realized that single payer is off the table, it's not discussed
in Congress, it's not discussed much in White House circles, HHS, the
press doesn't discuss it-they don't ask the question, "Senator, what do
you think of single payer-most of the doctors, the majority of the
nurses never ask. So this little group believes in direct action. The
first thing they did was they burned their medical bills in front of
the HMO headquarters in Washington. That's on the Web site, by the way.
The second thing they did was, some of their spouses have joined
belly-dancing clubs. It's spreading in the country. It's good exercise,
I'm told. So they had a demonstration in West Virginia called "Shake It
Up for Single Payer." And it made the front page of the newspapers.
They had belly dancers in the cold weather, too.
What does that tell you? That tells you that you have to go down the
ladder of sensuality to start getting press. You can't get press with
the arguments, you can't get press with the studies, you can't get
press with the data, the suffering, the death, the waste. That doesn't
get you press. Ask the Harvard professors who put out these studies.
What will get you press are very innovative, on the ground, on the
street theater, within bounds. That's what they're doing. And they ask
you to join them and spread your ideas of demonstrative protests, so to
speak. They're doing it without any big money or anything. They're just
feeding a very severe unease, fear, anxiety and tragedy that affects
all too many Americans in our country.
Let's say we get single payer. Is it going to be locked in stone? No,
no. Every success produces some problems. We should want to have those
problems compared to this system. But you have built into the system
options for revision, for reconsideration, refinement, retooling,
discipline, accountability. And single payer will bring more
primary-care physicians into practice. We have a very severe shortage
now. Less than 15% of medical students want to become primary-care
doctors. They work harder and get paid less, and they're always on the
front line, getting beat upon; whereas a specialty-look what
anesthesiologists can get four years out of medical school compared to
a G.P. doctor, family practice. With single payer you can develop these
incentives at medical school in terms of scholarships, payments, and so
forth to bring more physicians into general practice.
Ideally, my ideal, is community health clinics for primary care.
Doctors are employed, they've got a life besides being doctors. They're
not harassed, they're not asked to stay 25 hours in a row. And the
board of directors are the lay people, who are knowledgeable and
sensible and who are among the patient class. So you have a nice
combination of expertise and accountability to keep the purpose of the
clinic service-oriented rather than profit or profiteering. Then you
have regional or larger hospitals that deal with specialties. So in a
place like Connecticut you might have four or five hospitals that deal
with all the specialized referrals. We're quite a long ways away from
that.
For heaven's sake, isn't this worth discussing in the year 2009, when
we are told it is not going to be delayed, we will have health care
reform, says Obama, but we won't talk about the major type of health
insurance in Western countries and that is supported by the majority of
the people and the professions? Is there something missing there? Is
there something oligarchic, plutocratic, we know best? In fact, when
Obama had these meetings with citizens, around the country, to get
their ideas, single payer was brought up repeatedly, but it didn't get
back to the White House to invite more than two belatedly to the White
House session.
Those of you who want to go into more detail on this, the Web site for
the Physicians for a National Health Program is pnhp.org. That will
radiate a lot of other medical journal articles and reports and Q and
As. They have a great Q and A, 35 questions, about single payer, the
criticisms, the challenges, the alternatives. It's very, very good. If
you want to start a discussion center first and then start an action
center, link to singlepayeraction.org. Thank you for your patience.
For information about obtaining CDs, MP3s, or transcripts of this or
other programs, please contact:
David Barsamian
Alternative Radio
P.O. Box 551
Boulder, CO 80306-0551
(800) 444-1977
info@alternativeradio.org
www.alternativeradio.org
(c)2009
|
