Like most everything that happens in health care today, our ideas about sickness are being shaped in the long shadows cast by the global drug giants. Yet the narrowing of the focus is making it harder for us to see the bigger picture about health and disease, sometimes at great cost to the individual, and the community. To use a simple example, if an improvement in human health was our primary aim, some of the billions currently invested in expensive drugs to lower the cholesterol of the worried well might be far more efficiently spent on enhanced campaigns to reduce smoking, increase physical activity, and improve diet.
(Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning Us All Into Patients, by Ray Moynihan, Alan Cassels – Prologue, p xv)

There are two things I would change on my first day as dictator: 1) outlaw advertising to children; and 2) outlaw advertising of prescription drugs to the general public.

The first is a no-brainer. Advertisers, who are adults schooled in the art of psychological manipulation, have a decidedly unequal bargaining position over children. These poor schmucks, these kids, should be able to enjoy their childhoods. Advertising makes them dissatisfied with what they have. That’s its whole purpose, and why it works – it makes them unhappy.

Advertising to adults about drugs is no different. We grown-ups are supposedly better able to evaluate information and make wise choices, but with drugs, absent some medical training, we are children at the feet of the ad moguls.

The book I cited above is an exposé of the world of consumer drugs – overpriced remedies to manufactured conditions. The premise is that drug companies are more concerned with inventing diseases than curing them. The chapters of the book are each devoted to a particular malady – depression, high cholesterol, menopause, ADD and ADHD, high blood pressure, PDD (premenstrual dysphoric disorder), social anxiety, IBS (irritable bowel syndrome) and female sexual dysfunction. Each is either mythical or over-hyped.

The drug companies’ business model is to 1) invent (or (exaggerate the prevalence of) the disease; 2) conduct self-financed and self-directed clinical studies of drugs to treat the disease; 3) convince a large segment of the public that they have the disease; 4) market the remedy.

For any of this to be effective requires complicity of the regulatory agency, the FDA. Incredibly, in a blatant conflict of interest, that agency depends on drug companies for much of its funding. The regulator is employed by the regulatee.

Take just one ‘disease’ – high blood pressure. There’s no consensus that the measurement we use to delineate what constitutes “high” is terribly useful by itself. It is far better that people stop smoking, eat better, and are physically active. Non-smokers who eat well and exercise can endure higher blood pressure without risk. All of the billions that we devote to drugging the population to lower the numbers would be far better spent in education on how to avoid the need for the drug at all. Far more people take high blood pressure medicine than need it.

Dr.James McCormack does presentations for senior citizens, and asks them the following:

Would you take a drug every day for five years if it …?

A: Lowered your chance of having a heart attack by 33%?
B: Lowered your chance of having a heart attack from 3% down to 2%, a difference of 1%?
C: Saved one person in a hundred from having a heart attack but there is no way of knowing in advance who that one person will be?

That’s three ways of saying the same thing. People who attend McCormack’s seminars leave feeling relieved that they are far less at risk as they are led to believe.They become less susceptible to the drug company advertising, which hits hard on A while studiously avoiding C.

Other ‘diseases’, like ADD/ADHD, are controversial at best, over-treated and over-hyped. Female sexual dysfunction, for instance, is far more likely to be a product of stress in relationships than any physical disorder. Women who feel loved and who are comfortable in their relationships are far more likely to enjoy sex than those who aren’t. There ain’t no pill for that.

There are two problems here indicative of a dysfunctional society: 1) we allow advertisers unimpeded access to the market with their crap, and 2) that our drugs are supplied by drug companies whose primary motive is their bottom line. Pharmaceutical companies long ago realized that the most profitable drugs were those taken daily for years. It was only two logical steps further that they would invent diseases and advertise the cures.

The profit motive interferes with health care delivery, and advertising interferes with information and education. Two underpinnings of capitalism lead to dysfunction. I must be a damned socialist!

Some very good work passes by our eyes every Friday might on Bill Moyers’ Journal, and July 10 was no exception. His guest was Wendell Potter, former head of corporate communications for CIGNA, the nation’s fourth largest health insurance company.

Potter had an epiphany of sorts, not unlike Dr. Peter Rost, former pharmaceutical executive who wrote a tell-all book, The Whistleblower: Confessions of a Health Care Hitman. Potter’s came when he went to a health care expedition in Wise, West Virginia.

I borrowed my dad’s car and drove up 50 miles up the road to Wise, Virginia. It was being held at a Wise County Fairground. I took my camera. I took some pictures. It was a very cloudy, misty day, it was raining that day, and I walked through the fairground gates. And I didn’t know what to expect. I just assumed that it would be, you know, like a health– booths set up and people just getting their blood pressure checked and things like that.

But what I saw were doctors who were set up to provide care in animal stalls. Or they’d erected tents, to care for people. I mean, there was no privacy. In some cases– and I’ve got some pictures of people being treated on gurneys, on rain-soaked pavement.

And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee– all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.

There could have been people and probably were people that I had grown up with. They could have been people who grew up at the house down the road, in the house down the road from me. And that made it real to me.

BILL MOYERS: What did you think?

WENDELL POTTER: It was absolutely stunning. It was like being hit by lightning.

Potter recalls later riding on a CIGNA jet and eating food from gold leaf china. The contrast between West Virginia and corporate luxury troubled him deeply.

“Okay, I can’t do this. I can’t keep– I can’t.” One of the books I read as I was trying to make up my mind here was President Kennedy’s “Profiles in Courage.”

And in the forward, Robert Kennedy said that one of the president’s, one of his favorite quotes was a Dante quote that, “The hottest places in hell are reserved for those who, in times of moral crisis, maintain a neutrality.” And when I read that, I said, “Oh, jeez, I– you know. I’m headed for that hottest place in hell, unless I say something.”

That’s rare. Rare indeed. Most of us adapt our minds to the power structure around us, internalizing the contradictions and self-justifying as we must, shutting out everything else. I doubt any other health insurance executives in this country bother to attend health care expeditions. They are more likely to be found in their blinded offices looking over financial reports and making decisions that destroy lives. All in insulated splendor.

Sources now say that there’s a parade of lobbyists going in and out of Senator Max Baucus’s office. Recently the Washington Post disclosed (Familiar Players in Health Bill Lobbying) that Baucus is being lobbied by two former chiefs of staff, David Castagnetti, whose clients include PhRMA and America’s Health Insurance Plans, and Jeffrey A. Forbes, working now for PhRMA, Amgen, Genentech, Merck and others.

He’s completely shut off from ordinary people. He doesn’t know how bad it is, how ordinary people on Main Street don’t go see doctors because of cost, don’t have insurance because they can’t afford it or are not allowed the privilege.

Potter says that the industry has its ways. He talked about Michael Moore’s movie, Sicko, and how the insurance industry deliberately set out to blunt its effect on Capitol Hill:

WENDELL POTTER: …part of the effort to discredit this film was to use lobbyists and their own staff to go onto Capitol Hill and say, “Look, you don’t want to believe this movie. You don’t want to talk about it. You don’t want to endorse it. And if you do, we can make things tough for you.”

BILL MOYERS: How?

WENDELL POTTER: By running ads, commercials in your home district when you’re running for reelection, not contributing to your campaigns again, or contributing to your competitor.

BILL MOYERS: This is fascinating. You know [quoting from a document circulated on Capital Hill], “Build awareness among centrist Democratic policy organizations–”

WENDELL POTTER: Right.

BILL MOYERS: “–including the Democratic Leadership Council.”

WENDELL POTTER: Absolutely.

BILL MOYERS: Then it says, “Message to Democratic insiders. Embracing Moore is one-way ticket back to minority party status.”

The people who lobby Capitol Hill are not amateurs, and they do not persuade by force of reason alone. Money and relationships are part of it, to be sure.

But my dark side also thinks that there is more, much more going on that we’ll never be privy to. There are potentially damaging financial relationships and sexual dalliances, knowledge of which is available to lobbyists when needed to keep congress people in line. John Ensign was recently exposed – how many other lay awake at night knowing that someone knows something about them- that they’ve been Abscammed or given the Gary Hart treatment?

In my many dark moments of concern for Max Baucus, I wonder if he’s been caught doing something naughty, perhaps even entrapped. That is, after all, a common form of persuasion – one that we seldom hear about. We only know the fallout.

We’re shut out. Our job is to break down the barriers, make our voices heard inside the velvet curtains of the offices of Congress. It’s not an easy task. Blogs don’t do it – staffers only monitor us for damage control. Phone calls and letters don’t do much good either -these people are not fools – they know what public opinion says. They are unable to respond to it.

Protests are routinely ignored – as Russian expatriate Dmitry Orlav observed,

The American way of dealing with dissent and with protest is certainly more advanced [than that in Russia]: why imprison dissidents when you can just let them shout into the wind to their heart’s content?

Baucus, of course, ham-handedly adopted the Russian response. He’s not particularly good at public relations.

What is the answer? It is no different for us than any other country under the thumb of power – we have to rise up and cast off our rulers. The various peoples of the Soviet Union did this with apparent ease, but theirs was a different situation. Most of them did not suffer the illusion of living under a democratic regime. Americans are deliberately led to think they are in charge of their own lives by mere exercise of meaningless voting rituals every two years, replacing one set of scoundrels with another. If it were that easy, the whole planet would be free.

I don’t see change happening any time soon, I’m afraid. I talk to very few people who have a much of a level of awareness of the true nature of our society and government. There are not enough to make a difference at this time.

So the only answers are patience and education.

The Bozeman Daily Chronicle* today had a relatively long piece (Health reform will affect how Montanans access care) on the health care debate, and in uncharacteristic fashion, took a few shots at Senator Max Baucus. It starts at paragraph 48:

But some are skeptical Montana’s six-term senator is capable of pushing substantive change.

“Max Baucus is purely a satrap of industry,” said [Rick] Meis from Montanans for Single-Payer. “He is a small power figure who is totally manipulated by the powers that be.”

Between 2003 and 2008, 23 percent of money raised by Baucus’ campaign and political action committee came from the health industry.

A range of medical interests are represented in his list of donors. According to the Center for Responsive Politics, the insurance industry provided $784,685; health professionals gave $848,141; and health services and HMOs chipped in $465,750.

Two of Baucus’ biggest contributors are Schering-Plough Corp., a health care company that contributed $92,200 during the five-year period, and Blue Cross Blue Shield of Montana, which contributed $62,350.

Meis said Baucus’ proposal is heavily influenced by those donors.

“It’s what the insurance industry is telling him, because they’re buying him,” Meis said.

From Meis’ perspective, single-payer is the obvious choice if not obscured by industry interests.

“There’s not a single-payer system in the world that doesn’t work better,” he said.

A Baucus spokesman, Ty Matsdorf, quickly circled the wagons, saying that Baucus has on occasion done things the industry didn’t like, as if now doing them the biggest favor in the world now was thereby justified.

But that’s not the point. Even though it didn’t happen until paragraph 48, a Montana newspaper went after Max Baucus. I’m not sure what that means – it could be (one can only hope) that the health care crisis and Democratic attempts to crap on us are having severe fallout, and that Max’s usual base of support, which includes major Montana newspapers, is eroding.

Time will tell. We must keep the pressure on. Please, everyone, do not make nicey with Max. Badmouth him at every venue, on every forum. Kindness only feeds him.

*The Bozeman Daily Chronicle has in the past been behind a subscription wall. I hope the practice has ended – this article is accessible at the time this is written.

**P.S. Did anyone else see the movie “Wag the Dog”?

You just can’t work with this Kucinich guy.

Vodpod videos no longer available.

By the way, Dr. David Gratzer reminds me an awful lot of the character Sheldon on the TV Show the Big Bang Theory, not that I watch it or anything.

“Let me give you a word of the philosophy of reform. The whole history of the progress of human liberty shows that all concessions yet made to her august claims, have been born of earnest struggle. The conflict has been exciting, agitating, all-absorbing, and for the time being, putting all other tumults to silence. It must do this or it does nothing. If there is no struggle there is no progress. Those who profess to favor freedom and yet depreciate agitation, are men who want crops without plowing up the ground, they want rain without thunder and lightening. They want the ocean without the awful roar of its many waters.” Frederick Douglass, 1857

This is a message to health care reform advocates who think the best way to get what we want is to “work with” Democrats who want to “work with” Republicans and come up with a “compromise solution” that gives everyone a little bit of what they want. Nonsense!

As Douglass also said, or should have said, power concedes nothing without a demand. It takes a fight, and there is no fight to be had if you don’t even know who your enemies are. (They are Democrats.)

Working with power to get things from the powerful is as useful as working with your bank to get your payment lowered. Unless you can somehow threaten them, hurt them in some manner, they yield nothing. The word that comes to mind concerning “working with” recalcitrant Democrats is “losing”.

With that in mind, Obama has suggested that MoveOn and others who have been running ads against Mary Landrieu in Louisiana stop doing so. That tells me something important: Those ads are hurting Landrieu, and should continue. Pain is good.

Too bad, however, that she just got reelected. Nonetheless, MoveOn should continue inflicting pain. If nothing else, hurting a “Frenemy“** is reward enough.

**I just learned this word today, and could not wait to use it.

Dear Mark:

Thank you for contacting me about reforming our health care system.

Recently, a number of Montanans have taken time to share their personal stories about health care with me. These situations are often frustrating and emotional, but they reinforce the need for significant health care reform. I deeply appreciate your willingness to share your story with me.

Some of the letters I received have come from uninsured Montanans. Today, nearly 154,000 Montanans do not have health insurance. Other letters come from folks who are dangerously underinsured, who are paying more than they can afford, or from folks who are worried about loved ones losing jobs. Montanans concerned about health care come from all walks of life.

I firmly believe that all Americans should have access to quality, affordable health care without discriminatory practices. I believe proposals to fix our system should maintain patient choice, emphasize preventative care, and control costs to consumers and the government.

The Senate plans to take up this important issue in the coming weeks. In fact, we are already evaluating a number of competing proposals. I will look closely at all of them. Moving forward, I will keep your views in mind because personal stories like yours are the best evidence of the need for reform.

Please do not hesitate to contact me again in the future if I can be of further assistance.

Sincerely,

Jon Tester
United States Senator

An email this A.M from my brother on our wonderful system of private insurance::

I had mom to the dermatologist yesterday. All her cancer lesions have healed nicely except for the end of her nose. We will do four more weeks of treatment (ointment three times a week), and I will bring her back to the doctor on August 5. Here’s a complication however. It turns out the prescription ointment is very expensive (her last prescription, which ran out a couple weeks ago) was over $600. The doctor’s office sent over some samples, which will last about another week. The doctor gave me another prescription, but the pharmacy at Billings H & R will not fill it because mom’s insurance (Sterling) turned down the claim on the first prescription and so Billings H & R is already out $600 on this deal. So I’m going to visit with the doctor and see if we can get some samples to finish out mom’s treatment, and also see if he will file an appeal with the insurance company to pay for the first prescription.

I had a nice visit with the pharmacist, who is really upset with Sterling, and with supplemental insurance in general. He said they readily approve prescriptions for cheap drugs, and constantly turn down prescriptions for expensive drugs. In his opinion if we don’t get a single payer, or at least a public option, we’re headed for increasing disasters. Don’t you love all the benefits free-market health care brings us!

We have been paying insurance premiums to Sterling (currently over $180 per month) for decades now. We do a lot for their bottom line. They don’t do a thing for ours.

This is certainly not original, but bears repeating. When Republicans were in charge of Congress and Democrats were the minority, we were told it was impossible to implement a progressive agenda due to sheer numbers. That was accurate, but worse than that, Democrats, possessing more than the forty votes needed to stop the Republican agenda, could not do so because of miscreant conservative members of the party. So they went along with the tax cuts, the wars, appointment of young extremists to the Supreme Court, and a host of other right wing objectives. (They managed to rustle up 40 votes against Sam Alito, but did not use the filibuster. Hmmmm.) There was no meaningful opposition to the Republican agenda.

We were told that we needed a Democratic majority.

2006 gave us that majority, but nothing could be done because Republicans filibustered every move, Bush vetoed at his leisure, and Harry and the Democrats were hamstrung. They said they needed 60 votes and the presidency to get anything done.

Now they have 60 votes, the House and the presidency, and we still can’t get anything done. Obama is in the process of caving on a public health insurance option, the “white” part of the black-white gambit (part of triangulation), and we are going to be hit with insurance company subsidies and mandatory purchases from them.

They can’t even undo the pharmaceutical subsidy under Medicare D, whereby Medicare is not even allowed to negotiate prices. We are that openly corrupt.

And what do you suppose will happen when the tax cuts are due to expire and the Estate Tax due to be reinstated in 2011? Will 60 votes save us? Not very likely.

We don’t have sixty votes. It’s an illusion. We don’t have the presidency. We don’t even have enough votes to filibuster bad legislation.

All of this merely highlights the basic scam behind American democratic rule – that our interests are served by the existence of a far right party, which enforces meaningful policy change, and a weak second party, which incorporates that change into permanent policy and prevents the rise of third parties. We are not a functional democratic country. “Working within the system” is a cruel joke.

It’s heresy to say as much, but our constitution is outdated. It was innovative and different, but did not anticipate the rise of the corporation or the industrial revolution and the massive fortunes that it would build. I will not live long enough to see meaningful change, but our basic premise of government needs to change – we need an avenue for immediate removal of people from office who misbehave. Senator Max Baucus, who is a big player in the sellout to the insurance and pharmaceutical industrious, will not test his approval with the voters for five more years. By that time, his treason will be a distant memory.

If we had meaningful democratic rule, our government would fall in the wake of the Great Health Care Sellout of 2009. Our president would be replaced by a person directly accountable to our congress which would be directly accountable to voters. Congress would once again have a role to play other than to play patsy to the moneyed interests that currently run the presidency and own most elected offices.

I’ve made the rounds and made quite a reputation for myself regarding health care. I’ve gotten deep into it with quite a few bloggers and commenters, and have picked up a bit of wisdom here and there. Just a few more thoughts:

One, despite accusations, I do not “hate” Senator Max Baucus. (I made a sarcastic comment to that effect at 4 and 20 Blackbirds, and as per usual in this medium, the sarcasm was taken at face.) This reminds me of the days when legitimate criticism of George W. Bush was marginalized as “Bush Bashing”. Baucus does, however, embody much of what is wrong with the Democratic Party – he is under the spell of power and has been in office so long that he has adopted the objectives of those who keep him there, and ‘those’ are not voters. Beyond that, I have no patience with Democrats who automatically endorse anyone with a ‘D’ by their name. That’s been standard with me for many years. We don’t get “80% of what we want” from them, and the “good” that they want in opposition to “perfect” ain’t so hot.

I accept all that is good with the American medical system – our technology is superior, and those who have access to it get very good care and mostly positive outcomes. We are innovative – a healthy mix of government and private-funded research.

Insurance is a workable model only if the profit motive is removed from the picture. If treated as a public utility and forced to offer its product to everyone who applies, it can be an effective rationing agent for care. Furthermore, if treated as a utility, subsidy would be in order. Those countries that rely on private insurance – Switzerland and the Netherlands – subsidize and heavily regulate it. I hear nothing about regulation of our health insurance industry in this debate.

The debate process is not a ‘give and take’ where there will be a good outcome where everyone walks away somewhat happy, somewhat disappointed. From the beginning, when Baucus took single payer “off the table”, the objective of the debate framers has been to guide everyone to a predetermined destination. Though I am not prescient, it is clear that destination does not hold a viable public option for us, nor regulation of insurance companies. Participation is dangerous, disruption is the best tactic. As with Medicare D, no change might be better than the change envisioned by those who are manipulating the debate boundaries.

Something has to be done about costs. We are wild and spinning out of control. That ‘something’ will not be pleasant, and must include some form of rationing; it must include a system to offer fair, but not extravagant outcomes for malpractice; cost controls; reimportation of prescription drugs and negotiation with pharmaceutical companies on drug prices; a meaningful public option, and uniform national standards for health insurance policies. For starters. Why is it that we spend twice as much per capita as other countries on health care?

And finally, Medicare must address it’s fraud problem. Why they haven’t is a mystery to me. I suspect that in addition to bureaucratic, there is also a political explanation.