Neurological Correlates

Here’s the clearest, most unbiased (I think) summary I’ve found of the health care bill, an it has links to the house records:

House Health Reform Bill released By: SHADOWFAX

The really great thing in the bill is that antitrust exemption for  health care insurance is over. The bad thing is that insurance companies can sell nationwide, so they’ll go to the states that have the most favorable regulations and then apply those regulations nation wide.

Now for ways to cut costs:

1. Find all the “reverse competition” and fix it. In a “reverse competition” –the middleman has every incentive to choose the most expensive choice, and the end user — that’d be the patient– is stuck with the bill.  Anyone who makes a % has an incentive to select the product or service with the highest base price. So, a doctor who makes sales price + 6% on the sale of a prescription, has an incentive to choose the highest price drug (6% of $100 is more than %6 of $10).  I won’t go through all of it but at every step of the way for just about every procedure, there is a “reverse competition” that aligns the middleman with selecting the most expensive, rather than provide the end user with a chance to choose the best based on merits in the market place. (I also won’t go into why healthcare is different from  other products/services, but consumers should have full transparency and choice).

2.   Speed up FDA approvals by making clinical trials smaller and leaner, but rely on post-market surveillance (and clean that up).   Biology has advanced such that the mode of action can be determined much more predictably than in the olden days. This is an advantage: if you know the mode of action, you can really look for adverse events.   The relatively rare side effects that happen in few people require ginormously cast of jillions clinical trials before they statistically pan out.   Forget that. Don’t even try to statistically power to see the rare event. Keep an eye on patients with post market surveillance for the rare effect. Even include patients in the process, don’t only rely on the docs.  Reduce trial size, speed things up, use better science and better monitoring.

3. One third of Medicare goes into last year of life (see here) – fix that.  Now,  you can’t say, “next year will be my last year of life” usually.  But, with older folks, you can look to statistics for the condition that takes a turn for the worse, or the accidents. Slip and breaking a hip puts older folks in intensive care.  Subsidize osteoporosis meds or artificial hips. And, put back in state product liability for med devices.  Federal law was written to pre-empt state prouduct liability for med devices (but not drugs), so what’s good enough for the FDA had to be good enough for all of us. The law for med devices is that if they were approved by the FDA, there’s no design defect or product liability. So, having that “pass go” card, the med device manufacturers too shortcuts (it seems) and possibly even had their elected officials go see the FDA (don’t have the link off hand).  Then, the ticker stop ticking, the stents break up, the knees, hips and everything else wears down. So do you give people a refund? Do you replace them? What do you do? (FDA tracking of defective implanted devices is abominable). Fix up the whole geriatric medicine area and get everyone aligned.

4.  Guns v. butter, stop the wars, this is hideously ridiculous.  I fully support the military, and way back on 9/11 was sort of in the thick of it, and coming to the belated realization that most of the world’s petroleum is underneath people who are crazy or are just kleptocrats, I’m big on setting up democracies in that region. Time to have another strategy, and my guess? Facebook will do more to set up a democracy than war ever will.

5.  Biologicals get 12 years market exclusivity? (Bill pending).  That’s just rewarding bad management.  Management messed up and wanted to loot the profits they were milking while not making any decisions that could jeopardize their jobs.  I won’t go into it, but giving these companies (and this is against my own financial interest)  12 years of no biosimilars is rewarding bad management and poor corporate governance.

6. One more thing: the major oncology biologicals were paid for by US taxpayers, but the profits go to Switzerland: Roche bought Genentech.  (More about Roche here). So Herceptin is now Swiss. But, the research and to some extent development  that arrived at Herceptin was paid for by US taxpayers.   I’m not protectionist, but US citizens are dying because they can’t get the drug, even though their tax money paid for the discovery, and then the profits go off shore. And, to add  a particularly nefarious twist, the Roche corporate ownership always struck me as strange in that “All shares in the Company are bearer shares, and for this reason the Company does not keep a register of shareholders.” Um, ok, except there are basically individuals, including family members, who are shareholders, along with Novartis — another Swiss biopharma within smelling distance on the Rhine.  So, the oncology drug that US taxpayers paid for, that US citizens can’t afford, has profits shipped off to Switzerland, home to secret bank accounts up until recently not paying US taxes.  So the 6th way to save on healthcare costs is to not have US taxpayers pay for research on a drug they won’t be able to afford.

(OK, so it’s 6 ways, not 5.)