Thursday, March 30, 2023

The Developed World’s Outlier on All Things Healthcare: The United States


It’s a push-pull for many mainstream Dems to appear as if they are centrists and appealing to independents who occasionally buy into the GOP claims of “creeping socialism.” Because of the same root word – “social” – in both “socialism” and “social programs,” two very different concepts, Republicans have coasted on using “socialism” simply to defeat government programs that have some taxpayer support and even those programs paid for by those generating the elder benefits.

Government ownership of all real estate, farms and manufacturing is “socialism.” Except for an occasional government corporate or bank bailout, there’s no sign that the United States is in any meaningful way veering toward “socialism.” Social programs, on the other hand, would include public schools, Social Security and Medicare. Republicans rely heavily on older generations who fought “communism” (forced socialism under heel of a powerful and repressive elite), and for whom “socialism/communism” are fighting words. The Korean and Vietnam wars were ostensibly focused on these “horribles.” Add the word “entitlements” to the mix, and the GOP hopes that they can make their anti-government constituents hopping mad.

You can pretty much get the equivalent of the some of the best US university educations in Germany for literally a few hundred bucks year and zero student loans. When you leave a hospital in any other developed country, usually, you just leave with discharge papers. No bill. No invoice. No insurance claims. No approvals. No risk of rejection. We are the only developed country in the world that lacks universal healthcare, perpetually rejected by Republicans as “creeping socialism.” The point to long delays in other countries, which does happen on occasion, claiming that those participating in universal healthcare hate it. Canadian healthcare is a favorite trashing grounds for Republicans, but any poll of Canadians reveals they’d rather give up hockey than the universal healthcare!

Healthcare costs were so high (union benefits added $2,000 per vehicle on average) that US automakers decamped to Ontario decades ago, where the same unions and wage rates existed, simply to cut those healthcare add-ons that did not exist in Canada. We also pay more for essential prescription drugs than any other country in the world. The recent reduction in the cost of insulin will not hit the drugmakers at all… their production volume has more than made up for any loss of profits. Big Pharma is a treasure trove of campaign contributions and a massive user of expensive lobbyists to ensure that they can charge pretty much what they want in the US. Insurance carriers have fought mightily against universal healthcare, and even though Trump’s earliest campaign promises (see above picture) assured Americans he had a plan, (a) that plan, if it even existed, was never presented to Congress and (b) the GOP filed lawsuit after lawsuit to get the Affordable Care Act repealed.

Michael Hiltzik, railing in the March 26th Los Angeles Times, digs deeper into resistance to reasonableness in healthcare: “You might get the impression from the Biden administration’s insulin price cut and its initiative allowing Medicare to negotiate over other pharmaceuticals that the drug pricing issue is finally being taken seriously in Washington… Sadly, no.

“The evidence that nothing much has changed arrived just this week, with a notice from the Department of Health and Human Services rejecting a petition for a price cut on Xtandi, a wonder drug for prostate cancer that was developed with public funding at UCLA… The drug is marketed in the U.S. by Pfizer and the Japanese drug company Astellas for $189,800 a year. In Canada, a year’s supply costs $32,558, and in Japan it costs $31,594. Neither country contributed a dime to Xtandi’s development. In no other developed country does it cost more than $57,000…

“The agency’s rejection is at odds with Biden’s stated goal of bringing down prescription drug prices across the board, which he expressed in a July 2021 executive order. The law allows the government to provide competition to bring prices down, but HHS won’t budge… HHS’ rejection also comes at a time when Moderna and Pfizer, the developers of the most widely used COVID vaccines, are coming under fire for planning to jack up the prices of the vaccines fivefold , to $130 per shot. That decision landed Moderna Chief Executive Stéphane Bancel in the hot seat for nearly two hours during a Senate committee hearing Wednesday [3/22]… Bancel explained that Moderna’s price is based on ‘the value of a product to the healthcare system. ... How much money can be saved’ from its usage.

“This is a standard price-setting method among drugmakers. In this, the pharmaceutical industry is unique: No other industry asserts that its prices should be based on the higher costs of alternatives… Xtandi’s pricing testifies to the lobbying power of Big Pharma. Last year, Pfizer spent $14.8 million on government lobbying; PhRMA, the drug industry lobbying arm, $29.2 million ; and Astellas Pharma, $2.4 million… The U.S. Chamber of Commerce spent $82 million on lobbying last year; as Matthew Cunningham-Cook and David Sirota of the Lever point out, Pfizer’s chief federal lobbyist, Jennifer Walton, is on the chamber’s board of directors.

“The legal grounds for the Xtandi users’ petition stems from the Bayh-Dole Act of 1980, which governs the exploitation of inventions developed with federal funding. Bayh-Dole allows private companies to commercialize inventions that grew out of federally funded research, but it reserves certain rights for the government to protect the taxpayers’ investments.

“Chief among them are ‘march-in rights,’ which allow the government to order rights holders to license a federally funded invention to other manufacturers… The law allows the government to offer a license itself to alternative drugmakers to ensure that the drug is widely accessible if it concludes that a manufacturer hasn’t taken sufficient steps to make a product publicly available or hasn’t brought it out on ‘reasonable’ terms… Pfizer, PhRMA, Astellas and the U.S. Chamber of Commerce have all listed Bayh-Dole march-in rights as a top lobbying concern.

“The government has never exercised its march-in rights. Xtandi was an ideal test case, because of the government’s indisputable role in its development, and because its U.S. price plainly narrows patients’ access to the drug.” While corporate America enjoyed the Trump-era reduction in the corporate tax rate from 35% to 21%, as the deficit soared as a result, costs soared for the rest of us. If you are wondering why Americans are willing to venture into cartel-dominated Mexican border towns for medical care and prescription drugs, you need only look at never-ending GOP resistance in Congress against what is common in every single other developed country on earth… and even some second world nations as well.

I’m Peter Dekom, and Republicans will support conspiracy theories, religious extremists, rabid and well-armed militia before they lift a finger to make life better for most of us; all they offer is a culture war that defies the Constitution.

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