Friday, March 29, 2013

CPRIT demonstrates why American healthcare expenses are out of control

The latest board member to resign from the scandal-plagued Texas cancer research board uses a little Orwellian language on his way out the door. The article in today's Chron summarizes where we stand today.

Tom Luce, a Dallas lawyer and former U.S. assistant secretary of education, said Thursday that he stepped down from the Cancer Prevention and Research Institute of Texas last week to accept the job of chief operating officer for the Dallas-based O'Donnell Foundation.


Luce's departure follows that of Nobel Laureate Al Gilman, who resigned after the agency ignored red flags he raised about a questionable $20 million grant to the University of Texas M.D. Anderson Cancer Center; and executive director Bill Gimson and chief commercialization officer Jerry Gibbs, who abruptly resigned after it was revealed that the agency awarded Peloton Therapeutics, a Dallas biotech company, an $11 million grant without proper review.

In response, the state's political leadership imposed a moratorium on future agency grants and hasn't yet included any funding for the agency in its budget for the 2014-2015 biennium. The agency is under criminal and civil investigations and numerous bills in the Legislature spell out terms for reform.

That raises the number of vacancies on the board to four. The governor has two appointments pending for the Lege to approve; Speaker Straus still has one to make.

Luce wrote that "I am honored to have helped in a small way to help restore the credibility of CPRIT."

'Small' kinda understates things, Tom. The first comment on that story by a reader illustrates precisely what the problem is with CPRIT -- and also the problem with the American healthcare system generally. GPackwood writes...

There is an additional problem on the horizon for this group that will be especially difficult for the Governor's office to swallow.

The scientific community has agreed that competitive research efforts across the country is neither efficient or effective for cancer research results. The focus now will be collaborative research efforts where cancer researchers from different parts of the country plan, share data and work together.
This 'we' effort for America instead of the 'me' effort in Texas will be a hard pill for Governor Perry and his group to swallow. Organizationally they need to do something soon in Austin before the rest of the country decides they don't want to work with cancer researchers in Texas at all.

"Competitive" highlights the profit motive, the greed factor, and the ultimate crony capitalist corruption that results; in short, everything that Rick Perry loves about Texas bein' good for bidness. Just read his reaction in this article about the feds bypassing the state agency for women's healthcare and giving a few million bucks in grant money to a crowd-sourced coalition (and read Kuff for more about that topic).

Odd that a pro-business Republican would scream about the federal government giving funds to a private outfit instead of the state government, isn't it?

Profit, greed, the cronies and sycophants and lickspittles of the governor, other corrupt business leaders, the state agencies 'fostering' research, and all of the ancillary pigs at the trough are features of our healthcare system, not bugs. And these corporations have billions invested (in politicians besides Rick Perry) in the status quo. The Gardasil fiasco exposed the governor's angle in the healthcare business but that hasn't reined in him any. And we all know that what's happening in Texas is a microcosm for what's happening all over the country.

Our healthcare system isn't in the business of helping people get well. It's in business to make  money, and to maximize its profit on a per-capita basis. You're not a patient, you're a customer. Actually you're a mark.

This system leaves many sick people outside looking in until a cataclysmic health event occurs, and then their expenses are borne by all of us taxpayers. You'd think this would be enough to motivate conservatives to action (it involves cutting government spending, you see), but because they lack empathy, they don't see the value of preventative healthcare in the same way as they do preventative maintenance on their car.

Healthcare has, to continue the auto analogy, become a Lexus paid in cash out of the trust fund left by Mom and Dad -- or the money they pulled out of their own bootstraps -- for some. For others it's an eight-year-old Chevy with low mileage. For a few more it's a Chrysler PT Cruiser that suddenly erupts in flames as it rolls down the road.

Then there's all the people that can only afford to ride the bus, and in last, the ones who can't. Or can't even so much as walk to the bus station.

But there's a simple solution: in order to gain some control over healthcare costs, the United States must reduce and gradually eliminate the profit motive in the healthcare industry, as every other country in the world has done.

In the U.S. health care system, everything costs more. Being in a hospital cost more. Because our drugs cost more (prescription drug prices can be 10X the rate in the UK or Germany). And our doctors cost more (a US family physician makes 3X her German counterpart). Because their education costs more (the education for a German physician's education is nearly free). And on it goes.

Why is American health care so expensive? Books could be written about this topic. And books have been written about this topic. In The Healing of America, T. D. Reid explored why American medicine falls behind other countries in quality while it races far ahead in cost of care.

Near the end of the book, Reid expands on two big reasons why U.S. health care is so expensive: (1) Unlike other countries, the U.S. government doesn't manage prices; and (2) the complications created by our for-profit system adds tremendous costs.

First, it really starts with the prices. While some developed countries have one health care insurance plan for everybody -- where the government either sets prices or oversees price negotiations -- the U.S. is unique in our reliance on for-profit insurance companies to pay for both essential and elective care. Twenty cents from every $1 goes, not to health care, but to "marketing, underwriting, administration, and profit," he says. In a system where government doesn't negotiate prices down, prices will be higher. In a system where for-profit companies need profit margins and advertising, prices will be higher.

Second, the absurd complexity of U.S. health care creates its own costs. There is a separate health care system for seniors, veterans, military personnel, Native Americans, end-stage renal failure, under 16 in a poor family, over 16 in a poor family, and working for the federal government, Reid writes. That's on top of hundreds of private plans:

All these systems require another inefficiency -- the existence of compilers, middlemen who compile the bills doctors submit and shuttle them thru the payment system. The US Government Accountability Office concluded that if we could get administrative costs of our medical system down to the Canadian level, the money saved would be enough to pay for health care for all the Americans who are uninsured.

We cannot be the greatest nation on Earth if we are willing to let millions of Americans die, or go bankrupt and ultimately die because they can't afford to go to a doctor... or pay their doctor's bills. It's as simple as that.

Obamacare never came close to going far enough for my approval. Single payer was never on the table; the public option came off the table early on. So these Republicans in Congress who constantly talk about repealing Obamacare, who introduce bills calling for the repeal of Obamacare, or tack on amendments every week to unrelated legislation attempting the same thing are quite obviously part of the problem and not the solution.

Changing this system is going to require a lot of people who don't vote, many of them poor and already ailing, registering to vote... and then getting themselves to the polling place and casting a ballot.  And a lot of sick people -- not all of them poor to start with but who were impoverished by the current system -- are going to suffer and die prematurely before that happens.

We will find out over the next few years whether we can change this situation, or whether we can't. Battleground Texas gets it, and even the stupidest of elected Texas Republicans gets it. Here's hoping the people whose lives hang in the balance -- one of whom will never be David Dewhurst -- start getting it faster.

Update: The CPRIT scandal has finally drawn the attention of the Texas attorney general, who has instructed the agency to stop spending money while he probes them. What do you suppose the chances are that Greg Abbott will uncover something that reflects poorly on the governor? Answer: Perhaps good, if an investigative whitewash can be used to blackball Rick Perry out of running for re-election in 2014.

No comments: