On March 29, 2017

Survival of the richest, health care part two

By Marguerite Jill Dye

Throughout life, coping with physical, mental, and emotional highs and lows is part of the human condition. Sometimes our challenges do us in; other times we survive and thrive. Now and then we require intervention of professionals in their fields, so I thought I’d see what professionals thought of healthcare in America and the defeated GOP plan. I donned my investigative reporter hat and didn’t have far to go to talk with our retired physician friend and neighbor.
“Most illnesses begin like a breeze and end up like a storm. Some illnesses cure themselves, but often people need a consultation,” the internal medicine doctor said. “The cost goes up if treatment is delayed. A simple cold can become pneumonia. Even over the phone help can be provided. Naturally, the utmost efficiency and speed are needed in cases of cancer or heart attack.”
Doc voiced another concern: the cost of pharmaceuticals. “Why has the epileptic drug, Dilantin, risen from a few dollars a month to over one thousand? And why has Mylan’s EpiPen (adrenaline) suddenly increased 400 percent? Why must the same medicine abroad cost ten times more at home? I have been at war with pharmaceutical companies that demand outrageous price hikes.”
Without regulations, the public is vulnerable to their will and corruption.
When it comes to mental health, which can have cumulative, far-reaching effects, conditions are often omitted from coverage. So I asked Jeanne Mahoney, a mental healthcare professional, about her greatest mental health concerns under the proposed GOP Trumpcare plan.
“Where do I begin?” she asked. “There are so many issues that arise directly due to the impact of someone dealing with mental health problems. For about 20 years I’ve dealt with children, adolescents, families, and adults, all with and without legal issues. Usually what brings them in for help, be it substance abuse/dependency, violent episodes, issues with children—are only the symptoms.”
“It takes time and money to get to any mental health problems underlying these symptomatic behaviors,” she explained. “These behaviors typically elicit negative assumptions, and there is a pervading posture of seeing this population as ‘lesser than.’ All these situations breed isolation and helplessness, which again perpetuates mental illness, learned helplessness, and more isolation.”
It sounds like a vicious cycle, I noted. She nodded in agreement and concluded her concerns.
“The solution is always meted out in money, and this proposed disaster of a bill reflects this loud and clear. The devastating cuts would leave the mentally ill, including those with substance abuse issues, to fend for themselves. The ripple effect would reach far and wide. Families, communities, and, most horribly, children, would suffer. The only winners here will be Big Pharma and the private prison systems,” said Mahoney.
I also recently learned more about healthcare fraud including health insurance, drug, and medical fraud. The FBI figures $80 billion in health care fraud costs per year are charged to American tax payers. In 2014, $5.7 billion was recovered through the quitam provision and False Claims Act, which paid over $300 million to whistleblowers. The GOP wants to blow the whistle and scapegoat the lucky lottery winner who’d be required to reimburse all prior medical payments received, instead of making intelligent improvements to the Affordable Care Act. I’d rather blow the whistle on corrupt and fraudulent lawmakers who propose slashing Medicaid and Medicare for the poor and increasing insurance by $5,269 for Americans aged 55-64, on average per year. I want to blow the whistle on arrogant, out-of-touch representatives who want to steal coverage from working and poor Americans to give $600 billion in tax cuts to mostly billionaires. I’d like to blow the whistle on pharmaceutical companies that pay physicians kickbacks for prescribing lucrative medications. I’d like to blow the whistle on the unethical drug market that “crony capitalism” created in doctors’ offices since the 1999 Medicare cuts.
Then I heard a whistle blowing in the wilderness when a Facebook friend from upstate New York posted a chart showing where insurance premiums go. According to the post from America’s Health Insurance Plans (AHIP), 22.1 percent go to prescription drugs, 22 percent go to  physician services, 20.5 percent insurance overhead and profit, 19.8 percent outpatient services, and 15.8 percent hospital services. She explained that the AHIP chart separated overhead from profit. “In a larger sense, from a patient and a societal perspective are multi-million dollar salaries, bonuses, and option plans really part of actual expenses or part of their profit?” she asked. “I spent most of my career in private industry as a manager,” she continued. “Operating costs can hide a slush fund of secret profits (company cars, jets, box seats, mountain and ocean retreats, etc…) Why should patients be paying for these?”
I was wondering how her keen interest in health care developed when she shared her riveting story. “My husband has chronic lymphocytic leukemia. In 2014, it mutated (17p) and became very aggressive. We were grateful that a new and life-saving medicine had just been fast track approved by the FDA. There was a ton of tax-payer funded National Institute of Health research that contributed to the early discovery and development of the active ingredient BTK. The drug is extremely effective, especially for people like my husband who have the 17p mutation and have no other choice. This drug has saved his life!”
“With this medicine, he works full time, pays taxes, supports our family, helps raise our 13-year-old daughter, and loves his grown sons and their growing families. Without it, in less than one year he will die. But there’s a catch. This medicine (Imbruvica) now costs $11,100 per month. The patent-owner is the sole manufacturer. They are a monopoly. Of course we’re terrified of losing insurance (through my husband’s employer). They’ve already paid out over a quarter-million-dollars on my husband’s behalf. And every new cancer drug is priced the same way: $80,000-$150,000 per year. The pharmaceutical companies are basically extorting desperate patients and their insurance companies whose choice is to ‘pay or die.’”
Most of us know what it’s like to celebrate life and give thanks for insurance that enabled essential or critical care. But most of us also have a story of a loved one who lacked healthcare at a time when they needed it most. How many lives have already been lost due to insufficient funds and inadequate care? The educated estimate of lives that would be lost from Trumpcare’s right to “access” instead of coverage, is staggering: 22,000-44,000 as cited in my last column, a number that comes from the White House Council of Economic Advisors and the New England Journal of Medicine.
The day after the anniversary of Obamacare, the GOP plan burned up in flames. Trump’s healthcare bill had a 17 percent approval rating nationwide, (6 percent according to one study) while the Affordable Care Act’s approval has grown to over 53 percent. The American people have spoken through a massive outpouring of calls and letters, protests and town halls collectively saying we will not allow our healthcare, a basic human right, to be sacrificed for tax cuts for the wealthiest among us. We, the people, deserve and demand health care and coverage we can live with and depend upon. Our president and representatives have no mandate to throw us to the wolves like a sacrificial lamb. Let’s improve the Affordable Care Act, conscientiously and gradually, and study the fully funded healthcare that 58 percent of Americans want (2016 Gallup Poll). Let’s tackle head on corruption and fraud in Big Pharma, insurance, and medical care. Let’s reaffirm our commitment to ensure that America is not based on the survival of the richest.
Marguerite Jill Dye is an artist, writer, and activist who believes in the Constitution, the Universal Declaration of Human Rights, and the Golden Rule. She is the paper cut illustrator of “Where is Sam?” and author/plein air illustrator of “Treasures Along the Camino: An Artist’s Empowering Journey Across Spain” which is yet to be released. She lives with her husband in the Green Mountains of Vermont and on Florida’s Gulf Coast.

Photo courtesy of Marguerite Jill Dye
A woman’s sign shows her disdain of “pay or die.”

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