Thursday, August 30, 2007

Who spent $83,959,239 in 6 months to 'educate' policy-makers and the public!!

If you answered Big Pharma and Associates, you're Right!!

Special thanks go to the Lobbying Disclosure Act of 1995 which allows public access to records of lobbying activity on Capitol Hill.

Between January 1, 2007 and June 30, 2007, Pharmaceutical Research and Manufacturers of America (PhRMA) invested at least $13,213,600 in congressional lobbying efforts, $2,525,000 of which was expended through outside firms on PhRMA's behalf. That's an expensive average $2,202,800 per month for "winning advocacy for public policies..."

Independently, PhRMA member companies spent an additional $67,954,211 during the same time period. Other organizations (ie. pharmaceutical companies, professional associations, county health departments, hospitals, universities, and special interest groups), not directly affiliated with PhRMA, spent $2,793,428 on congressional lobbying. These interested parties monitor healthcare issues, seek to educate officials, and influence legislation regarding Medicare , S-CHIP, drug importation, drug-price negotiation, intellectual property rights, government appropriations, health information technology, and healthcare reform, to name a few issues.

Total spent: $83,959,239

So what's the Return-On-Investment?

Obviously, investment in public policy must be financially advantageous for corporations and their stockholders, otherwise resources would be put to work elsewhere. We often hear how CEOs of the big pharmaceutical companies or of the health insurance corporations are making millions of dollars each year for overseeing these profitable businesses. The business of Health Care in America must be thriving with so much financial influence to fling around.


That's what the American free-market is all about...profit. If an entity is profitable, it is deemed successful and becomes a magnet for investors, which then helps the original entity be more successful and thus more profitable. The cycle is vicious and much so that public policies are often influenced by successful businesses, or industries, in an attempt to shape the rules of play, stacking the deck in their favor, and preserving opportunities to increase profitability.

Increasingly, elected and appointed officials who are the architects of the playing field and authors of the playbook leave public service to join the game. For a blatant example of public service leading to personal wealth, one only has to look to former U.S. Rep. Billy Tauzin who now heads PhRMA. As Chairman of the House Committee on Energy and Commerce (HCEC), Tauzin was instrumental in getting the Medicare Drug Act of 2003 passed which increased the role of private insurance in providing drug coverage to medicare beneficiaries while prohibiting government from participating in free-market tactics of negotiating prices.

Before Tauzin officially took the reins of PhRMA, Public Citizen commented on the turn of events in a Dec 2004 report, Washington's "Revolving Door" is Spinning Out of Control. "The selection of outgoing U.S. Rep. Billy Tauzin (R-La.) to be president of the pharmaceutical industry’s main lobbying group is yet another example of how public service is leading to private riches, Public Citizen said today."


Another example of Washington's "Revolving Door" can be found in a new private equity fund, Health Evolution Partners. On June 7, 2007, The New York Times published an article, "Venture Fund to Seek Out Cost Cutters in Health Care," by Steve Lohr. Dr. David J. Brailer, a former senior health official in the Bush administration, founded Health Evolution Partners, with an initial investment of $700,000,000 from CalPERS (California Public Employees' Retirement System).

Read the June 5, 2007 Press Release. To accomplish the goal of "realizing value in health care," Health Evolution Partners "brings together financial capital with deep industry know-how to help companies improve their business strategies, achieve large-scale commercial success and set new benchmarks for financial performance."

More on Dr. Bailer coming soon.


Commercial Success and Financial Performance

That's truly what is driving health care in America...MONEY!! As long as profit is the driver, concern for the health and security of American citizens will be secondary at best.

Physical Health, Emotional Health, Financial Health

Weakness in one too often causes weakness in all!!!

Monday, August 20, 2007

To Govern or Not To Govern...That is the Health Care Debate Question

As health care is widely debated and presidential candidates "Vow to Overhaul U.S. Health Care" (The New York Times, July 6, 2007), the debate is resonating loudly with American voters. It's good the candidates acknowledge the need to improve affordability and access to health care, or rather at least pander to our discontent. Unfortunately, President Bush has failed to demonstrate an understanding of the concerns of working-class americans in their pursuit of healthy lives and financial security. Or maybe Bush didn't read the 2006 Citizens' Health Care Working Group Report which was commissioned as part of the Medicare Drug Act of 2003. In any case, Bush's arrogance shined brilliantly through his recent statements at the Cleveland Clinic - "I mean, people have access to health care in America. After all, you just go to an emergency room." (Cleveland, Ohio, July 10, 2007).

As the media discusses each candidate's health proposal, one might led to believe that Congress has ignored the health care crisis in America. But that assumption would be incorrect as there are currently more than 800 proposed bills/resolutions which address various aspects of "health care" in our country. Check it out at the Library of Congress. However, only one such resolution, H.R.676 "United States National Health Insurance Act," has been specified in a candidate's campaign. Representative Kucinich co-sponsors H.R.676 and offers it as a solution to health care reform. Although other candidates' plans may closely resemble currently proposed legislation, none have identified a specific bill/resolution which matches the details put forth in their proposals. Wouldn't it be nice if they did so? That way we could study the bill and determine it's relevance to our personal situations. Interestingly enough, personal research has revealed that Senators Clinton and Obama co-sponsor much of the same legislation and seem to support the same health care views.

Moreover, according to popular media, the health care debate revolves around government control versus individual choice, "universal coverage" versus a free-market solution, individual mandates versus tax incentives. Too often these messages exploit our fear and attempt to distract from the possibility that effective policy change is possible and that citizens deserve a voice in the debate. As each candidate reveals his/her health care proposal, I try to consider it's effects and compare that with coverage I currently have. So far, I'm not convinced that any of the candidates or legislatures truly "get it" and understand the serious social plight of many Americans. For a physician's perspective, read "Worry, Government, Health Care and Ultimately....Health" by Zagreus Ammon.

Here's my perspective: As a self-employed person, I purchase health insurance in the private individual market. Premiums for an underwritten policy for a 38-year old woman in the Washington, D.C. area, cost me $3384 annually (up 20% from last year) with self-employment tax adding $478 to the total cost. This "managed-care" PPO plan features $25 doctors' visit copays, 10% coinsurance, a low $100 in-network deductible, and includes prescription coverage. Several presidential candidates are promoting increased participation in the individual health insurance market. That would mean many more americans would have coverage similar to my own. However, last year my health care expenses exceeded $15,000 out-of-pocket in addition to the cost of insurance premiums, with an adjusted gross income of $19,417 and total taxes due of $4761. I am forced by the current free-market system to keep my earnings below 200% federal poverty level in order to qualify for assistance in obtaining a single MS medication costing $21,000 annually. That's no freedom of choice!

In reality the debate is not whether to have more government control or less government control. As it is government regulations allow the private insurance and pharmaceutical industries to transfer wealth (or would-be financial security) to those who in turn expend enormous amount of money and power to influence the opinions and actions of both citizens and officials. For an enlightening view on the role of government in the market place, read Dean Baker's editorial, "Fixing Health Care: Not Government versus Market" (TruthOut, July 10, 2007).

Here is a sampling of current proposed legislation which addresses the need in making health care for affordable and accessible to american citizens. It is by no means exhaustive, but will be rather informative.

National Universal Coverage:

  • H.R.676 - "United States National Health Insurance Act" or "Expanded and Improved Medicare for All Act" - 27 pages

State-based Universal Coverage:

  • H.R.1200 - "American Health Security Act of 2007" - 178 pages

Create Health Service Force:

  • H.R.3000 - "Josephine Butler United States Health Service Act" - 135 pages
Encourage Healthy Behaviors:
  • H.R.2633 - "Healthy Lifestyles and Prevention America Act" or "HeLP America Act"- 173 pages

Individual Responsibility and Increase Use of Insurance Pools:

  • S.1783 - "10 Steps to Transform Health Care in America Act" - 291 pages
Increase Small Business Participation through Tax Incentives:
  • S.158 - "Access to Affordable Health Care Act" - 122 pages

Increase Individual Participation through Tax Incentives:

  • S.1019 - "Universal Health Care Choice and Access Act" - 164 pages
  • H.R.2626 - "Comprehensive Health Coverage And Reform Enhancement Act of 2007" or "Comprehensive HealthCARE Act of 2007" - 128 pages
Shared Responsibility and Termination of Government Programs:
  • S.334 - "Healthy Americans Act" - 166 pages
  • H.R.3163 - "Healthy Americans Act" - 170 pages

Full disclosure: I am not an expert in policy or the healthcare industry. I am an individual who has struggled in obtaining necessary care in the past two years without incurring great financial costs and expending enormous mental and emotional energy.

Wednesday, August 8, 2007

PhRMA and PPArx: How much are they really helping patients in need?

Healthcare reform is all the buzz in political discussions during this campaign season. As each presidential candidate reveals his/her proposed healthcare plan, the merits of each plan elicit debate. But whose plan seriously addresses the high pricetag of healthcare?

Fortunately, the pharmaceutical industry understands our plight and want you to know they care. That's one reason the Partnership for Prescription Assistance (PPA)was launched in April get the word out that help is available. At one time or another, you've probably seen the TV ads featuring the 'Help is Here Express' where a big orange bus travels throughout all 50 states to push the promise of 'free or nearly free' medications for patients who cannot afford their prescription medication.

Who is the force behind PPA? The Pharmaceutical Research and Manufacturers of America, PhRMA, the pharmaceutical industry's lobbying group.

"PhRMA's mission is winning advocacy for public policies that encourage the discovery of life-saving and life enhancing new medicines for patients by pharmaceutical/ biotechnology research companies. To accomplish this mission, PhRMA is dedicated to achieving in Washington, D.C., the states and the world: 1. Broad patient access to safe and effective medicines through a free market, without price controls; 2. Strong intellectual property incentives, and; 3. Transparent, efficient regulation and a free flow of information to patients." -

Named president and CEO of PhRMA in January 2005, Billy Tauzin previously served as the Chairman of the House Committee on Energy and Commerce (HCEC). As chairman of the HCEC, he helped President George W. Bush win passage of the Medicare Prescription Drug Improvement and Modernization Drug Act of 2003 which was "intended to alleviate financial pressures caused by medical expenses." With tax provisions established in the 2003 Medicare Act, consumers are encouraged to purchase high-deductible medical insurance plans and open health savings accounts. The idea is that "people seeking medical assistance or prescription medicine will be more cost conscious" and will have "a financial incentive to find the lowest-cost service provider."

So as consumers of medical services and pharmaceutical medications, we are supposed to be more cost conscious. Beyond being cost conscious, if not frugal in seeking medical attention, what are we supposed to do if we cannot afford to fill our prescriptions with or without insurance coverage?
One option is contacting the Partnership for Prescription Assistance which appears to be the brainchild of APCO Worldwide Inc.®, "a global communication consultancy specializing in building relationships with an organization's key stakeholders." APCO works to protect a client's reputation and create value by "pushing the boundaries of communication..." -

APCO offers a variety of services to address challenges their clients face and is staffed by "former elected leaders, ambassadors, government officials, political consultants, journalists and executives from both business and the nonprofit community."

A sampling of APCO's strategies:

Corporate Responsibility - "Whether forging innovative partnerships with governments and NGOs to accomplish joint goals; promoting and communicating sustainable business agendas; or leveraging enhanced transparency to increase public trust, APCO's team can show you how to turn your CR investment into a tangible Return on Reputation (ROR)."

Grassroots Outreach - "Public opinion and government policies affect everyone, yet policy-makers and the media tend to ignore one side of the issue if they are not hearing that perspective, potentially resulting in disastrous consequences. APCO makes sure clients have articulate and vocal allies to help send out and amplify common messages to elected leaders and the media. Working together with like-minded groups is critical to ensuring that public attention is directed toward an issue in a way that can win the day, rather than focusing attention back on a single organization promoting that issue."

Issue Management & Public Education Campaigns - "Drawing on our detailed knowledge and understanding of the political process, APCO develops campaigns that help educate the public and policy makers. APCO's campaigns achieve tangible business successes for our clients and have won awards internationally."

Media Relations - "Reporters, editors and news directors want timely information from credible, accessible sources. Because many of our staff are former journalists, we know how to provide the media with news they can - and do - use. APCO successfully places over 150 news stories and 100 opinion articles per month for our clients. APCO's in-house team of media experts also offers clients comprehensive media and message training."

Government Relations - "Through direct advocacy, relationship building and strategic counsel, we support clients and their solutions with elected leaders and government officials. Our staff includes practitioners who have served in the positions of those we seek to influence. Armed with that experience and knowledge, we develop tailored campaigns to achieve our clients' goals."
Read how APCO helped to launch the Partnership for Prescription Assistance.
So how many Americans are being helped by PPA's humanitarian effort?

According to a July 23, 2007 press release, Cora Simpson of Lexington, Kentucky, became the four millionth person helped by the Partnership for Prescription Assistance. "Simpson takes four medicines a day, and found nearly 10 programs through the PPA that could potentially help." -

"...could potentially help" - What?!! I could potentially mop my kitchen floor tomorrow, but that doesn't mean that I intend to or that I will. And you can't hold me to the promise I might be able to mop the floor.

Just moments ago, I conducted a search for programs to assist in obtaining a popular SSRI antidepressant, Zoloft®. The search produced 5 matching and non-matching programs. But 4 of those results are discount drug card programs (some requiring a fee) which offer the potential of 0%-75% discount off the cash retail price. And from personal experience with the one program offered directly by the drug manufacturer, assistance may likely be denied for dubious reasons.
How reliable is the four million count?

In the design of the PPA website,, Mindshare Interactive Campaigns LLC incorporated a tracking system used to monitor aggregate information about how targeted audiences were utilizing site tools. For instance, they are "able to tell how many and which drugs are being many people are getting successful matches and what specific program applications are being downloaded or printed."
Read here for more information regarding other design features of the website.

But wait...?

Doesn't that mean each time I conducted a search and found any program...matching or non-matching, free or with fee...I helped to inflate the numbers. During the past two years, I have conducted several searches and even called the 800 number, but none of these efforts provided any tangible benefit to me in the form of 'free or nearly free' medications.

Read here an informative and entertaining article, BIG PhRMA, BIG KaRMA, by David Schankula regarding the big four-million moment in Lexington, Kentucky.
But where is the follow-up with the patients using the PPA service?

Or what is the accountability of the member organizations?

Where are the statistics measuring how well the member organizations, specifically the pharmaceutical companies, are fulfilling their promise of help to those in need?

For example, I'd like to see an audit of the Pfizer Connection to Care program, through which Zoloft is available, addressing the following:
1. How many new patient applications are received in a calendar year?
2. How many of those applications are denied initially?
3. How many of those denied applications are appealed?
4. How many of those denied applications are approved on appeal?
5. What are the three most common reasons for denial?
6. How many self-employed persons have been discriminated against because the program refuses to recognize the adjusted gross income as representing total income?
Basically, prescription assistance programs are not new by any means. And the Partnership for Prescription Assistance is not the only source of information regarding available programs, although it is the flashiest!!

According to my research, the most impressive and exhaustive listing of programs is available at, developed in 1997 by Dr. Richard Sagall of Gloucester, MA. This is an easy-to-use site which provides more information than PPA, even when comparing entries for the same programs. If I were acting as an advocate for a patient, is where I would start my search.

Saturday, August 4, 2007

"AMERICA is at a crossroads when it comes to healthcare."

With the rise of discussion regarding what ails the American healthcare system, there is an avalanche of proposals coming out of the presidential campaign trail.

What is an ordinary citizen to believe and whom to trust?

And be careful not to think too hard about it or you just might be annoyed enough to maybe, just maybe, try to do something about it.

First read: "A free-market cure for US healthcare system."
Op-Ed by Rudolph W. Guiliani, The Boston Globe, August 3, 2007

Then read a comment I posted elsewhere earlier today regarding the same article:

It amazes me that the candidates from both parties do not understand some of the fundamental problems with our current healthcare system.

Guiliani-"Most Republicans believe in expanding individual choice and decision-making."

Too often the argument is for individual choice. I'd like to choose to have the same coverage and protections that our government leaders do, paid for by our tax dollars.

"We need to begin by bringing fairness to the tax treatment of healthcare. The current tax system penalizes millions -- including the rising ranks of the self-employed and 40 percent of employees at small firms -- who pay for insurance on their own and receive no tax benefit."

Wow...someone higher up who recognizes that the self-employed are unfairly penalized as they endeavor to be responsible and seek health insurance.

"If millions of people go into the marketplace looking for less expensive health insurance, it will drive the insurance companies to create less expensive products that meet individual needs instead of government mandates."

I disagree. Just because individuals may seek insurance products in a free-market system, that doesn't mean that price will decline or that insurance companies would be inclined to increase coverage options.

"One of the advantages of our federalist system is that different states can try different approaches to solving problems and learn from each other."

This is a fundamental problem with the current individual health insurance market in which non-group coverage is not required to provide equal benefits as offered by group coverage. And who do you think is consulted by state governments to determine how to establish mandates for individual coverage....representatives of the health companies or their lobbying fronts.

Being self-employed, I have individual private health insurance, regulated by state not federal government, and find that the state is unwilling to direct how "rider" coverage such as prescription coverage is structured. This tiny little detail leaves myself, and others, unprotected from catastrophic drug costs, as the insurance plan stops paying out at $1500 each year while my drug costs to treat MS and RA reach $30,000 each year. And if one believes that PAPs (Prescription Assistance Programs) and non-profits are eager to assist...think again!!

So far none of the candidates seem willing to address many of the root problems associated with the current US healthcare system. The problems go deeper than insured/uninsured, tax incentives/tax supported, private choice/government mandates, or affordability/cost controls. Who truly has the power here? Individuals? Government (employed by the individuals)? Or the Corporations who make the rules?

Jumping into the Blogging World

So here I am entering the blogging world. I plan to use this site to collect and comment on issues which concern me directly, especially healthcare. Please check back.