With great thanks to Matt Stoller for tweaking my brain and giving me many of the insights in this diary, most especially, Murder by Spreadsheet.
Matt also gave me an elegant way to frame the health policy debate going forward.
He said, "The simplist story in American politics is to ask, whose fault is it?"
"Once you've done that", Matt continued, "you find the bad people, then you name them.
Stoller was emphatic, "Eve, people will organize around a villan. You really want to know what they're doing? I call it murder by spreadsheet."
A red light went off in my brain.
And apologies, in advance for the length of this diary, but we're dealing with something like a a $ 2 trillion dollar a year industry which represents around 16% of GDP!
We know the villan.
It is a murderous villan, and its weapon is a spreadsheet. It is also a highly successful business model since depending on its medical-loss ratio it diverts approximately 15% of its revenues into administrative costs and profits!
And the murderous for-profit insurance industry is the darling of Wall Street primarily because of their consistently favorable medical loss ratios. That’s Wall Street speak for improving profits by reducing payments for health care services. With lower medical loss ratios, investors gain while patients and doctors lose.
This is Murder by Spreadsheet.
We now have psychic permission to call this depraved and mafia-like/Mafia-lite industry exactly what it is--murderous.
Aided and abbeted every step of the way in its murderous dealings by an army of enablers-- the media, the political class, lobbyists like AHIP, financial institutions, staggering amounts of money, think tanks, and huge volumes of misinformation fed to an essentially uninformed, though increasingly restive public.
Listen to the voice of the victim. This morning I woke up to an email from a Kossack asking for help. I receive lots of these heartbreaking emails. He directed me to a diary he had posted (which I missed) about the health care tragedy of his friend.
Recently a friend of a friend found out that she is in dire need of medical help. Thanks to the bureacracy of healthcare in the United States, she is now one of millions facing impossible choices about her health -- choices that essentially amount to "give up now or give up in six months."
. .In case you were wondering, you can't get private health insurance when you have a heart transplant looming in your near future. She will deny wanting one, but I want the option open to her, so I will just ignore that issue altogether. Regardless of her internal battle, a trip to a specialized cardiologist is expensive. More expensive, I am willing to bet, than "cash to meet basic needs for food, clothing, and shelter" can provide. Seeing as how I was unwilling to pay for a doctor to look at a potentially broken finger, I can only imagine what it costs to monitor your heart uninsured (I was given the rough dollar amount of $2, 500 per visit and that is when there is nothing wrong.)
My friend was given 6 months to a year to live.
Now read what The Manhattan Institute a member of the Murder by Spreadsheet Mafia has to say.
The Manhattan Institute is one of the most evil institutions operating in America today. It is a spewer of right wing talking points. It is also a highly regarded extremist right wing think tank. The more highly regarded, the more dangerous such an institution becomes, because the MSM is easily seduced and conned by a veneer of respectability.
The Manhattan Institute has already begun to co-opt the idea of murder by spreadsheet. But in their demented world of misinformation and outright lies, they have concocted an argument to support a discredited thesis. If Medicare is required to negotiate drug prices, the pharmaceutical industry will be forced to curtail lifesaving R&D, and this will result in death and misery.
They package their deceit under the rubric:
The Human Cost of Federal Price Negotiations:
The Medicare Prescription Drug Benefit and Pharmaceutical Innovation
In the short run, federal price negotiations would allow some consumers to receive medicines at lower prices, or, alternatively, would yield savings for federal taxpayers. The longer-term human costs of government price-negotiation, however, are likely to be large and adverse. This paper estimates that investment in new drug research and development would decline by approximately $10 billion per year. It estimates as well the effect of reduced pharmaceutical R & D investment on American life expectancies, or expected "life-years". Specifically, this work projects that federal price negotiations would yield a loss of 5 million expected life-years annually, an adverse effect that can be valued conservatively at about $500 billion per year, an amount far in excess of total annual U.S. spending on pharmaceuticals.
. . .That the reduced flow of new medicines, summarized above in Table 6, clearly will not be trivial underscores the stakes for individuals suffering from such specific conditions as cancer, diabetes, or Alzheimer’s disease.
And more bullshit on the same subject courtesy of a collaboration between NRO and the Manhattan Institute.
Federal price negotiations will cause sharp price reductions, but this will yield less research and development investment in new and improved medicines over time. Recent economic analysis published by the Manhattan Institute yields projections that the effect would be a reduction of about ten new drugs per year on average, causing a loss of about five million life-years each year, valued conservatively at $500 billion annually, a sum far in excess of total U.S. spending on pharmaceuticals.
All of this is simply not true. It's a lie.
Now take a look at how the MSM abets murder by spreadsheet by portraying in the most negative light imaginable the actually very feeble attempts by the Democrats to make prescription drugs just a bit more affordable. This headline is from Business Week. Notice the headline and the use of the verb, to force.
House Set to Vote on Forcing Medicare to Negotiate Drug Prices
And this headline from Forbes.
When they refer to something as the Democrat Plan (it should be the DemocratIC Plan), this is called dog whistle politics. They're "reporting" the news but using the language of the fundies, which other fundies will recognize. Used in this context the word "Democrat" is a perjorative.
CBO Faults Democrat Drug Plan
And more on the human consequences of Murder by Spreadsheet.
One such medicine is Gleevec, sold by Swiss drugmaker Novartis, which is designed for leukemia sufferers with a genetic disposition to overproduce white blood cells. Another is Herceptin, a highly successful anti-cancer treatment made by Genentech of South San Francisco. It is aimed at breast-cancer patients who share a genetic inclination to overproduce the so-called HER-2 protein, which can trigger tumorous growths.
Yet Gleevec costs a typical patient at least $2,200 a month and Herceptin $3,195. A sudden flood of such expensive medicines might not sit well with insurers, some experts warn.
If insurers won't pay for genetically customized drugs, consumers might have to bear the cost themselves, experts predict. Some say that could lead to growing health care inequities between the rich and poor. Others fear it could subject consumers to a marketing blitz from firms misrepresenting personalized medicines.
And speaking of Murder by Spreadsheet, how do you think Wall Street reacted to what amounted to a giveaway to the for-profit insurance industry by the Republican governor of California? Not well, not well at all because the Schwarzenegger plan actually makes insurers pay for health care. That's bad for profits, bad for Wall Street and bad for the for-profit insurance industry.
The shares of WellPoint Inc. , the biggest U.S. health insurer by membership, slumped nearly 3 percent Tuesday on worries a proposal by California's governor to boost health insurance coverage could eat into industry margins.
The most troublesome aspect of the plan for health insurers, previewed Monday by California Gov. Arnold Schwarzenegger, a Republican, is a proposal to require those companies to spend at least 85 percent of every dollar in premiums on medical care, analysts said.
Imagine that. An insurance company actually being required to pay for health care.
WellPoint, which provides insurance for 34 million Americans, is the most at risk because it currently spends the least on medical care out of the premium dollar in the state.
"If approved, (the California plan) would imply reductions in profitability for some, and for all, signal a step toward regulating health insurer profitability," John Rex, an analyst at Bear Stearns, wrote in an investor note, echoing other analyst comments.
. . .Schwarzenegger's plan requires health plans to meet at least an 85 percent medical loss ratio -- an industry gauge of how much of the premium dollar is spent on clinical care.
Wall Street applauds insurers with the lowest medical loss ratio, because it leaves greater room for profit.
WellPoint's average medical loss ratio has recently been less than 80 percent in California, according to analysts.
"If implemented, the proposal would appear to create some problems for WellPoint," CIBC Markets analyst Carl McDonald said.
Problems? Indeed. Murder by spreadsheet is legal in the United States of America.
And the human toll of murder by spreadsheet is enormous.
These merchants of death prey on all of us. Think for a moment of the 1.4 million people in the U.S. who will be diagnosed with cancer, and 565,000 people who will die from the disease. When for-profit insurance companies deny cancer patients lifesaving medication, that is murder by spreadsheet.
When corporate America is deprived of their greatest resource-their people-cancer cost corporate America more than $118 billion in lost productivity in 2005 and resulted in medical costs five times higher than those for employees without cancer, this too is murder by spreadsheet.
There's plenty arrayed against us. But we have the truth which sooner rather than later, the American people will first begin to understand, then embrace, and ultimately, internalize.
The American people are subjected to an inefficient, fragmented, outrageously expensive and corrupt system. In contrast, Medicare controls fees with virtually no additional administrative costs over the very nominal costs to run the system. A universal, or Medicare for All program would insure that costs would be contained and that fees would be equitable while also insuring administrative efficiency.
Why do our public officials continue to commit health policy murder by insisting that private bureaucratic parasites, the for-profit insurance industry be included in the health care equation?
But the equally significant question remains, why do the American people tolerate this?
Now return to Matt's original question, whose fault is it?
I can certainly pinpoint the villan(s).