Between Gupta and Daschle, Who Will Fix Health Care?

In his latest blog post, economist Paul Krugman has questioned the President-elect's choice for Surgeon-General, Dr. Sanjay Gupta, chief medical correspondent at CNN who anchors a range of medical affairs and documentary programming for the cable network.

Krugman brings the weight of his influence to bear on the hotly-contested topic of health care, alerting the new administration to foreseeable pitfalls and hoping to cast doubt on the direction in which a few new appointments may be headed. In his post, Krugman criticizes Gupta for smearing Michael Moore in a public debate on Larry King Live and other shows. Krugman rightly says Gupta discredits Moore as "unreliable, uncouth, and an outsider" by accusing him of "fudging facts" in his documentary Sicko. The film was released last summer, and described a few of the travails endemic to the nation's health system.

Sanjay Gupta and Michael Moore -- essentially two experts on health care who disagree ideologically on a range of health concerns -- had a fascinating exchange on Larry King Live. One that stood apart was Gupta's in which he criticized Moore for saying France and Canada have "free" care. In their tussle, Gupta clarified that citizens of European countries pay high taxes to afford single-payer care, and so, he said, the system isn't really free there.

But ours, of course, isn't free either. Gupta's comment hints he has more to say perhaps than time on Larry King's program might allow. Hopefully, when it comes to how health care within the US has been conducted so far, if given the right opportunity, perhaps Gupta will also point to some of its glaring failures, both from a cost and care perspective and propose ways to fix them.

In mid-2006, when I was still finishing j-school, my classmates and I were each assigned a master's level reporting project. I picked a health story. I'd studied biology and thought my background, naïvely perhaps, could shed some light. My classmates and I raked through reams of articles and sources, traveled coasts and far-away places to search for illuminating findings and fresh ideas.

My story was local, rooted in Northeast politics. It involved a government program, a prescription drug benefit under Medicare. Most politicians on the Hill were familiar, as were elderly beneficiaries of the program who had signed up (it was rolled out in January of that year). Medicare Part D had been voted in to help seniors pay low prices for their medications. It was widely rebuked by several House Reps and Congressmen, many of who tiptoed around the word, "scam" but described it mostly in those terms.

The reason they felt this way was that rather than saving taxpayers and beneficiaries money, as the program was promising to do, the budget was unrealistic from its very inception. Initial estimates were expected to rise (the latest Medicare fact sheet from the Kaiser Foundation reflects Part D has led drug spending to jump, from just 2 percent of total Medicare spending in '05 to 18 percent in '06); and the idea was that pharmaceutical companies had essentially sought to benefit from a hefty government contract that gave them unregulated access to the nation's most vulnerable (and sick) consumers of prescription drugs (Health and Human Services (HHS) reported 25.4 million beneficiaries were enrolled in the prescription drug plan in January 2008).

Several congressmen I interviewed stressed that the cost of the program would outstrip what Congress outlined in the bill, and hours of hand-wringing by pharmaceutical lobbyists to "keep the vote open" on the floor of the House the day the plan passed surpassed any filibustering that had ever taken place on Congress floors before. Put simply, keeping the vote open allowed lobbyists more time to garner more votes; and the strategy had worked. (For a sense of the costs, the HHS estimated $45 billion would be spent on Part D in 2008 and $55 billion in 2009.)

This year, as Congress opens for business, a bill for Medicare Part D will emerge on the House and Senate floors once more, though this time the question will not be whether to find a budget for the program, but hopefully, on how to allocate funds more efficiently so as not to fleece both taxpayers and beneficiaries. Presumably, this means Congress will assess how much they have underestimated costs in the past two years, and find ways to cut them, even if it troubles big pharma. Several members are hoping that at the session the government will finally insert a clause forcing pharmaceutical firms to negotiate directly with the federal government over the cost of drugs. It's a measure that has been fought over aggressively in past years since the plan took effect.

At the level of care for the nation's citizens, today, the Medicare Part D program continues to plague seniors. In this week's Des Moines Register, one reader expresses his frustration with the program, calling on Senator Grassley (R-IA), the 15th highest ranking senator in the US Senate, to resign. (Grassley endorsed the plan back in 2006.) The reader suggests it's high time health care policy be "focused primarily on what is best for the nation and its citizens," noting that the interests of pharmaceutical companies are, "quite rightly aligned with improving its profits, not the health care of the nation."

Back in 2006, several Democratic congressmen I interviewed stated how, "lobbyists would not allow the vote to close until the program had passed," and how the plan hurt seniors, "the most vulnerable members of our society." Members of Congress railed against pharma and insurance industry revenues once again as early as last month, although they haven't yet clarified how they plan to alter cost structures to be fair to the infirm and the elderly.

In the end, a federal plan costing in excess of several hundreds of billions of dollars and producing a windfall for pharmaceutical companies has been eclipsed by corporate bailouts. Though at the time Part D was enacted, some blamed lobbyists (seniors' groups blamed the government), after it was passed, thousands found they were paying for a service that in even some life-threatening circumstances offered no coverage. Many found confusing and conflicting health brochures almost impossible to navigate, and were locked out of access to affordable drugs despite paying premiums for them.

But the Medicare prescription drug benefit mired, as it is now, in years of controversy has faced limited change. In fact, premiums have risen again on a number of drug plans (the deadline for signing up was December 31), and complaints from beneficiaries keep coming. The wealthy have paid their way out by shelling out thousands from savings, while everyone else has tried to fend for themselves mostly by applying their modest Social Security payments toward their prescription medications.

At the time, back in 2006, when I was researching the project, one New York senior I interviewed lived in a rat-infested room in downtown Brooklyn and shared her apartment with two other roommates. She had been using nearly $200 of her monthly $800 in Social Security income to pay for a dizzying array of prescriptions and premiums; and, as a result, had a difficult time paying for weekly groceries.

Another woman, a former schoolteacher, had a pension to pay for healthcare, but still found her cancer meds were too expensive under Medicare Part D. To keep getting her meds, she would have to pay five thousand dollars to resume Medicare coverage under the new plan. (Her troubles were part of the infamous "donut hole" in which people with expensive illnesses had to shoulder a vast chunk of the cost of their drugs on their own, before the government stepped in to cover them again.) The schoolteacher, Ms. Blue, passed on a year after the interview. In the end, her efforts to raise the additional money through a church group had failed, and she died without ever again gaining access to the drugs she so desperately needed. A short video I produced on her at the time is posted here.

This year pharmaceutical companies may have something to celebrate. Besides the financial gains they've made since 2006, they now have Tom Daschle, a lifelong senator who has consulted for pharma clients in the past, speaking their interests as Secretary of Health and Human Services. It could be a coup for them. Had Governor Howard Dean, the prickly, progressive doctor from Vermont not been sidelined for the role, big pharma's Christmas stockings this year would likely not end up as healthy and overstuffed as before. Now, however, we can't be completely sure.

Daschle has been quoting Nelson Mandela of late, so maybe this time he means it. But as far as Dr. Krugman takes issue with Obama's choice for Surgeon-General, Dr. Gupta's compassion as a journalist and working surgeon makes him of lesser concern. As surprising as the Gupta choice may seem on the surface, eyes and ears should perhaps more keenly be focused on this year's members of Congress (and on Mr. Daschle) who now, quite literally, hold our lives in their hands, and have yet another chance to make amends.

Comments

[Pia Sawhney - Huffpost Blogger]

Thanks for commenting.

Wanted to direct your attention to this morning's NYT OpEd page, which has now also taken issue with Tom Daschle over the vague answers he provided yesterday, as part of his confirmation hearing, to questions on how he plans to improve health care.

The Times suggested Daschle was conciliatory throughout, and mostly left it open when it came to describing how he plans to manage costs; in response, the former senator was roundly endorsed by his colleagues, many of whom offered little resistance.

Daschle will soon begin a second confirmation hearing before the Senate Finance Committee in which Times editors hope he will address how he intends to deal with rising Medicare and Medicaid costs.

If he took the position of Surgeon-General, Gupta could, oddly enough, end up playing "outsider" to Congress members and others who have already spent considerable time sorting through the health care question. But this would only be if Gupta ultimately chose to expand or extend his role, and as history has shown (and readers here have suggested), there is little proof a Surgeon-General would ever take the lead on this front.

Cuddly Welcome for Mr. Daschle
http://www.nytimes.com/2009/01/09/opinion/09fri1.html

[JimR]

As other posters have noted, if either one is going to fix it, it would be Daschle. The Surgeon General does not set or influence policy.

[Eclectic Radical]

Daschle has consulted for pharmaceutical companies, yes, but he is also a bread-and-butter liberal who supports much wider national health care reforms than those advocated by the President-elect. He was one of the cadre Democrats to support single-payer in President Clinton's first term and he steadfastly opposed the straw-man 'Republican health plan' (that was abandoned as soon as single-payer was a dead issue) in favor of the White House plan when other Democrats defected because 'something' was better than 'nothing.'

Regulating the pharmaceutical industry is properly a function of FDA regulation and Congress, and is part of a larger package of corporate regulation necessary to restore freedom to the market system the deregulators have surrendered to corporate cartels. Reforming the pharmaceutical industry has as much to do with the Secretary of Commerce as the Secretary of HHS.

We need radical reform of health care in this country, not piece-by-piece reform of pharmaceutical companies and insurance companies. A genuine national health care system will force both.

[kenstremsky]

People who have Medicare should be allowed to buy prescription drugs from Medicare and not have to deal with Medicare Part D providers if they do not want to.

The federal government should use the Bayh-Dole Act to try to lower prescription drug prices. The Bayh-Dole Act allows the federal government to license the patents of drugs based on federal government research dollars to other companies when the prices are high. The more companies that make the same drugs the lower the prices of the drugs may be. I do not the Bayh-Dole Act has ever been used dealing with prescription drugs. It deals with government research dollars.

You may read about the Bayh-Dole Act at http://www.cptech.org/ip/health/bd/

I have known about the Bayh-Dole Act for several years. Hopefully, members of Congress will make sure taxpayers dollars have more bang for the buck when they are used for government funded research and other things.

Sincerely,

Ken Stremsky

[Sumocat]

Between Gupta and Daschle, Gupta is not being offered a position where he will shape policy; Daschle is. I know people think of the C. Everett Koop model when they think of the Surgeon General, but Koop was an anomaly, and it's been nearly twenty years since his time. On the other hand, Gupta would also be the first surgeon as Surgeon General since Koop, so maybe the similarities won't end there, but Daschle will be the one in position to fix health care.