Medicare-For-All (Who Want It) is a Carrot that needs a Stick.
Posted on | July 3, 2019 | Comments Off on Medicare-For-All (Who Want It) is a Carrot that needs a Stick.
Mike Magee
On June 27, 2019, Pete Buttigieg was asked whether he supported Medicare-For-All. He responded, “I support Medicare for all who want it.”
In doing so, he side-stepped America’s Achilles heel, the controversial debate over shifts of power from states to the federal government. He was suggesting that times have changed and that he might prevail with Red States nipping at his heels.
Two reality maps challenge that assumption. The first is a map produced by the Kaiser Family Foundation cataloging the status of ACA Medicaid expansion in the US. The current score card includes 36 states that have or will soon participate, and 14 hold-out’s. This latter group, as has been so well-expressed by former Ohio Gov. John Kasich in the past, has chosen to vote against its own state financial interests and the servicing of its states most vulnerable citizens in the interest of keeping the federal government out of their business.
The second map comes courtesy of the Rockefeller Institute of Government and demonstrates a footprint with significant overlaps to the KFF version. It measures the amount the states contribute to the federal government through taxpayer dollars against the amount they draw off the federal government in benefits. This lays bear the truth that Red States rejection of federal underwriting is highly selective and politicized.
As I outline in my new book, “CODE BLUE: Inside the Medical Industrial Complex”, at the close of WW II we diverged from both allies and foes and went all in on cures over care, and profit over planning. Seven decades later leaders of medicine, pharmaceuticals, insurance, hospitals, and medical research have coalesced into a Medical-Industrial Complex that has dealt everyone in – except the patient.
A status quo that favors and protects states rights maintains needless complexity – on purpose. The more complex, the less we understand, the more we pay. In addition, if you’re in the business of maintaining the status quo in American health care, it pays to be financially strong enough to simultaneously field lobbying forces in all 50 states and Washington, DC as well. It’s also helpful if your organizational structure is based on state and county societies – say, like the AMA. And if your government relations armies are willing to cross sectors and collusively plan resistance strategies, all the better.
Mayor Pete is right in suggesting that Medicare, extended to all comers, will have little difficulty competing with private plans and their purposeful complexity. But to achieve the desired outcome of high quality, low variability and efficiency, our nation requires an empowered majority that clearly expresses “enough is enough.” Otherwise the self proclaimed “Grim Reaper” Senate Majority leader will continue to determine all of our futures.
“Medicare-for-all (who want it)” can not stand alone. It must be anchored in shared principles including:
1. Less is more. Insurance Simplicity = Savings and Improved Quality and Performance. .
2. Health = Full Human Potential (not the elimination of disease). Innovative research is great, but it is no substitute for national health planning and public health programming.
3. The Public Option must reinsert appropriate checks and balances. The integrated career ladder that currently entangles academic medicine, pharma, insurers, hospitals and government regulators is a cesspool of conflicts of interest and no longer deserves safe haven.
Why CODE BLUE is in Staffers Bags in June, 2019.
Posted on | June 18, 2019 | Comments Off on Why CODE BLUE is in Staffers Bags in June, 2019.
Memorializing Three Soldiers
Posted on | May 27, 2019 | 1 Comment
Mike Magee
CODE BLUE (Grove/2020) began four decades ago in the noontime conference room of Colin (Tim) Thomas, M.D., chairman of surgery at the University of North Carolina, where I completed my surgical training in 1978. Tim’s pre-op conferences exposed us to his broad knowledge and understanding of medical history and its role in shaping compassionate and empathetic health professionals. Some two decades later, Eli Ginzberg PhD, the legendary Columbia health economist, generously guided me down the same pathway, and pointed me toward World War II as I struggled to understand how and why the physician had become so entangled in the Medical-Industrial Complex.
My father, William P. Magee, M.D., who was my professional and personal role model, died of Alzheimer’s disease in 1998 during my early tenure at Pfizer. He was a decorated captain in the Medical Corps of Patton’s 7th Army in Europe, one of Dr. William Menninger’s “30 Day Wonders”, trained to manage psychiatric casualties in battle zones during the war. Seeking his war records at Eli’s urging triggered a decade long exploration, reinforced by a two year, Viagra induced association with one famous World War II casualty, Senator Bob Dole.
During my travels with Dole, it became clear that my father and Bob likely crossed paths many years ago. Dole passed by stretcher through Southern Italy evacuation hospitals that my father was helping to staff prior to his participating in the invasion of Southern France.
The 5-tier “chain of evacuation” which spanned the distance between battlefield and stateside specialty hospitals saved the life of Dole and countless others. My father worked that chain, and Eli Ginzberg helped design it. These three – the military doctor, the injured soldier, and the wartime administrator – were my silent guides through the early years of unraveling the story of how American health care came to be the global outlier it has become.
As we depart another war zone in the summer of 2021, I remember each of them, and their service to this country, with gratitude.
The WHO’s “Triple Billion” Project
Posted on | May 7, 2019 | Comments Off on The WHO’s “Triple Billion” Project
Mike Magee
The WHO just released in most recent 5 year strategic plan. The plan in anchored in three “billion” labeled goals:
- Increase the number of glabal citizens with universal health coverage.
- Protecting 1 billion more citizens during health emergencies.
- Ensuring health and well-being for 1 billion more citizens.
To reach these onjectives, the WHO have outlined 10 Critical factors contributing to the planets global burden of disease. They are:
- Air Pollution and Climate Change
- Non-communicable Diseases like diabetes, cancer and heart disease.
- Prevent an Influenza Pandemic.
- Address 1.6 billion who survive in “fragile settings” due to drought, famine, conflict, and forced migration.
- Delay the emergence of antimicrobial resistance.
- Address Ebola and other high-threat pathogens.
- Enhance and extend reliable primary care networks.
- Ensure mass population wide vaccination.
- Address the 390 million mosquito borne infections due to Dengue Fever each year.
- Extend prophylaxis and early treatment of HIV.
These challenges are amplified by the growing levels of isolationism, hostility toward at-risk migrating populations, intolerance and hatred – home grown and otherwise. In short, the issue is human behavior not lagging science. We humans have created the crisis. Health care is built on three pillars – compassion, understanding, and partnership. Vulnerable populations are calling out in quiet desperation – “Give us more of that!”
“Going Up In Air” – Tobacco Strikes (again)
Posted on | May 3, 2019 | Comments Off on “Going Up In Air” – Tobacco Strikes (again)
Mike Magee
In chapter 8 (“Masters of Manipulation”) of my soon to be released (Grove Atlantic/June 4, 2019) book, CODE BLUE: Inside the Medical Industrial Complex, I trace the history of Big Tobacco’s complicit relationship with health care, and how unscrupulous marketers from opioid king Arthur Sackler, to stress racketeer Hans Selye, to ADHD opportunist Leandro Panizzon, whose wife Rita lent her name to the generic redo amphetamine “Ritalin”, followed the tobacco marketing playbook letter for letter.
This week the Ad Agency, Crispin Porter Bogusky, helped launch “Quit Big Tobacco”, asking marketing companies to voluntarily pledge not to work for the tobacco industry. But if you think the issue is about cigarettes, you’d be wrong. It’s about vaping, which is growing in leaps and bounds.
As Ad Exec Alex Bogusky points out, vaping is Big Tobacco in disguise. In his words, among the offenders are “Altria, which owns Philip Morris, the maker of Marlboro cigarettes, yet also holds 35 percent of the vaping giant Juul; Reynolds American, which owns Vuse; and Imperial Tobacco, which owns Blu.”
The recent statistics are alarming:
1. Among high school students vaping increased 80% from 2017 to 2018, with over 2 million middle and high school users..
2. A Juul “pod” has more nicotine than an entire pack of cigarettes. Juul controls 3/4 of the child market.
3. Vape liquid additives form carcinogenic compounds on combustion.
4. Juul store signage is deliberately placed at children’s eye ;levels.
5. Boardroom stated goal for vaping: “nicotine addiction no matter the vehicle.”
Courageous Ad giants are beginning to speak up. A few samples:
Madalene Milano: Partner, GMMB
“It’s kids — that’s the tipping point. It’s the manipulation of kids and getting kids hooked, who replace their adult smokers who die.”
Robin Koval: CEO & President, Truth Initiative
“The advertising and public relations community has a critical and urgent choice to make in the face of an e-cigarette epidemic among youth. Work for the tobacco industry to legitimize and spread its deception. Or be a force for good by refusing to help place a generation at risk for a lifetime of addiction.”
Katie Dain: CEO, NCD Alliance
“Tobacco use is one of the main risk factors for a number of #NCDs, including cancer, lung diseases & cardiovascular diseases. The NCD Alliance puts its mission first in everything we do. We do not work with any company that supports Big Tobacco.”
Jimmie Stone: Chief Creative Officer, Edelman NY
“We’re entering into a behavioral marketing era. The way you behave is your marketing. Not any longer can you build marketing with what you say, but with what you do.”
So far 175 individuals from the Ad and PR world have signed the pledge to Quit Big Tobacco. Join them HERE.
A Message for Apple’s “Top 5” Health Leaders
Posted on | April 25, 2019 | 1 Comment
Mike Magee
This week, STAT News led with the headline, “5 names to know at Apple: the people leading its move into health care.” For those following the consumer health space, this was one more bit of bait to attract and catch tech-savvy readers with hints of success that have circulated for nearly two decades.
Google famously played in this health space, and then very publically bowed out in 2011. The problem then, and arguably now, is confusion around “health” and “health care” in America. As I outline in CODE BLUE: Inside the Medical Industrial Complex”, the U.S. took a right turn after the war, when every other developed nation (including two we fully funded – Germany and Japan) went left and embraced universal and national health care as a human right for their citizens.
As a result of that decision, we released health care to entrepreneurs and profiteers and drank the Coolaid believing that defeating disease was synonymous with providing health. In the eight decades that followed, pharmaceuticals, diagnostics, and devices pushed common sense public health to the periphery, leaving America the only nation to spend more on health care than all other social services combined.
So it’s not surprising that tech companies attempting to integrate with US health care are a bit confused. Are they partners in this mess, cost-effective reformers, or competitors?
Some simple advice, first provided some 13 years ago, ask the basic question, “How do we make America and Americans healthy?”
Is it through “wearable” diagnostics? Will AliveCor’s medical grade EKG device lead to a healthy and productive nation or reverse the downward trend in life expectancy in our nation?
Will portability of data, or consumer controlled collection, or “wrist time” instant distribution and sharing of data place a dent in a hyper-competive society with crumbling infrastructure, environmental degradation, poor nutrition, crumbling schools, poor air and water, and population wide anxiety?
Apple’s “Top 5” – and Cerner, athenahealth and eClinicalWorks – should be looking at where we’re going, not where we have been. Legendary Health IT leader Don Detmer said as much to Congress in 2006 with these words, “While it is the undoubted world leader in high technology clinical care and biomedical research, the US healthcare system is an incredibly fragmented mix of very large and very small players – a conglomeration of 21st century medical science and cottage-industry business practices, and too often characterized by uneven access, delivery and outcomes.”
If there is a transformative role for technology (and one that might be profitable) in the health care space, it lies at the nexus of integrated lifespan planning and strengthened bonds between individual/family/clinician and community. Efficiency, universality and solidarity are the deliverables Apple’s “top 5” should be targeting.
Here’s a short video from 2006 worth a viewing:
Running a Health Care System: As Natural As Mother’s Milk?
Posted on | April 9, 2019 | Comments Off on Running a Health Care System: As Natural As Mother’s Milk?
Mike Magee
The latest recorded U.S. birth rate dropped for the second year in a row, down 3% from the prior year. In 2017, there were just under 4 million births, 500,000 fewer than in 2007. Even though there has been a 7% increase in women 20 to 39, women are delaying child birth. Over the past 10 years, women in their 30’s are now having more babies than women in their 20’s.
If you look at US health care outcomes, women can hardly be criticized for being cautious. Moms giving birth in the U.S. are three times as likely to die in the process as moms in Canada or the U.K. But that’s not the worst of it. For every woman who does die, 70 more (an estimated 50,000 moms) come close to dying.
The Obama administration recognized that lack of access to health insurance was a large factor, and targeted women for coverage. As a result, uninsured women under age 65 dropped from 20% to 11% overall, and for poor women uninsured declined from 34% to 18%.
For all interested in national health reform in the U.S., the measures of maternal-fetal health, safety, and care should be ground zero. That our performance – in 3rd world ratings for morbidity and mortality of both mothers and children – reflects the total absence of a national health plan let alone a national health system should be a national scandal.
We fail on every measure, even those most believe are our strong suits – like medical research. Case in point: Is the breast milk we’re feeding our children safe? This is the question raised in a New England Journal of Medicine article this week. It notes that 8 in 10 American women breast feed (at in least in part) during the first six months of their children’s lives. But we also know that over half (over 1.5 million lactating women) take one or more prescription drugs during that period. And these mothers often ask, is the milk safe?
You would think their doctors would know, but they don’t. After two decades of badgering, in 2006, the National Library of Medicine created a voluntary database called LactMed. Twelve years later, in 2018, there were 1408 products in the database. But only 2% had strong, evidence based data to support conclusions of safety.
This was consistent with an FDA analysis of 575 drugs in 2018 which included data on human lactation in only 15%. Research on breast-feeding, lactation, and breast milk garnered only .3% of the NIH budget in 2017. If you want to rise quickly in academic medicine, cancer or diabetes research if a far more lucrative and productive pathway.
But what if you’re a new mom trying to do right by your baby, and you’re on anti-hypertensive meds, is that OK? We don’t know. How about if you’re having trouble getting your milk to come in, and your doctor tells you to take the GI drug, metoclopramide, said to have an off-label benefit of increasing milk supply. Is that safe for your baby? We don’t know.
Bottom line is, when it comes to running a health care system, our priorities are all screwed up. And as health industry profiteers pursue their wildest genomic dreams, moms are left to wonder why they always seem to get the short end of the stick. I mean really – Is this any way to run a health care system?
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