Just What The Doctor Ordered: A Female Prosecutor
She has taken on Felons, Bankers, Polluters. Now, Let’s Ask Her to Take on Healthcare and Pharma Villians
We have great reason to feel hope and joy. We thank President Biden for the great work and now, have a bridge to a new era. Obama provided hope, Biden healed us and Harris will provide growth and innovation.
Of course, in order to get VP Kamala Harris elected as president, we have to do the work and concentrate each of our volunteer efforts on the seven swing states: Arizona, Michigan, Wisconsin, Pennsylvania, Virginia, Georgia and North Carolina.
How do we do that? Anybody in a blue state, and I’m talking to you, needs to help with phone banking, postcards, social media or if you can physically get to one of those states, start door knocking doors and helping campaigns on the ground. Folks, buckle up, get uncomfortable and find your power! We are going to need everyone. So, Google your local Indivisible team or Democratic Party headquarters in any state and get moving.
This is the reason for the great joy and hope: good news all the way around:
Þ Harris is polling much better right now than any other Democrat in the seven swing states of those considered in the field as presidential material, including President Biden
Þ In a few of those states, she is already beating Trump and it is only day four of her campaign
Þ With the VP, we bring in new coalitions: more women, more People Of Color and younger voters who were not inspired before but will be now as well as more progressives
Þ She brings enthusiasm and new high energy
Þ She is ready and, we are ready
Bottom line: we are going to beat Trump, his authoritarianism and Project 2025.
We got this.
Now, once we do elect Kamala Harris, what do we ask for and what are the possibilities?
We need President Harris to challenge the healthcare villains who have made us far less healthy (dangerously so) in our country for a long time without any consequence: Health Insurance Companies, Pharmacy Benefit Managers and Pharmaceutical Companies.
Further, we need a better solution. Broadly we can call it Healthcare For All, Once and For All – yes? Yes it would some version of many things we have already heard of!
How would that work and how would our new president do that? We, as a country, have some good foundational ideas that need to be built up, revised or greatly enhanced and we clearly need some innovation.
Before we do that, let’s talk about where we are as a nation from a health perspective.
According to KFF, an independent and well respected, healthcare polling firm
“Americans are struggling:
· About half of U.S. adults say it is difficult to afford health care costs, and one in four say they or a family member in their household had problems paying for health care in the past 12 months. Younger adults, those with lower incomes, adults in fair or poor health, and the uninsured are particularly likely to report problems affording health care in the past year.
· The cost of health care can lead some to put off needed care. One in four adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably six in ten uninsured adults (61%) say they went without needed care because of the cost.
· The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share say they have instead opted for over-the-counter alternatives. About one in ten adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost.
· Those who are covered by health insurance are not immune to the burden of health care costs. About half (48%) of insured adults worry about affording their monthly health insurance premium and large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and to out-of-pocket costs to see a doctor.
· Health care debt is a burden for a large share of Americans. About four in ten adults (41%) report having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt.
· Notable shares of adults still say they are worried about affording medical costs such as unexpected bills, the cost of health care services (including out-of-pocket costs not covered by insurance, such as co-pays and deductibles), prescription drug costs, and long-term care services for themselves or a family member. About three in four adults say they are either “very” or “somewhat worried” about being able to afford unexpected medical bills (74%) or the cost of health care services (73%) for themselves and their families. Additionally, about half of adults would be unable to pay an unexpected medical bill of $500 in full without going into debt.”
Those are the problems, but here is why we have those problems:
A. Healthcare Insurance companies continue to gouge us, plain and simple:
1. Premium Increases: Insurance companies raise premiums significantly and frequently, making healthcare coverage unaffordable for many Americans.
2. High Deductibles and Co-pays: Increasing out-of-pocket costs through high deductibles and co-pays can put a strain on individuals and families, discouraging them from seeking necessary healthcare.
3. Limited Coverage: Some insurance plans may have limited coverage options, leading to gaps in care and unexpected expenses for policyholders.
4. Denying Claims: Insurance companies denying claims for necessary medical services or procedures can leave individuals with hefty bills that they anticipated would be covered.
5. Lack of Transparency: Complex insurance policies and lack of transparency in pricing and coverage details can make it difficult for consumers to make informed decisions about their healthcare.
6. No Accountability: There is very little regulation, so they can continue these practices without any consequence.
B. Pharmacy Benefit Managers (PBMs) were created by health insurance and pharmaceutical companies to create a new revenue stream. They are borderline Machiavellian in their approach to deciding cost of drugs, who is covered and who is not as well as when drugs are received. I have personally gone to war with these groups and cannot underline enough how unfair this model is for all patients and their families. It is absolutely breaking Americans financially.
This is how their gouging tactics work:
Spread Pricing: PBMs use spread pricing to charge health plans more for medications than what they reimburse pharmacies, leading to higher costs for patients and health plans.
Rebate Retention: PBMs negotiate rebates with drug manufacturers but may not pass on these savings to health plans or patients, keeping a significant portion of the rebates for themselves.
Formulary Manipulation: PBMs may manipulate formularies to favor certain drugs over others, potentially leading to higher costs for patients if the preferred drugs are more expensive.
Lack of Transparency: The complex and opaque nature of PBM contracts and pricing structures can make it challenging for patients, pharmacies, and health plans to understand how costs are determined.
Steering Practices: PBMs may direct patients to use certain pharmacies or mail-order services, which can limit patient choice and potentially result in higher costs for patients.
These practices can contribute to rising healthcare costs and create barriers to accessing affordable medications for many Americans. Efforts are being made to increase transparency and regulate PBMs to ensure fair pricing and better outcomes for patients, but not fast enough.
For all of those reasons, the FTC is investigating PBMs (https://www.ftc.gov/news-events/news/press-releases/2023/05/ftc-deepens-inquiry-prescription-drug-middlemen). They need to be investigated and clearly, at a minimum, the model needs to be fairer for the average American. If found to be violating laws, they need to be dismantled. It does appear the FTC is looking to sue UnitedHealth, Cigna, and CVS over tactics as middlemen in negotiating drugs according to their website.
C. Pharma companies are raking in ridiculous profits at the expense of Americans.
Pharmaceutical companies use the following strategies to extract more revenue each day from each of us:
Price Manipulation: Pharmaceutical companies have been known to significantly increase the prices of prescription drugs, sometimes without any clear justification or rationale, leading to higher costs for patients.
Patent Protection: Companies may extend patents on drugs or engage in practices to prevent generic competition, maintaining monopolies on medications and keeping prices high.
Marketing and Advertising Costs: Pharmaceutical companies spend a substantial amount on marketing and advertising, which can drive up the overall cost of medications.
Pay-for-Delay Agreements: Companies may engage in pay-for-delay agreements with generic drug manufacturers to delay the entry of cheaper generic drugs into the market, keeping prices elevated.
Lack of Price Regulation: The lack of price regulation in the pharmaceutical industry in the United States allows companies to set prices independently, sometimes leading to unaffordable medications for many Americans.
These practices can contribute to the rising cost of healthcare and create financial burdens for patients, especially those with chronic conditions who rely on expensive medications. Efforts to increase transparency, promote competition, and regulate drug pricing are ongoing to address these issues and may make medications more affordable for Americans, but much more is needed.
So, What Can Be Done and What Do We Ask Our Soon-To-Be President to Work On?
Create a real, practical and robust healthcare for all system, (everybody in and nobody out). So, what are the steps? What are we asking for and what are the recommendations?
1. Build on some good foundational work that has been created:
A. The Affordable Care Act,
B. Insulin pricing reduction and cap
C. Partner with Mark Cuban’s company that eliminates the Pharmacy Benefit Manager model plus 15% markup and $9 dispensing. They are already partnering with hospital networks and
D. Get rid of the Pharmacy Benefit Manager model completely
E. We have an amazing framework in place called Medicare
2. We need to add a Healthcare Optimization Secretary (HOS) to the U.S. cabinet that will help concept, develop and implement a new healthcare model
A. Ask the president and the new HOS to bring in all the experts from various discipline to build a single payer system with the best ideas from all corners:
§ Healthcare for all
§ Medicare for all
§ Best practices from Europe and Canada
§ Patients, Doctors and Nurses
§ Mental health experts
§ Hospital leaders
§ Medicaid experts
B. Once conceived, it can be blended with existing systems and take for- profit companies out of the control seat, permanently
Other countries have done this with great success and in a wide variety of models. And before it is asserted, it is not socialism or socialized medicine. It would be the best of government and private brought together to create the highest quality of care to all Americans.
It can be done, but we must demand it.
First, you misspelled the Vice President's name and title. It is Vice President Kamala Harris. Second, please share which policies will "bankrupt" us and provide documentation. That way, we can actually have a conversation instead of a bunch "!!" statements. Many thanks.
What a joke!! Camala’s policies will go along way to bankrupting our country!! I for one don’t want my grandchildren to pay for the stupid policies of another socialist in the White House!!