Profits are No Reason to Run Health Care

By SAM URETSKY

It would have been 1986 or 1987, I wasn’t taking notes. We had just finished the ACTG, AIDS Clinical Treatment Group study. It was a remarkable study – preliminary results showed that azidothymidine (also known as AZT or by the brand name Retrovir) was effective against AIDS, at least for while. Because of the severity of the AIDS epidemic, the FDA approved a study that enrolled thousands of patients without a placebo group – just an attempt to get the drug to as many patients as possible. There was a sense of dedication in all the people working on the study, a degree of idealism that I hadn’t seen let alone felt before or since.

When the study was completed, the FDA approved AZT for continued treatment of the patients who had enrolled in the study, but with the requirement that patients had to register and get the drug from the hospitals where they had been treated.

I remember a conversation with W., an in-patient. After we went over the basic stuff – blood counts and evidence of new infections, he started talking about some of his friends, who were dealing less with the fear of the deadly disease than with the threat of penury. They had insurance, but had never studied the fine print, and only too late realized that their policy had a lifetime cap of $100,000. Treatment for AIDS could run through $100,000 in a year, and there were no programs to help them when the insurance ran out.

C. was less concerned with insurance, because he had the best policy – and was simply annoyed that he had to travel to the hospital each month for a new supply. He repeated “the best” like a mantra. Once the drug was available for sale, he would be able to go to his local pharmacy which was far more convenient than taking the subway to 33rd street.

I felt sorry for C. when the FDA approved AZT for distribution through normal channels. The drug was priced at about $10,000 for a year’s supply ($22,400 in 2019 dollars) an unheard of price at the time, and the insurers were looking for ways to avoid paying the price. Some, I recall, said that AZT was still an investigational drug, specifically excluded from their coverage. It wasn’t. Another rejected the drug because it wasn’t a cure – a strange justification since so many drugs aren’t cures, but only a means of controlling a chronic condition. It seemed evident that the insurers had no real chance of avoiding responsibility for payment in the long run, but if they could just delay for a few months, the patients would die inexpensively.

An excellent discussion of the state of American health care took place when Sen. Bernie Sanders appeared on Fox News Town Hall:

Q – how many people get their insurance from work, private insurance, right now, how many get it from private insurance? (Lots of hands went up) Okay, now of those how many willing to transition to what the senator says, a government-run system? (Loud cheers and applause).

President Trump seemed upset at the apparent betrayal by Fox News and tweeted “Many Trump Fans & Signs were outside of the @FoxNews Studio last night in the now thriving (Thank you President Trump) Bethlehem, Pennsylvania, for the interview with Crazy Bernie Sanders. Big complaints about not being let in-stuffed with Bernie supporters. What’s with @FoxNews?“

A review by the web site fivethirtyeight.com of polls conducted since the release of the Mueller Report shows that President Trump’s approval rating has barely slipped. This seems to fit with a Politico report (4/8/18) “Trump Thrives in Areas That Lack Traditional News Outlets.” The decline of regional newspapers and President Trumps attacks on the traditional media still have their effect – but some things still strike home. According to the Pew Research Center (2/5/19), “Among Democrats and Democratic-leaning independents, health care costs, education, the environment, Medicare and assistance for poor and needy people top the list of priorities ... None of these is among the five leading top priorities for Republicans and Republican-leaning independents (Medicare and health care costs rank sixth and seventh, respectively). Conversely, the two priorities named by more than seven-in-ten Republicans –”

But – even the most die hard Trump supporter will notice when medical costs go up. There are nine million people enrolled in Affordable Care Act policies (CNBC 12/21/17) in spite of Republican efforts to derail the system by reducing the enrollment window and allowing healthy people to buy minimal insurance, which would raise costs to those with greater needs. Medical costs strike home, and while the Republicans have promoted “repeal and replace” they have nothing to replace Obamacare with. According to the Congressional Budget Office (CBO) under the most recently promoted Republican plan, 14 million people would immediately lose coverage, a number that would eventually rise to 24 million over the next 10 years.

A true single-payer plan would be difficult to pass through a divided Congress, and would encounter tremendous opposition from insurance companies, but it’s something that everybody can understand, something that affects our everyday lives.

President Trump has promised a health care plan that’s even better, but he can’t tell us about it until after we’ve seen his tax returns.

Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sdu01@outlook.com.

From The Progressive Populist, June 1, 2019

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