Happy to see this topic being discussed at ADA, but what I want to know is what is ADA doing about it?
"SAN DIEGO — If the American Health Care Act of 2017 — passed by the House of Representatives in May as a replacement for the Affordable Care Act and currently wending its way through the Senate — is ultimately passed, there will be disastrous consequences for many people with diabetes, according to a presentation by experts here at the American Diabetes Association (ADA) 2017 Scientific Sessions.
When this new bill was approved by the House in May, “everybody in Washington was stunned. No one thought it would happen,” Marc M Boutin, JD, the chief executive officer of the National Health Council — an advocacy organization which represents 133 million people with chronic conditions and their caregivers — told ADA meeting attendees."
The most recent thing appears to be that the ADA has teamed up with American Medical Association, American Heart Association, American Cancer Society Cancer Action Network, AARP, American Hospital Association, Federation of American Hospitals and March of Dimes to address this debacle. They are planning a series of evens, the first is to be held today in Cleveland.
I’ve never been particularly impressed with how the ADA represents patients. They have been doing federal advocacy on these issues but they have not appeared to make it a very high priority.
We can’t count on big national organizations to lobby for us, individual patients. We have to contact our Senators ourselves and let them know our position on AHCA.
Yesterday (June 14th) was supposed to be a call-in day. That got derailed by other news. So it’s not too late to call your Senators. But soon it will be! Call your Senator’s office today.
Here’s the latest update on what’s happening with the AHCA in the Senate.
According to Politico, Senate Democrats are going to use procedural rules to halt (or at least dramatically slow down) what’s happening on the Senate floor. This will draw more attention to the bill and cause Senate Republicans to reconsider their votes.
The biggest issue, as I see it right now, is that Congressional discussion and support of the AHCA is not being driven or affected by lobbying from medical or consumer groups. There is plenty of lobbying going on, but the GOP congressional delegations don’t seem to care what such lobbies have to say.
When contacting my own representatives and senators, I got replies on this issue saying: “we know better and are doing what’s best for you, thank you for your support.” And I actually manage to get personal letters (probably because of having a title and being somewhat known in my state and to my federal representatives). But they act as if I’m supporting their positions even when I am extraordinarily precise about my position.
In short, from what I can tell, the GOP’s position on the AHCA is driven by political and tax policy concerns rather than medical or public health concerns. The only way to effect change at this point is to bring massive political pressure and exposure to their agenda. And that means… protests, campaigns, and other actions which make it very explicit: if you vote FOR the AHCA, you will be voted OUT of office in 2018, 20, or 22.
As much as it hurts us as individual patients (or PWD), the biggest albatross of healthcare legislation which restricts or tries to regulate the free market is that of cost. If we cap the amounts paid to pharmaceutical companies and healthcare providers, we restrict innovation and we push healthcare providers to either overwork themselves (that 15-minute appointment cap, of which you see your doctor for maybe 2) or to leave the market/profession. If we pay for everyone who needs it, to get top-level care, we bankrupt the nation. (Consider the cost of caring for someone living with severe brain injuries, or children and adults born with birth defects that make that it impossible for them to ever become contributors to our society; consider the costs of “extraordinary measures” for every nonagenarian with advanced Alzheimer’s Disease… the list goes on… and diabetes care, with “free” ad libitem test strips, insulin, infusion sets, and CGM sensors, is only the tip of that iceberg.)
Politicians would not be doing their job if they did not put some sort of limits on what sort of healthcare the government provides to its population. A more free market may leave some of us uncovered, but no good reason for pharmaceuticals to hike their prices for existing drugs to levels millionaires have difficulty paying, and no reason for healthcare providers to leave the market because they are too rushed to do the right thing by each patient or because they can never pay off the student loans, licensing costs, equipment loans, and insurance premiums they incur entering that profession.
That doesn’t seem to be happening in Europe, considering the quantity of new drugs that are continually coming from there, nor considering the quality of care which in many places is far higher than ours. I have a friend who spends part of the year in Austria and he says comparing health care there to here is like comparing a Lexus to a moped.
This is one of those notions that seems so intuitively obvious that it just must be true. If reality doesn’t conform to the cherished idea, reality must be wrong.
I’ve heard the argument before, and I can understand it. But I reject it categorically, based on real-world evidence. Either Europe and Canada disprove the assertion that capping payments restricts innovation and reduces service, or the US is subsidizing innovation and service for the rest of the world. In either case, it’s not so simple as “capping prices punishes the providers,” and I’m not OK with the situation the way it is.
Here’s another way to think about it: we don’t know what a regulated, price-capped, or even universal healthcare policy would do in the US. People have been making your argument for a very long time in US politics (since the 70s, at least, when the employer-subsidized insurance market started to show “issues”), and it’s been used as political cover to keep (or patch) the system while maintaining incredible profits for pharmaceutical companies, insurance providers, specialist MDs, and large medical service provider conglomerates. Meanwhile, elsewhere standards of care, service, and innovation are comparable (or better) than in the US, and prices are much, much lower. What’s missing? The incredible profit margins accruing in the US.
So, rationally speaking, I’d like to try instituting reforms that have worked elsewhere. What all of us agree on is that the current system only works for the wealthy and healthy. The AHCA literally just rolls back regulations to pre-ACA days and simultaneously undercuts Medicaid (see the released version from the Senate today). It’s not a “fix,” it’s going back to the “bad old days.”
I’d like to try a fix of the system for once. Price caps, single-payer, or anything else that some bright person can come up with that is also based on real-world evidence rather than pie-in-the-sky thinking or partisan ideology.
Here’s just one example: in Germany there is a federal law that no prescription med can ever be marked up more than 2000% over its cost of manufacture. That sounds like a lot, but wait. It means that a vial of insulin that costs maybe $1.50 to make can never under any circumstances be sold for more than $30. In the U.S. that exact same vial can easily cost $200 or more.
My own purely personal opinion, which I never ever thought I would live to hear myself say, is that our only real salvation is a true, engineered-from-the-ground-up single payer system, simply because the hole we have dug ourselves is so deep that nothing else will get us out of it, now.
(Continuing the metaphor, the First Rule of Holes is, “When you’re in one—stop digging!” Whereas, we are doing pretty much the opposite.)
And in the latest news, this unmitigated disaster may be DOA
Note that the objecting Senators (Rand Paul of Kentucky, Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah) are from the far right which want a total repeal of ACA and a minimization of government expenditures.
Your note is what worries me a bit, here. They really only need two of those four “dissenters” to come back to the fold to pass this (since Pence is guaranteed to follow the party line). So, if McConnell can find a way to make this just a little bit worse for the sick and poor, it’s not hard to imagine Cruz, Johnson, and Lee from signing back on. And the House certainly isn’t going to wrangle too much at this point.
I give it a 40/60 chance of passing at this point. Even though it is ridiculously unpopular and will only become more so as people dig into it (now that they can actually read it), the GOP seems hellbent on repealing the ACA (or most of it) at any economic, health, and political cost. It might bite them in the end.
My understanding is that pharma companies move overseas for cheaper labor rates and less regulatory hassle getting their goods to market (which lowers their production costs – research costs may or may not be the same), and because they can’t realize a profit in socialized-medicine countries (which they need to be able to keep doing increasingly-expensive research and testing for new and better drugs), they have to mark up the prices in countries where it’s possible to do so (like the US).
We HAVE seen single practitioners closing shop right and left because of the paperwork requirements of HITECH and many of the new insurance plans (some have joined group practices, which have been joining hospital-based supernetworks, because only those supernetworks can afford the cost of the new requirements). We have seen practices taken down by the law (I remember reading about one case in New York City) because they refused to take insurance and/or Medicaid/Medicare, preferring to treat a reasonable number of patients, on a reasonable retainer basis.
As for the protests that @David49 called for, some of that is happening. A group of disabled people and their supporters protested in the hall outside Mitch McConnell’s office yesterday and were carted away by the Capitol Police. The video of this makes for fine political fodder going forward. You can see some of the video here: Mitch McConnell: Disability Protesters Removed From Office | Time
Bottom line: We still need to contact our Senators and tell them to vote “no.”
