How Do Make Specialized Healthcare Accessible and Affordable?

Frederick G. Banting and Charles Best who discovered Insulin

New Orleans    In this brave new world of medicine involving stem cells and gene therapy, all of which were almost unimaginable in the past, we still are hitting our heads against the wall at the inability to craft a solution to the old problem in the United States of equal access and affordability.  Doctors are estimating the price tags on some of these treatments could hit up to $1 million in our current system.  Lacking universal health care in the United States that spells death and disaster for many families in the 99%.

When the FDA approves a treatment, especially if it is the only one likely to be effective, similar to the sickle-cell disease effecting so many in lower income, minority neighborhoods, government and private health care insurers face an moral obligation to provide the coverage and pay the bill.  We’ve been seeing too many stories of pharmaceutical companies jacking up the bill for rare medicines with limited manufacturing capabilities and forcing insurers to pay or families to do without.  Insurers, drug companies, and even government health officials since the Affordable Care Act fights have danced around so-called “death panels” or anything that might seem to impose price ceilings or the rationing of care, leaving us sucking air for a solution.

Michael Sherman, the chief medical officer of Harvard Pilgrim Health Care in Massachusetts, has made the case in Scientific American that under the existing regime something that might work would be a value-based agreement between institutions, drug companies, and insurers for new drugs.  The essence of the agreement is that if it works, they get paid their demand price, and if it doesn’t work, they are paid a substantially lowered price.  Sherman wonders if such agreements might work for gene therapies as well.

It seems a stretch.  Yes, making the companies prove their mettle is appealing, but it doesn’t deal with the issue that companies are setting exorbitant prices for any and all drugs in the first place in the US, the likes of which we see nowhere else in the world.  For example, the inventors of insulin donated the patent, rather than enriching themselves, but drug makers now charge $200 to $300 a vial for this lifesaver, many decades after its discovery.  It is hard to imagine gene therapies that depend on doctors, drug companies, hospitals, and insurers at this point would be able to come to a reasonable agreement that would make such treatment affordable to all.  I would have more hope for Congress!

Like it or not, it is hard to avoid the root question even as many speculate on how far they can climb out on the branches before falling:  we need universal health care protection for all Americans!  Without it, specialized drugs and path-breaking gene treatments, will make hospitals the new playgrounds of the rich, while the rest of us suffer and die.

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Poverty Wages and Working Conditions for Care Givers are a Crisis

New Orleans   Think about these projections and facts.

Caregivers including home health aides, personal care attendants and certified nursing assistants according to government projections are going to continue to be among the fastest-growing occupations. The Labor Department estimates that a million jobs in this classification will be added in the decade that started in 2014 and will end in 2024.

OK, there is a certain amount of guessing there, but the message is solid. As people get older, weaker, and more impaired, they are going to need more help, and the helpers are the caregivers in these categories. Anyone who has spent time in a hospital or cared for a loved one or wrestled with the issues of older relatives and their needs, knows that their lives – and often our own – depend on them completely. The primary sitters for my almost 94 year old mother are like family. One is a constant at Thanksgiving. Another was a union steward for Local 100 for decades. They make my mother’s life possible, and, frankly, mine as well, because without their constancy and competence, how would I work and travel on my schedule? I couldn’t.

But, the facts are also that a quarter of all such caregivers live in poverty. It’s also a fact that forty percent leave these occupations entirely within a year. Our union represents nursing home workers in Louisiana along with other care workers in homes and facilities for the residents who are differently-abled mentally. As part of our contracts and labor law, we get regular employee lists. The turnover is amazing.

We recently settled contracts for four nursing homes in Shreveport. We organized and brought the homes under contract in the mid-1980s, when they were owned by a family in the area. When we first won the elections the workers were all paid minimum wage with no holidays, no vacations, no nothing. Our workers are quietly celebrating their new contract now. In right-to-work Louisiana almost 50 have joined the union in the several weeks since we reached agreement. Some workers will get raises of between $1000 and $2000 per year for full-time work. Why? We were able – with the companies agreement – to get the base rate for certified nursing assistants up to $10 per hour and increase the level of annual and biannual raises. The Shreveport-based homes had been bought by a Dallas-based company that had realized in this economy they couldn’t continue to hire people and keep the staffing ratios without agreeing to raise wages.

Will there still be turnover? Oh, yes! Will some of our members still live in poverty? Oh, yes! Does this fit in with mega-political issues at the state and federal level? Oh, mercy, yes! Insurance is offered to all of workers, but none can afford it at these wages. The state is in permanent financial crisis affecting the reimbursement rate for caregivers and in fact the power of the nursing home industry and lobbyists has retarded the growth of home health care aides. Federally, Republicans are still trying to figure out how to cutback on support for Medicaid and Medicare, which is the bulk of the reimbursement.

Eduardo Porter argues in the New York Times that these critical caregiving jobs have to offer a path to the middle class. He’s right on the money, but who is willing to pay the bills, even when lives depend on it?

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