Mike Adams, the Health Ranger
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 In Big Pharma, of course, where 79 drug companies are now being accused of defrauding state medicaid programs by artificially inflating the prices of drugs. According to the Department of Justice, the actual wholesale price of many drugs and medical supplies is a mere fraction of what is claimed by the drug companies. The difference -- the "price spread" -- is pure profit for drug companies who are profiting handsomely at the expense of taxpayers. |
| It's yet another example of the widespread lack of ethics in the pharmaceutical industry, where seemingly any strategy that makes money is supported: scientific fraud, medicaid fraud, censorship, bribery, intimidation... and that's just what we've seen in the national headlines in the last month!
You see, the drug racket isn't just about dangerous drugs like Vioxx being peddled to tens of millions of Americans, it's also about financial fraud designed to extract even more money from taxpayers. |
Charles Barber
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 In 1945, only half a million people received Social Security benefits;66 medicaid and Medicare weren't created until 1965. Both of those programs also got off to relatively slow starts but now are massive components of the federal budget. Persons served by Medicare mushroomed from 7 million in 1967 to 27 million in 2002.67 Collectively, the entitlement programs of Social Security ($488 billion), medicaid ($300 billion), and Medicare ($176 billion) now make up almost half of the federal budget.
Feeling entided to all this, we think we are also entided to happiness. |
Shannon Brownlee
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 Looking to the future, the Centers for Medicare and medicaid Services predicts annual health care costs will hit $4.1 trillion by 201 6, eating up nearly 20 percent of our gross domestic product. We currently spend nearly $6,000 apiece on health care, two and a half times the median for the rest of the industrialized world.
What do we get for our money? Politicians are constantly telling us we have the best health care in the world, but that's simply not the case. |
| Then the family lost its medicaid coverage and Deamonte died, because his mother couldn't afford to pay for an $80 extraction. His brain infection cost the District of Columbia $250,000. The Institute of Medicine recently estimated that about eighteen thousand Americans die prematurely each year, simply because they lack health insurance.
It's not as if we haven't tried to fix the system—several times, in fact, over the past century, first in World War I, then again during the Great Depression
1 and the Truman and Eisenhower administrations. |
| The bottom layer would become medicaid, which would cover the indigent; the middle layer would be Medicare, which would cover the costs of hospital, nursing home, and home health care for the elderly; and the top layer he borrowed from Bettercare, a voluntary supplemental insurance to cover doctor's fees, in and out of hospitals. Cohen said later, "Like everyone else in the room, I was stunned by Mills' strategy. It was the most brilliant legislative move I'd seen in thirty years. |
| About 20 to 2c percent of Hopkins emergency room patients are uninsured, and another 1 c to 20 percent are "underinsured," which means they are on medicaid or a private plan that barely covers the hospital's expenses. Caring for the poor is part of the hospital's mission, but it comes at a cost.
The cancer center, by contrast, lures a better-insured clientele, in part because the disease itself is most common among Medicare recipients. |
| We all wind up paying for it, as this overinvestment drives up costs for Medicare, state medicaid programs, and private insurers.
Meanwhile, more than a hundred emergency rooms around the country have closed in the past decade, victims in part of rising rates of uninsured patients appearing at their doors. At hospitals that have kept their emergency doors open, administrators have not been eager to add the additional ER beds that are often so desperately needed, because that would mean caring for more uninsured (and unprofitable) patients. |
Bill Sardi
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 One uncooperative urologist was found guilty of violating the Federal False Claims Act and sentenced to six months of home arrest, excluded from Medicare for five years, required to provide 600 hours of free medical care to indigent patients and patients covered by Medicare or medicaid, and paid fines and restitution to the government. [Journal Clinical Oncology 23: 8894-905, 2005]
This mass-scale fraud has caused Medicare to downshift its reimbursement for Lupron and other cancer drugs. Many oncologists will earn 30 to 50% less a year as a consequence of the $1. |
Gerald E. Markle and Frances B. McCrea
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 The 1997 Balanced Budget Act requires medicaid and Medicare Programs to reimburse hospitals for what is called "reasonable care." Thus, although it was never planned that way, emergency departments have emerged as "the ultimate safety net for those whom other providers turn away,"4 as well as "the most important and least recognized federal health care safety net program."5
The most frequent visits to emergency departments were from the traditionally disadvantaged population.6 Those 75 and older, and African Americans, had a use rate about 75% higher than that for whites. |
Andreas Moritz
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 Their report, which was published in the New England Journal of Medicine in October 2004, covered the medical records of more than 4,400 medicaid patients, averaging 15 years per patient. Approximately 1,475 subjects suffered cardiac arrest during the study period. When the complete medication use of each subject was analyzed, researchers came up with these results:
• The rate of sudden death from cardiac causes was twice as high among patients using erythromycin compared to subjects that didn't use the antibiotic. |
Charles Barber
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| As a category, mental health issues are searched for more often than immunizations, dental health, Medicare or medicaid, sexual health information, or problems with drugs and alcohol.29 In July 2006, of the ten most popular online searches for pharmaceutical and medical products, six concerned psychiatric drugs or psychiatric disease. (They were, in order, Lexapro, Cymbalta, Zoloft, Wellbutrin [an antianxiety agent], Effexor, and the illness of depression itself.)30 Among people who have visited a medication site, depression is by far the most researched medical condition, with 2. |
Shannon Brownlee
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| The government picks up the tab for the rest through Medicare, medicaid, or a military agency.) A rational system would cover everybody, not only because it's the right thing to do, morally (and because it's what we would hope for if we didn't know whether we would have insurance), but also because the uninsured help distort our current system, pushing hospitals to shift costs to insured patients in order to cover their losses from the uninsured. |
Too Profitable to CureBrent Hoadley, Ph.D.
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| Medicaid spending. But since this obviously isn't adequate profit for Lilly, the company managed to keep hidden for a considerable time the link that shows Zyprexa is causing Type 2 diabetes. Can you guess what Lilly's second-leading money maker is...? Surprise! Drugs for treating diabetes. Talk about CREATING a market! Of course, none of this would be possible without unknowing or unscrupulous doctors, their handy little prescription pads, and a willingness to sacrifice patient well-being for pharmaceutical profiteering. |
Gerald E. Markle and Frances B. McCrea
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| The second role of the ER is a safety net provider for vulnerable populations: the uninsured, those on medicaid, and minorities. The question for this book then becomes: Is this latter function appropriate for the ER? and how does this second role affect the first one?
Let us examine this second set of questions first.
APPROPRIATENESS
The 1986 Emergency Medical Treatment and Labor Act mandates emergency screening, and, if necessary, emergency treatment, at least enough to stabilize the patient for transfer to another facility. |
Bottom Line Health
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| RECOMMENDATIONS
But what can medicaid recipients and the more than 45 million uninsured Americans do to boost the odds of getting to see a health-care professional promptly?
"Lie," says Dr. Mark Murray, a consultant and authority on patient access to care.
However, he agrees with Asplin that it's not just those who lack private insurance or those who have no insurance at all who find it difficult to get timely appointments. |
| THE FIRST STUDY
The first study gathered information from 19 medicaid patients and 24 health-care providers about the medications they use and prescribe. Nancy Sander, lead author of both studies and president and founder of AANMA, and her colleagues conducted two focus groups—one for patients and one for health-care providers—in Atlanta; Birmingham, Alabama; and San Antonio, Texas.
Both patients and providers said that preau-thorization policies and preferred drug lists limit their access to effective asthma treatment. |
| In addition, a caller claiming to have private insurance was almost twice as likely to get a timely appointment as someone who said they had medicaid (63% vs. 32%).
IMPLICATIONS
"What we were interested in understanding was how big a role health insurance plays in patients' ability to get access to care after they leave us," Asplin says. He concludes, "Health insurance matters—that's the basic message from this study. If you are not a card-carrying member of our health-care system, you have a very difficult time getting access to care. |
Mike Adams, the Health Ranger
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 The health insurance companies are paid to deny health claims and the government workers at Medicare and medicaid offices are paid to find new ways to deny payments to doctors and hospitals for services rendered. Thus, doctors' offices and hospitals have to employ entire armies of people to sit around and reclassify procedures in ways that can get paid by insurance companies, Medicare and medicaid. It's a massive waste of time, money and effort.
In the U.S. healthcare system, it's a paperwork nightmare. And there is a paperwork war taking place. |
Bottom Line Health
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| Jennifer Kim, an allergist at Children's Memorial Hospital in Chicago, says that preferred drug lists and preauthorization policies, such as those established by medicaid, can definitely be a problem. "For a group of people who already have poor access to health care, this only puts up more barriers and more hoops for them to jump through to get the treatment they need," she says.
The medications Kim has the most trouble obtaining for her patients are nonsedating antihistamines and Xolair (omalizumab), an injectable medication that is used to treat severe asthma, she says. |
| THE STUDY
The researchers looked at nearly 5,500 medicaid beneficiaries across the country who had received inpatient treatment for depression. They divided the people into two groups—those who had received antidepressants and those who had not.
They found that children between the ages of six and 18 who were taking antidepressants were 1.5 times more likely to attempt suicide and 15 times more likely to die in that attempt than individuals not treated with an antidepressant. This trend was not seen among adults who used the drugs. |
Mark Sircus
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 On April 25, 2005, the Ohio Columbus Dispatch reported an investigation of state medicaid records that found 18 newborn to 3 years-old babies in Ohio had been prescribed antipsychotic drugs in July 2004. It is a horrible crime and terrible sadness what is being done to the children by pediatricians and psychiatrists who live by the increasingly popular creed to drug the kids with toxic substances. |
Charles Barber
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| It worked. medicaid recipients, for example, who lived within three miles of the World Trade Center filed 18 percent more antidepressant prescriptions in the three months after the attacks.103 Some ads for Paxil appeared after shows depicting the World Trade Center towers collapsing. One television viewer, Rebecca Ames, commented, "The drug companies have to push those drugs, but it does make my little eyebrow go up a bit. The commercials make it seem like if you take the drug, all your troubles will go away. |
J. Douglas Bremner
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 We are also paying a lot of money for health care we may never even receive, as a result of the rising costs of individual health insurance, health-care benefits that drive companies into the ground, expensive Medicare drug benefits, and uncontrollable medicaid costs.
Many of the aforementioned expenses are related to expensive drugs that we often don't need, that are no more effective than older alternatives, or that are simply not as valuable as drug companies make them out to be. |
Melody Petersen
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 The year 2003 marked the first time that states spent more to pay the medical bills of the poor and the disabled covered by medicaid than they spent on elementary and secondary education. When the states added in what they paid for the medical care of government workers and inmates in the state prisons, health care consumed about a third of every state budget, a percentage that was rising every year.
State and local government officials across the country had been forced to raise taxes and cut services, including education and road construction, to cover the rising cost. |
Charles Barber
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| Collectively, the entitlement programs of Social Security ($488 billion), medicaid ($300 billion), and Medicare ($176 billion) now make up almost half of the federal budget.
Feeling entided to all this, we think we are also entided to happiness. |
Melody Petersen
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| By the end of six months, the doctor had written fifty-three Neurontin prescriptions for medicaid patients, most of them for uses the government had not approved.
Franklin said he found that many physicians did not question even the flimsiest or most reckless claims made by the company or the physicians they hired. Everyone—both doctors and the company's employees?seemed entirely comfortable with what was going on.
"I underwent a stunning revision of my beliefs about the medical profession," Franklin later recounted. |
Brenda Watson and Leonard Smith
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 Professional Organizations
Centers for Medicare & medicaid Services
7500 Security Blvd.
Baltimore, MD 21244 www.cms.hhs.gov
Centers for Disease Control and
Prevention (CDC) 1600 Clifton Rd.,N.E. Atlanta, GA 30333 404-639-3311/
800-CDC-INFO or 800-232-4636
Public inquiries: 404-639-3534 www.cdc.gov/a bout
Commonweal
PO Box 316
Bolinas, CA 94924
415-868-0970 commonweal@commonweal.org Environmental Working Group
Headquarters
1436 U St., N.W., Suite 100
Washington, DC 20009
202-667-6982
California Office
1904 Franklin St., Suite 703
Oakland, CA94612
510-444-0973 www.ewg.org www. |
Melody Petersen
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| Ray, a professor at Vanderbilt University, compared the prescription records of medicaid patients in Tennessee with police reports of motor vehicle accidents. On the basis of those data, he estimated that psychoactive drugs taken by older drivers were to blame for sixteen thousand motor vehicle accidents causing injuries every year in America. That is about forty-four injury accidents every day, just for drivers ages sixty-five and older.
The medications that Dr. Ray and his colleagues found the most dangerous were benzodiazepines such as Valium and tricyclic antidepressants such as Elavil. |
| Ryan Carnahan, a fellow of psychopharmacology at the University of Iowa, and his colleagues searched prescription data from the state's medicaid program to find older Iowans who filled their first prescription for Aricept, a medicine for Alzheimer's, in 1997, 1998, or 1999. They then looked at what medicines these patients had been taking in the three months before that initial Aricept prescription. They found that 30 percent of these Iowans had been taking drugs that were well known for causing dementia. |
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