Suggesting Policies and Practices for Increasing Justice and Assuring the Sustainability of the U.S. Healthcare System

Dyck, Arthur J.

doi:10.1007/978-3-030-21707-5_7

Arthur J. Dyck⁹

Part of the book series: Library of Public Policy and Public Administration ((LPPP,volume 13))

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Abstract

The goal of this chapter is to suggest policies and practices that would render the U.S. health care system just and sustainable by: (1) Curbing current unethical and scientifically unsound medical practices that are unjustifiably harmful and of little or no benefit; (2) Financing healthcare by drawing upon the profits earned by all those individuals, organizations, and manufacturers that provide healthcare. To have this happen, the healthcare system must be purged of conflicts of interest, especially the FDA. Dealing justly with costs requires that excess profits that amount to gouging be mandated to be used for medical interventions.

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Notes

1.
ⁱ Norton M. Hadler , Citizen Patient: Reforming Health Care for the Sake of the Patient, Not the System (Chapel Hill, NC: The University of North Caroline Press, 2005), 179.
2.
Ibid.
3.
Ben Goldacre , Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients (London, Great Britain: HarperCollins Publishers, 2012), 131. The Declaration of Helsinki added an amendment that required compelling and scientifically sound methodological reasons for using a placebo in a trial testing the efficacy or safety of an intervention and then only if the patient receiving the placebo will not be subject to any risk of serious or irreversible harm. A study found that between 2000 and 2010 that 70% of drugs approved by the FDA that needed to be compared to existing treatments did so. Of these, one-third provided no evidence that compared the drug tested with the currently best available treatment. See also, John Abramson , Overdosed American: The Broken Promise of American Medicine (New York: HarperCollins Publishers, 2004), 102–103.
4.
A list of some fines levied against drug companies appears in Allen Frances , Saving Normal: An Insider’s Revolt Against out-of-control psychiatric diagnosis, DSM-5, big pharma and the medicalization of ordinary life (New York, NY: HarperCollins Publisher, 2013), 96.
5.
Abramson, Overdosed America, 154.
6.
Ibid, 154–155.
7.
See ibid., 245–247, for examples, of high priced drugs unnecessarily approved because they are no more efficacious and sometimes less safe than much less costly drugs approved and in use earlier. In some instances there are interventions that are much more efficacious, safe, and inexpensive than any of the drugs in use.
8.
For a sample list of such drugs see William Faloon, Pharmocracy: How Corrupt Deals and Misguided Regulations Are Bankrupting American – and What to Do About It (Mount Jackson, VA: Praktikos Books, 2011), 280.
9.
Ibid, 276–278.
10.
Ibid, 280–287.
11.
Ibid, 138–139.
12.
Ibid, 137–138.
13.
See a list of current generic drugs, comparing the average prices charged at chain pharmacies with what free market prices would be if, for example, produced by vitamin manufacturers in ibid., 140–141.
14.
See a sample list in ibid., 143 reprinted form the April 15, 2009 issue of the Wall Street Journal.
15.
Faloon, Pharmacracy, 144. See also 145–147 for some of the benefits of less expensive drugs.
16.
Ibid, 203–206.
17.
Ibid, 52–54. Note that this was published in 2012.
18.
Ibid, 176–222 provides documentation of what Goldacre calls “bad trials.”
19.
Goldacre, Bad Pharma, 127–128.
20.
Abramson, Overdosed America, 87–88.
21.
Ibid, 86–87.
22.
Ibid. See 85–90 for a fuller account of FDA’s flawed approval process.
23.
Goldacre, Bad Pharma, 123–124.
24.
Abramson , Overdosed America, 89–90.
25.
Ibid, 249–253 and Hadler, Citizen Patient, 178–191. Abramson includes many of the suggestions I have made that should guide FDA decisions. Hadler advocates a replacement for the FDA and the reform of it much as I have outlined it.
26.
Stephen Brill , “Bitter Pill: How Outrageous Prices and Egregious Profits Are Destroying Our Health Care,” Time (March 4, 2013), 36.
27.
Ibid, 34.
28.
Finding of the University of North Carolina Health Research Program.
29.
Brill, Bitter Pill, 31 has listed 10 of the largest, most profitable non-profit hospitals. Recall that the top one achieved an operating budget of $769,706,094 and paid its CEO $5,975,462.
30.
Marty Makary, Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care (New York: Bloomsbury Press, 2012), 132.
31.
Ibid, 134.
32.
Ibid, 131.
33.
Ibid, 130–131.
34.
Ibid, 130.
35.
Brill, Bitter Pill, 54–55. Brill has also suggested taxing hospitals including salaries of CEOs. Readers may wish to consult a number of his suggestions and his rationale for them.
36.
For a brief description of the successful business model of Market Basket, see Dave Solomon , “Market Basket Protest: A Year Later,” New Hampshire Sunday News, July 5, 2015, vol. 69, No 39, pages A1 and A4.
37.
Brill, Bitter Pill, 54.
38.
Robert Frost , “A Masque of Mercy .” In the Poetry of Robert Frost: the Collected Poems, Complete and Unabridged, Edward Connery Latham, ed. (New York: Holt, Rinehart and Winston, 1979), 521.
39.
Abramson Overdosed America, 241.
40.
Ibid.
41.
Brill , Bitter Pill, 24.
42.
H. Gilbert Welch , Lisa M. Schwartz, and Steven Wotoshin, Overdiagnosed: Making People Sick in the Pursuit of Health (Boston, MA: Beacon Press Books, 2011), 161.
43.
Ibid, 163.
44.
Ibid, Assuming a 30 percent reduction in malpractice insurance premiums would yield an 0.4 percent decrease in total health care costs.
45.
Michelle M. Mello, Amitabh Chandra, Atul A. Gawande, and David M. Studdert, “National Costs of the Medical Liability System,” Health Affairs 29:9, September 2010, 1585–1592.
46.
Emily R. Carrier James D. Reschovsky Michelle M. Mello, Ralph C. Mayrell, and David Katz, “Physicians’ Fears of Malpractice Are Not Assuaged by Tort Reforms,” Health Affairs, 29:9, September 2010, 1585–1592.
47.
Ibid, 1591.
48.
Hadler, Citizen Patient, 116.
49.
Ibid, 117–118. Type I Medical Malpractice for Hadler refers to cases of untoward results from necessary medical interventions: Type II refers to unnecessary interventions that Hadler would like to include in considerations of malpractice.
50.
See ibid., 92–93 for Hadler’s explanation and discussion of the Supreme Court’s decision and the “Daubert Rule.”
51.
Mary Ann Glendon , A Nation Under Lawyers: the Impoverishment of Political Discourse (New York: the Free Press, 1991).
52.
Abramson , Overdosed America, 111.
53.
Welch , Overdiagnosed, 182,
54.
Ibid, 190.
55.
Ibid. On page 23 the millions and increasing millions who are made sick is documented in Table 2.1.
56.
Ibid, 16–17.
57.
Abramson, Overdosed America, 237–239. See also R. Estruch, E. Ross, J. Solas Savado, et alia, “Primary prevention of cardiovascular disease with Mediterranean diet ,” New England Journal of Medicine, 2013:308 (14), 1279–1290.
58.
For that documentation, see Frances , Saving Normal, 103–106 and 77–113.
59.
Ibid, 222.
60.
Ibid, 157.
61.
Ibid, 108.
62.
Ibid.
63.
Abramson , Overdosed America, 232–233.
64.
Ibid.
65.
Frances, Saving Normal, 74. For a full discussion of these issues, see pages 170–192.
66.
Hadler, Citizen Patient, 5.
67.
Ibid, 8.
68.
Ibid.
69.
Ibid, 7.
70.
Frances, Saving Normal, 212–213.
71.
Abramson, Overdosed America, 105–106.
72.
Ibid, 106–107.
73.
Ibid, 108–109. There are physicians who do not accept funding from drug and medical device companies at all. See Marty Makary Unaccountable, 139.
74.
C.P. Landrigan, “Temporal Trends in Rates of Patient Harm Resulting from Medical Care,” New England Journal of Medicine, 363, no. 22, 2010, 2124–34.
75.
Committee on Quality Health Care in American and Institute of Medicine with eds, L.T. Kohn, J.M. Corrigan, M.S. Donaldson, To Err is Human: Building a Safer Health System (Washington, D.C: National Academy Press, 2000).
76.
Denise Grady, “Four Transplant Recipients Contract HIV,” New York Times, November 13, 2007.
77.
Marty Makary, Unaccountable.
78.
Ibid, 20.
79.
Ibid, 170–172.
80.
Ibid, 23–27.
81.
Ibid, 90–92.
82.
Ibid, 57–74.
83.
Ibid, 181–184.
84.
Halder, Citizen Patient, 5.
85.
Ibid, 222.
86.
Reuters, “Doctors, Nurses Among Hundreds Charged With Defrauding Health Programs,” New Hampshire Union Leader, July 14, 2017, page A8.

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The Divinity School, Harvard University, Cambridge, MA, USA
Arthur J. Dyck

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Dyck, A.J. (2019). Suggesting Policies and Practices for Increasing Justice and Assuring the Sustainability of the U.S. Healthcare System. In: Achieving Justice in the U.S. Healthcare System. Library of Public Policy and Public Administration, vol 13. Springer, Cham. https://doi.org/10.1007/978-3-030-21707-5_7

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DOI: https://doi.org/10.1007/978-3-030-21707-5_7
Published: 06 July 2019
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-21706-8
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