Weekly blog by Dr. Steven Goldstein. Dr. Goldstein is a highly respected Houston based neurologist and the founder of the Houston Healthcare Initiative CO-OP.
Blood plasma covid treatment and pharmaceutical industry reform. On August 23, 2020 the Food and Drug Administration’s announced a decision to grant blood plasma treatment for Coronavirus/Covid-19 patients with a fast-track authorization for its emergency use as a treatment for hospitalized COVID patients. This “emergency use authorization” triggered an outcry from scientists and doctors, who said the decision was not supported by adequate clinical evidence and criticized the FDA for what was perceived as bowing to political pressure.
Big Pharma has a big influence on the congress from multi-million dollar lobbying effort.
News coverage about this potential treatment has done little to clarify whether its useful or not. The idea that there could be a motivation behind the fast track authorization for this potential treatment other than looking for a useful therapeutic is troubling. More to the point, who should decide what patients receive in treatment for their illnesses? To help us make sense of how reforms for the pharmaceutical industry could potentially help separate facts from spin and who we should all listen to is respected neurologist, Dr. Steven Goldstein. Click below to listen.
An association healthcare plan is a method of providing the advantages of a large group health insurance plan enjoyed by larger corporations, the federal government, or state governments for small businesses and individuals. Associations based on a shared profession, a line of business, or even just a geographic location, such as a state or city, can offer group health insurance with the ability to negotiate savings from healthcare providers and pharmacies. Membership in an association health insurance program also provides cost savings for premiums.
Let us suppose that you are the owner of a mom and pop eatery and want to provide your employees some good health insurance, but the number of people who work for you does not rise above the threshold of a large group as defined by your state’s regulator. In that instance, a restaurant association might offer a health insurance plan for its members, with the number of premium-paying members easily being above the cutoff line of a large group, thus qualifying for savings.
If you happen to be self-employed or a freelancer, the same idea applies. Say an association of everything from accountants to freelance writers or musicians can offer an association healthcare plan, rendering tremendous savings over individual health plans.
Individual health insurance plans in the United States are very expensive and have such huge deductibles that often having such a plan is the equivalent of not having one, despite the member paying huge premiums. Association healthcare plans provide an alternative to paying through the nose for health insurance or doing without it for people who don’t work for large employers.
Health insurance reform has been a contentious political issue in the United States for decades. Association healthcare plans, in the view of many, provide at least part of an answer to getting more people affordable insurance.
Dr. Steven Goldstein has ideas that will make the pharmaceutical industry more responsive to the American public.
The Reforms Big Pharmaceutical Companies Need. On his regular podcast, Dr. Steven Goldstein advocated dramatic reforms for the pharmaceutical industry and with good reason. To hear the podcast go to: SoundCloud, iHeartRadio, Stitcher, Backtracks, LibSyn, or the website at www.houstonhealthcareinitiative.org. Dr. Goldstein insists that for the health and welfare of the American public, the congress must pass reforms that limit the influence of the pharmaceutical industry and its lobby.
What Has To Change – Ban Pharmaceutical Lobbying
“Corporate lobbying by pharmaceutical companies should be illegal,” Dr. Goldstein told his audience. “It isn’t right.” The companies who make more expensive treatments for ailments that could be treated with generic medicines spend millions of dollars lobbying the congress. According to a study by Brigham Young University, the health sector lobby’s spending increased more than 10% in the first quarter of 2020 while the non-health lobby sector increased 1%. Meanwhile, the number of new lobbyists registered in the health sector increased a staggering 140% while non-health sector registrations increased 63%.
Patent Reform
Drug companies should not be permitted to obtain patents because of small modifications to already existing patented medication. “That is not what the spirit of patent protection was meant for,” Dr. Goldstein said. He also advocates that existing antitrust laws be enforced to stop price fixing. “An example is the predatory practice of larger drug companies paying off small generic manufacturers in order to eliminate competition,” Dr. Goldstein said.
Prescription Reform; Physicians Prescribe Not Pharmacists or Bureaucrats
Physicians should be free to prescribe drugs “off-label” without fear of lawsuit or sanctions from state or federal regulatory boards. “Full stop, no questions from non-physicians, pharmacists or government regulators,” Dr. Goldstein stated.
FDA Reform
The Food and Drug Administration (FDA) is charged with making sure drugs are “safe and effective”. “If you think about it, there is no such thing as a drug that is 100% safe or 100% effective,” Dr. Goldstein said. “Even aspirin can cause gastritis and intestinal bleeding that in rare instances can cause death. Drugs used to treat epilepsy are only about 50% effective. How then does the FDA decide what drugs to approve? After randomized controlled trials are performed, a panel of “experts” decides which drugs to approve.”
About Houston Healthcare Initiative and Dr. Steven Goldstein
Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America. The Reforms Big Pharmaceutical Companies Need.
Retracted Article Mischaracterizes Hydroxychloroquine. No one can un-ring a bell. No article can be ‘un-read’ or any eventual retraction definitely seen and understood. There are few more illustrative examples lately than when respected medical journals published information about the use of Hydroxychloroquine as a possible treatment for the Coronavirus/Covid-19 virus they later retracted.
Large French Real World Observational Study Reveals Hydroxychloroquine Azithromycin-Associated with Reduction in Hospitalization-Death for COVID 19 Patients.
On his podcast, respected, Houston based neurologist Dr. Steven Goldstein describes how the well-established, inexpensive drug Hydroxychloroquine was mischaracterized. To listen to the podcast please visit: SoundCloud, Libsyn,iHeart, and the Houston Healthcare Initiative web site.
Article Retracted But Damage Done
Early in the pandemic, Hydroxychloroquine looked like it could be a possible treatment for Coronavirus/Covid-19 ,but use of and studies about the drug quickly lost favor after articles in the Lancet and New England Journal of Medicinecast doubt. The later retracted study and reporting about it had an immediate impact. The World Health Organization (WHO) stopped their research into hydroxychloroquine. Multiple news web sites carried the message that Hydroxychloroquine was not effective, citing the New England Journal of Medicine as its source. One example was from the NBC News web site read, “Hydroxychloroquine fails to prevent COVID-19, large study finds.”
Damage Done
While the articles were retracted the information originally published, could not be ‘unseen.’ “The news media touted these articles, that falsely claimed there was no evidence that treatment with Hydroxychloroquine was effective,” Dr. Goldstein told his listeners. “A French study published March 20, 2020 suggested the drug helped people with coronavirus, reporting it “is significantly associated with viral load reduction/disappearance in patients with COVID-19.”
The article and its author, French physician and scientist, Dr. Didier Raoult, who authored papers showing favorable results, were personally and professionally attacked (The New York Times) among others. Suffice to say that way more people saw and continue to see these refuted articles, even though they were retracted. But the harm from them remains.
About The Houston Healthcare Initiative
Houston Healthcare Initiative is a group of physicians and health conscious patients that have joined together in a Healthcare cooperative to maintain and improve the physical and mental health of each member of the group. Visit online at https://houstonhealthcareinitiative.org.
June 25, 2020 N Engl J Med 2020; 382:2582. DOI: 10.1056/NEJMc2021225
“Retraction—Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis.” Published: June 05, 2020.
“He Was a Science Star. Then He Promoted a Questionable Cure for Covid-19.” The New York Times By Scott Sayare. Published May 12, 2020 Updated May 21, 2020
“French Doctor Leads Charge for Treating Coronavirus With Antimalarial Drug”
Health authorities say evidence is inconclusive that the treatment, which President Trump has backed, is effective. By Nick Kostov and David Gauthier-Villars
When discussing the “right” to adequate healthcare, it’s beneficial to first define what sort of right that is. Generally speaking, there are two possibilities: civil rights, or human rights. Civil rights are those granted to all legal members of a certain political state, while human rights are those which can be expected simply by virtue of being alive. The right to vote in an American election, for instance, is a civil right provided to all American citizens. The right not to be murdered, however, is a human right, of which we should all (ideally) have a reasonable expectation.
Healthcare, in our current system, is not a civil right. That is an objective fact, as defined by our Constitution and the legislation currently in place. The question, then, is whether healthcare is a human right. Should all human beings expect that their physical and mental well-being will be provided for? That certainly hasn’t been the case over our evolutionary history. But need we constrain ourselves to that history? It could be argued that the right not to be murdered, almost universally accepted now, was a fairly recent addition to the list of human rights. Other rights that most of us take for granted, including the rights not to be raped, beaten, or enslaved, have only taken hold in last couple of centuries. It’s clear, then, that human rights need not be restricted to those that were inherent to our species 300,000 years ago. Which is good, as such ideas almost certainly didn’t exist at the time.
Our evolution as a species has been both physical and cultural, and there’s no reason that it shouldn’t continue to be so. Amongst all the species on the planet, we’re uniquely suited to choose how we should evolve. At some point, we determined that murder was wrong. We then determined that theft was wrong. Rape, assault, slavery…the list continues. Throughout our history, we’ve shown an ability to come together as a society and decide that certain acts are wrong, and that protection from those acts should be expected by every member of our species, regardless of gender, race, religion, or nationality. In a time of unprecedented abundance, with the power of decades of exponential scientific progress, it seems only reasonable that we add protection from sickness and disease to that list. Having thus defined this human right, what choice would any advanced society have but to make it a civil right, as well?
In the Coronavirus/Covid-19 Pandemic Age Come Ideas for Drug Price Reform
In the coronavirus/covid-19 pandemic age drug reform is topical.
According to Dr. Steven Goldstein on his podcast, “without meaningful modification, drug prices and pressure on patient’s ability to pay and manufacturers resources for discovery will reach a tipping point.” Dr. Steven Goldstein lists the reasons for the discrepancy and how the U.S. could reform the laws that govern the ways therapeutic medicine gets from the lab bench all the way to the patient for whom it is intended.
Some of these include:
Reform drug patent law. The patent system for drugs needs to be reformed so that drug development costs can be recouped along with a profit. Once this occurs, the patent should expire.
Streamline approval. The FDA needs reform so that drug authorizations are more efficient. Possibly, an international FDA funded by a consortium of countries could approve drugs.
Eliminate monetary incentives from drug companies for writing prescriptions.
Drug discounts to insurance companies and Medicare should be illegal.
Enforce the laws already passed. Antitrust laws for price collusion need to be enforced.
In the coronavirus/covid-19 pandemic age drug reform is topical. For U.S. drug prices to be affordable and provide enough resources for continued research serious reform is needed.
Many people in the United States accumulate thousands of dollars of medical debt. According to CNBC.com, 137 million Americans struggle with medical bills with 66.5% leading to personal bankruptcy. One of the reasons for medical debt is the lack of transparency of between the consumer and the insurance companies. As stated by Conversation.com, insurance companies control procedure prices, length of hospital stay, home medical care, and the prices of medical items that a patient might need. In order for the consumer to assess the “correct” price of the product, Americans must jump from insurance plan to insurance plan. Most Americans do not have that luxury due to their occupation and their current financial standing.
The Patient Protection and Affordable Care Act (or Obamacare) attempted Universal Healthcare by penalizing those who don’t have insurance. The problem with Obamacare is that the plan assumes that Americans simply choose not to have healthcare, not because of financial standing. The penalty for not obtaining insurance is $695 per adult or 2.5% of household income. However, despite the high cost of the penalty, Obamacare packages still cost more than the penalty. Many Americans choose to pay the penalty over the healthcare packages because having no insurance is still cheaper than having insurance. Therefore, Americans do not reap the reward of any medical insurance despite paying money.
Proposed Healthcare Solutions
A solution to combat rising medical cost is to treat healthcare pricing like a shopping cart. Healthcare Bluebook encourages consumers to analyze healthcare providers and procedures by comparing prices in the consumer’s local area. They call price transparency- “fair price”, which means the normal cost of the procedure in today’s economic environment. The issue, with this site, is that the company doesn’t take into account medical insurance. Many of the “cheap” procedures require the consumer to pay out-of-pocket before the procedure.
Starting January 2021, the Trump administration will require that healthcare providers show their prices so that Americans can pick their providers and procedures like an object in a grocery store. Healthcare providers will then be subjected to the free market, where prices change due to supply and demand. The projected downfall of medical debt is still yet to be researched.
The concept of healthcare policies is like a complicated spider web. Americans must research the problem with medical insurance and vote accordingly in the next election.
Contact us for more information on healthcare pricing transparency and cutting American medical debt.
Even those with private, employer funded health insurance gasp at the price of some prescription medications. Learning that the same medicine is available north of the border at a substantially reduced price often produces other emotional reactions from surprise to anger. There are plenty of reasons those drugs are priced differently.
Why Are Prescription Drugs Cheaper in Canada? Prices in Canada are lower because the Canadian government regulates the price.
Listeners to the Houston Healthcare Initiative podcast will learn why as respected neurologist Dr. Steven Goldstein explains how the combination of foreign government requirements and U.S. government non-regulation combined to give the American public sticker shock at the drug store.
In short, drug prices in Canada are lower because the Canadian government regulates the price. In Canada, a review board decides on pricing and what they believe are reasonable or excessive prices. If they decide a drug is priced too high, they will not allow it on the drug formulary. This board, the Patented Medicine Prices Review Board, is described in Canada as a quasi-judicial agency.
Before a prescription drug can be sold in Canada it is scientifically reviewed to make certain that it can do what it is supposed to do. A committee of experts known as the Human Drug Advisory Panel will make recommendations about other valid drugs on which to make comparison, in addition to recommendations for the categorization of new drugs. The level of therapeutic improvement of an existing patented drug is used to determine a ceiling price, known as the Maximum Average Potential Price, at its introduction.
U.S. Prices Set by Industry
The U.S. government is prohibited by law from negotiating prices for Medicare and other government programs. “Obviously, the drug company needs to recoup the cost of research, manufacture, advertising and the cost of getting the drug approved by the FDA,” Dr. Goldstein told his listeners. “The people in this country essentially pay for all of this work as countries like Canada do not allow their citizens to share the cost.” New drugs are issued a patent giving the drug company a monopoly on sale of the drug for 20 years. The drug company is free to set whatever price it likes for prescription drugs. Prices are then negotiated between insurance companies and the manufacturers.
Needed Drug Price Reforms
The U.S. and Canadian systems each present two very different models for drug pricing, neither of which is reasonable. The Canadian system does not allow enough incentive for new drugs to be created. The American system results in unaffordable prices. “There are several needed reforms,” Dr. Goldstein said. “We are not able to flip a switch and adopt the prices charged in Canada, though that would be nice.”
The reforms Dr. Goldstein recommends are:
Reform drug patent law. The patent system for drugs needs to be reformed so that drug development costs can be recouped along with a profit. Once this occurs, the patent should expire.
Streamline approval. The FDA needs reform so that drug authorizations are more efficient. Possibly, an international FDA funded by a consortium of countries could approve drugs.
Eliminate monetary incentives for writing prescriptions.
Drug discounts to insurance companies and Medicare should be illegal.
Enforce the laws already passed. Antitrust laws for price collusion need to be enforced.
“If these reforms were enacted, prices for drugs would be determined more by supply and demand,” Dr. Goldstein said. “This would ensure an adequate supply at the lowest price. For high priced drugs of marginal benefit, demand would be low and would tend to cause the price to drop. For new orphan drugs, the government could provide subsidies.”
About Houston Healthcare Initiative
Houston Healthcare Initiative (HHI) was founded by Dr. Steven Goldstein. Like many Americans, Dr. Goldstein is concerned about the state of the U.S healthcare system as well as the sorry state of the public’s health. The Houston Healthcare Initiative web site is an aggregator of news, healthcare pricing information, and resources for those who want to help drive reform for the healthcare industry. HHI’s emphasis for reform is on free market innovation and personal responsibility.
Patients Can Save Money When They Pay Their Doctor In Cash
Even patients who have their own health insurance can often save themselves money by paying cash. The Houston Healthcare Initiative website (www.houstonhealthcareinitiative.org) now has a page that lists seventy-eight separate medical services that will accept cash payments. The number expands almost daily as independent providers look for ways to compete with the large conglomerates that provide most of the care here in the U.S. and provide more and better service to their patients. To go directly to the “Healthcare Pricing” page click here: https://houstonhealthcareinitiative.org/pricing.
There is no charge to visit the site, nor is there any fee to those who want to list their practice or
Save money when paying cash, even when patients have their own health insurance.
facility.
Direct Payments Are Counter Intuitive
How could a patients’ direct payments be more affordable than those from their health insurance? “People who have health insurance assume that the insured price is always better than the cash price, but that is not always the case,” said neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein. This has to do with meeting deductibles that are now higher than in years past. “Businesses who provide their employees with health insurance often require them to bare more of the cost in the form of higher deductibles, paying thousands of dollars on their healthcare before they can make a claim.” It is for these people and families that direct payments for service, on the day provided, makes sense.
But Do Not Go Without
Of course, this is not always the case nor is it a good reason to completely forgo health insurance. “Health insurance can protect people from high fees associated with serious long-term illnesses and accidents that could potentially bankrupt them,” Dr. Goldstein said. “But if someone has a high deductible and wants to save, this is a reasonable alternative that is at least worth investigation.”
Good For Doctors Too?
It is costly and labor intensive to administer health insurance. Healthcare providers benefit from accepting cash because of lower administrative and collection costs. “The labor required to file claims, negotiate with the insurance company and wait for payment, chase down their compensation from the insurance company or the patient saves the office manager a lot of time and hassle,” Dr. Goldstein said. “So much so that providers can pass that savings on to those who can pay cash.”
Potential Downside
The biggest potential negative for those who want to pay in cash is that often those payments will not count toward a deductible. All insurance companies have different rules for out of pocket payments and where the cap is for them. It is a good idea for those with such policies to investigate what the requirements and restrictions are in advance. Cash payment makes more sense for someone with a deductible not met or high enough that it likely will not be reached anytime in the same calendar year (deductibles reset annually). The insurance company web site or employer administrator will be able to answer these questions. “There is no substitute for knowing what a policy will or will not allow,” Dr. Goldstein said. “Before making a decision make sure it is informed.”
About Houston Healthcare Initiative
The Houston Healthcare Initiative web site is an aggregator of health news, healthcare pricing information, and resources for those who want to help drive reform for the healthcare industry. HHI’s emphasis for reform is on free market innovation and personal responsibility.
You have probably heard the term “healthcare provider” being used by insurance companies or on television. It is a broad term that may leave you wondering what a healthcare provider is.
Who Is A Healthcare Provider?
A healthcare provider is a professional or a company that provides you with care. Providers are dedicated to making sure patients are healthy. There are different kinds of providers. One of the more common ones you may meet is a primary care physician. Healthcare providers are divided into six groups:
Doctors are the primary care providers in the medical field. They can be general practitioners that treat the flu and make first-level diagnosis. Many doctors specialize in a specific field, such as a cardiologist or a dentist.
Nurses are often associated with hospitals, but there can also be registered nurses at a doctor’s office. Nurses constantly work with patients directly and help with their recovery. They pass patient information to the doctor.
Pharmacists study chemicals and medicines and are aware of their side effects. They provide you with medicine that has been prescribed by your doctor. They also advise about over-the-counter medicine.
An Administrative staff plays an important part in a doctor’s office or a hospital. They manage appointments, patient information, and insurance information.
Technicians are the ones who work in labs. They test blood or urine to analyze what is going on in the patient’s body. Some are responsible for taking x-rays.
Therapists work on helping patients recover from an injury or illness. They may work on physical areas such as walking or coordination. Three main types of therapists are physical therapists, occupational therapists, and speech therapists.
Provider Networks
Healthcare providers are a part of a provider network. This means that they offer services that are partially or completely covered by your healthcare plan. Not every provider will accept certain insurance companies. It is important to find an in-network provider if possible.
The Houston Healthcare Initiative provides information and tools regarding physical and mental health. To learn more, visit our site and contact us today.
