[CONTENT NOTE: misogyny, torture, extreme hostility to pregnant people.]
Rewire has a new piece by Amy Littlefield that details the unconscionable withholding of medical care from patients in Catholic hospitals.
AUSTIN, Texas (AP) — Lawmakers in Texas largely failed to take any significant action to address the state’s skyrocketing rate of pregnancy-related deaths just months after researchers found it to be the highest in not only the U.S., but the developed world.
Conservatives are pro-life, everyone. FYI.
Remember all those years ago when we laughed and laughed at the mooks carrying protest signs saying “keep government out of my Medicare”? I know I sure do!
Good times! But it turns out that we had them all wrong. The Tea Party is made up of psychic geniuses.
(Part 1 is here.)
[CONTENT NOTE: While this post contains no graphic descriptions or images of violence, it does contain discussion of: child sexual assault, abuse and death; suicide; hostility to consent, bodily autonomy and agency; homophobia; sex- and gender-based discrimination.]
Just a reminder: in the intro to Part 1, I noted that while atheist Big Willie Dr. Coyne may communicate some very useful and interesting things in this lecture (and elsewhere) that readers here may find worthwhile, he is exasperatingly prone to poo flinging, and I fully respect the decision of anyone who decides to pay him no attention whatsoever on this basis alone. As I said, FWIW I do not allow Coyne’s poo flinging in the remaining portions of the transcript to go unrebutted.
In February Jerry Coyne delivered the British Humanist Association’s annual Darwin Day Lecture in London. For those unfamiliar, Coyne is an evolutionary biologist, a professor emeritus at the University of Chicago, and the author of Why Evolution is True (which I have read) and Faith vs Fact (which I have not). He is a fierce critic of creationism and a fiery proponent of atheism; he blogs prolifically about these and other topics at Why Evolution Is True.
I genuinely like Jerry Coyne. He comes across as knowledgeable and affable, the kind of person I’d really enjoy sitting next to at a dinner party. Of course that doesn’t mean I agree with him all of the time, and in fact his annoying propensity to shit all over straw feminists is fucking exasperating (more on that in Part 2), as is his comical obliviousness to his own privilege (more on that later too).
But hey, nobody’s perfect. We can all decide for ourselves who we will expose ourselves to, on which topic(s) and under what circumstances. For example, Richard Dawkins is dead to me, barring his (highly unlikely) resurrection into a state of semi-self-awareness minimally capable of basic human decency and rationality. On the other hand, when a good friend recommends Jerry Coyne’s Darwin Day Lecture to me, I might be inclined to put on my (metaphorical) biohazard suit so as not to get splattered with (metaphorical) shit, and check it out. Those with less privilege are always making such calls: suit up and wade into the muck, or maybe sit this one out. Otherwise we would consistently miss out on some interesting and useful knowledge, and worse, we would hardly ever go to any dinner parties at all.
I get the Spidey-Sense that anyone reading this who is in some marginalized group(s)—i.e., not white, male, straight, cis-, able, etc.—is nodding along with me, because microaggressions are A Thing to which those privileged along these axes tend to remain haplessly oblivious. So I completely respect your making a different call about paying any attention whatsoever to Coyne (or Dawkins or anyone else).
there is a growing body of evidence that suggests that a robust welfare state (especially quality universal single-payer health care) decreases religiosity, while economic insecurity (with respect to wages, housing, food, etc.) increases it. See, e.g., Phil Zuckerman’s book “Society Without God.” Fiscal conservatism in the form of [American Atheists president] Dave Silverman’s “small government, low taxes, a free market” is entirely antithetical to taking the path most likely to get us to the very outcome he seeks: the death of religion.
I transcribed portions of Coyne’s lecture because I think readers may be genuinely infotained by it, but mainly because I’d like to have an easy link to it in order to help shut down the font of incoherent nonsense that is conservative movement atheism. In case it helps you decide whether to continue reading: I do not allow Coyne’s aforementioned (metaphorical) poo flinging in these portions of the transcript to stand unrebutted, and in any case no poo is flung in Part 1.
TRIGGER WARNING: Jerry Coyne.
(especially Part 2.)
[CONTENT NOTE: descriptions of anti-gay violence and horrific injuries; no graphic images here, but there are at the Washington Post and Go Fund Me links.]
Via my brilliant, brave and amazing friend Niki (who has a fantastic new blog at The Orbit that you should definitely check out) comes a story so fucking sad and enraging I am having tremendous difficulty writing about it. I’m shaking while I type. Also, my screen looks very blurry—there must be a lot of dust up in here.
A month ago, [Marquez] Tolbert, 21, and his boyfriend Anthony Gooden Jr., 23, were jolted out of sleep by the feeling of boiling water splashing across their torsos, faces and limbs. Gooden’s mother’s boyfriend, Martin Blackwell, stood over them, pouring the water, they say.
For a moment, Tolbert had no idea what could have provoked the alleged attack. Then Blackwell allegedly yanked him off the mattress and yelled, “Get out of my house with all that gay,” Tolbert recalled to WSBTV.
It was not Blackwell’s apartment. He didn’t even live there.
According to an incident report from the College Park Police Department, Blackwell told police that he was angry at the sight of the two men together.
“They were stuck together like two hot dogs … so I poured a little hot water on them and help them out,” he said to police, according to the incident report. “… They’ll be alright. It was just a little hot water.”
No, you monstrous fucking asshole, this was not “a little hot water” and no, these men will never be all right.
Now, Tolbert and Gooden are in the agonizing process of recovering from their second and third degree burns. Tolbert spent 10 days in the hospital undergoing surgery to repair the skin on his back. Gooden was hospitalized for five weeks, according to Project Q Atlanta.
[Tolbert] must now wear compression garments 23 hours a day for the next two years…and is attending weekly counseling and physical therapy sessions to deal with his emotional and physical scars. It’s difficult for him to go outside, because sunlight exacerbates the pain of his burns.
He told WSBTV “The pain doesn’t let you sleep. It’s excruciating, 24 hours a day. It doesn’t go anywhere, it doesn’t dial down. It’s just there.”
Gooden, who was burned even more severely, was in a medically-induced coma for several weeks…more than 60 percent of his body was burned, and he had to undergo skin graft surgery to repair damage to his face, neck, back, arms, chest and head.
Does that sound “all right” to you?
Recovery from second and third degree burns is a very long, difficult, painful (both physically and emotionally), expensive journey. There are Go Fund Me accounts set up for both of these men (REMINDER: graphic images of the men’s injuries at these links). Please, please donate whatever you can afford to give, and/or share this story far and wide.
I can only formulate two observations at the moment.
First, just yesterday, before I heard this story, I was commiserating with PZ over at Pharyngula that yes indeed, people really suck.
PZ nails exactly why I cannot identify as a humanist. Humans as a species are fucking terrible. Call it misanthropy, call it whatever you want, but I see it as an observable, evidence-based fact. And I don’t assume intentional malice to conclude this.
That said, I love and care deeply about many, many actual humans. And this may sound…odd? But giving up hope for us as a species has actually been liberating for me in a positive way. It helped me prioritize finding and spreading joy in the here-and-now, and doing what I can to ease the suffering of sentient beings while I’m alive. (Ironically, such efforts can have the side effect of giving other people hope.)
IOW, Martin Blackwell is Exhibit No. 7,409,586,791 in support of the motion that humans are truly fucking terrible.
The second thing is that Anthony Gooden Jr. and Marquez Tolbert are Exhibit Nos. 9,147,452,372,921 and 9,147,452,372,922, respectively, in support of the motion that the United States needs single payer healthcare RIGHT FUCKING NOW GODDAMMIT THE END. (Yes I’m glaring at you, Hillary Clinton.)
Just the other day, Oklahoma officials ordered a $235 million cut to state agencies in the wake of their second epic revenue failure. Apparently, Governor Mary Fallin and her merry band of conservative shitweasels in the state legislature passed into law a bunch of exemptions and tax cuts for Oklahoma’s richest people, thereby blowing a billion dollar hole in the budget. Now, of course, it’s time to replace those funds by (a) increasing taxes on middle- and lower-income people, and (by) defunding essential services, especially poor and rural communities. Always remember people, that whenever conservative policies fail (i.e. always), that can only mean one thing: we need more of them. THAT’S HOW LOGIC WORKS.
How bad is it? Well,
“Our schoolchildren are the ones who will pay the steepest price,” said Superintendent of Public Instruction Joy Hofmeister. She said the cuts will force many school districts in rural areas to go to a four-day school week and consider “heartbreaking decisions” that will affect students in the classroom.
Already the Republican-controlled Legislature has diverted millions of dollars previously earmarked for new textbooks and other educational materials to school operating expenses; as a result, many schools are using tattered textbooks that are as much as 10 years old and held intact with tape. In addition, class sizes have increased dramatically because of a chronic teacher shortage in Oklahoma while enrollment has grown by 51,000 students over the past eight years, and schools have been burdened with myriad mandates, [House Minority Leader Scott] Inman related.
To make the education funding crisis even worse, the governor endorsed education vouchers, which would “siphon off” public funds from public schools and reroute it to private schools.
In addition to her voucher plan, the governor suggested closure of more than 100 of Oklahoma’s rural schools…
What about health care?
The Oklahoma Health Care Authority [OHCA], for example, has had its budget cut by $446 million in the past five years and has reduced provider rates. These cuts have a ripple effect across the state “as they impact providers, especially in areas where the majority of the population is Medicaid-eligible, and they jeopardize rural hospitals that are at risk of bankruptcy,” Inman said.
The OHCA administers health care programs for more than 800,000 Oklahomans, including more than half a million children.
Rep. Earl Sears, chairman of the powerful House Appropriations and Budget Committee said “We’re just all going to have to weather that storm.” Some people more than others.
Meanwhile, just yesterday:
Any physician who performs an abortion would be unable to obtain a license to practice medicine in Oklahoma under a measure the state Senate approved overwhelmingly Tuesday over the objection of some Democrats who insisted the measure is unconstitutional.
The bill directs Oklahoma medical licensure officials not to renew or grant a license to any physician who performs an abortion. It also provides that any doctor who has performed an abortion can be prohibited from obtaining a medical license.
Senate Democratic Leader John Sparks said of SB 1552, “It will be defeated in the courts at a cost to Oklahoma, and it will have no impact, other than political.” Of course its impact is strictly political, Senator Sparks—that’s the entire point of the exercise. Sparks was able to amend the bill to require disclosure of the cost of defending a blatantly unconstitutional law in court. And it won’t be the first time Oklahoma lawmakers have racked up that taxpayer tab:
A New York abortion rights group has filed seven legal challenges in the last five years to various anti-abortion laws passed by the Oklahoma Legislature, and most of those laws have been overturned by the courts. Some legal challenges are still pending.
GO NEW YORK! Also: behold fiscally responsible conservatives!
Sounds like the scene at the Oklahoma Senate was quite a spectacle, too. Some Forced Birther named John Reasnor was urging the senators to make it a felony to perform an abortion, which he defended by saying “I think it’s a Christian obligation to seek out mercy for the least of us.”
He seems nice. And very concerned about women, too, whose lives surely do not merit anywhere near as much mercy as “the least of us.” A Christian and a gentleman!
The sponsor of SB 1552, Republican Sen. Nathan Dahm, was applauded by all the Forced Birthers packing the gallery when he said the intent of the bill was to “protect the life of the unborn,” and that “I think this is one of the core functions of government.”
But not education or healthcare, obviously. Those need to be privatized, because Jeezus. Or something.
Please welcome to the Abattoir 40 Oklahoma state senators. We have unlicensed physicians on hand to perform all of their involuntary organ extractions. Or they can opt to DIY instead, with whatever’s at hand. Allow us to suggest a coat hanger, senators.
Tired of what she considers the government inserting itself into women’s private lives, a Kentucky lawmaker has decided to return the favor.
Rep. Mary Lou Marzian, a Louisville Democrat, has introduced a bill that would force men who want to use erectile dysfunction drugs to jump through a series of humiliating hoops beforehand, such as visiting a doctor twice and getting notes from their wives.
“I want to protect these men from themselves,” Marzian, who is a nurse, told the Courier-Journal.
“This is about family values,” she added.
“We are very ‘family values’ in the Kentucky General Assembly — they are all awash in Christian family values, so that’s why I put that part in there that [erectile pills] can only be used in a marital relationship,” she said.
Mazian’s House Bill 396 also requires any man seeking ED drugs to “make a sworn statement with his hand on a Bible that he will only use a prescription for a drug for erectile dysfunction when having sexual relations with his current spouse.”
The bill is Marzian’s response to a new law signed last week by Kentucky Gov. Matt Bevin (R) requiring abortion seekers to participate in two separate consultations with doctors, 24 hours apart, before being permitted access to the safe, legal, medical procedure they want. Hilariously dubbed the “informed consent” bill—because apparently, Kentuckians keep showing up at abortion clinics without truly understanding that they (a) are pregnant, and (b) do not wish to be—this degrading little ditty passed in January, on a vote of 92-3.
Marzian knows her bill is a non-starter, but that is precisely the point: it is just as ridiculous, wildly intrusive, condescending and patronizing (matronizing?) as its counterpart.
This is not the first time a legislator has tried a similar tactic in order to force conservatives to empathize with people who are not them; longtime Loyal Readers™ may recall our presentation of the highly coveted Major Award for Protector of Men’s Health of the Day to Ohio state senator Nina Turner in 2012; South Carolina state Rep. Mia McLeod introduced similar legislation last December, saying “I purposely tried to make it as invasive, as intrusive, as hypocritical and unnecessary as possible to make the point.”
Still, I think we need more of Marzian’s approach, not less, and I like the way she talks about it:
“I have found that men are very touchy about their sexual lives, and they think that is very personal”, Marzian said.
“I started thinking, ‘How would this body of men feel if the government was injecting [itself] into their private medical decisions,’” she added.
“My point is to illustrate how intrusive and ridiculous it is for elected officials to be inserting themselves into private and personal medical decisions,” Marzian said by telephone.
She also said she intends to put forth “a bill that would require gun buyers to get counseling from victims of gun violence,” 24 hours before purchasing a firearm. “I’m just making sure the government is taking care of your safety,” Marzian said.
WHEREFORE, the Palace is pleased to present its highly coveted Major Award for Protector of Traditional Family Values of the Day to Kentucky State.
Congratulations, Rep. Marzian. Long may you mock.
In related news, Gov. Matt Bevin plus 92 Kentucky legislators are now residing in the Palace Abattoir. Of course we will force each of them to consult with their personal organ extraction surgeon twice, 24 hours apart, to make sure they are well informed before we begin harvesting their organs.
[CONTENT NOTE: harassment.]
This really should require no further explanation whatsoever. But since I’m snowed in because of a motherfucker of a blizzard, and my WIFI still seems to be working (so far…), I think I’ll spend a few minutes expounding upon “No.”
Anti-abortion activists should not be allowed to harass preschoolers.
Anti-abortion activists should not be allowed to harass anyone, and no one should be allowed to harass preschoolers.
No one should be allowed to harass anyone.
Jeezus, those winds are howling, and the view from my window is a complete whiteout:
LIVE! FROM NEW YORK! IT’S…WINTER STORM JONAS!
I have a nice hot pot of coffee and a temporarily content kitty (is there any other kind?) so…hey, what the hell?
A new Planned Parenthood clinic is currently under construction in Northeast DC, right next door to a school.
Over the past several months activists opposed to the clinic’s construction have been “purposely and aggressively menacing” school children as young as 3 years old with graphic images and language, causing “severe emotional stress,” according to a lawsuit filed in DC Superior Court by the school in December. Teachers have had to keep students inside at recess, and…with a larger crowd and a number of prominent antiabortion figures expected on account of the annual March for Life [sic], administrators decided to cancel school altogether.
The school closure cost [Bill Harper, parent of a 5- and 7-year-old students] $80 in extra childcare fees, but he was most angry about how the recurring demonstrations have disrupted the day-to-day educational experience for the students. “The whole school is focused on preventing the children from being terrorized. They’ve had to redesign the community,” he said, gesturing to black cloth draped across a fence to hide a playground. He told me that teachers sometimes have to take students on a long detour to reach the gymnasium across the street without encountering protesters. To Harper, they aren’t just a nuisance but a safety concern: One of the defendants named in the lawsuit, Robert Weiler Jr., was previously convicted of plotting to bomb an abortion clinic and shoot doctors in nearby Greenbelt, Maryland.
Why this particular terrorist wasn’t locked up for lifetime is perhaps a subject for another post, but I would be remiss if I did not make a few points about the d00d here.
“From all indications, it appears he was acting alone,” said Gregory K. Gant, the special agent in charge of the ATF’s Baltimore field division.
He’s a white terrorist, you see. And as we all know, white terrorists operate in a cultural void, and in any event they are uniquely impervious to violent rhetoric and ideologies. Also, we must be careful not to implicate a white terrorist’s race, nationality and/or religion in producing such terrorists: he is simply “Lone Wolf” No. 194,801.
Agent Gant also said this:
“In some ways, it could have been a bigger threat because it wasn’t something we were tracking, and we didn’t see it coming.”
Surveillance state: FAIL. While the state is quite keen on deploying counterterrorism tactics to infiltrate and monitor citizens opposed to U.S. economic policy, immigration policy, harmful trade agreements, union-busting, racial profiling, the death penalty, Israeli violence against Palestinians, endless wars, etc., white terrorists operating on US soil just aren’t people law enforcement would ever thinks to track. I mean, gosh, how could anyone possibly ever see anything like this coming?
But I digress. Back to the Forced Birth Bozo Brigades.
The lawsuit describes the protests as a form of coercion, intended to draft parents and administrators into a campaign to block the clinic from opening next door. The antiabortion activists “have promised they will ‘be back every week’ if the students and parents do not take action against the Planned Parenthood health center,” the complaint alleges. Protesters have shouted at children to “Tell your parents they kill kids next door.” In November, an activist named Jonathan Darnel sent an e-mail to school administrators that read, “I am not threatening you. Nevertheless, if you are failing to challenge Planned Parenthood, I feel a moral obligation to alert the community (including the parents of your students) myself…. I’m sure you don’t want to see me, my antiabortion friends and our graphic images any more than we want to be in your neighborhood.”
Defendant Larry Cirignano was at the protest on Thursday, wearing a banana-yellow tie stamped with the words “choose life.” I asked him if he was at all concerned for students who were disturbed by the images and messages he and other demonstrators present to them. “I’m worried more about the kids who are in the pictures,” he responded. “It’s sad that the school and parents didn’t think they should get involved.” Gesturing at the group waiting to hear [Dvideo campaign intended to take down Planned Parenthood] speak, he said, “Most of these people aren’t from around here.” Cirignano said he’s being represented by Mat Staver of Liberty Council, who also represents Kentucky County Clerk Kim Davis.avid Daleiden, the shitweasel behind the recent deceptive
These are just fantastic people: respectful, kind, informed, tolerant, exactly the kind of community exemplars you would definitely want to have around small children.
What to do about it.
As the lawsuit winds its way through the courts, it is worth remembering that the US Supreme court struck down a Massachusetts buffer zone law around women’s clinics—ones that were already open and operating, not construction sites. The justices so ruled from the safety and sanctity of their very own buffer-zone protected place of work.
As I noted at the time, that decision was unanimous—thus rendering the entire Supreme Court as currently constituted not just a bunch of flaming hypocritical @$$holes, but complicit in providing material support to terrorists.
As that’s how the state of affairs stands, I propose a simple strategy of tit-for-tat. To wit: picket the schools where the protesters’ children attend. Hold up giant posters picturing women killed and imprisoned as a result of anti-choicers—most prominently the photo of Geraldine Santoro taken at the scene of her death from a self-abortion attempt.[WARNING: extremely graphic violent image, NSFW.] Shout in the kids’ faces “Your parents want to kill mommies!” “Your parents like killing poor mommies!” “Your parents want to put poor mommies in jail!”
Stop when they stop.
Why no one will do this.
Because it’s fucking horrible, that’s why—even though it is, apparently, legal. Pro-abortion activists like to think of ourselves as better people than our enemies. And of course we are, demonstrably so: you don’t see us going around firebombing right-wing churches and shooting anti-abortion ringleaders, do you? We are certainly “above” directing such reprehensible tactics at innocent children, or frankly at anyone at all.
And therein lies our dilemma. Just think for a moment about what it actually takes for conservatives to change their minds, and not just about this issue but about anything. Global warming, for-profit healthcare, creationism, gun access, immigration, the unbroken record of failure of right-wing economic policy and governance, take your pick. Evidence is not enough. Epic calamities are not enough. Personal calamities are not enough. Experts who know what they’re talking about are not enough. These people cannot be reasoned with, and yet they are winning. There is no denying that their tactics, however reprehensible, are nonetheless effective.
It’s quite the conundrum, no? It certainly leaves me contemplating whether I ought to rethink that “No.”
I hope this edition of Ask Iris has been helpful.
Have a nice day.
Here we have a promoted story from The Washington Post highlighting a recent “scandal,” whereby some douchebro Martin Shkreli, CEO of Turing Pharmaceuticals, raised the price of an off-patent AIDS drug by like 5,000 percent or something, and now the entire Internet hates him. Even all the other drug companies hate him! The Post reports:
The major pharmaceutical and biotech industry groups have portrayed Shkreli’s actions as totally repugnant and the work of just one company, acting alone, with a flippant young chief executive who doesn’t reflect the broader values, practices, or trends of other companies.
Hahaha. Sure. The Post article proceeds to demonstrate that this is rank bullshit:
For example, tetracycline, an antibiotic discovered in 1948, cost 5 cents for a 500 milligram capsule back in November of 2013…Nearly two years later, it’s coming in at $11 a pill — a nearly 2,200 percent increase. Clomipramine, an antidepressant developed in the 1960s used to treat obsessive-compulsive disorder, cost 22 cents per pill in November 2012. Now, it’s $8.17 — a 3,600 percent increase.
In 2010, Amedra Pharmaceuticals bought the rights to abendazole, an off-patent drug used to treat intestinal parasites. At the time, the average wholesale price of the drug was $6 a day. By 2013, it was $120 — a nearly 2,000 percent increase.
These are hardly the only egregious examples the Post could have mentioned: this nifty interactive infographic from Bloomberg charts 74 top-selling drugs for which the cost increased in the US between 2007 and 2014 by at least 75 percent, and sometimes many multiples of that. Why, one might be inclined to wonder what’s going on here with all these skyrocketing drug prices. Alas, the Post only offers: “The trouble is this: right now, we can’t tell why prices are high, or even if they are high.”
IT’S TRULY MYSTIFYING. *shrug*
Oh wait, no. No, it’s not. See, drug prices are not this high everywhere else, or even anywhere else: USians pay from two to six times more than the rest of the world for pharmaceuticals. Why?
Well, the short answer is that US taxpayers and consumers massively subsidize the world’s pharmaceutical research costs. For a more comprehensive answer, anyone (presumably including the bewildered author of the Post piece) can read an in-depth article at Medscape Medical News entitled, appropriately enough, Why Are Drug Costs So High in the United States?
But that is not our forte at the Palace. Here, we will just want to highlight a few perverse and corrupt policies that impact US drug pricing, and what is responsible for them. SPOILER ALERT: it’s conservatism.
Econ 101: desperation vs. demand.
In the mythical world of the Free Market™, buyers and sellers will come to a compromise on the price for goods and services: too high, no one will buy; too low, and sellers will not have viable businesses. This is the storied principle of supply and demand, blah blah blah. But when it comes to health care, the “demand” side of the equation is driven by factors very different from those that drive demand for ordinary consumer goods. We are talking about human suffering, often profound, and sometimes the kind where life and death hangs in the balance. When that suffering human is you—or your child, or indeed anyone you love—you will pay anything for medicine and appropriate care, even if it means you lose everything.
Even post-ACA, health care is still the number one cause of personal bankruptcy in the US:
A recent Harvard University study showed that medical expenses account for approximately 62 percent of personal bankruptcies in the US. Interestingly, the study also showed that 72 percent of those who filed for bankruptcy due to medical expenses had some type of health insurance.
That said, the ACA is having a positive effect on some cost-related trends. For example, in 2012, 80 million people “didn’t visit a doctor or clinic for a medical problem, didn’t fill a prescription, skipped a follow-up, treatment or test, or did not get needed specialist care” because of the cost. Two years later, only 66 million people reported the same. That trend is encouraging, and so is the fact that in 2014 almost 9 million more people had health insurance coverage than in 2013, bringing the total share of uninsured down to 10.4 percent.
Now I really hate to be a Debbie Downer here, but I would be remiss if I did not point out that (a) bankruptcy and poverty are terrible fucking outcomes, (b) 33 million of us still remain uninsured, and (c) the 66 million of us who delayed or denied ourselves health care because we could not afford it is greater than the total population of the UK, where no citizen faces any of these problems for accessing health care. Ever. Nor do all 35,749,600 Canadians.
The ACA is based on a for-profit (read: conservative) health care reform model, one that Mitt Romney rolled out statewide as governor of Massachusetts. It did not slow medical bankruptcies there.
Elsewhere, single-payer and nationalized systems like the UK’s National Health Service (NHS) negotiate a single price with drug manufacturers for the entire country’s supply. By contrast, the US “system,” if one can even call it that, is mainly comprised of multiple for-profit insurance companies and hospital systems, all running countless different programs and plans, each of which negotiates pricing separately. In this scenario the sole supplier of any drug, patented or generic, has the upper hand. But where there are only a few large payers—or only one—drug companies are forced to come to the table and offer a reasonable price if they want access to that market.
And here’s the kicker: government-run Medicare, one of the largest payers for prescription drugs, is prohibited by law from negotiating drug pricing. You read that right. This was already true before the ACA, which only cemented it. That is because pharmaceutical companies got what they wanted with the ACA: “We got a good deal,” wrote Bryant Hall of the Pharmaceutical Research and Manufacturers of America (PhRMA), one of the largest, most influential lobbying groups in Washington.
One need look no further for proof of the power of negotiation than the government-run Veterans Administration, which is not barred from negotiating drug prices: costs run 25% to 50% lower than Medicare.
In 1992, federal Medicare spending on drugs was $400 million. By 1999 it was $7 billion. By 2013, $50 billion. Gosh, I wonder what it’ll be in a decade? EXCITING.
The ACA also banned reimportation: US patients cannot legally purchase less expensive drugs from another country like Canada. While the ACA was being cooked up by lobbyists and the Democratic president behind closed doors, PhRMA lobbyist Bryant Hall wrote that “WH [the White House] is working on some very explicit language on importation to kill it in health care reform.” Neat, huh?
But don’t you feel left out, my Canadian friends! PhRMA is coming for you, too:
“America’s big drug companies are intensifying their lobbying efforts to ‘change the Canadian health-care system’ and eliminate subsidized prescription drug prices enjoyed by Canadians” … “A prescription drug industry spokesman in Washington confirmed to CanWest News Service that information contained in confidential industry documents is accurate and that $1 million US is being added to the already heavily funded drug lobby against the Canadian system.” PhRMA was the leading drug industry trade group behind the increased lobbying and PR campaign. PhRMA was also independently spending $450,000 to target the booming Canadian Internet pharmacy industry, which has been providing Americans with prescription drugs at lower prices than in the United States.
And the UK’s NHS is barreling down the same road.
Comparative drug review.
Other countries compare drugs to determine whether a new, higher-cost treatment is any more effective than existing alternatives. These investigations can inform price negotiation, or determine whether a drug gets approval at all. In the US, our FDA has no legal authority to consider pricing, or to compare medications to one another. Even if it did have the authority, FDA does not even have the resources to confirm that data supplied by drug companies is accurate and complete—or, you know, not. Conservatives, chronically infected with deregulatory fever, will never task a federal agency with assessing the value of a new drug. After all, that might interfere with the Free Market™ gouging US patients on drug pricing. NO ONE WANTS THAT.
But what about research and development huh what about R&D?
The pharmaceutical industry defends its US pricing more or less thusly: it costs over a billion dollars to bring a new drug to market, and furthermore, more drugs fail to make it than succeed. We want to incentivize new and better drugs, don’t we?
YES! And that is why US taxpayers fund 85% of the basic research. No wonder US companies generate most new drug discoveries! GO USA! We also helpfully elect corrupt politicians who let the industry’s lobbyists write our nation’s health care laws. Yet strangely, we get nothing in return for any of this, while other countries reap the benefits. Consider the new hepatitis C drug, sofosbuvir. US patients will pay $80,000 to $160,000 for a course of treatment, while in Egypt and India the manufacturer has agreed to charge $900 per patient. And it’s still enormously profitable: a course of sofosbuvir costs only $138 to produce.
Nobody disputes that it’s a risky and expensive proposition to develop a new drug. But they do dispute the numbers. An oft-cited analysis by the Tufts Center pegs the development cost for a new drug at about $1.3 billion. Hagop M. Kantarjian, MD, professor and chair at the University of Texas M.D. Anderson Cancer Center, begs to differ. In a 2013 paper he co-authored on cancer drug costs, Dr. Kantarjian and his colleagues suggest the actual figure might be as low as 10% of that:
“The figure may be inflated, because it includes ancillary expenses, salaries, bonuses, and other indirect costs not related to research or development, as well as an 11% compounded discount rate over 10 years based on stock market returns on capital investment,” they write. “Other independent estimates of cost of drug development put the figure as low as 4% to 25% of this estimate.”
Moreover, “R&D” for some new drugs apparently means “buying a smaller company that already did the R&D.” Gilead’s sofosbuvir, the hepatitis C wonder drug, is once again illustrative. When Gilead bought Pharmasset, Inc. in 2012 for $11.2 billion, Pharmasset reported $62 million in R&D costs over the three years to develop sofosbuvir (out of $177 million spent on R&D company wide over the same period). Before the Gilead buyout, Pharmasset was planning to make a reasonable profit selling sofosbuvir at $36,000 for a course of treatment; Gilead is now charging $80,000 to $160,000. Unless you live in Egypt or India, of course—then it’s only 900 bucks. FREE MARKET™ HEALTH CARE, everyone.
Another analysis published in the BMJ estimates the typical R&D cost at between $60 million and $90 million. But even if the $1.2 billion figure is accurate, there is no justification for US taxpayers and patients disproportionately footing the bill. Especially when we pay dearly in other ways, too: with people bankrupted for accessing life-saving medication, or going without it altogether.
There is a solution: Medicare For All, where “all” includes congresscritters. Just for starters, you would see drug prices negotiated so fast it would make your head spin, and we’d all find just how far they can fall. We really could have a less corrupt and more equitable system, in which corporate greed is not the driver of pharmaceutical innovation or pricing—human health is. But it’s just not going to happen unless and until we find the cure for conservatism. And it sure as shit isn’t in the interests of the pharmaceutical industry to cure that.
And listen. Lest you think I’m just a lefty kook talking out of my ass with no skin in this game: I am alive today only because of pharmaceutical innovations and the privilege to access them affordably. I’m a Type 1 diabetic, and I inject two different bio-engineered insulin analogs daily. I also take several oral medications to mitigate or prevent complications of the disease. I am grateful for this every fucking day. My grandmother’s generation had few alternatives to pig-derived insulin, which could be suddenly and violently rejected at any time by the body’s immune system (sometimes causing premature death), and rendering it useless as an intervention such that the disease would take its natural course (always causing premature death). In fact, as a young adult my grandmother’s sister died from complications of Type 1 diabetes.
I am not arguing for abolishing profits and nationalizing the drug companies. (Not yet, anyway. But if they keep this shit up I just might.) Again, I am arguing for a less corrupt and more equitable paradigm, wherein corporate greed is not the primary driver of pharmaceutical innovation or pricing—human health is.