Robert W. Morrow, M.D.
Are you ready for industrial medicine? Profit-driven chains looking to sell candy, cosmetics, and your personal healthcare?
Ready or not, the transformation of US healthcare is underway. Retail chains are ready to make policy and provide our health services. And they know the best legislators and regulators that money can buy.
Vaccine in the 21st Century
(The subtitle above is a nod to Thomas Piketty’s, “Capital in the 21st Century,” a long, but important book about the ongoing uneven distribution of income and wealth that I strongly recommend.)
A patient came to my office recently and asked for the new shingles vaccine. I reply, ‘well, the data is rather thin on it compared to two doses of the older vaccine without an adjuvant. The adjuvant—an extra chemical to amplify the immune response-has little track record, in spite of the fact that they’ve started a mass immunization advertising campaign with it.’
Effective or not, proven safe or not, I cannot get the “new shingles vaccine” stock to my office. But you can get the vaccine at a chain drug store. Seems it has only been shipped to the chains, and that’s the same way influenza vaccine is shipped—to the big chains first.
No surprise there. We live in a competitive market for pharmaceutical products these days in the US.
Although I have argued in previous posts that the weight of debt undertaken by the healthcare systems in the US would soon become insupportable, I seem to have underestimated that the world finance markets are awash in cash, That’s due to the growth of the financial sector at the detriment of the sector of those of us that work for a pay check. (Hence the reference to Piketty’s book.)
Enter CVS
Who will buy the (discounted?) debt/bonds from the struggling health systems and commercial insurers? Yes, you heard about this… CVS, Walmart, JP Morgan Chase, Apple, Berkshire Hathaway, Google, and so on.
The creative disruption of health care in the near future involves pharmaceutical chains, IT, and finance capital. And yes, this has started.
The list of direct financial partnerships is plenty wild and presumptively is the tip of the finance capital iceberg. Current talk in this community is that commercial health insurers have no business justification or necessity in “value-based” health care services.
That includes sundry commercial sellers of governmental programs — think the privatization of Medicare Advantage plans and the Veterans’ Administration.
This crowd defines ‘value’ as cheaper and systematic, and big data driven. As an artisanal physician, this is chilling. Of course, as an independent family doc of 38 years, I cannot compete with venture/finance capital. And industrial-style health care has no tested proof of excellence, and does not have room for continuity care and real prevention, or professionalism and trust.
Big Data* – Big Money
We do have data, and the real world example of urgent care centers, the model for the future of US primary care.
Rotating providers, frequently in retail stores and themselves of unknown provenance, evaluate you, and then make referrals to telemedicine for specialists. No one has shown a benefit of this model of primary care. Research mostly shows higher costs, more amputations of diabetic feet [from the lack of continuity care), more expensive “shotgun tests,” and high bills that are unexpected, such as high facility fees.
Someone ultimately does pay for this low-cost, low-value ‘value.’ And for the shingles vaccine monopolized by CVS, Rite Aid, or whoever comes next.
But the vaccine is not available at my office. Even though I now use a big consignment company, which buys and bills for the vaccine.
Guess you now understand this snapshot of the future…commercial pharmacy chains and IT firms and telemedicine – all competing in the race for the bottom, and the capture of ‘attributed’ lives.
Dr. Bob gets the vaccine last if ever.
* Speaking of data, big data tends to be highly suspicious as a way to make individual decisions, largely because the data at the source needs to be curated before the math is applied. (May I recommend a spectacular book by a data academic Big Data, Little Data, No Data-Scholarship in the Networked World, by Christine L. Borgman.)
The Contrary Perspective 
Thank you, Dr. Morrow, for shining light on another specific corner (there are so many problematic corners!) of the mess we call healthcare here in “The Greatest Nation on Earth, Past/Present/Future” (!!) as some would have us believe. I minimize interaction with the medical world (like many who once worked in the field, though I was at the “low end”) as much as I can, but am at the age where I am interested in the (supposedly) improved shingles vaccine. The supply situation you describe is a perfect example of the overall, glaring problem that, like every other aspect of this society, Profit Before People rules the day. The obvious answer is “Medicare For All,” but in present-day USA that proposal is Dead BEFORE Arrival! If we hypothesize that the Democrats gain a majority in both US Senate and House of Reps come November, very little can change. The same lobbyists will continue to ply their trade in D.C. and anything that smacks of “socialism” will remain anathema in the USA. The rest of the world will continue to look at us and scratch its collective head over this, and our citizens will continue to suffer–unless they enjoy those “Cadillac level” healthcare plans dispensed by corporations and, via our tax dollars, enjoyed by precisely those members of Congress who will continue to fail to do the right thing. My own father, who grew quite conservative as he aged, would have said “That’s the way it is, baby!” For my part, I say “That’s the way it shouldn’t be, and something really needs to change!!”
Here in Taiwan, we have a single payer health care system that costs my wife and me the equivalent of $45 per month. Back in the United States, before we moved here in 2004, I had no employer-provided health insurance and I hadn’t reached the age of 65 and Medicare eligibility. I didn’t even have a Veterans Administration card. When I developed a skin cancer on one ear and had a heart attack, the doctors and hospitals here fixed me up and charged me very little in the way of ancillary costs (for things like regular check-ups and a few pills, etc.) I have a Health Care Card with a little memory chip on it that any hospital or clinic in the system (many of them on street corners) can read for my health history, etc. I would have died and left my wife impoverished if I hadn’t gotten out of the United States when I did. I will remain forever grateful to the Taiwanese people and their excellent health care system for saving my life — twice. I only hope that someday I can find a way to repay them.
But you Americans in the “homeland” cannot have a Single Payer Health Care system like Medicare for All. Why not? Because the Republican and Democratic party duopoly — and the Insurance and pharmaceutical oligopolies that own and operate them — say that you can’t. And, like pathetic sheep, you just bow your heads and whimper: “OK. If you say so. Who are we to think that we can have the same sort of excellent health care that so many other countries in the world enjoy?” But you can easily run yourselves into 21 trillion dollars of unrepayable debt fielding a bloated and hopelessly inept foreign legion composed of vainglorious uniformed Visigoths, dogs-of-war mercenaries, and corporate camp followers who regularly slaughter peasant farmers, wedding parties, funerals, and school buses in the (mostly Muslim) Third World. The Sordid Arabians and Zionist Occupiers of Palestine (who enjoy a Single Payer Health system subsidized by billions of U.S. taxpayer dollars) tell you that you must do without. And so you do.
Sure glad that I got my old Vietnam veteran’s ass out of that imploding excuse for a “country” when I did. I only wish that my own sons and their families could. America has crawled up its own ass and died, and we can smell the already rotting corpse from clear across the Pacific Pond. The Ruling Corporate Oligarchy, however, continues robbing Americans and their descendants because no one ever heard the Future yell: “Stop! Thief!” When Deputy Dubya’s V.P. Dick Cheney said: “Reagan taught us that deficits don’t matter,” he meant, of course, that generations of taxpayer debt didn’t matter to him and the rest of his corrupt, connected cronies. They’ve already gotten theirs, not just from the Present, but from the Future as well. Soon they’ll have to invent a new word for the time to come “After the Future” so they can rob that, too. The American people won’t object. Some snake-oil shit-salesmen like Bawl and Pillory Clinton and Barack Obama have told them that the mean Republicans just won’t allow them to do anything for the common people. And what self-denigrating corporate Democrat would ever fail to heed instructions from the “senior” right-wing faction of America’s infrared political “spectrum.” And so the Oligarchical Collective rolls in their riches and exults:
Buy some Republicans. They’ll shout, ‘GAWD BLESS.”
Rent a few Democrats. They’ll lose for less.
Somewhere along the line (probably in the immediate aftermath of WWII), Americans accepted the idea that the “government” runs them and not vice versa. Once rampant secrecy became securely established and corruption institutionalized, Americans ceased — except for a brief period in the mid 1960s to early 1970s — to demand that the wars-for-the-sake-of-war stop so that the nation could do something interesting and challenging like explore the solar system. I mean, half a century ago, America could send 24 human astronauts around the Moon and safely land 12 of them on its surface. But now the United States can’t put a National Health Care clinic on the nearest street corner? The Taiwanese people can. Why don’t you Americans send a team of medical professionals over here to learn how intelligent and well-educated people do things like that? If you can’t afford the trans-Pacific air fare, then just drive up to Canada and ask them for help. Any number of civilized countries could explain to you how these widely understood systems work — if you really wanted to know.
But, anyway: If you can’t do any good, at least do no harm. Can’t you — at a minimum — manage that?
Or, if this medical professional study group prefers a warmer clime, they can always go study Cuba’s public health service! JUST KIDDING!! And the latest (unshocking) news on the Dems is that apparently they don’t want to talk about impeachment because they fear it will stir Trump’s “base” (and how base can one get, indeed?!?) into an uproar, yay verily a tizzy. The Democratic Party USA, new definition of craven cowardice. And so it goes…