Friday, December 18, 2009

America's drug lords

About fifteen years ago, when I was still living in Canada, I took a railway trip from Seattle to Denver. The person in the seat next to me was a Japanese American. Somehow as we talked through the night, he happened to mentioned that a neighbor of his had recently gone into bankruptcy as a result of medical expenses. The man in the family had had a heart attack, which led to a short stay in hospital. By the time he was released and had had all the interventions his physicians recommended, his hospital bill was considerably higher than all the money he had put into his retirement plan. After losing all his savings, he sold his house, and even then did not have enough to pay all his medical expenses. As I listened to this story, the thought crossed my mind that I was having a conversation with a lunatic who entertained himself by making up unbelievable stories. Surely, I thought, no country could be so primitive and backwards that it would not provide for the medical needs of all its citizens. Since moving to the United States, I have learned that such stories are not uncommon, and that the United States is indeed a country so primitive and backwards that it does not provide for the medical needs of all its citizens.

Recently I had a first-hand experience that demonstrated to me just how dysfunctional the health-care system in the United States is. I was prescribed a medication called Lovenox (enoxaparin sodium), an anti-coagulant that helps the body deal with blood clots. When I went to the pharmacy to pick up my prescription, the pharmacist told me it cost $171. My first thought was that for some reason my insurance plan did not cover this medication. The reality, however, was that my prescription drug insurance plan does cover the cost of this medication. The dosage I was prescribed costs $1300, all but $171 of which was covered by my health insurance. A search on the Internet showed me that the same dosage in a Canadian pharmacy costs $292.

For years I have known about the difference between the costs of prescription drugs in the United States and in Canada. It is not unusual for name-brand prescription drugs to retail for a fraction of the retail price in the United States. (In the case of Lovenox, the Canadian price is 22% of the price in the United States.) What accounts for such a discrepancy? The answer is simple: government regulation. Canadian regulations allow for pharmaceutical manufacturers to make a reasonable profit; they do not allow pharmaceuticals to be sold at a price several times the cost of production. As a consequence, name-brand pharmaceuticals typically cost only slightly more than their generic counterparts.

Pharmaceutical companies in the United States have taken advantage of (and helped promote) the widespread paranoia in American culture about “big government.” By pinning the emotive label “government interference” on all attempts to protect consumers from the kinds of inflated prices that merge in a “free market economy” dominated by a few giant corporations that have squeezed small players out of the game, those with a vested interest in maximizing their profits have managed to convince much of the American public that it is in the interest of all Americans to have unregulated markets. The results of the blind prejudice for free-market capitalism—a prejudice that has prevailed since at least the end of the First World War—have been escalating medical costs, housing bubbles, and massive personal credit-card debt exacerbated by exorbitant interest rates. In the war on the public being waged by unregulated capitalists, the capitalists have won one campaign after another, and all but a tiny percentage of the public has suffered constant defeat and humiliation.

A friend of mine from Vietnam told me once than in his village there was a proverb that went something like this: “By ridding the village of bandits, we make room for the pirates.” He reported that where he grew up there was a sense of fatalism that no matter what one does to try to eliminate rogues, charlatans and crooks, the dishonest are always a step ahead and ready to bend every law to their own advantage. Ordinary people, and especially honest people, were thought not to stand a chance against those who were determined to take advantage of them. Perhaps that comes close to being a universal story of the world. What people often fail to recognize is that the sense of fatalism constantly works to the advantage of those who are out to take care of only their own interests, no matter what the consequences for everone else. Failing to be outraged by outrageous circumstances only serves to perpetuate them.

In my enounter with outrageously high pharmaceutical prices, I more or less got off the hook. I had an insurance plan that absorbed the costs. People without such insurance plans face either a life of untreated medical conditions that shorten their lives or make their lives less comfortable, or a life of financial hardship. And those of us who are fortunate enough to have insurance plans that pay the unnecessarily high medical costs face having to pay higher and higher premiums. Insurance companies are no less interested in making high profits than pharmaceutical companies. And they are no better regulated.

If America were a democracy with an informed electorate, people might be better protected from the drug lords and insurance moguls. Unfortunately, America has not been a representative democracy for quite some time. No candidate who is not backed by big finances has a chance to be elected. This means that almost everyone who is elected is at least as indebted to those who have financially backed their campaigns as they are to the citizens who voted for them. Hardly anyone has an interest in looking after the welfare of ordinary people. There is no money to be made in caring for people and maintaining a compassioante society. Being shameful and dishonorable in our society carries with it no penalty more severe than having to endure the scorn of an occasional blogger.

Friday, December 04, 2009

The war of the Nobel Peace Prize laureate

Oslo - US President Barack Obama has scratched items from the agenda surrounding his upcoming date to receive the Nobel Prize for Peace in Oslo, the Nobel Committee in the Norwegian capital Oslo reported Friday. A previously planned press conference before the ceremony on December 10 is to be cancelled, while a short press conference after Obama's meeting with Norwegian Prime Minister Jens Stoltenberg is also likely to be cut.

The US president's various domestic and international political commitments were given as the justification for the cancellations. (US World News)

It would be false to say that I am disappointed in how the first year of the Obama presidency has gone. Disappointment is a feeling that comes about when one was expecting something that did not come to pass. Unfortunately, the Obama presidency has turned out so far to be pretty much as I thought it would turn out. During the Democratic primaries, he seemed to have the least well-thought-out plans for health care reform. He consistently said he would take troops out of Iraq and put them into Afghanistan. His rhetoric on the importance of “finishing the job” in Afghanistan worried me throughout his campaign. His apparent commitment to the notion that “finishing the job” of hunting down Osama bin Ladin seemed naive, superficial, ill considered and ignorant of history. Of all the candidates in the Democratic primaries in the early stages of the campaign, I thought I could probably live with almost any of them, but there were two who worried me and who would, I hoped, be quickly eliminated from the race. Those two were Hillary Clinton and Barack Obama. When they were the only two left standing, I backed Hillary, reluctantly at first and then more enthusiastically as I got to know her (and her opponent) better. When Obama was chosen as the Democratic candidate, I began to think seriously about voting for Ralph Nader. If I had not panicked at the possibility of having Sarah Palin as a vice president, I might well have voted for Nader—or written in the name of Dennis Kucinich. I am neither surprised nor disappointed in Obama. I am, however, sick at heart.

Obama's feeble leadership in the the area of health care reform has led to limp bills that, if passed, will result in few positive changes. When House Minority Leader John Boehner speaks of the government takeover of the health care industry, I can only groan and say “If only the government could take the well-being of the American people out of the hands of rapaciously greedy and under-regulated insurance companies and for-profit health-care providers, we might have a chance to design a system in which caring for all people mattered more than caring for a few wealthy shareholders.” As it is, however, gutless leadership has led to a gutted set of measures that will still leave far too many people unable to afford even basically adequate health care, and will still leave insurance companies under-regulated, and will still leave American medical care overpriced and of the lowest quality among all industrialized nations.

Of all the failures of the Obama administration, there is none that matches the sheer folly of his Afghanistan policy. A couple of months ago at Leiden University I saw a poster advertising a talk by a Dutch political scientist, the title of which was "Afghanistan: De oorlog van Obama." (Afghanistan: Obama's war). That title captures a number of perceptions. The war in Afghanistan is not a war of the people of Afghanistan, nor a war of the people of the United States. Nor is it a war of necessity. Nor is it a war that is possible to win, if only because it is not at all clear what winning even means. It is a war that can only produce losers. Many Afghans will lose their lives; many more will lose their homes and their means of livelihood and their dignity and their self-respect. A few Americans will also die; many more will bear for the rest of their lives the psychological scars of seeing what no human being should ever have to see; even more Americans will continue to lose confidence in the ability of their own government to make rational decisions. America as a nation will continue to lose the respect of its allies. The American economy will continue to lose stability as war debts mount to levels far beyond the ability of any nation to pay. The only gain for America will be a gain in enemies, a dramatic increase in the number of people who are determined to bring American influence to an end and to establish their own autonomy. There is no one else whose war this is; it is indeed Obama's war in much the same way Vietnam became Johnson's war and Iraq the war of George Bush père and George Bush fils. It is another in the long series of wars into which America has been led by presidents obsessed by the demons of bad reasoning and a poor grasp of history.

When President Obama goes to Oslo on December 10 to receive his Nobel Peace Prize, one can only hope that he will hear a small, still voice coming from deep within his heart saying “Man, thou dost not deserve this honor.” Whether he will then be man enough to listen to that voice, admit his errors, turn down the prize and insist it be given to someone more deserving—that remains to be seen.