Drug Marketing and Free Speech: U. S. Supreme Court Says Data Mining Trumps Your Medical Privacy
Pharmaceutical companies, which spend billions of dollars a year promoting their products to doctors, have found that it is very useful to know what drugs a doctor has prescribed in the past. Many use data collected from prescriptionsprocessed by pharmacies — a doctor’s name, the drugs and the dosage — to refine their marketing practices and increase sales.
The Supreme Court on Thursday made it harder for states to protect medical privacy with laws that regulate such practices. In 2007, Vermont passed a law that forbade the sale of such records by pharmacies and their use for marketing purposes. The ruling upheld a lower court decision that struck down the law as unconstitutional.
Justice Anthony Kennedy, writing for the 6-to-3 majority, said the law violates First Amendment rights by imposing a “burden on protected expression” on specific speakers (drug marketers) and specific speech (information about the doctors and what they prescribed). It is unconstitutional because it restricts the transfer of that information and what the marketers have to say.
In dissent, Justice Stephen Breyer explains that the law’s only restriction is on access to data “that could help pharmaceutical companies create better sales messages.” He notes that any speech-related effects are “indirect, incidental, and entirely commercial.” By applying strict First Amendment scrutiny to this ordinary economic regulation, he warns, the court threatens to substitute “judicial for democratic decision-making.”
The law would have been upheld, Justice Breyer says, if the court had treated it as a restriction on commercial speech, which is less robustly protected than political speech. The court’s majority unwisely narrows the gap between commercial and political speech, and makes it harder to protect consumers.
By: Editorial, The New York Times, June 23, 2011
Corporate Tax Cuts Don’t Stimulate Job Growth
Prevailing conservative wisdom dictates that businesses need tax cuts—and investors need capital gains tax cuts—to get the economy moving. But two very well-executed articles on wages and taxes published recently suggest that targeting tax cuts at business executives may do little to improve the dismal unemployment picture.
The Washington Post offers a startling analysis of income disparity, noting that the gap between the very rich and the rest of us has grown dramatically in the past few decades, reaching current levels that have not been seen since the Great Depression. In 2008, the Post reports, the top one-tenth of one percent of earners took in more than a tenth of the personal income in the United States. But the moneyed class is not dominated by professional athletes or big-name artistic performers or even hedge fund managers, the Post found. Instead, it is due to a big increase in executive compensation, even as real wages for some of their workers have dropped:
The top 0.1 percent of earners make about $1.7 million or more, including capital gains. Of those, 41 percent were executives, managers and supervisors at non-financial companies, according to the analysis, with nearly half of them deriving most of their income from their ownership in privately-held firms. An additional 18 percent were managers at financial firms or financial professionals at any sort of firm. In all, nearly 60 percent fell into one of those two categories.
The New York Times has a fascinating story that serves as an unwitting companion piece to the Post story. Corporate executives, the paper reports, are clamoring for a tax holiday to encourage them to bring their offshore profits back to the United States. And the money in question is big, the Times notes: Apple has $12 billion in offshore cash, while Google has $17 billion, and Microsoft, $29 billion. The companies with money sitting offshore argue that if the federal government were to offer them a huge tax break—say, a one-year drop from 35 percent to 5.25 percent—the businesses would bring the money home and operate as a private-sector economic stimulus.
However, the Times notes:
(T)hat’s not how it worked last time. Congress and the Bush administration offered companies a similar tax incentive, in 2005, in hopes of spurring domestic hiring and investment, and 800 took advantage. Though the tax break lured them into bringing $312 billion back to the United States, 92 percent of that money was returned to shareholders in the form of dividends and stock buybacks, according to a study by the nonpartisan National Bureau of Economic Research.
Who needs a tax cut, then? The U.S. economy is very much consumer-driven; companies aren’t hiring, many business owners say, because people aren’t buying. The past behavior of corporations that have received huge tax cuts has not necessarily been to use the money to hire more people; the Bush-era tax cuts have been in place for a decade, and the unemployment rate is still 9.1 percent. And executive compensation has grown. Executives may feel entitled to earn more and more if their companies are doing well and expanding. But without customers, those companies will go bust.
By: Susan Milligan, U. S. News and World Report, JUne 20, 2011
Medicare Saves Money: Ensuring Health Care At A Cost The Nation Can Afford
Every once in a while a politician comes up with an idea that’s so bad, so wrongheaded, that you’re almost grateful. For really bad ideas can help illustrate the extent to which policy discourse has gone off the rails.
And so it was with Senator Joseph Lieberman’s proposal, released last week, to raise the age for Medicare eligibility from 65 to 67.
Like Republicans who want to end Medicare as we know it and replace it with (grossly inadequate) insurance vouchers, Mr. Lieberman describes his proposal as a way to save Medicare. It wouldn’t actually do that. But more to the point, our goal shouldn’t be to “save Medicare,” whatever that means. It should be to ensure that Americans get the health care they need, at a cost the nation can afford.
And here’s what you need to know: Medicare actually saves money — a lot of money — compared with relying on private insurance companies. And this in turn means that pushing people out of Medicare, in addition to depriving many Americans of needed care, would almost surely end up increasing total health care costs.
The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.
But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.
By the way, we have direct evidence about the higher costs of private insurance via the Medicare Advantage program, which allows Medicare beneficiaries to get their coverage through the private sector. This was supposed to save money; in fact, the program costs taxpayers substantially more per beneficiary than traditional Medicare.
And then there’s the international evidence. The United States has the most privatized health care system in the advanced world; it also has, by far, the most expensive care, without gaining any clear advantage in quality for all that spending. Health is one area in which the public sector consistently does a better job than the private sector at controlling costs.
Indeed, as the economist (and former Reagan adviser) Bruce Bartlett points out, high U.S. private spending on health care, compared with spending in other advanced countries, just about wipes out any benefit we might receive from our relatively low tax burden. So where’s the gain from pushing seniors out of an admittedly expensive system, Medicare, into even more expensive private health insurance?
Wait, it gets worse. Not every 65- or 66-year-old denied Medicare would be able to get private coverage — in fact, many would find themselves uninsured. So what would these seniors do?
Well, as the health economists Austin Frakt and Aaron Carroll document, right now Americans in their early 60s without health insurance routinely delay needed care, only to become very expensive Medicare recipients once they reach 65. This pattern would be even stronger and more destructive if Medicare eligibility were delayed. As a result, Mr. Frakt and Mr. Carroll suggest, Medicare spending might actually go up, not down, under Mr. Lieberman’s proposal.
O.K., the obvious question: If Medicare is so much better than private insurance, why didn’t the Affordable Care Act simply extend Medicare to cover everyone? The answer, of course, was interest-group politics: realistically, given the insurance industry’s power, Medicare for all wasn’t going to pass, so advocates of universal coverage, myself included, were willing to settle for half a loaf. But the fact that it seemed politically necessary to accept a second-best solution for younger Americans is no reason to start dismantling the superior system we already have for those 65 and over.
Now, none of what I have said should be taken as a reason to be complacent about rising health care costs. Both Medicare and private insurance will be unsustainable unless there are major cost-control efforts — the kind of efforts that are actually in the Affordable Care Act, and which Republicans demagogued with cries of “death panels.”
The point, however, is that privatizing health insurance for seniors, which is what Mr. Lieberman is in effect proposing — and which is the essence of the G.O.P. plan — hurts rather than helps the cause of cost control. If we really want to hold down costs, we should be seeking to offer Medicare-type programs to as many Americans as possible.
By: Paul Krugman, Op-Ed Columnist, The New York Times, June 12, 2011
Gov. Chris Christie: Earn $6,000 A Year? No Medicaid For You!
If you live in the state of New Jersey and are earning $118 a week, congratulations!
According to Gov. Chris Christie, you have escaped the bonds of poverty and no longer are in need of the state’s Medicaid program.
Never mind that $118 a week is but a fraction of the poverty line as defined by the United States of America. Pay no attention to the fact that New Jersey battles California for the mantle of having the highest cost of living of any state in the nation.
Chris Christie, everyone’s favorite no-nonsense, “tell it like it is” governor, has decided that you can manage quite nicely on this paltry sum while remaining fully capable of paying for your own medical care.
Sound like a joke?
It’s not. And it is difficult to imagine anything less humorous. Under the Christie plan, adults with a family of four who earn more than $6,000 a year would no longer qualify for the state’s Medicaid program. Currently, the cut-off to qualify is $30,000.
Think about that for a moment.
A single mother raising three kids on a weekly salary of $118 will no longer be eligible to take advantage of the medical social safety net should she fall ill.
I can hear my conservative friends rising in chorus – mom should have thought about that before having all those kids she couldn’t afford! Maybe she should have. If only there were some place these women could turn to for family planning advice so that they might avoid this problem.
But wait – there is such a program in New Jersey. Or, to be more precise, there was such a program in New Jersey. It turns out that women’s clinics are disappearing from the New Jersey landscape as Governor Christie uses the budget pen to wipe out women’s health programs that might also provide abortion services as a small part of what they make available to women so badly in need of their health care and counseling services. This, despite the fact that no state or federal taxpayer money went towards paying for any such abortion services long before Christie began his assault on women’s health.
In his last budget, Christy sliced $7.5 million from family planning clinics – a cut his new budget proudly continues. As a result, health and planning services so vital to low income women are becoming very hard to find in New Jersey- not to mention the many other states where Governors are using the budget to enact their social, anti-abortion agenda’s.
What do we call powerful people when they pick on the weakest among us?
We call them bullies. And Governor Chris Christie exemplifies the modern-day bully. Is it any wonder, then, that the GOP sees Christie as the man they would so gladly follow into the 2012 election battle?
Christie’s proposal to cut over $500 million from the state’s Medicaid program would not only affect parents earning far too little to support their families. Some of the deepest cuts would leave seniors, who require full-time, in-facility nursing home care, literally out in the cold as the funding that supports their ability to get the medical attention they need disappears.
I suppose these elderly can move back into the homes of their children – many of whom are the ones earning over $6,000 a year, but well below the national poverty line, who will no longer be able to care for their own health needs let another find a way to pay for the care of their sick parents.
There is some good news in this otherwise bleak story.
Come 2014, when the federal government steps in to play a larger role in financing the state Medicaid programs (they already pay for about half of the costs), it will be illegal for these people to be denied care. Accordingly, all these folks need do is see to it they do not get sick between now and 2014.
How hard can this be?
As New Jersey U.S. Senator Robert Menendez put it, “The state is effectively telling these families to wait until 2014 to get coverage again. Unfortunately, there is no
such thing as a waiver for getting cancer.” Certainly, some deal can be cut between man, woman and God resulting in that cancer scheduled to show up next year holding off until 2014 when care will be available.
And how much damage can uncontrolled diabetes really do when untreated for a three year period? So, maybe you lose a couple of toes as the diabetes ravages your body.
As Chris Christie would no doubt remind you, forfeiting a few digits for the common good of wealthy millionaires for whom Christie continues to cut taxes, is a small price to pay.
After all, those tax cuts might just result in your getting a better job in the future – assuming you’re still alive.
And if you aren’t, at least you will die in the knowledge that you will have given your life to improve Chris Christie’s chances of becoming President of these United States some day.
So, at least you’ve got that going for you.
By: Rick Ungar, The Policy Page, Forbes, June 12, 2011
When Food Kills: A Threat To Public Health
The deaths of 31 peoplein Europe from a little-known strain of E. coli have raised alarms worldwide, but we shouldn’t be surprised. Our food often betrays us.
Just a few days ago, a 2-year-old girl in Dryden, Va., died in a hospital after suffering bloody diarrhea linked to another strain of E. coli. Her brother was also hospitalized but survived.
Every year in the United States, 325,000 people are hospitalized because of food-borne illnesses and 5,000 die, according to the Centers for Disease Control and Prevention. That’s right: food kills one person every two hours.
Yet while the terrorist attacks of 2001 led us to transform the way we approach national security, the deaths of almost twice as many people annually have still not generated basic food-safety initiatives. We have an industrial farming system that is a marvel for producing cheap food, but its lobbyists block initiatives to make food safer.
Perhaps the most disgraceful aspect of our agricultural system — I say this as an Oregon farmboy who once raised sheep, cattle and hogs — is the way antibiotics are recklessly stuffed into healthy animals to make them grow faster.
The Food and Drug Administration reported recently that 80 percent of antibiotics in the United States go to livestock, not humans. And 90 percent of the livestock antibiotics are administered in their food or water, typically to healthy animals to keep them from getting sick when they are confined in squalid and crowded conditions.
The single state of North Carolina uses more antibiotics for livestock than the entire United States uses for humans.
This cavalier use of low-level antibiotics creates a perfect breeding ground for antibiotic-resistant pathogens. The upshot is that ailments can become pretty much untreatable.
The Infectious Diseases Society of America, a professional organization of doctors, cites the case of Josh Nahum, a 27-year-old skydiving instructor in Colorado. He developed a fever from bacteria that would not respond to medication. The infection spread and caused tremendous pressure in his skull.
Some of his brain was pushed into his spinal column, paralyzing him. He became a quadriplegic depending on a ventilator to breathe. Then, a couple of weeks later, he died.
There’s no reason to link Nahum’s case specifically to agricultural overuse, for antibiotic resistance has multiple causes that are difficult to unravel. Doctors overprescribe them. Patients misuse them. But looking at numbers, by far the biggest element of overuse is agriculture.
We would never think of trying to keep our children healthy by adding antibiotics to school water fountains, because we know this would breed antibiotic-resistant bacteria. It’s unconscionable that Big Ag does something similar for livestock.
Louise Slaughter, the only microbiologist in the United States House of Representatives, has been fighting a lonely battle to curb this practice — but industrial agricultural interests have always blocked her legislation.
“These statistics tell the tale of an industry that is rampantly misusing antibiotics in an attempt to cover up filthy, unsanitary living conditions among animals,” Slaughter said. “As they feed antibiotics to animals to keep them healthy, they are making our families sicker by spreading these deadly strains of bacteria.”
Vegetarians may think that they’re immune, but they’re not. E. coli originates in animals but can spill into water used to irrigate vegetables, contaminating them. The European E. coli outbreak apparently arose from bean sprouts grown on an organic farm in Germany.
One of the most common antibiotic-resistant pathogens is MRSA, which now kills more Americans annually than AIDS and adds hugely to America’s medical costs. MRSA has many variants, and one of the more benign forms now is widespread in hog barns and among people who deal with hogs. An article this year in a journal called Applied and Environmental Microbiology reported that MRSA was found in 70 percent of hogs on one farm.
Another scholarly journal reported that MRSA was found in 45 percent of employees working at hog farms. And the Centers for Disease Control reported this April that this strain of bacteria has now been found in a worker at a day care center in Iowa.
Other countries are moving to ban the feeding of antibiotics to livestock. But in the United States, the agribusiness lobby still has a hold on Congress.
The European outbreak should shake people up. “It points to the whole broken system,” notes Robert Martin of the Pew Environment Group.
We need more comprehensive inspections in the food system, more testing for additional strains of E. coli, and more public education (always wash your hands after touching raw meat, and don’t use the same cutting board for meat and vegetables). A great place to start reforms would be by banning the feeding of antibiotics to healthy livestock.
By: Nicholas D. Kristof, Op-Ed Columnist, The New York Times, June 11, 2011
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