Quotes from the GOP Leader of the Senate, Mitch McConnell

“Throughout the debate, Senate Republicans have argued that this misguided law represents an unprecedented and unconstitutional expansion of the federal government into the daily lives of every American. Most Americans agree. In both public surveys and at the ballot box, Americans have rejected the law’s mandate that they must buy government-approved health insurance, and I hope the Supreme Court will do the same.”

Government approved health insurance? In 2014 it will be a mandate to buy insurance from private companies who pay to finance your campaigns, Senator. The government has given a gift to the private companies with this mandate rather than setting up a government run program, like Medicare, to give them some competition. What’s the solution–private health insurance or a government run program like Medicare for Everyone?

MCCONNELL: Well, it doesn’t make any difference frankly whether you opt-in or you opt-out, it’s still a government plan. You know, Medicaid, the program for the poor now, states can opt-out of that, but none of them have. I think if you have any kind of government insurance program, you’re going to be stuck with it and it will lead us in the direction of the European style, you know, sort of British-style, single payer, government run system. And those systems are known for delays, denial of care and, you know, if your particular malady doesn’t fit the government regulation, you don’t get the medication.

MILLER: Right.

MCCONNELL: And it may cost you your life. I mean, we don’t want to go down that path.

No, of course there are no delays or denial of care now, Senator McConnell because we only have 45,000 Americans die each year due to lack of health insurance, so a public program that would cover everyone would lead to–coverage and health care?

 Americans..”don’t want is a Washington takeover of health care along the lines of what we’ve already seen with banks, insurance companies, and the auto industry. Americans don’t want a government-run system that puts bureaucrats between patients and doctors.”

The government has taken over the banks? The insurance companies? The auto industry? When did that happen? The only bureaucrats standing between patients and their doctors work for CIGNA, UnitedHealth, WellPoint and all the other health insurance companies.

Senator McConnell enjoys some of the finest government subsidized health care in the world thanks to the United States taxpayers, the Federal Employee Health Benefits Program. Ask the Senator from Kentucky if we should extend that government program to all United States citizens.

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Bits and Pieces; Updates on Campath/Lemtrada, Health Care Reform and the National MS Society.

If you have been following this blog because you or a family member has Multiple Sclerosis you may know about the Sanofi takeover of Genzyme. Alternately, if you are one the many pharmaceuticals or investors or PR and advertising firms that visit us, you already do know that Sanofi completed the $20.1 billion buyout of Genzyme.

Which brings us to Campath (acquired from Bayer by Genzyme) now known, or trying to be known, as Lemtrada. We have written about it here because of the shameful desire to increase the price of a relatively inexpensive cancer treatment to $60,000 per year for Multiple Sclerosis treatment.

It is NOT YET APPROVED for use by the FDA. Campath/Lemtrada is still in clinical trials. Here is a link to the latest in their Clinical Trials.

At one point, Genzyme was giving Campath away for compassionate use in cancer patients. This was done by Genzyme to erase the yearly sales figures so that when the same drug rolls out (when approved) the $60,000 per year price sticker for Multiple Sclerosis won’t have a sales comparison number–of something much, much cheaper. Redefines the whole meaning of compassion, doesn’t it?

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Health Care Reform:

While the Affordable Care Act is not yet a law–we still have until 2014 for the whole thing to go into effect–the GOP is back to using their favorite catch phrase, “death panels.”

Here is a link to an article in Talking Points Memo about Rep. Phil Gingrey (R-GA) raising the dirty spectre of death panels and rationing yet again. Just an FYI, Rep. Gingrey voted to abolish Medicare. I think the good doctor should know better than to espouse what he does, but here’s the quote:

“[U]nder this IPAB we described that the Democrats put in Obamacare, where a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy, I guarantee you when you withdraw that the patient is going to die,” Gingrey said. “It’s rationing.”

We’re the only democratic and industrialized nation in the world without a universal plan; a plan where anyone can buy into a risk pool and get themselves covered no matter what. We all get sick, it’s part of the human condition. It’s how we treat ourselves that defines our society.

My husband now, having been without insurance for six months, can finally apply to the new high risk pool–thanks to the Affordable Care Act. We ask the representative from Georgia, “What should we do, Dr. Gingrey?” Repeal the health care law like you and every member of the GOP want to do so that my husband (and all other Americans like him) will go without health insurance and health care?

Crying tort reform over and over, as Dr. Gingrey does, isn’t going to fix the system, but considering that the good doctor has himself been sued for malpractice several times, it becomes obvious why he repeats this so often. And why he’s introduced legislation into Congress that would limit damages for pain and suffering from malpractice cases. See H.R. 5 of the 112th Congress.

Dr. Gingrey has this to say about health care reform:

“Just one year has elapsed since the government takeover of our healthcare system and Obamacare has done nothing but create hardships for Americans and place burdens on businesses,” said Congressman Phil Gingrey. “Since its passage, state budgets have been crushed by rising Medicaid costs, businesses have struggled to keep their doors open due to onerous new administrative and tax burdens, and American citizens are being threatened with rising costs and less access to quality care. As we move forward in pursuit of a full repeal of Obamacare, we must stay committed to replacing it with meaningful, cost-cutting reforms that will improve health care, lower costs, and put Americans back to work.”

Government takeover of health care? A proven lie.

If government is so bad, why does Dr. Gingrey want to use government to sharply cut medical malpractice awards? Won’t the free market just sort things out on its own?

But if Dr. Gingrey is speaking about the government creation of a high risk pool to help my husband and all Americans with pre-existing conditions get access to health care by purchasing insurance that will cover them, then I suggest he re-read his Hippocratic Oath.

As for tax burdens and small businesses, small businesses love the Affordable Care Act because they get tax breaks. And read more here, from Fox News.

Are we being threatened by rising costs? Yes. Why? Because Dr. Gingrey and his GOP ilk refuse to expand Medicare to Everyone. A national health plan that would compete for customers may inspire the private health insurers to actually produce a good product. Competition does that. As it is now, the private health insurers have zero competition.

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Now onto the National Multiple Sclerosis Society:

We got a flyer from the National MS Society the other day about their teleconference series that, “is designed to support individuals with MS through the continuum of their work experiences; from staying employed, to retraining and on to post-employment options. Understanding how to access vital resources will help individuals make the best choices through any stage of their workforce journey.”

With all the money the National MS Society takes in (and spends), this piece of writing just sent me over the edge as it purports to say something without saying anything at all. They paid for that with your donation dollars. And it gets worse:

Applying Through Your Employer’s Long Term Disability Benefits When MS Progresses

Featured speaker Lisa Kantor, LLP from Kantor and Kantor will share her expertise as an advocate who has successfully represented people in Employment Retirement Income Security Act (ERISA) benefit claims for over 18 years. If you have MS and Long Term Disability Insurance through your employer, you will want to know how to apply for and access these vital benefits.

Let me just begin by saying that the whole reason I’m here writing this, the whole reason this Foundation exists is because of the way my husband was treated both by his Long Term Disability insurance carrier, CIGNA.

He was denied his benefits by CIGNA. Twice. We had no where to turn for help, including the MS Society at the time.

This sort of teleconference series makes the National MS Society look good, but doesn’t really help. And with all the money they have, imagine what they could do. They could start by lobbying Congress to fix ERISA–that would go a long way in helping not just those with MS but all who have been denied their benefits or who have been mistreated by their health insurer.

Listening to Ms. Kantor may be helpful, she may even gain a few clients from this teleconference, but she can’t help you “apply for and access these vital benefits.” She simply cannot and that has nothing to do with Ms. Kantor.

See, one cannot actually access their long term disability benefits. I wrote extensively about that over at Illness and Insurance Hell.

Your insurance carrier starts the process while you are still on short-term disability; they will insist you apply for Social Security benefits and prove that you have been through that process or else they’ll deny your claim. They will even offer you help with one of their attorneys to make sure you go through the Social Security process.

To make matters even worse, they will obfuscate the truth (that’s called lying) in the face of medical evidence; they make things up. And when they are threatened with legal action, they send photographers (bad ones I’d like to add) to your house to photograph you and your family. My husband has lesions on his brain and spinal cord, could the guy with the camera, snapping away at us, somehow disprove that?

Then, after all of that, they all attend conferences with federal judges (among others) to figure out how to defend against ERISA claims. Anything not to pay a claim.

Which brings me back to the Affordable Care Act, the Ryan plan to abolish Medicare and the GOP still trying to get rid of health care reform.

I ask this: If the GOP succeeds in repealing health care (doubtful) but say they do, then the provisions in the law that help people, that stop lifetime caps, give seniors free preventative care, that fill the Medicare donut hole, that stops insurers from retroactively cancelling your plan, that gives Medicare drug discounts–if the GOP stops all this then what good is that $8,000 Ryan Voucher?

The Shame in Ryan’s Plan or How the GOP Wants to Stick it to Seniors.

Regarding the Ryan/GOP plan to privatize Medicare, from Talking Points Memo today:

Under the House Republican plan, the government holds fixed the amount of money it’s willing to pay per patient per year, and leaves the residual costs for seniors to sort out with private insurers. Because private insurers are smaller, profit-driven, and less efficient than Medicare, those out-of-pocket costs will be significantly higher than they are now. And they’d grow much, much faster. Over the course of the program’s 75 year planning period, the difference would amount to $34 trillion.

And while they are trying to take away the Medicare you paid for all your working lives, the GOP is still trying to repeal or defund the Affordable Care Act, where the new health care laws were put into place to stop the health insurance industry from some of its more pernicious acts against sick people.

The GOP wants to get rid of the new health care law with its consumer protections; high risk pool for those with pre-existing conditions, relief for seniors who hit the donut hole, allowing your children to remain on your policy until they are 26 years old, eliminating yearly and lifetime caps on your benefits, to name but a few of its many benefits.

See how your Congressional rep voted on the Ryan Plan here with an interactive map from the New York Times.

Want to know Paul Ryan’s net worth–and all members of Congress as well? Go to Open Secrets and find out. You can search by individual and even download the list of all members of Congress–the ones you pay to represent you. From Open Secrets:

About 1 percent of all Americans are millionaires. In Congress, that number regularly hovers between 40 percent and 50 percent, meaning elected leaders generally need not worry about the economic pressures many Americans face – from securing gainful employment to grappling with keeping a family financially afloat. Decide for yourself if these congressional millionaires are adequately representing your financial interests.

If the deficit really matters, then it’s time for Medicare for Everyone.

From Ezra Klein’s article in the Washington Post today:

Back during the health-care reform fight, the Congressional Budget Office looked at the likely effect of adding a public option that paid Medicare rates. “In total, a public plan based on Medicare rates would save $110 billion over 10 years,” the agency concluded. Importantly, the savings would come because premiums would be lower. The basic mechanism here is not complicated: Just as you get better deals by shopping at a mega-retailer like Wal-Mart, you get better deals by working with a mega-insurer like Medicare. Size matters.

As for Ryan’s plan, CBO’s take was just the opposite. “Under the proposal,” they said, “most elderly people would pay more for their health care than they would pay under the current Medicare system.” That is to say, health-care costs go up.

Your Congressional Representatives who voted to Abolish Medicare aka The Ryan Plan

Erratum: In the original posting below, I stated that under the Ryan plan, seniors would receive $6,000 voucher to help with purchasing insurance. This is incorrect. The correct figure is $8,000 for the year or roughly $666 per month to pay your premiums, co-pays and pharmacy charges.

Link to full map of all Congressional reps who voted on the Ryan plan below. List of California reps who voted to abolish Medicare at bottom of posting.

As this Foundation has noted before, Rep. Paul Ryan’s budget plan calls for abolishing Medicare to all those under the age of 55 and handing your taxpayer money over to private corporations. What happens to all the money you have been paying into Medicare for the past 30+ years of your working lives? Answer is you get nothing in return.

This Foundation began in part because of the way my husband, who has Progressive-Relapsing Multiple Sclerosis, was treated by his insurance carrier, CIGNA, a private, for-profit corporation with a long and terrible history of denying claims to their sick, premium paying customers–one such denial resulted in the death of 17 year old Nataline Sarkisyan.

Rep. Ryan and all his GOP friends want to hand you a voucher for $6,000 and tell you to go and find a company, like CIGNA, who will insure you at the age of 65, for that amount of money–while at the same time they, the GOP, are trying to undo the Affordable Care Act that will prevent insurance companies from denying your claims. Doesn’t make one bit of sense, does it?

If you have Multiple Sclerosis or any other life-altering disease, you know how far $6,000 will get you. If you have MS, that’s the cost of your disease modifying drugs for just one month!

Call your representative if they voted to abolish Medicare. Tell them forget trying to get re-elected since they don’t seem to be serving the American public but their corporate paymasters instead. Contact information is embedded in each link and the full map of how Congress voted can be found at the New York Times. It’s time this country went to a single payer system. Medicare for Everyone, cradle to grave.

Call and be heard. It’s your money that pays for Medicare and pays for Congressional salaries. Remember, they work for us.

Your California Congressional Representatives who voted to abolish Medicare and hand your money over to private corporations:

1.  Rep. Herger, Walter [R-CA2] voted to abolish Medicare.

2.  Rep. Lungren, Daniel [R-CA3] voted to abolish Medicare.

3.  Rep. McClintock, Tom [R-CA4] voted to abolish Medicare.

4.  Rep. Denham, Jeff [R-CA19] voted to abolish Medicare.

5.  Rep. Nunes, Devin [R-CA21] voted to abolish Medicare.

6.  Rep. McCarthy, Kevin [R-CA22] voted to abolish Medicare.

7.  Rep. Gallegly, Elton [R-CA24] voted to abolish Medicare.

8.  Rep. McKeon, Howard [R-CA25] voted to abolish Medicare.

9.  Rep. Dreier, David [R-CA26] voted to abolish Medicare.

10. Rep. Royce, Edward [R-CA40] voted to abolish Medicare.

11. Rep. Lewis, Jerry [R-CA41] voted to abolish Medicare.

12. Rep. Miller, Gary [R-CA42] voted to abolish Medicare.

13. Rep. Calvert, Ken [R-CA44] voted to abolish Medicare.

14. Rep. Bono Mack, Mary [R-CA45] voted to abolish Medicare.

15. Rep. Rohrabacher, Dana [R-CA46] voted to abolish Medicare.

16. Rep. Campbell, John [R-CA48] voted to abolish Medicare.

17. Rep. Issa, Darrell [R-CA49] voted to abolish Medicare.

18. Rep. Bilbray, Brian [R-CA50] voted to abolish Medicare.

19. Rep. Hunter, Duncan [R-CA52] voted to abolish Medicare.

 

Campath by any other name–including Lemtrada–is still Campath, price included!

They’re still at it, Genzyme and Sanofi are still in talks about a takeover by Sanofi and Genzyme is still touting their as-yet-to-be-approved treatment for MS, now openly being called by the name “Lemtrada,” as a $3 billion per year seller.

Campath (Lemtrada) was approved in 2001 for the treatment of lymphocytic leukemia, so for it to be used as a possible treatment for MS, and for Genzyme to be using this as leverage for a higher asking price, is well, in our opinion, shameful considering the price of Campath, aka Lemtrada.

Campath now sells for $30,000 for leukemia treatment. But MS patients need only a fraction of the dose used in cancer patients. At the current price, MS patients could get Campath for $7,000 or so. That’s far less than other MS treatments; just consider Novartis’ new drug Gilenya, priced at $48,000 a year.

So, Genzyme has a dilemma. To get market prices for Campath use in MS, it would have to price the drug differently for each use. But what would stop doctors from using cancer-priced vials rather than MS vials? After all, off-label use is perfectly legal.

What would stop doctors from using the cancer-priced vials rather than the far more expensive MS priced vials?

Could this have anything to do with the name, Lemtrada? A small reformulation tied to a higher price? Rebranding to make us think it isn’t a cheaper drug? We think it’s one of those and we are awaiting more information as it becomes available and will post it up here on our site.

From Bloomberg.com:

Sanofi-Aventis SA and Genzyme Corp. said takeover talks now involve executives from both companies as the two sides discuss extra payments tied to Lemtrada, an experimental multiple sclerosis drug.

Genzyme’s Lemtrada, sold under the name Campath as a treatment for blood cancer, may have sales of $3 billion to $3.5 billion by 2017 if approved for multiple sclerosis, according to the Cambridge, Massachusetts-based company. Sanofi and Genzyme said they are discussing a “contingent value right,” under which the French drugmaker would make additional payments for regulatory approval of the treatment and the achievement of certain sales thresholds.

You can search for clinical trials of Campath here at ClinicalTrials.gov. More on what we wrote about Genzyme and Campath here.

The GOP using states’ rights to repeal health care reform. What about ERISA?

The GOP loves big business more than they care about those constituents who elect them. Even thought the GOP uses states’ rights as a big rallying cry for repealing health care reform, they have been totally against amending the federal law that strips the states of their rights–when it comes to health insurance.

Let me explain.

ERISA laws or the Employee Retirement Income Security Act of 1974 set standards for pension plans so that when employees retired (and retire even though 401k plans have replaced most pension plans) they can breathe some sigh of relief that their employers did not raid their pension plans leaving them penniless for retirement. That’s one of the things it does, but it does a lot of other things as well. It covers employer-based health insurance plans, 401k plans and some severance plans.

The unintended consequences of having a federal law cover these things, especially health benefits, are that these federal laws pre-empt state laws.

The law limits the abilities of state legislatures to regulate many types of health insurance, it restricts the kinds of remedies that states can authorize (such as a patient’s right to independent appeal of denials or to see specialists) and it can limit the ability of states to experiment with novel ideas for health care solutions.

Two real-life examples of how our state laws and consumer protections are meaningless if we have been abused by our health insurers: The first one is in the Michael Moore movie, Sicko, and features a child named Annette Noe. This is also brought up in Wendell Potter’s book, Deadly Spin. Annette needed cochlear implants in both her ears but CIGNA only paid for one, calling implants in both ears, “too experimental.”

Think Progress featured another child in November of last year, Madison Leuchtmann, who CIGNA also refused to pay for her cochlear implants with the knowledge that this child may remain deaf the rest of her life if she did not receive the implants:

Unfortunately, the Leuchtmann’s family insurer, Cigna, has issued “one denial after another,” flatly refusing to cover the $20,000 bill for the implant. In a written statement to the local news station Fox 2, Cigna explained, “It is not unusual for commercial benefit plans to exclude hearing assisted devices,” prompting Dr. Clary to angrily respond, “This is obviously medically necessary. You have a child that has no ear canals!” Dr. Clary also told Fox 2 that he sees these sort of denials “on a weekly basis.” Watch Fox 2′s report:

Now in Annette Noe’s case, her father used the power of Michael Moore’s movie to get Annette her implants. I have no follow up news for Madison. But more importantly here, could Madison’s parents sue CIGNA to make them pay for her implants? The answer is no. And that’s because of ERISA.

And why is that? Let’s turn to an ERISA expert, an attorney, Richard Johnston and his blog, The Problem is ERISA:

As of now we have a situation where the law tells insurers they face no meaningful consequences if they deny care improperly or even commit outright fraud. As one federal judge has commented, “if an HMO wrongly denies a participant’s claim even in bad faith, the greatest cost it could face is being compelled to cover the procedure, the very cost it would have faced had it acted in good faith. Any rational HMO will recognize that if it acts in good faith, it will pay for far more procedures than if it acts otherwise, and punitive damages, which might otherwise guard against such profiteering, are no obstacle at all.” Insurance companies, of course, are not charities, but corporations; their boards are subject to a fiduciary duty to maximize shareholder value. If it is possible to accomplish this by mistreating insureds, then it follows insurers will do precisely that (and believe me, they do).

There is no incentive, financially speaking, to pay for benefits and these include treatments, transplants and disability benefits that are all covered under the ERISA umbrella.

Where does that leave the GOP who are so “anti-big government but pro-states’ rights? They side with those who would keep these laws in tact every time: The Health Insurance Industry. Disturbing about both groups is their love of thumbing their noses to the new (unconstitutional, as they say) federal law while remaining steadfast on guarding another federal law that hurts the common good. I guess it’s only unconstitutional when it hurts the corporate common good.

Every time ERISA has come up in Congress for some tweaking, guess what has happened? AHIP hires lobbyists, front groups (like this National Coalition on Benefits, they are a real gem) and this group; they all go into action and We, the People, are left in serfdom at the corrupt feet of the Insurance Lords.