Tuesday, October 04, 2011

Exporting the US "Health Ecosystem" and its "Wonderful Technology, Wonderful Approaches," or Exporting "A Parasite Eating Its Host?"

Last week, an article in the Minneapolis Star-Tribune suggested that our US corporate health care giants think they are doing such a good job they want to export the "world's best health care system" overseas:
A coalition of U.S. health care businesses, including Minnesota-based UnitedHealth Group and Medtronic, proposes to rebuild America's battered economy by selling the country's 'health ecosystem' internationally.

The Alliance for Healthcare Competitiveness (AHC) wants the U.S. government to build its foreign free-trade policy around the health care industry, noting that the sector has been a significant jobs creator since the recession began in 2008. Breaking down tariffs and other forms of international discrimination against America's 'health ecosystem' will allow developing countries such as China, India and Brazil to improve medical care while allowing U.S. companies to rescue the American economy by hiring more people, AHC leaders said Monday.

The worldwide need for health care in aging populations will lead to a demand for goods and services that can drive sales of American insurance, medical devices and record-keeping technology, said Simon Stevens, UnitedHealth's president of global health and an AHC member.

AHC members seem really convinced of the value of what they have to sell:
'We've got a lot of wonderful technologies, wonderful approaches,' said Alex Gorsky, Johnson & Johnson's vice chairman.

The Star-Tribune did note that our "health ecosystem" is
beset with skyrocketing costs and inefficiencies. Americans currently pay more for health care and rank lower in life expectancy and infant mortality than much of the developed world.

The article also managed to find one slightly dissenting expert,
'It seems ironic, at best,' said Jean Abraham, a professor of health policy and management at the University of Minnesota

Let me add a little more irony. The AHC advocates are top leaders at UnitedHealth and Johnson and Johnson.

UnitedHealth Group's Sorry Record

UnitedHealth would be the company whose CEO once was worth over a billion dollars due to back dated stock options, some of which he had to give back, but despite all the resulting legal actions, was still the ninth best paid CEO in the US for the first decade of the 21st century (look here). UnitedHealth would be the company whose current CEO made a cool $106 million in 2009 (look here). Howver, UnitedHealth would also be the company known for a string of ethical lapses:
- as reported by the Hartford Courant, "UnitedHealth Group Inc., the largest U.S. health insurer, will refund $50 million to small businesses that New York state officials said were overcharged in 2006."
- UnitedHalth promised its investors it would continue to raise premiums, even if that priced increasing numbers of people out of its policies (see post here);
- UnitedHealth's acquisition of Pacificare in California allegedly lead to a "meltdown" of its claims paying mechanisms (see post here);
- UnitedHealth's acquisition of Sierra Health Services allegedly gave it a monopoly in Utah, while the company allegedly was transferring much of its revenue out of the state of Rhode Island, rather than using it to pay claims (see post here)
- UnitedHealth frequently violated Nebraska insurance laws (see post here);
- UnitedHealth settled charges that its Ingenix subsidiaries manipulation of data lead to underpaying patients who received out-of-network care (see post here).
- UnitedHealth was accused of hiding the fact that the physicians it is now employing through its Optum subsidiary in fact work for a for-profit company, not directly for their patients (see post here).

Johnson and Johnson's Sorry Record

Johnson and Johnson also would be the company known for recalling heroic numbers of products, 26 different recalls since 2009, the latest, of Eprex, two weeks ago (see the WSJ Health blog recall watch here.).

Johnson and Johnson also has an amazing recent record of ethical lapses and guilty pleas, including:
-  Convictions in two different states in 2010 for misleading marketing of Risperdal
-  A guilty plea for misbranding Topamax in 2010
-  Guilty pleas to bribery in Europe in 2011 by J+J's DePuy subsidiary
-  A guilty plea for marketing Risperdal for unapproved uses in 2011 (see this link for all of the above)
-  Accusations that the company, which makes smoking cessation products,  participated along with tobacco companies in efforts to lobby state legislators (see post here)
-  A guilty plea to misbranding Natrecor by J+J subsidiary Scios (see post here)

With the justification that "he met expctations," so despite, or maybe because of all this, Johnson and Johnson paid its CEO $29 million in 2010 (see post here).

So maybe UnitedHealth Group and Johnson and Johnson want to quickly export their brilliance before someone else realizes how bad their corporate records are, and takes action in response.  Note that the "international discrimination" against such companies noted above could simply be another description of better regulatory systems in other countries which are more able to defend against the sorts of sleazy behavior that has plagued US health care.  If US "free-trade" policy succeeds in challenging such regulation, other developed countries, which provide generally better health care at lower costs, could become more susceptible to catching the US health care dysfunction syndrome.
For more pithy comments, Minneapolis Public Radio published a commentary by David Durenberger in which he noted:
A physician I know read a story in Tuesday's newspaper at about the same time I did, 6 a.m. By 8 we'd found that we were having identical reactions to this absurdity. But he had a better way of expressing it: 'It's like a parasite eating its host.'

'They have bankrupted our culture, so now they want to try and bankrupt China and India,' he said.

Of course, if maybe we could export all of Johnson and Johnson, UnitedHealth Group, and other corporations with similarly bad records of crimes, legal settlements, ethical missteps, and bad leadership to India and China, maybe our health care system would start recovering from its dysfunction (but then pity the poor Chinese and Indians).

Maybe the corporate leaders quoted above suffer from the same apparently complete lack of insight that another health care CEO (actually former CEO) exhibited recently (look here). However, such glaring inability to perceive one's own problems surely will lead them to grief in the near future. Our corporate health care giants have already lead our dysfunctional health care system to enough grief.

True health care reform would favor leaders of health care organizations who understand the health care context, and uphold health care professionals' values, and have enough insight to realize when they are falling short of these standards.

Meanwhile, rest assured that US health care is the system where nothing can go wrong, go wrong, go wrong.


InformaticsMD said...

Here's a treatise on the wonders of the Healthcare IT ecosystem:


Its export worked so well that the UK shut down its £13 billion program for national health IT, and Australia also received a rude awakening.

-- SS

Steve Lucas said...

I have to view this as another marketing scheme put together by someone who does not know anything about other countries medical systems. In the rest of the world medical care is viewed as a cost, not a marketing opportunity.

The EU is fighting pharma’s efforts to bring DTC ads to market. I cannot find the reference, but a recent Toronto Sun article highlighted the $1B IT failure and how that money could have gone to support the 1M people in Ontario who do not have access to a doctor.

Time and time again we find failure after failure in the medical establishment. Recent stories highlight ineffective medications and test. Medications that are left on the market and test that do nothing to enhance the patient’s survival.

While no system is perfect, I hope other countries continue to build on their success and we look to them for guidance. Why reinvent the wheel? Or maybe that is the point: As long as systems with better outcomes at a lower cost exist, people will look to those as models.

Low cost and above average outcomes are not hallmarks of the American system.

Steve Lucas

Anonymous said...

Yes, the arrogance of the US HIT vendors has impeded safe medical care in the US, the UK, and Australia. The concept is a farce.

Caveat emptor could not apply more to the sales pitch of the HIT vendors.