The Forgotten Minority

A few years ago my son got a toothpick stuck in his toe. This was not really a serious situation, but it is odd how little things can sometimes snowball into a real big deal. The pain he experienced was more like something larger then a toothpick say an electric pole. Sure the doctor was able to take that toothpick out of his foot, but not without a little effort. Small things like prescribed medications can be a significant financial hardship for those on fixed incomes, such as the disabled. It can become a choice between buying food and buying medication. The problem needs to be identified and then a plan of action needs to be initiated. “At present 75% of prescriptions are paid out of pocket” (Fisher, 206). The impact of the price of prescription medications for the disabled is a problem that needs to be regulated, a sizeable portion of those disabled that are on Medicare are unable to afford their medications and some kind of long range plan to meet the medication needs of the disabled, the elderly, and all Americans.

The title of this essay is the “The Forgotten Minority’. The disabled are a large minority that rarely, if ever, is remembered in the minds of the pharmaceutical industry and many health professionals. It could be said that the pharmaceutical industry is one of the major obstacles between a fair market price for medications and a grossly expensive price for medications. The pharmaceutical industry sets their own price for their product and they do have a right to do so. However, what they should not have is a right to set that price so high that those who are desperately in need of their product can not afford it. They do not have a humanitarian right to make exorbitant profit off the consumer for whatever reason. They at this time have the right to exclusive right to sell their product as the product they discovered or developed for a period of seventeen years. Then to have them also involved in the process of determining what kind of prescription program that Medicare is supposed to have is very foolish. It does not sound like these big business concerns, such as the pharmaceutical industry have the best needs in mind for Americas disabled. It seems that when any company produces a product that is so important to our nation that they should be limited as to price. It is similar to letting the wolf baby-sit the sheep. Their stake is money not the safety and welfare of the patient.

When it comes to prescription needs whatever applies to the elderly applies to the disabled. Simply put the rules for Social Security and Medicare are the same for disabled and the elderly. The disabled when it comes to medical choices, including choices of what medications to use are at the mercy of the big three: doctors, Medicare and pharmaceutical industries. Congress formed a Bi–partisan Commission to look into ways to reform the program to make it more like a health insurance program and hence better suited to meeting these needs (McClellan, 22).

The nation’s doctors are much to willing to prescribe medications without any knowledge of the patients’ ability to pay. You want your doctor to be unbiased, but a doctor can not be unbiased if he is receiving undue influence from the pharmaceutical industry. It does not seem to matter if the prescription costs several more times then what a disabled patient on Social Security Disability is able to pay. This influence has the possible effect of skewing the doctors’ judgment (ABC News, 36). The doctor is under this situation prone to be more interested in his “bonus” then in what is best for his patient. Dr. Arnold Relman, a Harvard Medical professor says that “It makes the doctor beholden…it suborns the judgment of the doctor” (Ross, 2).

‘The economic, legal, and ethical questions” (Fisher, 209), concern the activities of the pharmaceutical industries sales persons. These sales people are called detailers it is their job to visit the doctors office to convince them to use a certain medication. Their activities, however, have included dinners, luncheons, vacations, pens, and whatever other “freebies” that they can give to influence the doctors to use their companies product. Most people have probably seen the advertisements on T. V., but that is only the tip of the ice berg when it comes to the advertising that these companies do. These “detailers” are operating behind the scenes to further jack up the price of medications. The consumer gets to pay the price, whether, they can afford it or not. Those on Medicare or the disabled are not always able to afford the medications that are prescribed for them and hence, have to resort to other means.

No single group in America is affected more by the power and influence of the pharmaceutical industry then the disabled. The disabled in most cases lack the financial resources to buy prescriptions, even if they are on Medicare. The price of the medication exceeds there ability to pay and take care of living expenses. Here was a time that the needs and cares of the patient came before profit. In fact there was not just a movement to provide treatment, but a concern as to whether the patient could afford the treatment. There was a sincere effort to provide medical treatment to everyone. It was believed that “…medical services must be available to the eligible public—economically, socially, and geographically…only as financial barriers to early and thorough care are removed” the “Quality of medical care” at one time was an indicator of the overall health of the society (Weinerman, 189). It is amazing that the suggestion was made in 1951, that medications should be available to everyone without a concern for there cost, social status, or where you live, that all existing obstacles to good health should be eliminated. It was thought of back then so it should be now.

The new prescription drug program is not going to make changes that will improve drastically how medications are provided for the disabled. For one thing it is up to the individual to find the appropriate carrier for their needs. As of now when talking to them on the telephone even the though it is confusing “it will be a smooth transition with no unseen problems” (UK pharmacy). However, medications will have to qualify under the “formulary” list in order to be paid for, then there will still be a co—pay to get medications. “The drug industry has a lock on Congress, and most of us don’t realize how bad Medicare is” (Kratz, 39). This is just what the pharmaceutical industry wants, after all this way will not cut into their profits. They have such a lock on legislation that they are one of the largest lobbies in Washington and it is doubtless that anything will get by them, “… while the drug-industry trade association increased spending on lobbying from $7 million in 2000 to more than $11 million in 2001” (Kratz, 39). Disabled Americans are going to have to foot the bill for their own medications in much the same way if things do not change. Medicare at present is unable to do anything because of the inability of Congress to make meaningful reform to the law. The changes that have been made were approved by the pharmaceutical industry, which is hardly unbiased in favor of anything that would reduce their profits (Peterson Walsh, 27).

At the same time that they are one of the largest lobby groups in Washington D.C. They also have one of the largest profit margins when compared to other business as we have seen. This profit is so that they can research more medications. The problem with this is that they also advertise very heavily and pass it on to the customers. Some of the customers no doubt can pay for their prescriptions without any trouble. However, some of those that are disabled find it extremely difficult to pay for their prescriptions and have money left for such important things as eating, paying rent, heating the house, cable service, and a telephone. Either have the government pay for medications outright or force the pharmaceutical industry to take a cut in profits.

Medicare is not being reformed fast enough, or sufficiently enough by congress to meet the needs of the disabled let alone everyone else. The net result of this is that the pharmaceutical industry is free to price their products at any level that they see fit. Congress has produced a new drug benefit, but the problem is that this is just a panacea that only covers a small part of the problem. The problem is that it is going to be turned over to the private sector, which just happens to be a part of the program. The net result of these budget problems that the Medicare program finds itself is that the government is attempting to balance the Medicare budget on the backs of the disabled, elderly and retired portion of American society (McClellan, 26).

The choices of what medical coverage for seeing a doctor or prescriptions should not be in the hands of the public sector. We should nationalize the whole of the health care industry. A patient ought not to be put on the spot of choosing what private carrier does not have a formulary. A formulary is a list of what medications that are covered. No patient ought to have to worry about a prescription being covered. When going to a doctor the only concern should be getting well. The only way that this can be done fairly is when the profit motive is no longer in the picture.

However, the problem is that this is no longer the case between the medical insurance business, HMO, pharmaceutical manufacturing, hospitals, doctors and nurses they have lost sight of the patients needs. No group of people in this nation has been more affected by this then the nations disabled. Without adequate income to afford medications it becomes a barrier to good health. The price of most of the prescription medications is way over the ability of most people on disability to be able to afford it. 14% of those on Medicare are disabled (Kaiser, 2). Being disabled can also mean in some cases poverty or near poverty existence. This chart illustrates the point about Medicare beneficiaries notice that 40% of the disabled on Medicare earn less then $10,000 per year and that was in 2002. A good case in point about what happens to those that are forced to use Medicare and its state partner Medicaid is what is now happening in the state of Mississippi. (Kaiser, 2)

The state of Mississippi is taking an aggressive attitude toward lowering the cost of those on Medicaid by establishing a $350 a month income limit and a name brand limit of two on prescriptions (Hart). Here is an attempt to curb medical costs, but the patients have been made to suffer and foot the bill for medications just so that the budget gets balanced. This needs to stop and it needs to stop as quickly as possible. Okay sure medical care has gotten expensive, but this is America and we solve problems here not create them. The problem has gotten so large that just the pharmaceutical area of it is a multi billion dollar industry that shows no interest in slowing down any time soon.

In 2001 while other industries were experiencing a “decline of 53% in 2001”, the pharmaceutical industries were experiencing profits of 32%. The explanation for this was it took this kind of money to do research into new drugs (Gottlieb, 1). It is apparent that the pharmaceutical industry is in business to make profits, but when these companies are effectively unregulated by congress it is a disgrace. No company deserves a right to extract enormous profits at the expense of people. They are in business to make profits and that is okay, but when the nations health is at risk making a profit based on sickness is wrong. What regulations exist is in effective and complicated. With the amount of power that they have in Washington they are in a position to stop any legislation that is not favorable to them.

Congress does nothing, but debate over what should be done, then compromises on a plan that meets few of the needs of the disabled. This last legislation went more to help Republican congressional representative to go home and say, “See what we have done?” However, nothing of any consequence has been done. The problems that need to be solved in the Medicare program are still there. Yes, there is the new Drug Prescription program, but it is up to the disabled and elderly to find there own private carrier to enact it. However, in some cases patients are not able to find these resources, especially those that are in a resthome.

Nursing home residents take large numbers of prescription drugs, an average of eight a day. But many have physical disabilities and brain disorders that impair their memory and judgment. So they cannot easily shop around for insurance plans to find the best bargains on their drugs, as other Medicare beneficiaries are supposed to do (Pear, 1).

For one thing the process is time consuming and very confusing. “They do not even know what is going to happen and the information is changing constantly. They seem to be handling any upcoming problem as it occurs, which, really makes it confusing,” says Cyndi Heringer.

A good solution would be again to nationalize health care for everyone. No one should have to go without a medication simply because they can not afford it. No one should have to go without because it is unavailable to them. No one should have to go without simply because of where they live. Take it out of the hands of the private sector because they seem unable to make changes or put aside wanting to make huge profits. We should look to Canada and copy their national health program, minus its shortcomings. It is admitted that some countries, such as Canada, that have a national health care system have had some problems, such as certain procedures taking to long. It would not be very difficult for congress to look into a program of national health care and make sure that none of the problems exists in our program.

Anything is better then the monopoly we have under the present program. Between the various parts of the health industry America is at their mercy. All of this centers on treatments that includes drugs, hospitals, HMOS, doctors, nurses, the pharmaceutical industry and private health insurance companies. Yes, pharmaceutical companies are a monopoly based on medications. Enormous profits on new medications for up to seventeen years and making the consumer pay for advertising

During a year in which there was much talk of sacrifice

Drug companies increased their astounding profits by hiking prescription prices, advertising more than Nike shoes, and successfully lobbying for lucrative monopoly patent extensions. (Gottlieb, 1)

their product. They advertise more then Nike does for their shoes and a pair of Nikes is a luxury.

The media has made the connection of the pharmaceutical industry being a monopoly, but they are not by themselves in this regard.. There has been some criticism along this line from academia as well, the point is made that these companies are not technically monopolies, but do wield the kind of power that a monopoly does.

“…concerns that the pharmaceutical companies may possess monopoly power, the United States Government, major U.S. hospitals, and health care commentators are focusing on the sales and pricing practices of pharmaceutical companies” (Fisher, 207).

They do act like a monopoly in how they handle their sales and how they price their product. Yet, do to a large lobby in Washington, they still get by with their practices.

If these entities are looking into the pricing practices of these mega firms, then it makes sense that there probably is some reason for concern.

Washington needs to be told that we have had enough of high priced medications that are being peddled by these monopoly drug pushers with a license. The American public should do something about this maybe only electing congressional representatives with the will to do it. Tell them what we want and force them to do it, by not voting for those that are not actively trying to help Americas disabled, poor, elderly, and retired. Demand that some action needs to be taken that is more then a white wash.

Finally, there has been several lessons learned from this paper. Pharmaceutical companies are a monopoly like a business that apparently put profit before a humanitarian spirit. The folks in Washington are listening to them more then they are listening to us. Good medical coverage for all Americans is not to be looked for in the near future so long as the pharmaceutical industry is lobbying against it. There are many people that need prescription drug coverage and medical benefits that are not getting it. People need to start coming before business as usual, the business being the pharmaceutical kind, adopting a nationalized medical coverage is not unattainable. Lastly, start listening to Americas disabled and elderly, they have something to say, “Stop pricing medications so I can not afford them”.

Works Cited

Fisher, Susan Heilbronner, “The Economic Wisdom of Regulating Pharmaceutical ‘Freebies’”, Duke Law Journal, (1991) Vol. 1991, No. 1, 206—239, <http:links.jstor.org>.

Gottlieb, Scott, “New Figures Prove Pharmaceutical Industry Continues to Fleece Americans”, AIDS Coalition to Unleash Power, (2002) New York, <http:links.jstor.org>.

Hart, Shaila Dewana Ariel, “In Mississippi, Soaring Costs Force Deep Medicaid Cuts”, New York Times, (2005), New York. <http://infoweb.newsbank.com.
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Kaiser, Henry J. Foundation, 2003, <http://www.kff.org/medicare/upload/Low-Income-Assistance-Under-the-Medicare-Drug-Benefit-Fact-Sheet.pdf>

McClellan, Mark, Medicare “Reform: Fundamental Problems, Incremental Steps”, The Journal of Economic Perspectives, (2000) Vol. 14, No. 2, 21-44
<http:links.jstor.org>.

Pear, Robert, “New Medicare Drug Plan Is Raising Difficult Issues For Nursing Home Patients”, New York Times, (2004). <http://infoweb.newsbank.com.
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Ross, Brian; Scott, David, “Pharmaceutical Companies; Influencing Doctors”, ABC News, (2002), <abcnews.go.com>

Weinerman, E. Richard, “The Quality of Medical Care,” Annals of the American Academy of Political and Social Science, Vol. 273, Medical Care for Americans, (1951), 185—191<http:links.jstor.org>.