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The Rapacious Prescription Drug Industry

There are two recent books that expose the unsalutary practices of the drug industry. One is "Our Daily Meds," by Melody Peterson  (left) and the other is "The Truth About the Drug Companies," by Marcia Angell (below). A recent study found that half the Americans that have health insurance are on some kind of prescription drug! Ever since drug advertising became legal in the US in 1997 (one of two nations in the world that allow it), the drug industry has beaten a drum to the tune that there is a prescription drug for every malady perceived or otherwise that will take care of the problem. They have even created diseases for which there was no prior awareness.

USA Today on Tuesday examined the "political clout of the pharmaceutical industry," which since 1998 has spent $758 million on lobbying efforts -- more than any other industry, according to the... Center for Public Integrity. The pharmaceutical industry in 2003 spent $143 million on lobbying activities. At that time, there were 1,274 registered pharmaceutical lobbyists in Washington, D.C. -- more than two for every member of Congress, USA Today reports. Of those, 476 were former federal officials, including 40 former members of Congress. Former Rep. Billy Tauzin (R-La.) earlier this year was named CEO and president of the Pharmaceutical Research and Manufacturers of America. According to USA Today, Tauzin's move to the private sector is "testament to the industry's power." Prior to taking his position with PhRMA, Tauzin helped pass the Medicare prescription drug benefit as chair of the House Energy and Commerce Committee. Currently, Senate Majority Leader Bill Frist (R-Tenn.) -- the "gatekeeper for legislation that comes to the Senate floor" -- is a "key lobbying target" for the industry, USA Today reports. During the 2004 election cycle, the drug industry contributed at least $17 million to federal candidates, including $1 million to President Bush and $500,000 to former Democratic presidential nominee Sen. John Kerry (D-Mass).

The pharmaceutical industry would have you believe that they need to charge such high prices for their wares so that they can do research to come up with more and better drugs. In point of fact their research budgets are meager compared to their outlays for advertising, lobbying and executive compensation packages. They've found that a "me too" drug can make them more money than a drug that they've developed from scratch. A "me too" drug is one that they've copied from a success by another drug company, but offers nothing new or original. As for research, they won't hesitate to put a drug on the market whose negative side effects almost outweigh the positive effects of the drug, and those positive effects may be little more than a placebo. As a result, US citizens are loading up on drugs in their systems which may be doing them more harm than good.

Doctors are totally in bed with the drug industry which offers them all kinds of money and perks to go along with the program. The drug industry will even ghostwrite the research papers for them (as well as the congressional legislation) and see that they are published in what used to be independent, unbiased journals. All the doctor need do is put his name on it. (All Congress need do is pass the legislation.)

The newer and scarier material in “Our Daily Meds” concerns the increasingly serious consequences of Americans’ dependency on prescription drugs. Disagreeing with Iowa’s nosologist, Ms. Petersen says the lethal consequences of overprescribed or misprescribed drugs are too readily accepted as “natural” death. She cites the unwillingness of pathologists to question the wisdom with which doctors dispense medications. The reluctance of hospitals to perform autopsies, she says, has impeded medical research into what these interactions can do.

So the accumulation of drugs is a person's system and the encouragement by the drug companies to increasingly rely on pills to cure every perceived pain or ailment goes hand in hand with the public's laziness and unwillingness to take responsibility for their own lives and to seek a panacea by altering their lifestyles - in particular diet and exercise. Dieting and excercise require work and a willingness to undergo pain and discomfort. Instead why not avoid the pain and discomfort by taking a pill? And if a particular drug does not solve the problem ... ? Not to worry, the doctor will simply prescribe another drug. If that one doesn't work, then another and another... In this way the profits are multiplied. So a failure is actually a success ... in terms of profits.

But while the rhetoric is stirring, it has very little to do with reality. First, research and development (R&D) is a relatively small part of the budgets of the big drug companies—dwarfed by their vast expenditures on marketing and administration, and smaller even than profits. In fact, year after year, for over two decades, this industry has been far and away the most profitable in the United States. (In 2003, for the first time, the industry lost its first-place position, coming in third, behind "mining, crude oil production," and "commercial banks.") The prices drug companies charge have little relationship to the costs of making the drugs and could be cut dramatically without coming anywhere close to threatening R&D. Second, the pharmaceutical industry is not especially innovative. As hard as it is to believe, only a handful of truly important drugs have been brought to market in recent years, and they were mostly based on taxpayer-funded research at academic institutions, small biotechnology companies, or the National Institutes of Health (NIH). The great majority of "new" drugs are not new at all but merely variations of older drugs already on the market. These are called "me-too" drugs. The idea is to grab a share of an established, lucrative market by producing something very similar to a top-selling drug. For instance, we now have six statins (Mevacor, Lipitor, Zocor, Pravachol, Lescol, and the newest, Crestor) on the market to lower cholesterol, all variants of the first.

Not only that but when a study shows that a drug such as Vioxx causes more harm than good or has disastrous side effects, the FDA allows them to keep it on the market, to keep selling it and to keep endangering peoples' lives. A conclusive study found that Vioxx was causing heart attacks and strokes, but it's still being sold as well as other drugs which have been found to be harmful.

The moral is profits first, human lives second and our government is in the pockets of the drug lobby.

France Best, US Worst in Preventable Death Ranking

A recent study has found that France is best and the US worst in rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations. This is considered an overall gauge of the quality of health care in the countries involved.

France did best -- with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people, in the study period of 2002 and 2003. Japan had 71.2 and Australia had 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people, the researchers said. After the top three, Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal, with the United States last. A key factor in the poor showing of the US is that 47 million US citizens lack any kind of health insurance while in every other case all citizens are fully insured by national health care insurance. If the US health care system performed as well as the top three countries, there would be 101,000 fewer preventable deaths per year.

But these studies miss the point. The US health care system is excellent for those who can afford access to it just as the education system is excellent for those who can afford access to it. The US is committed to a way of life that provides excellence for those who can afford it and crap for those who can't. This, of course, brings the averages down when people conduct studies based on overall measures of goodness or performance. Other advanced industrialized nations provide health care and education as a matter of course for all their citizens and hence are more egalitarian than the US. The US way of life is "Money talks; merde walks." In other words the US is based on privatized solutions to social welfare which are inherently unequal while other advanced countries are more socialist in nature. There is more of a welfarist component and a concern for the average citizen. The US government, at least under the Republicans, is committed to privatizing everything. Therefore, all welfare will be privately commodified and bought and sold with those who can't afford it forced out of the welfare market whether that market is for health, education, recreation, retirement or what have you.

In France education is free or almost free from the age of 2 through graduate  studies.

Education is almost free at all levels (tuition $100 a year at Sorbonne) except for private schools and business schools. 26% of university students receive scholarships. But it is a fact that French Universities do not offer as many services and facilities as American univeristies and from this standpoint, only Grandes Ecoles compare to the US system.

Annual costs for a student at the prestigious Sorbonne are less than $300! Meanwhile, in the US students are paying $50,000. to $100,000. per year and have to borrow huge sums of money from predatory loan operations like Sallie Mae which used to be government owned but now is completely privatized and corporatized complete with huge CEO salary. Administrative costs (read CEO  salaries and advertising) for private corporations are much higher in the US than in Europe whether it be for health care or education. The profit motive drives up these costs and makes the operations much less efficient than when the service is government provided to the public.

Unheard of in the US is the way the French support families:

The Family system (Allocations Familiales) is a financial help to all families (whatever their income) plus various services such as day-care or vacation centers (according to income) ; when a family is expecting a child, it gets approximately 2,000 Euros in three installments (the first two of them corresponding to a mandatory medical visit, the third to the birth) ; then the family receives a monthly allowance till the child is 20 (for two children or more, around 100 Euros/month/child).

And the retirement system is provided by the state not by private employers or the stock market. In fact French funding for retirees is not invested in the stock market so it is independent of market fluctuations and boom or bust cycles. In the US employer provided pensions have been largely replaced with employee funded 401ks. The difference is that the employee must now bear the risks associated with the market and could well end up with nothing at retirement even though he or she has invested consistently over the course of a lifetime. Risks have been shifted from employer to employee.

In France social security provides about 750 euros per month (about $1125.) to anyone who has worked 40 years. Note that it does not depend on the amount of money you have made as in the US system where high wage earners who have paid more into the system receive more than low wage earners. Everyone receives the same amount.

Contrary to what most Americans believe, the French government run social security system is more efficient than US privatized corporate provided systems with the administrative cost of the health care system being around 4.5% (for US private insurance companies it's 10 to 13%) and 1.2% for the retirement system (vs. around 10% for most pension funds).

Finally, consider what kind of society you want to live in: one that exhibits compassion towards its citizens, one where there truly is a social contract, or one that is devoted to the private pursuit of profit at all costs including leaving a substantial number of its citizens by the wayside and out in the  cold. Michael Moore dramatized the contradictions in US society contrasted with the beneficence of the French most effectively in his movie Sicko.

Health : by all standards the French health system compares very favorably to the US system. It is based on a moral and political consensus that protecting the health of citizens, and keeping them from what can be avoided in the trauma of illness and death, is one of the major responsibilities of the Society as a whole. Therefore, the State ensures that everybody is protected and people consider it to be in charge of controlling the quality of the health system and of regulating all its private and public players, including corporations which must contribute equally to it. The results : 100% people covered (see CMU), for a cost 30 or 40% [less than] America's (11,1% of GNP vs. more than 14% in the US) and with better results (see better ratios : life expectancy, infantile mortality, obesity, etc). The French are astonished when they are told that more than 40 million Americans have no health coverage (and even more no dental coverage). Being worried about the health bill does not exist in France. The social consensus is : "it is sad enough to be sick and one must not have an additional money problem about it". Saying "it is socialized medicine, therefore bureaucratic and inefficient" is ridicululous and wrong : look at the facts! See the WHO ranking : France comes first and read a column in the IHT ("French Lesson").

Privatizing Medicare: The Medicare Advantage Plan

The Republican goal is to privatize social security and medicare. But this doesn't necessarily have to happen in one fell swoop. It's happening quietly already with no fanfare, no outcry and right under our noses. When I signed up for Medicare  in 2006, I  was given the choice of signing up for traditional Medicare or the so-called  Medicare Advantage plan. I should point out that this only has to do with Medicare Part B, the part that covers doctors' visits and not Part A, hospitalization, which is free. To make matters more confusing, there is Part D, the drug part, which was enacted in 2003 when they also revamped the Advantage plan which had been laying around dormant, I guess. The Advantage plan, seemingly, offers additional benefits that traditional Medicare doesn't for the same amount of money. For instance, you get a free annual physical exam which you don't get under traditional Medicare. Why not? If preventative medicine and early diagnosis save the system money in the long run not to mention human misery, you'd think the government would want every enrollee to have a free annual check-up as part of Medicare. In addition, the Advantage plan I signed up for (there are  several available offered by different for profit, private corporations), Secure Horizons (part  of  United  Health Care whose CEO Bill McGuire made $100  million last year), offered free eyeglasses every two years, an optional dental plan etc. 

All these enticements were offered to get people to sign up for the Advantage plan which is privatized corporate sponsored health insurance rather than traditional government sponsored, single payer health insurance which is what  Medicare is.  So who wouldn't sign up for a plan that offered everything Medicare offered, but more!  So what's the catch? When I signed up, I had to choose a primary physician and a hospital.  I got to keep the doctor I was already going to and the hospital I would have prefered anyway so, seemingly, I was ahead of the game. I had also been going to a podiatrist for toenail fungus who was in the same network so I should have been able to keep seeing him, right? Not so fast. I needed a "referral" from my primary doctor or in other words, permission, to see the podiatrist and get reimbursed by Secure Horizons. He wouldn't give it to me because he didn't consider toenail fungus a serious enough problem to warrant my seeing the podiatrist. Neither would he treat it. So he was acting now as a "gatekeeper." Another ongoing situation was also now considered benign and nothing  should be  done about it. So I was denied seeing a specialist twice in a few short months. Now, granted, toenail fungus isn't life threatening, but it was covered under my Blue Cross health insurance prior to going on Medicare or Medicare Advantage. But a number of other life threatening problems have been denied to other people. That's how CEO Bill McGuire makes his $100 million, by denying people health care.

The advantage  of  traditional Medicare is that you can see any doctor or specialist you  choose for a  small co-pay. You don't need your primary  physician's approval. So you can get second opinions. Another thing I found was that, as soon as I was signed up for Secure  Horizons, I started getting tons of literature which, after I had waded through it, I discovered that its main purpose was to start rescinding some of  the "advantages" I was enticed into signing up for in the first place. Like, for example, the "free" eyeglasses every two years. That little benefit was unobtrusively dropped. I started getting the feeling that, as time went on, any link with Medicare would be broken and I would be fully privatized right out of the system. Then my benefits would be reduced and my premiums would skyrocket.

There has been much criticism of the Medicare Advantage plans. For instance, the government literature and Medicare.gov website  seems to make the Advantage plan much more attractive than  traditional Medicare. The  health care corporations pay the doctors more than traditional Medicare does for the same service making it more profitable for doctors to take on Advantage patients while rejecting traditional Medicare patients. Medicare Part B premiums keep going up so that the  government, which pays the  private corporations what they would normally charge the traditional Medicare recipient on a monthly basis, can pay them more each year making the advantage not to the patient but to the health care corporations. However, the more Medicare patients the government can off-load onto Advantage programs, the more money the government actually saves because neither the monthly premiums nor the payroll taxes that fund Medicare actually pay the full costs. It requires serpentine logic to make any sense of this but this is from the President's Executive Office of Management and Budget:

There is a common misperception that there is a Medicare surplus and that Congress must take action to preserve its assets. There is no Medicare surplus. Any excess cash collected from the payroll tax that is not used to provide hospital insurance is used for other Medicare spending such as doctor bills, which are not fully covered by premiums paid by beneficiaries. These premiums cover only about 25 percent of doctor bills and other costs paid from Medicare's other trust fund, the Part B, or Supplementary Medical Insurance trust fund. Additional funds come from the general fund of the government to cover Medicare's remaining costs. In fact, in 2002, without this general fund transfer, Medicare would face a $48 billion shortfall.

So the money essentaily comes from the government's general fund just as social security does (since the government borrows against payroll tax money collected for social security) making payroll taxes simply a farce. They are just a regressive excuse for burdening the middle class and poor while letting the rich off the hook tax wise. The increasing monthly premiums for Medicare Part B are wiping out cost of living social security increases for seniors:

Many Medicare beneficiaries could see next year’s cost-of-living increases in their Social Security checks much reduced by higher Medicare premiums that will grow by $11.60 a month in 2005, the largest annual dollar hike in Medicare’s history. The Part B premium, which covers doctors’ and outpatient services, will rise from $66.60 to $78.20 a month, a 17.4 percent increase. Next year’s Social Security benefits, not yet announced, are expected to rise only 2 to 3 percent, the rate of general inflation. Someone receiving a $600 check, for example, would get an extra $15 a month next year under a 2.5 percent cost-of-living increase, but the new Medicare premium would wipe out all but $3.40. "A 17 percent increase is alarming," says John Rother, AARP’s director of policy. "If that pattern repeats itself in future years, it means that nobody will get Social Security benefits that keep up with inflation."

The government under the Bush Administration is actually paying more to the private insurers per person than it's allocating for traditional Medicare. This allows the private insurers to pay its doctors more than they're paid for the same service by traditional  Medicare and undermines the whole government program:

AARP's support of Medicare Advantage doesn't benefit seniors Call it the riddle of AARP. It's truly puzzling why an organization that represents 38 million individuals 50 and over, many of whom depend on Medicare, would endorse a Medicare offshoot -- Medicare Advantage -- that siphons money from traditional Medicare and is seen by many as part of an effort to privatize Medicare. AARP says in ads, "Discover the only Medicare Advantage health plan that carries the AARP name." The plan is provided by United Healthcare, among the nation's largest for-profit health insurers. The particular plan AARP has put its name to is a private fee-for-service plan, the fastest growing segment of Medicare Advantage, up nearly 300 percent in a recent 18-month period. Why should anyone drop out of popular, tried and true government-run Medicare and opt for a private insurance plan? The chief reason is that Medicare has been grossly overpaying the private plans to cover seniors who desert traditional Medicare. The generous payments make it possible to lure seniors with attractive premiums and benefits. In some places they even rebate the $93.50 monthly Part B premium. It's not unusual for Medical Advantage plans to offer enrollees free health club membership and zero premium for coverage that includes the Part D drug benefit without extra cost. Of course, there is cost, including profits to the private insurer, but seniors are willing to enroll because it seems like such a good deal and because they may not realize that leaving traditional Medicare in the lurch weakens it for other seniors.

It seems clear that Republicans are trying to discourage seniors from enrolling in traditional Medicare and to discourage doctors from accepting traditional Medicare  patients by reducing their payments for services under traditional Medicare:

The Medicare Payment Advisory Commission (MedPAC), Congress’ expert advisory body on Medicare payments, reported this month that Medicare is losing billions of dollars each year because of excessive payments to private insurance plans through the Medicare Advantage program.  (Under that program, Medicare beneficiaries may elect coverage through private “Medicare Advantage” plans rather than through traditional fee-for-service Medicare.)  Although private plans ostensibly were brought into Medicare to introduce competition and reduce costs, MedPAC has found that, on average, the federal government is paying the private plans 12 percent more than it costs to treat comparable beneficiaries through traditional Medicare.

This year I decided to convert back to traditional Medicare starting in 2008 for several reasons: 1) I can go to my foot doctor again for a reasonable co-pay instead of his normal $140. charge for an office visit; 2) I don't want to support Bush's privatization plan for Medicare; 3) I don't want to support CEO Bill McGuire's $100 million annual salary and 4) if I did develop a serious medical condition, I don't want to be denied health care by my primary doctor acting as gatekeeper, the gate being to Bill McGuire's continued profits and fortune. At least at this point you can convert back. If the Republicans had their way - and some day they may - that link would be broken and once on the Advantage plan it would be impossible to go back. Then watch your benefits reduced and your premiums rise. I was told that I would have to get a supplementary "private" drug plan since traditional Medicare doesn't have an inherent drug plan while the Advantage plan does (another one of its "advantages"). Since I don't use any prescription drugs, I hesitated to pay additional for one, but then I was told there would be a penalty if I didn't sign up right then but wanted to later - another little tool to funnel money to private  corporations. So I signed up for the least expensive at $20 a month with Humana. This is another disincentive for traditional Medicare - you have to pay extra for Medicare Part D, the drug part. So traditional Medicare will cost me more each month for less benefits than the Advantage plan, and I may be rejected by some doctors who won't even service traditional Medicare patients because they don't get reimbursed enough.

The whole Advantage program, like Medicare Part D, is nothing more than a plan to privatize and corporatize Medicare. At the same time health care corporation CEOs like Bill McGuire are making obscene $100 million salaries and sitting on a billion dollars in stock options. Once seniors are on private plans and government sponsored health care is undermined till it collapses, seniors will be  forced to pay through the nose for less service. And the private health care corporations will do it like they do right now by denying people who really need them expensive health care procedures.

One of President Bush’s reasons for threatening to veto the expansion of the State Children’s Health Insurance Program, known as SCHIP, is that it would be financed partly by a cutback in something called "Medicare Advantage." If you don’t know about Medicare Advantage, that’s no surprise. It is popular in California, Florida, New York, Ohio and Pennsylvania, where more than 30 percent of Medicare beneficiaries have signed up for it. But in Maine, New Hampshire and Vermont, fewer than 3 percent belong, and some doctors have never heard of it. Medicare Advantage, heavily promoted by the Bush administration as an alternative to "socialized medicine," is a program that pays various private health plans to provide service less available under ordinary Medicare. Critics see it as an administration wedge intended to privatize Medicare, which now serves 44 million elderly and disabled people. About 8.7 million of them, 20 percent, get expanded Medicare benefits through these private plans. Mainers are well off to avoid these Medicare Advantage plans, as shown by a chorus of criticism and condemnation. The American Medical Association reported in May that its survey "paints a bleak picture of physicians’ experience with Medicare Advantage plans." More than half of the physicians surveyed said their patients had been denied coverage of services covered by the traditional, government run, Medicare plan. Eighty-four percent said their patients couldn’t understand how the private plans worked. AMA’s board chairman, Dr. Cecil Wilson, said: "The private health plans were supposed to inject competition into the Medicare program, but instead we’ve ended up with a federal handout to the insurance industry." He quoted government figures to show that eliminating overpayments to insurance companies will save Medicare $65 million over five years.

Medical Tourism

The following article entitled "US Patients choosing Mexican Hospitals for Price, Quality" by Alfredo Chorchado and Laurence Iliff appeared in the Dallas Morning News, July 28, 2007.

When Carrollton resident Brian Woods needed laser eye surgery last year, he scrutinized options in North Texas for the best deal. McAllen resident Cesar Vega was concerned about the long wait he faced to treat his broken leg after a motorcycle accident during the weekend leading into the July 4 holiday. Both ended up in Monterrey, Mexico. Traditionally, the city affluent residents have traveled to Dallas, Houston or San Antonio for their medical needs. "All around I was very impressed, and the experience surpassed any expectation I had," Mr. Woods said. "I could have been in Zurich, Switzerland, but it was Mexico. I found the care to be top quality, what you would expect at a U.S. hospital and more." Like vacations in sparkling Cancún or Cabo San Lucas, health care in Mexico is becoming high-quality, cheap and convenient, advocates say. As more Americans go without heath insurance or feel the pinch of managed care, some are making a run for the border for treatment ranging from routine care to live-saving procedures. Two North Texas-based hospital chains, Christus Health of Irving and International Hospital Corp. of Dallas, are tapping into a need and an opportunity by providing in their hospitals in Mexico what their executives say are the best of both worlds – U.S.-quality health care and relatively low Mexican prices. "Our goal is to have the safest hospitals in the international market," said Cliff Orme, CEO of International Hospital Corp. "We're implementing U.S. standards into these hospitals so you won't notice the difference going to a hospital in Dallas than one in a Latin American country." Some experts, including Peter Maddox of Christus Health, see Mexico as an answer to the complex question of how to treat aging and underinsured Americans at a time when the retirement of baby boomers will further tax the U.S. health care system. An estimated 43 million Americans, about 15 percent of the population, are uninsured, according to a Census Bureau study. "Our country will go broke unless we find a health care alternative," said Mr. Maddox, Christus' senior vice president for business, strategy and corporate development. "Mexico is a wonderful alternative with incredible potential." A New Kind of Tourist Indeed, Mexico is becoming a top destination for the multibillion-dollar "medical tourism" industry, joining countries including India, Thailand, Singapore and Malaysia. Experts estimate as many as 150,000 Americans travel abroad every year for lower-cost medical care. Although care in Mexico may not be as inexpensive as care in some Asian nations, the proximity to the U.S. is a big advantage to patients. Some U.S. companies are now sending employees to Mexico for their annual checkups. Underscoring the trend, Mexican state governments are spending money to refurbish communities near these hospitals, hoping visiting patients will stay there while receiving medical care or even move there permanently. Such is the case in Santa Eulalia, Chihuahua, and Villa de Santiago, near Monterrey. "We think that Villa de Santiago could also be an area for the retirees from the United States," said Alejandro Paez Aragón, secretary of economic development for the state of Nuevo León. "Our aim is to turn Monterrey into one of the world's medical tourism leaders in the next five to 10 years, and we're well on our way." David Warner, a health researcher at the LBJ School of Public Affairs at the University of Texas at Austin, said the hospitals run by U.S. companies are primarily for Mexicans, but they also hope to attract medical tourism, Americans without insurance and Mexicans living in the U.S. "And they'd like to get some U.S. insurers to cover them," he added. But Mexico faces serious challenges in trying to become a world leader in the medical tourism industry. A turf war among drug traffickers is keeping some tourists away. Monterrey, in particular, has seen a surge of drug-related killings in recent months. "Their plans aren't worth a thing if it's not safe to come here," said Luis Moreno, U.S. consul general in Monterrey. And Dr. Warner, the UT health researcher, said that surveys done by his students show that many Americans are pleased with the "tender loving care" they received in Mexico, but others have found services to be substandard. Nonetheless, over the next 10 years, Christus Muguerza, a partnership of Christus Health and Monterrey-based Muguerza, has identified 40 communities along the U.S.-Mexico border where it plans to expand. And International Hospital Corp. is finishing a new hospital in Puebla, near Mexico City. "I have patients coming here from Houston, Dallas, Austin, San Antonio," said Michael Tarabay, director International Hospital Corp.'s Santa Engracia hospital in Monterrey. "Whether you leave from Dallas, San Antonio, Houston or Austin, it's about an hour plane ride, a 20-minute taxi ride, and you're here." Cheaper Care Mr. Orme, International's CEO, said that his company's hospitals served "several hundred" American clients last year and that Santa Engracia has served about 300 so far this year. Mexico is on average 40 percent cheaper for basic surgical procedures, Mr. Warner and officials for both hospital companies said. A bill in the Texas Legislature sponsored this year by Sen. Eddie Lucio Jr., D-Brownsville, would have allowed U.S.-based insurers to cover health services in Mexico with the goal of making policies affordable for uninsured groups like the working poor. There was also a House version of the bill. Coverage would have been limited to Texans who live within 75 miles of the border. The bill did not get out of committee. "We have a crisis right now," Mr. Lucio said in an e-mail. "There are simply too many residents in Texas lacking health care coverage. Cross-border health plans present an opportunity to increase our rates of private health insurance coverage, particularly in an area of high poverty and greatest need." Cross-border health insurance plans typically cost 40 percent less than traditional policies, he said. "Cross-border health plans have been effective in California, and the primary concern for me is how we can address the lack of health care coverage along the border," he said. For now, most Americans coming to Mexico for health care are considered "medical refugees," as in the case of Mr. Woods, 43, a network engineer. He visited a Christus Muguerza hospital in Monterrey last Christmas and stayed with his wife's relatives there. He had looked into getting laser eye surgery close to home, but the cost made that impossible, he said. U.S. doctors wanted to charge him $4,000, Mr. Woods said, but he paid $1,500 in Mexico. "People were very cordial, warm," Mr. Woods said of the experience. "They treated me very well, and I wouldn't hesitate returning for other medical procedures." Mr. Vega's wife, Adriana, said the couple had a similar experience. She frantically checked South Texas hospitals after her husband's motorcycle accident, but was told hospitals were short-staffed before the holiday weekend. When Mr. Vega was examined, he was told he would have to wait more than 72 hours for treatment for his broken leg, she said. The exam alone cost $1,000, she said. Furious, Ms. Vega told her husband, "We're going to Monterrey." Once there, he was immediately admitted and operated on, she said. "I drove back to Texas two days later." The couple paid about $4,000 – one-third of what she was told the treatment would cost in Texas. "I thought the quality was the same as any U.S. hospital," she said. "What really stood apart, however, was the service. The Mexicans were much more cordial, warmer. Here in the U.S., everyone is worried about being sued, especially doctors. No one seems to smile." Impossible in the U.S. Christus Murguerza's specialties include cardiology, orthopedics, oncology, transplants and plastic surgery. Its hospitals in Monterrey boast state-of-the-art telemedicine systems, which allow doctors to monitor and follow up with patients anywhere in the world in hospitals that share this technology. International Hospital Corp.'s Santa Engracia hospital is in an upscale neighborhood, near hotels that give a preferential rate to hospital patients. In the hospital itself, a private room looks more like a hotel suite, with a separate living room, two televisions and space for an entire family for $300 per night – something unthinkable in the United States, said hospital director Mr. Tarabay, who has managed U.S. hospitals. About 90 percent of Santa Engracia patients are well-off or well-insured Mexicans, many of whom used to go to Texas for top-notch health care. Mr. Moreno, the U.S. consul in Monterrey, said he bought a home for retirement in San Antonio, in part to be close to the medical facilities in Monterrey, a four-hour drive away. "They have a cultural thing here in Mexico where you're not treated like a number," said Mr. Moreno. "Without a doubt, these are the best medical facilities that I've ever seen in my foreign-service career."

Dentistry in San Diego and Tijuana

A few years ago I broke off a front tooth eating an English muffin that was as hard as a rock. When I took it out of the freezer, I defrosted it in the microwave too long. That's how it got that way. I made one for myself and one for my girlfriend. I ate mine, but she said, "This is too hard for me." "Here," I said, "I'll eat it" and I promptly broke off my tooth. The dentist removed the part of the tooth that was hanging by a thread which was most of the tooth down to the gum line and gave me a flipper. I think the flipper cost $300. This was a while back and I don't remember what alternatives the dentist gave me, but I'm sure they were all expensive so I decided to keep the flipper as a permanent solution. This lasted a few years; then the flipper broke. I had it repaired; then it broke again. Finally, I gave up on the flipper and decided to seek a permanent solution.

The dentist I was going to in San Diego suggested a bridge cap as a more reasonable alternative to an implant. (Actually, I had gone to two dentists before that including the one who gave me the flipper and neither of them had proposed a reasonable solution.) What they would do for the bridge cap is grind down the two adjacent teeth, cap them and then those caps would support a third cap over my missing tooth. First they would extract what remained of my missing tooth below the gum line. This solution would cost $995. per cap or $2985. plus the extraction. I forget how much that was. And this was with my Secure Horizon high option dental insurance! So two front teeth would be destroyed, and one wouldn't be rooted in anything. And the dentist said she didn't know how long it would last.

After considerable thought and seeing some ads in the Reader which said that implants in Tijuana could be had for $1500., I decided to look for a dentist in Tijuana. I had been thinking about this for some time as a more economically feasible alternative to US dentistry which had been costing me more and more as time went on, and I was getting less and less satisfied with the quality and the way they treated patients as well as all the subterfuges surrounding how they dealt with insurance. Dental insurance was pretty much of a joke anyway as the dentists always seemed to find a way around it either by shorting the service or charging you for additional items the insurance didn't pay for.

As was my wont, I googled "dentistry in Tijuana" and checked out somewhat thoroughly what was available which was a lot. In fact I devoted an afternoon to it.  A lot of dentists had websites, and a ton of information was available. I had several criteria: qualifications and background of the dentist; quality of the website; location and appearance of the dental office. Some of these criteria are somewhat superficial, I admit, but I wanted a dentist with a nice office in a good neighborhood, not somebody who worked out of his house in a bad neighborhood. I finally settled on Baja Oral Center. I was impresssed with the qualifications of Dr. Martinez who did the dental implants. I called a local San Diego number (they have an 800 number too) and set up an appointment with Dr. Martinez to see about a dental implant. Everyone in the office speaks fluent English including the office manager and phone answerer, Berniece. They cover all the bases at Baja Oral Center. The general dentist there is Dr. Garcia. I was impressed with his credentials too. Their equipment is the latest and most modern. And their offices and waiting rooms are immaculate.

The day of my appointment at 11 AM, I  took the San Diego trolley from downtown. I allowed an hour and a half to get down there. My plan was to take the trolley to San Ysidro, walk across the border, then get a taxi to Jose Orosco St. where the offices are located in the Plaza Pacifico building, a relatively recently constructed high rise. It actually took me an hour and fifteen minutes including a fifteen minute walk to the trolley station from my apartment.  The taxi ride cost "cinco" dollars and took less than five minutes. The offices are located in the Zona Rio section of Tijuana, near Paseo de los Heroes and a huge modern shopping mall. There's a large statue of Abraham Lincoln (among others) nearby on Paseo de los Heroes.

I went up the elevator to the fourth floor and found the Baja Oral Center office. It seemed like the whole building was devoted to doctors and dentists. I met with Dr. Garcia who checked me out first, had a panoramic Xray which cost $27.00, and then Berniece escorted me up to Dr. Martinez' office in the penthouse. Dr. Martinez' office is truly stunning with fantastic views.  Everything about this building and the offices I've  seen is first class. Much nicer than most US dental offices that I've been in with much better "wall-of-glass" views. By the way Dr. Garcia, Dr. Martinez and Berniece all speak perfect English.

I told Dr. Martinez I was interested in an implant. As he examined me, he pulled and tugged on what was left of my front tooth. I couldn't figure out what he was doing. Finally, he  said, "I could give you an implant if you want it, but a better and less costly solution would be to put a post on your tooth since you still have part of one there and then a crown." Dr. Martinez pointed out that I had already had a root canal in that tooth so there should be no pain or complications. Why waste a perfectly good root canal? He would do some minor gum surgery first in order to expose more of the tooth and Dr. Garcia would do the rest. The total cost would be $850 including the gum surgery and a gold crown (gold on the inside, regular looking tooth on the outside). It would be a better solution than the bridge cap or the implant and would cost me $2135. less! We set up an appointment for the following week.

I wondered why no US dentist had proposed this solution. Was it because it was more labor intensive and less lucrative than the solutions they proposed? As it happened, I had an appointment the next day with my San Diego dentist for scaling and root planing, otherwise known as deep cleaning, for two quadrants of my mouth. My former, former dentist had told me I needed this 4 times a year. Then when I changed from Blue Cross to Secure Horizons (when I went on Medicare) the dentist told me I didn't need it at all. Blue Cross didn't cover this procedure at all but Secure Horizons did with a $50.00 copay. Seemed strange to me that one dentist would recommend it so often when it wasn't covered by insurance, and then the next one would not recommend it when it was covered by insurance. But they told me they would perform it if I wanted to pay the full freight! I guess he was fulfilling his role as gatekeeper for Secure Horizons! That's why I changed dentists again. This time they were pleased to do the deep cleaning under the insurance.

I was prepared to pay the $100.00 copay for half my mouth, and then there would be a follow-on appointment for the other half. The dentist jabbed me, and I mean jabbed, several times with novacaine, no topical anesthetic first (as a contrast Dr. Martinez applied a topical and I never even felt the novacaine needle), then proceeded to work on the two quadrants for less than an hour. This is something else I had noticed with US dentistry. When it was an insurance prodcedure, it always took far less time than when you were paying out of your pocket. I guess this is how they made up for the lesser payment from the insurance company. When I got out to the desk they told me the bill was $430! This included my $100.00 copay which I expected and then two charges of $55.00 each for an "unspecified perio procedure." There were also five $44.00 charges for arestin which is something they stick down below the gum line which is supposed to heal infection. I had agreed to the arestin, but they had not told me it was $44.00 a shot! It just took her seconds to put each one in so I felt the cost was ridiculous but I had agreed to it. Fool me once... but what really bothered me was the two $55.00 charges for an "unspecified procedure." I guess they are so brazen they just blow off the expected copay and charge you whatever they want. Right there I decided that I was going to have all my dentistry needs taken care of in Tijuana and not just the big items. I had contemplated having my routine work still done under my insurance in San Diego, but I came to the conclusion that dental insurance is a joke, and dentists would do whatever they had to do to work around it and still charge you exhorbitant prices or give you less than the standard service in terms of their time.

I called and canceled my second $400. plus dental appointment with my San Diego dentist, and after three visits to Dr. Garcia I had my front tooth back again with which I'm very happy. I guess I had gone toothless for about three months, but I'm happy with the final result and what I paid for it. By the way Dr. Garcia worked on me for about two hours putting in the post and the temporary tooth. Before that Dr. Martinez did some minor gum surgery to expose the tooth more. No separate appointments necessary for the two procedures! And I never had any pain during or after the procedure. Maybe the time it took for this procedure is why no San Diego dentist recommended it although I do believe it's preferable to either the bridge cap or the implant and far less costly, but it was labor intensive and US dentists want you in and out of the chair as quickly as possible. I credit Dr. Martinez' honesty for the less expensive diagnosis when he could have given me an implant and charged me a lot more, and Dr. Garcia's and Dr. Martinez' hard work for a very reasonable charge compared to the time they put in. Finally, they did all this for over $2000.00 less than what the San Diego dentist had proposed!

Subsequently, I took my daughter and two granddaughters to see Dr. Garcia. My granddaughters were worked on by Dr. Lizeth Fajardo, who specializes in pediatric dentistry, and Dr. Garcia saw my daughter. My daughter needed to see another specialist to get braces even though she's 36. She has some serious problems, but will save some serious money by not going to a San Diego dentist for her dentistry needs. Dr. Lizeth did a great job with the granddaughters. I found that all the dentists and assistants in Dr. Garcia's office were polite and kind and seemed to really care about our welfare as opposed to the arrogant and uncaring attitudes I found with some dentists and some office staff in San Diego. In fact some of the office staff I dealt with in San Diego were downright rude.

Today my daughter is taking her husband to see Dr. Garcia. He's a really nice guy, and I've been recommending him to everyone. If you require a specialist one is ususally available in the same building and will see you at the same time with no need for a separate appointment and two trips to Tijuana. A lot of people, including me, have given up completely on the exhorbitant prices and less than caring attitudes found in US dentistry, and some travel great distances to have their dental work done in Mexico. They are in fact "dental tourists." You hear a lot about the high cost of medical care in the US while the high cost of US dentistry slips under the radar. It's a scandal as big as US health care, I  think.

I found that the Tijuana dentists I dealt with were very professional and highly competent and used the latest equipment and techniques. More importantly, they seemed to really care about their patients as opposed to a lot of US dentists who, when you open your mouth, only see dollar signs.

Calling Michael Moore...

Waiting Times in US for Cancer Treatment Exceed Canadian Waiting Times for Elective Surgery

See here.

Business Week, no great fan of a national healthcare system, reported in late June that "as several surveys and numerous anecdotes show, waiting times in the U.S. are often as bad or worse as those in other industrialized nations -- despite the fact that the U.S. spends considerably more per capita on health care than any other country." A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada. ... Statistics Canada's latest figures show that median wait times for elective surgery in Canada is now three weeks -- that's less time than Aetna's chief medical officer says Americans typically wait after being diagnosed with cancer. Canada also has no waits for emergency surgeries. It also doesn't have 44 million people who are uninsured because everyone has a national healthcare card guaranteeing health care from any doctor or hospital they choose. And it doesn't burden those with insurance with rising deductibles or co-pays.

Michael Moore takes on Wolf Blitzer on CNN.

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