Tag Archives: Fran Quigley

Religion, Social Justice And Medicare For All

These are difficult days for genuinely religious folks–the ones who understand their theologies to require ethical and loving behaviors.

The 2016 election highlighted the glaring hypocrisies of Evangelical Trump supporters; more recently, it’s Catholics who are cringing. In Pennsylvania, a grand jury found the Church had concealed 70 years of sexual abuse by over 300 priests. Here in Indianapolis, the administration of a Catholic high school learned that a longtime, much-loved guidance counselor is in a same-sex marriage, and demanded that she divorce her wife or resign.

Not exactly ethical or loving behaviors.

On the other hand, dozens of local Catholics, including alumni of that high school, are publicly and vigorously supporting the counselor, and others are prominent advocates for social justice, and for programs to help the poor.

Local Catholics are also prominent advocates of establishing a “Medicare for All” chapter in Indianapolis.

In an essay for the National Catholic Reporter, law professor Fran Quigley argues eloquently that faith communities–including his– need to make a moral case for universal health care.

Mark Trover of Indiana had a job and access to health insurance, but the premiums and co-pays were too high for him to afford. A doctor had prescribed medicine for his dangerously high blood pressure, but the cost was high and Trover stopped filling the prescription — right up until the time he suffered a stroke that left him permanently disabled.

Karyn Wofford of Georgia has type 1 diabetes, and has often been forced to ration the insulin she needs to survive. The cost of the medicine has risen over 1,000 percent in recent years, and the 29 year-old knows there are many other Americans who have suffered and even died from diabetic ketoacidosis because they could not afford the medicine. “Having access to diabetic supplies and insulin, to feel okay when I wake up in the morning — that’s my dream,” she wrote for the T1 International blog.

These stories represent the status quo of U.S. health care. Even after the Affordable Care Act, there are over 28 million people in our country living completely without health coverage, a group disproportionately made up of people of color. Among those who do have insurance coverage, nearly a third are enrolled in high-deductible insurance plans that can force them to skip filling prescriptions or go without other necessary care.

These stories–and the millions of Americans who have similar ones–are shameful reminders that the United States lags behind virtually all other industrialized countries when it comes to the health of our citizens. Ironically, we are far more religious than citizens of countries that run circles around us when it comes to health care.

As Fran documents, however, religious leaders are finally mobilizing:

In response to the mean-spirited and fiscally self-sabotaging efforts to repeal the Affordable Care Act last year, faith groups raised their collective voice, and to great effect. Dozens of denominations and organizations from a wide range of faith traditions issued joint statements, mobilized their members, and conducted a dramatic Capitol Hill vigil. They brought a morally powerful foundation to the resistance to Affordable Care Act repeal efforts.

As a March 2017 letter signed by leaders of 40 faith organizations said, “The scriptures of the Abrahamic traditions of Christians, Jews, and Muslims, as well as the sacred teachings of other faiths, understand that addressing the general welfare of the nation includes giving particular attention to people experiencing poverty or sickness.”

That shared mandate compelled us as people of faith to act to preserve the Affordable Care Act, which has expanded care to millions of Americans who needed it. Now, those same sacred teachings require us to speak out with just as much urgency to fully repair the gaps left behind even after the act is preserved.

All major religious traditions recognize a responsibility to provide for the poor and the sick–and while the ACA is an important step in the right direction, it falls far short of being universal. What is needed is a single-payer system like those in other first-world countries.

Legislation packaged as “Expanded and Improved Medicare for All” has over 120 co-sponsors in the U.S. House of Representatives and support from a growing number of senators, reflecting polls that show a majority of Americans support a single-payer system.

But the will of the people does not always translate into changed policies, especially when heavily financed lobbyists and campaign contributors from insurance and pharmaceutical companies block the path. That is where the faith community comes in. The economic argument in favor of a single-payer, universal health care system is undeniably powerful, but the moral case for health care as a human right is even stronger. The faith community stands in the ideal place to advance that moral argument.

I encourage those reading this to click through and read the article in its entirety, or even one of my earlier posts, which comes to the same conclusion. I especially encourage you to attend the inaugural meeting of the Medicare for All Group next Thursday, August 23d, to be held at 6:30 at Indianapolis’ First Friends Church.

This effort is a timely reminder that sincere “people of faith”–all faiths–are working for social justice. They don’t make as much noise as the theocrats and hypocrites, and they aren’t as newsworthy, but these efforts remind us that there are also a lot of good people in those pews.

The Public Good

Americans need to reclaim the concept of the public good, and nowhere is that more important than in health policy.

Law Professor Fran Quigley has a new book coming out that examines the interface–or more accurately, the lack of an interface–between Big Pharma, Congress and the common good. Quartz recently published a review of the book, and began by referring to the infamous “Pharma Bro,” Martin Shkreli, who purchased a life-saving drug that had been on the market for some time, and jacked up the price astronomically–because he could.

Shkreli is not an outlier, according to Indiana University law professor Fran Quigley’s new book Prescription for the People. The pharmaceutical industry jacks up prices on life-saving drugs to extort windfall profits from desperate patients as a matter of course. That’s an immoral way to treat medicine, Quigley argues. The solution? Stop treating medicine as private property—and start treating it as a public good, like education or infrastructure.

It’s one thing to allow private companies and markets to set prices for items like big-screen TVs or cars, Quigley explains via email. In those cases, “purchasers can compare prices and walk away from the transaction if they wish.” But a patient with cancer or a child diagnosed with Type II diabetes can’t just walk away. “That kind of choice is not present when the good in question is life-or-death and there are no options for comparison shopping,” he writes.

 One of the great virtues of Quigley’s book is its explanation of the major role government plays in drug research. Big Pharma has long justified high prices by citing the costs of R & D; as Quigley points out, much of that research is funded with our tax dollars–but drug companies, not taxpayers, enjoy the return on that investment.

Furthermore, drug companies don’t actually funnel the bulk of their profits into research and development. Case in point: Reuters has reported that Pfizer made $45.7 billion in revenue in 2014, of which it spent $14.1 billion on sales and marketing and $8.4 billion on research.

The book details the various ways in which drug companies’ concern for the bottom line takes precedence over concern for the public’s health, and it goes into considerable detail about the perverse public policies that have facilitated those companies’ profitability.

The genesis of those favorable policies? Follow the money.

How did we get to this point? “In the last 40 years, the pharmaceutical industry has deployed billions of dollars of lobbying and political campaign contributions” to change laws to their benefit, Quigley says. One of their most remarkable successes was the 1980 Bayh-Dole Act, which allowed corporations to patent publicly-funded research. This means that pharmaceutical corporations essentially receive monopolies to sell government-created products, “truly one of the most bullet-proof business models in modern history,” Quigley says.

Quigley also takes aim at current patent practices.

The US should even consider ending medicine patents altogether, Quigley argues. “The patent system fails miserably in making medicines available to those who need them,” he says. Studies show that 70% of newly marketed drugs make no therapeutic advances on existing medicines; they are “me-too” drugs that try to carve out a portion of already existing markets for things like cholesterol medication, without bringing any improvements to the table. Furthermore, patents prevent competitors from building on previous research. Expanding grants for patent-free, open-source research would focus medical research on innovation, and make research findings available to everyone immediately, Quigley argues.

Quigley is not the only observer who faults the current patent system; economist Dean Baker goes considerably farther:

Are corporate patent and copyright monopolies a form of government-licensed private taxation? Dean Baker of CEPR thinks so: “Government-granted patent and copyright monopolies are actually much more important in determining future flows of income than debt. In the case of prescription drugs alone, patent and related protections raise the price of drugs by close to $370 billion a year over the free market price, a bit less than 2.0 percent of GDP. This is considerably larger than the current interest burden of the debt, which is approximately 1.6 percent of GDP, net of money refunded from the Federal Reserve Board to the Treasury. These monopolies are effectively like privately collected taxes.”

The book is Prescription for the People.

I know Fran Quigley, I know both his passion and his meticulous attention to fact and evidence. He’s a clear writer and a clear thinker. You should buy the book.

Pills and Profits

One of the many aspects of America’s mess of a healthcare landscape–a mess that the Senate GOP is trying to make much worse– is the issue of drug prices. Pharmaceutical companies defend that pricing by pointing to the significant costs of research and development.

That argument seems persuasive–if we ignore the inconvenient fact that taxpayers fund a considerable amount of that research. As Fran Quigley recently wrote in the New York Times, 

How’s this for a great deal? The United States government funded research and development of a new vaccine against Zika. But the Army, which paid a French pharmaceutical manufacturer for its development, is planning to grant exclusive rights to the vaccine to the manufacturer, Sanofi Pasteur, along with paying Sanofi up to $173 million.

Sanofi will be free to charge the United States American health care providers and patients any price it wishes. Although American tax dollars funded the vaccine, and the United States took the economic risks, history suggests that many Americans would not be able to afford it.

This is a negotiating strategy of unconditional surrender. Although President Trump said before taking office that drug companies were “getting away with murder” and had campaigned on lowering drug prices, his administration is doing the opposite. A draft order on drug pricing that became public in June would grant pharmaceutical companies even more power to charge exorbitantly. For example, it could shrink a federal program that requires companies to sell at a discount to clinics and hospitals serving low-income patients.

Another major problem is the fact that for-profit drug manufacturers have little incentive to produce medications for which there are no markets, so diseases that are widespread in poorer countries get little attention. Quigley notes that, of the 756 new drugs approved between 2001 and 2011, fewer than 4 percent targeted so-called “neglected” diseases, despite the fact that those diseases afflict one out of every six people in the world.

A new drug company intends to change that reality.

Pécoul and Doctors Without Borders decided to tackle the diseases that were killing the global poor. Doctors Without Borders dedicated its 1999 Nobel Peace Prize award money to providing seed funding for the Drugs for Neglected Disease Initiative, known as D.N.D.I. The aim was to see what could be accomplished when research priorities ignore questions of profitability, and the price of medicines is “delinked” from research costs, which are instead shouldered by public financing or philanthropy.

An immediate challenge was that D.N.D.I. possessed none of the required hardware for the expensive drug research and development process: It had no labs, no manufacturing facilities, and no distribution process. It fell to Pécoul to recruit partners, including private pharmaceutical companies he persuaded to share drug compounds that had been uncovered but abandoned because of lack of profitability…

D.N.D.I. has already delivered seven new patent-free, low-cost treatments for neglected diseases.

Interestingly, D.N.D.I. has created these seven drugs, with 30 more in testing, at a cost of $290 million to date. For-profit pharmaceutical manufacturers have long claimed that it costs them $2.5 billion to develop a single drug, although critics insist that the figure is an exaggeration intended to justify higher-than-necessary prices.

D.N.D.I. conducts “open source” research, and does not patent its drugs.

Pécoul and his D.N.D.I. colleagues say their biggest challenge now is securing sustainable funding for research — another illustration of the limits of a model with no profits to invest in research. But the government funds research all the time — it’s just often turned over to for-profit companies. The Zika vaccine is one example. The prostate cancer drug pacilataxel, the leukemia medicine imatinib and many mental health and H.I.V. medicines and vaccines can all trace their origins to government-funded research — only to be handed over to industry to charge what they want.

As the article makes clear, this model cannot replace for-profit drug manufacture. But if governments provide more resources to nonprofit companies modeled after D.N.D.I, their products, at least, would be available and affordable to everyone.

Some economists have argued that since Medicare and Medicaid are the leading purchasers of drugs (and Medicare is forbidden by law from negotiating on price), the money saved by buying from nonprofit drugmakers could easily replace all privately funded research and development. The increased public research dollars could then be applied, D.N.D.I.-like, to develop the medicines that would have the most significant public health impact.

Focusing tax dollars on the public good…what a concept!