Think of it. An alliance between Freddy Krueger, Michael Myers and Norman Bates, three of the scariest characters in horror moviedom. Stars of, respectively, A Nightmare on Elm Street, Halloween, and the Alfred Hitchcock classic Psycho, these guys all have three specialties. They jump out at you when least expected. They think of themselves as omniscient. And most importantly they keep coming back. And back. And back.
Come on now, admit it. The first person you’d go to for a consultation if you were diagnosed with cancer is the Freddy Krueger of the piece, that renowned international cancer specialist Dr. Pete Stark. Oh, sorry. Make that Congressman Pete Stark. Come to think of it, before he was a California Congressman, before he was apologizing on the House floor for his recent suggestion that the President of the United States sends American kids to die in Iraq just for “amusement,” Stark was not a physician at all but a millionaire banker.
Be that as it may, Freddy, I mean Dr. Starkâ€¦sorryâ€¦Banker Stark is now the chairman of the House Ways and Means Subcommittee on Health. Which makes him (but of course!) a physician in his own mind.
This would be humorous if the subject were not so serious. And make no mistake, it is deadly serious for cancer patients all over America. It’s also a story that illustrates with a particular clarity the danger that looms in the notion that your health care should be entrusted to government bureaucrats and politicians instead of your doctor.
At issue in this Washington version of a horror film is a July 30, 2007 “National Coverage Decision” a policy pronouncement by the third player in this drama, the Bates Motel of the piece otherwise known as the government Centers for Medicare and Medicaid Services, or CMS. The CMS, populated by an army of bureaucratic Norman Bates’s, has decided that it will restrict the use of a drug called Erythropoiesis Stimulating Agents (ESAs) under Medicare. In plain English, this is a drug that is provided cancer patients taking chemotherapy. Chemotherapy, of course, is designed to kill cancer cells. When it does so it has the unfortunate — and dangerous — side effect of killing good cells, including those that manufacture red blood cells. Without enough red cells, the patient becomes anemic, which in turn could force the end of the chemotherapy and the potential return of the cancer. The existence of ESAs, which contain the protein that stimulates the production of red blood cells, now permits patients to continue their chemotherapy while treating the anemia and eliminating the need for blood transfusions.
Sounds like a doctor-patient discussion to me and probably to you too.
Alas, Freddy…Dr. Stark…sorry, Banker Stark…disagrees. So too does his sidekick in this Washington Halloween story, the Michael Myers of the tale, the Banker’s California colleague Henry Waxman. Waxman, you will be shocked to learn, is not a cancer specialist either but rather a Beverly Hills lawyer. (American Spectator readers will remember that Waxman was last the subject of a story in these precincts revealing his determination to use his congressional power as chairman of the House Oversight Committee to decide what you can and cannot listen to on talk radio. Once publicized, Waxman denied the charge, although the facts in the story remain un-refuted.)
SPECIFICALLY, BANKER STARK and Lawyer Waxman have combined in a seriously scary Congressional combination as they consult with the Norman Bates Bureaucrats, the proprietors of Bates Motel, aka CMS. Under the circumstances, the fictional Freddie Krueger and Michael Myers are decidedly less scary than the real life Banker Stark and Lawyer Waxman. After all, the first two, however vivid, are celluloid creatures. The Banker and the Lawyer are seriously powerful real people who want to substitute their own judgment and that of the bureaucrats at CMS for the opinions of a cancer patient’s doctor as to extent of the use of ESAs under Medicare.
What does this mean for you? If you are covered by Medicare and you need this treatment, the Banker and the Lawyer agree that the Bureaucrat should blow off the fervently expressed concerns of the cancer specialists, in this case those of the cancer specialist doctors of the American Society of Clinical Oncologists and the American Society of Hematology. They, the Banker, the Lawyer and the Bureaucrats — not you and your doctor, thank you very much — will make the decision on whether you need this cancer treatment. Or not.
In fairness to the Banker and the Lawyer I should say specifically why they believe you and your doctor must be relieved of deciding the details of your medical care. They are afraid that doctors, egged on by the makers of the drug, will overuse the drug just so they can steal the Bureaucrat blind. This would be called Medicare fraud.
Let’s stop the Halloween tale here for a moment. On the eve of what will undoubtedly be a momentous election campaign in which health care will be a major issue, it’s important to note the two major underlying assumptions that divide the Banker, the Lawyer and the Bureaucrats from so many of the rest of us. Not only on the issue of health care but a whole host of other issues as well.
THE FIRST ISSUE IS capitalism. They don’t like it. The second issue is big government bureaucracies. They are crazy in love with those.
The first underlying assumption in turn makes the enemy in the Stark-Waxman narrative of this cancer medication case the makers of the ESAs. The drug companies. The capitalists. By name in this case the capitalists are Amgen (which is actually a biotech company) and Johnson & Johnson. The world view of the Banker Stark and Lawyer Waxman religiously insists capitalists are shady guys at best, seriously evil guys at worst. They are, to quote an obviously disturbed Stark on Amgen, “profit driven.” How does this translate in this situation? It means Banker Stark and Lawyer Waxman look at Amgen employees, for example, and see almost 18,000 Gordon Gekko’s, the slicked-haired, “greed is good” villain of Oliver Stone’s movie Wall Street, instead of 18,000 dedicated men and women working their tails off to come up with innovative advances in medicine. The Amgen folks, while a global company, have the bulk of those 18,000 employees right here in America. One does not need to know a single Amgen employee to understand that a crowd of 18,000 would include men and women who are husbands, wives, mothers, fathers, single parents busy parenting kids, and so on. They pay mortgages, buy groceries and, at least in America, they pay lots of federal (and other) taxes as well. Taxes that, yes indeed, pay for the upkeep of congressional salaries, lifestyles and those endless committee hearings and Waxman investigations overpopulated with well-fed staff with too much time on their hands.
So too do the Banker and his Lawyer sidekick view the doctors in this equation with barely disguised disdain. The men and women in the medical field that all of us have encountered in a life, the men and women who work incredible hours and have, in overwhelming numbers, assisted ourselves or family and friends in hours of medical need are, to the Banker and the Lawyer, a caricature of something else altogether. In the Stark-Waxman narrative cancer specialists are played as the Gordon Gekko’s of medicine, slick seekers of ways to violate the Hippocratic oath and deliberately mistreat patients because they are in league with the evil drug makers. You know, gotta rip off the government and sell the meds to keep up those country club dues.
Oddly, Banker Stark made his millions by being a capitalist himself. While he is long since out of the banking game, one can only presume that his current view of capitalism and its practitioners came sometime after he was collecting his obviously quite considerable banking paychecks, not to mention when he was negotiating his very capitalist salary with his board of directors. After all, how did Banker Stark become wealthy in the first place? One bets he did not want the federal government intruding into any of that!
Underlying assumption number two, the love of government bureaucracies, means that the Banker and the Lawyer attribute powers of wisdom and competence to bureaucrats working out of concrete boxes in Washington. When you are facing a serious medical problem, they honestly believe you should be directing your questions not to your doctor but rather to the people in those boxes. Not feeling well? Take two aspirin and call a Washington bureaucrat in the morning. Having spent time working in one of these bureaucratic boxes I can certainly say that, as with drug or biotech companies or doctors there are good people here too. But qualified to get between you and your doctor? Please.
These are two very serious philosophical differences, and they have deeply critical consequences, in this case for cancer patients. Make no mistake: today the targets are Amgen (which, by the by, not only provides good jobs to its 18,000 employees but health insurance as well) and Johnson & Johnson (ditto on the jobs and health insurance front) and doctors (presumably ditto again, if not in the same numbers as a big company.) Tomorrow it will be some other capitalist enterprise that provides good jobs at good wages for people performing a genuine service with valuable products or services for the rest of us. In Waxman’s case, as previously mentioned, the Lawyer is not only interested in making your medical decisions he wants to decide who you listen to on your radio. Think about that. Lawyer, doctor, radio censor. Interesting work if you can get it.
THANKFULLY THERE ARE PLENTY of people in both the House and Senate who are up in arms over the actions of the Banker, the Lawyer and their friends and political allies the Bureaucrats. Literally a majority of the Democrat-controlled House has joined together to protest the decision by the Bureaucrats at CMS on this issue, led by Michigan Republican Mike Rogers, a cancer survivor himself, and California Democrat Anna Eschoo. Over in the Senate no less then Senate Finance Chairman and Montana Democrat Max Baucus has sponsored a Senate Resolution to overturn the CMS decision, creating a very interesting difference between three prominent and powerful Democrats. Notably, Baucus has been joined by a bi-partisan list of Senators that includes Idaho’s Republican Mike Crappo, who has survived two bouts with prostate cancer, and Oklahoma’s Republican Tom Coburn who is — surprise! — actually a real, honest-to-goodness practicing physician, the only one in the Senate.
There is something else troubling here, and it goes to the sensitive (for conservatives) issue of just where the Bush White House puts its conservative principles on occasion. The CMS is, of course, a government agency. Which means it is overseen by Bush Cabinet member Michael Leavitt, the Secretary of Health and Human Services. The obvious question for conservatives is why in the world is the Bush administration letting the professional bureaucrats make a decision like this? To the point, this is an extension of the dissatisfaction that was expressed last November in the 2006 elections: why elect conservatives if they abandon conservative principle the moment they win and sit down to govern? Letting bureaucrats instead of doctors and patients decide who gets what cancer treatment is decidedly not a conservative — or for that matter 21st century — decision.
There are more gory details here, including the predictably slanted story in the New York Times this past May 9th. “Doctors Reap Millions for Anemia Drugs,” headlined one in a series of stories in this vein. Would you expect anything else from an Old Media institution that reaps millions by running plagiarized stories, revealing national security secrets and secretly giving cut-rate full page ads to its political soul mates? The fact that the paper uses its news stories and ad pages to push its various agendas really isn’t news anymore. While this is most prominently witnessed with stories about Iraq or the Bush administration, this episode is a timely reminder that the paper has other items on its agenda. In this instance discrediting oncology doctors with a story that simply ignored basic facts about the high incidence of chemotherapy-related anemia and neglected to speak to a single cancer patient choosing to receive ESAs is just one small way to make the case for government-run health care, a longtime favorite of the Times. Ditto the decision to ignore any detailed reporting on the basic economics of federal and private reimbursement of drugs used by oncologists, a reflection, of course, of elite journalist’s hostility to the basic facts of life in capitalism. As with Banker Stark, this hostility at the Times seems to vanish only when its reporters are picking up their pay checks or the Sulzbergers are protecting their stock options. To borrow from Al Gore, you might say such basic facts as the cost to produce or purchase drugs are “inconvenient truths” for the Times.
MAKE NO MISTAKE, BANKER STARK and Lawyer Waxman are above all emblematic of the glaring failures of a bureaucracy-driven government health care program. They believe they themselves, along with the bureaucrats, should be making decisions as to precisely what kind of health care you should be receiving. ESAs today, your pregnancy or prostate or Alzheimer’s medication or exam and treatment tomorrow. Stuck at worst in the 1930s mind-set of FDR’s New Deal or at best in the mid-1960s world view of LBJ’s Great Society, this is part and parcel of a mentality that prefers outdated concepts that have been repeatedly proven unreliable over 21st century principles that themselves have been developed as a result of past failures and new technology. Why, after all, are Stark and Waxman concerned about Medicare fraud? Because defrauding a bloated government-run bureaucracy created over forty years ago is easy to do. How easy? No less than Secretary Leavitt himself went before Congress last summer to request $1.3 billion to combat Medicare fraud. Gee. Imagine that.
Never once in this episode does it appear to occur to Stark that the goal should be to get the bureaucracy out of the way, bring knowledge from the Amgens of the world to doctor to patient even more rapidly, with patients and their doctors making the final decision on patient care. Government decisions (aka the Food and Drug Administration) reflecting the science about the reliability of a medicine is fine. In fact, in this case the FDA has issued a “black box” label that warns doctors of overprescribing. No responsible person would ever claim there is no role for serious science. But once the facts have been laid out for doctor and patient, the question is: do you really want to have politicians and bureaucrats making decisions about your personal medical situation? Speak now, because Freddy Krueger keeps coming back when you least expect him.
The job that lies ahead in health care is to insist on an environment that allows innovation and the free market to work. To give individual Americans real choice in their selection of health care. To make sure that when you are sick you are consulting with the doctor of your choice and not the Bureaucrat mandated by the Banker and the Lawyer. It is way past time as well, obvious or not, to have a fundamental respect for the capitalists who take the risks and put up the capital and do the work that provides the rest of us with everything from cancer drugs to the computers that analyze them. Stop demonizing the Amgens of the world and give them not only some credit where credit is due but a little simple respect for their contributions to the rest of us.
The idea that a banker and a lawyer in league with government bureaucrats are insisting they know more about the costs of making drugs then the drug-makers themselves, that they also insist they know more about treating cancer then cancer specialists, and that they have every intention of removing you from the decision-making aspects of your own medical treatment should tell Americans everything they need to know about the great debate that lies ahead. In two words? Can you say “Hillary Clinton”?
This fuss over ESAs isn’t about medicine, this is about a Washington style trick-or-treat. This isn’t health care, it’s brain dead politics. And the idea that you should entrust your health care to the likes of Pete Stark and Henry Waxman?