Healthcommentary – exploring human potential healthcommentary

The Medical-Industrial Complex in the United States is expert at feigning cross-sector competition while quietly signaling to members that there is plenty of graft and profit in the $4 trillion (20% of GDP) for all. The net output, more evident than it ever was in the days of ’90 era “Harry and Louise” efforts, is a hidden syndicate and a confused Congress and public.

Sen. Lamar Alexander (R-TN) is chair of the Senate Health Committee and is as confused as everyone else wondering aloud whether we need PBMs at all. Answer: NO. Why? PBM’s are the offspring of Merck, CVS, and UnitedHealthcare who decided that their was money to be made, shaving off the top, in data manipulation and supposed cost-containment.

Don’t be fooled by the fact that PBMs have their own lobbying association now – the Pharmaceutical Care Management Association or PCMA.


They’ll spend about $6 million this year on confusion campaigns. But the top guys – CVS Health, Express Scripts, and UnitedHealth Group – have ponied up another $6 million themselves individually – all while their parent companies fund PhRMA and the health insurers who they are supposedly opposing. Can you spell “collusion?”

Trump and HHS Secretary Alex Azar could learn a thing or two from the various Medical-Industrial Complex sectors about the “art of distraction”. They’ve been able over two decades to get Americans to spend twice the amount of all other developed nations on health services while mothers and children die in childbirth at astounding rates, white male survival curves have turned south, and hospitals have become the 4 th leading cause of preventable death in the U.S.

In the British Medical Journal in 1950, “expert” Dr. S.L. Simpson stated without evidence that “It is perhaps of clinical interest that for every one case of organic impotence that comes my way, I see at least 10 of psychological impotence.” Three decades later I published a paper in the journal UROLOGY titled “Psychogenic Impotence: A Critical Review”. In that paper I argued for the use of scientific nomenclature (“erectile dysfunction” versus “impotence”), additional research to define the physiology and pathophysiology of erectile function and dysfunction, and for the demystification and greater transparency around this essential bodily function.

As is clearly evident in this week’s stunning disclosures of system-wide abuse touching thousands of young lives in Pennsylvania, is that the Catholic Church’s problem is systemic. The three failings that victimized those suffering from erectile dysfunction, namely sloppy nomenclature, weak or absent research and non-transparency, have now trapped leaders of the Church in a downward spiral.

Words matter in science. Celibacy? What exactly does it mean? It is a religious, not a scientific term, surrounded by controversy. It is derived from the Latin word “caeleb” which means single. Some interpret it to mean “unmarried”; others define it as “refraining from sexual intercourse”; and others still believe a celibate life commits one to refraining from all sexual life including masturbation and sexual ideation. This lack of basic agreement on the meaning of fundamental definitions, as with the definition of “impotence”, cripples scientific research from the onset.

If the nomenclature is weak, so is the body of research. What passes for research in this field, on both sides of the argument, is as weak and unsubstantiated as was Dr. Simpson’s opinions on “psychological impotence” in 1950. Research has been hampered by limited access to the priests who are the subjects, poor study design, and rapid labeling of scientists who would dare tread into this dangerous minefield. As a result, we really don’t know whether mandating control over expression of one’s natural sexuality results in higher rates of sexual abuse, mental illnesses including depression and crippling anxiety, and higher then normal levels of drug and alcohol abuse compared to comparative control subjects.

First, make your priests available to researchers to rigorously and scientifically study the connection, if any, between mandated restrictions on adult sexual function and abnormal sexual behaviors and mental illness. As a derivative of this research, as occurred in the study of erectile function, rigorous scientific terminology to define the meaning of “celibacy” will be well defined.

Were we to proceed with a centralized health insurance system, while preserving local choice and autonomy over care delivery, estimates are that we would shave up to $1 trillion off of our nearly $4 trillion annual health care expenditure. Of course that means many insurance agents, coders, billers, and data specialists would lose their jobs. What’s to become of them?

Likely they would follow the money. But how might that $1 trillion be best spent? The best answer is embedded in the startling fact that the U.S. is the only developed nation that spends more on health care than all other social services combined. These services – including housing, education, transportation, environmental protection, sanitation, safety and security –are all proven determinants of health.

Last year, one enterprising health sector veteran saw an opportunity and seized it. Mark Switaj, a 15-year emergency medical technician who had come through Boston College and Georgetown University created RoundTrip based in Philadelphia. Contracting with local providers and insurers, his computerized Uber like patient transportation system was able to deliver a 4% no-show rate.

The initial battle lines were drawn some months back when Jeff Bezos, Warren Buffett and Jamie Dimon recognized a unique opportunity to dip into the wasteful troughs of American healthcare and targeted the control center of the Medical-Industrial Complex – the Pharmacy Benefit Manager. The PBM’s with original parentage from Merck, United Healthcare and CVS, are fast at work formalizing the rules of the syndicate game with hidden kickbacks that deal in everyone…except the patient.

Icahn’s open letter states, “When Cigna entered into this agreement several months ago I believed a $60 billion purchase price made no sense, but there were at least arguments that could be made by management to try to persuade us into thinking that it was not completely ridiculous. These arguments now disappear in light of certain material events of the last month, such as Amazon’s almost certain entrance as a competitor to Express Scripts and the government’s direct challenge to the highly flawed rebate system. As a result, Express Scripts’ earnings will almost certainly be seriously diminished, but even more importantly, Express Scripts will be existentially challenged, i.e., their very existence might well come into question over the next few years.”