Game of Thrones’s Emilia Clarke tells her journey with brain injury. It will break your heart.

Emilia Clarke Charity

If you feel you need yet another reason to admire actress Emilia Clarke, here it is. In this very person essay that runs in The New Yorker, she recounts her near-death experiences with two aneurysms—all while filming Game of Thrones.

Her candor is refreshing. Her response to her injuries—the creation of Same You, a foundation that raises money for treatment of others who are recovering from brain injuries and stroke—is nothing less than you'd expect from a woman who is the queen of so many hearts.

—Josie

Move over, Marty McFly. The Flux Capacitor is here and now. #TrashIntoGas


Backto the Future
This article, from the
New York Times, shows that as of today, we can be self-producing of clean fuels just by converting our garbage. This should be the most important US works project of the new millenneum. 

ALL states should be doing this, don't you think? Maybe a writing campaign is in order.

We're Back to the Future–and just in time to save Miami. 

But do we want to,

— Josie

Trash Into Gas, Efficiently? An Army Test May Tell

By PAUL TULLIS / New York Times

THERE is an indisputable elegance to the idea of transforming garbage into fuel, of turning icky, smelly detritus into something valuable.

But big drawbacks have prevented the wholesale adoption of trash-to-gas technology in the United States: incineration is polluting, and the capital costs of new plants are enormous. Gasification systems can expend a tremendous amount of energy to produce a tiny amount of electricity. Up to this point, it hasn’t seemed worth the trouble.

Mike Hart thinks that he has solved those problems. In a former Air Force hangar outside Sacramento, his company, Sierra Energy, has spent the last several years testing a waste-to-energy system called the FastOx Pathfinder. The centerpiece, a waste gasifier that’s about the size of a shower stall, is essentially a modified blast furnace. A chemical reaction inside the gasifier heats any kind of trash — whether banana peels, used syringes, old iPods, even raw sewage — to extreme temperatures without combustion. The output includes hydrogen and carbon monoxide, which together are known as syngas, for synthetic gas, and  can be burned to generate electricity or made into ethanol or diesel fuel. The FastOx is now being prepared for delivery to Sierra Energy’s first customer: the United States Army.

Ethanol has long been promoted as an alternative fuel that increases energy independence, and federal law requires the use of greater amounts of it. But most ethanol in this country is produced from corn or soybeans, and many people worry that the mandate is pushing upfood prices. Ethanol produced from trash — or agricultural waste, as others are trying — would allay such concerns.

Ineos Bio, a Florida company, announced last month that it had produced ethanol from gasified wood waste, using a method that it expects to be commercially viable, and KiOR Inc. will make one million to two million gallons of diesel and gasoline this year from wood waste at its plant in Columbus, Miss., according to Michael McAdams, president of the Advanced Biofuels Association. Mr. Hart said Sierra Energy’s technology should be complementary with the Florida company’s; the FastOx turns all municipal waste, not just wood scraps, into a gas that Ineos Bio could then transform into ethanol.

The FastOx gasifier is the brainchild of two former engineers at Kaiser Steel, patented by the grandson of one of them and commercialized by Mr. Hart. “It’s a modular system that can be dropped into any area,” Mr. Hart said, “using waste where it’s produced to make electricity where it’s used.” Once it’s off the ground, he said, “garbage will be a commodity.”  

From concept to construction, the story of the FastOx is of one fortuitous accident after another. And while Sierra Energy has not yet proved to be a successful company — it will be a long while before your garbage is shoveled into a FastOx — its system has become the first waste-to-energy technology acquired by the Defense Department, which paid $3 million for it through an environmental technology program. (The California Energy Commission, which supports renewable energy development in the state, also gave Sierra $5 million, to cover the portion of Sierra’s costs that the Pentagon couldn’t.)

The military is looking for ways to reduce its oil consumption, and to make it easier to supply the front lines with the fuel it uses in all its vehicles and generators. “These days, the supply lines are in the battlefield,” said Sharon E. Burke, the assistant secretary of defense for operational efficiency plans and programs. “And we consume a lot of fuel, which makes us a big target.”

MIKE HART got into the energy business by way of a train. In 1993, he bought the Sierra Railroad, a small freight and tourism line in Northern California. During the California blackouts of 2001, he had an idea: “As the lights were going out, I realized every one of my locomotives creates 2.1 megawatts of electricity,” he said — enough to power many hundred homes. “It’s a rolling generator, and inexpensive.”

The train-as-power-generator idea never really left the station, but it got Mr. Hart thinking about alternative energy. Then, as part of a settlement after a fuel spill from one of his trains, he promised to convert his trains to nonpolluting biodiesel.

Biodiesel, however, proved hard to find, and Mr. Hart started looking for new ways to source it. In 2002, he was asked to judge an annual business plan competition called the Big Bang, at the University of California, Davis. That’s where he met Chris Kasten.

Mr. Kasten came to the competition with an idea to use a modified blast furnace to turn waste into fuel. His grandfather, Bruce Claflin, a retired chief industrial engineer at Kaiser Steel in Fontana, Calif., had given him the idea.

Kaiser used blast furnaces to make steel, and Mr. Claflin and a colleague, John Jasbinsek, were tasked with finding “a way to make the blast furnace more efficient and less polluting,” said Mr. Jasbinsek, who is now 86.

Like all blast furnaces, Kaiser’s emitted a flue gas out of the top. It occurred to Mr. Clafin and Mr. Jasbinsek that this gas might have value. The two came up with the idea of injecting oxygen, instead of the atmospheric air that steel makers had always used, to create the chemical reaction that heats the inside of the furnace. This would cut pollution while raising the energy content of the flue gas — in essence, giving the steel maker a second product. But pure oxygen made the system too hot, so they added steam. This gave the furnace a third product: hydrogen, which can be used to produce electricity in fuel cells.

After Kaiser decided to close the Fontana plant in 1983, workers were told to toss all demolition debris into the blast furnace. It was then that Mr. Jasbinsek and Mr. Claflin realized that the furnace could take garbage, too. “No matter what they put in, the furnace melted and gasified it,” Mr. Kasten said. This meant a potential fourth revenue stream — from taking municipal waste that would otherwise go to landfills.

When Kaiser wasn’t interested, Mr. Jasbinsek recalled, “we took the idea to other steel companies, too.” But “nobody gave a damn!” he said. “Now there are hardly any steel companies left in the U.S.”

Kaiser Steel went bankrupt in 1987, so the idea belonged to Mr. Jasbinsek and Mr. Claflin. They were nearing retirement, though, so Mr. Claflin told his grandson about it. (Mr. Claflin died before the idea could be commercialized.)

Mr. Kasten’s first fruitful step in developing his grandfather’s idea was meeting with Chris Soderquist, founder of Venture Lab. “When you run a technology incubator, you see a lot of crazy and half-baked ideas,” Mr. Soderquist said. But Mr. Kasten’s was different; Mr. Soderquist could see right away the value of multiple revenue streams.

Gasification is more efficient than incineration and eliminates toxic byproducts that come from burning trash. But it was especially appealing from a business point of view because it relied on a proven technology and used materials in wide abundance: blast furnaces being abandoned as the American steel industry was collapsing.

“What was compelling from the start,” Mr. Soderquist said, “was repurposing existing infrastructure into a generator of clean energy, with a second revenue stream from people paying you to take their waste.”

Mr. Soderquist helped Mr. Kasten prepare for the Big Bang competition. “For a grad school business plan competition, it was quite a plan he presented,” Mr. Soderquist said, and the judges agreed: Mr. Kasten, now 43, won a $2,000 prize.

Mr. Hart, 51, as a competition judge and a serial entrepreneur, was intrigued. He had started his first business at 12, operating a string of candy machines in high schools throughout what would become known as Silicon Valley. Next, while still living at home, he opened a sort of temp agency for teenagers doing odd jobs. There were a lot of other businesses from the late 1970s to 1993, and stints as a developer for Steve Jobs’s company Next, and for Apple. Mr. Hart also did some consulting until he realized that he would make more money buying whatever devalued company he had been hired to help, and turning it around himself. That was when he bought the Sierra Railroad.

Mr. Hart checked out Mr. Kasten’s gasifier and decided to buy the patents. Then he applied to a Pentagon program established to shepherd proven concepts to the production stage. Results at the Defense Department’s testing facility near Sacramento have been promising; after about four hours, one ton of waste creates enough gas to produce 1,580 kilowatt-hours of electricity, which would power an average home in the United States for about a month and a half — at one-third the emissions of coal — and 42 gallons of renewably sourced fuel. And that’s with a 12-ton-a-day gasifier; existing blast furnaces can handle as much as 2,000 tons a day.

Now that the Pentagon is convinced that the FastOx will work as advertised, the system should be providing electricity later this year at Fort Hunter Liggett, a  training base in Monterey County, Calif., and fuel for vehicles and generators in early 2014.

“California produces 30 million tons of garbage a year,” Mr. Hart said. “If it decided to turn its waste into clean fuels, at that rate it could meet all its oil consumption needs and still export more fuel than some OPEC members.” That is, if the FastOx can do what no other waste-to-energy gasification technology has done before: take any kind of trash, in any succession, without additional separation or preparation.

Sierra plans to license its technology and to sell systems to make electricity or ethanol from the syngas produced by the FastOx. The first will be small and cost about $3 million. But Mr. Hart said he expects to sell larger systems to municipalities and biofuel makers that will go for much more.

Any waste-to-energy plan, however, must overcome a major hurdle: the wild inconsistency of the waste stream. “Until you’ve demonstrated that you can handle it all, nobody’s interested,” Mr. Hart said. “I can understand it; they’ve heard similar promises before. We’ve got 150 cities, communities and businesses lined up to be Serial No. 2. Nobody wants to be No. 1.”

NOBODY, that is, except the Pentagon. The Defense Department is the country’s largest single consumer of energy, spending $15 billion a year just on fuel.

“The mission drives this,” said Ms. Burke, the assistant defense secretary, “and the mission is inherently energy-intensive.”

The FastOx could reduce the military’s reliance on oil overseas and the grid at home. “I have a $24 million-a-year electric bill at Camp Pendleton” in Southern California, said that Marine base’s commander, Brig. Gen. Vincent A. Coglianese. “If I can reduce that cost, that’s more money I can put into training Marines and sailors.”

Ms. Burke added, “Something for military operations has to be really rugged, deployable, simple to use — all of those things.”

Consultants and municipal sanitation officials who’ve looked at the FastOx say it meets those criteria. John Conger, the acting deputy under secretary of defense for installations and the environment, who oversees management of military bases in the United States, says Sierra Energy’s technology should provide energy security for the military in the event of a blackout and provide budget savings as well.

The military’s cost of petroleum, when the costs of transporting and guarding it are factored in, can run as high as $50 a gallon. Moreover, about half of United States casualties in Iraq and Afghanistan between 2003 and 2007 were of servicemen and servicewomen moving and protecting fuel convoys, according to an Army report.

The appeal of Mr. Hart’s Pathfinder system is that it would produce fuel on site, eliminating the need to truck in fuel to dangerous military outposts. It would also reduce the need for trash-burning on bases, which creates pollution and noxious odors that have contributed to locals’ distaste for the American presence in Iraq and Afghanistan.  As a result, United States forces in Afghanistan are working to close burn pits.

“Waste is a problem,” Ms. Burke said. “So if we could dispose of waste and create energy at the same time, that would be a silver bullet.”

This article has been revised to reflect the following correction:

Correction: August 20, 2013

 

An earlier version of this article referred incorrectly to a product of Sierra Energy’s gasifier system. It  produces hydrogen and carbon monoxide, which together are known as “syngas,” for synthetic gas;  it does not produce “synthetic natural gas.”

 

This article has been revised to reflect the following correction:

Correction: August 20, 2013

 An earlier version of this article referred imprecisely to Fort Hunter Liggett, a training base in Monterey County, Calif. At more than 165,000 acres, it is not a “small” base.

(c) 2013 New York Times

 


HA-Vacation-to-Die-For-Final

My latest novel is

The Housewife Assassin's
Vacation to Die For

Now out, in

Amazon.com

Amazon.co.uk

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Pick up the first book in The Housewife Assassin series, for free!

 


 

Gotta love this headline in The New Yorker: “The Pay Is Too Damn Low.” Duh, yeah.

I don't feel the need to elaborate on this New Yorker article.

America, isn't it time you vote you pocketbooks, instead of letting the lobbyists decide your fates?

–Josie

THE FINANCIAL PAGE / The New Yorker

THE PAY IS TOO DAMN LOW

BY AUGUST 12, 2013

A few weeks ago, Washington, D.C., passed a living-wage bill designed to make Walmart pay its workers a minimum of $12.50 an hour. Then President Obama called on Congress to raise the federal minimum wage (which is currently $7.25 an hour). McDonald’s was widely derided for releasing a budget to help its employees plan financially, since that only underscored how brutally hard it is to live on a McDonald’s wage. And last week fast-food workers across the country staged walkouts, calling for an increase in their pay to fifteen dollars an hour. Low-wage earners have long been the hardest workers to organize and the easiest to ignore. Now they’re front-page news.

The workers’ grievances are simple: low wages, few (if any) benefits, and little full-time work. In inflation-adjusted terms, the minimum wage, though higher than it was a decade ago, is still well below its 1968 peak (when it was worth about $10.70 an hour in today’s dollars), and it’s still poverty-level pay. To make matters worse, most fast-food and retail work is part time, and the weak job market has eroded what little bargaining power low-wage workers had: their earnings actually fell between 2009 and last year, according to the National Employment Law Project.

Still, the reason this has become a big political issue is not that the jobs have changed; it’s that the people doing the jobs have. Historically, low-wage work tended to be done either by the young or by women looking for part-time jobs to supplement family income. As the historian Bethany Moreton has shown, Walmart in its early days sought explicitly to hire underemployed married women. Fast-food workforces, meanwhile, were dominated by teen-agers. Now, though, plenty of family breadwinners are stuck in these jobs. That’s because, over the past three decades, the U.S. economy has done a poor job of creating good middle-class jobs; five of the six fastest-growing job categories today pay less than the median wage. That’s why, as a recent study by the economists John Schmitt and Janelle Jones has shown, low-wage workers are older and better educated than ever. More important, more of them are relying on their paychecks not for pin money or to pay for Friday-night dates but, rather, to support families. Forty years ago, there was no expectation that fast-food or discount-retail jobs would provide a living wage, because these were not jobs that, in the main, adult heads of household did. Today, low-wage workers provide forty-six per cent of their family’s income. It is that change which is driving the demand for higher pay.

The situation is the result of a tectonic shift in the American economy. In 1960, the country’s biggest employer, General Motors, was also its most profitable company and one of its best-paying. It had high profit margins and real pricing power, even as it was paying its workers union wages. And it was not alone: firms like Ford, Standard Oil, and Bethlehem Steel employed huge numbers of well-paid workers while earning big profits. Today, the country’s biggest employers are retailers and fast-food chains, almost all of which have built their businesses on low pay—they’ve striven to keep wages down and unions out—and low prices.

This complicates things, in part because of the nature of these businesses. They make plenty of money, but most have slim profit margins: Walmart and Target earn between three and four cents on the dollar; a typical McDonald’s franchise restaurant earns around six cents on the dollar before taxes, according to an analysis from Janney Capital Markets. In fact, the combined profits of all the major retailers, restaurant chains, and supermarkets in the Fortune 500 are smaller than the profits of Apple alone. Yet Apple employs just seventy-six thousand people, while the retailers, supermarkets, and restaurant chains employ 5.6 million. The grim truth of those numbers is that low wages are a big part of why these companies are able to stay profitable while offering low prices. Congress is currently considering a bill increasing the minimum wage to $10.10 over the next three years. That’s an increase that the companies can easily tolerate, and it would make a significant difference in the lives of low-wage workers. But that’s still a long way from turning these jobs into the kind of employment that can support a middle-class family. If you want to accomplish that, you have to change the entire way these companies do business. Above all, you have to get consumers to accept significantly higher, and steadily rising, prices. After decades in which we’ve grown used to cheap stuff, that won’t be easy.

Realistically, then, a higher minimum wage can be only part of the solution. We also need to expand the earned-income tax credit, and strengthen the social-insurance system, including child care and health care (the advent of Obamacare will help in this regard). Fast-food jobs in Germany and the Netherlands aren’t much better-paid than in the U.S., but a stronger safety net makes workers much better off. We also need many more of the “middle-class jobs” we’re always hearing about. A recent McKinsey report suggested that the government should invest almost a trillion dollars over the next five years in repairing and upgrading the national infrastructure, which seems like a good place to start. And we really need the economy as a whole to grow faster, because that would both increase the supply of good jobs and improve the bargaining power of low-wage workers. As Jared Bernstein, an economist at the Center for Budget and Policy Priorities, told me, “The best friend that low-wage workers have is a strong economy and a tight job market.” It isn’t enough to make bad jobs better. We need to create better jobs. ♦

ILLUSTRATION: CHRISTOPH NIEMANN

(c) The New Yorker. All rights reserved.

 

TheHousewifeAssassinsHandbook_JosieBrown (134x200)My way to help the wage slave is to offer THE HOUSEWIEE ASSASSIN'S HANDBOOK for free. Download it here:

(Book 1) Signal Press  

FREE!  AmazonKindleButton

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Download a
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Read an excerpt…

Two health insurance articles you MUST read. Then go call Congress and tell it to support Obamacare, or your vote goes to someone who does.

Health400

The two articles, below explain the immediate effects of Obamacare on your health insurance costs. 

The first is from the New York Times. The second is from the New Yorker.

Here's the bottom line, folks. Until now, we've been at the mercy of health insurers who raised their rates at whimsy and for profit and greed. Their batallion of lobbyists paid off the best Congress money can buy. But with the passage of this health reform initiative, which requires that everyone participate — and allows for policies to be shopped around, even with "pre-existing conditions" —  patients/consumers have more choices, and aren't stuck with policies that cost too much while offering too little–let alone increase so egregiously each year.

The only thing more ideal than that is the Public Option, which would be the equivalent of Medicare for every citizen, not just those over sixty-five. Just imagine: you're in your twenties, and you can finally go to a doctor, without it costing you the equivalent of a month of rent!  Ask the citizens of Canada, the United Kingdom, and any other First World country who has it: it works. It's the most important service provided by their hard-earned taxes. It's fair for everyone.

Will Americans one day join their ranks? I hope so. I hope to see it in my lifetime, but I'm not so optimistic.

Not until all the lobbyists get out of the way.

Or until the citizens of the U.S. make it clear to their elected officials that they deserve the same heathcare plans provided to Congress and its families.

Yep, that's right: our elected officials gets it for free or for a pittance–and for life no less.

If they have it, you should, too.

Contact your U.S. senators, and tell the to support ALL platforms within the Affordable Care Act, because they will mandate patient healthcare reform.

Contact your Congressperson, to also support  the Affordable Care Act because it lowers your healthcare costs, as opposed to protecting the health insurers' profits. In fact, challenge him/her to write a bill that  provides you the same coverage as what they are getting for themselves.

Most importantly, contact your state's governor, and tell him future votes to him and his party are predicated on his expanding Medicaid in your state, which allows the Federal program to work for those most needy, and gives funds to your state to cover them.

— Josie

____________________________________

Health Plan Cost for New Yorkers Set to Fall 50%

By RONI CARYN RABIN and REED ABELSON / New York Times

Published: July 16, 2013 

Individuals buying health insurance on their own will see their premiums tumble next year in New York State as changes under thefederal health care law take effect, Gov. Andrew M. Cuomo announced on Wednesday.

State insurance regulators say they have approved rates for 2014 that are at least 50 percent lower on average than those currently available in New York. Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies, the cost will be even lower.

Supporters of the new health care law, the Affordable Care Act, credited the drop in rates to the online purchasing exchanges the law created, which they say are spurring competition among insurers that are anticipating an influx of new customers. The law requires that an exchange be started in every state.

“Health insurance has suddenly become affordable in New York,” said Elisabeth Benjamin, vice president for health initiatives with the Community Service Society of New York. “It’s not bargain-basement prices, but we’re going from Bergdorf’s to Filene’s here.”

“The extraordinary decline in New York’s insurance rates for individual consumers demonstrates the profound promise of the Affordable Care Act,” she added.

Administration officials, long confronted by Republicans and other critics of President Obama’s signature law, were quick to add New York to the list of states that appear to be successfully carrying out the law and setting up exchanges.

“We’re seeing in New York what we’ve seen in other states like California and Oregon — that competition and transparency in the marketplaces are leading to affordable and new choices for families,” said Joanne Peters, a spokeswoman for the Department of Health and Human Services.

The new premium rates do not affect a majority of New Yorkers, who receive insurance through their employers, only those who must purchase it on their own. Because the cost of individual coverage has soared, only 17,000 New Yorkers currently buy insurance on their own. About 2.6 million are uninsured in New York State.

State officials estimate as many as 615,000 individuals will buy health insurance on their own in the first few years the health law is in effect. In addition to lower premiums, about three-quarters of those people will be eligible for the subsidies available to lower-income individuals.

“New York’s health benefits exchange will offer the type of real competition that helps drive down health insurance costs for consumers and businesses,” said Mr. Cuomo.

The plans to be offered on the exchanges all meet certain basic requirements, as laid out in the law, but are in four categories from most generous to least: platinum, gold, silver and bronze. An individual with annual income of $17,000 will pay about $55 a month for a silver plan, state regulators said. A person with a $20,000 income will pay about $85 a month for a silver plan, while someone earning $25,000 will pay about $145 a month for a silver plan.

The least expensive plans, some offered by newcomers to the market, may not offer wide access to hospitals and doctors, experts said.

While the rates will fall over all, apples-to-apples comparisons are impossible from this year to next because all of the plans are essentially new insurance products.

The rates for small businesses, which are considerably lower than for individuals, will not fall as precipitously. But small businesses will be eligible for tax credits, and the exchanges will make it easier for them to select a plan. Roughly 15,000 plans are available today to small businesses, and choosing among them is particularly challenging.

“Where New York previously had a dizzying array of thousands upon thousands of plans, small businesses will now be able to truly comparison-shop for the best prices,” said Benjamin M. Lawsky, the state’s top financial regulator.

Officials at the state Department of Financial Services say they have approved 17 insurers to sell individual coverage through the New York exchange, including eight that are just entering the state’s commercial market. Many of these are insurers specializing inMedicaid plans that cater to low-income individuals.

North Shore-LIJ Health System, the large hospital system on Long Island, intends to offer a health plan for individuals as well as businesses for the first time. Some of the state’s best-known insurers, UnitedHealth Group and WellPoint, are also expected to participate. Insurers may decline to participate after they receive approval for their rates, but this is unlikely.

For years, New York has represented much that can go wrong with insurance markets. The state required insurers to cover everyone regardless of pre-existing conditions, but did not require everyone to purchase insurance — a feature of the new health care law — and did not offer generous subsidies so people could afford coverage.

With no ability to persuade the young and the healthy to buy policies, the state’s premiums have long been among the highest in the nation. “If there was any state that the A.C.A. could bring rates down, it was New York,” said Timothy Jost, a law professor at Washington and Lee University who closely follows the federal law.

Mr. Jost and other policy experts say the new health exchanges appear to be creating sufficient competition, particularly in states that have embraced the exchanges and are trying to create a marketplace that allows consumers to shop easily.

“That’s a very different dynamic for these companies, and it’s prodding them to be more aggressive and competitive in their pricing,” said Sabrina Corlette, a professor at Georgetown University’s Center on Health Insurance Reform.

But some consumers may still find the prices and plans disappointing. Jerry Ball, 46, who owns a recycling business in Queens, said the cost of covering his family increased so rapidly in the last few years that he had to scale back their coverage. Still, he pays nearly $18,000 a year for a high-deductible policy for a family of three.

He said he would be reluctant to part ways with his insurer, Oxford, and was disappointed that even the least expensive Oxford plan being offered next year would cost about as much as he pays now.

With another plan, he said: “Will I be able to maintain my doctors? I’m concerned that some of the better doctors aren’t going to take health insurance.”

He acknowledged that the new law would allow him for the first time to easily switch plans, but it is still hard for him to believe it guarantees coverage for pre-existing conditions. “I have to be careful. I can’t be denied coverage, right?” he asked.

(c) 2013 New York Times

___________________________________

JULY 17, 2013

OBAMACARE IN NEW YORK: SOME GOOD NEWS

POSTED BY  / New Yorker 

Obamacare-cassidy.jpg

Politically, these are rocky days for Obamacare. A couple of weeks ago, the Administration announced that it wassuspending for a year the employer mandate that will oblige businesses with fifty or more employees to offer health coverage or pay a fine. Instead of going into effect next January, as was originally planned, the mandate will apply beginning January 1, 2015. In seemingly trying to bury the news by putting it out just before the July 4th holiday, the Administration only made things worse. In Congress, gleeful Republicans seized upon their opponents’ discomfort, calling for theindividual mandate to be postponed as well.

The Administration rejected that idea, and plans are going ahead to get the insurance exchanges at the heart of the health-care reform up and running within six months. It’s a monumental task, in part because many G.O.P.-led states have refused to coöperate, but progress is being made. Following recent announcements in other states, including California and Oregon, confirming that a wide range of insurers have applied to sell individual and family plans through the exchanges, officials in New York are presenting some details of how the new insurance market will work here.

According to a front-page story in the Times on Wednesday, one important piece of news is that the cost of individual plans, which from Staten Island to Buffalo have long been astronomical, will come down substantially on the new exchange. In Manhattan, for example, people who have been paying well over a thousand dollars a month for individual coverage will be presented with a choice of plans that start at less than five hundred dollars a month. Those who make a modest income will be eligible for generous federal subsidies that will bring the cost down much further—perhaps as low as a hundred or two hundred dollars a month.

New Yorkers purchasing family plans will also get a break. For example, Empire Blue Cross currently charges Manhattanites $4,755 a month for a standard family plan. (Yes, that’s close to sixty thousand dollars a year.) On the new exchange, the monthly rate for a comparable plan will be $1,573, a difference of $3,182. Over twelve months, that adds up to more than thirty-eight thousand dollars. Elsewhere in the state, where current rates are a bit (just a bit) cheaper, the savings will be less, but they will still be considerable. And these numbers don’t even account for the new federal subsidies, which reflect a political decision to extend private health-care coverage to millions of Americans who couldn’t otherwise afford it. (I’ve long thought that the subsidies are so large that they may eventually encounter political opposition, but that’s not the issue here.)

How is this possible? The savings outlined in the previous paragraph reflect a chronic failure in the private health-care industry which Obamacare will help to correct. As such, they provide a timely reminder of why radical reform was necessary in the first place.

The first task of any health-care system is to provide readily available coverage for the sick, especially those with chronic conditions, such as heart disease or cancer. As it operates at the moment, the U.S. system doesn’t meet this standard. In many states, particularly in the South, health insurers refuse to sell individual coverage to people with serious illnesses on the perfectly logical grounds that they are likely to need a lot of costly care and attention.

In New York and other progressive states, the authorities require insurers to offer coverage to people with preëxisting conditions, but that has simply forced up the prices of individual plans to extortionate levels. As the cost of premiums rose, many young and healthy folks who didn’t have group plans chose to go without any coverage, at least until they got ill. That further biased the risk pool for individual plans toward sick people, and the insurers responded by raising the price of coverage even further, making it even more difficult to obtain for those who needed it most.

Economists refer to this problem as “adverse selection,” and the individual mandate was designed to address it. By obliging even healthy people to take out insurance, the government can change the nature of the risk pool, which should allow insurers to charge lower premiums. In New York, at least, the initial signs are encouraging. Today, the cost of individual insurance plans is so high that fewer than twenty thousand people buy them. Under the new system, state officials project, the number of people enrolled in individual plans will expand to more than six hundred thousand. In a state with a population of nearly twenty million, that isn’t an enormous number, but it is a significant one.

It’s too early to say how Obamacare will shake out. New York is just one state. In other, less regulated, places, where insurers are currently able to offer cheap plans that provide very limited coverage, the cost of individual plans may well go up—but so will their quality.

And expanding individual coverage is just part of a bigger picture. Without making the employer mandate work effectively, containing the cost of small-business plans and persuading more G.O.P.-run states to expand Medicaid, the whole thing won’t hang together.

Even if Obamacare does get up and running nationwide, there will still be questions about its cost, and about whether it wouldn’t have been cheaper and more effective to cut out the private insurers and adopt the public option.

But don’t let anyone tell you that the current health-care system is working well, or anything close to it. In Manhattan, where the median household income is about sixty-seven thousand dollars, it costs some families upward of fifty thousand dollars a year to purchase health coverage. That’s nuts, and it’s about to change for the better.

 (c) 2013 The New Yorker

Maternity Delivery: US is the COSTLIEST country in the world–by far.

This article, from the New York Times, should give pause to anyone who is having a baby–or has had a baby–in the United States. If this doesn't make the strongest case for health care reform in our country, then I don't know what does.

— Josie

 

American Way of Birth, Costliest in the World

Photo: Josh Haner/The New York Times

"I feel like I'm in a used-car lot." Renée Martin, who, with her husband, is paying for her maternity care out of pocket.

By  | Published: June 30, 2013

As you read this article, please share your experiences by responding to the questions that will appear. Your responses will inspire future articles in this series.

Elisabeth Rosenthal, reporter

YOUR PERSPECTIVE

What do you think the total cost of a woman’s pregnancy should be, from prenatal checkups through delivery and newborn care?

$

COMPARE

 

LACONIA, N.H. — Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.

At a prenatal class in March, she was told about epiduralanesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?”

Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors.

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

 

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.

“It’s not primarily that we get a different bundle of services when we have a baby,” said Gerard Anderson, an economist at the Johns Hopkins School of Public Health who studies international health costs. “It’s that we pay individually for each service and pay more for the services we receive.”

Those payment incentives for providers also mean that American women with normal pregnancies tend to get more of everything, necessary or not, from blood tests to ultrasound scans, said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health who studies the cost of women’s health care.

Financially, they suffer the consequences. In 2011, 62 percent of women in the United States covered by private plans that were not obtained through an employer lacked maternity coverage, like Ms. Martin. But even many women with coverage are feeling the pinch as insurers demand higher co-payments and deductibles and exclude many pregnancy-related services.

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold,according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

Women with insurance pay out of pocket an average of $3,400, according to a survey byChildbirth Connection, one of the groups behind the maternity costs report. Two decades ago, women typically paid nothing other than a small fee if they opted for a private hospital room or television.

YOUR PERSPECTIVE

What aspects of maternity care or its costs were unexpected for you?

Only in America

In most other developed countries, comprehensive maternity care is free or cheap for all, considered vital to ensuring the health of future generations.

Ireland, for example, guarantees free maternity care at public hospitals, though women can opt for private deliveries for a fee. The average price spent on a normal vaginal delivery tops out at about $4,000 in Switzerland, France and the Netherlands, where charges are limited through a combination of regulation and price setting; mothers pay little of that cost.

The chasm in price is true even though new mothers in France and elsewhere often remain in the hospital for nearly a week to heal and learn to breast-feed, while American women tend to be discharged a day or two after birth, since insurers do not pay costs for anything that is not considered medically necessary.

 

YOUR PERSPECTIVE

If you gave birth outside the United States, what was your experience with medical testing, procedures and costs?

 

Only in the United States is pregnancy generally billed item by item, a practice that has spiraled in the past decade, doctors say. No item is too small. Charges that 20 years ago were lumped together and covered under the general hospital fee are now broken out, leading to more bills and inflated costs. There are separate fees for the delivery room, the birthing tub and each night in a semiprivate hospital room, typically thousands of dollars. Even removing the placenta can be coded as a separate charge.

Each new test is a new source of revenue, from the hundreds of dollars billed for the simple blood typing required before each delivery to the $20 or so for the splash of gentian violet used as a disinfectant on the umbilical cord (Walgreens’ price per bottle: $2.59). Obstetricians, who used to do routine tests like ultrasounds in their office as part of their flat fee, now charge for the service or farm out such testing to radiologists, whose rates are far higher.

Add up the bills, and the total is startling. “We’ve created incentives that encourage more expensive care, rather than care that is good for the mother,” said Maureen Corry, the executive director of Childbirth Connection.

In almost all other developed countries, hospitals and doctors receive a flat fee for the care of an expectant mother, and while there are guidelines, women have a broad array of choices. “There are no bills, and a hospital doesn’t get paid for doing specific things,” said Charlotte Overgaard, an assistant professor of public health at Aalborg University in Denmark. “If a woman wants acupuncture, an epidural or birth in water, that’s what she’ll get.”

Despite its lavish spending, the United States has one of the highest rates of both infant and maternal death among industrialized nations, although the fact that poor and uninsured women and those whose insurance does not cover childbirth have trouble getting or paying for prenatal care contributes to those figures.

Some social factors drive up the expenses. Mothers are now older than ever before, and therefore more likely to require or request more expensive prenatal testing. And obstetricians face the highest malpractice risks among physicians and pay hundreds of thousands of dollars a year for insurance, fostering a “more is safer” attitude.

But less than 25 percent of America’s high payments for pregnancy typically go to obstetricians, and they often charge a flat fee for their nine months of care, no matter how many visits are needed, said Dr. Robert Palmer, the chairman of the committee for health economics and coding at the American College of Obstetricians and Gynecologists. That fee can range from a high of more than $8,000 for a vaginal delivery in Manhattan to under $4,000 in Denver, according to Fair Health, which collects health care data.

Rather it is the piecemeal way Americans pay for this life event that encourages overtreatment and overspending, said Dr. Kozhimannil, the Minnesota professor. Recent studies have found that more than 30 percent of American women have Caesarean sections or have labor induced with drugs — far higher numbers than those of other developed countries and far above rates that the American College of Obstetricians and Gynecologists considers necessary.

During the course of her relatively uneventful pregnancy, Ms. Martin was charged one by one for lab tests, scans and emergency room visits that were not included in the doctor’s or the hospital’s fee. During her seventh month, she described one week’s experience: “I have high glucose, and I tried to take a three-hour test yesterday and threw up all over the lab. So I’m probably going to get charged for that. And my platelets are low, so I’m going to have to see a hematologist. So I’m going to get charged for that.”

She sighed and put her head in her hands. “Welcome to my world,” she said.

Extras Add Up

Though Ms. Martin has yet to receive her final bills, other couples describe being blindsided by enormous expenses. After discovering that their insurance did not cover pregnancy when the first ultrasound bill was denied last year, Chris Sullivan and his wife, both freelance translators in Pennsylvania, bought a $4,000 pregnancy package from Delaware County Memorial Hospital; a few hospitals around the country are starting to offer such packages to those patients paying themselves.

The couple knew that price did not cover extras like amniocentesis, a test for genetic defects, or an epidural during labor. So when the obstetrician suggested an additional fetal heart scan to check for abnormalities, they were careful to ask about price and got an estimate of $265. Performed by a specialist from the Children’s Hospital of Philadelphia, it took 30 minutes and showed no problems — but generated a bill of $2,775.

“All of a sudden I have a bill that’s as much as I make in a month, and is more than 10 times what I’d been quoted,” Mr. Sullivan said. “I don’t know how I could have been a better consumer, I asked for a quote. Then I get this six-part bill.” After months of disputing the large discrepancy between the estimate and the bill, the hospital honored the estimate.

Christopher Gregory/The New York Times

"Most insurance companies wouldn't blink at my bill, but it was absurd." Dr. Marguerite Duane, who questioned line items on her hospital bill.

 

Mr. Sullivan noted that the couple ended up paying $750 for an epidural, a procedure that has a list price of about $100 in his wife’s native Germany.

Even women with the best insurance can still encounter high prices. After her daughter was born five years ago, Dr. Marguerite Duane, 42, was flabbergasted by the line items on the bills, many for blood tests she said were unnecessary and medicines she never received. She and her husband, Dr. Kenneth Lin, both associate professors of family medicine at Georgetown Medical School, had delivered babies in their early years of practice.

So when she became pregnant again in 2011, she decided to be more assertive about holding down costs. After a routine ultrasound scan at 20 weeks showed a healthy baby, she refused to go back for weekly follow-up scans that the radiologist suggested during the last months of her pregnancy even though medical guidelines do not recommend them. When in the hospital for the delivery of her son Ellis in February, she kept a list of every medicine and every item she received.

Though she delivered Ellis with a midwife 12 minutes after arriving at the hospital and was home the next day, the hospital bill alone was more than $6,000, and her insurance co-payment was about $1,500. Her first two pregnancies, both more than five years ago, were fully covered by federal government insurance because her husband worked for the Agency for Health Care Research and Quality.

“Most insurance companies wouldn’t blink at my bill, but it was absurd — it was the least medical delivery in history,” said Dr. Duane, who is taking a break from practice to stay home with her children. “There were no meds. I had no anesthesia. He was never in the nursery. I even brought my own heating pad. I tried to get an explanation, but there were items like ‘maternity supplies.’ What was that? A diaper?”

Ms. Martin is similarly well positioned to be an expert consumer of health care. She administered the health plan for a large art gallery she managed in Los Angeles before marrying and moving to Vermont in 2011 to enroll in a year of pre-med classes at the University of Vermont. She has a scholarship this fall for a master’s degree program at Vanderbilt University’s Center for Medicine, Health and Society, and then she plans to go on to medical school. Her father-in-law is a pediatrician.

RENÉE MARTIN’S PREGNANCY COSTS

Video by Dave Horn; Photography by Cheryl Senter for the New York Times

Statement after delivery without any discounts; not an official bill:
Hospital charges
$20,257
Obstetrician
4,020
Anesthesiologist
3,278
Drugs
1,125
Bills for prenatal care:
Emergency visit
1,600
Genetic testing
1,500
Ultrasound
1,191
Radiology
520
Hematologist
346

 

She and her husband, who works for a small music licensing company that does not provide insurance, hoped to start their family during the year they were covered by university insurance in Vermont, she said, but “nature didn’t cooperate.”

Then they moved to the New Hampshire summer resort of Laconia, her husband’s hometown, for a year before she started the grind of medical training. But in New Hampshire, they discovered, health insurance they could buy on the individual market did not cover maternity care without the purchase of an additional “pregnancy rider” for $800 a month. With their limited finances and unsuccessful efforts at conceiving, it seemed an unwise, if not impossible, investment.

Soon after buying insurance coverage without the rider for $450 a month, Ms. Martin discovered she was pregnant. Her elation was quickly undercut by worry.

“We’re not poor. We pay our bills. We have medical insurance. We’re not looking for a handout,” Ms. Martin said, noting that her husband makes too much money for her to qualify for Medicaid or other subsidized programs for low-income women. “The hospital is doing what it can. Our doctors are taking wonderful care of us. But the economics of this system are a mess.”

Not knowing whether the pregnancy would fall at the $4,000 or $45,000 end of the range the hospital cited, the couple had a hard time budgeting their finances or imagining their future. The hospital promised a 30 percent discount on its final bill. “I’m trying not to be stressed, but it’s really stressful,” Ms. Martin said as her due date approached.

YOUR PERSPECTIVE

How would you describe the ideal scenario for insurance coverage during pregnancy?

Package Deals

With costs spiraling, some hospitals are starting to offer all-inclusive rates for pregnancy. Maricopa Medical Center, a public hospital in Phoenix, began offering uninsured patients a comprehensive package two years ago. “Making women choose during labor whether you want to pay $1,000 for an epidural, that didn’t seem right,” said Dr. Dean Coonrod, the hospital’s chief of obstetrics and gynecology.

The hospital charges $3,850 for a vaginal delivery, with or without an epidural, and $5,600 for a planned C-section — prices that include standard hospital, doctors’ and testing fees. To set the price, the hospital — which breaks even on maternity care and whose doctors are on salaries — calculated the average payment it gets from all insurers. While Dr. Coonrod said the hospital might lose a bit of money, he saw other benefits in a market where everyone will have insurance in just a few years: mothers tend to feel allegiance to the place they give birth to their babies and might seek other care at Maricopa in the future.

Laura Segall for The New York Times

"Making women choose during labor whether you want to pay $1,000 for an epidural, that didn't seem right." Dr. Dean Coonrod, chief of obstetrics and gynecology at Maricopa Medical Center in Phoenix

 

The Catalyst for Payment Reform, a California policy group, has proposed that all hospitals should offer such bundled prices and that rates should be the same, no matter the type of delivery. It suggests that $8,000 might be a reasonable starting point. But that may be hard to imagine in markets like New York City, where $8,000 is less than many private doctors charge for their fees alone.

One factor that has helped keep costs down in other developed countries is the extensive use of midwives, who perform the bulk of prenatal examinations and even simple deliveries; obstetricians are regarded as specialists who step in only when there is risk or need. Sixty-eight percent of births are attended by a midwife in Britain and 45 percent in the Netherlands, compared with 8 percent in the United States. In Germany, midwives were paid less than $325 for an 11-hour delivery and about $30 for an office visit in 2011.

Dr. Palmer of the American College of Obstetricians and Gynecologists acknowledged the preference for what he called “medicalized” deliveries in the United States, with IVs, anesthesia and a proliferation of costly ultrasounds. He said the organization was working to define standards for the scans.

 

To control costs in the United States, patients may also have to alter their expectations, including the presence of an obstetrician at every prenatal visit and delivery. “It’s amazing how much patients buy into our tendency to do a lot of tests,” said Eugene Declercq, a professor at Boston University who studies international variations in pregnancy. “We’ve met the problem, and it’s us.”

Starting next year, insurance policies will be required under the Affordable Care Act to include maternity coverage, so no woman should be left paying entirely on her own, like Ms. Martin. But the law is not explicit about what services must be included in that coverage. “Exactly what that means is the crux of the issue,” Dr. Kozhimannil said.

If the high costs of maternity care are not reined in, it could break the bank for many states, which bear the brunt of Medicaid payouts. Medicaid, the federal-state government health insurance program for the poor, pays for more than 40 percent of all births nationally, including more than half of those in Louisiana and Texas. But even Medicaid, whose payments are regarded as so low that many doctors refuse to take patients covered under the program, paid an average of $9,131 for vaginal births and $13,590 for Caesarean deliveries in 2011.

Insured women are still getting the recommended prenatal care, despite rising out-of-pocket costs, according to a recent study. But that does not mean they are not feeling the strain, said Dr. Kozhimannil, the study’s lead author. The average amount of savings among pregnant women in the study was $3,000 to $5,000. “People will find ways to scrape by for medical care for their new baby, but are young mothers taking care of themselves? And what happens when they need to start buying diapers?” she asked. “Something’s got to give.”

Ms. Martin, who busied herself making toys as her due date neared, could not stop fretting about the potential cost of a complicated delivery. “I know that a C-section could ruin us financially,” she said.

On May 25, she had a healthy daughter, Isla Daisy, born by vaginal delivery. Mother and daughter went home two days later.

She and her husband are both overjoyed and tired. And, she said, they are “dreading” the bills, which she estimates will be over $32,000 before negotiations begin. Her labor was induced, which required intense monitoring, and she also had an epidural.

“We’re bracing for it,” she said.

(c) 2013 The New York Times.

 

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Another way in which our Congress is the best Big Pharma can buy.

Drug costs

This article in the New York Times spells it out succinctly. Having a mother who died of the blood disease Myelodysplasia, this truly breaks my heart. If she hadn't been old enough for Medicare, it would have bankrupted her.

Almost ten years ago, TIME magazine pointed out that "The prices Americans pay for prescription drugs, which are far higher than those paid by citizens of any other developed country, help explain why the pharmaceutical industry is — and has been for years — the most profitable of all businesses in the U.S. In the annual Fortune 500 survey, the pharmaceutical industry topped the list of the most profitable industries, with a return of 17% on revenue."[1]National expenditures on pharmaceuticals accounted for 12.9% of total health care costs, compared to an OECD average of 17.7% (2003 figures)…"

Not much has changed.  Like locusts, 12,389 Big Pharma lobbyists hover around our lawmakers. In fact, according to the Center for Responsive Politics, the pharmaceutical industry spent $18,530,000 in 2012 — and $232,583,920 between 1998-2012 – ensuring that the laws created protect their clients while decimating the health and wellbeing (and bank accounts) of the American people.

I guess a few hundred million over a span of fourteen years is a small price to pay for the tens of billions they net in revenue  each year.

These companies are profiting on our lives. — Josie

Doctors Denounce Cancer Drug Prices of $100,000 a Year

By ANDREW POLLACK / New York Times
Published: April 25, 2013 
 (c) 2013 New York Times

With the cost of some lifesaving cancer drugs exceeding $100,000 a year, more than 100 influential cancer specialists from around the world have taken the unusual step of banding together in hopes of persuading some leading pharmaceutical companies to bring prices down.

Prices for cancer drugs have been part of the debate over health care costs for several years — and recently led to a public protest from doctors at a major cancer center in New York. But the decision by so many specialists, from more than 15 countries on five continents, to join the effort is a sign that doctors, who are on the front lines of caring for patients, are now taking a more active role in resisting high prices. In this case, some of the specialists even include researchers with close ties to the pharmaceutical industry.

The doctors and researchers, who specialize in the potentially deadly blood cancer known as chronic myeloid leukemia, contend in a commentary published online by a medical journal Thursday that the prices of drugs used to treat that disease are astronomical, unsustainable and perhaps even immoral.

They suggested that charging high prices for a medicine needed to keep someone alive is profiteering, akin to jacking up the prices of essential goods after a natural disaster.

“Advocating for lower drug prices is a necessity to save the lives of patients” who cannot afford the medicines, they wrote in Blood, the journal of the American Society of Hematology.

While noting that the cost of drugs for many other cancers were just as high, the doctors focused on what they know best — the medicines for chronic myeloid leukemia, like Gleevec, which is enormously profitable for Novartis. Among the critics is Dr. Brian Druker, who was the main academic developer of Gleevec and had to prod Novartis to bring it to market.

Novartis argues that few patients actually pay the full cost of the drug and that prices reflect the high cost of research and the value of a drug to patients.

Gleevec entered the market in 2001 at a price of about $30,000 a year in the United States, the doctors wrote. Since then, the price has tripled, it said, even as Gleevec has faced competition from five newer drugs. And those drugs are even more expensive.

The prices have been the subject of intense debate elsewhere as well. The Supreme Court in India ruled recently that the drug could not be patented, clearing the way for use of far less expensive generic alternatives.

Some of the doctors who signed on to the commentary said they were inspired by physicians at the Memorial Sloan-Kettering Cancer Center in New York, who last fall refused to use a new colon cancer drug, Zaltrap, because it was twice as expensive as another drug without being better.

After those doctors publicized their objections in an Op-Ed article in The New York Times, Sanofi, which markets Zaltrap, effectively cut the price in half.

What impact the new commentary will have remains to be seen. The authors, however, call merely for a dialogue on pricing to begin.

The leader of the protest is Dr. Hagop M. Kantarjian, chairman of the leukemia department at the prestigious MD Anderson Cancer Center in Houston.

Many of the roughly 120 doctors who were co-authors of the commentary — about 30 of whom are from the United States — work closely with pharmaceutical companies on research and clinical trials. They say they favor a healthy pharmaceutical industry, but think prices are much higher than they need to be to ensure that.

“If you are making $3 billion a year on Gleevec, could you get by with $2 billion?” Dr. Druker, who is now director of the Knight Cancer Institute at Oregon Health and Science University, said in an interview. “When do you cross the line from essential profits to profiteering?”

Gleevec’s sales were $4.7 billion in 2012, making it Novartis’s best-selling drug. A newer Novartis leukemia drug, Tasigna, had sales of $1 billion.

Novartis said in a statement released Thursday: “We recognize that sustainability of health care systems is a complex topic and we welcome the opportunity to be part of the dialogue.”

It said that its investment in Gleevec continued after the initial approval, expanding the drug’s use to other diseases. It also said that it provided Gleevec or Tasigna free to 5,000 uninsured or underinsured Americans each year and to date had provided free drugs to more than 50,000 people in low-income countries.

Novartis and the manufacturers of the other drugs for chronic myeloid leukemia say the prices reflect the value of the drug. While many cancer drugs with equally high prices extend life by only a few months on average, it is widely agreed that Gleevec and rivals are near-miracle medicines that essentially turn a death sentence into a chronic disease likediabetes.

“It is a little surprising that their focus is in a cancer where the small-molecule medicines have had the greatest impact on long-term benefit,” said Dr. Harvey J. Berger, chief executive of Ariad Pharmaceuticals, which sells the newest and most expensive of the leukemia drugs, Iclusig.

Dr. Berger said the price of Iclusig was $115,000 a year, not the $138,000 a year cited in the commentary. Pfizer said the price of its drug, Bosulif, also was overstated in the piece. The manufacturers cite the price at which they sell to wholesalers, while the authors of the commentary were referring to a price they say better reflects what is charged by a pharmacy to patients. 

The other drugs for chronic myeloid leukemia are Sprycel from Bristol-Myers Squibb and Synribo from Teva.

The commentary noted that despite drug company programs, a minority of the estimated 1.2 million to 1.5 million people in the world with chronic myeloid leukemia were receiving one of the drugs. In many developing nations, it said, cancer experts were advocating risky bone marrow transplants because that is a one-time procedure that is cheaper than continuous treatment with one of the drugs.

The article also said the survival rate for patients in the United States appeared to be less than it should be, perhaps because costs are forcing patients to not take their medicine. Prices for the drugs are twice as high in the United States as in many other countries, which often apply some government pressure or price controls to keep drug costs down.

Even if out-of-pocket costs can be low, health systems in general still must pay for the drugs, the commentary says. And some patients say assistance programs are not always easy to use.

Raven Riedesel of Winlock, Wash., said she had been turned down by various charities — though she hadn’t yet tried Novartis itself — because her husband, a pipe fitter, makes too much money. Yet the insurance from his union would require her to pay $1,200 to $1,600 a month as a co-payment for Tasigna.

“It would take everything that we had left over after buying necessities and paying our bills,” said Ms. Riedesel, 28, a mother of two young children. She is now in a clinical trial allowing her to obtain Tasigna free; the trial will end in November.

Patients in the United States circulated an online petition last year protesting the price of Gleevec, but the effort was dropped after receiving about 400 signatures.

Cheap generic versions could enter the American market as early as 2015 when the main patent on Gleevec expires., Novartis might try to assert other patents to stave off competition, however. It is also trying to shift patients to Tasigna, which has a longer patent life.

Dr. John M. Goldman, emeritus professor of hematology at Imperial College in London and a co-author of the commentary, said he knew several researchers who declined to become authors because they feared losing research money from the industry.

Dr. Kantarjian, the lead author, said that was a risk.

“I am sure I am going to be blackballed,” he said. “My research career will be hurt.”

But he said it was time to speak out. “Pharmaceutical companies have lost their moral sense,” he said. Prices, he added, “are getting to the point where it is becoming unsustainable.”

(c) 2013 New York Times

My NaNoWriMo Tip #15 is on authors sabotage their writing, and their careers.


NaNo15
It's NaNoWriMo Month
!

(National Novel Writing Month, for the uninitiated…)

For those of you who have begun writing your first book, every day I'll repost my fave creative writing tips here, just for you. 

Here's Tip #15, for Thursday, the 15th…

The previous day's post can be accessed on this page, too.

Here's to your success as an author,

— Josie Brown

Don’t forget to enter my HOUSEWIFE ASSASSIN’S GUIDE TO GRACIOUS KILLING contest, for a chance to win a $100 gift card to the bookstore of your choice!

 

 

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My NaNoWriMo Tip #7: How to fix a dud chapter.


NaNo7
It's NaNoWriMo Month
!

(National Novel Writing Month, for the uninitiated…)

For those of you who have begun writing your first book, every day I'll repost my fave creative writing tips here, just for you. 

Here's Tip #7, for Wednesday, November 7th…

The previous day's post can be accessed on this page, too.

Here's to your success as an author,

— Josie Brown

Don’t forget to enter my HOUSEWIFE ASSASSIN’S GUIDE TO GRACIOUS KILLING contest, for a chance to win a $100 gift card to the bookstore of your choice!

 

 

HAH Hanging Man V2Buy THE HOUSEWIFE ASSASSIN'S HANDBOOK Today, on

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Lauren Allen joins the cast of the NBC TV show based on my novel, SECRET LIVES OF HUSBANDS AND WIVES

Love it! Another actress has been cast in Secret Lives of Husbands and Wives. I loved Lauren Allen in Awake, so I'm sure she'll be great in the show.

Check it out below, from Deadline Hollywood…

— Josie


Laura Allen Joins NBC’s ‘Husbands And Wives’

Laura Allen has been cast as one of the leads in NBC’s pilot The Secret Lives Of Husbands And Wives. The thriller/dramatic soap is from Jerry Bruckheimer TV and writer Sascha Penn and revolves around the lives of several couples. Allen, repped by Gersh and Impression Entertainment, will play Alison Dunn, a grounded and levelheaded mother and wife who happens to be hiding the darkest secret of all. It’s a return to NBC for Allen, who was cast in a supporting role then bumped up to female lead on the network’s Awake.

Nellie Andreeva

SECRET LIVES TV Show — Jesse L. Martin Added to the Cast

I'm so glad to hear Jesse L. Martin has been added to the cast of the TV show based on my novel Secret Lives of Husbands and Wives, since I love him on SMASH. Check it out in Deadline Hollywood.

— Josie

 

Nellie Andreeva Jesse L. Martin To Star In NBC’s ‘Secret Lives Of Husbands & Wives’ Pilot

Law & Order alum Jesse L. Martin is set to star opposite Martin Hendersonin the Jerry Bruckheimer-producedNBC drama pilot The Secret Lives Of Husbands And WivesIt is described as thriller-dramatic soap that centers on a murder and the secrets and lies within a tightly woven group of three suburban couples and their families exposed in its aftermath.

JesseMartin__120914173927Martin will play half of one of the couples, Greg Cooke, a perpetual frat boy and former hedge fund manager whose faltering finances force him into partnering with an unsavory business associate. Also starring in the pilot are Perrey Reeves and Nicole Ari Parker. Martin, repped by ICM Partners and manager Bob McGowan, is recurring on NBC’s Smash this season, and he signed on do the pilot after the schedules for the two NBC projects could be worked out. Helping the matter is the fact that both Smash and Secret Lives are shooting in New York.