Quora Question: Epipen Controversy Exposes Systemic Healthcare Flaws


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Answer from Dan Munro, author of Casino Healthcare:

It’s the same controversy that plagues much of U.S. healthcare. As a country, and as individuals, we don’t like it when there’s a big imbalance between the cost of healthcare and the need for it, especially for kids.

The EpiPen delivers about $1 worth of a drug (epinephrine) easily and conveniently to avoid a life-threatening condition (anaphylactic shock). The company that manufactures the EpiPen, Mylan, has raised the price dramatically through the years, especially relative to the cost of either the drug or the delivery mechanism. As hard as it is to believe, the reason they did this is simple: because they can. And the EpiPen is a big moneymaker for Mylan.

The EpiPen controversy isn’t unique to Mylan. It’s the same controversy as the one sparked by Martin Shkreli (Turing Pharmaceuticals Dramatically Raises Price) with the drug Daraprim. Not surprisingly, Mr. Shkreli was publicly supportive of Mylan’s pricing increases earlier this week. Ralph Nader referred to Mylan as: “Greed on steroids.”

Valeant Pharmaceuticals is another company (like Mylan and Turing) and they’ve generated similar controversies through the years with their price hikes.

See the pattern here?

There’s a really hard truth to these hemorrhoidal flare-ups of price gouging. We resent it, but not enough to understand it, and that’s a big problem (our collective problem) in trying to make real changes. Real change is difficult and requires a much deeper understanding of the whole healthcare system design. All too often, we simply throw up our hands and falsely conclude that our healthcare “system” is broken. The hard truth that we must face is that it really isn’t.

We think it’s “broken” because we don’t understand the evolutionary design of our healthcare system. There’s an urgent immediacy to our culture that makes history too long, too boring, too difficult, too much effort; but it always bites us. As the famous author Michael Chricton said:

If you don't know history, then you don't know anything. You are a leaf that doesn't know it is part of a tree.

In fact, there’s another quote, by another author, that I like to use to highlight our specific challenge with that deeper understanding of our healthcare system.

On the release of his book Flash Boys, author Michael Lewis was interviewed by Steve Kroft on "60 Minutes: and a quote from that interview was both the inspiration and influence for my book Casino Healthcare.

If it wasn’t complicated, it wouldn’t be allowed to happen. The complexity disguises what’s happening. If it’s so complicated that you can’t understand it – then you can’t question it.

What Lewis was referencing was high-speed trading on Wall Street, but the quote could just as easily be applied to all of U.S. healthcare, as well. In fact, it’s tailor-made. Our healthcare system has become so complicated that we can’t understand it. But that complexity is also by design, as a way to avoid and avert the hard questions. We desperately want someone, or something, to just fix it. We thought Obamacare might, and some truly believed it could, but Obamacare is really just a single step out of our healthcare wilderness. It’s the same wilderness we’ve been wandering around in for decades. At different times we’re angry, lost, confused, frustrated, hurt , and it winds up being more of a ghoulish nightmare than a wilderness.

2016-08-29T130513Z_3_LYNXNPEC7S0FS_RTROPTP_3_MYLAN-EPIPEN-COMPETITION EpiPen auto-injection epinephrine pens manufactured by Mylan. REUTERS/Jim Bourg/File Photo

But the hard truth in this wilderness is that in our "Casino Healthcare" (including sidestories like EpiPen) all the players are complicit. Payers, providers, pharma, politicians and suppliers are all aligned to a primary objective: their objective. These objectives are unique to them individually, but they’re the same collectively. It’s the for-profit business of revenue, stock price, shareholders, risk capital and campaign contributions. Safety, quality (and equality) in our system are secondary objectives — even though there are many that push hard on them for the full attention they deserve (myself included).

Mylan is simply doing what for-profit companies are legally required and expected to do ;  that is to work in the best interest of their board, their investors, their stockholders, and yes, themselves. Like her or not, the CEO of Mylan is doing exactly what she is paid (very well) to do. If she were fired tomorrow her personal life wouldn’t change measurably except that she’d get to spend more family and fun time in her allotted years. Worse still is that any replacement would simply dial back the pricing to avoid the heat and slowly ratchet it back up when our anger and frustration moves on. It always moves on.

We don’t like it, but we’re complicit too, just in a different way. We’re complicit in the satisfaction of our ignorance that we don’t dig deeper, we don’t understand and the media flare-ups do die down. Valeant, Turing and now Mylan are like accidents on the freeway. We slow down, we’re stunned and aghast at the horror, and then we move on.

So no, the EpiPen story isn’t rare or all that different. It’s just the latest in a long line of stories that will continue to repeat until we make systemic changes to the way U.S. healthcare is designed. We can make those changes. We should make those changes, but the first step for all of us is to understand that the system we have—now running at $3.4 trillion per year—isn’t broken at all. It was designed this way, and we just need a whole new design. One that’s not optimized for revenue and profits first, but one that puts patient safety, quality, and yes, equality first.

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