"Code Blue" by Mike Magee; Atlantic Monthly Press (368 pages, $27)
Although an opioid-abuse epidemic was raging, doctors who had access to the addictive drugs were brazenly selling them to addicts with no pretense of medical treatment, including one case in which a Memphis physician was doling out thousands of scripts in exchange for cash.
One "patient" crossed state lines and got 10 opioid prescriptions, under 10 fictitious names from the Memphis doctor, despite new federal laws designed to keep the drugs out of addicts' hands. Yet the doctor felt so persecuted that he took his case all the way to the U.S. Supreme Court.
In "Code Blue," a much buzzed-about book coming out this week, author Mike Magee dredges up this anecdote from 1919 and many others to show readers that the present dysfunction in U.S. health care is not an aberration, but a persistent feature of a system ruled by self-interested institutions. The book depicts more than a century of bad behavior by what Magee, himself a medical doctor, refers to as the Medical Industrial Complex.
The book exposes how doctors, drug companies, hospitals, pharmacies, insurers, lawmakers and special interests have colluded over the years to protect their own turf and profits, despite relentless public demand for a system that serves patients instead of entrepreneurs.
"We need to work out a system that includes a greater emphasis on preventive care, sufficient public funding for health insurance for those who cannot afford it in the private sector, competition among both health care providers and health care insurance providers to keep down the costs of both, and decoupling the cost of health care from the cost of adding workers to the payroll." These words were spoken not by Bill Clinton in 1993, nor Bernie Sanders in 2019, but by President Richard Nixon in 1972, Magee writes.
Nixon wasn't known for embracing liberal-leaning policies. So if he could find reason to criticize a lack of competition in our health care system and support for the tenets of universal health care coverage, how has the United States avoided adopting stronger policies to make the health care system work for patients?
"Code Blue" supplies the answer to that question. In the process, Magee comes out in favor of a "standardized single payer authority/multi-plan delivery system that provides a secure package of basic benefits for all," among other changes, making it well-timed reading for the upcoming Democratic presidential debates.
Magee's insight is based on his deep personal experience with the health care industry, which included executive roles in pharma, hospital leadership and direct patient care. Today he works as a professional observer of the industry, as editor of HealthCommentary.org and as a visiting scholar at Presidents College at the University of Hartford in Connecticut.
One of his key insights is that it is not a lack of checks and balances that causes the health care system to not work in patients' best interests. The problem is that the controls are compromised at each step in the system by executives who find rising paychecks as they hop from industry to industry, "always aware that their willingness to go along to get along in one arena can improve the quality of the placement in the next."
Physicians, and particularly the American Medical Association (to which Magee paid membership dues for 40 years), come in for a drubbing in "Code Blue."
Magee shows the association repeatedly putting its members' interests above the larger public health concerns of the U.S. public, including through decadeslong opposition to providing broad access to health care coverage. Hospitals don't take as critical a lashing as other players in the book, but the material that is included is strong. Magee's insider recounting of the "Philadelphia hospital wars" of the 1990s offers a juicy account of being pursued by an unwanted buyer.
But the material on Big Pharma is where the books cut deepest. As a former VP of global medical affairs for Pfizer, Magee describes a world in which needed drugs are not produced because profits don't justify it, but huge research-driven pharma companies cry foul when their work benefits the public cheaply after patents expire.
And if drugmakers chafe at the FDA and the regulations on their activities today, the anecdotes of the past show the industry has only itself to blame for piquing public ire.
For example, in 1937 drugmaker S.E. Massengill of Bristol, Tenn., became infamous for shipping 240 gallons of a medicine laden with the toxic industrial chemical diethylene glycol to distributors in 31 states. More than 100 people died, including dozens of kids.
Massengill paid a government fine of $24,500, and company head Samuel Massengill later wrote, "My chemists and I deeply regret the fatal results, but there was no error in the manufacture of the product. ... I do not feel there was any responsibility on our part." Massengill later became the trade name for a douche.
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