Former Pfizer executive and surgeon: U.S. ‘medical industrial complex’ is traced to WWII Massachusetts lawmakers advance ‘millionaire tax’ amendment

Stonington — Dr. Mike Magee can boil down three things people generally want out of the American health care system: coverage for all, full coverage and not “these skimpy plans,” and fair pricing — “Don’t pull the wool over our eyes; tell us upfront what it’s going to cost,” he said.

So how did we get to the point where health care in the U.S. costs twice as much as in other developed nations but with “abysmal” results, with shorter life expectancies and a higher likelihood of maternal mortality?

This question is at the heart of Magee’s new book, “Code Blue: Inside America’s Medical Industrial Complex,” which he said he spent the past 10 years researching.

Magee, a surgeon who served as vice president of science and medical advocacy at Pfizer from 1997 to 2007, talked about his book at La Grua Center on Wednesday evening, an event co-presented with Bank Square Books.

One screen of his p resentation showed multiple pillars: hospitals, National Institutes of Health, American Medical Association, Association of American Medical Colleges, Pharmaceutical Research and Manufacturers of America, and insurers.

Magee traces the roots of the medical industrial complex to World War II. For starters, the veterans were twice as likely to develop lung cancer, and many struggled with alcohol and drug abuse along with “psychiatric casualties,” he said.

He noted the country focused on intervention rather than prevention in its health care approach after the war, and that while Canada put together a strategic health board, the U.S. ended up with “collusive cross-sector partnerships.” Magee highlighted multiple people who were involved with both the pharmaceutical company Merck & Co. and the U.S. Office of Scientific Research and Development.

To the present day, “there is an integrated career ladder,” he said. “If you want to advance in any of these sectors, you have to cooperate with the others ... It is a matter of going along and getting along that allows you to advance.”

Magee noted the past half-century has involved a large focus on cures, and while he hopes for discoveries for as much as possible, “that’s not how you run a health care system.”

“A health care system is planned out, is deliberate and it deals with your everyday life,” Magee said. He previously stressed nutrition, housing, safety, security and clean air. Other concerns he cited include that health care costs are driven up by spending on direct-to-consumer advertising of pharmaceutical drugs — the U.S. and New Zealand are the only countries that allow such advertising — and that there are 16 people in the health care industry for every doctor.

“You can drop 15 percent of the bill just by simplifying how you buy insurance and how it’s processed,” he said.

He believes the country needs to restart from the beginning to build a better health care system, but it doesn’t matter much to him how we get there, whether it’s Medicare for All or employer-based.

Magee said when he started at Pfizer, he was considered an expert in cross-sector leadership, someone who could learn the languages of government, industry, academic medicine and hospital administration.

But he found he was inadvertently “contributing to the dismantling of important checks and balances.” Magee doesn’t blame the country’s current health care situation on any one individual or organization, but said the challenge now is, “How do you reassert control and how do you reassert balances?”

Boston — The Legislature advanced a constitutional amendment Wednesday calling for an additional tax on the state’s highest earners, while skirting any discussion of replacing Massachusetts’ current flat tax system with a graduated income tax.

Backers of the so-called millionaire tax say the 4% surtax on the portion of an individual’s annual income that exceeds $1 million would generate up to $2 billion in revenue earmarked for investments in education and transportation. Opponents, including Republicans and several business organizations, argue the measure could put a drag on the state’s booming economy.

The 147-48 vote by a joint session of the Democratic-controlled Legislature was unsurprising given the strong support shown for the millionaire tax in a procedural vote last month.

The amendment, however, still requires another favorable vote during the next twoyear session of the Legislature before it can come before voters for ratification in 2022.

The state’s constitution currently requires that all income be taxed at uniform rates. An earlier effort by a coalition of labor, religious and community groups to raise taxes on about 20,000 of the state’s wealthiest residents was knocked off the 2018 ballot after a legal challenge.

“The Massachusetts economy is working great for those in the upper 1%, but the time is now for all residents to reap the benefits of what this great state can accomplish through the revenue of the fair share amendment,” said Democratic Rep. James O’Day, using the term preferred by the measure’s most ardent supporters to describe it.

O’Day, the amendment’s lead House sponsor, cited two derailments on the Boston-area transit system in recent days as evidence the state needs more resources for transportation infrastructure. He also pointed to the state’s educational achievement gap and long waiting lists for preschool programs in urban neighborhoods.

Rep. Brad Jones, the House Republican leader, warned against a “bait and switch” scenario in which millionaire tax revenue supposedly promised for education and transportation is in fact diverted for other purposes. A proposal by Jones to add language further guaranteeing the revenue is spent exclusively on education and transportation was defeated in a mostly party-line vote.

Some potential drama was avoided just prior to Wednesday’s debate when a handful of lawmakers withdrew proposed language that would go far beyond the millionaire tax and remove entirely the constitutional prohibition on a graduated income tax.

Among U.S. states with income taxes, Massachusetts is one of just nine with a flat tax, while more than 30 have a graduated system that imposes higher tax rates on higher levels of income and is considered fairer by many Democrats.

No reason was immediately given for the graduated tax language being withdrawn, but legislative leaders may have been weary after several previous votes by Massachusetts residents against a graduated tax, most recently in 1994.

In a statement, Jim Lyons, chairman of the state GOP, said abolishing the flat tax would be a “blatant cash grab masquerading as class warfare.”