SINGLE PAYER LINKS #348

Posted 17 MAY 2024

Sticking to the single topic approach this week with a focus on hospital revenues and their financial health. —TF

If you want to listen instead of read, LISTEN TO PODCAST!

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Susanna Vogel, “Steward Health Care files for Chapter 11 bankruptcy,” Healthcare Dive, May 6, 2024 Read!

How did the “largest provider bankruptcy in decades” come about? The 30-hospital system operating in eight states is a sorry tale of private equity value extraction/corpse dumping. Most affected is Massachusetts, which must be embarrassing for a proud blue state full of biotech and Pharma companies. Especially hit hard is the southeastern part of the state with “lower-than-average incomes” and poorer health. Let me guess who mostly lives there—PoC perhaps? Why yes, it has a heavily Cape Verdean- and Portuguese-American population. This article details how Steward stiffed regulators and its own auditors by hiding its dire financial condition until it had to pull the plug on itself.

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Jonathan Weil, “The private-equity deal that flattened a hospital chain and its landlord,” Wall Street Journal, May 7, 2024 Read!

More on Steward Health, unfortunately paywalled and full of financier arcana. But here’s the key takeaway: “Cerberus [private equity] made a big profit, but Steward went bankrupt, and its landlord suffered big losses.” The pre-ordained result of the complex dealmaking was that the PE guys walked away with $800 million, the CEO of the zombified corporate holding company got a juicy payout (and bought himself a $40 million yacht), and the hospitals were left to crumble. As usual, it all started with the sale of the hospitals’ real estate in exchange for cash (easily extracted as dividends and fees) that left them paying huge rents for the same land they once owned. The fact that all this is legal means we are living in Tony Soprano’s world.

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Jenna Carlesso, “Yale New Haven Health wants out of deal to buy Prospect hospitals,” CT Mirror, May 3, 2024 Read!

Here’s another vulture-investor deal in which crooks extracted rent from hospitals, left them as smoking ruins, and are now trying to offload the rotting corpses for more than they’re worth. Yale New Haven Health was trying to pick up the properties but now wants out of the deal, accusing the financiers of “defaulting on rent and tax liabilities, allowing its facilities to deteriorate, mismanaging assets, driving away physicians and vendors.” Apparently, Connecticut is desperate to avoid a big hospital bankruptcy like neighboring Massachusetts. Maybe it’s time to stop the Wild West looting of hospitals in the first place.

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Tina Reed, “Hospital prices paid by private insurers vary widely, report finds,” Axios, May 13, 2024 Read!

Private health insurance on average pays hospitals two to three times Medicare rates for the same services. A new report from RAND confirms this well-known fact and doesn’t add much more than the “well-duh” idea that larger companies can negotiate better deals than smaller ones. The result is that a procedure in one hospital may cost way more than in another across town. The hospital lobby tut-tutted the whole report without bothering to contradict it—maybe because it’s true.

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Daniel Payne, “Hospitals’ new message for patients: Stay home,” Politico, May 11, 2024 Read!

“Health systems are trying to move more of the work they do to your house.” While that probably made sense during Covid, we can safely assume that its persistence is not for our benefit. And voila: “Hospital executives think they can more than make up the revenue by shifting their exam and recovery rooms to patients’ homes.” One Tampa hospital CEO is quoted: “It’s a real game changer for us, one of the silver linings to the pandemic.” I’m so happy for him and his success in “diversifying our revenue streams” through an event killing hundreds of thousands of people. Congress is happy, too, as pols, both R and D types, can shovel more government cash their way. Senators Marco Rubio (R-FL) and Tom Carper (D-DE) co-sponsored a proposal to maintain government reimbursement of home care, not in itself a bad thing, of course. Let’s see if hospitals get away with charging hospital rates for telehealth care, like they do for visits to doctors’ offices that they own even if patients never set foot in a hospital.

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Caitlin Owens, “U.S. health care is increasingly like a casino,” Axios, May 12, 2024 Read!

Where has this reporter been hiding? “Having insurance is only the first step toward receiving quality care. Affordability, while critical, isn’t synonymous with access.” You don’t say! The new news is that primary care is in shorter and shorter supply as new doctors are driven away from it due to lousy working conditions. And one other thing: “It’s hard to convince medical students graduating with mountains of debt to resist the draw of more lucrative specialties.”

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Grace Vitaglione, “HCA pruned staff at Mission Hospital, reaped soaring profits, academic study finds,” Carolina Public Press/NC Health News, May 2, 2024 Read!

Hospital giant HCA Healthcare gobbled up another unit in Asheville, NC, and promptly turned a tidy profit by slashing staff ratios. Easy peasy! The hospital lost money during Covid, but then reported a 350% rise in profits two years later after cutting staff-per-patient rates nearly in half. Meanwhile, the CEO “earned” $21 million a year. No wonder nurses are quitting.

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Michelle Crouch, “New freestanding ERs: faster care, but it can cost you,” Charlotte Ledger/NC Health News, May 13, 2024 Read!

“Sleek and efficient freestanding emergency rooms are springing up across the Charlotte region. Patients visiting one for the first time are often astounded at how quickly they can get in and out. But weeks later, they may be astounded again when they get the bill.” Another boutique service to gouge the gullible prosperous, and it seems to be working: “freestanding” ERs are now 11% of the total, up from 1% two decades ago. An aggressive entrant into this area: HCA Healthcare [see above]. People don’t realize that “freestanding ER” is not the same as “urgent care center,” and the difference may be 10 times higher charges.

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Noam N. Levey, “Their first baby came with medical debt. These Illinois parents won’t have another,” KFF Health News/NPR, May 10, 2024 Read!

Fully insured parents face an assault of post-birth co-payments: “It really felt like a full-time job some days, getting the baby down to sleep and then getting on the phone constantly with all the different people collecting money.” About 12% of medical debt is related to pregnancy or childbirth. “Parents with private health coverage now face on average more than $3,000 in medical bills related to a pregnancy and childbirth that aren’t covered by insurance.”

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Mathew Holding Eagle III, “In money-saving move, Mahnomen hospital shutters inpatient beds, keeps outpatient and emergency care,” Minnesota Public Radio, May 1, 2024 Read!

Many rural hospitals hanging on by a thread are forced to shed some key services in exchange for Federal support. This reservation-based Minnesota hospital is taking advantage of a new program that provides tiny payments if they eliminate some services. Closing inpatient beds will save this hospital a whole $1.5 million—a.k.a. couch lint. We can’t subsidize that in a $6 trillion Federal budget? You often hear that around half of all rural hospitals are “in the red.” Question: who cares? Why should that matter? Well, because under a neoliberal model, key services have to pay for themselves in a marketplace, so they have to stop birthing services, psych units, all that luxury stuff. But these are all policy choices dressed up as TINA (There Is No Alternative).

David Dayen has some great background on the great hospital data hack at the American Prospect. “Hospital lobbyists fought to cut penalties for cybersecurity breaches.” Long before the massive cyberattack that crushed the medical payment system throughout the country, and from which they still haven’t recovered, hospital lobbyists had made sure they wouldn’t be held accountable for exactly such catastrophes. “Members of the [congressional] committee flared in anger at how a single, consolidated middleman network could perpetuate such lasting harm.” But they had allowed a bill to slip through Congress in the last days of Trump that Dayen calls “legal immunity for hospitals.” The bill “limited penalties for health care providers whose patient records were breached in cyberattacks” as long as they had installed some self-designed (and obviously inadequate) security practices. The law also eliminated security audits of electronic records systems. Hospitals may have hundreds of billing clerks, but 86% have no cybersecurity expert. This built-in negligence guaranteed the disaster that inevitably ensued, and hospitals won’t pay the cost. Hospitals are supposed to be “critical infrastructure.” Can we do anything right?

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Dave Muoio, “Nonprofit hospitals aren’t immune to FTC’s noncompete ban, lawyers, Fitch analysts warn,” Fierce Healthcare, May 2, 2024 Read!

Look for more articles trumpeting the burden of the new ban on noncompete agreements on struggling rural hospitals. While true as far as it goes, the big, prosperous hospitals are the ones gunning to undermine the ban as it will force them to stop treating doctors and nurses like indentured servants. Noncompete clauses now “bind an estimated 35% to 45% of physicians.” It’s the same way big corporations push small businesses forward when they want a PR win that mostly benefits the giants.

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Kristen Hwang, “An ‘impossible situation’: Why California hospitals are suing a major health insurer,” Cal Matters, Apr 23, 2024 Read!

The California Hospital Association sued to stop insurance companies from dawdling with approvals of post-hospital after-care, which is costing them $3 billion a year on “unneeded hospitalization because of insurance delays.” The insurer can clog up the approval process and force hospitals to provide uncompensated hospital stays long after treatment is done. “Patients who no longer need to be hospitalized spend an average of 14 extra days in the hospital as a result of insurance delays.” Which patients are most affected? Those on Medicaid—quelle surprise—account for 46% of all unwarranted hospital days that can last for weeks or even months.

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Dave Muoio, “Jefferson Health, Lehigh Valley Health Network sign definitive agreement for $14B merger,” Fierce Healthcare, May 15, 2024 Read!

Another gigantic consolidation in the Philly area that will create a new Godzilla with 30 hospitals, 700 care sites, and 65,000 employees. It will also have its own insurance company. Boilerplate from the suits: “This combination promotes access, choice, innovation, opportunity, increased equity and stability.” They also said the merger “will reduce the cost of care,” which is a huge whopper and means that other stuff is BS, too.

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Health Care for All New York, “HCFANY notches important legislative victories and two major defeats in this year’s budget deal,” Apr 22, 2024 Read!

The good news from the New York state budget sausage-making is a set of restrictions on safety-net hospitals suing patients for debts. Great, but given their shaky finances, these hospitals need a better distribution of the offsetting state subsidies. No news on that happening, so this reform, while welcome, looks like a form of can-kicking. “Charity” hospitals now sue about 10,000 New Yorkers a year for unpaid bills.

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Rebecca Pifer, “Walmart Health shuts down,” Healthcare Dive, Apr 30, 2024 Read!

Whaddaya know, providing healthcare in our demented system isn’t so easy even for deep-pocketed entrants. Walmart Health grew to 51 centers in five states with plans for 4,000 more, but that’s now history due to a “rising administrative burden created by insurance companies, including complex billing processes, prior authorizations, denials, and appeals.” Earth to Walmart: You didn’t know that getting in? This is nothing but everything about our current system that makes it impossible to enter independently. Walgreens and Amazon had similar experiences though Amazon is still hanging in the clinical services sector along with CVS/Aetna.

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SINGLE PAYER LINKS #347

Posted 10 MAY 2024

[If you prefer to listen rather than read, LISTEN TO PODCAST!]

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Links this week are on a single issue, bird flu (H5N1)—although not at first glance a single-payer issue. But pandemic control and the entire mission of public health assumes human society as a collective, not an individual enterprise, which is the basis of that radical idea that all persons have the right to health and medical care. The Covid experience showed how discredited and debased our public sector is, and the handling of this bird flu outbreak shows how little we’ve learned. As one op-ed writer cited below opined, “It’s entirely possible that we’ll get lucky with H5N1 and it will never manage to spread among humans. But when dangerous novel pathogens emerge among humans, there is only a small window of time in which to stop them before they spiral out of control.” I propose to look at whether we are acting on that principle and why or why not.

Incidentally, avian flu is not a new phenomenon. H5N1 has been decimating wild bird populations for at least two years when it wiped out so many chickens that egg prices skyrocketed. What’s new is the cross-species contagion into dairy cows. —TF

P.S. I have mixed material from different articles to get everything on a single topic into one place and have tried my best to indicate where I’m inserting stuff out of order.

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The basics—what’s happening:

India Bourke, “‘Unprecedented’: How bird flu became an animal pandemic,” BBC, Apr 26, 2024 Read!

Bird flu is “decimating wildlife around the world and is now spreading in cows,” including the slaughter of half a billion [with a B] farmed birds. “Wild-bird deaths are estimated in the millions.” Bird flu has reached Antarctica: In the bird-rich, pristine Northern Weddell Sea, 40% of sites tested registered positive tests among different species. Biologists called it “the worst bird flu outbreak in wildlife on record.” Poultry makes up the majority of avian biomass worldwide. “Other highly infectious pathogens will continue to spread into the few wild birds remaining. More than 17,000 elephant seals are thought to have died from the virus during the 2023 breeding season, including 70% of all the season’s pups.”

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Lambert Strether, “H5N1 happily mutates away while public health establishment plods along, treating the virus as a food supply issue and not as a potential pandemic,” Naked Capitalism, Apr 30, 2024 Read!

What’s new about H5N1 is that the jump from birds to cows is unusual: Andrew Bowman, professor of veterinary preventive medicine at Ohio State University: “In previous spillovers into mammals, it seemed to be for the most part individual events that were isolated and didn’t continue to spread in those species. This is different.” Michael Osterholm of the University of Minnesota: “Every time another animal or human is infected, it’s another throw at the genetic roulette table in terms of whether the virus could become one that transmits from human to human, which is what is required for a pandemic. If you throw enough times, you may end up with an outcome that you don’t want.”

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Ed Cara, “Florida dolphin dies of bird flu as alarm grows over species spread,” Gizmodo, Apr 26, 2024 Read!

Although called the “first known and fatal case” of H5N1 in a bottlenose dolphin, it actually dates back to 2022. While cows seem to suffer only mild illness from the virus, that’s not true for other mammals. Those affected so far: foxes, cats, seals, bears, minks, bobcats, otters, martens, squirrels, skunks, porpoises, and opossum (a marsupial). Cats have consumed infected milk and died. Unpasteurized milk is still legally on sale in many states—consuming it now is a really bad idea.

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Melissa Rudy, “Texas cats die on dairy farm after drinking raw milk contaminated with bird flu, CDC warns,” Fox News, May 3, 2024 Read!

The felines developed ‘fatal systemic influenza infection’ after drinking the unpasteurized colostrum and milk from cows that tested positive for the virus.

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Berkeley Lovelace Jr., “Bird flu: 1 in 5 samples of pasteurized milk had bird flu virus fragments, FDA says,” NBC News, Apr 25, 2024 Read! and Julie Steenhuysen & Tom Polansek, “Bird flu: US tests show pasteurized milk is safe,” Reuters, Apr 26, 2024 Read!

Bird flu (H5N1) has been found in nine states so far: Colorado, Idaho, Kansas, Michigan, New Mexico, North Carolina, South Dakota, Ohio, and Texas. How dangerous is it? Based on past experience, more than half of the people who get it die. Is it elsewhere? Undoubtedly, but we don’t know where yet because testing is spotty. (See below.) One expert already thinks that “this virus has largely saturated dairy cattle throughout the country.”

But, the first message out of officialdom is NOT TO WORRY. “Experts agree that pasteurized milk is safe to drink.” Note that phrasing by the reporter—not much wiggle room for doubt. But when quoted directly, government and other expert spokespeople are less definitive: “Right now, all indication is that pasteurization is effective,” said our OSU vet quoted above. The FDA said, “To date, we have seen nothing that would change our assessment that the commercial milk supply is safe.” “The agency said there is no reason to believe the virus found in milk poses a risk to human health.” That sounds like some major hedging.

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Emily Cadei, Marcia Brown & David Lim, “The ‘milk supply is safe’: Biden administration scrambles to reassure Americans as bird flu spreads,” Politico, Apr 25, 2024 Read!

“Scrambles to reassure” as opposed to “scrambles to contain”: “The Biden administration and dairy industry are racing to convince the public not to worry.” USDA spokesman Allan Rodriguez: “We are treating it seriously and with urgency, which is why this week we issued a Federal Order to further protect the U.S. livestock industry from the threat posed by this virus.” Good news: human beings come next, right after commercial interests! “The administration has been careful to say that pasteurization is ‘likely’ to inactivate the avian flu virus in milk.” But officials also acknowledge that detecting the virus in dairy cows is a ‘novel and evolving situation’ and that studying how pasteurization affects bird flu viruses hasn’t been done up to now because these viruses have never previously spread to cattle. Fun fact: U.S. dairy production accounts for 3.5% of U.S. GDP.

Who are the human vectors most likely to generate a mass epidemic? Farm workers! So, are we taking precautions with them? Jessica Maxwell of the Workers Center of Central New York, which represents dairy farmworkers, says, “Lack of training and proper equipment is a very common complaint we hear from farmworkers already. If this were to blow up into a bigger outbreak, it’s clear that many farms don’t have basic preventive measures in place.”

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Will Stone, “The U.S. may be missing human cases of bird flu, scientists say,” NPR, May 2, 2024 Read!

After discovering that 36 herds in nine states were affected, “local and state health departments have tested about 25 people for the virus and monitored over 100 for symptoms.” A week ago, only 25 people in the whole country had been tested? Meanwhile, a Texas epidemiologist says: “We know that some of the workers sought medical care for influenza-like illness and conjunctivitis at the same time the H5N1 was ravaging the dairy farms.” He continues: “If the idea was to try to identify where there was spillover from these facilities to human populations, you’d want to test as many workers as possible.” Yes, IF you want to know that. Then again, if you’re afraid about what you’ll find out, drag your hooves.

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Testing

Megan Molteni, “Cattle testing for H5N1 bird flu will be more limited than USDA initially announced,” STAT, Apr 26, 2024 Read!

The Feds’ announcement on testing fell short of expectations. The guidelines “eased concerns from farmers and veterinarians about the economic and logistical burden of testing.” That’s the opposite of reassuring. During Covid, the impact on economic activity—not on persons—was the driving force behind policy decisions and the multitudinous errors committed—under both Trump and Biden.

How effective will the testing program be at containing additional outbreaks? Not very: “Laboratories and state veterinarians also must report to the USDA any animals that have tested positive for H5N1 or any other influenza A virus.” News flash: if you DON’T test your animals, no need to report anything! Further: “Farmers only have to test up to 30 animals in a given group. The guidance does not say how farmers should determine which 30 animals to test in larger groups that are being readied to be moved.” Okay, so hey guys, take out any cows whose milk is coming out yellow, and pick out 30 to test from the perkier looking ones. All set! “Cows that are to be moved between states must have samples collected and tested no more than a week prior to transport.” If they get sick 6 days later, no problem! Their tests are clean and legal! (Our concerns are “eased.”)

[From the Morning AgClips article below] The viral fragments found in the milk tested were reported to be “trace amounts of viral genetic material,” which “aren’t evidence that the virus is biologically active.” Are they evidence that it’s biologically inactive? No. “To evaluate whether the presence of the viral fragments corresponds to a virus with the capacity to replicate and cause disease, a different testing approach is necessary. That type of testing is underway.” Meaning that right now we don’t really know. But meanwhile, DON’T PANIC! On April 24, 2024, the FDA said it had found no reason to change its assessment that the U.S. milk supply is safe. And if they do find a reason to change it, we’ll know right away, right?

Erika Edwards, “Bird flu cases are likely being missed in dairy workers, experts say,” NBC News, Apr 27, 2024 Read!

“Dairy workers who were never in close contact with the sick cows also fell ill.” A Wisconsin veterinarian said he’s heard reports of flu-like illnesses on affected dairy farms. “There’s probably a lot of cases that are not documented.” He continues: “The biggest concern that we hear our dairy farmers say is, ‘I don’t want to test because they’re going to depopulate my herd.’” No tests, no problem!

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F.D. Flam, “Start mass testing dairy workers for bird flu,” Bloomberg, Apr 26, 2024 Read!

“Every jump to a human gives the virus a new chance to stumble on the combination of mutations that give it pandemic potential.” The 2021 outbreak was supercharged by crowded conditions in poultry farms and by the fact that “many chickens are bred to be genetically identical, making them vulnerable to infectious diseases.”

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Zeynep Tufekci, “This may be our last chance to halt bird flu in humans, and we are blowing it,” New York Times, Apr 24, 2024 Read!

“Having spent the past two weeks trying to get answers from our nation’s public health authorities, I’m shocked by how little they seem to know about what’s going on and how little of what they do know is being shared in a timely manner.” Unanswered questions include:

How is the infection transmitted between herds? We don’t know.

What does the unusually high viral load in the infected cows’ milk mean? Um, hmm. Have to get back to you on that.

Is the disease being spread through milking machines or from aerosolized spray when the milking room floors are power washed? Maybe both? Another good question, thank you for that.

Is it spread through the cows’ feed? “The U.S. allows farmers to feed leftover poultry bedding material—feathers, excrement, spilled seeds [eew]—to dairy and beef cattle as a cheap source of additional protein.” T-M-I!

Is the virus spread from dairy farms back to poultry farms? Like via people? Like via undocumented farm workers who will avoid authorities at all costs? Like via farmers who notoriously never go to doctors? How about spreading to pig farms? Pigs are a lot like us—people can get a transplanted pig’s heart, and it works.

“The USDA also told me it doesn’t know how many farmers have tested their cattle and doesn’t know how many of those tests came up positive”—ergo, there is no uniform, federally managed testing system.

One of the reassurances given by the CDC is that it is monitoring emergency room data to get signs of an epidemic. That guarantees that if it happens, we will find out after it’s already too late to stop it.

Tufekci concludes: “One troubling legacy of the coronavirus pandemic is that there was too much attention on telling the public how to feel—to panic or not panic—rather than sharing facts and inspiring confidence through transparency and competence.” I have to add: yes, plus constant lying, suppression of dissent, and pretending to know things that you don’t, all of which completely eroded trust.

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Jessica Wildfire, “Worried about bird flu? Welcome to the party, pal. You’re late,” OK Doomer, Apr 28, 2024 Read!

The author notes that the deadly 1918 flu epidemic was caused by an avian flu virus and then points out something about news coverage. “They design these stories to simultaneously trigger a fear response only to dismiss that fear and assure everyone that everything’s okay. They conveniently omit or downplay any proactive measure that anyone could take.” Given the new discourse that we overreacted to Covid, we can confidently predict that a huge slice of Americans won’t take protective measures this time around.

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[no byline] “How did bird flu virus fragments get into milk sold in stores?” Morning AgClips/The Conversation, Apr 28, 2024 Read! and Meredith Lee Hill, David Lim & Marcia Brown, “‘They need to back off’: Farm states push back on Biden’s bird flu response,” Politico, May 6, 2024 Read!

“Proper pasteurization should kill the virus.” There’s that hedge again: “should.” The FDA was quick to stress that it believes the commercial milk supply is safe. “Believes.”

What is being done? “Existing state and federal regulations and industry practices require sick cows or cows with abnormal milk to be segregated so that their milk does not enter the food supply.” Okay, but: New federal restrictions on the movement of dairy cows between states “are putting economic pressure on farmers.” Which means they will dig in their heels to prevent us from finding out if there is a problem. Here’s why they’re acting rationally from the Politico article:

“A big reason for the resistance: Farmers don’t want their farms to be “identified publicly as potential hotspots for the virus, nor do they want to draw scrutiny to their workers, a significant proportion of whom are undocumented immigrants and fearful of government officials.” Then we have the ideological motivations, which we can call “Don’t Tread On Me or My Cows”: The dammed gummint wants to protect public health, but they’ll have to pry my dead, cold fingers off my sick cow’s udders to do that!

Texas, the first state where the bird flu virus was detected, has not invited the CDC to conduct epidemiological field studies there. “We haven’t found a dairy farm that is interested in participating,” said a state official. In other words, we’re not going to force cooperation because some snowflake liberal wants to interfere with private enterprise.

The commercial milk supply is kept safe because producers voluntarily “divert or dispose of” milk from sick animals.” But we already know that some bird flu infections are asymptomatic. (Covid, duh) And there are serious financial reasons to cover up an outbreak in a specific dairy farm because [jumping to an NPR story below] “Dairy cattle farmers currently don’t get compensated for reporting infections in their herds—unlike poultry farmers who receive indemnity payments for losses” when they have to cull flocks. So, zero incentive to report and compelling reasons to even ignore signs of a problem.

“A farm worker who handled dairy cows contracted H5N1 in Texas in March 2024, but such cases are rare.” No, they are rarely found because only 25 farm workers were tested at the time of this article—a big difference.

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Joe Hernandez, “What consumers should know about the milk testing positive for bird flu,” NPR, Apr 24, 2024 Read!

Results from the tests on whether the virus particles found in the milk supply is really safe will be released “within days or weeks.” Federal officials emphasize that any milk from infected cows is “supposed to be discarded or destroyed” and not enter the human food supply. “Supposed to.” English translation: We don’t know for sure, so the preventive measure is to keep milk from infected cows out of the commercial supply by relying on dairy farmers whose livelihood is dependent on them not revealing they have sick cows.

Nature: Does pasteurization really for sure kill H5N1? The USDA spokeswoman replied that they “are working closely to collect and evaluate additional data and information.” Do we hear a clear, absolute affirmation that the current practice kills bird flu in milk? We do not.

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[More from] Lambert Strether, “H5N1 happily mutates away while public health establishment plods along, treating the virus as a food supply issue and not as a potential pandemic,” Naked Capitalism, Apr 30, 2024 Read!

Some good news: We can test wastewater for H5N1 because an assay already exists. However, “human-excreted and Concentrated Animal Feeding Operation (CAFO)-derived H5N1 both go into the same waste stream.” We can’t distinguish between how much is in people versus cows.

Here’s more than you really wanted to know about how we get cow milk: “In a milking operation, the stimulus to secrete milk comes not from the sight or touch of a calf but is usually provided by a farm worker. That person also cleans the animal’s teats with a damp cloth and then dips them into a disinfectant solution to protect them from infectious bacteria present on a farm. The teats are then attached to the milking unit, also called a claw, which consists of a cluster of four rubber or silicon-based liners that fit snugly around each teat. The milking lasts about six to nine minutes per animal, and then each cow receives another disinfectant treatment before it’s ushered out and another animal is brought in. The problem is that the milking equipment that comes into contact with the cow’s udders is typically not sanitized between individual animals. Liners, dip cups, washrags, and milkers’ gloved hands are all possible means of spreading the virus from one animal to the next. Washrags used on different animals are often laundered together before repeat use, but some dairies don’t use hot water, and researchers have found genetic traces of H5N1 on both used and clean rags using PCR testing.”

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Strether also quotes from Kristina Fiore, “Are we testing enough for H5N1?” MedPage Today, Apr 25, 2024 Read!

“A CDC spokesperson said that while the USDA is responsible for livestock testing, the agencies are ‘working together to characterize virus specimens and monitor for changes that might make these viruses more likely to transmit to or between humans.’” Strether points out that this means no one is in charge of pandemic prevention. But they are all on board with messaging properly. “Federal officials have been trying to reassure the public, holding a press briefing with officials from the HHS Administration for Strategic Preparedness and Response, USDA, FDA, CDC, and NIH at a public symposium led by the Association of State and Territorial Health Officials (ASTHO).” That’s teamwork! Alfred E. Newman rules: “What, Me Worry?”

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Plenty of good news this week! Not entirely, of course. LISTEN TO PODCAST!

SINGLE PAYER LINKS #346

3 MAY 2024

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Single payer via state action

John Canham-Clyne, “California, Oregon eye universal health coverage,” Healthcare Dive, Apr 24, 2024 Read!

Here’s an encouraging discussion of state-led attempts to build a comprehensive single-payer system—the same strategy we in New York have been pushing for years. It is inspired by the Canadian experience: Saskatchewan provincial premier Tommy Douglas led the way in 1961 with universal, province-financed coverage, which eventually caught on throughout the country. (Douglas is a national hero in Canada.) Oregon’s experiment looks more likely to proceed as they already have a state commission called the Universal Health Plan Governance Board engaged in crafting legislation. Federal cooperation could be a problem depending on vibes from Washington. If Oregon gets close, watch for the industry players (insurers, hospitals, Pharma, some docs) to set aside their differences and collectively freak out to guarantee failure and avoid a dangerous precedent. Key allies in favor: small business owners.

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Adam Beam, “New California rule aims to limit health care cost increases to 3% annually,” Associated Press, Apr 24, 2024 Read!

California keeps tinkering: the latest move is a 3% annual cap on price increases by hospitals, insurers, and doctors. Compare that figure with the actual 5.4% yearly jumps over the last two decades. But there are many loopholes, starting with delayed enforcement until 2030—plenty of time for lobbyists to undermine it or to convince regulators to ignore violations. Meanwhile, employer-based health insurance is killing businesses in California: “In 2006, just 6% of California workers had deductibles of $1,000 or more. By 2020, it was 54%.”

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The Hack

John Tozzi & Riley Griffin, “UnitedHealth CEO defends Change Healthcare deal after hack,” Bloomberg, Apr 16, 2024 Read!

Remember that huge data hack that is still causing chaos in the payment system? UnitedHealth says it’s a good thing their hacked affiliate is a huge monopoly because that way it’s easier to fix! Sure, that makes sense. Meanwhile, they expect all systems to be up and running just fine soon—um, in 2025. Anyway, that’s what the CEO told investors—when he comes up to Capitol Hill, he might sing a different tune. Some pols say the problem is UH’s own oligopoly status. In fact, bigness itself finally drew some heat. See next article.

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Paige Minemyer, “‘Too big to fail’: Consolidation concerns loom over hearing on Change Healthcare cyberattack,” Fierce Healthcare, May 1, 2024 Read!

UnitedHealth Group’s “sprawling empire” got some hostile attention this week in hearings about The Hack. UHG’s gigantic payments manager, Change Healthcare, became part of the insurance/provider Godzilla a couple of years ago despite opposition from federal regulators. Elizabeth Warren pointed out that the debacle could even help UH grow even bigger as it “picks at the bones” of companies harmed by its own failings. She called for the company to be broken up—a nice dream. The AMA says 90% of doctors nationally are losing revenue as a result of the cyberattack.

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Medicare/Medicaid

Paige Minemyer, “CVS stock tumbles as Medicare Advantage pressures drag Q1 results,” Fierce Healthcare, May 1, 2024 Read!

Best news of the year! CVS, which owns Aetna insurance company, took a huge hit because people starting using the services they pay Aetna for—can’t have that! The report says the company posted a 90.4% “medical loss ratio” in the first quarter, a weird phrase that means people got medical care, which is considered a “loss.” So, profits are way down to a mere $1 billion over three months, boo hoo, how tragic. The suits at Aetna promptly said they would embark on a “3- to 4-year journey” to get profits back up—so, more claim denials and higher premiums, amirite?

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D. Lipshutz, “Wall Street Journal editorial board’s love letter to Medicare Advantage ignores wasteful overpayments,” Center for Medicare Advocacy, May 2, 2024 Read!

Business loves privatized Medicare because they get rich on government money. What’s not to like? This takedown of the Wall Street Journal’s propaganda notes a key omission: “MA plans are significantly overpaid in relation to traditional Medicare. Through such overpayments, MA plans are able to offer extra benefits, which entice more people to enroll, leading to continued growth in the program.” A neat, circular boon to the for-profit world: the government gives you extra cash with which to tempt people away from the state-sponsored program into private ones. An $80 billion subsidy to encourage privatization—no wonder the WSJ likes it!

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Pharmaceuticals

Tom Murphy, “J&J to pump another $13B into its MedTech business with Shockwave deal,” Associated Press, Apr 5, 2024 Read!

Why would a big Pharma company shell out $13 billion for a product it hasn’t developed internally? I’m going to venture a wild guess: because they are pretty sure they can make that back and more? Johnson & Johnson paid that breathtaking sum for Shockwave Medical, a company whose products “help open clogged arteries.” Now they can start to unclog the arteries of the payment system and recover what they spent. J&J also paid even more ($16 billion) for another cardiovascular tech company, Abiomed. That’s a lot.

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Julie Steenhuysen, “Alzheimer’s drug adoption in US slowed by doctors’ skepticism,” Reuters, Apr 23, 2024 Read!

Only a couple thousand patients have signed up to take Leqembi, which promises to slow down their Alzheimer’s. Why don’t more doctors prescribe it? Um, well, maybe because it might not work while causing your brain to bleed. One expert put it this way: “If we take the trial result at face value [a big IF, by the way], the differences between placebo and treatment are likely small enough as to be undetectable by patients and family members.” Add up significant risks, twice-monthly infusions, frequent brain scans, and the staggering costs, enthusiasm is easily curbed. The company that owns the drug is going to beef up its sales force by 30% to overcome these hesitations.

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[no byline] Brazil opens insulin-producing plant,” MercoPress, Apr 27, 2024 Read!

Brazil will produce its own insulin under government license and distribute it for free to 15 million diabetics, thereby ending the importation of 95% of insulin Brazilians currently buy from foreign producers. It’s all part of Brazil’s National Strategy for the Development of the Health Economic-Industrial Complex launched last September. In the United States we leave the “health economic-industrial complex” in private hands.

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Berkeley Lovelace Jr., Erin McLaughlin & Jason Kane, “How one state is trying to make weight loss drugs cheaper,” NBC News, Apr 24, 2024 Read!

Drugmakers Novo Nordisk and Eli Lilly are pushing their pricey weight-loss drugs onto the state’s health insurance plan for state employees and not budging on price. The cost burden is staggering. The state covers 750,000 teachers, other state employees, and retirees, and so far, 10% of the state’s total spending on prescription drugs is going to the fat shots like Wegovy, Ozempic, and the others. First North Carolina, then the whole nation.

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Linda Searing, “Some 11% of U.S. children have been diagnosed with ADHD,” Washington Post, Apr 22, 2024 Read!

More than one out of every 10 kids in the U.S. supposedly has attention-deficit/ hyperactivity disorder (ADHD). What is wrong with this picture? Why are such a huge slice of the nation’s babes suddenly born with an abnormality? This question never seems to come up even in articles like these. Searing writes, “Although no single cause has been found for all cases of ADHD, medical experts often point to genetics, noting that children with ADHD frequently have a parent or relative with the condition.” Sorry, that’s BS: 100 years ago, we didn’t have an epidemic of ADHD, and human genetics don’t evolve that quickly. Searing then mentions drug treatments. The blithe acceptance of unexplained mass “illness” illustrates how deeply the pharmaceutical solution to everything has penetrated our consciousness.

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Private equity

Robert Freedman, “FTC noncompete ban risks blowing up private equity deals,” Legal Dive, Apr 25, 2024 Read!

“The [noncompete] ban could wreak havoc on private equity deal-making. The buyer wants assurances the outgoing executives won’t turn around to become a competitive threat.” Fewer private equity deals? How tragic. Meanwhile, doctors won’t be tied to hospitals like pre-emancipation Russian “souls” who can’t leave and go work somewhere else. The noncompete rule is likely to be tied up in litigation, but this article says that the FTC initiative could encourage people trapped in noncompete straitjackets to break free and try their luck in court if employers retaliate. “Some judges will be more skeptical of noncompetes, and some attorneys will have better arguments.”

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Prior authorization

Matthew Walker, “True peer-to-peer conversations will improve prior authorization,” STAT, Apr 26, 2024 Read!

A doctor outlines the burden of pointless begging sessions with insurance company bureaucrats who pretend to discuss a patient’s care needs. “Sometimes the conversation goes uneventfully. But it usually feels like talking to a wall—a distant voice reading scripted questions off a computer screen,” leading to a predetermined denial. But the author doesn’t think prior approval consultations are always bad because true collaboration between specialists is possible and could be a big help. Hard to see how this will emerge from a system based on built-in incentives to deny care and fatten the company’s profits. And the author is talking his book: Walker is an orthopedic spine surgeon from Evolent, a “management company that works with payers and providers.”

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Patrick M. Rucker & David Armstrong, “A doctor at Cigna said her bosses pressured her to review patients’ cases too quickly. Cigna threatened to fire her,” ProPublica, Apr 29, 2024 Read!

An interesting account of how an insurer’s speed-up pressure undermined quality in prior authorization reviews. A conscientious doctor was praised for being meticulous. But when her “productivity” lagged because she actually reviewed her cases, she was told to speed up and issue more rejections. The company standard was 4 minutes per decision. “All a Cigna doctor had to do was cut and paste the denial language that the nurse had prepared and quickly move on to the next case.” The insider term for this procedure was “click and close.” Now, even doctors are just toilers on the factory floor subject to the assembly line speed-up. (They need unions.)

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Prevention

Sarah Owermohle, “Biden administration punts menthol cigarette rule indefinitely,” STAT, Apr 26, 2024 Read! and Lauren Clason, “Decades of dallying led to current delay on menthol ban,” Roll Call, Apr 24, 2024 Read!

The Biden administration is shelving the recommendation to ban menthol cigarettes, influenced by a flood of comments from “various elements of the civil rights and criminal justice movement,” according to HHS chief Xavier Becerra. He means the tobacco industry, which successfully mobilized “Black law enforcement officers and tobacco industry lobbyists”—also Al Sharpton’s National Action Network—to oppose the ban. Cigarette companies are now free to keep marketing menthol smokes to Black kids as they have for decades.

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Hospital finance

Caitlin Owens, “Hospitals mount uneven recovery from the pandemic,” Axios, Apr 26, 2024 Read!

Rich hospitals are doing great; safety-net hospitals are tanking—a great set-up for further concentration and monopolization. “There’s a wildly large and growing difference between the operating margins of top-performing health systems and those at the bottom.”

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Anna Claire Vollers, “You’ve covered your copayment; now brace yourself for the ‘facility fee,’” Stateline, Apr 25, 2024 Read!

We might not object too much for a hospital “facility fee” if we have to go to one. But why do hospitals get to charge that even if we never set foot in the hospital itself? The loophole is that affiliated clinics can add huge charges to any medical bill by virtue of being part of a healthcare Godzilla. States are starting to react as “large hospital systems gobble up clinics, physician groups, and urgent care and imaging centers.” With everything under one roof, the charges shoot up. On the other hand, rural and other struggling hospitals rely on facility fees to stay solvent.

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Michelle Crouch & Charlotte Ledger, “The rise of mega-hospitals,” Charlotte Ledger/North Carolina Health News, Apr 22, 2024 Read!

A review of how hospital concentration has unfolded in a single state (although the main Godzilla in NC is now multi-state). Atrium Health/Advocate Aurora now forms the country’s third-largest public health care system with 67 hospitals and 1,000 care sites. “When it comes to growth, it seems like hospitals can’t get enough of it.” The article outlines the usual negative impacts on care, costs, and working conditions for providers and the increasing inability of smaller, poorer hospitals to resist absorption.

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SINGLE PAYER LINKS #345

Posted 26 APR 2024

Some good news this week! Lina Khan kicks serious butt with special attention to hospitals. See first article or listen to my comments on the weekly podcast here

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Concentration/antitrust

Matt Stoller, “FTC enrages corporate America by eliminating non-compete agreements,” BIG, Apr 24, 2024 Read!

This really is BIG, a big blow against bigness. Nail salons, hospitals, and fast-food joints can no longer force workers into indentured servitude by preventing them from getting a new job somewhere else. It’s also BIG for healthcare: “Non-competes facilitate consolidation, especially in health care, where doctors are trapped into practices bought by private equity groups.” An incredible 45% of family doctors already toil under this insane straitjacket. FTC head Lina Khan said in an interview that she was surprised how many healthcare workers weighed in on the anti-compete issue during the comment period. Lawsuits by well-oiled oligarch thinktanks immediately followed. Conservative lawyer Eugene Scalia, the son of former Supreme Court Justice Antonin Scalia, sued the FTC just hours after the announcement, which means they had it all written up in advance. The legal case is weak, but that means little these days with ideology reigning on the federal bench.

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Julie Rovner & David Hilzenrath, “FTC chief says tech advancements risk health care price fixing,” KFF Health News, Apr 23, 2024 Read!

On top of that step shaking up the entire corporate sector, the FTC’s Khan also announced that the agency will now look at tech tools that are destroying American markets with special attention to healthcare. Khan said the use of algorithms is “making it easier for companies to fix prices and discriminate against individual consumers.” The significance is that antitrust action used to rely on evidence of collusion among market players, but these computer-driven (or now I guess we have to say “AI-driven”) algorithms enable companies to fix prices without direct contact, and we’re seeing, for example, landlords jacking up rents in tandem. The FTC has been very focused on stopping the anti-competitive concentration rampant in the health sector, and the big trade associations are going nuts. The American Hospital Association complained that Khan’s guidelines “reflect a fundamental hostility to mergers.” Yeah, how about that, now hospitals have to prove they’re not just gobbling up the competition to create monopolies, how tragic for them.

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Mike Scarcella, “North Carolina backs FTC bid against $320 million health system deal, Reuters, Apr 16, 2024 Read!

The state is also unhappy about another hospital consolidation that would create a new Godzilla in the Charlotte area. North Carolina spends $4 billion a year on medical costs for its state employees, so it’s not abstract and theoretical.

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Medicare/Medicaid

Rebecca Pifer, “ACOs led by independent physicians save Medicare ‘substantially’ more money, CBO says,” Healthcare Dive, Apr 20, 2024 Read!

Department of Duh: “Independent physician-led ACOs [Accountable Care Organizations, i.e., privatization vehicles] have clear financial incentives to reduce hospital care to lower spending while hospital-led ACOs—which earn more revenue when patients are admitted—do not.” Create an incentive for higher income, people are going to say “THANKS!” and exploit it. This is not hard. Which is not to deny that fee-for-service financing contains perverse incentives as well. The Feds created ACOs as a cost-saving experiment that hasn’t demonstrated much, if any; some have turned out to be more costly.

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Noah Weiland, “5 Takeaways from a year of Medicaid upheaval,” New York Times, Apr 16, 2024 Read!

We’re now up to 20 million people kicked off their Medicaid insurance so far, one quarter of them children; 5 million of those booted have no replacement insurance; others were forced onto Obamacare plans with large deductibles; 70% of disenrollments were for technical or admin factors; Pennsylvania has 6,000 fulltime employees working on the process; voters who suddenly can’t see a doctor any more are enthusiastic Biden voters—kidding!

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Horrors of health insurance

Tina Reed, “Lawmakers target mergers in first hearing on Change Healthcare hack,” Axios, Apr 17, 2024 Read!

Rah-rah politicians can denounce Khan and the FTC for making their corporate friends mad, but suddenly when their constituents are affected, some of them get religion. The mega-hack that exposed the health info of fully one third of all Americans is sparking congressional interest not just in the giants’ lackadaisical security measures but also the inherent risks of over-concentration in the healthcare sector. The fact that even Republicans are unhappy suggests that aggressive enforcement by the FTC against anti-competitive practices might survive even Trump Redux.

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Samantha Liss, “Medical providers still grappling with UnitedHealth cyberattack: ‘More devastating than Covid,’” KFF Health News, Apr 19, 2024 Read!

Two months into the mega-hack of UnitedHealth’s payment manager, chaos still reigns. A New York urologist getting stiffed on 30% of his claims says, “Everyone is freaking out. We are like monkeys in a cage. We can’t really do anything about it.” One exec reassured everyone that “full operations” should resume next year. But UnitedHealth told shareholders that “business is largely back to normal.”

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Julie Appleby, “Lawsuit alleges Obamacare plan-switching scheme targeted low-income consumers,” KFF Health News, Apr 16, 2024 Read!

Criminal insurance brokers preyed on the poor. “Two call centers paid tens of thousands of dollars a day to buy names of people who responded to misleading advertisements touting free government ‘subsidies’ and other rewards. In turn, sales agents used the information to either enroll them in ACA plans or switch their existing policies without their consent.” Beware those late-night cable ads—once they have your name, scammers can make your life hell. This is a civil lawsuit—will prosecution follow?

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Mohana Ravindranath, “These tech startups are betting on hospital price transparency rules,” STAT, April 17, 2024 Read!

[paywalled] “Federal rules forcing hospitals and insurers to post rates for medical procedures have taken effect, but the data’s so messy that a crop of new startups is rushing in to make a business out of parsing it for whoever is willing to pay.” The whole Rube Goldberg machine is so complex and irrational that we have to pay people to figure out what people we should pay. One of the tech outfits is the baby of Reed Jobs, son of Steve Jobs. That is not reassuring.

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Private equity

Bruce Jaspen, “Elevance Health and private equity firm to invest in primary care,” Forbes, Apr 16, 2024 Read! and Lis Schencker, “Walgreens embarks on another round of layoffs,” Chicago Tribune, Apr 16, 2024 Read!

Elevance Health, which owns Blue Cross/Blue Shield in 14 states, is joining forces with private equity to get deeper into primary care. Meanwhile, rivals Aetna/CVS and UnitedHealth (insurer and provider network) are doing the same and apparently thriving. Why is Walgreens’s foray into direct medical services tanking while CVS/Aetna is expanding and Elevance is doing fine? Readers who have insights, please point me to relevant articles.

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Privacy

Julie Watts, “California can share your baby’s DNA sample without permission, but new bill could force state to publicly reveal who they’re giving it to,” CBS News California, Apr 17, 2024 Read!

(That would be whom they’re giving it to.) The California Department of Public Health stores DNA samples from every baby born in California. “If you’re even related to someone born in California since 1983, thanks to genetic genealogy, portions of your DNA are in the biobank too and can likely be used to identify you.” All part of the steady march toward creating a domestic Stasi to make sure we behave.

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Nursing non-shortage

Kate Wells, “He thinks his wife died in an understaffed hospital. Now he’s trying to change the industry,” KFF Health News/Michigan Public/NPR, Apr 19, 2024 Read!

This is about the fight for mandatory nurse staffing levels, led by a guy who’s convinced his wife died due to neglect by overworked providers. Hospitals hate the idea especially if they’re owned by private equity. Nurse unions point out while physician services are reimbursable, nursing is not. Logically, hospitals will see nursing only as a cost and try to reduce it to the minimum. This goes to the heart of the debate about whether there really is a shortage of nurses or a shortage of decent working conditions for them.

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Dahlia Lithwick, “The absurd case about whether doctors can let you bleed out in the ER is reaching SCOTUS,” Slate, Apr 22, 2024 Read!

An ectopic pregnancy used to be resolved simply based on straightforward medical decision-making. Not any more in some states: “Idaho’s anti-abortion law allows for an abortion when ‘necessary to prevent the death of the pregnant woman,’ but not when it might MERELY cause disability or seriously bodily harm.” Ergo, when a distressed pregnancy occurs in an ER, the docs have to wait until the woman is at risk of death before proceeding. Says one, “It’s not harmless to wait until the brink of death to intervene.” I wonder how the judges and state legislators would react if they showed up to the ER with chest pains, and the MD said, “We can treat you but only if you are about to die.”

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Covid

Dake Kang & Maria Cheng, “Toxic: How the search for the origins of COVID-19 turned politically poisonous,” Associated Press, Apr 22, 2024 Read!

The search for the origins of Covid “has gone dark in China,” say the authors, due to “political infighting.” This is a sorry tale of bureaucratic terror and high-level cover-up in China. Luckily, political infighting doesn’t block dispassionate inquiry over the lab-leak theory here in the U. S.—kidding again! Now that we’re at pre-war with China, cooperation on medical and other scientific matters is grinding to a halt.

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Elder care

Anna Claire Vollers, “‘Are nursing homes our only option?’ These centers offer older adults an alternative,” Stateline/Tribune News Service, Apr 19, 2024 Read!

PACE (Program of All-Inclusive Care for the Elderly) looks like a promising alternative to the nursing home experience to help people live at home with the right sort of help. Oregon, New Jersey, and Ohio are using the model, and other states are interested. But oops—guess who is moving in? “About 10 years ago, Congress allowed for-profit companies to open PACE centers. In 2016, a private equity-backed company called InnovAge became the country’s first for-profit PACE organization.” It already has been investigated by the state of Colorado for lousy services.

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Alejandra O’Connell-Domenech, “Home healthcare for elderly sees largest price increase ever,” The Hill, Apr 10, 2024 Read!

More on the relentlessly soaring healthcare costs, this time on home care for elders: up 14% in a year, “the largest percent increase since the Bureau of Labor Statistics began collecting data on home healthcare costs in 2005.”

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Environmental disease

Kathleen Blackburn, “We regulate a tiny fraction of the 12,000 ‘forever chemicals.’ There’s a better way,” New York Times, Apr 21, 2024 Read!

“The environmental violence exacted by PFAS, like the effects of radiation and polychlorinated biphenyls, or PCBs, can be difficult to prove.” Yeah, so our national policy is to let companies toss thousands of substances into our soil, air, water, and food, and only years later find out the many ways all that stuff is killing us. Colorectal and other cancers are on the rise, and there’s plenty of evidence pointing to environmental causes. But the real money is in expensive drugs to treat illnesses, not in preventing them. “In the 1930s and ’40s, manufacturing companies like DuPont and 3M began developing [PFAS] for use as repellent in nonstick items including Teflon pans, Scotchgard, and firefighting foams. But the chemical bonds that make them so useful as a repellent also make PFAS nearly indestructible; it’s why they have been labeled ‘forever chemicals.’” Toxicologists are hamstrung in generating proof of the consequences for human health, and the precautionary principle is ignored.

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Quinn Coffman, “Missouri House gives initial OK to bill protecting pesticide-makers,” Columbia Missourian/St. Louis Public Radio, Apr 19, 2024 Read!

We know that environmental factors generate a lot of disease and that that costs us a lot of money. So, what is Missouri doing to reduce the damage and save healthcare dollars? Making sure pesticide manufacturers can’t be sued! Bayer, which now owns Monsanto, is headquartered in St. Louis, so local pols want to stop lawsuits over whether a Monsanto pesticide is killing people. Bayer is facing tens of thousands of claims that it didn’t warn people about the dangers, and Missouri is going to keep the company happy at all costs by saying federal regulators approved it, so you can’t sue.

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Opioid overdoses

Madelyn Beck, “More than 90% of Wyoming’s local opioid settlement money goes unspent while overdose deaths climb,” Wyofile.com, Apr 22, 2024 Read!

Wyoming is a small state with tiny budgets, compared to most. But the story is a microcosm of the slow movement on getting the services in place. Cities and towns are often tempted to spend on law enforcement for things like SWAT equipment or “fentanyl resistant” gloves rather than wrap-around social services for the addicted. There’s a big role here for public monitoring and oversight.

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SINGLE PAYER LINKS #344

Posted 19 APR 2024

Public health teetering, private equity piracy, price gouging, hospital consolidation—the usual! LISTEN TO PODCAST!

Public health

Tom Frieden, “To rebuild trust in public health: Better communication, fewer mandates, and small wins,” STAT, Apr 11, 2024 Read!

“How can trust be restored?” asks this former CDC director. Let us count the (three) ways: (1) better communication; (2) fewer mandates; and (3) “steady progress on health issues that matter to people.” Predictably bland rhetoric. I have a different remedy: admit past lies and then stop lying. It wasn’t “inconsistent and ineffective messaging” that destroyed trust; it was falsehood, including the falsehood of pretending to know things while in fact just guessing. The public health establishment learned nothing from its miserable Covid performance, and this lame piece proves it.

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David Hilzenrath & Holly K. Hacker, “Ten doctors on FDA panel reviewing Abbott heart device had financial ties with company,” KFF Health News/NBC News, Apr 8, 2024 Read!

Here’s another way to restore trust: dismantle the industry-academia-regulator gangbang and the corruption it regularly produces. “When the FDA recently convened a committee of advisers to assess a cardiac device made by Abbott, the agency didn’t disclose that most of them had received payments from the company or conducted research it had funded.” A big surprise followed: “The panel voted almost unanimously that the benefits of the device outweigh its risks.” They take us for morons, which is very annoying.

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Lauren Weber, “How Ohio’s GOP governor sells public health: Don’t call it that,” Washington Post, Apr 10, 2024 Read!

Mike DeWine sounds like an old-fashioned, Eisenhower Republican who isn’t constrained by anti-government ideological tropes but has to dodge the p-word (“public”) to get any decent initiatives enacted. “It’s hard to sell stuff on the basis of public health,” he told Weber. Governor DeWine pushes things like safe sleep for infants, pre-K education, poison control, school health clinics, post-natal care, stricter seat-belt enforcement, and some failed ideas like higher tobacco taxes. But he could never cast any of it as the government improving people’s lives. What a commentary on the triumph of Reaganist libertarian nonsense (gummint=bad). Ohio—a large chunk of which is in Appalachia—has terrible health and life expectancy statistics.

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Jason Horowitz & Gaia Pianigiani, “What happened when this Italian province invested in babies,” New York Times, Apr 1, 2024 Read!

Italy provided “a thick network of family-friendly benefits” to parents who wanted a lot of children—sounds great, and it worked to boost births. But why should this only happen when governments embark on pronatalist campaigns? Why not provide it for everyone all the time? But that would presume that the government should be pro-active in helping people live better—can’t have that.

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Private equity

Susanna Vogel, “Over 20% of healthcare bankruptcies last year were linked to private equity,” Healthcare Dive, Apr 17, 2024 Read!

“Another wave of private equity-backed bankruptcies is likely this year, as almost all U.S. healthcare companies considered at high risk of default are backed by private equity. [A watchdog group] argues debt tactics instigated by private equity firms are to blame.”

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Susanna Vogel, “Medical Properties Trust offloads 5 hospitals to Prime Healthcare,” Healthcare Dive, Apr 11, 2024 Read!

Looks like an obscure financial news item. But: “Two of MPT’s assets—Steward Health Care and Prospect Medical Holdings—have recently fallen behind on rent payments.” Lo and behold and by total coincidence, the two hospital systems named are notorious private equity takeover vehicles, which cratered and left smoking ruins behind. But they were highly profitable for the financier manipulators during the collapses. Medical Properties Trust is an $18.3 billion giant that “turns a profit by investing in healthcare facility sales and leasebacks.” In other words, they don’t actually produce anything, but they shift assets around and make money off keystrokes on computer screens.

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Susanna Vogel, “Steward bankruptcy likely as massive debt remains, with few options left,” Healthcare Dive, Apr 16, 2024 Read!

And right on time! “Steward Health Care is on the clock,” i.e., facing bankruptcy, along with its 30 safety-net hospitals. Will this be enough to attract the attention of regulators/lawmakers? How about some grilling of the private equity gazillionaires responsible for the debacle? Steward was formed by PE firm Cerberus Capital Management in 2010, which then “partnered” with hospital landlord Medical Properties Trust in 2016. The standard playbook was followed: Steward sold its real estate and leased it back, providing the PE scam artists lucrative payouts while the core company imploded. “Cerberus made $484 million off the first Steward sale-leaseback deal.” CEO Tony Soprano took home a nice compensation package—kidding!

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Rebecca Pifer, “Elevance partners with private equity firm on primary care,” Healthcare Dive, Apr 16, 2024 Read!

Here’s another accelerating trend: insurance companies moving into the provider function. That way, they collect money from premiums and the government and then pay it to themselves. Neat! Naturally, private equity is standing by to participate in the bounty. “Insurers have been investing heavily in their provider networks, snapping up doctor’s offices and inking partnerships with other investors to expand their reach. By operating care delivery assets [English translation: owning doctors and clinics] and directing their members to those centers, health insurers can keep more of the healthcare dollar as profit.”

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Hospitals

Marty Makary, “Hospitals that make profits should pay taxes,” STAT, Apr 14, 2024 Read!

“In 2023 a Pennsylvania judge revoked a hospital’s property tax exemption. This action came after the Pottstown school district sued the hospital” over lost school revenue. I bet that focused the hospital admin’s thinking about its “community benefit” package.

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Dave Muoio, “High volume, high value hospital transactions kick off 2024,” Fierce Healthcare, Apr 11, 2024 Read!

The consolidation of the hospital sector proceeds and may be accelerating despite some regulatory obstacles. Underlying the merger activity is “the substantial portion of hospitals and health systems that are still losing money on operations.” The whales are gobbling up the struggling minnows. “We anticipate that continued financial headwinds [English translation: hospitals going bankrupt] will be a significant factor in M&A activity.”

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Ricky Sayer, “Lawmakers plead for help to finalize Washington Health System’s merger with UPMC,” CBS News/KDKA, Apr 10, 2024 Read!

Western Pennsylvania pols insist there’s no way to save the city of Washington’s (PA) hospital system unless the regional Godzilla at the University of Pittsburgh takes it over. Dissenters worried that UPMC takeovers lead to higher costs and staff cuts, but they’re drowned out. The terms of the 10-year agreement include promises of things like maintaining all services, not firing any staff, and $300 million in new investments. And if UPMC doesn’t fulfill its solemn promises, then what? Will the local pols clamoring for the takeover then get tough with it? (Hilarity ensures.)

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Data snooping

Jessica Lyons, “96% of US hospital websites share visitor info with Meta, Google, data brokers,” The Register, Apr 11, 2024 Read!

The big UnitedHealth data breach is just the tip of the iceberg: “Hospitals frequently use tracking technologies on their websites to share user information with Google, Meta, and other third parties,” including advertising firms and data brokers. Lesson: avoid giving them anything not essential for treatment since it all flows into the Great Data Maw.

Original paper: Read!

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Medicare/Medicaid

Rebecca Pifer, “Florida issues Medicaid managed care awards booting out UnitedHealth, CVS and Molina,” Healthcare Dive, Apr 15, 2024 Read!

Insurance companies duke it out over lucrative contracts as Medicaid moves entirely into the private sector—with government cash. “Evidence about managed care’s [privatization] efficacy is mixed, and concerns are growing that insurers are denying Medicaid members’ care more than they should to retain more government reimbursement as profits.” You don’t say! Louie, look into that gambling allegation immediately.

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Providers

Christopher Koller, Kyu Rhee & R. Shawn Martin, “No appointments available: America’s escalating primary care shortage,” Healthcare Dive, Apr 15, 2024 Read!

The authors claim that primary care is “on the brink of collapse” with 100 million Americans without a regular source of care. Primary care docs make a third of specialists’ earnings. “Primary care accounts for 35% of healthcare visits but receives only about 5% to 7% of total healthcare expenditures.” (Hospitals get 30%.) I guess you get what you pay for

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Pharmaceuticals

Sydney Lupkin, “Drugmakers’ low U.S. taxes belie their high sales,” NPR, Apr 15, 2024 Read!

An alternate, more direct headline showed up elsewhere attached to this article: “U.S. drugmakers lower taxes by shifting profits to overseas subsidiaries.” Drug makers exploit the U.S. market to make their big bucks, then shift the profits to overseas subsidiaries to avoid taxes. “The top five American pharmaceutical companies all had more drug sales in the U.S. than they did in all the other countries in the world put together.” But most of them reported losses in the U.S. operations.

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Robert Langreth, Fiona Rutherford & Tanaz Meghjani, “Americans are paying billions to take drugs that don’t work,” Bloomberg, Apr 15, 2024 Read!

The AIDS advocacy movement pushed government regulators to get the drug pipeline moving faster. But that had unintended consequences, and not everyone is happy. Speeded up drug approvals have led to billions in sales of meds that turn out to be flops. One critic says the FDA has approved things “where there’s literally no evidence except wishful thinking.” Pharma easily exploits desperate patients and their families, who naturally want to try anything with a remote chance of working. But the issue of whether the government should pay whatever the owners want to charge for these poorly tested molecules continues to be ignored—including by this article.

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Tom Murphy, “It’s the first drug shown to slow Alzheimer’s. Why is it off to a slow start?” Associated Press, Apr 13, 2024 Read!

The answer is in the second graf: “Some patients will hesitate to take Leqembi due to its limited impact and potential side effects.” Also, define “shown.” The evidence of these drugs’ efficacy is pretty thin, and the Aduhelm debacle didn’t inspire confidence in them. But there’s a lot of money at stake—see next item.

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Bob Herman & Rachel Cohrs, “Medicare expects to spend $3.5 billion on new Alzheimer’s drug in 2025,” STAT, Apr 11, 2024 Read!

[paywalled] “Medicare has estimated that a new Alzheimer’s treatment could cost the program well beyond what Wall Street or even the drug’s manufacturer has projected.” Struggling patients and families want to try anything that might slow down the process, and the Feds predict a “large increase in uptake.” We’re paying, and the evidence of efficacy is spotty—why can’t we decide on the price?

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What’s next?

Varsha Bansal, “This delivery app takes away health insurance when workers don’t meet quotas,” Rest of World, Apr 12, 2024 Read!

Delivery workers who don’t fulfill punishing job demands get dropped from their health insurance. Okay, so it’s happening in India. How long before it reaches the U.S. as part of our dash toward neofeudalism? Maybe when AI is in charge of scheduling for Uber drivers and UPS deliveries.

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SINGLE PAYER LINKS #343

Posted 12 APR 2024

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In response to a reader request, I’m including a brief explanation of private equity, which pops up a lot in these digests due to its ongoing infiltration of the healthcare sector. [You can listen instead of all that reading: HERE!

PE firms are investment vehicles. They look for companies to invest in but do not themselves have shares or stockholders—thus the term “private.” They typically are owned by pension funds, sovereign wealth funds (e.g., Saudi Arabia’s), and very wealthy individuals including the managers of the PE funds themselves.

PE firms buy other companies, usually with borrowed funds. By using other people’s money (leverage), mixed with some of their own, they maximize their profits from these deals. In addition, the interest they pay on the loans generates tax benefits. What is particularly perverse about the practice is that the acquired company—not the PE firm itself—shoulders the new debt.

Example: Toys R Us. Private equity giants including Bain Capital [Mitt Romney’s old firm] bought the flagging kids’ retail giant for $7.5 billion just as the retail toy industry was contracting due to online sales. The debt wrecked the famous company and drove it into bankruptcy.

PE bosses say that they buy weak firms that aren’t doing well so they can turn them around with better management. In fact, what often happens instead is that the PE investors loot the assets of struggling companies, pay themselves huge fees and dividends, and then dump the smoking ruin. When this involves things like hospitals or emergency rooms, the consequences are dire.

One of the worst tendencies associated with PE in health is monopolization. A PE company finds a niche—say anaesthesiology—in a certain city, buys up all the firms and doctors providing that service, and then jacks up costs for everyone.

PE has invaded healthcare massively in the last 20 years including acquisitions in hospital groups, staffing companies, and specialties like ER physicians and dermatologists. These deals are ongoing and even accelerating. The Federal Trade Commission is trying to regulate them and scoring some successes although that pushback is generating hostility from the usual suspects.

Now, onto the latest news:

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Dave Muoio, “Senator probes private equity, physician staffing firms for emergency care cost cutting,” Fierce Healthcare, Apr 2, 2024 Read!

Here comes another congressional inquiry on PE, this one covering ERs. One reason for congressional interest is the rash of insolvencies affecting the sector: “Envision Healthcare filed for bankruptcy within the past year; TeamHealth has over $1 billion in loans due this year; US Acute Care Solutions could face a forced sale by 2026; and American Physician Partners ‘abruptly’ halted operations and declared bankruptcy last summer.” Of course, the PE owners didn’t lose money even if the vehicles they used in their deals are now bust. But the PE loot-and-skedaddle playbook doesn’t look so good when it leaves failed healthcare services behind—it’s different from destroying a toy store. Given that PE firms now operate around 1/3 of the country’s ERs and a quarter of rural hospitals, we can expect more “bankruptcies” in the sector that are in fact asset stripping and dumping schemes. For example, “Steward Health Care [in Massachusetts] has lately become the lightning rod for such critiques. The for-profit picked up significant debts during its time under former owner Cerberus Capital Management and is now selling off assets to resolve its obligations.”

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Chris Hamby, “In battle over health care costs, private equity plays both sides,” New York Times, Apr 7, 2024 Read!

Here’s yet another financier suction device extracting cash from the healthcare system while adding nothing of value: “A tool backed by private equity is helping insurers make billions of dollars and shift costs to patients. Data iSight recommends how much of each medical bill should be paid,” which is whatever amount will funnel more to insurance companies and Wall Street intermediaries at the expense of providers and patients. That way, a California finance company and the Saudi Arabian government get a cut of every healthcare transaction, doctors get the shaft, and patients pay more. Market efficiency! Unless we read the tiny print on those mountainous insurance documents, we never learn a thing about this popular grift.

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Medicare (dis)Advantage

Background: Medicare Advantage is the misleading name of private insurance’s stealth takeover of Medicare, which was established as a single-payer, government program in the 1960s. MA is all those late-night ads on cable channels that promise to get you, as a senior, various cool benefits that you didn’t know about. What those ads don’t tell you is that by signing onto an Advantage plan, you give up access to traditional Medicare provided directly by the government. Instead, you’re now a client of a for-profit insurance company.

Already, half of all enrollees in Medicare are in these new privatized policies instead of traditional Medicare at a cost of $600 billion a year to the Federal treasury. There are several stories this week suggesting that the negative publicity about what we like to call Medicare Disadvantage has started to have an effect.

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Bob Herman, “Biden administration sticks with slight cuts to 2025 Medicare Advantage payments,” STAT, Apr 1, 2024 Read! and Rebecca Pifer, “Biden administration finalizes modest cut to 2025 Medicare Advantage rates,” Healthcare Dive, Apr 2, 2024 Read!

The usual routine is that Medicare administrators set an annual reimbursement base rate, insurers scream bloody murder, and the Feds back down. “Normally, after a public comment period (and aggressive industry lobbying), regulators finalize a friendlier notice than what they originally put out.” Not this time. The decision hurt the insurance industry that has “come to rely on Medicare Advantage for a steady stream of profits.” Insurer shares cratered after the announcement. (Boo hoo) Quite a shift, perhaps due to the strong pushback (from us!) against privatization and the proliferation of MA horror stories. Regulators have also begun to crack down on “improper care denials and deceptive marketing and brokerage practices.” None too soon.

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D. Lipschutz, “CMS holds the line against insurance industry pressure, but plans remain significantly overpaid,” Center for Medicare Advocacy, Apr 4, 2024 Read!

This thinktank points out that while the government did not buckle on reimbursement rates, the companies will still get an overall pay increase after risk adjustments—so it’s misleading to call it a “cut.” The Center notes that MA has been a cash cow for the health insurance industry for years and offers the following translation of industry’s howls of outrage: “Because there are finally attempts to rein in our overpayments, our products will not be as profitable and our shareholders will be unhappy, and we are going to make it an election issue.” Those plans’ changes will drop right in the middle of maximum campaign season in mid-October.

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Rebecca Pifer, “CMS caps broker payments in Medicare Advantage,” Healthcare Dive, Apr 8, 2024 Read!

“The final rule issued Thursday prevents insurers from paying brokers additional fees for steering beneficiaries to their plans.” Question: Why not fix the underlying issue and get rid of the private insurance invasion entirely? If there’s no marketing, then there’s no predatory marketing.

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Caitlin Owens, “Hospital and insurer battles over Medicare Advantage set to grow,” Axios, Apr 4, 2024 Read!

“Hospitals have been sounding the alarm about an uptick in MA plans denying claims, paying less than what providers bill for, and taking too long to review requests to authorize care, which they say is wreaking havoc on revenue streams.” Does this mean that MA is entering a death cycle in which lower profits=poorer service=unhappy customers=disaffiliations=lower profits=poorer service, etc.? Could be. “To maintain profitability, analysts say, plans will have to either extract higher payment rates from the government, find ways to pay for less care, drive harder bargains in negotiations with providers, contract with fewer providers, or reduce benefits offered to enrollees.” More than 60% of hospitals say are considering dropping MA plans this year. May the collapse begin!

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Tony Pugh, “Rural hospitals seek help as private Medicare patients increase,” Bloomberg Law, Apr 3, 2024 Read!

MA plans are spreading rapidly into rural areas, making the dire conditions of rural hospitals even worse because MA insurers pay lower rates, restrict coverage options, and force providers to jump through all kinds of prior authorization hoops. Says one expert: “More than other commercial payers, MA plans reduce and revoke payments for care already provided. Rather than appeal those decisions, rural hospitals often just cash the check that’s short what they should be paid. They don’t have the people or the resources to do the follow-up to try to get the claim paid correctly.”

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Berkeley Lovelace Jr., “Will Medicare raise your monthly premiums to cover Wegovy?” NBC News, April 2, 2024 Read!

Looks like yes: given that full-court, obesity-is-a-disease PR campaign (thanks, Oprah!), Medicare will probably be compelled to cover weight-loss shots under the cover of “heart disease” or “diabetes treatment.” We don’t know how much it will cost each of us to subsidize the lifetime drugs that now list at $1,300 a month. Medicare spending on the diabetes drug Ozempic doubled from 2021 to 2022, making it already a top-selling drug covered by Medicare, even before the propaganda and TV ads. Bernie Sanders cited a Yale study that found these shots could cost less than $5 a month to make.

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Suzanne Blake, “Medicare recipients lose thousands to ‘phantom billing,’” Newsweek, Apr 1, 2024 Read!

“Phantom billing occurs when fraudulent charges are filed to Medicare by health care providers and medical equipment companies without the recipient’s knowledge.” One more thing we have to look out for in those mind-numbing insurance statements.

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Medicaid

Sydney Halleman, “One year, 19M disenrollments: A look at Medicaid redeterminations so far,” Healthcare Dive, Apr 2, 2024 Read!

We’re now up to 19 million people booted from Medicaid in the year since the end of Covid protections. I wonder how many of those people are going to run out to vote for Joe Biden—just trolling, but it’s a fair question. There’s no variation in that figure of 70% of those terminated due to procedural reasons.

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Noah Weiland, “For red state holdouts like Kansas, is expanding Medicaid within reach?” New York Times, Apr 3, 2024 Read!

Kansas Gov. Laura Kelly says resistance to Medicaid expansion in her state is based on “conservative ideas about the nature of government-subsidized coverage and the people deserving of it.” Exactly—it’s not really a debate on the nuts and bolts of Medicaid or even the costs involved but rather the boogeyman of lazy adults (always males) sitting back and enjoying medical care for free. Currently, generous Kansas only awards Medicaid coverage if your family of four earns no more than $12,000 a year. This presumably also requires a fixed address, not counting “under the culvert by the bus station.”

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Annalisa Merelli, “Medicaid redetermination cost community health centers an average of $600K each,” STAT, Apr 8, 2024 Read!

Here are the current stats on the Great Medicaid Kick-Off (as in “kick ‘em off”): 19 million people booted out; 42m confirmed and retained; 31m pending. Community health centers have lost 23% of their Medicaid patients and accompanying payments due to the redeterminations. Add to that the admin burden of helping people deal with Medicaid paperwork—which is not a billable service.

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Antitrust/concentration

Susanna Vogel, “Novant’s proposed purchase of CHS hospitals ‘irreversibly’ harms competition, FTC says,” Healthcare Dive, Mar 29, 2024 Read!

Regulators moved to block another hospital merger, this one in North Carolina, that would “irreversibly consolidate” the hospital market in the northern suburbs of Charlotte. The FTC is asking for an immediate injunction to stop the deal that would grant a hospital cartel an “eye-popping” 64% share of the local market. The target hospital conglomerate already has 19 medical centers and 850 outpatient locations and just purchased three South Carolina hospitals for $2.4 billion.

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Rebecca Pifer, “Walgreens posts $6B loss on waning VillageMD value; ups clinic closures,” Healthcare Dive, Mar 28, 2024 Read!

Walgreens’ attempt to become a vertically integrated healthcare giant is floundering. After spending a whopping $6 billion-plus on primary care chain VillageMD, the drugstore biz is now closing those outlets by the dozen. Walgreens tried to combine primary care, at-home care, and specialty pharmacy services into a profitable Godzilla—not clear exactly why it failed or if Walgreens’ failures also mean doom for its rival cartels.

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Insurance nightmares

Julie Appleby, “ACA plans are being switched without enrollees’ OK,” KFF Health News/NPR, Apr 2, 2024 Read!

Another way retirement is becoming a fulltime job: “Unauthorized enrollment or plan-switching is emerging as a serious challenge for the ACA [Obamacare]. Rogue agents can get into policyholder accounts in the 32 states served by the federal marketplace.” Those affected can then hear from the IRS for back taxes based on improper use of the Obamacare subsidies. The practice is apparently rampant: one federal worker reports handling 20 complaints a day.

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Environmental health

Mikaela Conley, “Ultra-processed foods: increased risk of dementia, Alzheimer’s disease,” U.S. Right To Know, Apr 4, 2024 Read!

Alzheimer’s is about to boost the U.S. GDP as we get ready to spend untold billions on treatments of dubious utility, all of which will be considered productive in expert economists’ voodoo calculations. Meanwhile, we’ll continue to ignore the evidence cited here that “diets high in ultra-processed foods [from which Americans get half their calories] are associated with an increased risk of dementia as well as cognitive decline.”

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Pharmaceuticals

Ian T. T. Liu et al., “Clinical benefit and regulatory outcomes of cancer drugs receiving accelerated approval,” JAMA Network, Apr 7, 2024 Read!

“Most cancer drugs granted accelerated approval did not demonstrate benefit in overall survival or quality of life within 5 years of accelerated approval.” The FDA allows some drugs to enter the market provisionally subject to follow-up trials for confirmation of utility. A lot of them don’t work—but we only find out after spending billions on them. The HIV advocacy movement paved the way for this speed-up; some advocates don’t like where it led.

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Public health

Cecilia Nowell, “Rapid rise in syphilis hits Native Americans in the Southwest hardest,” Source NM/KFF Health News, Mar 26, 2024 Read!

Infection rates in a predominantly Native region of the Southwest are among the nation’s highest and worsening. Syphilis infections nationwide reached a 70-year high in 2022 while penicillin is in short supply. A local doula called the Navajo Nation a “maternal health desert” because on some parts of the reservation, patients have to drive more than 100 miles to reach obstetric services. Zero prenatal care=syphilis goes undetected. “More than half of U.S. rural hospitals no longer offer labor and delivery services.” So, it’s not just Navajos.

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Substance abuse

Lev Facher, “Rigid rules at methadone clinics are jeopardizing patients’ path to recovery from opioid addiction,” STAT, Mar 12, 2024 Read!

A sad tale about how methadone, which can help people stop opiate use, has turned patients into “prisoners of the treatment system” through compulsory observational dosing. “Hundreds of thousands spend each morning journeying to and from clinics to wait in line to swallow a small cup’s worth of medication.” Many methadone clinics are run like prisons and—surprise surprise—are owned by private equity firms. The system prevents people from holding down jobs or having much a life outside of their addiction. “Alienated by the clinics’ rigid controls, people who use drugs are often driven away from methadone treatment or never seek it in the first place.” The clinics want to maximize billable events to fatten profits and are also terrified of “diversion” of methadone and the resulting headlines in the tabloid press.

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Mike Baker, “Oregon is recriminalizing drugs. Here’s what Portland learned,” New York Times, Apr 1, 2024 Read!

An interview with Mayor Ted Wheeler of Portland about the “failed” decriminalization experiment. Take-home message: establish the back-up treatment and social services first, then remove criminal penalties. Oregon did it backwards; chaos ensured. Wheeler: “a huge mistake.”

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State regulation

Roslyn Murray & Andrew Ryan, “Hospital care costs are out of control. Price caps can help,” STAT, Apr 4, 2024 Read!

Here’s an Oregon experiment that did work—hospital price caps: “In October 2019, Oregon put in place an upper limit [2X Medicare rates] on what it pays hospitals for services provided to the 300,000 members on its state employee plan.” The result was huge savings for the state. No hospitals boycotted the state plan although they could have. A good example of a state using its buyer muscle to face off against hospital conglomerates. The authors conclude what should be obvious: “The typical market forces that keep prices in check are missing in hospital markets.” Mandatory price limits enforced by new laws are needed.

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Shalina Chatlani, “States want to make it harder for health insurers to deny care, but firms might evade enforcement,” Stateline, Apr 8, 2024 Read!

States are trying to alleviate the prior authorization nightmare without encouraging fraudsters or giving drug companies carte blanche to charge whatever they want. Two dozen states have tried out strategies to curb delays and denials. Texas has a “gold card” system that exempts docs who have a good approval record—but only awarded the privilege to 3% of doctors statewide. Washington and Michigan tried to set stricter rules, but one former industry exec said that “insurance companies are adept at finding ways to get around laws designed to hold them accountable,” especially if enforcement is weak. The best idea so far: make the insurance companies’ robotic deniers liable for harm to patients. As one expert said, “If those doctors could be sued for malpractice, all of this would go away.”

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Covid

Joseph Choi, “COVID subcommittee chair asks top science journal editors to testify on relationship with federal government,” The Hill, Apr 2, 2024 Read!

An Ohio Republican member of Congress wants to know if the country’s top scientific journals let political operatives from the White House influence “the scientific review or publishing process.” Indignant denials poured forth as there is definitely 100% for sure no gambling in Casablanca.

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SINGLE PAYER LINKS #342

Posted 5 APR 2024

LISTEN TO PODCAST!

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Consolidation/monopoly

Brett Kelman & Samantha Liss, “After Appalachian hospitals merged into a monopoly, their ERs slowed to a crawl,” KFF Health News/The Tennessean, Mar 25, 2024 Read!

More evidence that monopolization destroys quality of care and services. “In the 6 years since lawmakers in both states waived anti-monopoly laws and Ballad Health was formed as a 20-hospital system in Tennessee and Virginia, ER visits for patients grew more than three times as long.” Lawmakers in the two states allowed rival hospital systems to merge into a single company with no competition in a 29-county region with a million inhabitants. What could go wrong? “Ballad has also fallen short—by about $191 million over the past 5 years—of its obligation to provide free or discounted care for low-income patients.” Are state officials now angry? Not in the least! “The health department waived this obligation in each of the past four fiscal years. Ballad has said it would ask for another this year.”

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Susanna Vogel, “Steward’s legal battles offer insight into pattern of mismanagement,” Healthcare Dive, Mar 20, 2024 Read!

Dallas-based Steward Health Care is a hot mess that has generated a crisis in Massachusetts as several hospitals there teeter on the brink. It’s a typical case of what’s left after the private equity hustlers (Cerberus in this case) suck out assets, pay themselves unearned profits and fees, and wreck the entity’s finances. Cerberus bought the Steward system in 2010, giving them plenty of time to loot it. “[Steward] has shuttered hospitals, allegedly missed millions of dollars in payments to its landlord and vendors, and has been served at least 35 lawsuits over the past year.” The lawsuits include accusations of falsified checks and doctor kickback schemes—lovely! The state Health & Hospital Association is trying to salvage something out of the smoking ruins.

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Dave Muoio, “Optum to buy struggling Steward Health Care’s physician group under proposed deal,” Fierce Healthcare, Mar 27, 2024 Read!

What’s the solution to the Steward debacle? More monopolistic concentration! UnitedHealth, the nation’s largest health insurer, is angling to gobble up thousands more physicians. The possible sale “has already drawn antitrust concerns from federal lawmakers who pointed to [UH unit] Optum's major share of the physician staffing market,” i.e., 10% of all doctors in the entire country.

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Paige Minemyer, “Amedisys says Oregon regulators are reviewing its $3.7B acquisition by UnitedHealth,” Fierce Healthcare, Mar 20, 2024 Read!

Insurance Godzilla UH is also angling to buy a large home health provider. But regulators in Oregon are taking a look at the deal over “anticompetitive effects.” The Feds (DoJ) are doing the same.

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Private equity

Anna Claire Vollers, “Vets fret as private equity snaps up clinics, pet care companies,” Stateline, Mar 29, 2024 Read!

How creepy is a PE takeover of pet doctors? One vet said she and colleagues were “feeling pressure from management to make a certain amount of money from every appointment,” including pressuring pet owners for things they don’t need. Another industry encrapification well underway: JAB Consumer Partners, a global private equity firm based in Luxembourg, has acquired a large vet chain, and other PE firms “have spent billions over the past few years on veterinary practices, specialty animal hospitals, pet insurance services, and pet food companies.” Candy company Mars is another big practice owner. Even ASPCA Pet Health Insurance is owned by PE. “In February, asset management behemoth Blackstone Inc. acquired Rover, the nation’s largest online platform for pet sitting, dog walking and other services.” When PE owns your dog walker, it’s over.

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Susanna Vogel, “Ascension will outsource Illinois hospitalist functions to PE-backed staffing firm,” Healthcare Dive, Mar 26, 2024 Read!

The Catholic health system Ascension is “terminating more than 110 doctors and other providers at its Chicago-area hospitals and turning them over to a private equity-backed staffing firm while they continue to work in Ascension facilities.” The fired/rehired staff must be delighted! “Medical directors, doctors, nurse practitioners, and physicians’ assistants previously employed by Ascension will have to reapply for their jobs with SCP Health.” Doctors of the world, unite! You have nothing to lose but your chains. “Already, labor tensions are high at Ascension.” No kidding!

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Susanna Vogel, “Advocate offloads senior home care business to private equity firm,” Healthcare Dive, Mar 25, 2024 Read!

The constant ownership churn in these homes and their subcontractor businesses is a sign of PE value-extraction. “Private equity is voraciously acquisitive and engages in consolidation that largely flies under the antitrust radar.” They then proceed to strip assets, extract rents, and quickly decamp leaving rotting shells behind.

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Phil Galewitz, “Hospitals cash in on a private equity-backed trend: Concierge physician care,” KFF Health News/ABC News, Apr 1, 2024 Read!

“Nonprofit hospitals created largely to serve the poor are adding concierge physician practices, charging patients annual membership fees of $2,000 or more for easier access to their doctors. Concierge physicians typically promise same-day or next-day appointments. Some provide the doctor’s mobile phone number.” Finally, a solution to dysfunction and scarcity—create tiered services to keep the middle classes happy! Why didn’t I think of that? Guess who the concierge system was initially intended to serve? “High-end donors wanted to make sure they have doctors to care for them.” You bet they do. A defender of the practice said, “My philosophy is: It’s better to give world-class care to a few hundred patients rather than provide inadequate care to a few thousand patients.” I’d say that the entire system’s philosophy in a nutshell.

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Medicare/Medicaid

Katheryn Houghton, “Some Medicaid providers borrow or go into debt amid ‘unwinding’ payment disruptions,” KFF Health News/Daily Yonder, Mar 27, 2024 Read!

The Great Medicaid Kick-Off (as in kicking people off) is not only wrecking individuals’ lives but also driving small clinics, nursing homes, and safety-net health centers into insolvency. This example is from Montana where over 120,000 people have lost their Medicaid coverage in a year. It includes stories of a nursing home that took out bank loans at 8% interest and a clinic with a 6-month Medicaid payment backlog. Call centers leave people hanging on the line for hours. They should get concierge services and their provider’s mobile number!

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Liz Seegert, “Is Medicare keeping pace with our aging population? Experts say ‘we need to double down and go faster,’” Fortune, Mar 26, 2024 Read!

Americans are living longer than they did when Medicare was established [77 average years v/s 70]. “Medicare was never designed to help us live this long.” Therefore, what? We should figure out how to whack more seniors? (Covid was a good start in that case.) How about reframing the debate: it’s not about the elderly, it’s about our entire looney-tunes healthcare payment system.

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Noah Tong, “Payers say MA rate cut puts affordable care at risk,” Fierce Healthcare, Apr 1, 2024 Read!

They would say that, wouldn’t they? The Feds are “not deviating from a proposal to modestly rein in Medicare Advantage. Benchmark payments will still decrease 0.16%. The Medicare Disadvantage gang are pissed.

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Paula Span, “When Medicaid comes after the family home,” New York Times, Mar 16, 2024 Read!

State Medicaid agencies can seize the estates of people who innocently took advantage of offered services. Lesson: divest of your home well before needing expensive care. Most of those targeted: “low-income families, many of them Black and Hispanic.”

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Pharmaceuticals

Nick Corbishley, “UK medicines regulator’s role as Pharma ‘enabler’ during pandemic comes under microscope,” Naked Capitalism, Mar 12, 2024 Read!

The U.K. is looking into accusations that adverse events—specifically myocarditis and pericarditis in young adults—associated with the Covid vaccines were significantly underreported. “We conclude that the [U.K. regulatory agency] has indeed become an enabler for the pharmaceutical industry with patient safety no longer being its primary concern.” No need to conclude that—the regulator said so herself: Britain’s chief Pharma regulator Dame June Raine boasted of the agency’s transition from “the watchdog to the enabler” back in March, 2022.

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Lev Facher, “Switzerland had a drug overdose crisis. Then it made methadone easy to get,” STAT, Mar 26, 2024 Read!

“At a leading Swiss clinic, all patients in need of addiction care are given instant access to weeks’ worth of medication. They are not required to participate in counseling, or subjected to drug tests, or punished if they relapse and use illicit substances.” Result: Switzerland’s opioid death rate is 1/20th that of the United States. Its approach was once controversial, but with a runaway AIDS epidemic driven by IV drug use, they tried a radical approach with a “heavy emphasis on treatment and harm reduction—in particular, easy access to clinics that offered addiction medications like methadone and buprenorphine.” Why can’t this work in the United States? “Most European nations have some form of universal health insurance, making issues of cost and payment for addiction care far simpler.”

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Rebecca Pifer, “Elevance to buy Kroger’s specialty pharmacy,” Healthcare Dive, Mar 19, 2024 Read!

(Could also go under “consolidation/monopoly.”) Specialty pharmacies are those that provide meds for people with complex, chronic conditions, which account for 50% of all the money spent on prescription drugs in the U.S. Ergo, they’re big profit centers, and PBMs want grocery chain Kroger’s business to make up for customers dumping exploitative intermediaries. Meanwhile, Kroger is trying to justify its monopolistic mega-merger with competitor Albertsons by divesting itself of other businesses.

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Lisa Shah, “Oprah kicked off a national conversation on obesity and GLP-1 drugs. Let’s have it,” STAT, Mar 28, 2024 Read!

A twist on dieting from an obesity specialist who uses the fat shots in some cases. But she cautions: “Food plays a central role in cultural identity and social health; it’s a focal point for connection, for belonging, and for happiness. To take food off the table is to remove an element of joy from life.” The author discusses the downplayed side effects, efficacy, and cost issues. Oprah’s infomercial sidestepped them as she adds to the pressure to (get us to) pay for them.

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John Ingold, “Pharmaceutical company Amgen sues Colorado over price-setting prescription drug board,” Colorado Sun, Mar 25, 2024 Read!

Three years after its board was formed, Colorado finally got around to setting a price limit on one drug; a Pharma lawsuit immediately followed. “The company [Amgen] is seeking not just to overturn the board’s recent decisions about Enbrel but also to strike down major parts of the law creating the board.” Enbrel is used to treat rheumatoid arthritis and lists at around $90,000 a year. Amgen made $3.7 billion on it last year—enough to fund quite a few lawsuits!

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Mike Scarcella, “AstraZeneca sues Arkansas to block drug-discount program,” Reuters, Mar 26, 2024 Read!

Another state tries to cram down drug prices, also gets sued. “AstraZeneca’s lawsuit says the state-mandated discounts violate the constitutional bar on unlawful government ‘takings’ of private property.”

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Jonathan Gardner, “FDA approves Merck lung disease drug acquired in $11B deal,” Biopharma Dive, Mar 26, 2024 Read!

Merck can salvage its balance sheet with a new blockbuster drug for a rare lung disease. Typically, Merck didn’t spend any of its loot on discovering this drug—preferring to buy it from the inventors for $11 billion. Keep that fact in mind next time you hear how important it is that Pharma set its own prices because of its diligent work to find “new life-saving medicines.” The new product will be priced at $14,000 per shot, which will be needed every 3 weeks. Merck didn’t shell out $11 billion for nothing.

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Insurance nightmares

Daniel Payne, “Who pays when AI steers your doctor wrong?” Politico, Mar 24, 2024 Read!

What if an AI robot misdiagnoses you? Is anyone going to take responsibility? Count on the corporates to dodge it. One commentator warns, “Physicians are the ones that get left holding the bag.” We can anticipate the scenario: the MBAs pressure doctors to use AI and other algorithm-driven guidelines to keep profits high, but if shit happens, the MDs are to blame, not the C-suite. So, can a doc just not use AI? Nope. “Legal scholars foresee plaintiffs arguing that doctors were negligent because they didn’t use the best tools available to them.” To conclude: you’re screwed. And just try to unionize.

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Melanie Evans, “Hospitals are adding billions in ‘facility fees’ for routine care,” Wall Street Journal, Mar 25, 2024 Read!

New scam: charge patients for hospital overhead—even if the visit took place somewhere else. “Hospitals are adding billions of dollars in facility fees to medical bills for routine care in outpatient centers they own. Once an annoyance, the fees are now pervasive and becoming nearly impossible to avoid.” Medicare pays about $6 billion extra a year for these arbitrary charges, and states are starting to crack down on them while the Feds fiddle. It's another motive for hospitals to snap up clinics and doctors given that “many hospital systems now get at least half their revenue from patients who aren’t admitted.” Lesson: before any procedure, ask if the clinic charges a facility fee.

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Judith Graham, “The burden of getting medical care can exhaust older patients,” KFF Health News/Washington Post, Mar 27, 2024 Read!

“The run-around that so many people face when they interact with America’s uncoordinated health care system” is driving older patients nuts. “It’s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests. In addition to time spent receiving health care, this burden includes arranging appointments, finding transportation to medical visits, getting and taking medications, communicating with insurance companies, paying medical bills, monitoring health at home, and following recommendations such as dietary changes.” Gee, I wonder what could simplify the chaos that a multiple-payer, multiple-plan system creates?

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Environmental health

Pandora Dewan, “MS and Autism among brain health risks from common household chemicals,” Newsweek, Mar 25, 2024 Read!

Everyday cleaning agents “could be damaging our brains with potential links to a range of neurological conditions including multiple sclerosis and autism. The team found that 292 of the chemicals tested were deadly to these insulating brain cells.” But let’s look for pricey drugs to treat the polluted brains instead of addressing how to stop mass poisoning of the population.

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SINGLE PAYER LINKS #341

Posted 29 MAR 2024

LISTEN TO PODCAST here if you're tired of screen scrolling! On a computer, you do not need to download the Podbean app. (I am also looking into adding more podcast listening options. - Tim)

Environmental health

Medical News Today, “Another 3 common pesticides are now linked to Parkinson's disease risk,” Mar 9, 2024 Read!

Parkinson’s, the fastest-growing neurological disorder in the world, is associated with exposure to 14 pesticides, three of which were just added to the list with this new study. Anyone living near a lot of industrial farming has substantially higher chances of ending life with this unpleasant disease. Fun fact: Red wines in Dutch supermarkets were found to contain seven different pesticides, including known carcinogen glyphosate.

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Jessica Kutz, “Louisiana’s toxic air is linked to low-weight and pre-term births,” The 19th, Mar 14, 2024 Read!

More evidence, as if we needed it: air pollution contributes to premature and low-weight births, stillbirths, miscarriages, complications during labor, and infertility. Louisiana’s “Cancer Alley” is home to 200 petrochemical plants and refineries. Take a wild guess as to who lives there.

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Jonathan Buonocore et al., “Climate policies to reduce motor vehicle emissions can improve children’s health, save money,” Science Daily, Mar 12, 2024 Read!

Reducing carbon dioxide (CO2) would boost children’s health (and who knows, maybe adults’ as well). “Under the most stringent cap on CO2 emissions, [researchers] estimated 58,000 avoided cases of infant mortality, preterm birth, low birth weight, autism spectrum disorder, new cases of asthma, worsened asthma symptoms, and other respiratory illnesses.” But then we wouldn’t need to spend billions on drugs to treat all those illnesses, and what would that do to “shareholder value”?

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Charlie De Mar & Adam Harrington, “Study finds 129,000 Chicago children under 6 have been exposed to lead-contaminated water,” CBS News, Mar 19, 2024 Read!

According to a JAMA Pediatrics article, 68% of Chicago’s children have been exposed to lead-contaminated drinking water. Replacing all those contaminated pipes would cost around $9 billion.

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Medicare/Medicaid

Rebecca Pifer, “CMS launches model to increase primary care investment in Medicare,” Healthcare Dive, Mar 20, 2024 Read!

Here’s a new way for Medicare to shovel cash to for-profit invaders under something called ACO Primary Care Flex: the Feds will pay (private) accountable care organizations for “infrastructure and care design,” which, apparently, they don’t have enough money to do on their own. “The new model will give primary care clinicians more flexibility to target the care of their patient populations.” That sounds nice. Why does this have to happen through for-profit scalpers who retain their perverse incentives to do as little as possible and pocket the leftovers?

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Susanna Vogel, “Hospitals could face revenue hit if insurers play hardball over MA,” Healthcare Dive, Mar 21, 2024 Read!

Here’s why the for-profit invasion of Medicare can’t work: Medicare (dis) Advantage plans are booming because they’re cheaper and offer gewgaws and sparklers like gym memberships and cash for groceries. But once you need any kind of expensive care, MA insurance companies try to stiff you. Hospitals are moving away from MA because of payment delays and hassles, and people hate prior authorization hell and claim denials. “Insurers are becoming more aggressive because MA plans have become less profitable” due to what is euphemistically called “higher medical utilization”—meaning people wanting the services they’ve been paying for. Vogel predicts that as MA profits decline, insurers “could increase claims denials, delay or deny prior-authorization for treatment, delay approving post-acute care.” In fact, it’s already happening: “Between January 2022 and July 2023, MA denials increased by 55.7%, compared with a 20.2% jump in commercial insurance denials.”

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Andy Miller & Renuka Rayasam, “Georgia’s Medicaid work requirements costing taxpayers millions despite low enrollment,” KFF Health News/Atlanta Journal-Constitution, Mar 20, 2024 Read!

“Georgia Gov. Brian Kemp’s plan for a conservative alternative to Medicaid expansion has cost taxpayers at least $26 million so far with more than 90% going toward administrative and consulting costs rather than medical care for low-income people.” And? What’s the problem with that? No lazy palookas are getting any damn free stuff from the state, so all good, right? I mean, look how generous Georgia is: you can qualify even while making $15 grand a year—IF you can prove you’re busy slinging hash at Waffle House. (But taking care of an elderly parent doesn’t count as “employment.”) Kemp’s plan is called “Georgia Pathways to Coverage,” which is accurate because being on a “pathway” means you haven’t yet and may never arrive there. It has signed up a whole 3,500 people so far in a state with over 10 million residents. Republicans hate waste and fraud, but consultants are cashing in big on the $122 million in admin costs over four years, so I guess it’s a job-creation program for middle-class professionals. Contrast that with North Carolina, which finally agreed to expansion and enrolled 380,000 beneficiaries in a few months.

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Dave Muoio, “Providers ‘wasted’ $10.6B in 2022 overturning claims denials, survey finds,” Fierce Healthcare, Mar 22, 2024 Read!

“About 15% of all medical claims submitted for reimbursement were initially denied in 2022.” Providers spent $20 billion fighting denials, half of which were later overturned. Automatic denials clog up the payment system while providing extra profits for insurance companies. A chronic offender: MA plans.

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Brett Arends, “Medicare Advantage is overbilling Medicare by 22%,” Morningstar, Mar 26, 2024 Read!

“If Joe Biden or Donald Trump or anyone else wants to know how to ‘cut’ tens of billions from the Medicare budget without taking a single nickel from seniors, an obscure government body just revealed how.” Turns out this unknown entity, the Medicare Payment Advisory Commission (MedPac), just issued a report that “Medicare spends approximately 22% more for MA enrollees than it would spend if those beneficiaries were enrolled in [traditional] Medicare.” That adds up to $83 billion a year—a tidy sum and about 10% of the entire Medicare budget. This squares with a private study that estimated the MA waste in roughly similar amounts. That’s how much private insurance companies acting as middlemen are costing the system. Why not take all that back and use it to provide the dental, vision, and other extras that MA companies use to lure the elderly to sign up for their lousy plans?

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Pharmaceuticals

A. Bers, “Good progress in litigation against Medicare drug price negotiations,” Center for Medicare Advocacy, Mar 21, 2024 Read!

Pharma goes 0 for 9 in its legal challenges to the Medicare drug price negotiation program as courts in Ohio, Delaware, and Texas rejected their lawsuits. The Ohio court recalled that Medicare is a voluntary program, so hey companies, if you don’t want to submit to price talks, just sell your products independently for whatever you wish to charge, and patients can choose to buy them. Or not. The free market is a b****!

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Casey Smith, “Indiana AG Todd Rokita files lawsuit against drug companies, PBMs over inflated insulin prices,” Indiana Capital Chronicle, Mar 20, 2024 Read!

A bright red state is suing two big Pharma firms (Novo Nordisk and Sanofi) and a slew of PBMs for price fixing of their diabetes products. “The Republican attorney general claimed that a vial of insulin costs the accused pharmaceutical companies under $2 to produce” while a diabetic in the United States spends over $5K a year on it. Indiana is home to over half a million diabetics, 12% of the adult population.

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Angela Roberts, “Baltimore sues Eli Lilly, other drugmakers for artificially inflating insulin prices,” Baltimore Sun, Mar 20, 2024 Read!

Tough regulatory action has driven down insulin prices for Medicare patients, but Baltimore wants to recoup decades of overcharges paid by its self-funded city employee plan. It’s using the anti-racketeer RICO law to do it. In the crosshairs are 18 Pharma companies whom Baltimore accuses of colluding to inflate the cost of insulin and other diabetes medications. “Eli Lilly settled a similar lawsuit with Minnesota, agreeing to give residents access to insulin for $35 per month for at least the next 5 years.”

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Maya Goldman, “States’ drug pricing boards off to a slow start,” Axios, Mar 22, 2024 Read!

Ten states have moved to control drug prices, but nothing has happened after 5 years due to political roadblocks and cumbersome regulatory processes. For example, Maryland Gov. Larry Hogan couldn’t stop the creation of his state price control board, but he vetoed its funding—clever! A Federal action would be more efficient, but states do what they can. Once the states finally determine a fair price, expect Pharma lawsuits to try to overturn it.

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Sharlin Chatlani, “Taxpayers were overcharged for patient meds. Then came the lawyers,” Stateline, Mar 21, 2024 Read!

Even when the public wins, we lose. A nationwide scam involving PBMs led to big lawsuits and hefty settlements, but they could have been larger. Politically connected lawyers moved in, controlled the terms of the deals, and walked away with over $100 million in fees. “Some observers believe [insurer] Centene would have faced stricter penalties if the federal government had taken up the case instead of private lawyers hopscotching from one state to the next.”

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Matt Stoller, “Monopoly round-up: How FTC Chair Lina Khan cut inhaler costs to $35,” BIG, Mar 25, 2024 Read!

This is a fascinatingly wonky explanation of how medical devices provide Pharma a lucrative form of legal legerdemain. Stoller notes that an inhaler sold by Boehringer Ingelheim costs $489 in the U.S. but just $7 in France. He says Pharma used legal loopholes to maintain a monopoly using “an extremely boring form of fraud” that no one in government bothered to stop until FTC Chair Lina Khan came along. Prices are dropping precipitously.

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Daniel Gilbert, “Failure of ALS drug puts a spotlight on controversial FDA approvals,” Washington Post, Mar 16, 2024 Read!

The FDA has become lax about approving drugs even when they don’t show convincing evidence of usefulness, such as in the Alzheimer’s drug Aduhelm debacle. Desperate patients want to try things, which is understandable. (The AIDS advocacy movement demanded—and won—accelerated decisions.) But there’s a difference between allowing people experimental access to unproven drugs and making the government pay tens of millions of dollars for them. This article doesn’t draw the distinction. The two youthful owners of this drug get points for not trying to hide the failure.

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Nursing homes

T. Edelman, “A model for nursing home enforcement,” Center for Medicare Advocacy, Mar 21, 2024 Read!

New Jersey kicks at least some ass on fraud in nursing homes. Why don’t others? “In January 2024, the Office of the State Comptroller (OSC) suspended several home operators from the Medicaid program, partly based on litigation by the New York State Attorney General, who accused the owners “of siphoning $83 million from nursing homes” after earlier findings of “repeated and persistent fraud.” These abuses are rampant, and such regulatory crackdowns all too rare.

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Sean Campbell & Charlene Harrington, “For-profit nursing homes are cutting corners on safety and draining resources with financial shenanigans—especially at midsize chains that dodge public scrutiny,” The Conversation, Mar 14, 2024 Read!

A lengthy and revealing horror story. Sadly, it was government support for long-term care that opened the door to nursing home grifters. Wall Street rushed into the sector shortly after the creation of Medicare and Medicaid, smelling a profit center. Acquisitions and mergers followed, and profits ballooned through reducing nursing staff and care. “Operating under weak and poorly enforced regulations with financially insignificant penalties, the for-profit sector fosters an environment where corners are frequently cut, compromising the quality of care and endangering patient health.” We saw the results during Covid as poor infection control led to 170,000 deaths in nursing facilities. When private equity shows up, the whole process is supercharged. But privatization will work just fine for traditional Medicare! What could go wrong?

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Covid

Jane Merrick, “Thousands of disabled people died after Covid treatment withheld, inquiry to probe,” iNews, Mar 22, 2024 Read!

What does this sound like? (From the U.K.) “Do Not Resuscitate notices were placed on the medical files of many people with Down’s syndrome, autism, and other learning disabilities who were otherwise healthy before contracting the virus.” A U.K. query into the pandemic practices uncovered echoes of euthanasia. Chilling.

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John-Paul Ford Rojas, “Britain is suffering its longest sick note epidemic for 25 years as 2.7 MILLION people claim they are too ill to work,” Daily Mail (U.K.), Mar 24, 2024 Read!

The youngest and oldest workers are those driving the trend of increased worker sick leave, “the longest sustained trend since the late 1990s.” Whatever could be the cause of that?

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Anthony J. Leonardi, “The attack on Long Covid: A revisionist assault,” Easy Chair, Mar 25, 2024 Read!

“This week has brought an assault on the recognition of Long Covid as an entity. It was highly coordinated and impressively so.” The author says the attempt to deny the existence of LC is convenient if officialdom isn’t planning to do much about it. His account sounds suspiciously similar to the denialists’ reaction to Chronic Fatigue Syndrome (myalgic encephalomyelitis) as hysterical females carping about headaches. Now, we know or strongly suspect that CFS/ME is viral.

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Jess McAllen, “How Covid changed nursing,” The Baffler, Mar 14, 2024 Read!

“A huge chunk of the medical workforce, reeling in the aftermath of the relentless death and suffering they were exposed to on the job, either retired or switched careers completely.” But the pandemic also catalyzed a historic wave of organizing among nurses and strikes over staffing levels, pay, and burnout. An example: “Last year, Vassar [Brothers Medical Center] hired 158 nurses, and 124 of them left.” We hear a lot about a supposed nursing shortage, but that sounds like a retention issue—possibly related to keeping floors understaffed and nurses overworked.

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SINGLE PAYER LINKS #340

Posted 22 MAR 2024

This week: CDC says “Relax!” on all that Covid stuff; 18 million Americans have lingering symptoms, but oh well; The Hack that shut down medical billing and could bankrupt clinics; Medicaid follies; the PE vultures and corporatization of healthcare; and lo and behold a spot of potentially good news, glory be. Have a listen if you prefer: LISTEN TO PODCAST!

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Covid

Amy Maxmen, “Health workers fear it’s profits before protection as CDC revisits airborne transmission,” KFF Health News/NBC News, Mar 19, 2024 Read!

A nurse about the early days of Covid: “We were watching patients die and being told we didn’t need a high level of protection. Nurses were going home to their elderly parents, transmitting covid to their families. It was awful.” More than 3,600 died in the first year. The CDC chiefs said not to worry; they still do. In its final draft recommendations for Covid precautions, the agency downplays masking and defers to hospitals to decide what’s safe.

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Sara Moniuszko & Michael George, “Up to 5.8 million kids have long COVID, study says. One mother discusses the ‘heartbreaking’ search for answers,” CBS News, Mar 15, 2024 Read!

About a third of children who get Covid still have symptoms a year later. “Long Covid can raise the chances of a child developing type 1 diabetes.”

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Melody Schreiber, “‘Alarming’ rise in Americans with long Covid symptoms,” The Guardian, Mar 15, 2024 Read!

Alarming to whom? The CDC is about as relaxed as one can be while their own data shows 18m people could be have it, 7% of the entire U.S. adult population. One expert opined: “Nobody knows what long Covid will do 5 years from now. I don’t think it’s wise to throw all caution to the wind.” Scaredy-cats! Back to work, everyone!

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Rachel Beale, “Long Covid, with no treatment in sight, took my life as I knew it,” USA Today, Mar 15, 2024 Read!

“Before long COVID, I was active and healthy. I put myself through college, earned an MBA at night, and pursued a career in human resources. I loved my job.” Long Covid ended all that. “It was normal for me to go to school assemblies or shuttle my kids to their school activities after a full day of work, but now I need to plan to get as much rest as possible so that I can cheer on my kids. I used to work out every day, but now I need oxygen to catch my breath after a long conversation.” Very sad and all too common.

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Jeffrey D. Sachs, “What might the U.S. owe the world for Covid-19?” Common Dreams, Mar 16, 2024 Read!

Sachs marshals the evidence favoring the lab-leak theory. He doesn’t quite call it an established fact, but says a “vast amount of information” points to a lab origin and calls it “the most significant case of governmental gross negligence in history.” What he does considers entirely proven is this. After the outbreak, “the U.S. government lied in order to cover up its possible role.” What’s novel in Sachs’ account is how the NIH hosted “extensive research on potential pathogens for biowarfare and biodefense” for 20 years—which might explain the cover-up. Fun fact: one of the leading opponents of the research was Trump’s CDC appointee, Dr. Robert Redfield. Essential reading in full—also, note the tiny, alternative outlet where Sachs was forced to publish his exposé. A mainstream vehicle wouldn’t dare touch it.

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Jocelyn Kaiser, “‘Lab-leak’ proponents at Rutgers accused of defaming and intimidating COVID-19 origin researchers,” Science, Mar 15, 2024 Read!

The rhetoric by lab-leak theory backers (calling their rivals fraudsters, liars, perjurers, etc.) is arguably defamatory. So, will we see a courtroom trial including discovery of all sorts of juicy documents to review whether they are indeed liars and fraudsters? Unlikely. Much safer to ask for an internal university crackdown instead.

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Privatization

Pat Garofalo, “Oh so close to tackling the corporatization of medical care,” Boondoggle, Mar 12, 2024 Read!

In theory, 33 states prohibit the “corporate practice of medicine” to ensure that doctors are calling the shots instead of Wall Street bankers. But loopholes large enough to drive a loaded Brinks through enable private equity managers to do exactly that. Oregon almost managed to correct the situation, but lobbyists (Amazon, UnitedHealth) mobilized, and the corporates escaped. But it was a close call. The author notes that “health care reform has focused almost exclusively on cost containment and expanding insurance access—but [doesn’t] anything to fix the increasing corruption of the very plumbing of the health care system.” The PE invasion of healthcare took off in the last decade during which “corporate investment in primary medical care rose from $15 million to $16 billion, with a b.”

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Susanna Vogel, “For-profit hospital operators bet on outpatient services, expense reductions in 2023,” Healthcare Dive, Mar 12, 2024 Read!

Three of the four biggest for-profit chains made money in 2023 “on strong demand for outpatient services and rebounding investments.” They’re expanding ambulatory services as a more lucrative sector than admitting patients to their hospitals because it has lower overhead and needs fewer staff and less equipment. Also, “the decision is partially attributed to a change in Medicare reimbursements.”

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Harris Meyer, “Concerns grow over quality of care as investor groups buy not-for-profit nursing homes,” KFF Health News/Fortune, Mar 13, 2024 Read!

These horror stories are so consistent they write themselves. What are the regulators waiting for? “For-profit groups own about 72% of the roughly 15,000 nursing homes in the United States,” and “the type of for-profit companies that own these facilities has shifted toward private equity.”

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The Hack

Tina Reed, “Health care providers losing up to $1B a day from cyberattack,” Axios, Mar 11, 2024 Read!

“Hospitals, pharmacies, doctors, medical equipment vendors, and others could spend weeks or months sorting out patient eligibility, filing claims, and paying additional staff to handle the extra administrative burden.” It’s chaos after one payments management company was allowed to roll up one-third of all medical billing transactions in the entire country—to achieve “efficiency.” Getting things back online won’t solve everything: “Once the funds start flowing again, a significant amount of money due won’t actually be paid out because of paperwork errors and lack of prior authorizations.”

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Emily Olsen, “CMS releases Medicaid payment flexibilities during Change cyberattack,” Healthcare Dive, Mar 18, 2024 Read!

The American Hospital Association says 94% of hospitals in the U.S. reported a financial impact from the outage resulting from the cyberattack. The problems include interruption of insurance payments, confirmation of a patient’s coverage, prior authorization requests, and clinical record sharing.

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John Tozzi, Ike Swetlitz & Riley Griffin, “Cancer clinics face cash crunch after hack rocks U.S. health care,” Bloomberg, Mar 13, 2024 Read!

“Doctors across the U.S. are stretching to keep their practices afloat as a debilitating cyberattack on a once little-known company at the center of the health-care system continues to cause havoc.” Some of the most vulnerable companies are those clinics that infuse cancer patients with chemotherapies and “count on timely insurance payments to cover their drug purchases.” Crazy fun fact: the affected company, Change, processes $2 trillion worth of health-care claims annually. How did we get here? Change rolled up its competitors and turned itself into a payments Godzilla “reaching into every corner of the US health-care system.” PE was also involved, of course. A former employee said “there was little coherent strategy behind Change’s acquisitions.” Then, waves of layoffs contributed to a toxic culture. DoJ tried to stop the UnitedHealth buyout of Change, saying it would “put too much data about customers and competitors in the hands of UH. A federal judge disagreed and waved it through. Wired magazine claims that UH paid off the hackers with $22 million in bitcoin.

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Medicaid (non-)expansion/Medicare

Jackie Llano, “Florida set to spend $1.5 billion in variety of health care programs; Here’s where the funds would go,” Florida Phoenix, Mar 14, 2024 Read!

Instead of expanding Medicaid and getting a flood of Federal cash, Florida plans to spend $1.5 billion of its own money on a variety of patches. Approximately 61% of the funds earmarked in [one of the package’s bills] would go toward increasing the reimbursement rate service providers receive for Medicaid patients.” What percentage of that would have been supplied by the Feds under expanded Medicaid? This sounds nuts, but apparently ideology reigns supreme in the Sunshine State.

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Emily Wagster Pettus, “Mississippi has the nation’s worst infant mortality. It will allow earlier Medicaid to help babies,” Associated Press, Mar 13, 2024 Read!

Mississippi won’t expand Medicaid dadgummit, but now will allow 60 days of outpatient care for a pregnant woman’s care while her application is pending.

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Julia Johnson, “Sen. Braun demands full audit of Medicare after massive fraud discovery,” Fox News, March 13, 2024 Read!

Looks like a GOP campaign to discredit Medicare, but then again letting massive frauds take place does a pretty good job of that without any Republicans. An opening salvo in a letter from three R senators says that Medicare has an increasing tendency to be targeted by “highly sophisticated fraud schemes, including online phishing, data breaches, and international fraud rings.” Hard to argue with that. Now, will these same guys encourage HHS to crack down on the equally costly Medicare Advantage scam? Unlikely.

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Rebecca Pifer, “Government watchdog warns of Medicaid oversight gaps,” Healthcare Dive, Mar 18, 2024 Read!

The GAO (the federal auditor) states the obvious: Medicaid managed care has a built-in care-denial incentive because private insurance companies get a flat rate per enrollee. Therefore, the less they spend on services, the more they get to keep. This is not hard. The only balancing factor would be regulatory oversight, but a new GAO report points out that Medicaid doesn’t even require states to provide full information on outcomes or care denials and doesn’t analyze the data it does have. That’s because Medicaid serves poor people, and there are no cushy private-sector jobs to be had by being a tough regulator. Just my lay opinion!

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Vaccines

John Parkinson, “Measles cases are being reported: Are we losing our herd immunity?” Infection Control Today, Mar 4, 2024 Read!

Maybe. A measles patient is contagious for 21 days, and “if you put a person with measles in a room with 10 [unvaccinated, previously unexposed] people, nine of them will also get the disease.” Sixteen states now have outbreaks.

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Paul Law, “No parent who has seen the children I’ve treated for measles would refuse a vaccine,” STAT, Mar 12, 2024 Read!

“In the final stages, little lungs, filled with fluid and racked with inflammation, struggle for oxygen. The victims breathe faster and faster, gasping for air until, exhausted, they stop.” The author grew up and now lives in the Congo (Kinshasa) where nobody turns down a measles vaccine since they don’t enjoy the blessings of internet memes. Five hundred children died of measles in his province last year.

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Drug prices

Noah Tong, “Breaking down Biden's $7.3T proposed budget for 2025: Here are his top health priorities,” Fierce Healthcare, Mar 11, 2024 Read!

The Biden budget says all sorts of nice things, like how we should boost Medicare’s finances with a tax hike on upper incomes. What’s the chance of that happening? Perhaps the most likely proposal to actually get somewhere is the idea of subjecting more government-reimbursed drugs to price negotiations.

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Lynn Parramore, “Negotiating Big Pharma’s prices won’t stifle innovation—they don’t use the money to innovate!” Institute for New Economic Thinking, Mar 14, 2024 Read!

The Pharma propaganda: don’t control our prices because we need all that loot to research new products! Four Pinocchios: Pharma snaps up rights on drugs that the Feds already paid to develop. The top 25 companies now don’t bother with finding new drugs when they can use their huge profits to pay for products already in the pipeline. Then, once they have a blockbuster, it’s time for stock buybacks—instead of new R&D. Ironically, this leaves the Pharma giants fragile and exposed once their big patents run out since they’ve starved their internal R&D.

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April Dembosky, “A new postpartum depression drug is here. How will insurers handle it?” KQED/KFF Health News, Mar 12, 2024 Read!

Zuranolone is supposed to block PPD by targeting hormone function, but it costs $16,000 for a 2-week regimen. The article casts the problem as insurers placing unreasonable obstacles to access but never asks the obvious question: Why is the price set so high?

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Julie Appleby, “When copay assistance backfires on patients,” KFF Health News, Mar 15, 2024 Read!

Here’s another perverse twist: Pharma companies sometimes provide “copay assistance,” a subsidy to patients taking one of their expensive drugs. It’s a dubious practice because it makes the burden on an individual lighter while sticking the insurer with a big payout. But some patients who could apply that subsidy toward their deductible now can’t do that. “Insurers and employers have long complained that copay assistance programs are mainly a marketing ploy by the drug industry that encourages patients to stay on costly drugs when lower-cost alternatives might be available.” The whole thing is a complex mess that obscures the fact that Pharma slaps insane prices on its products, and we’ve forced to pay them.

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Nada Hassanein, “New way for states to cover pricey gene therapies will start with sickle cell disease,” Stateline, Mar 14, 2024 Read!

A set of eye-poppingly expensive drugs are emerging to treat sickle cell anemia. We’re talking up to $3 million per patient—so how to pay for that given the estimated 100,000 people with sickle cell in the U.S.? Some states are getting discounts in exchange for guaranteeing wider coverage. Once again, amid all the talk about access and racial equity, no one is asking why these treatments are priced in the stratosphere. They just are.

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Kenneth Mendez, “Backward drug industry incentives are hurting asthma patients,” Boston Globe, Mar 11, 2024 Read!

More cray-cray: “Flovent’s price odyssey shows how making a medicine cheaper in America’s convoluted drug marketplace can make medicines less accessible.” How can this be? The expensive Flovent will be replaced with a lower-cost alternative, but that knocks it off an insurer’s formulary and forces patients to pay for it themselves. The system pays a lot less, but individuals take the hit.

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Dave Muoio, “Health spending spikes in Massachusetts amid high drug expenses, unprecedented patient cost sharing, regulator warns,” Fierce Healthcare, Mar 15, 2024 Read!

Massachusetts spends more per resident on healthcare than the national average, and it’s getting worse. The culprit: drugs. “Pharmacy has been the biggest contributor to health care spending growth for several years.”

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Anomaly

Patrick Sisson, “In hospitals, affordable housing gets the long-term investor it needs,” New York Times, Mar 12, 2024 Read!

Kinda weird but at least better than stock buybacks: Some healthcare systems are joining forces with social housing developers to create a healthier patient base. It’s not all charity-inspired: “Managed care groups benefit financially from healthier populations.” Nonprofit hospitals also get credits toward their required givebacks that justify tax exemptions. Also, nearby housing units can be occupied by staff, which could be important given ongoing staffing problems. Hospitals often own properties that can be used as building sites. Interesting!

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SINGLE PAYER LINKS #339

Posted 15 MAR 2024

This week: regulatory moves to rein in the PE invasion of healthcare; more on the big UnitedHealth hack and its aftermath; apologetics (not apologies) for the Covid debacle; and a raft of other topics. LISTEN TO PODCAST!

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Private equity

Susanna Vogel, “Federal government probes healthcare private equity deals,” Healthcare Dive, Mar 6, 2024 Read!

The FTC rides to the bugles once again, this time joined not only by allies at DoJ but also Health & Human Services, which supervises Medicare/Medicaid. They will look at how the PE invasion and “corporate consolidation in healthcare” affect care quality, worker safety, and costs. Targets: PE takeovers of dialysis clinics, nursing homes, hospitals, hospices, primary care, and home health agencies. They should act fast: there were almost 800 PE deals last year.

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Faegre Drinker Biddle & Reath LLP, “Antitrust scrutiny of private equity in health care intensifies,” JD Supra, Mar 8, 2024 Read!

A law firm reports on the government antitrust enforcement move and notes one important change: blocking “serial roll-ups” in which a PE firm avoids scrutiny of individual acquisitions by keeping the dollar figure under an artificial threshold. States are also waking up: California may require PE firms to get approval before buying a physician group or other health facility.

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Dan Primack, ““Hospital debacle puts focus on private equity,” Axios, Mar 6, 2024 Read!

“When Cerberus Capital Management bought an unprofitable Massachusetts hospital chain in 2010, many viewed the deal as a financial lifeline. Now some believe it was actually a noose.” That pretty much sums up the PE playbook. The details are so familiar they’re hardly worth repeating, but the PE invasion in this case meant what it always means: extract value, then leave behind a rotting corpse. In this case, Cerberus pulled out $800 million before dumping everything on the state of Massachusetts.

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State action

Anna Claire Vollers, “Facing public backlash, some health care companies are abandoning hospital deals,” Stateline, Mar 11, 2024 Read!

Federal regulators are awake and surprisingly vigorous—but late. States are also getting into the act, “in some cases derailing deals [mergers] they think don’t serve the public interest.” Places where acquisitions have fizzled: Louisiana, Connecticut, and especially Minnesota where the state legislature strengthened oversight of hospital deals.

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Nancy Lavin, “Rhode Island’s health care system is sick. The State Senate has a 25-bill prescription,” Rhode Island Current, Mar 5, 2024 Read!

States are increasingly active in trying to repair the mess. Rhode Island’s HEALTH (Holistic Enhancement and Access Legislation for Total Health) bill includes consumer protections on medical debt and measures to boost and retain the workforce (hint: pay increases) and to control prescription drug costs.

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Seth Tupper, “Medicaid work requirement question will appear on South Dakota ballots in November,” South Dakota Searchlight, Feb 27, 2024 Read!

The state reluctantly is getting around to expanding Medicaid, but just to be sure no lazy palookas think they deserve free stuff, the legislature wants to make sure beneficiaries are busy slinging hash at Waffle House.

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Anna Maria Barry-Jester, “Syphilis is killing babies. The U.S. government is failing to stop the disease from spreading,” ProPublica, Mar 4, 2024 Read!

Pfizer has been the monopoly provider of syphilis antibiotics for two decades after it bought out the other two—what could go wrong? Well, everything. “Across the country, physicians, clinic staff, and public health experts say that the shortage is preventing them from reining in a surge of syphilis and that the federal government is downplaying the crisis. This emergency was predictable: There have been shortages of this drug in 8 of the last 20 years.” Syphilis infections are spiking everywhere, but South Dakota had the highest rates, including a more than 400% increase among pregnant women. But before we treat them, are they or are they not holding down those jobs at Waffle House?? State legislators want to know.

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Shaun Boyd, “Colorado bill would require insurers and Medicaid to cover weight loss drugs like Wegovy,” CBS News, Mar 6, 2024 Read!

A conundrum: how do our governments provide needed treatments to people while prohibited from negotiating how much they cost? At a thousand a month for the fat shots times millions of obese Americans, we’re staring at pharmaceutical bankruptcy.

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Carmen Sesin, “Florida’s Medicaid call center’s wait times, disconnection rates are hindering health care access, study warns,” NBC News, Mar 7, 2024 Read!

Eight out of 10 calls to the Medicaid call center in Florida were automatically disconnected before callers reached a human being, according to a Hispanic advocacy group. These are people trying to renew their coverage in a state that has kicked 1 million people off the rolls in the last year. “For Florida families who rely on hourly wages to make ends meet, spending hours just to connect is a costly proposition.” That’s a feature, not a bug.

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The Hack

Emily Olsen, “Change Healthcare faces potential class action as lawsuits rack up,” Healthcare Dive, Mar 7, 2024 Read!

The huge medical records hack that affected one third of everyone in the U.S. is going to cost UnitedHealth some coin—let’s hope. Those affected: people who couldn’t get their meds, providers who couldn’t meet payroll, and—if the shutdown lasts much longer—bankruptcies.

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American Hospital Association, “AHA expresses concerns with UHG program in response to cyberattack on Change Healthcare,” Mar 4, 2024 Read!

The hospital trade association told UHG their loan offers to help providers crushed by the hack are “not even a band-aid on the payment problems.” UHG’s punishing terms for a cash lifeline included allowing their affiliate “access to past, current and future claims payment data” and a liability waiver. Not happening. Meanwhile, UnitedHealth Group racked up a tidy $22 billion in profit in 2023.

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Covid

Ashish K. Jha, “The CDC’s new, relaxed Covid isolation guidance makes perfect sense,” STAT, Mar 6, 2024 Read!

Reasonable sounding and nefarious. “With nearly everyone in the U.S. having some degree of immunity against the virus (infected or vaccinated or both), the consequences of infection in 2024 are just very different for the majority.” Maybe, maybe not—Jha completely ignores the dangers of repeated infections for long Covid. He does nail one thing: “Public health guidance has been confusing during the pandemic.” Yes, because people like him swore to things they either didn’t know or knew to be false.

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Star-Ledger Editorial Board, “We ignored AIDS. Let’s not repeat the mistake on long COVID,” NJ.com, Mar 10, 2024 Read!

“America ignored the [AIDS] problem even though people were dropping dead by the thousands. We’re repeating the mistake now with long COVID. The government has largely turned its back.” The editors note the “paltry” $129 million annual research spending on long Covid versus the Operation Warp Speed crash program for a vaccine. “America isn’t seeing the full effects of this because so many people with long COVID are homebound.” The estimated 4 million people seriously affected “have disappeared from their active lives like ghosts, and for the most part, nobody noticed.”

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Medical debt

Health Care for All New York has a useful handout that can be downloaded here:

Read!

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Staffing

Bonnie Castillo, “We won’t let them ban our stories,” National Nurses United, Feb 23, 2024 Read!

“There is no shortage of nurses, just a shortage of nurses willing to work in a dangerous environment,” says the head of NNU, referring to the 1.3 million RNs not currently employed in the field. “The truth is that for decades—long before Covid—huge numbers of nurses have been actively driven away from the profession by their employers due to unsafe working conditions. Covid just amplified the abysmal conditions.”

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Keith M. Phaneuf, “Lamont negotiates big pay hike for CT home health aides,” CT Mirror, Mar 5, 2024 Read!

Connecticut stumbled upon an Invisible Hand that causes supply to increase when buyers become willing to spend more on a product—in this case, labor. Home health aide wages would reach $23 per hour in the next two years under the governor’s proposal in an industry that suffers 20% staff turnover per year. Amazing discovery! Give Governor Lamont the Nobel in Economics!

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Hospitals

Peter Sullivan, “Hospitals and PBMs seem to have dodged big federal reforms—for now,” Axios, Mar 5, 2024 Read!

“The combination of industry lobbying and dysfunction in Congress have conspired to stop anything from happening” on regulating PBMs or curbing hospital pricing abuses. Both remain untouched as the budget fight winds down. Even a pathetic effort to “improve transparency by requiring hospitals to disclose prices” got the axe in the budget squabble. That’s why big talk in things like the SOTU performance should never be taken too seriously—when the sausage eventually gets made, the big players usually dictate what goes into it.

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Jazmin Orozco Rodriguez, “Operating in the red: Half of rural hospitals lose money as many cut services,” KFF Health News, Mar 7, 2024 Read!

Half of rural hospitals lost money in the past year, leaving many “vulnerable to closure.” Question: Why does a rural hospital have to break even? Is a fire department expected to make a profit? Leaders in Montana credit Medicaid expansion 10 years ago as the reason not one hospital in that state has closed since 2015. Duh. Another big problem: “The rapid growth of rural enrollment in Medicare Advantage plans” because they don’t pay as well or as quickly as traditional Medicare.

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Pharmaceuticals

Lindsey Leake, “Mark Cuban’s $141K mistake: The Cost Plus Drugs cofounder says CEOs don’t understand health care coverage, and it’s costing them big,” Fortune, Mar 8, 2024 Read!

“If you’re using a Big Three PBM, you are getting ripped off,” Cuban tells Fortune. “Period. End of story.” Cuban, owner of the Dallas Mavericks, dumped PBMs and shifted drug purchases to a payment manager that passed rebates and discounts back to the client, i.e., his company. No brainer.

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Rebecca Pifer, “Community Health Systems to buy drugs from Mark Cuban Cost Plus,” Healthcare Dive, Mar 8, 2024 Read!

Cuban’s initiative is successfully poaching companies from the Big 3 PBM oligopoly, including a major coup when Blue Shield of California, one of the largest insurers in the state, inked a deal. CHS is another biggie: 70 hospitals and a 15-state outpatient network. Cost Plus buys from Pharma directly, cutting out the PBMs.

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Environment

Alexa Lee, “Girls are starting puberty earlier than ever. For some, that comes with major mental health risks,” STAT, Mar 7, 2024 Read!

Why are very young girls all over the world getting premature breast development and early menarche? One theory: endocrine-disrupting chemicals found in everyday items such as plastic packaging, beauty products, pesticides, furniture, and electronics. Also, childhood obesity, “which may be linked to earlier pubertal development in girls and delayed puberty in boys.”

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Nancy Lapid, “Plastic lodged in arteries may be linked to higher risk of heart disease and death,” Reuters, Mar 6, 2024 Read!

“Minuscule pieces of plastic lodged in the fatty deposits that line human arteries may be linked with higher risks for heart disease, strokes, and death.” And not just a little higher: a 4.5 times greater risk of experiencing a heart attack or stroke or dying. Said one researcher: “The low cost and convenience of plastics are deceptive.” But to see that, we would need a long-range point of view not tied to the quarterly profit reports.

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The Swamp

David Hilzenrath, “VIP health system for top U.S. officials risked jeopardizing care for soldiers,” KFF Health News/USA Today, Mar 8, 2024 Read!

There is something profoundly corrupt in the way the powerful think the rules don’t apply to them. Of course, they’re right—they don’t. “Top U.S. officials in the Washington area have received preferential treatment from a little-known health care program run by the military, potentially jeopardizing care for active-duty service members. The Washington elite could jump the line when filling prescriptions, book appointments through special call centers, and receive choice parking spots and escorts at military hospitals and other facilities.” Thank you for your service! Now, dear grunts, step aside.

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Jacob Bell, “Amylyx ALS drug fails crucial study, putting company’s future in doubt,” Biopharma Dive, Mar 8, 2024 Read!

Here’s an approved drug that top FDA advisors were dubious about. They were right. The drug’s owners, to their credit, didn’t try to fake the clinical trial outcomes and admitted that it had flopped. The FDA had given it the go-ahead “after receiving intense backlash from ALS patients and advocates.” (Couldn’t this be done under “compassionate use” without approving a drug for the market? Expert readers, please clarify!) The company pledged to withdraw the drug if it didn’t pass muster—let’s see if they do.

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Privatization

Cory Doctorow, “Palantir’s NHS-stealing big lie,” Pluralistic, Mar 8, 2024 Read!id="rcorners1" class="button" style="background-color: #009922; padding: 0px 15px;">Read!

Spyware firm extraordinaire Palantir wants access to the British National Health Service’s massive database. Palantir, we should note, is “a notorious human-rights abuser and supplier to the world's most disgusting authoritarian regimes,” founded by 10-billionaire libertarian Peter Thiel. Thiel’s Tory buddies will crow in unison “There is no alternative” to handing over the keys to private interests, but Doctorow points out that there is a patient-protecting alternative for deploying the data for research: a software called “Opensafely” that allows researchers to program its queries and extract aggregate data without ever accessing the raw files. The method has been “wildly successful: in just months, Opensafely collaborators published 60 blockbuster papers in Nature. But our overlords will insist that oligarchs like Thiel should be awarded this goldmine instead.

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SINGLE PAYER LINKS #338

Posted 8 MAR 2024

Lots this week on the UnitedHealth cyberattack and why we can expect more of the same; new CDC guidelines on Covid (Relax and Sneeze!); and why Medicare Advantage is bad for investors, not just its victims. LISTEN TO PODCAST!

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Healthcare Godzillas

Rebecca Pifer, “Walgreens to close VillageMD clinics in Florida,” Healthcare Dive, Feb 22, 2024 Read! and Emily Olsen, “Walgreens’ VillageMD to exit Illinois,” Healthcare Dive, Mar 1, 2024 Read!

Not all the new healthcare mutant turtles are doing so well. Walgreens is exiting its primary care presence in two states and shuttering hundreds of retail locations, all while watching its stock price sink. Walgreens, like CVS, tried to load up with a variety of direct health services to capitalize on the pharmacy customer base. Doesn’t seem to be working. Also, it still faces costly claims over its role in the opioid epidemic.

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Cyberattack

Darius Tahir, “Hacking at UnitedHealth unit cripples a swatch of the U.S. health system: What to know,” KFF Health News/CBS News, Mar 1, 2024 Read!

and James Rundle, Catherine Stupp & Kim S. Nash, “Medical providers fight to survive after Change Healthcare hack,” Wall Street Journal, Mar 1, 2024 Read!

Something important and dangerous happened at the country’s largest health insurance company: a successful hack of its affiliate handling 14 billion (with a “b”) payments per year for over 200 million individuals. Smaller providers could be wiped out over reimbursement delays. (A week without cash flow is a long time.) UH is also under DoJ investigation on antitrust grounds—this won’t help. According to one follow-up article, Bitcoin transaction records suggest that UH already paid a hefty ransom.

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Elise Takahama, “Why health care has become a top target for cybercriminals,” Seattle Times/Tribune News Service, Mar 1, 2024 Read!

Health systems are a juicy target for cybercriminals given the massive amount of patient data they handle, including medical records, financial information, Social Security numbers, names, and addresses, and insurance details. They’re also open 24/7 and have less tolerance for disruptions, making them more likely to pay a ransom. The data of more than 88 million people was exposed in the first 10 months of 2023. “A compromised credit card sells for about $1 to $5 each, [but] a compromised medical record can sell anywhere from $400 to $500.”

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Nicole Sganga & Andres Triay, “Cyberattack on UnitedHealth still impacting prescription access: ‘These are threats to life,’” CBS News, Feb 29, 2024 Read!

Havoc reined while the hackers controlled the payment and prescription system. “This cyberattack has affected every hospital in the country one way or another.”

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Maureen Tkacik, “Zoomer hackers shut down the biggest extortion ring of all,” American Prospect, Mar 1, 2024 Read!

“A ransomware gang cripples UnitedHealthcare. Could a comprehensive antitrust investigation finish the job?” We can dream anyway. This is a thorough description of the Pharmacy Benefit Manager version of organized crime and how it made the hack so much worse. “There’s a whole legalized extortion ring that small pharmacies need to pay off to access Medicare and Medicaid funds, a symptom of the middleman creep in the pharmaceutical transaction chain.” Now that they’re slaves to the PBMs, pharmacies can’t defend themselves against hacks. Smaller payers were all hoovered up in a classic mass aggregation/monopoly move; then, UH bought the whole package. The DoJ tried and failed to block UH’s acquisition—a judge believed UH’s claim to be creating new “efficiencies.” Yeah, efficiently vulnerable to a single hack team.

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Wendell Potter, “UnitedHealth Group: Vulnerable and ill-equipped to defend against modern threats like cyberattacks,” Healthcare Un-covered, Mar 5, 2024 Read!

“The cyberattack against UnitedHealth’s Change Healthcare unit highlights the inherent risk of consolidating vast amounts of patient and health care provider data under a handful of corporate entities.”

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Susanna Vogel, “Kaiser lays off IT workers for a second time in 4 months,” Healthcare Dive, Mar 5, 2024 Read!

And right on cue, California-based hospital conglomerate Kaiser announces that it will weaken its IT security by laying off dozens of tech workers. This is described in the article as “a bid to increase efficiencies—and cut costs.” No sense of irony there. Four months ago, Kaiser slashed over 100 more IT jobs, so get ready for the cyberattack on that outfit. And why does Kaiser need to cut costs? It only made $4 billion last year in what is euphemistically called “net income” (nonprofits don’t make “profits”). Conclusion: the theft of our sensitive medical and financial information is built in and anticipated.

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Hospitals, medical debt

Noam N. Levey, “With medical debt burdening millions, a financial regulator steps in to help,” KFF Health News/NPR, Mar 1, 2024 Read!

The Consumer Financial Protection Bureau (CFPB) was created in 2010 in the wake of the financial crisis as a sop to the millions of foreclosed homeowners who got bupkis from Obama. “Since then, the CFPB has done its share of policing mortgage brokers, student loan companies, and banks” and is now adding hospitals, nursing homes, and patient financing companies to the list. Howls of outrage predictably followed from the collections industry owners—who provide succulent campaign donations.

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The Lancet, [editorial] “What has the impact been of privatisation on the quality of care? Does competition work in this arena?” March 2024 Read!

“We found that hospitals converting from public to private ownership status tended to make higher profits than public hospitals that do not convert, primarily through the selective intake of patients and reductions to staff numbers. We also found that aggregate increases in privatisation frequently corresponded with worse health outcomes for patients.” Understatement du jour: “The profit motive might not always result in desired outcomes.” Debunks the standard theoretical arguments for encouraging market forces to nose their way into medicine.

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Susanna Vogel, “Northwell Health, Nuvance Health to merge,” Healthcare Dive, Feb 29, 2024 Read!

New York-based Northwell is set to grow even larger by moving into Connecticut’s Nuvance Health to create a 28-hospital health system with 14,500 providers. As often happens in the run-up to a hospital merger, Nuvance is in the red while Northwell is not.

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Nia Clark, “Some UnitedHealthcare members lose Mount Sinai coverage,” Spectrum/NY1, Mar 1, 2024 Read!

A hospital and an insurer slug it out in negotiations, can’t agree; 100K patients end up dumped. “Patients with United and Oxford health plans will no longer be part of Mount Sinai Hospital's network beginning March 1, 2024 after the hospital system and the healthcare company could not reach an agreement over reimbursement rates.” May not be final as walking away is sometimes a negotiating tactic. This squabble illustrates the logic of everyone involved trying to merge into the most bloated corporate entity possible given the need to square off against the sumo wrestlers on the other side.

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Julie Appleby & Phil Galewitz, “America worries about health costs—and voters want to hear from Biden and Republicans,” KFF Health News/CBS News, Mar 4, 2024 Read!

New poll: “health care tops the list of basic expenses Americans worry about—more than gas, food, and rent.” Costs for employer-sponsored insurance have reached new highs—weight-lost drugs are partly responsible. The article says commercial Obamacare plans are more “popular” now, which is hard to claim given that most buyers have no choice.

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Christopher T. Su & Scott D. Ramsey, “Medical debt—an iatrogenic epidemic with mortal consequences,” JAMA, Mar 4, 2024 Read!

“If medical debt were a chronic illness, it would be more common than coronary artery disease, diabetes, or cancer. But is it deadly?” The article describes a study that found a “statistically and clinically significant” association between levels of medical debt and [negative] outcomes. Medical debt is “not simply an economic issue but a public health crisis with morbid and mortal consequences.”

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Preventive health

Nada Hassanein, “States consider menthol cigarette bans as feds delay action,” Stateline, Feb 29, 2024 Read!

About 80% of Black smokers use menthol cigarettes, which is not an accident. “The marketing of Kool and Newport brand menthol cigarettes to Black people began gaining ground in the 1950s and included focused advertising and corporate sponsorships of events popular in Black communities, such as jazz concerts.” The industry playbook now is to get astroturf organizations to denounce banning menthol as racist.

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Monopoly

Joshua Mezrich, “Too many donor organs go to waste. Here’s how to get them into the patients who need them,” STAT, Mar 2, 2024 Read!

Incredible but true: thousands of hearts, lungs, livers, and kidneys are thrown out every year. The culprit, once again: monopoly. “The two groups that have faced the most blame for this situation are the Organ Procurement and Transplantation Network (OPTN), a government body, and the private nonprofit United Network for Organ Sharing (UNOS).” Congress recently passed a bill to break up UNOS. Over 100,000 people are awaiting kidney transplants alone.

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Drug prices

Dori Abel, “Insurers’ rules for expensive drugs are hurting doctors and patients,” Philadelphia Inquirer, Feb 28, 2024 Read!

Prior authorization hell: “Physicians and our staff spend an average of 14 hours each week completing them.” Each?

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Brian Platt & Laura Dhillon Kane, “Trudeau introduces bill on national drug coverage program,” Bloomberg, Feb 29, 2024 Read!

Canadians show signs of civilization in the healthcare arena, at least when they’re not staging celebrations for Nazis. “The government will start negotiations with provinces to provide universal, single-payer coverage for a number of contraception and diabetes medications.”

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Nursing homes

Andrew Jacobs, “Nursing home staffing shortages and other problems persist, report says,” New York Times, Feb 29, 2024 Read!

Staffing shortages in care homes are “monumental” due to high levels of burnout, frequent employee turnover, “and the burdens of constantly training new employees, some of whom fail to show up for their first day of work.” Hmm, I wonder some sort of Invisible Hand might work to make the jobs more attractive.

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Jacob Barker & Annika Merrilees, “Owners of shuttered St. Louis nursing home kept paying themselves as money dwindled,” St Louis Today, Mar 4, 2024 Read!

Nursing homes seem to attract all kinds of crooks. “In the years leading up to the chaotic closure of the Northview Village Nursing Home, revenues fell and resident counts dropped. Still, the owners of the north St. Louis nursing home, the largest in the city, were sending at least $1.5 million annually in rent and other payments to their companies.” The shutdown came with a few hours’ notice and left 174 patients shuttled to other sites without informing relatives. “One resident was lost on the streets for weeks.” But the owners extracted their dough right up to the collapse. Nice bunch.

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Medicare/Medicaid

Maya Goldman, “Why Medicare is adding prior authorization requirements as others cut back,” Axios, Mar 1, 2024 Read!

Medicare doesn’t engage in the prior authorization game generally as it’s not a profit-making entity. But fraud is a problem, so Medicare is slowing down approval of procedures at “certain outpatient surgical facilities that have seen a sharp uptick in billings.”

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Anne Blythe, “Dentists lobby for higher Medicaid reimbursement rates,” North Carolina Health News, Feb 28, 2024 Read!

North Carolina finally expanded Medicaid to a larger pool of low-income residents, which unleashed a predictable flood of new demand. Now, the state has to grapple with Medicaid’s insanely low reimbursement rates for dental work. Result: many NC dentists won’t take the new patients. Bad teeth is a notorious marker of income here, as in any underdeveloped country.

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Wendell Potter & Philip Verhoef, “Medicare Advantage is bad for patients and bad for investors,” STAT, Feb 28, 2024 Read!

The big Disadvantage isn’t just that for the patient-victims but also is starting to hit investors. Potter, a former insurance executive, notes that some hospitals are “refusing to accept MA at all, citing low reimbursement rates and excessive prior authorization as heavily burdensome to their work.” He says the MA model is in “serious jeopardy” as the government reins in abuses. From your lips to God’s ear.

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Tony Leys, “Without Medicare Part B’s shield, patient’s family owes $81,000 for a single air-ambulance flight,” KFF Health News/NPR, Feb 27, 2024 Read!

Service Provider: Med-Trans Corp., backed by private equity investors. Total bill: $81,739.40, none of which was covered by insurance. The victim had declined Medicare Part B; her estate is on the hook for the full amount.

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Tina Reed, “Medicare Advantage patients get less home health care: study,” Axios, Mar 4, 2024 Read!

JAMA: Medicare Advantage patients got skimpier home health care and worse outcomes than their counterparts in traditional Medicare. (“But I got a free gym membership!”) The results were small in percentage terms, but the study pool was huge (n=465,000).

Original study: JAMA Health Forum, Read!

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Covid ain’t the flu

“BEYOND ANGRY—Lots of confusion on CDC’s new isolation guidelines—why? Because The CDC MADE THEM CONFUSING & VAGUE ON PURPOSE. It allows a myriad of loopholes and subjective interpretations—exactly the kind of stuff corporate executives and politicians love—they can say they are complying with the CDC while doing nothing much at all!” How do you really feel about it, doc? Topol is a cardiologist, the author of The Creative Destruction of Medicine (2010), and, obviously, a CDC critic.

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Katherine J. Wu, “Why are we still flu-ifying COVID?” The Atlantic, Feb 28, 2024 Read!

Covid isn’t a flu or anything like a flu. It is “the most dangerous infectious respiratory illness regularly circulating in the U.S.” no matter what the “relax-and-sneeze” CDC says. The new guidelines are “a stark departure from the earliest days of the crisis when public-health experts excoriated public figures—among them, former President Donald Trump—for evoking flu to minimize COVID deaths and dismiss mitigation strategies.”

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Melody Schreiber, “Covid taught us a lot. The CDC now wants us to forget it,” New Republic, Feb 28, 2024 Read!

The CDC told us to isolate “based on symptoms” despite the confirmed knowledge that asymptomatic infection is common. Furthermore, “symptoms could be improving just as patients are reaching their most contagious period.” This is not a science-based decision but a political-economic one. If we object, will Facebook and YouTube give us “strikes” for peddling “malinformation”?

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Keren Landman, “The CDC has finally loosened Covid isolation guidelines. Here’s why that’s a good thing,” Vox, Mar 1, 2024 Read!

A CDC loyalist defends the decision: “Guidelines that seem to acknowledge that workers often don’t have paid sick leave and emergency child care and that social interactions are important to folks are more likely not only to be followed but to engender trust in public health authorities.” We’ll see about that. And BTW, isn’t public health’s role to insist that structural issues like people not having paid sick leave are a problem? For Landman, anything thinking that way is being a “public health purist.”

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Environmental health

Keith Schneider, “New report sparks questions and controversy over possible causes for Iowa ‘cancer crisis,’” New Lede, Mar 4, 2024 Read!

Iowa has the second highest cancer incidence among all 50 states. As a leading industrial agriculture state, it pours pesticides, weed killers, and fertilizers into its soil and water, including known carcinogen glyphosate. Iowa also has 24 million hogs whose poop interacts with nitrogen from fertilizer and contaminates drinking water. Lovely place! This study highlights binge drinking, which sounds like an attempt to shift the blame.

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Saboto Caesar, “Global pesticide ban is only way to stop us from a health epidemic,” Newsweek, Feb 28, 2024 Read!

“Despite repeated scientific and environmental warnings, world leaders are sleepwalking into a pesticide-fueled nightmare.” The author, the agriculture minister of tiny St Vincent and the Grenadines, notes that his country prohibited the use of glyphosate and suggests other countries might think about protecting their citizens as well. “A large percent of Americans tested positive for chlormequat, a crop-warping pesticide which is laced through a staggering 92 percent of oat-based foods.” Should we address the risks of these substances or concentrate on finding expensive pharmaceutical products to treat the diseases they cause? Don’t answer that.

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SINGLE PAYER LINKS #337

Posted 1 MAR 2024

Lots of meaty topics, including some good news, believe it or not. Antitrust enforcers are active, and states are getting into the act on reining in prescription drug costs. There are some debates about the failings and future of public health as well, worth reading in full. If you have a long commute, here’s the listening option: LISTEN TO PODCAST!

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Monopoly/mergers

Paige Minemyer, “WSJ: Department of Justice conducting antitrust probe of UnitedHealth Group,” Fierce Healthcare, Feb 27, 2024 Read!

Best news of the week: “Investigators are probing the impact of UnitedHealth’s sprawling provider acquisitions on others in the industry.” This is coming from the DoJ with perhaps the FTC not far behind. Few details so far but sounds like time for champagne cocktails! UHC already employs 90,000 doctors, so this may mean a challenge to practice of creating a payer/provider combo. The rumor of legal trouble for this Godzilla emerged during a “challenging week” after a huge cyberattack on its payment system highlighted the dangers of industry consolidation. See next item.

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Rebecca Pifer, “Pharmacies and providers nationwide are struggling to process prescriptions following the attack,” Healthcare Dive, Feb 23, 2024 Read!

UnitedHealth says it thinks a foreign country attacked a subsidiary that handles 15 billion payment transactions each year, touching one out of every three Americans. Gargantuan healthcare companies are juicy targets, and cybersecurity costs money, which could be better spent enriching executives and shareholders.

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Dave Muoio, “PE-backed anesthesiology group ends contracts with 5 Colorado hospitals, phases out non-competes to resolve monopoly inquiry,” Fierce Healthcare, Feb 27, 2024 Read!

A trend? Regulators don’t have to win every lawsuit to inhibit bad corporate behavior—just wake up and bring them. “U.S. Anesthesia Partners (USAP) will divest its exclusive contracts at five Denver-area hospitals and waive or phase out physicians’ noncompete agreements to resolve the state’s allegations of anticompetitive conduct.” USAP = private equity. It had hoovered up 70% of all Denver business and hiked prices by 30–40%. Next target: the USAP octopus in Texas.

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Marcus Neubauer, “Cancer patients in the crosshairs of hospital consolidation,” MedPage Today, Feb 16, 2024 Read!

As small oncology practices shut down or are absorbed by the giants, “hospitals and health systems nationwide engage in anti-competitive behavior, including patient steering, referral restraints, and strong-arm negotiating tactics that result in higher costs and limited access to care.” Also, non-compete agreements for doctors, gag clauses, all-or-nothing contract coercion, and of course hefty price hikes.

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Sara Fischer, “FTC chair Khan: Stop monopolies before they happen,” Axios, Feb 13, 2024 Read!

Lina Khan wants to “open up [tech] markets, inject competition, disrupt existing incumbents.” The approach applies to healthcare especially her focus on “close attention to vertical integration.”

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Long Covid

John Snow Project, “Long Covid is one of the world’s biggest challenges,” Feb 22, 2024 Read!

“There could be a variety of reasons why the world is suddenly seeing increased retirement, rising disability, staff shortages in a range of industries in almost every country, continued pressure on healthcare systems, and a massive rise in chronic school absences in almost every country that reports figures.” In other words, We can’t say all this is due to Long Covid, but we suspect it. The indictment: “Governments keen to reopen economies listened to those who gave optimistic assessments of this novel pathogen and who said that once the virus was no longer a novelty for our immune systems, repeat infections would be unlikely to cause harm. We now know this is not the case.” Understatement of the fact that public health was hijacked in favor of economic/political priorities.

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Erica Sweeney, “How repeat Covid infections can harm your health,” Men’s Health, Feb 21, 2024 Read!

Paywalled, but here’s the nub: “People who had two or more Covid infections had a higher risk for diabetes and pulmonary, cardiovascular, hematological, gastrointestinal, kidney, mental health, musculoskeletal, and neurological disorders,” as well as death, hospitalization, long Covid, and chronic fatigue. And repeated infections don’t generate lasting immunity.

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Jason Gale, “A spike in heart disease deaths since Covid is puzzling scientists,” Bloomberg, Feb 26, 2024 Read!

Covid “triggered a wave of deadly cardiovascular and metabolic illness,” i.e., 250,000 excess deaths over pre-Covid trends. Mortality from “hypertensive heart disease, rhythm abnormalities, blood clots, diabetes and kidney failure were 15–28% higher.” It’s not “just another flu.”

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Rachel Cohrs & Betsy Ladyzhets, “The NIH has poured $1 billion into long Covid research—with little to show for it,” STAT/MuckRock, Apr 20, 2023 Read!

Essential background from last year: The Feds burned through a cool billion provided for long Covid research with lackadaisical “observational” studies rather than testing for cures. The article outlines how slowly and bureaucratically long Covid research moved—in contrast to the warp-speed search for a vaccine—reflecting how little officialdom really cares about the long-term sick now that everyone (except them) is back to work. “The National Institutes of Health hasn’t signed up a single patient to test any potential treatments—despite a clear mandate from Congress to study them.”

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Eduardo Cuevas & Karen Weintraub, “Millions of Americans suffer from long COVID. Why do treatments remain out of reach?” USA Today, Feb 26, 2024 Read!

“The complexity of both the disease and the drug development system, not to mention the difficulty of getting doctors to believe them and insurance to pay for visits, has left long COVID patients feeling alone and adrift.” As the Feds tinker leisurely with “observational” studies (instead of clinical trials of treatments), individuals and unfunded providers desperately try different remedies. One patient formed an advocacy group called Long COVID Moonshot “to channel this grief over my life being ruined.”

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Pharmaceuticals

Mike Tanglis, “Mapping the PhRMA Grant Universe,” Public Citizen, Dec 14, 2023 Read!

How Pharma undermined opposition by handing out $6 billion to 20,000 different recipients over a decade—far more than they spend on lobbying, which is also a fortune. Ergo, suspect “patient advocate” organizations when they trot out tragic human-interest stories that just happen to toe the Pharma line.

Full report: Read!

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Luke Lukert, “Sky high prescription drug prices have Md. legislators looking for consumer relief,” WTOP, Feb 12, 2024 Read! and Stephanie Hudson, “Virginia doctors support board to lower prescription drug costs,” WAVY.com, Feb 12, 2024 Read!

States are grappling with skyrocketing prescription drug prices while federal action lags. Maryland is looking at its Lowering Prescription Drug Costs for All Marylanders Act of 2024 to cap prices in all plans (it already does so for government workers) while Virginia is considering a Prescription Drug Affordability Board to do the same. A survey showed support from ¾ of Virginia voters—doesn’t mean it will happen.

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Arthur Allen, “Patients see first savings from Biden’s drug price push as Pharma lines up its lawyers,” KFF Health News/ABC News, Feb 16, 2024 Read!

The confusingly named Inflation Reduction Act is achieving some gains in the drug pricing wars as the 2022 bill’s changes are just kicking in, starting with the $3,500 cap on out-of-pocket drug costs for Medicare beneficiaries, which will drop to $2,000 next year. Pharma is suing, and insurers are expected to jack up premiums in response.

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Sheila Poole, “Researchers find association between air pollution and Alzheimer’s,” Atlanta Journal-Constitution, Feb 23, 2024 Read!

But why do anything about pollution when we can pour billions into expensive pharmaceutical products instead?

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Bloodymindedness

Jonathan Mattise & Geoff Mulvihill, “14 GOP-led states have turned down federal money to feed low-income kids in the summer. Here’s why,” Associated Press, Feb 16, 2024 Read!

Why coddle the lazy brats who don’t want to work nights at the textile mills? Kidding! “Lower-income families with school-age kids can get help from the federal government paying for groceries this summer unless they live in one of the 14 states that have said no to joining the program this year.” Mostly the former Confederacy though Iowa Governor Kim Reynolds had the best line: “An EBT card does nothing to promote nutrition at a time when childhood obesity has become an epidemic.” Damn kids are eating too much food already.

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Public health

Eric Reinhart, “Want to fix public health? Stop thinking like a doctor,” The Nation, Mar 6, 2024 Read!

A fascinating and counterintuitive argument: doctors aren’t the best people to put in charge of public health. Their clinical experience leads them to assume a patient’s conditions are fixed, but public health is about treating populations, not individuals. Reinhart writes that the task of public health is “not to help individuals accommodate to oppressive social or labor contexts. It is instead to use the power of government to change conditions that are constraining people’s freedom. Public health thus requires seeing the world ‘from below,’ rather than through the eyes of bankers, economists, or opinion writers at national newspapers.” Worth a read.

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Greg Gonsalves, “We’re letting a public health disaster unfold in slow motion,” The Nation, Feb 22, 2024 Read!

“The people attacking public health are following [a well-known] template, consisting of three basic strategies: delegitimization, deconstruction, and control.” Gonsalves says there’s too little fightback against forces who don’t believe in public health—or a “public,” for that matter—which is fair enough but incomplete. He takes aim at the steady rollback of protective public health measures around Covid: “By ignoring the political machinations at work, public health plays into the hands of the right by suggesting all these wounds to public confidence are self-inflicted.” Okay, but a lot of them were. He doesn’t really acknowledge how the public health establishment delegitimized itself by lying to us. Resisting political control from the White House (and the “back-to-work-you-peons” message), admitting that scientific knowledge was spotty and uncertain, and honoring people’s bodily autonomy as a basic principle would have given the PH sector a solid battlement from which to fight back.

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Amy Maxmen, “Florida defies CDC in measles outbreak, telling parents it’s fine to send unvaccinated kids to school,” KFF Health News/CBS News, Feb 23, 2024 Read!

Result of vaccine mismanagement during Covid=supercharged antivax cray-cray. “As measles spread through Manatee Bay Elementary in South Florida, [state health chief] Ladapo sent parents a letter granting them permission to send unvaccinated children to school amid the outbreak.” Translation: “I am a free American and have the right to spread my germs on you! So do my kids! USA! USA!” Measles has now broken out in 11 states.

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Mark Honigsbaum, “‘It is shameful’: Why the return of Victorian-era diseases to the UK alarms health experts,” Guardian, Feb 18, 2024 Read!

The 19th-century curse of scabies is back in the U.K. as well as rickets and scurvy—signs of mass malnutrition and the breakdown of the once-revered public health sector. Dickens describes the horrors of British poverty during the Victorian period. We need a new one.

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Brian Mann, “How Portugal eased its opioid epidemic, while U.S. drug deaths skyrocketed,” NPR, Feb 24, 2024 Read!

“Portugal has roughly the same population as the state of New Jersey. But while New Jersey alone sees nearly 3,000 fatal drug overdoses a year, Portugal averages around 80.” But when Oregon tries to try the Portugal model, it faces a huge public backlash. What’s the winning formula? One difference is that Portugal doesn’t tolerate the kinds of open-air drug markets that we read about constantly. And Portuguese police have transformed themselves into trusted partners with the result that drug users often call the helpline numbers that cops there give out. (In the U.S., they rarely do.) Instead of exploring the elements of Portugal’s success, we now see efforts to recriminalize drug possession and return to the War on Drugs. One commentator added, “There’s a different political environment in the U.S. The way health care is funded is completely different. The role of police in American society is different.” All true.

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Rich hospitals/Poor hospitals

Natalie Krebs, “Report finds more than half of rural Iowa hospitals no longer deliver babies,” Iowa Public Radio, Feb 23, 2024 Read!

Most (61%) rural Iowa hospitals no longer have OB care because insurers and Medicaid don’t pay enough. Pre- and post-partum care will suffer while more births will become high risk. Unasked question: Why should small or rural hospitals have to break even?

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Elizabeth Cohen, “As midwife-assisted home births rise, so too do high-risk births outside hospitals,” STAT, Feb. 23, 2024 Read!

“More and more people are opting to give birth outside the hospital setting even when they have high-risk pregnancies.” Reasons: Covid in hospitals, forced Caesarians against the mother’s wishes, and general distrust of hospital care. (Not mentioned: cost!) In one study, 28% of women birthing in a hospital reported “various types of mistreatment” (scolding, shouting, ignoring requests) while only 5% had that experience in a home birth. The numbers are predictably higher for minority women. Maternal mortality among Black women has doubled in the last two decades.

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Michelle Crouch, “Some lawmakers call for review of decades-old law that governs hospital authorities like Atrium Health,” Charlotte Ledger, Feb 26, 2024 Read!

The Charlotte daily exposed how Atrium gets all the privileges of being “publicly owned” while raking in $19 billion in annual revenue and expanding to other states. Now, legislators are looking into how the state is being scammed. Prevention would have worked better.

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The sleaze

Rachel Bowman, “Feds launch massive investigation into organ donation firms accusing them of only taking money making tissues and leaving badly needed organs behind,” Daily Mail (U.K.), Feb 26, 2024 Read!

“U.S. attorneys from at least five states are looking into whether some [organ donor] groups used donors for body tissue and left badly needed organs behind.” Procuring organs is more expensive and requires more expertise than collecting tissues. Underlying problem: monopoly. “The system had only ever been run by the United Network for Organ Sharing, which has been criticized for long waitlists of people waiting for transplants,” 17 of whom die each day.

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Todd Bookman, “NH officials blast Anthem over handling of $69M contract for state retirees,” New Hampshire Public Radio, Feb 22, 2024 Read!

NH will seek punitive fines against a train-wreck Medicare Disadvantage insurer for “massively screwing up services for state retirees.” (But NYC retirees shouldn’t worry when they get shoved into MA, all will be fine.) Anthem could get booted from the state program. One state legislator said, “This is a disgrace.” Maybe, but it’s a profitable one!

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Emily Olsen, “False claims settlements in healthcare reached $1.8B in fiscal year 2023,” Healthcare Dive, Feb 26, 2024 Read!

Runaway corruption is plaguing the government reimbursement programs. How much of it is attributable to private-sector actors? “As the number of beneficiaries enrolled in privatized insurance coverage rises, stakeholders have raised concerns about fraud contributing to overpayments to MA plans.” Upcoding to make patients look sicker and trigger higher per-capita payments to the for-profit operators remains rampant.

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Dave Muoio, “Community Health Systems discloses DOJ investigation,” Fierce Healthcare, Feb 22, 2024 Read!

A 71-hospital for-profit system is under the DoJ microscope for a raft of undisclosed corrupt practices. Its precursor corporate entity had to cough up nearly $300 million in an earlier probe. Meanwhile, this odoriferous corporate vehicle is being eyed by various suitors eager to absorb its network and, we can assume, sweeten the stench of corruption with a new brand name.

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Final item from the Twitter/X account of Dr Jerome Adams. Note bolded phrase. Adams is a former U.S. Surgeon General. What chance do the rest of us have?

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SINGLE PAYER LINKS #336

Posted 23 FEB 2024

This week: Hospital system mergers are hitting opposition from state as well as Federal regulators; private equity is up to its old tricks; a “nonprofit” hospital hides behind collection agencies; new varieties of corruption in The Swamp; “honor The Science™! but don’t hold us to it” describes the abuse of that noble activity; North Carolina expanded Medicare coverage, the Apocalypse did not ensue, and its children didn’t suddenly turn binary. Listen during your commute here! [https://www.podbean.com/eas/pb-xxytx-158f114]

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Mergers

Susanna Vogel, “SCAN Group, CareOregon abandon merger plans,” Healthcare Dive, Feb 15, 2024 Read!

Plenty of stories about mergers that don’t go through, often (as here) “amid rising criticism from politicians and the public.” This combo would have targeted Medicaid and Medicare Advantage populations in Oregon, but Oregon’s Medicaid Advisory Committee weighed in against it.

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Rebecca Pifer, “Blue Cross of Louisiana halts sale to Elevance,” Healthcare Dive, Feb 15, 2024 Read!

Indiana-based Elevance, which already operates BCBS plans in 14 states, wanted to add Louisiana, but state regulators so far have blocked it over likely “anticompetitive effects” and premium increases.

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Susanna Vogel, “Primary care providers Marathon Health and Everside Health merge,” Healthcare Dive, Feb 9, 2024 Read!

But some deals still go through. A new Godzilla in the making are these Denver- and Indianapolis-based systems, which will control 2.5 million patients in 41 states once joined.

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Private equity

Paige Minemyer, “Private equity deals in MA are declining, but experts say regulators should keep an eye on this space,” Fierce Healthcare, Feb 13, 2024 Read!

A slowdown in the PE invasion of the healthcare sector is good news, for whatever reason. Deal volumes are slowing because of “rising interest rates that have made obtaining lending for debt-financed deals more challenging”—important since PEs don’t use their own money to perform their financial legerdemain. Another factor: “increased scrutiny of Medicare Advantage marketing practices” and upcoding fraud, stimulated by “the skyrocketing increase in complaints from consumers.”

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Susanna Vogel, “What’s going on at Steward Health Care?” Healthcare Dive, Feb 15, 2024 Read!

What’s going on is the typical and entirely predictable denouement that follows a private equity takeover of a “struggling” hospital. These deals are accompanied by jeroboams of promises and triumphalist rhetoric that quickly dissipate on the first spring breezes. The PE firm sells off assets like real estate, loads up the hospital with massive new debts, pockets obscene amounts of money in “fees” and dividends, and promptly decamps to greener pastures, leaving behind a smoking carcass. Tales of PE takeovers are so consistent they write themselves. “Steward Health Care was created in October 2010 when private equity firm Cerberus Capital Management purchased failing Caritas Christi Health Care for $895 million [with other people’s money]. Steward’s total liabilities ballooned to $1.4 billion. Cerberus exited its Steward play in 2020, $800 million richer,” exactly the amount Steward “lost.” Note the Wall Street term “play.” It’s Tony Soprano in a nicer suit.

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Hospitals

Phil Galewitz & Colleen DeGuzman, “In fight over Medicare payments, the hospital lobby shows its strength,” KFF Health News/NPR, Feb 13, 2024 Read!

Why does Medicare pay hospitals for certain services twice as much as it pays to doctors? “The rationale has been that hospitals have higher fixed costs, such as 24/7 emergency rooms and uncompensated care for uninsured people.” But hospitals game the system by buying up physician practices, replacing the shingle, and scooping up the double reimbursements. Now, there’s a fight on for “site-neutral” payments. The whole mishegoss arises from rival providers and entities struggling to vacuum up payments and stay solvent/rack up profits. Why should safety-net hospitals be pressured to break even? Meanwhile, the wealthiest hospitals will get their lobbying arms to showcase the struggles of poor, rural hospitals to argue for preserving those juicy bonus payments.

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John Ingold & Chris Vanderveen, “UCHealth sues thousands of patients every year. But you won’t find its name on the lawsuits,” Colorado Sun, Feb 19, 2024 Read!

The “nonprofit” and tax-exempt University of Colorado’s hospital has sued patients 15 thousand times in the last five years, mostly by hiding behind collection agencies in court. This investigative report might embarrass them into forgiving a bit more since the system made $839 million in profits—er, surplus revenue—last year.

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Annie Sciacca, “In California, faceoff between major insurer and health system shows hazards of consolidation,” KFF Health News/Sacramento Bee, Feb 19, 2024 Read!

Negotiations between King Kong and Godzilla broke down in California, leaving a half million enrollees in suspense. UC Health slugged it out with Anthem Blue Cross over terms while patients dangled in limbo. “Analysts say the conflict has become part of a trend in which patients are increasingly caught in the crossfire of contract disputes” and eventually get saddled with higher bills as a result of relentless industry consolidation. The ever-larger insurers get bigger discounts from the ever-larger hospitals systems, but the savings rarely filter down to the premiums.

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The Swamp

Nicholas Florko, “Juul’s internal playbook opens a rare window into influence in Washington,” STAT, Feb 15, 2024 Read!

An unusual lifting of the rock to find all sorts of biota squirming about in the Washington mud, specifically Juul’s “extensive behind-the-scenes efforts to promote its interests.” Nothing terribly surprising but a wealth of detail for those not squeamish, such as how the vape company shoveled cash to so-called nonprofits to gain influence, such as Majority Forward, a “recipient vehicle” for Senate Majority Leader Chuck Schumer, and another group, One Nation, favored by Senate Minority Leader Mitch McConnell. A former Schumer staffer appears in the article as working hard to “disempower the FDA and killing tobacco regulations.”

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Ben Schreckinger, “Biden’s brother used his name to promote a hospital chain. Then it collapsed,” Politico, Feb 18, 2024 Read!

Hunter’s not the only one trading on the magic surname. Brother Jim “invoked his brother’s name and clout” in putting together various deals that went nowhere, including an operator of hospitals that the government has accused of massive Medicare fraud. “The management failures took a human toll as hospital staff went unpaid, services dwindled, and authorities were forced to intervene.” Before the collapse, “Jim Biden received a $200,000 payment from Americore, [then] made out a check for his brother Joe.” Many gory details dripping with sleaze. One example: “With Americore in ruins, the federal government has filed a claim for more than $142 million from the defunct company for Medicare fraud alone.” Probably won’t recover a cent.

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Ruth Reader, “Artificial intelligence is making critical health care decisions. The sheriff is MIA,” Politico, Feb 18, 2024 Read!

AI is here, people are using it, and figuring out regulations is complex and costly. Therefore, “the AI rollout in health care is becoming a high-stakes experiment in whether the private sector can help transform medicine safely without government watching.” In other words, it’s a medical Wild West, and we’re the guinea pigs.

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The Science™

Nick Corbishley, “France’s Macron government is trying to criminalise criticism of officially recommended or mandated medical treatments,” Naked Capitalism, Feb 16, 2024 Read!

“A new escalation in the war on what governments deem to be medical mis-, dis- and mal-information appears to be under way.” If Macron pushes this through, French doctors who raise doubts about the Official Truth on things like treatments, vaccines, or what have you will face prosecution. If it sounds wacky and far-fetched, that doesn’t mean it’s impossible. “With the passage of the new bill, medical and scientific alerts, whether in the mainstream press, scientific journals, or in the alternative media landscape, could be met with penalties including fines and even risk of imprisonment.” We have an FDA that is supposed to regulate snake oil peddlers, but this is an attempt to stifle scientific inquiry. Two caveats: Vioxx and Thalidomide. The free play of ideas, in science as elsewhere, means we have to put up with crackpots. The alternative is this “battering ram to three basic fundamental human rights: the rights to freedom of expression, bodily autonomy, and bodily integrity.” Macron’s law goes beyond censorship of inconvenient opinions, de-monitizing YouTube channels, or all-out canceling—it establishes thought-crime.

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Julia Doubleday, “New CDC guidelines: Work ‘til you drop,” The Gauntlet, Feb 15, 2024 Read!

“In disastrous but truly unsurprising news, the CDC is now considering weakening COVID isolation guidelines yet again” by encouraging people to leave isolation within 24 hours if they have only a “mild” case. Mild for whom? The people whose third infection leads to long Covid and a life in bed? The people infected by contagious co-workers? Incredible that this get-back-to-work-you-peons policy is being peddled along with Macron-like attempts to stifle public debate on The Science™. This policy shift is utterly and completely unscientific but will enable employers to force sick people back to work. Great article, worth a full read. “The CDC isn’t even pretending its decision has anything to do with health, science, or disease control. They simply point out that no one is following their guidelines anyway, so why bother?”

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Lev Facher, “Fights over methadone, harm reduction, and more: 3 addiction stories to watch in 2024,” STAT, Dec 29, 2023 Read!

Although 110,000 people died of drug overdoses in 2023, “addiction medicine and drug policy hasn’t changed much in the past year.” The guideline: if it doesn’t work, continue undisturbed. “Much of the current debate centers on the Modernizing Opioid Treatment Access Act, or MOTAA, a bill that would allow board-certified addiction doctors to prescribe methadone directly to patients.” Methadone clinics are aghast at the threat to their business. Also, harm reduction is losing ground to the pressure for a return to a police-first drug policy; San Francisco and Oregon may reverse decriminalization measures.

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Pharmaceuticals

Mason Walker, “Strong growth outlook for AbbVie: Sales forecast for immunology drugs raised to $27 billion,” Medriva, Feb 2, 2024 Read!

AbbVie is losing its iron grip on the fabulously lucrative market for rheumatoid arthritis treatments as Humira’s 20-year monopoly, worth around $200 billion during that time, is finally facing generic competition. But the company has new immunology drugs to fill the profit gap and expects to rake in $27 billion on them this year alone.

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Joshua Goodman & Jim Mustian, “DEA reverses decision stripping drug distributor of licenses for fueling opioid crisis,” Associated Press, Feb 7, 2024 Read!

The Drug Enforcement Administration changed its mind and will allow one of the worst pill-mill suppliers during the Oxy debacle to stay in business. This is totally and not at all related to the fact that Morris & Dickson Co. hired a former top DEA official as a consultant and paid him handsomely.

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Medicaid/Medicare/Medicare Disadvantage

Katie Adams, “Why experts saw Cano Health’s bankruptcy coming from a mile away,” MedCityNews, Feb 8, 2024 Read!

“Private Medicare just isn’t the gold mine it once was.” Yay! Cano Health, a company once valued at $4.4 billion, is now bankrupt. One analyst says Cano’s core Medicare Advantage business imploded after the Feds cracked down on “risk adjustment coding loopholes,” i.e., upcoding fraud. Such a shame.

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Maya Goldman, “More than 2 million people dropped from Medicaid in Texas,” Axios, Feb 13, 2024 Read!

Texas is no. 1 in yet another field: more citizens kicked off their insurance than any other state, fully one-eighth of the national total of 16.4 million. The final estimate is around 30 million back to being uninsured, just in time for the November elections! Did anyone think this through at the DNC?

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Jaymie Baxley, “NC Medicaid rolls grow by 1,000 people a day as smooth expansion rollout continues its third month,” North Carolina Health News, Feb 15, 2024 Read!

There, now that didn’t hurt a bit, did it? NC, a stubborn non-expansion state, finally decided to accept billions in Federal cash and get a half-million citizens Medicaid coverage. Expansion raised the state’s income limit for Medicaid to a whopping $25,820 for a family of three—no Carolina lazybones getting free stuff, no sirree. “A disproportionate share of the state’s new enrollees are residents of rural, economically distressed counties” [who vote Republican]. Could N.C. be a bellwether? Lawmakers in Florida may now be looking to North Carolina as a model.” Only took a decade-plus.

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Maya Goldman, “Florida challenges federal requirement to keep kids on health insurance,” Axios, Feb 5, 2024 Read!

Florida wants a freer hand to dump its kids from health insurance. The lazy brats don’t want to go to work in chicken factories—what’s our youth coming to?? “Florida has removed about 420,000 children from Medicaid and CHIP since April” when Biden lifted Covid restrictions.

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Noah Tong, “‘A giant unknown’: What the alleged $2B Medicare catheter fraud scheme means for ACOs,” Fierce Healthcare, Feb 15, 2024 Read!

The 400,000 urinary catheters reimbursed by Medicare for people who hadn’t asked for or received them created a bit of a scandal now rippling out through the payment system. The massive fraud could undermine claims that Accountable Care Organizations and their value-based care models save money. The ACOs say it’s the Feds fault nobody noticed the sudden tsunami of catheter requests.

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Paul Berggreen, “Independent doctors like me are becoming an endangered species,” STAT, Feb 18, 2024 Read!

Three out of four U.S. physicians are now employees. The author, who heads an advocacy group for independent MDs, says the culprits are lagging reimbursement rates from Medicare (while payments for hospitals and others kept pace with inflation) and rising costs of malpractice insurance and other inputs. He recommends indexing Medicare fees to inflation. Workers of the world, unite!

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SINGLE PAYER LINKS #335

Posted 16 FEB 2024

Hi everyone, Lots of illuminating (and infuriating) links this week, which you can listen to while washing dishes here: LISTEN TO PODCAST!

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Pharmaceuticals

Rachel Cohrs, “In a showy hearing, Bernie Sanders gets few answers about lower drug prices,” STAT, Feb 8, 2024 READ IT HERE

A snide lede: “Call it Sen. Bernie Sanders’ prescription drug pricing theater.” Is putting pressure on bad actors always theatrical or just sometimes? Would Cohrs write that way about politicians she likes? The Pharma execs tried like hell to dodge the hearing so perhaps they didn’t see it entirely as a vaudeville act. While Sanders railed against price gouging, Mitt Romney tongue-bathed the suits thus: “Appreciate these executives taking time away from your responsibilities at your respective companies to give us an opportunity to pontificate on our various topics.” So, it’s just Bernie who does pontiff? Cohrs’ lede will score her points with sources in the Pharma industry.

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Sydney Lupkin, “Senators ask CEOs why their drugs cost so much more in the U.S.,” NPR, Feb 8, 2024 READ IT HERE

Here’s a different take on the same event that does not start from the premise that Bernie Sanders is an attention-seeking clown: “Sparks flew on Capitol Hill Thursday as the CEOs of three drug companies faced questions about why drug prices are so much higher in the United States.” Lupkin’s third graf describes some of the outrageous pricing that Sanders was denouncing.

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Ben Botkin, “Oregon lawmakers look for ways to curb prescription costs,” Oregon Capital Chronicle, Feb 12, 2024 READ IT HERE

While the Feds fiddle, states look for ways out of the Pharma nightmare. Oregon’s targets: tinkering with copays and deductibles and reining in pharmacy benefit managers (PBMs).

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Nathaniel Weixel, “Biogen walks away from controversial Alzheimer’s drug Aduhelm,” The Hill, Jan 31, 2024 READ IT HERE

The Aduhelm debacle has led drugmaker Biogen to dump the whole sorry business and sell off its Alzheimer’s turkey. It will also stop its post-approval clinical trial “to confirm the drug’s benefits” that plenty of people don’t think are there in the first place. The sale “closes the book on what was once projected to be a major blockbuster drug but ended up the center of a controversy that eroded trust in the FDA’s approval process.” Three members of an advisory panel resigned, and one called the FDA’s decision to overrule its opinion “probably the worst drug approval decision in recent U.S. history.” Biogen expected to haul in billions but instead lost money and looked like the “poster child of profit maximization above all else.”

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Vaccines

Helen Branswell, “HHS leaves vacant more than half the slots on a key vaccine advisory panel,” STAT, Feb 8, 2024 READ IT HERE

Paywalled, so I don’t know if the writer explains why. But the plain facts are alarming: “A critical government advisory committee charged with charting vaccination policy appears to be atrophying” with eight vacant slots out of 15 members. I guess there’s no controversy here in the U.S. about vaccines or anything like that. Or maybe they figure their credibility is too shot to make any difference. [Update Feb. 16: this article must have lit a fire under someone—the Feds announced that all eight slots will now be filled.]

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Health promotion & communication

Regina Benjamin & Jerome Adams, “Former U.S. surgeons general: The U.S. should ban menthol cigarettes,” STAT, Feb 9, 2024 READ IT HERE

Watch for Black leaders complaining that bans on menthol is discriminatory. But was it racist for menthol to be peddled specifically to Blacks for decades to entrap them into the nicotine habit? “More than 80% of Black people who smoke use menthol cigarettes.” Among white smokers, it’s 35%.

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Adam Kucharski, “Epidemiology has a causality problem,” Understanding the Unseen, Jan 29, 2024 READ IT HERE

Addresses the old “Correlation is not causation!” concept that your Epi 101 teacher screams at you from the first class. For example, if we observe that pregnant women smoke less than other women, that doesn’t mean giving up cigarettes causes pregnancy. But scientific illiteracy is a problem among reporters and editors. As that’s unlikely to change, the author says research should go straight to the question of what causes a disease and not dance around it. Given the politicization of health in general, we need to entirely rethink our approach to health communication, including reporting on research.

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Concentration/Monopolization

Jonathan Yeatman, “Mission sale wasn’t good for HCA either: A former top exec argues for a return to local control, nonprofit status,” Asheville Watchdog, Feb 1, 2024 READ IT HERE

This is an interesting reminder that the promises made when a large chain takes over a local hospital are just that—words. HCA is being sued for alleged antitrust behavior in various venues, so unfulfilled promises are nothing new. One question never posed by the author, a former official of the hospital taken over: why should rural hospitals be forced to make a profit?

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Rebecca Pifer, “Amazon closing One Medical corporate offices,” Healthcare Dive, Feb 9, 2024 READ IT HERE

Are Amazon’s latest forays into healthcare failing again? It acquired One Medical in 2023, keeps losing money on it, and laid off hundreds there as well as at Amazon Pharmacy. Being huge apparently isn’t enough to achieve success in this field. Maybe people just don’t want to get doctored by Mr Bezos.

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Eric Topol, “Toward the eradication of medical diagnostic errors,” Ground Truths, Jan 28, 2024 READ IT HERE

Topol is a thoughtful and critical medical academic and explains the potential utility of AI if—a very large caveat—it is incorporated as a diagnostic aid instead of an automated money-saver for hospitals and insurance companies. “There is real potential for generative AI to improve the accuracy of medical diagnoses, but the concerns for propagating bias need to be addressed.” The passive voice used here highlights the absence of anyone actually in charge of doing that.

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Medicaid/Medicare

Andrew Perez, “Republicans are planning to totally privatize Medicare—and fast,” Rolling Stone, Feb 5, 2024 READ IT HERE

“If Republicans win the presidential race this year, the push to fully privatize Medicare, the government health insurance program for seniors and people with disabilities, will only intensify.” Not that the Democrats are resisting it much, but Trump 1 openly pushed Medicare Disadvantage programs onto gullible seniors with emails headed, “Get more benefits for your money,” and “See if you can save money with Medicare Advantage.”

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Vallari Vaidya, “How a staggering rise in urinary catheter bills led investigators to alleged $2 billion Medicare scam,” Market Realist, Feb 12, 2024 READ IT HERE

This one is crazy: “Seven companies have submitted hundreds of thousands of bills to Medicare—using real patient data—asking the government to reimburse them roughly $2 billion for intermittent urinary catheters.” A tiny little problem: no one wanted the catheters or got them. The scammers used Medicare-accredited companies and stolen patient information to submit 400 thousand false claims. But how did this obvious fraud thrive for so long before someone blew the whistle? One bright spot: Accountable Care Organizations (ACOs), which are private companies that manage senior care, may get hit with penalties for the fraudulent bills.

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Verónica Zaragovia, “With Medicaid expansion off the table, entrepreneurs and nonprofits help Florida’s uninsured,” Health News Florida/WLRN, Feb 6, 2024 READ IT HERE

Instead of expanding Medicaid and taking advantage of Federal fiscal support worth billions, Floridians are casting around for patchwork substitutes. While the attempts are noble, the obvious inadequacy is glaring. One nonprofit is “educating people about medical debt, about what their patient rights are, about how to contend with medical debt when one receives a bill.” That’s nice, I guess.

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Paige Minemyer, “Medicare Advantage headwinds didn't prevent payers from turning a profit in 2023,” Fierce Healthcare, Feb 9, 2024 READ IT HERE

Here are some of the profit totals for 2023 among the top intermediaries between us and our doctors: UnitedHealth Group, $22.4 billion; CVS Health, $8.3 billion; Centene, $2.7 billion; Elevance Health, $6 billion; Cigna, $5.1 billion. Total of just these players: $44.5 billion, none of which was spent on healthcare.

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Debt

Anna Claire Vollers, “Governments can erase your medical debt for pennies on the dollar—and some are,” Stateline, Feb 13, 2024 READ IT HERE

An interesting twist: “Some states and cities will use federal money to forgive millions of dollars of their residents’ medical debt.” Connecticut, New Jersey, Pennsylvania, Louisiana, Michigan, Ohio are buying discounted debt and erasing it. Great, but next year there’ll be just as much new debt in the broken system.

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Elisabeth Rosenthal, “GoFundMe has become a health care utility,” KFF Health News/The Atlantic, Feb 12, 2024 READ IT HERE

No longer much use to fund honeymoon trips and overseas charities, GFM is now mostly for people to escape medical debt torture. “Perhaps the most damning aspect of this is that paying for expensive care with crowdfunding is no longer seen as unusual; instead, it is being normalized as part of the health system.” Even more incredible: “In some cases, patient advocates and hospital financial aid officers recommend crowdfunding as an alternative to being sent to collections.” Of course, if you’re not famous like Mary Lou Retton, your chances of success on the platform are iffy.

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Tina Reed, “How one company managed to cut its health spending by almost half,” Axios, Feb 8, 2024 READ IT HERE

How did they do it? Through a “complicated endeavor” including a deep dive into insurance claims data, cutting ties with a big insurer, and ongoing dialogue with employees about tradeoffs and their new role as advocates for their own care. An interesting case study especially given that the firm reduced its monthly health care spending from $812 to $442 per employee.

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Insurers

Bram Sable-Smith, “States target health insurers’ ‘prior authorization’ red tape,” KFF Health News/USA Today, Feb 12, 2024 READ IT HERE

Federal attempts to regulate prior authorization hell have stalled, so states are picking up the slack. “Last year, lawmakers in 29 states and Washington, D.C., considered some 90 bills to limit prior authorization requirements” New Jersey and Washington, D.C., passed them. Republicans are sometimes on board.

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Hospitals

Adrian Andrews, “House and Senate committees OK bills to create ‘rural emergency hospitals,’” Health News Florida/WFSU, Feb 9, 2024 READ IT HERE

The REH, an attempt to find a way around the inability of rural hospitals to make a profit: are a new category to provide emergency services, one-day observation stays, and outpatient services. However, anyone really sick will still have to be moved to a larger facility somewhere else.

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Rent extraction

Anna Claire Vollers, “Private equity’s growing footprint in home health care draws scrutiny,” Tribune News Service, Feb 8, 2024 READ IT HERE

“Help at Home employed nearly 800 caregivers scattered across every county in Alabama, helping 1,100 older and disabled clients with activities such as bathing, housework and meal preparation. And then suddenly, it was gone.” If the pickings aren’t tasty enough, the PE rent extractors are outtahere. But there’s plenty of loot to be hoovered up still: “From 2018 to 2019, private equity was involved in nearly half of home health care industry deals.”

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Gustavo Rivera, “Cutting expensive middle-men out of home care will save New York billions,” City Limits, Jan 22, 2024 READ IT HERE

A single-payer stalwart penned this op ed on how New York is “wasting billions of dollars on private insurance companies that act as expensive middle men between the state and home care workers.” He calls for returning home care management to the state. But those middlemen are undoubtedly generous campaign donors. Rivera’s bill is S. 7800—take note!

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This week, the news includes slipping profit margins in Medicare Disadvantage; some insights into structural issues such as vertical integration in healthcare conglomerates and the failed promise of electronic medical records; some clever new billing outrages; nonprofit hospitals taking advantage; and the steady loss of credibility among elite institutions. Listen to a 20-minute summary here: Do Not Resuscitate (This System)

SINGLE PAYER LINKS #334

Posted 9 FEB 2024

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Medicare (dis)Advantage

Rebecca Pifer, “Cigna sells Medicare businesses to HCSC for $3.7B,” Healthcare Dive, Jan 31, 2024 READ IT HERE

The lucrative MA business is losing its lustre. “Its earnings potential is shrinking following regulatory changes and unfavorable cost trends.” Why unfavorable? “Cigna agreed to pay $172 million to settle allegations it was inflating the health needs of its MA beneficiaries [a.k.a. upcoding] to snag higher reimbursement from the government.” Ah, so that trick is getting some regulatory oversight. Also, payment rules are changing—the calculus for big quality bonuses isn’t as easy to game; plus, MA enrollees are utilizing more healthcare. Ergo, the profits aren’t that interesting once you have to actually provide the services people bought. Is the gravy train is grinding to a halt at last?

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Emily Olsen, “Medicare Advantage profitability is declining, Moody’s says,” Healthcare Dive, Jan 30, 2024 READ IT HERE

More on why companies are skedaddling out of MA: earnings on the plans are edging lower despite more enrollees and higher premiums. They still make twice as much per patient than they do on their Medicaid contracts, but the profit margin overall for MA plans dropped from 4.9% to 3.4%—not enough for Wall Street. Great news, but caveat patientum: see next item.

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Terry Savage, “Insurers’ losses to squeeze Advantage plans,” Chicago Tribune, Jan 31, 2024 READ IT HERE

If MA insurers are losing money, “that should scare you. How will the insurers turn to recoup those margins? Most likely by raising costs for enrollees or by cutting services.” Impeccable logic.

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Megan Messerly, “‘The politics have changed’: South warms to expanded health benefits,” Politico, Jan 31, 2024 READ IT HERE

Glory be, there seems to be some movement toward common sense among the hold-out Medicaid non-expansion states as the idea of adding new beneficiaries has “lost its sting.” One factor: “a historic realignment that has seen more working-class voters gravitate to the GOP, largely driven by an affinity for the populist rhetoric of Donald Trump.” As the Democrats gravitate further toward the PMC and abandon low-income voters, conservative solons are now “moving out of the shadows” on whether Medicaid might not be all bad. Alabama, Georgia, and Mississippi are the states identified as getting over their ideological rejectionism, and a half million new enrollees could be the result. “Lawmakers and health care advocates also attributed the GOP’s shift to rural hospitals in conservative areas closing their doors.” North Carolina and South Dakota show the way.

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How we got here

Matt Stoller, “Obamacare created big medicine,” The Lever/BIG, Jan 29, 2024 READ IT HERE

This is a deep dive into one perhaps unintended consequence of Obamacare—the drive toward vertical integration of the whole industry. Not only are the corporate entities bigger, they’ve also combined once-incompatible functions such as acting as both provider and payer. With the conglomerates on both sides of every healthcare transaction, there’s no incentive to keep prices down and sometimes an incentive to boost them. There’s a lot more detail in the piece, well worth reading in full.

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Dharushana Muthulingam, “Why everyone hates the electronic medical record,” Logic(s), Dec 13, 2023 READ IT HERE

The promise: EMRs will be more accurate than handwritten notes; the information will be easily communicable among providers; we’ll have a huge database to turbocharge research; and we’ll all save time. The reality: redundancy, complexity, waste, providers glued to dictatorial screens while ignoring patients, data hoarding by rival provider entities (“an electronic bridge to nowhere”), multiple incompatible systems, opaque software, and violent hatred of the whole thing by doctors and nurses. The author says federal funds were pushed into EMR as an economic stimulus, leading to an emphasis on speed rather than workability. And of course, billing is the underlying priority—all else takes a back seat. One bright spot: the VA’s EHR system, which was rolled out more slowly in a process of close collaboration with clinical staff.

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Matt Stoller, “The dirty business of clean blood,” BIG, Feb 3, 2024 READ IT HERE

Should be an Edgar Allen Poe story or perhaps an H.P. Lovecraft: two companies run a ferocious near-monopoly over dialysis, which is life or death for patients. If they complain, they can get the latter. (“Clinics could and did refuse treatment to patients who complained or asked too many questions.”) Meanwhile, the Feds pick up the tab because kidney disease is a single-payer anomaly. Another oddity is that patients can’t get services far from home, so they’re stuck with local choices. Therefore, “The real acquisitions that matter are not big, but small, like whether the two dialysis clinics in their town become one.” Solution: improve at-home dialysis tech so that people can free themselves from these vampires. Fun Fact: Warren Buffet owns 40% of one of the two companies.

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New ways to torture us

Marshall Allen, “Your money or your life,” Healthcare Un-covered, Jan 31, 2024 READ IT HERE

Holy crap! This one is beyond belief: “Insured patients are showing up for medical appointments and being told to pay the ENTIRE BILL up front or they won’t get treatment. What should they do?” Can this really be happening!? Apparently yes. “Patients with health insurance arriving for appointments are told that they won’t be treated until they have paid the full price out-of-pocket—including the insurance plan’s portion—before any claim has been sent.” Why is this happening? Providers and hospitals are getting stiffed by insurance companies and so want to shift the hassle over to the sick person and their family—just as they are showing up for treatment. Medical ethics anyone?

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Adriel Bettelheim, “Surprise billing process still choked by claims: survey,” Axios, Jan 30, 2024 READ IT HERE

The No Surprises Act was supposed to force providers and insurers to stop hitting insured patients with charges no one told them about, but thinking they would cooperate was truly Pollyannish. Instead, they’ve clogged the system with hundreds of thousands of arbitration claims, sued over the rules and fees, and generally dug in their heels to protect profits. Nonetheless, some revised claims are accepted, so the measure seems to be a partial success.

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Elite disarray

Evan Bush, “A prestigious cancer institute is correcting dozens of papers and retracting others after a blogger cried foul,” NBC News, Jan 26, 2024 READ IT HERE

A lone guy with a computer in Wales spotted multiple image manipulations in research papers by top scientists at the once-respected Dana-Farber Cancer Institute in Boston. One whistleblower says pictures in the papers “looked like they had been digitally altered in ways that appeared intentional. I don’t understand how that would come as an accident.” What’s the underlying incentive system that drives people to these corrupt practices undermining our scientific establishment?

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Annalisa Merelli, “HPV vaccine study finds zero cases of cervical cancer among women vaccinated before age 14,” STAT, Jan 25, 2024 READ IT HERE

Here’s a vaccine that works as advertised, which highlights how damaging the public obfuscation over Covid has been. Scotland detected a grand total of zero cases of cervical cancer in women who were fully vaccinated against HPV in adolescence. It’s the first multi-year study to measure the effectiveness of the HPV shots. Sexophobes hate it because it presumes that vaccinated teens might avoid their due punishment for having sex.

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Pharmaceuticals

Noah Weiland, “U.S. makes initial offers in Medicare drug price negotiations,” New York Times, Feb 1, 2024 READ IT HERE

Opening salvo in what will be a long slugfest over Pharma’s current power to set drug prices in the stratosphere and force the Federal Government to pay them. Ten drugs are up for talks in the first phase of the new procedure.

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Bernie Sanders, “Big Pharma will have to answer to the American people,” Fox News, Jan 31, 2024 READ IT HERE

Tough rhetoric from The Bernie: “Why does Merck charge diabetes patients in the United States $6,900 for Januvia when the exact same product can be purchased in Canada for $900 and just $200 in France?” Et cetera. We’ll see if he can make headway against the insanely rich pharmaceuticals like Johnson & Johnson, which made $18 billion in profits last year and handed out $17 billion of that in stock buybacks and dividends. That’s enough loot to fund three lobbyists for every member of Congress.

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Elisabeth Rosenthal, “The FTC is attacking drugmakers’ ‘patent thickets,’” KFF Health News/Fortune, Jan 31, 2024 READ IT HERE

And none too soon. The patent scam has long been a favorite Pharma tool to dishonestly extend their exclusive marketing rights over big money-maker drugs. Now, the Feds have “challenged the validity of over 100 drug product patents in an effort to increase competition and potentially lower some prices.” Another innovation from the heroic FTC.

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How to corrupt

Nicholas Florko, “Juul spent big to court Black leaders to promote its e-cigarettes, new documents show,” STAT, Feb 3, 2024 READ IT HERE

Juul took a big hit a while back when its vape products were shown to poison users. But the company planned an aggressive campaign to fight bans, especially targeting prominent Black leaders—a direct copy of the tobacco industry’s playbook. Proposed targets of the Juul campaign were Al Sharpton, the NAACP, and the California Black Caucus although it’s unclear how much cash actually reached any of them. Juul also ghost-wrote articles that were later placed in Black newspapers.

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Erika Edwards, “Ohio reverses local flavored tobacco bans, infuriating doctors,” NBC News, Jan 30, 2024 READ IT HERE

“The city of Columbus, Ohio, did what the federal government has not been able to: ban the sale of menthol cigarettes. Three weeks later, the state Legislature voted to reinstate menthol and other flavored tobacco products—and strip all its cities of their ability to regulate what type of tobacco is sold.” Ohio’s smoking rate is way above the national average at 17%. Menthol cigarettes are far more popular among Black Americans than non-menthol varieties.

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Nick Corbishley, “Why is Tony Blair so keen for the UK’s National Health Service to sell off its patients’ health data to private companies?” Naked Capitalism, Feb 6, 2024 READ IT HERE

Former British PM Tony Blair has been busy raking in the billions. Now, he’s urging the National Health Service (which he helped wreck) to sell off its patients’ health data to boost the UK’s burgeoning biotech sector. It’s all consistent with Blair’s push to commercialize the once noble service, including his decision to saddle it with £11 billion of crippling debt that will cost the NHS £88 billion in repayments. Blair is particularly interested in patient data due to his long alliance with Oracle chief Larry Ellison, the world’s fourth-richest humanoid. Ellison shovels cash to the Tony Blair Institute, which courteously returns the favor by pillaging the public sector he once headed. These people are a disgrace. Meanwhile, “Last year, Oracle bought the US electronic health records giant Cerner last year for $28 billion. The company’s ultimate goal is to build a united national health database amalgamating thousands of separate hospital databases.” Britain’s massive patient data built up over decades on the public dime will come in very handy.

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Vianna Davila, “Under Ken Paxton, Texas’ elite civil Medicaid fraud unit is falling apart,” ProPublica/Texas Tribune, Jan 31, 2024 READ IT HERE

Conservatives purport to dislike government benefit programs because of “waste, fraud, and abuse.” But do they really? “For years, an elite team of lawyers at the Texas attorney general’s office went toe-to-toe with some of the biggest pharmaceutical companies in the world on a mission to weed out fraud and abuse in the Medicaid system. And the team was wildly successful, securing positive press for the attorney general’s office and bringing in money for the state—lots of it.” But when the fraud squad wouldn’t obey political interference to protect state officials’ powerful friends, it was suppressed and defunded.

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Concentration/monopolization

Dave Muoio, “New Jersey’s Atlantic health system, Saint Peter’s healthcare system plan to merge,” Fierce Healthcare, Feb 1, 2024 READ IT HERE

The FTC blocked an earlier merger attempt involving Saint Peter’s—now it has a new suitor. Saint Peters says it needs a merger for long-term survival. Given the inexorable metastasis of the entire industry, they may be right.

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Rural hospitals

Gracie Stockton, Cathy Wurzer & Mathew Holding Eagle III, “Essentia's decision to end labor and delivery services in Fosston sparks outrage,” Minnesota Public Radio, Jan 31, 2024 READ IT HERE

Rural hospitals are dropping childbirth services left and right. This closure in rural Minnesota same sparked public outrage. Forcing small-town hospitals to make money means residents get the shaft, and more high-risk pregnancies will end badly. Also, it stimulates further depopulation as the towns become less attractive to newcomers.

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Gabrielle Porter, “How hard is it for rural Colorado hospitals to hire CEOs? Ask the 24-year-old boss at the medical center in Julesburg,” Colorado Sun, Jan 22, 2024 READ IT HERE

Aidan Hettler interviewed to run the Sedgwick County Health Center in rural Colorado, ready to tell the panel that he “absolutely should not get the job.” But he did despite being only 22 with no experience. Flailing rural hospitals can’t find people willing to take the hot seat in isolated towns because they’re struggling to hire providers and fend off complaints from disgruntled locals. To repeat: rural healthcare can’t turn a profit and shouldn’t have to.

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“Nonprofit” hospitals

Gene Johnson, “After Washington state lawsuit, Providence health system erases or refunds $158M in medical bills,” Associated Press, Feb 1, 2024 READ IT HERE

A 14-hospital Seattle system is refunding a bundle of medical bills to settle allegations that it overcharged low-income patients and then harassed them for payment. Hospitals in many states are required to tell patients if they qualify for discounts but often don’t. Another good tactic for holding the “nonprofits” accountable for their tax breaks.

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Michelle Crouch, “Atrium Health: A unit of ‘local government’ like no other,” North Carolina Health News/Charlotte Ledger, Feb 5, 2024 READ IT HERE

What a clever new scam! This hospital conglomerate is legally public property and thereby avoids all taxes (even on non-medical facilities), can’t be sued for antitrust violations (which “has helped pave the way for its explosive growth”), and can use eminent domain to force property owners to sell to make way for expansions. Why haven’t other “nonprofit” hospitals figured out this hustle? They get all these benefits while acting like any other corporation and paying their execs millions.

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General bloodymindedness

Mary Van Beusekom, “US government failure to protect frontline workers from COVID led to thousands of deaths, scientists say,” Center for Infectious Disease Research and Policy (CIDRAP), Jan 30, 2024 READ IT HERE

“Federal policies on workplace exposure were developed to protect the supply chain of food or other vital products or to prevent staff shortages at healthcare facilities rather than to protect frontline workers from virus exposure. Some employers put production and profits ahead of worker safety and health.” You don’t say! As for enforcement the Occupational Safety and Health Administration “only has enough inspectors to visit every workplace once every 190 years.”

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As always, you can listen to a summary of the digest here: Do Not Resuscitate (This System)

SINGLE PAYER LINKS #333

Posted 2 FEB 2024

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Financialization/Privatization

Matt Stoller, “The nationalization of Boeing begins,” BIG, Jan 26, 2024 READ IT HERE

Not directly a healthcare story but a highly relevant one. Stoller tells how Boeing was taken over several decades ago by the neoliberal financial engineers, which was fatal for the once highly integrated technology giant. As the component parts were spun off to improve short-term profits and boost stock prices, the disintegration process accelerated: “that supplier in turn outsourced work to contractors, so now contractors of contractors are building Boeing aircraft, and no one in power knows how anything works. At the end of the day, the Reagan-era neoliberal era is crashing into reality, showing that a finance-and monopoly-friendly model of corporate governance just cannot build airplanes that work.” And I would add, cannot do healthcare either.

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Emily Olsen, “Medicare Advantage profitability is declining, Moody’s says,” Healthcare Dive, Jan 30, 2024 READ IT HERE

Profits in the lucrative privatized Medicare program may be weakening, according to a Wall Street credit rating company. The drag on profits? “Seniors utilize more medical care, and reimbursement rates tick down.” Annual earnings per member are “about double the earnings in Medicaid and 45% higher than in risk-based commercial plans.” So where is the savings that value-based care is supposed to achieve? Makes no sense.

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Paige Minemyer, “Humana CEO: Spike in MA utilization could lead entire industry to reprice plans for 2025,” Fierce Healthcare, Jan 25, 2024 READ IT HERE

All that pesky demand for the medical care we pay for is cutting into profits. Humana had a bad quarterly earnings report for its Medicare Disadvantage-heavy portfolio due to things like “increased outpatient services such as orthopedic surgeries, seasonal respiratory diseases,” etc. Expect premium hikes to follow.

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Patricia Kime, “In reversal, Defense Department, now wants to bring Tricare beneficiaries back to military health system,” Military.com, Jan 24, 2024 READ IT HERE

So much for another magical, market-based “solution” to healthcare finance issues. The Pentagon thought outsourcing care to for-profit providers would improve services and save money. Wrong again. “The Defense Department is doing an about-face, abandoning a plan to push family members and military retirees to private-sector care.” The 2017 overhaul “left military treatment facilities chronically understaffed and unable to deliver timely care to all patients.” One complicating factor: deployment of medical staff to combat zones. All those wars take a toll on resources back home.

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Susanna Vogel, “FTC sues to block Novant purchase of two CHS hospitals,” Healthcare Dive, Jan 26, 2024 READ IT HERE and Joe Marusak, “Feds sue Novant Health to try to thwart $320 million takeover of 2 NC hospitals,” Charlotte Observer, Jan 29, 2024 READ IT HERE

The Federal Trade Commission rolled out the antitrust guns once again, stopping a big NC operator from adding two more hospitals to its quiver because “the deal threatens to raise consumer prices and reduces incentives to provide quality care.” The hospital system, one of the most expensive hospital systems in the entire state, would have controlled 65% of a market in the Charlotte area.

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Covid-19

Hideki Kakeya, “Negligence by experts in the early response to COVID-19,” BMJ, Jan 24, 2024 READ IT HERE

Seriously calls out the tissue of misinformation and outright falsehoods peddled by officialdom over Covid with many examples of statements of Revealed Truth that turned out to be wrong (e.g., asymptomatic infection is rare and not likely to transmit Covid). Rule #1 of health communications: DON’T LIE. That includes pretending to know things when you’re just making it up. (If you aren’t sure, say that.) We can see the result—a huge drop in vaccinations, among other things. This is now aggravated by very compelling evidence that Covid is lab-originated, which the top scientists strongly suspected all along while saying the opposite. “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin” (The Lancet, Feb 2020). Kakeya calls for the virologists who peddled this lie to “be removed from the academic community” because hiding their secret communications led to a far worse pandemic. Wow. Worth reading in full.

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Danielle Ofri, “My patients used to be enthusiastic about the Covid vaccine. What changed?” New York Times, Jan 27, 2024 READ IT HERE

Dr. Ofri: read the article linked above, and get back to us after reviewing the ample evidence that people have every reason not to believe the official line. Her frustration with people ignoring white-coated advice leaks through: “I clear the deck, push myself away from the computer, make full eye contact and begin again. ‘Tell me what’s on your mind.’ I try to step into the gray zone of their responses and explore those awkward feelings. It’s tempting to shy away from the queasier realm of free-floating discomfort, but we can’t.” My dear doctor, it is not “awkward feelings” you are witnessing. It is well-founded distrust. Condescending comments about unruly emotions reflect a view of patients as little children who have to be told they are naughty for not believing adult messages after the adults have systematically lied to them. They are in the “queasy realm” of not wanting any more official BS from corrupt scientists.

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Max Kozlov, “Dana-Farber retractions: meet the blogger who spotted problems in dozens of cancer papers,” Nature, Jan 24, 2024 READ IT HERE

“The [once but maybe not so much now] prestigious Dana-Farber Cancer Institute (DFCI) in Boston acknowledged that it would seek retractions for 6 papers and corrections for an additional 31,” some written by their top executives. Who’s responsible for the decline in scientific credibility again? Patients with unregulated emotions?

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Mary Van Beusekom, “Updated WHO COVID prevention guidance may endanger rather than protect, some experts say,” CIDRAP, Jan 26, 2024 READ IT HERE

WHO’s newly updated Covid guidelines are a mess, and experts are telling them off. The official line remains wedded to the disproven droplet dogma, among many other shortcomings.

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Fat shots/pharmaceuticals

Rebecca Robbins, “Buried in Wegovy costs, North Carolina will stop paying for obesity drugs,” New York Times, Jan 26, 2024 READ IT HERE

The fat-shot craze is already breaking the backs of insurers: “Starting April 1, state employees in North Carolina will no longer have insurance coverage for costly weight-loss medications.” The $100 million price tag for just 3,000 people was threatening the system’s solvency. “In recent months, the University of Texas system and the hospital chain Ascension have stopped paying for the drugs for their workers.” Expect more of this.

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Arthur Caplan, “Ozempic and other weight-loss drugs are sparking a risky new war on obesity,” Scientific American, Jan 24, 2024 READ IT HERE

While states struggle with the costs of the fat shots, the companies are cranking up marketing: Lilly is starting “direct-to-consumer telemarketing. Its new website LillyDirect is a one-stop shop that helps people find a doctor or telehealth provider, who will provide prescriptions online with the drugs sent directly to them, no pharmacy needed.” What could go wrong? My X feed is chock-full of fat shot ads.

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Tina Reed, “Ozempic maker now worth more than $500 billion,” Axios, Jan 31, 2024 READ IT HERE

The Danish company Nova Nordisk is now Europe’s biggest company with a market cap—based on its stock price—$100 billion larger than the country’s entire GDP. As suspected, Europe is better at producing fat shots than artillery shells. Incidentally, “Novo is among the drug companies suing the Biden administration to scuttle Medicare drug price negotiations as unconstitutional.”

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Paige Minemyer, “Why this Fortune 100 company swapped from Caremark to a startup PBM,” Fierce Healthcare, Jan 24, 2024 READ IT HERE

Another major corporation is dumping the PBM cartel by shifting its business to a tiny competitor. Tyson Foods (140K employees) won’t get its workers meds through a Big 3 Pharmacy Benefit Manager (CVS Health Caremark). A major complaint: they can’t get straight information from the opaque PBM world. The newcomer’s model is to charge a capitation fee (per member per month) for all its services, enabling the company to provide drugs roughly at cost. This could be a trend. “People have had it with a system that only accretes profits and outcomes to a handful of large, vertically integrated insurance companies.”

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Tim Dickinson & Andrew Perez, “How Big Pharma is fueling a radical MAGA agenda,” Rolling Stone, Jan 25, 2024 READ IT HERE

Pharma is eager to block the new Medicare power to negotiate drug prices, so they are climbing into bed with the anti-abortionists and LGBTQ-hostile fanatics. “Pharmaceutical Research and Manufacturers of America, or PhRMA—donated $530,000 to groups involved with the Project 2025 agenda, policy roadmap for the early days of a new Donald Trump presidency.”

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Ian Hodgson & Christopher O’Donnell, “Records show Publix opioid sales grew even as addiction crisis prompted other chains’ pullback,” KFF Health News/Tampa Bay Times, Jan 29, 2024 READ IT HERE

“As national prescription drug distributors and pharmacies restricted the flow of oxycodone and other painkillers in response to the growing opioid crisis, Florida’s most popular grocery store ramped up its sales and distribution of the highly addictive drugs.” The Tampa paper dug into the records and found data that should induce legal pain for the supermarket chain. For some reason the state never went after Publix while collecting hefty settlements from Walmart and other opioid distributors. In a completely unrelated matter, “The grocery chain made $10.6 million in political donations in Florida from 2016 to 2022 when the state was preparing and pursuing its litigation. Most of the donations were for Republican committees and candidates, including $125,000 donated to the Friends of [state attorney general] Ashley Moody political action committee.”

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Ken Alltucker, “Diabetes patients lament drugmaker's decision to discontinue Levemir insulin,” USA Today, Jan 28, 2024 READ IT HERE

Retaliation against price controls? Insulin prices were driven down by regulatory action and public pressure, so Novo Nordisk is taking its marbles and going home. People who found this version of insulin worked for them are SOL.

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Insurance outrages/fighting back

Tina Shah & Devika Bhushan, “Other states should follow New Jersey’s lead on prior authorization reform,” STAT, Jan 25, 2024 READ IT HERE

Yay for New Jersey, which tightened up rules on prior authorization much more quickly than the lackadaisical Feds. The state forced insurers to respond in 24 hours for urgent requests (down from 15 days) and requires “actual peer-to-peer conversations for denials involving a physician from the same specialty.” Insurers also have to collect data on their denial practices. A slew of other states have similar bills pending; Federal mandates—weaker than New Jersey’s—don’t kick in until 2027. NB: “The recent New Jersey victory was fueled by an unprecedented joint mobilization of clinicians and patients, who together sent thousands of letters to legislators, strengthening the negotiating power of the Medical Society of New Jersey and other advocacy groups.”

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Elisabeth Rosenthal, “Ouch. That ‘free’ annual checkup might cost you. Here’s why,” KFF Health News/Washington Post, Jan 26, 2024 READ IT HERE

“Over the past several years, the medical industry has eroded the ACA’s guarantees, finding ways to bill patients in gray zones of the law. Patients going in for preventive care, expecting that it will be fully covered by insurance, are being blindsided by bills, big and small. The ACA’s authors didn’t reckon with America’s ever-creative medical billing juggernaut.” Yes, sir, your procedure was covered, but this little doohickey isn’t included. Also, careful with those innocent-sounding questions from your provider. One patient “learned that he had incurred the additional charge because when his doctor asked if he had any health concerns, he mentioned that he was having digestive problems. So, the office explained, his visit was billed as both a preventive physical and a consultation.” Next time, said the incredulous patient, when they ask me if I have health concerns, “I’ll say no, even if I have a gunshot wound.”

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Jordan Rau, “Senate probes the cost of assisted living and its burden on American families,” KFF Health News, Jan 25, 2024 READ IT HERE

Congress is hearing horror tales about the unsustainable costs of assisted living facilities, which are not federally regulated (unlike nursing homes). The national median cost is $54,000 a year, so only a tiny slice of the population can even get close enough to complain about it.

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Nada Hassanein, “More states offer health care coverage for certain immigrants, noncitizens,” Stateline, Jan 26, 2024 READ IT HERE

Colorado and California already have income-based criteria independent of citizenship status. A lot of the resentment these policies generate against immigrants would be neutralized if we were all freed from our insurance nightmares.

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David Raths, “OSU Wexner partners with CVS Accountable Care on ACO,” Healthcare Innovation, Jan 25, 2024 READ IT HERE

“OSU Wexner” is named for major donor Leslie Wexner, better known as Jeffrey Epstein’s BFF. Will the new outfit have pediatric services?

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“Readers weigh downsides of Medicare Advantage and stick up for Mary Lou Retton,” KFF Health News, Jan 29, 2024 READ IT HERE

KFF poked fun at the famous gymnast for not having health insurance and getting slammed with huge bills. Readers were not having it. One wrote back: “This notion that commercial health insurance guarantees access to health care is a false one. The industry business model is ‘Denial of Care.’ To suggest a citizen was not intelligent enough to navigate the barbaric and cruel commercial health insurance industry’s non-system of health care is reprehensible and repugnant.”

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Samantha Liss, “The colonoscopies were free, but the ‘surgical trays’ came with $600 price tags,” KFF Health News/NPR, Jan 25, 2024 READ IT HERE

More evidence on insurer-provider collusion to get around the “no-charge” services they’re supposed to offer. Once again, patients have to complain, appeal, threaten, denounce, and refuse to pay. “Health care providers may bill how they choose as long as they abide by their contracts with insurance—including for whatever goods or services they choose to list, and in ways that could leave patients with unexpected bills for ‘free’ care.” What a waste of everyone’s time and resources.

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Noah Weiland, “It’s boom times for Obamacare. Will they last?” New York Times, Jan 25, 2024 READ IT HERE

Given that the “boom” is strongly correlated to kicking 30 to 40 million people off Medicaid, it will probably wind down even before the extra subsidies offered during Covid expire in 2025. Now that people are back to work, and “the economy” is safe, the urgency for low-income people to have healthcare is over.

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Bobby Jindal & Heidi Overton, “To make health care affordable, give patients choices,” Newsweek, Jan 25, 2024 READ IT HERE

Ah, “choice,” the free-market magic that will ease all pain. Jindal was the governor of Louisiana and here flogs the tired idea that healthcare is just another commodity that responds to the same rules as Taylor Swift concert tickets. The authors correctly note that the ACA shovels money to insurance companies via the federal subsidies and proposes that the money flow be shifted from Federal Government to individuals and then to the insurance companies. And this is going to solve the affordability issue how? By enabling us to go healthcare shopping and impose market discipline on the insurance cartels. Whatever Bobby is smoking, I want some.

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Jason Millman, “More than half of U.S. rural hospitals don’t offer maternity care,” Axios, Jan 23, 2024 READ IT HERE

Two hundred rural hospitals—more than half—have stopped delivering babies in the past decade. If those country ladies would just stop getting pregnant, problem solved. Rural healthcare may not be profitable—so what? Neither are rural post offices.

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Ean Bett, “Why are sneaky big hospitals gobbling up tiny doctors’ offices and changing their logos?” Columbus Dispatch, Jan 24, 2024 READ IT HERE

Because “large hospital systems are purchasing independent physician offices, then charging patients more to offer the same services. You read that right—big hospitals buy local doctors’ offices, change the logo on the door, and raise the prices.” It’s called a “facility fee,” entirely legal, even when the service isn’t taking place in a hospital (the “facility”). Close one scam door, another opens.

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Jaymie Baxley, “Medicaid expansion bringing swift benefits in North Carolina,” North Carolina Health News, Jan 23, 2024 READ IT HERE

The state quickly added tens of thousands of new beneficiaries. The article contains stories of people whose lives were saved.

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Mike Stobbe, “The US hasn’t seen syphilis numbers this high since 1950. Other STD rates are down or flat,” Associated Press, Jan 30, 2024 READ IT HERE

A new/old epidemic due, according to one expert, to lack of testing. Maybe that’s not considered “medically necessary” for reimbursement.

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Don't miss the story on the White House pharmacy!

Tim

For an easy-listening summary version, go to LISTEN TO PODCAST

SINGLE PAYER LIKS #332

Posted 26 JAN 2024

It’s revealing to read healthcare finance news for the insider comments and the speeches of bond traders and investors at high-powered conferences. The language is all about how to make money on this commodity that happens to involve taking care of people who are sick or injured. They could be talking about plastic toys or lacrosse tournaments.

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Healthcare investment opportunities

Molly Castle Work & Arthur Allen, “What the health care sector was selling at the J.P. Morgan confab,” KFF Health News/CBS News, Jan 22, 2024 READ IT HERE

Over 8,000 people crammed into the “J.P. Morgan Healthcare Conference” where they learned that “the world’s first trillion-dollar drug company is out there somewhere.” Can’t wait! Non-profits were major players showing off their investor appeal. “When headliners like the Mayo Clinic and the Cleveland Clinic took the stage, chairs were filled, and late arrivals crowded in the back of the room.” We can assume not much attention was paid to the alleged “community benefits” these hospitals provide in exchange for freedom from taxation. They pitched their wares to Wall Street, “eager to demonstrate financial stability and showcase money-making mechanisms besides patient care.” [Non-profit] Mass General Brigham touted its corporate partnerships in drug development and the 300 for-profit companies it has helped create. Said one hospital CEO, “I think we’re a great, undervalued investment, and we get a great return.” J.P. Morgan—we’re always at your bedside, right behind the nurse!

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Tom Murphy, “Late-year medical costs spike forces Humana to scale back profit expectations for 2023,” Associated Press, Jan 18, 2024 READ IT HERE

The language is priceless: “Shares of Humana tumbled Thursday after the health insurer said it was dealing with higher-than-expected costs from its Medicare Advantage customers, forcing it to chop profit expectations.” English translation: People are starting to get the services they have been paying us for. Quick! Do something!

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Rebecca Pifer, “Humana slashes 2023 profit outlook as high medical costs continue,” Healthcare Dive, Jan 18, 2024 READ IT HERE and “Humana posts big loss, dour outlook on Medicare Advantage cost spike,” Healthcare Dive, Jan 24, 2024 READ IT HERE

These earnings reports from insurance companies reveal the obvious: providing healthcare cuts into profits. “Humana is the latest victim of elevated medical costs in the fourth quarter. Members utilized more healthcare than expected as the year drew to a close.” Earnings-per-share dropped as “seniors who put off non-essential care during the COVID-19 pandemic returned in droves to their doctors’ offices.” Can’t have that! Here’s the solution: “Payers promised investors that they were heading off the worst of medical care spikes through plan pricing [higher premiums] and cost containment measures [more denials and delays].” Humana gets most of its revenue from Medicare Disadvantage plans. A few days after this report, Humana stock took a 15% nosedive when it reported poor earnings “plagued by high medical spending,” i.e., having to do its job. Looks like the new rules forcing this MA plans to act like traditional Medicare might be undermining the business model. If so, YAY!

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Rebecca Pifer, “Elevance controls medical costs to $6B profit in 2023,” Healthcare Dive, Jan 24, 2024 READ IT HERE

This insurance company “curbed the worst of medical cost growth last year,” leading to happy faces all over Wall Street. Over at Elevance, they really know how to stop the bleeding—of corporate profits, that is. “Utilization concerns” (a.k.a. spending on healthcare) were bugging investors and pushing Elevance’s shares down, but this good news perked those numbers right up.

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Susanna Vogel, “Financial distress drove nearly a third of hospital M&A in 2023: Kaufman Hall,” Healthcare Dive, Jan 19, 2024 READ IT HERE

Concentration in the sector is driven by “financially distressed” hospitals being gobbled up by more prosperous ones. But that doesn’t answer the question of why so many hospitals can’t stay solvent despite the insane prices we all pay. Cited study available at www.kaufmanhall.com

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Anna Claire Vollers, “‘Shell game’: When private equity comes to town, hospitals can see cutbacks, closures,” Stateline, Jan 18, 2024 READ IT HERE

“Private equity buys out a hospital, saddles it with debt, and then reduces operating costs by cutting services and staff—all while investors pocket millions. Before the dust settles, the private equity firm sells and leaves town, leaving communities to pick up the pieces.” A few states are moving to rein in these outrages, but it’s already too late for the wrecked communities. PE now owns one out of every three for-profit hospitals in the U.S.

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Mike Scarcella, “Chicago’s NorthShore hospital to pay $55 mln in class-action settlement,” Reuters, Jan 18, 2024 READ IT HERE

When hospitals merge or are acquired, deal-makers and executives promise all sorts of things. Consumers had to battle this outfit in court for 16 years over unfulfilled agreements and finally settled for some cash.

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CUNY Graduate Center, “Who is most efficient in health care? Study finds, surprisingly, it’s the VA,” Medical Xpress, Jan 19, 2024 READ IT HERE

ZOMG socialized medicine scores higher: “Private-sector hospitals, clinics, and insurers are bloated, bureaucratic nightmares. Profit-seeking insurers try to avoid paying for care by imposing complex rules and documentation requirements.” Puzzling—what about those magical free-market incentives? “The VHA’s 171 medical centers and 1,113 outpatient sites receive lump-sum budgets covering almost their entire operations.” That’s a lot of billing paperwork dispensed with.

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Sarah Jane Tribble & Tony Leys, “Federal program to save rural hospitals feels ‘growing pains,’” KFF Health News/NPR, Jan 16, 2024 READ IT HERE

Some new federal aid is available to failing rural hospitals that agree to strip away everything but emergency and some outpatient services. Does this really “save” a hospital? And the payments aren’t overwhelming: 5% more for Medicare reimbursements and an average annual payment of around $3 million. Dissidents say small hospitals should be allowed to keep a dozen beds—perhaps including a psych and/or detox unit—given their difficulties of transferring people who may be in urgent need. And what about a birthing unit?

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Consumers

Emily Olsen, “Rising health insurance premiums linked to wage stagnation, study finds,” Healthcare Dive, Jan 17, 2024 READ IT HERE

Duh! If your employer is shelling out a small fortune for health benefits, not much will be left over for wages. This is not hard. “Families with employer-sponsored health insurance lost out on an average of more than $125,000 in earnings over the past 30 years.” Premiums absorbed around 8% of compensation in 1988; now it’s close to 18%. Meanwhile, nearly half of those covered under employer-sponsored plans face financial hardship in actually getting the care they paid for. Conclusion: we sacrifice income for health insurance that we can barely use.

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Mitchell Black & Noam N. Levey, “In this Oklahoma town, most everyone knows someone who’s been sued by the hospital,” KFF Health News/NPR, Jan 19, 2024 READ IT HERE

The town has 20,000 inhabitants; 5,000 of them have been sued by the town’s hospital in the last three decades. Voila! a solution for rural hospitals—mass debt peonage!

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Jessica Glenza, “Majority of debtors to US hospitals now people with health insurance,” Guardian, Jan 11, 2024 READ IT HERE

Uninsured people used to be the ones who ended up with medical debt. Now, out-of-pocket costs are so astronomical that everyone is getting hit—100 million Americans have medical debt of some kind. Obamacare plans permit nearly $10K in annual out-of-pocket costs—not counting premiums.

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Kate Gibson, “New York City looks to clear $2 billion in unpaid medical bills for 500,000,” CBS News, Jan 22, 2024 READ IT HERE and Roanoke Times, “Secular Society retires over $12 million in Southwest Virginia medical debt,” Jan 20, 2024 READ IT HERE

Everybody’s getting into the act with RIP Medical Debt, which buys up unpaid bills at a discount and forgives them. NYC will spend $18 million to erase more than $2 billion in debt hanging over city residents. An outfit named the Secular Society is doing the same for southwest Virginia residents. But as the next item shows, this is well-intentioned charity that solves nothing.

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Toni Preckwinkle, “We in Cook County have decided to abolish medical debt this year. Join us,” Newsweek, Jan 22, 2024 READ IT HERE

Cook County joins in, and the president of its Board of Commissioners has noble thoughts about it. But how does erasing old debt abolish the practice? “True justice extends even further into accessible and affordable healthcare for all,” says one commissioner. Very true, but the Biden folks and his party have made it clear that’s not on the table. Nonetheless, temporary relief measures like these make good campaign copy: “Using funds provided by President Joe Biden's American Rescue Plan Act, [the debt wipeout] has been a beacon of hope for our most vulnerable residents.” Ah. Cue heart-warming stories of individuals helped by the one-off debt forgiveness.

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Pharmaceuticals

Rebecca Robbins & Christina Jewett, “Six reasons drug prices are so high in the U.S.,” New York Times, Jan 17, 2024 READ IT HERE

Here are the six: (1) Lack of central government negotiating power; (2) No price controls; (3) Perverse incentives to doctors, hospitals, and intermediaries to, for example, use more expensive drugs when their fees are calculated as a percentage of the price; (4) An insanely complex and oblique purchasing system riddled with middlemen; (5) Patent manipulation (indulged by regulators and the courts); and (6) American wealth that can “bear” the prices charged. That last point is a variant of the famous Willie Sutton response to the question about why he robbed banks: “Because that’s where the money is.”

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Aimee Picchi, “Drugmakers hiking prices for more than 700 medications, including Ozempic and Mounjaro,” CBS News, Jan 18, 2024 READ IT HERE

Pharmaceutical companies are hiking prices for more than 700 medications, on average 4.5% but rising to 9% for some like the antidepressant Wellbutrin. The fat shots hover steadily at around $1K a month. Insulin prices were driven down by government action, which was quickly followed by insulin producers trying to retain the Medicare/Medicaid market. “The price of Novo Nordisk insulin products (Novolog) declined 75% compared with a year earlier.” Regulatory action works in the rare case that it is attempted.

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Theresa Gaffney, “Nearly 1 in 10 teens globally have used ‘budget Ozempic’ laxatives and other risky weight loss products, per study,” STAT, Jan 10, 2024 READ IT HERE

Teens can find stuff online that don’t require a doctor’s note, much less a prescription. Then there’s “budget Ozempic”—laxatives. But hey, no need to rein in those sexy ads. What could go wrong?

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Melissa Rudy, “Ozempic and Wegovy overdose calls have spiked, experts say,” Fox News Media, Jan 21, 2024 READ IT HERE

Reported overdoses on the fat shots more than doubled last year, including the counterfeit versions but also prescription products. People aren’t supposed to jump right into the full dose but sometimes do.

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Lauren Clason, “Long COVID advocates ask Congress to improve federal response,” Roll Call, Jan 18, 2024 READ IT HERE

“We are living through the largest mass disabling event in modern history.” But the urgency disappeared when people could go back to work, so a mass disabling won’t get emergency attention unless it cuts seriously—and noticeably—into the workforce.

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Mark Zdechlik & Russ Schmidt, “New Minnesota prescription drug board gets up and running but expects industry resistance,” Minnesota Public Radio, Jan 17, 2024 READ IT HERE

State leaders are “impatient with the pace of activity in Congress,” as in little to none. Minnesota joins Colorado in establishing these boards with the added twist that Minnesota’s has more power to cut prices on a drug it determines is overpriced. Industry lawsuits will follow along with screeches of indignant outrage.

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Brittany Tang, “The White House has a pharmacy—and it’s been a mess, a new investigation found,” STAT, Jan 23, 2024 READ IT HERE

Free drugs for the taking! Here’s how the world of the rich and powerful works: we have rules; they don’t. At the White House’s drug bin, “A doctor once asked if the staffer could give someone a controlled substance ‘as a parting gift for leaving the White House.’” Others handed out controlled drugs without prescriptions or allowed staff to use aliases, and records of distributions of fentanyl, ketamine, morphine, and Ambien were illegible, sloppy, or non-existent. Just say yes!

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Workforce

Alexis B. Paulson, “‘Brain drain’ of Tennessee doctors and nurses is real. State laws need to change,” The Tennessean, Jan 15, 2024 READ IT HERE

Tennessee refuses to expand Medicaid. Its rural hospitals are on the ropes. Doctors dealing with failed pregnancies that endanger women face legal jeopardy. Pay is low, and working conditions worsen. What medical professional would want to study and work in Tennessee?

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Rebecca Pifer, “Nurse sues UPMC over alleged labor abuses,” Healthcare Dive, Jan 23, 2024 READ IT HERE

Pushback against concentration/monopolization: “A nurse is suing the 95,000-employee University of Pittsburgh Medical Center for allegedly leveraging its monopoly control over the employment market in Pennsylvania to keep wages down and prevent workers from leaving for competitors, all while increasing their workload.” The plaintiff nurse seeks class action status to represent other staff at the “nonprofit” system. UPMC is the largest private employer in Pennsylvania; over the last two decades, it “acquired 28 competing healthcare providers, greatly expanding its market power.”

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General bloody-mindedness

Charles M. Blow, “Turning down food aid for millions of children reflects shocking political callousness,” New York Times, Jan 17, 2024 READ IT HERE

Fifteen states skipped the deadline to apply for a new federally funded program that would have provided $120 per child for groceries during the summer to children of low-income families. Surprise! half are Medicaid non-expansion states. Ergo, poverty is not an accidental outcome of policy but rather the goal.

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SINGLE PAYER LINKS #331

Posted Posted 19 JAN 2024

Also, tired of reading? Listen to a summary by Snidely Whiplash here: LISTEN TO PODCAST

Payment systems

Bryce Covert, “What happened to my health insurance?” New York Times, Dec 20, 2023 READ IT HERE

THE TOLL of people who have lost their Medicaid post-Covid: 14 million-plus and rising. This article has stories of people being surprised at the ER or in a pharmacy when they find out they’ve been dumped from Medicaid. The Covid-era freeze on eligibility tests meant people could take on better-paying jobs without worrying about their eligibility. No longer. Now, governors like Arkansas’ Sarah Huckabee Sanders are free to campaign against “government dependency” and bring out the axe. Question: Will the 30 million people set to lose Medicaid show up in 2024 to vote for the Democrats who presided over this nightmare? Asking for a friend.

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Benjamin Hardy, “Biden administration ‘deeply alarmed’ by Arkansas’s rush to kick kids off Medicaid,” Arkansas Times, Dec 18, 2023 READ IT HERE

Ooh, they’re “deeply alarmed,” I’m so skeered, says Governor Cruella de Ville. Arkansas has tossed 18% of child enrollees off Medicaid after they refused to work in chicken slaughtering plants (kidding!) “Advocates say the state emphasized speed over accuracy, booting many people off their insurance who were in fact eligible.”

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Joe Mario Pedersen, “Tech glitches among the top worries as Florida’s new Medicaid portal opens,” WMFE/Health News Florida, Dec 5, 2023 READ IT HERE

Florida rolled out a new online system for accessing state Medicaid, SNAP, and other benefits right during Medicaid re-eligibility applications were due. Eight million Floridians had to create new accounts at once, so—news flash—the system broke down. Making things difficult-to-impossible for people to get benefits they’re theoretically eligible for is an easy way to save money without leaving fingerprints.

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Neelam Bohra, “Nearly 1.7 million Texans lose Medicaid as state nears end of unwinding,” Texas Tribune, Dec 14, 2023 READ IT HERE

Texas has booted the most people from Medicaid of any state in the country. Trying to fix the administrative mistakes behind the majority of the cases is complicated by the “backlogs of hundreds of thousands of applications” for Medicaid and SNAP food benefits. Austin congressman Lloyd Doggett cited “an incredible amount of incompetence and indifference to poor people,” as if that were a mistake.

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Chelsea Cirruzzo, “Biden administration pleads with states after millions of kids lose Medicaid coverage,” Politico, Dec 18, 2023 READ IT HERE

“Fear us! We’re going to send you a stern letter!” This is regulatory action? Subject line: “Please don’t be so mean!”

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Brandon Smith, “Indiana Medicaid program is $1 billion more expensive after forecasting error,” WFYI/IPB News, Indianapolis, Dec 19, 2023 READ IT HERE

Miscalculations like Indiana’s won’t help those pushing the hold-out states to expand Medicaid. The accounting error is attributed to home- and community-based long-term care services, which were easier to get during the Covid, but then people turned out to need them permanently. Who coulda knowed?

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Drew Altman, “The CBO report that didn’t roar,” KFF Health News, Jan 4, 2024 READ IT HERE

The CEO of this respected health news outlet says we should pay more attention to a study that the Fed’s ballyhooed Centers for Medicare and Medicaid Innovation (CMMI) not only didn’t save the government a dime, but that their “value-based care” experiments actually cost Washington $5 billion in extra spending. That goes against the pro-market propaganda that all U.S. health care needs is a little more competition, transparency, and rugged entrepreneurship, including private equity goons invading from Wall Street. The individual experiments had a more mixed record, but the overall conclusions were brutal. That won’t stop the privateers from continuing their push to cram people into for-profit Medicare Disadvantage schemes or the like. “CMS’s goal remains to see every Medicare beneficiary in some form of accountable care arrangement in 7 years.”

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Matthew Cunningham-Cook, “The great Medicare Advantage marketing scam: How for-profit health insurers convince seniors to enroll in private Medicare plans,” Healthcare Un-covered, Jan 10, 2024 READ IT HERE

Among the unscrupulous marketers, one that stands out is TogetherHealth, “a subsidiary of Benefytt Technologies, owned by Madison Dearborn Partners, a Chicago-based private equity firm with ties to former Chicago mayor and current Ambassador to Japan Rahm Emanuel [and that runs those Joe Namath ads]. In 2022, the Federal Trade Commission forced Benefytt to repay $100 million for fraudulent activities.” But the company is still in the MA business.

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Noah Tong, “Medicare Advantage analysis sparks infighting at MedPAC meeting,” Fierce Healthcare, Jan 12, 2024 READ IT HERE

Sounds like a real food fight! MedPAC (the Medicare Payment Advisory Committee) is supposed to advise Congress and has been sympathetic to privatization plans like Medicare Advantage. But criticism slipped through, and the industry shills immediately screamed “politics!” Their systematic infiltration of Medicare to extract profits isn’t “political,” of course.

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Rebecca Pifer, “MA spending to outstrip traditional Medicare by $88B this year: MedPAC,” Healthcare Dive, Jan 16, 2024 READ IT HERE

The federal government could pay Medicare Advantage plans $88 billion more this year than it would be spending if those seniors were in traditional Medicare.” Inconvenient datum, so gotta accuse the messengers of getting all “political.”

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Susan Morse, “CMS suspends enrollment and marketing for two Centene Medicare Advantage plans,” Healthcare Finance, Jan 11, 2024 READ IT HERE

Two Arizona and North Carolina MA plans get the boot after failing the Feds’ benchmarks for 3 years straight.

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Sydney Halleman, “Kentucky-based Baptist Health drops UnitedHealthcare, Centene MA plans,” Healthcare Dive, Jan 10, 2024 READ IT HERE

Another large hospital system dumped Medical Disadvantage plans due to “denials and delays of medically necessary care to our patients.” This is the same outfit that was just unceremoniously dumped by the Feds in Arizona and North Carolina. Is someone at HHS paying attention at long last?

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Rebecca Pifer, “CMS finalizes rule tightening prior authorization turnaround for insurers,” Healthcare Dive, Jan 17, 2024 READ IT HERE

The Feds (eventually) will tighten the rules governing abusive prior authorization practices by MA plan runners—a max of 72 hours for urgent requests and 7 days for the rest. But the rule only takes effect 2 years from now. (It also will apply to Medicaid and CHIP plans.) “Payers will also have to provide a specific reason for denying a prior authorization request.” Why does this have to wait until 2026?

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Tara Bannow, “Hospitals try a new pitch to investors: other ways of making money,” STAT, Jan 8, 2024 READ IT HERE

Paywalled, but get a load of this lede: Nonprofit hospitals have “all but abandoned the prospect of making significant profit on patient care. Instead, they’re fully throwing their weight into other ways of making money—things like developing drugs or selling insurance. This news came out of the “J.P. Morgan Healthcare Conference,” which says a lot just in the title. Attendees at this dollar-sign-focused healthcare powwow heard about how hospitals need “revenue diversification” because they’re all losing money on taking care of patients in hospitals. Given the insane explosion of costs to us lowly peons, the fact that hospitals can’t make it suggests someone—an intermediary perhaps—is extracting all the loot.

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Paul Gallagher, “Wes Streeting wants to make it easier for tech firms to collaborate with the NHS,” Inews, Dec 29, 2023 READ IT HERE

Britain’s New Labour party is charging ahead to privatize the U.K.’s health system. (Streeting is the health minister-in-waiting.) His language is neoliberal gold, promising to “hold the door wide open to entrepreneurs” so that they can gobble up parts of the National Health Service stripped bare by successive Tory and Labour governments.

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Pharmaceuticals

Hope Stonner, “Colorado’s Prescription Drug Affordability Board shouldn’t buy into pharma industry fear tactics to protect its profits,” Colorado Sun, Dec 1, 2023 READ IT HERE

Colorado, followed by Minnesota and Illinois, is trying to rein in drug prices, starting with the five most expensive drugs used in the state. No one expects action from Washington in an election year; states are on their own.

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Rebecca Pifer, “Walgreens to pay Humana $360M to settle drug pricing dispute,” Healthcare Dive, Jan 9, 2024 READ IT HERE

The insurer said Walgreens’ pharmacy savings club gave people big discounts and then fraudulently collected the full price of the drugs from insurance companies. Humana won in court but settled for half the award to avoid further litigation.

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Jonathan Saltzman, “Sage CEO sees encouraging sales for new pill for postpartum depression,” Boston Globe, Jan 11, 2024 READ IT HERE

Paywalled, but graf #3 has this gem from Barry Greene, chief executive of Sage Therapeutics: “I believe that Zurzuvae is the key that unlocks the blockbuster potential of postpartum depression.” Isn’t life-threatening disease a great thing? I mean, money can be made!

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Beth Mole, “Canada vows to defend its drug supply against Florida importation plan,” Ars Tecnica, Jan 9, 2024 READ IT HERE

Those annoying Canadians say they can’t solve our pharmaceutical problem. What a selfish attitude! “Bulk importation will not provide an effective solution to the problem of high drug prices in the US,” says Health Canada, which negotiates better prices for their drugs. Apparently, nobody further south understands that concept. Maybe someone could sled down from Toronto and give us a tutorial!

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Industry concentration

Dave Muoio, “Healthcare Dealmakers—Jefferson Health, LVHN's $14B merger; Cigna's M&A shuffle and more,” Fierce Healthcare, Jan 3, 2024 READ IT HERE & Bruce Japsen, “Instead of Humana merger, Cigna opts for $10 billion stock buyback,” Forbes, Dec 10, 2023 READ IT HERE

This is a round-up of attempts by the healthcare Godzillas to merge and expand further. The biggest—mega-insurers Cigna and Humana’s potential $140 billion marriage proposal—crumbled though the author suggests it wasn’t due to regulatory action, which it certainly would have attracted had it prospered. The Forbes article says Cigna decided to enrich its shareholders instead with a massive stock buyback. No regulatory issues there. Cigna’s return on capital has averaged 13% annually—a lot better than I get on my savings account!

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Rebecca Pifer, “Amazon launches chronic condition management portal,” Healthcare Dive, Jan 8, 2024 READ IT HERE

Amazon’s new tool will look for “eligible benefits” to manage a variety of conditions when users search Amazon for related devices, “like a glucose monitor or blood pressure cuff.” As if we don’t have enough snooping into our online data, now we need one of these faceless algorithms to pop up and say, “You need us to provide you with a billable service!” Not quite as attractive as moseying over to old Doc Smith’s office on Maple Street. “Amazon has reportedly struggled to convince its members to sign up for its healthcare programs” like Amazon Pharmacy or One Medical, despite discounts. Maybe because some people actually value their privacy and don’t want to get their care from robots?

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Rebecca Pifer, “Elevance, BCBSLA resurrect $2.5B merger,” Healthcare Dive, Dec 23, 2023 READ IT HERE

Bad news for Louisianans as the state’s Blue Cross/Blue Shield revives a merger with a for-profit insurer. A prior attempt was blocked by state regulators “concerned about their potential to raise premiums, shrink networks, and lower provider reimbursement.” So, the two companies put lipstick on it and resubmitted.

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Regulatory capture

Kelli Whitlock Burton, “DSM-5-TR panel members received $14M in undisclosed industry funding,” MedScape Medical News, Jan 10, 2024 READ IT HERE

Over half of the doctors who write the famous DSM-5 received undisclosed industry funding. The Diagnostic and Statistical Manual of Mental Disorders is how providers get official recognition for their specialties, and it’s a key step toward treatment reimbursements. Many of the payments or gifts to the DSM writers were minor amounts (though some were in six figures), but that’s not the point. People feel obligated when they receive free stuff, whatever the value. “Of the 168 individuals listed as contributors to the manual, 92 [were] U.S.-based physicians with industry payments.” Doctors with a special interest in a particular diagnosis will push hard for expanding its definition.

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Roni Caryn Rabin, “U.S. diet panel adds another researcher with alcohol industry ties,” New York Times, Jan 10, 2024 READ IT HERE

These so-called “scientific advisory” bodies are so consistently infiltrated by monied interests as to be pretty useless. One critic summarizes it: “How could they appoint someone with a history of alcohol funding after removing the other two because of alcohol funding?” It’s out in the open now: hypocrisy, “the compliment that vice pays to virtue,” has disappeared. “Dr. Luc Djousse [from Harvard] has been funded by the Alcoholic Beverage Medical Research Foundation, an industry group. He was recently a featured speaker at a Beer and Health Symposium put on by beer makers.” He’ll be teaching us about the health impact of booze—take careful notes!

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Randy Hatton, “How two pharmacists figured out that decongestants don’t work,” Scientific American, Dec 21, 2023 READ IT HERE

Luckily, they didn’t have a multi-billion-dollar federal agency obstructing their observations. But it took the Food & Drug Administration 16 years to finally sit down and look at the scientific evidence that it was letting people buy an OTC medicine that was completely useless. “We naively contacted the FDA to inform them of what we had found. They were not interested. Oral phenylephrine was not harming anyone, so they saw no need to limit sales.” It’s still on the shelves.

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Structural issues

Toby Bressler & Lauren Ghazal, “The nursing staffing crisis has hit one role particularly hard: the nurse manager,” STAT, Jan 12, 2024 READ IT HERE

Nurse managers recruit and run nursing staff. “Hit hard by Covid burnout,” fully one third are unhappy at work, and 20% plan to leave their jobs due to “burnout and moral distress driven by unsustainable workloads, lack of work-life balance, and ever-increasing scope of responsibility.” They are “straw bosses,” stuck between senior leadership cutting costs and nurses trying to provide care.

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Caitlin Dewey, “Children’s nutrition program, revved up in the pandemic, faces severe cuts,” Stateline, Jan 8, 2024 READ IT HERE

The Special Supplemental Nutrition Program for Women, Infants, and Children—better known as WIC—is growing, but many of those eligible can’t access it. Once again, a feature, not a bug. “Many of the technology changes [like remote screening] that made it easier to participate were authorized by temporary federal waivers during the pandemic, and Congress would need to change the law to extend them.” Since Covid is officially no biggie, and people are safely back at work, it’s time to make benefits hard to get again. “A mother with two young children might have to visit her WIC clinic as often as three times a month to maintain her status in the program.”

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Jeneen Interlandi, “48 million Americans live with addiction. Here’s how to get them help that works,” New York Times, Dec 13, 2023 READ IT HERE

This is a gigantic series on what we’re doing wrong to address substance abuse. Its key message is that we know what to do but just aren’t willing to do it (or to pay for it). Known treatments, therapies, and strategies have proven effective in other countries and even in some states. But for the most part, the U.S. relies on a punitive model based on fallacies and prejudices about addiction and addicts. “Most medical professionals are still not comfortable or even familiar with the basics of addiction medicine. Neither are the judges, probation officers, or wardens who often hold sway over the fates of people with use disorders.” And it’s easy to win cheers with demagogic attacks on the addicted. The most pressing obstacle: poor salaries and insecure employment prospects for a critically understaffed workforce. The bright spot is Rhode Island’s holistic approach where prison officials, providers, and policymakers sat down to thrash out a strategy that actually works. Worth reading in full.

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Dilpreet Raju, “New Illinois program aims to fill gaps amid drug counselor shortage and record overdoses,” Capitol News Illinois/St. Louis Public Radio, Jan 9, 2024 READ IT HERE

One state trying to address the workforce problems noted in the last story. Illinois is only going to spend $3 million on this initiative—that’s couch lint compared to the vast opioid settlement money ready to course through states’ budgets. The median salary for a behavioral health counselor in Illinois is about $48K, but many make $30K.

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Anika Nayak, “New York’s new doula plan will cover services for anyone on Medicaid,” STAT, Jan 12, 2024 READ IT HERE

Good news although the pilot program’s reimbursement rates were crazy-stingy ($606 for eight visits and delivery accompaniment!). They will increase under the new, permanent program, but not by enough. Doula services reduce pain, use of C-sections, and labor time while increasing satisfaction with the birthing experience.

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Natalie Duddridge, “Health care workers protest closure of midwifery services at Manhattan hospital,” CBS News New York, Jan 12, 2024 READ IT HERE

One step forward, two steps back. “Allen Hospital [Inwood] announced the closure of its midwifery program with no explanation,” terminating seven midwives. Let me guess: hospitals get higher reimbursements if midwives are replaced by OB/GYNs? Asking for a friend.

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Sandee LaMotte, “Plastic chemicals linked to $249 billion in US health care costs in 2018 alone, study finds,” CNN, Jan 11, 2024 READ IT HERE

Mind-boggling evidence of harm from just four hormone-disrupting chemical groups out of the 16,000 chemicals used in making plastics (3,000 of which are known to be hazardous). “The four chemicals measured in the new study have been widely studied over decades. All are thought to interfere with the endocrine system and cause damage to developmental, reproductive, immune and cognitive systems.” But the serious money is to be made in drugs to treat the resulting diseases, not in preventing them.

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Maya Goldman, “States’ big 2024 health plans: Workforce support and cheaper drugs,” Axios Vitals, Jan 11, 2024 READ IT HERE

Now that the bountiful Covid dollars are no more, “at least 21 states last year considered legislation related to minimum nurse staffing levels as nurses warned that their heavier workloads were putting patients in danger.” Two states are experimenting with drug affordability boards, and a whopping 48 have Medicaid waiver requests pending.

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SINGLE PAYER LINKS

Posted Posted 12 JAN 2024

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I’m grouping the items thematically now—an outgrowth of my efforts to organize this material for easier listener comprehension on Podbean , which you can access here Do Not Resuscitate (This System) #330 Jan 12 2024. —Tim

Our bizarro-world payment system

Sarah Jane Tribble, “Older Americans say they feel trapped in Medicare Advantage plans,” KFF Health News/NPR, Jan 5, 2024 READ IT HERE

Because they are: Seniors are lured into signing up for MA plans with bells and whistles like gym memberships and eyeglasses. Then, when real health-related expenses kick in, they discover limited networks and prior authorization hell as the for-profit insurers try to deny them expensive care. When enrollees want to go back to traditional Medicare and a supplemental to absorb the 20% Medicare doesn’t cover, they face denials over pre-existing conditions in 46 states.

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Jakob Emerson, “Humana used AI tool from UnitedHealth to deny Medicare Advantage claims, lawsuit alleges,” Becker’s Payer Issues, Dec 13, 2023 READ IT HERE

Robot denials are pissing off more people; lawsuits follow. This class action targets an AI employed by insurance behemoth UnitedHealth to automatically deny Medicare Disadvantage claims. Any employee who authorized longer post-acute facility stays than the standard estimate was “disciplined and terminated,” say the plaintiffs. Needed: a federal crackdown with teeth.

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Michael Osso, “How to fight back if your health insurance claim is denied,” Dallas Morning News, Dec 15, 2023 READ IT HERE

Denials have spike to 11% of all claims while users of ACA marketplace plans appeal only 0.2% of them. We should learn to do so and clog up their admin pipelines because denials are “systemic efforts by insurers to control costs,” sometimes by using automated denial systems [see above]. Once appealed, patients are successful 82% of the time. So do it, but what a waste of everyone’s time and mental health!

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Dylan Scott, “The US doesn’t have universal health care—but these states (almost) do,” Vox, Nov 26, 2023 READ IT HERE

But wait: define “universal”—Scott thinks it means everyone has something called “insurance.” Any reader of this digest knows that’s a far cry from actually getting medical care when you need it and without going bankrupt. That a state’s uninsured rate is under 5% tells us next to nothing. “The country is inching toward universal coverage,” he notes without discussing premiums, deductibles, copays, or prior authorization. Compare U.S.-style “universal” care to Canada’s where you show your health card at any doctor’s office and then forget about it. That said, some states have made real improvements to Medicaid coverage such as the Basic Health Plans made possible by the ACA. But average workers with above-poverty incomes remain screwed.

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Michelle Crouch, “Charlotte hospitals say ‘no thanks’ to charity’s efforts to erase medical debt,” NC Health News/Charlotte Ledger, Dec 11, 2023 READ IT HERE

The Grinch in the form of North Carolina hospital CEOs told a church group not to bother buying up its medical debt and forgiving it. In Charlotte’s Mecklenburg County, 18% of families have medical debt in collections; 57% of them were insured when they incurred it. Paging Dylan Scott @ Vox: Is Charlotte “inching toward universal coverage”?

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Craig Idlebrook, “I went on a mind-boggling journey to get my son’s ADHD medication covered by insurance—twice,” STAT, Jan 5, 2024 READ IT HERE

A modern Kafka should write “The Prescription.” This father picked up a new generic drug for his son, which didn’t work. Then the fun began. “What followed was a frustrating and costly process that took a couple of months and several dozen hours on hold to straighten out.” But that’s nothing compared to the next tale.

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Andrew Popper, “Insurance companies are forcing psychiatrists like me to stop accepting their coverage,” STAT, Jan 4, 2024 READ IT HERE

A psychiatrist tried his best to deal with insurance companies, finally gave up, and now earns less but spends all that wasted reimbursement-pursuit time with patients. “The paper claims simply disappeared into the ether or were rejected because I had included too much or too little information. Slight deviations from the insurer’s opaque and ever-changing protocol would necessitate resubmitting the claim, even after waiting several weeks to hear back. My administrative time started exceeding my clinical time.” Popper wonders why we put up with it all. “This is the business model—customers pay for the right to be deprived of the product they’re purchasing.”

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Tom Price & Elaine Parker, “Biden’s health care agenda will make a broken system worse,” Newsweek, Dec 11, 2023 READ IT HERE

Price, a disastrous HHS chief under Trump who had to resign after racking up $1 million in private jet travel, now works for the libertarian “Job Creators Network.” Here, he denounces government regulation in favor of “free-market competition and patient choice” [yawn]. But under the broken-clock rule, Price accidentally lands on a fact about Obamacare subsidies for people buying private insurance: it’s “a temporary Band-Aid that does nothing to quell long-term inflationary pressures within health care. Middle-class families who don’t qualify for subsidies will continue to be financially squeezed while others are blindfolded to the real problem.”

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Kristen Hwang, “‘A market failure’: High prices at Monterey County hospitals drive away many insured Californians,” Cal Matters, Jan 4, 2024 READ IT HERE

Here’s what happens on planet Earth when Price’s ideological Fantasyland gets a toehold: price-gouging and varieties of insanity. Teachers driving to the next county because their insurance won’t pay local hospitals’ monopoly prices, which run four or five times the Medicare rates. Hospital fees averaging $12,000 a night (New York City’s average is $7000). Double-digit annual premium increases. In short, Tom Price-style free-market bliss!

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Ezekiel J. Emanuel, “Why haven’t health care cost increases exceeded inflation in recent years? There’s a very good reason,” STAT, Dec 21, 2023 READ IT HERE

The author, an insider involved in crafting the ACA (Obamacare), says providers now have an incentive to keep costs down through “value-based” care such as the Medicare Disadvantage system. Of course, he would say that; the ACA gave a huge boost to the insurance industry that he praises. Frugality in healthcare is surely a worthy goal. But when “value-based” means “don’t spend money on patients to protect our quarterly corporate profit statement,” there’s a problem that Emanuel doesn’t want to see. He dislikes traditional Medicare where people don’t have to fight rigged prior authorization systems. Inserting privateers into government-funded insurance programs is a recipe for exploitation of users and the state. This is neoliberal market-worship, subtler than the libertarian variety.

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Medicaid disenrollment

Bryce Covert, “What happened to my health insurance?” New York Times, Dec 20, 2023 READ IT HERE

Stories of people being surprised at the ER or the pharmacy when they find out they were kicked them off Medicaid. The Covid-era prohibition on losing Medicaid meant people could take on better-paying jobs without worrying about their eligibility. Not any more as governors like Arkansas’ Sarah Huckabee Sanders campaign to “reduce government dependency.” Will the 30 million people set to lose Medicaid show up in 2024 to vote for the Democrats who presided over this nightmare? Asking for a friend.

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Joe Mario Pedersen, “Tech glitches among the top worries as Florida’s new Medicaid portal opens,” WMFE/Health News Florida, Dec 5, 2023 READ IT HERE

A new online system for accessing state Medicaid, SNAP, and other benefits was instituted in the midst of a flood of Medicaid re-eligibility applications. Eight million new accounts must be set up: what could go wrong? Florida terminated 600,000 people from Medicaid in the last 6 months, 73% of them for procedural errors.

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Neelam Bohra, “Nearly 1.7 million Texans lose Medicaid as state nears end of ‘unwinding,’” Texas Tribune, Dec 14, 2023 READ IT HERE

Texas has booted the most people from Medicaid of any state in the country. Trying to fix the administrative mistakes behind the majority of the cases is complicated by the “backlogs of hundreds of thousands of applications” for Medicaid and SNAP benefits. Austin congressman Lloyd Doggett cited “an incredible amount of incompetence and indifference to poor people.” That’s a feature, not a bug.

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Benjamin Hardy, “Biden administration ‘deeply alarmed’ by Arkansas’s rush to kick kids off Medicaid,” Arkansas Times, Dec 18, 2023 READ IT HERE

Ooh, they’re “deeply alarmed,” I’m so skeered, says Governor Cruella de Ville. Arkansas has tossed 18% of child enrollees off Medicaid after they refused to work in chicken slaughtering plants (kidding!) “Advocates say the state emphasized speed over accuracy, booting many people off their insurance who were in fact eligible.”

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Chelsea Cirruzzo, “Biden administration pleads with states after millions of kids lose Medicaid coverage,” Politico, Dec 18, 2023 READ IT HERE

“Fear us! We’re going to send you a stern letter!” This is regulatory action? Subject line: “Please don’t be so mean!”

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Brandon Smith, “Indiana Medicaid program is $1 billion more expensive after forecasting error,” WFYI/IPB News, Indianapolis, Dec 19, 2023 READ IT HERE

Miscalculations like Indiana’s won’t help those pushing the hold-out states to expand Medicaid. The underestimate arose from home- and community-based long-term care services that outlasted Covid subsidies.

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Market concentration & antitrust

Matt Stoller, “Out with a bang as FTC beats the Pharma Bros,” BIG, Dec 30, 2023 READ IT HERE

Big deal from BIG: Khan’s FTC is addressing vertical integration in healthcare, which directly threatens the giants’ business model. Stoller reviews the victory in a case against medical data behemoth IQVIA, which was “trying to monopolize the business of advertising to doctors” by buying a competitor. He compares this move to Google’s successful attempt to monopolize online advertising. But IQVIA wasn’t so lucky. Khan’s win was the first challenge to a vertical integration merger in 40 years.

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Susanna Vogel, “Antitrust enforcements hit a high in 2022 with health deals impacted,” Healthcare Dive, Dec 22, 2023 READ IT HERE

The FTC is on fire, and health-related cartels are one big target. “The agency blocked three proposed health system transactions, including suits against for-profit giant HCA Healthcare, New Jersey-based RWJBarnabas Health System, and Rhode Island’s largest health systems Lifespan and Care New England.” The FTC lost a huge case against UnitedHealth Group, but the battle is joined.

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Dan Primack, “Sanofi scraps $750 million drug deal, after FTC sues on antitrust grounds,” Axios, Dec 12, 2023 READ IT HERE

“French pharma company Sanofi scrapped a $750 million drug licensing deal with California-based Maze Therapeutics, just hours after the FTC sued to block the arrangement.” Striking a blow against the “killer acquisition” strategy by which Pharma buys up something that could eventually compete with one of its cash cows. “This must be raising eyebrows among biotech VCs, who often generate returns via these sorts of bio-bucks deals.” Good!

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Susanna Vogel, “Essentia Health, Marshfield Clinic abandon merger plans,” Healthcare Dive, Jan 8, 2024 READ IT HERE

A massive, 25-hospital conglomerate stretching across Minnesota, Wisconsin, Michigan, and North Dakota is not to be. “Minnesota Attorney General Keith Ellison announced that his office would review the merger. The now-defunct deal is the latest in a series of called-off mergers.” More progress.

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Sydney Halleman, “HCA Healthcare buys 11 emergency centers in Texas,” Healthcare Dive, Dec 4, 2023 READ IT HERE

The bloated HCA monster continues to devour facilities, especially in its Texas base, and now has 13 hospitals, nine outpatient surgery centers, and 26 free-standing emergency departments in the Houston area alone. “The acquisitions come as part of a multi-year strategy to capture market share and become the dominant care provider in all of its markets. English translation: we plan to squeeze out everybody else and jack up prices. HCA has 46 hospitals throughout Texas, 184 overall.

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Emily Olsen, “Walgreens nearly halfway through planned VillageMD clinic closures,” Healthcare Dive, Jan 4, 2024 READ IT HERE

Walgreens doesn’t want to bother with “underperforming markets,” i.e., poor neighborhoods that drag down its reports to Wall Street. The independent pharmacies it and the other chains destroyed would have settled for a modest profit, but now the company is looking for greener pastures and shutting down its operations in “non-strategic” markets. Perhaps if they could have become the “dominant care provider” like HCA, they would act differently?

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Rebecca Pifer, “UnitedHealth, OptumRx sued by independent pharmacy over ‘unconscionable’ fees,” Healthcare Dive, Dec 20, 2023 READ IT HERE

Everybody’s piling onto the Pharmacy Benefit Managers as the villain du jour on drug costs. (Pharma is more than willing to chime in and get itself off the hook.) PBMs are a cartel of robber barons who can strongarm independent pharmacies into slave labor. Fees have soared and are now an incredible 1,000 times higher than in 2010 and up 33% in just a year. “Currently, almost half of U.S. counties are considered pharmacy deserts as a result of closures.”

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Systemic failures

Gretchen Morgenson, “Vital signs vs. dollar signs: At HCA hospitals, the person monitoring your heart may monitor 79 other patients, too.” NBC News, Dec 21, 2023 READ IT HERE

The staff watching patients’ heart rhythms, blood pressure, or respiratory functions in most hospitals aren’t the nurses caring for them but “telemetry” technicians who may be sitting in another building trying to follow dozens of screens simultaneously. Why would a hospital do this? “Technician salaries are significantly lower than those of registered nurses.” Ah. Given the importance of delays of mere seconds when a patient’s heart stops, this practice is guaranteed to produce serious harm and deaths.

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Kathleen McGrory & Neil Bedi, “When veterans in crisis can’t get help,” ProPublica, undated, READ IT HERE

A tragic exposé of how DoD can’t find enough money within its $800-plus billion budget to help veterans with PTSD and other psychiatric issues. “The military has long drawn recruits from remote towns across America, promising them a lifetime of health care in return for their service. But the VA has seldom staffed those same communities with the mental health professionals needed to help them once they return home.” Result: suicides and murders. “We were abandoned,” said one VA social worker. “We kept saying, there is going to be a problem. This is going to blow up.” Then it did.

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ProPublica/The City, “New York closed psych beds for youth in crisis. Now, foster care programs and host town are being pushed to the limit,” Jan 3, 2024 READ IT HERE

“Government child welfare authorities are placing kids with acute mental health challenges on campuses that are ill-equipped to handle them—largely because there’s nowhere else for them to go. New York has shut down one-third of its beds for youth in state-run psychiatric hospitals since 2014 under a plan rolled out by former Gov. Andrew Cuomo. The state has also greenlit the closure of more than half of the beds in residential mental health programs during the past decade—all while failing to deliver on promises to expand home- and community-based mental health services. Suicidal foster children sit for months on wait lists.” Part of a larger series, “How New York Wrecked Mental Health Care for Kids.”

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John Corsino, “We’ve created a generation of Ozempic users by ignoring America's obesity epidemic,” USA Today/The Tennessean READ IT HERE

“Obesity in America is a symptom of systemic failure.” So, let’s treat it with expensive drugs instead of looking at the system, right? “The phenomenon of urban food deserts is a known shortcoming of America’s cities. Access to fresh fruits and vegetables is constrained, but meat-product patties between sugary buns are omnipresent.” Hey, it’s a free market, and Tom Price likes it that way!

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Emerson Lynn, " Bernie’s fight with Big Food,” St Alban’s Messenger, Dec 15, 2023 READ IT HERE

Bernie Sanders raked the food and beverage industry over America’s obesity epidemic. “A survey found 41% of Vermont’s grade school kids overweight or obese. What’s being done about it? Not a thing.”

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Scott Kaplan et al., “Evaluation of changes in prices and purchases following implementation of sugar-sweetened beverage taxes across the U.S.,” JAMA Health Forum, Jan 5, 2024 READ IT HERE

Five cities cranked up local taxes on nutrient-free sugary drinks. Result: consumption of sugary drinks there dropped by a third. Solutions are there; political will is not.

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Sandee LaMotte, “Common pesticides in food reducing sperm count worldwide, study says,” CNN Health, Nov 15, 2023 READ IT HERE

Organophosphate and other pesticides may be the cause of a 50% drop in sperm concentration worldwide since the 1970s. That’s before looking at damage to individual sperm cells. Could pollutants be related to the rise in autism diagnoses, by any chance? Much more profitable to blame it on your measles vaccine. Another potential sperm-count risk: cellphones.

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Pharmaceuticals

Adam Cancryn, “Targeting costly meds, Biden admin asserts authority to seize certain drug patents,” Politico, Dec 6, 2023 READ IT HERE

Seeing is believing. Claiming an intention to seize patents might make good campaign rhetoric, but as I recall very well from the HIV/AIDS wars, actually defying Pharma over patents is extremely rare. “Progressives have long insisted that those [march-in] rights empower the administration to break the patents of pricey drugs that were developed with public funds.” And, “Biden officials now plan to make a fresh push to put health care at the center of Biden’s reelection platform.” Assume blah-blah until action follows.

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Ned Pagliarulo, “Lilly launches online service for home delivery of weight loss drug,” Healthcare Dive, Jan 4, 2024 READ IT HERE

“LillyDirect” now will make sure you get your expensive, government-reimbursed fat meds dropped right at your door. Virtue signaling alert: Lilly also released a letter saying that Zepbound should not be used for “cosmetic weight loss.” We totally do NOT want you to see our ads and then clamor for our slimming product and get the Feds to pay for it! Perish the thought.

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Jonathan Gardner & Ned Pagliarulo, “FDA authorizes Florida to import drugs from Canada,” BioPharma Dive, Jan 5, 2024 READ IT HERE

Florida may be followed by Colorado, New Hampshire, Texas, and Wisconsin to allow drug importation. Wouldn’t fixing the U.S. system instead be a bit more straightforward?

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Rebecca Robbins & Stephanie Nolen, “New sickle cell therapies will be out of reach where they are needed most,” New York Times, Dec 8, 2023 READ IT HERE

The scientific breakthrough utilizing gene therapy will remain meaningless for the millions of sickle cell sufferers in Africa where the insane price tags and complex manufacturing and delivery systems are a dream. Still, the HIV world faced the same conundrum and eventually pushed through a solution.

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Aneri Pattani, “The year in opioid settlements; 5 things you need to know,” KFF Health News/NPR, Dec 21, 2023 READ IT HERE

What’s up with the $1.5 billion in state and local government coffers extracted from the bad guys? We need to know given the pipeline that could reach $50 billion. Only 16 states are committed to transparency about how they spend the jackpot, and there’s no federal requirement that they do so. Some favorite targets for state outlays: treatments facilities, enforcement equipment for cops, D.A.R.E. type drug education programs (that don’t work), and that perennial favorite, covering unrelated budget shortfalls. The tobacco settlement also produced a cash bonanza, much of which was diverted elsewhere.

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Aneri Pattani, “‘They see a cash cow’: Corporations could consume $50 billion of opioid settlements,” KFF Health News/Fortune, Dec 18, 2023 READ IT HERE

The private sector eyes the gold rush: “The marketing pitches are bold and arriving fast: Invest opioid settlement dollars in a lasso-like device to help police detain people without Tasers or pepper spray. Pour money into psychedelics, electrical stimulation devices, and other experimental treatments for addiction. Fund research into new, supposedly abuse-deterrent opioids and splurge on expensive, brand-name naloxone. These pitches land daily in the inboxes of state and local officials.”

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Katheryn Houghton & Aneri Pattani, “Millions in opioid settlement funds sit untouched as overdose deaths rise,” KFF Health News/CBS News, Dec 13, 2023 READ IT HERE

The Billings-based Rimrock Foundation has a wait list for its behavioral health/substance abuse services while Montana can’t get its procedures together a year after the state began receiving millions of dollars. Caution is appropriate; so is speed.

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SINGLE PAYER LINKS #329

Posted Posted 5 JAN 2024

Catching up with the massive backlog of news from the holidays. BTW, I’m about to work with a mentor to boost the podcast audience. Do me a favor and click on it, listen for a few minutes, and give me feedback. Here is the link: READ IT HERE

—Tim

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Reid J. Epstein & Sheryl Gay Stolberg, “Dean Phillips, an upstart challenger to Biden, embraces ‘Medicare for All,’” New York Times, Dec 20, 2023 READ IT HERE

Long-shot candidate Phillips experiences illumination on the road to Damascus, er New Hampshire, and no longer thinks Medicare for All is a “nonsensical leftist notion.” Shall we slay the fatted calf for this prodigal son or await further signs of piety from the former board chairman of one of Minnesota’s largest healthcare systems? Which, incidentally, just announced on Dec 26 “that it would end its policy of denying medical care to patients with $4,500 or more in outstanding bills.”

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Annalisa Merelli, “U.S. government spent more on health care in 2022 than six countries with universal health care combined,” STAT, Dec 19, 2023 READ IT HERE

We know these crazy statistics, but it’s good to be reminded anyway: the U.S. government paid about a third more on healthcare than the governments of Germany, the U.K., Italy, Spain, Austria, and France combined, whose aggregate populations are roughly equivalent to ours. They got universal, state-financed care; we didn’t. Ergo, the arguments that a single-payer system would be too costly is disproven by the numbers.

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Anna Bawden, “NHS in England facing ‘storm of pressure’ as flu and Covid cases surge,” Guardian, Dec 29, 2023 READ IT HERE

The steady starvation of Britain’s once-wonderful NHS is further crippled by staff shortages due to Covid. “A six-day strike by junior doctors will begin [in January] over pay, with thousands more appointments and operations expected to be cancelled.” The coverage relentlessly addresses the strike action—much less about decades of budget cuts. Maybe it’s too sensitive since the Guardian backs pouring any spare cash into Ukraine.

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Susanna Vogel, “No Surprises Act dispute portal reopens again amid ‘challenging’ policy rollout,” Healthcare Dive, Dec 18, 2023 READ IT HERE and Paige Minemyer, “CMS finalizes updated fees for No Surprises Act dispute resolution,” Fierce Healthcare, Dec 18, 2023 READ IT HERE

The federal crackdown on surprise bills included what was to be a smooth arbitration process that would give hospitals and insurers a chance to work things out reasonably. “The dispute resolution process for payments between insurers and providers was meant to be simple.” [LOL emoji] Instead, both sides have gamed the system to maximize profits, including sustained lawfare in federal courts, and the Feds keep trying to straighten out the mess. Regulators anticipated receiving about 22,000 disputes in the first year of the new program; they got nearly half a million.

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Tina Reed, “CVS drug pricing overhaul signals a broader industry shift,” Axios, Dec 6, 2023 READ IT HERE and Heather Landi, “CVS Health revamps pharmacy reimbursement model amid scrutiny on high drug prices,” Fierce Healthcare, Dec 5, 2023 READ IT HERE

The insurance-pharmacy-provider conglomerate Aetna/CVS/Oak Street Health/Signify Health is changing the way it prices prescription drugs “amid increasing pressure from policymakers and industry upstarts”—in case anyone thought they had customers in mind. While the PR is that this is our kindly intermediaries giving us better prices, the background is “consumer anger directed at major industry players” and the heat emanating from Congress over price-gouging and secrecy on pharmaceuticals. Mark Cuban’s Cost Plus Drugs model of selling generics directly to patients plus 15% is an embarrassing competitor out there for all to see. But one observer quoted here notes that the amount of cash at stake is so vast that the existing model is far from dead. Also, the threat to employers of the insane costs of new anti-obesity medications is pushing them to Do Something.

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Rebecca Pifer, “CMS asks health plans, PBMs to ease up on independent pharmacies,” Healthcare Dive, Dec 18, 2023 READ IT HERE

Through its oligopolistic tactics, the PBM cartel has been squeezing independent pharmacies, which are closing “in droves.” The Federal Government is finally reacting now that many horses have left that barn. “Currently, almost half of U.S. counties are considered pharmacy deserts as a result of the closures.” Also, what kind of regulatory action is “asking” pretty please?

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Noah Tong, “House price transparency legislation passes with bipartisan support,” Fierce Healthcare, Dec 11, 2023 READ IT HERE

One chamber of Congress has passed a measure entitled the Lower Costs, More Transparency Act with a large, bipartisan majority “mandating that providers and PBMs publicly list prices [and] publish charges through machine-readable files.” Good, but the idea that people need to cost-compare so that they can “shop” for their healthcare is an ideological fantasy. Healthcare can never be a successful marketplace commodity. “Advocates anticipate the legislation could lower out-of-pocket costs for customers” (the triumph of hope over experience).

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Jon Hu, “Alzheimer’s drug approvals show we need a reevaluation of patient advocacy,” STAT, Dec 18, 2023 READ IT HERE

Patient advocacy groups have been perverted to serve Pharma and browbeat legislators and the FDA into qualifying expensive drugs for reimbursement. They bring heartbreaking anecdotal evidence to FDA advisory panels, overwhelming the agency’s mandate to approve new drugs based on hard evidence. Pharma kindly provides the funding to help them lobby; the RoI must be many thousands of percent.

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Yves Smith, “Is it time to tax ultra-processed foods because of the massive harm that they do to society?” Naked Capitalism, Dec 5, 2023 READ IT HERE

We mostly discuss health-related financial matters here, but there is an unmentioned elephant sitting right there on the national health spending accounts, namely, disease-causing corporate behavior, especially the systematic poisoning of our food supply. Big Food shovels packaged baked goods, snacks, fizzy drinks, sugary cereals, food additives, fat, and salt at the nation’s eaters nonstop, and then we wonder why half of American children are overweight or obese. Smith quotes Richard Murphy, a British academic thus: “Type 2 [acquired] diabetes is a disease largely created by the consumption of too much sugar in the form of fructose that can be reversed by eliminating fructose from the diet. The progression is known about, predictable, heavily researched, and largely unknown because there is a massive conspiracy to hide the truth.” Maybe the debate over insulin pricing is missing the larger point. Murphy adds, “The top five funders of the American Diabetes Association are the pharmaceutical companies Abbott, AstraZeneca, Eli Lilly, Novo Nordisk, and Regeneron.”

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Tim Cushing, “Every major pharmacy chain is giving the government warrantless access to medical records,” Tech Dirt, Dec 28, 2023 READ IT HERE

Did you think you had HIPAA protections against your private medical info being passed around without your consent? Not if law enforcement wants it. According to a congressional investigation, “all of the big pharmacy chains in the U.S. [CVS Health, Walgreens, Walmart, Cigna, Kroger, etc.] hand over records without a warrant.” The Feds could step in and say Whoa, you need a judge to review breaches of the Fourth Amendment privacy guarantee—so far, they haven’t. Of all the big players, only Amazon has agreed to at least tell customers when the cops have requested their medical histories.

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Sherman Smith, “Kansas governor unveils revenue neutral Medicaid expansion plan with work requirement,” Kansas Reflector, Dec 14, 2023 READ IT HERE and Tim Carpenter, “Kansas governor not drawn to horse-trade compromise on school choice to win Medicaid expansion,” Kansas Reflector, Dec 21, 2023 READ IT HERE

Ruby-red Kansas has a blue governor trying to drive Medicaid expansion through a recalcitrant legislature. She’s agreed to add a work requirement—so that no lazy palookas get free stuff—and a ban on abortions, but the Republican holdouts want in exchange a green light for vouchers that will shovel (very scarce) state tax dollars to private schools. Kansas tried to expand Medicaid in 2017, but the GOP governor vetoed it. Meanwhile, Kansas, one of only three non-southern holdout states, has given up $7 billion in federal funds by refusing to join, and 59 rural Kansas hospitals are at risk of closure. The president of the Kansas state senate calls Medicaid “welfare.” Currently, to qualify for Medicaid in Kansas, a single mother with one child can earn no more than $7,500 a year. Those women making 8K can get their own damn healthcare!

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Nada Hassanein, “Grassroots groups help Medicaid recipients regain lost coverage,” Stateline, Dec 21, 2023 READ IT HERE

The Great Medicaid Boot-Off has now deprived 13 million people, over 5 million of them children, of their health insurance. Well over half of them lost Medicaid due to paperwork issues and remain eligible, so nonprofits are working to find these one-time beneficiaries. Most of the tales in this article are about people who found out they weren’t covered at an emergency room or when trying to pick up their medications. The advocates do laudable work—but they shouldn’t have to exist.

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Diane Webber, “For the third year in a row, ACA health insurance plans see record signups,” NPR, Dec 20, 2023 READ IT HERE

Yeah, because 13 million people got kicked off Medicaid—so far.

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Jakob Emerson, “Hospitals are dropping Medicare Advantage plans left and right,” Becker’s Hospital CFO Report, Dec 14, 2023 READ IT HERE

The reason: “Excessive prior authorization denial rates and slow payments from insurers.” Or as one provider said, “It’s become a game of delay, deny, and not pay. Providers are going to have to get out of full-risk capitation [value-based care] because it just doesn’t work.” An Oregon hospital system is going a step further and advising elderly patients NOT to sign up for MA in the first place. The article lists 13 more instances of hospitals bailing from MA contracts. May the river become a mighty torrent!

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Josh Sisco, “‘She was put in this role to shake things up,’” Politico, Dec 22, 2023 READ IT HERE

On FTC Chair Lina Khan, whose heroic attempts to restore some semblance of a market economy has earned her all the right enemies. While not always winning court battles, the reawakened agency has already stopped a dozen mergers that previous chairs would have waved through. The business media hate her, but she has allies on the populist/Trumpian right.

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Rebecca Pifer, “FTC, DOJ finalize merger guidelines that could impede healthcare M&A,” Healthcare Dive, Dec 19, 2023 READ IT HERE

The two reawakened federal agencies that have taken on monopolistic corporate behavior finalized “stricter guidelines for mergers and acquisitions that could make it more difficult for healthcare deals to close.” And yay for them! Lina Khan’s FTC is demanding more up-front information from companies planning to merge so that the agency can determine the impact on competition before the deals are sealed. She has notched several recent wins; Wall Street Journal editors continue to suffer mass knickers-twisting.

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Dave Muoio, “Adverse events increased after hospitals acquired by private equity, study finds,” Fierce Healthcare, Dec 27, 2023 READ IT HERE Reed Abelson & Margot Sanger-Katz, “Serious medical errors rose after private equity firms bought hospitals,” New York Times, Dec 26, 2023 READ IT HERE

“A hospital’s acquisition by a private equity firm is linked to a rise in adverse events despite the pool of lower-risk patients they tend to admit,” according to study published in JAMA. Since the PE playbook starts with slashing staff, these findings are hardly surprising. But the scale of the deterioration is shocking: “Up to three years after [PE] hospital acquisition, the analysis shows a 27% increase in falls, a 38% increase in central line-associated infections, and about twice as many surgical site infections compared to control hospitals.” The FTC has been aiming its arrows at the PE invasion of healthcare and is now joined through a “cross-government public inquiry” by the Departments of Justice and HHS. The Common Dreams piece includes this tidy summary of the PE playbook: “They purchase enterprises using as much borrowed money as possible. That debt does not fall on the private equity firm or its investors, however. Instead, all of it is placed on the books of the purchased entity. To service the debt, the enterprise’s management, directed by their private equity ownership, must reduce costs, and increase its cash flow. The first and easiest way to reduce costs is by reducing the number of staff and by decreasing services. Of course, the quality of care then suffers. Meanwhile, the private equity firm charges the company fees.”

Here READ IT HERE is the JAMA study with even uglier details. For example, “Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume.”

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Anity Raghavan, “‘They were traumatized’: How a private equity-associated lender helped precipitate a nursing-home implosion,” Politico, Dec 24, 2023 READ IT HERE

Why would the PE model operate any differently in nursing homes than it does in destroying large corporations? It doesn’t. Financiers swoop in, saddle up the homes/companies with debt, extract fees, and decamp leaving the rotting carcass behind. When the bought and wrecked nursing homes collapse, “people are shoved around like old shoes. They didn’t tell them where they were going. They just woke them up and said, ‘You’re moving.’” Medicare and Medicaid pay out more than $100 billion a year on nursing homes and skilled nursing facilities, easily siphoned off by PE owners, and could crack down on the abuses. But the nursing home lobby is powerful, especially among Democrats.

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Jeff Lagasse, “Jefferson Health, Lehigh Valley Health Network set to merge,” Healthcare Finance, Dec 20, 2023 READ IT HERE

The combined systems would create a 30-hospital network with a reported $14 billion in revenue covering eastern Pennsylvania and southern New Jersey. In addition to the hospitals, the new behemoth will employ 62,000 faculty, clinicians, and staff at more than 700 sites. But “regulatory scrutiny” is pending (see above).

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David Chapman*, “Post-apocalyptic life in American health care,” Meta-rationality [blog], Dec 8, 2023 READ IT HERE

This is a long anecdote about trying to get health systems to communicate among themselves. “I had read that the biggest failing of the American health care system is its fragmentation; I’ve now spent hundreds of hours observing that first-hand. There is, in fact, no system. There are systems, but mostly they don’t talk to each other.” More: “At least seven experts spent roughly 10 full-time days trying to find out a basic fact about my mother’s insurance and finally failed. Meanwhile, many thousands of dollars were wasted on unnecessary hospitalization.” The author compares the experience to a post-apocalyptic sci-fi movie in which characters with spears hunt for wild boars in the ruins of a modern city. But boar-hunters have to talk to each other. [*Although the blog is unsigned, DC seems to have coined the term meta-rationality.]

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Health News Florida, “Florida Senate committee approves ‘game-changing’ health care plans,” Dec 13, 2023 READ IT HERE

Florida tinkers; observers stifle yawns. These measures are “game-changing” only if legislators are playing Minecraft in the cloak room. One of the bills “would create a Health Care Innovation Council to oversee a proposed low-interest loan program for innovative projects.” Just wow, man. “This is the most-creative, innovative way to really change Florida and put us on the map as the No. 1 health care state in the country,” said its author who also praised the convenience of these new ATMs.

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Bernard J. Wolfson, “Bold changes are in store for Medi-Cal in 2024, but will patients benefit?” KFF Health News, Dec 22, 2023 READ IT HERE

California, by contrast, is instituting some real changes. The biggest change: coverage of 700K undocumented Californians. Close behind, more pressure from the state to get people into managed care plans instead of direct-pay. Another improvement is the removal of the asset limit test for some categories—now, you won’t have to impoverish yourself to qualify. (How about making that universal? Dreaming, of course.) So many changes happening at once is likely to create administrative backlogs that could be a nightmare for beneficiaries, especially the approximately 1 million Californians set to lose their Medicaid coverage. But making the for-profit companies sign standardized contracts at least gives the state a chance to improve monitoring and enforcement. The main roadblock is an “acute” shortage of medical professionals in the state.

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Barak Richman, “Universities are prioritizing their health systems over teaching. That’s killing academic freedom,” Politico, Dec 31, 2023 READ IT HERE

“Universities with health systems are better understood as health systems with universities. As such, they are highly dependent on the graces and whims of policymakers [and] buckle to politicians’ whims.” Harvard just provided us with a stark example. The author describes how leaders at the University of North Carolina kept mum about attacks on academic freedom while seeking favors from the state legislature to benefit its hospital system. The UNC Health budget ($5.5 billion) dwarfs that of its flagship Chapel Hill campus ($3.5 billion).

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Lauren Sausser, “Cancer patients face frightening delays in treatment approvals,” KFF Health News/CBS News, Dec 22, 2023 READ IT HERE

After a reporter queried the VA about prior authorization delays, one patient’s case was quickly resolved. (Lesson: raise hell and call reporters.) While the Feds weigh new rules to rein in prior authorization abuse, “in the meantime, patients—many of whom are facing the worst diagnosis of their lives—must navigate a system marked by roadblocks, red tape, and appeals.”

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Jason Mast, “After ‘SNL’ skit on sickle cell CRISPR therapy, advocates cite errors and stereotypes,” STAT, Dec 20, 2023 READ IT HERE

“To many advocates, patients, and doctors, [the SNL sketch] seemed to perpetuate falsehoods and stereotypes: that sickle cell was strictly a ‘Black disease’; that patients didn’t or couldn’t make responsible decisions about their own disease—and would, for example, choose a Santa toy over a curative therapy.” The background: “Patients have long faced discrimination in medical settings, including accusations from doctors that they don’t comply with existing therapies and that they fake pain to obtain narcotic drugs.” The SNL skit’s timing was particularly bad given the arrival of a pricey new therapy that appears to work but costs millions. Unsurprisingly, something known as a “Black disease” is less likely to get government, institutional, and public support.

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Dulan Lokuwithana, “UnitedHealth’s secret rules denied rehab coverage for Medicare patients: Stat News,” Seeking Alpha, Dec 28, 2023 READ IT HERE

Summarized from a STAT article, which is paywalled. “UnitedHealth used a confidential set of rules to deny Medicare coverage for rehabilitation care requested by specific groups of severely ill patients who lived in nursing homes or suffered from cognitive impairment. Many were enrollees of Medicare Advantage plans.” Perhaps realizing the risk of discovery, UH managers told their clinical reviewers to stop using the secret algorithm in November.

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Anity Raghavan, “‘They were traumatized’: How a private equity-associated lender helped precipitate a nursing-home implosion,” Politico, Dec 24, 2023 READ IT HERE

Why would the PE model operate any differently in nursing homes than it does in destroying large corporations? It doesn’t. Financiers swoop in, saddle up the homes/companies with debt, extract fees, and decamp leaving the rotting carcass behind. When the bought and wrecked nursing homes collapse, “people are shoved around like old shoes. They didn’t tell them where they were going. They just woke them up and said, ‘You’re moving.’” Medicare and Medicaid pay out more than $100 billion a year on nursing homes and skilled nursing facilities, easily siphoned off by PE owners, and could crack down on the abuses. But the nursing home lobby is powerful, especially among Democrats.

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Here's a graphic from Dr Mark Lewis that shows the process he had to follow to get authorization from Cigna, his insurer, for a prescription refill.