SINGLE PAYER LINKS #378
24 JAN 2025
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Although Trump did not mention health in his inaugural address, one of his Executive Orders denounced in general terms the “crushing regulatory burden” and “unnecessary administrative expenses and rent-seeking practices that increase healthcare costs.” https://bit.ly/4gbNE1I
That oddly phrased EO calls all departments and agencies to “deliver emergency price relief [on what?], consistent with applicable law” and for his economic policy team to report to him on progress toward this goal within 30 days. It’s hard to reconcile the anti-regulatory screed peppering Trump’s rhetoric with this edict to rein in “rent-seeking practices” among his golfing buddies. I’m betting on the billionaires, but we shall see. —Tim
I seem to be having sound problems at Podbean, so this link may need to be fixed later: https://www.podbean.com/eas/pb-dgbgm-17c4b36
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Sarah Owermohle, John Wilkerson, Rachel Cohrs Zhang & Lizzy Lawrence, “Trump’s initial orders reverse Biden on health care costs, protections from discrimination,” STAT, Jan 20, 2025 https://bit.ly/4gbRM1Z
Trump’s first actions included blocking Medicare/Medicaid experimentation with cost-saving models (some of which are disastrous privatization schemes), cutting free access to Covid treatments and vaccines, withdrawing from the WHO, and reducing the enrollment period for Obamacare plans. Unsurprisingly, he also abolished the Gender Policy Council.
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Phil Galewitz, “Trump’s return puts Medicaid on the chopping block,” KFF Health News/CBS News, Jan 13, 2025 https://bit.ly/3PJcr2u
“Republicans in Washington say they plan to use funding cuts and regulatory changes to dramatically shrink Medicaid” and pry out some of the $900 billion that it costs for diversion into tax cuts or other schemes for their favored paymasters. But if they do, red states’ budgets will also take a hit, which won’t be popular. “State governments, managed-care organizations, long-term care providers, and everyone under the sun … will be highly motivated to push back on draconian cuts because it could affect their business model.” Bad ideas that could get a hearing: Medicaid block grants and lowering the 90% federal match for new enrollees under Obamacare expansion, which states agreed to when they signed up for the new costs. If states are suddenly stuck with shelling out more for Medicaid expansion beneficiaries, the non-expansion hold outs will have been proved right.
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Andrew Demillo, “Arkansas governor wants to revive state’s Medicaid work requirements under Trump administration,” Associated Press, Jan 16, 2025 https://bit.ly/42ov17N
Didn’t work the first time around—oh wait, yes it did if the true goal was to prevent low-income workers from getting medical care. “More than 18,000 people lost coverage when Arkansas previously enacted work requirements under [Gov Huckabee] Sanders’ predecessor.” Most of them were already working, but the bureaucratic obstacles successfully threw them off Medicaid, at least for a while. Other states (SC, IA) plan to follow suit with prove-you’re-not-a-lazy-slug rules; GA already has one under its expensive and useless “Pathways to Care.”
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Rachel Cohrs Zhang, “Trump finally finds a populist health care message in Kennedy’s MAHA,” STAT, Jan 20, 2025 https://bit.ly/3WvOr6J
Nothing exemplifies the built-in contradiction in Trump’s messaging like his endorsement of RFK Jr.’s promise to “Make America Healthy Again.” Rhetoric questioning our entire food system, the public health establishment, and the role of big business on drug pricing and bankruptcy-inducing health insurance joins uneasily with Trump’s full-court attack on gummint. In Trump I, the promise to repeal Obamacare fell flat, and he failed to lower drug prices. Even his success with the Covid vaccine clashed with his skeptical base. Given the staleness of the typical right-wing appeal to market-based solutions, it will be interesting to see where Trump goes in turning the MAHA message into policy, especially insofar as it means taking on giant corporations that fully expect a free ride from him.
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Lev Facher. “‘Tough love’: How RFK Jr.’s views on addiction could bring a new era of U.S. drug policy,” STAT, Dec 11, 2024 https://bit.ly/4aulL3V
Another likely clash will materialize in the world of drug use and addiction policy. RFK Jr himself famously needs addiction maintaining, but he says the government should wield threats of imprisonment or treatment coercion instead of harm reduction. (Reporters should ask him, Were YOU put in jail?) He expresses openness to supervised consumption sites such as OnPoint NYC but not their hands-off approach to voluntary treatment. HHS oversees key addiction agencies, and states and cities are looking at billions of dollars from Pharma, drug distributors, and pharmacies in opioid settlements—how will they spend it? Republicans traditionally hate anything suggesting compassion toward addicts.
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Lev Facher, “An NYC nonprofit has reversed 1,700 overdoses since 2021. Under Trump, it faces an uncertain future,” STAT, Jan 17, 2025 https://bit.ly/40sNCgd
Speaking of OnPoint NYC, it’s a safe injection site whose operations are threatened with closure and not just because of Trump. “Local officials in deep-blue cities like Philadelphia and San Francisco have blamed harm reduction for the cities’ continued drug crises.” Plenty of powerful people wouldn’t see OnPoint’s 1,700 overdose saves (and zero deaths) as a positive.
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Shannon Firth, “Major PBMs inflated drug prices, pocketing $7.3 billion along the way, FTC says,” MedPage Today, Jan 14, 2025 https://bit.ly/40J1yEa and Steve Kopack & Adiel Kaplan, “Top three insurers reaped $7.3 billion through their drug middlemen’s markups, FTC says,” NBC News, Jan 14, 2025 https://bit.ly/42qfYdv
The new FTC report is deadly: it outlines how the PBM triumvirate (Optum, CVS Caremark, and Express Scripts) acquire cheap generic drugs and pump up their prices to ridiculous levels, then pay their in-house pharmacies huge premiums. The profits they book are staggering: “Dispensing of the top specialty drugs represented about 12% of operating income reported by the three PBMs’ parent conglomerates” (United, CVS/Aetna, and Cigna) in 2021. Medicare/Medicaid suffered the increased costs, but employer-based plans also got hosed. “Between 2017 and 2021, spending by health plans and patients rose at compound annual growth rates of 21% for commercial claims and 14% to 15% for Medicare Part D claims. Half of the loot came from drugs for cancer and another quarter for multiple sclerosis meds.
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Nathaniel Weixel, “House Republicans launch investigation into CVS Caremark for potential antitrust violations,” The Hill, Dec 12, 2024 https://bit.ly/3E7ifAj
Republicans are on board to stick it to the PBMs. This House probe will examine whether CVS Caremark bullied independent pharmacies in violation of antitrust laws. (News flash: they did.)
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Kathleen Birrane, David Kopans & Peter Rice, “New York issues extensive new pharmacy benefit manager regulations,” DLA Piper, Nov 25, 2024 https://bit.ly/3WvLMKe
States are trying to rein in costs without waiting for federal action. New York added restrictions on PBM-pharmacy relationships (trying to halt self-dealing), banned secret contact terms, limited mergers and acquisitions, and inhibited PBM from steering customers to their affiliated in-house or mail-order pharmacies. The law firm that wrote this advisory says the new rules “may have a material impact on the PBMs’ business arrangements with a variety of affiliated and unaffiliated third parties.” None too soon.
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Paige Minemyer, “Optum Rx commits to passing through 100% of drug rebates, Witty says,” Fierce Healthcare, Jan 16, 2025 https://bit.ly/3WSvwDB
UnitedHealth Group is getting religion over its affiliated PBM’s pricing policies—no one knows why! CEO Andrew Witty announced the new policy: “We would like to work with others across the system to relentlessly achieve the lowest net cost for everybody in the system.” I like “relentlessly.”
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Nada Hassanein, “Independent pharmacies know their communities. But many are struggling to stay open,” Stateline, Jan 17, 2025 https://bit.ly/4juP9ej
One independent drugstore closes every day, “squeezed by the huge companies that reimburse pharmacies for costly medications.” That would be the PBMs, of course. Georgia’s state legislature overwhelmingly passed a law requiring the state to pay indies the same as chain pharmacies, but Gov Kemp vetoed it. A better solution: federal action to prohibit PBMs from paying their in-house pharmacies more and stiffing outsiders. One Georgia pharmacist says reimbursements for a third of the prescriptions she fills are less than the wholesale cost she pays for them. “Tennessee passed a law that prohibits PBMs from reimbursing pharmacies below acquisition costs.” How was that ever legal?
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Andy Miller, “PBM math: Big chains get $23.55 for blood pressure Rx as small drugstores get $1.15,” KFF Health News, Oct 24, 2024 https://bit.ly/4gr1g9P
Here’s how the big chains linked to the big cartels hog drug revenue and destroy the independents: “Chains were paid well beyond the family business for many of the same medications. For example, the chains received an average of nearly $54 for the antidepressant bupropion, while Bell’s Family Pharmacy in Tate, Georgia, got $5.54.” Mark Cuban’s Cost Plus PBM-wrecking alternative says the PBMs “siphon off about a third of the $400 billion a year spent on pharmaceuticals.”
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Tom Murphy, “Nearly 30% of U.S. drugstores closed in one decade,” Associated Press, Dec 3, 2024 https://bit.ly/3CayvA6
“Nearly three out of 10 U.S. drugstores that were open during the previous decade had closed by 2021,” and that was years before the latest round of branch closures by the major chains. Those most likely to close are independents and those with higher rates of Medicare/Medicaid beneficiaries.
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Jared S. Hopkins & Josh Ulick, “Medicare pays wildly different prices for the same drug,” Wall Street Journal, Nov 26, 2024 https://bit.ly/3PMMXkT
Our drug payment system is so irrational that a Pharma company can charge 2,000 different prices for the same drug in different plans. The pricing chaos leaves some users on the hook for thousands of dollars in copays. “The reason for the huge price differences: America’s complicated drug-reimbursement system, which uses middlemen to negotiate prices.” That would be the hated PBMs again, which “profit off the varying prices because Medicare can’t keep track of all the different sums it is paying.” And because the Federal Government never insisted on establishing a single price for them. There’s an opportunity for Trump to eliminate some “rent-seeking practices” if he really wants to.
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Ed Silverman, “Prices for 5 drugs were hiked without proof of new benefits, costing the U.S. $815M in 2023, report finds,” STAT, Dec. 12, 2024 https://bit.ly/3POS3Nz
Pharmaceuticals aren’t restricted in raising prices on most of their products, so they do, sometimes by insane amounts. Medicare was just recently empowered to negotiate a few prices on top sellers; will Trump continue to save government money or do a big favor for the industry by wrecking that initiative?
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Claudia Irizarry Aponte & Alyssa Katz, “Four things to know from our investigation of the Home Healthcare Workers of America, New York’s fastest-growing union,” The City, Jan 13, 2025 https://bit.ly/4g7ob9N
Hard-working home health workers are unionizing rapidly, isn’t that great? Perhaps not, given that the “union” involved is friendly with employers, enriches its top officials, and oh yes, neglects to tell its members that they belong to a union at all while regularly nicking their paychecks for dues. Home Healthcare Workers of America, an affiliate of the International Union of Journeymen and Allied Trades, paid its president over $1 million on the backs of the lowest-paid workers in New York. The president’s close relatives also had “jobs” with the union, paying half a million each. “At a Bronx trash hauling depot, management dissolved a Teamsters local and replaced it with an IUJAT local led by former mobsters, and workers saw their strict wage and benefit requirements vanish.” Lovely bunch. Incidentally, The City is essential reading for New Yorkers, and it relies on donations—no paywall.
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Emily Kopp, “WHO top scientist was ‘collaborator’ of Peter Daszak,” U.S. Right To Know, Jan 16, 2025 https://bit.ly/42ony8w
USRTK continues to dig around in Covid’s murky history and now reveals that the EcoHealth Alliance, which carried out Wuhan gain-of-function research (Fauci’s denials notwithstanding), had professional ties to the WHO’s chief scientific officer, Jeremy Farrar. That puts a new light on Farrar’s role in suppressing speculation about the lab-leak theory, which was heavily censored in social media during a crucial period. “The apparent connection between Farrar and [EcoHealth’s Peter] Daszak could present a previously unknown conflict of interest on the pandemic origins question at the highest levels of the WHO.” If gain-of-function viral fiddling really did produce SARS-CoV-2, we deserve ALL the facts.
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Steven Phillips, “Trump nominees for health positions should fail the ‘Fauci test.’” STAT, Jan 17, 2025 https://bit.ly/40GEUw6
Phillips has a nuanced view—not something in great demand these days. “Public health is not a hard science. Throughout the pandemic, both parties wrapped themselves in their truths by mixing data, expert opinion, and political exigencies.” He says dealing with fast-moving epidemics and other public health crises isn’t the same as the sort of plodding, conventional scientific inquiry that predominates elsewhere. Instead, epidemiological data often allows “a range of reasonable interpretations.” Therefore, the field requires a different approach, not ex catedra dictates from white-coated experts nor wild-eyed assertions from snake-oil peddlers. “Neither party has a claim to be the arbiter of evidence-based policy. Both can rely on evidence to support a range of rational agendas.”
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Lizzy Lawrence & Sarah Todd, “FDA bans red dye No. 3 in foods, decades after additive found to cause cancer in rats,” STAT, Jan 15, 2025 https://bit.ly/3PMjdEM
Only 30 years after red dye no. 3 was declared carcinogenic, our food-safety regulators have decided to act. Let’s not rush into anything! Red #3 was removed from cosmetics ages ago, so we can’t smear it on our faces. But we’re still allowed to put it down our gullets until 2027. “Concerted industry pressure” was largely responsible for the decades-long delay, say critics, which is why your maraschino cherry is still a perky red color along with 3,000 other red-tinted food products. What are the chances that other dangerous substances are among the tens of thousands the government never studied at all?
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Kay Tillow, Judy Albert, Claire M. Cohen, Ed Grystar & Ana Malinow, “Improved Medicare for All can heal this sick country,” Common Dreams, Jan 18, 2025 https://www.commondreams.org/opinion/medicare-for-all-2670870808
Refreshingly blunt language from single-payer advocates: “It’s the beginning of the end for corporate control of health care [and its] cruel denials, debt, disease, despair, and death at the hands of the investor-owned companies for whom patients are merely pawns for the extraction of profit.” How do you really feel? They point out that the seven largest insurers’ profits are three times what they were just a decade ago, and the steady encroachment of privateers into government-funded programs is getting worse. They argue that incremental tweaking of the system won’t work and conclude with a neat metaphor: “Runaway trains are not deterred by guardrails.”
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And to conclude: According to the Gaza Ministry of Health, the Israeli authorities have detained 330 healthcare workers there and killed 1,057, including three Palestinian MDs who have died in Israeli custody. The UN Human Rights Office documents 136 Israeli airstrikes on 40 hospitals and other medical facilities.
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See the full archive at www.nypan.org/single-payer-links
SINGLE PAYER LINKS #377
16 JAN 2025
This week: a changed atmosphere in the debate about health insurance; insurance scams roll on; merger and acquisition activity in healthcare picks up; physician militancy; what we learned/didn’t learn from Covid. —Tim
Listen here: https://www.podbean.com/eas/pb-7bs6k-17b3a25
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Don Tracy, “Additional security measures taken for J.P. Morgan healthcare conference,” PharmExec.com, Jan 10, 2025 https://bit.ly/42eBDFp
“San Francisco Police cancel time off requests to increase security at the J.P. Morgan Healthcare Conference, the largest annual gathering of healthcare executives and investors globally. The conference agenda can only be viewed by those invited to attend the event.” I wonder why!
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Bob Herman, “Cigna, Centene, Walgreens drop out of J.P. Morgan conference,” STAT, Jan 13, 2025 https://bit.ly/3PAjGK4
Cigna, Centene, Walgreens, two medical device makers, a physician practice management firm, two biotechs, and a chain of PT clinics all bowed out of the J.P. Morgan conference, “a possible sign that leaders of large health care companies are looking to avoid public appearances.” English translation: they’re scared shitless.
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Bob Herman, “Biden’s top antitrust official calls for breaking up powerful health care companies,” STAT, Jan 10, 2025 https://bit.ly/4gQaZrd
“Government officials need to consider breaking up the powerful companies that have price-gouged patients and suppressed competition.” The diagnosis comes from the outgoing head of antitrust at DoJ, Jonathan Kanter. He warns that the country’s entire healthcare infrastructure could end up as one or two companies if government doesn’t act. Kanter says these conglomerates aren’t really healthcare companies but “platforms” that use their hundreds of affiliates to extract excess profits all along the care continuum. The biggest target is UnitedHealth, which employs 90,000 docs through its Optum division and keeps trying to expand into new areas. Is anyone in the new team listening? We’ll soon find out.
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Tara Bannow, “DOJ seeks interviews with former UnitedHealth Group doctors,” STAT, Jan 12, 2025 https://bit.ly/4jexbwH
Will Justice Dept staff be allowed to continue putting the brakes on healthcare industry concentration? So far, permanent staff seem to be proceeding: “The Justice Department is interviewing former UnitedHealth Group physicians about their experiences working at practices owned by the health care giant.” They’re asking about systematic upcoding that enabled UH to extract juicier Medicare reimbursements, which should lead to a fraud complaint and a big clawback.
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Paige Minemyer, “UnitedHealth, Amedisys ask court to dismiss DOJ's challenge to $3.3B merger deal,” Fierce Healthcare, Jan 9, 2025 https://bit.ly/4hgvf4T
UnitedHealth Group and home health giant Amedisys argue that the government hasn’t specified where the alleged anti-competitive impact would be felt. But Kanter just said that’s not the point—the roll-up of different pieces of the healthcare continuum goes beyond restricting competition city by city. DoJ sued to block the deal last November because of UH’s “sustained strategy of acquiring, rather than beating, competition” as it morphed into the monolith it is today.
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Heather Landi, “Healthcare poised for ‘robust’ M&A activity in 2025,” Fierce Healthcare, Jan 6, 2025 https://bit.ly/3BZ17My
Despite “regulatory-driven hesitation towards large-scale transactions” (i.e., reawakened antitrust action under Kanter and the FTC’s Lina Khan), plenty of mergers and acquisitions are still occurring in the healthcare sector. Softening interest rates and a business-friendly Trump Administration are expected to stimulate more.
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Erica Carbajal, “AWS, General Catalyst partner on healthcare AI tools,” Becker’s Health IT, Jan 13, 2025 https://bit.ly/40idlbc
The health-business news is full of signals that we’ll enjoy more AI invasions in the sector. Amazon and GC will team up to delve into various aspects of healthcare “at an unprecedented scale and speed”—what could go wrong? Among the takeover terrains being eagerly eyed: analysis of medical images and automated administrative processes for clinicians. More robots, fewer people—great news!
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Mario Aguilar, “Transcarent to acquire Accolade for $621 million creating benefits tech giant,” STAT, Jan 8, 2025 https://bit.ly/40fikt3
Transcarent and Accolade are both “benefits companies,” i.e., intermediaries, which promise to “help self-insured employers deliver better health care at lower cost to their workers.” Good luck with that as costs spike relentlessly by 5–6% per year. The acquisition is funded by Wall Street dudes General Catalyst and 62 Ventures. The combined company will have 18 million members through 1,400 employers. Transcarent is basically an app “that connects members to virtual care and pharmacy benefits” and is rolling out a “generative AI chatbot that answers specific questions about people’s care and benefits.” More robots, fewer providers, bigger companies, fatter profits.
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Heather Landi, “Digital health venture funding hit $10.1B in 2024 as investors focused on earlier-stage dealmaking,” Fierce Healthcare, Jan 13, 2025 https://bit.ly/40vgQw9
It’s dizzying to try to make sense of the reporting in this world of high finance deal-making to exploit various niches in our healthcare “marketplace.” One wouldn’t know that doctors and patients have anything to do with these big-money deals in “mental health ($1.4 billion raised), cardiovascular ($1 billion), oncology ($700 million), weight management and obesity ($700 million), and reproductive and maternal health ($600 million).” Various stages of the care continuum are listed as “top value propositions,” such as treatment of disease ($1.9 billion raised), non-clinical workflow ($1.8 billion), monitoring of disease ($1.4 billion), on-demand healthcare ($1.3 billion) and clinical workflow ($1.2 billion). I guess there’s a ton of money everywhere if you just know where to stick your cash-vacuuming mandible.
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Dan Primack, “J&J strikes $14.6 billion deal for Intra-Cellular Therapies,” Axios, Jan 13, 2025 https://bit.ly/4ahJQL0
In the largest biotech merger of recent years, Pharma giant Johnson & Johnson will buy a company developing “new treatments for mental health disorders and neurological conditions and is currently working on an antidepressant drug.” For that price tag, there must be a lot of money to earn back. Shareholders of the acquired company got a nice surprise as J&J paid 60% over the closing stock price.
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Drew Altman, “The semi-sad state of consumer protection in health care,” KFF Health News, Jan 7, 2025 https://bit.ly/3E6ggMw
Kaiser Family Foundation chief Altman sees “little prospect of significant consumer protection legislation” despite the post-Luigi focus on health insurance. “Instead, we are likely to see a patchwork of pinprick actions at the federal and state level. Progress, but whack-a-mole.” He compares the situation to our reaction to gun violence, which is periodically rediscovered but never addressed. But he offers encouragement over some of the potential “pinpricks,” regulatory or legislative actions that might improve things a bit, for example: banning “ghost networks” of providers; making appeals easier; tightening pre-authorization rules and moving denial reviews to independent auditors; establishing so-called “gold card” programs for doctors whose records show they don’t overtreat or over-prescribe; limiting AI-driven chatbots; educating consumers to appeal denials routinely. Piecemeal reforms are “hyper-incremental,” he admits, but could be achieved in the current environmental of executive skittishness.
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Kristina Fiore, “Prospect is another casualty of private equity in healthcare,” MedPage Today, Jan 13, 2025 https://bit.ly/3CjfF9J
If health insurance is discredited, private equity’s invasion of healthcare is faring even worse. Along with the Steward PE debacle, now we have Prospect Medical Holdings collapsing into bankruptcy, leaving the familiar wake of ruined hospitals, bereft communities, and newly minted millionaires. PE owners Leonard Green & Partners extracted $645 million in “dividends and preferred stock redemption” from Prospect via loans that the financiers dumped on vulnerable hospitals before heading for the exits. Among the victims: the tottering hospital serving economically depressed Chester, Pennsylvania, and two Rhode Island safety net facilities. Prospect CEO Sam Lee pocketed a tidy $90 million from the decade-long looting.
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Sam Nunberg, “Vivek Ramaswamy is a fraud—and always has been,” Newsweek, Sep 1, 2023 https://bit.ly/4fWTi7N
If Trump’s team is seriously interested in reform, their record isn’t promising. Take big talking Ramaswamy: he has advice on everything, and we have to listen since he’s a billionaire. Turns out he’s also a scam artist. He pumped up a company experimenting with a possible Alzheimer’s drug using a study run by his mother, cashed in on the stock run-up, and then exited with massive profits while investors ate the 99% loss in value. But then again, Jim Cramer-style Republicans are the brand nowadays, so he fits right in.
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Adam Feuerstein, “Cassava Sciences and its Alzheimer’s drug are done. The damage lingers,” STAT, Nov 25, 2024 https://bit.ly/4gez5Lb
The author tried to raise the alarm on yet another Alzheimer’s treatment that turned out to be a fraud. (One employee has been indicted for falsification of research results.) “Four years on, the Cassava Sciences story ended exactly as many knew it would—with the company’s experimental drug, simufilam, proving to be nothing more than a placebo in a large clinical trial. The drug should never have advanced this far.” Feuerstein and others who blew the whistle on the fake trial were harassed by the company. RFK Jr has Pharma in the crosshairs, but the liberal public health establishment is all-in against him because of his crackpot vaccine theories.
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Elisabeth Rosenthal, “Removing a splinter? Treating a wart? If a doctor does, it can be billed as surgery,” KFF Health News/Washington Post, Dec 13, 2024 https://bit.ly/3Pz060C
The CPT code (17110) magically turns any “incision and removal of a foreign body, subcutaneous” into a surgical procedure. That includes removing a splinter with tweezers, probing an ear canal with a Q-tip, or putting ointment on a wart (because it penetrates the skin, thus “subcutaneous”). The 17110 Midas touch is applied in doctors’ offices nearly 3 million times per year to turn ridiculously minor acts into “operations.” RFK Jr. has called out the coding system and says the AMA shouldn’t be in charge of how payments to itself work. Rosenthal: “It’s common sense that the fox (physicians) should not be guarding the henhouse (payments).”
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Maya Miller & Duaa Eldeib, “Her mental health treatment was helping. That’s why insurance cut off her coverage,” ProPublica, Dec 31, 2024 https://bit.ly/4hgTGzm
Our insurance intermediary system at work: If the treatment is working, stop now since the problem is gone! OTOH, if the treatment isn’t working, also stop. Coverage denied in both cases. “Doctors are left to walk a tightrope trying to convince insurers that patients are making enough progress to stay in treatment as long as they actually need it but not so much that the companies prematurely cut them off from care.” Those begging sessions also gobble up provider time without compensation while the insurance company’s hired reviewer docs are comfortably on the corporate dime.
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Owais Durrani, “I’m an emergency physician. The modern telehealth model should have all of us concerned,” MSNBC, Dec 28, 2024 https://bit.ly/40lceYj
Telehealth exploded in popularity during and after the Covid lockdowns, but it’s just as problematic as the in-person kind. Example: An on-screen provider told a man with diabetes to go purchase an inhaler even though he was coughing up blood and short of breath and his feet were turning blue. He died. The family is suing Amazon One Medical for malpractice. “This wrongful death claim underscores the risks inherent in a health care model that prioritizes scalability and efficiency over the nuances of medical decision-making.” But telehealth companies need to rush through their appointments to maximize revenue. The for-profit system cannot fix this problem.
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Anastassia Gliadkovskaya, “Unionized doctors and NYC H+H affiliates reach contract deal on day of planned strike,” Fierce Healthcare, Jan 13, 2025 https://bit.ly/4hcQKUf
One result of the financier takeover of healthcare institutions is physician militancy as they see the benefits of collective action. A thousand unionized docs in New York City’s 11 safety-net hospitals won a better contract on the day of a planned strike. It included “salary incentives to enhance physician recruitment and retention” as well as improved working conditions, such as a rollback of 20-minute limits for patient appointments.
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Helen Branswell, “What Covid tried to teach us—and why it will matter in the next pandemic,” STAT, Jan 6, 2025 https://bit.ly/4jcj9vn
“Public trust in public health institutions has cratered.” Branswell is certainly right on that. She highlights “communications failures that undermined the CDC’s reputation” such as the confusion around the 10-day isolation rule suddenly shorted to five. She says the CDC was doing its best with a novel pathogen, but people wouldn’t give the agency the benefit of the doubt. But Branswell misses the key point: the CDC chiefs weren’t sure about what they were saying but PRETENDED THAT THEY WERE. At the same time, they insisted that we all follow their zigzagging advice like first graders. This is fatal—when scientists don’t really know something, they have to say so. Pretending to be the Voice of God in a white coat doesn’t work in the long run as was brutally demonstrated in this case. Wacko websites don’t help, but they’re the price of free speech, and snake-oil salesmen have regulatory fixes if we choose to use them. Branswell engages in a little disinformation of her own when she says that “people don’t fear Covid in the way they did a few years ago—nor should they” because we have acquired immunity. Tell that to the folks with long Covid after their third infection. And she—like the CDC she defends—fails to mention ventilation or air purification, which is probably the biggest CDC/WHO fail of all. Covid is an airborne virus.
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Samantha Liss, “Indiana state senator moves to scrap hospital monopoly law he helped create,” KFF Health News, Jan 8, 2025 https://bit.ly/3CawlQM
An Indiana hospital merger broke down in the face of public opposition. But the interesting twist is that a Republican-backed measure to make such mergers easy is now opposed by its own author. Indiana is one of 19 states that decided to facilitate hospital consolidation through so-called “Certificate of Public Advantage” laws, but six states have now repealed them. Turns out even Republicans are rethinking letting healthcare CEOs get their way in everything.
See the full archive at www.nypan.org/single-payer-news
SINGLE PAYER LINKS #376
10 JAN 2025
Plenty of hilarious outrages to enjoy along with a surprising dollop of mildly good news this week as we get ready for the MAGA v. Corporate America showdown.
Listen here: https://www.podbean.com/eas/pb-nbneg-17a6b21
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Cheryl Clark, “This year’s Shkreli Awards: Here’s who made the list,” MedPage Today, Jan 7, 2025 https://bit.ly/4fSZOg3
Let’s start with a few laughs at the unfolding tragicomedy. These annual awards are named after the notorious “pharma bro” Martin Shkreli who obtained the rights to a drug and then charged 50 times more for it—because he could. Dr Vikas Saini announced the awards: “It’s always a mixture of out-and-out fraud as well as just general venality and grasping.” Read the whole article if you’re not quite cynical enough yet. Topping the list: our man Ralph de la Torre of Steward Health Care who pocketed $250 million while driving 30 hospitals into bankruptcy. Close behind is UnitedHealth Group for its now famous sins. No. 6 is the “Pretty in Pink Boutique,” which billed Medicare beneficiaries for thousands of urinary catheters but was discovered not to exist. “There was no medical business at the address listed, and its phone number reached an auto body shop.”
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Shannon Firth, “Concerns continues over private equity’s reach into healthcare,” MedPage Today, Jan 2, 2025 https://bit.ly/4h98gbS
More on private equity’s greatest moment: “Approximately 15 patients in Steward hospitals died due to lack of medical equipment or staff, and many more lives were endangered. All the while, Steward CEO Ralph de la Torre spent $160 million on a yacht, two private jets, a luxury fishing boat, and a donation to an elite preparatory school.” Everything working as planned! Struggling hospitals will continue to be lured into PE deals as fancy Wall Street types show up “ready to help.”
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Paul Cuno-Booth, “State approves Catholic Medical Center sale to HCA Healthcare,” New Hampshire Public Radio, Jan 6, 2025 https://bit.ly/428FDHv
Here’s an example: NH is allowing for-profit HCA Healthcare to take over a failing hospital, “the latest in a series of hospital mergers and acquisitions reshaping New Hampshire’s medical landscape.” A previous HCA takeover led to reduced services and higher prices, but the state assures residents that HCA promises not to do that again. But “HCA agreed to a similar provision in 2020 when acquiring Frisbie Memorial Hospital in Rochester only to cut labor and delivery services two years later, citing financial and staffing reasons.”
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“Massachusetts lawmakers approve bill to close loopholes in health care market,” Associated Press, Dec 31, 2024 https://bit.ly/4fTiT1o
Massachusetts closes the barn door now that the horses are in Rhode Island. After the Steward collapse wrecked key safety net hospitals, the state legislature lamely decided to give regulators new powers to obtain hospitals’ financial data on the theory that they will then stave off the next steal. How bold! The bill boosts penalties “for not complying with the new proposed data reporting requirements.” How will that matter after the next hospital is asset-stripped and left bankrupt?
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Noah Tong, “Aetna sues drugmakers for widespread price-fixing and collusion,” Fierce Healthcare, Jan 3, 2025 https://bit.ly/3DIJIIk
Godzilla v. King Kong: Aetna is suing several Pharma giants for rigging the generic drug market, claiming they “communicated secretly to determine the market share, prices, and bids of certain drugs.” The lawsuit names several Pharma officials including a former executive of Israel’s Teva Pharmaceuticals, who pleaded guilty for price-fixing in 2020. Several states, including Connecticut, are doing the same, and two other large insurers, Humana and UnitedHealthcare, are also suing over price-fixing of generics.
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Duaa Eldeib & Maya Miller, “Insurers continue to rely on doctors whose judgments have been criticized by courts,” ProPublica, Dec 30, 2024 https://bit.ly/3W3cOZr
“Insurance companies use loyal physician ‘experts’ to keep those denials churning out.” This article details the career of one such expert whose automatic NO!s were regularly overturned if anyone had the patience and cash to haul the insurer and its loyal chief denialist to court.
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Bob Herman, “Aetna lawsuit alleges radiology group of fraudulent billing and abuse of federal arbitration,” STAT, Dec 27, 2024 https://bit.ly/425L6yM
The No Surprises Act was supposed to stop the practice of out-of-network doctors slapping bills onto patients who carefully chose an in-network facility. Insurer Aetna now says an outfit called Radiology Partners of sending fraudulent bills, then “flooding the arbitration process with thousands of out-of-network claims that should have been billed under existing contracts.” That gummed up the federal arbitration apparatus and led to big fees for lawyers enjoying the procedural thicket. And who should own Radiology Partners? “Venture capital firm New Enterprise Associates and a handful of private equity firms, including Whistler Capital Partners and Heritage Group.” Depressingly predictable.
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Rebekah Ninan, “Ghost networks and mental healthcare,” Bill of Health, Nov 17, 2024 https://bit.ly/4jot4yj
Ghost networks are insurer lists of providers who turn out not to exist, aren’t taking new clients, or are dead. Three New Yorkers are suing Anthem Blue Cross Blue Shield/Elevance over the practice, alleging that “only seven of the first 100 providers on the Anthem directory for the state were contactable, in network, or accepting patients.” Nice way to dodge legal requirements to provide the service.
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And now for some moderately good news:
Nathaniel Weixel, “House Republicans launch investigation into CVS Caremark for potential antitrust violations,” The Hill, Dec 12, 2024 https://bit.ly/3DOb8wC
Red-state pressure on the PBMs: House Republicans want to dig into anticompetitive practices by CVS’s giant pharmacy benefit manager Caremark.
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Noah Tong, “CMS sunsets Medicare Advantage value-based model, citing billions in costs,” Fierce Healthcare, Dec 17, 2024 https://bit.ly/4gQEqtf
The program to terminate next year is called the “Value-Based Insurance Design Model” used by Medicare Advantage plans. The reason given is the high cost of “increased risk score growth and Part D expenditures.” English translation: upcoding.
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Paige Minemyer, “CVS officially rolls out CostVantage model for commercial prescriptions,” Fierce Healthcare, Jan 6, 2025 https://bit.ly/4gLFT3T
CVS Caremark now will price prescriptions on a cost-plus basis and add a dispensing fee. Does this sound like Mark Cuban’s Cost-Plus pharmacy? Why yes, it does! Perhaps Cuban’s alternative is eating the big chains’ lunches. Yay for disruptive capitalism then.
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Joseph Choi, “Medicare’s new drug price cap kicks in Jan. 1,” The Hill, Dec 31, 2024 https://bit.ly/408Jba7
Some seniors now will have their out-of-pocket spending capped at $2,000 thanks to a law passed several years ago along with the Medicare drug price negotiation program. The article doesn’t say who is picking up the difference—presumably, the Feds, not Pharma companies. See next article.
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Michael Erman, “Drugmakers to raise US prices on over 250 medicines starting Jan. 1,” Reuters, Dec 31, 2024 https://bit.ly/4afhlhk
Reuters helpfully emphasizes that the increases aren’t really all that high and are less than in previous years. “Nearly all of the drug price increases are below 10%—most well below. The median price increase of the drugs being hiked is in line with the median for all price increases last year.” Lucky for us! “Larger drug price increases were once far more common in the U.S., but in recent years drugmakers have scaled them back after price hikes drew sharp criticism in the middle of the last decade.” Not from Reuters, I suspect.
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The coming struggle between the MAHAs and corporate Republicans, a.k.a. Trump’s golfing buddies:
Matt Stoller, “Big Ag vs Make American Healthy Again,” BIG, Jan 5, 2025 https://bit.ly/421W2O7
Our food supply is controlled by a set of cartels and organized through Soviet-style Five Year Plans known as the Farm Bills. As this behemoth is shepherded through Congress, urban Democrats wangle food stamps and other benefits for low-income people in exchange for signing off on Republican gimmies like subsidies for agribusiness and farmers. It’s up for renewal this year, but as Stoller reports, “Something has gone very wrong of late. America isn’t just de-industrializing in terms of manufacturing; we are becoming a country that increasingly imports our food as well.” The culprit: monopolization. “Increasingly, to older farmers, it doesn’t seem worth it to produce food anymore. [They] are mad that inputs like seeds and chemicals and fertilizers are consolidated and overpriced, and producers of chicken, pork, and beef feel they aren’t getting enough for their work from large processors.” Voila, another area where the red state populations are also unhappy with late-stage financialized capitalism. (It’s those transgender billionaires again!) Fun fact: “Pigs defecate three times as much as humans, and Iowa has 25 million of them. Yet pig waste isn’t held to the same standards as human waste, which is why industrial pig farming in Iowa is profitable. Giant processors offload the real cost in terms of massive pollution to the public.”
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Shalina Chatlani, “As demand for weight-loss drugs rises, states grapple with Medicaid coverage,” Stateline, Jan 6, 2025 https://bit.ly/4gLKwux
A whole lot of people in this country are obese. The new drugs seem to work pretty well for some people (with a lot of downsides that aren’t getting enough attention). The Pharma companies that own them are charging insane prices ($940 to $1,350 a month, list), as usual. What to do? States are floundering. Some try to authorize payments, then go broke. North Carolina and a dozen other states cover obesity diagnoses, but many states limit the GLP-1 drugs to diabetes patients. Even that is driving some into the red.
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April Baumgarten, “North Dakota becomes 1st state to cover weight loss medication with federally backed health insurance,” InForum, Jan 4, 2025 https://bit.ly/426ON7q
North Dakota will allow federally-subsidized insurance to cover weight loss drugs for individual plans.” Stand by to see the state’s reaction to the bills.
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Leah Willingham, “West Virginia patients are left in limbo over changing insurance coverage of obesity medications,” Associated Press, Jan 2, 2025 https://bit.ly/40pLRBv
States that find they can’t handle the cost of the GLP-1 drugs are cutting people off. West Virginia has the highest obesity rate in the country, one of the poorest populations, and is full of “rural food deserts” without even a grocery store, much less decent food. That’s the underlying problem, which the fat shots don’t address. GLP-1 costs caused premiums to go up by 14% for state employees and 12% bump for retirees. So, will people resent their obese neighbors?
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Nathaniel Weixel, “RFK Jr. vs. Oz sets up clash on weight loss drug coverage,” The Hill, Dec 30, 2024 https://bit.ly/4h40XCi
“Two of President-elect Trump’s top health nominees are on a collision course as the incoming administration faces a crucial decision on coverage for groundbreaking anti-obesity drugs.” Oz says yes, RFK says no because foreign companies are “counting on selling it to Americans because we’re so stupid and so addicted to drugs.” Later, he backpedaled slightly. The larger battle question is whether any of Trump’s iconoclastic appointees will be able/allowed to stare down corporate lobbies over anything.
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Sophie Gardner, “RFK Jr. wants to end chronic disease. But GOP lawmakers are targeting chronic disease prevention funding,” Politico, Jan 6, 2025 https://bit.ly/4h3hg28
Another clash-to-come: RFK Jr on chronic disease prevention v/s the Republican caucus who don’t want to fund it. “The potential conflict exposes the rift between conservative priorities and the ‘Make America Healthy Again’ movement.” Paywalled, but this will be a recurring theme.
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Brendan Pierson, “Lawsuit accuses major food companies of marketing ‘addictive’ food to kids,” Reuters, Dec 11, 2024 https://bit.ly/4jbLT7q
Plaintiffs say Kraft Heinz, Coca-Cola, General Mills, Nestle’s, Mars, Kellogg, and other big food companies intentionally designed and marketed junk to children while knowing their products were harmful and deliberately engineering them to create addictive consumption. It worked against tobacco companies, so let’s see.
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Andrea Love & Katie Suleta, “Will the Trump Administration be a dangerous ally to the wellness industry?” MedPage Today, Jan 3, 2025 https://bit.ly/3PxptQo
“The $5.6 trillion [!] wellness industry sells a seductive premise: pursue personal well-being and empowerment by bypassing the perceived failures of conventional medicine. The narrative fuels a market of unregulated supplements, unproven tests, and vague diagnoses—all sold under the guise of taking control of your health.” The authors warn that putting “wellness” promoters in charge could discredit the biz in the long term—after cutting a swath of destruction through the nation’s health. “Wellness” products are largely unregulated.
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Habib Benzian, “The U.S. health care system is broken. It’s time for real reform,” Newsweek, Dec 10, 2024 https://bit.ly/3DMfTH7
After the usual diagnosis of U.S. healthcare on life support, the dentist-author offers this way to “radical transformation”: health taxes on harmful products like tobacco, sugary beverages, and alcohol. That’s his idea of “bold, unflinching interventions.” It’s amazing how many of these chin-stroking articles get published that endlessly rehash all we know about our system’s dysfunction and then propose such lame-ass answers. Of course, mention of “single payer” is verboten.
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Lillian Mongeau Hughes, “For many rural women, finding maternity care outweighs concerns about abortion access,” KFF Health News/The 19th, Jan 2, 2025 https://bit.ly/4a9Nxm8
Rural hospital closures are forcing women to travel long distances for basic OB/GYN care. The consequences are obvious and dire: birth emergencies ending in permanent injury and death. Over half of all rural hospitals now lack obstetrics units.
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Joyce Frieden, “Do the new CMS rules on prior authorization go far enough?” MedPage Today, Jan 7, 2025 https://bit.ly/4j6vPUH
In general, one can safely answer any headline posed as a question with a “NO.” The new regs require that insurers “improve the electronic exchange of health information and prior authorization processes.” That sure sounds vague. Plan managers now are supposed to send their decisions within 72 hours for urgent requests and 7 calendar days for non-urgent ones and give a reason for denials. But the rules only apply to MA plans, Medicaid HMOs, and some Obamacare exchange plans. The few independent doctors still out there aren’t included in the protections and, as I understand it, that puts them at a disadvantage compared to those already owned by Aetna, Cigna, UH, etc. In addition, the new rules have to withstand court challenges, which is not guaranteed. Why can’t the government just set a standard that applies universally?
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See the full archive at www.nypan.org/single-payer-news
SINGLE PAYER LINKS #375
3 JAN 2025
This week, I dare to wonder if a tiny consensus might be building on reining in the health industry cartels and if something not terrible could conceivably emerge from Trumpland. Followed by the usual horror stories. –Tim
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Joshua P. Cohen, “Lawmakers want to break up healthcare conglomerates, forcing them to shed pharmacies,” Forbes, Dec 17, 2024 https://bit.ly/4gCCPHa
Two unlikely allies want to force pharmacy benefit managers (PBMs) to sell their retail pharmacy businesses. “Healthcare conglomerates such as CVS Health use their size and leverage to steer patients toward their own pharmacies, increasing prescription drug costs for patients, employers and government programs, while driving independent pharmacies out of business.” Senators Elizabeth Warren’s sidekick on this issue is none other than Josh Hawley (R-MO), and they’re in agreement on other antitrust bits as well. Seeing Warren team up with a bright red dude from Arkansas is a development worth watching. Hawley’s home-town newspaper, the St Louis Post-Dispatch, wrote, “If this keeps up, people are going to talk.”
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David Balto, “Will Donald Trump be the one to slay the PBMs?” STAT, Dec 17, 2024 https://bit.ly/4fE2ePm
Balto thinks PBMs should be worried. “Trump 2.0 is likely to be giving the PBMs some doses of regulatory medicine they certainly don’t want,” specifically restrictions on how they manipulate rebates, which are kickbacks that are currently not illegal.
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Arthur Allen, “How a duty to spend wisely on worker benefits could loosen PBMs’ grip on drug prices,” KFF Health News/Endpoints News, Dec 18, 2024 https://bit.ly/49UY4l7
Here’s one possible avenue for quick PBM reform, stemming from a lawsuit against Johnson & Johnson by a former employee. “Lewandowski charges that by contracting with the PBM Express Scripts, J&J failed in its duty to ensure reasonable drug prices for its 50,000 U.S. employees.” That is, her employer had a legal obligation to protect her from PBM gouging under the ERISA law that compels companies to exercise “prudent management” of employee retirement and health benefits. Lots of people think the PBM scam is low-hanging fruit. “In 2019, Connecticut became CVS’ first PBM customer to negotiate a transparent fee structure. Its contract required 100% of drug rebates be passed along to the state and eliminated spread pricing.”
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Lizzy Lawrence, “Truth-teller or reflexive contrarian: Which Marty Makary would run the FDA?” STAT, Dec. 17, 2024 https://bit.ly/4fFHp6h and Matt Stoller, “Trump’s FDA pick knows how to fix medical shortages,” BIG, Dec 1, 2024, https://bit.ly/4gYxwlk
The new guy at the FDA sounds like an ambitious attention seeker who nonetheless isn’t a full-blown crackpot. He often “denounces injustice in the health care system, attracting constant media and political attention along the way.” He’s also sloppy with the facts, but alongside Trump’s usual corporate picks, he looks independent-ish. “It just shows that the bar is pretty low,” said a neurologist author of books on the antivax movement. Fun fact: Makary is a native Brit born to Coptic (Christian) Egyptian parents. His latest book, Blind Spots, says we should be more skeptical of doctors (presumably including himself). But he doesn’t come from Big Pharma like his two predecessors. Also, Stoller notes happily that Makary has written astutely about the wholesaler cartel of hospital Group Purchasing Organizations (GPOs), which the FTC started to investigate against the howls of outrage from lobbyists and bought-off media doctors like Sanjay Gupta.
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Paige Minemyer, “AMA study: Insurance markets remain ‘stubbornly highly concentrated,’” Fierce Healthcare, Nov 19, 2024 https://bit.ly/4gzl4Z7
Meaning that there is essentially no real consumer choice for insurance in most U.S. cities in half of which “a single insurer owned at least 50% of the market.”
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Daniel Urie, “Pa. hospital to close; more than 800 people to be laid off,” PennLive/Patriot News, Dec 19, 2024 https://bit.ly/41ULX5y
The collapse of the Steward Health Care System put its 31 hospitals and 400 other facilities in eight states in jeopardy. Will anyone take action? See next article.
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Sri Taylor, “Crackdown on private equity in health care flops in state houses,” Yahoo Finance/Bloomberg, Dec 22, 2024 https://bit.ly/3DB4REx
While Steward’s hospitals sink into penurious dysfunction all over the U.S. thanks to private equity-induced asset stripping and bankruptcy, PE itself remains immune. Despite the wave of public fury, “the would-be crackdown is fizzling.” California Governor Gavin Newsom led the way by vetoing a bill to block PE healthcare deals. “Efforts to bolster oversight of financial firms or outright prohibit certain health-care investments also faltered in Pennsylvania, Connecticut, Oregon, Washington, and Minnesota”—almost all blue states. Meanwhile, PE companies were responsible for a fifth of health sector bankruptcies last year, but they pull out their “profits” before letting the empty shell implode. (For example, Cerberus Capital Management pulled $800 million out of Steward before dumping it and bragged later that it had “rescued and restored critical community hospitals in Massachusetts.” Quick! More rescues!) So, we can expect more bankrupt hospitals leaving nurses with no choice but to pack up dead newborns in cardboard boxes, as occurred at one Steward unit.
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Luigi time
Joanne Kenen, “He was Surgeon General—and he’s got thoughts about the reaction to the UnitedHealthcare killing,” Politico, Dec 17, 2024 https://bit.ly/3DMqeT3
“It signals a profound loss of confidence in structures that are meant to support and protect the public,” said former S-G Jerome Adams. (Gosh, really? What was your first clue?) “Insurers absolutely cannot ignore this moment. Anger is also coming from providers, pretty much everybody who has to deal with these pre-authorization reviews, with being on the phone and emailing insurers.” One immediate response: insurers are taking the names and photos of their top executives off their websites.
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Noam N. Levey, “Rage has long shadowed American health care. It’s rarely produced big change,” KFF Health News/Fortune, Dec 18, 2024 https://bit.ly/3DyA5vZ
“Cycles of rage have been so much sound and fury, producing only modest reforms.” Sometimes, the fixes made things worse: “The HMO backlash in the late 1990s and early 2000s prompted employers to embrace high-deductible health plans [now] driving tens of millions of Americans into debt.” The industries are adept at sidestepping radical changes, in part benefitting from “a paradox in how Americans think about their health care.” We think it stinks in general, but most of us still rate our own care as “excellent or good.” At least that’s what some surveys say, if we can believe them. (See the Potter rebuttal below.)
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Wendell Potter, “Don’t overlook Wall Street’s role in the broken system,” STAT, Dec 11, 2024 https://bit.ly/4gDNTUs
Potter, a former insurance company flack, says “much of [corporate PR] spending was to create the illusion that we Americans are happy with our health care system and don’t want politicians to get any bright ideas about changing it.” So, those polls showing that we just love our insurance are questionable. He notes that the late Brian Thompson was en route to pitch his company’s profit-making to industry investors where the word “patient” would not pass from any lips, as opposed to phrases like “shareholder value.” Potter thinks the Obamacare requirement that insurers pay out a high percentage of their revenue in care services (the “medical loss ratio”) has backfired and stimulated vertical integration. “Hundreds of acquisitions later, UnitedHealth is now the fourth largest U.S. company—just behind Walmart, Amazon, and Apple.”
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Christopher Weaver, Anna Wilde Mathews & Tom McGinty, “UnitedHealth’s army of doctors helped it collect billions more from Medicare,” Wall Street Journal, Dec 29, 2024 https://bit.ly/4237Dw6
A thorough takedown of the criminal gang running UnitedHealth, sadly paywalled (but <archiv.is> is your friend). The intro: “Like most doctors, Nicholas Jones prefers to diagnose patients after examining them. When he worked for UnitedHealth UNH Group, though, the company frequently prepared him a checklist of potential diagnoses before he ever laid eyes on them.” But this only applied to Medicare Advantage patients because upcoding those on traditional Medicare doesn’t bring in extra reimbursements. Newly hired UH doctors get special training in how to dig around for lucrative diagnoses, and if they don’t get the message, a supervisor promptly shows up: “If you don’t [upcode], they come bothering you.” Some of the anecdotes are beyond absurd, like the time UnitedHealth sent a doctor included a “potential diagnosis” of a lower-leg amputation, even though the patient wasn’t missing a limb. (We’ll cut it off you for, how’s that!) Doctors who play nice earn big bonuses.
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Matt Stoller, “It’s time to break up big medicine,” BIG, Dec 12, 2024 https://bit.ly/4a3zyOz
“UnitedHealth Group is not an insurer; it’s a platform.” In this lengthy and wonky (but worth the effort) essay, Stoller dismantles the industry counter-argument that insurance companies aren’t really villains and that the real problem is providers happily gouging us while sticking UH and Aetna with the collection duties while they innocently try to hold down costs. He points to administrative bloat that absorbs fully one third of the gargantuan U.S. healthcare spending; debunks “overconsumption” of healthcare services as a convenient myth to justify copays and premiums; and zeroes in on what he calls the real culprit: monopoly pricing power resulting from the consolidation of vertically integrated healthcare cartels. For example, UH has rolled up an astonishing 1,300 new companies just since 2021. Bankers, not providers, are now in charge, and they like monopolies. “UHG is not primarily a health insurer, but something new. It is the biggest employer of doctors in the nation; it has a significant software business; and it sits in the middle of the pharmaceutical pricing chain.” It also owns a bank. The company recycles its vast revenues by self-dealing at every care point, enabling its multiple entities to peel off profits at every stage. With these hundreds of tentacles and interlocking business, UH is more like Google than an old-fashioned insurer. Essential reading!
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Robert Kuttner, “How AARP shills for UnitedHealthcare: Why does the supposed advocate for the elderly steer them to the industry’s worst insurer?” American Prospect, Dec 11, 2024 https://bit.ly/3BDBX64
The 38-million-strong AARP “is basically an insurance marketing scheme masquerading as an advocacy group for the elderly.” Kuttner explains: AARP gets a tidy 4.95% of premium income from UH policies taken out by members. That amounts to over a billion dollars, dwarfing AARP’s income from membership dues. And as a “nonprofit,” it pays no income taxes. “AARP’s conflicted role crowds out much-needed genuine organizations to advocate for seniors,” such as the vastly poorer National Committee to Preserve Social Security and Medicare < https://www.ncpssm.org> whose annual budget is $8 million. Insurance-friendly AARP’s is a billion and a half.
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Elisabeth Rosenthal, “‘Bill of the Month’: The series that dissects and slashes medical bills,” KFF Health News/NPR, Dec 20, 2024 https://bit.ly/4gVElUB
These billing horror stories are excellent illustrations of everything wrong about U.S. healthcare and are great teaching tools. Two featured patients ended up at the White House to build pressure for the No Surprises Act (including Elizabeth Moreno who was billed $18,000 for a urine test). Many of the bills were rescinded after reporters made inquiries. Takeaway messages: ask if a provider is in-network before a procedure or visit; read waiting-room forms closely (and before signing, add notes like “in-network only”; never pay the first bill—ask for it to be fully itemized; question charges that don’t make sense; avoid hospitals for simple procedures and ask your clinic if a hospital owns them (and can charge accordingly); ask urgent care centers if they are really free-standing ERs, i.e., much more expensive; see if paying cash will be cheaper than using your insurance (it sometimes will). After all that, have a speedy recovery from your stroke!
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Paul Kiel, “How a decades-old loophole lets billionaires avoid Medicare taxes,” ProPublica, Dec 11, 2024 https://bit.ly/41UBKpt
Many of us don’t realize that Medicare tax “takes a bite out of every paycheck” since we never see it. But billionaires have a way to opt out. In 2016, Steve Cohen, the owner of the New York Mets, paid $0. So did Stephen Schwarzman, head of the investment behemoth Blackstone [who got his name on the main NYPL reading room on Fifth Avenue]. They use an obscure tax loophole to save millions. Important for the panic coverage about the terrible burden of Medicare on the federal budget.
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Cory Franklin, “Journalists failed to ask Dr. Anthony Fauci the hard questions during the pandemic,” Chicago Tribune, Dec 18, 2024 https://bit.ly/4gXFpHo
Fauci is discussed as a possible pardon candidate over his “disingenuous” testimony before Congress on gain-of-function research. But the author says the real damage from Fauci’s reign was that he was never seriously interrogated. “Your average NFL coach gets more probing questions after the game than Fauci got from the news media.” Instead, they fawned over him and wrote obsequious profiles for National Geographic and the fashion magazine InStyle. “Imagine how differently things might have gone if science journalists had done their due diligence and questioned the experts as they would a municipal official accused of graft. Closer attention earlier on to indoor ventilation in office buildings, nursing homes, meatpacking plants, and prisons might have reduced that number [of deaths]. The information was out there; nobody asked.”
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Anil Oza, “How retractions get weaponized on social media,” STAT, Dec 24, 2024 https://bit.ly/49UX3tj
“Because retractions acknowledge that peer-reviewed research isn’t infallible, they can also strengthen distrust in science and present avenues for scientists to be attacked.” Yeah, bad faith actors can take advantage of an admission of error—so what? We should never cop to a mistake? That seems to be the public health establishment’s position. The author says that when a paper on using hydroxychloroquine for Covid was pulled, social media blew up with accusations that “Big Pharma or the medical establishment had attempted to discredit hydroxychloroquine to push more expensive drugs.” Heaven forfend that we should distrust pharmaceutical companies! The implication is that we should somehow fix things so that people don’t fall for outlandish tales. Yeah, that’s called censorship.
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Aneri Pattani, “How are states spending opioid settlement cash? We built a database of answers,” KFF Health News/NPR, Dec 16, 2024 https://bit.ly/3PoQo0J
A slurry of cash is flowing to states, cities, and counties to repair some of the damage from the opioid epidemic. Where is that money going, who is getting it, and is it doing any good? Some good treatment programs are funded through it, some of it is spent on inoffensive but probably ineffective stuff, some of it beefs up police forces or goes into the general fund, and a full third of all the money is not tracked at all. One big issue for even the best programs: what happens when the opioid settlement money dries up?
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Rebecca Raney, “Pesticide-related PAC money surges into state legislatures as companies seek to limit damage awards in court,” U.S. Right To Know, Oct 31, 2024 https://bit.ly/40cGR38
As people are successfully suing pesticide companies for their cancer diagnoses, the producers are buying their way into state legislatures to sidestep legal exposure. Industry have poured hundreds of thousands of dollars to state pols. Top goals: limits on tort damage awards, stopping bans on their products, and blocking labeling standards.
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Juan Cole, “With Israel’s destruction of Kamal Adwan Hospital, UN Rapporteur calls for global medical boycott,” Informed Comment, Dec 31, 2024 https://bit.ly/4gsxGBr
Francesca Albanese, the UN Special Rapporteur for the Israeli-Occupied Palestinian Territories, told medical professionals to “sever all ties with Israel as a concrete way to forcefully denounce Israel’s full destruction of the Palestinian healthcare system in Gaza, a critical tool of its ongoing genocide.” It’s not the first call for a medical boycott. Doctors isolated German scientific and medical establishment during World War I.
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