Posted Dec 24, 2020

Dan Goldberg & Brianna Ehley, “Biden’s other health crisis: A resurgent drug epidemic,” Politico, Nov 28, 2020

“Biden, who has stocked his team with addiction experts with extensive backgrounds in public health, will emphasize new funding for substance abuse treatment and prevention, while calling to eliminate jail time for drug use. It’s a departure from his tough-on-crime approach as a senator.” Meanwhile, “States are contending with double-digit spikes in overdose deaths; sparse public health workforces are already stretched thin fighting the coronavirus; and widening budget deficits brought on by the pandemic could force states to make painful cutbacks to public services. Ohio recorded 543 overdose deaths in May, the most ever in a single month, said Dennis Cauchon, president of Harm Reduction Ohio. ‘It’s a slaughter out there.’” Kind of karmic that Biden will have to deal with the mess he contributed so much to creating.

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Joyce Frieden, “House Dems, GOP agree: Sacklers, Purdue Pharma ‘Sickening,’” MedPage Today, Dec 17, 2020

Virtue signaling from Congress. Talk is cheap, but don’t count on any strong action to prevent a new Oxycontin-like debacle in the future.

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Anonymous, “SCOTUS: States can regulate insurance plan contractors,” Angry Bear, Dec 18, 2020

Sotomayor wrote the ruling that prohibits Pharma Benefit Managers (PBMs) from imposing “gag” rules to hide their price lists and lower-cost options for patients. The 8-0 decision “handed a win to state healthcare cost control efforts” and, says AB, directly threatens the loot skimmed through the distribution of drugs from manufacturer to drugstores. Note unanimity with the Trumpians.

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Ron Zoeller, “What purpose do pharmacy benefit managers serve?” Buffalo News, Nov 26, 2020

An interesting take on how PBMs scoop up a hefty slice of the healthcare dollar—through exercising monopolistic control, as far as I can tell. (Knowledgeable readers, please weigh in.) The author is the CEO of a small, local health plan trying to survive the cutthroat environment.

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Richard E. Heller, “Atlas shrugged? The legacy of Scott Atlas, MD,” MedPage Today, Dec 20, 2020

Couldn’t resist this for the title, but the author makes an important distinction: he doesn’t criticize Atlas for being an “outsider” to infectious disease or epidemiology who should “stay in his lane”—many important dissident ideas come from questioning the prevailing wisdom in a given field—but says Atlas “began with an ideological position and then used data to support those beliefs.”

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Harvey Risch, “FDA obstruction: Patients die, while Trump gets the blame,” Washington Examiner, Oct 19, 2020

Look past the right-wing source (the author couldn’t place it in Dem-friendly venues) and consider the arguments of this non-Trumpian critic: ripping Trump for his promotion of hydroxychloroquine is “driven by craven politics and Big Pharma conflicts of interest,” he says. He notes the Pharma links of all those who piled on: Pfizer, Johnson & Johnson, BioTime, Viamet Pharmaceuticals, AstraZeneca. “Many of these companies manufacture patented COVID-19 vaccines and medications. . . . in direct competition with generic, low-cost drugs that FDA has been asked to approve for outpatient COVID-19 use, but that it has refused. The FDA has undermined its own credibility, and it has done so brazenly in plain sight. No president was needed for that.” Worth giving him a hearing.

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Sarah Lazare, “Pfizer helped create the global patent rules. Now it’s using them to undercut access to the Covid vaccine,” Common Dreams, Dec 18, 2020

Pfizer (and Pharma more generally) bask in the heroic glow for the vaccine, so of course the company is “a vocal opponent of a global effort to ensure poor countries are able to access it.” The Global South won’t have any until 2022, forcing countries to look for more humane alternatives (Chinese or Russian vaccines?). “It is difficult to think of a clearer case for suspending intellectual property laws than a global pandemic.” Not in Pfizer’s opinion.

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Dean Baker, “Vaccines, vaccines, vaccines—why doesn’t everyone have one or two?” Patreon, Dec 21, 2020

A cogent critique of the free-market obstacles to getting vaccines quickly to the public. “Why don’t we have four hundred million vaccines sitting in warehouses right now?” Answer: our rickety state refuses to step in and direct public resources in the public interest.

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Maryn McKenna, “The antibiotic paradox: why companies can’t afford to create life-saving drugs,” Nature, Aug 19, 2020

Speaking of the public interest left in the hands of private enterprise, crucially important antibiotics are notoriously under-researched and -developed. Why? No money in it. “The market for antibiotics is broken. The large corporations that once dominated antibiotic discovery have been fleeing the business, saying that the prices they can charge for these life-saving medicines are too low to support the cost of developing them. Most of the companies now working on antibiotics are small biotechnology firms, many of them running on credit, and many are failing.”

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Abby Zimet, “First in the room, back of the line: America’s profiteering health system does it again,” Common Dreams, Dec 19, 2020

“In a harbinger of let-them-eat-cake things to come within a grossly inequitable health system, frontline residents at Stanford Medical Center just held a rowdy protest after the hospital distributed almost all its 5,000 first-round vaccines to executives and other suits who’ve stayed safely home for months.” Executives quickly blamed it on “the algorithm,” as if such things are not created by sentient persons. What do all those highly paid university administrators actually do? The protests forced Stanford to throw out the magic formula.

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Tahir Amin, “Drug monopolies must have their big tech moment,” Daily Poster, Dec 18, 2020

Now that Congress is lining up against Facebook and Google, what about the Pharma monopolists? “Pharmaceutical companies regularly file dozens, and increasingly hundreds, of patents on a single drug. And because each granted patent gets awarded 20 years of exclusivity, they can secure 40 years or more of potential market exclusivity simply by strategically spacing out their patent filings.” Some patents are for drug alternatives that the companies have no intention of making but want to ensure that no one else can either. Example: AbbVie’s drug Humira for rheumatoid arthritis and Crohn’s disease (often peddled on TV), lists for $44,000 a year and rakes in $19 billion a year. “AbbVie had filed 247 patent applications and amassed 130 granted patents on Humira,” 90% of them filed just as the main patent was about to expire.

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Alex Kacid, “Baylor Scott & White to cut a third of its corporate finance department,” Modern Healthcare, Dec 7, 2020

The Dallas-based health system will outsource “around 100 accounting and finance employees” to India. No details as to exactly what tasks these 100 performed—patient billing complaints perhaps? The “third-party vendor” taking over the work will hire back some of the laid off employees—another triumph of corporate globalism. You used to work for the local hospital? The bosses just moved to Hyerabad.

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Peter H. Lewis, “A done deal: How Mission Health wooed HCA,” North Carolina Health News, Nov 26, 2020

This article and the next by the same author show how the relentless hospital consolidation process can be handled to the benefit—or detriment—of the affected communities. In one case, secretive negotiations with obvious favoritism to one interested buyer led to a shoddy deal, loss of local control, and juicy rewards for shareholders of the for-profit takeover king (which, not incidentally, has a lousy record for Medicare/Medicaid fraud and ignoring their contractual obligations). In the other case (outlined below), a transparent, participatory process extracted a much higher purchase price and guarantees over services. Lesson: even if consolidation cannot be resisted, how it is done is crucial.

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Peter H. Lewis, “Mission sale: Good for WNC, or just HCA?” North Carolina Health News, Nov 27, 2020

In this second sale of a small hospital, the buyers had to pay $5.1 billion. “That’s more than $3 billion higher than the total package the Mission board [case above] accepted from HCA.” The difference? An open negotiation process with public input.

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Lizzie Presser, “Tethered to the machine,” ProPublica, Dec 15, 2020

A sad tale of mismanagement, race-based neglect, and profit. “When patients get dialysis, they enter a system in which the corporations that stand to profit from keeping them on their machines are also the gatekeepers to getting a transplant.” What could go wrong?

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Merrill Matthews, “With new drug pricing order, Trump flirts with socialism,” Holland [MI] Sentinel, Dec 4, 2020

Trump channels Karl Marx! Tired Pharma propaganda from an unoriginal corporate shill. But he has one compelling turn of phrase: “Bureaucrats in those [European] nations’ socialized medical systems simply refuse to cover drugs unless manufacturers sell the medicines for pennies on the dollar.” And?

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Kristina Fiore, “Black doctor who died of COVID said racism impacted care,” MedPage Today, Dec 23, 2020

Even being a knowledgeable, insistent MD wasn’t enough to penetrate the built-in racial prism that undermined her care.

Posted Dec 16, 2020

Yves Smith, “An internal medicine doctor and his peers read the Pfizer vaccine study and see red flags,” Naked Capitalism, Dec 14, 2020

A long must-read: what Pfizer may not be telling us about their Wondrous Vaccine. BTW, these are not anti-vaxxers—quite the contrary. They are skeptical observers who have learned not to gobble up crumbs from Pharma and declare them tasty. Many additional learned details in the comments.

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Michelle Andrews, “Think your health care is covered? Beware of the ‘junk’ insurance plan,” Kaiser Health News, Dec 4, 2020

Trump let sneak back into the market plans that deny care for pre-existing conditions. “[Patient] Bloechl assumed he was buying a comprehensive plan that would cover him for a life-threatening illness although at the time he had no inkling he was sick. But when doctors said Bloechl needed a stem cell transplant, Golden Rule [a unit of United Healthcare] denied the request. The reason: He had visited a chiropractor for back pain before he bought the plan.” On the hook for $800,000. Also Golden Rule.

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Alice Miranda Ollstein, “Trump’s health nemesis gets a new starring role: Reversing Trump’s policies,” Politico, Dec 7, 2020

Becerra (1): Although he won’t have initiative on new legislation, he could affect policy in a myriad of ways through regulation and day-to-day management. First up: reverse “signature Trump policies” on reproductive health, refugees, and Medicaid. Drawbacks: no public health, admin, or Washington experience.

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Sarah Kliff, “Becerra supports ‘Medicare for All,’ and could help states get there,” New York Times, Dec 10, 2020

Becerra (2): “The HHS secretary oversees an array of waivers that states can use to cover new groups or provide different types of health plans” that do not require congressional approval. Experiments with statewide public option plans are more likely. “Helping” states get to M4A? A mega-stretch (see below).

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Nichlas Florko, “Becerra took more campaign cash from health groups than any other industry,” STAT, Dec 10, 2020

Becerra (3): Paywalled, but the headline is quite enough. “Over the course of his career in the House of Representatives, Becerra pulled in more than $1 million from political action committees affiliated with doctors and other health professionals, more than $300,000 from hospitals and nursing homes, and more than $300,000 from pharmaceutical companies and the manufacturers of other health care products.”

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Laura Ungar, “Thousands of doctors’ offices buckle under financial stress of COVID,” Kaiser Health News, Nov 30, 2020

“A survey by the Physicians Foundation estimated that 8% of all physician practices nationally have closed under the stress of the pandemic” especially primary care. Some 82 million Americans live in “health professional shortage areas” or about a quarter of the entire population. No link between need and supply given that the healthcare system awards profit to certain healthcare activities and shortchanges others. Meanwhile, see next story:

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Dhruv Khullar, “America is running out of nurses,” New Yorker, Dec 15, 2020

Fascinating anecdotes. The author comments on provider “moral injury, a term originally coined to describe trauma suffered by soldiers at war, but adapted for the struggles of health-care workers contending with a system that often hinders their ability to do what’s right for patients.” All that “hindering” is attributed to the emergency conditions, not the healthcare system per se. Nonetheless, as the article notes, “The covid-19 death rate at poorly resourced hospitals was two, even three, times that of well-resourced ones.”

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Joyce Frieden, “Direct contracting model comes to Medicare,” MedPage Today, Dec 3, 2020

More neoliberalism introduced into healthcare by the outgoing HHS team: “When [we] allow providers to take financial risks, we get better outcomes, lower costs, and better quality.” The scheme will allow doctor groups to bid on managing Medicare for a patient pool. Doctors will make more money by showing superior outcomes, similar to the standardized testing model for public education. Goal: $2 billion in Medicare cost savings. What could go wrong?

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Giovanni Cafori, “The U.S. must support access to care and incentives for the innovation that transforms it,” STAT, Dec 1, 2020

Key red flag word: “innovation.” The author argues that that other guy is the villain, either the pharmacy benefit managers who have muscled their way into control of distribution or maybe the insurance companies. Pharma, on the other hand, will virtuously “continue to explore flexible pricing mechanisms and pursue innovative contracting approaches with payers to ensure that patients have low out-of-pocket costs.” In other words, we’ll dole out charity, but don’t touch our prices. Caforio is the CEO of Bristol Myers Squibb and the outgoing head of PhRMA, the pharmaceutical lobby.

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Stephanie Armour, “Medicaid cuts on the table as states grapple with impact of pandemic on program enrollment,” Wall Street Journal, Nov 27, 2020

Knives out for Medicaid as job loss leads to expanded enrollment (up 8% nationally) and state tax revenues sink. Medicaid now absorbs 30% of all state spending. A federal single-payer substitute would remove that burden.

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Kenny Stancil, “‘Seems like a good policy!’ CBO shows Medicare for All could cover everyone for $650 billion less per year,” Common Dreams, Dec 11, 2020

The (Congressional Budget Office) analysis shows that administrative costs under a single-payer healthcare system “will be lower than what even the most rabid Medicare for All supporters have traditionally claimed.” Opposition comes from those “who would rather spend more money to provide less health care.” It is not, has never been, about the total dollars but rather who gets them.

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Ted Okon, “Trump’s ‘most favored nations’ experiment undermines care for millions covered by Medicare,” STAT, Dec 11, 2020

Objections to the last-ditch attempt by Trump to do something, anything, about drug prices after dawdling on the issue for four years. Pegging prices to an international standard would be dangerous, says the author, as it would “force drug companies to lower prices.” A better alternative: “strip away regulations [to] foster drug competition.” Those pesky regulations stand in the way, as usual. Mr Okon is ED of the Community Oncology Alliance. Sounds grassroots-y, no? However, its website announces that the group’s members “include oncologists, hematologists, pharmacists . . . and, industry representatives. So it’s the astroturf component of the patient-doctor-hospital-insurance-Pharma-industrial complex.

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Brian Krans, "Amazon Pharmacy boasts big discounts for prescription meds, but probably isn’t the best deal,” Healthline, Dec 4, 2020

Amazon wants to become another PBM (Pharmacy Benefit Manager), gatekeepers who purchase in bulk, negotiate (control) prices, and skim off profits. “We designed Amazon Pharmacy to put customers first—bringing Amazon’s customer obsession to an industry that can be inconvenient and confusing,” said T.J. Parker, vice president of Amazon Pharmacy. Monopolists always claim that by undercutting and driving out the competition, they benefit consumers. Also “customer obsession.”

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David Sirota, “Here’s what Medicare for All supporters in Congress can actually do,” Daily Poster, Dec 13, 2020

Instead of calling for a symbolic floor vote, the author suggests four other actually achievable steps: (1) oust industry toady Richard Neal from the Ways & Means chair (won’t happen); (2) let states create single-payer health care systems if they want to (long-shot); (3) get Biden to expand Medicare by executive authority (he can); (4) create a presidential commission to craft a Medicare for All program. Raises the interesting question of what measures take us closer to M4A despite not being the whole enchilada. My two cents: make all covid-related care payable by Medicare; a year from now, ask people how they liked single-payer.

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Richard Gottfried, “What Covid and the 2020 elections taught us: It’s time to do right by New Yorkers on health care,” Gotham Gazette, Dec 16, 2020

Op-ed by the principal sponsor of the NY Health Act: “Three quarters of our neighbors are afraid that they cannot afford their health care or health coverage and fear medical debt. Each year, a third of families who have health coverage have a household member who goes without needed health care because of cost; their health coverage doesn’t do the job.” And we’re going backwards in access. “Taking insurance companies out of the picture will save New York $55 billion a year we now waste on insurance company bureaucracy, marketing, and profit.”

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Alex Thompson & Theodoric Meyer, “Wikipedia page for Biden’s new Covid czar scrubbed of politically damaging material,” Politico, Dec 3, 2020

At least they’re sensitive to being outed. Biden’s Covid czar, Jeff Zients, comes from private equity and the board of directors of Facebook, also tried to push the Trans-Pacific Partnership debacle on American workers. A perfect Democrat, in other words, but someone hastened to bleach the evidence. “Hypocrisy: the homage vice pays to virtue.”

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Associated Press [Kansas], “Public health workers leaving jobs amid pandemic, politics,” Dec 7, 2020

Not in headline: 80-hour work weeks and threats requiring armed guards: “I had the local police watching my house because my family was home and I was not. I had escorts to and from work.”

Posted Dec 11, 2020

Ken Miller, “Oklahoma governor declares day of prayer as virus surges,” Associated Press, Dec 1, 2020

“I believe we must continue to ask God to heal those who are sick, comfort those who are hurting, and provide renewed strength and wisdom to all who are managing the effects of COVID-19,” said the governor. Does “managing the effects” include “paying the medical bills”? If not, could you maybe throw that in?

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David Sirota and Andrew Perez. “Biden HHS pick backed Medicare for All, pressed Obama for tough action against Pharma,” Daily Poster, Dec 6, 2020

A hasty conclusion, IMO. Becerra has been a loyal soldier in the one-party (Dem) state of California and doesn’t rock boats. The President sets policy, not his employees; Biden hates M4A. However, Becerra also “launched myriad lawsuits against wayward health industry players like the opioid manufacturers Purdue Pharma and Mallinckrodt and extracted a half-billion-dollar fee to settle an antitrust case against Sutter Health, a major Northern California health provider and hospital chain.” So he knows how it’s done if he gets back-up.

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Ross Barkan, “Can New York pass single-payer in 2021?” New York Focus, Oct 12, 2020   

The pandemic crisis that threw ¾ million New Yorkers off their health insurance (along with an additional 600,000+ dependents) seems the perfect moment for radically reshaping the state’s healthcare financing scheme. But to establish a statewide single-payer system to finance medical costs, the state must obtain the dollars now flowing to insurer-intermediaries. (The Federal Government can deficit spend as it is doing now.)

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Lee Harris, “New York taxes shoes and soda. Why not stocks?” New York Focus/ Gotham Gazette, Oct 13, 2020

Not immediately obvious why this is a single-payer story, but it is: the state is facing massive budget cuts unless new revenue sources are found. “A stock transfer tax could bring in billions in new revenue. Wall Streeters threaten to pick up and leave—but tax experts say they’re bluffing.” Excellent background for the coming debate over how to Tax the Rich. Fun fact: “As the pandemic roiled stock markets in the spring, New York’s tax authority recorded surging revenue from an obscure tax on Wall Street stock trading. From April to June of this year, according to state tax department data, it collected $2.9 billion. But the money never made it to state coffers: New York does not actually keep the tax revenue. Instead, since 1981, it has rebated the money to investors, meaning that, in practice, the stock transfer tax is little more than an administrative hurdle for brokers’ legal teams.”

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Lynn Westmoreland, “What better start for bipartisanship and healing than lowering drug costs?” Newsweek, Nov 26, 2020

Former Republican congressman pens an op-ed acknowledging that everyone wants action on drug costs. “An April 2019 report found that over a 12-month period, [seniors] withdrew approximately $22 billion from their long-term savings just to cover medical expenses.” Supports Trump’s last-minute measures, plus other tinkering. But, see below . . .

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Akela Lacy, “Effort to take on surprise medical billing in coronavirus stimulus collapses,” The Intercept, Dec 8, 2020  

Thanks to Rep. Neal, a mainstream Dem stalwart who survived a primary challenge from pro-M4A mayor of Holyoke who was subjected to sleazy gay-baiting by the ever-so-liberal Massachusetts party. “Neal has drawn criticism for his ties to Blackstone, his top funder this cycle. Many private equity executives are known to own vacation homes in the Berkshires, which Neal represents.”

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Jonathan Easley, “Group launches ads opposing bipartisan fix to ‘surprise’ medical bills,” The Hill, Dec 1, 2020

Six-figure ad buy to sink the broadly popular measure from a “fiscally conservative group.” Why do news outlets award this term to groups feathering their own nests? Also, note the angle used in the attack: they accuse the bill of aiding bad-guy insurance companies while they “stand with our front-line doctors.” Impoverished doctors! No mention that doctors’ practices are increasingly owned by private equity.

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David Sirota & Andrew Perez, “The next war against a public option is starting,” Daily Poster, Dec 9, 2020

Eminently predictable: Once surprise billing is safely protected, industry will gear up to crush the other threat, a public option “compromise” pushed by supposed centrists. The new lobby groups led “by a former Hillary Clinton aide” will switch gears from their trashing of M4A during the primaries to block the weak-tea alternative.

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John Tozzi, “UnitedHealth expects $2 billion Covid earnings hit next year,” Bloomberg, Dec 1, 2020

In a reversal from what happened this past spring, people aren’t postponing non-Covid-related care, so the pandemic costs will hurt insurers’ profits. “UnitedHealth said it expects revenue between $277 billion and $280 billion next year, with earnings from operations of $22.6 billion to $23.4 billion.” So not doing so bad even so.

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Aneri Pattani, Robert Lewis & Christina Jewett, “OSHA let employers decide whether to report health care worker deaths. Many didn’t,” Guardian, Dec 1, 2020

Not single-payer but health-related and appalling. “A Department of Labor spokesperson said that an employer must report a fatality within eight hours of knowing the employee died and after determining the cause of death was a work-related case of COVID-19. Since the part in italics is impossible, employers were off the hook.

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Joyce Frieden, “2021 Medicare fee schedule includes 10.2% cut in conversion factor,” MedPage Today, Dec 2, 2020

Changes in Medicaid arcane payment system will benefit some specialties (radiology endocrinology, rheumatology, oncology) and hurt others (pathology) as hospitals lose on ER care and fight furiously for high-reimbursement non-Covid patients. Modest boosts for visits by chronic-ailment patients to help primary care providers. Current law requires “budget-neutral” actions, so someone has to lose if others gain.

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Ryan Basen, “Fired nurse faces board review for wearing hospital scrubs,” MedPage Today, Dec 4, 2020

Retaliation against a nurse who criticized unsafe conditions. Willmeng says “his firing has been orchestrated to scare other healthcare workers away from reporting safety violations.” Bosses now threatening his nursing license. He’s suing for whistleblower retaliation and wrongful termination. Meanwhile, needs a job and is blackballed by medical centers despite an acute nurse shortage nationwide.

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Aaron Mitchell & Deborah Korenstein, “Drug companies’ payments and gifts affect physicians’ prescribing. It’s time to turn off the spigot,” STAT, Dec 4, 2020

Amply researched and here confirmed yet again: Do doctors prescribe more of a drug if they receive money from that drug’s manufacturer? Yes. “The results were unanimous: All 36 studies showed that receiving industry money increases prescribing. This was consistent across all medical specialties and types of drugs,” including cholesterol medications, drugs for Alzheimer’s disease, for multiple sclerosis, for cancer, and for blood thinners, and opioids.” Self-regulation is a failure; time to outlaw them.

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Achal Prabhala, Arjun Jayadev & Dean Baker, “Want vaccines fast? Suspend intellectual property rights,” New York Times, Dec 7, 2020

“This is not the beginning of the end; it is only the beginning of an endless wait: There aren’t enough vaccines to go around in the richest countries on earth, let alone the poorest ones.” The authors say the India/South Africa proposal to free the world from vaccine patents is the way to go. (Baker has been on this issue for years.) Rich countries opposed. Recall similar fights over HIV medications.

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Yves Smith, “Medical system cracking: New Rochelle nurses strike over unsafe staffing levels; Washington State warns of potential for “catastrophic loss of medical care,” Naked Capitalism, Dec 11, 2020

Details of how the hospitals’ corporate organizational model with things like just-in-time supply chains and low bed vacancies left the country unprepared. “If the US does not bring the pandemic under control, the problems facing nurses in places like the Bronx could become more widespread. ‘You expect this in minority-serving hospitals,’ Dr Aiken said. ‘What’s unexplainable is how it’s started to happen everywhere.’” Do these doctors hear themselves when they talk? You just said minority populations should expect lousy service.

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Erin Arvedlund, “With new program, Temple Health helps doctors and nurses cut their massive student loan burdens" Philadelphia Inquirer, Dec 2, 2020

This public service student loan forgiveness program was supposed to forgive debts once you made 10 years of payments. But as this article points out, the administration was bungled, and the rules changed suddenly, wiping out the credits those who had been making payments in good faith. A case in point: ME! I made 8 years of payments, then was told to start over from scratch. Under Obama. Proposals to simply wipe out some or all debt makes more sense than this Rube Goldberg-designed scam.

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Sarah O’Brien, “Most Medicare beneficiaries worry about the cost of treating Covid. Here’s how much they may pay,” CNBC, Dec 3, 2020

Get ready for the mega-bills since Medicare only covers 80%.

Posted Dec 1, 2020

Tami Luhby, Caroline Kelly & Devan Cole, “Here are 7 Trump health care measures that Biden will likely overturn,” CNN, Nov 16, 2020

The 7: eliminate state-based Medicaid work requirements (and possibly lock-outs for failure to pay premiums) at least in future state waivers; block short-term plans from refusing people with pre-existing conditions; restore ACA funding for navigation assistance and advertising; revoke the prohibition on abortion referrals for federal grant recipient agencies; permit foreign nonprofits that promote abortions to receive U.S. funding (the “Mexico City” policy that gets reimposed with every R presidency, then re-revoked by the Ds); restore Planned Parenthood eligibility for Medicaid funding; restore LGBT non-discrimination guarantees for federal health programs. Almost entirely industry-acceptable mods.

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Joyce Frieden, “Trump pushes last-minute Part B drug rules,” MedPage Today, Nov 21, 2020

Among other changes, the proposal would eliminate the doctor’s percentage cut of drugs they prescribe, an obvious incentive for them to choose the priciest ones possible. It also overhauls the Pharmacy Benefit Manager (PBM) skimming system. Biden & Co. could sign on to this measure and conceivably attract a few R votes. The industry will kick and scream, which is probably why Trump never got around to it when he had the chance.

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Dylan Scott, “What Amazon’s big pharmacy news means for US health care,” Vox, Nov 23, 2020

Argues that Amazon’s move is “buying information,” i.e. preparing for wading more deeply into healthcare in the future: “Amazon surely isn’t finished expanding its health care portfolio. The latest pharmacy play is a chance for the company to get a better idea of what it takes to run a pharmacy business before it takes another step. The rest of the sector has been put on notice.”

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Christina Farr & Annie Palmer, “Amazon jumps into the pharmacy business with online prescription fulfillment, free delivery for Prime members,” CNBC, Nov 17, 2020

Amazon is entering the $300 billion sector, up against CVS, Walgreens, and Walmart all of whose shares tanked at the announcement. Those companies might be supportive of the antitrust sentiment building up in Congress. “Even for people who have health coverage, the [Amazon] Prime price might still end up being more affordable than the copay.” Should also be causing panic attacks at AARP/UnitedHealthCare, among others.

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Vinay Prasar, “What does ‘Follow the Science’ mean anyway?” STAT, Nov 23, 2020

“Science will never be sufficient to guide choices and trade-offs. Science cannot make value judgments. Science does not determine policy. Policy is a human endeavor that combines science with values and priorities.” Just because we take scientific evidence seriously doesn’t mean we will immediately know what policy choices are correct. “Scientists can help define these trade-offs, but scientists have no special ability to speak about values on behalf of all citizens.” A good corrective to the notion that experts, however defined, will always know what to do best.

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Judy Melinek, “Culture shock: Why New Zealand’s response to COVID-19 worked,” MedPage Today, Nov 24, 2020

How did New Zealand have success with COVID? “Go hard, go early.” Speed, coordination, communication, support for public health officials, and maybe “kiwi” culture that “emphasizes empathy and cooperation.” Alien life on our own planet.

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Miriam E. Van Dyke, Tia M. Rogers, Eric Pevzner et al., “Trends in county-level COVID-19 incidence in counties with and without a mask mandate— June 1–August 23, 2020, Kansas,” Mortality and Morbidity Weekly Report, Nov 27, 2020

This is the CDC’s technical bulletin. “The governor of Kansas issued an executive order requiring wearing masks in public spaces, effective July 3, 2020, which was subject to county authority to opt out. After July 3, COVID-19 incidence decreased in 24 counties with mask mandates but continued to increase in 81 counties without mask mandates.” Only 24 out of 105 counties said yes to masks. Public health measures are coercive. Deciding that everyone should make up their own rules in a plague environment is wacko.

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Phil Galewitz, “Florida’s new hospital industry head ran Medicaid in state and fought expansion,” Kaiser Health News, Nov 20, 2020

“Mayhew, who led the state’s Medicaid agency since 2019, has been a vocal critic of the Affordable Care Act’s Medicaid expansion. The Florida Hospital Association has signaled that seeking legislative approval to expand Medicaid to nearly 850,000 uninsured adults won’t be among its top priorities.” “Not a top priority” is putting it rather mildly. A bureaucrat turned health industry exec, in both roles enthusiastically dedicated to making sure people don’t get medical care—only in America.

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Christine Sexton, “Florida Medicaid enrollment is up 16% since March,” Palm Coast Observer, Nov 30, 2020

Medicaid totals surge anyway due to COVID while the state refuses ACA-based expansion wherein the federal government picks up 90% of the added costs. Officials eagerly await HHS guidelines that “spell out the details of when states can begin disenrolling people.”

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Robin Feldman, “Make list price the touchstone for drug pricing across the supply chain,” STAT, Nov 23, 2020

This article and the one following address a complicated issue about transparency in how pharmaceutical companies price their products. Trump is pushing a measure to force them to reveal details of the deals they give insurers and go-betweens, information that now is carefully hidden from view as business secrets. The industry is howling because they say if they have to reveal the discounts parceled out here and there, everyone else will want the lowest price. Unsaid: the best deals are obtained by the ever more consolidated hospital systems and the three giant Pharmacy Benefit Managers, which suggests that the problem isn’t transparency but monopoly. Also, while these private bidders can negotiate discount deals, Medicare, thanks to GW Bush’s 2006 Medicare Part D drug assistance plan, cannot—despite being the biggest purchaser of them all. Worth a read for those interested in this batch of weeds and who want to figure out if the Trump tweak is a positive step or a distraction.

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Harris Meyer, “Surprise federal drug rule directs insurers to reveal what they pay for prescription drugs,” Kaiser Health News, Nov 19, 2020

“The departing Trump administration’s most ambitious effort to illuminate the complex, secret, and lucrative system of prescription drug pricing in which health plans, drug manufacturers and pharmacy benefit management firms agree on prices.” The whole package gets its legal authority from the ACA, so the Supreme Court ruling on it could make the discussion moot.

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Brooke Sepiel, “Articles of impeachment filed against GOP Ohio governor over coronavirus orders,” The Hill, Nov 30, 2020

By his Republican colleagues who argue that Gov. DeWine’s face-mask rule “promotes fear, turns neighbors against neighbors, and contracts the economy by making people fearful to leave their homes.” The right to infect others while killing oneself shall not be infringed.

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Arthur Allen, “Government-funded scientists laid the groundwork for billion-dollar vaccines,” Kaiser Health News/California Healthline, Nov 18, 2020  

An old story but worth repeating: government-funded basic vaccine research was key to the breakthroughs for which the vaccine developers now will rake in billions. “Federal scientists helped invent it, and taxpayers are funding its development. It should belong to humanity.”

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Sydney Lupkin, “Pfizer’s Coronavirus vaccine supply contract excludes many taxpayer protections," NPR, Nov 24, 2020

Pfizer gets $1.95 billion through Operation Warp Speed to supply its vaccine without having to share even those intellectual property rights “typically found in federal contracts.” An HHS spokesperson argued that the U.S. government “did not fund and is not funding any of Pfizer's or BioNTech's R&D used to create the intellectual property for their mRNA vaccine,” a completely and utterly false statement (see above).

Posted Nov 25, 2020

Usha Lee McFarling, “‘They’ve been following the science’: How the Covid-19 pandemic has been curtailed in Cherokee Nation,” STAT, Nov 17, 2020

“While the United States flounders in its response to the coronavirus, another nation— one within our own borders—is faring much better,” even while surrounded by basket-case Oklahoma. Maybe it’s related to “a team that jumped into action in late February, holding coronavirus task force meetings twice a day, instituting procedures to screen thousands of employees, stockpiling PPE, protecting elders, ensuring food security, and educating residents in both English and the Cherokee language.” Result: only 33 deaths and zero workplace transmissions. Not mentioned: the boost from the estimated $300 million the tribe takes in from its casinos.

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Amy Goldstein & Erica Werner, “Biden presses to expand health insurance on uncertain congressional terrain,” Washington Post, Nov 10, 2020

Pundit pessimism on even the weak-tea aspects of Biden’s health plan. Could another quarter million COVID deaths shake loose public opinion? Some tinkering around the ACA edges may be in store. “Advisers suggest that Biden might consider adapting the idea of a public option to a more private-sector approach. They say it could be similar to Medicare Advantage, part of the vast federal insurance program for older Americans that operates through private health plans. The GOP has long favored the arrangement.” Bipartisanship!

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Robert Laszewski, “What a Biden win means to health care,” Forbes, Nov 7, 2020

The author sees any form of public option as unlikely. Better chances: “improvements” to Obamacare via higher subsidy payments to insurance companies and executive measures to ease drug prices along the lines of the Trump proposal.

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Joyce Frieden, “Trump pushes last-minute Part B drug rules,” MedPage Today, Nov 21, 2020

Speaking of which: Trump’s late response to the pressure for action on drug costs is facing headwinds. Democrats could try to preserve it, tweak it—or bow to lobbyists.

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Phil Galewitz, “Biden plan to lower Medicare eligibility age to 60 faces hostility from hospitals,” Kaiser Health News, Nov 11, 2020

The idea is popular with the public, but hospitals will resist because of lower Medicare reimbursement rates. Without compensating for the resulting revenue hole, they’ll mobilize against it with Democrat legislators cheering them on.

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James Arkin, “Health care vs. ‘radical leftists’: Parties re-running 2020 playbooks in Georgia runoffs,” Politico, Nov 15, 2020

Democrats have no coherent answer to the “socialism” attack. The two Dem Senate candidates concentrate on Medicaid expansion, saving rural hospitals, and protecting those with pre-existing medical conditions.

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Patricia Murphy, “Health care center stage for Senate runoffs,” Atlanta Journal-Constitution, Nov 11, 2020

OTOH, Georgia is facing a “near-crisis of health insurance coverage,” ranking 47th out of 50 states. Top issue for voters.

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Bruce Broussard, “Interoperability: an untapped tool in America’s fight against Covid-19,” STAT, Nov 18, 2020

The author (“president and CEO of Humana, a health insurance company”) says systems of electronic health records (EHRs) should be designed to communicate fluidly with each other so that we can “prevent, isolate, and control outbreaks of infectious disease.” He acknowledges that EHRs now are organized to facilitate billing, not public health. “Making interoperability a widespread reality requires contending with the fact that vendors profit from building closed systems that are only marginally interoperable.” His solution: force systems integration through regulation. (Mine: eliminate multiple billers, including Humana.)

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Juliette Michel, “Covid-19: As lab execs sell shares worth millions, questions arise,” Medical Xpress, Nov 15, 2020,

Thumb-sucker: should Pharma execs cash in for millions in the midst of a public health emergency? “From the start of the federally coordinated effort to develop vaccines on May 15 until August 31, officials at five pharmaceutical companies made more than $145 million by selling shares.”

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John P. Geyman, “Beyond COVID-19: The power struggle over alternatives for health care reform,” Counterpunch, Nov 19, 2020

Addresses the three possible approaches: (1) build on Obamacare; (2) Medicare for Some (variants of the public option); (3) Medicare for All. This is a fairly straightforward summary of the arguments.

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David Oshinsky, “Health care: The best and the rest,” New York Review of Books, Oct 22, 2020

Another book about the world’s health care systems. “Who are the winners and losers?” Norway, Germany, Taiwan, the Netherlands at the top; USA and China at the bottom.

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Richard Lardner & Jason Dearen, “Trump admin funds plasma company based in owner’s condo,” Associated Press, Nov 1, 2020

What are the chances that the wholesale looting that is taking place under the “emergency COVID response” rubric will ever appear in court documents? Rick Santorum is part-owner of the plasma company that no one ever heard of. The manufacturing facilities touted by the Trump Administration consists of the CEO’s condominium in Charleston’s French Quarter. “The company has no other presence in South Carolina—or any other state.”

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Angela Hart, “California’s progressive—and expensive—health care ambitions rely on Biden win,” California Healthline, Nov 2, 2020

“California Democrats — who control all statewide elected offices and hold a supermajority in the legislature — are poised to go big on health care, pushing aggressively for a health care system that covers all Californians, regardless of their immigration status or ability to pay.” There’s even a statewide single-payer bill in play. Note emphasis on “pay-for” aspect in the headline—never an issue except when discussing social programs.

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Rep. Mark Green (R-TN), “Americans have a choice: Socialized medicine or health care freedom,” The Hill (opinion), Oct 26, 2020

Boogie man alert! “Government-run socialized medicine,” which will lead to “increased taxes, longer wait times, delayed care, and fewer incentives to maintain a healthy lifestyle.” Get that last part? Go on a diet, or pay up. Green thinks “unaccountable bureaucrats” now have no influence on your medical care. Of course, they don’t for those, like him, enjoying the single-payer Senate healthcare system.

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Nick Martin, “Scott Atlas, star disciple in Trump’s Covid death cult,” New Republic, November 17, 2020

So how do you really feel about him? “In mid-October, Atlas tweeted, ‘Masks work? NO,’ before listing a string of false information. Still two months of his leadership to go.

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Kristina Fiore, “Students update the Hippocratic Oath,” MedPage Today,Nov 18, 2020

Pittsburgh U. med students added their own, which includes the line, “We recognize the fundamental failings of our health care and political systems in serving vulnerable communities.” Doesn’t prescribe a solution, but offers hints. One graduating doc compared his work in the Bronx unfavorably with his childhood in St. Lucia in the Caribbean: “The healthcare gap is so much bigger here.”

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David Dayen, “How Biden could give everyone Medicare on his own,” American Prospect, Nov 17, 2020

“The people of Libby, Montana, population 2,628, share something in common with the rest of the developed world, but not their compatriots in the United States. They all have access to a single-payer, Medicare-for-All system.” Libby-ans were exposed to an environmental hazard, and the federal government took over their healthcare—via executive action. Um, is the entire country exposed to a similar hazard today? “The incoming Biden administration can give all 11 million people infected with COVID—and if they want to be really aggressive, all Americans who have tested positive for coronavirus—the option of free Medicare coverage, immediately.” So “everything” doesn’t really depend on who wins in Georgia in January. The Presidency is powerful—if you choose to use it.

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Michael Hiltzik, “The colossal problem of publicly funded vaccines in private hands,” Los Angeles Times, Nov 21, 2020

We already gave Moderna $1 billion for the vaccine. How much more should it extract in profits? And what incentive exists for cooperating with non-wealthy countries who need it?

Posted Nov 16, 2020

Nicholas Florko, “‘Science was on the ballot’: How can public health recover from a rebuke at the polls?” STAT, Nov 4, 2020

“A significant portion of America doesn’t want science.” Is this a fair interpretation of the vote for Trump? What about the role of agnotology, i.e., the deliberate creation of ignorance such as that pioneered by the tobacco industry, then imitated by fossil fuels, etc.?

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Phil Galewitz, “Biden want to lower Medicare eligibility age to 60, but hospitals push back,” NPR/Kaiser Health News, Nov 11, 2020

“Biden’s simplest strategy is lowering the eligibility age for Medicare from 65 to 60. But the plan is sure to face long odds.” Republicans will hate it, and “the nation’s hospitals — a powerful political force—are poised to derail any effort.” Democrats tend to favor hospitals and their lobbying money while Republicans lean toward the insurers. Both are on the Pharma gravy train.

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J.C. Reindl, “Surprise out-of-network medical bills now illegal in Michigan,” Detroit Free Press, Oct 30, 2020

The law, which forbids medical providers from sending big surprise bills to patients who received emergency care outside of their insurance network, “passed through the state legislature by wide bipartisan margins.” Thirty-one states now have similar measures on the books, and a federal law could be an easy win for Biden. But major players in surprise billing by corporate doctor groups are private equity firms like Envision and TeamHealth.

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Paige Minemyer, “New York ER docs sue UnitedHealth for alleged underpayments," Fierce Healthcare, Nov 3, 2020

Slugfest among the players: in this corner, private-equity backed physician groups facing off against the insurance companies in the other. Any chance of a double KO?

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Yves Smith, “Quick comments on the Biden-Harris Covid plan: Not much sizzle and no steak,” Naked Capitalism, Nov 10, 2020

Points out differences between the announced plan and what was on the campaign website, which does not bode well for whatever promises Biden made on improvements to the ACA. “The severe downgrading of his Covid plan shows Biden embracing the Obama playbook: meet the Republicans 75% of the way when you start negotiating with the expectation that the final deal will move even more in the Republicans’ direction. Their current scheme isn’t close to adequate.”

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Nathan Whitlock, “Where health care is a human right,” New York Review of Books, Nov 19, 2020

Interesting review of the Canadian system, including problems with creeping privatization and the demographic challenges of an aging population. “Possibly the most astonishing thing about the CHA is that the entire piece of legislation, including both English and French texts, barely fills 18 pages. By comparison, the 2010 Affordable Care Act, also known as Obamacare, runs to more than 900. That brevity is part of the CHA’s ‘genius’: establishing the bedrock principles within Canada’s broad and frequently combative federal system requires a document that is simple and direct.” Canada’s single payers are the provinces, so there is plenty of room for both experiment and tension with the central authorities. Books reviewed here are worth a further look.

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Cheryl Clark, “HCA workers tell investors the company fails to protect them,” MedPage Today, Nov 5, 2020

A new tactic: go straight to the shareholders with safety complaints since OSHA is useless. Meanwhile, “HCA [told investors] that the company is not suffering financially, continuing to report profits while curtailing expenses.”

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Rebecca Tan, “Nontraditional nursing homes have almost no coronavirus cases. Why aren’t they more widespread?” Washington Post, Nov 3, 2020

Background on the great “Green House” model of elder care that is probably not sustainable in a for-profit environment.

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Michael E. Miller, “A Maryland family battled COVID-19 at the same time as Trump. It devastated them," Washington Post, Oct 28, 2020

A tale of two universes: free, expert care for the rich and powerful; for the rest of us, a bit less. “Carol Coates had battled COVID-19 at the same time as the president. But instead of a suite at Walter Reed, the 46-year-old Black teacher self-isolated nine miles away in the basement of her family’s home. And instead of the experimental cocktail of antibodies that Trump was given, she received get-well cards from her fifth-grade students.” She died.

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Max Fraser, “Public health, private equity, and the pandemic,” New Labor Forum/CUNY, September 2020

“The federal government now designates nearly 80 percent of rural America as ‘medically underserved.’ Yet even before COVID, hospital closures had turned whole swathes of the country into vast ‘health care deserts’ where in some cases there is no doctor or hospital bed for a hundred miles in any direction.” Culprits: (1) heavily rural states that refuse Medicaid expansion and (2) private equity.  

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Jackie Fortiér, “They work in several nursing homes to eke out a living, possibly spreading the virus,” KPCC/Kaiser Health News, Nov 2, 2020

Poorly paid nursing home workers held down multiple jobs to survive—and took COVID along with them.

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Paige Winfield Cunningham, “The Health 202: Obamacare marketplaces survived Trump’s term better than expected,” Washington Post, Nov 2, 2020

The Obamacare marketplaces are mostly stable with more modest price increases lately than in the early years. Trump’s impact “has probably been more muted than most expected—at least so far.” The single most significant change: Trump’s move to scrap cost-sharing payments led to insurers raising premiums, which triggered more generous government subsidies to enrollees. So insurers raised their rates, and the government had to pay up.

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Alex Carchidi, “Is drug pricing backlash a serious risk for big Pharma stocks?” Motley Fool, Oct 31, 2020

Should the 1% be worried? Not so far, says this Wall Street advisor. Even big scandals don’t have staying power: “There’s no evidence that this outcry has hurt the earnings of Bristol Myers or any other pharmaceutical company, and harm to share prices may be transient.”

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Robert Moffit, “America heads closer to medical price transparency with new rule,” The Hill (opinion), Nov 2, 2020

This Heritage Foundation writer cheers “transparency,” which is conservative code for leave-it-to-the-market. Once prices are no longer “hidden,” Americans will garner “vastly more control over their care” because they will be able to shop around for the best deals, leading to lower costs. So easy!

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Caitlin Owens, “The election killed any dreams of big health care changes,” Axios, Nov 6, 2020

The current consensus, that “gridlock and incrementalism” will neutralize Biden’s modest proposals for change, presumes passivity on the part of the citizenry—perhaps accurately. One possible area for administrative action: drug pricing.

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Christine Sexton, “Obamacare supporters lost big in Florida,” Tampa Bay Times, Nov 5, 2020  

“Florida Democrats tried to paint President Donald Trump as the man who would repeal the Affordable Care Act and place millions of people with pre-existing conditions at risk. He won, and so did other Republicans who oppose Obamacare.” Donna Shalala, former HHS secretary, also lost her seat. No attempt to examine whether the lousy part of Obamacare might have played a role.

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Kristen Kendrick, “Despite ACA coverage gains, millions still suffer ‘catastrophic’ health care costs,” NPR, Nov 12, 2020

Eleven million to be exact. “Catastrophic expenditures” is defined as health care spending that absorbs more than 40% of a person’s income after food and housing costs. Those with low incomes and private insurance are doing worse than ever while Medicaid beneficiaries are better off. “The goal of insurance is to protect us against catastrophic costs,” but more than half of the people facing catastrophic costs are privately insured. So it’s failing?

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Judy George, “Nurses reject N.D. policy on working with COVID-positive,” MedPage Today, Nov 12, 2020

North Dakota followed Trump’s lead in poor-poohing the whole COVID thing, now asks nurses to play catch-up at risk to their own and patients’ health. The state finally instituted a mask mandate Nov. 14.

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Margaret Flowers, “Supreme Court challenge to ACA highlights why we need Medicare for All,” Truthout, Nov 11, 2020

The for-profit insurers “are increasingly turning to government plans as a major source of revenue,” about $415 billion in 2021 via privately managed Medicaid and Medicare. So they’re basically becoming administrators of government programs. Why do we need them again? Fun fact: one-third of our healthcare dollars go to admin.

Posted Nov 6, 2020

Margaret Bombard, “Don’t fall for Renna’s misguided approach to healthcare,” syracuse.com, Oct 26, 2020  

A sterling letter to the editor criticizing the site’s endorsement of a GOP candidate’s health insurance plan. Got published even though 700 words long.

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Lauren Coleman-Lochner, “Shaky U.S. hospitals risk bankruptcy in latest Covid wave,” Bloomberg, Oct 14, 2020

Hospital income estimated to drop by 30% this year as workers lose insurance coverage and postpone procedures. Rural hospitals are “closing down left and right,” just as we need them most. But we can’t do anything because markets.

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Yamil Berard, “A broken-hearted Cuthbert says goodbye to its hospital,” Atlanta Journal-Constitution, Oct 22, 2020

One case: “As Southwest Georgia Regional Medical Center closes Thursday, it becomes the 133rd rural hospital to cease operations in the U.S., and the eighth to be shuttered in Georgia, since 2010.” Essential services that can’t compete in the marketplace have no place in our system.

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Jordan Rau, “North Carolina treasurer took on the hospitals. Now he’s paying the political price,” Kaiser Health News, Oct 26, 2020

By contrast, the hospitals in this story are thriving and have clout after consolidating into a few large networks. “Cartel is a term frequently associated with illegal narcotics syndicates. In North Carolina, it has become the favored word of State Treasurer Dale Folwell to describe the state’s hospital industry, the antagonist in his quest to lower health care prices for state employees.” Relentless price increases in healthcare are always someone else’s fault. Republicans tend to side with insurance companies, Democrats with (prosperous, urban) hospitals.

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Vasudevan Mukunth, “The medicine Nobel for Hep C should force us to think about patents, patients, profits,” The Wire, Oct 6, 2020

The Nobel committee casually spoke of “eliminating chronic Hepatitis C” while paying no attention to the price-gouging that makes any such thing completely unrealistic. Wiping out the disease would put an end to Gilead’s fabulously lucrative sofosbuvir gravy train.

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John Carroll, “Eli Lilly lines up a blockbuster deal for Covid-19 antibody, right after it failed a NIAID trial,” Endpoints News, Oct 28, 2020

“Two days after Eli Lilly conceded that its antibody bamlanivimab was a flop in hospitalized Covid-19 patients, the US government is preparing to make it a blockbuster.” Further undermining FDA credibility.

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Ben Spencer, “Test & trace consultants are being paid £7,360 a DAY each: Fury as private sector company is handed cash equivalent of £1.5 million annual salary for coronavirus tracking,” Daily Mail (UK), Oct 14, 2020

Plenty of corruption to go around. PM Boris Johnson’s grift enables the favored privateers to “earn” over 7,000 pounds a day (US$9000) in no-bid contracts. Much more fun than boosting funding to the National Health Service. Plus, the tracing didn’t work.

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Mike Masnick, “US patent boss says no evidence of patents holding back COVID treatments, days before Pharma firms prove he’s wrong,” TechDirt, Oct 9, 2020

Argument: we need patents to provide “incentives” to for-profit Pharma companies. Huh? How about the vast demand for a life-saving product? “Governments around the world are going to pay for any vaccine because it’s necessary, and the boost to any economy is going to be well worth making the developers of a vaccine very, very wealthy.” Also, why did Moderna have to pledge not to utilize its totally-will-not-stand-in-the-way-of-access vaccine patent?

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Gianrico Farrugo, Tom Mihaljevic & Andrew D. Badley, “Needed: a national coalition to coordinate Covid-19 clinical trials,” STAT, Oct 26, 2020

Clinical trials overlap, fight for the same study subjects, and waste resources. What about markets? Don’t they always, always work best to allocate economic resources?

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Parsa Erfani, Caroline Lee & Nishant Uppal, “Why isn’t routine Covid-19 testing happening in prisons and immigrant detention centers?” STAT, Oct 27, 2020

“Most testing performed in correctional and immigration detention facilities is still reactionary — only symptomatic individuals get tested — and many of these facilities have not performed mass testing a single time, let alone routinely. In settings where even soap can be hard to come by, the lack of testing has proven to be a disaster.” Not only do prison COVID rates far outstrip the general population, inmates moving in and out of incarceration means the persistently high rates inside undermine public health on the outside. Because testing is left to individual states, “nearly 16% of all Covid-19 infections in Illinois may have been linked to Chicago’s sprawling Cook County Jail.” Duh. A national testing strategy—or even a national health system—might address this truck-sized gap.

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Jeremy Borden & Justin Glawe, “Emails show Trump's CDC went MIA in Pennsylvania,” Daily Poster, Oct 29, 2020

Not just testing and not just prisons: everything and everywhere. “As with mask mandates, testing regimens, and decisions on re-opening the economy—it has been up to states and localities to implement contact tracing programs.” The article describes problems in getting a phone tracing app running in several states.

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John Fabian Witt, “Republican judges are quietly upending public health laws,” New York Times, Oct 15, 2020

“The Republican Party’s campaign to take over the federal and state courts is quietly upending a long and deeply embedded tradition of upholding vital public health regulations. The result has been a radically novel and potentially catastrophic sequence of decisions blocking state responses to the coronavirus pandemic.” Government should always take a back seat to the private sector because markets and now because “freedom,” i.e., to infect others. However, emergency powers are fine when the problem is “terrorism.”

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Anna Almendrala, “Savvy patient fought for the price she was quoted—and didn’t give up,” Kaiser Health News, Oct 27, 2020

Good for her, but “didn’t give up” is misleading. A reporter—the one who wrote this story—called the provider, triggering a fresh look at the facts. How many people get the benefit of media pressure v/s those stuck with an unexpected bill despite carefully inquiring in advance? Reporter’s advice: “get promises in writing before the day of surgery. Make sure the offer is explicit about which services are included and what might count as a complication. Ask whether you’ll have to pay upfront.” Holy billing codes, Batman!

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Alex Soderstrom, “Financial adviser/nonprofit chairman helps people pay medical bills during pandemic,” Orlando Business Journal, Oct 21, 2020

Banker Lawrence Hatch seems like a decent guy who wants to help people pay their crushing medical bills. One question the reporter is not asking: “Why do people have to pay crushing medical bills?” though, to his credit, Hatch says, “If at any point in the future our services are no longer required, that means we must have fixed something from a governmental perspective.” Or, to translate into English, “If someday our elected officials would pass laws to put an end to medical bankruptcy. . .” Orlando has one of the highest uninsured rates in the country.

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Mark Shrayber, “5 staggering hospital bills from COVID-19 patients,” Yahoo Finance, Oct 22, 2020

Death by sticker shock, like when Janet Mendez left the hospital to recuperate and was told she owed $75,000. “Accidental” bills abound for COVID patients promised they won’t have to pay. Once again, a reporter’s calls fixed the problems, always then attributed to “isolated incidents.” If there were no patient bills in the first place, such problems would really be isolated.

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Sarah Kliff, “A $52,112 air ambulance ride: Coronavirus patients battle surprise bills,” New York Times, Oct. 13, 2020

The patient was moved between two hospitals, both in-network, but the helicopter transport wasn’t. Just the kind of news you need when on a ventilator. “The plan to ban these kinds of bills was popular and bipartisan, and it was backed by the White House. It fell apart at the 11th hour after private-equity firms, which own many of the medical providers that deliver surprise bills, poured millions into advertisements opposing the plan.”

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Andy Miller, “Breaking down Georgia’s waiver plans after capitol ceremony,” Georgia Today, Oct 15, 2020

Georgia established complex restrictions on Medicaid eligibility to limit the “expansion” to 50,000 people instead of the 500,000 who would have qualified under a standard package. Trump Administration approved it as a “market-driven, innovative approach.” Georgia ranks 49^th in the country in coverage with 13 percent uninsured. Republican Governor Kemp said the nasty part out loud: “Georgia Pathways is a ‘hand up’ for hard-working Georgians in our state who are more than deserving.’’ The system also provides opportunities for many deserving insurance brokers who can earn commissions by persuading people what policy to buy. What could go wrong?

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Libby Watson, “Biden’s health care plan is somehow still a mystery,” New Republic, Oct 29, 2020

“The Biden campaign has almost gone out of its way to foster a specific sort of unknowableness about the shape of his presidency.” Watson outlines the contradictory statements coming from Biden and his campaign website and highlights a lack of curiosity from the news media. “Sanders and Elizabeth Warren took a lot of pointed questions about their health care plans over the past year. At some point, someone may want to ask Biden about his.”

Posted Oct 29, 2020

Lisa Richardson & Allison Crawford, “How indigenous communities in Canada organized an exemplary public health response to COVID,” Scientific American, Oct 30, 2020

“COVID-19’s rates among Indigenous people in Canada have been less than one quarter that of non-Indigenous Canadians, with a third of the fatalities and a 30 percent higher recovery rate.” Authors attribute the success to these communities’ “shaping their own public health strategies after confronting the toll wrought by previous disease outbreaks and long-running neglect by health authorities.” Border closings and some culturally appropriate public education approaches are highlighted.

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Amanda D'Ambrosio, “Who are the scientists behind the Great Barrington Declaration?”  MedPage Today, Oct 19, 2020

A Koch-funded neo-liberal think tank pushed the herd immunity/let-‘em-die approach to COVID. Bamboozled media outlets took it seriously for a few seconds. Their phony science helped Trump’s propaganda campaign.

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Abby Cartus & Justin Feldman, “The ‘herd immunity strategy’ isn’t part of a scientific debate about COVID-19. It’s a well-funded political campaign,” Medium, Oct 11, 2020

Dismantles the Koch-backed, old-folks-should-die approach: “The proposal is not evidence-based and does not reflect even a minority view in the scientific community. Rather, it appears to be the product of an organized, well-funded political campaign in the US and UK . . . coordinated by two right-wing think tanks and the Trump administration. We believe the herd immunity campaign is primarily designed to create an illusion of scientific disagreement [and] cast doubt on the value of public health interventions.” The tactic was perfected by the tobacco industry several decades ago.

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Great Barrington replies:

Mark Pruhenski, “Town rejects affiliation with ‘Great Barrington Declaration,’” Town of Great Barrington, Massachusetts, Oct 15, 2020

“The town itself had no role in, or forewarning of, the declaration bearing the town’s name. This Declaration has gained national headlines and has created harmful misperceptions—just as we are doing all we can to protect residents, employees and visitors. Anyone who might avoid Great Barrington, due to confusion over the Declaration, is invited to visit and see how COVID-safe works in a small New England town. Please wear a mask.” BWAHAHA

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Sen. Susan Collins, “Increasing transparency and lowering health care costs,” seacoastonline.com, Sep 22, 2020

The pathetic depths to which the GOP has sunk in pretending to have a healthcare policy other than, Kindly die, now! If there is a God, Collins, the master “concerned” chin-stroker, will soon be a footnote. “Transparency between buyer and seller on both the price and quality of the goods or services in a transaction is fundamental to our free-market economic system.” Voila, the healthcare marketplace! Get your red-hot doctoring at our booth!

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Dave Sproat, “Millions of COVID-19 test swabs are sitting in a warehouse while shortages needlessly plague the U.S.,” Fierce Pharma, Oct 1, 2020

And speaking of markets, here is a fascinating case of how Friedmanite capitalism is operating in a deadly crisis. The author is sitting on 12 million unsold swabs while hospitals run short. “What is going wrong? Problems began at COVID-19’s onset when distributors frantically over-ordered personal protective equipment and masks at premium cost from Asia, leaving them with warehouses full of expensive supplies that went unused for various logistical and quality-control reasons. With this temporary excess, the market swung to the opposite extreme, adopting a very cautious approach to purchasing more supplies than health systems might immediately use.” Logistics is a complicated business, requiring perhaps, um, a Visible Hand. “Our experience also increases my personal fear for how our national supply chain will handle the distribution of a life-saving vaccine once it’s available if we can’t even figure out the simple distribution of swabs.”

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Reshma Ramachandran, “During the debate, President Trump said he’s ‘cutting drug prices.’ He’s not,” South Florida Sun-Sentinel, Oct 6, 2020

Trump’s last-minute braggadocio ignores the 33% rise in prescription drug prices since 2014, and his boast of imminent “80 or 90 percent” price cuts was the usual unfounded bombast. His claim to have reduced insulin prices is also false, etc., etc. How do you fact-check a parallel universe?

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Dean Baker, “Yet another diatribe on patent monopolies and how they are not talked about in polite company,” Patreon, Oct 23, 2020

Re the Purdue opioid settlement, “I did not see any mention anywhere of the fact that government-granted patent monopolies give companies like Purdue an incentive to push unsafe or ineffective drugs. Lying about the safety and effectiveness of drugs is a 100 percent predictable result of patent monopolies. It would be as though news reports on the low agricultural output in the Soviet Union never made reference to its system of central planning.”

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Julia Rock & Andrew Perez, “A bait and switch on pre-existing conditions,” Daily Poster, Oct 22, 2020

Notwithstanding Republican promises, “the bill being touted by the GOP’s most politically endangered senate incumbents would permit insurers to avoid existing caps on out-of-pocket costs for patients, institute annual or lifetime caps on spending, circumvent coverage requirements for essential benefits, and charge women higher premiums than men.” The lifetime spending cap essentially reintroduces pre-existing conditions exclusions indirectly. They know it’s unpopular, so they resort to bald-faced lying. “[NC Sen.] Tillis’s new bill is part of a Republican pattern of introducing legislation that sounds like one thing, but does another.”

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Ekaterina Cleary, “Remdesivir’s hefty price tag ignores NIH investment in its creation,” STAT, Oct 22, 2020

The NIH invested $230 billion to support the basic science behind remdesivir and other drugs between 2000 and 2019. Gilead’s price-gouging for its mediocre drug (remdesivir cuts an average of four days off hospitalization, has no effect on mortality) will last only as long as no better COVID meds arrive. Top executives will cash out before that.

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Sharon Lerner, “Trump sets up Pharma billionaires for Coronavirus payday,” Intercept, Oct 23, 2020

All sorts of shady dealings to pour public funds into Pharma chiefs’ pockets. One example (of many): “While the July agreement was made ‘on behalf of’ the Department of Defense, it was done through a third party called Advanced Technologies International, Inc. Because it is a nongovernmental entity, Advanced Technologies International is not subject to public records laws, which will make it difficult or impossible for the public to review the contract or its terms.” Regeneron’s chief Leonard Schleifer, a Trump golfing buddy, is worth $2.4 billion.

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Peter Elkind, “A hospital chain said our article was inaccurate. It’s not,” ProPublica, Oct 12, 2020

The ProPublica article was included in a previous Single Payer Links. The rebuttal here is tedious but shows to what lengths the sleazebag hospital owners will go to deflect the devastating exposé.

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Agence France Presse, “Biden pledges free Covid vaccine for ‘everyone’ in US if elected,” Oct 23, 2020

M4A but only for this disease. Won’t people get ideas? Also, does “everyone” include undocumented residents who also can get sick/transmit COVID? Is Biden ready for that fight?

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Kat Jercich, “Trump administration crackdown ‘couldn’t come at a worse time’ for hospitals,” HealthCare IT News, October 15, 2020

HHS cracks down on hospitals not reporting their flu and COVID data properly, even threatening to withhold Medicare reimbursements. Hospitals plead for mercy as they have trouble being in compliance. OTOH, reporting data to insurance companies for billing purposes seems to be going well. Also, see the CDC article below for how the Trump Administration privatized data gathering to shove the CDC aside and control the narrative.

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James Bandler, Patricia Callahan, Sebastian Rotella & Kirsten Berg, “Inside the fall of the CDC,” ProPublica, Oct 15, 2020

Not to be missed: “a comprehensive inside look at the escalating tensions, paranoia and pained discussions that unfolded behind the walls of CDC’s Atlanta headquarters” including topics such as “the botched COVID-19 tests, the unprecedented political interference in public health policy, and the capitulations of some of the world’s top public health leaders.” They should have quit en masse early on; now, nobody takes them seriously.

Posted Oct 22, 2020

Reed Abelson, “Kamala Harris and the push to cut hospital bills in California,” New York Times, Oct 6, 2020

Harris was awful on the mortgage fraud bankers (Mnuchin), but she took on the drug and hospital industry in California. A ray of hope, perhaps, especially given the new attention to antitrust issues, Google, etc. OTOH, the health care industry has shoveled big bucks to the Biden-Harris campaign.

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Wendell Potter, “The Potter Report: Edition 4,” Tarbell, Oct 21, 2020

“Judge Amy Coney Barrett says she’d base rulings about health insurance on how ‘the founders’ might have intended. This might make sense if health insurance companies actually existed then.” Ben Franklin’s Cigna was insuring ships in the 1780s, not people. Oh wait, Aetna was about to start insuring slaves, so maybe that’s what Barrett has in mind. Such is the debased depths to which we’ve sunk that a nutcase judge threatens to shred our safety net based on what George Washington thought about “pre-existing conditions.”

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James C. Capretta, “Trump’s desperate, extraconstitutional, and probably illegal ploy to lower drug prices,” The Bulwark, Sep 24, 2020

Pretty irrelevant now, but a late Hail Mary from Trump went nowhere, angered the Pharma giants (who are backing Biden), and was legally dubious. Another sign that the drug price issue is a hot political potato about which no one can do anything. Hilarious detail: drug companies offered to provide voluntary discounts to seniors instead, but the plan crashed when Trump insisted on it coming in the form of “Trump cards” to be delivered in October. But if they had struck a deal, where was Congress (the branch of government that supposedly controls public spending) in all this?

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Christopher Quinn, “Georgia veterans’ wait times for medical help skyrocketed,” Atlanta Journal-Constitution, Oct 11, 2020

“A rocky transition to a private company that manages referrals are contributing to the worsening delays.” Instead of the legally mandated 30-day wait limit, “4,632 north Georgia veterans who use the Atlanta VA hospital in Decatur waited at least 180 days to get an appointment with an outside medical provider.” As usual, privatization turns out to cost more for worse service. Also, a good reminder of how far the glassy-eyed admiration we have for all things military goes when applied to grunts.

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Will Stone, “Getting health care was already tough in rural areas. The pandemic has made it worse,” National Public Radio, Oct 7, 2020

One in four rural Americans reports inability to get care for serious problems just as over half (54%) of new coronavirus infections are concentrated in rural counties. Isn’t lack of speedy access the argument always raised against a uniform, single-payer system?

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Lev Facher, “First-of-its-kind examination shows how widely pharma showers campaign cash at the state level,” STAT, Oct 15, 2020

Remarkably small amounts needed to tuck state legislators into Pharma’s pocket. “In 10 states, more than half of all state legislators accepted pharma cash: California, Illinois, Oregon, Texas, Louisiana, Florida, Virginia, Arizona, Ohio, and New Jersey.”

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Sabine Franklin, “Trump’s executive order on health care puts America last,” Tarbell, Oct 14, 2020

“This order carries no legal weight and is mostly symbolic. What is (in)significant about the [Trump] plan is that it points out flaws [in the ACA] but not how to fix them. . . . Health care will continue to become more expensive where quality care and drugs are reserved for those who can afford it. This is not because the American health care system is broken; rather, it was designed this way and is working as intended.” Refreshingly clear language from Tarbell.

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Chris Jones, “For actors and other arts professionals, the healthcare safety net has been ripped to pieces,” Chicago Tribune, Oct 15, 2020

“The health care and retirement systems by which performing artists sustain themselves have fallen apart in the pandemic with potentially catastrophic results on both personal and systemic levels. There has to be a better way to do this.” Yes, there is! The theatre business has a system whereby short-term contracts can qualify a person for health benefits, but that has collapsed along with live shows. Under single-payer, they could wait it out along with the rest of us. Sad details, including turf fights among unions over who covers streaming shows. “The dire situation faced by those who work for your entertainment adds further weight to the argument that meaningfully expansive healthcare reform will need to be at the top of the agenda for the next president of the United States.”

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Patrick Cockburn, “When does incompetence become a crime?” Counterpunch, Oct 20, 2020

“Many governments get it wrong when trying to choose between experts who know what they are talking about and those that do not. But in deciding to create a massive test and trace apparatus earlier this year, the government took the self-destructive decision to put this highly specialised business into the hands of amateurs with no experience. The government handed the project over to the private sector, pouring great sums of money into the creation of a new but dysfunctional system.” Ming-boggling details of profiting off the disaster. “The antics [of the Johnson government] would provide rich material for a Gilbert and Sullivan comic opera, except that there is nothing funny about the unnecessary deaths of so many people.”

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Lucien Bruggeman, “11 state treasurers call on Gilead to reduce Remdesivir pricing,” ABC News, Sep 17, 2020

Expect more state action as their budgets nosedive and Medicaid costs rise. The state treasurers pleaded with Gilead “in a spirit of shared sacrifice.” Hope springs eternal!

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Dan Diamond, “Government watchdog will probe Trump officials’ interference at CDC, FDA,” Politico, Oct 19, 2020

“The government’s independent watchdog will investigate whether Trump administration officials improperly interfered with the coronavirus response at the Centers for Disease Control and Prevention and the Food and Drug Administration.” Will public statements by the president that we all saw on TV be entered into evidence?

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Dan Primack, “Tech investor Chamath Palihapitiya bets big on Medicare Advantage provider,” Axios, Oct 6, 2020

He runs Clover Health with venture capital funding. “More than 10,000 people turn 65 each day. Even if Biden doesn’t win, that’s around a billion dollars in new revenue possibly created each week. It doesn’t take a genius to work out the compounding effect.” Or to dig in for the juicy profits!

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Mallory Hackett, “Walmart partners with Clover Health to offer Medicare Advantage plans,” Healthcare Finance, Oct 1, 2020

Walmart climbs aboard the Medicare Advantage gravy train along with Clover.

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Jeremy B. Merrill & Marshall Allen, “‘Trumpcare’ does not exist. Nevertheless, Facebook and Google cash in on misleading ads for ‘garbage’ health insurance,” ProPublica, Oct 20, 2020

“Facebook and Google have promised to crack down on lies and misinformation about politics in the run-up to next month’s presidential election, but they have run tens of thousands of ads in the past year containing false claims about health insurance reform and plans.” If you respond, you get inundated with calls from sleazy brokers peddling crap a la “The Wolf of Wall Street.”

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Rebecca Kolins Givan, “President Trump is benefiting from single-payer, single-provider health care. We all should,” STAT, Oct 10, 2020

“The president will not face the familiar onslaught of paperwork, the confusing ‘explanations of benefit,’ or the ongoing bills that distract so many Americans as they attempt to recuperate from their illnesses. These health care systems [used by Trump] provide care that is free at the point of use, based on need, not on ability to pay. The costs are covered by general taxation, not insurance or user fees. The staff in these systems are paid salaries, so they are not incentivized to provide more or pricier care that may not be medically necessary.” Nicely phrased—will the logic dawn on our fellow citizens one of these days?

Posted Oct 14, 2020

Nicholas Florko, “‘You just got better at making money’: Democrats blast Celgene, Teva for price hikes detailed in internal documents,” STAT, Sep 30, 2020

“The Squad” vs. Pharma square off in a round over 200% price hikes on Teva’s multiple sclerosis drug copaxone and Bristol-Myers Squibb’s multiple myeloma drug revlimid. “You just refined your skills at price gouging.” Nice enough though these set-piece congressional hearings are good at staging outrage that leads nowhere.

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Liam Bendicksen, Joshua M. Sharfstein, & Aaron S. Kesselheim, “Increase transparency at the FDA: We need sunlight to fight the pandemic,” STAT, Sep 29, 2020

Feed people a steady diet of lies, and they become skeptical. Who would have known! “Disclosing de-identified participant-level clinical data to qualified researchers would have several advantages, including allaying fears that political influence may be corroding the FDA’s conclusions and helping curb actual political intimidation. The likelihood that others will be able to directly review the data makes the FDA as an institution more resistant to outside interference.” Translation: if the FDA puts out more raw data, we can help it get Trump off their backs. Also, why the worrying over these outfits’ “confidential commercial information” when the government is pre-paying billions to them for the work?

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Libby Watson, “The pandemic has been great for the health insurance industry,” New Republic, Oct 9, 2020

An average policy now costs $21,342 per family, up 4% in a year. (Employees covered at work pay about a quarter of that.) “Anthem, the third-largest health insurer in the United States, announced at the end of July that it expects to repurchase more than $1.5 billion in stock over the next year. Anthem’s CEO, Gail Boudreaux, was paid more than $15 million in 2019.”

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Melody Schreiber, “Why Trump’s experimental Covid-19 treatment could be bad news for everyone else,” New Republic, Oct 7, 2020

“Even if Regeneron’s manufactured antibodies are working for the president, the ripple effects could harm the pandemic response down the line.” Thousands clamoring for the “miracle” drug Trump attributes to his recovery could undermine enrolment in any randomized, controlled trial. And if he suddenly tanks, even worse. And according to Trump himself, he wasn’t that sick, so he didn’t need “compassionate use” of an untested drug. P.S. Regeneron’s founder and CEO, Leonard S. Schleifer, belongs to Trump’s golf club in suburban New York.

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Kathryn Ardizzone, “Taxpayers are subsidizing 80 percent of Regeneron’s COVID-19 treatment’s R&D costs,” Knowledge Ecology International, Oct 8, 2020

The Federal Government “is obligated to fund 80%” of R&D costs of the drug Trump is trumpeting. Profits, however, will be fully privatized, as usual.

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Christopher Rowland, “Remdesivir may not cure coronavirus, but it’s on track to make billions for Gilead,” Washington Post, Sep 30, 2020

Remdesivir is “a modestly beneficial drug with little evidence it improves survival.” But Trump likes it, and so does Gilead at $3,120 price per course of treatment, or $9 billion in annual profits. Gilead argues that the cost is reasonable given the (completely insane) cost of staying in an American hospital.

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Rebecca Kolins Givan, “President Trump is benefiting from single-payer, single-provider health care. We all should,” STAT, Oct 10, 2020

Too easy but worth repeating. “The president’s health care is free at the point of delivery, funded from general taxation, and paid for by all taxpayers.” Socialized medicine at the top.

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Frank J. Thompson, “Six ways Trump has sabotaged the Affordable Care Act,” Brookings, Oct 9, 2020

The six: 1. Reduced outreach for enrollment in the ACA exchanges. 2. Cut ACA subsidies to keep private insurers in the exchanges. 3. Allowed cheap, lousy insurance policies to siphon off healthy younger people out of the insurance pool. 4. Promoted waivers that allowed work requirements and watered-down coverage options. 5. Instituted the “public charge” rule that discouraged green card holders from enrolling. 6. Tried to kabosh the entire ACA through a Supreme Court ruling.

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Lambert Strether, “Why the phrase “access to health care” should always pin your bullsh*t detector,” Naked Capitalism, Oct 11, 2020

Does “access to care” actually mean “barriers to care” or even “no care”? Read this provocative lesson in parsing one’s key terms. Includes the example: “I have access to a BMW; sadly, I cannot afford to buy one.” And that’s before you try to navigate the administrative burdens standing between you and the BMW, or in this case the 15-year-old Dodge.

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Marc Lipsitch & Yonatan Grad, “How to fix public health weaknesses before the next pandemic hits,” Washington Post, Sep 24, 2020

“Electronic medical records—envisioned as a boon for public-health surveillance, providing data that could be readily analyzed—turn out to be much better for billing than for the exchange of data.” They get the diagnosis right, but not the remedy (standardize billing to a sole payer). Instead, the Harvard academics propose “significant investment to link public health agencies at the local level to state and national databases and to ensure that the information coming into these systems is of adequate quality.” Lots of new jobs for the PMC! Or as they put it: “All this will require new investment in these good ideas, IT infrastructure, highly skilled personnel and equipment to run large numbers of diagnostic tests.” The Biden campaign is targeting upper-income suburbanites for a reason.

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Darragh Roche, “Big Pharma backs Joe Biden, but people don’t think he’ll fix drug pricing,” Newsweek, Sep 29, 2020

Biden: $5.9 million from Pharma v/s Trump $1.5 million. “It is likely that drug companies will remain the most important lobbyists, spending 50/50 on both sides of the aisle,” meaning more of the same.

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Sen. Tom Cotton, “Prescription drug prices are sky high—It’s time for a tougher approach to lowering prices,” Fox News, Oct 13, 2020

Even this wacko has to admit things are awful. GOP solutions: “better markets,” more “transparency,” less “red tape.”

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Grant Schulte, “Expanded Medicaid begins in Nebraska after years of dispute,” Associated Press, Sep 30, 2020

Good news/bad news: over a decade after the passage of Obamacare and two years after voters said to expand Medicare, Nebraska finally got around to it. No rush! Delays were caused by the work requirement, a complex two-tiered arrangement (“a massive undertaking that required numerous layers of federal approval”) to limit coverage to the undeserving poor. Private contractors will manage the new behemoth, which will include “a financial incentive to provide [deny] health care services while keeping costs low [maximizing profits].” Beneficiaries are limited to earnings of $36,156 for a (deserving) family of four.

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Amy Goldstein, “Why Vermont’s single-payer effort failed and what Democrats can learn from it,” Washington Post, Apr 29, 2020

An account of the collapse of Vermont’s attempt at single-payer from 2019, still germane. Contains only a glancing reference to the difficulties facing an individual state versus how the Feds could finance it (i.e., with a keystroke at the Federal Reserve).

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Laura Ungar, “Moved by plight of young heart patient, stranger pays his hospital bill,” Kaiser Health News, Oct 8, 2020

A kid slammed with the typical die-or-go-bankrupt hospital bill gets relief from a faraway stranger who saw the story on TV. Those not getting their stories on TV proceed to go bankrupt. “I felt led by the Holy Spirit to do that,” said the kindly donor. “When you help other people, it gives you joy.” Would she feel the same way about paying into a universal insurance pool that would help everyone? Or would she shun “taxes” for a program handled by “gummint”?

Posted Oct 7, 2020

Sara Murray and Kevin Liptak, “Trump has personally pressured drug company CEOs repeatedly to speed vaccine,” CNN, Oct 6, 2020

Then bragged about it: “Even before his diagnosis, the President had taken to calling drug companies to check on their vaccine trials, asking how much longer they'll take and ginning up the pressure around his desire for a vaccine before Election Day. He’s also signaling he might speed up the federal approval process, conspicuously stalling FDA recommendations that would delay a vaccine authorization.” Further boosting official credibility around the eventual vaccines that will be peddled to us.

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Melody Schreiber, “Trump is encouraging big Pharma’s worst instincts,” New Republic, Sep 29, 2020

“Unprecedented political interference” has resulted in massive loss of faith in the FDA. Remarkable.

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Nicholas Florko, “New document reveals scope and structure of Operation Warp Speed and underscores vast military involvement,” STAT, Sep 28, 2020

Hard to know what to make of Operation Warp Speed, a “highly structured organization in which military personnel vastly outnumber civilian scientists.” The armed forces have experience in logistics, to be sure; however, the presence of “more than 100 officials in the corridors [of HHS] wearing Desert Storm fatigues” does not suggest, um, a persuasion-based approach to vaccination.

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Rebecca Drobbins & Erin Brodwin, “As insurers move this week to stop waiving telehealth copays, patients may have to pay more for virtual care,” STAT, Sep 29, 2020  

The emergency fades, cost-sharing bounces promptly back. Therefore, it’s time to stop feeling unsafe at the doctor’s office, okay? Also, will patients know that the suspended fees have been reinstated or just get a bill later?

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Peter Elkind & Doris Burke, “Investors extracted $400 million from a hospital chain that sometimes couldn’t pay for medical supplies or gas for ambulances,” Kaiser Health News, Sep 30, 2020

Continued legal looting: “In the decade since Leonard Green & Partners, a private equity firm based in Los Angeles, bought control of a hospital company named Prospect Medical Holdings for $205 million, the owners have done handsomely. It extracted $400 million in dividends and fees for itself and investors in its fund—not from profits, but by loading up the company with debt. Prospect CEO Sam Lee, who owns about 20% of the chain, made $128 million.” Private equity is pouring into the healthcare sector to repeat this “success” story. Very long: the details of constant misconduct, stiffing suppliers, and zero enforcement just keep repeating themselves.

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F. Douglas Stephenson, “Is it time to end profiteering on public health and nationalize big Pharma?” Informed Comment, Oct 1, 2020

“Because Big Pharma rarely invests in prevention, it has very little motivation to invest in preparedness for a public health crisis.” And the post hoc scramble for vaccines required vast pre-discovery public investments to ensure no losses for the companies on R&D. The authors lay out a series of recommendations for how to transform the entire business and reorient it to human needs.

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Felipe De La Hoz, “When your Covid symptoms outlast your insurance,” New Republic, Oct 1, 2020

Uninsured persons with active Covid infection are covered by a variety of programs, but what happens when your disease is not “active” and yet symptoms persist? Also, the undocumented are left out of many options, including seniors at high risk both for infection and further transmission. [One possible model: HIV care, finally understood as an epidemic and public health emergency, doesn’t depend on legal status. TF]

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Nicholas Florko & Lev Facher, “Republicans blasted Obama’s use of an obscure Medicare law. Now Trump’s using it on $200 drug coupons—and the GOP is silent,” STAT, Sep 25, 2020

“The last time a president used an obscure law to spend billions of Medicare dollars without congressional approval, Republican lawmakers called it a political ploy, a technicality, a way to write a ‘blank check’ to help win an election. They launched investigations and issued subpoenas.” This time, they don’t care. Hypocrisy, of course, but that’s the danger of setting precedents. (The Guantánamo dungeons are still open.)

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Craig Brammer & Tim Elwell, “The U.S. needs a national Covid-19 testing strategy, not a state-by-state patchwork,” STAT, Oct 1, 2020

And what if we had a national health system rather than a patchwork of private insurers? Maybe health workers would have PPE six months after the crisis began.

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Dean Baker, “Waiting for a vaccine: Killing for inequality,” Patreon, Oct 5, 2020

“Trump explicitly turned the development of a vaccine into a race. He created ‘Operation Warp Speed,’ to which he committed more than $10 billion of public funds. This effort is supposed to develop both vaccines and treatments for the coronavirus. This nationalistic patent monopoly route [instead of international research pooling] was the one Trump choose to pursue. It should be mentioned there was little visible opposition from leading Democrats in Congress [including Warren, Bernie, AOC]. It is more than a bit bizarre that political figures who devote so much effort to combating inequality look the other way when we design a pandemic health care research plan that both slows research progress and gives more money to those at the top.” Contrast with the following:

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Sacha Sadan, Yo Takatsuki, & Damiano de Felice, “Global investors must support pharma solidarity and collaboration in the response to Covid-19,” STAT, Sep 28, 2020 https://bit.ly/2GocXD3

Three Pharma execs call for public-private “cooperation” to avoid “medical nationalism.” Hmm, why this epiphany? “Covid-19 represents the opportunity of a generation for pharmaceutical companies to save hundreds of thousands of lives, thereby recovering the industry’s somewhat tarnished reputation and relationship with all stakeholders. Moreover, government subsidies are offsetting the majority of the current costs of R&D and manufacturing, as well as reducing the risks of testing as-yet-unproven technologies, such as mRNA vaccines, which could be employed for profitable treatments in the future.” The shape of things to come under a reassuring President Biden?

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Marc Bourreau et al., “Google’s mission is to monetize the world’s data—and health data is exceptionally monetizable in ways that can directly harm consumers,” VoxEU, Sep 30, 2020

The Google-Fitbit merger, a singularly bad idea, would give Google “a toehold in wearables from which to combine sensitive health data with the personal profiles of users collated from other services. . . . The combination of Fitbit’s health data with Google’s other data creates unique opportunities for discrimination and exploitation of consumers in healthcare, health insurance and other sensitive areas, with major implications for privacy too.” Further details on the vast profit opportunities in the health sector. Worth reading in full especially for reminders of Google Health (“a repository of health records and data intent on developing a specific search engine for medical records”), Project Nightingale (“a secretive joint project by Google Cloud and Ascension, a large private healthcare system in the US, which collates enormous medical records on millions of citizens”) and other creepy details.

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Casey Ross, “‘Covid is all about privilege’: Trump’s treatment underscores vast inequalities in access to care,” STAT, Oct 6, 2020

Contrast between the royal treatment given Trump versus what the rest of us might aspire to. “They [we] are told to stay home and monitor their symptoms. If they do become severely ill, there is only a remote chance they will get access to the antibody cocktail, which was developed by Regeneron Pharmaceuticals and is being tested in clinical trials.” Ten people have received it so far. Fun fact: “About 35% of patients with household income under $15,000 became seriously ill, compared to just 16% of patients with income over $50,000.”

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Paul Kiel & Jeff Ernsthausen, “Debt collectors have made a fortune this year. Now they’re coming for more,” ProPublica, Oct 5, 20202

Banner year for debt collectors who are launching thousands of new lawsuits, including against those crushed by medical debt. “Earlier this year, the pandemic swept across the country, killing 100,000 Americans by the spring, shuttering businesses and schools, and forcing people into their homes. It was a great time to be a debt collector.” Also, many stimulus checks went into paying down debt rather than consumption. One outfit, Encore Capital, announced record earnings as the CEO Ashish Masih told investors the company was “particularly excited about the prospects for increased supply [of defaulted debts] in the future.” And courts are reopening, so wages can be garnished again.

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Lancet Public Health, “Public health must be a priority in the 2020 US election” [editorial], Oct 1, 2020

The U.S. could save $730 billion a year (27% of all health expenditures) by addressing five modifiable risk factors: obesity, high blood pressure, high sugar, other “dietary risks,” and smoking. Now you’re telling us?

Posted Oct 1, 2020

During the train wreck of Debate I, Biden did manage to say some things about healthcare. [transcript]

Lambert Strether @ Naked Capitalism comments: “This is just bizarre. First, the public option is an option. Automatic enrollment, not being optional, makes no sense. Second, a means-tested public option that is in essence a Medicaid buy-in is like no public option I’ve ever heard of. Third, apparently Biden’s so-called public option is apparently geography-tested besides being means-tested: It will only apply in the 12 states that did not join ObamaCare’s Medicaid expansion. Fourth, why not just legislate Medicare expansion, if that is the goal, instead of this kludgy workaround? Biden’s odd version of the public option will no doubt increase coverage somewhat, but at the cost of even more complexity and hence no decrease in cost, leaving ObamaCare as vulnerable to assault as ever.”

Vice President Joe Biden on his public option proposal: (13:32) “It does not [kill private insurance—Trump’s accusation]. It’s only for those people who are so poor they qualify for Medicaid they can get that free in most States, except Governors who want to deny people who are poor Medicaid. Anyone who qualifies for Medicaid would automatically be enrolled in the public option. The vast majority of the American people would still not be in that option.”

This assumes that anyone in the Biden camp is serious about actually carrying out his policy, whatever it is.

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KHN and PolitiFact staff, “The first presidential debate: A night of rapid-fire interruptions and inaccuracies,” Kaiser Health News/PolitiFact, Sep 30, 2020

Heroic journalists trudging through the mire for something resembling a policy discussion.  

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Sara R. Collins, Munira Z. Gunja & Gabriella N. Aboulafia, “Which health care issues matter most to U.S. voters?” Commonwealth Fund, Sep 24, 2020

Trump is distrusted on protecting coverage for preexisting conditions, named the “most important” health concern in six swing states (Arizona, Michigan, Minnesota, Ohio, Pennsylvania, and Wisconsin).

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Charles Liu, Karan R. Chhabra & John W. Scott, “Catastrophic health expenditures across insurance types and incomes before and after the Patient Protection and Affordable Care Act,” JAMA, Sep 24, 2020

Improvements in coverage occurred during the decade of the 2010s through Medicaid expansion and Obamacare. However, 11 million Americans still incurred “catastrophic expenditures” related to health in 2017, defined as costs absorbing 40% or more of annual income. One third of the catastrophic spending hit people with private insurance. “Financial protection improved for the lowest income quartile, which was one of the ACA’s principal aims. However, improvements were not observed in higher income quartiles or among the privately insured.”

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Christi A. Grimm, “Medicare Advantage should not ‘game the system’ but prioritize patient care, honest billing,” Healthcare Dive, Sep 23, 2020

Grimm, an HHS inspector, highlights “abuse of risk adjustment in Medicare Advantage programs,” also known as upcoding. “Our recent report found that Medicare Advantage paid $2.6 billion a year [i.e., MA companies billed the USG] for diagnoses unrelated to any clinical services.” Most of these dubious charges arise from home visits by third-party entrepreneurs looking for ways to diagnose healthy elders as “high-risk.” Will any of these businesses get penalized and/or prosecuted? Note the tell in the headline: “should.”

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Isaac Arnsdorf, “Trump’s vaccine czar refuses to give up stock in drug company involved in his government role,” ProPublica, Sep 23, 2020

Further stimulating trust in the products eventually approved by Trump’s loyal bureaucrats. Moncef Slaoui protested that he has “a personal compass in ethics” that should preclude any doubts about his probity and that it was “extremely painful” that anyone would even think that a Trump employee should be trying to enrich himself. Slaoui’s Warp Speed colleagues who also have personal ethics compasses—as well as stock holdings—include William Erhardt (Pfizer, Thermo Fisher Scientific, PhaseBio Pharmaceuticals), Rachel Harrigan (Pfizer), and Carlo de Notaristefani (Teva Pharmaceuticals, makers of hydroxychloroquine).

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Vijay Prashad & John Ross, “The difference between the US and China’s response to COVID-19 is staggering,” Canadian Dimension, Sep 16, 2020

China had zero domestic transmissions this month. The US has 45,000 a day.

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Michael Friedman, “A recipe for disaster: Yih and Kulldorff’s ‘radical’ Covid strategy,” Spectre, Sep 24, 2020

A rebuttal to the leftish defenders of quasi-Trumpian back-to-work orders given the damage to human welfare of unemployment, etc. “Community immunity via natural infection is not a strategy; it’s a sign that government failed to control an outbreak and is paying for that in lives lost.” If we’re willing to say goodbye to 1 in 500 U.S. residents, i.e. 650,000 people, heavily skewed to nonwhites and the elderly, then let’s do it!

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Fareed Zakaria, “What sets apart countries that successfully handled the pandemic? Failure,” Washington Post, Sep 17, 2020

“Taiwan gets the gold medal for its coronavirus strategy. It has had just seven deaths. New York state, with a smaller population, has had 33,000. Taiwan’s greatest asset turns out to be its failed response to a pandemic in 2003, SARS, which taught it many important lessons.” Zakaria couldn’t say “single-payer” if threatened with death, but he does acknowledge that other countries do far better with far less.

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Nikki Haley, “How much are we paying to treat Covid? There’s no way to know, and that’s a problem we should fix,” Politico, Sep 21, 2020

They have no shame. Actively conspire to create a horrible mess, then pretend to care. (Haley was governor of South Carolina—where she refused to expand Medicaid.)

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Rachana Pradhan, “It’s not just insulin: Lawmakers focus on price of one drug while others rise too,” Kaiser Health News, Sep 22, 2020

Lesser-known or -used drugs don’t get the attention but suffer similar price gouging. “The costs of 17 top-selling brand-name drugs more than doubled from 2012 to 2017. Many of the drugs that made the list are household names.” Meanwhile, Pharma benefits from the good PR around their vaccine research.

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Rohit Anand, Dhiksha Balaji, Aparna Narendrula & Jasmine Serpen, “Ask Trump and Biden how they’d fix gross inadequacies of US health care: Medical students,” USA Today, Sep 21, 2020

Cleveland med students land an op-ed in a mass circulation daily on the eve of the debate: “In medical school, we rely on acronyms. We have one to describe key aspects that we hope our health care system will one day embody: USA — universal, simple, affordable.” But the authors never say “single payer,” which might be why they throw in “affordable.” If individuals don’t have to pay at point of care, it’s automatically affordable.

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Gerald Posner & Margarida Jorge, “Pharma insiders are taking in money despite no guaranteed COVID-19 vaccine,” Newsweek, Sep 15, 2020

“Insiders from at least 11 companies with vaccine announcements sold over $1 billion of shares just from March through late July. About a third of those sales were from three companies—Moderna, Inovio and Vaxart—that at the time had never successfully brought any drug to the market.” U.S. government investments in a COVID vaccine to date: $15.69 billion.

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Abigail Adams, “Donald Trump is losing on an issue voters care a lot about,” Time, Sep 17, 2020

Why Trump’s big announcement about drug prices is bluster: he said the same in July, then did nothing; it authorizes only an experimental project that could take years to show results; drug companies will sue to slow it down further; the Democrat-controlled House passed a similar bill that Trump said he would veto; Trump’s attention span is not great, and he isn’t known for veracity.

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Sarah Jane Tribble, “Rural hospitals teeter on financial cliff as COVID Medicare loans come due,” Kaiser Health News, Sep 22, 2020

Emergency loans from the Feds didn’t alleviate underlying financial stress of rural hospitals.

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Russel Gold & Melanie Evans, “Why did Covid overwhelm hospitals? A years-long drive for efficiency,” Wall Street Journal, Sep 17, 2020

Paywalled, but the first graf tells the whole story: “Banner Health had figured out how to get ahead in the modern health-care industry. The Phoenix-based nonprofit hospital system relentlessly focused on costs. It trimmed labor, carrying 2.1% fewer employees for every bed filled compared with the year before. The result was a financial powerhouse with $6.2 billion in cash and investments and a bond rating that is the envy of corporate financial officers. But when the pandemic hit, the strategies that had helped it become a model for other hospital systems suddenly became weaknesses.”

Posted Sep 24, 2020

Yves Smith, “How hospitals’ profit orientation led to Covid-19 unpreparedness,” Naked Capitalism, Sep 18, 2020

“Major hospitals’ fixation with efficiency meant they had no slack when Covid-19 struck. The critical shortages most often weren’t beds but medical personnel, above all emergency room nurses.” Glosses a Wall Street Journal article that is behind a paywall and takes down its neoliberal bias: “If humans were optimized for efficiency, we wouldn’t have two kidneys since it’s possible to live with only one.”

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Cetona, “Tales from the telly,” Health Care Renewal, Sep 11, 2020

Telemedicine has plusses (convenience, speed, safety) and many minuses: an easy way to provide less care and extract more in fees. “The problems of telemedicine mirror those of the larger society,” e.g. medicine-for-profit.

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Eric Boodman, “Not trusting the FDA, black doctors’ group creates panel to vet Covid-19 vaccines,” STAT, Sep 21, 2020

Trust in the feds now sinks so low that the National Medical Association (the black AMA formed during the Jim Crow 1890s) had to take charge of communicating with wary black audiences.

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Jessie Hellman, “GAO report finds brokers offered false info on coverage for pre-existing conditions,” The Hill, Sep 16, 2020

“In 31 undercover phone calls in which employees of the GAO posed as customers looking for health insurance that covered their preexisting conditions, eight of the sales representatives ‘engaged in potentially deceptive marketing practices,’ the agency concluded. One sales representative told a GAO employee they were purchasing a comprehensive health insurance plan, but instead sold them two limited benefit insurance plans that don’t cover preexisting conditions.” Eliminate the need to buy insurance in the first place & problem solved!

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Jordan Rau & Emmarie Huetteman, “Urban hospitals of last resort cling to life in time of COVID,” Kaiser Health News, Sep 17, 2020

Safety-net urban hospitals join rural hospitals on the ropes. “The economic damage inflicted by the COVID-19 pandemic on safety-net hospitals and the ailing finances of the cities and states that subsidize them are helping push some urban hospitals over the edge.”

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Susannah Luthi, “More Americans lacked health insurance last year — even before pandemic hit, census reports,” Politico, Sep 15, 2020

“Nearly 30 million Americans went without health coverage at some point in 2019, up by roughly 1 million from the previous year.” That’s before taking Covid-related mass unemployment into account.

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Matt Taibbi, “Big Pharma’s Covid-19 profiteers,” Rolling Stone, Aug 13, 2020

Good overview of how the pharma scam has worked for decades—and will work on Covid-19. “Gilead develops an antiviral drug with the help of $99 million in American government grant money. Though the drug may cost as little as $10 per dose to make, and is being produced generically in Bangladesh at about a fifth of the list price, Gilead ended up selling hundreds of thousands of doses at the maximum conceivable level, i.e., the American private-insurance price. But almost no one cared. A day after the remdesivir price was announced, Donald Trump bought 500,000 doses through September, basically the entire world supply of the drug.” Not that the Dems would raise much of a complaint.

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Lev Facher, “Following court ruling, NIH warns drug and device companies to post missing trial data,” STAT, Aug 4, 2020

Publication bias is a crucial way that pharmaceutical companies control access to “the science,” making sure that studies showing their products are turkeys never see the light of day. The new ruling won’t mean anything, however, unless the FDA and NIH enforce it—which they have steadfastly refused to do.

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Ed Silverman, “‘Everyone was left to guess what went wrong’: An open letter to AstraZeneca’s CEO on transparency,” STAT, Sep 9, 2020

Speaking of transparency, this health writer notes that AstraZeneca withheld details of the “adverse event” in its drug trial but then shared them with its investors. “Everyone was left to guess what went wrong and what it might mean.”

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Helen Branswell, Matthew Herper, Lev Facher, Ed Silverman & Nicholas Florko, “Operation Warp Speed promised to do the impossible. How far has it come?” STAT, Sep 8, 2020

“In placing itself at the front of the line to receive vaccine doses from the OWS manufacturers, the United States has ignited a vaccine nationalism wildfire, which is reaching conflagration status. Wealthy governments have locked down more than 4 billion doses of vaccines so far, with the United States topping the list.”

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Andrea Germanos, “Rich nations hoarding potential Covid-19 vaccine doses, Oxfam warns,” Common Dreams, Sep 17, 2020

“A handful of rich nations representing just 13 percent of the world's population have snatched up over half of the promised Covid-19 vaccine doses.” They are: the UK, US, Australia, Hong Kong, Japan, Switzerland, Israel, and the EU. None in Latin America or Africa.

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Susan Peschin, “Trump’s ‘most favored nation’ executive order on drug prices is a scam for seniors,” STAT, Sep 16, 2020

The author argues that the use of metrics to control drug prices is unfair to seniors. Her think tank, Alliance for Aging Research, is funded by drug companies.

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Susannah Luthi, “Biden wants to restore Obamacare. He may have trouble,” Politico, Sept 15, 2020

“Despite Trump’s failure to repeal Obamacare, he’s forced changes on the health care system that Biden will find hard to immediately reverse, if at all. Trump’s expansion of skimpier health insurance alternatives to Obamacare, curbs on reproductive health funding and rollback of contraception coverage have been upheld in the courts. Efforts to reverse those policies are likely to draw legal battles in a court system that will bear the imprint of Trump’s conservative appointees for years.” Also, “Powerful health care lobbies have been preparing a ferocious assault against the public option, a centerpiece of Biden’s health plan”—from which anonymous Biden campaign sources already have backed away.

Posted Sep 17, 2020

NicholasFlorko, “With election looming, Trump releases major, last-ditch drug pricing order,” STAT, Sep 13, 2020

“Election looming” = campaign fluff. “The Trump administration still hasn’t released formal regulations to implement the policy.” Could have done it, or tried to, in 2017.

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H. Holden Thorp, “Trump lied about science,” Science, Sep 11, 2020

An unprecedented statement from a top journal. Scientific American followed suit September 15. “This may be the most shameful moment in the history of U.S. science policy.”

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Alexander Borsa, Joseph Bruch & Sarah S. Richardon, “When private equity firms invest in women’s health clinics, who benefits?” STAT, Sep 14, 2020

Wild guess? “The industry has set its sights on women’s health in part because of its high profitability and the limited regulation of fertility services. It also presents an opportunity to consolidate health practices at once and hold more market power.” PE takeovers of repro health clinics totaled $79 billion in 2019, five times the rate of a decade ago. PE firms typically cut costs, extract fees and paper profits, then dump the remains. Also, medical advice and procedures will be influenced by the profit motives of hidden partners –what could go wrong?

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William Brangham & Jason Kane, “How Switzerland delivered health care for all—and kept its private insurance,” PBS News Hour, Sep 2, 2020

Another installment in the four-part PBS series. A casual viewer could miss the part about how the Swiss strictly regulate all the “private” insurance plans. Also, as amply covered in the broadcast, forcing all citizens to buy in generates resentment over an “unnecessary” expense, unlike how a single-payer system absorbs them in all public outlays.  

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Laura Ungar, “With no legal guardrails for patients, ambulances drive surprise medical billing,” Kaiser Health News, Sep 14, 2020

A 4-mile ride across town cost one woman $1,206. Nothing happened on surprise bills in Congress, thanks to Rep. Neal (D-MA), who recently fought off a primary challenge.

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Amy Goldstein, “Medicaid rolls swell amid the pandemic’s historic job losses, straining state budgets,” Washington Post, Sep 14, 2020

Budget pressure on states is just beginning. “The spiraling demand for Medicaid is colliding with a diminished ability by the state to pay for it.” Expect cuts in already low reimbursement rates along with elimination of benefits.

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Sarah Kliff, “Coronavirus tests are supposed to be free. The surprise bills come anyway," New York Times, Sep 9, 2020

“For months, Americans have been told not to worry about the costs of coronavirus tests, which are crucial to stopping the pandemic’s spread.” So why are we getting bills? “In some cases, the charges appear to violate new federal laws that aim to make coronavirus tests free for privately insured patients. In other cases, insurers are interpreting gray areas in these new rules in ways that work in their favor.” Enforcement? Penalties? Adult supervision?

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Dean Baker, “It’s not vaccine nationalism, it’s vaccine idiocy,” Patreon, Sept 16, 2020

“In the early days of the pandemic there was a large degree of international cooperation, with scientists around the world quickly sharing new findings. We quickly shifted to a path of nationalistic competition. But the issue was not just nationalism; it is also the monopolization of research findings. If Moderna, Pfizer, or one of the other U.S. drug companies ends up developing a safe and effective vaccine, they fully intend to sell it at a considerable profit, and they will be sharing the money with their top executives and their shareholders, not the American people. This outcome makes sense if the point of the policy is to maximize drug company profits. It makes no sense if the policy goal is to produce the best health outcomes at the lowest possible cost.” Especially if the Chinese vaccine works and rolls out first.

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Jerry Avorn & Aaron S. Kesselheim, “Up is down—pharmaceutical industry caution vs. federal acceleration of Covid-19 vaccine approval," New England Journal of Medicine, Sep 15, 2020

A brave new world wherein the drug companies assure us that they won’t be pressured by their regulatory agency to do something unsafe. “The CEOs’ pledge to hold back on seeking marketing permission prematurely could lead to the unusual situation of the government advocating for quick approval of a medical product even as its manufacturer declines to request such approval. Then what?” This requires a new term: “regulatory counter-capture”?

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Noam N. Levey, “Vaccine maker got $1 billion from taxpayers. Now it’s boosting prices,” Los Angeles Times, Sep 14, 2020

“[AstraZeneca] raised prices in a way that stood out even among other big drug companies. It announced not just one set of price hikes in 2020 but two, often on the same drugs.”

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Associated Press, “Ex-Omaha weatherman accused of targeting health director,” Sep 14, 2020

He threatened to cut her throat in an anonymous text. Death threats against public health officials are increasingly common. Many quit.

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Julia Rock, “Stop bashing unions,” TMI, Sep 16, 2020

“Unionized nursing homes had 30% lower mortality rates than non-unionized ones.”

Posted Sep 12, 2020

Jackson Williams, “Seeing the ‘deep pocket’ effect when insurers pay for health care,” STAT, Aug 31, 2020

Thesis: health care is more expensive because it is insured—another dose of crazy for our medical payment system. “For all services for which insurers pay more than $5,000, the price quoted to the Plain communities [Amish, who do not use commercial insurance] is between 49% and 64% of insurers’ prices.” As the Amish pay with their own money, they don’t settle for price-padding by providers because there are no premium-paying businesses to whom to pass on the inflated costs.

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Nick Martin, “Health care in America is exactly like a ‘new dress shirt,’” New Republic, Sep 9, 2020

“Just like if I want to go to the store and buy a new dress shirt,” Sen. Tillis’s [R-NC] staffer told a constituent with cancer. “If I can’t afford it, I don’t get to get it.” The staffer is a nasty piece of work; he’s also right on the money. Healthcare in America is just one more retail business.

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Lev Facher, “A Senate race in Kansas between two doctors sets the stage for an election hyper-focused on health policy — and on Covid-19,” STAT, Sep 9, 2020

“The surprisingly close race, in an otherwise deep-red state, is hyper-focused on health care: the Democratic nominee has campaigned aggressively on policies to expand the state’s Medicaid program, allow Medicare to directly negotiate drug prices, and outlaw surprise medical bills.” The Democrat also has the advantage of hearing her opponent say things like, “There is a group of people that just don’t want health care and aren’t going to take care of themselves, just, like, homeless people.”

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Liz Szabo, “Health officials worry nation’s not ready for COVID-19 vaccine,” Kaiser Health News/AP, Sep 2, 2020

Cart before the horse a little? “The CDC’s director, Dr. Robert Redfield, wrote to governors last week about the urgent need to have vaccine distribution sites up and running by Nov. 1.” Underfunded public health departments are being told to scramble to get everything ready; meanwhile, no news of extra funds. Details of the enormously complex logistics, which this government is, like, totally prepared to manage.  

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Andrew Perez, Walker Bragman & David Sirota, “Health care lobby tried to buy corporate immunity from both parties,” TMI, Sep 9, 2020

Both parties line up to feed at the trough: “Senate Majority Leader Mitch McConnell on Tuesday released new legislation that would make New York Gov. Andrew Cuomo’s corporate immunity statute the law of the land in every state in America — the second time in two months that Senate Republicans have spliced Cuomo’s controversial provision into their proposed coronavirus response legislation.”

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Robert Wood Johnson Foundation, “The impact of coronavirus on households across America,” Sep 2020

“At least half of households in the four largest U.S. cities—New York City (53%), Los Angeles (56%), Chicago (50%), and Houston (63%)—report serious financial problems including depleted savings, and trouble paying bills or affording medical care.”

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Andrew Siddons, “Drug price spikes still unchecked, five years after controversy,” Roll Call, Sep 9, 2020

The “Pharma Bro” debacle is already five years old. Appalled condemnation was followed by a solemn promise of reform. Today, Daraprim still lists for $750 per pill, up from $13.50.

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[U.S. Reps.] Rosa DeLauro, Jan Schakowsky & Earl Blumenauer, “Ahead of a coronavirus vaccine, Mexico’s drug pricing to have far-reaching impacts on Americans,” The Hill, Sep 3, 2020

How to slip in corporate favors when you lose the democratic debate. The authors carefully worked in protection for cross-border drug purchasing in the revised NAFTA, then were blindsided when “someone” got Mexico’s congress to undermine it. Possible implications for keeping coronavirus drug costly.

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Dan Diamond & Adam Cancryn, “$2,933 for ‘Girl’s Night’: Medicaid chief’s consulting expenses revealed,” Politico, Sep 10, 2020

Three and a half million for this public servant’s self-promotion campaign. Nauseating details—the lady should have pitched a reality show instead.

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Ariel Hart, “Critics say thousands would lose coverage, but the governor says more would be insured,” Atlanta Journal-Constitution, Sep 4, 2020

The punishment will continue until morale improves. “Insurers and web-brokers, who would be in charge of helping Georgians find health insurance, have developed a track record of steering consumers toward substandard plans that expose them to catastrophic costs if they get sick.”

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J. Russell Teagarden & Arthur L. Capan, “‘Hell has frozen over’: The pharmaceutical industry stands in for a politically impaired FDA,” STAT, Sep 10, 2020

How bad has it got when Pharma has to reassure the public that the FDA “regulators” won’t push dangerous drugs on us?

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William Brangham & Jason Kane, “Is U.S. health care the best or least effective system in the modern world?” PBS NewsHour, Aug 31, 2020

Part 1 of 4. Cautiously Talmudic in tone (“on the other hand”) but devastating about how our system provides miracles for some and dumps others by the roadside. [Only 15 minutes, so plug in—I’ll include the other parts in future digests.]

Posted Sep 5, 2020

Marshall Allen, “A doctor went to his own employer for a COVID-19 antibody test. It cost $10,984,” ProPublica/Texas Tribune, Sep 5, 2020

And the insurer paid it, despite the fact that the test sells for $8. Why would the insurance company submit to this extortion? Fear of criticism for refusing payment during a pandemic? To keep high-fee facilities in their networks? Or: “For-profit insurance companies don’t want to spend the time and money it takes to hold fraudulent medical providers accountable.” The doctor, an opponent of M4A, says, “If instances like these go unchecked, it will provide more ammo for advocates of a single-payer system.” Uh-huh.

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Caitlin Hu, “With Canada and Mexico borders closed, Americans are trapped in their own health care system,” CNN, Aug 31, 2020

Build the wall! Build the wall! No more cheap Canadian insulin or Mexican dentists for diseased Americans. Includes details on informal (and illegal) insulin exchanges.  

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Ed Silverman, “Moderna failed to disclose federal funding for vaccine patent applications, advocates say,” STAT, Aug 28, 2020

It matters because if the government put in money for development, the taxpayer would have partial ownership rights. Moderna is one of the big beneficiaries of Trump’s pre-testing vaccine buys. “The group examined the 126 patents assigned to Moderna or ModernaTx as well as 154 patent applications. None mentioned the government research money the company got.”

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Derek Lowe, “Convalescent plasma: The science and the politics,” Science Translational Medicine, Aug 24, 2020

Technical, but the point is about halfway down: “This shows the perverse danger of being too free with emergency use. If you just turn everyone loose on a bunch of therapies, they will be used under all sorts of conditions and the chances of getting a useful read on any of them go down. Look at our current situation: we have data on over 35,000 patients who have received convalescent plasma, but we still don’t have a good comparison to not receiving it.” This faulty science was further aggravated by all the hype about a “historic breakthrough,” “a truly historic announcement,” etc., to make Trump look good. The shame is that convalescent plasma may well be a good remedy—we just may never know for sure. And the eventual vaccine is already pre-condemned to failure IMHO.

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Abby Goodnough, “Trump program to cover uninsured Covid-19 patients falls short of promise,” New York Times, Aug 29, 2020

Another piecemeal program with plenty of cracks for people to slip through. “Some patients are still receiving staggering bills. Others don’t qualify because conditions other than Covid-19 were their primary diagnosis.”

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Libby Watson, “Covid patients are receiving eye-popping bills. It’s not all Trump’s fault,” New Republic, Sep 2, 2020

“His plan to help with hospital charges is poorly designed. But even a well-crafted plan would have been no match for our inept health care system.” Informative and wickedly written. The program only covers COVID, not pre-existing co-morbidities, which is why most people end up hospitalized in the first place.

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Jordan Chariton, “Untangling Joe Biden’s web of healthcare donors may explain his refusal to budget on Medicare For All amid deadly pandemic," Status Coup, May 18, 2020

From May: many industry names appear here that will become familiar if Biden wins. “Biden’s intransigence against proposing broader publicly-funded healthcare amid a deadly pandemic [that stripped] tens of millions of their healthcare is a stark contrast to his views on healthcare in 2007 [when he also was running for president,] ‘I think everyone should essentially be able to be from age 1 on essentially have the same kind of coverage you have in Medicare; it should be just universal across the board and we can afford to do it.’”

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Sam Baker, “Hospitals charge a lot more when Wall Street owns them,” Axios, Aug 26, 2020

About 30% more. And “Hospitals recorded a sicker overall patient population after they were acquired, which could suggest that they’re upcoding [i.e., committing fraud] in search of higher reimbursements.”

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Sean Williams, “2 big Medicare changes Joe Biden wants to make,” Motley Fool, Aug 30, 2020

1. Lower the qualifying age for Medicare to 60 (includes the usual pearl-clutching over costs); and

2. Allow the federal government to negotiate for lower prescription drug prices (and permit individual purchases overseas).

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Leah Willingham, “After victories, Medicaid expansion revisited in Mississippi,” Associated Press, Aug 30, 2020

New grassroots efforts to force Medicaid expansion in recalcitrant red states. But backers in Mississippi will need to gather 100,000 signatures and wait until November, 2022 for a shot at the ballot.

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Angela Hart & Samantha Young, “California Rx: State may dive into generic drug market,” Kaiser Health News, Sep 1, 2020

“California is poised to become the first state to develop its own line of generic drugs, targeting soaring drug prices and stepping into a fiercely competitive drug market dominated by deep-pocketed pharmaceutical companies.” Insulin would be a likely target. States have to consider action given the relaxed indifference at the federal level.

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Matthew Perrone & Ricardo Alonson-Zaldivar, “Health agencies’ credibility at risk after week of blunders,” Associated Press, Aug 28, 2020

This is happening just months or even weeks before the entire nation will be asked to trust them as they inject a chemical into our bodies.

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Marina Pitofsky, “Half in new poll concerned major health event will lead to bankruptcy,” The Hill, Sep 1, 2020

“Adults who said they were “concerned” or “extremely concerned” about a major health event leading to bankruptcy has gone up from 45 percent in 2019 to 50 percent in 2020. The largest spike in the survey was among nonwhite adults (64%) and young adults (55%).”

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Emily Rauhala & Yasmeen Abutaleb, “U.S. says it won’t join WHO-linked effort to develop, distribute coronavirus vaccine,” Washington Post, Sep 1, 2020

Another giant step toward international isolation. Trump “doubles down on [his] bet that the United States will win the vaccine race.” What if we don’t? “It eliminates the chance to secure doses from a pool of promising vaccine candidates. . . . akin to opting out of an insurance policy.” But America-first is consistent with Trump’s attitude to everything; many agree. “Are you a reliable partner, or, at the end of the day, are you going to keep all your toys for yourself?” Important because vaccine politics will loom large in coming months.

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Beth Snyder Bulik, “HHS hands D.C. consultants $250M to ‘inspire hope’ with pandemic campaign,” Fierce Pharma, Sep 2, 2020

Coronavirus: nothing a little expert PR can’t solve. That said, competent behavioral messaging is not a bad thing, in theory—but would any campaign that contradicted Trump on masks or treatments pass the HHS censors? More likely: “Just Say No” to COVID-19.

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Robin Francis, “COVID: Where science goes to die,” Medlife Crisis, Aug 23, 2020

Must-see video on the errors and manipulations plaguing “science” reporting on COVID.

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Posted Aug 28, 2020

Carolyn Y. Johnson, Laurie McGinley, Josh Dawsey & Seung Min Kim, “Experts say the blood product is probably beneficial but not a game changer,” Washington Post, Aug 23, 2020

Forget the science, forget the trials—it might work, so get it into people asap.

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Matthew Perrone & Deb Riechmann, “FDA chief apologizes for overstating plasma effect on virus,” Associated Press, August 25, 2020

Hahn confused relative risk with absolute risk, which would get him an “F” in Epidemiology 101. Maybe he was flustered by the stable genius standing next to him. It’s hard to accept Hahn’s assurance that the FDA decision was based on “sound science” when he himself doesn’t grasp the basics.

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Kristina Fiore, “Convalescent plasma: The unanswered questions,” MedPage Today, Aug 25, 2020

“The data don’t show anything useful.” Details for epi nerds, showing what a total debacle the plasma show was.

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Lev Facher, “Trump has launched an all-out attack on the FDA. Will its scientific integrity survive?” STAT, Aug 27, 2020

Or return from the dead? Ironic that Trump’s base among the anti-vaxxer crowd sees no contradiction between his browbeating of the FDA and their paranoia about vaccines. The FDA’s new communications director is a gun booster who makes up her facts. “Peter Navarro, a top White House trade adviser, has reportedly told FDA officials: ‘You are all Deep State, and you need to get on Trump Time.’”

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Michael Specter, “Trump’s convention push for a coronavirus cure puts politics before health,” New Yorker, Aug 27, 2020

“The agency’s willingness to accede to Trump’s wishes raises an even more serious concern: What will happen as the President continues his campaign to force the F.D.A. to approve a vaccine before the election?” How confident will the public be about anything with Trump’s seal of approval on it?

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David Tuller, “A dilemma for ‘long-haulers’: Many can’t prove they ever had Covid-19,” STAT, Aug 26, 2020

Just what you need when saddled with a chronic condition: a brand-new form of pre-existing-conditions refusals. “‘By the time they reach me, they’ve been told their story is not believable,’ said [Dr] Griffin. ‘They might have lost half their hair and can’t go up a flight of stairs, but if they don’t have proof of Covid, a lot of providers don’t want to deal with them or will refer them to a psychiatrist.’” A direct result of the testing debacle in the U.S. and very similar to what patients with myalgic encephalomyelitis (ME ex-“chronic fatigue syndrome”) go through.

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Remdesivir:

Ed Silverman, “Urged on by scientists, NIH will study Gilead’s remdesivir-like compound against Covid-19,” STAT, Aug 24, 2020

Gilead won’t move on this drug with favorable prospects, so the NIH had to step in. Why wouldn’t a pharmaceutical want to do research on a potentially effective COVID medication that it owns? (hint: patents & profits). “We expect to conduct these studies quickly and make the results available to the research community for further consideration,” said the NIH.

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Public Citizen, “NIH agrees with Public Citizen, will conduct preclinical trials of the potential COVID-19 treatment GS-441524,” Aug 24, 2020

This Ralph Nader-inspired group had pushed NIH to step in. “We hope that Gilead will commit to working collaboratively with the NIH, even if it means the company may reap lower profits than expected from the marketing of remdesivir.”

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Lucien Bruggeman, “For company behind Coronavirus drug, sharp questions over pricing, potentially cheaper option,” ABC News, Aug 13, 2020

More bad PR for Gilead: why are you charging thousands for your treatment and not researching a cheaper option? Thirty-four state attorneys-general called the pricing of remdesivir “outrageous and unconscionable.” More: “It is unfortunate that Gilead has chosen to place its profit margins over the interests of Americans suffering in this pandemic.”

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Walker Bragman, Julia Rock & Andrew Perez, “Rep. Richie Neal’s campaign sends threatening letter demanding removal of ad about his corporate PAC cash,” TMI, Aug 26, 2020

Ads must have stung. This is the race in which the state Democrats cooked up a homophobic smear campaign against Neal’s primary opponent, Neal being the No. 1 congressional beneficiary of corporate cash. More is pouring in as he looks vulnerable, including a half million from the American Hospital Association. Neal retorts that he spreads his cash around generously, including to “every single member of the Black Caucus”—exactly.

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Andrew Perez and David Sirota, “Under Neal, a Wall Street tax break survives to keep enriching his donors,” TMI, Aug 29, 2020

Neal doesn’t just do the bidding of the hospital industry; he’s an all-round favorite of Wall Street plutocrats. “Even President Donald Trump has pretended he wants to do away with [the carried-interest loophole]. And yet, Democratic legislation to call Trump’s bluff and fix the problem is bottled up in the powerful tax-writing committee chaired by U.S. Rep. Richard Neal, who has lately been raking in campaign cash from finance industry donors that have lobbied to preserve it.” Democrats controlled both houses of Congress in 2009 but somehow forgot to repeal it then.

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Michael Sainato, “‘Bills kept coming’: Families of US Covid victims forced to crowdfund funerals,” Guardian, Aug 28, 2020

Piles of hospital bills, plus GoFundMe campaigns for burials. “The median cost of a funeral in the US last year was $7,640 but can be far higher depending on the type of service and where someone lives.” Multiply by thousands of families.

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Steven Findlay, “Primary care doctors look at payment overhaul after pandemic disruption,” Kaiser Health News, Aug 12, 2020

“Charbonneau, 43, his two partners and 10 staff members are struggling to keep their rural practice alive. Patient volume is slowly returning to pre-COVID levels. But the large Seattle-area company that owns his practice is reassessing its operations. The doctors have until September to cut costs, increase revenue, and “demonstrate that his practice is financially viable.” Doctors join the proletariat. Worth reading in full.

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Harris Meyer, “COVID data failures create pressure for public health system overhaul,” Kaiser Health News/California Healthline, Aug 14, 2020

“Nineteen years [after 9/11], there is still no national data network that enables the health system to respond effectively to disasters and disease outbreaks. Many doctors and nurses must fill out paper forms on COVID-19 cases and available beds and fax them to public health agencies, causing critical delays in care and hampering the effort to track and block the spread of the coronavirus.” Fractured, hyper-complex, multi-payer, for-profit healthcare cannot fix this. Grifting by the Trumpers makes it worse.

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Mary Ellen McIntire, “Even with one-party rule, Biden health care plan is no slam dunk,” Roll Call, Aug 19, 2020

Biden’s plans once included a reduction in the eligibility age for Medicare and/or a “public option.” The article assumes facts not in evidence, i.e., that Biden will actually push for either.

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Lisa Newcomb, “‘Threadbare’ US system denounced as study shows 12 million lost employer-tied healthcare during pandemic,” Common Dreams, Aug 26, 2020

The logic of delinking healthcare from employment is now overwhelming. Both parties ignore it.

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C. J. Polychroniou, “If Trump had followed Vietnam’s lead on COVID, US would have fewer than 100 dead,” Truthout, Aug 22, 2020

Vietnam has 95 million people and 3 percent of American per capita income. Total: 22 deaths.

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Laura Ungar, Jason Dearen & Hannah Recht, “Florida’s cautionary tale: How gutting and muzzling public health fuel COVID fire,” Kaiser Health News/AP, Aug 24, 2020

“Florida is both a microcosm and a cautionary tale for America. As the nation starved the public health system intended to protect communities against disease, staffing and funding fell faster and further in the Sunshine State, leaving it especially unprepared for the worst health crisis in a century.” And: “Duval County’s [Jacksonville] overall caseload is rising so fast that Goldhagen, the former health department director, said the agency has given up on contact tracing.”

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Juliegrace Brufke, “GOP lawmaker introduces bill clamping down on hospital consolidation,” The Hill, Aug 26, 2020

Brawling among the various components of the healthcare-industrial complex: Walmart, Boeing, and Comcast back this bill; Democrats aren’t interested, perhaps reflecting their proximity to the hospital wing of the biz. “The bill is unlikely to advance in the Democrat-controlled House.”

Posted Aug 24, 2020

Biden on healthcare from his DNC acceptance speech: “And the assault on the Affordable Care Act will continue until it’s destroyed, taking insurance away from more than 20 million people, including more than 15 million people on Medicaid and getting rid of the protections that President Obama worked so hard to get for 100 million more people who have pre-existing conditions. … We’ll not only build back, we’ll build back better…. with a healthcare system that lowers premiums, deductibles, drug prices, by building on the Affordable Care Act he’s trying to rip away.”

What happened to lowering the age of Medicare and the public option? Snatched away at the first sign of oppo. Let’s remember that next time M4A gets a hearing, and the centrists/moderates/pragmatists respond, “Oh wait, let’s go step by step and start with a public option.”

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Lev Facher, “Trump campaign’s Facebook ad blitz casts Biden as pharma’s preferred candidate,” STAT, Aug 18, 2020

Trump opportunistically positions itself to the left of the Dems with phony attacks on Pharma. Cynical, but then again, since that real estate is empty, why not occupy it? “Big Pharma is attacking President Trump. They liked it better with Joe Biden when healthcare costs SKYROCKETED.” GOP ads use the term “Big Pharma”—did anyone hear that phrase at the DNC?

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Igor Derysh, “Pharma CEOs privately scoff at Trump’s drug pricing orders: ‘Not expecting any impact,’” Salon, Aug 5, 2020

“Largely symbolic moves.” But the industry makes a big show of opposition to Trump’s publicity stunts.

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Dean Baker, “The burden of the debt: Lessons for Biden adviser Ted Kaufman,” CEPR, Aug 20, 2020

A Biden insider says the new prez will have to worry about the deficit rather than the nation’s needs: a good indication of where the incoming admin’s priorities will lie (i.e., no new programs that cost money). “It takes some very deliberate head-in-the-ground economics to argue that we are somehow limited by the size of the government debt.” But Biden, like Obama, may choose to accept what preceded him, not reverse it.

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Jose F. Figueroa, Fabiola Molina & Benjamin D. Sommers, “The Trump administration’s ‘public charge’ rule and Covid-19: bad policy at the worst time,” STAT, Aug 21, 2020

Rates among Hispanics are five times higher than among whites in some areas. Where people are fearful of damaging their citizenship chances, they won’t seek public services. This is not hard. “Few of their jobs provide adequate—if any—paid leave. What’s more, immigrants often live in multi-generational households, with larger household sizes and in close quarters.” Viruses don’t know from visas or passports.

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Marisa K. Dowling, Janice Blanchard & Jennifer Lee, “Medicaid expansion is the shot in the arm America needs,” The Hill, Aug 19, 2020

“Medicaid expansion is having a moment.” Two red states voted to expand it despite kicking and screaming from Republican state leaders. Four more states may see votes in the future as a result of grassroots efforts.

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Lucien Bruggeman, Olivia Rubin & Matthew Mosk, “Health care execs have made millions during COVID, more scrutiny needed: Critics," ABC News, Aug 5, 2020

Suspicious stock trades precede major announcements.

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Margaret A. Murray, “Short-term health plans are a threat, not a victory, for sick patients,” The Hill, Aug 3

Equivalent of a degree from Trump University.

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Nik DeCosta-Klipa, “Ed Markey and Joe Kennedy spar over who has led fight for Medicare-For-All,” Boston.com, Aug 12, 2020

Irony alert: which of us two was faster to jump aboard M4A? Will the primary contest winner be quite as insistent in the general? Neither one has been consistent.

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Reid Wilson, “Dozens of public health officials are quitting during pandemic,” The Hill, Aug 17, 2020

State and local leaders, imitating Trump, politicize the epidemic, blame the messenger, fail to protect scientists from armed threats by psychos, etc. Who needs it? Incompetent toadies then step in. “Almost 50 state and local health officials have resigned, retired or been fired since April.” Just wait until the vaccine is ready.

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Paige Winfield Cunningham, “The pandemic has closed the window for fixing the drug pricing system in 2020,” Washington Post, Jul 29, 2020

No movement likely on drug pricing despite the arm-waving by Trump. Democrat Neal blocked a fairly decent measure from Grassley (R). “Lobbyists and advocates acknowledge drug pricing legislation has sunk low on the list of priorities for lawmakers, even after momentum seemed to be building during this election year.”

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Adam Ramsay & Seth Thévoz, “Deloitte gets another huge COVID contract—for ‘crazy’ plan to test millions each day,” Open Democracy, Aug 21, 2020

Britain’s Tory government shovels COVID cash to the private sector. “Civil servants greeted the scheme with widespread incredulity, given the government's previous record on testing and tracing.”

*

Thomas Frank, “It’s the healthcare system, stupid,” Le Monde Diplomatique, Aug 2020

“Though much of this catastrophe of over 170,000 dead can be laid at Trump’s door, some of it has to do with the uniquely awful American system of for-profit health care. It is the healthcare system, not Trump, that routinely denies people treatment if they lack insurance; that bankrupts people for ordinary therapies; that strips people of their coverage when they lose their jobs.” Frank dismantles the Them-stupid/Us-smart anti-populist paradigm, well worth a read.

Posted Aug 17, 2020

Kurt Erickson, “Missouri voters narrowly approve Medicaid expansion,” St Louis Post-Dispatch, Aug 5, 2020,

Check out the interactive map showing overwhelming opposition from the rural counties—where hospitals are closing down in bankruptcy—while the major cities backed the measure by equally huge margins. (Some suburbs were marginally supportive as well.) A stark view of the increasingly polarized politics of everything. Missouri is #5 of red states that bucked their GOP leadership on expansion (the others are Idaho, Utah, Oklahoma, and Nebraska). Also Maine, not red but led for years by a tutti-frutti governor.

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E.J. Dionne Jr., “Missouri shows us a lot about health care,” Washington Post [opinion], Aug 5, 2020

“They tried to rig the timing of the referendum by forcing the vote during a relatively low-turnout primary on Tuesday rather than in November. That failed. They played on racial prejudice and nativism by falsely claiming a yes vote would mean ‘illegal immigrants flooding Missouri hospitals . . . while we pay for it!’ That failed, too.” If other red states could vote on expansion, they’d probably pass it as well.

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Andrew Perez & David Sirota, “Dems begin signaling a post-election surrender on health care,” TMI, Aug 17, 2020

“The Partnership for America’s Health Care Future (PAHCF) announced on Friday that it is launching a new national ad campaign to persuade Democrats to abandon their plans to create a public health insurance plan.” That didn’t take long once M4A was taken off the table by the Biden camp. Recall that the “centrists” insisted that the public option was the more reasonable, practical, doable, gradualist, step-by-step way to get to universal coverage. “[Biden] aides quickly start promising a retreat after the health care industry begins attacks.” Just as in 2008-09, the “public option” only surfaces to deflect interest away from M4A, then is quickly buried to keep the insurance moguls happy and those campaign contributions rolling in.

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Peter Sullivan, “Health care industry launches new ads against public option for convention,” The Hill, Aug 14, 2020

One of the industry’s ads says, “They make it sound great, but here’s what they don’t tell you: Your taxes would pay for a public option.” The tax boogeyman.

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Joyce Frieden, “Medicare for All a sore point for some Democratic convention delegates,” MedPage Today, Aug 13, 2020

Platform language is pretty meaningless, but the Dems used to include a nod to a universal extension of Medicare. No longer. The new hedge is formal support for a “public option”—which was just jettisoned in backroom conversations as the convention is set to begin. There could be a substantial “No” vote on the platform language.

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Walker Bragman, “How the pandemic humiliated critics of Medicare for All,” TMI, Aug 13, 2020

Recalls that in March anti-M4A politicians pointed at the pandemic’s onslaught in single-payer countries like Italy as evidence we shouldn’t go that route. Not an argument you hear much today. Here’s Joe Biden at the March debate: “With all due respect for Medicare for all, you have a single-payer system in Italy. It doesn’t work there. That would not solve the problem at all.”

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Joshua Cohen, “Biden’s Medicare for More: Not radical, but feasible,” Tarbell [opinion], Jul 16, 2020

A friendly commentary on the Biden plan for “building incrementally on the existing framework of both the Medicare program and the Affordable Care Act (ACA).” This is the Medicare buy-in, which is short of the now-abandoned “public option” and which probably will not survive much longer either.

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Libby Watson, “The deadly coronavirus vaccine gold rush,” New Republic, Aug 7, 2020

Trump wants a vaccine for political reasons; Pharma wants it for profit reasons; people want it to get their lives back. What about safety? “Over the last 20 years, a number of high-profile cases has revealed how Big Pharma hides data that wouldn’t support the approval of their drugs or even data that would reveal the drugs were dangerous.” Also, what happens to those hefty stock prices if a company has to admit its vaccine is a flop?

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Donald Shaw, “Hospitals bankroll the Democrat who lets them send patients surprise bills,” TMI/Sludge, Aug 12, 2020  

Richard Neal (D-Hospitals) is getting megabucks from the industry to block legislation on “surprise” medical bills and to thwart Medicare for All. A rare bipartisan consensus was forming on surprise billing action until Neal blew the whole thing up earlier this year. [Not in the article: Neal is facing a tough challenge from the 30-year-old mayor of Holyoke who was just smeared in a homophobic campaign launched by the college Young Democrats. It may have backfired.]

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David P. Fidler, “Vaccine nationalism's politics,” Science [editorial], Aug 14, 2020 - 369(6505): 749

We once had fairly good international cooperation on global health threats. Now it’s politicized and devil-take-the-hindmost as the rich countries muscle others aside. “Perhaps the mounting desperation for scientists to deliver a vaccine against COVID-19 will provide an incentive for leaders to rebuild health policies sufficiently so that, when the next pandemic hits, politicians and citizens will be less likely to drink the hydroxychloroquine.”

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Valerie Bauman & Susan Decker, “Virus vaccine rush leaves little recourse for anyone it harms,” Bloomberg Law, Aug. 14, 2020

“Americans who suffer adverse reactions to coronavirus vaccines that the U.S. is racing to develop will have a hard time getting compensated for injuries from the drugs.” The Pharma companies will be exempt from liability. Meanwhile, will Trump confront the anti-vaxxers? Or once in opposition, pump them up?

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Alex Fitzpatrick, “Why the U.S. is losing the war on COVID-19,” Time, Aug 13, 2020

Why are we stuck with an out-of-control epidemic while similar countries bring it under control? The author lists several factors but leaves out the impact of a fractured, privatized health system. Blaming “cultural attitudes about individuality” is a cop-out. Our “willingness to accept mass death as an unavoidable part of everyday life” is closer to the mark.

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Rebecca Robbins, “Teladoc Health reaches agreement to buy Livongo in a $18.5 billion deal,” STAT, Aug 5, 2020

More consolidation in the healthcare industry, this time merging two virtual medicine giants. The Teledoc boss told the reporter, “It became very clear that we were either going to team up to create the greatest virtual care platform on the market, or we were going to end up competing with each other.” Competition, can’t have that!

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Lev Facher, “Pharma is showering Congress with cash, even as drug makers race to fight the coronavirus,” STAT, Aug 10, 2020

“Barrage of contributions”—over $10 million so far, which in comparison with the potential pay-off in treatment/vaccine revenue = couch lint. *

Posted Aug 5, 2020

Marshall Allen, “How a $175 COVID-19 test led to $2,479 in charges,” ProPublica/Texas Tribune, Aug. 1, 2020

Another hidden charge: the “facility fee.” While waiting for her $175 drive-in COVID test, a lawyer read that the clinic’s facility fee could be “between $500 and $100,000” while an additional “observation fee” could double that. Another patient was charged $2,479 for a three-minute test. Part of the testing debacle that goes beyond Trump’s feckless indifference. As usual, people have no idea what anything in healthcare costs.

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Katie Moore & Matthew Kelly, “Missouri got millions to fight COVID-19, but 50 health agencies haven’t seen a penny,” Kansas City Star, Aug 2, 2020

Ideological wack-a-doodle: county officials block public health money while high on the anti-shutdown Kool-Aid. “Of Missouri’s 114 counties, only 17 local health agencies reported receiving aid. Thirteen said they did not apply for funds.” Some sent the money back. How will they respond to an eventual vaccine? No contact tracing for rural Missouri, which has the second highest COVID increase rate in the country, but a Missouri cruise company got $226,000.

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Emma Court, “U.S. created a data disaster with its uneven Covid response,” Bloomberg, Jul 29, 2020

“Fifty states find almost as many approaches to Covid counts.” State-based data collection reflects lack of interest in public health. Gathering of billing data, however, is highly developed throughout the healthcare system.

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Rupert Neate, “‘Major’ breakthrough in Covid-19 drug makes UK professors millionaires,” The Guardian, Jul 24, 2020

At least here the actual researchers are getting the payout, not C-suite MBA weenies. And the treatment looks promising. “Imagine if we had done this work five years earlier, this drug could have been stockpiled by governments,” Marsden said. Yeah.

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Akela Lacy, “ALEC develops bill for corporate liability protections amid pandemic,” The Intercept, Jul 21, 2020

The Koch network is hard at work making sure corporations can endanger workers with impunity. If the federal liability waiver doesn’t make it through Congress, ALEC will turn its attention to more malleable state legislatures. North Carolina, Oklahoma, Wyoming, and Utah have already acquiesced.

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The Lancet, “The truth is out there, somewhere,” [editorial], Aug 1, 2020, 396(1): 291

Short and fascinating: infodemic, “an overabundance of information—some accurate and some not—that makes it harder for people to find trustworthy sources and reliable guidance when needed.” According to the authors, an infodemic does not merely spring up at critical moments but is manipulated by commercial, corporate, and/or political interests, using techniques originally developed by the tobacco industry. To combat it requires strategic action by behavioral scientists and communications specialists, backed by a strong public health sector. Fractured, weak states facing fiscal crises are no match for these well-funded campaigns.

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Igor Derysh, “Kentucky Gov. Andy Beshear wants to give black residents health coverage,” Truthout, Jul 18, 2020

Using emergency measures that, unfortunately, will expire though Medicaid expansion has helped. “I believe that there is a health care product, whether it’s public or private, that everyone qualifies for,” Beshear said. “Qualifies for” does not = “can afford.” Also, KY is home to 930,000 people laid off from their jobs and faces a $1 billion budget gap. How far can Medicaid fill the gap under those conditions?

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Sen. Chuck Grassley & Sen. Martha McSally, “Coronavirus pandemic has accelerated need to cut drug prices,” Fox News, July 28, 2020

“The clock is ticking for policymakers to fix what’s broken in America’s drug pricing system. The current structure is riddled with rebates and incentives that allow middlemen and Big Pharma to game the system and pad their profits, often at taxpayer expense.” Tough rhetoric from corporate-friendly GOP senators and on Fox, no less.

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Jake Johnson, “‘History will not judge this kindly’: DNC platform committee votes down Medicare for All amendment,” CommonDreams, Jul 28, 2020

“It’s like opposing the New Deal during the Great Depression.” They also voted against reducing the Medicare eligibility age to 55. Even though party platforms are promptly ignored by those in power, the 125-36 snub is breathtaking.

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Sarah Owermohle, “Vaccine distribution will be ‘joint venture’ between CDC and Pentagon,” Politico, Jul 30, 2020

For the next chapter, let’s invent a whole new distribution bureaucracy! The CDC, now a smoking ruin, used to run a centralized ordering system for state and local officials. “Pentagon chief spokesperson Jonathan Hoffman told reporters that distribution would be ‘a collaborative process’ between the private sector and the military.” Oh, okay.

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Sharon LaFraniere, Katie Thomas, Noah Weiland, Peter Baker & Annie Karni, “Scientists worry about political influence over Coronavirus vaccine project,” New York Times, Aug. 2, 2020

“Under constant pressure from a White House anxious for good news and a public desperate for a silver bullet to end the crisis, the government’s researchers are fearful of political intervention in the coming months and are struggling to ensure that the government maintains the right balance between speed and rigorous regulation.” Anyone who thinks regulators will resist Trump’s order to proceed has not been paying attention. The decision-makers are intimately tied to the companies set to make billions on the vaccine candidates. Past behavior is the key to future action.

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Michael S. Kinch, “A Covid-19 vaccine, amazingly, is close. Why am I so worried?” STAT, Jul 31, 2020

“Hey, Food and Drug Administration: Don’t be rash! Premature approval of a sub-standard Covid-19 vaccine could have dire implications, and it could harm public health for years, if not generations, to come. The FDA and its staff of chronically overworked and underappreciated regulators will face enormous public and political pressure to approve a vaccine. Some will stand firm. Some may resign in protest. But others could break and allow a bad vaccine to be released.” “Bad” as in not effective enough or with side effects that aren’t immediately obvious. Given the level of anti-vax fanaticism in this country, he isn’t exaggerating. We risk not just COVID but also polio, measles, mumps, rubella, diphtheria, whooping cough, and tetanus. Some of us remember thalidomide.

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Lev Facher, “Following court ruling, NIH warns drug and device companies to post missing trial data,” STAT, Aug 4, 2020

Good news (sorta): in theory, drug makers will have to cough up the hidden data that don’t support their claims or that suggest safety issues. And now, enforcement, anyone? “Federal research agencies routinely fail to enforce their own rules regarding clinical trial transparency. The FDA has never imposed a fine on a clinical trial’s sponsor, and the NIH has never withheld grant funding [for violations].”

Posted Jul 29, 2020

Ted M. Burns, Gordon Smith & Jason L. Crowell, “‘How painful is the cost of your health care?’ The case for a new vital sign,” STAT, Jul 23, 2020

“On a scale of 0 to 10, how painful is the cost of your health care?” Brilliant! The authors argue that it is providers’ responsibility to ask patients how the cost of their care is going to affect their well-being. Of course, that implies that the MDs and nurses know or want to find out—which they often don’t. “High costs can also directly compromise health, such as splitting pills or skipping doses, abandoning prescriptions, missing clinic visits, and making more trips to the emergency department. These can prevent optimal care and make future health complications — and expenses — more likely. They can also require hospitalization and sometimes lead to premature death, for which the literal and figurative price tags are impossible to gauge.” Completely redefines the doctor-patient-healthcare industrial complex relationship.

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Sarah Owermohle, Adam Cancryn & Susannah Luthi, “Trump signs limited drug pricing orders after last-minute debate,” Politico, Jul 24, 2020

Trump brags that his orders “completely restructure” the market for prescription drugs. Others say the ambitious plans are “rife with limitations.” Most if not all of the measures won’t take effect until after November. But it’s all confusing enough to make for good campaign propaganda, especially as the industry immediately attacked him [see below]. And Biden is vulnerable as the Democrats also have done nothing.

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Alex Gangitano, “Group launches ad against potential White House plan to address drug prices through international price indexing,” The Hill, Jul 24, 2020

Major boo-hoo from Pharma over the threat to “innovation” and new cures, that old industry talking point. But even Trump’s disorganized and lame proposals have to be knocked out quickly before anyone gets ideas.

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Helen Branswell, “Confusion spreads over system to determine priority access to Covid-19 vaccines,” STAT, Jul 22, 2020

Who is first in line to get the vaccine? Making things complicated and dysfunctional will facilitate corruption and influence-peddling, or as one expert said, “We’ve just assigned four different air traffic control towers to land the same plane.”

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Hannah Denham & Carolyn Y. Johnson, “Pfizer, BioNTech reach $1.95 billion covid-19 vaccine deal with U.S. government,” Washington Post, Jul 22, 2020

More federal largesse to drug-makers who haven’t created a workable product yet (but will insist on their exclusive ownership if they find one). Also: Peter Lurie, president of the Center for Science in the Public Interest, says: “Certain rich countries are snapping up the candidate vaccines.” What are the chances that people in Iran or Venezuela will get doses? “Pfizer stock jumped 5.1 percent on the news, closing Wednesday at $38.56. BioNTech soared 13.7 percent, to $104.17 a share.”

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Hamza Shaban, “Novavax executives stand to collect millions even if Covid-19 vaccine doesn’t work,” Washington Post, Jul 22, 2020

“Stock options earmarked for CEO Stanley Erck and three other company officials are worth more than $100 million based on Tuesday’s closing stock price.” Novavax shares are priced 31 times higher than in January.

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Elisabeth Rosenthal, “Analysis: How a COVID-19 vaccine could cost Americans dearly," Kaiser Health News, Jul 8, 2020

“If a COVID-19 vaccine yields a price of, say, $500 a course, vaccinating the entire population would bring a company over $150 billion, almost all of it profit.” The 1950s polio vaccine was provided free by March of Dimes, but that was “before health insurance for outpatient care was common, before new drugs were protected by multiple patents, before medical research was regarded as a way to become rich.”

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Wendell Potter, “The rigged game of private health insurance,” Potter Report, Jul 24, 2020

Insurance companies launched a battle to stop Connecticut from protecting a small percentage of poorly insured insulin users. “One of the things health insurance lobbyists will not admit is that health insurance executives and their shareholders actually benefit from rising health care costs. Higher premiums translate into higher revenues, meaning there is more money available to convert to profits and reward shareholders.” Potter, who used to be a PR shill for CIGNA, knows whereof he speaks.

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David U. Himmelstein & Steffie Woolhandler, “Health insurance status and risk factors for poor outcomes with COVID-19 among U.S. health care workers: A cross-sectional study,” STAT, Apr 28, 2020

“Our data indicate that millions of health workers likely to be exposed to SARS–CoV-2 have medical conditions that increase their risk for poor COVID-19 outcomes. Many lack health insurance and paid sick leave, and more than 600,000 live in poverty, potentially compromising their ability to maintain social distancing outside their workplace.” One fun fact: Among health care personnel with patient contact, an estimated 28.6% did not have paid sick leave.

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David Shulkin, “Why COVID-19’s biggest impact on healthcare may not be until 2022,” Health Care Dive, Jul 23, 2020

A drop in more lucrative private insurer payments, fiscal pressures on Medicare, and state budget austerity as revenues drop present a tsunami of challenges. Shulkin headed the VA. But he doesn’t realize that Medicare can’t run out of money (or become “insolvent”) because the Federal Government, unlike individual states, issues dollars. If Medicare needs more cash, the Federal Reserve can hit a keystroke on its computer, just as it did for American Airlines.

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Clifford Marks, “America’s looming primary-care crisis,” New Yorker, Jul 25, 2020

What better illustration of our irrational health financing system than the destruction of primary care in the middle of a pandemic? “The way that patients interact with their doctors and the path that American health care takes in the future may be about to shift.” Also discusses the relative merits of fee-for-service versus capitation payment models. Upheavals are opportunities for radical change—such as M4A.

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Julie Appleby, “Pandemic forced insurers to pay for in-home treatments. Will they disappear?” Kaiser Health News, Jun 23, 2020

“The biggest wild card in whether current innovations persist may be how generously insurers decide to cover them. If insurers decide to reimburse telehealth at far less than an in-person visit, that ‘will have a huge impact on continued use,’” said one expert. So our medical care decisions are made by bureaucrats rather than doctors?

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David Sirota, Andrew Perez & Walker Bragman, “Senate GOP copied & pasted Cuomo’s corporate immunity law word-for-word,” TMI, Jul 28, 2020,

Why selfishly hoard a great idea? “While raking in cash from health care industry donors, Senate Republicans copied key parts of New York Gov. Andrew Cuomo’s controversial corporate immunity law and pasted it word-for-word into their new coronavirus relief proposal released on Monday.” No. 1 beneficiary of nursing home industry cash? Mitch McConnell.

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Michael McGough, “Sacramento test centers closing amid case surge,” Sacramento Bee, Jul 7, 2020

County can’t keep the centers operating due to lack of supplies. “Sacramento County is now within a two-plus-week spike of new confirmed coronavirus cases and has seen its hospitalization and intensive care unit numbers soar to unprecedented highs.” Not much contact tracing will be done if no one can get a test.

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Christina Potter, “Zero COVID-19 deaths in Vietnam,” Center for Health Security/Johns Hopkins University, Jul 9, 2020

Amazing how an academic center can lay out with such precision how Vietnam beat COVID-19 without mentioning that they have a single-payer system with no private players. Perhaps they assume that we know that because Vietnam is a socialist country. But the same thing happens in discussions of South Korea or Taiwan, which have modern capitalist economies. The components of Vietnam’s success: preparedness; high priority on public health over economic activity; organized response with participation by armed forces, 11,000 community health centers, and local officials; quick response including airport screenings, school closings, travel restrictions, mandatory quarantine; contact tracing; blanketed mass communications; early lockdowns at outbreak sites. See the full archive at: http://uptownprogressiveaction.org/?page_id=759

Posted Jul 21, 2020

Charles Piller, “Data secrecy is crippling attempts to slow COVID-19’s spread in U.S., epidemiologists warn,” Science, Jul 16, 2020

“In 4 months of the epidemic, collecting millions of records, no one in California or at the CDC has done the basic epidemiology.” But look over here! Chinese and Russian hackers are stealing our for-profit Pharma industry’s federally subsidized data! What if public health, rather than profit, were the guiding principle? NYC publishes detailed data for public use: “Oxiris Barbot, the city’s health commissioner, says the system was crucial in decreasing cases by about 94% and deaths by about 98% since the April peak.”

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Helen Branswell, “Public health group calls for standardized data collection to more clearly track Covid-19,” STAT, Jul 21, 2020

The “critical data” isn’t being collected, so a nonprofit has to pick up the slack from an incompetent, hamstrung federal agency. The NGO is led by former CDC chief Frieden who “acknowledged [that] state officials may have some of the information, but it isn’t being posted because they are afraid to share it for fear of being blamed for the sorry state of the pandemic response.” Politicization, chaos and dysfunction=mass death.

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Nicholas Florko & Eric Boodman, “How HHS’s new hospital data reporting system will actually affect the U.S. Covid-19 response,” STAT, Jul 16, 2020

Just as hospitals are struggling to avoid collapse, here’s a brand-new data system you have to train your staff to use. Profit motives? Perish the very thought! “It’s too early to tell how big of a deal this is,” said John Auerbach, president and CEO of Trust for America’s Health. No, it isn’t. Trump made it clear he wants to suppress the true numbers for political gain—fewer public data, more opportunity to get away with it. “The move comes just days after the president and vice president both openly pressured the CDC to rewrite its guidelines for safely reopening schools, and news broke that a top HHS official had attacked the CDC for releasing a report on how Covid-19 impacts pregnant women.”

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Libby Watson, “The Democrats’ baffling silence as millions of Americans lose their health insurance,” New Republic, Jul 16, 2020

“Months into the pandemic, the twin crises of Covid-19 and gaps in insurance are compounding each other.” Good point: job loss creates uninsured; uninsured create disease vectors; disease vectors increase COVID-19; increased COVID-19 creates job loss. “Once a government gets used to a situation where tens of millions of people don’t have health insurance, how do we get our leaders to care when another five or 10 million are added to that number?”

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Mike the Mad Biologist, “Think tank gap really hurt our COVID-19 response,” Jul 2, 2020

MMB postulates that no one in the think tank world could formulate a truly workable CV-19 plan because they are all ideologically straitjacketed. It would include: “rent and mortgage suspension, for businesses and residents; temporary universal healthcare coverage, including for those who lost their jobs; significant income supplements for households; mandatory sick leave.” Failing that, he says, we stumble around with zigzagging shutdowns that won’t work.

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Dara Lind, “Hospitals are suddenly short of young doctors—because of Trump’s visa ban,” ProPublica, July 17, 2020

Yes, Trump’s usual blunderbuss approach to all things immigration. However, the larger issue is why doctors get protectionism while factory workers have to compete against sweatshops in Honduras and Bangladesh.

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Wendell Potter, “The Potter Report,” Tarbell, Jun 30, 2020

Why U.S. docs burn out so quickly and the looming doctor shortage: “Physician burnout has reached such proportions among American doctors that researchers are now using a term that comes from war: ‘moral injury.’ Physicians know how to best care for their patients but are blocked from doing so by systemic barriers related to the business side of health care.”

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Li Tso, “How I changed my mind on ‘Medicare For All,’” The Hill, Jul 14, 2020 

“Universal coverage was once championed only by the most progressive. Then came COVID-19. Universal coverage is no longer charity or a luxury, it’s now medically necessary as protection for us all.” Tso, Harvard professor and MD, marshals the arguments in a compelling way. Welcome, prodigal son. Slay the fatted calf!

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Bob Herman, “UnitedHealth posts most profitable quarter in its history,” STAT, Jul 15, 2020

“Health insurers heavily benefited as people held off on going to the doctor or hospital, resulting in fewer medical claims that needed to be paid.” The medical loss ratio at UH fell to 70.2%, ten points below that legally mandated by the ACA. Will there be any enforcement?

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Susannah Luthi & Roubein, “‘Surprise’ billing fix likely out of next Covid-19 package as fight over tests play out,” Politico, Jul 20, 2020

Because of meanie Republicans? Yes, and also Richard Neal (D-Health Industry), who kiboshed the last attempt. However, “Neal, a 30-year veteran of Congress, is facing a tough primary challenge from progressive Alex Morse, the mayor of Holyoke, Mass., who has showcased the issue since Neal weighed in and blocked Congress from passing reforms late last year.” Pray for rain.

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Elliot Smith, “British pharma firm claims small trial on a coronavirus treatment could signal ‘major breakthrough,’” CNBC, Jul 20, 2020

COVID-19 profiteering in five easy steps: (1) Issue a press release touting a favorable, cherry-picked statistic about your drug’s “efficacy”; (2) withhold the data and avoid peer review; (3) get coverage in the business press; (4) watch stock price hit the ionosphere; (5) exercise stock options. Rinse and repeat. “The study has not yet been published in a peer-reviewed journal and has not released the full data.”

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Babu Aakash, “Synairgen shares soar as drug shows lower risk of severe COVID-19 cases,” Reuters, Jul 20, 2020

Shares up 600% on Monday. Too easy.

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Sam Metz, “Nevada passes cuts to health care, education, amid pandemic,” Associated Press, Jul 19, 2020

“Immense” cuts—sign of what’s to come for states and cities if the feds do not share revenue.

Posted Jul 17, 2020

This is an unusual digest as it is comprised of a single, long-form article. I believe it merits your time and attention. While I cannot vouch for the accuracy of all its assertions—nor is it directly related to single-payer healthcare financing—I believe it is crucial for understanding where the debate over single-payer may well go in the future under a Biden Administration.

In summary, the authors accuse Gates and the Gates Foundation of: taking over the World Health Organisation and setting its agenda through its massive donations (even more important with the U.S. pullout); colluding with corporate agricultural interests to foist a new version of the “green revolution” on developing countries; using poor Asians and Africans as drug-test guinea pigs without their informed consent; pushing harmful vaccines no longer permitted in the U.S.; pushing contraceptives banned elsewhere like Norplant and Devo-Provera on Third World women; and setting up the entire world for COVID-19 vaccination schemes using inadequately vetted molecules while Gates’ Pharma partners cash in (and recycle profits back to . . . the Gates Foundation, which is a major shareholder). It’s a heady list and deserves a hearing. At the very least, the article illustrates some of the dangers of entrusting public policy to individuals whose wealth is larger than most countries’ GDP.

Incidentally (or not), the authors point out that the Gates Foundation’s largesse to media outlets “has meant that scrutiny of the billionaire and his machinations is increasingly prevalent on the far-right of the political spectrum.” Doesn’t mean they’re automatically wrong.

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Jeremy Loffredo and Michele Greenstein, “Why the Bill Gates global health empire promises more empire and less public health," The Grayzone, Jul 8, 2020

“Behind a veil of corporate media PR, the Gates Foundation has served as a vehicle for Western capital while exploiting the Global South as a human laboratory. The coronavirus pandemic is likely to intensify this disturbing agenda.”

Posted Jul 15, 2020

Natalie Shure, “What’s missing from the Biden-Bernie task force Plan? Medicare for All,” In These Times, Jul 9, 2020

Democratic Party unity stops short of Bernie’s core issue, endorsing instead “Medicare for COVID,” i.e., temporary, CV-19-related emergency measures. Oh, and the inevitable “public option” reappeared, as always happens when M4A gains momentum, then fades away once that danger is past. More interesting: proposals to lower Medicare age eligibility from 65 to 60 and to create waivers for state single-payer programs. While Biden seeks “bipartisan compromise,” opposition from the industry and bipartisan corporate toadies will be as furious as ever.

*

Susannah Luthi & Alice Miranda Ollstein, “How Democrats tack to center with election year health care bill,” Politico, Jun 23, 2020

In a new virtue-signaling exercise, Pelosi asks for even less: no public option, no expansion of Medicare. Admits it’s all for show since the Republican-controlled Senate will immediately toss it.

*

Dave Lindorff, “Big win for Medicaid expansion in Oklahoma referendum,” Tarbell, Jul 7, 2020

Finally, some good news, despite “major out-of-state funding for the opposition [Koch brothers].” Razor-thin margin of 50.48% to 49.52% to raise the eligibility level from starvation levels to the merely underfed: $17,236 for individuals and $35,535 for a four-member family. Total no-brainer to treat more people in the midst of a pandemic, but the state GOP leadership was agin’ it despite the ongoing, severe threat to rural hospitals of uncompensated care. Next fight: get it implemented. Interesting details on the enormous obstacles faced by proponents as the measure had to be a constitutional amendment.

*

Laura Santhanam, “These countries tamed Coronavirus. Here’s what the U.S. can learn,” PBS NewsHour, Jul 9, 2020

Three lessons: clear, consistent messaging; massive mask use; contact tracing. Never mentioned by anyone (including this author): all the successful countries have universal coverage with single-payer financing systems. That lesson apparently is too advanced.

*

Damian Garde & Adam Feuerstein, “Inovio claims positive results on Covid-19 vaccine but key data are missing,” STAT, Jun 30, 2020

More science-by-press-release, producing not much science but lots of juice for Pharma stocks. Curiously, the news leak didn’t work in this case: the stock dropped 13%, probably because analysts could see through the hype.

*

[No byline] “US grants Novavax $1.6 billion for vaccine orders,” Industry Week, Jul 7, 2020

Nice work if you can get it: big bucks for untested vaccine candidates. Other beneficiaries of “Operation Warp Speed” include: Johnson & Johnson, $456 million; Moderna, $486 million; AstraZeneca/Oxford University, $1.2 billion. Pfizer Inc. and Merck & Co. are also in the soup line. “Novavax stock traded below $5 in January, now has shot up to $100 in the hours after last week’s announcement.”

*

Yves Smith, “Big Pharma wants to pocket the profits from a COVID treatment you already paid for,” Naked Capitalism, Jul 9, 2020

In general, public money covers 30% of drug research; in remdevisir’s case the figure is probably closer to 80%. “We identified 6,567 research publications including 1,263 that had received NIH support totaling $1.9 billion, as well as 11,073 research publications on [a related protein], including 2,319 with NIH support totaling $4.6 billion.” Patent law protects Gilead’s, but not the public’s, contribution.

*

Melissa Repko, “Walgreens strikes deal with primary-care company to open doctor offices in hundreds of drugstores," CNBC, Jul 8, 2020

A new model of for-profit care tied to a major pharmacy chain: what could go wrong? Walgreens now joins Walmart Health and CVS/Aetna’s HealthHUB stores to monetize primary care. “Walgreens co-Chief Operating Officer Alex Gourlay pointed to the 6 in 10 Americans who live with at least one chronic condition that requires multiple daily medications.” Ergo, ample growth opportunities! And one-stop shopping!

*

J. David McSwane, “You can make millions selling masks to the government in three easy steps,” ProPublica, Jul 11, 2020

Another opportunity for massive grift, the “coronavirus mask trade.” Inflating the cost of supplies bought with government money on no-bid contracts is one of the oldest scams around, worthy of kleptocracies the world over. Nice to be joining the ranks of Bolivia, Azerbaijan, and Nigeria.

*

Gretchen Morgenson and Kit Ramgopal, “It was his dream job. He never thought he'd be bribing doctors and wearing a wire for the feds” NBC News, Jul 7, 2020

Grotesque corruption, a huge fine ($678 million), but not a single criminal charge on either company execs or the tens of thousands of MDs found with their hands held out. Are kickbacks not felonies? Abundance of gory details, e.g., “In Rockford, Illinois, Novartis held 124 speaker programs over eight years with the same 10 doctors, or a subset, as the only people attending. Novartis paid one doctor to speak at 102 of the events.” No wonder medicine costs a fortune.

*

Markian Hawryluk, “Colorado, like other states, trims health programs amid health crisis,” Kaiser Health News, Jul 10, 2020

States left to twist in the wind as their revenue streams implode. Especially hard-hit: mental health and Medicaid expansion: “Colorado had to defer plans for a public health insurance option for people buying insurance on their own.”

*

David S. Levine, “Covid-19 should spark a reexamination of trade secrets’ stranglehold on information,” STAT, Jul 10, 2020

Interesting discussion about what should be shielded for commercial and research purposes versus what should be in the public domain during a worldwide crisis. For example, finding out a particular line of inquiry doesn’t work should be shared freely. Others things might be allowed to stay private to encourage more study. However, while our entire healthcare system is locked up by for-profit interests, we can’t even start the debate.

*

Stan Dorn, “The COVID-19 pandemic and resulting economic crash have caused the greatest health insurance losses in American history,” Families USA, Jul 13, 2020

Not exactly news but here are the numbers: 5.4 million laid-off workers became uninsured, surpassing 2008-09 when 3.9 million nonelderly adults became uninsured. “Nevertheless, no federal COVID-19 legislation signed into law has attempted to restore or preserve comprehensive health insurance.” Nearly half (46%) of the increases occurred in five states: California, Texas, Florida, New York, and North Carolina.

In eight states 20% or more of adults are now uninsured: Texas (29%); Florida (25%); Oklahoma (24%); Georgia (23%); Mississippi (22%); Nevada (21%); North Carolina (20%); and South Carolina (20%).

Full Families USA report here

Posted Jul 9, 2020

Stephen Nakrosis, “Novartis finalizes $678 million settlement,” MarketWatch, July 1, 2020

DoJ: “Novartis hosted tens of thousands of speaker programs and related events ‘under the guise of providing educational content, when in fact the events served as nothing more than a means to provide bribes to doctors.’ And here I thought bribery was a felony! As usual, there is no hint of anything in the criminal realm in the entire discussion.

*

Zachary Brennan, “Gilead sets price for Covid-19 treatment as HHS secures doses,” MarketWatch, Jun 29, 2020

At $2,340 per patient for a five-day course of treatment for Medicare/Medicaid, and 50% more for the privately insured. We still don’t have solid evidence that it will reduce mortality or accelerate recovery. And no provisions in place for universal access.

*

Jake Johnson, “‘A scandal’: Contracts show Trump giving big Pharma free rein to price gouge taxpayer-funded coronavirus drugs," Common Dreams, Jul 2, 2020

Private agreements with potential producers of vaccines and/or treatment drugs are getting exemption from “reasonable” pricing guidelines and protection from generic competition. Meanwhile, huge government sums flow to the companies to test drugs that may flop.

*

Matthew Herper & Erin Ringlin, “Data show panic and disorganization dominate the study of Covid-19 drugs," STAT, Jul 6, 2020

Researchers have launched 1,200 COVID clinical trials since January, but there is no guiding plan. “It’s a huge amount of wasted effort and wasted energy when actually a bit of coordination and collaboration could go a long way and answer a few questions,” said Martin Landray, a professor of medicine at Oxford University. But the results can be milked in press releases for quick media buzz and a stock price boost.

*

Marc Cooper, “The numbness edition,” Coop Scoop, Jul 7, 2020  

Not directly a single-payer topic, but worth a look for the brutal indictment of systemic breakdown and the chilling future unfolding before us.

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Adam Gaffney, “Bill of health: How market logic hobbles the nation's hospitals," The Baffler, Jul 2020

The logic of organizing healthcare around profit in a health crisis: “Just as we found ourselves feeling busier than ever before, something strange happened to hospitals nationwide: the sector went into free fall. In the first quarter of 2020, spending on health services plunged by 18 percent, sinking gross domestic product with it. The health sector shed some 1.4 million jobs, . . . physicians and nurses, even in Covid-19 hotspots, faced pay cuts and job losses. The U.S. health system was, paradoxically, defunded.” Interesting history of hospital financing going back to the Middle Ages and some key facts about the inequities built into the CARES reimbursement system. Gaffney is president of Physicians for a National Health Program.

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Carmen Forman, “Oklahoma voters approve Medicaid expansion at the ballot box," The Oklahoman, Jul 2, 2020

Another state (the fifth) forced to act by voters after state legislators sat on their hands for a decade. Rural voters rejected it even though their hospitals are failing.

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Sebastien Canderle, “Private equity and the pandemic: Brace for impact. . . investing,” Naked Capitalism, Jul 8, 2020  

“The Covid-19 crisis has given dealmakers another chance to remodel their image as social citizens and actively pursue this market-wide value-signaling trend.” Get ready for more private equity looting under the banner of “impact investing.” PE takeovers are why you might go to an in-network hospital and then get a surprise bill from doctors working for firms like Blackstone or KKR. Next PE targets: dermatologist practices, OB/GYNs, PT, ambulances, mental health practitioners, and even fire departments (!), 4% of which nationwide are privately owned. “Under Warburg’s ownership, Rural/Metro’s fire-fighting unit made it a habit of suing victims, who often had lost their homes in a fire, for unpaid bills.”

Posted Jul 1, 2020

Jake Johnson, “‘Free handout to insurance industry’: Trump Administration tells insurers they don’t have to cover Covid-19 tests for workers,” Common Dreams, Jun 25, 2020

Companies may force you to prove you’re free of COVID, but now your (employment-based) insurance doesn’t have to pay for it. Trump used a loophole to get around a clear congressional provision intended to prevent just this.

*

Lauren Weber et al., “Hollowed out public health system faces more cuts amid virus,” AP/Kaiser Health News, Jun 30, 2020

Utter madness: woefully underfunded public health departments now face cutbacks in the midst of a public health emergency. “State and local government health workers on the ground are sometimes paid so little [that] they qualify for public aid. They track the coronavirus on paper records shared via fax. Working seven-day weeks for months on end, they fear pay freezes, public backlash and even losing their jobs.” Note the mention of major cuts during the Obama Administration. Next up: a sharp drop in childhood vaccinations.

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Dhruv Khullar, “The coronavirus pandemic’s wider health-care crisis,” New Yorker, Jun 29, 2020

“U.S. hospitals are bleeding $50 billion dollars a month during the pandemic. The hundreds of thousands of doctors in independent practice . . . may be forced to shutter their operations or merge them with others.” Or go corporate.

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Editorial, “Trump’s perverse pandemic response has thrown health officials into a vortex of fury,” Washington Post, Jun 27, 2020

“In Orange County, one person suggested that the [facemask] order might make it necessary to invoke Second Amendment rights to bear arms, while another read aloud the home address of the order’s author — the county’s chief health officer.”

*

Dan Goldberg & Alice Miranda Ollstein, “States scramble to contain Covid spikes without enough workers to track outbreaks,” Politico, Jun 28, 2020

“Severe shortages of public health workers to track disease spread helped fuel coronavirus spikes in states like Florida, Texas and Arizona and could make it harder to stamp out new hot spots.” Florida needs 15,000 workers to trace contacts, but only employs 1500. And who wouldn’t want to go door to door in a bright red state to promote actions Trump has denounced?

*

Ed Silverman, “Some Covid-19 trial sponsors never posted other study results in an EU database. Will they hide data again?” STAT, Jun 17, 2020

Pre-listing your study is meant to prevent “publication bias,” or the tendency not to publish results when the drug (or vaccine) doesn’t work. “Failed studies are important for science—though useless to for-profit drug developers.”

*

Ray Moynihan, Helen Macdonald, Lisa Bero & Fiona Godlee, “Commercial influence and covid-19,” The BMJ [Editorial], Jun 24, 2020

The leading British medical journal calls for greater independence from corporate influence over drugs, devices, and tests. “The UK government used ‘commercial confidentiality’ to justify concealing the names of nine covid-19 antibody tests that had been found to be insufficiently accurate. Manufacturers of antibody tests are not allowed to make false claims, but tests do not need to work well to be approved in Europe.” And: “Equally concerning is the release of partial or preliminary findings before peer review—often through commercial press releases—that is distorting public perceptions, ongoing evaluations efforts, and political responses to the pandemic.” Brutal comments on the manipulation of remdesivir studies to boost Gilead’s sales.

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David Sirota, "Gilead is profiteering off a COVID drug we already paid for,” TMI, Jun 30, 2020

“The American public helped finance the development of remdesivir — and will now be charged $3,000 for a treatment that experts say costs less than $10 to produce.” A “reasonable pricing” rule was eliminated by Clinton in the 90s.

*

STAT staff, “Experts are calling for a 9/11-style commission on U.S. coronavirus response. Here’s where it could start,” Jun 29, 2020

Some questions for the investigators: Why did officials from Trump down resist mitigation measures? Why did the country ignore the need for public health infrastructure? Why did Trump downplay the virus even when mass deaths began? How could the CDC testing debacle have occurred? Why was the CDC sidelined, silenced and prohibited from briefing the press? Why was politics put above science? Why were preventive measures watered down, e.g., advice against choral singing in churches? Why were people entering the U.S. from China after the travel ban not screened? Why were advisories for cruise ships and travel held up by HHS? Why did the FDA approve hydroxychloroquine as a treatment with no evidence of efficacy? How did the PPE shortage occur and persist? Why was the rollout of remdesivir bungled? Who decided it was okay to reopen non-essential businesses? Why were we told not to wear masks, then to wear them?

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Theodoric Meyer, “PhRMA’s top communicator, a fierce defender of the industry, leaves for ExxonMobil,” Politico, Jun 12, 2020

From Pharma to heating up the planet, how appropriate.

*

Carl Elliott, “An ethical path to a Covid vaccine,” New Yorker, Jul 2, 2020

Interesting debate on the ethics of performing a “challenge” vaccine study in which healthy subjects would be infected with COVID to see if a vaccine candidate works. Typically, volunteers for such trials are poor and unemployed. What does “informed consent” really mean in such cases? 

*

Abby Goodnough & Reed Abelson, “Obamacare faces unprecedented test as economy sinks” New York Times, Jun 27, 2020

“The law is offering a vast majority of newly unemployed people a path to stopgap health coverage, providing a cushion that did not exist during the last crushing recession — or ever before. But the crisis has also highlighted fundamental weaknesses with its patchwork system — ones magnified by Republican efforts to undermine and dismantle it, but also seized on by some Democrats pushing for a sweeping overhaul.” Revisits well-known shortcomings of the ACA.

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Michael Ollove, “Medicaid rolls surge, adding to budget woes,” Stateline, Jun 16, 2020

Millions of new enrollees combined with massive budget cuts—what could go wrong? GOP-led Congress: let’s wait and watch the economy rebound! States could be forced to cut certain benefits and/or (already low) reimbursement rates.

*

Jaime S. King, “Covid-19 and the need for health care reform,” New England Journal of Medicine, Jun 25, 2020

The editorialist ably criticizes the patchwork nature of our current system, then proposes patchwork reforms to get through the pandemic. Though the suggestions are good ones, the motto of these and similar cautious analyses should be, “Think small.”

*

Nathaniel Weixel, “Short-term health plans leave consumers on the hook for massive medical costs, investigation finds,” The Hill, Jun 25, 2020

Dismantling of Obamacare regs has paved the way for these cheap scam insurance policies.

*

Libby Watson, “The hell that was health care reform,” New Republic, Dec 23, 2019

From last year. “A clear lesson for the future: Passing a bill crafted with industry approval and based on ideas that originated with the Heritage Foundation and Mitt Romney—and then insisting that it’s the most progressive thing since the New Deal and we should all be grateful for it—set the party up for the single-payer movement that’s happening now. If only this had been its intention.” Excellent and a relentless reminder that “improving” the ACA is the position of both right-wing Democrats and the healthcare insurance industry.

Posted Jun 24, 2020

Katie Thomas, “Coronavirus attacks the lungs. A federal agency just halted funding for new lung treatments,” New York Times, Jun 19, 2020

Another politicized decision on how science should proceed: develop vaccines or prophylaxis, dump those already sickened as dead meat. “The new policy highlights how staunchly the Trump administration has placed its bet on vaccines as the way to return American society and the economy to normal in a presidential election year.” This is the same agency that ousted its head in April over Trump’s hydroxychloroquine fetish and objections to insider graft.

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Rachel Weiner & Ariana Eunjung Cha, “Amid threats and political pushback, public health officials are leaving their posts,” Washington Post, Jun 22, 2020

Mass resignations as public health workers receive threats and inadequate protection. “Georgia’s public health director said last month that she receives threats daily and now has an armed escort.”

*

Jake Johnson, “Senators find $14 billion in unspent funds after Trump admits to ordering slowdown in Covid-19 testing,” Common Dreams, Jun 22, 2020

Out of $25 billion authorized. Unspent funds: testing $8 billion; contract tracing $4 billion; uninsured testing $2 billion. Trump said in Tulsa that he doesn’t like too much testing as it finds cases.

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Caroline Chen, “'Fast-tracking'” a coronavirus vaccine sounds great. It’s not that simple,” ProPublica, Jun 17, 2020

The speed-up may entail allowing the vaccine producer to argue that a biomarker (like production of antibodies) is sufficient proxy evidence of efficacy without waiting to see clinical end-points, like whether people don’t get sick. But “immune correlates” like antibodies may or may not predict that the vaccine works. 

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Ed Silverman, “Lawmakers push Covid-19 bills to prevent price gouging, track federal funds used to discover drugs,” STAT, Jun 22, 2020

A new bill “would prohibit drug makers from price gouging and also require all taxpayer-funded Covid-19 research to be recorded in a federal database.” The U.S. government contributed an estimated $70.5 million to work that helped lead to the discovery of remdesivir, now in the hands of Gilead. But such money trails are hard to follow as a lot of the information is concealed as “proprietary” information.

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Peter Walter & R. Dyche Mullins, “To fight Covid-19, open access to scientific publishing,” STAT, Jun 16, 2020

Why is this even a debate?

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Sarah Owermohle, “The ‘biggest challenge’ won’t come until after a coronavirus vaccine is found,” Politico, May 11, 2020

“The nation is already grappling with a shortage of the specialized glass used to make the vials that will store any vaccine. Producing and distributing hundreds of millions of vaccine doses will also require huge quantities of stoppers — which are made by just a handful of companies — as well as needles and refrigeration units. Low stocks of any one of these components could slow future vaccination efforts, much as shortfalls of key chemicals delayed widespread coronavirus testing.”

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David Sirota, “They had the Medicare-for-All money all along,” TMI, Jun 16, 2020

Remember all the somber thumb-sucking about “how to pay for” M4A last winter during the Democrat primary debates? How it would surely entail terrible deficits or politically deadly tax increases on the sainted “middle class”? Then COVID-19 hits, and the Federal Reserve decides to create $2 trillion by, as chair Jerome Powell told Congress, “hitting a button.” Pay-for never came up.

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Topher Spiro, “Emergency health coverage for the unemployed and uninsured in response to the pandemic and economic crisis,” Center for American Progress (CAP), Jun 22, 2020

Good: CAP (conservative Democrat think tank, which “receives undisclosed sums from corporate donors,” including Walmart, CitiGroup, Wells Fargo, Northrop Grumman, America’s Health Insurance Plans, and Eli Lilly) now pushes Medicaid expansion without the usual complex eligibility requirements. Bad: proposes a whole new set of complex eligibility requirements. Summary: corporate Dems cannot resist the logic of single-payer, but will keep trying. However, the movement toward opening up Medicare further is significant from a key anti-M4A player.

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Ariel Hard, “Unemployed Georgians scramble for health insurance in pandemic,” Atlanta Journal-Constitution, Jun 21, 2020

Georgia’s Medicaid rolls have increased by 100,000 to 1.9 million. Meanwhile . . . 

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James Salzer, “Georgia senate backs $2.6 billion in spending cuts on party-line vote,” Atlanta Journal-Constitution, Jun 19, 2020

“Millions of dollars would also be cut from a host of health care programs, forcing staff furloughs in the agency that for the past three months has been fighting the coronavirus pandemic.” Legislators refused to raise tobacco tax to alleviate cuts. And how much did Georgia give up by refusing Medicaid expansion ten years ago? [see below]

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Laura Harker, "Georgia can’t afford to delay Medicaid expansion,” Atlanta Journal-Constitution, Jun 6, 2020

One of 14 remaining non-expansion states, mostly in the south: North and South Carolina, Alabama, Mississippi, Florida, Tennessee, Texas, Oklahoma, and Missouri, as well as Kansas, South Dakota, Wisconsin, and Wyoming. Nebraska adopted the expansion but has not yet put it in practice. “Georgia has already missed out on $21 billion federal health care dollars because of our refusal to expand Medicaid.” (Feds pick up 90% of costs.)

Posted Jun 15, 2020

Dan Goldberg, “Pandemic upends state plans to expand health insurance,” Politico, May 28, 2020

Partial measures would alleviate some suffering but have been derailed by state budget crises (that are just beginning). Public options are toast, and Medicaid expansion in non-expansion states has been postponed. Meanwhile, cuts to Medicaid are on the table as the Federal Government lets states and cities twist in the wind.

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Els Torreele, “Collective intelligence, not market competition, will deliver the best Covid-19 vaccine,” STAT, June 10, 2020

“Science thrives, and technological progress is made, when knowledge is exchanged and shared freely, generating collective intelligence by building on the successes and failures of others in real time instead of through secretive competition. Regrettably, market logic has come to overtake medicinal product innovation, including the unproven premise that competition is an efficient way to advance science and deliver the best solutions for public health.” Even the eventual “winner” obtaining FDA or EU approval may not be the best vaccine to improve global public health.

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Damian Garde, “Moderna executives have cashed out $89M in shares this year, as stock price has soared on vaccine hopes,” STAT, May 27, 2020

And speaking of cooperative science: “The volume and timing might prove alarming to Moderna’s shareholders, especially in light of the company’s May decision to raise more than $1 billion in a stock offering. If Moderna’s early-stage vaccine can one day prevent coronavirus infection and the company’s best days lay ahead, why are insiders selling?” Two top executives now own no shares.

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Eric Lipton, Abby Goodnough, Michael D. Shear, Megan Twohey, Apoorva Mandavilli, Sheri Fink & Mark Walker, “The CDC ‘waited its entire existence for this moment’: What went wrong?” New York Times, Jun 3, 2020

Mega-report on political interference and bureaucratic bumbling that reach Chernobyl levels of criminal incompetence.

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Christopher Rowland, “Hedge fund manager stands to profit on ‘flip’ of taxpayer-funded coronavirus drug,” Washington Post, Jun 11, 2020

“Molecule flipping.”

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Jerri-Lynn Scofield, “States sue drug companies and execs for generic price-fixing: Is the tide turning on willingness to allow big Pharma a get-out-of-jail-free card for its egregious behavior?” Naked Capitalism, Jun 11, 2020

Connecticut-led lawsuit targets 26 companies and 10 individuals covering 80 generic drugs. “Among the records obtained by the States is a two-volume notebook containing the contemporaneous notes of one of the States’ cooperators that memorialized his [price-fixing] discussions during phone calls with competitors and internal company meetings over a period of several years.”

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Michael Stein & Nicole Huberfield, “A straightforward solution to the newly uninsured,” The Hill, Jun 8, 2020

Calls for a speed-up of Medicaid expansion and broadening eligibility but does not question the insurance-based model. “Insurance coverage is the gateway to accessing health care and a backstop for financial, food, and housing stability for individuals, financial support for health care providers, and a source of financial stability for states’ budgets.” Why?

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Jonathan LaMantia, “N.Y. insurers request nearly 12% increase in premiums,” Modern Healthcare, Jun 8, 2020

“Some [New York insurers] cite COVID-19 as necessitating higher premiums in 2021.” So how are you going to pay for that? Will taxes go up on the middle class? [snark alert]

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Sara Hansard, “Covid-19 testing could cost insurers billions of dollars yearly,” Bloomberg Law, Jun 10, 2020  

Diagnostics: $6-25 billion/year; antibody testing: $5-19 billion. Congress has mandated no cost-sharing. “Will taxes go up on the middle class?”

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Dean Baker, "Patents and the pandemic, again,” Patreon, Jun 12, 2020  

Baker has been relentless on this topic for years. In this article, he focused on the higher level of distrust in the science of any eventual candidate given the enormous financial rewards involved and pressure from the White House for approval. Also: “Drugs are expensive because we give drug companies patent monopolies. It seems more than a bit absurd that we make drugs expensive with these monopolies and then struggle to find ways to make them affordable.”

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Danny Westneat, “Seattle coronavirus survivor gets a $1.1 million, 181-page hospital bill,” Seattle Times, Jun 12, 2020

Michael Flor, a COVID-19 patient who unexpectedly did not die, says his heart “almost failed a second time when he got the (181-page) bill.” Total tab: $1,122,501.04. [I love those extra 4 cents!] “I feel guilty about surviving,” he says. “Why did I deserve all this? Looking at the incredible cost of it all definitely adds to that survivor’s guilt.”

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Angela Hart, “At a time of great need, public health lacks ‘lobbying muscle,’” Kaiser Health News, Jun 15, 2020

California faces a $54 billion budget deficit. Private health industry groups, benefiting from the current financing model, have vastly more resources and lobbying clout.

Posted Jun 10, 2020

Helaine Olen, “We’re in a pandemic. Why have we stopped talking about Medicare-for-all?” Washington Post, May 28, 2020

Problems related to how we finance health care haven’t gone away. Some are getting worse, e.g., millions of newly uninsured, no movement on drug prices, bankruptcies among hospitals.

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Martha Bebinger, “Where’s the money? A dispute boils between doctors, hospitals, and health insurers in Massachusetts,” WBUR, May 8, 2020

“It looks like everyone in health care is taking a huge hit during the pandemic — except health insurers. “They are still getting all of those monthly fees and then people are avoiding coming in at all cost.” See below. And P.S. “A dispute boils among (not between) doctors, etc. . .” Important because it’s a three-way.

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Dan Weissmann, “‘An arm and a leg’: Health care takes a financial hit in the midst of pandemic,” Kaiser Health News, May 11, 2020

An 18-minute podcast laying out how fully half of the spike in unemployment is due to the layoff of health-related workers, another crazy phenomenon of our payment system. Fun fact: one of every five primary care practices could be forced to close post-COVID.

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Sarah Owermohle, “The ‘biggest challenge’ won’t come until after a coronavirus vaccine is found,” Politico, May 11, 2020

Why merely discovering a workable COVID vaccine is only the first step: “Potentially making it even harder is that the U.S. is striking out on its own. The administration has snubbed an international collaboration spearheaded by the World Health Organization.”

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Greg Myre, “In the battle against COVID-19, a risk of ‘vaccine nationalism,’” NPR, May 27, 2020

The author sets up an equivalency between the U.S. and China as “competitors” while eliding the fact that one of the two is refusing international cooperation. In the middle of the article, we get this pop-up headline: “U.S. officials: Beware of China and others trying to steal COVID-19 research,” along with quotes from military/spook types about nefarious Chinese behavior. Of course, if the research were in the public domain and shared out of global solidarity, no one would have to “steal” anything. “It’s set up to be a massive geopolitical battle,” says one of the author’s sources (note the passive voice, removing human agency). Yes, if you are determined to approach it that way. “Greg Myre is an NPR national security correspondent.”

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Ed Silverman, “Pharma leaders shoot down WHO voluntary pool for patent rights on Covid-19 products,” STAT, May 28, 2020

Big shock: the industry sees mega-profits, not a shared, worldwide emergency. But happy to take hundreds of millions in public funds. “They want to seize our patents!” is the bad-faith argument.

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Tom Bergin & Lawrence Delevingne, “Exclusive: U.S. taxpayers’ virus relief went to firms that avoided U.S. taxes,” Reuters, May 28, 2020

Book the profits overseas, but when the company needs to socialize losses, ask for cash from the United States, not the Cayman Islands. White-collar looting, all perfectly legal.

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Jan Schakowsky & Francis Rooney, “Coronavirus treatments and vaccines will only work if they are affordable,” Newsweek, Jun 2, 2020

Does the title of this article tell us something that would escape a child? Hundreds of millions of people would have to get an injection, so if we make it expensive, what will happen? “As the global search for a COVID-19 vaccine continues, the American public has good reason to be skeptical that pharmaceutical corporations will be our saviors.” The authors are representatives in Congress, and Schakowsky is the one who keeps asking Trump officials to assure her people will be able to buy the vaccine. (They don’t). She has introduced a bill to mandate this, but her colleagues did not make it a condition of signing off on vaccine grants to Moderna Therapeutics ($430 million) and Johnson & Johnson ($456 million). As usual, Dems pretend to be helpless and fall back on rhetorical gestures.

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Susannah Luthi, “The $7,000 Covid test: Why states are stepping in to shield consumers,” Politico, Jun 8, 2020

Wild West billing practices. “In Oklahoma, health plans received 175 out-of-network claims for coronavirus tests over a single week that ranged from $153 to $2,315 per test.” No logic, no consistency, no one in charge.

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Vincent J. Rogusky, “Time to reform the prior authorization process of health insurance companies,” The Hill, May 27, 2020

“The prior authorization process is a lengthy one, in which denials and appeals are often repeated several times for each patient. As one nurse told me, ‘The insurance company fights to deny, we fight for approval, and whoever is left standing at the end of the process wins.’” Under single-payer, treatment restrictions might apply and might even include issues of economy. But the criterion ideally would be medical need and capacity, not automatic denial to increase profit.

Posted Jun 6, 2020

Edward Luce, “Inside Trumps’ coronavirus meltdown,” Financial Times, May 14, 2020 

[no FT paywall on COVID-19 articles] “At some point, Congress is likely to establish a body like the 9/11 Commission to investigate Trump’s handling of the Covid-19 pandemic. The inquiry would find that Trump was warned countless times of the epidemic threat in his presidential daily briefings, by federal scientists, the health secretary Alex Azar, Peter Navarro, his trade adviser, Matt Pottinger, his Asia adviser, by business friends and the world at large.” Devastating details.

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Ady Barkan, “Yes, the government can control the cost of a coronavirus vaccine,” Newsweek, May 7, 2020

“The claim that the U.S. government has no control over drug prices is, simply put, a lie. But it isn't a new lie. It's one that millions of Americans have already been living with for decades. Every day, Americans suffer and die because of our government's refusal to provide for its citizens in the way that every other industrialized nation does—by using its power to regulate pharmaceutical monopolies and patents, stop price gouging and control the prices consumers pay for their drugs.”

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Emmanuel Felton, “They’re working in healthcare during a pandemic. They don’t get health insurance,” Buzzfeed, May 13, 2020

“Roughly 18.5 million people are employed in the US health industry. And nearly 10% of them — 1.7 million — earn so little that they get healthcare through Medicaid. Another 1.4 million have no health insurance at all.”

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Janet Holbrook, “Hogan adds insult to injury with veto of Maryland Drug Affordability Act,” Capital Gazette, May 12, 2020

Hogan is thought to be interested in the 2024 Republican nomination so can’t offend Pharma.

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Julie Rovner, “Sebelius, looking back at ACA, says the country’s never ‘seen this kind of battle,’” Kaiser Health News, Mar 19, 2020

From March, a fascinating interview on the tenth anniversary of the ACA. Sebelius, asked what she would have done differently, says: “Frankly, it probably would have been better to be a government takeover of health care. We got blamed for it. And yet we really didn’t do that. We ran most of this through the private system, so costs are still blossoming out of control.” Great, ten years later they say we were right. Many incredible details of their blind faith in the “bipartisan” ship that never sailed.

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Jake Johnson, "Battle covid-19, not Medicare for All: Doctors demand hospital industry stop funding dark money lobby group," Common Dreams, May 21, 2020

PNHP initiative demanding that the American Hospital Association (AHA) “divest completely from a dark-money lobbying group that has spent millions combating Medicare for All,” referring to the Partnership for America's Health Care Future (PFAHCF). COVID relief funds are pouring into lobbying efforts, e.g., Tenet Healthcare, “an investor-owned hospital company that has donated hundreds of thousands to PFAHCF,” got $345 million in the bailout. Similar pressure got the AMA to drop out.

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Asaree Thaitrakulpanich, “Meet rural health volunteers, the unsung heroes on virus frontline,” Khaosod [Thailand], May 15, 2020  

One million “village health volunteers,” inspired by the (Maoist) barefoot doctor model. Originally designed for low-resource environments, it might hold lessons for our dysfunctional system in an era of contact tracing and local health departments on a starvation diet. 

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Audrey Farley, “The nonprofit grifters who want a cut of the coronavirus bailout,” New Republic, May 14, 2020

How patient groups, funded by drug makers, are turned into lobbying tools to stop drug industry reform. Grotesque details.

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Kari Paul, “Iowa touted its Covid-19 testing. Now officials are calling for an investigation,” Guardian, Jun 4, 2020

Iowa wants to get its bars and public spaces reopened and so signed a no-bid $26 million contract with Nomi Health “after being pitched on the company by Ashton Kutcher, the actor-turned-investor who is originally from Iowa.” What could go wrong? “Health experts and lawmakers are raising questions about the program and the little-known company behind it, pointing at missed deadlines, long test delays and complaints over the accessibility of testing sites.” One expert questioned why the state hired a company never involved in diagnostics previously “instead of utilizing established public health entities.” Where’s the profit in that?

Posted May 28, 2020

Sharon Lerner, “Despite the hype, Gilead’s remdesivir will do nothing to end the coronavirus pandemic,” The Intercept, May 26, 2020

Highlights alternatives to remdesivir that may work better. “People who took the combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin got better in seven days as opposed to 12 days for those who didn’t take it.” But those drugs are no longer under patent, so no profits & no PR campaign to push their use. Meanwhile, Gilead’s commercial rollout of remdesivir with a hefty price tag is set for June.

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Victoria C. Yan & Florian L. Mullermay, “Gilead should ditch remdesivir and focus on its simpler and safer ancestor,” STAT, May 14, 2020

“Gilead has another compound in its pipeline that is easier to make, has been shown to be effective against coronavirus in animal models, and is potentially as effective as remdesivir, if not more so.” But the other molecule has an older patent that will expire eight years before remdesivir’s. Technical detail and an interesting exchange in comments.

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Matt Egan and Chris Isidore, “Moderna unveiled encouraging coronavirus vaccine results. Then top execs dumped nearly $30 million of stock,” CNN Business, May 22, 2020

Pharma execs cashed in right after the company successfully inflated its stock price by announcing “encouraging” vaccine trial results. “Moderna’s chief financial officer exercised 241,000 options for $3 million on Monday, filings show. He then immediately sold them for $19.8 million, creating a profit of $16.8 million.” All perfectly legal.

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William A. Haseltine, “Did the Oxford COVID vaccine work in monkeys? Not really,” Forbes, May 16, 2020  

Pretty technical but concludes that the early tests are not all they are pumped up to be. This seems to be a trend: science by press release, which does wonders to improve the health of certain companies’ stock values.

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Sarah Marsh, “Cuba credits two drugs with slashing coronavirus death toll,” Reuters, May 22, 2020

Will the Cuban drugs work? Who knows? And will the Cuban biotech industry be taken seriously? Unlikely.

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Heather Perlberg, “How private equity is ruining American health care,” Bloomberg, May 20, 2020

Expect more reports of malpractice as private equity giants gobble up practices and install cost-cutting, upcoding, promotion of unnecessary procedures, etc. Also shows how the whole trend could blow up: “It’s ultimately going to backfire,” says Dr. Jane Grant-Kels of the University of Connecticut School of Medicine. “There’s a limit to how much money you can make when you’re sticking knives into human skin for profit.”

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Matthew Lewis, Zac M. Willette & Brian Parkman, “Calling health care workers ‘heroes’ harms all of us,” STAT, May 21, 2020

A counterintuitive argument worth listening to. “A word that’s increasingly being used during this pandemic is making their lives even harder. . . . Shifting the attention from systemic failures to rugged champions has consequences — sometimes deadly ones.”

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Alex Thompson, “Warren pivots on ‘Medicare for All’ in bid to become Biden’s VP,” Politico, May 21, 2020

M4A jettisoned with a flourish. Warren: “I think right now people want to see improvements in our health care system, and that means strengthening the Affordable Care Act.” This melds neatly with the Biden position.

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Brian Mann, “Trump team killed rule designed to protect health workers from pandemic like COVID-19,” NPR, May 26, 2020

Yes, but with the active support of the American Hospital Association that likes the anti-regulatory stance.

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Andy Slavitt, “The time to prepare for a second covid-19 wave is now,” Medium, May 12, 2020

“We don’t want to live through March again,” writes Slavitt. “In February after I was sent the projected Italy and South Korea curves, I wrote letters to all the governors urging us to be South Korea and act aggressively to contain. We didn’t. Next time, we should aim to be South Korea.” So Andy, former Goldman Sachs and UnitedHealth Group executive, would that include eliminating the health insurance gatekeepers from our system the way the South Koreans do? I guess not since you collect money @United States of Care from Buffett, Bezos, and Dimon to prevent M4A. 

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Prabhjot Singh, “Why the U.S. health care system failed the coronavirus test,” Foreign Policy, May 12, 2020

What passes for establishment analysis: a long thumb-sucker about how to fix the healthcare system (“microgrids”!) that completely sidesteps the question of who pays.

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Eric Boodman & Casey Ross, “Doctors lambaste federal process for distributing Covid-19 drug remdesivir," STAT, May 6, 2020

Distribution is “uneven and opaque,” say doctors. “About two dozen hospitals are believed to have been chosen to receive the drug so far, but clinicians told STAT it is unclear why some medical centers were chosen to receive coveted doses while others weren’t — and who is making those decisions in the first place.” Wild guess: key factor is being FoJ (Friends of Jared).

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Matt Chase, “How coronavirus broke America’s healthcare system,” Financial Times, Apr 30, 2020

Paradox: while healthcare has never been more important, some hospitals are on the verge of bankruptcy. Rich hospitals are doing fine and will consolidate their dominance post-COVID. “[Poor ones] will face long-term economic consequences: credit will be harder to access; they will have to cover costs when unemployed patients are unable to meet their bills, and the states are likely to cut insurance payment rates as tax revenues fall.” A U.K. finance paper sees through our dysfunction and takes note of the $760 billion “wasted in unnecessary health spending.”  

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David Sirota, “Hospitals and nursing homes spent $98 million on state politics. Now they want immunity for patient deaths,” Jacobin, May 27, 2020

Cuomo got a jump on the other states by shielding executives in the royal state budget. Others will follow: “Among the states that have granted that immunity, the largest streams of [bipartisan] cash flowed into Massachusetts ($25 million), Illinois ($5.6 million), New York ($5.2 million), Arkansas ($1 million) and Michigan ($1 million).”

Posted May 22, 2020

Jessie Hellman, “Governors eye Medicaid cuts to ease COVID-19 budget pain,” The Hill, May 17, 2020

Millions of newly unemployed flock to Medicaid; enrollment will rise from 71 million to as many as 100 million people. Logically, Trump seeks cuts to Medicaid funding. New target: already inadequate provider payments.

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Julie Rovner, “Medicaid providers at the end of the line for federal COVID funding,” Kaiser Health News, May 18, 2020

Details of how cuts to Medicaid providers will devastate the safety net. Also, vaccination rates are way down, suggesting future outbreaks of measles, etc.

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Tahir Amin & Rohit Malpanimay, “Covid-19 has exposed the limits of today’s drug development model,” STAT, May 19, 2020

“That so much hope is being pinned on remdesivir, the drug Gilead is testing for Covid-19, reflects the failure of our system for new drug development rather than the unqualified success some commentators are making it out to be.” Pharma scores an undeserved image boost with silver-bullet research. “Despite clear warnings that another viral pandemic could emerge, the pharmaceutical industry failed to sustain investment into new treatments and vaccines.” And “The private pharmaceutical sector contributed just 17% —$650 million — a drop in the ocean considering that the revenue of the top 20 pharmaceutical companies was more than $661 billion in 2019.” Contains a prescription for how to revamp the entire pharma industry.

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Alexander Sammon, “Trump helps health insurers swell their profits,” American Prospect, Apr 30, 2020

Congress may reward the industry by letting them keep bundles of healthcare cash by relaxing Obamacare’s Medical Loss Ratio requirement as insurers pay out less for elective procedures. Meanwhile, “UnitedHealthcare, along with other insurance giants including Aetna and Cigna, have pushed for significant pay cuts for doctors.” United CEO’s David Wichmann “earned” a salary of $52 million last year.

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Lev Facher, “9 ways Covid-19 may forever upend the U.S. health care industry,” STAT, May 10, 2020

Some interesting speculation on how medical care and financing might change post-COVID. Plausible: acceleration of telemedicine; rethinking nursing homes (more interest in home health care); shifting drug production back to the U.S. or at least away from China; broader use of non-MDs in primary care; lump-sum payments by employers in lieu of health insurance. Implausible: any major shift on the drug pricing debate. Highly implausible: “The differences in coronavirus death rates between white and Black people in the U.S., many argued, are too dramatic, and too immediate, to ignore.” Really? Even with 200 years of practice?

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Helen Branswell, “Vaccine experts say Moderna didn’t produce data critical to assessing Covid-19 vaccine,” STAT, May 19, 2020

Moderna’s stock valuation skyrocketed to $29 billion, “an astonishing feat for a company that currently sells zero products.” And, let us add, that trumpets a vaccine product based on EIGHT (8) study subjects. But they give good press release.

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Andrew Perez, “Dems aim to subsidize the opponents of progressives change,” TMI, May 20, 2020

This outrage got pulled back partially after this article blew the whistle on bailouts for lobbyists through its “special loan fund for nonprofits.” Good detail about how lobbyists pay off reporters.

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Daniel Lippman, Sarah Owermohle, Zachary Brennan & Adam Cancryn, “Dubious history for leader of new made-in-America drug venture,” Politico, May 19, 2020

The beneficiary company of a $354 million government contract (the largest in history for this agency) has no experience in drug manufacturing but does know how to price-gouge for naloxone treatments.

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Anna Gronewold, Sally Goldenberg & Erin Durkin, “Cuomo, De Blasio blame ignorance, but not themselves, in wake of damning report,” Politico, May 21, 2020

“When the first cases were confirmed, [Cuomo] focused on minimizing panic, and emphasizing statistics that suggested the disease would largely spare the young and healthy; that 80 percent of those infected would easily recover at home.” On the other hand, he’s not demented though that’s rather a low bar. De Blasio also was late to the party.

Posted May 19, 2020

Sara R. Colins et al., “New survey finds Americans suffering health coverage insecurity along with job losses,” Commonwealth Fund, Apr 21, 2020

News flash! “Health Coverage Insecurity Accompanies Job Losses.” Who knew? Also 20% of the newly unemployed had no job-based health insurance to begin with. And: “Nearly two-thirds (64%) of adults age 18 and older said the potential out-of-pocket costs would be very or somewhat important in their decision to get care if they had symptoms of the coronavirus.”

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Andrew Perez, “Democrats are now retreating on a public option amid the pandemic,” TMI, May 5, 2020

“How even in a blue state [Colorado], health care industry propaganda and lobbying can kill a modest reform at the worst possible time.” The plan was a statewide public option, shot out of the sky by the Partnership for America’s Health Care Future Action, “a secretive new group.” Not secret to us.

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David Sirota, “Insurance companies are not ‘selfless,’” TMI, May 18, 2020

Brilliant reframing: “Health insurance companies now want you to think they are doing you a favor by giving you the product you paid for.”

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L.J. Dawson, “Under COVID cloud, prisons in rural America threaten to choke rural hospitals,” Kaiser Health News, May 14, 2020

Rural areas economically dependent on prisons and with weak clinical infrastructure face disaster. “Any outbreak has the potential to overwhelm our medical resources.”

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Erin Cox & Steve Thompson, “Very few of Maryland’s coronavirus tests from South Korea have been used so far. Here’s why,” Washington Post, Apr 29, 2020

Gov. Hogan (R) had to mobilize the National Guard to keep Jared Kushner’s mitts off his state’s stash. But then Hogan the Hero started channeling Kushner: “First of all, the state is going to maintain those tests. We’re not just going to send them off to people.” Also, tests need reagents and swabs. “Without [those] things, they are sort of like paperweights.”

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Will Dunn, “How America built the best pandemic response system in history – and threw it away,” New Statesman, Mar 24, 2020

The infrastructure included inter-agency coordination mechanisms that now have to be reconstructed. Minor budgets for disaster preparedness were slashed in 2018. Bolton then dissolved the Global Health Security team within the NSC. Chaos reigns.

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Craig Murray, “Profiting from coronavirus,” Craig Murray [blog], May 17, 2020

Hysteria over foreign governments attempting to hack research findings obscures the fact that ALL findings should be in the public domain as part of international cooperation. “The UK and the US are attempting to hide their vaccine and treatment research results from the rest of the world to make money out of them. They are jealously guarding [their results] and each working in a bubble hoping to be the first in order to cash in.”

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Willoughby Mariano & J. Scott Trubey, “‘It’s just cuckoo’: State’s latest data mishap causes critics to cry foul,” Atlanta Journal-Constitution, May 13, 2020

Gov. Kemp was desperate to show good pandemic numbers to justify quick re-opening. The state’s health department then produced a chart with the dates in reverse—voila! A decline! “Where does May 2 come before April 26?” In Georgia.

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Leila Fadel et al., “As hospitals lose revenue, more than a million health care workers lose jobs,” NPR, May 8, 2020

“The very workers tasked with treating those afflicted with the virus are losing work in droves.” 1.4 million of them to date as “elective” surgeries are postponed. Meanwhile, insurance companies, with lower payouts, are cashing in. Important details to read in full.

Posted May 14, 2020

Akela Lacy & Jon Walker, “HEROES Act delivers a win to the health insurance industry,” The Intercept, May 12, 2020

Of the three main players in healthcare delivery—hospitals, doctors, and insurance companies—only the last are thriving. Pelosi’s plan showers them with more benefits instead of recognizing that employer-based health insurance is a failed model. COBRA subsidies do nothing for people who weren’t covered at work to begin with or those who bought policies on the exchanges. “Tying health insurance to employment and therefore, ensuring a loss of insurance during times of unemployment, was a huge problem well before the crisis; the only real difference now is that it is happening to so many people at once.”

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Lauren Coleman-Lochner, John Tozzi & Jeremy Hill, “Virus pushes America’s hospitals to the brink of financial ruin,” Bloomberg, May 8, 2020

Especially hospitals already on the ropes. Also, private equity ownership of hospitals has “left some facilities hamstrung with debt”—just like PE wrecked Sears and Toys R Us. Expect hundreds more hospital closings, especially in underserved areas.

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Emily Shugerman, “The hospital CEOs keeping seven-figure salaries as frontline workers go without pay,” Daily Beast, May 2, 2020

And yet: “Thousands of health-care workers across the country have had their wages cut and hours slashed. But some executives don’t seem willing to share in the suffering.” The average hospital CEO’s salary increased 93 percent in the decade between 2005 and 2015 while the average provider’s salary increased just 8 percent.

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Tim Dickinson, “The four men responsible for America’s COVID-19 test disaster,” Rolling Stone, May 10, 2020

How the Federal Government acted like a deer in the headlights while the virus spread out of control. Staggering details.

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E. J. Dickson, “Judy Mikovits, disgraced doctor at the center of ‘Plandemic,’ has a bestselling book on Amazon,” Rolling Stone, May 12, 2020

Reminiscent of the HIV-denialist movement, which persisted despite mountains of solid debunking evidence. The anti-vaxers will flog this for years. The book “features a forward by noted anti-vaccine huckster Robert F. Kennedy Jr.”

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Caroline Lewis, “Cuomo won’t back down on Medicaid cuts—even if it means spurning billions in coronavirus aid,” Gothamist, Mar 31, 2020

“Cuomo has made it clear that he is determined to cut Medicaid in the midst of a massive public health crisis—even if it means risking federal funds designated to provide relief.” The state is giving up $6.7 billion as Cuomo tinkers with Medicaid eligibility. Expect more crying poverty to justify state austerity measures, such as cuts to the indigent care pool.

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Sydney Lupkin, “Gilead lobbying rose as interest in COVID-19 treatment climbed,” NPR, May 2, 2020

Handy chart

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Associated Press, “Schumer calls on VA to explain use of unproven drug on vets,” May 10, 2020

About 28% of veterans who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone. Thank you for your service! “A whistleblower complaint filed this past week by former HHS official Rick Bright alleged that the Trump administration, eager for a quick fix to the onslaught of the coronavirus, wanted to ‘flood’ hot spots in New York and New Jersey with the drug.” [see story below]

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Sharon Lerner, “Whistleblower details how Trump’s bureaucrats refused to secure N95 masks as pandemic loomed,” The Intercept, May 7, 2020

“Though officially tasked with quickly mobilizing a national response to public health crises, [Robert] Kadlec, the assistant secretary for preparedness and response and formerly Bright’s boss, is described in the report as a petty tyrant who ignored, mocked, and thwarted Bright’s repeated efforts to address the imminent shortage of masks and other personal protective equipment in January and February as the virus began spreading across the country.” Also, “Kadlec had repeatedly pushed Bright to award government contracts to politically connected companies, including one tied to Trump’s son-in-law, Jared Kushner. Prior to that, Kadlec had served on the staff of Sen. Richard Burr, R-N.C., who is now best known for dumping his stocks while assuring the public about the coronavirus.” [And whose home was raided by the FBI this week]

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Elisabeth Rosenthal, “We knew the coronavirus was coming, yet we failed 5 critical tests,” Kaiser Health News, May 11, 2020

“Our system requires every player — from insurers to hospitals to the pharmaceutical industry to doctors—be financially self-sustaining, to have a profitable business model. As such, it excels at expensive specialty care. But there’s no return on investment in being primed and positioned for the possibility of a once-in-a-lifetime pandemic.” Which is why language like “return on investment” has no place in health care.

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David Quammen, “Why weren’t we ready for the coronavirus?” New Yorker, May 4, 2020

Comparisons with the successful response to SARS, ignored as the threat was dismissed. “A smoke alarm doesn’t work when the battery has been removed.”

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Sarah Owermohle, “The nation’s supply chain isn’t anywhere close to ready,” Politico, May 11, 2020

An interesting dip into the many aspects of getting a vaccine into billions of people that go far beyond the scientific confirmation of efficacy—if that ever comes. “Meeting the overwhelming demand for a successful coronavirus vaccine will require a historic amount of coordination by scientists, drug-makers and the government. The nation’s supply chain isn’t anywhere close to ready for such an effort.” Glass vials, rubber stoppers, refrigeration units, etc., not to mention the U.S. insistence on autarky while the rest of the world works together.

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Meredith Deliso, “Oklahoma city reverses face mask requirement amid threats of violence,” ABC News, May 3, 2020

Show up with guns and get your way (white people only). “Stillwater (OK) had required customers to wear masks in stores and restaurants. But the mayor quickly amended that policy on Friday afternoon after employees were ‘threatened with physical violence and showered with verbal abuse.’”

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And finally, some non-COVID news:

Merrill Goozner, “Why are patient groups silent on high drug prices?” Washington Monthly, April/May/June, 2020

A neat hustle: Pharma funds patient groups, which then defend or at least remain silent on price-gouging. “Drugmakers also buy goodwill through funding programs that provide help to poorer patients who can’t afford their co-pays and deductibles.” The author says patient organizations have to look beyond their disease silos.

Posted May 8, 2020

David Sirota, “A coronavirus cover-up is already starting,” TMI, May 7, 2020

Democrats move quickly to ensure that we learn nothing from the debacle and permit Trump to drive the narrative. “The call for bipartisanship is the last refuge of scoundrels who don’t want to be held accountable for anything.” Key figure in this maneuver: South Carolina’s James Clyburn, the CBC power-broker who saved Biden’s campaign. The enthusiasm for George W. Bush’s kumbaya moment fits neatly here.

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Anna Russell, “The underground efforts to get masks to doctors,” New Yorker, May 7, 2020

“With supply chains gone haywire and the government doing little, ordinary citizens have organized to keep health-care workers protected.” Starve the state; point to its incompetence; privatize; rinse and repeat. Surreal tales of doctors shipping equipment around in unmarked trucks like drug dealers to avoid seizure by FBI agents working on behalf of Kushner. On the other hand, consider the organizing potential of all the pop-up hyper-local groups forming to respond to the emergency.

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Angus Liu, “Fair price for Gilead’s COVID-19 med remdesivir? $4,460, cost watchdog says,” Fierce Pharma, May 4, 2020

“The drug was initially developed as part of a collection of hepatitis C drug candidates, and Gilead has already recouped those costs by successfully selling other treatments in the area.” So, there is no need for Gilead to make anything more than a modest profit on production costs, which are about $10 per 10-day course of treatment.

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Lee Fang, “Private hospitals, now demanding bailouts, lobbied to defeat cost-saving health reform as coronavirus crisis grew,” The Intercept, Apr 28, 2020

“Private hospital mega-chains have maneuvered in recent months to defeat the expansion of low-cost health insurance coverage, while demanding unprecedented bailouts over the coronavirus crisis.” The Partnership for America’s Health Care Future concentrated on M4A during the presidential primary season, now aims at any threats of state action with a special focus on Colorado. “True West Strategies, a company recently registered by a former aide to former Gov. John Hickenlooper, was also paid by the campaign.” Recall Hickenlooper’s prominent anti-M4A role in the debates. Also: “The chairman of PAHCF, Chip Kahn, the chief lobbyist for the [investor-owned] Federation of American Hospitals, disclosed that his team worked to secure emergency funding for hospitals as part of the nearly $3 trillion in recent federal spending.” A neat pivot: feed at the public trough and while insisting that states “can’t afford” single-payer. Worth reading in full to grasp the level of looting underway.

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Theodore Hamm, “As virus spreads in nursing homes, Gov. Cuomo’s big donors are immune from liability,” The Indypendent, Apr 23

The liability protection, “tucked away inside the budget bill,” benefits Cuomo’s five-figure donors who own nursing homes. “The Greater New York Hospital Association took credit for writing the legislation.” And here I thought we had an elected legislature.

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Ese Olumhense, “Family of Bronx woman who died in childbirth gets $2K hospital bill,” The City, May 5, 2020

“Amber Isaac died just days after tweeting that she wanted to write a ‘tell all’ about the ‘incompetent doctors at Montefiore.’” She was pushed into a tele-medicine instead of in-person visit despite a low platelet count. Anecdotal but disturbing.

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J. David McSwane, “How profit and incompetence delayed N95 masks while people died at the VA,” ProPublica, May 1, 2020

This one is beyond belief: “It’s unclear why the VA gave Stewart’s fledgling business — which had no experience selling medical equipment, no supply chain expertise and very little credit — an important [no-bid!] contract. Or why the VA agreed to pay nearly $5.75 per mask, a 350% markup from the manufacturer’s list price.” Chaotic incompetence is a prerequisite for corruption.

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Josh Wingrove, Daniel Flatley & Shira Stein, “Kushner airlift moves millions of masks, but details are secret,” Bloomberg, May 1, 2020

“A program created by Donald Trump’s son-in-law Jared Kushner has airlifted millions of gloves, masks and other coveted coronavirus supplies into the U.S. from overseas -- but it isn’t clear who’s getting them and at what price or how much private-sector partners are earning through the arrangement. The U.S. government provides the air transportation for free to speed the arrival of the products. The six distributors keep the profits, if any.” NB: Trump has already said congressional oversight is a joke and ignored impeachment-related subpoenas.

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Yasmeen Abutaleb & Ashley Parker, “Kushner coronavirus effort said to be hampered by inexperienced volunteers,” Washington Post, May 5, 2020

More on Kushner’s amateur hour. A feature not a bug as corruption first requires chaos and incompetence.

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Jordan Fabian, “Trump outbid governors on coronavirus supplies after telling them to buy their own,” Bloomberg, Mar 19, 2020

The background for those who came in late.

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Dan Gorenstein & Leslie Walker, “Coronavirus conundrum: How to cover millions who lost their jobs and health insurance,” WBUR [Boston], May 04, 2020

Why Nancy Pelosi’s proposal to subsidize COBRA is a lousy idea. As usual, the NPR affiliate never considers single-payer as an alternative approach.

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Rachel Roubein & Dan Goldberg, “States cut Medicaid as millions of jobless workers look to safety net,” Politico, May 5, 2020

State budgets are in freefall, so Medicaid, a large expense, is under threat just as need explodes with millions of newly unemployed. Democrats handed Trump trillions while not insisting on protecting it, now will complain.

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Jon Asplund, “Ill. nursing home workers offered raise ahead of planned strike date,” Modern Healthcare, May 06, 2020

Direct action is all we have left.

Posted May 4, 2020

Patrick Kennedy, “CEO pay watch: UnitedHealth’s David Wichmann made more than $52 million last year,” [Minneapolis] Star Tribune, Apr 26, 2020

A national emergency won’t get in the way of mega-payouts for the leaders of health finance companies, e.g., total 2019 compensation for David Wichmann, UnitedHealth Group’s CEO was $52,098,104; CEO-to-median employee ($54,322) pay ratio there: 348 to 1.

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Angela Hart, “Newsom’s ambitious health care agenda crumbles in a ‘radically changed’ world,” Kaiser Health News, Apr 9, 2020  

California governor had planned to “expand the pool of undocumented immigrants covered by Medicaid, enable California to manufacture its own generic drugs, pour billions into the Medicaid program to address chronic homelessness, and dramatically increase mental health and addiction treatment statewide.” Now the state’s budget is in shambles, but some of the plans to get aggressive on costs will make more sense than ever.

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Arielle Kane, “COVID-19 makes it clear: Medicaid block grants will make everyone worse off,” The Hill, Apr 4, 2020

“COVID-19 demonstrates why block grants are irresponsible and hurt the most vulnerable.” A pre-set fixed dollar contribution from the feds makes no sense in a huge medical emergency. Also, Medicaid is counter-cyclical, meaning that when the economy tanks, Medicaid spending goes up, and the fresh injection of federal dollars helps sustain purchasing power. Oklahoma and Tennessee push ahead with block grants anyway.

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Susannah Luthi & Rachel Roubein, “White House still scrambling to cover virus treatment for the uninsured,” Politico, Apr 20, 2020

Talk is cheap, but the bills keep coming. “The White House pledged [in early April] to cover coronavirus treatment for uninsured Americans — but the administration still doesn’t have a plan for how to do it.” Meanwhile, Democrats insist that federal funds be funneled through for-profit insurers. And hospitals don’t know where to send the bill.

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Laurie McGinley, “FDA did not review many coronavirus antibody tests flooding the market,” Washington Post, Apr 19, 2020

Here are the four tests that have been rigorously examined and authorized: Cellex, Chembio Diagnostic Systems, Ortho Clinical Diagnostics and Mount Sinai Laboratory. The other 80-plus on the market also might work—or not. Also, the degree of immunity—if any—indicated by an antibody-positive test is unknown.

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Carmen Heredia Rodriguez, “COVID tests are free, except when they’re not,” Kaiser Health News, Apr 29, 2020

Labyrinthine rules for when a provider can order the test, when a patient is covered, and how much the insurer has to pay.

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Isaac Arnsdorf, “Health insurers to investors: We’re good. Health insurers to lawmakers: Please help,” ProPublica, Apr 28, 2020

Brilliant juxtaposition of what insurers say to Wall Street analysts and what they say to Congress when lobbying for subsidies.

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Susannah Luthi, “The unlikely alliance trying to rescue workplace health insurance,” Politico, Apr 28, 2020

“Big businesses and powerful Democrats are aligning around a proposal to bail out employer health plans.” What’s unlikely about that? Democrats have been more enthusiastic than Trump about keeping insurance companies in the financing loop. The hospital-insurance-union lobbying group pushing this is called “Families USA.” Aww.

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Daniel Horn, Wayne Altman & Zirui Song, “Primary care must be saved from being devastated by covid-19,” STAT, Apr 29, 2020

“Most [primary care practices] rely on an outdated payment model: each in-person visit with a patient generates a payment. Without in-person visits, there is little to no revenue. To prevent the spread of Covid-19, practices are actively discouraging patients from coming into the office.” And Medicare compensates telemedicine visits at half the usual rate. Sixty thousand independent practices may collapse. The authors propose capitation payments as an alternative to fees-for-service.

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Daniella Silva, “Health care experts say coronavirus exposes major flaws in medical system,” NBC, Apr 29, 2020

Amazing that such an astute, critical examination of the problems facing our current healthcare delivery system can totally omit single-payer as a conceivable solution. Self-censorship or ideological blinders?

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Ivana Kottasová, Tami Luhby & Valentina Di Donato, “She was asked to pay thousands for her coronavirus treatment, he got a free ride. She’s American. He’s Italian,” CNN, May 1, 2020

“Leah Blomberg and Marco Paolone both called an ambulance when their coronavirus symptoms worsened. Both spent time in intensive care, both were unconscious for days, and both were on a ventilator.” He paid zero; she’s on the hook for $2000 just for the ambulance. “The evidence so far suggests that more centralized, publicly funded systems with universal coverage and a solid chain of command and control have been weathering the crisis better.” Really?

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Arman Azad, “Remdesivir: US government will decide where drug goes amid coronavirus pandemic, Gilead Says,” CNN, May 3, 2020

Hardly reassuring to put the decisions about treatments in the hands of Jared Kushner and Trump as they openly retaliate against critics. Will New York get any?

Posted Apr 28, 2020

Charles Duhigg, “Seattle’s leaders let scientists take the lead. New York’s did not,” New Yorker, Apr 26, 2020

Today’s must-read, no paywall. Why Washington State is way down the list of corona hotspots while New York buries hundreds per day. Lesson 1 from epidemic experts: don’t put politicians on camera every night.

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Vale Disamistade, “No, Italy is not the case against Medicare for All,” The Nation, Apr 14, 2020

In fact, just the opposite: “When Covid-19 reached Italian shores, it found a country in the midst of a private-sector transformation that has been turning the country’s single-payer health care system into an Italian version of Biden’s beloved ‘public option.’” Italy’s system was being Americanized through austerity and the simultaneous decision to rip open the healthcare field to private competition.

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Marc A. Thiessen, “Why this pandemic is an indictment of socialized medicine,” Washington Post, Apr 14, 2020

Playbook: (1) cut public services, drown government in the bathtub, wreck the bureaucracy; (2) point at how awful things are; (3) privatize; (4) hire PR shills to tout the superior private sector; (5) rinse and repeat. The article is a (4). “Contrast the incredible job our private health-care system is doing today with the utter incompetence of the federal government in preparing for today’s pandemic.” Thiessen is a right-wing hack from the American Enterprise Institute and wrote a book defending torture.

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Siddhartha Mukherjee, “What the coronavirus crisis reveals about American medicine,” New Yorker, Apr 27, 2020

A deep dive into the problems COVID has unearthed from the supply chain folly of outsourcing to the destruction of doctor notes by Electronic Medical Records (“Because notes are used to bill, determine level of service, and document it rather than their intended purpose, which was to convey our observations, assessment, and plan. Our important work has been co-opted by billing.”) Twitter works better. The only shortcoming of the article is its assumption that those in charge must want government to work efficiently, instead of recognizing their deep, structural attachment to its failure [see previous article].

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Angela Hart & Anna Maria Barry-Jester, “The inside story of how the Bay area got ahead of the COVID-19 Crisis,” Kaiser Health News, Apr 21, 2020

“[Public health authorities] were able to move swiftly because they had a secret weapon: a decades-long alliance seeded in the early days of the AIDS epidemic that shields them from political blowback when they need to make difficult decisions.” The Bay area’s stay-at-home order came days before any of the states took action. Also, “County health officers in California have immense power to act independently in the interest of public health, including the authority to issue legally binding directives. They don’t need permission from the governor or mayors or county supervisors to act.” Politicians had to take a back seat.

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Isaac Arnsdorf, “Medical staffing companies cut doctors’ pay while spending millions on political ads,” ProPublica, Apr 20, 2020  

The companies behind the ads, TeamHealth and Envision Healthcare, are owned by private equity firms KKR and Blackstone. Their astro-turf vehicle, called “Doctor Patient Unity,” [aww] spent $57 million on ads since June 2019. They also demand bailout money.

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Karl Evers-Hillstrom, “Congress invests big in pharmaceutical, tech stocks,” opensecrets.org, Apr 27, 2020

“In the most recent financial disclosures filed last year, lawmakers reported holding tens of millions of dollars in tech and pharmaceutical stocks.”

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Anna Case & Angus Deaton, “American health care is an engine of inequality,” New York Times, Apr 14, 2020

Case & Deaton introduced the concept of “deaths of despair” as a byproduct of modern capitalism. “The first step to reform is to change the way we think about the health care system. Many Americans think their health insurance is a gift from their employers — a ‘benefit’ bestowed on lucky workers by benevolent corporations. It would be more accurate to think of employer-provided health insurance as a tax.”

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Cathy O'Neil, “10 reasons to doubt the Covid-19 data: The pandemic’s true toll might never be known,” Bloomberg, Apr 13, 2020,

How to read the numbers.

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Anita Kumar & Gavin Bade, “States still baffled over how to get coronavirus supplies from Trump,” Politico, Apr 13, 2020

Tragicomic incompetence and playing favorites based on who lavishes praise on Trump.

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Jay Hancock, Phil Galewitz & Elizabeth Lucas, “Furor erupts: Billions going to hospitals based on Medicare billings, not COVID-19,” Kaiser Health News, Apr 10, 2020

“States such as Minnesota, Nebraska and Montana, which the pandemic has touched relatively lightly, are getting more than $300,000 per reported COVID-19 case in the $30 billion. On the other hand, New York, the worst-hit state, would receive only $12,000 per case.”

Posted Apr 24, 2020

Shelby Livingston, “Health insurer CEOs score big paychecks despite public scrutiny,” Modern Healthcare, Apr 22, 2020

Insurance execs doing fine. “UnitedHealth Group CEO David Wichmann's total compensation reached $18.1 million [$25.1 million with stock options].” Glad to see my premiums are doing God’s work!

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Susan B. Glasser, “How did the U.S. end up with nurses wearing garbage bags?” New Yorker, Apr 9, 2020

“A fragmented procurement system now descending into chaos.” Gory details of why states have to take matters into their own hands. One source describes “a government failure by design—not a problem to be fixed but a policy choice”—an important insight: make it fail, then demand privatization.

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Sheelah Kolhatkar, “How private-equity firms squeeze hospital patients for profits,” New Yorker, Apr 9, 2020

Private equity firms Blackstone and KKR bought up doctors’ practices, then jammed out-of-network bills on powerless consumers. Congress acquiesced. The multiple COVID-19 bailouts have not fixed this.

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David Willman, “Contamination at CDC lab delayed rollout of coronavirus tests,” Washington Post, Apr 18, 2020

“The failure by the Centers for Disease Control and Prevention to quickly produce a test kit for detecting the novel coronavirus was triggered by a glaring scientific breakdown at the CDC’s central laboratory complex in Atlanta.” Logical conclusion to the government-is-the-problem, let’s-drown-it-in-the-bathtub approach. “Where was the adult supervision?” a former CDC lab chief said.

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Michael Grabell, Bernice Yeung & Maryam Jameel, “Millions of essential workers are being left out of COVID-19 workplace safety protections, thanks to OSHA,” ProPublica, Apr 16, 2020

“Even as the federal worker-safety agency has been inundated with complaints, it has rolled back safety standards and virtually eliminated non-health care workplaces from government protection.” OSHA is not represented on the White House Coronavirus Task Force. However, strikes have had some effect.

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Katharine Gammon, “How the anti-vaccine community is responding to covid-19,” Undark, Apr 16, 2020

When and if there is a vaccine, count on these Trumpian activists to undermine its effectiveness.

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Jeanmarie Evelly, “Decades of shrinking hospital capacity ‘spelled disaster’ for New York’s COVID response,” City Limits, Apr 15, 2020

Pushback on big hospital chains’ moves to eliminate community hospitals as they prefer costlier specialty procedures. Result: we need a Navy ship to handle an emergency. “They have been prioritizing same-day surgery and other profitable services and trying to abandon lower-income communities, where patients are predominantly people of color.” Details on the shutdown of Mount Vernon Hospital.

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Howie Klein, “There are worse governors than Andrew Cuomo, but none who are personally responsible for as many coronavirus deaths,” Down with Tyranny, Apr 13, 2020

“In the midst of the pandemic response he botched so badly, Cuomo just forced through a budget that drastically cuts healthcare funds to [minorities with high COVID death rates].” Also reports that Maggie Moran, Cuomo's top political operative (“the one not currently serving a prison term”) is helping organize and fundraise against AOC. But he speaks so nicely!

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Dan Ming, “We talked to an ICU nurse working in an overwhelmed coronavirus ward,” Vice, Apr 14, 2020

Moving testimony about conditions and a broader view of healthcare delivery 2020.

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David Dayan, “Unsanitized: The mystery of Donna Shalala’s unreported stock sales,” American Prospect, Apr 21, 2020

No accident that former Obama cabinet officer Shalala was Pelosi’s choice for the corporate bailout oversight panel. Shalala’s chief of staff, Jessica Killin, previously spent ten years as the top lobbyist for a bank.

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David Lim & Brianna Ehley, “Inside America’s testing snafu,” Politico, Apr 22, 2020

“The problem with the federal plan is that it is not a federal plan,” said Jeremy Konyndyk, a former USAID official who worked on Ebola response during the Obama administration. “It’s a list of things they think the states should do.” Yet, mass testing and contact tracing are supposed to part of the back-to-work strategy.

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Fenit Nirappil, Erin Cox & Gregory S. Schneider, “Maryland buys 500,000 coronavirus test kits from South Korea, Hogan announces,” Washington Post, Apr 20, 2020

Maryland’s (Republican) governor wangled a purchase of 500,000 tests from South Korea through his Korean wife. The Trump administration “made it clear over and over again that states have to go out and do it ourselves.”

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Ed Kilgore, “What Biden can do about pressure to embrace Medicare for All,” New York, Apr 13, 2020

“Whether or not this approach appeals to him, Biden needs to start making serious concessions to the left on health-care policy or let it be known quietly that he’s gone as far as he can. . . . The key would be recognition of a single-payer system like Medicare for All as an ultimate goal.” Erroneously assumes facts not in evidence, i.e., that Biden and the corporate wing want to sideline the for-profit insurance companies.

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Justine Coleman, “New York nurses’ union sues state, hospitals over coronavirus working conditions,” The Hill, Apr 20

Montefiore Medical Center, Westchester Medical Center and the state DoH.

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Justine Coleman, “Chile to issue world’s first ‘immunity passports’ to people who have recovered from coronavirus, The Hill, Apr 20, 202

This presumes that antibodies = immunity, which has not been demonstrated. Chile’s right-wing government is fully in the Trumpian mode of saving the economy, even if kills the workers

Joseph Zeballos-Roig, “Fed Chair Jerome Powell calls out massive US health spending, says Americans are ‘getting nothing’ in return,” Business Insider, Feb 12, 2020

A curious additional voice calling out the dysfunction in U.S.-style health care. “We spend 6% to 7% of GDP more than other countries. That’s a lot of money that you are effectively spending and getting nothing." This business paper called the statement “brutal.”

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Eoin Higgins, “Why the unnecessary 6?: Medicare for All advocates warn Biden that lowering age to 60 solves nothing,” Common Dreams, Apr 9, 2020

Not a U-turn as it refuses to touch the role of for-profit insurance in the financing of health care. Also, is there any evidence that this incremental change wouldn’t be opposed just as ferociously as M4A?

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Rachel Roubein, “Rural hospitals shut out of stimulus loans face financial crisis," Politico, Apr 14, 2020

“Government-owned hospitals [are] in danger of running out of money just as the virus hits the heartland.” Democrats now “plead” with Trump to fix the problem with an exception—why didn’t they demand it before saying yes? Dems can veto anything but choose not to.

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Rosie Collington, “Who benefits when the price of insulin soars?” Institute for New Economic Thinking, Apr 16, 2020

“Contrary to pharmaceutical company claims, revenue from high insulin prices are [sic] going to shareholders, not R&D.” Nothing new.

Posted Apr 20, 2020

C. Jason Wang, Chun Y. Ng & Robert H. Brook, “Response to COVID-19 in Taiwan,” Journal of the American Medical Association (JAMA), Mar 3, 2020

“Taiwan has 23 million citizens of whom 850,000 reside in and 404,000 work in China. In 2019, 2.71 million visitors from the mainland traveled to Taiwan. . . . COVID-19 occurred just before the Lunar New Year during which time millions of Chinese and Taiwanese were expected to travel for the holidays.” Nonetheless, Taiwan has almost NO cases of COVID-19. Why? “Taiwan quickly mobilized and instituted specific approaches for case identification, containment, and resource allocation to protect the public health. Taiwan leveraged its national health insurance database and integrated it with its immigration and customs database to begin the creation of big data for analytics; it generated real-time alerts during a clinical visit based on travel history and clinical symptoms to aid case identification.” Other fascinating details of how a real public health system works. We’re light-years away from anything comparable.

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Clio Chang, “Democrats big coronavirus idea is to subsidize health insurers,” Vice, Apr 14, 2020

Democrats’ response to the collapse of employer-based health insurance: keep private gatekeepers in charge by paying 100% of COBRA premiums. Opens up room for Trump to run to the left of the Democrats as the White House floats the idea of paying hospitals directly for COVID care.

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Natalie Shure, “The Democrats’ COBRA proposal is an insurance industry bailout,” In These Times, Apr 17, 2020

“Private insurance firms require public funding to perform basic functions less satisfactorily than their peer programs in the public sector.”

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Donald Shaw, “Dems’ health insurer bailout follows bundled checks from the industry’s lobbyists,” Sludge, Apr 15, 2020

Why do it this way? “Health insurance lobbyists have collected nearly a quarter of a million dollars for the DCCC so far this cycle.” The COBRA-reimbursement plan “mirrors a recommendation put forward recently by the health insurance industry.” Good return on investment: a million bucks in exchange for billions in fresh cash.

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David Sirota, “Will big Pharma fleece us on a COVID treatment that we helped fund?” Too Much Information, Apr 18, 2020

Gilead: the company that “raked in billions in profits from exorbitantly priced Hepatitis C medications that were developed with taxpayer dollars, then shifted those profits to offshore tax havens where it dodges U.S. taxes.” COVID drug Remdesivir had ample government funding in its early stages, so no, drug companies should not be compared to Jonas Salk.

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Carol D. Leonnig, Jonathan O'Connell & Michelle Ye Hee Lee, Washington Post, “Behind the scenes, private equity angles for a piece of stimulus,” Washington Post, Apr 6, 2020

Private equity sausage getting made at the White House. “The private-equity industry is pushing to qualify for various pots of stimulus funds, arguing that companies with investors should not be left out of the relief effort.” Note the bipartisan lobbying effort on behalf of the plutocrats.

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Michael Sainato, “U.S. for-profit healthcare sector cuts thousands of jobs as pandemic rages,” Guardian, Apr 14, 2020

In March alone, 43,000 health care jobs were lost because they were engaged in high-return activities that suddenly shut down. “We have a healthcare system where you excel in normal times by stressing what’s needed the least, and then when we have an emergency and the need is greatest, you’re in financial trouble.”

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Rachana Pradhan & Lauren Weber, “The COVID-19 bailout that’s left every hospital unhappy in its own way,” Kaiser Health News, Apr 16, 2020

Unequal per-patient compensation, vast differences in patient populations and disparities among states, rural v/s urban realities, and a single $100 billion pot for hospital support, plus “complete discretion” on who gets it by Trump’s top health officials—what could go wrong? (Indiana did well.)

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Mira B, “Detroit nurses ordered to leave hospital after refusing to work,” The Source, Apr 8, 2020

Work stoppages as a last resort: “We had two nurses the other day who had 26 patients with 10 ventilators,” [ER nurse Sal] Hadwan shared. “The nurses need extra help because for three straight weeks they’ve had more than 110 patients in the ER.” Where’s the political support—anyone?

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Luke Kenton, “‘Land of the free!’ Healthcare workers are heckled by anti-lockdown protesters as they stand in front of their cars in Colorado and more demonstrations erupt across the US,” Daily Mail, Apr 19, 2020  

Additional comment superfluous.

Posted Apr 14, 2020

Supply chain follies

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Andy Kroll, “Absolute clusterf–k’: Inside the denial and dysfunction of Trump’s Coronavirus Task Force,” Rolling Stone, [advance of publication] May 2020

VP Pence’s official Task Force v/s Kushner’s insiders committee. [Sen. Chris Murphy (D-Conn.)] says, “I walked away from that conversation scratching my head, like, ‘Who’s in charge?’” Possible answers:  the White House, DOD, FEMA, HHS, and Jared Kushner’s father-in-law. Tragicomic story about Chicago mayor Lightfoot’s attempt to find out what her airport was supposed to do.

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Brent Korson, “‘This is going to be constant from this point on’: As coronavirus surges, tracking the PPE shortage storm in some states, and the calm before, in others,” Tarbell, Apr 10, 2020

“Like being on eBay with 50 other states” in a bidding war.

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Jonathan Allen, Phil McCausland & Cyrus Farivar, “Behind closed doors, Trump's coronavirus task force boosts industry and sows confusion,” NBC News, Apr 7, 2020

The Federal Government, under Trump’s new emergency powers, can take control of orders, divert shipments, and decide which private entity gets to profit, i.e., excellent conditions for corrupt insider-dealing. Also clarifies Kushner’s statement that “it’s supposed to be our stockpile, it’s not supposed to be states’ stockpiles.” Also: “Controlling the flow of goods at a time of scarcity and need gives Trump tremendous leverage to reward allies and punish enemies, including governors, mayors and executives at companies.”

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Geoff Mulvihill, “U.S. state shares, get creative in hunt for medical supplies,” Associated Press, Apr 9, 2020

“President Donald Trump told governors to take care of their own needs. States said they were trying but that bidding in a global marketplace for the supplies was highly competitive and expensive, pitting states against each other, their own hospital systems and other countries, including the U.S. government.” And red states get priority: “Alaska and Wyoming, for example, received more than 300 respirators for every confirmed case, while hard-hit New Jersey received just six per case.”

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Noam N. Levey, “Hospitals say feds are seizing masks and other coronavirus supplies without a word,” Los Angeles Times, Apr 7, 2020

“The federal government is quietly seizing orders, leaving medical providers across the country in the dark about where the material is going and how they can get what they need to deal with the coronavirus pandemic.” Equipment purchases can’t get answers. No one is in charge, but don’t dare criticize.

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Lydia DePillis, “Lessons learned from running ICUs in disaster zones,” ProPublica, Apr 11, 2020  

“Hospitals are starting to look less like part of a wealthy country’s medical system and more like the makeshift clinics in disaster zones or the developing world.” Tips for the USA from Rwanda and Guinea.

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Jacqueline Charles & Alex Harris, “Caribbean nations can’t get U.S. masks, ventilators for COVID-19 under Trump policy,” Miami Herald, Apr 11, 2020

“In the past week, three Caribbean nations —the Bahamas, Cayman Islands and Barbados —have all had container loads of personal protective equipment purchased from U.S. vendors blocked from entering their territories by U.S. Customs and Border Protection.” Including 8 ventilators headed for the Cayman Islands. Eight.

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Juliet Eilperin, Michael Scherer, Josh Dawsey & Seung Min Kim, “Politicians jockeying for covid-19 tests find proximity to Trump is the fastest route,” Washington Post, Mar 25, 2020

Don’t seek help from FEMA, HHS, or the CDC. Try the FOT instead (Friends of Trump).  

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Christina Jewett & Lauren Weber, “Hospital suppliers take to the skies to combat dire shortages of COVID-19 gear,” Kaiser Health News, March 26, 2020

Cities and states scramble to get supplies as the Federal Government flails about and the Jared commission cooks up deals. Says one logistics VP, “From our perspective, it’s this unbelievable place we find ourselves in — realizing we have a vulnerable supply chain.” Translation: I never knew we bought all our stuff from China!

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Greg B. Smith, “An insane situation: Inside the chaos at Bellevue Hospital,” The City, Apr 13, 2020

Official optimism and 7:00 o’clock cheers v/s reality in the hospitals.

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And finally . . .

Charles Rabin & Aaron Leibowitz, “Private island bought coronavirus tests for every resident,” Miami Herald, Apr 13, 2020

“Fisher Island — an exclusive enclave of multimillion-dollar condos and homes and one of the wealthiest ZIP codes in the country — has purchased thousands of rapid COVID-19 blood test kits from the University of Miami Health System for all of its residents and workers.” The rest of Florida has a 1% testing rate.

Posted Apr 12, 2020

Rachel Cohrs, “HHS to use coronavirus relief funds to pay for care for uninsured,” Modern Healthcare, Apr 3, 2020 

Trump floats the idea of moving toward single-payer for COVID-19, suggesting that the Federal Government might pay hospitals directly, bypassing insurers. Says one expert: “It is astounding that the Trump administration would prefer that people remain uninsured, with the federal government picking up the entire tab for COVID treatment, than enroll in private health insurance.” Only if you think Trump is constrained by ideology. Also, non-Medicaid-expansion states like Texas would get more money this way. Weirder things have happened. After all, the innovation of universal, state-funded healthcare came from Bismarck.

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Ezra Klein, “It’s time to move past employer-based health insurance,” Vox, Apr 9, 2020

Klein, a middle-of-the-roader, admits that “Tying health insurance to employment is now, and always has been, a disaster” and that now it will get worse. He disses the Biden plan and offers as an alternative Medicare Extra, “the middle ground that this moment demands.” He doesn’t explain why the industry that will do anything to stop M4A would be any happier with this.

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Adriana Belmonte, “Coronavirus and the U.S. health insurance system is ‘a recipe for disaster,’” Yahoo Finance, Apr 10, 2020

Nothing much new in this article except that it comes from the financial media and focuses on the crushing payouts facing the insurance industry. Estimates of next year’s premium increases range up to 40%.

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Adam Gaffney, “Eight needed steps in the first against COVID-19,” Boston Review, Apr 3, 2020

From PNHP. Most of the 8 are political 180s and unlikely for now. But (1.) “Immediately protect patients from medical costs due to COVID-19” and (6.) “Stabilize hospital financing while protecting patients from hospital costs” are doable even for ideologically straitjacketed Republicans.

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Susannah Luthi, “'Surprise’ billing fix could hitch ride on next coronavirus relief bill,” Politico, Apr 9, 2020

Still no resolution on how much of COVID care will hit patients’ pocketbooks as confusion abounds in the multi-payer system. Deaths go unrecorded as people avoid treatment. “[A]bout 30 percent of emergency departments are run by private equity-backed physician groups — including some companies currently being investigated by Congress for their billing practices.”

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Blake Farmer, “Long-standing racial and income disparities seen creeping into COVID-19 care,” Nashville Public Radio, Apr 6, 2020

Findings: “Doctors may be less likely to refer African Americans for testing when they show up for care with signs of infection.” And in Nashville, “Most of the testing in the region took place at walk-in clinics managed by Vanderbilt University Medical Center, and those are primarily located in historically white areas.” Most localities are not disaggregating data by race/ethnicity.

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Isaac Scher, “The Trump administration issued a new rule that blocks guaranteed paid sick leave for 75% of American workers,” Business Insider, Apr 3, 2020

Trump & Co. immediately drive their tank through a loophole to punish workers trying to get sick leave. Secretary of Labor: Eugene Scalia, son of late Supreme Court Justice Antonin Scalia.

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Eileen Appelbaum & Rosemary Batt, “Hospital bailouts begin…for those owned by private equity firms,” American Prospect, Apr 2, 2020

Step (1): acquire a hospital through a leveraged buyout (LBO), loading up the hospital with new debt; (2) run the hospital’s finances into the ground by selling its real estate and forcing it to pay rent, plus the new debt; (3) apply for a bailout from the CARES slush funds, threatening to close the hospital if no pay-off materializes. Voilà, the “emergency” COVID-19 funding fattens the bank accounts of the super-rich.

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Ray M. Poses, “During the pandemic, follow the money: Hospitals and health care provider organizations put money ahead of clinician and patient safety, public’s health,” Health Care Renewal, Apr 2, 2020

“Most hospitals, like other health care organizations, are in the grip of managerialism, which makes short-term revenue the first priority of all organizations and undermines the health care mission.”

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Isaac Arnsdorf, “A major medical staffing company just slashed benefits for doctors and nurses fighting coronavirus," ProPublica, Mar 31, 2020

They are employed by Alteon Health, backed by private equity outfits Frazier Healthcare Partners and New Mountain Capital.

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Harris Meyer, “Utah suspends Medicaid work requirement due to COVID-19,” Modern Healthcare, Apr 2, 2020

Utah bows to reality as 16 million U.S. jobs disappear in less than a month. Oklahoma, on the other hand, plows forward with its Medicaid work requirement, premiums, and copays. “The punishment will continue until morale improves.”

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Saurav Upadhyay, “The problem with saying we’re ‘at war’ with the coronavirus,” American Friends Service Committee [Quakers], Apr 8, 2020

Cautionary words about the use of war metaphors. We went through this with HIV. It’s not helpful.

Posted Apr 6, 2020

Today’s focus is on market economics as a way to provide healthcare.

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Maria Cramer, “Philadelphia hospital to stay closed after owner requests nearly $1 million a month,” New York Times, Mar 27, 2020

Five hundred beds gone. But see below: even without the hospital deal, the new owner is set to get a big tax break.

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Akela Lacy, “A private equity baron sitting on an empty Philadelphia hospital is in line for huge tax gift in the COVID-19 stimulus,” The Intercept, Apr 1 2020

The bill retroactively change real estate depreciation rates plutocrats can use to avoid taxes. “Former Vice President Joe Biden, a Pennsylvania native whose campaign headquarters is in Philadelphia, has not taken a position on the issue.”

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Peter S. Arno & Philip Caper, "Medicare for All: The social transformation of U.S. health care,” Health Affairs, Mar 25, 2020

Corporatization of healthcare: “The problem is not that these corporate entities are doing something they shouldn’t. They are simply doing too much of what they were created to do—generate wealth for their owners. . . . The cultural changes accompanying these trends have affected every segment of the US health care system, including those that remain nominally not-for-profit.” The top 7 investor-owned health insurance corporations control $913 billion of national health-related spending.

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Meagan Day, “Decades of hospital closures led to this disaster,” Jacobin, Apr 4, 2020

“Desperate times call for desperate measures. But these times didn’t have to be so desperate to begin with. New York City has lost nearly twenty hospitals, and tens of thousands of hospital beds, in the last two decades.” Man of the Hour, Austerity Andrew Cuomo, watched this process benignly as the failing “businesses” were shuttered.

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Mark Brown, “Illinois adjusts on the fly to meet medical supply needs in a coronavirus ‘Wild West,’” Chicago Sun-Times, Apr 3, 2020

Free-market tragicomedy: a state official raced to hand-deliver a check to beat out the competition for N95 masks. “When they find what they need, they have to move immediately to complete the purchase before losing out to another bidder — even as the competition causes prices to jump.”

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Peter Slevin, “Illinois confronts a chaotic White House approach to the Coronavirus,” New Yorker, Apr 4, 20020

The Keystone Kops’ “Emergency Preparedness” training film: “What I’m hearing from mayors across the country [says Chicago Mayor Lightfoot] is this little bit of the allocation that they’re getting is essentially worthless. It’s product that is expired and, worse, that is really in poor condition and disintegrating.” Laugh & cry details abound.

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Kim Willsher, Julian Borger & Oliver Holmes, “US accused of ‘modern piracy’ after diversion of masks meant for Europe,” Guardian, Apr 3, 2020

Bare-knuckles slugfest in the best of all possible free-market worlds. Cuomo: It’s “like being on eBay with 50 other states.” Meanwhile, Trump orders 3M not to sell to Canada or Latin America.

Posted March 30, 2020

Wendell Potter, “Millions of Americans are about to lose their health insurance in a pandemic,” Guardian, Mar 27, 2020

The irrationality of tying healthcare to employment: “The very pandemic that threatens to infect and kill millions is simultaneously causing many to also lose their health coverage at their gravest time of need.”

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Christina Jewett & Lauren Weber, “Hospital suppliers take to the skies to combat dire shortages of COVID-19 gear,” Kaiser Health News, Mar 26, 2020

“Demand is outstripping what’s available due to a damaged supply chain heavily reliant on China and a struggling Strategic National Stockpile.” No one thought of that when profits from just-in-time purchasing were high.

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Nicholas Kulish, Sarah Kliff & Jessica Silver-Greenberg, “The U.S. tried to build a new fleet of ventilators. The mission failed,” New York Times, Mar 29, 2020

Amazing story of cutthroat capitalism at its best: a federal program to produce an inexpensive ventilator was sidetracked when a competitor bought the grantee company. The authors deploy breathtaking understatement: “Private companies’ focus on maximizing profits is not always consistent with the government’s goal of preparing for a future crisis.”

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Mike Hixenbaugh, “Scientists were close to a coronavirus vaccine years ago. Then the money dried up,” NBC News, Mar 5, 2020

“There is a problem with the ecosystem in vaccine development, and we’ve got to fix this.” For-profit pharmaceutical companies can’t be bothered with projects unlikely to hit it big. Worth remembering the next time Pharma reps insist they need huge profits to fund R&D.  

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Caroline Chen, Marshall Allen & Lexi Churchill, “Internal emails show how chaos at the CDC slowed the early response to coronavirus,” ProPublica, Mar 26, 2020

One of the CDC’s core functions is to spot and track disease outbreaks. The current team didn’t know how to do that.

*

Jon Walker, “The pandemic could overwhelm the insurance industry. We must expand Tricare for everybody who needs it,” The Intercept, Mar 26, 2020

Interesting. The author argues that the current system could buckle under the twin pressures of spiking treatment needs and a huge drop in revenues. To avoid a bailout of the health insurance industry, he proposes “an off-the-shelf solution” that can be deployed at a huge scale: Tricare, which covers 10 million U.S. military personnel, and Tricare Select for military families and retirees under 65. It offers full coverage, including drugs, small copays, rules against surprise billing, and roughly Medicare provider reimbursement rates. “It is exactly the kind of insurance we want people to have during this crisis, and, most importantly, it already exists.”

*

Juliet Eilperin, Michael Scherer, Josh Dawsey & Seung Min Kim, “Politicians jockeying for covid-19 tests find proximity to Trump is the fastest route,” Washington Post, Mar 25, 2020

Headline says it all. Meanwhile, “Maryland Gov. Larry Hogan (R) said this week that the state has bought coronavirus tests from China, is trying to buy them from South Korea and is ‘beating on the federal administration every day to get us more tests.’”

*

Drew Altman, “Why the U.S. doesn’t have more hospital beds,” Axios, Mar 30, 2020

“The shortage of hospital beds in the U.S. didn’t happen by accident. It’s a result of both market pressures and public policy.” To have enough for a crisis, they have to be empty at other times. MBA hospital administrators hate that.

*

Carla K. Johnson & Mike Stobbe, “Sick staff fueled outbreak in Seattle-area care centers,” Associated Press, March 18, 2020

Hard evidence of the predicted effect of using low-paid workers without sick leave in jobs like nursing home aides.

*

Mark Dudzic, “The labor movement must fight for Medicare for All — not employer-based plans,” Jacobin, Jan 17, 2020

From January, a look at union resistance to M4A. Perhaps now that all that great coverage disappeared along with the jobs, the terms of the debate will shift. A prescient excerpt: “This parochial perspective ignores the reality that New York unions are only one election or economic downturn away from catastrophe.”

*

Isaac Stonermarch, “Saving lives should be good business. Why doesn’t that apply to finding new antibiotics?” STAT, Mar 18, 2020

A biomedical researcher and entrepreneur describes why finding new antibiotics is a money-loser (and should be directly funded by government-doh).

*

Emmarie Huetteman, “Senators who led Pharma-friendly patent reform also prime targets for Pharma cash,” Kaiser Health News, Mar 24, 2020

Sen. Thom Tillis (NC), chairman of the subcommittee on intellectual property rights: $156,000; Sen. Chris Coons (DE), ranking Democrat: $124,000. “Over the past 10 years, the pharmaceutical industry has spent about $233 million per year on lobbying, according to a new study published in JAMA Internal Medicine, more than any other industry, including the oil and gas industry.”

*

Michael Ollove, “Medical groups slam Trump Medicaid rule,” Stateline, Feb 28, 2020

Trump Administration looking for ways to cut Medicaid and Medicare under the rubric of fighting fraud. “If the rule is implemented, there will be locations that will close, especially in rural areas.” Good thing rural people don’t need hospitals these days!

*

Posted March 26, 2020

Zach Carter “Democrats are handing Donald Trump the keys to the country,” HuffPost, Mar 25, 2020

Bailout money will flow to rich people with bipartisan collusion. “The Senate coronavirus bill is not an economic rescue package, but a sentence of unprecedented economic inequality and corporate control over our politics that will resonate for a generation.” Litany of disaster: the bill permits bailed out companies to lay off up to 10% of their workforce over the next six months; Mnuchin can let all future profits accrue to the companies, not the government that saved them; restrictions on stock buybacks are weak and short-term; dividends still permitted; the “independent auditor” provision is a joke—corporations will ignore him & nothing will happen. In short: Democrats, who just impeached Trump for misconduct over funds, now hand him trillions to play with.

*

Wendell Potter, “Coronavirus pandemic reveals just how devastating the greed of for-profit insurance industry has become,” Tarbell, Mar 18, 2020

From a former industry PR executive: “Behind the PR spin, they’ll be doing everything they can to deny care and maintain profits while making it look like they’re heroes.” Insurance companies happy to give you COVID testing (which the government will reimburse), but your copays for treatment will remain. [Update: Aetna and other companies announced they will drop copays for treatment.]

*

Erica Werner, Mike DeBonis & Paul Kane, “Senate, White House reach $2 trillion stimulus deal to blunt coronavirus fallout,” Washington Post, Mar 25, 2020

Amid all the debate on the bill’s particulars, no one is addressing the elephant in the room: what about people who had employer-based health insurance? What do they do now? There seem to be NO provisions for that.

*

Jeanne Whalen, Tony Romm, Aaron Gregg & Tom Hamburger, “Scramble for medical equipment descends into chaos as U.S. states and hospitals compete for rare supplies,” Washington Post, Mar 24, 2020

Not only is there no federal healthcare system, we just barely have a federal country. “A mad scramble for masks, gowns and ventilators is pitting states against each other and driving up prices. . . . Hospitals are requesting donations of masks and gloves from construction companies, nail salons and tattoo parlors.”

*

Isaac Scher, “‘It is unclear why quality control did not detect this issue’: Early CDC tests couldn’t distinguish between coronavirus and water,” Business Insider, Mar 19, 2020

Staggering scientific incompetence from the newly installed ideologues at CDC. Supplier remains unnamed (a Kushner company?)

*

Farhad Manjoo, “How the world’s richest country ran out of a 75-Cent face mask,” New York Times, Mar 24, 2020

By offshoring production and using just-in-time stocking to cut costs. Good for profits! (For emergencies, not so much.) “Two decades ago, most hospital protective gear was made domestically. But like much of the rest of the apparel and consumer products business, face mask manufacturing has since shifted nearly entirely overseas.”

*

Shelby Livingston, “COVID-19 could prompt higher 2021 insurance premiums, benefit cuts,” Modern Healthcare, Mar 23, 2020

How the epidemic will further increase insurance costs if nothing is done to revamp the entire system. “Absent any federal action, those costs could prompt commercial health insurers to increase premiums between 4% to 40% in 2021.” Struggling businesses will either absorb the costs, push them onto their employer-covered workforce, or even drop coverage entirely. Major impact once the dust settles. “This is where there’s no place for insurers to hide.”

*

Allyson Y. Schwartz, “Congress quietly sets a new bipartisan record on health care,” Modern Healthcare, Feb 21, 2020

Overwhelming two-party backing for creeping privatization of Medicare via Advantage supplemental policies. Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance, represented Pennsylvania in the House of Representatives from 2005 to 2015. Revolving doors: the key to prosperity!  

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Christopher Baum, “New York Gov. Cuomo’s panel proposes Medicaid cuts amid coronavirus crisis,” Truthout, Mar 21, 2020

While Cuomo gets national attention for not being completely incompetent, Austerity Andrew stages a stealth strike on the state budget. Stage 1: “strengthen” the public hospitals by slashing their Medicaid payments by $186 million (which the city will have to make up). Very good on neoliberal “lean management,” i.e., “just-in-time” staffing and inventory translated to the hospital sector.

*

Max Blumenthal, “The new Cold War with China has cost lives against coronavirus,” [Chicago] Reader, Mar 24, 2020  

Many examples of focusing on China’s initial cover-up rather than the lessons they could teach us. “The creator of the groundbreaking [40-minute] test, Weihong Tan, was a professor at the University of Florida’s cancer research lab until last year when the Department of Justice targeted him with a McCarthy-style investigation. Accused by a Cold War-crazed U.S. government of failing to disclose Chinese funding for his department, he returned to Hunan University, where he found ample government support for his lifesaving research.”

*

Julia Conley, “‘This is a massive scandal’: Trump FDA grants drug company exclusive claim on promising coronavirus drug,” Common Dreams, Mar 24, 2020

Gilead scores again: “A pharmaceutical company with ties to the Trump administration [but also everyone else in DC] has been granted exclusive status for a drug it is developing to treat the illness—a potential windfall for the company that could put the medication out of reach for many Americans.” Gilead can now enjoy seven years of exclusive profits, “block manufacturers from developing generic versions of the drug” and get grants and tax credits. The “orphan drug” designation was designed to stimulate R&D, but the drug in question already existed, developed with government money, of course.

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Anders Fogh Rasmussen, “Taiwan has been shut out of global health discussions. Its participation could have saved lives,” Time, Mar 18, 2020

Why does Taiwan, just a few miles from China, have only 100 cases? Good public health planning, which thanks for the mainland’s hostility, gets little notice. (Not that anyone here would have paid attention.) Rasmussen was the Prime Minister of Denmark 2001-2009.

*

Anna Irrera & Koh Gui Qing, “How one elite New York medical provider got its patients coronavirus tests,” Reuters, Mar 20, 2020 h

Just pay $5K a year for boutique medical care to get what you need!

*

Chris Talgo, “ObamaCare: 10 years of distress and disappointment,” The Hill, Mar 5, 2020

The author is from a libertarian and conservative think tank, but the critique is devastating. “In its first decade, ObamaCare has failed to solve many of the health care problems it was supposed to address. Even worse, it has compounded many of the issues it was meant to fix.” Good overview of the broken promises: will cut premium costs by $2500 a year (premiums have doubled); will drastically reduce the uninsured population (Medicaid expansion did, but uninsured total today is 28 million and rising); you can keep your health care plan (4.7 million active policies were canceled); you will be able to keep your doctor (false).

*

Posted March 23, 2020

Shashank Benagli & Ralph Jennings, “‘A mess in America’: Why Asia now looks safer than the U.S. in the coronavirus crisis,” Los Angeles Times, Mar 20, 2020

“Suddenly, it seems, the U.S. is the basket case, an aloof, inward-looking power that had already weakened its alliances, failed to lead on global emergencies such as climate change and shrunk in a crisis.”

*

Rachel Cohrs and Jessica Kim Cohen, “Senate GOP wants to suspend Medicare sequester, expand telehealth,” Modern Healthcare, Mar 19, 2020

Now that we have to test and treat massively, even (some) Republicans are pulling back from slashing Medicare and Medicaid. “The sequester, which reduced spending for most benefits by 2% starting in 2013, would be suspended from May 1 to December 31, 2020.” After that, we can get back to destroying both.

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Brooke Seipel, “US woman gets $34,927.43 bill for coronavirus treatment,” The Hill, Mar 20, 2020

Uninsured. As will be soon many of those with employment-based insurance. Cost of the COVID-19 test alone: $907.

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John Buell, “Why Americans should stop talking about “China Flu” and learn some things from China," Informed Comment, Mar 20, 2020

“Trump’s insistence on calling the virus the China virus is not only misleading and a source and intensifier of ethnic conflict. It is also an accelerant of the pathogen.” We need cooperation, not finger-pointing (though criticism of the Chinese response is legit).

*

Jill Burcum, “Coronavirus pandemic: What’s ‘normal’ now? What’s next? An interview with Michael Osterholm,” [Minneapolis] Star-Tribune, Mar 22, 2020

“None of this was really that difficult. It was pretty straightforward right in front of us. People who knew health care knew that health care [had been] carved down to the bone for which there was no resiliency of any substantial nature, no excess capacity, no monies to stockpile large volumes of protective equipment.” But no one was listening. Of interest: he notes that school closings apparently had no effective on the epidemic in Hong Kong.

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Robin Young & Allison Hagan, “While some wait for COVID-19 tests, the wealthy cut the line,” WBUR (Boston), Mar 19, 2020  

Queue-jumping by rich people. “One concierge doctor who stocked up on virus swabs is organizing drive-through testing in Silicon Valley for his clients only.” Harvey Weinstein got a test in prison.

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Maureen Callahan, “‘We should blow up the bridges’ — Coronavirus leads to class warfare in Hamptons,” NY Post, Mar 19, 2020

The rich are not like you and me. “A wealthy Manhattan woman who tested positive called tiny Southampton Hospital to say she was on her way and needed treatment. The woman was told to stay in Manhattan. Instead, she allegedly got on public transportation, telling no one of her condition. Then she showed up at Southampton Hospital, demanding admittance.” Southampton has four ICU units and but only one guillotine.

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David H. Freedman, “Is Bernie Sanders right about Medicare for All? How government-run health care actually works,” Newsweek, Mar 16, 2020

Cover story and excellent corrective to the “government takeover” talking point: guess what, it already exists. “It's taken on the care of millions of some of America’s most challenging patients, including residents of isolated rural communities and older patients who need long-term care. It trains most of America’s doctors. It is a leader in telehealth, electronic health care records, precision medicine and many other important, forward-looking technologies. It earns quality-of-care ratings that most hospitals would envy. It keeps costs generally below average and charges most patients little or nothing. The system is the Veterans Health Administration. . . . If that’s not socialism, what is?”

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Lee Fang, “Banks pressure health care firms to raise prices on critical drugs, medical supplies for coronavirus,” The Intercept, Mar 19, 2020

How to profit from a catastrophe. Forgot toilet paper hoarders, these are the real sociopaths. Remdesivir is the hands of Gilead (which did not discover it), the same company that has made billions on marketing a Hepatitis C treatment that it also didn’t discover. U.S. Pharma has not been particularly interested in low-profit vaccine development, unlike peers in Germany, China, and Japan.

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By Jordan Fabian, “Trump told governors to buy own virus supplies, then outbid them,” Bloomberg, Mar 19, 2020

The Federal Government is “not a shipping clerk,” said Trump.

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Whitney Webb, “U.S. intel agencies played unsettling role in classified coronavirus response plan,” Mint Press, Mar 13, 2020  

How classifying top-level meetings on domestic coronavirus response as “top secret” hampered the response. “The classification decision prevented key experts from participating in meetings and slowed down the ability of HHS and the agencies it oversees” while shifting responsibility to the military and spooks, probably so that they could use the crisis against Iran and China. Meanwhile, they all knew the epidemic would explode and let Trump deny it.  *

And finally, one non-corona story:

John Horgan, “The cancer industry: Hype vs. reality,” Scientific American, Feb 12, 2020

Lots of healthcare spending, marginal benefits to patients.

Posted March 13, 2020

Shelby Livingston, “CMS encourages Medicare Advantage plans to remove barriers to COVID-19 care,” Modern Healthcare, Mar 11, 2020

“Encourages”? Why can’t the government order them to provide the service in the midst of a national emergency?

*

Sarah Karlin-Smith, “How the drug industry got its way on the coronavirus,” Politico, Mar 5, 2020

“Industry lobbyists successfully blocked attempts this week to include language in the $8.3 billion emergency coronavirus spending bill that would have threatened intellectual property rights for any vaccines and treatments the government decides are priced unfairly.” So the government ponies up $3 billion for the pharmaceutical companies to take over marketing and profits once the vaccine exists. Meanwhile, promises of “access” to treatment are as meaningful as “access” to the Ritz Carlton. Pelosi is okay with it.

*

Christopher Rowland & Peter Whoriskey, “U.S. health system is showing why it’s not ready for a coronavirus pandemic,” Washington Post, Mar 4, 2020

Hospitals and doctors “improvise emergency plans daily, even as they remain uncertain how bad the crisis will get.” States take action but not the MIA federal government. And no gowns or masks from China, where we have outsourced production. Meanwhile, many nursing home employees get no sick leave.

*

Vera Bergengruen & W.J. Hennigan, “‘Doomed from the start.’ Experts say the Trump Administration’s coronavirus response was never going to work,” Time, Mar 5, 2020

“Everything is under control” has a comforting ring, but wishing doesn’t make it so. “COVID-19 has likely been spreading in Washington state since mid-January, weeks before the U.S. implemented travel and quarantine measures.”

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Jennifer Wright, “Four disastrous mistakes that leaders make during epidemics,” Washington Post, Mar 3, 2020

(1) Deny the disease exists or, if it exists, say it’s not a big deal; (2) suppress scientific information; (3) blame vulnerable minorities; (4) say anyone who gets sick had it coming. Trump is 4 for 4.

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Trudy Lieberman, “Thinking about health: Generic drugs not always equivalent, sometimes dangerous,” Tarbell, Mar 2, 2020

“We are dependent on distant drug manufacturers yet have little visibility into their methods.” FDA oversight is light, and “no law requires a drug maker to disclose the country of origin for either the ingredients or the manufacturing of the drug itself.”

*

John Buell, “Will DC’s neoliberal model of drug costing finally kill us all?” Informed Comment, Mar 9, 2020

Why is there even a debate on how to pay for an eventual vaccine? The polio vaccine was developed by a nonprofit and distributed for free.

*

Jay Hancock and Elizabeth Lucas, “VCU Health halts 30-year campaign that seized patients’ wages, put liens on homes,” Kaiser Health News, Mar 11, 2020

VCU [Virginia Commonwealth University] slammed by bad publicity, finds Jesus, asks for forgiveness for trying to seize patients’ homes. Debt jubilees were an essential part of the ancient Babylonians’ rule—we could try catching up to them. “Forgive us our debts as we forgive our debtors.”

*

Abha Bhattarai & Peter Whoriskey, “Companies are putting out hand sanitizer. But for years, many have campaigned against sick pay,” Washington Post, Mar 9, 2020

“At least a dozen states, including Florida and much of the Southeast, have passed legislation since 2011 to block efforts to require medical leave. Stopping Orlando’s sick pay requirement, former governor Rick Scott (R) said at the time, was ‘essential to ensuring a business-friendly environment.’” Any regrets? New fun term: “contagious presenteeism.”

Posted March 9, 2020

Mary T. Bassett & Natalia Linos, “The coronavirus could hit the U.S. harder than other wealthy countries,” Washington Post, Mar 2, 2020

What makes us especially vulnerable: low trust in institutions, disdain for science, “truthiness,” officials making stuff up, and of course the skewered healthcare financing system. How many people will avoid seeking care for a fever due to cost? Not mentioned: dismantling of public health departments to save money for finer things.

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Anonymous, “Statement by a quarantined nurse from a northern California Kaiser facility,” California Nurses Association/National Nurses United, Mar 5, 2020

Real-life incompetence at the top: a nurse treating a coronavirus patient gets sick, can’t get “authorization” from the CDC for a test. Meanwhile, South Korea, a first-world country, performs 10,000 tests a day at ten-minute drive-throughs.

*

Robinson Meyer & Alexis C. Madrigal, “The strongest evidence yet that American is botching coronavirus testing,” The Atlantic, Mar 6, 2020

Former CDC director Friedan: “I don’t know what went wrong this time.” As the data on total tests performed is incomplete and perhaps not even gathered, we have no idea of the denominator to calculate positives/total tests. Louisiana’s governor helpfully provided his state’s: 0 positive out of 5 tests. Reassuring.

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Ben Conarck, “A Miami man who flew to China worried he might have coronavirus. He may owe thousands,” Miami Herald, Feb 24, 2020

Probably a lazy “taker” just trying to get healthcare for free at the expense of hard-working Americans. “Azcue [who had signed up for a junk plan to save on premiums] said he heard from his insurer that he would also have to provide three years of medical records to prove that the flu he got didn’t relate to a preexisting condition.”

*

Yves Smith, “Mr. Market loses it over coronavirus risk: Oil tanks, S&P futures trades halted on limit down overnight, gold jumps,” Naked Capitalism, Mar 9, 2020

Scroll past the financial round-up to Smith’s review of the unfolding nightmare in Italy and the likely incapacity of the U.S. healthcare system to cope.

*

Craig Murray, “Momento Mori – Unpopular thoughts on corona virus,” craigmurray.org.uk, Mar 7, 2020

“Consider this: 100% of those who contract coronavirus are going to die. 100% of those who do not contract coronavirus are also going to die.” Welcome perspective.

*

Rachel Cohrs, “Colorado public option fight kicks off as hospitals push alternative,” Modern Healthcare, Mar 5, 2020

The state is pushing a weak-tea version of the “public option” alternative to M4A, described as a “privately administered public insurance option in the individual market.” That should be complex and confusing enough to satisfy most centrist corporate lobbyists, but alas, the state’s hospital association opposes the program because it might actually give the state some say over pricing.

*

MSNBC, “Trump response to coronavirus compared to Wilson and ‘Spanish Flu,’” Mar 8, 2020

Fascinating look at how Woodrow Wilson covered up the “Spanish” flu to pursue war aims, leading to millions of deaths. War-time censorship empowered him to do so. BTW, a more accurate name for it would be “American” flu. Spain got the blame because as a neutral country in WW1, it did not hide its numbers.

*

Ben Schreckinger, “James Biden’s health care ventures face a growing legal morass,” Politico, Mar 9, 2020

Another Biden relative (James, “sometimes business partner” of nephew Hunter) emerging from the swamp. Rich targets abound.

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Liucija Adomaite & Mantas Kačerauskas, “27-hour hospital stay leaves parents of a killed one-year-old not only in grief but also in $175K of medical debt,” Bored Panda, Feb 27, 2020

Today’s horror story.

Posted March 5, 2020

Toluse Olorunnipa, Josh Dawsey & Yasmeen Abutaleb, “Pence seizes control of coronavirus response amid criticism of his qualifications,” Washington Post, Feb 27, 2020

All statements on the outbreak must pass through the White House and, presumably, reflect Trump’s Pollyannish spin.

*

Monique O. Madan, “Immigration officials vow not to raid hospitals as coronavirus spreads,” Miami Herald, Mar 4, 2020

Great way to make sure people don’t report to healthcare facilities when they feel sick—induce fear of deportation. Immigrants are over-concentrated in service roles, meaning they tend to have contact with large numbers of people. Does anyone trust the Trump Administration to rein in ICE raiders? HIPAA protects medical privacy, but will any hospital openly state they will not cooperate with ICE and risk Trump’s wrath sooner or later?

*

Jonnelle Marte & Heather Timmons, “Fragile safety net leaves U.S. economy vulnerable to coronavirus hit,” Reuters, Mar 4, 2020

Workers who cannot take sick days are more likely to go to work sick and infect others. This is not hard. In a survey, “54% [of all workers] said they were not financially prepared to handle a contagious disease that may limit their ability to work for weeks.” Also, those laid off in ten states will find their unemployment benefits skimpier than after the 2008-09 bust.

*

Noah Smith, “Coronavirus might make Americans miss big government,” Bloomberg, Mar 4, 2020

Tragicomic list of all the ways the U.S. has bungled the response.

*

Gavin Yameymarch, “A coronavirus vaccine should be for everyone, not just those who can afford it,” STAT, Mar 5, 2020

Appalling and disgraceful that we even have to discuss this. “[D]espite taxpayer funding of these [vaccine development] efforts, Azar speculated that vaccines might not be affordable to all.”

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Sara R. Collins & David Blumenthal, “Why the coronavirus crisis proves we need universal healthcare,” Los Angeles Times, Mar 5, 2020

The epidemic may generate pressure to reverse some of Trump’s Medicaid cuts.

*

Yvette Stephens, “I work at the airport in the eye of the coronavirus without health insurance,” USA Today, Mar 3, 2020

Thousands of airport workers are uninsured. The author got a pay raise and lost Medicaid eligibility, recounts hair-raising personal stories among her co-workers. However, her proposed solution is a band-aid to protect workers like herself rather than a universal coverage plan.

*

Lev Facher, “Trump’s tone toward pharma shifts, as he looks to drug makers to help with coronavirus response,” STAT, Mar 2, 2020

From a scolding over drug pricing to happy talk about a coronavirus vaccine with Pharma “geniuses.” Next: will Trump break with the anti-vaxxer crowd?

*

Eion Higgins, “‘What more do you need to know?’ Health insurance stocks drive Wall Street rebound on Biden Super Tuesday wins,” Common Dreams, Mar 4, 2020

Cigna up 10%, UnitedHealth Group 12%, Anthem 14%.

Posted Feb 20, 2020

Adrienne M. Gilligan, et al., “Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer,” American Journal of Medicine, Oct 2018

Fascinating concept: “financial toxicity.” A representative sample of cancer patients showed that the average hit to net wealth was $92,098 with 42% experiencing “complete asset depletion,” academic-speak for total wipe-out, after two years. Financial burden “worsened with improving diagnosis,” so if the cancer doesn’t kill you, the bills will. The impact on morbidity is so severe that these clinicians treat financial aspects as part of their duties of disease management.

*

Michael Hiltzik, “Trump’s budget proposal shreds Social Security and Medicaid benefits,” Los Angeles Times, Feb 10, 2020

Dismantles the official talking points about the Trump budget to expose the class war underneath.

*

Ben Conarck, “Miami woman doing 35 years in prison for bilking Medicare gets sentence commuted by Trump,” Miami Herald, Feb 18, 2020

Keep in mind the next time a Trump Administration official insists that cutbacks in Medicaid or food stamps are designed to “reduce fraud.”

*

Matt Bruenig, “The Culinary [Union’s] health insurance is not that great,” People’s Policy Project, Feb 13, 2020

The reports on this dust-up between the big Las Vegas union and Bernie Sanders has not included detail about the supposedly great employer-based insurance that the union has won for its members. Here are some surprising facts about the insurance-everyone-loves.

*

Michael Sainato, “‘We can’t afford healthcare’: US hospital workers fight for higher wages,” Guardian, Feb 17, 2020

Hospital employees organize to improve pay, working conditions, and yes, health insurance that they can actually use.

*

Alison P.Galvani, et al., “Improving the prognosis of health care in the USA,” Health Policy, Feb 15, 2020

Another academic study endorsing the single-payer approach as fairer, cheaper, and “would save more than 68,000 lives and 1·73 million life-years every year compared with the status quo.”

*

Elisabeth Rosenthal, “Who’s profiting from your outrageous medical bills?” New York Times, Feb 14, 2020

Hospitals, doctors, and insurance companies are in a “three-way competition for your money.” The jockeying over legislation reflects the relative strength of each sector’s lobbyists, meaning that the victims of this gouging are a distant fourth.

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Igor Derysh, “American health care system costs four times more than Canada’s single-payer system,” Alternet/Salon, Feb 15, 2020

The U.S. spends $812 billion per year in health administration, or 34% of all health-related spending. On a per capita basis, it is $933 per American (versus $196 in Canada). “The increase in costs was driven in large part due to private insurers’ growing role in administering publicly-funded Medicare and Medicaid programs.”

*

Meris Lutz, “Marietta [GA] sues drug company over medicine that went from $40 to $39,000,” Atlanta Journal-Constitution, Feb 18, 2020

Amazing that Pharma gets away with stunts like this, usually after paying a cost-of-doing-business fine. “Marietta says Mallinckrodt has been able to keep Acthar’s price artificially high by acquiring and then shelving the rights to a cheaper synthetic alternative.”

Posted Feb 18, 2020

Caitlin Oprysko, “Nevada culinary union lays into Sanders supporters after health care backlash,” Politico, Feb 12, 2020

The union slammed M4A, then called the pushback “vicious.” The online bio of the union official cited here, Geoconda Argüello-Kline, notes that she “fled” Nicaragua in 1979 as a political refugee, which strongly suggests that her family backed the Somoza dictatorship. Might explain her hostility to “socialism.”

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Russell Mokhiber, “NPR and the escalating attack on single-payer health care,” Counterpunch, Feb 14, 2020

Beltway hack Mara Liasson coins the term “Mandatory” Medicare for All in an NPR report since people will have to be coerced into not paying for their healthcare. Anticipate NPR’s next attacks on “mandatory clear air” and “mandatory garbage removal.” No discussion of Buttigieg’s “voluntary” coverage that will cost $7,000 in fines if you don’t sign up.

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Roy M. Poses, “What the heck happened to surprise billing legislation?” Health Care Renewal, Feb 10, 2020

A review of how hospital-friendly corporate Democrats blocked a late 2019 deal to end surprise medical bills.

*

Peter Sullivan, “Ex-HHS chief threatens to vote ‘no’ on surprise medical billing measure,” The Hill, Feb 7, 2020

For example, here’s Rep. Donna Shalala (D-Fla.), Obama’s secretary of Health and Human Services, lining up with hospitals and doctor groups controlled by private equity.

*

[No author], “Appeals court rebukes administration’s attempt to force work requirements, other barriers on Medicaid program,” National Health Law Program, Feb 14, 2020

A welcome judicial veto to the Trump Administration’s attempts to gut Medicaid, which, however, will continue.

*

Ian Hill, Emily Burroughs & Gina Adams, “New Hampshire’s experiences with Medicaid work requirements: New strategies, similar results,” Urban Institute, Feb 10, 2020

Yet again, a state’s Medicaid work requirement is shown not to improve entry into the workforce among beneficiaries. However, if the real purpose is to make access to healthcare harder and push people out of the program, then it might be deemed a success.

*

Harris Meyer, “Employer health plan spending jumped 4.4% in 2018,” Modern Healthcare, Feb 13, 2020

How long can the beloved employer-based health insurance system sustain these increases? Four percent a year is more than double core inflation and well above the average pay raise. Average per-person spending for someone with a single chronic condition was $9,187 in 2018.

*

Lauren Weber, “Patients stuck with bills after insurers don’t pay as promised,” Kaiser Health News, Feb 7, 2020

This week’s horror story: “retrospective denial.” When your insurer says yes, then retracts after the bills come in.

*

Catherine Rampell, “On health care, is Trump malicious or just incompetent? Yes,” Washington Post, Feb 3, 2020

“Republicans appear to remain laser-focused on taking insurance away from as many Americans as possible.” While gaslighting the public with a menu of falsehoods.

*

Phil McCausland, “‘On the brink’: Trump's push for Medicaid transparency could worsen rural hospital crisis,” NBC News, Feb 15, 2020

Another example: the Trump Administration’s “financial transparency” rule change designed to further squeeze struggling hospitals, especially those in rural areas. Note that powerful hospital chains are successfully resisting surprise billing legislation while these poorer players are on the chopping block. “The closing of rural health care facilities increased the mortality rate in those populations by 5.9 percent.” Is that a bug or a feature?

Posted Feb 11, 2020

Jess Mason, “Trump slashes foreign aid, cuts safety net programs in new budget proposal,” Reuters, Feb 9, 2020

Cuts to Medicaid, Medicare, disability, and other safety-net programs would total $4.4 trillion over 10 years. In response, will the Dems (1) refuse to succumb to deficit panic; (2) exercise their veto over the runaway war budget; or (3) accept social spending cuts in principle, insist on a little less, then claim they did the best they could?

*

Jonathan Cohn, “The Trump Administration is coming for Medicaid again,” HuffPost, Jan 30, 2020

Block grants offer “flexibility” to help states cut coverage and dump beneficiaries, described by the Trump official in charge as “providing better care at a lower cost.” Also includes user fees and lots of talk of “sustainability,” meaning cuts now or cuts later. Plus, states can keep money in block grants not spent on healthcare, so they will have an incentive to grab the cash for other projects.

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Amy Goldstein, “Trump administration’s Medicaid block-grants option touches off ideological fight,” Washington Post, Jan 30, 2020

The Trump block grant proposal targets “able-bodied” beneficiaries, code for nonwhite people who sit around inventing healthcare needs. Broader attacks on other undeserving poor people will follow.

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Doktor Zoom, “Utah flies public employees to Mexico to fill prescription and isn’t that normal?" Wonkette, Jan 06, 2020

RX tourism—expect to hear more about it! “The cold equations mean that it’s literally far cheaper, by thousands of dollars, to fly teachers and office workers—plus a friend!—from Salt Lake City to San Diego, then drive ’em to Hospital Angeles, in a nice upscale part of Tijuana, instead of paying what US pharmaceutical companies would charge.” State of Utah saved $225,000 so far on only ten employee beneficiaries. Next stop: a Vancouver airport pharmacy. This is not excerpted from a science fiction novel.

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CBS NEWS [no byline], “‘You wouldn’t think you’d go to jail over medical bills’: County in rural Kansas is jailing people over unpaid medical debt,” Feb 9, 2020

Local lawyer figured out a new business plan: force medically indebted folks to show up in court every three months for a public shaming, then put them in debtors’ prison if they don’t.

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Dan Primack, “Health care VCs haven’t made plans for a Bernie Sanders win,” Axios, Feb 5, 2020

VC=venture capitalist, the guys who scratch around the economy for quick payouts. They’re not worried since Bernie can’t win.

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Martha E. Gaines, Austin D. Auleta & Donald M. Berwick, “Changing the game of prior authorization: The patient perspective,” JAMA (Journal of the American Medical Association), Feb 3, 2020  

Significant that the AMA is questioning pre-authorization abuse, including the (incredible) “retrospective denials” that saddle patients with bills after they have obtained the go-ahead.

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Megan Messerly, “Culinary Union suggests Sanders, Warren asking union members to trade health plans for ‘promises,’” Nevada Independent, Feb 7, 2020

Union officials say they support the right to healthcare but want to preserve their 130,000 members’ high-end plan, provided “through a special trust fund.” The trust fund must be enormous. Does the union run it in-house? Incidentally, the Nevada Independent is the originator of the tale of the 2016 caucus chair-tossing incident that never happened and marked the onset of the “Bernie Bro” narrative.

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STATE WATCH: GEORGIA

Steven Findlay, “Feds slow down but don’t stop Georgia’s contentious effort to ditch ACA marketplace," Kaiser Health News, Feb 7, 2020

Georgia proposes to bar residents from the federal Obamacare health insurance exchange in favor of forced enrollment with private companies. Cost savings plan includes the possibility of a waiting list if the pre-set spending cap is reached. Insurers could also sell plans that don’t comply with ACA requirements. “For example, one proposed type of plan could cover just half of a consumer’s costs for care, as opposed to the 80% to 90% levels of ACA’s silver and gold plans. Such a plan would have lower premiums but sharply higher out-of-pocket costs.”

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STATE WATCH: TEXAS

Mitchell Schnurman, “Will voters revolt over health care prices? Texans have plenty of reason to push for change,” Dallas Morning News, Feb 9, 2020

“A growing number of Americans who have health insurance are finding it too expensive to use.” This category (the “underinsured”) is now 25% of all Americans; in Texas it’s almost 50%. “Most Americans are saying they’re ready to give up on the private sector,” said Den Bishop, president of Holmes Murphy, an insurance brokerage and consulting firm. “We’re absolutely at a tipping point.”

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STATE WATCH: OHIO

Cathy Candisky, “Cause for alarm: Thousands more Ohio children have lost health insurance,” Columbus Dispatch, Jan 6, 2020

Rates of uninsured children are creeping up, despite the low unemployment. Reasons are people earning too much to qualify for Medicaid and a “time-consuming and cumbersome” annual renewal process, plus cuts in federal outreach and enrollment assistance.

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STATE WATCH: OHIO

Laura Hancock, “State reveals $1.2 billion Ohio Benefits system riddled with defects a year out from Medicaid work requirements,” cleveland.com, Jan 16, 2020

Another software debacle. System doesn’t work; meanwhile, Ohio is gearing up to add work requirements, guaranteeing further dysfunction.

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STATE WATCH: CALIFORNIA

Melody Gutierrez, “California eyes selling its own brand of generic prescription drugs to battle high costs,” Los Angeles Times, Jan 9, 2020

California would become the first state to sell its own brand of generic prescription drugs. The proposal also includes merging all state providers to negotiate drug prices as a bloc.

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STATE WATCH: TENNESSEE

Nathaniel Weixel, “Democrats warn against Tennessee Medicaid block grant,” The Hill, Jan 14, 2020

What are the chances that “vigorous oversight” will happen or be effective in the face of the huge incentive to save Medicaid block-grant money and spend it elsewhere? Block grants are inconsistent with the original Medicaid legislation, but interpretation will depend on Trump-appointed judges.

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STATE WATCH: IOWA

Jeff Stein, “Most Iowa Democratic caucus-goers support a single-payer health-care plan," Washington Post, Feb 3, 2020

These polls bring in wildly divergent results, usually attributable to differences in phrasing of the question.

Posted Feb 3, 2020

Terri Wilder, “Oral arguments in antitrust case against HIV drug companies began last week. Plaintiff Peter Staley explains the case,” The Body Pro, Jan 28, 2020

This week’s must-read: a lawsuit aims to discover whether Gilead illegally kept generic HIV medications off the market through a secret deal. ACT UP stalwart Staley is a plaintiff, and the article includes background on how activism scored earlier successes against Pharma. Many useful insights.

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Michael Elsen-Rooney, “Queens College professor says he fears financial ruin over cost of crucial HIV drugs under CUNY union’s healthcare plan," New York Daily News, Nov 13, 2019

Local professor finds that a loophole in his coverage puts him on the hook for tens of thousands of dollars for his HIV medication. “I always thought having a full-time job at a big-time institution meant I had a certain kind of security around things like healthcare,” he said. ACT UP is on this.

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Rachel Cohrs, “Healthcare industry launched lobbying blitz ahead of year-end spending deal,” Modern Healthcare, Jan 24, 2020

Pharma, hospitals, and doctors spent big and scored big. “The Greater New York Hospital Association, an influential force in Senate Minority Leader Chuck Schumer’s (D-N.Y.) home state,” threw in hefty bags of cash. Schumer coincidentally intervened against the surprise billing legislation, which had bipartisan support but tanked at the last minute. Tax repeals amounting to $400 billion of lost revenue did pass, so the companies are getting huge returns on their paltry investments in elected officials.

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Jake Johnson, “Medicare for All ‘is what patients need’: New Harvard study shows even those with private insurance can’t afford care,” Common Dreams, Jan 27, 2020

Sicko by Michael Moore made the same point in 2007. The Harvard study shows financial obstacles among the insured “no improvement in unmet need for physician services.” In fact, their data indicates things have got worse.

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Rachel Cohrs, “States could be next trailblazers for policy regulating hospital costs,” Modern Healthcare, Jan 18, 2020

“The healthcare industry is worried enough that a national coalition has spent six figures advertising against [the Colorado public option] proposal.” State-level fights may be the best tactic for now in the absence of federal action. Note that the ferocious opposition is against a plan that would be run by private insurers, i.e., any change to the status quo will be resisted.

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Luke Darby, “Health-care CEOs made an infuriating amount of money last year,” GQ, Apr 8, 2020

From April, in case we had forgotten: “Last year, 62 CEOs of health-care companies made a combined total of $1.1 billion in compensation.” Or about $17 million each. Or more than the CDC spends on disease control.

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Shannon Brownlee & Judith Garber, “Fragmented health system contributes to medication overload for seniors,” Modern Healthcare, Jan 30, 2020

How overprescribing by specialists not communicating with each other endanger elderly patients.

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Melissa Healy, “US health system costs four times more to run than Canada's single-payer system,” Los Angeles Times, Jan 8, 2020

Medical admin and insurance company employees “who play no direct role in providing patient care” cost every American man, woman and child an average of $2,497 per year. In Canada, the equivalent cost is $551 per person.

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Sam Finkelstein, “Buttigieg backed by Pharma lobbyist who sought drug price hikes in poor countries,” Sludge, Jan 30, 2020

Touting his seasoned foreign policy team, Mayor Pete failed to vet a top Pharma lobbyist on his list.

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Jake Johnson, “'Cruelty is the point’: Trump takes aim at Medicaid with plan that could harm millions,” Common Dreams, Jan 24, 2020

Trump ramping up the block grant idea to indirectly slash Medicaid.

Posted Jan 22, 2020

Jon Queally, “In historic shift, second largest physicians group in US has new prescription: It’s Medical for All,” Common Dreams, Jan 20, 2020

A huge move toward single-payer from a major group of MDs despite a glaring inconsistency: they simultaneously endorse single-payer AND a public option, which are incompatible.

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Jonathan Cohn, “‘Medicare For All’ has real trade-offs. So does the public option,” Huffington Post, Jan 22, 2020

A fair summary of the current debates although laughably gullible on the “public option” pushed by some candidates, both in terms of its operations and its political viability. The author also slips fully into the canard that taxes must cover federal spending in the face of overwhelming contrary evidence. The conclusion is incoherent.

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Harris Meyer, “Q&A: Kansas Hospital Association CEO praises bipartisan Medicaid expansion deal,” Modern Healthcare, Jan 14, 2020

Red-state Kansas is on the verge of Medicaid expansion after years of official self-harm. “The expansion is expected to ease the rural hospital crisis in his state, where five hospitals have closed since 2010 and another 29 are on the financial brink.” Interestingly, Kansas Republicans did not insist on a punitive work requirement, citing administrative and legal obstacles. But it did include a “work readiness questionnaire” to make sure lazy & undeserving poor people don’t get a free ride.

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Luke Darby, “72 percent of all rural hospital closures are in states that rejected the Medicaid expansion,” GQ Jul 30, 2019

Background from earlier last year. Fun fact: Utah was the only red state to say yes to Medicaid expansion and has had no rural hospital closures.

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Shelby Livingston, “UnitedHealthcare expects big Medicare Advantage gains in 2020,” Modern Healthcare, Jan 15, 2020

For-profit companies eagerly infiltrate Medicare: “Given Medicare Advantage’s rapid growth and support from the federal government, it’s no wonder health insurers are clamoring for a piece of the lucrative market.”

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Dylan Scott, “Taiwan’s single-payer success story — and its lessons for America,” Vox, Jan 13, 2020

“In the 1990s, Taiwan did what has long been considered impossible in the US: The island of 24 million people took a fractured and inequitable health care system and transformed it into something as close to Sen. Bernie Sanders’s vision of Medicare-for-all as anything in the world.” Read in full for the many fascinating details, including problems of physician burnout. “A majority of people in Taiwan disapproved of the single-payer plan when it took effect,” but today, approval is 80%, and spending as a percentage of GDP is flat.

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Rachel Cohrs, “CMS rejects Wyoming plan to lower air ambulance costs,” Modern Healthcare, Jan 16, 2020

The Trump Administration suddenly discovers federal law and finds a way to prevent a state from providing a universal benefit.

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Priyanka Dayal McCluskey, “State seeks to rein in largely unregulated urgent care industry,” Boston Globe, Jan 20, 2020

New for-profit players in the health field dig in their heels against regulation.

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Ana B. Ibarra, “For 2020, California goes big on health care,” California Healthline, Jan 17, 2020

California might take the lead on forcing drug price negotiations and halting surprise bills. Howls of outrage follow.

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Alex Gangitano, “Progressives raise red flags over health insurer donations,” The Hill, Jan 16, 2020

So far in the election cycle: $4.5 million from four companies although the numbers come from not only the industry and its PACs but also “employees and their immediate families.” So it is not the same as lobbyist cash and may reflect the diverse nature of these insurers’ workforces. Nonetheless, the amounts are a reflection of the health industry’s huge role in the overall economy (currently 18% of GDP).

Posted Jan 13, 2020

Michael Kruse, “The great American health care panic,” Politico, Oct 15, 2018

Over a year old, but could have been written yesterday. Healthcare costs are still the #1 issue on people’s (voters’) minds.

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Bryce Covert, “How Medicaid expansion is transforming politics as we know it,” The Nation, Jan 6, 2020

Medicaid expansion, i.e., enrolling people in a simplified, single-payer system without expensive premiums, deductibles, and co-pays, is extremely popular across all political viewpoints. Who knew?

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Michael Brady, “States can do more to make healthcare affordable, report says,” Modern Healthcare, Jan 7, 2020

Oregon has done best in cramming down costs through “efforts to increase price transparency, creating a permanent organization to oversee healthcare spending, establishing all-payer spending benchmarks and building out claims data for all payers.”