SINGLE PAYER LINKS #246

Posted Dec 28, 2021

Rebecca C. Lewis, “Is it finally, finally the year for the New York Health Act?” City & State, Dec 15, 2021

Runs down the outlook for the NYHA as Gottfried prepares to retire (after 50 years!) In favor of the bill’s chances: Senate leader Stewart-Cousins’ creation of a working group to “build consensus” on its content; supporters’ determination to push it through; Governor Hochul’s non-committal “willingness to discuss the details.” Negatives: public sector union reluctance or outright opposition and the (unmentioned) limitless pockets of the threatened industries. No matter what happens, Gottfried leaves behind a core group of determined legislators and a well-thought-out model bill.

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Health Action Network, “TAKE ACTION—Urge Governor Hochul to VETO A.1396/S.3762!” n.d.  

Health Action Network™ is a front group for the insurer Anthem. It uses this astroturf outfit that sounds like a progressive advocacy group to kabosh a state measure that would cost Pharmacy Benefit Managers (PBMs) money. “As written, this bill eliminates many of the cost-saving tools that PBMs use to help keep drug costs down and improve care.” The cynicism of calling PBMs cost-savers is breathtaking. Expect more of this if the New York Health Act gains support.

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Mark Kreidler, “Why advocates want health care for all Californias—regardless of immigration status,” Capital & Main, Dec 15, 2021

“The consequences of failing to offer even routine health care to all residents of the state can have dramatic, deleterious effects during a health crisis.”

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Fred D. Ledley, “Why the big questions about drug prices are rarely asked: It’s hard to do,” STAT, Dec 16, 2021

This professor and director of a Center for the Integration of Science and Industry asks: “Do pharmaceutical companies have a responsibility to provide medicines to those in need, or is their primary purpose as corporations to maximize value for shareholders? Does government have a responsibility to provide medicines to the public, or is its role to incentivize companies to make medicines available by linking increased profits to the provision of important products?” He tried to get his colleagues to answer these questions with empirical research and ended up only with furious polarization. The study got shelved. Fun fact: “From 2000 to 2018, the 35 largest pharmaceutical companies collectively had revenue of $11.5 trillion, spent $1.8 trillion on research and development, had profit measured by net income of $1.9 trillion, and distributed $1.8 trillion of this amount to their shareholders through dividends or stock buybacks.”

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Vinay Prasad, “At a time when the U.S. needed Covid-19 dialogue between scientists, Francis Collins moved to shut it down,” STAT, Dec. 23, 2021

Prasad is a critical, non-Fauci-worshipping voice and worth hearing out. Here, he criticizes NIH head Collins for calling outsider voices “fringe scientists” and shutting down debate instead of welcoming it. Given the sorry state of public health and the politicization of everything, trying to stamp out dissent backfired into mutual demonization, which is where we are now. See some of Prasad’s other work below.

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Alyson Haslam, Mark P. Lythgoe, Emma Greenstreet Akman & Vinay Prasad, “Characteristics of cost-effectiveness studies for oncology drugs approved in the United States from 2015-2020,” JAMA Network Open, Nov 18, 2021

Industry-sponsored studies find that a drug is cost-effective 96% of the time while in those studies where the industry is not involved, the figure is only 30%. “A drug was 40 times more likely to be deemed cost-effective when the study was funded by pharmaceutical companies compared with no funding.” The authors conclude that conflict-of-interest statements are meaningless and that all cost-effectiveness studies should be funded independently. 

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Matthew Herper, “FDA authorizes Merck’s Covid-19 pill but stresses its use should be limited,” STAT, Dec. 23, 2021

Another questionable OK from the increasingly discredited FDA: emergency authorization for Merck’s molnupiravir Covid treatment. The vote was a narrow 13-10 among the expert reviewers, not as egregious as that of the Aduhelm scandal but hardly reassuring given that the drug is “only modestly effective” and can cause birth defects. Recall that Merck initially said it reduced hospitalizations by 50% (faithfully echoed by the specialty media via science-by-press-release), then had to admit the real figure was 30% when revealing the full data. “Another concern raised at the advisory committee for molnupiravir was that the drug might lead to new variants of SARS-CoV-2 because of its mechanism of action,” i.e., inducing mutations. One commentator wrote: “There is no way a vote of 13-10 should be sufficient to approve any drug. This is not a goddamn election!”

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William A. Haseltine, “Harming those who receive it: The dangers of molnupiravir (part 2),” Forbes, Nov 2, 2021

Written before the FDA approval: “The drug inserts errors into the virus’ genetic code every time it copies itself. Insert enough errors and you essentially kill off the virus, preventing it from replicating any further. The trouble with the drug, however, is that its mutagenic powers may also create havoc among other enzymes in the body, including the nucleic acids in our own healthy DNA.” Another FDA-approved Merck drug, the Vioxx painkiller, killed an estimated 56,000 people and gave another 140,000 persons heart disease before being withdrawn from the market. But molnupiravir is an expensive Pharma pill, so the same reporters who mock ivermectin as “horse tranquilizer” only taken by stupid bubbas treat it reverently.

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Neil Bedi & Maryam Jameel, “‘Get this thing out of my chest,’” ProPublica, Dec 20, 2021

“A life-sustaining [Medtronic] heart pump was taken off the market after years of problems and FDA inaction. Thousands of people are now stuck with it embedded in their hearts. Most of all, they now live with the stress of knowing the HeartWare Ventricular Assist Device has such serious issues—a higher rate of deaths and strokes than an alternative pump and a history of unexplained malfunctions—that the Food and Drug Administration and the device’s maker agreed this summer it should be taken off the market.” But surgery to get it out is more dangerous than leaving it in. Another massive FDA fail.

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Yves Smith, “California suit takes aim at private equity engaging in illegal practice of medicine by owning outsourced MD practices,” Naked Capitalism, Dec 22, 2021

Finally, someone is taking on private equity’s steady invasion of our bodies via the healthcare “system.” Non-MDs are not authorized to practice medicine. (Try it yourself and see what happens.) They also brought us surprise billing. The article embeds the legal document at the end—reading through those things can be very educational.

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Beth Mole, “Stripped of power, Missouri health depts abandon COVID health measures,” Ars Tecnica, Dec 12, 2021

“Local [Missouri] health departments are abandoning efforts to stop the spread of the pandemic disease, saying their hands have been tied by the state’s attorney general and a recent court ruling. One local agency announced that it has ceased all COVID-19-related work, including case investigations, contact tracing, quarantine orders, and public announcements of current cases and deaths.” The plaintiff sued over any and all “restrictions to prevent the spread of disease.” Will they next sue the USDA to stop it from inspecting food?

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Helaine Olen, “Trump had a scheme to privatize Medicare. The Biden Administration isn’t stopping it,” Washington Post, Dec 13, 2021

Points out that Biden’s people are doing little to stop the stealth privatization of Medicare through Direct Contracting.

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Ryan Grim & Austin Ahlman, “Medicare privatization scheme faced legal questions about profiteering,” The Intercept, Dec 14, 2021

Direct Contracting again. Turns out the brains behind it belonged to CMMI director Adam Boehler, “a former dorm-mate of Jared Kushner.” The original program document specifically mentioned Boehler’s buddies at certain companies, such as Chen Med, Oak Street Health, and Verily, suggesting that “this model has been designed with specific private sector entities in mind.” Why won’t the incoming Biden people stop continued grifting by Trump’s relatives and their childhood friends? Maybe because they can insert a hand into the till also: “The trend is bipartisan. Andy Slavitt, Obama’s head of CMS and an outspoken resistance Democrat, has now linked up with Oxeon—the same VC firm that was funding Boehler—for his own direct contracting enterprise.”

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Joanna Robin, “The troubled insurance sales firm behind those Joe Namath ads for Medicare Advantage,” New Republic, Dec 13, 2021

“Benefytt Technologies has been shaking off lawsuits and regulators for years. It’s now peddling Medicare Advantage plans to seniors,” plans sometimes called “massively deceptive.” Namath’s smiley face touting the company’s products has been seen 7.7 billion times.

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April Simpson, “‘Poor folks trying to make it as best we can’: Surviving Mississippi’s miserly healthcare system,” ProPublica/Center for Public Integrity, Dec 16, 2021

The usual horror stories of how Mississippi punishes the poor when it could save money by not punishing them. It also threatens the state’s struggling hospitals. “Since Louisiana expanded Medicaid in 2016 [by executive order, sidestepping the reactionary state legislature], uncompensated care costs dropped 55% among the state’s rural hospitals.” But Mississippi prefers to spend its money on continued repression even if everyone’s life is made more miserable as a result.

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Anthony Kuhn, “The riddle of Japan’s dramatic drop in COVID numbers,” NPR, Dec 20, 2021

Japan is doing well with omicron, seeing a 99% drop in cases from 2020 peaks, and no one can quite figure out why. Predictably, the ivermectin wars cropped up with the for and against sides battling it out. Japan has a high vaccination rate, and mask-wearing is nearly universal. But that’s also true in South Korea, which has an exploding epidemic. Then someone noticed that the head of the Tokyo Medical Association had recommended ivermectin use, and the Covid culture wars were off and running. There’s no definitive answer, but everyone thinks they have one. See the next two articles.

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Bruce Y. Lee, “No, ivermectin did not help Japan bring down Covid-19 coronavirus delta surge,” Forbes, Nov 27, 2021

This author belongs to the don’t-be-ridiculous-ivermectin-is-a-horse-tranquilizer school and deploys deep sarcasm to explode the magic drug theory: “Here IVM presumably stands for “ivermectin” rather than “I varnish mangos” or “I value muskrats.” This author presumably insists on a formal randomized, clinical trial to see hard data about ivermectin, but … see the next article.

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Jennifer Henderson, “Ivermectin arm of PRINCIPLE trial put on hold,” MedPage Today, Dec 14, 2021

The ivermectin arm of the U.K.’s PRINCIPLE trial is “currently paused due to temporary supply issues,” according to the trial’s website. No explanation for why, which will stimulate more skepticism and distrust, especially since Merck is the manufacturer/supplier. Merck also has a lot to lose if ivermectin turns out to work since it costs 6 cents per dose—somewhat less than the fancy pharmaceuticals Merck wants to peddle to governments. Despite having no hard data, Merck stated that “the probability of ivermectin providing a potentially safe and efficacious treatment option for SARS-CoV-2 infection is low.” As Mandy Rice-Davies quipped decades ago, “Well, he would [say that], wouldn’t he?”

Posted Dec 15, 2021

STAT, “8 lingering questions about the new Covid pills from Merck and Pfizer,” Nov 15, 2021

“That drug, molnupiravir, reduced hospitalizations by 50% and prevented deaths entirely a large randomized clinical trial when it was given within five days of when symptoms began.” That’s what the Merck news release said, picked up by all and sundry, as in this article. However, when the full data was released later, the efficacy rate dropped to 30% (see article below). If anyone tried to pass off a bait-and-switch like this on the unnamable, cheap (6 cents per dose), public-domain, WHO-approved, antiviral drug already given to over 1 billion people for other diseases (hint: starts with “i”), the Science Police would go effing nuts. But since it’s an expensive Pharma pill of dubious utility, the reporters bow so deeply they have gravel on their foreheads.

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Rebecca Robbins & Carl Zimmer, “Merck’s Covid treatment pill wins blessing of FDA panel,” New York Times, Nov 30, 2021

The vote was a “surprisingly narrow” 13-10, reflecting “doubts about the pill’s effectiveness and concerns that it could cause reproductive harm.” The U.S. has pre-paid for millions of the new pills at $700 per treatment, a bit of a mark-up from the $18 it costs to produce. Note this sentence: “In a clinical trial, molnupiravir was found to reduce by 30% the risk of hospitalization or death.” What happened to Merck’s 50% pre-announcement claim? Not even a reference.

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House Committee on Oversight and Reform, “Chairwoman Maloney releases comprehensive staff report culminating the committee’s sweeping drug pricing investigation,” Dec 10, 2021

“New documents reveal how manufacturers raise prices on lifesaving drugs.” No great mystery: they just do it by changing the price sticker since they can. A crackdown on patent abuse could reduce some of the price-gouging. “Weaknesses in our health care system have allowed them to get away with outrageous prices and anticompetitive conduct.” Stopping it would require the legalized bribery-mill masquerading as a legislature to reform itself. “The drugs in the Committee’s investigation are now priced at a median of almost 500% higher than when they were brought to market.”

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Dean Baker, “Did the pharmaceutical industry buy Senator Sinema a fluff piece in the Washington Post?” Center for Economic and Policy Research (CEPR), Nov 19, 2021

Yes! It did! Sinema headlined her piece, “No one tells me what to do.” Baker: “In fact, there is ample evidence that the pharmaceutical industry and rich contributors tell her exactly what to do.”

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Phil Galewitz, “West Virginia Sen. Manchin takes the teeth out of Democrats’ plan for seniors’ dental care,” Kaiser Health News, Dec 10, 2021

Included for the champion headline. “In West Virginia a quarter of people 65 and older have no natural teeth, the highest rate of any state in the country.” And yet they seem not to think they should replace the elected representative who keeps wrecking their lives.

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Markian Hawryluk, “How rural communities are losing their pharmacies,” Kaiser Health News, Nov 15, 2021

Monopolization of the entire economy drives enterprises like a family pharmacy into near-extinction. “Pharmacy deserts” now affect 41 million Americans. “Independent pharmacies are struggling due to the vertical integration among drugstore chains, insurance companies and pharmaceutical benefit managers, which gives those companies market power that community drugstores can’t match.” Medicare Part D innovations made things worse. Market logic applied to healthcare condemns smaller communities to increasing marginalization from needed services.

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Andy Miller, “A rural Georgia community reels after its hospital closes,” Atlanta Journal-Constitution/Kaiser Health News, Dec 10, 2021

“The EMTs loaded Gipson into the ambulance and drove her more than 25 miles to the hospital in Eufaula, Alabama, where she was pronounced dead” because the local hospital was shuttered. Nineteen rural hospitals have closed in 2020, nearly all in states that refused to expand Medicaid.

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Samantha Reid, “Health care access is hampered by administrative hurdles,” Teen Vogue, Dec 7, 2021

Remarkable Teen Vogue once again pivots away from hair and make-up to hard-hitting reports on teen survival. “Sararosa Davies, a 23-year-old podcast producer from Portland, Oregon, blocks off several hours each Friday to handle administrative tasks related to treating her chronic illnesses.” Another patient: “At some point, you begin to question if seeking care is worth the effort.” Refers to this study in Health Services Research

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Paul Thompson, “Cassava Sciences faces increased scrutiny of Alzheimer's drug, presses ahead with advanced trials,” Austin Business Journal, Nov 19, 2021

Allegations of data manipulation are credible given the ongoing Aduhelm debacle. However, the research scientists who filed a “citizen’s petition” with the FDA complaining about the drug under study are also holders of “short” positions in the company’s stock, meaning that they profit if the stock tanks. It did. Everyone scams everyone, system working.

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Trina Paul, “How to negotiate a medical bill,” CNBC, Dec 13, 2021

News you can use: (1) check the detail. “If you talk to experts who look at medical bills for a living, they’ll tell you that most of them contain some type of error.” Find the five-digit billing codes, and look up what they mean. (You can only look up five a day for free on the AMA website—why isn’t this in the public domain?) Watch for upcoding, i.e., making the charge more complex and costly than merited. Call the billing department to point out discrepancies. (2) Then get the evidence, including your medical records directly from the hospital or your doctor. (3) If the billing office doesn’t budge, consider small claims court. That will “flip the power balance” because the hospital doesn’t want to face a judge or deal with the bother. (4) If you have to pay, negotiate a payment plan. Do not pay with a credit card and get saddled with insane interest charges. If there is no alternative, get a new introductory card with no interest charges for the first year.

P.S. Medical bills should not exist in the first place.

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Anna Werner, “Texas resident gets over $4,000 in bills after getting tested for COVID: “I felt deceived,’” CBS News, Dec 3, 2021

Why appeals to everyone to get Covid tests regularly fall on many deaf ears. The guy’s insurance eventually paid after a year of hassles and collection agency calls.

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John Tozzi, “One state’s history of hospital debt lawsuits reveals racial gap,” Bloomberg, Dec 6, 2021 

Patients are getting sued more than ever. Minority populations are most affected, which surprises exactly no one. And, “Wisconsin nonprofit hospitals were more likely to sue than for-profit medical centers,” the same nonprofits getting tax breaks and extra public money to provide charity care.

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Julie Appleby, “Oncology doctors say the Build Back Better Act will slash cancer care funding—a skewed argument,” Kaiser Health News, Dec 8, 2021

Now that Biden’s BBB plan inches toward (possible) passage, the knives come out to carve up threats to lucrative claims on the public purse. This one is from oncologists circling their IV drips with tendentious paid ads to protect the profits. “The percentage-based payment formula has the unintended consequence of incentivizing expensive drugs over lower-cost options: A 6% add-on to a $10,000 drug translates to a lot more money than for a $1,000 drug.” Therefore, boosting reimbursed spending on expensive drugs gives them a larger slice of a larger pie.

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David Lazarus, “Soaring insulin prices reveal clout, and greed, of healthcare middlemen,” Los Angeles Times, Nov 30, 2012

“The [insulin] patent was made available royalty-free to drug companies to foster widespread use of the life-saving hormone. Drug companies, in turn, did what they do best: They cashed in.” But Pharma is not solely to blame: there is also “a profit-hungry horde of middlemen,” i.e., PBMs, which now hoover up 53% of insulin spending.

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Michael Symons, “NJ looks to take on prescription drug costs with new review board,” New Jersey 101.5, Nov 15, 2021

Argument against: pharmaceutical companies might move to other states, i.e., they could blackmail us.

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Meagan Cuthill, “Oregon pharmacies are short on staff and drug price managers have something to do with it,” Oregon Public Broadcasting, Nov 13, 2021

An Oregon pharmacist: “PBMs were just someone that processed claims on the behalf of insurance, but they have grown and consolidated throughout the entire pharmacy industry to the point now that they have a complete oligopoly on the pharmacy marketplace. Since the pharmacies can’t change what they pay for drugs, and they can’t change what they’re getting paid for drugs, the only thing they can do is cut back their expenses. And the only controllable expenses they have really is staffing.”

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Ricardo Alonso-Zaldivar, “Cap on drug price hikes for privately insured sparks battle,” Associated Press, Nov 21, 2021

BBB includes an “inflation cap” for some drugs. Expect a Jan. 6-style assault on the Capitol by Pharma lobbyists if it nears passage.

Posted Dec 8, 2021

Adam Feuerstein & Damian Garde, “Biogen’s reckoning: How the Aduhelm debacle pushed a troubled company and its fractured leadership to the brink,” STAT, Dec 8, 2021

Best news of the month: Biogen shot itself in the foot by manipulating the FDA process to get its useless drug approved. Now, the authors say, the departure of the company’s chief scientist is an effort to blame him for the disaster. “Biogen is now preparing for its largest-ever layoffs, . . . and the very future of the company may be at stake.” Paywalled.

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Jake Johnson, “Sanders calls on Biden to slash ‘outrageous’ Medicare premium hike,” Common Dreams, Dec 3, 2021

Thanks to the FDA’s sleaze-ridden approval of the Alzheimer’s non-drug Aduhelm, 57 million senior citizens will pay $11.50 more a month in Medicare premiums. Biogen, the drug owner, can set any price it wants, and Medicare has to find a way to pay for it IF it decides to make Aduhelm a reimbursable medication. “The notion that one pharmaceutical company can raise the price of one drug so much that it could negatively impact 57 million senior citizens and the future of Medicare is beyond absurd,” said Sanders. Raise this issue the next time sometimes warns of Medicare’s imminent “bankruptcy.” If the drug completely crashes, could this hike get reversed? Unclear.

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Bram Sable-Smith, “A tale of two Medicaid expansions: Oklahoma jumps in while Missouri lags,” Kaiser Health News, Dec 3, 2021

Oklahoma quickly enrolled over 200,000 people while Missouri dawdles and throws up barriers. OK Republicans even dare to say good things about the program and its impact, and no one has called for them to be lynched. Louisiana, Idaho, and Virginia are also fairly happy with being forced to expand. What gives with Missouri? The article doesn’t say.

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Megan Molteni, “‘Just stupid stuff’: Logistics and lack of testing stymied finding the Omicron variant in the U.S.,” STAT, Dec 2, 2021

We have little genetic sequencing capacity in our balkanized, Rube Goldberg health system. As a result, “it’s less likely that something new and scary [e.g., omicron] will ever get onto a swab, let alone a sequencer. That means public health departments in large parts of the country are still flying blind.”

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Justin Yu, James M. Perrin, Thomas Hagerman & Amy J. Houtrow, “Underinsurance among children in the United States,” Pediatrics, Dec 6, 2021

“From 2016 to 2019, the proportion of US children experiencing underinsurance rose from 30.6% to 34.0%, an additional 2.4 million children. This trend was driven by rising insurance inadequacy, which was mainly experienced as unreasonable out-of-pocket medical expenses.” Hardest-hit households are those with incomes above 200% of the federal poverty line and those with private health insurance, undoubtedly affected by the failure to expand Medicaid in the hold-out states.

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Tahir Amin & Priti Krishtel, “Solving the U.S. drug pricing crisis starts with a crucial confirmation hearing,” STAT, Dec 6, 2021

A new appointee to the U.S. Patent and Trademark Office would oversee a system that is regularly gamed to line Pharma pockets at the expense of patients. “Companies play a numbers game [by] throwing patent applications at the wall to see what sticks. It’s a system that rewards cunning, not genuine invention.” If they score patents on obscure minutiae like converting a medication from a liquid to a tablet, that’s another 20 years of exclusivity. Example: Imbruvica, a cancer drug from AbbVie, which generates billions a year in sales. “AbbVie has filed 165 patent applications on Imbruvica, and the USPTO has granted more than half of them, [extending] Imbruvica’s market monopoly for nine years at an estimated cost to Americans of $41 billion.” The authors run the Initiative for Medicines, Access & Knowledge (I-MAK), an outfit worth looking into.

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Michael L. Millenson, “It’s time to open up health care’s secret analytics,” STAT, Dec 6, 2021

Medicare Advantage plans use consumer data, including “up to 5,000 individually certified variables for every adult in America.” The plan owners don’t advertise this modern way to save themselves money.

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Associated Press, “Health care coverage axed for striking WVa hospital workers,” Nov 11, 2021

Another reminder for union members convinced that they are fine because of employer-provided coverage.

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Wendell Potter, “New rule gives insurers upper hand in surprise billing battles,” Un-covered, n.d.,

The No Surprises Act, set to take effect January 1, was supposed to resolve this ubiquitous scandal and included “a fair, independent dispute process if the physician felt that the payment they received was not right.” But then various government agencies started to tinker with it and set out a new rule to screw things up in favor of insurance companies. “Before the ink was dry, one big insurer, Blue Cross Blue Shield of North Carolina, sent a letter to several hospital-based physician groups demanding an immediate—and in many cases deep—reduction in reimbursement in anticipation of the January 1 implementation of the rules.” What sexual favors were exchanged in the secret warrens of the bureaucracy to undermine this decent law?

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Luke Savage, “Making health care “accessible and affordable” isn’t the same as making it universal and free,” Jacobin, Dec 1, 2021

Highlights the rhetorical sleight-of-hand in the use of the terms “accessible and affordable,” which, when paired with healthcare as a “right,” sound merely like reinforcing flourishes. But saying that healthcare should be “affordable” means accepting that it remain a commodity, which is inconsistent with universality and accessibility. “There is, quite simply, no actual way to make health care a right without removing the logic of commodities from the equation altogether: a route that by definition precludes talk of better ‘affordability’ or ‘access.’”

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[Graphic] Illustration of vertical integration of insurers, PBMs, and providers among the top healthcare mega-corporations: Worth having a look.

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Sarah Pringle, “Carlyle to buy health IT company CNSI,” Axios, Dec 2, 2021

CNSI runs IT systems for state and federal agencies. “This is about modernizing how Medicaid agencies process medical claims and manage provider enrollment,” i.e., figuring out how to upcode and extract the maximum number of dollars from the government. President Biden spent Thanksgiving at Carlyle co-founder David Rubenstein’s Nantucket estate.

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Scott Terry, “Wasted resources,” Tarbell, Sep 8, 2021

A curious thesis: that rallying around issues like abortion, gun rights, and even voting laws drives the polarizing tendencies in society while putting more attention on single-payer would be more unifying. “I contend that a healthier and less stressful population creates a more prosperous country in which the fear of losing power or individual rights that are not necessarily for the public good is less vocal and thus, less prominent in our society.”

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Eli Hager, “Utah makes welfare so hard to get, some feel they must join the LDS church to get aid,” ProPublica/Salt Lake Tribune, Dec 2, 2021

“Utah’s safety net for the poor is so intertwined with the LDS Church that individual bishops often decide who receives assistance. Some deny help unless a person goes to services or gets baptized. . . . Near the start of the pandemic, in a gentrifying neighborhood of Salt Lake City, visitors from The Church of Jesus Christ of Latter-day Saints arrived at Danielle Bellamy’s doorstep. They were there to have her read out loud from the Book of Mormon, watch LDS videos, and set a date to get baptized, all of which she says the church was requiring her to do in exchange for giving her food.” Bill Clinton ended “welfare as we know it,” and this is what we got. The story of how the LDS church moved to substitute itself for New Deal programs, which were very popular in the state (Utahans voted for FDR four times), is interesting.

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Taylor Knopf, “Targeting the opioid crisis, NC lawmakers give $10M to new church ministry,” North Carolina Health News, Dec 6, 2021

The state is sending a succulent grant to a church-linked nonprofit that has no track record in treatment addictions. Now that overdose deaths are over 100,000 a year and the Sackler family is making off with most of its billions, it’s time to find new ways to cash in. Clinton may have ended “welfare as we know it,” but new forms keep cropping up.

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Michael Erman & Julie Steenhuysen, “J&J sees potential for 14 new multibillion-dollar drugs by 2025,” Reuters, Nov 18, 2021

“[J&J] projected average peak sales of $4 billion a year for each.” Meanwhile, it will spin off the consumer health division that is being sued for a carcinogenic product.

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David Lim & Adam Cancryn, “Biden seeks to require private health plans to pay for at-home Covid tests,” Politico, Dec 2, 2021

White House: Go spend money you don’t have on tests, then fight with your recalcitrant insurance company for reimbursement. And then they wonder why people are alienated/pissed off/distrustful of current leadership. Civilized countries just send test kits to everybody.

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Felice J. Freyer & Nick Stoico, “[Mayor] Wu announces free COVID tests, masks, and vaccination clinics to confront ‘urgent situation,’” Boston Globe, Dec 7, 2021  

Twenty thousand free tests to start, plus “expanded access to vaccinations, including at new high-volume clinics and city schools.” Boston sounds civilized.

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Posted Dec 2, 2021

Jake Johnson, “Congress ‘asleep at the switch’ as Biden continues Trump-era ploy to privatize Medicare,” Common Dreams, Nov 30, 2021

Direct Contracting, which “if left unchecked, will hand traditional Medicare off to Wall Street investors.” And Congress won’t even get a vote on it unless they revolt. PNHP seems to be the only entity alert to this or doing anything about it. The lump sum payments contemplated in Direct Contracting will create an incentive to deny care a la Medicare Advantage. What could go wrong? Ironically, it was the ACA (Obamacare) that permitted the government to tinker in this way without congressional approval; the Trumpians took advantage. The government agency cooking this up is “currently headed by Elizabeth Fowler, who previously served as vice president of public policy and external affairs for WellPoint, Inc.—a health insurance giant.” Fowler also helped write the ACA while working for Max Baucus (D-MT).

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Sarah Lazare & Maurizio Guerrero, “He exposed Colombia’s vaccine contracts with big Pharma. Then the right came for him,” In These Times, Oct 18, 2021

Not single-payer nor U.S.-based, but a good look at the vicious tactics that come into play when Pharma billions are threatened.

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Rachel Cohrs, “7 policies in Biden’s spending plan aimed at health equity,” STAT, Dec 1, 2021

“Democrats have made big promises to tackle racial inequities across society” in the mega-bill, including measures “to help make health care services more accessible and affordable for Americans who slipped through the cracks of existing safety-net policies.” In this writer’s mind, then, inequities are strictly race-, not class-based, and any worker not experiencing “racial inequities” is therefore presumed fine. With this framing, Manchin should pay no political penalty for smashing the whole thing to bits.

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Molly Osberg, “Wealthy countries are to blame for the omicron variant’s spread,” New Republic, Nov 29, 2021

“Nationalist vaccine hoarding and pharmaceutical companies’ profit motives have contributed to the endless pandemic. Each day, rich countries provide six times as many booster shots to their citizens as low-income nations give out first doses.” Utterly predictable that potentially dangerous new variants would arise in the ignored and vulnerable South. Fifteen million doses were discarded in the U.S. in the last six months.

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Associated Press, “China to donate 600 million COVID-19 vaccine doses to Africa,” Nov 29, 2021

China is easily winning the PR wars as western countries, helpless to rein in Pharma, hoard their doses for their own populations. China is also producing an additional 400 million doses in Chinese facilities in Africa.

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Sydney Lupkin, “Hormone blocker sticker shock—again—as patients lose cheaper drug option,” Kaiser Health News/NPR, Nov 10, 2012

A family gets a pricey but affordable drug for their daughter’s rare condition but then finds there is a “manufacturing problem” that leaves only the alternative drug that costs 10 times as much—only to discover that the same company produces both at the same facility. Pure coincidence that the cheap one was hit with problems so severe that the company decided to cease production of it entirely. We really live in a gangster state.

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Bob Herman, “Private insurers pay steep markups for hospital drugs,” Axios, Nov 9, 2021

Up to 800%, but the article doesn’t explain why everyone goes along with it. In some cases, padding prices enables everyone to get a larger slice of the expanded pie while premium-payers and governments pick up the tab.

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Robin Respaut, Chad Terhune & Deborah J. Nelson, “Drugmakers pushed aggressive diabetes therapy. Patients paid the price,” Reuters, Nov 4, 2021

Subhead: “America’s losing battle against diabetes.” This one is not a pricing scandal but the deadly effect of pushing a new, arbitrary health goal: keeping one’s blood sugar at artificially low levels. “A drug industry campaign that began two decades ago to promote an aggressive diabetes treatment goal—the A1c below 7%—is driving up episodes of hypoglycemic attack”—which can kill you. Pharma cashes in as doctors start over-prescribing insulin to reach this target, and patient “advocacy” groups, like the American Diabetes Association (ADA), go along with it after getting big “support grants” from insulin manufacturers. “U.S. sales of diabetes drugs soared, to $74 billion last year from $7.3 billion two decades earlier.”

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Jon Hamilton, “New Alzheimer’s drug Aduhelm flops with doctors and patients,” NPR, Nov 8, 2021

“The pendulum of public opinion has swayed strongly against this drug.” And none too soon. Biogen seems to have only a handful of takers while Medicare’s decision on the turkey is pending. See the September story below for a remarkable example.

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Noah Higgins-Dunn, “Do not enter: Biogen reps banned from D.C.-area neurology clinics over controversial Alzheimer’s drug Aduhelm,” FiercePharma, Sep 22, 2021

“The warning is just the latest example of the frosty reception Aduhelm has received since scoring an FDA nod in June.” Frosty.

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Eric Sagonowsky, “Biogen used charity giving to illegally boost multiple sclerosis drug sales, Humana lawsuit says,” FiercePharma, Sep 27, 2021

The company behind the Alzheimer’s scam is accused by an insurer: “Biogen sought to boost sales for multiple sclerosis drugs Tysabri, Avonex, and Tecfidera by ‘seeding’ patients with free sample drugs then ‘sweeping’ them onto Medicare and other government insurance programs through its charity giving.” An old trick that will only go away if other for-profit players stop them since the government only slaps hands with cost-of-doing-business fines. 

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Mark R. Wilson, “Vaccine manufacturers are profiteering. History shows how to stop them,” Politico, Nov 4, 2021

Pfizer’s profit on revenue is in the “high-20” percent while aggregate sales have doubled. Moderna, a tiny outfit pre-Covid, is set to rake in profits of 65% on its sudden windfall. The author, a history professor, argues that during wartime emergencies, private companies weren’t allowed to cash in unduly and were hit with “excess profits” taxes. That’s without taking into account the government cash used to develop the vaccines. Once upon a time, emergencies meant shared sacrifice.

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Bob Herman, “Health insurance costs for workers rose 4% during pandemic,” Axios, Nov 10, 2021

Employer-based health insurance now costs an average of $22,200 a year for a typical family.

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Dana Branham, “Over 200,000 Oklahomans now have health coverage through Medicaid expansion,” The Oklahoman, Nov 3, 2021

The state expanded Medicaid kicking and screaming after a referendum forced its hand. Forty percent of the new beneficiaries are from rural areas that voted against it. Income limit is $36,588 for a family of four.

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Julie Appleby, “New health plans offer twists on existing options with a dose of ‘Buyer Beware,’” Kaiser Health News/U.S. News & World Report, Nov 4, 2021

Some of the shiny new plans aren’t Obamacare and don’t cover the things that might cost real money, like maternity. One plan “doesn’t cover lab work, X-rays, hospital care or expensive drugs.” Like all lousy insurance, it’s great as long as you don’t use it.

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Daniel Lehewych, “The medical system is at its tipping point,” Newsweek, Nov 8, 2021

Laments the tribulations of healthcare providers but, typically, says nothing about the impact of our payment model.

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Jacob Knutson, “U.S. to buy $1 billion worth of Merck's antiviral COVID pill,” Axios, Nov 9, 2021

The U.S. will acquire 3.1 million courses of molnupiravir for $2.2 billion after an FDA authorization for “emergency use.”

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Robert F. Service, “A prominent virologist warns COVID-19 pill could unleash dangerous mutants. Others see little cause for alarm,” Science, Nov 7, 2021

But not everyone is eager to push the new Merck pill massively onto the population as it works by generating RNA mutations of the virus. The FDA advisory committee split 13 to 10 on the authorization. Note that despite the weak evidence and expert caution, no news reports mock the drug as medical quackery or even question Biden’s decision to go all-in.

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Bob Herman, “Pandemic fuels activity in health care’s billing industry,” Axios, Oct 8, 2021

An “industry” that adds no social value whatsoever and should not exist. They now call themselves “revenue cycle managers” as they pore over complex billing systems for ways to upcode procedures into larger reimbursements for insurers while providing no new services. “The more [people] you hired, the more revenue you could generate,” said one exec. Cue nurse shortages.

Posted Nov 27, 2021

Mike Rea, “With 128 Covid vaccines in clinical development, we don’t know if the approved/authorized ones are the best ones,” STAT, Nov 17, 2021

“There is still no unifying framework for what makes a vaccine ‘best.’” Pfizer, Moderna, J&J, and AstraZeneca only account for four of the 128. “Just because massive, globally established pharmaceutical companies and universities have fueled the world’s vaccine supply to date doesn’t mean they have created the best ones.” Therefore, potentially good or even better (not to mention cheaper) alternatives don’t get attention, financing for large study trials, and eventually production. Under the current system, “finance is a proxy for ‘best.’”

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Michael McAuliff, “Becerra says surprise billing rules force doctors who overcharge to accept fair prices,” Kaiser Health News, Nov 22, 2021

Can’t make your business succeed at reasonable prices? asks the HHS secretary. Go into another line of work. Surprise billing abuse has consequences (at long last) although some 150 members of Congress are trying to kill the measure.

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Bob Herman, “Private equity firms buy Athena Health, again,” Axios, Nov 23, 2021

Private equity capital continues to pour into healthcare.

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Alicia Doniger, “Google is still ‘all in’ on health care,” CNBC, Oct 21, 2021

Google dissolved its in-house health unit but is still looking for a way into the sector (like all big tech firms). They face public distrust, however, because of the potential for misuse of private health data.

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Yeganeh Torbati & Jonathan O’Connell, “Pharmaceutical industry likely to shatter its lobbying record as it works to shape Democrats’ spending bill,” Washington Post, Nov 5, 2021

A good review of the furious Pharma lobbying campaign against drug price limits, including lies so crude they sometimes backfire. “In September, Rep. Andy Kim (D-NJ) began noticing mailers arriving at homes across his district with an alarming message, that Kim was intent on preventing Medicare patients from getting the drugs they needed.” The sponsor, A Healthy Future, LLC, is protected from revealing its sources, most likely drug companies. “The [Pharma] industry spent more than any other by a wide margin so far this year, deploying so many lobbyists—1,600—that they outnumber members of Congress 3 to 1.” But the investment is hugely profitable (see below).

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Andrew Perez & Julia Rock, “Big Pharma’s favorite Democrats saved the drug industry half a trillion dollars,” Jacobin, Nov 17, 2021

“Corporate Democrats like Senator Kyrsten Sinema saved Big Pharma $450 billion by watering down the party’s drug pricing plan.” A few million in campaign contributions brought in a 170,000% return—beats the Dow!

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David Moore, “Republican billionaires are donating to Manchin and Sinema,” Sludge, Nov 16, 2021

Because of course.

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Fred Schulte, “Medicare Advantage plans costing billions more than they should,” Kaiser Health News, Nov 11, 2021

Upcoding. “Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher.” Which should be obvious from the bombardment of ads pushing MA during the sign-up period. But they have their defenders: “13 U.S. senators, including Sen. Kyrsten Sinema (D-AZ), sent a letter to CMS opposing any payment reductions.”

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Harris Meyer, “The Medicare enrollment blitz doesn’t include options to move into Medigap,” WUSF Public Media, Nov 10, 2021

Dirty little secret: Medicare Advantage plans sound great because Glasses! Hearing aids! But they don’t pick up the 20% that standard Medicare saddles you with. On a $100K bill, that’s $20K. Medigap plans, which cover the difference, are costlier and get no publicity or clear explanations for beneficiaries. And once you choose MA, insurers can deny you a Medigap plan later—when you need it. The pre-existing conditions ban on insurers doesn’t apply in this case (except in New York and 3 other states).

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Susan Jaffe, “Medicare’s open enrollment is open season for scammers,” Kaiser Health News, Nov 11, 2021

“Federal officials say complaints are rising from seniors tricked into buying policies—without their consent or lured by questionable information—that may not cover their drugs or include their doctors. In response, the Centers for Medicare & Medicaid Services has threatened to penalize private insurance companies if they or agents working on their behalf mislead consumers.” Oo, oh, “penalties”! Hard to police an industry that is based on perverse incentives to start with, i.e., providing as little healthcare as possible while extracting maximum payments. Scamming is up 74% in 2021 over last year.

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Arthur Allen, “Stranded by the pandemic, he had only travel insurance. It left him with a $38,000 bill,” California Healthline, Nov 17, 2021

Duy Hoa Tran, a retired Vietnamese schoolteacher, came to the U.S. for a short visit and got trapped by the lockdown. His daughter quickly got him travel insurance, but “she might as well not have bothered.” An emergency surgery was pre-approved in writing, then denied. Despite paying $6000 in premiums, Tran was hit with a bill for $38,000. The pre-approval made things worse because if the physicians had known he was paying out of pocket, the charges would have been one-third of that. “As for Seven Corners’ refusal to pay despite precertification, this is not uncommon. By pre-certifying, the insurer verifies that a procedure is a covered benefit but doesn’t guarantee the insurer will cover it for that particular patient.” Good to know for those of us who normally communicate in the English language.

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Benjamin Ryan, “‘This will shut us down’: HIV prevention clinics brace for Gilead reimbursement cuts,” NBC News, Jul 7, 2021

A messy, complicated drug pricing law called 340B has been a cash lifeline for many worthy groups. But now it’s being exploited by big health systems, and Gilead is pulling the plug. Patchwork solutions of this sort are always vulnerable to collapse in the absence of a real healthcare safety net. HIV service agencies are generally mum as they are “wary of alienating Gilead, given the clinics’ further dependency on charitable grants from the company.”

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Sarah Jane Tribble & Emily Featherston, “As big Pharma and hospitals battle over drug discounts, patients miss out on millions in benefits,” Kaiser Health News/InvestigateTV, Nov 16, 2021

Smaller, poorer hospitals and other (real) nonprofits have benefited from the 340B program, which provides a spread on certain pharmaceutical sales. The program, designed to help patients, has also brought lucrative rewards for rich hospitals and middlemen like PBMs. While a rural hospital might get a few million, and some patients rely on it, Vanderbilt University Medical Center has 300 contract pharmacies all over the country and cleared $177 million in income over expenses in 2021. There has to be a better way.

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Mark Kreidler, “Will California get its shot at single-payer health care?” Capital & Main, Nov 12, 2021

California state Assemblymember Ash Kalra (D-San Jose) hopes the Covid experience will wake people up to the inequities of our healthcare system. Kalra’s bill would cover all California residents, including the state’s 3.2 million uninsured. Gov. Newsom ran on supporting it but probably won’t follow through. “In public remarks, Newsom has begun invoking the phrase ‘universal coverage,’ a more general term that does not specifically favor single payer.” However, with former California A-G Becerra at the head of HHS, the state could count on the essential federal waivers and support—for now.

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Ashlea Ebeling, “Medicare Part B premiums to rise 14.5% in 2022 with premiums for highest-income couples nearly $14,000 a year,” Forbes, Nov 12, 2021

“The Part B increase will consume the entire annual cost of living adjustment of Social Security recipients with the very lowest benefits (about $365 per month).”

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David Jackson, “Illinois’ $16 billion health program riddled with industry ties and potential conflicts of interest,” Modern Healthcare, Nov 12, 2021

“The upper echelon of the state agency charged with overseeing Medicaid is peppered with representatives of the for-profit insurance industry state officials are supposed to be policing. Program leaders toggle between government appointments and top jobs at the for-profit insurance firms.” One example, of many: “Since 2017, Howard A. Peters III has earned $105,000 per year through the state Office of Medicaid Innovation as an ‘expert adviser’ to HFS. At the same time, Peters lobbied the agency and lawmakers on behalf of insurance giant Aetna, one of the four companies hired by the state to run the Medicaid program.” Corruption is eternal, but this particular form would be largely sidelined by single-payer.

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Rose Adams, “A former Enron executive has poured tens of millions into national drug pricing reform. Why hasn’t it worked?” American Prospect, Nov 15, 2021

John Arnold walked away from Enron with an $8 million bonus (just as the company collapsed and obliterated employees’ pensions). Now he’s a natural gas billionaire—but with a (guilty?) conscience. “After surveying the many market failures in the health care system, the couple took on drug pricing reform as one of their pet projects.” But Arnold’s millions were no match for Pharma and its bought patient advocacy groups—whose members would save thousands. Also, Arnold “never supports reforms that would dramatically change the pharmaceutical system and its profit structure.” And his approach is strictly persuasion among elites with no movement-building. More details of interest about the limits of philanthropy-based social reform.

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STAT, “8 lingering questions about the new Covid pills from Merck and Pfizer,” Nov. 15, 2021

Amazing how these specialty articles cite Merck’s news release as revealed truth, despite no access to the data nor even a peer-reviewed journal article. We only know that molnupiravir “reduced hospitalizations by 50%” because Merck says so. Pfizer’s drug is called “Paxlovid,” or “Peace and Love.” [Update: A Nov. 26 STAT article https://bit.ly/3nVYEbK  says Merck now recognizes the drug’s efficacy is only 30%. Will STAT formally retract or at least stop citing Pharma statements as fact?]

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Rachel Cohrs, “How America’s largest Catholic hospital system is moonlighting as a private equity firm,” STAT, Nov 16, 2021

Paywalled, but the first graf tells the story: “The nation’s largest Catholic hospital system, a sprawling behemoth of more than 140 hospitals called Ascension, is quietly building an unprecedented and strikingly unusual $1 billion private equity operation, using its wealth to invest like a Wall Street firm.”

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Sophie Putka, "Texas Medical Association sues feds over surprise billing,” MedPage Today, Nov 2, 2021

King Kong v/s Godzilla. Doctors want to keep those surprise bills coming. “The legislation plus the regulation is going to clip [providers’] ability to do that far more severely than they thought it would.” In 2016 surprise bills followed over 40% of ER visits. The new law “removes the patient from the equation [and] leaves providers to battle it out with insurers.”

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Natalie Posgate, “TeamHealth trial: A threat, a delay, a juror down,” Texas Lawbook, Nov 9, 2021

The trial is “a closely-watched dispute among healthcare circles” over ER billing. “Both sides accuse one another of charging or paying ‘whatever they wanted’ for ER services, corporate greed, and orchestrating schemes to fatten their own pockets.” Surely not! [fans self vigorously]. TeamHealth has nine other lawsuits pending against UnitedHealthcare and another 45 against other insurers.

Posted Nov 16, 2021

Correction from LINKS #232, 3 NOV 2021:

In my comment on this article [Beatrice Adler-Bolton, “The vengeful specter of cuts to Medicare Advantage,” Blind Archive, Oct 22, 2021], I stated that “A Kaiser Family Foundation study showed that the average Medicare Advantage plan ‘spent more than twice the amount of money on advertising as it did on care.’” That was a misreading of the article. What it actually said is, “The average private insurer spent more than twice the amount of money on advertising Medicare Advantage plans as was spent on advertising for Part D plans ($30.1 million vs. $13.7 million), tipping the scales in favor of MA. . . .” An alert reader pointed out the unlikelihood of the original statement, and I appreciate the opportunity to correct it.

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Mike Obel, “Why 2022 Medicare Part B premiums soared,” Yahoo Finance, Nov 15, 2021

“The surprisingly big jump in Medicare Part B premiums for 2022 reflects the sky-high cost of a controversial Alzheimer’s disease drug [Aduhelm].” The standard monthly premium for Medicare is rising from $148.50 to $170.10, or 14.5%. Thank you, FDA, for saddling us with a turkey drug that will cost everybody an eye and doesn’t work. The Part B deductible also popped nearly 15%, and the Part A deductible is now over $1500 a year. Blue Dog Democrats and all Republicans constantly wring their hands over Medicare going broke but will do nothing to stop the price-gouging by Pharma that is a major contributor.

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Elisabeth Rosenthal, “A procedure that cost $1,775 in New York was $350 in Maryland. Here’s why,” Kaiser Health News, Oct 26, 2021

Maryland is the “one state in the nation that controls what hospitals can charge.” Maryland also caps hospitals’ total income per year—and the sky hasn’t fallen there.

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Buchanan, Ingersoll, Rooney, “Key takeaways from the denial of Tower Health’s tax exemption bid,” Oct 27, 2021

Fascinating legal analysis of the ruling that blocked property tax exemptions for a big “nonprofit” hospital group. Lawyers will be poring over this for a long time to see if other hospitals are taking advantage in similar ways. A Pennsylvania judge said the hospitals were hardly a “public charity” if it pays top executives giant bonuses based on how much cash the hospital is pulling in. Also, Tower Health’s uncompensated care was less than 1% of the care it provided. The authors write: “Most, if not all, non-profit hospitals and health systems engage in some level of incentive compensation plans for their executives. So, non-profit healthcare systems must carefully review their compensation plans that emphasize the ‘bottom line.’” Financially strapped municipalities should be taking a good look at this potential revenue source.

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Frances d’Emilio, “Moderna has no plans to share its COVID-19 vaccine recipe,” Associated Press, Oct 11, 2021

“Executives have concluded that scaling up the company’s own production is the best way to increase the global supply.” Moderna’s chairman Noubar Afeyan co-founded the Aurora Humanitarian Initiative, which aims to “empower modern-day saviors to offer life and hope” to those urgently needing basic humanitarian aid. The entity has given away $5 million in grants. In the third quarter of 2021, Moderna’s net income was $3.3 billion. Its government-subsidized vaccine is the company’s only product.

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Carrie Teicher, “What Moderna owes the world,” STAT, Nov 4, 2021

Moderna will rack up $20 billion in sales of its vaccine while only 4% of the populations of low-income countries have received their first dose. Although the Moderna vaccine wouldn’t exist without massive government support for both R&D and purchase guarantees, the company sees no reason to budge on sharing “its” vaccine technology. Biden could force the issue through the Defense Production Act. (He won’t.) Teicher, from Doctors Without Borders/USA, thinks that stinks.

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Robyn Begley, “The trajectory of our healthcare workforce is unsustainable,” MedPage Today, Oct 21, 2021

“In the survey, 38% of [nurse] respondents named staffing shortages as the biggest new challenge. Low morale/burnout was a close second.” Begley, the top nurse at the American Hospital Association, argues that we need to loosen visa restrictions so that the U.S. can attract more foreign-trained nurses to fill the gap. Two questions: don’t they also need nurses in the Philippines, and are “staffing shortages” due to no available nurses or poor pay and working conditions?

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Kara Grant, “State officials threaten docs for not providing ivermectin,” MedPage Today, Oct 21, 2021

The intense politicization of the use of cheap, off-patent ivermectin is driving disturbing interventions into the clinical setting by unqualified outsiders. OTOH, who else is questioning the Revealed Truth about what drugs work according to the self-interested Pharma companies and its paid toadies?

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Joyce Frieden, “Final physician fee schedule rule includes a nearly 4% payment cut,” MedPage Today, Nov 3, 2021

“Physicians will see a nearly 4% cut in their fee-for-service Medicare payment under the 2022 Physician Fee Schedule (PFS) final rule released by CMS.” The “budget neutrality” (pay-for) foolishness self-imposed by Congress is generating this rob-Peter-to-pay-Paul mentality. It’s also a good way to further weaken Medicare by stiffing doctors who accept it.

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Amanda D’Ambrosio, “What’s healthcare’s role in combating the climate crisis?” MedPage Today, Nov 5, 2021

Interview with Gary Cohen of Health Care Without Harm: Global health systems are responsible for 4.4% of worldwide greenhouse gas emissions; in the U.S., it’s about 10%. Cohen: “The healthcare sector, whose mission is to heal, was [and is] contributing a huge amount of pollution, which had [has] links to cancer, birth defects, neurological problems, and so many other health issues. The irony was that the very sector of our economy that had healing as its mission was [is] an enormous polluter.”

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Anand Swaminathan, Utibe R. Essien & Esther Choo, “Molnupiravir: another Covid-19 treatment, another opportunity to recognize inequity,” STAT, Nov. 3, 2021

The FDA’s emergency use authorization for this Covid therapy “will only heighten inequities wrought by the pandemic. . . . For molnupiravir to be effective, it apparently must be taken within five days of symptom onset. This requires that an individual: recognize they have symptoms indicative of Covid-19; secure a Covid test; get the test results back in a timely manner; make an appointment with a doctor; get a prescription from the doctor; buy the medication.” How many uninsured/underinsured are even going to know that they have to do that? Remdesivir was “given to Black cancer patients with Covid-19—a high-risk group—half as often as it was given to white patients. Its distribution was also uneven: safety-net public hospitals waited for supplies of remdesivir while smaller, private hospitals, which tend to serve higher-income populations, had earlier access.”

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Marisa Fernandez, “Gates Foundation to send $120 million of COVID antiviral pills to lower-income countries,” Axios, Oct 20, 2021

Cheap, favorable headlines for Gates while he continues to block technology-sharing that could lead to massive vaccine coverage. And funneling foundation money into the expensive molnupiravir will normalize whatever price Merck decides to set.

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Matt Stoller, “#PizzaIsNotWorking: Inside the pharmacist rebellion at CVS and Walgreens,” BIG, Nov 5, 2021

The rush to relax antitrust law over the last 40 years has led to massive concentration in the pharmacy sector. CVS, already a monster, then acquired Aetna insurance company along with a PBM (Caremark) to solidify its vertical integration. Pharmacists employed by the chain, predictably, are being squeezed for higher profits in sweatshop conditions. The hashtag refers to the gesture of bosses handing out free pizza to keep the peons at the wheel; it also signals ongoing organizing efforts inside the company. Worker speed-ups in pharmacies are not just inhumane; they’re dangerous for obvious reasons.

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Paul D. Jacobs & Steven C. Hill, “ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly,” Health Affairs, Nov 2021,

“In 2015 half of this middle-class population (400-600% of poverty) would have paid at least 7.7% of their income for the lowest-cost bronze plan; in 2019 they would have paid at least 11.3%. By 2019 half of the near-elderly ages 55–64 would have paid at least 18.9%.” The authors it probably will get worse “after the temporary [Covid] subsidies expire.”

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David Armstrong & Ryan Gabrielson, “St. Jude hoards billions while many of its families drain their savings,” ProPublica, Nov. 12, 2021

The Danny Thomas-founded St. Jude Children’s Research Hospital sits on a massive cash pile (currently $5.2 billion) and promises that “families will never receive a bill.” But parents still go broke trying to manage the many other costs of child cancer, like travel and loss of employment. Many have to resort to GoFundMe. Half of its annual take of around $2 billion goes to medical care and research; the rest is eaten up by its fundraising operations (30%), and a hefty portion goes into its investment portfolio. In addition, St. Jude siphons donations away from other children’s hospitals while “more than 400 of the fundraising arm’s employees are paid over $100,000.” If every hospital could promise that families “will never receive a bill,” the St. Jude “nonprofit” edifice wouldn’t have to exist.

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Monique Beals, “Opioid makers win major victory in California trial,” The Hill, Nov 3, 2021

“Santa Clara County, Los Angeles County, and the city of Oakland argued billions of pills in their communities contributed to overdose deaths after the drugmakers marketed their product in ways that minimized their addictive nature and promoted them for more widespread use than intended.” A judge disagreed because the prescribing practices were “medically appropriate.”  

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Sophie Putka, “Texas Medical Association sues feds over surprise billing,” MedPage Today, Nov 2, 2021

Slugfest among the industry’s various players: the doctors say new regs favor insurers rather than them. Says one expert: “This is a fight about money. The providers who could use out-of-network billing strategies to get sizable additional amounts are not very happy that the legislation plus the regulation is going to clip their ability to do that far more severely than they thought it would.” Fully 40% of ER visits result in a “surprise” bill from out-of-network docs.

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Jimmy Jenkins & Beth Schwartzapfel, “Arizona privatized prison health care to save money. But at what cost?” Arizona Republic/Marshall Project, Oct 31, 2021

Grisly testimony, such as people dying of cancer without treatment or palliative care, about what happens when for-profit contractors are allowed to treat prisoners. If the average patient feels powerless in the face of the healthcare system, imagine what an inmate goes through. The largest prison healthcare provider companies are “an attractive investment for private equity.” Privatization was pushed as a way to save Arizona money, but it hasn’t done that either.

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Kristen Mosbrucker, “First hospital system in Louisiana creates Medicare Advantage plan,” The Advocate, Oct 17, 2021

A major Louisiana hospital chain climbing aboard the MA gravy train. “The Kaiser Family Foundation found that the annual gross margins among Medicare Advantage plans were 24% higher in 2020 when compared with 2019.”

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Dan Weissmann, “Hello? We spend 12 million hours a week on the phone with insurers,” Kaiser Health News, Oct 18, 2021

That’s the collective “we,” i.e., all of us.

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Ed Yong, “How public health took part in its own downfall,” The Atlantic, Oct 23, 2021

“As the 20th century progressed, the field moved away from the idea that social reforms were a necessary part of preventing disease and willingly silenced its own political voice. By swimming along with the changing currents of American ideology, it drowned many of the qualities that made it most effective.” The U.S. could learn a lot from the highly political public health (or “sanitarian”) movements of Latin America, where the idea that people’s health is massively affected by their surroundings and social class is inescapable. We prefer to see poor health as a matter of personal irresponsibility. “This approach appealed, too, to powerful industries with an interest in highlighting individual failings rather than the dangers of their products. Tobacco companies donated to public-health schools at Duke University and other institutions. The lead industry funded lead research at Johns Hopkins and Harvard universities.” Worth reading in full.

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Bob Herman, “Merck’s cancer drug Keytruda on page for $17 billion of sales,” Axios, Oct 29, 2021

The drug may soon be the most lucrative drug in the world, listing for $175,000 a year. It must be administered on-site, “exposing cancer patients to high out-of-pocket spending regardless of their insurance.” Merck’s Covid therapy drug molnupiravir should pull in another $5 to $7 billion as it is being eagerly pushed by Gates and most mainstream media. Keytruda’s patent lasts until 2028; Merck just raised the price 2%.

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Shiv Sudhakar, “Merck’s COVID-19 pill could carry serious safety concerns, scientists warn,” Fox News, Oct 6, 2021

A cautionary alert on molnupiravir: “The oral antiviral medication integrates into the genetic makeup of the virus, causing a large number of mutations to destroy the virus. However, some laboratory tests indicated the drug’s ability to cause mutations in genetic material of mammalian cells.” Thus, more caution is indicated, especially to “young people of reproductive age. The Merck trial currently excluded pregnant women.”

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Jeff Lagasse, “Northwell Health selects Northwell Direct’s provider network for employee benefit plan,” Healthcare Finance, Oct 13, 2021

Dumping UnitedHealthcare and side-stepping all traditional insurance companies to keep coverage in-house. Northwell is the state’s largest healthcare employer (75,000).

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Angela Hart and Samantha Young, “Health industry wields power in California’s high-stakes battle to lower health costs,” Kaiser Health News/San Francisco Chronicle, Oct 13, 2021

“Gavin Newsom put California’s health care industry on notice when he was a candidate for governor, vowing in 2018 to go after the insurance companies, doctors and hospitals that leave many Californians struggling with enormous medical bills and rising insurance premiums.” Newsome pledged to lead California’s single-payer movement, but a watered-down version of Newsom’s proposals died in the state legislation. Still, Californians are facing crippling cost increases and want relief, with 82% of state residents saying it’s “extremely” or “very” important for the governor and legislature to make health care more affordable. Meanwhile, “Doctors and Blue Shield have given Newsom millions of dollars to support his political career over many years, including a $20 million donation in September 2020 from Blue Shield for his homelessness initiatives.”

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Caroline Chen, “Babies are dying of syphilis. It’s 100% preventable,” ProPublica, Nov 1, 2021

Reported syphilis cases have doubled in the last five years. As public health staff continues to decline nationally, further rises are anticipated.

Posted Nov 3, 2021

Dan Weissmann, “‘An Arm and a Leg’: How one state protects patients from hospital lawsuits,” Kaiser Health News, Oct 7, 2021

A fascinating success story involving an academic and a big research department at the nurses’ union (NNU), teaming up to embarrass Johns Hopkins and other hospitals about their practice of suing the indigent while enjoying tax breaks as “nonprofits” and pocketing state money for charitable care. Result: Maryland outlawed the practice. Invaluable lessons. Podcast with transcript.

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Harold Brubaker, “Tower Health is denied property-tax exemption for three Chester County hospitals," Philadelphia Inquirer, Oct 19, 2021

The judge said the “nonprofit” hospitals looked a lot like profit-making entities, taking note in particular of “bonus plans mostly tied to financial performance” and the many doctors employed by for-profit external entities. Thus, the operations don’t deserve exemption from property taxes, he said. “The judge expects an appeal and hopes his ruling will prompt a review of qualifications for property-tax exemptions in health care.” Long overdue. I’m searching for the full text of the ruling if anyone knows how to track down legal documents.

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F.A.Cadegiani, A. Goren, C.G. Wambier & J.McCoy, “Early COVID-19 therapy with azithromycin plus nitazoxanide, ivermectin or hydroxychloroquine in outpatient settings significantly improved COVID-19 outcomes compared to known outcomes in untreated patients,” New Microbes and New Infections, Sep 2021

Shall we “follow The Science”? Here’s a peer-reviewed article about combination therapy with a bunch of cheap molecules including ivermectin (“horse dewormer” to our mass media overlords swimming in Pharma cash) and their impact on 585 Brazilian patients. Results: very significant improvement on viral shedding, disease duration, respiratory complications, and hospitalization (p < 0.0001 for all). The findings were so strong that the researchers stopped the study for ethical reasons—meaning that, given what they were seeing, they couldn’t justify keeping any patient on placebo. The success of the drug combo may explain why ivermectin or hydroxychloroquine alone don’t show good results. “The Science” here doesn’t lend itself to huge Pharma profits, so don’t expect to hear about it on CNN. For anyone who reads technical research, scroll down to page 6 of the pdf and have a look at the table.

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Ezekiel Emanuel, “Why we can have both innovative drugs and lower drug prices,” Politico, Oct 13, 2021

Goes over familiar ground vis-à-vis drug prices and R&D.

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Bob Herman, “Aduhelm is bombing,” Axios, Oct 21, 2021

“Potentially the worst drug launch of all time” amid Biogen’s “persistent hyperbole about the drug’s purported benefits” to Alzheimer’s patients. Third quarter sales were only $300K ($1.2m per year), quite a drop from early estimates of a billion. The company is counting on the publication of a peer-reviewed journal article to goose sales—hope the editors are holding out for some very friendly pats on the back.

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Matt Salo, “Much Adu(helm) about nothing: New Alzheimer’s drug threatens state Medicaid budgets,” STAT, Oct 12, 2021

Medicaid is required by law to cover all FDA-approved drugs. (Medicare is not.) Unless the law is changed, the poorest will pay once again to save Biogen from disaster.

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Richard Eisenberg, “Medicare is not enough—why so many Americans over 65 can’t afford health care,” MarketWatch/NextAvenue, Oct 11, 2021

“The average 65-year-old couple may need about $300,000 saved for health care costs in retirement” because of Medicare’s 20% copay on Part B bills, annual deductibles, and premiums, plus dental, vision, hearing, and long-term care. Result: “44% of Medicare beneficiaries have difficulty hearing, and 35% have difficulty seeing.”

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Sophie Putka, “$22K for 10 stitches, a year and a half later,” MedPage Today, Oct 28, 2021

Surprise billing and its aftermath. “Emergency physicians or doctors on call often aren’t employed directly by the hospital. They can be contractors who are out-of-network for a patient’s insurance even if the hospital is in-network. Hospitals can send insurers separate bills for their part of the work.” The unlucky patient is stuck trying to get answers from professional buck-passers. One suggestion: write in “in-network only” on the promise-to-pay forms they make you sign at check-in.

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Lee Fang, “Drug industry hires its former critics as lobbyists against Medicare price negotiations,” The Intercept, Oct 13, 2021

“In 2004, then-Sen. Blanche Lincoln (D-AR) cast herself as a conservative, commonsense Democrat focused on finding savings, such as allowing Medicare to negotiate lower drug prices. Lincoln now serves Pfizer as a lobbyist focused on blocking the very cost-saving proposal she once championed.” She’s friends with South Carolina’s Clyburn, unsurprisingly, another major Friend of Pharma. Many other Democrats swarmed to the Pharma cash table, including Lincoln’s former co-senator, Mark Pryor (also D-AR), and Remy Brim, “a former health policy adviser to Sen. Elizabeth Warren D-MA, and Michaeleen Crowell, former chief of staff to Sen. Bernie Sanders, I-VT.”

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Jeff Lagasse, “Patients hospitalized for COVID-19 this year could pay thousands in bills,” Healthcare Finance, Oct 22, 2021

Covid briefly brought us a taste of what single-payer healthcare could be like. That’s about to end. “Even with the [Covid] waivers, patients sometimes received bills from clinicians for seeing patients in the hospital or were occasionally hit with ambulance bills.” The danger of bringing back cost-sharing: “People with severe COVID symptoms are going to delay going to the hospital owing to concerns about costs.” Important datum: federal pressure to require insurers to cover Covid costs “was muted by the fact that providers voluntarily chose to cover the costs.” Once the heat is off, they can voluntarily choose not to. Anger toward the unvaccinated could easily be tapped to justify making people pay up.

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Jacob Bacharach, “Talk to your doctor, TALK to your doctor, talk to your DOCTOR,” Gawker, Oct 11, 2021

“Boner pills, heart pills, arthritis pills, brain pills. I have a recurring case of mild psoriasis, and am now pursued by an algorithmic Cyndi Lauper, also a sufferer, who implores me to ask my doctor if Cosentyx is right for me.” But this assumes that the durable, long-term bond between patient and physician still exists in some recognizable form.

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Ryan Grim, “Sen. Bob Menendez’s opposition to drug pricing reform may imperil the Democratic agenda," The Intercept, Oct 7, 2021

New Jersey has more Pharma headquarters than any other state, and Menendez is a major beneficiary of its largesse.

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Dan Diamond, “White House: We don’t have ‘unlimited rights’ to Moderna vaccine recipe,” Washington Post, Oct 25, 2021

The Biden administration says its hands are tied by legal technicalities despite Moderna’s enjoyment of $10 billion of public funds. So screw the unvaccinated countries.

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Olivia Goldhill & Rosa Furneaux, “‘Naively ambitious’: How COVAX failed on its promise to vaccinate the world,” STAT/Bureau of Investigative Journalism, Oct 8, 2021

Long-form dismantling of the COVAX debacle, which the rich countries point to as the “solution” for the rest of the world. “[Foreign] officials have received supplies months late or with little notice, throwing vaccination campaigns into chaos and sometimes delaying people’s second doses if they got them at all. In some cases, vaccines delivered close to their expiration dates were returned or thrown away after governments were unable to distribute them in time.” Many details of Dysfunction, but also exposes how the Gates-funded vaccine NGOs pushed charity rather than mandated sharing of patents and technology (which Gates opposes). “In total, wealthy countries have pledged to donate 785 million doses to COVAX as of Sept. 24. But just 18% have arrived. At the same time as promising donations, some wealthy countries have dipped into COVAX supplies themselves.”

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Public Citizen, “How Pfizer silences world governments in vaccine negotiations,” Oct 19, 2021

The six ways: (1) nondisclosure (silencing) provisions; (2) stipulation that countries can’t accept additional vaccine donations; (3) liability exemptions; (4) forced, secret arbitration of contract disputes instead of courts; (5) waivers of sovereign immunity so countries remain exposed to Pfizer lawsuits; (6) Pfizer’s self-granting of sole power over deliveries in case of supply shortages. For example, “The Brazilian government accepted a contract with Pfizer that waived sovereign immunity; imposed no penalties on Pfizer for late deliveries; agreed to resolve disputes under a secret private arbitration under the laws of New York; and broadly indemnified Pfizer for civil claims.” Also, Brazil agreed not to discuss the terms publicly. Full report at https://bit.ly/3vDMmXI

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Beatrice Adler-Bolton, “The vengeful specter of cuts to Medicare Advantage,” Blind Archive, Oct 22, 2021 

Argues that insurers are pushing Medicare Advantage plans so intensively because they’ve wrecked their own commercial insurance market by driving up costs to such insane levels. MA is thus the “crown jewel” of the industry and the only sector still growing. Also, companies cleverly twist attempts to rein in their free money by advertising the measures as “cuts to Medicare.” A Kaiser Family Foundation study showed that the average Medicare Advantage plan “spent more than twice the amount of money on advertising as it did on care.”

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Kevin Sieff & Dan Diamond, “U.S. communities want to share unused vaccines with Mexico, but the White House won’t let them,” Washington Post, Oct 22, 2021

“For months, health officials and hospital executives in Southern California watched as coronavirus vaccines neared their expiration dates unused while demand for doses waned. But as the plan was readied, it was blocked by the White House Vaccine Task Force. The doses were instead discarded.” The feds insist that vaccines are their property and have to be distributed through the White House donation program. A turf fight means people can’t carry usable vaccines two miles across the border.

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Paige Minemyer, “UnitedHealthcare to expand ACA exchange footprint into 7 new states for 2022,” Fierce Healthcare, Oct 28, 2021

Alabama, Florida, Georgia, Illinois, Louisiana, Michigan and Texas—mostly non-Medicaid-expansion states.

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David Pitt, “Auditor: Iowa’s privatized Medicaid illegally denies care,” Associated Press, Oct 20, 2021

“Investigators found a massive increase in illegal denials of care by managed care organizations, or MCOs, under privatized Medicaid.” Privatization started in 2016 and is defended by GOP governors “amid complaints that service has suffered, payments to service providers are sometimes delayed, and promised savings never materialized.” Cases in which a judge overruled denial of Medicaid services rose 891% after privatization.

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Haider J. Warraich, “Start now to prevent the next Purdue Pharma debacle,” STAT, Sept. 17, 2021

“The Purdue Pharma deal is a grand miscarriage of justice. However, punishing Purdue and the Sacklers alone fails to capture the scope of corruption throughout the health system that helped spread the opioid epidemic. The opioid epidemic reflects in part the enormous control the pharmaceutical industry has over how physicians practice medicine. The more money (or even donuts) opioid manufacturers provided to physicians in a particular area, the more fatal overdoses occurred there.” Also, “Shortly after the FDA’s approval of OxyContin in 1995, the FDA reviewer for the drug was hired as a senior executive by Purdue.” Janet Woodcock, who oversaw this debacle, is still the FDA’s interim commissioner. P.S. “In 2020, every fifth heart donated for transplantation came from a young person dying of a drug overdose, the highest proportion in U.S. history.”

Posted Oct 24, 2021

Casey Buchholz, Stephanie Attar & Gerald Friedman, “The state road to universal single-payer health care,” Jacobin, Oct 15, 2021

A useful discussion of the states-first strategy. Single-payer bills are now pending at 18 state legislatures. “Nearly every movement for social reform in US history began on the state level where political conditions were favorable. These states serve as laboratories for social movements, demonstrating that reform is possible, that social movements can achieve political change.” One example: civil rights. “Between 1945 and the enactment of national legislation in 1964 [the Civil Rights Act], fair employment practices legislation was enacted in twenty-six states, first in New York and New Jersey in 1945.” There was also a precursor to Medicaid, the 1960 Kerr-Mills Act.

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Olivia Webb, “The failure of Walmart Health,” Acute Condition, Oct 7, 2021

“It’s not that it failed, it’s that it failed doing something so boring.” The author argues that Walmart tried to reinvent the Rube Goldberg wheel that is U.S. healthcare instead of experimenting with something it could actually be good at, like creating a “food pharmacy” that would offer “food, menus, and recipes to patients with poorly controlled diabetes as well as their families.” Because Walmart covers its employees internally rather than going through an external insurer, it could pilot this and all sorts of other ideas. And it, um, sells food. But no: “Walmart fell prey to the ‘businessman politician’ phenomenon where they thought they could run healthcare like a business and do it more efficiently.”

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Eric Reinhart, “Why U.S. pandemic management has failed: Lack of attention to America’s epidemic engines,” STAT, Oct 5, 2021

On U.S. Covid failures: “It is a dangerous delusion to imagine that responsibility ends with any single individual, administration, or political party rather than with long-standing systems and institutions—responsibility for which is owned by both Democrats and Republicans—that have rendered the U.S. distinctly vulnerable to health disasters.” Oddly, the author does not call out for-profit medicine except to mention “revenue-oriented operating procedures,” which “foster the deep distrust in medicine and government that is now impeding vaccine uptake and mask use in many parts of the country.”

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Jay Hancock, “Major insurers running billions of dollars behind on payments to hospitals and doctors,” Kaiser Health News, Oct 6, 2021

Easy to use the excuse of Covid to delay payouts and deny ER claims. Top culprit: Anthem. “Hospitals point to a variety of Anthem practices contributing to payment delays or denials, including new layers of document requirements, prior-authorization hurdles for routine procedures and requirements that doctors themselves—not support staffers—speak to insurance gatekeepers.” Avoid Anthem.

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Jennifer Adaeze Okwerekwu, “Operating at a loss: Our health care system depends on physicians donating their time,” STAT, Oct 13, 2021

“Every doctor I asked—both psychiatrists like me and other specialists—told me they, too, were chronically behind and spent a few uncompensated hours outside of work each day catching up on notes and responding to patient messages.”

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Jennifer Henderson, “Documentary seeks truth behind ‘super-villain’ of drug prices,” MedPage Today, Oct 14, 2021 https://bit.ly/3lPsUnH

New film tries to humanize “Pharma Bro” Martin Shkreli, fails. Does, however, succeed in reminding viewers that he’s a simple product of his industry: “The film’s parting words appear on the screen: ‘Daraprim is still $750 per pill. There remains no national pharmaceutical price gouging or drug price transparency law in the United States.’”

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Bob Herman, “The $10,000 suppository,” Axios, Oct 18, 2021

A box of 30 anti-inflammatory rectal suppositories that treat arthritis, called Indocin, had a price tag of $198 in 2008. Today, it costs $10,350. “Indocin is another example of how nothing prevents some drug companies from hiking prices at will. Martin-Shkreli-type price increases never disappeared.”

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Cheryl Clark, “Medicare patients don’t compare plans,” MedPage Today, Oct 13, 2021

“Medicare Advantage plans have provider networks that limit access to certain hospitals and doctors, and networks may change from one year to the next.” (Avoid Medicare Advantage.) Also, a likely reason for failure to comparison shop is complexity: “The average Medicare beneficiary has 33 Medicare Advantage plans and 30 Part D stand-alone prescription drug plans to choose from.” The plans slip in big price increases, then prepare for customer outrage: “Several counselors told this reporter they are bracing for calls from angry enrollees and are in training sessions on how to manage them.”

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Michael Gartland, “NYC retiree health care plan has former city workers fearing they’ll go broke,” New York Daily News, Oct 10, 2021

City retirees now can either enter the Medicare Advantage casino and hope for the best or bear the cost of paying their own “medigap” plan for about $200 a month extra. Note that the architect of this take-back is the Municipal Labor Committee, which fought the NYHA tooth and nail in Albany. Puts a new twist on the most-people-are-happy-with-their-healthcare argument.

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Sam Mellins, “Retirees flee city Medicare program as deadline looms for move to private health plan,” The City, Oct 20, 2021

“Droves of city government retirees are preparing to pay thousands annually to keep their existing health insurance rather than taking a chance on a new cost-cutting plan. Beneficiaries can’t get straight answers from a chaotic, confused, contradictory helpline.” Kudos to The City for breaking open this story after months of secret city-MLC negotiations. “Of the 880 retirees who responded to the Organization of Public Service Retirees’ survey, 46.2% said that at least some of their doctors told them either that they will not accept the Alliance’s plan or that they had not heard of it. Just 2.5% said that their providers would accept the plan.” Secrecy + incompetence = savings.

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Michael Schulson, “Dispensing doctors: Should physicians sell drug to patients?” Undark, Oct 11, 2021

VendRx puts pharmaceutical vending machines in doctors’ offices. What could go wrong? It’s legal in 45 states (not including New York, with minor exceptions). OTOH, failure to act on insane drug prices will drive people to find new solutions.

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Andrew Perez, “Big Pharma’s reward,” Daily Poster, Oct 15, 2021

Pharma cash rolling in to their chief mercenary, Sen Kyrsten Sinema (D-AZ), who “previously campaigned on lowering drug prices.” Given the multi-billions at stake, a mere 100K tossed over to Sinema is a smart investment by the drugsters.

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Julie Appleby, “Insurance focused on virtual visits? The pros and cons of a new twist in health plans,” Kaiser Health News/Fortune, Oct 15, 2021

On the post-Covid pressure to replace in-person doctor visits with telemedicine. Great potential savings especially if expensive diseases aren’t caught by the video exam. “Virtual-first health plans may carry lower premiums or provide such financial incentives as no copays for online visits.” What could go wrong?

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Jamie Smyth, “J&J spent $1.4bn on legal move to shield it from talc cancer claims,” Financial Times, Oct 19, 2021

Step 1: Poison the public.

Step 2: Get sued.

Step 3: Create a subsidiary to “manage the allegations.”

Step 4: Have the subsidiary declare bankruptcy.

Step 5: Find a sympathetic judge to sign off on desultory damage claims.

Step 6: Rinse and repeat.

“J&J increased its 2021 profit forecast following strong 3Q earnings growth. The company said it was gearing up to apply to US regulators for full approval for its vaccine ahead of a shift away from not-for-profit sales pricing to more commercial pricing. Shares in J&J jumped about 3 per cent to $165 following the company’s updated guidance.”

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Kristina Fiore, “Virginia docs get just $15 for certain Medicaid ED visits,” MedPage Today, Oct 14, 2021

Because 800 diagnoses, including asthma attacks heart failure, and newly diagnosed brain tumors, are “avoidable” emergency visits under a little-noticed phrase in a state law.

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Jennifer Henderson, “Goldman Sachs, Charlesbank acquire widespread primary care network,” MedPage Today, Oct 18, 2021

“Goldman Sachs and Charlesbank have scooped up a sprawling primary care network with a unique business model”—namely, membership, paid on top of insurance, copays, etc. “The annual member fee is for a wellness program, a yearly health assessment that includes advanced diagnostic tests and screenings, according to the company. The screenings and subsequent physician counseling focus on heart and respiratory health, emotional well-being, diabetes risk, hearing and vision, sexual health, weight management, and bone health, among other areas.” Yet another clever way to extract healthcare dollars as an intermediary.

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Mark Winne, “Police say hospital discharged seriously ill man, left him on the street,” WSB-TV, Oct 16, 2021

“CONYERS, GA—Police want answers after a local hospital discharged a sick 68-year-old man and left him alone on the sidewalk. A hospital employee told officers that the man had been at the hospital for 35 days and that Medicare would not continue to pay for his treatment.”

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Nicholas Florko, “Elizabeth Warren on over-the-counter hearing aids, health lobbying, and the FDA’s independence,” STAT, Oct 19, 2021

New HHS rules will enable people to get hearing aids over the counter. The law was passed in 2017, but the FDA dragged its feet until Secretary Becerra lit a fire under it. Warren: “It’s been an exercise in enormous frustration—no one would ever say no, they just wouldn’t move it forward. Everyone I called for four years said, ‘Yes, that’s good, we will work on it, we are looking at it, yada, yada, yada.’ But it never moved, and it was never possible to find where the blocking point was.”

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John Tozzi, “The hunt for the riskiest, most lucrative patients,” Businessweek, Oct 13, 2021

Upcoding for fun and profit by Medicare Advantage plans. “Submitting an additional diagnosis means a plan gets paid more, whether it affects that patient’s treatment and even if no treatment is given for the specified malady.” Incentives to cheat will lead to cheating. This is not hard. One whistleblower complaint “described mandatory ‘coding parties’ in which physicians gathered in a single room with computers to update patient records with retroactively added diagnoses.”

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John Horgan, “An elbow injury exposes the exorbitant costs of health care,” Scientific American, Oct 6, 2021

“Bills totaling $287,365.08 provide insights into the dysfunctional economics of American medicine.” Including per-night room charge of $18,000. “I’ve described my case to a few health care veterans, and they say it’s not unusual. Providers routinely overcharge insurance companies, which in turn routinely underpay the providers. Providers and insurers then haggle over the difference. Providers also seek reimbursement from patients, even though this practice is usually banned. All of this paperwork and haggling consumes time, energy and money.” Last line: “My elbow is fine. I wish I could say the same for our broken health care system.”

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Clarissa Donnelly-DeRoven, “Six Republican counties in WNC pledged their support for Medicaid expansion. What’s changed?” North Carolina Health News, Oct 11, 2021

Slow shift from ideology to practicality among red-state local officials. “What we have learned is if you cut out all the political rhetoric and just get down to the real facts of this issue, which then that puts it on a human being level, it’s not about Republicans. It’s not about Democrats,” Wiggins said in a recent conversation. “It’s about my neighbors, your neighbors, [who] are human beings. And in 2021, people need health care.” Also, the mountains of western NC are largely white, as proponents don’t fail to mention: “Cooper points out that many of the uninsured in the western part of the state are white people, mothers, and veterans,” i.e., the deserving poor.

Posted Oct 14, 2021

Damien Contandriopoulos, “The year public health lost its soul,” Authorea, Sep 24, 2021

Worth a read for understanding how the public health establishment is steadily losing credibility. Its thesis: Public health, as a discipline, rests on three basic tenets: fostering individual and collective health, scientific approaches, and equity. But also: “public health is firmly embedded in the state administrative apparatus. State-run public health bureaucracies therefore always had to carefully thread the line between their disciplinary ambitions and the political acceptability of their interventions.” That is, public health has a strong authoritarian streak—of necessity—and has to operate in the realm of immediate public policy. Lessons re Covid: “The [early] emphasis was on fomite and respiratory droplets. However, by the summer of 2020, it became clear that the virus was likely airborne and caused by aerosol transmission,” but the CDC/WHO, et al., stubbornly held to their original bias, such that “public health institutions found themselves stonewalling and actively contradicting scientific developments in the field” while also being bent to the will of economic actors wanting business as usual back. The latter undermined equity insofar as the most vulnerable economically were most exposed to Covid morbidity.

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Mark Frauenfelder, “Woman charged for crying during surgery,” Boing Boing, Sep 30, 2021

Not The Onion. You can be charged under CPT Code 96127 “Behavioral or Emotional Assessment.” I guess this is when the nurse says, “This may hurt a little” and then bills you for it. “One woman went to her doctor to get a mole removed. She cried at one point during the operation, and her bill, which she posted to Twitter, showed an $11 charge for “Brief Emotion.” Luckily, they couldn’t charge her for the more extensive emotion she experienced upon getting the bill.

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Buzz Hollander, “Lessons from the ivermectin debacle,” Real Clear Science, Sep 8, 2021

Once again, the basics: ivermectin is an anti-parasitic medication that has been prescribed to humans (not horses) over 3 billion times with fewer side effects at low doses than those of acetaminophen. It is widely used for river blindness and topically for things like the autoimmune skin condition known as rosacea. As for its Covid efficacy, there is still weak evidence for it, and more rigorous studies aren’t completed. But the health establishment panic over it is unwarranted, and the use of veterinary dosages likely stems from the crackdown on regular access. Ivermectin is a cheap, off-patent drug; ergo, no fortunes are to be made. Just sayin’.

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Lambert Strether, “Direct Contracting Entities: The latest scam to privatize Medicare,” Naked Capitalism, Sep 27, 2021

Useful detail on the topic of a recent PNHP seminar, including a recap of the trajectory of the frightful Liz Fowler (Senate aide, temporarily borrowed from the for-profit healthcare sector to write the ACA for Max Baucus, then administer it under Obama, from whence she decamped backed to the insurance biz), “value-based care,” and other unlovely components of the health policy sausage. Note how the Center for Medicare and Medicaid Innovation (CMMI) is used to sneak privatization in by the side door by promoting “payment models,” which do not need congressional authorization, consistently fail at their announced goals, but are spread around further anyway. Patients can be shifted into these DCE plans without their consent (just as the NYC retirees just were shoved into Medicare Advantage).

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J. Emory Parker, “See how much Covid-19 relief money health care providers in your state got,” STAT, Sep 24, 2021

NY Presbyterian got $631 million, three times as much as all of Puerto Rico. Interactive and searchable.

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Matthew Herper, “Merck’s antiviral pill reduces hospitalization of Covid patients, a possible game-changer for treatment,” STAT, Oct 1, 2021

Molnupiravir did pretty well in a trial run by Merck, according to Merck’s data-light news release. The Pharma PR announcement was eagerly gobbled up by the industry media given that the new drug is taken orally (rather than by infusion) and will cost a lot.

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Bob Herman, “Taxpayers funded development of COVID-19 antiviral pill,” Axios, Oct 5, 2021

“The antiviral pill that showed promising results against severe COVID-19 was originally developed at Emory University with $35 million of taxpayer grants.” Therefore, the Feds co-own the patent, which it undoubtedly will hand over to Merck for nothing.

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Travis Whitfill, “A likely new treatment for Covid-19 was made possible by government-funded innovation,” STAT, Oct. 5, 2021

“The story behind molnupiravir is intriguing and a testament to government-funded innovation.” Gory details about the university-private investment-Pharma complex and how it extracts rent from the state (i.e., us). 

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Natalie Shure, “Big Pharma’s revolving door is imperiling democracy,” New Republic, Oct 5, 2021

“The industry’s titanic profits power a perpetual stranglehold over our government with only one goal in mind: raking you clean of every last dime.” Nothing much new but a good summary polemic. “Not only do drug companies unilaterally name their prices, they benefit from long-term private patents (often forged from publicly funded research conducted at mind-bogglingly flush universities); have carte-blanche permission to advertise nonstop directly to patients; bankroll one of the most formidable lobbies in Washington, regularly buying off both of its major political parties” and welcome into their ranks “a majority” of former FDA officials who have just greenlighted lucrative industry products.

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Ned Pagliarulo, “Eisai, Biogen to test FDA by asking for approval of second Alzheimer's drug,” BioPharma Dive, Sep 28, 2021

Aduhelm was such a success that the two partners behind it are moving ahead with a second, similar drug with similar efficacy failures in its record: “Lecanemab’s one-year results from the Phase 2 study on which Eisai is basing its application showed the drug was unlikely to work.” But, voila, six months later someone found a way to say that it does.

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Jonathan Saltzman, “Mass General Brigham won’t offer Biogen’s new Alzheimer’s drug,” Boston Globe, Sep 28, 2021

Aduhelm continues to struggle to find doctors willing to shoot it into frail seniors despite the brain hemorrhaging issues. Said Dr. Sam Gandy of New York’s Mount Sinai, “This emperor has no clothes,” adding that no patients or caregivers have asked him about getting the medicine in the past month.

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Christopher Magoon, “The part of the ‘Free Britney’ saga that could happen to anyone,” Kaiser Health News, Sep 29, 2021

“Every year hundreds of thousands of psychiatric patients also receive involuntary care, and many are stuck with the bill. When patients pose an acutely high risk of harm to themselves or others, psychiatrists are obligated to hospitalize them against their will even if it could lead to long-term financial strain.”

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Kevin Dunleavy, “Amid new pricing pressure, Lilly cuts cost of generic insulin by another 40%,” FiercePharma, Sep 28, 2021  

When political heat increases, targeted industries often taken “voluntary” action—an old tobacco industry playbook—to stave off more effective governmental action. “That move came just weeks after Sen. Ron Wyden (D-OR) pointed out in a drug-price hearing that Humalog’s cost per vial had jumped from $21 in 1996 to $275 in 2019.”

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Aneri Pattani, “A Covid test costing more than a Tesla? It happened in Texas,” Kaiser Health News, Sep 30, 2021

The Patient: Travis Warner, 36, is self-employed and bought coverage from Molina Healthcare off the insurance marketplace. Total bill for his PCR and antigen tests: $56,384, including $54,000 for the PCR test and the balance for the antigen test and an ER facility fee. Molina’s insurer paid nearly $17,000. “Yet it’s perfectly legal. For Covid tests—like much else in American health care—there is no cap to what providers can charge.” One reason for this scam is the federal law requiring insurers to pay for Covid tests without cost sharing. “While the policy was intended to help patients, it has unintentionally given providers leeway to charge arbitrary, sometimes absurd prices, knowing that insurers are required to pay and that patients, who won’t be billed, are unlikely to complain.”

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Bob Herman, “The U.S. is the drug industry's gold mine,” Axios, Sep 30, 2021

U.S. sales alone accounted for $101 billion for the world’s 20 top-selling drugs, 64% of the total.

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Ashley Lopez, “Death in Dallas: One family’s experience in the Medicaid gap,” KUT, Sep 30, 2021

How Texas’s racist refusal to expand Medicaid affects those in the “coverage gap” who earn too much to qualify, of whom about 70% are Latino or Black.

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Janet Trauwein, “Op-ed: Lowering the age for Medicare eligibility is a lousy idea we can’t afford,” Chicago Tribune, Sep 29, 2021

“Janet Trautwein is CEO of the National Association of Health Underwriters.” Have yet to see a pitch against expanding Medicare/Medicaid not written by someone in the pay of the industry. 

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Aditi Shrikant, “People who carry debt also have more physical pain, new study shows,” GROW, Oct 1, 2021

“Those with consistently high debt were 76% more likely to have pain that interfered with their daily life, such as joint pain and stiffness, compared to those without unsecured debt.”

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Zachary Brennan, “Pfizer loses closely watched court case on kickbacks and subsidizing drugs,” Endpoints News, Oct 1, 2021

“Pfizer had attempted to convince the court that it should be able to provide kickbacks help patients overcome a financial barrier to obtain the company’s rare disease drug tafamidis, which comes with a $225,000 list price for a single year’s supply.” A judge disagreed: “The stated intent of the payments Pfizer proposes here are [sic] to increase the number of Medicare beneficiaries who purchase the drug.” That’s still illegal, for now.

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Jessica Schorr Saxe, “When your doctor leaves a practice, you shouldn’t have to play hide and seek,” Charlotte Observer, Sep 30, 2021

“Friends recently received letters informing them that their doctors were leaving their practices. The letters were perfunctory, acknowledging the doctor’s service and telling the patients that they could see other providers in the office. In no case did the letters discuss the departing doctors’ plans—notably that they will still be practicing in Charlotte—nor tell the patients how they could continue care with their primary physicians. I am both shocked and not surprised. This is one more example of the encroachment of business decisions on the practice of medicine. Patients: Be vigilant and watch out for financial decisions taking precedence over your care. If your healthcare system claims to be patient-centered yet is willing to sever the doctor-patient relationship, let them know that violates your trust.”

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Emily Kopp, “Nonprofit linked to PhRMA behind ads opposing drug pricing changes,” Roll Call, Sep 30, 2021

Big surprise: a cable TV ad campaign ubiquitous on television screens in Washington, D.C., and 13 states and that is aimed at undermining widespread support for letting Medicaid negotiate drug prices is a Pharma astro-turf operation. Expect more if any favorable changes to healthcare policy edge nearer to approval. Executive director Kenneth Thorpe is a former health care official under the Clinton administration, hired to help drug companies better court Democrats—successfully, as seen in recent weeks.

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Joel Achenbach & Yasmeen Abutaleb, “Messy, incomplete U.S. data hobbles pandemic response,” Washington Post, Sep 30, 2021

The to-do over coronavirus booster shots has shown how little we actually know in our piecemeal, atomized health system. “The data is a mess. Critically important data on vaccinations, infections, hospitalizations and deaths is scattered among local health departments [and] is often out of date and hard to aggregate at the national level.” Also, “Some hospital systems want to hang onto their data because they see that as a potential future revenue stream.”

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Khadijah M. Silver, “Pharmacists join chorus calling for DOJ to stop Optum-Change Healthcare merger,” MedCity News, Oct 6, 2021

Resistance to yet another hospital merger—this time, from pharmacists. “Independent and community pharmacy advocates warned that if allowed, the deal would create a ‘corporate monster’ that would lay waste to market competition and further harm pharmacies struggling to stay afloat amidst what they describe as predatory Pharmacy Benefit Manager (PBM) practices. One of the prospective partners is a unit of UnitedHealth Group, which already covers 70 million people.

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Wendell Potter, “Lower out-of-pockets NOW,” Tarbell, Sep 27, 2021

Potter, a former health insurance industry executive, describes how his bosses pushed to eliminate managed care plans in favor of high deductible, high cost-sharing alternatives. Potter’s job was to get employers to fall for Cigna’s talking points—that the changes would “empower their employees to make their own decisions about their health care, which, we said, would reduce unnecessary care,” meaning that Americans go to the doctor too much. The result: underinsured people skip care or slip into financial crisis for medical costs. The legal out-of-pocket maximum under the ACA is now $17,400 for a family, up from $12,700 in 2014.

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Christopher H. Loo, “The end of job security in healthcare,” MedPage Today, Oct 11, 2021 

“It took just over 20 years for physicians to witness the erosion of the once prosperous profession of medicine. With the institution of managed care, physician benefits such as compensation, autonomy, lifestyle, job security, and career satisfaction have all but disappeared.” Workers of the world, unite! etc., etc.

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Andrew Perez, “The corporate health care industry just detailed some of its biggest scams,” Jacobin, Oct 11, 2021

“The industry typically presents a united front in defense of for-profit medicine—but in a new letter to regulators, the hospital industry has detailed some of the most abusive techniques being used by insurers to fleece Americans.” Splits within the industry over who gets the biggest slice of the pie could redound to the public’s benefit. Good detail on the various insurer scams and a key piece of advice: appeal claim denials (very few patients do).

Posted Sep 30, 2021

Matt Stoller, “The corrupt system behind Covid medical shortages,” BIG, Sep 26, 2021

“If there are shortages [of medical supplies], why can’t hospitals buy from new producers?” That is, why aren’t markets working like they do in economics textbooks? Because giant Group Purchasing Organizations (GPOs) have rolled up the industry and control the supply chain. When Congress allowed kickbacks in 1987, higher costs meant that everyone got a larger slice if the pie grew bigger. Now, vendors have to pay to be included, GPOs get more revenue, and hospital execs cash in as well. “Vendors compete for exclusive GPO contracts based not on who can supply the best product at the best price but on who can pay the highest fees.” Also, “Many hospital executives have learned to rely on that share back as an integral part of their annual compensation.” A.K.A. legalized bribery and kickbacks. Ninety percent of all medical supplies are purchased by four GPOs from three wholesalers.

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Rachana Pradhan, “Public health experts ‘flabbergasted’ that Biden still hasn’t picked an FDA chief,” Kaiser Health News, Sep 22, 2021

Maybe the combination of slick PR professional and corruptible friend of Pharma is a tough find.

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Brook K. Baker, “Biden’s global summit Covid-19 targets are woefully inadequate and must be corrected,” STAT, Sep 22, 2021  

“These targets downplay the obligations of rich countries to reverse the horrific consequences of vaccine, testing, and therapeutics apartheid that they—and the biopharmaceutical industry—have engendered. Inexplicably, the summit targets do not mention the need to overcome intellectual property barriers and to mandate—or forcibly incentivize—vaccine technology transfer from reluctant, uncooperative rightsholders.” What’s inexplicable about that?

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Fred Schulte, “Justice Department targets data mining in Medicare Advantage fraud case,” Kaiser Health News, Sep 14, 2021

First case involving a data mining company that is accused of systematic upcoding to boost MA payouts from Medicare. Underlying problem: Medicare Advantage itself. Medicare pays MA plans extra based on a “risk score,” which is easily gamed. For example, “[Whistleblower] Teresa Ross alleged that the plan billed for ‘major depression’ in a patient described by his doctor as having an ‘amazingly sunny disposition.’”

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Trudy Lieberman, “This latest under-the-radar program could push Medicare deeper into private hands,” Center for Health Journalism, Mar 11, 2021

Here comes privatization in Medicare, very much under the radar (this is from March): “Beneficiaries in traditional Medicare in 10 metro regions across the country will be required to enroll in what’s being called a ‘direct contracting entity.’ That entity, which could be a physician group, insurance company, managed care organization, or accountable care organization, would deliver all the care for those in the plan and receive one payment from the government for giving that care. It would work sort of like Medicare managed care does now, but unlike people in Medicare managed care who have chosen to be in that program, beneficiaries who live in one of those selected regions would be required to choose one of these new entities in order to receive any Medicare benefits at all.” More background on the “Geo” program in the next article.

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Diane Archer, “Trump administration attempts to privatize traditional Medicare,” Just Care, Dec 17, 2020

Background on the Geo privatization experiment, which is supposed to be an investigation of alternative models. However, “The model does not provide for a meaningful way for CMS [the Federal Government] to oversee the direct contracting entities (DCEs) that will be assuming full financial risk for all medical and hospital services people receive. It does not call for the DCEs to turn over encounter or claims data. What protections will be available to people in Medicare who are forced into the GEO model if they are unable to get the care they need? The model does not allow them to opt out. Their out-of-pocket costs should not increase, but how will CMS know if they do?” Many other unanswered questions, suggesting that the whole thing is a Trojan horse to get private insurers deeper into the Medicare gravy train.

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Victoria Derbyshire, “NHS waits: More people feeling forced into private healthcare,” BBC Panorama, Sep 27, 2021

Millions of people across the UK are currently on NHS waiting lists—in Northern Ireland there are over 465,000 people while in England 5.6m are queuing for treatment.” Everything is going according to plan! Starve and wreck public services, then claim that privatization will solve everything.

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Matthew Herper, “Remdesivir reduces Covid hospitalizations when given early, study shows,” STAT, Sep 22, 2021

Science reporting by press release, giving the company full control over the spin: “Gilead’s Covid-19 drug remdesivir appeared to reduce hospitalizations by 87% in high-risk patients diagnosed early in the disease in a new study, the company said Wednesday.” It’s suspicious—and reporters should be more skeptical—when these announcements are not accompanied by all the technical info. “The new results could help shore up the perception that the medicine is effective. They also could boost hopes for the use of oral antiviral drugs being developed by drug companies including Pfizer and Merck to treat people in the early stages of Covid-19. A study conducted by Gilead and the National Institutes of Health showed that it helped patients recover faster. But a second large trial, conducted by the World Health Organization, failed to show any benefit for the drug in reducing Covid deaths.” How unusual—the company-sponsored trial says it works, the WHO one says it doesn’t.

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Victoria C. Yan & Florian L. Muller, “Why Remdesivir failed: Preclinical assumptions overestimate the clinical efficacy of Remdesivir for COVID-19 and Ebola,” Antimicrobial Agents and Chemotherapy, Sep 17, 2021

“Several trials have not found statistically significant differences in either time to clinical improvement or mortality between remdesivir-treated and control groups. For both COVID-19 and Ebola, significant discordance between the robust preclinical data and remdesivir’s lackluster clinical performance have left many puzzled.” And yet no moral panic or jokes about horse medicines.

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Breck Dumas, “States warn of COVID-19 antibody drug shortage,” Fox News, Sep 18, 2021

Curious that the fanatically skeptical non-vaxxers are rushing to get hold of these treatments despite spotty efficacy records. But they cost lots of money, so they must be good.

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Times of India, “Uttar Pradesh: Covid cases down by 99% since peak,” Sep 25, 2021

“All 63 districts in the state reported zero cases in the last 24 hours.” UP authorities attribute their success to the massive used of cheap, off-patent, antiviral ivermectin as a prophylactic, known here as “horse de-wormer” only used by dumb bubbas who never went to college. For more see https://bit.ly/3kLKtVg

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Kellie Schmitt, “Does Medicaid take better care of Americans and their finances than exchange plans?” Center for Health Journalism, Sep 20, 2021

“19% of people surveyed with private marketplace [Obamacare] plans skipped prescriptions, delayed care and faced financial problems,” compared to only 10% of Medicaid patients.

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Sofia Pitt, “Never Pay the First Bill author and medical bill expert: Top tips to make sure you’re not being overcharged,” GROW, Sep 15, 2021

News you can use: (1) Make sure your insurance company was billed. (2) Review the itemized bill and insist on the billing codes, which can be interpreted with a simple internet search. (3) Compare costs for your medical procedure, then contest overcharges.

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Stephen Parodi, “COVID’s assault on the moral fiber of medicine,” MedPage Today, Sep 24, 2021

Cautions that blaming patients for their illness is contrary to medical ethics. “We can look to our predecessors for some guidance. In 1983 a small group of physicians and nurses at San Francisco General Hospital opened Ward 5B, the first dedicated AIDS ward in the U.S. Despite an unimaginably high fatality rate, lack of evidence about how the disease was transmitted, and an anemic governmental response, these volunteers were determined to bring humanity to their increasingly isolated and desperate patients. At great personal sacrifice, they set aside their fears and an onslaught of societal judgment, including a hostile narrative that squarely blamed the ‘personal choices’ of those who contracted HIV.”

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Luke O’Neil, “The American healthcare system damages your ‘thinking,’ not just the public health,” Welcome to Hell World, Sep 26, 2021

Lots of lovely anecdotes of people who lived in civilized countries and don’t understand the concept of “medical bill.”

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Kamran Abbasi, “The next step in immorality: charging to create and cure disease,” BMJ, Sep 16, 2021

Strong language for a normally sedate medical journal. “The next step in immorality is to charge patients to become sick and be paid to help with treatment. It’s a step that Philip Morris International, one of the world’s richest tobacco companies, is seeking to take with its proposed £1bn purchase of Vectura, a pharmaceutical company that makes inhalers for respiratory diseases. The question for healthcare organisations, including medical publishers, is whether they will treat Vectura as they do any other tobacco company.” Abbasi, BMJ’s editor, says they won’t publish its research.

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Rose Hoban, “More emergency surgeries, more ‘catastrophic’ bills in states without Medicaid expansion,” North Carolina Health News, September 20, 2021

“Two emergency procedures—gallbladder removal and heart catheterizations—are the top two surgeries performed on uninsured patients in states such as North Carolina that have not moved to expand Medicaid. These catastrophically expensive emergency surgeries often could have been avoided if the patient had had access to preventive health care services.” The income limit to qualify for Medicaid in NC, a non-expansion state, is $10,760 for a family of three.

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Audrey Xu & Samuel Hammond, “Expand Medicaid, crush “predatory lenders”—how medical debt fuels financialization,” Niskanen Center, Aug 9, 2021

Argues that tweaking the rules on predatory lending doesn’t address the underlying problem: medical debt, which the authors compare to the myth of Sisyphus. “Workers stuck in low-wage jobs without health coverage face insurmountable challenges in paying for medical expenses and, when forced to resort to high-cost borrowing, fall into even deeper financial distress, just as Sisyphus was doomed to roll a boulder uphill only to see it roll back down.” Crushing debt burdens are thus built into the system. Tennessee authorized payday lenders to charge up to 279% annual interest, making traditional loan sharks obsolete. As Tony Soprano’s colleagues said in one episode, “There’s no more room for the little guy.”

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Kristina Fiore, “Fired Covid whistleblower: Profit motive isn’t working in healthcare,” MedPage Today, September 27, 2021

Ming Lin, the ER doc from Washington state fired for speaking out about unsafe conditions: “The atmosphere we work in is becoming increasingly corporate. Are the companies we work for any different from Amazon or Microsoft, whose primary objective is profit?” Also, new doctors’ student debt burdens make them more docile.

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Jade Khatib, “One key study highlights how cancer-drug prices continue to rise in the US—even if they don’t elsewhere,” Business Insider, Sep 10, 2021

“The U.S. doesn’t negotiate drug prices, allowing pharmaceutical companies to charge whatever they think insurers will pay. In the U.K., Germany, and Switzerland, the government or an organization of insurers negotiates with pharmaceutical companies on drug prices.”

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Noah Higgins-Dunn, “Gilead, Merck and others slapped with ‘pay-for-delay’ lawsuits over lucrative HIV and cholesterol meds,” Fierce Pharma, Sep 24, 2021

“Gilead and Merck engaged in what’s known as ‘pay-for-delay’ deals, settling with up-and-coming generic rivals to stall their market entry.” The only restraint on gouging and other scams seems to be legal challenges from other industry giants getting shut out of their share. The governmental regulatory apparatus is rarely seen. 

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"Bausch pays whopping $300M to settle Glumetza pay-for-delay lawsuit after 800% price hike,” Fierce Pharma, Sep 10, 2021

“The lawsuit that claimed the Canadian drugmaker paid off its generic rivals nearly a decade ago, allowing the company to jack up prices for the type 2 diabetes heavyweight by 800% shortly thereafter.” After paying off the generic competition, Bausch jacked up the price for its diabetes drug from around $6 per tablet to $51. Unanswered question: does the fine fully disgorge the profits made, or is a typical cost-of-doing-business charge? As usual, no individual is charged criminally.

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Howard Fine, “How GoodRx fended off Amazon,” Los Angeles Business Journal, Sep 20, 2021

“The GoodRx prescription drug marketplace got its start in 2011 when [a former Facebook executive] decided to create a platform to help consumers find the lowest prescription drug price in their area. The company now has the ability to price drugs at 70,000 pharmacies across the United States.” Technology at the service of human welfare! Except, “its fastest growing segment is a set of arrangements with 19 of the top 20 pharmaceutical companies to enable them to boost patient and consumer awareness of drug manufacturer-sponsored discount programs for their prescription drug products.” So GoodRx now helps Pharma corral patients into using its expensive products. And the company’s “growth in revenue has been slow to translate into increased profits because of $500 million-plus payouts” to the two co-founders. Hey, if you can’t walk away with a cool half-billion, why get into healthcare? Also, “GoodRx moved into the insurance arena to guide its senior citizen customers to the most suitable and affordable Medicare Advantage plans.”

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Shawn Shinneman, “How Mark Cuban plans to dunk on the drug industry,” Texas Monthly, Sep 15, 2021

By cutting out the monopolistic intermediaries like the three near-monopoly drug wholesalers and the PBM cartel. Easier: ban the practice and break up the monopolies, which, however, would require a functioning regulatory apparatus. Nonetheless, it will be interesting to see if the plan works, and Cuban has deep pockets to sustain losses.

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Posted Sep 21, 2021

Rachel Cohrs, “Moderate Democrats sink Pelosi’s aggressive drug pricing bill in key committee vote,” STAT, Sep 15, 2021

Three DINOsaurs turn Republican to squash the vastly popular measure that would empower Medicare to negotiate drug prices. The three (Scott Peters CA, Kurt Schrader OR, and our own Kathleen Rice of Long Island) all gobbled up loads of Pharma cash while doing the bosses’ bidding. “Last December, House Democrats’ steering committee voted to put Rice on the energy and commerce panel instead of the progressive New York representative Alexandria Ocasio-Cortez.” So, the Blue Dog chamber that Nancy built undermines the Biden package. Whocuddanode? Will the Dem leadership now be less enthusiastic about filling their ranks with corporate toadies? No. Note how the news media—especially the specialty organs—insist on whitewashing these corrupt Pharma shills as “moderates.”

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Peter Sullivan, “Democrats suffer blow on drug pricing as 3 moderates buck party,” The Hill, Sep 15, 2021

Because it would “harm innovation,” a routine Pharma talking point. Will they be punished by the leadership for torpedoing a key provision of the Biden program?

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David Sirota & Andrew Perez, “Guess what the three Democrats blocking lower medication prices have in common?” Guardian/Daily Poster, Sep 20, 2021

Juicy shares of $1.6m of campaign cash from pharmaceutical and health products companies, that’s what. “Peters and his family were worth an estimated $60m in 2018. His wife is the CEO of Cameron Holdings, an investment firm whose portfolio company provides manufacturing and packaging for pharmaceutical companies.” And, “Schrader received an inheritance from his grandfather, who was vice president and director of biochemical research and development at Pfizer.” And, “Schrader’s longtime top aide, Paul Gage, left the congressman’s office earlier this year and quickly started lobbying for Pharmaceutical Research and Manufacturers of America (PhRMA), the powerful Washington drug lobby.”

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Daniel Marans and Kevin Robillard, “Unions are helping Big Pharma fight Democrats’ prescription drug bill,” HuffPost, Sep 2, 2021

“TV ads sponsored by pharmaceutical companies and unions [via the Pharmaceutical Industry Labor-Management Association] claim that a bill empowering Medicare to negotiate lower prices would destroy union jobs.” The unions include: the International Association of Sheet Metal, Air, Rail, and Transportation Workers (SMART); the International Brotherhood of Electrical Workers (IBEW); the United Association of Plumbers and Pipefitters (UA); the International Brotherhood of Boilermakers (IBB); the International Association of Bridge, Structural, Ornamental, and Reinforcing Iron Workers (Iron Workers union); the International Union of Operating Engineers (IUOE); the International Union of Police Associations (IUPA); and the International Association of Fire Fighters (IAFF).

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Alfred Engelberg, “Outdated rule increases Medicare’s costs for generic drugs by $26 billion a year,” STAT, Sep 10, 2021

And here’s what the Blue Dogs just preserved: “The difference between the highest and lowest price being charged for the same generic drug is so large that many billions of dollars could be saved each year by having prescriptions filled at the lowest-cost pharmacies.” Why? “The answer resides in a lack of transparency about the true cost of generic medicines. Insurance plans and pharmacy benefit managers price their generic prescriptions at levels the market will bear rather than at a reasonable markup. Patients and payers believe they are getting a bargain when they get a 70% discount and pay 30 cents per pill for the generic version of a branded medicine for which they previously paid $1. They have no idea that the pharmacy acquired that pill for only a penny or two. The high markup imposed by insurance plans and pharmacy benefit managers explains why the government pays 26 cents a pill for atorvastatin while Amazon sells it for 5 cents. Medicare should be able to fill generic prescriptions at the lowest price charged for those prescriptions in the competitive retail market. But the 2003 law that created Part D prohibits the government from shopping for the best price and gives private insurance plans exclusive authority to set the price.” Peters, Schrader, and Rice just made sure the prohibition remains in place.

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Kyle Knight & Margaret Wurth, “COVID-19 exposes warped global health power: The system needs a course correction,” Business and Human Rights Journal, Aug 31, 2021 [not paywalled]

“By June 2021, most high-income countries had achieved around 50 per cent vaccination of their populations, while lower-income countries were struggling to achieve 1 per cent. COVAX, the global vaccine procurement mechanism on which many low- and middle-income countries depend, had no vaccines to give in June and is struggling to deliver even on its modest goal to provide at least 20 per cent coverage.” Again, why? “Governments funding Covid-19 vaccine development with public money failed to condition these funds on affordability and sharing technology, leaving companies to decide how, when, and where they will manufacture, distribute, and price vaccines.”

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Sam Mellins, “Biden could share vaccine data with the world,” Daily Poster, Sep 7, 2021

“In a 2020 contract with Moderna, a division of the Department of Health and Human Services agreed to bankroll much of the vaccine development and manufacturing process, partially in exchange for ‘access to all documentation and data generated under this contract,’ including the vaccine technology, and can “unilaterally publish or share the data with anyone.” So, the U.S. doesn’t need Pharma consent. “As of August, COVAX, the World Health Organization’s (WHO) vaccine sharing initiative, had distributed 188 million vaccines worldwide, just 19 percent of the 1.1 billion that the WHO says are needed to end the pandemic.” Negotiations at the WTO are stalled, not accidentally. Meanwhile, “Moderna’s stock price has increased from $130 in March 2020 to $395 today.”

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Benjamin Mueller & Rebecca Robbins, “Where a vast global vaccination program went wrong,” New York Times, Aug 2, 2021

“Known as Covax, the program was supposed to be a global powerhouse, a multibillion-dollar alliance of international health bodies and nonprofits that would ensure through sheer buying power that poor countries received vaccines as quickly as the rich. Instead, Covax has struggled to acquire doses: It stands half a billion short of its goal. Poor countries are dangerously unprotected as the Delta variant runs rampant, just the scenario that Covax was created to prevent.” But note: “Driven by a nonprofit funded by the Gates Foundation, Covax is a creation without precedent.” Later in the article: “Covax was the answer, bringing together two Gates-funded nonprofits, Gavi and the Coalition for Epidemic Preparedness Innovations, or CEPI; the World Health Organization; and UNICEF, which would lead delivery efforts.” Since Gates is a major funder of the latter two, that’s actually four Gates-heavy nonprofits. And Gates demands intellectual property protection for Pharma. Should the failure of Covax really be so surprising?

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Helen Branswell, “A conversation with Bill Gates on how public health has fared in the midst of the pandemic,” STAT, Sep 13, 2021

Softball interview by a medical news agency with questions like, “Your foundation likes to focus on the positive. Do you ever wonder whether focusing on the positive downplays the urgency of the situation?” Question not asked: “Do you still insist on protecting Pharma patents at the expense of vaccine access for poor countries?” That would be a hanging offense for Ms. Branswell.

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Sarah Gantz, “COVID-19 vaccine is free, but medical bills or fear of cost a barrier to vaccination for some,” Philadelphia Inquirer, Aug 18, 2021

“While actually receiving a bill for the vaccine appears to be rare, many more people believe they may be charged for the shot and so don’t get vaccinated. The cost of health care is infamously mysterious in the United States. People rarely know how much a service will cost—or how much of it will be covered by insurance—until they get the bill. Even procedures that are supposed to be covered in full by insurance can lead to surprise bills.”

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Jared Ortaliza et al., “Most private insurers are no longer waiving cost-sharing for COVID-19 treatment,” Peterson/Kaiser Family Foundation, Aug 19, 2021

“While a handful of states required or created agreements with insurers to waive COVID-19 out-of-pocket treatment costs for their fully-insured plan enrollees, there is no federal mandate requiring insurers to do so.” So is it any wonder that people think they’ll be hit with unexpected charges? “[Some] insurers may have also feared the possibility of a federal mandate to provide care free-of-charge to COVID-19 patients, so they voluntarily waived these costs for at least some period of time during the pandemic. Now, health insurers may no longer face political or public relations pressure to continue waiving costs for COVID-19 treatment.” Lesson: corporate goodwill has a short shelf life.

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Nick Moran, “15 million people could lose coverage after public health emergency ends, report says,” Becker’s Hospital Review, Sep 15, 2021

“Medicaid enrollment initially swelled as a result of early pandemic joblessness and continuous coverage requirement of the Families First Coronavirus Response Act.”

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Megan Molteni, “The 60-year-old scientific screwup that helped Covid kill,” Wired, May 13, 2021

“All pandemic long, scientists brawled over how the virus spreads. Droplets! No, aerosols! At the heart of the fight was a teensy error with huge consequences. After WHO had tweeted ‘FACT: #COVID19 is NOT airborne,’ [aerosol scientists] were trying to warn the WHO it was making a big mistake.” The aerosol scientists were right; the WHO poohbahs wrong. Millions died. #The Science.

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Damian Garde & Adam Feuerstein, “Biogen admits Aduhelm launch ‘slower than we anticipated,’” STAT, Sep 9, 2021

“Wall Street’s earnings estimates for Biogen implied that about 12,000 patients were receiving Aduhelm, suggesting a massive disparity between investor expectations and commercial reality. The company has lost nearly 25% of its value since Aduhelm was approved.” Such suffering for shareholders.

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Emily Milligan & Katherine R. McCurdy, “Aduhelm backlash threatens to reverse progress in FDA’s reviews of rare and ultra-rare disease drugs,” STAT, Sep 14, 2021 

“As advocates for people living with Barth syndrome—an ultra-rare, life-threatening genetic condition affecting just 130 children and young adults in the U.S.—we fear the pushback [against Aduhelm] will discourage the FDA from consistently exercising appropriate flexibility in its approval standards to improve access to safe and effective therapies.” But Alzheimer’s is hardly “ultra-rare,” so the argument is a big stretch.

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Bishal Gyawali, Benjamin N. Rome & Aaron S. Kesselheim, “Regulatory and clinical consequences of negative confirmatory trials of accelerated approval cancer drugs: Retrospective observational study,” BMJ, Sep 9, 2021

A mouthful of a title that means, “What happens when the FDA gives a drug accelerated approval conditioned on proving that the thing actually works?” Answer: even if the drug fails, the FDA often lets Pharma keep the erroneous recommendations on its product labels. This is an important point in the Aduhelm debate because 10 years from now when the drug is shown not to work, there could easily be zero consequences and certainly no disgorgement of ill-gotten gains.

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Nina Kreuzberger et al., “SARS‐CoV‐2‐neutralising monoclonal antibodies for treatment of COVID‐19,” Cochrane Database of Systematic Reviews, Sep 2, 2021

“Our certainty in the evidence for all non‐hospitalised individuals is low and for hospitalised individuals is very low to moderate. We consider the current evidence insufficient to draw meaningful conclusions regarding treatment with SARS‐CoV‐2‐neutralising mAbs.” Yet these expensive Pharma products get respectful treatment—no one points in horror at the dumb bubbas injecting themselves with these unproven (but profitable) products.

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Joseph Bustos, “SC Gov. McMaster takes on Biden after he pulls back on Trump’s Medicaid work approval,” The State, Sep 15, 2021

Otherwise, the undeserving poor might get health care they shouldn’t. The governor was against expanding Medicaid at all because “having people work is the best way out of poverty.” Presumably, all jobs in South Carolina include attractive health insurance benefits.   

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Rebecca Grapevine & Andy Miller, “Georgia eyes new Medicaid contract, but how is the state managing medical care?” Georgia Health News/Kaiser Health News, Sep 13, 2021

Georgia pays three insurance companies over $4 billion each year to run its Medicaid program, which puts nearly $200 million per year profits into private pockets. “Yet Georgia lacks some of the financial guardrails used by other states.” Forty states use managed-care companies to run their Medicaid programs, typically allowing 15% off the top for admin and profit. In Georgia they get more. “‘Profits for Georgia Medicaid HMOs are very healthy,’ said Allan Baumgarten, an independent analyst and consultant”—although Georgians may not be. “Compared with other states, Georgia has a stunningly low rate of referring poor children to specialty services under Medicaid. And, currently, the state is reporting low covid vaccination rates for those 12 and older covered by the Medicaid managed-care companies.”

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Wendell Potter, “Medicare Advantage and the privatization of Medicare: An advantage for insurance firms, not patients,” Tarbell, Jun 28, 2021

“Medicare Advantage, originally called Medicare Choice, deserved neither [moniker] as it doesn’t improve choice nor is it an advantage.” One advantage that only MA gets: “a bonus paid annually to insurance companies for enrolling patients who are characterized as sicker, frailer, older or more seriously injured.” The reclassification is easily gamed. The MA industry last year pulled in $288 billion of Medicare spending of $776 billion, or about one-third of the total federal outlay.

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Dan Weissmann, “‘An arm and a leg’: Meet the Mississippi lawyer who helped start the fight for charity care,” Kaiser Health News, Aug 24, 2021

Dick Scruggs initiated the lawsuits against nonprofit hospitals to enforce their legal obligation to provide charity care. Fun!

Posted Sep 9, 2021

Alexander Zaitchik, “The great American science heist,” The Intercept, Aug 29, 2021

A full history of the public science giveaway codified in the Bayh-Dole Act of 1980 that handed monopoly patent protection to Pharma for drugs developed with public funds. Biden could reverse the trend, starting with action over the prostate cancer drug Xtandi, just bought by Pfizer for $14 billion.

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Libby Watson, “Don’t have your baby in January,” Sick Note, Aug 30, 2021

How annual deductibles screw over new parents: many try to push the little bumble out in December to beat the reset. Also, January births mean no child tax break for the prior year. “Many hospitals see a rush of patients scheduling elective procedures in December when they may have already spent most of their deductible. But for most parents, trying to schedule their baby’s birth for December is difficult.” New father Michael comments: “It's so frustrating that one of the first things that I said out loud was like, ‘Oh my God, she’s gonna be born in January again, when the deductibles roll over.’” The Brave New World of parenting.

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Unsigned review, “Joseph Q. Jarvis, The Purple World: Healing the harm in American health care,” Blue Ink Review, Jul, 2019

Proposes a states-first approach to single-payer. The Purple World refers to his suggestion that the fight should be nonpartisan, which is a lovely reverie. It is not clear from the brief review whether Jarvis sees his states-based approach as a strategy to get to a national program a la Canada. Since states do not issue currency, any state program will remain vulnerable to budget shortfalls and cutbacks.

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Nick Corbishley, “Why is the Gates Foundation funding the UK’s medicines regulator?” Naked Capitalism, Aug 27, 2021

The Gates tentacles’ pervasive reach: “What could possibly be wrong with granting funds to an organization in charge of deciding which pharmaceutical products and medical devices reach the market and which don’t?” Here’s a reason: “The Gates Foundation’s roughly $60 billion in assets include shares in some of the world’s largest pharmaceutical companies, whose products the MHRA has to regulate on a regular basis. This is a blatant conflict of interest.” Also: “Gates played a key role in convincing Oxford University to drop a prior commitment to donate the rights to its [AstraZeneca Covid] vaccine to any global drug maker.” Gates has relentlessly defended intellectual property rights over public health while at the same time his foundation acquires said intellectual property for itself. “In other words, an organization that has poured billions of dollars into the research and development of vaccines, other novel treatments, and medical devices has also been funding the UK agency responsible for approving those vaccines, novel treatments, and medical devices.”  

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Jordan Rau, “Mission and money clash in nonprofit hospitals’ venture capital ambitions,” Kaiser Health News, Aug 24, 2021

“Eager to find new sources of revenue, hospital systems of all sizes have been experimenting as venture capitalists for health care startups. Health system officials assert many of these investments are dually beneficial to their nonprofit missions, providing extra income and better care through new medical devices, software, and other innovations.” In 2019, “nonprofit” hospital systems sat on $283 billion in stocks, hedge funds, private equity, venture funds and other investment assets of which only 7% were “principally devoted to their nonprofit missions.” In short, hospitals are slowly becoming banks. “Catholic hospital chain Ascension has been in business for two decades and this year topped $1 billion, including contributions from 13 other nonprofit health systems eager to capture a piece of the returns.” For stock tips, see Mother Merciful Debentures of the Sisters of the Perpetual 3-for-1 Split!

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Wendell Potter, “The $140 billion the New York Times says Americans owe in medical debt is just the tip of the iceberg,” Tarbell, Aug 2, 2021

The number was nearly double early estimates of total medical debt, but Potter says it’s still an undercount because costs charged on credit cards to meet deductibles or copays aren’t included.

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Anna Maria Barry-Jester, “Hard lessons from a city that tried to privatize public health,” Kaiser Health News, Aug 6, 2021

“When politicians shutter a school or close a subway stop, the impacts are immediate and visible, sparking sharp public blowback. But when a health department fires its contact tracers or closes its infectious diseases lab or stops testing children for lead exposure, the impact is more subtle. At least at first.” Detroit’s health department had 700 employees in 2008; when the city went bankrupt in 2012, it fell to five. Now it’s back to 270, but the damage was done. Detroit’s health numbers are appalling on every measure. “A 2018 health needs assessment found that 9% of children under age 6 have blood lead levels elevated above accepted thresholds, a figure that jumps to 22% in some neighborhoods.”

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Julie Rovner, “Why doesn’t Medicare cover services so many seniors need?” Kaiser Health News, Aug 11, 2021

“Sorry, Joe Namath. Despite what you keep saying in those TV ads, under Medicare seniors are not ‘entitled to eliminate copays and get dental care, dentures, eyeglasses, prescription drug coverage, in-home aides, unlimited transportation and home-delivered meals, all at no additional cost.’” Namath works as a shill for Medicare Advantage because only people old enough for Medicare will know who he is (was). (We should pay star football players more so they don’t have to debase themselves later.) Rovner describes a Democrat-led bill that would add the things Namath falsely promises. She answers her own question in the title with a form of “It’s complicated” and “a great puzzle,” finally highlighting the rightward trend in overall fiscal policy, the incursion of private Medigap policies that take the pressure off those who can afford them, and the (now nearly forgotten) promise to lower the Medicare eligibility age to 60, which would add to costs.

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Fred Schulte, “Surgeons cash in on stakes in private medical device companies,” Kaiser Health News, Aug 10, 2021

“Whistleblowers and government fraud fighters have argued for years that money passing from industry to doctors can corrupt medical judgment, inflate costs, and lead to unnecessary operations or otherwise harm patients. Some of the harshest criticism has been directed at surgeons who profit from the sale of orthopedic devices.” Orthopedic surgeons, “among the highest-paid specialists in medicine,” typically pull in $500,000 a year. But: “Doing surgery is a loss leader for what you can get for selling your own products,” said Dr. James Rickert, head of the Society for Patient Centered Orthopedics.” Loss leader.

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John Baackes, “Now is the time to improve the Affordable Care Act,” Roll Call, Aug 12, 2021

Baackes calls for the public option to be back on the table because it “can provide commercial plans with the competition that will ensure affordable premiums as well as equity in care.” The author is convinced that healthcare financing can be solved with more marketplace competition via public plans, perhaps related to the fact that he runs one for the city of Los Angeles. If M4A ever gets close to a serious hearing again, count on these models to be brought out of hiding as workable, non-M4A alternatives.

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Aytan Y. Bellin, “My aunt’s Kafkaesque journey to get the home care she needs,” STAT, Aug 26, 2021

Needs an appropriate Kafka title, but “In the Penal Colony” is already taken. How a managed care organization (MCO) makes it impossible for high-cost patients to get what they need. Even though the author is an attorney specializing in “long-term care rights litigation, elder law, and consumer law,” he couldn’t penetrate the labyrinth facing his aunt.  

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Elsa Pearson, “Hospital mergers and acquisitions are a bad deal for patients. Why aren’t they being stopped?” STAT, Sep 2, 2021

“Hospital mergers and acquisitions aren’t good for patients. They rarely improve access to health care or its quality, and they don’t reduce prices.” But the trend accelerates with half of all U.S. physicians now employed by a health system or hospital. Because hospitals are “nonprofits,” the Federal Trade Commission can only make unenforceable recommendations against anticompetitive behavior.

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Robby Soave, “The media fell for a viral hoax about ivermectin overdoses straining rural hospitals,” Reason, Sep 6, 2021

“KFOR, an Oklahoma news channel, reported last week that rural hospitals throughout the state were in danger of becoming overwhelmed by victims of overdoses of ivermectin, an anti-parasite drug promoted by vaccine skeptics as a possible treatment for COVID-19. The story went viral and was seized upon by the mainstream media. But its central claim is substantially untrue.” Promoted by vaccine skeptics gives away the game: you can’t take ivermectin seriously if you are a real scientist. Also, did the media “fall for” the story or gobble it up like candy at the first sighting?

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Matt Taibbi, “Moral majority media strikes again,” Taibbi Substack, Sep 7, 2021

The breathless reports of an Oklahoma emergency room overwhelmed by ivermectin overdoses cases turned out to be false. But it fit the BlueAnon narrative of stupid-bubbas-take-horse-medicine so perfectly that no one bothered to practice journalism. Taibbi recalls the glee of Falwell’s Moral Majority over homosexuals getting AIDS as a parallel.

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Nick Corbishley, “As U.S. prepares to ban ivermectin for Covid-19, more countries in Asia begin using it,” Naked Capitalism, Sep 7, 2021

“Pfizer and Merck have announced new trials for their experimental oral antiviral drugs for COVID-19. Merck said in June that the U.S. government has already agreed to pay about $1.2 billion for 1.7 million courses of molnupiravir—working out at $705 per course of treatment—if it is proven to work and is given the green light by regulators. Pfizer, meanwhile, said that it will file for emergency approval between October and December this year.” Ivermectin would be a direct competitor to these potential new blockbuster drugs, which of course is completely unrelated to the sustained attack on it.

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Libby Watson, “The policy that costs sick patients thousands,” Sick Note, Aug 19, 2021

The hated deductible and the perils of “step therapy” in which you have to try and fail on a cheaper drug before your insurance company will authorize a pricier one. “51% of US workers are enrolled in high deductible health plans.”

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Sean Dickson, “To lower drug costs, define ‘cost’ to mean net cost after rebates,” STAT, Sep 7, 2021

Biden, among others, has emitted urgent rhetoric on the unsustainability of high cost of medications and endorsed empowering Medicare to negotiate prices. This think tank piece argues for reform of how drug prices are calculated to alleviate the burden of the 25% paid by Part D beneficiaries. If the cost basis for that calculation reflected all the rebates and deals negotiated in secret, he writes, consumers would pay a lot less. For example, “a senior vice president of insulin maker Eli Lilly disclosed that while the average monthly list price of one of its insulin products was $600, the net price after rebates was just $135. That means someone covered by Medicare would pay $150 per month for this insulin, more than its [real] net price.” Yes, taking away one leg of the Rube Goldberg machine would be a slight improvement.

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Ryan Grim, “Heather Bresch, Joe Manchin’s daughter, played direct part in Epipen price inflation scandal,” The Intercept, Sep 7, 2021

“The former Mylan CEO [Bresch] worked with her counterpart at Pfizer to corner the market and keep costs up. The deal between Pfizer and Mylan led the former to withdraw its competitor from the market and partner with Mylan on Epipen, locking down a monopoly. Following the deal with Pfizer, Mylan drove the price above $600 within five years [from its previous price of less than $100]. Pfizer, while denying wrongdoing, has since settled a class-action suit for price fixing and will pay $345 million over the company’s practices related to the EpiPen market.”

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Joyce Frieden, “PhRMA warns of dire consequences if Medicare allowed to negotiate drug prices,” MedPage Today, Sep 8, 2021

Dramatic knicker-twisting by Pharma over a faint threat to their trillions.

Posted Aug 25, 2021

Brian Schwartz, “Gov. Kathy Hochul’s daughter-in-law is top lobbyist at pharma firm that has sought to influence NY lawmakers,” CNBC, Aug 24, 2021

Biogen, no less, employs Christina Hochul as “director of federal policy,” meaning that she had a role in the Alzheimer’s drug Aduhelm scam as the company she works for “has been involved with a recent lobbying campaign in New York on “potential legislation related to Alzheimer’s disease.” CH has also worked for Amgen, Allergan, and Merck. Meanwhile, first husband William Hochul is “senior vice president and general counsel at gambling and hospitality giant Delaware North,” a business heavily regulated by the state. All in the family! Recall that Gov. Hochul was mum on Cuomo’s destruction of the anti-corruption Moreland Commission.

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Benjamin Mazer, “The FDA is a melting iceberg,” The Atlantic, Jul 13, 2021

“The rising floodwaters of ineptitude have finally yielded a catastrophe. The long-standing and gradual erosion of the agency’s scientific standards makes me think of the eroding coastlines and thawing icebergs associated with climate change. If an independent investigation leads to a reversal of the aducanumab [Aduhelm] decision, then perhaps such an unprecedented turn of events will prompt a real public reckoning. The most likely outcome, though, is that the bad headlines will recede and a new, lower bar for evidence will be set. With each alarming declaration of ‘the hottest day on record,’ after all, it gets harder to remember what cooler temperatures felt like in the first place.”

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Sarah Kliff & Josh Katz, “Hospitals and insurers didn’t want you to see these prices. Here’s why,” New York Times, Aug. 22, 2021

Trump pushed a new regulation requiring hospitals to reveal their prices. Mass panty-twisting ensued. “Data from the [few] hospitals that have complied hints at why the powerful industries wanted this information to remain hidden. It showed that hospitals are charging patients wildly different amounts for the same basic services. In many cases, insured patients are getting prices that are higher than if they pretended to have no coverage at all.” Also: “This secrecy has allowed hospitals to tell patients that they are getting steep discounts while still charging them many times what a public program like Medicare is willing to pay. And it has left insurers with little incentive to negotiate well” given that insurers keep a percentage of gross revenue. Thus, higher costs, more profit. The set-up makes hash of the notion that healthcare “consumers” could shop for the best insurance deals. Worth reading in full.

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Mario Aguilar, “Mental health giants Headspace and Ginger to merge into $3 billion company,” STAT, Aug 25, 2021

“As investors have thrown huge sums into mental health, there’s been an increasing sense that consolidation must be on the horizon.” Otherwise, how will anyone make a buck? Also, Headspace?

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Oriana Gonzalez, “FDA urges people to stop taking ivermectin to treat COVID-19,” Axios, Aug 21, 2021

Another FDA fail magnified by sloppy reporting: ivermectin is a safe antiviral that has been administered over 1 billion times worldwide. The problem is people self-medicating with veterinary doses. The headline treats ivermectin as some sort of poison when there is good evidence that it works against Covid [see below]. The New York Times made the same mistake in its headline: “Ivermectin Should Not Be Used To Treat Covid.” No. The FDA said the evidence that it works is not good enough—so far—very different from “should not be used.”

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F. A. Cadegianim et al., “Early COVID-19 therapy with azithromycin plus nitazoxanide, ivermectin or hydroxychloroquine in outpatient settings significantly improved COVID-19 outcomes compared to known outcomes in untreated patients,” Science Direct, 2021

“Subjects with early COVID-19 treated with two-to-four drug combinations showed overwhelming improvements compared to untreated patients.” The treatment arm of the RCT “showed reduction of 31.5–36.5% in viral shedding (p < 0.0001), 70–85% in disease duration (p < 0.0001), and 100% in respiratory complications, hospitalization, mechanical ventilation, deaths and post-COVID manifestations (p < 0.0001 for all).” Those p values are miniscule, meaning the likelihood that these results are accidental is equally tiny.

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Alexandria Hein, “AstraZeneca antibody therapy prevents COVID-19 in trial, company says,” Fox News, Aug 21, 2021

“Promising results for a combination antibody therapy that prevents COVID-19, possibly opening the door to an alternative option” for people not getting full protection from a vaccine. Potential blockbuster drugs being developed by big Pharma get a fair hearing, unlike ivermectin and other cheap, off-patent, readily available ones.

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Lenny Bernstein & Laurie McGinley, “Monoclonal antibodies are free and effective against Covid-19, but few people are getting them,” Washington Post, Aug 20, 2021 

Regeneron is not “free” even if patients don’t pay for it. The drug was given to Trump and credited by some (including him) for his recovery. It’s important to add something other than vaccines to the pandemic toolkit.

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Brendan Farrington, “DeSantis top donor invests in COVID drug governor promotes,” Associated Press, Aug 18, 2021

“DeSantis has been flying around the state promoting a monoclonal antibody treatment sold by Regeneron, which was used on then-President Donald Trump after he tested positive for COVID-19. Citadel, a Chicago-based hedge fund, has $15.9 million in shares of Regeneron Pharmaceutical Inc. Citadel CEO Ken Griffin has donated $10.75 million to a political committee that supports DeSantis.” OTOH, Citadel has larger stakes in Pfizer and Moderna, whose vaccines DeSantis doesn’t peddle.

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Christine Sexton, “Florida applies for $1.1 billion in additional Medicaid funds,” Health News Florida, Jul 13, 2021

Biden is tempting Medicaid expansion hold-out states with large bonus funds. DeSantis wants to say yes but only for one-off purchases “directed toward one-time payments to businesses that provide home- and community-based services to Medicaid clients.”

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Jeremy Blackman, “Texas is boosting healthcare access for new moms, but there’s a catch,” Houston Chronicle, Aug 23, 2021

Another hold-out state. “To get the legislation over the finish line, Democrats agreed to move the state’s family planning and women’s health program, Healthy Texas Women, entirely into managed care. Critics of managed care say some companies abusively deny services and pocket the savings.” (Why ever would they say that?) The move is a back-door way to further weaken Medicaid, which Texas Republicans hate worse than sin.

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Dan Primack, “Illumina CEO on closing a merger the FTC sued to block,” Axios, Aug 202, 2021

“Illumina CEO Francis deSouza said his company is not trying to defy U.S. or European regulators by completing its $7.1 billion purchase of cancer testing company Grail, despite doing so amidst ongoing government reviews.” Well, if they didn’t mean to, then all is forgiven. “We deeply believe by moving forward there are lots of lives to be saved,” said the CEO, who took home $11.7 million last year. When wealthy elites say they “deeply believe” something, it’s automatically true. However, the new, more militant FTC may have other ideas.

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Sarah Jane Tribble, “Pfizer CEO to public: Just trust us on the Covid booster,” Kaiser Health News, Aug 13, 2021

Even though he has been proven wrong repeatedly. “The company lacks late-stage clinical trial results to confirm a booster will work against Covid variants including delta, which now accounts for 93% of new infections across the U.S.” But Pfizer CEO Albert Bourla is “very, very confident” that it will. So, alrighty then [see “deeply believe,” above]. Pfizer expects to rake in $33.5 billion in Covid-19 vaccine revenue this year.

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Kip Sullivan & James G. Kahn, “Stop the failed Accountable Care Organization experiment,” STAT, Aug. 23, 2021

“Managed care” came about based on the belief that high healthcare costs are caused by individuals who seek unnecessary medical services that can be cut by strict monitoring of their bad behavior. Result: healthcare inflation is worse, outcomes are no better, and administrative costs are off the charts. “In an article published online this month in the Journal of General Internal Medicine, we reviewed evaluations of all four of Medicare’s accountable care experiments conducted since 2005. All four failed to affect Medicare spending. If we include the costs that ACOs incur in their futile efforts to reduce Medicare spending, such as contracting with insurance companies to manage risk and hiring more nurses, these organizations actually raise health care costs.”

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Nick Corbishley, “Going, going, almost gone: UK government speeds up privatization of National Health System,” Naked Capitalism, Aug 20, 2021

“While continuing to lavish praise on the bravery and sacrifice of the NHS’ frontline workers, the government is exploiting the pandemic to embed even more private interests across the system.” Playbook: starve the entity, squeeze staff, wreck services (waiting lists are “through the roof”), generate discontent, announce the solution: privatization! Nonetheless, the NHS is still loved by UK citizens. The Tory strategy is to use outsourcing to obscure its privatizing tendencies. U.S.-based companies stand to land lucrative contracts. “Google, whose AI arm, London-based DeepMind, has partnered with the NHS since 2016, initially to improve the detection of acute kidney injuries. This gave it access to the sensitive data of over a million NHS patients. More than 40 pharmaceutical, consultancy and data companies worldwide have already had access to UK hospital data and medical records for years, including McKinsey & Company, KPMG, Novavax, AstraZeneca, marketing firm Experian, and a data company co-founded by the Sackler family. In February, the Government sold off 58 GP practices in London, with approximately 500,000 patients, to US health insurance giant Centene.”

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Noah Smith, “The best prescription for growth? National health care,” Bloomberg [opinion], Jul 10, 2021

“Now is therefore the perfect time to revisit a big idea that seems to have fallen by the wayside: national health insurance.” Not strictly a pro-M4A column (he favors keeping the current Medicare model with supplemental private insurance), but an op-ed in a business paper by a Republican calling for universal Medicare is noteworthy. “A national health insurance system would unleash dynamism in the business world. In recent years, new business formation has fallen substantially and workers have been moving less and less between jobs. America’s sclerotic, outdated health-insurance system might be partially at fault. Republicans are casting about for an issue that could cement their status as a working-class party, and this could be it.” A more astute and disciplined Trump could have rammed something like this through, or tried to at least, and blown everyone’s mind.

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Mia Jackson, “My family has been doctors in the black community for generations. What if they’re the last?” Newsweek, Aug 9, 2021

“In 1911, when my great grandfather, Dr. Isaiah Allen Jackson, opened his primary care practice in Richmond’s Jackson Ward neighborhood, a Black person couldn’t drink from most water fountains. His practice started above a pharmacy and offered quality care to the Black community. My grandfather and then my father took over his practice, Dominion Medical Associates, and it has been serving low-income and primarily Black patients for over three generations. But practices like my family’s face a dire prognosis.” Conglomerates are taking over, and severing the patient-doctor connection is particularly harmful to nonwhite populations. “From Tuskegee to Puerto Rico, there’s a long history of distrust between the largely white establishment medical community and minority patients.” (See vaccine hesitancy.) “My grandfather saw his role as a community healer. Most years, he rented a large boat and hosted free fishing trips where his patients and staff socialized. In the 1980s, he hosted a dinner-dance for patients over 65.” Another world, another age.

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Rebecca Robbins & Benjamin Mueller, “While South Africa waits for vaccine supplies, J.&J. doses made there are sent to Europe,” New York Times, Aug 17, 2021

“Many Western countries have kept domestically manufactured vaccine doses for themselves. That wasn’t possible in South Africa because of an unusual stipulation in the contract the government signed this year with Johnson & Johnson, [which] required South Africa to waive its right to impose export restrictions on the company’s vaccine doses.”

Posted Aug 18, 2021

(Sen.) Dick Durbin, “With the tobacco settlement, the U.S. missed its moment to fortify public health. We can’t make that mistake with the opioid settlement,” STAT [opinion], Aug 5, 2021

A reminder from a top Democrat that the big cash pile from the multi-state suit against Big Tobacco got diverted into all sorts of things instead of public health, which was the whole point of the settlement. Fun facts: 500,000 American opioid deaths (so far); 20 million addicts; 100 billion pills handed out between 2006-14. Also: worst year for opioid overdose deaths: 2020 (93K).

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Christina Jewett, “National Academies report took Pharma-friendly stance after millions in gifts from drugmakers,” Kaiser Health News, Aug 12, 2021

A simple enough federal request to a scientific body: look into the Pharma habit of packaging its drugs in huge vials such that a lot of the expensive medication has to be thrown out—$750 million worth annually. The National Academies of Sciences, Engineering and Medicine gets the job and later issues a surprisingly pro-Pharma set of conclusions, including a recommendation not to bother about trying to recoup the costs or even to regulate the practice. In fact, the panel urges, stop tracking drug waste entirely. “Yet the report left out a few key facts: one committee member was paid $1.4 million to serve on the board of a pharmaceutical corporation in 2019.” Another reported consulting income from a dozen pharmaceutical companies. Furthermore, the NAS itself “for years has been collecting at least $10 million from major drugmakers since 2015.” None of these facts made it into the report’s disclaimers. Ah, The Science!

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Brian Mann, “Justice Department blasts Purdue Pharma’s bankruptcy plan,” National Public Radio, Jul 19, 2021

The proposed settlement would let the Sacklers get away with an estimated $6 billion from their opioid-peddling business. A dozen states are ready to buckle in exchange for ready cash while victims could get as little as $3500 each. Sackler, Inc., used the bankruptcy laws to get out from under liability—those laws not available to indebted college students. Idea: get the National Academies to prepare a report!

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Scott Bauer, “[Gov.] Evers defends his signing of opioid bill despite concerns,” Associated Press, Jul 6, 2021

Wisconsin’s Democrat governor caves on the “partially unconstitutional” Sackler/Purdue settlement to get some quick cash—even though the Republican-dominated state legislature will control the disbursements. Republicans cheered his display of bipartisanship while all Democrats but one were opposed.

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Mike Spector, Jessica Dinapoli & Dan Levine, “J&J exploring putting talc liabilities into bankruptcy,” Reuters, Jul 19, 2021

Why not? It worked for the Sacklers. “Johnson & Johnson is exploring a plan to offload liabilities from widespread Baby Powder litigation into a newly created business that would then seek bankruptcy protection.” The company’s lawyers are dangling this option to force the 30,000 plaintiffs into settlements. The baby powder in question contained carcinogenic asbestos: “The plaintiffs include women suffering from ovarian cancer and others battling mesothelioma.”

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James Anderson, “Polis: Colorado program keeps health insurance costs low,” Associated Press, Jul 20, 2021

Health insurance inflation will be kept to 1.4% for individuals this year due to a state subsidy program. “[Colorado] covers the highest-cost cases under the so-called reinsurance program that began in 2019, allowing insurers to moderate their rates. It’s also allowed them to extend their coverage, especially in rural areas.” Ergo, the state picks up the sickest and most expensive patients so that private insurers can safely “extend their coverage.” But for small businesses (<100 employees), premiums will go up an average of 5.3%.

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Leonard Fleck, “FDA made a mistake in approving a questionable Alzheimer’s drug, but Medicare could act to reduce false hopes and unethical profits,” MarketWatch [opinion], Jul 2, 2021

Answers the argument, Why not just let people try drugs that might work (as AIDS activists pushed for in the 1980s-90s)? “The government should reimburse Biogen only for actual production costs while further clinical trials determine whether aducanumab really helps patients.” That’s a lot different from forcing Medicare to shell out $50K per patient for a probable turkey. Forcing Biogen to complete the study before making any profit would reverse the current incentive to delay everything for years while cashing in.

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Andrew Joseph & Rachel Cohrs, “Alzheimer’s patients are in limbo as hospitals, insurers grapple with whether to offer Aduhelm,” STAT, Aug 4, 2021

Because of the “very contentious FDA approval,” health systems now “have to go back and do the same reviews that the FDA did and decide on whether we think the benefits outweigh the risks.”

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Keith Flanagan, “Congress should fix FDA’s accelerated approval program for the next 30 years,” STAT, Aug 12, 2021

A defender of accelerated approval who says it save thousands of lives. The author calls for “constructive, bipartisan fixes,” such as “front-loading confirmatory study design” and “modernizing the process for withdrawing an approval” when a drug flops. He says nothing about whether Medicare/Medicaid should pay top dollar for these drugs while the experiments on patients proceed, perhaps because the former Senate staffer “now consults for biopharmaceutical innovators and investors.”

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Helene Olen, “Home health care belongs in the infrastructure package. We all pay for it anyway,” Washington Post [opinion], Jul 7, 2021

“There are hundreds of thousands of elderly or disabled people who have qualified for in-home care paid for via Medicaid but are on waiting lists that can stretch for years because state and federal funding hasn’t kept up with the demand. At the same time, turnover is high in the paid caretaker workforce due to the combination of low salaries and long hours of hard physical and emotional labor.”

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Crain’s Chicago Business, “Healthcare SPAC raises $250 million,” Aug 3, 2021

“Healthwell is a special-purpose acquisition company, or blank-check firm, that’s raising money from investors on the public markets to acquire one or more businesses” in healthcare. SPACs are newfangled Wall Street vehicles created to separate the gullible from their cash. The savvy crew involved in this one includes: Alyssa Rapp, who previously led private equity-backed Surgical Solutions; former Playboy Enterprises CEO Christie Hefner; and former Deloitte senior executive Carl Allegretti. A hedge fund also owns 10 percent. Stay tuned for news of innovative contributions to the nation’s health from “Healthwell.”

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Bob Herman, “UnitedHealthcare luring new members with Peloton perk,” Axios, Jul 20, 2021

Gym memberships as part of health insurance benefits aren’t new, but they encourage cherry-picking of low-risk customers. “While Peloton gets new, subsidized members, UnitedHealthcare gets to insure people who are less likely to have expensive or chronic health conditions.”

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Bob Herman, “Medicare has become more of a private marketplace—and it’s costly,” Axios, Aug 11, 2021

The shift to (privately owned) Medicare Advantage plans is a “fundamental change in the architecture of Medicare, evolving into a program that looks more like a marketplace of private plans with a public plan as a backup option.” MA plan managers upcode every patient to the max to increase their reimbursements. Because “it’s like Pooh Bear sticking his paw in the honey pot,” venture capital is moving into MA swiftly. When people get sick and realize their MA plans impose limits, they switch to traditional Medicare.

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Emily DeRuy, “Are Bay Area hospitals complying with new price transparency rule?” Bay Area News Group, Jul 20, 2021

“So you need surgery? Good luck figuring out exactly what the procedure will cost you.” Fewer than 6 percent of the 500 hospitals analyzed were complying.

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Bernard J. Wolfson, “Effort to decipher hospital prices yields key finding: Don’t try it at home,” Kaiser Health News, Jul 9, 2021

Patients—er, sorry, health consumers—were supposed to be able to compare hospital prices after the Federal Government imposed a “price transparency” rule. “I set out to test that by comparing prices in two major California hospital systems. I am sorry to report that the tangled web that long has cloaked hospital pricing is alive and well. After three months of glazed eyes and headaches from banging my head against walls of numbers, I am throwing in the towel.”

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Caitlin Owens, “HCA hospital gets hit with a data-driven antitrust lawsuit,” Axios, Aug 11, 2021

One bright spot: hospital price-transparency data made it possible for these North Carolina-based plaintiffs to show monopolistic price gouging. They allege that “HCA is able to use its monopoly power and anti-competitive negotiation tactics to obtain these high prices.”

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Jon Skolnik, “Rand Paul calls for civil disobedience over vaccines: ‘They can’t arrest all of us,’” salon.com, Aug 10, 2021

Rand’s rant against forcing vaccines on people as unjustified by The Science. Plus, it’s bad for business [see below].

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Isaac Stanley-Becker, “Rand Paul discloses 16 months late that his wife bought stock in company behind covid treatment,” Washington Post, Aug 11, 2021

The missus bought Gilead Sciences, which makes remdesivir, in February, 2020. The timely purchase “raised questions about whether the Kentucky Republican’s family had sought to profit from nonpublic information about the looming health emergency.” Paul is a member of the Senate health committee, “which in January hosted Trump administration officials for a briefing on the coronavirus.”

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Rose Adams, “UnitedHealthCare guided Yale’s groundbreaking surprise billing study,” The Intercept, Aug 10 2021

King Kong v. Godzilla: “Internal emails between executives at UnitedHealthcare provided to The Intercept reveal that the insurance giant provided its data while working behind the scenes to influence the paper and a 2017 follow-up [that] portrays private equity-run hospital staffing companies, which are perpetually at odds with insurers over physician compensation, in a negative light.” So, even useful research may be secretly at the service of one of the major players seeking to keep/increase its share of the healthcare loot. “The 2017 Yale paper was the first major study to pin surprise billing on private equity-owned staffing companies, effectively letting insurers off the hook.”

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Natalie Shure, “Here’s a terrible idea: Making the unvaccinated pay higher insurance premiums,” New Republic, Aug 16, 2021

Argues that punitive measures against the unvaccinated would be a giant step backwards toward “individual responsibility” for one’s health and, by extension, healthcare. “One of the most damaging ideological underpinnings of our market-based health care system is that patients are responsible for their own care as consumers of commodities. We place the onus on individuals or families to navigate enrollment, to perform administrative tasks, and to select plans each year that fit their needs and budget. If someone is unlucky enough to get sick, they may find themselves tortured by hours of hold music on calls with insurers and providers.” Instead, “All care should be free at the point of use. Individual health care use shouldn’t determine how much anyone pays into the system.” Period. Charging smokers more also didn’t work.

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Morgan Lee, “Hospital physicians seek to unionize amid pandemic turmoil,” Associated Press, Aug 11, 2021

Rehoboth McKinley Christian hospital in Gallup, New Mexico. Arise! ye prisoners of starvation, etc.

Posted Aug 10, 2021

Ed Silverman, “Federal watchdog will review the controversial FDA approval of Biogen’s Alzheimer’s drug,” STAT, Aug 4, 2021

HHS’s Office of Inspector General—not the in-house FDA probe drummed up by Woodcock after the Aduhelm scheisse hit the fan. “Unprecedented controversy over regulatory standards” is not good copy for the FDA. Neither are “most controversial approval ever,” “intense scrutiny,” nor “circuitous path to greenlight the medicine.” The refusal of some major insurers and providers to prescribe the turkey drug along with drawn-out scrutiny of the corrupt process might just be enough to cause the whole scam to crumble—which would be a sight to behold.

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Manas Mishra & Carl O’Donnell, “Eli Lilly bets on Alzheimer’s disease drug data as it chases Biogen,” Reuters, Aug 3, 2021

Lilly tries to join in the looting so that if Aduhelm survives, we’ll have to pay for two crap drugs that don’t do anything. “If you believe that lowering amyloid plaque is a good thing to do, you’ll believe anything you’re going to want the drug that lowers amyloid plaque the most,” Chief Scientific Officer Daniel Skovronsky told investors on a call. Lilly shares were up 4% for the day on the announcement.

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Jennifer Henderson, “Over 100 drugs given speedy approvals still lack proof of clinical efficacy,” MedPage Today, Jul 29, 2021

The defenders of Aduhelm point to FDA’s requirement that Biogen run a confirmatory trial to see if it actually works. Here’s why that means nothing: “Of 253 drugs authorized through the FDA’s accelerated approval pathway [used for Aduhelm], 112 have not been confirmed as clinically effective. Some [of the 112] have been on the market for more than 2 decades, often with a high price tag.” Of the 253 drugs approved this way since 1992, only 16 were ever withdrawn.

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Jag Ghalla, “Biotechnology greed is prolonging the pandemic. It’s inexcusable,” Undark [opinion], Aug 5, 2021

Commenting on Boris Johnson’s notorious comment that “vaccine success is because of capitalism, because of greed.” And will greed get low-income nations more than the current 0.3 percent of the global vaccine supply? No. Mentions the utter balls of AstraZeneca CEO Pascal Soriot’s claim that IP rights are “fundamental” to the industry, given that AZ had nothing to do with developing the vaccine gifted to it by Oxford University at the behest of Bill Gates.

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Emilee Larkin, “Third Circuit tosses $448 million penalty in pay-for-delay case,” Courthouse News Service, Aug 3, 2021

“The common industry practice known as ‘pay-for-delay’ involves pharmaceutical companies paying or otherwise incentivizing a competing company to keep cheaper generic drugs off the market.” Two Trump judges and a Bush I holdover find that yes, the Pharma companies did it and no, they don’t have to give back any of the money.  

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Julia Rock, “New York Democrats seem to be giving up on state-level Medicare for All,” Jacobin, Jun 11, 2021

From June, so it only refers to the past session. “In addition to lobbying by health insurance companies and business groups in the state, public sector unions including the United Federation of Teachers (UFT) have been lobbying against the bill. Realities of Single Payer—a coalition of businesses, insurance lobbying groups, and unions opposing the legislation—has been running television and radio ads.”

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Bob Herman, “Companies won’t stress to find opioids settlement cash,” Axios, Jul 27, 2021 

Since 2016, the four companies responsible for pushing deadly opioids onto the American populace—Johnson & Johnson, McKesson, AmerisourceBergen and Cardinal Health—"have funneled a combined $100 billion to shareholders through stock buybacks and dividends. Those companies won't have much trouble paying off a combined $26 billion settlement agreement.” The four paid shareholders $10.5 billion just last year, so a measly $5b shouldn’t be problem.

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Gopal Sarma, “The first challenge for ARPA-H should be electronic health record migration,” STAT, July 27, 2021

EHR was supposed to be a high-tech innovation that would streamline medical care and promote research. Instead, it remains at the service of medical billing, an entirely different animal. Instead of improving practice, “electronic health records have increased the burden of data entry, contributed to physician burnout, and had a nebulous impact on the quality of care.” The author highlights the disconnect between purchaser and user: “EHR buyers are typically health care executives; the users are health care workers. EHRs are excellent billing and claims management systems, which satisfies their purchasers, but are notorious for their clunky and un-intuitive user interfaces, which negatively affect their users.”

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BBC, “Tobacco giant Philip Morris raises bid for respiratory drugmaker,” Aug 8, 2021

This should be illegal: a tobacco peddler trying to whitewash its image by diversifying into “health” while still selling 10 percent of all cigarettes consumed in the world. But imagine the PR advantages to be simultaneously producing products for asthma. “PMI intends to operate Vectura as an autonomous business unit that will form the backbone of its inhaled therapeutics business,” the tobacco company said. Inhaled therapeutics.

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Shoshana Wodinsky, “Senators ask FDA and FTC to investigate after Juul bought its way into an academic journal,” Gizmodo, Aug 5, 2021

Just a letter, but a Senate investigation could harm Juul’s pursuit of FDA approval for e-cigs. The controversy is Juul’s purchase of an entire issue of the American Journal of Health Behavior while obscuring the fact that all the articles were company-produced. “The full spread included 11 studies across the journal’s May-June issue that all seemed to be written with one goal in mind: make Juul look like the healthiest smoking alternative possible.” All 26 authors were in Juul’s pocket—a detail left out of the “scholarly” articles. Tell your university to cancel its subscription to AJHB.

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Matt Stoller, “Pfizer and Modern mock Biden, raise vaccine prices,” Big, Aug 6, 2021

Pfizer expects revenue of $33 billion in vaccine sales this year alone while restricting distribution to rich countries that can pay through the nose—a repeat of the scandalous handling of antiretroviral therapy for HIV in the 1990s. The WTO-based waiver of IP to get billions more doses produced was a workable plan, but Biden now has to make it happen or be exposed as a Pharma toady. Meanwhile (1), “Germany’s Angela Merkel has been highly supportive of ensuring that these monopolists maintain control of key public resources during a pandemic.” And meanwhile (2), “China and Russia have been putting together exactly the strategy that Biden outlined and Merkel blocked. They are cutting financing and tech transfer deals all over the globe to produce vaccines they helped develop.”

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Dean Baker, “If a vaccine resistant strain develops in Africa, will Dr. Fauci lose his job?” Patreon, Aug 8, 2021

“If GE or Lockheed had developed a new sonar in World War II that made it easier to detect German submarines, does anyone think we would just sit there and say that this is proprietary knowledge and nothing can be done if the companies chose not to share it with the government?” Paywalled, IM me for more.

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BizNews Post [picked up from STAT], “As White House mulls FDA commissioner job, a sign of industry backing for Woodcock surfaces,” Aug 9, 2021

“Shortly after the Biden administration took office, a letter-writing campaign erupted over who should be the next Food and Drug Administration Commissioner. One supportive letter was signed by 95 oncologists, many of whom work for some of the most prestigious cancer centers and universities across the U.S. And since nearly two-thirds of those physicians and researchers accepted considerably more industry money than most doctors over the past several years, it is being held out as an example of the need for a fresh start at the top of the FDA.” English translation: Take the FDA out of the hands of the usual corrupt players.

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Fred Schulte, “Injuries mount as sales reps for device makers cozy up to surgeons, even in operating rooms,” Kaiser Health News, Aug 9, 2021

“Orthopedic surgeons and neurosurgeons received a total of about $511 million in industry consulting fees from 2013 through 2019 and nearly $300 million more for ‘serving as faculty or speaker’ at industry-sponsored events.” Many of the devices “come to market through a streamlined Food and Drug Administration process that approves their use because they are essentially the same as what is already being sold.” Ergo, there are too many duplicative products on the market, which encourages doctors to rely on industry reps to figure them out. Some doctors bring sales reps right into the OR to guide their surgeries—what could go wrong?

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Amir Vera, Martin Savidge, Maria Cartaya & Jason Hanna, “This Arkansas hospital is so short on nurses in this newest Covid-19 surge, it's offering a $25,000 signing bonus,” CNN, Aug 5, 2021

“Burnout and staffing shortages are plaguing Arkansas’ health care system. Some employees are walking off on the job in the middle of their shifts.” Being told they’re part of a Democrat plot to insert microchips in people probably doesn’t help morale, either. Gov. Hutchinson now “regrets” signing a statewide ban on face mask mandates. “In hindsight, I wish that had not become law,” Hutchinson said at a news conference, sidestepping the role of his own signature on the decision.

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Andrew Keshner, “What does earning $62,000 a year buy you in America? Not great access to health care,” MarketWatch, Aug 5, 2021

About the same amount of health-care affordability problems as lower-income citizens in three other highly developed countries. “Around one-quarter (27%) of higher income Americans said they skipped doctors’ visits, tests, treatments, follow-up appointments or drug prescriptions due to costs last year.”

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Hugh Son, “JPMorgan takes stake in healthcare start-up, will begin offering service to employees in fall,” CNBC, Aug 4, 2021

The bank will take a stake in Vera Whole Health and offer its “subscription-type model” to its employees for their healthcare. How will this solve the runaway costs of insurance? “By making primary care teams accountable for the health of employees. Companies pay a flat monthly fee per patient, and primary care doctors are tasked with coordinating all their users’ care.” The idea is to avoid fee-for-service: “In our care model, our teams are paid a salary plus bonus, and that bonus is tied specifically to their outcomes.” Echoes of wellness models that have not worked terribly well, but good luck.

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Andrea Halland, “Feds to nix work requirements in Montana Medicaid expansion program,” Kaiser Health News, Aug 5, 2021

Ditching the Trump/GOP insistence on making access to a doctor conditional on displays of worker virtue. It didn’t work except to drive people off the Medicaid rolls and reduce costs. Next, the Republican governor will look for other ways to raise revenue through higher premiums for the 100,000 beneficiaries, whose income must be below $26,500 for a family of four.

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Ilene MacDonald, “GAO report: Large number of dying MA beneficiaries switch to traditional Medicare in last year of life,” Rise, Aug 2, 2021

“Medicare Advantage (MA) beneficiaries in the last year of life dropped their coverage to join traditional Medicare at more than twice the rate of all other MA beneficiaries, according to a new Government Accountability Office (GAO) report,” probably because of “potential limitations accessing specialized care under MA.” MA plans get your premiums while you’re healthy, then traditional Medicare picks up the major costs when you’re sick. Great business model! Full report here: https://www.gao.gov/assets/gao-21-482.pdf

Posted Jul 30, 2021

Shamus Cooke, “The left’s curious silence about the Medicare For All demonstrations,” Counterpunch, Jul 16, 2021

Why did the July 24th demonstration in DC not get universal endorsement by ostensibly allied groups? The usual ambiguity from Dem insiders makes sense, but why so little support from DSA, pro-M4A electeds, Bernie, AOC, etc.? [Readers: Does anyone know?] Meanwhile, the new infrastructure bill “failed to mention lowering the Medicare age,” a central Biden campaign promise.

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Joyce Frieden, “Biden executive order targets competition to lower drug prices,” MedPage Today, Jul 12, 2021

Leaders both red and blue demand actions on drug prices and then find myriad ways not to take any: Biden’s executive order “does nothing to restrain the cost of the priciest Part B drugs or to impose an inflation penalty.” The order also endorses some other desirable changes but doesn’t establish them. Trump was also good at this sort of virtue-signaling.

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Peter Yim, “NIH COVID-19 panel member received massive windfall from ivermectin non-recommendation,” Trial Site News, Jul 15, 2021

Ivermectin is a promising, off-patent, repurposed antiviral that the Pharma/FDA/ NIH/WHO+social media universe has so far suppressed. Two months after the latest NIH expert panel pronouncement on it, the NIH announced that Duke University would receive $155 million to “study the use of repurposed drugs in COVID-19.” And it turns out that the principal investigator of the big trial will be Susanna Naggie—who is also a member of the NIH COVID-19 Treatment Guidelines Panel, which refused to endorse its use. A positive ivermectin recommendation would have undermined the rationale for the pricey research.

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John Gever, “Public unlikely to benefit from hospitals’ advertising,” MedPage Today, Jul 2, 2021

Researchers found that hospitals that mount public advertising campaigns tend to be those in the best financial shape, but their quality measures are no different than for facilities with no ad spending. Ergo, don’t get your insurance from Geico.

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Jessie Hellmann, “Congress proposes sequester extension to pay for infrastructure bill,” Modern Healthcare, Jul 28, 2021

“Despite fervent opposition from hospitals and other healthcare providers, the Senate is slated to vote on an infrastructure bill that would be financed, in part, by extending Medicare payment cuts.” The utterly discredited “pay-for” posture whose phony claims are trotted out to justify austerity.

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Jay Hancock, “Pfizer could fight could legalize Medicare copays and unleash ‘gold rush’ in sales,” Kaiser Health News, Jul 29, 2021

How Pharma gets people to demand its expensive drugs and Uncle Sam to pay for them: “Three years ago, pharma giant Pfizer paid $24 million to settle federal allegations that it was paying kickbacks and inflating sales by reimbursing Medicare patients for out-of-pocket medication costs. By making prohibitively expensive medicine essentially free for patients, the company induced them to use Pfizer drugs even as the price of one of those medicines, covered by Medicare and Medicaid, soared 44% to $225,000 a year.” The lawsuit could end up legalizing the kickbacks.

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Jeremy Redmon, “A financial boost for DeKalb clinic that cares for uninsured,” Georgia Health News, Jul 28, 2021

“Since it opened in 2015, the Clarkston Community Health Center has attracted long lines of impoverished patients, at times becoming so busy that it has been forced to turn some away. Some have traveled from Alabama, South Carolina and Tennessee.” A heart-warming tale—but why does this project depend on private philanthropy? Georgia has the nation’s third-highest rate of uninsured people and has refused to expand Medicaid.

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Andrew Mark Miller, “Newsom signs bill granting taxpayer funded health care to elderly illegal immigrants,” Fox News, Jul 28, 2021

Fox News’ pants totally on fire—very gratifying. California extended health benefits to individuals ages 19-25, regardless of immigration status, last year.

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Samantha Young, “Olympic dream dashed after bike crash and nightmare medical bill over $200K,” Kaiser Health News, Jul 29, 2021

A cyclist took a nasty spill on the road, but the real collision came later when he ran into three health insurance companies that all found ways not to pay for his care. Result: $200K in bills, of which only $52K are reimbursed to date. “Gaimon said he could sell his house and pay these bills, ‘but I shouldn’t have to. I have insurance.’” Included in the charges: $25K for one day in the ICU. “After a reporter made inquiries, a representative from the Hospital for Special Surgery called Gaimon, offering to help him apply for financial assistance.”

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Mary Katherine Wildeman, “Clyburn has taken more than $1 million in pharma money in a decade, far surpassing peers,” [Charleston] Post & Courier, Sep 14, 2020

From last year but still germane. Clyburn, the No. 3 House Democrat, represents an ultra-safe district, so he doesn’t need the money for his own races and can sprinkle it around.

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Rebecca Pifer, “Medical debt overtakes nonmedical as largest source in collections. COVID-19 may be making it worse,” Health Care Dive, Jul 21, 2021

Medical debt now outweighs all other kinds with 18% of all Americans in collection. “Debt was significantly more concentrated in states that had yet to expand Medicaid.” All data is pre-Covid.

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Fraiser Kansteiner, “Sanofi, Lilly, Novo and a trio of PBMs face racketeering claims over pricey insulin drugs,” Fierce Pharma, Jul 13, 2021

No judgment yet, but the judge is allowing the RICO claims to stand, “given the plantiff's compelling case that the drugmakers may have engaged in bribery, plus mail and wire fraud.” The drugs involved are NovoLog, Levemir, Humalog, Lantus, and Toujeo.

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Sally Greenberg, “Congress must fix loophole that is costing patients at the pharmacy,” The Hill [opinion], Jul 26, 2021

Describes a complicated loophole that lets insurance companies wriggle out of an ACA requirement to cover prescription costs above a deductible. The author, a consumer advocate, pleads for tweaking this item to “build on the remarkable success of the ACA,” an example of the limits of mainstream consumer advocacy.

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Alexandra Ellerbeck & Paige Winfield Cunningham, “Texas is cutting red tape for doctors and patients,” Washington Post, Jul 26, 2021

Elimination of advance authorization for most medical procedures, i.e., those “from doctors who have a strong track record of getting the greenlight from insurance companies.” Surprising defeat for the insurance companies in a bright red state.

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VACCINE EQUITY

Dean Baker, “The drug companies are killing people,” Center for Economic & Policy Research, Jul 18, 2021

“They are using their government-granted patent monopolies and their control over technical information about the production of vaccines to limit the supply of vaccines available to the world.” Points out that the endorsement of the vaccine patent suspension proposed at the WTO occurred 9 months ago and has been blocked by Pharma ever since.

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Lori Hinnant, Maria Chent & Aniruddha Ghosal, “Vaccine inequity: Inside the cutthroat race to secure doses,” Associated Press, Jul 18, 2021

“Inoculations go begging in the United States while Haiti, a short plane ride away, received its first delivery July 15 after months of promises—500,000 doses for a population over 11 million. Canada has procured more than 10 doses for every resident; Sierra Leone’s vaccination rate just cracked 1% on June 20.” A long, thorough account of how the rich countries hoarded access to vaccines—and still are. Says one African doctor: “We have no access to vaccines either as donations or available for us to purchase. Am I surprised? No, because this is where we were with the HIV pandemic. Eight years after therapeutics were available in the West, we did not receive them, and we lost 10 million people.”

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Ashleigh Furlong, “Africa wants to produce a coronavirus vaccine—and Big Pharma’s not happy,” Politico, Jul 30, 2021

A proposed mRNA tech transfer hub would let multiple manufacturers learn how to produce vaccines. The tech innovation’s promise “goes beyond coronavirus and holds the potential for applications related to cancer, Ebola, or HIV. But it’s exactly this potential that makes pharmaceutical companies all the more keen to cling to their newly minted technology even more tightly.”

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Tony Leys, “‘Hugely disappointing’: Iowa may have to toss out tens of thousands of expiring COVID vaccine doses,” Des Moines Register, Jul 23, 2021

How about “hugely immoral”? Iowa’s DoH says that 38,730 of the state’s doses are set to expire by the end of July and another 178,651 by the end of August. Meanwhile, Gov. Reynolds blamed the new spike in cases on immigrants. And in Arkansas, a vaccine advocate reports, “We’re drowning in this stuff.”

ADUHELM

Michael S. Sinha & Stephen Latham, “Patient advocacy organizations and FDA drug approval: Lessons from Aduhelm,” STAT, Jul 23, 2021

Defending the FDA’s public horizontal embrace of Pharma in the Aduhelm scam, Alzheimer’s Association CEO Harry Johns condemned the “negative voices” pointing out the giant holes in the agency’s reasoning as “not pro-patient.” Why are lax standards and the approval of expensive drugs that show no sign of working “pro-patient”? Advocates argue that patients should get access to stuff if there’s any hope for benefit, but do these experiments have to cost $50K per head, paid for by Medicare? Another widely missed datum: the “successful” Aduhelm trial only enrolled 11 Black patients out of 1400 even though Alzheimer’s is more prevalent among minorities.

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Patrizia Cavazzoni, Billy Dunn & Peter Stein, “Here’s why we approved the first new Alzheimer’s drug in two decades,” Washington Post [opinion], Jun 23, 2021

All three are FDA employees. In this article, they bet that repeating phrases like “rigorous science,” “thorough evaluation,” “extensive review,” “carefully considered,” “thorough, expert analysis,” and “uncompromising adherence to scientific standards” will overwhelm public skepticism about the FDA’s decision to hand several tens of billions of dollars to a pharmaceutical company for a fantasy fulfillment. In a more lucid section, they acknowledge that the approval was an incentive for other drug companies to find something better: “Even though not every [FDA-approved experimental cancer] drug worked as expected, these approvals have propelled progress forward.” As long as progress is being “propelled forward,” I guess it’s all right. If it “propelled progress backward,” then maybe not.

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Emil D. Kakkis, “Aduhelm’s accelerated approval offers a promising roadmap for rare neurological diseases,” STAT, Jul 7, 2021

Kakkis, “CEO, president, and founder of Ultragenyx Pharmaceutical; a developer of novel treatments for rare diseases,” talks his book: “The biomedical research community would not be where it is today without striving for progress over perfection. The imperfect, uncertain first steps of accelerated approval are needed to walk the path to optimal treatment.” He argues that approving a clunker drug “is likely to rejuvenate this depleted area [of research], inevitably leading down the long walk to better and better therapies.” Plenty of experts say it will do the opposite by green-lighting more turkeys.

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Madhav Thambisetty, “‘When Memory Fades’: Misinformation about Alzheimer’s disease and Aduhelm must be limited,” STAT, Jul 21, 2021

Today’s must-read: how Biogen is already pumping up eagerness for Aduhelm through sleazy, manipulative ads and outright lies. Ironic in a time of warnings about “false, inaccurate, or misleading” health information. “The [Biogen] website offers a multiple-choice ‘symptoms quiz’ that allows users to report how often they forget appointments, lose their train of thought, or struggle to find the right word during a conversation. Responses to the six questions are then displayed and guidance is offered, presumably based on the severity of symptoms. One can take the quiz multiple times. I took it twice—first choosing the ‘often’ option for all questions and then the ‘never’ option. To my consternation, the advice for both scenarios was to ask my doctor if ‘cognitive screening may be right for you.’”

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Susan Molchan, “With Aduhelm, is history repeating itself with another win for Wall Street and a loss for patients?” STAT, Jul 9, 2021

Reviews the history of a prior Alzheimer’s drug, tacrine (Cognex), “despite its questionable effectiveness,” in 1993, later removed from the market—but not before earning $3 billion in revenues in its peak year of use. The Alzheimer’s Association was once again an enthusiastic backer. The author, a former FDA employee, notes the role of the Wall Street Journal in pumping up both Cognex and Aduhelm with headlines like, “Biogen’s Alzheimer’s Drug Is a Wall Street Winner, Controversy or Not.” She adds that “one could often predict a doctor’s or researcher’s answer if one knew whether or not they were getting paid by the corporation making the drug although it was often difficult to know as this was not always disclosed.”

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Andrew C. von Eschenbach, “With Aduhelm, history can repeat itself by following cancer’s success,” STAT, Jul 29, 2021

Another pro-Aduhelm column from a member of the FDA-Pharma-academia-industrial complex. “von Eschenbach is former director of the National Cancer Institute, former commissioner of the Food and Drug Administration, and a member of the board of Wren Therapeutics.” I have yet to see a single public pro-Aduhelm comment that is not authored by someone financially tied to the company or its biosimilars.

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Bob Herman, “Biogen pulled Aduhelm paper after JAMA demanded edits,” Axios, Jul 27, 2021

Biogen has yet to publish aducanumab trial results in a scholarly journal. “I suspect [Biogen] is reluctant to have the full data undergo the greater scrutiny that the peer review process would provide,” Scott Emerson, a University of Washington biostatistician and a member of the FDA committee who voted against Aduhelm. Biogen says it is pursuing other publication options—instead of the No. 1 U.S. medical journal—which means they couldn’t get their fishy data past the reviewers.

Posted Jul 19, 2021

The Aduhelm fraud may be collapsing. Perhaps impunity is not yet total.

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Melody Schreiber, “What the $%&! is going on at the FDA?” New Republic, Jul 14, 2021

FDA acting head Woodcock was compelled to empanel an “independent” investigation into how her staff shepherded the product over the objections of technical experts and hid at least one private meeting between an FDA official and the Pharma sponsor. She’s now a lot less likely to get the nod as permanent commissioner. “The agency is in turmoil.”

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Rachel Cohrs, “FDA chief Janet Woodcock acknowledges agency may have mis-stepped in process leading up to Alzheimer’s drug approval,” STAT, Jul 14, 2021

Woodcock: “The process could have been handled in a way that would have decreased the amount of controversy involved.” Translation: where can we hang the blame for the bad PR? Question 1 for the investigators: Was Woodcock “aware of a May 2019 off-the-record meeting between an FDA regulator she supervised and Biogen”?

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Rachel Cohrs, “Powerful House Democrats demand documents from Biogen about coordination with FDA on new Alzheimer’s drug,” STAT, Jul 12, 2021

Carolyn Maloney (D-NY) and Frank Pallone (D-NJ). “The request prominently references a STAT investigation that revealed Biogen had an off-the-books meeting with a prominent FDA regulator ahead of the drug’s unprecedented approval, and that the back-channel relationship between the two started earlier and was far more extensive than disclosed.” The two members referred to Biogen’s Project Onyx to sidestep the expert panel and get the drug approved as a “secret campaign.” Not a good look.

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Alexandria Hein, “Panel says Biogen’s Aduhelm Alzheimer’s drug shows no benefit,” Fox Business, Jul 16, 2021

The Institute for Clinical and Economic Review, a 15-member expert panel, voted on “whether the drug provides a net health benefit, if it has other potential benefits and important contextual considerations, and the long-term cost-effectiveness.” No, no, and no. 

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Pam Belluck, “Cleveland Clinic and Mount Sinai won’t administer Aduhelm to patients,” New York Times, Jul 14, 2021

Mount Sinai: “Aduhelm will not be considered for infusion into patients on any of its campuses until and unless [the investigation] affirms the integrity of the F.D.A.-Biogen relationship and goes on to reaffirm” the F.D.A.’s basis for approving the drug. This is a serious blow. Also: “In a recent survey of nearly 200 neurologists and primary care doctors, most said they disagreed with the F.D.A. decision and did not plan to prescribe the drug to their patients.”

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Jonathan Saltzman & Anissa Gardizy, “FDA narrows recommended use of Biogen Alzheimer’s therapy after flood of criticism,” Boston Globe, Jul 8, 2021

“The FDA didn’t limit the medication to those people [studied in three clinical trials—the mildly impaired] when it approved Aduhelm, raising the specter that anyone diagnosed with the disease—an estimated 6 million Americans—might seek it.” But doctors can do anything they want with an approved drug, so the change doesn’t mean all that much, especially in the face of pressure from patients and/or families.

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Max Nisen, “FDA Alzheimer’s drug fix is a patch job,” Bloomberg Opinion, Jul 8, 2021

Nisen points out that after the new guidelines limiting use of Aduhelm came out, Biogen’s stock went up by 4%. One explanation: the initial approval was so inexplicably broad that the new guidance could help contain the backlash. But the sudden switch creates more doubts about the whole approval. “The FDA’s laissez-faire guidance created the strange circumstance of making Biogen executives seemingly worried about selling too much of its medicine and multiplying public criticism of the drug’s $56,000-a year cost.” 

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Laurie McGinley, “The controversial approval of an Alzheimer’s drug reignites the battle over the underlying cause of the disease,” Washington Post, Jul 16, 2021

“A new medication targets amyloid clumps in the brain, but researchers have long debated whether that will actually help patients”—and have never found any supporting evidence for the theory. “Years of testing drugs that target amyloid had yielded a string of failures.” Meanwhile, continued attention to this likely dead end—and the free money you get for pursuing it—is a catastrophe for alternative approaches.

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Elisabeth Rosenthal, “Why we may never know whether the $56,000 Alzheimer’s drug actually works” [opinion], Washington Post, Jul 7, 2021

“If [follow-up] studies fail to verify clinical benefit, the FDA may—may—withdraw them. But those follow-up studies have often taken years to complete, if they are finished at all. That’s in part because of the FDA’s notoriously lax follow-up and in part because drugmakers tend to drag their feet. When the drug is in use and profits are good, why would manufacturers want to find out that a lucrative blockbuster turns out to be a failure?”

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A. Peticola, “The future of Aducanumab—as a medicine and as a financial product—what happens now?” Health Care Renewal, Jul 8, 2021

The author outlines the best outcome for Aduhelm: “Insurers and legislators force down the price somewhat, and it’s prescribed to a large number of people but not as large as originally predicted. The brain swelling side effects prove to be not too troubling, and although clinical effects overall are marginal to none, it does help some people more than averages would indicate, and some individuals do realize a substantial benefit for themselves.” How likely is this scenario? “Murky and uncertain.” But as a financial, rather than a medical product, the future of aducanumab is quite rosy as it “extracts vast amounts of money from people in the form of premiums, taxes, and co-pays, and greatly enriches Biogen and its stockholders.” Comment by a finance blog: “Aducanumab [is] a drug so unlikely to make a material difference to Alzheimer’s victims that it looks like Big Pharma’s answer to faith healing.”

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Judith Graham, “Paying billions for controversial Alzheimer’s drug? How about funding this instead?" Kaiser Health News, Jul 6, 2021

“If you could invest $56 billion each year in improving health care for older adults [instead of giving 1 million elderly patients Aduhelm], how would you spend it?” The total annual budget for the NIH is $43 billion. So no, the drug is not “better than nothing” and no, people shouldn’t get vast public subsidies to place a casino bet.

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Alexander Zaitchik, “Long, strange TRIPS: The grubby history of how vaccines became intellectual property,” New Republic, Jun 1, 2021

An excellent dive into the origins of “intellectual property” protections and how drug patents kill people. “The day after Salk’s polio vaccine was declared a success, Dwight Eisenhower offered to share all information and know-how with every country that requested it, including the Soviet Union. A month before John F. Kennedy’s assassination, he enraged the drug companies by issuing a memorandum that restricted private monopoly claims on government science—especially federal research in ‘fields which directly concern the public health.’” TRIPS ended that era. 

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Alia Paavola, “CMS unveils surprise-billing rule: 10 things to know,” Becker’s Hospital Review, Jul 15, 2021  

The No Surprises Act bans surprise billing for emergency services, high out-of-network cost-sharing, and ancillary services (such as anesthesiology, a regular trick since the patient is unconscious and can’t object). It also requires patient consent for balance billing (Just Say No!)

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Mike Bassett, “U.S. sees pricier cancer drugs at launch, and it gets worse from there,” MedPage Today, Jul 7, 2021

Also, many super-expensive cancer drugs provide “only incremental additional benefit.” But Medicare can’t do anything without the power to negotiate prices. One answer: patients can refuse to receive crappy, expensive drugs.

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Daniel Marans, “A Massachusetts Democrat flush with Pharma cash echoes industry talking points,” HuffPost, Jul 16, 2021

“Politics watchers were more surprised to see Rep. Jake Auchincloss (D-MA), a freshman from a liberal district, as the lead co-author of a letter to House Speaker Nancy Pelosi [that] echoed the pharmaceutical industry’s familiar concerns that empowering Medicare to negotiate lower prescription drug prices would discourage research and development.” Auchincloss, who took over from RFK, Jr., got a bucketload of dough for his tight primary race from Pharma.

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Caroline Lewis, “NYC unions confirm decision to shift retirees onto privatized health insurance,” New York Progressive Action Network (NYPAN), Jul 17, 2021

What’s that about how unions can’t back M4A because they won great health insurance for their members? Or do union brass have interests that diverge from their members’? “The move will affect some 250,000 municipal retirees, hundreds of whom marched against the changes in Manhattan last week” after having found out at the 11^th hour about the backdoor renegotiations affecting their benefits.

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Marisa Fernandez, “Childbirth highly susceptible to surprise medical bills,” Axios, Jul 6, 2021

“Nearly one in five newborn hospitalizations or childbirth deliveries have at least one surprise medical bill, especially if cesarean delivery or neonatal intensive care services are provided.” A lucrative business as people keep having babies. A new rule from HHS should curb the practice, starting next January.

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Ryan Basen, “Juul bought out medical journal for $51K,” MedPage Today, Jul 13, 2021

Further evidence of ongoing debasement of The Science: Juul financed an entire issue of a medical journal to peddle its strategic obfuscation. It only cost $50K—couch lint. Should spark further discussion of the whole scientific publishing business. “The recent proliferation of journals whose obvious focus is the for-profit generation of revenue without regard to science constitutes a development that creates a major problem for reputable journals.” True, but those “reputable journals” are also a huge hustle.

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Rena Conti, “Walmart’s low-price insulin is a band-aid on a broken system,” MedPage Today, Jul 11, 2021

Walmart’s discount insulin sounds like progress, but its $73 price tag (compared to the product’s list of $289) is still 6 to 10 times more than insulin costs anywhere else. Americans thus will “save” by paying only $1749 per year while a French or German patient pays $150. Syringes and blood sugar monitoring supplies are extra, of course.

Posted Jul 6, 2021

Peter Sullivan, “Democrats seek new ways to expand Medicaid in holdout states,” The Hill, Jun 20, 2021  

Two of the strategies to get around Republicans’ refusal to expand Medicaid in the 12 non-expansion states are: (1) allow counties or cities to work directly with Washington to expand local Medicaid expansion; or (2) create a federally-run Medicaid program to do so. The industry would hate the latter idea more as it could provide a template for M4A.

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Katie Adams, “Medical debt grew for patients by 6.5% in spring,” Becker’s Hospital Review, Jun 14, 2021

Up 9%: the number of people facing past-due medical bills. Also, “The number of Americans who filed for personal bankruptcy rose by 30% from February to March this year.” Any correlation?

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Mark Wilson, “How hospitals inflate bills and shake down patients for cash,” Fast Company, Jun 28, 2021

A third of working Americans have medical debt. “Ultimately, patients are the ones caught in the middle of this price war between hospitals and insurers. Many patients don’t end up paying inflated list prices, but they bear the costs in the form of rising premiums and large surprise bills for out-of-network coverage.” Interactive graphics.

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Melanie Evans & Anna Wilde Mathews, “Medical-debt charity to buy, wipe out $278 million of patients’ hospital bills,” Wall Street Journal, Jun 15, 2021

“A push to speed financial relief to patients, many of whom shouldn’t have been billed at all under the hospitals’ financial-aid policies.” Why do charities have to step in and pay hospitals for care they are supposed to provide for free?

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Katie Adams, “Northwell creates new role: medical debt ombudsman,” Becker’s Hospital Review, Jun 16th, 2021

After some stinging negative publicity earlier this year, Northwell seems determined to present itself as a benign system: "I want to underscore that Northwell does not pursue legal action against patients who do not have the ability to pay,” said the CEO. The announcement came a day after Johns Hopkins University released a report showing that 26 high-earning U.S. hospitals filed some 40,000 court actions against patients; six of the 26 were in New York.

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Adam Shaw, “Oregon lawmakers pass bill to make illegal immigrants eligible for Medicaid, Dem gov expected to sign into law,” Fox News, Jun 27, 2021

Fox predictably getting its knickers into a huge bunch over state aid to THOSE PEOPLE. A deadly, airborne epidemic might have taught us that we’re all in it together when it comes to health—but apparently not. Meanwhile, Republicans in holdout states also refuse to provide care to bona fide citizens, so at least they’re consistent.

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Jessie Hellmann, “Hospitals decry extending Medicare cuts to pay for infrastructure bill,” Modern Healthcare, Jun 29, 2021

“Not only did hospitals not get the money they sought in President Biden’s bipartisan infrastructure package, under the framework Biden announced last week, Medicare reimbursement reductions would help cover the legislation's $1.2 trillion cost.” Reduce payments by 2% through “at least 2031,” what a great idea! Further undermine Medicare by increasing the gap between private insurer reimbursements and the government program, impoverish safety-net hospitals while the big chains thrive, and deepen the dual-track, class-based healthcare system.

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Dustin Walsh, “Rising pay in other industries blows holes in healthcare’s workforce,” Crain’s Detroit Business/Modern Healthcare, Jun 30, 2021

“As one of the lowest paid clinical jobs in healthcare—the median wage in the U.S. is $17.23 per hour—medical assistant jobs are increasingly difficult to fill.” Hmm, perhaps there is some automatic mechanism built into capitalism that could solve this problem, something invisible?

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James Brieding, “A better way to pay for health care,” Scientific American, Jun 16, 2021

The author’s hot new idea: self-funded health savings accounts so that patients have “skin in the game” and shop around more successfully. This is what passes for groundbreaking science in a major popular magazine.

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Amanda Eisenberg, “32BJ severs ties with NewYork-Presbyterian amid broader fight for pricing transparency,” Politico, Jun 4, 2021 

An affiliate of SEIU dropped NYP from its network after finding that its health fund “paid, on average, 358% more than Medicare for the same services.” The new rule requiring hospitals to disclose their prices should help other employer plans to compare real prices.

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David Nash, “Google’s rise in healthcare,” MedPage Today, Jun 30, 2021

“For Google, the arrival of the COVID-19 pandemic presented a unique opportunity to intensify its development of partnerships. [For example,] the State of New York launched a web-based tool developed in partnership with Google to connect state residents with resources for food, housing, and COVID-19-related services during the pandemic.” Several other examples follow, leading to this conclusion: “The platform capability of a Google-like EHR [Electronic Health Records system] enables overlap of databases and shifts the focus to the value created by integrating and analyzing disparate data.” What could go wrong? Nothing according to this author, an academic and “special assistant” to a 5-hospital network in the Philly area, who concludes: “I believe that Google will surprise us all in the very near term with its ability to create value.” And that is automatically a good thing?

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Amanda D’Ambrosio, “How patients can get wise to bad billing practices,” MedPage Today, Jun 22, 2021

A new book (Never Pay the First Bill) on how to handle industry sleaze. Step one: don’t pay until you get a fully itemized bill with the billing codes.

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DRUG COSTS

Marisa Fernandez, “Pricey drugs paid by Medicare lack cost-effectiveness data," Axios, Jun 21, 2021

While 10% of all healthcare spending in the U.S. is eaten up by drug costs, Pharma can get reimbursements without having to prove their products are worth what they charge. Also, without data, Medicare can’t justify using generic alternatives.

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Noah Higgins-Dunn, “Biogen’s $56K price tag on Aduhelm? Think again, ICER says, calling for discounts of around 90%,” Fierce Pharma, Jun 30, 2021

The Institute for Clinical and Economic Review maintained that Aduhelm’s $56,000 price tag is “not in reasonable alignment with its clinical benefits.” More like 15% of that, says the watchdog group. Assuming Aduhelm works at all—an assumption not in evidence.

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Brett Molina, “Walmart launching its own low-cost insulin to ‘revolutionize’ affordability for diabetics,” USA Today, Jun 20, 2021

The average price for an insulin prescription nearly doubled from 2012 ($344) to 2016 ($666).

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Damian Garde & Nicholas Florko, “Calls grow for an investigation into FDA approval of Biogen’s Alzheimer’s drug,” STAT, Jun 30, 2021

Former health secretary Donna Shalala joined the chorus of critics “demanding answers on the close relationship between Billy Dunn, head of the FDA’s neuroscience division, and Biogen executives in the run-up to the approval of Aduhelm.” Dunn still working at the FDA pending his lateral move to . . . which pharmaceutical company?  

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Katheryn Houghton, “States step up push to regular pharmacy benefit managers,” Health News Florida, Jun 30, 2021

Over 100 bills in 42 states this year alone seek to remove these vampire squids’ mandibles from the healthcare system. “A handful of the companies, CVS Caremark, Express Scripts, and OptumRX, are a cartel control the vast majority of the market while also operating national pharmacy chains.” Both Republican- and Democrat-led states are trying to battle them, including New York, Wisconsin, Florida, and Montana. Independent pharmacies are getting squeezed out entirely.

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Bruce DePuyt, “Colorado creates Maryland-style prescription drug price containment board, as other states consider action,” Maryland Matters, Jun 21, 2021

States continue to act without waiting for Washington. Colorado, Maryland, and Maine now have state panels that can block prescription drug prices. And they are learning from each other, even down to what kinds of slogans work best to build support, like Maryland’s “Drugs don’t work if people can’t afford them.”

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Kevin Dunleavy, “With $1.2B deal for molnupiravir, U.S. bets on Merck’s oral COVID-19 antiviral,” Fierce Pharma, Jun 9, 2021

Merck’s drug could bring in billions, but not if ivermectin is shown to be an effective (and vastly cheaper) alternative, which would block Merck’s bid for an Emergency Use Authorization (EUA). But the federal government is promising Merck $1.2b if they can come up with trial data and discredit the competition. Stand by for The Science!

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Mychael Schnell, “Schumer backing plan to add dental, vision and hearing coverage to Medicare,” The Hill, Jun 21, 2021

Schumer, facing a possible 2022 challenge from someone (AOC?), looks more leftish by the day. However, he is always “working for” something and “working with” various progressives like Bernie Sanders—but usually falling a bit short of actually accomplishing the supposedly desired goals as in this case, termed an “uphill effort.” It’s easy to trumpet one’s good intentions and never quite accomplish things that would make your rich backers mad.

Posted Jul 1, 2021

Rachel Cohrs & J. Emory Parker, “Will Biogen’s new Alzheimer’s drug’s burden on Medicare be big, huge, or catastrophic?” STAT, Jun 28, 2021

On the “eye-popping” impact of the probably useless Alzheimer’s drug Aduhelm on Medicare’s finances: an estimated $29 billion a year if only half a million patients are put on the drug. That’s just the cost of the drug itself, not including the infusion process and the extensive tests required to monitor its very frequent side effects. The CDC’s annual budget is about $6.6 billion.

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Derek Lowe, “Open the floodgates,” Science Translation Medicine, Jun 24, 2021

The next element of the Aduhelm debacle: another Pharma company (Lilly) will trot out its failed anti-amyloid drug and say, It’s as good as Biogen’s! Then stand by to watch Biogen and Lilly relentlessly peddle two useless drugs to desperate families. “The agency [FDA] approved a drug that shows no solid evidence of helping anyone, allowing everyone else to jump on the same damn bandwagon with data that are no better.”

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Ed Silverman, “Alzheimer’s Association blasts Biogen over price of new drug Aduhelm,” STAT, Jun 12, 2021

Outrage theatre. The Association gets loads of cash from Pharma, including $275,000 from Biogen in 2020.

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Chris McGreal, “Biden urged not to give top FDA job to official over her role in opioid crisis,” Guardian, Jan 26, 2021

Janet Woodcock, who is “not concerned” about criticism of her Aduhelm decision, also presided over the opioid debacle. She headed the Center for Drug Evaluation and Research (CDER) when it approved OxyContin as safe and “often overruled its own scientific advisors and ignored the pleas of public health groups, state Attorneys General, and outraged victims of the opioid crisis.” This article is from January, long before Woodcock outdid herself with Aduhelm.

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Matthew Herper, Damian Garde & Adam Feuerstein, “Newly disclosed FDA documents reveal agency’s unprecedented path to approving Aduhelm,” STAT, Jun 22, 2021

The gory details on how Biogen conspired with top FDA officials to overlook its failed clinical trials and ram Aduhelm through the approval process. “Chastened after a decisively negative review from outside advisers, the Food and Drug Administration convened a series of internal meetings in March and April where top officials hammered out a plan to approve Biogen’s Alzheimer’s drug.” Hammered out.

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Megan Molteni, “A crucial, overlooked question on the new Alzheimer’s drug: When should patients stop taking it?” STAT, Jun 24, 2021

The drug “medicalizes someone’s life” with hourlong, monthly infusions, frequent lab tests, and brain scans to detect swelling or bleeding. “Headaches, dizziness, nausea—all might trigger more time spent in the hospital. Such constraints could make it difficult to travel internationally or spend time with family members in other states.” Patient families rushing to cram this turkey into granddad’s veins can look forward to all this and more. When the buyer’s regret kicks in, whom will they sue?

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Lev Facher, “Prescription politics,” STAT, Jun 9, 2021

Details of the 2,400 state lawmakers who get Pharma cash for their campaigns. No wonder state initiatives to control drug prices get sidetracked consistently. And the amounts are chicken feed relative to what a member of Congress costs.

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Lee O. Sanderlin, “Mississippi reaches $55.5 million settlement with Medicaid contractor Centene,” Mississippi Clarion Ledger, Jun 14, 2021

Cost-of-doing business fine for a company with $111 billion in annual revenue. Not only will there be no criminal penalty for systematically cheating, but Mississippi was forced to agree to a statement that Centene has provided “high quality” pharmacy benefit services to the state.

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Ann Woloson, “Bills to address rising health care, drug costs advance despite attacks from Big Pharma” [opinion], Maine Beacon, Jun 11, 2021

While Maine looks at five bills to lower costs of treatments and drugs, Pharma is pouring in money to stop them, spending “between $75,000 to $90,000 on two Facebook ads alone just in the last month.” Or about 18 months of Aduhelm prescriptions for one patient.

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Matt Taibbi, “Ivermectin: Can a drug be ‘right-wing’?" TK News, Jun 25, 2021

How the politicization of drugs turned ivermectin into a suspect, Trumpian, snake oil remedy. “Ivermectin has suffered the same fate as thousands of other news topics since Donald Trump first announced his run for the presidency, cleaved in two to inhabit separate factual universes for left and right audiences.” Anything Trump likes has to be a fraud. Suppression by YouTube or Facebook then feeds Q-type conspiracy cults with the result that a promising drug only gets a hearing on Fox News.

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Andrew Bannister, “Conflict of interest in WHO recommendation against Ivermectin” [opinion], Trial Site News, Jun 17, 2021

The WHO takes positions on treatments and public health practices and is believed to be a neutral, scientific body. But it’s dependent on non-state entities like the Gates Foundation—which have their own agencies—for 80% of its funding. Case in point: the WHO’s strange recommendation against use of ivermectin is based on a study by scientists at McMaster University in Canada. But McMaster is not any old school. It is “designing and producing” second-generation COVID-19 vaccines, is a Gates beneficiary, and “shares personnel such as Edward Mills, a McMaster associate professor and clinical trial advisor for the Gates Foundation.” The WHO named Mills to head the ivermectin study.

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Trial Site News, “Merck tests monupiravir, an investigational product, at the Lung Center of the Philippines while large ivermectin trial runs in parallel,” Jun 7, 2021

“Although Merck developed a version of ivermectin that’s been used to safely quell parasitic-born illness in many tropical areas for four decades, the company went on the offensive against its own product’s use as a therapy for the COVID-19 indication. So now the American pharmaceutical company is in a race against time and its own generic product to carve out market share.” The clearest explanation to date for why ivermectin is getting the silent treatment. Drugs can’t get an emergency designation if there are viable alternatives already in existence.

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Trial Site News, “DGHS hatchet chops ivermectin nationally while positioning unproven tocilizumab despite success of Utter Pradesh,” Jun 7, 2021

India originally included off-patent, inexpensive ivermectin in its national Covid treatment guidelines, but the recommendation was quickly rescinded. Costly Remdesivir (that virtually no Indian citizen can afford) is still approved, however, as well as Roche’s tocilizumar, which “failed to meet endpoints in the Phase 3 study involving COVID-19 pneumonia.” We worship The Science but only sometimes.

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David Sirota, "Big Pharma may finally lose this one,” Daily Poster, Jun 3, 2021

An ongoing fight over importing drugs from Canada, which some Republican governors like DeSantis favor. “[Bernie] Sanders helped pass legislation through the Republican Congress that would have allowed Americans to import lower-priced prescription drugs from other industrialized countries. However, Clinton’s Health and Human Services Secretary Donna Shalala vetoed the importation program.” When it comes to Pharma campaign and lobbying cash, our leaders demonstrate consistent bipartisanship.

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Robert Bazell, “How the drug industry has exploited reforms started in the fight against AIDS,” Nautilus, Jun 28, 2021

“The push by AIDS activists for an effective treatment was a breakthrough in the medical industry. It showed the power of a grassroots movement to spur the government and Big Pharma to action. But it had a dangerous and lasting side effect,” i.e., Pharma realized they could use patient advocacy to cram through approval for dubious products [see above]. An important cautionary note about patient activism.

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Julia Rock, “The New York City unions whose backdoor deal sold out retirees, helped insurance industry,” Newsweek, Jun 28, 2021

The anti-single payer Municipal Labor Committee (MLC) helped block a vote on the New York Health Act while simultaneously “engaging in backdoor negotiations with the city, resulting in a proposal to switch nearly a quarter-million people from Medicare to privately administered Medicare Advantage plans.” Also, MLC personnel have conflicts of interest, e.g., Gregory Floyd, President of the Teamsters Local 237 and Secretary of the MLC, is on the board of EmblemHealth. As employer-based health insurance continues to deteriorate over relentless cost increases, the union leaders’ arguments about how they win their members great benefits will look increasingly thin.

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Dr. James Mumford, “Ad makes false assumptions about single-payer healthcare in NY” [opinion], Syracuse.com, Jun 15, 2021

The writer, president of the New York State Academy of Family Physicians, answers industry propaganda point by point. Good to see systematic defense of single payer in the letters/op-ed columns.

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Caitlin Owens, “Most hospitals aren’t complying with price transparency rule,” Axios, Jun 15, 2021

Congress can pass laws, but then somebody has to enforce them. “Most hospitals aren't fully complying with a new federal rule requiring them to make their prices available.” If patients can truly shop around for better deals, hospitals could lose money. “Compliance could be limited because the penalties for noncompliance are minimal (maximum $300 per day).”

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Bob Herman, “Health care executive pay soars during pandemic,” Axios, Jun 14, 2021

“The CEOs of 178 health care companies collectively made $3.2 billion during the coronavirus pandemic, which was 31% more than 2019. The CEOs of the six health insurance conglomerates (Anthem, Centene, Cigna, CVS Health, Humana, and UnitedHealth Group) made a combined $236 million in 2020, 45% more than in 2019.”

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Jay Hancock, “In alleged health care ‘money grab,’ nation’s largest hospital chain cashes in on trauma centers,” Kaiser Health News, Jun 14, 2021

A new scam: “activation” of a hospital trauma team. “Basically, it was just a gash on my arm,” said [patient] Knight, 71. “The emergency team that they assembled didn’t really do anything”—except for sending a bill for $17,000. The secret is to obtain a “trauma designation,” then charge ten times what a regular ER can get away with. Avoid HCA Healthcare hospitals, the entity pioneering this new rent-extraction instrument.

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Michelle McGhee & Will Chase, “How America’s top hospitals hound patients with predatory billing,” Axios, Jun 14, 2021

“Nonprofit” hospitals enjoy tax benefits but don’t hesitate to take people to court, including Stephen Swett, 44, who went to the emergency room at Westchester Medical Center in 2018, sat on a gurney for a few hours, was discharged and billed $2,539.43. “You don’t even take my temperature, you don’t do anything, you just basically let me sit, and then you stick me with a bill and take me to court.” Under the ACA, “nonprofit” hospitals have to tell people if they’re eligible for financial assistance, but often don’t.

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Natalie Shure, “The success of Medicaid expansion could break it,” New Republic, Jun 28, 2021

The inadequacies of Medicaid, despite its crucial role: narrow networks; underfunded providers; dependence of states subject to cost pressures and austerity pushes, including onerous procedures for reconfirming eligibility; the stigma of being a safety-net program; the vast differences among state programs. Meanwhile, 80 million people rely on it, one in four Americans. “Far from signifying the success of our safety net, skyrocketing Medicaid numbers reflect the increasingly obvious failure of our standard insurance system to justify its own existence.”

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James K. Galbraith, “The G7 vaccine charade,” Project Syndicate, Jun 23, 2021

The 500m vaccine doses offered so far is a drop in the ocean IF the promises pan out. (The language of the promise is “aim to deliver”—weasel words.) “The US alone is reputed to have the capacity to produce 4.7 billion doses by the end of 2021—four billion more than America needs. Where are those doses going? Apparently to wealthy customers.” Chinese and Russian vaccine diplomacy will step into the gap. Russia plans to produce 850m doses of Sputnik V in India alone.

Posted Jun 21, 2021

Wendell Potter, “Death & debt by deductibles,” Potter Report, Jun 1, 2021

April 17 was Deductible Relief Day, “the day where the average person with employer-based health insurance has met their deductible.” In 2005, it was February 28. Many people avoid care when the entire cost comes out of their pocket.

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Wendell Potter, “The three trends fueling health insurers’ frightening growth and profitability,” Uncovered, [undated, Jun 2021]

Important: health insurance companies are now among the most profitable businesses in America. They thrive in three ways: (1) vertical integration, i.e., entering deeper into health delivery, not just insurance (UnitedHealth employs 50,000 doctors); (2) branching out to capture “public” insurance revenues, i.e., Medicare Advantage and state Medicaid programs; (3) cutting back on care through higher copays, prior authorization obstacles, and restrictive networks. Full of illuminating detail, such as the fact that three insurers are now in the Fortune top 20: CVSHealth/Aetna #5, UnitedHealth Group #7, and Cigna #13.

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John G. Singer, “‘Healthcare’ is the economy,” MedPage Today, Jun 5, 2021

Billionaire Buffett called healthcare “a tapeworm in the American economy.” But even he and his powerful allies (Amazon, JPMorganChase) couldn’t do anything about it by tinkering around the margins. The tapeworm won. “Even the biggest and most powerful companies in the country don’t really have the leverage to go up against the healthcare system.” There is no magic fix to healthcare finance short of removing the financiers’ mandibles.

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Natalie Shure, “Many more Americans would be vaccinated if our health care system weren’t so terrifying,” New Republic, Jun 7, 2021

“Though Congress passed legislation mandating that Covid-19 vaccines be free, around one-third of unvaccinated people cited fear of cost as a significant reason they’ve yet to get the jab.” Promises from Biden or anyone else don’t convince people they won’t get slammed with unexpected bills. “Many people do know that the jabs are supposed to be free. They just don’t believe it.”

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David Sirota & Andrew Perez, “Nobody should be celebrating the Affordable Care Act,” Jacobin, Jun 7, 2021

“The ACA’s modest popularity proves that an initiative can now be considered a political win even as it preserves a problem, steamrolls alternatives, and makes a crisis more difficult to fix.” Problems the ACA didn’t solve (or are getting worse): 30 million Americans are uninsured; insurers deny one out of every six medical claims; average family premiums in employer-sponsored plans are now $21,342 per year; “the proportion of adults unable to afford doctor visits climbed from 11.4 percent to 15.7 percent.” Insurance industry campaign donations to Democrats reached $150 million since Obamacare was first enacted.

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Key Tillow, “Liz Fowler is back! And she’s writing US health policy again,” Counterpunch, Jun 7, 2021

Fowler played a critical role in designing the Affordable Care Act. Then she moved to Wellpoint, a giant insurance company (now Anthem); now, she’s back as head of the Center for Medicare and Medicaid Innovation (CMMI) within the Center for Medicare and Medicaid Services (CMS), “the top spot to direct the future of health care.” Fowler was a top aide to Senator Max Baucus, who “refused to allow single payer advocates to participate in the hearings on the Affordable Care Act. When nurses, doctors, and others stood to speak, Baucus called the police and had them arrested.”

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Duncan Maru, “Memorialize those we lost to COVID. Pass the NY Health Act now,” Queens Daily Eagle, Jun 2, 2021

Nice pro-NYHA opinion column by a Jackson Heights Covid doc: “Many of my COVID-19 patients lacked health insurance or access to primary care. For years prior to the pandemic, they have been denied care necessary to protect them from conditions that put them at greater risk.” The writer had been in favor of piecemeal steps; Covid changed his mind.

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STATES AND MEDICAID EXPANSION

TEXAS

Paul Flahive, “Congressional Democrats try to go around conservative state leaders to expand Medicaid in Texas, elsewhere,” Houston Public Media, Jun 17, 2021

They’ll try to let the feds fund local hospitals and municipalities directly through “demonstration” programs. Texas has more uninsured people than any other state: 5.2 million.

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MISSOURI

Summer Ballentine, “Missouri risks Medicaid funding over contraceptive fight,” Associated Press, Jun 17, 2021

The state’s Republican legislature may shoot itself in the head out of ideological resistance to birth control. Billions at stake—real money in Missouri.

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OKLAHOMA

Dana Branham, “More than 113,000 Oklahomans approved for health coverage through Medicaid expansion,” The Oklahoman, Jun 18, 2021

Two thirds are women.

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Anne E. P. Frosch, Aileen Ahiskali & Chandy C. John, “Unaffordable treatment for severe malaria highlights U.S. drug market pitfalls,” STAT, Jun 11, 2021 

The FDA approved a drug in 2020 that costs $5 in most African countries. But owner Amivas LLC charges $30,000. Therefore, try to get malaria in Gabon, not Florida.

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Matti Gellman, “10% of prescription drugs make up majority of Medicare drug spending, study finds,” Modern Healthcare, Apr 19, 2021

Super-expensive drugs account for a large percentage of government spending on meds. But Medicare isn’t allowed to negotiate over prices. Keep in mind while reviewing the fallout over Aduhelm [below].

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ADUHELM DEBACLE

Natalie Shure, “The sleazy story of how Biogen’s new Alzheimer’s snake oil got approved,” New Republic, Jun 14, 2021

“The pharmaceutical lobby has torn the FDA to shreds. The FDA’s decision has done little more than put the neediest and most desperate patients in harm’s way.”

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Vinay Prasad, “The FDA is failing the American people,” MedPage Today, Jun 16, 2021

The FDA collapsed not just by waving through Aduhelm, but also for four “cancer immunotherapies where clinical trials had failed to confirm that the drugs extended survival or improved quality of life.” “The lesson was painfully clear: once the toothpaste is out of the tube it is hard to get it back in.” So, forget about the new Aduhelm trial that Biogen is supposed to conduct to see if their drug works—scheduled for completion in 2030.

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Madhav Thambisetty, “Why a controversial decision won’t stop me from serving on FDA advisory committees,” STAT, June 17, 2021

His argument for sticking with the FDA is less interesting than his description of what is happening with relatives of Alzheimer’s patients: “I compared the results of his recent cognitive performance to those from a year ago. He sat motionless while his son made copious notes as I spoke, rarely taking his eyes off the notepad. Then came the question—variations of which I have been asked several times since by patients and their loved ones: ‘When can my dad get the new antibody treatment?’” The pressure to prescribe the $50,000 sugar pill will be overwhelming.

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Sam Gandy, “6 ways the FDA’s approval of Aduhelm does more harm than good,” STAT, Jun 15, 2021

“Even the most sophisticated patients are unable to resist the pull of desperation potentiated by the false hope engendered by Aduhelm’s approval. They are rushing to resign from their current trials and queuing up to start Aduhelm infusions.” As a result, “the improper approval of Aduhelm poses an immediate and permanent threat to the discovery of real effective disease modifiers for dementia” by destroying other ongoing clinical trials. Furthermore, Aduhelm will push aside better, existing treatments such as galantamine whose users “virtually never declined past moderate-stage dementia. Far superior data pointing to a safe, affordable, orally active, immediately available medication are almost totally ignored.”

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Elizabeth Cooney, “‘I’m just winging it’: Faced with confusing data on the new Alzheimer’s drug, doctors scramble to advise their patients,” STAT, Jun 14, 2021

“Their phones are ringing off the hook and their email inboxes are filling up with questions without answers.”

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Dylan Scott, “The new Alzheimer’s drug that could break Medicare,” Vox, Jun 10, 2021

“Medicare’s inability to negotiate pharmaceutical prices has meant that a budget crisis is always just one drug approval away. With aducanumab, that crisis has arrived.”

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Kevin Dunleavy, “Biogen’s hefty Aduhelm cost sparks even more talk of a drug pricing crackdown. But will it happen?” FiercePharma, Jun 10, 2021

“Because so many Alzheimer’s patients are on Medicare, there isn’t any organized resistance to the price. Such a high cost could be a catalyst for movement on drug price reform.” But see below.

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Susannah Luthi & Rachel Roubein, “A pricey new drug that may not work? Why drug pricing critics are staying quiet,” Politico, Jun 12, 2021

“Hardly anybody on Capitol Hill is talking about it, worried they’ll be seen as dashing desperate patients’ hope for an Alzheimer’s treatment—even one that may provide little or no benefit.” Craig Garthwaite, a health economist who lambasted FDA’s Aduhelm approval, said, “They hear there’s a new treatment and that’s great, it’s a sign of hope. Do you want to be the politician who says, ‘I want to take that away from you?’” Emotional blackmail from families, weaponized by Pharma.

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Laurie McGinley, “Furor rages over FDA approval of controversial Alzheimer’s drug,” Washington Post, Jun 17, 2021

One possible source of potent resistance: the insurers who will have to tell people no. “The FDA has transferred its responsibility down to the payers and making payers out to be the bad guy.”

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Amanda D’Ambrosio, “One in six families face $5K in out-of-pocket childbirth costs,” MedPage Today, June 17, 2021

“The high out-of-pocket costs documented in this research could be a contributor to low birth rates in the U.S. It’s a serious deterrent for young families to have a second and a third child.”

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Olivia Webb, “The banality of evil: the prior authorization process,” Acute Condition, Jun 17, 2021

A writer on healthcare finance’s own drama through the authorization maze for a drug that she had been taking for years. “Theoretically, Aetna should be incentivized to cover medications that do a great job of keeping my expensive chronic condition managed; I’ll cost less long-term. But the insurer seems totally incapable of even tracking that, let alone making proactive value-based decisions.”

Posted Jun 14, 2021

Biogen’s stock is up 50% on a crazy-expensive Alzheimer’s drug that doesn’t work: a special edition of SINGLE PAYER LINKS on the world-historical, appallingly corrupt, venal, iniquitous, mercenary, and perfidious official triumph of commerce over healthcare: the Aduhelm fraud.

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Elizabeth Cooney, “What you need to know about the Alzheimer’s drug Aduhelm,” STAT, Jun 7, 2021

The basics: The Food and Drug Administration approved Biogen’s new Alzheimer’s drug. Although it was only tested among patients with mild cognitive impairment, the approval is for anyone with Alzheimer’s. Desperate families will desperately seek it.

Cost: $56,000 a year. Principal payer: You (Medicare, i.e., the U.S. government).

Benefits: marginal. “As measured by tests of cognition and function, the difference between Aduhelm and placebo was a fraction of a point on an 18-point scale.” That’s for the study that showed any benefit at all—the companion study was a total flop.

Side effects: severe. “In two clinical trials, about 40% of clinical trial patients who got the approved dose of Aduhelm developed painful brain swelling, headache, dizziness, visual disturbances, nausea, and vomiting; about 17% to 18% of patients had microhemorrhages.”

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Laurie McGinley, “Two members of an FDA advisory committee quit after approval of controversial Alzheimer’s drug,” Washington Post, Jun 9, 2021

The expert panel voted 10 to 0 (with 1 abstention) against approval. “David S. Knopman, a neurologist at the Mayo Clinic, said he did not ‘wish to be part of a sham process. The approval of aducanumab appears [to] have been foreordained.’” The agency cleared the medication based not on the clinical data but on the drug’s ability to reduce beta-amyloid in the brain. This surrogate endpoint, said the FDA, means the drug is “reasonably likely” to benefit patients. See below for dissenting views.

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Andrew Joseph, “Member of FDA’s expert panel resigns over controversial Alzheimer’s therapy approval,” STAT, Jun 8, 2021

Biostatistician Scott Emerson, University of Washington: “This isn’t the first time when I was on a committee where the committee voted one way and the FDA decided another. This was the first time that nobody voted for approval of this drug— nobody—and they went against that.” He also reiterates that the FDA told them not to consider the surrogate endpoint issue, then made the approval decision based on exactly that. “It left experts on the panel scratching their heads.”

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Andrew Joseph, “Third member of FDA expert committee resigns over controversial Alzheimer’s therapy decision,” STAT, Jun 10, 2021

Aaron Kesselheim, member of the expert advisory committee: “It is clear to me that FDA is not presently capable of adequately integrating the Committee’s scientific recommendations into its approval decisions.” Kesselheim notes that the approval was based not on a clinical outcome (do patients improve) but rather on a surrogate endpoint, i.e., the removal of beta-amyloid clusters from the brain, which depends on a discredited theory of the origin of Alzheimer’s. This basis was not included in the original considerations for approval, but the FDA changed the criteria after the trials failed—without telling its own experts.

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Simon Makin, “The amyloid hypothesis on trial,” Nature, Jul 25, 2018

From 2018 about how thin the evidence is for linking beta-amyloid as the causal factor in Alzheimer’s.

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Karl Herrup & Jonathan Goulazian, “Bad medicine: aducanumab is a lackluster drug with a high price tag,” STAT, Jun 8, 2021

“There is strong evidence that amyloid plaques do not themselves cause Alzheimer’s disease. For evidence, look no further than the poor performance of virtually every anti-amyloid drug investigated to date. Why are we investing hundreds of millions of dollars each in dozens of human trials based on the same basic idea? The answer to this question does not lie in public health; it lies in stock price.”

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Bob Herman, “Pharma industry insiders disavow FDA’s approval of Aduhelm,” Axios, Jun 10, 2021

The consensus of 1,400 people who work in the biotech and pharmaceutical industries is that approval of Aduhelm is “a big mistake.” One comment: “Aducanumab priced at $56k with the efficacy of a sugar pill is taking advantage of patients and the health care system.”

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Jacqueline Howard, “New Alzheimer’s drug aducanumab: Cost, side effects, timeline and other questions answered,” CNN, Jun 9, 2021

Patients’ families are easily manipulated into grasping at expensive straws: “We're optimistic this will spark a wave of new research and innovation in this space.” Subtext: even if this one doesn’t really work, all the cash pouring into Biogen will stimulate others to find us something.

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Ricardo Alonso-Zaldivar, “Medicare copays for new Alzheimer's drug could reach $11,500,” Associated Press/ABC News, Jun 10, 2021

The cost to Medicare for just 500,000 patients taking Aduhelm would be $29 billion a year. “At this price, the cost of this one drug alone could top all others covered by Medicare.”

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Robert King, “Top Dem senator calls price of aducanumab ‘Unconscionable,’” Fierce Healthcare, Jun 10, 2021

Sen. Ron Wyden, D-Oregon: “There is little data showing it actually does what the company says it will do.”

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Caitlin Owens, “New Alzheimer’s drug could blow up health spending,” Axios, Jun 9, 2021

“If half of the newly eligible Americans in a year began treatment with Aduhelm, the cost would be $14 billion—roughly equivalent to Medicare Part B spending in 2019 on the next 8 products combined. But that’s a conservative estimate of annual spending on Aduhelm, as it only applies to half of one year’s worth of newly diagnosed Alzheimer’s patients.” Pharma dream: an insanely expensive drug targeted toward a huge percentage of the population.

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Berkeley Lovelace Jr., “Biogen faces tough questions over $56K-a-year price of newly approved Alzheimer’s drug,” CNBC, Jun 8, 2021

“J.P. Morgan analyst Cory Kasimov later asked executives how much federal health insurance program Medicare will be expected to pay for the drug and how concerned executives are about the ‘backlash’ the industry will face over its pricing.” Backlash indeed—but will any of the opponents of M4A who freak out about what a universal healthcare system would cost object to this?

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G. Caleb Alexander, Scott Emerson & Aaron S Kesselheim, “Evaluation of adecanumab for Alzheimer disease: Scientific evidence and regulatory review involving efficacy, safety, and futility,” Journal of the American Medical Association, May 4, 2020

One author is among the three who quit the expert panel. Paywalled, but here is the money quote: “Any treatment will appear to be more effective if individuals in whom it works least are removed from the analysis. Post hoc analysis of trials that change the populations of interest, end points, or methods of analysis introduce what may be regarded as unacceptable threats to statistical validity and scientific rigor, and they are usually performed as hypothesis-generating exercises [meaning that such analyses are only useful for thinking up new areas for research—but:] “Analyses based on a post hoc selection of the better of 2RCTs—the one reaching statistical significance— without methods that acknowledge this purposeful choice increase the risks of inadvertently selecting data precisely because those data were consistent with the outcomes that were hoped for.” Cherry picking your data to suit your desired conclusions.

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Andrew Joseph, “An extra twist in the FDA’s Alzheimer’s decision: no limits on which patients can get the drug,” STAT, Jun 7, 2021

“The flimsy studies showed only slight improvements for people in early stages, but the FDA didn’t limit the eligibility just to them.” One doctor said, “If you’re a neurologist in private practice, there’s probably more incentive to try to satisfy the family demands.”  Also, doctors also receive an extra markup when prescribing an infused drug.

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Julie Steenhuysen & Deena Beasley, “U.S. approval of Biogen Alzheimer’s drug sends shares soaring, hailed as ‘big day’ for patients,” Reuters, Jun 7, 2021

Biogen’s Japanese partner’s shares also jumped. But because of Japan’s system for setting drug prices for its national health care system, total cost there won’t surpass $1 billion.

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Bob Herman, “Aduhelm’s price to squeeze Medicare and patients,” Axios, Jun 8, 2021

“Aduhelm could create massive strains on Medicare spending and could create financially ruinous prospects for patients and their families.” If the drug triggers Medicare’s “significant cost” policy, Medicare Advantage plans wouldn’t be at risk for paying Aduhelm claims.  Translation: Once people on MA plans start costing real money, they will be sent back to traditional Medicare to be covered on the government dime.

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Bob Herman, “Experts question FDA standards with Aduhelm approval,” Axios, Jun 8, 2021

“The FDA is green-lighting an IV drug that has not proven to be better than a placebo, carries a risk of brain swelling and hemorrhages, requires patients to undergo a lifetime routine of imaging scans and doctor visits, and is based on a hypothesis of brain plaques that is losing scientific credence.”

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Jason Karlawish, “If the FDA approves Biogen’s Alzheimer’s treatment, I won’t prescribe it,” STAT, May 30, 2021

“The FDA allowed Biogen to skip a crucial step in drug development: the Phase 2 trial,” which enables researchers to play with dosage and get “the right balance of safety and benefit.” But that was skipped. “Skipping a key phase of research and performing a futility analysis weren’t scientific decisions; they were business decisions.”

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Meredith Cohn, “There’s a new Alzheimer’s drug, so what’s the problem? A Johns Hopkins doctor explains," Baltimore Sun, Jun 9, 2021

Advocacy groups had pushed for approval of this therapy. “Harry Johns, the president and CEO of the Alzheimer’s Association, said the approval is “about reinvigorating scientists and companies in the fight against this scourge of a disease.” Sounds an awful lot like, Let’s throw mega-billions at the drug companies so that they’ll keep looking for something that actually works. “Studies were halted in 2019 after showing no benefits but revived after the companies took another look at the data from one of the studies.” “Took another look” is research-speak for “statistical spear-fishing.”

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Kayla Rivas, “Who should take new Alzheimer’s drug? Expert weighs in,” Fox News, Jun 8, 2021

“Patients with late-stage Alzheimer’s disease are unlikely to benefit.” But since the FDA didn’t restrict who can get it, the drug ads will flood our screens, and people will besiege their doctors until they give in. “We’ll take anything,” said one advocate even though “sometimes it causes a little bit of a leak.” Also known as hemorrhaging.

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Los Angeles Times, “This isn’t how the FDA should OK Alzheimer’s drugs” [editorial], Jun 8, 2021

“There is far more evidence that it doesn’t work than evidence that it does.” Well, but why not let people try it? What’s the harm in that? “While the cost of healthcare heads inexorably higher, the nation has to start asking itself what to do with its finite healthcare dollars. Massive expenditures on pharmaceuticals that lack robust results in clinical trials [don’t work] aren’t the way.” Also, widespread use of Aduhelm will seriously impede new trials for other Alzheimer’s drugs given the reduced candidate pool.

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Max Nisen, “Approving Biogen’s Alzheimer’s drug is a big mistake,” Bloomberg, Jun 7, 2021

“Science took a back seat.” “This decision does more than bend standards — it shatters them.” “Many other medicines have targeted amyloid. Unfortunately, all failed to help patients, leading scientists to question whether removing the plaque does anything.” Public Citizen, the Naderite advocacy group, is asking for an investigation into the process. Question: which FDA employee will decamp to a cushy job at Biogen in coming months?

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Dana Goldman & Darius Lakdawalla, “FDA’s approval of aducanumab paves the way for ‘more momentous’ Alzheimer’s breakthroughs,” STAT, Jun 7, 2021

A rare voice praising the FDA decision: coincidentally, both authors are beneficiaries of cash from Biogen. Their argument: “The FDA decided not to make perfect be the enemy of the good. It approved the drug on the condition that Biogen complete a large clinical trial to confirm that removing beta-amyloid has cognitive benefits.” What are the chances that Biogen will conduct a study that finds its mega-billion-dollar blockbuster drug doesn’t work? Also, they have 9 years to present the results.

[COMMENTS]

Comment #1 Brian Hurwitz, Jun 7, 2021

“I’ve yet to read a positive take about aducanumab that isn’t followed by a declaration of a relationship with Biogen or the Alzheimer’s Association. This piece particularly feels like propaganda.”

Comment #2 JC, Jun 7, 2021

Precisely.

STAT: Comments are closed.

Posted Jun 9, 2021

Megan Messerly, “New amendment proposes making changes to Medicaid portion of public option bill in effort to reduce fiscal impact,” Nevada Independent, May 20, 2021 

Now that Biden has ditched his campaign promise to create a national “public option” (an insurance plan sponsored by the government), the fight for changes in health financing has moved to the states. The leader of this Nevada version is scrambling to find ways to make the budget numbers add up. She recently cut out a proposal to add Medicaid services that would cost somewhere around $25-40 million a year—pocket change in the federal budget but important amounts for individual states. “The new amendment will allow Medicaid to make those changes in services only if the money is available to do so—in effect, making the changes optional.” Also, the public option, if passed, would start in 2026. No rush!

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Tami Luhby, “Biden has paused a public option. Nevada is about to try its own,” CNN, Jun 7, 2021 

State-level plans are more easily sidetracked by lobbyists as happened earlier in Washington state. “Neither is truly a government-run public option. As in Washington, the plans in Nevada would be sold by private insurers but with government input in their design.” How will Nevada overcome industry resistance? “Carriers offering Medicaid managed care plans in the state would have to submit bids to sell public option policies, and doctors and hospitals who participate in Medicaid or the state employee health program would have to join at least one network.” All such measures can be attacked, watered down, challenged in court, and denounced in ads. Washington’s plan has been mostly a bust so far: only 2,000 people signed up to Cascade Select, which is only available in half the state’s counties in any case.

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Markian Hawryluk, “Colorado lawmakers wage multifront assault on high drug costs,” Kaiser Health News, May 25, 2021 

Another state tired of waiting for federal action “even if it must do so with one arm tied behind its back, unable to set prices or change patent protections.” Colorado spends $1 billion a year on meds for its neediest residents and wants to create a “drug affordability board” that would cap costs under various triggers—for example, when prices increase by more than 10% per year or exceed $30,000 annually. Threats from Pharma include refusing to sell certain drugs in Colorado. “Nearly every single state and U.S. territory is considering some sort of prescription drug cost bill this year.”

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Health News Florida, “Florida weights in on lawsuit over Canada drug imports,” Jun 3, 2021 

DeSantis opposing Pharma on drug importation: “The lawsuit is another desperate attempt by Big Pharma to prevent the importation of safe and effective prescription drugs from Canada. Floridians have been waiting long enough.” Will Democrats be outflanked on the left by GOP governors?

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Associated Press, “Nebraska officials drop plans for 2-tier Medicaid system,” Jun 2, 2021 

A Trump-era plan to create different benefits for the deserving versus the undeserving poor was dropped after the Biden Administration made it clear it would veto the idea. Another twist on the work requirement-for-healthcare tradeoff that didn’t work in Arkansas except insofar as it was meant to punish poor people. (That it did successfully.) Nebraska voters endorsed expanded Medicaid in 2018, but the state has dragged its feet ever since.

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Peter Sullivan, “Schumer backs Sanders’ push on drug prices, lowering Medicare age,” The Hill, Apr 30, 2021 

Schumer gears up for a primary fight with AOC by looking progressive. Rhetorical support costs nothing while actually pushing for votes and whipping Democrats into meaningful action would alienate his donors. “Bernie Sanders and I agree on this,” Schumer said. “He and I must talk almost every single day.” Translation: I’m virtually a Bernie Bro! Don’t leave me! More Schumersprach with helpful annotations: “It’s too early [maybe later]. I want to pass the biggest, boldest bill that, of course, we can pass [though my hands are tied]. And we’ve got to figure all that out [It’s all so complicated!]. We’re going to try to fight hard to try to get these in the bill. [We won’t succeed.]” Democrats love to say they’re “fighting for” something and then never actually achieve it.

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Stephanie Akin & Mary Ellen McIntire, “Democrats try to counter attack ads over drug prices,” Roll Call, May 25, 2021 

Facing a $5 million barrage of ads attacking their health care plans as “socialist,” Democrats are hitting back. Yay, resistance! Oh wait, the Dems’ counterattack will be a “five-figure digital campaign.” The DCCC ads “feature 16 Democrats in competitive races. Pictures of their faces are superimposed over text that says they have ‘the nerve to fight for lower prescription drug prices.’ Fight, fight, fight!

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Lev Facher, “More than two-thirds of Congress cashed a pharma campaign check in 2020,” STAT, Jun 9, 2021 

“Seventy-two senators and 302 members of the House of Representatives cashed a check from the pharmaceutical industry ahead of the 2020 election—representing more than two-thirds of Congress. Pfizer’s political action committee alone contributed to 228 lawmakers, or half the lawmakers on Capito Hill.” Interactive graphics.

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Kara Grant, “Are vaccines advisors more conflicted than we thought?” MedPage Today, May 28, 2021 

About the long tentacles of Pharma industry financing for academics, much of which is not revealed even in conflict-of-interest disclosures—another example of the flimsiness of appeals to The Science: “Officially, only two members of the FDA’s advisory committee [on Covid vaccines] reported having conflicts of interest during meetings in late 2020. But, when Thackers looked into each panelist on the Open Payments disclosure website, he found more significant financial conflicts.” If we want to reestablish trust in public health authorities, here’s one place to start.

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Samuel U. Takvorian et al., “A hidden opportunity—Medicaid’s role in supporting equitable access to clinical trials,” New England Journal of Medicine, May 22, 2021 

An interesting detail about why lower-income people are frequently underrepresented in clinical trials: Medicaid wouldn’t reimburse the routine study costs. Now that could change: “Hidden deep within the $2.3 trillion omnibus spending and relief package passed by Congress in December 2020 lies . . . coverage of the ‘routine costs’ associated with clinical trial participation for all Medicaid beneficiaries.” Could reduce the current bias toward white participants in cancer and other clinical trials.

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Justin Haskins & S. T. Karnick, “A free-market alternative to government-controlled health care,” Chicago Tribune, May 10, 2021 

The authors, hostile to both single-payer plans and M4A-lite alternatives, try to address the problems with the current system. Their groundbreaking innovation: “health ownership accounts” through which you save up tax-exempt cash like a retirement IRA to cover any pesky medical bills down the road. Is this Rube Goldberg mechanism—complex and messy enough to attract curiosity from Democrats—the best they can do? Illustrates why the Republicans never bothered to repeal Obamacare because the alternatives would be just as convoluted, nutty, and exasperating as the worst aspects of the ACA. As we saw during the early Trump years, the GOP/industry oppo will stick to denouncing any problems as the Democrats’ fault while making sure the current system remains intact. “Justin Haskins is the director of the Stopping Socialism Project at The Heartland Institute.” A question: who exactly is the intended audience for Mr Stop Socialism’s going-nowhere-fast schemes?  

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Harris Meyer, “FDA weighs approval of a lucrative Alzheimer’s drug, but benefits are iffy,” Kaiser Health News, Jun 4, 2021 

[Update: the FDA did approve it.] The drug (Biogen) doesn’t work, but its owners have powerful friends and can manipulate the approval process at the FDA “despite a near-unanimous rejection of the product by an FDA advisory committee of outside experts.” Contrast with the total white-out on off-patent ivermectin that actually does work (for Covid). Biogen, which experts said will not help Alzheimer’s patients and may harm them, will cost $50K a year. Stand by for the heart-warming TV ads. A patient advocacy group supports the drug but did not mention that it gets a half-million annual subsidy from the drugmaker.

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Fred Schulte, “Humana health plan overcharged Medicare by nearly $200 million, federal audit finds,” Kaiser Health News/NPR, Apr 20, 2021 

A system that incentivizes fraud will generate fraud. This is not hard. For-profit Medicare Advantage plans have infiltrated the Medicare program to the tune of 26 million subscribers, all of whom are potential candidates for upcoded billings. “Medicare Advantage has been the target of multiple government investigations, Department of Justice and whistleblower lawsuits, and Medicare audits that concluded some plans boosted their government payments by exaggerating the severity of illnesses they treated.” One estimate of annual MA fraud: $16 billion. Expect the industry flaks to sputter with rage and then go after the auditors’ budgets—it worked for banking.

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Emily Baumgaertner, “Pfizer-BioNTech, Moderna refused to join WHO’s C-TAP for vaccines. Now the India surge is causing crisis,” Los Angeles Times, Apr 30, 2021 

Because Pfizer and Moderna did not want to share their (government funded) mRNA technology with the world amidst a global health emergency, a single producer in India, the Serum Institute, became the central manufacturer for the AstraZeneca vaccine. “Now facing its own COVID-19 catastrophe, India has all but halted its vaccine exports, leaving dozens of mostly poor countries it supplies in the lurch.” If they had joined the WHO’s plan to share technology, everyone might have a chance to get vaccinated. However, since the federal government owns the patent on some of the companies’ vaccines technology, the White House could force sharing. Only 1 billion of the 11 billion vaccine doses needed in the world have been administered to date.

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Dave Muoio, “In many U.S. cities, most and least racially inclusive hospitals are neighbors, Lown Institute says,” Fierce Healthcare, May 25, 2021 

Our class-stratified healthcare system in a nutshell: “Providers on both ends of the spectrum [high Medicaid percentage v/s low percentage] can be located just a short cab ride away from each other in many cities.” Most segregated hospital cities: Philadelphia, Newark, New York (Manhattan) “with the largest proportion of their total hospitals falling into one extreme or another.” Metropolitan Hospital Center is near Lenox Hill Hospital, “which was ranked 3,163 in terms of inclusivity. Seventy-seven percent of the former’s Medicare patients were people of color versus the latter’s 33%.”

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Sigrid Forberg, “How millennials are driving up health insurance costs for everyone else,” MoneyWise, May 25, 2021 

Surprise—millennials are generally in worse health than Gen Xers, and trends are even more negative. “Compared to the general public, millennials account for a higher percentage of migraines, major depression, asthma, neurodevelopmental disorders, and mental health issues like eating disorders and psychotic disorders.” They tend not to have a primary care physician and so get less preventive care. Therefore, the healthy-youth component of the insurance pool doesn’t exist, and future prices will probably reflect that.

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Daniel Chang & Carol Marbin Miller, “A program promised to pay for brain-damaged infants’ care. Then it sent families to Medicaid instead,” Miami Herald/ProPublica, Jun 1, 2021 

“Florida lawmakers stripped parents of the right to sue over births gone terribly wrong, created a program to cover those claims, made hundreds of millions investing the program’s funds and then offloaded much of the actual costs to Medicaid.” Anyone trying to get reimbursement from the fund first had to exhaust options at Medicaid, get the run-around, prove they had got the run-around, provide doctor’s letters verifying need, and then wait patiently. Beyond perverse. ProPublica, as usual, kicks ass.

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Sachin H. Jain, “Why healthcare needs a civil rights-style movement,” Forbes, May 26, 2021 

“There will come a time in the not-too-distant future when we look back at the healthcare system as it is today with shame and embarrassment. We’ll wonder how anyone got the right kind of care and rue the policy and clinical decisions that have made our system unaffordable, inaccessible, wasteful, and inferior to our peer nations.” In Forbes (!) Righteous, worth reading in full, especially on the propensity in our system to “aggressively intervene when chronic diseases become complicated but do little to prevent or treat those chronic diseases in the first place.”

Posted Jun 1, 2021

Nick Corbishley, “‘I don’t know of a bigger story in the world’ right now than ivermectin,” Naked Capitalism, May 25, 2021

Classic pharmaceutical imperialism: “Because of ivermectin, [best-selling author Michael] Capuzzo says, there are ‘hundreds of thousands, actually millions, of people around the world, from Uttar Pradesh in India to Peru to Brazil, who are living and not dying.’ Yet media outlets have done all they can to ‘debunk’ the notion that [cheap, off-patent] ivermectin may be an effective, easily accessible and affordable treatment for Covid-19.” Total fail of the sacred “present both sides” mantra of mainstream journalism, like the Wuhan lab origin story that was pooh-poohed for months and has suddenly become plausible. A factor: Trump Derangement Syndrome, which dictates that anything Trump said or thought must be scorned. Another: Pharma wants to sell us expensive drugs and will do anything to crush cheap competitors. Caputo had to publish his article in an obscure magazine. Read the whole thing here https://bit.ly/3vt2dYo, and if still not convinced, check out the 17 studies he listed in a peer-reviewed journal article here https://bit.ly/3p86RZh. I have done so: the evidence is overwhelming.

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Carlos del Rio, “Why monoclonal antibody COVID therapies have not lived up to expectations,” Scientific American, May 18, 2021

Contrast with the above: MCAs like Regeneron don’t work very well, but they’re advertised on TV and treated respectfully—because they cost an arm and a leg. The subhead of the Scientific American article: “But they still have a role to play.” So where is The Science?

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Kristina Fiora, “Indian states turn to ivermectin in COVID crisis,” MedPage Today, May 18, 2021

The author can’t resist sniping at the officially unwelcome ivermectin by stating in the lede sentence that “experts warn against” prescribing it—tendentious bias on stilts. There are virtually no cases of adverse events from ivermectin despite billions (with a “b”) doses administered over the years worldwide for a variety of illnesses. An industry reporter trying to give ivermectin an honest treatment would soon have editorial and employment problems.

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Matt Stoller, “Why are there shortages of plastic bags need for vaccine production? Monopolies and patents,” BIG, May 11, 2021

Stoller writes about the problems of monopolization of everything. “The government needs to go on an emergency trust-busting spree using every tool in its arsenal. Waiver and compulsory licensing of monopoly patents throughout the supply chain could potentially address bottlenecks, which is why India and South Africa included the entire supply chain as part of their waiver proposal to the WTO.” Industry roll-ups have left only four major players for these essential inputs.

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Joyce Frieden, “Trust in healthcare system needs rebuilding, internal medicine group says,” MedPage Today, May 24, 2021

“We really are living in a world in which facts themselves—the whole existence of facts—is in dispute,” said Dr Richard Baron. “How do we explain the number of people in the country who are turning away from pretty established science?” Maybe because “pretty established science” has been exposed as highly politicized, commercialized, and untrustworthy?

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Jacob Silverman, “Amazon wants to eat health care next,” New Republic, May 28, 2021

A rundown of the many ways Big Tech is trying to insert its tentacles into the healthcare sector especially via data accumulation and mining. “Fancy artificial intelligence diagnostic tools and online pharmacies have not solved the essential problem of provisioning and accessing care. These initiatives do nothing for a diabetic patient struggling to afford insulin or a new parent drowning under five-figure medical bills.” Asks a provocative question: “If public libraries were proposed now for the first time, how many Democrats would join Republicans in voting against them?”

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Maia Anderson, “Amazon Pharmacy launches new prescription services,” Becker’s Hospital Review, May 13, 2021

The Amazon Prime prescription savings benefit “allows Prime members to search for their medications and compare costs at Amazon Pharmacy and more than 60,000 other retail pharmacies.” And then Amazon can undercut all the sellers to gain market share and drive out the competition—its time-honored business plan.

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Max Nisen & Brian Chappatta, “Jamie Dimon rejoins the health fight Warren Buffett fled,” Bloomberg, May 20, 2021

Buffett knew when to give up; Dimon, “the Sisyphus of health care,” doesn’t. Among Dimon’s proposed policy guideposts: “Empower employees to make better choices through more transparent employer plan pricing” and “create better tools to enable comparison shopping for nonemergency care.” Dimon can’t divorce himself from the idea that healthcare is just another commodities market.

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Joyce Frieden, “Biden’s FY 2022 budget proposal includes lots of healthcare spending,” MedPage Today, May 28, 2021

The proposal contained a variety of healthcare-related initiatives, including hefty sums for the VA, women's health, mental health, suicide prevention, and veterans' homelessness, research (including on opioids and gun violence). Not included: Biden’s campaign promises for a public option and lowering the Medicare enrollment age to 60—though these two measures receive “reiterated support”—meaning rhetorical notice.

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Olivia Goldhill, “Shuttered hospitals, soaring Covid-19 deaths: Rural Black communities lose a lifeline in the century’s worst health crisis,” STAT, May 26, 2021

How rural residents’ lack of nearby hospitals increased the likelihood of late care and death from Covid. Some rural counties’ death rates are triple the statewide average. “The communities affected when rural hospitals closed often have significant Black populations.”

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Laura Sullivan & Huo Jingnan, “Hospitals serving the poor struggled during COVID-19. Wealthy hospitals made millions,” NPR/Frontline, May 18, 2021

The gap between Medicare/Medicaid reimbursement and private insurance payments has grown from 1.50:1 to 2.50:1 in just over a decade, meaning that safety-net hospitals serving people on those programs are falling further and further behind. Then, because Covid assistance went to hospitals in proportion to their revenue, richer hospitals got bigger boosts. Class divisions in healthcare therefore are likely to get worse.

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Eddie Burkhalter, “Report: 38 percent of Alabama COVID deaths tied to insurance coverage gaps,” AL Reporter, Apr 30, 2021

“The report also found that 47% of COVID-19 cases in Alabama were associated with high community rates of uninsured.” In heavily Hispanic DeKalb County, it was worse: 63%. “Community spread is higher in places where more people are uninsured, and lack of insurance falls heavily on people who work in the jobs that we’ve deemed essential. These folks are valuable, but they’re not valued.”

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Luke Muggy, Catherine Cohen & Kristie Gore, “How Biden’s cutting-edge health agency could succeed,” Los Angeles Times, May 24, 2021

The new agency, Advanced Research Projects Agency for Health (ARPA-H), would be modeled on a high-tech outfit at the Pentagon, known as DARPA, which developed the computer mouse and other IT breakthroughs. ARPA-H would pursue cures for Alzheimer’s, cancer, and diabetes. Obama tried to create it but was stymied. Unresolved question: will the results be hived off to for-profit marketers?

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Tara Bannow, “AMA: Most physicians now work outside of private practice,” Modern Healthcare, May 5, 2021

Down from 60% just a decade ago. For doctors under 40, two-thirds are more often employed by hospitals, large medical groups, or private equity. Student debt is a factor. “The volume of private equity deals is tremendous right now.” Costs are likely to rise.

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Jessie Balmert, “Ohio might ax smaller health departments; Officials call it a ‘gut punch,’” Cincinnati Enquirer, May 10, 2021

Covid all done! No need for public health departments!

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David Blumenthal, “Restore a better balance to public-private funding of biomedical research,” STAT, May 20, 2021

There are ways (alternatives to patent monopolies) for the U.S. to reduce drug prices while encouraging innovation and discovery. “Public funding is the primary engine for genuine scientific breakthroughs that industry ultimately brings to market.” So increase it. The author proposes using the savings from getting Medicare to negotiate drug prices to boost NIH R&D spending.

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Mike Ludwig, “Pharma breaks lobbying record defending high drug prices and vaccine patents,” Truthout, May 8, 2021

A 6% increase over 2020, including “a conservative dark money group [American Action Network] that launched a $4 million advertising blitz this week against H.R. 3, legislation backed by House Democrats” that would allow Medicare to negotiate for lower prescription drug prices.

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Jared Golden, “Don’t be fooled by Big Pharma when it comes to lowering drug prices,” Piscataquis Observer, May 16, 2021

Decent column by a Maine congressman that he has to drop in the newspaper of a rural county of 18,000 inhabitants. Pharma ads have a bit more reach.

Posted May 27, 2021

Erin E. Trish, Eugene Lin & Matthew Fiedler, “Congress should end dialysis companies’ third-party games with insurance coverage,” STAT, Apr 29, 2021

What a scam: Dialysis companies donate to the American Kidney Fund, which then pays poor patients’ premiums for private insurance. Then the newly insured patients get their treatments reimbursed at triple the Medicare rate ($10K vs. $3K), and everybody makes out like bandits—except the US government. Total excess rent extraction for the financiers: $7 billion a year. A good example of how a mixed public/private system (“public option”) would be gamed by the corporate players.

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Stephanie Armour, “Democrats lower their sights on healthcare changes,” Wall Street Journal, May 22, 2021

Paywalled but contains this: “Many progressive Democrats and President Biden are facing the political reality that far-reaching healthcare overhauls aren’t likely to succeed in the short term, which means their hopes may rest instead on building on recent Affordable Care Act changes and reducing prescription drug costs.” The statement assumes that “progressive Democrats” and “President Biden” started out in agreement on these things, a fact not in evidence, to say the least.

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Public option fight moves to the states: CONNECTICUT

Jenna Carlesso, “CT public option bill dies after governor threatens veto,” CT Mirror, May 21, 2021

Third year in a row. The industry turned its guns on Connecticut after demolishing any lingering thought that Biden would fulfill his campaign promise on the public option. We SO feel your pain. Cigna had threatened to leave the state if it passed.

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MISSOURI

Jonathan Shorman & Jeanne Kuang, “‘It’s just shocking’: How Missouri Republican politics drove twin crises in Medicaid,” St Louis Post-Dispatch/Kansas City Star, May 23, 2021

Shocking why? Missouri currently outpaces all states in wackadoodle. “For the first time in three decades, legislators failed to approve a Medicaid provider tax that allows Missouri to receive an additional $3 billion in federal funds that are then returned to the providers to care for elderly, disabled and low-income residents. Failure to renew the tax would set the program on the course to financial apocalypse.”

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MISSOURI bis

Tessa Weinberg & Rudi Keller, “Missourians, health care providers pause plans as Medicaid expansion heads to court,” Missouri Independent, May 22, 2021

Continuing ideology-driven punishment of the poor by Missouri Republicans. Voters approved a constitutional change last year to provide Medicaid to single people earning under $17,774 a year. Clearly far too generous—Stop the Steal! Meanwhile, in one rural Missouri county: “It’s been over two years since the only hospital closed its doors in a county where roughly 16 percent of the population was uninsured in 2018.” Nonetheless, 67% of the county’s population voted against Medicaid expansion because local farmers and ranchers “have lived by the code of take care of yourself.” Except that when they need care, they get uncompensated charity treatment and failing hospitals have to absorb the cost.

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FLORIDA

Christine Sexton, “Report points to benefits of Florida Medicaid expansion,” Health News Florida, May 21, 2021

“Florida could add 134,700 jobs, lower the number of uninsured residents by 852,000 and pump billions of additional federal dollars into the economy if it would expand Medicaid to low-income adults without children.” Florida has nearly 10% of the 30 million uninsured people nationwide. The situation illustrates the potent pull of ideology and the importance to the powers that be keeping poor people poor even when improving their lot would benefit everyone.

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WYOMING

Tom Coulter, “New reports highlight benefits of Medicaid expansion for Wyoming workforce,” Wyoming Tribune Eagle, May 23, 2021

“A pair of new studies highlighted the potential benefits that could come to Wyoming workers, as well as the state’s employment numbers, if lawmakers decide to opt into the federal program,” i.e., 1900 new jobs and $100 million in new federal funds (real money in Wyoming). Same as above—we’d rather all suffer to make sure those people get nothing.

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TEXAS

Houston Chronical, “Texas keeps dropping eligible kids from Medicaid. The Senate must fix that” [editorial], May 19, 2021

“Thousands of kids in Texas lose Medicaid coverage every month based on a flawed process that checks for program eligibility several times a year and puts the burden on parents to fix quickly any errors or else see their kids kicked off the program.” The punishment will continue until morale improves!

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PENNSYLVANIA

Ron Southwick, “Pa. Sen. Bob Casey Jr. is pitching a big, expensive plan to help kids. And he’s ready for a fight,” Penn Live, May 24, 2021

Casey is all-in on an ambitious safety-net-improvement program and ready to promote it to dubious Pennsylvanians. It includes expanded Medicaid and Head Start, tax credits for low-income families, and higher taxes on the wealthy. Refreshing to see some Dems veer away from Clinton-era austerity and “ending welfare.”

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KANSAS

John Hanna, “Kansas governor vetoes bill on short-term health insurance,” Associated Press, May 20, 2021

Restraining the cray-cray: junk insurance that take your premiums and then dump you got nixed by an adult governor. Meanwhile, Kansas Republicans hold up Medicaid expansion in the state legislature.

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WISCONSIN

A. J. Bayatpour, “GOP guts Evers’ budget, rejects Medicaid expansion once more,” WKOW, May 6, 2021

More war on Medicaid expansion. “The rejection will deny BadgerCare coverage to about 90,000 Wisconsinites who earn between $17,240 a year for a couple and $26,200 for a family of four.” Wisconsin is the last holdout state in the Midwest.

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CALIFORNIA

Angela Hart, “Salesforce, Google, Facebook. How big tech undermines California’s public health system,” Kaiser Health News, May 6, 2021

No-bid coziness: “California Gov. Gavin Newsom has routinely outsourced life-or-death public health duties to his allies in the private sector. At least 30 tech and health care companies have received lucrative, no-bid government contracts. The vast majority are Newsom supporters and donors who have contributed more than $113 million to his political campaigns and charitable causes since his first run for statewide office in 2010. Newsom’s unprecedented reliance on private companies—including health and technology start-ups—has come at the expense of California’s overtaxed and underfunded public health system.” Many gory details. Meanwhile, “In his first year as governor, the year before the pandemic, Newsom denied a budget request from California’s 61 local public health departments to provide $50 million in state money per year to help rebuild core public health infrastructure, which had been decimated by decades of budget cuts.”

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Brian Maffly, “How BYU scientists struck pharmaceutical gold—and the fight over who keeps the money,” Salt Lake Tribune, May 16, 2021

A tawdry tale of how Pharma discovery jackpots bring out the worst: “Cutting-edge science is nearly always a team effort, but cash and accolades are often reserved for the team captains while behind-the-scenes contributors can go unrecognized.” Do scientists really need the incentive of maybe becoming billionaires to spur their research?

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Reed Abelson, “Buoyed by federal Covid aid, big hospital chains buy up competitors,” New York Times, May 21, 2021

“Billions of dollars in Covid aid cushioned financial losses caused by the pandemic at some of the nation’s largest hospital chains. But those bailouts also helped sustain the big chains’ spending sprees as they expanded even more by scooping up weakened competitors and doctors’ practices.” Meanwhile, “rural hospitals and underserved communities were overwhelmed with Covid patients and struggled to stay afloat.” The Provider Relief Fund totaled $178 billion, i.e., real money. Contains many examples, such as this one: “Tenet Healthcare, a for-profit chain that received more than $500 million in federal aid, announced a $1 billion purchase of 45 ambulatory surgery centers last December.” 

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John E. McDonough, “The tortured sage of America’s least-loved policy idea,” Politico, May 22, 2021

The Obamacare individual mandate designed to compel the purchase of health insurance: “Initially a policy favored by many Republicans and conservatives and reviled by most Democrats, both sides swapped roles during the ACA’s creation between 2008 and 2010.” Now the Supreme Court has to pore over it and decide if it meets constitutional muster. This article is a lengthy thumb-sucker about how sincere monetarist ideologue Stuart Butler was about the benefits of privatizing government services. News flash: if we treated healthcare like a new fighter bomber and financed it through public funds, there would be no need for the Supreme Court to determine how many angels dance on the head of a pin.

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Sigrid Forberg, “Health insurance companies owe refunds to millions of consumers—maybe you?” MoneyWise, May 22, 2021

They made so much money by not providing care during the pandemic that they now have to give some back. Average refund per private insurance customer: a whopping $300.

Posted May 21, 2021

William Wan, “Biden announces $7.4 billion to hire more public health workers amid pandemic,” Washington Post, May 13, 2021

“After decades of chronic underfunding, U.S. public health departments last year showed how ill-equipped they are to carry out basic functions, let alone serve as the last line of defense against the most acute threat to the nation’s health in generations. In the years before the pandemic struck, local public health agencies had lost almost a quarter of their overall workforce since 2008. The agencies’ main source of federal funding — the CDC’s emergency preparedness budget—had been cut 30 percent since 2003.” But California doesn’t need it? See below.

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Angela Hart, “Despite pandemic, Newsome declines to boost local public health budgets—again,” Kaiser Health News, May 20, 2021

“. . . despite a projected budget surplus of $76 billion.” Good way to mobilize supporters against the recall petition from Republicans.  

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Kurt Erickson & Jack Suntrup, “Centene CEO again threatens to leave Missouri, this time over Medicaid expansion,” St Louis Post-Dispatch, May 19, 2021

From Republicans to Trumplicans: How far from being the party of big business have you strayed when a health insurance giant says your state is bonkers? Private management of expanded Medicaid means big new bucks for what used to be the GOP’s best friends. “Calling Missouri an ‘embarrassment,’ [Centene’s CEO] is again threatening to abandon the state for a new corporate headquarters in North Carolina.” Missouri voted for Medicaid expansion in 2020, but the state legislature refuses to cover its 10% of the cost.

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Andy Miller, “Potential seen for big financial paybacks from insurers to Medicaid,” Georgia Health News, May 19, 2021

“Big paybacks,” “best bang for the buck,” “clawbacks”—language not conducive to a focus on optimum care for Georgia’s low-income residents, who collectively generate $4 billion a year in reimbursements for the lucky bidders on the new state contract.

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Kristina Fiore, “Two [Indian] states give anti-parasitic preventatively to large swaths of population despite warnings,” MedPage Today, May 18, 2021

Despite warnings—the medical news establishment continues the warfare against off-patent, cheap ivermectin and downplays the ample evidence that it probably works. Also in sentence #1: “even as experts warn against doing so,” i.e., prescribing it. Doctors, however, are finding that it helps actual patients survive, whatever the Pharma shills say. See companion article below.

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Yves Smith, “Resignation in protest, Frontiers in Pharmacology topic editors, “Treating COVID-19 With Currently Available Drugs,’” Naked Capitalism, May 11, 2021

Research misconduct by a major scientific journal: another sign that the fix is in to prevent word getting out about cheap alternative treatments for Covid while billions are to be made from vaccines. “Discussion of using old off-patent drugs as treatments as treatments is being depicted as crank-dom.” The paper being pushed as “proof” that ivermectin doesn’t work “would be embarrassing for anything other than a paper submitted to a Junior High School Science Fair.”

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Tim Dickinson, “Katie Porter delivers another knockout punch,” Rolling Stone, May 19, 2021

DO NOT MISS the 3-minute video of Porter washing down the Capitol tiles with the CEO of AbbVie and demolishing the “We need billions for R&D” argument. AbbVie spent $2.45 billion on research over five years while dumping $4.7 billion on advertising and gobbling up its own shares with stock buybacks. Porter redefines kicking butt—no wonder they hate her.

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Casey Tolan, “‘There’s no way I can pay for this:’ One of America’s largest hospital chains has been suing thousands of patients during the pandemic,” CNN, May 18, 2021

Endless horror stories of lawsuits against impoverished patients—even from one hospital that no longer exists. (But the bill collection function still does.) “Even as [nursing home employee] Bull was helping send patients to Moberly Regional, the hospital was in the process of suing her and at least one other former employee at the nursing home.” And seizing a portion of the woman’s $850-per-month salary.

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Julia Rock, “After Joe Biden broke his health care pledge, emboldened lobbyists are targeting the states,” Newsweek, May 17, 2021

The public option was quickly dropped once its utility as a counter to M4A was no longer needed. That threat extinguished, the industry can now go after any states trying to fill in the gap, e.g., Colorado and Connecticut, even though the measures are weak tea. “In Colorado, PAHCF Action is smashing state lobbying records by spending millions of dollars to kill its public option proposal. The organization is running a full-scale advocacy campaign, blanketing the television airwaves and filling people's mailboxes with propaganda.” An unfortunate ally: the Service Employees International Union (SEIU) of Colorado, which “argued that the premium-cutting measures in the legislation would lead to layoffs of health care workers at hospitals.” Next target: Nevada, a state with one of the highest uninsured rates in the nation.

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Alice Mirando Ollstein & Susannah Luthi, “Pelosi drug price plan threatened by centrist defections,” Politico, May 11, 2021

For “centrist” or “moderate,” read “bursting with Pharma cash.” “Rep. Scott Peters of California, who hails from a biotech-heavy district in San Diego, led the letter to Pelosi.”

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Alex Kacik, “Employers, payers seek transparent pharmacy benefit models,” Modern Healthcare, Apr 26, 2021

With Biden and the states blocked from action, private actors seek relief wherever they can. “More employers and payers are contracting directly with PBMs, increasingly working with more transparent managers that pass all the drug rebates and discounts to employers and payers for a set fee.” Monopoly control by the top three PBMs is generating rebellion among their victims. Example, “Ohio plans to implement a state-run pharmacy benefit manager this year after a state consultant found that some of the large conglomerates were overcharging the state up to six times the market rate.”

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VACCINES

Dean Baker, “Biden’s big step on TRIPS: Getting the world vaccinated, CEPR, May 6, 2021 https://bit.ly/3hzrQCv

How did it happen: activists and pressure from large, poor states like India and South Africa. “I have been writing on patent and copyright monopolies for a quarter-century. This is the first time I have ever seen IP issues get any substantial amount of attention from a general audience.” So our agitation pays off.

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Matt Stoller, “Joe Biden punches Pharma in the nose,” BIG, May 9, 2021 https://bit.ly/3yu5hp3  

Why the “huge shock”? “First, there was a knock-down drag-out fight across American political institutions,” which gave the Biden team a political opening. But Biden also might have been just a tad worried about new viral strains breaking out requiring new lockdowns. And finally, “vaccine diplomacy”: the U.S. stands to look bad in the eyes of the world while China, Russia, and Cuba offer their jabs everywhere. Stoller compares the significance to Reagan’s 1981 firing of the air traffic controllers, which launched decades of union-busting.

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Karen DeYoung, “Samantha Power wants to restore U.S. prestige by getting American-made vaccines ‘into arms’ around the world,” Washington Post, May 11, 2021 https://wapo.st/3u6CXFW

“By spearheading global vaccine distribution, the United States could beat China at the biggest soft-power contest in generations, regain its reputation as the world’s ‘indispensable’ nation and, not incidentally in Power’s view, do good.” Not incidentally.

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Janine Jackson, “Government money that’s gone into vaccine development is being privatized by a handful of companies,” Fairness & Accuracy in Reporting (FAIR), May 12, 2021 https://bit.ly/3foWqMz

Bill Gates did everything he could to block Biden’s move. “Gates himself has an ideological connection to strong intellectual property rights and privatization of government-funded research. Ever since he was in college, he’s always thought that they were good things, not bad things. I don’t think people realize how radical he is on those views. Even during the height of the AIDS pandemic, when there were very few people getting access to treatment, he was trying to block every effort to expand access to generic HIV drugs, despite the fact that there were probably 9,000 people a day dying from the disease at the time.”

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Ashleigh Furlong, “Big vaccine makers reject offers to help produce more jabs,” Politico, May 14, 2021 https://politi.co/3hWJXmr

“As much of the world remains starved for coronavirus vaccines, a group of companies is offering to partner with larger drugmakers as one way to rev up production. But they're getting the same answer: No thanks. This reluctance to merge forces is even more puzzling given Big Pharma's line that current production capacity is to blame for vaccine under-supply. It’s this reasoning that drugmakers cite to counter arguments in favor of waiving intellectual property for vaccines — a movement that got a jolt last week when the U.S. gave rhetorical support to the idea.”

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Lisa Gillespie, “Is your hospital performing unnecessary tests and procedures?” Modern Healthcare, May 4, 2021 https://bit.ly/33ZrOvQ  

“Many hospital doctors continue to perform unnecessary medical procedures and surgeries every year, according to a new report from the nonpartisan healthcare think tank Lown Institute.” The procedures include major surgeries that brings in revenue but that patients may not need. When reimbursement is the goal, such perverse incentives are inevitable. “The institute found that 64% of all hysterectomies, 44% of carotid endarterectomies and 24% of coronary stent procedures met criteria for overuse.”

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Christopher Quinn, “Georgia veterans’ wait grows for medical appointments,” Atlanta Journal-Constitution, May 5, 2021 https://bit.ly/345tvYN

Recall how privatization was supposed to improve services that bad, useless, government-run services can’t do right? However, “A Veterans Affairs system to quicken access to health care by sending military veterans to private doctors is showing backlogs and strains in Atlanta. The number of North Georgia veterans who had not gotten a response from the Atlanta VA Health Care System more than 30 days after applying for such help ballooned from about 6,700 last September to more than 18,000 in early May.”

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David Dranove & Lawton Robert Burns, “Here’s why local hospitals, not insurance companies, are to blame for exploding healthcare costs,” [opinion], MarketWatch, May 4, 2021 https://on.mktw.net/3hIXZI1

“The lion’s share of the responsibility [for rising costs] belongs with our healthcare providers, whose decisions account for 85% of health spending.” The authors cite monopoly consolidation of hospital systems that “don’t deliver better quality than smaller systems and independent providers; they just get paid more.” Curious that these writers from the business-boosting Kellogg Institute are arguing for antitrust action and stricter regulation of hospital practices. The KI home page describes its mission as “To educate, equip and inspire brave leaders who build strong organizations and wisely leverage the power of markets to create lasting value.” Kellogg graduates are CEOs of 17 Fortune 500 companies.

Posted May 14, 2021

Jenny Dean, “He bought health insurance for emergencies. Then he fell into a $33,601 trap,” ProPublica, May 8, 2021

Not even a PhD from Trump University will save you from the short-term “junk insurance” scam he promoted. “The 2020 congressional investigation found that broker enrollment for short-term plans rose 120% toward the end of 2019 ACA open enrollment, which suggests the marketers were especially aggressive as people searched for coverage. Brokers selling noncompliant plans earned on average a 23% commission on every plan sold. The average commission rate for an ACA-compliant plan was 2%.”

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David Sirota, Walker Bragman & Andrew Perez, “Vaccine waiver pledge tests Biden-world’s Pharma ties,” Daily Poster, May 7, 2021

All the Biden courtiers who have links to drug companies:

• Sec of State Antony Blinken, formerly from WestExec Advisors: clients include Gilead, which lobbied on international trade and protection of intellectual property.

• UN Ambassador Linda Thomas-Greenfield, previously with the [Madeleine] Albright Stonebridge Group, which has represents Pfizer.

• Deputy chief of state Jennifer O’Malley Dillon, formerly of Precision Strategies: clients include Gilead and Pfizer.

• Counselor Steve Ricchetti, formerly lobbyist for Novartis, Eli Lilly, and Sanofi. Brother of lobbyist Jeff Ricchetti, lobbyist for pharmaceutical firm Vaxart.

“In 2000, Biden was one of eight Democratic senators to vote with Republicans against reinstating the government’s ability to compel reasonable pricing for pharmaceutical products developed with federal assistance.”

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Matt Stoller, “Why Joe Biden punched Big Pharma in the nose over Covid vaccines,” BIG, May 9, 2021  

Surprising, given the previous item. “What Biden just did could be as significant as Reagan firing the air traffic controllers in 1981, or Teddy Roosevelt taking on JP Morgan in 1904 over a giant railroad combination. It’s a signal that the American order is changing.” Stoller points out that the continuation of the pandemic via developing countries’ unvaccinated populations will assure that there are new strains that will require everyone to get booster shots. A cynic could say it’s therefore not in Pfizer et al.’s interest to let everyone in the world get a vaccine. Also, interesting background on how forcing an end to anti-competitive uses of patents has a long history in the U.S. and boosted innovation.

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Christopher Rowland, “Pfizer coronavirus vaccine revenue is projected to hit $26 billion in 2021 with production surge,” Washington Post, May 4, 2021

“The biggest-selling pharmaceutical product in the world”—2^nd place: AbbVie’s Hepatitis C drug, Humira, $20 billion. “Both companies have said they expect their vaccines will remain in demand for at least several years as coronavirus variants proliferate around the world [see above] and people require booster shots to maintain immunity after their initial doses.”

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None too soon . . .

Jacob Silverman, “Big Pharma: There’s no easy way out of the vaccine crisis we created,” New Republic, May 6, 2021

“We’re more than 15 months into a pandemic that should have provoked immediate, emergency reforms in health care policy, from providing free government-provisioned care to making sure that new treatments and vaccines would be shared widely around the world. The pandemic has clarified the public’s understanding of our broken health care infrastructure and the system’s fundamental inequities.”

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However, . . .

Melody Schreiber, “There’s something missing from Biden’s move to free the Covid vaccines,” New Republic, May 6, 2021

“Each mRNA vaccine uses more than 100 different patents, owned by a variety of companies, research institutions, and individuals. Moderna might not have enforced the patents it owns, but it can’t free the others upon which the vaccine relies.”

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Nicholas Florko, “Pharma showers Menendez with rare, off-cycle burst of campaign cash,” STAT, May 5, 2021

“A sign of the central role he will play in deciding whether Democrats are able to pass substantial drug pricing reforms this year.”

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Amy Littlefield, “The rise of the corporate-Catholic ‘zombie hospital,’” New Republic, May 4, 2021

“Massive health systems use weak religious affiliations as cover for toxic practices, from unions to reproductive health.” They buy a traditionally Catholic charity unit, long divorced from the religious entities that formed it, and use that to restrict care in the new corporate hybrid. “Many patients and communities are left with massive health care systems that can wield their religious affiliations to limit access to care and skirt laws intended to protect workers, while conveniently overlooking the more than century-long Catholic tradition of support for workers and unions.”

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Natalie Shure, “Nothing exposes the GOP’s cruelty more than its war on Medicaid expansion,” New Republic, May 10, 2021

Medicaid expansion was far more effective than Obamacare’s tinkering with the private market. Naturally, that’s where Republicans dig in their heels to prevent it. Missouri is ground-zero of the ongoing sabotage.

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Nita Schwartz, “Nevada public option best way to tackle rising health care costs,” Reno Gazette Journal [opinion], April 30, 2021

Op eds by physician supporters of health finance reform are a common tactic by advocates. However, the oppo is just as ferocious against public option plans as for single-payer. Her pitch to “compel private health corporations to compete for business through lower premiums, fewer out-of-pocket costs and more services” is a threat to their business model.

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Jennifer Henderson, “Judge orders hospital to give Covid patient ivermectin,” MedPage Today, May 4, 2021

“Despite no evidence of efficacy in the treatment of COVID-19,” starts out the article from a major online health news agency. A false statement parading as objective fact. Amazing how the medical establishment has lined up against this cheap, available drug for which evidence of its potential is at least worthy of dispassionate study. But it offers no opportunities for Big Pharma profits.  

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Nicole Lou, “Industry involvement in clinical trials huge, often downplayed,” MedPage Today, Oct 3, 2018

From 2018, a timely reminder for considering which vaccine or medication is best and the question of “untested” Cuban, Russian, or Chinese versions. “Industry partners had a hand in designing, analyzing, and/or publishing most clinical trials they funded, researchers found, and this was not always disclosed in the final publications.” Also: "We also found that, in some cases, what was described as an independent steering committee in fact involved employees of the industry funder."

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Erin Cunningham & Robyn Dixon, “Brazil rejects Russia’s Sputnik V coronavirus vaccine, citing safety concerns,” Washington Post, Apr 27, 2021

An earlier version of the article included the phrase “in blow to Moscow’s soft power efforts.” America’s rivals can never be shown to do good in the world while the U.S. hoards supplies of vaccine. “U.S. officials pushed Brazil to reject Russia’s coronavirus vaccine, according to HHS report.”

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Gene Dorio, “Advocating restoring the leadership of hospitals by medical professionals, thus reversing the managers’ coup d’etat,” Health Care Renewal, May 2, 2021

Hospital administrators routinely “practice medicine without a license,” which would get you or me arrested. This article outlines the grotesque forms of corruption allowed to flourish in the medical setting as policies are changed to bring in more revenue. “Staff started to leave daily notes on my charts forcing me to discharge patients even though they were not ready to leave the hospital. These notes included a printed statement ‘Not a Part of the Medical Record’ which was removed later by the Medical Records Department erasing hospital culpability.”

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Madelaine Feldman & Jay Salliotte, “Insurers bet big on bribing patients,” MedPage Today, May 11, 2021

Legal bribery as practiced by Pharma, worth a read just for the SMH value. “Currently, pharmaceutical companies are granted a special exemption from kickback laws for the rebates and discounts they pay to PBMs and insurers.”

Posted May 5, 2021

Rachel Cohrs, “Biden called for drug pricing reform this year. But it’s an empty call,” STAT, Apr 28, 2021

After calling for enabling Medicare to negotiate drug prices, “the president snubbed drug pricing policy in his sweeping proposal to reform the social safety net—a move that leaves it out of one of the few policy packages that has a meaningful chance of clearing Congress this year.” Congressional Democrats could overrule him and force the issue. Trump also got nowhere on drug pricing.

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Natalie Shure, “Joe Biden is blowing a big moment for Medicare,” New Republic, Apr 28, 2021

“After winning back the White House and the Senate, Democrats are in a position to achieve the greatest expansion of Medicare since its enactment. Not only is the program wildly popular with the public, it’s also more cost-efficient. With the right approach, an expansion would represent a significant incremental step toward single-payer health care and provide a measurable benefit to a vital political constituency in the process. Significantly expanding the scope of the Medicare program, lowering the age of eligibility for it, and rolling back the profits of the private insurers that leech money and efficiency from the public system writ large, would be the type of incremental step that all of the Democrats participating in the larger health care reform debate could end up commending—and reaping an electoral advantage from.”

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Wendell Potter, “Want a public option? Not so fast, say health insurers,” MedPage Today, May 1, 2021

Insurance companies getting ready to throw everything at even the most modest attempts at disrupting their business model—including the public option. Connecticut is the latest target.

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Julie Appleby, “After accident, patient crashes into $700,000 bill for spine surgery,” Kaiser Health News, Apr 22, 2021

Another form of insurance torture: car insurance kicks in first and has very different payment procedures. “That creates a host of financial landmines for patients.” Just what you need when trying to get your body put back together. Lesson: learn (or get someone to learn) how the policies coordinate, and obtain estimates in writing for non-emergency procedures.

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Susannah Luthi, “Biden faces health industry fight over new ‘surprise’ billing ban,” Politico, Apr 23, 2021

A “lobbying onslaught” is coming to once again halt surprise bills. Rival industry groups (hospitals, doctors, insurers) will battle to shove the costs onto the other guy. “What once appeared to be an easy fix to the problem turned into a two-year slog in the last Congress, after physician staffing groups—in some cases, backed by private equity interests—spent heavily attacking the initial bipartisan framework for ending surprise bills. Hospitals also fought the plan.” Survival tip: when signing hospital consent forms, write in “in-network only.”

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Amy Goldstein, “In the coronavirus relief package, a prescription to expand Medicaid,” Washington Post, Mar 15, 2021

“Our goal in crafting this was to create an offer that was too good [for red states] to refuse,” said Rep. Frank Pallone Jr. (D-NJ), chairman of the House Energy and Commerce Committee—underestimating the ideological allergy among Republicans to government-funded healthcare.

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Kim Chandler, “Medicaid expansion incentives under review,” Associated Press, Mar 22, 2021

In Alabama—the governor made a comment that was less than the usual adamant refusal to even consider it. New beneficiaries could total 300,000 residents.

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Phil McCausland, “Missouri voters passed Medicaid expansion. Now state Republicans may not pay for it,” NBC News, Mar 30, 2021

Silly season in Missouri: The Republican state legislature responds to a referendum victory for Medicaid expansion by cutting $130m from the state Medicaid budget, thus sacrificing $1.4b in federal subsidies. “Because expansion is an amendment to the state constitution, the state will still have to provide those additional 230,000 Missourians with Medicaid coverage — it will just have less money for Medicaid services.”

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Dan Diamond & Jeff Stein, “White House is split over how to vaccinate the world,” Washington Post, Apr 30, 2021

Nutty season on the D side: “Sen. Christopher A. Coons (D-DE), a close ally of Biden, has even invoked the Jan. 6 storming of the Capitol among the reasons to protect patents, saying it revealed the need to unite the country. ‘A central part of being successful in this competition [with China] is continuing with our constitutionally created protected-property right of a patent.’” Gazillionaire pharmaceutical companies will face down the Asian Menace.

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Katie Gallogly-Swan, “Biden, do the right thing and release the vaccines from Pharma’s grip," New Republic, Apr 30, 2021

Excellent rundown of the arguments and phony counter-arguments. “Vaccine inequality has been the biggest failing of the global pandemic response. At the beginning of the pandemic, world leaders lined up to commit to cooperation and solidarity, but this rhetoric quickly unraveled as governments prioritized national efforts—hoarding more vaccines than they need and initiating export controls to keep goods within their territories.”

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Sharon Lerner & Lee Fang, "Factory owners around the world stand ready to manufacture Covid-19 vaccines,” The Intercept, Apr 29, 2021

Contradicts Pharma assertions that there is no idle production capacity standing by to manufacture vaccines were the patents to be lifted. “Factory owners around the globe, from Bangladesh to Canada, have said they stand ready to retrofit facilities and move forward with vaccine production if given the chance.” Four Pinocchios to Bill Gates. “The state of Florida, which has a population of 21.5 million, has now received some 20 million vaccine doses—more than Covax has delivered to all of Africa, which is home to 1.2 billion people.”

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Joseph E. Stiglitz & Lori Wallach, “Preserving intellectual property barriers to covid-19 vaccines is morally wrong and foolish,” Washington Post [opinion], Apr 26, 2021

“Not one vaccine originator has shared technologies with poor countries through the World Health Organization’s voluntary Covid-19 Technology Access Pool. The global Covax program, which aims to vaccinate 20 percent of developing countries’ most vulnerable populations, has delivered about 38 million doses to 100 countries; meanwhile, the United States administers 3 million doses daily.” Poor countries are now projected to achieve mass vaccination only in 2024.

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Kalpana Jain, “India’s Covid-19 catastrophe reflects years of neglecting its health system,” STAT, May 2, 2021

“Over the years, the emphasis moved to for-profit tertiary care hospitals, mainly in big cities, with state-of-the-art that provided care mainly to the urban rich [and medical tourism, a $3 billion/year industry]. Successive governments before Modi’s supported this unplanned growth, paying little heed to the health infrastructure that was underfunded, poorly staffed, and falling apart. A senior politician in the [ruling] Bharatiya Janata party told me in 1999, “Health is a thing for the rich. We in India have to focus on getting bread to the poor.” Eat, then die.

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Bill Hammond, “10 reasons to oppose ‘Albanycare,’” [opinion] Gotham Gazette, Apr 29, 2021

Oppo propaganda: it’s too risky; it’s disruptive; it costs too much; it raises taxes; it has no cost controls; it’s the nanny state again; people will leave; Albany can’t do things right. Expect to hear a lot more of this.  

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Joyce Frieden, “CMS rules for insurers punt on drug copay relief,” MedPage Today, Apr 30, 2021

Another way to drive users crazy: Pharma-awarded medication copay cards don’t count toward your deductible—but no one tells you that. “Patients don't know this is happening, and they’re picking up the drug thinking their copay assistance is counting, and all of a sudden they get stuck with a $1,000 bill.” Essentially, double-billing by insurance, ignored by the Biden Administration.

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Markian Hawryluk, “What a difference a year makes in Colorado’s case for a public option plan,” Kaiser Health News, Apr 29, 2021

Colorado was pushing forward a public option until Covid. Then: “It is much more difficult now that we have this narrative of the health care heroes,” said a Denver-based health advocacy organization that pushed for the public option. The state legislature caved and instead “mandated lower premiums for those buying coverage on the individual or small-group markets”—but with weak enforcement provisions. Interesting detail: polls showed that a “hefty” advertising campaign against the public option did not weaken its popularity.

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Matt Stoller, “Is Biden accidentally giving the green light to mega-mergers?” BIG, Apr 29, 2021

Some encouraging appointments to key antitrust positions have not resulted in tougher enforcement so far. “Last week, the FTC allowed the $39B merger of AstraZeneca-Alexion without any significant probing, much earlier than investors expected. And that’s not the only pharma merger Slaughter has waived through. Investors are already taking these clearances as a signal that it’s business as usual in the merger world.”

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Olivia Webb, “30% of healthcare workers want to leave medicine. Now what?” Acute Condition, Apr 29, 2021

Provider shortages on the horizon as medical personnel quit: “I can’t help but think that the landscape is inevitably rolling towards change. COVID accelerated a lot of things, including the breaking of the existing healthcare system; it was bad before COVID, but—if the above healthcare worker survey is any indication—the damage is accelerated now.”

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Bryan Lowry, “President Biden signs Kansas Republican Marshall’s pharmaceutical bill into law,” Kansas City Star, Apr 24, 2021

Uncontroversial bill, passed by voice vote, is all we can expect in terms of “bipartisan” relief action. The measure “will require that drug products must include an active molecule not previously approved by the FDA to qualify for exclusivity.”

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Nona Tepper, “Humana pays $5.7 billion for remaining share of Kindred At Home, could take business public,” Modern Healthcare, Apr 27, 2021

Insurer Humana moves aggressively into home and hospice care—more consolidation. “Fully integrating Kindred at Home will enable us to more closely align incentives to focus on improving patient outcomes and on reducing the total cost of care,” Humana CEO said in a statement. Humana has 4.4 million Medicare Advantage customers.

Posted Apr 28, 2021

From STAT’s daily digest:

“Biden ducks big health care fight in next legislative push.

“President Biden will give his first speech before a joint session of Congress tonight [28 April], that may be light on health care initiatives. Despite frantic lobbying by Democrats over the past week, Biden will leave several high-profile health care reform policies, including allowing Medicare to negotiate prescription drug prices, out of his next legislative proposal. The only health policy he will include is making permanent increased subsidies for insurance bought on Affordable Care Act exchanges. Senior administration officials said drug pricing reform and is “something he deems urgent.” [But not urgent enough to actually do.]

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Medicins sans Frontieres, “US should stop blocking COVID-19 WTO waiver to boost vaccines, treatments worldwide,” Feb 28, 2021

WTO=World Trade Organisation. This call to waive intellectual property rules, signed by dozens of consumer, faith, health, labor, human rights, development and other civil society groups, is particularly timely given the unfolding catastrophe in India. Of the 9 million vaccine doses available, wealthy nations have locked up half in purchase agreements.

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Ashish K. Jha, “India’s coronavirus surge could collapse its health system. The U.S. can help,” [opinion], Washington Post, Apr 24, 2021

But not by suspending patents via WTO’s TRIPS (Trade-Related Aspects of Intellectual Property Rights). That suggestion is unlikely to emerge from a distinguished senior advisor at the Albright Stonebridge group, headed by former Secretary of State Madeleine Albright, and populated by a bevy of Beltway insiders whose clients include Pfizer and the Gates Foundation. Jha, dean of the Brown University public health school, sticks to low-hanging fruit like “support India’s testing infrastructure” and “send more oxygen.”

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Ed Silverman, “Millions sign petitions urging the U.S. to back a WTO proposal for greater Covid-19 vaccine access,” STAT, Apr 23, 2021

“More than two million petitions were sent to the White House in hopes of convincing the Biden administration to support a proposal that would temporarily waive trade agreement provisions in a bid to widen access to Covid-19 vaccines in low and middle-income countries.” That’s nice, but Bill Gates still gets more votes.

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Brian Schwartz, “The brother of a top Biden advisor lobbied the White House this year on behalf of big health-care companies,” CNBC, Apr 21 2021 

Jeff Ricchetti, the brother of Biden counselor Steve Ricchetti, “lobbied the White House this year on behalf of big health-care companies,” namely GlaxoSmithKline, Horizon Therapeutics, and Vaxart Inc.” But the Ricchettis swear, swear, that they never discuss such things at barbecues. “I have not even mentioned to him the names of clients that I currently represent,” said Brother 1. So we’re good.

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Jake Johnson, “NIH scientist who developed key vaccine technology says patents give US leverage over big Pharma,” Common Dreams, Apr 23, 2021

“Virtually everything that comes out of the government’s research labs is a non-exclusive licensing agreement so that it doesn’t get blocked by any particular company.” The government could “use the threat of litigation of the patent to convince Moderna to share its own patents, trade secrets, and other intellectual property with vaccine manufacturers around the world.” Not if the Ricchetti brothers have anything to do with it, they won’t.

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Kat Lonsdorf, “U.S. pledges medical aid to India, where COVID-19 is overwhelming hospitals,” NPR, Apr 25, 2021

Not including patent relief.

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Lee Fang, “CVS Health quietly made massive donation to dark-money group fighting access to care,” The Intercept, Apr 21 2021

Namely, PAHCF, the Partnership for America’s Health Care Future. CVS owns health insurer Aetna. “The seven-figure donation from CVS is the largest known contribution to PAHCF. Last year, PAHCF swamped voters in Democratic primary states such as South Carolina with ads urging voters to oppose Medicare for All.” Same playbook as 2009: dispatch the M4A/Bernie threat with loose talk about a “public option.” That done, bury the public option, this time adding in attacks on state-based experiments in Colorado, Maine, Montana, Connecticut, Washington, D.C., and Nevada. Other beneficiaries of PAHCF cash: Schumer, McConnell, Third Way, the Congressional Black Caucus Foundation, and the Congressional Hispanic Caucus Institute.

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Waheed M. Shoumann, “Use of ivermectin as a potential chemoprophylaxis for COVID-19 in Egypt: A randomised clinical trial,” Journal of Clinical and Diagnostic Research, Feb 2021

(n=304). “Fifteen contacts (7.4%) developed COVID-19 in the ivermectin arm compared to 59 (58.4%) in the non-intervention arm (p<0.001). Conclusion: ivermectin is suggested to be a promising, effective and safe chemoprophylactic drug in management of COVID-19.” These are very persuasive statistics, but ivermectin was trashed by the FDA and WHO. The trial was conducted in Egypt since no rich-country research outfit seems interested. Could it be related to the fact that Ivermectin costs about $6 a pill retail and will not make billions for any pharmaceutical company? Asking for a friend.

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Liora Engel-Smith, “As NC’s Medicaid managed care transition draws near, consumers express concerns and confusion,” North Carolina Health News, April 8, 2021

“Come July 1, North Carolina’s Medicaid program is being placed into the hands of commercial insurers. The move will change Medicaid, the largest public insurer in the state, into something that looks and acts more like private health insurance.” What could go wrong? The jackpot: around $15 billion in combined state and federal healthcare revenue.

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Ge Bai & David A. Hyman, “Tax exemptions for nonprofit hospitals: It’s time taxpayers get their money’s worth,” STAT, Apr 5, 2021

For-profit hospitals are more generous than “nonprofits” by around 65% but get no benefits for doing so. Originally funded by religious groups and philanthropists to serve the indigent, “nonprofit” hospitals are now huge corporations with lots of “retained earnings.” Big ones in wealthy areas get more benefit from the exemptions than safety-net hospitals. The authors propose that tax and other subsidies be directly tied to real charity care provided, not how hospitals label themselves.

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Darrel Rowland, “As part of revamp, Ohio Medicaid hires watchdog for state-run pharmacy benefits manager,” Columbus Dispatch, Apr 14, 2021

PBMs sucked hundreds of millions out of the state’s healthcare budget, so the (R) governor decided to hire a watchdog overseer and give the pharmacy contract to a state-run entity and toss out the former PBMs entirely. “A Dispatch investigation found that the [now fired] PBMs were directing many prescriptions for the most expensive specialty drugs toward pharmacies owned by the same firms as the PBMs.” Greed finally gets comeuppance—from a Republican governor.

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Joe Malinconico, “Paterson police and firefighters lose health insurance ruling,” Paterson Press, Apr 19, 2021

“At issue was [Mayor] Sayegh administration’s 2018 decision to switch all municipal workers from a costly self-insurance program for employee health coverage to the state benefits plan, a move city officials said saved about $20 million per year.” Pricey union-negotiated health insurance, even for all-powerful cop unions, are on the chopping block. “The appeals court cited Paterson’s ‘distressed financial state’ in its ruling.” Premiums that can’t be paid won’t be paid.

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Sam Mellins, “Health care costs for retired city workers could dramatically increase under city plan,” New York Focus/The City, Apr 21, 2021

The scheme has been hatched in secret negotiations between the Municipal Labor Committee representing city retirees and the de Blasio administration, known for its philanthropic bona fides. The two sides agreed to shave $600 million a year off health care costs; Medicare Advantage plans managed by private insurers will see to that. “Contract-related documents made public by the city Office of Labor Relations suggest an increase of as much as $6,000 annually in potential out-of-pocket costs per retiree could be in store”—instead of the current cap of about $1,000.

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Debbie Hart, “We can find a fair way to price drugs that will help seniors and people of color,” [Opinion], [NJ] Star-Ledger, Apr 20, 2021

Oppo columns like this one by a biotech company CEO are popping up with increasingly frequency to combat state-led efforts to rein in drug prices. Expect to hear relentless use of the word fair, as in this title.

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Joe Lonsdale, “FTC’s challenge to Illumina’s vertical merger with Grail is all wrong,” STAT, Apr 20, 2021

Another oppo column, this one by an author who is “an investor in one of Grail’s competitors that has a short-term financial interest in supporting the FTC’s decision to block the merger.” He appeals to heart-rending stories of people in need of treatment, which supposedly can only be provided by massive, vertically integrated, for-profit corporations. “The threat to American innovation is simply too great to remain silent.” Innovation is another key word, as in “If you deprive us of our vast profits, Science will be destroyed.”

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Travis Whitfill, “To create value, pharma companies should prioritize innovation, not shareholders," STAT, Apr 23, 2021

Pharma companies should stop buying back their own shares to boost stock prices and executive compensation. The buybacks have totaled over $300 billion in the last decade.  

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Phil McCausland, “Medical debt is engulfing more people as pandemic takes its toll,” NBC News, Apr 23, 2021

Newest victims: Covid patients whose lingering symptoms aren’t covered by emergency relief measures. “The number of people with past due medical debt grew by nearly 9 percent, from 19.6 million to 21.4 million. A survey found that 60 percent of Americans who were polled faced medical debt.” More than half.

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Julie Appleby, “Time to say goodbye to some insurers’ waivers for Covid treatment fees,” Kaiser Health News, Apr 26, 2021

Insurers voluntarily waived Covid-related deductibles and copays—voluntarily being the key word. Avoiding a legal mandate means they can now unwaive them. “Setting aside those fees was a good move from a public relations standpoint. The industry got credit for helping customers during tough times.” But “the initial step not to charge treatment fees may have preempted any effort by the federal government to mandate it.” Only testing and vaccination are mandated to be no-cost by federal statute.

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Lee Fang, “Pharmaceutical industry dispatches army of lobbyists to block generic Covid-19 vaccines,” The Intercept, Apr 23, 2021 https://bit.ly/3aLaWwS

Lead voices among the 100 lobbyists mobilized against easing the IP rules: Sen. Thom Tillis (R-NC) and Howard Dean, the former Vermont governor and Democratic National Committee chair. Biden has not taken a position yet.

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Beth Mole, “Contractor that ruined 15M doses of J&J vaccine is holding up vaccine to India,” Ars Technica, Apr 27, 2021

“About 10 million AstraZeneca doses already made in the US are ensnared in the problems of Emergent BioSolutions, the contract vaccine manufacturer notorious for ruining 15 million doses of Johnson & Johnson’s COVID-19 vaccine. No doses of AstraZeneca’s vaccine can be shipped out of the US to any other country until they meet the FDA’s quality standards.” The same outfit is being investigated for scoring a huge federal contract via links to Trump & friends, “despite a long track record of failings and persistent quality-control problems.”

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Fun facts from Forbes: New York state now has 125 billionaires. Of those 125, only 19 lost money during the global pandemic. Michael Bloomberg's wealth increased by $11 billion in the past year to $59 billion. Julia Koch & Family saw their fortune(s) rise from $38 billion to $46 billion in a year. Chanel owner Alain Werthmeier saw his $17 billion double to $34 billion. The total number of billionaires nationwide is now 2,755, up from 2,095 a year ago; 328 of them are women. Their total net worth is $13 trillion, up $8 trillion (160%) from last year. Jeff Bezos is now worth $177 billion, $64 billion more than in 2019. If he were a country, he would be #53 in the world by GDP.

Posted Apr 21, 2021

Caitlin Owens, “Democrats, led by Biden, are aiming big on health care,” Axios, Apr 13, 2021

“Big” in this case means more ACA premium subsidies, somehow getting expanded Medicaid into red states, and the infrastructure plan that includes boosting home care. However, attempts to actually fulfill Biden’s campaign promises, says the author, would cause the fight with the industry to “go nuclear.”

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Julia Rock, “Biden’s inaction moves health care right to states,” Daily Poster, Apr 19, 2021

Biden’s healthcare proposal during the 2020 campaign was a nationwide public insurance option as the steady-as-you-go, moderate road to universal coverage, just like M4A only better—more realistic, pragmatic, less disruptive. Where is all that now? So far, more billions funneled to private insurers through increased ACA subsidies. Meanwhile, some states (WA, CO, CT, OR) have stepped up to fill in the gaps—though not very well: The first to set up a public option was the state of Washington. “But so far, enrollment has only reached about 1 percent of the population, largely because the program does not require hospitals to accept the insurance and most have chosen not to.” Washington also left administration of the public option to for-profit insurers. Pragmatism!

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So what is happening in the other states? A partial rollcall:

WISCONSIN

A. J. Bayatpour, “Rejection of Medicaid expansion costs WI $1.6 billion,” WKOW [Madison, Wisconsin], Mar 19, 2021

Despite getting federal dollars for 90% of the costs of covering those just above the poverty line, Wisconsin Republicans shoot expansion down regularly because its “welfare.” The fact that 200,000 newly unemployed residents of the state had to scramble post-Covid for new insurance didn’t move them.

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MICHIGAN/WISCONSIN

Michael Ollove, “Biden revokes Medicaid work requirements in 2 more states,” Stateline/Pew, Apr 7, 2021

Work requirements do nothing to increase employment for Medicaid beneficiaries. But surely some punishment is surely necessary to exclude the unworthy poor and to avoid “dependency on public assistance [Verma]”! Most people on Medicaid already work—for poverty wages.

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IDAHO

Keith Ridler, “Senate committee kills Idaho Medicaid expansion bill that would have required recipients to work,” Associated Press, Mar 27, 2021

A federal judge’s decision to toss work requirements for Medicaid in two other states buried the Idaho measure. Red state politicians insist on linking health care with proving you want to have a job. Where that’s been tried, the result is confusion, bureaucratic obstacles, and handy excuses to deny treatment. Idaho voters approved Medicaid expansion in 2020.

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MICHIGAN

Top & Viral, “Michigan Blues to pay $100-$125 million to settle national antitrust lawsuit,” Mar 22, 2021

Blue Cross was accused of overcharging through suppressing the competition. Total settlement is $2.67 billion—this is just Michigan’s portion. (Lawyers will get $800 million.) One million plaintiffs were part of the lawsuit; Blue Cross has 100 million enrollees.

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ARKANSAS

Associated Press, “Arkansas lawmakers approve overhaul of Medicaid expansion,” Mar 30, 2021

They now “encourage” beneficiaries to work instead of requiring them to prove worthiness. Those who don’t can get moved over to traditional Medicaid rather than the state’s government-funded, privately-owned program. But they won’t be automatically dropped as before.

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MISSOURI

Kansas City Star [editorial], “Missouri Republicans defy voters’ will on Medicaid expansion,” Mar 31, 2021

“The competition for the looniest argument against expanding Medicaid in Missouri was stiff Tuesday, but state Rep. Justin Hill, a Republican, took the prize. Hill wandered away from the outer edges of sanity some time ago. ‘Even though my constituents voted for this lie, I’m going to protect them,’ he said.” Or as Brecht famously quipped: “Would it not be simpler if the government simply dissolved the people and elected another?” Hill also joined the gang at the Capitol on Jan. 6. Missourians voted for Medicaid expansion in August 2020.

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MISSOURI bis

Kurt Erickson, “After rejecting Medicaid expansion, Missouri Republicans look to spend cash elsewhere,” St Louis Post-Dispatch, Apr 7, 2021

The $1 billion set aside for Medicaid expansion instead will to other social programs. The state is flush due to extra billions in federal aid over the past year, “giving [Gov] Parson’s administration a robust cushion heading into the next fiscal year.” The vote to expand Medicaid won with large majorities in urban (minority) areas while rural (white) Missouri voted it down.

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WYOMING

Bob Beck, “Medicaid expansion fails again,” Wyoming Public Radio, Mar 31, 2021

Republican lawmakers claim that government funding could be yanked away once the program is established. So would they support a permanent, federally-funded, universal program?

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INDIANA

Phil Galewitz, “Indiana’s Medicaid expansion, designed by Pence and Verma, panned in federal report,” Kaiser Health News, Apr 1, 2021

Verma was brought from Indiana to DC as head of Centers for Medicare & Medicaid Services by Pence (a former IN governor). The two of them earlier had introduced “personal responsibility” into their version of expanded Medicaid. Enrollees paid monthly premiums and created health savings accounts. Shocking news: their complex and punitive program “proved no better at improving health and access to care than other state expansions.” The damning report was ready a year ago but held up by CMS while Trump extended Indiana’s Medicaid waiver for another 10 years—instead of the usual 3-year renewal. Republicans favor “skin in the game” approaches for people before they can merit medical attention. “About half of enrollees pay only $1 a month” because they have so little income, so why bother?

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VIRGINIA

Cameron Jones, “Virginia expands Medicaid access for legal immigrants,” Capital News Service, Apr 14, 2021

Eliminates the “40-quarter” rule that requires Social Security and Medicare beneficiaries to have 10 years paying into the system to qualify for benefits. Recent immigrants can’t meet it.

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OKLAHOMA

Carmen Forman, “Oklahoma lawmaker introduces bill to rival Gov. Kevin Stitt's Medicaid overhaul,” Oklahoman, Apr 8, 2021

Governor wants insurance companies to manage $2 billion in Oklahoma Medicaid spending. “Privatized managed care is an approach to health insurance coverage that seeks to maximize health care quality while cutting costs.” What could go wrong?

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TEXAS

Jeremy Blackman, “Biden administration rescinds billions in Medicaid funding for Texas,” Houston Chronicle, Apr 16, 2021

Texas refuses to expand Medicaid, so the feds may have found a way to make that decision sting. The 20% uninsured rate in Texas is the highest in the country. Congress offered the state an additional $3 billion for the expansion, which so far has been refused.

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Jennifer Henderson, “Redfield joins ventilation company,” MedPage Today, April 14, 2021

Ex-CDC director Redfield, like former colleague Deborah Birx, parlayed his notoriety into a private-sector gig. The company, Big Ass Fans [sic], sells its fan for $9,450 each. “There’s no other way to say it—it’s completely unproven whether these devices would work in a real-world setting,” said Timothy Bertram, PhD, a chemistry professor at the University of Wisconsin-Madison. Not The Onion.

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Alexander Zaitchik, “How Bill Gates impeded global access to Covid vaccines,” New Republic, April 12, 2021

“Gates acted fast to stop the push for sharing the knowledge needed to make the products—the know-how, the data, the cell lines, the tech transfer, the transparency that is critically important in a dozen ways.” With his billions, Gates virtually owns WHO at this point. (One source in the article says, “Gates can get you fired from a UN job.”) Now, herd immunity worldwide won’t arrive before 2024 at the earliest.

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Kate Aronoff, “Let other countries copy the Covid vaccines,” New Republic, Apr 15, 2021

“Just 1 percent of Africans have been vaccinated, compared with 36 percent of North Americans and 22 percent of Europeans. As long as large populations remain unvaccinated, the virus will keep evolving, raising the likelihood that variants will emerge against which current vaccines are less effective.”

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Dalindyebo Shabalala, “How to get COVID-19 vaccines to poor countries—and still keep patent benefits for drugmakers,” The Conversation, Apr 14, 2021

Compulsory licensing is an alternative to waiving patent rights. Pharma hates that, too.

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Yves Smith, “The CDC’s VAERS and vaccine complications: The system is broken,” Naked Capitalism, Apr 19, 2021

The authors are not anti-vaxxers. They raise the alarm about the government’s adverse event reporting system (VAERS) and suggest that there is too much rah-rah about vaccines and not enough straight talk about problems. They call for fewer “noble lies” that assume we’re too immature to handle the facts. “There was a time when our federal medical folks would have this kind of situation [blood clot reports] front and center and some kind of messaging to the physicians of America of what would we should be on the lookout for—and what we can do to treat. So far NOTHING. This is now all about protecting Big Pharma and the money machine.” Adds the doctor, “The VAERS system is currently reporting over 3000 deaths related to the Pfizer and Moderna COVID vaccines. VAERS was never a system meant to be perfectly accurate—but having a 100-200X difference in mortality rates [versus the flu vaccines] should be attention-getting to everyone in medicine.” He mentions that his own report of a post-vaccine death to VAERS was ignored.

Posted Apr 13, 2021

Ed Mahon & Ese Olumhense, “A huge spike in Medicaid enrollment in Pennsylvania shows how devastating the coronavirus has been,” Morning Call/Spotlight PA, Mar 22, 2021

Medicaid enrollment in PA is up 13.7% in a year. “More families in the region are becoming homeless, sleeping in tents and cars. Many others need help getting food.” Conservatives hate increasing the proportion of the population who get their healthcare through government programs. And Pennsylvanians who go back to work are protected from losing their Medicaid due to earning too much—thanks to “a policy that began under former President Donald Trump.” (!) Details about how complex, tedious, and bureaucratic it is to get either Medicaid or sign up on the ACA exchange.

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Lauren Weber, “How one state’s public health defunding led to vaccination chaos,” Kaiser Health News, Mar 26, 2021

“The state bypassed its 115 local health departments in its initial vaccine rollout plans. Instead, state officials largely outsourced the work to hospitals, consultants and federal programs. Meanwhile, local health departments and federally qualified health centers, which typically reach the most vulnerable populations not connected to traditional health systems, were each initially left to divvy up about 8% of the state’s vaccine supply.” Result: “Only 9.9% of Black Missourians are vaccinated, as opposed to 18.3% of white Missourians.” So the system is working as designed. Meanwhile, “No one is wearing masks in the [state] Capitol.”

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Rebecca Kolins Givan, “Single payer health care is having its moment, one vaccine at a time” [opinion], Newsweek, Apr 9, 2021

“After vaccination, you can snap a selfie, take a picture of your vaccination card and continue on your way. You don't have to worry about a co-pay, or a confusing ‘explanation of benefits’ statement, or a denial of benefits or even a bill. Like the best of socialized health care, the vaccine, paid for by general taxation, is free at the point of use and comes without a mountain of paperwork.” People could get ideas.

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Ryan Basen, “Big healthcare companies paid no income taxes,” MedPage Today, Apr 7, 2021

“Three healthcare entities—Community Health Systems, Dexcom, and Hologic—reported receiving federal rebates in 2020 rather than making a net payment of federal corporate income taxes. Community Health Systems reported pre-tax income of $323 million, yet received a $1-million rebate. Dexcom reported a net $0 in taxes on $265 million in income. Hologic received $87 million back despite $887 million in income.”

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Jennifer Henderson, “Anesthesiology group squeezed ‘like a boa constrictor’ sues insurer,” MedPage Today, April 6, 2021

Battle of the Titans: giant provider network enters the arena against giant insurer. Giant hospitals wave from the stands. “USAP stated in each complaint that the alleged scheme has involved bribing in-network surgeons with new contracts that provide incentives—such as about 50% more compensation—in exchange for their commitment to steer patients away from USAP.”

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Jennifer Henderson, “Stripped of hospital privileges, St. Louis cardiologists go to court,” MedPage Today, Apr 2, 2021

“St. Louis Heart and Vascular claims it was unexpectedly notified by SSM Health in January that the health system had entered into an exclusive agreement with another provider for adult cardiovascular services. St. Louis Heart and Vascular has seen patients at SSM Health facilities for decades.” Thirty-five thousand patients (the product) could be affected. Looks like reporter Henderson has a fulltime gig tracking the rentier wars.

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Natalie Shure, “The labor-rights legislation that could make Medicare for All a reality,” New Republic, Apr 6, 2021

“By securing the legal framework for a resurgent, militant labor movement, the PRO Act could bring staggeringly ambitious demands like Medicare for All within our collective reach.” The author argues that union membership makes people more politically engaged, which seems a bit of a stretch to M4A. “Labor’s ambivalence about Medicare for All illustrates this dynamic: While many unions have officially endorsed or even campaigned for it, others have been hesitant to back a policy that would involve them giving up health care coverage for which their members have bargained.”

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J. David McSwane, “Documents show Trump officials skirted rules to reward politically connected and untested firms with huge pandemic contracts,” ProPublica, Mar 31

Details of vast fraud, which is surprising because . . . Without indictments will anything be done about it aside from a damning report that no one will read? Which of those named will discover the word “embarrassment” in their dictionaries?

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Arpan Patel, “Elegant analysis sheds light on high-risk groups at risk for financial toxicity,” MedPage Today, April 9, 2021

Wow, it’s a full-fledged pathology! However, “financial toxicity” should not be confused with actual biological toxicity. The article summarizes a medical journal report showing that those suffering from FT had an 8.75 times higher likelihood of going off their cancer meds and 13 fewer months of survival time. Amazing to read epi terms like AHR (adjusted hazard ratio) applied to a category of insurance coverage, complete with the appropriate confidence intervals.

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Lubab al-Quraishi, “Foreign-trained doctors like me were asked to help fight Covid-19. Now we’re being tossed aside,” STAT, Apr 9, 2021

An Iraqi physician, whose country the U.S. destroyed, now works as a pathologist’s assistant after a stint at a New Jersey Popeye’s. She took over treating patients in high-risk nursing homes last year when other providers didn’t want to. But that emergency authorization expired. Before: “After graduating ninth in my class of 300 at Baghdad College of Medicine, I worked as a licensed pathologist for a decade in Iraq’s capital city. My family and I had to flee when death squads tried to kill us.” After: “I’ve come to realize that in America, medical licensing is a business. It’s all about money.”

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Lee Fang, “Howard Dean pushes Biden to oppose generic Covid-19 vaccines for developing countries,” The Intercept, Apr 8 2021

Progressive hero Dean now shilling for the pharmaceutical industry with rhetoric straight out of their PR manual: “Companies would never invest hundreds of millions in research and development if rivals could simply copy their drug formulas and create knockoffs.” Fang: “Dean has reversed his positions on virtually every major progressive health policy issue since moving to work in the world of corporate influence peddling. He sorts of pops up whenever you argue against anything that would lower drug prices.” Sad.

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Amanda D’Ambrosio, “One-fifth of Americans give to medical crowdfunding campaigns,” MedPage Today, Apr 2, 2021

Now if we could just convince people that a single-payer plan with universal coverage is kinda like a mega-GoFundMe with fixed donations. “Nearly 40% of people who donated to a medical crowdfunding campaign were from households with annual income less than $60,000.” A third of them were unemployed.

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Scott Terry, “Misinformation, propaganda and dark money are fueling Universal Healthcare’s newest enemy—a ‘personal’ option being lobbied for by Charles Koch and his PAC, Americans for Prosperity,” Tarbell, Mar 29, 2021

The Koch front is lobbying intensively for a “personal option” (to combat the “public option,” get it? so clever). It will involve tax credits, health savings accounts, and other lame tinkerings. The Kochoids, quiet on this issue during Trump, will be back in force now to head off any (unlikely) effort by Biden to actually push his 2020 platform centerpiece.

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Mohana Ravindranath & Susannah Luthi, “Pharmacies score customer data in vaccine effort. Some are crying foul,” Politico, Apr 3, 2021

How might pharmacies use our vaccine data to boost profits? Force us to create user accounts at their chains; trick people into pharmacy “loyalty” programs that then generate marketing texts and emails; send us coupons for flu shots or checkups; aggregate our data into large sets that will give them crucial commercial information about populations. “CVS chief officer Jon Roberts described the company’s ‘opportunity with the vaccines’ to convert newcomers into long-term customers, starting with the 15 minutes patients are supposed to wait in the store after receiving a Covid shot. During that observation period, store employees could try to sell patients on the company’s MinuteClinics for regular health care visits and CarePass, its paid pharmacy membership service.”

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Christopher Rowland, “CEO at troubled vaccine plant received 51 percent compensation boost in 2020,” Washington Post, Apr 10, 2021

Failure is not an obstacle. “Emergent BioSolutions ruined 15 million doses of Johnson & Johnson vaccine this year and has caused delays in delivery of shots to states.” So clearly you deserve a raise to $5.6 million!

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Dean Baker, “Patents and the pandemic: Can we learn anything?” Patreon, Apr 11, 2021

According to Betteridge’s Law, no. “Given the enormous costs associated with a vaccine resistant strain, we should be doing everything possible to get the whole world vaccinated as quickly possible. We clearly are not going this route as the U.S. and other wealthy countries insist on maintaining patent protections, as well as doing nothing to ensure that the technologies needed to manufacture vaccines are made widely available, instead of being kept as industrial secrets.” Also debunks the rah-rah over the vaccines’ development as proof of Pharma R&D wondrousness.

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Erin Brodwin, “Google is exploring a health record tool for patients,” STAT, Apr 9, 2021

Google wants your medical records. What could go wrong?

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Dina Bass, Liana Baker & Kiel Porter, “Microsoft makes big bet on health-care AI technology with Nuance,” Bloomberg, Apr 11, 2021

Nuance Communications brought us Siri and has been working with Microsoft for two years “on AI software that helps clinicians capture patient discussions and integrate them into electronic health records.” In the Soviet Union, people passed each other notes back and forth to avoid the microphones.

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Brian Alexander, “If you think the health care industry is unhealthy now, just wait till Amazon gets in deeper” [opinion], Boston Globe, April 4, 2021

What to look forward to: “a landscape of regional or national oligopolies in which doctors, local hospitals, labs, and pharmacies are owned by distant corporations.” You ask for a doctor appointment and get a starter Zoom call with a triage nurse. The consolidation is already well advanced; Amazonization is the logical next step.

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Adrian N. Billings & Janice Blanchard, “COVID-19 has revealed weaknesses in rural care that need long-term solutions” [opinion], Dallas Morning News, Apr 11, 2021

“Our health system is not equipped to vaccinate rural communities” where 20% of Americans live and are now relying on the emergency mobilization of the National Guard. “Eighty percent of rural counties do not have adequate numbers of providers, and many have none at all.” Not a new problem, but one that is unsolvable under a market framework.

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Katie Adams, “Bristol Myers Squibb pays $75M to resolve claims it underpaid rebates to Medicaid,” Becker’s Hospital Review, Apr 5, 2021

Cost-of-doing-business wrist-slap. Not only are there no criminal charges, the DoJ announcement states: “The claims resolved by the settlement are allegations only; there has been no determination of liability.” Cheat, get caught, pay a fine; rinse and repeat.

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Steve Bousquet, “Vaccines for votes: DeSantis’ shot-in-the-arm strategy,” South Florida Sun-Sentinel, Feb 19, 2021

Vaccines-for-votes, a perfect illustration of everything. The Florida governor personally delivers vaccines straight to his politically friendly territory and cuts out the poor and nonwhite (where Covid rates are higher). “This week, DeSantis’ pop-up politics took him to 34211 and 34202, two affluent zip codes that include the high-end gated communities of Lakewood Ranch in Manatee County, near Sarasota. Those getting the needle were 65 and over, white and wealthy.” This has become so normal that it probably won’t hurt him.

Posted Apr 6, 2021

Many of the following authors recognize major problems in our current system. Their solutions are remarkably marginal.

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Anupam B. Jena, “To really lower health-care costs, look beyond prescription drugs” [opinion], Washington Post, Feb 16, 2021

Why do drug costs get special attention? asks this academic. Because we deal with their costs more directly than with those of hospitals or doctors and don’t get to do cost comparison. Since we can’t shop for hospitals and doctors quite as well as we do for drugs, we don’t know how to get more bang for our buck. Ergo, we need more data! Amazing to read an entire essay on healthcare costs in a major newspaper by a Harvard expert with not one reference to how we pay for care or medications.

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Marian W. Wentworth, “Covid-19 could bring a new era of public health leadership. But will it?” STAT, Mar 5, 2021

Five recommendations: Strengthen national public health institutions; create more health data managers; hire more community health workers; convince the private sector to take a bigger stake in public health; restore trust. Not a word on financing models. Wentworth is “president and CEO of Management Sciences for Health,” a $125 million operation with board members from academia, the medical device industry, a bank, and Planned Parenthood.

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David Nash, “Swan song for traditional employer-sponsored health insurance?” MedPage Today, Mar 30, 2021

Yet another non-answer to the rolling train wreck of employer-based insurance: “workplace health centers.” Because mergers throughout the healthcare industry are making health insurance unaffordable, says Dr Nash, let’s shift to an “employer-healthcare joint venture—in essence, make the employers responsible not only for financing the health services but providing them. What could go wrong? “Under this model, employers from multiple companies collaborate in not-for-profit alliances to take advantage of combined marketing power, yet each maintains its own system and corporate culture.” Sounds exactly like the big innovation attempted by the Amazon-Berkshire Hathaway-JPMorganChase alliance, which totally flopped. Nash is an academic and editor of a prestigious journal. Expert diagnoses like his are so accurate, and the yet the remedies they offer remain so lame. Physicians, heal thyselves!

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David Callender, “How Texans can work together to solve the health care cost equation” [opinion], Houston Chronicle, Feb 12, 2021

“An estimated 37 percent of Harris County residents under age 65 are currently without health insurance.” Add another 10% who have lost their employer-based coverage under Covid. The author, a safety-net hospital president, endorses Medicaid expansion but also worries about ever-rising costs, noting that “price increases of 80 percent or more are common across many different classes of drugs” and that “the cost of medical supplies and devices, such as stents, artificial joints and pacemakers, is nearly surpassing hospitals’ staffing costs.” No mention of changing the payment modality or how that might affect cost inflation.

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Elisabeth Rosenthal, “The Trump health care policies that deserve to stick around” [opinion], New York Times, Mar 16, 2021

The author, a fan of M4A, reminds the Biden team of four measures from the Trump years that were positive: required hospitals to reveal their standard prices (though there is no enforcement mechanism); ordered drug-makers to list prices in their ads; authorized imports from Canada; paved the way for limiting Medicare’s drug costs to prices paid in other rich countries.

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Robert E. Moffit, “Washington can no longer ignore the coming Medicare crisis” [opinion], Chicago Tribune, Mar 4, 2021

Koch-funded think-tank panty-twisting over Medicare’s alleged “insolvency.” Deficit doomsayers will be back in force now that tax cuts for billionaires are off the table.

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American College of Physicians [internists]: “Time to re-emphasize ethical foundation of medicine,” MedPage Today, Mar 15, 2021

Warnings about the private equity invasion. “Today, changing practice dynamics place greater focus on the business aspects of medicine.” You don’t say! Maybe it’s because private equity firms “typically take a large stake in the practice, invest in it to increase market share and revenue, take actions to decrease costs, and sell the practice within a few years to generate returns for investors.” Why on earth would such innocent behavior endanger ethical practices? In the crosshairs: practices in dermatology, radiology, and ophthalmology.

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Madlen Davies, Ivan Ruiz, Jill Langlois & Rosa Furneaux, “‘Held to ransom’: Pfizer plays hardball in Covid-19 vaccine negotiations with Latin American countries,” Bureau of Investigative Journalism/STAT, Feb 23, 2021

Pfizer has “asked some countries to put up sovereign assets, such as embassy buildings and military bases, as a guarantee against the cost of any future legal cases.” Sounds like the way the EU stripped Greece bare of everything. (The Parthenon marbles were already long gone.) When countries contract for Chinese, Russian, or Cuban vaccines, we’ll know why.

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David E. Mitchell, “Taxpayers fund research and drug companies make a fortune” [opinion], New York Times, Mar 24, 2021

“I worry about the day where the vaccine will no longer be free,” said the new head of the CDC. As well she should: the shots’ owners could jack up the price to whatever they want once the pandemic “ends”—as defined by whom? Pfizer’s chief noted that “normal” vaccine prices are $150-175, not the 20 bucks they get now.

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Iain MacLeod, “Do the math: Vaccines alone won’t get us out of this pandemic,” STAT, Feb. 10, 2021

Does the math. Demonstrates why achieving “herd immunity” is unrealistic for a good while. Instead, “it’s time to start looking to reinforce all aspects of the health care response as we concede that Covid-19 will become an endemic disease that will continue to lurk in the population.”

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Scott W. Stern, “A rust belt city’s new working class,” New Republic, Mar 31, 2021

Review of The next shift: The fall of industry and the rise of health care in rust belt America, by Gabriel Winant, about how Pittsburgh’s heavy industry was replaced by the health business. “By the time I was finishing high school, Pittsburgh was back. Everyone said so. Former mills and shuttered factories converted into upscale shopping centers; biotech companies, startups, and cool new restaurants dotted the cityscape; affluent hipsters were moving back from those greener pastures.” The health care sector replaced manufacturing as the region’s principal industry. But that’s not the whole story. “The industrial jobs wrought havoc on workers’ bodies, prematurely stooping them or poisoning them over time; the decline of these jobs wrought further havoc on the workers’ mental health. As steel jobs fell, health care jobs rose, with more and more workers needed to care for the aging, suffering former industrial laborers, especially as neoliberalism dismantled community institutions and punctured the social safety net. Yet while the steel jobs had been unionized and often provided enough to support an entire family, the health care jobs are largely low-wage and excluded from numerous labor protections.” Read the whole article; better yet, let’s get the book.

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Adam Feuerstein, Meg Tirrell & Damian Garde, “An antitrust expert weighs in on the FTC’s complaint against Illumina,” STAT, Apr 2, 2021

If the FTC is taking antitrust action, the case must be egregious. Illumina is a “$56 billion titan of genomics [that] has become the world’s leading supplier of DNA sequencing technology.” Now it wants to acquire a cancer testing company that relies on its own tech—classic vertical integration that enables a company to crush competition.

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John Connolly, “We all agree hospital consolidation needs more oversight,” MedPage Today, Apr 4, 2021

Argues that Becerra could find common cause with Republicans in opposing hospital consolidation. Becerra fought California’s Sutter Health on antitrust grounds.

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Alex Kacid, “Hospitals’ Medicare billing practices suggest upcoding, OIG says,” Modern Healthcare, Feb 25, 2021

Patients aren’t actually sicker, but coders are cleverer. “The number of inpatient stays billed at the highest severity codes increased nearly 20% from fiscal year 2014 through the 2019 fiscal year” even though the average length of stay decreased. Hospitals are sometimes fined small amounts for “inappropriate” billing, but the practice is too lucrative to end without drastic government action. It has even spawned the creation of “revenue cycle specialists” to game the system.

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Andy Miller, “Federal antitrust scrutiny revealed in wake of Navicent-Houston merger collapse,” Georgia Health News, Mar 4, 2021

Another sign of increased FTC militancy on hospital mergers. The proposed partners called off the deal after FTC review that found likelihood of “significant harm to central Georgia patients and businesses.”

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Foo Yun Chee, “EU regulators team up with U.S. and UK on pharmaceutical mergers,” Reuters, Mar 16, 2021

More signs of antitrust agitation, this time aimed at Pharma. The new partners of the EU’s antitrust office: Federal Trade Commission (FTC), the Canadian Competition Bureau, Britain’s Competition and Markets Authority and the U.S. Department of Justice.

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Adriana Belmonte, “About 46 million Americans can’t afford quality health care, according to Gallup,” Yahoo News, Apr 1, 2021

Very different from the 5% “uninsured” rate that you hear about in NY State (n=3,753). 46 million people = 18% of the population. A quarter of all fundraisers on GoFundMe are for medical costs.

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Katie Adams, “36% of Americans forgo medications to pay for essentials, survey says,” Becker’s Hospital Review, Feb 15, 2021

Including 21% of Caucasian respondents and 47% of everyone else (n=1728). Forty-one percent overall have “skipped or altered medication doses to make their prescription last longer.”

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Paige Minemyer, “COVID-19 costs, care deferrals came back to bite insurers in Q4 2020,” Fierce Healthcare, Feb 22, 2021

People are catching up with procedures and diagnoses deferred during the Covid emergency. But while insurer profits “fell short of expectations” in Q4, looks like they’ll be okay. “Despite the challenges in the quarter, these payers were all profitable for full-year 2020. UnitedHealth Group led the way in 2020 profits, bringing in $15.4 billion.”

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Mark Kreidler, “California’s counties revolt against Blue Shield’s vaccination role,” Capital & Main, Mar 16, 2021

Excellent tale of a rare victory, “a broad-scale revolt against the idea of health industry giant Blue Shield of California controlling the statewide [vaccination] process.” Counties rebelled and won. One particular beef: Blue Shield’s request for an “expansive scope of access to patient data.” The insurer, a major donor to the governor’s campaigns, was tossed out by “health officials who were (and remain) convinced that they, not the corporate entity, knew best how to distribute doses in their areas.”

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Molly Rutherford, “Kentuckians shouldn’t have middlemen raising the price of their healthcare,” Lexington Herald Leader,” Mar 11, 2021

An “independent physician” correctly identifies PBMs as unnecessary “middlemen” but doesn’t want to acknowledge the obvious parallel with for-profit health insurance. Also peddles the right-wing attack on the whole idea of an insurance pool that covers everyone: Healthy young people “shouldn’t be forced to pay for coverage they don’t need.” The article’s interest is how she uses a progressive policy left over from Trump to attack Biden from the left in the service of maintaining the overall status quo.

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David Lenihan, “Debt from attending an elite medical school shouldn’t keep new doctors from working in underserved areas,” STAT, Feb 3, 2021

Average student debt for medical doctors at private schools: $215,000. Then off to rural Appalachia to serve the needy! Not. Average time to pay it off: 13 years. A loan forgiveness program from the Federal Government sounded great until the rules were changed mid-stream (under Obama).

Posted Mar 30, 2021

“In the American system of health care, you are not a consumer. You are not a customer. You are the product.” –Dr. Abdul El-Sayed

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Nurses’ Campaign for Medicare for All, “What’s next in the fight for Medicare for All?” March 2021

“Our job as a movement is to keep organizing locally, district by district, to pressure more members of Congress—particularly the Democrats who still don’t support Medicare for All and sit on key committees.” The nurses are targeting 19 of them [listed in the attachment below]. They are also exposing and targeting campaign cash from M4A opponents like Partnership for America’s Health Care Future.

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Daniel McGraw, “Joe Biden just fixed Obamacare’s ‘subsidy cliff,’” The Bulwark, Mar 24, 2021

Define “fixed”! The cutoff point for federal subsidy assistance to meet one’s insurance premiums is called “one of Obamacare’s lingering problems.” And this is a surprise because . . . The huge costs of marketplace policies made compulsory insurance virtually unusable for middle-income families. Now, instead of the “public option” that Biden promised during the campaign (to head off enthusiasm for M4A), we get increased bonuses for private insurers. Republicans are likely to not fight too hard over it while complaining about deficits and how relatively well-off people are getting handouts: “A family of four with an income of $120,000 will save about $7,000 a year.” The “savings” will be made up by U.S. Treasury payments to Aetna et al.

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Chris Mamula, “The new COVID relief bill has slashed Obamacare health insurance premiums—that’s good news for early retirees,” MarketWatch, Mar 23, 2021

Probably good electoral politics, too—at a hefty price. Caveat: “This new legislation is in effect for only two years. There will be a midterm election then. The political winds may shift again.”

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Noam N. Levey, “Democrats gave Americans a big boost buying health insurance. It didn’t come cheap,” Kaiser Health News, Mar 24, 2021

“Health care researchers consider this move a short-term fix for a long-term crisis, one that avoids confronting an uncomfortable truth: The only clear path to expanding health insurance remains yet more government subsidies for commercial health plans, which are the most costly form of coverage.” The government will shell out next year “more than $8,500 for every American who gets a subsidized health plan through insurance marketplaces created by the ACA, up 40% from the cost of the marketplace subsidies in 2020.” And this is before the deductibles.

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Jessie Hellmann, “Health care industry groups back ObamaCare reforms proposed by Democrats,” The Hill, Feb 10, 2021

Insurance, doctors, and hospitals unite behind Biden’s plans to “build on” the ACA. Note the disappearance of the public option that the “moderates,” including Biden, were all over during last year’s campaign. Same playbook as 2009: first, dispatch M4A “in favor” of the public option alternative; then, wipe away the public option in favor of an industry-friendly partial measure; finally, emit pious phrases such as the following: “While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable health care market that provides access to high-quality care and affordable coverage for all.” That boilerplate was co-signed by America’s Health Insurance Plans (AHIP), the American Hospital Association, the American Medical Association, and the U.S. Chamber of Commerce.

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Lanhee J. Chen, Tom Church & Daniel L. Heil, “A public option for health insurance could be a disaster, especially in times of crisis,” STAT, Feb 11, 2021

Just in case anyone missed the converging consensus among the mainstream and the big industry players, here come the right-wing think tanks to shoot the public option in the neck.

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Harris Meyer, “As drug prices keep rising, state lawmakers propose tough new bills to curb them,” Kaiser Health News, Feb 12, 2021

“Fed up with a lack of federal action to lower prescription drug costs,” state legislators are kicking around their own ideas. Among those taking steps: Hawaii, Maine, North Dakota, Oklahoma, Rhode Island, Colorado, Florida, Maryland, Massachusetts, and Washington. Contender for worst offender: AbbVie’s blockbuster Humira for rheumatoid arthritis, which sells for 80% less in Europe where competitor drugs are on the market. 

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John Ingold, “To fix soaring prescription costs, Colorado lawmakers have a new plan: A board to cap drug prices,” Colorado Sun, Mar 17, 2021

States are acting while the Federal Government is paralyzed. “The board will have the authority to set maximum prices that can be charged in Colorado for those drugs deemed unaffordable. No other state in the nation currently has a board that does that.” Yet.

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Sarah Ganz, “Prescription-drug prices keep rising in the pandemic. Yet public opinion of the pharma industry is soaring too,” Philadelphia Inquirer, Mar 18, 2021

“Prior to the coronavirus pandemic, tackling the high cost of prescription medication was a rare unifying cause for Republicans and Democrats.” But the latest poll shows positive opinions of drug companies rose from 32% to 62% in the last year.

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Helaine Olen, “Opinion: Bernie Sanders wants to remind you the pharmaceutical industry is still ripping Americans off,” [opinion] Washington Post, Mar 24, 2021

Despite Pharma’s glowing rep post-vaccine, Sanders is pushing three actions to stop price-gouging: enabling Medicare to negotiate prices; pegging prices to international standards; and authorizing imports from Canada and elsewhere. No other country lets Pharma decide how much government money it should have.

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Bruce Schreiner, “Beshear [KY governor] signs bill to cap out-of-pocket insulin costs,” Associated Press, Mar 22, 2021

Limits insulin costs to $1 a day for people on state-regulated health plans. Down from $1000 a month for some residents now. Vote was unanimous.

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Bossier Press-Tribune [Louisiana], “Senate passes two pieces of Cassidy legislation to lower prescription costs,” March 11, 2021  

Closes a loophole “to prevent awarding market exclusivity to products that do not represent true innovation and unduly delay cheaper generics from entering the market.” Interesting that Republicans are eager to take credit for reining in the pharmaceutical companies.

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Chris Christie, “Governor’s [OH] plan will ‘substantially’ lower prescription drug costs,” [opinion] Columbus Dispatch, Mar 22, 2021

Christie tries to stay relevant by publishing fawning columns in out-of-state newspapers about other Republicans. Everyone is piling on to the issue of “solutions” for out-of-control drug prices.

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Julie Calley & Abdullah Hammoud, “Bipartisan legislation would lower prescription drug cost,” [opinion], Detroit Free Press, Mar 22, 2021

Two state representatives in Michigan on their bill to expose the workings of the PBMs.

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Bob Herman, “Centene’s CEO made $59 million in pandemic year,” Axios, Mar 4, 2021

A tidy 50% increase for CEO Michael Neidorff who exercised stock options while laying off 6% of his workforce “in an effort to increase profits”—in his own words.

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Kris Tripplaar, “Ohio sues Centene over millions in alleged pharmacy benefits overcharges,” Modern Healthcare, Mar 11, 2021

“By contracting with multiple sister companies, [Attorney-General] Yost alleged that Centene filed reimbursement requests for amounts already paid by third parties, artificially inflated drug dispensing fees and didn’t accurately disclose the true cost of its pharmacy services.” The state A-G accuses Centene of “conspiracy to obtain Medicaid payments through deceptive means.” If found guilty, Centene will pay a fine.

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Douglas MacMillan & Kevin Schaul, “Congress questions drug companies on opioid settlement tax deductions,” Washington Post, Mar 4, 2021

Should the drug companies that together paid $26 billion to settle claims over the opioid debacle get to deduct the fines from their taxes? Immoral but not illegal. To avoid this sort of cynicism, next time indict individuals rather than corporate structures.

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Lachlan Markay, “Former aides to new Biden Cabinet members cash in,” Axios, Mar 24, 2021

“On Tuesday, within days of Xavier Becerra's confirmation as secretary of Health and Human Services, lobbying firm Ferox Strategies announced it had hired his former chief of staff. Debra Dixon, who led Becerra's House office, registered to represent three new clients for the firm, including pharmaceutical company Eli Lilly.” My boss and I “share the same values,” said Dixon. Good to know.

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Christina Jewett & Lauren Weber, “Birx joins air-cleaning industry amid land grab for billions in federal Covid relief,” Kaiser Health News, Mar 24, 2021

Birx, one of faces of The Science under Trump, joins ActivePure Technology, formerly the Electrolux vacuum company, “one of many in a footrace to capture some of the $193 billion in federal funding to schools.” Though not everyone agrees that the company’s technology works, Birx’s presence should guarantee hefty sales, and she knows how to stand quietly by when people make outrageous claims.

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Marian W. Wentworth, “Covid-19 could bring a new era of public health leadership. But will it?” STAT, Mar 5, 2021

STAT’s shoulds: strengthen national health systems; improve data management and sharing; boost the community health workforce; give a “bigger stake” to the private sector; “restore trust.” Not a word about changing the payment model—unsurprising for a medical reporting outfit that depends upon the industry for its daily bread. Betteridge’s Law of Headlines states: “Any headline that ends in a question mark can be answered by the word no.”

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Melinda B. Buntin & Kristine Martin Anderson, “The pandemic slingshot: Propelling from national crisis to a resilient health care system,” STAT, Feb 22, 2021

Another thumb-sucker about all the innovations that took place during the pandemic with no mention of healthcare finance despite Buntin’s job as a professor of “health economics” at Vanderbilt.

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David Wallace-Wells, “How the West lost Covid,” New York, Mar 15, 2021

Speculation on whether the West could have halted Covid as occurred in Taiwan and Australia and whether “pandemic Orientalism” reigned in our national discourse. “For decades, the richest nations of the world had told themselves a story in which wealth and medical superiority offered, if not total immunity from disease, then certainly a guarantee against pandemics, regarded as a premodern residue of the underdeveloped world. That arrogance has made the coronavirus not just a staggering but an ironic plague. Invulnerability was a myth, of course, but what the pandemic revealed was much worse than just average levels of susceptibility and weakness. It was these countries that suffered most, died most, flailed most.” Interesting details and a corrective to the Fauci myth, plus an analytical distinction between the clinical and the public health perspective.

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Joyce Frieden, “U.S. drug prices should be lowered—but how?” MedPage Today, Mar 23, 2021

A review of the different approaches to reining in Pharma: Bernie (enable Medicare to negotiate) vs. GOP (“innovation”). Another proposal: stop patent abuse, e.g., by requiring head-to-head testing of drugs touted as “new, improved” versions.

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Nisarg Patel, Daniel Liebman & Smitha Ganeshan, “If we want to defeat Covid, we need to boost Medicaid," Politico, Feb 8, 2021

“Medicaid is more important now than ever but also at its most vulnerable. Its enrollment and spending increase during economic downturns, meaning that just when it’s needed most, states may be forced to slash Medicaid spending.” Like Cuomo tried to do even before Covid.

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Robert P. Kocher, Soleil Shah & Amol S. Navathe, “Overcoming the market dominance of hospitals,” JAMA, Feb 19, 2021

Paywalled but ask me if you want to read the whole thing. “Hospital consolidation in the past decade has not improved quality. Additionally, legal limitations have weakened the ability of the Federal Trade Commission (FTC) to enforce antitrust rules on nonprofit hospitals, even though these hospitals are involved in most hospital and health system mergers.” In one 18-month period, hospitals acquired “8,000 medical practices, and 14,000 physicians left private practice to become employed by hospitals.”

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Gaby Galvin, “About 7 in 10 voters favor a public health insurance option. Medicare for All remains polarizing," Morning Consult, Mar 24, 2021

68% of voters (Ds 80%, Rs 56%) support a public health insurance option. “The pandemic has exposed all of the holes in our existing health care safety net and how fragile our employer-based system is, but it doesn’t seem to be that the higher level of awareness is translating into support for Medicare for All.” Not with mainstream Dems attacking it. Support for the public option is always promoted when M4A is a threat; once that’s over, the public option will be attacked instead.

Posted Mar 22, 2021

HEALTHCARE FINANCING

Dean Baker, “The big Biden move on health care and making Medicare for All affordable,” Patreon, Mar 16, 2021

Long-form discussion of the boost to ACA subsidies in the Covid relief bill, including the 8%-of-income cap for insurance premiums. The move temporarily makes insurance more affordable for more people at the cost of more billions going into for-profit coffers. One perhaps unintended side-effect: “Employers are likely also in many cases to stop offering insurance to effectively share the savings with their workers.” Further weakening of employer-based insurance is good, and the cost pressures will make arguments for M4A stronger.

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Ryan Grim (podcast & transcript), "Medicare for All just got a massive boost,” The Intercept, Mar 19, 2021

The reintroduced M4A bill now is co-sponsored by a major Dem hierarch who also will hold hearings on it as chair of the House Energy and Commerce Committee. The bill’s author, Pramila Jaypal, has some interesting comments in this interview about the legislative process and its utility for educating members on the fence. Also includes an interesting discussion with the author of a new book on what is changing for doctors: “It’s no coincidence that the median doctor now believes in single-payer health care. Young doctors know that they have been victimized by the system that has been victimizing patients for decades now.”

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Lanhee J. Chen & James C. Capretta, “We can improve health care. It just takes compromise,” New York Times, Jan 26, 2021

How do Mr. Chen (Hoover Institution) and Mr. Capretta (American Enterprise Institute) suggest we go about it? By “setting aside ideological ambitions”! Bipartisan solutions that Republicans will sign off on are the way to go, i.e., keep things mostly as they are and boost free-market solutions such as convoluted improvements to healthcare shopping since “consumers often have little incentive to find lower-priced options.” Those pesky heart attacks.

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Gerald Friedman & Travis Campbell, “Medicare expansion is a discount compared to Obamacare,” The Hill [opinion], Feb 2, 2021

The authors address runaway healthcare costs and insist that Medicare, “which has a scale and simplicity that allow the administrative efficiency and market power needed,” is the solution. “Every person who moves from private health insurance to Medicare lowers our national health care bill.”

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Donald R. Frey, “The Haven debacle shows the need to adopt Medicare for All,” Omaha World-Herald, Mar 4, 2021

More on the gigantic flop of the Amazon-Berkshire Hathaway-JP Morgan Chase experiment: “To date, there’s been no evidence of meaningful innovation [from Haven]. Advocates of market-based health care are now scratching their heads. If three of America’s most successful business leaders can’t solve our country’s health care cost dilemma, who can?” Gee, I dunno. “If we continue to just nibble incrementally around the edges of our health care crisis, we should expect our results to be no different than those of Haven.”

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David Engel et al., “Fraud is rampant in Medicare Advantage,” MedPage Today, Mar 13, 2021

“Can a patient have and not have diabetes at the same time? According to private insurers participating in the Medicare Advantage program, the answer is yes.” The scam of upcoding and downcoding to increase reimbursements and reduce payouts.

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Alexandra Ellerbeck & Paige Winfield Cunningham, “Hospitals drag feet on new regulations to disclose costs of medical services,” Washington Post, Jan 25, 2021

“Hospital compliance is spotty.” Will anyone enforce the new law? Some hospitals “only posted price estimates, uploaded files in difficult to use formats, or promised to release information only after someone inputs their insurance.” Fines are $300 a day—couch lint.

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Dominique Vervoort, “Meet the law office leeching off the pandemic,” MedPage Today, Mar 15, 2021

How hospitals “got lured into the business of suing their patients after caring for them.” In Virginia, 36% of hospitals garnish wages. However, bad publicity often makes them scramble to stop the practice.

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VACCINES

Alex Pareene, “Most of the world has a simple vaccine request. America isn’t listening,” New Republic, Mar 15, 2021

The request: the right to manufacture their own vaccines. The block: insistence on patent rights amidst a worldwide health emergency. Principal backer of patent rights: saintly Bill Gates. “When our corporate press talks about international vaccine production and distribution, it tends to treat the existing intellectual property regime as sacrosanct—almost akin to an immutable natural law—and not something imposed on the rest of the world largely by the U.S.” 

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Jerri-Lynn Scofield, “Indian vaccine manufacturers: U.S. use of wartime export controls threatens world vaccines production,” Naked Capitalism, Mar 15, 2021

In normal times, India produces over half of all vaccines in the world, but the Defense Production Act is causing shortages of intermediate goods (aside from the patent issue). Isn’t it curious how the U.S. can act as a single healthcare authority when defending multinational corporations and their profits but wouldn’t dream of doing the same to actually deliver health care?

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Jake Johnson, “‘Disturbing’: Rich nations vaccinating person per second while blocking effort to share recipe with poor countries,” Common Dreams, Mar 14, 2021

“Vaccine apartheid”—rich countries quickly vaccinate, everyone else will wait two or three years. How long will it take for a variant to develop in, say, Nigeria that ends up restarting the whole thing?

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Lee Fang, “Drugmakers promise investors they’ll soon hike Covid-19 vaccine prices,” The Intercept, Mar 18, 2021

Pfizer, Moderna, and Johnson & Johnson pledged affordable vaccines—but only during the “pandemic.” Once that is officially over, says Frank D’Amelio, CFO of Pfizer, “we think there’s a significant opportunity for our vaccine from a demand perspective, from a pricing perspective.” English translation: we can make a mint. Pfizer expects to bank a profit of $4 billion this year on sales of $15 billion; total U.S. government spending on vaccines: $18 billion. One obstacle: the “optics” of raiding the public purse.

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DRUG PRICING

Bobbi Sheldon, “State releases next step in plan to import prescription drugs from Canada,” 9News/NBC, Jan 25, 2021

States struggle to find ways to curb drug costs as the Federal Government remains crippled by industry lobbies.

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Max Richtman, “With a new president and a new Congress, it's time for Medicare drug price negotiation,” The Hill [opinion], Jan 20, 2021

Reviews the rich rhetoric and poor performance of Congress on drug pricing. The author is “president and CEO of the National Committee to Preserve Social Security and Medicare.”

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Madison Black, “Why are insulin prices going up? Chuck Grassley explains it,” PolitiFact, Feb 2, 2021

Insulin costs twice as much now as it did less than a decade ago. Grassley (R-Iowa) has been denouncing it for years, blames PBMs, pharmacies, and drug companies. Would Grassley break ranks with fellow Rs to allow Medicare to negotiate drug prices? No evidence for that so far.

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CUOMO/NURSING HOMES

Sidney Madden, Braeden Waddell & Yanqi Xu, “Industry lobbying left nursing homes vulnerable,” North Carolina Health News, Mar 7, 2021

“The long-term care industry has long used its political influence to push against reforms that would have increased staffing requirements, training, transparency and oversight. Now, the industry is pushing for—and in some states, successfully passing—legislation to shield nursing home owners from lawsuits during the pandemic.” They learned from Cuomo.

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Cheryl Clark, “Why 130,000 nursing home patients died of COVID-19,” MedPage Today, Mar 18, 2021

Minimum wage workers “were so short-staffed at the facility in Greenville, Rhode Island, they had to choose which of their dying patients needed care first.” But when the company (Genesis) got a government bailout, it awarded its outgoing CEO a $5.2-million-dollar bonus.

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Caroline Lewis, “Cuomo pushes cuts to safety-net hospitals after they stepped up during pandemic,” Gothamist, Mar 17, 2021

No good deed goes unpunished. “The state Health Department routinely seeks to close, shrink, or merge safety-net hospitals that are losing money, which often reduces the capacity for patients. These strategies are left over from a Pataki-era task force on hospitals known as the Berger Commission, whose policies have contributed to the loss of 20,000 hospital beds across the state over the last 20 years.” Bipartisanship! Good detail on various hospitals in our area.

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Joe Sexton, “Cuomo’s nursing home scandal raises questions for one of his senior aides,” ProPublica, Mar 10, 2021

“Jim Malatras stood by a Cuomo administration report on nursing home deaths he knew undercounted the true loss of life. Today, he is chancellor of New York State’s public university system.” Failing up.

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David Scales & Devin Worster, “This fertilizer king funneled Cuomo $1 million—and got a New York health-care empire,” Daily Beast, Mar 9, 2021

Brutal must-read of the week. “He’s an international man of mystery—a reclusive billionaire who once bought a lower Manhattan skyscraper in cash. He’s cut multimillion-dollar business deals with now-sanctioned figures in Russian autocrat Vladimir Putin’s circle. And thanks in part to Gov. Andrew Cuomo and his administration, he was left in charge of the health and well-being of thousands of poor and elderly New Yorkers throughout the COVID-19 pandemic.” Who needs public health “experts”? “The vast domain Rovt built with his state contracts, grants, and approvals were the scene of some of the [Covid] outbreak’s worst carnage.”

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Dalia Faheid, “Undocumented immigrants sought far less health care after Trump launched his campaign, new study shows,” STAT, March 22, 2021

As predicted: a 34.5% fall in adult primary care visits and 43.3% for children’s. Ideal for pandemic control, of course.

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The Oregonian/AP, “Oregon Senate wants voters to make health care a fundamental human right,” Mar 18, 2021

The state may vote on a constitutional amendment to that effect.

Posted Mar 15, 2021

Emmarie Huetteman, “Pandemic aid package includes some relief from high health plan premiums,” Kaiser Health News/NPR, Mar 9, 2021

The Covid relief bill’s changes will help some people, like Stephanie Salazar-Rodriguez of Denver, who was facing more than $10,000 in health insurance premiums this year and will now get a subsidy for $7000 of that. The Federal Government will pay the difference though Stephanie’s insurance company will still decide when (and if) she gets treatment. Since the Biden wing won’t contemplate the sweeping changes required of a truly universal plan, they can only tinker with the clunky rules governing Obamacare to make them less clunky. “Republicans hammered Democrats over the years that many of the marketplace plans are not affordable”—correctly! The changes are only temporary and will have to be refought to become permanent.

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Michael Ollove, "Biden aims to build on Obamacare’s cost-cutting measures,” PEW/Stateline, Mar 8, 2021

Biden’s proposals to reduce costs: the public option, price negotiations by Medicare (currently prohibited), blocking further hospital consolidation, outlawing surprise medical billing, and more “transparency.” Obamacare slowed growth in per capita health spending, in part by cutting Medicare reimbursement rates and generating incentives for insurance companies “to negotiate better [lower] reimbursement rates with medical providers.”

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Hadley Heath Manning, “Biden’s slow creep toward ‘Medicare for all,’” Washington Examiner, Feb 12, 2021

From your lips to God’s ear. . . A right-wing paranoid fantasia—unfortunately. The author’s key metric: the number of Americans who depend on the government to pay for their healthcare, now 138 million or 44% of the population, which “makes reforming these entitlement programs politically difficult.” The author argues that halfway measures like the ACA are relentless steps along the slippery slope to M4A rather than ways to keep healthcare in private hands while the government pays. “It’s almost as if the remaining large insurers are simply competing for the government contract to manage a single-payer program, whenever that might one day be enacted, likely as a response to ‘dwindling market competition.’” Hope she’s right!

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Andrew Perez, “Dems’ gift to health insurance predators,” Daily Poster, Feb 24, 2021

Here’s a completely different view: “Democrats want to pay billions to put Americans on expensive corporate health insurance plans rather than expand Medicare or create a public option.” Complains that the Covid relief bill only temporarily lowers premiums, doesn’t stop out-of-pocket copayments and deductibles, and pushes people onto the exchanges for expensive plans in which “one in six in-network medical claims were denied in 2019.” Still uninsured: 28 million.

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Los Angeles Times, “Congress wants to make health insurance more affordable — but only for some, and only temporarily” [Editorial], Mar 9, 2021 

“Combined with steadily rising deductibles, high premiums have been one of the biggest challenges not just for the ACA but for the entire U.S. healthcare system. Higher subsidies are a straightforward response to the growing costs, but they’re the equivalent of a pill that treats the symptoms without curing the disease.”

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Wendell Potter, “COVID bill is a windfall for health insurance companies,” Tarbell, Mar 10, 2021

Potter: “No one will be more excited about the new COVID-19 package than my old friends in the corporate insurance industry.” Increased premium subsidies will funnel $48 billion of federal funds to them, “after their most profitable year to date.”

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Rachel Cohrs, “With the ear of Joe Manchin, West Virginia hospitals helped secure billions in new Covid relief funds,” STAT, Mar 9, 2021

An $8 billion payoff to secure the 51^st vote on the Biden relief package. A top beneficiary: WVU Health System, which “overtook Walmart in 2016 to become the state’s single largest private employer.” At least for once it wasn’t the consolidated urban hospital systems getting all the loot.

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Washington Post [Editorial], “Congress just brought the country closer to universal health-care coverage,” Mar 14, 2021

Another sunny view: the Covid relief bill has “a major down payment on Mr. Biden’s promise to build on Obamacare and move the nation closer to universal coverage without excessive cost or disruption.” How will this work? More Medicaid expansion (take that, Hadley Heath!) and higher subsidies for those purchasing marketplace plans. Getting more people into the insurance pools will drive premium costs down, and “the whole system will be more stable.” Sounds great, albeit magical. Democrat plans always include intricately complex eligibility requirements rather than across-the-board universal benefits.

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Noam N. Levey, “Why Biden has a chance to cut deals with red state holdouts on Medicaid,” California Healthline, Feb 17, 2021

“The opportunity emerges as the covid-19 pandemic saps state budgets and strains safety nets. That may help break the Medicaid deadlock in some of the 12 states that have rejected federal funding.” Among those shut out of Medicaid due to state refusals: 1.5 million low-income Texans and another 800K Floridians.

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Michael Ollove, “Wyoming edges closer to Medicaid expansion,” PEW/Stateline, March 9, 2021

“Buried in President Joe Biden’s COVID-19 relief bill is a provision intended to entice 12 holdout states to extend health coverage to more low-income adults by expanding Medicaid under the Affordable Care Act. The strategy appears to be working.” Another hold-out state inches closer to Medicaid expansion. Statewide budget shortfalls are a powerful incentive.

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Alex Pareene, “Why are troops leading the vaccination effort?” New Republic, Mar 2, 2021

“America’s armed forces are stepping in for the dismantled state.” Other activities being handled by the National Guard’s “coronavirus missions”: food banks, testing sites, processing unemployment benefits, handing out PPE. “In other words, the National Guard was simply doing various essential tasks the pandemic revealed our state was too broken to handle. The military is state-building in the U.S.”

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Joanne Kenen, Adam Cancryn & Darius Tahir, “Biden vaccine website pledge invokes the ghosts of Obamacare,” Politico, Mar 12, 2021

The co-director of this ambitious IT rollout? Jeff Zients, leader of the Obamacare HealthCare.gov website. What could go wrong? OTOH, improving on the states’ performance won’t be hard.

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Rachel Cohrs, “Andrew Cuomo’s Covid-19 nursing home fiasco shows the ethical perils of pandemic policymaking,” STAT, Feb. 26, 2021

Cuomo would not have been faulted for hasty decisions amid an emergency, but he made two fatal errors: he pushed everyone else aside so that he could be the sole owner of state policy (and the limelight), thus making himself solely responsible for mistakes. Second, he exploited that power to obscure public health data for personal gain. 

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Steve Cohen, “Instead of prior authorization, insurers should go back to the old ‘pay-and-chase’ model,” STAT, Mar 11, 2021

“The news Jennifer G. and her husband got from her medical team was devastating. If you had come to us a month sooner, they said, we would have used chemotherapy to treat your cancer. But because of the delay, we have to amputate your leg, your hip, and your pelvis.” Horror tales of prior authorization and automatic denials. “Doctors report that 20% of patients always or often abandon the treatment their doctors have recommended while awaiting authorization; and another 55% sometimes do.” How innovative!

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Ed Silverman, “‘Deeply problematic’: AmerisourceBergen rewards its CEO despite the ravages of the opioid crisis,” STAT, Mar 11, 2021

Because the company “excludes the costs of legal settlements in evaluating executives,” it set aside a tiny detail in calculating the top guy’s bonus: the $6.6 billion fine the firm paid for its role in tens of thousands of deaths from drug overdoses. The state treasurers of Rhode Island and Connecticut were not pleased. “The payout reflects poorly on AmerisourceBergen’s broader culture,” they wrote, illustrating the figure of speech known as “understatement.”

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David Tuller, “For Covid ‘long haulers,’ battling for disability benefits adds aggravation to exhaustion,” Kaiser Health News, Mar 10, 2021

More on the perverse situation faced by people who can’t prove they ever had Covid in the first place. “Around 30% of patients who had tested positive for the coronavirus still reported symptoms when they were surveyed one to 10 months later.” But if you didn’t get a test in the early days, you have to fight with lawyers to get coverage—hopefully without “brain fog.”

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L. J. Dawson, “Without COVID safety net, immigrants in U.S. illegally fall through cracks,” Health News Florida, Mar 9, 2021

An estimated 4 out of 5 of the country’s 11 million undocumented immigrants work in essential jobs, are more likely to get sick, and have no access to the relief benefits.

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Eric Lach, “Andrew Cuomo’s refusal to vaccinate inmates is indefensible,” New Yorker, Feb 13, 2021

Prisoners don’t get the jab, but corrections officers were included in the first-phase priority populations. Maybe now that he’s been stripped of his hyper-powers, the other 200 elected officials can set policy instead of one guy. Not precisely a single-payer issue, but a good example of overall bloody-mindedness.

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Sen. Greg McCortney, “Lower prescription costs essential to better health outcomes” [Opinion], The Oklahoman, Mar 7, 2021

A Republican state legislator in a bright-red state cites Trump in supporting curbs on drug prices. “Oklahomans can’t afford the drugs they need because drug companies inflate prices in the United States so they can sell them cheaper in Canada.” So if everyone agrees, why is action on this issue always blocked?

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Dean Baker, “The New York Times has not heard of China’s (or Russia’s) vaccines,” CEPR, Mar 4, 2021

A lengthy NYT podcast giving a tongue bath to Bill Gates for his “efforts to make vaccines available to the developing world” had nothing to say about Sputnik or Sinovac—the two vaccines reaching most of the aforesaid “developing world.” Baker: “Are New York Times reporters prohibited from talking about the Chinese and Russian vaccines?” Maybe not explicitly. Gates is also the No. 1 obstacle to suspending patent exclusivity on vaccines and putting them in the public domain.

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John McEvoy, “Washington pressured Brazil not to buy ‘malign’ Russian vaccine,” Brazil Wire, n.d.

Tucked away inside an HHS report: “OGA’s [HHS’s Office of Global Affairs] Health Attaché office persuade[d] Brazil to reject the Russian COVID-19 vaccine and offered CDC technical assistance in lieu of Panama accepting an offer of Cuban doctors.” Meanwhile, Brazil dawdled and ending up buying the more expensive AstraZeneca version. The comment appeared under the subheading “Combatting malign influences in the Americas.”

Posted Mar 4, 2021

Nick Corbishley, “Pfizer’s sordid vaccine sales practices in Latin America could be a big boon for China and Russia,” Naked Capitalism, Mar 2, 2021

Trump moved to hoard vaccines for Americans, ignore needy countries with less disposable cash, and guarantee bonanzas for Pharma. Thus empowered and enriched, Pfizer tried to extort insane concessions from foreign buyers—that didn’t always work. Some turned to Chinese and Russian alternatives as well as the AstraZeneca-Oxford option from the U.K. “Five LatAm countries—Uruguay, El Salvador, Guatemala, Honduras and Cuba—still hadn’t received a single vaccine from overseas as of last week.” Cuba has produced its own vaccine, not yet approved for use.

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Abdul Qadir Sediqi, “China to provide Afghanistan with 400,000 doses of COVID-19 vaccine,” Reuters, Mar 1, 2021

Apparently, it was too much to ask the country occupying the place for the last two decades to provide any. Afghanistan also got a half-million doses from India.

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Ilarik Kaila & Joona-Hermanni Makinen, “Finland had a patent-free COVID-19 vaccine nine months ago—but still went with Big Pharma,” Jacobin, Feb 28, 2021

“A team of leading Finnish researchers had a patent-free COVID-19 vaccine ready last May, which could have allowed countries all over the world to inoculate their populations without paying top dollar. Yet rather than help the initiative, Finland’s government sided with Big Pharma.” A stunning example of how the patent system overrules everything else, including common sense, and effectively slows down R&D because it “incentivizes companies to conceal their findings from each other and from the wider scientific community.” But isn’t Finland a social-democratic paradise? “Mirroring a general trend among its counterparts, the ruling Social Democratic Party began to remodel itself in the 1990s after Tony Blair’s New Labour and the Clinton Democrats. In 2003, Finland’s national vaccine development program was discontinued after 100 years in operation.”

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Dean Baker, “To prevent the resurgence of the pandemic, can we talk about open-source research?” Center for Economic and Policy Research, Feb 26, 2021

Covid mutations may leave us in a “whack-a-mole situation, where we have to constantly alter our vaccines and do new rounds of inoculations.” The patent model won’t help things (see above). Why should, for example, Pfizer, reveal that its vaccine is not effective against a given strain?

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Competition Policy International, “New Mexico opens suit against Gilead, Bristol-Myers, Teva over HIV meds,” Feb 25, 2021

Antitrust for price-fixing alleging the companies “engaged in coordinated schemes to suppress the entry of cheaper generic versions of each drug into the market and to delay the development of safer drugs.” The HIV advocacy world has long battled Pharma over its death-dealing practices, occasionally winning.

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Emmarie Huetteman, “4 vital health issues—not tied to Covid—that Congress addressed in massive spending bill,” Kaiser Health News, Jan 28, 2021

Some surprising measures that got lost in the post-election noise: a ban on surprise medical bills, money for training new doctors to fill the rural provider gap, a boost for mental health coverage in insurance policies, some data collection measures that “could be used to rein in high medical bills.” Also included was another blow to industry secrecy: a ban on so-called gag clauses in contracts between health insurers and providers.

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Cyrus Farivar & April Glaser, “Why big tech isn’t dominating the vaccine rollout,” NBC News, Feb 27, 2021

“If Amazon can deliver a phone charger in two days, why can’t it use its logistical prowess to speedily vaccinate a nation? With all the data that Google collects about its users, why can’t it track down and identify who needs a vaccination?” Turns out public health infrastructure can’t be replaced with an algorithm. Who knew?

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Steven T. Dennis, “Biden’s relief plan threatens to trigger Medicare cuts,” Bloomberg, Feb 26, 2021

“The spending cliff is entirely of the Democrats’ making. Under the 2010 Pay-As-You-Go law passed by Democrats and signed by then-President Barack Obama, spending increases and tax cuts that add to the deficit—like Biden’s plan—trigger automatic cuts the following calendar year.” Austerity madness, Democrat-style. PayGo was waived for Trump’s massive 2017 tax cut on a nobly bipartisan vote of 91–8.

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Helena Bottemiller Evich, “Parents erupt over FDA failure to regulate toxic metals in food,” Politico, Feb 28, 2021

“Four major baby food brands — Beech-Nut, Gerber, Earth’s Best Organic and HappyBABY — sold products that their own internal testing showed contained arsenic, lead, and cadmium at levels far higher than what most health experts consider safe for infants.” But it’s not illegal as “the FDA has not set standards for most heavy metals in baby food”—or any food, for that matter. Market-based innovation is always best.  

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Kaitlin Lange, “Indiana Gov. Holcomb signs COVID liability bill, lawsuit protection,” Indianapolis Star, Feb 18, 2021

Taking a page from the Cuomo playbook. The governor says the measure will prevent “frivolous lawsuits,” but critics note that the law could end up a get-out-of-jail-free card for abuses unrelated to Covid.

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Angela Hart and Rachel Bluth, “New single-payer bill intensifies Newsom’s political peril,” Kaiser Health News, Feb 19, 2021

“The single-payer bill adds to his political peril from the left if he doesn’t express support and from the right if he does.” Industry opponents have united in the “Californians Against the Costly Disruption of our Healthcare.” Costly disruption.

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Melinda B. Buntin & Kristine Martin Anderson, “The pandemic slingshot: Propelling from national crisis to a resilient health care system,” STAT, Feb. 22, 2021

Lauds American “innovations” seen throughout the healthcare system in response to Covid. Curiously, one author (Buntin) is a professor of health economics, but, in her extensive prescription for the future of the industry, has nothing at all to say about how healthcare is paid for—which is a good reason to be skeptical of the focus on “innovation” and all similarly obfuscatory techno-babble.

Posted Feb 24, 2021

Cheryl Clark, “Why Haven’s encounter with reality proved fatal,” MedPage Today, Feb 19, 2021

The promise of the mega-initiative by Amazon, JP Morgan Chase and (Warren Buffett’s) Berkshire Hathaway was going to be nothing short of a miracle: to both lower costs and improve healthcare quality for the three companies’ 150K workers. They had experts! Mountains of cash! A celebrity chief (Atul Gawande)! What could go wrong? Gawande: “On the good side, we designed a coverage model with no co-insurance, no deductibles, no cost for 60 critical drugs, and low-cost mental health services and primary care.” What was the fatal flaw? “We have an employer-based system. A job-based system is a broken system in a world where people are moving every couple of years to different roles and many, many kinds of jobs.” How much did it cost to make that breathtaking discovery?

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Susannah Luthi, “Amazon’s offering to help Biden’s vaccine push. There may be a reason why,” Politico, Jan 23, 2021

“The move could also help the company boost its own ambitions of expanding into the $3.8 trillion health care marketplace. The offer may give Amazon a valuable new trove of health data just as it’s expanding into pharmacy and digital health.” So there may indeed be a reason.

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Bernard J. Wolfson, “Head-scratching over Newsom’s choice of Blue Shield to lead vaccination push,” Kaiser Health News, Feb 1, 2021 

No-bid contract entirely unrelated to the insurer’s history as a major donor to Newsom’s campaigns. Public health officials could find themselves sidelined.

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Darrel Rowland, “After federal OK, Ohio names one state PBM to replace others, save money,” Columbus Dispatch, Jan 11, 2021

Slay the Pharmacy Benefit Manager (PBM) dragon with a counter-dragon: a state-controlled PBM monopoly. Gainwell Technologies “will replace the multibillion-dollar conglomerates such as CVS Caremark and Express Scripts that currently serve as middlemen in the prescription drug supply chain for 3 million poor or disabled [Medicaid beneficiary] Ohioans.” Potential savings: a chunk of the $250 million a year now going to the privates. Downside: Gainwell is a for-profit company backed by private equity. (Ohio is run by Republicans.) Next on the state’s agenda: OhioRISE, a “specialized managed care organization with expertise in providing services for children with complex [read “expensive”] behavioral health needs.”

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Robert King, “Walgreens announces creation of new tech startup aimed at developing comprehensive patient platform,” Fierce Healthcare, Jan 13, 2021

Walgreens’s goal is “a new patient platform that blends physical and digital tools. “We see an extremely complex healthcare system in the U.S. where the patients are confused,” said Walgreens Chief Financial Officer James Kehoe. Kehoe’s solution: “Offer every single patient their choice on who they want to manage their healthcare.” When health corporations say “choice,” place hand firmly over wallet.

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Pamela Wood, “Maryland lawmakers override Hogan vetoes on education, advertising bills,” Baltimore Sun, Feb 12, 2021

Not a health story, but a relevant tax-the-rich story. Maryland will now tax tech giants on sales of internet ads, “potentially raising $250 million per year for the state.”

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Kate O'Flaherty, “Google confirms Fitbit deal: Here’s what it means,” Forbes, Jan 17, 2021

Another notch in the Google monopoly giving it access to your personal health data if you have a Fitbit. Google has already harvested “tens of millions” of medical records for its machine-learning project. “Google has agreed not to use Fitbit users’ health and location data for advertising” as a condition of the deal. Alrighty then!

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Markian Hawryluk, “Amid Covid health worker shortage, foreign-trained professionals sit on sidelines,” Kaiser Health News, Jan 25, 2021

Doctors’ earnings are kept artificially high through restrictions on foreign professionals. (Factory workers, meanwhile, get no protection from low-wage foreign competition.) “Many of the medical professionals stuck on the sidelines have unique skills and experience that would be invaluable during the pandemic.” It could also solve the provider shortage in rural America.

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Jordan Rau, “If this self-sufficient hospital cannot stand alone, can any public hospital survive?” Kaiser Health News/Fortune, Jan 29, 2021

Hospital consolidation (a.k.a. monopolization) is rampant and undermining care while increasing costs: “Numerous studies have found that charges to insurers and patients are higher from hospitals with more market power. One study calculated the premium to be 7% to 9%; another study found 12%.” The strange part is that the hospital in question, New Hanover Regional Medical Center in Wilmington, North Carolina, is solvent, popular, and charges insurers less than its competitors.

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Alex Kacik, “Hospital price growth driving healthcare spending,” Modern Healthcare, Feb 4, 2021

“For inpatient care, hospital prices grew 42% from 2007 to 2014 while physician prices rose 18%.” Consolidation is a major factor. Hospital care absorbs 33% of all health-related spending and virtually 100% of total compensation gains by American workers. “The gains [workers] would have gotten in income have gone toward paying their insurance, and the largest chunk of that goes toward paying their local hospital.” One immediate solution: subject hospital mergers to antitrust enforcement.

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Ayla Ellison, “12 states with the most rural hospitals at risk of closure,” Becker’s Hospital Review, Jan 27, 2021 

“Across the U.S., more than 800 hospitals — 40 percent of all rural hospitals in the country — are either at immediate or high risk of closure.” The 12: Connecticut: 3 hospitals (100 percent); Kansas: 76 hospitals (72 percent); Hawaii: 8 hospitals (67 percent); Alabama: 30 hospitals (63 percent); Mississippi: 41 hospitals (62 percent); Arkansas: 29 (60 percent); New York 30 (59 percent); Tennessee: 30 (59 percent); Oklahoma: 41 (56 percent); Texas: 82 (56 percent); Missouri: 31 (54 percent); Louisiana: 26 (53 percent).

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Jonathan Cook, “By putting Big Pharma’s patents before patients, doctors will further erode trust in experts,” Jonathan Cook Blog, Feb 22, 2021

A curious critique of why we don’t trust our institutions. Lengthy but worth it. The specific case is the trashing of Covid-prophylaxsis research on Vitamin D by the medical establishment while it pumps up lame contrary evidence. But Vitamin D isn’t an expensive pharmaceutical product.

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Vinay Prasad, “Vivek Murthy's multimillion dollar conflicts are cause for concern,” (opinion), MedPage Today, Feb 22, 2021

Subhead: “The Surgeon General will only treat corporate America’s woes.” Murthy received $2.6 million in consulting and speaking fees after January 2020 (when it was clear he would be an insider in the Biden government). Included: $400K from Carnival cruise lines. The loot will totally not at all influence any actions of his that could affect these businesses such as authorization for Carnival to restart its services. Fun fact: Elizabeth Warren was all over Trump’s appointees for similar payoffs; on Murthy: “Warren's office did not respond to repeated requests for comment.”

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Andy Miller, “PBMs: Power brokers in the prescription drug world,” Georgia Health News, Feb 10, 2021

State-level action to rein in PBMs is increasingly popular—and bipartisan. Will the Feds follow? Some interesting anecdotes on how PBMs drive up costs and drive out independents. West Virginia saved a bundle by eliminating PBMs from Medicaid.

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Adam Gaffney, David Himmelstein, & Steffie Woolhandler, “Congressional Budget Office scores Medicare-for-All: Universal coverage for less spending,” Health Affairs Blog, Feb 16, 2021  

Policy wonk paradise in 200+ pages: “The report makes many sound assumptions but also some questionable ones that are overly pessimistic. Yet overall, its bottom-line estimates should reassure those concerned about the economic feasibility of single payer.” Main conclusion: single-payer will save money. Good to know though we also know that the cost was never the real reason for opposition.

Posted Feb 17, 2021

Marco D'Eramo, "The biopolitics of nursing homes," Sidecar, Feb 12, 2021

“In the financialized world of elderly care, each bed corresponds to a patient, causing confusion over what exactly is bought, sold or offered as a guarantee for loans. Normally envisaged as a vortex of derivatives, futures, swaps, and options, it’s somewhat strange to imagine international finance as an emporium of impaired senior citizens. But that is how it is.” Chilling details of how grandma is now a financialized commodity. “Without [nursing homes], our entire mode of social organization would be impracticable. The much-acclaimed ‘flexibility’ of modern labour tacitly requires dismantling the extended family and atomizing life itself.”

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Bloomberg [Editorial], “How to end surprise medical bills,” Feb 9, 2021 https://bloom.bg/3u39AFz

Interesting sentiments from a financial news site: “The scandal of surprise bills has been tolerated far too long. The new law is an important step forward—but it’s too soon to declare it a success. First, it must be made to work.” The editorialists point out possible loopholes in the new law (included in the December Covid relief package) that billers could exploit. The process of writing precise regulations to govern the arbitration procedure will have to be watched closely as that’s where lobbyists shine.

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Joyce Frieden, “Insurer, provider groups slam final prior authorization rule,” MedPage Today, Jan 19, 2021

Insurance companies are mad as wet hens, so something good must be in the new regs, set to take effect in 2023. On the other hand, prior authorization, the laborious and costly process that absorbs 1/6 of all provider work time, isn’t substantially simplified—nor can it be with multiple payers eager to delay or deny care. Outgoing Trumpers rushed the process through by “reviewing” thousands of pages of comments in only 9 business days, so everything is likely to be tied up in the courts. Even safety-net plans aren’t on board despite supporting some of the measures included.

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Nathan J. Robinson, “The definitive case for ‘Medicare For All,’” Current Affairs, Feb 3, 2021

A review of what looks like a must-read new book: Medicare for All: A Citizen’s Guide. (Authors will speak Mar 2 at an 8 pm PNHP webinar—here’s the Zoom ID: 815 6291 2159 pw: 835306). “Medicare for All: A Citizen’s Guide is structured simply. First, it looks at what is wrong with the U.S. healthcare system and why it has been so difficult to fix. Next, it explains how Medicare for All would work. Finally, it looks at how we can actually get M4A implemented despite the range of entrenched interests thwarting it.”

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Dylan Scott, “What Biden should do if he’s serious about bringing down US health care costs,” Vox, Feb 1, 2021

He should target hospital monopolies, says Scott, which have “helped make America’s medical costs the highest in the world.” Incoming HHS chief Becerra went after one particularly abusive hospital system in California (Sutter) and won a big settlement. “Antitrust enforcement is not the sexy version of health care reform. It’s certainly not Medicare-for-All. But it can help prevent providers from inflating the prices they charge health insurers, which inevitably pass along those costs to patients in the form of higher premiums.” Given that knives are out for Facebook, Microsoft, and Amazon, can hospitals be far behind? Worst cities for monopolized hospitals: Springfield, Missouri; Peoria, Illinois; Cape Coral, Florida; Albuquerque; Reno; Omaha. One obstacle: the Federal Trade Commission cannot take action against “nonprofits,” which most hospitals theoretically are.

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Chetanya Robinson, “Senator Bob Hasegawa introduces Washington universal healthcare bill,” South Seattle Emerald, Jan 30, 2021

Washington State is the newest candidate for pushing an M4A equivalent across the line. The sponsor’s goal is to get legislative hearings on the measure and in the future a ballot initiative. The bill is like single-payer proposals in New York State and federally. However, it would allow private insurance to survive in parallel “to protect healthcare plans negotiated by unions, which may be better than the baseline universal plan” and to avoid ERISA prohibitions (the federal law that protects pensions and, by extension, negotiated health plans). Fun fact: Hasegawa, the sponsor, is a former truck driver and was president of the largest Teamsters Union in the northwest.

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Dylan Scott, “Biden’s Covid-19 relief plan has a Medicaid expansion problem,” Vox, Feb 3, 2021

The Rube Goldberg-style American healthcare non-system locks out families earning under $26,500 because they’re ineligible for premium subsidies under the ACA. They were supposed to get Medicaid, but because 12 states haven’t signed on to the expansion, these families are SOL unless someone gets inside the machine to tweak that. “The wonky structure of the ACA combined with the Supreme Court’s decision [allowing states to opt out] have locked millions of Americans in poverty out of health coverage.” Even worse, possible solutions will bring new problems. “The tricky part is getting coverage to poor people in the Medicaid coverage gap without creating incentives for states that have already expanded Medicaid to drop the expansion.”

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Rachel Cohrs, “Hospitals’ Covid-19 heroics have them poised for power in the new Washington,” STAT, Feb. 9, 2021

In the coming battles among the industry giants, hospitals could best insurance companies, especially as Democrats tend to side with hospitals against Pharma and insurers. “For [hospital] lobbyists in Washington, the picture couldn’t be rosier. Lawmakers showered the industry with more than $275 billion last year and handed hospitals wins even on seemingly unrelated issues.” As one optimistic lobbyist put it: “If you get straight A’s, it might be the time to ask your parents for a new iPhone.” One sour note: the hospitals’ massive ad campaign against Biden’s public option plan during the primaries did not endear them to him. And not all hospitals are created equal: safety-net hospitals are the poor cousins.

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Michelle A. Williams, “Public health is being undermined. These 10 actions can restore it,” STAT, Feb. 5, 2021

A sensible list, including things like boosting public health investment, improving coordination among state and federal agencies, stopping the nationalistic madness and rejoining the world, replenishing the national supply stockpile, repairing the surveillance and reporting system, boosting doctor and nurse training to cover the provider gap, and oh yes, rebuilding public trust.

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Lila Thulin, “Why the U.S. is struggling to track coronavirus variants,” Smithsonian Magazine, Feb 11, 2021

“Why did scientists in the United Kingdom, and not other nations, first pinpoint a more transmissible variant of the virus that causes Covid-19?” Because the Brits were actively looking. Who coulda thought of that? The U.S. is sequencing 1% of its cases, ranking #34 in the world. “People need to work together in a cooperative and collective way, setting aside individual priorities,” wrote Peacock [a British scientist] in a blog post about the U.K.’s sequencing success.” Meanwhile, in the U.S., “It’s the Wild West. It’s a bunch of random cats, and no one is trying to herd them.”

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Jessie Hellman, “Vaccine research funding misused for decade, says special counsel office,” The Hill, Jan 27, 2021

The Office of Assistant Secretary for Preparedness and Response “misused a fund intended for vaccine research to pay for unrelated expenses since at least 2010,” which might be related to the recently witnesses lack of preparedness and response. “From 2007 to 2016, ASPR was unable to account for more than $517 million in administrative expenditures.”

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Shayna Skarf, “Denied treatment, some Covid long-haulers could become lifelong-haulers,” STAT, Jan 28, 2021

A particularly perverse punishment for people who got “chronic Covid” early on when testing was either not available or inaccurate: since they’re not provably Covid patients, they can’t get Covid benefits nor experimental treatments. “Long-haulers are truckers who are on the road for a long time. But in the end they reach a destination, deliver their shipment, and go home. For me, there’s no end.” This eligibility gaps may affect as many as 70% of those sufferers who don’t recover.

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Carmen Forman, “Despite opposition, Health Care Authority moves forward with $2B plan to privatize Medicaid,” The Oklahoman, Jan 27, 2021

After resisting Medicaid expansion, Oklahoma now wants to figure out a way to shortchange the program and divert profits to the private sector. However, a significant number of Republican legislators don’t like the idea. A lawsuit against the plan failed. Stay tuned.

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Frank E. Lockwood & Michael R. Wickline, “18 states back Arkansas on Medicaid work rule,” Arkansas Democrat-Gazette, Jan 28, 2021

While Biden’s team indicates no more federal waivers to permit punitive work eligibility rules for Medicaid recipients, 18 Republican states joined Arkansas to preserve them in a case at Supreme Court. Lower courts tossed out the work requirements, but Arkansas argues that “conditioning Medicaid expansion benefits on work, education, or volunteering would lead to healthier outcomes for its beneficiaries.” The experiment led to 18,000 people losing their health coverage in Arkansas in just 9 months.

Posted Feb 9, 2021

J. David Goodman, Joseph Goldstein & Jesse McKinley, “9 top N.Y. health officials have quit as Cuomo scorns expertise,” New York Times, Feb 1, 2021

Mass resignations, plummeting morale, and Cuomo on TV nightly as the one and only authority. What could go wrong? Silver lining: if anything does, we know whom to blame.

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Will Bunch, “Still can’t get COVID vaccine? Sure, blame President Trump, but blame President Reagan, too,” Philadelphia Inquirer, Jan 3, 2021

“The United States so far is failing at the task of administering doses for the same reason it didn’t know how to create the testing-and-tracing regimes that have largely worked across Asia or to avoid the embarrassing shortages of protective gear that had some nurses wearing trash bags. This country has been waging war on the very concept of good government for 40 years, and public health has been in the front trench taking World War I-level casualties. Trump might be finishing the job, but the president who created this mess was Ronald Reagan, who assured a similarly anxious nation upon taking office in 1981 that “government is not the solution to our problem.” Reagan slashed the HHS budget by 25 percent on his first few days in office. Dems accepted it.

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Judy Melinek, “The cost of liability: The view from a U.S. doctor living in New Zealand,” MedPage Today, Jan 23, 2021

“If you are injured in New Zealand, the ACC [a special government fund] will pay for your hospital costs—whether in the emergency department, as an outpatient, or as an inpatient. Whatever you need to get fixed up, they'll do it. Chronic injuries suffered over time in the workplace are covered. So are sports injuries. The ACC covers all your rehabilitation costs and transportation costs that are a consequence of your injury. You are paid weekly compensation for being out of work, even if your injury makes that work stoppage permanent. It also pays for mental health help associated with some injuries, with a special focus on victims of sexual violence. ACC will pay for your funeral if you die as the result of an accident.” Non-citizens included. 

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Michael Lighty, “How to win Medicare for All under President Biden,” In These Times, Jan 20, 2021

“Our task is not to simply convince Biden to change his views on Medicare for All, but to change the political waters in which that view holds sway.” Okay, how? The author proposes that when the bill to fix the ACA moves through committee, there will be a strategic opportunity to demand a ​“mark-up” of the bill and include key policy priorities—“such as lowering prescription drug prices and eliminating out of pocket expenses—in whatever bill emerges. This process could bring media and political attention to the policy advantages of Medicare for All.” Not crazy given Bernie’s role as head of the Budget Committee. Also discusses the single-state pathway.

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Ryan Basen, “Healthcare fraudsters among those pardoned by Trump,” MedPage Today, Jan 21, 2021

Amazing run-down of the fraudsters, grifters, crooks, mountebanks, charlatans, pill-mill operators, swindlers, racketeers, sharks, and embezzlers who got Trump’s sympathetic ear. For example, beneficiary Glen Moss was given merit points by the Trump White House for his philanthropic spirit as reflected in his contributions to a community group that, upon hearing the news, replied, “We have no Glen Moss in our system at all. I don’t know where they got that information.” Tinpot dictators everywhere believe governments are piggy-banks for the powerful. Swamp intact.

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Jon Healey, “Biden trying to reverse Trump’s assault on healthcare. He has a long way to go,” Los Angeles Times, Jan 29, 2021

Good as far as it goes—which is not very. “It will certainly help to have the federal government resume promoting state insurance exchanges. It will also help hold down premiums in those exchanges to cut back on temporary insurance plans that offer cheaper but far more limited coverage—plans that drew younger, healthier people out of the exchanges.” In his lament over costs, this editorial writer never addresses insurance company profits, massive administrative waste in multiple billing, or Pharma pricing. [To get around the annoying paywall, select all with CRTL-A and paste as unformatted text.]

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RT, “No freebies! Pfizer to charge for ‘extra’ Covid-19 vaccine doses as doctors squeeze vials of every drop to inoculate more people,” Jan 23, 2021

[RT was formerly Russia Today.] “Pfizer has pressured regulators to declare its vials contain an “extra” dose of the vaccine and will now count them in deliveries, after frontline health workers found they could dispense six shots from one vial, instead of five.” Genius! They need more R&D cash so their scientists can make further life-saving discoveries!

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Julie Appleby, “Hospital prices just got a lot more transparent. What does this mean for you?” NPR/Kaiser Health News, Jan 5, 2021

Not clear how much shining the light on prices will affect individual consumers, but certainly employers who provide insurance coverage for large numbers of workers “will want to know how much they are paying each hospital compared with others in the area and how well their insurers stack up in negotiating rates.” The author concludes: “Price transparency can help, but the market power of the various players might matter more.”

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Maura Calsyn & Thomas Waldrop, “How the next administration can lower drug prices,” Center for American Progress, Sep 17, 2020

CAP (=mainstream Dems) calls for action on drugs whose prices have been raised by pharmaceutical companies during the pandemic, which it calls “especially egregious during a global health crisis.” One recommendation: work around Pharma’s manipulation of its discounts so that Medicare gets them, too. The explanation is very wonky-weedy as should be expected from a conservative think tank headed by Neera Tanden and funded by Pharma, defense contractors, Bloomberg, and the Emiratis.

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Thomas Neuburger, “Oxford pledged to donate Covid vaccine right, then sold them, thanks to Bill Gates," Neuberger Substack, Jan 26, 2021 [with reprint of Jay Hancock, “They pledged to donate right to their COVID vaccine, then sold them to Pharma,” Kaiser Health News 8/25/20]

Vaccines never interested Pharma much as you only need to get it once (or twice). Gates played a nefarious role in getting the producers to claw back intellectual property rights despite huge public subsidies. “Drug industry executives and their shareholders will get rich with no assurance that future vaccines will be inexpensively available to all.” Gates is a major funder of vaccine projects and vaccine-promoting nonprofits as well as the WHO, which is maybe possibly why we haven’t heard of this before.

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Sam Pizzigati, “Greed in the suites, from Walgreens to Walmart,” Counterpunch, Jan 26, 2021

“Walgreens illustrates—personifies—the long-term economic trends that the Trump years so cavalierly doubled down upon: top corporate executives busily pocketing immense paychecks at the direct expense of their workers.” Walgreens pays the worst of the entire chain store empire ($10/hour starting wage). Hazard pay for Covid? 18 additional cents an hour. Meanwhile, Walgreens CEO Stefano Pessina took home $17 million in 2020. An interesting response: some cities have special tax penalties for corporations with such skewered executive/worker pay disparities.

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Julia Rock, “COVID-19 vaccine developers ask the SEC to help keep the secret of how they set prices,” Newsweek, Feb 1, 2021

“When the U.S. government awarded over $10 billion in contracts and advance- purchase commitments to drug companies working on COVID-19 vaccine and treatments, it did not require the recipients of government money to agree to offer their products at fair prices or share intellectual property rights to enable faster production. Now, two of the companies awarded those contracts—Pfizer and Johnson & Johnson—are trying to prevent shareholders from voting on resolutions to require the companies to disclose information about the impact of government funding on vaccine access.” So what’s the question they quake in terror at having to answer: “Did you take government funding into account” when setting your vaccine price? The fight turns on the meaning of “nonprofit” given that J&J promised to distribute a COVID-19 vaccine “on a nonprofit basis.” A simple, but not easy, question. 

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Ruth McCambridge, "Profit as primary driver: The daily disaster of U.S. healthcare,” Nonprofit Quarterly, Jan 19, 2021

Lots on the hellscape of private equity in nursing homes. Says Ernie Tosh, an Austin-based attorney who runs a side business analyzing nursing home data. “The nursing home industry should not be looked at through the lens of normal corporate America. If you think of it as organized crime, it will make a lot more sense.”

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Ed Gryster, “Single payer: Which way forward?” Dissident Voice, Jan 17, 2021

Why the disconnect between the obvious need and the permitted discourse about solutions? “In the middle of a pandemic, the USA’s for-profit healthcare system has no national plan or coordinated response. Instead, since so few Americans are going to the doctor this year, there is resounding joy in the industry as profits mount simultaneously with the despair of millions.” And yet “for journalists and talking heads in the mainstream media, this dysfunctional monstrosity is just the acceptable reality of our healthcare system. Discussing any responsibility or alternatives are disregarded.” The author endorses the “Force the Vote” campaign and criticizes insider baseball with Dems.

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Nicholas Florko, “Trump officials actively lobbied to deny states money for vaccine rollout last fall,” STAT, Jan 31, 2021

Part of the explanation for the woefully unprepared rollout. “Even after the Trump administration spent billions helping drug makers develop Covid-19 vaccines, it not only dismissed states’ concerns about the help they would need to roll them out but actively undermined their efforts to press Congress to get the funding they needed.”

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Sarah Kliff & Jessica Silver-Greenberg, “How rich hospitals profit from patients in car crashes,” New York Times, Feb 1, 2021

A new scam: hospitals that refuse to bill your Medicaid coverage and instead saddle you with a huge bill so you can’t get a settlement until you submit to their blackmail. Prime targets: widows and veterans.

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Kristina Fiore, “EHR vendor pays $18m to settle kickback allegations,” MedPage Today, Feb 2, 2021

The company took customers to the Kentucky Derby and the Masters Tournament, plied them with food and drink, and handed out cash payoffs to cooperating doctors. “The firm agreed to the settlement without admitting guilt.” Cost of doing business.

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Peter Elking, “Rich investors stripped millions from a hospital chain and want to leave it behind. A tiny state stands in their way,” ProPublica, Feb 4, 2021

Rhode Island. Follow-up to an earlier, incredible exposé: “Private equity firm Leonard Green and other investors extracted $645 million from Prospect Medical before announcing a deal to sell it and leave it with $1.3 billion in financial obligations. Four states approved it—but Rhode Island is holding out.” Also, unions representing hospital workers.

Posted Feb 1, 2021

Matt Stoller, “How monopolies slowed the vaccine roll-out and small business sped it up,” BIG, Jan. 26, 2021

“CVS and Walgreens didn’t deliver. Local pharmacists did.” Which state has the best record for vaccine distribution? West Virginia because it has few chain pharmacies and lots of local independents. Stoller is a former congressional aide and expert on monopolization of the U.S. economy. This is a single-payer must-read and, for those interested in the broader issue, lots more on non-health topics.

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Ross Barkan, “Why isn’t New York vaccinating more people?” Political Currents, Jan 5, 2021

Takes the sheen off Cuomo’s allegedly brilliant performance. “Cuomo failed utterly to contain the virus and lock down the city in early March when COVID-19 was first spreading. He kept comparing coronavirus to the flu and proclaimed the fear of the virus was worse than the virus itself.” Then there was the nursing home debacle and the dismal vaccination rollout. “The real problem with Cuomo dangling million-dollar fines over providers for administering a vaccine to anyone who does not meet the state’s strict priority guidelines is that it will discourage mass vaccinations at a time when New York desperately needs them.” Stories of vaccine doses being thrown out quickly demolished the threats. “Como’s million-dollar hammer is one more manifestation of his authoritarian instincts.”

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Dean Baker, “The coronavirus vaccine fail and international elites,” Patreon, Jan 25, 2021

“If we can explain the failure to have more rapid distribution in the United States on Trump’s Keystone Cops crew, what explains the failures in [Denmark, Germany, France]?” The author argues that forging a true international collaboration, including pooled vaccine research for public benefit, “could call into question the merits of patent monopoly financing of prescription drug research.” The danger: if it turns out to be a good model in a pandemic, why not use it all the time?

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Aneri Pattani, “For health care workers, the pandemic is fueling renewed interest in unions,” Kaiser Health News/NPR, Jan 11, 2021

“The urgency and desperation we’ve heard from workers is at a pitch I haven’t experienced before in 20 years of this work. We’ve talked to workers who said, ‘I was dead set against a union five years ago, but COVID has changed that.’” Lack of PPE is a big motivator along with other forms of management negligence. “The pandemic didn’t create most of the root problems they’re concerned about, but it amplified them and the need to address them.”

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Joyce Frieden, “Copay assistance programs help patients but confuse them too,” MedPage Today, January 13, 2021

“If you’re having trouble paying for your medications, Drug Company X may be able to help.” Beware the scam. Sometimes, you use the coupon, then are charged the same amount when the insurance company doesn’t count it toward your deductible.

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Brianna Bailey, “How the CARES Act forgot America’s most vulnerable hospitals,” ProPublica/The Frontier, Jan 26, 2021

“COVID-19 relief was meant to give a lifeline to hospitals, especially the small, rural facilities that struggled to stay open before 2020.” The price tag was $100 billion—real money. But bureaucratic tie-ups and hastily written rules meant that “the hospital rescue program helped wealthier facilities pad their bottom lines while poorer hospitals struggled.”

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Sara R. Collins, “The number of Americans without health insurance has been trending up. Let’s turn it down again,” STAT, Jan 25, 2021

Despite the ACA, the uninsured rate has “trended upward over the past four years.” Reasons: Trump policies that undermined the ACA; continued state refusal to expand Medicaid; the “public charge” rule inhibiting immigrants from legal benefits; affordability. Biden has started some reversals; he could also: simplify marketplace plan choices; increase marketplace subsidies; block junk policies.

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Bernie Sanders, “This is the agenda Democrats should pursue under Biden's leadership,” CNN, Jan 19, 2021

The list: Medicare for all Covid-related costs, increases for community health centers, beat down drug prices, forgive healthcare workers’ student debt. Also, $2000 relief payments, emergency unemployment benefits at $600/week, aid to state and local governments, hazard pay for frontline workers, aid to the USPS, new initiatives for homelessness and hunger, infrastructure spending, 12 weeks of paid family leave, universal pre-K education, tuition-free college, and $15 minimum wage.

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John Gever, “Drug prices: We’ve seen this movie before,” MedPage Today, Jan 22, 2021

“Average wholesale prices for products in five classes increased in lock-step each year from 2015 to 2020.” Prima facie evidence of price-fixing “far outpacing not only inflation in general but even the 2.1% average for all prescription drugs.” Another oligopoly.

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Michael Erman & Carl O’Donnell, “Drugmakers to hike prices for 2021 as pandemic, political pressure put revenues at risk,” Reuters, Dec 31, 2020

“The companies kept their price increases at 10% or below,” says Reuters encouragingly—in a virtually zero inflation environment. 

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Denise Fulton, “Drug price transparency in the Biden era,” Regulatory Focus, Jan 18, 2021

The author reviews a (paywalled) article that suggests one Trump-era measure to address runaway drug prices was less bungled than usual and might survive court challenges, namely, the transparency rule—that hospitals must disclose list prices for medications covered by Medicare/Medicaid. Includes a sketch of the legal issues involved. Biden expressed support for the idea during the campaign. “Nearly one third of US drug spending is for drugs dispensed in health care settings.”

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Terry McAuliffe, “Opinion: Virginians need lower drug prices,” Washington Post, Jan 14, 2021

Former governor McAuliffe’s non M4A solutions: “transparency” (again), price limits set by states, a crackdown on PBMs, bulk purchasing by states to increase leverage, importing from Canada.

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Kristina Fiore, “Here’s how much more the U.S. spends on Rx drugs,” MedPage Today, Jan 28, 2021

On average, prescription drug prices were 2.56 times higher in the U.S. than in 32 other developed countries (for brand-name drugs, 3.44 times). Oddly, “unbranded generics cost slightly less in the U.S., 84% of the price in other nations on average”—even though the U.S. uses more generics than other countries. That means the huge price-gouging on branded drugs—i.e., the ones we see advertised on TV—is what drives up the costs so enormously.

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Doni Bloomfield & Aaron S. Kesselheim, “Biden can lower drug prices without Congress doing anything,” Washington Post, Jan 5, 2021

By giving out fewer stupid patents. For example, for its auto-immune disease drug Humira, AbbVie obtained 100 patents to stave off generic competition. Its price fell 80% when the patents finally ran out. Patent office examiners “are given bonuses in part based on how quickly they are able to crunch through applications” to grant 20-year exclusivity to drugs that might bring in billions in sales. Trump made the problem worse; Biden could improve the system by administrative action.

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Mark Dudzic, “Take my benefits—please! Employment-based health care has become an anchor around the neck of the U.S. working class," New Politics, Winter 2020

Despite being the “biggest cause of strikes, lockouts, and concession bargaining,” job-based health benefits attract support across the political spectrum from anti-union Republicans to the head of the AFL-CIO. Unions fought for these benefits and now resist giving them up to join a universal program. But the current system is unsustainable, especially given the chronic weakness of the labor movement and runaway costs. “If something can’t go on forever, it will stop.”

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Shayna Skarf, “Denied treatment, some Covid long-haulers could become lifelong-haulers,” STAT, Jan 28, 2021

Arbitrary cruelty baked into the current system: “Long-haulers who had Covid-19 in early March and weren’t able to promptly get tested for Covid-19 or antibodies aren’t eligible for treatment” under the federal programs to cover Covid costs. This affects 7 out of 10 people with the chronic Covid conditions. Also, they don’t get experimental drugs.

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Lev Facher, “Major health companies and trade groups suspend campaign contributions after Capitol riot,” STAT, Jan 12, 2021

The Pharma lobby and Blue Cross register objections. Other insurers, the AMA, and the American Hospital Association did not join them. However, “In many ways, these are symbolic actions, especially given that corporate PAC donations account for a small portion of the overall fundraising pie.” Also, the next election is two years away; no one needs money right now.

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Wendell Potter, “How big insurance funds Republican insurrection,” Tarbell, Jan 13, 2021

Big Insurance favs? Ted Cruz and Josh Hawley.

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Mari Uyehar, “Medicare for All needs a sunrise movement,” New Republic, Jan 18, 2021

Spends too much attention on the “force the vote” boomlet pushed by Jimmy Dore, but has some interesting suggestions for modeling an M4A movement: “By growing and reinforcing a trained activist organization across the country, scoring some undeniable electoral wins, and moving the president-elect leftward, the Sunrise Movement has advanced the cause of climate action in some substantial ways in a short amount of time.”   

Posted Jan 22, 2021

Nicholas Florko, Lev Facher, Rachel Cohrs, Andrew Joseph & Casey Ross, “The 9 biggest challenges Biden will face on Covid-19, from today on,” STAT, Jan 20, 2021 

How many things on this list can be fixed by market forces? (1) Suppressing the current spread of Covid-19; (2) Changing minds on masks; (3) Setting up mass vaccination sites; (4) Extracting money for Covid-19 relief from a narrowly divided Congress; (5) Improving a worn-down supply chain for just about everything (still not enough PPE); (6) Using technology to track vaccinations and ensure equity; (7) Wrangling local officials resistant to Covid-19 mitigation tactics; (8) Boosting morale among burnt out health care workers; (9) Tackling everything else (postponed preventive care, overdoses, suicide). The authors add a 10th: Rebuilding the country’s pandemic preparedness. “Re”-building?

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Tami Luhby, Caroline Kelly & Devan Cole, “5 Ways Biden plans to reset health care after Trump,” CNN, Jan 19, 2021 

“Trump’s multitude of changes to the ACA will keep Biden’s team busy.” Easy fixes: restore ACA’s open enrollment period to three months; increase funding for ACA marketing and enrollment assistance; get private insurance brokers out of the business entirely; stop letting states impose work requirements for Medicaid eligibility; restore Planned Parenthood’s eligibility for Medicaid reimbursement. Harder: suppress short-term junk health plans (many people already have them); stop states from subcontracting ACA exchanges to the private sector (as Georgia did). Entirely unlikely: fulfill the campaign promise to create a public option or lower the age of Medicare eligibility. Entirely likely: more generous federal subsidies—free money for the insurance companies.

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Victoria Knight, “Health issues carried weight on the campaign trail. What could Biden do in his first 100 days?” Kaiser Health News, Jan 22, 2021 

What are the chances that the following promises are fulfilled—or even proposed—by the Biden team? “I’ll not only restore Obamacare, I’ll build on it. You can keep your private insurance. If you like it, you can choose a Medicare-like public option.” [-Joseph R. Biden, Nov. 2, 2020, Pittsburgh] “Health policy experts we consulted said implementing a public option seems extremely unlikely in the current environment. So does lowering the Medicare eligibility age from 65 to 60, another divisive idea among Democrats.”

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Nicholas Sargen, “3 ways Biden will reshape regulatory policy,” The Hill, Jan 19, 2021

Where do the money boys think Biden will go in the regulatory arena? Drug prices are a big issue but vaccine development “has cast pharmaceutical companies in a more favorable light.” More generous Medicare drug benefits could be on the table, especially if they don’t challenge Pharma’s power to set list prices. A 2019 Senate bill authored by Grassley (R) and Wyden (D) wants to do just that, but Republicans killed it. The author, a money manager, claims drug prices haven’t risen much lately (see next article).

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Michael Hiltzik, “Trump utterly failed to cut drug prices. Here’s how Biden could do better,” Los Angeles Times, Jan 19, 2021

Excellent, clear background on the status of attempts to rein in runaway drug costs. “As a sort of sour welcome for the Biden administration and a final slap in the face for Donald Trump, America’s drug companies jacked up prices on hundreds of prescription drugs, including some of their top sellers, at the very start of this year. The drug industry’s semiannual price hikes have made a mockery of the Trump administration’s claim to have brought prescription prices down. That’s not to say that anyone familiar with the industry ever took these claims seriously.” Outlines how Trump’s bumbling approach made it easy for Pharma to play him and what Biden could do better, starting with the House bill HR3, known as the [Elijah] Cummings Act, which would “mandate the use of an international price index as a benchmark for the government to negotiate drug prices for Medicare and Medicaid. Those negotiated prices could then be used by private insurers.”

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Paul Jay, “What can Sanders do as budget chair?” TheAnalysis.News, Jan 20, 2021

Educate the public and embarrass the hell out of a lot of people, for one thing. The chair can call for and schedule hearings on anything he wants. Interview with Rob Johnson, formerly Senior Economist for the Budget Committee. Podcast or transcript.

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Ellyn Ferguson, “Biden’s choice to lead USDA helped monitor OxyContin maker,” Roll Call, Jan 11, 2021

Vilsack, an $800K-a year-lobbyist for the dairy industry, was selected by opioid purveyor Purdue Pharma to oversee its bankruptcy settlement (add $145K for that gig). If he had been tough, would he be back in the cabinet as Ag Secretary?

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Gregg Miller, “A broken system killed my young patient,” MedPage Today, Jan 18, 2021

“I’d like to say it was the worst case in my life except we all know that we’ve had plenty of other cases like that. This young woman didn’t have to die. No one had called her about her lethal level of potassium, about this abnormal lab. No clinician at triage in the waiting room had looked it up. No one had done lab work on her. No one had drawn her blood in the waiting room despite the fact that she’d been there for three or four hours. We had so many opportunities to save this young woman, but no one had built a system that would do that.”

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Suveen Angraal et al., “Evaluation of internet-based crowdsourced fundraising to cover health care costs in the United States," JAMA Network, Jan 11, 2021

“From May 2010 through December 2018, more than $10 billion was sought through [more than 1 million] online medical fundraisers in the U.S., with more than $3 billion raised.”

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Martin Makary, “Hospitals: Stop playing vaccine games and show leadership,” [opinion] MedPage Today, Jan 12, 2021

“America’s hospitals are supposed to be the center of scientific genius, but in stewarding the COVID-19 vaccine, many hospitals have been the center of poor management and cronyism. Wealthy health systems with thousands of employees have been making excuses why they don’t have the funds, staff, or state guidance to immunize vulnerable seniors in their community while at the same time these hospitals are vaccinating their own administrators and young, work-from-home communications staff, human resources staff, and accounting personnel. The total administrative cost to vaccinate seniors from the community in clinic is less than one-quarter of their CEO’s pay in a single year. Given the health emergency this year, we physicians need to urge our hospitals to live up to their community mission.” Strong language from an industry publication.

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Serena Marshall & Lara Salahi, "The Distribution Debacle,” MedPage Today, Jan 13, 2021

Plenty of money available for the magic bullets, none for public health infrastructure.

Posted Jan 12, 2021

Alia Paavola, “Northwell rescinds 2,500 suits filed against patients to collect unpaid debt,” Becker’s Hospital Review, Jan 8, 2021

Bad PR led to action hours later.

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Giles Bruce, “Illinois is the first in the nation to extend health coverage to undocumented seniors,” Kaiser Health News, Jan 7, 2021

Untreated chronic conditions among the undocumented are aggravating Covid morbidity and leading to clogged ERs. However, the income limit of $12,670 for an individual will limit the program’s reach.

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Erin Brodwin, “Haven, ambitious health venture backed by Amazon, to shut down,” STAT, Jan 4, 2021

The Amazon-JPMorgan Chase-Berkshire Hathaway joint venture has collapsed, which is probably good news. “There was this general chat about access, primary health care, and transparency, but not a big idea about how to get those end results.”

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Yves Smith, “Schaudenfreude alert: Bezos-Buffet-Dimon health care industry disruptor Haven makes faceplant, announces closure,” Naked Capitalism, Jan 5, 2021

Possible reasons why: none of the three partners had healthcare expertise; the 3-way merger was unwieldy and prone to turf wars and overlap with in-house initiatives already in place (e.g., Amazon Care); money isn’t enough (they had plenty); unseriousness (57 total employees); leadership vacuum (top execs jumped ship after a few months); late to the party—private equity has already scooped up the healthcare chokepoints where they can leverage market power and skim off profits. Also: “To the extent there was an idea, it was dumb. They announced a goal of ‘simplified, high-quality and transparent healthcare’: What on earth can possibly be transparent about an appendectomy?” Elephant in the room: Haven’s originators had no idea what to do about costs.

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Brian Barnett, “Who’s choosing Americans’ medications — doctors or insurers? The bane of prior authorization,” STAT, Jan 1, 2021

“[We providers] are increasingly wondering who’s actually doing the prescribing—us or people with no medical training who read patients’ names on computer screens?” But prior authorization deters people from taking the meds, thus saving the insurance companies those costs. “For every prior authorization request, a provider can lose up to an hour or more wading through an administrative quagmire. There are often labyrinthine phone trees to maneuver through, patient records to unearth, and faxes—yes, faxes—to be sent.” Denials push the delay—and reimbursements—further into the future. Fun fact: average annual cost for physician interaction with insurers: $70,000.

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Lown Institute, “2020 Shkreli Awards,” Jan 5, 2021

“Top ten worst examples of profiteering and dysfunction in health care,” such as: #10—Private-equity backed companies spend millions to protect surprise billing while cutting physician pay and pocketing relief dollars; #7—Hospitals punish mask-wearing clinicians for “scaring the public”; #6—Hospital CEO pens op-ed* justifying high vaccine prices, neglects to disclose $487,000 stock option conflict of interest (CEO of a Boston hospital, who quit after being outed); #3—Hospitals with extra beds refuse to take uninsured patients from overrun neighboring hospitals, instead saving the beds for lucrative insured patients. [*What about the newspapers that allowed the Boston CEO to shill for her investment portfolio without checking her background first?]

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Susannah Luthi & Rachel Roubein, “How powerful health providers tamed a ‘surprise’ billing threat,” Politico, Dec 21, 2020

Speaking of #10 above: “Powerful hospital and [private-equity-owned] physician groups that tied up Congress for nearly two years on how to end ‘surprise’ medical bills saw their efforts pay off with the compromise lawmakers inserted in the giant year-end spending package.” The winning combo: high-powered lobbyists, attack ads, and bottomless wells of campaign cash. Democrat Neal (D-Mass.) played, as usual, a particularly nefarious role. “The legislation still doesn’t bar ground ambulances from sending massive bills to insured patients. Other policy changes aimed at stopping anti-competitive practices among health insurers, hospitals, prescription drug middlemen and the pharmaceutical industry were either watered down or axed.”

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Samantha Young, “Dialysis industry spends millions, emerges as power player in California politics,” Kaiser Health News, Dec 10, 2020

The two top dialysis companies in the state have revenues above $10 billion a year each—lots to spread around to keep it that way. “Nearly every member of the legislature, the Democratic and Republican parties, and dozens of political campaigns—including some local school board and city council races—received a contribution from a dialysis company.” Most of their cash comes from Medicare, so even their money to lobby school boards is provided by the public sector.

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Sarah Kliff, “This is the health system that Biden inherits from Trump,” New York Times, Dec 16, 2020

You’d think lower medical spending would be a good thing overall. But “gains in care for the poor and vulnerable are under threat” as systems lost revenue in March and April when people stayed away from routine care. Safety-net hospitals “are facing major financial pressure while wealthier hospital systems expect to emerge slightly bruised but not broken.” Also, key staff can decamp for lucrative temp jobs in hard-hit states.

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Ben Guarino, “ER doctors on the front lines against Covid struggle to find jobs,” Washington Post, Jan 4, 2021

A quarter of emergency medicine residents are having trouble finding work. ERs without nurses, doctors without jobs, hospitals without income—why isn’t the free market in healthcare allocating resources efficiently in the best of all possible economies? “Durrani, 29, has treated hundreds of covid-19 patients but cannot find a company in his hometown of Houston ready to hire him when he graduates [from medical school] next year. Many people stayed away from hospital emergency rooms this past year, wary of contracting the virus. As patient numbers dropped, emergency departments brought in less money. As a result, cash-strapped employers stopped recruiting new doctors.” Also: “Fewer places can afford newly minted emergency medicine doctors during a crisis in which it would seem they should be in high demand.” Everything is working as planned! More than half of the emergency doctors in the United States are employed by financial companies.

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John P. Moore & Ian A. Wilson, “Decades of basic research paved the way for today’s ‘warp speed’ Covid-19 vaccines,” STAT, Jan 5, 2021

Well-known but worth repeating. “The Covid-19 vaccines did not come from nowhere. Decades of [often government- and foundation-funded] research by tens of thousands of scientists worldwide put in place the essential knowledge and methods that underpinned their rapid development.”

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Samantha Liss, “UnitedHealth’s Optum to buy Change Healthcare in $13B deal,” Healthcare Dive, Jan 6, 2021

Further consolidation of industry giants. “The move consolidates Optum’s dominance in the healthcare data analytics space. The UnitedHealth venture, which also includes a PBM and doctors’ unit, has been a consistent driver of revenue for the biggest private insurer in recent years.”

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Eric Sagonowsky, “Should pharma charity contributions be publicly disclosed, just like doctor payments? Senators say yes,” Fierce Pharma, Jan 8, 2021

The scandal over $65 million paid to opioid-pushing groups like the “American Chronic Pain Association” that helped addict millions is leading to possible federal measures to rein in astroturf front groups pushing pharmaceuticals. So far, Pharma companies are only getting wrist-slap fines in which companies “admit no wrongdoing.” Those paying such get-out-of-jail-free-card fines include Gilead, Sanofi, Pfizer, Astellas, Amgen, Alexion, and United Therapeutics.

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Geoff Mulvihill, “Senate report: Opioid industry has paid advocacy groups $65M,” Associated Press, Dec 16, 2020

The “Alliance for Balanced Pain Management” was run by drug distributor Mallinckrodt, which just paid a $1.6 billion settlement of thousands of lawsuits. A reminder to never eat at a diner called “Mom’s.”

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Paul LeBlanc, “Republican lawmakers who downplayed Coronavirus concerns face backlash over early vaccinations,” CNN, Dec 22, 2020

After maskless rallies and silence over Trump’s nonsense, some electeds can’t wait to be first in line.

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Harris Meyer, “Seniors face crushing drug costs as Congress stalls on capping Medicare out-of-pockets,” Kaiser Health News, Jan 4, 2021

Unlike private health insurance, Medicare Part D drug plans have no cap on patients’ 5% coinsurance costs, except for very low-income beneficiaries. Patients with expensive medications have to scramble for grants, compassionate care programs, or donors on GoFundMe. “The out-of-pocket cost for Medicare and private insurance patients is often set as a percentage of the list price, as opposed to the lower rate negotiated by insurers.” An incentive for price hikes into six figures, not unusual for cancer drugs.

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Ashish K. Jha, “Vaccination is going slowly because nobody is in charge,” Washington Post, Dec 31, 2020

“The responsibility of vaccine distribution has fallen on state health departments. These relatively poorly funded agencies have been managing the full pandemic response for months. They are squeezed and stretched, and to make matters worse, their leaders are receiving death threats and other forms of harassment, prompting some to quit.” Aside from the particular dysfunction of Trumpism, the highly fractured system does not lend itself to centralized planning for an emergency. “Once a blame culture is set, the finger-pointing continues: in Mississippi, the health chief says it’s not the state’s job to ensure vaccines get into people’s arms, and he is now blaming front-line providers for the slow rollout.” Doggone nurses.

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Emily DeCiccio, “‘Planning is the antidote to panic’: Providence Hospital System defies America’s slow vaccine rollout trend,” CNBC, Jan 4, 2021

While the vaccination campaign flounders, one hospital system did a good job and has vaccinated half its 120,000 employees. Their deep, dark secret? They started planning for it in September. Who could have thought of that?

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Phil Galewitz, “Trump Administration approves first Medicaid block grant, in Tennessee,” Kaiser Health News, Jan 8, 2021

A first: Tennessee will get its Medicaid money in a lump sum, increasing incentives to cut back on care. “Instead of the open-ended federal funding that rises with higher enrollment and health costs, Tennessee will instead get an annual block grant. If the state can operate the program at a lower cost than the cap and maintain or improve quality, the state then shares in the savings.” Tennessee never expanded Medicaid eligibility under the ACA.

Posted Jan 4, 2021

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

A health care industry front group [Partnership for America’s Health Care Future] “run by a former Hillary Clinton aide has amassed millions to block a public health insurance option.” Recall that the line used against single-payer a year ago during the primaries was that there are “other ways” to get to universal coverage, such as the public option. Once the threat is neutralized, the public option is quickly shelved, just as in 2009.

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Mariana Mazzucato, “Covid exposes capitalism’s flaws,” Financial Times, Dec 28, 2020

Remarkable language for the FT (Britain’s Wall Street Journal): “Covid-19 is the moment to do capitalism differently. The pandemic showed our economic system is not simply in crisis, it is structurally flawed.” Good diagnostics about all the ways things went wrong, and a few of the suggested solutions are conceivable even in the present environment, such as refusing stimulus money to companies that stash the loot offshore.

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Giacomo Tognini, “Meet the 50 doctors, scientists and healthcare entrepreneurs who became pandemic billionaires in 2020,” Forbes, Dec 23, 2020

Newcomers of the year to the billionaires’ club include vaccine developers Uğur Şahin ($4.2 billion) and Stéphane Bancel ($4.1 billion), glass vial manufacturer Sergio Stevanato ($1.8 billion), antibody treatments producer Carl Hansen ($2.9 billion), contract research magnate August Troendle ($1.3 billion), and Harvard immunologist Timothy Springer ($2 billion from his timely Moderna investment). China accounts for 35 of the 50 new billionaires.

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Chad Terhune, “Wealthy hospitals rake in U.S. disaster aid for COVID-19 costs,” Reuters, Dec 29, 2020

“Large and well-capitalized nonprofit systems—which typically pay no taxes—do not need the additional relief money” but are taking it anyway. Although an argument could be made against means-testing the aid, something is wrong when huge outfits fatten their coffers while rural and safety-net hospitals go under. For example, the Cleveland Clinic picked up $400+ million in pandemic aid while “the system’s net income—including strong investment gains—tripled to $604 million in the most recent quarter, compared to a year ago.” Nonprofit investment gains always come in handy.

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J. David McSwane, “‘Those of us who don’t die are going to quit’: A crush of patients, dwindling supplies and the nurse who lost hope,” ProPublica, Dec 30, 2020

Collapse of care in the VA system. “While every American hospital was stretched by the pandemic, the VA’s lack of an effective system for tracking and delivering supplies made it particularly vulnerable. The COVID-19 pandemic came more than a year into a massive reorganization by the administration of President Donald Trump that left hundreds of jobs empty and sent the VA scrambling to hire contract positions to help with, among other things, procurement of supplies.” Thank you for your service! P.S. The VA nurses still don’t have PPE.

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Michael Grabell & Bernice Yeung, “The Battle for Waterloo,” ProPublica, Dec 21, 2020

Subhead: “As COVID-19 Ravaged This Iowa City, Officials Discovered Meatpacking Executives Were the Ones in Charge.” Not strictly a single-payer story, but a good illustration of how public health was completely subordinated to immediate considerations of profit. Would The Jungle (1906), Upton Sinclair’s famous indictment of the appalling conditions in the meatpacking industry, today look benign by comparison? A fascinating deep dive.

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Til Schuermann & Helen Leis, “We stress tested banks in 2009. We need to do the same thing now for U.S. hospital systems,” STAT, Dec 29, 2020

A classic of neoliberal logic: since we “stress test” banks to make sure they’re solvent, we need to do the same for hospitals to make sure they can stay afloat. Because hospitals are just like banks! No attempt in the article to question the underlying system that puts hospitals into near-bankruptcy for doing their job.

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Matthew Cunningham-Cook, “Hospital CEOs have gotten rich cutting staff and supplies. Now they’re not ready for the next wave,” The Intercept, Dec 20, 2020

“Nonprofit” hospitals, forced into the corporate mold, make all the market-driven mistakes like just-in-time staffing and supplies while enjoying tax-free real estate. “In 2006, Montefiore Medical Center in the Bronx had healthier patients, just enough nursing staff to take care of them, and a CEO who was earning $2 million a year. Fifteen years later, its patients are sicker than ever before, its staffing levels are inadequate, and its new CEO is earning $13 million per year.” Fun fact: 58% of U.S. hospitals are “nonprofit” (20% public, 21% for-profit). Fun quote: “At the heart of the matter is the conversion of health care from social good to a commodity”—spoken not by a critic but by a hospital CEO.

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Mary Beth Pfeiffer, “In far-flung places, COVID-19 is being treated early and well. Here’s why Americans don’t know this,” Trial Site News, Dec 27, 2020

Government and industry in the U.S. downplay therapeutic successes and sometimes even undermine them with alarmist statements. Meanwhile, fortunes are to be made in vaccines. Probably a coincidence. “At isolated hospitals and nursing homes, in parts of India and Africa, in countries like Bangladesh and Egypt, and even in a few American doctors’ offices, COVID-19 is quietly and effectively being managed. Fewer patients in those places go to hospitals. Those admitted don’t stay as long. Fewer die.” But the treatment debates have been hyper-politicized; if Trump mentions a drug, it’s automatically snake oil. “Drug companies, meantime, invest only in new and expensive treatments,” like remdesivir. Others get censored by Twitter and YouTube. Also includes a theory of why some African countries are getting hit less hard by Covid.

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Harold Brubaker, “New Jersey may be the first state to impose per-bed fees on nonprofit hospitals for municipal services,” Philadelphia Inquirer,” Dec 23, 2020

The state is making hospitals’ property-tax exemption contingent on better fulfillment of their contractual responsibility to provide community service, including indigent care. The action comes “in response to a landmark 2015 New Jersey Tax Court ruling involving Morristown [NJ] Medical Center that ‘the operation and function of nonprofit hospitals do not meet the criteria for property tax exemption’ under state law.” Cities have taken 40 of the state’s 60 nonprofit hospitals to tax court.

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Connor Perrett, “The US is vaccinating people way too slowly. A top doctor says the federal government is to blame,” Business Insider Australia, Dec 30, 2020

Dr. Ashish K. Jha, dean of Brown University’s School of Public Health: “The worst part is no real planning on what happens when vaccines arrive in states. No plan, no money, just hope that states will figure this out.” Public health departments have been starved of funds, trashed by Trump, and attacked by the meatheads and now are supposed to perform miracles.

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David Wallace-Wells, “America’s vaccine rollout is already a disaster,” New York Magazine, Dec 30, 2020

The U.S. is failing, says the author, “in precisely the same way as we did earlier in the year” at test, trace, isolate. Why would we succeed at distribution and administration? “Despite the horrible continuing brutality of this pandemic and the incredible efforts and good intentions of health-care workers, we are, practically speaking, not even bothering to try to end it.”

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Scott Squires & Jake Rudnitsky, “Argentina kicks off vaccination drive with Russia’s Sputnik,” Bloomberg, Dec 29, 2020

The Russian shot costs $20; poorer countries are likely to use it and/or Chinese alternatives. The U.S. would rather restart the pandemic than contemplate such a thing.

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Alfred Engelberg, “Unaffordable prescription drugs: the real legacy of the Hatch-Waxman Act,” STAT, Dec 16, 2020

Detailed explanation of how Pharma gamed the “compromise” with the generic drug industry. “How is it possible to have a prescription drug price crisis when 90% of prescriptions are filled with generic drugs that cost, on average, $1 a day? The answer: The remaining 10% of prescriptions have an average cost of $20 a day and account for 80% of all prescription drug spending.” A real solution would entail empowering Medicare to negotiate prices down.

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