SINGLE PAYER LINKS #285

Posted 24 DEC 2022

Hi all, There will be no LINKS next week as I need to recharge my snark battery. So that's it for 2022. Happy whatevers & rest up!

Tim

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Bernard J. Wolfson, “ER doctors call private equity staffing practices illegal and seek to ban them,” Kaiser Health News/States Newsroom, Dec 22, 2022 READ IT HERE

Pushback against the corporate practice of medicine, banned in 33 states and the District of Columbia but pervasive nonetheless. Finally, doctors are stepping up to block the insalubrious influence of PE firms like Envision (owned by KKR) and TeamHealth (owned by Blackstone). PE now manages one quarter of all ERs in the country. Plaintiffs in a California lawsuit accuse Envision of using “shell business structures to retain de facto ownership of ER staffing groups.” A plaintiff attorney said the doctors aren’t interested in the usual cash settlement following by business as usual but rather a ban on the whole model. The California Medical Association supports the lawsuit, and individual doctors elsewhere are filing complaints against shell company front doctors with state A-Gs and medical boards. Expect many losses before any progress against the infiltration of MBAs into the practice of medicine.

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Heather Landi, “Healthcare companies’ default risk steadily rising, with most owned by private equity: Moody’s,” Fierce Healthcare, Dec 12, 2022 READ IT HERE

Not all are making bank, and deteriorating economic conditions plus “social risk” (i.e., we hate you) are obscuring the sector’s financial prospects. “About 80% of North American healthcare companies are now speculative grade,” meaning that they might not be able to pay off any borrowing they undertake. One factor involved is the private equity invasion that saddles physician practices and hospitals with high levels of debt while extracting quick profits. Two of the most indebted companies: Envision and Team Health [see above].

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Hailey Mensik, “For most of COVID-19 pandemic, major for-profit hospitals’ operating margins exceeded years prior,” Healthcare Dive, Dec 5, 2022 READ IT HERE

The health industry media are full of news about failing hospitals, but some large systems are unaffected or even thriving. “Operating margins [profits] at the three largest for-profit healthcare systems in the country—HCA Healthcare, Tenet Healthcare and Community Health Systems—have exceeded pre-pandemic levels.” Their stock prices have also gone through the roof—CHS was up 383% in three years.

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Dave Muoio, “Faced with costly discharge bottlenecks, hospitals want Congress to pay for patients’ extended stays,” Fierce Healthcare, Dec 6, 2022 READ IT HERE

Meanwhile, the hospital lobby wants new payments from Medicare for “patients who are ready to leave the hospital but have nowhere to go.” Since the warehousing costs hospitals money, they want a new, “temporary” reimbursement. Rehab facilities of all sorts are “facing discharge logjams due to industrywide workforce shortages.”

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Jacob Bell & Shaun Lucas, “For ALS patients, doctors, a new medicine reignites concerns about healthcare access,” ProPublica/BioPharma Dive, Dec 15, 2022 READ IT HERE

It’s unfair that people with ALS (amyotrophic lateral sclerosis) are blocked from getting a medication that might help them because they have lousy health insurance. OTOH, when a drug is priced in six figures that offers at best “modest” benefits, the problem is deeper than insurer greed. A new ALS drug is coming on the market, and desperate patients are clamoring for it—at a cost of $170,000 per year. Given the manipulation of drug trial outcomes by interested parties, who knows if the stuff does any good? “At an advisory committee meeting, FDA staff were critical of the ways Amylyx [the company] collected and analyzed data, and the committee narrowly sided against the drug. Six months later, the second meeting had the opposite outcome.” Shades of Aduhelm? Drug access is one thing; enriching Pharma is another. “Consensus among Wall Street analysts is that Relyvrio at its peak will generate $900 million to $1 billion in annual sales.”

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Dean Baker, “We don’t need government-granted patent monopolies to finance drug development,” Center for Economic and Policy Research, Dec 14, 022 READ IT HERE

The industry defends crazy pharmaceutical costs in the name of expensive R&D. Baker argues that alternatives exist: he notes, for example, that Corbevax, an open-source Covid vaccine developed at a Texas pediatric hospital, uses public technology, “and there are no patents or other restrictions preventing its manufacture anywhere in the world.” It’s easy to produce, costs $2 a shot, and works. Even though 70 million people in India have received it, no billionaires were created (unlike Moderna’s five). “If the next great cancer drug sells for a few hundred dollars, instead of a few hundred thousand, it will be hard to ignore.” One, two, many Corbevaxes.

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Joseph Choi, “Biden administration approves Washington state request to offer health insurance to undocumented immigrants,” The Hill, Dec 12, 2022 READ IT HERE

Now the undocumented can buy into ACA plans through state exchanges and enjoy the high deductible/high copay benefits that full citizens get.

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Heather Landi, “10 healthcare companies that hit $1B valuations in 2022,” Fierce Healthcare, Dec 19, 2022 READ IT HERE

Startups valued at over $1 billion are known as “unicorns.” Now the healthcare sector has some despite the “market downturn and investor caution.” Among the favored firms: staffing platforms that provide travel nurses and AI-powered analysis and diagnostic companies.

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Dave Muoio, “New Jersey’s Cooper University Health Care, Cape Regional Health System unveil $2.2B merger,” Fierce Healthcare, Dec 15, 2022 READ IT HERE

More consolidation: The merged system would include 900 beds at two hospitals plus six urgent care centers and 130 ambulatory locations in PA and NJ. The FTC blocked an earlier merger of two large hospital systems in New Jersey.

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Samantha Liss, “Scan Group, CareOregon to merge, forming $6.8B health plan,” Healthcare Dive, Dec 15, 2022 READ IT HERE

The new nonprofit outfit will have nearly 800,000 Medicaid and Medicare members in five states. They argue that they’re at a disadvantage with for-profit competitors like Centene with 15 million Medicaid enrollees. Could be true as all the consolidating sectors slug it out for an ever-larger share of the pie.

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Andrew Joseph, “Limits of ‘Fauci effect’: infectious disease applicants plummet, and hospitals are scrambling,” STAT, Dec 7, 2022 READ IT HERE

“The lack of doctors entering ID fellowships—and the ensuing shortage of these specialists—has been a concern for years, with experts pointing to the comparatively low earnings these physicians make as a major disincentive.” Now, it’s gotten much worse due to the politicization of the field and the Covid debacle. Who would want the grueling workloads and public hostility?

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Bob Herman, “Cancer patients endure an overlooked financial burden: hospital parking fees,” STAT, Dec 7, 2022 READ IT HERE

“Parking fees consistently come up, unprompted, in conversations that oncologist Mustafa Al Balushi has with his patients. ‘That’s a major concern when you tell them they need to come to the hospital every single day for the next five or six weeks.’” And that’s in Canada with a single-payer system. Parking rates at New York hospitals are often $30 or more per day. “Financial toxicity” is the idea that having a serious illness like cancer is made worse when people may have to cope with both direct and indirect expenses like this one, plus lost income.

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Robert King, “Pharmacies slam Cigna and Express Scripts for shrinking TRICARE network by 15K,” Fierce Healthcare, Dec 7, 2022 READ IT HERE

Monopoly power at work: “Pharmacy groups say Cigna and Express Scripts are trying to steer TRICARE members to their own mail order or specialty pharmacies.” They’re shrinking the network by offering contract terms to independents “with rates below the cost of drugs.” TRICARE serves veterans (“Thank you for your service—now pay up.”)

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Samantha Liss, “The Advocate-Atrium merger closed without an antitrust challenge. What does that mean for competition in 2023?” Healthcare Dive, Dec 22, 2022 READ IT HERE

“Health systems have morphed into multi-regional players through acquisitions, but have evaded federal antitrust enforcement”—so far. The FTC didn’t go after this one, but it has blocked others and its awakening from a long slumber is cooling the merger mania generally. The difference in this case is that it’s “cross-market”; because the combined hospitals don’t currently compete with each other, the FTC couldn’t argue the threat of monopoly pricing in a single metro area. That doesn’t mean anticompetition enforcement won’t catch up with such mergers in the future. Advocate-Atrium is now the fifth-largest nonprofit hospital conglomerate with 67 hospitals in six states and employs 21,000 physicians.

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Erica E. Phillips, “Legislators: Day Kimball takeover could limit health care in region,” CT Mirror, Dec 22, 2022 READ IT HERE

Double-whammy: further consolidation of the hospital sector in Connecticut, which tends to make costs rise, plus the takeover by out-of-state and Catholic-owned Covenant Health means fewer reproductive health services. “Day Kimball is one of a dwindling number of independent hospitals left in Connecticut, many of which have faced extreme financial challenges during the pandemic years.”

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Zach Hirsch, “In Florida, ‘health freedom’ activists exert influence over a major hospital,” NPR, Dec 21, 2022 READ IT HERE

Three local citizens got themselves elected to the board of a public hospital in Sarasota. They want to dismantle vaccine mandates and block treatments. But the tactic could be used by others. “While most of the 6,000 hospitals in the United States are privately-run, about 200 are controlled by publicly-elected board members.” As usual, the right-wingers come up with the most creative direct-action tactics.

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Christine Spolar, “Centene, under siege in America, moved into Britain’s National Health Service,” Kaiser Health News/St. Louis Post-Dispatch, Dec 22, 2022 READ IT HERE

The Tory goal of privatizing the NHS takes a giant step forward: “In the final days of 2020, a Centene subsidiary, Operose Health, took over nearly three dozen medical practices in London—gateways for NHS care. [Centene] became the largest private supplier of general practice services in the United Kingdom” and now handles 570,000 patients. Centene has paid $657 million in fines to settle overbilling allegations in 15 states, but that’s no obstacle to getting big U.K. contracts. And then there’s the revolving door greed to be satisfied: “Advocates for market-based efficiencies, including former NHS chiefs who were hired by Centene-related businesses, portray the managed-care titan as a change agent that can innovate and trim costs.” Innovation! Because new=good.

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Fred Schulte & Holly K. Hacker, “How Medicare Advantage plans dodged auditors and overcharged taxpayers by millions,” Kaiser Health News/NPR, Dec 13, 2022 READ IT HERE

“Health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.” Insurers claim to have lost damning files in floods and warehouse fires or through administrative error or because the doctors involved had moved, retired, or died. Only about 5% of Medicare Advantage plans are audited yearly, so fudging the books is rarely detected—especially if you then lose the books.

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Frank Diamond, “Genetic testing lab owner convicted in $463M Medicare fraud case,” Fierce Healthcare, Dec 15, 2022 READ IT HERE

Even at today’s inflated prices for everything, that’s real money. “Patient brokers, call centers, and telemedicine companies also allegedly cashed in, as [convicted mastermind] Patel paid them kickbacks and bribes after the Medicare beneficiaries agreed to take the tests.” Good to see inspectors at work though one wonders how nobody noticed something fishy while the scheme was racking up half a billion in fake reimbursements.

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Nathaniel Weizel, “Panel recommends leadership overhaul at FDA food program,” The Hill, Dec 6, 2022 READ IT HERE

Fallout from the baby formula scandal: a report says the Food half of the FDA is rudderless, reactive, “risk-averse,” and reluctant to use its enforcement powers. A shake-up is anticipated. Good, now do the Drug side, which is worse.

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SINGLE PAYER LINKS #284

Posted 16 DEC 2022

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Heather Landi, “Mark Cuban's drug company targets self-insured employer market,” Fierce Healthcare, Dec 9, 2022 READ IT HERE

Cuban’s experiment to bring down drug costs now moves from a direct-to-consumer service to the employer-based group coverage market by connecting with a PBM (Pharmacy Benefit Manager) characterized as a “pipeline for lower-cost medicines.” Worth watching.

Sorry, that’s ALL the good news for this week.

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Greg Jasani, “If you think health care is dysfunctional now, just wait until after January 1,” STAT, Dec 8, 2022 READ IT HERE

Primary care docs are sounding the alarm about proposed cuts in Medicare reimbursement rates scheduled for 2023. But this ER physician has another set of worries: people who can’t access primary care at all. ER docs like him find themselves managing diabetes and high blood pressure instead of gunshot wounds and heart attacks. “Ensuring that a patient with diabetes is controlling their blood sugar is far less expensive than having that patient be rushed to an emergency department in a diabetic coma.” But the for-profit incentives determine how medicine is practiced.

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Sanjula Jain, “Deferral of primary care signals a troubled future for Americans’ health,” STAT, Dec 7, 2022 READ IT HERE

There are new investment opportunities! Because primary care visits are down 10% relative to pre-pandemic levels, diagnoses that might have been caught early will show up as more serious ones later. Life science companies see “an increasing burden of chronic disease,” and M&A activity is intense in rare diseases, cardiovascular disease, and immuno-oncology.

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Liz Szabo, “Hospital financial decisions play a role in the critical shortage of pediatric beds for RSV patients,” Kaiser Health News/CBS News, Dec 9, 2022 READ IT HERE

The dire shortage is “a byproduct of financial decisions made by hospitals over the past decade.” Pediatric units, down 19% in a decade, are less profitable than those for adults or specialty operations like joint replacements (partly because Medicaid reimbursement rates suck). The profit logic is inexorable. “There’s no incentive for hospitals to provide money-losing services.” So, they don’t.

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Heather Landi, “UnitedHealthcare, AARP team up to lower the cost of hearing aids,” Fierce Healthcare, Nov 18, 2022 READ IT HERE

The headline might as well have been written by UH’s PR squad with the enthusiastic endorsement of AARP, its partner in line for a cut. (They have a huge insurance deal that taps into the AARP membership.) “Prices start as low as $699” reads the article—couldn’t the reporter just livestream the company’s ads and decamp to a stenography course? It continues with bleats from UH executives about how much they care about “the whole health of an individual.” The hearing aid biz has long pushed devices on people who could get along without them as evidenced by this subtle wording of cool new offers “for people with self-diagnosed mild to moderate hearing loss.” After a hearing screen by this team, you can pretty much bet the recommendation will be BUY.

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Kenny Stancil, “‘Heartbreaking’ and ‘pathetic’: U.S. obstructs patient waiver for Covid tests and treatments,” Common Dreams, Dec 6, 2022 READ IT HERE

“In June, Big Pharma-aligned policymakers—most of them from highly vaccinated rich countries—defeated a popular proposal to waive coronavirus-related patents to boost the global supply of jabs, diagnostics, and therapeutics.” Biden has no interest in alienating his Pharma pals.

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Emily Baumgaertner, “A rural hospital’s excruciating choice: $3.2 million a year or inpatient care?” New York Times, Dec 9, 2022 READ IT HERE

The federal government offers to resuscitate rural hospitals with infusions of cash but on condition that they end all inpatient care. Huh? To get the bailout, they have to become “rural emergency hospitals” and discharge or transfer all their patients to bigger hospitals within 24 hours. Declining volume means the rural units can’t survive in the cutthroat world of hospital economics—but why should they have to? The small hospitals will have to beg bigger ones to take their patients who will then be transported sometimes hundreds of miles while in delicate health. One in every 12 rural jobs will disappear. What could go wrong?

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Rebecca Pifer, “CMS proposes new prior authorization requirements for payers, including MA plans,” READ IT HERE and “Payers, providers applaud new CMS prior authorization rule,” Healthcare Dive, Dec 7 & 8, 2022 READ IT HERE

One important change if new rule is finalized: Medicare Disadvantage can’t get away with denials as easily as before when patients and doctors had the hassle of appealing (which they won in 75% of cases, so it’s just a money-saving delay tactic). Downside: It won’t take effect until 2026.

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Alex Ruoff, “Progressives say insurers on Medicare pilot have fraud history,” Bloomberg Government, Dec 9, 2022 READ IT HERE

Who doesn’t these days? But the geniuses behind the stealth Medicare privatization scheme known as ACO REACH aren’t budging so far. The program, previously called direct contracting, hands for-profit insurance companies a cohort of (coerced) Medicare enrollees in exchange for a lump sum payment. The temptation to cut back on care and keep the cash will be irresistible. Nine of the companies involved in the Trump-era version of the program (Centene, Sutter Health, Humana, Cigna) “have been accused of health care fraud or settled fraud allegations.” None have been excluded from further contracts.

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Nicholas Florko, “Hundreds of incarcerated people are dying of hep C—even though we have a simple cure,” STAT, Dec 15, 2022 READ IT HERE

“Over one thousand people died of hepatitis C-related complications in states’ custody in the six years after the first cure, a Gilead antiviral drug called Sovaldi, hit the market in late 2013.” Lots of quotes from people like Francis Collins and Chelsea Clinton about how terrible that is without addressing the underlying reason: the crazy price Gilead charges for the drug—that it bought in an acquisition. After an outcry, Gilead dropped its price from $84,000 to $24,000 per course of treatment, but that is still far too high to get states to shell out. “In many cases, prison officials did not simply fail to act, but actively erected barriers to hepatitis C testing … to ensure they wouldn’t have to treat as many people.” The worst states: Indiana, Iowa, Nebraska, West Virginia, South Dakota, and Georgia. Federal prisons do somewhat better.

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Paige Minemyer, “Employers estimate health benefits costs will rise 5.4% next year,” Fierce Healthcare, Dec 8, 2022 READ IT HERE

Total health benefit costs per employee reached $15,013 on average in 2022, up 3.2% YoY. How are managers responding? “High-performance networks and high-value care,” whatever those mean. More practical: jack up deductibles so that workers don’t use their insurance.

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Rebecca Pifer, “National health spending reached $4.3 trillion in 2021,” Healthcare Dive, Dec 14, 2022 READ IT HERE

What are we getting for all that money, $12,914 per person per year or 18.3% of GDP? Clearly, resources are not the problem but how they’re used. “Private health insurance remained responsible for the largest percentage of total health expenditures by payer type, at 28%.” Out-of-pocket spending was up 10%, and hospitals “continue to rake in the lion’s share of U.S. healthcare dollars overall”—yet many are in the red. Go figure.

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Arwa Mahdawi, “The hospital wants $83,135 for saving my wife. She’s worth it—but where did that figure come from?” Guardian, Dec 14, 2022 READ IT HERE

“How on earth could it cost so much money to remove an appendix? This is just what happens in the US: there is no fixed price for anything … they just pluck extraordinarily large numbers out of the air, and all parties involved—insurance company, medical provider, patient—haggle until a slightly smaller large number is agreed upon.” Pretty accurate description—the couple asked for an itemized bill and saw several charges disappear. But for that they had to spend several hours on hold with various insurers, “listening to music that I swear is formulated by psychologists to drive you crazy and force you to put the phone down in frustration.”

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Paul Nuki, Ben Butcher, Jorg Luyken & Henry Samuel, “The NHS is now no match for its foreign counterparts. These are the alternatives,” Telegraph (U.K.), Dec 10, 2022 READ IT HERE

NHN=National Health Service, Britain’s socialized medicine system. “The number of people on NHS waiting lists in England [is] now at 7.2 million—12 per cent of the population. Not surprisingly, many are starting to vote with their feet.” Starve the public service, denounce its delays and errors, promote privatization, rinse & repeat. “The number of patients paying for private treatment in the UK is up 39% over the past two years.”

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Katie Palmer, Todd Feathers & Simon Fondrie-Teitler, “‘Out of control’: Dozens of telehealth startups sent sensitive health information to big tech companies,” STAT/The Markup, Dec 13, 2022 READ IT HERE

Telehealth companies take your private info and sell it to big tech advertisers. Included among the tracking firms: Meta, Google, TikTok, Bing, Snap, Twitter, LinkedIn, Pinterest. The sites ratting you out to them: industry leaders Hims & Hers, Ro, Thirty Madison. WTF happened to HIPAA, the supposed protection of medical privacy?? The only telehealth platform that the analysis did not find sharing data with outside tech giants was Amazon Clinic, a platform probably launched too recently to get in on the game. “I thought I was at this point hard to shock,” said Ari Friedman, an emergency medicine physician who researches digital health privacy. Lesson: You can never be too rich, too thin, or too cynical. The reporters created fake identities complete with email and social media accounts, then watched network traffic to see their intimate data shipped off immediately online.

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Alex Philippidis, “Amgen to acquire Horizon for $27.8 billion, expanding rare disease pipeline,” Genetic Engineering & Biotechnology News, Dec 13, 2022 READ IT HERE

The year’s biggest biopharma acquisition deal to date to make up for the end of patent protection for its current moneymaker. There must be a lot of reimbursement potential in the new company’s products to make it worth that sale price.

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Nikesh Patel, “Physical and occupational therapy are on the Medicare chopping block,” MedPage Today, Dec 13, 2022 READ IT HERE

PT and OT face a cut of 4.5% for 2023. “The continued practice of annual Medicare cuts threatens the sustainability of the country's physical and occupational providers, especially in rural and underserved areas where they are needed most.” Why are any covered services facing cuts in a high-inflation environment??

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Elise Takahama, “WA hospitals start cutting services as huge financial losses continue,” Seattle Times, Dec 13, 2022 READ IT HERE

With all the money sloshing around the healthcare sector, why are so many hospitals crashing financially? The personnel shortage is forcing many to hire expensive travel nurses, but that still doesn’t explain everything. Cuts in auxiliary services means 10-20% of beds in Washington State are occupied by patients with nowhere to go because long-term facilities are also understaffed.

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Liz Carey, “Traveling oral surgeon meets small-town people where they live,” CT Mirror/Daily Yonder, Dec 3, 2022 READ IT HERE

Stories like these, which are very popular and could fill a news museum, use depoliticized human interest to show how people respond individually to structural injustice. The subjects are truly admirable, like this heroic dentist who brings people dental care. But his efforts are a drop in the huge empty bucket of unmet need built into the system. “Reaching rural residents who may not otherwise have access to oral surgeons has been a calling since Lewis’ sophomore year in college.” But: “Over 46 million Americans live in a dental health professional shortage area.” Maybe another quarter million Dr. Lewises would cover it.

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Susan Kelly, “18M projected to lose Medicaid coverage at end of COVID-19 emergency,” Healthcare Dive, Dec 6, 2022 READ IT HERE

Some will pick up (often worse) coverage on the exchanges, but 19 states could see rates of uninsured spike by 20% or more. If it coincides with the expected recession, holy moley.

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Noah Weil & Sarah Kliff, “For the uninsured, Covid care has entered a new stage of crisis,” New York Times, Dec 6, 2022 READ IT HERE

When the nation faced a “public health emergency” that could interrupt business, you mattered. Now that it’s “over,” you don’t. “Difficulty getting care for Covid-19 has become an increasingly common problem for poor, uninsured Americans. After paying about $25 billion to health care providers over the course of the pandemic to reimburse them for vaccinating, testing, and treating people without insurance, the federal government is running low on funds for Covid care for the nearly 30 million Americans who are uninsured.” Biden soon will allow treatments and vaccines to go commercial, so we’re on our own once again. But see below! A solution!

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Rhiannon Williams, “A new app aims to help the millions of people living with long covid,” MIT Technology Review, Dec 5, 2022 READ IT HERE

“A new app could help people with long Covid cope with their condition by giving them a clearer understanding of what helps—and hinders—their health.” The new app, called Visible, helps people “by collecting data every day” on their symptoms. And someone probably can use that, maybe Google or perhaps Amazon. So, you may die, but think of it as advancing Science™.

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SINGLE PAYER LINKS #283

Posted 9 DEC 2022

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Rebecca Pifer, “Cleveland Clinic losses top $1.5B amid inflation pressures,” Healthcare Dive, Dec 1, 2022 READ IT HERE

Down a billion-five just in the first nine months of 2022, due in part to staffing shortages that have to be plugged with expensive travel nurses and temps. But also, “The Ohio-based system’s investment losses totaled almost $1.3 billion in the first nine months of 2022” v/s a profit of $1.1 billion last year. So, a good part of the lamentation is that the hospital’s stock portfolio is down, boo hoo.

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Sydney Halleman, “UnitedHealth Group projects up to $360B in 2023 revenue, buoyed by Optum growth,” Healthcare Dive, Nov 30, 2022 READ IT HERE

Meanwhile, the insurers are making out like bandits. UH gobbled up Optum Insight recently, which is anticipating “double-digit revenue growth over the long term” especially in Medicare Disadvantage and “commercial risk-based plans.” The DoJ is appealing a court’s decision to allow the merger.

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Hailey Mensik, “Hospitals to end year with negative margins, Kaufman Hall reports,” Healthcare Dive, Nov 30, 2022 READ IT HERE

So why are some hospitals drowning in red ink? “Ongoing staffing shortages are a key contributor to the heightened expenses facing hospitals today.” And ER visits are up sharply. Still, the picture isn’t complete.

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Dave Muoio, “Texas hospitals warn of rural closures, care delays and service cuts without legislative support,” Fierce Healthcare, Nov 30, 2022 READ IT HERE

One out of ten hospitals in Texas is teetering; for rural hospitals, it’s one in four. (In Mississippi, half.) Labor expenses are up 20%, and medical supplies cost around 8% more. Emergency Covid funding staved off the worst—that’s now ending.

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Brian J. Miller & Jesse M. Ehrenfeld, “Stop hospital consolidations to lower health care prices for all Americans,” The Hill, Nov 28, 2022 READ IT HERE

“Half of the nation’s health care expenditures are spent on care delivered in hospitals and clinics, both markets suffering from the ills of monopoly. . . . 90 percent of metropolitan statistical areas [are] considered highly concentrated for hospital care,” exacerbated by hospitals now buying up physician practices. The authors detail typical monopoly practices by the hospital giants, which are “nonprofit” in name only. They recommend changing regs so that more procedures can take place outside of hospitals, and they seem to endorse the tougher FTC posture on new mergers.

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Susan Kelly, “Advocate Aurora plans to hike rates at Wisconsin locations,” Healthcare Dive, Nov 30, 2022 READ IT HERE

Advocate Aurora just announced a merger with Atrium Health to create a 67-hospital monster in six states. Naturally, prices had to go up immediately.

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Heather Landi, “Digital health VCs eye healthcare workforce, cancer care as ripe for startups in 2023,” Fierce Healthcare, Dec 2, 2022 READ IT HERE

VC=venture capital looking for new profit opps (“value creation”) in healthcare. There’s a lot of money out there trying to go forth and multiply, and “digital health” attracted a whopping $29 billion last year, up nearly 100%. But VC cash kings don’t want any old boring biz making a silly little profit; rather, “those that have that stellar ROI, not 30% 40%, but 2x, 3x and 5x, even 10x.” ROI=return on investment, and 2x means your profits on invested capital are 100%. Where can such gold be mined in healthcare? “With ongoing labor shortages and clinician burnout reaching sky-high levels, startups that use technology to address workforce challenges and administrative burdens will be a hot sector next year.” For example, “using computer vision and AI to correctly triage people and to finish clinicians’ notes, which allow visits to happen faster,” as well as “reimbursement models” and specialized fields like home oncology care. Anticipate robotic (“digital”) services in these areas that will seamlessly separate you from the contents of your wallet.

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Rachana Pradhan, “The business of clinical trials is booming. Private equity has taken notice,” Kaiser Health News/Fortune, Dec 2, 2022 READ IT HERE

Those expensive clinical studies can provide a huge ROI, so of course PE is interested. Plus, Pharma already knows how to manipulate them to produce the desired results. “That is why a private equity-backed startup like Headlands Research saw an opportunity in creating a network of clinical sites and wringing greater efficiency” for Moderna, Pfizer, Biogen et al. Headlands is a creature of financiers KKR who tout their expertise in “bringing ethnically diverse populations” to their studies. So don’t dare criticize them. There are nearly half a million ongoing clinical trials, more than triple than were running only ten years ago.

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Rebecca Pifer, “One Medical’s innovation chief on Amazon, Medicaid and more,” Healthcare Dive, Nov 18, 2022 READ IT HERE

One Medical, recently acquired by Amazon for $3.9 billion (pending FTC action), is expanding its business “beyond the healthy, wealthy well and into the riskier—but potentially more lucrative—Medicare environment” where it cashes in on Medicare Disadvantage and direct contracting. Also, they have a “huge interest” in Medicaid. The CEO said proudly, “Imagine a world where we can serve you when you’re young through our pediatrics programs. And then you start getting your first job and work for an employer who’s paying for One Medical. You happen to leave that employer, you can pay a membership fee yourself. You become a senior, you join a plan, we serve you.” Sounds like a great, integrated system—why does it need a for-profit intermediary?

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Rebecca Pifer, “UnitedHealth’s $5.4B buy of LHC expected to close in Q1,” Healthcare Dive, Dec 7, 2022 READ IT HERE

UnitedHealth=largest health insurer in the country; LHC Group=a home health and hospice provider. The Federal Trade Commission is holding it up. “Antitrust regulators have been a thorn in the side of UnitedHealth’s M&A plans this year.” As they should be. “Analysts said that acquiring home health assets made sense for large Medicare Advantage insurers, allowing them to track patients’ health conditions and coordinate in-home care.” And extract maximum profits at each stage of life.

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Rebecca Pifer, “Elevance plans to continue aggressive M&A, CEO says,” Healthcare Dive, Nov 15, 2022 READ IT HERE

Elevance Health, one of the largest insurers in the U.S., will “aggressively pursue acquisitions” in things like palliative care and home-based nursing.

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Rebecca Pifer, “Google, Epic partnering to allow Epic hospital clients to run EHRs on Google Cloud,” Healthcare Dive, Nov 14, 2022 READ IT HERE

Google Cloud and Epic, the largest electronic health records company in the U.S., are joining forces. Epic had previously allowed itself to be courted by Microsoft and Amazon “as Google faced a wave of backlash over the ethicality of its data-sharing agreement with hospital chain Ascension.” But all is forgiven apparently. And “Google is increasingly pursuing new integrations and partnerships, including with academic medical center Mayo Clinic and for-profit behemoth HCA.” Bigger, always bigger.

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John Ingold, “Colorado officials accused of unfairly boosting a [Governor] Polis health insurance policy,” Colorado Sun, Dec 2, 2022 READ IT HERE

What would happen if we actually had a national “public option” like the one Colorado established to rein in costs? For-profit rivals screaming “unfair” from the rooftops. Meanwhile, HHS allows Medicare Disadvantage plans to flood the airwaves to benefit owners. “The Colorado Option, created by the legislature last year, is a government-designed health insurance plan that offers a standardized set of benefits. It is then priced and sold by private insurance companies on the open market at premium rates that are mandated by law to eventually drop to 15% below 2021 levels, taking into account inflation. If prices don’t drop enough, the state insurance commissioner will be able to step in and dictate hospital prices to achieve the premium reductions.” Can’t have that.

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Lisa Gutierrez, “New KCK pharmacy dispenses bargain medicine and hope,” Kansas City Star, Nov 27, 2022 READ IT HERE

A charity-based Christian pharmacy tries to brings drugs to people who can’t afford their prescriptions or don’t take them as indicated due to cost. A noble project that is a drop in the bucket of need.

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Thomas Neuburger, “Will Mark Cuban’s Cost Plus Drugs venture finally disrupt Big Pharma?” God’s Spies, Dec 1, 2022 READ IT HERE

Cost Plus provides certain medications at cost + 15%. Can this model work to end “ridiculous” drug prices? For example, it offers a generic iron reducer that typically costs $2,332 for $15. The author says the promising scheme could fail in three ways: (1) Cuban decides he’s bored, and his company is bought by someone who then kills it. (2) Pharma gets its government toadies to outlaw it somehow based on “unfair competitive advantage” or something. (3) Cuban wakes up to find a horse’s head in his bed. Or anonymous “intelligence officials” assure us he’s an agent of Vladimir Putin. (I added that one.)

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Rebecca Pifer, “UnitedHealthcare loses lawsuit to TeamHealth—again—in ongoing battle over billing,” Healthcare Dive, Dec 2, 2022 READ IT HERE

King Kong v. Godzilla: In the years-long dispute between the nation’s biggest insurer and a PE-backed provider group, UH has had to pony up a half billion dollars to settle multiple lawsuits for underpayment. OTOH, “Physician groups like TeamHealth are often fingered as a major driver of out-of-network spending as their clinicians are often out-of-network even at in-network facilities, leaving them free to charge patients unexpected rates even after collecting a portion of the bill from a patient’s insurer.” The Gambinos denounce the Bonnanos while squeezing the Colombos. “In 2020, [UH] canceled its in-network contracts with PE-backed U.S. Anesthesia Partners in Texas [and] cut Envision’s 25,000 clinicians from its network, citing high prices.”

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Heather Landi, “Google Health strikes deal with iCAD to commercialize mammography AI,” Fierce Healthcare, Nov 28, 2022 READ IT HERE

Oh good, now Google Cloud will be able to ID you through your privates, how comforting. Next up: prostate screens. I wonder if the passport office will strike a deal with them.

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Frank Diamond, “4 ways Medicaid could manage high-price drugs,” Fierce Healthcare, Nov 21, 2022 READ IT HERE

Medicaid [though not Medicare] “must cover all drugs approved by the FDA, even the ones OK’d via the accelerated approval program. Those meds can be very expensive, while also lacking complete efficacy data.” AIDS activism created this unintended consequence, which Pharma exploited. State programs fear getting their budgets crushed by having to pay insane prices that drug owners can set arbitrarily. The authors lay out some needed reforms—none of them easy to get through the heavily lobbied Congress or past industry-captured Medicare/Medicaid administrators.

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Ava Kofman, “How to research your hospice (and avoid hospice fraud): A guide for readers, patients and caregivers,” ProPublica, Dec 6, 2022 READ IT HERE

Since we now know that PE and fraudsters are worming their way into the hospice sector, we need a guide to keep our loved ones from being either shoved into hospice when they’re not dying or getting pushed out of their wheelchairs when they linger too long for the accountants. Recommended rating sites includes Hospice Compare, the National Hospice Locator, and Ever Loved. Meanwhile, inquire of any hospice whether they are nonprofit or for-profit, who owns them, and what motivated them to go into the field. Red flags include: being enrolled without your permission, being enrolled without physician certification (or a forged one), offers of gifts or cash. Also, beware of hospice agents prowling around nursing homes. Sheesh.

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Matthew Narvaiz, “End of the line: Why some New Mexicans may no longer qualify for Medicaid next year,” Albuquerque Journal, Nov 27, 2022 READ IT HERE

Covid measures included a suspension of the annual requalification requirement for Medicaid. Once the extra federal funds run out, millions face getting thrown off. The new budget burden on states will reinforce the fears (or hostile arguments) of conservatives in the non-expansion states. Also, how will making people give up health benefits because of “excess” earnings affect all those low-level jobs that are going unfilled?

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Jess McAllen, “The sick proletariat,” The Baffler, Dec 5, 2022 READ IT HERE

Radical action around healthcare was key for the Black Panthers and Young Lords who once “commandeered a mobile chest X-ray unit and took it to East Harlem to test the many residents affected by tuberculosis.” The Jane Collective facilitated illegal abortions, and then there was ACT UP. This review of a provocative new book called Health Communism contains this timely comment for New York City: “Critiques of psychiatric control should be focused on the austerity that leads to the choice between medication or incarceration.”

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SINGLE PAYER LINKS #282

Posted 2 DEC 2022

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Matthew Cunningham-Cook & Rebecca Burns, “Senators help donors derail paid sick days,” The Lever, Dec 1, 2022 READ IT HERE

Although Democrats escaped the predicted mid-term slaughter, they apparently concluded that they can now screw workers without electoral consequences. “The rejected proposal to provide rail workers sick leave would have cost railroad barons [Warren Buffett et al.] just four days’ worth of their recent profits.” Biden can make all sorts of tweaks to Obamacare and brag about them, but for workers without sick days, it won’t mean diddlysquat. Biden promised paid sick leave for all in 2020—imagine what Trump could do with those clips in 2024.

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Ava Kofman, “Endgame: How the visionary hospice movement became a for-profit hustle,” ProPublica/New Yorker, Nov 28, 2022 READ IT HERE

A long piece on a huge new grift, the story of easy (federal) money and “an industry rife with fraud and exploitation,” shocking even for the cynical: hospice patients don’t rack up high costs, and Medicare pays based on numbers. What could go wrong? Unscrupulous for-profit companies can pull in patients not really terminal and dump them before the 6-month limit to protect their reimbursements. Don’t miss the story of the corrupt judge protecting the industry while her son coincidentally gets hired as an intern as well as the sidebar on the DoJ lawyer who tried to sell the top-secret identities of whistleblowers to targeted companies (and is getting a short prison term). Private equity is involved as well, of course, to cash in on the “$22 billion juggernaut funded almost entirely by taxpayers.” Family members, beware of what outfit you send your relatives to: “A hospice owner tried to evade the Medicare-repayment problem by instructing staff to overdose patients who were staying on the service too long. He texted a nurse about one patient: ‘He better not make it tomorrow. Or I will blame u.’” The epicenter of the fraud? poor, African American areas of the Deep South, what a surprise. This week’s must read.

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Robert Kuttner, “Hospital billing is a crime against American patients,” American Prospect, Nov 22, 2022 READ IT HERE

Kuttner paid about $900 for a cardiac emergency in Paris and asks, “How are American hospitals able to bill at 10 or 20 times these rates?” His answer: parallel consolidation in both the hospital and the insurance industries with players on both sides fighting for market share of the most lucrative specialized procedures. The mergers’ costs are part of your bill, so a scan costs 280 euros in France and $4,750 here. Medicare is hamstrung by the political power of hospitals, which are often major employers and connected to influential universities.

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Heather Landi, “There’s an ‘arms race’ in health tech. Who could be the next M&A target?” Fierce Healthcare, Nov 23, 2022 READ IT HERE

The M&A frenzy so far has produced several juggernauts building a growing healthcare oligopoly: CVS Health/Signify; Amazon/One Medical; Walmart (32 health centers attached to its Supercenter stores; (insurer) Humana/Kindred at Home; UnitedHealth Group/LHC (home health)/Optum data analytics; Alphabet/Verily. “These ‘nontraditional players’ are gaining traction and have the potential to grab as much as 30% of the U.S. primary care market by 2030.” CVS trails but is hunting around for a primary care partner.

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Katherine DeClerq, “‘It’s not getting better’: Unions call for action to ease overburdened health-care system,” CP24 [Canada], Nov 24, 2022 READ IT HERE

Five unions accuse the Ontario provincial government of under-funding the single-payer healthcare system. A familiar strategy: defund the public sector leading to delays, shortages, and inadequate care; claim the public system is a failure; move to privatize. The Conservative government’s crisis response plan includes investing in private clinics that can duplicate the public system’s services.

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Robert King, “AMA adopts policy to curb influence of private equity on new doctor training,” Fierce Healthcare, Nov 18, 2022 READ IT HERE

“The goal of the policy is to protect residents in case a teaching hospital gets acquired” by PE and leaves medical residents in the lurch as occurred recently in Philadelphia. But the policy sounds mostly exhortative and toothless, like encouraging greater “transparency.”

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John Tozzi, “NJ spends $75 million on controversial health-care program as premiums soar,” Bloomberg, Nov 16, 2022 READ IT HERE

Despite paying big bucks for a patient navigation program that purports to “help members find the most efficient medical providers,” premium costs for public employees in New Jersey are up 20% this year. It’s amazing how many futile cost-saving acrobatics states, cities, and the feds come up with while single-payer remains off the table.

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Joshua Cohen, “Pfizer hiking Covid vaccine prices against weaker demand speaks volumes about U.S. healthcare,” Forbes, Nov 1, 2022 READ IT HERE

Pfizer’s announcement that it will jack up its vaccine price by 400% will produce an extra $2.5-$3 billion of revenue per year once the Federal Government stops being the sole payer. Pfizer already has $100 billion of “dry powder” standing by from its vaccine goldmine to use in gobbling up more potentially lucrative companies and their products.

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Raghav Mahobe & Nandhini Srinivasan, “Provention prices diabetes drug above analysts' estimates at $13,850/vial,” Reuters, Nov 18, 2022 READ IT HERE

At that price, a 14-day regimen of the drug would cost $193,900 wholesale, more Pharma gold as the 1 million-plus potential users line up for treatment. However, the company’s stock suffered because investors “have some level of concern that this pricing could lead to insurance hurdles.” Hurdling to be done, of course, by the patients and harried providers.

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Matthew Perrone, “$3.5M gene therapy for hemophilia gets FDA approval,” Associated Press, Nov 22, 2022 READ IT HERE

The company promptly said the cost was justified because it would obviate the need for frequent trips to our ridiculously overpriced healthcare system that would cost even more, which is a neat circular argument since overpriced meds are a big contributor. “Most of the cost of the new treatment will be paid by insurers—not patients—including private plans and government programs.”

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“GSK to withdraw multiple myeloma therapy from US market,” Healio, Nov 22, 2022 READ IT HERE

The drug had received accelerated approval but couldn’t prove efficacy two years later—an unusually fast enforcement requirement. Could the FDA—still embarrassed by the Aduhelm debacle—be getting stricter about pricey drugs not measuring up?

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Walter J. O’Donnell, “Minimizing administrative harm: a key step to improving health care,” STAT, Nov 28, 2022 READ IT HERE

A curious concept that apparently isn’t new: “administrative harm.” The clinician author laments the amount of mind-numbing paperwork he’s saddled with that reduces his patient care time. All sorts of rosy rhetoric accompanied the move to electronic medical records (EHR), and he endorses attention to preventing medical error. But he notes the lack of provider participation in the creation of the EHR system he’s forced to use and calls the digital drudgery he faces “a human-made trauma.” As MBAs take over more and more authority in healthcare, expect admin harm to increase in tandem.

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Ken Dilanian & Laura Strickler, “Brett Favre helped an experimental drug maker get $2M in welfare money. Experts doubt the drug can work,” NBC News, Nov 21, 2022 READ IT HERE

Football guy Favre used his fame to flog a magic elixir for concussion symptoms while simultaneously lobbying Mississippi for “$2.1 million in federal welfare money that was intended to help poor families.” Meanwhile, there is “no evidence” that the experimental drug does anything. Mississippi is famously hostile to “welfare”—perhaps with some exceptions.

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Lev Facher, “Resistance to FDA’s opioid-disposal plan raises concerns about CADCA, a powerful advocacy group,” STAT, Nov 29, 2022 READ IT HERE

“Across the country, medicine cabinets are littered with unused, potentially addictive opioids. So, the federal government wants to distribute prepaid envelopes alongside new painkiller prescriptions, allowing Americans to mail back their leftovers.” But Community Anti-Drug Coalitions of America objects because, they say, our mails are so insecure. Instead, they push the use of drug deactivation devices that just so happens to be made by a company with which it has a “cozy relationship.” The company is a major donor to the nonprofit, and its CEO sits on the nonprofit’s board. Everywhere one looks, it’s the same story: a high-end hustle with powerful players.

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Robert King, “Senate bill seeks to improve Medicare handbook amid spike in marketing complaints,” Fierce Healthcare, Nov 22, 2022 READ IT HERE

The feds are both late and lame in their moves to rein in deceptive Medicare Disadvantage advertising, which is now flooding the airwaves during the sign-up period. This bill would add some language to the huge Medicare booklet mailed to all beneficiaries every year that nobody reads. Meanwhile, Joe Namath and other corporate courtesans harangue us from every available soapbox. This bill looks like an attempt by our electeds to pretend they’re doing something while knowing the effect will be zilch. The only real regulatory measure with teeth is the requirement for prior approval of TV spots starting next year.

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SINGLE PAYER LINKS #281

Posted 25 NOV 2022

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Jake Johnson, “Austin AFL-CIO council becomes latest to urge Biden to end Medicare privatization scheme,” Common Dreams, Nov 21, 2022 READ IT HERE

The pilot program [now ACO REACH], which inserts for-profit middlemen between patients and providers, was created without fanfare during the final months of the Trump administration.” Biden is continuing it in a slightly altered form. It shoves Medicare beneficiaries into a privately run insurance plan without their consent or even knowledge. “The CMS Center for Medicare and Medicaid Innovation (CMMI), which is overseeing ACO REACH, is currently headed by Elizabeth Fowler, the former vice president of public policy and external affairs at WellPoint, Inc., a health insurance firm that later became Anthem.” The revolving door is a key factor in government complicity with privatizing tendencies.

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Matthew Cunningham-Cook, “Why is AARP boosting Medicare privatization?” The Lever, Nov 21, 2022 READ IT HERE

Maybe because it earned $814 million as part of the deal last year. The AARP CEO pulls in $1.3 million of that. AARP also is cutting a deal with Oak Street Health to get its hands on some ACO REACH (Medicare privatization) income. AARP says Oak Street is a “trusted provider,” but the Justice Department is investigating its marketing practices.

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Fred Schulte & Holly Hacker, “Audits—hidden until now—reveal millions in Medicare Advantage overcharges,” Kaiser Health News/NPR, Nov 21, 2022 READ IT HERE

The few audits performed by the feds of MA plans reveal systematic upcoding running at over $1000 per patient on average. But foot-dragging by officials suggests regulatory capture. “Officials at the Centers for Medicare & Medicaid Services have said they intend to extrapolate the payment error rates from those samples across the total membership of each plan—and recoup an estimated $650 million as a result. But after nearly a decade, that has yet to happen. CMMS auditors only scrutinize 30 contracts a year out of 1,000 Medicare Advantage contracts nationwide. KHN had to sue under FOIA to get copies. “In one case, CMS charged a law firm an advance search fee of $120,000 and then provided next to nothing in return.”

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Susan Kelly, “Midwest health systems on track to merge,” Healthcare Dive, Nov 23, 2022 READ IT HERE

More consolidation: two Wisconsin-based hospital operators will form an 11-hospital system with 100 affiliated clinics in four states. Meanwhile, Advocate Aurora Health in the Midwest and Atrium Health in the South merged into a 67-hospital operation spanning six states.

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Samantha Liss, “UnitedHealth-Change deal approval faces appeal from DOJ,” Healthcare Dive, Nov 21, 2022 READ IT HERE

The Department of Justice and the states of New York and Minnesota are appealing a federal court decision to allow an industry merger combining a giant insurer with a massive claims database. The judge cited “convincing testimony from senior executives” that the company wouldn’t take unfair advantage. Perhaps he was unaware of accusations that UnitedHealthcare improperly billed Medicare for $3.7 billion it didn’t deserve through upcoding its Medicare Disadvantage customers. Another question: why is this purchase worth $13 billion, which is what UH offers to pay?

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Cezary Podkul, “What will UnitedHealth’s new trove of claims data mean for consumers?” ProPublica, Nov 16, 2022 READ IT HERE

“UnitedHealth says it won’t use the data to give itself an edge.” Well, that’s solved then! Except that the acquisition would enable UnitedHealth to “access and analyze a quarter of all medical insurance claims in the U.S.” Why does that matter? UnitedHealth is already the biggest insurer in the country and would then get access to its competitors’ claims data. Seems like an antitrust no-brainer, one area in which the Biden Administration seems to be surprisingly alert.

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Hayleigh Colombo, “Medicaid expansion remains on hold in Texas as state struggles with medical debt, high uninsured rate,” Public Service Journalism Team, Nov 11, 2022 READ IT HERE

About 60% of uninsured Texans are Hispanic—yet Dems are losing Hispanic support, perhaps because they don’t campaign on these issues? “Texas is home to three of the worst 10 U.S. counties for medical debt” where over 40% of residents are on the hook for “delinquent” medical bills. Texas is a non-Medicaid-expansion state, but many of the debtors are (poorly) insured.

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Caitlin Owens, “New Medicare dental benefits give Democrats get a small reason to smile,” Nov 4, 2022 READ IT HERE

Medicare Disadvantage is popular because of extras like dental and vision. Medicare could compete by offering them, too, so why don’t they? Medicare will now be able to cover a tiny portion of dental costs “only in those situations when dental care is linked to a covered medical procedure, such as before an organ transplant.”

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Phil Galewitz, “Stopping the churn: Why some states want to guarantee Medicaid coverage from birth to age 6,” Kaiser Health News/Los Angeles Times, Nov 10, 2022 READ IT HERE

Children get enrolled and regularly dropped from Medicaid because families start earning too much to qualify or just don’t fill out the paperwork correctly. The end of the special Covid emergency will cause as many as 5 million kids to get dumped from coverage again unless states act. Oregon will allow children who qualify for Medicaid “to enroll at birth and stay enrolled until they turn 6, regardless of changes in their household’s income and without having to reapply.” Washington, California, and New Mexico may follow suit. Uninsured children in the U.S. fell from 6.7% to 3.7% of the total during the Covid period.

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Kelly Gooch, “At hospital where nurse called 911, ‘zero candidates interviewing’ for ED roles, says president,” Becker’s Hospital Review, Nov 4, 2022 READ IT HERE

She didn’t actually use 911, but she did call for fire fighters to come help at the ER in Kitsap, Washington. The mismanaged hospital now has 300 positions open and no applicants. “Workers repeatedly sounded the alarm,” but got nowhere, says the union.

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Nathan Pilling, “Faced with an overwhelmed ER, a St. Michael Medical Center nurse called 911 for help,” Kitsap Sun, Oct 12, 2022 READ IT HERE

The original report in a local paper, which quotes the town’s fire chief: “They feel like they’re drowning because they had over 45 patients in the waiting room and only five nurses.” Fire fighters cleaned rooms, moved patients, and took vital signs.

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Tamir Aldad, “Physician burnout—the national crisis no one is talking about,” Newsweek, Nov 21, 2022 READ IT HERE

“America’s doctors are struggling to thrive in a broken health care system that has become more and more defined by red tape and bureaucracy. Some doctors who entered the field to heal sick community members do not feel like they can make a difference and are leaving the health care field early. Only about half of surveyed physicians indicated they would choose to become a doctor if they could do it all over again.”

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Arielle Dreher, “More physicians unionize in the face of burnout, consolidation,” Axios, Nov 7, 2022 READ IT HERE

As more and more doctors become corporate employees, they’ll need protections like other workers. Residents, who may have to put in 80 hours a week while earning on average $64K a year, are the most eager while about 7% of physicians are already unionized. Here at home, 1,200 resident physicians and interns at Montefiore Medical Center just voted to form a bargaining unit although the hospital hasn’t recognized it yet.

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Heather Landi, “Amazon’s latest push into digital health: A virtual clinic for common conditions like allergies and hair loss,” Fierce Healthcare, Nov 15, 2022 READ IT HERE

This attractive feature, a “virtual health service” for things like hair loss, will provide quickie, online, quasi-medical treatment from telehealth outfits like HealthTap, which will then shuttle you over to Amazon Pharmacy to buy some stuff. More fun than a video game!

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Noam N. Levey & Aneri Pattani, “How banks and private equity cash in when patients can’t pay their medical bills,” Kaiser Health News/NPR, Nov 17, 2022 READ IT HERE

Now you can enter debt slavery directly from the ER. Inevitably, the giant health systems are partnering with financiers, kinda like when General Electric became an investment bank. You get sick, go to the hospital, and instead of the old no-interest bills that were bad enough, now you get an in-house payment plan from a finance company. They earn money by charging interest on outstanding bills while hospitals, for a fee, wash their sterile hands of the tawdry business of collecting. When patients go broke, the hospital can say, as UNC Health did, “Any payment plans above zero-interest terms/conditions in place with AccessOne are in place at the request of the patient.” But the best payment terms are reserved for wealthier patients while others get slammed with 13% interest charges.

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Sarah Pringle, “Nursing homes still a PE challenge,” Axios, Nov 22, 2022 READ IT HERE

“Despite private equity owning only an estimated 5% of the nursing home industry, its high-profile problems in the sector have made it a bogeyman to politicians and the public.” The PE solution is to concentrate on the homes’ real estate assets where some easy money can be made while looking for opportunities in “elder care.”

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Sarah Pringle, “Private equity tries to reshape elder care,” Axios, Nov 19, 2022 READ IT HERE

Senior care is now the site of a “financial arms race” with PE firms rushing in to extract cash in non-nursing home services. Large “investment pockets” are out there, including Medicare Disadvantage and in-home care. “The high utilization of health care among the over-65 population makes for a gold rush that can’t be matched elsewhere.” The young and healthy population is less consistently lucrative.

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Jazmin Orozco Rodriguez, “Mistrust and polarization steer rural governments to reject federal public health funding,” Kaiser Health News, Nov 18, 2022 READ IT HERE

Local officials refuse government money out of ideological bias against “government overreach” and general lack of trust in federal agencies. Hostility to the public health function will only make things worse. “More than 200 small governments in 15 states declined pandemic relief funds.”

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Michael Goldberg, “Over half of Mississippi’s rural hospitals risk closing,” Associated Press, Nov 22, 2022 READ IT HERE

Refusing Medicaid expansion means Mississippi foregoes an infusion of federal cash that could keep them open. Typically, the poorest parts of the state will be hardest hit.

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Robert King, “Advocacy groups press FTC to probe GPOs’ role in supply chain shortages,” Fierce Healthcare, Nov 23, 2022 READ IT HERE

“Several patient and consumer advocacy groups are clamoring for the Federal Trade Commission (FTC) to examine the role of group purchasing organizations in exacerbating supply chain shortages” and pushing prices higher through concentration and monopsony practices.

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Adam Feuerstein, “Pfizer CEO says Covid vaccine will remain ‘free for all Americans,’ overlooking indirect costs,” STAT, Nov 18, 2022 READ IT HERE

Pfizer chief Albert Bourla says their vaccines will remain “free” to consumers but neglects to add that someone, somewhere, is going to pay handsomely for them. The U.S. government paid Pfizer $30 a shot, but now the company will charge between $110 to $130. Insurers will make up that outlay with higher premiums.

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Arthur Allen, “Pfizer’s Covid cash powers a ‘marketing machine’ on the hunt for new supernovas,” Kaiser Health News/Fortune, Nov 8, 2022 READ IT HERE

Pfizer now has $100 billion of “dry powder” to gobble up other biotech companies in search of the next blockbuster drug for things like migraines, ulcerative colitis, prostate cancer, sickle cell disease, or obesity. Pfizer’s CFO still sees Covid as a “multibillion-dollar franchise.” Pfizer has given investors $25 billion in dividends over the past three years and has jacked up its share price with $9 billion in stock buybacks.

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Samantha Liss, “Lawmakers object to latest surprise billing rule, call for changes,” Healthcare Dive, Nov 22, 2022 READ IT HERE

This one is a bit confusing: the solons in question—House Ways and Means Committee Chairman Richard Neal (D-MA) and ranking member Kevin Brady (R-TX)—are famously industry-friendly, so their objection sounds like a lobbyist-induced pressure campaign. Any readers out there who understand this?

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SINGLE PAYER LINKS

Posted 18 NOV 2022

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Bruce Japsen, “Medicaid expansion wins in red state South Dakota,” Forbes, Nov 9, 2022 READ IT HERE

By 56% to 44% and despite opposition from the Republican governor. The Fairness Project helped in SD as well as other states where people used the referendum process and now are undefeated in seven states (after Maine, Nebraska, Idaho, Utah, Missouri, and Oklahoma) since 2017. No states have voted down expansion given the choice. Eleven are still holding out and foregoing a big pot of federal dollars.

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Dylan Scott, “South Dakota voters decide to extend Medicaid coverage to 45,000 people,” Vox, Nov 9, 2022 READ IT HERE

Additional details: “Many of those who would qualify for Medicaid in South Dakota—about 14,000—are American Indians currently ineligible for coverage.” The three successful campaign messages were: “hearing from neighbors who will benefit; bringing federal tax dollars back to the state; and protecting the solvency of rural hospitals and clinics.” One ad showed a farmer who says he “wants to keep his family farm running but can’t afford health care right now.” Ballot initiatives are almost single-handedly responsible for adding an estimated 811,000 to Medicaid eligibility and demonstrate how little state legislatures respond to popular will.

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Dave Muoio, “CommonSpirit Health kicks off its fiscal 2023 with a $397M net loss, 0.3% operating margin,” Fierce Healthcare, Nov 16, 2022 READ IT HERE

“Investments dragg[ed] its performance down by over half a billion dollars.” Investments.

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Andrew Joseph & Jason Mast, “U.S. set to face third Covid winter, this time without key tools and treatments,” STAT, Nov 10, 2022 READ IT HERE

“Free at-home tests are no longer showing up at people’s doorsteps. States are reporting outbreak data less frequently, and globally, testing and surveillance programs have been curtailed. Support for community vaccination campaigns has dwindled. And next year at some point, the U.S. government will stop paying for Covid vaccines and treatments, which could widen gaps in access as the products move to being covered by insurance.” So much for our brief experiment with treating health as a public good and paying for it out of pooled resources. But expect to hear relentless exhortations to get the lucrative booster shots.

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Wendell Potter, “As health insurance premiums and out-of-pocket obligations increase, so does the number of Americans who are ‘functionally uninsured,’” Wendell Potter Now, Nov 3, 2022 READ IT HERE

Employer-based insurance for a family of four now costs an average of $22K a year, up 43% in a decade. Out-of-pocket costs, which are the source of much medical debt, are up 61%. Getting covered through your job is becoming an unsustainable model.

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John Tozzi, “Union seeks penalties for NJ insurer over 20% medical cost jump,” Bloomberg, Nov 8, 2022 READ IT HERE

A police union, to be precise, the state PBA. The state contract supposedly had guarantees built in against big price hikes, but hey, promises, promises. The company pays a fine for the violation and keeps the difference.

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Fred Schulte, “Sick profit: Investigating private equity’s stealthy takeover of health care across cities and specialties,” Kaiser Health News/USA Today, Nov 14, 2022 READ IT HERE

The $1 trillion PE invasion of the health sector “has led to higher prices and diminished quality of care” while PE firms have paid $500 million in fines under the False Claims Act. When PE execs get prison time for phony billing, it might stop. Government oversight is handicapped because deals worth under $101 million aren’t eligible for review.

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Heather Landi, “Walgreens’ VillageMD inks $9B deal to buy Summit Health, marking largest physician deal of the year,” Fierce Healthcare, Nov 7, 2022 READ IT HERE

The two entities will end up with 680 locations and 20,000 employees in 26 cities including primary, urgent, and specialty care. Walgreens, CVS, and Amazon, are engaged in a “frenzy of M&A activity” to vacuum up larger chunks of the healthcare system. Walgreens’ Summit owns all those CityMD clinics you see around town.

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Heather Landi, “Crossover Health, Aetna pilot primary care service for Seattle employers with fixed-fee payment model,” Fierce Healthcare, Nov 10, 2022 READ IT HERE

Another fixed-fee payment model touted as containing costs by getting employers to “take more ownership of their total healthcare spend.” That vague verbiage sounds like, We leave the cost-cutting details to you! “Aetna is excited to bring something innovative like this to the market, and it’s innovative in different ways to other value-based care arrangements. It’s the next step in that innovation,” said an exec. When you hear someone say “innovation” every 10 words, place both hands over wallet. CVS now owns Aetna and is moving aggressively into primary care.

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Dave Muoio, “Midwest nonprofits Sanford Health, Fairview Health Services target a 58-hospital merger for 2023,” Fierce Healthcare, Nov 15, 2022 READ IT HERE

A rural health complex based in South Dakota and a Minneapolis-based, 11-hospital system with 5,000 doctors are merging to form a 58-hospital “juggernaut.” Elsewhere in the Midwest, Advocate Aurora Health and Atrium Health are seeking a merger to create a 67-hospital system in the Chicago and Milwaukee areas, er, I mean “markets.” The consolidation continues.

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Steve Cohen, “Replace the failure of Medicare Advantage with ‘Medicare Part F,’” STAT, Nov 15, 2022 READ IT HERE

The diagnosis is correct: “Medicare Advantage (MA) is a failure for seniors, who receive worse care than they do under traditional Medicare; for doctors, who must negotiate costly and dangerous prior authorizations for their patients; and for the federal government, which spends more per capita on MA than on traditional Medicare.” Cohen calls his solution “Medicare Future,” which would be MA without the prior authorization requirements. A bit naïve to think that for-profit insurers wouldn’t find a way around that, too.

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Rep. Jan Schakowsky & Wendell Potter, “How Medicare Advantage scams seniors,” Newsweek, Nov 15, 2022 READ IT HERE

“What happens when seniors need care beyond a wellness check-up or lunch delivery? Some networks are so limited that seniors must pay hundreds or thousands of dollars if they travel out of state or need more substantive care. Because networks are usually confined to specific geographic areas, seniors can end up on the hook for the entire bill.” Another good diagnostic but without a prescription for how to end the scam. Schakowsky, a member of Congress, notes how the lobbying muscle of the industry blocks regulatory action.

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Carol Marbin Miller, “A Florida fund for injured kids raided Medicaid. Now it’s repaying $51 million,” ProPublica/Miami Herald, Nov 15, 2022 READ IT HERE

“The Birth-Related Neurological Injury Compensation Association, or NICA, settled a three-year-old whistleblower complaint that alleged the program grew assets of nearly $1.7 billion partly by dumping health care and caregiving costs onto Medicaid” instead of using the funds for their stated purpose. Maybe DeSantis will boast about that as part of his commitment to “fiscal conservatism.” The program was established as “no-fault,” meaning parents could avoid the needless nightmare of proving malpractice to get the aid they need. But they ended up fighting the state misers instead.

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Julie Washington, “Some electronic messages to Cleveland Clinic healthcare providers could cost $50,” Cleveland Plain Dealer, Nov 14, 2022 READ IT HERE

Maybe doctors should follow lawyers and charge patients in 5-minute blocks! On the list of queries that will cost your policy (or your deductible) 50 bucks are: reporting new symptoms, reporting changes to a long-term condition, or requests to complete medical forms. Not billable: Patient messages that lead to providers recommending a visit—that bill will come after you show up! Prescription refill requests (Pharma money) also will remain free. “Ask your doctor whether an email is right for you!”

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Dave Muoio & Annie Burky, “Advocate Aurora, WakeMed get served with class action over Meta’s alleged patient data mining,” Fierce Healthcare, Nov 4, 2022 READ IT HERE

Facebook/Meta scraped patient data off hospital records and sold it to advertisers. “IP addresses, doctor names, appointment times, medication information, search terms and connections to users’ Facebook accounts were all among the data being collected and sent to the tech company.”

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Dave Muoio, “HLTH22: Centene’s new CEO sees opportunities to tap into massive trove of data to tackle health equity,” Fierce Healthcare, Nov 14, 2022 READ IT HERE

The growing consensus that “social determinants” affect population health is now being turned into a justification for the giants to gather a slew of data on us and then claim that everyone wins: “Centene has collected extensive information on its managed care populations over the years. Codifying those data represents a ‘high-tech, low-cost intervention’ benefiting underserved members and company shareholders alike,” says its CEO. Centene has files on its 26 million members who use both Medicaid and Medicare Disadvantage, which it promises to use for our benefit. Reassuring!

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SINGLE PAYER LINKS #279

Posted 11 NOV 2022

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Tina Reed, “Arizona tests a progressive take on medical debt relief,” Axios, Oct 31, 2022 READ IT HERE

The referendum would impose a 3% cap to interest charges on medical debt (from a previous cap of 10%) and limit wage garnishments. Update: it passed 72-28 (!). Fourteen states already have similar caps, including New York.

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Helen Branswell, “Pfizer, BioNTech report new Covid booster is more protective against recent Omicron variants than original vaccine,” STAT, Nov 4, 2022 READ IT HERE

Several paragraphs down: “The trial did not test whether people who received the updated boosters were less likely to contract Covid than people who received one of the older boosters.” Translation: it may be useless. But you read the headline, and that’s good for business. And it was enough for the White House to sign off on yet another “emergency use authorization” even though Covid is officially not an emergency any more—or even a thing!

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Vinay Prasad, “Pfizer’s NEW press release on bivalent booster abs: What does it mean?” YouTube, Nov 5, 2022 READ IT HERE

A crucial antidote to the obfuscatory stenography masquerading as science journalism in our mainstream. Headlines like these. . .

CNN: Pfizer/BioNTech Say Updated Covid-19 Booster Generates ‘Substantially Higher’ Protection Against Omicron Subvariants Than Original Vaccine

New York Times: Study Shows New Covid Booster Improves Protection For Older People, Pfizer Says

Washington Post: Pfizer Says New Booster Shot Increases Omicron-Fighting Antibodies

. . . sidestep the fact that the White House leads the FDA by the nose. Top political appointees met with Pfizer execs to announce their trial results based on a study with 76 participants. Prasad points out that a rise in antibody titers may or may not be clinically meaningful and that Pfizer has not been required to prove that they are. Pfizer made a ginormous bundle on Covid—why doesn’t Biden forced them to get hard data before letting them make even more?

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James Stout, “The public shouldn’t pay for drugs twice,” Undark, Nov 3, 2022 READ IT HERE

“By one estimate, the National Institutes of Health spent $17 billion on vaccine technologies fundamental to the Covid-19 vaccine.” Public funding lies behind most pharmaceutical advances, but the government awards production and distribution to the hyper-profitable drug companies on cushy terms. Universities own the IP of drug innovations developed with federal cash (thanks to the Bayh-Dole Act, one of those terrific “bipartisan” deals) and then can sell them for tidy sums.

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David Blumenthal & Sara Collins, “Millions of Americans have health insurance that isn’t ‘good enough,’” STAT, Nov. 4, 2022 READ IT HERE

Being “covered” doesn’t mean people can get treatment because “high health care costs and coverage exclusions are making insurance less protective each year.” Forty percent of “fully insured” Americans avoid or delay treatment due to cost. Yet, the authors offer only tinkering with the current market-based system. No mainstream health news magazine like STAT—dependent on industry patronage—will last long if it pushes the obvious solution. That said, some reforms theoretically could push states closer to single-payer.

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Allison Bailes, “Ionizer company sues indoor air quality expert,” Energy Vanguard, Oct 4, 2022 READ IT HERE

Since Covid is airborne, some prescient voices insisted on looking at ventilation/filtration measures for enclosed spaces. One expert in the field shared her research—and promptly got sued by a Goliath company that didn’t like her findings about their product. It probably didn’t help that the CDC has been very late and is still wishy-washy on aerosol transmission, clinging to the traditional (discredited) fomite/droplet theory of respiratory ailments. Dr Marwa Zaatari is fighting back and has a GoFundMe page: READ IT HERE

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Nick Corbishley, “NHS hired US ‘spy-tech’ firm Palantir to extract patient data without patient consent,” Naked Capitalism, Nov 8, 2022 READ IT HERE

Peter Thiel’s Palantir is about to get access to the medical records of Britain’s 55 million users of the National Health System, which it can then sell to third parties for a lot of dough. The pretext is to improve the notorious wait times for medical care resulting from both Tory and Labour governments’ practice of slashing NHS funding. Two former top NHS officials already decamped to Palantir’s executive offices—for strictly humanitarian reasons! Palantir’s main business is “to provide data-mining technology to support US military operations, mass surveillance, and predictive policing and to identify illegal migrants before detaining and deporting them.” What could go wrong?

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Michael P. Norton, “Massachusetts nursing home job vacancies hold at historic highs,” State House News Service/WBUR, Nov 3, 2022 READ IT HERE

MA has “6,900 registered nurse, licensed practical nurse, and certified nurse assistant (CNA) positions open at nursing facilities,” or 22% of all jobs in the sector.

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Dave Muoio, “Charity care accounts for less than 1.4% of operating expenses at half of US hospitals,” Fierce Healthcare, Nov 8, 2022 READ IT HERE

A study noted “weak oversight in federal and [state] government’s requirements for nonprofit hospitals to retain their tax-exempt status or other funding benefits.” Some spent 0.1%.

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Bram Sable-Smith, “This open enrollment season, look out for health insurance that seems too good to be true,” Kaiser Health News/NBC News, Nov 1, 2022 READ IT HERE

“It took nearly a year for Kelly Macauley to realize the health plan she bought while shopping for insurance coverage last October was not, in fact, insurance,” which cost her $40K in unpaid bills. It was from a “healthcare sharing ministry,” i.e., a religious fraud. When citizens are turned into healthcare “consumers,” scammers will go forth and multiply. The FTC is taking action and already has secured $100 million in refunds.

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Maya Goldman, “Home health providers get reprieve from Medicare cuts,” Axios, Nov 1, 2022 READ IT HERE

“The $125 million increase announced Monday is a reprieve of sorts after the Centers for Medicare and Medicaid Services proposed an $810 million cut in June.” Why the government is still trying to make cuts in this area is a mystery.

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Erica Breunlin, “More than 200,000 Colorado kids could lose Medicaid coverage starting next year, though many remain eligible for government help,” Colorado Sun, Nov 1, 2022 READ IT HERE

Beneficiaries have to scramble to stay covered when the Covid emergency ends Jan. 11. No one has a right to healthcare, so heaven forbid you don’t update your mailing address or erroneously fill out a form. “Nationwide, about 5.3 million children under age 18 could lose coverage from a government health insurance plan with three out of four kids losing coverage while still eligible.”

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Nathaniel Weixel, “House investigation finds insurers, benefit managers improperly limit access to birth control,” The Hill, Oct 25, 2022 READ IT HERE

“Insurers and PBMs required patients to pay some of the cost or otherwise limited coverage of more than 30 birth control products,” especially non-pill alternatives. Patients who are turned down have to go through a laborious appeal process.

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American Medical Association, “New study shows Medicare Advantage markets lack competition,” Nov 1, 2022 READ IT HERE

“Unchecked market power among insurers is a formula for higher premiums, lower coverage, and inadequate levels of patient care. Most large Medicare Advantage insurers are accused of fraud and flouting the authority of federal agencies. . . . exploitative business practices are already commonplace.”

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Jonathan Wolfson & Josh Archambault, “Give Americans the right to save on health care,” STAT, Nov 2, 2022 READ IT HERE

This is nuts: sometimes NOT using your insurance saves you money because the insurer fails to negotiate the best deal. Patients rarely know that the total cash price of a service may be lower than their copay.

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Ian Millhiser, “The nightmarish Supreme Court case that could gut Medicaid, explained,” Vox, Nov 3, 2022 READ IT HERE

The Supreme Court could decide that while the Federal Government gives tens of billions to the states to pay for Medicaid, it cannot enforce any rules on how the money is spent. “Should the defendants prevail, tens of millions of patients could effectively be stripped of legal safeguards intended to guarantee them a certain quality of care. In some cases, individual patients may lose their health coverage altogether. The defendants’ legal arguments are weak and would require the Court to overrule a half-century of precedents.” But that clearly hasn’t stopped them. OTOH, this highly politicized court must have noticed that demolishing Roe kept some of their favorites from elective office, which might discourage them from dropping a bomb on Medicaid.

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Oriana Gonzalez, “ACA’s preventative care requirement under attack,” Axios, Oct 25, 2022 READ IT HERE

Another dangerous case (Kelley v. Becerra) in federal court could kabosh the Obamacare requirement for coverage of preventive health services, like cancer screenings and mental health treatment. Over 160 million policyholders could be affected.

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Samantha Young, Andy Miller & Rebecca Grapevine, “Centene showers politicians with millions as it courts contracts and settles overbilling allegations,” Kaiser Health News/California Healthline, Nov 4, 2022 READ IT HERE

Nevada Gov. Steve Sisolak (D), among others, got a cool $100K. “Centene has similarly amplified campaign contributions to governors in New York and South Carolina. Centene earns billions of dollars from governments and then uses its profits to back the campaigns of the officials who oversee those government contracts.”

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Blake Farmer, “Hospital giant HCA fends off accusations of questionable inpatient admissions,” Kaiser Health News/The Tennessean/Nashville Public Radio, Nov 4, 2022 READ IT HERE

“For more than a decade, large health systems have faced scrutiny for admitting patients to costly hospital stays when less expensive treatments or short periods of observation in the ER would have been appropriate.” HCA is accused of setting admissions quotas for doctors under its control. SEIU is pushing the investigation and claims HCA overcharged Medicare $1.8 billion through the practice.

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Katheryn Houghton, “Montana backs away from innovative hospital payment model. Other states are watching,” Kaiser Health News, Oct 27, 2022 READ IT HERE

Montana established maximum amounts, pegged to Medicare rates, for its public employees’ medical coverage. It was unusual in that it covered all services. Despite saving millions, now Montana is “modernizing” through a contract with Blue Cross/Blue Shield to administer the plan, giving the blues “flexibility” in negotiating deals with individual providers. Two private companies deciding how much the state should pay out of public funds—sounds like a great set-up.

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Caitlin Owens, “The next health care wars are about costs,” Axios, Nov 2, 2022 READ IT HERE

“All signs point to a crushing surge in health care costs for patients and employers next year—and that means health care industry groups are about to brawl over who pays the price.”

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Editorial Board, “Hopkins v. CareFirst: A resolution has been reached, but not before significant damage was done,” Baltimore Sun, Oct 26, 2022 READ IT HERE

Maryland just suffered through the “clash of the titans”—its largest provider system v/s its largest insurer. Users were left in limbo just as enrollment season began. The state sat back and watched while multi-million-dollar CEOs decided what’s best for Marylanders’ health. The Sun says, “It would be nice to hear some testimony on why both nonprofits pay their top leaders millions of dollars each year. Maybe there’s some waste to be trimmed.” LOL

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SINGLE PAYER LINKS #277

Posted 27 OCT 2022

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Anastassia Gliadkovskaya, “The FTC and DOJ have vowed to scrutinize private equity deals. Here’s what it means for healthcare,” Fierce Healthcare, Oct 21, 2022 READ IT HERE

About time. The article doesn’t break any new ground, but its prose (“verticals with promising returns from consolidation”) reflects the unquestioning balance-sheet approach to the provision of medical care.

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Paige Minemyer, “Walmart Health plans to open 16 more Florida clinics next year,” Fierce Healthcare, Oct 26, 2022 READ IT HERE

Expanding in the “Jacksonville, Orlando, and Tampa markets.”

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Joyce Famakinwa, “DOJ requests more information regarding CVS Health’s pending purchase of Signify Health,” Home Health Care News, Oct 20, 2022 READ IT HERE

The newly energized Federal Trade Commission is not rolling over in the face of health industry concentration as it used to do routinely. Signify Health employs over 10,000 clinicians in all 50 states. The pharmacy chain CVS Health’s offer to buy it for $8 billion would create another health monster. Also under review: UnitedHealth Group’s attempt to purchase LGC Group ($5.4 billion) and Amazon’s plan to buy One Medical ($3.9 billion).

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Cheryl Clark, “Mayo warns it won’t take most Medicare Advantage plans,” MedPage Today, Oct 20, 2022 READ IT HERE

Serious backlash at the Florida Mayo Clinic (not the original in Minnesota): “Medicare Advantage plans have been under increasing scrutiny and investigation because so many of them have been accused by federal agencies of denying care, exaggerating the severity of illnesses to pull billions more from Medicare, and delaying care with lengthy prior authorization requirements.”

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Robert King, “House progressive bill wants to take Medicare out of Medicare Advantage's name,” Fierce Healthcare, Oct 13, 2022 READ IT HERE

A great idea that won’t happen. Eighty percent of all House members just signed a pro-MA support letter. Said co-sponsor Ro Khanna, “Medicare Advantage is just private insurance that profits by denying coverage, and the name is being used to trick seniors into enrolling.” But the self-styled “progressive” caucus seems more and more like a PR exercise. Or Will Khanna confront Biden over it?

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Peter Sullivan, “Hill Dems frustrated with Biden inaction on ‘junk’ health insurance,” Axios, Oct 19, 2022 READ IT HERE

Trump “promoted these cheaper plans that offer fewer benefits, which have been derided by Democrats for not meeting ACA coverage requirements and for the way they can deny coverage to people with pre-existing conditions.” Two years into the Biden era, nothing has been done about them while gullible consumers are lured into the plans with deceptive marketing. A project for the progressive caucus?

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Frank Diamond, “Employers rein in health benefits for pre-Medicare and Medicare-eligible retirees,” Fierce Healthcare, Oct 12, 2022 READ IT HERE

Many employers expect to revamp medical benefits for staff with some “looking to replace their traditional group plans with individual insurance coverage through private marketplaces.” Union contracts with good health coverage are increasingly in the crosshairs.

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Jonathan Michels, “A new doctors’ union in the South is a model for health care organizing,” Jacobin, Oct 20, 2022 READ IT HERE

The union includes non-physicians like midwives, NPs, and PAs. Provider shortages and longstanding complaints about working conditions strengthened their efforts. Their nonprofit (FQHC) bosses promptly hired a union-busting law firm at $500-an-hour. Includes interesting discussions about the particular factors of unionizing in a healthcare setting. “Although they must work shoulder-to-shoulder to care for patients in life-and-death situations, health care workers remain divided from one another along rigid professional lines.”

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Ann Brown, “Tobacco companies target black Democrats who are desperate for campaign cash,” Moguldom Nation, Oct 22, 2022 READ IT HERE

And who aren’t choosy about where it comes from. Among the recipients: Rep. Yvette Clarke (D-NY) along with most of her colleagues on the Congressional Black Caucus, the CBC’s political action committee, and a raft of African-American advocacy groups like the NAACP and the Urban League. One Chaka Burgess from the CBC PAC now handles “legislative and FDA affairs” for vape-master Juul.

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Jeff Goldsmith, “The future for practicing physicians in a corporate world,” STAT, Oct 14, 2022 READ IT HERE

Fewer than half of U.S. doctors now work in physician-owned settings; UnitedHealth Group employs 60,000. However, the idea that going corporate will simplify their practice “has proven simplistic, and many of the clinicians seeking shelter from [paperwork, burnout] have not found it.” The author wonders whether “physicians seeking influence over the conditions of medical practice eventually [will] clash with corporate cultures, operational control, and human resource policies.” Eventually?

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Annie Burky, “Physician-led hospitals earn nearly 7 times higher patient experience rating,” Fierce Healthcare, Sep 28, 2022 READ IT HERE

Providers are better at providing than MBAs, who would have imagined that? “Forty-one percent of physician-led hospitals received the highest rating of patient experience as opposed to 6% of non-physician-led hospitals,” according to a study [bias alert] done by a doctors’ group.

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Paige Minemyer, “SCAN launches new Medicare Advantage plan for LGBTQ+ seniors,” Fierce Healthcare, Oct 18, 2022 READ IT HERE

Oh great, rainbow flags on our prior authorization charts.

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Elizabeth Yuko, “First they got long Covid. Then, it made them homeless,” Rolling Stone, Feb 25, 2022 READ IT HERE

Long Covid can undermine not only health but also “put folks over the edge financially with very limited safety nets.”

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Jay Asser, “Some health insurers overpaying for common radiology services,” Health Leaders, Oct 19, 2022 READ IT HERE

“CT and MRI services had the most price variation within a hospital and within a hospital-insurer pair, with brain CT having the widest gap. The study [in the journal Radiology] found that higher prices for higher cost services imply higher hospital profitability, which can influence hospitals to opt for high-cost imaging and lead to inefficient spending for payers and patients.” Not explored: do insurers not care that much since they get to keep a percentage of the payments that flow through them? Asking for a friend.

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Alison Bateman-House, “What ALC and Alzheimer’s drug approvals have in common,” New York Times, Oct 14, 2022 READ IT HERE

People will try anything when facing something like these dreaded diseases, and AIDS activism pressured the FDA to speed things up. However, those individual choices are more complicated when everyone has to pay for drugs that have no proven record of either safety or efficacy. And pushing through approvals for any old thing edges us closer to a return of the “magic elixirs” of frontier days, the difference being that snake oils only bankrupted the buyer, not the entire Medicare system. The author, a medical ethicist, ignores the payments issue.

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CNN, “Opinion: How to fix American health care, according to 6 experts,” Oct 20, 2022 READ IT HERE

1 Theresa Brown (nurse): Federally mandate nurse-to-patient staffing ratios in hospitals.

2 Brian Miller (American Enterprise Institute): Allow competition in hospital markets through physician entrepreneurship.

3 Syra Madad (epidemiologist): Rebuild trust in science. (Good luck with that.)

4 Max Richtman (safety net advocate): Expand Medicaid.

5 Lala Tanmoy Das (PhD/MD student): Diversify the pool of doctors.

6 Jennifer Lee: (ex-director of Medicaid for Virginia) Get more Americans ACA subsidies to help pay for their insurance.

Not listed: Sideline for-profit health insurance through single payer.

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Sandhya Raman, “As hepatitis C proliferates, states lift barriers to treatment,” Roll Call, Oct 19, 2022 READ IT HERE

Insane prices for the cure have left many without treatment while Hep C cases rise nationally. “Only 35% of individuals with private insurance get treatment within a year of diagnosis. That number drops to 28% for Medicare recipients and 23% for Medicaid beneficiaries.” States are slowly shouldering the fiscal burden and lowering barriers. If the treatments were widespread enough to drastically reduce Hep C rates, the blockbuster drug would lose much of its market.

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Michael Erman, “Pfizer expects to hike U.S. COVID vaccine price to $110-$130 per dose,” Reuters, Oct 21, 2022 READ IT HERE

Four times higher than what the Feds paid during the “emergency” phase. “It is not yet clear what kind of access people without health insurance will have to the vaccine.” None?

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Rachel Bluth, “Labor tries city-by-city push in California for $25 minimum wage at private medical facilities,” Kaiser Health News/Sacramento Bee, Oct 21, 2022 READ IT HERE

“Currently, a living wage in L.A. County for a single adult with no children is $21.89 hourly or a little more than $45,500 a year, according to a tool from the Massachusetts Institute of Technology. Occupations like ‘healthcare support’ generally pay around $33,000 annually in the county.” Organizers are trying to get the minimum set through ballot measures in two cities, Inglewood and Duarte.

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SINGLE PAYER LINKS #276

Posted 21 OCT 2022

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Robert King, “Biden administration finalizes rule to get rid of ACA’s ‘family glitch,’” Fierce Healthcare, Oct 11, 2022 READ IT HERE

Some workers needing coverage for the entire family were left out of the ACA subsidy scheme. Now, they’ll be included with the result that even more federal cash will flow to private insurers.

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Mariana P. Socal, Matthew A. Crane, Jeromie Ballreich & Gerard F. Anderson, “The new Medicare Part D out-of-pocket cap will have unintended consequences,” Health Affairs, Oct 6, 2022 READ IT HERE

This analysis funded by Arnold Ventures (a rather secretive philanthropy) raises an interesting point: once the patient copays stop after the $2K cap, patient and doctor incentives to control costs disappear. “The cap means that both a $10,000 drug and a $100,000 drug will have the same out-of-pocket cost for Medicare Part D beneficiaries. It will also increase manufacturers’ incentives to raise their drugs’ launch prices.” Fair enough, but instead of returning to copays, we could empower regulators to control launch prices as the Europeans do. Expensive specialty drugs already eat up 20% of Part D spending.

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Frank Diamond, “Employers rein in health benefits for pre-Medicare and Medicare-eligible retirees,” Fierce Healthcare, Oct 12, 2022 READ IT HERE

Relentless healthcare costs are eating away at the retiree insurance packages that have been key union selling points. Some employers are “looking to replace their traditional group plans for pre-Medicare and Medicare-eligible retirees with individual insurance coverage through private marketplaces.” Ergo, the New York City retirees fight to keep their benefits is the tip of the iceberg.

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Gretchen Morgenson, “This won’t hurt a bit: The anesthesiologist who is putting you under may work for a private-equity firm,” New York Times, Oct 10, 2022 READ IT HERE

“North American Partners in Anesthesia is the nation’s largest anesthesia staffing company, employing 6,000 clinicians at 500 facilities in 21 states. The company is owned by two well-heeled private-equity firms. Four of NAPA’s nine directors are private-equity executives.” How reassuring for anyone heading into the OR. The FTC is investigating.

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Travel Weekly Asia, “Phuket finds new calling in medical tourism with MoU signing,” Oct 11, 2022 READ IT HERE

Thailand is putting $130 million into a deluxe medical facility for foreigners priced out of decent care at home. They can get their surgeries while staying at a seaside resort “that allows its guests to recuperate in luxury.”

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Rae Ellen Bichell, “Baby, that bill is high: Private equity ‘gambit’ squeezes excessive ER charges from routine births,” Kaiser Health News/Fortune, Oct 13, 2022 READ IT HERE

A new mom “was surprised to discover she was an ‘unknown accident’—at least from a billing standpoint.” Insurers have come up with a new category, “obstetrics emergency,” complete with its own department. “A doctor briefly checked her cervix, timed her contractions, and monitored the fetal heartbeat.” That “emergency” was billed for $1300 even though the woman was told to go home and come back later. Surprise alert: “Three of the four major companies that set up and staff OB emergency departments are affiliated with private equity firms.”

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Lauren Gardner, “Battle over pregnancy drug highlights risks of FDA expediting drugs to market,” Politico, Oct 16, 2022 READ IT HERE

The FDA is loose and easy when handing out approvals but lax about enforcing its accompanying requirements that Pharma prove the things actually work, known as “confirmatory trials.” In a rare move, it will try to get Makena, a pregnancy drug, off the shelves after 10 years of probably not doing anything to prevent preterm births. But the drug extracted $700 million from Medicaid over the decade, so in one sense it’s clearly a “success.”

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Health Affairs, “Administrative waste’s role in excess U.S. health spending,” Oct 6, 2022 READ IT HERE

“Researchers have estimated that at least half of all administrative spending in the United States [15-30% of all health expenditure] is wasteful. That spending does not contribute to health outcomes in any discernible way.” Oddly, the study was funded by Pharma and an insurer, which could mean some big players are trying to pin the blame for runaway costs on others.

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Paige Minemyer, “Humana joins forces with USAA for new co-branded MA plan for veterans,” Fierce Healthcare, Oct 12, 2022 READ IT HERE

Stealth privatization continues at the VA: insurer Humana offers veterans a for-profit “complementary” plan called “Honor.” What could go wrong? The announcement is heavy on boilerplate about how much Humana supports our troops. Meanwhile, the partnering group, USAA, never writes out its full title even on its own website: United Services Automobile Association. We should all get our health care from car insurance companies like the lucky veterans!

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Sharon Udasin, “200M pounds of toxic chemicals dumped into US waterways in 2020: analysis,” The Hill, Sep 28, 2022 READ IT HERE

Not directly single-payer related but a good reminder of those pesky “social determinants” that we could pay more attention to if we weren’t drowning in the details of our dysfunctional payment system. “Toxic discharge flowed into one in every three local watersheds across the country and included many cancer-linked chemicals,” according to study released for the 50th anniversary of the Clean Water Act. If the Supreme Court has its way, #50 will be the last.

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Dave Muoio, “Hospital and health system transactions remain infrequent but hefty in Q3 2022,” Fierce Healthcare, Oct 12, 2022 READ IT HERE

Merger and acquisition deals in the hospital sector are fewer but larger—perhaps because there are fewer players left to be hoovered up.

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Associated Press, “A major hospital merger in New Orleans means big change,” Oct 11, 2022 READ IT HERE

New Orleans-based LCMC Health will acquire three Tulane hospitals from HCA Healthcare, leaving the city two mega-systems. “The bigger system will have more negotiating power against suppliers and insurance companies”—not to mention patients.

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Fred Clasen-Kelly, “As giant hospitals get bigger, an independent doctor feels the pinch,” Kaiser Health News/Charlotte Observer, Oct 13, 2022 READ IT HERE

A community doc is holding out but getting crushed by the big players. “Billions of dollars in federal aid at the beginning of the crisis favored large hospital systems even as lawmakers vowed to fight consolidation. Seven large hospital systems in North Carolina received $1.5 billion in Covid relief money while collectively seeing their cash and investments grow by $7.1 billion.” Says the main subject of the article: “If I could go back 30 years, I wouldn’t become a doctor. Looking back at life, this was the wrong choice.”

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Heather Landi, “One in 4 clinicians want to leave healthcare, citing burnout. Here’s what providers can do to stem the tide,” Fierce Healthcare, Oct 11, 2022 READ IT HERE

Why do they want to quit? Burnout/working conditions/understaffing, inadequate pay, and lack of “clinically focused job responsibilities” (i.e., providing healthcare v/s moneymaking). One third of those planning to stay are looking for better jobs. Says one headhunter: “Solving the burnout crisis is complicated as many of its drivers are rooted in the business of healthcare.” The business model will undermine those “staff wellness” initiatives.

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SINGLE PAYER LINKS #275

Posted 17 OCT 2022

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Meghan McIntyre, “Doula services now covered under Virginia Medicaid expansion,” Virginia Mercury, Oct 10, 2022 READ IT HERE

Good for Virginia, “the fourth state in the nation to offer community doula services” to Medicaid enrollees. Who wouldn’t want to get their care from these ladies? [in the photo attached]

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Reed Abelson & Margot Sanger-Katz, “‘The cash monster was insatiable’: How insurers exploited Medicare for billions,” New York Times, Oct 8, 2022 READ IT HERE

Five of the six top Medicare Advantage firms—which now cover half of all Medicare enrollees—have been accused of fraud (i.e., upcoding). We already knew that, but the fact that it’s the subject of a big exposé in the Times may indicate a shift of winds. “The insurers have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits. As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.” Many gory details but no attention to how eagerly Medicare’s own administrators push MA plans onto seniors. “Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but C.M.S. [Centers for Medicare & Medicaid Services] has never chosen to do so.” Why not? “Several top officials have swapped jobs between the industry and the agency.” Ah.

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Tom Murphy, “Exercise caution with zero-premium Medicare Advantage plans,” Associated Press, Oct 5, 2022 READ IT HERE

No-premium MA plans with enticing features will flood the market during the sign-up period. But “experts say shoppers should exercise caution. The adage that nothing in life is free applies here.” MA plans have restricted networks and require prior authorizations (leading to denials) like all commercial insurance. Copays differ widely.

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Arthur Allen, “Pharma-funded FDA gets drugs out faster, but some work only ‘marginally’ and most are pricey,” Kaiser Health News/Los Angeles Times, Sep 30, 2022 READ IT HERE

One positive result of the acute politicization of medicine is that people now view the FDA imprimatur as just one more opinion. Maybe that’s because “accelerated approval allows pharmaceutical companies to license promising treatments without proving they are effective.” The Alzheimer’s turkey, Aduhelm, is the best recent example, but there are many others. Patient advocacy groups (usually Pharma-funded) play a key role; so did the AIDS activist movement, which pushed the FDA to speed things up. But it’s one thing to broaden access to experimental treatments; it’s entirely another to force the government to pay whatever the Pharma experimenters want to charge based on dubious evidence of efficacy.

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Julie Carr Smyth, “Drug companies in opioid crisis donated $27K to Ohio’s Ryan,” Associated Press, Oct 5, 2022 READ IT HERE

Everyone gets a piece of the Pharma action. Ryan is the D candidate for U.S. Senate.

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Mitchell Schnurman, “Texas Health hospitals charge over three times Medicare rates—and want a big increase,” Dallas Morning News, Sep 30, 2022 READ IT HERE

“The state’s largest insurer balked at the proposed increase, and the providers responded by filing to terminate the contract,” i.e., threatening to push a half million patients out of network. According to the article, the Dallas-Fort Worth region has the highest health costs in the state, and Texas Health is “among the higher-priced hospital systems in the country.” But they’re so big they can bully even insurance giants.

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Emily Baumgaertner, “As hospitals close children’s units, where does that leave Lachlan?” New York Times, Oct 11, 2022 READ IT HERE

“Adult beds are more lucrative than children’s beds. So as institutions look to boost profit margins, pediatrics is often among the first services to be cut.” A commentator: “Why are we giving hospitals any control over health care policy at all? Unless, of course, you’re a eugenicist who believes that only fit children should survive.” Or in the words of one hospital exec with an MD degree: “‘Should we take care of kids we don’t make any money off of, or use the bed for an adult who needs a bunch of expensive tests?’ said Dr. Daniel Rauch, chief of pediatric hospital medicine for Tufts Medicine. “‘If you’re a hospital, that’s a no-brainer.’” Okay, now define “hospital.”

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Tony Cook & Johnny Magdaleno, “Marion County agency wants SCOTUS to strip protections for millions of vulnerable Americans,” Indianapolis Star, Oct 6, 2022 READ IT HERE

Indiana is special: the county that includes its capital city wants the Supreme Court to block beneficiaries of safety net programs like Medicaid from defending their rights in court. We’ll no longer have “entitlement” programs if states can simply refuse to follow the law with no citizen recourse. Said one advocate, “This case is to Medicaid what Dobbs was to abortion.”

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Victoria Knight, “Hospitals still aren’t complying with transparency rules,” Axios, Oct 6, 2022 READ IT HERE

Why should they if there’s no enforcement even though only 6% of hospitals are compliant with the new law? In one study, researchers looked into disclosed prices and cross-referenced insurance company files. “Some of the prices that are found in insurance company price files appear with an ‘N/A’ or are blank in the corresponding hospital price lists,” evidence that the hospitals know what they’re doing. As often happens, it’s up to states to step in: “[Colorado] Gov. Jared Polis signed bipartisan legislation into law in June that prohibits hospitals or collection agencies from collecting unpaid patient bills if the facility isn’t in compliance with federal transparency rules.” A good idea for Albany.

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Roni Caryn Rabin, “Medical care alone won’t half the spread of diabetes, scientists say,” New York Times, Oct 5, 2022 READ IT HERE

“There is no device, no drug powerful enough to counter the effects of poverty, pollution, stress, a broken food system, cities that are hard to navigate on foot, and inequitable access to health care, particularly in minority communities.” All that cash poured into expensive insulin means lost opportunity costs of doing something more useful with our government dollars. Repeat for dozens of other illnesses. “Many teenagers are developing what was once considered to be a disease of older people; 40 percent of young adults will be diagnosed with it at some point in their lives.” Meanwhile, one dollar out of every four spend on healthcare goes to treat diabetes.

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Anastassia Gliadkovskaya, “Mark Cuban Cost Plus Drug Company announces first health plan partner, Capital Blue Cross,” Fierce Healthcare, Oct 6, 2022 READ IT HERE

Cuban’s Cost Plus “currently offers approximately 350 unique generic prescription drugs that it says reflect manufacturer prices plus a 15% fee.” An interesting experiment by a billionaire, and if there’s a catch, I haven’t found it yet. Note it’s only for generics.

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Terry Wilcox, “Medicare’s cuts to home health are a step in the wrong direction,” STAT, Oct 11, 2022 READ IT HERE

“Medicare is considering implementing a permanent nearly 8% cut in payments to home health services” now that the Covid emergency is “over.” The things we started to do right during Covid can’t be allowed to continue. Home health care has overwhelming support from the public, but we’d need to live in a democracy for that to matter.

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SINGLE PAYER LINKS #274

Posted 7 OCT 2022

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Robert King, “Medicare Part B premiums to decline slightly in 2023 due to low Aduhelm use,” Fierce Healthcare, Sep 27, 2022 READ IT HERE

Since Aduhelm is such a turkey that even cowed physicians balked at forcing it on their infirm patients, the feds are now rolling back the big jump in Medicare premiums that were imposed on everyone to pay for it. The drop is only $5 per month, but given that that was coming from every Medicare beneficiary essentially to pay for one drug, it’s pretty scandalous—or would be if we were capable of being scandalized.

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Caitlin Owens, “New ALS treatment sparks yet another drug pricing debate,” Axios, Oct 3, 2022 READ IT HERE

Next up: Relyvrio, approved by the FDA “without the clinical trial evidence the agency usually requires.” Given public faith in the FDA’s sterling record of probity, that shouldn’t stop Medicare from shelling out owner Amylyx Pharmaceuticals’s price of $158,000 a year. Note the role of the (industry-funded) patient advocacy groups in hastening approval. The accelerated approval scam is out of control.

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Mario Aguilar, “Health app companies wrestle with how to design studies to prove treatments work,” STAT, Sep 29, 2022 READ IT HERE

Paywalled, but the headline accidentally gives away the game. Innocent me, I thought scientists designed studies to find out the truth.

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Lauren Weber, “Shattered dreams and bills in the millions: Losing a baby in America,” Kaiser Health News/NPR, Sep 23, 2022 READ IT HERE

Peak cruelty: harassment of parents whose infant did not survive for 7-figure medical bills. “Because many crises that befall premature or very sick babies are in-the-moment emergencies, there may not be time for the pre-approvals that insurers often require for expensive interventions. That leaves parents in crisis—or in mourning—tasked with fighting with insurers to have treatment covered.”

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Tim Courtney & Rachel Stewart, “Medicare Advantage costs less than original Medicare,” Wakely/America’s Health Insurance Profiteers Plans (AHIP), Sep 21, 2022 READ IT HERE

First red flag: the reference to “apples-to-apples” comparisons, meaning, Let’s compare two things as if they were the same even though they’re not. This study funded by an insurers’ trade group purports to show how “original Medicare costs would change if it capped maximum out-of-pocket (MOOP) costs just as MA plans do.” That is, if we were to make up a world different from the one we live in, MA would be cheaper! And if people had wings, we could fly like great blue herons! Utterly pathetic attempt at porcine maquillage, demonstrating the conceptual bankruptcy of the industry (not to mention the moral kind). Hilarious side note: AHIP doesn’t spell out its full name anywhere on its website home page, perhaps to avoid the words “health insurance.”

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Jonathan Stempel, “Anthem must face U.S. government lawsuit alleging Medicare Advantage fraud,” Reuters, Oct 3, 2022 READ IT HERE

Anthem, now Elevance, must go to trial on charges of false upcoding, also known as a “cash cow” for MA purveyors. Fraudulent overpayments “appeared to be well over $100 million,” a fraction of the estimated $12 billion in excess billing stemming from MA employees digging around in people’s charts to find ways to make them looker sicker. Other MA companies are also facing lawsuits—a true apples-to-apples comparison!

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Susan Jaffe, “Nursing home surprise: Advantage plans may shorten stays to less time than Medicare covers,” Kaiser Health News/Fortune, Oct 4, 2022 READ IT HERE

“Medicare Advantage plans are increasingly ending members’ coverage for nursing home and rehabilitation services before patients are healthy enough to go home.” So, to bill the government more, MA plans make you look sick. But when you need extra care because you are sick, the same plans say you’re actually good to go. Traditional Medicare leaves that decision up to the medical team. Action: tell your elderly relatives NOT to sign up for Medicare Disadvantage!

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Bruce Japsen, “Big health insurers will expand Medicare Advantage to hundreds of new counties for 2023,” Forbes, Oct 1, 2022 READ IT HERE

Nonetheless, all the big insurers are planning big new footprints in the lucrative MA biz. MA “is one of the few areas of healthcare and U.S. policy in general that has bipartisan support in Congress” and now accounts for 45% of all Medicare enrollment.

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Christine Spolar, “Britain’s hard lessons from handing elder care over to private equity,” Kaiser Health News/Fortune, Sep 27, 2022 READ IT HERE

Four Seasons Health Care (500 sites, 20,000 residents) is no more. “After years of private equity investors rolling in one after another to buy its business, sell its real estate, and at times wrest multimillion-dollar profits through complex debt schemes,” the last corporate vulture collapsed. This playbook is so old that it’s almost too boring to recap: swoop in, load up the entity with debt, pay yourself huge fees, save on expenses by wrecking services, sell off real estate, force the crippled company to rent it back, get out with a bundle; rinse and repeat. “Years ago, [British] care homes were largely run by families or local entities. In the 1990s, the government promoted privatization, triggering investments and consolidations.”

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Corey Doctorow, “How Palantir will steal the NHS: Stealth privatisation was always the endgame for public-private-partnerships,” Pluralistic, Oct 1, 2022 READ IT HERE

How cartoon villain Peter Thiel’s “sinister” outfit is oozing its way into the U.K.’s National Health Service. Because Palantir has a bad rep for its role in police and political surveillance, it doesn’t directly bid for contracts through the heads-I-win, tails-you-lose public-private partnerships scam. Instead, it simply buys up other companies to “take down a lot of political resistance.”

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Dave Muoio, “HHS expands ownership data set for 15,000 Medicare-certified nursing homes,” Fierce Healthcare, Sep 26, 2022 READ IT HERE

The newly available ownership data “allows researchers, regulators, law enforcement, and others to better identify whether certain owners are linked to poor care quality or other impacts on residents.” Private investments in the sector, which pulls in billions in federal support, are “ballooning.”

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Juliana E. Morris, “Doctors who knowingly spread Covid-19 lies should be held accountable,” STAT, Sep 27, 2022 READ IT HERE

The author demands that “rogue physicians” responsible for “anti-vaccine conspiracy theories” should lose their board licenses when they propose crazy things like “drinking methanol and taking ivermectin,” which, she warns, “can be harmful.” Fair enough, so let’s review the facts on IVM: prescribed over a billion times for parasitic diseases like river blindness and elephantiasis (which it cures); currently being studied with an NIH grant for efficacy in Covid treatment; utility for Covid prophylaxis undetermined though not disproven. So, if calling it “harmful” is misinformation, should Dr Morris be decertified under her own rules?

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[No author], “Study confirms link between COVID-19 vaccination and temporary increase in menstrual cycle length,” National Institutes of Health, Sep 27, 2022 READ IT HERE

Wasn’t that called a conspiracy theory at one point? Along with the lab-leak possibility, now considered very plausible?

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Melody Schreiber, “Biden picked the worst possible moment to declare the pandemic over,” New Republic, Oct 4, 2022 READ IT HERE

“In June, the Biden administration reportedly discussed how many deaths from Covid are acceptable. That number appears to be more than 200,000 so far this year,” long Covid not included. Since “terrorists” aren’t doing it, zero problem. If we get a deadly new variant, we’ll be without tools and without public support for any needed actions.

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Nicholas Florko, “The U.S. is terrible at keeping businesses from worsening public health, experts say,” STAT, October 6, 2022 READ IT HERE

You’ve heard of “social determinants of health.” How about “commercial determinants of health,” an equally worth topic? It’s studied only at a George Washington University institute dedicated to it. Sounds like a field with a future.

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Noam N. Levey, “Few places have more medical debt than Dallas-Fort Worth, but hospitals there are thriving,” Kaiser Health News/NPR, Sep 28, 2022 READ IT HERE

Correction: “and hospitals are thriving.” None of this but. “Though exempt from taxes as nonprofit institutions, several [hospitals] notched double-digit margins in recent years, outperforming many of the area’s Fortune 500 companies. But patients aren’t sharing in the good times.” There’s that but again. Fully a quarter of the DFW area population is saddled with medical debt. “If you walk into a hospital today, chances are you are going to walk out with debt, even if you have insurance.”

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Casey Ross, “Call it data liberation day: Patients can now access all their health records digitally,” STAT, Oct 6, 2022 READ IT HERE

“Private data brokers make huge profits by amassing hundreds of millions of de-identified medical records and selling insights to drug companies, device makers, and insurers without patients’ knowledge or consent.” But until now, patients couldn’t get their own info. Expect resistance and heel-digging to sabotage the spirit of the new regs, especially since there are no penalties for failing to comply.

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Dave Muoio, “Providence plans to refund hundreds of poor patients wrongly charged for charity care,” Fierce Healthcare, Oct 5, 2022 READ IT HERE

Providence is forced to reimburse poor patients who were billed when their “nonprofit” hospitals didn’t tell people they could apply for charity care. This is the outfit that hired McKinsey & Co. to plot how to squeeze more cash from the patients they’re supposed to serve in lieu of paying property taxes.

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SINGLE PAYER LINKS #273

Posted 30 SEP 2022

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Matt Stoller, “The antitrust shooting war has started,” BIG, Sep 24, 2022 READ IT HERE

Excellent background as always in Stoller’s BIG; particularly salient for healthcare is this part: The proposed deal between mega-insurer UnitedHealth Group and payments data quasi-monopoly Change was a “comically unlawful merger,” but the government lost its attempt to block it. The judge that supported the merger, Carl Nichols, “filed his decision eleven days after the trial ended. That is either shockingly fast, or more likely, Nichols was already writing his decision during the trial. But more importantly, Judge Nichols is deeply conflicted. As of his last financial disclosure, Nicholas owned $50,000 in UHG bonds.” Much revolting detail about UHG [“at the center of the controversy over the botched rollout of Healthcare.gov”] and other sleazy judges. The feds can still appeal.

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Vinay Prasad, “Double standards: Legacy media covers a doctor’s unproven anecdote but not myocarditis in young men,” YouTube, Sep 26, 2022 READ IT HERE

A deep dive into our skewed reporting of The Science™. Worth a listen to train the ear and the eye.

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Dave Muoio, “Envision Healthcare at high risk of bankruptcy or major restructuring, Moody's warns,” Fierce Healthcare, Sep 22, 2022 READ IT HERE

Physician staffing service Envision, bought by private equity firm KKR in 2018 for $10 billion, is teetering due to “significant negative publicity” over its surprise billing practices. How terrible for them. Though the PE playbook apparently flopped for once, KKR will do fine with the fees already extracted.

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Adam C. Urato, “A pharma company is arguing that Makena should be kept on the market because it may work in Black people. But it doesn't work in any people,” STAT, Sep 26, 2022 READ IT HERE

“FDA: Ignore a pharma company’s deceptive racial equity argument for keeping Makena, an ineffective preterm labor drug.” Set this one next to the CIA’s unveiling of a statue of Harriet Tubman as an “intelligence pioneer” [not satire]. Not surprisingly, this drug is owned by another PE outfit. Note the role of the nonprofit front group HealthyWomen.

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Lola Duffort, “State employees gear up for fight over cost-cutting Medicare Advantage plans,” Vermont Digger, Sep 23, 2022 READ IT HERE

Vermont government retirees are suiting up for a fight over forced MA just like their NYC counterparts. The state cost-cutters use the same lame arguments to bamboozle the beneficiaries, who apparently are not buying it. Steve Howard, executive director of the Vermont State Employees’ Association: “We want to maintain collective bargaining and not privatize this benefit out to an industry that is renowned for denying health care services to people when they need it the most.” The state’s retired teachers already got shoved over to an MA plan, which are regulated by the feds, i.e., the Centers for Medicare & Medicaid Services (CMS) where, says Howard, it’s “very hard to get any kind of regulatory response.” The Vermont retirees are fighting to avoid hassles with prior authorizations and long trips to find an in-network provider.

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Rose Lundy, “Maine to walk away from multi-million-dollar Juul settlement,” Bangor Daily News/Maine Monitor, Sep 23, 2022 READ IT HERE

Good for Maine. “As part of the agreement, Juul wanted states to waive the rights of school districts to pursue their own lawsuits.” Maine wasn’t willing to agree to that given Juul’s proven record of campaigning to attract youth users “with launch parties, social media posts and free samples.”

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Heather Landi, “Redesign Health scores $65M to create and launch more healthcare startups,” Fierce Healthcare, Sep 15, 2022 READ IT HERE

Healthcare startups are all the thing, says Redesign Health head of strategy and finance Samantha Lynch: “We believe in enabling a new innovation model in healthcare,” citing “industry leaders” like CVS. When anyone says that “innovation” is the solution to our healthcare system’s problems, place both hands firmly over wallet.

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Christine Vestal, “More states extend postpartum Medicaid since Roe’s demise,” Stateline, Sep 20, 2022 READ IT HERE

But only with a big dose of federal cash.

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Meredith Cohn, “Coronavirus, inflation push up cost of health insurance in Maryland,” Baltimore Sun, Sep 20, 2022 READ IT HERE

Carriers requested 11% increases; Maryland gave them 6.6%.

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Jessica Silver-Greenberg & Katie Thomas, “They were entitled to free care. Hospitals hounded them to pay,” New York Times, Sep 24, 2022 READ IT HERE

“With the help of a consulting firm, the Providence hospital system trained staff to wring money out of patients, even those eligible for free care [in exchange for their $1 billion in tax exemptions].” Which consulting firm? Mayor Pete’s McKinsey & Co., of course. Providence is not in Rhode Island; it’s a massive conglomerate based in Washington State with $27 billion in annual revenues whose units “have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line.” It also has a $10 billion investment arm with its own venture capital fund. Washington State is suing them.

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Gracie Himmelstein, Joniqua Ceasar & Kathryn E.W. Himmelstein, “Hospital financing in black and white,” STAT, Sep 20, 2022 READ IT HERE

“Just 10% of all hospitals provide three-quarters of all care for Black people covered by Medicare. The current-day hospital payment system continues to cement these inequities by assigning different dollar values to the care of different patients: lower values for care delivered to people who are uninsured or covered by Medicaid, and higher values to care for the privately insured and patients with Medicare—especially those able to pay deductibles, copayments, and coinsurance.”

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Beth Schwartzapfel, “Guess who’s tracking your prescription drugs?” Marshall Project, Aug 2, 2022 READ IT HERE

“Your doctor, your pharmacist... and the police,” all in the name of ending opioid abuse. DEA agents, medical boards, and who knows who else can look at your prescription records because a judge ruled that “patients have no reasonable expectation of privacy” over their medications. “In 21 states and the District of Columbia, police can access the databases as a matter of course; some have their own log-ins to use at their discretion.”

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Tatum Hunter & Jeremy B. Merrill, “Digital health care has its advantages. Privacy isn’t one of them,” Washington Post, Sep 22, 2022 READ IT HERE

“When you fire up a symptom-checker or digital therapy app, you might be unknowingly sharing your concerns with more than just the app maker. Drugs.com, Medication Guide, WebMD: Symptom Checker, and Period Tracker gave advertisers the information they’d need to market to people or groups of consumers based on their health concerns.” Caveat digitor.

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Robert King, “Texas Medical Association lobs new surprise billing lawsuit taking aim at tweaked rule,” Fierce Healthcare, Sep 23, 2022 READ IT HERE

Doctors fight restrictions on their billing practices, say insurers have too much advantage.

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Katie Thomas and Jessica Silver-Greenberg, “How a hospital chain used a poor neighborhood to turn huge profits,” New York Times, Sep 24, 2022 READ IT HERE

A “hollowed-out” hospital in Richmond’s poorer neighborhood can’t serve local patients well but pulls in huge profits. How? “The secret to its success lies with a federal program that allows clinics in impoverished neighborhoods to buy prescription drugs at steep discounts, charge insurers full price, and pocket the difference. . . . Starting in the mid-2000s, big hospital chains figured out how to supercharge the program: Build clinics in wealthier neighborhoods where patients with generous private insurance could receive expensive drugs, but on paper make the clinics extensions of poor hospitals to take advantage of 340B.” Meanwhile, strip the poor-people’s hospital of services and shift resources to the suburbs. “Dr. Samuel Hunter, 81, who worked for more than four decades as a pathologist at Richmond Community, said the disparity reminded him of his childhood in segregated Florida.”

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Mariel Padilla, “Why the nursing shortage isn’t going away anytime soon,” The 19th, Sep 23, 2022 READ IT HERE

Aging population + aging workforce + pandemic deaths + pandemic burnout = not enough nurses. Current average age of a nurse is 51. Nursing schools turned away more than 90,000 qualified applications last year due to lack of teaching staff. Also, an unusual number of nurses quit months after taking their first job—would poor working conditions be a factor?

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Andrew Joseph, “An Alzheimer’s therapy scores winning results, but what could it mean for patients?” STAT, Sep 28, 2022 READ IT HERE

We should be hyper-wary of medicine-by-Pharma-press-release by now, especially with Groundbreaking! Successful! new Alzheimer’s drugs. But the “science” press hasn’t learned much (Bloomberg: “How Japanese Drugmaker Eisai Got The ‘Clean Win’ Over Alzheimer’s”). Grounds for skepticism: We have NO hard data, only PR statements. The rating system to determine “improvement” in cognitive function (the Clinical Dementia Rating sum of boxes) is highly subjective and susceptible to tweaking. The improvement allegedly measured is .45 on an 18-point scale, “probably too small to be noticed by patients and their families.” Statistical significance does not equal clinical significance. Not emphasized in the coverage: 20% of experimental users experienced brain swelling. Next question: how many billions will this drug cost Medicare if approved?

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Kim Krisberg & David Leffler, “A free medical clinical opened in rural East Texas. Thousands poured in for help,” Public Health Watch/Texas Tribune, Sep 21, 2022 READ IT HERE

Because Texas is a nightmare for poor people who get sick, thousands of people poured into a free clinic opened by retired docs. The article includes many details of their struggles to keep it going due to bureaucratic obstacles for obtaining federal support (forget the state).

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Katy Golvala, Erica E. Phillips & Dave Altimari, “CT’s big hospital systems are buying up private practices and small hospitals. What does that mean?” CT Mirror, Sep 21, 2022 READ IT HERE

Deepening concentration in the health care industry means fewer resources for rural residents, higher costs, more expensive insurance, and greater burdens on small businesses.

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Sarah Jane Tribble, “Buy and bust: After Platinum Health took control of Noble sites, all hospital workers were fired,” Kaiser Health News, Sep 22, 2022 READ IT HERE

“The drama playing out in Paul Huemann’s [Missouri] hometown is familiar to many who live in rural America: Communities are so desperate to keep their hospital open that they’re willing to gamble on any buyer, including those backed by private equity.” It doesn’t end well for them. The owner of the firm involved in the buyout and shutdown, previously convicted of Medicare fraud, is now busy with new projects in Dubai.

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Markian Hawryluk, “Death is anything but a dying business as private equity cashes in,” Kaiser Health News/Fortune, Sep 22, 2022 READ IT HERE

PE firms are now adding funeral homes to their profit portfolios, given their skill in providing customers. Look for consolidation and monopoly pricing practices in the death biz. PE already owns 5% of the sector.

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SINGLE PAYER LINKS #272

Posted 22 SEP 2022

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Kay Tillow, “How this rural Wisconsin county put publicly funded, non-profit, national health care on the ballot,” Common Dreams, Sep 12, 2022 READ IT HERE

The board of supervisors of Dunn County WI (pop. 45,000) unanimously voted to place a resolution on the November ballot: “Shall Congress and the President of the United States enact into law the creation of a publicly financed, non-profit, national health insurance program that would fully cover medical care costs for all Americans?” The county currently spends over $10 million a year, or 11% of its total budget, on health insurance. Trump carried Dunn County in 2020 by 56%. Unfortunately, the article includes no background on how this remarkable event came about, who promoted it, or how they overcame the usual objections. However, to learn more, here’s the link to a Sept. 28 webinar (8:00 pm Eastern) with the National Single Payer Working Group to meet the organizers, John Calabrese and Dr. Lorene Vedder. READ IT HERE

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Lisa Jarvis, “Why is the FDA rushing a new and unproven ALS drug?” Herald.net/ Bloomberg, Sep 12, 2022 READ IT HERE

Another dubious FDA approval as the government “watchdog” agency is deep in budget talks with its Pharma funders. Amylyx Pharmaceuticals wants its ALS drug approved even though no one will know if it works until 2024 “at the earliest.” The new FDA standard apparently isn’t that a drug works, but rather that it’s not a proven dud. FDA staff turned down the application in March, but (following the script for the Alzheimer’s turkey Aduhelm) the company got a second change to massage the trial data and voila! won an approval. Why would anyone trust the U.S. government on Pharma products at this point? The antivax crowd now has new ammo. “Billy Dunn, director of FDA’s office of neuroscience, called on Amylyx to voluntarily withdraw the study if a Phase 3 study failed.” Reassuring!

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Elizabeth Cooney, “Francis Collins on trust in science, how Covid communications failed, and his current obsession,” STAT, Sep 19, 2022 READ IT HERE

NIH’s long-time now ex-chief is “very concerned” about public skepticism. Perhaps a real communications strategy would have helped, one that didn’t involve lies and letting Pharma write the rules and finance its own regulators.

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Christina Jewett, “F.D.A.’s drug industry fees fuel concerns over influence,” New York Times, Sep 15, 2022 READ IT HERE

Half of the FDA’s budget (¾ in its drug division) comes from the pharmaceutical industry. “Every five years, top officials of the Food and Drug Administration go behind closed doors to negotiate the terms of its core budget in dozens of meetings with representatives of the companies whose products the agency regulates.” So Mr Collins might start there in his labor of “restoring confidence” in public health. Bernie Sanders: “The industry is regulating itself.” The FDA’s tobacco division, with 1,200 employees, is entirely industry funded, which might be related to the steadily revolving door between the two.

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Amy Gordon Bono, “Legislature’s attack on primary care providers will harm health of all Tennesseans,” The Tennessean, Aug 23, 2022 READ IT HERE

Putting targets on the backs of all OB/GYNs will undermine primary care, says the author. “In Tennessee, many women do not have a primary care provider until they encounter their first big health event in life—often their first pregnancy.” Imagine trying to recruit medical students to go into this field and work in Tennessee.

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Dave Muoio, “‘Unsustainable’ losses are forcing hospitals to make ‘heart-wrenching’ cuts and closures, leaders warn,” Fierce Healthcare, Sep 16, 2022 READ IT HERE

Something weird is happening in hospital finance: smaller and rural hospitals are losing tons of money while a few mega-systems rake it in. “Anywhere from 53% to 68% of the nation’s hospitals will end 2022 with their operations in the red” with a lot of the deficit due to high personnel costs. Hospitals are so short staffed that some have had to shut down services. After a national health emergency and billions in federal money injected into the system, why are things falling apart? Meanwhile, private equity continues to hoover up more and more medical services and extract profits [see below].

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Lauren Weber, “Private equity sees the billions in eye care as firms target high-profit procedures,” Kaiser Health News/Fortune, Sep 19, 2022 READ IT HERE

Another juicy medical field ripe for draining by PE. “Ophthalmology Consultants is part of EyeCare Partners, one of the largest private equity-backed U.S. eye care groups” with 1000 eye doctors in 19 states. PE now controls 8% of all U.S. ophthalmologists.

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Rublas Ruiz, “Our health care system is facing massive staffing shortages. A crisis is looming,” Newsweek, Sep 1, 2022 READ IT HERE

Why are healthcare providers leaving their jobs in droves? Poor working conditions (inadequate staffing), “low pay, disrespect, and disregard for their well-being,” says this nurse. Covid aggravated everything, but the problem pre-dates it. Quite a departure from the 7 p.m. cheer sessions of 2020.

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Dave Muoio, “Wellstar's Atlanta hospital closure has government leaders scrambling to head off care shortages,” Fierce Healthcare, Sep 13, 2022 READ IT HERE

A major safety-net hospital will need a big infusion of (federal) government funds, including Covid emergency cash. The problem is a hot topic in Georgia’s race for governor.

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Dave Muoio, “Lawsuit accuses RWJBarnabas Health of ‘years-long’ monopolistic scheme to crush 3-hospital competitor,” Fierce Healthcare, Sep 13, 2022 READ IT HERE

Battle of the hospitals: CarePoint, a relatively small hospital group, is suing the local behemoth and its insurance collaborators for monopolistic practices. CarePoint accuses the giant of “strategically adjusting its service offerings in competitive markets to drive uninsured or underinsured patients to CarePoint facilities while using its relationships with Horizon and ambulance operators to drive emergency room traffic and well-insured patients, respectively, to competing locations.” The Federal Trade Commission blocked an acquisition attempt by RWJBarnabas earlier this year, forcing them to call it off.

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Phil Galewitz, “Hospitals divert primary care patients to health center ‘look-alikes’ to boost finances,” Kaiser Health News/Fortune, Sep 9, 2022 READ IT HERE

“A growing number of hospitals are outsourcing often-unprofitable outpatient services for their poorest patients by setting up independent, nonprofit organizations to provide primary care.” Not in itself a bad thing though real FQHCs (Federally Qualified Health Centers) get direct government stipends and other benefits to offset money-losing care that the look-alikes don’t. Diverting patients to a clinic setting away from ERs for primary care makes sense, but the whole initiative reflects the need for more Rube Goldberg-style solutions to the system’s financing irrationality.

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Samantha Liss, “Congressman calls on HHS to investigate HCA over emergency room admissions,” Healthcare Dive, Sep 16, 2022 READ IT HERE

A congressional committee wants to look into HCA Healthcare’s emergency department over alleged “systematic, unnecessary inpatient admissions” calculated to raise reimbursements. Says one member: “HCA sets admissions targets and retaliates against clinicians if those targets are not met.” HCA’s profits nearly doubled in 2021.

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Simone Betchen, “Surgery needs a new pay model, free from incentives to do more procedures,” STAT, Sep 19, 2022 READ IT HERE

“About 15 million Americans have surgery each year, and up to one-quarter of these operations are deemed unnecessary” because, argues the author, surgeons get paid more if they perform more operations, especially if complicated ones. This is an incentive problem that wouldn’t be solved by a single-payer system alone.

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Isabella Cueto, “Medicare is using one of its biggest hammers to try to fix the dialysis system: How providers are paid,” STAT, Sep 19, 2022 READ IT HERE

Medicare pays for most dialysis nationally, and the industry is concentrated in just two main players: DaVita and Fresenius. Rates of home dialysis remain low (12.6%), and the process of connecting patients to kidney transplant options is lackadaisical. (A transplanted patient doesn’t need dialysis anymore.)

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Julia Reinstein, “Monkeypox is leaving working-class people in financial ruin,” BuzzFeed, Sep 7, 2022 READ IT HERE

“With [few] laws guaranteeing workplace sick leave in the US, the lengthy quarantine period can put people who catch monkeypox in a precarious financial position long after their lesions heal.” This is a key worker demand in the on-again, off-again national rail strike. The article includes various stories of workers fired for the crime of falling sick. “The vast majority of jobs in the US are considered ‘at-will,’ meaning employers can legally fire staff for pretty much any reason at any time.”

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Annie Burky, “Google Cloud teams up with LifePoint Health to expand the reach of its healthcare data engine,” Fierce Healthcare, Sep 14, 2022 READ IT HERE

The company will use Google Cloud’s data to give providers “near real-time, globalized views of patients’ records,” pitched as improving care for marginalized populations. Assumes that Google scooping up our medical records and “bringing data together from hundreds of sources and applying AI and machine learning to it” is a priori a good thing. (We can assume one of the “hundreds of sources” used by Google is whether a given patient has money or good insurance.) LifePoint Health “was recently embroiled in controversy [over] allegations about denying patients care who can’t pay for treatment.”

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Heather Landi, “Verily clinches $1B from parent company Alphabet, shakes up leadership team,” Fierce Healthcare, Sep 11, 2022 READ IT HERE

Alphabet being, of course, the Google octopus. The “eye-popping funding round” will boost Verily’s activities in health data and life sciences, such as biomedical research, virtual care, wearables, sleep apnea, and diabetes. “Verily expanded the reach of its virtual clinic, called Onduo, bring[ing] Verily a step closer to its goals of delivering whole-person care through a single telehealth app.” All the facts about you in one place—convenient!

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Matt Stoller & Matt Seiler, “Big health care is already too big,” American Prospect, Sep 1, 2022 READ IT HERE

Local pharmacies face extinction if giant insurance companies can muscle them out of the business. “UnitedHealthcare can use its data and its power over customers to steer patients to its suppliers and kill local pharmacies.” And “UnitedHealthcare is trying to get bigger [by] buying Change Healthcare, the largest repository of medical claims data in America.” The FTC is saying no, but judges may approve it. Meanwhile, the pharmacy benefit manager (PBM) oligopoly is now fully linked with their insurance counterparts: Aetna/CVS, UnitedHealthcare/Optum, and Cigna/Express Scripts. Stoller’s website “BIG” is a must-read for following the evolution of U.S. finance capitalism.

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Andy Miller & Samantha Young, “Centene to pay $166 million to Texas in Medicaid drug pricing settlement,” Kaiser Health News/Dallas Morning News, Sep 19, 2022 READ IT HERE

The insurer—more exactly, its in-house pharmacy benefit manager (PBM)—is getting sued by states one by one for defrauding Medicaid. But “exactly how the company may have overcharged states is not disclosed in the settlements.” When individuals commit fraud, prison is often the result. But Centene has obtained new contracts even in states that have sued it, including Texas.

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Michael Ollove, “Pandemic prompts more states to mandate paid sick leave,” Stateline/PEW Charitable Trusts, Sep 16, 2022 READ IT HERE

Covid stimulated New Mexico to require paid sick leave. Why is sick leave left to the states? “The virus’ remarkable spread through meatpacking plants made a particularly strong impression on policymakers” who saw they could be affected personally.

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Michael Hiltzik, “A lifesaving drug, but it will cost $2.8 million,” [Santa Rosa CA] Press Democrat, Sep 13, 2022 READ IT HERE

Specialty drugs are welcome and an obvious public good. In a sane world, research would be publicly funded, and the drugs made available to whoever needs them. Instead, “at the price of $2.8 million set by its developer, Cambridge, Massachusetts-based Bluebird Bio, it’s the most expensive single-treatment drug ever approved in the U.S.” Reinsurance programs that would absorb such high-cost treatments are allowed under the ACA, but only seven states have created them.

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Sabrina Moreno, “Study: Medical debt threatens people's health, housing,” Axios, Sept 19, 2022 READ IT HERE

Of course it does. “Even private insurance offers little protection against unaffordable bills” due to copays, deductibles, out-of-network fees, and things that are simply not covered.

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Mike Stobbe, “‘Out of control’ STD situation prompts call for changes,” Associated Press, Sep 19, 2022 READ IT HERE

Syphilis cases, which once had fallen below 7,000 a year nationally, are now running at 52,000. Good moment to crack down on sex education and increase teenager shaming.

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Brian Mann, “J&J tried to block lawsuits from 40,000 cancer patients. A court wants answers,” NPR/WNYC, Sep 19, 2022 READ IT HERE

The company used a bankruptcy maneuver to stop lawsuits linked to Johnson's baby powder, which used the carcinogen asbestos. J&J, based in New Jersey, created a subsidiary in Texas, saddled it with the baby powder claims, and then declared it bankrupt. So instead of paying the dying women who used their product (and are running up huge medical bills), J&J used its cash for stock buybacks. The Justice Department is suing, but if a judge (or the Supreme Court) agrees, that’s the end of consumer harm lawsuits.

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Peter A. Bonis, “Health care’s shift from covenant to commodity comes with consequences,” STAT, Sep 9, 2022 READ IT HERE

Today’s understatement: “Health care delivery today bears little resemblance to [Norman Rockwell’s] iconic painting.”

SINGLE PAYER LINKS #271

Posted 14 SEP 2022

I always try to lead with some good news, and this is the closest I could come to some today. —Tim

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Yuki Noguchi, “After wiping out $6.7 billion in medical debt, this nonprofit is just getting started,” Kaiser Health News/NPR, Aug 16, 2022   Read

RIP Medical Debt’s novel approach “involves buying bundles of delinquent hospital bills and then simply erasing the obligation to repay them.” Bill Gates’s ex-wife gave RIP $50 million. Question: Why does it have to exist?

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Martha Lincoln & Anne N. Sosin, “Ending free Covid tests, U.S. policy is now ‘You do you,’” The Nation, Sep 9, 2022 Read

It’s time for “joy and optimism,” according to Biden’s education secretary, so no more need for federal cash for vaccines, treatments, and tests. Presumably, deaths for the amply insured should drop, and the rest will do what they must. “Over the past year, we’ve seen a worrying pivot from aspiration to acceptance in pandemic policy—with CDC and White House officials normalizing high levels of death and other poor outcomes rather than articulating a road map for reducing them to the lowest possible levels.” The Science™ now says, Back to school!

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Helen Branswell, “A Q&A with WHO’s Maria Van Kerkhove on Covid and fatigue over the pandemic,” STAT, Sep 1, 2022 Read

We can’t “forget about Covid,” says the WHO official, since 15,000 people are still dying per week. But we should “right-size our response to it” because “the world just so badly wants it to be over.” Who exactly constitutes “the world” in this case? WHO’s advice: “Live your life. Live it responsibly, be safe, get all the vaccine doses that are recommended for you. . . Just think about your daily activities and take some decisions based on your own risk.” Or as Thatcher would say, “Who is society? There is no such thing!”

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Alex Stein, “Health insurers just published close to a trillion hospital prices,” DoltHub, Sep 3, 2022 Read

Need to sabotage transparency requirements? Bury the curious under a mountain of data. “The sum total [of the data drop] weighs in at around 100TB. . . . dwarfing the Library of Congress, the LibGen catalog, the full uncompressed English Wikipedia, and the entire HD Netflix Catalog—combined.” And because prices change, the insurers can release new versions of these 100TB files monthly. The tobacco industry did the same thing when forced to release backlogs of internal files.

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Rachel Cohrs, “Pfizer isn’t sharing Covid vaccines with researchers for next-gen studies,” STAT, Sep 6, 2022 Read

Researchers have to get permission from Pfizer or Moderna to study things like nasal or pan-coronavirus vaccines. Unsurprisingly, the patent holders show no sign of a sharing frame of mind. “[Researcher] Iwasaki brought the issue up briefly at the White House’s summit on the future of Covid vaccines, and presidential science adviser Francis Collins said at the time that he ‘would not have thought of that’ hurdle.”

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Eric Sagonowsky, “Pfizer, riding high on COVID windfall, strikes $5.4B buyout of Global Blood Therapeutics,” Fierce Pharma, Aug 8, 2022 Read

Pfizer has so much vaccine cash that it is scouring the field for new acquisitions, such as GBT’s sickle cell drug, Oxbryta, migraine remedy producer Biohaven ($11.6 billion), and Arena Pharmaceuticals ($6.7 billion). Let the good times roll.

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Tucker Doherty, “Health care providers are shouldering rising costs. That could change soon,” Politico, Aug 10, 2022 Read

Rates were set before the upheavals related to Covid, so prices have lagged behind the sudden new costs. Overall inflation could now start to catch up.

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Laura Bratton, “Following a long line of N.H. hospitals, Frisbie Memorial Hospital in Rochester announces plans to close birth center,” New Hampshire Public Radio, Aug 11, 2022 Read

Nine other NH hospitals have shut down maternal units in the last two decades, so the state is unprepared for the new forced-birth policies emanating from the Supreme Court.

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Sarah Jane Tribble, “Buy and bust: Collapse of private equity-backed rural hospitals mired employees in medical bills,” Kaiser Health News/USA Today, Aug 16, 2022 Read

“Noble Health swept into two small Missouri towns promising to save their hospitals. Instead, workers and vendors say it stopped paying bills. Within two years—after taking millions in federal Covid relief and big administrative fees—it locked the doors.” The new company also stopped paying employees’ health insurance premiums—without telling them. Noble is owned by PE firm Nueterra Capital. Even though it had no prior experience running hospitals, no government authority blocked the acquisition.

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Jared Berberade, “Long COVID outpaces diabetes in 2022 employer health spending,” LabPulse.com, Aug 31, 2022 Read

Costs for long Covid patients beats diabetes by 26% on average, meaning that lingering costs from the pandemic should start to ripple through health costs, premiums, etc., quite soon.

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Nicholas Florko, “With a promising new plan to pay for pricey cures, two states set out to eliminate hepatitis C. But cost hasn’t been the biggest problem,” STAT, Sep 13, 2022 Read

Washington state and Louisiana signed “Netflix-model” deals in 2019 to address the crazy costs the Pharma owners had set in which the states paid a fixed amount in exchange for unlimited supplies. But the arrangement has failed in its goal of increasing access to the treatment even though many of those in need of treatment are a captive population—literally incarcerated in the states’ prisons. The article is vague on the reasons why. “Nearly every aspect of Washington’s plan fell by the wayside due to budget shortfalls and the Covid-19 pandemic, state officials acknowledged.” Perhaps the health of inmates isn’t a top priority?

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Rebecca Pifer, “Walmart, UnitedHealth ink 10-year collaboration deal on value-based care,” Healthcare Dive, Sep 7, 2022 Read

The mega-insurer and the mega-store will roll out “a co-branded Medicare Advantage plan in Georgia,” with the handle “UnitedHealthcare Medicare Advantage Walmart Flex,” a confidence-inducing title, to be sure. What could go wrong when millions of users of two humongous monopolies get corralled into Medicare Disadvantage?

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Amanda Seitz, “Americans give health care system failing mark: AP-NORC poll,” Associated Press, Sep 12, 2022 Read

“An overwhelming majority of Americans, nearly 8 in 10, say they are at least moderately concerned about getting access to quality health care when they need it. Forty percent like the single-payer idea, and 58% endorsed a “public option,” a government-run insurance plan competing with the privates.

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Katie Sobko, “NJ’s public workers rally in Trenton to protest historic health insurance increase,” NorthJersey.com, Sep 13, 2022 Read

Insurance costs for state employees could rise by 20%, which will hit the state budget and eventually rate-payers as counties and cities are on the hook to cover a portion of the increases.

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Paul O'Donnell, “Dallas-based Signify Health sells to CVS in $8 billion deal,” Dallas Morning News, Sep 5, 2022 Read

A bidding battle among various heavyweights is won by CVS, eager to expand its direct medical services business with Signify’s network of 10,000 clinicians. “This is not a deal about money,” Signify Health CEO Kyle Armbrester told the paper. What heartless cynic suggested that? Home health care got a boost from Covid as people shied away from visiting hospitals. Signify is backed by private equity firm New Mountain Capital.

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Sam Whitehead & Andy Miller, “Impending hospital closure rattles Atlanta health care landscape and political races,” Kaiser Health News/Word in Black, Sep 14, 2022 Read

Rapidly gentrifying Atlanta is losing its safety-net hospitals one by one. Georgia refuses Medicaid expansion, burdening hospitals that treat large numbers of the uninsured. The pattern is repeated in other cities where large healthcare corporations acquire properties and jettison the least-profitable ones, especially if they sit on pricey downtown real estate that can be sold off.

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Reuters, “Philip Morris appoints two former U.S. FDA officials to key roles,” Sep 14, 2022 Read

Badrul Chowdhury, a 20-year FDA veteran, will become PMI’s “chief life sciences officer” joining Matthew Holman, vice president of U.S. scientific engagement and regulatory strategy (the area he oversaw at the FDA), and Keagan Lenihan, formerly the FDA chief of staff and now head of PMI’s Washington office. Are people who don’t believe FDA guidance anti-science or simply taking good notes?

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SINGLE PAYER LINKS #270

Posted 8 SEP 2022

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Kate Riga, “The most alarming case on the Supreme Court’s docket you haven’t heard of,” Talking Points Memo, Sep 2, 2022 READ IT HERE

A case before the Supreme Court, sometimes called “Dobbs for Medicaid,” could “blow a gaping hole in the social safety net.” An Indiana nursing home, responding to a lawsuit for negligence, is asking the Supreme Court to abolish the way plaintiffs sue to enforce federal rules in federally-funded programs, such as Medicaid. Without enforcement, users of safety-net programs could be powerless if states decide not to do what the government requires. The Court’s decision to accept the case “surprised and alarmed experts in equal measure. Justices quietly took it up—dragging behind them a paper trail peppered with their inclination to overturn 50 years of precedent.” The statute at risk dates from 1871 when the feds tried to stop states from terrorizing newly-freed slaves—today’s must-read.

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Paul Blest, “Insurance refused to cover her vomiting condition, so she barfed outside their office,” Vice News, Sep 2, 2022 READ IT HERE

“After repeatedly being denied coverage for treatment that would help alleviate symptoms of the illness that had been causing her to vomit constantly for the last three years,” a patient decided to visit Anthem Blue Cross in person where she had herself videotaped “barfing in the parking lot and trying to talk to employees about her plight.” Instead of a hearing, she got a visit from two LAPD officers and a threat of involuntary psychiatric confinement. The treatment she was fighting for is a simple Botox injection to relax the stomach, which worked twice for her in the past. The patient concludes, “Who is this middleman that’s deciding if we’re sick enough to receive care that we’re paying for?”

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Eric Larson, “Texas judge says HIV drug mandate violates religious freedom,” Bloomberg, Sep 7, 2022 READ IT HERE

An employer argued that because pre-exposure prophylaxis (PrEP) “subsidizes homosexual behavior,” they shouldn’t have to cover it. The judge agreed. PrEP is used daily by hundreds of thousands of gay men and has contributed to a sharp drop in new HIV infections. The fallout from the Supreme Court’s Dobbs decision continues.

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Leonard Rodberg, “Medicare dis-Advantage: Shortchanging the patients while enriching the insurer,” Common Dreams, Aug 31, 2022 READ IT HERE

Creeping privatization: Rodberg (of PNHP) explains that while MA plans get more money per capita from Medicare, they actually have less cash available to provide care because of high overhead and profit extraction. Thus, once an MA client gets sick and needs expensive treatments, the pressure is on—through high copays and deductibles, network limits, and prior authorization obstacles—to nudge (or shove) them over to traditional Medicare and the public purse. “Medicare Advantage has become the most profitable sector of the health insurance industry.”

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Branko Marcetic, “Anthony Fauci should have resigned a long time ago,” Jacobin, Sep 1, 2022 READ IT HERE

Along with Trump’s bluster, Fauci damaged trust in public health by treating the public as children to be shielded from the truth, i.e., lying for our own good. “Fauci saw his role not [as] a scientist dispassionately doling out critical public health information but increasingly as a political figure calibrating his advice to who was in power and what he felt the national mood was. On several key questions around pandemic policy, Fauci ended up more aligned with business voices than with scientists.”

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Steve Lohr, “Illumina defeats F.T.C. in major antitrust case,” New York Times, Sep 1, 2022 READ IT HERE

Illumina, a gene-sequencing company, prevailed over the Federal Trade Commission, which had challenged its $8 billion purchase of Grail, a start-up with blood-test technology for detecting cancer. “The commission argued that the cancer-testing industry was dependent on access to Illumina’s gene sequencers and thus Illumina could stifle Grail rivals in the small but fast-growing market.” The judge disagreed, but at least the FTC made the effort rather than letting the deal sail through in the name of market efficiency or whatever.

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Annie Burky, “Backlash against CVS, Walgreens raises questions about role of retail in post-Dobbs world,” Fierce Pharma, Sep 1, 2022 READ IT HERE

The pharmacy chains, pulled willy-nilly into the abortion wars, must now juggle how to maximize profits while not alienating anybody. CVS frets that “pharmacists are caught in the middle of the issue” and, sadly, must take a position one way or the other. The New York A-G immediately issued a stern warning to chains in the state against prescription denials. Meanwhile, CVS wants to move into providing more direct medical services, which will make avoidance of abortion controversies even harder. Ditto for its ownership of health insurer Aetna.

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Heather Landi, “Walgreens steps up focus on home health with $330M CareCentrix deal,” Fierce Healthcare, Sep 1, 2022 READ IT HERE

Walgreens rolled out its direct services arm, Walgreens Health, a year ago. Like the other pharmacy giants, it’s scooping up companies in “healthcare services delivered after [hospital] discharge, one of the fastest growing segments in healthcare today,” accounting for $75 billion a year in reimbursements. It will now battle CVS, Amazon, and UnitedHealth Group for the $8 billion home health company Signify. The FTC may have something to say about that, too.

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Libby Watson, “Amazon really believed it could sell you a health care fantasy,” New York Times, Sep 2, 2022 READ IT HERE

“Any company [like Amazon] claiming its innovation will revolutionize American health care by itself is selling a fantasy. There is no technological miracle waiting around the corner that will solve problems caused by decades of neglectful policy decisions and rampant fraud.”

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Lee Fang, “Moderna among firms quietly granted powers to seize patent rights during early days of Covid pandemic,” The Intercept, Aug 23, 2022 READ IT HERE

Patents are sacred! Except when Pharma seeks patent suspension for itself. “The Trump administration quietly invoked a World War I-era law to give companies racing to produce Covid-19 medications, vaccines, tests, and other pandemic-related products special authority to seize virtually any patent they wished without authorization.” Moderna took advantage of it and is facing a contentious patent infringement lawsuit. An FOIA document dive found 62 federal pandemic-related contracts that had clauses permitting “the use of patented inventions without the permission of patent holders.” Compulsory licensing, which causes howls of outrage when proposed for low-income countries, was immediately utilized when the government determined the U.S. needed to do it.

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Sarah Owermohle, “New Covid vaccines are hitting pharmacy shelves. What happens to the original shots?” STAT, Sep 3, 2022 READ IT HERE

At least 20 million Moderna and 30 million Pfizer shots are in government stockpiles, all bought and paid for. But the shiny new “bivalent” vaccine will quickly make them obsolete. Pretty cool business model.

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Susan Haigh & David Crary, “Catholic hospitals’ growth impacts reproductive health care,” Associated Press, Jul 24, 2022 READ IT HERE

Blue states scramble to protect abortion access, but even there “options for reproductive health care are dwindling due to expansion of Catholic hospital networks. Concerns in these blue states pertain to such services as contraception, sterilization, and certain procedures for handling pregnancy emergencies.” A proposed merger in Connecticut could see a secular hospital be absorbed by Catholic-run Covenant Health. At the same time, Catholic institutions often take on serving low-income communities when secular for-profits aren’t interested. Catholic hospitals receive one out of every seven U.S. in-patients.

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Heather Landi, “Patient safety issues with VA Cerner EHR caused harm to veterans, federal watchdog says,” Fierce Healthcare, Jul 20, 2022 READ IT HERE

Fancy new electronic records systems aren’t a panacea and can screw things up royally. “The new EHR sent thousands of orders for medical care to an undetectable location or unknown queue instead of the intended care or service location, effectively causing the orders to disappear without letting clinicians know they weren’t delivered.” Tech is only as good as the people running it. The VA’s $10 billion EHR deal was signed in May 2018, but the cost has since ballooned to $16 billion.

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L’Oreal Thompson Payton, “Health care costs are so high that 98 million Americans say they’ve had to cut spending on food and gas,” Fortune, Aug 4, 2022 READ IT HERE

Ninety-eight million Americans = 38% of everyone, and not all are low-income: almost 20% of households earning more than $180K a year had to cut back as well.

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Matthew Perrone & Dave Collins, “Juul to pay nearly $440M to settle states’ teen vaping probe,” STAT, Sep 6, 2022 READ IT HERE

Juul used the ancient tobacco industry playbook to lure youth into nicotine vaping, now has to cough up some of its profits. “Juul marketed its e-cigarettes to underage teens with launch parties, product giveaways, and ads and social media posts using youthful models.” Now let’s see the states collect [see below].

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Erik Larson, “Tobacco firms sued for $133 million in missed settlement payouts,” Insurance Journal/Bloomberg, Jul 29, 2022 READ IT HERE

Iowa won a huge settlement in the historic tobacco lawsuit in 1998 but has to go back to court again and again to get the agreed-upon payments. The state A-G said the companies withheld a portion of their annual payments to Iowa “through a scheme of false claims and feigned ignorance.” He said that Iowa won the last such dispute in 2021, but the companies still refused to pay.

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Rebecca Carballo, “UnitedHealthcare donates $2.5 million in grants to Texas nonprofits,” Houston Chronicle, Aug 11, 2022 READ IT HERE

Couch lint found to beef up an insurance’s giant influence in a major city. “The funding will go to organizations that address social determinants, which are nonmedical issues, such as food, housing, transportation and the financial means to pay for basic daily needs.” Count on the beneficiary groups to steer clear of any controversy involving their benefactor.

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SINGLE PAYER LINKS #269

Posted 31 AUG 2022

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Matt Stoller, “The ridiculous Amazon-One Medical deal,” BIG, Aug 25, 2022 READ IT HERE

“Amazon bought One Medical and then immediately closed its own provider subsidiary,” Amazon Care, a direct competitor. Why go head-to-head with your product and have to compete in the marketplace when you can just buy up the other guy? The Federal Trade Commission (FTC) should block this and might. Amazon also “is in the bidding for Signify Health, a home health care provider.” Recall that, according to some advocates, industry concentration could make even a single-payer system unviable.

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Heather Landi, “Amazon Care is shutting down at the end of 2022. Here’s why,” Fierce Pharma, Aug 24, 2022 READ IT HERE

“The deal also gives Amazon rapid access to the lucrative employer market as One Medical works with 8,000 companies.”

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Alexander Chaitoff, Khin-Kyemon Aung & Alexander Zheutlin, “Amazon and One Medical: Minding the data gaps,” STAT, Aug 29, 2022 READ IT HERE

Meanwhile: “Communities with One Medical clinics are overwhelming comprised of urban, wealthy, non-Hispanic white, college-educated individuals.” The big database that Amazon would be acquiring is thus full of inherent bias.

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Anjalee Khemlani, “U.S. to end purchase of COVID-19 vaccines as industry pivots to commercial market,” Yahoo News, Aug 17, 2022 READ IT HERE

Covid czar Ashish Jha told a U.S. Chamber of Commerce (!) Foundation event that he hopes most Covid products will be sold commercially instead of bought by the government for distribution. Meaning the epidemic is officially over? In any case, we’ll soon be figuring out whether to get booster shots and calculating our insurance co-pays and deductibles.

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Eric J. Topol & Akiko Iwasaki, “Operation Nasal Vaccine—Lightning speed to counter COVID-19,” Science Immunology (7) 74, Jul 21, 2022 READ IT HERE

Experts are closely watching the progress of 12 potential nasal Covid vaccines because, unlike the Pfizer/Moderna varieties, they can produce “mucosal immunity,” which could block transmission to others (i.e., “sterilizing vaccines”). The new Omicron-specific vaccines won’t be. Coverage in the popular press, however, tends to highlight the products owned by big Pharma companies like Astra Zeneca, rather than Indian alternatives that are much further along the research pipeline. See the next items.

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Financial Express, “Covid intranasal vaccine phase III trials over, proven safe: Bharat Biotech,” Aug 16, 2022 READ IT HERE

This Indian nasal vaccine has a good safety profile, so full randomized trials can begin. We might even hear about this because Washington University in St Louis is a partner.

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Hannah Devlin, “Scientists hope nasal vaccines will help halt Covid transmission,” Guardian, Aug 20, 2022 READ IT HERE

An example of the slant: “More than a dozen clinical trials of nasal vaccines are under way, including a phase 1 trial of a nasal version of the Oxford/AstraZeneca vaccine.” No mention of the Indian product, which is much further along. One theory as to why: Pharma may be looking for a new round of government largesse: “There are market failures in vaccine development because companies are reluctant to take the risks. If they’re going to have to bear the costs and risks without substantial public funding, not enough research happens.” You shoulder the risk; we keep the billions if it works.

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Elsy Fors Garzon, “Cuba’s Mambisa vaccine candidate meets study expectations,” Prensa Latina, Apr 17, 2022 READ IT HERE

Cuba’s nasal vaccine is looking good as well; however, a product with sterilizing immunity would threaten the tens of billions now flowing to Big Pharma. The likelihood of a Cuban product finding an audience here is zero, but independent-minded countries in the global South might be interested.

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Benjamin Mueller, “Fall vaccination campaign will bring new shots, worse access,” New York Times, Aug 28, 2022 READ IT HERE

“With the virus killing far fewer people than it once did and many Americans reverting to their pre-pandemic ways, the country’s no-expenses-spared attitude to saving lives has evolved into a response that has put a greater onus on individuals to protect themselves.” The local infrastructure that disseminated the early shots is being dismantled. Deaths have “plateaued” at just under 500 a day (x365=182,500 a year), which apparently is considered acceptable. “Of the hundreds of barbershops nationally that once hosted vaccination events, nine out of 10 are struggling to keep offering shots.”

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Cayla Bamberger, “Pfizer gives $1.5M grant to NYC schools’ STEM programs,” New York Post, Jul 11, 2022 READ IT HERE

Pfizer digs around in the couch and finds some cash for the city’s science programs, reaps a tongue-bath from the mayor. “If we don’t educate, we incarcerate, and this generous grant will bolster STEM educational programs to give our middle and high school students the ability to thrive in life by giving them the opportunity to explore careers many never thought possible,” said Adams in a statement. “Thanks to Pfizer for their generous support.” Pfizer made nearly $10 billion in profits in just the second quarter of 2022. Also, would a similar announcement at a mostly white, suburban school include references to incarceration?

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Matthew Herper, “Pfizer seeks authorization for updated Covid vaccine, without fresh clinical trial data,” STAT, Aug 22, 2022 READ IT HERE

Clinical studies aren’t yet done, but Pfizer will ask for the green light to provide (sell) the omicron-targeted vaccine anyway. The mutations are occurring so fast that testing new, tweaked versions of the vaccine can’t keep up. [Update: Both Pfizer and Moderna got the authorizations today.]

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Julio López Varona, “Puerto Rico has a big-Pharma problema,” The Nation, Aug 19, 2022 READ IT HERE

Pharma production is huge in PR because of tax advantages, but the island doesn’t get much by way of benefit as it goes without the tax income and can’t stop off-shoring of profits by the giants. Even the few jobs offered pay poorly. “People who’ve worked at the same pharmaceutical sites for nearly 30 years are still making minimum wage, and for many, benefits remain nonexistent.” Business-friendly incentive packages rarely fulfill their glowing promises.

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Phil Galewitz & Bram Sable-Smith, “Community health centers’ big profits raise questions about federal oversight,” Kaiser Health News/Washington Post, Aug 15, 2022 READ IT HERE

Hustlers abound, including in the nonprofit world. While the tax-exempt CHCs mostly do wonderful work, a few seem to have found ways to game the system. Some of the retained profits (“surpluses”) are going into expansion and building projects, but one altruistic CEO serving the poor pays himself nearly $900,000 a year.

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Andrew Wickline, “Surgeons fold against Medicare’s stacked deck,” STAT, Aug 25, 2022 READ IT HERE

Complaints of unfair reimbursement treatment by Medicare, a reflection of our two-tier health system characterized by generous private-insurance reimbursements and stingy government ones. “After two decades of fixing the price of joint replacement at a paltry $1,300, Medicare lured doctors into an experimental program to save the government even more money. I was among the few lucky ones. The protocols I developed helped me decrease costs and beat the house by reducing medical complications. But as happens in Las Vegas, when you win, the house makes new rules. Even though my program featured one of the lowest costs in the country, Medicare lowered my target price even further. Once I realized it had rigged the game, I cashed out before I lost my shirt.” Meanwhile, hospitals got a hefty reimbursement boost.

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John Timmer, “U.S. government to make all research it funds open access on publication,” Ars Technica, Aug 25, 2022 READ IT HERE

Long overdue. Computer genius Aaron Swartz tried to make this happen by liberating thousands of papers and was indicted on felony charges by the federal government. He died by suicide.

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Moe Ekacik, “‘A place to die’: Inside a nightmare for-profit hospital in rural America,” More Perfect Union, Aug 18, 2022 READ IT HERE

Re: the private equity takeover of a rural North Carolina hospital: “This is an extraction operation. It’s a billionaire factory. And they’re doing that by essentially mining the wealth of poor rural communities.” One private-equity hospital’s performance is so bad that it is being threatened with withdrawal of Medicare funding, “an extremely rare move.” Tony Soprano would be proud. Since this is happening in rural, usually red, districts, a bipartisan pushback is not unthinkable. “Private equity firms plowed $750 billion into American health care institutions between 2010 and 2020.”

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Robin Fields, “How polio crept back into the U.S.,” ProPublica, Jul 26, 2022 READ IT HERE

Britain routinely tests sewage for new pathogens; we don’t. Therefore, “the first sign of trouble surfaced when a young man in Rockland County sought medical treatment for weakness and paralysis in June.” It was polio, but no one knew that for a month.

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Heather Landi, “InterWell Health finalizes $2.4B kidney care merger to combine tech, value-based care capabilities,” Fierce Healthcare, Aug 30, 2022 READ IT HERE

The merger will combine a dialysis administrator, a tech company, and a network of 1,600 nephrologists “to create a kidney care powerhouse” with $11 billion in revenues. What could go wrong?

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Nicholas Florko & Elissa Welle, “The FDA stands by as the vaping industry flouts its orders,” STAT, Aug 24, 2022 READ IT HERE

Vape companies regularly ignore the FDA’s rules not to make, stock, or sell flavored ape liquids and hyper-powered nicotine disposables. “The defiance is on display at thousands of smoke shops around the country and at countless more online retailers.” The FDA could crack down and issue huge fines but chooses not to. In unrelated news, a top FDA tobacco control official just quit and went to work for Philip Morris International.

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Dave Muoio, “Investment losses and massive growth in expenses push Cleveland Clinic to $787M loss,” Fierce Healthcare, Aug 30, 2022 READ IT HERE

Led by a $600+ million loss in the hospital group’s investment portfolio. A tanking Wall Street is putting “a procession of nonprofit systems” in the red—what’s wrong with this picture?

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Marc Rodwin & Alan Sager, “The No Surprises Act: A Band-Aid protecting business as usual,” STAT, Aug 31, 2022 READ IT HERE

“Neither the legislation nor the recently published final regulations address the endemic flaws in private insurance that give rise to surprise bills: high out-of-pocket costs and restricted choice of caregivers.” Also: “The No Surprises Act incorporates key toxic ingredients of U.S. health care recipes: complexity, costly administration, and ongoing financial warfare. The act authorizes $500 million to finance its arbitration and regulatory system. . . . insurers will invest $5 billion to implement the act.” A simpler alternative: make physicians and hospitals in a given setting act as a single bloc instead of as separate billing entities.

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SINGLE PAYER LINKS #268

25 AUG 2022

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Lauren Sausser, “The $18,000 breast biopsy: When having insurance costs you a bundle,” Kaiser Health News/NPR, Aug 23, 2022 READ IT HERE

Paying cash sometimes costs less than using your insurance. A biopsy patient inquired about costs and got quotes from $1,400 and $4,000. Final charge: $17,979. Medicare would have paid $1200, leaving the patient to pay the remaining $300. “Insured patients should reach out to their health plan for a good-faith estimate before a procedure. Ask for an ‘Advanced Explanation of Benefits,’” said one expert who added that “this part of the law isn’t being enforced yet.”

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Adiel Kaplan, Kenzi Abou-Sabe & Vicky Nguyen, “Frustrated pharmacists are opting out of the insurance system, saving some customers hundreds of dollars a month,” NBC, Aug 19, 2022 READ IT HERE

Same story, but with drugs: “A small but growing number of ‘cash’ pharmacies take no insurance, instead selling generic drugs, often at far lower prices than customers pay with insurance. Cash pharmacy owners are able to avoid many of the fees and rules that inflate medication prices.” Mark Cuban’s CostPlus Pharmacy is taking advantage of the same dynamic. May the PBMs and insurers continue to kill the goose!

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Gary Alvernia & Richard Phillips, “Dr David Berger: A principled advocate for equality and science in healthcare,” World Socialist Web Site, Aug 9, 2022 READ IT HERE

Disciplinary actions against MDs are a hot-button topic in the Covid world. This one targeted an Australian doctor who criticized the “live with Covid” stance of that country’s government. While things like selling fraudulent vitamin cures, attacking ethnic groups, or mocking sexual assault victims certainly merit action, Berger’s smackdown was for using “emotive and pejorative language” on social media, causing his readers to “lose confidence in the public health pronouncements and programmes promoted by them.” Sounds like censorship.

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Utibe R. Essien, “The Inflation Reduction Act: One step closer to pharmacoequity?” STAT, Aug 19, 2022 READ IT HERE

Equity is a worthy goal but only if the standard is set high enough. Equally sharing in a lousy system is missing the point. Yes, the bill extends the Obamacare subsidies to marketplace insurance. No, it doesn’t address the shortcomings of those policies.

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Antonio Dajer, Christie Lech & Lucy Willis, “Medical error: An epidemic compounded by gag laws? STAT, Aug 17, 2022 READ IT HERE

Our litigious culture criminalizes medical error when a no-fault system could fulfill the two goals that should result from mistakes: learning what went wrong and taking care of those harmed. Instead, “health care providers keep making the same mistakes” because post-error discussions are subject to discovery by malpractice lawyers. “In New York State, anything a doctor says or writes—to colleagues, friends, partners, or even relatives—can be used in court against them. The Catch-22 is obvious: doctors must prevent mistakes, but they will be punished for honestly analyzing them.” Malpractice liability was suspended during Covid as doctors scrambled for treatments. We started to learn which ones worked and which ones didn’t. It’s not academic: 100,000 Americans die of medical error annually.

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Erica E. Phillips, “Rural CT coalition opposes Catholic hospital takeover of Day Kimball,” CT Mirror, Aug 18, 2022 READ IT HERE

Financially vulnerable rural hospitals are unable to resist takeovers by Catholic systems, which then proceed to kabosh reproductive health services. “Top Catholic health systems are becoming dominant providers in their regions, growing through acquisition of smaller, struggling hospitals. Four of the country’s 10 largest health care systems are Catholic.”

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Julie Carr Smyth, “Vance’s anti-drug charity enlisted doctor echoing Big Pharma,” Associated Press, Aug 18, 2022 READ IT HERE

Notably sleazy even for today’s electoral candidates: Hillbilly Elegy author J.D. Vance founded a charity to address opioid addiction. After winning the GOP nomination for Senate from Ohio, he shuttered it. “The charity’s most notable accomplishment—sending an addiction specialist to Ohio’s Appalachian region for a yearlong residency—was tainted by ties among the doctor, the institute that employed her, and the manufacturer of OxyContin”—the institute being right-wing think tank AEI, which pocketed nearly a million dollars from Purdue Pharma.

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Stephanie Armour, “U.S. plans to shift bill for Covid shots and treatments to insurers, patients,” Wall Street Journal, Aug 18, 2022 READ IT HERE

The government instituted single-payer for Covid to address an emergency. Now that we’re instructed to “live with Covid,” we can go back to the for-profit model. “The change presents challenges including how to make shots and treatments available to the roughly 30 million people without insurance coverage.” Also, long-Covid sufferers will be tossed onto the tender mercies of Aetna, Cigna, etc.

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John Ingold, “Colorado moves another step closer to importing lower-cost prescription drugs from Canada,” Colorado Sun, Aug 18, 2022 READ IT HERE

First in the nation and an admirable experiment though why we should have to go through Canada to create a rational system is quite an indictment. Product “safeguards” include giving manufacturers a veto over authorization of purchases, which could detail the whole thing.

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Meredith Cohn, “Maryland extends unique health care payment deal with feds for better, lower cost health care,” Baltimore Sun, Aug 18, 2022 READ IT HERE

Maryland will set uniform hospital rates throughout the state using Medicare payments, which are higher than average. States continue to experiment while Washington remains largely paralyzed.

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Juliette Cubanski, Tricia Neuman, Meredith Freed & Anthony Damico, “How will the prescription drug provisions in the Inflation Reduction Act affect Medicare beneficiaries?” Kaiser Family Fund, Aug 18, 2022 READ IT HERE

A useful summary with all the detail. Perhaps the most concrete measure is the cap on Medicare beneficiaries’ out-of-pocket spending under Part D, “first by eliminating coinsurance above the catastrophic threshold in 2024 and then by adding a $2,000 cap on spending in 2025.” Approximately 1 ½ million people with chronic conditions, cancer, or the like will benefit. The insulin cap only applies to federally insured diabetics because the GOP blocked extending it to everyone.

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Jeff Lagasse, “Humana acquiring Inclusa, expanding Medicaid services in Wisconsin,” Healthcare Finance, Aug 15, 2022 READ IT HERE

More concentration in health insurance: Humana is set to acquire Wisconsin-based Inclusa, which manages care for some 16,000 disabled and elderly residents, “in an effort to expand its Medicaid presence in that state.” Interestingly, Humana lost a big chunk of its Medicare Advantage clients “due to a large number of terminations.”

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Lisa Rab, “The medical crisis that finally convinced Republicans in North Carolina to expand Medicaid,” Politico, Aug 14, 2022 READ IT HERE

Reality finally focuses the minds of legislators after years of resistance. Elected officials from rural areas “have come to recognize that full Medicaid expansion would provide insurance to people working in low-paying jobs.” Wow, news flash. A state senator who had decried Medicaid as inefficient three years ago, championed the bill, saying, “Medicaid expansion has now evolved to the point where it is good state fiscal policy,” now that it is in the hands of a managed care corporation. NC added 559,000 people to its rolls between March 2020 and March 2022; full expansion would add another half million.

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Arielle Dreher, “Some NIH-funded clinical trials never report results,” Axios, Aug 17, 2022 READ IT HERE

“Publication bias” is the tendency of scientific journals to only report clinical trials that make the drug or device look good. To avoid it, the NIH requires trials to register and then cough up the data—but the government research behemoth doesn’t enforce its own rule. A federal inspection of 72 NIH-funded trials found that researchers in a third of them never submitted results. Nonetheless, the NIH did nothing and even funded new studies for the violators.

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Noam N. Levey, “Her brother landed in a nursing home. She was sued over his bill,” Kaiser Health News/NPR, Aug 18, 2022 READ IT HERE

Even though she had never signed anything. “In Monroe County [New York], 24 federally licensed nursing homes filed 238 debt collections cases from 2018 to 2021 seeking almost $7.6 million. Nearly two-thirds of the cases targeted a friend or relative. Many were accused — often without documentation — of hiding residents’ assets.” Useful fact: the victim suspects her signature was forged from the visitors’ log—don’t sign it.

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Bob Herman, Kate Sheridan, J. Emory Parker, Adam Feuerstein & Mohana Ravindranath, “Health care’s high rollers: As the pandemic raged, CEOs’ earnings surged,” STAT, Jul 18, 2022 READ IT HERE

Includes a fun, interactive graphic that shows you how many Cessnas, houses, Teslas, and college tuitions each of the plutocrats could buy with their yearly “earnings.” Top industry buccaneer: Regeneron Pharmaceuticals CEO Leonard Schleifer who pulled in “an astounding $453 million,” almost 10% of the $4.5 billion that the top 300 healthcare companies’ CEOs scooped up.

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Baharak Tabarsi, “We need to start routinely tracking the ways in which insurance companies’ red tape affects patient care,” BMJ, Aug 19, 2022 READ IT HERE

Prior authorizations, delays and denials of care, endless appeals, and other bureaucratic obstacles are all ways insurers avoid shelling out since “our care is a minus sign in the accounts.” The author, a clinician, decided to meticulously document every obstacle placed by an insurer in his patients’ medical records. “Should the delay in care caused by insurance carriers lead to a poor patient outcome, this kind of documentation is critical for the purposes of peer review and litigation.” Furthermore, “It’s time that delays in care caused by insurance companies are clearly documented and given their own code so that they can be tracked and studied on a larger and more detailed scale.” Brilliant.

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SINGLE PAYER LINK #267

18 AUG 2022

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Adam Ferrise, “Federal judge orders pharmacies to pay Trumbull, Lake counties $650 million in first opioid trial for national chains,” Cleveland Plain Dealer, Aug 17, 2022

Walgreens, CVS, and Walmart will pony up for “recklessly” dispensing painkillers in a first test of the pharmacy chains’ liabilities. Three thousand other cities and counties have also sued—sounds like real money. In the years covered by the lawsuit, “more than 80 million opioid pills reached Trumbull County when the population was slightly under 200,000.”

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Sam Mellins, “Medicare standoff threatens cuts to current city workers’ benefits,” The City/New York Focus, Aug 10, 2022 READ IT HERE

A judge halted the city’s attempt to cram retirees into Medicare Advantage against their will. So now, it’s time to pit current workers against former ones in “a battle over scarce benefit dollars.” Not getting the $600 million in savings from the switcheroo, the city and its unions have to scramble to find new money to fill a union-controlled fund “that pays for active workers’ health benefits.” A statewide single-payer plan would obviate the need for it, but no, unions have to “protect their members’ benefits.” Or something. A city budget official said the obvious: “There could be implications in negotiating their labor contracts because if they want to continue to offer premium-free services, they’re going to have to find savings in a different way.” Oh really? Having to fight to preserve health insurance benefits affects salary demands, who knew?

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Lee Fang, “Eli Lilly Charity finances groups that oppose insulin price caps under the auspices of ‘community development,’” The Intercept, Aug 10, 2022 READ IT HERE

Because of course it does. Lilly also issued a nearly inaudible complaint about Indiana’s Draconian abortion prohibition long after it might have mattered. “Many large grants distributed by the Lilly Endowment are given far from Indiana to think tanks that work to shield corporations from taxation or government regulation.” Like libertarians, the Federalist Society, and the ubiquitous Sally C. Pipes, who slams single-payer at every opportunity. Three companies—Lilly, Sanofi, and Novo Nordisk—control the insulin market in the U.S.

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Schuyler Mitchell, “Ticket to ride: Ambulance rides still aren’t protected from surprise billing—and subscriptions do little to help,” The Intercept, Aug 8, 2022 READ IT HERE

New trick: even if you have a subscription to an ambulance service, a dispatcher can send one from another county that isn’t in your plan. So, stay alert during your heart attack and check the logo on the side. Ground ambulances are not covered by the No Surprises Act. Medicare prohibits balance billing, so those beneficiaries can’t be scammed in this way. But they can be bamboozled into getting a subscription that they don’t need. Useful fact: you do not have to board an ambulance when it shows up.

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Katherine Ellen Foley, “FDA’s chief tobacco scientist to leave for major tobacco company,” Politico, Jul 26, 2022 READ IT HERE

Biochemist Matthew Holman, after 20 years at the FDA, most recently as head of the tobacco science office, has decamped for Philip Morris International. All hail the highly credible FDA, home of The Science™.

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Dan Vergano, “An FDA official bolting to Big Tobacco shines a light on the agency’s revolving-door problem,” Grid, Aug 3, 2022 READ IT HERE

“At least 2,700 ex-FDA employees now work for the pharmaceutical industry. Another 1,100 current FDA employees have moved the other way, from industry to the agency.” Holman [see above] recently authorized PM to “market its heated tobacco products using language saying that such a product ‘significantly reduces your body’s exposure to harmful or potentially harmful chemicals.’” Straight from the tobacco industry talking points. This is Miracle-Gro for the antivax movement.

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Bruce E. Levine, “Behind Rolling Stone’s hatchet job on a psychiatrist critical of neoliberal capitalism,” Counterpunch, Aug 11, 2022 READ IT HERE

Joanna Moncrieff published the famous “umbrella review” showing no evidence for the link between serotonin levels and depression, putting in question the rationale for a mega-billion-dollar industry. The big cannons rolled up to her door immediately. RS said her work is popular among Scientologists (so?) and noted how the right-wing echo chambers jumped all over it. Moncrieff’s question: Why doesn’t the left jump all over it? Her previous article pointed out how psychiatry is “inappropriately medicalizing distress and thereby obscuring the effects of social injustice, poverty, inequality, racism, child abuse, [which] should be a major concern for the left.”

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Brinna Ludwig, “Who is your health insurer? More employers self-fund health insurance plans, bypassing state regulation and potentially increasing costs,” New York Progressive Action Network (NYPAN), Aug 2022 READ IT HERE

The company name on your insurance card may not be your real insurer. A company self-funded plan may use a “third-party administrator” that, however, does not take on any risk. Sixty-four percent of workers in the United States have a self-funded health plan, but they must conform only to federal, not state, legal protections.

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Nicole Wetsman, “Amazon is getting into mental health care with a Ginger partnership,” The Verge, Aug 12, 2022 READ IT HERE

“Ginger, a digital mental health platform that gives people 24/7 access to mental health coaches and therapists, will be available as an optional add-on for companies that use Amazon Care.” That way, Amazon will know not only everything you consume but also how anxious it all makes you and, with recently acquired One Medical, whether it’s giving you a rash. Then, with Roomba the robot vacuum cleaner, it can map out your home—maybe to help you decide what handy products you still need.

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Samantha Delouya, “Meta is being sued for giving US hospitals a data-tracking tool that allegedly ended up disclosing patient information to Facebook,” Business Insider, Aug 2, 2022 READ IT HERE

Meta “has used people’s medical data without permission for targeted ads on Facebook,” according to a second lawsuit against hospitals who shared patient info with the tech giant. “The complaint says that these hospitals used Meta's Pixel tool—that allows businesses to measure and build audiences for ad campaigns—which then accessed patients' password-protected portals and shared sensitive health information that Meta then sold to Facebook advertisers.” About one third of the largest hospitals in the U.S. use Meta Pixel.

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Tara Bannow, “Parents and clinicians say private equity’s profit fixation is short-changing kids with autism,” STAT, Aug 15, 2022 READ IT HERE

A tiresomely familiar story: “Like other pockets of the health care industry, [autism treatment] has been transformed over the past decade by a flood of investments from private equity firms, drawn by the promise of insurance reimbursement and the rising rate of autism in children across the U.S. Financial investors’ fixation on profit has degraded the quality of services kids receive, turning it into the equivalent of fast-food therapy.” Also, rampant billing fraud has led to audits in Nevada and Florida, and investigations have uncovered “allegations from nearly every corner of the country. In Nevada, one clinician billed for 65 [therapy] hours in a single day.” HHS’s Office of Inspector General has stepped in.

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Vinay Prasad, “POLO trial is back. OS is negative. But the manuscript is full SPIN CYCLE. Insane!” YouTube, Jul 20, 2022 READ IT HERE

Prasad, an oncologist, takes no prisoners in demonstrating the utter corruption of the medical publishing business by zeroing in on the Journal of Clinical Oncology, which allowed this Pharma-ghostwritten disgrace into print. He shows how the hired-gun authors took a badly designed study that showed no benefit of a new drug and spun it into its opposite. Wonky but priceless if you have a slight background in statistical analysis. Prasad is beyond exasperated and kind of hilarious. A good insight into how all sorts of useless crap gets peddled to us. [OS=Overall Survival, a common endpoint in clinical trials]

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Blake Farmer, “Buy a rural hospital for $100? Investors pick up struggling institutions for pennies,” Kaiser Health News/NPR, Aug 16, 2022 READ IT HERE

“Braden Health is buying buildings worth millions of dollars for next to nothing with a promise to keep running them as health centers serving their communities.” If private equity shows up, there’s almost no chance of that. Braden Health, a tiny outfit with 40 employees, seems to be making a real effort. But if it fails, “Braden is getting more than $10 million worth of real estate [in Tennessee] for less than the price of an appendectomy.”

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Helen Branswell, “In an effort to address its missteps during Covid, CDC plans an ‘ambitious’ agency overhaul,” STAT, Aug 17, 2022 READ IT HERE

CDC head Rachel Walensky acknowledged errors in the agency’s response to Covid and monkeypox, alluding to the testing debacle and the confusion over quarantine guidance. Critics point to excessive wonkiness, glacial bureaucratic reviews, an overly cautious research-based culture, and poor management skills among the many MDs and PhDs. But what if those aren’t the real problems, versus, say, aligning policy to political directives from Washington in response to industry interference?

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Ayla Ellison, “Mass General Brigham posts $949M quarterly net loss,” Becker Hospital News, Aug 12, 2022 READ IT HERE

Counterintuitive. How can a near monopoly hospital lose money during a period of increased demand? MGB’s revenues were up by $18 million in the quarter. But: “The health system posted a nonoperating loss of $828.81 million, reflecting unfavorable volatility in the financial markets.” Those pesky Wall Street portfolios!

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Prabir Purkayastha, “The WTO and vaccinations: Greed and profits win,” Committee for the Abolition of Illegitimate Debt (CADTM), Aug 3, 2022 READ IT HERE

Rich countries “blocked almost all possibilities of providing cheap vaccines, antiviral drugs and diagnostics to the world.” Meanwhile, “less than 20 percent of the 700 million people in Africa have been fully vaccinated while millions of vaccine doses are going to waste in the United States.” Of course, it isn’t clear what efficacy the now two-year-old vaccines have against current variants. Cuba’s five available vaccines won’t get a field test because countries fear secondary sanctions from the U.S. for daring to try them. Meanwhile, “If Pfizer were a country, its earnings of $81 billion last year would have placed it ahead of the GDP of Ethiopia, Ghana or Kenya.”

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Niall Brennan, “The fatal flaw in hospital price transparency rules,” MedPage Today, July 2, 2022 READ IT HERE

Compliance ranges from 6% to 50%—why? Staffing issues, complexity, and just maybe perhaps intentional foot-dragging. (Hospitals fought the legislation.) Also, “Vague requirements and a lack of repercussions have not created the sense of urgency that regulators hoped for”—today’s understatement. The goal was to empower healthcare “consumers” (i.e., people) to “shop” for the best deal. Perhaps the entire framework is erroneous?

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SINGLE PAYER LINKS #266

11 AUG 2022

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Rachel Cohrs, “Here’s who Democrats’ drug pricing bill will actually help,” STAT, Aug 9, 2022 READ IT HERE

“Millions of patients in the Medicare program could eventually see lower prescription drug costs if Democrats pass their latest drug pricing plan into law.” Emphasis on eventually and could. A more concrete benefit is the annual Part D out-of-pocket cap of $2,000, starting in 2025, that will save money for a couple million people. Also, Medicaid beneficiaries in the higher income brackets will get relief from onerous drug cost-sharing, and the significant Obamacare subsidies for people at or above the poverty line (established by the 2021 American Rescue Plan Act) will be extended. P.S. "Whom"

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Thomas Neuburger, “The IRA drug price ‘victory,’” God’s Spies, Aug 10, 2022 READ IT HERE

President Manchin’s Biden’s IRA (Inflation Reduction Act) “sweeping” bill has been hailed for “lowering drug prices.” How much of the hype is true? The precedent of empowering government programs finally to negotiate prices is an important crack in the wall. But, “the drug-price victory that many people are celebrating is far less than it seems.” Medicare can only negotiate for 10 drugs starting in 2026, then another 10 three years after that (2029). But 20,000 prescription drugs are marketed and sold in the U.S. Ten drugs every three years will take 20,000/10 X 3 = 6000 years at current rates. Meanwhile, the biggest moneymakers, biologics like Humira and Eliquis, are exempt for 13 years.

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Common Dreams, “‘What the hell is wrong with them?’ GOP senators kill $35 cap on insulin,” Aug 7, 2022 READ IT HERE

Misleading: Republicans led the charge, but Democrats went along. “The Senate parliamentarian had earlier ruled that the [cap] is not primarily related to the federal budget and thus not eligible for a reconciliation bill.” But Schumer could remove the parliamentarian over this and other rulings. Mitch McConnell wouldn’t hesitate.

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David Sirota, “Schumer lets aide kill key drug price reforms,” The Lever, Aug 6, 2022 READ IT HERE

The parliamentarian’s ruling stripped several key provisions from the measure, including the insulin cap and restrictions on drug cost inflation in private health insurance plans. “Democrats’ signature drug pricing measure is now a shell of the proposal that lawmakers debated for much of last year and far weaker than the compromise deal negotiated by the party’s drug industry allies.” More Pharma cash is pouring into Democratic candidates’ coffers than the Republicans’. Schumer himself is the second-highest recipient ($289,000).

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Mike Stobbe, “Fewer than 1 in 3 insured hepatitis C patients getting cure,” Associated Press, Aug 9, 2022 READ IT HERE

The article mentions “expensive treatments” without exploring the obvious question: who priced it that high? “Insurance restrictions appear to be part of the reason for the surprisingly low percentage, and treatment rates were lowest for patients in state-administered Medicaid plans.” No kidding. If the drugs—developed with government research support—didn’t cost $84,000 for a 12-week course ($1000 per pill) as originally set, everyone could get the treatment who needs it.

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Howard Dean, “It’s time to expose the secret drug scam at the heart of American health care,” Fortune, Jul 26, 2022 READ IT HERE

Dean attacks the shady practices of PBMs (Pharmacy Benefit Managers), correctly. He’s also a lobbyist-in-all-but-name for Pharma interests, which dovetails nicely with this particular blame game.

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Nick Corbishley, “Costa Rica’s new government overturns Covid-19 vaccine mandate, launches investigation into Pfizer contract,” Naked Capitalism, Aug 9, 2022 READ IT HERE

Costa Rica pioneered vaccine mandates for the entire population down to 5-year-olds. The article lists many details of the type of contract Pfizer forced upon countries desperate to stem the Covid tide, including indemnity against claims of harm from the injections. “That includes countries putting up sovereign assets, such as federal bank reserves, embassy buildings, military bases, and even glaciers as insurance against the cost of any future legal cases.” And secrecy clauses mean citizens can’t find out what their governments signed onto. No wonder the antivax movement has received such a shot in the arm (sorry).

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Julie Appleby, “Health insurance price data: It’s out there, but it’s not for the faint of heart,” Kaiser Health News/NPR, Jul 27, 2022 READ IT HERE

“So much data is flowing in from insurers—tens of thousands of colossal digital files from a single insurer is not unusual—that it could still be weeks before data firms put it into usable forms for its intended targets: employers, researchers, and even patients.” But Turquoise Health is delighted—it aims to “commercialize” the data and then “share organized data with its paying customers.” Ordinary folks may get access “sometime after that.”

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Un-covered, “Will new federal rules bring health insurers’ shady negotiation tactics to light?” Jul 19, 2022 READ IT HERE

Amid the discussion of what impact the new requirement for price disclosure by insurers will have, the perverse incentive created by the “medical loss ratio” requirement is important to keep in mind. “Insurers are required to spend approximately 80% of all premium dollars on medical care,” which was meant to make sure that plans spend most of the revenue on medical costs, not their CEOs. However, because premiums rise along with costs, when everything gets more expensive, insurers get a larger payout. “They can still only keep 20% of the pie—but that 20% just got bigger.”

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Emily Wagster Pettus, “Hospital system says it’s hurt by lack of Medicaid expansion,” Associated Press, Jul 19, 2022 READ IT HERE

A Gulf Coast hospital system is slowly starving as Mississippi refuses to expand Medicaid and receive the federal dollars that would come with it.

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Brett Kelman, “They lost Medicaid when paperwork was sent to an empty field, signaling the mess to come,” Kaiser Health News/NPR, Aug 3, 2022 READ IT HERE

File under “The beatings will continue until morale improves.” Amazing how punitive state Medicaid agencies can be, including the use of accidentally-on-purpose “bureaucratic error.” The Lester family lost coverage because TennCare (Tennessee Medicaid) “mailed paperwork to a horse pasture.” They’re now buried under $100,000 in unpayable medical debt. “Prior investigations of TennCare revealed that most people are dropped because of incomplete or unreturned forms. As few as 5% of those dropped are found to be ineligible.” A lawsuit accuses TennCare of “befuddling its members with vague and contradictory instructions; demanding information it already has or does not need; ignoring the info that members provide; improperly rejecting termination appeals; and, sometimes, sending essential paperwork to addresses that it knows, or should know, are wrong.” Or in plain English, it’s a feature not a bug because Tennessee wants to kick people off Medicaid.

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Julie Steenhuysen & Jennifer Rigby, “Years of neglect leaves sexual health clinics ill-prepared for monkeypox,” Reuters, Jul 18, 2022 READ IT HERE

STI clinics are the optimum places to handle monkeypox, given a common transmission route (though clearly not the only one). But STIs are the poor cousins even in the traditionally underfunded public health sector. Federal spending on STI control has dropped by 40% in the last two decades; states and cities have cut back as well, turbocharged by ideological opposition to sexual behavior.

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Jared Whitlock, “Nursing home chain’s tangled corporate structure and bankruptcy threats stymied litigation,” STAT, Aug 5, 2022 READ IT HERE

A negligence suit against a nursing home owned by Consulate Health Care (the sixth largest national chain at the time) was nearing settlement in 2021 when negotiations suddenly stopped because the corporate owner filed for bankruptcy. Its lawyers then offered a tiny payout to the family under the threat of getting nothing in the bankruptcy proceedings. Over a hundred other cases followed a similar playbook: “Before bankruptcy, the company used a convoluted corporate structure that stymied litigation, including dividing up ownership of its nursing homes and keeping paltry liability insurance.” All perfectly legal. Consulate is owned by private equity firm Formation Capital. The company also got out of a $258 million phony Medicaid/Medicaid billing judgment levied in 2020. But it paid CEO Christopher Bryson a $2 million bonus eight months before the bankruptcy.

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Ken Frazier, “Addressing social drivers of health is a big opportunity for tech entrepreneurs,” STAT, Aug 4, 2022 READ IT HERE

Sure, we can address inequities in healthcare—if there’s money in it! “Some of the best business opportunities in health care will involve developing technologies that analyze and address the factors that contribute to health disparities.” The author is employed by General Catalyst, owner of start-up Cityblock Health, which “uses software and partnerships with insurers and hospitals to bring health care to low-income people,” and Papa, “a platform to match young adults with seniors to help seniors live at home and stay out of hospitals.” In addition to his philanthropic turn at General Catalyst, Frazier is the former CEO of Merck and co-chair of OneTen, “a coalition of organizations committed to upskilling, hiring, and promoting one million Black Americans into family-sustaining jobs.” All rise to salute corporate altruism.

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Bram Sable-Smith, “The ambulance chased one patient into collections,” Kaiser Health News/NPR, Jul 27, 2022 READ IT HERE

Moral of this story: If you’re not too badly injured, take a taxi. A 2020 study found that “71% of ambulance rides were out of network, meaning the ambulance companies were not bound by a rate that was negotiated in advance with the insurer and could basically charge whatever they want. Even local fire departments can decline to join local insurance networks.” That means “balance billing” since ambulances are exempt from the recent law restricting surprise bills. To repeat: you do not have to get into an ambulance just because it rolled up to the scene.

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SINGLE PAYER LINKS #265 Posted 3 AUG 2022

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Sam Mellins, “Health insurers just killed the Medicare plan city retirees railed against,” New York Focus/The City, Jul 19, 2022 READ IT HERE

Facing a court challenge, Elevance Health and Empire BlueCross BlueShield “pulled out of a controversial deal to switch retired city workers to privately run health insurance.” [Yay!] The backroom cost-saving deal, negotiated with city union leaders to force beneficiaries into privatized (Medicare Advantage) care, collapsed when the for-profit companies demanded impossible guarantees. City officials will now look for other MA insurers and try to resuscitate the plan or a revised version.

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Caitlin Owens, “Health industry’s post-pandemic profit boom,” Axios, Jul 20, 2022 READ IT HERE

“Providers and payers are doing just fine in the wake of the pandemic,” with profits estimated to rise by 6% a year until 2025. “Profits will increasingly come from government markets,” especially MA and managed Medicaid plans.

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Caitlin Owens & Arielle Dreher, “Post-pandemic Affordable Care Act premium hikes on the horizon,” Axios, Jul 21, 2022 READ IT HERE

Dems are trying to boost subsidies for ACA exchange purchasers so the consumer won’t get hit, but if that works, the tab for increases of between 5% and 14% will then end up with the Feds. Enrollees who don’t qualify for subsidies will have to pay it themselves.

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Rebecca Pifer, “Amazon will see you now: Reading between the lines of the One Medical acquisition,” Healthcare Dive, Jul 25, 2022 READ IT HERE

“The acquisition [of 190 clinics with 770,000 members] should fast-track the e-commerce giant’s goal of assembling a vertically integrated healthcare business to penetrate the employer market.” Also, One Medical “serves Medicare patients, steering them into full-risk arrangements and capturing revenue through savings.” “Revenue through savings” sounds ominously like the MA model: collect the premiums and then erect roadblocks to care services.

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Julie Appleby, “How much health insurers pay for almost everything is about to go public,” Kaiser Health News/NPR, Jul 1, 2022 READ IT HERE

Yes, in theory, but we’ll see. Hospitals have figured out ways to obscure the numbers or just stonewall. To prevent that, “The new rules are far broader than those that went into effect last year requiring hospitals to post their negotiated rates. Now, insurers must post the amounts paid for ‘every physician in network, every hospital, every surgery center, every nursing facility.’” Fines are also larger. But the datasets will be immense. Will we see for-profit intermediaries jump in to interpret the data for a small fee?

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Jennifer Henderson, “Here’s where private equity is most involved in medicine,” MedPage Today, Jul 28, 2022 READ IT HERE

The PE invasion is most advanced in dermatology (7.5%) and gastroenterology (7.4%) and in the Northeast region (6.8%), followed by urology (6.5%), ophthalmology (5.1%), obstetrics and gynecology (4.7%), and orthopedics (1.9%). “The states that had the highest private equity penetration were Washington, DC (18.2%), Arizona (17.5%), New Jersey (13.6%), Maryland (13.1%), Connecticut (12.6%), and Florida (10.8%).” The estimates could be low given their use of secondary data.

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Eileen Appelbaum & Rosemary Batt. “How public real estate investment trusts extract wealth from nursing homes and hospitals,” Institute for New Economic Thinking, Aug 1, 2022 READ IT HERE

Real estate asset stripping is nothing new as private equity invaders often sell off a business’s property and then force it into expensive leases on the same site it used to own. This is a further twist using “healthcare REITs” (real estate investment trusts) to perform the same operation on nursing homes. REITs, because of their tax advantages, “have expanded the pool of capital available for transactions that monetize real property and turn it into tradable assets—financial widgets with little or no connection to the real purpose of the productive enterprises.” The result is huge PE-owned chains of nursing homes with market dominance and an ever-greater disconnect between owners and the services they supposedly provide.

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Markian Hawryluk, “Hospices have become big business for private equity firms, raising concerns about end-of-life care,” Kaiser Health News/Fortune, Jul 29, 2022 READ IT HERE

“The ability to turn a quick profit in caring for people in their last days of life is attracting a new breed of hospice owners: private equity firms.” Ah, to end one’s life in the gentle hands of a private equity administrator! For-profit companies now control 2/3 of all hospices in the U.S., and their profit margins were 19% in 2019 compared with 6% for nonprofits. Because costs are higher at the beginning and the end of the stay, for-profits prefer dementia patients who may linger instead of people with cancer who die more quickly and predictably. Recruitment ghouls hit assisted-living facilities where they can figure out which candidates are money-makers. And it works: “In 2017, Webster Equity Partners bought Bristol Hospice, with 45 locations in 13 states, for $70 million. Last year, the firm reportedly entertained purchase offers for the hospice chain as high as $1 billion.”

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Un-covered, “‘No-fault’? Yeah, right. Centene’s foibles are starting to add up,” Jun 30, 2022 READ IT HERE

The nation’s largest managed care organization (MCO) settled with New Mexico for a pattern of overcharges. But “Centene’s failings in New Mexico aren’t a one-time fluke. Centene paid more than $236 million in settlements in five additional states” (Ohio, Illinois, Arkansas, Mississippi, and New Hampshire). “Is it time the United States takes a federal approach to regulating and actually enforcing these kinds of practices? Is it possible that these one-off, quick-hit, no-fault penalties aren’t really doing the deterrence they’re intended to?”

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Reuben Guttman & Liza Vertinsky, “Demanding more impact from impact litigation: lessons to be learned from multi-state opioid settlements,” STAT, Jul 25, 2022 READ IT HERE

Did state lawsuits against opioid manufacturers and distributors result in good deals? “The results did too little to change the market ecosystem that fueled the epidemic. Multi-million-dollar opioid settlement resolutions are touted in press releases as major successes while the culprit corporations admit to nothing, simultaneously telling investors that the settlement was a business decision and will not affect the long-term bottom line.” Cost of doing business, rinse and repeat. Confidentiality agreements mean no one ever really sees into the inner workings of the conspiracy.

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James C. Capretta, “The public option debate moves to Colorado,” The Dispatch, Jul 20, 2022 READ IT HERE

Washington, Nevada, and Colorado have something called “public” insurance plans, but they’re really just private plans with greater state oversight and regulation. The result is a complex arrangement with multiple opportunities for pushback and sabotage. The author, who holds the “Milton Friedman Chair” at the American Enterprise Institute, suggests that if the plans lower anyone’s reimbursements, they will hit a wall.

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Senate Finance Committee, “Wyden demands Merck, Abbot comply with investigation,” Jul 27, 2022 READ IT HERE

Wyden (D-OR) calls out two Pharmas for stiffing his committee on their tax documents, specifically how they avoid U.S. taxes by domiciling their operations in low- or no-tax offshore sites. “There appears to be a substantial discrepancy between where Merck generates prescription drug sales [USA] and where Merck books profits from those drug sales for tax purposes” (Puerto Rico, Switzerland, Ireland, the Netherlands, Costa Rica, Singapore, and Malta).

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Stefanie Dodt, “Pharma companies sue for the right to buy blood from Mexicans along border,” ProPublica/ARD German TV, Jul 14, 2022 READ IT HERE

“In a suit challenging the ban [on Mexicans entering the U.S. to sell blood], the companies acknowledged that up to 10% of the blood plasma collected in the U.S.” comes from foreign citizens on short-term visas. Selling blood is illegal in Mexico, but here you can do it twice a week.

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Alexander Sammon, “It’s time for public pharma,” ProPublica/American Prospect, Jul 25, 2022 READ IT HERE

“The COVID-19 pandemic showcased the profound inadequacy of the uniquely privatized and financialized American system, where for-profit (and ‘nonprofit’) hospitals and for-profit insurance companies teamed up to help the United States secure its worst-in-the-world national death toll while notching one best-ever earnings call after another. Public pharmaceutical manufacturing in the U.S. could be a game-changer because it would break the monopoly.” Brazil successfully fought price-gouging over HIV drugs because it had its own state pharma capacity. A tiny step: California is trying to produce its own insulin.

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SINGLE PAYER LINKS #264

Posted 27 JUL 2022

Joe Davies, “Seminal Alzheimer's study claiming memory-robbing disease was caused by build-up of protein in brain may have been MANIPULATED, damning investigation claims,” Daily Mail (U.K.), Jul 22, 2022 READ IT HERE

Science magazine found strong evidence that “the data behind the most influential theory of what causes Alzheimer’s disease” was tampered with. That theory, which generated billions of dollars in research funding, is the claim that the build-up of amyloid beta plaques is the driving cause of the malady. Not incidentally, this same amyloid theory underpinned the FDA decision to approve the blockbuster-that-wasn’t, Aduhelm, that was going to make billionaires of the owners of Biogen while driving up the base Medicare deductible (which hasn’t come down BTW). “Images from the study, which involved injecting mice with the protein, appear to be doctored to ‘better fit a hypothesis,’” according to several forensic image consultants. That might explain why dozens of follow-up studies could never discover a therapy that slowed down Alzheimer’s by removing the amyloid beta plaque. See details in the original article below.

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Charles Piller, “Blots on a field?” Science, Jul 21, 2022 READ IT HERE

Investors asked scientist Matthew Schrag to look into the experimental drug Simulfilam being developed by Cassava Sciences. What Schrag found: image tampering in the seminal 2006 article that established the Alzheimer’s-amyloid beta link and made the amyloid hypothesis “the scientific equivalent of the Ptolemaic model of the Solar System.” Mega-dollars for follow-up studies followed while other lines of Alzheimer’s research were starved. Since then, Schrag has identified 20 other suspect papers by the same authors. The entire Alzheimer’s field is in a well-deserved uproar, and the revelations should cause remaining heads of any FDA employee involved in the Aduhelm debacle to roll all the way to the Potomac. Meanwhile, questioning the FDA’s Revealed Truth on things like vaccine side effects or non-pharmaceutical therapies for Covid are bounced from YouTube because The Science™ must rule. And—can’t resist—doesn’t “Simulfilam” have echoes of “simulate” and “flimflam”?

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Sarah Wild, “No link between depression and serotonin, finds major analysis,” New Scientist, Jul 20, 2022 READ IT HERE

And if that weren’t enough: “A review of 17 previous studies finds no evidence for a link between depression and low serotonin levels, which SSRI antidepressants focus on.” That supposed link is the basis upon which we have been medicating tens of millions of people for decades.

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Ari Levy, “Amazon already knows a lot about me, but One Medical takes it to a whole new level,” CNBC, Jul 23, 2022 READ IT HERE

“Amazon’s agreement this week to buy One Medical for almost $4 billion raises important questions about medical data and privacy.” You don’t say! The price paid was a 77% premium over the current share price of One Medical, an indication of how important the buy was to Amazon’s expansion plans. “The same company that sends me countless boxes every week, peppers my Kindle with book recommendations and my smart TV with film suggestions, tells my kids the weather forecast when they call Alexa, and offers Prime discounts when I shop at Whole Foods is about to provide my medical services and own the portals containing my most sensitive information.” Question: Why did you let a billionaire-owned company gather all that data on you? “Amazon already has a health tracker called “Halo” that gathers information such as body fat percentage, activity levels and sleep.” Suggestion for today: Do not download “Halo.”

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Wylecia Wiggs Harris & Tom Cox, “A national patient ID is essential for patient safety,” STAT, Jun 22, 2022 READ IT HERE

Miggs Harris (CEO of the American Health Information Management Association) and Cox (president of Experian Health, “a provider of health care software solutions”) preach their books. To avoid medical errors, they say, patients should all have an interchangeable, national ID number. What could go wrong? In fact, maybe Amazon should be in charge of managing it.

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Danielle Abril, “Rite Aid wants to put your pharmacist in your pocket,” Washington Post, Jun 15, 2022 READ IT HERE

“Q [to the new Rite Aid CEO]: How does Rite Aid’s tech help pharmacists target customers with care they may need? A: Because we get all the data [based on prior visits, purchases and health plans]—I know it may sound a little creepy—we know whether you’ve been taking your medications regularly. So, when you come to the store, we can suggest a test you may need, actually physically give you one, or suggest that you go to your physician. Health plans provide us with information on their members and the specific clinical categories that they want us to do an intervention on. The pharmacy of the future to me is always going to start with your phone.” Can’t wait!

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Denis Campbell, “Worst NHS staffing crisis in its history is putting patients at serious risk, MPs warn,” Guardian, Jul 24, 2022 READ IT HERE

Playbook: (1) starve a public service to the point where it can’t perform well; (2) fill the airwaves with criticism of its poor performance; (3) push for privatization as the solution; (4) through step-by-step (deniable) privatization, shift the lucrative parts of the activity to your friends; (5) hit them up for hefty campaign contributions, which will be a tiny fraction of all the money you’ve made them; (6) rinse and repeat. “NHS Digital figures suggest that the service has vacancies for 38,972 nurses and 8,016 doctors. However, the real figures could be as high as 50,000 and 12,000 respectively.

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Heather Landi, “VA hits pause on future rollouts of EHR until 2023 while lawmakers raise fresh concerns about patient safety risks,” Fierce Healthcare, Jun 22, 2022 READ IT HERE

A pricey new electronic records system at the VA has been a huge mess. “The VA signed a $10 billion deal with Cerner in May 2018 to move from the VA’s customized VistA platform to an off-the-shelf EHR. The cost of the project has since ballooned to $16 billion.”

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Stephen Parodi & Ceci Connolly, “Congress: Don’t let hospital care at home shrivel when the public health emergency ends,” STAT, Jul 15, 2022 READ IT HERE

Covid led to much greater use of home-care even for conditions that would previously have meant hospitalization. Good in theory though vulnerable to cost-saving abuse, like everything else in our “system.” The regulatory environment post-Covid is uncertain, so many hospitals are hanging back. One obvious advantage: “Just 0.1% of in-home patients acquired an infection compared to 8.6% of all hospital patients.”

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Harris Meyer, “Biden’s FTC has blocked 4 hospital mergers and is poised to thwart more consolidation attempts,” Kaiser Health News/USA Today, Jul 18, 2022 READ IT HERE

One of the few areas of government that regularly emits good news. The article contains details of recent anti-monopoly victories, including one initiated by Trump and continued under Biden. (There is considerable cross-party support for stopping hospital consolidation.) The Democrat FTC commissioners also want to stop “vertical” mergers, such as when hospitals acquire physician practices and then force doctors to sign exclusivity arrangements.

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Physician Growth Partners, “Gastroenterology private equity, Fall 2021 Update,” Fall 2021 READ IT HERE

This is a site for private equity types looking for their next deal. It’s full of chilling prose about how to scoop up profits from medical specialties, which you needn’t know anything about. Gastroenterology is now “one of the fastest moving sectors” for PE invasion as “nearly 10% of the 14,000 gastroenterologists in the United States now are partners or employed by a private equity backed platform.” Much more about “strong ancillary revenue streams” and “increased reimbursement leverage.” It also mentions the favorable interest rate environment and subsequent large pools of cash lying about in investors’ hands that needed somewhere to go.

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Bob Herman, “Collateral damage of the Fed’s interest rate hikes: People who put medical bills on credit cards,” STAT, Jul 25, 2022 READ IT HERE

Forty percent of people paying off medical debt use credit cards to cover ballooning out-of-pocket expenses. Another perverse development: “Some hospital systems have started offering credit cards to patients” such as the new AdventHealth credit card that spikes to a 27% annual rate if you fall behind on your payments.

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Kip Sullivan, Ana Malinow & Kay Tillow, “Value-based payment has produced little value. It needs a time-out,” STAT, July 26, 2022 READ IT HERE

Value-based programs offer doctors and hospitals “incentives to encourage more efficient practices,” the most famous vehicle being the accountable care organization, or ACO. Obamacare supercharged the move to ACOs, and the CMMS, which runs Medicare, continues to push Medicare beneficiaries into them. “Despite the tens of billions of dollars—perhaps hundreds of billions—spent on these [value-based] programs, they have done little to improve Americans’ health or lower health care costs.” No surprise there. That’s because highly touted cost-savings plans aren’t meant to reduce costs at all; their purpose is to slick up the privatization process with some greasy rhetoric. By the time they’ve clearly “failed” at the purported goal, no one will have remembered the earlier promises. For example, CMMS has conducted experiments with more than 50 models of value-based payment and found that only 5 had cut Medicare costs—from between 0 and 1 percent. Meanwhile, ACOs increase administrative costs and subject physicians to increased paperwork. In short, ACOs work perfectly at their true goal—to provide juicy profits for their owners. Or as the authors write, “The amazing opportunity to make a buck off the tortured U.S. health care system while rarely laying eyes on patients may be the single most important reason why health policy mavens continue to embrace value-based payment despite its miserable track record.”

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Deborah Veneziale, “Why the U.S. failed to control COVID-19: incompetence, class violence, deception, and lies,” MR Online/Guancha, Jul 18, 2022 READ IT HERE

An article originally written for a Chinese audience and full of uncritical statements about the Chinese approach. That said, it also has some zingers about the U.S. performance: “If China had done as ‘well’ as the United States, 380 million Chinese would have been infected and 4.46 million would have died.” Or this: “Sixty-five percent of nurses across the United States have been verbally or physically assaulted in the past year, and one in three has claimed that they will resign by the end of the year. Meanwhile, billionaires and large corporations are reaping huge financial benefits during the pandemic. So, it’s no surprise that Musk tweeted ‘Give people back their goddamned freedom.’” Hard to argue with any of that.

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David Moore, “Big tech lobbyists butter up Dems,” Sludge, Jul 21, 2022 READ IT HERE

Bills to rein in tech firms have broad support, but sponsors can’t get Chuck Schumer to schedule a vote. Could this be a factor? “One of Schumer’s daughters is a registered lobbyist for Amazon in New York and another daughter works as a product marketing manager at Facebook.” And, “During the first six months of the year, as the antitrust bills stalled, tech industry lobbyists and lobbying firms, as well as their owners, bundled more than $1 million for the Democratic Senatorial Campaign Committee (DSCC), the main group in charge of defending Schumer’s Senate majority.”

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SINGLE PAYER LINKS #263

Posted 16 JULY 2022

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Adam Beam & Don Thompson, “California first to cover health care for all immigrants,” Associated Press, Jul 1, 2022 READ IT HERE

California will eliminate immigration status as a criterion for Medicaid coverage. Eighteen states now provide prenatal care for everyone, and five (CA NY OR WA IL) plus DC cover children from low-income families.

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Fred Schulte, “Government watchdogs attack Medicare Advantage for denying care and overcharging,” Kaiser Health News, Jun 29, 2022 READ IT HERE

Pushback from Congress on the string of abuses committed by MA plans, including overcharging the Federal Government while shunting the sickest patients back onto traditional Medicare as soon as they start costing money. But officials from CMS, which runs Medicare, refused to attend the hearing, a strong signal that there is no pressure from the top to crack down on the looting. CMS promised to audit MA plans more closely, but Kaiser discovered that the government agency hasn’t completed audits dating back to 2011.

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Matt Stoller, “Buckraking: Did a medical monopolist buy off CNN?” BIG, Jul 7, 2022 READ IT HERE

Why are there shortages for things like baby formula or imaging dyes? As usual, there is a monopoly explanation: “In hospital purchasing, the ‘power buyers’ aren’t the federal government, but a small number of firms called Group Purchasing Organizations. GPOs are purchasing agents for hospitals, and after a decade of mergers, three of them—Vizient, Premier, and HealthTrust—now manage an estimated $300 billion of hospital purchasing for 5000 health systems, or 90% of hospital supplies in the United States.” Lo and behold, Sanjay Gupta, CNN’s white-coat expert on all things medical, takes big bucks from Vizient, which has totally nothing to do with his habit of avoiding the GPOs’ role in these messes in his reports.

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Tina Reed, “Consumers will soon get access to huge amounts of health care price data,” Axios, Jul 1, 2022 READ IT HERE

Yes, that’s the theory. Then again, someone will have to make insurers and employers obey the new law, and the track record on hospital price transparency isn’t great. “Starting today, insurers will have to list their negotiated rates with in-network providers as well as out-of-network allowed amounts and billed charges for certain items and services.” But the complexity of medical billing provides many opportunities for insurers to issue the data in ways impossible to understand.

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Judith Garber & Vikas Saini, “Are tax-exempt hospitals giving back their fair share to communities? It depends on what you count,” STAT, Jul 7, 2022 READ IT HERE

Nonprofit hospitals are supposed to provide free care to uninsured people or otherwise improve community health to justify their tax exemptions. Unsurprisingly, they don’t do this very convincingly. The authors, from the Lown Institute, found that they underspend by $18 billion a year. Hospitals game the calculations by including the difference between Medicaid reimbursements and what they call “actual costs.” They also claim medical education and research as part of their charitable largesse.

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Ted Okon, “Hospitals and for-profit PBMs are diverting billions in 340B savings from patients in need,” STAT, Jul 7, 2022 READ IT HERE

How a well-intentioned program to get medicines to the uninsured and low-income patients was gamed by drug intermediaries and their wealthy hospital colluders: “Large supposedly ‘nonprofit’ hospitals and for-profit pharmacy benefit managers together divert billions of dollars in savings that should be helping patients in need.” The hospitals buy the drugs at the required steep discounts, then charge insurers whatever they want. Pharma companies are starting to cut off the discounts, to which the PBMs reacted with opportunistic attacks on “greedy drug companies.” PBMs are anticompetitive monopolies that control 80% of the prescription drug market in the U.S.

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Mallory Locklear, “Insulin is an extreme financial burden for over 14% of Americans who use it,” Yale News, Jul 5, 2022 READ IT HERE

Spending for insulin is “catastrophic” for 14% of users in the U.S. Humalog cost $21 a vial when it was released in 1996; now, it’s over $200. The article blames “supply chains,” which just means that intermediaries have figured out how to block patient access and take hefty cuts.

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Munira Z. Gunja, Evan D. Gumas & Reginald D. Williams II, “Are financial barriers affecting the health care habits of American men?” The Commonwealth Fund, July 14, 2022 READ IT HERE

Big shocker: yes. “In the U.S., men with lower income or frequent financial stress are less likely to get preventive care, more likely to have problems affording their care, and more likely to have physical and mental health conditions.” Sixteen million U.S. men have no insurance coverage, which might have something to do with it.

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Aaron E. Carroll, “What’s wrong with health insurance? Deductibles are ridiculous, for starters,” New York Times, Jul 7, 2022 READ IT HERE

The ACA has not protected people from crippling medical costs, says the author, due to copays and deductibles, which “assume that all medical spending is the same and that the system should disincentivize all of it, starting over each Jan. 1.” When people have to pay more, they avoid even urgently needed care. This is not hard.

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Arthur Allen, “How Pfizer won the pandemic, reaping outsize profit and influence,” Kaiser Health News/Daily Beast, Jul 5, 2022 READ IT HERE

Pfizer’s influence is so vast at top government levels that “the company’s executives have frequently announced the next stage in the fight against the pandemic before government officials have had time to study the issue.” Even though “Paxlovid’s value to vaccinated patients isn’t yet clear, and Pfizer’s covid vaccine doesn’t entirely prevent infections.” So the products are mediocre, but we should keep funneling them billions while ignoring alternatives, including preventive measures. The next purchase of 105 million vaccine doses will go for $30 a pop, up from $19.50. “During a recent investor call, a Pfizer official could spin the recent reports that the virus can hide from Paxlovid into good news, predicting that, as with the vaccine, patients may need multiple courses.” Any disease that can’t be cured but needs constant medication is good for business.

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Orion de Nevers, “Kansas set up an election for voters to ‘decide’ abortion. Then it stacked the deck,” Slate, Jul 5, 2022 READ IT HERE

A non-single-payer item to remind us of the limits of the electoral response to our shrinking rights: Kansas Republicans have scheduled a crucial vote on whether to outlaw abortion in the state constitution during the primary election when turnout is typically abysmal and when unaffiliated “independents” cannot vote at all.

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SINGLE PAYER LINKS #262

Posted on 7 JUL 2022

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Sam Mellins, “City employee health plan could switch to lower-cost company under new proposal,” The City/New York Focus, Jun 15, 2022 READ IT HERE

“New York City is seeking to replace the main health insurance plan that it provides to its employees with a new, lower-cost option,” affecting 750,000 employees, retirees and dependents. As usual, the Municipal Labor Committee, a group representing most of the city’s local government unions, is supporting the move, just as it did with the switch to MA for retirees.

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Cliff A. Megerian & Peter Pronovost, “Now is not the time for Congress to further cut hospitals’ Medicare payments,” STAT, Jun 27, 2022 READ IT HERE

CMMS set a 1% cut in hospital reimbursement rates on the heels of a 1% cut in Medicare payments. What could go wrong? Safety-net hospitals already get reimbursements far below commercial insurance rates.

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David Gortler, “Biden pays big bucks for Pfizer’s latest flop,” American Conservative, Jun 27, 2022 READ IT HERE

The magazine, a Republican, but not Trump-loving, periodical, calls Paxlovid “Pfizer’s unoriginal and ineffective drug,” which was created from two already existing drugs, i.e., not engineered to treat Covid. The authors outline how Pfizer jiggered its trial to almost guarantee a positive outcome, and the government played along. “The drugmaker limited its study to people who were unvaccinated and faced the greatest risk from the virus due to age or health problems, such as obesity.” $10 billion in public funds followed. Emergency-use approval came from the same FDA employee who shepherded along the Alzheimer’s turkey with credibility-destroying consequences. Says the author, “The circumstances surrounding Pfizer’s Paxlovid clinical outcomes are similarly awful.” Cheap, generic alternatives for treating Covid have been successfully marginalized.

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John Timmer, “How hiring the wrong medical “expert” derailed US pandemic response,” ArsTechnica, Jun 23, 2022 READ IT HERE

How Scott Atlas, “a neuroradiologist with no infectious disease experience,” was put in charge of Covid and promptly pushed the herd immunity strategy that left 1 million Americans dead. Atlas predicted that letting the virus rip through the population would only kill 10,000. To avoid criticism for putting a political hack in charge, “Atlas was told to continue working remotely from California, not to introduce himself on conference calls, and to hide his White House ID card when he met with Birx.” Atlas then “crafted parallel data streams for the president that didn’t reflect official government pandemic figures.” Sounds exactly like the handling of the run-up to the Iraq war, right down to the dodgy data.

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“Privatized healthcare fears rise following a court ruling on for-profit hospitals,” The Blue Roof (South Korea), Apr 27, 2022 READ IT HERE

There’s just so much money in health these days that efficient single-payer systems are under assault everywhere. “South Korea’s National Health Insurance Service sets the price for most types of medical care and pays for most of the medical bills out of the funds collected via taxes. Only non-profit corporations may open and operate a hospital.” However, one autonomous province “may set its own travel and investment rules to encourage international tourism and investment.” Eyeing that loophole, investors set up a for-profit hospital and tried to get around the NHIS. “The provincial government prohibited the hospital from accepting Korean nationals as customers out of the fear that such a move would pave the way toward privatized healthcare.” It lost. “President-elect Yoon Suk-yeol has promised to allow investment capital into the healthcare sector.”

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Jesse & Tyrel Ventura, “Let debt be thy medicine,” Die First Then Quit, Jun 23, 2022 READ IT HERE

The former Minnesota governor’s subtitle is “For-Profit Health Care is Killing Us All.” He discusses the new statistics on medical debt in the U.S. “Debt is no longer just a bug in our system. It is one of the main products. We have a health care system almost perfectly designed to create debt.”

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Kyle Balluck & Julie Manchester, “Democratic group launches 7-figure campaign highlighting efforts to cap insulin costs,” The Hill, Jun 9, 2022 READ IT HERE

Triumphantly advertising something they have not achieved, a classic demonstration of the party’s belief that every problem can be boiled down to public relations. Manchin blocked this effort, but will a million dollars be available to primary him? HAHA

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David C. Harvey, “The next epidemic may be here. The U.S. isn’t ready for it,” STAT, Jun 28, 2022 READ IT HERE

“Monkeypox highlights just how close the U.S. public health system is to its breaking point.” Argues that the country has ignored out-of-control STI rates for years, now running at 2.5 million annually. Congenital syphilis (among newborns) is up over 200% in the last five years, and gonorrhea is at all-time highs. “It will be difficult for the nation to address monkeypox if it can’t address diseases that have been on the rise for decades.” Harvey is the executive director of the National Coalition of STD Directors.

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Ronald Mann, “Justices validate denial of insurance coverage for outpatient dialysis,” Scotusblog, Jun 22, 2022 READ IT HERE

Those old Supremes are nothing if not consistent. The opinion, in a case called “Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc.”, will facilitate shifting costs of end-stage kidney disease onto Medicare once the private insurers have collected all available premiums. This merely codifies by court diktat what Medicare Advantage plans already enjoy through the Trump-Biden bureaucracy.

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Susan K. Livio & Brent Johnson, “Murphy officials let Horizon keep $34M after whistleblower said insurer failed to deliver on contract, report says,” NJ.com, Jun 23, READ IT HERE

A state employee tried to hold NJ Blue Cross/Blue Shield to the terms of its contact. She got nowhere and finally quit. “I was unprepared for (the) absolute backlash I would face when I attempted to enforce the contractual terms agreed upon.” Gov. Murphy is quoted praising BCBS’s top lobbyist.

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The Lancet, “Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013-20: An observational study of NHS privatization,” July 1, 2022 READ IT HERE

A technical study article based on a massive set of U.K. data, which concludes: “We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0.38% (95% CI 0.22–0.55; p=0.0016) or 0.29 (95% CI 0.09–0.49; p=0.0041) deaths per 100,000 population in the following year” [emphasis added]. That translates into an additional 557 deaths per percent of increased privatization. Also, “Our results suggest that these [outsourcing] processes are not associated with improvements in service provision.”

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Noam N. Levey, “She almost died. Then $250K debt took their house,” Kaiser Health News/NPR, Jun 16, 2022 READ IT HERE

“Cindy Powers needed 19 surgeries over the course of five years for abdominal problems and life-threatening infections. Her illnesses led to $250,000 in bills, bankruptcy, and eventually foreclosure on the couple’s house in Texas. [Husband] Jim described Cindy’s illness as five years of hell. The financial consequences for the couple lasted even longer.” One of many stories in this lengthy investigative series.

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Health News Florida, “DeSantis signs bill to increase oversight of pharmacy benefit managers,” Jun 22, 2022 READ IT HERE

DeSantis, whose ambitions are no secret, takes steps to alleviate the drug cost burden that the feds seem unable to address. Small, independent pharmacy owners are delighted.

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John Ingold, “Colorado moves one step closer to a government-designed health insurance plan,” Colorado Sun, Jun 23, 2022 READ IT HERE

Colorado continues to experiment with health payment innovations short of single-payer. This one establishes a state-backed (but privately managed) health insurance plan “mandated to be sold at lower prices.” HHS signed off on it, which was a requirement under the ACA, and means extra federal dollars to implement it. The plan is aimed at small business and individuals, including the undocumented, and in theory will produce savings for both the state and the Federal Government. Success will depend on keeping overall costs from continuing their steady climb. Will for-profit companies accept mandated price controls?

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Meg Cunningham, “Missouri declines to extend postpartum health care, but moms say ‘we need more time,’” Kansas City Beacon/St Louis Public Radio, Jun 27, 2022 READ IT HERE

Have ALL the babies, just don’t ask us for any help raising them.

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SINGLE PAYER LINKS #260

Posted 16 JUNE 2022

Seeking Alpha, “Klobuchar & Porter want investigation into Bristol-Myers Squibb, Pfizer, Janssen price hikes,” Jun 14, 2022 READ IT HERE

Easy headline for looking good, we’ll see if anything comes of it. “Fighting for” does not = achieving anything. The senators noted that blood thinner drugs Eliquis and Xarelto “were, respectively, the first and third highest spend on drugs for Medicare in 2020,” Eliquis at $16.7 billion and Xarelto at $7.5 billion.

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Paige Minemyer, “Whistleblower suit: CVS prevented Part D members from accessing generics,” Fierce Healthcare, Jun 16, 2022 READ IT HERE

The claim: “CVS Health subsidiaries coordinated to prevent members from accessing generic drugs in a bid to boost the bottom line.” A CVS employee brought the abuse to a supervisor, who reportedly said “the benefits of the alleged scheme outweighed the likelihood of being caught.” When patients are pushed into costlier brand drugs, the rebates to the chain are higher even though overall costs rise. Meanwhile, “the Federal Trade Commission said last week that it would dig into the business practices of six major PBMs.” [see below]

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Federal Trade Commission, “FTC to ramp up enforcement against any illegal rebate schemes, bribes to prescription drug middleman that block cheaper drugs,” Jun 16, 2022 READ IT HERE

“Bribes”—strong language from a regulator. Looks like Lina Khan et al. are serious. “Paying rebates and fees to exclude competitors offering lower-cost drug alternatives can violate competition and consumer protection laws.” The FTC announcement specifically mentions the soaring price of insulin as a motivator for the action. Once again, the vote was 5-0, meaning even Republicans are on board.

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Dave Muoio, “FTC celebrates antitrust win as RWJBarnabas Health, Saint Peter's Healthcare System call off merger plans,” Fierce Healthcare, Jun 15, 2022 READ IT HERE

One tiny step away from the hospital monopolization trend: two Jersey systems throw in the towel. “The FTC brought the hammer down on the proposed merger” arguing that the transaction “would have combined two hospitals located less than a mile from each other, which also happen to be the only two hospitals in the city of New Brunswick. With combined shares of approximately 50% for inpatient general acute care services in Middlesex County, the transaction . . . would have resulted in higher prices and lower quality of care for New Jersey residents.” Voila, the government is not powerless. The FTC has filed two other complaints against hospital mergers.

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Shelby Harris, “Why a small NC mountain city is taking on nation’s largest hospital system,” Carolina Public Press, Jun 17, 2022 READ IT HERE

The town is suing for monopolistic practices HCA Healthcare, owner of a third of all hospitals in the western part of North Carolina and up to 90% of some counties’ acute care facilities. “Since 2019, HCA has closed outpatient rehabilitation, primary care, and chemotherapy service clinics” all over the state. The lawsuit also complains about understaffing, which has caused a massive outflow of providers. Procedures cost 75-100% more than elsewhere in the state. Sounds like a nightmare we should all prepare for.

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Anand Swaminathan, Jessica Smith & Esther Choo, “The irony—and ignominy—of medical conferences as super-spreader events,” STAT, Jun 14, 2022 READ IT HERE

You’d think doctors who see people die from Covid would be cautious, say these MDs. “You’d be wrong.” They logged in remotely to a conference of 3,000 people and later found that post-meeting Covid infection rates ranged from 18% to 67% among attendees. Has the medical establishment bought the everyone-will-get-it-anyway line? Apparently so, no doubt based on The Science™.

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Megan Brooks, “‘Bane of my existence’: The burden of Medicare Advantages denials,” MedScape, May 10, 2022 READ IT HERE

A report from the Office of Inspector General (HHS) found that between 13% and 18% of MA denials were for covered and permitted services. Providers weigh in on the burden of helping MA operators make more money: “We spend enormous and increasing amounts of time on prior approvals, and we get denials quite frequently,” sometimes twice and three times, such that staff must spend time filing and scheduling an appeal. Because traditional Medicare has clear rules for some of these procedures, like MRIs or post-acute recovery stays, they would routinely be approved if it weren’t for the MA linebackers micromanaging patient care. “Physicians and their staff spend nearly two days a week on prior authorizations, and 40% of physicians have staff who work exclusively on prior authorizations.”

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Len Rodberg, “Report of the NYHA Modification Work Group of Labor Activists for NY Health,” Aug 2021 READ IT HERE

A deep dive into the questions people raise about the NY Health Act. For advocates, this is worth a patient read and filing away for reference. Labor Activists for NYH are trying to build support for the act within the labor movement and took up the objections they have heard one by one. Here are the eight:

1. Since tax rates are not specifically laid out in the bill, how do we know workers won’t spend more under NYHA than they do now? “Important issues such as these should not be left to be determined after passage of the Act,” say the authors. They note that the NYC Charter requires that “the benefits be provided at no cost to the employee.” So, putting in specifics would address the fear that public sector unions would have to renegotiate something already achieved. Rodberg suggests alternative financing plans, de-emphasizing the payroll tax.

2. How to handle out-of-state retirees? Under the current language, if you retire outside the state, you’re no longer covered. Active out-of-state workers are covered, so the proposal here is to give that status to anyone who has worked in NYS for 10 years while at the same time requiring that they pay the same tax that other beneficiaries pay.
3. Medicaid/Medicare services notoriously pay much less than private insurers. How do we guarantee that quality of care is uniform throughout the system? Their answer is that total equality has never been achieved, but incentives to providers to go to rural areas or poor neighborhoods are common and work to some extent.
4. Same for hospitals: how to reduce the disparities between the bigger, richer ones and the rest? How to assure that everyone gets competent care? This is a tough one given the current complexity of hospital funding streams from federal, state, and city sources. “Hospital funding will be a terrain of political struggle even after passage of NYHA though the terrain should be much more favorable to those advocating for equity than is currently the case. The issue will be out in the open” because the data from a single source instead of dozens of payers should make it easier. The authors point to the ongoing fight over the Indigent Care Pool, which still unduly rewards wealthy hospitals.
5. Will union staff get enough work as care coordinators? Unions employ a lot of staff to manage healthcare billing and benefits. These workers wouldn’t be needed under NYHA. OTOH, throwing millions of U.S. factory workers out of their jobs didn’t inhibit the globalizers, so this complaint, while reasonable, is ironic. See also #7.
6. Should workers comp and occupational health regulations be specified in NYHA? This complicated issue takes up several pages of the document. The authors conclude: “Substantial cost savings could occur through integrating worker’s comp medical costs into NYHA.” They also recommend folding the medical part of workers comp into the universal NYH apparatus instead of maintaining two systems and separating out the worker-safety and wage-loss compensation issues.
7. What transitional help will there be for people working in union benefit and other insurance-related offices? “We need to guarantee that any displaced workers will get jobs in the new system or elsewhere that provide comparable income—not just job training.” One estimate: “as many as half” of the 300,000 workers now employed in health care administration in New York would be displaced. Some increased demand for healthcare would offset this, but clearly a very solid plan is needed to address this “disruption in the labor market of such a magnitude.” They propose a five-year income guarantee, among other measures.
8. Will the Board of Trustees function effectively to run the plan, or will it just be a tool of the Governor? Very good question! (Just think of the MTA.) Statutory membership by consumers, providers, and other stakeholders—not just state officials or appointees—would be one approach.

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Noam N. Levey, “100 million people in America are saddled with health care debt,” Kaiser Health News/NPR, Jun 16, 2022 READ IT HERE

The current system is “systematically pushing patients into debt on a mass scale.” Because much of the debt is hidden as family loans, exploding credit card charges, or lengthy hospital payment plans, the numbers are much higher than previously reported. “Debt is no longer just a bug in our system. It is one of the main products,” said one doctor. And: “About 1 in 7 people with debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills.” Harassment of patients is now “epidemic” with many unaware of where the debt they supposedly owe came from. Medical debt accounts for 58% of all debt in collection.

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Mark Satter, “Senate passes major benefits expansion for sick veterans,” Roll Call, Jun 16, 2022 READ IT HERE

The bill adds two new conditions—hypertension and monoclonal gammopathy of undetermined significance, or MGUS—to the list of illnesses linked to Agent Orange, which eliminates the requirement that vets prove that their disease is linked to their military service. It also clears up the “burn pit” controversy where veterans couldn’t confirm their exposure because service records said nothing about whether a soldier was ever near one. In a rational health system, people would get treatment because they have a disease without arguing over where got it.

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Sam Whitehead, “States extend Medicaid for new mothers—even as they reject broader expansion,” Kaiser Health News/U.S. News & World Report, Jun 17, 2022 READ IT HERE

Nine (mostly southern) states have or plan to extend post-partum Medicaid coverage. It could lead to broader Medicaid expansion, or it could provide cover to lawmakers who can claim credit for improving maternal health as they criminalize abortion. “Peeling away a small, uncontroversial group for coverage extension leaves uncovered less politically sympathetic groups,” such as unemployed males.

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SINGLE PAYER LINKS #259

Posted 10 JUN 2022

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Annmarie Timmins, “From skepticism to insurance denials, long COVID patients in N.H. face more than only health challenges,” New Hampshire Bulletin/NH Public Radio, Jun 4, 2022 READ IT HERE

The usual horrors of negotiating with insurance companies for an illness with no established treatment protocols. One patient was told her prescription would be covered “only if she had a diagnosis, [but] that’s an impossible ask for those suffering with long COVID because there’s no way to confirm the illness. It cannot be diagnosed through a test, exam, x-ray or any other tool.” And a symptom-based diagnosis won’t work either because they vary so widely from one patient to the next. It sounds like what sufferers from myalgic encephalomyelitis (“chronic fatigue syndrome”) went through for years.

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Joe Lieberman & Michelle McMurry-Heath, “Russian aggression underscores the U.S.’s need for greater investment in medical countermeasures,” STAT, May 17, 2022 READ IT HERE

Washington insiders plead the case for big spending boosts on products made by the financial backers of their think tank/lobbying operation. The grift is so out in the open that hypocrisy is no longer needed. Say the authors: “U.S. policymakers and lawmakers need to [prepare] for human-generated chemical, biological, radiological, and nuclear threats” by authorizing “robust government investment” in the life-saving products helpfully supplied by their sponsors, such as the biopharma backers of Lieberman’s Bipartisan Commission on Biodefense. Lieberman is joined there by former senator Tom Daschle (Obamacare), former Homeland Security chief Tom Ridge, and war criminal Scooter Libby.

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Emily Baumgaertner, Ben Stockton & Ryan Lindsay, “How Big Tobacco used George Floyd and Eric Garner to stoke fear among Black smokers,” Los Angeles Times, Apr 25, 2022 READ IT HERE

Truly execrable exploitation of the incidents that led to BLM by the tobacco industry frantically trying to save its lucrative business of pushing menthol cigarettes on black Americans. Note the role of Al Sharpton as a beneficiary. “Using the specter of Floyd’s tragic death and the social justice protests it inspired, [a tobacco-funded cop] suggested that prohibiting menthol cigarettes would increase policing in Black communities and create a new layer of racism in America.” Black kids were recruited to join a pro-tobacco protest: “Menthol T-shirts will be provided. The pay is $80 for 2½–3 hours.” Reynolds American earned $15.3 billion in U.S. sales last year, about half from Newports.

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Pema Levy, “Missouri’s proposal anti-abortion law has an eerie resemblance to the Fugitive Slave Act,” Mother Jones, Mar 10, 2022 READ IT HERE

Instead of single-payer, states will allow us to track down our neighbors and earn rewards, just like in the good old days. Under the FSA, “private individuals could under protection of law surveil, stalk, kidnap and apprehend individuals and receive a bounty for doing so.” The Supreme Court upheld these laws, so nothing new there.

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Fred Schulte, “AARP’s billion-dollar bounty,” Kaiser Health News, Jun 6, 2022 READ IT HERE

The American Association of Retired Persons (AARP) makes a huge portion of its income from what it calls “royalties,” i.e., product endorsements, including health insurance policies (which bring in $752 million per year). This creates a conflict of interest for the huge retiree lobby, especially when it partners with shady outfits. “In September, AARP agreed to promote a burgeoning chain of medical clinics called Oak Street Health,” a chain active in 20 states. Two months later, we learn that Oak Street is under DoJ civil investigation for, among other things, false reimbursement claims. Oak Street is also a player in the “direct contracting” privatization scam, which should alone have disqualified it from the AARP seal of approval. “AARP, which strongly supported the 2003 law that created Medicare Advantage, has received a fixed monthly fee from UnitedHealthcare for use of its name in marketing the [MA] health plans” though they won’t say how much. Another DoJ case alleges that UnitedHealthcare “reaped $1 billion or more in illegal overcharges.” It goes to trial in 2023.

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Jane Horvath, “Why pharmaceutical market reform is so hard and what to do about it,” Maryland Matters, May 18, 2022 READ IT HERE

A dizzyingly confusing account of how the drugs market “works.” (I’ve read it twice and still don’t get it.) Maryland and Colorado may set rates on some pricey drugs. “Statewide all-payer, all-purchaser rate-setting will force alignment of incentives such that consumers benefit along with the rest of the system. Rate setting can do what no other policy approach can do to reduce the monumental amount of administrative time and money spent managing high-cost drugs in our current system.” Seems like the only way to get some clarity in this opaque corporate thicket.

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Samantha Liss, “Advocate Aurora faces lawsuit over all-or-nothing contracting,” Healthcare Dive, May 25, 2022 READ IT HERE

Forcing providers to sign up for all of a dominant insurer’s products—including those priced wildly higher than the others in the same area—is an anticompetitive practice. Regulators should step in. “The price for a hip or knee replacement at an Advocate Aurora facility in Milwaukee is $62,538, more than $21,000 above a competitor’s price five minutes away, the lawsuit alleges.” Aurora is planning to get even bigger by merging with Atrium Health in a $27 billion deal to create a 67-hospital system in six states.

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Sarah Kwon, “Burned out by Covid and 80-hour workweeks, resident physicians unionize,” Kaiser Health News/Los Angeles Times, May 27, 2022 READ IT HERE

The medical proletariat fights back.

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Adriel Bettelheim, “FDA: Pharmacists and wholesalers can import drugs from Canada,” Axios, May 25, 2022 READ IT HERE

“With President Biden’s drug pricing agenda still stalled, the FDA is further clarifying how states could take advantage of lower drug costs abroad without the need to limit prices in the U.S.” However, “the administration has sent decidedly mixed signals on importation, supporting the idea in theory while arguing in legal briefs it won’t work.”

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Angus Liu, “Global cancer drugs launches—and cost—hit a record in 2021,” FiercePharma, May 26, 2022 READ IT HERE

Spending on oncology medicines reached a new high. “In the U.S., the number of new cancer drugs that cost over $200,000 a year is on the rise, accounting for a third of launches in the past five years.” Ten years ago, it was only 2%.

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Dan Gorenstein & Ryan Levi, “Fixing the Obamacare ‘glitch’ that pushed one couple to divorce,” Side Effects Public Media/Iowa Public Radio, May 28, 2022 READ IT HERE

“A young couple stands solemnly before the judge. They’ve been married just a year, and they’re here—for the second time—to ask for a divorce. The judge thinks there is something fishy about their request. And he’s right. The young people want to be together. But the only way they can afford that is to legally split up.” Why? their health insurance. Five million people are ineligible for Obamacare subsidies because spouses are disqualified if one member of the couple has employer-based coverage. “Going from Obamacare with subsidies to Obamacare without subsidies, Marshall’s premiums jumped from $40 a month to more than $400.” After the divorce, “I immediately called healthcare.gov and reported I had a divorce, and my plan dropped back down to $40.”

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Katheryn Houghton & Tony Leys, “Montana hires a Medicaid director with a managed-care past,” Kaiser Health News, Jun 1, 2022 READ IT HERE

Montana’s government still runs its state Medicaid program but probably not for long if its choice of director is any indication. The guy brought managed (privatized) care to Iowa and Kansas. “[Incoming chief] Randol most recently was an executive with Cerner Corp., which provides health information technology services.” Montana has resisted privatization because of a bad experience with outsourcing its mental health Medicaid program. “In 2011, widespread opposition led the state to scrap plans for a managed-Medicaid pilot program in five counties.” The Iowa program, overseen by Randol, “was plagued by complaints that Iowans with disabilities had been improperly denied care and that the management companies lost hundreds of millions of dollars in the initial years.” But one fails upward in our system.

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Competition Policy International, “Italy fines drugmaker for price-fixing,” Jun 1, 2022 READ IT HERE

“Antitrust regulators in Italy have fined a drugmaker nearly $3.8 million for years of ‘excessive’ price hikes on a rare disease medicine. The drug, a treatment for a rare genetic disease, was inexpensive until it was bought by Leadiant Biosciences in 2014, “which began raising the price in several countries before withdrawing the medicine from the market entirely the following year.” Other EU countries also fine price gouging.

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Christopher Rowland, “Medicare Advantage insurance firms accused of data-mining patient records and submitting false bills,” Washington Post, Jun 5, 2022 READ IT HERE

“Firms mined patient records for outdated, irrelevant conditions to increase profits, Justice Department contends.” Shocked, shocked. “Palo Alto Medical Foundation, which has 1,600 doctors, and its parent affiliate, Sutter Health, which runs 24 hospitals in Northern California, settled the case with the government in August 2021 for $90 million [for upcoding MA clients]. It admitted no wrongdoing or liability.” And got no prison terms.

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SINGLE PAYER LINKS #258

Posted 5 JUN 2022

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Matthew Cunningham-Cook, “Biden hikes Medicare prices and funnels profits to private insurers,” The Lever, Jun 1, 2022 READ IT HERE

An excellent way to enrich one’s plutocrat friends, remind voters that elites don’t care about their economic worries, and kick off the fall campaign season with a catastrophically losing strategy. “This comes after Biden raked in roughly $47 million from health care industry executives during his 2020 campaign.” A big Medicare rate hike was locked in to pay for the dangerous and likely useless Alzheimer’s drug that the corrupt FDA approved based on no evidence, but now HHS says it can’t revoke the increase until next year. Meanwhile, privatization via Direct Contracting Entities and the ongoing Medicare Advantage hustle accelerates, and a big pay boost to corporate MA insurers remains intact.

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Joseph Choi, “Progressives slam HHS decision to keep higher 2022 Medicare premium,” The Hill, Jun 3, 2022 READ IT HERE

But couldn’t do anything about it, and don’t play hardball. “The cost of a premium jumped by $21.60 in 2022, the largest increase in the program’s history.”

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Greg Krief, “Biden-backed Democrat defeated by progressive in Oregon primary,” CNN, Jun 1, 2022 READ IT HERE

The execrable Kurt Schrader, who sabotaged the Biden program along with other Blue Dogs, but still attracted DNC and Biden’s personal endorsement. “Outside groups” poured $2 million into his campaign as Schrader outspent the challenger 10-1, to no avail. (Which “outside groups” would those be?) In his ads the shameless Schrader called for the government to intervene to lower drug prices, right after kaboshing the bill that would have done exactly that.

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isa L. Gill, “How to save on prescription medications,” Washington Post, May 9, 2022 READ IT HERE

Since the government is determined not to stop Pharma piracy, we have to survive any way we can. Click through to get some tips, including ways to pay cash and save on your “insurance” options.

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Katy Golvala, “As hospital systems grow in CT, rural patients lose services,” CT Mirror, May 8, 2022 READ IT HERE

“Most hospitals are no longer independent but instead part of larger health systems that own multiple facilities. In Connecticut, two systems—Yale New Haven and Hartford HealthCare—are on the brink of owning more than half the 27 hospitals in the state.” Result: closed OBGYN services, ICU, and psych units, along with “temporary” suspensions of others allowed during Covid. When medicine is reduced to a business, decisions will be based on profit maximization. Smaller hospitals away from dense, wealthy population centers will be stripped bare.

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Marty Schladen, “As pandemic ebbs, fears grow that Ohioans will be improperly forced off of Medicaid,” Ohio Capital Journal, Apr 25, 2022 READ IT HERE

Ohio’s Medicaid rolls rose by 20% during Covid to cover nearly a third of the state’s residents, but now that many are back at work, some may earn too much to qualify. Ohio will rush the decertification process to save money. Instead of using the health emergency to expand coverage, Biden & Co. are doing the opposite—quickly undoing benefits and cutting extra aid to states. Eagerness to dump beneficiaries is so great that Ohio hired a data bounty-hunting outfit, the Boston-based Public Consulting Group, which will pocket 10%-20% of the savings they obtain by kicking people out of the program. What could go wrong?

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Howard Koplowitz, “Robert Bentley urges Ivey, Legislature to expand Medicaid: ‘Healthcare simply must be prioritized,’” AL.com, Apr 23, 2022 READ IT HERE

Even though Bentley, the previous Alabama governor, didn’t do it while he was in charge.

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Michelle Andrews, “Why so slow? Legislators take on insurers’ delays in approving prescribed treatments,” Kaiser Health News/Forbes, May 17, 2022 READ IT HERE

Prior authorization is a cost-saving measure utilized by insurers to delay treatments and thus payments for routine services and to frustrate patients until they give up. States have tried to restrict permitted delays, but in the end the commercial incentives are too great.

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Robert King, “AMA: Payers not following prior authorization reforms they agreed to in 2018,” Fierce Healthcare, May 25, 2022 READ IT HERE

“Despite a voluntary 2018 agreement among payer groups to reform the practice” of prior authorization abuse, nothing much changed, according to the AMA. Five areas were supposed to improve, such as transparency about what does and doesn’t need an insurer okay. That flopped along with a “national standard for electronic prior authorization to speed up the process for requests and approvals.” When companies agree to “voluntary” changes with no enforcement teeth, assume business as usual.

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Kelsey Waddill, “No Surprise Act may have blocked 2M surprise billing claims,” HealthPayer Intelligence, May 24, 2022 READ IT HERE

In just two months, according to a survey. Along with relieved patients, insurance companies are mostly happy while the out-of-network doctor groups at in-network hospitals (and their private equity overlords) are pissed.

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Comesite100.com, “FTC sues to block merge between Utah healthcare rivals HCA Healthcare and Steward Health Care System,” June 3, 2022 READ IT HERE

The FTC is headed by an appointee who is acting serious about excess concentration and antitrust enforcement. Two for-profit Utah giants seek to merge, “which would eliminate a low-cost competitor to the larger HCA. This would enable HCA to command even higher reimbursement rates.” The FTC vote was 5-0, meaning even the Republicans signed on. The FTC also moved to block a merger between New Jersey’s RWJBarnabas Health and St. Peter's HealthCare System.

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Pratik Pawar, “It took 35 years to get a malaria vaccine? Why?” Undark, May 25, 2022 READ IT HERE

“The core ingredient of the path-breaking vaccine was actually almost 35 years old—and researchers have known since the late 1990s that the formula was probably somewhat effective at protecting against malaria.” But malaria hits Africans, especially African children, so there won’t be much profit in the vaccine. No rush.

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Gunnar Beck, “Shocking: EU Commission exempts Big Pharma from competition rules,” Philosophy Perennis, Jun 2, 2022 READ IT HERE

The author criticizes the EU for shoveling an extra 300m euros to the makers of a Covid vaccine in violation of European competition rules. He also makes a good point: “The fact that the EU Commission refers to citizens as ‘patients’ is also extremely worrying.” Beck is largely antivax and a member of the ultra-right AfD party, but if similar criticisms aren’t coherently formulated and forthcoming from progressive critics, someone else will occupy that populist territory.

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Rose Hoban & Rachel Crumpler, “NC Senate Republicans float Medicaid expansion bill,” North Carolina Health News, May 26, 2022 READ IT HERE

“Republican leaders in the state senate have been staunch opponents” but the logic of expansion is finally sinking in. Why now? Republicans like the idea of aiding the “working poor” (read, good poor people, not lazy ones), and “there is no fiscal risk to the state budget” given that hospitals will be on the hook for the 10% state contributions while the Feds pick up the remaining 90%. Finally, Medicaid in NC is managed by for-profit insurance companies, so that reassures Republican lawmakers. Still not a done deal though.

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Emily Pisacreta & Emmarie Huetteman, “Betting on ‘Golden Age’ of colonoscopies, private equity invests in gastro docs,” Kaiser Health News/Fortune, May 27, 2022 READ IT HERE

The PE takeover of colonoscopies services in one Texas city has jacked up prices for users. “Preventive colonoscopies are covered without patient cost sharing under the Affordable Care Act, but colonoscopies for patients with existing conditions are not.” In addition to that bit of madness, one PE group owns two dozen of the clinics in San Antonio that perform the procedure. “The GI Alliance operates in a dozen states with more than 400 locations—and is growing fast.” PE now controls 10% of all GE docs in the country. Said one investor, “We are in the Golden Age of older rectums.” True on many levels.

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SINGLE PAYER LINKS #257

Posted 29 MAY 2022

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Editor, “Single payer docs now want national health service,” Corporate Crime Reporter, May 9, 2022 READ IT HERE

Some high-profile single payer advocates (familiar names to us) are now calling for full-on socialized medicine, a la Veterans Administration (VA)-style universal healthcare. They argue that “the accelerating corporate transformation of US health care delivery” is making even single-payer obsolete since concentration is leaving health care in the hands of corporate middlemen who could easily game a single-payer system. Canada’s move to single payer occurred in a different era in which a multitude of providers and decentralized systems could be paid directly by the provinces. Worth reading in full.

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Matthew Cunningham-Cook, “How Wall Street is taking over Medicare,” The Lever, May 11, 2022 READ IT HERE

A long look at “direct contracting entities (DCEs), poised to further privatize Medicare with the additional twist of aiding the private equity invasion: “slightly more than a quarter [of DCEs] are backed by private equity firms, which are known for extracting profits at the expense of workers, the environment, and even their own pension fund investors. The firms include big-name firms like the Carlyle Group, General Atlantic, Clayton, Dubilier & Rice, Benchmark Capital, and Warburg Pincus.” A likely effect: pressure to improve reimbursements that can flow to the big Wall Street firms while services remain the same or worsen. Some DCEs have close links with top Democrats: “The private equity firm Warburg Pincus, which backs a DCE called Excelera, was co-founded by the father of current Secretary of State Antony Blinken and boasts former Obama Treasury Secretary Tim Geithner as its president.”

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Laura Beerman, “A tale of two equities: Private and health,” Health Leaders, May 26, 2022 READ IT HERE

Now that “social determinants of health” are a thing, how long did it take for the concept to become a brand (SDOH) and attract investors? “To paraphrase the holiday favorite, It's a Wonderful Life: Every time a healthcare bell rings, a cottage industry gets its wings. The bell that’s ringing, loudly, is health equity.” So now we have venture capital forging the way in the “for-profit SDOH industry”—what could go wrong? So far, 58 companies have received $2.4 billion in private equity funding, concentrated in the “SDOH subsectors” of community care coordination (20.7%), food insecurity and nutrition (10.3%), nonemergency medical transportation (10.3%), and value-based care (8.6%).

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Hannah Smoot, “Major Atrium Health deal will double size of hospital system, as it expands to Midwest,” Charlotte Observer, May 11, 2022 READ IT HERE

A bloated NC hospital system will now expand into the Midwest to become the fifth largest hospital conglomerate in the country with 1,000 care sites. “It points to a new scale of lack of competition. A new scale of monopoly power,” said one critic. The FTC, no longer entirely dominated by corporate toadies, still has to approve it. North Carolina State Treasurer Dale Folwell has come out against the “six-state medical behemoth.”

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Un-covered, “UnitedHealthcare’s ‘evil empire’ strikes back against a new lawsuit,” May 20, 2022 READ IT HERE

A Nashville-based physician group claims United is offering unfairly low reimbursement rates to force providers out of its network—and into its gigantic, in-house physician group. “This is classic insurer strategy—strong-arming physicians to accept drastically reduced payments or leave the insurer’s network. Essentially, these physicians are caught between a rock and a hard place—being paid less than their services are worth, versus seeing fewer patients altogether.” Doctors as proletarian worker ants crushed by monopoly power.

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Khadeeja Safdar & Gregory Zuckerman, “Millions of Americans are turning to therapy, and investors see an opportunity,” Wall Street Journal, May 8, 2022 READ IT HERE

Your once-independent shrink may soon be controlled by a buyout king. “Venture capitalists and private-equity firms are pouring billions of dollars into mental-health businesses, including psychology offices, psychiatric facilities, telehealth platforms for online therapy, new drugs, meditation apps, and other digital tools.” Lockdown anxiety and the ease of online therapy is turning the sector into a gold mine. Early complaints: pressure to prescribe drugs like Adderall.

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Rebecca Pifer, “Oscar Health withdraws from 2 states,” Health Care Dive, May 11, 2022 READ IT HERE

An insurer specializing in ACA-subsidized clients is pulling out of a couple markets because profits are too low to concentrate “on markets where we can win.”

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Tom Murphy, “Pfizer to spend $11.6B on migraine treatment maker Biohaven,” Associated Press, May 10, 2022 READ IT HERE

Pfizer has so much cash from its vaccine profits that it has to find new companies to absorb. It will spend $11.6 billion—less than one quarter’s profits—on a migraine drug. “Pfizer plans to put its marketing muscle into the drug with potential launches for it in 70 countries.” Avoid drugs you see advertised on TV.

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Katherine Eban, “They don’t want the backlash”: Top doctors balk as Team Biden tries to turn the page on COVID,” Vanity Fair, May 20, 2022 READ IT HERE

The promise of the new Biden team was to put an end to “the previous regime’s Lord of the Flies–style pandemic response” and instead to mount a massive vaccination campaign that would stop Covid in its tracks. That didn’t pan out, so they’re now pivoting to a new, “personal responsibility” approach based on the idea that since Americans have access to “vaccines, powerful therapeutics such as Pfizer’s Paxlovid, and an array of other treatments,” we can let the virus and the public slug it out while the government watches passively. Of course, not all Americans have equal access to these wonderful things, and with new Covid money blocked, we can expect the inequities to worsen.

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Jeff Victor, “As COVID-19 maintenance grows more individualistic, the uninsured find themselves in a familiar situation,” Wyoming Public Radio, May 6, 2022 READ IT HERE

“COVID maintenance could be getting pricier for many people.” Free testing is over, and even insurance coverage isn’t guarantee once the official public health emergency is declared over.

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Tim Tonkin, “Let down,” British Medical Association, May 19, 2022 READ IT HERE

About Britain, but applicable here: The U.K. Government’s handling of the initial stages of the crisis was “one of the most important public health failures the UK has ever experienced.” An early example: PPE guidance was driven by shortages, not safety nor The Science™. “[It was] like going over the top in WW1 with a bow and arrow.” Also, the mental health toll on providers is still not fully appreciated. “I see dead colleagues in the trust news emails, local and national press. I dream about it at night. I’m intermittently consumed by the ocean of sadness it has caused.” Meanwhile, British tabloids and politicians mocked them: “Extremely demoralising as a GP to have worked very hard for the last two years to then be derided in the press and by politicians as lazy and told to get our act together and see patients face to face.”

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Libby Watson, “Patients keep getting charged for crying,” Sick Note, May 20, 2022 READ IT HERE

File under “The beatings will continue until morale improves.” Don’t cry at the doctor’s office, or it’ll cost ya! That’s coded as “brief emotion” (CPT #96127). When the bill arrives, expect to experience “lengthy emotion” along with homicidal ideation. (Is there a code for that?) In fairness, the patients aren’t charged for crying, per se, but rather for “being screened for depression or other mental health problems.” Yeah, but there’s wiggle room, so whaddaya know! —it’s exploited by insurers. Here’s an excerpt from an advice-to-billers column: “96127 can be billed up to four times per client, per session. . . . if a Medicare beneficiary comes in for 15 total sessions plus an intake, administering four instruments per visit and successfully reporting MIPS data could potentially increase your revenue for this client by nearly $400!” Why leave money on the table?

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Nicole Lyn Pesce, “‘This isn’t just gonna go away’: Long COVID is crashing the retirement hopes of many Americans,” MarketWatch, May 19, 2022 READ IT HERE

“Long COVID could be keeping more than 1 million workers from the labor force at any given time, accounting for upward of 15% of unfilled jobs.” Plus, they have to convince Social Security that they’re disabled on top of managing nonstop medical appointments and billing nightmares. Latest horror story: insurers refusing to reimburse for rehabilitation because it is not yet an “approved treatment” while an employer can say, “Well, I don’t believe you have long COVID—prove to me you have it.”

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Nzingha H., “I'm an abortion doula in the Deep South. This is what I want you to know,” Scalawag, May 18, 2022 READ IT HERE

Lessons from where people essentially have been living without Roe for a while now. “Half of Georgia counties are without an OBGYN, and 96 percent are without an abortion clinic. That means people are driving multiple hours for everything from their pap smear, to prenatals, to post-partum appointments—or for an abortion. This is a reality for millions of Southerners.” So, perversely, they may be better prepared for a post-Roe crackdown.

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Charles Ornstein, “New documents show how drug companies targeted doctors to increase opioid prescriptions,” ProPublica, May 17, 2022 READ IT HERE

These reporters built a database called “Dollars for Docs” to see how much Pharma cash was flowing to whom. “Readers searched the database tens of millions of times to see if their doctors had financial ties to the companies that made the drugs they prescribed. Law enforcement officials used it to investigate drug company marketing, drug companies looked up their competitors and doctors searched for themselves.” And didn’t they find interesting tidbits! One-quarter of the 239 medical professionals ranked as top prescribers by opioid maker Mallinckrodt Pharmaceuticals in 2013 “were later convicted of crimes related to their medical practices, had their medical licenses suspended or revoked, or paid state or federal fines after being accused of wrongdoing.”

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Arnav Shah & Lovisa Gustafsson, “What states can do to address commercial health care prices,” Commonwealth Fund, May 10, 2022 READ IT HERE

Given the lack of federal action, “effective policy efforts to control spending growth are most likely to occur at the state level” through strategies like price regulation, targets (caps) on spending, and “population-based payment.” All band-aids but worth exploiting nonetheless, assuming that states can shake off the powerful hospital, Pharma, insurer, and specialist lobbies. One promising area: “oversight of provider consolidation to prevent anticompetitive practices and price increases” because these fights split the various industry players into opposing camps.

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Martin F. Shapiro & Sidney M. Wolfe, “NEJM, other journals: Provide more transparency about conflicts of interest or don’t publish conflicted articles,” STAT, May 19, 2022 READ IT HERE

“Are medical journals reliable sources of objective information, or do they, at times, act as shills for the pharmaceutical industry and other interests?” Wild guess: the latter? The authors take a major one to task for presenting “the perspective of the pharmaceutical industry on what drugs should cost without explicitly revealing the industry ties of its authors.” The criticized article echoed the industry’s “value-based pricing” scam, meaning if your loved one’s extra six weeks of life is worth $1 million to you, that’s what they should get in reimbursement.

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Ed Silverman, “U.S. spending on pharmaceuticals jumped 12% in 2021, fueled by costs of Covid-19 vaccines and therapies,” STAT, Apr 21, 2022 READ IT HERE

Paywalled, but the key numbers are:

• Out-of-pocket costs paid by patients: $79 billion, up $4 billion (5%) in a year;
• Patient copays ran $125 for about 1% of all prescriptions filled;
• Prescriptions not filled last year: 81 million.

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Quynh Anh Nguyen, “We shouldn’t have to clean up after the Sacklers,” Daily Trojan, Apr 19, 2022 READ IT HERE

About why the peddlers of oxy targeted Appalachia, where the opioid death rate is 72% higher than in non-Appalachian counties. The author, a USC student, highlights needed changes in the bankruptcy laws that enabled the opioid family to get off the hook.

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Nicole Goodkind, “The United States is in a maternal health crisis, Goldman Sachs wants to change that,” CNN Business, May 8, 2022 READ IT HERE

Asserts facts not in evidence: Why would GS want to put an end to a revenue stream? Amended headline: “Goldman Sachs wants to cash in on the maternal health crisis, preferably forever.” There, fixed it for you. Which is not to say that the start-up couldn’t do decent things, secondarily. “Maternal and infant health care is a $160 billion industry in the United States. ‘If we even scratch the surface of solving this problem for any mothers and babies in this country,” said [start-up head Melissa] Hanna, ‘we have unlocked billions of dollars of potential here.’”

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Will Atwater, “As DEQ, EPA are slow to act on PFAS, private manufacturers look to fill the gap,” North Carolina Health News, May 9, 2022 READ IT HERE

Water supplies poisoned with PFAS present a public health problem. Lack of government action, “creates an opening for manufacturers,” which citizens then have to pay for somehow—in this case, a special water filter to purify the tainted public supply. “Not only are homeowners required to provide their own filtration systems—schools are as well. The pollutant-producing company isn’t held responsible.

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Tina Reed, “Prescription drug rebates on the rise,” Axios, May 9, 2022 READ IT HERE

Drugmakers negotiate to get their product on the formularies of middlemen known as pharmacy benefit managers (PBMs) and health plans. The insurers get savings; patients, pushed or forced into pricey branded drugs, don’t. “We have the sick people paying more than their fair share for the drug, and the rebate goes back to the plan to reduce premiums for the healthy.”

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Wendell Potter, “Why your inhaler costs so much,” Potter Report, May 27, 2022 READ IT HERE

Because the FDA for years has mostly approved only branded inhalers with long patent protection periods instead of generics. One generic finally getting through may be sidelined by the PBMs, which can force users onto expensive Pharma products so that the big guys keep getting their hefty cuts. An alternative: order from Canada, Turkey, or New Zealand.

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Mary Ellen Schneider, “Study: Inhaler manufacturers use patents, exclusivity to shut out generic competition,” Regulatory Affairs Professionals Society, May 19, 2022 READ IT HERE

“Brand-name inhaler manufacturers have successfully used patent hops, cross-listed patents, and other nonpatent regulatory exclusivities to keep generic manufacturers out of the U.S. inhaler market over the last 35 years.”

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Adam Andrzejewski, “Fauci’s royalties and the $350 million royalty payment stream HIDDEN by NIH,” OpentheBooks, May 9, 2022 READ IT HERE

The NIH doesn’t only hand out big bucks—it also brings some in via royalties, both to the Institutes and to individual researchers. “Because those payments enrich the agency and its scientists, each and every royalty payment could be a potential conflict of interest and needs disclosure.” Among the beneficiaries over the years: Anthony Fauci, 23 royalty payments; NIH chief Francis Collins, 14 payments; Clifford Lane, Fauci’s deputy, 8 payments. But the reporters don’t know how much the payments were for nor from whom—those details were redacted from the FOIA documents. They did learn that in the late 90s, Fauci got $45K for an AIDS treatment, which had been funded by NIH to the tune of $36 million. Good to know next time Fauci goes on TV to give advice on what treatments the government should buy.

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SINGLE PAYER LINKS #256

Posted 19 MAY 2022

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Austin Ahlman, “Rep. Kurt Schrader, the “Joe Manchin of the House,” nears defeat in his Oregon primary,” The Intercept, May 18, 2022 READ IT HERE

Schrader was the key committee vote against drug pricing reform in the Build Back Better package, which is now stymied thanks to sabotage by Schrader and a handful of other Blue Dogs. He is about to lose to a lesbian rancher despite outspending her by 10 to 1 with truckloads of cash from Pharma and the Israel lobby. “By March, internal polling found that the race was a dead heat, and Schrader began running ads touting his alleged support for many of the key proposals that he has worked to undermine.” That old trick didn’t work, and other corporate Democrats flopped as well.

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Julie Rovner, “Sen. Orrin Hatch’s legacy tracks the GOP’s evolution on health,” Kaiser Health News, Apr 28, 2022 READ IT HERE

The late Hatch teamed up for years with Ted Kennedy to pass a series of healthcare bills such as the Hatch-Waxman Act to enable generic drugs to compete with brands, the Ryan White law that funds a huge portion of AIDS-related care to this day, and the Americans with Disabilities Act. He even backed the Children’s Health Insurance Program (CHIP). But the days of Republican “pragmatists” are fading into the distant past as party ideologues demand total obedience. Hatch once supported the kind of individual insurance mandate that ended up in Obamacare but quickly pivoted when it became a Democrat vehicle and called it “the stupidest, dumbass bill that I’ve ever seen.”

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Tom Church & Daniel L. Heil, “Medicare at 60 would have harmful unintended consequences,” STAT, May 3, 2022 READ IT HERE

Deficit-hysteria appears like clockwork as soon as the gazillions for tax cuts and armaments are safely authorized and banked. The authors from the right-wing Hoover Institution linked up with the Partnership for America’s Health Care Future to claim that huge, scary costs would accrue if we were to cover more people in Medicare. (For a glance at who is behind the bland-sounding PAHCF, hold nose and click) READ IT HERE

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Billy Kenber, “The man behind ‘value-based pricing’ saw Pharma distorting his message—and walked away,” STAT, May 13, 2022 READ IT HERE

Mick Kolassa is the now-repentant pioneer of the “value-based pricing” argument, which is that drugs should cost whatever their “value to patients and society” might be, i.e., if you really want grandma to survive, that’s worth millions, right? He helped Pharma execs get over any lingering shame about charging astronomical prices once they realized that public outcries could be ignored along with congressional criticism. Thus, MS treatments, which once cost around $10K a year, now go for $80K. Since demand is inelastic, people (or their insurers) are forced to pay up. Kolassa now regrets his role and atones through the playing of bluegrass music.

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Bruce Japsen, “Health plans brace for specialty drugs eclipsing 50% of prescription spending,” Forbes, May 3, 2022 READ IT HERE

The blockbuster drugs that only account for a tiny percentage of total pharmacy claims are the main drivers of Pharma profits. Therefore, any regulatory moves to rein in their costs will spark furious combat. Payers are “closely monitoring patients” who are on these insurer-bankrupting drugs, which is likely to lead to ongoing authorization nightmares for beneficiaries.

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Susan Jaffe, “Medicare surprise: Drug plan prices touted during open enrollment can rise within a month,” Kaiser Health News, May 3, 2022 READ IT HERE

“Something strange happened between the time Linda Griffith signed up for a new Medicare prescription drug plan during last fall’s enrollment period and when she tried to fill her first prescription in January.” The price had gone up by 400%, all perfectly legal.

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Paul Fenyves, “Does Paxlovid work in people vaccinated against Covid-19?” STAT, May 18, 2022 READ IT HERE

Answer: we don’t really know. The article provides insight into how the design of a study—including who the study subjects are—can be jiggered to provide the desired evidence. “Paxlovid appears to be highly effective with a clinical trial showing an 89% relative reduction in hospitalizations or death among high-risk patients. I say ‘appears to be’ because there’s a problem: the single trial supporting the FDA’s emergency use authorization of Paxlovid included only unvaccinated people who had never previously had Covid-19. Since 76% of U.S. adults are now vaccinated, and an estimated 58% of Americans have already had Covid, the trial supporting Paxlovid is not directly applicable to a majority of Americans.” So, we’re flying blind on treatment, but because Paxlovid is a pricey, branded drug that the Federal Government already has shoveled $5 billion at Pfizer to acquire, no one gets booted off YouTube for saying it works.

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Harris Meyer, “States watching as Massachusetts takes aim at hospital building boom and costs,” Kaiser Health News/Fortune, May 3, 2022 READ IT HERE

The state is not sitting idly by while mega-health systems gobble up smaller players and boost costs. Massachusetts’s rapidly rising health care costs have slowed as the state government gets involved. In April, “an 11-hospital system that includes the famed Massachusetts General Hospital unexpectedly withdrew its proposal for a $223.7 million outpatient care expansion in the suburbs after being told by state officials it wouldn’t be approved” because it would shift patients away from cheaper options. MA is also the first state to order a hospital to explain how it’s going to keep costs down. Other states are watching. Since the various players in the healthcare industry were on opposite sides in this case, regulators could resist the usual pressures. “It’s like the sheriffs rediscovered their badge and realized they really could say no.”

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Giles Bruce, “Downsized city sees its health care downsized as hospital awaits demolition,” Kaiser Health News/Chicago Sun-Times, May 2, 2022 READ IT HERE

St Margaret Hospital in Hammond, Indiana, started by dedicated nuns 124 years ago, will be mostly demolished, wiped out by the cost differential in payments from Medicare/Medicaid (used by residents of de-industrialized, Rust Belt Hammond) versus reimbursements from private insurers whose users live in the tonier suburbs. “Since the 1930s, the urban hospitals most likely to close are those serving low-income, minority populations.” Hammond residents will now be served by another hospital nearby where they will be welcomed with open arms by the administrators eager to take on Medicaid patients with lousy reimbursement rates.

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Caitlin Andrews, “Maine can’t do much about a big dispute between its largest insurer and hospital,” Bangor Daily News, May 18, 2022 READ IT HERE

These sorts of disputes keep popping up all over: Maine’s dominant health insurer is going at it tooth and claw with its largest hospital, exposing “the state’s limitations in managing the relationship.” The two giants can’t agree on who gets to gouge more out of each other, and the threatened decoupling “would mean anyone covered by [Anthem, the insurer] would be billed for costlier out-of-network services if they sought care at Maine Medical Center.” A curious—and common—feature: Republicans side with the insurance company, Democrats sympathize more with the hospital. “Maine AllCare called it ‘a stunning example of why market forces can’t do the job.’”

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NewsQuick24, “Insurance lobby calls for greater oversight of private equity transactions,” May 17, 2022 READ IT HERE

More Godzilla v. King Kong: America’s Health Insurance Plans wrote in a letter to Biden, “In too many segments of our healthcare system, competition has been stymied by powerful healthcare providers and drug manufacturers gaming the rules to their advantage and inadequate laws and enforcement to protect competitive markets.” With PE penetration of the entire industry accelerating, the once-comfy insurers are getting nervous about “anti-competitive behavior,” i.e., their own weakening position, and want the feds to force disclosure of PE “purchases of ambulance providers, emergency room physicians, and other specialized groups.”

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Maurie Backman, “How much will healthcare cost in retirement? Prepare to be shocked,” Lincoln [Nebraska] Journal Star, May 18, 2022 READ IT HERE

A warning that the promise that Medicare will mean an end to worries about healthcare costs late in life is fast eroding. “Medicare, which seniors commonly rely on starting at age 65, has its limitations,” deadpans the author, who estimates average post-65 expenses at $315,000 per couple even when both are fully enrolled in Medicare Parts A, B, and D.

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SINGLE PAYER LINKS #255

Posted 12 MAY 2022

Community Service Society, “CSS thanks New York State lawmakers for protecting patients’ homes and wages from predatory medical collection actions,” May 10, 2022 READ IT HERE

Yay, a victory, albeit a small one. Hochul’s signature is all that’s needed to stop New York hospitals from placing liens on patients’ home and garnishing their wages.

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Megan Messerly & Krista Mahr, “‘It’s insanity’: Providers end Covid care for uninsured in the wake of congressional inaction,” Politico, Apr 27, 2022 READ IT HERE

Now that the pandemic emergency is officially over, it’s time to go back to for-profit medicine. “Covid-19 programs around the country have shrunk over the last month, a consequence of Congress’ failure to provide fresh funding to combat the pandemic. In New York, a pharmacist who was administering thousands of vaccine doses a week to underinsured communities has stopped his outreach work.” At least in NY State, you now won’t lose your house. But federally funded health centers (FQHCs) are required to treat patients regardless of insurance status, so they’ll get squeezed. If the virus rebounds, we’ll be as unprepared as the first time around.

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Noah Weiland, “Loss of pandemic aid stresses hospitals that treat the uninsured,” New York Times, May 1, 2022 READ IT HERE

“Billions of dollars in [federal] aid not only guaranteed that uninsured Covid patients would not face medical bills during the pandemic but also offered a lifeline for financially stressed institutions like Nashville General that provide extensive uncompensated care for the poor.” That’s all over now that we’ve buried our first million, so it’s back to tales of postponed care and teetering safety-net hospitals. “The crisis of the uninsured is especially acute in Tennessee, which has one of the highest rates of hospital closures in the country and is among a dozen states that have chosen not to expand Medicaid.”

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Jonathan Lambert & Alex Leeds Matthews, “Nurses are not OK: Why they’re quitting their jobs, and what it means for the future of healthcare,” GRID, May 2, 2022 READ IT HERE

Covid aggravated working conditions for nurses, leading them to quit in droves. As staffing levels shrink, even more get burnt out, further worsening the situation. “A wave of hospital consolidations in recent decades has helped hold down nurses’ pay and contributed to understaffing. But Covid has turned a problem into a crisis. More than one-third of nurses plan to leave their current role by the end of the year, [and] 66 percent of acute and critical-care nurses have considered leaving the profession.” Lots of dire testimony, such as this one from a NJ nurse: “You were always drowning. We didn’t have any help. We had more patients die than live, and right now I’m just kind of blacking that out.” All that clapping in the streets did not translate into improved working conditions.

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Joseph Mercola, “California bill would strip licenses from doctors who spread COVID ‘misinformation,’” The Defender, May 5, 2022 READ IT HERE

As defined by whom? Yesterday’s “misinformation” is today’s consensus, but someone wants thought control to enter the world of medical licensing. Wild guess: the only views deemed permissible under this wacko proposal will be those compatible with the interests of Pharma and the medical insurance industry.

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John E. McDonough, “Republicans have stopped trying to kill Obamacare. Here’s what they’re planning instead,” Politico, Apr 26, 2022 READ IT HERE

The author, who worked on the ACA as a congressional staffer, says repeal is off the table. But the GOP could move to enact “major improvements,” such as getting rid of the tax on higher-end insurance policies and the individual mandate penalty. Another Republican idea: repeal the Independent Payment Advisory Board that could interfere with industry plans for Medicare spending. “Dismissal of ACA repeal does not indicate agreement with core ACA policies,” he writes in an understatement. Some of the criticisms are valid and even perversely echo Bernie’s M4A rhetoric though the GOP’s preferred solutions generally would make things worse, such as enabling more privatization and “consumer choice.” The author notes that GOP attacks on Medicare and Medicaid are fading since the privatization process is already far advanced. One possible nightmare scenario: a push for “Medicare Advantage for All.”

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Ariel Hart, “Biden Administration suspends Georgia plan to block access to ACA website,” Atlanta Journal-Constitution,” Apr 29, 2022 READ IT HERE

A taste of the GOP wish list once the Dems go: “Currently, 700,000 Georgians are covered by ACA plans, and the majority buy them on the website healthcare.gov. Under the Kemp plan, when shoppers went to the website to shop for plans, it would have instead directed them to buy their plans from individual insurance companies or private brokers.” Kemp didn’t get away with it but could under Trump II.

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Michaelle Proser, “How hospitals and health systems can help patients avoid medical debt,” STAT, Apr 26, 2022 READ IT HERE

A wish list of demands that could ease the burdens of medical debt (that should not exist in the first place—but I digress): improve financial assistance and repayment programs, including “presumptively assuming eligibility for aid”; help patients make the right decisions given their options; “proactively identify and support patients at risk of medical debt” (that’s not everybody?) Well-intentioned but weak tea.

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Jakob Emerson, “States that have proposed public option health plans,” Becker’s Payer Issues, Apr 22, 2022 READ IT HERE

In total, 23 states have tried to create public health plans in the last decade or so, three successfully (Colorado in 2021 and Washington and Nevada starting in 2023 and 2026 respectively).

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Nicholas Florko, “Prisons didn’t prescribe much Paxlovid or other Covid-19 treatments, even when they got the drugs,” STAT, May 5, 2022 READ IT HERE

“Federal prisons used just a fraction of the antiviral drugs they were allocated to keep incarcerated people from getting seriously ill or dying of Covid-19”—363 doses out of 1500 provided by the Feds—a measly number to start with. Prison healthcare is criminal.

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Blake Farmer, “Shopping for space, health systems make over malls,” Kaiser Health News/Nashville Public Radio, Apr 26, 2022 READ IT HERE

An apt metaphor for the changing landscape of the U.S. economy: while retail dies, far more lucrative health services expand and thrive. “Hickory Hollow Mall has been in a downward death spiral for more than a decade. Now the mammoth complex is on track to join the ranks of malls making a transition into a booming economic sector: medicine.” And: “What big-city health systems need most is something shopping malls have plenty of: space and parking. Right now, they’re doing surgery where people used to buy sheets and towels.”

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Joshua M. Sharfstein, “Congress has to ask how much McKinsey hurt the FDA,” New York Times, Apr 26, 2022 READ IT HERE

McKinsey’s consultants were simultaneously working for oxy-peddlers Purdue Pharma and the FDA. Tiny little conflict of interest maybe, working for Purdue while also “advising the FDA on how to regulate opioids?” The author was the No. 2 at the FDA, so he’s part of the problem and, to his credit, seems to realize it.

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Paula Andalo, “After medical bills broke the bank, this family headed to Mexico for care,” Kaiser Health News/NPR, Apr 27, 2022 READ IT HERE

Mexico may have to build a wall to keep us out. The featured insured family was hit with thousands in bills after dad got Covid and others racked up additional health problems. They couldn’t afford the deductible and other copays on top of their $1000 per month premium.

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James Miessler, “Nearly one-quarter of post-market trial reports were late or not filed in fiscal 2020,” CenterWatch, May 2, 2022 READ IT HERE

When the FDA rammed through approval of the Alzheimer’s turkey Aduhelm, the decision was justified in part with the argument that the company would have to do follow-up studies to confirm efficacy. The dirty little secret is that no one really pays much attention to these agreements when they’re blatantly violated, so the company involved gets to vacuum up cash for years, dawdle, and then apologize. “Although the agency has the authority to levy financial penalties on noncompliant sponsors, to date it has not done so.”

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Bobby Jindal, “Championing consumer freedom in health care,” Newsweek, Apr 27, 2022 READ IT HERE

A remarkably lame set of right-wing talking points from the pen of the former, forgotten governor of Louisiana lauding “consumer choice” in medicine. Is anyone convinced by these fanciful descriptions of a Candide-like magical marketplace in which fully empowered and informed consumers wisely purchase their optimum healthcare products? Catastrophic failure only drives the Jindals to double down and insist on more of the same.

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Paige Minemyer, “Humana making headway in updating approach to MA sales after underwhelming open enrollment,” FierceHealthcare, Apr 27, 2022 READ IT HERE

Headline toned down by an editor from the original, “Humana’s Q1 profit jumps 12% year-over-year to $930 million” [see the URL]. The article outlines how Humana scrambled to get more MA patients after disappointing open-enrollment-period numbers via “new training for contracted call center workers; new compensation structures for plan brokers; and additional ways to ease the member experience.” Humana stock had tumbled earlier when its pace for acquiring new MA members slackened. “Easing the member experience” is important for people who just turned 65 since once you’ve entered an MA plan, your options for getting out of it immediately shrink.

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Tina Reed & Caitlin Owens, “Medicare Advantage debate rekindled by report on coverage denials,” Axios, Apr 29, 2022 READ IT HERE

A federal watchdog found “inappropriate denials of services and payment requests that met Medicare coverage rules.” The report is stirring debate over “whether the program is helping seniors or simply padding insurers’ pockets,” given that MA plans pocketed $12 billion more than the Feds would have paid for the same population in traditional Medicare. MA is mostly isolated from criticism since enrollees like it (until they get sick), Republicans love privatization, and Democrats either do too or stand by watching.

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Els Torreele, “Pharma investors, shareholders should not determine global health,” STAT, May 3, 2022 READ IT HERE

“[WHO director-general] Tedros Adhanom Ghebreyesus took the unprecedented step of supporting a shareholder resolution put forward by Oxfam to compel companies to share the know-how and technology underlying Covid-19 vaccines.” He lost, of course. Although shareholder motions are a fun way to highlight horrors, says the author, “the key issue is that pharmaceutical companies and their investors should not be the ones having the power to decide about public health issues.” Interesting details on the financialization of the biotech industry.

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Susan Kelly, “Insurers may be padding Medicaid physician networks, study finds,” Health Care Dive, May 3, 2022 READ IT HERE

“Yale and Cornell university researchers found that about 16% of adult primary care physicians listed in Medicaid managed care networks did not file any Medicaid claims in a year.” That is, an insurer may show a bunch of doctors in their system, but you won’t be able to get an appointment with many of them. When Medicaid enrollees are pushed onto private “managed care” plans (70% of all beneficiaries), who enforces the rules? Intimidated, understaffed state bureaucracies?

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Ian Munro, “As demand for dental care skyrockets, Medicaid providers struggle to find an empty chair,” Virginian-Pilot, May 3, 2022 READ IT HERE

North Carolina expanded covered services, but nobody figured out how to increase the number of dentists that will take Medicaid enrollees, especially given the 15-year freeze in Medicaid reimbursement rates. Charity care can only go so far.

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SINGLE PAYER LINKS #254

29 APR 2022

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Amanda Dunker, “2022 Budget Roundup,” Health Care for All New York, Apr 26, 2022 READ IT HERE

What happened in the state’s annual mud wrestle over spending? A lot of things, some pretty good, lots of disappointments. Eligibility criteria for insurance coverage were improved in some cases; post-pregnancy Medicaid was extended to a full year; Medicare will now be available to immigrants, i.e., useful adjustments that improve some outcomes. However, given the 31% increase in tax revenue and resulting budget surplus, much more could have been done. The single-payer bill (A880A/S1572A) is still pending. One immediate battle to come: a bill to prohibit liens for medical debt on primary residences.

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Bob Herman, “The doctor who is trying to bring back surprise billing,” STAT, Apr 27, 2022 READ IT HERE

An acute-care surgeon on Long Island is suing the federal government to overturn the No Surprises Act because it “violates his constitutional rights to bill patients directly.” He stays out of almost all insurance networks and wants to set his own fees, which result in a $400K annual income. The legal argument is essentially that the government shouldn’t regulate commerce, so it’s unlikely to prosper—though who knows these days?

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Wendell Potter, “An analysis of UnitedHealth Group’s earnings report,” Tarbell, Apr 22, 2022 READ IT HERE

“The U.S. government has become the biggest and most reliable cash cow for America’s for-profit health insurers. Over the past 10 years, UnitedHealth Group, America’s biggest health insurer, has seen its profits more than triple as the number of its private-paying customers actually shrank.” But as its Medicare/Medicaid customer base has grown, UHG now gets 54% of its total revenues from the U.S. government. Its Optum division now employs over 50,000 physicians.

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Max Moran, “Will Biden’s new COVID czar protect the world or big Pharma?” The Lever, Apr 27, 2022 READ IT HERE

Probably the latter. Dr. Ashish Jha got the job more for his media presence and is loyally declaring Covid mostly done. “Jha has a questionable history when it comes to picking fights for the sake of the public good, particularly on subjects like waiving intellectual property rights and holding Big Pharma accountable.” He also keeps his financial ties secret.

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Milton Packer, “Are academic collaborators just useful pawns to industry?” MedPage Today, Apr 27, 2022 READ IT HERE

An interesting discussion of how academics should (but often don’t) deal with Pharma in running clinical trials. He sounds ethical and independent, and at the same time his article suggests that plenty of his colleagues don’t follow his guidelines. Worth a reading in full especially for his conversation with a company rep who wanted assurances that he would promote a drug before the trial even began. “Shifts in a corporate commitment to academic independence can change quickly when a trial ends especially if internal oversight moves from the company’s research arm to its marketing department.”

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Kendall Taggart, John Templon, Anthony Cormier & Jason Leopold, “Profit, pain, and private equity,” Buzzfeed News, Apr 25, 2022 READ IT HERE

On private equity giant KKR’s role in care homes for the disabled. Using the PE model of buying up a company, loading it with huge debts, selling off its valuable assets, pocketing fat fees, and then exiting and letting the crippled business deal with the wreckage. Destroying Toys R Us is one thing, but destroying nursing home capacity has even more dire ramifications. A year-long investigation found that KKR kept wages so low that the homes couldn’t find or keep staff. “Reporters . . . again and again found residents consigned to live in squalor, denied basic medical care, or all but abandoned.” But the PE guys made out like bandits. “In 2021 alone, private equity firms invested about $172 billion—more than 10 times the budget of the Centers for Disease Control and Prevention—in U.S. healthcare companies.”

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Health Justice Monitor, “California commission affirms unified financing,” Apr 22, 2022 READ IT HERE

Another study boosting the economics of single-payer: “Under almost all scenarios analyzed, in the first year of implementation unified financing is expected to result in lower total health care expenditures than under the status quo.” A commentator adds: “Don’t let the precise technical prose fool you—this is a full-throated endorsement of the critical core of single payer: unified financing for universal coverage.”

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Arthur Allen, “Why cheap, older drugs that might treat Covid never get out of the lab,” Kaiser Health News/U.S. News & World Report, Apr 12, 2022 READ IT HERE

Many front-line doctors scrambled to find plausible drug candidates among already existing compounds and organized seat-of-the-pants trials under emergency conditions. The author points out how little credence is given even to successful drugs like fluvoxamine compared to the costly alternatives like molnupiravir, which is similar in everything but cost ($733 per dose versus $5). “The molnupiravir data was not that great, but we’re spending billions on the drug, and it got fast-track emergency use authorization” while fluvoxamine remains in a gray area.

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Lambert Strether, “Complex eligibility requirements, much-beloved of liberal Democrats, are lethal when they take the form of Medicare co-pays and deductibles,” Naked Capitalism, Apr 24, 2022 READ IT HERE

Strether regularly slams Dems for parsing endless nuances of eligibility to, in his words, provide a “jobs guarantee for credentialed gatekeepers and an opportunity for endless moralizing about who is worthy of government assistance and how much.” Here, he reports on an academic study showing harms from cost-sharing arrangements, such as those that populate our healthcare Rube Goldberg apparatus. The paper concludes: “We find that small increases in cost cause patients to cut back on drugs with large benefits, ultimately causing their death.” Strether: “The obvious solution is, of course, to blow the entire system to smithereens with a single payer system, eliminating the lethal co-pays entirely. One will, of course, have to pry complex eligibility requirements from the cold, dead hands of liberal Democrats, but a man can dream.”

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I'Jaz Ja'ciel, “Vigil at Fidelis calls for accountable health care,” Spectrum News 1, Apr 9, 2022 READ IT HERE

A young man’s insurance was canceled when he missed a $20 payment, and he was denied a prescription refill for his mood stabilizer. After his subsequent suicide, local advocates denounced the insurance company at its offices. “Daniel’s father, Scott Desnoyers, is calling for the resignation of Fidelis Care founder and Vice President of Social Responsibility Fr. Patrick Frawley.” How much does one earn as a VP of “social responsibility”?

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Apoorva Mandavilli, “Scientists question data behind an experimental Alzheimer’s drug, New York Times, Apr 18, 2022 READ IT HERE

Better to get the anomalies and irregularities on the record quickly before the FDA rushes to approve another Alzheimer’s turkey. Huge profits are standing by awaiting a “successful” drug, so the incentives to cut corners are vast. “PLoS One retracted five papers by [Cassava scientist] Wang after a five-month investigation into ‘serious concerns about the integrity and reliability of the results.’” Cassava only recently got into Alzheimer’s research—with NIH funding—after trying unsuccessfully to break into the opioid market.

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Caitlin Owens, “Hospitals’ massive cancer drug markups,” Axios, Apr 19, 2022 READ IT HERE

“Median price markups [to private insurers] ranged 118% to 634% above the estimated acquisition cost. Prices varied widely between cancer centers and even between payers within the same center.” Insurers pay through the nose, then pass on the costs in higher premiums.

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Elisabeth Rosenthal, “Is my copay coupon charity—or a bribe?” Los Angeles Times, Apr 19, 2022 READ IT HERE

Getting a pharmaceutical company’s coupon can be a pleasant surprise, but it has to mean that the list price of the drug is pretty steep. Keeping the copay down encourages patients to stay on the drug while the insurer picks up the bulk of the cost. The company can also write off the coupon cost from its income tax bill. Rosenthal: such coupons amount to “profitable charity.”

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Joyce Frieden, “200 rural hospitals at risk of closing in the next few years, study finds,” MedPage Today, Apr 22, 2022 READ IT HERE

“Inadequate payments from private insurers [are] a large part of the reason”—quite a different conclusion than the usual blaming of Medicare and Medicaid. Why the lousy reimbursement rates? Small, rural hospitals haven’t got the heft of big conglomerates to negotiate decent deals or to make money on large volumes. “The day of reckoning for the hospitals that were losing a lot of money was pushed back by the pandemic, but it's still coming.”

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Vincent DeMarco, “A three-pronged approach to widening health care access in Maryland,” Baltimore Sun, Apr 21, 2022 READ IT HERE

Maryland has built on the ACA, but 6% of residents are still uninsured. The author, the head of Maryland Health Care for All! Coalition, offers additional adjustments, such as automatic enrollment in ACA plans, more state subsidies for premiums, and coverage for immigrants. He illustrates (perhaps inadvertently) the difference between single-payer and “universal” healthcare, given that the latter seeks to bring everyone into the for-profit insurance model.

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SINGLE PAYER LINKS #253

Posted 22 APR 2022

Ariana Eunjung Cha, “She went to one doctor, then another and another,” Washington Post, Apr 18, 2022 READ IT HERE

“[Long Covid patient] Polega’s demoralizing, two-year odyssey speaks to the dysfunction of the organ-centered U.S. health-care system when it comes to long Covid and the challenge of trying to treat an ill-defined illness for which there is no clear cause and no test, . . . leaving [them] struggling to navigate a maze of doctors and diagnoses on their own.” But each of those doctors and labs can then bill for reimbursement, so from the system’s perspective what’s the problem? Given estimates of 20 million people with long Covid, business will boom.

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Robert Hart, “Common antidepressant likely cuts risk of Covid hospitalization, study finds,” Forbes, Apr 6, 2022 READ IT HERE

Inexpensive fluvoxamine gets a fair hearing on efficacy while ivermectin still stirs hysterical denunciations [see below]. Three clinical trials say fluvoxamine indicated “at least a moderate reduction in Covid-19 hospitalizations.”

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Timothy Caulfield, “Why the Covid cult of ivermectin won’t die,” NBC News/Think, Apr 5, 2022 READ IT HERE

“Cult,” “bunkum,” “nonsensical,” etc. The author is a Canadian academic and correctly states, “Ivermectin very quickly became not about science but about ideology and in-group signaling.” That applies to both the Trumpian pro-IVM and Caulfield’s own anti-IVM camps. “Believing in ivermectin has become a badge of affiliation indicating a particular worldview.” As is not believing in it. Caulfield also falsely accuses IVM of having “known side effects” when in fact it is safer than Tylenol. But no social media gatekeeper will ding him for sloppy science.

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Aneri Pattani, “When resolved medical bills keep popping up,” Kaiser Health News/NPR, Apr 7, 2022 READ IT HERE

Here’s another way to be battered by billing: getting dunned and even sent to collections for bills you’ve already paid. “The covid-19 pandemic has exacerbated potential errors. New medical billing employees may have received quick, virtual training and are working remotely with little interaction with team members or oversight. Some billing departments are understaffed.”

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Samantha Young, California handed its Medicaid drug program to one company. Then came a corporate takeover,” Kaiser Health News/Los Angeles Times, Apr 8, 2022 READ IT HERE

To save money on its massive Medicaid program—where drug costs were exploding by 20% annually—California turned to the private sector, contracting with an outfit called Magellan Health. But then Magellan was bought by industry giant Centene, “already a big player in state Medicaid drug programs”—and not a very nice one. “The company was accused by six states of overbilling their Medicaid programs for prescription drugs and pharmacy services and settled to the tune of $264.4 million.” Undeterred, California pressed on to neoliberal paradise: “Thousands of low-income Californians were left without critical medications for weeks. Doctors, pharmacists, and patients calling for help often languished on hold for as many as eight hours.”

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Bernard J. Wolfson, “Battle lines are drawn over California deal with Kaiser Permanente,” Kaiser Health News/Sacramento Bee,” Apr 18, 2022 READ IT HERE

Kaiser got a no-bid Medicaid contract to operate in 32 counties while the state’s eight other commercial health plans must compete for theirs. Do we see a pattern here? Kaiser is criticized for cherry-picking healthier enrollees, which boosts its profits.

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Paige Minemyer, “Louisiana AG sues UnitedHealth, alleging drug overcharges in Medicaid,” Fierce Healthcare, Apr 20, 2022 READ IT HERE

More heat on the PBMs (Pharmacy Benefit Managers): Louisiana claims that UnitedHealth Group inflated drug costs for the state Medicaid program by using its in-house PBM “to help UHC meet required medical loss ratio targets.” So, the right hand charges a huge mark-up so the left hand can show higher costs. The lawsuit is similar to the ones that cost Centene over $1 billion in settlements with other states. Integration of PBMs with insurance giants is widespread.

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Mansur Shaheen, “Experts warn that ‘patient influencers’ are being paid by big pharma companies to hawk drugs to US consumers without telling them,” Daily Mail (U.K.), Apr 12, 2022 READ IT HERE

Take-away message: Don’t get your pharmaceutical advice from any of the Miss Kardashians. “While Direct-to-Consumer (DTC) drug advertisements are heavily regulated [but should be illegal-ed.], by using these so-called ‘patient influencers,’ the companies can avoid some of the standard disclosures required by law to sell prescription drugs.” Fun fact: 44% of people who ask their doctor for a drug will get a prescription for it. But the underlying problem is not people’s gullibility. “Patients also often crowd-source answers. Many do not have access to health care, and even some Americans that do cannot afford regular doctor visits due to high co-pays.” Lack of consistent access drives them online and to decisions based on guesswork and empathy.

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Tina Reed, “Whistleblower explains how Medicare Advantage plan bilked millions,” Axios, Apr 13, 2022 READ IT HERE

“Major Medicare plans are often inflating how sick their members are—and in at least one example, went so far as to add diagnoses doctors hadn’t made—to bilk millions of dollars from the health care system, a whistleblower told Bloomberg. Health insurers that sell private Medicare plans collected $12 billion more caring for seniors in 2020 than it would have cost in traditional Medicare.” Meanwhile, the Biden Administration just gave MA plans a “bigger than expected pay bump.”

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Lown Institute, “Are nonprofit hospitals earning their tax breaks?” Apr 12, 2022 READ IT HERE

Short answer: no. The authors calculated what they call “fair share spending” by 1800 hospitals by comparing charity care outlays and “community investment” against the value of the property tax exemption they get as charities (“nonprofits”). Two New York systems made the top 25: NY Presbyterian (#12—a $319 million deficit) and Northwell (#18—$245 million). “The total fair share deficit for these 227 hospital systems amounted to $18.4 billion in 2019. Many of these systems also received hundreds of millions from the CARES Act in 2020 and ended the year with high net incomes.” Contains lots of detail on the largest abusers.

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John Ingold, “Why Colorado’s ongoing fight against high hospital prices is now a lot more complicated,” Colorado Sun, Apr 15, 2022 READ IT HERE

The state is reviving its campaign to lower some of the country’s highest rates for hospital services. Denver hospitals claimed that their billions in reserves enabled them to deal with Covid. But “most hospitals increased their reserves during the pandemic instead of spending down their rainy-day funds” due to $1 billion in federal stimulus money and “a roaring stock market delivering gains on investment revenue.”

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SINGLE PAYER LINKS #252

Posted 15 APR 2022

Mariah Timms, “‘Zero regrets about telling the truth’: Ex-nurse RaDonda Vaught speaks out ahead of guilty verdict,” The Tennessean, Mar 25, 2022 READ IT HERE

Not specifically single-payer-related, but important: a nurse was convicted of “criminally negligent homicide” for administering the wrong medication to a patient resulting in death. She quickly admitted to the mistake, and there was never any question that she intended to cause harm. Is this how we should react to medical errors? Will this help our nurse shortage? Will people who commit errors readily admit them in the future or cover them up to avoid prison? Is the problem a “criminally negligent” nurse or industry conditions?

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Dana Kellis, “I’m a former hospital administrator; prosecuting RaDonda Vaught may worsen safety,” The Tennessean, Mar 25, 2022 READ IT HERE

The author argues that Vaught’s trial will erode patient safety for four reasons: errors are “systemic” because hospitals emphasize cost efficiency over safety; raising nurses’ fear levels will make them focus on personal liability rather than patient care; nursing, already a dangerous profession, just got a lot worse; no one will ever self-report again. “By instilling severe penalties for those whose errors are discovered, the chance that errors will be appropriately addressed becomes even more remote.”

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Brett Kelman & Hannah Norman, “Why nurses are raging and quitting after the RaDonda Vaught verdict,” Kaiser Health News/NPR, Apr 5, 2022 READ IT HERE

Stressed nurses say that the “pressure cooker of pandemic-era health care” makes medical errors more likely. The demoralizing verdict will further thin the ranks. “On TikTok, videos with the #RaDondaVaught hashtag totaled more than 47 million views.”

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Clarissa Donnelly-DeRoven, “NC rural hospitals with worst financials are in poorer, more diverse counties,” North Carolina Health News, Mar 30, 2022 READ IT HERE

Logical: in our healthcare model, poor communities will have poor hospitals. If medical care is a business based on what’s profitable, rural areas with no money will get fewer services even though rural populations tend to be older and sicker. Includes discussion of a curious concept related to urban imbalances: “medical gentrification” in which hospital expansion itself pushes long-term residents out of an area in favor of higher-income newcomers.

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Katheryn Houghton, “The pandemic exacerbates the ‘paramedic paradox’ in rural America,” Kaiser Health News/USA Today, Apr 7, 2022 READ IT HERE

The paradox: rural residents need paramedics the most and have the fewest. Most EMTs prefer urban settings instead of rural jobs that mean long drives, constant calls, rudimentary hospitals, and pay scales dependent on poor municipalities, i.e., low. “21 of Montana’s 56 counties don’t have a single licensed EMS paramedic.”

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Kendall Crawford, “A lack of EMTs in Iowa leads to less stable care for rural residents,” Iowa Public Radio, Apr 6, 2022 READ IT HERE

“Nationwide, emergency medical services are seeing high rates of turnover for emergency service technicians and paramedics—with an average of 20 to 30 percent leaving annually.” The problem can set off a domino effect as communities come to rely more on larger hospitals, further impoverishing their rural counterparts. Meanwhile, 911 calls are rising by 20% per year.

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Mohana Ravindranath, “Health systems are using machine learning to predict high-cost care. Will it help patients?” STAT, Apr 13, 2022 READ IT HERE

A technocratic approach to “high utilizers” (i.e., sick and therefore costly patients) and their needs aimed at getting costs down by identifying “patients at highest risk of being readmitted to the hospital, which can rack up more big bills.” Improving care is a worthy goal that may or may not be served by the emphasis on savings. “In one study, researchers found that certain factors like dropping out of high school or being diagnosed with schizophrenia were linked to frequent—and expensive—visits. Another analysis suggested that lack of income was strongly linked to homelessness, which in turn has been linked to costly psychiatric hospitalizations.” They needed a computer to figure out that?

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Ricardo Alonso-Zaldivar, “COVID pandemic’s end may bring turbulence for US health care,” Associated Press, Mar 31, 2022 READ IT HERE

The cumbersome U.S. health system was temporarily more generous and flexible because of the Covid emergency, so now it’s time to restore the status quo. An estimated 15 million Medicaid recipients will have to scramble for coverage, telehealth rules may change, and reimbursements for doctors and hospitals will go back to the unlovely pre-Covid normal. Given our uniquely labyrinthine way of doing health, chaos may ensue. Ergo, the end of free Covid tests are the least of it. Medicare now pays hospitals 20% more for Covid care, but only while the official “emergency” lasts.

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Gerard Vitti, “Averting the looming purge of people from Medicaid,” STAT, Apr 8, 2022 READ IT HERE

During peak Covid, the Federal Government upped reimbursements to states to encourage Medicaid sign-ups in exchange for states agreeing not to kick anyone off. Once the emergency is declared over, the funds will dry up, and the de-enrollments begin. “The federal government is calling on states to implement the change gradually over a year’s time so that people who become ineligible can be seamlessly transferred to a subsidized insurance program that states run through their health exchanges. The reality is that the change will be anything but orderly.” Punitive states that hate Medicaid in the first place will be delighted. “Redetermination” (Medicaid renewal) processes are notoriously complex.

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Bram Sable-Smith & Rachana Pradhan, “Patients’ perilous months-long waiting for Medicaid coverage is a sign of what’s to come,” Kaiser Health News/NPR, Apr 4, 2022 READ IT HERE

“Missouri had nearly 72,000 pending Medicaid applications at the end of February and was averaging 119 days to process one, more than twice the maximum turn-around time of 45 days allowed by federal rules.” Another way to sabotage the popular will after Missourians voted to expand Medicaid. Perhaps the post-emergency culling of Medicaid rolls will be handled more efficiently.

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Julie Appleby, “ACA sign-ups for low-income people roll out amid brokers’ concerns about losing their cut,” Kaiser Health News, Apr 5, 2022 READ IT HERE

Why would health insurers not want brokers out there aggressively signing up new clients? Turns out that the “special enrollment season” tends to attract sicker patients, which was why the industry opposed it. In addition, those soon to be kicked off Medicaid, i.e., unprofitable patients, also will be looking for ACA alternatives.

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Sharon Klahr Coey, “HHS is investigating how consumers are marketed accelerated approval drugs,” Fierce Pharma, Mar 29, 2022 READ IT HERE

The backlash to the Aduhelm debacle is putting the spotlight on accelerated approval through which the FDA allows a Pharma product to get onto the market with fewer barriers. “Most patients probably assume the drug they’ve been prescribed has gone through a long and arduous process before getting that all-important FDA green light.” But often it hasn’t, and the drug’s marketers are in no hurry to tell consumers. HHS will study how patients told to take the drugs understand this nuance. But are consumers the underlying problem?

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Pam Belluck, “Inside a campaign to get Medicare coverage for a new Alzheimer’s drug,” New York Times, Apr 6, 2022 READ IT HERE

An account of the deep-pocketed Alzheimer’s Association’s efforts to restore Medicare reimbursement for Aduhelm. The Association “with revenue of about $400 million, is highly influential in the Alzheimer’s field: it runs an international conference, provides research grants and publishes a journal.” Note the next two articles that take opposing views on the HHS decision to restrict Aduhelm reimbursement to ongoing clinical trials.

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John N. Mafi & Catherine Sarkisian, “Medicare got it right: Unproven Alzheimer’s drug would have threatened the financial stability of 60 million Americans,” STAT, Apr 8, 2022 READ IT HERE

The authors, who work in the Alzheimer’s field but not for drug companies, endorse the decision to sharply restrict coverage of Aduhelm. “Historically, Medicare’s coverage decisions have required health services to be ‘safe and effective.’ Aduhelm fails on both counts.” Also, “the drug’s long-term toxicities remain unknown” while trial participants had very high rates of brain swelling (41%).

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Dennis J. Selkoe & Jeffrey Cummings, “CMS made the wrong decision on Aduhelm. But there might be a silver lining,” STAT, Apr 9, 2022 READ IT HERE

These opinion columns are so predictable it’s boring. Supporters of government funding for the Biogen drug, which the FDA’s own experts rejected, invariably are Pharma-funded. “Selkoe . . . has consulted for Eisai. Cummings has consulted for [Biogen] and Lilly, Eisai, and Roche, which are developing anti-Alzheimer’s monoclonal antibodies.”

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Caitlin Owens, “Medicare blockbusters’ list prices more than doubled since launch,” Axios, Apr 6, 2022 READ IT HERE

“In 2011, Johnson & Johnson’s Xarelto entered the [statins] market, and Bristol Myers Squibb and Pfizer’s Eliquis followed it in 2013” at more than $200 for a month’s supply. Both now cost over $500/mo. Medicare spent $46 billion on these two drugs over a six-year period. PBMs are taking a big chunk though no one knows how large. “Finger-pointing by various industry players obfuscates who wins in this scenario.”

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Yanira Cruz, “Mark Cuban’s online pharmacy exposes the real sharks in the pharmaceutical industry,” Pittsburgh Post-Gazette, Apr 14, 2022 READ IT HERE

“To lower drug costs, cut out the middlemen in the pharmaceutical supply chain, namely Pharmacy Benefit Managers (PBMs). More than half of every dollar spent on drugs in the U.S. went toward supply chain middlemen.” Cruz, CEO of the National Hispanic Council on Aging, points to Mark Cuban’s Cost Plus Drug Company, which charges a mere 15% flat markup for all pharmaceuticals, as a way forward. I don’t see the catch, if there is one. Does anyone have a contrary view?

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Orion Rummler, “‘Leaving victims with the bill’: Sexual assault survivors are often charged hundreds of dollars for rape kits,” The 19th, Apr 6, 2022 READ IT HERE

Beyond Belief Dept: sexual assault survivors are sometimes charged for a rape kit, around $350. “The Violence Against Women Act requires states to bear the cost of rape kit exams, but hospitals don’t always know that or have the right people to work with victims.” Also, “survivors are often charged for other forms of medical care during their hospital visit. Most states do not cover those additional services—like X-rays, pregnancy tests, MRIs, STI testing, prescriptions, ambulance fees and additional doctor’s visits.” Such charges can even endanger them if the perpetrator is a family member and sees the bill.

“COVID-19 early treatment: real-time analysis of 1,660 studies,” undated. READ IT HERE

“Analysis of 40 COVID early treatments, database of 673 treatments. 72 countries have approved early treatments.” Not an article but a fascinating chart (attached) listing all the known drugs that have ever been tested with the numbers of studies & total patients studied for each, how robust the data is, and the relative risk reductions found in meta-analyses. The red circles indicate which of the drugs have been approved for use by clinicians—each and every one is an expensive pharmaceutical product, regardless of where they fall in the chart of utility and effectiveness. Commentator: “Remember, the asymmetry of standards, media coverage, and censorship that has been applied to the Big Pharma drugs vs. dozens of other cheap drugs and supplements,” especially by reporters on The Science™ beat.

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SINGLE PAYER LINKS #251

Posted 8 APR 2022

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Sharon Zhang, “Bernie Sanders calls for the cancellation of all medical debt,” Truthout, Mar 22, 2022 READ IT HERE

Bernie said medical debt shouldn’t exist, so let’s cancel it rather than jiggle with “grace periods” and exceptions like those the three credit reporting agencies have announced. “‘Medical debt’ and ‘Medical bankruptcy’ are two phrases that should not exist in the United States of America,” said Sanders. But that would mean discharging $140 billion-worth of pre-pandemic bills, which is a lot of yachts.

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Nicholas Florko, “Califf admits controversy over FDA’s Alzheimer’s drug decision impacted experts’ trust in the agency,” STAT, Mar 31, 2022 READ IT HERE

“It’s pretty clear that the controversy around this has temporarily impacted the trust in the FDA,” says Robert Califf, who added the modifier “by people who pay attention to these things,” i.e., not the general public who presumably remain fully bamboozled. Perhaps Califf hasn’t noticed the ginormous boost to the anti-vax movement experienced in the last two years due to decisions like Aduhelm and other forms of governmental ineptitude and prevarication.

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Rachel Cohrs, “‘A slow-moving glacier’: NIH’s sluggish and often opaque efforts to study long Covid draw patient, expert ire,” STAT, Mar 29, 2022 READ IT HERE

Although Congress gave the NIH over a billion dollars to study “long Covid” in 2021, not much has happened yet. “Critics charge that [the NIH] is taking on vague, open-ended research questions rather than testing out therapies or treatments.” Given the potential that millions of people will be struggling with debilitating illness for decades, you’d think someone would feel the same sense of urgency that we see in, for example, getting people back into restaurants and offices.

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Abigail Kramer, “Cuomo set out to ‘transform’ mental health care for kids. Now they can’t get treatment,” The City/ProPublica, Mar 28, 2022 READ IT HERE

Under a 2014 plan announced by Gov. Cuomo, New York eliminated a third of state-run psychiatric hospital beds for children. The promise was that the money saved would be shifted to “community-based and outpatient mental health programs that were supposed to prevent kids from needing to be hospitalized in the first place.” As so often occurs, the part related to cuts proceeded while the alternative care part fell short. Mental health ER visits “remain high because kids still can’t get into community-based mental health programs before they end up in crisis.” Among the problems: low reimbursement rates, leading many providers to refuse insurance; low pay/high turnover at outpatient clinics; shrinking federal dollars replaced by block grants that states can spend however they choose. “In many ways, the problems come down to money.” Good insight into the system that fails people like the subway shovers; the state now may move to reinstate some long-term psych beds, at least for adults.

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Robert King, “CMS finalizes 8.5% rate hike for Medicare Advantage, Part D plans in 2023,” Fierce Healthcare, Apr 4, 2022 READ IT HERE

Despite criticisms that MA plans “engage in risk adjustment tactics such as up-coding to increase unnecessary diagnoses and glean overpayments,” CMS [Center for Medicare & Medicaid Services] said it wouldn’t touch coding practices while authorizing a succulent boost for them.

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Wendell Potter, “Biden Admin gives insurers big pay raise,” Tarbell, Apr 6, 2022 READ IT HERE

“Insurers’ new cash cow is the federal government’s Medicare program, which has become increasingly privatized. Investors were so pleased that they rushed to buy shares of Anthem, Centene, Cigna, Humana, and UnitedHealth Group,” all big MA players. Shares of the biggest, UnitedHealth, hit some $526, “around $500 a share more than its value when Congress passed the Medicare Modernization Act in June 2003.” Recall next time discussion of the dire finances of the Medicare Trust Fund comes up.

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Matt Stoller, “The red wedding for rural pharmacies,” BIG, Mar 28, 2022 READ IT HERE

PBMs (Pharmacy Benefit Managers) go ballistic at the threat to their successful grifting i.e., extracting a huge slice of the cost of drugs in their role as middlemen pushing paper around. The phrase “red wedding” comes from a GOT episode in which one set of crazed thugs massacres another at a jolly peacemaking feast. “Because of an exemption from anti-kickback laws, PBMs don’t use their bargaining power to reduce consumer prices. Instead, they force pharmaceutical firms to compete over who will give the PBM the biggest kickback.” Prices go crazy, everyone gets a cut, and patients and the government pay while independent pharmacies are strangled. Worth reading in full, especially for the patient testimonies.

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Jessica Wapner, “Cancer patients are at high risk of depression and suicide, studies find,” New York Times, Mar 28, 2022 READ IT HERE

“The psychological distress brought on by cancer is significant for many patients,” says the author, citing the impact of surgery and lengthy treatments with radiation or chemotherapy. However, she doesn’t ask whether bankruptcy-inducing costs might have anything to do with suicidal ideation.

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Lev Facher, “‘All the shrapnel that’s in my back’: Defiant Robert Redfield blasts former CDC directors for criticism during Covid-19,” STAT, Apr 5, 2022 READ IT HERE

Boo hoo. Instead of whining, Redfield could have done something useful by returning the fire and highlighting the incoherence, politicization, and incompetence reigning at the CDC.

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Patrick Martin, “The end of COVID-19 testing for the uninsured: The American ruling class doubles down on mass infection,” World Socialist Web Site, Apr 4, 2022 READ IT HERE

The feds have stopped paying for Covid tests for the uninsured. “Some clinics have already started to turn away people without insurance who come to get tested and cannot afford to pay for it.” The Covid spending deal that just squeezed through Congress exclusively covers test supplies, therapies, and vaccines, not procedures. If there’s a new Covid wave, we’re on our own.

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Rachana Pradhan & Victoria Knight, “Big Pharma is betting on bigger political ambitions from Sen. Tim Scott,” Kaiser Health News/Post & Courier [SC], Mar 28, 2022 READ IT HERE

Extracted from KHN’s database on political contributions. What’s remarkable is how cheap it is to buy politicians given the billions they can then shovel to your company. “Scott was the top recipient of pharma campaign cash in Congress during the second half of 2021, receiving $99,000.” That’s couch lint. Scott, an African-American Republican considered presidential timber, will release his memoir this summer entitled, “America, A Redemption Story.” He often partners with Pharma’s (D) darling, Kyrsten Sinema of Arizona.

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Alex Thompson, “A Google billionaire’s fingerprints are all over Biden’s science office,” Politico, Mar 28, 2022 READ IT HERE

“A foundation controlled by Eric Schmidt, the multi-billionaire former CEO of Google, has played an extraordinary, albeit private, role in shaping the White House Office of Science and Technology Policy over the past year. His charity arm, Schmidt Futures, indirectly paid the salaries of two science-office employees.” Should be illegal but given the Bill Gates precedents, it won’t be. Schmidt sits on a bunch of tech companies that stand to benefit from government policy decisions. BTW, the resignation of top White House science advisor Eric Lander over accusations of office bullying may well be related to an employee’s objection to Schmidt’s role.

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Amol Navathe, Risa Lavizzo-Mourey & Joshua Liao, “How to fix the two-tier U.S. health payment system,” STAT, Mar 29, 2022 READ IT HERE

How the U.S. pays for health care is neither efficient nor fair,” say the authors, because publicly funded programs—for poorer people—reimburse at lousy rates compared to private insurance. Their solution? Rejiggered “value-based” payment arrangements instead of the fee-for-service model. Not surprisingly, that ignores the role of for-profit intermediaries. It’s amazing the complicated tweaks experts come up with while averting their gaze from that elephant on the sofa.

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Elaine S. Povich, “Rideshare riders could get stuck with medical bills in a crash,” Stateline (Pew Charitable Trust), Mar 29, 2022 READ IT HERE

A chef was injured in a vehicular crash and “his life has never been the same. Nor has his pocketbook” due to a loophole in Colorado’s rideshare insurance laws that left him on the hook for six-figure bills. Not all states make sure crashes involving Uber or Lyft rides are covered. One more thing to worry about!

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Gretchen Morgenson, “Doctor fired from ER warns about effect of for-profit firms on U.S. health care,” NBC News, Mar 28, 2022 READ IT HERE

A doctor canned after criticizing care practices at his ER “isn’t an anomaly” as more emergency departments are staffed by for-profit companies. Private equity firms, such as KKR’s TeamHealth and Blackstone Group’s Envision Healthcare, now control about 40% of U.S. emergency departments. Companies use the Willy Sutton theorem since ERs are where the big money is even though “33 states have laws preventing nonphysicians from influencing clinical decisions.” So where are the lawsuits? Regulatory enforcement? Whistleblowers are easily iced if the state is corrupt enough. The DoJ has pursued some of these scammers but then lets them keep participating in federal insurance programs under “corporate integrity” settlements.

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David U. Himmelstein, Steffie Woolhandler, Adam Gaffney, Don McCanne, John Geyman, “Medicare for All is not enough,” The Nation, Mar 31, 2022 READ IT HERE

The insidious dangers of concentration in the health sector: “Medicare for All would not, by itself, address the ill effects of the corporate ownership of physicians’ practices, hospitals, and other health care institutions. Avaricious firms—both for-profit and non-profit—are gobbling up the vital resources needed for care, gaming even traditional Medicare’s payment incentives, and prioritizing profitability over patients’ and communities’ needs. Hence, health care reform must address who owns health care, not only who pays the bill.” Thought-provoking.

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Rebecca Grapevine and Andy Miller, “State hits Anthem with whopping fine for insurance violations,” Georgia Health News, Mar 29, 2022 READ IT HERE

The state was “inundated with complaints about Anthem from individuals, from doctors, hospitals and others” for things like false listings of in-network providers, failures to list those who were contracted providers, and payments delays so lengthy that staff layoffs resulted. Anthem = Blue Cross-Blue Shield and is Georgia’s largest insurer. “Earlier this month, Anthem announced that it is changing its name to Elevance Health.” Problem solved!

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“UnitedHealth signs $5.4b acquisition deal for home health biz LHC,” PYMNTS, Mar 29, 2022 READ IT HERE

Big push into home care by the behemoths. UnitedHealth is also being sued by an antitrust unit at the DoJ over another $13 billion deal seeking to acquire patient data from a health tech firm. “LHC operates in 37 states and cares for more than 500,000 patients every year. Many of its home healthcare and hospice programs are operated in partnerships with hospital networks. Humana, UnitedHealthcare’s biggest competitor, recently acquired a 60% stake in Kindred at Home for roughly $5.7 billion.” Gigantism proceeds as planned.

SINGLE PAYER LINKS #250 - Posted 30 MAR 2022

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Joanne Kenen, “Joe Biden’s never-ending campaign to build on Obamacare,” Politico, Mar 23, 2022 READ IT HERE

Biden distanced himself from Bernie Sanders and M4A by promising to “build on the existing law,” get more people into Obamacare, and reduce costs both to individuals and overall. Covid enabled him to do some of the former, but “his efforts have since stalled out.” Assuming that Biden really meant what he said, key Democrat saboteurs protected the industries while Biden continued to “fight for” (and lose) his professed goals. Expanded ACA coverage subsidies are set to expire at the end of 2022, hitting right around the midterms.

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Julia Rock & Andrew Perez, “The corporate threat in Dems’ must-win Senate race,” The Lever, Mar 29, 2022 READ IT HERE

Democrat Erik Smith runs super-PAC Penn Progress when he isn’t being a spokesperson for a healthcare industry front group. Penn is cranking up a blizzard of ads attacking Senate candidate John Fetterman, Pennsylvania’s lieutenant governor, as a “socialist” who supports a “government takeover of health care.” Smith “helped launch the Partnership for America's Health Care Future (PAHCF), an anti-Medicare for All front group backed by health insurers, drug companies, and investor-owned hospital chains.” Democrat playbook: promote corporate shills like Manchin and Synema, attack progressives, then cry, “Our hands are tied!”

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Michael Rainey, “Obamacare turns 12 with record enrollment but trouble ahead,” Fiscal Times, Mar 23, 2022 READ IT HERE

“Clouds on the horizon: A record 15.5 million people signed up for health care through the ACA marketplaces in 2022 [because] Democrats provided additional subsidies to reduce the cost of coverage and expanded the sign-up window via the $1.9 trillion American Rescue Plan. The White House wants to make the subsidies permanent, but the Build Back Better bill that contained such a provision has stalled in Congress.” That pesky Manchin guy again.

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Austin Ahlman, “With local Oregon Democrats endorsing his challenger, Rep. Kurt Schrader starts campaigning against himself,” The Intercept, Mar 24, 2022 READ IT HERE

Schrader did Pharma’s dirty work in kaboshing drug price-control measures in the BBB, but now, due to a primary challenge, he has to erase all that asap. His campaign ads say he is “making sure Medicare can negotiate lower drug prices and leading the fight to get big money out of politics” with no sense of irony. Four of the six county Democrat organizations voted overwhelmingly to endorse his opponent. Schrader first got into Congress by using his family’s large fortune from pharmaceutical profits.

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Alice Miranda Ollstein, “With Democrats’ health agenda stalled, lawmakers turn to insulin,” Politico, Mar 23, 2022 READ IT HERE

A quick fix on insulin is pushed along to make up for Biden’s failures on substance in healthcare financing. Democrats hope the “narrower policy fix will bolster the midterm fortunes of key members.” If you think the underlying problem is nothing but poor messaging, this makes sense.

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Erica E. Phillips, “Lawmakers weigh ‘anti-competitive’ practices in health care,” CT Mirror, Mar 16, 2022 READ IT HERE

Another state-led attempt to rein in healthcare costs in the face of federal torpor. This one is a brake on anticompetitive contracts forced on insurers by ever larger hospital conglomerates. Connecticut’s health sector now has two large and expanding hospital cartels, Hartford HealthCare and Yale New Haven Health. A template for the bill, provided by the National Academy for State Health Policy (READ IT HERE

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Darrel Rowland, “As a Midwestern state’s hospitals continue to merge, some experts worry about higher prices, quality of care,” Columbus Dispatch, Mar 22, 2022 READ IT HERE

Hospital consolidations continue in Ohio, where seven medical systems now run more than 40% of hospitals in the state. “The state offers a glimpse into the national trend of health care mergers and acquisitions.”

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Daniel Payne, “The South’s health care system is crumbling under Covid-19. Enter Tennessee,” Politico, Mar 19, 2022 READ IT HERE

Long-form piece on how our patchwork system ravages rural health services. Hospitals close, residents are forced to drive far away even for emergency care, often die first, and no longer trust their providers. Counties with shuttered hospital have the lowest vaccination rates, and the epidemic of closures continues since sparsely populated areas are unprofitable. One doctor says: “We have a residency program in Guyana on the coast of South America. These are the types of things that [I see] for the Amerindian population that are coming out of the villages and need a canoe to get to a hospital.”

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“Attorney General’s office had ‘great concerns’ Mission-HCA deal was rigged ‘from the beginning,’” Asheville Watchdog, Mar 20, 2022 READ IT HERE

Shady dealings in a big hospital acquisition. But the A-G can’t stop the merger because NC state law doesn’t empower him to do so.

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Jon Jureidini & Leemon B. McHenry, “The illusion of evidence-based medicine,” BMJ, Mar 16, 2022 READ IT HERE

“Evidence-based medicine has been corrupted by corporate interests, failed regulation, and commercialisation of academia. The release into the public domain of previously confidential pharmaceutical industry documents has given the medical community valuable insight into the degree to which industry-sponsored clinical trials are misrepresented. . . . Industry suppresses negative trial results, fails to report adverse events, and does not share raw data with the academic research community.” And, they conclude, once-independent universities have become corporate tools. The whole (short) paper is worth a read and is quite an indictment.

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Jeanne A. Markey & Raymond M. Sarola, “Private equity, health care, and profits: It’s time to protect patients,” STAT, Mar 24, 2022 READ IT HERE

Private equity deals in the health field tripled in value during the 2010s and now amount to $750 billion worth of assets such as hospitals, nursing homes, travel nurse companies, and behavioral health programs. Important point for the lay observer: private equity fund-runners use OPM (Other People’s Money), so they cash in on financial manipulation via debt and have no permanent stake in the businesses they run (and ruin). Phony claim practices are almost baked in given the incentives for quick profits.

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Caitlin Owens, “Private equity’s pandemic-era health care push,” Axios, Mar 23, 2022 READ IT HERE

Private equity firms invested nearly $70 billion in the life sciences and medical device industries last year, a sharp increase from $25 billion in 2020.

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Peter S. Arno & Kathryn Ardizzone, “March-in opponents are wrong: The US Government can protect the public from unreasonably high drug prices,” Common Dreams, Mar 24, 2022 READ IT HERE

The government can “march-in” on (seize) a federally-funded invention (like a drug) if the for-profit owner is price-gouging. “That can happen to assure that the invention’s benefits are . . . available to the public on reasonable terms.” The authors use the example of cancer drug Xtandi, developed with NIH and U.S. Army money, that now sells for $189,000 a year in the U.S., five times what it costs elsewhere.

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Dave Lieber, “Dear Watchdog, how does GoodRx knock down the price so steeply for many drugs at the pharmacy?” Dallas Morning News, Feb 24, 2022 READ IT HERE

The convoluted ways a patient might stumble upon a big discount for their drugs. The author finds that a discount card from GoodRx reduced a buyer’s medication cost by 85%. The coupon only works at favored pharmacies of its PBM partners, which get the sale and peel off a percentage of the purchase price for GoodRx. “In other industries, these payments could be called illegal kickbacks. But in the early 1990s, Congress exempted drug companies’ rebates from federal anti-kickback laws.”

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Jesus Jiménez, “Viatris agrees to settle EpiPen antitrust litigation for $264 million,” New York Times, Feb. 28, 2022 READ IT HERE

Viatris (formerly Mylan) settled for $264 million over allegations that the company engaged in “an illegal scheme to monopolize the market for epinephrine auto-injector devices known as EpiPens.” The lawsuit arose after Mylan raised the price of two EpePens from $100 to $608 overnight. EpiPens are made by the national heroes at Pfizer, which settled earlier for another $345 million.

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Pien Huang, “COVID treatments like Paxlovid to be prescribed on the spot in some pharmacies,” NPR, Mar 8, 2022 READ IT HERE

Everything for expensive, branded Pharma products; nothing for cheap, off-patent generics.

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Adam Taylor, “Why Covax, the best hope for vaccinating the world, was doomed to fall short,” Washington Post, Mar 22, 2022 READ IT HERE

Why was the wealthy West unable to get vaccines to everyone in the world even while some officials recognized the common threat posed by an infectious disease? Did the initiative’s backers “badly midjudge the desperation and myopia of wealthier countries, which raced to manufacturers to snatch up doses for their own people”? Or perhaps they were stuck in their commercial-medicine mindset, insisting that “countries should buy doses rather than seek donated ones” (or produce their own) and holding key early meetings “that excluded officials from the developing world, but included McKinsey & Co., a U.S. consulting firm with close ties to pharmaceutical companies.” Meanwhile, Bill Gates was blocking any move to force technology sharing. What on earth could ever go wrong?

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Julie Appleby, “The case of the $489,000 air ambulance ride,” Kaiser Health News, Mar 25, 2022 READ IT HERE

A cross-country medical flight resulted in that massive bill because it went ahead without prior authorization and was later deemed not medically necessary. BlueCross covered $72,000 in a check to the patient, then three months later demanded the full amount back. As so often happens, when KHN started asking around, the bills disappeared. Can advocacy move in this direction?

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Abdallah Fayyad, “Does anyone actually like their health care plan?” Boston Globe, Mar 21, 2022 READ IT HERE

Answers the industry talking point about how most people like their insurance. “Insured people are more likely to report that they are happy with their health care plan when they’re not actually using it.” The reporter then describes his own trip through Purgatory after a serious illness, including authorization delays, copayments, and overall confusion over the hurricane of bills. “People with insurance have so much trouble navigating and paying for medical services that a fifth of households that make over $120,000 have avoided seeking medical care because of the associated costs.” But Fayyad ignores the state’s fairly advanced exploration of an M4A alternative.

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David Eggert, “Michigan legislature votes to speed health care approvals,” Associated Press, Mar 24, 2022 READ IT HERE

“Michigan insurers that require health providers to get pre-approval to cover treatment would have to promptly respond to doctors’ requests or those requests would be automatically granted.” Another state-led attempt to get action on insurance nightmares as dysfunctional Washington sits on its hands.

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SINGLE PAYER LINKS #249

Posted 23 MAR 2022

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Angela Hart, Rachel Bluth & Samantha Young, “California governor’s big promises on drug prices are slow to materialize,” Kaiser Health News, Mar 4, 2022 READ IT HERE

Newsom’s vow to save big by negotiating bulk drug purchases is stuck because “only a few counties are participating in the program.” (The article doesn’t explain why others aren’t.) The promise that California would manufacture its own generics is still just a nice idea. Meanwhile, next-door Oregon, Nevada, and Washington have formed a joint drug purchasing operation. Why doesn’t California sign on? Drug spending by the state is up 5% so far in Newsom’s term.

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Phil Galewitz, “Medicare Advantage plans send pals to seniors’ homes for companionship—and profits,” Kaiser Health News, Mar 15, 2022 READ IT HERE

New frontiers in cynicism. “Widowed and usually living alone, Gloria Bailey walks with a cane after two knee replacement surgeries and needs help with housekeeping. So, she was thrilled last summer when her Medicare Advantage plan, SummaCare, began sending a worker to her house in Akron, Ohio, to mop floors, clean dishes, and help with computer problems. Some days, they would spend the two-hour weekly visit just chatting at her kitchen table.” Heart-warming until you realize the goal is to “help the plans collect more money from Medicare by persuading members to get annual wellness exams, fill out personal health risk assessments, and undergo covered health screenings.” Bailey is one of thousands of seniors served by Papa Inc., which sends around “Papa pals” to MA enrollees to look for “health issues that may earn higher reimbursement rates from Medicare.” Papa pals.

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Julia Kollewe, “‘Betting against the NHS’: £1bn private hospital to open in central London,” The Guardian, Mar 17, 2022 READ IT HERE

Here comes two-tier healthcare for the U.K. “A new 184-bed private hospital is about to open in London, the second-largest in the capital, where patients will enjoy views of Buckingham Palace and will be treated by doctors understood to be paid up to £350,000 a year. It provides a stark contrast with the NHS, which is buckling under the strain of record waiting lists, backlogs for cancer care and routine operations and a resurgence of Covid cases that is putting pressure on wards and staffing.” As wealthy Brits line up to get boutique care at the new London branch of the Cleveland Clinic, they will be even less inclined to boost spending on second-tier care for everyone else. The private health sector is “booming” in the U.K. as a series of governments have imposed austerity on the NHS and juicy private-sector salaries pull providers away from it.

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Patricia Kime, “These 17 medical centers would close and more than 30 built or replaced under VA plan,” Military.com, Mar 14, 2022 READ IT HERE

The plan to close 17 VA hospitals and shift services to 30 beefed up ones is drawing howls from “areas with diminishing veteran populations.” Politicians from those states, both reds and blues, are demanding that socialist healthcare for veterans continue as is. The plan also includes new medical centers and major upgrades, so the available pork should lead to massive food fights. Also, there is pressure to move services to non-VA facilities. Significantly, the pro-privatization Concerned Veterans for America praised the recommendations.

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“Zients failed and the world paid the price,” Public Citizen, Mar 17, 2022 READ IT HERE

Nader’s group says the U.S. promised to be the “vaccine arsenal” for the world—but isn’t. “The Zients-led Covid response refused to challenge Big Pharma’s monopoly control over technologies that relied crucially on public support.”

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John P. Moore & Luciana L. Borio, “Covid-19 vaccine policy should be made by public health experts, not company executives,” STAT, Mar 22, 2022 READ IT HERE

But Pharma billionaires are the new public health experts, didn’t you know? The old-fashioned authors say that instead of letting Pfizer’s or Moderna’s CEOs tell us what we should do (and contradict each other), maybe we could get back to advice from neutral scientists if any still exist. They note that Biden’s science advisors overruled recommendations from FDA and CDC committees last year on shot #3. When the vaccine hammer is the only tool in the kit, Pharma bosses always will discover more nails.

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Lisa Jarvis, “Here’s one good way to lower the cost of insulin,” Bloomberg, Mar 10, 2022 READ IT HERE

Civica Rx’s plan to sell diabetes medicines at transparent prices “will apply needed pressure to repair a dysfunctional drug-pricing system.” Seems like a better approach than Biden’s quickly fading proposal to cap insulin costs at $35 a month for users, which would not affect the price paid by someone else in the system. Civica’s plan is to produce cheap, generic insulin in India and ship it back home.

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Bruce Japsen, “Blue Cross health insurers back nonprofit drug maker’s cheaper insulin,” Forbes, Mar 3, 2022 READ IT HERE

Insurers sign on as federal action remains rhetorical. Of 8 million insulin users in the U.S., one quarter say they skip or reduce doses due to cost.

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Julie Steenhuysen, “Biogen publishes Alzheimer’s drug data in lesser-known journal,” Reuters, Mar 16, 2022 READ IT HERE

Biogen dropped its dubious data on the Alzheimer’s drug that was rammed through FDA approval against expert advice into a minor journal where one of its authors is editor-in-chief.

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“Who changed the scientific conclusions of a paper that could have saved millions? At last, we may have a name,” FLICC Alliance Community, Mar 8, 2022 READ IT HERE

FLICC are promoters of ivermectin. Here, they narrate a tale of interference in scientific publication that severely hampered consideration of IVM’s utility for Covid. For example, “just days before its publication, the paper appeared on a pre-print server with its conclusions changed. Instead of concluding that ivermectin should be rolled out globally, it now concluded that more studies were needed.” Who stuck his spoon in to alter the report? Professor Andrew Owen, a U.K. pharmacology professor “prolific in the art of receiving money from pharmaceutical companies.” Designer drugs with a hefty price tag get a fair hearing; cheap, off-patents don’t.

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Daniel Horowitz, “Ivermectin being confiscated by customs while Chinese fentanyl pours through the mail,” Blaze Media, Mar 6, 2022 READ IT HERE

“I’m getting numerous complaints from podcast listeners that they are having their [IVM, doxycycline, and even zinc!] packages confiscated by customs and the FDA. Meanwhile, Chinese fentanyl pours through the mail.” Demonization of IVM and other cheap drugs has led to this.

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Wendell Potter, “Underinsurance,” Tarbell, Mar 18, 2022 READ IT HERE

Potter has a unique voice given his former role as a shill for the insurance companies, a sin for which he is in permanent atonement mode. “I’d like to introduce you to a couple of former colleagues of mine who played key roles in making sure you pay a lot out of your own pocket before your coverage kicks in.” High deductibles lead people to GoFundMe appeals and general despair. But one of Potter’s former colleagues now makes $11 million a year, so underinsurance works well for some.

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Minyvonne Burke, “Most medical collection debt is about to fall off of consumer credit reports,” NBC News, Mar 18, 2022 READ IT HERE

The three credit reporting bureaus will drop some (not all) medical debt from consumers’ reports based on the finding that about 2/3 of it is due to “acute medical need” and not because people are such deadbeats. Good news. Now, in addition to not counting the medical debt, how about abolishing it entirely?

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Christina Jewett, “The loophole that’s fueling a return to teenage vaping,” New York Times, Mar 8, 2022 READ IT HERE

The FDA’s crackdown on Juul was supposed to be the end of marketing to teens, but the industry has found ways around the new regs. “Since early 2020, overall e-cigarette sales are up nearly 50 percent to about 22 million units per month.” School bathrooms are vaping havens all over the country as 11% of high school students, who largely shun cigarettes, now consume nicotine that way.

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David Armstrong & Ryan Gabrielson,” St. Jude fights donor’s families in court for share of estates,” ProPublica, Mar 21, 2022 READ IT HERE

High-pressure fund-raisers court donors, then slug it out in court with heirs in “long and costly legal battles over wills.” The hospital made famous by Danny and Marlo Thomas raises billions for its 73-bed hospital in Memphis and sucks in charitable donations from all over the country.

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Marisa K. Kowling, Jesper Ke & David Velasquez, “A ‘new normal’ can’t mean the same old health insurance,” Newsweek, Mar 16, 2022 READ IT HERE

“Millions of Americans fall into the Medicaid coverage gap: making too much to qualify for Medicaid in their state but not enough for private health insurance premium subsidies.” Now that the emergency is officially over, special subsidies for this group are set to disappear.

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Devi Shastri, “‘Huge number’ in Wisconsin to lose Medicaid as COVID emergency ends,” Milwaukee Journal Sentinel, Mar 15, 2022 READ IT HERE

Kicking people off Medicaid was halted during Covid, now will restart as the pressure on Biden is off. In other news, Vladimir Putin is to receive the Nobel Prize in Medicine for making Covid disappear.

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“Arizona to resume disenrolling people from Medicaid program,” Associated Press, Mar 15, 2022 READ IT HERE

A half million Arizonans will have to re-qualify.

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Lexi Krupp, “Vermont’s largest hospital system and a massive insurance company are deadlocked. Thousands of patients are caught in the middle,” Vermont Public Radio, Mar 16, 2022 READ IT HERE

As the U. Vermont system gobbles up smaller hospitals and demands higher reimbursements from UnitedHealthcare, patients have to drive hours to alternative providers, adding expenses for gas, sitters, and even hotels.

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Dan Weissmann, “How to avoid surprise bills—and the pitfalls in the new law,” Kaiser Health News, Mar 16, 2022 READ IT HERE

More helpful tips: Don’t ask, “Do you take my insurance?” Instead, ask, “Are you in my insurance plan’s network?” That’s because your carrier may have a number of plans, so the answer to the two questions may differ. Also, be careful of a clinic or hospital staffer handing you a form called the “Surprise Billing Protection Form” because you may be waiving your protections from the new law. A corrected title would be: “I’m Giving Away All of My Surprise Billing Protections When I Sign This Form.” Also, don’t sign on an iPad that doesn’t show the full text of any document. If you are bleeding out and can’t afford to refuse treatment, write “signing under duress” and “Emergency medicine facilities are not allowed to present this form.” Then take a picture of the form with your notes on it. The federal hotline for reporting violations of the No Surprises Act is 800-985-3059. After you’ve done all that, proceed to have your heart attack or whatever.

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Howard A. Selinger, “A doc’s advice on navigating your health insurance,” CT Mirror, Mar 17, 2022 READ IT HERE

A doctor writes: “Here’s my brief and bewildering story” about his kidney stone attack, surgery, and brief hospitalization. The details involve labyrinthine errors and communications chaos. His advice: “Never pay a bill to the provider until you fully understand and accept the reasons for the charges.” His saga shows that our system “can frustrate even the most sophisticated and knowledgeable patient,” i.e., himself. Dr Selinger calls for “persistence and determination” to achieve a similarly happy ending.

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Katrine Bruner, “$700 million in state funding will help Moffitt build massive cancer complex in Pasco County,” WUSF [Tampa], Mar 17, 2022 READ IT HERE

Florida legislators “awarded a total of $706 million to Moffitt Cancer Center over the next 30 years to help the nonprofit build a . . . hub for cancer research, education and patient care.” The project will be named the “Casey DeSantis Cancer Research Program.”

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SINGLE PAYER LINKS #238

Posted 18 MAR 2022

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Eileen Appelbaum & Rosemary Batt, “Envision Healthcare hits the skids,” American Prospect, Mar 14, 2022 READ IT HERE

Finally, some bad news for the cancerous private equity industry: “Creditors have lost confidence in [Envision Healthcare’s] ability to repay its huge debt,” a tidy $5.3 billion of OPM (other people’s money), which it used to vacuum up emergency departments around the country. The business model was to then use surprise billing to gouge patients and insurers alike. When Congress finally reacted to popular outrage about the practice, Envision tanked. Its parent company, however, private equity giant KKR, will jettison the failing parts of the company while keeping its useful assets along with the many fees charged off along the way. Why any of these Wall Street moneychangers are allowed to dictate medical practices remains an open question.

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Jack Johnson, “‘Can’t fool us’: 250+ groups reject Biden rebrand of Trump’s Medicare privatization ploy,” Common Dreams, Mar 8, 2022 READ IT HERE

The Biden Administration’s name-change sleight of hand (from “Direct Contracting” to “ACO-REACH”) “won applause from the healthcare industry” [gasps of surprise]. The non-change change also includes “a superficial nod to equity” and “a no-strings-attached bonus for enrolling vulnerable beneficiaries.”

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Jeff Lagasse, “Cigna company CareAllies participating in CMS’ direct contracting model,” Healthcare Finance, Mar 3, 2022 READ IT HERE

The rebranding by Biden hasn’t affected Cigna’s plans to use DC cum ACO-REACH to expand its subsidiary, CareAllies. Cigna said its business will “improve quality of care while further reducing expenditures for Medicare beneficiaries, especially those with complex, chronic conditions.” In other words, we promise to spend lots of money on expensive patients.

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Susan Jaffe, “Seeking to shift costs to Medicare, more employers move retirees to Advantage plans,” Kaiser Health News/Fortune, Mar 3, 2022 READ IT HERE

Highlights as an example the New York City move to dump its retirees into MA. The arrangement saves the employer money because the federal capitation payments lower employer (the city in this case) contributions. Meanwhile, beneficiaries face restricted networks and prior approvals or new fees if they want to stay in traditional Medicare—other ways to “save.”

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Shari Rudavsky, “Indianapolis-based Anthem to change name to Elevance Health,” Indianapolis Star, Mar 10, 2022 READ IT HERE

What’s the sudden passion for renaming one’s company like Alphabet (Google) and Meta (Facebook)? Could it be aimed at shaking off negative associations? The official explanation from Anthem is that “the new name better reflects the broad scope of holistic programs that go beyond health benefits,” followed by bureaucratic boilerplate about “behavioral and social drivers” and “healthy lives.” Anthem used to be called WellPoint Inc., which certainly could benefit from covering its corporate tracks, such as its role in writing the ACA to fit its requirements.

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[No byline], “Humana begins rebrand of Kindred at Home,” Home Care, Mar 3, 2022 READ IT HERE

“Kindred at Home” will become “CenterWell Home Health.” Along with “new interior and exterior signage, . . . employees will receive new uniforms, apparel, and other branded materials to help bring the brand to life,” perhaps in lieu of living wages? Corporate parent Humana is the nation’s no. 2 Medicare Advantage contractor, and CenterWell has more than 200 primary care clinics, expected to grow to 260 by year end.

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Angela Hart, “The demise of single-payer in California trips up efforts in other states,” Kaiser Health News, Feb 28, 2022 READ IT HERE

California Democrats, despite enjoying a huge majority, scared themselves over “taxes” while living patiently with the rickety, expensive, for-profit healthcare system. The article quotes New York advocates about the importance of support from public unions, an ally in the governor’s office, and one state to lead the way.

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Bob Herman, “Workers have to pay more upfront for care, Axios, Feb 25, 2022 READ IT HERE

Employers respond to rising costs by cutting benefits. “The average single worker’s deductible has tripled since 2006, and 30% of all companies now have annual deductibles of $2,000 or more.” For families, it’s more like $5000. How high does it have to go before unions stop resisting single-payer?

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Linda Bonvie & Bill Bonvie, “Rat out your doctor: Biden’s Surgeon General calls on informants to report use of generic drugs,” Rescue, Mar 11, 2022 READ IT HERE

Dr Vivek Murthy issued a booklet a few months ago entitled, “Confronting Health Misinformation” that warned against the serious threat to public health of wrong statements and called for “a whole-of-society effort” to combat it. Now, Murthy is more explicit: he wants us to turn in anyone, including our own doctors, who is guilty of spreading “health information that is false, inaccurate, or misleading according to the best available evidence at the time.” Murthy admits that what is considered false one moment turns out to be true the next, but that doesn’t stop him. He says we should dig through search engines, content sharing platforms, social media, instant messaging systems, and what-have-you to find “research, case studies, data sets, images, data visualizations, interviews, and personal testimonies” about anything not in harmony with the party line du jour. What could go wrong? “Ironically enough, the announcement came on the same day that administration officials were said to be deeply concerned about Russia’s crackdown on what that country was calling ‘fake news.’” So, it’s true that the Ukraine war is all about resuscitating the Soviet Union—it just wasn’t clear where.

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Judith D. Auerbach & Andrew D. Forsyth, “Ignoring behavioral and social sciences undermines the U.S. response to Covid-19,” STAT, Mar 9, 2022 READ IT HERE

The authors say that the exclusive focus on vaccines (and to a lesser extent treatments) reflects the nation’s “biomedicine-centric” coronavirus response strategy that offered “a false assurance that advances in biomedicine—new tests, vaccines, treatments, and the like—will be uniformly accepted, and all individuals will act rationally in their own self-interest.” They point to the lessons from the HIV epidemic, which also involved massive misinformation and eventually led to important insights into how people absorb and apply scientific knowledge—lessons that have been roundly ignored. I would add that the bias in favor of pharmaceutical products over the nuances of human psychology has an obvious monetary foundation.

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Michael McAuliff, “Plan to fix Postal Service shifts new retirees to Medicare—along with billions in costs,” Kaiser Health News/NPR, Feb 25, 2022 READ IT HERE

This bill passed, ending the crazy legal requirement that the USPS pre-fund 75 years of retirement health benefits, which made the service look like a perennial money-loser and softened it up for privatization. In return, it shifts postal retirees from federal health insurance over to Medicare. How long it will be until someone decides they need to be redirected to an MA plan?

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Bob Herman, “Hospitals and doctors hold leverage over employers,” Axios, Feb 25, 2022 READ IT HERE

“The failure of Haven—the joint venture among Amazon, Berkshire Hathaway and JPMorgan Chase—is the most recent example of how employers lack the clout to push back against the market power of increasingly consolidated systems of hospitals, doctors and other medical providers.” Even these three giants couldn’t face down the increasingly concentrated healthcare behemoths.

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Alvin Greenberg, “Stop the Yale acquisition of hospitals,” CT Mirror, Mar 3, 2022 READ IT HERE

Yale New Haven Health’s system includes five hospitals on seven campuses, and it wants to add three more around the state. The only other game in CT is Hartford Hospital, making it easy for the two to boost prices in tandem. “Putting so much of our state’s medical care under a single roof will allow a continual increase in consumer costs. Why wouldn’t Yale increase fees? There is really no incentive to keep costs down.”

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Charlotte Morabito, “Why health-care costs are rising in the U.S. more than anywhere else,” CNBC, Feb 28, 2022 READ IT HERE

Nothing much new, but a couple of startling stats: the United States now accounts for more than 40% of all global health spending, and such spending, which made up 5% of total U.S. GDP in 1960, rose to 20% in 2020.

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Victoria Knight, “Biden’s blanket statement—‘No More Surprise Billing’—doesn’t quite cover it,” Kaiser Health News, Mar 1, 2022 READ IT HERE

“Millions of hardworking Americans will no longer have to worry about unexpected medical bills.” That’s what Biden said, but it’s not quite so simple. The exceptions: emergency ambulance services and services at urgent care centers, hospice, addiction treatment facilities, and nursing homes are not covered. In addition, patients have to be wary of “post-emergency stabilization care,” which has to be in-network even if that means moving the patient to a nearby facility. Finally, “Facilities can ask patients to sign a prior written consent that waives their rights under the No Surprises Act.” Never sign!

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Jamon Jordan, “Detroit had 18 Black-owned and operated hospitals: Why they vanished,” Detroit Free Press, Feb 27, 2022 READ IT HERE

Dr William Ferguson, who attended Michigan’s first racially integrated kindergarten class and was the first African American in the state legislature, could not practice in Detroit’s segregated hospitals. (The practice ended only in 1960.) Eighteen black-owned and -operated hospitals sprang up in Detroit (and 500 nationwide) as a result. Only one is left—Howard University Medical Center in Washington, D.C. Ironically, their demise was caused by the anti-segregation clauses of the 1965 Medicare and Medicaid acts, which forced whites-only hospitals to change their practices—and then, presumably, wipe out the competition.

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Isabelle Taft, “Republican legislators oppose Medicaid expansion, but want federal dollars to pay for prisoner healthcare,” Mississippi Today, Mar 1, 2022 READ IT HERE

“[Mississippi] Republicans have balked at expanding Medicaid but are embracing legislation that would take advantage of the federal program to pay for healthcare for very sick incarcerated people—and likely create a money-making opportunity for nursing homes.” Or to put it another way, keep lots of young, healthy people in prisons for long periods, then shunt them off to the Federal Government when they can’t work and need expensive care. Meanwhile, non-incarcerated Mississippians are kept off Medicaid because the state refuses to expand the program.

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Emily Wagster Pettus, “Mississippi House leaders kill postpartum Medicaid extension,” Associated Press, Mar 9, 2022 READ IT HERE

Don’t get an abortion, but after you have the kid, you’re on your own.

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SINGLE PAYER LINKS #247

Posted 8 MAR 2022

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Physicians for a National Health Program (PNHP), “Physicians to HHS: Rebranding won’t fix Direct Contracting’s fatal flaws,” Feb 24, 2022 READ IT HERE

The Biden Administration kills and zombifies Direct Contracting (DC), now to be known as “ACO REACH.” What is NOT changed is the insertion of a cash-sucking mandible between your medical providers and your wallet. The new/not new scheme also will shovel government funds to useless profiteers and allow them to keep up to 40% for “administering” our care. DC was a Trump golem; ACO REACH is Biden’s love-child.

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Christopher Snowbeck, “Mayo stops scheduling out-of-network Medicare Advantage patients in Minnesota,” Star Tribune, Feb 14, 2022 READ IT HERE

More on the headaches associated with MA: the Mayo Clinic is stuck in disputatious negotiations with United Healthcare, and patients are marooned as a result. While the stand-off continues, United’s MA enrollees showing up at Mayo facilities are turned away. “Networks are a common feature in health plans, often impacting what people pay for medical care,” says the article. Traditional Medicare, however, doesn’t have “networks.”

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Nick Corbishley, “UK government awards CIA-linked spyware firm, Palantir, another juicy NHS contract, Naked Capitalism, Mar 8, 2022, READ IT HERE

NHS=Britain’s National Health Service. Palantir is not just “linked” to the CIA; it was birthed with CIA cash, got its start in Iraq and Afghanistan, and now supports “U.S. military operations, mass surveillance, and predictive policing.” Clearly a perfect fit for a healing enterprise! Palantir hasn’t earned a dime of profit in its 19 years of existence, but worming its way into Britain’s socialized medical apparatus should fix that. The U.K. deal gives Palantir access to “one of the planet’s most valuable repositories of data. . . decades of consistent, high-quality, trusted data on 55 million individuals.” The company, which “has intimate ties with police and security forces all over the world,” is also employed in the U.S. to collect data on us for HHS. What could go wrong?

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Michelle Chapman, “Microsoft closes on $16 billion acquisition of Nuance,” TechXplore, Mar 4, 2022 READ IT HERE

The deal for the speech recognition company “helps Microsoft Corp. get more entrenched into hospitals and the health care industry through Nuance’s widely used medical dictation and transcription tools.” Nuance, which created Siri, will now tap into the trillions spent annually on healthcare.

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Nick Cahill, “Judge halts California ban on ‘pay to delay’ pharma deals,” Courthouse News Service, Mar 4, 2022 READ IT HERE

A curveball for states trying to act where the feds fear to tread: The law was an attempt to stop Pharma companies from maintaining their monopolies by buying off generic competitors. But because the measure could affect deals occurring outside the state, a court said no. Appeals probably will follow. The Federal Government, which regulates interstate commerce, could ban the practice but doesn’t.

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[Nevada] Department of Health & Human Services, “Nevada joins Northwest Prescription Drug Consortium,” Feb 28, 2022 READ IT HERE

Yet another strategy for states to get drug prices down while the Federal Government twiddles its thumbs. The Consortium, originally formed by Oregon and Washington, offers lower prescription costs “by negotiating discounts through aggregating prescription drug purchase volume.” It’s been around since 2006 and is free to all residents of the three states.

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Bob Herman, “The growing evidence against drug copay cards,” Axios, Feb 15, 2022 READ IT HERE

“Drug copay coupons make medications free or very cheap for patients at the pharmacy counter. But they drastically increase the amounts paid by employers, insurers and other workers.” These cards enable Pharma to argue that individual patients can get help to pay for expensive meds, but the practice simply shifts the costs to insurers. Medicare and Medicaid don’t allow them.

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A word from your editor on the ivermectin (IVM) debate: I start from the core beliefs that pharmaceutical companies are motivated by profit and that their executives lie to us regularly. Further, I note that IVM is safe at proper doses, costs 6 cents each, and would wreck some corporate balance sheets if it were found to be effective either as prophylaxis or Covid therapy. Next, I take as a given that our news media are so ideologically captured by Pharma that they labor under unconscious biases in favor of expensive drugs marketed by big companies. Finally, I take into account the profound polarization of everything in our culture such that a drug favored by Trumpian meatheads v/s one favored by snowflake liberals will immediately be denounced by the rival camp. So, judge for yourselves based on my priors.

In conclusion: I don’t know that IVM works, and you don’t know that it doesn’t. Let’s keep an open, skeptical mind. I offer below some observations and a few, dare I say, facts?

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León Krauze, “Mexico City’s decision to distribute ivermectin marked a new low for pandemic mismanagement,” Washington Post, Feb 9, 2022 READ IT HERE

A particularly hysterical article on IVM. Perhaps Mexico City’s decision to distribute it along with aspirin and another drug of uncertain utility was imprudent, but the assertion that there was “no evidence” of its efficacy is false. The argument that its producer (Merck) recommends against its use is disingenuous since Merck produces a costly competitor while IVM costs virtually nothing. This article even compares Mexico City’s action to the infamous Tuskegee syphilis experiment even though IVM is safer than Tylenol.

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A.D. Santin et al., “Ivermectin: a multifaceted drug of Nobel prize-honoured distinction with indicated efficacy against a new global scourge, COVID-19,” New Microbes, New Infections, Aug 3, 2021 READ IT HERE

Peer-reviewed and summarizing 20 RCTs and six meta-analyses, which “found notable reductions in COVID-19 fatalities with a mean 31% relative risk of mortality vs. controls.” If we are exhorted to trust The Science™, then let’s include ALL of it. Have a look at these studies, and then see if you can insist there is “no evidence” that IVM works.

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Amy Maxmen, “South African scientists copy Moderna’s COVID vaccine,” Nature, Feb 3, 2022 READ IT HERE

South African biotech researchers, after being refused help from the vaccine owners to replicate it, did so on their own. Moderna and Pfizer have sent “more than 70% of their doses to wealthy nations. Meanwhile, millions of doses purchased by or promised to low- and middle-income countries have been delayed.” Although the companies stiffed them, individual scientists all over the world lent a hand. “I think a lot of scientists were disillusioned with what had happened with vaccine distribution,” says [researcher] Petro Terblanche, “and they wanted to help get the world out of this dilemma.”

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Angus Liu, “Biogen starts layoff round as the Aduhelm maker struggles with Alzheimer’s rollout,” Fierce Pharma, Mar 3, 2022 READ IT HERE

Biogen is taking a $500 million hit as its Alzheimer’s drug continues to tank. Mass layoffs ensue. Recall that the FDA, our primary, science-driven watchdog agency, approved this turkey despite furious opposition from their own experts.

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Alina Bills, “Turning to social media to get affordable insulin: a clear sign of a broken health care system,” STAT, Mar 3, 2022 READ IT HERE

“I am part of an underground market for drugs.” Insulin, that is. “Once my insurance hits my out-of-pocket max, I store away extra insulin to ensure I have enough for any emergencies and to give to others who may need it.” The horrors of life in an underdeveloped country.

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Tasneem Bulbulia, “[South African] Commission asks Tribunal to prosecute Roche for alleged excessive pricing of breast cancer treatment drug,” Engineering News, Feb 9, 2022 READ IT HERE

The country’s Competition Commission said Roche’s excessive price violated the South African constitution’s guarantee of equality in healthcare. The body looked at manufacturing costs of biosimilars and found that Roche was price-gouging, which left thousands of South African women unable to access the treatment. Prosecution of the complaint will follow.

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Olivia Webb, “Value-based oncology and medication efficacy,” Acute Condition, Feb 25, READ IT HERE

“Cancer care costs are expected to grow to $245 billion by 2030.” How do we determine which pricey drugs to use and when? “The medical system currently lacks the capacity for wide-scale, accurate determinations of a drug’s efficacy, especially on a personalized basis.” While the entire system is in the grip of for-profit entities, that’s unlikely to change.

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Katherine J. Wu, “The Biden Administration killed America’s collective pandemic approach,” The Atlantic, Mar 2, 2022 READ IT HERE

The CDC’s decision to have us toss off the masks delivers “a final blow to what little remained of the country’s collective approach to quashing the pandemic. In the new playbook, recommendations for individual people, not communities, sit front and center.” Therefore, we no longer need to act in the public interest and should now think only about ourselves—fully consistent with a system that makes healthcare reliant on an individual’s commercial relationship with a for-profit gatekeeper rather than the insurance-pool/group solidarity idea behind a single, universal payer. Masking is now, in the CDC’s words, about “personal preference, informed by personal level of risk.” You’re on your own, once again.

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Managed Healthcare, “A devastating toll of the healthcare affordability crisis on U.S. workers is revealed,” Feb 18, 2022 READ IT HERE

In this survey, nearly 60% of workers with employer-based coverage said costs are “having a detrimental impact on overall financial wellbeing and behaviors.” One in every ten households reported skipping a meal to pay for a medical expense.

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Vikas Saini, Judith Garber & Shannon Brownlee, “Nonprofit hospital CEO compensation: How much is enough?” Health Affairs, Feb 10, 2022

“While some hospital executives took modest pay cuts for a few months to make up for financial losses, more than 80 percent of hospitals continued [during Covid] to provide CEO bonuses even as other hospital workers were furloughed or had their pay slashed.” The article uses academic language and tools, but one anecdote sums it up nicely: a heroic, front-line custodian was named employee of the month and given a $6 gift voucher for the hospital cafeteria. Meanwhile, the system’s CEO got a raise worth $30.4 million.

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Sally C. Pipes, “Will the independent medical practice become extinct in America?” The Tennessean, Feb 7, 2022 READ IT HERE

Pipes is ideologically a mortal enemy of single-payer, but even she laments the trend toward concentration in the healthcare arena. “Physicians are shuttering their private, independent practices to partner up with larger hospitals that have near-monopolies” in their cities, resulting in “less personalized care and higher overall costs.” But she is incapable of entertaining any non-market solution.

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Kevin Maloney, “Connecticut public option could hurt small business and taxpayers,” CT Mirror, Feb 18, 2022 READ IT HERE

The author, a small business owner, says that “the ability to offer health coverage people can afford is one way that we’re able to stay competitive in the job market.” That’s backwards: removing expensive employer-based health insurance would cut a huge cost, partially or wholly offset the ensuing tax increase, and make his business more competitive even if he were paying higher wages. But his argument is based on ideology, not economics.

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SINGLE PAYER LINKS #246

Posted 28 FEB 2022

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Rachael Levy & Adam Cancryn, “Trump-era Medicare program under increased scrutiny,” Politico, Feb 16, 2022 READ IT HERE

DC, that is, Washington, takes note of opposition to DC, that is, Direct Contracting, a.k.a. stealth privatization of Medicare, sparked in part by Elizabeth Warren’s apt quote about “corporate vultures hoping to feed” on the popular program. An internal HHS review “prompted a lobbying blitz from provider groups.” No doubt. The anti-DC campaign spearheaded by PNHP has been effective—though not yet successful.

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Maximilian Brockwell & James Tyler Moore, “Biden’s costly failure to stop Medicare privatization experiment in Ohio,” [opinion] Cleveland.com, Feb 16, 2022 READ IT HERE

More agitation against Direct Contracting, including this well-written op-ed in a regional publication. “Biden should walk the walk of health care reform by protecting Medicare recipients, not the legacy of Trump, or the profits of the middlemen.” Unsurprisingly, the authors are med students affiliated with PNHP.

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Jake Johnson, “‘Band-Aid on a tumor’: Critics blast Biden rebrand of Trump’s Medicare privatization scheme,” Common Dreams, Feb 25, 2022 READ IT HERE

In response, the Biden Administration announced a “redesign” of the Direct Contracting Entities program under a brand-new name, “Accountable Care Organization Realizing Equity, Access, and Community Health,” or ACO REACH. Democrats reliably treat every problem as solvable through enhanced PR and embarrassing slogans. Industry lobbyists suggested the name change to “communicate how this model is part of the evolution to accountable care.” Actually, it’s just DCEs in tacky drag; privatization proceeds.

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Steve Wishnia, “Adams’ Medicare Advantage flip: From ‘bait & switch’ to ‘best’ thing for city retirees,” Labor Press, Feb 8, 2022 READ IT HERE

Adams ran for mayor on criticism of the stealth switcheroo forcing city retirees into MA, but once in office discovered that the new arrangement offers them “new and enhanced benefits,” like the extra $191 a month ($2292 per year per person) it will cost to stick with traditional Medicare from now on. Another benefit: MA’s prior authorization nightmare.

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Vignesh Ramachandran, “As politics infects public health, private companies profit,” Kaiser Health News, Feb 17, 2022 READ IT HERE

Political fights are leading some counties and cities—especially wealthy ones—to set up their own independent public health agencies. Since they’re jettisoning in-house expertise, the field is ripe for private contractors, and voila, for-profit public health! What could go wrong?

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Ge Bai & David A. Hyman, “Nonprofit hospitals’ community benefits should square with their tax exemptions. They often don’t,” STAT, Feb 17, 2022 READ IT HERE

To keep the succulent tax breaks they enjoy, nonprofit hospitals report “unreimbursed costs” for Medicaid beneficiaries (44% of total reported “community benefit”) and charity care (another 17%). Sounds good, but in fact, for-profit hospitals have a better record on both metrics. Therefore, say the authors, “Tax exemption provides no assurance that these hospitals will behave in accordance with their charitable mission and gives them an unfair competitive advantage.” So, either put up real money or pay taxes like any other business.

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Bob Herman, “Patients are coming after hospital monopolies,” Axios, Feb 16, 2022 READ IT HERE

Another lawsuit “arguing [that] hospital consolidation has led to the rise of anti-competitive contracts that force insurers and employers to accept take-it-or-leave-it terms.” The target: Hartford HealthCare, which is gobbling up hospitals around the state. Similar suits have succeeded in California (Sutter Health) and North Carolina (Atrium Health). Fun fact: most metropolitan area hospital systems are heavily consolidated, so there’s plenty of fertile ground for other alert lawyers.

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David McCabe, “Justice Dept sues to block $13 billion deal by UnitedHealth Group,” New York Times, Feb 24, 2022 READ IT HERE

UH wanted to acquire Change Healthcare, a tech company that “would give UnitedHealth sensitive data that it could wield against its competitors in the insurance business.” Change processes more than half of all medical insurance claims, according to the lawsuit, a goldmine of commercially relevant information.

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Nicole Leonard, “Advocates warn hospital merger could be ‘bad news’ for CT patients,” Connecticut Public, Feb 22, 2022 READ IT HERE

Alarms over consolidation in Connecticut: giant Yale New Haven Health sets its sights on two more health systems. Mergers benefit institutions, not users.

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Alexa Gagosz, “R.I. attorney general denies Lifespan-Care New England health care merger,” RI Business, Feb 17, 2022 READ IT HERE

More resistance to healthcare oligopolies: Rhode Island joined the rejuvenated Federal Trade Commission to shoot down a gigantic corporate merger in the state, effectively killing it.

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Maya Kaufman, “Residents of the Rockaways face higher cancer rates, few treatment options,” Crain’s NY Business, Feb 28, 2022 READ IT HERE

Care shortages in another poor neighborhood: after the struggling Peninsula Hospital closed in 2012, 130,000 residents of the Rockaways are left with one small infusion center at St. John’s Episcopal Hospital with a total of four chemotherapy chairs.

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Community Service Society, “End medical debt,” n/d, READ IT HERE

Bills are pending the New York State legislation to prohibit property liens and wage garnishments for medical debt. Find out more at the link. “Between 2015 and 2020, over 52,000 New Yorkers were sued by hospitals—all of which are non-profit charities.”

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Ramona Sequeira, “Pharma in 2022: Building trust and extending collaboration,” STAT, Feb 17, 2022 READ IT HERE

“I have the honor of being the first female chair of PhRMA’s board of directors. In this role, I will highlight the need for the pharma industry to demonstrate inclusive leadership as its companies and others work together to be part of a more equitable and sustainable health care system in the U.S.” Even when boardroom faces don’t look alike, they often still think alike as in Ms. Sequeira’s endorsement of “value-based care” (e.g., highly profitable Medicare Advantage) over fee-for-service (traditional Medicare).

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Fraiser Kansteiner, “Vertex’s Trikafta pricing central to cystic fibrosis treatment disparities, study says,” Fierce Healthcare, Feb 14, 2022 READ IT HERE

“Just 12% of some 162,000 people estimated to have CF worldwide are getting Vertex’s pricey triple-combination therapy Trikafta.” That’s because they cost between $270K and $310K per year. Where do the lucky patients live? The U.S. and Europe. Africans with CF live half as long.

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Sidney Ontai et al., “Early multidrug treatment of SARS-CoV-2 (COVID-19) and decreased case fatality rates in Honduras,” MedRXiv/BMJ, July 2021 READ IT HERE

A (so far) non-peer-reviewed account by doctors in a resource-poor setting doing the best they can. The country instituted a new therapeutic regimen and measured its impact on deaths in comparison with deaths in Mexico, which did not change its treatment regimen. Result: “A case fatality rate decrease from 9.33% to 2.97% [compared with] no decrease in Mexico.” The Hondurans used a mix of cheap, off-patent drugs. Since if their success were to be confirmed and billions could thus be diverted from pricey new Pharma drugs, expect to hear nothing about this.

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Brenda Goodman, “Ivermectin doesn’t prevent severe disease from Covid-19, new study finds,” CNN, Feb 18, 2022 READ IT HERE

Wow, an RCT that provides some hard information about ivermectin (IVM)—that should tamp down the unsupported claims pro and con, right? Only if you place “severe disease” above “death” as the main outcome. Here’s CNN’s authoritative lede: “The antiparasitic drug ivermectin doesn’t prevent severe disease from Covid-19 any more effectively than symptom management,” according to a study, etc. [italics added]. True if “severe disease,” however you define it, is more relevant than who died more often (10 of those in the placebo group v/s 3 with IVM, p=.09). The author says that’s not a “meaningful” difference, but the deceased might beg to differ, as would scientists looking at the 95% confidence interval (0.09-1.11), suggesting that a real difference could have been found with a larger enrollment pool. The author then wraps up, “Ivermectin didn’t work.”

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Igor Chudov, “CNN says study shows Ivermectin does not work—but it shows that it DOES,” Igor’s Newsletter, Feb 18, 2022 READ IT HERE

Chudov notes that the cited study included persons with comorbidities already hospitalized, so it was selecting for a pool of people highly likely to advance to “severe disease” before any intervention, or none. Igor wrote in a tweet, “Clearly, Ivermectin showed positive effect; 3 vs 10 deaths is a huge benefit. ‘p = .09’ means there is a 91% chance that the effect was not by chance. The study likely saved about 7 lives by giving Ivermectin to 241 persons.” He got flagged by Twitter for “misleading” information.

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Jessica Rose, “The new 1טeרmEזכiה paper proves it works. Trust the scientists. Thank you, Igor Chudov,” Unacceptable Jessica, Feb 18, 2022 READ IT HERE

Note how Rose has to use weird symbols to even breathe the name of the drug under discussion out of fear of censorship. She notes that the Malaysia trial was not double-blinded, meaning that clinicians knew who was getting what while determining who had progressed to “severe disease” and who had not. This format notoriously lends itself to researcher bias and mis-categorization of outcomes.

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Alexander Marinos, “What went wrong with the recent I-TECH ivermectin study published in JAMA?” Thread Reader, Feb 19, 2022 READ IT HERE

Given the Malaysian trial’s design, “any other antiviral, such as Paxlovid or Molnupiravir, would also have failed.” Marinos explains: “An antiviral started avg 5.1 days after symptom onset, with a primary endpoint that is triggered 3.1 days after start of treatment, when treatment is for 5 days, will be almost impossible to show benefit. The avg patient didn't even have time to complete the treatment.”

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Steven Chee Loon Lim et al. & I-TECH Randomized Clinical Trial,

“Efficacy of ivermectin treatment on disease progression among adults with mild to moderate COVID-19 and comorbidities,” JAMA, Feb 18, 2022 READ IT HERE

This is the study. The Malaysian researchers found no improvement with ivermectin (IVM) use on its main outcome, “severe disease,” which oddly differs from the WHO definition, which calls the same set of symptoms “moderate disease.” Nonetheless, “the study findings do not support the use of ivermectin for patients with COVID-19.” Meanwhile, another clinical trial is underway in Malaysia, that of Merck’s expensive Covid-19 treatment molnupiravir, a direct IVM competitor that will cost a bit more than IVM's 6 cents per dose.

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Meredith Cohn, “Two may be better than one drug to treat COVID-19, University of Maryland study finds,” Baltimore Sun, Feb 14, 2022 READ IT HERE

“The researchers looked at 18,000 FDA approved drugs to tackle COVID-19 in the lab . . . and found 122 candidates.” Were any of them cheap, off-patent molecules, or were they all platinum Pharma products, like the three found to work well in mice?

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Apoorve Mandavilli, “The C.D.C. isn’t publishing large portions of the Covid data it collects,” New York Times, Feb 20, 2022 READ IT HERE

“When the C.D.C. published the first significant data on the effectiveness of boosters in adults younger than 65 two weeks ago, it left out the numbers for a huge portion of that population: 18- to 49-year-olds, the group least likely to benefit from extra shots, because the first two doses already left them well-protected.” Why would they do that unless it were to hide unfavorable information? The CDC doesn’t need more reasons to distrust it. A spokeswoman said the caution is due to “fear that the information might be misinterpreted,” i.e., we will continue to treat you as minor children. So, we can’t hear about the limitations of vaccination while at the same time we are relentlessly told that vaxing is the only solution to Covid.

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Tina Reed, “Ambulance rides are getting a lot more expensive,” Axios, Feb 22, 2022 READ IT HERE

How to upcode an ambulance ride: add “advanced life support” to the report thereby jacking up the reimbursement from an average of $486 to $758. Because Medicare’s rates haven’t risen much, patients are on the hook for the difference and not protected by the new “surprise billing” law unless you’re in a state that enacted its own (CO DE FL IL ME MD NY OH VT WV).

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Anne Blythe, “Is this the year NC will expand Medicaid?” North Carolina Health News, Feb 21, 2022 READ IT HERE

Coverage for a half million residents is at stake. NC is turning down $1.5 to $2 billion a year in federal subsidies to avoid helping low-income Carolinians. The GOP-controlled state is slowly warming to the idea though they now avoid the term “Medicaid expansion” since they succeeded in turning it into anathema among their followers.

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Keith Vossel, “The first treatment for Alzheimer’s taught us some hard lessons,” Los Angeles Times, Feb 19, 2022 READ IT HERE

Vossel, an Alzheimer’s researcher, says, “The FDA’s surprise approval of Aduhelm last year was a mess on practically every level.” Unusual frankness from someone who could easily have been in the rah-rah camp. He notes that other Pharma companies are preparing to ask for authorization for drugs that only “slow the spread of amyloid plaques,” never convincingly shown to affect Alzheimer’s. So Aduhelm has eager imitators.

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Arthur Allen, “Inside the tactical tug of war over the controversial Alzheimer’s drug,” Kaiser Health News/Fortune, Feb 16, 2022 READ IT HERE

Counterattack by the drug industry, patient advocates, and congressional Republicans over the deflated Aduhelm balloon that was supposed to bring in hefty profits. “They’ve gone as far as to accuse them of tacit racism, ageism, and discrimination against the disabled.” (Perhaps Pharma’s new female board chair led the charge?) “For the industry, the campaign has a broader existential target: to prevent CMS from using its payment decisions to keep FDA-approved drugs off the market” given that “FDA programs to speed approval of new drugs have led to a rash of entries with often minimal scientifically sound evidence to prove they work.” Translation: we rigged the system fair and square, so leave it alone! Patient advocacy groups get big grants from the drugmakers and act accordingly.

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Markian Hawryluk, “Other watchful eye on snags in Washington’s pioneering public-option plan,” Kaiser Health News, Feb 23, 2022 READ IT HERE

“Washington state, in its second year of offering the nation’s first public-option health insurance plan, has learned an important lesson: If you want hospitals to participate, you’re probably going to have to force them.” The state’s version of a public option is a sort of deformed hybrid with heavy private-sector participation in which the state doesn’t actually administer the programs. Hospitals boycotted it, and the industry is poised to point to another “failure” of anything but the for-profit model. “Washington’s stumble out of the gate reflects the difficulty of lowering health care costs while working within the current system.” Amen.

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Jay Hancock, “An $80,000 tab for newborns lays out a loophole in the new law to curb surprise bills,” Kaiser Health News, Feb 23, 2022 READ IT HERE

“The Bulls’ ordeal points up a loophole in coverage for emergency care—even under the No Surprises Act, which took effect Jan. 1 and outlaws many kinds of surprise medical bills.” Emergency care is covered, but “what if the insurance company denies that the care is for an emergency? Or the hospital doesn’t supply the paperwork to prove it? That’s what happened to the Bulls” because the surrogate mother was not admitted through the emergency department by her OB. Hundreds of hours on hold followed for the busy parents of twins. Lesson: while performing CPR or trying to stop the bleeding, make sure you or your family member is admitted through the ER.

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SINGLE PAYER LINKS #245

Posted 17 FEB 2022

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UE News, “Eastern Region endorses NY Health Act,” Feb 2, 2022 READ IT HERE

UE = United Electrical, Radio and Machine Workers of America. Another chink in the union resistance to single-payer in New York removed. Region President George Waksmunski said, “We need to take health care out of the hands of the employers who use it to bludgeon us in contract negotiations.” He encouraged locals to discuss the legislation.

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Douglas Rooks, “Efforts underway to bring Medicare for All to Maine,” Seacoastonline, Feb 4, 2022 READ IT HERE

Via a ballot initiative. Maine tried something like it in 2003 but got nowhere with the hostile Bush Administration.

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Susan Rogers, letter to HHS Secretary Becerra, Physicians for a National Health Program, Feb 15, 2022 READ IT HERE

PNHP’s response to the Direct Contracting (DC) industry’s offer to tweak some aspects of the latest privatization program: You cannot “fix” a plan to shift beneficiaries’ care to third-party middlemen, so kill it. Rogers also pointed to gross conflicts of interest among those responsible for creating the DC program in the first place. “From HMOs to Medicare Advantage to Direct Contracting, Medicare has been ‘experimenting’ with managed care models for nearly 40 years. These models have never reduced spending or improved patient care.”

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Robert King, “Provider groups scramble to convince lawmakers, CMMI to continue Direct Contracting model,” Fierce Healthcare, Feb 15, 2022 READ IT HERE

Feeling the heat, Direct Contracting operators crank up lobbying to save their juicy new biz. “No one is trying to privatize traditional Medicare,” said Don Crane, president and CEO of America’s Physician Groups. Also, Prince Andrew did not have sex with that girl.

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Linda H. Aiken & Claire M. Fagin, “Medicare can help fix the nurse shortage in hospitals,” STAT, Feb 8, 2022 READ IT HERE

“There’s no polite way to say this: The U.S. health care system failed the American people during the Covid-19 pandemic. Hospital leaders have blamed everyone but themselves for not having enough nurses.” Describes the various scapegoats trotted out by hospitals to avoid blame while ignoring the causes of nurse burnout. Adequate staffing requirements would cost hospitals money, so they fight it, e.g., New York’s failure to pass safe patient-to-nurse ratios last year. Medicare could issue rules to fix the problem, so it doesn’t depend on persuading President Manchin.

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Anjeanette Damon, “He donated his kidney and received a $13,064 bill in return,” ProPublica, Feb 11, 2022 READ IT HERE

“Malin knew the surgery could put his health at risk. What he didn’t anticipate was that it would put his finances in jeopardy.” A kidney donor gets harassing bills from a variety of providers, and the insurers can’t get around to fixing it until a reporter calls up to ask if they want a huge black eye in the national media. The bills promptly disappear.

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Wendell Potter, “Wall Street investors punish Cigna for not promising them bigger profits,” NOW, Feb 4, 2022 READ IT HERE

Cigna announces that its profits are down slightly, and billions vanish from its stock price. “As a result of yesterday’s bloodbath, Cigna’s management is now under intense pressure from shareholders to raise health insurance premiums, dump unprofitable customers, pay doctors less, and make patients spend more out of their own pockets.” Even a stock buyback worth $7.7 billion didn’t save Cigna from “disappointing” the market, which was not satisfied with billions in profit, mostly from its intermediary role in drug purchasing through an in-house PBM.

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Rachel Burr Gerrard, “There’s no autism epidemic. But there is an autism diagnosis epidemic,” STAT, Feb 10, 2022 READ IT HERE

“Since 2001, all 50 states have instituted mandates requiring non-self-funded private insurance plans to cover behavioral therapies for autism. Insurance mandates increase autism rates because, in borderline cases, practitioners and parents push for a diagnosis that ensures a child receives coverage.” Medicine by billing code.

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Nicholas Florko, “Senate narrowly confirms Robert Califf to lead the FDA,” STAT, Feb 15, 2022 READ IT HERE

Saved 50-46 by the “voices of reason” Republicans Romney, Collins, Murkowski, and Toomey when even Joe Manchin couldn’t stomach the guy. Califf presided over the opioid debacle, showing that massive failure is no more obstacle to promotion at the FDA than it is at the Pentagon. His chief sidekick will be Janet Woodcock, fresh from approving Aduhelm, the Alzheimer’s drug that successfully removes dangerous balances out of your bank account.

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Rep. Kathleen Rice twitter account, READ IT HERE

“As I turn to the next chapter of my own personal and professional story, I do so with profound thanks . . . etc.” Rice (D-Nassau County) is leaving Congress after playing a key role in killing the drug cost control measures contained in Biden’s BBB. Stand by to learn of her next lucrative gig.

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Ricardo Alonson-Zaldivar, “U.S. buys 600K doses of new COVID antibody awaiting clearance,” Associated Press, Feb 10, 2022 READ IT HERE

Eli Lilly’s drug is “yet to be approved,” but you don’t see headlines with terms like “unproven,” or “controversial” describing the $720 million bonbon for the company. If it cost 4 cents a dose, we’d have dire warnings from white coats on CNN. “Should BA.2 [omicron bis] keep rising, the new antibody drug could offer a viable treatment option and a chance to keep pace.” The language suggests that no one knows that yet, but the hope-based contract draws no further scrutiny. Lilly says it has supporting data—who has seen it?

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Bob Herman, “Pharmacies feel stiffed on COVID pill payments,” Axios, Feb 7, 2022 READ IT HERE

“Some pharmacies are getting paid as little as $1 to dispense the COVID antiviral pills made by Pfizer and Merck.” That would be for the entire process of preparation and checking the patient’s other medications for possible interactions.

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Jaimy Lee, “Four drug makers raked in $14 billion in sales of COVID-19 treatments in 2021. How will they do this year?” MarketWatch, Feb 4, 2022 READ IT HERE

Quite well, it turns out, unless Covid fizzles. Bright spots: molnupiravir and Paxlovid should rack up sales of $5 billion and $22 billion respectively.

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Karen Brooks Harper, “Houston scientists acclaimed for their patent-free COVID-19 vaccine,” Texas Tribune, Feb 10, 2022 READ IT HERE

Two doctors worked in obscurity to come up with a Covid vax that could be cheap, easy to make, and patent-free. But they struggled for funding since if it worked, no one would get a yacht. Their product, Corbevax, is being tested in India. Disclosure: the hospital where they work is a funder of the Texas Tribune, along with adorable “Tito’s Handmade Vodka,” which chipped in $1 million to the research.

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Don Thompson, “3 million plaintiffs seek $1.2b from California health firm,” Associated Press, Feb 10, 2022 READ IT HERE

More pressure on hospital monopolies: plaintiffs accuse Sutter Health of market abuse by “discouraging patients from using lower-cost insurance and lower-cost hospitals.” Sutter settled a similar suit two years ago for $575 million and is under court-mandated monitoring for 10 years.

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Erica E. Phillips & Katy Golvala, “Yale New Haven Health to acquire three hospitals in central CT,” CT Mirror, Feb 10, 2022 READ IT HERE

Meanwhile, further hospital consolidation up north. If the deal proceeds, two giant systems will control half of Connecticut’s 27 hospitals. The state A-G is sounding displeased. Fun fact: tucked into the governor’s budget request is $400,000 for a study of “anti-competitive practices across the health care industry.”

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Kurt Erickson, “GOP plan to gut Medicaid advances to floor of Missouri House,” St Louis Post-Dispatch, Feb 8, 2022 READ IT HERE

Missouri voters endorsed Medicaid expansion, but the Republican-controlled state legislature keeps looking for ways to wreck it. Now, they are pushing a constitutional amendment (no less) to empower themselves to block the state’s portion of Medicaid funding.

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Aaron E. Carroll, “Covid drugs may work well, but our health system doesn’t,” New York Times, Feb 13, 2022 READ IT HERE

“Nearly every step of the pathway by which Americans might get these [Covid treatments] seems designed to prevent it from happening.” The reasons: because of the crucial time factor involved in starting treatment, our rickety testing system is the first barrier. Then you need a doctor’s visit to get the prescription—further delays. Next, find the pharmacy your insurer uses; then, hope the pill is in stock. The author sees the problems, but doesn’t draw the single-payer conclusion—or perhaps wasn’t allowed to.

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SINGLE PAYER LINKS #244

Posted 11 FEB 2022

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Michael Lighty, “States now hold the key to making Medicare for All a reality,” Portside/In These Times, Feb 5, 2022 READ IT HERE

An upbeat summary of where single-payer is more or less on the table: New York, California, Washington (state), Oregon, Rhode Island, Minnesota, Massachusetts. I always try to lead with some cheerful news, and this one tries hard.

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Bernard J. Wolfson, Angela Hart & Samantha Young, “California inks sweetheart deal with Kaiser Permanente, jeopardizing Medicaid reforms,” Kaiser Health News/San Diego Union-Tribune, Feb 3, 2022 READ IT HERE

Just days after Newsom’s Dems jettisoned a single-payer plan, they quickly pivoted to shovel state cash over to for-profit, campaign-financier-extraordinaire Kaiser Permanente in a secret deal. The Medicaid contract “would allow the health care behemoth to expand its reach in California and largely continue selecting the enrollees it wants, which other health plans say leaves them with a disproportionate share of the program’s sickest and costliest patients.” More gory details on the ongoing incest carried on between KP and the entire state government, leading to even greater gigantism in the industry.

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Erika Fry, “A labor union is accusing America’s biggest hospital chain of Medicare fraud—and stoking a debate over for-profit medicine and soaring health care costs,” Fortune, Feb 2, 2022 READ IT HERE

The target: HCA Healthcare. The accusation: HCA’s unusually high emergency room admission rates to goose Medicare reimbursement “without respect to medical need.” HCA has had other settlements with the Department of Justice over fraud allegations, which means that the DoJ lets them get away with a fine and wrist-slaps.

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CNN, “Health insurance companies make record profits as costs soar in US,” Feb 3, 2022 READ IT HERE

No. 1 UnitedHealth booked net earnings of $17.7 billion in 2021, of which $5 billion went to shareholders as dividends. Meanwhile, “the price of an employer-sponsored family policy is up 47% since 2011.” Premiums and deductibles now absorb 11.6% of an average family’s income.

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Gibson Dunn [law firm], “2021 year-end False Claims Act update,” Feb 3, 2022 READ IT HERE

Of the $5.6 billion worth of federal fraud judgments in fiscal 2021, 90% involved the healthcare industry. Purdue Pharma accounted for half of that. Primary areas of enforcement were: opioid abuse, Medicare Advantage (Part C) fraud, illegal kickbacks, and provision of medically unnecessary services. "The emergence of alleged Medicare Advantage fraud as one of DoJ’s top sources for FCA settlements is a relatively new development.”

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Jeff Lagasse, “Medicare Advantage receiving bipartisan support in House of Representatives,” Healthcare Finance, Jan 31, 2022 READ IT HERE

While the wars over small stuff continue to boil, bipartisanship reigns when it comes to protecting corporate profits. “More than 340 members of the U.S. House of Representatives [78% of the total], signed a letter urging [CMS] to maintain stability with Medicare Advantage.” Translation of “maintain stability”: pile more public money onto the for-profit sector while starving Medicare, which will then pick up the expensive patients once they get sick enough to need costly care.

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Megan Messerly, “Next big health crisis: 15M people could lose Medicaid when pandemic ends,” Politico, Feb 2, 2022 READ IT HERE

Now that everything is back to “normal,” the Biden Administration is set to cut back emergency coverage while also ending the additional federal matching funds to pay for higher enrollment (up 20% during Covid). Eligibility audits have been suspended for the past two years but will restart. Ohio has contracted with an outside vendor “that will automate eligibility redeterminations in exchange for a cut of state Medicaid savings.” What could possibly go wrong?

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Olivia Webb, “On facility fees and virtual visits,” Acute Condition, Feb 3, 2022 READ IT HERE

“People aren’t expecting a cascade of hospital bills tied to virtual visits.” Now, they should. Describes bills for ER “facilities” charged even when patients don’t set foot in them. The Supreme Court has allowed the charges in principle; Connecticut banned them (temporarily).

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Nicholas Florko, “Despite Biden’s big promises and a far better understanding of the virus, Covid-19 is still raging through the nation’s prisons,” STAT, Feb 2, 2022 READ IT HERE

“President Biden promised to order the federal Bureau of Prisons to reevaluate its Covid-19 protocols and release additional data on the spread of the virus in prisons. But that specific order never came.” The Bureau of Prisons has poor data on testing practices, infection totals, deaths, and vaccine access, which makes it easier to cover up problems. “People in prison are roughly three times more likely to die of Covid-19 than the general population.” Alderson women’s prison in West Virginia has a “waitlist” for vaccination. This is something entirely within Biden’s powers, so he can’t use the excuse of meanie Republicans or Manchin/Sinema.

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Caroline Behr & Michael L. Barnett, “High-risk individuals should get priority access to Covid therapies. That isn’t happening,” STAT, Feb 4, 2022 READ IT HERE

Describes the dysfunctional non-system facing people with special vulnerabilities seeking Covid therapies after infection. “Getting treatment requires a positive Covid-19 test result and traveling to an infusion center no later than 10 days after symptoms start. Those are not easy tasks for individuals experiencing with Covid symptoms in the first place”—especially if you’re already disabled.

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Olivia Webb, “The evolution of the Mark Cuban Cost Plus Drugs Company and the growing number of companies trying to circumvent the pharma system altogether,” Acute Condition, Jan 27, 2022 READ IT HERE

Cuban’s vanity project is an attempt to do an end run around the PBM oligopoly. Is that possible?

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Candice Bernd, “Nursing unions say for-profit health care is driving omicron staffing crisis,” Truthout, Jan 18, 2022 READ IT HERE

The unions argue that “the for-profit health care system artificially deflates staffing levels to protect hospital employers’ bottom lines,” similar to the profit-maximizing just-in-time supply-chain strategy that has caused huge disruptions in the entire economy.

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CMH, “Conservatives surprising views on simplicity and affordability in American healthcare,” Daily Kos, Jan 17, 2022 READ IT HERE

The author surveyed 252 self-described Republicans and found several curiosities: 70% thought we could afford to make healthcare affordable for all Americans. “Fear of subsidizing others was a very small minority.” A whopping 95% agreed that American healthcare should be simple. But only 60% agreed that the lack of universality—not having everyone covered—makes things more complicated and costly for everyone, and 43% thought private insurers did a better job administering insurance than the government. Wendell Potter: “Health insurers have been successful at two things, making money and getting the American people to believe they're essential.”

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Yves, Smith, “Ending drug price gouging: A regulatory framework for pricing of medicine innovation,” Naked Capitalism, Feb 4, 2022 READ IT HERE

Introduction to a longer article that includes a concise summary of why Pharma propaganda is such crap: the “innovation” fantasy (88% of patent applications are for tweaking existing drugs); Pharma's grotesque marketing budgets; and how R&D is largely government-funded while profits are handed to shareholders.

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Barbara Caress, “The dark history of Medicare privatization,” American Prospect, Jan 24, 2022 READ IT HERE

Medicare Advantage now hoovers up $343 billion in revenue through 26 million enrollees, and Direct Contracting—MA on steroids—is not far behind. But privatization of Medicare has a long history. “The growth of Medicare Advantage is a 35-year-long saga of a program conceived as a cheaper, better Medicare transformed into a behemoth that has not saved one cent nor produced better outcomes. Yet MA has beaten back every attempt to make it accountable for its cost and care.” And: “Over the last 12 years (2009–2021), Medicare paid the MA plans $140 billion more than would have been spent if the same people stayed in Medicare.”

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Dan Diamond, “Government watchdog says HHS is at ‘high risk’ of botching a future crisis,” Washington Post, Jan 27, 2022 READ IT HERE

“The Department of Health and Human Services repeatedly ignored recommendations to improve its pandemic response and is at high risk of mismanaging a future crisis.” White House chief of staff Klain was the Ebola czar, so he knew. What did he do about it?

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James Schneider, “Entrepreneurs launch Goodbill to target at-home COVID test reimbursement, negotiate hospital bills,” Fyne Fettle/ Crain’s Detroit Business, Feb 5, 2022 READ IT HERE

In a sane world, we would just go get a Covid test and be done with it. Instead, because we have to navigate the Kafkaesque world of U.S. medicine, there is a new software package that “is designed to allow users to tabulate whether they had been overcharged for a hospital procedure by generating comparable procedures from the hospital price-transparency data.” Sounds like fun, only different. The founding entrepreneurs, who undoubtedly will go far, are also building an app to “automate bill negotiation for the user”—for a modest fee.

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Alex Keown, “Biogen recoups much-needed $2.3B with sale of Samsung Bioepis stake,” BioSpace, Jan 28, 2022 READ IT HERE

To deal with the expensive debacle of Aduhelm, the Alzheimer’s drug that doesn’t work and costs the family farm.

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John Hendel, “Crisis Text Line ends data-sharing relationship with for-profit spinoff,” Politico, Jan 31, 2022 READ IT HERE

A suicide hotline was selling its data to a commercial company. Hell was raised. They stopped.

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Elizabeth Weise & Karen Weintraub, “‘Not typical’: FDA takes unusual step in urging Pfizer to seek approval for child vaccine,” USA Today, Feb 2, 2022 READ IT HERE

Why would the FDA break protocol to solicit an approval application from Pfizer for vaccines in children? Pressure from the vaccine-and-only-vaccine White House? Probably will not help the agency’s wobbly credibility.

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Cynthia A. Fisher, “Hospital price disclosures reveal prices can vary by ten times,” Los Angeles Daily News, Feb 1, 2022 READ IT HERE

“Hospitals currently blind consumers, including patients, employers, and unions from prices, then blindside them with massive bills weeks and months later. This price opacity enables hospitals to engage in overcharging, waste, and vast price differences for the same care—even at the same hospitals.” A federal price transparency rule went into effect last year but is widely ignored.

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Charlie Zong, “Texas Tech joins study testing unproven ivermectin, other controversial ‘repurposed drugs’ for COVID effects,” Houston Chronicle, Feb 2, 2022 READ IT HERE

Note the tendentious descriptors used in this headline: what account of a Pharma drug trial would call the experimental molecule “unproven” and “controversial”? (All drugs in a clinical trial are “unproven”—why else would you test them?) And why the scare quotes around “repurposed drugs”? Because they cost pennies per dose? The article makes sure to point out in the first line that “federal health agencies have warned against” using ivermectin, which is misleading as the warning is about using high-dose formulations for animals. Ivermectin is safer than Tylenol and has been prescribed billions of times worldwide. If hard evidence surfaces that IVM is effective, billions in profits go down the drain.

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SINGLE PAYER LINKS #243

Posted 4 FEB 2022

Susan Rogers, “Medicare Direct Contracting: A threat to seniors and to Medicare’s future,” Physicians for a National Health Program, Feb 2, 2022 READ IT HERE

Dr. Rogers’ prepared testimony before the Senate Finance Committee on the new, very serious, privatization threat to Medicare. This week’s must read.

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Health Justice Monitor, “Alert: Past & present privatization of Medicare,” Jan 28, 2022 READ IT HERE

Medicare Advantage was sold to policymakers as a cost-saving strategy. Now that the opposite has happened, that excuse has been dropped. “It’s now become a costly, unaccountable cash cow for private insurance companies that is swallowing traditional Medicare.” But that’s only the beginning: Direct Contracting would enable for-profit companies to “make deals with networks of providers, manage beneficiary care and costs, and pay the bills, while keeping the difference. Medicare’s only role would be as banker.” Also: “HHS senior official Liz Fowler (an architect of the Affordable Care Act) projects the transition of all traditional Medicare to DC to be complete by 2030.” Unless we raise holy hell.

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Danielle Brown, “CMS eyes 8% revenue increase for Medicare Advantage,” McKnight’s Long-Term Care News, Feb 4, 2022 READ IT HERE

CMS asked plans to answer how each MA plan “advances health equity” and specifically “how often plans screen for common health-related social needs, such as housing insecurity, food insecurity and transportation problems.” That is, the MA plans that embody the creeping privatization—that, in the long run, will exacerbate health inequity—are being asked how they plan to address current health inequities, for which they will be rewarded with a huge payment increase in advance of showing any results. MA operators will get extra money to “improve risk scores” of their enrollees through “forming value-based relationships between post-acute and managed care.” Wild prediction: the risk scores will not improve, but the MA plans will not be penalized.

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Geert De Lombaerde, “Humana targets $1B from cost cuts, productivity push,” Healthcare Innovation, Feb 3, 2022 READ IT HERE

Humana will “redeploy the generated cash to their MA and healthcare services units.” Humana knows where the bread can best be buttered now that private payers have been squeezed and is targeting the lucrative government-reimbursement markets.

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Dan Walters, “Newsom backs away from single-payer health care pledge,” Cal Matters, Jan 18, 2022 READ IT HERE

He needn’t have bothered since the bill’s sponsor cooperatively withdrew it before anyone had to go on the record with a vote. During his campaign for governor, Newsom said, “I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive, or someone else’s problem.” As governor, Newsom focused entirely on boosting coverage through Medicaid, which doesn’t threaten insurance companies’ profits. Single-payer does.

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Melody Gutierrez, “Single-payer healthcare proposal fizzles in California Assembly,” Los Angeles Times, Jan 31, 2022 READ IT HERE

Because [California] Assembly Bill 1400 supposedly “did not have the necessary votes to move forward,” Assemblyman Ash Kalra (D-San Jose) opted to let the bill die instead of forcing a vote that “could be politically damaging for some of his Democratic colleagues.” The California Nurses Association called Kalra’s action “cowardly” and said it “provided cover for those who would have been forced to go on the record.”

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San Jose Mercury News & East Bay Times, “California single-payer bill shows state can’t go it alone,” [editorial], Jan 26, 2022 READ IT HERE

Can’t or won’t. The editors say that the U.S. system has to be “more cost-effective” but that the switch requires a plan that “has the support of business and labor,” which presumably includes the business of healthcare that now comprises 20% of the economy. Therefore, the state should permanently kneecap itself in thrall to these interests, according to the authors. The editorial argues that any one-state system would be at the mercy of a hostile administration in Washington that could block the use of the state’s Medicare/Medicaid portion to finance it through denying a waiver.

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Allison Bell, “Aflac organizes medical debt awareness campaign,” Think Advisory, Jan 21, 2022 READ IT HERE

Altruistic Aflac will provide grants “for people and communities hurt by medical debt,” that is, a company that sells insurance policies to fill in the gaps left by other insurance policies will alleviate a few people’s insurance-induced pain. Or to put it another way, Aflac is offering some handouts as part of an advertising campaign to soften people up and pitch them another product. “If the new Close the Gap campaign is successful, it could buoy sellers of all supplemental health insurance products—such as accident insurance, hospital indemnity insurance, critical insurance, and Medicare supplement insurance.”

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Laure Beerman, “4 key findings from Commonwealth Fund reflect rising employee healthcare costs,” HealthLeaders, Jan 24, 2022 READ IT HERE

“Employees in 37 states spend more than 10% of their income in premiums and deductibles [up from 10 states in 2010]. Employees in 22 states are considered underinsured and at risk for deferred care and medical debt [up from one state in 2010].” Things are getting worse for the employer-based insurance system, which workers purportedly love. Worst states: Mississippi and New Mexico.

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Jennifer Goldsack & Soujanya (Chinni) Pulluru, “Break the stranglehold of the doctor-patient visit on health care innovation,” STAT, Jan 28, 2022 READ IT HERE

Goldsack (CEO of the Digital Medicine Society) and Pulluru (Walmart Health and Wellness) talk their book. When anyone says “innovation,” immediately cover your wallet with both hands. Also, is “stranglehold” an inflammatory term at all? The authors want robotic, digital contacts—which, coincidentally, their companies offer—to replace those pesky face-to-face interactions.

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Eric Boodman, “Patchwork system for rationing a Covid drug sends immunocompromised patients on a ‘Hunger Games’ hunt,” STAT, Jan 27, 2022 READ IT HERE

The mad scramble for access to the specialty drug that transplant recipients, MS patients, and other immunocompromised people need results in crazy internet searches, a dash to the airport to grab a dose in South Dakota, Florida, or Virginia, and success only for the affluent and savvy. “There’s no national system for distributing [Evusheld] equitably,” possibly because there’s no national system for providing healthcare.

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National Law Review, “Massachusetts DPH delays enforcement penalties for state surprise billing law,” Jan 5, 2022 READ IT HERE

A raft of articles describe how providers and hospitals are trying to undermine the guarantee that we won’t get slapped with “surprise” bills from out-of-network providers operating out of in-network hospitals. Billers are whining that they have to rejigger “complex” payments systems as if they didn’t have advance notice that this law was taking effect on January 1.

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Natalia Mesa, “Most medical papers didn’t disclose industry payments,” The Scientist, Jan 24, 2022, READ IT HERE

The researchers discovered that 81% of authors whose work appeared in the country’s two top medical journals (JAMA and NEJM) in 2017 “failed to disclose conflicts of interest in the form of industry payments.” To keep in mind the next time someone demands worship of The Science™. The original: MedRxiv READ IT HERE

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Harris Meyer, “Resistance to a Boston hospital’s expansion centers on rising prices,” Kaiser Health News/Fortune, Jan 27, 2022 READ IT HERE

Pushback on hospital consolidation: “The state’s 11-member Health Policy Commission unanimously concluded that these expansions would drive up spending for commercially insured residents by as much as $90 million a year and boost health insurance premiums.” They also ordered Mass General Brigham to slow its cost growth, “believed to be the first time in the country.” Cost growth in Massachusetts hit 4.3% in 2019 in a zero-inflation environment. Safety-net hospitals would be slammed by the diversion of patients into the more expensive Mass Gen system. Other states are looking into the impact of hospital mergers on competition and cost.

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Casey Ross, “How a decades-old database became a hugely profitable dossier on the health of 270 million Americans,” STAT, Feb 1, 2022 READ IT HERE

MarketScan has data on 270 million of us and not just any data but our medical histories, including things we specifically don’t tell anyone else. Now, a private equity firm wants to pay $1 billion for it—what could go wrong? “Patient data have become far more valuable as they are fed into an exploding array of software and artificial intelligence tools whose financial returns enrich technology entrepreneurs and their investors.” The Federal Government has done nothing to regulate this open market in our personal data. Why would anyone confide in their doctor now?

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Keith Ridler, “Bill to put teachers on state health insurance advances,” Associated Press, Jan 31, 2022 READ IT HERE

A bright red state (Idaho) faces the dysfunctional reality of health insurance for a key component of the state workforce. Teachers will now be able to dump private insurance for a state-funded alternative. The measure will leave more cash in teachers’ pockets and alleviate school levies that districts have to keep raising for pay insurance costs. “The bill creates a dedicated fund that would hold money needed for public schools to buy into the state’s medical and dental group insurance plan.” Red states will continue to surprise us on this issue IMHO though not all of them (see below).

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Jeremy Blackman, “Texas cut Medicaid staffing during the pandemic. Millions are now at risk of being dropped from the program,” Houston Chronicle, Jan 25, 2022 READ IT HERE

Now that the crisis is supposedly over, Texas can go back to its traditional punishment of low-income workers. “Emergency federal funding [deterred] states from dropping recipients during the health crisis.” Now, they can, and will. Texas is also a non-expansion state.

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Dave Stanke & Adriane Fugh-Berman, “CMS makes the right decision on Alzheimer’s drugs,” Detroit Free Press, Jan 19, 2022 READ IT HERE

More bad news for Biogen’s turkey drug that doesn’t work. The authors are from a nonprofit; every single article I have seen protesting the CMS decision against Aduhelm is by an author getting subsidized in one way or another by the industry.

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Joe Crowley, “How Build Back Better could be even better,” Newsweek, Jan 19, 2022 READ IT HERE

Crowley, last seen getting creamed by AOC in an historic upset, trots out industry’s blame-the PBMs talking point as a cover for wrecking BBB’s tougher measures. Crowley now works for the $25 million-a-year lobbying firm Squire Patton Boggs. Good to see him monetizing his connections.

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Katrine Bruner, “Study finds employees in Florida pay among the highest rates for health insurance, WUSF Public Media, Jan 20, 2022 READ IT HERE

Floridians on average paid for premiums and deductibles $9,284 in 2020, or 16% of the state’s median income, up from $5,205 – or 11% of the state’s median income, 10 years ago. People like their employer-based health insurance!

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Shari Rudavsky & Kaitlin Lange, “Indiana lawmakers target healthcare costs: ‘Fix it, the best solution will come from you,’” Indianapolis Star, Jan 24, 2022 READ IT HERE

Another red state gearing up for a clash. Indiana lawmakers asked “hospital and insurance leaders” to find a way to cut costs before they step in with legislation. Dear foxes, how can we better protect the chickens? Indiana is another high-cost state for healthcare, so it will be interesting to see what they come up with. “Business owners and individuals have contacted lawmakers to complain that the high costs of care impacts business and individuals’ budgets.” Legislators will face tough choices when they see that none of their competing corporate sponsors want to budge.

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SINGLE PAYER LINKS #242

Posted 27 JAN 2022

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Wendell Potter, “UnitedHealth’s $24 billion profit,” Tarbell, Jan 24, 2022 READ IT HERE

Of which $5 billion was used to buy back shares and another $5.3 billion distributed via dividends. “Most of United’s membership and revenue growth now comes from the company’s Medicare Advantage plans and the state Medicaid programs it manages,” i.e., government funds. Nice work if you can get it!

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Bob Herman, “The big Medicare Advantage players keep getting bigger,” Axios, Jan 19, 2022 READ IT HERE

Six health insurers control roughly three-quarters of the fast-growing Medicare Advantage market.” No 1: UnitedHealth Group with 7.9 million MA members, followed by Humana, CVS, Anthem, Kaiser Permanente, Centene, and Cigna. Total MA market: $412 billion of government cash.

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James Schneider, “Humana grows private equity-backed primary care,” Fyne Fettle, Jan 21, 2022 READ IT HERE

Insurance giant Humana plans to operate 260 of its CenterWell clinics in 12 states by the end of this year using a pile of private equity cash. Vertical integration means Humana gets a cut at every stage of healthcare delivery. “By directing its 4.3 million Medicare Advantage members to outpatient sites for care and addressing their social determinants of health needs, Humana aims to inspire better patient outcomes and lower healthcare costs.”

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Dean Baker, “Why pay less? The U.S. strategy for vaccinating the world,” Center for Economic and Policy Research, Jan 16, 2022 READ IT HERE

A new Covid vaccine has been developed by scientists in Texas. “What makes this development so important is that [lead inventor Dr. Peter] Hotez is making his vaccine freely available to the world. They are also freely sharing the technology, not claiming industrial secrets like Pfizer and Moderna. If further research supports their initial findings, the world will have a cheap, effective vaccine that can quickly be produced in sufficient quantities to vaccinate the world.” The dose price should be a few dollars per shot, versus $20 for the mRNA vaccines. India has given the vaccine an emergency use authorization.

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Howard Wolinsky, “Active surveillance for prostate cancer: The gift that keeps on giving,” STAT, Jan 11, 2022 READ IT HERE

The U.S. healthcare system incentivizes prostate surgery because “the more prostatectomies [urologists] perform, the more income they generate.” In Sweden, where urologists are paid the same whether they operate or not, 94% of men with low-risk diagnoses choose “active surveillance” instead of the knife. Here in the U.S., VA doctors are government employees and get a base salary rather than payment for procedures, and their patients choose active surveillance at the Swedish rate. Just a coincidence! Another factor: U.S. doctors can face huge malpractice suits if an aggressive cancer develops in a patient who has opted against surgery.

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Josef Federman, “Pfizer chief Albert Bourla wins $1 million Genesis Prize,” Associated Press, Jan 19, 2022 READ IT HERE

The prize is for “contributions to humanity and commitment to Jewish values,” awarded by a government-linked Israeli foundation. Pfizer arranged a deal with Israel that enabled the country quickly to provide up to four vaccine doses to its citizens (though not to people subject to Israeli military occupation). Bourla doesn’t need the money since he makes more than that each month from his base salary of $378,000 a week.

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Gail F. Levine et al., “US FTC/DOJ launch process to potentially rewrite merger guidelines,” Mayer Brown, Jan 21, 2022 READ IT HERE

FTC Chair Lina M. Khan and DoJ colleagues propose to update antitrust guidelines to take into account how competitive markets have changed. Expect howls of well-funded outrage from Amazon, social media companies, and others. “The thrust of the questions strongly suggests that the agencies view the current guidelines as too permissive and are considering ways to both strengthen the agencies’ hand during the merger review process and to lower the substantive bar that the agencies must clear to successfully challenge mergers.” Some factors could apply to the merger frenzy in health-related industries.

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Phil Taylor, “The top 10 biopharma M&A deals in 2021,” Fierce Pharma, Jan 18, 2022 READ IT HERE

Biopharma merger and acquisition (M&A) activity dropped off in 2021 after a few busy years. “The industry’s shift to smaller deals seemed to help avoid what appears to be an increasingly challenging antitrust environment in the U.S. under the Biden administration’s Federal Trade Commission.” [See above.]

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Justice News Flash, “More states target hospitals with anti-competitive contracting policies,” Jan 24, 2022 READ IT HERE

More court battles over the creeping consolidation in the health field, such as hospitals using monopoly power to control doctors’ patient referrals. A big case against California hospital group Sutter resulted in a $575 million fine. “Research shows that physician consolidation and the dominant health system’s exclusivity contract programs increase healthcare costs.”

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Medical Finance News, “5 digital health categories led VC investment in 2021,” Jan 20, 2022 READ IT HERE

Telehealth and data analytics were the most popular. “Venture capital investors have poured $89 billion into digital health companies since 2010.”

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Rachel Cohrs, “The Biden administration used billions in hospital Covid-19 funds to pay drugmakers, STAT, Jan 26, 2022 READ IT HERE

Biden took nearly $7 billion from a hospital support fund to buy Covid-19 vaccines and therapeutics. “The move is similar to the Trump administration’s decision to divert $10 billion from the same fund to Operation Warp Speed.” Biden promised in a private chat with donors during the campaign that “nothing will fundamentally change.”

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Katherine Ellen Foley & Megan Wilson, “‘Not a tolerable situation’: Patient groups take aim at CMS over Alzheimer’s coverage decision,” Politico, Jan 17, 2022 READ IT HERE

“Their goal is to strong-arm the Centers for Medicare and Medicaid Services into covering Aduhelm, the $28,200-per-year drug, for far more people.” Strong language. The patient groups complain that “no one’s going to invest in this space” if FDA approval isn’t enough. They should have thought of that before endorsing a rushed approval process and shrugging their shoulders over the insane original price. CMMS said their goal is to protect beneficiaries from a drug “without known benefits”—which immediately raises the question, Why did it get FDA approval? The Alzheimer’s Association and others plan to flood the CMMS with complaints during the 30-day public comment period.

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Matthew Perrone, “FDA halts use of antibody drugs that don’t work vs. omicron,” Associated Press, Jan 24, 2022 READ IT HERE

No complaints from patient advocates on this one. If it doesn’t work, why use it?

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Natalie Missakian, “How can pharma engage with caregivers? Try programs that ease their stress,” Fierce Pharma, Jan 10, 2022 READ IT HERE

“Pharma companies spend much of their marketing energy on doctors and patients, but another key stakeholder—the caregiver—is sometimes overlooked. And that’s a lost opportunity [because] 92% say they either spearhead or take an active part in their patients’ decision.” Oh, great, now relatives and home aides can be bombarded with Pharma ads and intrusive visits from pill peddlers. Who writes this stuff? Other recommendations: caregiver training and education programs, caregiver-specific information hubs, support services, online chat forums, and support groups. “I am Your True Friend, the drug company sales rep.”

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Janet Midega, “New global data showing 1.27 million deaths a year reveal the urgent need to address antimicrobial resistance,” STAT, Jan 19, 2022 READ IT HERE

Nothing much is left in the arsenal to treat common infections—result: a million-plus deaths a year. “As funders of the research, Wellcome, the UK Department of Health and Social Care, and the Bill and Melinda Gates Foundation are fully committed to supporting effective use of the data to inform action on AMR.” NOT “fully committed” to any revamping of the pharmaceutical system that led to this huge and dangerous gap, nor any mention of what caused it—as would be expected from a Gates-funded outfit partnered with a drug company.

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Julie Appleby, “HHS proposal for marketplace plans carries a hefty dose of consumer caution,” Kaiser Health News/NPR, Jan 19, 2022 READ IT HERE

Another way we can be defrauded: “Some insurance brokers are enrolling people into Affordable Care Act health plans without their consent, perhaps for the commissions [perhaps??], a move that could put consumers in danger of owing back the subsidies connected with the coverage.” Also, “previous [regulatory] actions have not done enough to curb the problem.” Agents, brokers, and web-based services are paid on commission and so have an incentive to commit fraud. At worst, they face only civil penalties and dismissal.

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Tom Avril, “Another old drug is being tried vs. COVID-19, and might actually help,” Philadelphia Inquirer, Jan 20, 2022 READ IT HERE

“Fluvoxamine, a 40-year-old drug that costs a fraction of the pricey new treatments for COVID, now looks as if might actually help.” And will be given a fair look UNTIL a Trumpian says something good about it. The early trial results are much less impressive than those testing dreaded ivermectin, the accursed “horse dewormer” that the blue team mocks the red team over.

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Michael Hiltzik, “A new study calculates the incredible cost of ivermectin stupidity,” Los Angeles Times, Jan 18, 2022 READ IT HERE

If Hiltzik knew the research better, he would not state in the first sentence that “it [IVM] doesn’t work on COVID-19.” We don’t know that yet as studies proceed, so the rest of his rant is, in fact, “ivermectin stupidity.” And saying that IVM is “promoted by the anti-vaccine crowd” is mere slander.

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Ross Douthat, “How being sick changed my health care views,” New York Times, Jan 19, 2022 READ IT HERE

Right-winger Douthat reviews what he learned/didn’t learn about healthcare American-style by getting seriously ill. All that “unnecessary” care he and his fellow experts blame for the high cost of healthcare and why we can’t possibly have M4A suddenly became entirely necessary exploratory tests when it came to the case of the needs of Monsieur Le Pundit soi-meme. “I went from doctor to doctor, specialist to specialist, submitting to tests that succeeded only in ruling out various plausible diagnoses, without actually pinning down the source of all my blazing pain. In these months I was given an object lesson in the ambiguities contained in terms like ‘overtreatment’ and ‘unnecessary care.’” But being on the receiving end of medical need only went so far for him—the idea that everyone should get the same benefit that Douthat had through his platinum New York Times coverage continues to elude him.

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SINGLE PAYER LINKS #241

Posted 20 JAN 2022

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Michael Hiltzik, “Single-payer healthcare is the right system. Can California build it on its own?” Los Angeles Times, Jan 14, 2022. READ IT HERE

CalCare would “say goodbye to the dead hand of private health insurers, to navigating in-network and out-of-network charges, to deductibles and co-pays, to substandard dental, vision, and hearing services.” Hiltzik, a senior health reporter, says Covid may have shifted the landscape because insurers are no longer waiving Covid-related costs, and he outlines details of CalCare’s proposed financing in a way that shows he finds it plausible. Also, he says, the state’s ACA exchange “has not only worked exceptionally well, but it also is arguably the most successful ACA exchange in the country,” undermining standard GOP talking points about the superiority of the private sector. California has been here before and backed off, but the case for single-payer is creeping forward steadily.

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Matt Stoller, “Hope on the horizon,” BIG, Jan 15, 2022 READ IT HERE

California passed a law in 2020 to break the insulin cartel by manufacturing insulin itself. Stoller, an antitrust expert, often covers anti-competitive aspects of healthcare.

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Richard Gilfillan & Donald M. Berwick, “Medicare Advantage, Direct Contracting, and the Medicare ‘money machine,’ Part 1: The risk-score game,” Health Affairs, Sep 29, 2021 READ IT HERE

Huge amounts of new investment are going into corporate vehicles that manage Medicare benefits. “Mr. Sutton, why do you rob banks?” “Because that’s where the money is.” Average Medicare spending per beneficiary is roughly $12,000 per year; over the lifetime of an individual, that’s a lot of reimbursement. Given that care providers only get a fraction of this total, there is a lot of arbitrage available to clever financiers like Medicare Advantage plan operators who extract excess fees from the government (upcoded through “risk adjustment”) while providing no additional clinical benefits. “These extraordinary profits are more likely to be captured by the for-profit parent entities rather than passed through to physicians delivering care.”

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Robert King, “MedPAC: Majority of Medicare beneficiaries to be on MA by 2023, but coding issues remain rampant,” Fierce Healthcare, Jan 14, 2022 READ IT HERE

The Medicare Payment Advisory Commission (MedPAC) “continues to raise alarms” over how these programs exploit the law to boost revenue. MedPAC found that the rush to MA programs “has not led to more savings for traditional Medicare,” which is the argument always used to let for-profit entities worm their way in. About 2/3 of the excess payments handed over to MA plan operators “are due to chart reviews and health risk assessments,” which, unsurprisingly, is a booming new business.

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Bob Herman, “Medicare Advantage enrollment soars almost 9%,” Axios, Jan 18, 2022 READ IT HERE

And why wouldn’t it? (See above.)

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Austin Ahlman, “Congressional Democrats join Republicans to undermine Biden Administration’s surprise medical billing rule,” The Intercept, Jan 17, 2022 READ IT HERE

The No Surprises Act was supposed to stop hospitals and doctors’ groups from inflating bills with the “out-of-network” trick that leave patients no recourse. It would require arbitration based on the insurers’ average charge and “could become a first step toward allowing the federal government to standardize rates for medical procedures covered under private insurance plans,” the very idea of which sets insurance execs’ hair on fire. Among the industry shills trying to kneecap the measure: Massachusetts Rep. Richard Neal, whom the Democrats defended from a credible primary threat by smearing his opponent over his (gay) sex life. “Neal has taken hundreds of thousands of dollars from the American Hospital Association over his more than three decades in Congress.”

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Annie Nova, “Many surprise medical bills are now banned. What to do if you get one anyway,” CNBC, Jan 7, 2022 READ IT HERE

“Unfortunately, providers aren’t going to write ‘Surprise!’ on top of a now-illegal bill,” said Caitlin Donovan, a spokeswoman for the National Patient Advocate Foundation. “It’ll be up to patients to recognize when the new protections should apply.” Oh, great. Advice from the article: examine all bills, flag anything higher than a normal copay or deductible, and then get ready to start fighting with the insurer, followed by a complaint to the feds (800-985-3059). If you get sent to collections, inform the agency that the bill is in dispute. Pay nothing. Meanwhile, remind yourself that “most Americans like their health insurance!”

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H. Gilbert Welch & Barnett Kramer, “The crazy confluence of Congress, liquid biopsies, Medicare, and health inequities,” STAT, Jan 12, 2022 READ IT HERE

All hail THE SCIENCE! Dozens of members of Congress want to mandate “an expensive cancer screening test backed by zero proof that it saves lives.”

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Ryan Finnerty, “Hochul signs new laws reducing prescription drug costs,” WBFO [Buffalo], Jan 4, 2022 READ IT HERE

The New York governor signed two of three bills passed with near unanimous approval in the state legislature. Pharmacy Benefit Managers (PBMs) are in the crosshairs and none too soon. Hochul vetoed a third bill dealing with Medicaid reimbursement rates for pharmaceuticals.

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Sarah Pringle, “GTCR nears $1.3 billion deal for electronic health records company Experity,” Axios, Jan 12, 2022 READ IT HERE

GTCR, a private equity firm, is buying into health data provision for the urgent care sector because of the uptick in that market due to Covid testing. Experity serves half of urgent care clinics in the U.S. “Investors see a lot of runway behind the digitization of health records and billing.” Runway.

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Lauren Gardner, “Senate panel advances Biden’s FDA pick in 13-8 vote,” Politico, Jan 13, 2022 READ IT HERE

Bernie Sanders, one of two Democrat NO votes, had this to say: “After leaving the FDA in 2017, [Biden’s FDA nominee Robert Califf] received consulting fees from Merck, Biogen and Eli Lilly. He owns up to $8 million in the stocks of major drug companies. That is exactly the close relationship Big Pharma has exploited to regulate the FDA instead of the FDA regulating them.”

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Ricardo Alonso-Zaldivar, “Medicare limits coverage of $28,000-a-year Alzheimer’s drug,” Associated Press, Jan 11, 2022 READ IT HERE

The yearly tab used to be $56,000, but the new drug was such a flop that Biogen had to cut it in half. Now, Medicare will only reimburse for Aduhelm if the patient is enrolled in a clinical trial to see if it works—which raises the question of why the FDA already approved it. The ruling applies to all drugs in Aduhelm’s class, “monoclonal antibodies designed to reduce amyloid plaques,” which means the other drug companies also got burned by Biogen’s debacle. Good! Next, we’ll have to see if Medicare Part B premiums, which were pre-emptively boosted to pay for Aduhelm, will come down.

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Bob Herman, “Big Pharma’s last-ditch lobbying blitz for Aduhelm,” Axios, Jan 14, 2022 READ IT HERE

After Medicare restricted reimbursement for Biogen’s turkey to patients enrolled in clinical trials, Pharma rolled out the guns to try to reverse the decision. Other drug companies have Alzheimer’s drugs in the pipeline and, following Biogen, want to guarantee themselves a payoff whether or not their treatments are any good. Patient advocacy groups, buried deep inside Pharma pockets, will chime in on their side.

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Mark Pazniokas, “AG, lawmakers review implications of hospital antitrust suit,” CT Mirror, Jan 13, 2022 READ IT HERE

More signs that the monopoly aspects of medicine are getting increased attention from both states and affected parties. Some of the fights are in the Mothra v. Godzilla category. (State Rep. Jonathan Steinberg: “At least we have two 800-pound gorillas in Connecticut, not just one.”) This case is about hospitals buying physician practices to create a closed clinic-to-hospital pipeline.

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Ben Adams, “The drive to digital in pharma marketing is ‘overwhelming’ doctors. Solution? Train digitally savvy reps,” FiercePharma, Jan 10, 2022 READ IT HERE

From a study: “62% of HCPs are overwhelmed by product-related promotional content they receive from drugmakers.” Covid-related restrictions on in-person visits have led to electronic avalanches. Bigger question: Why are doctors getting their drug info from parties that have an incentive to bamboozle them?

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Melody Gutierrez, “California poised to remove all immigration status rules for Medi-Cal healthcare,” Los Angeles Times, Jan 10, 2022 READ IT HERE

The governor proposes to use some of the state’s huge budget surplus to treat everyone living there equally vis-à-vis Medicaid eligibility. California first allowed immigrant children and seniors to qualify. Support for the change is growing among voters, according to polls.

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Blake Farmer, “App attempts to break barriers to bankruptcy for those in medical debt,” Kaiser Health News/Nashville Public Radio, Jan 11, 2022 READ IT HERE

Bankruptcy is expensive. “Upsolve” enables people to file without hiring a lawyer. “Upsolve’s data shows nearly half of its African American [and 40% of white] users cite the pandemic as the primary reason for filing.” Average Upsolve users had about $7,000 in medical debt before the pandemic; now, they have twice that.

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Rebecca Riddell, “Why is the U.S. trying to export its flawed health-care policies around the world?” Washington Post, Jan 10, 2022 READ IT HERE

The U.S. Agency for International Development is pushing “aggressive deployment of the full breadth of USAID’s financial and nonfinancial resources” to give private health companies the chance to give poor countries all the good things they have provided us. Enthusiastically backing the agency’s work with “private actors” is USAID director Samantha Power, Obama’s UN Ambassador.

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Li Cohen, “Arkansas inmates who were given ivermectin to treat Covid in jail file federal lawsuit: ‘They used as an experiment,’” CBS News, Jan 17, 2022 READ IT HERE

Of course, inmates should not be administered drugs without their informed consent, and the story describes practices that do sound like experimentation. But note the inflammatory language about a medication that is less risky than Tylenol. “The FDA and the CDC have repeatedly warned against the use of ivermectin for COVID.” No, the FDA has not “warned” people not to use it; it says there is no evidence it works. The exact language is “currently insufficient data to recommend” its use.

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Lucy Kerr, Flavio A. Cadegiani, Fernando Baldi et al., “Ivermectin prophylaxis used for Covid-19: A citywide, prospective, observational study of 223, 128 subjects using propensity score matching,” Cureus, Jan 15, 2022 READ IT HERE

Speaking of “currently insufficient data”: a massive study (n=159,561) incorporating an entire city in Brazil showed that ivermectin prophylaxis led to a 44% reduction in infection rates, a 56% reduction in hospitalization, and a 68% reduction in deaths (p < 0.0001 in each case). After all the clamoring for evidence, will this outcome shift the discourse about “horse dewormer”? There are no fortunes to be made in repurposing off-patent drugs, so don’t count on it.

SINGLE PAYER LINKS #240

Posted 11 JAN 2022

Arielle Zionts, “South Dakota Medicaid expansion will be on November 2022 ballot,” South Dakota Public Broadcasting, Jan 3, 2022 READ IT HERE

Another of the final 12 states holding out on Medicaid expansion is edging toward changing course. Voters in every state but one (Montana) who have had a chance to vote on the issue have said yes—red states residents are not suicidal, despite what their leaders think. But the SD state legislature is trying to change the referendum process to require 60% approval for any measures that raise taxes. People will probably like the sound of that although support might be strong enough anyway [see below].

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Eric Mayer, “AARP survey shows widespread support for Medicaid expansion [in South Dakota],” Keloland.com, Jan 4, 2022 READ IT HERE

Pro-expansion is 80% across party lines among voters over 50 y/o though AARP is biased in favor. Governor Kristi Noem, a rising GOP star, is opposed.

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Dave Ramsey, “Biden administration says premiums for Arkansas Medicaid expansion must end in one year,” Arkansas Nonprofit News Network, Jan 3, 2022 READ IT HERE

Arkansas will have to eliminate Medicaid premiums and drop the employment exception that led to 18,000 people losing their medical care in a matter of months. Some states dragged kicking and screaming into expanding Medicaid often add a virtue clause, i.e., you must jump through job-seeking hoops to prove you are worthy of seeing a doctor. The fact that these burdens—in a program called “Arkansas Works”—didn’t actually increase employment didn’t matter. If no one had to pay for health access, the whole debate about who deserves this “handout” would be meaningless.

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Richard Craver, “Forsyth [NC] legislators chosen to lead committee reviewing Medicaid expansion, reform,” Winston-Salem Journal, Jan 5, 2022 READ IT HERE

A bipartisan legislative committee will study how to expand Medicaid in North Carolina, another one of the 12 state holdouts. Ideological opposition from the Republican-controlled legislature is fading. One reason: a poll showed high levels of support for expansion among all voters, even 64% of Republicans. North Carolina is a large, relatively prosperous state where a decision to stop shooting itself in the collective foot would be significant. “The nonpartisan Commonwealth Fund [says] that North Carolina could gain 80,000 health-care jobs by expanding Medicaid coverage.”

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Adam Beam, “California Democrats revive universal health care bill,” Associated Press, Jan 6, 2022 READ IT HERE

California Dems are trying to set up a payment mechanism for the nation’s first healthcare system that marginalizes private insurance. Since states, unlike the Federal Government, have to pay for a single-payer system out of revenues, the heavy lift will be to convince Californians that a new insurance fee will be offset by the elimination of their current premiums, copays, and deductibles (and their huge costs to their employers). The average California employer now spends 9.9% of their payroll for health care, a figure the bill’s sponsor says would fall to 1.25% under his plan.

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Alex Keown, “460 drug prices already increased in 2022,” BioSpace, Jan 4, 2022 READ IT HERE

Price increases in the 3–7% range are common. Among the hikes: Perdue Pharma’s OxyContin. Another big jump was for Noden Pharma’s drugs for high blood pressure, up 9%. Drug companies charge whatever they want.

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Sarah Pringle, “Scoop: Novo buying Medical Knowledge Group at $1.15 billion valuation,” Axios, Jan 3, 2022 READ IT HERE

MKG provides “marketing services to drug companies,” which are aimed at providers to entice them to use specific Pharma products. Since the blockbuster-profit drugs are often for rare diseases, the companies need to influence specialty doctors. “MKG’s current owner is private equity firm Court Square.”

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Nick Stoico, “St. Vincent nurses approve contract, ending strike after nearly 10 months,” Boston Globe, Jan 3, 2022 READ IT HERE

“We can proudly say we have achieved our goals,” said nurse Marlena Pellegrino who co-chaired the bargaining unit. The new contract was endorsed by a vote of 487–9.

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Cyrus Moulton, “‘Mutual healing time’ at St. V: Can striking nurses, replacements hospital work together?” Telegram & Gazette, Jan 10, 2022 READ IT HERE

The comments suggest that while the nurses won, the cost was high. Tenet, the employer, held out for months to raise the cost of its concessions and discourage imitators. Nurses who return—expected to be about two-thirds of the strikers—will now go to work alongside the replacement and non-striking nurses. “It would be foolish to say we go in there and things would be Pollyanna, hunky-dory, but I think we will be fine,” said one.

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Blake Farmer, “Why an HBCU med school decided to put CARES Act money into students’ pockets,” Nashville Public Radio, Jan 4, 2022 READ IT HERE

The Meharry Medical College president sent $10,000 of CARES Act money to each current student (who then plotzed). Black students face extra obstacles to enter the medical professions: only 5% of the nation’s working doctors are Black. HBCU=Historically Black Colleges and Universities; Meharry is one of the oldest.

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Reuters, “Dr Reddy’s to launch generic COVID-19 Merck drug at about 50 cents a pill,” Jan 4, 2022 READ IT HERE

The Indian drugmaker will produce an equivalent for the Covid treatment (molnupiravir) that Merck sells for $700. Price in India: 20 bucks, available next week.

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Tim Stelloh, “Walmart, Kroger raise at-home Covid test prices after White House agreement expires,” NBC News, Jan 5, 2022 READ IT HERE

Emergency’s over, time for profit-as-usual.

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Nick J. Adam, “How Biogen fumbled Aduhelm, its once-promising Alzheimer’s drug,” TechLive, Jan 5, 2022 READ IT HERE

Includes some background on the error-strewn path of Aduhelm’s FDA approval. The company failed in many ways in the review process, but it knew how to get to the key bureaucrats who would buck scientific opinion and ram through the OK. Also, some good details on the sausage-making, specifically how the company met with top FDA officials outside the scientific review process. The only thing that can save Aduhelm now is a Medicare decision to approve its use.

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Kevin B. Kimble, “Why prescription drug access should be treated as a racial justice issue,” [opinion] The Tennessean, Dec 28, 2021 READ IT HERE

PBMs (Pharmacy Benefit Managers) were originally created to keep drug prices down. Eventually, they merged into just three oligopolistic mega-firms that do the opposite. Everyone pays the price, and the poorest suffer the most.

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Erika Gonzalez, “Drug price controls are essential for small businesses,” The Hill, Dec 28, 2021 READ IT HERE

Lays out the divergence of interests between old-fashioned capitalist enterprises and the financiers running the show, though she doesn’t phrase it like that. Biden’s stalled BBB package “includes key health care and prescription drug reforms small businesses have long been clamoring for.” But ideology-driven Republicans and big boy-friendly Democrats don’t hear them.

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Erin Brodwin, “Nomi Health buys Artemis for $200M,” Axios, Jan 6, 2022 READ IT HERE

One of the myriad financial deals going down involving the lucrative health sector that now accounts for 1/5 of the U.S. GDP. These two outfits will use data to “help U.S. employers fine-tune health offerings.” Nomi connects employers and providers while Artemis “scans employers’ health care budgets to trim the fat.” Not as in diets.

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Rebecca Pifer, “Biden admin proposes stricter network adequacy, marketing standards for MA plans,” Healthcare Dive, Jan 7, 2022 READ IT HERE

And none too soon. Medicare Advantage companies promote their plans with deceptive tactics and incomplete information while regulators are nowhere to be found. The proposed regs are heavy on monitoring services that the MA plans provide but weak on preventing practices like that shown here [attached]. (Note how the promo card I received is designed to look like an official Medicare communication rather than offering a commercial product.) “According to CMS, the number of beneficiary complaints about third-party marketing tactics more than doubled from 2020 to 2021.”

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Andrew Perez, “Joe Biden’s lobbyists are helping big Pharma profiteers,” Jacobin, Jan 4, 2022 READ IT HERE

“President Joe Biden’s top media buying firm is helping Big Pharma’s efforts to kill his party’s watered-down drug pricing legislation and targeting Senate Democrats up for reelection this year. A top Democratic Party media buying firm, Canal Partners Media, is placing ads for drug industry front groups that want to block Democrats from lowering drug prices as promised in the Biden reconciliation bill.” CPM handled $450 million in ad buys for the Biden 2020 campaign, no doubt awarding itself a succulent percentage.

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Stacy Bratcher, “The No Surprises Act: Beyond the emergency department, a silver lining of patient engagement,” STAT, Jan 2, 2022 READ IT HERE

The new law should enable people to know what a medical procedure is going to cost them before getting hit with the bill. This goes beyond the notorious problem of an ER visit that generates uncovered charges because of out-of-network doctor groups nested in in-network hospitals. Now, hospitals will have to provide a “good-faith” estimate. If the final bill comes in $400 or more above the estimate, the bill is supposed to go to “dispute resolution.”

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Neil Bedi, “A high-risk medical devise didn’t meet federal standards. The government paid millions for more,” ProPublica, Jan 7, 2022 READ IT HERE

The pump was found to be faulty, but the FDA didn’t communicate its finding to other agencies. Seriously? What sexual favors were provided to make sure no one in the gigantic CMMS or Veterans Affairs was ever told to read the small print? Meanwhile, “the FDA received thousands of reports of suspicious deaths and injuries and more than a dozen high-risk safety alerts from the manufacturer.” Multiple horror stories follow.

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Rachel Cohrs, “Covid-19 politics force state lawmakers to ponder pharma campaign cash,” STAT, Jan 4 2022 READ IT HERE

The spread of anti-vaxxer suspicion of the drug companies makes some candidates wary of taking Pharma money. Does it really matter if the logic behind anyone’s doubts is screwy? “The debate over Covid-19 politics is sure to be a hot-button issue in the midterm elections later this year, and campaign contributions will garner additional scrutiny.” Good.

Posted 5 Jan 2022

CBS News, “Elizabeth Holmes convicted of fraud but acquitted on other charges,” Jan 4, 2022 READ IT HERE

Bamboozling millionaires? Criminal. Endangering people’s health? Meh. From a wrap-up in the Wall Street Journal: “But the patients themselves barely featured in the nearly four-month trial. Just three patients testified out of 29 witnesses brought by the U.S., spending a combined 65 minutes on the stand, far less than 1% of the total time spent on witness testimony.”

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Darrel Rowland, “Billions of dollars potentially at stake for consumers, taxpayers in new probe of PBM fees,” Columbus Dispatch, Dec 17, 2021 READ IT HERE

“In a surprise move, a top federal regulator promises to delve into extensive fees assessed on pharmacies by drug-chain middlemen in what could be the first nation-wide crackdown on pharmacy benefit managers.” The regulator in question: Centers for Medicare and Medicaid Services (CMS) (the same outfit allowing the stealth Medicare-privatization scheme known as Direct Contracting to go forward). PBM fees, now totaling over $11 billion a year, were only $200 million in 2013. PBM practices drive the massive shutdown of independent pharmacies nationwide.

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Gretchen Morgenson, “‘Get that money!’ Dermatologist says patient care suffered after private equity-backed firm bought her practice,” NBC News, Dec 20, 2021 READ IT HERE

Private equity provider hell: “An email to the health care workers was like something out of The Wolf of Wall Street. ‘Don’t forget the August bonus incentive for all patients scheduled in August! That’s the easiest money you can make. Get that money!!’” After all, that’s why you studied medicine, right?

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Pitchbook, “Analyst note: Established private equity healthcare provider plays,” Dec 21, 2021 READ IT HERE

The main targets: dentistry, dermatology, behavioral health, vision care. “Positive reimbursement and demand dynamics have made behavioral health the hottest private equity provider segment.” Demand dynamics.

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Jeremy Menchik, “Confessions of a ‘human guinea pig’: Why I’m resigning from Moderna vaccine trials,” STAT, Jan 4, 2022 READ IT HERE

“I volunteered for the trial because I believed that helping Moderna develop a vaccine to help get the world out of the pandemic was worth it. That initial feeling has receded in recent months as I have come to understand that the noble enterprise of science-making I had imagined I was a part of is actually, first and foremost, an exercise in ruthless corporate profit-making.” His problem: Moderna not making its mRNA technology available for global production while the company racks up $15 billion in sales. Surprising that the guy, a college professor, was surprised.

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Rachael Levy, “Health spending growth more than doubled in first year of pandemic,” Politico, Dec 15, 2021 READ IT HERE

Spending on health care rose 9.7% last year while the overall economy contracted 2.2%. Nearly the entire increase came from the Feds. Healthcare is now almost 1/5 of the entire U.S. GDP.

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Tina Reed, “Democrats raise birth control coverage concerns,” Axios, Dec 21, 2021 READ IT HERE

“Providers and patients [are] being asked to jump through ridiculous, unnecessary, harmful hoops just to get the birth control,” said Washington senator Patty Murray. The industry replies that it is required by law only to provide “one product in each of the 18 contraception categories defined by the FDA.” A variation on “narrow networks.”

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Bernard J. Wolfson, “Layers of subcontracted services confuse and frustrate Medi-Cal patients,” Kaiser Health News, Dec 22, 2021 READ IT HERE

Medi-Cal is California’s $124 billion-a-year Medicaid program, which subcontracts to managed-care plans, which then subcontract to doctor networks or another layer of providers, which then hire external “claims managers.” What could go wrong? “Critics say each layer of administration diminishes the pool of dollars available for health care.”

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Michelle Andrews, “‘The charges seem crazy’: Hospitals impose a ‘facility fee’—for a video visit,” Kaiser Health News, Dec 17, 2021 READ IT HERE

Patient’s mom received a second bill for a “hospital facility fee” that the user never set foot in. The facility fee concept is invading doctors’ offices as well: “Patients seeing the same doctor for the same care as at earlier visits are now on the hook for the extra fee—because of a change in ownership.” Connecticut, the state where this occurred, banned charges for video visits but only until June 2023.

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Victoria Knight, “NICU bill installment plan: That’ll be $45,843 a month for 12 months, please,” Kaiser Health News, Dec 21, 2021 READ IT HERE

Horror Story of the Week: “After baby Dorian Bennett arrived two months early and spent more than 50 days in the neonatal ICU, his parents received a bill of more than $550,000—despite having insurance.” The new mom wasn’t worried as she worked for an insurance company and had carefully chosen her plan. But “Baby Dorian was born in 2020 and needed hospital care into 2021, and Bennett’s employer shifted its health plan to a different company in January 2021. Both insurance plans said the bill contained dates of care when Dorian was not covered, so neither paid the hospital.” The family repeatedly had to explain the two different billing dates to the geniuses in the various billing/reimbursement offices, none of whom could quite grasp the concept of a calendar. After KHN started asking questions, the original bill was knocked down to $300—suggesting there is an untapped role for advocates in similar cases.

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Jef Feeley & Anna Edney, “Unsealed emails show how J&J shaped report on talc’s links to cancer,” Bloomberg, Nov 8, 2021 READ IT HERE

“J&J and its talc supplier chose the scientists hired by their trade association, the Personal Care Products Council, to write the 2009 report [to the FDA] assessing talc-based powders’ health risks. They also show the researchers changed the final version of their report at the companies’ behest. The FDA said it relied in part on the report in its decision to forgo a warning for the product.” J&J is being sued by the state of Mississippi for refusing to put an ovarian cancer safety warning on the product, which the company avoided for almost 40 years. Advocates began warning of the risks of talc use in 1983. Meanwhile, J&J created a new corporate unit to ring-fence the parent company against a flood of lawsuits. Read the account of the discovered emails—looks like a slam-dunk case for corporate fraud and cover-up. The FDA relies on industry-massaged reports due to its tiny oversight budget.

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Kathleen R. Hennessey, “Retired teachers, do your homework when choosing a health insurance plan,” CT Mirror, Nov 9, 2021 READ IT HERE

During the enrollment period, insurers offered information sessions throughout the state “heavily slanted toward the Advantage plan. Additionally, in the complimentary tote bag given to all participants, only Advantage plan materials have been provided. Supplement [Medigap] plan materials were provided only upon request to those who thought to ask.” Where are the state regulators? AWOL or paid off? Also, why should anyone have to do “homework” over this stuff?

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Yamil Berard, “Children’s Healthcare of Atlanta amasses immense wealth as some Georgia families struggle to access quality pediatric care,” Atlanta Journal-Constitution, Dec 19, 2021 READ IT HERE

“Children’s is one of the richest pediatric health care systems in the country [with] unrestricted cash reserves of more than $6 billion. Yet the system provides relatively little free and discounted care to families who may face overwhelming bills for their children’s treatment.” Children’s charity care averages less than $25 million a year. Some calls for tougher standards have emerged from Congress, most notably from GOP Sen. Charles Grassley of Iowa. Republicans tend to side with the insurers, Dems with hospitals.

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Peter Arno, Robert Sachs & Kathryn Ardizzone, “Will the Biden administration use ‘march-in’ to protect prostate cancer patients from excessive drug prices? STAT, Jan 3, 2022 READ IT HERE

“Astellas Pharma is charging U.S. patients $156,000 a year for the prostate cancer drug Xtandi (enzalutamide)—more than three to five times what it charges residents of other wealthy countries. Adding insult to injury, Xtandi was discovered by scientists at the University of California, Los Angeles, with grants from the National Institutes of Health (NIH) and the U.S. Army.” The HHS could exercise “march-in rights” and lower the cost—an easy win for Biden whose approval ratings are crashing due to inflation and lack of action on health/drug costs. Do Democrats want to govern, or do they prefer life in the “resistance”?

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Nick Corbishley, “Why is the UK’s National Health Service being run by former bankers?” Naked Capitalism, Dec 31, 2021 READ IT HERE

Because bankers are taking over everything as part of the replacement of industrial capitalism by financiers. Senior banker Richard Meddings is the new chair of NHS. He joins health secretary Savid Javid, who formerly structured mortgage bonds for JPMorganChase—clearly an ideal resumé for running a health service.

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Ricardo Alonso-Zaldivar, “Medicare urged to flex its power and slash back premium hike,” Associated Press, Dec 13, 2021 READ IT HERE

Now that Aduhelm is being rejected by providers, why is the entire Medicare population still paying for it? Half the announced $22 hike is due to the useless turkey from Biogen that doctors and patients are running away from. With the Democrats due to get clobbered in November over inflation, this should be a no-brainer.

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Lydia DePillis, “This scientist created a rapid test just weeks into the pandemic. Here’s why you still can’t get it,” ProPublica, Dec 21, 2021 READ IT HERE

The FDA has hilariously lax benchmarks for approving expensive sugar pills like Aduhelm but held Irene Bosch’s ready-to-go rapid Covid test to such a high standard that there were no tests available for the first year of the pandemic—another example of the massive fail over testing that has plagued the U.S. from the start. Two years too late, the FDA “has been coming around to [Bosch’s] way of thinking. Last month, it published a new template that lowered the sensitivity standard for single-use over-the-counter tests to 80%. Bosch had tests a year and a half ago that missed that bar by 1%.”

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Linda Bonvie & Mary Beth Pfeiffer, “A myth is born: How CDC, FDA, and media wove a web of ivermectin lies that outlives the truth,” Substack, Dec 23, 2021 READ IT HERE

I’ve read this twice and still can’t believe it: gross journalistic malpractice about “ivermectin overdose” combined with confirmation bias/outright deception from governments, plus the medical-industrial complex’s worship of expensive pharmaceutical drugs and the companies that produce them. “New Mexico officials admit they were wrong: Two people died from covid. NOT from ivermectin. Yet the CDC generated the nation’s highest health alert and a thousand fake headlines on false cases.” After these reporters asked for the data on which the CDC based its national health alert, “the CDC asserts in a letter to us that it no longer possesses the data.” For the record, ivermectin has been prescribed 4 billion times worldwide and is safer than Tylenol.

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Morgan Artyukina, “Israeli pharma giant Teva found responsible for opioid addiction epidemic in New York trial,” Sputnik International, Dec 30, 2021 READ IT HERE

In a lawsuit brought by the state attorney-general. Combined with the judge tossing Perdue’s cozy bankruptcy deal and an adverse jury ruling in Ohio against three pharmacy chains, things are looking a little less prosperous for the whole opioid cabal. The article includes this rare comment: “Drug addiction is a symptom of a much larger problem: painkillers have become a stopgap measure for millions of poorer Americans unable to afford expensive treatments for chronic illnesses.”

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