SINGLE PAYER LINKS

Posted 12 DEC 2023

Hi everyone,

Just one article with a long commentary this time as I am taking some holidays. Tim

Here is the “Do Not Resuscitate” podcast covering this SPL: LISTEN TO PODCAST!

AND HERE IS THE ARTICLE

This is a truncated version of SPL highlighting a single topic: the lawsuit against Pfizer brought by the Consumer Protection Division of the Texas Attorney General’s office over Pfizer’s “serial misrepresentations and deceptive trade practices.” I included a link to this action last week and mocked it as containing “performative antivax wackadoodle.” While the antivax sentiment is definitely there, I was unfair about the content of the lawsuit. I have since read it in its entirety and found much to explore further.

Texas has a standing Deceptive Trade Practices Act (DTPA), which prohibits “false, deceptive, and misleading acts and practices in the course of trade and commerce.” The state claims in a 64-page filing that Pfizer did just that. If the suit is allowed to proceed, Texas may be granted discovery of all sorts of internal Pfizer documents and communications that could tell us a lot.

Texas first argues that Pfizer—with the active encouragement of the White House and the regulatory apparatus—intentionally confused the public by trumpeting certain statistics and obscuring others. The FDA specifically warns against statistical legerdemain in public communications because to an innumerate population like ours (or probably any in the world), Pharma can make drugs look great whether or not they really are.

In the clinical trial that led to Pfizer’s vaccine approval, the company put approximately 17,000 people into each of two arms: one group got the shot while the other got a placebo. After two months, only 8 vaccinated patients got symptomatic Covid versus 162 among the placebo takers. Sounds like a slam dunk. But there are problems with this conclusion.

Pfizer did NOT count as a case of Covid infection any that occurred in the period between shot 1 and shot 2. We now know that a lot of infections occurred in that window, namely 409 in the treatment arm and 287 in the placebo arm. The fact that a substantially larger number of infections popped up among people just vaccinated with shot 1 is certainly noteworthy in itself—not that anyone ever mentioned it to us. But if we add them to the other totals, we get 417 (vaccine) versus 449 (no vaccine) cases—a much less impressive statistic.

This says nothing about the vaccine’s efficacy in keeping people out of hospitals, which anecdotally we assume it had—Pfizer didn’t study that. (A nurse friend told me that all his Covid ICU patients were unvaccinated in 2022.) This debate is strictly about identifiable cases of Covid infection, which formed the basis of the FDA’s accelerated approval.

Another problem with the rosy stat that Pfizer used to broadcast its vaccine’s merits is that the key study measured only symptomatic Covid cases, NOT confirmed cases on Covid-positive tests. While one could argue that this made practical sense as we needed to know whether or not the vaccine helped us avoid getting sick, it was misleading when Pfizer tried to convince us that vaccination was key to stopping forward transmission to others. Texas is particularly scathing on this point.

The lawsuit points out that Pfizer had zero evidence that their shots prevented people from passing Covid on to others despite the guilt-inducing rhetoric about our responsibility as altruistic citizens and the virtue of “protecting your loved ones.” Pfizer chief Albert Bourla even talked about his vaccine “killing” the virus when the study hadn’t even asked that question, much less answered it. Similarly, Bourla bragged about the vaccine’s protective effects lasting for at least 6 months when their study hadn’t even accumulated 6 months’ worth of data.

States Texas: “Pfizer’s false and misleading statements had a cascading effect in the media, which through multiple formats repackaged and disseminated Pfizer’s deception campaign to the public.” Media cooperation with the official narrative was indeed overwhelming as anyone alive during that time can attest.

Starting at page 46, or about two-thirds into the brief, Texas opens up what could be the most damaging claim against Pfizer (and others not named as defendants): that the company “intimidated and silenced persons who spread information about the vaccine that undermined its false efficacy narrative.” The detail includes communications between ex-FDA chief Scott Gottlieb, then a member of Pfizer’s board, and Twitter demanding that it censor reporter Alex Berenson who was (accurately) questioning the claims that the vaccine prevented transmission or was quite as effective as the official narrative insisted. Berenson was promptly banned from Twitter.

We have since learned that this was just the tip of the censorship iceberg and that a massive campaign led by “disinformation” operatives closely linked to government agencies successfully suppressed unhelpful (even if true) commentary about the vaccines’ less than stellar performance. Bourla calling people who dissented from the official line “criminals” who were “costing millions of lives” was just the more inflamed sort of pro-vax rhetoric that stamped out public debate on the facts.

Conclusion: The fact that Texas A-G Ken Paxton is not a nice person is irrelevant to the merits of these claims. Furthermore, while Paxton is undoubtedly pandering to anti-vax sentiment among his political base and strengthening the dangerous anti-vax movement, that does not mean the arguments made here are wrong. In fact, one could argue—and I do—that the suppression of debate, whether honest, dishonest, sober, ill-intentioned, well informed, or wacko, in the long run will discredit backers of vaccination campaigns for decades to come. What could be more damaging to the future of vaccines against measles, diphtheria, and rubella than evidence that we were systematically lied to while Pfizer pocketed billions of (our) dollars and joined government officials in crushing dissent?

I hope the lawsuit proceeds.

Happy holiday season to all, and see you in 2024!

Tim

This is a longer digest and podcast as I wind down for the holidays. Next week will be a very short one, then I'm off until January.

Tim

Listen to the summary of SPL #327 here: https://www.podbean.com/ep/pb-jqhg4-151db25

PAYER LINKS #327

Posted 8 DEC 2023

*

Wendell Potter, “Cigna said to be going after Humana to buy its way into Medicare Advantage,” HEALTH CARE un-covered, Nov 28, 2023 READ IT HERE

Deeper, broader, and deadlier concentration: The engineers of this mega-merger will try to sidestep antitrust enforcement by arguing that because Humana mostly runs Medicare (Dis)Advantage plans while Cigna mostly does commercial insurance, they aren’t in competition. But at the very least, it would create a gigantic pharmacy benefit manager (PBM) in an already highly concentrated sector. Also, see Matt Stoller below on how the ACA facilitated a particularly dangerous type of concentration in healthcare that is at least as bad as old-fashioned horizontal monopolies.

*

Matt Stoller, “How Obamacare created big medicine,” BIG, Apr 7, 2023 READ IT HERE

From April, eye-opening: “Obamacare caused health care payers to combine with health care providers, transforming health insurers into much larger and more powerful conglomerates.” Today, UnitedHealthcare not only sells insurance but also employs 50,000 doctors. The result: “In 2004, the average insured family of four paid $11,192 in health care costs; by 2022 that amount was $30,260.” Highly recommended reading for understanding today’s health finance landscape of vertically integrated behemoths and why tinkering around the edges won’t work.

*

Paige Minemyer, “Cigna, Humana exploring insurance mega-merger,” and “Analysts say a Cigna-Humana merger is likely to face major antitrust opposition. But here's how the payers could eke out a win,” Fierce Healthcare, Nov 29, 2023 & Dec 1, 2023 READ IT HERE

This one will be in the crosshairs of the Federal Trade Commission as letting these two insurance giants get together would exacerbate concentration. But “because Cigna and Humana have fairly different focuses, the merger could be viewed as more of a vertical deal than a horizontal one.” Industry leader UnitedHealth is already a “growth juggernaut” that combines a PBM, clinical care, data analytics, telecare, and other elements of the are continuum.

*

Harris Meyer, “FTC chief gears up for a showdown with private equity,” KFF Health News/Fortune, Nov 30, 2023 READ IT HERE

The FTC recently sued a big anesthesiology group over monopolistic practices that “sharply drove up prices,” a harbinger of tighter scrutiny of the PE invasion of healthcare. The innovation is that the Commission is targeting “roll-ups” by which a PE firm gets into a particular market and starts absorbing the competition little by little to avoid regulatory oversight. If the FTC is successful, it won’t be as easy for these Wall Streeters to use borrowed cash to wreck medical services in pursuit of short-term profits, then dump everything and leave. “The PE firm’s goal is to garner at least 20% dividends a year and then sell the group to another investor for at least three times the purchase price in 3 to 7 years,” also known as “looting” Tony Soprano-style.

*

Dave Muoio, “Missouri nonprofit systems BJC HealthCare, Saint Luke's $10B merger will close Jan. 1,” Fierce Healthcare, Nov 29, 2023 READ IT HERE

Another hospital merger in a major city will create a 28-hospital, cross-market behemoth spread over Missouri, Illinois, and Kansas. This corporate marriage avoids some of the usual regulatory scrutiny because the entities aren’t rolling up the competition in a single city or area, which could draw an antitrust complaint. However, the FTC is starting to look at these multi-city mergers as well.

*

Sarah Schutz, “Mergers, prices, and innovation: Lessons from the pharmaceutical industry,” University of Pennsylvania [academic paper], Nov 8, 2023 READ IT HERE

“Ultimately, M&A leaves consumers at a net loss with higher drug prices and a pharmaceutical industry that is less efficient at producing the innovation that defines its business model.”

*

Jessica Wildfire, “The kids are not okay. Stop making them sick,” Jessica Wildfire, OK Doomer, Dec 2, 2023 READ IT HERE

Despite the unusual outbreaks of pneumonia around the world, we’re consistently told not to panic. The author suggests that we’re stuck in the post-Covid mindset in which authorities tut-tut concerns about infectious disease. “It’s alarming to see a pathogen considered mild suddenly resulting in surges of pediatric hospitalizations.” She doesn’t explicitly echo what others are saying: that Covid infections may have undermined people’s immunity.

*

Olivia Casey & Frederick W. Miller, “Autoimmunity has reached epidemic levels. We need urgent action to address it,” Scientific American, Dec 1, 2023 READ IT HERE

Given that autoimmune diseases now affect 1 in 5 Americans, the authors call for work on better ways to prevent, diagnose, treat, and cure them. But why have autoimmune diseases tripled among U.S. teens in recent decades? They mention diet, sleep deprivation, stress, air pollution, exposure to toxic chemicals, and infections as possibilities but then propose a specialized research institute to be created within the NIH—a good way to narrow the focus to a disease/treatment model and pour cash into the testing of expensive pharmaceuticals.

*

The John Snow Project, “Where are our leaders? The social, economic and public health costs of pretending we can live normally by ignoring COVID-19 are not sustainable,” 25 Nov 2023 READ IT HERE

JSP is the anti-Great Barrington Declaration group whose members believe Covid may be much more serious in the long run than we are encouraged to think. They note the “alarming rise in disability and excess mortality in the United States” that others are passing off as vaccine-related. “Vaccine skeptics are promoting the dangerous falsehood that COVID-19 vaccines, not COVID-19 itself, are the cause of the unprecedented decline in almost every measure of public health.” A lively debate, which should NOT be censored off social media by the information nannies. Also, they list the surprising personnel shortages in a range of “high-contact” professions and work categories, chronic absences in schools, and general cognitive decline at the population level.

*

Jeff Lagasse, “[A study claims that*] Medicare Advantage beneficiaries see better health outcomes,” Healthcare Finance News, Nov 8, 2023 READ IT HERE

A new study claims that MA patients are hospitalized less, readmitted less, and take high-risk meds less often than a comparable group of traditional Medicare, fee-for-service (FFS) patients. Maybe that’s because MA plans spend less money on their enrollees? The causal pathway needs some clarification. (P.S. *Fixed the headline for you. Studies describe what researchers think they found, not Revealed Truth.)

*

Madhav Thambisetty, “Manufacturers need to be more open about a dangerous Alzheimer’s drug side effect,” STAT, Nov 28, 2023 READ IT HERE

“While the modest benefit of Leqembi in slowing the progression of Alzheimer’s has been highlighted both in medical journals and the media, relatively less attention has been paid to common side effects of the drug: brain swelling and bleeding,” which occurred in the test group among 12% to 35% of all patients. The skeptical author, who treats Alzheimer’s patients, notes that there is no follow-up data on the long-term effects and little attention to the infrequent but devastating adverse events associated with the drug.

*

Rebecca Pifer, “Medicare Advantage rate change bedevils UnitedHealth’s 2024 outlook,” Healthcare Dive, Nov 30, 2023 READ IT HERE

“UnitedHealth is now saying that MA growth could be depressed next year thanks to a rate notice from the CMS that’s deeply unpopular with insurers.” That’s a shame. UH’s Medical Loss Ratio will rise one point to 84%—isn’t it just awful that insurers have to spend their hard-earned money on healthcare? “The changes also include a new approach to risk adjustment meant to curb upcoding, a practice where insurers inflate their members’ sicknesses to get higher payments from the government.” Those pesky regulators again!

*

Julie Appleby, “Medicare Advantage increasingly popular with seniors—but not hospitals and doctors,” KFF Health News, Nov 29, 2023 READ IT HERE

“A hospital system in Georgia. Two medical groups in San Diego. Another in Louisville, Kentucky, and nearly one-third of Nebraska hospitals. Across the country, health care providers are refusing to accept some Medicare Advantage plans even as [they] increasingly displace the traditional government program.” Yay hospitals! Go doctor groups! Maybe they can shake some sense into our AWOL officials and politicians over things like robot-issued claim denials and prior authorization hell.

*

Gary D. Robertson & Hannah Schoenbaum, “Hundreds of thousands in North Carolina will be added to Medicaid rolls this week,” Associated Press, Nov 30, 2023 READ IT HERE

North Carolina finally agrees to add 600,000 of its citizens to Medicaid with the Federal Government picking up 90% of the costs. How many died waiting the 10 years it took NC to make up its mind?

*

Isabella Cueto, “New research supports potential link between low-level lead exposure and liver injury,” STAT, Nov 27, 2023 READ IT HERE

New research “suggests a link between Black Americans’ higher exposure to environmental toxins and advanced liver scarring, which can lead to disease and cancer. African American participants had higher blood levels of almost all pollutants associated with liver disease.” Ambient poisons should get more attention, but there’s more profit in looking for expensive treatments after the horse has left the barn.

*

Spencer Kent, “Bitter strike over as nurses, N.J. hospital reach tentative agreement after 120+ days,” NJ.com, Dec 2, 2023 READ IT HERE

After striking a hospital owned by RWJBarnabas Health for 4 months, nurses won their core demands including enforceable nurse-to-patient ratios—the same issue that New York nurses struck over earlier this year.

*

Noam Scheiber, “Why doctors and pharmacists are in revolt,” New York Times, Dec 3, 2023 READ IT HERE

Unionization among health workers is taking off as doctors lose independence and nurses are squeezed by corporate management eyeing revenues and share prices. A big healthcare union, SEIU, says it’s getting more calls from doctors around the country about unionizing because “they are being asked to do more as staffing dwindles, leading to exhaustion and anxiety about putting patients at risk.” The pandemic exacerbated trends already underway.

*

Jacob Wendler, “Northwestern Medicine physicians file to unionize,” Daily Northwestern, Dec 1, 2023 READ IT HERE

The system’s 1,300 physicians intend to unionize with the Committee of Interns and Residents, an SEIU local. Their familiar beef: inadequate staffing and support systems that undermine patient care.

*

Chad Terhune & Robin Respaut, “Maker of Wegovy, Ozempic showers money on U.S. obesity doctors,” Reuters, Dec 1, 2023 READ IT HERE

Pharma incentivizes doctors to flog their fat shots: Novo Nordisk shelled out $25 million in direct payments to MDs, not counting cash for research. Of the 57 doctors who each got at least $100,000 from Novo, “41 were obesity specialists who run weight-management clinics, work at academic hospitals, write obesity-treatment guidelines, or hold top positions at medical societies.” This is considered normal practice. And the patient advocacy groups are not far behind: The Obesity Action Coalition relies on funding from Novo [for] more than $500,000 annually”—couch lint for Novo, which is raking in billions.

*

Stephanie Nolen, “Egypt wiped out hepatitis C. Now it is trying to help the rest of Africa,” New York Times, Dec 1, 2023 READ IT HERE

Egypt cured 9 million citizens of Hep C and is even donating treatments to other African countries. That was through an extraordinary public health campaign to screen and treat everyone in the country, made possible because Egypt negotiated a price of $10 a pill for Hep C drugs while they still cost $1000 in the U.S., guaranteeing that we’ll have a (lucrative) Hep C epidemic for decades to come. Deadly fact: Western agencies pushed mass vaccination campaigns in Egypt starting in the 1950s, but the use of improperly sterilized needles to prevent one disease spread another—Hepatitis C—throughout the population.

*

Francis Collins, “We are squandering one of the most important medical advances of the 21st century,” New York Times, Nov 28, 2023 READ IT HERE

Ex-NIH chief Collins reports that 2.4 million Americans remain infected with hepatitis C without access to the cure. Why is that, Dr. Collins? Go ahead, spit it out—price gouging. Nope, he can’t say it. “The cost of curative medications remains stubbornly high.” Note the lack of human agency—prices “remain high” without anyone actually setting them there. He recommends the Louisiana “Netflix model” in which the state buys a whole batch of treatments for a lump sum. Not Word One about forcing the prices down. Egypt eradicated Hep C; we refuse to.

*

April Rubin & Erica Pandey, “Aging America faces a senior care crisis,” Axios, Dec 3, 2023 READ IT HERE

As America's population of seniors grows, affordable long-term care is increasingly hard to find. Medicare doesn't cover many of these services, and Medicaid often has long waiting lists for at-home support.

*

Reed Abelson, “Desperate families search for affordable home care,” New York Times/KFF Health News, Dec 4, 2023 READ IT HERE

“In dozens of interviews, families described a desperate and sometimes fruitless search for aides to help loved ones with simple tasks at an hourly rate they can afford. There is precious little assistance from the government.” For people who have built up any retirement income, end-of-life care, especially when dementia is involved, is guaranteed to soak up the assets and leave nothing. Ironically, the only exception is people already poor enough to qualify for Medicaid. Given our demographic trends, a serious country would be making plans to address this.

*

Karen Brooks Harper, “Texas attorney general sues Pfizer, claiming vaccines didn’t end pandemic quickly enough,” Texas Tribune, Nov 30, 2023 READ IT HERE

Please, can they both lose? The Texas AG is just back at the job after an impeachment trial for bribery failed. His lawsuit alleges Pfizer “engaged in false, deceptive, and misleading acts and practices” about its vaccine product. Notwithstanding Pfizer’s shortcomings, the lawsuit is full of performative, antivax wackadoodle.

*

Jennifer Rigby, “‘Staggering’ rise in measles cases last year, says WHO and CDC,” Reuters, Nov 16, 2023 READ IT HERE

Measles cases were up 18% worldwide, mostly among children, with “large or disruptive outbreaks” in 37 countries. Culprit: declining vaccination rates.

*

Dean Baker, “When it comes to prescription drugs, the Washington Post can’t even conceive of free trade,” Center for Economic and Policy Research, Nov 27, 2023 READ IT HERE

Baker mocks the free-traders who love protectionism for pharmaceuticals and reminds us that patents aren’t the only way to encourage drug discovery. The government could fund research directly as it did with Moderna’s Covid vaccine. “While the WaPo would usually go on the warpath over a tariff of 10–25%, it is apparently just fine with this much larger tariff that keeps drug prices high.”

*

SINGLE PAYER LINKS #326

Posted 2 DEC 2023

*

Here's the podcast summary of this week's digest: LISTEN TO PODCAST! And contact Tim Frasca here.

*

Susan Jaffe, “Uncle Sam wants you … to help stop insurers’ bogus Medicare Advantage sales tactics,” KFF Health News/NPR, Nov 30, 2023 READ IT HERE

MA snake-oil sales are way up because the Feds are incompetent at stopping their lies. It’s so out of control that the Medicare overseers are pleading for citizen militants to become “fraud detectives.” As usual, the Feds set rules and then wring their hands at mass corporate abuse of them. Here are just a few of the lies being peddled nonstop on our airwaves:

• Promises that MA benefits are available to all who sign up when only some individuals qualify;
• Mentions of benefits not available in the area where they are advertised;
• Claims of hugely unrealistic savings on drugs that apply only in rare circumstances;
• Displays of the official Medicare name, membership card, or logo suggesting the message is from the government;
• Calls pretending to be from the government-run Medicare program (which does not cold-call beneficiaries);
• Promises of expanded access to doctors. [I’m adding this one, which I witnessed in an ad and is a blatant lie.]

“If you think a company is violating the new rules, contact CMS at 800-MEDICARE, its 24-hour information hotline.” How about instead of chasing after a runaway train, we abolish MA entirely?

*

Dave Muoio, “Hospitals: UHC’s 2024 MA coverage policy ‘blatantly violates’ new CMS coverage requirements,” Fierce Healthcare, Nov 27, 2023 READ IT HERE

Here’s why the Feds will always be fighting a rearguard battle trying to get for-profit Medicare Advantage portfolios to match traditional Medicare’s simpler procedures. Insurers are openly announcing that they will ignore the new rules as in “Whaddaya gonna do about it?” One plan “issued a policy that adopts a more stringent standard than CMS for evaluating a physician’s judgement at the time of admission.” It’s called blocking care to increase profits.

*

Bill Haskell, “AHA urges CMS to correct Medicare Advantage plan 2024 rule violations,” Angry Bear, Nov 26, 2023 READ IT HERE

More on Business as Usual regardless of federal rules: Despite “far-reaching changes” announced by the Feds for 2024, “it is striking that several large [MA purveyors] report to our members that they do not intend to make any modifications to their utilization management protocols.” The government issues rules; insurance companies promise to ignore them. Among the violations being prepared: retroactive review of inpatient stays even though they received prior authorization and ignoring the 60-day limit to resolve appeals (lengthy back-and-forths delay payments). The sleaziest trick by the MA plans is denials based on what they call a “payment integrity administrative review,” which they then pretend is separate from a determination of medical necessity. In summary, for regulations to be meaningful, monitoring and enforcement must follow. I keep seeing a role for the advocacy world—is that naïve?

*

Robert King, “‘It was stunning’: Bipartisan anger aimed at Medicare Advantage care denials,” Politico, Nov 24, 2023 READ IT HERE

“Enrollment in Medicare’s private-sector alternative is surging—and so are the complaints to Congress.” Legislators are ramping up criticism and tinkering with the rules. One senator remarked, “It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care.” Hospitals are fighting back by refusing to take MA patients. Good for them, but why not just abolish it entirely?

*

Sydney Halleman, “Healthcare bankruptcies are rising. Here are five major filings so far in 2023,” Healthcare Dive, Nov 22, 2023 READ IT HERE

Over 80 healthcare companies have filed for bankruptcy this year, including staffing firms, hospitals, pharmaceutical companies, and senior living facilities. The reasons listed here include: lapse of Covid funding; the No Surprises Act, which enabled insurance companies to stiff them; and debt, especially where private equity is involved, such as the case of nurse and doctor staffing agency Envision that just went bust. Another bankrupt staffing outfit, American Physician Partners, blamed the No Surprises Act because insurers could “significantly delay and unilaterally reduce or deny payments.” Tough to see other corporates getting the shaft from insurance companies just like we mortals do.

*

David Gorski, “The Great Barrington Declaration and “natural herd immunity” versus public health three years later,” Science Based Medicine, Nov 13, 2023 READ IT HERE

Bear with me for a lengthy note on this one: Covid killed over a million Americans, but incredibly, the idea of a public health response to an infectious agent is now discredited—even illegal in some states. The responsibility for this debacle is broadly shared. This article takes to task the ideologues behind the Great Barrington Declaration, promoted by a “free-market” think tank to recommend that we let the Covid pathogen rip through society and forget protective measures in the name of “natural herd immunity.” Such thinking fit nicely with laissez-faire economics—ignore the deaths and get back to work.

GBD’s idea was that the young and healthy, presumably at very low risk of serious illness and death from COVID-19, should go about their business while vulnerable seniors and chronically ill would get “focused protection.” But there was a problem: herd immunity can only occur if the pathogen is blocked after infection—Covid doesn’t work that way. Instead, we have new variants popping up regularly for which we are unprotected either by vaccine or prior infection. The author claims that the GBD was “eugenicist” in that it “basically advocated letting the elderly and unhealthy die in service of society.” That was loathsome, but the attempt to suppress the GBD and similar sentiments didn’t work—its authors were celebrated by Trump, DeSantis, and Boris Johnson while censorship only discredited the Dem-leaning public health experts and collaborating media.

GBD was crackpot, but relentless lying on the other side by the purveyors of The Science™ didn’t help either. This is a dense but must-read post mortem—obituary really—for any public health response to disease outbreaks in the future. The anti-GBD camp gathered at the John Snow Project laments: “Public health interventions are [now] an unacceptable assault on ‘personal freedom’ that must be resisted at all costs.” So much for the successful efforts to control diphtheria, pertussis, hepatitis B, polio, measles, mumps, rubella, malaria, typhus, typhoid, leprosy, cholera, tuberculosis, and whatever pops up next. We’re on our own, or as M Thatcher would say, “There is no such thing as society.”

*

C. A. Bridges, “What’s new in Florida Department of Health COVID reports after the lawsuit? What’s missing?” Florida Today, Nov 27, 2023 READ IT HERE

“After years of slow-walking or refusing public records requests for specific COVID data and changing the way it counts cases,” Florida is promising to share the facts—some of them anyway. At least we’ll know how many Floridians died of Covid—hidden up to now. But the new format for the numbers is designed to obscure what they mean. “The data is there. But the easy-to-understand charts which allowed average readers to see at a glance the increase or decrease in cases, positivity rates, and doses administered are no longer provided.”

*

Evan Blake, “Thanksgiving travel fuels latest COVID-19 wave amid collapse of public health,” World Socialist Web Site, Nov 21, 2023 READ IT HERE

“Misled by the government and media, the vast majority of [Thanksgiving travelers] are unaware that their travel coincides with and will facilitate yet another wave of the COVID-19 pandemic across the US.” An estimated 750,000 new Covid infections occur every day in the U.S., projected to rise to 1.3 million daily by Christmas. Flu deaths in October: 145; Covid deaths: 5,305.

*

Department of Justice, “Pharmacy owners and doctor convicted for $145 million health care fraud, money laundering, and tax evasion scheme,” Nov 17, 2023 READ IT HERE

Pharmacy owners conspired with a doctor to bilk a state agency and an insurer for tens of millions. The lobbying arm of the PBMs (Pharmacy Benefit Managers) immediately crowed, “That’s why you need us! We steal legally!”

*

[No byline], “Insurance executives refused to pay for the cancer treatment that could have saved him. This is how they did it,” ProPublica/Scripps News, Nov 26, 2023 READ IT HERE

A patient needed a cutting-edge therapy. His insurer was legally compelled to provide it. They didn’t. He died. “Companies can get away with this because the thinly staffed state agencies that oversee many insurers typically don’t open investigations unless patients file complaints.” Advocates: Again, isn’t this an area for informed intervention? Why not help people learn their rights and join with them to pester insurers, legislators, and bureaucrats, even sue? It would be both practical and educational.

*

Rachana Pradhan, “Lost in the mix of Medicaid ‘unwinding’: Kentucky cut off her health care over a clerical error,” KFF Health News/NPR, Nov 21, 2023 READ IT HERE

A Kentucky woman was ready for surgery to treat chronic uterine bleeding when the hospital said her Medicaid coverage was terminated after the state’s computerized system (run by Deloitte) wouldn’t take her application. Multiply by tens of thousands of horror stories nationwide.

*

Ken Alltucker, “Cigna denied a cancer patient’s lung transplant. Now the insurer says it was an ‘error,’” USA Today, Nov 24, 2023 READ IT HERE

A woman was all set for transplant surgery when her insurer reversed itself and denied payment. She had to publicize her dilemma on social media, upon which Cigna backed down. Just what you need when getting ready for two new lungs! Said the patient: “There is no logical explanation other than greed.” Funny how often oopsies are reversed when a little publicity is shined upon them.

*

Susan Morse, “Nursing homes are required to disclose more ownership information in final rule,” Healthcare Finance, Nov 15, 2023 READ IT HERE

The increasingly concentrated (and PE-heavy) nursing home industry will have to come clean and reveal who owns what. They will also have to disclose corporate hidey-holes, like who earns rent the nursing home pays or what outfits are getting admin and consulting contracts. “Private equity-backed nursing homes had a COVID-19 infection rate and death rate that were 30% and 40% above statewide averages respectively.”

*

Scott Wilson, “A hospital’s abrupt closure means, for many, help is distant,” Washington Post, Nov 16, 2023 READ IT HERE

A county near Fresno joins the many rural areas where women now have to travel long distances while in labor. “The collapse of one California county’s only adult-care hospital has exposed the fragility of a system that primarily serves the poor in a rich state.” The commodification of hospital care means low-return areas get nothing while big-city outfits thrive.

*

Katy Golvala & Jenna Carlesso, “Meet the hospital mega-landlord at the center of the Yale-Prospect deal,” CT Mirror, Nov 16, 2023 READ IT HERE

Connecticut is resisting further concentration in its hospital sector, but something has to be done to get three hospitals away from the serial looters at Prospect Medical Holdings and their corporate accomplices. Prospect uses borrowed money to buy up struggling hospitals, pay itself huge dividends, then sells off the hospitals’ properties and forces them into leaseback arrangements. Now Yale New Haven Health will pay the new landlords additional millions to buy back the failing operations, probably with a state subsidy. Tony Soprano would be proud.

*

Madison Muller & Diana Li, “How much Eli Lilly, Novo Nordisk spend on advertising Mounjaro, Ozempic, Wegovy,” Bloomberg, Nov 27, 2023 READ IT HERE

Pharma spends plenty on ads for its fat shots, but most of the buzz they get for free from “a combination of pop culture, social media, and third-party marketers looking to cash in on the hype.” Jimmy Kimmel mentioning them at the Oscars didn’t hurt either.

*

Tina Reed, “The big question about obesity drugs: Can people ever stop taking them?” Axios, Nov 27, 2023 READ IT HERE

Should we spend ourselves into oblivion on weight-loss drugs that people stop taking after a year and then gain back most of the weight? Should we bankrupt Medicare and shovel billions to pay Pharma for them? Sober experts are stroking their chins vigorously while considering this complex question.

*

Arizona Attorney General, AG Mayes sues pharmacy benefits managers and insulin manufacturers over insulin pricing scheme,” Nov 27, 2023 READ IT HERE

These lawsuits over insulin price manipulation are proliferating at both state and city level. Says Arizona, “Despite promises to pass along the increased rebates to health insurers and patients, the PBMs instead used complex financial and business structures to keep a large part of the inflated profits for themselves.”

*

Drew Altman, “Family health insurance is no longer affordable through small employers,” KFF Health News, Nov 28, 2023 READ IT HERE

Staggering figures: the average price for a family of four to be insured is over $23,000 of which the employee has to pony up about a third just on premiums. That’s before the deductible, which averages about another $4,000. The bottom line: At the pizza shop, dry cleaners, or other mom-and-pop outfits that employ 50 million American workers, health insurance is unthinkable.

*

Garret Grove, “Mississippi has a diabetes epidemic,” WJTV [Jackson MS], Nov 26, 2023 READ IT HERE

Amazing stat: half of the state’s residents are either diabetic or pre-diabetic. No need to expand Medicaid there though—that would cost money. Fun fact: One in four healthcare dollars nationally is spent on people with diagnosed diabetes. And plenty more on the undiagnosed.

*

Katheryn Houghton, Rachana Pradhan & Samantha Liss, “Medicaid ‘unwinding’ makes other public assistance harder to get,” KFF Health News/NBC News, Nov 29, 2023 READ IT HERE

File under “The Beatings Will Continue Until Morale Improves.” It isn’t enough to dump people from their Medicaid coverage, now this: “Low-income families that need safety-net services have become collateral damage in the bureaucratic scramble” because the same state workers and computer systems handle both Medicaid and other benefits like food stamps.

*

Greetings for all those wallowing in tryptophan! My SPL podcast, tentatively entitled "Do Not Resuscitate" covering this digest is up at Podbean LISTEN TO PODCAST!

SINGLE PAYER LINKS #325

Posted 24 NOV 2023

*

Maya Goldman, “States rethink Medicaid enrollment efforts as millions lose coverage,” Axios, Nov 14, 2023 READ IT HERE

Biden’s political team seem to think that booting 30 million people off Medicaid—well over half over paperwork issues—is no big deal in a presidential election year. A major expansion of Medicaid was needed during 2020–23 to get people treated and back to work during Covid. Now that the economy is humming again, we’re looking at the “largest-ever purge” of the rolls. Aside from the effect on individuals, “An expected increase in the uninsured rate is starting to impact the health care system. Hospitals’ uncompensated care as a percentage of operating revenue rose from 6.4% in March to 8.7% in July.” Expect the hospital execs to traipse up to Capitol Hill for relief. People without insurance are also staying away from emergency rooms, meaning health disasters and higher costs for the future.

*

Noah Tong, “Civil rights groups deal failing grades to states on Medicaid disenrollments,” Fierce Healthcare, Nov 17, 2023 READ IT HERE

The mainstream groups (NAACP, National Urban League, UnidosUS, etc.) delivered an A grade only to Hawaii, which paused all disenrollments, while no other states passed. Florida earned an “F-minus.” States had time to plan and cash from the Feds; still flunked.

*

Amanda Seitz & Kenya Hunter, “The Biden administration is slow to act as millions are booted off Medicaid, advocates say,” Associated Press, Nov 14, 2023 READ IT HERE

A litany of state-led abuses, especially egregious in states already hostile to Medicaid and its beneficiaries: Arkansas worked to “swiftly disenroll” 420,000 people in just 6 months using forms “that wrongly told people they needed to reapply for Medicaid instead of simply renew it.” Federal regulators are awfully slow to respond.

*

Harold Brubaker, “Pennsylvania is restoring Medicaid benefits for 105,000 people, including many children,” Philadelphia Inquirer, November 13, 2023 READ IT HERE

Children qualify for Medicaid/CHIP at higher income levels. When Pennsylvania disenrolled people based on household income, lots of kids got erroneously kicked off. The Feds got involved, none too soon, and some children are back on Medicaid while the state sorts out things properly.

*

ProPublica/Scripps News, “Health insurers have been breaking state laws for years,” Nov 18, 2023 READ IT HERE

“States have enacted hundreds of laws dictating precisely what insurers must cover so that consumers aren’t driven into debt or forced to go without medicines or procedures.” However, states largely defy those laws, even when patients’ lives are at risk. The culprits: regulatory thumb-twiddling and fiscal starvation of state enforcement offices. “ProPublica surveyed every state’s insurance agency and identified just 45 enforcement actions since 2018 involving denials that have violated coverage mandates.” Instead of using cases to establish blanket rules for perhaps thousands of similar situations, regulators resolve them individual as one-offs.

*

Arthur Allen, “Biden Administration’s limit on drug industry middlemen backfires, pharmacists say,” KFF Health News/CBS News, Nov 15, 2023 READ IT HERE

Pharmacists are unhappy with the recent crackdown on PBMs because it left too many loopholes that the giant intermediaries promptly wriggled through. Here’s how it works: “When you’re filling the prescription, the PBM tells you the patient pays $20 for this drug, we’ll pay you $100. As the pharmacist, I say, OK, I get a total of $120 for a drug that cost me $110 from the wholesaler. Then three months later, the PBM says, ‘Actually, I’m only going to pay you $83.’ So, I lost $17 on the sale and I have no ability to object.” The underlying problem is that PBMs are a tripartite oligopoly and can bully pharmacists into slave labor or drive them out of the market entirely.

*

Pramila Jayapal & Diljeet Singh, “Medicare Advantage is giving away billions to corporate insurers. It’s time we put a stop to it,” The Hill, Nov 17, 2023 READ IT HERE

Good stuff from Jayapal, which is drowned out by the torrent of insurance company advertising during the sign-up period. “Constituents call in with stories of being lured into an MA plan and then denied care or prevented from seeing their doctor. Cancer patients face weeks of delay because of onerous pre-authorization requirements.” Singh is the VP of Physicians for a National Health Program.

*

Susanna Vogel, “New AMA policies focus on GLP-1 coverage, resisting corporate medicine,” Healthcare Dive, No 14, 2023 READ IT HERE

The AMA called out corporate “encroachment of administrators” into medical practices and noted the rather obvious conflicts of interest between financial owners and clinicians. OTOH, they also endorsed insurance coverage of the fat shots.

*

Eli Frankel, “Inhospitable: Process mismanagement in American health care,” The Baffler, Nov 15, 2023 READ IT HERE

Nurses at a big Jersey hospital rebelled when hospital admin turned them into cogs in a Taylorite production line. They’ve been on strike for 4 months. “In the last three years, nurses in Wisconsin, California, Oregon, New York, and elsewhere have walked out to protest deteriorating, if not outright unsafe, working conditions. By one estimate, nurse strikes accounted for over half of all workers involved in strikes that year.” Turns out that “just in time” medicine borrowed from Toyota’s management philosophy isn’t working. Good, granular data about how “lean management” plays out in hospital corridors (versus how it sounds in business journals).

*

Dave Muoio, “Prior authorization and other regulatory burdens have increased since last year, practices tell MGMA,” Fierce Healthcare, Nov 13, 2023 READ IT HERE

How are insurance company demands the same as “regulatory burdens”? They aren’t—this is mixing apples with oranges. “Nine in 10 polled medical practices say their regulatory burden has increased over the past year with prior authorization, audits, and appeals”—repeats the category error. Of course, payers gotta make those numbers for the investors through decision delays, paperwork demands for routine procedures, etc.

*

Leroy Leo & Khushi Mandowara, “Boom in weight-loss drugs to drive up US employers' medical costs in 2024,” Reuters, Nov 17, 2023 READ IT HERE

The fat shots accelerate our rush toward bankruptcy: Employers paid 8.4% more for drug benefits this year after a 6.4% boost the year before.

*

Jeanita Lyman, “Feds, state sue to block John Muir Health’s acquisition of San Ramon hospital,” DanvilleSanRamon.com, Nov 17, 2023 READ IT HERE

The FTC rides again! It’s nixing a hospital merger in northern California that would “eradicate competition between [sic] hospitals along the I-680 corridor.” The state of California joined the antitrust suit. John Muir hospitals already are known to be more expensive than other facilities in the area.

*

Ayesha Rascoe, “Amazon is getting into health care. Will it actually make care more accessible?” NPR, Nov 12, 2023 READ IT HERE

Two reporters chat about Amazon’s incursion into primary care and the move by insurers to vertically integrate by providing healthcare services directly through an affiliate. The interviewer asks, “What happens if they can’t turn a satisfying profit in health care?” Answer: nobody knows, but let’s watch them destroy the competition anyway. Final comment on the broadcast: “And just to note, Amazon is one of NPR’s financial supporters.” And here I thought the “P” in NPR meant “public.”

*

Reed Abelson & Jordan Rau, “Facing financial ruin as costs soar for elder care,” KFF Health News/New York Times, Nov 14, 2023 READ IT HERE

“The escalating costs of in-home care, assisted living facilities, and nursing homes devour the savings and incomes of older Americans and their relatives.” Another great profit center as the population ages rapidly. It doesn’t have to be this way (see below).

*

Jordan Rau, “What long-term care looks like around the world,” KFF Health News/New York Times, Nov 14, 2023 READ IT HERE

Japan: everyone has long-term care insurance paid on a sliding scale. “Workers can also take up to 93 days of paid leave to help relatives with long-term care needs.” Everyone has a care manager. The Netherlands: All long-term care is state-run; taxes are substantial—but you get something for them. Singapore: Everyone is automatically enrolled in long-term care insurance at age 30 and nursing home care is subsidized, also on a sliding scale.

*

Felicity Nelson, “World’s leading theory on Alzheimer’s in crisis after major drug trials fail,” Science Alert, Nov 16, 2023 READ IT HERE

The highly touted approval of new drugs to treat Alzheimer’s was based on an already dubious theory: that reducing amyloid beta tangles in brain matter would improve cognitive performance. There was already reason to be skeptical about that, and a new study blows it up once again. But the drugs that do this possibly irrelevant thing are already approved, and desperate families will demand to try them at huge cost to Medicare.

*

MND Staff, “López Obrador says state ‘mega pharmacy’ will open in December,” Mexico News Daily, Nov 21, 2023 READ IT HERE

Mexico’s president says the country needs a state agency to centralize pharmaceutical purchases. The facility will be located next to an airport that will “allow drugs to be transported to clinics and hospitals across Mexico within 24 hours.” Nice to learn of a civilized country on the North American continent.

*

Angus Liu, “With filing in Sanofi and Mylan insulin lawsuit, FTC amps up scrutiny on pharma’s patent tactics,” Fierce Pharma, Nov 21, 2023 READ IT HERE

The FTC used an amicus brief to highlight pharmacy patent abuse that blocks competition from cheaper competitor drugs. The agency told 10 Pharma giants last year that it was challenging 100 of their patents.

*

Derek Lowe, “The dark side of a clinical trial,” Science, Nov 14, 2023 READ IT HERE

The author describes a huge scandal in which whistleblowers exposed data manipulation and falsification at an important lab and asks, How did this go on for so long “through years and years of high-profile work, copious publications, [and] huge amounts of grant money”? He compares the institutionalized fraud to the Bernie Madoff saga. One likely answer: junior researchers risk career death by raising objections.

*

SINGLE PAYER LINKS #324

Posted 17 NOV 2023

Podcast: Listen to podcast here! summarizing this (extensive) digest. Tons of revealing items and even some good news--especially the first one.

*

Casey Ross & Bob Herman, “UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care,” STAT, Nov 14, 2023 READ IT HERE

A kick-ass exposé based on internal company documents & a must-read: UnitedHealth, the nation’s largest health insurance company, boosted its profits by cutting off rehab coverage based on an “unregulated algorithm.” The illegal part: “UnitedHealth pressured clinical employees to follow the algorithm’s length-of-stay determinations, even when they, and the patients’ own clinicians, disagreed.” Legally, a provider has to make that call, not a robot.

More: “UnitedHealth Group has repeatedly said its algorithm, which predicts how long patients will need to stay in rehab, is merely a guidepost for their recoveries. But inside the company, managers delivered a much different message: that the algorithm was to be followed precisely so payment could be cut off by the date it predicted. Former employees said missing the target for patients under their watch meant exposing themselves to discipline, including possible termination. The strategy was conceived and executed by former top Medicare officials.” A class action lawsuit followed. Lots of detail about the guys behind this scheme, including a former Toyota executive and Tom Scully, who ran Medicare under former President George W. Bush and played a pivotal role in creating Medicare Advantage. Of course he did. The good news: Appeals are rising rapidly across the MA scam-iverse.

*

Anika Nayak, “How pharmacy deserts are putting the health of Black and Latino Americans at risk,” STAT, Nov 10, 2023 READ IT HERE

People who take prescription meds suffer in obvious ways if there’s no pharmacy nearby. The question is, How were these deserts created in the first place? “Smaller, independent pharmacies started to go out of business when the big retail giants entered the community over the past 10 to 15 years.” But when the profits aren’t juicy enough, the chains decamp, closing “underperforming” stores—in the same sites where the independents did fine. Neighborhoods like Chicago’s black-majority South Side once had plenty of pharmacies; now 33% of its areas are classified as “pharmacy deserts,” compared with only 1% of white counterparts.

*

Elaine Chen, “Wegovy cuts risk of heart attacks in milestone cardiovascular trial,” STAT, Nov 11, 2023 READ IT HERE

Novo Nordisk claims its obesity drug Wegovy lowers the risk of heart attacks by 20%. We knew that from the breathless pre-publication headlines in August that boosted NN’s stock price nicely. Now, there’s more data to back up the claims—although I can’t lay hands on it due to the paywall. We do know two fun facts: Novo Nordisk funded the study, and 16% of participants on Wegovy dropped out of the trial because of side effects “or other issues,” compared to around 8% in the placebo group.

*

Dani Blum, “Wegovy is shown to reduce risk of heart attacks and strokes in some patients,” New York Times, Nov 11, 2023 READ IT HERE

Medicaid is prohibited by statute from paying for weight-loss drugs, and since that’s the reason everybody and her uncle wants it, there’s an obstacle to getting the Federal Government to pay for them. But if the drug companies can show other medical effects aside from getting customers into smaller clothes, they can clean out Fort Knox. Thus, the full-on campaign to pump up clinical trial results like this one just coincidentally funded by the companies who own the drugs. Note that the articles express zero skepticism despite the obvious conflict of interest.

*

Tina Reed, “Doctors grapple with patients’ demand for weight-loss drugs,” Axios, Nov 13, 2023 READ IT HERE

Primary care doctors generally don’t have specialized knowledge on obesity and are inundated with requests for the now-famous fat shots. Since they do spend a lot of time trying to prevent heart attacks, they’ll be tempted to say yes. Said one, “I think the idea that we’re going to put 110 million Americans on a GLP-1 for $1,000 a month is a problem.” Ya think? Fun fact: 68% of patients who go on the fat shots for weight loss drop off of them within a year either due to side effects or because they like their new bods.

*

Kimberly Marselas, “Primary care gets a pay boost. Skilled nursing providers may pay the price,” McKnight’s Long-Term Care News, Nov 7, 2023 READ IT HERE

The 2024 Medicare Physician Fee Schedule revision means doctors will get an extra fee for “visit complexity,” that is, for cases that require more intense care management, people with chronic conditions and the like. But because of “budget neutrality,” extra payments to Peter will come from Paul. “Therapists and others who deliver care not under the skilled nursing prospective pay rule will experience cuts.

*

Yves Smith, “U. S. health care strip-mined for profit: primary care physicians becoming scarce, poorly trained nurse practitioners run wild,” Naked Capitalism, Nov 13, 2023 READ IT HERE

“Primary care doctors are increasingly being replaced by nurse practitioners, who simply don’t have the training or experience to perform the key job of a front-line doctor, that of diagnosis.” Possible factors: fewer doctors entering and staying in primary patient care; mass burnout and departure from primary care or medicine entirely through retirement; an MBA scheme to lower the costs. This article highlights one key problem: overuse of referrals to specialists, resulting in increased costs and waste. Having a PCP is key to good health outcomes (and savings), and the shortage is becoming acute. The average age of U.S. physicians is rising, and one-fifth of doctors say they will likely leave their current practice within the next 2 years. Meanwhile, med students aren’t that crazy about primary care or even patient contact of any kind. In a recent survey, 58% of medical and nursing students they viewed their current studies as “a stepping stone to careers in health care that don’t involve treating patients.” Interesting take on how the generalist and family medicine docs are the linchpin of the entire system, so if patient care is dirty work to the new crop of docs, we’re looking at a systemic collapse.

*

Susanna Vogel, “HCA outlines plans to expand market share by 2030,” Healthcare Dive, Nov 10, 2023 READ IT HERE

Earnings reports in the healthcare sector are so revealing because the company spokespeople are talking to Wall Street types, not the general public. Hospital giant HCA Healthcare revealed it’s targeting a 29% market share in healthcare services by the end of the decade. Don’t you love the open boast about rolling up an oligopoly position? [According to a measure called the concentration ratio, “An oligopoly is apparent when the top five firms in the market account for more than 60% of total market sales.” And one company alone is aiming to corner half of that?] HCA is also putting lots of cash into ERs, noting that emergency room care can drive inpatient admissions and surgeries.” Note the strict corporate logic—what does any of this have to do with delivering better care?

*

Noah Tong, “Humana raises MA enrollment projections again, beats EPS market estimates,” Fierce Healthcare, Nov 1, 2023 READ IT HERE

More investor-speak: Humana is a big player in Medicare Disadvantage, which is finding a surprising uptick in “utilization,” which means people actually trying to use their supposed insurance. So, listen to this from a corporate exec: “Humana noted it was deploying a proactive engagement strategy and adopting standardized risk stratification to help bend this curve.” English translation: we’re looking for ways to make people stay away from their doctors. “Standardized risk stratification” sounds a lot like robot-generated care denials.

*

Anthony Pudlo, “Pharmacists warn Tennessee patients to protect themselves against benefit managers,” The Tennessean, Oct 30, 2023 READ IT HERE

PBMs were created to control prescription drug prices, but that got perverted quickly. They have since figured out all sorts of ways to scam the system, such as restricted formularies pushing people away from generics onto more expensive drugs; forcing clients to use their in-house pharmacies; spread pricing that creates higher costs for plan sponsors (employers) and higher premiums.

*

Will Stone, “Syphilis among newborns continues to rise. Pregnant moms need treatment,” NPR, November 7, 2023 READ IT HERE

An “out-of-control” epidemic, says one expert, due to staff cutbacks, inadequate prenatal testing, and even a shortage of the key antibiotic to treat syphilis. Cases jumped by 30% last year; minority women are eight times more likely to be diagnosed. “The increase in cases indicates that syphilis is spreading unchecked in much of the country and also evidence of a breakdown in the public health infrastructure around maternal care.” Half of the cases examined were diagnosed but not treated. Chlamydia and gonorrhea are also up. Hundreds of millions in STD control funds were just siphoned off to calm down the howling wolves during “debt ceiling” negotiations.

*

Jonathan Gardner, “FTC challenges patents held by nine big drugmakers, citing unfair competition,” Healthcare Dive, Nov 8, 2023 READ IT HERE

Good for the FTC (Federal Trade Commission) once again for going after some “patent thickets” by which Pharma keeps cheap competitors away from the markets for its blockbusters. Among the targets: the owners of EpiPen, which had a notorious price spike some years ago, face challenges to four of its device patents. Attracting negative press is bad for business.

*

Rebecca Pifer, “Optum Rx moves 8 insulins to preferred formulary status as pressure mounts on PBMs,” Healthcare Dive, Nov 10, 2023 READ IT HERE

Response to bad PR: “Members of the pharmaceutical supply chain have faced intense public pressure to lower the cost of insulin following steep list price increases before the pandemic. As a result, more than a million Americans with diabetes reported rationing their insulin in 2021.” Exposés and congressional scrutiny focused the Pharma mind, at last. The Inflation Reduction Act forced the price of insulin down to $35 for Medicare beneficiaries; this will move most privately insured patients into the same category.

*

Khushi Mandowara, “Biogen-Sage Therapeutics postpartum depression pill priced at $15,900,” Reuters, Nov 7, 2023 READ IT HERE

Is that all? I should have thought it worth more than that. After all, the treatment takes 14 whole days.

*

Anastassia Gliadkovskaya, “Nonprofit health plans are better poised to address beneficiaries’ needs, SCAN Health Plan exec says,” Fierce Healthcare, Nov 3, 2023 READ IT HERE

A nonprofit entity is trying to grow into the Medicare Disadvantage arena. Good luck! They seem well intentioned, so the question is whether something like MA can be made functional and decent by removing the crudest profit(eering) motives. As the reporter says, “It can be hard for nonprofits to stand out in a world where competitors have seemingly endless investments in growth and marketing.” Or will nonprofits just evolve into pale imitations of their for-profit rivals through the relentless pressure of commodity medicine?

*

Chris Otts, “As Humana-Baptist feud drags on, Medicare patients caught in middle,” WDRB.com, Nov 7, 2023 READ IT HERE

This is about the trials Medicare Disadvantage enrollees face once they sign up and all the hype dies down. A major health system in Louisville, Kentucky, can’t strike a deal with major MA payers, and people have to scramble to find care somewhere else. The hospital getting a divorce from local MA plans said they’re tired of routine care denials.

*

Brad Dress, “Biden expands veterans’ health care coverage,” The Hill, Nov 10, 2023 READ IT HERE

“Starting this month, all living World War II veterans can access health care services from the Department of Veterans Affairs at no cost, including nursing home care, the White House said.” Great, now how about expanding it to “all living people”?

*

Katie Jennings, “Amazon Prime’s new $9 primary care subscription undercuts Amazon’s other health services,” Forbes, Nov 8, 2023 READ IT HERE

Who can keep up? Amazon is giving Prime members half off to sign up for primary care at its recently-bought One Medical. But Amazon also owns Amazon Clinic where customers get a text- or video-based visit with, supposedly, a human doctor. Who would pay for that when for the same money you can get a whole year at One-M? Looks like Amazon is throwing money at all sorts of experiments to see what actually works. (When you have money to burn after destroying retail, you can do that.) One Medical registered a net loss last year; other Amazon health experiments have failed. “Amazon does not currently offer One Medical memberships as a benefit to its own 1.5 million employees.”

*

Nick Thomas, “Prospect Medical faces scrutiny over lack of funding to Rhode Island hospitals,” Becker’s Hospital Review, Nov 10, 2023 READ IT HERE

Los Angeles-based Prospect is a serial offender and should get the death penalty. It acquires struggling hospitals, loots them, and lets them collapse. “In October, at least 19 elective surgeries at [the two RI hospitals] were canceled because the required equipment was not available due to Prospect not paying vendors.”

*

Sarah Fentem, “Missouri one of only four states with a significant rise in infant deaths,” St. Louis Public Radio, Nov 10, 2023 READ IT HERE

Aside from those four, the entire country is seeing a rise for the first time in 2 decades. Infant mortality in Missouri went up 16% last year. Would that have anything to do with abortion bans and lack of comprehensive OB/GYN care by any chance? Or the epidemic of hospital closures in rural areas?

*

Markian Hawryluk, “Why it’s so tough to reduce unnecessary medical care,” KFF Health News/CBS News, Nov 13, 2023 READ IT HERE

Because the U.S. health system “rewards doctors for providing more care rather than the right care,” it’s difficult to stop waste. People expect tests and procedures, and sometimes it’s hard for doctors to say you don’t need them. Of course, when patients know their insurers are trying like crazy to say no to everything that cuts into their profit, why would we trust our providers to know what they’re doing?

*

John Cheves, “Kentucky’s veterans centers sit half-empty while aging veterans wait for a vacant bed,” Lexington Herald-Leader, Nov 14, 2023 READ IT HERE

“Kentucky’s four state-run nursing homes for military veterans, with 681 beds between [sic] them, are sitting half-empty while some elderly veterans wait for months to hear if there is any room for them to be admitted.” Empty beds, people waiting to get in, no workers—what is wrong with this picture?

*

SINGLE PAYER LINKS #323

Posted 10 NOV 2023

Hey, my podcast is getting better! Listen to it here:       Listen to the podcast here

Julie Rovner, “The AMA may reconsider single-payer health care,” KFF Health News, Nov 1, 2023 READ IT HERE

Glory be! Doctor dissatisfaction has reached the point where the famously conservative American Medical Association is going to take up a single-payer resolution. A med student proposal in 2019 attracted surprisingly strong support (47%), but this year doctors put forward the resolution. One former Obamacare official now back in academia told the reporter, “The system sucks worse than ever,” but added he didn’t think things are quite bad enough yet for a major reform.

*

Dave Muoio, “Hospitals file lawsuit to bar HHS’ ban on 3rd-party web trackers,” Fierce Healthcare, Nov 2, 2023 READ IT HERE

Hospitals are madder than wet hens over the Feds’ demand that they stop using third-party trackers, those little cookies in your online medical charts that help them compile mountains of population data (and monetize it). “A recent University of Pennsylvania study suggests that more than 9 in 10 hospitals’ homepages have at least one third-party cookie.” The most notorious ones are Meta Pixel and Google Analytics, and we can totally believe their assurances that they aren’t misusing our data. The hospitals argue that the Federal Government itself does the same (so let’s ban that, too!) They claim that the data is anonymized, but—big shocker—IP addresses are easily linked back to individuals. Big data in medicine could be used to improve outcomes, but the only thing we know for sure is that it currently serves billing and profit-seeking.

*

Paige Minemyer, “CMS bumps up pay increase to 3.1% in final FY24 OPPS rule,” Fierce Healthcare, Nov 2, 2023 READ IT HERE

Hospitals get a 3.1% pay increase overall from government-funded insurance programs. But see below—doctors are getting a cut.

*

Heather Landi, “Physician groups decry finalized Medicare payment cuts for 2024 as expenses rise,” Fierce Healthcare, Nov 2, 2023 READ IT HERE

Because the Feds are straitjacketed by congressional budget-balancing BS, they can only boost reimbursements in one category if they make cuts elsewhere. Medicare payments to physicians declined 26% from 2001 to 2023—further consolidating the two-tier health system privileging people with private insurance. The new increases are for things like primary care, mental health care, navigation services for the seriously ill, family caregivers—all worthy recipients. Why do we have to rob Peter to pay Paul? “The declining revenues in the face of steep cost increases disproportionately affect small, independent, and rural physician practices, as well as those treating low-income or other historically minoritized or marginalized patient communities.”

*

Teresa Carr, “Amid regulatory gaps, telehealth prescribers flourish,” Undark, Nov 1, 2023 READ IT HERE

Quick online consults are handy—also fraught with risk for consumers. They fall into a regulatory gray zone: they aren’t medical providers, drug companies, or online pharmacies. “Instead, they’re middlemen who can exploit that status to market drugs online, free from government oversight.” Fraudsters and scammers quickly took advantage. If you’re getting sold a face cream, who cares? But plenty of people will be getting drugs they shouldn’t take—if they’re even genuine.

*

Alexander Tin, “FDA investigating reports of hospitalizations after fake Ozempic,” CBS News, Nov 7, 2023 READ IT HERE

“At least three Americans have been reported hospitalized after using suspected counterfeits of Ozempic.” There were a total of 42 adverse event reports, 28 of them “serious.” And that’s not counting the side effects of real Ozempic.

*

Joel Lexchin, “Semaglutide: a new drug for the treatment of obesity,” BMJ Journals, Undated READ IT HERE

From the abstract: “Once the medication is stopped, people regain most of their pretreatment weight. Gastrointestinal adverse events occur commonly.”

*

“Novo Nordisk: 80% of U.S. Wegovy patients with insurance paying less than $25/month,” Reuters, Nov 2, 2023 READ IT HERE

Oh great, health insurance is covering the fat shots, so that means we’ll all pay higher premiums. The Pharma owners say 50 million Americans may want the quick-slim magic. At $1K a month—which is a discount from the list price—that’s $50 billion x12 = $600 billion annually. Insanity on stilts.

*

Susan Kelly, “Drilling down on obesity drugs: What medtech executives are saying,” Healthcare Dive, Nov 6, 2023 READ IT HERE

If people can shed weight more easily through the fat shots, they won’t need things like bariatric surgery and sleep apnea devices. But get a load of the rhetoric from this industry publication: “The potential threat to medical device sales has spooked investors, who have sold shares in companies across the sector.” One insider said, “We believe the risk is more perceived than real.” So, people getting healthier is a bad thing? You’d think people in health-related industries might have something to say about positive outcomes other than the damage to their profits, but no.

*

Susanna Vogel, “North Carolina AG threatens lawsuit against HCA,” Healthcare Dive, Nov 2, 2023 READ IT HERE

Big hospital chains often gobble up struggling local competitors while swearing to preserve local services; then they don’t. NC is suing the HCA chain for shutting down oncology units and forcing patients to travel long distances for care. Its track record is a typical one: “Soon after the buyout, Mission raised prices by 10% and began charging unexpected fees. Last month, a coalition of 50 Mission doctors penned an open letter saying HCA had ‘gutted the heart and soul of our community healthcare system.’”

*

Alander Roch, “Medicaid unwinding: 28,300 Alabamians lost coverage in July; total losses top 50,000,” Alabama Reflector, Nov 1, 2023 READ IT HERE

Incredible not-fun fact: Non-disabled adults in Alabama only qualify for Medicaid if they earn no more than 18% of the poverty line ($4,475 for a family of three). Fifty thousand have been kicked off Medicaid so far this year in the state with another 170,000 in the crosshairs; 10 million have lost coverage nationally with another 20 million set to get the axe next year.

*

Andrea Gallo, “Why Louisiana’s Medicaid expansion has not improved infant mortality: “coverage is not care,’” New Orleans Times-Picayune, Nov 2, 2023 READ IT HERE

One big reason: the state has lousy reimbursement rates, so OB/GYN care is scanty despite 6 in 10 Louisiana pregnancies being financed by Medicaid. Just expanding the program isn’t enough if the state then starves it. Although Louisiana spends a quarter of its annual budget on Medicaid, the two-tier system separating Medicaid from privately insured patients remains full of gaps.

*

Camilo Sánchez, “The most ambitious ‘health tax’ in Latin America debuts in Colombia,” El Pais [Spain], Nov 1, 2023 READ IT HERE

Colombia’s new taxes on a series of ultra-processed foods are one of the most ambitious public health measures in Latin America. It involves slapping a gradual “health tax” on junk food rising gradually to 20% in 2025. Will be interesting to see if it works. An estimated 56% of Colombians are overweight. Latin America is moving more firmly to avoid America’s obesity madness. Other countries’ nutritional labeling laws have forced producers to reduce sugar, sodium, and overall calories in their food products.

*

Emily Olsen, “Walmart inks partnerships with health system, insurer in Florida,” Healthcare Dive, Nov 2, 2023 READ IT HERE

Big retailers are moving more aggressively into direct healthcare services. This deal with a private insurer is a first for Walmart’s 23 clinics in Florida, which are expected to feed patients into the partner’s hospitals. Meanwhile, CVS is expanding its primary care operations, and Walgreens is not far behind. Amazon has a telehealth operation and bought up a primary care chain earlier this year.

*

T. Christian Miller, “Big insurance met its match when it turned down a top trial lawyer’s request for cancer treatment,” ProPublica, Nov 7, 2023 READ IT HERE

A lawyer needed a special kind of radiation therapy on a throat tumor, but his insurance company said first he had to try cheaper methods that would endanger all his sensory organs, i.e., sight, hearing, smell, taste, and brain function, before they’d approve it. Mr Lawyer then paid $100K for the treatment out of his own pocket and sued Blue Cross, arguing that the insurer had ignored modern clinical trial evidence. He won. Too bad we can’t all be expert trial lawyers. “To overcome a system tilted heavily in favor of the insurance industry, you need money, a dogged doctor, and a friend with unusual skills.” Now, the insurer is arguing that it should only pay him back the discounted rate they had negotiated—around $35,000. He’ll probably have to re-sue them.

*

Robin Fields, “How often do health insurers say no to patients? No one knows,” ProPublica/Capitol Forum, Nov 7, 2023 READ IT HERE

Denial rates are “a closely held secret.” No consumer or employer can look up frequency of denials, “let alone whether a particular company is likely to decline to pay for procedures or drugs that its plans appear to cover.” Under the ACA (Obamacare), regulators could fix that but haven’t. State insurance commissioners do collect this data but refuse to share it (except for CT and VT). Estimates are somewhere between 1 in 5 and 1 in 3 claims are denied. Vermont, which does publish its data, has lower denial rates than the average—probably not a coincidence. Activists: we need workshops to teach people how to appeal denials!

*

Nathaniel Weixel, “Johnson embraces deficit fight, setting up battle over Medicare, Social Security,” The Hill, Nov 6, 2023 READ IT HERE

The new speaker nobody’s ever heard of is a “fervid supporter” of big cuts in social spending and could take aim at Social Security and Medicare, but it’s a mistake to think that this is a Republican-only campaign. Plenty of Democrats will be standing by eager to offer “bipartisan” slasher help while denouncing it at election time.

*

Elisabeth Rosenthal, “A new era of vaccines leaves old questions about prices unanswered,” KFF Health News/Time, Oct 27, 2023 READ IT HERE

Should the government agree to pay hundreds of dollars per shot for vaccines that we may have to get annually? And should we be hit with constant, fear-inducing ads for them? “Other developed countries have deliberate strategies for deciding which vulnerable groups need a particular vaccine and how much to pay for it. The U.S. does not.” Useful fact: most adults don’t need RSV shots; babies do.

*

Meghann Myers, “Troops’ personal data can be purchased for pennies, researchers find,” Military Times, Nov 7, 2023 READ IT HERE

Data brokers basically can run freely through websites and scoop up everything about us. This is a hint that it might not be consistent with national security—which means someone might actually act on it. Researchers from Duke University went to the brokers and obtained “multiple troves of active-duty service member data and data on their families, purchased for as little as $0.12 per file,” including data on health data, finances, and information about religious practices.” How about credit scores, sexual orientation, mental health, or gambling info? But not to worry!

*

Liz Whatsherface, “The pandemic isn’t over,” Normalcy Fugitive, Oct 20, 2023 READ IT HERE

One look at the names of this author and her blog says it’s worth checking out. “Everything you have been led to believe about the virus is a lie. Covid is more dangerous, more transmissible, and more out of control than everyone in power is telling you.” A thorough run-down of the lies we’ve been told—so far—and lots of detail about how the rich continue to take Covid very seriously. “Billionaires gathered at Davos took maximum precautions at the World Economic Forum in January 2023. High-filtration masks were made available, and participants were required to have a negative PCR test result for their badges to be activated. HEPA air cleaners were set up in every room, and UV lights were installed.” But the rest of us should relax and keep the economy humming along.

*

Lambert Strether, “CDC’s HICPAC passes draft gutting patient protections against airborne respiratory viruses, faces challenge at HHS Office of the Inspector General (and you can help),” Naked Capitalism, Nov 9, 2023 READ IT HERE

HICPAC=CDC’s Healthcare Infection Control Practices Advisory Committee, which is putting in the fix to let hospitals ignore Covid protective measures and assure us that all is well—so drop the masks! The CDC (and WHO) were very late to acknowledging aerosol transmission (versus droplets), and now doubles down. Strether reports the CDC’s panel-packing, its failure to include ventilation or aerosol transmission experts, and its illegal secrecy. Although the CDC has an entire institute, NIOSH, with expertise in respirators and masks, none were included in the window-dressing exercise. “The HICPAC committee members are in the pleasant position of being able to ratify as guidance policies that their institutions have already adopted.” Nurses United and other advocates ask for calls to the CDC’s Inspector General to protest, recalling the thousands of health workers who died. The whole thing is worth a thorough read. The HHS IG has nearly 2,000 employees and oversees $2 trillion worth of federal spending, so they have clout to insist upon answers.

*

SINGLE PAYER LINKS #322       Listen to the podcast here

Posted 3 NOV 2023

*

Annmarie Timmins, “Huge and historic: NH care providers celebrate big Medicaid rate increases,” New Hampshire Bulletin, Oct 25, 2023 READ IT HERE

A whopping 42% increase for home-care agencies that keep people out of nursing homes. “Astounding” say the delighted agency heads. Also in line for big boosts: ambulance providers, a children’s dental program, and midwives. Good news though only for tiny NH. Imagine the impact if it were scaled nationally.

*

Anastassia Gliadkovskaya, “New multispecialty advocacy group wants to protect independent practices from hospitals’ buyouts,” Fierce Healthcare, Oct 26, 2023 READ IT HERE

Fighting a rearguard action against further consolidation in the healthcare sector and loss of doctor independence, the 5,000 docs of the American Independent Medical Practice Association (AIMPA) say they seek to protect the 47% of physicians still in private practice. Among the advantages: lower costs, walk-in services, clinics in underserved communities, and holistic care. Their complaint: shrinking Medicare reimbursement rates.

*

Rebecca Love, “Want to end historic health care strikes? Fix a broken, outdated reimbursement model,” STAT, Oct 26, 2023 READ IT HERE

Love, an owner-operator of a nurse staffing service, says the reimbursement system is the reason for short staffing and mass abandonment of the nursing profession. She explains that nurses were once provided by independent nursing practices (like hers) and billed patients directly. When hospitals took over, nurses became overhead rather than a billable service. “The contributions of registered nurses were soon obscured within room and board fees,” and the reimbursement was the same whether you had one nurse on a floor or eight. Naturally, hospitals try to cut back, and “nurses sit squarely on the losing side of health care systems’ profit-and-loss statements.” Interesting.

*

Aneri Pattani, “Using opioid settlement cash for police gear like squad cars and scanners sparks debate,” KFF Health News/NPR, Oct 23, 2023 READ IT HERE

Since the War on Drugs has been such a rousing success, why not use the loot extracted from the opioid narcos to beef up cops to the tune of “hundreds of thousands for vehicles, body scanners, and other equipment”? At this rate, the $50 billion in settlements paid out over 18 years will disappear with no impact on addiction. For example, sheriffs’ offices in Louisiana will receive $65 million over the lifetime of the payouts and have no obligation to report how they spend it.

*

Julie Appleby, “When that supposedly free annual physical generates a bill,” KFF Health News/NPR, Oct 30, 2023 READ IT HERE

New scam: During an insured annual wellness visit, your doctor asks you a couple of questions about a side issue like depression, a mole, or heart palpitations, and you innocently answer. That’s then charged as a separate “consultation,” which triggers a co-pay. Anything to discover another billing code that can be loaded onto your chart. Caveat for patients: ask your provider if any discussion you are having with them will be billed separately. “Additional time spent during a wellness exam discussing or diagnosing a condition or prescribing medication can be considered beyond preventive care and result in separate charges.” What’s next? Is there a billing code for handshakes?

*

Katy Golvala & Jenna Carlesso, “In 2016, Rockville was a bustling local hospital. Then Prospect Medical took over,” CT Mirror, Oct 29, 2023 READ IT HERE

A familiar story: struggling hospital gets acquired by an out-of-state outfit with promises of new investment, is left to rot while the hospital overlords collect emergency Covid cash and pay themselves dividends. State health officials AWOL on oversight. “Once a comprehensive 102-bed hospital at the heart of its community,” Rockville Hospital in Vernon CT is now a shell. Meanwhile, the purchaser, Prospect Medical, “took out a $1.1 billion loan and used the funds to pay its executives and shareholders a $457 million dividend.” Oh, and private equity firm Leonard Green & Partners also got a cut: before selling its stake of Prospect, the firm had paid itself roughly $658 million in fees and dividends. There’s plenty of money—it just goes to Wall Street instead of medicine.

*

Kenya Hunter, “Syphilis and other STDs are on the rise. States lost millions of dollars to fight and treat them,” Associated Press, Oct 28, 2023 READ IT HERE

Congress squabbles over the national debt and throws the GOP extremists red meat by jettisoning an STD control program. Result: Nevada, where congenital syphilis jumped 44% from 2021 to 2022, lost $10 million and had to cut key staff. Syphilis control relies on trained personnel to do contact tracing and outreach. When the positions are eliminated, it can take years to rebuild the workforce. Syphilis cases in the U.S. were up 31% annually in the most recent statistics.

*

Ted Godbout, “Health care cost worries threaten retirement dreams for many,” National Association of Plan Advisors, Oct 23, 2023 READ IT HERE

About 6 in 10 seniors “lack confidence in their ability to pay for health care costs as they age.” Even more say financial ruin is their top fear for old age. Hardly news, but interesting that it’s an ample majority.

*

Brendan Pierson, “Former HealthSun exec accused of Medicare fraud resulting in $53 mln overpayment,” Reuters, Oct 26, 2023 READ IT HERE

Someone got caught fraudulently upcoding charts, but there’s an added element: criminal charges against the individual perp—not just wrist-slapping fines for the company, which cooperated with investigators. But the brazenness of the fraud suggests that the case may be atypical: the indictment says the exec used fake doctor login details to systematically add diagnoses to charts. Subtler scams, which are rampant in MA, will be harder to detect. “Multiple insurance companies have been sued by the government for allegedly falsifying claims in order to get higher reimbursements,” including the biggest ones.

*

Noah Tong, “Direct Contracting Model reaches nearly $500M in net savings,” Fierce Healthcare, Oct 24, 2023 READ IT HERE

The Direct Contracting Model, now rebranded as ACO REACH, is a Medicare privatization program, vigorously denounced by Medicare’s defenders. It has notoriously NOT saved the government money, so this article is a bit mysterious. Maybe the answer is that some programs report savings while others don’t. Readers?

*

Dave Muoio, “HCA Healthcare’s newly consolidated physician staffing venture is bleeding $50M per quarter, execs tell investors,” Fierce Healthcare, Oct 24, 2023 READ IT HERE

This (and the next two articles) reveal much about the machinations of hospital and provider finance in our wonderful system. In 2011, for-profit hospital chain HCA bought up doctor groups through a joint venture with EmCare, which was later absorbed into the now bankrupt Envision Healthcare. HCA is losing money on their new herds of doctors hand over fist, in part because the absorption into HCA’s 183-hospital, 2,300-clinic system isn’t going that well. Execs promise that the consolidation will continue and that they will “address revenue trends” to stanch the red ink. English translation: expect price rises. Meanwhile, HCA bought back $1.14 billion worth of common stock to keep dividends juicy. More below:

*

Marty Stempniak, “Private equity-backed radiology provider Envision Healthcare to exit bankruptcy; CEO departing for Humana,” Radiology Business, Oct 11, 2023 READ IT HERE

Envision Healthcare is going bankrupt, but its CEO Jim Rechtin just got a promotion to run insurance giant Humana. Huh? Bankruptcy is good for the C.V.? Envision rolled up 17,000 clinicians in emergency medicine, radiology, anesthesiology, and neonatology but still couldn’t break even. The bankruptcy will stiff lenders for $5.6 billion in bad debt, including private equity backers KKR, who are on the hook for a chunk of that. See below for an explanation.

*

Dr. Jim Dahle, “The Envision Healthcare bankruptcy filing and what we can learn from it,” White Coat Investor, Jun 11, 2023 READ IT HERE

Envision was a prime target of complaints about surprise billing, including from ER docs who said its focus on profit was endangering patients. Private equity plutocrats KKR bought Envision in 2018 for $10 billion. But KKR didn’t have $10 billion—it put in 5 and borrowed the rest. Envision blames Covid, doctor shortages, inflation, and the No Surprises Act for its financial problems, but other ER doctor groups are okay because they’re not saddled with huge debts. When conditions worsened—including the crackdown on surprise billing—Envision was toast. “Envision’s business model was reliant on exploiting questionable business practices and loopholes. It was a model taking advantage of pricing distortions and patients who are not in a position to shop for emergency care.” In the Godzilla v. King Kong battles, the insurance companies—which are taking advantage of the No Surprises Act to stiff providers—wins this one. The American Association of Emergency Medicine sued Envision in California for violating the state ban on the corporate practice of medicine, and that lawsuit will continue despite the bankruptcy because the AAEM wants to pursue the principle and isn’t seeking money damages.

*

Phil Galewitz, “Smaller employers weigh a big-company fix for scarce primary care: Their own clinics,” KFF Health News/USA Today, Oct 27, 2023 READ IT HERE

With the price of health insurance for employers going through the roof, some companies are opting to bring medical services in-house. This is logical but only under our crazy system. Should an overcoat factory have to set up its own care facilities? Winston Griffin, a grocer in Kentucky, runs a clinic that provides checkups, blood tests, and other primary care for his 250 employees. He contracts with a local hospital and pays $100K a year for the service. “Why did we do this? So my employees would not drop dead on the floor,” Griffin said. Yes, there’s that.

*

Dave Muoio, “Biden admin proposes overhauls to lambasted out-of-network billing dispute resolution process,” Fierce Healthcare, Oct 27, 2023 READ IT HERE

The No Surprises Act implementation is a mess. Claims are flooding into an arbitration system that is unprepared, and insurers are slow-walking unfavorable judgments and even not paying them at all. Insurers counterclaim that a few providers are taking advantage of the system. As usual, tweaks to a dysfunctional system create new problems.

*

Meg Tirrell, “Pfizer more than doubles price of lifesaving Covid-19 medication Paxlovid as US transitions out of pandemic phase,” CNN Health, Oct 18, 2023 http://cnn.it/3smqSkV

The price of antiviral Paxlovid will be 2.6 times higher than the $530-per-course price paid by the US government during the official emergency. Under a temporary single-payer experiment, Paxlovid cost a fraction of what it will in a commercial marketplace, but Pfizer still made a profit. Will anyone notice? Also, vaccine costs just went up fourfold.

*

Maya Goldman, “Unnecessary coronary stents cost taxpayers $800 million yearly,” Axios, Oct 31, 2023 READ IT HERE

A researcher highlights “the financial incentives to perform surgical procedures, which are more lucrative than other interventions.” A 2022 study found no advantage to getting heart medicine through a stent, but hospitals apparently love putting them into people at $10K a pop.

*

Phil Galewitz, Katheryn Houghton, Brett Kelman & Samantha Liss, “‘Worse than people can imagine’: Medicaid ‘unwinding’ breeds chaos in states,” KFF Health News/USA Today, Nov. 2, 2023 READ IT HERE

Hours waiting on hotlines; patients dying in a hospital fighting to retain coverage; offers of unaffordable alternatives; renewal forms sent to expired addresses; 10 million terminated nationwide—and counting. Idaho has been particularly zealous in the kick-em-off process: out of 153,000 enrollees reviewed, 121,000 got the boot. Of those, about 10% signed up for an Obamacare policy. “What happened to the rest, state officials say they don’t know.” And officially don’t care.

*

Maya Goldman, “Medicare plans that help seniors afford groceries surge,” Axios, Nov 2, 2023 READ IT HERE

The latest bribe offered to unwary seniors to snare them into Medicare Disadvantage: grocery money.

*

Carol Paris, “Seniors, beware: Medicare open enrollment feels like ‘open season’ on older Americans,” The Tennessean, Oct 30, 2023 READ IT HERE

“My mailbox is already filling with official-looking letters from commercial insurance companies posing as Medicare.” Yeah, mine, too! [see a typical mailing below]. But Paris doesn’t go into any detail about how MA plans affect individuals: closed networks, prior authorization, claim denials. Maybe placing this op-ed required her to go easy on that part and stick to the ways MA gouges Medicare. One bright side: more hospitals are dropping MA because of prior authorization and slow (or never) payment of claims.

SINGLE PAYER LINKS #321     LISTEN TO THE PODCAST HERE!!

Posted 27 OCT 2023

*

Michelle Starr, “Major study claims to identify the root cause of obesity: Fructose,” Science, Oct 20, 2023 READ IT HERE

Let’s ignore any structural reasons for the obesity epidemic, shall we? That way, we can concentrate on filling people up with expensive pharmaceuticals to resolve their weight problems. This study says “fructose is the pernicious little demon driving" obesity. It "triggers our metabolism to go into low power mode and lose our control of appetite.” Cheap, high-fructose corn syrup is the ubiquitous sweetener in our food supply.

*

Lenny Bernstein, Lauren Weber & Dan Keating, “How Lunchables ended up on school lunch trays,” Washington Post, Oct 17, 2023 READ IT HERE

The authors compare (unfavorably) the influence of giant U.S. food corporations over national nutritional guidelines with the strict labeling rules established in Chile. The result is ultra-processed fast food spreading throughout American schools, subsidized by the government. “Kraft Heinz sees a $25 billion growth opportunity in the school lunch market where the company has access to generations of future customers,” many of whom, not incidentally, will be candidates for the Ozempic/Wegovy fat shots. What a marvelous circle of rent extraction! Fast-food for kids is attractive for schools that can’t hire enough low-wage kitchen workers and only give students 20 minutes to wolf down lunch. “The food industry and its allies in Congress have beaten back repeated federal attempts to improve what children are fed and limit the type of advertising they are exposed to.” Result: “whole-grain” Cheez-Its on the lunch tray.

*

Ariel Zilber, “Pharma firms testing weight loss drugs for kids amid Ozempic craze,” New York Post, Oct. 20, 2023 READ IT HERE

Get ready for “Ozem-kids.” The fat shot companies are testing out their products on children as young as 6. Maybe they’ll select those getting Lunchables at school! But they don’t really need to since 1 in 5 U.S. children already are considered obese.

*

Hana Mensendiek, “Report: Nearly half of dietary guidelines advisory committee have conflicts of interest,” U.S. Right To Know, Oct. 4, 2023 READ IT HERE

“Nine out of 20 members of the Dietary Guidelines Advisory Committee have conflicts of interest with food, pharmaceutical, or weight loss companies or industry groups with a stake in the outcome of the guidelines.” The DGAC sets dietary advice for the Feds.

*

Caitlin Tilley, “Will Ozempic change junk food forever? Nestle developing ‘companion products’ for weight loss drugs amid fears consumers will lose their appetite for sweets,” Daily Mail Online (U.K.), Oct 20, 2023 READ IT HERE

Given predictions that 24 million Americans (7% of the population) will be on the fat shots in 10 years, demand for sweets and chips is already dropping. To counter this threat to revenues, “Chocolate bar maker Nestle has started to work on new products for people who might be on weight-loss drugs.” Nestle’s shares are dropping as “retailers have already noticed a marked impact on grocery hauls and restaurant orders.”

*

Nathaniel Meyersohn, “CVS, Walgreens and Rite Aid are closing thousands of stores. Here’s why,” CNN Business, Oct 17, 2023 READ IT HERE Marley Jay, “Rite Aid bankruptcy means pharmacies will keep dwindling,” NBC News, Oct 18, 2023 READ IT HERE Jin Yu Young, “Rite Aid is closing 154 stores as it starts to shed debt,” New York Times, Oct 19, 2023 READ IT HERE Rachel Bowman, “America’s pharmacy deserts: Rite Aid, CVS and Walgreens will shut more than 1,500 stores due to crime and competition—leaving MILLIONS without access to healthcare,” Daily Mail (U.K.), Oct 24, 2023 READ IT HERE

After wiping out neighborhood pharmacies and populating the known universe with their stores, the big drugstore chains now find that selling stuff and filling prescriptions aren’t profitable enough, especially as the PBMs bite into their margins. Now, they’re shuttering stores like crazy. Ironically, Rite Aid vows to come back as a “modern neighborhood pharmacy.” Pending that sunny future, one in four U.S. neighborhoods is now a “pharmacy desert.” CVS and Walgreens have moved aggressively into health insurance and direct clinical services. Telepharmacy and mail order dispensing probably will take up the slack while the knowledgeable neighborhood pharmacist joins the dodo bird.

*

D. Lipschutz, “Senate Finance Committee holds hearing on Medicare Advantage marketing misconduct,” Center for Medicare Advocacy, Oct 19, 2023 READ IT HERE

More pressure is building on “deceptive practices” by MA peddlers. Chairman Wyden, an Oregon Dem, slammed “sleazy marketers,” and even an MA-friendly Republican senator (Crapo-ID) called for “a vibrant and competitive broker landscape,” implying there isn’t one at present. The underlying problem corrupting the insurance-advisor role is that brokers get double or triple commissions for funneling people into Disadvantage plans. Another senator (Lankford, R-OK) lamented that “in my state some hospitals won’t take Medicare Advantage at all” because the MA plans stiff them for payment.

*

Sarah Jane Tribble, “Tiny, rural hospitals feel the pinch as Medicare Advantage plans grow,” KFF Health News/NPR,” Oct 23, 2023 READ IT HERE

Speaking of getting stiffed: Medicare Disadvantage penetration is greater in rural areas, making hospitals there more vulnerable to the for-profit entities’ exploitative tactics. MA plans use their market share to offer lousy reimbursement rates with the threat of not including hospitals in their networks. (Traditional Medicare has none.) Those that succumb to the pressure then have to get the privates to pay up. Lagging or simply refusing to pay providers by MA companies has become so common that Congress is getting involved. But you get free rides to your appointments! And a gym membership!

*

Rebecca Pifer, “Express Scripts sued by independent pharmacies over alleged price fixing,” Healthcare Dive, Oct 23, 2023 READ IT HERE

Insurer Cigna owns Express Scripts. According to the lawsuit, they colluded with rival Prime Therapeutics to overcharge pharmacies. Through an anti-competitive deal signed in 2019, the lower-cost Prime agreed to raise its fees to match Cigna’s. Between the two companies, they cover 133 million people in the U.S. This is just one example of how PBMs are taking it on the chin: Hawaii, California, Ohio, and Kentucky have all sued them, and the FTC is digging around in their poorly lit closets.

*

Dave Muoio, “Mayo Clinic, LifePoint Health sue pharmas over ‘pay for delay’ deals keeping blood cancer drug prices high,” Fierce Healthcare, Oct 19, 2023 READ IT HERE

This lawsuit claims that a pharma company and the producer of a generic alternative blood cancer drug conspired to delay the cheaper version for several years and split the resulting lucre. The original patent expired in 2019, but that hasn’t meant anything so far.

*

Sam Allard, “Cleveland Clinic dinged for charity care levels,” Axios, Oct 18, 2023 READ IT HERE

“Cleveland Clinic spent 1.5% on charity while paying CEO $6.6 million. As of 2018, the Clinic owned about $2.4 billion in property, all of which is tax-exempt.”

*

David Wallace-Wells, “Why are so many Americans dying?” New York Times, Oct 18, 2023 READ IT HERE

“Simply being American can cut as much as five years off your life expectancy if you’re part of the bottom half of income earners.” How to escape the curse? Be in the 1% of top earners whose lifes pans are equal to those of Europeans. By contrast, one of out every 25 kindergartners in the U.S. will die before age 40. We immediately think of overdose deaths, but that’s only a fraction of the total. Other causes: firearms, accidents, car crashes, fires, poor birthing conditions, and of course obesity.

*

[no author] “Medicaid enrollment and unwinding tracker,” KFF Health News, Oct 23, 2023 READ IT HERE

Total kicked off Medicaid to date: 9.3 million; rate of disenrollment: from 11% of current beneficiaries in Illinois to 66% in Texas; those booted for procedural reasons who may actually remain eligible: 71%; children as a percentage of those disenrolled: 39% (range 14% in Massachusetts to 68% in Texas).

*

Jaymie Baxley & Rose Hoban, “Throwing a financial lifeline to rural NC health care providers,” North Carolina Health News, Oct 25, 2023 READ IT HERE

North Carolina finally broke with its fellow Confederate states and voted to expand Medicaid. A bonanza of federal funds will follow, and lawmakers want to spend some of it to improve the state’s rural health infrastructure and stave off further rural hospital closings.

*

Anna Claire Vollers, “10 Medicaid holdout states scramble to improve health coverage,” Stateline, Oct 19, 2023 READ IT HERE

Red-state solons in Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming say expanding Medicaid is too expensive or those in charge “remain ideologically opposed to government-funded health care.” Some scramble to find alternative patches, like pregnancy or mental health programs. But non-expansion states “continue to fare poorly on most health metrics” and account for most of the rural hospital closures. “In Alabama, a single parent with two children can’t qualify for Medicaid if he or she makes more than $4,476 per year.”

*

“Georgia Medicaid program with work requirement has enrolled only 1,343 residents in 3 months,” Associated Press, Oct 20, 2023 READ IT HERE

States like Idaho, Arkansas, and now Georgia go through amazing contortions to make sure no lazy palookas are getting any damn free health care. The latest effort is Gov. Kemp’s “Georgia Pathways to Coverage” that makes beneficiaries prove they spent 80 hours a month either at a job, studying, or volunteering. (Hours spent figuring out health insurance paperwork doesn’t count.) Only 1,343 people have enrolled in this complex scheme after three months. Meanwhile, the state is knocking people off Medicaid with admirable efficiency.

*

Don Thompson, “California expands paid sick days and boosts health worker wages,” KFF Health News/Desert Sun, Oct 25, 2023 READ IT HERE

“Newsom blessed a rare agreement between labor and the health industry to gradually phase in a $25-an-hour statewide minimum wage for health workers.” And five whole sick days.

*

Danielle Ofri, “It shouldn’t be this easy to lose your health insurance,” New York Times, Oct 25, 2023 READ IT HERE

“Why do Americans have to remember to get health insurance every year? We don’t ask citizens to remember to enroll with the fire department every year, or to remember to sign up for electricity service or water. Yet with health insurance, we’ve set up an unwieldy mechanism where millions of people have to opt in every year or do without.” It’s not just Medicaid beneficiaries who have to re-up every year—some private plans require it as well as this busy doctor found out. She concludes, “None of this would be necessary if the only requirement for getting insurance was being born.” Indeed.

*

Melissa Rudy, “Dementia’s staggering financial cost is revealed in new report: It’s ‘bankrupting families,’” Fox News, Oct 23, 2023 READ IT HERE

Big surprise: U.S. patients’ financial wealth plummets after dementia diagnosis, and their families’ does, too. Given that life expectancy after diagnosis is 4 to 8 years, the costs to families can go on for a long time with little help from our system.

*

Alejandra O’Connell-Domenech, “Giving birth is pricey in the US, and growing pricier,” The Hill, Oct 22, 2023 READ IT HERE

The median cost for an in-network vaginal birth in the U. S. is now $13,000 and can reach $20,000. Even with insurance, out-of-pocket costs often run into thousands. “It’s crazy that having a kid is like buying a new car now.”

*

Elizabeth Cherot & R. Lawrence Moss, “Congress must face the preemie crisis,” Roll Call, Oct 20, 2023 READ IT HERE

Premature births have been on the rise in the U.S. for a decade and have now reached a 15-year high with one in every 10 babies born too early. “Black and Native American women are 62% more likely to give birth prematurely, and their babies are twice as likely to die.” Why? No one really knows: “No less than two-thirds of preterm births occur without any evident risk factor.” But not being white is clearly one of them.

*

Ken Alltucker, “Why are families paying $24,000 a year for health insurance when inflation is going down?” USA Today, Oct 18, 2023 READ IT HERE

“The average cost for a family health insurance plan offered through an employer jumped 7% this year to $23,968.” Last year, premiums only rose 1%.

*

Emily Olsen, “Walgreens, Alignment partner on co-branded MA plans,” Healthcare Dive, Oct 18, 2023 READ IT HERE

They’ll tempt 1.6 million gullible seniors in Arizona, California, Florida, and Texas with zero premium plans and zero copays on thousands of prescription drugs at Walgreens. They’ll be delighted until they actually face the Disadvantage hell of narrow networks, prior authorization, and denials. Walgreens already has an MA deal with UnitedHealthcare.

*

SINGLE PAYER LINKS #320

Posted 20 OCT 2023

*

Anabel Sosa, “New California law takes a step toward single-payer healthcare,” Los Angeles Times, Oct 8, 2023 READ IT HERE

California will seek a waiver to permit the state to shift (someday) its federal Medicaid and Medicare funds to a single-payer system. The bill’s author argues that it brings California closer to single-payer because partial steps like his will work better than a revamp of the entire system. The state nurses’ association disagrees and says the bill is redundant. In any case, the headline indicates that the idea of single-payer is alive and well.

*

Richard Payerchin, “Physician group slams insurers for overcharging taxpayers for Medicare Advantage,” Medical Economics,” Oct 10, 2023 READ IT HERE

PNHP’s new study is a must. It lays out how Medicare Advantage has become a cash cow for insurance companies even as patient care suffers. Surprisingly, the authors found that upcoding accounts for a relatively small portion of MA overpayments, only around $17 billion in excess payments. “Favorable selection,” on the other hand, where by MA sellers try to weed out patients who might actually need care, accounts for around $50 billion. PNHP notes that the estimated excess spending could be used to cover dental and vision coverage under traditional Medicare—which are the add-ons that MA plans use to tempt seniors to sign up.

Here’s the report: Physicians for a National Health Program (PNHP), “Our payments, their profits: Quantifying overpayments in the Medicare Advantage program,” undated READ IT HERE, and you can listen to a webinar on it here: READ IT HERE

*

Candi Bolden, “Another rural Kansas hospital is closing. A new fight over Medicaid expansion has begun,” Wichita Eagle, Oct 3, 2023 READ IT HERE

Relentless destruction of rural healthcare nationwide: Kansas legislators want to cut taxes on the wealthy while simultaneously pleading the state’s too poor for Medicaid expansion. That might have saved the latest hospital to go, this one in Fort Scott near the Missouri border. “The pace of rural hospital closures doubled in 2013–2017 compared to the previous five years.” Four-fifths of the closures occurred in states that have refused to expand Medicaid.

*

Pooja Salhotra, “La Grange hospital shutters amid financial struggles,” Texas Tribune, Oct 12, 2023 READ IT HERE

This rural hospital shut its doors and laid off its 50 employees after Covid funding dried up. (That was an emergency, but dozens of dying hospitals isn’t?) Texas is No. 1 in this category, with 26 rural facility closures out of 120 nationally. It also has the largest uninsured population in the U.S.

*

Bracey Harris, “Fears rise as 3 maternity units prepare to close in Alabama,” NBC News, Oct 15, 2023 READ IT HERE

Three more Alabama hospitals are shutting down maternity units. Some women will have to drive 100 miles to give birth—bad outcomes in emergencies are guaranteed in a state with the country’s 4th highest maternal mortality rate. One third of Alabama counties are “maternity care deserts with no hospital with obstetrics care, birth centers, OB-GYNs or certified nurse midwives.” Also, Alabama outlawed almost all abortions, and 9% of residents have no insurance.

*

David Raths, “North Dakota critical access hospitals form network,” Healthcare Innovation, Oct 13, 2023 READ IT HERE

One state is looking at alternative ways to keep its rural health services from collapsing. A 23-hospital network called Rough Rider got $3.5 million from the state to coordinate care in various specialties that the individual entities can’t sustain on their own. The total patient pool is 225,000 people, which could help them all survive. “The network is exploring shared solutions in pharmacy, laboratory, telehealth, information technology, health information exchange, clinical staffing, supply chain and other areas.” Could work, who knows? ND also has the country’s only publicly owned bank.

*

Brittany Trang, “Is there a nursing shortage in the United States? Depends on who you ask,” STAT, Oct 16, 2023 READ IT HERE

[You mean “whom.”] The hospital trade association says we’re short a million nurses; National Nurses United says there are plenty of nurses—they just won’t submit to current conditions, especially hospitals trying to save on staff. Turnover in nursing is high, and the rash of strikes reflects dissatisfaction—which leads to more nurses quitting and thus worse nurse-to-patient ratios. If healthcare is run as a business, corporate cost-cutting logic is inevitable.

*

Susanna Vogel, “Physician burnout rate doubled between 2019 and 2021, study finds,” Healthcare Dive, Oct 6, 2023READ IT HERE and Susanna Vogel, “Healthcare worker exodus continued through 2022, new data shows,” Healthcare Dive, Oct 17, 2023 READ IT HERE

Healthcare hasn’t recovered from Covid. JAMA defines burnout as, “a state of emotional, physical and mental exhaustion caused by prolonged stress in the workplace.” More than 145,000 providers left the industry from 2021 through 2022, half of them physicians. Same complaints: low staffing levels, untenable hours, depression, and stress.

*

Dominick Reuter, “Why pharmacy workers are walking off the job,” Insider Today, Oct 9, 2023 READ IT HERE

Another strike wave: Pharmacy staff at dozens of Walgreens locations struck over workplace conditions. “Users described ongoing problems with unrealistic demands from Walgreens management.” CVS also had a stoppage. Once again, inadequate staffing levels is a big issue. A professional association decried “pharmacists being coerced to perform illegal acts, to downplay unsafe conditions, to endure abusive, hostile, and threatening behaviors from customers and mangers, and to perform high volume/high risk work with undertrained co-workers, led by inexperienced managers.” Needless to say, a rushed pharmacist can make deadly mistakes.

*

Dave Muoio, “Allina Health clinicians to form largest group of unionized physicians in US private sector,” Fierce Healthcare, Oct 16, 2023 READ IT HERE

Doctors in unions? Why not as Modern Times comes to medicine, and they’re reduced to cogs in giant corporate machinery. Providers at 50 Minnesota and Wisconsin primary and urgent care centers voted 325-200 to become “what could be the largest group of unionized docs in private practice in the U.S.” Another 100 hospital physicians who work for the same outfit voted to unionize in March. “Doctors Council SEIU Local 10MD”—that has a nice ring! Motivations to vote yes to the union: understaffing, burnout, onerous admin duties, and care quality.

*

Max Kozlov, “NIH director hearing highlights science’s politicization in wake of COVID pandemic,” Nature, Oct 19, 2023 READ IT HERE

“Although senators across the political spectrum lauded Monica Bertagnolli’s qualifications to direct the NIH, many pressed her on hot-button issues. By contrast, [her predecessor] had unanimous support from the Senate, and no confirmation hearing was held.” Yes, public health along with The Science™ have been politicized. Whose fault is that? Those who lied outright, manipulated research, and worshipped their own suppositions as Revealed Truth in service to their political ends, i.e., BOTH sides of the self-righteous debate. See the next story for a crucial example.

*

Naomi Oreskes, “What went wrong with a highly publicized COVID mask analysis?” Scientific American, Nov 1, 2023 READ IT HERE

“The Cochrane Library, a trusted source of health information, misled the public. [It] seriously muddied the waters with a report that gave the false impression that masking didn’t help.” The anti-masker folks said they couldn’t find randomized trial evidence that surgical masks slow the spread of Covid and concluded that wearing them “probably makes little or no difference.” The conclusions were trumpeted far and wide as Masks Don’t Work!, including by the lead author. Epi-nerd technical note: Studying masking via randomized trials is problematic because it’s impossible to accurately record what people do and don’t do with their masks—they forget or make things up. Unless you’re physically observing them over long periods, it’s all fuzzy recall. (Nutrition studies are the same: Did you eat your vegetables this week? Oh yes!) By contrast, a Kansas-based natural experiment in which some counties mandated masking and others didn’t showed mask efficacy—but that finding wasn’t convenient, so we didn’t hear about it. Saint Anthony and the rest made stuff up as they went along based on what we children were supposed to think and do as decided by the White House—that was fatal, and empowered mass nuttiness.

*

Alex Philippidis, “European Commission orders Illumina to divest of Grail,” Genetic Engineering & Biotechnology News, Oct 12, 2023 READ IT HERE

Corporate execs rammed through a merger in the biotech sector without waiting for permission; the European Commission was not amused. Result: mandated divorce and a half-billion-dollar fine. The FTC also has acted to block the merger in the U.S. Regulators have awakened.

*

Emily Olsen, “Amwell, Nestlé partner on digital nutrition programs,” Healthcare Dive, Oct 6, 2023 READ IT HERE

I’m so old I remember Nestlé’s nefarious role in the campaign to get pregnant women to stop breastfeeding and use its formula instead. The idea of that letting that outfit anywhere near healthcare should set off alarm bells. But telehealth company Amwell promotes Nestlé’s “Impact Advanced Recovery drink for patients undergoing major elective surgery in the U.S.” So, you have an operation, and afterward a nice nurse explains there’s a wonderful new program that will help you get well—but doesn’t mention who’s getting reimbursements nor from whom.

*

Rebecca Pifer, “Uber adds Optum-enabled benefits cards to health platform,” Healthcare Dive, Oct 9, 2023 READ IT HERE

Another offering from some Disadvantage plans: They give you a benefit card that enables you to have Uber rides to the doctor and your groceries delivered. In exchange, you get narrow networks, prior authorization hell, and care denials. “The new deal has made Uber a ‘patient entry point’ into the health benefits system.” Sort of like entry to a roach hotel.

*

Rebecca Pifer, “Microsoft unveils new generative AI products for health systems,” Healthcare Dive, Oct 10, 2023 READ IT HERE

The healthcare industry is “a wellspring of data”—equivalent to 10 billion MP3 music files from hospitals alone—and 97% of that data goes unused.” That sounds like an investment opportunity! Enter Microsoft, which is “releasing new capabilities meant to free up information for clinicians.” Microsoft says its new product will alleviate the paperwork burden on providers, ergo, doctors need more electronic labor-saving tools from tech giants. Expect fewer interactions with actual people and more chatbots on the other end of the line.

*

Emily Olsen, “Share of MA, Part D plans earning top star ratings drops in 2024,” Healthcare Dive, Oct 13, 2023 READ IT HERE

MA scams are getting a little less praise from the Feds through their five-star ranking system that triggers juicy extra reimbursements. Federal bonus payments will total $12.8 billion this year (up 30% yoy), but one company, Centene, got less than expected and had to shed 2,000 employees.

*

Heather Landi, “Rite Aid files for Chapter 11 bankruptcy protection as it faces rising debt, opioid litigation,” Fierce Healthcare, Oct 16, 2023 READ IT HERE

Rite Aid is getting left behind in the transition from retail to the new generation of provider-online marketer-telemedicine combos, like competitor CVS that owns insurer Aetna and a PBM. Maybe the local independent pharmacy will make a comeback as the big chains transition to some kind of weird hybrids.

*

Rebecca Pifer, “Walgreens, chasing profits, to close 60 VillageMD clinics in 2024,” Healthcare Dive, Oct 12, 2023 READ IT HERE

Another chain with problems: Walgreens is making less on Covid testing and vaccines and closing some of its “underperforming” primary care clinics in regions where it doesn’t have enough price-gouging opportunities market share. Walgreens’s health-related cartel, U.S. Healthcare, comprising VillageMD, CityMD, Summit Health, home care provider CareCentrix, specialty pharmacy Shields Health Solutions, and a clinical trials division, “has not ramped up to profitability as quickly as Walgreens had wanted,” said an exec. That means Wall Street was unimpressed. Maybe healthcare is a tad more complicated than selling toothbrushes.

*

Angus Liu, “Mallinckrodt wins court go-ahead for 2nd bankruptcy, cutting $1B from opioid payout,” Fierce Healthcare, Oct 11, 2023 READ IT HERE

A big opioid distributor has essentially walked back its promise to pay $1.7 billion to settle charges thanks to the company’s second bankruptcy in two years. Establishing its corporate home in low-tax Ireland didn’t hurt. The first bankruptcy settlement barred opioid victims from suing Mallinckrodt ever again, but now, the company is ditching its part of the deal.

*

Emily Olsen, “Financial distress is driving health system M&A,” Healthcare Dive, Oct 17, 2023 READ IT HERE

Mergers and buy-ups by big healthcare systems usually are driven by the desire for concentration and “market share.” But now a lot of deals are because of financial troubles.

*

Dave Muoio, “Healthcare Dealmakers—Elevance, BCBSL's $2.5B merger paused; NextGen's $18B PE buyout and more,” Fierce Healthcare, Oct 5, 2023 READ IT HERE

The old gobble-up-everything-and-raise-prices mergers haven’t disappeared though. For example, Walmart is looking to buy 125 ChenMed clinics; UnitedHealth Group plans to acquire a home health company for $3 billion if the Feds don’t block them; Elevance Health and BCBS of Louisiana want to proceed with a $2.5 billion merger.

*

Anastassia Gliadkovskaya, “Medical AI scribe startup Nabla rolling out tool to the Permanente Medical Group docs in Northern California,” Fierce Healthcare, Oct 9, 2023 READ IT HERE

Another AI-driven note-taking software rushing in to “allow doctors to focus on patient care,” namely 10,000 of them affiliated with the Kaiser system. It transcribes doctor-patient conversations and generates a clinical note in 20 seconds. What could go wrong?

*

Kyle Davidson, “Michigan Senate votes to advance prescription drug bills, nixes most GOP amendments,” Michigan Advance, Oct 4, 2023 READ IT HERE

State action while Congress decides who gets the corner office. Michigan’s Prescription Drug Affordability Board could “set upper payment limits on drugs sold in the state.”

*

Marissa Plescia, “Instacart partners with Mount Sinai, launches co-branded MA plans with Alignment,” MedCity News, Oct 5, 2023 READ IT HERE

More bribery to lure people into Disadvantage plans: Instacart & Mount Sinai will “launch a new partnership that provides post-operative and post-partum patients with grocery stipends.” In exchange for the 100 bucks in free food, you tie yourself to the for-profit MA dystopia.

*

Sarah Kliff, “Mary Lou Retton crowdfunded her medical debt, like many thousands of others,” New York Times, Oct 12, 2023 READ IT HERE

And she pulled down $350K in two days, seven times the announced goal. Most un-famous people never get enough to cover their bills even when they’ve paid for health insurance. (Retton didn’t.) According to a study, the typical fund-raiser generates about $2K; fewer than 12 percent of campaigns meet their goals. The fact that they exist at all is a scandal. “Young white men coping with unexpected medical crises tend to attract the most support while Black women were underrepresented among successful campaigns.”

*

Sarah Jane Tribble, “What mobile clinics in Dollar General parking lots say about health care in rural America,” KFF Health News/NPR, Oct 4, 2023 READ IT HERE

While rural hospitals are allowed to collapse, discount retail outlets experiment with quickie primary care services. This outfit charges $69 per visit for the uninsured or non-network patients. Maybe healthcare in a parking lot is the future.

*

Joseph Choi, “Medicare Part B premiums to rise by 6 percent in 2024,” The Hill, Oct 12, 2023 READ IT HERE

Sounds high since the Social Security COLA increase is only about half that. However, last year some Medicare premiums dropped while the SS adjustment for inflation for a hefty 6%.

*

Robin Respaut & Chad Terhune, “Wegovy, other weight-loss drugs scrutinized over reports of suicidal thoughts,” Reuters, Oct 12, 2023 READ IT HERE

The FDA “has received 265 reports of suicidal thoughts or behavior in patients taking these or similar medicines since 2010. Thirty-six of these reports describe a death by suicide or suspected suicide.” Reuters had to use public records requests to get the data. Wegovy and Saxenda have warning labels about suicidal ideation; Ozempic does not.

*

Frances Stead Sellers & Catarina Fernandes Martins, “A tale of two sisters, two countries, and their health systems,” Washington Post, Oct 17, 2023 READ IT HERE

The sisters both suffer from rheumatoid arthritis. One uses Portugal’s humane and personalized health services; the other “has cobbled together her treatment” in the patchwork U.S. system and flies to Lisbon when she can’t afford care. Nothing readers here will find surprising except perhaps this fun fact: Portugal’s combined decriminalization of person drug use and universal, single-payer healthcare has resulted in 11 annual drug overdoses per million inhabitants, compared to the U.S. rate of 450/million.

*

Or listen to a podcast summary under "Do Not Resuscitate (This System)" LISTEN TO IT HERE

SINGLE PAYER LINKS #319

Posted 13 OCT 2023

*

Paige Minemyer, “Experts debate the flaws, future of Medicare Advantage,” Fierce Healthcare, Oct 10, 2023 READ IT HERE

Topic at a high-powered health execs conference: “Can the faults in Medicare Advantage be solved, or is the answer to scrap the program entirely?” I’ve never seen those words uttered at a mainstream industry setting, so let’s hope it’s the kiss of death. The panel was set up as a yes/no debate between two former officials at the Center for Medicare/Medicaid Services; one of them didn’t mince words: “MA today is not value-based care, it’s value-destroying. It destroys the value of what we have in our healthcare dollar, taking dollars out for profits, corporate stock buybacks, and dividends.” One area of agreement: traditional Medicare should offer some of the MA add-ons.

*

Dave Muoio, “UnityPoint Health, Presbyterian Healthcare Services call off $11B merger,” Fierce Healthcare, Oct 11, 2023 READ IT HERE

The two entities said regulatory pressure had nothing to do with it. That might be true. Or not. “The cross-market deal would have yielded a 48-hospital nonprofit with more than 4 million patients and $11 billion in annual revenue. Both jilted partners reported a loss for the past year—but many big systems have Wall Street portfolios that tanked.

*

Jonathan Howard, “Overhyping vaccines wasn’t pro-vaccine. It was pro-stop-worrying-about-COVID,” Science-Based Medicine, Oct 1, 2023 READ IT HERE

What is being truly “pro-vaccine”? Sticking to the truth and admitting what we don’t know—the exact opposite of how Covid was handled. “No vaccine is 100% effective or safe,” so we should acknowledge uncertainty, especially with new or experimental ones. Covid vaccines were both. But caution and humility were sorely lacking and still are. Instead of learning, we’re pushed into a giant pep rally. Includes a long list of false statements by top authorities.

*

Robert Hart, “Ultra-processed food—especially artificial sweeteners—linked to depression, study finds,” Forbes, Sep 20, 2023 READ IT HERE

Those who gobbled up the most crap had a 50% higher risk of depression. Especially deadly: artificial sweeteners and drinks that contain them. “Another major downside to the pervasive ingredients that dominate American diets and have already been linked to major problems like cancer, diabetes and obesity.” But forget that in favor of pharmaceuticals to treat all the illness our diets create. Contrary evidence: the study found a correlation but doesn’t claim causality—maybe depressed people eat more crap.

*

Peter Schwartz, “Germany’s war budget,” World Socialist Web Site, Sep 6, 2023 READ IT HERE

A side effect of the Ukraine war spending: Germany’s public health system is getting hit with a starvation budget. Health spending in Germany was €64.4 billion in 2022; this year it will be €24.5 billion. Meanwhile, “International investment groups are buying up doctors’ practices in Germany, and private equity now owns hundreds.”

*

Jake Johnson, “Medicare Advantage overbills taxpayers by $140 billion a year—enough to wipe out Medicare premiums,” Common Dreams, Oct 8, 2023 READ IT HERE

Headline is misleading: the estimate is a range with the lower bound $88 billion, which reflects the impact of upcoding. The Biden folks tried to crack down, then buckled in the face of industry pressure and is giving them 3 years to stop committing fraud.

*

Chris Stanton, “The two words that can make health care a nightmare,” New York, Jul 10, 2023 READ IT HERE

The deadly words are prior authorization. “The typical physician submits 45 prior authorizations per week; some hire extra staff to help with the administrative burden. Multiple pages of paperwork have to be filled out and sometimes fed into a fax machine, often only for the first request to be denied. The insurer might then suggest a cheaper treatment alternative before moving onto a ‘peer-to-peer,’ in which the doctor gets on the phone with someone at the insurance company and attempts to justify the treatment plan they developed for their patient.” Some outsource prior authorization to a separate company that brags about how many denials it issues. Thirty states are weighing bills to rein in prior authorization.

*

Wendell Potter, “After missing mid-year financial expectations, here are the ways big health insurers are going to get back into Wall Street's good graces,” Healthcare Un-Covered, Sep 14, 2023 READ IT HERE

Insurance stocks are falling while the Dow and other Wall Street indices are humming along, so why? Potter, a former insurance company exec, tries to explain why some of the big players aren’t racking up enough juicy profits since the $40 billion recorded in just the first half of 2023 isn’t good enough. Because top executives’ compensation is tied to shareholders returns, CEOs will start to slash benefits, use stricter prior authorization criteria, deny more claims, get tougher in negotiations with hospital systems and doctor groups, and cut their own staff. For example, “UnitedHealth Group sent letters to numerous physician groups demanding pay cuts of up to 60% [or be] kicked out of UnitedHealth’s provider network.” Also, they’ll scramble even harder for MA clients since the Feds don’t negotiate as hard as private employers. “MA insurers reported gross margins averaging $1,730 per enrollee,” double the margins reported by insurers in other categories.

*

Stephanie Stephens, “New Medicare Advantage plans tailor offerings to Asian Americans, Latinos, and LGBTQ+,” KFF Health News/Los Angeles Times, Sep 28, 2023 READ IT HERE

The MA hustle continues with IdPol pitches to gullible seniors: “Three Southern California companies are pioneering new types of plans that target cultural and ethnic communities with special offerings and native-language practitioners,” with extra bennies like “coverage for Eastern medicines and treatments” for Asians and specialized pitches to Hispanic and LGBT prospects.

*

Susan Jaffe, “Feds rein in use of predictive software that limits care for Medicare Advantage patients,” KFF Health News/Washington Post, Oct 5, 2023 READ IT HERE

Are you gonna believe our robot or your lying eyes? Instead of actual providers looking at actual people, UnitedHealthcare—the nation’s largest health insurance company—uses naviHealth to “analyze data” and issue orders. Result: a patient who can’t walk and uses a colostomy bag can told she’s fine and sent home. The program “anticipates what kind of care a specific patient will need and for how long. But patients, providers, and patient advocates in several states said they have noticed a suspicious coincidence: The tool often predicts a patient’s date of discharge, which coincides with the date their insurer cuts off coverage.” MA is so great! I get free glasses!

*

Christopher M. Whaley, Sebahattin Demirkan & Ge Bai, “What’s behind losses at large nonprofit health systems?” Health Affairs, Mar 24, 2023 READ IT HERE

The pandemic strained many large hospital systems’ financial resources due to patient loads, supply costs, and costly labor shortages. More lucrative elective procedures plummeted as people stayed away. But operating revenue stayed fairly steady, and the Feds provided emergency financial assistance. Why did they go into the red? Their portfolios! “Investment losses account for approximately 85% of overall financial losses.” Ergo, when hospitals became more like banks, they entered the business cycle and are more vulnerable just when we need them the most. “When losses are driven by risky financial investments, it is not clear whether patients, employers, insurers, and taxpayers should be responsible for paying higher prices to offset the impact of overall market declines.” I’d say it’s perfectly clear: NO.

*

Berkeley Lovelace Jr., “Popular weight loss drugs linked to rare but severe stomach problems, study finds,” NBC News, Oct 5, 2023 READ IT HERE

A top journal (JAMA) says some fat-shot patients develop stomach paralysis. “They can also lead to abdominal pain, nausea, and vomiting, as shown in clinical trials and noted on drug labels.” Money quote: “The clinical trials that drug companies conducted prior to the drugs’ approval were not large enough to detect rarer side effects.” But that new silhouette!

*

Brendan Pierson, “AstraZeneca to pay $425 million to end US lawsuits over heartburn drugs,” Reuters, Oct 3, 2023 READ IT HERE

Another Pharma coughs up cash over a class of drugs that was all the rage in its day. Nexium and Prilosec were peddled for heartburn, but the fact that they could cause chronic kidney disease was downplayed.

*

Sean Scanlon, “Connecticut’s comptroller explains his thinking about GLP-1s for state employees,” STAT, Oct 10, 2023 READ IT HERE

At least this state official is trying to add lifestyle coaching to the fat shots if CT is going to be paying thousands per month for a slew of residents.

*

Maya Goldman, “Doctors question Medicare quality program as more face steeper penalties,” Axios, Oct 5, 2023 READ IT HERE

Performance bonuses sound like a good idea: doctors show their patients are doing better, and they get higher reimbursements. The program, known as the Merit-Based Incentive Payment System (MIPS), was designed to get tougher as providers got more accustomed to tracking quality metrics, but it’s zero-sum—top performers only get a bonus based on how many doctors are penalized and their reimbursements cut. The AMA now thinks it’s a lot of paperwork for little reward. Plus, speculates the writer, “Congress should consider whether the current system incentivizes providers to ‘game MIPS,’” rather than actually doing a better job. Could that be??

*

Brendan Pierson, “Hawaii accuses top pharmacy benefit managers of illegally driving up prices,” Reuters, October 5, 2023 READ IT HERE

Hawaii, joining California, Ohio, and Kentucky, goes after PBMs for “driving up brand-name prescription drug prices through a complex system of rebates and fees.”

*

Rebecca Pifer, “Warren, Jayapal call for closer scrutiny of UnitedHealth-Amedisys deal,” Healthcare Dive, Oct 4, 2023 READ IT HERE

More heat on anti-competitive mergers: the $3.3 billion transaction between UHC and a home care/hospice agency gives the insurer too much market power, say the pols. Some backstopping of the FTC’s new toughness from Congress.

*

Sanika Santhosh, “Colombia’s bid for compulsory license of HIV drug may set precedent in region,” Health Policy Watch, Oct 5, 2023 READ IT HERE

Big if it actually happens. Countries have long been intimidated by Pharma and U.S. government threats against utilizing their legal compulsory license authority. Colombians now pay $100 a month for dolutegravir instead of $2 for the generic version. HIV is still on the rise in the country, plus people are pouring in from Venezuela for treatment.

*

Inti Pacheco, “Home Depot tracked a crime ring and found an unusual suspect,” Wall Street Journal, Oct 7, 2023 READ IT HERE

“[Drug-rehab operator] Robert Dell was telling people who went to his recovery program to steal tools from Home Depot stores all over Florida and drop them off at his home. Using the eBay account Anointed Liquidator, he sold $3 million of items online since 2016.” Nice side hustle, and a reminder that “drug treatment” programs need eagle-eye monitoring. A commentator says, “Of the many reasons to oppose the Sackler bankruptcy settlement, a big one is that it will funnel billions more dollars to fake pastors who bribe junkies with drugs into doing crimes and then bill CMS.”

*

Rachel Cassandra, “Alaska health department changes Medicaid renewal process to keep thousands covered,” Alaska Public Media, Oct 9, 2023 READ IT HERE

Alaska shows how Medicaid eligibility renewal can be done without unnecessarily abusing beneficiaries. One-third of the state’s residents are on Medicaid, and 37% of them were “procedurally disenrolled” after Biden lifted the Covid emergency. Now, they hit the brakes and are re-enrolling people incorrectly dumped.

*

Jeremy Olson, “The dilemma of medical debt lawsuits in Minnesota: Too big to pay, too small to fight,” Star-Tribune, Oct 10, 2023 READ IT HERE

Over half of civil court business in Minnesota is for “helping debt collectors and creditors collect money from Minnesotans,” 20% of them for medical expenses. The average medical debt in the state is $1500, and most of those sued are insured. The info is from a state study launched after news that one hospital was refusing care to people who had unpaid bills.

*

Rebecca Pifer, “‘Hope is not a strategy’: Health startups short on cash staring down consolidation, investors say,” Healthcare Dive, Oct 11, 2023 READ IT HERE

Healthcare startups are rarer these days as the Covid-era scramble fades. That signals bigger deals as the smaller players get absorbed into the monsters. “Mega-deals worth $100 million suggest an appetite for strategic tie-ups.” The language of healthcare investment is jarring, given the “product” they’re selling. For example, “Smaller vendors are starting to approach larger platforms about a combination, especially in the area of chronic condition management.” In English: we’re working on how to best profit from really sick people.

*

To listen to a summary of last week's articles, click here: https://www.podbean.com/ep/pb-4mff2-14ce8fe

SINGLE PAYER LINKS #318

Posted 6 OCT 2023

*

Angel Adegbesgan, “Weight-loss drugs like Ozempic are in such huge demand that spending on them will hit $100 billion by 2035, analyst says,” Fortune/Bloomberg, Sep 22, 2023 READ IT HERE

$70 billion of which will come from the U.S.

*

Josh Nathan-Kazis, “Ozempic and Wegovy could break the healthcare system,” Barron’s, Sep 21, 2023 READ IT HERE

Paywalled: “Novo Nordisk and Eli Lilly are about to start raking in tens of billions of dollars a year on their new obesity drugs. That could be a disaster for the companies and government agencies set to pick up the bill.” If Pharma is successful, anticipate stories about Medicare’s imminent “bankruptcy.”

*

Lee Fang, “Behind Ozempic media buzz, undisclosed drugmaker money,” Substack, Sep 26, 2023 READ IT HERE

How are we being convinced that the fat shots are great and necessary? “Celebrities, physicians, patient advocacy groups, public health experts, academics, and a variety of community leaders have appeared in dozens of media outlets to tout the wonders of a new class of weight loss drugs without disclosing financial ties to Novo Nordisk. An ABC News story quoted only one physician, Dr. Deborah Horn, who advocated for Medicare to cover the medication. However, the article omitted that Horn has received nearly a quarter of a million dollars from Novo Nordisk since 2020.” Also, see below re Fix Is In.

*

Noah Tong, “CMS urged to change GLP-1 drug coverage determination,” Fierce Healthcare, Sep 25, 2023 READ IT HERE

“In a joint press conference hosted by health experts at [Democrat-heavy, hyper-connected law firm] Manatt, Phelps & Phillips and the Obesity Action Coalition, advocates laid out a legal basis in support of covering [the fat shots]. Repeat after us: “Obesity is a disease,” which means it requires drugs (which our Pharma friends, coincidentally, sell). If they’re not passing out gold bars, someone should file a complaint.

*

Igor Derysh, “Not just Sinema: Sen. Bob Menendez took $1M from pharma; shoots down bill to lower drug costs,” Salon, Oct 25, 2021 READ IT HERE

Retrieved from 2021, this review of gold-bar Bob’s long-standing star role as Pharma shill is highly germane today as Menendez pleads Latino victimhood.

*

Rebecca Pifer, “PBMs, PhRMA trade blame over drug costs in House hearing,” Healthcare Dive, Sep 19, 2023 READ IT HERE

Always a pleasure to see a Godzilla v. King Kong slugfest. PBMs’ business practices are getting most of the stick, for now, and some action on rebate incentives and PBM secrecy seems fairly likely. “PBMs frequently restrict access to low-cost generic and biosimilar medications by not including them on formularies because of financial incentives pushing them toward high-price brands. One cancer drug could be purchased for as little as $55 a month but cost $6,600 a month for a patient covered by [PBMs] Caremark or Express Scripts.”

*

Emily Olsen, “CMS requires 30 states to pause Medicaid disenrollments after systems error,” Healthcare Dive, Sep 22, 2023 READ IT HERE and Noah Weiland, “Nearly 500,000 in U.S. will regain health insurance after state errors,” New York Times, Sep 21, 2023 READ IT HERE

Seven million have lost Medicaid coverage since April, including 1.4 million children. Many states conducted the checks with faulty software. The catastrophic culling is so bad that the Feds stepped in: “Regulators ordered 30 states to pause procedural disenrollments of Medicaid beneficiaries after warning about inappropriately removing children and other enrollees.” A half million people will get their coverage back—for now. Amazing efficiency when it comes to kicking people off a benefit; getting them back on is a bit slower.

*

Rachel Mipro, “Top Kansas Republicans push flat tax proposal, pan Medicaid expansion,” Kansas Reflector, Sep 21, 2023 READ IT HERE

Despite popular support, Kansas GOP is digging in its heels against Medicaid expansion (too expensive), but are teeing up a flat-tax proposal that will “primarily benefit the state’s wealthiest residents” and cost the state $330 million in annual revenue. Class warriors are nothing if not consistent. Kansas is determined to drive itself into penurious feudalism.

*

Aaron Kheriaty, “The White House’s ‘misinformation’ pressure campaign was unconstitutional,” Newsweek, Sep 26, 2023 READ IT HERE

The author is a plaintiff in the suit against the Feds’ “years-long pressure campaign designed to ensure that [social media messages] aligned with the government’s preferred viewpoints,” in the words of a judge who ruled in his favor. Specifically, the Feds policed Covid-related debates, and as we know, the platforms capitulated. We’ll now be hearing all about how this ruling is inhibiting officials from expressing themselves, as opposed to coercive censorship. Kheriaty counters, “The government can say whatever it wants publicly; it just cannot stop other Americans from saying something else.” Once upon a time, liberals fought against the silencing of criticism. Now, that makes you a tinfoil-hatted MAGA who must be supervised by Minitrue. Remember when suggesting the lab-leak theory of Covid’s origin was a forbidden conspiracy theory that got you kicked off YouTube? That speech was not untrue, merely unwelcome.

*

Matt Taibbi, Alex Gutentag & Michael Shellenberger, “Fauci diverted US government away from lab leak theory of COVID’s origin, source say,” Public, Sep 27, 2023 READ IT HERE

The lab-leak theory, which now is probably the majority view on Covid’s origin, was actively suppressed by guardians of The Science™: “Fauci visited CIA headquarters to ‘influence’ its review of COVID-19 origins.” Did Fauci’s pressure work? Yes! “Seven CIA experts received performance bonuses after changing a report to downplay concerns about a possible lab origin of the virus.” Fauci also allegedly continued his rounds “agency by agency” to stamp out dissident views. During his secretive trips to the CIA, says the whistleblower, he was treated “like a rockstar.”

*

Matt Taibbi, “Did Anthony Fauci impede the investigation of the Covid-19 pandemic?” Racket News, Sep 27, 2023 READ IT HERE

Adds this detail: The government’s “malinformation” apparatus was vigorously coercing Internet platforms to suppress lab-leak talk while in possession of “significant evidence supporting that theory.” Gee, why don’t people trust their public health officials?

*

Naomi Nix, Cat Zakrzewski & Joseph Menn, “Programs tracking misinfo are buckling amid campaign led by Rep. Jim Jordan,” Washington Post, Sep 23, 2023 READ IT HERE

Good! “An escalating campaign, led by Rep. Jim Jordan (R-Ohio) and other Republicans, has cast a pall over programs that study political disinformation and the quality of medical information online.” English translation: it took some GOP meatheads to stand up for the First Amendment since nobody else would do it. WaPo bemoans the end of “programs that study political falsehoods,” i.e., opinions we don’t like. These “disinformation researchers” are party hacks colluding in government-sponsored censorship and will be much happier as prison guards. Await more talk of scientists “not being allowed to speak,” which is total BS. Say whatever you want, just don’t use your state powers to shut up other people. “This whole area of research has become radioactive,” said one whiner. Bravo! About time. And put “research” in quotation marks.

*

Annalisa Merelli, “As Biden plans to ban medical debt from credit scores, advocates press for more change,” STAT, Sep 22, 2023 READ IT HERE

The Feds propose bans on medical credit cards and denials of care for the indebted. But, “Ultimately, the most important action to take on medical debt is to get rid of it.” Amen.

*

Dave Muoio, “Biden signs bill introducing more competition to US’ organ transplant network,” Fierce Healthcare, Sep 25, 2023 READ IT HERE

The new law will “break up the current system that for nearly four decades allowed a single private nonprofit to be the sole contractor managing the country’s Organ Procurement and Transplantation Network (OPTN).” Sheesh, you can’t even get a damn kidney without playing Monopoly.

*

Emily Olsen, “Hospices bought by PE, public companies had more dementia patients, study finds,” Healthcare Dive, Sep 26, 2023 READ IT HERE

Because they stay longer, require less complex care, and rack up big reimbursements to the Wall Street owners. They also moved more care to patients’ homes—cheaper and more profitable. For-profit hospices now make up 2/3 of all agencies. “Both PE firms and public companies use a ‘platform and roll-up’ approach to hospice investments, buying a large and well-managed agency and then acquiring smaller hospices to increase market share and capture referrals.”

*

Sydney Halleman, “Thoma Bravo to buy NextGen Healthcare in take-private deal,” Healthcare Dive, Sep 6, 2023 READ IT HERE

NextGen is another of the corporate squids worming its way into Medicare and Medicaid, which now account for 1/3 of its business. The acquisition can go forward now that NextGen has settled charges under the False Claims Act for $31 million.

*

Rebecca Pifer, “Cigna pays $172M to settle MA upcoding allegations,” Healthcare Dive, Oct 2, 2023 READ IT HERE

Upcoding is submitting “false diagnosis codes for its Medicare Advantage enrollees to increase its reimbursements.” This often involved sending friendly nurses to chat up seniors and then “flag conditions for the payer that Cigna used to claim higher payments from the CMS.” Cigna, which joins MA fraudsters Sutter Health, Kaiser Permanente, and Elevance, had to promise not to be naughty in the future and submit to an “annual independent review of its risk adjustment data.”

*

Rebecca Pifer, “CMS to get ‘tougher’ on Medicare Advantage, official promises,” Healthcare Dive, Sep 22, 2023 READ IT HERE

Big talk from Medicare/Medicaid overseers. Is it real? Care denials, aggressive upcoding, favorable beneficiary selection, quality bonus engineering—they all add up to an estimated $75 billion in MA overpayments. Although fraudsters at Cigna, Sutter Health and Kaiser Permanente have paid fines for these practices, CMS continues to promote privatization.

*

Paige Minemyer, “Medicare enrollment begins in 2 weeks. Here’s what major payers are offering for 2024,” Fierce Healthcare, Oct 2, 2023 READ IT HERE

Get ready for the flood of slightly-less pernicious Medicare Disadvantage ads as the big private insurers spruce up their packages to tempt people into dumping traditional Medicare. The offers from UnitedHealthcare, Humana, Elevance, Cigna, and Aetna will include gewgaws like taxis to the doctor’s office, gym memberships, shopping discounts, and even cash “allowances” in exchange for signing up for narrow networks, prior authorization hell, and care denials later on when you really need them. The Feds estimate that MA enrollment will reach almost 34 million this year or roughly half of all Medicare beneficiaries.

*

Noah Tong, “An inside look at Walgreens’ primary care and pharmacy model,” Fierce Healthcare, Sep 21, 2023 READ IT HERE

Walgreens sees its future as a primary care shop and easy pickup point for prescriptions, not a retail store. It recently bought the VillageMD clinic chain, medical practice Summit Health, specialty pharmacy Shields Health, and home care provider Care Centrix.

*

Paige Minemyer, “Virgin Pulse, HealthComp to merge in $3B deal aimed at improving employer health,” Fierce Healthcare, Sep 26, 2023 READ IT HERE

Another private equity invasion involving several outfits. including “the healthcare arm of JPMorgan Chase” that promises lower costs for self-insuring companies through “a tech-enabled platform to leverage artificial intelligence.” English translation: let our robots automatically block, delay, and deny healthcare spending on your workers, thereby saving you money.

*

Joshua Goodman & Jim Mustian, “Revolving door redux: The DEA’s recently departed No. 2 returns to a Big Pharma consulting firm,” Associated Press, Sep 20, 2023 READ IT HERE

“Washington’s revolving door kept spinning this week.” About the Drug Enforcement Agency’s No. 2 Louis Milione who, “like dozens of colleagues went to work as a consultant for some of the same companies he had been tasked with regulating. That included serving as a $600-per-hour expert for Purdue Pharma as it fought legal challenges over its aggressive marketing of Oxycontin other highly addictive painkillers.” Total regulatory capture of the narcs by the narcos.

*

Susanna Vogel, “Judge greenlights LCMC Health’s $150M hospital buy,” Healthcare Dive, Sep 28, 2023 READ IT HERE

A setback for the regulators trying to hold the line against hospital consolidation. States have issued “certificates of public advantage (COPAs),” to shield big mergers from federal antitrust scrutiny, but the FTC argues that any temporary benefits to struggling hospitals are outweighed by the formation of a local monopoly. Louisiana approved the merger involving New Orleans hospitals, and the judge agreed. But the pressure against consolidation remains—see next story.

*

Rebecca Pifer, “Elevance, BCBSLA pause $2.5B merger amid regulatory scrutiny,” Healthcare Dive, Sep 26, 2023 READ IT HERE

Elevance operates plans in 14 states, and Blue Cross/Blue Shield, the largest insurer in Louisiana with 1.9 million policyholders, wanted to combine with it. Louisiana didn’t like the idea. Apparently, states are less likely to sign off on nonprofits like the Blues going for-profit.

*

Nick Corbishley, “A valuable lesson from Mexico: AMLO government cancels extortionate public-private partnerships for 9 public hospitals,” Naked Capitalism, Sep 22, 2023

While Spain and U.K. continue to gut their public health systems, Mexico is “rowing in the opposite direction.” Mexico president AMLO unveiled plans to take back management of nine hospitals and put an end to juicy long-term management contracts for private owners. His rhetoric was reminiscent of Allende’s nationalization of Chile’s copper mines.

*

George Wylesol, “How a big Pharma company stalled a potentially lifesaving vaccine in pursuit of bigger profits,” ProPublica, Oct 4, 2023 READ IT HERE

GSK, the company that owns a promising anti-tuberculosis vaccine, decided to use the technology to produce a shingles vaccine instead because that tapped a lucrative market in wealthy countries. Meanwhile, millions die of TB. “GSK patented the adjuvant and took control of the supply of the ingredients in it. It accepted government and nonprofit funding to develop a TB vaccine using the adjuvant. But even though it isn’t carrying the vaccine to the finish line, it isn’t letting go of it entirely either, keeping a tight grip on that valuable ingredient.”

*

Emily Olsen, “CMMI increased federal spending by $5.4B during its first decade, report finds,” Healthcare Dive, Sep 29, 2023 READ IT HERE

Obamacare created the CMMI, a special office to sponsor “innovative” pilot programs that would reduce government spending on Medicare and Medicaid. Instead, it’s led to over $5 billion in additional costs. The CMMI’s director is Liz Fowler who, coincidentally, came from the insurance industry.

*

Theresa Gaffney, “Women spend 20% more per year on out-of-pocket health costs, says report,” STAT, Sep 29, 2023 READ IT HERE

The “pink tax”: Women pay more for healthcare, only 2% of which is attributable to maternity. This is not legal under the ACA, but it keeps happening. “Women spend more on radiology, laboratory, mental health, emergency care, office visits, and physical or occupational therapy.” It could be the result of lousier insurance policies for women in the kinds of industries where they predominate.

*

Maureen Tkacik, “Heads they cha-ching! Tails they take away your malpractice insurance,” American Prospect, Sep 22, 2023 READ IT HERE

This is a good, detailed primer on the private equity invasion and its nefarious effects on things like anesthesiology practices, where cost-cutting can lead to horrific errors. But the cash rolls in to the Wall Street paper-shufflers. “Private equity firms swallowed nearly 1,100 medical practices from 2012 to 2022 in transactions so frequent and frenzied it appeared as though Wall Street had found some sort of ‘cheat code’ that promised unlimited profits.” The FTC recently filed its first-ever lawsuit against a PE firm for “conspiracy to roll up a medical specialty.”

*

Dave Muoio, “Hospital, ED staffer American Physician Partners files for Chapter 11 bankruptcy,” Fierce Healthcare, Sep 20, 2023 READ IT HERE

“The company was founded in 2015 and is a portfolio company of Brown Brothers Harriman Capital Partners,” which had wormed its way into ERs and critical care management in 15 states. The docs claim the surprise billing arbitration process isn’t working because even after the arbitrator settles a given claim, the insurance companies sometimes refuse to pay.

*

Audrey Nath, “The sneaky reason American medical bills are rising,” Houston Chronicle, Sep 24, 2023 READ IT HERE

How two scams work: hospitals buy up physician practices and turn their offices into “outpatient departments” for the same procedure. Nothing has changed except the shingle out front—you’re now being treated in a hospital, which gets a higher reimbursement. Some of the increases are enormous: “For an epidural injection in a doctor’s office, Medicare is billed $255; in a “hospital,” it’s $740. Also, the hospital can slap on a “facility fee,” and the price of a simple ultrasound suddenly quadruples.

*

Brett Kelman & Samantha Liss, “These Appalachia hospitals made big promises to gain a monopoly. They’re failing to deliver,” KFF Health News/USA Today, Sep 29, 2023 READ IT HERE

“Five years ago, rival hospital companies in this blue-collar corner of Appalachia [Tennessee] made a deal. If state lawmakers let them merge, leaving no competitors, the hospitals promised not to gouge prices or cut corners. They agreed to dozens of quality-of-care conditions, spelled out with benchmarks, and to provide hundreds of millions of dollars in charity care to patients in need.” [Big surprise coming next:] The new monopoly “has not met many of the quality benchmarks nor provided much of the charity, falling short by about $148 million over a four-year span. In those same years, Ballad took thousands of patients to court to collect unpaid bills.”

*

SINGLE PAYER LINKS #317

Posted 22 SEP 2023

*

Matt Stoller, “‘Cha-Ching!’ Lina Khan attacks private equity in health care,” BIG, Sep 22, 2023 READ IT HERE

Huge news: “FTC Chair Lina Khan is seeking to stop a brazen scheme to monopolize health care in Texas. Private equity is big mad.” Finally, a major regulator wants to block the creeping financialization of medicine. The case should be a slam-dunk if anyone in the judiciary still believes in capitalism. The PE perps, based on Park Avenue, bought up a bunch of anesthesiology clinics in Dallas and Houston to consolidate practices in key markets and then jack up their prices. The FTC blew the whistle. PE response on Twitter: “This is terrifying.” Just as the PE roll-up of practices has been contagious, the crackdown from the FTC could ripple throughout medicine. Long live Lina, hate-object of Wall Street! And incidentally, Stoller’s Substack is worth reading and subscribing to see how monopoly and financialization work in the entire economy.

*

Lina Khan, “It’s time to halt roll-up schemes that violate antitrust laws,” Financial Times, Sep 22, 2023 READ IT HERE

Paywalled but accessible if you dig around. Khan lays out the FTC’s approach.

*

Frank Diamond, “New AMA report slams PBM industry for lack of competition,” Fierce Healthcare, Sep 12, 2023 READ IT HERE

None too soon, the AMA is rolling out its guns to confront the PBM (Pharmacy Benefit Managers) cartel, which controls 80% of all drug purchases in the country and is fully integrated with giant insurers, to wit:

Express Scripts-Cigna

Optum Rx-UnitedHealthcare/UnitedHealth Group

CVS Health-Caremark-Aetna

Prime Therapeutics-Blue Cross/Blue Shield

*

Paige Minemyer, “GoodRx, Walgreens team to lower prices for 200 drugs,” Fierce Healthcare, Sep 12, 2023 READ IT HERE

Meanwhile, the huge latent demand for alternatives to these gangsters is leading to interesting initiatives, such as GoodRx and Mark Cuban’s Cost Plus Drugs. GoodRx offers deals “without any deductibles, restrictions, or paperwork” for selected products. Who wouldn’t want that?

*

Anastassia Gliadkovskaya, “Intermountain’s Select Health joins forces with Mark Cuban Cost Plus Drugs,” Fierce Healthcare, Sep 19, 2023 READ IT HERE

Cuban’s online pharmacy charges a flat fee over cost. “Select Health members will have access to more than 1,000 prescription products, including those for high blood pressure, certain cancers, dementia, asthma, diabetes and more.” Cuban’s outfit sounds like a threat to the PBMs—how long will it be before a former lover accuses him of rape?

*

Merina Thomas et al., “Comparison of hospital online price and telephone price for shoppable services,” JAMA Internal Medicine, Sep 18, 2023 READ IT HERE

“There was poor correlation between hospitals’ self-posted online prices and prices they offered by telephone to secret shoppers.” The authors gently suggest that hospitals face “problems in knowing and communicating their prices” rather than intentionally create obfuscation. The study illustrates how nuts it is to try to treat healthcare as a market commodity in which we “shop” for the best deals.

*

W. T. Whitney, “Big privatized healthcare fraud in Maine,” CounterPunch, Sep 14, 2023 READ IT HERE

MA upcoders busted: “Martin’s Point received extra Medicare funding by means of exaggerating the seriousness of illnesses of older patients in its care.” The allegedly nonprofit charity, which had $472 million in revenue and paid its CEO nearly $1 million in 2020, was fined $22 million and need not “admit wrongdoing.” Here’s what they did: “Martin’s Point inflated their numbers of sick patients by assigning additional diagnoses to them. Old and even inconsequential diagnoses became active problems. They imposed conditions on the promised benefits, including delaying and/or denying care. Approved providers are rationed through geographical limitations. And co-payments escalated with the gravity of the illness.” No wrongdoing there!

*

Emily Olsen, “Majority of ground ambulance rides were out of network in 2022, report finds,” Healthcare Dive, Sep 14, 2023 READ IT HERE

What can an injured or sick person do to avoid a surprise bill for an ambulance? Not much. Out-of-network rides made up over half of all ground ambulance claims in 2022. The federal No Surprises Act doesn’t apply to them.

*

Jazmin Orozco Rodriguez, “How will rural Americans fare during Medicaid unwinding? Experts fear they’re on their own,” KFF Health News/USA Today, Sep 20, 2023 READ IT HERE

While 72% of people kicked off Medicaid are actually still eligible, the obstacles to getting expert assistance—and avoiding shyster insurance brokers—are legion. Nevada’s 277 family service specialists receive 200,000 calls a month. The chaos is so bad that federal officials have told states to cool their jets and do something to keep people—and their children—covered.

*

Michelle Andrews, “Hep C’s number comes up: Can Biden’s 5-year plan eliminate the longtime scourge?” KFF Health News/CBS News, Sep 20, 2023 READ IT HERE

Now that cures are available, why aren’t they getting to people? Insane costs, for starters: Gilead put the treatment originally at $84,000 a year. Even now with the price dropping to a mere $20K, there are other barriers to treatment: 13% of sufferers are in prison; many people don’t know they have Hep C infection; testing and treatment are disconnected. A new initiative included in the 2024 federal budget could address the issues.

*

Noah Tong, “Low-income seniors report deceptive marketing plans by Medicare,” Fierce Healthcare, Sep 19, 2023 READ IT HERE

Deceptive marketing is inevitable when the product for sale stinks. This is not hard. The bamboozling includes lying to customers about whether they can keep their doctors and demanding people’s Social Security or Medicare ID numbers before explaining the offers. Scammers intentionally target low-income populations. One researcher said, “More needs to be done to understand why and how this is happening” when the answers are perfectly obvious: there’s money to be made, and the Federal Government enables the hustlers.

*

Maya Goldman, “Medicare Advantage ads will look different this fall,” Axios, Sep 20, 2023 READ IT HERE

At long last, there will be a few controls on the MA scam ads: no more images of government Medicare cards or the Medicare logo or advertising benefits in areas where they aren't available. Ads for MA aired 650,000 times last year in just nine weeks.

*

Frank Diamond, “Michigan Blues chief announces retirement day after 1K workers go on strike,” Fierce Healthcare, Sep 15, 2023 READ IT HERE

This strike by another UAW, the local that represents staff at Blue Cross/Blue Shield, coincided with the resignation of the BCBS chief. But not before he outsourced 40% of previously union jobs to private contractors and pocketed $17 million in salary. The immediate cause of the walkout was a BCBS rule that “employees must work for the insurer for 22 years before they can get a pay hike.”

*

Dave Muoio, “Ascension wraps the year with $2.7 billion loss thanks to higher expenses, one-time impairment loss,” Fierce Healthcare, Sep 15, 2023 READ IT HERE

Why are some hospitals thriving and others deep in the red? Catholic-owned Ascension comprises 140 hospitals and 40 senior living facilities, employs roughly 134,000 people in 20 states, and reported $28 billion in revenue in 2022. And yet an operation of that size is losing money? Can someone explain?

*

Arvind Venkat, “Medical debt is killing our patients,” MedPage Today, September 16, 2023 READ IT HERE

Venkat, an ER doc and Pennsylvania state legislator, proposes tinkering with medical debt instead of abolishing it. His Medical Debt Relief Act “would use state funds to contract with a medical debt relief coordinator who would partner with hospitals and other healthcare providers to identify unpaid medical debt among those who make less than 400% of the federal poverty level or pay more than 5% percent of their annual income in medical debt, purchase that debt, forgive it, and notify the patient.” Sound complicated? It is—the favored approach of professional poverty managers who prefer narrowly tailored “programs” over broad, effective solutions. Which is not to deny that, if passed, it might help some people. But these schemes are job-creation programs for the professional-managerial class.

*

Chelsea Cirruzo, “The CDC wants your trust back: It’ll ‘take time to rebuild,’” Politico, Sep 16, 2023 READ IT HERE

Mandy Cohen, the new CDC director, wants to win back America’s trust and starts by promising to “level with people about what we knew—and don’t know. She then proceeds to push the booster vaccine, based on zero data on its effectiveness and safety.

*

Arthur Allen, “Save billions or stick with Humira? Drug brokers steer Americans to the costly choice,” KFF Health News/Los Angeles Times, Sep 19, 2023 READ IT HERE

Why wouldn’t doctors and patients go straight to the low-cost generic alternatives for their autoimmune conditions when they could save a bundle on Humira? Turns out Pharma and PBMs have all sorts of tricks to keep people paying top dollar: Humira’s owner, AbbVie, “warned health plans that if they recommended biosimilars over Humira, they would lose rebates on purchases of Skyrizi and Rinvoq, two drugs with no generic imitators that are each listed at about $120,000 a year. In other words, dropping one AbbVie drug would lead to higher costs for others.” They also upped rebates to PBMs that could be passed on to insurers. But Mark Cuban’s Cost Plus Drugs pharmacy is selling a cheap equivalent at 15% of Humira’s cost, so perhaps some users—and their docs—will get the message.

*

Kristina Fiore, “Rural hospital turns to GoFundMe to stay afloat,” MedPage Today, Sep 12, 2023 READ IT HERE

A big factor in the ongoing wreckage of rural hospitals is Medicare Disadvantage’s penetration of the rural population. Bucktail Medical Center in central Pennsylvania was getting decent reimbursements from Medicare, but the steady takeover by MA plans is devastating its finances because they “are more likely to deny claims, and smaller hospitals just don't have the resources to fight back.” Bucktail needs a mere $1.5 million, but with a patient base of just 3000 people, they aren’t profitable. If it closes, the next closest ER is 27 miles away “which means 37 minutes down a two-lane country road that winds along the west branch of the Susquehanna River.” So, when the hospital asks for locals to donate, they are in effect “subsidizing the health insurance plans that are underpaying the hospital for care.” Question: Where are the politicians representing these red-voting areas?

*

Lauren A. Haynes & Sara R. Collins, “Can older adults with employer coverage afford their health care?” Commonwealth Fund, Aug 10, 2023 READ IT HERE

No. Next question? “More than two of five low-income older adults with employer coverage reported difficulties paying medical bills and medical debt, and nearly half reported skipping or delaying needed care because of cost.” This is about the people in the 50-64 age bracket who aren’t yet eligible for Medicare and tend to use more medical services. Some have such high out-of-pocket costs that they are considered “underinsured” despite being technically “covered” at their workplace.

*

Noam N. Levey, “What one lending company’s hospital contracts reveal about financing patient debt,” KFF Health News, Aug 8, 2023 READ IT HERE

“Hospitals and other medical providers are increasingly shuttling their patients into loans serviced by banks, credit cards, and other financial services companies,” leaving patients with interest-bearing debt. The Consumer Financial Protection Bureau may intervene.

*

Anna Wilde Mathews, “Health-insurance costs are taking biggest jumps in years,” Wall Street Journal, Sep 7, 2023 READ IT HERE

Get ready for “the biggest [rate] increase in more than a decade” for employer-based coverage: 6.5% on average on top of the current cost to companies of $14,600 per worker annually. No wonder American companies can’t compete in world markets. ACA premiums are also expected to go up 6%. Among the cost factors: “hospitals’ higher labor costs and heavy demand for new and expensive diabetes and obesity drugs.”

*

Associated Press, “Home health provider to lay off 785 workers and leave Alabama, blaming state’s Medicaid policies,” Sep 16, 2023 READ IT HERE

Without Medicaid expansion, the company can’t continue to operate in the state. Alabama gave up more than $2 billion available in federal Medicaid support and left 300,000 residents without coverage. But the football team wins national championships, so there’s that.

*

Adam Ganucheau, “Are Republicans about to leave Gov. Tate Reeves behind on Medicaid expansion?” Mississippi Today, Sep 12, 2023 READ IT HERE

Next door in Mississippi, even the Republicans think the governor might need a math lesson. “Anywhere between 65% and 80% of Mississippians—and well over 50% of Republicans—support [expansion, which] would provide Mississippi billions in new revenue and create tens of thousands of new jobs.” And it might save a few rural hospitals.

*

Nate Bear, “No, Covid can never, ever be ‘just a cold.’ Here’s why,” Ko-Fi, Jun 30, 2023 READ IT HERE

“Covid infects cells in the human body in a very different way to any other viruses that cause colds,” i.e., through the ACE2 enzyme “that live in pretty much all of our organs.” Colds remain in the respiratory tracts; Covid doesn’t, which is why it can affect the heart, liver, kidneys, gut, brain, and thyroid. Not a common cold, no matter what Mandy Cohen/Ashish Jha/expert-du-jour want us to think.

*

SINGLE PAYER LINKS #316

Posted 15 SEP 2023

This week: a lot on pharmaceuticals and finance, timely given the contradictory pressures upon us vis-à-vis Covid: on the one hand “That’s all over now,” but on the other, Go get another shot; and more on the steady consolidation of the healthcare industry and the vampire squid sinking its tentacles into Medicare. —Tim

*

Gina Kolata, “We know where new weight loss drugs came from but not why they work,” New York Times, Aug 17, 2023 READ IT HERE

Breathless gushing over the fat shots, along with some acknowledgements that “much about the drugs remains shrouded in mystery,” like what’s really going on in the human body when you take them. Given that the drugs “expose the brain to hormone levels never seen in nature” and have to be taken for life, the daredevil patients who try them must be monitored for side effects basically forever. Fun fact: Danish company Novo Nordisk, marketer of one of the fat shots, now accounts for “most of the country’s economic growth.”

*

Berkeley Lovelace Jr., Jessica Herzberg & Marina Kopf, “Price gouging of cancer drugs in short supply hits some hospitals hard,” NBC News, Aug 17, 2023 READ IT HERE

“As the cancer drug shortage drags on, some suppliers are jacking up the prices of the lifesaving medications.” Marvels of market-based healthcare. “Gray market” dealers watch for shortages, then scramble for supplies from legal or clandestine markets and score big profits.

*

Office of Public Affairs, Department of Justice, “Major generic drug companies to pay over quarter of a billion dollars to resolve price-fixing charges and divest key drug at the center of their conspiracy,” Aug 21, 2023 READ IT HERE

Big spanking over illegal collusion for Teva USA, which will pony up $225 million in fines with its co-conspirator Glenmark USA tossing in another $30 million. This is the reawakened DoJ Antitrust Division led by Jonathan Kanter who is working closely with Lisa Khan’s reawakened Federal Trade Commission. Howls of outrage are emitted regularly from the editorial pages of the Wall Street Journal, which means they’re on the right track. “During the multi-year investigation, [we] uncovered price-fixing, bid-rigging, and market-allocation schemes affecting many generic medicines.” One former Pharma exec is still facing criminal charges.

*

Tera L. Fazzino, Daiil Jun, Lynn Chollet-Hinton & Kayla Bjorlie, “US tobacco companies selectively disseminated hyper-palatable foods into the US food system: Empirical evidence and current implications,” Addiction, Sep 8, 2023 READ IT HERE

The authors did an unfunded (and therefore independent) study looking at food companies owned by Big Tobacco over two decades (1980–2001) and found that tobacco-owned foods were 29% more likely to have high fat, carb, and salt content than foods that were not tobacco-owned. They conclude: “Tobacco companies appear to have selectively disseminated hyper-palatable foods into the US food system between 1988 and 2001.” But obesity is caused by a chemical in your brain!

*

Nicholas Florko, “The food industry has tried to stack a key nutrition policy panel with its preferred experts, documents show,” STAT, Sep 12, 2023 READ IT HERE

More grotesque regulatory capture by the relentlessly shameless industries determined to sell us any crap they want. “The panel deliberates the latest nutrition science for the better part of two years and then submits a report to regulators, who then decide on any ultimate tweaks to the national dietary guidelines.” For obvious reasons, industry desperately wants their toadies in those meetings. “The nominations are not completely outlandish: nearly all of the researchers hold positions at prestigious universities,” which is an indictment of the latter as well as the industry-captured American Society for Nutrition and the Academy of Nutrition and Dietetics. One sitting panelist: Fatima Cody Stanford, an academic in the pay of the fat-shot guys.

*

Mikaela Conley, “Atrazine, an endocrine-disrupting herbicide banned in Europe, is widely used in the U.S.,” U.S. Right To Know, Sep 12, 2023 READ IT HERE

“Atrazine, an endocrine disruptor linked to various cancers, premature birth and birth defects” (and banned in the EU 20 years ago), is applied to 65% of all corn crops in the U.S. as well as on golf courses and lawns. Amazing details of the company’s war against a dissident scientist and capture of the EPA such that it uses industry-funded research in its “deliberations.” But obesity is caused by a chemical in your brain! Autism comes from vaccines! Alzheimer’s can now be treated!

*

Joseph Walker, “Generic drugs should be cheap, but insurers are charging thousands of dollars for them,” Wall Street Journal, Sept. 11, 2023 READ IT HERE

This is about how vertical integration of insurers, pharmacies, and PBMs keep prices nice and high. “The cancer drug Gleevec went generic in 2016 and can be bought today for as little as $55 a month. But many patients’ insurance plans are paying 100 times that.” Generics are supposed to bring prices down when patents expire, but when PBMs own their own pharmacies, “the very companies that are supposed to keep a lid on drug spending can maximize their profits by marking up the prices.”

*

Emily Olsen, “‘Revolving door’ between HHS and industry could influence regulation, study says,” Healthcare Dive, Sep 7, 2023 READ IT HERE

A third of government employees at the Department of Health and Human Services between 2004 and 2020 decamped to the private sector, and 15% of them came from there in the first place before joining HHS. Worst offenders: CDC and the regulators of Medicaid and Medicare at CMS. “Seema Verma, who served as CMS administrator under President Donald Trump, took a position at Oracle earlier this year as the software vendor expands its presence in the healthcare sector. Marilyn Tavenner, who ran the CMS from 2013 to 2015, worked for for-profit hospital giant HCA for 25 years before joining the government. Thomas Scully was the CEO of hospital lobby Federation of American Hospitals before joining CMS as administrator in 2001, and became a partner at private equity firm Welsch, Carson, Anderson and Stowe following his departure in 2003.” Gack.

*

Helen Branswell, “Amid another rise in cases, Covid’s new normal has set in,” STAT, Sep 10, 2023 READ IT HERE

Who exactly set in “the new normal,” Ms. Branswell, or did it just happen? Yes, some of us old-fashioned holdouts are still paying attention to Covid-19, unlike our fashionable and up-to-date peers who have decided that it’s “just a flu” and “masks don’t work.” Thoroughly Modern Helen assures us that “this is our life now,” and by implication there’s nothing much we can do about it (except get a booster shot!). The no-big-deal camp has no interest in non-pharmaceutical protective measures, ignores ventilation improvements, and certainly is not going to be kept from “enjoying life” by a few sour-puss long Covid sufferers. Branswell notes the “lack of data as compared to a year or two ago,” but neglects to assign agency, such as to the CDC, which intentionally stopped collecting it.

*

Michael Hiltzik, “COVID lockdowns saved millions of lives—so of course Ron DeSantis is angry about them,” Los Angeles Times, Aug 29, 2023 READ IT HERE

Hiltzik takes one side of the lockdown debate, which is welcome. Unfortunately, the censorship-industrial complex suppressed the other side, which is now roaring back with a vengeance and with vengeance in mind as seen in the Republican presidential debate parsed here by Hiltzik. He notes that anti-lockdown De Santis’s state is No. 1 in children per capita who lost a caregiver to Covid. Public health is heavy-handed by nature; now, it’s discredited, perhaps fatally.

*

Jon Cohen, “CIA bribed its own COVID-19 origin team to reject lab-leak theory, anonymous whistleblower claims,” Science, Sep 12, 2023 READ IT HERE

An unnamed CIA employee says that six analysts there were offered cash to reject the lab-leak theory of Covid’s origins. Given how they cooked up the fraudulent Hunter Biden laptop story and beat the Russiagate drum based on no evidence, it’s certainly plausible.

*

Elevance Health Public Policy Institute, “Coding for high-complexity office visits on the rise,” Aug 2023 READ IT HERE

Elevance is an insurer, so its research is going to have a bias, to say the least. That said, their finding of a steady increase in upcoding toward the “high complexity” categories is logical given that that triggers bigger reimbursements. “In 2006, 25% of outpatient visits were coded level 4 or 5, and that percentage steadily increased over time to 38% of visits in 2022.”

*

Susanna Vogel, “Patients ‘steered’ toward health systems, more costly treatment after vertical consolidation, study finds,” Healthcare Dive, Sep 5, 2023 READ IT HERE

After hospital cartels gobble up primary care practices, patients tend to be herded into “increased specialist visits, emergency department visits, and hospitalizations,” all of which generate juicy reimbursements. But but but . . . [snark alert] reliance on the market will produce equilibrium and fix everything in the best of all possible worlds, right? I thought since healthcare is just one more commodity that we buy through exercising our consumer choice, we don’t need big gummint to interfere. Or am I misreading my Milton Friedman?

*

Rebecca Pifer, “Walmart reportedly exploring ChenMed acquisition,” Healthcare Dive, Sep 11, 2023 READ IT HERE

Walgreens wants to get in on the “exceedingly lucrative” Medicare privatization schemes via ACO REACH along with tech start-up Pearl Health, like rival pharmacy chain CVS and retail giants Amazon and Walmart. Walmart is angling for a primary care chain for seniors, ChenMed. “Integrating primary care capabilities allows retailers to provide a front door to the medical system for consumers and nudge them toward other services, like pharmacy capabilities, urgent care clinics, or medical devices for sale in stores.” Once you get the patients and their data, it’s much easier to peddle all sorts of things to them, even things they might need.

*

Bob Herman, J. Emory Parker, Adam Feuerstein, Lizzy Lawrence & Mohana Ravindranath, “Health care CEOs hauled in $4 billion last year as inflation pinched workers, analysis shows,” STAT, Aug 17, 2023 READ IT HERE

“The CEOs of more than 300 publicly traded health care companies combined to make $4 billion in 2022. Topping the list: Moderna’s Stéphane Bancel, who leveraged government-funded research into a $400 million payout. David Cordani at insurer Cigna only got a measly $54 million.

*

Helen Branswell, “Group behind ProMED fires three top moderators amid strike,” STAT, Sep 7, 2023 READ IT HERE

Ugly corporate behavior from a nonprofit infectious disease surveillance outfit. Striking experts said they hadn’t been paid their pathetic $7000 annual stipends in months, so the boss fired the organizers.

*

Jeannie Fuglesten, Gabrielle Clerveau, Anthony Damico & Tricia Neuman, “Medicare Advantage enrollment, plan availability, and premiums in rural areas,” KFF, Sep 7, 2023 READ IT HERE

Subhead: “MA enrollment has quadrupled in rural areas since 2010.” MA peddlers are bamboozling rural residents at a booming clip. Now, 40% of rural elders choose the privatized version, up from only 11% in 2010. Wait until the country folk discover the limited MA networks and find themselves driving all over creation when they need doctors.

*

SINGLE PAYER LINKS #315

Posted 8 SEP 2023

*

Dave Muoio, “AHA: Biden admin’s short-term plan crackdown a good start on addressing ‘convoluted’ coverage gaps,” Fierce Healthcare, Aug 29, 2023 READ IT HERE

The Feds are going after unscrupulous insurers peddling “junk plans” to people as cheap alternatives without telling them what little coverage they get for their low premiums. The American Hospital Association applauds the crackdown but says it doesn’t go far enough, noting “both the amount and the complexity of patient cost-sharing even in ACA-compliant health plans.” Including the insanely high deductibles before coverage even kicks in.

*

Chris Hedges, “Nurses fight Godzilla,” Scheerpost, Aug 4, 2023 READ IT HERE

Hedges surmises that Robert Wood Johnson University Hospital in New Jersey is less concerned about the typical concessions that get negotiated in contracts than in crushing the nurses union entirely. Because hospitals continue to refuse to staff properly, a third of New Jersey’s nurses have left the profession in the last three years, which makes conditions even worse, so more nurses quit, etc. RWJBarnabas Health owns 12 hospitals, has 37,000 employees, including 9,000 physicians, and treats 3 million patients a year. It is a not-for-profit charitable organization pulling in $6.6 billion in annual revenue and paying its CEO $16 million a year.

*

Sydney Halleman, “Texas judge rules to vacate more No Surprises Act regulations,” Healthcare Dive, Aug 28, 2023 READ IT HERE

Another Texas judgment prompts the Feds to pause all federal dispute resolution over surprising billing once again. We get a watered-down law finally through a recalcitrant Congress, and then the legal wrangling begins to delay implementation.

*

Maggie Harrison, “Scientists find that microplastics cause dementia-like symptoms in mice,” Neoscope, Aug 31, 2023 READ IT HERE

The microplastics that are now everywhere in our environment make mice senile—imagine that. One chilling detail: the mice were only fed the microplastics for three weeks and nonetheless showed severe effects, including the post-mortem discovery of the substances “deep in the brain tissue.” But let’s concentrate on peddling expensive drugs that probably don’t work to Alzheimer’s patients rather than doing something about the poisons around us.

*

John Holland, “Surgeons are double and triple booking procedures that residents must perform,” Bloomberg, Aug 31, 2023 READ IT HERE

Another way to scam private and government insurers: “Surgeons scheduling two or even three operations at virtually the same time, leaving during critical portions, then billing Medicare for work they didn’t do.” Result: “staggering profits.” Busted so far: Erlanger Health System in Chattanooga, Tennessee; University of Pittsburgh Medical Center; USC Keck Hospital and the affiliated Los Angeles County Medical Center; many others are suspected of the practice.

*

Gregg Gonsalves, “Welcome to the “You Do You” pandemic, The Nation, Sep 1, 2023 READ IT HERE

“Covid is still a leading cause of death, yet some of the most powerful medical figures in the country are telling us to ignore it. Shouldn’t that disconnect be a bigger deal?”

*

Gretchen Morgenson, “‘You’re not God’: Doctors and patient families say HCA hospitals push hospice care,” NBC News, Jun 21, 2023 READ IT HERE

Remember Sarah Palin’s “death panels”? Here’s a warning for the next Covid wave: find out if your hospital also owns a hospice unit. If so, they’ll be tempted to hustle your relative into one instead of trying to save their life. Alternatively, they may disrupt a dying patient’s final hours to cart them over to hospice so that the hospital’s mortality statistics remain low. This version of patient-centered care includes using death stats in executive comp packets, such as one hospital CEO who got an extra $300K (out of his total $35.3m package) as “incentive pay generated by the mortality rate calculation.” And AI plays a role, too: hospitals can point to a robotic algorithm to claim these decisions are only a “factual—and unquestionable—conclusion of a mathematical process, not mere profit-seeking.”

*

Andy Miller & Sam Whitehead, “AI may influence who can get or prescribe pain medication,” KFF Health News, Aug 30, 2023 READ IT HERE

Welcome to the “Narx Score,” which is a robot-determined number tracking your medication use. If it’s too high, you don’t get pain relief. You can’t see how it’s calculated, and there’s no appeal. And doctors caught up in the algorithm have been prosecuted (HAL says naughty-naughty).

*

Lisa Miller, “The mystery of long Covid is just the beginning. At Yale’s clinic, medical sleuth Lisa Sanders is trying almost everything,” New York Magazine, Aug 29, 2023 READ IT HERE

A long piece on one of the few clinics in the country trying to get a handle on long Covid rather than avoid the whole topic since patients with complex and mysterious symptoms “are every doctor’s worst nightmare.” While long Covid sufferers wait for months for appointments, “scientists and pundits heaped skepticism on the very notion of long COVID, arguing that infection made people stronger, that new variants posed no threats, that the danger of long COVID was overblown.”

*

Dave Muoio, “Here are 22 health systems billing patients for certain EHR and text messages,” Fierce Healthcare, Aug 16, 2023 READ IT HERE

It’s a trend: price tags for getting an email reply from your provider, in some cases as much as 50 bucks a pop. What if we write to ask for a prescription refill? Will that carry a fee? To be fair, doctors are shackled to their computers most of the day already since The Billing must take precedence.

*

Doug McIntyre, “The pharmaceutical war on obesity has begun,” Los Angeles Daily News, Aug 13, 2023 READ IT HERE

Big Pharma has “set their sights on the obesity epidemic,” and the cash is already rolling in. Morgan Stanley forecasts that the “global obesity market” is headed for $77 billion in annual sales by 2030. The previous estimate was $54 billion.

*

Sarah Fentem, “South St. Louis hospital’s closure leaves social, economic void in Dutchtown,” St. Louis Public Radio, Aug 10, 2023 READ IT HERE

Another urban hospital serving a low-income population disappears. But many hospitals are making bank like never before. Hmm.

*

Annie Waldman, “Unstoppable: This doctor has been investigated at every level of government. How is he still practicing?” ProPublica, Aug 9, 2023 READ IT HERE

Despite a decade of sanctions, fines, and lawsuits, Dr. James McGuckin continues to perform “vascular” procedures on unwitting victims—er, patients. “He’d been disciplined by medical boards in over a dozen states, lost privileges in multiple hospitals and settled federal allegations of fraud, admitting that his company had performed procedures without any documented need.” And yet McGuckin has reaped $50 million in federal insurance reimbursements over the last decade and still practices. At least he didn’t prescribe ivermectin! Warning: avoid clinics that do invasive vascular treatments ostensibly to “remove plaque” or “widen arteries.”

*

University of Gothenburg [Sweden], “Many expensive cancer drugs have unclear patient benefit,” Science Daily, Aug 15, 2023 READ IT HERE

All those fancy new drugs getting the go-ahead from the FDA may not work after all. That’s because the priority now is to “reach patients sooner” and hope for some solid evidence of efficacy later. This Swedish study looked at 22 drugs and found that for 15 of them “randomized controlled trials failed to show increased life expectancy or improved quality of life.” Takeaway: read the clinical reports yourself before saying yes to any treatment.

*

Marianne Todd, “Hospitals say New Mexico’s rising malpractice payout cap puts insurance out of reach,” Santa Fe New Mexican, Sep 3, 2023 READ IT HERE

Malpractice should have two goals: (1) help providers and hospitals learn from medical error and (2) compensate those harmed. Our current system does neither. Instead, lawmakers have to come up with complex schemes to keep everyone happy, often with unintended consequences. New Mexico raised the cap on potential malpractice payouts, which hospitals and trial lawyers liked, leading to insurers abandoning the state and premiums going through the roof. Solution: remove the need for most malpractice litigation by covering everyone’s medical expenses through a single-payer system. That way, errors could be examined dispassionately instead of through who’s-at-fault litigation, and medical care improved.

*

Cheryl Clar, “I set out to create a simple map for how to appeal your insurance denial. Instead, I found a mind-boggling labyrinth,” ProPublica/Capitol Forum, Aug 31, 2023 READ IT HERE

“The insurance industry and its regulators have made it so complicated to file an appeal that only a tiny percentage of patients ever do” (two-tenths of 1% of patients in Obamacare plans). There are no mandated standards, so the complexity is out of control, and meant to stay that way. One oncology doc spends $350K a year “on a designated team of denial fighters whose sole job is to request prior authorization for cancer care—an average 67 requests per day—and then appeal the denials.” Everything is denied at the outset, and the insurers will routinely “lose” the first batch of records. Insurers gain by the delays, especially if the patient dies. “Death is cheaper than chemotherapy.” Here is a wide-open opportunity for activism IMHO: workshops to teach people how to appeal denials, thereby boosting that tiny percentage and costing the insurers time and money while exposing the abuse.

*

SPL #314 podcast from Sep 1, 2023 here: Code Green: How Profiteers and Big Finance Are Taking Over American Medicine

SINGLE PAYER LINKS #314

Posted 1 SEPT 2023

*

Noah Tong, “Eliquis, Jardiance, Xarelto headline CMS’ price negotiation list,” Fierce Healthcare, Aug 29, 2023 READ IT HERE

The Feds announced plans to use the government’s purchasing power to rein in galloping drug prices under its new authority. First targets are blood clot meds Eliquis and Xarelto and diabetes drugs Jardiance and Januvia. Estimated savings: $160 billion although since negotiations haven’t begun, it’s not clear how they can know that. Pharma are staging hunger strikes and opening GoFundMe pages—kidding! Lawyers for Merck, Bristol Myers Squibb, Boehringer Ingelheim, Astellas, Johnson & Johnson, and AstraZeneca are suing to stop the threats to their yachts.

*

Elisabeth Rosenthal, A peek at Big Pharma’s playbook that leaves many Americans unable to afford their drugs,” KFF Health News, Aug 18, 2023 READ IT HERE

Good though incomplete. Yes, Pharma is shamelessly suing to stop Medicare from negotiating drug prices. The lawfare, even if it fails, could get them extra months or years to price-gouge, which translates into billions. But Rosenthal doesn’t mention the huge sums government plows into research that Pharma regularly usufructs for private profit, patent manipulation that gives them extra years of exclusivity, and the insane way they’re allowed to peddle drugs direct to patients. (Ask your doctor if bankruptcy is right for you!)

*

Rebecca Pifer, “Blue Shield of California drops CVS Caremark in pharmacy benefit overhaul,” Healthcare Dive, Aug 17, 2023 READ IT HERE

An insurer is dumping its PBM and setting up new arrangements with multiple pharmacy intermediaries, including Amazon and Mark Cuban’s Cost Plus Drug Company. Blue Shield CA says it should save $500 million a year by “simplifying the price structure and eliminating any hidden fees or rebates.” CVS’s stock tanked after the announcement. PBMs are in the crosshairs and none too soon.

*

Anne Bucher & Abraham Jewett, “Gilead Sciences agrees to $246.8m settlement in HIV drug antitrust case,” Top Class Actions, Aug 23, 2023 READ IT HERE

Resolution of a 15-year-old lawsuit by drug purchasers (insurance companies) alleging that Gilead and erstwhile rival Teva Pharmaceuticals colluded to delay a cheaper alternative to a top-selling HIV medication. They claimed overcharges of $3.6 billion but settled for a fraction of that. “Pay for delay” is a common Pharma practice to squeeze extra billions out of its patent exclusivity for a few more lucrative years.

*

Krutika Amin et al., “How do prices of drugs for weight loss in the U.S. compare to peer nations’ prices?” KFF Health System Tracker, Aug 17, 2023 READ IT HERE

Badly: The list price for one month of Ozempic in the U.S. ($936) is over 5 times that in Japan ($169) and about 10 times more than in Sweden, the U. K., Australia, and France. An incredible one-third of all U.S. adults are obese.

*

Nicholas Florko, “Kellogg’s is going to war over Mexico’s nutrition label rules. A similar fight is coming to the U.S.,” STAT, Aug 21, 2023 READ IT HERE

What? Mexicans aren’t obese yet? Determined to ply Mexican children with Tony the Tiger to encourage them to consume sugary breakfast foods, Kellogg’s is “throwing everything they have” into legal challenges and loopholes in government regulations. One trick to avoid warning labels: designing their products with identical front and back labels so that clerks can turn the warnings to the back of shelves. In due course the label wars will follow here as well while Mexico’s children fatten up.

*

Susanna Vogel, “CMS threatens to cut hospices from Medicare if they can’t prove legitimacy,” Healthcare Dive, Aug 24, 2023 READ IT HERE

Finally, the Federal Government is demanding that “hospices” prove they really are: “The agency identified potentially fraudulent operations by making unannounced visits to more than 7,000 hospice providers,” especially in fraud-heavy states Arizona, California, Nevada, and Texas. The article notes that “7 out of 10 of the largest hospice [chains] in the U.S. have been sued at least once under the federal False Claims Act.”

*

Ira Byock, “The hospice industry needs major reforms. It should start with apologies,” STAT, Aug 22, 2023 READ IT HERE

Hospice has been infiltrated by shyster investor-operators who fraudulently enroll non-terminal patients and then neglect them while collecting succulent Medicare payments—all of which was exposed in a recent New Yorker-ProPublica investigation. Trade groups treat corruption as a PR problem. “They bemoan the befouling of the environment as if it were a natural disaster. Propose an anodyne set of public policy recommendations. Refrain from taking independent corrective actions.”

*

F. Douglas Stephenson, “Medicare for all, not Medicare Advantage,” Common Dreams, Aug 23, 2023 READ IT HERE

Another tidy summary for filing away: “MA plans raid taxpayer funds and routinely fail to deliver the care that patients expect and deserve.” Insurers Humana, Centene, and Molina now get over 85% of their health-plan revenues from government programs. Nice work welfare if you can get it!

*

Committee for a Responsible Federal Budget, “New evidence suggests even larger Medicare Advantage overpayments,” Jul 17, 2023 READ IT HERE

If unimpeded, MA plans will upcode clients into an estimated $810 billion to $1.6 trillion in overpayments through the next decade. That’s real money even in the healthcare industry. “Private MA plans cost the federal government significantly more per beneficiary than FFS [fee-for-service plans] in large part due to diagnostic ‘coding intensity,’ which makes MA enrollees look sicker than demographically similar enrollees in the FFS program,” which gets them bigger per capita payments. And why exactly wouldn’t they do everything to boost income given that a for-profit enterprise is for profit?? This is complex research to tell us something we already know intuitively. See chart at the bottom.

*

Rebecca Pifer, “CMS tweaks ACO REACH to stabilize model,” Healthcare Dive, Aug 15, 2023 READ IT HERE

ACO REACH=more privatization of Medicare. These new Fed tweaks are so meaningless that they were “applauded by stakeholders, including the National Association of ACOs.” The industry-corrupted CMS wants Medicare to be entirely taken over by the for-profit outfits by the end of the decade.

*

Harris Meyer, “Promising better, cheaper care, Kaiser Permanente’s national expansion faces wide skepticism,” KFF Health news/Sacramento Bee, Aug 15, 2023 READ IT HERE

Why is a California-based giant acquiring hospitals in Pennsylvania, and how exactly is this going to improve performance for beneficiaries they already have? Kaiser aims at growing into another Godzilla that can compete with Amazon, Aetna CVS Health, Walmart Health, and UnitedHealth Group, the other mutants already on the scene. Pennsylvania-based Geisinger owns 10 hospitals and 1,700 physicians while Kaiser controls half the private insurance market in CA. “Federal and state antitrust regulators have expressed growing concern about consolidation of hospitals and physician groups into ever-larger organizations with the power to drive up prices.” However, doctor groups may prefer Kaiser to a private equity alternative.

*

Alejandra O’Connell-Domenech, “Price of elder care soars as demand increases, baby boomers age,” The Hill, Aug 13, 2023 READ IT HERE

Nursing home care now costs an average of $9,000 a month. That’s $300 a day—why not just check into the local Sheraton? Assisted living is a bargain $4000 a month. “More than two-fifths of baby boomers don’t have any retirement savings,” and at this rate those who do won’t end up with any.

*

Nada Hassanein, “Despite federal warnings, red and blue states aggressively cull Medicaid rolls,” Stateline, Aug 25, 2023 READ IT HERE

Total kicked off to date: 5.4 million. Texas leads with half a million, 80% removed for procedural reasons. Florida close behind with 408,000.

*

Noah Tong, “Plenty of uncertainty looms over North Carolina’s Medicaid expansion plan,” Fierce Healthcare, Aug 22, 2023 READ IT HERE

Delay, obstruct, mess around, fiddle, complain—anything to keep those undeserving poor out of clinics and hospitals. “Nearly five months after North Carolina passed legislation allowing the state to expand Medicaid, there is uncertainty surrounding when, or whether, the program will be expanded after all.” Six hundred thousand residents earning under $20K a year are standing by (while avoiding bankruptcy-inducing healthcare). Kicking people OFF Medicaid, on the other hand, is proceeding efficiently.

*

Jill Nolin, “Sluggish start to Georgia’s modest expansion of Medicaid reignites debate over health coverage policies,” Georgia Recorder, Aug 10, 2023 READ IT HERE

Georgia’s Rube Goldberg Medicaid “expansion” machine has approved a grand total of 265 people who worked through complex rules for “verifying work hours.” The work requirement is to make sure lazy people don’t see doctors. Also, earning more than $15,000 a year means you’re too rich. Gov. Kemp unveiled Georgia Pathways to Coverage four years ago—and now we see he wasn’t lying. On a pathway, there’s no guarantee you’ll ever arrive! Meanwhile, 100,000 people lost Medicaid coverage during the June eligibility checks alone, two-thirds of them children. The state has a budget surplus—maybe it was saving for the rainy day that arrived this week.

*

Rebecca Pifer, “Florida sued over Medicaid redeterminations,” Healthcare Dive, Aug 23, 2023 READ IT HERE

Florida is eagerly kicking people off Medicaid with over 400K losing coverage so far. Finally, someone is suing to stop the carnage: “The suit argues that Florida failed to sufficiently inform enrollees that their coverage was in danger of ending and not giving them information on how to appeal.”

*

Tom Price, “A new threat to healthcare breakthroughs: litigation investment entities,” Healthcare Dive, Aug 18, 2023 READ IT HERE

Price was a disaster as Trump’s Health & Human Services secretary, but under the broken clock rule he’s onto something here: “litigation investment entities” are figuring out how to extract rent through lawsuits through patent infringement claims. How it works: “They provide funding for the upfront costs of legal action and then profit if they get a favorable award or settlement.” Criminal minds never sleep.

*

Pranshu Verma, “Hospital bosses love AI. Doctors and nurses are worried,” Washington Post, Aug 10, 2023 READ IT HERE

Mount Sinai has drummed up $100 million in private philanthropy for AI research, but some see “enormous hype” in the shiny new thing. “Front-line workers worry about the technology making wrong diagnoses, revealing sensitive patient data, and becoming an excuse to cut staff in the name of innovation and efficiency.” A nurses union leader asks, Why is AI being installed before we have clinical trials to prove it works?

*

Julia Kollewe, “Former Covid medical officer Van-Tam takes role at vaccine maker Moderna,” The Guardian, Aug 18, 2023 READ IT HERE

Britain’s revolving door: the U.K.’s Fauci sashays over to Moderna, the company he helped make hundreds of billions.

*

Bram Sable-Smith, “Funyuns and flu shots? Gas station company ventures into urgent care,” KFF Health News/USA Today, Aug 16, 2023 READ IT HERE

Not The Onion. Gas stations can also provide healthcare in our entrepreneurial system. Walmart and Target can do it, so why not Mobil and Exxon? Or Five Guys pizza parlors? Instead of an ER where you wait for hours and then get $2000 bills for an aspirin, at least the gas station posts its prices.

*

Rebecca Pifer, “Kroger, Intermountain subsidiary Select Health launch co-branded MA plan,” Healthcare Dive, Aug 16, 2023 READ IT HERE

“Kroger, the network of grocery stores, has announced its third Medicare Advantage plan offering in partnership with a health insurer.” I’ll have the broccoli and an EKG, please! Once for-profit entities were invited to take over Medicare, why not a supermarket? Next up: Wellness at Wendy’s! MA ads targeting shoppers at Kroger will be interspersed among the produce and dairy products with pop-ups next to the Metamucil. Kidding again!

*

Sarah Rankin, “Some ‘Obamacare’ plans could see big rate hikes after lawmakers fail to agree on reinsurance program,” Associated Press, Aug 10, 2023 READ IT HERE

Virginia created a “reinsurance” program to cover expensive patients so that the private market could remain profitable while keeping premium costs down. But now lawmakers can’t agree on terms for renewing the subsidy, and insurance companies are threatening rate increases of 28%. Turns out that subsidizing private profit without bankrupting the state isn’t so easy. Nationally, private market insurance premiums are expected to rise by an average of 6%.

*

Kim Komando, “Trusting Amazon with your health records might not be worth a purely intermediary service,” Fox News Media, June 18, 2023 READ IT HERE

“When you sign up for treatment through Amazon Clinic, you also ‘authorize’ all those involved (doctors, pharmacies, labs) to share your Protected Health Information, or PHI, with Amazon.” Amazon can then “facilitate services from other providers,” non-euphemistically known as bombarding you with ads. Your HIPAA protections go out the window. As attractive as the Florida leprosy outbreak.

*

Tina Reed, “UnitedHealth cutting back on prior authorizations,” Axios, Aug 10, 2023 READ IT HERE

A bit of good news: insurers are reacting to pressure. “Federal regulators consider tougher curbs on the practice” of prior approval abuse. Under threat of explicit regulations, the companies are dropping things like demanding authorization for colonoscopies and cardiac stress tests. All it took was for Congress to be “eyeing a plan” to regulate the lucrative MA plans.

*

SINGLE PAYER LINKS #313

Posted 18 AUG 2023

*

Michelle Bocanegra, “Judge ‘permanently’ blocks Medicare Advantage switch for 250K NYC retirees, city to appeal,” Gothamist, Aug 11, 2023 READ IT HERE

A win at last: New York City is now “permanently enjoined” from breaking its long-standing contract with retired city workers and forcing them into the Disadvantage. The City will appeal.

*

Dave Muoio, “MultiPlan’s contracts are ‘like a mafia enforcer for insurers,’ AdventHealth alleges in antitrust lawsuit,” Fierce Healthcare, Aug 11, 2022 READ IT HERE

King Kong claims illegal monopolistic behavior by Godzilla. Insurer AdventHealth refers to the enemy as the “MultiPlan Cartel.” Yum! Too bad they both can’t lose—or maybe they can. This sort of profit-inhibiting lawfare must be very annoying to the monster class. Good to see the Sherman Antitrust Act enjoying a heyday with one side accusing the other of a “multi-year, ongoing conspiracy,” which is certainly true but applies to the whole system.

*

Heather Landi, “Microsoft partners with Epic to roll out EHR cloud database solution, starting with Mount Sinai,” Fierce Healthcare, Aug 11, 2023 READ IT HERE

Microsoft now has a new, cloud-based electronic health records system that can run 50 million database accesses per second, and New York’s Mount Sinai system is going to use it. Hospitals are getting into using computational power to stay competitive against the insurance companies’ computational power. It will help “accelerate machine learning,” says the article, along with a lot of other IT-speak that does not reassure, such as: “AI-driven clinical decision support systems will support proactive patient management.” If that doesn’t mean robots are going to make treatment decisions, then I’m not fluent in English.

*

Rebecca Pifer, “DOJ hits UnitedHealth, Amedisys with second request over $3.3B deal,” Healthcare Dive, Aug 11, 2023 READ IT HERE

Monkey wrench inserted into a merger plan: This time it’s from the Department of Justice, which is coordinating closely with the vigorously antitrust folks at the Federal Trade Commission. This deal involves insurance giant UnitedHealth, which is gobbling up home health businesses with the aim of “prodding its beneficiaries toward the low-cost settings.” How long until a robot decides when we’re ready to be discharged?

*

Paige Minemyer, “Insurers are set to receive $12.8B in MA bonus payments this year. These are the companies getting the biggest payouts,” Fierce Healthcare, Aug 10, 2023 READ IT HERE

The bright idea behind Medicare Disadvantage was to get the privateers to perform better by awarding them bonuses for good outcomes among the people who signed up. But lo and behold, the companies figured out how to game the ratings system through upcoding and other scams, and now the “star ratings” that bring a bonus payment miraculously jumped 30% last year. The bonuses run as high as $500 per patient with mega-insurer UnitedHealth getting the biggest pot of loot. So, privatization turns out to cost more—and this is a surprise because . . . ?

*

Yves Smith, “FDA tries to pretend it didn’t oppose ivermectin use for Covid,” Naked Capitalism, Aug 12, 2023 READ IT HERE

Does anyone recall that taking IVM was only for crazies who patronize animal feed stores? (Remember the line “You’re not a horse”?) Or the late-night hosts guffawing over those Trumpian rubes for taking horse paste? (See a roundup at READ IT HERE

*

Mobeen Sayed, “FDA in court for the Ivermectin statements,” YouTube, Aug 15, 2023 READ IT HERE

Want to scream in disbelief? Watch this video.

*

Mary Paquette, “In defense of physicians who treated COVID with alternative approaches,” [Minneapolis] Star Tribune, Aug 14, 2023 READ IT HERE

Understatement du jour: “When the government repeatedly stated as fact their latest recommendations, only to later change those ‘facts,’ it undermined patient confidence. The polarization that has resulted has now created the epidemic of mistrust.” Lesson: when you don’t really know, don’t act as if you do. Corollary: Don’t shill for Big Pharma.

*

Darius Tahir, “The NIH ices a research project. Is it self-censorship?” KFF Health News/CBS News, Aug 7, 2023 READ IT HERE

The NIH wanted to study health communications to combat “conspiracies and false information.” Then it dumped the whole idea. Explanations are fishy—here’s mine: they didn’t want to document how much BS they themselves peddled to the public and how much blatant censorship they exercised on social media. The author seems to think the NIH is afraid of Republicans rather than exposure of the government’s violation of the No. 1 rule of health communications: DON’T LIE.

*

Noam N. Levey, “What one lending company’s hospital contracts reveal about financing patient debt,” KFF Health News, Aug 8, 2023 READ IT HERE

Providers like to shove patients off to healthcare loans from financial services companies and free themselves from the sticky business of debt collection. But the lenders charge interest (unlike most doctors or hospitals), driving people into debt penury. “Within two years of [UNC Health in North Carolina] signing a contract with AccessOne, a private equity-backed lender, nearly half of its patients were in loans that charged interest.” The feds are getting interested in looking into the new rent-extraction scams.

*

Cezary Podkul, “Why doctors pay millions in fees that could be spent on care,” ProPublica/NPR, Aug 15, 2023 READ IT HERE

“Imagine if each time your wages were deposited in your bank account, your employer deducted a fee of 1.5% to 5% to provide the money electronically. That, increasingly, is what health insurers are imposing on doctors.” Or else you don’t get the reimbursement at all. What a bunch of gangsters. “Almost 60% of medical practices said they were compelled to pay fees for electronic payment,” meaning billions in more fees for useless intermediaries. Allowing electronic payment under the Affordable Care Act was intended to lower costs, not facilitate theft. The article outlines how a former CMS employee-turned-lobbyist for an electronic payment company, Matthew Albright, finagled CMS to allow the scam.

*

Victoria A. Brownworth, “Millions more Americans have medical debt than student debt. Where’s their relief?” Philadelphia Inquirer, Jul 28, 2023 READ IT HERE

Fair question, especially for a presidential election year. The author had a three-week hospital stay and ended up with a co-pay of $52,000, “money I didn’t have.” Then she inherited her late spouse’s medical debt on top of that.

*

Arielle Dreher, “Uninsured rate hit record low in early 2023, CDC says,” Axios, Aug 3, 2023 READ IT HERE

That’s nice, but post-Covid the numbers will start creeping back up with 3.8 million kicked off Medicaid so far—and we’re just getting started. The South has the highest uninsured rate at 16%.

*

Joseph Choi, “DOJ blasts industry attempt to delay Medicare drug price negotiations,” The Hill, Aug 14, 2023 READ IT HERE

The Chamber of Commerce, the trade group PhRMA, Merck & Co., and Bristol Myers Squibb are suing over the negotiation program. Don’t anyone dare to try to stop price-gouging of Medicare and everyone else to fund their stock buybacks and yachts. DoJ’s argument: don’t want to negotiate? Don’t participate in Medicare—it’s a free country.

*

Arielle Dreher, “Costliest Medicare drugs more than tripled in price since entering market: report,” Axios, Aug 11, 2023 READ IT HERE

“The 25 drugs that accounted for the highest Medicare Part D spending in 2021 more than tripled in price since they first entered the market.” Who knows, maybe that’s why all the fuss about negotiating prices?

*

Peter Sullivan, “Scrutiny over drug costs shifts to pharmacy benefit managers,” Axios, Aug 14, 2023 READ IT HERE

“The pharmaceutical industry has taken most of the heat in Congress and the public’s mind for high drug prices.” That’s now shifting to the PBMs, so Godzilla is suiting up to slug it out. More popcorn.

*

Tara Bannow, “Not-for-profit CommonSpirit Health paid its CEO $35 million in 2021, STAT, Aug 14, 2023 READ IT HERE

[paywalled] “The size of Lloyd Dean’s pay package is likely to reignite questions about health system CEO pay, especially at tax-exempt organizations.” Does “nonprofit” mean anything at this point?

*

Betsy McKay, “Ozempic settles the obesity debate: It’s biology over willpower,” Wall Street Journal, Aug 14, 2023 READ IT HERE

Thank you, WSJ, from all of us at Big Pharma about to cash in bigtime! We can now see how the narrative over the fat shots will unfold: your brain chemistry is the culprit, not you or a food system that crams high fructose corn syrup into everything. And of course, now that you’re obese, you need costly drugs to “cure” you.

*

Howard M. Fillit, “We finally have new Alzheimer’s drugs. How do we decide who gets them?” STAT, Jul 7 2023 READ IT HERE

This doctor, the co-founder of the Alzheimer’s Drug Discovery Foundation, is optimistic about the new drugs. He’s trying to find a way around the need for a PET scan (pricey) or a spinal tap (icky) to see if the patient has the beta amyloid plaque buildup that the drugs are supposed to treat. However, the veteran of 40 years of Alzheimer’s research also makes a claim against interest: “We have identified seven other pathways centered around the biology of aging that contribute to the onset of the disease.” Meaning that the beta amyloid theory of Alzheimer’s causation is just that? We should spend 80 grand a year per patient to reduce beta amyloid despite recognizing seven other important (perhaps equally important) causes? Ah, we learn, but there are more drugs in clinical development to address these other possible causes, so the Pharma jackpot is just getting rolling. “As researchers explore these other pathways associated with aging, such as neuroinflammation, metabolic disturbances, and vascular dysfunction, we must also advance the pipeline of diverse biomarkers.” Not to mention the pipeline of lovely new meds for each one costing several thousand a month! Or as the doctor puts it, “Ultimately, it will take a combination therapy approach, similar to those used in cancer treatment, to slow down the progression of the disease.”

*

Tom Murphy, “Insurers won’t cover new Alzheimer’s treatment for some customers,” Associated Press, Aug 11, 2023 READ IT HERE

Some private insurers say Leqembi is experimental and not reimbursable while Medicare has already agreed to cover it. Independence Blue Cross reviewed the evidence and concluded that it “does not allow for conclusions to be drawn about the safety and effectiveness of Leqembi.” Of course, they have a financial incentive to think that, but the dissent signals that the science behind the approval remains questionable.

*

Mount Sinai Today, Jul 26, 2023 READ IT HERE

Here’s some pro-Pharma propaganda sent out by a hospital to its senior patients about the new Alzheimer’s drug: Leqembi represents “an exciting chapter for treating Alzheimer’s disease,” which is now “treatable,” says Mount Sinai. It will make “a big impact in treating this condition,” an assertion of fact not in evidence. The hospital correctly notes that Leqembi produced a “statistically significant” reduction in cognitive decline but then goes on to claim that it is also a “clinically meaningful” one, which is hotly debated. Last line on the rah-rah blurb: “serious adverse events” were reported in 14% of patients who took it.

*

Alexander Tin, “Air pollution may be to blame for thousands of dementia cases each year, researchers say,” CBS News, Aug 14, 2023 READ IT HERE

But let’s ignore that in favor of developing costly drugs that may or may not work but will generate billions in new revenue for Pharma.

*

Jan Hoffman, “Opioid settlement money is being spent on police cars and overtime,” New York Times, Aug 14, 2023 READ IT HERE

The estimated $50 billion pot of money coming to states and cities sounds like a huge windfall, but spread over 18 years it’s not so fabulous especially if police departments siphon off large chunks for cruisers, spying equipment, and body armor. Critics are pointing at the massive tobacco settlement that ended up plugging holes in state budgets with little left over for actual tobacco control. Cops tend to think that drug problems can be solved with increased arrests. Louisiana will spend 20% of its opioid money on sheriffs.

*

Anna Claire Vollers, “Hospitals block much-needed birth centers in the South,” Stateline, Aug 11, 2023 READ IT HERE

“Established medical providers use regulatory requirements to quash competition.” While hospitals relentlessly close all over the South, those still standing utilize monopoly power to veto midwife-run birth centers that provide maternity care at a fraction of the cost.

*

Julie Appleby, “Proposed rule would make hospital prices even more transparent,” KFF Health News/NPR, Aug 14, 2023 READ IT HERE

“How much is the ice cream?” says a customer. “A woman behind the counter responds with a smile: ‘Prices? No, we don’t have those anymore. We have estimates.’ The advertisement is part of an ongoing campaign by the advocacy group Patient Rights Advocate” to embarrass hospitals. I suspect it will succeed if these ad ever get onto the airwaves.

*

SINGLE PAYER LINKS #312

Posted 11 AUG 2023

*

There has been a rash of articles about the fat pill—which I should start calling the fat “shot” to be precise—based on a corporate news release, which, despite the variations in wording, basically all trumpet the company’s PR. USA Today says, “Wegovy Weight-Loss Drug Appears To Reduce Heart Attack, Stroke Risk.” The Wall Street Journal is more definitive: “Weight-Loss Drug Wegovy Cuts Stroke, Heart-Attack Risk By 20% In New Study.” As usual, no one has seen the raw data, so these are free headlines based on a company claim that people who get the fat shot once a month have fewer heart attacks and strokes. Now, that’s logical enough given the negative effects of obesity. However, we can easily glimpse the campaign to come: downplay the vanity aspects of these shots that are driving a wild clamor of demand in favor of a new emphasis on their alleged overall benefits. We’re not just slimming, we’re getting healthy, right?

*

Adriel Bettelheim, “Medicare could save billions covering obesity meds: study,” Axios, Aug 2, 2023 READ IT HERE

And just in time there’s a new modeling study out that says if Medicare were to cover the fat shots for pretty much anyone who fits the guidelines, the system would save a gigantic pot of money in the long run. That is certainly good news for the companies peddling these treatments, and the USC Schaeffer Center for Health Policy and Economics has provided it. The Center says a whopping $200 billion in savings over a decade would result from the reduced hospital care and other public health benefits of getting all that fat off people. But Medicare doesn’t reimburse weight-control drugs, which is an obstacle for the Pharma owners. Here’s the Schaeffer Center study to see for yourself READ IT HERE

*

Rachana Pradhan, “Seeking Medicare coverage for weight loss drugs, Pharma giant courts black influencers,” KFF Health News/NPR, Aug 8, 2023 READ IT HERE

Pharmaceutical Novo Nordisk is getting the black leadership class to help peddle the fat shots, which cost over $1K a month, by urging Medicare to overturn its policy against reimbursing weight-loss drugs. “Obesity is a disease” is the mantra, soon to be followed by, “Not fully reimbursing Novo Nordisk is racist.” NN generously supports the Obesity Action Coalition, which assures us that that cash has nothing zero zilch nada to do with its advocacy for the company’s products. And “in 2021, Novo Nordisk gave hefty donations to the Congressional Black Caucus Foundation and the Asian Pacific American Institute for Congressional Studies." Coincidentally, both of those caucuses back the company on changing Medicare policy.

*

Max Baucus, “Breakthrough Alzheimer’s drugs are out of reach for many in rural states like Montana,” STAT, Aug 3, 2023 READ IT HERE

Baucus, after highlighting his role in creating the Affordable Care Act, complains that Medicare isn’t shoveling the new Alzheimer’s drugs at patients fast enough in his state. Baucus repeats the whining over the FDA’s insistence on keeping patient data in real time to monitor whether these drugs actually work. He says that’s “a potential administrative burden” for small outfits like Montana hospitals. They don’t know how lucky they are that their doctors can’t rush them toward these drugs.

*

Rebecca Pifer, “CMS pausing Medicaid redeterminations in states noncompliant with renewal requirements,” Healthcare Dive, Jul 20, 2023 READ IT HERE

Missed this earlier: Biden officials have intervened with 12 states to slow them down as they enthusiastically kick people off Medicaid given that of the 3 million dumped so far, ¾ have lost coverage for “procedural reasons.” The Feds can issue these stop orders because they fund Medicaid while states only administer it, i.e., the paymaster sets the rules. “Regulators are particularly concerned about coverage in states that have yet to expand Medicaid.”

*

Sydney Halleman, “Kentucky sues major PBMs over rising insulin prices,” Healthcare Dive, Aug 4, 2023 READ IT HERE

Another state joins the legal assault on PBMs and Pharma for “artificially inflating insulin prices,” i.e. price-fixing. The three PBM defendants control approximately 80% of the market and are all owned by major insurance companies. Kentucky joins California and the city of Cleveland, Ohio. Fun fact: KY spends one out of every four of its healthcare dollars on people with diabetes.

*

Andrew Cass, “Rhode Island AG objects to rate hike proposals from largest payers,” Becker’s Payers, Aug 9, 2023 READ IT HERE

Here’s another state taking action while Congress hems, haws, and fiddles. Rhode Island empowers its attorney general, Peter Neronha, to weigh in when they think the insurance companies are raising their prices too high. His reasons were the high inflation affecting Rhode Island consumers and the companies’ very tidy profits. “The full weight of rising healthcare costs should be a shared responsibility borne by all stakeholders including health insurance companies.” A remarkable statement arguing that the function of health insurance should be to guarantee coverage for residents, not unlimited profit. It’s as if medicine isn’t just a consumer product even in a capitalist society!

*

Rebecca Pifer, “5 takeaways from health insurers’ second-quarter earnings,” Healthcare Dive, Aug 8, 2023 READ IT HERE

Post-Covid, insurers worried that people might go back to doctors to deal with health issues put on hold. No worries: The companies “generally outperformed expectations.” The prospect that “spooked investors” of having to take care of people’s medical needs post-Covid didn’t materialize. Whew! To help investors rest easy, insurers are planning to ask an average of 6% rate increases in 2024.

*

Betsy Ladyzhets, “‘Underwhelming’: NIH trials fail to test meaningful long Covid treatments—after 2.5 years and $1 billion,” STAT, Aug 9, 2023 READ IT HERE

While the Feds famously went warp-speed on vaccines, research on Covid treatments has been remarkably slow-moving. The National Institutes of Health has a billion dollars in hand from Congress, but the trials finally set up are “unlikely to deliver meaningful treatments.” Why is that? Most of the research is observational rather than the classic clinical tests of different medications. One expert calls the government’s long-Covid funding approach “wasted.” The topic is worth more public discussion, but in the highly charged atmosphere of Covid politics, that’s unlikely. What is clear is that treating the millions of people affected—an estimated 6% of all U.S. adults—is a very low priority. A big question: given the vast potential market, why isn’t this of more interest to the pharmaceutical industry? Don’t they need all those billions to do R&D?

*

Madeline Miller, “Long covid has derailed my life. Make no mistake: It could yours, too,” Washington Post, Aug 9, 2023 READ IT HERE

A sobering reminder of the estimated 20 million Americans whose Covid symptoms didn’t go away. “Our public institutions have turned their back on containment. The virus is still very much with us, but the CDC has stopped reporting on cases. States have shut down testing. Corporations, rather than improving ventilation in their buildings, have pushed for shield laws indemnifying them against lawsuits.” FYI cases in New York City are up 60%; I just heard from two friends this morning who are reinfected.

*

Sarah Owermohle, “Senators push IRS to launch nonprofit hospital probe,” STAT, Aug 8, 2023 READ IT HERE

A bipartisan group of senators wants the IRS to see if nonprofit hospitals deserve their exemptions and actually provide charity care. Sounds good, but will four senators overcome the massive hospital lobby? One of them, Chuck Grassley of Iowa, has been on this warpath for a long time and managed to embarrass some “nonprofit” hospitals over their aggressive debt collecting practices. He’ll need more Democrats to join him though—Dems tend to side with hospitals while Republicans like insurance companies and Pharma—although both camps like big money lobbyists.

*

Heather Landi, “CVS Health trims 2024 profit outlook as it faces higher medical costs, plots clinic expansions,” Fierce Healthcare, Aug 2, 2023 READ IT HERE

CVS is a pharmacy chain, as we know, but it also owns the insurer Aetna, plus a primary care chain, a home care company, and a pharmacy benefit manager. The conglomerate is trying, like its rivals, to pull people into getting everything health-related from one of their affiliates. But they’re facing higher costs, as CEO Karen Lynch said, because of “greater than expected utilization in outpatient settings,” which translated into English means, “Damn, people keep wanting us to give them healthcare in exchange for their premiums. But we’re working on that.”

*

Jeff Lagasse, “Aetna sued by Kraft Heinz for allegedly mishandling data,” Healthcare Finance, Jul 6, 2023 READ IT HERE

This is an interesting story about a lawsuit brought by employees of a company, namely Kraft Heinz, against their employer-based health insurance company, Aetna. What they allege is that Aetna overpaid claims and did other things to increase their administrative fees, which is a curious complaint because the plaintiffs basically are arguing that the insurance company harmed their employers’ finances. Bloomberg covered this and a similar story earlier in July with the comment that “Employers are losing trust in the companies they hire to run their health plans.” Here’s the court filing: READ IT HERE

*

Frank Diamond, “Elevance Health, AHA spar over hospital consolidation,” Fierce Healthcare, Aug 3, 2023 READ IT HERE

Godzilla v. King Kong again: “Large health systems are scooping up independent hospitals, and that consolidation negatively affects employers, insurers and patients.” Note that the study was commissioned by an insurer, so the hospitals naturally have a different view of the problem. When the big guys slug it out, interesting facts sometimes fall out of their pockets. For example, we learn that hospital care accounts for $1.3 trillion of the country’s total $4.3 trillion in healthcare expenditures. Also, the insurance company study highlights that prices they pay hospitals rise faster when small independent hospitals are bought up by large chains. The article quotes the head of the American Hospital Association firing back about insurer Elevance’s $2 billion in profit just in Q2. “You’re a greedy pig! No, you’re a greedy pig!” More popcorn. The study is here: READ IT HERE

*

Susanna Vogel, “Primary care providers say field is ‘crumbling,’” Healthcare Dive, Jul 20, 2023 READ IT HERE

A new survey of primary care doctors and nurses found that the post-Covid burnout persists in that field and may be getting worse. Eighty percent of respondents said they were understaffed, and 60% described primary care in the U.S. as “crumbling.”

*

Phil Galewitz, “His anesthesia provider billed Medicare late. He got sent to collections for the $3,000 tab,” KFF Health News/NPR, Jul 28, 2023 READ IT HERE

This week’s medical bill horror story is about a man with both Medicare and a supplemental policy who did everything right and got stuck with a bill for $3,000 because his providers didn’t send in their bill on time. Providers and insurance companies get things confused all the time, and we have to be psychic to know what’s going on between them. But when they mess up, we’re on the hook. All we can do is try to pore over those confusing statements and make sure the doctors and labs and hospitals get their bills in to the appropriate payers.

*

Bernard J. Wolfson & Melissa Montalvo, “Giant health system almost saved a community hospital. Now it wants to ‘extract every dollar,’” KFF Health News/Fresno Bee, Jul 21, 2023 READ IT HERE

A sorry tale of a “white knight” health conglomerate swooping in to rescue a struggling safety-net hospital and then looking pretty much like a private equity-type carcass-picker. Madera hospital in a low-income, largely Hispanic city in California was courted by a multi-state, 88-hospital Catholic chain named St Agnes, based far away either in Michigan or Idaho. The deal fell apart, and now St Agnes is in bankruptcy court trying to hurry up the closure of the town’s only acute care facility.

*

Rebecca Pifer, “Health insurers ignore surprise billing decisions, providers allege,” Healthcare Dive, Aug 4, 2023 READ IT HERE

File this one under “It never ends.” We got the Surprise Billing Act, which is supposed to prevent us from getting blindsided with bills from out-of-network services while we’re in network getting care. Well, now it turns out that even when these bills go into arbitration so that the hospitals and the doctors can work out a fair deal, insurance companies are refusing to pay up! A doctors’ group claims that half of all awards from these arbitrations then meet resistance from the insurers who either say the decisions are “not binding” or they simply stiff the providers. The group found in a survey of thousands of docs that half of all awarded claims were never paid, a third of payments were for an incorrect amount, and half of those incorrect payments came late. Are there any adults in the room?

*

Dave Muoio, “Hospitals’ risk of data breach doubles just before, after a merger deal, research shows,” Fierce Healthcare, Aug 7, 2023 READ IT HERE

Data breaches are a recurring problem for big health systems and, by extension, for us as users because our identity can be stolen, not to mention the exposure of our private matters. Turns out the year before and the year after a merger are particularly risky for hospitals. During that two-year window, a merging hospital is twice as likely to suffer a hack. Well, if it’s on the web, it’s not secure. Can we opt out of exposing ourselves in this way? The hospitals don’t make it easy to say no.

*

Molly Castle Work, “As a union pushes to cap hospital CEO pay, it’s accused of playing politics,” KFF Health News/LA Daily News, Aug 9, 2023 READ IT HERE

Yes, class struggle is political, imagine that. And? Slogging past the editor’s tendentious headline, we find that the union is making the scandalously partisan demand that their bosses’ pay be limited to $450,000 a year instead of the $2 to $6 million local hospital CEOs pull in. How political of them!

*

SINGLE PAYER LINKS #311

Posted 4 AUG 2023

*

Jomo Kwame Sundaram & Nazihah Noor, “Government health financing for all, not insurance,” IPS/Challenging Development+, Aug 2, 2023 READ IT HERE

Sundaram is a former UN Assistant Secretary General, I gather of Malaysian nationality. His argument goes beyond M4A: “Insurance-based systems—both private and social—not only incur unnecessary costs, but also undermine ensuring health for all.” He means, Don’t bother with Medicare/Medicaid-like programs, ditch all that along with the privates, and go straight to state-run systems (“revenue financed universal coverage”). Worth reading in full for a brief, clear argument.

*

Mark Kreidler, “Americans with health insurance are increasingly putting off important medical treatments they can’t afford,” Capital & Main, Jul 27, 2023 READ IT HERE

“Nearly four in 10 Americans said they or a family member postponed medical treatment in 2022 because of the cost,” a huge rise in just one year. Enormous deductibles (like $17,000 for a family) mean insured people can’t get treatment. But the news isn’t all bad; the CEOS of the seven insurance/medical group Godzillas “raked in more than $335 million in compensation, up 18% over the year before. Joseph Zubretsky of Molina Healthcare pulled in $181 million—and he’s worth every penny, having figured out how to extract 80% of Molina’s revenue from Medicaid, the government program for poor people.

*

Natu Tweh, “Billionaires pay $264 million in medical debt for 125,000+ Miami-Dade residents,” Health News Florida/WLRN, Jul 30, 2023 READ IT HERE

The Jane and Daniel Och Family Foundation gave a giant donation to an outfit called RIP Medical Debt, which buys up unpaid hospital bills on the cheap and erases them. That’s sweet and a life-saver for 125,000 low-income Miamians. The larger question, of course, is why medical debt exists in the first place.

*

Jason Clayworth & Oriana González, “Iowa’s maternal death rate rises as birthing units close,” Axios, Jul 31, 2023 READ IT HERE

Death rate for new mothers in Iowa doubled in the last decade reflecting national trends. One cause: “Labor and delivery units have shuttered in multiple rural counties across the state in recent years.” Meanwhile, abortion restrictions will mean more unplanned births with haphazard prenatal care.

*

Clara Bates, “One-third of Missouri’s rural hospitals at risk of closure, new data shows,” Missouri Independent, Aug 1, 2023 READ IT HERE

Of the state’s 57 rural hospitals, 19 are in trouble, and eight teetering on the brink. Ten have closed in the last decade.

*

Michelle Andrews, “Sen. Sanders says millions of people can’t find a doctor. He’s mostly right,” KFF Health News, Jul 31, 2023 READ IT HERE

“Sanders introduced legislation in July that would invest $100 billion over five years to expand community health centers and provide training for primary care doctors, nurses, dentists, and other health professionals.” The reporters looked into Sanders’s claim and confirmed that 100 million Americans live in a “health professional shortage area” where the population-to-provider ratio is at least 3,500 to 1.

*

Maureen Tkacik, “Shock treatment in the emergency room,” American Prospect, Jul 29, 2023 READ IT HERE

Another reason to stop private equity takeovers: rippling disasters occur when they go bust. American Physician Partners is collapsing, affecting its 135 hospital emergency rooms in 18 states. The PE model involves saddling companies with huge debts, then extracting fees and dividends, and often letting them go bankrupt. One particular complication in ERs is that international staff visas are linked to the employer; when that changes, their visas are invalid. Doctors getting stiffed on their paychecks for a month or two definitely focuses the mind. Said one, “Never in a million years would I have imagined members of my profession talk about joining a union.”

*

Bob Herman, “Physician groups backed by private equity giant lobby on mergers,” STAT, Aug 1, 2023 READ IT HERE

“Three large and growing physician groups backed by the private equity giant Welsh, Carson, Anderson & Stowe have hired a prominent lobbying firm to influence federal policy covering mergers and acquisitions. Over the past two weeks, United Musculoskeletal Partners, U.S. Anesthesia Partners, and U.S. Radiology Specialists each registered with Forbes Tate Partners, a lobbying shop.” Who are Forbes Tate? Well, founding partner Jeffrey A. Forbes is “a 20-year veteran of political campaigns,” starting with Al Gore’s in 1988, a stint as chief of staff to Sen. Max Baucus, another at the DNC, and later a gig directing legislative affairs for Bill Clinton and a role in the Obama campaign. So, the Democrats are gearing up to protect PE.

*

Katrina Dix, “Bon Secours drops Anthem-managed Medicare plans,” Virginian-Pilot, Jul 31, 2023 READ IT HERE

Negotiations between a hospital system in Virginia and a local insurer broke down, leaving patients in the lurch if they have a “managed Medicare plan,” which has to mean Medicare Disadvantage although the article never says so explicitly. Now, 6,000 people have to scramble to find new doctors or fall back on traditional Medicare. I wonder if they were informed of that possibility when they signed up.

*

Noah Tong, “UnitedHealth sued by US Labor Department over thousands of claims denials,” Fierce Healthcare, Aug 1, 2023 READ IT HERE

DoL says the insurer blanket-denied thousands of claims based on diagnosis codes without looking into the details; “98% of those claims were overturned upon appeal.” The company did not tell those insured the reasons, cite their plans’ provisions, or inform claimants of the appeal process.

*

U.S. Senate Committee on Finance, “Deceptive marketing practices flourish in Medicare Advantage: A report by the majority staff,” undated, READ IT HERE

An explosion of complaints about Medicare Disadvantage marketing spurred this investigation. They found:

• “Insurance agents tell seniors [falsely] that their doctors are covered by the new plans.
• “Seniors receive mailers that look like official business from a Federal agency, yet the mailer is a marketing prompt from an MA plan or its agent or broker.
• “An insurance agent calls seniors 20 times a day to convince them to switch their Medicare coverage.
• “Widespread television advertisements with celebrities claim that seniors are missing out on benefits, including higher Social Security payments, to prompt seniors to call MA plan agent or broker hotlines.

“Of particular concern to the Committee were reports of agents changing vulnerable seniors’ and people with disabilities’ health plans without their consent.” Nice bunch of folks.

*

Sara Moniuszko, “Leprosy could be endemic in Central Florida, researchers say. What to know about the disease,” CBS News, Jul 31, 2023 READ IT HERE

While Florida is tackling that dire problem of too much talk about lesbians and gays, leprosy is back in the southeastern U.S. Time for more Bible study to learn about being kind to our leprous neighbors!

*

David A. Lieb, “Paperwork problems drive surge in people losing Medicaid health coverage,” Associated Press, Jul 28, 2023 READ IT HERE

It’s official: “Large numbers of people are being dropped from the [Medicaid] rolls for failing to return forms or follow procedures.” To be exact, 4 out of 5 of those kicked off remain legally eligible. But Biden Administration officials are urging states to be more careful rather than issuing new regs to stop the debacle. Biden prohibited disenrollment during Covid; he could do it again or mandate that states extend the redetermination window.

*

Nick Blizzard, “‘I’m going to be homeless’: Ohio Medicaid collects $87.5M from families after loved ones’ death,” Dayton Daily News, Jul 29, 2023 READ IT HERE

States can recoup Medicaid spending from the estates of deceased beneficiaries. One lady was shocked to find herself about to lose the family home to medical bills. Turns out medical bankruptcy can follow you to the grave and beyond.

*

Heather Landi, “Amazon bets big on virtual care, unveils nationwide telehealth service through its website, mobile app,” Fierce Healthcare, Aug 1, 2023 READ IT HERE

“Amazon Clinic is expanding to all 50 states through its website and mobile app to connect consumers with licensed clinicians who can diagnose, treat, and prescribe medication for a range of common health and lifestyle conditions.” They can then pick up their meds at an Amazon pharmacy. Amazon also acquired One Medical, a national walk-in primary care chain with 188 locations, earlier this year.

*

Rebecca Pifer, “Amazon launches generative AI-based clinical documentation service,” Healthcare Dive, Jul 26, 2023 READ IT HERE

Amazon rolled out a “clinical documentation service” using AI to automatically create medical notes. What could go wrong? “HealthScribe uses speech recognition and generative AI to create transcripts of patient visits, identify key details, and create summaries that can be entered into an electronic health record.” Amazon joins Microsoft-owned Nuance and Google partner Suki in using AI for clinical notetaking. Since electronic medical records are primarily to facilitate billing, further automation should be highly profitable, if not accurate.

*

Associated Press, “Merger talks end between large health care systems in Minnesota, South Dakota,” Jul 28, 2023 READ IT HERE

But there’s pushback on healthcare concentration: A merger that would have created one of the largest health service companies in the Upper Midwest has been scrapped. Instead of a 50-hospital system with 78,000 staff, the two states’ systems will remain separate. The University of Minnesota and local unions opposed the merger; apparently, the FTC didn’t play a role.

*

Gregg Gonsalves, “These new Alzheimer’s drugs are a travesty,” The Nation, Jul 27, 2023 READ IT HERE

“They cost a ton, have major side effects, and there’s deep skepticism that they even work.” But they’re going to mint billionaires! Gonsalves, an ACT UP veteran, blasts the Alzheimer’s Association for gushing over the costly new meds while ignoring their “imperceptible” impact and the high risk of brain bleeds. He notes that ACT UP pushed for accelerated access to new drugs but also demanded details about utility and side-effects and didn’t swallow Pharma PR whole.

*

Lisa Jarvis, “Drugs for obesity and Alzheimer’s propelled Eli Lilly to the top,” Bloomberg, Jul 31, 2023 READ IT HERE

Paywalled, here’s the lede: Both the fat pill and the new Alzheimer’s drug “represent multi-billion-dollar opportunities for Lilly and have propelled the company’s stock steadily upward.” Lilly didn’t used to rank in the top ten Pharma outfits—now it’s an industry leader.

*

Arthur Allen, “The real costs of the new Alzheimer’s drug, most of which will fall to taxpayers,” KFF Health News/CBS News, Aug 2, 2023 READ IT HERE

“In addition to the company’s $26,500 annual price tag for the drug, treatment could cost U.S. taxpayers $82,500 per patient per year for genetic tests and frequent brain scans, safety monitoring, and other care.” Medicare premiums already went up 15% in anticipation of the cost burden.

*

Julie Steenhuysen, “Quest Diagnostics launches Alzheimer’s blood test for consumers,” Reuters, Jul 31, 2023 READ IT HERE

Another money-maker for the Alzheimer’s industry, based on the questionable beta amyloid theory of disease causation. But at $399 a pop (not $400!) with pretty much every older adult in the country nervous about the big A, that’s a lot of potential business. Knowing that you have increased beta amyloid doesn’t tell you anything about your future Alzheimer’s status, but who cares? There is plenty of money to be made by getting people ever more anxious about future dementia. The tests don’t require FDA review or approval, just a prescription. The FDA’s greenlighting of pricey amyloid-removal drugs as a “treatment” for Alzheimer’s will stimulate more focus on this dubious approach. “Quest’s consumer test is aimed at adults aged 18 and older who may have mild memory loss or a family history of Alzheimer’s.” Stand by for the TV ads. Tens of billions will be wasted.

*

Paige Minemyer, “Express Scripts joins Optum in adding more Humira biosimilars to its formulary,” Fierce Healthcare, Jul 10, 2023 READ IT HERE

AbbVie’s Humira is finally getting some generic competition after scooping up hundreds of billions in reimbursements by means of holding 311 patents on this single drug. With its monopoly, AbbVie steadily cranked up the cost of the drug to nearly five times more than its original list price.

*

Nicholas Florko, “Novo Nordisk bought prescribers over 450,000 meals and snacks to promote drugs like Ozempic,” STAT, Jul 5, 2023 READ IT HERE

Paywalled, but the intro says: “Novo Nordisk spent $11 million on [457,000] meals and travel for thousands of doctors last year as part of its push to promote Ozempic [the fat pill] and other weight loss-inducing diabetes drugs.” Which had no, nada, zero, zilch impact on their interest in these drugs or their prescribing behaviors.

*

Sydney Halleman, “Cleveland sues major PBMs, drug manufacturers over rising insulin prices,” Healthcare Dive, Jul 26, 2023 READ IT HERE

A new twist: a city suing price manipulating health cartels. “Cleveland accused major pharmacy benefit managers and drug manufacturers of colluding to jack up insulin prices in a city where 17% of residents are diabetic.” Grist for the congressional committees shining a light on PBM/Pharma practices. California sued the same PBMs earlier this year over the same behavior. “Although manufacturers can produce insulin for as low as $2, individual vials can cost between $300 and $700.”

*

Mary Kekatos & Youri Benadjaoud, “Why rising COVID hospitalizations should not necessarily be a cause for concern,” ABC News, Aug 1, 2023 READ IT HERE

Covid hospitalizations are ticking upward (by 12% last week), but “there is no reason to panic just yet.” Says who? People who are working from home? And given that the whole thing is officially “over,” and most testing and surveillance has been dismantled, what confidence can we have in those numbers? “National wastewater levels containing traces of the virus have increased nearly 65% in the past month.” But nothing to see here, back to work, everyone. That attitude might change when Pfizer needs to sell more booster shots.

*

Michelle Andrews, “Be aware: Someone could steal your medical records and bill you for their care,” KFF Health News/NPR, Jul 31, 2023 READ IT HERE

Yet another scam to be on the lookout for: patient data breaches can lead to identity theft and bills in your mailbox for other people’s treatments.

*

Neeraj Sood & Jagpreet Chhatwal, “Congress can eradicate hepatitis C and reduce the deficit at the same time,” STAT, Jul 14, 2023 READ IT HERE

The authors praise Biden’s ask for $12 billion on Hep C to save in healthcare costs in the long run. The plan involves an indirect price negotiation mechanism in which the Feds put out a huge contract for bulk purchase of the expensive drugs, which is a backdoor way of recognizing that exploitative pricing by Pharma is blocking disease eradication. Currently, the cures still cost Medicare beneficiaries about $4,000 out of pocket. (Hep C is still mostly a baby-boomer disease although that’s changing.) Meanwhile, civilized countries like Egypt, Mongolia, and Rwanda have nearly eliminated it.

*

Umair Haque, “(Why) the death of the NHS is a parable of civilizational collapse,” Manchester Evening News, Jul 5, 2023 READ IT HERE

“We should be expanding institutions which care for us—but slowly, instead, they appear to be dying off.” System working as designed.

*

Drew A. Harris, “Black lung disease is making a comeback with coal miners,” New York Times, Aug. 2, 2023, READ IT HERE

“By the end of the last century, severe black lung had nearly been eliminated. But with changes in technology and conditions in coal mines in central Appalachia, cases are back to the highest level in decades.” Why? Lower safety standards. (Joe Manchin will be on this any day now.) The author is the medical director of a black lung clinic. “Countless miners have shared stories with me of employers hiding evidence of dangerous conditions. Miners described incidents of new and improved ventilation systems being temporarily put in place right before government inspectors came for quarterly visits.”

*

SINGLE PAYER LINKS #310

Posted 28 JULY 2023

*

Liran Einav & Amy Finkelstein, “Enough with the health care policy patchwork. It’s time for universal insurance,” STAT, Jul 25, 2023 READ IT HERE

A fascinating tale: “The United States enacted the world’s very first national, compulsory health insurance law. In 1798. No, that’s not a typo.” In fact, none other than Alexander Hamilton convinced Congress, barely a decade old, to enact a compulsory, tax-financed, health insurance program for commercial seamen. Sailors were nomadic; when they fell ill, they became a burden on port communities. To alleviate that, “whenever a U.S. ship arrived back from a foreign port, each ship owner had to deduct a tax of 20 cents per sailor per month at sea from the sailors’ wages and pay it to the customs agent who then transmitted this money to the federal government,” which then paid for the sailors’ care. The good old days of colonial single-payer!

*

Dave Muoio, “Dozens of studies paint private equity’s provider purchases in a negative light,” Fierce Healthcare, Jul 24, 2023 READ IT HERE

In case we needed yet more evidence of the nefarious role of private equity ownership of nursing homes, hospitals, and physician groups, a new meta-analysis confirms the higher costs and poorer quality outcomes. PE ownership is “unequivocally” linked to increased charges and associated with “lower staffing density and turnover.” The academic researchers found “no consistently positive effects of PE in healthcare,” which, given the model’s value-extraction methodology, surprised someone?

*

Paige Minemyer, “Docs urge Congress to step in as CMS proposes ‘biblical’ cuts to their payments,” Fierce Healthcare, Jul 17, 2023 READ IT HERE

The Biden administration wants to boost payments for primary care and, due to the “budget neutrality” straitjacket Congress imposed on itself, Biden proposed obtaining that cash by cutting specialty doctors’ fees. The AMA called for “a permanent solution that addresses financial instability.” No argument there. The weird “biblical” metaphor refers to the 7 lean years in the O.T. story of Joseph in Egypt. Doctor associations say they haven’t kept up with inflation in many years. Austerity and runaway healthcare costs occurring simultaneously—what is wrong with this picture.

*

Caroline Hudson, “How a recession could benefit a tight healthcare labor market,” Modern Healthcare, Jul 24, 2023 READ IT HERE

Paywalled, but the lede clearly outlines the idea: “For healthcare organizations, an economic downturn could bring some benefits, . . . reduced reliance on contract labor” and fewer demands for pay increases.

*

Mark Landler, “A national treasure, tarnished: Can Britain fix its health service?” New York Times, Jul 16, 2023 READ IT HERE

Does it want to? would also be a question. The British political class’s privatization recipe is familiar: starve the public sector, widely publicize the failings that result, present as a solution—private ownership! Final step: take money from the privateers for your next campaign and for think tanks propagating the “market solution” line. Rinse and repeat. One beef with this article: the authors say “simple fixes are impossible.” How about providing the NHS more money? This is not hard. Britain keeps finding $2 billion a year for a certain war.

*

BBC News, “Modern slavery gangmasters exploit care worker shortage,” Jul 25, 2023 READ IT HERE

Provider shortages in the U.K. enable human traffickers to cajole immigrants into employment deals that amount to slave labor. “The rise in calls [to help lines] about the care sector is because the government has made it easier for overseas social care staff to fill thousands of job vacancies” and can then be exploited by ruthless hiring firms. Victims are “extremely vulnerable” because anti-immigrant laws make it virtually impossible to seek relief from British authorities.

*

Richard Nieva, “Cigna sued over algorithm allegedly used to deny coverage to hundreds of thousands of patients,” Forbes, Jul 24, 2023 READ IT HERE

“The software system allows claim rejections without doctors ever opening patient medical records. Over two months last year, the company denied more than 300,000 claims, spending an average of 1.2 seconds on each claim.” Maximum efficiency! System working as designed!

*

Susanna Vogel, “COVID relief funds helped some hospitals soar to ‘all-time high’ operating margins,” Healthcare Dive, Jul 19, 2023 READ IT HERE

Some of the [Covid] support “may not have been necessary” as 75% of hospitals studied reported doing just fine during the epidemic. Some poorer hospitals needed the cash, but a lot of them didn’t, especially giant for-profit systems. The situation is highly reminiscent of the way charity-care payments are unfairly distributed, such as in New York State where hospitals with huge endowments and investment portfolios gobble up funds needed by safety-net hospitals. Meanwhile, the American Hospital Association continues to sing the blues about their members’ “extraordinary financial pressures.”

*

Dave Muoio, “Providers improperly collected $784M from a fund for uninsured COVID patients. Now, the government wants it back,” Fierce Healthcare, Jul 21, 2023 READ IT HERE

Nearly one-fifth of the money HHS paid out to hospitals for testing and treatment of Covid patients was “improper,” according to an internal audit because those patients either had independent insurance or were getting non-Covid-related treatments. Clawbacks may follow.

*

Emily Olsen, “States’ varying approaches complicate effort to determine impact of Medicaid redeterminations,” Healthcare Dive, Jul 13, 2023 READ IT HERE

Covid is over, time to get all those unworthy poor people off Medicaid! Only 2 million have been booted so far, but states are getting busy, following federal mandates to disenroll in bulk. Another 13 million are set to get the boot, based on early estimates—though some of those predictions have been off by 100%.

*

Ana B. Ibarra, “More than 220K people kicked off Medi-Cal in its first checkup since COVID,” CalMatters, Jul 21, 2023 READ IT HERE

The 225,0000 Californians who lost their Medicaid coverage have 90 days to fix their paperwork. All but 3% of those kicked off so far remained eligible. This article cites an estimate of 24 million liable to lose Medicaid nationwide, a significantly higher figure than I’ve seen elsewhere.

*

Jon Schwarz, “Senate committee passes potential first step to radically lower drug prices,” The Intercept, Jul 23, 2023 READ IT HERE

Perhaps the “first step” of a journey of 1,000 miles, but hope springs eternal, etc. The 17-3 vote is an encouraging albeit modest sign of consensus. It tosses a few coins ($3 million—couch lint in D.C.) toward a study of alternatives to the current system of drug development in which federal dollars pay for a lot of the basic research, after which Pharma moves in to scoop up obscene profits. “Money from the National Institutes of Health contributed to the development of every single one of the 210 new drugs approved by the FDA from 2010–16, providing a cumulative subsidy to the drug industry of $100 billion.” Moderna, for example, reaped $36 billion for its Covid-19 vaccine, which was developed mostly with government dollars. Do we really need to wait two more years for another study?

*

Eric Sagonowsky, “Novo Nordisk, Eli Lilly, and Boehringer Ingelheim back bill to bring obesity drug coverage to Medicare,” Fierce Healthcare, Jul 20, 2023 READ IT HERE

Lobbying gears up to get the government to pay for the fat pill. Current law says Medicare can’t cover it. Key (bipartisan) Pharma shills pushing the change are: Sen. Bill Cassidy (R-LA), Sen. Tom Carper (D-DE), Rep. Brad Wenstrup (R-OH), and Rep. Raul Ruiz (D-CA), joined by the American Diabetes Association, YMCA, and Weight Watchers. Even without Medicare, the fat pill peddlers can’t keep up with demand and “are investing billions to bolster their manufacturing capacity.”

*

Rebecca Robbins & Sheryl Gay Stolberg, “How a drugmaker profited by slow-walking a promising H.I.V. therapy,” New York Times, Jul 23, 2023 READ IT HERE

Gilead had a new version of its blockbuster HIV drug tenofovir and held it back for a decade as part of its “patent extension strategy,” as internal Gilead documents showed. The old version damaged patients’ kidneys and bones, but the company opted for keeping that one on the market as long as possible to maintain the gravy train. [Personal anecdote: I worked in the HIV field for 30 years and am still a member of the New York City’s HIV Planning Council. I repeatedly saw people soft-pedal or avoid criticizing Gilead and other Pharma players. There is so much Pharma money sloshing around the HIV industry that people don’t even realize how deeply they’ve been compromised to accept the unacceptable.] Good luck to the 26,000 plaintiffs who were harmed—may they extract billions from these gangsters.

*

Celine Castronuovo, “FTC pulls back from prior support for pharmacy benefit middlemen,” Bloomberg Law, Jul 19, 2023 READ IT HERE

FTC making it official: the old pass to pharmacy benefit managers (PBMs) is withdrawn. Previous statements about the alleged benefits of these neo-monopolies “no longer reflect current market realities.” The largest PBMs are co-owned with giant insurers control nearly 80% of the market. They are: Caremark (CVS), Express Scripts (Cigna), and OptumRx (UnitedHealth Group).

*

Emily Olsen, “FTC reaches proposed settlement with Surescripts in antitrust case,” Healthcare Dive, Jul 28, 2023 READ IT HERE

A company created a monopoly in “routing,” that is, sending prescriptions from your doctor to your pharmacy, then cranked up its charges. The FTC cried foul and has forced it to back down. Its 2019 complaint said Surescripts “had maintained a 95% share in both markets using threats and loyalty agreements that charged higher prices to customers that didn’t exclusively use its services.” After the FTC filed its complaint, Surescripts’ fees came down by 77%.

*

Federal Trade Commission, “FTC sues to block IQVIA’s acquisition of Propel Media to prevent increased concentration in health care programmatic advertising,” Jul 17, 2023 READ IT HERE

“Given the rampant consolidation across the pharmaceutical industry, it is critical that the market for health care product advertising remains competitive to ensure that patients and their doctors have access to high quality, affordable products.” Listen for more howls of outrage and attacks on FTC chief Lina Khan in the financial media. However, should we be tolerating “health care product advertising” in the first place? A separate question.

*

“FTC launches antitrust review of Pfizer’s $43 billion takeover of Seagen,” Competition Policy International, Jul 16, 2023 READ IT HERE

That purchase price is eye-popping. “The Pfizer-Seagen deal is being viewed as an indicator of the Federal Trade Commision’s attitude towards mergers and acquisitions amongst biopharmaceutical firms. It will likely set a long-term trend across the industry.”

*

Taylor Giorno, “Top 5 largest US pharma firms’ net earnings topped $81.9 billion last year: watchdog,” The Hill, Jul 24, 2023 READ IT HERE

Profits at the five top Pharma companies were up 10% in 2022. Eli Lilly, Johnson & Johnson, Merck, AbbVie, and Pfizer contributed to the loot with $4.4 billion in stock buybacks. While the drugmakers insist they need all that cash to find “innovative” medications, they spend more ($125 billion) on enriching shareholders than on R&D ($112 billion).

*

Dietrich Knauth, “Johnson & Johnson sues researchers who linked talc to cancer,” Reuters, Jul 13, 2023 READ IT HERE

Aggressive tactics against academics who bring bad news. J&J is also trying to force disclosure of the research participants’ identities—a highly unusual demand. OTOH, the expert doctors are vulnerable given their huge cash earnings for testifying in asbestos-related lawsuits against the company—around $3 million each.

*

Sarah Fentem, “BJC-St. Luke’s merger could mean hospital patients pay more, experts say,” St. Louis Public Radio, Jul 25, 2023 READ IT HERE

Barnes-Jewish Hospital and its new partner St Luke’s will now be the biggest conglomerate in Missouri with two dozen hospitals under one roof. As a “cross-market” merger, it’s tougher for federal regulators to say no. Hospitals used to seek consolidation within a city or region, but now they like mergers across geographic regions, which face fewer regulatory hurdles.

*

Heidi Evans, “Mount Sinai merges with owner of Beth Israel, St. Luke’s creating one of the nation’s largest not-for-profit health systems,” New York Daily News, Jul 17, 2023 READ IT HERE

Manhattan’s Beth Israel Medical Center, owned by Continuum Health Partners, will merge with Mount Sinai to create another giant. Continuum also owns St. Luke’s and Roosevelt Hospitals and the New York Eye and Ear Infirmary.

*

Matt Stoller, “How to forget the lessons of the pandemic,” BIG, Jul 28, 2023 READ IT HERE

Supply-chain issues: “Four days ago, Donald Trump went on YouTube and attacked the Biden administration for allowing medical shortages to get worse. ‘China produces 95% of all ibuprofen, 91% of hydrocortisone, 70% of all Tylenol, and nearly half of all penicillin.’ Trump is right.” The pandemic reminded us that it’s important to actually make things at home and to retain the knowledge and skills involved. It blew away the cultish faith in globalization and especially the wisdom of dismantling domestic industry and shipping it all to China. But, says Stoller, the Biden Administration’s response has been erratic and inconsistent, which encourages Wall Street vested interests to cry bloody murder and attack Biden’s own officials trying to compel changes. Trump also had anti-trust instincts (sometimes). But neither camp has FDR’s determination to confront elite power, to “reorganize our social hierarchy” and “displace the financial elite.” Of course not, the financial elites own them.

*

Gary Ruskin, “Did a Coca-Cola front group sway a WHO review of aspartame?” U.S. Right To Know, Jul 19, 2023 READ IT HERE

Artificial sweeteners are getting bad press. But the WHO’s Joint Expert Committee on Food Additives (JECFA), long infiltrated by members of a Coca-Cola front group, watered down the warning statement.

*

Muna Muday, “How Tennessee health care faces some of same challenges as sub-Saharan Africa,” The Tennessean, July 24, 2023 READ IT HERE

Comparing a state to the poorest regions of Africa must sting. “While the U.S. is a high-income country unlike Sub-Saharan Africa, we still face the same primary health care challenges.” But the author’s numbers don’t match his argument—yet. Tennessee is 44th among U.S. states for health outcomes, dead last for maternal mortality.

*

Elisabeth Rosenthal, “Your exorbitant medical bill, brought to you by the latest hospital merger,” New York Times, Jul 25, 2023 READ IT HERE

How hospital monopolies gouge patients: “[Mr X went to his longtime primary care doctor, now employed by Ballad, who sent him to an orthopedist’s office that had been purchased by Ballad. That doctor sent him to get an X-ray at a Ballad-owned facility, and then he was referred to a physical therapy center called Mountain States Rehab that was now owned by Ballad as well. Though none of the interventions took place in an actual hospital, all came with a hospital ‘facility fee.’ When the price of [physical therapy] doubled overnight, there was nowhere else to go in 29 counties of the Appalachian Highlands in Tennessee, Virginia, North Carolina and Kentucky.” Healthcare is now “the land of giants.” There are over 90 mergers and acquisitions per year; the FTC blocks about two. It’s too late to take the free market theory of healthcare competition seriously; even red states are looking for ways to directly rein in prices.

*

Slightly off-topic & fun!

READ IT HERE

SINGLE PAYER LINKS #309

Posted 21 JUL 2023

*

Liran Einav & Amy Finkelstein, “We’re already paying for universal health care. Why don’t we have it?” New York Times, Jul 18, 2023 READ IT HERE

Most health-financing articles that make it to the Times peddle tweaks to the current system. Not this one: “Incremental reforms won’t work.” “There is no shortage of proposals for health insurance reform, and they all miss the point.” “The only solution is universal coverage that is automatic, free, and basic.” Could it reflect a gnawing, post-Obamacare realization within a certain elite readership that the current approach is bankrupt? The authors recognize the obvious—that health insurance American-style is no guarantee against care-induced financial disaster and that complex entitlement programs don’t do the job. Their solution: “guaranteed basic coverage and the option for people to purchase upgrades” as you would on a budget airline. How did this slip through? Perhaps because the authors are economists and don’t use the term single-payer?

*

Reed Abelson & Margot Sanger-Katz, “Who employs your doctor? Increasingly, a private equity firm,” New York Times, Jul 10, 2023 READ IT HERE

PE now owns more than half of all U.S. specialists. In some cities, it’s a single firm gobbling up huge portions of the “market.” Unsurprisingly, costs for those services have spiked. The juiciest targets are gastroenterology, dermatology, and OB/GYN. Future targets: urology, ophthalmology, cardiology, oncology, radiology, and orthopedics. It all adds up to “a fundamental change in how medicine is being practiced in the U.S.,” according to a co-author of the cited study (read it here READ IT HERE

*

Sophy Ridge, “The NHS is ‘not serving its purpose’ and needs to ‘cooperate with private sector,’ says Tony Blair,” Sky News, Jul 16, 2023 READ IT HERE

Here’s Blair demonstrating once again that the two main British parties are in lockstep on turning the U.K.’s beloved NHS into a profit center for their respective friends. “cooperation” in this context meaning the NHS presents its bare neck on a stump to facilitate beheading by the privateers. “The truth is,” said Blair, “you’re not going to have a lot more money to spend,” eliding completely the long-standing austerity policies that created the financial shortfall and the long queues in the first place. These people are so predictable.

*

Paige Minemyer, “UnitedHealth execs dig into expectations for medical costs this year,” Fierce Healthcare, Jul 14, 2023 READ IT HERE

Reports on insurance company earnings can be so educational. Get a load of the language the Wall Street guys use when describing healthcare services: “One analyst asked the [UHC] leadership team during an earnings call if the increases in care use could be ‘self-inflicted’ as benefits packages have evolved.” Translation: why are you letting people spend so much of our money on healthcare? Can’t you stiff them more efficiently? Meanwhile, UHC merrily reported $5.5 billion in profit for Q2 of the year, “alongside double-digit revenue growth.”

*

Nick Corbishley, “The dark, shady past of Spain’s likely next prime minister, Alberto Núñez Feijóo,” Naked Capitalism, Jul 18, 2023 READ IT HERE

Spain is about to imitate Colombia this weekend by electing a creepy right-winger who is BFFs with a major narco. He’s also big on privatization of Spain’s excellent public health system: “[Núñez Feijoo’s] government in Galicia was an early pioneer in this area,” using the usual playbook of cutting the healthcare budget and causing waiting lists to soar. “The biggest beneficiaries of the systemic impoverishment and dismantlement of Galicia’s public healthcare sector have been large Spanish and foreign (mainly US) healthcare multinationals,” including Medtronic and Centene. Meanwhile, “Galicia quickly became the gateway for roughly 80% of all the cocaine that entered Europe.”

*

Rebecca Pifer, “FTC withdraws ‘outdated’ antitrust policy statements. Hospitals cry foul,” Healthcare Dive, Jul 18, 2023 READ IT HERE

The Federal Trade Commission keeps signaling to the monopolists that they will be under heightened scrutiny. The old guidelines are out of date, said the FTC, because the industry is evolving significantly and, it implies, not in a good way. So, no more free rides—now the hospital systems will have to justify their constant expansion and show why it won’t harm services and competition. The change should slow the frantic pace of industry concentration.

*

Irene Ly, “Budget cuts to the Federal Trade Commission will hurt kids and consumers,” Common Sense, Jul 13, 2023 READ IT HERE

Someone slipped a $50 million cut to the FTC budget into the big reconciliation bill in the House. The Senate could restore it. The Commission is now operating under a pay and hiring freeze, and head Lina Khan is a regular target of corporate smear pieces.

*

Dave Muoio, “Hospital M&A deal volume returns to pre-pandemic levels as systems seek out complementary services,” Fierce Healthcare, Jul 14, 2023 READ IT HERE

Hospital sector concentration is back to pre-Covid trends with 20 new M&A deals unveiled just in the second quarter of this year. The three largest are set to take place in California (Kaiser Permanente), Wisconsin, and Missouri.

*

Richard Van Noorden, “Medicine is plagued by untrustworthy clinical trials. How many studies are faked or flawed?” Nature, Jul 18, 2023 READ IT HERE

“Investigations suggest that in some fields at least one-quarter of clinical trials might be problematic or even entirely made up.” A British journal editor decided to scour all 500 manuscripts he received on randomized controlled trials (RCT), the supposed gold standard of medical research. He looked at the original participant data and found that nearly half had incorrect calculations and that 26% were simply untrustworthy. Usually though, reviewers and editors don’t have access to the raw data and have to trust the aggregate numbers provided by the authors and sponsors. Says one epidemiologist, “If you search for all randomized trials on a topic, about a third will be fabricated.”

*

Noah Tong, “Broader Leqembi coverage could burden Medicare, critics warn,” Fierce Healthcare, Jul 17, 2023 READ IT HERE

“If just 10% of people with Alzheimer’s take the drug, it would cost $17.8 billion.” Get ready for another rise in Medicare Part B premiums as desperate families rush to try the latest magic elixir that only promises to “moderately” slow cognitive decline. Leqembi is another infusion targeting beta-amyloid plaque build-up, a dubious theory of Alzheimer’s causation that will cost $26,500 a year, meaning those in traditional Medicare or Medicare Disadvantage plans will be on the hook for 20% or roughly $5,000. FDA approval was based on an RCT that showed a small improvement in the rate of cognitive decline. One expert called it “statistically significant and not meaningful. The patient won’t notice the difference; the physician won’t notice the difference.” But the drugmakers will notice a difference—in their corporate income: “Eisai and Biogen are poised to realize $12.9 billion in revenue from the drug through 2028.” The FDA’s expert panel approved it unanimously—perhaps because more skeptical reviewers quit after the Aduhelm debacle.

*

Abdullahi Tsanni, “We have a cure for hepatitis C—so why aren’t more people getting treatment?” STAT, Jun 29, 2023 READ IT HERE

Because, duh, the Pharma marketers priced it too high. “Only one 1 of 3 adults diagnosed with the disease have been cured since 2013 when those highly effective curative drugs were first approved.” The medications cost roughly $24,000 per course of treatment. Meanwhile, Hep C infections are surging by 15% a year nationwide.

*

James K. Glassman, “Health care providers are raking in profits by exploiting programs meant for the poor,” The Hill, Jul 17, 2023 READ IT HERE

The well-intentioned 340B program was supposed to help struggling nonprofits serving poor clients and was quickly exploited by the giants for free money. “[Clinics] have a huge incentive to leverage the flawed structure to resell as many discounted drugs as possible to insured patients, not the low-income, uninsured Americans who were supposed to be the beneficiaries.” Almost all the 80,000 pharmacies that benefit from the program are part of the three mega-chains: CVS, Walgreens and Wal-Mart. Pharma is fine with it because they don’t have to discount their products—the Feds pay full price.

*

Jaymie Baxley, “New DHHS numbers show more people losing Medicaid than anticipated,” North Carolina Health News, Jul 19, 2023 READ IT HERE

North Carolina began kicking Medicaid participants off the rolls as the Covid emergency ended, including some who remain eligible for it. So far in NC, 35,000 people have lost coverage, 85% of them for “procedural reasons,” like not being reached when the caseworker called for information. Potentially, 600K beneficiaries could be axed, double the original estimates.

*

Joseph Choi, “J&J joins legal fight against Medicare drug price negotiation,” The Hill, Jul 18, 2023 READ IT HERE

Drugmakers let loose a “deluge” of lawsuits to block any attempts by the government to dare to negotiate over prices. As usual, Pharma argues that their insane profits are necessary to protect “innovation” while spending vast sums on advertising. This tiny little step toward reining in costs will be resisted tooth and claw.

*

Bobby Harrison, “AG Lynn Fitch wants to make info on out-of-state abortions available to Mississippi authorities,” Mississippi Today, Jul 13, 2023 READ IT HERE

Amazing how the righteous defenders of the citizenry against intrusive public health measures are simultaneously eager to snoop into women’s medical records. This is a challenge to HIPAA privacy terms to enable anti-abortion prosecutors to reach across state lines for medical data. Return of fugitive slaves was not part of the request.

*

Annika Kim Constantino, “Obesity drug maker Versanis to be bought by Eli Lilly for $1.9 billion,” CNBC, Jul 16, 2023 READ IT HERE

Next blockbuster/gold mine in the Pharma world: fat pills. Analysts say the market could pull in $100 billion given the estimated 40% of all U.S. adults who qualify as obese.

*

Meg Tirrell, “European regulator expands investigation into risks of suicidal thoughts in users of popular weight-loss medications,” CNN Health, Jul 12, 2023 READ IT HERE

European regulators are looking into 150 reports of suicidal thoughts among patients taking popular drugs for weight loss. Ads for the fat pills will show slim models untouched by any of that.

*

SINGLE PAYER LINKS #308

Posted 14 JULY 2023

Hi everyone,

These LINKS are shorter than usual as I was stranded by my airline after a flight cancellation and had to wander around a city where I don't know anybody for 48 hours. I do not want to go anywhere ever again for the rest of my life. --Tim

*

Dave Muoio, “The top 10 nonprofit health systems by 2022 operating revenue,” Fierce Healthcare, Jun 20, 2023 READ IT HERE

A hefty data dump from the strange world of the “nonprofit” mega-corporations that dominate healthcare in key cities and whole regions: Despite the “worst financial year since the start of the pandemic,” these Godzillas are unlikely to suffer more than temporary red ink. Although many had negative operating margins in 2022 (those traveling nurses were expensive!), operating revenues for them as a group continued to rise, up 5% from 2021 to 2022 after a 15% increase the previous year. Relentless cost increases are setting up these businesses to do fine in the future once the pandemic-related difficulties end. And the portfolio losses on their Wall Street investments are only temporary. There’s fascinating detail here, starting with the numbers for industry leader Kaiser Permanente:

2022 total operating revenue: $95.41 billion

2021: $93.14 billion

2020: $88.73 billion

While Kaiser lost money in 2022, the future forecast is “sunny and clear.” Meanwhile, Kaiser announced its intention to go national by acquiring a 10-hospital chain in Pennsylvania. A good view of our healthcare non-system from within its logic as capitalist enterprise.

*

Caroline Catherman, “Florida is taking sick kids off Medicaid months before planned,” Orlando Sentinel, Jun 28, 2023 READ IT HERE

True to form, Florida immediately started dumping Medicaid beneficiaries off the program as soon as the Covid emergency was lifted. About 300,000 residents were purged in April and May.

*

Katy Golvalam, “Most CT residents enduring Medicaid ‘unwinding’ keep coverage,” CT Mirror, Jul 12, 2023 READ IT HERE

OTOH, a state that wants to keep as many people as possible on Medicaid can do so. CT hired 100 new staff to manage the paperwork and to walk people through their eligibility renewals. Three-quarters of beneficiaries held onto their coverage, but 62,000 CT residents lost theirs, the great majority because they “did not update their personal information as the application process requires.” Some of those went back to work and are now too wealthy to qualify given those $1-an-hour raises at Wendy’s. Connecticut seems to be doing the best it can under a punitive system.

*

Noah Tong, “Federal inquiry aims to protect consumers against predatory medical debt and collection practices,” Fierce Healthcare, Jul 11, 2023 READ IT HERE

None too soon: the Consumer Financial Protection Bureau (CFPB) is moving against the latest horrible new thing, patients lured into “medical credit cards and installment loans,” often before getting the medical care they seek. “Financial firms are partnering with healthcare players to push products that can drive patients deep into debt,” said the agency. Usurious interest rates, typically 27%, are a feature of these cards, which also let hospitals and providers off the hook for charity care or the need to offer reasonable payment plans. In addition, hospitals sometimes get a cut from the cash extracted by the finance companies that issue the cards. Kill it with fire.

*

Chris Deacon, “Hospitals’ latest ‘innovation’: ‘patient-centric payment capabilities,’” Healthcare Un-covered, Jul 7, 2023 READ IT HERE

Here’s some euphemistic language to get around saying, “Pay first, or die.” Hospitals are now using their electronic records not just for billing but also to dun you in advance. This “patient-centered financial engagement” starts with the health portal you’ve innocently signed up to. It sticks you with advance bills or, failing that, politely inquires “if they want to speak to an employee prior to arriving.” Or to avoid having to spend staff wages on that conversation, you could be shoved over to San Antonio-based Baptist Health System’s “interactive, voice response-based phone system to nudge patients.” That’s a great reason to refuse to enroll in MyChart or any other of those robotic bill-collectors. And here in New York City, our public hospital umbrella agency H+H created a new collection process to engender a “change in culture so people now know to expect a financial conversation every time they come in.” No wonder providers are leaving the industry in droves.

*

Heather Landi, “What CVS’s exit from clinical trials means for other retail players,” Fierce Healthcare, Jun 23, 2023 READ IT HERE

Walgreens, Walmart, and Kroger all have “community-based” drug trial businesses, a reflection of the recent attention to the lack of diversity in the testing of pharmaceuticals. The drugstore chains are positioned to recruit non-white participants because they’re located in disadvantaged areas and can “leverage patient and customer relationships.” Participating in clinical trials isn’t necessarily bad though one would like to see something about scientific goals in these write-ups rather than the relentless concentration on “big opportunities to grow their business in healthcare.” CVS is dropping out of the game as it concentrates on its huge investments in primary care and its expansion in Medicare Disadvantage.

*

Aaron Birnbaum & Matthew Makansi, “The staggering financial burden of giving birth—even with insurance,” STAT, Jun 23, 2023 READ IT HERE

One out of five new mothers ends up with an unpaid bill. “Privately insured families pay on average about $3,000 for maternal and newborn hospitalizations.”

*

Susanna Vogel, “DOJ charges dozens in multiple states for $2.5 billion healthcare fraud,” Healthcare Dive, Jun 29, 2023 READ IT HERE

Over telemedicine scams that are hard to detect: “Rampant fraud has proven difficult to curtail despite federal and state agencies’ efforts to identify and remove bad actors from the industry.”

*

Daniel Fishel, “Health insurance claim denied? See what insurers said behind the scenes,” ProPublica, May 10, 2023 READ IT HERE

Another useful compilation of how to suit up for a fights no one should have to engage in: “When a health insurance company is deciding whether to pay for your medical treatment, the company generates a file around your claim. All the records associated with your case should be part of your file. This includes documents explaining the reasons your claim was denied. You have a right to see this file.” Of course, insurers will do everything possible to not tell you this. NB: a claim file request is not the same as an appeal; sometimes, you should ask for the former first.

*

Robert Faturechi, “The biotech edge: How executives and well-connected investors make exquisitely timed trades in health care stocks,” ProPublica, June 22, 2023, READ IT HERE

A new trick for cheating on Wall Street: buying stock or options in a rival company based on what you know about your own. It’s still illegal but harder to detect.

*

Dave Muoio, “FTC floats changes to merger review process that could slow down deal-approval timelines,” Fierce Healthcare, Jun 28, 2023 READ IT HERE

The newly awakened Federal Trade Commission is going to ask for more granular detail from hospitals or other health-related entities seeking to gobble up smaller fish and increase anti-competitive concentration. Expect howls of outrage about the number of new hours of paperwork required from these multi-billion-dollar corporations. (Republicans just pilloried FTC chief Khan in Congress this week.) The form to be updated is 45 years old, and commissioners noted that times have changed: “Deal volume has soared. Transactions are increasingly complex. Investment vehicles have also changed. Against the backdrop of these vast changes, the information currently collected is insufficient for our teams to determine whether a proposed deal may violate the antitrust laws.” They also noted “unreported acquisitions” by tech giants such as Apple, Amazon, Google, and Microsoft.

*

SINGLE PAYER LINKS #307

Posted JUN 23, 2023

*

Caitlin Owens, “Pharmaceutical lobbyists challenge Biden’s drug law in friendly territory,” Axios, Jun 22, 2023 READ IT HERE

Because of course they did, and of course they chose the Texas 5th District. Delay, delay, sidestep overwhelming popular pressure, thumb your nose, enjoy the yacht.

*

Mariah Taylor, Ashleigh Hollowell & Giles Bruce, “Hospitals will be ‘rare exception’: What healthcare will look like in 100 years,” Becker’s Hospital Review, Jun 8, 2023 READ IT HERE

They asked hospital admin types what medicine will be like 100 years from now, assuming facts not in evidence, i.e., that we’ll still be here. If so, consider the lovely scenarios these plutocrats imagine for us: “Healthcare and well-being will be personalized to the extreme. . . every human will be fully sequenced at birth. . . real-time monitoring based on a variety of sensors, worn or implanted. . . fixed diagnostics devices in homes and other locations. . . Surgeries, if required, will be performed by AI-enabled robots.” Can’t wait!

*

Bob Herman, “‘It’s beyond unethical’: Opaque conflicts of interest permeate prescription drug benefits,” STAT, Jun 20, 2023 READ IT HERE

Paywalled, but a large excerpt is accessible describing this year-long investigation into a new scam: Big employers hire consultants to get good deals on costly pharmaceuticals as part of their insurance packages for employees. But according to this exposé, the consultants conspire with PBMs to rip off the corporate marks. “Some consulting firms often are getting paid more—a lot more—by the PBMs and health insurance carriers that they are supposed to scrutinize than by companies they are supposed to be looking out for.” Another sleazy practice for congressional oversight committees to delve into since they’re already investigating PBMs. If Pharma, hospitals, and insurance company Godzillas combine to gang up on this lone King Kong, perhaps we’ll see some progress.

*

Sandeep Jauhar, “Bloated patient records are filled with false information, thanks to copy-paste,” STAT, Jun 20, 2023 READ IT HERE

“I recently took care of a patient whose medical records included multiple notes about her past open-heart surgery. Only she had never undergone open-heart surgery. She was being prepared for an invasive procedure based on this misinformation.” If the main purpose of electronic records is to maximize billing, crazy outcomes like this error should surprise no one. But AI will solve everything, right? “A narrative element is often missing in medical charts today as chunks of information are pasted haphazardly into notes. Narratives humanize patients, who, despite what modern electronic medical records may suggest, are not disconnected lists of copied and pasted facts.” Ah, but for the payment system, that’s exactly what we are.

*

Rebecca Pifer, “US health spending to surpass $7T by 2031, CMS actuaries say,” Healthcare Dive, Jun 15, 2023 READ IT HERE

“By 2031, about $1 of every $5 spent in the U.S. will be on healthcare.” Beyond nuts and unsustainable.

*

Kay Tillow, “Why are corporate healthcare fraudsters being handed ‘Get Out of Jail Free’ cards?” Common Dreams, Jun 19, 2023 READ IT HERE

Because the Center for Medicare and Medicaid Services (CMS) grants venture capital, private equity, and health insurance entities “fraud and abuse” waivers so that they can violate anti-corruption laws without penalty—another sign of our gallop toward banana republic status as hypocrisy (“the compliment vice gives to virtue”) cedes the field to open theft. The waivers go to participants in the ACA-created Innovation Center programs that were supposed to explore ways to save money and improve care. They turned out to be mostly Medicare privatization schemes (quel surprise!). “The models are neither saving money nor improving care, but the Innovation Center has $10 billion dollars to spend each decade and keeps churning out new models.” (Tillow: coordinator of the All Unions Committee for Single Payer Health Care.)

*

Sharon Begley, “The maddening saga of how an Alzheimer’s ‘cabal’ thwarted progress toward a cure for decades,” STAT, Jun 25, 2019 READ IT HERE

Research for a cure to Alzheimer’s disease has a miserable record. Begley argues that the obsessive focus on the beta-amyloid theory of causation means other promising lines of inquiry have been sidelined. That monopoly continues to this day—the FDA just approved a costly medication based on it. Anyone with dissident ideas saw their research careers sidetracked. Worth a read for anyone considering putting their relative on the new non-wonder drugs.

*

Jason Karlawish, “The FDA needs a risk evaluation and mitigation strategy for Alzheimer’s drug lecanemab,” STAT, Jun 16, 2023 READ IT HERE

Dr Karlawish “has been a site co-investigator on clinical trials sponsored by Biogen, Eisai, and Lilly,” so we can safely assume he’s on board with the new Alzheimer’s drugs he studied (at $25K a year per patient). But he’s worried that the costly new treatments will attract negative publicity because of vague and hard-to-define outcomes and little things like brain swelling, a common side effect. “In the months after the drugs are approved, news organizations will recount the sad stories of patients who received a prescription that was neither reasonable nor necessary. They were prescribed the drugs following sloppy diagnoses and went on to suffer risks that weren’t properly mitigated.” And this is after we accept the (dubious) proposition that Alzheimer’s is caused by beta-amyloid build-up. But Medicare will spend billions on this experiment.

*

Ryan Cooper, “How Big Pharma rigged the patent system,” American Prospect, Jun 6, 2023 READ IT HERE

Patent abuse: pharmaceutical companies file “dozens or even hundreds of patents on the same drug,” averaging 74 applications per med, “to create a huge legal deterrent to any generic or biosimilar competitors who might attempt to enter the market when the original patent expires.” Hardly news but bears repeating. “All this outrageous price-gouging is a major reason why American health care is so expensive.”

*

Peter Sullivan, “Drug patent reforms set off Senate tug of war,” Axios, Jun 12, 2023 READ IT HERE

We all know about abuses of the patent system [see above]. Now try to do something about it in the face of the Pharma lobby with unlimited resources. Interestingly, the PBM King Kongs like the idea of clipping Pharma’s wings. “Putting a stop to drug companies’ common and egregious, anti-competitive abuses of the drug patent system” is a great idea, said PBM’s chief flak while Pharma thinks Congress should beat up on PBMs. Nothing bad can come of mutual hate from the megas.

*

Aaron E. Carroll, “I studied five countries’ health care systems. We need to get more creative with ours,” New York Times, Jun 13, 2023 READ IT HERE

The author dives into healthcare systems in Britain, France, Australia, New Zealand, and Singapore and has interesting things to say. However, he shows his priors on single-payer with a throwaway comment: “Canada performs almost as poorly as we do in many international rankings.” Hold it right there: did you include medical bankruptcy in that assessment? How about annual deductibles of $18,000 per family? I’d guess not. Given that set of blinders, it’s hard to wade through his detail about these alternative models. “Universal coverage matters, not how we get there,” he says, missing the point about what exactly constitutes “universal.” Am I “covered” if I can’t afford to use my coverage? Or am driven into penury afterward?

*

Lev Facher, “White House ‘naloxone summit’ omitting prominent advocates for lower costs,” STAT, Jun 15, 2023 READ IT HERE

The grassroots groups who made naloxone part of the debate about overdose deaths were excluded from a big White House powwow in favor of the manufacturers whose price-gouging is making overdose reversal too expensive for mass use. Nicely played, corporate America! The activists open the door, and you walk through it to pick up the cash. Even in corrupt Washington, this is gruesome. “Remedy Alliance and the organizations we work with came up with community-based naloxone distribution!” said one non-invitee. Keeping us out “conveys a fundamental misunderstanding of how community-based naloxone distribution should work.” But it conveys an excellent understanding of how to help your corporate donor friends cash in. “Naloxone manufacturers have taken heat in recent years for hiking prices and for introducing new, high-priced products to the market,” which are not superior to the cheaper products but provide for tidy cash flows from state and local health departments—especially if you have a corruptible purchasing agent in a key position.

*

Shira Fischer, “Your health insurance may not be as good your state requires—and it’s perfectly legal,” STAT, Jun 9, 2023 READ IT HERE

If your employer is “self-insured,” they don’t have to meet state minimum requirements for policies. That means a state can mandate coverage for birth control while the company, governed by federal rules, can legally refuse to provide it.

*

Wendy Dean & Simon Talbot, “How the conversation about moral injury in health care is changing,” STAT, Jun 7, 2023 READ IT HERE

Distinguishes moral injury from simple “burnout” by examining the long-term impact on providers when they can’t practice medicine adequately. The authors call it the “frustration, anger, and disorientation associated with existential threats to our professional identity [as healthcare providers] as corporate interests undermine the oaths we swore to put our patients’ needs first.” That’s not the same as working too many hours.

*

Lynn Parramore, “ER doctor: ‘Private equity in medicine is dangerous to patients,’” Institute for New Economic Thinking, Jun 22, 2023 READ IT HERE

The PE-driven transformation of U.S. health care continues as the moneybags continue their massive shopping spree, turbocharged by Covid: 2022 broke all records as PE snapped up 1400 health care companies for $206 billion. “PE acquisitions of medical practices result in more lengthy and costly care for patients as well as reduced access to services.” And more moral injury, too.

*

Emily Olsen, “Medicare Advantage overpayments could exceed $75B this year, study finds,” Healthcare Dive, Jun 14, 2023 READ IT HERE

Not fraud but the common practice of MA plan managers to seek out healthy clients who won’t cost them much. Such “favorable selection” practices were thought to bring in around 6% more cash through upcoding and “quality” bonuses—this study says it’s more like 14%. Curiously, the moaners and doomsayers who worry us about Medicare-induced bankruptcy rarely want to zero in on this costly abuse.

*

Dave Muoio, “HCA Healthcare accused of pushing patients toward end-of-life care to boost performance metrics,” Fierce Healthcare, Jun 21, 2023 READ IT HERE

The 182-hospital conglomerate is “encouraging staff to transition more patients to palliative and end-of-life care, thereby increasing churn and boosting hospital quality scores.” When patients die off-site, it helps the hospital’s mortality stats, which “are directly linked to the incentive payment calculations of top executives and hospital administrators.”

*

SINGLE PAYER LINKS #306

Posted 16 JUN 2023

*

Rachel Cohrs, “With Fat Joe concerts and Super Bowl ads, a cadre of billionaires is mounting an unorthodox campaign against hospitals,” STAT, May 25, 2023 READ IT HERE

Big money is behind new pressure on hospitals to force price disclosure. All of a sudden, they hate billionaires! The philanthropists are buying Super Bowl ads, staging concerts with big rock stars, and financing advocacy groups to get hospitals to cough up the numbers. Seems to be working: one hospital lobbyist complained that “because of their unlimited pocketbook and vast resources, they have flooded the field.” So unfair.

*

Sarah Kliff & Jessica Silver-Greenberg, “Nonprofit health system pauses policy of cutting off care for patients in debt,” New York Times, Jun 9, 2023 READ IT HERE

Hospital Godzilla Allina Health got shamed by the Times for its habit of refusing care to people with unpaid bills and backed off some of its Dickensian policies—for now. “I hope this is not just a temporary pause until the heat is off,” said one doc. Allina avoided roughly $266 million in state, local and federal taxes in 2020 due to its “nonprofit” status.

*

Frank Diamond, “For providers, consolidation may be key to staying afloat, experts tell senators,” Fierce Healthcare, Jun 9, 2023 READ IT HERE

More concentration in the various arms of the healthcare industry is leading to. . . more concentration. “For those that want to stay independent, watching their peers unite can be intimidating.” Three quarters of the country’s 129K physicians now work for a hospital, an insurance company, or some other corporate entity. “When corporate hospital systems acquire physician practices, the prices they charge grow by an average of 14%.”

*

Lindsey Bever, “9 tips to help you negotiate a medical bill,” Washington Post, May 15, 2023 READ IT HERE

The fact that we should have to read an article like this is outrageous, but here goes: (1) Understand how medical codes work, especially if your condition is unusual or ill-defined like Lyme disease; (2) Get pre-authorization for tests, procedures, and don’t settle for verbal assurances—ask for a letter or at least a reference number; (3) If it was covered in the past, push to get it covered again, that is, keep calling and bugging them; (4) Protect yourself from out-of-network costs by writing in advance of procedures to insist on in-network providers (sheesh); (5) Get an itemized bill with procedure codes; (6) Loop in your health-care provider; (7) Consider an appeal but start with phone calls; (8) Enlist help from a patient advocate—but first ask them what they charge; (9) Take advantage of financial assistance. “Each situation—and each medical bill—is different and requires its own approach to solve,” says a company that can help you slog your way through this jungle—and also shouldn’t exist.

*

Wendell Potter, “Amid Congressional PBM scrutiny, CVS/Aetna CFO assures investors of continued profits, even at expense of employers and taxpayers,” Health Care Un-covered, Jun 8, 2023 READ IT HERE

Potter, a former insurance industry PR guy, knows where the bodies are buried. “A few days ago at CVS headquarters, the company's chief financial officer told investors not to worry” about politicians’ plans to rein in pharmacy benefit managers (PBMs). If Congress cramps our profits in one way, we’ll find another, said the exec, given the huge importance of PBM profits to overall corporate earnings. “CVS’s PBM, Caremark, now contributes more to CVS’s total revenues than either Aetna, the big insurance company it bought in 2018, or the company’s 10,000 retail stores.” That’s pretty amazing, and we can assume it’s also true at the other two major PBMs owned by giant insurers, Cigna’s Express Scripts and UnitedHealth’s Optum RX.

*

Sydney Halleman, “Insurers report stable performance amid industry headwinds, but cost pressures loom,” Healthcare Dive, Jun 7, 2023 READ IT HERE

Despite inflation and high staffing costs, “the financial performance of the seven largest [commercial] insurers remains stable.”

*

Kayuanna Quach, “Healthcare org with over 100 clinics uses OpenAI’s GPT-4 to write medical records,” The Register, Jun 8, 2023 READ IT HERE

“Robodoc will see you now. Retrieve your medication below.”

*

Jude Karabus, “Criminals spent 10 days in US dental insurer’s systems extracting data of 9 million,” The Register, May 31, 2023 READ IT HERE

Criminals got private info on millions of people, including poor families and their kids during a hack into Managed Care of North America (MCNA). A tad light on the “managed” part? The Medicaid data stolen included “patients’ full names, dates of birth, addresses, telephone numbers, email addresses, Social Security numbers, driver's license numbers, and health insurance information. Parents were offered advice on how to deal with the possibility that their child’s identity was now in the hands of a criminal gang. But don’t worry about AI-driven healthcare!

*

Emily Olsen, “HHS offers aid amid Medicaid redetermination coverage losses,” Healthcare Dive, Jun 13, 2023 READ IT HERE

Exasperating: HHS will help states to kick people off Medicaid more humanely and properly. Targeted outreach, aid with filling out forms, help with the subsidized exchanges for the newly ineligible—all patches to deal with something that shouldn’t happen in the first place. One million beneficiaries already have been expelled from Medicare since April. HHS secretary Becerra: “Nobody who is eligible for Medicaid or the Children’s Health Insurance Program should lose coverage simply because they changed addresses, didn’t receive a form or didn’t have enough information about the renewal process.” Delete everything after “should lose coverage,” and you’re good.

*

Susanna Vogel, “Expanded federal safety net during COVID led to improved health access for adults, report finds,” Healthcare Dive, Jun 13, 2023 READ IT HERE

Covid emergency measures, which helped 18 million Americans get Medicaid, led to “less difficulty paying medical bills and less [loss of] needed medical care due to costs,” which especially benefited Black and Hispanic adults. But the faux “debt ceiling” theatre helped Biden dump the working poor from the program in exchange for all the Ukraine money he wanted.

*

Michelle Andrews, “Lawyer fees draw scrutiny as Camp Lejeune claims stack up,” KFF Health News/States Newsroom, May 17, 2023 READ IT HERE

Anyone who watches TV will have seen a flood of commercials begging veterans to contact personal injury law firms with big dollar signs in their corporate eye sockets. But, “some veterans’ advocates worry that families who have already suffered from toxic exposure may get shortchanged” because lawyers’ fees could take half of their eventual awards. Lawyers already have spent over $100 million on the ads, so they obviously know something. As usual, the grotesque spectacle spotlights the perverse way we handle environmental (as well as iatrogenic) harm—in a sane system, those huge medical bills wouldn’t exist in the first place. Because vets will have to first repay whatever medical and disability benefits they’ve already received from their settlements, some could end up owing money while their lawyers walk away with huge fees.

*

Charlie Katebi, “Indiana leads the way in tackling health-care costs,” City Journal, May 16, 2023 READ IT HERE

The author from the right-wing Manhattan Institute lauds Indiana’s approach to containing healthcare costs because that state promotes marketplace competition. But the article says nothing about that; instead, it discusses the state (and a similar federal) push for site-neutral payments so that hospitals can’t pretend that outpatient procedures are actually occurring within their walls and charge triple for them. Fair enough. But Indiana has unusually high healthcare costs driven by widespread hospital consolidation into six “powerful regional monopolies.” How does the Manhattan Institute figure that this a competitive market?

*

Kelsey Bolar & Judy Pino, “When the charge for Tylenol is $4,000, it’s clear the U.S. health system is failing us,” Miami Herald [opinion], May 31, 2023 READ IT HERE

The authors advocate greater “price transparency,” which is reasonable but hardly a game-changer. The Trump-era Hospital Price Transparency Rule should inhibit hospitals from charging $23 for a Q-tip, but they do it anyway, and patients have to slug it out with them. Despite the new regulation, “hospital lobbyists and special-interest groups have fought to keep patients confused and in the dark,” largely with success. To think, as the authors do, that transparency in the price of healthcare products and services is a “simple solution to lack of affordability” is delusional.

*

Dulan Lokuwithana, “Billions of dollars at stake as FDA shortcut allows half-proven drugs,” Seeking Alpha, May 21, 2023 READ IT HERE

The FDA will give drug developers a shortcut known as “accelerated approval,” which lets them market their products while results are still iffy. The shortcut, stimulated by the AIDS epidemic, is worth billions to companies that then have to promise solemnly to conduct further tests. Unsurprisingly, these studies drag on for years. “In December, Congress passed legislation that required developers to have confirmatory clinical trials underway at the time of approval.” Stand by for Pharma to scream bloody murder.

*

Estelle Willie, “Four communication lessons we learned the hard way during the pandemic,” STAT, June 6, 2023 READ IT HERE

Completely wrong from start to finish. Her lesson #1 is “Don’t assume science is enough.” How about, “Don’t lie to the public with fake science that you made up”?

*

Scott Bauer, “Wisconsin Republicans block meningitis vaccine requirement for students,” Associated Press, Jun 7, 2023 READ IT HERE

Aftermath of the sustained bamboozling that went on during Covid. Tragic and predictable. Health communication rule No. 1: don’t lie.

*

William B. Feldman & Aaron S. Kesselheim, “How the makers of inhalers keep prices so high,” Washington Post [opinion], June 1, 2023 READ IT HERE

Through anti-competitive practices and patent manipulation. “The market for inhalers has become so lucrative that the tobacco giant Philip Morris International recently purchased an inhaler device manufacturer to treat the very disease the company helped create.”

*

Brian Mann, “A landmark appeals court ruling clears way for Purdue Pharma-Sackler bankruptcy deal,” NPR, May 30, 3034 READ IT HERE

Sacklers win a get-out-of-jail-free card in exchange for a cash payout to states and municipalities and $750 million to victims’ families. The innovation is that they used bankruptcy law to protect themselves without actually declaring bankruptcy. Companies that pollute and otherwise destroy lives must be watching the ruling with interest. (It only applies—so far—to New York, Connecticut, and Vermont, so we’ll see.)

*

David J. Hass, “Healthcare deserts in CT are unacceptable: Raise Medicaid rates now,” CT Mirror, May 31, 2023 READ IT HERE

Surprising: Connecticut ranks 47th in retaining the physicians who train there. The author says one reason is that “Medicaid reimbursements for many physician specialists have been frozen at 57.5% of the 2007 rates.” The Medicaid doctor pool then shrinks, leading to more ER visits, higher costs, and less enthusiasm to increase reimbursements—rinse and repeat. Medicaid expansion can’t work if there aren’t enough providers. [P.S. I’m very interested in CT and what gives there—please send links, seminar alerts, or whatever.]

*

Megan Messerly, “Minnesota wanted to curb health spending. Mayo Clinic had other ideas,” Politico, May 30, 2023 READ IT HERE

Minnesota wanted to rein in healthcare costs; then, the Mayo Clinic threatened to hold up billions in new investments. Guess who won? “Following Mayo’s threat, Minnesota lawmakers scaled back their proposal to establish a health care affordability board that would have had the power to fine hospitals, doctors, and insurers for out-of-control cost growth.” Perversely, cost increases mean the healthcare Godzillas get even more powerful.

*

Robert Benincasa & Nick McMillan, “Many people living in the ‘Diabetes Belt’ are plagued with medical debt,” KFF Health News/NPR, May 30, 2023 READ IT HERE

In half of the 644 mostly Southern counties where rates of diabetes are high, medical debt rates hover around 20% of the entire population, compared to the national average of 13%. Most are in Medicaid non-expansion states making sure those lazybones don’t get any free stuff.

*

Jim Mustian & Joshua Goodman, “DEA’s failure to punish distributor blamed in opioid crisis raises revolving door questions,” Associated Press, May 24, 2023 READ IT HERE

Grotesque revolving-door corruption at DEA: “After temporarily leaving the DEA in 2017, [Principal Deputy Administrator Louis] Milione immediately went to work as a consultant for some of the same companies he had been tasked with regulating.” And didn’t: he allowed them to keep shipping opioids for years after a judge told the DEA to crack down. How many drug users are in the slammer for doing 1/1000th of this damage?

*

Kaitlin Sullivan, “Weight loss drugs can lead to muscle loss, too. Is that a bad thing?” NBC News, May 20, 2023 READ IT HERE

Not if there are fortunes to be made selling them, to judge from this article. All the “experts” cited are either Pharma reps or on the drugmakers’ dime. To her credit, the reporter at least takes note of that fact.

*

Cara Korte, “Ozempic side effects could lead to hospitalization—and doctors warn that long-term impacts remain unknown,” CBS News, Jun 10, 2023 READ IT HERE

An endocrinologist says “at least 10%” of people getting the fat jab have to stop because of side effects like constant nausea, diarrhea, constipation, and abdominal pain. Then there are the less common down sides: “thyroid tumors, pancreatitis, hypoglycemia, gallbladder issues, kidney failure, and cancer.” But you’ll be thin!

SINGLE PAYER NEWS #305

Posted 9 JUN 2023

*

[No link yet] Students for a National Health Program (SNAP) just announced that their resolution to the student section of the AMA calling on that body to drop its decades-long opposition to single-payer health care has passed unanimously. Encouraging!

*

Tina Reed, “More states embrace drug price boards to curb health costs,” Axios, Jun 6, 2023 READ IT HERE

In the face of lame or non-existent federal efforts, some states are seeing what they can do independently to push down drug costs through state regulatory bodies. Maryland has taken the lead while Colorado and Washington are considering action. Several other states have pharmacy “advisory boards” with no real power to control payments.

*

Deidre McPhillips, “Drug costs lead millions in the US to not take medications as prescribed, according to CDC,” CNN, June 2, 2023 READ IT HERE

Including 1.3 million diabetics who ration their insulin.

*

Heather Landi, “Home health bidding wars heat up: Optum makes $3B unsolicited offer for Amedisys,” Fierce Healthcare, Jun 5, 2023 READ IT HERE

Behemoths scramble to hoover up a home health and hospice firm, “provider of post-acute care and infusion services,” indicating that someone knows where the next big payoff is. Insurance giant UnitedHealth Group recently spent $5.4 billion to absorb another home health outfit and is now angling for this one by offering a juicy 26% premium over a rival’s offer. The move is part of a national trend toward vertically integrated health monsters. Currently, “in-home care is provided by thousands of organizations nationwide, with no single participant having more than a single-digit percentage share,” which makes it a ripe target for consolidation.

*

Dan Crawford, “Small town and rural hospitals are at risk of closing due to funding,” Angry Bear, Jun 7, 2023 READ IT HERE

Struggling rural hospitals are often bought up by the giants, which then close them down entirely, forcing people to travel long distances for care. But the blame is often placed on low Medicare/Medicaid reimbursements, which isn’t necessarily true. Private payers are not covering the cost of rural care, which is higher than in high-volume, urban settings. “A small rural community will have fewer ED visits than a larger community simply because there are fewer residents, but the minimum cost of staffing the ED on a 24/7 basis will be the same, so the average cost per visit will be higher.” A market-based system cannot address this disparity. Will the overwhelmingly Republican pols who represent the 600 rural communities whose hospitals are at risk see the light? North Carolina’s experience suggests they might. (See graphic at bottom in which New York State joins the Confederacy.)

*

Tony Leys, “As fewer MDs practice rural primary care, a different type of doctor helps take up the slack,” KFF Health News/NPR, Jun 6, 2023 READ IT HERE

Osteopaths are filling the gap, and rural America is generally fine with that. For example, “DOs now make up more than a third of rural Iowa physicians, and that proportion is expected to grow.” Do they cost less?

*

Matthew Miller & Danielle Salisbury, “During the darkest days of COVID, some Michigan hospitals made 100s of millions,” MLive.com, Jun 6, 2023 READ IT HERE

Some hospitals clearly are suffering, but many cried the blues during Covid while posting very tidy revenues, including hefty boosts from federal emergency assistance. “During the first years of the pandemic, Michigan hospitals told the public their situation was dire. Their staffs were overworked. Emergency rooms were bursting with patients. Many furloughed staff, cut workers’ salaries or trimmed executive pay, at least temporarily.” But: “Sixty-four of 116 Michigan nonprofit and government hospitals made more money in 2021 than they did in 2018.” And their CEOs did just fine as well, like one whose salary is now $8 million.

*

Emily Olsen, “Tenet to pay over $29M to settle kickback allegations at Detroit Medical Center,” Healthcare Dive, Jun 2, 2023 READ IT HERE

A whistleblower generated the facts for the case (and will walk away with a quarter of the settlement.) Referrals are supposed to be based on care quality, not business relationships. The industry hates these prosecutions and will likely take aim at the relevant laws.

*

Dave Muoio, “Massachusetts provider’s unexpected closure prompts class action alleging negligence,” Fierce Healthcare, Jun 5, 2023 READ IT HERE

What happened to this for-profit primary and urgent care outfit that also housed a few specialties like cardiology? It suddenly closed all its facilities on May 31 with no warning. Neither patients nor employees knew anything in advance, and the article doesn’t explain much. Maybe they weren’t gargantuan enough to survive.

*

Erica E. Phillips & Jenna Carlesso, “Lamont, CT hospitals reach deal to lower health care costs,” CT Mirror, Jun 5, 2023 READ IT HERE

The agreement includes pared-back regulations of hospital and drug prices, including some steps against “anti-competitive” practices. But a cap on prices for out-of-network care was eliminated. Perhaps the hospitals are an easier target in a state that is home to major insurers. (Do any readers know more?) Note the ambiguity in this statement by Ted Doolittle, Connecticut’s health care advocate: “I do commend the governor for his initial sweep of proposals, which was really groundbreaking. I’m looking forward to finding out how many teeth remain.”

*

Dan Weissman, “‘An arm and a leg’ podcast: A ‘payday loan’ from a health care behemoth,” KFF Health News, Jun 6, 2023 READ IT HERE

Relates how UnitedHealthcare squeezes independent doctors by delaying payment (or simply stiffing them), then offers them cash advances on amounts owed and takes a huge discount a.k.a. “the vig” or “the juice.” Amazing. Where are the local prosecutors?

*

Emily Olsen, “FTC urges North Carolina legislators to drop UNC Health antitrust exemption bill,” Healthcare Dive, Jun 7, 2023 READ IT HERE

The Federal Trade Commission is stepping into a debate even before the monopoly-friendly bill is passed. It reflects the agency’s vastly more pro-active stance about concentration and anti-competitive behavior. The pro-bill argument, as usual, is that UHC should “save” rural hospitals, which is exactly what a takeover is unlikely to do. Another FTC target: “Certificates of Public Advantage, or COPAs, arrangements that protect hospital mergers from federal antitrust scrutiny in exchange for prolonged state oversight.” No wonder FTC chair Lina Khan is the object of a relentless hate campaign in the financial media.

*

Arielle Zionts, “Thousands face Medicaid whiplash in South Dakota and North Carolina,” KFF Health News/CBS News, May 18, 2023 READ IT HERE

Enrollees fall through the cracks between the end of Covid-emergency Medicaid and the start of expanded eligibility just agreed in both states. The coverage gap could be avoided with workarounds, but apparently that’s too much trouble.

*

Jessie Hellmann, “Medicare Advantage supplemental health plans draw scrutiny,” Rollcall, May 22, 2023 READ IT HERE

Big shock, MA plans don’t live up to their late-night cable ads. Promises of dental care are especially deceptive. Because there are thousands of MA plans available, buyers have to read the fine print. How many do? The Federal Government has lax reporting requirements for the plans and so doesn’t know very much about what’s being provided—despite paying extra to the plans’ owners.

*

Sarah Kliff & Jessica Silver-Greenberg, “This nonprofit health system cuts off patients with medical debt,” New York Times, Jun 1, 2023 READ IT HERE

“Doctors at the Allina Health System, a wealthy nonprofit in the Midwest, aren’t allowed to see poor patients or children with too many unpaid medical bills. A 12-page document reviewed by The Times instructs Allina’s staff on how to cancel appointments for patients with at least $4,500 of unpaid debt. The policy walks through how to lock their electronic health records so that staff cannot schedule future appointments.” They’re not alone: 20% of hospitals nationwide do the same although not all are “nonprofits,” which theoretically have an obligation to provide charity care in exchange for the billions they save in taxes. After this exposé, other “nonprofits” will be more careful about what they put in writing.

*

SINGLE PAYER LINKS #304

Posted 2 JUN 2023

*

Hannah Recht, “As Medicaid purge begins, ‘staggering numbers’ of Americans lose coverage,” KFF Health News/USA Today, Jun 1, 2023 READ IT HERE

An epidemic that killed 1 million Americans might have led to a public debate on not just the moral implications of depriving people of adequate healthcare but also the economic insanity of leaving “essential workers” to their fates and afraid to take a sick day—if they had any. Instead, we have a politicized shouting match over the efficacy of masking and whether people are “free” to ignore public health concerns. We’ll now be treated to the spectacle of seeing some 15 million Medicaid beneficiaries—20% of the total—threatened with losing coverage now that eligibility redeterminations, suspended during Covid, are back. The vast majority of the 600,000-plus already ousted from the program since April 1 “were removed from state rolls for not completing paperwork.” Unsurprisingly, Florida leads the nation in numbers of beneficiaries thrown off.

*

Caroline Lewis, “Many NYers unaware they could soon lose Medicaid coverage, national survey finds,” Gothamist, May 31, 2023 READ IT HERE

New York’s Medicaid enrollees rose from 6 to 8 million during Covid, but now they’ll face the tedious process of proving eligibility, along with those whose children are in Child Health Plus.

*

Jaymie Baxley, “‘Unwinding’ could undermine Medicaid expansion in North Carolina,” North Carolina Health News, Jun 1, 2023 READ IT HERE

Republican-dominated North Carolina finally got religion and decided to join the Medicaid expansion—a decade later. But that vote happened within days of the expiration of the federal Covid emergency, which means that some 800K North Carolinians who got Medicaid during Covid could now lose it. So, while the state eventually will qualify new beneficiaries under the expansion on the one hand, they’ll first be dropping an estimated 300K others based on the old rules. As usual, complexity and means-testing keep the poorest insecure and on the edge of medical disaster. A single mother with two children earning $25,000 a year could find her coverage discontinued.

*

Catherine Rampell, “Government incompetence is knocking eligible Americans off Medicaid,” Washington Post, Jun 1, 2023 READ IT HERE

This critical op-ed about the Medicaid mass expulsions is timely. However, the writer seems to think that administrative incompetence is a bug or an embarrassment rather than a feature of an oligarchic state that chips away at public benefits by making them harder and harder to access. “The burden of proof is usually placed on poor people, and benefit-eligible families and children fall through the cracks.” Exactly.

*

Matt Volz, “More states OK postpartum Medicaid coverage beyond two months,” KFF Health News/U.S. News & World Report, Jun 1, 2023 READ IT HERE

Anti-abortionists can’t defend lousy services to low-income mothers, leading some red states to shell out. (Medicaid covers 40% of all births in the U.S.) Legislators in Alaska, Mississippi, Missouri, Montana, Texas, Utah, and Wyoming extended postpartum Medicaid coverage from 60 days to a year. Arkansas, which has the highest maternal mortality rate in the country, is a holdout.

*

Siddharth Cavale, “Walmart is raising wages for pharmacists, opticians in healthcare push,” Reuters, May 31, 2023 READ IT HERE

A supermarket sets the salary scale for healthcare providers—is this from a chapter by Ursula K. LeGuin? “Walmart is the nation's largest private employer, and the salary move comes on the heels of its announcement to double the number of its in-store healthcare centers and expand into new states.” Walmart, Amazon, and CVS are rapidly gobbling up chunks of the healthcare continuum to become vertically integrated mutants.

*

Heather Landi, “Employers face soaring demand for obesity care benefits. Virtual care players are jumping in with a slew of offerings,” Fierce Healthcare, May 26, 2023 READ IT HERE

A mad rush for the magic fat pill is on! Workers are demanding that their companies’ health plans reimburse the diet-free treatment despite warnings. The competing brands Ozempic, Wegovy, and Rybelsus racked up $10.7 billion in drug spending in 2021, a 90% increase, and they’re just getting started. Estimates go as high as $54 billion by 2030. The upward pressure on premiums will be massive.

*

Angel Adegbesan & Robert Langreth, “Obesity shot frenzy makes Eli Lilly world’s most valuable drugmaker,” Bloomberg, May 31, 2023 READ IT HERE

Lilly surpassed Johnson & Johnson in net worth, based on news of the juicy government reimbursements coming its way for its obesity and Alzheimer’s drugs.

*

Heather Landi, “Medicare to broaden coverage of Alzheimer’s drugs after full FDA approval, but with some restrictions,” Fierce Healthcare, Jun 1, 2023 READ IT HERE

The Feds will pay (through the nose) for the latest Alzheimer’s wonder drug, demonstrating that last year’s Aduhelm debacle had only a passing impact on the pharmaceutical-industrial complex. Eisai’s Leqembi, like Aduhelm, got “accelerated” approval, but the fallout from Aduhelm’s highly suspect approval process led to coverage for it to be limited to clinical trials. But then the lobbying machinery cranked into high gear: “The agency has faced intense pressure from lawmakers, patient advocacy groups, and pharmaceutical companies” to change its decision. Industry-funded patient groups like the Alzheimer’s Association run interference while the Pharma cash spigots are cranked up. Clinical trial data purportedly showing the efficacy of the costly drugs are based on the subjective Clinical Dementia Rating–Sum of Boxes (CDR-SB), and even that shows a teeny-tiny improvement. Finally, they all rely on the beta-amyloid theory of Alzheimer’s causation, for which evidence remains scant.

*

Rachel Cohrs, “Medicare holds firm on Alzheimer’s drug coverage policy,” STAT, Jun 1, 2023 READ IT HERE

More squeals of outrage from Pharma over the requirement that use of their pricey Alzheimer’s drugs be linked to “patient registries” so that the government can collect data in real time over whether they really work. Drug companies usually promise to study efficacy in exchange for approval and then drag their feet for years. “Critics of the restrictions argue that no other medication faces similar restrictions.” Well, they should. The Alzheimer’s Association predictably is toeing the industry line and seems to have no problem with this underreported data point: “The medication has been plagued by patient safety concerns about brain swelling,” which affected 12.6% of all who received it, according to an industry-sponsored study.

*

Oriana González, “New CMS Alzheimer’s drug coverage plan raises questions around worth,” Axios, Jun 2, 2023 READ IT HERE

Understatement du jour: “A Medicare plan for covering new Alzheimer’s drugs is reviving thorny questions about whether pricey treatments with modest success slowing the disease’s progression are worth the cost and safety concerns.” Leqembi will cost $26,500 per year, the “success” rate is small, and the impact when successful is marginal. But patients and their families are desperate, so they’ll rush to try it. The FDA was supposed to protect vulnerable people from such stuff, but the cash involved is massive. “An April report from the Institute for Clinical and Economic Review found that the drug's yearly $26,500 price tag could cause ‘rapid growth in health care insurance costs that would threaten sustainable access to high-value care for all patients.’”

*

John Arcano, “Big Pharma uses fuzzy math to discredit discount drug program,” Common Dreams, May 24, 2023 READ IT HERE

Pharma is on the warpath against a program known as 340B, which invites drug companies to discount prices to certain nonprofits in return for access to lucrative Medicare and Medicaid reimbursements. Although drug makers are not forced to participate in 340B and have the entire commercial insurance and federal entitlement drug markets to reap massive profits, they hate having to get less for any portion of their sales.

*

Rebecca Pifer, “Pharma-backed report targets federal clinics for benefiting financially from 340B drug discounts,” Healthcare Dive, May 23, 2023 READ IT HERE

Here’s the industry campaign against 340B, which will get plenty of airtime in coming months. Pharma will point to the more prosperous hospitals that are cashing in on a safety-net program and not sharing the benefits.

*

Paige Minemyer, “Walmart investors vote down bid to study consumers’ data privacy and reproductive rights,” Fierce Healthcare, May 31, 2023 READ IT HERE

“The proposal requested that the company investigate known and potential risks associated with filling information requests from law enforcement and other agencies that could criminalize patients seeking abortions.” You’ve been warned—Walmart will not protect you. In a 2022 case, “Meta, the parent company of Facebook, satisfied a warrant for messages between a mother and her teenage daughter, which led to felony charges for an illegal abortion.” Credit card companies ditto.

*

Dave Muoio, “Missouri nonprofit health systems BJC HealthCare, Saint Luke's targeting $10B merger,” Fierce Healthcare, May 31, 2023 READ IT HERE

A new “cross-market” deal would create a 28-hospital academic health system. Mergers that combine hospitals in different cities can more easily avoid anti-monopoly action by the reawakened Federal Trade Commission. BJC HealthCare is based in St. Louis and parts of Illinois while Saint Luke’s operates in western Missouri and Kansas. Consolidation is sold to the public as a cost-saver but rarely results in any.

*

Elisabeth Rosenthal, “Denials of health insurance claims are rising—and getting weirder,” KFF Health News/Washington Post, May 26, 2023 READ IT HERE

More and more claim denials are fed by computer algorithms rather than a medically informed decisionmaker. “An automated system, called PXDX, allowed Cigna medical reviewers to sign off on 50 charts in 10 seconds, presumably without examining the patients’ records.” How is this legal? The Feds could force these insurers to cough up their claim-denial rates so that people shopping for policies could know that a given plan turns down, say, 50% of all submitted claims. But there’s zero enforcement of already weak rules. Those affected appeal about one out of every 500 cases, so insurers know they can get away with it. An opening for single-payer advocates: workshops to help people appeal ALL their claim denials.

*

Wes Ely, “As long COVID turns three, Americans play disability roulette,” Boston Globe, May 26, 2023 READ IT HERE

Covid is now not a “mass death” event, says this critical care doc, but a “mass disability event.” The stats: Something like 10K of those getting Covid each week in the U.S. will have long-term consequences, and vaccination is no guarantee of escaping permanent damage. “These patients fall through the cracks. They are repeatedly denied disability benefits and struggle to find health care because they are newly out of work and without insurance.” They often end up bankrupt and even homeless. But Covid is totally last year. “A recent reflection on the pandemic in the New England Journal of Medicine did not mention long Covid.”

*

Paige Minemyer, “CVS braces for $1B hit following Medicare Advantage star ratings drop,” Fierce Healthcare, May 26, 2023 READ IT HERE

The Feds give Medicare Disadvantage plans ratings of 1 to 5 stars, and for some reason the CVS Health properties got hit with a big downgrade.

*

SINGLE PAYER LINKS #303

Posted 26 MAY 2023

*

Christine Eibner, “Can the health insurance system handle massive Medicaid reductions?” The Hill, May 12, 2023 READ IT HERE

“Redeterminations,” that is, of eligibility, cause people to be thrown off Medicaid if they dare to earn a living wage. The government halted them during Covid as the priority was to get service workers back to work; Medicaid enrollment grew by 25%. Now that Covid is old news, 15 million people could lose coverage. This RAND study outlines various helpful tweaks that will protect some of the victims of eligibility whiplash, such as increased Obamacare subsidies if they move to commercial products. But the author doesn’t provide an answer to her own question, which is yes, the insurance sector will be just fine. “Still, these are patches to an imperfect system, and plenty of gaps remain,” she concludes rather cheerily.

*

Joe Mario Pedersen, “About 250,000 Floridians were kicked off Medicaid. Experts say most were still eligible,” WMFE, May 23, 2023 READ IT HERE

Only 10% of those kicked off Medicaid in Florida since “redeterminations” began April 1 were actually ineligible; 82% lost coverage for procedural reasons, such as not having responded to mail, having outdated contact info, or computer glitches. Advocates are asking famously compassionate Gov. DeSantis for a pause while another 650K Floridians face disenrollment.

*

Rebecca Pifer, “UnitedHealth notches record revenue in first quarter,” Healthcare Dive, Apr 14, 2023 READ IT HERE

UH revenue is up 15% from last year, especially due to increased reimbursements from Medicare Advantage and Medicaid membership, “two key growth priorities.” Even the move to throw people off Medicaid won’t hurt them, say executives, because “redeterminations could even be a net positive as the payer recaptures members in commercial plans,” i.e., newly uninsured are forced into costly Obamacare plans.

*

F. Douglas Stephenson, “New Medicare-for-All legislation introduced by Sanders, Jayapal, Dingell, others: Why is the greatest health system in the world only for the affluent?” Informed Comment, May 22, 2023 READ IT HERE

“The ACA is too expensive, unsustainable, overly complex, and bureaucratic. Even worse, it’s a gift to private insurers and other 1% corporate stakeholders and profiteers in the neoliberal medical-industrial-congressional complex. The private insurance industry is very happy with the ACA.” Fun fact: “Big Insurance revenues and profits have increased by 300% and 287% respectively since 2012.”

*

Wendell Potter, “Finally, big insurance’s pharmacy benefit managers are being probed by Congress,” Healthcare Un-covered, May 15, 2023 READ IT HERE

Potter applauds Congress for finally addressing the PBM cartel and takes note of an 18-3 vote “to ban spread pricing in which PBMs charge their customers more than they pay pharmacies” and pocket the difference. He sees signs of bipartisan enthusiasm for reining in the worst abuses, such as putting a stop to the PBMs’ $140 billion worth of stock buybacks since the days of the 2008 financial panic. Though his optimism is heartwarming, given the torrents of cash greasing congressional wheels, skepticism would not be irrational. Cigna’s Express Scripts PBM “now generates far more in revenues and profits than Cigna’s health plans.” That’s a big cash cow.

*

“FTC deepens inquiry into prescription drug middlemen,” Federal Trade Commission, May 17, 2023 READ IT HERE

The anti-monopoly FTC, rescued from zombiehood, has ordered two more PBMs to cough up internal documents. In its statement, the agency said PBMs are “integrated with the largest health insurance companies and wholly owned mail-order and specialty pharmacies.” They are also killing independents with anti-competitive practices, like (as listed by the order) “charging fees and clawbacks to unaffiliated pharmacies; steering patients towards PBM-owned pharmacies; potentially unfair auditing of unaffiliated pharmacies; the use of complicated and opaque pharmacy reimbursement methods; and negotiating rebates and fees with drug manufacturers that may skew the formulary incentives and impact the costs of prescription drugs to payers and patients.” Quite a list.

*

Sydney Halleman, “House committee centers blame on PBMs for rising healthcare costs,” Healthcare Dive, May 18, 2023 READ IT HERE

More talk of bipartisan impatience with the PBM scam. But there are notes of caution: “Even what I view as extremely modest and narrow reforms on Medicare price negotiation that were adopted last year are under attack,” said Rep. Lloyd Doggett (D-TX). Even so, Pharma likes to blame the PBMs (and vice versa) and has the insurers as a potential finger-pointing ally. So that’s two Godzillas versus one King Kong.

*

Matt Stoller, “Martin Shkreli was too honest,” BIG, May 19, 2023 READ IT HERE

A “wave of shock and fear just came over the pharmaceutical industry.” Finally, some good news! In challenging the $27 billion merger of two pharmaceuticals, Federal Trade Commission (FTC) Chair Lina Khan is “putting the current business model of big pharma on trial and trying to move drug discovery back to the center of the industry.” The FTC action aims to stop Amgen from buying Horizon Therapeutics for access to two blockbuster drugs that cost around half a million dollars a year each. Amgen would then squeeze potential competitors working on cheaper alternatives to keep them out of the market. Why should Big Pharma bother developing new drugs when they can just buy up other people’s work and create a bottomless cash pit? “When the FTC announced it was challenging the deal, the industry absolutely freaked out. Horizon’s stock fell 19%.” More like this!

*

Eric Boodman, “In a town plagued by an environmental crisis, a local abortion debate consumes public attention,” STAT, Apr 18, 2023 READ IT HERE

A landfill wafts toxic fumes over twin cities on the Virginia-Tennessee border, but many locals are too busy trying to ban abortions within city limits to worry about poisons. The yellow “Safe Zone for Life” stickers only apply to fetuses, not live children.

*

Emily Olsen, “HCA to acquire 41 urgent care clinics in Texas,” Healthcare Dive, May 19, 2023 READ IT HERE

HCA Healthcare, one of the nation’s largest for-profit health systems, will double its presence in the urgent care sector in Texas.

*

Rebecca Pifer, “Pennsylvania unions file antitrust complaint against UPMC,” Healthcare Dive, May 19, 2023 READ IT HERE

Unions accuse the giant University of Pittsburgh Medical Center of “abusing its dominant market position” to suppress wages, drastically increase workloads, and block staff from getting jobs elsewhere through “non-compete” clauses. UPMC has 41 hospitals, 92,000 employees, and operates 800 doctors’ offices and clinics. It even offers its own health insurance plans.

*

Dave Muoio, “UPMC aims to fund facility expansion plan with highest-to-date $1.6B bond issue,” Fierce Healthcare, Apr 12, 2023 READ IT HERE

The Pennsylvania health mega-cartel recently issued $1.6 billion in bonds—some tax-exempt—to further its expansion. One project is a “digital, high-tech, 17-story inpatient tower with 636 private rooms.” Godzilla on steroids.

*

Lizzy McLellan Ravitch, “Penn Medicine residents voted to unionize, creating the biggest new union in Philadelphia in more than 50 years,” Philadelphia Inquirer, May 9, 2023 READ IT HERE

Meanwhile, over in Philly: some 1,400 residents and fellows at the University of Pennsylvania Health System are the first group of doctors in training to unionize in the state after a vote in which 89% approved.

*

Dave Muoio, “Home care industry touts bipartisan bill to expand Medicare in-home benefits, reimbursement,” Fierce Healthcare, Apr 24, 2023 READ IT HERE

Provider cartels and big tech firms are happy with a bipartisan bill to shift authorized care (and reimbursements!) from hospitals to home care companies. Whatever the advantages of home care, the enthusiasm for the payments shift among the likes of “DaVita Kidney Care, Ascension, Amazon, Signify Health, Current Health, Intermountain Healthcare, and a dozen other industry groups” merits caution. The corporates are grouped in a lobbying outfit called Moving Health Home and enjoy a working alliance with single-payer advocate Debbie Dingell (D-MI). One eerie quote for anyone aware of the link between home visits and upcoding: “Medicare Advantage plans have seen the value of help in the home, and [we believe] the time has come to make this benefit accessible to all Medicare beneficiaries.”

*

Nash Weerasekera, “In the ‘Wild West’ of outpatient vascular care, doctors can reap huge payments as patients risk life and limb,” ProPublica, May 24, 2023, READ IT HERE

An appalling tale of a medico-entrepreneur who foists unnecessary treatments on patients and cleans up with reimbursements. He’s been sued repeatedly while collecting $30 million from the Federal Government for hundreds of dubious procedures. “One man had to have his leg amputated after Dormu administered multiple invasive treatments for mild pain. A 62-year-old grandmother bled out and died shortly after Dormu cut into her.” Et cetera. The payments are so lucrative that a small pool of 90 MDs racked up $1 billion dollars in reimbursements. “CMS kicked off the problem 15 years ago, when it tried to rein in the swelling hospital costs for vascular care. Over the past few decades, advances in technology allowed patients to undergo minimally invasive treatment,” thus the wide-open field for abuse.” So, moving to home health care isn’t a slam dunk.

*

Michael Berens, “How doctors buy their way out of trouble,” Reuters, May 24, 2023 READ IT HERE

And speaking of how wealthy doctors get out of jail free . . . Prosecutors will spend the time and money to get common criminals off the streets, but they’re far more lax with white-collar crime, including medical fraud. “When federal enforcers alleged in 2015 that New York surgeon Feng Qin had performed scores of medically unnecessary cardiac procedures on elderly patients, they decided not to pursue a time-consuming criminal case. Qin agreed to pay $150,000 and walked free to perform more cardiac surgeries.” Qin didn’t even have to notify patients who may have been harmed. Incredibly, when Qin promptly repeated the offenses and was exposed by a nurse-whistleblower, prosecutors let him off the hook again with his medical license intact. As it turns out, the case is hardly unique: “Over the last decade alone, at least 540 doctors and healthcare practitioners collectively paid the government hundreds of millions of dollars [while victims got bupkis] to negotiate their way out of trouble via civil settlements, then continued to practice medicine without restrictions on their licenses despite allegations that included fraud and patient harm.” Conclusion: get a second opinion because if you’re harmed by a doctor, you’re pretty much on your own.

*

Ezekiel J. Emanuel, “Cancer patients shouldn’t be responsible for out-of-pocket costs,” STAT, May 23, 2023 READ IT HERE

Our miracle cancer treatments aren’t so great after all since people can’t afford them. “More than 40% of patients spend their entire life savings in the first two years of treatment.” They delay care, avoid appointments, cut back on essentials, and get depressed. Emanuel’s solution: eliminate cancer co-pays and deductibles as in civilized countries like Canada and Norway—a disease-by-disease approach. Sounds a bit cracked, frankly, but hardly nuttier than the current system.

*

Nicholas Florko, “‘Worse than what we thought’: New data reveals deeper problems with the Bureau of Prisons’ Covid response,” STAT, May 23, 2023 READ IT HERE

Federal prison inmates received “substandard mitigation measures throughout the pandemic” even in high-risk facilities meant to take care of the sickest incarcerated people. Prisons failed to perform Covid tests of enough inmates, then dawdled in vaccinating them. Maybe we should sign them all up to Medicare Advantage plans so they can get upcoded and produce juicy reimbursements for someone.

*

Naomi Kresge, “Taking diet drug Wegovy for a year comes with a major added benefit, study finds,” Fortune, May 19, 2023 READ IT HERE

Science by press release as reporters get behind the Next Big Thing in pill-popping: slim down with Pharma, which is telling us that obesity is a disease, probably genetic, and of course requires medication, i.e., NOT due to sugar-laden, addictive foods. The article (and others I found) claim that the magic anti-fat drug will also lower heart attack risk, but none of them link to the study, nor do the writers seem to have examined it even superficially. They rely on study authors, like one Dr. Andres Acosta, who lists holdings in Pharma stock and Pharma consultancies, as objective sources for The Science™. Here’s a detail we won’t hear a lot about: “As many as 5% of the Wegovy patients required hospitalization or a visit to the emergency room due to severe side effects.” See below for a corrective.

*

James Li, “EXPLAINED: The Obesity Industrial Complex,” Breaking Points/YouTube, May 21, 2023 READ IT HERE

Li takes apart a recent 60 Minutes special on the new diet wonder drugs in which doctors in white coats assure us that obesity is a disease that can be fixed with pills.

*

Markian Hawryluk, “This panel will decide whose medicine to make affordable. Its choice will be tricky,” KFF Health News/Fortune, May 25, 2023 READ IT HERE

Maryland, Colorado, and now Washington (state) are trying to control drug costs through a state price-setting board. They all have problems. In Colorado’s case, “the state’s Prescription Drug Affordability Board will choose up to 18 high-cost drugs for review to determine whether to cap what health plans and consumers pay for them. But with hundreds of expensive drugs to choose from, the board members face tough decisions about who will get help now and who will have to wait.” State action is slow and handicapped by powerful industry lobbies standing by ready to sue. In addition, many patient groups are bought off by Pharma and side with the industry.

*

SINGLE PAYER LINKS #302

Posted 12 MAY 2023

*

Yves Smith, “Rochelle Walensky: Not with a bang but a puddle of tears,” Naked Capitalism, May 8, 2023 READ IT HERE

Smith indicts Walensky as incompetent and dangerous. The bill of particulars: she repeated White House talking points on Covid without checking the facts (famously citing a CNN report on vaccine efficacy as the basis for a decision); did nothing to maintain adequate case tracking and data-gathering; lied about the vaccines as sterilizing; allowed non-medically trained personnel to run the Vaccine Adverse Events Reporting System (VAERS), which buried inconvenient news on side effects; ignored non-pharmaceutical safety interventions (e.g., ventilation improvements); promoted the (false) droplet theory of transmission; demonized the unvaccinated based on the (false) idea that vaccines prevent onward transmission; compared masks to a “scarlet letter” that the vaccinated don’t need; was clueless about the low rate of vaccine uptake among the poorest and did nothing about it; failed to maintain liaisons with state public health agencies. Summary: “Walensky played a major role, arguably larger Anthony Fauci, in destroying faith in public health and vaccines in particular.”

*

Claudia Irizarry Aponte & Haidee Chu, “Doctors at Elmhurst Hospital vote to authorize strike, following Jamaica and Flushing peers,” The City, May 3, 2023 READ IT HERE

Sign of the times: “Three Queens hospitals could see [resident] physicians walk off the job in New York City for the first time in a generation.” The pandemic radicalized many. “Elmhurst Hospital was the epicenter for the world at one point,” said one. “There were dead bodies everywhere with nowhere to go. We were there the whole time. And the fact that we were not compensated or at least acknowledged for that is disappointing.”

*

Tyler Driscoll, “Prevent rising healthcare costs by stopping healthcare mergers,” CT Mirror, Apr 11, 2023 READ IT HERE

Connecticut is an interesting case, home to big insurers but also trying to rein in runaway costs one way or another. [Readers in CT, pls steer me to more sources!] This opinion column is an example of the ongoing debate. “In just over 20 years, the number of independent hospitals in the state has shrunk from 23 to six,” which drives up costs and undermines service. The author points out that administrative paperwork can overwhelm smaller hospitals or the vanishing independent MD: “One provider in Connecticut described needing six full-time employees simply to handle to business aspects [read: billing, pre-authorization, and denial appeals] of the practice.”

*

Erica E. Phillips & Katy Golvala, “In CT, a ‘battle royale’ over lowering health care costs,” CT Mirror, Apr 10, 2023 READ IT HERE

Connecticut seems to be helping insurers (King Kong) take on the concentrated hospital sector (Godzilla) as the state looks for relief from 6% annual cost increases. One interesting proposal is to cap what hospitals can charge out-of-network patients, which could drive down other costs as well. Hospitals scream bloody murder. Is government slowly recognizing the need for price controls? But see below for a built-in obstacle.

*

Ge Bai & Cynthia Fisher, “Health insurance makes many kinds of hospital care more expensive,” Washington Post, Apr 11, 2023 READ IT HERE

“The price that a hospital charges a cash-paying patient for a procedure is often lower than the negotiated price that a commercial insurance plan would pay. This finding contradicts the conventional wisdom that insurers use their bargaining power to drive prices down.” An excellent look at how our Rube Goldberg system inflates costs and provides multiple opportunities for rent extraction by useless intermediaries. For example, a colonoscopy can often cost $5,000 v/s the national median cash price of $1,635. But if you force people into high-deductible plans, they’re shelling out all that dough before the “insurance” kicks in. The system undermines the concept of insurance as pooled risk.

*

Dave Altimari & Jenna Carlesso, “After 50 years, a five-star nursing home closes—with a warning,” CT Mirror, Apr 30, 2023 READ IT HERE

A switch in emphasis to home- and community-based care is hitting smaller nursing facilities hard. CT plans to shed 1000 nursing home beds even as the population of older residents increases. But “the small neighborhood nursing home is what we want to see more of. I would rather see the big business chains get forced out.” Private equity will continue to invade the industry and extract whatever remaining assets facilities have.

*

Michelle Andrews, “Some private companies charge hefty fees to help veterans with disability claims,” KFF Health News, April 30, 2023 READ IT HERE

Unaccredited “coaches” who promise to help veterans get their benefits for things like burn-pit exposure can provide no useful services and then gouge the “beneficiaries” for fees. Accredited assistance agencies, by contrast, are monitored and have better records. Oddly, the VA has no authority to regulate the free-lancers who scam vets.

*

Sydney Halleman, “Envision wins $91M in arbitration against UnitedHealthcare,” Healthcare Dive, May 3, 2023 READ IT HERE

UH was found to have “unilaterally reduced reimbursement to Envision clinicians” in a retaliatory move. But that didn’t save Envision, which went bankrupt anyway. Monopolies often use anti-competitive tactics to kill off threats and have deeper pockets to wait out lawsuits, even successful ones. UH claims that Envision “systematically deceived” it through upcoding, which is also possible.

*

Sydney Halleman, “Envision Healthcare planning Chapter 11 bankruptcy filing, WSJ reports,” Healthcare Dive, May 10, 2023 READ IT HERE

“A bankruptcy filing would wipe out private equity firm KKR’s [$5 billion] investment in Envision.” How tragic!

*

Baruch Fischhoff, Martin Cetron & Katelyn Jetelina, “Do masks work? Randomized controlled trials are the worst way to answer the question,” STAT, May 2, 2023 READ IT HERE

A big fail of science journalism, if it merits that honorable title: The pressure to get people back to work was so overwhelming that news sources hoisted highly dubious research into headlines that encouraged us to dump masks. Two widely reported meta-analyses “have been widely misinterpreted as showing that face masks don’t work. What they really show is that the [studies] asked questions that they could not answer.” The issue is that mask-wearing in a population is so full of side issues (confounders) that most studies can’t detect meaningful outcomes. The over-worshipped randomized controlled trial (RCT) does not work in all cases as in the famous example: Do parachutes work to save lives? (You can’t establish a control group for that.)

*

Vanessa Kerry and Travis Bias, “The Global North can’t solve its health care worker shortage by recruiting from the Global South,” STAT, May 3, 2023 READ IT HERE

“Fifteen percent of health care workers globally are working outside their country of birth.” We let other countries train them, then transport them here to fill in the gaps. Because labor costs account for half of hospital budgets, we siphon off trained providers from poorer countries, which then end up with shortages. One solution: spend the money needed to train our own damn nurses! And provide working conditions that make them want to stay in the field.

*

Tatiana Walk-Morris, “Synchrony, Wells Fargo, Bread Financial lead medical credit card market,” Healthcare Dive, May 8, 2023 READ IT HERE

From 2018 to 2020, consumers paid $1 billion in deferred interest payments on healthcare credit cards and loans. Medical credit cards typically charge an APR of 26.99%” [let’s call it 27%, shall we?] Good grief—as if the original charges weren’t punishment enough. These “CareCredit” cards are now held by 11.7 million people, triple from the total a decade ago. Medical debt shouldn’t exist in the first place, much less evil scalpers standing by to further impoverish people with it. Suggested names for the companies: Beelzebub Capital, Old Scratch Assurance Corp., and Deep Pit Partners. (As Enid Strict might ask, “Could it be. . . Satan?”) In fact, “Sezzle,” one of the real companies, captures the mood rather nicely.

*

Till Bruckner, “Multiple sclerosis drugs: Insights from 29 clinical trials lost forever?” TranspariMed, May 2, 2023 READ IT HERE

Publication bias, a well-documented way to manipulate The Science™. The example: “A new study has identified 29 [out of 150] clinical trials of multiple sclerosis drugs whose results remain completely unknown to scientists and doctors” and probably will stay that way. Why the secrecy? Probably because the results were inconvenient to the Pharma sponsors. “Trials that showed that a drug did not help patients or caused more harm than good were far less likely to be reported in scientific journals.” The FDA could fine companies for hiding trial results but never does.

*

Aliza Chasan, “Sexually transmitted infection rates rose in 2021, new CDC data shows,” CBS News, Apr 11, 2023 READ IT HERE

Syphilis up 32% annually; Chlamydia and gonorrhea up 4%. No causal factors are mentioned, but one could surmise several: attacks on public health funding and its very existence; Sex Panic! and opposition to sex ed.

*

Julian Gill, “Texas leads the nation in babies born with syphilis. The problem is getting worse,” Houston Chronicle, May 9, 2023 READ IT HERE

Texas’s solution: Stop talking about it.

*

No author, “Reject big Pharma’s drug pricing distractions. Protect your bargaining power,” AHIP, undated, READ IT HERE

AHIP=America’s Health Insurance Plans, but you wouldn’t know that from their website because they never translate their acronym. I wonder why! This is the Pharmacy Benefit Managers’ lobby pointing the finger at the drug companies for your insane drug costs. Pharma points the finger right back at the PBMs. [They’re both right.] The core PBM argument: “We’re not middlemen.” [Yes, you are.] “We’re your bargaining power standing in the way of even higher drug prices.” [No, you’re a cartel extracting unearned rents.]

*

Reed Abelson, “Corporate giants buy up primary care practices at rapid pace,” New York Times, May 8, 2023 READ IT HERE

“Large health insurers and other companies are especially keen on doctors’ groups that care for patients in private Medicare [Disadvantage] plans.” I’ll bet they do. And why are the megasaurs gobbling up primary care? It funnels patients into their affiliated pharmacies, clinics, and hospitals. The Feds pay out $400 billion a year to the MA hustle, so the big players want to stick a funnel into that vast pot of cash by becoming a one-stop shop for everything health-related. Shocker: “Only about 5 percent of One Medical’s 836,000 members are enrolled in [MA plans], but roughly half of its revenue comes from that tiny slice of patients.”

*

Paige Minemyer, “UnitedHealth quietly scoops up New York physician group Crystal Run,” Fierce Healthcare, Apr 10, 2023 READ IT HERE

“Earlier this year, UHG acquired Crystal Run Healthcare, a New York-based physician group with about 400 doctors.” Nobody knew until Mid-Hudson News got an internal email. Optum Health is UH’s vehicle for gobbling up physician practices and now employs 70,000 doctors nationwide.

*

Michael Karpman, Stephen Zuckerman & Sarah Morriss, “Health care access and affordability among US adults aged 18 to 64 years with self-reported post-COVID-19 condition,” JAMA, Apr 10, 2023 READ IT HERE

“Improved health care access for adults with PCC [long Covid] may require developing clinical protocols and addressing insurance-related barriers.” Well, duh! And how does the AMA propose we “address” such barriers? The study showed a 15–25% increase in care and insurance problems for the long-Covids compared to everyone else, which means it is only marginally worse than the usual nightmares.

*

Frank Diamond, “With judge’s ruling, some employers may cut off no-cost preventive care: survey,” Fierce Healthcare, May 8, 2023 READ IT HERE

One of those Texas judges rides again to strike down an Obamacare mandate (so much easier than pushing unpopular measures through a legislature). Result: Some employers have already stopped paying for certain preventive services.

*

Jerome Groopman, “Saving lives and making a killing,” New York Review of Books, May 25, 2023 READ IT HERE

How the biotech industry turns a few financiers into billionaires while we pay through the nose. The actual inventors of life-saving drugs do pretty well also, but the really big bucks are scooped up by Wall Street. The figures are staggering: “When Pharmacyclics was sold to AbbVie, CEO Duggan made a payday of cosmic proportions, $3.5 billion. Investor Rothbaum made $2.8 billion on an initial investment of $80 million. His friend Edelman reaped $700 million for his hedge fund.” The senior scientist/inventor took home a mere $20 million.

*

Daniel Fishel, Health insurance claim denied? See what insurers said behind the scenes,” ProPublica, May 10, 2023 READ IT HERE

If your insurance company denies a claim, you have the right to see the whole file! Who knew? The article provides detailed instructions—worth filing away. Sample tip: it might be better to file a request for the record before appealing a denial.

*

SINGLE PAYER LINKS #301

Posted 5 MAY 2023

*

Matt Stoller, “How Obamacare created big medicine,” BIG, Apr 7, 2023 READ IT HERE

A long, meaty, educational article, IMO a must-read for advocates. Stoller’s central thesis: “Obamacare didn’t address the key problem in the U.S. health care system—monopoly power. It spurred a big consolidation wave, transforming health insurers into much larger and more powerful conglomerates” while also “letting payers and providers be owned by the same entities”—generating an obvious conflict of interest between them and us. Stoller calls for a “health care Glass-Steagall,” referring to the New Deal measure to block dangerous concentration in the banking industry—whose removal contributed mightily to our recurring financial meltdowns.

On concentration in healthcare: “The hospital sector represents a third of health care spending. Starting in the 1980s and accelerating after the ACA, hospital systems have merged into giant monopolies, driving huge price hikes and increasingly poor quality. Private equity has come into everything from ambulances to urgent care to nursing homes.” And that’s not counting the insurance sector itself: revenues at UnitedHealth Group, one of our biggest, have quadrupled under Obamacare as it morphs into a vertically integrated monster with 50,000 in-house physicians. A family of four now pays on average “the cost of a small car every year” for protection against medical bankruptcy. (No wonder our workers can’t compete with China and Mexico.)

Much more in the full article.

*

Usha Lee McFarling, “Wealth, not health: For this hospital, closing Chicago’s alarming ‘death gap’ didn’t mean more clinics,” STAT, May 2, 2023 READ IT HERE

Fascinating and unusually hopeful: this hospital approached “social determinants of health” as more than facile rhetoric and got involved in improving their catchment area’s economics in a variety of ways. The 14-year difference in life expectancy between two nearby neighborhoods was a spur, and the long-term, comprehensive strategy seems to be scoring some success.

*

Libby Watson, “Awareness campaigns have made cancer more treatable—but not more affordable,” The Baffler, Mar 23, 2023 READ IT HERE

Review of a new book about the evolution of cancer treatment and social perceptions of a cancer diagnosis. Watson points out that, progress notwithstanding, the financial aspects of dealing with cancer are worse than ever—a topic avoided by the optimistic book. “We have made enormous progress both in our ability to treat cancer and our ability to face up to it. It is thanks to all this that, finally, we can look cancer patients in the eye and tell them, ‘You are not alone. We’re going to help you beat this. Your copay is $3,000.’”

*

Anne N. Sosin, Esther Choo & Martha Lincoln, “The covid public health emergency is ending: It now joins the ordinary emergency that is American health,” BMJ, Apr 26, 2023 READ IT HERE

The authors outline how Covid led to positive changes to the healthcare landscape, including free Covid testing, vaccines, and treatment and historically low levels of uninsurance due to Medicaid expansion. “The country made sweeping changes to daily life to prevent the collapse of the healthcare system. These experiences might have inspired Americans to think differently for the future.” But they mostly didn’t.

*

Liz Theoharis, “Whose world is this anyway?” Tom Dispatch, May 2, 2023 READ IT HERE

More on this topic: “When the pandemic first hit, the federal government temporarily banned any Medicaid or Children’s Health Insurance Program (CHIP) cuts, mandating that states offer continuous coverage. The government instituted eviction moratoriums, extended unemployment insurance, issued stimulus payments directly to tens of millions of households, and expanded the Child Tax Credit (CTC).” But now that economic activity is back, all that is over. Covid deepened inequality in the U.S. as life expectancy gaps between rich and poor grew larger while peer countries with civilized healthcare systems did much better.

*

Jordan Hart, “Moderna’s billionaire CEO draws criticism for earning nearly $400 million in stock options last year and then getting a raise on top of it,” Business Insider, Apr 29, 2023 READ IT HERE

Stéphane Bancel cashed out $393 million of his vaccine-related stock options in 2022, but he still needed a 50% salary increase for some reason. He touts his charity contributions while still sitting on “stocks valued around at least $2.8 billion.” A tidy sum from a drug developed with government research money.

*

Brendan Ballou, “Private equity is gutting America—and getting away with it,” New York Times, Apr 28, 2023 READ IT HERE

“Over the last decade, private equity firms were responsible for nearly 600,000 job losses in the retail sector alone.” Ditto mobile homes, prison health care, emergency medicine, nursing homes, ambulances, apartment buildings, and more. PE titans like Mitt Romney make a bundle, then go on to influence our political and decision-making process. “Since 1990, private equity and investment firms have given over $900 million to federal candidates and have hired an untold number of senior government officials to work on their behalf.” Interesting that an op-ed like this finally lands in the Times, a suggestion that the term “private equity” itself is starting to mean “greedy bastards” in public perception.

*

Sydney Halleman, “Last year was second-best ever for healthcare private equity deals, Bain finds,” Healthcare Dive, Apr 11, 2023 READ IT HERE

PE deals in 2022 totaled $45.7 billion though interest rate and inflationary pressures may dampen future activity, at least temporarily. Likely future PE targets: primary care and Medicare Disadvantage.

*

Naheed Rajwani-Dharsi, “Mexico’s allure for medical tourism,” Axios Dallas, Apr 21, 2023 READ IT HERE

An estimated 1 million Americans head to Mexico every year for dental work, prescriptions, and who knows what else. Coyotes not needed.

*

Lee Fang, Pfizer quietly financed groups lobbying for COVID vaccine mandates,” leefang.com, Apr 24, 2023 READ IT HERE

“Many of the supposedly independent consumer, medical, and civil rights groups that created the appearance of broad support for the mandate received funding from one of the vaccines’ manufacturers. “In the midst of a contentious debate about Chicago’s plan to force employers to require their workers to take the COVID-19 vaccine, Karen Freeman-Wilson, president of the Chicago Urban League, appeared on television to dismiss complaints that such rules would disproportionately harm the Black community.” She didn’t mention that her organization had received $100K from Pfizer to do exactly that. Other outfits receiving Pfizer cash while simultaneously promoting the vaccine: American Academy of Pediatrics, National Consumers League, The Immunization Partnership, American Pharmacists Association, American College of Preventive Medicine, Academy of Managed Care Pharmacy, American Society for Clinical Pathology, American College of Emergency Physicians, National Hispanic Medical Association. “The pharmaceutical industry remained largely in the background on these controversial mandate policies.”

*

Christopher M. Whaley, Sebahattin Demirkan & Ge Bai, “What’s behind losses at large nonprofit health systems?” Health Affairs, Apr 24, 2023 READ IT HERE

Ten of the largest nonprofit health systems report “financial strain driven primarily by investment losses” while revenue from providing care to patients was steady. And the investment losses occurred because Covid wrecked the economy. Ergo, the current system means that exactly when our healthcare needs are most acute—say, during a pandemic—hospitals are more likely to go into a financial tailspin. Why do hospitals have “investment portfolios” in the first place? Say the authors: “When losses are driven by risky financial investments, it is not clear whether completely effing insane that patients, employers, insurers, and taxpayers should be responsible for paying higher prices to offset the impact of market declines.” There, fixed that.

*

Heather Landi, “Nearly a third of nurses looking for the exit, survey shows. Here's what health systems can do to reverse the trend,” Fierce Healthcare, May 1, 2023 READ IT HERE

The key complaint heard again and again: understaffing leading to exhausting, stressful working conditions and demoralization. “Only 15% of hospital nurses say they will continue in the same job in one year.”

*

Jaclyn Diaz, “Nearly a third of nurses nationwide say they are likely to leave the profession,” NPR, May 2, 2023 READ IT HERE

Another take: “The staffing crisis didn’t just happen. It’s been around for years. Unions have been sounding the alarm that organizations were putting profits before patients.” Nurses complain they rarely have time for bathroom breaks or meals during their shifts. “First-and second-year nurses [are] leaving the profession at a higher rate because it’s not what they expected.” Eight of the 25 largest U.S. work stoppages in 2022 involved nurses.

*

Jake Offenhartz, “Low-income New Yorkers win the right to a root canal,” Associated Press, May 1, 2023 READ IT HERE

“A mouth with just four pairs of matching back teeth [was] considered ‘adequate for functional purposes,’ according to New York’s rules for Medicaid recipients.” And if you had eight functional choppers, you couldn’t get Medicaid to cover a root canal or a crown. That inhuman rule is now due to change, “expanding dental coverage for an estimated 5 million people.” But it took a 2018 lawsuit by the Legal Aid Society.

*

Kevin Walker, “Rural pharmacies at risk without reform,” Spokesman-Review [Spokane WA], Apr 30, 2023 READ IT HERE

A good summary of how PBMs screw local pharmacies: “Many pharmacists are familiar with the ‘cash-price conundrum,’ which is where some patients would actually pay less for their medications out-of-pocket without using their insurance coverage. Unfortunately, pharmacists who do point customers to lower out-of-pocket spending options have experienced retaliation from PBMs through excessive contracting fees, predatory audits, or other administrative penalties. Pharmacists can also get dropped from plan networks altogether, driving their customers elsewhere.” Monopolies can usually get their way. Walker is “a Yakama Nation descendant, raised on the reservation in rural Eastern Washington, and serves as president of RPhAlly, a pharmacy community striving to advocate for patients.”

*

Heather Landi, “CVS closes $10.6B acquisition of Oak Street Health to expand primary care footprint,” Fierce Healthcare, May 2, 2023 READ IT HERE

CVS Health also recently gobbled up home health company Signify for another $8 billion and now expects to have 300 clinics nationally by mid-decade. CVS also owns insurer Aetna and PBM Caremark. Its revenues have quadrupled under Obamacare.

*

Frank Diamond, “Michigan Blues plan takes Vermont Blues under its wing in affiliation deal,” Fierce Healthcare, May 1, 2023 READ IT HERE

Blue Cross and Blue Shield of Vermont (BCBSV) team up with Blue Cross and Blue Shield of Michigan (BCBSM) to “stay viable in a competitive market,” meaning concentrate or get gobbled up by larger fish. Vermonters will now be insured by a company in another state.

*

Spencer Kimball, “Eli Lilly Alzheimer’s treatment donanemab slowed disease progression in clinical trial,” CNBC, May 3, 2023 READ IT HERE

That’s according to the drug company standing to make billions but refusing to share the data justifying this assertion. This is journalism by corporate news release. Statements such as this lede: “Patients who received donanemab demonstrated a 35% slower decline in memory, thinking, and their ability to perform daily activities, according to clinical trial data from its maker, Eli Lilly.” No, that’s according to Lilly’s spin of the clinical trial data, which they’re not showing anyone yet. We have learned nothing from the Aduhelm debacle. Meanwhile, Lilly’s stock jumped 6%.

*

Sydney Halleman, “Microsoft, Epic partner to integrate Azure OpenAI into EHRs,” Healthcare Dive, Apr 17, 2023 READ IT HERE

Epic is an electronic records purveyor that will now partner with Microsoft’s artificial intelligence software. What could go wrong? One of the sparkly new tools will be “automatically drafted message responses,” which should reassure patients everywhere. What are the chances that these robotic messages will include, “No, you cannot have that procedure” and “Your payment is past due”?

*

Noam Levey, “Biden administration warns consumers to avoid medical credit cards,” Kaiser Health News/NPR, May 4, 2023 READ IT HERE

The Consumer Financial Protection Bureau says using these too-convenient payment methods can boost your overall payments by 25%. “Lending outfits are designing costly loan products to peddle to patients looking to make ends meet on their medical bills.” And guess who is big in the “patient financing” business? Private equity, of course. The cards are often marketed in doctors’ and dentists’ offices. A good way for hospitals to avoid steering patients to their required compensatory-care programs and wash their hands of the messy (and embarrassing) collections process.

*

Brian T. Horowitz, “Half of all Medicare beneficiaries are now enrolled in MA plans,” Healthcare Dive, May 3, 2023 READ IT HERE

MA now has more enrollees than original Medicaid.

*

SINGLE PAYER LINKS #300

Posted 28 APR 2023

*

Tami Luhby, “Republicans use debt ceiling bill to push work requirements for millions receiving Medicaid and food stamps,” CNN, Apr 26, 2023 READ IT HERE

There is a lot of to and fro in Washington that is superficially about the debt ceiling but really over all sorts of policy disputes. For example, the GOP is determined to force work requirements onto Medicaid and food stamp recipients despite the evidence that such measures are an administrative nightmare and mostly just punish poor people. (I suppose that’s the whole point.) “The House GOP package would jeopardize the health coverage of about 21 million people.” Most Medicaid beneficiaries already are employed but earn lousy wages.

*

Kyle Swenson, “Iowa to spend millions kicking families off food stamps. More states may follow,” Washington Post, Apr 16, 2023 READ IT HERE

File under: The beatings will continue until morale improves! While dumping millions off Medicaid, let’s take away their food aid as well. If that generates more drug overdoses and petty crime, all the better! The Iowa measure is “part of a broader national crackdown” on food stamps pushed by a network of conservative think tanks. The roll-purging will cost the state $6 million in new admin costs annually, compared to the $2.2 million Iowa spends to run the entire program.

*

Heather Landi, “Sanders, Cassidy reach deal to increase access to generic prescription drugs, reform PBMs,” Fierce Healthcare, Apr 25, 2023 READ IT HERE

Bernie is pretty good at forging cross-party alliances to push reforms. This multi-pronged assault on the abuses of the pharmacy benefit manager (PBM) system is stimulating howls of pain from same [see below]. Senators will review a package of measures in May, and the fact that Republicans are signing on means that even deep-pocketed lobbyists may not be able to blunt the momentum. An advantage is that everyone hates PBMs, including Pharma. Another bipartisan plan at the Senate Finance Committee suggests the PBMs will get it in the neck over anticompetitive practices that push up drug prices. Meanwhile, the FTC continues its PBM investigation.

*

Rebecca Pifer, “AHIP’s new ad spot targets pharma over drug costs as Congress scrutinizes PBMs,” Healthcare Dive, Apr 25, 2023 READ IT HERE

King Kong v. Godzilla: both want to convince you they’re on YOUR side against the greedy types—look over there! The PBM/insurers’ (AHIP) ad campaign includes such shameless sentences as this one: “Health insurance providers are your bargaining power, securing savings and providing more choices than ever before, helping you access quality care you can afford.” Bad guys? Pharma, not us. One important twist: the biggest PBMs are owned by insurers, so they get to gouge twice: CVS Caremark=Aetna; Express Scripts=Cigna; OptumRx=UnitedHealthcare.

*

Reuven Blau, “NY Hospitals on track to miss Hochul’s deadline to reopen psych beds,” The City, Mar 23, 2023 READ IT HERE

One-fifth of psych beds have been eliminated in New York State in the last decade as hospitals prefer to use them for pricey alternatives (like NY Presby’s spine surgery center) rather than the paltry Medicaid reimbursements available for treating the mentally ill. In the absence of hospital capacity, emergency rooms and prisons take up the slack. “Currently, over 50% of people in city jails have some type of mental health diagnosis with 16% deemed seriously mentally ill,” according to a NYC report.

*

Merrill Goozner, “Private equity and its hospitals,” Washington Monthly, Mar 24, 2023 READ IT HERE

How PE plunders hospitals for quick profit. The playbook is depressingly familiar—but it’s good that the practices are getting attention from more mainstream outlets like WM. Some states are trying to block the most egregious practices as the Feds stand by gawking.

*

Jonathan Lapook, Michael Kaplan & Sheena Samu, “‘Less about people and more about profits’: Investors’ role in next week’s closure of San Antonio hospital under scrutiny,” CBS Mornings, Apr 25, 2023 READ IT HERE

More attention to PE destroying safety-net hospitals, this time in heavily Hispanic San Antonio: sell the real estate to extract quick dividends, then force the hospital to rent its own space back and eventually collapse in a pile of debt. Pretend all along that “it’s for your own good.” Why is this legal? (In Rhode Island, the state can stop the practice—and did.) “Based in Birmingham, Ala., the publicly-traded Medical Properties Trust has bought up the real estate of nearly 200 U.S. hospitals, often in low-income communities.” Its CEO makes around $15 million a year. The ongoing abuses are finally getting some airtime.

*

Phil Galewitz, Lauren Sausser & Daniel Chang, “How a 2019 Florida law catalyzed a hospital-building boom,” KFF Health News/USA Today, Apr 26, 2023 READ IT HERE

Weird: some wealthy Florida communities have a surfeit of hospitals due to the state’s decision to go all cowboy capitalism in healthcare. While poor areas’ hospitals get shut down, new ones pop up in affluent neighborhoods. Georgia, Kentucky, and South Carolina are considering similar moves. “More hospital beds and services can actually boost the cost of patient care as pressure to recoup all that investment spreads through the system.”

*

Rebecca Pifer, “Hospitals look for immediate return on investments in tough operating environment,” Healthcare Dive, Apr 20, 2023 READ IT HERE

Note the Wall Street language that the health reporter and her sources seem completely comfortable using. ROI (Return On Investment) is corporate-speak tossed around among financiers. “Hospitals—especially large nonprofit systems with substantial cash pools—have been acting more like venture capitalists in recent years, ramping up investments in companies with products they can use and scale down the line.” How is being a “nonprofit system” consistent with “acting like venture capitalists”? The question doesn’t occur to anyone in the article, including the author.

*

Robert King, “Senator slams HHS’ implementation of No Surprises Act as ‘big mess’ after legal battles,” Fierce Healthcare, Mar 23, 2023 READ IT HERE

For some reason, the Biden Admin didn’t realize that forcing hospitals and PE-owned doctor groups into arbitration over how much money they would get out of us would lead to a flood of cases—10 times more than anticipated. The whole system got clogged up though now it’s supposedly doing better.

*

Alex R. Rosenblat, “I declined to share my medical data with advertisers at my doctor’s office. One company claimed otherwise,” STAT, Apr 7, 2023 READ IT HERE

“During my recent maternity leave, I spent most of my hands-free time trying to figure out why my doctors were trying to give my medical data away to advertisers—even after I opted out.” An amazing account of how hospital staff badgered this woman to agree to let advertisers snoop into her life. Shameful and instructive (she fought back successfully). Useful lesson: Do not believe the bright red “Required” highlights on the forms you sign, which may embed sneaky consents.

*

Julie Appleby, “The big squeeze: ACA health insurance has lots of customers, small networks,” Kaiser Health News/NPR, Apr 5, 2023 READ IT HERE

New ways for Obamacare policies to suck: people who have paid their premiums can’t find specialist doctors even when the plans list a bunch of them. While Covid boosted Obamacare enrollee numbers, the insurance companies have simultaneously shrunk their networks of allowed doctors and hospitals. Includes horror stories of people spending hours tracking down a doctor using inaccurate lists provided by their insurers. Even when they find a doc, patients face months-long waits. Zero oversight, zero enforcement.

*

Associated Press, “J&J proposes paying $8.9B to settle talcum powder lawsuits,” Apr 4, 2023 READ IT HERE

Johnson & Johnson had to earmark $9 billion to cover allegations that its talc-laced baby powder caused cancer after failing to get away with a Texas two-step bankruptcy scam. But it still gets to deny wrongdoing. Will a judge somewhere ever escalate beyond these cost-of-doing- business payoffs?

*

Chris Dodd, “How the U.S. health care system is like a Jackson Pollock painting,” STAT, Apr 5, 2023 READ IT HERE

HAHA: “When I envision the U.S. health care system, the first thing that comes to mind is splashes of color chaotically surrounding white space.” Most proposed fixes are aimed at isolated bits of that white space: “Hey, I’ll take this one disease, this one organ, this one unfilled niche, and develop a solution to effectively address it.” The underlying problem: fragmentation and complexity that keeps prices and admin costs high.

*

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

“The National Institutes of Health hasn’t signed up a single patient to test any potential treatments—despite a clear mandate from Congress to study them.” Plus, the NIH used a lot of the huge money dump to track symptoms instead of going straight to testing treatments, infuriating patients who need answers. Long Covid affects an estimated 16 million Americans and who knows how many more elsewhere. The billion-plus funding pot was unprecedented, but “more than two years in, the agency hasn’t started testing a single treatment. Nor is it planning to test many in the future.” On a separate but related topic: What about all the billions of public dough we poured into the vaccine owners’ coffers? Why aren’t they required to spend some of it following up given how easy it would have been to do randomized studies? Now, it’s probably too late, especially since we’re being told to forget about the whole episode. Signs of continued dysfunction in the NIH/CDC universe. Contrast with Operation Warp Speed to produce a vaccine and get everyone back to work.

*

Heather Landi, “AmerisourceBergen, TPG to acquire specialty practice network OneOncology in $2.1B deal,” Fierce Healthcare, Apr 25, 2023 READ IT HERE

More PE financiers figuring out how to profit off your cancer treatment regimen. What could go wrong?

*

Robin Buller, “In a liberal US state, my life-saving abortion cost $55,000,” Guardian, Apr 16, 2023 READ IT HERE

The other abortion restriction: our wacko health finance system. The author was “flabbergasted by the cost of medical care I could have died without.” Specifically, $55,000 in OR, hospital, and surgery charges. She grew up in Canada and therefore had a sane reaction to this madness.

*

SINGLE PAYER LINKS #299

Posted 7 APR 2023

*

Robert King, “CMS finalizes changes to Medicare Advantage star ratings, prior authorization reforms,” Fierce Healthcare, Apr 5, 2023 READ IT HERE

Finally, some good news (I think). The Feds will require that Medicare Disadvantage plans only use prior authorization “to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary.” That last phrase sounds like a big loophole, but let’s see if the insurers howl in outrage. There are also new restrictions on the crass and deceptive marketing practices that we so enjoy on late-night TV.

*

Jennifer Scholtes & Caitlin Emma, “15 budget asks that are actually Biden’s reelection pitch,” Politico, Mar 9, 2023 READ IT HERE

“Call it the reelection-bid budget,” meaning that the wish-list proposed by the White House includes plenty of stuff they have no illusions about achieving or even fighting for. But it will sound good in campaign ads. Some top features: measures to supplant Chinese suppliers (an easy win since China is the new hate object); guaranteed sick days and family leave (Manchin will kill that); taxes on stock buybacks (dead in the water).

*

Dylan Scott, “Biden’s budget goes all in on protecting Medicare. Just how much danger is it in?” Vox, Mar 9, 2023 READ IT HERE

The tired old debate about Medicare “going bankrupt” is being resuscitated in time for a new electoral cycle. Biden’s budget included a plan to “extend Medicare for another generation. The implication of Biden’s rhetoric is that Medicare faces impending extinction” and needs to increase its income stream somehow. That’s mostly BS, but count on everyone to indulge in alarmist demagogy. Here’s one detail that won’t get much airtime: “Medicare Advantage plans are more expensive to the government, and their growing enrollment is contributing to the solvency problem.”

*

Alice Mirando Ollstein, “Republicans take aim at Medicaid as budget talks heat up,” Politico, Mar 8, 2023 READ IT HERE

The budget is always time for GOP threats to Medicaid—the means-tested program is more vulnerable than sacrosanct Social Security and Medicare, which aren’t. Proposed cuts will be cast as efforts to “save” Medicaid by slashing it. Count on no discussion of the Trump tax cuts’ contribution to the ballooning federal deficit, which Dems could roll back but probably won’t.

*

Phil Galewitz, “Medicaid health plans try to protect members—and profits—during unwinding,” Kaiser Health News/Fortune, Mar 9, 2023 READ IT HERE

In that order? As 15 million people face getting booted from Medicaid, where is the debate? Alarm bells? Urgent calls for action? I guess because this affects mere persons rather than banks. Note that the surge in Medicaid enrollment “led to a windfall” for big Medicaid plans run by UnitedHealthcare, Centene, and Aetna. While only about 15–20% of enrollees are expected to end up completely uninsured, the “lucky” ones will face deductibles and copays that they escaped under Medicaid.

*

Shannon Muchmore, “CMS increases MA rate bump for 2024,” Healthcare Dive, Apr 3, 2023 READ IT HERE

MA crybabies got Daddy to refill the bottle: Medicare Disadvantage plans will now get a 3.3% increase instead of originally the proposed 1%. Sen. Warren estimated that overpayments to MA plans will total $23 billion this year though she didn’t specify how much of that would be due to fraud. Next up for MA: stop the government from demanding clawbacks of proven fraudulent gains from the past.

*

Kenneth E. Thorpe, “Biden’s latest drug price control plans threaten war on cancer, Alzheimer’s and more,” Healthcare Dive, Mar 31, 2023 READ IT HERE

Speaking of crybabies, here’s the line the Pharma snowflakes will be pushing for the next 100 years: No one will research new drugs if we have no chance of getting a private jet at the end! Boo hoo, wahhh! BTW, Thorpe is a Clinton Administration official, formerly the deputy assistant secretary for health policy at HHS, where he surely fit right in with the Medicare privatizers.

*

Arthur Allen, “Why does insulin cost so much? Big Pharma isn’t the only player driving prices,” Kaiser Health News/CNN, Mar 9, 2023 READ IT HERE

Last week, we noted how Mr Allen loaded up his copy with disparaging remarks about “fire and brimstone” Bernie Sanders. In this installment, Allen subtly goes to bat for Pharma. He can’t entirely acquit them of cashing in on insulin, whose average list price has risen 500% in the last two decades, but he can divert attention to the other “players,” namely, the pharmacy benefit managers (PBMs). “Drugmakers have long ceased to be the only, or even primary, villain of the insulin price scandal,” writes Allen. With spin skills like these, he has a bright future ahead of him. Meanwhile, “Germans with diabetes pay around $5 for a month’s worth of insulin. In the United Kingdom, patients pay nothing.” In any Godzilla v. King Kong fight, both sides can say true things while covering for their preferred plutocrats.

*

Stephanie Colombini, “High inflation and housing costs force Americans to delay needed health care,” NPR/WUSF/Kaiser Health News, Mar 10, 2023 READ IT HERE

“Horrible” housing costs squeeze health spending. The article’s featured Florida community (Sarasota) has seen rents rise by 50% during Covid, leaving residents dependent on free health services given that the state refuses to expand Medicaid. “In a recent Gallup poll, 38% of Americans surveyed said they had put off medical treatment last year due to cost, up from 26% in 2021.” Note that this tendency is independent of how many people are “insured,” American-style, i.e., stuck in plans that still cost money they don’t have.

*

Jessie Hellmann, “Noncompete rule puts doctors, hospitals at odds,” Roll Call, Mar 9, 2023 READ IT HERE

Doctors like the prohibition on noncompetes; hospitals hate it. And? When did bosses ever celebrate losing power over their workers? Side benefit: “The FTC estimated the proposed rule could reduce health care spending by $148 billion annually.”

*

Aneri Pattani, “$50 billion in opioid settlement cash is on the way. We’re tracking how it’s spent,” Kaiser Health News/NPR, Mar 30, 2023 READ IT HERE

Some states are keeping mum about how they’re distributing their share of the $54 billion coming to them from the opioid makers and distributors as “compensation” for the 250K people killed by their products (so far). The similar tobacco settlement bonanza led to all sorts of nefarious behavior, like states using the jackpot of cash to lower corporate taxes. How this one plays out will depend upon citizens raising hell. “With scant oversight nationwide, many people fear dollars may flow to efforts that research has proven mostly useless but jibe with the local political bent, like arresting people who use drugs, expanding jails, and favoring abstinence-only recovery over medications.”

*

Sydney Halleman, “Sanford, Fairview delay merger indefinitely; Minnesota AG continues review of deal,” Healthcare Dive, Apr 4, 2023 READ IT HERE

Pressure from Minnesota officials is cooling the merger frenzy in the state—perhaps a sign of more vigorous local action in parallel with the reawakened Federal Trade Commission.

*

Rebecca Pifer, “Study finds ‘ubiquitous’ third-party tracking on hospital websites, compromising user data,” Healthcare Dive, Apr 4, 2023 READ IT HERE

Egad: “Almost 99% of hospital websites include tracking software that transfer data to third parties, including technology and social media companies, data brokers, advertisers, and even private equity firms.” How is this legal? Well, HIPAA “doesn’t cover many health actions taken online”—like your telehealth therapy session. Patiens emptor. Original study (paywalled) here: READ IT HERE

*

Gerard F. Anderson, Peter Hussey & Varduhi Petrosyan, “It’s still the prices, stupid: Why the US spends so much on health care, and a tribute to Uwe Reinhardt,” Health Affairs, January 7, 2019 READ IT HERE

Wonky but illuminating. A seminal article from 15 years ago (Reinhardt) argued that despite ever-increasing prices, the U.S. was not ipso facto devoting more resources to healthcare. This article updates and confirms it: we pay a lot more and get nothing better than the countries who shell out half or a third as much. The numbers are appalling: we spend over $1K per capita on pharmaceuticals v/s the EU’s $400. Our average hospital bill is over $20K; Europe’s is half that. Admin costs are $737 per capita compared to the OECD average of $94. Et cetera.

*

Arielle Dreher, “State public option plans keep hitting obstacles,” Axios, Mar 24, 2023 READ IT HERE

Some people knew the “public option” was a head-fake from the get-go, but it worked to cover the Obama team’s collective bucket as it censored any discussion of single-payer in the run-up to passing the ACA. Now, the attempt to set up competition through public insurance programs within a multi-payer market are “stalling in the face of resistance” from providers and insurers who “aren’t going to willingly cooperate with programs that threaten their profits and revenues.” Who could have ever predicted that? Biden is shameless enough to try to trot it out again next year unless someone tells him to get stuffed.

*

Ahmed Aboulenein, “Alzheimer’s Association lobbies for Medicare coverage of Leqembi and other drugs,” Reuters, Mar 16, 2023 READ IT HERE

Weaponization of suffering patients by Pharma: “The Alzheimer's Association has deployed 1,000 people diagnosed with or caring for someone with the disease to meet with all 535 members of Congress and urge them to press Medicare for early access to a new class of drugs that promise to slow the disease.” A “promise,” that is, from the Pharma owners who stand to make a killing on them and who slip millions to the Association. The drugs in question rely on an unproven (even discredited) amyloid plaque theory of Alzheimer’s, which means we could shell out billions for years on a useless pill. Why don’t single-payer advocates mount a counter-lobbying campaign against spending Medicare billions on such thin evidence?

*

Robert King, “FDA’s Robert Califf calls on insurers to help providers participate in critical clinical drug trials,” Fierce Healthcare, Mar 16, 2023 READ IT HERE

The former FDA chief says insurers should share the costs of post-approval drug trials that are often mandated and just as often never completed. The Feds proposed to cut Medicare payments to accelerated approval drugs until a confirmatory trial is complete, giving drugmakers “an incentive to finish the trial.” Meaning that now there isn’t any.

*

Will Bauer, “St. Louis health director urges caution as hospitals drop mask requirements,” St Louis Public Radio, Mar 16, 2023 READ IT HERE

More hospitals are tossing the masks now that Covid is so last year. Given that Covid spreads during the asymptomatic phase, what will they do if there’s a new outbreak that will appear only when already out of control?

*

Bram Sable-Smith, “Temp nurses cost hospitals big during pandemic. Lawmakers are now mulling limits,” Kaiser Health News/USA Today, Mar 17, 2023 READ IT HERE

Various states are considering anti-price-gouging measures against staffing agencies that made out like bandits during the Covid emergency. Interesting that pols would consider interfering in the market for nurses when they would never dream of doing the same for doctors or rein in healthcare financial engineering by private equity. And how many states moved to protect nurses when the conditions of their jobs were so dangerous?

*

Sandhya Raman & Ariel Cohen, “OB-GYN workforce shortages could worsen maternal health crisis,” Roll Call, Mar 16, 2023 READ IT HERE

What med student would go into OB-GYN care in the current environment? Only a dedicated warrior for reproductive health prepared for a career fraught with shifting rules and the permanent danger of prosecution. The shortage comes “at a time when cesarean delivery, preterm birth rates, and low birth weights are all increasing.” Half of all U.S. counties currently lack a single OB-GYN. Another problem: impossibly low Medicaid reimbursement rates.

*

Robert Higgs, “600 hospitals in danger of closing, per study: Is yours on the list?” cleveland.com, Mar 16, 2023 READ IT HERE

Many of them are in rural or low-population areas. Two hundred are at “immediate risk” of shutting down, and many also manage the only primary care facility in the area. A market-based system cannot serve its rural population in part because the “standby capacity” critical for community wellbeing is uneconomic.

SINGLE PAYER LINKS

Posted 31 MAR 2023

*

Dave Muoio, “Taxpayers shouldn’t foot the bill for health systems’ massive 2022 investment losses, health economists say,” Fierce Healthcare, Mar 24, 2023 READ IT HERE

That flurry of news about hospitals losing large sums sounds dire until you read the fine print about how often it involved tanking stock portfolios. The top 10 largest hospital systems had big overall losses but “patient care revenue obtained by providing hospital services rose by just under 1%.” Smaller hospitals are a different story (see below), but the Feds should let these casino gamblers swallow their losses.

*

Sharon LaFraniere, “‘We’re going away’: A state’s choice to forgo Medicaid funds is killing hospitals,” New York Times, Mar 28, 2023 READ IT HERE

How Mississippi carries on a war against its poor: small, rural hospitals face annihilation while the state refuses an infusion of federal Medicaid funds. “States that opted against Medicaid expansion or had just recently adopted it accounted for nearly three-fourths of rural hospital closures between 2010 and 2021.” The 100K Mississippians who would qualify for expanded Medicaid have “death rates at or near the nation’s highest for heart disease, stroke, diabetes, cancer, kidney disease and pneumonia. Infant mortality is also sky-high, and the Delta has the nation’s highest rate of foot and leg amputations because of diabetes or hypertension.” Nothing to see here, just poor people dying young, 60% of whom are Black. The state has a nearly $4 billion budget surplus, but Gov. Reeves wants to use it to eliminate the state income tax rather than providing care for which the Federal Government picks up 90% of the cost.

*

Karen Tumulty, “Expanding Medicaid is a good deal. So why are some states holding out?” Washington Post, Mar 29, 2023 READ IT HERE

Now that North Carolina has voted to expand Medicaid, only 10 states resist the standing offer of hundreds of millions in Federal aid. How NC built the coalition and persuaded the ideologues to look at facts is interesting, but this writer never answers her own question. The usual anti-expansion arguments are about “entitlements, welfare, and tax increases.” Could it really be so simple and banal?

*

Katy Golvala, “Boost to CT Medicaid rates could mean more access for patients,” CT Mirror, Mar 24, 2023 READ IT HERE

How to keep providers in the Medicaid system: improve reimbursements. Connecticut is providing “the broadest [rate] increases for physician services in over 15 years” for the state’s Medicaid program known as HUSKY, which serves a quarter of CT residents. Payments will gradually rise to match Medicare’s by 2028.

*

Alan Condon & Giles Bruce, “Lina Khan’s FTC has challenged health system mergers—but not disruptors,” Becker’s Hospital CFO Report, Mar 24, 2023 READ IT HERE

The authors point out that while the Federal Trade Commission (FTC) has vigorously acted to stop hospital mergers, the agency has been less pro-active in stopping big retailers like Amazon and CVS from entering the healthcare field through acquisitions. One explanation is that the FTC is having a hard time finding a legal theory for those cases since they couldn’t cogently argue which part of the market would be monopolized. On the other hand, they can—and do—act on misuse of patient data. The FTC recently warned Amazon not to use patient data “for marketing or advertising purposes.” Perish the thought!

*

Michael Hiltzik, “The drug-pricing follies,” Los Angeles Times, Mar 24, 2023 READ IT HERE

Subhead: “Biden blows a chance to force a price cut on a crucial cancer drug by 80 percent.” Details the Biden Administration’s failure to get tough with the owners of prostate cancer drug Xtandi—developed with federal grant money—that lists for $189K here v/s $32K in Canada. The government has what are called “march-in rights” to pharmaceutical products developed with federal cash, and Xtandi was a perfect test case because the Feds’ role in its creation is not in debate. But the government has never, ever used its powers on any drug. Nonetheless, we will hear endless psalms about how tough this White House is on Pharma next year.

*

Adam Cancryn & Lauren Egan, “The Covid vaccine king on Biden world’s nerves,” Politico, Mar 22, 2023 READ IT HERE

Why did nobody in the White House rush to Moderna’s defense when Bernie lit into its plutocrat CEO in a hearing? Turns out even Biden thinks the company is piggish, which is saying a lot. “Inside the administration, Biden officials openly complained about Moderna’s hardball negotiation tactics and characterized its representatives as difficult to deal with.”

*

Patrick Rucker, Maya Miller & David Armstrong, “How Cigna saves millions by having its doctors reject claims without reading them,” ProPublica/Capitol Forum, Mar 25, 2023 READ IT HERE

“Cigna doctors reject patients’ claims without opening their files.” How is this legal? (Apparently, it’s not, but where’s the enforcement?) A patient—who is also an MD—was suspicious about a claim denial and discovered that the “doctor” who denied his claim had single-handedly rejected another 60,000 in one month. It works like this: “A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off.” Unfortunately, we have no crusading prosecutor ready to perp-walk somebody for these batch-denials. The automated-fraud system is called “PXDX” and was developed by a guy working for private equity Blackstone. Cigna loves the process because the denials are for relatively small amounts that patients infrequently appeal.

*

Matt Stoller, “The monopolies behind the Adderall shortage,” BIG, Mar 25, 2023 READ IT HERE

Another story of automated decision-making that’s good for corporate earnings and hell for people. In the wake of the Pharma-driven opioid disaster, the burden of proof is now on wholesalers to show that they’re not dispensing too many dangerous drugs. Therefore, any distribution of a drug like Adderall can trigger a tripwire notification that they are shipping too much restricted stuff. Instead of installing a careful review system, it’s easier for a wholesaler to stop handling sensitive drugs at all. “They arbitrarily stiff pharmacies who increase the amount of controlled substance they dispense” through computer-generated algorithms. Result: “Drugs are cut off with no advance notice or rapid recourse,” and people who legitimately need them are SOL. Underneath it all is the problem of industry concentration: just three companies control over 85-90% of all pharmaceutical distribution. A dense but highly educational article (like Stoller’s entire Substack).

*

Hailey Mensik, “Ohio AG sues ‘modern gangsters’ Cigna, Humana for alleged PBM price fixing,” Healthcare Dive, Mar 28, 2023 READ IT HERE

Amazing language from a bright-red state: A-G Yost called pharmacy benefit managers (PBMs) gangsters “[who] scheme in the shadows to control drug prices.” PBMs aren’t popular these days and are throwing a bucketful of cash into lobbying and PR. In this case, Ohio accuses them of setting up a group purchasing company based in Switzerland to secretly share price information, i.e., illegal market manipulation. Yost casts his case as a defense of “mom-and-pop pharmacies in rural Ohio.” Since Ohio is a GOP dictatorship, it will be interesting to see if this populist assault can withstand corporate pressure.

*

Haley Ott, “Ozempic-like weight loss drug Wegovy coming to the U.K. market, and it will cost a fraction of what Americans pay,” CBS News, Mar 3, 2023 READ IT HERE

The British National Health Service will list Wegovy for about $88 per pack of four pre-filled injection pens versus a list price of $1,349 in the U.S. for the same product. However, aside from the usual price-gouging, this sidesteps the issue of whether we should be mass consuming weight-loss drugs in the first place.

*

Daniel J. Stone, “How has American healthcare gone so wrong?” Los Angeles Times, Mar 4, 2023 READ IT HERE

“The way the U.S. distributes and pays for healthcare makes it the most expensive failed enterprise in the history of human civilization.” And this from an internal medicine doc who practices in Beverly Hills, no less. His litany of complaints: huge obstacles to mental health care despite a “deluge of demand”; crazy drug costs; the even crazier two-tier hospital revenue system. The author predicts that only a “national calamity” will overturn the status quo. Apparently, a million deaths from an infectious disease didn’t qualify.

*

Yonat Shimron, “For many congregations, wiping out medical debt has become a popular calling,” Religion News Service, Mar 1, 2023 READ IT HERE

Here’s a classic case of why poor people welcome charity but would prefer justice. Churches and synagogues often buy up medical debt for pennies on the dollar and provide relief to those burdened by it. “Helping ease medical debt, especially for people of color, is an increasingly popular social justice project among liberal Christian, Jewish, and Muslim congregations. Some 800 U.S. congregations have partnered with RIP Medical Debt to do so.” That’s nice. Now, how about a theology lesson on why the very existence of medical debt is a sin?

*

Lev Facher, “How the drug industry uses fear of fentanyl to extract more profit from naloxone,” STAT, Mar 28, 2023 READ IT HERE

“Pharmaceutical companies have used the opioid crisis and the nation’s fear of fentanyl to aggressively market high-cost naloxone products that divert resources away from cheaper forms of the lifesaving medication. These expensive new products serve largely as an excuse to charge exorbitant prices for a medication that has been off patent for nearly 40 years.” Now, you can buy a mechanized Narcan injector with robotic voice instructions and higher-dose formulations that don’t work any better. Stand by for the ads telling us that these products are better than the off-patent ones. But if your school, police department, or public health officials want to buy this expensive crap, object loudly!

*

Benjamin Ryan, “California’s plan for cheaper insulin collides with Big Pharma’s price cuts,” New York Times, Mar 24, 2023 READ IT HERE

Whaddaya know, just when California decided to put teeth into its pleas for lower insulin prices by producing its own, the Big 3 insulin price-gougers decided to drop their prices, a classic monopoly move to squeeze out competition. Nonetheless, the plan is going forward and could provide more opportunities to disrupt the insane death-grip of Pharma on drug prices. Currently, “14 percent of insulin users spent more than 40 percent of their disposable income on the drug.”

*

Annie Burky, “Physicians are twice as likely as the general population to attempt suicide, Medscape survey finds,” Fierce Healthcare, Mar 3, 2023 READ IT HERE

“The trauma from COVID-19 didn’t disappear just because the full ICUs did.” Nearly 10% of surveyed physicians reported suicidal ideation, and a quarter reported clinical depression. One cause: “a fractured healthcare system that virtually guarantees moral distress.” Many avoid treatment for fear of professional consequences, like involuntary detention or reporting of psych meds to state boards.

*

Richard Gilfillan & Donald M. Berwick, “Born on third base: Medicare Advantage thrives on subsidies, not better care,” Health Affairs, Mar 27, 2023 READ IT HERE

A very wonky but fascinating explanation of how MA plans are allowed to miscalculate their alleged savings when compared to traditional Medicare and thus submit bids that distort reality and “earn” rebates that now average $164 per beneficiary (i.e., a profit goldmine). “A close examination of the bid process reveals that most of these savings are artifacts of the process and not due to better or more efficient care. The inflation of benchmarks and risk score gaming finance the rebates that drive MA market success. . . . The bottom line: we are systematically driving people out of TM by subsidizing the more expensive MA.” As more seniors flood into MA plans, we will see increased overall costs, no improvement in outcomes, and further pressure to “save” Medicare with additional privatization.

*

Emily Kopp & Karolina Corin, “‘They should do decent science’: Report on raccoon dogs and Covid origins spurs ethics flap,” U.S. Right To Know, Mar 24, 2023 READ IT HERE

This is ostensibly about a breach of protocol on data use, but it sure looks as though the underlying story is a rush to discredit the lab-leak theory of Covid. “A handful of virologists has twice used unpublished China CDC data to advance the idea that COVID-19 comes from a wet market.” The “prominent Western virologists” who grabbed the Chinese data and used it to flog this new “raccoon dog” theory (forget those pangolins and bats) are among those who pumped up the 2020 experts letter pooh-poohing the lab leak as a conspiracy theory. They insisted in another article a year ago that the natural cause/wet market origin theory was a slam-dunk. “The researchers who reported the data have a documented track record of exaggerating their findings, concealing doubts about their findings, and hiding major conflicts of interest.” In other news, six guys on a yacht blew up the Nord Stream 2 pipeline, BWAHAHA.

*

SINGLE PAYER LINKS #297

Posted 24 MAR 2023

*

Gary D. Robertson, “NC approves Medicaid expansion, reversing long opposition,” Associated Press, Mar 24, 2023 READ IT HERE

A prodigal state sees the light! Slay the fatted calf! North Carolina joins civilization after a decade of debate. It will mean help for 600K new Medicaid enrollees and comes with support from a comfortable majority of Republicans in the legislature, especially those representing rural areas where hospitals are teetering on the brink. Contact with reality swayed some of the ideological opponents of expansion: “A turning point came last May when Senate leader Phil Berger, a longtime expansion opponent, described the situation faced by a single mother who didn’t make enough money to cover insurance for both her and her children, which meant that she would either end up in the emergency room or not get care.” It took him a decade to figure that out? Berger should get out more.

*

Arthur Allen, “Sen. Sanders shows fire but seeks modest goals in his debut drug hearing as Health chair,” Kaiser Health News, Mar 23, 2023 READ IT HERE

This KHN reporter sprinkles unusually insulting language into his coverage of Bernie’s lifelong positions: Bernie’s “harsh attacks” are “moralizing” and like “fire and brimstone”; he “bullies his way” toward results and “excoriates” Pharma. Tell us how you really feel! His target was the CEO of Moderna who pulled down a tidy $400 million last year and is sitting on another $3 billion in stock options while refusing to acknowledge how much government funding enabled him to make a fortune. But for this scribe, that doesn’t merit any “harsh moralizing” from Bernie. Let’s follow Arthur Allen’s career as he rises through the specialty health media ranks with this kind of corporate-friendly coverage.

*

Alan Yu, “Medical residents unionize at hospitals around the country,” NPR/WHYY, Mar 23, 2023 READ IT HERE

As doctors lose independence and become subject to corporate discipline, unionization is catching on, especially among younger MDs. Recent successful union drives have occurred at Penn Medicine, Stanford, New York’s Montefiore, University of Vermont Medical Center, Jersey City Medical Center, George Washington University Hospital in Washington, DC, and Mass General Brigham in Boston. This article highlights residents, who face 80-hour work weeks as well as a dismissive attitude toward their complaints. Penn, for example, just opened a billion-dollar hospital that has no rest quarters for residents on 24-hour shifts.

*

Christian Rose, Adaira I. Landry & Kaitlin M. Bowers, “Will there be any emergency doctors to see you in the future?” STAT, Mar 20, 2023 READ IT HERE

ERs are a mess: they’re short on staff while experiencing increased visits; they have to deal with productivity “metrics” to satisfy the upstairs bean counters; providers are burnout and burdened with student loans and malpractice insurance, and it’s all is aggravated by the private equity invasion. Now add abandonment of the specialty by medical students. No wonder that the three ER doc authors are worried and contemplating “an emergency medicine physician union to address these issues.”

*

Gabby Birenbaum, “How Medicare Advantage could become a marquee issue in Nevada's 2024 Senate race,” Nevada Independent, Mar 22, 2023 READ IT HERE

Attack ads characterize moves to stop Medicare fraud as “cutting benefits.” The cynicism is breathtaking. Front groups funded with insurance money are already slamming pols who want the government to rein in illegal coding practices. They argue that taking away money from insurers equals reducing care—which is remarkable logic and rather threatening, when you think about it. MA plans got an 8.5 percent raise last year, but they’re howling about only getting 1 percent this year.

*

Reed Abelson & Margot Sanger-Katz, “Biden plan to cut billions in Medicare fraud ignites lobbying frenzy,” New York Times, Mar 22, 2023 READ IT HERE

Big insurance is orchestrating a massive campaign to flood Medicare administrators with hostile comments on the crackdown against Medicare Advantage fraud. No matter that most of the top MA providers have had to pay big fines to settle lawsuits for upcoding violations. The way the fraud works is that MA docs diagnose vascular disease or diabetes with complications on anyone with a pulse and then collect higher per capita reimbursement rates. Some doctors’ practices get paid a percentage of premiums, so they have an incentive to play along. However, support for MA may be softening among some Democrats—perhaps because they finally learned what a scam it is. But given Democrats’ longstanding support for privatization, they’ll have a hard time articulating a credible message to voters.

*

Trudy Lieberman, “One way or another, the federal government is still bent on pushing Medicare into private hands,” Center for Health Journalism, Jun 22, 2023 READ IT HERE

From last year, good for a refresher on Medicare Disadvantage/ACO REACH and similar privatization maneuvers: “Transforming Medicare into a program managed by private insurers has been a long-sought goal of politicians, dating back to House Speaker Newt Gingrich in the 1990s and embraced by successive administrations. The Biden administration is no exception and has set a goal of placing all Medicare beneficiaries in one of these so-called ‘value-based care’ arrangements by 2030.” The article traces the current privatization strategy to a provision of Obamacare that mandated “innovations” that would save the program money.

*

Cheryl Clark, “Medicare plan commissions may steer beneficiaries to wrong coverage,” MedPage Today, Feb 28, 2023 READ IT HERE

Subhead: “Opaque, misaligned agent incentives influence enrollment choices.” Health insurance is such a nightmare of confusion that people often seek “expert” advice without realizing that the experts have their own interests, namely commissions up to three times higher for getting them into Medicare Disadvantage. Why is this legal? Probably because Medicare officials want people to be pushed into for-profit plans. A telling detail: “For themselves, most brokers and agents said they would reject MA plans in favor of traditional Medicare with a Medigap.”

*

Max Bayer, “Dunn with the FDA: Head of agency’s neuroscience unit to depart,” Fierce Biotech, Feb 27, 2023 READ IT HERE

Discredited FDA official Billy Dunn, who shoehorned the probably useless Alzheimer’s drug through the approval process (and caused a huge PR debacle for the agency in the process), quietly decamps for greener pastures. An investigation by Stat News uncovered all sorts of back-channel dealings between Dunn and the drugmaker, which explained why the FDA ignored its own expert panel and approved the drug. Dunn might be heading for a big reward from Pharma somewhere—or maybe he’ll just be dumped because he got caught.

*

Jon Schwarz, “Hooray, we now have Medicare for All (bank deposits),” The Intercept, Mar 13, 2023 READ IT HERE

Snark alert: obviously not really health coverage for all people, only deposit coverage for all banks. The argument: “If the government is going to guarantee all bank deposits, then much of the banking industry is parasitical and should be euthanized.” Ditto the health insurance companies where “the logic likewise inexorably points to universal insurance funded and supervised by the government.”

*

John Gever, “Docs’ liking for knee injection tied to industry payments,” MedPage Today, Mar 20, 2023 READ IT HERE

Yet more evidence that those little favors handed out by Pharma reps actually do cause doctors to buy their products—in case there were any lingering doubts. “Physicians accepting payments from drug and device companies administered significantly more [3X as many] hyaluronic acid (HA) injections to Medicare beneficiaries for knee osteoarthritis.”

*

Lambert Strether, “New, buzzy Cochrane study sets the ‘fool’s gold’ standard for anti-maskers,” Naked Capitalism, Feb 27, 2023 READ IT HERE

The Cochrane review got big coverage as “proof that masks don’t work” even though the meta-analysis didn’t say that. Bret Stephens in the Times pushed that lie. (This week, Stephens wrote, “20 Years on, I Don’t Regret Supporting the Iraq War,” so there’s that.) The tendentious coverage fit the desired narrative—Nothing to see here, move along—vis-à-vis masking and Covid in general. Strether also notes the links between key authors and the dark-money-funded Brownstone Institute, so there are also questions of intellectual integrity. Dense but worth a read to see how The Science™ continues to be manipulated, pureed, and turned into a tasty smoothie for mass consumption. In comments, Strether adds, “One might almost imagine propagating [the masks-don’t-work] talking point was the whole point of the study as opposed to any serious analysis or science.”

*

Paige Minemyer, “A look at how payer executives are thinking about novel, high-cost therapeutics,” Fierce Healthcare, Mar 15, 2023 READ IT HERE

“The high cost of new therapeutics [drugs] may lead to access being restricted largely to the wealthiest patient groups.” Insurance companies are worried about Pharma gouging and preparing to deny coverage to protect their profits. No surprise there—but who will step in to drag prices down? A smaller insured pool is vulnerable to these crazy-expensive drugs because one or two members who need them can bankrupt it.

*

Robert King, “CMS: ‘Astronomical’ volume of surprise billing dispute cases taking toll on agency,” Fierce Healthcare, Mar 16, 2023 READ IT HERE

The No Surprises Act set up an arbitration process to force insurers and providers to stop saddling patients with huge bills through in-network/out-of-network trickery. The process then promptly broke down as submitted claims turned into a flood. Add legal challenges, and you have a big mess—and King Kong and Godzilla have to fight each other now that they can’t just stomp on the mini-bipeds down there, i.e., patients.

*

Dave Muoio, “CMS gives an early look at how it plans to negotiate Part D drug prices in 2026,” Fierce Healthcare, Mar 15, 2023 READ IT HERE

Meanwhile, the Feds are slowly setting up another negotiation process—to determine a “maximum fair” price for the 10 drugs newly subject to Medicare bargaining—providing ample opportunities for tweaking and lobbying by drug owners to preserve their pricing impunity. The VA is the only agency that can negotiate drug prices now, so Pharma will throw everything at this innovation to defang it.

*

Marc S. Ryan, “A Republican argument for affordable universal healthcare,” MedPage Today, Mar 10, 2023 READ IT HERE

The author lines up the well-known arguments against continuing down the current path of payer dysfunction. He assures us that “universal” coverage is not socialism (whew!). He then further reassures us that covering everyone won’t sidestep “personal responsibility,” so important to prevent the undeserving poor from getting sick on purpose. After this lengthy preamble, where’s the beef? His “three pillars for healthcare reform” are: cost reduction, “pivoting from utilization management to care management,” whatever that means, and “affordable universal coverage and access.” That’s it, no detail, no definitions. This passes for a “Republican argument”? Or any argument?

*

Tara Bannow, “Same patient, same drug, same insurer—coverage denied,” STAT, Mar 2, 2023 READ IT HERE

“A window into the confounding, seemingly irrational world of insurance coverage, one that’s given rise to a network of billing gurus dedicated to helping patients fight denials.” The underlying problem: Pharma pricing impunity.

*

Bernard J. Wolfson, “California’s Covid misinformation law is entangled in lawsuits, conflicting ruling,” California Healthline/Desert Sun/Kaiser Health News, Mar 17, 2023 READ IT HERE

Criminalizing “false” information means somebody has to determine “truth” and enforce it. In the Covid universe, that has meant whatever the Fauci/CDC/White House gang determines—even when they’re proven wrong later. Democrats no longer believe in the free exchange of dangerous ideas. Luckily, Guantánamo is still open to receive offenders!

*

SINGLE PAYER LINKS #296

Posted 17 MARCH 2023

*

Mark Pazniokas, “Lamont administration takes aim at hospital and drug costs,” CT Mirror, Feb 21, 2023 READ IT HERE

Something interesting is happening in Connecticut: Governor Lamont seems to be challenging business as usual in Pharma and the hospital industry. An advisor dared to say, “When the market is not working, states can take action.” The first targets: outpatient “facility fees” and a cap on out-of-network patient costs. The state is also looking at the possibility of joining an initiative by Nevada, Oregon, and Washington to bulk purchase generic drugs. Expect howls of outrage, especially from the increasingly concentrated CT hospital sector.

*

Mark Pazniokas, “Legislators question Lamont’s approach to cutting health costs,” CT Mirror, Mar 13, 2023 READ IT HERE

On cue, heels dig in against Lamont’s cost-cutting moves. “The administration’s aggressive stance on health costs rattled hospitals.”

*

Katy Golvala, “AG Tong: Plaintiffs have standing in Hartford HealthCare antitrust case,” CT Mirror, May 14, 2023 READ IT HERE

The state is also taking a hard line on hospital consolidation. A lawsuit, joined by the state attorney-general, “alleged the network uses its market dominance to charge higher prices to the state’s commercially insured residents.” Whether the case succeeds in court or not, the tougher posture is signaling that mergers are not going to get a free pass.

*

Associated Press, “Catholic system pulls out of Connecticut hospital merger,” Mar 15, 2023 READ IT HERE

The hostile environment for new mergers is reflected in Covenant Health’s decision to abandon a proposed acquisition. In addition to the state’s unhappiness with hospital concentration, there is the added concern about a Catholic system blocking reproductive health options for Connecticut women.

*

Lauren Sausser, “Feds move to rein in prior authorization, a system that harms and frustrates patients,” Kaiser Health News/CNN, Mar 13, 2023 READ IT HERE

Prior authorization “has exploded in recent years,” and people are pissed about it. New rules (starting in 2026!) would force a slightly faster response for routine procedures although the underlying cause— commercial medicine that incentivizes denial of care—remains unaddressed. States are moving much more decisively: “In Oregon health insurers must respond to nonemergency prior authorization requests within two business days. In Michigan, insurers must report annual prior authorization data, including the number of requests denied and appeals received.” Insurance companies often take weeks to respond. The delays and denials force patients and providers to spend hours fighting over care and often simply give up.

*

Jeff Lagasse, “Medicare Advantage plans denying more inpatient claims,” Healthcare Finance News, Feb 21, 2023 READ IT HERE

From February, still germane. Claims denials by insurers are growing in the Medicare Disadvantage sector—big surprise. “Through November of 2022, the initial inpatient level-of-care claim denial rate for MA plans was 5.8%, compared with 3.7% for all other payer categories.” The nasty little secret of the “immensely popular” MA plans only reveals itself when you get sick and start facing prior authorization obstacles and denials.

*

Casey Ross & Bob Herman, “Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need,” STAT, Mar 13, 2023 READ IT HERE

“Artificial intelligence is now driving their denials to new heights in Medicare Advantage,” which is probably inevitable since the perverse incentives embedded in the program make denials of care a top priority. Why not turn it over to machines? “Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient’s treatment.” Appeals can last for years while patients have to shell out from their own resources. Meanwhile, insurers can bank on the appeal outlasting the beneficiary. Insurance companies are deploying AI to “make life-altering decisions with little independent oversight. The black box of the AI has become a blanket excuse for denials.” Famous last words of an affected beneficiary: “I just never thought when I signed up for Medicare Advantage that I wouldn’t be able to get the care I need.”

Incidentally, a big player in AI-generated denials is NaviHealth, owned by UnitedHealth Group. “NaviHealth started making its sales pitch to Medicare Advantage plans: Let us manage every piece of your members’ care for the first 60 to 90 days after they are discharged from the hospital, and we’ll all share in any savings.” Everybody wins—except patients.

*

Dave Muoio, “DaVita, Fresenius’ kidney care charity connections trigger another investigation,” Fierce Healthcare, Feb 24, 2023 READ IT HERE

Two dialysis giants are under investigation in the District of Columbia over their “relationship with and donations to the nonprofit American Kidney Fund (AKF).” A whistleblower said AKF was “improperly steering charity care patients” toward the two companies as a quid pro quo. Medical providers and especially pharmaceutical companies often hijack patient-advocacy groups to turn them into fronts for their products. DC raising the anti-competitiveness issue is an interesting twist.

*

Leonard Rodberg, “The city and its unions declare war on their retirees,” New York Daily News, Mar 8, 2023 READ IT HERE

An excellent summary with historical details on NYC’s attempt to cram retirees into Medicare Disadvantage in breach of their long-standing contracts. The fight is over the 20% of costs that traditional Medicare doesn’t cover and which the retirees had won as a permanent benefit (in exchange for foregoing wage demands). The new costs for avoiding MA hell will be 5K to 6K a year per retiree. How the city poohbahs think they’ll save money by shoehorning a for-profit agency between retirees and providers is a mystery—except that it’s not. They know the so-called beneficiaries will just get lousier services and be saddled with copays, prior authorizations, and other care-denying trickery.

*

Alfred Engelberg, “Clearing the patent thicket: A pathway to faster generic drug approvals,” STAT, Mar 10, 2023 READ IT HERE

Describes the way Pharma uses patent trickery to block competitors. They make “small changes to a previously patented drug that have no material effect on its safety or effectiveness and then acquire trivial patents on those changes.” A loophole in the law, misinterpreted by the industry-captured FDA, enables drug companies to throw up these bogus claims to delay generic competition. They eventually lose in court but keep the ill-gotten gains. “Revelations that AbbVie, the manufacturer of Humira, made more than $100 billion in extra profits by abusing the patent system to delay generic competition has spurred efforts by the Biden administration and Congress to limit the length of patent monopolies over prescription drugs.” Good luck dismantling the system in the face of deep-pocketed lobbyists.

*

Nathaniel Weixel, “Veterans Affairs will cover pricey experimental Alzheimer’s drug,” The Hill, Mar 14, 2023 READ IT HERE

This smells funny. The new “miracle” Alzheimer’s drug (Leqembi) has all the same problems as Aduhelm, and Medicare is treating it the same way—reimbursement only for clinical trials. It uses the same discredited amyloid plaque theory of Alzheimer’s causation and has the same potentially dangerous side effects. In addition, the trial results are based on equally subjective and dubious measurements. Yet the VA will pony up $26,500-per-year for it. Aduhelm benefited from agency insider manipulation—will we discover something fishy about this Leqembi approval long after the drug’s owners have made their millions?

*

Paige Minemyer, “Senators urge CMS to rethink narrow Medicare coverage for Alzheimer's drugs,” Fierce Healthcare, Feb 21, 2023 READ IT HERE

Twenty Pharma shills in the U.S. Senate clamored for Medicare to pony up for the turkey drug Aduhelm that probably doesn’t work and could kill you. Among the sleaze-merchants: Susan Collins, Amy Klobuchar, and a dozen other reliably corrupt Republicans.

*

Sydney Halleman, “Biden’s proposed HHS budget aims to make pandemic-era subsidies permanent,” Healthcare Dive, Mar 9, 2023 READ IT HERE

While direct assistance gets cut back and looser Medicaid eligibility rules abolished, Biden is happy to increase subsidies to the for-profit insurance industry by $183 billion. A measure to empower Medicare to negotiate prices for more drugs is included but will have to win over some GOP support.

*

Annie Burky, “As SNAP benefits wane, food-as-medicine companies carve out a niche in healthcare,” Fierce Healthcare, Feb 27, 2023 READ IT HERE

Covid emergency measures are winding down, leaving many poor beneficiaries facing a sharp cutback to food assistance. To the rescue: new for-profit companies! While the food-as-medicine movement may have noble intentions and even effects, underneath is a move away from government responsibility toward privatized charitable action. And of course Medicare Disadvantage stands ready to boost its PR: “FarmboxRx is a food delivery service partnering with Medicaid and Medicare programs as an Advantage Benefit.” Simple services like these look good to potential enrollees who can be lured to sign up. Then they’re stuck when they need expensive care and have to fight for it.

*

Kevin Dunleavy, “With $43B buyout, Pfizer sees cancer specialist Seagen as a ‘goose’ laying ‘golden eggs,’” Fierce Pharma, Mar 13, 2023 READ IT HERE

If Pfizer is laying out the staggering sum of $43 billion to buy this cancer drug producer, how much more are they expecting to make out of it? The FTC may have something to say on the acquisition. Meanwhile, Pfizer CEO Albert Bourla said on a conference call that “We are acquiring the goose that is laying the golden eggs.” Bourla should remember the moral of that story—dead goose, no more gold. Pfizer had a huge pile of cash thanks to Covid.

*

Elaine Chen, “Covering new weight loss drugs could strain Medicare, policy experts warn,” STAT, Mar 11, 2023 READ IT HERE

Pharma makes a killing by finding a drug that costs a lot, that millions want or need, doesn’t cure the condition, and has to be taken forever. The latest candidate in the beauty contest is a class of obesity drugs that are sure to be wildly popular. The slimming rush could create “significant costs for Medicare, likely leading the federal insurer to raise premiums” given that an estimated 42% of all Americans are obese. Instead of addressing how our food system promotes unhealthy eating, let’s give everyone pills!

*

Zack Whittaker, “Telehealth startup Cerebral shared millions of patients’ data with advertisers,” TechCrunch, Mar 10, 2023 READ IT HERE

Those telehealth appointments we had during Covid? Turns out they were a great way to gather health data on us to turn around and sell us stuff. “Cerebral has revealed it shared the private health information, including mental health assessments, of more than 3.1 million patients in the United States with Facebook, Google and TikTok.” A similar recent case led to a tiny FTC fine and lame promises to sin no more. “While not mentioned, the tech giants are under no obligation to delete the data that Cerebral shared with them.”

*

Scott Zamost & Contessa Brewer, “Inside the mind of criminals: How to brazenly steal $100 billion from Medicare and Medicaid,” CNBC, Mar 9, 2023 READ IT HERE

Crooks are free to roam through the Medicare and Medicaid landscape and milk the government. Some get caught, but most skate away with millions. South Florida is ground zero for the frauds. Inspectors who could nab them are far too few.

*

Blake Farmer, “In Tennessee, a Medicaid mix-up might land you on a ‘Most Wanted’ list,” Kaiser Health News/Nashville Public Radio, Feb 22, 2023 READ IT HERE

By contrast, Tennessee is super-tough on fraud—especially when people don’t commit it. A woman had an outdated driver’s license from another state and was charged with a felony for receiving Medicaid. Prosecutors finally let her see the charges six months later while she lost her job and racked up legal bills. Online searches of her name still highlight the words ‘fraud’ and ‘most wanted.’”

*

Tina Reed, “Walmart Health eyes Medicare Advantage business with planned expansion,” Axios, Mar 3, 2023 READ IT HERE

Walmart is doubling the number of its in-store clinics to cash in on the lucrative Medicare Disadvantage biz along with its partner, UnitedHealth Group. The mega-retail sector is slugging it out over who will make the most money on primary care: CVS, Amazon, Walmart, or Walgreens.

*

Jamie Godwin, Zachary Levinson & Scott Hulver, “Estimated value of tax exemption for nonprofit hospitals was nearly $28 billion in 2020,” Kaiser Family Foundation, Mar 14, 2023 READ IT HERE

Why are these businesses still getting free money from states, cities, and the feds while they pursue collections against the indigent, garnish wages, and drive people into bankruptcy? The $28 billion tax benefit represents 43% of their net income, according to the authors—a huge chunk. Fancy donors who want their names on facilities also get a tax benefit on their largesse.

*

SINGLE PAYER LINKS #295

Posted 10 MAR 2023

*

Julie Rovner, “Why do politicians weaponize Medicare? Because it works,” Kaiser Health News/NPR, Feb 21, 2023 READ IT HERE

“Generally, the party accused of menacing the sacrosanct entitlements pays a price.” Ergo, the game is to twist actions like clawing back fraudulent payments to Medicare Disadvantage hustlers as “cuts.” Incidentally, if this program is so wildly popular, why the fanatical resistance to extending it to everyone?

*

Sydney Halleman, “Insurers, trade groups ask CMS to delay MA rule,” Healthcare Dive, Mar 7, 2023 READ IT HERE

CMS (Medicare’s admin) tries to curtail fraudulent upcoding; Medicare Disadvantage plan owners howl in outrage. These regs will be called “cuts” to Medicare in next year’s electoral propaganda.

*

Maya Goldman & Caitlin Owens, “The administration’s next crack at lower drug prices,” Axios, Feb 15, 2023 READ IT HERE

These proposals address “some of the most timely drug pricing issues of the day and could boost President Biden's political arsenal for 2024.” Aha. It’s not clear how many of these measures are serious vs. grandstanding to set up blame-the-Republicans campaign rhetoric. Granted, some sound pretty good: “One [law] would encourage Medicare prescription drug plans to offer a standardized set of about 150 generic drugs to patients for a maximum copayment of $2 per month.” But I wouldn’t bet the farm on seeing it happen.

*

Annie Burky, “Hospital-at-home steps out of the COVID-era through new Atrium Health, Best Buy partnership,” Fierce Healthcare, Mar 7, 2023 READ IT HERE

“Best Buy Health” is a thing? Apparently! What’s next, Arby’s Amalgamated Neurosurgeons? Jimmy Choo Orthopedic Associates? Said one exec of the new partnership: “This transition that happens from discharging a patient from a hospital to the void of their home is the dark side of the moon.” Whatever that means. Then there’s this mysterious explanation of what Best Buy Health brings to the table: “its strengths around an innovative omnichannel experience.” For my part, I like the sound of an “omnichannel experience.” I guess if AI is going to replace our doctors and nurses, then getting your bodily tune-up at the same place that sells you a TV makes sense. Doctor, I need my channels changed!

*

Peter Arno, “Consolidations and profiteering: the relentless rise of hospital expenditures,” Health Care Un-covered, Mar 2, 2023 READ IT HERE

Let’s put hospitals in our sights along with Pharma, insurance, and private equity. The culprits: high admin costs in handling multiple payers; upcoding fraud; overpriced pharmaceuticals; and especially hospital M&A (mergers and acquisitions), which are concentrating hospital services into a few giants. “By 2018, over 95% of metropolitan areas had highly concentrated hospital markets” and the higher prices that go with them.

*

Noam N. Levey, “Biden Administration urged to take more aggressive steps to relieve medical debt,” Kaiser Health News/NPR, Mar 7, 2023 READ IT HERE

This is a campaign by 50 advocacy groups to rein in aggressive debt collection tactics by hospitals, especially “nonprofits” that often simultaneously deny mandated financial assistance to eligible patients. Nationwide, about 1/3 of all Americans carry medical debt. The campaign’s target is the Consumer Financial Protection Bureau (CFPB), which could set federal standards (instead of the state-by-state action that’s needed now).

*

Sanjay Kishore & Suhas Gondi, “Nonprofit hospitals are failing Americans. Their boards may be a reason why,” STAT, Feb 27, 2023 READ IT HERE

A ripe target for activism: why do these giant corporations enjoy charity tax benefits? “Some nonprofits have billed patients who should have qualified for charity care. Some have aggressively collected on medical debt. Others have exploited poor communities by maintaining a token presence there to qualify for federal subsidies that benefit the needy, only to expand in rich communities.” Many of them have huge investment portfolios and treat providers and auxiliary staff poorly while enriching their CEOs. The authors propose targeting hospital boards of directors, which are obliged by statute to “oversee quality” and rarely do that. One possible reason: 44% of board members are financiers while only 1% are nurses. The authors couldn’t even find a public list of board members for five of the 20 “top” hospitals in the country.

*

Michelle Crouch & Rose Hoban, “How much should nonprofit hospital CEOs make?” Charlotte Ledger, Feb 20, 2023 READ IT HERE

Easy question! As much as possible! “The executives of North Carolina’s nine largest nonprofit hospital systems have received double- and triple-digit percentage raises over the past decade,” according to a state report. NC’s giant hospitals paid their top executives more than $1.75 billion from 2010 to 2021. The average package per CEO was $3.4 million in 2020. Tax-exempt charity pays!

*

Dave Muoio, “Healthcare dealmakers—CVS buys Oak Street Health for $10.6B; Amazon closes $3.9B One Medical deal; and more,” Fierce Healthcare, Mar 6, 2023 READ IT HERE

A handy run-down of all the M&A activity in healthcare during February. It can be hard to keep up with the dizzying accounts of healthcare financial engineering, but it should get easier as the players become fewer and fewer.

*

Rebecca Pifer, “Why regulators didn’t challenge Amazon-One Medical deal, despite data concerns,” Healthcare Dive, Mar 1, 2023 READ IT HERE

The FTC is famously tougher on these deals since chair Lina Khan awakened it from a decades-long slumber. But despite concerns about this one amid the frenzy of similar acquisitions, some observers think the agency couldn’t find a credible legal theory to pursue a blocking action. Amazon is suspect because of its vast storehouse of data on most Americans to which it can now add our medical histories. “[Naderite group] Public Citizen said by bundling One Medical and Prime membership, Amazon could create new revenue streams distinct from the provision of healthcare, such as targeting product advertising related to medical conditions.” Or, Here are your shoes—would you like a podiatrist visit with that? How about a chiropractor?

*

Rebecca Pifer, “Walmart Health plans clinic expansion in 2024, pushing into 2 new states,” Healthcare Dive, Mar 2, 2023 READ IT HERE

And here comes Walmart bringing up the rear with plans to open 28 new Walmart Health centers in 2024, bringing the total to 75 in six southern states. Walmart’s facilities target “patients with no or poor insurance coverage in underserved areas” and are located next to or inside Walmart Supercenters.

*

Rebecca Pifer, “Walgreens-backed VillageMD acquires Connecticut medical group,” Healthcare Dive, Mar 3, 2023 READ IT HERE

Walgreens/VillageMD hoovered up Starling Physicians to add their 30 CT locations to their 700-plus others.

*

Kayode Crown, “As Mississippi hospitals fail, leaders kill Medicaid expansion efforts again,” Mississippi Free Press, Feb 2, 2023 READ IT HERE

Mississippi digs in against Medicaid expansion despite the fiscal advantages and collapsing hospitals around the state. But ideology reigns. Gov. Reeves railed against “the expansion of Obamacare, welfare, and socialized medicine.” An opponent proposes to call it “Trumpcare” if that would help.

*

Michael Goldberg, “Doctor, GOP governor clash over private Medicaid discussion,” Associated Press, Feb 2, 2023 READ IT HERE

Juicy: a top Mississippi doctor said the governor privately admitted Medicaid expansion would be “in the best interest of the state” but opposes it anyway out of political cowardice. However, see next article.

*

Michael Goldberg, “Mississippi backs 1 year of postpartum Medicaid for new moms,” Associated Press, Mar 7, 2023 READ IT HERE

While refusing Medicaid expansion, the generous Mississippi solons agreed to keep those mothers poor enough to qualify covered for a year (from the previous 60 days). The Dobbs case that overturned Roe originated in the state. Sixty percent of all births in Mississippi are covered by Medicaid.

*

Robert King, “Majority surveyed not aware of looming Medicaid eligibility redeterminations,” Fierce Healthcare, Feb 17, 2023 READ IT HERE

Most of the people about to get kicked off Medicaid don’t know it. OTOH, if they watch late-night TV, they’ll know all about the glories of Medicare Disadvantage.

*

Claire Cleveland, “Community resurrects Colorado birth center closed by private equity firm,” Kaiser Health News/Colorado Sun, Feb 9, 2023 READ IT HERE

Nice! Private equity owners shut down a midwife-run maternity center, but the employees revived it. Their reimbursements are a fraction of what a hospital birth commands, but as one birth assistant said, “We’re not going to let capitalism take us down.” The outfit has to raise contributions to stay afloat despite the billions flowing through the insurer-hospital-PE-industrial complex.

*

Maricarmen Cajahuaringa, “CT Republicans pitch their hopes for more affordable health care,” CT Mirror/Connecticut Public, Feb 20, 2023 READ IT HERE

Articles like these show how much complicated tweaking of the dysfunctional system goes into attempts to get costs down without interrupting the basic model of commercial medicine. Fiddle with the tax code, insist on price transparency (as if we’re shopping for a lawn mower), allow small businesses to pool funds to buy their group plans, etc. It’s all well-meaning and mostly window-dressing because no one wants to confront the big guns from insurance-hospitals-Pharma-Wall Street.

*

SINGLE PAYER LINKS

Posted 3 MAR 2023

Cassidy Morrison, “Finally a fair shot for diabetics: Pharma giant Eli Lilly caps price of insulin at $35 amid huge public backlash over alleged price gouging,” Daily Mail [U.K.], Mar 1, 2023 READ IT HERE

The Daily Mail is a Tory publication, which shows the extent of disgust with Pharma’s deadly pricing practices. Note the caveats: “Lilly will cap the cost at $35 at certain pharmacies for diabetics with insurance.” A recent omnibus bill limited the price limit to Medicare patients. Ironically, the discoverer of insulin thought it was unethical to profit from a life-saving drug and refused to patent it.

*

Matt Stoller, “Did Lina Khan just slash insulin prices?” BIG, Mar 1, 2023 READ IT HERE

Stoller says yeah, pretty much. Khan’s FTC alerted last June that it had “received complaints about rebates and fees paid by drug manufacturers to pharmacy benefit managers (PBMs) and other intermediaries to favor high-cost drugs,” which the agency said sure looks illegal. Interesting that the direct target was not Pharma but the PBMs. In any case, Lilly acted to forestall unpleasant publicity and possible legislative action. Stoller explains: “Basically, to make money, PBMs solicit bribes in the form of a rebate from pharmaceutical firms in return for letting their products on their formularies. As of 2018, pharmaceutical producers like Eli Lilly were getting 47% of the revenue from their insulin products, and PBMs were getting 53% of it.” Happy days except for people dying of untreated diabetes. Stoller fills in lots of good detail on exactly what Lilly did. Downside: newer, improved forms of insulin are not discounted, and the lower price is still comparatively high. Upside: just the threat of FTC action drove down prices.

*

Robert King, “House oversight panel launches new probe into major PBM tactics,” Fierce Healthcare, Mar 1, 2023 READ IT HERE

The big three PBMs will be exposed to deserved scorn by the House Oversight Committee, now run by Republicans. CVS Caremark, UnitedHealth Group’s subsidiary OptumRx, and Cigna’s Express Scripts will be asked about how they extract up to half of the purchase price of pharmaceuticals through anti-competitive practices. The FTC is also investigating, all of which help explain Eli Lilly’s recent move on insulin.

*

Megan Lopez, “Colorado lawmakers propose bill to add more patient protections around medical bills,” Denver7.com, Feb 14, 2023 READ IT HERE

More and more states are taking action as the feds lag behind: Colorado may cap interest rates on medical bills (NY did this recently) and pause debt collection on disputed bills, 58% of which are medical debt-related.

*

Natalie Fahmy, “Ohio proposal pushed for transparency in medical costs,” NBC4 [Columbus OH] Feb 14, 2023 READ IT HERE

Republicans have a total lock on Ohio state government, so any movement on medical bills there is automatically bipartisan. This measure is “modeled after one that went into effect a year ago in Colorado,” called the Prohibit Collection Hospital Not Disclosing Prices Act. Are states learning from each other? Hospitals that fail to publish their prices would be prohibited from putting people into collections or suing in state courts.

*

Andrew Solender & Victoria Knight, “GOP spends $2 million trying to flip the script on Medicare,” Axios, Mar 2, 2023 READ IT HERE

Election 2024 spending is starting already, and this pot of cash is aimed at flipping the script on who wants to cut Medicare. Rs will claim that the very modest attempts to rein in Medicare Disadvantage (a.k.a. privatization) is Biden “cutting” benefits instead of what it actually is, clawing back money extracted through fraudulent claims. The cynicism is breathtaking. But the Dems could be on the back foot because they like privatization and so can’t really tell the truth about what’s happening.

*

March Merger Madness

Dave Muoio, “UnityPoint Health, Presbyterian Healthcare set sights on 40-plus hospital merger,” Fierce Healthcare, Mar 2, 2023 READ IT HERE

Another merger: two “nonprofit” hospital cartels based in Iowa and New Mexico want to become one 46-hospital unit with 4 million patients and 40,000 employees. Mergers across various “markets” (cities or areas) can sometimes dodge antitrust scrutiny.

*

Dave Muoio, “Trinity Health's MercyOne, Genesis Health System close Midwest health system merger,” Fierce Healthcare, Mar 2, 2023 READ IT HERE

Trinity, one of the country’s biggest hospital cartels, will add some Iowa and Illinois “care centers” for a total of 110 hospitals in 26 states.

*

Heather Landi, “With Oak Street Health deal, CVS pushes healthcare ambitions as investment in value-based care heats up,” Fierce Healthcare, Feb 9, 2023 READ IT HERE

These are the metastasizing cartels that are shaping U.S. healthcare as payers & providers merge:

• Walgreens/Cigna/Village MD/Summit/Express Scripts
• Amazon/One Medical
• CVS/Aetna/CVS Caremark/Oak Street Health
• UnitedHealthcare/Optum Rx

Within them, insurance, doctors, medical records, pharmacies, urgent care centers, PBMs all combine to create coordination of compensation, referrals, and medical records. Bye bye, independents, privacy, and the old-fashioned doctor-patient relationship. Note how they talk about the provision of medical care: “The network of clinics is expected to grow to over 300 centers by 2026 with each offering $7 million in potential embedded earnings before interest, taxes, depreciation and amortization.” Putting patients first!

*

Brett Kelman & Blake Farmer, “Doctors are disappearing from emergency rooms as hospitals look to cut costs,” Kaiser Health News/Nashville Public Radio, Feb 13, 2023 READ IT HERE

Surprise culprit: private equity. The article describes shoddy service at a hospital that “had outsourced its emergency rooms to American Physician Partners, a medical staffing company owned by private equity investors. APP employs fewer doctors in its ERs as one of its cost-saving initiatives.” The three big players gobbling up ERs as part of the “staffing industry” are TeamHealth, owned by PE firm Blackstone; Envision Healthcare, owned by KKR; and American Physician Partners, 50% owned by BBH Capital Partners. Patients largely have no idea that PE is determining how 43% of us are getting emergency care. Hospitals don’t advertise that part.

*

Morgan Stephens, “Long Covid disabled them. Then they met a ‘broken’ Social Security disability process,” CNN Business, Feb 25, 2023 READ IT HERE

An estimated 23 million Americans have long-Covid symptoms like chronic fatigue, pain, and memory loss (an underreported aspect of the tight labor market). But the understaffed Social Security Administration can’t keep up with disability claims, leaving tens of thousands in the lurch. Even pre-Covid, 10,000 people died each year waiting for an eligibility determination. Most people need a lawyer to fight the denials. “Trying to apply for SSDI makes doing your taxes look like a kindergarten watercolor painting.” The punishment will continue until morale improves.

*

Ryan Gabrielson & J. David McSwane, “A Christian health nonprofit saddled thousands with debt as it built a family empire including pot farm, a bank, and an airline, ProPublica, Feb 25, 2023 READ IT HERE

“Despite a history of fraud, one family has thrived in the regulatory no man’s land of health care sharing ministries where insurance commissioners can’t investigate, federal agencies turn a blind eye, and prosecutors reach paltry settlements.” When you hear the words “healthcare sharing ministry,” place both hands firmly on wallet and look for the exits.

*

Sarah Owermohle, “Medicare for all … of East Palestine?” STAT, Feb 24, 2023 READ IT HERE

What will happen to the people affected by the Ohio toxic chemical disaster? An obscure provision of Obamacare could put the whole town into Medicare, but confusion reigns. To avoid laborious person-by-person applications, Biden and Invisible Pete would have to create a special program such as was done for 9/11 clean-up victims (who were also told Everything Is Fine! BTW). Meanwhile, federal inaction hands a political goldmine to a certain presidential candidate.

*

Shira Shavit, “Medicaid during incarceration: a step toward health equity,” STAT, Feb 20, 2023 READ IT HERE

This noble doc advocates a specific Medicaid waiver to get incarcerated patients enrolled in Medicaid 90 days in advance of their release date. Nearly 10 million people get out of prison or jail each year “often with multiple chronic conditions, few medical records or medications, and no insurance or continuum of care.” A no-brainer to save money and ease reintegration—states have to ask one by one, and about a dozen have requests pending.

*

Bracey Harris, “Mississippi hit by 900% increase in newborns treated for syphilis,” NBC News, Feb 11, 2023 READ IT HERE

Goes with the state’s worst-in-the-nation record for infant mortality. But the problem is national: cases across the U.S. have more than doubled in the last five years. Syphilis is treatable, but screening for it is inconsistent. Six states, including Mississippi, do not even mandate prenatal syphilis screening. Maybe it has to do with the ongoing assault on public health as Mississippi closes county health departments. “Many pregnant Mississippians have to wait weeks before their first prenatal visit.”

*

Kim Keck, “How to save three-quarters of a trillion dollars in health care costs,” STAT, Feb 14, 2023 READ IT HERE

Sounds good, except that the solution comes from the head of Blue Cross/Blue Shield, so her solutions are to weaken King Kong while leaving Godzilla alone. She promotes “competition among providers” by preventing hospitals from acquiring private practices (boo hospitals!); stopping patent abuse by drug companies (boo Pharma!); and replacing fee-for-service reimbursement with more lucrative capitation payments (yay insurance companies!). No surprises, but interesting to see how the different giants blame each other for our dysfunctional system.

*

Joseph Choi, “White House announces plans to enhance transparency over nursing home ownership,” The Hill, Feb 13, 2023 READ IT HERE

It’s hard to find out who owns nursing homes and especially their contractors, which is very handy for the PE firms taking them over.

*

Deb Gordon, “Nearly 80% of women with breast cancer face financial toxicity,” Forbes, Feb 14, 2023 READ IT HERE

“Financial toxicity” is a great term and reflects the poisonous impact of saddling sick people with the confusing nightmare of bills and payments even when insured. Out-of-pocket costs include treatments, hospital and pharmacy bills, lab charges, outpatient expenses, plus transportation and lodging related to treatment and the indirect costs of lost wages.

*

Nina Kohn & Irina D. Manta, “Hospitals that ditch masks risk exposure,” Bill of Health, Feb 20, 2023 READ IT HERE

They mean legal exposure. “Ending routine masking in hospital settings is a dangerous move. Hospitals have a common law duty to act reasonably. If they unreasonably expose patients to risk, and the patients are harmed as a result, hospitals may be liable for damages.” Acting “reasonably” in this case would be pretty easy to prove if the burden is simply putting a mask on. You’d think our litigious society would be on high alert over this risk, especially given that it involves money.

*

Tara Bannow, “Same patient, same drug, same insurer — coverage denied,” STAT, Mar 2, 2023 READ IT HERE

Today’s insanity: an insurer was covering a woman’s infusions for a rare kidney disease—until it didn’t. “Her story offers a window into the confounding, seemingly irrational world of insurance coverage, one that’s given rise to a network of billing gurus dedicated to helping patients fight denials.” Cruel and bizarre.

*

Steven Goldsmith, “The profession formerly known as medicine,” American Mind, Feb 27, 2023 READ IT HERE

Well worth a read on how medicine, in the writer’s opinion, has become mechanized and soulless. “Exhibit A. Medical students report rates of depression up to 30% higher than the general population. About 400 U.S. physicians commit suicide annually. One in five intend to leave their practice within two years.” Goldsmith denounces the dictatorship of the computer screen, which he calls “groveling before the alter” of the electronic record. “Unless doctors start treating whole people, AI will displace them, and no one will know the difference.” The guy takes no prisoners: “Doctors, stop being Big Pharma’s bitches.”

*

SINGLE PAYER LINKS #293

Posted 24 FEB 2023

*

Heather Landi, “Amazon closes $3.9B One Medical deal as it builds out healthcare strategy,” Fierce Healthcare, Feb 22, 2023 READ IT HERE

The acquisition puts Amazon deeper into primary care through One Medical’s 188 clinics and nearly 1 million members and gives Amazon access to the lucrative employer market via One Medical’s 8,000 client companies and its “trove of member health data.” The FTC didn’t block the sale but said it “will continue to look at possible harms to competition,” which sounds like the story is not quite over. [Update: the FTC gave in.] An interesting detail is that One Medical has remained unprofitable throughout its 15 years in business. If Amazon wants a money-losing outfit, it must have significant value for vertical integration and occupying all the right “market” niches.

*

Paige Minemyer, “UnitedHealth, LHC Group close $5.4B merger deal,” Fierce Healthcare, Feb 22, 2023 READ IT HERE

Another huge acquisition by a rival cartel: LHC is a home health provider and will join UH’s Change Healthcare, bought last year for $8 billion despite a DoJ attempt to block the sale.

*

Samantha Liss, “SUNY Upstate, Crouse Health System call off merger,” Healthcare Dive, Feb 17, 2023 READ IT HERE and Dave Muoio, “FTC celebrates after SUNY Upstate, Crouse Health System scrap merger plans,” Fierce Healthcare, Feb 17, 2023 READ IT HERE

On a much smaller scale, this is a victory for the reawakened FTC: a SUNY hospital in Syracuse won’t merge with its main competitor across town. The feds said competition between the two systems “benefits patients and employers in the area through lower costs and better quality” and urged New York State to block them from joining. The proposed joint entity would have controlled 45% of commercially insured inpatient hospital services in the area. The FTC also said, “These [hospital merger] agreements often bring few of the promised benefits to their markets and should be considered with greater scrutiny.”

*

Samantha Liss, “CommonSpirit to acquire 5 Steward hospitals, expanding reach into Utah,” Healthcare Dive, Feb 16, 2023 READ IT HERE

This deal is going through because the FTC blocked hospital cartel HCA from buying the Utah hospitals. CommonSpirit is big enough (22 states) but not a Godzilla.

*

Hailey Mensik, “Surgical procedures cost significantly more at hospitals in networks versus independent facilities, study finds,” Healthcare Dive, Feb 14, 2023 READ IT HERE

So much for economies of scale: big hospital systems with preponderant market share can demand higher rates from insurers. “The findings come as hospitals have remained noncompliant with federal price transparency rules requiring providers to publicly post prices for healthcare services to help patients shop around for care and boost competition.” The argument for commercialized medicine is that “customers” can shop around for the best deal. But this non-market market is completely rigged.

*

Arielle Dreher, “States jump into fight over prior authorization requirements,” Axios, Jan 27, 2023 READ IT HERE

Biden officials are trying to tweak regs to overcome the bureaucratic nightmare of prior authorization that insurance companies put us through. But they won’t attack the core problem—the built-in motivation to deny care embedded in commercial medicine. “Clinicians say the situation has worsened in recent years, causing delays for patients, including those with chronic conditions that haven’t changed in years.” The feds are looking at various proposed solutions: awarding a “gold card” to physicians to sidestep prior authorization if they have a good approval rate; requiring insurers to reply within 24 hours instead of dawdling; exempting treatments for chronic conditions. Caveat: state governments can only regulate individual and small-group employer plans and their in-house plans for state employees.

*

Rebecca Pifer, “Louisiana systems hit with lawsuits for allegedly sharing patient data with Facebook,” Healthcare Dive, Feb 16, 2023 READ IT HERE

More snooping into our medical records to then pepper us with ads. The hospitals used a computer program that “analyzed, gathered, and shared the protected medical data of hundreds of thousands of patients in violation of the HIPAA privacy law,” according to a class-action lawsuit. “In one instance, a woman received online ads about heart disease and joint pain moments after entering her information on one of the hospital websites.” The tracking tool has been found in dozens of hospitals’ websites, from which sensitive medical data leaks onto social media. This will continue until a hospital administrator somewhere does prison time. Fines won’t stop them.

*

Reed Abelson, “Higher bills are leading Americans to delay medical care,” New York Times, Feb 16, 2023 READ IT HERE

Nothing new but getting worse: “The inability to afford medical tests and treatment began emerging as a much more striking issue last year. Nearly four of 10 Americans said they had put off care in 2022 because of cost,” the highest number ever recorded.

*

Eric Sagonowsky, “GSK was warned repeatedly about Zantac impurity but played down risks: Bloomberg,” Fierce Pharma, Feb 15, 2023 READ IT HERE

A new report says GSK scientists have long known about cancer risks from the popular heartburn drug Zantac (approved way back in 1983) while the company officially denied it. According to Bloomberg, “GSK was warned by its own scientists and independent researchers [for decades] about a potential cancer-causing impurity in the drug.” GSK faces tens of thousands of lawsuits and should study Johnson & Johnson’s “Texas Two-Step” maneuver (create a subsidiary, shift all the liabilities to it, then declare bankruptcy).

*

Carlo Martuscelli & Eddy Wax, “European Parliament chiefs block public scrutiny of von der Leyen over Pfizer contract,” Politico, Feb 17, 2023 READ IT HERE

The EU pooh-bahs hide whether the EU Commission president cut a corrupt deal with Pfizer for billions of euros in vaccine buys. Ironic display of “democracy” by a secret cabal immune from even the slightest monitoring or oversight. Instead of a public hearing to question Ursula von der Leyen, who negotiated the €35 billion deal with Pfizer by text message, the EU will only ask her to answer questions “in private at some point in the future.”

*

Kimberlee Kruesi, “Tennessee cuts HIV program with Planned Parenthood ties,” Associated Press, Jan 20, 2023 READ IT HERE

Tennessee will forgo $10 million in federal funding for HIV prevention and testing to keep any cash from reaching Planned Parenthood. Shelby County (Memphis) has one of the highest HIV rates in the country.

*

Kimberlee Kruesi & Jonathan Mattise, “Tennessee Gov. Lee proposes $100M for anti-abortion centers,” Associated Press, Feb 6, 2023 READ IT HERE

OTOH, Tennessee will happily spend $100 million of its own citizens’ money for things like ultrasound machines in “crisis pregnancy centers.” Meanwhile, the governor wants to expand paid family leave as the destruction of Roe now presents anti-abortion states with the reality of unwanted births.

*

Rebecca Robbins, “How a drug company made $114 billion by gaming the U.S. patent system,” New York Times, Jan 28, 2023 READ IT HERE

“Through its savvy but legal exploitation of the U.S. patent system, Humira’s manufacturer, AbbVie, blocked competitors from entering the market” for its arthritis drug. The patent trickery won AbbVie an additional six years of monopoly, making Humira “the most lucrative franchise in pharmaceutical history,” generating an additional $114 billion in revenue. Competition will finally arrive after Medicare spent an estimated $2.2 billion more on Humira is just four years than it would have spent if competitors had arrived sooner. Don’t expect the politicians raising alarms over Medicare’s “solvency” to address this form of welfare for their corporate sponsors. Meanwhile, patients trying to access treatment have to resort to drastic measures. One lady’s company will fly her to the Bahamas every four months for a local prescription and a supply of the drug at a fraction of the cost. But the hustle is drawing unwanted attention in Congress. “Last year, the company’s tactics became a rallying cry for federal lawmakers as they successfully pushed for Medicare to have greater control over the price of widely used drugs that, like Humira, have been on the market for many years but still lack competition.”

*

Irving Kent Loh, “Healthcare may be headed for a cliff,” VC Star, Jan 28, 2023 READ IT HERE

The author points out the increasingly obvious personnel problem: “If you’ve been paying attention, there are stories every week of healthcare systems losing hundreds of millions if not billions of dollars despite the huge bills patients get.” That’s partly because staffing costs are skyrocketing: “Post-pandemic, [nurses] are now line items on P&L statements for healthcare systems. Hospitals and healthcare facilities are hemorrhaging nurses because of difficult working environments.” Hiring travel nurses to fill in is expensive. Meanwhile, “fewer of our smartest youth want to go into healthcare” to work for a faceless corporation determined to pinch pennies everywhere.

*

Darius Tahir, “Mark Cuban has been taking on the drug industry. But which one?” Kaiser Health News/Fortune, Feb 17, 2023 READ IT HERE

Billionaire Mark Cuban’s Cost Plus Drugs is supposed to save us money on prescriptions, and sometimes does. Other times, it doesn’t. “In many cases, the price quotes that patients see on the [CPD] website are higher than they’d get at their local pharmacy. It has to do with the segment Cuban is playing in—generic drugs—but also the layers of complexity peculiar to the American health system.” Still, CPD seems like a useful entrant into the pharmaceuticals biz, and if Cuban really does build his own factory for generics, things could get even more interesting.

*

Ed Silverman, “‘Caught in the middle’: A battle between Vertex and insurers is leaving cystic fibrosis patients with crushing drug costs,” STAT, Feb 20, 2023 READ IT HERE

Vertex, manufacturer of a cystic fibrosis medicine, announced it would slash financial assistance for needy patients, driving up copays into the tens of thousands of dollars. Behind the move is “a grinding, behind-the-scenes struggle between pharmaceutical companies [Godzilla] and health insurers [King Kong] across the U.S. in response to the rising cost of prescription medicines.” Hard to untangle the threads of this complicated battle though, as usual, underneath is unconscionable price-gouging. The annual list prices for the two most common CF drugs are (Orkambi) $286,000 and (Trikafta) $322,000. Last year, these medications generated $8.9 billion in revenue for the company, an 18% increase from the year prior.

*

Olivia Goldhill, “How a depression test devised by a Zoloft marketer became a crutch for a failing mental health system,” STAT, Feb 21, 2023 READ IT HERE

Paywalled, unfortunately. “A bedrock of the U.S. mental health system—a nine-item questionnaire used to spot depression—began not with a doctor, but with a marketing man.” A Long Island doctor came up with the PHQ-9 depression scale to help Pfizer sell Zoloft. Then it took off and became a standard screening tool everywhere, “cited in more than 11,000 scientific papers and routinely handed to patients during primary care checkups and OB-GYN visits, regardless of whether they voice mental health concerns.” Pharma loves new ways to tell us we have a disease that their pills can treat.

*

Helen Krim, “Fox put in charge of hen house,” Riverdale Press, Feb 17, 2023 READ IT HERE

A letter to the editor of a local newspaper by one of our single-payer advocates—a great job of explaining the Medicare Disadvantage/ACO REACH disasters in clear, direct language. “The latest privatization attempt by the government truly puts the fox in charge of the hen house. Private equity has no interest in reducing the cost of medicine. The argument that privatization of government health care will lower costs is simply unfounded and absurd.”

*

Howard K. Koh and Michael Fiore, “Tobacco companies pledge ‘harm reduction’ but are doing the opposite,” STAT, Feb 21, 2023 READ IT HERE

Tobacco companies manipulate the harm reduction message to keep themselves in business. “The tobacco industry’s take on harm reduction includes mass marketing nicotine-laden vaping products that flood retail outlets while furiously lobbying against the regulation of traditional cigarettes.” This has enabled the industry to bring back all sorts of prohibited advertising with sexy ladies smoking so-called “less harmful” products like e-cigarettes. And now we have a whole generation of youth addicted to nicotine through vaping. Both the top e-cig brands in the U.S. are fully or partially owned by Big Tobacco. They need new customers to replace the ones killed by their products.

*

Eric Reinhart, “Want to fix public health? Stop thinking like a doctor,” The Nation, Feb 22, 2023 READ IT HERE

“Biden and his advisers must confront the fact that the rot in public health is structural: It cannot be cured by simply rotating the figureheads who preside over it.” The author points to the medicalization of PH, most of which does not require biomedical expertise. “Since 1953, every director of the Centers for Disease Control and Prevention (CDC) has had a doctor of medicine, or MD, degree as their primary credential, with secondary degrees serving mostly as résumé decor.” We see the result: a complete collapse of coherent public health messaging. But we continue to think doctors know best. “Neither doctors’ irrelevant medical knowledge nor relative ignorance of essential fields—labor history, social anthropology, political economy, epidemiology, environmental sciences—is the most troubling aspect of physician control of public health. Rather, it’s the lack of epistemic humility, an inability to recognize the limits and hazards of clinical reasoning.” Public health requires a view from the collective perspective; clinician training induces the opposite. Clinicians treat patients; public health addresses populations. This is worth reading in full for the insightful contrast.

*

Annie Waldman, “Steak dinners, sales reps, and risky procedures: Inside the big business of clogged arteries,” ProPublica/Wichita Eagle, Feb 16, 2023 READ IT HERE

About “the lengths to which Medtronic, the world’s largest medical device company, allegedly ‘groomed’ doctors to overuse its vascular products in patients at a veterans hospital.” The Pharma playbook used in this case to boost use of things like stents, catheters, and angioplasty balloons with receptive surgeons who were extensively wined and dined. Medtronic has previously paid millions of dollars to settle illegal kickback accusations. But a former assistant U.S. attorney told the reporters that there are “real questions as to whether the sanctions imposed by DOJ are sufficient to deter wrongdoing.” Hmm, yes, real questions [strokes chin].

*

Eric Boodman, “‘A slippery slope’: A looming nationwide abortion pill ban could undermine the entire drug approval system,” STAT, Feb 23, 2023 READ IT HERE

If mifepristone is banned by an anti-abortion state, could it lead to state bans or any other drug? This plausible version of states’ rights redux, if upheld by the Supreme Court as advanced fetal protectionism, could blow a hole in the entire FDA approval process. The Supremes have no idea what they already have unleashed and show no signs of toning down their radicalism.

*

SINGLE PAYER LINKS #292

Posted 17 FEB 2023

*

Physicians for a National Health Program (PNHP), “PNHP celebrates win for activists as CMMI Director reveals Medicare REACH program is capping participation,” Feb 13, 2023 READ IT HERE

A victory, how gratifying: Chief of Medicare “innovation” Liz Fowler (ex-Wellpoint, ex-Obamacare architect) shut the door on ACO REACH expansion, capping it at 2.1 million “beneficiaries.” REACH is a Trojan horse enabling private insurers to sneak into Medicare and slaughter it. This would never have happened without sustained and vigorous opposition from us.

*

Arthur Allen, “‘We ain’t gonna get it’: Why Bernie Sanders says his ‘Medicare for All’ dream must wait,” Kaiser Health News, Feb 8, 2023 READ IT HERE

Bernie knows how the sausage is made and has a track record of finding areas of agreement across ideological camps. His priority targets as head of the Senate health committee are: expanding primary care through FQHCs; increased training of new nurses; addressing the disastrous state of U.S. dental care; hospitals’ abuse of their nonprofit status; and drug costs, including how Pharma uses public money for private gain. Note the Moderna reversal on charging for Covid vaccines just as Bernie is set to call them onto the carpet.

*

Heather Landi, “With Oak Street Health deal, CVS pushes healthcare ambitions as investment in value-based care heats up,” Fierce Healthcare, Feb 9, 2023 READ IT HERE

Oak Street has 169 medical centers in 21 states aimed at Medicare patients. CVS also agreed to buy Signify Health, a home health and technology company, for another $8 billion. The deals would permit CVS-owned insurer Aetna to design its MA plans around its in-house primary care services. Vertical integration, i.e., getting a piece of the entire care chain, means one company can arrange compensation, reimbursement, referrals, and medical records surveillance to maximize its income at every point of encounter.

*

Zak Holdsworth, “CVS’s acquisition of Oak Street doesn’t address health care’s woes,” STAT, Feb 10, 2023 READ IT HERE

CVS Health’s purchase of primary care chain Oak Street for the whopping sum of $10.6 billion is “just the latest in a string of primary care clinic buyouts by retailers and insurance companies,” like Walgreen’s and Amazon. The author says these companies can’t improve our healthcare delivery system because “they are so closely tied to the fundamentally flawed insurance fee-for-service infrastructure.” His solution: “direct primary care,” i.e., capitation in which a lump-sum payment replaces billing for each item. If I understand this correctly, “value-based care” is the same idea. But these per-head payments can also incentivize shortcuts in care for the more “expensive” patients and other trickery as seen with Medicare Disadvantage plans. That doesn’t solve the “fundamental flaw.”

*

Liz Kirk, “Tipping point is in sight: Value-based care is driving meaningful financial results,” Healthcare Dive, Feb 10, 2023 READ IT HERE

“With only one exception, the health systems reporting the strongest and most consistent financial performance from 2020 to 2022—with operating margins between 6% to 12%—either have sizable health plans or a significant number of covered lives in value-based or shared savings plans.” That means value-based care is great for the companies managing capitated payments models while lagging health systems are playing catch-up. “Some [health systems] are planning to use a ‘command and control’ approach to costs,” so expect more cutbacks and more obstacles to care. CMS officials have said they wants ALL Medicare enrollees eventually to be in value-based care plans so both for-profit and “nonprofit” systems can skim off 6 to 12 percent of our healthcare dollars.

*

Mike Dennison, “How an Obamacare remnant survives and prospers in Montana,” Montana Free Press, Jan 16, 2023 READ IT HERE

Under the original ACA, uninsured individuals would be able to buy a policy through cooperatives that would compete with the commercial outfits like Blue Cross; these entities mostly failed, but Mountain Health in Montana hung on even after “a pair of omnibus budget deals between the Obama administration and Republicans in Congress dealt crushing financial blows to many co-ops.” Lawsuits followed and succeeded, but most cooperatives were already dead by then. Mountain Health survived with a loan from a Boise hospital that didn’t want to be at the mercy of a single insurer. Its policies still have huge deductibles, but competition, for what it’s worth, was preserved.

*

Munira Z. Gunja, Evan D. Gumas & Reginald D. Williams II, “U.S. health care from a global perspective, 2022: Accelerating spending, worsening outcomes,” Commonwealth Fund, Jan 31, 2023 READ IT HERE

“The U.S. spends nearly 18 percent of GDP on health care, yet Americans die younger and are less healthy than residents of other high-income countries.” Many well-known statistics in one place: The U.S. has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, among the highest suicide rates, the highest rate of people with multiple chronic conditions, an obesity rate nearly twice that of European countries, and the highest rate of infant mortality.

*

Katie D. Schenk, “I was laid off from a public health job. Trust me, tech layoffs are different,” STAT, Feb 3, 2023 READ IT HERE

While tech layoffs get the attention, the public health workforce is getting slashed in relative silence. Federal Covid funding has dried up, and the epidemiologists, contact tracers, and community health workers are no longer needed. “Public health professionals always knew, based on long and bitter experience, that our jobs were precarious and insecure.” American Rescue Plan funding will be left to state discretion, meaning that many won’t rehire people from the now-stigmatized PH sector.

*

Samantha Liss, “Nonprofit hospitals may evade noncompete ban enforcement, experts say,” Healthcare Dive, Jan 20, 2023 READ IT HERE

Half of all U.S. hospitals are “nonprofits,” so it isn’t clear if they have to abide by the FTC ban on noncompete agreements. Expect lawsuits although the FTC has prevailed in some past cases over challenges to its authority in the nonprofit sphere.

*

Rachel Cohrs, “Sen. Tammy Baldwin criticizes Ascension’s for-profit investment activities, requests returns and fees info,” STAT, Feb 13, 2023 READ IT HERE

Ascension is cutting services at its Wisconsin hospitals but remains busy with over $1 billion in private equity investments alongside TowerBrook Capital Partners and a collection agency. Doing God’s work! Baldwin’s letter was “prompted by Ascension’s decision to close a maternity ward and by long wait times at another facility.” Ascension is a tax-exempt charitable organization that currently sits on a portfolio of $18 billion in cash and investments.

*

Anastassia Gliadkovskaya, “How the current economic downturn impacts healthcare funding and investor strategy,” Fierce Healthcare, Feb 10, 2023 READ IT HERE

“Health tech is hot” for investors. Some hospital systems had big losses driven by “weak investment returns,” i.e., stock portfolios. Also, emerging markets like Bangladesh are attractive because “there’s tremendous excess demand for healthcare in these markets.” Perhaps the “nonprofits” can seek opportunities there?

*

Steven Lane, “Mr. President, health care has a data problem. ‘Let’s finish the job,’” STAT, Feb 8, 2023 READ IT HERE

Electronic health records are a mess, using different IT systems and different storage formats, leading to administrative inefficiencies, says this MD and “informaticist.” He sidesteps an underlying reason for the problem: data fragmentation is a natural outgrowth of payer fragmentation. If an EHR system is designed to facilitate billing, interoperability and its potential benefit to care is secondary.

*

Sam Mellins, “Hochul ditched promise of health insurance for undocumented people. She could cost New York $500 million,” New York Focus, Feb 9, 2023 READ IT HERE

Hochul pledged last April to seek a federal Medicaid waiver to cover immigrants. But now she’s backtracking. Without the federal cash, the state will have to pay for emergency care out of state funds. Immigrants make up 25% of the 1 million uninsured New Yorkers. Other states have led the way on immigrant care, but Hochul must be worried about political blowback and nasty headlines on Fox. And why shouldn’t citizens be angry when they aren’t getting free coverage, too?

*

Dave Muoio, “CMS halts, recalls billing arbitration decisions after Texas court vacates guidance,” Fierce Healthcare, Feb 14, 2023 READ IT HERE

A federal judge threw a monkey wrench into the way CMS set up the arbitration process for surprise bills, so the whole system is on pause. Godzilla (hospitals and doctor groups) wins a round against King Kong (insurers).

*

Laura Santhanam, “How this law reshaped medical billing and what challenges remain for patients,” PBS NewsHour, Jan 20, 2023 READ IT HERE

The No Surprises Act has helped. “Only” 11 percent of Americans now say they have problems with medical bills, compared with 14 percent pre-Covid. The problem is that so many surprise billing complaints poured in that the new forced-arbitration system broke down even before a federal judge stopped enforcement of the current regulations. HHS tried raising the filing fee from $50 to $350 to discourage frivolous claims, but doctors in Texas are suing over that, too.

*

Bob Herman, “Patients still have no protection against surprise ambulance bills. And there’s no solution in sight,” STAT, Feb 13, 2023 READ IT HERE

“Ground ambulances were excluded from the federal law that banned most types of surprise medical bills starting in 2022—even though roughly 85% of all emergency ambulance rides are out-of-network.” Congress is dragging its feet on a solution because the ambulance biz is full of small players like local fire departments. Patients can’t do much but appeal bills and try to harass the insurer and ambulance company into settling.

*

Dean Baker, “The NYT tells us that drugs are cheap, government-granted patent monopolies make them expensive,” Center for Economic and Policy Research, Feb 7, 2023 READ IT HERE

Baker is being snarky. The Times piece describes Pharma’s large investments in drug development, but “neglects to mention that the we could eliminate this problem if we simply paid for the research up front, then having all new drugs and treatments available as cheap generics.”

*

Jake Johnson, “Washington Post runs Medicare newsletter sponsored by insurance lobby front group,” Portside, Feb 11, 2023 READ IT HERE

The paper “sprinkled its coverage of an intensifying fight over Medicare with ads purchased by an organization that promotes private Medicare Advantage plans.” Further collapse of U.S. journalism, now openly deployed for corporate propaganda. The article was “presented by” an astroturf organization funded by MA companies.

*

Xinye Qiu et al., “Association of long-term exposure to air pollution with late-life depression in old adults in the US,” JAMA, Feb 10, 2023 READ IT HERE

Growing up with polluted air is associated with increased risk of late-onset depression diagnosis among older adults. There is suggestive evidence that other neurodegenerative are correlated with pollution as well. Low-income neighborhoods are widely associated with worse ambient pollution and have correspondingly higher late-life depression levels. But billions will be poured into finding the magic pharmaceutical bullet.

*

Eric Topol, “The hospital-at-home movement: The pandemic gave it a jolt, and it's just getting started,” Ground Truths, Feb 11, 2023 READ IT HERE

Covid created a wedge for telemedicine and reimbursement for electronic interfacing. Will home treatment in lieu of hospitalization follow? Half of our $4 trillion-plus medical expenditures goes to hospitals, so there will be plenty of resistance to HaH, which requires up-front investments.

*

Ana Malinow & Kay Tillow, “No amount of fraud deters government agencies when it comes to privatizing Medicare,” Common Dreams, Feb 3, 2023 READ IT HERE

These repeat-offender fraudulent companies may be sidelined by the Monday news that ACO REACH is not expanding, but meanwhile, Medicare Disadvantage expands by leaps and bounds. The next phase of privatization is aimed at doctors and group practices, which are enticed by getting a cut of the money MA plans save on patients. “Once the PCP joins, their patients are automatically enrolled into the ACO REACH, without their informed knowledge or consent.” Many gory details.

*

Delaware Court of Chancery, “ALS Association Arizona Chapter et al. v. The Amyotrophic Lateral Sclerosis Association,” Jan 20, 2023 READ IT HERE

A dozen state branches of this “patient advocacy” group are suing their national office for abolishing the local chapters, grabbing their funds, and centralizing everything. Looks like the passion for monopoly concentration is filtering down to the NGO level. At stake: all that loot from the famous “ice bucket challenge.”

*

Rebecca Pifer, “FTC’s enforcement action against GoodRx unveiled a new regulatory threat. Should digital health apps be concerned?” Healthcare Dive, Feb 13, 2023 READ IT HERE

GoodRx sold private medical information to advertisers. The FTC was not amused. Its sanctions are “likely to be the first of many against companies trafficking in user’s sensitive medical data.” But the fine was a paltry $1.5 million.

*

Nicholas Florko, “Vape maker Elf Bar wants to donate to the American Cancer Society, but it doesn’t want tobacco money,” STAT, Feb 14, 2023 READ IT HERE

Vape companies are trying the old tobacco industry scam of pretending to care about people’s health to whitewash their image. The ACS seems to have retained a modicum of integrity—other groups would have sold out immediately. “The American Cancer Society does not partner with or accept funds from tobacco companies and has sent a cease-and-desist letter to Elf Bar to prevent further public deceit.”

*

Dean Baker, “The Washington Post wants to cut Social Security and Medicare (yeah, what else is new?)” CEPR, Feb 5, 2023 READ IT HERE

“For the 43,578th time, the Washington Post called for cuts to Social Security and Medicare.” While the Post correctly rejects Republican games with the debt ceiling, it predictably says the two programs are on “unsustainable trajectories.” Austerity and cuts are always couched as “protecting programs for future generations.”

*

Editorial Board, “A targeted Rx for rural health care,” [Minneapolis] Star Tribune, Jan 22, 2023 READ IT HERE

“One out of every three rural physicians reports planning to leave their profession within the next five years, exacerbating existing shortages.”

*

Tony Leys, “Wave of rural nursing home closures grows amid staffing crunch,” Kaiser Health News/NBC News, Jan 25, 2023 READ IT HERE

“Owners say the closures largely stem from a shortage of workers, including nurses, nursing assistants, and kitchen employees.” The sector is down 300,000 positions nationwide, and 129 nursing homes have closed. Here’s a crazy idea: employ immigrants from Venezuela and Honduras.

*

Physicians Committee for Responsible Medicine, “CBS’s 60 Minutes news segment was an unlawful weight loss drug ad,” Jan 19, 2023 READ IT HERE

How is this legal? “After receiving advertising payments from Novo Nordisk, CBS’s 60 Minutes aired a 13-minute promotion of Wegovy, the Novo Nordisk weight loss drug, during its Jan. 1 broadcast, making it appear to be a news story.” The only doctors allowed to speak during the piece were those on the Novo Nordisk payroll. PCRM are suing CBS for the deception and asking that it be held to the same standards as the ads we see daily, including a careful inclusion of dangerous side effects such as gallstones, pancreatitis, and hypoglycemia. The Pharma owners of the new diet drug want government insurance programs to reimburse for it to the tune of $1300 a month. More shameful corporate toadyism parading as journalism.

*

Charles Piller, “FDA and NIH let clinical trial sponsors keep results secret and break the law,” Science, Jan 13, 2023 READ IT HERE

The 2007 requirement to register clinical trials is aimed at preventing publication bias, i.e., the tendency to only reveal study results when the drug or treatment under investigation can be made to appear successful. Pharma prefers to suppress failed studies. But a law is useless unless enforced: “Of 184 sponsor organizations with at least five trials due, 30 companies, universities, or medical centers never met a single deadline.” Including the NIH itself.

*

Adriane Fugh-Berman, “Too soon to celebrate new Alzheimer’s drug,” Baltimore Sun, Jan 23, 2023 READ IT HERE

Here we go again: “Leqembi is similar to Aduhelm (aducanumab), approved last year by the FDA despite its advisory committee soundly rejecting it.” Both used as clinical markers a subjective measure of cognition that showed improvement of a half-point on an 18-point scale. Also, they both rely on the amyloid plaque theory of Alzheimer’s even though “many patients with brains full of amyloid have no symptoms of dementia.” The Alzheimer’s Association, naturally (being a recipient of Pharma money), thinks leqembi is just great—as it did with Aduhelm.

SINGLE PAYER LINKS #291

Posted 10 FEB 2023

*

Adriel Bettelheim, “Pandemic years saw a reduction in medical debt,” Axios, Jan 18, 2023 READ IT HERE

“The CARES Act, American Rescue Plan Act, and other pandemic relief legislation may have indirectly softened the blow of medical debt by providing direct monetary payments, increasing the percentage of people covered by insurance using COBRA premium subsidies and expanding eligibility for subsidies in Affordable Care Act markets.” Okay, enough good news already, time for some moral improvement through suffering.

*

Caroline Lewis, “Millions of New Yorkers will feel health care change as COVID emergency ends. Here’s how,” Gothamist, Feb 6, 2023 READ IT HERE

What happens when Covid is officially over on May 11? For starters, 8 million Medicaid beneficiaries will have to reapply. “This move will restore a cycle of disenrollment and reenrollment that’s known to generate interruptions in health care among low-income communities.” Also, no more free Covid tests unless NYC keeps supplying them; Paxlovid will go commercial; vaccine charges may start to appear. The city added 1 million Medicaid enrollees during the epidemic (up to 4.3 million); kicking lots of them off as federal aid dries up could cause a bit of an earthquake. When the country needed people to be healthy, single-payer tendencies abounded. Now that the needs of The Economy have changed, we can go back to commercialized medicine.

*

Brian Witte, “As many as 80K Marylanders could lose Medicaid eligibility,” Associated Press, Feb 5, 2023 READ IT HERE

Maryland officials say the state is in a better position than many because of an “integrated system between Medicaid and qualified health insurance plans.” It also has kept up with redeterminations for eligibility and so won’t be hit with a wave of exclusions. But some worry about the sheer number of people affected.

*

Jack Bernard, “Too many rural Americans have no health insurance and they deserve better,” The Tennessean, Jan 25, 2023 READ IT HERE

An unusual opinion column not only critical of Obamacare but explicitly endorsing single-payer. Tennessee is among the 11 states that have refused to expand Medicaid; most commentators simply plead for a reversal. Sixteen percent of rural Tennesseans ages 18–64 are uninsured.

*

Rebecca Pifer, “Cigna addresses MA overhaul, fresh off $6.7B in profit,” Healthcare Dive, Feb 3, 2023 READ IT HERE

CEO David Cordani is happy that the Federal Government won’t claw back fraudulent MA charges dating from before 2018, so Cigna (now a unit of CMS) can rest easy. Cigna’s medical loss ratio was 84%, meaning that it pocketed 16% of its reimbursement and premium income for admin and profit. (Medicare admin costs run about 2%.) Also, those millions of people thrown off Medicaid “represent an opportunity for us,” said Cordani, because those folks will have to buy lousy Obamacare plans, preferably from Cigna.

*

Wendell Potter, “How prior authorization can kill: a 2-year-old with cancer; a young woman needing chemo; and a 17-year-old in need of a transplant,” Health Care Un-covered, Feb 2, 2023 READ IT HERE

Horror stories that only get reversed through bad publicity or an insider contact. Potter reminds readers of why he got sick of working for Big Insurance. “Some of you know that I left my job at Cigna after being in the middle of a prior authorization battle involving a teenager in Los Angeles who needed a liver transplant. Cigna denied it. After an appeal failed, the family decided to be a very loud squeaky wheel. Media inquiries started pouring in, and the resulting negative publicity was beginning to tarnish the company’s reputation. The company’s top brass ultimately decided to reverse the denial.” But the 17-year-old girl died the next day. Potter quit.

*

Dave Muoio, “Bayer, EMD Serono announce 340B restrictions in wake of pharma’s courtroom win,” Fierce Healthcare, Feb 2, 2023 READ IT HERE

The 340B drug discount program helps some worthy safety-net providers and is also gamed by thriving hospitals that aren’t safety-net at all. Pharma is trying to pare it back and has had some success with friendly judges. Another version of King Kong v. Godzilla with vulnerable underlings trampled underfoot.

*

Bari Faye Dean, “The ‘hard truth’ about staffing shortages: They aren’t going away,” Becker’s Hospital Review, Feb 2, 2023 READ IT HERE

Does having providers “over-worked, under-staffed and under-resourced hurt patient care?” Big surprise: yes. When residents were limited to 16-hour shifts, “reported medical errors and adverse events dropped by more than a third.”

*

Eric Reinhart, “Doctors aren’t burned out from overwork. We’re demoralized by our health system,” New York Times, Feb 5, 2023 READ IT HERE

American doctors are showing signs of demoralization syndrome, “a sense of helplessness and loss of purpose commonly associated with terminal illness.” Except it’s not a medical condition, says the anthropologist/MD author, but a reaction to “the diseased systems for which we work.” When doctors see that their best efforts do nothing to fix a broken system, they tend to give up. Only 40,000 new doctors joined the work force in 2021 while 117,000 left it. “What has been identified as occupational burnout is a symptom of a deeper ‌collapse. We are witnessing the slow death of American medical ideology.” He means that providers no longer believe in the system they are a part of, which is a much more profound phenomenon than being pissed off at your boss. He calls for “universal” healthcare and paid sick leave but, given that this is the Times, daren’t say “single payer.”

*

Wicker Perlis, “Bill to make hospital collaboration, mergers easier passes Senate amid rural health crisis,” [Mississippi] Clarion Ledger, Feb 3, 2023 READ IT HERE

The state legislature wants to facilitate hospitals mergers to save its rural hospitals, half of which face closure. Smaller units banding together sounds reasonable, but in practice the bigger systems often gobble up the assets of struggling hospitals and then let them die anyway.

*

David Armstrong, Patrick Rucker & Maya Miller, “UnitedHealthcare tried to deny coverage to a chronically ill patient. He fought back, exposing the insurer’s inner workings,” ProPublica/Capitol Forum, Feb 5, 2023 READ IT HERE

UHC had a gold mine contract to insure healthy Penn State students, but one suffering from a crippling disease with an expensive treatment regimen cut way into their profits. Medical criteria flew out the window until the guy’s parents—both PSU professors—sued and found out the gory details of misconduct. This is a sorry tale with a happy ending but only because a deep-pocketed and determined family could slug it out with a giant corporation. Worth a read for the dogged strategy and amazingly corrupt practices by the insurer and the university. Of course, why even a specialty drug should cost half a million a year isn’t addressed though the article does mention the $140 million in compensation that UHC’s top exec made.

*

Dave Muoio, “DOJ withdraws ‘outdated’ and ‘overly permissive’ healthcare antitrust enforcement guidance,” Fierce Healthcare, Feb 3, 2023 READ IT HERE

More signals that DoJ is getting serious about hospital consolidation from an antitrust perspective. “The healthcare industry has changed a lot since 1993, and the withdrawal of that era’s out of date guidance is long overdue,” said Assistant A-G Jonathan Kanter. Kanter often teams up with the FTC’s Lina Khan to block or challenge mergers. They don’t always win, but the attempts alter the landscape. Biden’s SOTU speech also hit the antitrust theme surprisingly hard.

*

Rebecca Pifer, “CVS buys Oak Street Health for $10.6B,” Healthcare Dive, Feb 8, 2023 READ IT HERE

The latest wave of consolidation involving major retailers absorbing primary care: CVS/Oak Street Health is a step toward “a vertically integrated healthcare business including physicians, pharmacy a health plan, and more.” CVS also has invested in other healthcare companies: primary and urgent care provider Carbon Health ($100 million); tele-mental health company Array Behavioral Care ($25 million); home health provider Signify Health ($8 billion). MA is a “key growth area” since Oak Street specializes in contracting managed care for Medicare patients.

*

Heather Landi, “Aledade, Mark Cuban’s drug company, and a handful of others are public benefit corporations. Could it be the Rx to improve healthcare?” Fierce Healthcare, Feb 3, 2023 READ IT HERE

Could shifting from a “shareholder value” healthcare corporation into some other legal structure make a difference? Some are rebranding as public benefit corporations (PBC), which are for-profit entities that have “adopted a public benefit purpose” and so have to consider nonfinancial interests in their behavior. But why don’t ALL corporations have that responsibility given the many benefits they enjoy as a publicly recognized legal personages? (The “shareholder value only” concept is just convenient BS.) The Mark Cuban outfit joins others companies-with-a-conscience like Ben & Jerry’s, and while that’s nice, does the values-laden rebranding really change anything? If it does, will it outlast the well-intentioned founders?

*

Marshall Allen, “How to enlist the media to help you with your bogus medical bill,” Allen Health Academy, Jan 31, 2023 READ IT HERE

How to use the news media to kick your insurance company’s butt: a step-by-step guide for going to war over medical bills that shouldn’t exist in the first place. (1) check the billing codes and fair prices on HealthcareBluebook.com and FairHealthConsumer.org; (2) try negotiating with the billers and collection agencies; (3) write them letters (with expert advice if possible); (4) then either (a) go to small claims court or (b) hit up reporters because “going to the media hits them where it hurts.” To go this route, you need to line up all the documentation and understand the arcane coding because if you do the reporter’s legwork first, you have a better chance.

*

Ike Brannon, “Pharma’s strategy to exploit a depression-era antitrust law would raise drug costs for consumers,” Forbes, Jan 23, 2023 READ IT HERE

In the King Kong v. Godzilla fights, a lot of nasty truths are flung about. This guy, a “senior fellow at the Jack Kemp [remember him?] Foundation, represents the PBMs, which blame high prices on nasty Pharma pirates—and sidesteps the huge cut PBMs carve out for themselves. “Middlemen” like us, says he, don’t have a pernicious effect on the drug market—perish the thought!

*

Megan Ford, “Exclusive survey reveals ‘worryingly high’ levels of long Covid among nurses,” Nursing Times, Feb 1, 2023 READ IT HERE

“Almost one in 10 (9.5%) of the nursing staff who responded have long Covid.” Skewed by the self-selection bias in the responses, but still.

*

Artie Vierkant & Beatrice Adler-Bolton, “Why the White House shouldn’t privatize COVID vaccines,” Teen Vogue, Jan 26, 2023 READ IT HERE

“The Biden administration has spent years painting the situation as beyond their control and as something we will have to accept. The administration has pursued a vaccine-only strategy, leaving layered protections like masking by the wayside while as many as 61% of COVID deaths in a given month are among the vaccinated.” Much more and very on point—am I too old for a Teen Vogue subscription?

*

Oriana Gonzalez, “Health experts want FDA safety review of fast-tracked Alzheimer's drug,” Axios, Feb 6, 2023 READ IT HERE

Some people think the FDA is cutting corners again with a new Alzheimer’s drug. “The FDA didn't follow its customary process and convene an advisory panel before green-lighting the accelerated approval last month. Eisai reported 13 deaths out of the nearly 1,800 participants in the trial” but has not released detailed data on them. But patients “are willing to risk a brain hemorrhage,” says one researcher. Also, the “success” relies on reduction of amyloid plaques, a partially discredited theory of Alzheimer’s cause—though apparently not at the FDA.

*

Aria Bendix & Rob Wile, “Women suing J&J await their day in court after the company failed to get talc cases moved to bankruptcy court,” NBC News, Feb 4, 2023 READ IT HERE

J&J used a legal maneuver called the “Texas Two-Step” in which they create a subsidiary and saddle that entity with product liability claims. Within days of its creation in 2021, LTL declared bankruptcy. By this logic, whenever charged with a crime, just create a corporate subsidiary and say, “They robbed that bank, not me!” So far, J&J isn’t getting away with it.

*

Thalia Beaty, “Gates Foundation takes up question of its own power,” Associated Press, Jan 17, 2023 READ IT HERE

The Bill & Melinda Gates Foundation asks itself if it has too much power and influence and answers with a resounding NO! These thumb-sucking exercises (“Let’s sit around and contemplate whether we are entirely virtuous or just mostly.”) are achingly predictable. Gates sits on a $70 billion endowment, owns the WHO, and gives news media hundreds of millions to guarantee positive coverage of his majestic Self. Ruling from his golden throne, Gates has outsized influence on the known universe, including education and health policy, especially vaccines. It’s unhealthy to even debate whether gazillionaires should dominate us because it sidesteps the issue of how they accumulated all that loot in the first place.

*

Fang Block, “MacKenzie Scott’s unrestricted gifts transform the organizations that receive them, study finds,” Barron’s, Dec 12, 2022 READ IT HERE

Which anyone in the nonprofit sector could have told these researchers before they drafted their questionnaire. Bezos-ex Scott donated $13 billion in unrestricted gifts to 277 nonprofit organizations, an average of $8 million each, 80 times the size of the typical foundation grant. “Both in the surveys and interviews, we really did not hear any significant unintended consequences that these nonprofit experienced as a result,” reported one insouciant academic. Yes, people on the receiving end of large amounts of cash rarely object, but it’s still highly destabilizing.

*

Samantha Liss, “Judge’s ruling on surprise billing threatens to disrupt arbitration process,” Health Care Dive, Feb 7, 2023 READ IT HERE

Fights continue over how to divvy up payments among competing participants. “The No Surprises Act set up a process for how payers and providers could resolve these payment disputes,” with emphasis on them, not patients. Now, doctor groups, hospitals, and insurers are slugging it out over the rules.

*

SINGLE PAYER LINKS #290

Posted 3 FEB 2023

*

Samantha Liss, “Minnesota attorney general asks Sanford-Fairview to delay merger,” Healthcare Dive, Jan 30, 2023 READ IT HERE

States gingerly wade into anti-concentration enforcement, perhaps emboldened by the newly energized FTC: South Dakota-based Sanford Health wants to merge with Minnesota’s Fairview Health Services to create an 11-hospital, $14 billion system. One sign of public interest and possibly opposition: the state A-G has already received 3,500 comments on the deal.

*

Rebecca Pifer, “Louisiana sends cease-and-desist order to Express Scripts over delayed insurance claims,” Healthcare Dive, Jan 30, 2023 READ IT HERE

Louisiana received “multiple complaints” about pharmacies being stiffed when the Cigna-owned PBM Express Scripts failed to pay claims. Other PBMs have paid out hundreds of millions to settle similar allegations. Could tougher state action be a trend? Meanwhile, the FTC has launched a global investigation into PBMs and is now pouring through documentation on the business practices of the six largest ones. California is suing PBMs over insulin pricing. Even Congress might act.

*

Wendell Potter, “Big Insurance in-fighting: Why it’s so important that Cigna is suing CVS,” Health Care Un-covered, Jan 30, 2023 READ IT HERE

King Kong v. Godzilla, this time over a “noncompete” agreement—pass the popcorn. A top Cigna exec defected to CVS, and war was declared. Huge profits are involved since “Express Scripts, which Cigna bought in 2018, generates far more revenue and profits for the company than its health plan business.” Similarly, CVS’s PBM, Caremark, which it absorbed in 2006, makes more money for the parent company than either insurer Aetna—which it also owns—and all those seasonal decorations and candy bars they sell at 10,000 CVS retail stores. PBMs are where the big bucks are.

*

Fred Schulte, “Did your health plan rip off Medicare?” Kaiser Health News, Jan 27, 2023 READ IT HERE

Probably. KHN released details of audits covering the years 2011–2013 “that reveal millions of dollars in overpayments to Medicare Advantage health plans for seniors.” These audits of nearly decade-old reimbursements are just the tip of the iceberg while the Feds are doing everything they can to push more people into these rip-off policies. KHN had to sue for three years to get the documents through FOIA. The clawback payments from just these audits alone could amount to $650 million, but the overcharges must run to billions or even tens of billions.

*

Samantha Liss, “CMS to crack down on Medicare Advantage audits, poised to claw back billions of dollars from insurers,” Healthcare Dive, Jan 31, 2023 READ IT HERE

Confirming the overcharges backlog: “By CMS’ own estimates, Medicare made $50 billion in overpayments from 2013 through 2017.”

*

Rylee Wilson,” In blow to payers, CMS implements tougher Medicare Advantage audit rule,” Becker’s Payer Issues, Jan 30, 2023 READ IT HERE

Insurers that have cashed in could be “on the hook for billions of dollars in repayments to the federal government.” But they can keep overcharges collected before 2018. And the guilty can continue to hustle elders to sign up to MA plans with CMS complicity.

*

Robert King, “Medicare Advantage plans lose out in final RADV audit rule that ditches fee-for-service adjuster, Fierce Healthcare, Jan 30, 2023 READ IT HERE

The MA-bsters will howl in outrage, but the rule to restrict upcoding is softer than it could have been. One advance: Medicare officials will extrapolate from an audit sample of a plan’s records and then charge the error rate based on all enrolled customers. Though the MA plans may have to cough up half a billion, the plans have pocketed multiples of that through the same practice over a decade. “Agency officials told reporters that they declined to apply extrapolation to plan years 2011 through 2017 in light of major pushback from the insurance industry.” Well, alrighty then! As long as everyone’s happy! Insurance companies will probably sue anyway.

*

Samantha Liss, “Insurance lobby blasts Medicare Advantage audit rule,” Healthcare Dive, Jan 31, 2023 READ IT HERE

As predicted, the fraudsters denounce the cops. Industry placard: “Defund CMS!”

*

Samantha Liss, “Humana expects 14% hike in 2023 MA enrollment as it taps new leaders,” Healthcare Dive, Feb 1, 2023 READ IT HERE

“Humana expects to pick up 625,000 individual Medicare Advantage members in 2023, a nearly 14% hike from last year.” No interruption of the business for a little thing like massive financial fraud.

*

Susan Morse, “CMS releases three initiatives to grow Medicare ACO participation,” Healthcare Finance News, Jan 18, 2023 READ IT HERE

The Centers for Medicare and Medicaid Services is finding new ways “to advance its goal of having 100% of people in traditional Medicare in an accountable care relationship in seven years.” These are not all ACO REACH or MA, but even physician-led ACOs (accountable care organizations) have an incentive to reduce care through the “Shared Savings Program.” This is only a good idea if you believe in market logic to produce good healthcare.

*

Mitchell Thompson, “Canada’s health care system is on life support,” Jacobin, Jan 7, 2023 READ IT HERE

“The results of austerity are not theoretical—people are dying in Canada’s waiting rooms.” How wearying to think that establishing a single-payer system is not the end of the battle since a government can then try to starve and undermine it. Canada once shared costs with provinces on a 50/50 basis, but that formula “came to a quiet end” in 1977. “This accelerated in the 1990s as the Liberal party implemented one of the harshest austerity programs in the industrialized world—cutting transfer payments to the provinces by nearly 50 percent.” Calls for privatization followed, of course.

*

Rebecca Pifer, “Agency officials said they’re putting the market on watch with the action against GoodRx,” Healthcare Dive, Feb 1, 2023 READ IT HERE

The Federal Trade Commission penalized GoodRx for years of sharing users’ sensitive health information with advertisers and hit them with a laughable million-and-a-half buck fine—not enough to grease a skillet with. GoodRx’s revenues just in the third quarter of last year was $187 million, and gross earnings $52 million. If anyone thinks this will discourage data mining of our medical affairs, bridges are on sale today. GoodRx offers discounts on prescriptions in exchange for making you a tradable commodity.

*

Hailey Mensik, “Consolidated systems charge more for ‘marginally’ better care, study finds,” Healthcare Dive, Feb 1, 2023 READ IT HERE

The giant systems cost a lot more and perform only slightly better. Concentration in the hospital sector is advanced: large systems account 89% of admissions, and 40% of doctors work for one (75% of doctors are no longer self-employed). That gives them market power to demand higher prices whatever their performance.

*

Lev Facher, “Venture capital is investing little in new treatment for addiction, report finds,” STAT, Feb 2, 2023 READ IT HERE

I’m shocked beyond all description. “In the past decade, investment firms have poured roughly 270 times more money into developing cancer drugs than addiction cures.” Admittedly, the idea that any drug can cure an addiction is debatable. Meanwhile, insurers resist coverage for injectable buprenorphine, one of the more promising options.

*

Annie Burky, “Healthcare ranked lowest for employee satisfaction, Qualtrics survey finds,” Fierce Healthcare, Jan 19, 2023 READ IT HERE

Last out of 28 industries. “Only half of healthcare employees believe they are paid fairly, 38% report they are at risk of burnout, and 39% are considering leaving their organizations.”

*

Arielle Dreher, “Study finds hospitals are still not posting prices,” Axios, Jan 19, 2023 READ IT HERE

“Only 19% of hospitals fully comply with the Centers for Medicare and Medicaid Services rule that requires facilities to post estimated costs for items and services, an analysis published in the Journal of General Internal Medicine has found.” Why obey an inconvenient law when you don’t have to?

*

Medicaid expansion

Jeff Victor, “Medicaid expansion back on the table in 2023,” Wyoming Public Radio, Jan 16, 2023 READ IT HERE

Wyoming is the last holdout state in the Mountain West. Advocates hope to push expansion through this year.

*

Geoff Pender, “Poll: 80% of Mississippians favor Medicaid expansion,” Mississippi Today, Jan 18, 2023 READ IT HERE

Even 70% of Mississippi Republicans want Medicaid expansion. If we lived in a democracy, this would matter.

*

Jason Tidd, “Up to 125,000 Kansans will get kicked off Medicaid this year. Here’s who wants it to happen faster,” Topeka Capital-Journal, Jan 18, 2023 READ IT HERE

A fun piece on the banshee hellcats who think poor people don’t suffer enough. Let’s get those pregnant women and low-income children back on the streets now!

*

Christopher O'Donnell, Romy Ellenbogen & Lawrence Mower, “Medicaid coverage to end in April for nearly 1 million in Florida,” Tampa Bay Times, Jan 19, 2023 READ IT HERE

Advocates warn a “looming tidal wave” of people will lose coverage that they’ve had for three years. In Florida, it could affect nearly a million people. The official in charge is the state “assistant secretary for economic self-sufficiency.” And here I thought one went to Florida to laze around! Florida is a non-expansion state. Working parents who earn more than $7,000 per year aren’t eligible.

*

Arielle Dreher, “Hospital obstetrics on chopping block as facilities pare costs,” Axios, Jan 17, 2023 READ IT HERE

“Hospitals trying to shed unprofitable business lines are increasingly scaling back or halting maternity services.” The economics don’t add up with lower birth rates, staff shortages, and lousy Medicaid reimbursement. And what med student wants to go into obstetrics in this environment? As for rural counties, 45% have no obstetrics services. The only growth sector: “luxury birthing suites with a high price tag.” No wonder we have high maternal mortality rates.

*

SINGLE PAYER LINKS #289

Posted 27 JAN 2023

*

Jeet Heer, “Biden’s next chief of staff is a disaster in the making,” The Nation, Jan 23, 2023 READ IT HERE

Jeff Zients, set to take over from Ron Klain as chief consigliere, got rich through predatory health companies, including the notorious surprise-billing champion NorthStar Anesthesia and others forced to pay tens of millions in fines for Medicare and Medicaid fraud. Full steam ahead on privatization.

*

Julie Rovner, “As US bumps against debt ceiling, Medicare becomes a bargaining chip,” Kaiser Health News, Jan 19, 2023 READ IT HERE

“While repealing the Affordable Care Act seems to have fallen off congressional Republicans’ to-do list for 2023, plans to cut Medicare and Medicaid are back.” What better way to get that started than to turn the phony debt-ceiling fight into an austerity pact with willing Democrats (led by Zients). Expect to hear lots of rhetoric about “protecting” these programs and Social Security by slashing benefits.

*

Robert King, “CMS: More providers serving as ACOs in 2023 amid new reforms and scrutiny,” Fierce Healthcare, Jan 17, 2023 READ IT HERE

Accountable care organizations (ACOs) get paid based on “value-based” care criteria, ostensibly an incentive to do a better job. But the “shared savings” model fits nicely with austerity goals, especially when the operators are for-profit entities. The Medicare bosses’ goal is “to have every Medicare beneficiary in a value-based care relationship by 2030.”

*

Robert King, “Providers seek more incentives in ACO REACH to target highly underserved areas,” Fierce Healthcare, Jan 18, 2023 READ IT HERE

To justify creeping privatization, Biden’s Medicare officials are touting the need to address “health inequities” suffered by minority and low-income beneficiaries. The discussion is an excellent smokescreen to shift attention from the move to deliver a government program to for-profit operators. “We want to be in these underserved communities because we believe everyone should get access to primary care in this country and they are not getting it,” said Gary Jacobs, executive director of the Center for Government Relations and Public Policy for VillageMD.” Village MD is owned by Walgreens.

*

Robert King, “CMMI Director Liz Fowler: Expect advance primary care, total cost models to be released in 2023,” Fierce Healthcare, Jan 24, 2023 READ IT HERE

The Feds will offer states more flexibility not just with Medicaid spending but also Medicare and are pointing to a Maryland experiment that awards some state hospitals a lump sum for Medicare payment. The idea is to “incentivize hospitals to get rid of unnecessary hospitalizations.” The official in charge of the new plans is none other than Liz Fowler, director of the Center for Medicare and Medicaid Innovation (CMMI), architect of Obamacare as a key aide to Max Baucus (D-MT), prior to that a VP at Johnson & Johnson and a lobbyist for Wellpoint, and now an enthusiastic backer of Medicare privatization through ACO REACH. What could go wrong? Amid all the talk of “value-based care” that neatly obscures the wide-open door to private and for-profit infiltration: lots of references to “health equity” and fairness to racial minorities.

*

Rebecca Pifer, “CVS, Rush partner on new ACO for Chicago Medicare patients,” Healthcare Dive, Jan 24, 2023 READ IT HERE

Here’s another entrant into the ACO REACH scramble to privatize Medicare: CVS, which owns Aetna, teaming up with a Chicago health system. CVS now covers patients in Florida, Georgia, Illinois, Indiana, Kansas, Missouri, North Carolina, and New York and is looking for a primary care provider to further its vertical integration plans.

*

Margot Sanger-Katz, “The December omnibus bill’s little secret: It was also a giant health bill,” New York Times, Jan 22, 2023 READ IT HERE

Lots of health policy sausage got made in the waning days of the previous Congress. One positive: expanded Medicaid benefits for postpartum care and for children through CHIP. It also includes measures to block states from “automatically dumping large numbers of adult enrollees after the end of an emergency policy that protected enrollments during the pandemic.” The “Covid-is-over” Medicaid dump will be a big issue for 2023.

*

Robert M. Kaplan & Paul Tang, “Upcoding: one reason Medicare Advantage companies pay clinicians to make home health checkups,” STAT, Jan 19, 2023 READ IT HERE

Those Medicare Disadvantage youngsters are so nice! They come visit me at home and chat with me about all my health issues. Red alert! They’re pumping you for information that can be used to up your risk score so that the parent company can charge Medicare higher fees. “Business consultants have created an entire industry dedicated to gaming the system,” say the authors. Upcoding costs Medicare an estimated $20 billion per year in unnecessary reimbursements, but don’t expect to hear either party suggest reining in that abuse to “save” Medicare’s allegedly rickety finances.

*

Sylvia Allegretto & Dave Graham-Squire, “Monopsony in professional labor markets: Hospital system concentration and nurse wage growth,” Institute for New Economic Thinking, Jan 19, 2023 READ IT HERE

“Labor shortages among hospital-based nurses, which may be a symptom of monopsony, have been endemic in the industry for many years.” But nurses’ wages have been stagnant since the mid-90s. This research “strongly suggests” that when the hospital sector consolidates, nurses get shafted. “Monopsony” means concentration of demand (single buyer) versus monopoly, which is concentration of supply (single seller). A single-payer system is essentially a public monopsony.

*

Lauren Gravitz, “Scientists are finding increasing evidence for a link between air pollution and neurodegenerative diseases like Alzheimer’s,” STAT, Jan 11, 2023 READ IT HERE

One not insignificant side effect of the relentless search for the magic Alzheimer’s pill is to pull attention away from the likely environmental causes of the Alzheimer’s epidemic that cannot be fixed with a Pharma product. A neuroscientist found that Mexico City residents—where birds once fell dead from the polluted skies—are “at noticeably increased risk for Alzheimer’s and other neurodegenerative conditions.” But no billionaires will be minted by addressing that cause.

*

Ed Silverman, “Lawmakers again urge the Biden administration to use federal law to widen access to a cancer drug,” STAT, Jan 11, 2023 READ IT HERE

The medicine in their crosshairs is the Xtandi prostate cancer drug, developed at UCLA with NIH funding that now lists for $156,000. Because a key inventor was a UCLA professor, the school could cut a deal with Pharma for a big payout. In short, public monies were used to create a budget-busting drug to create new billionaires. Patient groups are asking the government to exercise “march-in” rights by which the government can force patent-sharing on a product developed with its money. The NIH is stonewalling.

*

Danielle Ofri, “Even with lawsuits and copay caps, will insulin ever be affordable?” STAT, Jan 20, 2023 READ IT HERE

“The headlines generated by the Inflation Reduction Act’s insulin copay cap gave many people the impression that Congress had done its job to control insulin costs. But that is hardly the case.” I had that impression as well, so this is an important (though confusing) corrective. California is accusing the three near-monopoly insulin producers of colluding to jack up prices. But also involved in the scam are the pharmacy benefit managers (PBMs) that now are all owned by major insurers. “Although the [PBMs’] job is to negotiate drug prices on behalf of insurance companies—and thus for patients—a hefty chunk of the savings they extract from drugmakers ends up in their own pockets and is not passed on to the insurance companies or their customers.” That means the PBMs have a built-in incentive to go with higher cost products to get a larger fee as a percentage of the transaction. As a result, the big headlines about the insulin price cap amount to “even less than a Band-Aid, helping only a small fraction of people needing insulin” while diabetic Americans continue to pay up to 10 times more for insulin than their non-U.S. peers.

*

Ava Kofman, “Pressure mounts for hospice reform,” ProPublica, Jan 20, 2023 READ IT HERE

A major exposé has forced the industry to move quickly to head off government action. ProPublica found rampant abuses, and now several government investigations are underway after. Private equity is moving into hospice in a big way.

*

Samantha Liss, “Doctors no longer bound by non-competes under FTC’s proposed ban,” Healthcare Dive, Jan 11, 2023 READ IT HERE

Doctors, including nearly half of primary care physicians, are often stuck in their jobs due to prohibitions on working for alternative employers in their area. “Nonprofit” hospitals probably will sue to block the measure and argue that the FTC can’t regulate “charities.”

*

Lee Fang, “Covid-19 drugmakers pressured Twitter to censor activists pushing for generic vaccine,” The Intercept, Jan 16, 2023 READ IT HERE

How Pharma tried to use Twitter to suppress the voices of advocates for patent reform, based on internal communications released by Musk. For example, BioNTech asked Twitter to shield its own and other Pharma corporate accounts and to monitor certain hashtags like #PeoplesVaccine. It’s not yet clear whether Twitter complied, but the lobbying campaign to avoid patent sharing with poor countries worked. “The largely successful assault against the creation of generic vaccines resulted in an unprecedented explosion in profit for a few select biopharmaceutical drug interests,” including $37 billion in revenue from Covid vaccines in a single year.

*

Brigid Tonry, “More nurses: The smart way to save lives, money—and nurses,” STAT, Jan 12, 2023 READ IT HERE

A nurse argues for mandated staffing levels, a key demand in the recently settled nurses’ strike in New York. “The odds of a patient dying in the hospital increases by 13% for each additional patient added to the average nurse’s workload.” Burned out nurses are leaving the profession in droves as hospitals learn how short-term savings can be expensive.

*

Jenna Carlesso, “Lawmakers pledge to address health care worker shortage,” CT Mirror, Jan 23, 2023 READ IT HERE

Connecticut is moving toward exactly the sort of action recommended above: “mandated nurse staffing ratios, closing a loophole that allows hospitals to impose mandatory overtime, and examining recruitment and retention strategies to boost employee numbers.” Staff vacancy rates in CT hospitals are around 30-35%.

*

David M. Newman, “Reject the cruelty of Medicare Advantage, NYC,” NY Daily News, Jan 16, 2022 READ IT HERE

A widowed spouse describes the marvels of privatized Medicare: “We did not anticipate that the last six months of her life would be consumed by constant battling with our medical insurer. This happened largely because our excellent union-negotiated, employer-provided retiree health care coverage had been downgraded from traditional public Medicare to a for-profit Medicare Advantage plan.” The family needed direct intervention by a member of Congress to get approval for hospice care. But most pols are still hypnotized by well-financed propaganda from the Disadvantage companies.

*

Samantha Liss, “Elevance to acquire Blue Cross and Blue Shield of Louisiana,” Healthcare Dive, Jan 24, 2023 READ IT HERE and “Will Elevance’s Louisiana acquisition kick off BCBS consolidation wave?” Healthcare Dive, Jan 25, 2023 READ IT HERE

More consolidation, bringing the total reach of Elevance Health (ex-Anthem) to 47 million members in 15 states. “The proposed purchase reminds some industry experts of a period beginning in the 1990s, when nonprofit BCBS [Blue Cross/Blue Shield] plans were acquired by for-profit groups,” like Wellpoint. “Wellpoint was later rebranded to Anthem following a merger between the two and recently changed its name to Elevance.” Rinse and repeat.

*

Samantha Liss, “Elevance reports $6B profit in 2022 on higher medical membership,” Healthcare Dive, Jan 25, 2023 READ IT HERE

“Total revenue climbed 13% to nearly $157 billion for the year as the insurer collected higher premium revenue from its Medicaid plans.”

*

Byerin Prater, The FDA is proposing a move to annual COVID shots. Some experts worry it’s too soon, and too simple of an approach,” Fortune, Jan 23, 2023 READ IT HERE

The industry-captured FDA wants to “simplify” vaccine campaigns and turn Covid into a benign affair like the flu shot. That would eliminate the need for “nuanced vaccine guidance that’s difficult to understand and could reduce uptake.” That is, further suppress skepticism about the official message while continuing to ignore non-Pharma protective measures and the evidence that year-long protection is, at best, unproven.

*

Heather Landi, “How Amazon’s latest pharmacy move lays the groundwork for longer-term play,” Fierce Healthcare, Jan 26, 2023 READ IT HERE

Amazon is rolling out a subscription pharmacy service that “also provides Amazon with a treasure trove of health data on their [150 million] Prime members, which is significant given the company's recent deal to buy One Medical for $3.9 billion.” Walmart already has a similar service, but Amazon may be willing to take a loss on the program in exchange for data—and to elbow out the competition like Mark Cuban’s Cost Plus Drugs. Another possible motive: it could be a way to attract non-Amazon Prime members to sign up.

*

SINGLE PAYER LINKS #288

Posted 20 JAN 2023

*

Jenna Carlesso, “CT Medicaid expansion launches for kids of any immigration status,” CT Mirror, Jan 10, 2023 READ IT HERE

Connecticut already covered kids age 8 and under if the parents were Medicaid-eligible; this expands it to 12 and under.

*

Eve Simmons, “Key study into anti-stroke drug taken by millions found to be ‘unreliable’ and potentially fatal side effects were ignored, documents reveal,” Daily Mail [U.K.], Jan 7, 2023 READ IT HERE

Xarelto, “taken by thousands worldwide” and a big earner, was approved based on questionable, even “fake,” data while its “potentially fatal side effects” were kept secret. The FDA once denied approval for it based on an efficacy study in which “the data used were unreliable. Two years later, after three subsequent studies by a different research group,” it got approval—sounds familiar! BMJ reported that two of the 16 hospital study sites “failed to report serious side effects, and four of the patients taking rivaroxaban in the trial died, which the researchers failed to explain.” Coincidentally, the German firm Bayer developed the drug, partially funded the study, and pulled in sales to the tune of £5 billion year from it. Don’t tell me that a company with a huge financial stake in a study’s outcome might manipulate its results!

*

Nick Hayes, “For addiction treatment, longer is better. But insurance companies usually cut it short,” STAT, Jan 13, 2023 READ IT HERE

“Millions of Americans get substandard treatment or none at all.” We now have 100K overdose deaths per year—how many do we need before a viable treatment pipeline is in place? But insurers won’t pay for what actually works. “Treatment requires multidisciplinary expertise, costly resources, and durations that are, on average, exponentially longer than those for acute medical treatments. . . . payers work to minimize cost by accelerating or shortening the addiction treatment timeline.” Length of treatment is a key factor in success for addiction treatment.

*

Professional Staff Congress/CUNY, “Proposal for NYC employee health benefits program,” Dec 30, 2022 READ IT HERE

The city council and its interlocutors on the Municipal Labor Committee insist that retirees must move onto Medicare Disadvantage because TINA (“There Is No Alternative”—Margaret Thatcher™). This group begs to differ: “Even if a Medicare Advantage program were put in place today and the savings were $600 million annually, the underlying problems would remain. Within a few years, the City would find itself back in the same crisis it is facing now.” They propose measures to address the underlying problem: runaway healthcare costs. Plenty of details of city insurance sausage-making, not easy to follow but important. Their main target is hospital prices: “New York City could use its regulatory powers and unique market share to lower hospital prices without damaging the capacity to deliver quality care.” Imagine the howls of outrage from the powerful hospital cartels. In any case, how is shifting government monies into a system that slices off a huge percentage in admin costs going to save money in the long run? That doesn’t make sense.

*

Wendell Potter, “Here is the truth: Medicare Advantage is neither Medicare nor an advantage,” Common Dreams, Jan 14, 2023 READ IT HERE

“Medicare Advantage is a money-making scam. I should know. I helped to sell it.” Potter is uniquely brutal on the MA hustle as he was a sausage-maker himself. UnitedHealth Group, the nation’s largest health insurer, got 72% of its overall revenue from government reimbursements last year. The insertion of unnecessary financier skimming in all sectors of our economy isn’t just affecting health care—everything is overpriced and underperforming due to the dictatorship of the banksters.

*

Committee on Oversight and Accountability [U.S. H of R], “Maloney and Pallone release staff report on review, approval, and pricing of Biogen’s Alzheimer’s drug Aduhelm,” Dec 29, 2022 READ IT HERE

“This report documents the atypical FDA review process and corporate greed that preceded FDA’s controversial decision to grant accelerated approval to Aduhelm.” Among the findings were at least 115 suspect (“atypical”) contacts between the drug’s corporate sponsors and top FDA officials—could be more since officials often hid them. FDA and the drug company also jointly prepared a briefing document for the external review panel, then overruled the skeptical experts anyway. Truly a historic example of FDA capture by the industry it supposedly regulates. FDA credibility isn’t yet as low at the CDC’s, but it’s well on its way.

*

Helena Bottemiller Evich, “‘I know firsthand they failed’: Parents decry lack of FDA action on infant formula safety,” Politico, Dec 31, 2022 READ IT HERE

You had one job: keep dangerous shit off the market. But: “Reviews by outside experts and internal officials found serious flaws in the nation’s food-inspection programs after four infant hospitalizations and two deaths were linked to infant formula.” The review found significant problems with monitoring of all food products. “There is still no single official clearly in charge of food at FDA, and the agency suffers from serious organizational and cultural problems that make it painfully slow to get just about anything done.”

*

Elaine Chen, “Diabetes in youth is set to skyrocket in coming decades,” STAT, Dec 30,2022 READ IT HERE

If current 3% annual increases continue.

*

Kaitlin Sullivan, “New guidelines for treating childhood obesity include medications and surgery for first time,” NBC News, Jan 9, 2023 READ IT HERE

Oh great, so the solution is to put kids under the knife and pump them up with expensive new drugs. Who are the American Academy of Pediatrics anyway, and how much of their budget comes from interested parties? Their website lists corporate partnerships without further detail. The CEO makes $600,000 a year, so no one’s relying on high-fructose corn syrup at that shop.

*

Neeraj G. Patel, Thomas J. Hwang, Steven Woloshin & Aaron S. Kesselheim, “Therapeutic value of drugs frequently marketed using direct-to-consumer television advertising, 2015 to 2021,” JAMA Network, Jan 13, 2023 READ IT HERE

“Fewer than one-third of the most common drugs featured in direct-to-consumer television advertising were rated as having high therapeutic value, defined as providing at least moderate improvement in clinical outcomes compared with existing therapies.” Why anyone would take a drug advertised on TV is beyond me even if Joe Namath weren’t the guy flogging it. “Drugs with substantial therapeutic value are likely to be recognized and prescribed without advertising.” Obviously.

*

Leroy Leo & Kannaki Deka, “GE HealthCare rises 8% in market debut, eyes small deals,” Reuters, Jan 4, 2023 READ IT HERE

I’m so old I remember when GE made light bulbs. There’s no real money in manufacturing things any more, just financial engineering to suction up government welfare via reimbursements.

*

Anjeanette Damon, “Medicare keeps spending more on Covid-19 testing. Fraud and overspending are partly why,” ProPublica, Dec 30, 2023 READ IT HERE

Federal reimbursement for tests “is not subject to some of the same financial and regulatory constraints as other tests covered by Medicare.” Enter the ghouls eager to cash in with slapdash products. The most common fraud is identity theft. “Nefarious labs would snag Medicare beneficiaries’ information and use it to bill for services not provided or expensive and unnecessary add-on tests.” Caveat for consumers: “Be cautious of any COVID-19 testing site that requires your financial or medical information in order to receive a free test.”

*

Lorie Konish, “Successfully applying for Social Security disability is difficult. Applying as a long Covid patient is even trickier,” CNBC, Jan 9, 2023 READ IT HERE

The average wait time for a decision on disability is now over six months (20 months in California, 22 in Washington), and two-thirds of applications are turned down. Appeals can take another 18 months.

*

Physicians for a National Health Program (PNHP), Letter to HHS and CMMS officials, Jan 17, 2023 READ IT HERE

Single-payer advocates reiterate their disapproval of third-party middlemen getting between patients and providers to extract profit, a Trump-era program rebranded by Biden as “ACO REACH.” But this letter homes in on the corrupt entities allowed to participate: “PNHP’s investigation of a small sample of current DCEs [contractors] and their parent and affiliated companies uncovered instances of health care fraud—including Medicare fraud—or other malfeasance that should raise alarms for CMS, lawmakers, and the Biden administration at large.” Should. List of the uglies attached.

*

Nicole DeFeudis, “Supreme Court rejects Pfizer’s bid to review anti-kickback case,” EndPoints News, Jan 10, 2023 READ IT HERE

Drug companies like to provide “assistance” to people burdened by copays who otherwise wouldn’t take their drugs, thus depriving the company of the succulent reimbursements. The drug in this case costs over $200K a year, so Pfizer kindly picked up the $13K copay and banked the difference. The government called that an illegal kickback, which it is. Even this Supreme Court agreed.

*

Lauran Neergaard & Matthew Perrone, “New drug slows Alzheimer’s but comes with caveats,” Associated Press, Jan 7, 2023 READ IT HERE

Correction: Pharma company says its new drug slows Alzheimer’s. Don’t we have enough precedent by now for exercising a little headline skepticism? Just past the first sentence come a few important details: “The drug isn’t a cure, it’s only intended for early-stage patients, requires IV doses every two weeks, and comes with some safety concerns [like brain hemorrhages].” But the PR was accomplished, thanks AP! Also, this drug targets the increasingly discredited beta-amyloid theory of Alzheimer’s, just like Aduhelm. And the measures used to show efficacy are based on highly subjective criteria that can be gamed by researchers. “Experts are divided over how meaningful a benefit” the new candidate drug provides. But we’ll be expected to pay top dollar for it.

*

Berkeley Lovelace Jr., “A new Alzheimer’s drug will cost $26,500 a year. Who will be able to get it?” NBC News, Jan 9, 2023 READ IT HERE

“A newly approved drug intended to slow the progression of Alzheimer’s disease offers patients hope, but it will come with a steep price tag: $26,500 a year.” Much more nuanced language in a discussion of cost barriers. Still no reference to the dubious beta amyloid theory behind the drug’s alleged efficacy.

*

Chris Sommerfeldt, “NYC pols, retired city workers blast Mayor Adams’ health insurance proposal,” New York Daily News, Jan 9, 2023 READ IT HERE

“Members of Mayor Adams’ administration faced jeers and hours of critical questioning during a Monday City Council hearing on his controversial attempt to make retired municipal workers pay for some forms of health insurance. When Adams’ deputy commissioner of labor relations said retirees do not ‘need to be concerned about’ Advantage plans requiring some medical procedures to be preauthorized by a private health insurance provider, retirees in the room burst out in derisive laughter.” The jeering worked! Council members shelved the proposal that would have paved the way to push 250,000 retirees into Medicare Disadvantage. They may still get booted into it anyway, but the opposition to MA is an important crack in the privatization wall. The entire scheme is weirdly pitched as a way to save the city money—by shifting benefits to a private enterprise that skims off a far greater percentage that traditional Medicare. That only makes sense if retirees will get less care.

*

Cynthia A. Fisher, “American patients must enforce their right to medical price transparency,” Los Angeles Daily News, Jan 8, 2023 READ IT HERE

People with high-deductible insurance dread January when they have to start paying through the nose again until coverage kicks in. They “have little to no protection from notoriously overcharging American hospitals.” The author says they should defend themselves by “demanding to know the real price of care before it is delivered.” The posted prices may be a maze of arcane code listings, so these beleaguered healthcare “consumers” will probably have to use decoder software. Her advice: refuse care until you get firm cost estimates.

*

Erika Edwards, Tonya Bauer & Anne Thompson, “Epinephrine costs not covered by some high-deductible health plans,” NBC News, Jan 7, 2023 READ IT HERE

“Even as the cost of EpiPens and other epinephrine auto-injectors have stabilized, many are paying thousands of dollars out of pocket each year due to high-deductible insurance.” Those high-deductible plans (now averaging $1700 per person annually) look cheaper at first glance if you don’t check what’s covered pre-deductible. Obamacare stimulated the move to higher deductibles as coverage expanded and included higher-risk enrollees. A prescription that once cost $30 can soar into hundreds until the deductible is covered. New Year’s Eve dread again.

*

Noam N. Levey, Aneri Pattani & Yuki Noguchi [KHN] and Bram Sable-Smith [NPR], “Upended: How medical debt changed their lives,” Kaiser Health News/NPR, Jan 10, 2023 READ IT HERE

“Of the nation’s 20 most populous counties, none has a higher prevalence of medical debt than Tarrant County, where Fort Worth is located. Second is adjacent Dallas County, credit bureau data shows. Nevertheless, Dallas-Fort Worth medical systems have been thriving. Though many are exempt from taxes as nonprofit institutions, several notched double-digit profit margins in recent years, outperforming many of the area’s Fortune 500 companies.” Many of those debtors, perhaps most, were insured. The series is an endless litany of horror stories.

*

Ravikash, “Novartis to pay $245M to settle antitrust lawsuit on hypertension drug Exforge,” Seeking Alpha, Dec 29, 2022 READ IT HERE

The complaint said that Novartis conspired with a generic to delay the 2011 launch of a competitive product. Among the plaintiffs: CVS, Kroger, Rite Aid, and Walgreens. Always good to see King Kong busting it up with Godzilla. Note the 11-year delay while Novartis enjoyed its ill-gotten gains.

*

SINGLE PAYER LINKS #287

Posted 12 JAN 2023

*

Sydney Halleman, “Sen. Bernie Sanders to target high healthcare costs as leader of influential committee,” Healthcare Dive, Jan 9, 2023 READ IT HERE

“High healthcare costs—including prescription drugs like insulin—nursing education, and elder care are issues Sanders anticipates focusing on, calling the national healthcare system dysfunctional, unsustainable and disgraceful.” Can Sanders turn a bully pulpit into action despite the vast resources of industry players? Historically, he’s been clever at teaming up with ideological foes on specific issues.

*

Frank Diamond, “2023 forecast: Employers that self-insure face new responsibilities and opportunities,” Fierce Healthcare, Dec 21, 2022 READ IT HERE

Provisions of the [just passed] Consolidated Appropriations Act put greater responsibility on employers to insure that workers get “the best coverage for a reasonable price.” Now that more data are available, employers can’t plead ignorance so easily. The feds are making insurance companies release more info on their charges and reimbursements, but the data dumps have been so massive that no one can make much sense of it all. Hospitals are also required to release price data, but many simply don’t. It’s always illuminating to see how the various industry players go after each other given the huge stakes around who gets how much of the giant pie.

*

Annie Nova, “Here’s what people with long Covid need to know about navigating health insurance,” CNBC, Jan 5, 2023 READ IT HERE

For the 2 to 4 million formerly full-time workers now out of the labor force due to long Covid, none of the options are terribly reassuring. You can get Medicaid if you’re destitute, Medicare if you’re old enough, or buy an Obamacare plan with premiums, deductibles, and copays. Social Security Disability Insurance can take forever to prove eligibility. Another suggestion: sign up for non-coercive clinical trials! Experts warn: “With so much still unknown about long Covid, insurers may be more likely to reject coverage for a particular treatment or service,” so patients should get ready to fight back through appeals since otherwise they’d just be sitting at home bored.

*

Nicholas Florko, “South Dakota plans major ramp-up of hepatitis C treatment in prison,” STAT, Jan 9, 2023 READ IT HERE

South Dakota now pledges to treat everyone with Hep C in the state’s prisons after only providing meds to seven inmates last year. The new policy “comes just weeks after a major STAT investigation that named the state one of the worst in the nation for hepatitis C care for incarcerated individuals.” Florko should get a medal for embarrassing state officials all over the country as they let prisoners die of a treatable illness. But he still refuses to point out that the crazy price of the medications created the problem in the first place.

*

Nicholas Florko, “Officials in Nebraska, South Dakota, Oklahoma begin to probe prisons’ hepatitis C treatment efforts,” STAT, Jan 6, 2023 READ IT HERE

Members of Congress took notice of Florko’s series, including Rep. Hank Johnson (D-GA), who was cured of hepatitis C himself a decade ago. With the spotlight on their terrible performance, state officials are scurrying to deflect the bad news. “The White House is rallying support for a $10 billion national plan to eliminate the virus in the United States”—the closest anyone has come to exposing the underlying cost problem.

*

Samantha Liss, “The portal to resolve surprise bills has been inundated with disputes,” Healthcare Dive, Jan 4, 2023 READ IT HERE

For-profit physician groups working as in-house hospital contractors can’t just make up fees under the No Surprises Act, but they can force hospitals into arbitration, which they’re doing aggressively. “The volume of disputes filed in a five-month window exceeded the amount the departments initially anticipated receiving for a full year. The vast majority of disputes originated from emergency room visits.” The most frequent complaints are against PE-backed staffing firms, and five states—Texas, Florida, Georgia, Tennessee, and North Carolina—accounted for 60% of all submissions.

*

Sarah Jane Tribble & Lauren Weber, “The system feds rely on to stop repeat health fraud is broken,” Kaiser Health News/USA Today, Dec 12, 2023 READ IT HERE

Government-funded health programs are a huge and tempting pile of cash that is relatively easy to scam if you know the systems. Inspectors have to cover a huge field, but this loophole must make them crazy: Fraudsters legally banned from the system have to “self-report their infractions or criminal histories on federal and state applications when they move into new jobs or launch companies that access federal health care dollars.” Gosh, some forget to do that! “Seven repeat violators raked in tens of millions of federal health care dollars before getting caught by officials after a prior exclusion.”

*

Natalie Krebs, “Iowa announces a $44 million settlement with Medicaid managed care organization Centene,” Iowa Public Radio, Dec 15, 2022 READ IT HERE

Centene, a major player in Medicare Disadvantage, ponies up for another billing scam. Nonetheless, it won’t lose its contract with the state Medicaid program, and Iowa Attorney General Tom Miller allowed Centene to settle without admitting wrongdoing. Miller is the same A-G who led the get-out-of-jail settlement with the banks over mortgage fraud in the late 00s.

*

Dave Muoio, “Healthcare dealmakers—Centene’s Magellan Rx divestiture; Sparrow joining University of Michigan Health and more,” Fierce Healthcare, Jan 5, 2023 READ IT HERE

Relentless consolidation proceeds apace: “Cooper University Health Care and Cape Regional Health System [NJ] signed a letter of intent to merge into a system of more than 10,000 employees and over $2.2 billion in annual revenues. UnitedHealth Group and home health provider LHC Group have bumped back the timeline of their [$5.4 billion] merger agreement [to absorb 30,000 care aides into UHG] as federal regulators take a deeper look at the deal. Amazon’s proposed acquisition of One Medical, a tech-enabled primary care provider, took a step forward with an all-clear from the Oregon Health Authority.”

*

Annalee Armstrong, “Biogen, FDA’s inappropriate Aduhelm coordination detailed in blistering congressional report,” Fierce Healthcare, Dec 29, 2022 READ IT HERE

Confirming what could easily be surmised: “Biogen and the FDA worked together to prepare briefing documents for the advisory committee” and maintained other “inappropriate” and “atypical” contacts. Calling them “atypical” may be unduly generous. The whole sorry affair turned into a huge embarrassment for the industry-captured FDA.

*

Ned Pagliarulo, “Eisai, in pricing new Alzheimer’s drug, tries to sidestep controversy,” Healthcare Dive, Jan 9, 2023 READ IT HERE

Eisai is trying to avoid the Aduhelm debacle in which a greedy company went too far in charging for a drug that had no real proof of efficacy. Of course, only in our demented system could a cost of $26,500 per year for the new experimental med be considered cheap. Medicare reimbursement is still up in the air since the Eisai drug is still under emergency-use approval.

*

Deena Beasley, “U.S. new drug price exceeds $200,000 median in 2022,” Reuters, Jan 5, 2023 READ IT HERE

“After setting record-high U.S. prices in the first half of 2022, drugmakers continued to launch medicines at high prices in the second half. The latest numbers imply double digit year-over-year price growth,” and a rise of 53% in the last five years. The limited authority given to Medicare last year to negotiate drug prices doesn’t apply to new medications.

*

Dan Primack, “The bad business of developing new antibiotics,” Axios, Jan 5, 2023 READ IT HERE

We need new ones, but antibiotics don’t create billionaires, so who cares?

*

Daniel Payne & Krista Mahr, “AbbVie exits the lobby,” Politico, Dec 15, 2022 READ IT HERE

AbbVie, a top pharmaceutical company, is dropping its membership in PhRMA, another biotech lobbying group, and the Business Roundtable. But no one can say why. The industry lost a major fight when Congress enabled Medicare to negotiate prices of a few drugs—you’d think that would make them want more lobbying muscle, not less.

*

Jónas Atli Gunnarsson et al., “Big food and drink sponsorship of conferences and speakers: A case study of one multinational company’s influence over knowledge dissemination and professional engagement,” Public Health Nutrition, Dec 1, 2022 READ IT HERE

From the abstract: “[M]ultinational corporations, including The Coca-Cola Company, seek to influence public health research and policy through scientific events, such as academic and professional conferences. . . . Coca-Cola provides direct financial support to institutions and organisations hosting events in exchange for benefits, including influence over proceedings. Also, indirect financial support passed through Coca-Cola-financed non-profits, . . . and third-party involvement further concealed Coca-Cola funding.” Astroturf: industry front groups pretending to be grassroots. Many scandalous details even for confirmed cynics. Pharma uses this model to promote their products through “patient advocacy” groups.

*

Paige Minemyer, “Humana bounces back from poor MA enrollment showing in 2022, boosts guidance on membership growth,” Fierce Healthcare, Jan 10, 2023 READ IT HERE

Humana started to slip in its push to enroll millions more into its Medicare Disadvantage plans after only flummoxing 200K victims in 2022. It’s more optimistic about this year.

*

Harris Meyer, “More orthopedic physicians sell out to private equity firms, raising alarms about costs and quality,” Kaiser Health News/CBS News, Jan 6, 2023 READ IT HERE

The PE invasion moves into orthopedics where physicians “are rapidly catching up with other specialist physicians, such as dermatologists and ophthalmologists, in selling control of their practices to private equity investment firms.” When PE moves in, established docs can get a juicy upfront cash payout. But, “A recent study found that in the two years after a sale, PE-owned practices had average charges per claim that were 20% higher than at places not owned by private equity.” PE is based on exiting after making quick profits, so a practice can be flipped from one set of MBAs to another, which each financial engineer gobbling up juicy returns. What with all the knee and hip replacements needed among the elderly and $1.8 trillion in PE cash sitting around, we can expect more raids on orthos, especially since “The standard playbook of private equity firms is to pull profits of 20% out of their physician groups each year, then reap up to a 350% return on their cash investment when they sell the platform.” And the incentives for pushing patients into expensive surgeries over less invasive therapy are obvious.

*

Rachana Pradhan & Daniel Chang, “Why Medicaid expansion ballots may hit a dead end after a fleeting victory in South Dakota,” Kaiser Health News/ Tampa Bay Times, Dec 16, 2022 READ IT HERE

Most other states make citizen-led ballot initiatives nearly impossible. Florida requires nearly a million signatures to get one before voters and a 60% approval margin to pass it.

*

Christina Maxouris, “Survivors of mass shootings are left with lifelong wounds—and mounting bills,” CNN, Dec 11, 2022 READ IT HERE

“My first night in the ER, that was in the back of my mind: I’m being whisked away to a hospital, and I’m not sure how much this is going to cost. You just went through a shooting, you just got shot, but that’s where my brain went to.” For those who survive the physical and psychological carnage, there are “the lifelong costs of an altered lifestyle: many are unable to return to work because of disabilities and may need follow-up surgeries, rehabilitation for months or years, mental health treatment and home care.” GoFundMe campaigns are the only option for some. According to one shooting victim, “the holes and the wounds” heal faster than the finances.

*

SINGLE PAYER LINKS #286

Posted 7 JAN 2023

Michael Ollove, “This state could be the last one (for a while, anyway) to expand Medicaid,” Stateline, Jan 4, 2023 READ IT HERE

North Carolina is the state in question, due to a change of heart by a Republican bigwig; the details are interesting. His fears about the lazy, undeserving poor getting handouts ended when he realized most Medicaid beneficiaries already work or study. He thought the federal pledge to cover 90% of expansion costs might fizzle out—but it hasn’t. The pol also knows that rural NC hospitals are failing and need the Medicaid income.

*

Arielle Dreher, “Some red state hospitals pitch Medicaid expansion to solve rural health woes,” Axios, Dec 8, 2022 READ IT HERE

With federal pandemic aid drying up, struggling hospitals desperately need a boost from Medicaid expansion. But ideology trumps practicality in places like Mississippi where a dozen hospitals are in danger of closing or Texas, which makes hospitals absorb $7 billion in uncompensated care.

*

Emily Wagster Pettus, “Mississippi cuts welfare to the poor nearly 90% while sending it to Brett Favre and other connected players,” Fortune/Associated Press, Jan 3, 2023 READ IT HERE

“In Mississippi, where elected officials have a long history of praising self-sufficiency and condemning federal antipoverty programs, a welfare scandal has exposed how millions of dollars were diverted to the rich and powerful—including pro athletes—instead of helping some of the neediest people in the nation.” Not a single-payer story but insightful on why Medicaid expansion isn’t likely in most southern states.

*

Rebecca Pifer, “Progressive lawmakers call on CMS to cull companies with history of Medicare fraud from ACO REACH,” Healthcare Dive, Dec 12, 2022 READ IT HERE

“At least 10 organizations with records of healthcare fraud and abuse participated in the direct contracting program last year despite CMS screening requirements.” Aetna, the MA company New York City officials want to push onto city government retirees, isn’t on the list—perhaps taking over care for several hundred thousand NYC retirees will get them on the next one. The long acronym ACO REACH (Biden’s repackaged version of a Trump initiative) means Accountable Care Organization Realizing Equity, Access, and Community Health Model—that’s a lot of words but still doesn’t include “privatization.” The fraudsters already making bank with ACO REACH include Centene, Sutter Health, Clover Health, AdventHealth, Humana, Vively Health, Cigna, Bright Health and Nivano Physicians.

*

Jessie Hellmann, “Providers say Medicare Advantage hinders new methadone benefit,” Roll Call, Jan 4, 2022 READ IT HERE

MA through Aetna will save the city money! Or so we’re told. Here’s one way: make addicts who have agreed to treatment wait for prior approval some days or weeks later, which they won’t do. Then they leave, and the providers who convinced them to seek treatment have to start all over. “It’s basically a benefit without being a benefit,” says one treatment professional, because the built-in roadblocks make access impossible.” A real benefit would facilitate immediate entry into detox and rehab—but that would be costly. Other tactics by MA plans: charging copays that the homeless don’t have, diddling providers forever with confusing requirements, and simply not paying the bills. “In 2022, 85 percent of Medicare Advantage enrollees were in plans that require prior authorization for coverage of opioid treatment programs.”

*

Nicholas Florko, “With little more than a typewriter, an Idaho man overturns the entire state’s policy on hepatitis C treatment in prison,” STAT, Dec 15, 2022 READ IT HERE

A heroic tale that is very rarely repeated given the obstacles to jailhouse litigation: An inmate persisted and finally got pro bono aid from a lawyer who pushed Idaho to make Hep C treatment available. Not mentioned: the crazy prices charged for the life-saving cures that make access a nightmare even if you’re not in prison.

*

Kevin Dunleavy, “2022 drug approvals: After Aduhelm fiasco, FDA endorsements drop to 37,” Fierce Healthcare, Jan 3, 2023 READ IT HERE

The Aduhelm fiasco “sent tremors through the industry and even triggered federal scrutiny of the FDA’s accelerated approval pathway. It wasn’t a good look for the agency, considering it overruled the advice of a panel of independent experts that decided Aduhelm wasn’t up to snuff.” Which doesn’t mean they won’t do the same thing a bit more subtly next time. Some “tightening of the reins” is seen by this author in the fact that the FDA’s approval rate is down slightly in 2022, including a “late rush” of five approvals around Christmas, a black hole for news.

*

Hannah Recht, “Paxlovid has been free so far. Next year, sticker shock awaits,” Kaiser Health News/CBS News, Dec 7, 2022 READ IT HERE

When the feds stop footing the bill for Covid treatment, look out. “A bill for several hundred dollars or more would lead many people to decide the medication isn’t worth the price.” Medicare Part D doesn’t pay for it because Paxlovid has emergency-use authorization, not full approval. But Medicaid will cover it at least for another year.

*

Lauren Sausser, “Public health agencies try to restore trust as they fight misinformation,” Kaiser Health News/NBC, Jan 4, 2023 READ IT HERE

How do we define “misinformation,” given that things we were forbidden to say two years ago are now accepted facts? Bellyaching about public mistrust is tendentious whining—we have to start by recognizing that officialdom consistently lied and pushed policies without a scientific basis. Telling people that a vaccine is sterilizing when it isn’t won’t help other vaccination campaigns, and now we get explosive growth of demagoguery. “Misinformation has changed everything,” says one public health officer. True that!

*

Nafeez Ahmed, “World Health Organisation doomed the world by concealing evidence of airborne COVID transmission,’” Byline Times, Dec 23, 2022 READ IT HERE

Canadian expert consultant Mario Possamai experienced “shock and frustration at the WHO’s failure to address the airborne nature of COVID-19,” which misled governments around the world. This is undeniably true though neither the author nor Possamai can explain the persistence of “outmoded scientific orthodoxy” about droplet (not aerosol) transmission even after the experience of SARS and MERS, which were clearly airborne. All they say is that the WHO inexplicably suppressed it and suggest a nefarious influence of “right-wing libertarian lobbying groups” who pushed things like business-friendly “herd immunity” strategies. Plausible, but vague.

*

Ken Alltucker, “Half of ambulance rides yield surprise medical bills. What’s being done to protect people?” USA Today, Dec 13, 2022 READ IT HERE

Because ambulance rides aren’t covered under the (fairly successful) No Surprises Act, half of the 3 million patients who need one every year get hit with charges even after an insurer pays a portion. A few states have some consumer protections (CO, DE, FL, IL, ME, MD NY, OH, VT, WV), but state bans on surprise bills “don’t apply to most employer-provided health insurance plans,” which fall under a different regulator.

*

Patrick Damp, “Pittsburgh City Councilman introduces proposal to erase medical debt,” CBS Pittsburgh, Dec 14, 2022 READ IT HERE

The councilman says Pittsburgh should join up with “RIP Medical Debt,” buy people’s outstanding bills in collection, and forgive them. No nuttier than the system that produced the bills in the first place.

*

Noam N. Levey, “What Germany’s coal miners can teach American about medical debt,” Kaiser Health News/NPR, Dec 14, 2022 READ IT HERE

To abolish it, of course! Germany’s West Virginia has the same problems as any coal country, but its miners are healthier because they aren’t hassled with bills. “German health officials, business leaders, and economists say the access to affordable health care has also helped the Saarland get back on its feet economically, bolstered by the assurance that workers could get to the doctor.” One quarter of all West Virginians are in collection for medical bills, and many have large deductibles before their insurance kicks in.

*

Caitlin Owens, “Out-of-pocket health costs spiked in 2021,” Axios, Dec 15, 2022 READ IT HERE

Americans’ OOP spending rose 10.4% last year, especially on dental services, eyeglasses, and medical supplies, a lot of it due to care that was suspended during Covid lockdowns.

*

Manas Mishra & Bhanvi Satija, “Amgen dives deeper into rare disease drugs with $27.8 bln Horizon deal,” Reuters, Dec 12, 2022 READ IT HERE

Amgen Inc is paying $27.8 billion for Horizon Therapeutics’ fast-growing gout and thyroid eye disease treatments. Both have “orphan drug” designations, which makes them particularly lucrative and keeps them exempt from Medicare’s newly acquired price negotiation powers. Given the hefty price tag for the merger, Amgen is going to have to gouge aggressively.

*

Julie Appleby, “Employers use patient assistance programs to offset their own costs,” Kaiser Health News/CBS News, Dec 6, 2022 READ IT HERE

Another convoluted, Rube Goldberg financing scheme to defray the crazy cost of specialty drugs: employers and entrepreneurs like SaveOnSP designate expensive medications “nonessential,” which sidesteps the ACA limits on out-of-pocket spending. Then, the employee taking the drug is coerced into Pharma-sponsored discount plans to avoid the copays they can’t afford. The savings are then split between the employer pays less and SaveOnSP, the vendor, which helps patients through the complicated charity application process. Pharma is suing.

*

Patty Wight, “A new health insurer in Maine hopes its unique approach will encourage primary care and lower costs,” Maine Public Radio, Dec 5, 2022 READ IT HERE

These doctors ditch all insurance and instead charge a monthly membership fee. While it doesn’t include lab or test fees and members still need catastrophic insurance, users are relieved of the everyday headaches for minor consultations. “It’s such a joy to be able to practice medicine this way,” said one doctor. Imagine if that model applied to the whole system.

*

Tony Pugh, “Insurers to drive Medicaid customers to Obamacare as Covid eases,” Bloomberg Law, Dec 7, 2022 READ IT HERE

Once federal Covid emergency aid ends and an estimated 15 million people lose Medicaid benefits, a “scramble for enrollees” by for-profit insurers will follow.

*

HOSPITALS

Rebecca Robbins, Katie Thomas & Jessica Silver-Greenberg, “How a sprawling hospital chain ignited its own staffing crisis,” New York Times, Dec 15, 2022 READ IT HERE

“Ascension, one of the country’s largest health systems, spent years cutting jobs, leaving it flat-footed when the pandemic hit.” Do their execs fly Southwest? This “nonprofit” hospital slashed staffing levels for years while building up $18 billion in cash reserves; then, lo and behold! It couldn’t provide healthcare when needed. Whocouddanode? A good insight into why nurses are set to strike here. Meanwhile, the 19-state behemoth Ascension, which enjoys tax exemptions as a charitable enterprise, has its own investment company whose CEO last year pulled down $13 million.

*

Nick Blumberg & Vernal Coleman, “Medical care and politics go hand in hand at a Chicago safety net hospital,” Chicago PBS/ProPublica, Dec 15, 2022 READ IT HERE

Fun and games in the “nonprofit” sector: “Under the leadership of CEO Tim Egan, Chicago’s Roseland Community Hospital has awarded business to his friends and acquaintances, employees have donated to his political funds, and he has appeared in a campaign ad for the state’s comptroller.” Will the IRS enforce the rules against blatant political use of its tax exemption?

*

Andy Miller, “Squeezed by temp nurse costs, hospital systems create their own staffing agencies,” Kaiser Health News/Fortune, Dec 15, 2022 READ IT HERE

Understaffed hospitals have to pay through the nose to employment agencies for travel nurses amid a huge labor shortage. Some are trying to get around the costly intermediaries—who often grab a third of the emergency pay—by offering better pay and flexibility in-house. What a novel idea! Turnover for RNs was 27.1% last year, up from 18.7% in 2020.

*

Alexander Stockton & Lucy King, “Why saving kids is bad business in America,” New York Times, Jan 4, 2023 READ IT HERE

“Health care providers make more money treating adults than they do children.” So that’s what they do. As a result, “when the number of Respiratory Syncytia Virus cases skyrocketed in late 2022, the American health care system wasn’t prepared.” Expect more provider burnout, quitting, staffing shortages, service deterioration, leading to more provider burnout, quitting, etc.

*

Jon Lapook & Michael Kaplan, “‘What they’ve done is extremely evil’: Pennsylvania hospital shutdown spurs questions about private equity in health care,” CBS News, Dec 6, 2022 READ IT HERE

Private equity plows into hospital ownership and watches them fail—how is that a viable business model? They can saddle up a hospital with huge debts and pay themselves juicy “dividends.” After that, it doesn’t matter if the place collapses. “They are drawing the value out of these hospitals as they would money from a piggy bank.” One outfit forced a billion-dollar loan on a hospital and promptly took out $457 million of it—$90 million went directly to the CEO. Tony Soprano would be proud. More explanation in the next article.

*

Matt Stoller, “Ponzi hospitals and counterfeit capitalism,” BIG, Jan 4, 2023 READ IT HERE

A deep—but not technical—dive into how private equity turns “insider skimming” into a fine art: PE firms have hidden from investors (who keep pumping them up with new cash) the bankrupt state of much of their portfolios—including hospitals. But the end of cheap money means “these Ponzi finance-dependent models are not sustainable without low-level accounting fraud or a bailout. Or both.” Worth a read to understand the unsavory sausage-making and prepare for the impact on a key part of our healthcare “system.”

*