SINGLE PAYER LINKS #387

28 MAR 2025

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More this week on the ongoing dismantling of pretty much everything, how the cuts to Medicaid will deepen penury and overall suffering, and Trumpland’s plans to further enrich the plutocrats and leave the rest of us in peonage. Maybe it’s a plan!

Listen here: https://www.podbean.com/eas/pb-b63zq-1864f9b

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Karoun Demirjian & Jesus Jimenez, “Food banks left in the lurch as some shipments are suspended,” New York Times, Mar 20, 2025 https://bit.ly/4c5B1F8

“Food banks across the country are scrambling to make up a $500 million budget shortfall after the Trump administration froze funds for hundreds of shipments of produce, poultry, and other items.” I’m beginning to think Trump’s strategy to consolidate control is to induce mass impoverishment so that we’re too busy looking for our next meal to complain about anything. The halt comes in addition to other recent cuts to federal food assistance, including SNAP (food stamps). Meanwhile, demand at pantries is way up despite the allegedly low levels of unemployment. “Oregon’s food banks reported a 31% increase in use of their services last year.” Private donations won’t replace the sudden shortfall.

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Alexander Zaitchik, “Dr. Oz and the plot against Medicare,” Drop Site/Truthdig, Mar 24, 2025 https://bit.ly/4hNSYcz

Dr. Oz now heads the agency that runs Medicare, so we can expect a further boost to Medicare Advantage plans that “are killing seniors and bankrupting hospitals.” Oz was a regular TV pitchman for MA and just divested his hefty investments in UnitedHealth and an array of investments in medical devices, supplements, and pharmaceuticals. Private insurers can now figure out how to vacuum up the remaining half of Medicare beneficiaries still in traditional Medicare. They can either force new enrollees into it or simply transfer us into the hated plans against our will. Or Oz could avoid congressional oversight by using the Center for Medicare and Medicaid Innovation (CMMI) to “test” new payment plans as pilots, then declare them a big success, evidence to the contrary notwithstanding.

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Drew Altman, “Why most states will not replace federal Medicaid cuts,” KFF Health News, Mar 21, 2025 https://bit.ly/4iG34gK

Unlike the Federal Government, states have to balance their budgets. That means higher Medicaid expenses will mean cuts elsewhere. States already spend a lot on Medicaid, and because health costs almost always outpace inflation, merely maintaining the status quo costs more and more. The numbers are staggering: for example, if the Medicaid cuts go through, Ohio will have to replace $2 billion a year in lost federal funds, nearly equivalent to what it spends on higher education ($2.7 billion), and corrections ($2.3 billion). Cuts also “roll downhill” in many states to affect counties and cities.

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Alexandra Kukulka, “Indiana Medicaid bill amended to remove 500,000 cap, but health officials say bill still harmful for recipients,” Post-Tribune, Mar 19, 2025 https://bit.ly/3E6Fmey

Indiana is one of those states set to slash benefits if the federal cuts happen. Medicaid grew rapidly in the state, and the budget numbers are untenable. Most of the new revenue accruing to Indiana’s coffers already go to cover Medicaid costs. If the Feds cut the expansion reimbursement rate from the current 90%, radical downsizing will follow.

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Sarah Melotte & Ilana Newman, “GOP cuts to Medicaid could threaten rural hospitals,” Daily Yonder, Mar 17, 2025 https://bit.ly/4kWZQHt and Scott S. Greenberger, “The most likely Medicaid cuts would hit rural areas the hardest,” Stateline, Mar 12, 2025 https://bit.ly/3DUP048

Battering Medicaid will cause real trouble for rural hospitals because residents there are more likely to be enrollees; in some areas, over one third of the entire population uses the program. Those areas’ hospitals also depend on it especially after the Obamacare expansions, “creating a dilemma for Republicans looking to make deep cuts to the health care program.” But GOP pols don’t dare object because Trump takes revenge on dissenters.

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Tara Bannow, “Congress created a unique plan to save rural hospitals—but few are using it,” STAT, Mar 18, 2025 https://bit.ly/4j9JPfD

Teetering rural hospitals have an option (for now) to bank a monthly check from the Feds and stay open: become a Rural Emergency Hospital. The trade-off is that they have to end inpatient care, fire nurses, and just keep their ERs and labs. They also can’t have rehab beds, which is a deal-breaker for some because that’s easy money for a poor hospital. (Rehab patients don’t need expensive medical care.) Patients and their families appreciate being able to stay local while they recover.

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Alan Condon, “Work requirements could strip 5 million people of Medicaid,” Urban Institute/Robert Wood Johnson Foundation, Mar 17, 2025 https://bit.ly/3DUXqs2

Work requirements for the “able-bodied” are popular among people trained to think of healthcare as “welfare.” The rules don’t get people into jobs, but they do provide bureaucratic ways to kick people off coverage. Five million adults could lose care if these nice-sounding measures spread. “Work requirements are a blunt tool that creates costly administrative red tape and separates eligible people from health coverage they rightfully qualify for.” That’s the point. Nine out of 10 Medicaid users already either work, care for dependents, attend school, or are disabled. How about a work rule that mandates the state to find unemployed people jobs?

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Jazmin Orozco Rodriguez, “Tribal health leaders say Medicaid cuts would decimate health programs,” KFF Health News/CBS News, Mar 19, 2025 https://bit.ly/3Rn3QDo

Native populations are really on the chopping block since they’re an “underserved” population that we’re not supposed to care about any more. Medicaid “helps tribes cover chronic funding shortfalls from the Indian Health Service” and accounts for 2/3 of tribal clinic revenue. Native Americans have a high incidence of chronic illness and the lowest life expectancy of any demographic group in the U.S. (64 years). The IHS is supposedly exempt from the Muskrat-led slash-and-burn, but the clinics will take a huge hit from the Medicaid cuts.

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Julie Appleby, “Trump health care proposal billed as consumer protection but adds enrollment hoops,” KFF Health News, Mar 10, 2025 https://bit.ly/4iHieSX

“Fraud!” cried the Muskrats. Time to “protect” Obamacare exchange plans! Yeah, right. Instead of loading up beneficiaries with new burdens, how about ending the well-documented and ongoing Medicare Advantage scam costing tens of billions? Too easy.

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Bob Herman, “Medicare Advantage enrollment growth slows drastically,” STAT, Feb 26, 2025 https://bit.ly/3Rjw5Tw

MA plans added new members at a rate of only 3% annually, far below expectations. Previous years saw 9–10% increases. Hmm, why? “Medicare Advantage faces criticism from lawmakers, regulators, and beneficiaries themselves over its bloated payment system and onerous denials of care.” Is the PR blitz not working so well anymore?

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Noam N. Levey, “Nursing homes and the AMA, once Medicaid defenders, hang back as GOP mulls big cuts,” KFF Health News, Mar 11, 2025 https://bit.ly/4iKIQCO

Unlike the broad mobilization in 2017 against the attempt to repeal Obamacare, not everyone is joining the latest coalition to oppose Medicaid cuts: “Two industry groups have been notably restrained: doctors and nursing home operators. They’re busy lobbying Republicans for other priorities: doctors’ fees and staffing requirements. Hospitals are all in to fight the cuts, but “this year, the AMA hasn’t sent a single letter or issued any news releases opposing Medicaid cuts.” Another actor that is notably absent in the opposition coalition is the AARP, which makes a huge pot of money through its marketing partnership with UH.

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Ellen Mitchell, “‘Gut punch’: Democrats decry Trump’s plan to cut 80,000 employees at VA,” The Hill, Mar 9, 2025 https://bit.ly/4hIzoyl

Thousands of VA staff already have been laid off while Trump’s goons “insist the dismissals won’t damage or delay veterans’ medical care or benefits.” And everyone gets a pony! Now explain how slashing 83,000 more employees (out of 470,000) is going to have no impact on services. Veterans “already face long wait times for VA care.” Thank you for your service! Here, try on this prosthetic limb. Bye!

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Phillip Reese, “Thought inflation was bad? Health insurance premiums are rising even faster,” KFF Health News/Los Angeles Times, Mar 11, 2025 https://bit.ly/4j4P8gj

Costs are doubling every 15 years. Average annual premiums for families with employer-provided health coverage in California went from about $12,000 in 2008 to almost $24,000 today. The culprit: rising hospital and nursing home costs. “The average annual deductible for an employer-provided family health insurance plan was about $3,200,” meaning that a lot of people don’t seek care at all.

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Tiffany Yu, “Americans borrowed $74 billion last year to cover healthcare costs,” West Health, Mar 5, 2025 https://bit.ly/4iHdMDJ

About one fifth of all Americans under 50 had to borrow money for medical costs last year. Oddly, among adults aged 50–64 only one tenth had to even though logically they would have more medical needs. Maybe the older folks figure they have to buy insurance even when it bankrupts them.

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Michelle Andrews, “In New York, providers must put patient costs on the table,” KFF Health News/NPR, Mar 20, 2025 https://bit.ly/3Xt76AQ

A new law in New York state is yet another attempt to fix the unfixable albeit a worthy one: anyone seeking medical care here now will have to be presented with an explanation of costs before the consent forms are shoved under their noses. They can still extort you in exchange for treatment, but now they first have to say how the extortion will work.

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John Wilkerson, “HHS agency responsible for health care quality research threatened with mass layoffs,” STAT, Mar 20, 2025 https://bit.ly/4j7k1kk

Regulatory monitoring is being dismantled systematically: Trump decimated a small agency that studies medical products and services, the Agency for Healthcare Research and Quality (AHRQ). It will be reduced to almost nothing despite doing exactly the kind of research that RFK Jr says he wants: studies on nutrition, childhood obesity, long Covid, hospital-acquired infections. Their sin: daring to mention “equity” and “underserved populations,” such as rural residents. They should have put “combatting anti-Zionism” in there instead.

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Paul Blumenthal & Jonathan Cohn, “Trump Administration shutting down HHS legal offices that help fight fraud,” Huffpost, Mar 11, 2025 https://bit.ly/3QLLX0Z

More incoherence from Trumpworld: they blather on and on about fraud and waste while making sure there’s more of both. Firing the in-house HHS lawyers will make it easier to violate federal standards and to defraud the government.

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Paige Minemyer, “Optum Rx to overhaul pharmacy reimbursement models,” Fierce Healthcare, Mar 20, 2025 https://bit.ly/428UXT6

Pharmacy Benefit Managers (PBMs) are in the crosshairs of pretty much everybody. Unsurprisingly, some of them are scrambling to neutralize the hatred. “Optum Rx is shifting to a cost-based model,” reminiscent of the main disruptor of their business, Mark Cuban’s Cost Plus Drugs. The announcement came just one day after Optum Rx said it would “ease [prior] reauthorization requirements” for 80 drugs.

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Matt Stoller, “The real reason Walgreens collapsed,” BIG, Mar 13, 2025 https://bit.ly/4iHhehI

Walgreens died “because of a failure to enforce antitrust laws against unfair business methods and illegal mergers. The 124-year-old company is being squeezed to death by monopolistic pharmacy benefit managers.” It will now be taken over by PE firm Sycamore Partners who will pick over the bones of the chain pharmacy before dumping its carcass. Worth reading in full to get all the gory details on consolidation of the PBMs into a three-headed oligopoly.

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Kim Chandler, “Alabama lawmakers advance regulations on pharmacy benefit managers,” Associated Press, Mar 21, 2025 https://bit.ly/4l3vMKj

States continue to act while Washington fiddles: the state senate of Alabama, where one drugstore per week is closing its doors, voted unanimously to stop the PBMs from driving community pharmacists out of business. Other states are looking at similar laws.

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Tony Cook, “Residents suffer as county hospitals divert $2.6 billion from poorly staffed nursing homes,” Indianapolis Star, Mar 18, 2025 https://bit.ly/4hYjxfq

Stamp out one hustle, another appears: Indiana’s county-owned hospitals “kept nearly half of the $5.6 billion their nursing homes generated in extra Medicaid payments,” leaving the facilities ranked 50th in the nation for total nurse staffing. Poor state and federal oversight enabled the hospitals to game Medicaid and loot the cash from nursing homes. Now that regulatory officials are being fired left and right, new scams will undoubtedly pop up.

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Rylee Wilson, “Cigna, HCSC close $3.3B Medicare Advantage sale,” Becker’s Payer Issues, Mar 19, 2025 https://bit.ly/4233bff and Rohan Kulkarni, “Cigna bails on Medicare to focus on healthcare services—but it’s not for everyone,” HFS Research, Mar 11, 2024 https://www.hfsresearch.com/research/cigna-medicare-hcsc/

This one is counterintuitive: Cigna is getting out of MA and will use the $3 billion it’s getting for the sale to repurchase stock, i.e., enrich shareholders. MA made up only 4% of its business, but why is it exiting a lucrative operation? A financial analyst (the second article) argues that these companies are getting out of the insurance business entirely—huh? Yes, Kulkarni says that big players like Cigna are moving away from their classic underwriting role and into providing direct medical services while letting the Federal Government and private employers handle the insurance side. “Cigna is no longer interested in the risk business.” Instead, vertical integration allows it to make bank all along the care continuum through its lucrative PBM and specialty pharmacy operations and other patient care services that already generate 75% of its revenue. Sounds like an important trend to watch. Here’s the key chart:

Exhibit 1: The US federal government and employers are now the de facto health insurers in the US

Data: CMS, US Dept of Labor, CBO, Kaiser Family Foundation
Source: HFS Research, 2024

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Isabella Cueto, “ME/CFS research program shuts down at Columbia after Trump cuts,” STAT, Mar 19, 2025 https://bit.ly/3E6ATIO

Targeting of Columbia University resulted in the destruction of a center studying ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome). ME could offer important insights into the long Covid phenomenon, but we’re supposed to forget about all that. “A study of patients with Gulf War Illness—an obscure, fatigue-inducing condition in veterans of the 1991 war—also ended with a pile of already collected data unanalyzed.

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Kristen Monaco, “Top societies decry Trump’s funding cuts to landmark diabetes study,” MedPage Today, “Mar 20, 2025 https://bit.ly/3Xwl9FE

Trump dumps 30 years of data monitoring people with diabetes into the trash. Researchers in 21 states were told to stop work immediately. Any peep out of RFK Jr who allegedly wants us to understand diabetes and food health? Nah. The cancelation is probably due to the assault on Columbia University for not privileging its Zionist cheerleaders.

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Helen Branswell, “Vaccine critic’s apparent selection to head HHS autism study shocks experts,” STAT, Mar 26, 2025 https://bit.ly/41QThPi

Jaws are dropping in what’s left of the scientific world. The guy who is to head a pointless new study looking for a non-existent autism-vaccine link, one David Geier, “does not have a medical degree and was disciplined by the State of Maryland for practicing medicine without a license.” This is called “policy-based evidence-making” and proves that the crackpot faction is just getting started.

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Annie Sciacca, “Amid falling diversity at med schools a warning of DEI crackdown’s chilling effect,” MedPage Today, Mar 20, 2025 https://bit.ly/4cfCkkX

Medical schools have already seen an “unexpectedly steep drop in diversity” among their students, which can only get worse as schools shed targeted scholarships, trainings, and recruitment programs. The numbers of Black and Hispanic medical school enrollees fell by double-digit percentages in the 2024–25 school year. The decline in enrollment of American Indian or Alaska Native students was even worse: 22%.

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Federal Trade Commission, “FTC challenges medical device coatings deal,” Mar 6, 2025 https://bit.ly/3DIFu45

This obscure acquisition is significant because the now GOP-led FTC is blocking it, signaling that antitrust action might continue. The attempt to create a monopoly in producing this key component of medical equipment, said the agency, “would create a combined company controlling more than 50% of the market,” prohibited under antitrust law. The FTC vote was unanimous. Even in Trumpland, somebody still believes in capitalism! Antitrust expert Matt Stoller adds: “Wall Street dealmakers are extremely angry at this merger challenge because they were expecting a more lax regulatory environment. And this challenge goes at private equity, which has generally been a sacred cow on the right.”

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See the full archive at www.nypan.org/single-payer-news

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21 MAR 2025

After focusing on the threat to Medicaid, I’m going to try to pull back and offer a bird’s-eye view of some broader trends. Kindly bear with me!

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Listen here: https://www.podbean.com/eas/pb-fvtrb-1858861

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Antisemitism in America: A Warning by “Chuck” Schumer

Yes, Schumer, the nation’s top Democrat, is worried and has to warn us about something. But it’s not Donald Trump or Elon Musk or their wholesale dismantling of the U.S. government. Instead, it’s the dire threat to the nation of “anti-Semitism,” a.k.a. insufficient loyalty to Israel. No wonder Schumer waved through the radical budget plan containing broad new powers for the Muskrats. After all, he had to concentrate on his book tour in the company of gay Bronxite Rep. Ritchie Torres (D-Tel Aviv).

Frank Thorp V, Sahil Kapur & Ryan Nobles, “Chuck Schumer postpones book events due to ‘security concerns’ amid Democratic backlash over shutdown fight,” NBC News, Mar 17, 2025 https://bit.ly/4bXN2wa

To Schumer’s apparent surprise, people are so furious at him that he had to squash his book tour. Schumer and nine other Senate Democratics (including fellow NYer Gillibrand) voted to advance a 6-month funding bill Friday that Republicans could not push through on their own. The way is now cleared for further destruction of Medicaid, Medicare, Social Security, and anything else Trump’s gazillionaires don’t fancy. But count on Chuck to keep “fighting for” us—if he’s not in Guantánamo!

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Jeff Stein, “Funding bill grants Trump, Musk more control over federal spending,” Washington Post, Mar 14, 2025 https://bit.ly/41XbHfS

“Many congressional Democrats had hoped to use the deadline over government funding to force Republicans to reverse—or at least limit—the Trump administration’s unilateral cuts.” Schumer unilaterally disarmed them. The usual appropriations process includes great specificity on how money should be spent. But under the budget measure passed last week, the administration can “repurpose funds” from one program to another at will. Trump/Musk will now have even more discretion over what money is spent, not spent, blocked, canceled, held up, or redirected.

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“Trump’s War on Healthcare: Public Health Watch,” Protect Our Care, Mar 17, 2025 https://www.protectourcare.org/trumps-war-on-health-care-public-health-watch-2/

Here is a handy summary of the wreckage visited on everything health-related. Protect Our Care is a new outfit “aimed at practical and concrete steps in defense of public health and health policy during the second Trump Administration.” Impossible to keep up with everything, so aggregators are helpful.

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Sarah Wetter & Lawrence O. Gostin, “Are President Trump’s executive orders on health legal?” MedPage Today, Mar 6, 2025 https://bit.ly/4kyjqtl

Courts may order Trump to reverse course on some of his radical acts. Will he obey? “Many of these orders and actions violate legal statutes—or even the Constitution. The Supreme Court has already ruled against President Trump on a key effort to dismantle global aid, and rulings against other orders could follow.” But how many divisions does the Supreme Court have?

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O. Rose Broderick, “‘Deliberate trauma’: SAMHSA employees detail a federal agency in shambles,” STAT, Mar 12, 2025 https://bit.ly/4im2FA3

The Muskrats are particularly eager to crush the federal agency that sees substance abuse as a medical problem instead of a police matter. SAMHSA (Substance Abuse and Mental Health Services Administration) lost 10% of its workforce during the “Valentine’s Day Massacre,” and the rest face a viciously hostile environment. We’ll be back to locking up drug users and hoping they kill themselves more quickly. Rural areas that voted heavily for Trump will be affected as six of the ten SAMHSA regional offices close. Key employees of the 988 national crisis hot-line (that has fielded 14 million calls) have quit or retired. Overdose deaths in the U.S. are still 80K per year.

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Vittoria Elliott, “‘It’s a heist’: Real federal auditors are horrified by DOGE,” Wired, Mar 18, 2025 https://bit.ly/4kycY5L

While the Muskrats say they are “auditing” government, real auditors say they don’t have a clue. Audits normally take 6 to 18 months and involve interviewing staff in detail, pouring over financial records, and combing through data and reports. One auditor quoted says, “You can’t coherently audit something like the whole Social Security system in a week or two.” But you can pretend to and then rip the place apart based on your bogus findings. “None of them have any auditing background, none have any certifications, none have any clearances.” One of them is a 19-year-old high school graduate who goes by the online moniker “Big Balls.” These are the high-level administrators of our key government institutions with access to vast quantities of data.

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Jeffrey Okoro, “I’m head of an NGO in Kenya. The shutoff of USAID support has been devastating,” STAT, Mar 15, 2025 https://bit.ly/3DMRAZU

“In an instant, more than 1,000 patients at my health care clinic outside Nairobi lost access to lifesaving HIV treatments. The consequences of the aid freeze on our communities will be vast.” PePFAR, which brought AIDS treatments to a dozen African countries, was instituted by George W. Bush to repair some of the reputational damage to the United States caused by the Iraq invasion. It worked to some extent. Now, we don’t care if people in other countries hate our guts.

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Arthur Caplan & Lisa Kearns, “Who will volunteer for clinical trials now?” MedPage Today, Mar 12, 2025 https://bit.ly/3DSvOE3

“Can anyone trust the U.S. government when it comes to their future health? For participants in clinical trials, the answer is a hard no.” This is deadly for future research—including pharmaceutical research—by U.S. companies. Suddenly halting ongoing trials that involve promises to study subjects is not only unethical but fatal to future recruitment. “It forces researchers to abandon participants—a mortal sin in medical ethics—and puts trial volunteers at considerable physical risk.” The partial data gathered at the cost of millions is now worthless. About half of drug trials run by American companies take place in foreign countries because they’re much cheaper. Are these pharmaceutical gangsters going to emit even a peep of complaint?

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Arielle Kane, “My firing represents the death of public service,” MedPage Today, Mar 7, 2025 https://bit.ly/41X1HU7

The author, summarily sacked from HHS in February, asks, “Who will want to serve in [public service] roles if they are continually vilified?” That includes military enlistments, by the way, even though soldiers are more flattered than scorned. “We now seem to revere money and internet fame more than the consistent, middle-class work of giving back to your country through civil service. Instead, the government will most likely shift more and more work to private contractors who will run programs like businesses.” And cost more.

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Sharon Lerner, “Industry-backed bills would bar use of science behind many environmental protections,” MedPage Today, Mar 9, 2025 https://bit.ly/42dtT69

IRIS, the “Integrated Risk Information System,” was established in the early days of the EPA to enable scientists to look at chemicals in their real-world context, that is, as they’re actually used together instead of one by one. Republican lawmakers and industry lobbyists have always hated it. Now, they’re on the verge of getting their maximum wish: to finally prohibit the EPA from carrying out its mission. “If the act passes, companies could even use the law to fight the enforcement of environmental rules that have long been on the books that limit their toxic emissions.” This is on top of Trump’s plan to slash the agency’s budget by 65%. We’ll be back to operating from industry-funded toxic chemicals pseudoscience that says everything’s fine.

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Jonel Aleccia, “RFK Jr. and influencers bash seed oils, baffling nutrition scientists,” Associated Press, Mar 8, 2025 https://bit.ly/43WhLaZ

RFK Jr has a screwy notion of how to use scientific evidence. He expresses extreme skepticism of things he doesn’t like and total loosey-goosey acceptance of things he does. He’s opening up a debate about seed oils—okay, fine—but immediately touts the superiority of rendered animal fat. What’s the evidence for that other than his fevered personal opinions? Seed oils are used in fried and ultra-processed foods, which have been linked to a host of health problems. But beef tallow is also processed. The RFK Jr era is shaping up to be even more crackpot than Trump I.

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“RFK Jr. says federal vaccine advisers are beholden to industry. The evidence does not support him,” Science, Mar 7, 2025 https://bit.ly/4iohFgP

Here’s RFK Jr getting all meticulous about unhealthy influence over a panel where it probably doesn’t matter—vaccine advisories. Said one critic: “What RFK Jr. is doing has nothing to do with real undue influence by pharmaceutical companies. This is just him trying to stack the committee with people who are like-minded.” Okay, you hate vaccines, we get it.

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John Wilkerson, “CDC’s reported study on vaccines and autism could test RFK Jr.’s pledges to a key senator,” STAT, Mar 12, 2025 https://bit.ly/4iBcVUR

We know that the autism-vaccine link is bullshit. The only reason to crank up yet another study is to deepen the confusion and stimulate even more fantastical and nutty arguments. If 5 years from now, the study confirms what we already know, will the denialists be persuaded? Of course not. Sen. Bill Cassidy (R-LA) who signed off on RFK Jr based on assurances about vaccines, now agrees that such a study would be a waste of time and money. Too late.

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Pooja Salhotra, “With crumbling public health infrastructure, rural Texas scrambles to respond to measles,” Texas Tribune, Mar 10, 2025 https://bit.ly/3E3BStg

In the measles epicenter, Gaines County, runners drive specimens 70 miles to the nearest FedEx office to ship specimen to a state lab. Texas got the most money of any state through the CDC’s Public Health Infrastructure Grants, but they’d rather starve themselves.

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Pamela Ferdinand, “Glyphosate poses widespread risks to female fertility and reproductive health, researchers say,” U.S. Right To Know, Mar 15, 2025 https://bit.ly/3FDm9BH

If RFK Jr wants to use real science to improve our food supply, he could start with the well-known damages to our genes and hormones and to women’s reproductive organs caused by glyphosate, “the world’s most widely used herbicide.” But that would upset Trump’s golfing buddies in the Big Food industries. A recent survey of urine samples from U.S. residents showed that 80% contained glyphosate.

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Michael Waterbury, “Health plans need to take accountability for a broken system,” STAT, March 4, 2025 https://bit.ly/4hH7m6j

An insurance exec calculates his job and his family’s insurance costs: “Over the past 25 years, my family [of five] and my employer have paid more than $429,000 in premiums—$771,232 when adjusted for inflation—yet our actual medical costs totaled only $200,000. The rest? That money didn’t go to care, it did not go to risk pooling for others’ health care costs. It went to health plan profit. Eventually, I couldn’t ignore the reality of how the system operates. The numbers made it impossible to look the other way.” Good diagnosis, but his remedies are the usual weak tea. Despite his clear understanding of the facts, he can’t bring himself to admit the obvious: the commercial healthcare system cannot be fixed.

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Ruth Rosenthal & Casey Chiappetta, “Medical debt reforms fall short without addressing consumer debt litigation,” Pew Charitable Trust, Feb 27, 2025 https://bit.ly/4iEMEVN

Another illustration of unfixability: schemes to provide relief to the millions of Americans burdened by medical debt are noble endeavors and sometimes curb some of the more egregious abuses. But they don’t—and can’t—solve the underlying problem—that medical debt shouldn’t exist in the first place. This article points out that state laws to protect people from medical debt bankruptcy have a crucial flaw: they don’t help courts decide what is medical debt to distinguish it from other kinds. If a person is sued by a collections agency, it won’t look the same as if the suit were brought by a hospital.

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Lisa Bohman Egbert, “Why I closed my OB-GYN practice in Ohio after 27 years,” STAT, Mar 11, 2025 https://bit.ly/4ifTa5x

Independent physician practices are dying out. This woman gave up after 27 years leaving 2,500 Ohio women without a gynecologist. “By the time I closed my office, I had so little money coming in that I had stopped taking a salary. I was using my own savings just to keep the practice afloat.” The fatal combo: 2 decades of steadily increasing costs, steadily reduced Medicare reimbursements, insurance company concentration, and the impossible burden of prior authorizations. How can the Feds cut Medicare reimbursements year after year in an inflationary environment? This predates Trump/Must and their Texas chainsaws.

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Noam N. Levey, “Republicans once wanted government out of healthcare. Trump voters are different,” KFF Health News, Mar 2, 2025 https://bit.ly/4ifYplL

Republicans traditionally hate gummint daring to control healthcare prices—or any prices. But the MAGA-verse has a slightly different view. Instead of the mantras of “choice” and “free markets” of a decade ago, a wide majority of GOP voters now back things like an annual cap on how much patients pay towards medical debt.

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Yuki Noguchi, “She got her dream job at CDC back. But she's already moving on,” NPR, Mar 7, 2025 https://bit.ly/3RhMLuA

We wrote about Ms. McNulty last week and how she was shit-canned a few weeks into her elite internship at an Iowa cancer center. Now the CDC wants her back; she told them to go fly a kite. She has a new job in a different city and wasn’t impressed by an unsigned notification apologizing for the “error.” She compared it to getting a stalking email from an abusive partner.

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Matt Parr, “Stephen Feinberg’s Cerberus owned military contractor that paid millions to settle government fraud suits,” Private Equity Stakeholder Project, Dec 4, 2024 https://bit.ly/4ihN3h0

Feinberg, now the no. 2 at the Pentagon, is co-founder of the private equity sleaze-mill Cerberus, notorious in these pages for its role in looting Steward Health and leaving wrecked hospitals in the laps of states and cities trying to keep them open. He also defrauded the Pentagon, but he now fails upward into the sleaze-o-sphere of Trumpland. (No wonder the U.S. has lost the arms race with Russia.) Feinberg’s Cerberus owned Steward Health Care, a 31-hospital system, for a decade during which it extracted hundreds of millions in fees and dividends while suppliers were stiffed and employee payroll taxes were diverted.

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Maureen Tkacik & Teri Buhl, “A hospital empire is closing its doors—but the stock is on a tear,” American Prospect, Mar 18, 2025 https://bit.ly/4hnIG2J

This is a long investigative piece about one of the corporate entities involved in the private equity-backed looting of the Steward hospital chain, specifically the real estate vehicle, Medical Properties Trust. Cerberus sold the victim hospitals’ property to MPT, which then leased it back to them at rip-off rates. That enabled the corporate overlords to extract hundreds of millions and leave the hospitals as smoking ruins. How this is in any way legal is a testament to the utter corruption of our entire financial apparatus. The salient details—not reported elsewhere to my knowledge—are these: while the whole Steward mess is being untangled in bankruptcy courts, MPT’s shares are booming because various state entities are throwing the failing hospitals a lifeline, and MPT (and even the disgraced Steward owners) are extorting yet more money from them under threat of letting everything collapse. “Retail investors stampeded back into the stock, which has a tantalizing 8.5% dividend. What MPT decisively does not have any money left over for is keeping the doors open of the hospitals.” Lawyers and consultants have so far scooped up $186 million in fees while nurses search the trash cans for surgical supplies. Massachusetts has spent $786 million to bail out the Steward hospitals in that state—so far. If any of these scumbags ever do face criminal charges, who wants to bet they top the list of the next round of presidential pardons?

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Bob Herman, “UnitedHealth continues making stealthy deals, pushing deeper into medical care as scrutiny mounts,” STAT, Mar 7, 2025 https://bit.ly/4iAul3V

Despite all the negative attention, UnitedHealth Group continues to roll up new acquisitions to further expand its insurance-provider-pharmacy-whatever empire. Last year, UH bought more than 100 surgery centers, specialty pharmacies, and 250 other subsidiaries including highly profitable outfits like heart cath labs and orthopedic surgery, ophthalmology, and gastroenterology practices. “The new additions to UnitedHealth come as federal antitrust reviewers scrutinize how the company’s different subsidiaries work with each other.” I guess there’s a bright side though: UH is getting so big that when the country finally does decide to nationalize healthcare through a single-payer system, the takeover will go fairly smoothly because just one or two companies will be managing everything.

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Helen Santoro, “You’ve already paid $6 billion for weight-loss drugs you can’t afford,” Lever News, Mar 6, 2025 https://bit.ly/4kTEmeH

The Federal Government spent $6 billion researching, developing, and implementing new blockbuster weight-loss drugs that private owners now charge $1K a month for in the U.S. The $50 billion or so that the country now pays for the fat shots are “a major driver of higher prescription drug costs” and are expected to spark an 8% rise in premiums next year. Medicare spent $5.7 billion on this class of drugs, 10 times what it spent in 2018. Ozempic only costs $93 a month in the United Kingdom.

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Bee Wilson, “Ultra-processed babies: are toddler snacks one of the great food scandals of our time?” The Guardian, Mar 15, 2025 https://bit.ly/41Dz79Z

“Over-sweetened, mushy foods are creating a generation of choosy consumers whose teeth are already rotting.” Preschool teachers notice that toddlers are “eating—or rather not eating—in a new way. A significant percentage just don’t seem to like texture.” One teacher thinks the rise in the number of nonverbal 3-year-olds to “the fact that the skills and muscles needed for chewing are related to those needed for speech.” The baby food aisle is the new target for expert marketers convincing parents that the sweet, gooey ready-mades are healthier options that plain old food. The author asks, “How bad do things have to get in the baby food aisle before the government finally decides to protect infants and parents?

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Elaine Chen, “NIH cancels funding for landmark diabetes study at a time of focus on chronic disease,” STAT, Mar 17, 2025 https://bit.ly/4ihYu8s

“The Trump administration has canceled funding for an ongoing 30-year, nationwide study tracking patients with prediabetes and diabetes at a time when top officials have emphasized their determination to curb the incidence of such chronic conditions.” It’s not as if anything should be making sense these days. But wrecking a 30-year-old database, the source of 200 scientific papers, is reaching for new heights of crazy.

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See the full archive at www.nypan.org/single-payer-news

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DO NOT RESUSCITATE #385

14 MAR 2025

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This is a shorter version of Do Not Resuscitate due to some travel days and the need to sift through the mountains of news to focus on a single topic: the threat to Medicaid. —Tim

Listen here: https://www.podbean.com/eas/pb-snw4k-1843feb

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Nathaniel Weixel, “Republicans need to cut Medicaid to hit budget savings target, CBO finds,” The Hill, Mar 5, 2025 https://bit.ly/41Odt2Q

News flash: The GOP leadership is lying to us. They promise not to slash Medicaid to ribbons while planning to do exactly that. The proof is in the budget resolution announcing $2 trillion in cuts while they bleat on about “waste, fraud, and abuse” that doesn’t exist in anywhere near the dimensions they claim. The Congressional Budget Office (CBO) just clarified the lies for anyone interested: “Even if Republicans eliminate every program under Energy and Commerce other than Medicaid and CHIP, it would only be able to save a maximum of $135 billion.” That committee is charged with finding $880 billion to cut; the other $655 billion has to come from Medicaid, the program that currently provides healthcare for one-fifth of the population. Case closed.

The CBO letter: https://www.cbo.gov/system/files/2025-03/61235-Boyle-Pallone.pdf

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Andrew Solender, “House Dems go into ‘complete meltdown’ as Schumer folds,” Axios, Mar 13, 2025 https://bit.ly/3R9adKr

Offered a golden opportunity to throw a cinderblock at the Trump-Musk machine dismantling the Federal Government, Schumer surrendered. He voted to allow the budget-massacring House resolution to get Senate approval while getting bupkis in return. House Democrats feel betrayed—kinda like the American people who keep getting played by the good cop/bad cop routine. One pol said, “I have also never had so many people from home personally texting me—ANGRY. I don’t think they knew who Chuck Schumer was before today, but they know now, and they hate him.” We in New York are way ahead of them.

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Josh Marshall, “Biggest federal employee union says shutdown is preferable to Elon/Trump CR,” Talking Points Memo, Mar 12, 2025 https://bit.ly/4bx34x0

AFGE, the federal workers union, pointed out that the Federal Government is already shut down—by Musk. AFGE president Everett B. Kelley asked senators to vote NO and also mentions Trump’s cancellation of the government’s collective bargaining agreement with TSA workers, declaring that the agency is now “union-free.” Democrats tossed unionized workers under the usual bus.

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“The Republican House Budget Resolution’s potential $880 billion in Medicaid cuts by congressional district,” Center for American Progress, Feb 24, 2025 https://bit.ly/3DTpgF3

A handy table showing the number of residents by district of people who would be affected by the GOP Medicaid cuts, based on current Medicaid and CHIP enrollment. On average, each congressional district would lose $2 billion in federal funding over 9 years. Example: My district (NY-13) has about 330,000 Medicaid/CHIP beneficiaries, of whom 156,000 could get knocked off with a loss of $4 billion in federal funds over the next decade. Will Congressman Espaillat do something or promise to “fight for” us at some future date?

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Shannon Schumacher et al., “The public’s views on potential changes to Medicaid,” KFF Health News, Mar 7, 2025 https://bit.ly/4253Y0t

How do Americans feel about Medicaid? A few zealots (17%) agree with slashing it to bits. But twice as many (42%) think it should be increased. If we lived in a democracy, this would matter. “The public’s staunch opposition to Medicaid cuts likely reflects the fact that about half (53%) of adults say they or a family member has received help from Medicaid at some point.” Even among Trump voters, it’s a hefty 45%. Nonetheless, some of the reactionary propaganda has been effective. A majority (62%) of adults “incorrectly believe that most working-age adults on Medicaid are unemployed” and thus support work requirements, which don’t get people into jobs but successfully toss eligible people out of the program. When people learn the facts, that number drops to 32%.

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N. Adam Brown, “We’re getting the Medicaid message wrong—and it’s costing us,” MedPage Today, Mar 8, 2025 https://bit.ly/3DCOCHj

This ER doctor illustrates the cost of failing to actively defend Medicaid and to explain to the public what it is, what it does, and who the beneficiaries are. People on Medicaid are the working poor with few exceptions, and—incredibly—even many people on it themselves do not realize that fact. Medicaid is not called “Medicaid” in most states. It’s Healthy Connections in South Carolina, TennCare in Tennessee, and Buckeye Health in Ohio. “In Florida, Medicaid sounds like an orange juice brand: Simply Healthcare.” That’s the result of letting private companies get contracts to deliver Medicaid and use their corporate logos while downplaying the fact that the government is paying. “No wonder Tennesseans shrug when we talk about Medicaid recipients. They don’t think, or even know, they are one.” They may be in for rude awakenings. Note to advocates—say this: “If Republicans’ Medicaid plans come to fruition, you could lose your Buckeye Health Plan [or whatever] insurance.”

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Jessie Hellmann & Sandhya Raman, “Medicaid work rules have increased coverage loss, not employment,” Roll Call, Feb 27, 2025 https://bit.ly/3FFYQXP

Here’s one way the GOP plans to slash Medicaid while pretending they aren’t: impose work requirements, playing on the false notion that beneficiaries are lay-abouts. It appeals to the brainwashed public that is hostile to “welfare,” meaning things people think shouldn’t be free like medical care. As Arkansas proved in 2018, work requirements don’t increase employment, but they do successfully create bureaucratic labyrinths that push people out of coverage. The state dropped 18,000 people from its Medicaid rolls who did not get better jobs but did postpone treatment and did accumulate more medical debt. Governor Huckabee Sanders thinks that was a success and plans to bring it back. Iowa, Montana, and Ohio also want to add the useless paperwork.

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Bernard J. Wolfson, “To patients, parents, and caregivers, proposed Medicaid cuts are a personal afront,” KFF Health News/Orange County Register, Mar 6, 2025 https://bit.ly/3FFYEb3

Nearly 15 million people—a third of the population of California—are on Medi-Cal. The cost is $161 billion, of which 60% comes from Washington.

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Rachel Bluth, “Medicaid shortfall forces California to borrow $3.44B,” Politico, Mar 12, 2025 https://bit.ly/3FxoU7A

California will be a prime target for the Trump/Musk slashers as the state covers undocumented immigrants under a special Medicaid program—a double red flag! The state originally estimated it would cost around $3 billion per year to insure that population. But one year after the program has been fully implemented, the new price tag is $8.4 billion.

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Hannah Schoenbaum, “Montana Legislature green lights Medicaid expansion as Congress considers program cuts,” Associated Press, Feb 27, 2025 https://bit.ly/4hCPcCG

Red states face a dilemma if they have dared to expand Medicaid under the Obamacare rules. Montana raised the income limit for eligibility a decade ago with some bipartisan support and now faces a higher bill than promised. They’re happy with the lower rates of uncompensated care and better outcomes among Native populations with almost all of it (90%) covered by the Feds. Now the state could be saddled with higher costs as the standard Medicaid portion paid by Washington averages around 62%. Several states are getting ready to reverse the expansion if costs rise sharply.

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Tony Leys, “Iowa Medicaid sends $4m bills to two families grieving deaths of loved ones with disabilities,” KFF Health News/Des Moines Register, Feb 18, 2025 https://bit.ly/41IzDmY

The cruelty is the point. “Collection agents for the state of Iowa seek millions of dollars from the estates of at least two people with disabilities who died after spending most of their lives in a state institution.” Most of those billed had zero assets, so the “Estate Recovery” program didn’t really apply. But it’s fun to send out the dunning letters anyway, and Iowa is “particularly aggressive” about the collections. Clawbacks don’t apply to any other federal benefit, including Medicare.

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Kate Giammarise & Tom Riese, “New weight-loss drugs like Ozempic, Wegovy spike Pennsylvania’s Medicaid costs,” WESA-FM, Mar 7, 2025 https://bit.ly/41PDGOv

States are getting slammed by the cost of the fat shots even before the axe falls in Washington. Pennsylvania will slow down authorization of Ozempic and other obesity drug prescriptions, “first requiring patients to attempt weight loss through diet and exercise programs or try less expensive medications.” Only the most obese patients will get the nod to receive the $1000-a-month treatments. We can foresee the fights to come once the massive cuts go through—there won’t be enough in the Medicaid pot to serve everyone, so slug it out among yourselves, the obese versus pregnant women, cancer patients against diabetics.

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Phil Galewitz, “Medicaid advocates say critics use loaded terms to gain edge in congressional debate,” KFF Health News, Mar 7, 2025 https://bit.ly/4ht7NkR

The GOP slasher party likes terms like “money laundering,” “discrimination,” (because the Feds match state Medicaid funding at a higher rate for expansion enrollees), and a special favorite, “able-bodied” adults who get coverage, meaning “lazy minorities.” Said one exasperated advocate, “These people spend their lives searching for the newest slogans, the newest quips, and the newest nonsensical monikers that they think somehow will persuade Congress to completely upend the program.”

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Gov JB Pritzker, “Up to a million Illinoisans will lose health care coverage with slashing of Medicaid,” Chicago Tribune, Mar 3, 2025 https://bit.ly/4i9zPCU

The governor of Illinois highlights the other likely Trump move: elimination of the extra subsidies for commercial insurance policies that people buy through the Obamacare exchanges. The result will be that people drop the unaffordable policies and rejoin the uninsured lists.

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Noah Tong, “CMS rescinds Medicaid’s health-related social needs guidance,” Fierce Healthcare, Mar 5, 2025 https://bit.ly/4ivScls

Programs that fund housing, nutrition, and other social services for high-risk Medicaid and CHIP enrollees are out. These wraparound services such as temporary housing and meals for homeless people improve outcomes. But we can’t have any talk of “social determinants of health,” which might include the term “equity” in there somewhere. RFK Jr made sympathetic noises during his confirmation hearings but quickly turned his back on anything about “underlying causes” out of ideological fealty to the wreckers.

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Maya Goldman, “Medicaid cuts put adult dental care on the chopping block,” Axios, Mar 5, 2025 https://bit.ly/4it1xup

Some dental services are covered by Medicaid, but when money is tight, they’re the first to go. (The reimbursement rates are also terrible.) For our new feudal lords, poor people should have terrible teeth as a sign of their moral unworthiness. “Without coverage, many will delay care or turn to emergency rooms, driving up health care costs and worsening health outcomes.” But even with strong benefits, low Medicaid reimbursement rates for dental care make it hard to convince dentists to take the insurance. Meanwhile, Utah just banned fluoridation of public water supplies.

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Jaymie Baxley, “NC Medicaid expansion faces uncertain future as GOP eyes federal cuts,” North Carolina Health News, Mar 5, 2025 https://bit.ly/4ky2JOP

North Carolina finally expanded Medicaid 2 years ago and incorporated half a million new beneficiaries, one third of them in rural areas. They also figured out a way for the state itself to pay almost nothing by taxing providers for the 10% not reimbursed by Washington. Now, it’s all at risk. “The almost nonexistent financial burden on the state is partly why Republican lawmakers in North Carolina finally assented to supporting the measure after more than a decade of resistance. [But] the measure includes a ‘trigger law’ that brings expansion to a halt if the feds pick up anything less than 90%.” All the recently covered enrollees will be summarily dumped, and the struggling hospitals that got a lifeline from the expansion will again teeter on the brink of collapse from the burden of uncompensated care.

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See the full archive at: www.nypan.org/single-payer-news

SINGLE PAYER LINKS #384

7 MAR 2025

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This week: measles is back; Muskrats’ rolling takeover of the unity executive continues; our food is killing us, but don’t be mean to the companies who make it; digging around in the world’s viruses; tweaking our healthcare system = pounding out dents on a car that has no wheels.

Listen here: https://www.podbean.com/eas/pb-9wmtt-182a257

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Mary Kekatos, “Measles cases reported in New Jersey, Kentucky amid ongoing outbreak in Texas,” ABC News, Feb 27, 2025 https://bit.ly/4h6FcBz

Several outbreaks around the country are linked to international travel. Are the disease monitoring employees at airports among those fired by the Muskrats? Measles was declared eliminated from the U.S. 20 years ago. If it’s back to stay, we may have to show proof of vaccination to travel overseas.

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Neha Mukherjee, “RFK Jr. said measles outbreaks are ‘not unusual’ in the US. Doctors say he’s wrong,” CNN, Feb 27, 2025 https://bit.ly/41BQDN4

RFK Jr first downplayed the Texas measles outbreak as “not unusual” and refused to discuss vaccination as a remedy. Then, he partially backtracked a few days later and said it was a “top priority” as new cases surfaced in Rhode Island, Georgia, California, Alaska, and New Mexico. The Texas cases occurred in Gaines County, home to “a strong homeschooling and private school community” and lots of antivax sentiment. It started in a Mennonite community that doesn’t discourage vaccines, but a local doctor says “the anti-vaccine activist groups got to them.”

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Andrew Joseph, “On measles outbreak, the Trump administration’s messaging strikes some as off-key,” STAT, Feb 27, 2025 https://bit.ly/41pchml

A few years ago, even Trump-era officials would have sung a consistent tune about the importance of vaccinations to halt contagious disease outbreaks. Trump himself said in 2019, “They have to get the shot. The vaccinations are so important.” The new official strategy is to let measles—and by implication any other contagious pathogen that pops up—rip through society and hope for the best.

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Eleanor Klibanoff, “Texas leaders quiet amid the biggest measles outbreak in decades,” Texas Tribune, Feb 28, 2025 https://bit.ly/3DiSdtV

“Declining vaccination rates, decreasing trust in government, and a political unwillingness to endorse vaccines is shaping Texas’ measles response.” No students are being told to stay home after exposure. One Houston epidemiologist explained: “Texas is such an independent state. People don’t want to be told what to do.” Even when what they do affects other people? Guess so. Texas legislators did say they would pray for the family whose kid died, so there’s that.

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Adrienne Matei, “Formerly anti-vax parents on how they changed their minds: ‘I really made a mistake,’” The Guardian, Feb 27, 2025 https://bit.ly/4inuebE

A series of anecdotes about parents who didn’t get their children vaccinated and later reconsidered includes this telling detail: “Anti-vax rhetoric may be so persistent because it is profitable.” A whopping 70% of early Covid-19 anti-vax disinformation “was generated by 12 individuals with collective annual revenues of around $36m.” Nice business model! The author adds that mothers become more susceptible to antivax narratives when their questions are brushed off by providers. But given the assembly-line approach to modern medicine, not many doctors or nurses have time to be patient with the patients.

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Clare Ansberry, “We don’t trust doctors like we used to,” Wall Street Journal, Feb 23, 2025 https://bit.ly/4h5XvH1

Big drop in high ratings for MDs because “people feel less confident. They see a series of time-pressed physicians who keep visits short and struggle to build rapport with patients. That often makes it seem as if they are dismissing concerns.” Doctors and nurses are the point of contact; they pay the price of the corporate sins underlying the system.

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Zeynep Tufekci, “The Texas measles outbreak is even scarier than it looks,” New York Times, Feb 28, 2025 https://bit.ly/4klfXhH

Older folks among us may think of measles as just another childhood disease that we all had and got over. “But startling research about the virus unfortunately tells a new and very different story. Measles destroys immune cells. Even people who recover from the virus lose much of their immune memory.” And, “Earlier measles infections may have been implicated in as many as half of all childhood deaths from infectious diseases.” Just what we need as Covid already has massively weakened the population’s overall immunity.

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Jason Gale, “As measles cases surge in Texas, WHO’s global control program risks collapse,” Bloomberg, Feb 26, 2025 https://bit.ly/4bourt8

The WHO tests 500,000 patient samples annually to identify disease outbreaks “before they cross borders.” Now, its 760 labs face radical cutbacks as the U.S. pulls its cash. Maybe immigrants can’t cross our borders, but communicable diseases are welcome!

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Rebecca Falconer, “HPV vaccine has huge impact on cervical cancer prevention, CDC study suggests,” Axios, Feb 28, 2025 https://bit.ly/41gi5hO

Pre-cervical cancerous lesions among young women fell by 80% in the past decade, almost certainly due to the human papillomavirus (HPV) vaccine that RFK Jr calls “dangerous and defective.” Conservatives also had a cow over it since it’s given to children when they’re 11 or 12 years old based on the crazy possibility that they might someday have sex.

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Pamela Ferdinand, “Agricultural pesticide exposure linked to childhood cancers, study says,” U.S. Right To Know, Feb 16, 2025 https://bit.ly/4bmEJKj

While parents are freaking out over vaccines, thousands of nasty substances are entering their kids’ bodies through proximity to farmland. “A 10% increase in agrichemical mixtures was associated with a significant rise in pediatric cancers in Nebraska.” The pesticides and herbicides include the notorious glyphosate and paraquat along with a slew of other creepy sounding chemicals like quizalofop and triasulfuron. The cancers this stuff encourage include tumors of the brain and central nervous system and leukemia. Previous studies looked at the chemicals individually, but this one studied them in combination, which is a better reflection of what happens in the real world.

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Natasha Gilbert, “As EPA considers cancer links to nitrates in drinking water, industry downplays the risks,” U.S. Right To Know/Sierra, Jan 30, 2025 https://bit.ly/4incPjp

Dismantling the EPA will stop any meaningful action on all the poisons we’re consuming in our food and drink. “Nitrates leach from chemical fertilizers and animal manure to pollute groundwater, rivers, and streams” and are suspected in the rise of cancers in farm states.

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Yuki Noguchi, “Iowa has high cancer rates. Trump’s cuts to CDC and NIH are already hitting the state,” NPR, Feb 28, 2025 https://bit.ly/4h7eIQp

Iowa has the second-highest cancer incidence rates in the country (after Kentucky), and it’s getting worse. The state was trying to catch more cases with earlier diagnoses in rural areas and had a brand-new CDC intern helping out at the Iowa Cancer Consortium to work on it. She just got canned by the Muskrats after a bogus performance review and will have to leave Iowa. Although she was smart enough to land a highly competitive internship, job-hunting won’t be easy for her “because you have these extremely highly educated people who all just got let go at the same time and are all looking for a new job.”

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Sarah Ladd, “Kentucky legislature moves to implement Make America Healthy Again,” Kentucky Lantern, Feb 25, 2025 https://bit.ly/3DhnjC2

Speaking of Kentucky, they’ve decided to make MAHA local, but their rhetoric about what they plan to achieve reflects the contradictions built into the RFK/MAHA universe. The state’s MAHA Kentucky Task Force will address the state’s dismal health statistics since it’s one of the sickest places in the country. They listed their goals as limiting overspending on the fat shots like Ozempic and getting people less dependent on pharmaceuticals and thinking more about “root causes” of illness. It all sounds great and has bipartisan support. But their announced desire to “restore American health over corporate profit” is going to put them on a collision course with their traditional corporate friends. Another supporter said she wants to “enhance public health and prevent overmedication, not to attack agriculture, not to attack pharmaceutical companies, not to attack processed food industries.” Huh? You’re going to ask them politely? Good luck!

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Karolina Corin, “Could our nation’s newest virus-hunting program cause the next pandemic?” U.S. Right To Know, May 30, 2024 https://bit.ly/4kr1EIk

Virus hunters are out there uncovering “yet-to-be-recognized deadly viruses,” which sounds like a worthy scientific endeavor, sampling bats and dozens of other mammals to find the next Covid bug. But there are risks as we all now know—harvesting viruses or fiddling around with them to make them deadlier opens the door to lab leaks or, theoretically, biological warfare. One biology professor pointed out that just publishing genetic sequences of potential pathogens could provide bad actors “blueprints for an arsenal of plagues.” Others say there’s no upside to the search: “The only applications are bioweapons-agents discovery and bioweapons-agents threat assessment.”

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Cristina Criddle & Stephanie Stacey,” Pollution from Big Tech’s data centre boom costs US public health $5.4bn,” Financial Times, Feb 23, 2025 https://bit.ly/3QzSICW

“Data centres cause pollution through high electricity use.” Since AI and other Big Tech activities gobble up enormous quantities of electricity, they lead to lots more air pollution. Air pollution is highly carcinogenic. The U.S. plans to massively increase AI, which requires a huge investment in new energy infrastructure. Data center energy use is already about 4% of the total U.S. consumption. One could argue that the fancy AI innovations promising to improve healthcare delivery will be fixing the new health problems that AI itself creates.

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Pamela Ferdinand, “Billions in drug and medical device company payments to medical specialists may compromise patient care,” U.S. Right To Know, Feb 27, 2025 https://bit.ly/4kgAR1z

“Financial relationships with drug companies impacts decision-making in ways that benefit drug companies, including altering prescribing habits.” English translation: People, including doctors, are susceptible to bribes. Ethical doctors should not let themselves be wined and dined by Pharma. The amount of cash sloshing around is astounding: billions of dollars for things like free travel and meals at conferences, speaking fees, product samples, and other benign-looking emoluments. There’s plenty of research evidence that these little—or big—gifts influence prescribing habits. Pharma knows this: they spend $2 billion a year on the stuff. “A BMJ report shows doctors who received industry-sponsored meals were more than twice as likely to prescribe a new heart failure drug to Medicare recipients.” Another big payout area is royalties for inventions. Takeaway lesson: If you’re getting a knee replacement, ask you surgeon if he’s getting money (aside from his fee) for the product he proposes to put in you.

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Miranda Yaver, “My $30,000 health insurance claim was denied. Then I tweeted about it,” The Guardian, Feb 26, 2025 https://bit.ly/4inVSW7

Yaver shamed her insurer by publicizing its denials on social media. She also prepared a killer 17-page appeal full of technical arguments. So yes, complain on Twitter. But why are we reduced to this indignity?

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Richard K. Leuchter, “An open letter to RFK Jr: Stop the spread of private equity in healthcare,” MedPage Today, Feb 19, 2025 https://bit.ly/4kqvlsY

For all the attention to the malignant influence of private equity (PE), it’s still a booming business. The author says RFK Jr, given his priors, should naturally want to halt the trend, but that would put him at odds with Trump’s golfing buddies.

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Joyce Frieden, “Health prices are getting more transparent, but it’s still not enough,” MedPage Today, Nov 20, 2025 https://bit.ly/41EPTqk

Nineteen states now have price transparency laws covering PBMs, and Trump recently called for less secrecy in hospital pricing. We can know a little more about the big variations in, say, what a hospital charges to different insurance plans. But price data is still completely arcane and presented in ways that no average person can figure out. Frieden quotes a critic: “For something to be ‘shoppable,’ it needs to be specific, and it needs to be searchable. It needs to be easy.” But who says we need “shoppable” healthcare? Illnesses and injuries are not washing machines.

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Julia Shapero, “Arizona advances bill to keep AI from rejecting medical claims,” The Hill, Feb 21, 2025 https://bit.ly/4h9sHFj

Arizona state lawmakers voted 58–0 to ban the use of artificial intelligence (AI) to deny medical claims. Fine. But why won’t insurers simply get one of their doctor-slaves to take a pile of AI denials and sign the whole lot? The underlying problem is the power the insurers have, not their means of exercising it.

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Dave Muoio, “RFK Jr. orders HHS to end ‘extra-statutory’ notice, public comment process in rulemaking,” Fierce Healthcare, Feb 28, 2025 https://bit.ly/41pBTzl

No more public comment on pending health regulations and policy changes. “The new instructions appear to run at odds with the secretary’s promises of leading a more transparent public health apparatus.” Now, the priority is to speed things up before anyone can react. Trumpians and the Supreme Court insisted on upholding the public comment practice when conservatives were trying to block everything.

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Sriparna Roy & Amina Niasse, “DOJ launches UnitedHealth billing probe,” Reuters, Feb 21, 2025 https://bit.ly/4hmUz9f

UH hasn’t been doing well, and even Trump isn’t cutting them a break. It shares are tanking, and its executives are hiding out. A fraud investigation over MA upcoding has been in the works for a while, and its PBM is vulnerable as well. The UH suits better up their game and make more friends at Mar-a-Lago.

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Brian Witte & Rodrique Ngowi, “Fired cybersecurity chief for Veterans Affairs site warns that health and financial data is at risk,” Associated Press, Feb 25, 2025 https://bit.ly/3XpikGp

“Sensitive financial and health data belonging to millions of veterans and stored on a benefits website is at risk of being stolen or otherwise compromised.” The guy in charge of keeping it safe just got the boot. He said keeping the databases decentralized is protective; the DOGEbags want to centralize it, “increasing the chances for abuse.”

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Juan Cole, “Palestinian life expectancy in Gaza cut from 75.5 to 40.6 years by Israeli total war,” Informed Comment, Feb 22, 2025 https://www.juancole.com/2025/02/palestinian-expectancy-israeli.html

The Lancet says the 35-year drop is hardly surprising given the “deliberate targeting of civilians and reckless disregard for civilian life.” Gazans’ life expectancy (40 years) is now the lowest in the world, below Chad and Lesotho. Israel’s is 82.7 years.

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See the full archive at www.nypan.org/single-payer-news

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Muskrats with chainsaw

Do Not Resuscitate #383 ex Single Payer Links

Tim Frasca

Mar 4

28 FEB 2025

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Trump/Musk tag team take a chainsaw to the Federal Government; Democrats prepare to surrender; early casualty lists; fat-shots cripple state budgets; Pharma revolving door wind tunnel.

Listen here: https://www.podbean.com/eas/pb-eudqh-1820881

*

Stephen Semler, “How Biden set the stage for GOP budget cuts,” Polygraph, Feb 15, 2025 https://bit.ly/3XjaaPH

After all those calming promises about how Trump won’t attack Medicare or Social Security, we now have some hard facts in the budget resolution: cuts of at least $1.5 trillion. The big targets are $230 billion from Agriculture (SNAP a.k.a. food stamps) and a whopping $880 billion from Energy and Commerce (Medicaid). Even Armed Services ($100 billion) and Homeland Security ($90 billion) get a theoretical whack. But: “The GOP’s budget resolution would have sparked greater public outcry if Biden hadn’t spent the last two years normalizing social welfare cuts. Expanded Medicaid coverage, enhanced SNAP benefits, and the student loan pause were all meant to be temporary—but they didn’t have to be. The broader war on welfare is bipartisan.” The Trump I tax cuts were peddled as “temporary” also, but keeping them is a top GOP priority (not the deficit, which will they will let rise). Who wants to bet that Dems will go along with making the tax cuts permanent? A personal note/rant: I spent most of last year banging the drum about Biden letting 25 million people get kicked off Medicaid. Can Democrats really raise a hue and cry over Trump going them one better? Ditto for SNAP—the post-Covid pullback severely cut food aid—in 2023. “Congress buried these cuts in a nearly 1,700-page bill passed over the holidays, leaving virtually no room for public debate.” Democrats were complicit then and will be now—Schumer and Pelosi backed the cuts because the package had money for Ukraine and the Pentagon. Expect no real fight against the Trump chainsaw.

*

Sahil Kapur, “Trump and Musk's slash-and-burn tactics are a sticking point in talks to prevent a shutdown, NBC News, Feb 26, 2025 https://bit.ly/41aWffC

Buried in this inside-baseball chronicle about the DOGE takeover of the Federal Government is a revealing tidbit: while the two sides are at odds over the Muskrat hatchet, they are “close on the numbers,” according to the top GOP negotiator. That can only mean one thing: the Democrats are ready to go along with massive cuts to Medicaid. Oklahoma senator Tom Cole: “We’re pretty far apart still on trying to limit presidential powers,” adding that Republicans will insist on abolishing inconvenient portions of the Constitution. By contrast, Democrats will give up their leverage by inserting toothless language about “following the law” instead of forcing Trump to stop breaking it.

*

Eli Hager, “Anxiety mounts among Social Security recipients as DOGE troops settle in,” ProPublica, Feb 22, 2025 https://bit.ly/3QwqHw2

“Social Security recipients rely on in-person service in all 50 states, and the shuttering of offices everywhere from rural West Virginia to Las Vegas could be hugely consequential. Elon Musk’s team has descended on an already understaffed Social Security Administration.” Meanwhile, Trump continues to issue reassurances that you are not seeing what you are seeing. “Social Security will not be touched.” (“It’s just a shower.”) Technically that could even be true, but if the 119,000 daily visitors to SSA offices are suddenly bunched into fewer sites where people can’t get an appointment, the “untouched” benefits will be out of reach. Trump also floated the idea of outsourcing SSA jobs so that instead of visiting an SSA office, we deal with a voice in the Philippines.

*

Melanie Zanona, Sahil Kapur & Ben Kamisar, “House Republicans representing large shares of Medicaid, SNAP beneficiaries face tough budget test,” NBC News, Feb 21, 2025 https://bit.ly/3D7plER

A few Republicans are skittish about throwing thousands of their constituents off Medicaid/SNAP. Despite making some weak “concern” noises, none of them voted no on the budget. They might fear their voters, but they fear Trump more. Rep. David Valadao from central California is the most nervous GOP member because he already lost his seat once after voting to end Obamacare. His district has the second highest Medicaid population in the country. (No. 1 is the Israeli-occupied Bronx district of Ritchie Torres.) Fun fact: one third of all Medicaid spending goes to elderly people in nursing homes and assisted living.

*

Blake Jones, “Valadao treads lightly on Medicaid as Obamacare vote haunts him,” Politico, Feb 20, 2025 https://bit.ly/4bi7nvS

Valadao’s San Joaquin Valley district “is being bombarded with TV ads pressuring him not to slash Medicaid.” Didn’t work. Democrats are postponing their “resistance” until November, 2026. That won’t work either.

*

Allan Smith, Melanie Zanona & Laura Strickler, “USDA says it accidentally fired officials working on bird flu and is now trying to rehire them,” NBC News, Feb 18, 2025 https://bit.ly/3QAqzvB

Oopsie. The wrecking crew “accidentally” fired the people in charge of dealing with bird flu (H5N1) and then thought better of the idea. These supposed gaffes are a feature, not a bug; DOGE is staffed with people who have no prior experience by design. They remind everyone that there are no rules and no consequences.

*

Lizzy Lawrence, “Trump administration rehires some FDA employees it fired,” STAT, Feb 23, 2025 https://bit.ly/41yb90S

Fire, aim, ready! “The Trump administration has started quietly rehiring some of the FDA employees it fired last week, including “all 12 of the people who worked in the office reviewing surgical and infection control devices. It’s not clear if the 200 workers who check out hip implants, pacemakers, and AI software will get callbacks.

*

Megan Messerly & Adam Cancryn, “Trump officials defend HHS cuts as more methodical than the slashing at other agencies,” Politico, Feb 15, 2025 https://bit.ly/4hTpwTp

“More methodical” is supposed to be reassuring. We should accept “surgical” cuts as better than. . . what exactly? Those done by dull machetes or a Texas chain-saw? Trump officials “stressed that employees in key areas—namely politically sensitive staffers such as CDC and FDA scientists, frontline health care workers, and Medicare employees—had been exempted.” This is false and adds to the (intentional) confusion. “Probationary staffers spent much of the day in the dark over whether and when they would be fired. Supervisors were unclear even on what criteria was used to make the decisions.”

*

Usha Lee McFarling, Angus Chen & Sarah Owermohle, “Growing number of federal health agencies are combing grants for taboo words, unnerving researchers,” STAT, Feb 13, 2025 https://bit.ly/41lL6Jj

Conservatives have raised hell about private/public censorship of some of their views on social media during Biden’s term. But they don’t have a problem with the word-search censorship now rampant in government, nor the systematic search for trigger words, like “trans,” “diversity,” “bias,” “equity,” and “women.” Absurdities abound. A microbiome or a set of galaxies can be “diverse.” “Bias” is a technical term used in statistical analysis. Other words that trigger the MAGA snowflakes: “political,” “trauma,” “female.” I guess RFK Jr should avoid discussing “trans fat” products!

*

Alexander Tin, “Mental health agency loses 1 in 10 staffers to DOGE cuts, 988 hotline team impacted,” CBS News, Feb 21, 2025 https://bit.ly/4h3vBey

Substance abuse and those who suffer from it have never been a priority, and now we are to go back to ignoring or simply imprisoning them. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) lost 10% of its entire staff, including people working on the 988 suicide hotline. It’s as if they want people to die off or something.

*

Annie Waldman & Duaa Eldeib, “They worked to prevent death. The Trump Administration fired them,” ProPublica, Feb 22, 2025 https://bit.ly/4klRGb9

Congress slowly and tediously authorized the hire of some specialty workers to tackle issues of bipartisan consensus. Now, they’re out. One reviewed e-cigarettes to block designs and flavors that appeal to kids; another worked on the high rates of maternal mortality in the U.S. that are heavily skewed by racial group (which is no longer to be mentioned). A third tracked transplantable organ shipments so that they don’t get lost in transit and destroyed. “One [kidney] was accidentally left on an airport luggage trolley.” She’s been fired.

*

Filip Timotija, “White House restores 9/11 health program funding after uproar,” The Hill, Feb 21, 2025 https://bit.ly/3DbahWI

A few of the firings generated enough backlash to be reversed. For example, a slew of GOP pols went to bat for the 9/11 victims whose disability needs were about to be undermined. New York senators Schumer and Gillibrand joined in. They know how to fight back if they want to.

*

David Lipschutz, “Threats to Medicare, Medicaid, and other health programs increasing, Center for Medicare Advocacy, Feb 20, 2025 https://bit.ly/3EUlD1X

Trump said people working on Medicare management wouldn’t be fired—another lie. Also, cuts of 90% were applied to the navigator program helping people understand and obtain their Medicaid/CHIP benefits.

*

Megan Molteni, Usha Lee McFarling & Angus Chen, “Graduate student admissions paused and cut back as universities react to Trump orders on research,” STAT, Feb 19, 2025 https://bit.ly/4bfIlxq

Universities are holding up acceptance letters; grad students are rethinking their careers; labs are contemplating shutdowns; and experts warn of a “cascading” chain reaction that will cripple the country’s research base. Young Americans will be the next wave of foreign students as they escape to greener pastures.

*

Sarah Todd & Lizzy Lawrence, “The ‘GRAS’ loophole lets untested additives into Americans’ food. Can RFK Jr. close it?” STAT, Feb 19, 2025 https://bit.ly/4bppkJ5

One thing RFK Jr could do that most people would go along with is to end the abuse of the FDA’s GRAS (“generally recognized as safe”) rule. This allows food manufacturers to introduce new additives without first receiving regulatory approval—in fact, they don’t even have to tell the FDA what they’re putting in their products. It’s basically “innocent until proven guilty” applied to chemicals rather than its opposite, the precautionary principle, i.e., prove it’s safe before you feed it to people. GRAS has let “thousands of ingredients never reviewed by the FDA to become embedded in the foods Americans eat.” But RFK Jr can’t do much without staff, and his boss just canned 1/3 of the people who review additives. Even though 99% of chemicals now in the U.S. food supply were added without any FDA oversight, don’t expect anything to happen to the “natural flavors” listed on food packages.

*

Anne Hultgren, “How one foundation changed its approach to diversify grant recipient institutions,” STAT, Jan 8, 2025 https://bit.ly/3EVeNJH

The lost spirit of broadening one’s base of beneficiaries, once known as “equity,” scored some successes before being beaten to death in the basement. This foundation head said her institution found itself “perpetuating the concentration of grant funding at elite institutions” and decided to review grant proposals blinded by gender, race, or institutional identifiers. Even applicants’ names were deleted. The result was “a reduction in the relative advantage of applicants from the more prestigious institutions.” Enough of that—elitism is back.

*

Kelly Hooper, “Diet drug boom weighs heavily on state budgets,” Politico, Feb 12, 2025 https://bit.ly/4i6Ellg

“Colorado’s spending on highly effective but costly weight-loss drugs for state workers more than quadrupled last year, and costs are doubling every 6 months. Now, the state wants to scrap the benefit.” A lot of states are in the same boat. They leapt into the fat-shot frenzy with both feet and are now suffering buyers’ remorse. More than 10% of everyone in the U.S. reports taking a GLP-1 drug—how crazy is that? North Carolina and West Virginia have already eliminated coverage. Delaware estimated the cost for its state employees at around $2 million and instead spent $14 million with projections for next year at $53 million. The situation pits state officials against patients and unions while Pharma sits placidly on the sidelines watching the catfights.

*

Matt Stoller, Monopoly Roundup, BIG, Feb 12, 2025 https://bit.ly/439CJmy

“ConEdison is asking to raise its rates on electricity by 11% and gas by 18%. I went through the docket to find out why it needs so much money. A small part of the increase has to do with the company passing along the costs of its workers using Ozempic.” The flood of cash into the fat-shot companies are affecting electric utility rates!

*

Christine Mai-Duc, “Top California Democrats clash over how to rein in drug industry middlemen,” KFF Health News/San Francisco Chronicle, Feb 13, 2025 https://bit.ly/3ESW41n

Drug prices are too high, so California’s Democrats—who rule the state—got ready to do something and passed a bill nearly unanimously. The governor promptly killed it. Meanwhile, drug costs are up 50% in California in the last decade.

*

Adam Feuerstein, “Pfizer CEO Albert Bourla inflicts injury on his company—and all of pharma,” STAT, Feb 24, 2025 https://bit.ly/3DaCb5c

Pfizer snapped up a new employee: former top FDA drug regulator Patrizia Cavazzoni will be its new chief medical officer. This isn’t a revolving door—it’s a particle-accelerator wind tunnel. So much for the MAHA fretting about the Pharma/FDA coziness. “Bourla has just given every pharma-hating, vaccine-doubting person in this country a legitimate reason to further loathe and distrust the industry.”

*

Madeline Ashley, “Massachusetts hospitals face ‘perilous’ dual crisis,” Becker’s Hospital CFO Report, Feb 10, 2025 https://bit.ly/43jjAyv

Massachusetts’ hospitals are in a mess. On the one hand, the meltdown that followed the systematic looting by crooks at Steward Health bankrupted several hospitals in the state; some closed. Meanwhile, the more prosperous units are facing financial headwinds with more than half losing money on operations. (Moi: Why do hospitals have to break even? Why is medicine a commodity?) Paradox: while hospitals are laying off staff to save money, a state-funded study says hospitals have 15,000 unfilled vacancies.

*

Alejandra O’Connell-Domenech, “New York sues major vape companies for targeting kids, teens,” The Hill, Feb 20, 2025 https://bit.ly/4igbLhm

States will take on more regulatory functions as the Feds abandon the field. New York is suing vape distributors for continuing to illegally sell flavored products like Puff Bar and Elf Bar to minors. New York and several other states collected $462 million from Juul in a similar suit.

*

Paul Cuno-Booth, “Some Medicaid recipients would pay premiums under Ayotte’s budget plan,” New Hampshire Public Radio, Feb 24, 2025 https://bit.ly/3QBCDMT

States are following suit and looking at ways to make up for the anticipated Medicaid cuts from Washington: New Hampshire doesn’t currently charge premiums for beneficiaries, but that is likely to change. Parents could start owing 5% of their annual income to keep the children’s coverage. That’s around $3000 a year for a family at the upper end of the eligibility income scale.

*

Kristina Fiore, “Supplemental benefits offer few advantages for MA enrollees,” MedPage Today, Jan 15, 2025 https://bit.ly/3EZezRC

Despite all those bells and whistles that lure people into signing up for Medicare Advantage (MA) plans—dental, vision, and hearing extras, “enrollees didn’t get more care and spent just as much out of pocket as those with traditional Medicare.” A lot of the enrollees don’t use the benefits they have—a major reason for that is that they don’t know about them. “Many MA beneficiaries weren’t aware that they had dental (54.2%) or vision (54.3%) coverage.” Solution: stop paying billions in extra costs to MA plans and use the savings to expand traditional Medicare benefits. This is not hard; won’t happen.

*

See the full archive at www.nypan.org/single-payer-news

SINGLE PAYER LINKS #383

28 FEB 2025

*

Trump/Musk tag team take a chainsaw to the Federal Government; Democrats prepare to surrender; early casualty lists; fat-shots cripple state budgets; Pharma revolving door wind tunnel.

Note: I'm sticking with the email blast as usual, but you should also get the digest for this week via Substack as I am migrating everything there. Still in the experimental stage! 

Listen here: https://www.podbean.com/eas/pb-eudqh-1820881

*

Stephen Semler, “How Biden set the stage for GOP budget cuts,” Polygraph, Feb 15, 2025 https://bit.ly/3XjaaPH

After all those calming promises about how Trump won’t attack Medicare or Social Security, we now have some hard facts in the budget resolution: cuts of at least $1.5 trillion. The big targets are $230 billion from Agriculture (SNAP a.k.a. food stamps) and a whopping $880 billion from Energy and Commerce (Medicaid). Even Armed Services ($100 billion) and Homeland Security ($90 billion) get a theoretical whack. But: “The GOP’s budget resolution would have sparked greater public outcry if Biden hadn’t spent the last two years normalizing social welfare cuts. Expanded Medicaid coverage, enhanced SNAP benefits, and the student loan pause were all meant to be temporary—but they didn’t have to be. The broader war on welfare is bipartisan.” The Trump I tax cuts were peddled as “temporary” also, but keeping them is a top GOP priority (not the deficit, which will they will let rise). Who wants to bet that Dems will go along with making the tax cuts permanent? A personal note/rant: I spent most of last year banging the drum about Biden letting 25 million people get kicked off Medicaid. Can Democrats really raise a hue and cry over Trump going them one better? Ditto for SNAP—the post-Covid pullback severely cut food aid—in 2023. “Congress buried these cuts in a nearly 1,700-page bill passed over the holidays, leaving virtually no room for public debate.” Democrats were complicit then and will be now—Schumer and Pelosi backed the cuts because the package had money for Ukraine and the Pentagon. Expect no real fight against the Trump chainsaw.

*

Sahil Kapur, “Trump and Musk's slash-and-burn tactics are a sticking point in talks to prevent a shutdown, NBC News, Feb 26, 2025 https://bit.ly/41aWffC

Buried in this inside-baseball chronicle about the DOGE takeover of the Federal Government is a revealing tidbit: while the two sides are at odds over the Muskrat hatchet, they are “close on the numbers,” according to the top GOP negotiator. That can only mean one thing: the Democrats are ready to go along with massive cuts to Medicaid. Oklahoma senator Tom Cole: “We’re pretty far apart still on trying to limit presidential powers,” adding that Republicans will insist on abolishing inconvenient portions of the Constitution. By contrast, Democrats will give up their leverage by inserting toothless language about “following the law” instead of forcing Trump to stop breaking it.

*

Eli Hager, “Anxiety mounts among Social Security recipients as DOGE troops settle in,” ProPublica, Feb 22, 2025 https://bit.ly/3QwqHw2

“Social Security recipients rely on in-person service in all 50 states, and the shuttering of offices everywhere from rural West Virginia to Las Vegas could be hugely consequential. Elon Musk’s team has descended on an already understaffed Social Security Administration.” Meanwhile, Trump continues to issue reassurances that you are not seeing what you are seeing. “Social Security will not be touched.” (“It’s just a shower.”) Technically that could even be true, but if the 119,000 daily visitors to SSA offices are suddenly bunched into fewer sites where people can’t get an appointment, the “untouched” benefits will be out of reach. Trump also floated the idea of outsourcing SSA jobs so that instead of visiting an SSA office, we deal with a voice in the Philippines.

*

Melanie Zanona, Sahil Kapur & Ben Kamisar, “House Republicans representing large shares of Medicaid, SNAP beneficiaries face tough budget test,” NBC News, Feb 21, 2025 https://bit.ly/3D7plER

A few Republicans are skittish about throwing thousands of their constituents off Medicaid/SNAP. Despite making some weak “concern” noises, none of them voted no on the budget. They might fear their voters, but they fear Trump more. Rep. David Valadao from central California is the most nervous GOP member because he already lost his seat once after voting to end Obamacare. His district has the second highest Medicaid population in the country. (No. 1 is the Israeli-occupied Bronx district of Ritchie Torres.) Fun fact: one third of all Medicaid spending goes to elderly people in nursing homes and assisted living.

*

Blake Jones, “Valadao treads lightly on Medicaid as Obamacare vote haunts him,” Politico, Feb 20, 2025 https://bit.ly/4bi7nvS

Valadao’s San Joaquin Valley district “is being bombarded with TV ads pressuring him not to slash Medicaid.” Didn’t work. Democrats are postponing their “resistance” until November, 2026. That won’t work either.

*

Allan Smith, Melanie Zanona & Laura Strickler, “USDA says it accidentally fired officials working on bird flu and is now trying to rehire them,” NBC News, Feb 18, 2025 https://bit.ly/3QAqzvB

Oopsie. The wrecking crew “accidentally” fired the people in charge of dealing with bird flu (H5N1) and then thought better of the idea. These supposed gaffes are a feature, not a bug; DOGE is staffed with people who have no prior experience by design. They remind everyone that there are no rules and no consequences.

*

Lizzy Lawrence, “Trump administration rehires some FDA employees it fired,” STAT, Feb 23, 2025 https://bit.ly/41yb90S

Fire, aim, ready! “The Trump administration has started quietly rehiring some of the FDA employees it fired last week, including “all 12 of the people who worked in the office reviewing surgical and infection control devices. It’s not clear if the 200 workers who check out hip implants, pacemakers, and AI software will get callbacks.

*

Megan Messerly & Adam Cancryn, “Trump officials defend HHS cuts as more methodical than the slashing at other agencies,” Politico, Feb 15, 2025 https://bit.ly/4hTpwTp

“More methodical” is supposed to be reassuring. We should accept “surgical” cuts as better than. . . what exactly? Those done by dull machetes or a Texas chain-saw? Trump officials “stressed that employees in key areas—namely politically sensitive staffers such as CDC and FDA scientists, frontline health care workers, and Medicare employees—had been exempted.” This is false and adds to the (intentional) confusion. “Probationary staffers spent much of the day in the dark over whether and when they would be fired. Supervisors were unclear even on what criteria was used to make the decisions.”

*

Usha Lee McFarling, Angus Chen & Sarah Owermohle, “Growing number of federal health agencies are combing grants for taboo words, unnerving researchers,” STAT, Feb 13, 2025 https://bit.ly/41lL6Jj

Conservatives have raised hell about private/public censorship of some of their views on social media during Biden’s term. But they don’t have a problem with the word-search censorship now rampant in government, nor the systematic search for trigger words, like “trans,” “diversity,” “bias,” “equity,” and “women.” Absurdities abound. A microbiome or a set of galaxies can be “diverse.” “Bias” is a technical term used in statistical analysis. Other words that trigger the MAGA snowflakes: “political,” “trauma,” “female.” I guess RFK Jr should avoid discussing “trans fat” products!

*

Alexander Tin, “Mental health agency loses 1 in 10 staffers to DOGE cuts, 988 hotline team impacted,” CBS News, Feb 21, 2025 https://bit.ly/4h3vBey

Substance abuse and those who suffer from it have never been a priority, and now we are to go back to ignoring or simply imprisoning them. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) lost 10% of its entire staff, including people working on the 988 suicide hotline. It’s as if they want people to die off or something.

*

Annie Waldman & Duaa Eldeib, “They worked to prevent death. The Trump Administration fired them,” ProPublica, Feb 22, 2025 https://bit.ly/4klRGb9

Congress slowly and tediously authorized the hire of some specialty workers to tackle issues of bipartisan consensus. Now, they’re out. One reviewed e-cigarettes to block designs and flavors that appeal to kids; another worked on the high rates of maternal mortality in the U.S. that are heavily skewed by racial group (which is no longer to be mentioned). A third tracked transplantable organ shipments so that they don’t get lost in transit and destroyed. “One [kidney] was accidentally left on an airport luggage trolley.” She’s been fired.

*

Filip Timotija, “White House restores 9/11 health program funding after uproar,” The Hill, Feb 21, 2025 https://bit.ly/3DbahWI

A few of the firings generated enough backlash to be reversed. For example, a slew of GOP pols went to bat for the 9/11 victims whose disability needs were about to be undermined. New York senators Schumer and Gillibrand joined in. They know how to fight back if they want to.

*

David Lipschutz, “Threats to Medicare, Medicaid, and other health programs increasing, Center for Medicare Advocacy, Feb 20, 2025 https://bit.ly/3EUlD1X

Trump said people working on Medicare management wouldn’t be fired—another lie. Also, cuts of 90% were applied to the navigator program helping people understand and obtain their Medicaid/CHIP benefits.  

*

Megan Molteni, Usha Lee McFarling & Angus Chen, “Graduate student admissions paused and cut back as universities react to Trump orders on research,” STAT, Feb 19, 2025 https://bit.ly/4bfIlxq

Universities are holding up acceptance letters; grad students are rethinking their careers; labs are contemplating shutdowns; and experts warn of a “cascading” chain reaction that will cripple the country’s research base. Young Americans will be the next wave of foreign students as they escape to greener pastures.

*

Sarah Todd & Lizzy Lawrence, “The ‘GRAS’ loophole lets untested additives into Americans’ food. Can RFK Jr. close it?” STAT, Feb 19, 2025 https://bit.ly/4bppkJ5

One thing RFK Jr could do that most people would go along with is to end the abuse of the FDA’s GRAS (“generally recognized as safe”) rule. This allows food manufacturers to introduce new additives without first receiving regulatory approval—in fact, they don’t even have to tell the FDA what they’re putting in their products. It’s basically “innocent until proven guilty” applied to chemicals rather than its opposite, the precautionary principle, i.e., prove it’s safe before you feed it to people. GRAS has let “thousands of ingredients never reviewed by the FDA to become embedded in the foods Americans eat.” But RFK Jr can’t do much without staff, and his boss just canned 1/3 of the people who review additives. Even though 99% of chemicals now in the U.S. food supply were added without any FDA oversight, don’t expect anything to happen to the “natural flavors” listed on food packages.

*

Anne Hultgren, “How one foundation changed its approach to diversify grant recipient institutions,” STAT, Jan 8, 2025 https://bit.ly/3EVeNJH

The lost spirit of broadening one’s base of beneficiaries, once known as “equity,” scored some successes before being beaten to death in the basement. This foundation head said her institution found itself “perpetuating the concentration of grant funding at elite institutions” and decided to review grant proposals blinded by gender, race, or institutional identifiers. Even applicants’ names were deleted. The result was “a reduction in the relative advantage of applicants from the more prestigious institutions.” Enough of that—elitism is back.

*

Kelly Hooper, “Diet drug boom weighs heavily on state budgets,” Politico, Feb 12, 2025 https://bit.ly/4i6Ellg

“Colorado’s spending on highly effective but costly weight-loss drugs for state workers more than quadrupled last year, and costs are doubling every 6 months. Now, the state wants to scrap the benefit.” A lot of states are in the same boat. They leapt into the fat-shot frenzy with both feet and are now suffering buyers’ remorse. More than 10% of everyone in the U.S. reports taking a GLP-1 drug—how crazy is that? North Carolina and West Virginia have already eliminated coverage. Delaware estimated the cost for its state employees at around $2 million and instead spent $14 million with projections for next year at $53 million. The situation pits state officials against patients and unions while Pharma sits placidly on the sidelines watching the catfights.

*

Matt Stoller, Monopoly Roundup, BIG, Feb 12, 2025 https://bit.ly/439CJmy

“ConEdison is asking to raise its rates on electricity by 11% and gas by 18%. I went through the docket to find out why it needs so much money. A small part of the increase has to do with the company passing along the costs of its workers using Ozempic.” The flood of cash into the fat-shot companies are affecting electric utility rates!

*

Christine Mai-Duc, “Top California Democrats clash over how to rein in drug industry middlemen,” KFF Health News/San Francisco Chronicle, Feb 13, 2025 https://bit.ly/3ESW41n

Drug prices are too high, so California’s Democrats—who rule the state—got ready to do something and passed a bill nearly unanimously. The governor promptly killed it. Meanwhile, drug costs are up 50% in California in the last decade.

*

Adam Feuerstein, “Pfizer CEO Albert Bourla inflicts injury on his company—and all of pharma,” STAT, Feb 24, 2025 https://bit.ly/3DaCb5c

Pfizer snapped up a new employee: former top FDA drug regulator Patrizia Cavazzoni will be its new chief medical officer. This isn’t a revolving door—it’s a particle-accelerator wind tunnel. So much for the MAHA fretting about the Pharma/FDA coziness. “Bourla has just given every pharma-hating, vaccine-doubting person in this country a legitimate reason to further loathe and distrust the industry.”

*

Madeline Ashley, “Massachusetts hospitals face ‘perilous’ dual crisis,” Becker’s Hospital CFO Report, Feb 10, 2025 https://bit.ly/43jjAyv

Massachusetts’ hospitals are in a mess. On the one hand, the meltdown that followed the systematic looting by crooks at Steward Health bankrupted several hospitals in the state; some closed. Meanwhile, the more prosperous units are facing financial headwinds with more than half losing money on operations. (Moi: Why do hospitals have to break even? Why is medicine a commodity?) Paradox: while hospitals are laying off staff to save money, a state-funded study says hospitals have 15,000 unfilled vacancies.

*

Alejandra O’Connell-Domenech, “New York sues major vape companies for targeting kids, teens,” The Hill, Feb 20, 2025 https://bit.ly/4igbLhm

States will take on more regulatory functions as the Feds abandon the field. New York is suing vape distributors for continuing to illegally sell flavored products like Puff Bar and Elf Bar to minors. New York and several other states collected $462 million from Juul in a similar suit.

*

Paul Cuno-Booth, “Some Medicaid recipients would pay premiums under Ayotte’s budget plan,” New Hampshire Public Radio, Feb 24, 2025 https://bit.ly/3QBCDMT

States are following suit and looking at ways to make up for the anticipated Medicaid cuts from Washington: New Hampshire doesn’t currently charge premiums for beneficiaries, but that is likely to change. Parents could start owing 5% of their annual income to keep the children’s coverage. That’s around $3000 a year for a family at the upper end of the eligibility income scale.

*

Kristina Fiore, “Supplemental benefits offer few advantages for MA enrollees,” MedPage Today, Jan 15, 2025 https://bit.ly/3EZezRC

Despite all those bells and whistles that lure people into signing up for Medicare Advantage (MA) plans—dental, vision, and hearing extras, “enrollees didn’t get more care and spent just as much out of pocket as those with traditional Medicare.” A lot of the enrollees don’t use the benefits they have—a major reason for that is that they don’t know about them. “Many MA beneficiaries weren’t aware that they had dental (54.2%) or vision (54.3%) coverage.” Solution: stop paying billions in extra costs to MA plans and use the savings to expand traditional Medicare benefits. This is not hard; won’t happen.

*

See the full archive at www.nypan.org/single-payer-news

SINGLE PAYER LINKS #382

21 FEB 2025

*

Muskrats run amok, crush the civil service, wreck research infrastructure, permanent damage; Medicaid next. Then Medicare, SS? DOGE=Dangerous Oligarchs Grabbing Everything

Listen here: https://www.podbean.com/eas/pb-ixmvi-180f445

*

Dave Muoio, “Department of Veterans Affairs lays off over 1,000 probationary employees, promises reinvestment in care,” Fierce Healthcare, Feb 14, 2025 https://bit.ly/419cCJI

Musk’s minions fire hundreds of staff, then promise improved services. “The 1,000-plus dismissals will free up over $98 million annually, which will be redirected to veterans’ care, benefits, and services.” The Red Queen said it better: “When I use a word, it means just what I choose it to mean—neither more nor less!”

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Lizzy Lawrence, “FDA’s head of device safety among employees terminated in ‘challenging’ weekend,” STAT, Feb 18, 2025 https://bit.ly/42ZBF4r

Who needs a service that reviews Covid tests, hip implants, pacemakers, or other stuff doctors insert? Nah, just shove it in us. PS, Musk has a company testing a brain implant. I’m betting on a wave-through especially if his company is funding its own review (which is a common practice).

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Helen Branswell, “Drug inspectors, AI experts, maternal health workers: Trump’s health agency cuts are far-reaching,” STAT, Feb 17, 2025 https://bit.ly/416XooB

“Thousands of probationary workers across the huge Department of Health and Human Services were summarily fired for ‘poor performance’ even though no one remotely believes any evaluations had taken place.” No pretense of following procedure, just a raw power exercise. Why would anyone fight their way back over an illegal firing to then sit in a hostile environment for years to come? “Among those fired were people who inspect pharmaceutical manufacturing plants.” What, me worry?

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Matthew Herper, “FDA’s former top food official says Trump firings are ‘dismantling’ the division,” STAT, Feb 18, 2025 https://bit.ly/41lRUYj

How will RFK Jr carry out his assault on Big Ag over our nasty food if the very agency that regulates food is “decimated”? The just-resigned head of the division, Jim Jones, said the cuts “imperil the [RFK Jr] agenda,” which he supports. Jones was a key figure in the recent ban of red dye no. 3, a known carcinogen. Of the 29 employees who study chemical additives, nine were canned. How long will RFK Jr stay around if he’s reduced to a rhetorical figurehead?

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Adam Feuerstein, “As outcry builds over Trump cuts to NIH payments, drugmakers are MIA,” STAT, Feb 11, 2025 https://bit.ly/3X7abX8

Pharma “has largely stayed quiet” even though they reap enormous benefits from publicly financed research. The article reveals that they’re not eager to raise their heads above the parapet as early critics of Trump. The industry has opted for “appeasement and behind-the-scenes engagement, hoping to appeal more quietly to [Trump’s] pro-business sensibilities.” A bit odd for an industry that regularly goes off against government policy when their interests are concerned.

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Christopher Morten et al., Gilead’s short-term win threatens the future of pharmaceutical public-private partnerships,” STAT, Feb 12, 2025 https://bit.ly/418Hiel

Here’s a good example: federal money was crucial for discovering how HIV medications could be used as a preventive, the enormously popular and effective PrEP (Pre-Exposure Prophylaxis). The Feds tried to reassert some ownership rights over it, but one of Biden’s last acts was to settle with Gilead and let it keep its billions in profits. We still don’t know if Gilead will have to share a dime. The multiple authors say this could jeopardize future government-Pharma collaborations, but another possibility is that they will continue as they are done now with corporate insiders getting the intellectual property essentially for free.

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Robin Fields, “What a $2 million per dose gene therapy reveals about drug pricing,” ProPublica, Feb 12, 2025 https://bit.ly/3CNSBjY

Here’s another one on public-private partnerships: a family with a child suffering from a rare genetic disease worked tirelessly to raise money for groundbreaking research. The result: a wonder drug, which was promptly seized by their erstwhile doctor BFF and his financier buddies who walk away with hundreds of millions. The family was then unceremoniously dumped by the roadside. The Wall Street guys priced the drug at $2 million a dose, and insurers and government (us) have to pony up for it. Heartbreaking and illustrative. Takeaway lesson: nail down property rights with a good lawyer before giving these people a dime.

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Suzanne B. Robotti, “FDA clinical trial inclusivity guidelines will be back,” STAT, Feb 6, 2025 https://bit.ly/433uTdX

Trump’s new rules against DEI mean you can’t carve out anything special for certain groups such as “women.” That will sustain the historical practice of populating clinical drug trials with white men and then applying the results to everyone. But doesn’t the MAGA movement insist that women and men are different? I guess for the purposes of medical research, they’re exactly the same. How non-binary!

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Stephanie Nolen, “Abandoned in the middle of clinical trials because of a Trump order,” New York Times, Feb 6, 2025 https://bit.ly/4hAm7IZ

“The stop-work order on USAID-funded research has left thousands of people with experimental drugs and devices in their bodies with no access to monitoring or care.” I can’t keep up with the flood of stories of contracted studies getting blown up in mid-stream with no recourse. The idea that it’s “just” for a 90-day review is BS—lots of projects won’t last a month. Trump may have fatally wounded U.S. research abroad: belief in promises originating here is probably destroyed. One senior researcher summed it up: “We have betrayed the trust of ministries of health and the regulatory agencies in the countries where we were working and of the women who agreed to be in our studies who were told that they would be taken care of. I’ve never seen anything like it in my 40 years of doing international research.” Will Pharma react to the end of access to inexpensive study subjects in Africa for their clinical trials?

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Angus Chen & Jonathan Wosen, “Trump policies spark fears of brain drain, threatening to undermine U.S. dominance in biomedicine,” STAT, Feb 12, 2025 https://bit.ly/42XvcHp

“The current political climate is weakening researchers’ resolve to stick with careers in academic science.” Ya think? “Talented young scientists may abandon academic research for jobs in industry or other careers.” Some are looking to go abroad. “There’s a fire sale on American academics right now.”

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Rachael Robertson, “Meet the world’s healthcare billionaires,” MedPage Today, Feb 13, 2025 https://bit.ly/418Q4J0

Six of them are worth a combined $90 billion. No. 1 is Thomas Frist, Jr., co-founder of the Hospital Corporation of America (HCA), net worth: $28.8 billion. His brother was a U.S. senator from Tennessee and Majority Leader during Bush II. I’ve placed this item out of logical order to illuminate the following article.

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Maureen Tkacik, “The DOGE czar’s plan to loot Medicare,” American Prospect, Feb 14, 2025 https://bit.ly/4b8J6Z7

Two of the chief Muskrats/DOGEbags are Brad Smith and Steve Davis. Smith previously ran a rather obscure HHS entity that had a $10 billion fund to experiment with money-saving schemes for Medicare. They spent it on “alternative payment models,” basically varieties of “value-based care” that were the playground of for-profit insurers figuring out how to best feed at the Federal udder. No surprise given that Smith came from the orbit of the Frist family, longstanding champions of extracting wealth from the healthcare industry [see above]. All their pricey experiments showed that value-based care would not save money but would fatten up their corporate friends’ profit lines, ergo, let’s proceed! Tkacik thinks a good $100 billion a year in fraudulent waste could be found in Medicare Advantage overpayments, but professional grifters will have no interest in looking under that rock. Tkacik combines excellent analysis with a wealth of detail and is always worth a read.

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Chad Van Alstin, “Private equity tied to 21% of healthcare bankruptcies for second consecutive year,” Health Exec, Feb 12, 2025 https://bit.ly/3EFV14K

“56% of large corporate bankruptcies in all industries had a history of private equity ownership. Of the eight such filings in healthcare last year, seven companies had a history of private equity ownership.” Private equity is wealth extraction, reflective of a hyper-financialized economy no longer based on producing things but on seizing them.

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Ken Klippenstein, “Government monitoring those with ‘negative’ views of health insurance companies,” kenklippenstein.com, Jan 18, 2025 https://www.kenklippenstein.com/p/government-monitoring-those-with

If you expressed “negative sentiment” about health insurance after the Luigi moment, turns out the government was watching. I guess that would be me! I had immediately texted a friend, “Millions of suspects.” That probably put me on yet another list. Badge of honor!

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Ed Silverman, “What happens when a rare disease drug seems to work, but the health care system doesn’t?” STAT, Feb 5, 2025 https://bit.ly/3X5VLGB

Here’s another bizarre dysfunction in our pharmaceutical payment system: people with rare diseases can get a doctor to prescribe an off-label treatment that seems to work for them. But insurers don’t have to pay for it. When the drug costs $800,000 a year, that means it’s time to die.

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Jim Reed, “Rise of vaccine distrust—why more of us are questioning jabs,” BBC, Jan 15, 2025 https://www.bbc.com/news/articles/c1jgrlxx37do

This type of story consistently devolves into lengthy chin-strokers along the lines of, What is wrong with people? Why don’t they see the obvious Good Thing in front of them? The authors rarely recognize that if people aren’t told the truth, they become skeptical (like scientists). “We’re in this complicated, murky world with public attitudes where some people thought [the vaccines] weren’t what was promised.” Are they wrong? (Biden: You won’t get Covid. Vaccines won’t be mandatory. Walensky: You can’t give it to anyone else.)

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“States absorb increases for sicker Medicaid enrollees after the pandemic,” Associated Press, Feb 10, 2025 https://bit.ly/4b92OEn

Spending is up because people put off medical treatments during Covid. Since states are co-owners of Medicaid and have to shoulder some costs, this further undermines the program. Pennsylvania is looking at a 5% increase in overall state outlays. Making the federal help to boost enrollment during the Covid emergency temporary, then withdrawing it, has made things worse.

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Anna Claire Vollers, “State lawmakers embrace RFK Jr.’s health policies,” Stateline, Feb 12, 2025 https://bit.ly/43lQXkv

Republican state legislators are filing “a flurry of bills” with the usual RFK Jr-like mix of crackpot and sensible, targeting things like fluoride in water, state vaccination requirements, ultra-processed foods in schools, and candy and soda purchases with food stamps. (Always easier to impose new rules on people getting benefits than to slap taxes on the stuff—not even New York ever managed that.) “Many conservatives a decade ago fought then first lady Michelle Obama’s efforts to make school lunches healthier.” But Christians welcome repentance!

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Victor Roy, Victor Amana, Joseph S. Ross & Cary P. Gross, “Shareholder payouts among large publicly traded health care companies,” JAMA Internal Medicine, Feb 10, 2025 https://bit.ly/3QtOvRg

“A large proportion of US health care spending appears to be directed to corporate shareholders.” The numbers are staggering: while governments account for 70% of total healthcare spending, corporations have extracted $2.6 trillion of it in dividends and stock buybacks over the last 20 years. This demonstrates that to provide universal, publicly funded healthcare, we don’t need to spend more, only smarter.

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Eric Reinhart, “Health workers face a stark choice: become collaborators or resisters,” STAT, Feb 11, 2025 https://bit.ly/4gJrRyU

“Do not comply in advance,” says this author, a critic of the rush to obey every outrageous order from above. “Rather than protect their institutions, attempts at strategic collaborationism by hospital and university administrators will only accelerate the destruction of the ideals upon which their organizations are supposedly based. They will also embolden Trump’s attempts to exert yet further control.” He adds that American providers are already conditioned to go along with abuse “after having spent decades normalizing the deadly exclusion of millions of people from care by our for-profit health care system.” Excellent point!

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Charles Piller, “How the ‘amyloid mafia’ took over Alzheimer’s research,” STAT, Feb 11, 2025 https://bit.ly/4gMJHkn and Dennis J. Selkoe, “There is no ‘amyloid cabal’ in Alzheimer’s research,” STAT, Feb 14, 2025 https://bit.ly/3EGa922

A ton of cash has flowed into Alzheimer’s research, but according to Piller you had to join the Church of the Holy Amyloid to get any of it. He means that the field has been dominated by promoters of the amyloid theory of Alzheimer’s causation to the exclusion of others. The theory got a huge boost and hundreds of millions in research funding from a famous 2006 journal article that was later discovered to be based on falsified images (retracted in 2024). The result is a series of treatments that do little or nothing for patients, cost a lot, and carry severe side effects to some users such as “massive cerebral hemorrhage.” Despite this dubious history, a couple of amyloid-sweeping treatments have won FDA approval and are being peddled to unsuspecting families at huge cost to them and us. Conclusion: there’s a lot that could be reformed in the NIH system. Sadly, Trump and the Muskrats decided to use a bulldozer and wrecking cranes to do it. Selkoe, the amyloid-theory enthusiast, rebuts the critique in the same online magazine and says that other theories are getting plenty of exposure and funding. That’s how debates should work, so good for STAT for hosting it.

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Dave Muoio, “Nearly half of rural hospitals in the red, 432 vulnerable to closure, report finds,” Fierce Healthcare, Feb 13, 2025 https://bit.ly/3QpD5Oc

“Inpatient care access has ended across 182 rural communities since 2010 due to either closures or transitions to other models such as long-term care or Rural Emergency Hospital designations.” Another 400 are teetering, and nearly half of all rural hospitals are operating at a loss with the median operating margin is 1%. Meanwhile, urban “nonprofits” like New York Presbyterian can pay their CEO $8 million a year. The 2% Medicare cut scheduled for this year will slash another $500 million from rural hospital revenues. Will the Republicans who overwhelmingly represent these rural districts react or lie down and roll over?

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J. Emory Parker, “STAT is backing up and monitoring CDC data in real time,” STAT, Feb 14, 2025 https://bit.ly/3QoHm4p

An alert technie scooped up 112 GB worth of data from the CDC’s website before Trump’s marauders had a chance to erase it. “As rumors began swirling near the end of January that federal websites would be taken down entirely, we downloaded and archived all available files from data.cdc.gov.” The word “gender” was the main target of the purge along with youth-focused survey data. Now it’s safe—quick thinking!

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Gregg Gonsalves, “When ‘just asking questions’ about science turns into 300,000 dead,” New York Times, Feb 13, 2025 https://bit.ly/411z7jH

The author saw first-hand how a steady, multi-pronged mass movement finally overturned AIDS denialism in South Africa and opened the door to a massive program to provide HIV-suppressing drugs to very poor people. He anticipates we’ll need something similar to combat the dangers of an RFK Jr. reign of error at HHS, including his “flirtation with the rejection of germ theory.”

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See the full archive at www.nypan.org/single-payer-news

SINGLE PAYER LINKS #381

14 FEB 2025

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Topics: the DOGE invasion; Medicaid on the chopping block; a wrecking ball slams into medical research; chaos takes many forms. It’s difficult to keep up with the news, so I am trying to focus on trends rather than chasing after specific events that change 24 hours later. The annotated links here are a fraction of the material pouring in. —Tim

Listen here: https://www.podbean.com/eas/pb-ajn3i-17f9221

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Matt Stoller, “On ending the Consumer Financial Protection Bureau,” BIG, Feb 9, 2025 https://bit.ly/411t66S

Among the lesser-noticed acts by the Musk commissars was pulling the plug on the CFPB, established after the financial crash of 2008–09 to save the banks from themselves. Banks fought it tooth and nail, and now they got their wish—it’s dead. Stoller: “We can now expect rampant fraud and cheating in banking and fintech, regular losses of life savings by people, illegal foreclosures, random seizures of the working capital of small businesses, abuse by debt collectors, and routine deception by even respected financial firms.” Sounds like banker heaven, right? Hold on: “Elon Musk’s stated goal with X is to create an ‘everything app,’ which you would use to communicate, engage with social media, pay for things, hail cabs, shop, and so forth. The CFPB was proposing to treat these companies with payment systems as, well, payment systems and subject them to the same supervisory treatment that banks have. Now that’s out the window, so big tech firms have a competitive advantage over banks.” Stoller is saying that the banks have now set themselves up for cutthroat competition that they will lose. While we’ll all be subject to bank runs, hidden fees, scams, and losing our shirts just like in the good old 1930s, the breakdown will also enable Musk & Co. to hand Jamie Dimon his ass. Healthcare, now nearly one-fifth of the economy and increasingly involving big finance, will not escape.

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Dan Diamond, Lauren Kaori Gurley, Lena H. Sun, Hannah Knowles & Emily Davies, “DOGE broadens sweep of federal agencies, gains access to health payment systems,” Washington Post, Feb 5, 2025 https://bit.ly/4gFSWCW

At first, we heard assurances that Musk’s teenagers did not have admin rights at the huge federal databases, but it turns out they did at least temporarily—by “accident.” A reported 40,000 federal workers quickly took the supposed buyout/retirement packages dangled in front of them, but since the legality of all these moves is so fuzzy, I wonder if Trump/Musk will really have to honor the terms. Putting one’s faith in promises from Donald Trump has not historically been a wise business decision.  

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Eloise Goldsmith, “Medicaid work requirements could boot 36 million people off their health coverage,” Common Dreams, Feb 7, 2025 https://www.commondreams.org/news/republicans-work-requirements-36-million

The great Medicaid Kick-off that began under Biden could get supercharged, starting with a green light for adding work requirements to eligibility tests. Nearly half (44%) of all Medicaid enrollees are at risk. The fact that two-thirds of adults on Medicaid already work and most of the rest are disabled, in school, or caring for family members doesn’t stop states like New Hampshire, Arkansas, and Georgia from imposing new and useless red tape that will stealthily cut the beneficiary rolls. The work requirement was part of Project 2025’s blueprint for Trump II and reinforces the idea that healthcare is some kind of “welfare” only due to the virtuous.

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Hugh Cameron, “Florida removes 1.3m people from health care plan,” Newsweek, Feb 9, 2025 https://bit.ly/41eO4k0

The end of Covid-era emergency Medicaid expansion led to a million Floridians losing their health insurance so far. The disenrollment rate in Florida (38%) is one of the highest in the country. Over half of those kicked off their insurance were terminated for procedural reasons while still eligible. Nationwide, about 25 million people lost their Medicaid coverage, and only 10 million got it back. That’s before Trump gets started looking for quick cash to pay for more tax cuts.

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Anna Claire Vollers, “Health insurance for millions could vanish as states put Medicaid expansion on chopping block,” Stateline, Feb 10, 2025 https://bit.ly/3CATPir

Republican lawmakers in several states are taking aim at Medicaid expansions. Legislators in Idaho want to repeal a voter-approved (by 61%) Medicaid expansion; Montana is considering allowing the state’s Medicaid expansion to expire. Nine states already have trigger laws to automatically cut Medicaid if Congress reduces the federal contribution—which Trump is threatening to do. Most citizens of these states want to preserve the expansion, but who cares what the people think? Repeals are being promoted by conservative think tanks/lobbyists such as the Foundation for Government Accountability and the Paragon Health Institute.

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Hafiz Rashid, “House GOP reveals plan to devastate Medicaid and food stamp programs,” Yahoo News, Feb 12, 2025 https://bit.ly/3QlmAm8  

Speaker Johnson’s preliminary budget plan released Wednesday mandates a whopping $2 trillion spending cut. Where are they going to find all that money? “While the text doesn’t mention Medicaid by name, it directs the Energy and Commerce Committee to cut $880 billion in its budget, which is near impossible to do without touching the health care program.” Another $230 billion is supposed to come out of Agriculture, meaning food stamps (SNAP).

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Adam Cancryn, “DOGE working with two Trump health appointees to examine Medicare and Medicaid books, Politico, Feb 7, 2025 https://bit.ly/41bilQu

If Musk is keen on cost-cutting at HHS, it’s curious that among Trump’s top appointees there are pharmaceutical lobbyist Kim Brandt and Rebekah Armstrong who spent 3 lucrative years at AHIP, the insurance industry’s trade association. Providing healthcare to the poor and elderly is a “cost”; enriching bloated corporations spending billions on stock buybacks isn’t.

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Jaymie Baxley, “Successful rural county health program could go statewide—if politics don’t get in the way,” North Carolina Health News, Feb 6, 2025 https://bit.ly/4hPp3RJ

An innovative rural program helps people with “nonmedical health needs” like food, rides to doctor’s appointments, and housing (a key need in hurricane-affected NC). If the GOP bosses don’t like giving people medical care, they’re going to really hate free taxis to the clinic. Although the initiative saved money overall and NC wants to expand it, the program, unsurprisingly, isn’t safe. NC got a waiver to sustain it through 2029, but budget cuts from Washington could force the state to absorb more costs or simply kill it.

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Stephanie Armour, Sam Whitehead & Julie Rovner, “Washington power has shifted. Here’s how the ACA may shift, too,” KFF Health News, Nov 22, 2024 https://bit.ly/3QfpkBz

Trump I included a promise to repeal the ACA, which failed. But House Speaker Johnson now says the ACA needs “massive reform.” How might Trump II go about weakening it? Further Medicaid expansion is now unlikely, and expansion states could see a big jump in costs (further discouraging non-expansion states). Premium subsidies for Obamacare exchange policies could end, tossing millions back onto the lists of uninsured. Minimum requirements for health insurance could be weakened (again), permitting the proliferation of cheap junk plans. Government lawyers could stop defending the law in courts against insurance companies violating it.

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Kiera Butler, “I’m appalled at the silence from the American Medical Association,” Mother Jones, Feb 4, 2025 https://bit.ly/4hNk1pr

The AMA has been curiously silent about the assault on medical research, RFK Jr’s nomination, the WHO pullout, immigration raids in hospitals, and of course the murder of doctors and nurses in Gaza. (But it did have plenty to say about Ukrainian hospitals <https://bit.ly/3WWLcW5>, a denunciation that aligned it with U.S. foreign policy.)

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Noah Tong, “‘Biggest data breach in history’: Labor unions sue Trump admin over Treasury takeover, with healthcare privacy impacts far-ranging, Fierce Healthcare, Feb 5, 2025 https://bit.ly/3QcHmo3

One arena of pushback involves the privacy implications of Musk’s invasion of government IT systems. Two government labor unions and an advocacy group sued Musk and his Hardy Boys for breaking into the nation’s payment infrastructure. AFGE and SEIU along with the Alliance for Retired Americans say Musk got access to their members’ bank account information, home and email addresses, and telephone and Social Security numbers. Musk-owned companies now have access to a vast trove of data that competitors at Amazon and Google can only dream about. That’s in addition to the Musk team’s power to access and (re)write code on the payment system responsible for more than a fifth of the U.S. economy.

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Jonathan Wosen, Megan Molteni, Jason Mast & Usha Lee McFarling, “NIH plans to slash support for indirect research costs, sending shockwaves through science,” STAT, Feb 7, 2025 https://bit.ly/42WO8Gl

Big research universities take a huge percentage of their employees’ NIH grants for things like buildings, labs, supplies, and the personnel infrastructure to run it all. Trump pointed to private foundations only allowing 10% for indirect costs, but that’s because those grants go to places that already have NIH money covering the basics. The biggest beneficiaries probably overdo it: Harvard’s indirect cost rate is 69%, Johns Hopkins’ 63%, Children’s Hospital of Philadelphia 75%. (I think Columbia’s was 56% when I worked there.) Cutting them off by EO is probably illegal, not that that will stop anybody. “Since 2017, the annual [NIH] spending bill has included language that prohibits changes to indirect cost rates.” Project 2025 demanded this change based on culture war grounds because indirect costs allegedly subsidize “leftist agendas.”

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Carrie Wolinetz, “Indirect research costs are complicated, wonky—and crucial to science,” STAT, Feb 8, 2025 https://bit.ly/41bGvKz

After 20 years in research, “there is no issue I hate talking about more than indirect costs.” They’re boring, wonky, and complicated, managed by “obscure federal agencies most people have never heard of, like the HHS Division of Cost Allocation.” All of which makes them an easy target for demagogues. Suddenly imposing an abrupt cap on these rates Trump-style “is just like you putting the costs of a business trip on your personal credit card only for your employer to decide they are not going to reimburse you for those expenses.” While the issue works its way through courts, biomedical research is being kneecapped. The surprise attack will probably drive the rates down without the bother of a lengthy negotiation process with Congress.

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Scott Turner, “Katie Britt vows to work with RFK Jr. after NIH funding cuts cause concern in Alabama,” AL.com, Feb 8, 2025 https://bit.ly/40Rpa8B

Like rain falling on both the godly and the impious, Trump’s blitzkrieg hits red and blue states alike. Because Birmingham is a huge healthcare/medical research hub, Alabama’s junior senator is nervous and calls for “a smart, targeted approach” to dismantling gummint. English translation: cut those northern elite schools, not ours! UA Birmingham is among the top 30 recipients of NIH funding and the largest employer in the state. Ouch.

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CHAOS-FREEZE

Marcia Brown, “USDA pauses 2 organic programs, leaving farmers on the hook for millions,” E&E News by Politico, Feb 6, 2025 https://bit.ly/4jNBejX

“Federal officials are continuing to withhold money for a pair of major organic agriculture programs that make payments directly to farmers, jeopardizing millions of dollars in crucial funding just ahead of planting season.” Hard to imagine anyone trusting government grant programs ever again after seeing people invest millions based on promises—or even contracts—from the USDA or any other agency that can be peremptorily yanked. “Even if the pause on funding is lifted, it could put farmers out of business.”

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CHAOS-FREEZE

Apoorva Mandavilli, “Foreign aid freeze leaves millions without HIV treatment,” New York Times, Feb 5, 2025 https://bit.ly/3EBs6i4

Bush II brought out PEPFAR to bring affordable AIDS drugs to Africa as a way to revive America’s reputation after the Iraq war. Now that we don’t care what the world thinks, no need to keep all those dark-skinned people alive, including the 20 million people dependent on the USAID-managed program. Rubio issued a waiver to the freeze for “lifesaving medicines” but did not mention PEPFAR, then accused the administering agencies of sabotaging it. “The stop-work orders compelled each program to cease immediately. . . they cannot proceed on the basis of a general memo.”

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CHAOS-FREEZE

Alex Guillén & Annie Snider, “EPA puts 168 staffers on administrative leave,” Politico, Feb 6, 2025 https://bit.ly/3WVdnEQ

Forget “environmental justice” at the Environmental Protection Agency. All those polluted communities where nonwhites and poor people live can just breathe deeply and suck it up. The EJ office was barely 2 years old.

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CHAOS-FREEZE

Jessie Hellmann & Sandhya Raman, “Community health centers caught up in funding freeze,” Roll Call, Feb 6, 2025 https://bit.ly/42TjJIK and Shannon Pettypiece & Bracey Harris, “Health clinics face cuts, closures as Trump's funding fight ripples outside of Washington,” NBC News, Feb 6, 2025 https://bit.ly/3EzmDsa

Despite officials saying all is well or soon will be, “Across the country, health clinics and nonprofit organizations largely serving rural and low-income patients have found themselves unable to access previously allocated federal funds. Many grant programs, including Head Start and Title X, continue to experience financial shortfalls despite an injunction issued against the freeze.” These are awarded grant monies, i.e., signed agreements that the clinics are fulfilling. But they’re not bankers blowing up the financial system, so the contracts don’t have to be honored. 

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CHAOS-DEI

Anil Oza, “Researchers ‘stunned’ after HHMI abruptly cancels program to make science more inclusive,” STAT, Feb 6, 2025 https://bit.ly/4hu0x8U

Times change, and private philanthropy bends like a wind sock. The Howard Hughes Medical Institute, the nation’s largest private funder of biomedical research, “abruptly ended a $60 million program aimed at improving the retention of a diverse student body in STEM programs.” Just 3 years ago, HHMI said it would pour $2 billion into “inclusion and equity” programs in over 100 institutions. So much for the idea that major charities will step in to cushion government austerity moves. “All mention of the program was immediately removed from HHMI’s website.” What rank cowardice.

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CHAOS-TARIFFS

Joseph Choi, “The US relies on China for key medicines. They won’t be spared from tariffs,” The Hill, Feb 8, 2025 https://bit.ly/41avitK

China produces a lot of the drugs we take, including the generics that account for 91% of prescriptions dispensed in the U.S. Profit margins are “razor-thin,” and the added 10% tariff could screw up the supply chain, which operates on a just-in-time basis.

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CHAOS-TARIFFS

Dave Muoio, “Hospitals ask Trump to exempt medical, pharma products from tariffs,” Fierce Healthcare, Feb 5, 2025 https://bit.ly/41ceJhh

The hospital lobby is petitioning President Donald Trump to spare medical devices and drugs from the tariff punishment. They first tongue-bathed the new prez (“We commend your focus on this issue”) before begging to be spared. Hospital costs could surge another 15%. Get ready for a hefty premium increase!

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CHAOS-VACCINES

Amy Maxmen, “Measles outbreak mounts among children in one of Texas’ least vaccinated counties,” KFF Health News, Feb 7, 2025 https://bit.ly/3EAXI7u

Measles is spreading in a Texas county. In one district only 46% of kindergarten students got their shots. Meanwhile, a school board in the Houston area voted to remove references to vaccines in its curriculum.

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CHAOS-VACCINES

Sarah Boden, “House cats with bird flu could post a risk to public health,” KFF Health News/NPR, Feb 10, 2025 https://bit.ly/3QfOxfu

Oh great, murder-suicide by cat: “More than 80 domestic cats have been confirmed to have had bird flu since 2022” though they are mostly barn cats. “Companion animals, and especially cats, are 100% a public health risk in terms of the risk of zoonotic transmission to people,” said a virologist although H5N1 remains “pretty rare.” Cautionary advice includes not feeding raw food or milk to your furry friend.

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Mark J. Ratain, “U.S. taxpayers should stop funding clinical trials of industry-owned drugs,” STAT, Feb 4, 2025 https://bit.ly/4hw58HT

Now that the profits from cancer drugs have exploded ($200 billion a year worldwide), there’s no reason to use public cash to test industry-owned drugs, which is most of what gets studied. This is a no-brainer, not to mention that many of the expensive new drugs we’re paying to test aren’t that much better than the ones they replace.

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Robert P. Charrow, “A bold experiment: Let’s bribe West Virginia to reduce its obesity rate,” STAT, Feb. 3, 2025 https://bit.ly/3WZrzNo

Obesity is terrible and expensive. Therefore, says this Trump I official, let’s experiment with letting a particularly obese state—West Virginia—get a tax break for slimming its children. Charrow calls his program “No Child With a Behind Left.” Already, I’m for it.

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Ron Harman King, “Big tech moves to make Americans uninformed and unhealthy,” MedPage Today, Feb 7, 2025 https://bit.ly/3WYLXOF

While Trump’s government is axing forbidden terms from public discourse (not to mention funding), the newly anti-woke tech sector is imposing its own version of censorship. King’s marketing and consulting firm found its regular advertising rejected by search engines for mentioning human reproduction, birth control, in vitro fertilization, or vaccines. Keywords were removed for “72 reproduction-related search phrases we’ve tried using.” King might now understand the importance of antitrust action.

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M. Gregg Bloche, “We are all complicit in the big lie of health insurance,” STAT, Feb 5, 2025 https://bit.ly/40X9G2Z

The author says we know insurers engage in healthcare rationing and demand it in the name of “cost-containment,” but then we don’t like the inevitable results. “These practices meet a need we insist upon but are loath to admit—for limits on health spending.” But he doesn’t question where the huge costs are coming from and how intermediaries inflate them.

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Jerome Adams, “America needs a better discourse on DEI,” STAT, Feb 4, 2025 https://bit.ly/3CYN6ia

“Every one of us embodies diversity in some form—be it gender, age, disability, geography, military status, or socioeconomic background. Should we stop collecting data on breast or prostate cancer because it means directing resources based on gender?” The former surgeon-general seems nice: he calls for “meaningful discussion,” nuance, and compassion, which prompts a question: What planet is he living on? That train left the station a while ago.

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See the full archive at www.nypan.org/single-payer-news

SINGLE PAYER LINKS #380

7 FEB 2025

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This week there’s more on RFK Jr, the immigration raids and their impact on healthcare, and the usual litany of system collapse indicators. I’m encouraged by how much the dysfunction is becoming clearer to anyone paying attention.

Listen here: https://www.podbean.com/eas/pb-xamf7-17eb48c

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Rachel Cohrs Zhang, Sarah Owermohle & Isabella Cueto, “The 7 big topics RFK Jr. addressed during a fiery confirmation hearing,” STAT, Jan 29, 2025

RFK Jr flunked his orals but passed anyway. In any case, the confirmation process was illuminating. Despite his long-standing discourse about our awful food supply, he had nothing concrete to offer about how to fix it. He also had no idea how Medicaid and Medicare are financed, could barely tell them apart, and thinks Medicare Advantage is great because he personally hasn’t had any problems. He knows less about the system he’s about to run than your grandma.

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Isabella Cueto, “Analysis: In confirmation hearing, RFK Jr. diagnoses a nation’s health ills but fails to prescribe remedies,” STAT, Jan 29, 2025 https://bit.ly/3EqbTfE

RFK Jr had “no concrete details on how he would tackle the nation’s chronic disease epidemic.” Given that this was the big selling point that encouraged people to overlook his crackpot theories, his non-existent plans for how to MAHA is quite an indictment. “Kennedy stumbled through recycled statistics before mentioning U.S.-specific food additives and chemicals used during farming” and called for more research on them. That’ll be hard with the government’s research apparatus shut down.

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Jessie Hellmann, “Trump’s immigration plans could imperil long-term care workforce,” Roll Call, Jan 9, 2025 https://bit.ly/4gpAuhZ

Thousands of nursing home and personal care workers are recent immigrants, some citizens, some legal residents, some undocumented. There’s already a shortage. 

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Anushka Bhaskar, Aaron S. Kesselheim & Daniel Carpenter, “How to protect HHS, FDA, NIH, and other health agencies from political interference,” STAT, Jan 31, 2025 https://bit.ly/3EAg7kI

You mean like the political and commercial interference that they’re under now, i.e. long before Trump? Yes, Trump made things worse, but Americans have good reason to mistrust the public health establishment and specifically the FDA based on looking at the evidence of their past behavior. That’s actually pretty “scientific” of us. For example, “By September 2020, several states announced they would establish their own independent vaccine review panels. Most had Democratic governors, who suggested that they did not trust the federal government under Trump. The National Medical Association, representing Black physicians, created a separate task force to vet FDA decisions—an unprecedented vote of no confidence in the agency’s independence from political influence.” The authors propose better protections for whistleblowers, but that train left the station a while back except for anti-DEI campaigners. The first step in addressing “political interference” is to recognize how both camps enthusiastically practice it. Lab-leak theory anyone?

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Sara Gorman, Heather Lanthorn, Kenneth H. Rabin & Scott C. Ratzan, “‘Safe and effective’ is FDA-speak. It’s time to put it to bed,” MedPage Today, Jan 28, 2025 https://bit.ly/3Q3dkTO

Vaccines have become a hard sell because of distrust of big companies and the invisibility of success (not getting sick). The authors argue that repeating that they’re “safe and effective” no longer cuts it. People hear “government gobbledygook from a distant bureaucracy.” Ergo, say the authors, we need to explain things more fully. Fine, but when we need 95% compliance for efficacy—which is the generally accepted threshold for vaccines—patient persuasion to nudge millions of parents along won’t get us there. The authors, who jointly founded the Council for Quality Health Communication, clearly weren’t consulted during the Covid debacle. They recommend “being open about what we don’t know.” Too late! That’s exactly what didn’t happen. The damage will take decades to repair after we recognize error—which hasn’t happened yet.

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Jeanne Lenzer & Shannon Brownlee, “Big Pharma is pushing potentially deadly Alzheimer’s drugs,” Jacobin, Feb 1, 2025 https://bit.ly/40Zurw2

This is a harrowing account of how Pharma and the FDA have pushed Alzheimer’s treatments on a desperate public that (a) probably don’t work and (b) frequently kill and maim users. Severe cerebral inflammation is a byproduct of all of them, and alleged evidence of their effectiveness in slowing symptoms is dubious at best. Read the whole article if you have a relative contemplating taking Leqembi or Kisunla. Asked for a comment in this article, one of the companies peddling the drugs called theirs “safe and effective.” Where have we heard that?

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Katie Dangerfield, “From hearing aids to pacemakers, tariffs may drive up medical device costs,” Global News, Jan 31, 2025 https://bit.ly/4aKo4Qk

Medical equipment has typically been exempt from tariffs between Canada and the U.S. since NAFTA. That includes MRI machines, ventilators, wheelchairs and the like. If Trump makes them more expensive, we’ll be nostalgic for those mere 5% annual premium increases.

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Daniel Zingale, “What I learned about health insurance rage as the nation’s first ‘HMO czar,’” STAT, Jan 30, 2025 https://bit.ly/4aKYiLO

Zingale was the first director of California’s Department of Managed Health Care, formed in response to public anger over HMOs. He says they made the for-profit outfits do better on denials and other procedures but still fell short. “We succeeded over and over. Things got better for many California HMO patients, and public anger simmered down.” Where did they fail? Zingale says they didn’t address price gouging in hospital systems and doctors’ groups, didn’t act on surprise ambulance bills, and ignored “mergers and other anti-competitive practices that boxed out nonprofit health care providers.” He concludes: “We need a more profound regulatory overhaul that takes on any entity that puts profits before people’s health.” But that’s the underlying business model, which better oversight can’t and won’t transform.

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Jakob Emerson, “‘We’re going to have to fix this ourselves’: 5 CFOs on navigating Medicare Advantage,” Becker’s Hospital Review, Nov 13, 2024 https://bit.ly/3EAbvLn

The reporter asked five top hospital administrators what they were doing about MA plans’ administrative hurdles like prior authorization denials and payment delays. Some are canceling MA contracts, but most are slugging it out. The underlying realities aren’t encouraging: “We no longer have a growing commercial population to offset the [Medicare] losses, and more people are moving into MA. Medicare isn’t profitable. No one is tackling this problem head-on.” Conclusion: a market-based, for-profit healthcare system cannot fix the problems it creates.

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Samantha Liss, “Indiana governor appoints business leader to shake up health care,” KFF Health News/Governing, Feb 4, 2025 https://bit.ly/3Q6qAHh

Indiana is a bright red state that discovered that “the free-market approach of limited government intervention, long favored by the GOP, doesn’t work with health care.” The governor has put a lady into a newly created post in charge of getting prices down further, building on her work as a small business leader. Indiana once was the most expensive state in the country for hospital care but took action to improve transparency and block monopolistic mergers. “Health care isn’t like a grocery store,” says the new appointee. Would be interesting if resistance to job-killing healthcare costs finally emerged from the business sector more widely. Indiana now dropped to ninth most expensive place in the U.S., and its new governor is joining the wave of actions against PBMs.

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Paige Minemyer, “Moody’s downgrades insurers’ credit outlook to negative amid ongoing cost pressures,” Fierce Healthcare, Feb 3, 2025 https://bit.ly/4114NXO

Moody’s, the bond rating agency, turns bearish on insurance: “Premium increases are not likely to offset the increase in spending, especially given competitive pressures around contract negotiations with providers in the commercial market.” So, profits will come down further. Also, “Further push into value-based models and digital solutions will also be a driver of a more stable credit outlook.” English translation: when insurance companies get a lump sum per patient, it’s easier to deny them healthcare and keep more of the loot.

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Christopher McGowan, “I no longer think GLP-1s are the answer,” MedPage Today, Jan 30, 2025 https://bit.ly/3CBsZXd

McGowan, an obesity doc, “shared the excitement” around the fat shots (Ozempic et al.), but now he’s having second thoughts. He’s worried about “what happens to the body and mind when these medications are discontinued?” That’s an important question since ¾ of everyone who starts the shots stop them within 2 years. Many then regain much of the weight lost; some end up cycling on and off the appetite inhibitors. No one knows what the long-term health effects will be—although we can already guess at the long-term fiscal impact.

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Kristen Monaco, “Most ditch GLP-1 drugs for weight loss within a year,” MedPage Today, Jan 31, 2025 https://bit.ly/3WKUYKW

The reasons: side effects, cost. Over half dropped the drugs before 1 year; median duration of treatment was about 6 months.

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Andrea Mazzarino, “American the unwell: The corporate greed threatening our stability,” Informed Comment, Aug 21, 2024 https://bit.ly/3EnryMx

The author is a shrink serving military families but turns away dozens of new clients every month “because I can’t afford to lose more time and income dealing with the complications of their insurance. I then wonder what will happen to that suicidal three-times-deployed Afghanistan and Iraq veteran with young kids at home.” But thank you for your service!

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Lauren Sausser, “Across the South, rural health care has become ‘trendy.’ Medicaid expansion has not,” KFF Health News/Daily Yonder, Feb 3, 2025 https://bit.ly/412wmQA

“If rural health was profitable, we wouldn’t have a rural health problem.” Correct, which means that talk of finding a market-based solution to it is hot air. As a substitute, various charitable efforts arise. “Clemson [SC] Rural Health attempts to fill this gap by providing primary care, cancer screenings, nutrition education, and diabetes management for uninsured patients free of charge or at reduced rates.” Great, but what if you need surgery or get into a car crash? Georgia and Tennessee are spending a measly $81 million on a variety of rural health initiatives, “prompted by a wave of rural hospital closures—more than 100 since 2010.” Medicaid expansion would have made a real dent, but now that Trump is threatening to reduce the 90% federal subsidy of the increased costs, the holdout states aren’t likely to change their minds. One pol explains that conservative lawmakers often consider projects such as building new rural clinics more “politically palatable” than expanding Medicaid coverage. Sure, they can cut ribbons on buildings and then ignore how people are supposed to paying for using them.

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Julie Appleby, “Most insurance cover IUDs. Hers cost more than $14,000,” KFF Health News/Washington Post, Jan 31, 2025 https://bit.ly/3QqpKFD

This week’s billing horror story: a woman asked about any in-network costs for her IUD and was told they are “almost universally covered under insurance.” Almost is doing a lot of work there. The Final Bill: $14,658 for a 10-minute procedure. No one told her that because her plan pre-dated Obamacare, the insurer wasn’t required to provide contraceptive services. She ended up paying over 5 grand.

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Paige Minemyer, “Express Scripts takes new steps to improve transparency, address affordability,” Fierce Healthcare, Jan 30, 2025 https://bit.ly/4gwjnLt

Time for the PBMs to act fast since everyone hates them, even Trump. Cigna, owner of Express Scripts, must be getting plenty nervous. Its PBM “will provide patients a personalized summary of annual total prescription drug costs, including medication prices, negotiated savings inclusive of discounts and rebates, plan paid amounts, and total savings.” So, they admit that their behavior in the past was secretive and opaque—why were they hiding all that basic information before?

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Bruce Japsen, “Amazon’s One Medical partners with New York’s Montefiore health system,” Forbes, Jan 29, 2025 https://bit.ly/3WNC9qH

Bezos’ Godzilla now has deals with the Cleveland Clinic, Emory Healthcare in Atlanta, Mass General Brigham in Boston, and now Montefiore in suburban New York’s Westchester County. Why is Amazon expanding while other retailers like Walgreens and CVS Health are struggling with their direct medical services? One explanation: Amazon One Medical forms partnerships with “more established players in the markets it is entering.” Next expansion plans: New Jersey and Northeast Ohio beyond Cleveland.

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Robert Kuttner, “Mass General’s growth comes at expense of affordable health care,” Boston Globe, Jan 11, 2025 https://bit.ly/4jJQdeC

An excellent case study in the irrationality of organizing healthcare through markets. “The deliberate expansion of large health care systems maximizes their market power to increase bills to private insurers, Medicare, the Commonwealth, and patients.” Mass General/Brigham and Beth Israel Lahey Health are both on a merger/expansion binge as well as gobbling up physician practices to maximize referrals. This makes business sense: the two giants can now negotiate with payers more effectively. It also undermines the health of Bostonians. “Some 1,600 patients are taking up acute care beds in Boston area hospitals awaiting discharge to rehabs or home health care. Is that because Massachusetts is short of beds? Yes and no. What it has are too few beds in the right places.” There are not enough rehab beds because of the lousy reimbursements for those services. “In other words, the system spends too much money on the costliest parts and not enough money on the most cost-effective parts. There is no central health planning agency, no policy coordination, and no single spigot of money.”

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Phil Tenser, “Hospitals say Steward demanding millions more for essential IT services,” WCVB, Jan 31, 2025 https://bit.ly/4hMILh8

Steward Health Care, the poster child of PE-induced hospital looting, is still at it: “The company is threatening to cut off medical record and billing services unless the new owners pay millions of dollars more than previously agreed.” The bankruptcy agreement said Steward couldn’t do that, but they are anyway. Grifters gotta grift.

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Jonah Valdez, “She exposed a prestigious medical journal’s silence on the holocaust. Now she’s asking about Gaza,” The Intercept, Oct 17, 2024 https://bit.ly/4hnqKpv

The top-rated New England Journal of Medicine just published a mea culpa about how it ignored Nazi atrocities like racist health policies, mass killings, and medical experimentation when it could have mattered. So, how do they deal with those taking place today? The author asked why the journal has said nothing about Gaza. Since The Intercept doesn’t include an answer, we can assume there wasn’t one.

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IM Doc, [comment to its Water Cooler column], Naked Capitalism, Feb 5, 2025 https://bit.ly/4hOkhDR

This regular commenter on medical and scientific issues responded to a discussion about where to get reliable technical information on the latest research. He attends rigorous journal clubs weekly in which experts delve into the weeds on published studies, their study designs, statistical methods, and conclusions. Here’s what he says about the New England Journal of Medicine (and holds true for other “top” journals in his opinion):

“Articles from NEJM are skewed heavily to new Pharma items that have not been tested well, the research indicates they are not tested well, and the articles are clearly written by Pharma ghost writers. Invariably, when these interventions finally come out, they are hideously expensive, therefore unusable in our climate today, and often come with lots of problems (the safety part of the research is laughable). Their review articles and case studies are now at a kindergarten level. I am a subscriber to NEJM [out of] a kind of duty to the past. It has become a legacy joke. The NEJM brand, like so much else in our society, has besmirched itself and no longer has the caché it once had. The only ones quoting it now are usually outlets like the NYT in an attempt to mislead their audience with propaganda. It really is quite sad.”

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Kate Wells, “After Congress ended extra cash aid for families, communities tackle child poverty alone,” Michigan Public/KFF Health News, Nov 14, 2024 https://bit.ly/4hltjZp

Rx Kids gives Flint residents $1,500 mid-pregnancy, and $500 each month for the baby’s first year, no strings attached. Every baby is eligible—it’s not means tested. Many other [civilized] countries, including Austria, Belgium, Canada, France, Germany, Ireland, Norway, Sweden, and the U.K., already offer a child cash benefit. So did the U.S. during the coronavirus pandemic: “hundreds of dollars per kid in direct, monthly payments for 6 months. Child poverty dropped.” But why preserve something that works? People might get ideas. The state of Michigan came up with Rx Kids as a replacement for selected cities, but each community has to raise millions in matching funds. Not all can.

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Jane Smith-Rogers, “The damage to federal medical research is already done,” Wired, Jan 31, 2025 https://bit.ly/3Q5YbB5

“Clinical trials may have to be scrapped, research applications will be pushed back, and unpaid researchers will quickly leave the sector—even if the Trump administration’s funding pause is only temporary.” The nation’s research apparatus is slow-moving and highly technical; such a blanket freeze is unprecedented. Merit-based competitive grantmaking looks to be permanently politicized in new ways. One immediate effect: a brain drain as early-career researchers just give up and look for something stable. “This chaos does not portend well for the future of the United States as a pinnacle of scientific excellence.”

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See the full archive at www.nypan.org/single-payer-news

SINGLE PAYER LINKS #379

31 JAN 2025

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Trump II seemed so focused and prepared compared to Trump I, but then Trump-id took over. The slash-and-burn approach is likely to backfire though who knows these days.

Apologies for an unusually fat set of links this week—and I left out plenty more. —Tim

Listen here: https://www.podbean.com/eas/pb-fj48c-17dd8df  I think it's fixed! 

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Angus Chen, Usha Lee McFarling & Jonathan Wosen, “Researchers reel as Trump administration moves quickly to cut funding and end DEI health programs,” STAT, Jan 27, 2025 https://bit.ly/3EeNbih

Abrupt contract terminations are hitting federally financed projects of all sorts. One at Northern Arizona University helped Native American students to embark on careers in science and medicine. Trump is also wrecking ongoing studies that purposefully recruited “diverse” populations to get better impact data. Since the term DEIA (diversity, equity, inclusion, and accessibility) is not defined in the executive order, no one knows if special attention to groups like rural white Americans, veterans, or the disabled are also forbidden as racist/woke/whatever. 

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Amy Maxmen, “The growing inequality of life expectancy among Americans,” KFF Health News/ABC News, Jan 22, 2025 https://bit.ly/4gg8LQO

Speaking of Native populations, life expectancy among those in the western United States has dropped below 64 years, on par with the Democratic Republic of the Congo and Haiti. Asian-Americans get on average 20 additional years, comparable to Japan and Switzerland. About 1 in 5 Native Americans in the Southwest don’t have health insurance. But we can’t do anything special for them because that would be unfair to people in Kentucky. Or something.

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Stephanie Armour & David Hilzenrath, “Junk food turns public villain as power shifts in Washington,” KFF Health News, Jan 20, 2025 https://bit.ly/4hyi5An

There sure is plenty of talk about the need to regulate junk food, fast food, and ultra-processed food. But simultaneously, Trump is cutting a swath of destruction through the regulatory apparatus. Is there really a chance for warning labels, changes to agribusiness subsidies, or limits on what you can buy with food stamps? “It’s likely to be a pitched battle because the food industry wields immense political influence and has successfully thwarted previous efforts.” Meanwhile, the liberal-ish medical establishment is singularly focused on blocking RFK Jr, showing no interest in the food fight. One interesting element of the battle: personal injury lawyers are “actively investigating ultra processed food cases” with an eye to lawsuits. And the companies’ vulnerability mirrors that of the tobacco industry given the extensive evidence of youth-seducing “integrated marketing tie-ins with cartoons, toys, and games, along with social media advertising.” Meanwhile, a top USDA official says, “You’re lucky if you get to 18 without a chronic disease.”

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KLG/Yves Smith, “Make America Healthy Again: Is MAHA a trope or a movement?” Naked Capitalism, Jan 15, 2025 https://bit.ly/40PsfqI

This look at what MAHA actually means, based on the book Good Energy (2024) by RFK Jr-adjacent author Dr Casey Means, finds that the solutions offered are “only for the American affluenza with its food recommendations like organic eggs and dairy products from grass-fed cows.” Very few people have access to all these cool products, much less the cash to buy them. Means is a major MAHA influencer and not a crackpot. Her science of human metabolism is apparently quite coherent as is her determination to find causes rather than treat symptoms. But so far, the solutions are aimed at a tiny slice of the professional classes that can afford them. “The problem with Good Energy is that responsibility for poor diet and unhealthy lifestyle is placed entirely on the individual. This is the recurring theme of the Neoliberal Dispensation. Unless MAHA is willing to go past ‘Yes, we have an app for that!’ and take on Big Ag and Big Food with the public good as the primary focus, MAHA will remain nothing but a performative trope.” Meanwhile, 77% of U.S. 21-year-olds are not physically fit enough to perform military service.

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Berkeley Lovelace Jr., “RFK Jr’s No. 1 hurdle to take on unhealthy food: Money,” NBC News, Nov 18, 2024 https://bit.ly/3X0i80f

Unlike the FDA’s drug division funded by fees from pharmaceutical companies, its food division relies more heavily on funding from Congress.” The current spending on nutrition and chronic disease is an imperceptible $25 million a year. Therefore, any serious attempt to intervene in the massive food industry to tackle ultra-processed foods and additives will require serious budget support. Good luck with that! (Not that having the food biz fund its own regulators, just saying. But I digress.) By comparison, the food industry spends almost $14 billion a year on advertising its fast food, sugary drinks, candy, and other food-like substances, not to mention its lobbying budget, which must be staggering. Expect glacial progress if any, to wit: “In July, the FDA finally banned brominated vegetable oil, a food additive primarily used in fruit-flavored sports drinks and sodas that carries potential health risks, including damage to the liver, heart, and brain. That ban, however, was only proposed last year, several decades after the agency concluded that its use in foods wasn’t safe.” No rush!

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Joyce Frieden, “Trump Administration withdraws plans to ban menthol cigarettes,” MedPage Today, Jan 24, 2025 https://bit.ly/40FMDJU

The proposed rule had been in the works since mid-2022, but the Biden Administration dawdled. One possible reason for the delay: Biden’s fear of alienating Black voters. Black smokers overwhelmingly favor menthol brands. Another example of how our regulatory apparatus regularly fails us.

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Judy George, “HHS inspector general raises concerns over FDA’s accelerated approvals,” MedPage Today, Jan 16, 2025 https://bit.ly/4hc8uzw

The Inspector General did so—hold that thought. Accelerated drug approval was an AIDS-era innovation meant to move drugs quickly through the system given the emergency. It was quickly turned into a Pharma loophole, most egregiously in the Aduhelm debacle (the Alzheimer’s drug) in which the FDA “broke with its own protocols by inappropriately collaborating with drugmaker Biogen.” The Inspector General found additional abuses, such as the case of the muscular dystrophy drug eteplirsen, which the drug’s manufacturer still hasn’t shown to work 9 years after its fast-lane approval. Despite that, the U.S. government has spent $3 billion on it, which wasn’t supposed to happen. But since Trump just fired all inspectors general, no one will be bothered with such findings in the future.

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Sharon Lerner, “Donald Trump’s No. 2 pick for the EPA represented companies accused of pollution harm,” ProPublica, Jan 22, 2025 https://bit.ly/4h8zBeI

Good grief. But we’ve been here before when Ronald Reagan installed all sorts of corporate toadies into the EPA, including Supreme Court Justice Neil Gorsuch’s mother Anne (who only lasted 2 years after handing the agency over to the businesses it was to regulate). Now here comes corporate lawyer David Fotouhi, “who recently challenged a ban on asbestos and worked to roll back climate regulations and water protections” during Trump I. He’ll be the no. 2 behind New York’s corporate cheerleader Lee Zeldin. These revolving-door shills may eventually be sidelined after doing their damage, but the regulatory capture initiated by Reagan was largely successful. The EPA was crippled and remained timid even under the less obvious but still corporate-friendly Democrats. “The EPA banned [asbestos] in March, long after its dangers first became widely known.” Yeah, like decades afterward. The EPA drags its feet over obvious and known threats to public health, thanks to Reagan and his successors. So far, MAGA means, Let’s keep pumping out plenty of deadly chemicals into Americans’ water and food. Will its partisans notice?

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Hiroko Tabuchi, “Two industry executives join EPA to help oversee chemical rules,” New York Times, Jan 22, 2025 https://bit.ly/4hyeLVV

A former executive from the American Chemistry Council is back, having already served a stint at the EPA interfering in agency science and policymaking during Trump I. She’ll be joined by a 30-year veteran of DuPont. “Currently, more than 80,000 chemicals on the market are not subject to environmental testing or regulation.” And they won’t be any time soon. How about some of those as possible causes of autism?

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Matt Taibbi, “What’s the right way to cover the Trump presidency?” Racket News, Jan 22, 2025 https://bit.ly/4gkiaXB

A telling detail pops up in this article on the private equity takeover of everything: “One of the most aggressive buyers of medical practices, Ralph de la Torre and Steward Capital, hired Christopher Steele to paint a short-selling critic [of PE buyouts] as an agent of the Kremlin.” Voila, Wall Street sleazebags intersect with Russiagate fantasists. De la Torre is the guy who bankrupted two dozen hospitals while extracting hundreds of millions and buying himself two yachts and is likely to face federal corruption charges soon. Taibbi notes that “Democrats in the Trump era bathed in money from layoff artists and job exporters.” So did Republicans, of course: one member of Steward Capital’s board—until he hurriedly resigned—was former Speaker of the House John Boehner.

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Bob Herman, “Warren wants close FTC scrutiny of drug distributors buying cancer medical groups,” STAT, Oct 29, 2024 https://bit.ly/40PVEkN

Along with the PT invasion, we also have Pharma wholesalers buying up oncology practices. Elizabeth Warren sounds the alarm: “McKesson and Cardinal Health want to now become cancer care providers, i.e., become both buyers and sellers of products and services, including high-priced cancer drugs.” How is this even remotely legal? The conflicts of interest are glaring as Warren points out: “Common ownership introduces incentives to employ tactics that will drive greater profits to the parent company—such as increasing drug dosages, drug prices, and the number of patients doctors see at affiliated oncology practices.” Another great opportunity for Trump to take his own promises seriously.

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Jennifer Henderson, “FTC settles with private equity firm over anesthesia investments,” MedPage Today, Jan 22, 2025 https://bit.ly/4gfOWJ9

The Federal Trade Commission (FTC) announced a settlement with a private PE firm and its portfolio affiliate that bought up all the major anesthesiology practices in Texas to give itself monopoly pricing power. The FTC settlement doesn’t force them to divest but only limits further acquisitions. Experts called it a positive step though not a complete triumph. However, all five FTC commissioners, including in the incoming Republican chair, signed off on it, a sign that hostility to monopolies sometimes crosses the aisle.

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Nina Matthews, “Small businesses want low health care costs, but Big Pharma proposals do opposite,” The Tennessean, Oct 13, 2024 https://bit.ly/4axISdN

King Kong v. Godzilla. One powerful ally of the drive to clip the pharmacy benefit managers’ (PBMs’) wings is the pharmaceutical industry itself, now campaigning to impose new regulations on the other guys. This folksy op-ed, written by a small business owner, defends the PBMs as noble cost-savers protecting her business from rapacious drug companies and burdensome regulations. If this lady didn’t get expert editorial support from a fancy PBM lobbyist, she should send an invoice. Matthews attacks big-gummint Democrats, but now Trump also wants to rein in PBMs. Who will win the battle for the heart of Trumpism?

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Gwen Dilworth, “House passes pharmacy benefit manager transparency bill,” Mississippi Today, Jan 23, 2025 https://bit.ly/42smAIz

States aren’t waiting for federal action. Mississippi is poised to require monopolistic PBMs to stop operating in the dark, but critics say the steps aren’t enough to save local independent pharmacies. “Collecting the data is one thing. Doing something with it is another,” said Robert Dozier, the head of the state indies’ trade association. The bill doesn’t require standard pricing for drugs, which leaves too much wiggle room. It passed 88-8, suggesting that the bright red state’s legislators want to look like they’re doing something about the problem.

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Matthew Herper, “Do a pharmacy and a health insurer make sense together?” STAT, Oct 21, 2024 https://bit.ly/4hsA8ry

From last year, still germane. CVS/Aetna is one of the healthcare cartels, but it’s not doing so well nearly a decade after the two companies’ $70 billion merger. Wall Street not happy—what went wrong? Well, Aetna apparently is missing out on the MA gravy train. “A decline in the ratings of Aetna’s [MA] plans is part of the reason for CVS’ woes.”

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Marissa Plescia, “Why Walgreens is reportedly considering a private equity buyer,” MedCity News, Dec 22, 2024 https://medcitynews.com/2024/12/walgreens-sell-private-equity/

Solution! Let private equity in to loot the moribund companies and leave behind carcasses. Turns out that Walgreens’ network of 12,000 stores, which looked like such a good idea when the chains were driving out local pharmacies, is now “less an asset than a liability.” The mentioned suitor is Sycamore Partners, which “doesn’t have much experience in healthcare.” That won’t be needed if the plan is to sell off the remaining assets, take out loans to pay Sycamore investors big dividends and fees, and then exit while sadly shaking their heads.

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Shelby Kinsey, “I have a rare form of ALS. I have to fight my insurance company every six months for a game-changing drug,” STAT, Dec 13, 2024 https://bit.ly/4h3ulsR

“When I was diagnosed at age 22 with ALS, I knew I was going to have to fight for my life. I just didn’t know I would also have to fight against insurance companies denying me access to life-extending treatments.” A lot of people could have told her that was exactly what she could expect. She battles for an approval; Blue Cross gives her 6 months of access; the war restarts. Then there’s the question of why her drug costs $200K a year.

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Ellen Gabler, “How a company makes millions off a hospital program meant to help the poor,” New York Times, Jan 15, 2025 https://bit.ly/4hz8ERf

The federal 340B program was put in place to help hospitals serving low-income neighborhoods to make extra income on prescription arbitrage. As usual, it has been exploited by money-grubbers on the lookout for lucrative loopholes. The country’s large nonprofits have figured out ways to look like safety-net hospitals to cash in on 340B. The program has been in the crosshairs for a while, and the Times exposé should get it more attention. Pharma, of course, hates anything that cuts into its profits, so they’ll be a powerful ally to kabosh the thing, taking down the opportunists and the struggling public hospitals alike.

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Speaking of “nonprofit” hospitals, Columbia University in the City of New York must file a form 990 with the IRS. Its 2023 report shows revenue of $6,654,842,677 (that’s 6 ½ billion smackeroos) and lists the following top earners:

Key Employees and Officers                        Compensation           Related           Other

Lawrence Gerald Lenke (Professor of Surgery)     $5,488,624      $0                    $67,110

Lee C Bollinger (President (Through 6/30/23))     $4,449,336      $0                    $545,479

Ronald Arthur Lehman Jr (Professor of Surgery)  $3,486,493      $0                    $75,149

Note that Dr Lenke and his spinal surgery colleague Lehman pocketed a tidy $9 million. No wonder Columbia wanted to dump the low-revenue psych inpatient unit at the Allen Pavilion on the Harlem River <https://bit.ly/4jxYGBk> and replace it with the Och Spine Hospital, which Lenke directs <https://bit.ly/40RFUxy>. If they’re paying those eye-popping salaries to these two, you can be sure they’re earning that back and more.

ProPublica has a database on the “nonprofit” health sector. https://bit.ly/4aC8rKG

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Miranda Yaver, “‘Rationing by inconvenience’: Health insurers count on customers not appealing denials,” STAT, Jan 23, 2025 https://bit.ly/4hdNBUx

Insurers pressure their in-house reviewing doctors to whip through requests quickly and to default to DENIED since “patients can appeal.” The problem is that only 1% of patients whose claims are denied do so. “Many Americans go without prescribed care not due to final denial but rather because of accumulations of inconveniences and the psychological toll of the appeal process. It may even make them more reluctant to seek future treatment.” And no wonder: “Some UnitedHealthcare plans have appeal packets as long as 14 single-spaced pages detailing three levels of standard and three levels of expedited appeals.”

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Casey Ross, “AI versus AI: The emerging arms race over health insurance denials,” STAT, Dec 12, 2024 https://bit.ly/3Eo7Wb3

BWAHAHA, a new AI startup is designed to automate APPEALS of healthcare denials from insurance companies. They use the technology “to analyze clinical data and coverage requirements and draft appeal letters for doctors and patients.” What fun! An AI arms race, Robot v. Robot, how very modern. One company advertises an 85% success rate, which is substantially better than the rate for individuals. Among the choices available (take notes): Banjo Health, Crosby Health, ParX Solutions, CoFactor AI, Guardian AI, CoverMyMeds, eBlu Solutions, Claimable, and the easy-to-remember FightHealthInsurance.com, open source and free.

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Bob Mercer, “House wants voters to vote on Medicaid a third time,” Capitol News Bureau/KELO, Jan 22, 2025 https://bit.ly/42wuH6H

The democratic process will continue until the proper result is confirmed! South Dakota voters put Medicaid expansion into the state constitution 3 years ago, but solons now want to add a caveat: “If federal funding for the expansion portion of the Medicaid program ever drops below 90%, the Legislature could then decide whether to continue the expanded portion of the program.” Since Trump folks are contemplating exactly that change, they may be on to something.

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Kyle Pfannenstiel, “Idaho House committee introduces Medicaid expansion repeal bill,” Idaho Capitol Sun, Jan 24, 2025 https://bit.ly/40PIWlR

Ditto Idaho, which expanded Medicaid eligibility via a 2020 ballot initiative, proving that democracy doesn’t always work because people sometimes vote wrong. The state legislature wants to fix that with a repeal bill they say would save $110 million while losing $1 billion in federal Medicaid funds. Budget planning is hard and requires higher mathematics! “Republican state lawmakers have long worried states would be left to pay higher costs for expansion if the federal government reduced its extra pay”—which is a proposal circulating now.

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Shoshana Walter, “Hospitals gave women medications during childbirth, then reported them for using illicit drugs,” Reveal/The Marshall Project, Dec 11, 2024 https://bit.ly/42w77Y0

Dept of WTF!? “Across the country, hospitals are dispensing medications to patients in labor only to report them to child welfare authorities when they or their newborns test positive for those same substances on subsequent drug tests.” You get a benzo in the delivery room, and then bam, Child Protective Services is knocking at the door. Another outgrowth of the criminalization of pregnancy by the destruction of Roe v. Wade. “In New York, a mother with no history of drug use lost custody of her toddler and newborn for five months after she tested positive for fentanyl that the hospital had given her in her epidural.”

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Jamie Court, “The killing of a UnitedHealthcare executive won’t improve anyone’s insurance. This would,” Los Angeles Times, Dec 12, 2024 https://bit.ly/40Btt7S

This consumer advocate says Congress should overturn a Supreme Court ruling that took away patients’ right to sue insurers if they’re covered at work. People on Medicare or using the Obamacare exchanges can sue, but the 100 million workers with employer-based insurance can’t. “That’s why insurance companies often act as if they have a license to kill: They face scant legal consequences.” He writes that one insurer (Aetna) even trains staff “how to process claims differently for those with and without a right to sue.”

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David Klepper, “The CIA believes COVID most likely originated from a lab but has low confidence in its own finding,” Associated Press, Jan 26, 2025 https://bit.ly/4hbK4Gs

Oh, so now the CIA is telling us the opposite of what they were saying 2 years ago just in time for bipartisan China-bashing led by Trump. I remember when The Science™ assured us that Covid’s natural origin in the Wuhan wet market was beyond doubt and that anyone suggesting a lab leak was circulating dangerous fringe conspiracy misinformation. The liberal public health establishment—to which I belong—is suffering from a serious double standard as it slams the crackpot theories of RFK Jr. while refusing to look at its own slavish obedience to the Fauci-led groupthink on Covid and accompanying censorship of dissenting views.

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Indu Subaiya & Benjamin Kaska, “What we learned after four years of offering street medicine,” STAT, Jan 24, 2025 https://bit.ly/3PUiD7T

Healthcare in Action treats the homeless with innovative measures like tracking devices attached to their belongings so they don’t get lost. (The patients give permission.) HIA also benefit from a variety of state, local, and private funding streams, including commercial insurers, and have won over a local hospital for further support. As is so often the case, we can learn what needs to be done even when the political will to do it is lacking. “In our experience, most patients want to say yes to services that they feel assured will help them. Each time we did something for [a client] that produced a positive outcome, he agreed to a further intervention.” Improved health sometimes leads to clients getting off the streets. An inspiring project.

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Tareq S. Hajjaj, “Released Gaza prisoners say they were held at notorious torture camp with Dr. Hussam Abu Safiya,” Mondoweiss, Jan 18, 2025 https://bit.ly/4hx01GS

Gaza’s Kamal Adwan Hospital director, Dr. Hussam Abu Safiya, was abducted by Israeli forces from north Gaza a month ago and probably taken to Sde Teiman. Has the medical profession mobilized to save his life?

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Mansoor Malik, Ravi Chandra & Gary S. Belkin, “The willful and dangerous silence of the U.S. medical establishment on Gaza,” Mondoweiss, Dec 15, 2024 https://bit.ly/4az29LQ

“Despite overwhelming documentation of plausible genocide and medical war crimes in Gaza, major U.S. medical organizations, journals, and lobbies have neglected their duty to take a stand against these atrocities. Major medical organizations such as the Bill and Melinda Gates Foundation, the American Medical Association, and American Pediatric Associations have not called for a ceasefire or investigation of war crimes. This is in sharp contrast to their earlier reaction to the Ukraine war, the Hamas attacks on October 7, 2023, and even the recent statements of the U.S. government. Medical organizations are obligated to stand up against medical war crimes and genocide. This willful ignorance of the wholesale slaughter, starvation, and the deliberate destruction of medical infrastructure displayed by the U.S. medical associations, journals, and lobbies is discriminatory, racist, myopic, disingenuous, and dangerous.”

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See the full archive at www.nypan.org/single-payer-news

SINGLE PAYER LINKS #378

24 JAN 2025

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Although Trump did not mention health in his inaugural address, one of his Executive Orders denounced in general terms the “crushing regulatory burden” and “unnecessary administrative expenses and rent-seeking practices that increase healthcare costs.” https://bit.ly/4gbNE1I

That oddly phrased EO calls all departments and agencies to “deliver emergency price relief [on what?], consistent with applicable law” and for his economic policy team to report to him on progress toward this goal within 30 days. It’s hard to reconcile the anti-regulatory screed peppering Trump’s rhetoric with this edict to rein in “rent-seeking practices” among his golfing buddies. I’m betting on the billionaires, but we shall see. —Tim

I seem to be having sound problems at Podbean, so this link may need to be fixed later: https://www.podbean.com/eas/pb-dgbgm-17c4b36 

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Sarah Owermohle, John Wilkerson, Rachel Cohrs Zhang & Lizzy Lawrence, “Trump’s initial orders reverse Biden on health care costs, protections from discrimination,” STAT, Jan 20, 2025 https://bit.ly/4gbRM1Z

Trump’s first actions included blocking Medicare/Medicaid experimentation with cost-saving models (some of which are disastrous privatization schemes), cutting free access to Covid treatments and vaccines, withdrawing from the WHO, and reducing the enrollment period for Obamacare plans. Unsurprisingly, he also abolished the Gender Policy Council.

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Phil Galewitz, “Trump’s return puts Medicaid on the chopping block,” KFF Health News/CBS News, Jan 13, 2025 https://bit.ly/3PJcr2u

“Republicans in Washington say they plan to use funding cuts and regulatory changes to dramatically shrink Medicaid” and pry out some of the $900 billion that it costs for diversion into tax cuts or other schemes for their favored paymasters. But if they do, red states’ budgets will also take a hit, which won’t be popular. “State governments, managed-care organizations, long-term care providers, and everyone under the sun … will be highly motivated to push back on draconian cuts because it could affect their business model.” Bad ideas that could get a hearing: Medicaid block grants and lowering the 90% federal match for new enrollees under Obamacare expansion, which states agreed to when they signed up for the new costs. If states are suddenly stuck with shelling out more for Medicaid expansion beneficiaries, the non-expansion hold outs will have been proved right.

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Andrew Demillo, “Arkansas governor wants to revive state’s Medicaid work requirements under Trump administration,” Associated Press, Jan 16, 2025 https://bit.ly/42ov17N

Didn’t work the first time around—oh wait, yes it did if the true goal was to prevent low-income workers from getting medical care. “More than 18,000 people lost coverage when Arkansas previously enacted work requirements under [Gov Huckabee] Sanders’ predecessor.” Most of them were already working, but the bureaucratic obstacles successfully threw them off Medicaid, at least for a while. Other states (SC, IA) plan to follow suit with prove-you’re-not-a-lazy-slug rules; GA already has one under its expensive and useless “Pathways to Care.”

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Rachel Cohrs Zhang, “Trump finally finds a populist health care message in Kennedy’s MAHA,” STAT, Jan 20, 2025 https://bit.ly/3WvOr6J

Nothing exemplifies the built-in contradiction in Trump’s messaging like his endorsement of RFK Jr.’s promise to “Make America Healthy Again.” Rhetoric questioning our entire food system, the public health establishment, and the role of big business on drug pricing and bankruptcy-inducing health insurance joins uneasily with Trump’s full-court attack on gummint. In Trump I, the promise to repeal Obamacare fell flat, and he failed to lower drug prices. Even his success with the Covid vaccine clashed with his skeptical base. Given the staleness of the typical right-wing appeal to market-based solutions, it will be interesting to see where Trump goes in turning the MAHA message into policy, especially insofar as it means taking on giant corporations that fully expect a free ride from him.

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Lev Facher. “‘Tough love’: How RFK Jr.’s views on addiction could bring a new era of U.S. drug policy,” STAT, Dec 11, 2024 https://bit.ly/4aulL3V

Another likely clash will materialize in the world of drug use and addiction policy. RFK Jr himself famously needs addiction maintaining, but he says the government should wield threats of imprisonment or treatment coercion instead of harm reduction. (Reporters should ask him, Were YOU put in jail?) He expresses openness to supervised consumption sites such as OnPoint NYC but not their hands-off approach to voluntary treatment. HHS oversees key addiction agencies, and states and cities are looking at billions of dollars from Pharma, drug distributors, and pharmacies in opioid settlements—how will they spend it? Republicans traditionally hate anything suggesting compassion toward addicts.

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Lev Facher, “An NYC nonprofit has reversed 1,700 overdoses since 2021. Under Trump, it faces an uncertain future,” STAT, Jan 17, 2025 https://bit.ly/40sNCgd

Speaking of OnPoint NYC, it’s a safe injection site whose operations are threatened with closure and not just because of Trump. “Local officials in deep-blue cities like Philadelphia and San Francisco have blamed harm reduction for the cities’ continued drug crises.” Plenty of powerful people wouldn’t see OnPoint’s 1,700 overdose saves (and zero deaths) as a positive.

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Shannon Firth, “Major PBMs inflated drug prices, pocketing $7.3 billion along the way, FTC says,” MedPage Today, Jan 14, 2025 https://bit.ly/40J1yEa and Steve Kopack & Adiel Kaplan, “Top three insurers reaped $7.3 billion through their drug middlemen’s markups, FTC says,” NBC News, Jan 14, 2025 https://bit.ly/42qfYdv

The new FTC report is deadly: it outlines how the PBM triumvirate (Optum, CVS Caremark, and Express Scripts) acquire cheap generic drugs and pump up their prices to ridiculous levels, then pay their in-house pharmacies huge premiums. The profits they book are staggering: “Dispensing of the top specialty drugs represented about 12% of operating income reported by the three PBMs’ parent conglomerates” (United, CVS/Aetna, and Cigna) in 2021. Medicare/Medicaid suffered the increased costs, but employer-based plans also got hosed. “Between 2017 and 2021, spending by health plans and patients rose at compound annual growth rates of 21% for commercial claims and 14% to 15% for Medicare Part D claims. Half of the loot came from drugs for cancer and another quarter for multiple sclerosis meds.

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Nathaniel Weixel, “House Republicans launch investigation into CVS Caremark for potential antitrust violations,” The Hill, Dec 12, 2024 https://bit.ly/3E7ifAj

Republicans are on board to stick it to the PBMs. This House probe will examine whether CVS Caremark bullied independent pharmacies in violation of antitrust laws. (News flash: they did.)

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Kathleen Birrane, David Kopans & Peter Rice, “New York issues extensive new pharmacy benefit manager regulations,” DLA Piper, Nov 25, 2024 https://bit.ly/3WvLMKe

States are trying to rein in costs without waiting for federal action. New York added restrictions on PBM-pharmacy relationships (trying to halt self-dealing), banned secret contact terms, limited mergers and acquisitions, and inhibited PBM from steering customers to their affiliated in-house or mail-order pharmacies. The law firm that wrote this advisory says the new rules “may have a material impact on the PBMs’ business arrangements with a variety of affiliated and unaffiliated third parties.” None too soon.

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Paige Minemyer, “Optum Rx commits to passing through 100% of drug rebates, Witty says,” Fierce Healthcare, Jan 16, 2025 https://bit.ly/3WSvwDB

UnitedHealth Group is getting religion over its affiliated PBM’s pricing policies—no one knows why! CEO Andrew Witty announced the new policy: “We would like to work with others across the system to relentlessly achieve the lowest net cost for everybody in the system.” I like “relentlessly.”

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Nada Hassanein, “Independent pharmacies know their communities. But many are struggling to stay open,” Stateline, Jan 17, 2025 https://bit.ly/4juP9ej

One independent drugstore closes every day, “squeezed by the huge companies that reimburse pharmacies for costly medications.” That would be the PBMs, of course. Georgia’s state legislature overwhelmingly passed a law requiring the state to pay indies the same as chain pharmacies, but Gov Kemp vetoed it. A better solution: federal action to prohibit PBMs from paying their in-house pharmacies more and stiffing outsiders. One Georgia pharmacist says reimbursements for a third of the prescriptions she fills are less than the wholesale cost she pays for them. “Tennessee passed a law that prohibits PBMs from reimbursing pharmacies below acquisition costs.” How was that ever legal?

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Andy Miller, “PBM math: Big chains get $23.55 for blood pressure Rx as small drugstores get $1.15,” KFF Health News, Oct 24, 2024 https://bit.ly/4gr1g9P

Here’s how the big chains linked to the big cartels hog drug revenue and destroy the independents: “Chains were paid well beyond the family business for many of the same medications. For example, the chains received an average of nearly $54 for the antidepressant bupropion, while Bell’s Family Pharmacy in Tate, Georgia, got $5.54.” Mark Cuban’s Cost Plus PBM-wrecking alternative says the PBMs “siphon off about a third of the $400 billion a year spent on pharmaceuticals.”

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Tom Murphy, “Nearly 30% of U.S. drugstores closed in one decade,” Associated Press, Dec 3, 2024 https://bit.ly/3CayvA6

“Nearly three out of 10 U.S. drugstores that were open during the previous decade had closed by 2021,” and that was years before the latest round of branch closures by the major chains. Those most likely to close are independents and those with higher rates of Medicare/Medicaid beneficiaries.

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Jared S. Hopkins & Josh Ulick, “Medicare pays wildly different prices for the same drug,” Wall Street Journal, Nov 26, 2024 https://bit.ly/3PMMXkT

Our drug payment system is so irrational that a Pharma company can charge 2,000 different prices for the same drug in different plans. The pricing chaos leaves some users on the hook for thousands of dollars in copays. “The reason for the huge price differences: America’s complicated drug-reimbursement system, which uses middlemen to negotiate prices.” That would be the hated PBMs again, which “profit off the varying prices because Medicare can’t keep track of all the different sums it is paying.” And because the Federal Government never insisted on establishing a single price for them. There’s an opportunity for Trump to eliminate some “rent-seeking practices” if he really wants to.

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Ed Silverman, “Prices for 5 drugs were hiked without proof of new benefits, costing the U.S. $815M in 2023, report finds,” STAT, Dec. 12, 2024 https://bit.ly/3POS3Nz

Pharmaceuticals aren’t restricted in raising prices on most of their products, so they do, sometimes by insane amounts. Medicare was just recently empowered to negotiate a few prices on top sellers; will Trump continue to save government money or do a big favor for the industry by wrecking that initiative?

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Claudia Irizarry Aponte & Alyssa Katz, “Four things to know from our investigation of the Home Healthcare Workers of America, New York’s fastest-growing union,” The City, Jan 13, 2025 https://bit.ly/4g7ob9N

Hard-working home health workers are unionizing rapidly, isn’t that great? Perhaps not, given that the “union” involved is friendly with employers, enriches its top officials, and oh yes, neglects to tell its members that they belong to a union at all while regularly nicking their paychecks for dues. Home Healthcare Workers of America, an affiliate of the International Union of Journeymen and Allied Trades, paid its president over $1 million on the backs of the lowest-paid workers in New York. The president’s close relatives also had “jobs” with the union, paying half a million each. “At a Bronx trash hauling depot, management dissolved a Teamsters local and replaced it with an IUJAT local led by former mobsters, and workers saw their strict wage and benefit requirements vanish.” Lovely bunch. Incidentally, The City is essential reading for New Yorkers, and it relies on donations—no paywall.

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Emily Kopp, “WHO top scientist was ‘collaborator’ of Peter Daszak,” U.S. Right To Know, Jan 16, 2025 https://bit.ly/42ony8w

USRTK continues to dig around in Covid’s murky history and now reveals that the EcoHealth Alliance, which carried out Wuhan gain-of-function research (Fauci’s denials notwithstanding), had professional ties to the WHO’s chief scientific officer, Jeremy Farrar. That puts a new light on Farrar’s role in suppressing speculation about the lab-leak theory, which was heavily censored in social media during a crucial period. “The apparent connection between Farrar and [EcoHealth’s Peter] Daszak could present a previously unknown conflict of interest on the pandemic origins question at the highest levels of the WHO.” If gain-of-function viral fiddling really did produce SARS-CoV-2, we deserve ALL the facts.

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Steven Phillips, “Trump nominees for health positions should fail the ‘Fauci test.’” STAT, Jan 17, 2025 https://bit.ly/40GEUw6

Phillips has a nuanced view—not something in great demand these days. “Public health is not a hard science. Throughout the pandemic, both parties wrapped themselves in their truths by mixing data, expert opinion, and political exigencies.” He says dealing with fast-moving epidemics and other public health crises isn’t the same as the sort of plodding, conventional scientific inquiry that predominates elsewhere. Instead, epidemiological data often allows “a range of reasonable interpretations.” Therefore, the field requires a different approach, not ex catedra dictates from white-coated experts nor wild-eyed assertions from snake-oil peddlers. “Neither party has a claim to be the arbiter of evidence-based policy. Both can rely on evidence to support a range of rational agendas.”

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Lizzy Lawrence & Sarah Todd, “FDA bans red dye No. 3 in foods, decades after additive found to cause cancer in rats,” STAT, Jan 15, 2025 https://bit.ly/3PMjdEM

Only 30 years after red dye no. 3 was declared carcinogenic, our food-safety regulators have decided to act. Let’s not rush into anything! Red #3 was removed from cosmetics ages ago, so we can’t smear it on our faces. But we’re still allowed to put it down our gullets until 2027. “Concerted industry pressure” was largely responsible for the decades-long delay, say critics, which is why your maraschino cherry is still a perky red color along with 3,000 other red-tinted food products. What are the chances that other dangerous substances are among the tens of thousands the government never studied at all?

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Kay Tillow, Judy Albert, Claire M. Cohen, Ed Grystar & Ana Malinow, “Improved Medicare for All can heal this sick country,” Common Dreams, Jan 18, 2025 https://www.commondreams.org/opinion/medicare-for-all-2670870808

Refreshingly blunt language from single-payer advocates: “It’s the beginning of the end for corporate control of health care [and its] cruel denials, debt, disease, despair, and death at the hands of the investor-owned companies for whom patients are merely pawns for the extraction of profit.” How do you really feel? They point out that the seven largest insurers’ profits are three times what they were just a decade ago, and the steady encroachment of privateers into government-funded programs is getting worse. They argue that incremental tweaking of the system won’t work and conclude with a neat metaphor: “Runaway trains are not deterred by guardrails.”

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And to conclude: According to the Gaza Ministry of Health, the Israeli authorities have detained 330 healthcare workers there and killed 1,057, including three Palestinian MDs who have died in Israeli custody. The UN Human Rights Office documents 136 Israeli airstrikes on 40 hospitals and other medical facilities.

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See the full archive at www.nypan.org/single-payer-links

SINGLE PAYER LINKS #377

16 JAN 2025

This week: a changed atmosphere in the debate about health insurance; insurance scams roll on; merger and acquisition activity in healthcare picks up; physician militancy; what we learned/didn’t learn from Covid. —Tim

Listen here: https://www.podbean.com/eas/pb-7bs6k-17b3a25

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Don Tracy, “Additional security measures taken for J.P. Morgan healthcare conference,” PharmExec.com, Jan 10, 2025 https://bit.ly/42eBDFp

“San Francisco Police cancel time off requests to increase security at the J.P. Morgan Healthcare Conference, the largest annual gathering of healthcare executives and investors globally. The conference agenda can only be viewed by those invited to attend the event.” I wonder why!

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Bob Herman, “Cigna, Centene, Walgreens drop out of J.P. Morgan conference,” STAT, Jan 13, 2025 https://bit.ly/3PAjGK4

Cigna, Centene, Walgreens, two medical device makers, a physician practice management firm, two biotechs, and a chain of PT clinics all bowed out of the J.P. Morgan conference, “a possible sign that leaders of large health care companies are looking to avoid public appearances.” English translation: they’re scared shitless.

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Bob Herman, “Biden’s top antitrust official calls for breaking up powerful health care companies,” STAT, Jan 10, 2025 https://bit.ly/4gQaZrd

“Government officials need to consider breaking up the powerful companies that have price-gouged patients and suppressed competition.” The diagnosis comes from the outgoing head of antitrust at DoJ, Jonathan Kanter. He warns that the country’s entire healthcare infrastructure could end up as one or two companies if government doesn’t act. Kanter says these conglomerates aren’t really healthcare companies but “platforms” that use their hundreds of affiliates to extract excess profits all along the care continuum. The biggest target is UnitedHealth, which employs 90,000 docs through its Optum division and keeps trying to expand into new areas. Is anyone in the new team listening? We’ll soon find out.

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Tara Bannow, “DOJ seeks interviews with former UnitedHealth Group doctors,” STAT, Jan 12, 2025 https://bit.ly/4jexbwH

Will Justice Dept staff be allowed to continue putting the brakes on healthcare industry concentration? So far, permanent staff seem to be proceeding: “The Justice Department is interviewing former UnitedHealth Group physicians about their experiences working at practices owned by the health care giant.” They’re asking about systematic upcoding that enabled UH to extract juicier Medicare reimbursements, which should lead to a fraud complaint and a big clawback.

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Paige Minemyer, “UnitedHealth, Amedisys ask court to dismiss DOJ's challenge to $3.3B merger deal,” Fierce Healthcare, Jan 9, 2025 https://bit.ly/4hgvf4T

UnitedHealth Group and home health giant Amedisys argue that the government hasn’t specified where the alleged anti-competitive impact would be felt. But Kanter just said that’s not the point—the roll-up of different pieces of the healthcare continuum goes beyond restricting competition city by city. DoJ sued to block the deal last November because of UH’s “sustained strategy of acquiring, rather than beating, competition” as it morphed into the monolith it is today.

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Heather Landi, “Healthcare poised for ‘robust’ M&A activity in 2025,” Fierce Healthcare, Jan 6, 2025 https://bit.ly/3BZ17My

Despite “regulatory-driven hesitation towards large-scale transactions” (i.e., reawakened antitrust action under Kanter and the FTC’s Lina Khan), plenty of mergers and acquisitions are still occurring in the healthcare sector. Softening interest rates and a business-friendly Trump Administration are expected to stimulate more.

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Erica Carbajal, “AWS, General Catalyst partner on healthcare AI tools,” Becker’s Health IT, Jan 13, 2025 https://bit.ly/40idlbc

The health-business news is full of signals that we’ll enjoy more AI invasions in the sector. Amazon and GC will team up to delve into various aspects of healthcare “at an unprecedented scale and speed”—what could go wrong? Among the takeover terrains being eagerly eyed: analysis of medical images and automated administrative processes for clinicians. More robots, fewer people—great news!

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Mario Aguilar, “Transcarent to acquire Accolade for $621 million creating benefits tech giant,” STAT, Jan 8, 2025 https://bit.ly/40fikt3

Transcarent and Accolade are both “benefits companies,” i.e., intermediaries, which promise to “help self-insured employers deliver better health care at lower cost to their workers.” Good luck with that as costs spike relentlessly by 5–6% per year. The acquisition is funded by Wall Street dudes General Catalyst and 62 Ventures. The combined company will have 18 million members through 1,400 employers. Transcarent is basically an app “that connects members to virtual care and pharmacy benefits” and is rolling out a “generative AI chatbot that answers specific questions about people’s care and benefits.” More robots, fewer providers, bigger companies, fatter profits.

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Heather Landi, “Digital health venture funding hit $10.1B in 2024 as investors focused on earlier-stage dealmaking,” Fierce Healthcare, Jan 13, 2025 https://bit.ly/40vgQw9

It’s dizzying to try to make sense of the reporting in this world of high finance deal-making to exploit various niches in our healthcare “marketplace.” One wouldn’t know that doctors and patients have anything to do with these big-money deals in “mental health ($1.4 billion raised), cardiovascular ($1 billion), oncology ($700 million), weight management and obesity ($700 million), and reproductive and maternal health ($600 million).” Various stages of the care continuum are listed as “top value propositions,” such as treatment of disease ($1.9 billion raised), non-clinical workflow ($1.8 billion), monitoring of disease ($1.4 billion), on-demand healthcare ($1.3 billion) and clinical workflow ($1.2 billion). I guess there’s a ton of money everywhere if you just know where to stick your cash-vacuuming mandible.

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Dan Primack, “J&J strikes $14.6 billion deal for Intra-Cellular Therapies,” Axios, Jan 13, 2025 https://bit.ly/4ahJQL0

In the largest biotech merger of recent years, Pharma giant Johnson & Johnson will buy a company developing “new treatments for mental health disorders and neurological conditions and is currently working on an antidepressant drug.” For that price tag, there must be a lot of money to earn back. Shareholders of the acquired company got a nice surprise as J&J paid 60% over the closing stock price.

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Drew Altman, “The semi-sad state of consumer protection in health care,” KFF Health News, Jan 7, 2025 https://bit.ly/3E6ggMw

Kaiser Family Foundation chief Altman sees “little prospect of significant consumer protection legislation” despite the post-Luigi focus on health insurance. “Instead, we are likely to see a patchwork of pinprick actions at the federal and state level. Progress, but whack-a-mole.” He compares the situation to our reaction to gun violence, which is periodically rediscovered but never addressed. But he offers encouragement over some of the potential “pinpricks,” regulatory or legislative actions that might improve things a bit, for example: banning “ghost networks” of providers; making appeals easier; tightening pre-authorization rules and moving denial reviews to independent auditors; establishing so-called “gold card” programs for doctors whose records show they don’t overtreat or over-prescribe; limiting AI-driven chatbots; educating consumers to appeal denials routinely. Piecemeal reforms are “hyper-incremental,” he admits, but could be achieved in the current environmental of executive skittishness.

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Kristina Fiore, “Prospect is another casualty of private equity in healthcare,” MedPage Today, Jan 13, 2025 https://bit.ly/3CjfF9J

If health insurance is discredited, private equity’s invasion of healthcare is faring even worse. Along with the Steward PE debacle, now we have Prospect Medical Holdings collapsing into bankruptcy, leaving the familiar wake of ruined hospitals, bereft communities, and newly minted millionaires. PE owners Leonard Green & Partners extracted $645 million in “dividends and preferred stock redemption” from Prospect via loans that the financiers dumped on vulnerable hospitals before heading for the exits. Among the victims: the tottering hospital serving economically depressed Chester, Pennsylvania, and two Rhode Island safety net facilities. Prospect CEO Sam Lee pocketed a tidy $90 million from the decade-long looting.

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Sam Nunberg, “Vivek Ramaswamy is a fraud—and always has been,” Newsweek, Sep 1, 2023 https://bit.ly/4fWTi7N

If Trump’s team is seriously interested in reform, their record isn’t promising. Take big talking Ramaswamy: he has advice on everything, and we have to listen since he’s a billionaire. Turns out he’s also a scam artist. He pumped up a company experimenting with a possible Alzheimer’s drug using a study run by his mother, cashed in on the stock run-up, and then exited with massive profits while investors ate the 99% loss in value. But then again, Jim Cramer-style Republicans are the brand nowadays, so he fits right in.

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Adam Feuerstein, “Cassava Sciences and its Alzheimer’s drug are done. The damage lingers,” STAT, Nov 25, 2024 https://bit.ly/4gez5Lb

The author tried to raise the alarm on yet another Alzheimer’s treatment that turned out to be a fraud. (One employee has been indicted for falsification of research results.) “Four years on, the Cassava Sciences story ended exactly as many knew it would—with the company’s experimental drug, simufilam, proving to be nothing more than a placebo in a large clinical trial. The drug should never have advanced this far.” Feuerstein and others who blew the whistle on the fake trial were harassed by the company. RFK Jr has Pharma in the crosshairs, but the liberal public health establishment is all-in against him because of his crackpot vaccine theories.

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Elisabeth Rosenthal, “Removing a splinter? Treating a wart? If a doctor does, it can be billed as surgery,” KFF Health News/Washington Post, Dec 13, 2024 https://bit.ly/3Pz060C

The CPT code (17110) magically turns any “incision and removal of a foreign body, subcutaneous” into a surgical procedure. That includes removing a splinter with tweezers, probing an ear canal with a Q-tip, or putting ointment on a wart (because it penetrates the skin, thus “subcutaneous”). The 17110 Midas touch is applied in doctors’ offices nearly 3 million times per year to turn ridiculously minor acts into “operations.” RFK Jr. has called out the coding system and says the AMA shouldn’t be in charge of how payments to itself work. Rosenthal: “It’s common sense that the fox (physicians) should not be guarding the henhouse (payments).”

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Maya Miller & Duaa Eldeib, “Her mental health treatment was helping. That’s why insurance cut off her coverage,” ProPublica, Dec 31, 2024 https://bit.ly/4hgTGzm

Our insurance intermediary system at work: If the treatment is working, stop now since the problem is gone! OTOH, if the treatment isn’t working, also stop. Coverage denied in both cases. “Doctors are left to walk a tightrope trying to convince insurers that patients are making enough progress to stay in treatment as long as they actually need it but not so much that the companies prematurely cut them off from care.” Those begging sessions also gobble up provider time without compensation while the insurance company’s hired reviewer docs are comfortably on the corporate dime.

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Owais Durrani, “I’m an emergency physician. The modern telehealth model should have all of us concerned,” MSNBC, Dec 28, 2024 https://bit.ly/40lceYj

Telehealth exploded in popularity during and after the Covid lockdowns, but it’s just as problematic as the in-person kind. Example: An on-screen provider told a man with diabetes to go purchase an inhaler even though he was coughing up blood and short of breath and his feet were turning blue. He died. The family is suing Amazon One Medical for malpractice. “This wrongful death claim underscores the risks inherent in a health care model that prioritizes scalability and efficiency over the nuances of medical decision-making.” But telehealth companies need to rush through their appointments to maximize revenue. The for-profit system cannot fix this problem.

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Anastassia Gliadkovskaya, “Unionized doctors and NYC H+H affiliates reach contract deal on day of planned strike,” Fierce Healthcare, Jan 13, 2025 https://bit.ly/4hcQKUf

One result of the financier takeover of healthcare institutions is physician militancy as they see the benefits of collective action. A thousand unionized docs in New York City’s 11 safety-net hospitals won a better contract on the day of a planned strike. It included “salary incentives to enhance physician recruitment and retention” as well as improved working conditions, such as a rollback of 20-minute limits for patient appointments.

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Helen Branswell, “What Covid tried to teach us—and why it will matter in the next pandemic,” STAT, Jan 6, 2025 https://bit.ly/4jcj9vn

“Public trust in public health institutions has cratered.” Branswell is certainly right on that. She highlights “communications failures that undermined the CDC’s reputation” such as the confusion around the 10-day isolation rule suddenly shorted to five. She says the CDC was doing its best with a novel pathogen, but people wouldn’t give the agency the benefit of the doubt. But Branswell misses the key point: the CDC chiefs weren’t sure about what they were saying but PRETENDED THAT THEY WERE. At the same time, they insisted that we all follow their zigzagging advice like first graders. This is fatal—when scientists don’t really know something, they have to say so. Pretending to be the Voice of God in a white coat doesn’t work in the long run as was brutally demonstrated in this case. Wacko websites don’t help, but they’re the price of free speech, and snake-oil salesmen have regulatory fixes if we choose to use them. Branswell engages in a little disinformation of her own when she says that “people don’t fear Covid in the way they did a few years ago—nor should they” because we have acquired immunity. Tell that to the folks with long Covid after their third infection. And she—like the CDC she defends—fails to mention ventilation or air purification, which is probably the biggest CDC/WHO fail of all. Covid is an airborne virus.

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Samantha Liss, “Indiana state senator moves to scrap hospital monopoly law he helped create,” KFF Health News, Jan 8, 2025 https://bit.ly/3CawlQM

An Indiana hospital merger broke down in the face of public opposition. But the interesting twist is that a Republican-backed measure to make such mergers easy is now opposed by its own author. Indiana is one of 19 states that decided to facilitate hospital consolidation through so-called “Certificate of Public Advantage” laws, but six states have now repealed them. Turns out even Republicans are rethinking letting healthcare CEOs get their way in everything.

See the full archive at www.nypan.org/single-payer-news

SINGLE PAYER LINKS #376

10 JAN 2025

Plenty of hilarious outrages to enjoy along with a surprising dollop of mildly good news this week as we get ready for the MAGA v. Corporate America showdown.

Listen here: https://www.podbean.com/eas/pb-nbneg-17a6b21  

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Cheryl Clark, “This year’s Shkreli Awards: Here’s who made the list,” MedPage Today, Jan 7, 2025 https://bit.ly/4fSZOg3

Let’s start with a few laughs at the unfolding tragicomedy. These annual awards are named after the notorious “pharma bro” Martin Shkreli who obtained the rights to a drug and then charged 50 times more for it—because he could. Dr Vikas Saini announced the awards: “It’s always a mixture of out-and-out fraud as well as just general venality and grasping.” Read the whole article if you’re not quite cynical enough yet. Topping the list: our man Ralph de la Torre of Steward Health Care who pocketed $250 million while driving 30 hospitals into bankruptcy. Close behind is UnitedHealth Group for its now famous sins. No. 6 is the “Pretty in Pink Boutique,” which billed Medicare beneficiaries for thousands of urinary catheters but was discovered not to exist. “There was no medical business at the address listed, and its phone number reached an auto body shop.”

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Shannon Firth, “Concerns continues over private equity’s reach into healthcare,” MedPage Today, Jan 2, 2025 https://bit.ly/4h98gbS

More on private equity’s greatest moment: “Approximately 15 patients in Steward hospitals died due to lack of medical equipment or staff, and many more lives were endangered. All the while, Steward CEO Ralph de la Torre spent $160 million on a yacht, two private jets, a luxury fishing boat, and a donation to an elite preparatory school.” Everything working as planned! Struggling hospitals will continue to be lured into PE deals as fancy Wall Street types show up “ready to help.”

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Paul Cuno-Booth, “State approves Catholic Medical Center sale to HCA Healthcare,” New Hampshire Public Radio, Jan 6, 2025 https://bit.ly/428FDHv

Here’s an example: NH is allowing for-profit HCA Healthcare to take over a failing hospital, “the latest in a series of hospital mergers and acquisitions reshaping New Hampshire’s medical landscape.” A previous HCA takeover led to reduced services and higher prices, but the state assures residents that HCA promises not to do that again. But “HCA agreed to a similar provision in 2020 when acquiring Frisbie Memorial Hospital in Rochester only to cut labor and delivery services two years later, citing financial and staffing reasons.”

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“Massachusetts lawmakers approve bill to close loopholes in health care market,” Associated Press, Dec 31, 2024 https://bit.ly/4fTiT1o

Massachusetts closes the barn door now that the horses are in Rhode Island. After the Steward collapse wrecked key safety net hospitals, the state legislature lamely decided to give regulators new powers to obtain hospitals’ financial data on the theory that they will then stave off the next steal. How bold! The bill boosts penalties “for not complying with the new proposed data reporting requirements.” How will that matter after the next hospital is asset-stripped and left bankrupt?

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Noah Tong, “Aetna sues drugmakers for widespread price-fixing and collusion,” Fierce Healthcare, Jan 3, 2025 https://bit.ly/3DIJIIk

Godzilla v. King Kong: Aetna is suing several Pharma giants for rigging the generic drug market, claiming they “communicated secretly to determine the market share, prices, and bids of certain drugs.” The lawsuit names several Pharma officials including a former executive of Israel’s Teva Pharmaceuticals, who pleaded guilty for price-fixing in 2020. Several states, including Connecticut, are doing the same, and two other large insurers, Humana and UnitedHealthcare, are also suing over price-fixing of generics.

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Duaa Eldeib & Maya Miller, “Insurers continue to rely on doctors whose judgments have been criticized by courts,” ProPublica, Dec 30, 2024 https://bit.ly/3W3cOZr

“Insurance companies use loyal physician ‘experts’ to keep those denials churning out.” This article details the career of one such expert whose automatic NO!s were regularly overturned if anyone had the patience and cash to haul the insurer and its loyal chief denialist to court.

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Bob Herman, “Aetna lawsuit alleges radiology group of fraudulent billing and abuse of federal arbitration,” STAT, Dec 27, 2024 https://bit.ly/425L6yM

The No Surprises Act was supposed to stop the practice of out-of-network doctors slapping bills onto patients who carefully chose an in-network facility. Insurer Aetna now says an outfit called Radiology Partners of sending fraudulent bills, then “flooding the arbitration process with thousands of out-of-network claims that should have been billed under existing contracts.” That gummed up the federal arbitration apparatus and led to big fees for lawyers enjoying the procedural thicket. And who should own Radiology Partners? “Venture capital firm New Enterprise Associates and a handful of private equity firms, including Whistler Capital Partners and Heritage Group.” Depressingly predictable.

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Rebekah Ninan, “Ghost networks and mental healthcare,” Bill of Health, Nov 17, 2024 https://bit.ly/4jot4yj

Ghost networks are insurer lists of providers who turn out not to exist, aren’t taking new clients, or are dead. Three New Yorkers are suing Anthem Blue Cross Blue Shield/Elevance over the practice, alleging that “only seven of the first 100 providers on the Anthem directory for the state were contactable, in network, or accepting patients.” Nice way to dodge legal requirements to provide the service.

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And now for some moderately good news:

Nathaniel Weixel, “House Republicans launch investigation into CVS Caremark for potential antitrust violations,” The Hill, Dec 12, 2024 https://bit.ly/3DOb8wC

Red-state pressure on the PBMs: House Republicans want to dig into anticompetitive practices by CVS’s giant pharmacy benefit manager Caremark.

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Noah Tong, “CMS sunsets Medicare Advantage value-based model, citing billions in costs,” Fierce Healthcare, Dec 17, 2024 https://bit.ly/4gQEqtf

The program to terminate next year is called the “Value-Based Insurance Design Model” used by Medicare Advantage plans. The reason given is the high cost of “increased risk score growth and Part D expenditures.” English translation: upcoding.

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Paige Minemyer, “CVS officially rolls out CostVantage model for commercial prescriptions,” Fierce Healthcare, Jan 6, 2025 https://bit.ly/4gLFT3T

CVS Caremark now will price prescriptions on a cost-plus basis and add a dispensing fee. Does this sound like Mark Cuban’s Cost-Plus pharmacy? Why yes, it does! Perhaps Cuban’s alternative is eating the big chains’ lunches. Yay for disruptive capitalism then.

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Joseph Choi, “Medicare’s new drug price cap kicks in Jan. 1,” The Hill, Dec 31, 2024 https://bit.ly/408Jba7

Some seniors now will have their out-of-pocket spending capped at $2,000 thanks to a law passed several years ago along with the Medicare drug price negotiation program. The article doesn’t say who is picking up the difference—presumably, the Feds, not Pharma companies. See next article.

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Michael Erman, “Drugmakers to raise US prices on over 250 medicines starting Jan. 1,” Reuters, Dec 31, 2024 https://bit.ly/4afhlhk

Reuters helpfully emphasizes that the increases aren’t really all that high and are less than in previous years. “Nearly all of the drug price increases are below 10%—most well below. The median price increase of the drugs being hiked is in line with the median for all price increases last year.” Lucky for us! “Larger drug price increases were once far more common in the U.S., but in recent years drugmakers have scaled them back after price hikes drew sharp criticism in the middle of the last decade.” Not from Reuters, I suspect.

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The coming struggle between the MAHAs and corporate Republicans, a.k.a. Trump’s golfing buddies:

Matt Stoller, “Big Ag vs Make American Healthy Again,” BIG, Jan 5, 2025 https://bit.ly/421W2O7

Our food supply is controlled by a set of cartels and organized through Soviet-style Five Year Plans known as the Farm Bills. As this behemoth is shepherded through Congress, urban Democrats wangle food stamps and other benefits for low-income people in exchange for signing off on Republican gimmies like subsidies for agribusiness and farmers. It’s up for renewal this year, but as Stoller reports, “Something has gone very wrong of late. America isn’t just de-industrializing in terms of manufacturing; we are becoming a country that increasingly imports our food as well.” The culprit: monopolization. “Increasingly, to older farmers, it doesn’t seem worth it to produce food anymore. [They] are mad that inputs like seeds and chemicals and fertilizers are consolidated and overpriced, and producers of chicken, pork, and beef feel they aren’t getting enough for their work from large processors.” Voila, another area where the red state populations are also unhappy with late-stage financialized capitalism. (It’s those transgender billionaires again!) Fun fact: “Pigs defecate three times as much as humans, and Iowa has 25 million of them. Yet pig waste isn’t held to the same standards as human waste, which is why industrial pig farming in Iowa is profitable. Giant processors offload the real cost in terms of massive pollution to the public.”

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Shalina Chatlani, “As demand for weight-loss drugs rises, states grapple with Medicaid coverage,” Stateline, Jan 6, 2025 https://bit.ly/4gLKwux

A whole lot of people in this country are obese. The new drugs seem to work pretty well for some people (with a lot of downsides that aren’t getting enough attention). The Pharma companies that own them are charging insane prices ($940 to $1,350 a month, list), as usual. What to do? States are floundering. Some try to authorize payments, then go broke. North Carolina and a dozen other states cover obesity diagnoses, but many states limit the GLP-1 drugs to diabetes patients. Even that is driving some into the red.

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April Baumgarten, “North Dakota becomes 1st state to cover weight loss medication with federally backed health insurance,” InForum, Jan 4, 2025 https://bit.ly/426ON7q

North Dakota will allow federally-subsidized insurance to cover weight loss drugs for individual plans.” Stand by to see the state’s reaction to the bills.

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Leah Willingham, “West Virginia patients are left in limbo over changing insurance coverage of obesity medications,” Associated Press, Jan 2, 2025 https://bit.ly/40pLRBv

States that find they can’t handle the cost of the GLP-1 drugs are cutting people off. West Virginia has the highest obesity rate in the country, one of the poorest populations, and is full of “rural food deserts” without even a grocery store, much less decent food. That’s the underlying problem, which the fat shots don’t address. GLP-1 costs caused premiums to go up by 14% for state employees and 12% bump for retirees. So, will people resent their obese neighbors?

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Nathaniel Weixel, “RFK Jr. vs. Oz sets up clash on weight loss drug coverage,” The Hill, Dec 30, 2024 https://bit.ly/4h40XCi

“Two of President-elect Trump’s top health nominees are on a collision course as the incoming administration faces a crucial decision on coverage for groundbreaking anti-obesity drugs.” Oz says yes, RFK says no because foreign companies are “counting on selling it to Americans because we’re so stupid and so addicted to drugs.” Later, he backpedaled slightly. The larger battle question is whether any of Trump’s iconoclastic appointees will be able/allowed to stare down corporate lobbies over anything.

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Sophie Gardner, “RFK Jr. wants to end chronic disease. But GOP lawmakers are targeting chronic disease prevention funding,” Politico, Jan 6, 2025 https://bit.ly/4h3hg28

Another clash-to-come: RFK Jr on chronic disease prevention v/s the Republican caucus who don’t want to fund it. “The potential conflict exposes the rift between conservative priorities and the ‘Make America Healthy Again’ movement.” Paywalled, but this will be a recurring theme.

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Brendan Pierson, “Lawsuit accuses major food companies of marketing ‘addictive’ food to kids,” Reuters, Dec 11, 2024 https://bit.ly/4jbLT7q

Plaintiffs say Kraft Heinz, Coca-Cola, General Mills, Nestle’s, Mars, Kellogg, and other big food companies intentionally designed and marketed junk to children while knowing their products were harmful and deliberately engineering them to create addictive consumption. It worked against tobacco companies, so let’s see.

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Andrea Love & Katie Suleta, “Will the Trump Administration be a dangerous ally to the wellness industry?” MedPage Today, Jan 3, 2025 https://bit.ly/3PxptQo

“The $5.6 trillion [!] wellness industry sells a seductive premise: pursue personal well-being and empowerment by bypassing the perceived failures of conventional medicine. The narrative fuels a market of unregulated supplements, unproven tests, and vague diagnoses­—all sold under the guise of taking control of your health.” The authors warn that putting “wellness” promoters in charge could discredit the biz in the long term—after cutting a swath of destruction through the nation’s health. “Wellness” products are largely unregulated.

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Habib Benzian, “The U.S. health care system is broken. It’s time for real reform,” Newsweek, Dec 10, 2024 https://bit.ly/3DMfTH7

After the usual diagnosis of U.S. healthcare on life support, the dentist-author offers this way to “radical transformation”: health taxes on harmful products like tobacco, sugary beverages, and alcohol. That’s his idea of “bold, unflinching interventions.” It’s amazing how many of these chin-stroking articles get published that endlessly rehash all we know about our system’s dysfunction and then propose such lame-ass answers. Of course, mention of “single payer” is verboten.

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Lillian Mongeau Hughes, “For many rural women, finding maternity care outweighs concerns about abortion access,” KFF Health News/The 19th, Jan 2, 2025 https://bit.ly/4a9Nxm8

Rural hospital closures are forcing women to travel long distances for basic OB/GYN care. The consequences are obvious and dire: birth emergencies ending in permanent injury and death. Over half of all rural hospitals now lack obstetrics units.

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Joyce Frieden, “Do the new CMS rules on prior authorization go far enough?” MedPage Today, Jan 7, 2025 https://bit.ly/4j6vPUH

In general, one can safely answer any headline posed as a question with a “NO.” The new regs require that insurers “improve the electronic exchange of health information and prior authorization processes.” That sure sounds vague. Plan managers now are supposed to send their decisions within 72 hours for urgent requests and 7 calendar days for non-urgent ones and give a reason for denials. But the rules only apply to MA plans, Medicaid HMOs, and some Obamacare exchange plans. The few independent doctors still out there aren’t included in the protections and, as I understand it, that puts them at a disadvantage compared to those already owned by Aetna, Cigna, UH, etc. In addition, the new rules have to withstand court challenges, which is not guaranteed. Why can’t the government just set a standard that applies universally?

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See the full archive at www.nypan.org/single-payer-news

SINGLE PAYER LINKS #375

3 JAN 2025

This week, I dare to wonder if a tiny consensus might be building on reining in the health industry cartels and if something not terrible could conceivably emerge from Trumpland. Followed by the usual horror stories. –Tim

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Joshua P. Cohen, “Lawmakers want to break up healthcare conglomerates, forcing them to shed pharmacies,” Forbes, Dec 17, 2024 https://bit.ly/4gCCPHa

Two unlikely allies want to force pharmacy benefit managers (PBMs) to sell their retail pharmacy businesses. “Healthcare conglomerates such as CVS Health use their size and leverage to steer patients toward their own pharmacies, increasing prescription drug costs for patients, employers and government programs, while driving independent pharmacies out of business.” Senators Elizabeth Warren’s sidekick on this issue is none other than Josh Hawley (R-MO), and they’re in agreement on other antitrust bits as well. Seeing Warren team up with a bright red dude from Arkansas is a development worth watching. Hawley’s home-town newspaper, the St Louis Post-Dispatch, wrote, “If this keeps up, people are going to talk.”

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David Balto, “Will Donald Trump be the one to slay the PBMs?” STAT, Dec 17, 2024 https://bit.ly/4fE2ePm

Balto thinks PBMs should be worried. “Trump 2.0 is likely to be giving the PBMs some doses of regulatory medicine they certainly don’t want,” specifically restrictions on how they manipulate rebates, which are kickbacks that are currently not illegal.

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Arthur Allen, “How a duty to spend wisely on worker benefits could loosen PBMs’ grip on drug prices,” KFF Health News/Endpoints News, Dec 18, 2024 https://bit.ly/49UY4l7

Here’s one possible avenue for quick PBM reform, stemming from a lawsuit against Johnson & Johnson by a former employee. “Lewandowski charges that by contracting with the PBM Express Scripts, J&J failed in its duty to ensure reasonable drug prices for its 50,000 U.S. employees.” That is, her employer had a legal obligation to protect her from PBM gouging under the ERISA law that compels companies to exercise “prudent management” of employee retirement and health benefits. Lots of people think the PBM scam is low-hanging fruit. “In 2019, Connecticut became CVS’ first PBM customer to negotiate a transparent fee structure. Its contract required 100% of drug rebates be passed along to the state and eliminated spread pricing.”

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Lizzy Lawrence, “Truth-teller or reflexive contrarian: Which Marty Makary would run the FDA?” STAT, Dec. 17, 2024 https://bit.ly/4fFHp6h and Matt Stoller, “Trump’s FDA pick knows how to fix medical shortages,” BIG, Dec 1, 2024, https://bit.ly/4gYxwlk

The new guy at the FDA sounds like an ambitious attention seeker who nonetheless isn’t a full-blown crackpot. He often “denounces injustice in the health care system, attracting constant media and political attention along the way.” He’s also sloppy with the facts, but alongside Trump’s usual corporate picks, he looks independent-ish. “It just shows that the bar is pretty low,” said a neurologist author of books on the antivax movement. Fun fact: Makary is a native Brit born to Coptic (Christian) Egyptian parents. His latest book, Blind Spots, says we should be more skeptical of doctors (presumably including himself). But he doesn’t come from Big Pharma like his two predecessors. Also, Stoller notes happily that Makary has written astutely about the wholesaler cartel of hospital Group Purchasing Organizations (GPOs), which the FTC started to investigate against the howls of outrage from lobbyists and bought-off media doctors like Sanjay Gupta.

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Paige Minemyer, “AMA study: Insurance markets remain ‘stubbornly highly concentrated,’” Fierce Healthcare, Nov 19, 2024 https://bit.ly/4gzl4Z7

Meaning that there is essentially no real consumer choice for insurance in most U.S. cities in half of which “a single insurer owned at least 50% of the market.”

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Daniel Urie, “Pa. hospital to close; more than 800 people to be laid off,” PennLive/Patriot News, Dec 19, 2024 https://bit.ly/41ULX5y

The collapse of the Steward Health Care System put its 31 hospitals and 400 other facilities in eight states in jeopardy. Will anyone take action? See next article.

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Sri Taylor, “Crackdown on private equity in health care flops in state houses,” Yahoo Finance/Bloomberg, Dec 22, 2024 https://bit.ly/3DB4REx

While Steward’s hospitals sink into penurious dysfunction all over the U.S. thanks to private equity-induced asset stripping and bankruptcy, PE itself remains immune. Despite the wave of public fury, “the would-be crackdown is fizzling.” California Governor Gavin Newsom led the way by vetoing a bill to block PE healthcare deals. “Efforts to bolster oversight of financial firms or outright prohibit certain health-care investments also faltered in Pennsylvania, Connecticut, Oregon, Washington, and Minnesota”—almost all blue states. Meanwhile, PE companies were responsible for a fifth of health sector bankruptcies last year, but they pull out their “profits” before letting the empty shell implode. (For example, Cerberus Capital Management pulled $800 million out of Steward before dumping it and bragged later that it had “rescued and restored critical community hospitals in Massachusetts.” Quick! More rescues!) So, we can expect more bankrupt hospitals leaving nurses with no choice but to pack up dead newborns in cardboard boxes, as occurred at one Steward unit.

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Luigi time

Joanne Kenen, “He was Surgeon General—and he’s got thoughts about the reaction to the UnitedHealthcare killing,” Politico, Dec 17, 2024 https://bit.ly/3DMqeT3

“It signals a profound loss of confidence in structures that are meant to support and protect the public,” said former S-G Jerome Adams. (Gosh, really? What was your first clue?) “Insurers absolutely cannot ignore this moment. Anger is also coming from providers, pretty much everybody who has to deal with these pre-authorization reviews, with being on the phone and emailing insurers.” One immediate response: insurers are taking the names and photos of their top executives off their websites.

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Noam N. Levey, “Rage has long shadowed American health care. It’s rarely produced big change,” KFF Health News/Fortune, Dec 18, 2024 https://bit.ly/3DyA5vZ

“Cycles of rage have been so much sound and fury, producing only modest reforms.” Sometimes, the fixes made things worse: “The HMO backlash in the late 1990s and early 2000s prompted employers to embrace high-deductible health plans [now] driving tens of millions of Americans into debt.” The industries are adept at sidestepping radical changes, in part benefitting from “a paradox in how Americans think about their health care.” We think it stinks in general, but most of us still rate our own care as “excellent or good.” At least that’s what some surveys say, if we can believe them. (See the Potter rebuttal below.)

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Wendell Potter, “Don’t overlook Wall Street’s role in the broken system,” STAT, Dec 11, 2024 https://bit.ly/4gDNTUs

Potter, a former insurance company flack, says “much of [corporate PR] spending was to create the illusion that we Americans are happy with our health care system and don’t want politicians to get any bright ideas about changing it.” So, those polls showing that we just love our insurance are questionable. He notes that the late Brian Thompson was en route to pitch his company’s profit-making to industry investors where the word “patient” would not pass from any lips, as opposed to phrases like “shareholder value.” Potter thinks the Obamacare requirement that insurers pay out a high percentage of their revenue in care services (the “medical loss ratio”) has backfired and stimulated vertical integration. “Hundreds of acquisitions later, UnitedHealth is now the fourth largest U.S. company—just behind Walmart, Amazon, and Apple.”

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Christopher Weaver, Anna Wilde Mathews & Tom McGinty, “UnitedHealth’s army of doctors helped it collect billions more from Medicare,” Wall Street Journal, Dec 29, 2024 https://bit.ly/4237Dw6

A thorough takedown of the criminal gang running UnitedHealth, sadly paywalled (but <archiv.is> is your friend). The intro: “Like most doctors, Nicholas Jones prefers to diagnose patients after examining them. When he worked for UnitedHealth UNH Group, though, the company frequently prepared him a checklist of potential diagnoses before he ever laid eyes on them.” But this only applied to Medicare Advantage patients because upcoding those on traditional Medicare doesn’t bring in extra reimbursements. Newly hired UH doctors get special training in how to dig around for lucrative diagnoses, and if they don’t get the message, a supervisor promptly shows up: “If you don’t [upcode], they come bothering you.” Some of the anecdotes are beyond absurd, like the time UnitedHealth sent a doctor included a “potential diagnosis” of a lower-leg amputation, even though the patient wasn’t missing a limb. (We’ll cut it off you for, how’s that!) Doctors who play nice earn big bonuses.

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Matt Stoller, “It’s time to break up big medicine,” BIG, Dec 12, 2024 https://bit.ly/4a3zyOz

“UnitedHealth Group is not an insurer; it’s a platform.” In this lengthy and wonky (but worth the effort) essay, Stoller dismantles the industry counter-argument that insurance companies aren’t really villains and that the real problem is providers happily gouging us while sticking UH and Aetna with the collection duties while they innocently try to hold down costs. He points to administrative bloat that absorbs fully one third of the gargantuan U.S. healthcare spending; debunks “overconsumption” of healthcare services as a convenient myth to justify copays and premiums; and zeroes in on what he calls the real culprit: monopoly pricing power resulting from the consolidation of vertically integrated healthcare cartels. For example, UH has rolled up an astonishing 1,300 new companies just since 2021. Bankers, not providers, are now in charge, and they like monopolies. “UHG is not primarily a health insurer, but something new. It is the biggest employer of doctors in the nation; it has a significant software business; and it sits in the middle of the pharmaceutical pricing chain.” It also owns a bank. The company recycles its vast revenues by self-dealing at every care point, enabling its multiple entities to peel off profits at every stage. With these hundreds of tentacles and interlocking business, UH is more like Google than an old-fashioned insurer. Essential reading!

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Robert Kuttner, “How AARP shills for UnitedHealthcare: Why does the supposed advocate for the elderly steer them to the industry’s worst insurer?” American Prospect, Dec 11, 2024 https://bit.ly/3BDBX64

The 38-million-strong AARP “is basically an insurance marketing scheme masquerading as an advocacy group for the elderly.” Kuttner explains: AARP gets a tidy 4.95% of premium income from UH policies taken out by members. That amounts to over a billion dollars, dwarfing AARP’s income from membership dues. And as a “nonprofit,” it pays no income taxes. “AARP’s conflicted role crowds out much-needed genuine organizations to advocate for seniors,” such as the vastly poorer National Committee to Preserve Social Security and Medicare < https://www.ncpssm.org> whose annual budget is $8 million. Insurance-friendly AARP’s is a billion and a half.

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Elisabeth Rosenthal, “‘Bill of the Month’: The series that dissects and slashes medical bills,” KFF Health News/NPR, Dec 20, 2024 https://bit.ly/4gVElUB

These billing horror stories are excellent illustrations of everything wrong about U.S. healthcare and are great teaching tools. Two featured patients ended up at the White House to build pressure for the No Surprises Act (including Elizabeth Moreno who was billed $18,000 for a urine test). Many of the bills were rescinded after reporters made inquiries. Takeaway messages: ask if a provider is in-network before a procedure or visit; read waiting-room forms closely (and before signing, add notes like “in-network only”; never pay the first bill—ask for it to be fully itemized; question charges that don’t make sense; avoid hospitals for simple procedures and ask your clinic if a hospital owns them (and can charge accordingly); ask urgent care centers if they are really free-standing ERs, i.e., much more expensive; see if paying cash will be cheaper than using your insurance (it sometimes will). After all that, have a speedy recovery from your stroke!

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Paul Kiel, “How a decades-old loophole lets billionaires avoid Medicare taxes,” ProPublica, Dec 11, 2024 https://bit.ly/41UBKpt

Many of us don’t realize that Medicare tax “takes a bite out of every paycheck” since we never see it. But billionaires have a way to opt out. In 2016, Steve Cohen, the owner of the New York Mets, paid $0. So did Stephen Schwarzman, head of the investment behemoth Blackstone [who got his name on the main NYPL reading room on Fifth Avenue]. They use an obscure tax loophole to save millions. Important for the panic coverage about the terrible burden of Medicare on the federal budget.

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Cory Franklin, “Journalists failed to ask Dr. Anthony Fauci the hard questions during the pandemic,” Chicago Tribune, Dec 18, 2024 https://bit.ly/4gXFpHo

Fauci is discussed as a possible pardon candidate over his “disingenuous” testimony before Congress on gain-of-function research. But the author says the real damage from Fauci’s reign was that he was never seriously interrogated. “Your average NFL coach gets more probing questions after the game than Fauci got from the news media.” Instead, they fawned over him and wrote obsequious profiles for National Geographic and the fashion magazine InStyle. “Imagine how differently things might have gone if science journalists had done their due diligence and questioned the experts as they would a municipal official accused of graft. Closer attention earlier on to indoor ventilation in office buildings, nursing homes, meatpacking plants, and prisons might have reduced that number [of deaths]. The information was out there; nobody asked.”

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Anil Oza, “How retractions get weaponized on social media,” STAT, Dec 24, 2024 https://bit.ly/49UX3tj

“Because retractions acknowledge that peer-reviewed research isn’t infallible, they can also strengthen distrust in science and present avenues for scientists to be attacked.” Yeah, bad faith actors can take advantage of an admission of error—so what? We should never cop to a mistake? That seems to be the public health establishment’s position. The author says that when a paper on using hydroxychloroquine for Covid was pulled, social media blew up with accusations that “Big Pharma or the medical establishment had attempted to discredit hydroxychloroquine to push more expensive drugs.” Heaven forfend that we should distrust pharmaceutical companies! The implication is that we should somehow fix things so that people don’t fall for outlandish tales. Yeah, that’s called censorship.

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Aneri Pattani, “How are states spending opioid settlement cash? We built a database of answers,” KFF Health News/NPR, Dec 16, 2024 https://bit.ly/3PoQo0J

A slurry of cash is flowing to states, cities, and counties to repair some of the damage from the opioid epidemic. Where is that money going, who is getting it, and is it doing any good? Some good treatment programs are funded through it, some of it is spent on inoffensive but probably ineffective stuff, some of it beefs up police forces or goes into the general fund, and a full third of all the money is not tracked at all. One big issue for even the best programs: what happens when the opioid settlement money dries up?

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Rebecca Raney, “Pesticide-related PAC money surges into state legislatures as companies seek to limit damage awards in court,” U.S. Right To Know, Oct 31, 2024 https://bit.ly/40cGR38

As people are successfully suing pesticide companies for their cancer diagnoses, the producers are buying their way into state legislatures to sidestep legal exposure. Industry have poured hundreds of thousands of dollars to state pols. Top goals: limits on tort damage awards, stopping bans on their products, and blocking labeling standards.

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Juan Cole, “With Israel’s destruction of Kamal Adwan Hospital, UN Rapporteur calls for global medical boycott,” Informed Comment, Dec 31, 2024 https://bit.ly/4gsxGBr

Francesca Albanese, the UN Special Rapporteur for the Israeli-Occupied Palestinian Territories, told medical professionals to “sever all ties with Israel as a concrete way to forcefully denounce Israel’s full destruction of the Palestinian healthcare system in Gaza, a critical tool of its ongoing genocide.” It’s not the first call for a medical boycott. Doctors isolated German scientific and medical establishment during World War I.

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