SINGLE PAYER LINKS #382

21 FEB 2025

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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

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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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