Mar 30, 2021

“In the American system of health care, you are not a consumer. You are not a customer. You are the product.” –Dr. Abdul El-Sayed

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Nurses’ Campaign for Medicare for All, “What’s next in the fight for Medicare for All?” March 2021

“Our job as a movement is to keep organizing locally, district by district, to pressure more members of Congress—particularly the Democrats who still don’t support Medicare for All and sit on key committees.” The nurses are targeting 19 of them [listed in the attachment below]. They are also exposing and targeting campaign cash from M4A opponents like Partnership for America’s Health Care Future.

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Daniel McGraw, “Joe Biden just fixed Obamacare’s ‘subsidy cliff,’” The Bulwark, Mar 24, 2021

Define “fixed”! The cutoff point for federal subsidy assistance to meet one’s insurance premiums is called “one of Obamacare’s lingering problems.” And this is a surprise because . . . The huge costs of marketplace policies made compulsory insurance virtually unusable for middle-income families. Now, instead of the “public option” that Biden promised during the campaign (to head off enthusiasm for M4A), we get increased bonuses for private insurers. Republicans are likely to not fight too hard over it while complaining about deficits and how relatively well-off people are getting handouts: “A family of four with an income of $120,000 will save about $7,000 a year.” The “savings” will be made up by U.S. Treasury payments to Aetna et al.

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Chris Mamula, “The new COVID relief bill has slashed Obamacare health insurance premiums—that’s good news for early retirees,” MarketWatch, Mar 23, 2021

Probably good electoral politics, too—at a hefty price. Caveat: “This new legislation is in effect for only two years. There will be a midterm election then. The political winds may shift again.”

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Noam N. Levey, “Democrats gave Americans a big boost buying health insurance. It didn’t come cheap,” Kaiser Health News, Mar 24, 2021

“Health care researchers consider this move a short-term fix for a long-term crisis, one that avoids confronting an uncomfortable truth: The only clear path to expanding health insurance remains yet more government subsidies for commercial health plans, which are the most costly form of coverage.” The government will shell out next year “more than $8,500 for every American who gets a subsidized health plan through insurance marketplaces created by the ACA, up 40% from the cost of the marketplace subsidies in 2020.” And this is before the deductibles.

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Jessie Hellmann, “Health care industry groups back ObamaCare reforms proposed by Democrats,” The Hill, Feb 10, 2021

Insurance, doctors, and hospitals unite behind Biden’s plans to “build on” the ACA. Note the disappearance of the public option that the “moderates,” including Biden, were all over during last year’s campaign. Same playbook as 2009: first, dispatch M4A “in favor” of the public option alternative; then, wipe away the public option in favor of an industry-friendly partial measure; finally, emit pious phrases such as the following: “While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable health care market that provides access to high-quality care and affordable coverage for all.” That boilerplate was co-signed by America’s Health Insurance Plans (AHIP), the American Hospital Association, the American Medical Association, and the U.S. Chamber of Commerce.

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Lanhee J. Chen, Tom Church & Daniel L. Heil, “A public option for health insurance could be a disaster, especially in times of crisis,” STAT, Feb 11, 2021

Just in case anyone missed the converging consensus among the mainstream and the big industry players, here come the right-wing think tanks to shoot the public option in the neck.

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Harris Meyer, “As drug prices keep rising, state lawmakers propose tough new bills to curb them,” Kaiser Health News, Feb 12, 2021

“Fed up with a lack of federal action to lower prescription drug costs,” state legislators are kicking around their own ideas. Among those taking steps: Hawaii, Maine, North Dakota, Oklahoma, Rhode Island, Colorado, Florida, Maryland, Massachusetts, and Washington. Contender for worst offender: AbbVie’s blockbuster Humira for rheumatoid arthritis, which sells for 80% less in Europe where competitor drugs are on the market. 

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John Ingold, “To fix soaring prescription costs, Colorado lawmakers have a new plan: A board to cap drug prices,” Colorado Sun, Mar 17, 2021

States are acting while the Federal Government is paralyzed. “The board will have the authority to set maximum prices that can be charged in Colorado for those drugs deemed unaffordable. No other state in the nation currently has a board that does that.” Yet.

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Sarah Ganz, “Prescription-drug prices keep rising in the pandemic. Yet public opinion of the pharma industry is soaring too,” Philadelphia Inquirer, Mar 18, 2021

“Prior to the coronavirus pandemic, tackling the high cost of prescription medication was a rare unifying cause for Republicans and Democrats.” But the latest poll shows positive opinions of drug companies rose from 32% to 62% in the last year.

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Helaine Olen, “Opinion: Bernie Sanders wants to remind you the pharmaceutical industry is still ripping Americans off,” [opinion] Washington Post, Mar 24, 2021

Despite Pharma’s glowing rep post-vaccine, Sanders is pushing three actions to stop price-gouging: enabling Medicare to negotiate prices; pegging prices to international standards; and authorizing imports from Canada and elsewhere. No other country lets Pharma decide how much government money it should have.

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Bruce Schreiner, “Beshear [KY governor] signs bill to cap out-of-pocket insulin costs,” Associated Press, Mar 22, 2021

Limits insulin costs to $1 a day for people on state-regulated health plans. Down from $1000 a month for some residents now. Vote was unanimous.

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Bossier Press-Tribune [Louisiana], “Senate passes two pieces of Cassidy legislation to lower prescription costs,” March 11, 2021  

Closes a loophole “to prevent awarding market exclusivity to products that do not represent true innovation and unduly delay cheaper generics from entering the market.” Interesting that Republicans are eager to take credit for reining in the pharmaceutical companies.

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Chris Christie, “Governor’s [OH] plan will ‘substantially’ lower prescription drug costs,” [opinion] Columbus Dispatch, Mar 22, 2021

Christie tries to stay relevant by publishing fawning columns in out-of-state newspapers about other Republicans. Everyone is piling on to the issue of “solutions” for out-of-control drug prices.

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Julie Calley & Abdullah Hammoud, “Bipartisan legislation would lower prescription drug cost,” [opinion], Detroit Free Press, Mar 22, 2021

Two state representatives in Michigan on their bill to expose the workings of the PBMs.

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Bob Herman, “Centene’s CEO made $59 million in pandemic year,” Axios, Mar 4, 2021

A tidy 50% increase for CEO Michael Neidorff who exercised stock options while laying off 6% of his workforce “in an effort to increase profits”—in his own words.

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Kris Tripplaar, “Ohio sues Centene over millions in alleged pharmacy benefits overcharges,” Modern Healthcare, Mar 11, 2021

“By contracting with multiple sister companies, [Attorney-General] Yost alleged that Centene filed reimbursement requests for amounts already paid by third parties, artificially inflated drug dispensing fees and didn’t accurately disclose the true cost of its pharmacy services.” The state A-G accuses Centene of “conspiracy to obtain Medicaid payments through deceptive means.” If found guilty, Centene will pay a fine.

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Douglas MacMillan & Kevin Schaul, “Congress questions drug companies on opioid settlement tax deductions,” Washington Post, Mar 4, 2021

Should the drug companies that together paid $26 billion to settle claims over the opioid debacle get to deduct the fines from their taxes? Immoral but not illegal. To avoid this sort of cynicism, next time indict individuals rather than corporate structures.

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Lachlan Markay, “Former aides to new Biden Cabinet members cash in,” Axios, Mar 24, 2021

“On Tuesday, within days of Xavier Becerra’s confirmation as secretary of Health and Human Services, lobbying firm Ferox Strategies announced it had hired his former chief of staff. Debra Dixon, who led Becerra’s House office, registered to represent three new clients for the firm, including pharmaceutical company Eli Lilly.” My boss and I “share the same values,” said Dixon. Good to know.

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Christina Jewett & Lauren Weber, “Birx joins air-cleaning industry amid land grab for billions in federal Covid relief,” Kaiser Health News, Mar 24, 2021

Birx, one of faces of The Science under Trump, joins ActivePure Technology, formerly the Electrolux vacuum company, “one of many in a footrace to capture some of the $193 billion in federal funding to schools.” Though not everyone agrees that the company’s technology works, Birx’s presence should guarantee hefty sales, and she knows how to stand quietly by when people make outrageous claims.

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Marian W. Wentworth, “Covid-19 could bring a new era of public health leadership. But will it?” STAT, Mar 5, 2021

STAT’s shoulds: strengthen national health systems; improve data management and sharing; boost the community health workforce; give a “bigger stake” to the private sector; “restore trust.” Not a word about changing the payment model—unsurprising for a medical reporting outfit that depends upon the industry for its daily bread. Betteridge’s Law of Headlines states: “Any headline that ends in a question mark can be answered by the word no.”

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Melinda B. Buntin & Kristine Martin Anderson, “The pandemic slingshot: Propelling from national crisis to a resilient health care system,” STAT, Feb 22, 2021

Another thumb-sucker about all the innovations that took place during the pandemic with no mention of healthcare finance despite Buntin’s job as a professor of “health economics” at Vanderbilt.

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David Wallace-Wells, “How the West lost Covid,” New York, Mar 15, 2021

Speculation on whether the West could have halted Covid as occurred in Taiwan and Australia and whether “pandemic Orientalism” reigned in our national discourse. “For decades, the richest nations of the world had told themselves a story in which wealth and medical superiority offered, if not total immunity from disease, then certainly a guarantee against pandemics, regarded as a premodern residue of the underdeveloped world. That arrogance has made the coronavirus not just a staggering but an ironic plague. Invulnerability was a myth, of course, but what the pandemic revealed was much worse than just average levels of susceptibility and weakness. It was these countries that suffered most, died most, flailed most.” Interesting details and a corrective to the Fauci myth, plus an analytical distinction between the clinical and the public health perspective.

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Joyce Frieden, “U.S. drug prices should be lowered—but how?” MedPage Today, Mar 23, 2021

A review of the different approaches to reining in Pharma: Bernie (enable Medicare to negotiate) vs. GOP (“innovation”). Another proposal: stop patent abuse, e.g., by requiring head-to-head testing of drugs touted as “new, improved” versions.

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Nisarg Patel, Daniel Liebman & Smitha Ganeshan, “If we want to defeat Covid, we need to boost Medicaid,” Politico, Feb 8, 2021

“Medicaid is more important now than ever but also at its most vulnerable. Its enrollment and spending increase during economic downturns, meaning that just when it’s needed most, states may be forced to slash Medicaid spending.” Like Cuomo tried to do even before Covid.

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Robert P. Kocher, Soleil Shah & Amol S. Navathe, “Overcoming the market dominance of hospitals,” JAMA, Feb 19, 2021

Paywalled but ask me if you want to read the whole thing. “Hospital consolidation in the past decade has not improved quality. Additionally, legal limitations have weakened the ability of the Federal Trade Commission (FTC) to enforce antitrust rules on nonprofit hospitals, even though these hospitals are involved in most hospital and health system mergers.” In one 18-month period, hospitals acquired “8,000 medical practices, and 14,000 physicians left private practice to become employed by hospitals.”

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Gaby Galvin, “About 7 in 10 voters favor a public health insurance option. Medicare for All remains polarizing,” Morning Consult, Mar 24, 2021

68% of voters (Ds 80%, Rs 56%) support a public health insurance option. “The pandemic has exposed all of the holes in our existing health care safety net and how fragile our employer-based system is, but it doesn’t seem to be that the higher level of awareness is translating into support for Medicare for All.” Not with mainstream Dems attacking it. Support for the public option is always promoted when M4A is a threat; once that’s over, the public option will be attacked instead.

Mar 22, 2021

HEALTHCARE FINANCING

Dean Baker, “The big Biden move on health care and making Medicare for All affordable,” Patreon, Mar 16, 2021

Long-form discussion of the boost to ACA subsidies in the Covid relief bill, including the 8%-of-income cap for insurance premiums. The move temporarily makes insurance more affordable for more people at the cost of more billions going into for-profit coffers. One perhaps unintended side-effect: “Employers are likely also in many cases to stop offering insurance to effectively share the savings with their workers.” Further weakening of employer-based insurance is good, and the cost pressures will make arguments for M4A stronger.

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Ryan Grim (podcast & transcript), “Medicare for All just got a massive boost,” The Intercept, Mar 19, 2021

The reintroduced M4A bill now is co-sponsored by a major Dem hierarch who also will hold hearings on it as chair of the House Energy and Commerce Committee. The bill’s author, Pramila Jaypal, has some interesting comments in this interview about the legislative process and its utility for educating members on the fence. Also includes an interesting discussion with the author of a new book on what is changing for doctors: “It’s no coincidence that the median doctor now believes in single-payer health care. Young doctors know that they have been victimized by the system that has been victimizing patients for decades now.”

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Lanhee J. Chen & James C. Capretta, “We can improve health care. It just takes compromise,” New York Times, Jan 26, 2021

How do Mr. Chen (Hoover Institution) and Mr. Capretta (American Enterprise Institute) suggest we go about it? By “setting aside ideological ambitions”! Bipartisan solutions that Republicans will sign off on are the way to go, i.e., keep things mostly as they are and boost free-market solutions such as convoluted improvements to healthcare shopping since “consumers often have little incentive to find lower-priced options.” Those pesky heart attacks.

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Gerald Friedman & Travis Campbell, “Medicare expansion is a discount compared to Obamacare,” The Hill [opinion], Feb 2, 2021

The authors address runaway healthcare costs and insist that Medicare, “which has a scale and simplicity that allow the administrative efficiency and market power needed,” is the solution. “Every person who moves from private health insurance to Medicare lowers our national health care bill.”

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Donald R. Frey, “The Haven debacle shows the need to adopt Medicare for All,” Omaha World-Herald, Mar 4, 2021

More on the gigantic flop of the Amazon-Berkshire Hathaway-JP Morgan Chase experiment: “To date, there’s been no evidence of meaningful innovation [from Haven]. Advocates of market-based health care are now scratching their heads. If three of America’s most successful business leaders can’t solve our country’s health care cost dilemma, who can?” Gee, I dunno. “If we continue to just nibble incrementally around the edges of our health care crisis, we should expect our results to be no different than those of Haven.”

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David Engel et al., “Fraud is rampant in Medicare Advantage,” MedPage Today, Mar 13, 2021

“Can a patient have and not have diabetes at the same time? According to private insurers participating in the Medicare Advantage program, the answer is yes.” The scam of upcoding and downcoding to increase reimbursements and reduce payouts.

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Alexandra Ellerbeck & Paige Winfield Cunningham, “Hospitals drag feet on new regulations to disclose costs of medical services,” Washington Post, Jan 25, 2021

“Hospital compliance is spotty.” Will anyone enforce the new law? Some hospitals “only posted price estimates, uploaded files in difficult to use formats, or promised to release information only after someone inputs their insurance.” Fines are $300 a day—couch lint.

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Dominique Vervoort, “Meet the law office leeching off the pandemic,” MedPage Today, Mar 15, 2021

How hospitals “got lured into the business of suing their patients after caring for them.” In Virginia, 36% of hospitals garnish wages. However, bad publicity often makes them scramble to stop the practice.

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VACCINES

Alex Pareene, “Most of the world has a simple vaccine request. America isn’t listening,” New Republic, Mar 15, 2021

The request: the right to manufacture their own vaccines. The block: insistence on patent rights amidst a worldwide health emergency. Principal backer of patent rights: saintly Bill Gates. “When our corporate press talks about international vaccine production and distribution, it tends to treat the existing intellectual property regime as sacrosanct—almost akin to an immutable natural law—and not something imposed on the rest of the world largely by the U.S.” 

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Jerri-Lynn Scofield, “Indian vaccine manufacturers: U.S. use of wartime export controls threatens world vaccines production,” Naked Capitalism, Mar 15, 2021

In normal times, India produces over half of all vaccines in the world, but the Defense Production Act is causing shortages of intermediate goods (aside from the patent issue). Isn’t it curious how the U.S. can act as a single healthcare authority when defending multinational corporations and their profits but wouldn’t dream of doing the same to actually deliver health care?

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Jake Johnson, “‘Disturbing’: Rich nations vaccinating person per second while blocking effort to share recipe with poor countries,” Common Dreams, Mar 14, 2021

“Vaccine apartheid”—rich countries quickly vaccinate, everyone else will wait two or three years. How long will it take for a variant to develop in, say, Nigeria that ends up restarting the whole thing?

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Lee Fang, “Drugmakers promise investors they’ll soon hike Covid-19 vaccine prices,” The Intercept, Mar 18, 2021

Pfizer, Moderna, and Johnson & Johnson pledged affordable vaccines—but only during the “pandemic.” Once that is officially over, says Frank D’Amelio, CFO of Pfizer, “we think there’s a significant opportunity for our vaccine from a demand perspective, from a pricing perspective.” English translation: we can make a mint. Pfizer expects to bank a profit of $4 billion this year on sales of $15 billion; total U.S. government spending on vaccines: $18 billion. One obstacle: the “optics” of raiding the public purse.

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DRUG PRICING

Bobbi Sheldon, “State releases next step in plan to import prescription drugs from Canada,” 9News/NBC, Jan 25, 2021

States struggle to find ways to curb drug costs as the Federal Government remains crippled by industry lobbies.

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Max Richtman, “With a new president and a new Congress, it’s time for Medicare drug price negotiation,” The Hill [opinion], Jan 20, 2021

Reviews the rich rhetoric and poor performance of Congress on drug pricing. The author is “president and CEO of the National Committee to Preserve Social Security and Medicare.”

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Madison Black, “Why are insulin prices going up? Chuck Grassley explains it,” PolitiFact, Feb 2, 2021

Insulin costs twice as much now as it did less than a decade ago. Grassley (R-Iowa) has been denouncing it for years, blames PBMs, pharmacies, and drug companies. Would Grassley break ranks with fellow Rs to allow Medicare to negotiate drug prices? No evidence for that so far.

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CUOMO/NURSING HOMES

Sidney Madden, Braeden Waddell & Yanqi Xu, “Industry lobbying left nursing homes vulnerable,” North Carolina Health News, Mar 7, 2021

“The long-term care industry has long used its political influence to push against reforms that would have increased staffing requirements, training, transparency and oversight. Now, the industry is pushing for—and in some states, successfully passing—legislation to shield nursing home owners from lawsuits during the pandemic.” They learned from Cuomo.

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Cheryl Clark, “Why 130,000 nursing home patients died of COVID-19,” MedPage Today, Mar 18, 2021

Minimum wage workers “were so short-staffed at the facility in Greenville, Rhode Island, they had to choose which of their dying patients needed care first.” But when the company (Genesis) got a government bailout, it awarded its outgoing CEO a $5.2-million-dollar bonus.

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Caroline Lewis, “Cuomo pushes cuts to safety-net hospitals after they stepped up during pandemic,” Gothamist, Mar 17, 2021

No good deed goes unpunished. “The state Health Department routinely seeks to close, shrink, or merge safety-net hospitals that are losing money, which often reduces the capacity for patients. These strategies are left over from a Pataki-era task force on hospitals known as the Berger Commission, whose policies have contributed to the loss of 20,000 hospital beds across the state over the last 20 years.” Bipartisanship! Good detail on various hospitals in our area.

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Joe Sexton, “Cuomo’s nursing home scandal raises questions for one of his senior aides,” ProPublica, Mar 10, 2021

“Jim Malatras stood by a Cuomo administration report on nursing home deaths he knew undercounted the true loss of life. Today, he is chancellor of New York State’s public university system.” Failing up.

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David Scales & Devin Worster, “This fertilizer king funneled Cuomo $1 million—and got a New York health-care empire,” Daily Beast, Mar 9, 2021

Brutal must-read of the week. “He’s an international man of mystery—a reclusive billionaire who once bought a lower Manhattan skyscraper in cash. He’s cut multimillion-dollar business deals with now-sanctioned figures in Russian autocrat Vladimir Putin’s circle. And thanks in part to Gov. Andrew Cuomo and his administration, he was left in charge of the health and well-being of thousands of poor and elderly New Yorkers throughout the COVID-19 pandemic.” Who needs public health “experts”? “The vast domain Rovt built with his state contracts, grants, and approvals were the scene of some of the [Covid] outbreak’s worst carnage.”

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Dalia Faheid, “Undocumented immigrants sought far less health care after Trump launched his campaign, new study shows,” STAT, March 22, 2021

As predicted: a 34.5% fall in adult primary care visits and 43.3% for children’s. Ideal for pandemic control, of course.

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The Oregonian/AP, “Oregon Senate wants voters to make health care a fundamental human right,” Mar 18, 2021

The state may vote on a constitutional amendment to that effect.

Mar 15, 2021

Emmarie Huetteman, “Pandemic aid package includes some relief from high health plan premiums,” Kaiser Health News/NPR, Mar 9, 2021

The Covid relief bill’s changes will help some people, like Stephanie Salazar-Rodriguez of Denver, who was facing more than $10,000 in health insurance premiums this year and will now get a subsidy for $7000 of that. The Federal Government will pay the difference though Stephanie’s insurance company will still decide when (and if) she gets treatment. Since the Biden wing won’t contemplate the sweeping changes required of a truly universal plan, they can only tinker with the clunky rules governing Obamacare to make them less clunky. “Republicans hammered Democrats over the years that many of the marketplace plans are not affordable”—correctly! The changes are only temporary and will have to be refought to become permanent.

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Michael Ollove, “Biden aims to build on Obamacare’s cost-cutting measures,” PEW/Stateline, Mar 8, 2021

Biden’s proposals to reduce costs: the public option, price negotiations by Medicare (currently prohibited), blocking further hospital consolidation, outlawing surprise medical billing, and more “transparency.” Obamacare slowed growth in per capita health spending, in part by cutting Medicare reimbursement rates and generating incentives for insurance companies “to negotiate better [lower] reimbursement rates with medical providers.”

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Hadley Heath Manning, “Biden’s slow creep toward ‘Medicare for all,’” Washington Examiner, Feb 12, 2021

From your lips to God’s ear. . . A right-wing paranoid fantasia—unfortunately. The author’s key metric: the number of Americans who depend on the government to pay for their healthcare, now 138 million or 44% of the population, which “makes reforming these entitlement programs politically difficult.” The author argues that halfway measures like the ACA are relentless steps along the slippery slope to M4A rather than ways to keep healthcare in private hands while the government pays. “It’s almost as if the remaining large insurers are simply competing for the government contract to manage a single-payer program, whenever that might one day be enacted, likely as a response to ‘dwindling market competition.’” Hope she’s right!

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Andrew Perez, “Dems’ gift to health insurance predators,” Daily Poster, Feb 24, 2021

Here’s a completely different view: “Democrats want to pay billions to put Americans on expensive corporate health insurance plans rather than expand Medicare or create a public option.” Complains that the Covid relief bill only temporarily lowers premiums, doesn’t stop out-of-pocket copayments and deductibles, and pushes people onto the exchanges for expensive plans in which “one in six in-network medical claims were denied in 2019.” Still uninsured: 28 million.

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Los Angeles Times, “Congress wants to make health insurance more affordable — but only for some, and only temporarily” [Editorial], Mar 9, 2021 

“Combined with steadily rising deductibles, high premiums have been one of the biggest challenges not just for the ACA but for the entire U.S. healthcare system. Higher subsidies are a straightforward response to the growing costs, but they’re the equivalent of a pill that treats the symptoms without curing the disease.”

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Wendell Potter, “COVID bill is a windfall for health insurance companies,” Tarbell, Mar 10, 2021

Potter: “No one will be more excited about the new COVID-19 package than my old friends in the corporate insurance industry.” Increased premium subsidies will funnel $48 billion of federal funds to them, “after their most profitable year to date.”

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Rachel Cohrs, “With the ear of Joe Manchin, West Virginia hospitals helped secure billions in new Covid relief funds,” STAT, Mar 9, 2021

An $8 billion payoff to secure the 51st vote on the Biden relief package. A top beneficiary: WVU Health System, which “overtook Walmart in 2016 to become the state’s single largest private employer.” At least for once it wasn’t the consolidated urban hospital systems getting all the loot.

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Washington Post [Editorial], “Congress just brought the country closer to universal health-care coverage,” Mar 14, 2021

Another sunny view: the Covid relief bill has “a major down payment on Mr. Biden’s promise to build on Obamacare and move the nation closer to universal coverage without excessive cost or disruption.” How will this work? More Medicaid expansion (take that, Hadley Heath!) and higher subsidies for those purchasing marketplace plans. Getting more people into the insurance pools will drive premium costs down, and “the whole system will be more stable.” Sounds great, albeit magical. Democrat plans always include intricately complex eligibility requirements rather than across-the-board universal benefits.

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Noam N. Levey, “Why Biden has a chance to cut deals with red state holdouts on Medicaid,” California Healthline, Feb 17, 2021

“The opportunity emerges as the covid-19 pandemic saps state budgets and strains safety nets. That may help break the Medicaid deadlock in some of the 12 states that have rejected federal funding.” Among those shut out of Medicaid due to state refusals: 1.5 million low-income Texans and another 800K Floridians.

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Michael Ollove, “Wyoming edges closer to Medicaid expansion,” PEW/Stateline, March 9, 2021

“Buried in President Joe Biden’s COVID-19 relief bill is a provision intended to entice 12 holdout states to extend health coverage to more low-income adults by expanding Medicaid under the Affordable Care Act. The strategy appears to be working.” Another hold-out state inches closer to Medicaid expansion. Statewide budget shortfalls are a powerful incentive.

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Alex Pareene, “Why are troops leading the vaccination effort?” New Republic, Mar 2, 2021

“America’s armed forces are stepping in for the dismantled state.” Other activities being handled by the National Guard’s “coronavirus missions”: food banks, testing sites, processing unemployment benefits, handing out PPE. “In other words, the National Guard was simply doing various essential tasks the pandemic revealed our state was too broken to handle. The military is state-building in the U.S.”

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Joanne Kenen, Adam Cancryn & Darius Tahir, “Biden vaccine website pledge invokes the ghosts of Obamacare,” Politico, Mar 12, 2021

The co-director of this ambitious IT rollout? Jeff Zients, leader of the Obamacare HealthCare.gov website. What could go wrong? OTOH, improving on the states’ performance won’t be hard.

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Rachel Cohrs, “Andrew Cuomo’s Covid-19 nursing home fiasco shows the ethical perils of pandemic policymaking,” STAT, Feb. 26, 2021

Cuomo would not have been faulted for hasty decisions amid an emergency, but he made two fatal errors: he pushed everyone else aside so that he could be the sole owner of state policy (and the limelight), thus making himself solely responsible for mistakes. Second, he exploited that power to obscure public health data for personal gain. 

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Steve Cohen, “Instead of prior authorization, insurers should go back to the old ‘pay-and-chase’ model,” STAT, Mar 11, 2021

“The news Jennifer G. and her husband got from her medical team was devastating. If you had come to us a month sooner, they said, we would have used chemotherapy to treat your cancer. But because of the delay, we have to amputate your leg, your hip, and your pelvis.” Horror tales of prior authorization and automatic denials. “Doctors report that 20% of patients always or often abandon the treatment their doctors have recommended while awaiting authorization; and another 55% sometimes do.” How innovative!

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Ed Silverman, “‘Deeply problematic’: AmerisourceBergen rewards its CEO despite the ravages of the opioid crisis,” STAT, Mar 11, 2021

Because the company “excludes the costs of legal settlements in evaluating executives,” it set aside a tiny detail in calculating the top guy’s bonus: the $6.6 billion fine the firm paid for its role in tens of thousands of deaths from drug overdoses. The state treasurers of Rhode Island and Connecticut were not pleased. “The payout reflects poorly on AmerisourceBergen’s broader culture,” they wrote, illustrating the figure of speech known as “understatement.”

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David Tuller, “For Covid ‘long haulers,’ battling for disability benefits adds aggravation to exhaustion,” Kaiser Health News, Mar 10, 2021

More on the perverse situation faced by people who can’t prove they ever had Covid in the first place. “Around 30% of patients who had tested positive for the coronavirus still reported symptoms when they were surveyed one to 10 months later.” But if you didn’t get a test in the early days, you have to fight with lawyers to get coverage—hopefully without “brain fog.”

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L. J. Dawson, “Without COVID safety net, immigrants in U.S. illegally fall through cracks,” Health News Florida, Mar 9, 2021

An estimated 4 out of 5 of the country’s 11 million undocumented immigrants work in essential jobs, are more likely to get sick, and have no access to the relief benefits.

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Eric Lach, “Andrew Cuomo’s refusal to vaccinate inmates is indefensible,” New Yorker, Feb 13, 2021

Prisoners don’t get the jab, but corrections officers were included in the first-phase priority populations. Maybe now that he’s been stripped of his hyper-powers, the other 200 elected officials can set policy instead of one guy. Not precisely a single-payer issue, but a good example of overall bloody-mindedness.

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Sen. Greg McCortney, “Lower prescription costs essential to better health outcomes” [Opinion], The Oklahoman, Mar 7, 2021

A Republican state legislator in a bright-red state cites Trump in supporting curbs on drug prices. “Oklahomans can’t afford the drugs they need because drug companies inflate prices in the United States so they can sell them cheaper in Canada.” So if everyone agrees, why is action on this issue always blocked?

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Dean Baker, “The New York Times has not heard of China’s (or Russia’s) vaccines,” CEPR, Mar 4, 2021

A lengthy NYT podcast giving a tongue bath to Bill Gates for his “efforts to make vaccines available to the developing world” had nothing to say about Sputnik or Sinovac—the two vaccines reaching most of the aforesaid “developing world.” Baker: “Are New York Times reporters prohibited from talking about the Chinese and Russian vaccines?” Maybe not explicitly. Gates is also the No. 1 obstacle to suspending patent exclusivity on vaccines and putting them in the public domain.

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John McEvoy, “Washington pressured Brazil not to buy ‘malign’ Russian vaccine,” Brazil Wire, n.d.

Tucked away inside an HHS report: “OGA’s [HHS’s Office of Global Affairs] Health Attaché office persuade[d] Brazil to reject the Russian COVID-19 vaccine and offered CDC technical assistance in lieu of Panama accepting an offer of Cuban doctors.” Meanwhile, Brazil dawdled and ending up buying the more expensive AstraZeneca version. The comment appeared under the subheading “Combatting malign influences in the Americas.”

Mar 4, 2021

Nick Corbishley, “Pfizer’s sordid vaccine sales practices in Latin America could be a big boon for China and Russia,” Naked Capitalism, Mar 2, 2021

Trump moved to hoard vaccines for Americans, ignore needy countries with less disposable cash, and guarantee bonanzas for Pharma. Thus empowered and enriched, Pfizer tried to extort insane concessions from foreign buyers—that didn’t always work. Some turned to Chinese and Russian alternatives as well as the AstraZeneca-Oxford option from the U.K. “Five LatAm countries—Uruguay, El Salvador, Guatemala, Honduras and Cuba—still hadn’t received a single vaccine from overseas as of last week.” Cuba has produced its own vaccine, not yet approved for use.

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Abdul Qadir Sediqi, “China to provide Afghanistan with 400,000 doses of COVID-19 vaccine,” Reuters, Mar 1, 2021

Apparently, it was too much to ask the country occupying the place for the last two decades to provide any. Afghanistan also got a half-million doses from India.

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Ilarik Kaila & Joona-Hermanni Makinen, “Finland had a patent-free COVID-19 vaccine nine months ago—but still went with Big Pharma,” Jacobin, Feb 28, 2021

“A team of leading Finnish researchers had a patent-free COVID-19 vaccine ready last May, which could have allowed countries all over the world to inoculate their populations without paying top dollar. Yet rather than help the initiative, Finland’s government sided with Big Pharma.” A stunning example of how the patent system overrules everything else, including common sense, and effectively slows down R&D because it “incentivizes companies to conceal their findings from each other and from the wider scientific community.” But isn’t Finland a social-democratic paradise? “Mirroring a general trend among its counterparts, the ruling Social Democratic Party began to remodel itself in the 1990s after Tony Blair’s New Labour and the Clinton Democrats. In 2003, Finland’s national vaccine development program was discontinued after 100 years in operation.”

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Dean Baker, “To prevent the resurgence of the pandemic, can we talk about open-source research?” Center for Economic and Policy Research, Feb 26, 2021

Covid mutations may leave us in a “whack-a-mole situation, where we have to constantly alter our vaccines and do new rounds of inoculations.” The patent model won’t help things (see above). Why should, for example, Pfizer, reveal that its vaccine is not effective against a given strain?

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Competition Policy International, “New Mexico opens suit against Gilead, Bristol-Myers, Teva over HIV meds,” Feb 25, 2021

Antitrust for price-fixing alleging the companies “engaged in coordinated schemes to suppress the entry of cheaper generic versions of each drug into the market and to delay the development of safer drugs.” The HIV advocacy world has long battled Pharma over its death-dealing practices, occasionally winning.

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Emmarie Huetteman, “4 vital health issues—not tied to Covid—that Congress addressed in massive spending bill,” Kaiser Health News, Jan 28, 2021

Some surprising measures that got lost in the post-election noise: a ban on surprise medical bills, money for training new doctors to fill the rural provider gap, a boost for mental health coverage in insurance policies, some data collection measures that “could be used to rein in high medical bills.” Also included was another blow to industry secrecy: a ban on so-called gag clauses in contracts between health insurers and providers.

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Cyrus Farivar & April Glaser, “Why big tech isn’t dominating the vaccine rollout,” NBC News, Feb 27, 2021

“If Amazon can deliver a phone charger in two days, why can’t it use its logistical prowess to speedily vaccinate a nation? With all the data that Google collects about its users, why can’t it track down and identify who needs a vaccination?” Turns out public health infrastructure can’t be replaced with an algorithm. Who knew?

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Steven T. Dennis, “Biden’s relief plan threatens to trigger Medicare cuts,” Bloomberg, Feb 26, 2021

“The spending cliff is entirely of the Democrats’ making. Under the 2010 Pay-As-You-Go law passed by Democrats and signed by then-President Barack Obama, spending increases and tax cuts that add to the deficit—like Biden’s plan—trigger automatic cuts the following calendar year.” Austerity madness, Democrat-style. PayGo was waived for Trump’s massive 2017 tax cut on a nobly bipartisan vote of 91–8.

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Helena Bottemiller Evich, “Parents erupt over FDA failure to regulate toxic metals in food,” Politico, Feb 28, 2021

“Four major baby food brands — Beech-Nut, Gerber, Earth’s Best Organic and HappyBABY — sold products that their own internal testing showed contained arsenic, lead, and cadmium at levels far higher than what most health experts consider safe for infants.” But it’s not illegal as “the FDA has not set standards for most heavy metals in baby food”—or any food, for that matter. Market-based innovation is always best.  

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Kaitlin Lange, “Indiana Gov. Holcomb signs COVID liability bill, lawsuit protection,” Indianapolis Star, Feb 18, 2021

Taking a page from the Cuomo playbook. The governor says the measure will prevent “frivolous lawsuits,” but critics note that the law could end up a get-out-of-jail-free card for abuses unrelated to Covid.

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Angela Hart and Rachel Bluth, “New single-payer bill intensifies Newsom’s political peril,” Kaiser Health News, Feb 19, 2021

“The single-payer bill adds to his political peril from the left if he doesn’t express support and from the right if he does.” Industry opponents have united in the “Californians Against the Costly Disruption of our Healthcare.” Costly disruption.

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Melinda B. Buntin & Kristine Martin Anderson, “The pandemic slingshot: Propelling from national crisis to a resilient health care system,” STAT, Feb. 22, 2021

Lauds American “innovations” seen throughout the healthcare system in response to Covid. Curiously, one author (Buntin) is a professor of health economics, but, in her extensive prescription for the future of the industry, has nothing at all to say about how healthcare is paid for—which is a good reason to be skeptical of the focus on “innovation” and all similarly obfuscatory techno-babble.

Feb 24, 2021

Cheryl Clark, “Why Haven’s encounter with reality proved fatal,” MedPage Today, Feb 19, 2021

The promise of the mega-initiative by Amazon, JP Morgan Chase and (Warren Buffett’s) Berkshire Hathaway was going to be nothing short of a miracle: to both lower costs and improve healthcare quality for the three companies’ 150K workers. They had experts! Mountains of cash! A celebrity chief (Atul Gawande)! What could go wrong? Gawande: “On the good side, we designed a coverage model with no co-insurance, no deductibles, no cost for 60 critical drugs, and low-cost mental health services and primary care.” What was the fatal flaw? “We have an employer-based system. A job-based system is a broken system in a world where people are moving every couple of years to different roles and many, many kinds of jobs.” How much did it cost to make that breathtaking discovery?

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Susannah Luthi, “Amazon’s offering to help Biden’s vaccine push. There may be a reason why,” Politico, Jan 23, 2021

“The move could also help the company boost its own ambitions of expanding into the $3.8 trillion health care marketplace. The offer may give Amazon a valuable new trove of health data just as it’s expanding into pharmacy and digital health.” So there may indeed be a reason.

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Bernard J. Wolfson, “Head-scratching over Newsom’s choice of Blue Shield to lead vaccination push,” Kaiser Health News, Feb 1, 2021 

No-bid contract entirely unrelated to the insurer’s history as a major donor to Newsom’s campaigns. Public health officials could find themselves sidelined.

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Darrel Rowland, “After federal OK, Ohio names one state PBM to replace others, save money,” Columbus Dispatch, Jan 11, 2021

Slay the Pharmacy Benefit Manager (PBM) dragon with a counter-dragon: a state-controlled PBM monopoly. Gainwell Technologies “will replace the multibillion-dollar conglomerates such as CVS Caremark and Express Scripts that currently serve as middlemen in the prescription drug supply chain for 3 million poor or disabled [Medicaid beneficiary] Ohioans.” Potential savings: a chunk of the $250 million a year now going to the privates. Downside: Gainwell is a for-profit company backed by private equity. (Ohio is run by Republicans.) Next on the state’s agenda: OhioRISE, a “specialized managed care organization with expertise in providing services for children with complex [read “expensive”] behavioral health needs.”

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Robert King, “Walgreens announces creation of new tech startup aimed at developing comprehensive patient platform,” Fierce Healthcare, Jan 13, 2021

Walgreens’s goal is “a new patient platform that blends physical and digital tools. “We see an extremely complex healthcare system in the U.S. where the patients are confused,” said Walgreens Chief Financial Officer James Kehoe. Kehoe’s solution: “Offer every single patient their choice on who they want to manage their healthcare.” When health corporations say “choice,” place hand firmly over wallet.

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Pamela Wood, “Maryland lawmakers override Hogan vetoes on education, advertising bills,” Baltimore Sun, Feb 12, 2021

Not a health story, but a relevant tax-the-rich story. Maryland will now tax tech giants on sales of internet ads, “potentially raising $250 million per year for the state.”

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Kate O’Flaherty, “Google confirms Fitbit deal: Here’s what it means,” Forbes, Jan 17, 2021

Another notch in the Google monopoly giving it access to your personal health data if you have a Fitbit. Google has already harvested “tens of millions” of medical records for its machine-learning project. “Google has agreed not to use Fitbit users’ health and location data for advertising” as a condition of the deal. Alrighty then!

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Markian Hawryluk, “Amid Covid health worker shortage, foreign-trained professionals sit on sidelines,” Kaiser Health News, Jan 25, 2021

Doctors’ earnings are kept artificially high through restrictions on foreign professionals. (Factory workers, meanwhile, get no protection from low-wage foreign competition.) “Many of the medical professionals stuck on the sidelines have unique skills and experience that would be invaluable during the pandemic.” It could also solve the provider shortage in rural America.

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Jordan Rau, “If this self-sufficient hospital cannot stand alone, can any public hospital survive?” Kaiser Health News/Fortune, Jan 29, 2021

Hospital consolidation (a.k.a. monopolization) is rampant and undermining care while increasing costs: “Numerous studies have found that charges to insurers and patients are higher from hospitals with more market power. One study calculated the premium to be 7% to 9%; another study found 12%.” The strange part is that the hospital in question, New Hanover Regional Medical Center in Wilmington, North Carolina, is solvent, popular, and charges insurers less than its competitors.

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Alex Kacik, “Hospital price growth driving healthcare spending,” Modern Healthcare, Feb 4, 2021

“For inpatient care, hospital prices grew 42% from 2007 to 2014 while physician prices rose 18%.” Consolidation is a major factor. Hospital care absorbs 33% of all health-related spending and virtually 100% of total compensation gains by American workers. “The gains [workers] would have gotten in income have gone toward paying their insurance, and the largest chunk of that goes toward paying their local hospital.” One immediate solution: subject hospital mergers to antitrust enforcement.

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Ayla Ellison, “12 states with the most rural hospitals at risk of closure,” Becker’s Hospital Review, Jan 27, 2021 

“Across the U.S., more than 800 hospitals — 40 percent of all rural hospitals in the country — are either at immediate or high risk of closure.” The 12: Connecticut: 3 hospitals (100 percent); Kansas: 76 hospitals (72 percent); Hawaii: 8 hospitals (67 percent); Alabama: 30 hospitals (63 percent); Mississippi: 41 hospitals (62 percent); Arkansas: 29 (60 percent); New York 30 (59 percent); Tennessee: 30 (59 percent); Oklahoma: 41 (56 percent); Texas: 82 (56 percent); Missouri: 31 (54 percent); Louisiana: 26 (53 percent).

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Jonathan Cook, “By putting Big Pharma’s patents before patients, doctors will further erode trust in experts,” Jonathan Cook Blog, Feb 22, 2021

A curious critique of why we don’t trust our institutions. Lengthy but worth it. The specific case is the trashing of Covid-prophylaxsis research on Vitamin D by the medical establishment while it pumps up lame contrary evidence. But Vitamin D isn’t an expensive pharmaceutical product.

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Vinay Prasad, “Vivek Murthy’s multimillion dollar conflicts are cause for concern,” (opinion), MedPage Today, Feb 22, 2021

Subhead: “The Surgeon General will only treat corporate America’s woes.” Murthy received $2.6 million in consulting and speaking fees after January 2020 (when it was clear he would be an insider in the Biden government). Included: $400K from Carnival cruise lines. The loot will totally not at all influence any actions of his that could affect these businesses such as authorization for Carnival to restart its services. Fun fact: Elizabeth Warren was all over Trump’s appointees for similar payoffs; on Murthy: “Warren’s office did not respond to repeated requests for comment.”

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Andy Miller, “PBMs: Power brokers in the prescription drug world,” Georgia Health News, Feb 10, 2021

State-level action to rein in PBMs is increasingly popular—and bipartisan. Will the Feds follow? Some interesting anecdotes on how PBMs drive up costs and drive out independents. West Virginia saved a bundle by eliminating PBMs from Medicaid.

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Adam Gaffney, David Himmelstein, & Steffie Woolhandler, “Congressional Budget Office scores Medicare-for-All: Universal coverage for less spending,” Health Affairs Blog, Feb 16, 2021  

Policy wonk paradise in 200+ pages: “The report makes many sound assumptions but also some questionable ones that are overly pessimistic. Yet overall, its bottom-line estimates should reassure those concerned about the economic feasibility of single payer.” Main conclusion: single-payer will save money. Good to know though we also know that the cost was never the real reason for opposition.

Feb 17, 2021

Marco D’Eramo, “The biopolitics of nursing homes,” Sidecar, Feb 12, 2021

“In the financialized world of elderly care, each bed corresponds to a patient, causing confusion over what exactly is bought, sold or offered as a guarantee for loans. Normally envisaged as a vortex of derivatives, futures, swaps, and options, it’s somewhat strange to imagine international finance as an emporium of impaired senior citizens. But that is how it is.” Chilling details of how grandma is now a financialized commodity. “Without [nursing homes], our entire mode of social organization would be impracticable. The much-acclaimed ‘flexibility’ of modern labour tacitly requires dismantling the extended family and atomizing life itself.”

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Bloomberg [Editorial], “How to end surprise medical bills,” Feb 9, 2021 https://bloom.bg/3u39AFz

Interesting sentiments from a financial news site: “The scandal of surprise bills has been tolerated far too long. The new law is an important step forward—but it’s too soon to declare it a success. First, it must be made to work.” The editorialists point out possible loopholes in the new law (included in the December Covid relief package) that billers could exploit. The process of writing precise regulations to govern the arbitration procedure will have to be watched closely as that’s where lobbyists shine.

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Joyce Frieden, “Insurer, provider groups slam final prior authorization rule,” MedPage Today, Jan 19, 2021

Insurance companies are mad as wet hens, so something good must be in the new regs, set to take effect in 2023. On the other hand, prior authorization, the laborious and costly process that absorbs 1/6 of all provider work time, isn’t substantially simplified—nor can it be with multiple payers eager to delay or deny care. Outgoing Trumpers rushed the process through by “reviewing” thousands of pages of comments in only 9 business days, so everything is likely to be tied up in the courts. Even safety-net plans aren’t on board despite supporting some of the measures included.

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Nathan J. Robinson, “The definitive case for ‘Medicare For All,’” Current Affairs, Feb 3, 2021

A review of what looks like a must-read new book: Medicare for All: A Citizen’s Guide. (Authors will speak Mar 2 at an 8 pm PNHP webinar—here’s the Zoom ID: 815 6291 2159 pw: 835306). “Medicare for All: A Citizen’s Guide is structured simply. First, it looks at what is wrong with the U.S. healthcare system and why it has been so difficult to fix. Next, it explains how Medicare for All would work. Finally, it looks at how we can actually get M4A implemented despite the range of entrenched interests thwarting it.”

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Dylan Scott, “What Biden should do if he’s serious about bringing down US health care costs,” Vox, Feb 1, 2021

He should target hospital monopolies, says Scott, which have “helped make America’s medical costs the highest in the world.” Incoming HHS chief Becerra went after one particularly abusive hospital system in California (Sutter) and won a big settlement. “Antitrust enforcement is not the sexy version of health care reform. It’s certainly not Medicare-for-All. But it can help prevent providers from inflating the prices they charge health insurers, which inevitably pass along those costs to patients in the form of higher premiums.” Given that knives are out for Facebook, Microsoft, and Amazon, can hospitals be far behind? Worst cities for monopolized hospitals: Springfield, Missouri; Peoria, Illinois; Cape Coral, Florida; Albuquerque; Reno; Omaha. One obstacle: the Federal Trade Commission cannot take action against “nonprofits,” which most hospitals theoretically are.

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Chetanya Robinson, “Senator Bob Hasegawa introduces Washington universal healthcare bill,” South Seattle Emerald, Jan 30, 2021

Washington State is the newest candidate for pushing an M4A equivalent across the line. The sponsor’s goal is to get legislative hearings on the measure and in the future a ballot initiative. The bill is like single-payer proposals in New York State and federally. However, it would allow private insurance to survive in parallel “to protect healthcare plans negotiated by unions, which may be better than the baseline universal plan” and to avoid ERISA prohibitions (the federal law that protects pensions and, by extension, negotiated health plans). Fun fact: Hasegawa, the sponsor, is a former truck driver and was president of the largest Teamsters Union in the northwest.

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Dylan Scott, “Biden’s Covid-19 relief plan has a Medicaid expansion problem,” Vox, Feb 3, 2021

The Rube Goldberg-style American healthcare non-system locks out families earning under $26,500 because they’re ineligible for premium subsidies under the ACA. They were supposed to get Medicaid, but because 12 states haven’t signed on to the expansion, these families are SOL unless someone gets inside the machine to tweak that. “The wonky structure of the ACA combined with the Supreme Court’s decision [allowing states to opt out] have locked millions of Americans in poverty out of health coverage.” Even worse, possible solutions will bring new problems. “The tricky part is getting coverage to poor people in the Medicaid coverage gap without creating incentives for states that have already expanded Medicaid to drop the expansion.”

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Rachel Cohrs, “Hospitals’ Covid-19 heroics have them poised for power in the new Washington,” STAT, Feb. 9, 2021

In the coming battles among the industry giants, hospitals could best insurance companies, especially as Democrats tend to side with hospitals against Pharma and insurers. “For [hospital] lobbyists in Washington, the picture couldn’t be rosier. Lawmakers showered the industry with more than $275 billion last year and handed hospitals wins even on seemingly unrelated issues.” As one optimistic lobbyist put it: “If you get straight A’s, it might be the time to ask your parents for a new iPhone.” One sour note: the hospitals’ massive ad campaign against Biden’s public option plan during the primaries did not endear them to him. And not all hospitals are created equal: safety-net hospitals are the poor cousins.

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Michelle A. Williams, “Public health is being undermined. These 10 actions can restore it,” STAT, Feb. 5, 2021

A sensible list, including things like boosting public health investment, improving coordination among state and federal agencies, stopping the nationalistic madness and rejoining the world, replenishing the national supply stockpile, repairing the surveillance and reporting system, boosting doctor and nurse training to cover the provider gap, and oh yes, rebuilding public trust.

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Lila Thulin, “Why the U.S. is struggling to track coronavirus variants,” Smithsonian Magazine, Feb 11, 2021

“Why did scientists in the United Kingdom, and not other nations, first pinpoint a more transmissible variant of the virus that causes Covid-19?” Because the Brits were actively looking. Who coulda thought of that? The U.S. is sequencing 1% of its cases, ranking #34 in the world. “People need to work together in a cooperative and collective way, setting aside individual priorities,” wrote Peacock [a British scientist] in a blog post about the U.K.’s sequencing success.” Meanwhile, in the U.S., “It’s the Wild West. It’s a bunch of random cats, and no one is trying to herd them.”

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Jessie Hellman, “Vaccine research funding misused for decade, says special counsel office,” The Hill, Jan 27, 2021

The Office of Assistant Secretary for Preparedness and Response “misused a fund intended for vaccine research to pay for unrelated expenses since at least 2010,” which might be related to the recently witnesses lack of preparedness and response. “From 2007 to 2016, ASPR was unable to account for more than $517 million in administrative expenditures.”

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Shayna Skarf, “Denied treatment, some Covid long-haulers could become lifelong-haulers,” STAT, Jan 28, 2021

A particularly perverse punishment for people who got “chronic Covid” early on when testing was either not available or inaccurate: since they’re not provably Covid patients, they can’t get Covid benefits nor experimental treatments. “Long-haulers are truckers who are on the road for a long time. But in the end they reach a destination, deliver their shipment, and go home. For me, there’s no end.” This eligibility gaps may affect as many as 70% of those sufferers who don’t recover.

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Carmen Forman, “Despite opposition, Health Care Authority moves forward with $2B plan to privatize Medicaid,” The Oklahoman, Jan 27, 2021

After resisting Medicaid expansion, Oklahoma now wants to figure out a way to shortchange the program and divert profits to the private sector. However, a significant number of Republican legislators don’t like the idea. A lawsuit against the plan failed. Stay tuned.

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Frank E. Lockwood & Michael R. Wickline, “18 states back Arkansas on Medicaid work rule,” Arkansas Democrat-Gazette, Jan 28, 2021

While Biden’s team indicates no more federal waivers to permit punitive work eligibility rules for Medicaid recipients, 18 Republican states joined Arkansas to preserve them in a case at Supreme Court. Lower courts tossed out the work requirements, but Arkansas argues that “conditioning Medicaid expansion benefits on work, education, or volunteering would lead to healthier outcomes for its beneficiaries.” The experiment led to 18,000 people losing their health coverage in Arkansas in just 9 months.

Feb 9, 2021

J. David Goodman, Joseph Goldstein & Jesse McKinley, “9 top N.Y. health officials have quit as Cuomo scorns expertise,” New York Times, Feb 1, 2021

Mass resignations, plummeting morale, and Cuomo on TV nightly as the one and only authority. What could go wrong? Silver lining: if anything does, we know whom to blame.

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Will Bunch, “Still can’t get COVID vaccine? Sure, blame President Trump, but blame President Reagan, too,” Philadelphia Inquirer, Jan 3, 2021

“The United States so far is failing at the task of administering doses for the same reason it didn’t know how to create the testing-and-tracing regimes that have largely worked across Asia or to avoid the embarrassing shortages of protective gear that had some nurses wearing trash bags. This country has been waging war on the very concept of good government for 40 years, and public health has been in the front trench taking World War I-level casualties. Trump might be finishing the job, but the president who created this mess was Ronald Reagan, who assured a similarly anxious nation upon taking office in 1981 that “government is not the solution to our problem.” Reagan slashed the HHS budget by 25 percent on his first few days in office. Dems accepted it.

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Judy Melinek, “The cost of liability: The view from a U.S. doctor living in New Zealand,” MedPage Today, Jan 23, 2021

“If you are injured in New Zealand, the ACC [a special government fund] will pay for your hospital costs—whether in the emergency department, as an outpatient, or as an inpatient. Whatever you need to get fixed up, they’ll do it. Chronic injuries suffered over time in the workplace are covered. So are sports injuries. The ACC covers all your rehabilitation costs and transportation costs that are a consequence of your injury. You are paid weekly compensation for being out of work, even if your injury makes that work stoppage permanent. It also pays for mental health help associated with some injuries, with a special focus on victims of sexual violence. ACC will pay for your funeral if you die as the result of an accident.” Non-citizens included. 

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Michael Lighty, “How to win Medicare for All under President Biden,” In These Times, Jan 20, 2021

“Our task is not to simply convince Biden to change his views on Medicare for All, but to change the political waters in which that view holds sway.” Okay, how? The author proposes that when the bill to fix the ACA moves through committee, there will be a strategic opportunity to demand a ​“mark-up” of the bill and include key policy priorities—“such as lowering prescription drug prices and eliminating out of pocket expenses—in whatever bill emerges. This process could bring media and political attention to the policy advantages of Medicare for All.” Not crazy given Bernie’s role as head of the Budget Committee. Also discusses the single-state pathway.

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Ryan Basen, “Healthcare fraudsters among those pardoned by Trump,” MedPage Today, Jan 21, 2021

Amazing run-down of the fraudsters, grifters, crooks, mountebanks, charlatans, pill-mill operators, swindlers, racketeers, sharks, and embezzlers who got Trump’s sympathetic ear. For example, beneficiary Glen Moss was given merit points by the Trump White House for his philanthropic spirit as reflected in his contributions to a community group that, upon hearing the news, replied, “We have no Glen Moss in our system at all. I don’t know where they got that information.” Tinpot dictators everywhere believe governments are piggy-banks for the powerful. Swamp intact.

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Jon Healey, “Biden trying to reverse Trump’s assault on healthcare. He has a long way to go,” Los Angeles Times, Jan 29, 2021

Good as far as it goes—which is not very. “It will certainly help to have the federal government resume promoting state insurance exchanges. It will also help hold down premiums in those exchanges to cut back on temporary insurance plans that offer cheaper but far more limited coverage—plans that drew younger, healthier people out of the exchanges.” In his lament over costs, this editorial writer never addresses insurance company profits, massive administrative waste in multiple billing, or Pharma pricing. [To get around the annoying paywall, select all with CRTL-A and paste as unformatted text.]

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RT, “No freebies! Pfizer to charge for ‘extra’ Covid-19 vaccine doses as doctors squeeze vials of every drop to inoculate more people,” Jan 23, 2021

[RT was formerly Russia Today.] “Pfizer has pressured regulators to declare its vials contain an “extra” dose of the vaccine and will now count them in deliveries, after frontline health workers found they could dispense six shots from one vial, instead of five.” Genius! They need more R&D cash so their scientists can make further life-saving discoveries!

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Julie Appleby, “Hospital prices just got a lot more transparent. What does this mean for you?” NPR/Kaiser Health News, Jan 5, 2021

Not clear how much shining the light on prices will affect individual consumers, but certainly employers who provide insurance coverage for large numbers of workers “will want to know how much they are paying each hospital compared with others in the area and how well their insurers stack up in negotiating rates.” The author concludes: “Price transparency can help, but the market power of the various players might matter more.”

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Maura Calsyn & Thomas Waldrop, “How the next administration can lower drug prices,” Center for American Progress, Sep 17, 2020

CAP (=mainstream Dems) calls for action on drugs whose prices have been raised by pharmaceutical companies during the pandemic, which it calls “especially egregious during a global health crisis.” One recommendation: work around Pharma’s manipulation of its discounts so that Medicare gets them, too. The explanation is very wonky-weedy as should be expected from a conservative think tank headed by Neera Tanden and funded by Pharma, defense contractors, Bloomberg, and the Emiratis.

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Thomas Neuburger, “Oxford pledged to donate Covid vaccine right, then sold them, thanks to Bill Gates,” Neuberger Substack, Jan 26, 2021 [with reprint of Jay Hancock, “They pledged to donate right to their COVID vaccine, then sold them to Pharma,” Kaiser Health News 8/25/20]

Vaccines never interested Pharma much as you only need to get it once (or twice). Gates played a nefarious role in getting the producers to claw back intellectual property rights despite huge public subsidies. “Drug industry executives and their shareholders will get rich with no assurance that future vaccines will be inexpensively available to all.” Gates is a major funder of vaccine projects and vaccine-promoting nonprofits as well as the WHO, which is maybe possibly why we haven’t heard of this before.

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Sam Pizzigati, “Greed in the suites, from Walgreens to Walmart,” Counterpunch, Jan 26, 2021

“Walgreens illustrates—personifies—the long-term economic trends that the Trump years so cavalierly doubled down upon: top corporate executives busily pocketing immense paychecks at the direct expense of their workers.” Walgreens pays the worst of the entire chain store empire ($10/hour starting wage). Hazard pay for Covid? 18 additional cents an hour. Meanwhile, Walgreens CEO Stefano Pessina took home $17 million in 2020. An interesting response: some cities have special tax penalties for corporations with such skewered executive/worker pay disparities.

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Julia Rock, “COVID-19 vaccine developers ask the SEC to help keep the secret of how they set prices,” Newsweek, Feb 1, 2021

“When the U.S. government awarded over $10 billion in contracts and advance- purchase commitments to drug companies working on COVID-19 vaccine and treatments, it did not require the recipients of government money to agree to offer their products at fair prices or share intellectual property rights to enable faster production. Now, two of the companies awarded those contracts—Pfizer and Johnson & Johnson—are trying to prevent shareholders from voting on resolutions to require the companies to disclose information about the impact of government funding on vaccine access.” So what’s the question they quake in terror at having to answer: “Did you take government funding into account” when setting your vaccine price? The fight turns on the meaning of “nonprofit” given that J&J promised to distribute a COVID-19 vaccine “on a nonprofit basis.” A simple, but not easy, question. 

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Ruth McCambridge, “Profit as primary driver: The daily disaster of U.S. healthcare,” Nonprofit Quarterly, Jan 19, 2021

Lots on the hellscape of private equity in nursing homes. Says Ernie Tosh, an Austin-based attorney who runs a side business analyzing nursing home data. “The nursing home industry should not be looked at through the lens of normal corporate America. If you think of it as organized crime, it will make a lot more sense.”

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Ed Gryster, “Single payer: Which way forward?” Dissident Voice, Jan 17, 2021

Why the disconnect between the obvious need and the permitted discourse about solutions? “In the middle of a pandemic, the USA’s for-profit healthcare system has no national plan or coordinated response. Instead, since so few Americans are going to the doctor this year, there is resounding joy in the industry as profits mount simultaneously with the despair of millions.” And yet “for journalists and talking heads in the mainstream media, this dysfunctional monstrosity is just the acceptable reality of our healthcare system. Discussing any responsibility or alternatives are disregarded.” The author endorses the “Force the Vote” campaign and criticizes insider baseball with Dems.

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Nicholas Florko, “Trump officials actively lobbied to deny states money for vaccine rollout last fall,” STAT, Jan 31, 2021

Part of the explanation for the woefully unprepared rollout. “Even after the Trump administration spent billions helping drug makers develop Covid-19 vaccines, it not only dismissed states’ concerns about the help they would need to roll them out but actively undermined their efforts to press Congress to get the funding they needed.”

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Sarah Kliff & Jessica Silver-Greenberg, “How rich hospitals profit from patients in car crashes,” New York Times, Feb 1, 2021

A new scam: hospitals that refuse to bill your Medicaid coverage and instead saddle you with a huge bill so you can’t get a settlement until you submit to their blackmail. Prime targets: widows and veterans.

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Kristina Fiore, “EHR vendor pays $18m to settle kickback allegations,” MedPage Today, Feb 2, 2021

The company took customers to the Kentucky Derby and the Masters Tournament, plied them with food and drink, and handed out cash payoffs to cooperating doctors. “The firm agreed to the settlement without admitting guilt.” Cost of doing business.

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Peter Elking, “Rich investors stripped millions from a hospital chain and want to leave it behind. A tiny state stands in their way,” ProPublica, Feb 4, 2021

Rhode Island. Follow-up to an earlier, incredible exposé: “Private equity firm Leonard Green and other investors extracted $645 million from Prospect Medical before announcing a deal to sell it and leave it with $1.3 billion in financial obligations. Four states approved it—but Rhode Island is holding out.” Also, unions representing hospital workers.

Feb 1, 2021

Matt Stoller, “How monopolies slowed the vaccine roll-out and small business sped it up,” BIG, Jan. 26, 2021

“CVS and Walgreens didn’t deliver. Local pharmacists did.” Which state has the best record for vaccine distribution? West Virginia because it has few chain pharmacies and lots of local independents. Stoller is a former congressional aide and expert on monopolization of the U.S. economy. This is a single-payer must-read and, for those interested in the broader issue, lots more on non-health topics.

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Ross Barkan, “Why isn’t New York vaccinating more people?” Political Currents, Jan 5, 2021

Takes the sheen off Cuomo’s allegedly brilliant performance. “Cuomo failed utterly to contain the virus and lock down the city in early March when COVID-19 was first spreading. He kept comparing coronavirus to the flu and proclaimed the fear of the virus was worse than the virus itself.” Then there was the nursing home debacle and the dismal vaccination rollout. “The real problem with Cuomo dangling million-dollar fines over providers for administering a vaccine to anyone who does not meet the state’s strict priority guidelines is that it will discourage mass vaccinations at a time when New York desperately needs them.” Stories of vaccine doses being thrown out quickly demolished the threats. “Como’s million-dollar hammer is one more manifestation of his authoritarian instincts.”

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Dean Baker, “The coronavirus vaccine fail and international elites,” Patreon, Jan 25, 2021

“If we can explain the failure to have more rapid distribution in the United States on Trump’s Keystone Cops crew, what explains the failures in [Denmark, Germany, France]?” The author argues that forging a true international collaboration, including pooled vaccine research for public benefit, “could call into question the merits of patent monopoly financing of prescription drug research.” The danger: if it turns out to be a good model in a pandemic, why not use it all the time?

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Aneri Pattani, “For health care workers, the pandemic is fueling renewed interest in unions,” Kaiser Health News/NPR, Jan 11, 2021

“The urgency and desperation we’ve heard from workers is at a pitch I haven’t experienced before in 20 years of this work. We’ve talked to workers who said, ‘I was dead set against a union five years ago, but COVID has changed that.’” Lack of PPE is a big motivator along with other forms of management negligence. “The pandemic didn’t create most of the root problems they’re concerned about, but it amplified them and the need to address them.”

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Joyce Frieden, “Copay assistance programs help patients but confuse them too,” MedPage Today, January 13, 2021

“If you’re having trouble paying for your medications, Drug Company X may be able to help.” Beware the scam. Sometimes, you use the coupon, then are charged the same amount when the insurance company doesn’t count it toward your deductible.

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Brianna Bailey, “How the CARES Act forgot America’s most vulnerable hospitals,” ProPublica/The Frontier, Jan 26, 2021

“COVID-19 relief was meant to give a lifeline to hospitals, especially the small, rural facilities that struggled to stay open before 2020.” The price tag was $100 billion—real money. But bureaucratic tie-ups and hastily written rules meant that “the hospital rescue program helped wealthier facilities pad their bottom lines while poorer hospitals struggled.”

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Sara R. Collins, “The number of Americans without health insurance has been trending up. Let’s turn it down again,” STAT, Jan 25, 2021

Despite the ACA, the uninsured rate has “trended upward over the past four years.” Reasons: Trump policies that undermined the ACA; continued state refusal to expand Medicaid; the “public charge” rule inhibiting immigrants from legal benefits; affordability. Biden has started some reversals; he could also: simplify marketplace plan choices; increase marketplace subsidies; block junk policies.

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Bernie Sanders, “This is the agenda Democrats should pursue under Biden’s leadership,” CNN, Jan 19, 2021

The list: Medicare for all Covid-related costs, increases for community health centers, beat down drug prices, forgive healthcare workers’ student debt. Also, $2000 relief payments, emergency unemployment benefits at $600/week, aid to state and local governments, hazard pay for frontline workers, aid to the USPS, new initiatives for homelessness and hunger, infrastructure spending, 12 weeks of paid family leave, universal pre-K education, tuition-free college, and $15 minimum wage.

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John Gever, “Drug prices: We’ve seen this movie before,” MedPage Today, Jan 22, 2021

“Average wholesale prices for products in five classes increased in lock-step each year from 2015 to 2020.” Prima facie evidence of price-fixing “far outpacing not only inflation in general but even the 2.1% average for all prescription drugs.” Another oligopoly.

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Michael Erman & Carl O’Donnell, “Drugmakers to hike prices for 2021 as pandemic, political pressure put revenues at risk,” Reuters, Dec 31, 2020

“The companies kept their price increases at 10% or below,” says Reuters encouragingly—in a virtually zero inflation environment. 

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Denise Fulton, “Drug price transparency in the Biden era,” Regulatory Focus, Jan 18, 2021

The author reviews a (paywalled) article that suggests one Trump-era measure to address runaway drug prices was less bungled than usual and might survive court challenges, namely, the transparency rule—that hospitals must disclose list prices for medications covered by Medicare/Medicaid. Includes a sketch of the legal issues involved. Biden expressed support for the idea during the campaign. “Nearly one third of US drug spending is for drugs dispensed in health care settings.”

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Terry McAuliffe, “Opinion: Virginians need lower drug prices,” Washington Post, Jan 14, 2021

Former governor McAuliffe’s non M4A solutions: “transparency” (again), price limits set by states, a crackdown on PBMs, bulk purchasing by states to increase leverage, importing from Canada.

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Kristina Fiore, “Here’s how much more the U.S. spends on Rx drugs,” MedPage Today, Jan 28, 2021

On average, prescription drug prices were 2.56 times higher in the U.S. than in 32 other developed countries (for brand-name drugs, 3.44 times). Oddly, “unbranded generics cost slightly less in the U.S., 84% of the price in other nations on average”—even though the U.S. uses more generics than other countries. That means the huge price-gouging on branded drugs—i.e., the ones we see advertised on TV—is what drives up the costs so enormously.

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Doni Bloomfield & Aaron S. Kesselheim, “Biden can lower drug prices without Congress doing anything,” Washington Post, Jan 5, 2021

By giving out fewer stupid patents. For example, for its auto-immune disease drug Humira, AbbVie obtained 100 patents to stave off generic competition. Its price fell 80% when the patents finally ran out. Patent office examiners “are given bonuses in part based on how quickly they are able to crunch through applications” to grant 20-year exclusivity to drugs that might bring in billions in sales. Trump made the problem worse; Biden could improve the system by administrative action.

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Mark Dudzic, “Take my benefits—please! Employment-based health care has become an anchor around the neck of the U.S. working class,” New Politics, Winter 2020

Despite being the “biggest cause of strikes, lockouts, and concession bargaining,” job-based health benefits attract support across the political spectrum from anti-union Republicans to the head of the AFL-CIO. Unions fought for these benefits and now resist giving them up to join a universal program. But the current system is unsustainable, especially given the chronic weakness of the labor movement and runaway costs. “If something can’t go on forever, it will stop.”

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Shayna Skarf, “Denied treatment, some Covid long-haulers could become lifelong-haulers,” STAT, Jan 28, 2021

Arbitrary cruelty baked into the current system: “Long-haulers who had Covid-19 in early March and weren’t able to promptly get tested for Covid-19 or antibodies aren’t eligible for treatment” under the federal programs to cover Covid costs. This affects 7 out of 10 people with the chronic Covid conditions. Also, they don’t get experimental drugs.

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Lev Facher, “Major health companies and trade groups suspend campaign contributions after Capitol riot,” STAT, Jan 12, 2021

The Pharma lobby and Blue Cross register objections. Other insurers, the AMA, and the American Hospital Association did not join them. However, “In many ways, these are symbolic actions, especially given that corporate PAC donations account for a small portion of the overall fundraising pie.” Also, the next election is two years away; no one needs money right now.

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Wendell Potter, “How big insurance funds Republican insurrection,” Tarbell, Jan 13, 2021

Big Insurance favs? Ted Cruz and Josh Hawley.

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Mari Uyehar, “Medicare for All needs a sunrise movement,” New Republic, Jan 18, 2021

Spends too much attention on the “force the vote” boomlet pushed by Jimmy Dore, but has some interesting suggestions for modeling an M4A movement: “By growing and reinforcing a trained activist organization across the country, scoring some undeniable electoral wins, and moving the president-elect leftward, the Sunrise Movement has advanced the cause of climate action in some substantial ways in a short amount of time.”   

Jan 22, 2021

Nicholas Florko, Lev Facher, Rachel Cohrs, Andrew Joseph & Casey Ross, “The 9 biggest challenges Biden will face on Covid-19, from today on,” STAT, Jan 20, 2021 

How many things on this list can be fixed by market forces? (1) Suppressing the current spread of Covid-19; (2) Changing minds on masks; (3) Setting up mass vaccination sites; (4) Extracting money for Covid-19 relief from a narrowly divided Congress; (5) Improving a worn-down supply chain for just about everything (still not enough PPE); (6) Using technology to track vaccinations and ensure equity; (7) Wrangling local officials resistant to Covid-19 mitigation tactics; (8) Boosting morale among burnt out health care workers; (9) Tackling everything else (postponed preventive care, overdoses, suicide). The authors add a 10th: Rebuilding the country’s pandemic preparedness. “Re”-building?

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Tami Luhby, Caroline Kelly & Devan Cole, “5 Ways Biden plans to reset health care after Trump,” CNN, Jan 19, 2021 

“Trump’s multitude of changes to the ACA will keep Biden’s team busy.” Easy fixes: restore ACA’s open enrollment period to three months; increase funding for ACA marketing and enrollment assistance; get private insurance brokers out of the business entirely; stop letting states impose work requirements for Medicaid eligibility; restore Planned Parenthood’s eligibility for Medicaid reimbursement. Harder: suppress short-term junk health plans (many people already have them); stop states from subcontracting ACA exchanges to the private sector (as Georgia did). Entirely unlikely: fulfill the campaign promise to create a public option or lower the age of Medicare eligibility. Entirely likely: more generous federal subsidies—free money for the insurance companies.

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Victoria Knight, “Health issues carried weight on the campaign trail. What could Biden do in his first 100 days?” Kaiser Health News, Jan 22, 2021 

What are the chances that the following promises are fulfilled—or even proposed—by the Biden team? “I’ll not only restore Obamacare, I’ll build on it. You can keep your private insurance. If you like it, you can choose a Medicare-like public option.” [-Joseph R. Biden, Nov. 2, 2020, Pittsburgh] “Health policy experts we consulted said implementing a public option seems extremely unlikely in the current environment. So does lowering the Medicare eligibility age from 65 to 60, another divisive idea among Democrats.”

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Nicholas Sargen, “3 ways Biden will reshape regulatory policy,” The Hill, Jan 19, 2021

Where do the money boys think Biden will go in the regulatory arena? Drug prices are a big issue but vaccine development “has cast pharmaceutical companies in a more favorable light.” More generous Medicare drug benefits could be on the table, especially if they don’t challenge Pharma’s power to set list prices. A 2019 Senate bill authored by Grassley (R) and Wyden (D) wants to do just that, but Republicans killed it. The author, a money manager, claims drug prices haven’t risen much lately (see next article).

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Michael Hiltzik, “Trump utterly failed to cut drug prices. Here’s how Biden could do better,” Los Angeles Times, Jan 19, 2021

Excellent, clear background on the status of attempts to rein in runaway drug costs. “As a sort of sour welcome for the Biden administration and a final slap in the face for Donald Trump, America’s drug companies jacked up prices on hundreds of prescription drugs, including some of their top sellers, at the very start of this year. The drug industry’s semiannual price hikes have made a mockery of the Trump administration’s claim to have brought prescription prices down. That’s not to say that anyone familiar with the industry ever took these claims seriously.” Outlines how Trump’s bumbling approach made it easy for Pharma to play him and what Biden could do better, starting with the House bill HR3, known as the [Elijah] Cummings Act, which would “mandate the use of an international price index as a benchmark for the government to negotiate drug prices for Medicare and Medicaid. Those negotiated prices could then be used by private insurers.”

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Paul Jay, “What can Sanders do as budget chair?” TheAnalysis.News, Jan 20, 2021

Educate the public and embarrass the hell out of a lot of people, for one thing. The chair can call for and schedule hearings on anything he wants. Interview with Rob Johnson, formerly Senior Economist for the Budget Committee. Podcast or transcript.

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Ellyn Ferguson, “Biden’s choice to lead USDA helped monitor OxyContin maker,” Roll Call, Jan 11, 2021

Vilsack, an $800K-a year-lobbyist for the dairy industry, was selected by opioid purveyor Purdue Pharma to oversee its bankruptcy settlement (add $145K for that gig). If he had been tough, would he be back in the cabinet as Ag Secretary?

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Gregg Miller, “A broken system killed my young patient,” MedPage Today, Jan 18, 2021

“I’d like to say it was the worst case in my life except we all know that we’ve had plenty of other cases like that. This young woman didn’t have to die. No one had called her about her lethal level of potassium, about this abnormal lab. No clinician at triage in the waiting room had looked it up. No one had done lab work on her. No one had drawn her blood in the waiting room despite the fact that she’d been there for three or four hours. We had so many opportunities to save this young woman, but no one had built a system that would do that.”

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Suveen Angraal et al., “Evaluation of internet-based crowdsourced fundraising to cover health care costs in the United States,” JAMA Network, Jan 11, 2021

“From May 2010 through December 2018, more than $10 billion was sought through [more than 1 million] online medical fundraisers in the U.S., with more than $3 billion raised.”

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Martin Makary, “Hospitals: Stop playing vaccine games and show leadership,” [opinion] MedPage Today, Jan 12, 2021

“America’s hospitals are supposed to be the center of scientific genius, but in stewarding the COVID-19 vaccine, many hospitals have been the center of poor management and cronyism. Wealthy health systems with thousands of employees have been making excuses why they don’t have the funds, staff, or state guidance to immunize vulnerable seniors in their community while at the same time these hospitals are vaccinating their own administrators and young, work-from-home communications staff, human resources staff, and accounting personnel. The total administrative cost to vaccinate seniors from the community in clinic is less than one-quarter of their CEO’s pay in a single year. Given the health emergency this year, we physicians need to urge our hospitals to live up to their community mission.” Strong language from an industry publication.

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Serena Marshall & Lara Salahi, “The Distribution Debacle,” MedPage Today, Jan 13, 2021

Plenty of money available for the magic bullets, none for public health infrastructure.

Jan 12, 2021

Alia Paavola, “Northwell rescinds 2,500 suits filed against patients to collect unpaid debt,” Becker’s Hospital Review, Jan 8, 2021

Bad PR led to action hours later.

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Giles Bruce, “Illinois is the first in the nation to extend health coverage to undocumented seniors,” Kaiser Health News, Jan 7, 2021

Untreated chronic conditions among the undocumented are aggravating Covid morbidity and leading to clogged ERs. However, the income limit of $12,670 for an individual will limit the program’s reach.

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Erin Brodwin, “Haven, ambitious health venture backed by Amazon, to shut down,” STAT, Jan 4, 2021

The Amazon-JPMorgan Chase-Berkshire Hathaway joint venture has collapsed, which is probably good news. “There was this general chat about access, primary health care, and transparency, but not a big idea about how to get those end results.”

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Yves Smith, “Schaudenfreude alert: Bezos-Buffet-Dimon health care industry disruptor Haven makes faceplant, announces closure,” Naked Capitalism, Jan 5, 2021

Possible reasons why: none of the three partners had healthcare expertise; the 3-way merger was unwieldy and prone to turf wars and overlap with in-house initiatives already in place (e.g., Amazon Care); money isn’t enough (they had plenty); unseriousness (57 total employees); leadership vacuum (top execs jumped ship after a few months); late to the party—private equity has already scooped up the healthcare chokepoints where they can leverage market power and skim off profits. Also: “To the extent there was an idea, it was dumb. They announced a goal of ‘simplified, high-quality and transparent healthcare’: What on earth can possibly be transparent about an appendectomy?” Elephant in the room: Haven’s originators had no idea what to do about costs.

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Brian Barnett, “Who’s choosing Americans’ medications — doctors or insurers? The bane of prior authorization,” STAT, Jan 1, 2021

“[We providers] are increasingly wondering who’s actually doing the prescribing—us or people with no medical training who read patients’ names on computer screens?” But prior authorization deters people from taking the meds, thus saving the insurance companies those costs. “For every prior authorization request, a provider can lose up to an hour or more wading through an administrative quagmire. There are often labyrinthine phone trees to maneuver through, patient records to unearth, and faxes—yes, faxes—to be sent.” Denials push the delay—and reimbursements—further into the future. Fun fact: average annual cost for physician interaction with insurers: $70,000.

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Lown Institute, “2020 Shkreli Awards,” Jan 5, 2021

“Top ten worst examples of profiteering and dysfunction in health care,” such as: #10—Private-equity backed companies spend millions to protect surprise billing while cutting physician pay and pocketing relief dollars; #7—Hospitals punish mask-wearing clinicians for “scaring the public”; #6—Hospital CEO pens op-ed* justifying high vaccine prices, neglects to disclose $487,000 stock option conflict of interest (CEO of a Boston hospital, who quit after being outed); #3—Hospitals with extra beds refuse to take uninsured patients from overrun neighboring hospitals, instead saving the beds for lucrative insured patients. [*What about the newspapers that allowed the Boston CEO to shill for her investment portfolio without checking her background first?]

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Susannah Luthi & Rachel Roubein, “How powerful health providers tamed a ‘surprise’ billing threat,” Politico, Dec 21, 2020

Speaking of #10 above: “Powerful hospital and [private-equity-owned] physician groups that tied up Congress for nearly two years on how to end ‘surprise’ medical bills saw their efforts pay off with the compromise lawmakers inserted in the giant year-end spending package.” The winning combo: high-powered lobbyists, attack ads, and bottomless wells of campaign cash. Democrat Neal (D-Mass.) played, as usual, a particularly nefarious role. “The legislation still doesn’t bar ground ambulances from sending massive bills to insured patients. Other policy changes aimed at stopping anti-competitive practices among health insurers, hospitals, prescription drug middlemen and the pharmaceutical industry were either watered down or axed.”

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Samantha Young, “Dialysis industry spends millions, emerges as power player in California politics,” Kaiser Health News, Dec 10, 2020

The two top dialysis companies in the state have revenues above $10 billion a year each—lots to spread around to keep it that way. “Nearly every member of the legislature, the Democratic and Republican parties, and dozens of political campaigns—including some local school board and city council races—received a contribution from a dialysis company.” Most of their cash comes from Medicare, so even their money to lobby school boards is provided by the public sector.

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Sarah Kliff, “This is the health system that Biden inherits from Trump,” New York Times, Dec 16, 2020

You’d think lower medical spending would be a good thing overall. But “gains in care for the poor and vulnerable are under threat” as systems lost revenue in March and April when people stayed away from routine care. Safety-net hospitals “are facing major financial pressure while wealthier hospital systems expect to emerge slightly bruised but not broken.” Also, key staff can decamp for lucrative temp jobs in hard-hit states.

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Ben Guarino, “ER doctors on the front lines against Covid struggle to find jobs,” Washington Post, Jan 4, 2021

A quarter of emergency medicine residents are having trouble finding work. ERs without nurses, doctors without jobs, hospitals without income—why isn’t the free market in healthcare allocating resources efficiently in the best of all possible economies? “Durrani, 29, has treated hundreds of covid-19 patients but cannot find a company in his hometown of Houston ready to hire him when he graduates [from medical school] next year. Many people stayed away from hospital emergency rooms this past year, wary of contracting the virus. As patient numbers dropped, emergency departments brought in less money. As a result, cash-strapped employers stopped recruiting new doctors.” Also: “Fewer places can afford newly minted emergency medicine doctors during a crisis in which it would seem they should be in high demand.” Everything is working as planned! More than half of the emergency doctors in the United States are employed by financial companies.

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John P. Moore & Ian A. Wilson, “Decades of basic research paved the way for today’s ‘warp speed’ Covid-19 vaccines,” STAT, Jan 5, 2021

Well-known but worth repeating. “The Covid-19 vaccines did not come from nowhere. Decades of [often government- and foundation-funded] research by tens of thousands of scientists worldwide put in place the essential knowledge and methods that underpinned their rapid development.”

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Samantha Liss, “UnitedHealth’s Optum to buy Change Healthcare in $13B deal,” Healthcare Dive, Jan 6, 2021

Further consolidation of industry giants. “The move consolidates Optum’s dominance in the healthcare data analytics space. The UnitedHealth venture, which also includes a PBM and doctors’ unit, has been a consistent driver of revenue for the biggest private insurer in recent years.”

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Eric Sagonowsky, “Should pharma charity contributions be publicly disclosed, just like doctor payments? Senators say yes,” Fierce Pharma, Jan 8, 2021

The scandal over $65 million paid to opioid-pushing groups like the “American Chronic Pain Association” that helped addict millions is leading to possible federal measures to rein in astroturf front groups pushing pharmaceuticals. So far, Pharma companies are only getting wrist-slap fines in which companies “admit no wrongdoing.” Those paying such get-out-of-jail-free-card fines include Gilead, Sanofi, Pfizer, Astellas, Amgen, Alexion, and United Therapeutics.

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Geoff Mulvihill, “Senate report: Opioid industry has paid advocacy groups $65M,” Associated Press, Dec 16, 2020

The “Alliance for Balanced Pain Management” was run by drug distributor Mallinckrodt, which just paid a $1.6 billion settlement of thousands of lawsuits. A reminder to never eat at a diner called “Mom’s.”

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Paul LeBlanc, “Republican lawmakers who downplayed Coronavirus concerns face backlash over early vaccinations,” CNN, Dec 22, 2020

After maskless rallies and silence over Trump’s nonsense, some electeds can’t wait to be first in line.

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Harris Meyer, “Seniors face crushing drug costs as Congress stalls on capping Medicare out-of-pockets,” Kaiser Health News, Jan 4, 2021

Unlike private health insurance, Medicare Part D drug plans have no cap on patients’ 5% coinsurance costs, except for very low-income beneficiaries. Patients with expensive medications have to scramble for grants, compassionate care programs, or donors on GoFundMe. “The out-of-pocket cost for Medicare and private insurance patients is often set as a percentage of the list price, as opposed to the lower rate negotiated by insurers.” An incentive for price hikes into six figures, not unusual for cancer drugs.

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Ashish K. Jha, “Vaccination is going slowly because nobody is in charge,” Washington Post, Dec 31, 2020

“The responsibility of vaccine distribution has fallen on state health departments. These relatively poorly funded agencies have been managing the full pandemic response for months. They are squeezed and stretched, and to make matters worse, their leaders are receiving death threats and other forms of harassment, prompting some to quit.” Aside from the particular dysfunction of Trumpism, the highly fractured system does not lend itself to centralized planning for an emergency. “Once a blame culture is set, the finger-pointing continues: in Mississippi, the health chief says it’s not the state’s job to ensure vaccines get into people’s arms, and he is now blaming front-line providers for the slow rollout.” Doggone nurses.

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Emily DeCiccio, “‘Planning is the antidote to panic’: Providence Hospital System defies America’s slow vaccine rollout trend,” CNBC, Jan 4, 2021

While the vaccination campaign flounders, one hospital system did a good job and has vaccinated half its 120,000 employees. Their deep, dark secret? They started planning for it in September. Who could have thought of that?

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Phil Galewitz, “Trump Administration approves first Medicaid block grant, in Tennessee,” Kaiser Health News, Jan 8, 2021

A first: Tennessee will get its Medicaid money in a lump sum, increasing incentives to cut back on care. “Instead of the open-ended federal funding that rises with higher enrollment and health costs, Tennessee will instead get an annual block grant. If the state can operate the program at a lower cost than the cap and maintain or improve quality, the state then shares in the savings.” Tennessee never expanded Medicaid eligibility under the ACA.

Jan 4, 2021

David Sirota & Andrew Perez, “The next war against a public option is starting,” Daily Poster, Dec 9, 2020

A health care industry front group [Partnership for America’s Health Care Future] “run by a former Hillary Clinton aide has amassed millions to block a public health insurance option.” Recall that the line used against single-payer a year ago during the primaries was that there are “other ways” to get to universal coverage, such as the public option. Once the threat is neutralized, the public option is quickly shelved, just as in 2009.

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Mariana Mazzucato, “Covid exposes capitalism’s flaws,” Financial Times, Dec 28, 2020

Remarkable language for the FT (Britain’s Wall Street Journal): “Covid-19 is the moment to do capitalism differently. The pandemic showed our economic system is not simply in crisis, it is structurally flawed.” Good diagnostics about all the ways things went wrong, and a few of the suggested solutions are conceivable even in the present environment, such as refusing stimulus money to companies that stash the loot offshore.

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Giacomo Tognini, “Meet the 50 doctors, scientists and healthcare entrepreneurs who became pandemic billionaires in 2020,” Forbes, Dec 23, 2020

Newcomers of the year to the billionaires’ club include vaccine developers Uğur Şahin ($4.2 billion) and Stéphane Bancel ($4.1 billion), glass vial manufacturer Sergio Stevanato ($1.8 billion), antibody treatments producer Carl Hansen ($2.9 billion), contract research magnate August Troendle ($1.3 billion), and Harvard immunologist Timothy Springer ($2 billion from his timely Moderna investment). China accounts for 35 of the 50 new billionaires.

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Chad Terhune, “Wealthy hospitals rake in U.S. disaster aid for COVID-19 costs,” Reuters, Dec 29, 2020

“Large and well-capitalized nonprofit systems—which typically pay no taxes—do not need the additional relief money” but are taking it anyway. Although an argument could be made against means-testing the aid, something is wrong when huge outfits fatten their coffers while rural and safety-net hospitals go under. For example, the Cleveland Clinic picked up $400+ million in pandemic aid while “the system’s net income—including strong investment gains—tripled to $604 million in the most recent quarter, compared to a year ago.” Nonprofit investment gains always come in handy.

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J. David McSwane, “‘Those of us who don’t die are going to quit’: A crush of patients, dwindling supplies and the nurse who lost hope,” ProPublica, Dec 30, 2020

Collapse of care in the VA system. “While every American hospital was stretched by the pandemic, the VA’s lack of an effective system for tracking and delivering supplies made it particularly vulnerable. The COVID-19 pandemic came more than a year into a massive reorganization by the administration of President Donald Trump that left hundreds of jobs empty and sent the VA scrambling to hire contract positions to help with, among other things, procurement of supplies.” Thank you for your service! P.S. The VA nurses still don’t have PPE.

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Michael Grabell & Bernice Yeung, “The Battle for Waterloo,” ProPublica, Dec 21, 2020

Subhead: “As COVID-19 Ravaged This Iowa City, Officials Discovered Meatpacking Executives Were the Ones in Charge.” Not strictly a single-payer story, but a good illustration of how public health was completely subordinated to immediate considerations of profit. Would The Jungle (1906), Upton Sinclair’s famous indictment of the appalling conditions in the meatpacking industry, today look benign by comparison? A fascinating deep dive.

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Til Schuermann & Helen Leis, “We stress tested banks in 2009. We need to do the same thing now for U.S. hospital systems,” STAT, Dec 29, 2020

A classic of neoliberal logic: since we “stress test” banks to make sure they’re solvent, we need to do the same for hospitals to make sure they can stay afloat. Because hospitals are just like banks! No attempt in the article to question the underlying system that puts hospitals into near-bankruptcy for doing their job.

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Matthew Cunningham-Cook, “Hospital CEOs have gotten rich cutting staff and supplies. Now they’re not ready for the next wave,” The Intercept, Dec 20, 2020

“Nonprofit” hospitals, forced into the corporate mold, make all the market-driven mistakes like just-in-time staffing and supplies while enjoying tax-free real estate. “In 2006, Montefiore Medical Center in the Bronx had healthier patients, just enough nursing staff to take care of them, and a CEO who was earning $2 million a year. Fifteen years later, its patients are sicker than ever before, its staffing levels are inadequate, and its new CEO is earning $13 million per year.” Fun fact: 58% of U.S. hospitals are “nonprofit” (20% public, 21% for-profit). Fun quote: “At the heart of the matter is the conversion of health care from social good to a commodity”—spoken not by a critic but by a hospital CEO.

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Mary Beth Pfeiffer, “In far-flung places, COVID-19 is being treated early and well. Here’s why Americans don’t know this,” Trial Site News, Dec 27, 2020

Government and industry in the U.S. downplay therapeutic successes and sometimes even undermine them with alarmist statements. Meanwhile, fortunes are to be made in vaccines. Probably a coincidence. “At isolated hospitals and nursing homes, in parts of India and Africa, in countries like Bangladesh and Egypt, and even in a few American doctors’ offices, COVID-19 is quietly and effectively being managed. Fewer patients in those places go to hospitals. Those admitted don’t stay as long. Fewer die.” But the treatment debates have been hyper-politicized; if Trump mentions a drug, it’s automatically snake oil. “Drug companies, meantime, invest only in new and expensive treatments,” like remdesivir. Others get censored by Twitter and YouTube. Also includes a theory of why some African countries are getting hit less hard by Covid.

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Harold Brubaker, “New Jersey may be the first state to impose per-bed fees on nonprofit hospitals for municipal services,” Philadelphia Inquirer,” Dec 23, 2020

The state is making hospitals’ property-tax exemption contingent on better fulfillment of their contractual responsibility to provide community service, including indigent care. The action comes “in response to a landmark 2015 New Jersey Tax Court ruling involving Morristown [NJ] Medical Center that ‘the operation and function of nonprofit hospitals do not meet the criteria for property tax exemption’ under state law.” Cities have taken 40 of the state’s 60 nonprofit hospitals to tax court.

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Connor Perrett, “The US is vaccinating people way too slowly. A top doctor says the federal government is to blame,” Business Insider Australia, Dec 30, 2020

Dr. Ashish K. Jha, dean of Brown University’s School of Public Health: “The worst part is no real planning on what happens when vaccines arrive in states. No plan, no money, just hope that states will figure this out.” Public health departments have been starved of funds, trashed by Trump, and attacked by the meatheads and now are supposed to perform miracles.

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David Wallace-Wells, “America’s vaccine rollout is already a disaster,” New York Magazine, Dec 30, 2020

The U.S. is failing, says the author, “in precisely the same way as we did earlier in the year” at test, trace, isolate. Why would we succeed at distribution and administration? “Despite the horrible continuing brutality of this pandemic and the incredible efforts and good intentions of health-care workers, we are, practically speaking, not even bothering to try to end it.”

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Scott Squires & Jake Rudnitsky, “Argentina kicks off vaccination drive with Russia’s Sputnik,” Bloomberg, Dec 29, 2020

The Russian shot costs $20; poorer countries are likely to use it and/or Chinese alternatives. The U.S. would rather restart the pandemic than contemplate such a thing.

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Alfred Engelberg, “Unaffordable prescription drugs: the real legacy of the Hatch-Waxman Act,” STAT, Dec 16, 2020

Detailed explanation of how Pharma gamed the “compromise” with the generic drug industry. “How is it possible to have a prescription drug price crisis when 90% of prescriptions are filled with generic drugs that cost, on average, $1 a day? The answer: The remaining 10% of prescriptions have an average cost of $20 a day and account for 80% of all prescription drug spending.” A real solution would entail empowering Medicare to negotiate prices down.

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