Do Not Resuscitate: How We Spend Trillions to Enrich Intermediaries Instead of Making Ourselves Healthier

Do Not Resuscitate (This System) #338 Mar 8 2024

The week's news about how we squander trillions on medical care to make intermediaries rich instead of ourselves healthier. Hihglights: the big cyberattack on UnitedHealth affecting 200 million users and why that's likely to be repeated elsewhere; the new CDC guidelines on Covid, a.k.a. "Relax and Sneeze!" [snark]; some Medicaid updates; is Medicare Advantage losing its lustre for investors?; and some environmental dangers that we ignore in favor of finding expensive pharmaceuticals treatments for the diseases they cause. 
The articles mentioned are the following: 
Rebecca Pifer, “Walgreens to close VillageMD clinics in Florida,” Healthcare Dive, Feb 22, 2024 https://bit.ly/3wDUagE and Emily Olsen, “Walgreens’ VillageMD to exit Illinois,” Healthcare Dive, Mar 1, 2024 https://www.healthcaredive.com/news/walgreens-villagemd-closes-illinois-clinics/709012/
Darius Tahir, “Hacking at UnitedHealth unit cripples a swatch of the U.S. health system: What to know,” KFF Health News/CBS News, Mar 1, 2024 https://bit.ly/4c3iFEb and James Rundle, Catherine Stupp & Kim S. Nash, “Medical providers fight to survive after Change Healthcare hack,” Wall Street Journal, Mar 1, 2024 https://on.wsj.com/3T7eZZp
Elise Takahama, “Why health care has become a top target for cybercriminals,” Seattle Times/Tribune News Service, Mar 1, 2024 https://bayareane.ws/3T1zOpn
Maureen Tkacik, “Zoomer hackers shut down the biggest extortion ring of all,” American Prospect, Mar 1, 2024 https://prospect.org/health/2024-03-01-zoomer-hackers-shut-down-unitedhealthcare/
Wendell Potter, “UnitedHealth Group: Vulnerable and ill-equipped to defend against modern threats like cyberattacks,” Healthcare Un-covered, Mar 5, 2024 https://wendellpotter.substack.com/p/unitedhealth-group-vulnerable-and
Susanna Vogel, “Kaiser lays off IT workers for a second time in 4 months,” Healthcare Dive, Mar 5, 2024 https://bit.ly/3uSwOng
The Lancet, [editorial] “What has the impact been of privatisation on the quality of care? Does competition work in this arena?” March 2024 https://bit.ly/49HlIjR
Nia Clark, “Some UnitedHealthcare members lose Mount Sinai coverage,” Spectrum/NY1, Mar 1, 2024 https://bit.ly/49ClgU4
Julie Appleby & Phil Galewitz, “America worries about health costs—and voters want to hear from Biden and Republicans,” KFF Health News/CBS News, Mar 4, 2024 https://bit.ly/3uPR9tn
Christopher T. Su & Scott D. Ramsey, “Medical debt—an iatrogenic epidemic with mortal consequences,” JAMA, Mar 4, 2024 https://bit.ly/4342ClG
Nada Hassanein, “States consider menthol cigarette bans as feds delay action,” Stateline, Feb 29, 2024 https://bit.ly/437OcAV
Brian Platt & Laura Dhillon Kane, “Trudeau introduces bill on national drug coverage program,” Bloomberg, Feb 29, 2024 https://bloom.bg/3IqWXwv
Maya Goldman, “Why Medicare is adding prior authorization requirements as others cut back,” Axios, Mar 1, 2024 https://bit.ly/49IYj1M
Anne Blythe, “Dentists lobby for higher Medicaid reimbursement rates,” North Carolina Health News, Feb 28, 2024 https://bit.ly/49Cyald
Wendell Potter & Philip Verhoef, “Medicare Advantage is bad for patients and bad for investors,” STAT, Feb 28, 2024 https://bit.ly/3v2EPG7
Tony Leys, “Without Medicare Part B’s shield, patient’s family owes $81,000 for a single air-ambulance flight,” KFF Health News/NPR, Feb 27, 2024 https://bit.ly/3SZAk73
Eric Topol, [Twitter thread], Mar 4, 2024 https://bit.ly/4c0Kj4R
Katherine J. Wu, “Why are we still flu-ifying COVID?” The Atlantic, Feb 28, 2024 https://www.theatlantic.com/health/archive/2024/02/covid-anniversary-flu-isolation-cdc/677588/
Melody Schreiber, “Covid taught us a lot. The CDC now wants us to forget it,” New Republic, Feb 28, 2024 https://newrepublic.com/article/179304/covid-cdc-guidelines-isolation-symptoms
Keren Landman, “The CDC has finally loosened Covid isolation guidelines. Here’s why that’s a good thing,” Vox, Mar 1, 2024 https://bit.ly/3Tq9dDV
Keith Schneider, “New report sparks questions and controversy over possible causes for Iowa ‘cancer crisis,’” New Lede, Mar 4, 2024 https://bit.ly/4c31dQk
Saboto Caesar, “Global pesticide ban is only way to stop us from a health epidemic,” Newsweek, Feb 28, 2024 https://bit.ly/49E9acZ
Find my whole archive at <nypan.org/single-payer-news>, and if you'd like to get my weekly digest direct to your inbox, write me at tfrasca@gmail.com

Do Not Resuscitate (This System) #337 Mar 1 2024

I’m Tim Frasca, and every week I tell you about what’s in the mainstream and specialty healthcare news media about how we spend trillions of dollars making intermediaries rich instead of making ourselves healthier. This week, I’ll look at some good news about excessive concentration in the healthcare sector; why people with long Covid and getting the short shrift; what’s happening to fight the runaway prices of prescription drugs; some interesting debates on where public health went wrong; and a look at why some hospitals are rich and others go broke. Here are all the links to the articles I mention: 
Paige Minemyer, “WSJ: Department of Justice conducting antitrust probe of UnitedHealth Group,” Fierce Healthcare, Feb 27, 2024 https://bit.ly/42YfHN7
Rebecca Pifer, “Pharmacies and providers nationwide are struggling to process prescriptions following the attack,” Healthcare Dive, Feb 23, 2024 https://bit.ly/3wvjjKH
Dave Muoio, “PE-backed anesthesiology group ends contracts with 5 Colorado hospitals, phases out non-competes to resolve monopoly inquiry,” Fierce Healthcare, Feb 27, 2024 https://bit.ly/49viDmR
Marcus Neubauer, “Cancer patients in the crosshairs of hospital consolidation,” MedPage Today, Feb 16, 2024 https://www.medpagetoday.com/opinion/second-opinions/108780
Sara Fischer, “FTC chair Khan: Stop monopolies before they happen,” Axios, Feb 13, 2024 https://bit.ly/42YjoCH
John Snow Project, “Long Covid is one of the world’s biggest challenges,” Feb 22, 2024 https://bit.ly/49OPqDk
Erica Sweeney, “How repeat Covid infections can harm your health,” Men’s Health, Feb 21, 2024 https://bit.ly/49lIoGl
Jason Gale, “A spike in heart disease deaths since Covid is puzzling scientists,” Bloomberg, Feb 26, 2024 https://archive.ph/lRG9N#selection-1181.0-1181.66
Rachel Cohrs & Betsy Ladyzhets, “The NIH has poured $1 billion into long Covid research—with little to show for it,” STAT/MuckRock, Apr 20, 2023 https://bit.ly/3IiQvru
Eduardo Cuevas & Karen Weintraub, “Millions of Americans suffer from long COVID. Why do treatments remain out of reach?” USA Today, Feb 26, 2024 https://bit.ly/48verCA
Mike Tanglis, “Mapping the PhRMA Grant Universe,” Public Citizen, Dec 14, 2023 https://bit.ly/3UYeJ1v
Full report: https://www.citizen.org/article/mapping-the-phrma-grant-universe/
Luke Lukert, “Sky high prescription drug prices have Md. legislators looking for consumer relief,” WTOP, Feb 12, 2024 https://bit.ly/48xl72T and Stephanie Hudson, “Virginia doctors support board to lower prescription drug costs,” WAVY.com, Feb 12, 2024 https://bit.ly/42WZO9H
Arthur Allen, “Patients see first savings from Biden’s drug price push as Pharma lines up its lawyers,” KFF Health News/ABC News, Feb 16, 2024 https://bit.ly/3wAdagh
Sheila Poole, “Researchers find association between air pollution and Alzheimer’s,” Atlanta Journal-Constitution, Feb 23, 2024 https://bit.ly/42QQPXT
Jonathan Mattise & Geoff Mulvihill, “14 GOP-led states have turned down federal money to feed low-income kids in the summer. Here’s why,” Associated Press, Feb 16, 2024 https://bit.ly/42WLo9V
Eric Reinhart, “Want to fix public health? Stop thinking like a doctor,” The Nation, Mar 6, 2024 https://bit.ly/3Idxw1o
Greg Gonsalves, “We’re letting a public health disaster unfold in slow motion,” The Nation, Feb 22, 2024 https://www.thenation.com/article/society/undermining-public-health/
Amy Maxmen, “Florida defies CDC in measles outbreak, telling parents it’s fine to send unvaccinated kids to school,” KFF Health News/CBS News, Feb 23, 2024 https://bit.ly/3UVMJLT
Natalie Krebs, “Report finds more than half of rural Iowa hospitals no longer deliver babies,” Iowa Public Radio, Feb 23, 2024 https://bit.ly/48BA7wC
Elizabeth Cohen, “As midwife-assisted home births rise, so too do high-risk births outside hospitals,” STAT, Feb. 23, 2024 https://bit.ly/3ST7JAj
Rachel Bowman, “Feds launch massive investigation into organ donation firms accusing them of only taking money making tissues and leaving badly needed organs behind,” Daily Mail (U.K.), Feb 26, 2024 https://bit.ly/49OhqqE
Todd Bookman, “NH officials blast Anthem over handling of $69M contract for state retirees,” New Hampshire Public Radio, Feb 22, 2024 https://bit.ly/42Xt6p2

Do Not Resuscitate (This System) #336 Fe 23 2024

This week, I review articles about hospital mergers & acquisitions, some blocked, some successful; private equity’s ongoing hospital-destroying rent extraction doings; corrupt behavior in The Swamp including Biden family dealings; how officialdom demands respect for The Science while ignoring it; good news on Medicaid expansion in North Carolina, and bad news on Medicaid expulsions in Texas. Write me for the full written digest at tfrasca [at] gmail.com and explore the full 6-year archive at nypan.org/single-payer/news. Here are all the links mentioned in this week's run-down. 
Susanna Vogel, “SCAN Group, CareOregon abandon merger plans,” Healthcare Dive, Feb 15, 2024 https://bit.ly/49lsJqE
Rebecca Pifer, “Blue Cross of Louisiana halts sale to Elevance,” Healthcare Dive, Feb 15, 2024 https://bit.ly/3T8bzH2
Susanna Vogel, “Primary care providers Marathon Health and Everside Health merge,” Healthcare Dive, Feb 9, 2024 https://bit.ly/3UHyGcW
Paige Minemyer, “Private equity deals in MA are declining, but experts say regulators should keep an eye on this space,” Fierce Healthcare, Feb 13, 2024 https://bit.ly/3SLmup2
Susanna Vogel, “What’s going on at Steward Health Care?” Healthcare Dive, Feb 15, 2024 https://bit.ly/42JGOf3
Phil Galewitz & Colleen DeGuzman, “In fight over Medicare payments, the hospital lobby shows its strength,” KFF Health News/NPR, Feb 13, 2024 https://bit.ly/49yRrDK
John Ingold & Chris Vanderveen, “UCHealth sues thousands of patients every year. But you won’t find its name on the lawsuits,” Colorado Sun, Feb 19, 2024 https://bit.ly/49lGxBu
Nicholas Florko, “Juul’s internal playbook opens a rare window into influence in Washington,” STAT, Feb 15, 2024 https://bit.ly/4bOErvl
Ben Schreckinger, “Biden’s brother used his name to promote a hospital chain. Then it collapsed,” Politico, Feb 18, 2024 https://politi.co/48vFugN
Ruth Reader, “Artificial intelligence is making critical health care decisions. The sheriff is MIA,” Politico, Feb 18, 2024 https://politi.co/3ORjW7I
Nick Corbishley, “France’s Macron government is trying to criminalise criticism of officially recommended or mandated medical treatments,” Naked Capitalism, Feb 16, 2024 https://bit.ly/48rul0w
Julia Doubleday, “New CDC guidelines: Work ‘til you drop,” The Gauntlet, Feb 15, 2024 https://www.thegauntlet.news/p/one-little-covid-infection-is-no
Joshua Goodman & Jim Mustian, “DEA reverses decision stripping drug distributor of licenses for fueling opioid crisis,” Associated Press, Feb 7, 2024 https://bit.ly/49Lpw3t
Maya Goldman, “More than 2 million people dropped from Medicaid in Texas,” Axios, Feb 13, 2024 https://bit.ly/3SLNnsM
Jaymie Baxley, “NC Medicaid rolls grow by 1,000 people a day as smooth expansion rollout continues its third month,” North Carolina Health News, Feb 15, 2024 https://bit.ly/49oXACu
 
 

Do Not Resuscitate (This System) #335 Feb 16 2024

Tim Frasca here to tell you about what’s in the mainstream and specialty healthcare news media about how we spend trillions of dollars making intermediaries rich instead of making ourselves healthier. This week, I observe variations on coverage of Bernie Sanders' committee hearing on drug costs. Then, I comment on the failures of health communication and reporting on health-related research, and there are also stories about concentration in the healthcare sector and the ongoing nightmare of medical debt. Here are the links to all the articles mentioned:
Rachel Cohrs, “In a showy hearing, Bernie Sanders gets few answers about lower drug prices,” STAT, Feb 8, 2024 https://bit.ly/3UHNAjl
Sydney Lupkin, “Senators ask CEOs why their drugs cost so much more in the U.S.,” NPR, Feb 8, 2024 https://n.pr/3uyA07i
Ben Botkin, “Oregon lawmakers look for ways to curb prescription costs,” Oregon Capital Chronicle, Feb 12, 2024 https://bit.ly/3uCneVq
Nathaniel Weixel, “Biogen walks away from controversial Alzheimer’s drug Aduhelm,” The Hill, Jan 31, 2024 https://bit.ly/3UHT3XA
Helen Branswell, “HHS leaves vacant more than half the slots on a key vaccine advisory panel,” STAT, Feb 8, 2024 https://www.statnews.com/2024/02/08/acip-vacancies-hhs-vaccines/
Regina Benjamin & Jerome Adams, “Former U.S. surgeons general: The U.S. should ban menthol cigarettes,” STAT, Feb 9, 2024 https://bit.ly/3P7KIc7
Adam Kucharski, “Epidemiology has a causality problem,” Understanding the Unseen, Jan 29, 2024 https://kucharski.substack.com/p/epidemiology-has-a-causality-problem
Jonathan Yeatman, “Mission sale wasn’t good for HCA either: A former top exec argues for a return to local control, nonprofit status,” Asheville Watchdog, Feb 1, 2024 https://bit.ly/3OL4CcJ
Rebecca Pifer, “Amazon closing One Medical corporate offices,” Healthcare Dive, Feb 9, 2024 https://bit.ly/42EygFY
Are Amazon’s latest forays into healthcare failing again? It acquired One Medical in 2023, keeps losing money on it, and laid off hundreds there as well as at Amazon Pharmacy. Being huge apparently isn’t enough to achieve success in this field. Maybe people just don’t want to get doctored by Mr Bezos. 
Andrew Perez, “Republicans are planning to totally privatize Medicare—and fast,” Rolling Stone, Feb 5, 2024 https://bit.ly/48ovgyJ
Vallari Vaidya, “How a staggering rise in urinary catheter bills led investigators to alleged $2 billion Medicare scam,” Market Realist, Feb 12, 2024 https://bit.ly/3UCoMt5
Verónica Zaragovia, “With Medicaid expansion off the table, entrepreneurs and nonprofits help Florida’s uninsured,” Health News Florida/WLRN, Feb 6, 2024 https://bit.ly/3wpX4p7
Anna Claire Vollers, “Governments can erase your medical debt for pennies on the dollar—and some are,” Stateline, Feb 13, 2024 https://bit.ly/49hlgZq
Elisabeth Rosenthal, “GoFundMe has become a health care utility,” KFF Health News/The Atlantic, Feb 12, 2024 https://bit.ly/4bAOXGz
Tina Reed, “How one company managed to cut its health spending by almost half,” Axios, Feb 8, 2024 https://bit.ly/4bDkdoe
Gustavo Rivera, “Cutting expensive middle-men out of home care will save New York billions,” City Limits, Jan 22, 2024 https://bit.ly/49y7DoA
You can get my weekly written digest at tfrasca@gmail.com or delve into the archive of 6 years of links and comments at nypan.org/single-payer-news

Do Not Resuscitate (This System) #334 Feb 9 2024

Tim Frasca here to tell you what’s in the mainstream and specialty healthcare news media about how we spend trillions of dollars making intermediaries rich instead of making ourselves healthier. This week, I look at slipping profit margins in Medicare Disadvantage; some big structural issues such as vertical integration in the healthcare conglomerates and the failed promise of electronic medical records; as always, some news on pharmaceuticals; some clever new billing outrages; nonprofit hospitals taking advantage; and the steady loss of credibility among elite institutions. You can get my full written digest i(including six years of back issues) at nypan.org/single-payer-news and here are the links to the articles mentioned this week: 
Rebecca Pifer, “Cigna sells Medicare businesses to HCSC for $3.7B,” Healthcare Dive, Jan 31, 2024 https://bit.ly/3w6Dcr3
Emily Olsen, “Medicare Advantage profitability is declining, Moody’s says,” Healthcare Dive, Jan 30, 2024 https://bit.ly/3ulPR9b
Terry Savage, “Insurers’ losses to squeeze Advantage plans,” Chicago Tribune, Jan 31, 2024 https://bit.ly/495e7eC
Megan Messerly, “‘The politics have changed’: South warms to expanded health benefits,” Politico, Jan 31, 2024 https://politi.co/48bT20S
Matt Stoller, “Obamacare created big medicine,” The Lever/BIG, Jan 29, 2024 https://www.levernews.com/how-obamacare-created-big-medicine/
Dharushana Muthulingam, “Why everyone hates the electronic medical record,” Logic(s), Dec 13, 2023 https://bit.ly/49reuQF
Matt Stoller, “The dirty business of clean blood,” BIG, Feb 3, 2024 https://bit.ly/3usfvsT
Marshall Allen, “Your money or your life,” Healthcare Un-covered, Jan 31, 2024 https://wendellpotter.substack.com/p/your-money-or-your-life
Evan Bush, “A prestigious cancer institute is correcting dozens of papers and retracting others after a blogger cried foul,” NBC News, Jan 26, 2024 https://nbcnews.to/3uoO2Z8
Annalisa Merelli, “HPV vaccine study finds zero cases of cervical cancer among women vaccinated before age 14,” STAT, Jan 25, 2024 https://bit.ly/494l5kh
Noah Weiland, “U.S. makes initial offers in Medicare drug price negotiations,” New York Times, Feb 1, 2024 https://nyti.ms/3HWoRA1
Bernie Sanders, “Big Pharma will have to answer to the American people,” Fox News, Jan 31, 2024 https://fxn.ws/49mIFs0
Elisabeth Rosenthal, “The FTC is attacking drugmakers’ ‘patent thickets,’” KFF Health News/Fortune, Jan 31, 2024 https://bit.ly/48nfpkl
Nicholas Florko, “Juul spent big to court Black leaders to promote its e-cigarettes, new documents show,” STAT, Feb 3, 2024 https://bit.ly/3ulPTOl
Erika Edwards, “Ohio reverses local flavored tobacco bans, infuriating doctors,” NBC News, Jan 30, 2024 https://nbcnews.to/49kxdOl
Nick Corbishley, “Why is Tony Blair so keen for the UK’s National Health Service to sell off its patients’ health data to private companies?” Naked Capitalism, Feb 6, 2024 https://bit.ly/3UAvLCG
Michelle Crouch, “Atrium Health: A unit of ‘local government’ like no other,” North Carolina Health News/Charlotte Ledger, Feb 5, 2024 https://bit.ly/3HQKx0D
Gene Johnson, “After Washington state lawsuit, Providence health system erases or refunds $158M in medical bills,” Associated Press, Feb 1, 2024 After Washington state lawsuit, Providence health system erases or refunds $158M in medical bills

Do Not Resuscitate (This System) #333 Feb 2 2024

This week's Believe It or Not tales and horror stories about how we spend trillions of dollars making intermediaries rich instead of making ourselves healthier. This week, I start with some general news about the financier takeover of our economy, then pivot to the current state of Medicare Disadvantage where some of the big players in that privatization scheme aren’t making as much money as they’d like; there's an update on hospital mergers, how the fat shots are bankrupting North Carolina, and a scathing review of expert performance during Covid and why a lot of people don't trust scientific officialdom. Find the full digest at NYPAN.org/single-payer-news

Do Not Resuscitate (ThisSystem) #332 Jan 26 2024

I’m Tim Frasca, and every week I tell you about what’s in the mainstream and specialty healthcare news media about how we spend trillions of dollars making intermediaries rich instead of making ourselves healthier. This week there’s a fascinating set of stories about health insurance companies losing money because they are required to provide healthcare. Can't have that! More on how consumers get slammed, a town where a quarter of the residents have been sued by their hospital, and the medical debt forgiveness movement; some pharmaceutical pricing news; and workforce issues, like why doctors and nurses are fleeing Tennessee and a potentially big class-action lawsuit by a Pittsburgh nurse. Find all the links at  https://nypan.org/single-payer-news
I also refer to a study about hospitals that are failing financially and being forced into mergers, which can be found at www.kaufmanhall.com

Do Not Resuscitate (This System) #331 Jan 19 2024

Every week I share news about how we spend trillions of dollars making intermediaries rich instead of making ourselves healthier. This week, I look at payment systems including government insurance; privatized Medicare such as Medicare Advantage and other for-profit invasions; some news on drug prices; the state of our feeble regulatory apparatus; and some general stories about the structural barriers to a healthy population. Find the whole digest and archive of back issues at nypan.org under "single payer news". 

Do Not Resuscitate (This System) #330 Jan 12 2024

I review health news in the mainstream and specialty media about how we spend trillions of dollars making intermediaries rich instead of making ourselves healthier. This week's topics are: the crazy way we pay for our healthcare; the Medicaid disenrollment debacle; good news on the antitrust front against further concentration in healthcare; some short pharmaceutical updates; and two sad tales about systemic breakdown in psychiatric care for veterans and minors. The full archive can be found at NYPAN.org under "single payer news." The script follows (not verbatim as I can't resist making wisecracks). 
 
12 JAN 2024
Hello and welcome to “Do Not Resuscitate (This System”) for the week ending January 12, 2024. I’m Tim Frasca, and every week I tell you about what’s in the mainstream and specialty healthcare news media about how we spend trillions of dollars making intermediaries rich instead of making ourselves healthier. This week we’ll discuss news about the crazy way we pay for our healthcare; more on the Medicaid disenrollment debacle; good news on the antitrust front against further concentration in healthcare; some short pharmaceutical updates; and some sad tales about systemic breakdown in psychiatric care for veterans and minors.
Let’s start with some general news about our crazy-ass payment system. Sarah Jane Tribble writes for KFF Health News that “Older Americans say they feel trapped in Medicare Advantage plans.” Well, news flash, they are. Seniors are lured into signing up for MA plans with bells and whistles like gym memberships and eyeglasses, all hustled in those ads with Joe Namath and Captain Kirk. Then, when they have any kind of major episode and start costing the insurance company money, guess what? They act like an insurance company! Limited the available networks and subject patients to prior authorization hell with frequent denials and red tape. When enrollees want to go back to traditional Medicare and add a supplemental to absorb the 20% Medicare doesn’t cover, those companies can reject them for pre-existing conditions—except for four states.
And I’m not making that up about the automated denials. Jakob Emerson at Becker’s Payer Issues writes about a lawsuit over the use of artificial intelligence to issue mass denials of MA claims. Emerson describes how any provider who deviated from the strict limits on post-acute facility stays faced “discipline and termination.” We need a federal crackdown with teeth.
Michael Osso from the Dallas Morning News gives some helpful advice on “How to fight back if your health insurance claim is denied.” I almost hate to read these admittedly useful details because WHY DO WE HAVE TO DO THIS IN THE FIRST PLACE? And denial rates are increasing—they’re up to 11% of all claims from users of ACA marketplace plans. Only 0.2% of these denials are appealed—that’s 1 in 500. Yes, we should learn to appeal and fight these SOBs and clog up their admin pipelines. And appeals are successful, says Osso, 82% of the time. So we should do it while reminding ourselves that this time-sink is an abuse.
Now here’s an interesting piece with an unacknowledged conceptual error, or you could say even an ideological one: Dylan Scott at Vox writes that, “The US doesn’t have universal health care—but these states (almost) do.” But wait: let’s define “universal”—Scott thinks it means everyone has something called “insurance.” Now, any listener to this podcast knows that being insured doesn’t mean you actually get medical care when you need it and without going bankrupt. That a state’s uninsured rate is under 5% tells us next to nothing. “The country is inching toward universal coverage,” Scott claims but without any discussion of premiums, deductibles, copays, or prior authorization. Compare U.S.-style “universal” care to Canada’s where you show your health card at any doctor’s office and then forget about it.
An excellent example comes from NC Health News and the Charlotte Ledger where Michelle Crouch tells the incredible tale of how “Charlotte hospitals say ‘no thanks’ to charity’s efforts to erase medical debt.” These hospital CEOs are auditioning for The Grinch, I swear. This church group wants to buy up people’s medical debt and then forgive it, and the city’s hospitals refuse to sell it to them. Charlotte’s Mecklenburg County, 18% of families have medical debt in collections; 57% of them were insured when they incurred it. Paging Dylan Scott @ Vox: Is Charlotte “inching toward universal coverage”? All these people on the hook for thousands in hospital debt—are they really insured? What does that even mean?
From the provider side, things are even worse. Andrew Popper told his story in STAT with the headline, “Insurance companies are forcing psychiatrists like me to stop accepting their coverage.” This poor guy tried his best to deal with insurance companies, finally gave up, and now earns less but spends all that wasted reimbursement-pursuit time with patients. Here’s what his prior life was like: “The paper claims simply disappeared into the ether or were rejected. Slight deviations from the insurer’s opaque and ever-changing protocol would necessitate resubmitting the claim. My administrative time started exceeding my clinical time.” Popper wonders why we put up with it all and winds up with a memorable phrase. “This is the business model—customers pay for the right to be deprived of the product they’re purchasing.”
But for Tom Price & Elaine Parker writing an op ed in Newsweek, we need more of the same. They criticize Biden’s health care agenda as not being sufficiently friendly to free enterprise. Price, we should recall, was Trump’s disastrous HHS chief who had to resign after racking up $1 million in private jet travel. Now, he works for the libertarian “Job Creators Network.” He denounces government regulation in favor of “free-market competition and patient choice” [yawn]. But under the broken-clock rule, Price accidentally lands on a fact about Obamacare subsidies for people buying private insurance: he says it’s “a temporary Band-Aid that does nothing to quell long-term inflationary pressures within health care. [true] Middle-class families who don’t qualify for subsidies will continue to be financially squeezed while others are blindfolded to the real problem.”
Kristen Hwang at Cal Matters describes how that free market in healthcare is working on planet Earth, as opposed to the ideological Fantasyland where Tom Price lives. Her article entitled, “A market failure” tells us about Monterey County where insured Californians can’t use local hospitals because of their monopoly prices, which run four to five times Medicare rates, such as $12,000 a night for a hospital room and double-digit annual price increases for premiums. But hey, reality doesn’t intrude too much in the Tom Price world.  
Now, there’s a subtler version of the market worship in Ezekiel Emanuel’s STAT piece purporting to tell us, “Why health care costs haven’t exceeded inflation in recent years?” Emanuel was an insider involved in crafting the ACA (Obamacare), so not surprisingly he says that value-based care, such as that used by the Medicare Disadvantage system, created incentives to keep costs down, so that’s the way forward, privatize Medicare and get those free-market incentives to work. But Emanuel doesn’t address how “value-based” translates as “if we don’t spend money on patient care, we get to keep more of the money.” How is that not a perverse incentive? Emanuel wants us all to have to fight rigged prior authorization procedures because that’s going to produce cost savings. Yeah, and who gets that saved cash? Three guesses. Emanuel’s neoliberal market-worship is the Democrats’ version of what Tom Price is peddling.
Now, let’s move on to the Medicaid disenrollment debacle. Bryce Covert asks in the New York Times, “What happened to my health insurance?” and tells us about people being surprised at the ER or the pharmacy when they find out they were kicked them off Medicaid. During Covid, people were guaranteed continued coverage, which meant people could take on better-paying jobs and not worry about losing their eligibility for making too much money. Well, that went out with the window, and now 30 million people are set to lose Medicaid; 13 million already have. Are these millions going to show up in 2024 to vote for the Democrats who presided over this nightmare? Asking for a friend.
There is a slew of stories of the Medicaid nightmare in various states. Texas is the worst with 1.7 million people thrown off so far. Neelam Bohra at the Texas Tribune quotes one Texas Congress member who complained about “an incredible amount of incompetence and indifference to poor people” as if that were an accident. Texas has a “backlog of hundreds of thousands of applications” for Medicaid and other benefits, which provides convenient excuses for kicking people off who actually remain eligible.
The enforcement from the Feds who actually stump up the cash to pay states for their Medicaid programs has been pretty pathetic. Benjamin Hardy in the Arkansas Times writes that the “Biden administration [is] ‘deeply alarmed’ by Arkansas’s rush to kick kids off Medicaid.” Oh, they’re “deeply alarmed,” isn’t that skeery for Governor Cruella de Ville who takes delight in dumping her state’s poor. Arkansas so far has tossed 18% of child enrollees off Medicaid after they refused to work in chicken slaughtering plants (ha, just kidding!)
Chelsea Cirruzzo at Politico has a similar tale: “Biden administration pleads with states after millions of kids lose Medicaid coverage.” Pleading, that’s the regulatory response. Yes, we will send you a stern letter! With the subject line: “Please don’t be so mean!”
There’s some good news on the market concentration & antitrust front. Matt Stoller writes at his very informative and really must-read blog BIG, “Out with a bang as FTC beats the Pharma Bros.” This is a story about Lina Khan’s tenure at the Federal Trade Commission, which used to be one of those Federal agencies you never heard about because they never did anything important. But she and her team are addressing vertical integration in healthcare, which is crucial for us because it threatens the healthcare cartels’ business model. Stoller relates how a medical data behemoth named IQVIA was “trying to monopolize the business of advertising to doctors” by buying out a competitor, exactly the way Google monopolized online advertising, successfully, to our detriment. But Khan sued IQVIA and beat them in court, the first challenge to a vertical integration merger in 40 years. We should pay attention to this fight because it is extremely important for the future of the entire $4 trillion a year industry.
Susanna Vogel at Healthcare Dive notes that “Antitrust enforcements hit a high in 2022 with health deals impacted.” The FTC blocked three big proposed health system mergers in 2023, and although they didn’t always win, at least they’re fighting and shaking up the giants.
For example, Dan Primack at Axios notes that drugmaker Sanofi had to scrap its attempt to buy out a company that was developing a potential competitor drug. This is known as “killer acquisitions,” which obviously destroy innovation in the pharmaceuticals, which is supposedly the reason these companies have to make so much dough, right? In a killer acquisition, a drugmaker buys up anything that might come along to compete with its blockbuster sellers to make sure that we have no alternative. Primack writes, “This must be raising eyebrows among biotech venture capitalists, who often generate returns via these sorts of bio-bucks deals.” Couldn’t happen to a nicer bunch.
There were some sad tales about systemic failures as well, such as Gretchen Morgenson’s long piece for NBC News entitled, “Vital signs vs. dollar signs: At HCA hospitals, the person monitoring your heart may monitor 79 other patients, too.” This is a chilling tale about how the person watching your heart rhythms, blood pressure, or respiratory functions when you’re hospitalized might be a low-paid techie sitting in another building watching dozens of screens simultaneously. Why would a hospital do this? “Technician salaries are significantly lower than those of registered nurses.” Ah. So those precious seconds when your heart stops can and is easily missed by someone whose eyes glazed over in front of a bank of beeping screens.
Kathleen McGrory & Neil Bedi investigated the Veterans Administration’s mental health services and, not surprisingly, found them lacking in a ProPublica piece, “When veterans in crisis can’t get help.” Here’s the key statement: “The military has long drawn recruits from remote towns across America, promising them a lifetime of health care in return for their service. But the VA has seldom staffed those same communities with the mental health professionals needed to help them once they return home.” You’d think in that $800-plus billion-dollar Pentagon budget there might be a line for enough psychiatrists, but apparently not. “We were abandoned,” said one VA social worker. “We kept saying, there is going to be a problem. This is going to blow up.” Then it did.
ProPublica did a joint investigation with The City, a wonderful online new source for us New Yorkers, “New York closed psych beds for youth in crisis. Now, foster care programs and host town are being pushed to the limit.” This one’s about the overstretched acute care facilities for minors, specifically one in Westchester County that is drawing ire from locals because they can’t control their residents. This goes back to Gov. Cuomo’s closure of half of psychiatric care beds in the state, which the current administration apparently wants to reverse, and none too soon. It’s a heartbreaking story of how suicidal kids wait for months on wait lists for a treatment program, part of a larger ProPublica series called “How New York Wrecked Mental Health Care for Kids.”
Finally, two items about pharmaceuticals: Adam Cancryn at Politico reports that the Biden Administration is “targeting costly meds and asserts authority to seize certain drug patents.” Yeah, I’ve heard this one before, but it falls into the category of All Hat, No Cattle. I recall very well from the HIV/AIDS wars some heady rhetoric about defying Pharma over patents, but it almost never happened. But it does make good copy for an election campaign. And Cancryn notes that “Biden officials now plan to make a fresh push to put health care at the center of Biden’s reelection platform.” So I’ll wait for action and ignore speeches, but that’s just me.
And I could not leave out this marvel from Ned Pagliarulo at Healthcare Dive, “Lilly launches online service for home delivery of weight loss drug.” So yes, now you can not only get your expensive fat meds paid for by the government, but Lilly will even drop them on your doorstep. To stave off criticism, Lilly added a virtue signaling statement that its product should not be used for “cosmetic weight loss.” Oh no, we totally do NOT want you to see our ads and then clamor for our slimming product from your doctor! Perish that thought.
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That’s it for Do Not Resuscitate (This System) for the week ending January 12, 2024. I’m Tim Frasca, and each week I compile news and commentary about how the lack of a single-payer system is giving us lousy services for a ton of money. All these articles and more are in my written digest, and you can look that up at the website of the New York Progressive Action Network, that’s NYPAN.org N-Y-P-A-N and search for Single Payer News—I’ll put a link in the program notes along with my email in case you would like to receive my written digest to your inbox. I’ll be back next Friday with more news about our ongoing national project to squander trillions and make intermediaries rich. Thank you for listening.

Do Not Resuscitate (This System) #329 Jan 4 2024

This is Tim Frasca. Every week, I cover the mainstream and specialty healthcare news media about how we spend trillions of dollars making intermediaries rich instead of making ourselves healthier. This week, I discuss the sudden conversion of presidential candidate Dean Phillips to Medicare for All; the problems with the federal ban on surprise bills in hospitals; how the drug pricing business is starting to get a shake-up; more on the ongoing mass expulsion of millions of people from Medicaid; the fight against monopolistic practices in healthcare being led by the Federal Trade Commission, and several other items of interest. Find my full digest at NYPAN.org under "single payer links".