Monday, February 12, 2024

Sunday, January 21, 2024

Need to change how U.S. handles drug pricing

A complicated system of intermediaries and a lack of legal constraints have contributed to high drug prices in the United States.Credit...Paola Chapdelaine for The New York Times NYT article copy access if NYT can't be accessed

Friday, December 15, 2023

Medicare Advantage wastes our money and gives away millions to corporations

Medicare Advantage routinely denies reimbursements for necessary care, hospital execs say 31 million people are on Medicare Advantage plans, a private alternative to traditional Medicare. The plans are often cheaper and promise better benefits. However, the CEOs of rural hospital systems in six states told NBC News that Medicare Advantage routinely denies reimbursements for necessary care. NBC News’ Sam Brock reports. A video from MSN that tells the story.

Wednesday, November 29, 2023

Trump vows again to try to ‘terminate’ Affordable Care Act

Trump vows again to try to ‘terminate’ Affordable Care Act News and commentary from Founding Editor Pat Kreitlow - Up North News Even as former President Donald Trump promised to try again to “terminate” the Affordable Care Act (ACA), Wisconsin progressives doubled down on their own promise to expand healthcare coverage and make it more affordable for working families. Trump put a post on his Truth Social account last Sunday that criticized Republicans who refused to “terminate” the ACA—adding “we should never give up.” Democrats immediately amplified the post, given the strong and growing public support for affordable health care. “Christmas has come early” for Democrats and President Joe Biden, reported Axios. Robert Kraig, executive director for Citizen Action Wisconsin, told UpNorthNews Radio the better path would be for Wisconsin Republicans to take advantage of an ACA provision that would expand and strengthen Medicaid—better known in Wisconsin under the name BadgerCare. For more than a decade, Republicans in the Legislature have blocked BadgerCare expansion, leaving Wisconsin as one of only 10 states in the country missing out on the extra federal funding that would cover more families. Democratic legislators recently introduced a bill that would also add a public option to BadgerCare, allowing families and small businesses to buy into Medicaid coverage and use ACA subsidies to help make premiums even more affordable.

Thursday, November 16, 2023

Excessive Corporate Control in Medicine

Summary: A valuable report lays out the harm due to a corporate takeover of medicine –deleteriously affecting the experience of both providers and patients. The American Medical Association is failing to fight this trend. Regulatory action and physician activism are needed. The Corporate Practice of Medicine TAKE MEDICINE BACK October 2023 By Mitchell Li, Sailesh Konda, Robert McNamara [HJM bolding] Conclusion: The corporate practice of medicine doctrine was integral in providing an ethical basis for the practice of medicine. Today, the American Medical Association (AMA) explicitly tolerates the corporate practice of medicine, and state prohibitions on CPOM are broadly unenforced. The vast majority of physicians are now employees of increasingly consolidated corporations, while moral injury and burnout among physicians are at unsustainable levels. Rapid horizontal and vertical consolidation of non-physician healthcare corporations that employ physicians not only increases monopoly power over consumers, which in return increases costs, but also increases monopsony power over physician labor. This has resulted in anti-competitive labor practices that lead to intimidation of, and retaliation against physicians who advocate for patients. This places the public at risk through greater corporate influence over the practice of medicine. Corporations are increasingly replacing physicians with lesser-trained non-physician practitioners in order to maximize profits, while increasing costs to patients and taxpayers and eliminating remaining safeguards of physician expertise from the unfettered corporate practice of medicine. A new era of robust antitrust enforcement in healthcare is needed. Past FTC actions against the AMA restricting the ability to impose ethical restrictions on its members should be re-examined in the context of unintended consequences of enabling corporatization and consolidation. A national prohibition on the corporate practice of medicine is necessary to accompany the strengthening, and enforcement of existing state-based prohibitions. Physician organizations must collectively reject non-physician corporate ownership of medical practices. Reclaiming the profession from corporate interests will take time, and greater protections for employed physicians are needed now in order to protect patients. In the face of legislative inaction at the state and federal level, employed physicians should use the tools available to labor and organize through unionization. Comment by: Don McCanne This very impressive 63-page report on the corporate practice of medicine explains very well how the monopoly (one seller) power over health care consumers has increased costs, and the monopsony (one buyer) power over physicians has led to intimidation of and retaliation against physicians who advocate for their patients, resulting in moral injury and burnout. And this is just the beginning of the harm being done. Coincidentally, Sen. Bernie Sanders is currently holding hearings with the message that we need to expand union organizing in this country to rein in corporate greed if we are going to save the middle class and the workers in this country ( This report on the corporate practice of medicine closes its Conclusion with the following two sentences: “Reclaiming the profession from corporate interests will take time, and greater protections for employed physicians are needed now in order to protect patients. In the face of legislative inaction at the state and federal level, employed physicians should use the tools available to labor and organize through unionization.” Remarkably, the American Medical Association, at its interim meeting of its Congress of Delegates this week, actually brought this report up for consideration. However, the membership is down to 10% of US physicians, and they are predominantly politically conservative in my opinion (I’m a Life Member), so their Council on Legislation recommended that it not be adopted. But at least some more concerned members did have it pulled out of the “not for consideration” list of resolutions. There is some moral spark within the AMA such as those who attempted to have the AMA withdraw their long-standing opposition to single payer. Even though that effort failed this time, maybe the good guys and gals will eventually prevail. Anyway, for those of us who care about our patients, we need to end the private corporate control of health care, and we need to take the immediate action of using the tools available to labor and organize through unionization.

Wednesday, October 4, 2023

Lancet Panel on Investor-Owned Health Care

Summary: The recent Lancet webinar on private for-profit ownership of US health care assembled leading experts on this crucial issue. We must – and can – reverse this commoditization of health care. Public policy and health in the USA: should investors own healthcare? (scroll down to “On-demand webinars”) The Lancet Webinars Sep, 2023 Claudia Fegan: The question of “Should investors own healthcare,” I believe is the most important policy question facing healthcare in the United States today. We spend over 4 trillion dollars a year, 18 percent of our gross domestic product is spent on healthcare in the U.S. each year. That is more than twice as much as most other developed countries. Yet we rank miserably in the outcome measures such as life expectancy, preventable hospitalizations, maternal mortality, and suicide. We need to ask what role in the U.S. the current investor-driven system plays in causing and exacerbating the racial disparities in healthcare. Donald Berwick: In the past few years I’ve tried to understand how such a noble system can be so underperforming in its potential at the cost of the well being and spirit of the work force and the patients it serves, I have come to use the word GREED, and I’ve been challenged for that because most of the people that work everyday in all of the sectors of healthcare feel quite good about what they’re doing, they’re trying to help patients. But when we look at the underlying dynamics, I believe the commoditization, commercialization, the role of changing ownership to private hands, and the proletarianization of the healthcare workforce lie at the core of at least some of the reasons why this system is so deeply underperforming. You cannot find a sector in healthcare in which greed is not just manifest, but I would claim even dominant. Greed right now effectively concentrates wealth in the United States; wealth concentrates political power and influence through the role of lobbying and political contribution, and that political contribution stops efforts to reign in or place constraint on greed. Rosemary Batt: Private equity turns healthcare from a social good into a financial asset. It extracts wealth through financial strategies and not primarily by providing better care. There may be some improvements in care, but the fundamental focus is on financial gain. (She explains the mechanisms that private equity uses for wealth extraction.) Steffie Woolhandler: What we’ve seen is what I’ll call financialization of the entire healthcare system: money has become the mission. Traditionally providers invested money in buildings and equipment in order to produce medical care. That was our service mission or social mission. Now, financial entities are investing in medical care to produce money through profit, and money is their mission, and that, fundamentally, is what is wrong with the U.S. healthcare system today. This is happening despite the fact that the majority of the American people do not want this. Polls continue to show that the majority of the American people want a nonprofit, single payer, Medicare for All system for the United States. But Medicare for All is not enough. We need to address ownership, and we need to take back hospitals, community resources, the doctors’ practices, we need to take them back from investors and return control to community providers and patients (see HJM post on The Nation “Medicare For All Is Not Enough”). Q & A: Don McCanne: Is there any prospect that the United States could have a progressive legislature and administration that would support a healthcare financing system exclusively devoted to the service of universal patient care rather than being devoted to private wealth? Steffie Woolhandler: Absolutely. There’s that possibility. Other nations have succeeded in establishing non profit, publicly owned, sometimes publicly regulated and publicly administered systems. If they can do it, we can do it. It’s just going to take a lot of organizing and a lot of educating the public about the possibility. Donald Berwick: I’ll add that we are the outlier. Every other country finds a way to guarantee care to everyone – every other developed country – at a cost of about half of ours. So no-one can say, “it can’t be done.” It’s a matter of will, and I fear nowadays it’s a matter of political will. Comment by: Don McCanne This excellent one hour webinar by The Lancet explains why single payer alone is not enough. Not only do we have to establish an equitable, affordable financing system that makes healthcare accessible for all (single payer), we are going to have to address the issue of ownership of the healthcare delivery system such that our healthcare dollars that derive from us, the people, end up serving the public, social mission of providing healthcare for all instead of the private mission of enhancing personal megawealth for the few. The notice of this Lancet webinar should be distributed to all who care, and to those who don’t now seem to care but may have within them the capacity to care when the facts are understood. Whether nominally public or private, it’s our money; let’s spend it on us.