F. Douglas Stephenson – Informed Comment https://www.juancole.com Thoughts on the Middle East, History and Religion Sat, 07 Jan 2023 13:18:03 +0000 en-US hourly 1 https://wordpress.org/?v=5.7.8 Big Pharma spent more on Stock Buybacks and Dividends than on Research and Development even during COVID https://www.juancole.com/2023/01/buybacks-dividends-development.html Sun, 08 Jan 2023 05:02:07 +0000 https://www.juancole.com/?p=209315 Gainesville, Florida (Special to Informed Comment) – The 14 largest publicly-traded pharmaceutical companies spent $747 billion on stock buybacks and dividends from 2012 through 2021 — substantially more than the $660 billion they spent on research and development. So argue economists William Lazonick, professor emeritus of economics at University of Massachusetts, and Öner Tulum, a researcher at Brown University, in a new paper.

Recently Big Pharma bluntly and unashamedly announced price hikes in the United States on more than 350 drugs while continuing to brazenly insist that large price hikes are necessary for innovation. The Lazonick/Tulum research shows that the business model of America’s largest pharmaceutical companies involves far more spending on enriching shareholders and executives than on research and development.

Big business, Big Insurance and Big Pharma industries dominate our government with public health taking a back seat to the need for large private profit. Many government leaders from both political parties share the same ‘profits over public health’ ideology, even though the Covid-19 pandemic clearly showed how our economic system failed to serve our citizens by allowing these groups to privatize, sabotage, fragment and cripple our health, public health and other social services.

No greater disconnect exists between the public good and private interests than in the U.S. system of monopoly, for-profit Big Pharma.

Over forty years of profiteering by Big Pharma and oligarch control of our economy left the public totally exposed and ill-prepared to face the public health crisis of COVID-19. Because Big Pharma rarely invests in prevention, it has very little motivation to invest in preparedness for a public health crisis. Drugs for prevention do not contribute to share-holder value and profit. Instead, cures are designed once a public health crisis strikes.

The sicker we are the more profit they earn.

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Parasitic Private Equity is Consuming U.S. Health Care from the Inside Out https://www.juancole.com/2022/11/parasitic-private-consuming.html Mon, 28 Nov 2022 05:08:03 +0000 https://www.juancole.com/?p=208428 Gainesville, Fl. (Special to Informed Comment) – Private equity has succeeded in depicting itself as part of the productive economy of health care services. even as it is increasingly being recognized as being parasitic. The essence of this toxic parasitism is not only to drain the host’s nourishment, but also to dull the host’s brain so that it often does not even recognize that the parasite is there. This is the illusion that health care services in the United States suffer under today. 
  
Parasitic private equity is consuming US health care from the inside out, weakening its structure and strength and enriching investors at the expense of patient care and patients. Incremental health reforms have failed. It’s time to move past political barriers to achieve consensus on real reform. says J.E. McDonough, Professor of Practice at the Harvard T. H. Chan School of Public Health. Private equity firms are financial termites devouring the woodwork and foundations of the US health care system. Laura Katz Olson documents in her new book, Ethically Challenged: Private Equity Storms US Health Care, “PE firms are gobbling up physician and dental practices; homecare and hospital agencies; mental health, substance abuse, eating disorder, and autism services; urgent care facilities; and emergency medical transportation.” Private equity has become a growing and diversified part of the American health care economy. Demonstrated results of private equity ownership include higher patient mortality, higher patient costs, fewer jobs, poorer quality, and closed facilities.

What is Private Equity?

A private equity fund is a large unregulated pool of money run by financiers who use that money to invest in and/or buy companies and restructure them. They seek to recoup gains through dividend pay-outs or later sales of the companies to strategic acquirers or back to the public markets through initial public offerings. But that doesn’t capture the scale of the model. There are also private equity-like businesses who scour the landscape for companies, buy them, and then use extractive techniques such as price gouging or legalized forms of complex fraud to generate cash by moving debt and assets like real estate among shell companies. PE funds also lend money and act as brokers, and are morphing into investment bank-like institutions. Some of them are public companies.

While the movement is couched in the language of business, using terms like strategy, business models returns of equity, innovation, and so forth, and proponents refer to it as an industry, private equity is not business. On a deeper level, private equity is the ultimate example of the collapse of the enlightenment concept of what ownership means. Ownership used to mean dominion over a resource, and responsibility for caretaking that resource. PE is a political movement whose goal is extend deep managerial controls from a small group of financiers over the producers in the economy. Private equity transforms corporations from institutions that house people and capital for the purpose of production into extractive institutions designed solely to shift cash to owners and leave the rest behind as trash. Like much of our political economy, the ideas behind it were developed in the 1970s and the actual implementation was operationalized during the Reagan era.

Matt Stoller, distinguished journalist, describes the essential business plan of private equity:
Financial engineers… raise large amounts of money and borrow even more to buy firms and loot them. These kinds of private equity barons aren’t healthcare specialists who help finance useful health products and services, they do cookie cutter deals targeting firms/practices/hospitals they believe have market power to raise prices, who can lay off workers or sell assets, and/or have some sort of legal loophole advantage. Often, they will destroy the underlying business. The giants of the industry, from Blackstone to Apollo to Bain, are the children of 1980s junk bond king and fraudster Michael Milken. They are essentially super-sized mobsters.

Economists Akerloff, Romer, Public Health Professor McDonough elaborate:

The classic description of this looting-for-profit practice process is presented by economists George Akerloff and Paul Romer : “Firms have an incentive to go broke for profit at society’s expense (to loot) instead of to go for broke (to gamble on success). Bankruptcy for profit will occur if poor accounting, lax regulation, or low penalties for abuse give owners an incentive to pay themselves more than their firms are worth and then default on their debt obligations.” The fact that paper gains from stock prices can be wiped out when financial storms occur makes financial capitalism less resilient than the industrial base of tangible capital investment.

 Professor McDonough notes that in the past 45 years the US economy has become heavily financialized more rapidly and decisively than in our peer nations. “Just as General Electric’s Jack Welch transformed (ruined) his company from a goods manufacturer to a financial services company, so have financial flood waters now penetrated every corner of American health care. Private equity is winning, and any health care organization is a potential takeover target. Patients and patient visits become commodities and data points to be exploited for high profits by private equity’s “financial intermediaries who view healthcare organizations as vehicles for extracting wealth.”

Don McCanne, M.D., Physicians for a Nation Health Program (PNHP) describes private equity modus operandi:
All around us we see private equity firms moving into health care by clustering specific specialties into new corporate entities. These equity firms may profess to infuse quality and efficiency into the systems they create, but their true objective is not altruism. Their interest is found in their label: equity, the more ($$) the better. Distinguished California physician, Don McCanne, M.D. of PNHP, describes private equity modus operandi:
1) acquire a relatively large platform practice in a given specialty
2) then acquire smaller practices in the same geographic area and merge them into the platform practice
3) use debt to finance the acquisitions and assign that debt to the acquired practices,
4) find ways to increase net revenue from the agglomerated practices
5) sell the agglomerated practices within 3 to 5 years for considerably more than the price paid by the private equity company.


Via Pixabay.

Conveniently, Dr. McCanne notes, the debt is left with the practices they purchased, and the equity investors walk away with the money. How does this benefit the patients? How does this benefit the health care professionals? We know how it benefits the equity firm investors, but does anyone seriously contend that this is what health care should be about? But that’s what it has become.

Consequences:
 1).Consider Noble Health, a private equity-backed Kansas City startup launched in 2019. In rural Missouri, Noble acquired Audrain and Callaway Community Hospitals in the early days of the COVID-19 pandemic. 
 2). In March 2022, all hospital services ceased with the furlough of 181 employees. 
 3). Notes Kaiser Health News, “…venture capital and private equity firm Nueterra Capital launched Noble in December 2019 with executives who had never run a hospital, including Donald R. Peterson, a co-founder who prior to joining Noble had been accused of Medicare fraud.”
4). St. Joseph’s Home for the Aged in Richmond, Virginia, as retold in The New Yorker. 
5). A New Jersey private equity firm called the Portopiccolo Group bought the home, 
a).“reduced stuff, cut amenities, and 
b). set the stage for a deadly outbreak of COVID-19” that included a doubling in patient deaths.
6). The numbers of stories of private equity-generated health system harm grows rapidly. And if the health part of the business goes bust, as occurred in 2019 at Philadelphia’s now closed Hahnemann Hospital, the underlying real estate still offers rich rewards.
7). Patients at North Carolina-based Atrium Health get what looks like an enticing pitch when they go to the nonprofit hospital system’s website: a payment plan from lender AccessOne. The plans offer “easy ways to make monthly payments” on medical bills, the website says. You don’t need good credit to get a loan. Everyone is approved. Nothing is reported to credit agencies. Very high interest rates are standard however
8). In Minnesota, Allina Health encourages its patients to sign up for an account with MedCredit Financial Services to “consolidate your health expenses.” Very high interest.
9). In Southern California, Chino Valley Medical Center, part of the Prime Healthcare chain, touts “promotional financing options with the CareCredit credit card to help you get the care you need, when you need it.” As usual, very high interest rates.

As Americans are overwhelmed with medical bills, patient financing is now a multibillion-dollar business, with private equity and big banks lined up to cash in when patients and their families can’t pay for care. By one estimate from research firm IBISWorld, profit margins top 29% in the patient financing industry, seven times what is considered a solid hospital margin.

Mental health services controlled by a buyout king:

The Private Equity Newsletter reports that psychiatrists, psychologists, clinical social workers once ran their own practices. Now the local therapist office could be controlled by a buyout king. Venture capitalists and private-equity firms are pouring billions of dollars into mental-health businesses, including psychology offices, psychiatric facilities, telehealth platforms for online therapy, new drugs, meditation apps and other digital tools. Nine mental-health startups have reached private valuations exceeding $1 billion last year, including Cerebral Inc. and BetterUp Inc.

Demand for these services is rising as more people deal with grief, anxiety and loneliness amid lockdowns and the rising death toll of the Covid-19 pandemic, making the sector ripe for investment, according to bankers, consultants and investors. They say the sector has become more attractive because health plans and insurers are paying higher rates than in the past for mental-health care, and virtual platforms have made it easier for clinicians to provide remote care.

“Since Covid, the need has gone through the roof,” said Kevin Taggart, managing partner at Mertz Taggart, a mergers-and-acquisitions firm focused on the behavioral-health sector. “Every mental-health company we are working for is busy. A lot of them have wait lists.”

In the first year of the pandemic, prevalence of anxiety and depression increased by 25%, the World Health Organization said in March. About one-third of Americans are reporting symptoms of anxiety or depression, according to the Centers for Disease Control and Prevention.

The number of behavioral-health acquisitions jumped more than 35% to 153 in 2021 versus the previous year, and of those, 123 involved private-equity firms, according to Mertz Taggart. In the first quarter of this year, there were 41 acquisitions, of which 30 involved PE firms.

The push into mental health carries risks. A rush of private-equity firms could send prices for practices higher, reducing potential profits. A risk for patients and clinicians is that new owners could focus on profits rather than outcomes, perhaps by pressuring clinicians to see more patients than they can handle. If care becomes less personal and private, patient care might also suffer.

Online mental-health company Cerebral and other telehealth startups have begun to face scrutiny over their prescribing practices. The Wall Street Journal has reported that some of Cerebral’s nurse practitioners said they felt pressure to prescribe stimulants. This past week, Cerebral said it would pause prescribing controlled substances such as Adderall to treat ADHD in new patients. Last year, Cerebral logged a $4.8 billion valuation.

Investors poured $5.5 billion into mental-health technology startups globally last year, up 139% from 2020, according to a report by CB Insights, an analytics firm. Of that, $4.5 billion was spent on U.S. firms. They range from platforms like SonderMind that match people with clinicians to meditation apps like Calm.

How bad has it gotten?
Private equity-owned healthcare companies have also seen the following issues:
    * Reduced staffing, or filling beds without adequate staffing ratios
    * Over-reliance on unlicensed staff to reduce labor costs
    * Failure to provide adequate training
    * Pressure on providers to provide unnecessary and potentially costly services
    * Violation of regulations required for participants in Medicare and Medicaid such as anti-kickback provisions, creating litigation risk

Dentristry:
Kaiser Health News (KHC) reports that private equity business tactics have been linked to scandalously bad care at some dental clinics that treated children from low-income families.

    * In early 2008, a Washington, D.C., television station aired a shocking report about a local branch of the dental chain Small Smiles that included video of screaming children strapped to straightjacket-like “papoose boards” before being anesthetized to undergo needless operations like baby root canals.
    * Five years later, a U.S. Senate report cited the TV exposé in voicing alarm at the “corporate practice of dentistry in the Medicaid program.” The Senate report stressed that most dentists turned away kids enrolled in Medicaid because of low payments and posed the question: How could private equity make money providing that care when others could not?
    * “The answer is ‘volume,’” according to the report.
    * Small Smiles settled several whistleblower cases in 2010 by paying the government $24 million. At the time, it was providing “business management and administrative services” to 69 clinics nationwide, according to the Justice Department. It later declared bankruptcy.
According to the 2018 lawsuit filed by his parents, Zion Gastelum was hooked up to an oxygen tank after questionable root canals and crowns “that was empty or not operating properly” and put under the watch of poorly trained staffers who didn’t recognize the blunder until it was too late.
    * Zion never regained consciousness and died four days later at Phoenix Children’s Hospital, the suit states. The cause of death was “undetermined,” according to the Maricopa County medical examiner’s office. An Arizona state dental board investigation later concluded that the toddler’s care fell below standards, according to the suit.
    * Less than a month after Zion’s death in December 2017, the dental management company Benevis LLC and its affiliated Kool Smiles clinics agreed to pay the Justice Department $24 million to settle False Claims Act lawsuits. 
    * The government alleged that the chain performed “medically unnecessary” dental services, including baby root canals, from January 2009 through December 2011.
    * In their lawsuit, Zion’s parents blamed his death on corporate billing policies that enforced “production quotas for invasive procedures such as root canals and crowns” and threatened to fire or discipline dental staff “for generating less than a set dollar amount per patient.”
    * Kool Smiles billed Medicaid $2,604 for Zion’s care, according to the suit. FFL Partners did not respond to requests for comment. In court filings, it denied liability, arguing it did not provide “any medical services that harmed the patient.”

Professor Olson concludes that private equity does not belong in medicine/health care:
Laura Katz Olson . Distinguished Professor of Political Science at Lehigh University, author of : “Ethically Challenged: Private Equity Storms U.S. Health Care”, concludes, private equity does not belong in medicine at all and should it be banned.

We really need to prohibit, I think, the corporate practice of medicine, period. If you look at the private equity playbook, its only goal is to make outsized profits – they can’t make ordinary profits. If they make ordinary, respectable profits, their investors will go somewhere else because of the risk.

Private equity doesn’t care whether the product is Roto-Rooter or hospice. That’s one of the major differences between PE and a regular company, which may care about the community, the reputation of the company, and the quality of the product. They want to keep their customers. They care about the future. 

But private equity doesn’t work like that. Because private equity often aims to sell a company after four or five months, they don’t care about the future. They don’t care about the product at all. Private equity is antithetical to our health care system.

So yes, we need to ban private equity from health care. But given that it’s not going to happen, I would say that we need to prohibit the corporate practice of medicine – anybody can make a case for that. 

You can eliminate their tax advantages. 

You can limit the debt imposed on companies, especially in the health sector. You could easily control consolidation and monopolies in the health sector. 

You could use specific anti-trust laws. I would definitely forbid investment by retail customers such as their 401(k)s. 

I would forbid non-disclosure and non-disparagement agreements, which make it so difficult to obtain information. I had such a hard time interviewing people. When I could get people to talk to me – and that was really hard — they were extraordinarily careful. 

I would also prohibit “stealth branding” – where the PE firm buys a chain, like a dental chain, but gives each office its own name, like Marilyn’s Happy Dental Care. It’s very deceptive.

 PE players and firms don’t tend to be household names. They’ve really managed to fly under the radar. Here are some names that came up frequently in the research. Folks to look out for:

 Bain Capital, the PE company that Mitt Romney still profits from, is one. 

The Carlyle Group has really been involved in recruiting high-ranking people from the government – one of its co-founders, David Rubenstein, served as Deputy Assistant to the President for Domestic Policy during the Carter administration. 

George H.W. Bush became a senior member of its Asia advisory, and so on. 

KKR, of course, is one of the biggest. They control a lot in health care.

Dr. Olson concludes with concerns that can effect all communities. “As PE gets more and more money – with these pension funds, and especially if they get their hands into the 401(k)s – they’re just going to keep buying up anything and everything. And it’s not just health care. More and more of these firms are appearing and getting into more and more industries. As young people, or even older people involved in the well-established financial firms, realize how much money is involved, they just start a PE firm. Look at Jared Kushner [Affinity Partners]. It’s a very worrisome situation”.

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How Medicare for All would also be a Huge Investment in America’s Mental Health https://www.juancole.com/2022/08/medicare-investment-americas.html Sat, 20 Aug 2022 04:02:24 +0000 https://www.juancole.com/?p=206474 Gainesville, Florida (Special to Informed Comment) — The Affordable Care Act (ACA) was supposed to contain costs and make insurance for health / mental health care affordable. It did bring coverage to 20 million but 30 million remain uninsured. Data indicate that the bad outweighs the good. It’s too expensive, unsustainable, overly complex and bureaucratic. Even worse, it’s a gift to private insurers and other 1% corporate stakeholders and profiteers in the neoliberal medical-industrial-Congressional complex. Since the Affordable Care Act (ACA) was enacted in March, 2010, Big Insurance has lobbied Congress hard to ensure that most non-elderly Americans become compulsory customers of the private insurance industry and approve taxpayer financing of massive subsidies for that industry. The private insurance industry is very happy that with ACA. Americans are forced to purchase the product of their private industry plus give huge tax-financed subsidies to their industry in the amount of a half-trillion dollars per decade.

Because the for- profit, private insurance industry so thoroughly dominates our health care system as indicateds above, the basic concept, purpose and system of health insurance is defined by them. The U.S. subscribes to a private business model of health insurance that defines insurers as commercial entities. Private insurers maximize profits by mainly limiting benefits, maximizing health policy premiums or by not covering people with health problems. Like all businesses, their goal is to make money. Under the business model, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored; excluding the poor, the aged, the disabled and the mentally ill is sound business policy, since it maximizes profit.

Although health insurance affordability for the majority of US citizens still remains elusive, President Biden’s health insurance plan wants to shift many more dollars into private, Wall Street insurance industry hands. The takeover of health insurance by private Wall Street entities continues apace as Democrats/Biden propose to increase taxes and give it to the private profit insurance industry—the basic source of our profound administrative waste, along with the costly administrative burdens they place on the delivery system that requires large profits. Profiteering continues unabated as private insurance sells us services we don’t need/want , such as deductibles and other cost sharing, maintenance of narrow networks, requiring prior authorization with increased administrative costs, excessive ongoing paperwork/documentation requirements, all while avoiding paying for surprise bills and other denied benefits.

FUNDAMENTAL PRINCIPLES OF THE NEOLIBERAL HEALTH INSURANCE INDUSTRY:

1). Promote deregulation—working/lobbying for the removal of government control over the industry. Historic examples of deregulated industries in the U.S. include the airline, telecommunication, and trucking industries.

2). Maintain, strengthen and increase privatization—promote the transfer of ownership, property, or business from the government to the private sector. Examples of privatization include the health insurance industry, the correctional system in the form of for-profit private prisons, interstate highway system construction, privatization of public schools into private charter schools, privatization of medical diagnostic and treatment services such as dialysis centers, speciality hospitals and other outpatient units.

3). With neoliberalism, increase transfer of ownership and control of economic programs/services from the government to the private sector; promote the private sector’s influence on the economy by achieving deep reductions in government spending via austerity and large cutbacks; discourage/block spending on all social welfare/mental health / public jobs programs (similar to the Works Progress Administration (WPA) of the 1930’s) and other state/local/federal government programs. Governmental austerity paves the way for more profiteering by those who seek to replace government programs with private corporate entities.

Against this background, a burgeoning mental health crisis where millions of Americans cannot access or afford mental health care has emerged. More than 10% of Americans with mental illness have no health coverage, but even those with costly commercial insurance plans can’t afford care. Commercial plans discriminate against mental health care by limiting choice of covered mental health providers; paying mental health providers far less than other health providers; and restricting or denying common treatments such as prescriptions, psychotherapy/counseling and hospitalization. A growing body of evidence shows that ignoring mental illness leads to more sickness, more death and higher health costs for everyone.

SOBERING MENTAL HEALTH STATISTICS:

1). Suicide is the tenth leading cause of death overall in the U.S., and the second leading cause of death among youth and young adults aged 10-34. The suicide rate in the U.S. has increased by 35% since 1999.
https://www.nimh.nih.gov/health/statistics/suicide.shtml

2). In 2019, 20.6% of U.S. adults suffered from at least one mental illness, up from 17.7% in 2008. The percentage of Americans with serious mental illness in 2019 increased to 5.2%, up from 3.7% in 2008 https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm

3). Nearly one in ten (9.7%) youth in the U.S. had severe major depression in 2018. The State of Mental Health in America

4). Drug overdoses caused more than 70,000 deaths in 2019, a 57% increase from 2013. https://www.cdc.gov/mmwr/volumes/70/wr/mm7006a4.htm

5). Mental health conditions have increased even more sharply among younger adults. The percentage of Americans aged 18-25 with mental illness went from 18.5% in 2008 to 29.4% in 2019. The percentage of young adults with serious mental illness more than doubled, from 3.8% in 2008 to 8.6% in 2019. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm

OPPOSITION TO PUBLIC MENTAL HEALTH/HEALTH PROGRAMS AND INSURANCES

Even with the dangerous coronavirus pandemic, big insurance and big pharma continue opposing legislation for the new Medicare for All. These resistant, self-serving industries have the most to lose if their huge profits are redirected to direct patient care for all. Individual and corporate predators regard democracy, government and community as obstacles to their greed and avarice, always placing profits over individual patients, families and public health. It’s no wonder so many beholden members of Congress want to protect the interests of big insurance and big pharma, industries that spent $371 million on lobbying in 2017 alone.

HEALTH INSURANCE PROFITS-2021

US health insurance companies beat analyst expectations and reported billions in profits in the first quarter of 2021, after making a windfall in the first year of the Covid-19 pandemic. The insurers’ success comes as small healthcare providers face unprecedented financial stress and millions of Americans struggle to cover health costs. The large profits reaped by the insurance firms are also likely to increase criticism of the US healthcare sector.

The nation’s largest health insurer, UnitedHealth Group, reported $4.9bn in profits in the first quarter of 2021 compared to $3.4bn in the same period in 2020 – a 44% increase. The higher than anticipated profits prompted the company to raise its projections for the year. Anthem also beat estimates in its report of $1.67bn in profits in the first three months of 2021, a 9.5% increase from the same period last year. Humana’s net income was $828m in the first quarter, a 75% increase from the same period the year before.

CVS Health, which owns the Aetna health insurance provider and drugstores, reported $2.2bn in profits, up from $2bn in the same quarter a year before. Cigna reported its net income fell to $1.17bn from $1.19bn in the same period last year, but it still raised its forecasts for the year. Together, the companies represent the country’s five biggest health insurers by membership. (The Guardian, May, 2021).

Neoliberalism support for privatization of health insurance is grounded in the philosophy espoused by University of Chicago economist, Milton Friedman. Friedman said “the corporations should not take into account the public interest” and added that “the government itself should not take into account the public interest. The job of the government is to simply let everybody make as much money as they can, however they can”.

Classical economist Michael Hudson notes that Big Pharma , like Big Insurance, doesn’t want any kind of anti-monopoly legislation . “Essentially you have what is called a free market, as advocated by Milton Friedman. A free market means the wealthiest people dominate the market and the supply of credit, the management of the economy that allocates credit, and who gets what shifts from Washington to Wall Street. It shift’s from the government to the private financial sector, and allows the financial sector to do the planning. One problem with this is the financial sector lives in the short run. So, it means that they only look for the next three months, the next year’s balance sheet, because the free market is so complex you don’t know what’s going to happen. Well, of course, since you’re managing it from Wall Street you in reality do know what’s going to happen but you don’t want to tell people exactly what’s going to happen”.

We have several decades of experience with neoliberal conversion of mental health services/insurance into a business. Our health care is being rationed, with care guidelines determined by profitability and secrecy decided in private corporate boardrooms. To realize large profits demanded by Wall Street investors, our health system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill. So far, this country has been unable to eliminate private control of health insurance even in spite of the small value it offers when 15 to 25 percent of the health care dollar is skimmed off for private corporate profit and overhead. Neoliberals avoid the fact that if the existing public, non-profit Medicare program could be extended to all citizens for both mental and physical health and still containing lower costs.

UNINFORMED VOTERS MAKE IRRATIONAL CHOICES

American voters have fallen victim to an elections marketing system who’s task is to create uninformed voters who will make irrational choices. In a private business-run society, you market commodities, you market candidates. Most electoral campaigns are designed to marginalize and avoid serious policy issues like inequality, insurances, mental health services, public health, Medicare, Medicaid, social services, women’s health, DACA, progressive taxation, climate change etc. Important economic issues are avoided with political energy deflected onto wedge issues, superficialities, personality, rhetorical style, body language, mood swings, tweeting and other topics that amount to us foolishly chasing our tails. In the end, this allows the country to be run by a few big 1% economic interests looking only after themselves. Many voters are not deluded because they just don’t really see any real choices or significant differences offered to them by Democrats or Republicans in the business-managed electoral system, where unfortunately the most heavily funded candidate almost always wins.

Not only have both major U.S.political parties abandoned ideas and innovation, but also abandoned most voters. Republicans and Democrats alike are merely reactive to events/problems as demanded by their sponsors/donors in big business, oligarchs and large unaccountable corporations. 2022 politics in the US has devolved into one party, the “business party”, with two branches, democrats and republicans., who engage in and promote distracting contests giving us the illusion that they are basically different from one another on basic economic issues.

Since a reality TV star and real estate developer was elected president of the US, it’s clear that celebrity culture is an essential component of the corporate controlled economic system that govern our lives under the “business party”. Buffoon politicians from both parties have become shameless, beholden tools and lackeys of corporate America. They offer us a devil’s bargain mix of self-serving toxic programs and policies, frequently changing their positions as fast as others change socks. Will Rogers wrote: “A fool and his money is soon elected”.

Conditions as described above have led to the observation that U.S.voters popular desires cannot be achieved because there’s no vehicle to express their unhappiness, and there’s no way in which American voters can express what they want either in the Democratic or the Republican parties because they are really the same party and are in full agreement with what they are doing.
The voters don’t matter; remember we are talking about the American definition of democracy, which is an oligarchy. Polls have shown large popular support by citizens for Medicare for All, but neither political party has supported it. Michael Hudson writes that by “conquering the brains of a country by shaping how people think, you can twist their view into ‘unreality economics’ and make them think you are there to help them and not to take money out of them, then you’ve got them hooked.” This is how Big Insurance and Big Pharma maintain control of U.S. health insurance. Our system is privatized, financialized and unregulated so that private, big insurance companies can make money”.

President Biden and many Democrats have spent their careers defending the financial sector, including big insurance and big pharma, whose policy is also to maintain and further privatize basic health care financing and infrastructure. Economist Hudson further notes that, “Biden’s long political career has been right-wing. He’s the senator from Delaware, the country’s most pro-corporate state—which is why most U.S. corporations are incorporated there. As such, he represents the banking and credit-card industry. He sponsored the regressive bankruptcy “reform” written and put into his hands by the credit-card companies. As a budget hawk, he’s rejected Modern Monetary Theory (MMT), and also “Medicare for All” as if it is too expensive for the government to afford—thereby making the private sector afford to pay 18% of US GDP for health-insurance monopolies, far more than any other country. That means blocking governments from providing basic services at cost or on a subsidized basis—education, health care/health insurance, roads and communications. Privatized and financialized economies are high-cost.”

CITIZEN’S UNITED SUPREME COURT DECISION: A DARK DAY IN AMERICAN HISTORY

January 21, 2010 will go down as a dark day in the history of American democracy when editors of the New York Times wrote that the Supreme Court “Citizen’s United” decision that day “strikes at the heart of democracy” by having “paved the way for corporations to use their vast treasuries to overwhelm elections and intimidate elected officials into doing their bidding by reaching into the political process to hand unprecedented power to corporations.”

The Supreme Court ‘Citizen’s United’ decision opened the floodgates for big money in our politics, allowing giant corporations and a handful of the wealthiest families to spend obscene amounts of money in our elections. Citizens United is just one of a line of terrible Supreme Court decisions holding that money equals speech and corporations are people under the First Amendment — thereby allowing huge corporations and the super wealthy/oligarchs to buy undue access to members of Congress, and to effectively dictate legislative outcomes. This is significant in policy decisions reinforced by influence of corporate lobbies, now further enhanced by the Court’s decision which favors the very small 1% sector of the population that dominates the economy. Our society is run by a class-conscious 1% business community dedicated to reducing the political and economic power of the 99%.

Resistance to true campaign finance reform, and strong support for the U.S.Supreme Court’s, ‘Citizens United’ decision by unaccountable/unregulated large corporations and ultra-wealthy individuals/families, is based on their Machiavellian understanding of the purpose of dark money in politics: to use dark money to change political outcomes to favor themselves, the 001% oligarchs and becomes a threat to democracy because its source is not made public. Dark money is corruption that erodes confidence and trust in local, state and national government and in both major political parties. It’s used to throw referendums and elections from which can come many of today’s social, economic, public health, mental health and environmental problems. Dark money is used to hide conflicts of interests and self promotion with bogus scientific controversies, fake news and fake grassroots campaigns.

Corporate big business ideology asserts that human society is a market, and social relations are commercial transactions with a “natural hierarchy” of winners and losers. Attempts to limit competition, change social outcomes eg, estate tax issue, mandated health insurance, etc. is treated as hostile to liberty and big business interests. Count on the neocons/GOP to crush unions and collective bargaining, minimize or eliminate tax and public protection regulations, privatize public services and promote privatization of all social/mental health/health programs. Inequality is okay since it’s a result of a reward for merit and generates wealth for the tiny .001%, which the false neoliberal myth says trickles down to enrich everyone in the 99%. Tax and other social policies to create a more equal society are dismissed as counterproductive to the interests of the ultra wealthy.001%.

The assumption that whatever the market produces is rational and functional is the bedrock of Western economies. And it’s wrong , says economist Michael Hudson, because It negates the fact that you really need some government power strong enough to override the self-serving special interests of oligarchs and other 1% corporate interests. And that takes a very strong government, which is why the free market people have always opposed strong government and why their economic models don’t give any acknowledgement for government investment in infrastructure that Biden wants or any government activity that is able to override that of the 1% rentier class, the financial class, the property-owning class and the corporate monopolists. That’s the problem we have.

“GOING THERE WITH DONALD TRUMP”: Adam Gopnik further describes how this problem is exacerbated in his 2016 New Yorker article,“ Going There with Donald Trump”:

(Gopnik excerpts prepared by Paul Street in CounterPunch, Aug 18,2022 article, “The Tendentious Mr. Brooks: the Chickenshit Conformist of the NYT”) …….. ‘an incoherent program of national revenge led by a strongman; a contempt for parliamentary government and procedures; an insistence that the existing, democratically elected government…is in league with evil outsiders and has been secretly trying to undermine the nation; a hysterical militarism designed to no particular end than the sheer spectacle of strength; an equally hysterical sense of beleaguerment and victimization; and a supposed suspicion of big capitalism entirely reconciled to the worship of wealth and “success” It is always alike, and always leads inexorably to the same place: failure, met not by self-correction but by an inflation of the original program of grievances, and so then on to catastrophe. The idea that it can be bounded in by honest conservatives in a Cabinet or restrained by normal constitutional limits is, to put it mildly, unsupported by history…To associate such ideas too mechanically with the rise of some specific economic anxiety is to give the movement and its leader a dignity and sympathy that they do not deserve. In France, Jean Marie Le Pen’s voters are often ex-Communists, working people who also believe their national identity to have been disrupted by immigration. That does not alter, or make more sympathetic, the toxic nature of his program; the ideology that it resonates to is an ancient and persistent one, that thrives through good times and bad. That Trump can dominate an increasingly right-wing nationalist party with a right-wing, white-nationalist creed is neither surprising nor all that complicated. Anyway, the notion that a class cure can be had for a nationalist disease was the persistent, tragic delusion of progressive politics throughout the twentieth century.’

PRIVATE HEALTH INSURANCE IN FULL CONTROL OF MENTAL HEALTH SERVICES – STILL

With private commercial insurance companies in full control, they continue to further restrict mental health care by limiting or denying claims for hospital stays, outpatient (office) visits, medication, psychotherapy/counseling, and other common treatments for mental illness and substance use disorders.

1). Insurers are required by law to cover mental health and other health services equally, but courts have found that they routinely deny claims based on financial — not medical — reasons.

2). In one case, United Behavioral Health — the largest managed mental/behavioral health company in the country — was found guilty of denying 60,000 mental health claims for financial reasons. The lead plaintiff in the case was an insured patient who was denied coverage and had paid nearly $30,000 out-of-pocket for medically necessary treatment. https://www.statnews.com/2019/03/18/landmark-ruling-mental-health-addiction-treatment/

3). Commercial plans also restrict access to needed medications: A study of 84 different commercial health plans found that a majority of the plans covered fewer than 50% of antipsychotic medications, which are critical in treating illness like schizophrenia. In one-third of these insurance plans, the majority of antipsychotic medications are only provided on a “restricted” basis, requiring that patients pay higher out-of-pocket costs. https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead

4). A review of more than 90 studies shows that mental and behavioral services can reduce a patient’s overall health care costs by an average of 20%. The Impact of Psychological Interventions on Medical Cost Offset: A Meta‐analytic Review

5). Experience with Medicaid shows that eliminating the waste and greed of commercial insurance improves outcomes and saves money. In 2012, Connecticut’s Medicaid program abolished its commercial insurance-run “managed care” model in favor of a nonprofit single-payer plan for enrollees. By eliminating the insurance middleman, Medicaid could invest directly in mental health by integrating physical and behavioral health care and adding community-based programs. Among Medicaid enrollees, emergency room visits have since fallen by 25%; administrative costs dropped dramatically, from 25% to 3.5% of total costs; and overall health costs https://cthealthpolicy.org/index.php/2019/02/18/seven-years-later-connecticut-medicaid-still-saving-taxpayers-money/#:~:text=Seven%20years%20later%2C%20Connecticut%20Medicaid%20still%20saving%20taxpayers%20money,-

By%20Ellen%20Andrews&text=As%20with%20most%20health%20care,over%20the%20prior%20four%20years.&text=Connecticut%20Medicaid%20accomplished%20this%20without%20an%20increase%20in%20administrative%20funding. dropped http://cthealthpolicy.org/wp-content/uploads/2019/02/Medicaid-2019-brief-formatted-copy.pdf

MEDICARE FOR ALL MEANS MENTAL HEALTH CARE FOR ALL

Commercial health insurers discriminate against mental health care and keep Americans from getting the services we need. There is a better way: Single-payer Medicare for All would eliminate the greed and administrative waste of commercial insurance and cover everybody in the U.S. for all medically necessary care, including behavioral and mental health services, substance use disorder treatment, and prescription medications. With Medicare for All, coverage is lifelong and portable, and services are provided without the copays, deductibles, and surprise bills that keep patients from getting care. And unlike commercial insurance, Medicare for All provides free choice of any hospital or provider, including psychiatrists, psychologists, clinical social workers, licensed mental health counselors, and licensed marriage and family therapists.

SUPPORT MEDICARE— A SOLID INVESTMENT IN OUR COUNTRY

Let’s never forget that Universal Medicare for All is a solid investment in all citizens of our country by simply promoting a social service for universal access to affordable health care insurance for all. Aren’t we a society that cares enough to see that everyone receive the health care they need? That’s the basic purpose of Medicare for All, and it’s certainly the right thing to do now with the Covid-19 pandemic.

The history of our most successful national health insurance program, Medicare, provides one of the best arguments for expanding the program to cover everyone. When Medicare was enacted 57 years ago, following a broad grassroots campaign, many believed the dream of a full national health insurance system was right around the corner.

Unfortunately, five decades later, Medicare still has not been expanded. Most of the changes have been contractions with higher out-of-pocket costs for beneficiaries and repeated attempts at privatization by big pharma, the health insurance industry and its “champions” in the White House and Congress.

It’s time to end inadequate and dangerous health insurance programs. Insist on real health insurance reform essential for individuals and families. American history is filled with examples of fundamental, democratic change brought about by successful mass action and public pressure against the counseling of the neoliberal, privatization, 1% self-serving oligarchs/vested interest crowd. No more waiting! Ask your legislators to fully support Medicare For All now. Join the majority of Americans who support improved Medicare for All. Ask your legislator to support legislation now filed in the House (H.R. 1976) and Senate (S. 4204) that would establish this badly needed reform.
Full text-HR 1976.
https://www.congress.gov…(S.4204)

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Why we Should Celebrate Medicare’s 57th Birthday by Enacting Medicare for All https://www.juancole.com/2022/07/celebrate-medicares-birthday.html Mon, 25 Jul 2022 04:04:22 +0000 https://www.juancole.com/?p=205970 Gainesville, Florida (Special to Informed Comment) — On July 30. 1965, Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history. President Lyndon B Johnson signed the Medicare Act into law and created two new programs, Medicare for those who had reached the social security retirement age of 65 years, and Medicaid for those whose incomes were below specific levels. In the long history of struggles to obtain national health insurance in the USA, this was a momentous act that provided health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 57 years since, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private, for-profit health insurance, which has administrative costs above 15 percent.

Medicare’s costs have risen more slowly than those of private health insurance. Medicare provides better access to care, better financial protection and higher patient satisfaction. Although many have negative feelings toward government, and examples of government inefficiency and incompetence exist, the record of private health insurers is far worse. Dozens of financial profiteering scandals have wracked private insurers and HMOs in recent years. Everyone should categorically reject fear tactics about ‘Medicare for All’ that try to frighten seniors and others by telling them they will lose Medicare benefits under a new M4A program, that pointy-headed government bureaucrats will make medical decisions, determine the cost vs benefits of procedures, including age and quality of life considerations and medical personnel will be in short supply.

Beholden members of Congress want to protect the interest of insurance and Pharma — these two industries spent $371 million on lobbying in 2017 alone. Big Pharma, Big Insurance industries have literally bought most of our legislators (both Democrat and Republican). A massive disinformation/fear campaign has promoted the myth that Medicare for All would limit choice of doctors and hospitals, create unsustainable costs, and expansive, uncontrolled bureaucracy. These myths better describe the reality of our present system based on the private insurance industry.

Opposition to Medicare for All is based on irrational fears, folklore/myth and general prejudice against government programs. Fear-mongering about waiting lists, bankrupt doctors and hospitals, and socialism is exactly the same fearful/false rhetoric used in the campaign to block LBJ’s original Medicare program in 1965. The Wall Street Journal then warned about “patient pileups,” and the American Medical Association mounted a campaign featuring Ronald Reagan that smeared Medicare as creeping socialism that would rob Americans’ freedom.

Research in the New England Journal of Medicine showed that administration consumes a total of 31 percent of U.S. health spending, with much of that waste attributable to private insurance company overhead and profit. If the single-payer plan pays health care professionals, hospitals and drug companies at levels comparable to Medicare’s current substantially lower rates, premiums for all individuals and families could be so low that the public plan could consume the market and end private health insurance.

M4A is a solid investment in our country because it promotes a social service for universal access to affordable health insurance for everyone. The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the death and illness ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it.

LET’S IMPROVE MEDICARE IN 2022

To continue our progress, it’s time to upgrade Medicare by establishing a new improved, 21st century “Medicare for All” health insurance system that covers all age groups, cradle to grave. Newborns will leave the hospital with their new Medicare card, and drop it off years later at life’s end. The U.S. Senate’s new Medicare for All Act of 2022, has been introduced by Sen. Bernie Sanders and 14 co-sponsors. In the US House, Reps. Pramila Jayapal (D, WA) and Debbie Dingell, (D., MI) introduced the modern MEDICARE FOR ALL ACT of 2021 (H.R. 1976) i. M4A 2021 is new legislation calling for a single-payer national health program in the United States that addresses decades of health/mental health-related injustices that have been made even more painfully apparent by the COVID-19 pandemic.

The list of features in common between S. 4204, and the most recent House Bill (H.R. 1976) is substantial .Each of these bills provides all residents of the United States and its territories with a nationally consistent comprehensive benefit design, eliminates nearly all copays and deductibles, is funded through an equitable tax model, protects current benefits and services for veterans and Native Americans while also including them in Medicare for All, and dedicates expanded resources towards improving equity and justice in health care/health insurance.

Covered are all medically necessary services, including primary care, medically approved diet and nutrition services, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, palliative care, podiatric care, mental health services, dentistry, oral surgery, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, mental health and other providers, hospitals, clinics, and practices.

Co-pays and deductibles paid at health professionals offices are ended because payment for health insurance is fully pre-paid directly into Medicare, much like Social Security, and covered at first dollar amounts. This means the obsolete 80%/20% payment split between private health insurance companies and Medicare is eliminated, with Medicare for All now covering 100%.

All citizens are guaranteed insurance for professional health care while achieving significant overall savings compared to our existing system by lowering administrative costs, controlling the prices of prescription drugs and fees for physicians, mental health and other health care professionals, hospitals, reducing unnecessary treatments and expanding preventive care.

INSURANCE FOR HEALTH CARE ESTABLISHED AS A BASIC HUMAN RIGHT

Good health care would be established as a basic human right, as in almost all other advanced countries. Nobody would have to forego needed treatments because they didn’t have insurance or they couldn’t afford high insurance premiums and copays. Nobody would have to fear a financial disaster because they faced a health care crisis in their family. Virtually all families would end up financially better off and most businesses would also experience cost savings under Medicare for All compared to what they pay now to cover their employees.

HOW TO FINANCE IMPROVED MEDICARE

We finance our new Medicare for All by slashing administrative waste and eliminating profiteering by the private health insurance industry. The new system would be funded in part by the savings obtained from replacing today’s welter of inefficient, profit-oriented, private insurance companies, and the system-wide administrative waste they generate, with a single streamlined, nonprofit public payer health insurance system. Such savings, estimated in 2017 to be about $500 billion annually, would be redirected to patient care for all. With the advantage of risk insurance pooling that includes everyone, all beneficiaries are eligible for the same health insurance benefits, and the cost of providing those benefits is largely financed by broad-based revenue sources (e.g., progressive income or payroll taxes), completely separating enrollee health status from financing of the programs’ benefits.

Existing tax revenue would fund much of the system. According to a 2016 study in the American Journal of Public Health, tax-funded expenditures already account for about two-thirds of U.S. health spending. That revenue would be retained and supplemented by modest progressive taxes based on ability to pay, taxes that would typically be fully offset by ending today’s very high premiums paid to the for-profit private insurance industry and out-of-pocket expenses for care. The vast majority of U.S. households, one study says 95 percent, would come out financially ahead. The system would reap savings by dealing with drug and medical supply companies for lower prices. It also saves money by giving hospitals annual lump-sum (“global”) budgets to run their operations.

More than two dozen independent analyses of federal and state single-payer legislation by agencies such as the Congressional Budget Office, the General Accountability Office, the Lewin Group, and Mathematica Policy Research Group have found that the administrative savings and other efficiencies of a single-payer program would provide more than enough resources to provide first-dollar coverage to everyone in the country with no increase in overall U.S. health spending.

WHAT MEDICARE IS – AND IS NOT

Often the public is confused and fearful when the “socialized medicine” label is conflated with single-payer, Medicare-for-all, which simply is “socialized health insurance.” Whatever the pros/cons of socialized medicine, Medicare for All is not socialized medicine. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. Health-care professionals in the U.S. Veterans Administration and the armed services are paid this way. The good health systems in Great Britain and in Spain are other examples.

Most European countries, Canada, Australia and Japan have socialized health insurance, but not socialized medicine. The government pays for care that is delivered in the private (mostly not-for-profit) sector. This is similar to how Medicare works in this country. Physicians and other health professionals are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage medical or mental health practices or hospitals.

PRIVATIZATION OF HEALTH INSURANCE

The U.S. subscribes to a private business model for health insurance that defines insurers as commercial entities. Private health insurers also maximize profits by limiting benefits or by not covering people with health problems. Like all businesses, their goal is to make money. Under this business model of health insurance, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored. Excluding many in the middle class, the poor, the aged, the disabled and the mentally ill is sound business practice policy since it maximizes profit.

Today we still have tens of millions of individuals without insurance, many more who are underinsured, many who have impaired access to their physicians because of insurer network restrictions, many who face financial hardship when health needs arise, and an outrageously expensive system due to the profound administrative waste of the insurers and the burden they place on the health care delivery system when immense profit is required. With millions losing their jobs due to Covid-19, the dangers of connecting health insurance to employment are painfully clear. Health insurance must NOT be tied to employment.

Almost none of these problems would exist if the government, instead of the private insurers, served us as the health insurance financing authority. It is inhumane to allow consumer-directed, moral-hazard based private health policies to erect barriers to health care for millions of citizens with minimal or modest resources.

We now have several decades of experience with the conversion of health/mental health care into a business. Our health care is being rationed, with care guidelines determined by profitability and secrecy decided in private Walll Street corporate boardrooms. To realize large profits demanded by Wall Street investors, our health system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill.

To maintain corporate control of U.S. health care insurance, our system is privatized and unregulated. Private, big insurance companies are in the business of making money, not providing health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs (and immense profiteering ) are greater in the private health care insurance system, and even Medicare itself is weakened by having to work through the private system.

The country’s largest health insurer, UnitedHealth Group, reported its profits were $6.7bn in the second quarter of 2020 compared with $3.4bn in last year’s. Anthem’s profits rose to $2.3bn from $1.1bn for the same three-month period in 2019. Humana reported its earnings rose to $1.8bn, compared with $940m in 2019. Steffie Woolhandler, M.D., a longtime advocate of single-payer healthcare and a professor at Cuny Hunter College, said in normal circumstances she considered the billions insurance companies collect a “scandal”.
“It is particularly glaring and inappropriate in a pandemic,” said Woolhandler, a co-founder of Physicians for a National Health Program.

POLITICIANS FOLLOW 1 % DONORS DEMANDS

President Biden and many Democrats have spent their careers defending the financial sector, including big insurance and big pharma, whose leading policy is to maintain and further privatize basic health care financing and infrastructure. Distinguished classical economist Michael Hudson notes that, “Biden’s long political career has been right-wing. He’s the senator from Delaware, the country’s most pro-corporate state – which is why most U.S. corporations are incorporated there. As such, he represents the banking and credit-card industry. He sponsored the regressive bankruptcy “reform” written and put into his hands by the credit-card companies. As a budget hawk, he’s rejected Modern Monetary Theory (MMT), and also “Medicare for all” as if it is too expensive for the government to afford – thereby making the private sector afford to pay 18% of US GDP for health-insurance monopolies, far more than any other country. That means blocking governments from providing basic services at cost or on a subsidized basis – education, health care/health insurance, roads and communications. Privatized and financialized economies are high-cost.”

Although health insurance affordability for the majority of US citizens remains a very large problem, Pres. Biden’s latest health insurance plan wants to shift many more dollars into private, Wall Street insurance industry hands. The takeover of health insurance by private Wall Street entities continues apace as Democrats/Biden propose to increase taxes and give it to the private profit insurance industry – the source of our profound administrative waste, along with the costly administrative burdens they place on the delivery system. Profiteering continues unabated as private insurance sells us services we don’t need/want , such as deductibles and other cost sharing, maintenance of narrow networks, requiring prior authorization with increased administrative costs, excessive ongoing paperwork/documentation requirements, all while avoiding paying for surprise bills and other denied benefits.

SUPPORT MEDICARE— A SOLID INVESTMENT IN OUR COUNTRY

Let’s never forget that Universal Medicare for All is a solid investment in the citizens of our country. This investment simply promotes a social service for universal access to affordable health care insurance for all. Aren’t we a society that cares enough to see that everyone receive the health care they need? That’s the basic point of Medicare for All, and it’s certainly the right thing to do now with the Covid-19 pandemic.

Nobel Prize recipient Bernard Lown, M.D., of the Harvard School of Public Health sumed it up nicely: “One may only hope that Winston Churchill’s quip will soon be realized: ‘You can always count on Americans to do the right thing, after they have tried everything else.’ The United States has tried any number of bad solutions for providing its people with health care/insurance. Long overdue is the recognition that medicine is a necessary social service that should be accessible to all citizens.”

Join the majority of Americans who support improved Medicare for All. Ask your legislator to celebrate Medicare’s 57th birthday by supporting legislation in the House (H.R. 1976) and Senate (S. 4204) that would establish this badly needed reform.

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Medicare still Superior at Age 57 https://www.juancole.com/2022/07/medicare-still-superior.html Wed, 06 Jul 2022 04:10:23 +0000 https://www.juancole.com/?p=205624 Gainesville, Florida — On July 30, 1965, US President Lyndon B Johnson signed the Medicare Act into law. The law created two new programs, Medicare for those who had reached the social security retirement age of 65 years, and Medicaid for those whose incomes were below specific levels. In the long history of struggles to obtain national health insurance in the USA, this was a momentous act that provided health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 57 years since, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private, for-profit health insurance, which has administrative costs above 15 percent.

In light of the burgeoning, severe losses of jobs/employment/health insurances caused by the ravages of the COVID-19 pandemic, it’s very Important to remember that Medicare is still providing stable coverage for everyone 65 and older. If the new and improved Medicare for All, as outlined below, were in place today, everyones health insurance, in spite of the COVID-19 pandemic, would continue uninterrupted because the Medicare for All insurance system is not based on employment.

IMPROVED MEDICARE FOR ALL IN 2022

The U.S. Senate’s new Medicare for All Act of 2022, has been introduced by Sen. Bernie Sanders and 14 co-sponsors. The list of features in common between S. 4204, and the most recent House Bill (H.R. 1976) is substantial .Each of these bills provides all residents of the United States and its territories with a nationally consistent comprehensive benefit design, eliminates nearly all copays and deductibles, is funded through an equitable tax model, protects current benefits and services for veterans and Native Americans while also including them in Medicare for All, and dedicates expanded resources towards improving equity and justice in health care/health insurance.

2021 was a very special year in the history of single-payer health insurance and public health in the USA because Reps. Pramila Jayapal (D, WA) and Debbie Dingell, (D., MI) introduced the modern MEDICARE FOR ALL ACT of 2021 (H.R. 1976) in Congress. M4A 2021 is new legislation establishing a single-payer national health program in the United States that addresses decades of health/mental health-related injustices that have been made even more painfully apparent by the COVID-19 pandemic.

MEDICARE FOR ALL MEANS EVERYBODY IN, NOBODY OUT !

HR 1976 upgrades Medicare with a 21st century modern and improved “Medicare for All” health insurance system that covers all age groups, cradle to grave. Newborns will leave the hospital with their new Medicare card, and drop it off years later at life’s end. Benefits of HR 1976 health insurance include the following new items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment or rehabilitation of a health condition:

(1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.

(2) Ambulatory patient services.

(3) Primary and preventive services, including chronic disease management.

(4) Prescription drugs and medical devices, in- cluding outpatient prescription drugs, medical de- vices, and biological products.

(5) Mental health and substance use treatment services, including inpatient care.

(6) Laboratory and diagnostic services.

(7) Comprehensive reproductive, maternity, and newborn care.

(8) Dentistry/Oral health, audiology, and vision/ophthalmology services.

(9) Rehabilitative and habilitative services and devices.

(10) Emergency services and transportation.

(11) Early and periodic screening, diagnostic, and treatment services.

(12) Necessary transportation to receive health care services for persons with disabilities, older indi- viduals with functional limitations, or low-income in- dividuals (as determined by the Secretary).

(14) Hospice care.

(15) Services provided by a licensed marriage and family therapist or a licensed mental health counselor.(In addition to psychiatrists, licensed clinical psychologists, licensed clinical social workers, psychiatric nurses.)

Co-payments and deductibles paid at health professionals’ offices are ended because payment for health insurance is fully prepaid directly into Medicare, just like pre-payment into Social Security, and covered at first dollar amounts. This means the obsolete 80 percent/20 percent payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2021 covering 100 percent.

All residents are guaranteed access to quality health care while achieving significant overall savings compared to our existing Medicare system by lowering administrative costs, controlling the prices of prescription drugs and fees for physicians and other health/mental health-care professionals and hospitals, reducing unnecessary treatments and expanding preventive care.

Good health care is established as a basic human right, as in almost all other advanced countries. Nobody would have to forego needed treatments because they didn’t have insurance or they couldn’t afford high insurance premiums and co-pays. Nobody would have to fear a financial disaster because they faced a health care crisis in their family. Virtually all families would end up financially better off and most businesses would also experience cost savings compared to what they pay now to cover their employees. Health insurance is based on residence, not employment.

With M4A, citizens are guaranteed access to health care while achieving significant overall savings compared to our existing obsolete system. This is accomplished by lowering administrative and eliminating profiteering Big Insurance costs, controlling Big Pharma prices of prescription drugs, fees for physicians and other health-care professionals and hospitals, reducing unnecessary treatments and expanding preventative care.

Co-payments and deductibles paid at health professionals’ offices are ended because payment for health insurance is fully prepaid directly into Medicare, just like pre-payment into Social Security, and covered at first dollar amounts. This means the obsolete 80 percent/20 percent payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2021 covering 100 percent.

We finance our new and improved Medicare for All system by eliminating profiteering by the private health insurance industry and slashing the system-wide administrative waste they generate, with a single streamlined, nonprofit public payer health insurance system. Such savings, estimated in 2017 to be about $500 billion annually, would be redirected to patient care.

More than two dozen independent analyses of federal and state single-payer legislation by agencies such as the Congressional Budget Office, the General Accountability Office, the Lewin Group and Mathematica Policy Research Group have found that the administrative savings and other efficiencies of a single-payer program would provide more than enough resources to provide first-dollar coverage to everyone in the country with no increase in overall U.S. health spending.

According to a 2016 study in the American Journal of Public Health, tax-funded expenditures already account for about two-thirds of U.S. health spending. That revenue would be retained and supplemented by modest progressive taxes based on ability to pay, taxes that would typically be fully offset by ending today’s very high premiums paid to the for-profit private insurance industry and out-of-pocket expenses for care. The vast majority of U.S. households — one study says 95 percent —would come out financially ahead. The system would reap savings by dealing with drug and medical supply companies for lower prices.

M4A is a solid investment in our country because it promotes a social service for universal access to affordable health insurance for everyone. The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the death and illness ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it.

OPPOSITION TO MEDICARE FOR ALL

The real boogeymen opposing M4A are the private health insurance and pharmaceutical industries who have the most to lose if their profits are redirected to direct patient care. Beholden members of Congress want to protect the interest of their insurance and Pharma donors — these two industries spent $371 million on lobbying in 2017 alone. Big Pharma and Big Insurance industries have literally bought most of our legislators (both Democrat and Republican). A massive disinformation/fear campaign has promoted the myth that Medicare for All would limit choice of doctors and hospitals, create unsustainable costs, and expansive, uncontrolled bureaucracy. These myths better describe the reality of our present system based on the private insurance industry.

If we are a society that cares enough to see that everyone receive the health care they need, the basic point of Medicare for All, then it’s important that citizens reject catastrophic expectations and predictions, false fear and scare tactics of the M4A opposition. Citizens now better understand that the real cause of high US health insurance costs is the private insurance industry’s need for high profit. A record number of Americans reject our fractured, profit-based health insurance system and support programs like House Bill H.R. 1976 or Senate Bill S.4204, which improve Medicare’s benefits by adding in previously uncovered services such as dental, hearing, vision, and long-term care while eliminating cumbersome out-of-pocket fees with prepaid health insurance.

Although Medicare for All supporters are often derided as unrealistic, in fact it’s not realistic to expect that Americans will continue passively accepting ‘how much money is in the bank account’ as the most significant factor in their mortality. By seeking to weaken Social Security, Medicaid and Medicare to fund tax cuts for the rich during a time of the Covid-19 public health crisis, the one percenters have elevated self-interest even further above life itself for the ninety-nine percent.

The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it. In addition to strickly following the basic principles of public health and epidemiology, the very best way to cope with the vast dangers of COVID-19 to everyone is to immediately implement improved Medicare for All legislation now filed in Congress, H.R. 1976/S.4204.

A majority of Americans support Medicare and want expansion of this program to provide health insurance for all. Write to your senators and representatives and let them know how you feel about expanding Medicare. The very best way to cope with the vast dangers of COVID-19 to everyone is to immediately implement improved Medicare for All with H.R.1976/S.4204. By making health insurance available to all age groups, we can enjoy and celebrate Medicare’s 57th birthday with the assurance that this life-saving health insurance program will continue.

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People Die as Weapons Industry Profits https://www.juancole.com/2022/05/weapons-industry-profits.html Thu, 26 May 2022 04:08:19 +0000 https://www.juancole.com/?p=204840 Gainesville, Florida (Special to Informed Comment) – Citizens are waking up to the fact that so many politicians can be so easily bought by the weapons industry, an industry that doesn’t care how many people must die to protect their huge profits. SafeHome.org reports that after a record year in 2020, gun sales in the U.S. dipped slightly in 2021. Still, with nearly 19 million guns sold, 2021 was the second-highest year for gun sales in the U.S. — behind only 2020, when estimated gun sales topped 21 million. The previous record year was 2016, with about 16 million guns sold. Total estimated gun sales fell 13 percent between 2020 and 2021, but they remained higher than they were in 2019 (up nearly 40 percent).

The total number of guns sold in 2021 is more than double the number sold in 2001; in fact, sales in the U.S. rose by about 155 percent between 2002 and 2021. No state had more gun sales in 2021 than Texas, where an estimated 1.6 million firearms were sold in the nation’s second-largest state. Florida followed closely with 1.4 million firearms sold.

Thereload.com reported that weapons makers Ruger and Winchester both had profit spikes in recent earnings filings. Their latest 2021 quarters topped record sales the companies had experienced even during the height of the 2020 gun sales surge. The numbers come after July 2021 came in as the second-best July on record for FBI background checks on gun sales.

Ruger reported its net sales in the first six months of 2021 were up over $130 million or 51 percent over the same time last year. The company did nearly $200 million in firearms sales alone between April and June. That represents a 54 percent increase over the same period in 2020, even though the onset of the coronavirus pandemic and rioting drove Americans to gun stores at record rates during that time period.

Gross profits increased 96 percent over the April to June timeframe. They were up 98 percent in the January to June period.

Similarly, Winchester reported the first six months of 2021 produced a $412 million or 108 percent increase in sales. The gun and ammo maker’s sales increased even further, by 110 percent, when looking at the April to June period. Winchester’s parent company, Olin Corporation, saw net income climb from a $120 million loss in the April to June period of 2020 to a $355 million profit in 2021. They went from a $220 million loss in the January to June 2020 period to a $599 million profit in 2021.

In spite of the above numbers, many citizens are also realizing that the idea of the Second Amendment guaranteeing the right of individual gun ownership is radical and wrong, and was never intended by the Founders to be a barrier to establishing stringent weapons safety and control laws for our community. Turning gun violence into a mental health problem is incorrect , dangerous and irresponsible as anyone with even minimal knowledge of mental health issues knows. It’s of course true people who kill children en masse are crazy, but asserting this really says nothing. All countries have mentally ill and violent people, but U.S. citizens are increasingly more aware that only the USA arms them.

Although the U.S public is demanding real changes for much better safety in weapons regulation, the toxic results of our current lack of adequate weapons control policies continues its deadly pace. The USA cannot any longer allow the profiteering military/industrial complex and their beholden politicians to get away with hiding or changing the subject, hoping the public forgets about the problem until the next mass shooting. By using denial over many years to reject and avoid the need for stringent gun control legislation, the GOP and some Democrats have fallen into a miasma of self induced indifference and dangerous permissiveness toward gun ownership and its deadly consequences.

The large number of weapons in the USA is not only highly profitable for the weapons industry, but also further supports the myth that guns are necessary to maintain the image of ‘rugged individualism’. This is why resistance to legislative proposals to better control gun culture and gun violence itself seem to many gun owners as attacks on their own personality and national identity. The bigger, more powerful the weapon, the more powerful the gun owner feels. Many marginalized and enraged lone wolf murderers, thanks to easy access to assault-style weapons , can misuse Second Amendment gun rights to cleanse the world. Twenty first century U.S. culture still venerates violence with our myth of heroic frontier psychology, but at the very high cost of crippling and killing our children. Historian Roxanne Dunbar-Ortiz in her book “Loaded: A Disarming History of the Second Amendment”, gives alarming statistics about weapons and gun deaths in the USA:

* There are 310 million firearms in the United States, 114 million handguns, 110 million rifles and 86 million shotguns.

* The number of military-style assault weapons in private hands—including the AR-15 semi-automatic rifles used in the massacres at Marjory Stoneman Douglas High School in Parkland, Fla., and at the Sandy Hook Elementary School in Newtown, Conn.—is estimated at 1.5 million.

* The United States has the highest rate of gun ownership in the world, an average of 90 firearms per 100 people.

* “Total gun deaths in the United States average around 37,000 a year, with two-thirds of those deaths being suicides, leaving approximately 12,000 homicides, a thousand of those at the hands of the police.

* Mass shootings—ones that leave four or more people wounded or dead—now occur in the United States, on average, at the pace of one or more per day.

* Disturbing as that fact is, mass shootings currently account for only 2 percent of gun killings annually.

* The number of gun deaths—37,000—is roughly equal to death-by-vehicle incidents in the United States per year.

The Second Amendment, written by James Madison and adopted in 1791, says “a well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.” Although generations of activists, gun owners and jurists have disagreed about how this should be interpreted in a modernizing world, what has not been recognized is what the Second Amendment was really to be used for.

History professor Roxanne Dunbar-Ortiz documents in, “Loaded, A Disarming History of the Second Amendment”, the purpose of armed militias of the Second Amendment . “The kind of militias and gun rights of the Second Amendment had long existed in the thirteen British colonies and were expected to continue fulfilling two primary roles in the new United States:

1).destroying Native communities in the armed march to possess the continent.

2). brutally subjugating the enslaved African population.

Dunbar-Ortiz demonstrates that the violence sanctioned by the Second Amendment was a key factor in transforming America into a “militaristic-business” powerhouse. As the fledgling nation embarked on its relentless westward expansion in the nineteenth century, the labor of millions of slaves was making America exponentially richer and more powerful. Meanwhile, America’s nascent gun culture was growing in tandem with the country’s increasingly sophisticated publishing and firearms-manufacturing industries. Pulp novels romanticized ex-Confederate soldiers and rifle-wielding frontiersmen. Brand-name weapons acquired special status. “In the two decades after the Civil War,” Dunbar-Ortiz writes, “the Winchester rifle was fetishized for killing Indians, and the Colt revolver for outlawry. In the process, gun violence and civilian massacres were not just normalized, but commercially glorified, packaged, promoted and mass marketed.” In twenty first century America, fantasy and myth about frontier psychology still continue being played out by Hollywood, video/internet games and other manufactured fantasies that promote weapons sales.

Just as communities today rely on professional public health experts in epidemiology to control the incidence, distribution, and control of disease in any population, so too for public safety/ health we should rely on experts in weapons control and distribution to advise and design adequate/stringent legislation for community weapons control/regulation. The profile of a gun safety program could include:

1). Prior to approving access to any weapon potential weapon owners should be required to get formal instruction and pass a rigorous background check.

2). An annual inspection by law enforcement authorities on how ammunition and weapons are stored, plus full inspection of weapons themselves should be conducted.

3). Banned weapons could be collected by law enforcement as well.

4). Reimbursement, if any, for banned firearms would be the responsibility of the taxpayer and should be considered an investment in public safety.

After mass shootings many have or will use an amateur and banal analysis of the psychology of killers to provide much needed camouflage for the profiteering military/gun/industrial complex/NRA. Declare that it is a mental health/behavioral health problem all in the killer’s mind and perhaps we won’t notice that our pathetic U.S./state/local non-control weapons policy results in amazingly high murder rates, suicides and frequent mass murders. When deranged people have such remarkably easy access to arsenals of weapons, every so often one of them will go ballistic. We can’t eliminate all political, religious extremism or mental illness, but we can most certainly prevent people from having access to rapid-fire/semi-automatic weapons and thousands of rounds of ammo. The UK has one sixth our murder rate, not because they are psychologically healthier or nicer than the USA. The UK and many other countries just don’t have or allow the weaponry/ hardware to be available do as much damage.

Thoughts and prayers are of little value unless we accept the fact that our laws reducing access to weapons need to be greatly strengthened, not loosened. Gun supporters and expedient politicians who take NRA, firearms industry and other military/industrial complex big donor money while expressing heartfelt prayers, thoughts and condolences for dead children, grieving parents and disrupted communities are disingenuous, disgusting, and deserving maximum shame for their preposterous and irresponsible scapegoating of the mentally ill while letting politicians, devotees of loose access laws and the profiteering gun industry itself continue to squirm out of any responsibility.

REFERENCES:

1). “Loaded: A Disarming History of the Second Amendment”, by Roxanne Dunbar-Ortiz.

    This is a very well researched history of guns and gun laws in the United States, from the original colonization of the country to the present. Dunbar-Ortiz explains that to understand the current obstacles to gun control, we must understand the history of U.S. guns, from their role in the settling of America and the early formation of the new nation continuing up to the present.

__________________

2). Richard Slotkin, Olin Professor of English and American Studies, Wesleyan Univ, has written an award-winning trilogy on the myth of the frontier in America includes:

    1). “Regeneration Through Violence”,
    2). “The Fatal Environment”
    3). “Gunfighter Nation” offers an original and highly provocative interpretation of our national experience.

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Is the Government Stealthily Privatizing Medicare without Telling You? https://www.juancole.com/2022/01/government-stealthily-privatizing.html Mon, 31 Jan 2022 05:02:57 +0000 https://www.juancole.com/?p=202719 Gainesville, Florida (Special to Informed Comment) – ALERT TO ALL ENROLLEES IN THE TRADITIONAL MEDICARE PROGRAM : The Center for Medicare and Medicaid Services (CMS) plans to move all those in Traditional Medicare into a deceptively innocent “care relationship” with third party, for profit private middlemen without seniors’ knowledge or consent, and without congressional oversight. So far, more than 300,000 seniors in 38 states have been enrolled in the program. In developing this toxic privatization scheme, the CMS must have consulted with Shakespeare since we hear very strong echoes of Shakespeare’s, “Song of the Witches” (Macbeth: IV.i 10-19; 35-38):

Double, double toil and trouble;
Fire burn and caldron bubble.
Fillet of a fenny snake,
In the caldron boil and bake;
Eye of newt and toe of frogWool of bat and tongue of dog,
Adder’s fork and blind-worm’s sting,
Lizard’s leg and howlet’s wing,
For a charm of powerful trouble,
Like a hell-broth boil and bubble.

Double, double toil and trouble;
Fire burn and caldron bubble.
Cool it with a baboon’s blood,
Then the charm is firm and good.

Sly and devious, Shakespeare’s witches use riddles to give Macbeth a false sense of security. One riddle stated that he could “Not be slain by someone born of woman” later resulted in Macbeth’s death because he lacked a sense of caution/fear. By portraying themselves as having true vision and insight into the future, they sought Macbeth’s downfall by falsely convincing him of his great future as King of Scotland. Guiding Macbeth toward his fate using false security theatrics, the destruction of Macbeth was assured much to the smiling satisfaction of the three witches.

Just as Macbeth was convinced of security and success, so too does Direct Contracting(DSEs) assure that the stated aim is to bring ‘organizations that currently operate exclusively in Medicare Advantage (MA) into traditional Medicare, engaging the very MA insurers and investor-controlled provider firms that are driving the MA overpayments.

The founder of Just Care and highly respected health policy expert, Diane Archer, clearly explained how Medicare Advantage plans and new DCEs, in a recent Intercept article make money.“The way they make money is by spending as little as possible on patient care, while ensuring as best they can that they have all diagnoses possible for their enrollees in order to maximize government payments. The more diagnoses, the higher the government payments. Government payments are set upfront and unrelated to the cost or number of services people receive.”

“And, yes, the incentive is to deny as much care as possible, and it’s also to delay as much care as possible and create administrative and financial barriers that make it hard for enrollees to get care, even if the DCE does not delay or deny care,” she said, referring to direct contracting entities approved to participate in the program.

Aside from the looting of public funds and the depreciation of care, the shift toward privatization has profound implications for the political economy of health care. Every new private equity or venture capital-backed firm that grabs a bigger piece of the health care market becomes an incumbent corporate stakeholder and a well-funded obstacle to public-minded reform efforts”.

The program titled the “Global and Professional Direct Contracting” model in a little-known government agency known as the Center for Medicare and Medicaid Innovation (“The Innovation Center”) is already moving (over 300,000 to date) Traditional Medicare seniors, without their knowledge or consent, to “risk-bearing,” for-profit middlemen known as Direct Contracting Entities (DCEs). The goal: to end what’s left of traditional Medicare as a public, non-profit social/health insurance program.

Simply put, it proposes that a “risk-bearing,” for-profit middleman manage health care for traditional Medicare beneficiaries, just like Medicare Advantage plans are for seniors who have signed up for Medicare Advantage plans. The difference is that while 26 million seniors have voluntarily signed up for a middleman when they chose Medicare Advantage, the 38 million seniors in traditional Medicare have not.

How do you get seniors who have specifically chosen traditional Medicare to switch to a non-traditional Medicare-Advantage-like plan with a mysterious name like “Direct Contracting Entity”? You don’t tell them! You lure their primary care providers to participate in a DCE by promising the doctors much better Medicare reimbursement rates and more time with their patients, and once the doctors sign up with a DCE, all their patients are automatically “aligned” by CMS with the DCE the doctor has chosen.

The DCE sends patients a letter they are likely not going to read or understand, and presto! Millions of seniors previously on traditional Medicare now belong to a DCE. That’s how DCEs leverage and monetize the doctor-patient relationship for the profit of private corporations, oligarchs and other Wall Street entities.

The DCE pilot program aims to enroll every Traditional Medicare beneficiary into a third-party “Direct Contracting Entity” (DCE). Instead of paying doctors and hospitals directly for care, Medicare gives DCEs a monthly payment to cover a defined portion of each seniors’ medical expenses, allowing DCEs to keep as profit what they don’t pay for in care. Virtually any type of company can apply to be a DCE, including commercial insurers, venture capital investors, and even dialysis centers. Applicants are approved by CMS without input from Congress.

Hapless Traditional Medicare beneficiaries are to be “auto-alligned” in DCEs if their primary care physician is affiliated with that DCE. CMS automatically searches two years of seniors’ claims history — without their consent or knowledge — to find any visits with a participating DCE provider as the basis for aligning them with that DCE. If left unchecked, DCEs could essentially privatize Traditional Medicare within the next few years.

Medicare’s other privatization project — Medicare Advantage — demonstrated that injecting a profit motive into patient care actually leads to higher costs for taxpayers, with tragic consequences for patients. Thousands of physicians, nental health professionals and other advocates have signed a petition calling for Secretary of Health and Human Services Xavier Becerra to halt the DCE program, provide real oversight of CMS’ Innovation Center, and protect Medicare for future generations.

Please join the fight against Medicare Direct Contracting by calling your member of Congress at (202) 224-3121 and asking them to demand HHS end this dangerous and insidious program; hold hearings on DCEs; and establish Congressional oversight of the Center for Medicare and Medicaid Innovation (CMMI), traditional Medicare. Lastly, re-read or see, “Macbeth”, as a refresher primer for better understanding of the 21st century.

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Opioid Crisis: Purdue Pharma/ Sackler Family Fails in End Run around Justice https://www.juancole.com/2021/12/opioid-sackler-justice.html Sat, 18 Dec 2021 05:02:56 +0000 https://www.juancole.com/?p=201850 Gainesville, Florida (Special to Informed Comment) – In a seismic victory for justice and accountability that re-opens the deeply flawed recent September, 2020 settlement of the Purdue pharma bankruptcy case, the Sackler family will be forced to confront the pain and devastation they have allegedly caused. Judge Colleen McMahon of the U.S. District Court for the Southern District of New York, ruled, Dec.16, 2021,that the settlement, part of a restructuring plan for Purdue approved in September by a bankruptcy judge, Robert Drain, U.S. Bankruptcy Court,White Plaines, N.Y., should not go forward because it releases the company’s owners, members of the billionaire Sackler family, from liability in civil opioid-related cases.

HISTORY

Flying under the chaos of the Covid-19 pandemic, one of America’s richest families, the billionaire Sackler family who fully own Purdue Pharma and put themselves forward as the epitome of good works funded by the fruits of the capitalist system, are being held to account for allegedly earning their fortune at the expense of millions of people who are addicted. Although it’s shocking how long they have gotten away with it, legal proceedings against them, if carried out in full, may not, unfortunately, avoid the ‘justice delayed, justice denied’ conundrum. By seeking a ‘release from liability’ from the federal court handling Purdue’s bankruptcy case, the court could help them hold on to their wealth by releasing them from liability for the ravages of the opiod epidemic caused by OxyContin, and allow them to continue benefiting at the expense of victims.

In a bankruptcy filing, a New York Times article,”The Sacklers Could Get Away With It”, reported, “debts are forgiven — “discharged,” in legal terms — after debtors commit the full value of all of their assets (with the exception of certain types of property, like a primary home) to pay their creditors. That is not, however, what the Sacklers want, and indeed the members of the family have not filed for bankruptcy themselves. What they proposed instead is to be shielded from all OxyContin lawsuits, protecting their tremendous personal wealth from victims’ claims against them. What’s more, a full liability release would provide the Sacklers with more immunity than they could ever obtain in a personal bankruptcy filing, which would not protect them from legal action for fraud, willful and malicious personal injury, or from punitive damages”.

PROFIT, DEATH, DYING

The untimely overdosing death of famous singer Tom Petty can be traced to the Sackler family and Purdue Pharma according to many addiction specialists.The family of Tom Petty said that the singer’s death was caused by an accidental overdose with a cocktail of prescription drugs and pain pills, including oxycodone and fentanyl. Although prescriptions for opioids fell in response to the crisis, Americans didn’t shake the habit or seek rehab; they turned to heroin instead. Four out of five people in the US who try heroin today started with prescription painkillers, according to the American Society of Addiction Medicine. Alarmingly, street heroin started being secretly cut with the dangerous synthetic opioid fentanyl.

By misleading physicians about the safety of OxyContin in order to earn $35bn in sales revenue from the toxic pain drug between 1995 and 2015, many addiction specialists say that Purdue Pharma owners, the Sackler family, bear the lion’s share of the responsibility for many deaths and today’s opioid crisis.

EPITOMES OF GOOD WORKS?

With charitable foundations on both sides of the Atlantic, the Sacklers, who are based in New York, have donated millions to the arts and sponsored faculty at Yale and many other universities. In each case, the family’s name is displayed prominently as the benefactor. Forbes listed the collective estimated worth of the 20 core family members at $14bn in 2015, partly derived from $35bn in sales revenue from OxyContin between 1995 and 2015. The name Sackler is displayed in the forecourt at the Victoria and Albert Museum in London and was noted in the Sackler Gallery at the Serpentine in 2013. The ancient Egyptian Temple of Dendur has a Sackler Wing in the Metropolitan Museum in New York. The Sackler Centre for Arts Education at the Guggenheim and many other arts institutions around the world have galleries or wings named after the Sackler family.

But few know Sackler wealth comes from Purdue Pharma, a private Connecticut company the family developed and wholly owns. In 1995, the company revolutionised the prescription painkiller market with the invention of OxyContin, a drug that is a legal, concentrated, chemical version of morphine or heroin. It was designed to be safe; when it first came to market, its slow-release formula was unique. After winning government approval it was hailed as a medical breakthrough, an illusion that many now refer to as “magical thinking”.

It was marketed to physicians, many of whom were taken on lavish junkets, given misleading information and paid to give talks on the drug . Patients were wrongly told the pills were a reliable long-term solution to chronic pain, and in some cases were offered coupons for a month’s free sample. DEA data says that the US has been flooded with about 10 billion pain pills a year. Most pain drugs were sold by a small number of pharmacies, with prescriptions for these drugs written by a small number of physicians at pill mill clinics that charged cash for prescriptions. Data has shown these clinics were good OxyContin customers for the Sacklers/Purdue Pharma. Launched in 1996, Purdues OxyContin sales strategy was highly successful for twenty years because it allegedlconcentrated aggressive OxyContin marketing programs on what Purdue labeled ‘supercore clinics’, i.e., pill mills.

In a New Yorker Magazine expose, Allen Frances, M.D., former chair of psychiatry at Duke University school of medicine said, “Their name (Sackler/Purdue Pharma) has been pushed forward as the epitome of good works and of the fruits of the capitalist system. But, when it comes down to it, they’ve earned this fortune at the expense of millions of people who are addicted. It’s shocking how they have gotten away with it.” Long overdue, the Sacklers and Big Pharma are finally starting to pay for the opiod crisis.

Unfortunately,”the bankruptcy court has granted injunctions stopping proceedings in several hundred lawsuits charging that Sackler family members directed the aggressive marketing campaign for OxyContin; it and other opioids have been implicated in the addictions of millions of patients and the deaths of several hundred thousand.”

The Sacklers would walk away with an estimated several billion of OxyContin profits while leaving unresolved a crucial question asked by victims and their families: Did the Sacklers create and coordinate fraudulent marketing that helped make their best-selling drug a deadly national scourge? With that question left unanswered, many of those injured by OxyContin would feel victimized again.

Legal experts, the NYT writes, conclude that “allowing the bankruptcy court to impose a global OxyContin settlement may at first appear to be an efficient way to resolve litigation that could drag on for years, the Sacklers will benefit from this expediency at the expense of victims. At stake is whether there will ever be a fair assessment of responsibility for America’s deadly prescription drug epidemic. Protection from all OxyContin liability for the Sackler family would be an end-run around the reckoning that justice requires”.

Just like all Big Pharm corporations, Sackler/Purdue pharma are dedicated to the bottom line of maximization of profit; everything else is of insignificant value compared to this. Their large and aggressive marketing campaign to sell the supposedly ‘safe’ pain drug OxyContin appears to have disregarded all boundaries and turned this dangerous drug into immense profit for themselves. There are always among us those self-serving and toxic individual and corporate predators who regard democracy/government regulation/community as an obstacle to their greed and avarice. The opioid epidemic is now burgeoning in the U.S. with millions of ruined lives, individuals, families. The Sacklers want to retreat back into their money and vast profiteering, and let other people clean up and pay for the overall and inevitable long-term suffering, death and destruction they allegedly created.

JUDGE OVERTURNS PURDUE/SACKLER OPIOID SETTLEMENT

Judge McMahon agreed with lawyers for the U.S. Trustee who argued that shutting down the ability of plaintiffs to sue the Sacklers violated the plaintiffs’ due process rights. The Sacklers, they argued, should not be rewarded for their contribution because they “created the need for that money” by taking it out of the company in the first place, setting up the situation where they would be protected from lawsuits “by piggybacking on the bankruptcy of their company.” U.S. Attorney General Merrick B. Garland said in a statement, “The bankruptcy court did not have the authority to deprive victims of the opioid crisis of their right to sue the Sackler family.” Cheers and many thanks to Judge Colleen McMahon.

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Stop Wall Street from Grabbing Traditional Medicare https://www.juancole.com/2021/12/grabbing-traditional-medicare.html Sat, 11 Dec 2021 05:08:10 +0000 https://www.juancole.com/?p=201725 Gainesville, Florida (Special to Informed Comment) – The Center for Medicare and Medicaid Services “Innovation Center” recently announced that by 2030, they will move all traditional Medicare enrollees into a “care relationship” with a 3rd party private, for profit middleman, labeled a “Direct Contracting Entity (DCE) without seniors’ knowledge or consent, and without Congressional oversight. Every enrollee in traditional Medicare should take note of the dangers. A program titled the Global and Professional Direct Contracting model in a little-known government agency known as the Center for Medicare and Medicaid Innovation (“The Innovation Center”) is already moving them, without their knowledge or consent, to “risk-bearing,” for-profit middlemen known as Direct Contracting Entities (DCEs). The goal: to end what’s left of traditional Medicare as a public, non-profit social/health insurance program.

Simply put, it proposes that a “risk-bearing,” for-profit middleman manage health care for traditional Medicare beneficiaries, just like Medicare Advantage plans are for seniors who have signed up for Medicare Advantage plans. The difference is that while 26 million seniors have voluntarily signed up for a middleman when they chose Medicare Advantage, the 38 million seniors in traditional Medicare have not.

How do you get seniors who have specifically chosen traditional Medicare to switch to a non-traditional Medicare-Advantage-like plan with a mysterious name like “Direct Contracting Entity”? You don’t tell them! You lure their primary care providers to participate in a DCE by promising the doctors much better Medicare reimbursement rates and more time with their patients, and once the doctors sign up with a DCE, all their patients are automatically “aligned” by CMS with the DCE the doctor has chosen. The DCE sends patients a letter they are likely not going to read or understand, and presto! Millions of seniors previously on traditional Medicare now belong to a DCE. That’s how DCEs leverage and monetize the doctor-patient relationship for the profit of private corporations,oligarchs and other Wall Street entities.

The “Medicare Direct Contracting Program” is a pilot program that aims to enroll every Traditional Medicare beneficiary into a third-party “Direct Contracting Entity” (DCE). Instead of paying doctors and hospitals directly for care, Medicare gives DCEs a monthly payment to cover a defined portion of each seniors’ medical expenses, allowing DCEs to keep as profit what they don’t pay for in care. Virtually any type of company can apply to be a DCE, including commercial insurers, venture capital investors, and even dialysis centers. Applicants are approved by CMS without input from Congress.

Hapless traditional Medicare beneficiaries are to be “auto-alligned” in DCEs if their primary care physician is affiliated with that DCE. CMS automatically searches two years of seniors’ claims history — without their consent or knowledge — to find any visits with a participating DCE provider as the basis for aligning them with that DCE.

Most physicians, seniors, and even members of Congress have not heard of the DC program for a good reason. It was created during the Trump Administration and continued by the Biden Administration using the CMS “Innovation Center,” whose mission is to test and implement health payment models without Congressional approval. The DC “pilot phase” includes 53 DCEs in 38 states, potentially covering 30 million of the 36 million Traditional Medicare beneficiaries. If left unchecked, DCEs could essentially privatize Traditional Medicare within the next few years.

There are different types of DCEs, but they all assume some level of “risk sharing,” meaning they keep as profit some or all of what they don’t spend on care, or take as a loss some or all of what they spend beyond the capitation payment. This payment model is very similar to Medicare Advantage, establishing an incentive for DCEs to both “upcode” diagnoses to increase capitation payments, and then spend as little as possible on patient care.

However, the opportunity for profit is much higher in the DCE program: While Medicare Advantage(MA) insurers are required to spend 85% of their revenues on patient care, DCEs have an “implicit but irrelevant” medical loss ratio requirement of approximately 60%, positioning them to keep virtually all savings as profits. Virtually any company can apply to be a DCE, including investor-backed startups that include primary care physicians, MA plans and other commercial insurers, accountable care organizations (ACOs) or ACO-like organizations, and for-profit hospital systems. Applicants are approved by CMS without input from Congress or other elected officials.

There are three types of DCEs: Geographic (GEOs), Professional Direct Contracting, and Global Direct Contracting:
1). Geographic DCEs (GEOs) are the most extreme of the three models, with the potential to fully privatize Traditional Medicare. Under the GEO model, every TM beneficiary living in a number of large geographic regions is auto-assigned into a DCE, with no right to opt out. GEO DCEs assume 100% risk (profits and losses) for a beneficiary’s medical services. Under pressure from health care advocates, the GEO pilot was paused by the Biden Administration in early 2021.

2). Professional DCEs assume a 50% risk-sharing arrangement with CMS, and can also participate in “primary care capitation,” receiving a monthly payment from CMS for primary care services only, at an amount determined by each enrollee’s risk score.

3). Global DCEs assume 100% risk via two payment options from CMS: primary care capitation or total care capitation, for all services provided by the DCE and its contracted “preferred” providers.

In both the Professional and Global DCE models, patients are allowed to get medical care outside of the DCE’s network; those providers are then paid directly by CMS at Medicare-contracted rates, and CMS ultimately reconciles those costs back to the DCE. The DCE thus has a business , profit motive imperative.

DCEs privatization will make money for oligarchs, investors and other Wall Street entities because:
1). Medicare pays DCEs more money for sicker patients, DCEs have a strong incentive to engage in a type of fraud called “upcoding,” meaning they exaggerate — or falsify — seniors’ diagnoses.
2). DCEs are allowed to keep as profit and overhead what they don’t pay for in health services, a dangerous financial incentive to restrict seniors’ care.
3). Former CMS Administrator Dr. Don Berwick and former CMS Innovation Center director Dr. Rick Gilfillan estimate that DCEs may spend as little as 60% of Medicare payments on patient care, keeping 40% as overhead and profit.

DCEs once again clearly show that President Biden, the Democratic Party and America’s neoliberal vision of world order is rooted in an economic philosophy of privatization and financialization. To maintain corporate control of U.S. health care insurance, our system is privatized and unregulated. Private, big insurance companies are in the business of making money, not providing health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs (and immense profiteering ) are greater in the private health care insurance system, with Medicare itself weakened by having to work through the private system.

Biden and many Democrats have spent their careers defending the financial sector, including big insurance and big pharma, whose leading policy is also to maintain and further privatize basic health care financing and infrastructure. Distinguished economist Michael Hudson notes that, “Biden’s long political career has been right-wing. He’s the senator from Delaware, the country’s most pro-corporate state – which is why most U.S. corporations are incorporated there. As such, he represents the banking and credit-card industry. He sponsored the regressive bankruptcy “reform” written and put into his hands by the credit-card companies. As a budget hawk, he’s rejected Modern Monetary Theory (MMT), and also “Medicare for all” as if it is too expensive for the government to afford – thereby making the private sector afford to pay 18% of US GDP for health-insurance monopolies, far more than any other country. That means blocking governments from providing basic services at cost or on a subsidized basis – education, health care/health insurance, roads and communications. Privatized and financialized economies are high-cost.”

Although health insurance affordability for the majority of US citizens remains a very large problem, Pres. Biden wants to shift many more dollars into private, Wall Street insurance industry hands. The complete takeover of health insurance by private Wall Street entities continues apace with DCEs as Democrats/Biden also propose to increase taxes and give it to the private profit insurance industry – the source of our profound administrative waste, along with the costly administrative burdens they place on the delivery system. Profiteering continues unabated as private insurance sells us services we don’t need/want , such as deductibles and other cost sharing, maintenance of narrow networks, requiring prior authorization with increased administrative costs, excessive ongoing paperwork/documentation requirements, all while avoiding paying for surprise bills and other denied benefits.

A new grassroots movement has formed to stop DCEs, a flawed and dangerous scheme. DCEs could radically transform Medicare into a bonanza for Wall Street while incentivizing harmful restrictions on patient care. Advocates argue that if left unchecked, DCEs could essentially privatize Traditional Medicare without the consent of its own enrollees, or even a vote by Congress.

Medicare’s other privatization project — Medicare Advantage — demonstrated that injecting a profit motive into patient care actually leads to higher costs for taxpayers, with tragic consequences for patients. Thousands of physicians, mental health professionals and other advocates have signed a petition calling for Secretary of Health and Human Services Xavier Becerra to halt the DCE program, provide real oversight of CMS’ Innovation Center, and protect Medicare for future generations.If you’d like to join the fight against Medicare Direct Contracting, please call your member of Congress at (202) 224-3121 and ask them to demand HHS end this dangerous and insidious program; hold hearings on DCEs; and establish Congressional oversight of the Center for Medicare and Medicaid Innovation (CMMI). traditional Medicare.

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