ALL OF MARYLAND'S DEMOCRATS PUSHED ACA......THEY ARE NEO-LIBERALS!
All health plans will end up in these health co-ops....Medicare/Medicaid, union health plans....and the 3 tiered structure of insurance will have most people unable to access most health care. Many will die if this policy is left in place
Remember how Obama and Congressional neo-liberals immediately gave a pass to PHARMA during the health care reform even as PHARMA is a great part of the cost problem? That was because the Affordable Care Act is about making health care into global health systems and maximizing profits at the cost of patient access and quality of care. All across the country public universities are being corporatized and partnered with biotech corporations as the taxpayer subsidizes the cost of PHARMA development....YOU KNOW, JUST AS WHAT IS HAPPENING IN BALTIMORE WITH HOPKINS AND UMMS AND THEIR BIOTECH BUILDINGS/BUSINESSES. Obama and Congressional neo-liberals are criss-crossing the world marketing US PHARMA and demanding nations that subsidize their health care so citizens have quality care end that practice. US NEO-LIBERALS SHOUT LOUDLY AND STRONGLY-----WE ALLOW OUR CITIZENS TO DIE EARLY DEATHS FROM LACK OF ACCESS AND SO SHOULD YOU! The US is one of few developed nations that is moving towards complete denial of access to care for most of its citizens and it is purely profit-driven.
THESE ARE REAL SOCIOPATHS PEOPLE! IS IT MURDER WHEN POLITICIANS ALLOW PEOPLE TO DIE FROM LACK OF ACCESS TO HEALTH CARE JUST SO CORPORATE PROFITS GROW?
Once again we see how Obama and Congressional neo-liberals pretend to 'fix' a problem but never actually address the cause of the problem....because to solve it cuts into corporate profits. ALL MARYLAND DEMOCRATS ARE NEO-LIBERALS. Cummings, Cardin, Sarbanes Sr, and Hoyer all voted Glass Steagall down knowing these global corporations would rule. ALL OF BALTIMORE'S POLS.
How a Cabal Keeps Generics Scarce
By MARGARET CLAPP, MICHAEL A. RIE and PHILLIP L. ZWEIG Published: September 2, 2013
ABOUT a year ago, President Obama signed a law that was supposed to end chronic shortages of lifesaving drugs. But the critical lack of generic drugs continues unabated. It is a preventable crisis that is inflicting suffering on patients and, in some cases, causing needless deaths.
According to the American Society of Health-System Pharmacists, a group that maintains a closely watched drug-shortage database, 302 drugs were in short supply as of July 31, up from 211 about a year earlier.
The new law, which among other things requires manufacturers to report anticipated shortages, is ineffective because it addresses symptoms, not the underlying economic cause. Policy makers apparently failed to ask the important question: How could this happen in a free-market economy? That would have steered them to the giant purchasing organizations that control the procurement of up to $300 billion in drugs, devices and supplies annually for some 5,000 health care facilities. These cartels have undermined the laws of supply and demand.
Most of the drugs in short supply are sterile injectables that have been cheap mainstays for decades. They’re generally administered in hospitals and outpatient clinics and sold through hospital purchasing organization contracts, not through retail pharmacies or pharmacy benefit managers.
Scarce or unavailable drugs include anesthetics, chemotherapeutic agents, antibiotics, nutrients for malnourished infants, painkillers and even intravenous solutions. Physicians have been forced to improvise with less desirable or more expensive substitutes. One study reported in an issue of The New England Journal of Medicine last December found that children with Hodgkin’s disease were at greater risk of relapse because the most effective generic, mechlorethamine, wasn’t available. Propofol, the preferred anesthetic for many surgical procedures, is scarce because there’s just one supplier of the generic in the United States in full production.
Improvisation has caused some patients to wake up during operations — or not at all. A March 2012 survey by the American Society of Anesthesiologists, in which about 3,000 members responded (out of around 50,000), attributed six deaths, as well as other adverse outcomes, to shortages of drugs.
A deadly outbreak of fungal meningitis, which was first identified last September in Tennessee, was triggered by shortages of a steroid painkiller, prompting providers to turn to the now bankrupt New England Compounding Center, which, as a so-called compounding pharmacy, was not held by the Food and Drug Administration to the same stringent standards as regular drug manufacturers. The pharmacy’s sister company, Ameridose, which has also been closed, had supply contracts with five of the largest American hospital purchasing organizations: MedAssets, Novation, Premier, HealthTrust and Amerinet. This tragedy had killed 63 and sickened 749, according to the Centers for Disease Control and Prevention.
The Government Accountability Office is investigating the role of the group purchasing organizations in the shortages and the meningitis debacle. The agency’s report is expected in 2014.
The F.D.A. has permitted temporary imports, which almost surely have created shortages in other countries. That’s because there is finite global manufacturing capacity; production cannot be ramped up overnight. Hospitals are rationing medications, while their pharmacists spend untold hours scrambling to find them.
The economic root cause is simple: the purchasing organizations have squeezed manufacturers’ operating margins to razor-thin levels. By awarding select suppliers exclusive contracts in return for exorbitant (and undisclosed) “administrative,” marketing and other fees, they have reduced the number of suppliers to just one or two for many generics. Further, they’ve crimped investment in maintenance and quality control, resulting in adverse F.D.A. inspections and plant closings.
This perverse system was created in 1987 when Congress enacted the Medicare anti-kickback “safe harbor,” which exempted these buying organizations from criminal prosecution for accepting vendor kickbacks. Spurred by a 2002 New York Times investigation into anticompetitive purchasing group practices, Congress held several hearings to determine whether greater federal regulation was needed. Antitrust lawsuits and more government investigations and exposés followed. A study in fall 2011 issue of the Journal of Contemporary Health Law and Policy found that group purchasing organization kickbacks inflated supply costs by at least $30 billion annually. But little has changed because of the enormous political clout of the industry’s lobby, which includes the Healthcare Supply Chain Association and the American Hospital Association.
The Obama administration and Congress must protect patients by repealing the anti-kickback safe harbor and restoring free-market competition to the hospital purchasing industry.
Margaret Clapp is a former chief pharmacy officer at Massachusetts General Hospital. Michael A. Rie is associate professor of anesthesiology at the University of Kentucky College of Medicine and co-chairman of Physicians Against Drug Shortages, where Phillip L. Zweig is the executive director.
“I think it was misguided all along,” Robert B. Reich, the former labor secretary, said in an e-mail. When the law was being written, he said, he worried that the tax was “a blunt instrument that could too easily become a bargaining chit for cutting back benefits of
That is exactly what it is as the unions now have the only strong health coverage left for workers. This law was specifically meant to break those plans.
IF UNIONS ARE NOT DEMANDING THAT HEALTH FRAUD AND PROFITEERING IS THE CAUSE OF HEALTH COST......NOT WORKER COVERAGE....THEY ARE NOT WORKING FOR YOU AND ME!
Why is it that union leaders support these policies and then understand they work against their members? Make sure your union leaders are working for you and me!
Health Care Law Raises Pressure on Public Unions
By KATE TAYLOR Published: August 4, 2013
Cities and towns across the country are pushing municipal unions to accept cheaper health benefits in anticipation of a component of the Affordable Care Act that will tax expensive plans starting in 2018.
The so-called Cadillac tax was inserted into the Affordable Care Act at the advice of economists who argued that expensive health insurance with the employee bearing little cost made people insensitive to the cost of care. In public employment, though, where benefits are arrived at through bargaining with powerful unions, switching to cheaper plans will not be easy.
Cities including New York and Boston, and school districts from Westchester County, N.Y., to Orange County, Calif., are warning unions that if they cannot figure out how to rein in health care costs now, the price when the tax goes into effect will be steep, threatening raises and even jobs.
“Every municipality with a generous health care plan is doing the math on this,” said J. D. Piro, a health care lawyer at a human resources consultancy, Aon Hewitt.
But some prominent liberals express frustration at seeing the tax used against unions in negotiations.
“I think it was misguided all along,” Robert B. Reich, the former labor secretary, said in an e-mail. When the law was being written, he said, he worried that the tax was “a blunt instrument that could too easily become a bargaining chit for cutting back benefits of workers.”
“Apparently, that’s what it’s become,” Mr. Reich, who is a professor of public policy at the University of California, Berkeley, said.
Under the tax, plans that cost above a certain threshold in 2018 — $10,200 annually for individual plans and $27,500 for family plans, with slightly higher cutoffs for retirees and those in high-risk professions like law enforcement — will be taxed at 40 percent of their costs in excess of the limit. (The thresholds will rise with inflation after 2018.)
State and local governments across the country tend to offer more expensive health plans than private businesses do, and workers often accept smaller wage increases to retain their benefits. Because of this, state and local government employees are expected to be disproportionately represented among those whose plans will be subject to the tax.
New York City expects its two most popular employee health plans to reach taxable Cadillac levels by 2018 or shortly after. This year, the city projects that it will pay a total of $7,128 for individuals and $18,249 for families in its most popular plan, including the costs the city pays into union welfare funds to cover prescription drug benefits. That is above the national average for employer-sponsored health care coverage, which last year was $5,615 for single coverage and $15,745 for family coverage, according to a 2012 Kaiser Family Foundation survey.
The total health care cost for the city’s nearly 300,000 municipal employees, pre-Medicare-age retirees and their dependents is expected to approach $8 billion by 2018. DO YOU KNOW THAT TRILLIONS OF DOLLARS IN HEALTH FRAUD JUST LAST DECADE WILL EASILY PAY THAT MERE $8 BILLION?
In a letter in April to the head of a labor coalition, Caswell F. Holloway IV, deputy mayor for operations, said the Cadillac tax would cost New York City $22 million in 2018, increasing to $549 million in 2022. (This year, the total city budget, excluding federal and state aid, is just over $50 billion.)
“We know that, on the current trajectory, we’re going to be hit with that tax and it would increase very steeply,” Mr. Holloway said.
So the administration of Mayor Michael R. Bloomberg, in its final months in office, is asking municipal unions to agree to seek new bids for the city’s health insurance business, hoping to lower premiums. It has already achieved one small victory, getting the city’s current primary insurer to freeze premiums for one year if it keeps the city’s business, the mayor said on Friday.
But lower-cost plans are likely to involve greater out-of-pocket costs and more limited networks of doctors, and so far, the response from labor has been cool.
Ninety-five percent of city employees and 93 percent of retirees are in the two largest plans, which require employees to pay nothing toward their premiums. According to the Kaiser Family Foundation survey, the average contribution by public employees throughout the country is 12 percent for individual plans and 23 percent for family plans.
Harry Nespoli, the chairman of the Municipal Labor Committee, the labor coalition that negotiates with the city on health care, said that he was concerned about the tax, but also that the burden of any cuts would fall largely on workers at the bottom of the pay scale.
Mr. Nespoli said his staff was looking over the request for proposals that the city had written, but he said he was skeptical that the process of seeking new health insurance could be completed before the next administration.
“We’re not going to turn around and do a $7 billion contract that affects our members for the next 10 years out without looking at it very carefully,” he said.
Most of Boston’s 20,000 employees are currently in plans that by 2018 would exceed the tax threshold. The city and its unions are preparing a request for proposals for new insurance coverage.
“The tax is going to be a hit, and, if you’re not expecting it, it’s going to be very shocking,” said Meredith Weenick, the chief financial officer for Boston.
Jim Finley, the executive director of the Connecticut Conference of Municipalities, said he thought it would be hard for Connecticut towns and cities to get their unions to agree to cheaper health care benefits to avoid the tax.
“In the end, it’s the taxpayer that’s going to bear that burden,” Mr. Finley said.
In Orange County, Calif., the Newport Mesa Unified School District warned employees during contract negotiations that if the district’s health care costs continued rising at the current rate, the district could face a $2.3 million burden from the tax in 2018.
The teachers’ union ultimately agreed to accept greater out-of-pocket costs to reduce the increase in its premium this year to 3 percent from 6 percent, but union leaders said they resented the district’s using the threat of the tax as a negotiating tactic.
Municipal unions opposed the inclusion of the tax in the health care law, and it was partly their efforts that succeeded in delaying its effective date until 2018.
Steven Kreisberg, the director of collective bargaining and health care policy at the American Federation of State, County, and Municipal Employees, said the term Cadillac tax was misleading, because it “connotes a certain aspect of luxury in these health plans that is just factually incorrect.”
The announcement last month that the Obama administration would delay by a year the mandate that larger employers offer coverage to their workers does not affect the timing of the excise tax, although it may provide encouragement to those who hope that the assessment will be delayed or scrapped altogether.
“Some skeptics, and I’m not one of them, say that that’s why the tax was put into effect in 2018 — that it’s far enough away that people can consider whether or not they really want it to go into effect,” Mr. Piro, the health care lawyer, said.
Jonathan Gruber, an economist at the Massachusetts Institute of Technology who was a paid consultant to the Obama administration on health care policy, said forcing state and local governments to rein in health care costs was exactly what the tax was intended to do.
“This is intended to shift compensation away from excessively generous health insurance toward wages,” he said.
In New York, if the Bloomberg administration does not succeed in getting new health insurance before the end of the year, the problem will fall in the lap of the next mayor.
Mr. Holloway said the Bloomberg administration, like many city governments, had long been concerned about the rising cost of health care and its impact on the budget.
But the 2018 tax “adds a sense of real urgency to getting a handle on this,” he said.
“We’ve got to start thinking about this now,” he continued. “Why is it that my plan is so expensive per person? What are the ways that we could get that under control?”
Op-Ed Contributor Diagnosis: Insufficient Outrage
By H. GILBERT WELCH Published: July 4, 2013 New York Times
HANOVER, N.H. -- RECENT revelations should lead those of us involved in America’s health care system to ask a hard question about our business: At what point does it become a crime?
I’m not talking about a violation of federal or state statutes, like Medicare or Medicaid fraud, although crime in that sense definitely exists. I’m talking instead about the violation of an ethical standard, of the very “calling” of medicine.
Medical care is intended to help people, not enrich providers. But the way prices are rising, it’s beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufactures — are the ones benefiting.
A number of publications — including this one — have recently published big reports on the exorbitant cost of American health care. In March, Time magazine ran a cover story exposing outrageous hospital prices, from $108 for a tube of bacitracin — the ointment my mother put on the scrapes I got as a kid and that costs $5 at CVS — to $21,000 for a three-hour emergency room evaluation for chest pain caused by indigestion.
Of course, Medicare will have none of this — it sets its own prices. And private insurers negotiate discounts. So no one is actually charged these amounts.
Check that. The uninsured are. They are largely young and employed (albeit poorly) and have little education. So the biggest medical bills go to those least able to pay.
At what point does it become a crime?
Consider another recent shift in health care: hospitals have been aggressively buying up physician practices. This could be desirable, a way to get doctors to use the same medical record so that your primary care practitioner knows what your cardiologist did.
But that may not be the primary motivation for these consolidations. For years Medicare has paid hospitals more than independent physician practices for outpatient care, even when they are providing the same things. The extra payment is called the facility fee, and is meant to compensate hospitals for their public service — taking on the sickest patients and providing the most complex care.
But now hospitals are buying up independent practices, moving nothing, yet calling them part of the hospital, and receiving the higher rate.
In North Carolina, Duke’s health system has been aggressively buying up local cardiology practices, thereby increasing the number of echocardiograms performed “in the hospital” by 68 percent in one year, and bumping the Medicare payment from $200 to $471, according to The Charlotte Observer and The News & Observer, in Raleigh.
It’s happening in my hometown hospital, Boulder Community Hospital, where my late mother was a trustee. The Denver Post reported in May on a patient whose cardiac stress test cost around $2,000 one year, and around $8,000 the next, after his doctor’s practice was bought by the hospital.
Same office, same machine, same doctor, but it cost four times more. Mom would want to know: what happened to the word “community” next to the word “hospital”?
The problem is not just prices, but also volumes: how much we do to patients, and how often. Look at colonoscopies. There are good reasons to believe that they can reduce the number of deaths from colon cancer. Expert panels recommend that most people need a colonoscopy only once every 10 years. But a study published in 2011 in The Archives of Internal Medicine found that 46 percent of Medicare beneficiaries with a normal colonoscopy nevertheless had a repeat exam in fewer than seven years. For some gastroenterologists, it seems, the primary finding from your colonoscopy is that you need another one.
Cardiology has a similar problem. Each year millions of Medicare beneficiaries undergo an echocardiogram. Half of them have the test repeated within three years. It sure looks as if some cardiologists are doing the test annually.
Finally we’ve learned the value of new capacity: if you build it, they will come. Two proton beam facilities were recently approved for Washington. One is already being built in Baltimore, only 40 miles away. There may be some role for proton beam radiation in children who have brain and spinal tumors, but there are only about 140 such children a year in Washington and Baltimore. Three facilities have the capacity to serve well over 10 times that. It’s hard to imagine that some of the roughly 8,000 men in the area destined to develop prostate cancer next year won’t receive proton beam therapy, despite the fact that there’s no good evidence that it’s any better than standard radiation for their condition.
But it is certainly more expensive: profits at one of the facilities are expected to reach almost $16 million a year by 2019.
The word “crime” is awfully strong. Many prefer to call all this a problem of perverse incentives: good people, working in a bad system.
We could make the system better. We could ensure that everyone has access to the same set of prices, like the Medicare fee schedule. We could end the “fee for service” positive feedback loop — in which doctors and hospitals earn more for every procedure they do, which leads to overtreating patients — and instead have a flat fee. But the incentives will never be perfect. Ultimately, society needs individuals to be guided by ethical standards. And in medical care, those standards are getting pretty darn low.
Too many of us have passively accepted the situation as being beyond our control. Medical care in America could use a dose of moral outrage. It would be best for all if it was self-administered.
H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is an author of “Overdiagnosed: Making People Sick in the Pursuit of Health.”
This article has been revised to reflect the following correction:
Correction: July 12, 2013
An Op-Ed article on Friday, about the high price of health care, incorrectly cited a study of colonoscopies. It was published in 2011 in The Archives of Internal Medicine (now JAMA Internal Medicine), not The Journal of the American Medical Association.