PNHP

COVID-19 vaccine rollout in the face of racial inequities in health care system

COVID-19 vaccine rollout in the face of racial inequities in health care system

By Arika Shaikh and Kalyani Ballur
The Augusta (Ga.) Chronicle, April 29, 2021

Should race determine who gets the COVID-19 vaccine? The answer is no. However, despite recent vaccination efforts, clear disparities exist in America’s vaccine distribution plan.

A New York Times analysis from March reported that the vaccination rate for Black Americans is half that of white and the gap for Hispanics is even greater. Furthermore, CDC data showed that approximately 66% of those who received the vaccine were white, 11% were Hispanic, 9% were Black, 5% were Asian, and 1% were American Indian with other groups having low rates as well.

With greater exposure to the virus working in front-line jobs and having high rates of comorbidities such as diabetes and obesity, people of color are at even more of a risk for severe COVID-19 infection. It is clear that the communities that are being the most affected by the pandemic have the slowest vaccination rates.

There are multiple variables that come into play with vaccine access and distribution. They span from the level of the federal government to individual communities. One analyst compares the vaccine rollout similar to purchasing tickets to a concert: it depends on availability, access, and responsiveness.

Initially with the vaccination guidelines, it was not taken into consideration the specific health makeup of the African- American community. The average life expectancy of African Americans falls below 75 years of age, which was the cutoff for the first phase of vaccine eligibility. From the beginning, this put Black populations more at risk to severe COVID-19 infections. One factor that contributes to the unequal distribution of vaccines is the lack of vaccination sites in underserved communities, who have limited access to transportation and Internet. The privileged are more likely to benefit from mass vaccination centers due to higher access to transportation and greater flexibility in their work schedule to wait in the lines. From a historical standpoint, there has been an ongoing mistrust of the health care system in certain communities which has projected into vaccine hesitancy, especially in the hard hit populations.

On multiple levels, there need to be changes to address the inequities with the vaccination rollout. The Biden administration has recognized these issues by shipping vaccines to community centers, especially in underserved communities, rather than to the state, hoping to minimize the inequities in vaccine distribution. While this is a step in the right direction, there is much work ahead that needs to be done and done quickly with COVID cases rapidly increasing.

Looking in our own community, Augusta University Health system is partnering with local religious institutions to provide awareness and greater access to underprivileged populations. Recently, the Medical College of Georgia partnered with 100 Black Men of Augusta to specifically work with minority communities to address concerns and myths about the vaccine. This is a greater call to action for academic institutions and local communities to work together to bridge the vaccine inequities.

Although these racial disparities have come more into light with the recent pandemic, these issues have always been prevalent in our community. One of the biggest contributors is the inequity with access to health care insurance.

As medical students and members of Students for a National Health Program (SNaHP) at MCG, we seek to dismantle this infringement of basic human rights through our proposal of Medicare for All. Establishing a national health program will ensure equal access to health care for all populations and improve health outcomes. At the local level, we have proposed this resolution to benefit the Augusta community. If you would be interested in joining this initiative, please support us by signing our petition.

Arika Shaikh and Kalyani Ballur are first-year medical students at the Medical College of Georgia. They wrote this on behalf of the advocacy group Students for a National Health Program. Views are their own and do not reflect those of their institution.

https://www.augustachronicle.com…

John Geyman: The Medical-Industrial Complex…plus exciting changes at qotd

“America’s Mighty Medical-Industrial Complex: Negative Impacts and Positive Solutions”

By John Geyman

This book has three goals: (1) to bring an historical perspective to how medicine and health care have evolved over the last 100 years, including the transformation of their original ethic of service with a moral purpose and how that ethic has been compromised by corporate greed; (2) to describe where an engulfing medical-industrial complex has brought us in terms of decreasing access to affordable health care, unacceptable quality of care, profiteering and fraud; and (3) to consider whether and how our unsustainable health care system can be brought into line against this deepening crisis in serving the needs of our people.

Copernicus Healthcare: http://www.copernicus-healthcare.org

Amazon: https://www.amazon.com…

Comment:

By Don McCanne, M.D.

Most of us want a health care system that has a mission to maintain and improve our health, yet we have a system that has lost its way in that its mission places a priority on advancing the interests of the medical-industrial complex at the cost of compromising our health care. John Geyman explains how we got there and how detrimental the impact has been. Although the political barriers to reform seem almost insurmountable, he does show us that there is a path to the essential reform that we need to bring health care justice to all. By understanding the source and nature of the dysfunctions, we can find our way out.

Exciting changes at qotd

As some of you may have heard, the interruption in the Quote of the Day messages was due to a TIA/stroke suffered by the author. Fortunately, the recovery has been dramatic, though incomplete. As a result, after two decades of daily commentaries in his retirement years, it is time for a change.

Future messages will be from noted health policy experts within and outside of PNHP. We will be receiving the latest from the best. With this change in format, we will also be changing the name to “Health Justice Monitor.” Launch is planned for next week.

I hope that you are as excited as I am as I become a consumer rather than a producer of the latest in health policy science. The more we understand, the sooner we will have health care justice for all.

Peace,
Don McCanne

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

The pandemic and the health care crisis

By Carl DeMatteo, M.D., Ahmed Kutty, M.D., and Jim Murphy, R.N.
The Keene (N.H.) Sentinel, Letters, April 17, 2021

About 30 million Americans remained uninsured and 40 million underinsured before the pandemic struck our country in early 2020. The consequent economic catastrophe on Main Street has swelled those numbers to well over 100 million. Granite Staters got their fair share of the avoidable misery.

Health care corporations like United Health posted record profits during the pandemic, thanks to the tax-dollar subsidy handed to them, ostensibly to make insurance affordable to the low- and middle-income families. This may have helped some, but was inadequate to the huge task. In addition, building on the Affordable Care Act, while expanding coverage with public funds, virtually does nothing to control health care costs in America, with its fantastical belief that there is a free-market solution to every socioeconomic problem.

The recently reintroduced bill — HR 1976, “To establish an improved Medicare for All national health Plan” by Rep. Jayapal, D-Wash. — is an ambitious, long-overdue and transformative measure, covering all medically necessary services to all Americans regardless of ability to pay, as social insurance and a human right, while saving the nation $500 billion annually and costing substantially less to 95 percent of families, compared to their current tab.

There is currently a group of concerned citizens circulating a petition urging the Keene City Council to pass a resolution calling on our senators and congressional representatives to support the passage of HR 1976. We hope that when given the chance, all citizens of Keene will sign on to this petition and let the council know that this resolution must be passed, as has been done in other New Hampshire communities. Time to act as engaged citizens is now.

For more information on this critical topic, please go to pnhp.org/housebill or congress.gov.

https://www.sentinelsource.com…

Medicare for All Explained Podcast: Episode 54

Interview with Dr. Jane Katz Field

April 15, 2021

PNHP-VT vice president Dr. Jane Katz Field describes the year-and-a-half effort to pass a single-payer resolution at the Vermont Medical Society. “We owe it to our patients,” she says, “not just to advocate for their medical needs at the bedside, but to reform the system.”

Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Single Payer vs. Free Market: A Debate on the Future of Healthcare

Sponsored by PNHP-Oregon

Oregon Health Forum, April 13, 2021

When the current paradigm of healthcare delivery began four decades ago, the goal was to control costs by improving care. Can we do better with today’s knowledge and experience? Join us for a lively two-sided debate designed to be entertaining, to draw out key policy differences and implications for our community on our hopeful path to universal coverage and to learn what both sides have to offer.

Download slideshow HERE.

Rep. Cedric Hayden-R, District 7, Roseburg

Cedric is a dentist, business owner, and an Oregon State Representative for District #7.  Now completing his second session as State Representative, Cedric serves as the Vice-Chair for the House Committee for Health Care and is also a member of both the House Early Childhood and Family Supports; and Ways and Means Subcommittee on Human Services. Cedric Hayden grew up in rural Fall Creek, Oregon, a member of what is now a sixth generation Covered Wagon pioneer family. In fact, his great-grandmother was the first female mayor of Burns, Oregon.  In 1994, he graduated from the University of Missouri-Kansas City School of Dentistry after attending undergraduate school in Walla Walla, Washington and joined the family dental practice.  He resides in Fall Creek, Oregon with his wife Julie and their five children. In his spare time he enjoys being at home with his family and taking care of his horses. Cedric has on several occasions been honored as an outstanding quarter horse breeder.

Contact Rep. Cedric Hayden at rep.cedrichayden@oregonlegislature.gov

Michael F. Cannon, Director, Health Policy Studies, The Cato Institute

Michael Cannon has been described as “an influential health‐​care wonk” (Washington Post) and “ObamaCare’s single most relentless antagonist” (New Republic). He has appeared on numerous television networks and his articles have been featured in a variety of publications. Cannon is the coeditor of Replacing Obamacare: The Cato Institute on Health Care Reform, author of 50 Vetoes: How States Can Stop the Obama Health Care Law, and coauthor of Healthy Competition: What’s Holding Back Health Care and How to Free It. Previously, he served as a domestic policy analyst for the U.S. Senate Republican Policy Committee, where he advised the Senate leadership on health, education, labor, welfare, and the Second Amendment. Cannon holds a BA in American government from the University of Virginia, and an MA in economics and a JM in law and economics from George Mason University. He is a member of the Board of Advisors of Harvard Health Policy Review.

Contact Michael Cannon at mcannon@cato.org.

Samuel Metz, M.D., Vice President, Physicians for a National Health Program – Oregon

As vice president of the Oregon chapter of Physicians for a National Health Program and a founding member of Mad As Hell Doctors, Dr. Metz has become a renowned advocate for universal health coverage. He was a member of Oregon’s 2018 Universal Access to Health Care legislative work group and a member of the Oregon Medical Association’s 2018 Universal Healthcare Task Force. He is a current member of Oregon’s SB 770 Task Force on Single Payer Health Care. Dr. Metz serves as an Adjunct Associate Professor of Anesthesiology and Perioperative Medicine at Oregon Health & Science University.

Contact Dr. Metz at s@samuelmetz.com.

https://www.oregonhealthforum.org…

Quote of the Day interlude

By Don McCanne, M.D.

Quote of the Day will take a brief interlude. We are refining our approach to communicating information to educate and advocate for single payer and health care justice for all.

See you soon.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

More trouble: Drug industry consolidation

Drug companies keep merging. Why that’s bad for consumers and innovation.

Over 30 years, dramatic consolidation has meant higher prices, fewer treatment options and less incentive to innovate

By Robin Feldman
The Washington Post, April 6, 2021

In the past few decades, three waves of mergers have substantially increased concentration in the pharmaceutical industry.

All told, between 1995 and 2015, the 60 leading pharmaceutical companies merged to only 10.

As a result, now only a handful of manufacturers are responsible for sourcing the vast majority of prescription drugs: Just four companies, for example, produced more than 50 percent of all generic drugs in 2017.

Drug companies were drawn to merging because of the lure of increased market power, improved synergies, larger economies of scale and more diverse product portfolios.

In the period following merger waves one and two, the industry generated fewer new molecular entities each year compared to pre-merger levels. Merged drug companies also spent proportionally less on research than their non-merged competitors.

Consolidation also enabled drugmakers to directly quell competition through what were known as “killer acquisitions,” in which they acquired innovative peers solely to stop potential competition.

In short, consumers were the losers from the two waves of drug company mergers. They confronted higher prices and fewer choices — and saw companies exploring fewer paths that might produce breakthroughs. To make matters worse, around 2010, another wave of mergers began.

As with the earlier waves, giant drug companies have merged. But in a new twist, in recent years, most consolidation has featured bigger players acquiring smaller start-ups. The difference reflects a dramatic shift in the structure of the pharmaceutical industry. Faced with stagnating research productivity, large drugmakers now rely on outsourcing their new drug research to start-ups and other small pharmaceutical firms.

Increasingly, these smaller players specialize in high-risk research and early drug development, with larger firms then gobbling them up and navigating the FDA’s regulatory process. For example, 63 percent of all new molecular entities in 2018 came from smaller biopharma firms, compared with just 31 percent in 2009.

The end result of now three waves of pharmaceutical consolidation is decreased or diverted new drug innovation, fewer treatment options and higher prices. Consumers have lost as firms fuse together to bolster the bottom line.

Robin Feldman is director of the UC Hastings Center for Innovation.

https://www.washingtonpost.com…

Comment:

By Don McCanne, M.D.

Yesterday we discussed consolidation of UnitedHealth/Optum and how it has become a mega-corporation of the medical-industrial complex. Today’s selection discusses consolidation within the pharmaceutical industry. The article describes how we can expect decreased or diverted drug innovation, fewer treatment options, and above all, higher prices. Works for the industry, but not so well for the people.

We’re just trying to introduce single payer Medicare for All. How much impact can that have on these mega-corporations? Where is our government in all of this? Aren’t they supposed to protect us? Maybe we’re aiming too low by advocating for a social insurance program. Maybe we should be taking over the industry so that we can gear it up to better serve us, the people. International comparisons do rate national health services very high in performance. Maybe if we talk about it a little more we can convince them that Medicare for All is a compromise that they can live with. We think we can too.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Will mega-corporations trump Medicare for All?

The Big Tech of Health Care

The merger between a subsidiary of UnitedHealth and Change Healthcare would create a vertically integrated, all-seeing giant.

By Krista Brown, Olivia Webb
The American Prospect, April 5, 2021

It’s not often that the American Hospital Association — known for fun lobbying tricks like hiring consultants to create studies showing the benefits of hospital mergers — directly goes after another consolidation in the industry.

But when the AHA caught wind of UnitedHealth Group subsidiary Optum’s plans, announced in January 2021, to acquire data analytics firm Change Healthcare, they offered up some fiery language in a letter to the Justice Department. “The acquisition… will concentrate an immense volume of competitively sensitive data in the hands of the most powerful health insurance company in the United States, with substantial clinical provider and health insurance assets, and ultimately removes a neutral intermediary.”

If permitted to go through, Optum’s acquisition of Change would fundamentally alter both the health data landscape and the balance of power in American health care. UnitedHealth, the largest health care corporation in the U.S., would have access to all of its competitors’ business secrets. It would be able to self-preference its own doctors. It would be able to discriminate, racially and geographically, against different groups seeking insurance. None of this will improve public health; all of it will improve the profits of Optum and its corporate parent.

UnitedHealth is the largest health care entity in the U.S., using several metrics. United Healthcare (the insurance arm) is the largest health insurer in the United States, with over 70 million members, 6,500 hospitals, and 1.4 million physicians and other providers. Optum, a separate subsidiary, provides data analytics and infrastructure, a pharmacy benefit manager called OptumRx, a bank providing patient loans called Optum Bank, and more. Through Optum, UnitedHealth also controls more than 50,000 affiliated physicians, the largest collection of physicians in the country.

Acquisitions of entities as varied as DaVita’s dialysis physicians, MedExpress urgent care, and Advisory Board Company’s consultants have already changed the health care landscape. As Optum gobbles up competitors, customers, and suppliers, it has turned into UnitedHealth’s cash cow, bringing in more than 50 percent of the entity’s annual revenue.

On a recent podcast, Chas Roades and Dr. Lisa Bielamowicz of Gist Healthcare described Optum in a way that sounds eerily similar to a single-payer health care system. “If you think about what Optum is assembling, they are pulling together now the nation’s largest employers of docs, owners of one of the country’s largest ambulatory surgery center chains, the nation’s largest operator of urgent care clinics,” said Bielamowicz. With 98 million customers in 2020, OptumHealth, just one branch of Optum’s services, had eyes on roughly 30 percent of the U.S. population.

Change Healthcare has access to all of the data that flows between physicians and insurers and between pharmacies and insurers—both of which give insurers leverage when negotiating contracts. Insurers often send additional suggestions to Change as well; essentially their commercial secrets on how the insurer is uniquely saving money. Acquiring Change could allow Optum to see all of this.

If the acquisition proceeds and Change is owned by UnitedHealth, the largest health care corporation in the U.S. will own the ability to peek into the book of business for every insurer in the country.

The most obvious potential outcome of the merger is that the flow of data will allow Optum/UnitedHealth to preference their own entities and physicians above others. This means that doctors (and someday, perhaps, hospitals) owned by the corporation will get better rates, funded by increased premiums on patients. Optum drugs might seem cheaper, Optum care better covered. Meanwhile, health care costs will continue to rise as UnitedHealth fuels executive salaries and stock buybacks.

Optum’s acquisition of Change heralds the end of that status quo and the emergence of a new “Big Tech” of health care. With the Change data, Optum/UnitedHealth will own the data, providers, and the network through which people receive care.

There are signs that the DOJ knows that to approve this acquisition is to approve a new era of vertical integration. In a document filed on March 24, Change informed the SEC that the DOJ had requested more information and extended its initial 30-day review period. But the stakes are high. If the acquisition is approved, we face a future in which UnitedHealth/Optum is undoubtedly “the thing that ate American health care.”

https://prospect.org…

Comment:

By Don McCanne, M.D.

UnitedHealth/Optum is BIG – the largest health care entity in the U.S. – representing that medical-industrial complex that Arnold Relman warned us about so many years ago. Well, it’s here. And it is structured to make money – a lot of it – and patients just happen to be an essential element in their equation, but patient care is an expense. So much of what they do is to create administrative functions that are designed to reduce spending on patients, and, further, to increase revenues by selling those administrative services. By gaining control of much of the industry – hospitals, doctors, pharmacies, insurance functions – they are in a position to dictate the business terms for health care.

So what will happen should we ever be able to enact and implement a single payer Medicare for All program? The model calls for negotiating rates with physicians, global budgets for hospitals and bulk purchasing of pharmaceuticals. How do you do that with a mega-corporation like UnitedHealth/Optum? Do you really think that they will accept government negotiations for payment rates for health care entities such as doctors, hospitals and pharmacies while not being paid for their large infrastructure that has been designed to increase revenues? Change Healthcare is a data analytics firm that is used to leverage higher revenues (profits, executive salaries, stock dividends and buybacks); it is not for the purpose of providing quality and value in patient care. Again, the entire corporation is structured to make money with patient services being a necessary expense that is to be minimized as much as possible.

Will Medicare for All legislation be written in a way that we can remove passive corporate investors and excess executive salaries from the equation, thus essentially destroying the for-profit corporate structure? Would our conservative courts even uphold such limitations?

Health care should be guided by a patient service ethic rather than a business ethic. Can we rein in the medical-industrial complex, or is it too late? The transition to Medicare for all will certainly cross paths with this corporate monster, and something will have to give.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Dr. Adam Gaffney on “The Choice”

PNHP immediate past president Dr. Adam Gaffney appeared on “The Choice” on March 24, 2021. He was joined by Christine Eibner, senior economist at the RAND Corporation, to discuss the merits of a public option compared to single-payer Medicare for All.

Dr. Gaffney argued that, while a public option might help some people, “it would leave the core dysfunctions and injustices of the U.S. health care system intact.”

Charity care in government, nonprofit, and for-profit hospitals

By Ge Bai, Hossein Zare, Matthew D. Eisenberg, Daniel Polsky, and Gerard F. Anderson
Health Affairs, April 2021

Abstract

The different tax treatment of government, nonprofit, and for-profit hospitals implies different charity care obligations, with the greatest obligation for government hospitals and the least for for-profit hospitals. Prior research has not examined charity care provision among all three ownership types at the national level. Using 2018 Medicare Hospital Cost Reports, we compared charity care provision across 1,024 government, 2,709 nonprofit, and 930 for-profit hospitals. In aggregate, nonprofit hospitals spent $2.3 of every $100 in total expenses incurred on charity care, which was less than government ($4.1) or for-profit ($3.8) hospitals. No hospital ownership type outperformed the other two types with respect to charity care provision in a majority of hospital service areas containing all three types. Using different kinds of analyses, we also found wide variation in charity care provision within ownership types and a lack of a consistent pattern across ownership types. These results suggest that many government and nonprofit hospitals’ charity care provision was not aligned with their charity care obligations arising from their favorable tax treatment. Policy makers may consider initiatives to enhance hospitals’ charity care provision, particularly hospitals with government and nonprofit ownership.

https://www.healthaffairs.org…

Comment:

By Don McCanne, M.D.

There has long been a concern that nonprofit hospitals fail to provide charity care commensurate with the tax advantages afforded by the government. This study indicates that nonprofit hospitals provide even less charity care than for-profit hospitals (although others have questioned whether for-profit hospitals take liberties in adjusting off bad debt or contractual reductions in charges labeled as charity care).

Although under a single payer Medicare for All system issues would remain regarding the relative status of government, nonprofit, and for-profit hospitals, nevertheless a well designed single payer system should obviate the need for charity care since the system should be truly universal, comprehensive, and equitable.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.