The Psychiatric Drug Crisis
Posted by Gary Greenberg
It’s been just over twenty-five years since Prozac came to market, and more than twenty per cent of Americans now regularly take mind-altering drugs prescribed by their doctors. Almost as familiar as brands like Zoloft and Lexapro is the worry about what it means that the daily routine in many households, for parents and children alike, includes a dose of medications that are poorly understood and whose long-term effects on the body are unknown. Despite our ambivalence, sales of psychiatric drugs amounted to more than seventy billion dollars in 2010. They have become yet another commodity that consumers have learned to live with or even enjoy, like S.U.V.s or Cheetos.
Yet the psychiatric-drug industry is in trouble. “We are facing a crisis,” the Cornell psychiatrist and New York Times contributor Richard Friedman warned last week. In the past few years, one pharmaceutical giant after another—GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Merck, Sanofi—has shrunk or shuttered its neuroscience research facilities. Clinical trials have been halted, lines of research abandoned, and the new drug pipeline has been allowed to run dry.
Why would an industry beat a hasty retreat from a market that continues to boom? (Recent surveys indicate that mental illness is the leading cause of impairment and disability worldwide.) The answer lies in the history of psychopharmacology, which is more deeply indebted to serendipity than most branches of medicine—in particular, to a remarkable series of accidental discoveries made in the fifteen or so years following the end of the Second World War.
In 1949, John Cade published an article in the Medical Journal of Australia describing his discovery that lithium sedated people who experienced mania. Cade had been testing his theory that manic people were suffering from an excess of uric acid by injecting patients’ urine into guinea pigs, who subsequently died. When Cade diluted the uric acid by adding lithium, the guinea pigs fared better; when he injected them with lithium alone, they became sedated. He noticed the same effect when he tested lithium on himself, and then on his patients. Nearly twenty years after he first recommended lithium to treat manic depression, it became the standard treatment for the disorder.
In the nineteen-forties and fifties, schizophrenic patients in some asylums were treated with cold-induced “hibernation”—a state from which they often emerged lucid and calm. In one French hospital, the protocol also called for chlorpromazine, a new drug thought to increase the hibernation effect. One day, some nurses ran out of ice and administered the drug on its own. When it calmed the patients, chlorpromazine, later named Thorazine, was recognized in 1952 as the first drug treatment for schizophrenia—a development that encouraged doctors to believe that they could use drugs to manage patients outside the asylum, and thus shutter their institutions.
In 1956, the Swiss firm Geigy wanted in on the antipsychotics market, and it asked a researcher and asylum doctor, Roland Kuhn, to test out a drug that, like Thorazine, was an antihistamine—and thus was expected to have a sedating effect. The results were not what Kuhn desired: when the schizophrenic patients took the drug, imipramine, they became more agitated, and one of them, according to a member of the research team, “rode, in his nightshirt, to a nearby village, singing lustily.” He added, “This was not really a very good PR exercise for the hospital.” But it was the inspiration for Kuhn and his team to reason that “if the flat mood of schizophrenia could be lifted by the drug, then could not a depressed mood be elevated also?” Under the brand name Tofranil, imipramine went on to become the first antidepressant—and one of the first blockbuster psychiatric drugs.
In 1949, John Cade published an article in the Medical Journal of Australia describing his discovery that lithium sedated people who experienced mania. Cade had been testing his theory that manic people were suffering from an excess of uric acid by injecting patients’ urine into guinea pigs, who subsequently died. When Cade diluted the uric acid by adding lithium, the guinea pigs fared better; when he injected them with lithium alone, they became sedated. He noticed the same effect when he tested lithium on himself, and then on his patients. Nearly twenty years after he first recommended lithium to treat manic depression, it became the standard treatment for the disorder.
In the nineteen-forties and fifties, schizophrenic patients in some asylums were treated with cold-induced “hibernation”—a state from which they often emerged lucid and calm. In one French hospital, the protocol also called for chlorpromazine, a new drug thought to increase the hibernation effect. One day, some nurses ran out of ice and administered the drug on its own. When it calmed the patients, chlorpromazine, later named Thorazine, was recognized in 1952 as the first drug treatment for schizophrenia—a development that encouraged doctors to believe that they could use drugs to manage patients outside the asylum, and thus shutter their institutions.
In 1956, the Swiss firm Geigy wanted in on the antipsychotics market, and it asked a researcher and asylum doctor, Roland Kuhn, to test out a drug that, like Thorazine, was an antihistamine—and thus was expected to have a sedating effect. The results were not what Kuhn desired: when the schizophrenic patients took the drug, imipramine, they became more agitated, and one of them, according to a member of the research team, “rode, in his nightshirt, to a nearby village, singing lustily.” He added, “This was not really a very good PR exercise for the hospital.” But it was the inspiration for Kuhn and his team to reason that “if the flat mood of schizophrenia could be lifted by the drug, then could not a depressed mood be elevated also?” Under the brand name Tofranil, imipramine went on to become the first antidepressant—and one of the first blockbuster psychiatric drugs.
http://www.newyorker.com/online/blogs/elements/2013/09/psychiatry-prozac-ssri-mental-health-theory-discredited.html?printable=true¤tPage=all
Maine Voices: Affordable Care Act will usher in burdensome health insurance tax
The levy may force small businesses to scrap health care plans, lay off workers or even close their doors.
By Rick Snow
SCARBOROUGH - As a small-business owner, I have seen a great deal of change over the past decade. both here in Maine and nationally. We have experienced prosperous years and years of recession, as well as changes in the governor's office and in the White House.
Unfortunately, one change that has become increasingly challenging for our family-owned and -operated company -- Maine Indoor Karting -- is the rising cost of doing business.
The spiraling cost of health care not only depresses overall disposable income, resulting in fewer customers visiting our company, but also directly affects how we run our business. With the Affordable Care Act a mere months from implementation in January, I am concerned for the future.
I am especially troubled by the health insurance tax. The health insurance tax was included in the Affordable Care Act to raise revenue to pay for these reforms by taxing health insurance plans bought on the fully insured marketplace.
But nearly 88 percent of American small businesses purchase coverage through this marketplace -- meaning that this new tax will be passed directly on to small-business owners and their employees. In Maine, this will affect our nearly 150,000 small businesses and the nearly 500,000 workers we employ.
Single Payer Health Care
Even Sue Saltmarsh, the founder of the Drive for Universal Healthcare organization, admits that promoting a group with the acronym of D-U-H 'spell out the letters' may not evoke admiration and respect 'does raise some eyebrows and cause a few snickers?'. But then again, the Chicago resident also sees its value."It's sort of a universal word that people understand for universal healthcare," Saltmarsh said. Does America need a new healthcare system? Duuh-uhh."
During a State House press conference, Saltmarsh recounted her own personal healthcare crisis that left her $30,000 dollars in debt. Realizing that a national health care plan similar to the government sponsored program in Canada is a difficult sell in Washington, Saltmarsh says she now wants to build new support at the local level.
"I can't change the world, but I'm determined to change all the towns I'm going to and I'm hoping that along the way, people will get in their cars and drive for an hour or two, go home and talk about it to their neighbors and get encouraged and energized to be a part of the movement actively," Saltmarsh said.
How a Cabal Keeps Generics Scarce
By MARGARET CLAPP, MICHAEL A. RIE and PHILLIP L. ZWEIG
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.
Exploring the New Food Focus at Scientific American
By ANDREW C. REVKIN
Scientific American is obsessed with food at the moment, running Food Week on its blogs and devoting its September print issue to all aspects of the substances we consume. You can follow the discussion on Twitter using #SciAmFood.
But, demonstrating that this is not some passing craving, the magazine today has also launched Food Matters, a group blog taking a multi-dimensional look at the science of food — from the fields where it is grown to the dark recesses of the gut where it is digested and beyond.
The bloggers are a talented bunch, and I got to hang out with most of them a few days ago (virtually) thanks to their editor, Bora Zivkovic.
Here’s our Google+ video chat:
Zivkovic introduces the team in a Scientific American post. Here are excerpts describing two contributors who couldn’t make our Hangout:
Pamela Ronald (homepage, old blog, Twitter) received her Ph.D. from UC Berkeley. She is a professor in the Department of Plant Pathology and the Genome Center at the University of California, Davis. She is one of the world’s leading experts on GMO crops and, together with her husband who is an organic farmer, has written a wonderful book “Tomorrow’s Table: Organic Farming, Genetics and the Future of Food.”Apart from various aspects of GMOs, she will probably write about botany, evolution, domestication, molecular biology, biotechnology, modern agricultural practices and more, all as related to food. You have seen Dr. Ronald on our pages before, including on the Guest Blog with these two posts: Genetically Engineered Crops—What, How and Why and Lets Talk: A Story of Interspecies Communication.Layla Eplett (old blog, Twitter) has an M.S. in Social Anthropology of Development from The University of London’s School of Oriental and African Studies, and her interests lie in global development issues revolving around food. She spends much of her time in developing countries, especially Egypt, where she can study it first-hand. Oh, and she ends each post with a recipe! You have seen her work numerous times on the Guest Blog over the past couple of years, e.g, Food Fights: Reconsidering Famine and War in the Horn of Africa, Talk “Dirty” to Me: Blood, Purity and Cuisine, When Sparks Fly: Aphrodisiacs and the Fruit Fly, Viral Videos and Infectious Disease–Healing in Northern Uganda, Fava–the Magic Bean, Exploring the DromeDairy: Camels and Their Milk, Second Helpings: Recycling Cairo’s Food Waste, and Rub a Dub Dub, Is It Time to Eat Grubs?.
It’s great to see science blogging thriving. I’ll keep close track of the team’s posts and hope you will, too.
The Central Challenge in U.S. Health Policy
By UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
“Health Care Costs Climb Moderately, Survey Says” read the headline in The New York Times last week. It appears that health insurance premiums for job-based family coverage rose “only” 4 percent between 2012 and 2013, although still twice as fast as did wages.
The survey in question is the Kaiser Family Foundation’s annual survey of employment-based health insurance, widely viewed as a gold mine for anyone seeking information on that part of the American health system. The full report is easily accessible, or readers may prefer to read just the summary or browse through the fine group of charts the foundation provides. Here is a telling chart from that pack.
The premiums shown in this chart are in current dollars, meaning they are not adjusted for inflation. They do not reflect a common benefit package. Furthermore, they are only averages that differ substantially from the experiences of individual companies.
For example, as is shown in Figure 2 (which is a slightly different format of Exhibit 1.7 in Kaiser’s full report), 21 percent of the companies in the Kaiser survey paid premiums in excess of $19,387 for families and in excess of $7,062 for singles in 2013 — a hefty amount. At the other end, about a fifth of the companies in the sample paid less than $13,225 for family coverage and less than $4,708 for single coverage. The other bars in the chart can be similarly interpreted.
For example, as is shown in Figure 2 (which is a slightly different format of Exhibit 1.7 in Kaiser’s full report), 21 percent of the companies in the Kaiser survey paid premiums in excess of $19,387 for families and in excess of $7,062 for singles in 2013 — a hefty amount. At the other end, about a fifth of the companies in the sample paid less than $13,225 for family coverage and less than $4,708 for single coverage. The other bars in the chart can be similarly interpreted.
There is also apt to be considerable intercompany variance not only in the level of premiums but also in the year-to-year growth of premiums. That will be especially so among small companies that are experience-rated – which means their premiums are based on the average health status of only their few employees. Many of these companies experienced premium growth in the double digits last year, as has happened every year in the past.
At the moment, there is great uncertainty about the premium increase between 2013 and 2014 that these small companies may experience as a result of the onset ofcommunity rating, beginning in 2014.
The Kaiser surveys include detailed data on the contributions that employees make out of their paychecks toward the premiums for their coverage, but they do not include data on the out-of-pocket spending for health care by employees and their families through deductibles, co-insurance and exclusions of health care services from coverage.
State bill to boost use of nurse practitioners goes nowhere
The effort to ease shortage of primary-care doctors would have let nurse practitioners work without direct MD supervision. Powerful doctors group had opposed it.
By Melanie Mason
7:48 PM PDT, September 1, 2013
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SACRAMENTO — An effort to ease a shortage of primary-care doctors in some California communities by letting nurse practitioners operate more independently has flat-lined in the Legislature after a fierce lobbying battle.
A bill by Sen. Ed Hernandez (D-West Covina) would have allowed nurse practitioners, who have more training than registered nurses, to practice without the direct supervision of a physician.
The proposal failed in a committee Friday, under fire from the California Medical Assn., the powerful lobbying arm for the state's physicians. The organization teamed with some specialists and labor unions to mobilize lobbyists, engage doctors across the state and even dedicate Twitter accounts as it waged its campaign against the bill.
The group supported a separate measure to permit nurse practitioners and some other non-physicians to perform first-trimester abortions, which lawmakers passed and sent to Gov. Jerry Brown last week.
Jockeying over the scope of medical professionals' practice has intensified this year as California prepares for full implementation of the new national healthcare law, which will bring an influx of newly insured patients.
Still in play, for example, is a Hernandez bill that would authorize pharmacists to do more. It would permit them to administer some vaccines and provide certain types of smoking-cessation medicine and hormonal birth control without a doctor's oversight. The physicians group is neutral on the measure.
But "the sticking point for the nurse practitioner bill [was] the word 'independent,'" said Hernandez, who chairs the Senate health committee. "For organized medicine, that's the … line in the sand."
The bill's supporters pointed to a shortage of primary care providers in rural and inner-city areas. A 2009 study by the California HealthCare Foundation, an Oakland-based grant-making and research group, found that only 16 of the state's 58 counties had enough primary-care doctors. Allowing nurse practitioners to set up their own practices could alleviate those gaps in care, proponents say.
Physicians said the bill made no assurances that independent nurse practitioners would work in underserved areas. And they argued that letting the practitioners, who have fewer years of education and clinical training than doctors, work without oversight would put patients at risk.
"California's nurse practitioners should be working more closely with physicians, not independently," said Dr. Paul Phinney, president of the medical association.
Hernandez changed the proposal to authorize nurse practitioners to work autonomously only in certain group settings, such as hospitals or clinics.
Some national groups, such as AARP and the American Assn. of Nurse Practitioners, pulled their support in response, not wanting the revised proposal to become a model for other states. But the California Medical Assn. remained the bill's biggest obstacle.
Going up against the doctors group "is like taking on labor or the NRA," Hernandez said.
http://www.latimes.com/local/la-me-healthcare-20130902,0,5340623,print.story
Officials break ground on 7-story, $287 million EMMC expansion, upgrades
BANGOR, Maine — Maine’s second-largest hospital broke ground Tuesday on what one official called “the most important project in its history.”
Eastern Maine Healthcare Systems President and CEO Michelle Hood said during a ceremony held on the footprint of the future 7-story, $247 million facility at Eastern Maine Medical Center that “there will always be need for a strong, modern, efficient center,” the linchpin of a growing health care system.
More than a dozen EMHS, hospital, city and Cianbro Corp. officials broke ground on the site of the construction Tuesday morning.
The expansion effort is being funded through a combination of $155 million in bonds, $11 million from a MaineCare settlement with the state, more than $100 million in operations cash and equity and about $20 million in private fundraising, according to Brad Coffey, vice president of philanthropy.
In addition to the $247 million expansion, the hospital expects to spend about $40 million on replacement equipment during the course of the upgrades, Coffey said. The hospital currently has about 350 beds, but will be able to fully operate up to its license of 411 after the expansion, which will decrease patient wait times, officials say.
The new building will house modern surgical spaces, cardiac services, obstetrics, nurseries and neonatal services, as well as more private, single-patient rooms, and give the hospital more room to grow, according to hospital officials.
“The new building will allow us to provide much better space for [specific] services that we provide so that we can better care for patients with very serious illnesses and injuries,” hospital president and CEO Deborah Johnson said during the event. “It will provide new operating rooms, new neonatal intensive care units, new labor and delivery suites and cardiac services.”
Officials hope to have a ribbon-cutting ceremony to celebrate the opening of the new building in about 2½ years.
Liane Judd, chairwoman of the hospital’s board of trustees, likened this expansion decision to the one hospital officials made in the early 1970s to build “what seemed to be then an outrageously large inpatient tower,” the Grant building.
“Looking back, was it the right decision? Of course it was,” Judd said.
Is sugar a toxin? Experts debate the role of fructose in our obesity epidemic
Posted Sept. 04, 2013, at 8:25 a.m.
American eaters love a good villain. Diets that focus on one clear bad guy have gotten traction even as the bad guy has changed: fat, carbohydrates, animal products, cooked food, gluten. And now Robert Lustig, a pediatric endocrinologist at the University of California at San Francisco, is adding sugar to the list. His book “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease” makes the case that sugar is almost single-handedly responsible for Americans’ excess weight and the illnesses that go with it. “Sugar is the biggest perpetrator of our current health crisis,” says Lustig, blaming it for not just obesity and diabetes but also for insulin resistance, cardiovascular disease, stroke, even cancer. “Sugar is a toxin,” he says. “Pure and simple.”
His target is one particular sugar: fructose, familiar for its role in making fruit sweet. Fruit, though, is not the problem; the natural sugar in whole foods, which generally comes in small quantities, is blameless. The fructose in question is in sweeteners — table sugar, high-fructose corn syrup, maple syrup, honey and others — which are all composed of the simple sugars fructose and glucose, in about equal proportions.
Although glucose can be metabolized by every cell in the body, fructose is metabolized almost entirely by the liver. There it can result in the generation of free radicals (damaged cells that can damage other cells) and uric acid (which can lead to kidney disease or gout), and it can kick off a process called de novo lipogenesis, which generates fats that can find their way into the bloodstream or be deposited on the liver itself. These byproducts are linked to obesity, insulin resistance and the group of risk factors linked to diabetes, heart disease and stroke. (Lustig gives a detailed explanation of fructose metabolism in a well-viewed YouTube video called “Sugar: The Bitter Truth.”)
Everyone agrees that fructose can be metabolized that way, but not that it always is metabolized that way when people consume it in moderate amounts. In rats, the link between fructose and metabolic diseases is so well established that researchers who want to study insulin-resistant rats feed them fructose to get them to that state. Fructose metabolism research in people, though, is limited by scientists’ inability to kill their human subjects in order to dissect their livers and is further complicated by variation from human to human: Race, sex, exercise, melatonin, probiotics and antioxidants, among other things, affect how our bodies deal with fructose.
In some human studies, large doses of fructose have certainly been shown to do harm, and alarmingly quickly. One 2009 study fed 16 men a controlled diet, then that same diet plus a fructose supplement that added 35 percent to their calorie consumption, and found fat deposits on their livers, increased triglycerides and insulin sensitivity after just one week. But as the fructose dose decreases, so does the strength of the link to disease. Luc Tappy of the University of Lausanne in Switzerland concluded in a recent paper that, although large doses of fructose undoubtedly cause problems, “there is no solid evidence that fructose, when consumed in moderate amounts, has deleterious effects.”
Tappy, one of the prominent participants in the fructose debate that Lustig ignited, gives voice to the position that many doctors and scientists share: Sugar is a bad guy, but not the one, overarching bad guy. “Telling people the problem is all fructose is completely wrong,” says Walter Willett, chair of the nutrition department at the Harvard School of Public Health. “In the amounts being consumed, sugar can lead to serious damage and premature death. I think it’s fair to say that’s toxic,” he says. “But it doesn’t mean everything else is good.”
One in four U.S. heart disease deaths could be prevented, CDC says
Posted Sept. 04, 2013, at 8:06 a.m.
CHICAGO — About one in four U.S. deaths from heart disease could be avoided with better prevention efforts and treatment, according to a first-of-its-kind report from the U.S. Centers for Disease Control and Prevention released on Tuesday.
As many as 200,000 Americans might have been spared an early death in 2010 from a heart attack or stroke if they had received screening and treatment for preventable causes of heart disease such as high blood pressure, high cholesterol, obesity and smoking, the report found.
Heart disease is the leading killer in the United States, accounting for nearly 800,000 deaths a year — about 30 percent of all U.S. deaths.
The report looked at preventable deaths from heart disease and stroke defined as those that occurred in people under age 75 that could have been prevented by more effective public health measures, lifestyle changes or medical care.
While the CDC has long tracked deaths from heart disease, it never previously issued a report estimating how many such deaths could be prevented.
In 2010, the states with the highest avoidable death rates were located primarily in the South, including Mississippi, Oklahoma, Tennessee and Louisiana, the report stated. The states with the lowest rates were Minnesota, Utah, Colorado, Connecticut and New Hampshire, according to the report.
‘A new way’
CDC officials said that the 2014 launch of key elements of the U.S. healthcare law signed by President Barack Obama in 2010 could help reduce avoidable deaths. The law is intended to provide better access to treatment for millions of uninsured Americans and routine coverage for preventive screenings.
“Beginning in October, the health insurance marketplaces will provide a new way for people to get health insurance so more patients have access to quality health insurance and coverage beginning as early as January 2014,” CDC Director Dr. Tom Frieden told a conference call with reporters.
The new health insurance exchanges are expected to provide coverage for up to 7 million uninsured Americans next year, according to government estimates. The law faces ongoing opposition among Republicans in Congress who say it imposes a financial burden on consumers and state governments.
The rate of preventable deaths from heart disease and stroke — those that could have been avoided by treating high blood pressure and cholesterol and by discouraging smoking — fell nearly 30 percent between 2001 and 2010, the report said.
Labor's Love Lost Over Obamacare?
By Steve Early
The Huffington Post, Aug. 30, 2013
The Huffington Post, Aug. 30, 2013
Like many labor negotiators, I looked to health care reform for legislative relief from endless haggling with management over employee benefit costs. My own union and others worked hard for passage of President Obama's Affordable Care Act (ACA) three years ago. Despite its failure to take health insurance issues off the bargaining table, as a more preferable Medicare-for-All system would do, Obamacare was widely cheered by labor.
Union members were told, correctly, that the ACA would expand Medicaid access for millions of lower-income Americans and make private insurance coverage more consumer-friendly for everyone else. Organized labor also expected the new law to aid union bargaining by leveling the playing field among all employers, much like the minimum wage and other protective labor legislation does.
Unions hoped that the ACA would restrain medical cost inflation and corporate pressure for health care cost shifting. Both trends have been a major cause of recent strikes or contract rejections at AT&T, Verizon, and United Parcel Service.
Instead, just months before key ACA provisions go into effect, Obamacare is backfiring in multiple ways on a labor movement already battered and bruised. Contrary to repeated White House assurances, many unionized workers now face more, rather than fewer, health plan problems and costs. Alarmed by Obama administration decisions and ACA provisions unfriendly to labor, top union leaders now fear that Obamacare will create "nightmare scenarios" for millions of workers, retirees, and their families.
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