Rep. Katie Porter unleashes whiteboard on big pharma executive over skyrocketing drug prices
by Marissa Higgins - The Daily Kos - May 19, 2021
On Tuesday, Democratic Rep. Katie Porter took out her famous whiteboard and gave the internet a breath of fresh air. Porter, as well as colleagues in the House Oversight Committee, grilled Richard Gonzalez, the CEO of AbbVie, a pharmaceutical company, over the increasing price of Humira—an anti-inflammatory drug used to treat conditions like Crohn’s—in the U.S. while apparently reducing the cost of the drug in other countries. While the company has argued the price increases came down to innovations in the drug, Porter and fellow Democrats on the committee were far from convinced.
"You lie to patients when you charge them twice as much for an unimproved drug,” Porter stated in the two-minute video that’s quickly going viral. “And then you lie to policymakers when you tell us that R&D justifies those price increases.” Zing! Let’s check out the full video, and Porter’s history of grilling executives with her whiteboard in hand, below.
During the hearing, Porter asked Gonzalez how much money AbbVie spent on dividends and stock buybacks. Gonzalez didn’t have a specific number available to offer, so Porter supplied her own, saying that the company spent $50 billion between 2013 and 2018 on stocks to help shareholders. In comparison, the company contributed a far smaller amount to research and development. Mind you, research and development is the part of the company that actually improves drugs.
Porter described "the Big Pharma fairy tale” as focused on innovative research and development that theoretically justifies the high prices of these medicines, but, as she put it, “the pharma reality is that you spend most of your company's money making money for yourself and your shareholders."
"You're not honest about that with patients and policymakers,” Porter continued. “You're feeding us lies that we must pay astronomical prices to get 'innovative' treatments. The American people, the patients, deserve so much better."
Porter also asked Gonzalez to share how much the company paid its
executives. Gonzalez said executives were compensated with about $60
million per year—a truly staggering number. The number Porter offered
was even more staggering, bordering on the surreal: a cool $334
million.
Editor's Note -
Big Pharma wins again!
Or - does Katie Porter win again? Click on the link, then you be the judge.
-SPC
https://www.dailykos.com/stories/2021/5/19/2031150/-Watch-Rep-Katie-Porter-grill-big-pharma-executive-for-two-minutes-straight-whiteboard-in-hand
Op-Ed: How doctor culture sinks U.S. healthcare
by Robert Pearl - Los Angeles Times - May 16, 2021
Over the last pandemic year, we’ve seen doctors work heroically to save lives. Their dedication, expertise and work ethic represent the best of medical culture. But as we return to normality, we need to acknowledge that the same culture that turns doctors into heroes is also contributing to a healthcare crisis of rising costs and decaying standards.
Physicians, policy experts and academics all insist that American healthcare suffers from systemic issues. By “systemic,” they mean bureaucratic. Clinicians, they say, are bogged down by administrative burdens, pesky prior-authorization requirements and cumbersome computers that (literally) sit between doctors and patients.
I agree. Correcting these deficiencies will be vital for reform. But if these administrative fixes are the only healthcare changes we accomplish, then everyone will be sorely disappointed with the results.
In addition to fixing the system, we must also look closely at the values and norms that doctors acquire in medical school and carry throughout their careers. This invisible force — medical culture — wields tremendous influence over patients and physicians, with physical, financial and psychological consequences that range from lifesaving to life-ending.
COVID-19 made the physical harm of medical culture clear. Consider that nearly two-thirds of patients hospitalized with COVID-19 had at least one chronic disease, such as obesity, diabetes, hypertension and heart failure, according to National Institutes of Health research.
In critical care units, doctors pulled many of these patients back from the brink of death. But if American physicians had dedicated more time and effort toward preventing and better managing these types of chronic diseases, tens of thousands wouldn’t have needed hospitalization in the first place. And many of them would still be alive.
One obstacle is that insurers reimburse physicians too little for the time it takes to prevent disease. However, an equally large part of the problem is rooted in the priorities of physicians themselves. Preventing disease isn’t as visibly “heroic” as a lifesaving intervention. It’s undervalued, even in terms of compensation, although multiple studies show that when healthcare providers place a high value on primary care, they reduce chronic disease by half compared with national averages.
That medical bills can lead to financial ruin is no secret. According to a Gallup poll, half of U.S. patients worry that one major illness could force them to declare bankruptcy. We tend to blame the insurance and pharmaceutical industries for the high price of medical care. But we fail to recognize the role doctors play.
A review of articles published in the New England Journal of Medicine determined that one-third of “established medical practices … are found to be no better than a less expensive, simpler, or easier therapy or approach.” Another study estimated that 25% of all healthcare spending from 2012 to 2019 was wasted.
Physicians insist they put the needs of patients first. And yet it’s doctors who order unnecessary tests, overprescribe medications and perform risky surgeries when less-expensive approaches would be just as valuable. And when doctors benefit economically at the expense of patients, medical culture shields them from the shame of hypocrisy, assuring them that doing more is never wrong.
Finally, medical culture does psychological harm. In early 2020, a friend was diagnosed with ovarian cancer that rapidly spread to her liver, lung and brain. While delivering the news, her doctor added, “It’s not a death sentence.”
I have no idea why he would have said that. If he was implying a cure was possible, then he was more sadistic than compassionate. My friend deserved the truth. She died three days later.
Physicians are trained to offer hope, even when hope disguises an ugly truth. In 2014, a study of 70 Food and Drug Administration-approved chemotherapy agents found the cancer treatments extended life by an average of only 2.1 months. That time was often spent in a hospital, rather than at home or in palliative care. Hiding uncomfortable truths remains a cultural norm in medicine, one that benefits providers far more than patients.
How do we cure a culture that’s invisible yet highly influential? Begin at the beginning, with those who are educating and training our next generation of physicians.
To reduce the physical harm medical culture inflicts on patients, medical school deans must elevate the esteem of primary care, make clear its crucial role. To start, more internal medicine physicians should take the places of specialists in lecture halls.
Inflicting less financial harm on patients will mean lowering overall healthcare expenditures. In general, communities with more specialists have a higher frequency of procedures performed, greater healthcare costs but no improvement in quality or life expectancy. Again, the balance of specialists and primary care doctors is key. Leaders in academic medical centers can help, by increasing the ratio of primary care residents admitted to their programs.
Finally, much psychological damage could be avoided if physicians were trained to treat every patient like a family member. We would produce more compassionate physicians if residents and interns were asked, ”Did you treat all of your patients today as you would want if they were your parent, sibling or child?”
Many factors contribute to our nation’s soaring medical costs, flagging clinical quality and the rising dissatisfaction of both doctors and patients. The one problem we continually overlook with tragic consequences is the flawed culture of medicine.
Dr. Robert Pearl is a plastic and reconstructive surgeon and former chief executive of the Permanente Medical Group (Kaiser Permanente). He teaches at Stanford. His latest book is “Uncaring: How the Culture of Medicine Kills Doctors and Patients,” scheduled for publication in mid-May.
Washington State: Single-Payer Health Care Here We Come
Washington State's history-making Single-Payer directive legislation, signed into law yesterday by Gov. Jay Inslee, establishes the Evergreen State as the leading force for universal healthcare justice in the United States.
The Evergreen State in the Great Northwest just took a formal leap where no U.S. state has gone before. When Gov. Jay Inslee affixed his signature to SB 5399, at 12 noon PT yesterday, May 13, he set in motion a process designed to create the first-in-the-nation Single-Payer / Medicare for all healthcare system. Olympia-based legislators are charged with implementing a comprehensive, guaranteed, universal health care funding and delivery system, in coordination with federal authorities, through the recommendations and work of the permanent universal healthcare commission. (This is the best healthcare news in this country since Congress passed Medicare and Medicaid legislation in 1965.) Therefore, what the province of Saskatchewan was for Canada in the mid-twentieth century - a demonstration model for the single-payer solution that paved the way for national Medicare for all - Washington State can be for the United States in the first quarter of the twenty-first century.
Here's what the rollout will look like. The newly-established universal healthcare commission begins its work within ninety days to transition Washington State to a "universally financed healthcare system" (aka, single-payer). The commission will implement the essential programs and design elements, including benefits packages, reimbursement rates, and federal-state financing mechanisms to establish a streamlined, one-payer financing system, in coordination with federal authorities. On a parallel track, the bill requires the WA State Health Care Authority to begin the application process for federal waivers - both legal and financial - within sixty days of their availability, while empowering state agencies to implement specific recommendations from any of the reports issued by the commission.
"We deserve access to the healthcare we need when we need it. And we deserve that healthcare at a cost we can afford," said Sen. Emily Randall (D-Bremerton), the author of SB 5399. "That's why I was proud to work with Alliance for a Healthy Washington to establish the Universal Healthcare Commission that will coordinate local and federal efforts to build a system that covers everyone. Together we're laying the groundwork for a healthier Washington, a healthier future for all of us."
"COVID-19 has been a stress test on all of our institutions and has shone a bright light on the inequities and unsustainability of our current fractured system. States have long been incubators for lasting systemic change in the U.S., and I truly believe that Washington State will lead the way in transitioning the nation to a truly universal healthcare system," said Alliance for a Healthy Washington's Board President Bevin McLeod.
As the nation's leading forum and advocacy organization for healthcare justice at all levels - local, state, regional, and national - the One Payer States (OPS) community is thrilled with the news out of Washington State. Our sister partner is heading to the finish line, carrying all of our hopes for a healthy and promising tomorrow, wind-aided by our collective support and energy.
More than that, however, yesterday's breakthrough in Olympia is not only a legislative victory - it represents the fruit of determined, focused, strategic action by policy, communications, and organizer super-volunteers - inspiring for and emblematic of movement politics that connects issues of health justice (e.g., housing, food, education) to healthcare justice. This is what democracy looks like. This is what transformative universal justice looks like. This is what health and healthcare justice looks like.
Chuck Pennacchio
President, One Payer States
Nearly one million people signed up for Obamacare coverage this spring.
Nearly one million Americans have signed up for Affordable Care Act coverage during the first 10 weeks of a special open enrollment period the Biden administration began in February.
A total of 940,000 people enrolled in Obamacare coverage between Feb. 15 and April 30, new data released Thursday by Health and Human Services shows. Of those new enrollees, nearly half bought coverage last month, after Congress added billions in subsidies included in the most recent stimulus package.
With that additional funding, the average monthly premium that Healthcare.gov consumers paid fell to $86 for those signing up in April, down from $117 in February and March (before the new subsidies).
The surge in sign-ups reflects a growing demand for health insurance. Many Americans have lost job-based coverage during the pandemic, and others who were uninsured before found themselves newly interested in coverage. The numbers undercount the overall new insurance sign-ups; they reflect enrollment only in the 36 states with marketplaces that the federal government manages.
The increase most likely reflects increased publicity about the opportunity, the availability of more financial help with premiums, and health fears related to the pandemic. The Trump administration made deep cuts in advertising and marketing for Healthcare.gov. The Biden administration reversed many of those changes, committing to spending $100 million to advertise this new enrollment period.
The new subsidies make a substantial difference in the affordability of insurance for many Americans. About four million who are currently uninsured can qualify for plans that will cost them no premium, according to an analysis by the Kaiser Family Foundation (the government subsidy would cover the entire monthly cost).
Another group, higher up the income scale, qualifies for financial assistance for the first time. Some families will be eligible for discounts of more than $10,000 a year. Under the stimulus bill, these new subsidies will last until the end of 2022. But the president has said he will seek to extend them as part of his American Families Plan legislation.
Around two million Americans who were already enrolled in Obamacare coverage have returned to the marketplace to take advantage of new subsidies, according to the department. That number represents a fraction of those eligible for new discounts. Biden administration officials opted against an automatic update of subsidies, and have instead been trying to encourage consumers to come back and request them individually.
Everyone eligible for a new discount will get it eventually, but those who sign up now will receive monthly discounts on their insurance, while those who do not will get the money as a refund when they file their taxes next year.
Sign-ups for health plans in most states will remain open until Aug. 15 this year.
https://www.nytimes.com/2021/05/06/upshot/obamacare-signups.html?referringSource=articleShare
First They Faced the Virus. Now Come the Medical Bills.
Insurers and Congress wrote rules to protect coronavirus patients, but the bills came anyway, leaving some mired in debt.
by Sarah Kliff - NYT - May 21, 2021
One coronavirus survivor manages her medical bills in color-coded folders: green, red and tan for different types of documents. A man whose father died of the virus last fall uses an Excel spreadsheet to organize the outstanding debts. It has 457 rows, one for each of his father’s bills, totaling over $1 million.
These are people who are facing the financial version of long-haul Covid: They’ve found their lives and finances upended by medical bills resulting from a bout with the virus.
Their desks and coffee tables have stacks of billing documents. They are fluent in the jargon of coronavirus medical coding, after hundreds of hours of phone calls discussing the charges with hospitals, doctors and insurers.
“People think there is some relief program for medical bills for coronavirus patients,” said Jennifer Miller, a psychologist near Milwaukee who is working with a lawyer to challenge thousands in outstanding debt from two emergency room visits last year. “It just doesn’t exist.”
Americans with other serious illnesses regularly face exorbitant and confusing bills after treatment, but things were supposed to be different for coronavirus patients. Many large health plans wrote special rules, waiving co-payments and deductibles for coronavirus hospitalizations. When doctors and hospitals accepted bailout funds, Congress barred them from “balance-billing” patients — the practice of seeking additional payment beyond what the insurer has paid.
Interviews with more than a dozen patients suggest those efforts have fallen short. Some with private insurance are bearing the costs of their coronavirus treatments, and the bills can stretch into the tens of thousands of dollars.
“There are things I’ve researched, and known I should do, but I have a fear of being blindsided by the bills,” said Lauren Lueder, a 33-year-old teacher who lives in Detroit. She has depleted $7,000 in savings to pay for treatment so far. “You end up with a battery of tests, and every single thing adds up. I don’t have the disposable income to constantly pay for that.”
For 10 months, The New York Times has tracked the high costs of coronavirus testing and treatment through a crowdsourced database that includes more than 800 medical bills submitted by readers. If you have a bill to submit, you can do so here.
Those bills show that some hospitals are not complying with the ban on balance billing. Some are incorrectly coding visits, meaning the special coronavirus protections that insurers put in place are not applied. Others are going after debts of patients who died from the virus, pursuing estates that would otherwise go to family members.
Hospitals and insurers say that they have tried to adapt to the different billing guidance for the pandemic, but that confusion can arise when new charge codes are created and new rules set up quickly.
Coronavirus patients face significant direct costs: the money pulled out of savings and retirement accounts to pay doctors and hospitals. Many are also struggling with indirect costs, like the hours spent calling providers and insurers to sort out what is actually owed, and the mental strain of worrying about how to pay.
Ms. Miller, like many other patients, described trying to sort out her complicated medical charges — in her case in color-coded folders — while also battling the mental “brain fog” that affects as many as half of coronavirus long-haul patients.
“I have a Ph.D., but this is beyond my abilities,” she said. “I haven’t even begun to look at my 2021 bills because we’re still dealing with 2020 bills. When the bills come nonstop, you can only deal with so much.”
The United States is estimated to have spent over $30 billion on coronavirus hospitalizations since the pandemic began, according to Chris Sloan, a principal at the health research firm Avalere. The average cost of each hospital stay is $23,489. Little research has been published on how much of that cost is billed to patients.
“The government is focused on getting the vaccine out, but it doesn’t look like there is anyone out there thinking more about the long-term impacts on the people experiencing unusually high costs from Covid,” said Nancy-Ann DeParle, a former Obama administration health policy adviser and co-chair of the Covid Patient Recovery Alliance, a new nonprofit that plans to study the issue.
Patients who have tried to take advantage of their insurers’ cost waivers are sometimes finding themselves thwarted by hospitals and providers that don’t code their bills as related to coronavirus. Without the right coding, the patients’ normal deductibles and co-payments apply.
One coronavirus patient in Chicago recounted spending 50 hours trying to get the coding for an M.R.I. scan changed, to show it was related to coronavirus. His insurer will pay the entire bill if that happens — but if not, he is responsible for $1,600. So far, the issue is still unresolved.
“I’ve heard so many stories of people being completely stymied filling out reimbursement forms and trying to get insurance to cover them,” said Senator Tina Smith, Democrat of Minnesota, the lead sponsor of a bill to make coronavirus care free. “It’s almost as if the system is designed to make it hard to get reimbursed.”
Congress mandated that insurers make coronavirus testing free last spring, but never wrote a similar requirement for treatment coverage — in part because insurers were volunteering to waive patient costs, she said.
Insurers are now starting to wind down those special protections: Aetna, Anthem and UnitedHealthcare — three of the country’s largest health plans — have ended some portion of their waivers this year. They have decided to treat the virus the same as the many other diseases that send patients to doctors’ offices and hospitals.
Some emphasized they are now focused on ensuring patients get Covid vaccines without facing any costs.
“There was a feeling that many private plans were initially covering treatment, but now that is petering out and leaving people on the hook,” Senator Smith said.
Some Covid financial long-haulers never became ill themselves, but are overwhelmed by the bills that deceased loved ones left behind.
Rebecca Gale, 64, lost her husband of 25 years, Michael, to coronavirus last summer. Their insurance fully covered most of the “big stack” of medical bills that Ms. Gale received after his death. But it paid only a small portion of the $50,009 air ambulance bill for Mr. Gale’s transport between hospitals when his condition was deteriorating.
“I cry every day; this is just another thing that breaks my heart, that on top of losing my husband I have to deal with this,” Ms. Gale said.
The family’s health insurance plan limits its coverage of air ambulances to $10,000, and the air ambulance company spent months pursuing an additional $40,009 from Mr. Gale’s estate. Ms. Gale retired last year, from a job at an Ohio automotive factory stamping car parts, anticipating she would get to spend more time with her husband. After he died and the bills started to show up, she considered looking for a part-time job to help pay the charges.
Health care companies have discretion over what to do about the debts of deceased patients, sometimes pursuing their estates for reimbursement.
The air ambulance company, PHI Medical, declined to comment on Mr. Gale’s bill but said in a statement that it “followed the regulatory requirements” for billing coronavirus patients. It did cancel the charges, however, after The Times inquired about the bill.
Shubham Chandra left a well-paying job at a New York City start-up partly to manage the hundreds of medical bills resulting from his father’s seven-month hospitalization. His father, a cardiologist, died from coronavirus last fall.
For months he has spent 10 to 20 hours a week working through the charges, using his mornings for reading through new bills, and his afternoons for calls to insurers and hospitals. His spreadsheet recently showed 97 bills rejected by insurance with a potential of over $400,000 the family could owe. Mr. Chandra tells providers that his father is no longer alive, but the bills continue to accumulate.
“A large part of my life is thinking about these bills,” he said. “It can become an impediment to my day-to-day. It’s hard to sleep when you have hundreds of thousands of dollars in outstanding debts.”
Some coronavirus patients are postponing additional medical care for long-term side effects until they can resolve their existing debts. They are finding that long-haul coronavirus often requires visits to multiple specialists and many scans to resolve lingering symptoms, but they worry about piling up more debt.
Irena Schulz, 61, a retired biologist who lives in South Carolina, became ill with coronavirus last summer. She has multiple lingering side effects, including problems with her hearing and her kidneys. She recently received a $5,400 bill for hearing aids (to help with coronavirus-related hearing loss) that she had expected her health insurance to cover.
She has eschewed trips to the emergency room when feeling ill because she worries about the costs. She’s managing her kidney-related pain by herself, at home, until she feels she can afford to see a specialist.
“I keep on with Tylenol and drinking a lot of water, and I’ve noticed it does help if I drink a lot of pineapple juice,” she said. “If the pain gets past a certain threshold, I’ll see a doctor. We’re retired, we’re on a fixed income, and there are only so many things you can accumulate on the credit card.”
