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*From Capitol Hill*
*Wednesday 27 May 2024, 11:35 am ET*
*202-224-3121 Switchboard # for all Members of Congress*
*Big news in the fight for Single-Payer / Expanded and Improved Medicare
for All!*
Sen. Ed Markey (D, MA) has agreed to introduce the Senate companion bill to
Rep. Khanna's (D, CA) H.R. 6270 "State-Based Universal Health Care Act"
(SBUHCA) as soon as next week. We need to recruit our Senators *this week*,
with a cutoff *deadline of Friday 29 March, 5pm ET*, for original
(pre-publication) co-sponsoring Senators to sign on.
*Please call the Capitol Hill switchboard at 202-224-3121 now and urge both
of your Senators to co-sponsor SBUHCA. Emails, portal messages, and social
media posts are also powerful. And keep an eye out for our national
petition that is circulating with 82 state and national partners on the
Action Network platform (more to come on that front over the coming weeks).*
If this SBUHCA breakthrough was not enough, Senator Markey will be hosting
the *first-ever hearing on the SBUHCA bill* (and refresh discussion on the
Green New Deal Health Act [GNDHA]) in *Boston, April 3rd, 11am-2pm ET*.
Sen. Markey will be leveraging his chair position on Primary Health and
Retirement Security Subcommittee (part of Sen Sanders' HELP -- Health,
Education, Labor, Pensions -- Committee) to highlight the deepening
financial crisis of the private equity firm Steward Health Care System, and
the existential threat it poses to several Boston-area hospitals.*
We all know that the Solution to this Crisis -- and a fundamental linchpin
for addressing so many more crises -- is restored, enhanced and expanded
Medicare for All. In this case, '*Medicare for All through state and
regional plans*' is not only the most politically viable path forward,
given the array of medical-industry power assembled here in Washington,
D.C. (where I live, learn and lobby), but it will provide the best model
for the national Single-Payer system that constitutes the gold standard for
healthcare justice in the United States.
Thanks for doing everything you do, and more. We. Are. Winning.
Yours in radical hope and strategic action,
*Chuck*
Chuck Pennacchio, Ph.D.
President, One Payer States
*From Capitol Hill* *Wednesday 27 May 2024, 11:35 am ET* *202-224-3121 Switchboard # for all Members of Congress* *Big news in the fight for Single-Payer / Expanded and Improved Medicare for All!* Sen. Ed Markey (D, MA) has agreed to introduce the Senate companion bill to Rep. Khanna's (D, CA) H.R. 6270 "State-Based Universal Health Care Act" (SBUHCA) as soon as next week. We need to recruit our Senators *this week*, with a cutoff *deadline of Friday 29 March, 5pm ET*, for original (pre-publication) co-sponsoring Senators to sign on. *Please call the Capitol Hill switchboard at 202-224-3121 now and urge both of your Senators to co-sponsor SBUHCA. Emails, portal messages, and social media posts are also powerful. And keep an eye out for our national petition that is circulating with 82 state and national partners on the Action Network platform (more to come on that front over the coming weeks).* If this SBUHCA breakthrough was not enough, Senator Markey will be hosting the *first-ever hearing on the SBUHCA bill* (and refresh discussion on the Green New Deal Health Act [GNDHA]) in *Boston, April 3rd, 11am-2pm ET*. Sen. Markey will be leveraging his chair position on Primary Health and Retirement Security Subcommittee (part of Sen Sanders' HELP -- Health, Education, Labor, Pensions -- Committee) to highlight the deepening financial crisis of the private equity firm Steward Health Care System, and the existential threat it poses to several Boston-area hospitals.* We all know that the Solution to this Crisis -- and a fundamental linchpin for addressing so many more crises -- is restored, enhanced and expanded Medicare for All. In this case, '*Medicare for All through state and regional plans*' is not only the most politically viable path forward, given the array of medical-industry power assembled here in Washington, D.C. (where I live, learn and lobby), but it will provide the best model for the national Single-Payer system that constitutes the gold standard for healthcare justice in the United States. Thanks for doing everything you do, and more. We. Are. Winning. Yours in radical hope and strategic action, *Chuck* Chuck Pennacchio, Ph.D. President, One Payer States See: https://onepayerstates.org (to get more involved and donate) 215 828 5055 (cell/text)
See: https://onepayerstates.org (to get more involved and donate)
215 828 5055 (cell/text)
Obamacare Is in Grave Danger, Again
by Paul Krugman - NYT - March 25, 2024
Are you better off than you would have been 14 years ago? If you’re one of the millions of Americans who have a preexisting medical condition and don’t have a job that comes with health benefits, the answer is, overwhelmingly, yes.
Why? Because before the Affordable Care Act, a.k.a. Obamacare — signed into law on March 23, 2010, although many of its provisions didn’t kick in until 2014 — you probably wouldn’t have been able to get health insurance. Today you can, thanks to provisions in the law that prevent insurers from discriminating based on medical history and that subsidize insurance premiums for many Americans. (These subsidies also provide healthy people with an incentive to purchase insurance, improving the risk pool.)
And President Biden strengthened the program, notably by extending provisions eliminating the “cliff” that cut off subsides for many middle-class Americans.
But in the near future, you may well lose that hard-won access. In 2017, Donald Trump and Republicans in Congress tried to eviscerate the A.C.A. and almost succeeded in passing a bill that the Congressional Budget Office estimated would have left 22 million more Americans uninsured by 2026. There’s every reason to believe that if the G.O.P. wins control of Congress and the White House in November, it will once again try to bring back the bad old days of health coverage. And it will probably succeed, since it failed in 2017 only thanks to a principled stand by John McCain — something unlikely to happen in today’s Republican Party, where slavish obedience to Trump has become almost universal.
Before I get to the politics, let’s talk about what Obamacare has achieved.
During the Obama era, voices on the right made many dire predictions about its effects. They claimed that the law wouldn’t really expand coverage, that it would be a fiscal disaster and a job killer.
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None of these predictions came true. The percentage of Americans without health insurance has fallen by almost half since 2010. Federal spending on health programs, far from exploding, has grown much more slowly than forecast. Back in 2010, the budget office expected outlays on major mandatory health programs to reach 10 percent of G.D.P. by the mid 2030s and “continue to increase thereafter”; it now expects that number to be less than 7 percent. As for jobs, the employment rate among Americans in their prime working years is at its highest level in more than two decades.
And Obamacare, initially a political liability for Democrats, is now quite popular. Indeed, the narrowly failed Republican attempt to gut the law probably played a large role in Democratic success in the 2018 midterm elections.
So why is this success story in grave danger?
First, it’s important to remember that Trump, aside from his venomous attitude toward immigrants and his protectionist instincts, has shown that he neither knows nor cares much about the details of policy. Last week, he posted a screed about how an “INVASION” of migrants is “KILLING SOCIAL SECURITY AND MEDICARE,” which is both the opposite of the truth and a demonstration that he has little idea how even the biggest, most important government programs work.
When he was in office, Trump was putty in the hands of right-wing economic ideologues, who actually know how to write legislation that serves their objectives; practically his only major budgetary initiatives were a tax cut for the wealthy and corporations, which passed, and the attempted gutting of Obamacare, which fell just short.
And what we know is that even though Trump likes to portray himself as a populist, right-wing economic ideology still rules among congressional Republicans, who are as eager as ever to effectively destroy Obamacare. Last week, the Republican Study Committee, which includes a majority of G.O.P. members of the House of Representatives, released a budget proposal that teed up many of the 2017 “reforms” that would have caused millions of Americans to lose health coverage. (It also called for down-the-road cuts in Social Security and Medicare.)
What I found striking about the budget proposal was how its authors deal with the fact that none of the dire predictions right-wingers made about Obamacare have come true. The answer is that they simply pretend that the bad things they predicted, which didn’t happen, did. I was struck, for example, by the assertion that Obamacare “dramatically escalated the unsustainable rise in American health care spending.” Indeed, in 2010, total U.S. health care spending was 17.2 percent of G.D.P. By 2022 that number had risen to … 17.3 percent of G.D.P.
So the reality of Obamacare’s success won’t deter Republicans who want to destroy it. If anything, the law’s success only increases their determination to kill it, because it shows that, contrary to their ideology, government actually can make Americans’ lives better.
And Trump will go along — he’ll egg them on — because making Americans’ lives better isn’t his primary objective.
Ultimately, right-wingers would like to rip up America’s whole safety net. But they’ll probably start with Obamacare; if they sweep this year, I won’t be surprised if the program is effectively gone by 2026.
Biden is Breaking Campaign Rule No. 1. And It Just Might Work.
by Felicia Wong - NYT - March 27, 2024
Ms. Wong is president and chief executive of Roosevelt Forward, a progressive advocacy organization.
Should we have trillionaires? Should we even have billionaires? According to at least one recent analysis, the economy is on track to mint its first trillionaire — that is one thousand billion — within a decade. Such staggering accumulations of wealth are made possible in large part by the fact that America’s federal tax burden is so comparatively light. After a long period of seeming to venerate the 1 percent, or the 1 percent of 1 percent of 1 percent, American sentiment is swinging hard against this imbalance.
Now Joe Biden, behind in many polls and presiding over an economy that is objectively strong but politically unpopular, is hoping to boost his re-election bid with a policy idea that would once have been almost unthinkable: For this portion of the population, at least, he is vowing — almost gleefully — to raise taxes.
Even for a popular president, this would seem like a huge risk. For a Democrat with low job approval ratings and precarious poll numbers on his handling of the economy, it’s a shocking rebuke to conventional wisdom — and practically an invitation to critics to call him a tax-and-spend liberal. But on the politics as well as the policy, Mr. Biden is making the right call. Economic ideas that were once dead on arrival are now gaining traction on both the left and the right. The moment has arrived for changes in the tax code — and maybe beyond.
For at least the last half-century, raising taxes has been the third rail of American politics. Ronald Reagan rode the wave of the late-1970s “tax revolt” into the Oval Office. I was a kid in California then, and I remember how fierce the anti-tax sentiment was. Howard Jarvis and his followers, mostly older white property owners, pushed for the ballot initiative known as Proposition 13 because they were, in their own words, “mad as hell” that their rising taxes would help educate immigrant families. The anti-taxers won by a nearly two-to-one ratio.
Time magazine put Mr. Jarvis on its cover and called Prop. 13 the “most radical slash in property taxes since Depression days.” The movement devastated schools and social services. But it was political gold and spread nationwide.
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During his first year as president, Mr. Reagan cut the highest personal income tax rate from 70 percent to 50 percent. He cut taxes for low-income Americans, too, decreased the maximum capital gains rate from 28 percent to 20 percent and cut corporate taxes. These tax cuts caused such deficits that Mr. Reagan had to reverse some of them throughout the rest of his time in office, but that is not how history remembers his presidency. By the end of his second term, the top individual rate was only 33 percent.
Anti-tax activists made cutting taxes an explicit political litmus test. In 1988, George H.W. Bush famously pledged “read my lips, no new taxes.” Twenty-five years later, Barack Obama did modestly raise taxes on the highest-earning Americans, but he kept quiet about it, instead touting middle-class tax cuts that, he said, left middle-income families with a lower tax rate than at “almost any other period in the last 60 years.”
Fast forward to Joe Biden, who is making $5 trillion in tax increases central to his re-election campaign. During his State of the Union speech this month, he even made fun of Republicans for favoring cuts. Getting the rich to pay their share is right up there with getting greedy companies to stop charging you junk fees and, he says, shrinking your Snickers bars.
What explains the pivot? The president is following the money. Over the last decade, and even more since the pandemic, wealth concentration has shot up astonishingly. Elon Musk was worth about $25 billion in 2020 and at the end of 2023 was worth almost 10 times that. In 1990, there were nearly 70 American billionaires. Today, there are nearly 700. To what earthly end are we encouraging trillionaires?
The trend toward extreme inequality has fueled tremendous populist outrage, like the tax revolt in reverse. It may have been the Bernie Sanders left that started the “billionaires are a policy failure” meme, but poll after poll shows that between two-thirds and three-quarters of Americans want higher taxes on the wealthy and corporations.
It isn’t all outrage, though. A lot of it is common sense. As one of the wealthy nations with the lowest tax rate, the United States has put off investing in our families and children. This deferred maintenance is costly: Our child care, health care, family leave and higher education systems are, as a result, among the most expensive and least accessible in the world. Making these arenas a priority is affordable and effective, and they have waited far too long.
Raising high-end taxes can be good for business, too. In the 1960s, George Romney, Mitt’s father, regularly turned down his bonuses from his auto executive job, perhaps in part because his marginal tax rate would have been about 90 percent. It made more sense for companies then to invest excess profits back into their businesses rather than in C.E.O. pay packages. Today, C.E.O. pay at the largest companies has skyrocketed while businesses have invested less in research, physical plant and other capital assets.
“Tax and spend” wasn’t always an epithet. Reagan Republicans and 1970s-era right-wing populists weaponized the label every chance they got. “You could be talking about the Mets versus the Dodgers,” the former U.S. Representative Steve Israel of New York recalled, “and good Republican operatives would be able to weave in tax-and-spend.”
But the term, as Mr. Biden and his team clearly know, no longer stings in quite the same way, especially not if taxes are linked to a vision that would make Americans’ lives less anxiety-ridden and more stable. Donald Trump’s hallmark legislative achievement, the 2017 “Tax Cuts and Jobs Act,” which cut more than $1 trillion in taxes — mostly for the wealthy and corporations — has major provisions that are set to expire next year. A partisan battle will ensue. Mr. Biden’s 2024 push on taxes is a shot across that bow. Can we imagine an even bigger shift on taxation than the one Mr. Biden is making?
Could we get past the sense that taxes are what the government takes, and toward an idea of taxes as a means of patriotism, a kitty we all pay into to build something for community use: a school, a library, a road, a college, a hospital? What if taxation could bring us all together? It’s not that wild an idea. As the political scientist Vanessa Williamson notes, both liberal and conservative Americans view paying taxes as a moral duty. Just think of the pride with which people refer to themselves as taxpayers.
Of course, taxes are only a civic good if the tax rules are perceived as being fair. Which is why Mr. Biden’s calculated risk could pay many dividends come November.
Felicia Wong is president and chief executive of Roosevelt Forward, the advocacy partner of the progressive think tank the Roosevelt Institute.
https://www.nytimes.com/2024/03/27/opinion/biden-tax-wealthy.html
The Unbearable Vagueness of Medical ‘Professionalism’
When Joel Bervell thought about professionalism as an undergrad, he thought of “Grey’s Anatomy.” Specifically, he thought about how residents on the show were expected to be, although often were not: on time, prepared for their cases and respectful to everyone around them.
“That was the only standard that I had of what it meant to be a doctor — especially someone like me, who doesn’t come from a family of doctors,” said Mr. Bervell, 28, a fourth-year medical student at Washington State University. Mr. Bervell, who is Ghanian American, is one of the first Black medical students at the medical college, which opened in 2017.
From the moment students set foot in medical school, they are instilled with the concept of medical professionalism: their sacred responsibility to conduct themselves with the values of a profession that is granted automatic trust in society. “It is the first thing they tell you: You are now literally a medical professional,” Mr. Bervell said.
The same metric can be used to determine whether or not a med student becomes a doctor at all.
Starting in their third year, Mr. Bervell learned, he and his classmates would be regularly assessed on their professional behavior, along with other attributes like communication skills. Faculty, staff and other students could also report specific concerns about an individual’s professionalism, resulting in write-ups the contents of which could become attached to their permanent records, following them like scarlet letters.
The problem, as many medical students have also learned, is that where “professional” is vague, “unprofessional” is even more so. Depending on who makes the call, unprofessional behavior can mean hugging your program director, letting a bra strap show, wearing braids, donning a swimsuit over the weekend or wearing a “Black Lives Matter” sweatshirt in the E.R.
As a result, professionalism exists at two levels, as both a lofty standard of behavior and a (sometimes literal) list of dos and don’ts that blur ethics and appearance. That second meaning can prove particularly pernicious to residents of color, said Dr. Adaira Landry, an adviser at Harvard Medical School and co-author on a recent journal article on the “overpolicing” of Black residents.
The article, published in The New England Journal of Medicine, adds to growing literature documenting the ways residents of color are disciplined or pushed out of medicine. In 2015-16, 20 percent of trainees dismissed from their residency were Black, although Black students make up only 5 percent of residents, according to unpublished data from the Accreditation Council for Graduate Medical Education, or A.C.G.M.E.
For students who did not grow up in the culture of medicine or do not resemble an outdated notion of what a doctor should look like (white, male, elite), these opaque rules can present a minefield. “The environment is so restrictive of what is allowed that when you behave or look or speak differently, it feels like it’s unprofessional,” Dr. Landry said.
Among minority students with whom Dr. Landry works and who are facing probation or dismissal, she has seen a common thread. “I have never had a student reach out to me that they’re being kicked out because of an academic grade,” she said. “The overwhelming theme is that it’s interpersonal conflicts, labeled as professionalism challenges.”
From ethics code to dress code
The lofty ideals that Mr. Bervell encountered on his first day are more in line with how professionalism was originally conceived, said Dr. David C. Leach, who served as executive director of the A.C.G.M.E. from 1997 to 2007.
At the time, medicine was at a crossroads. Giant companies were snapping up individual practices and turning them into for-profit enterprises. Doctors saw their time with patients dwindle, and patients saw their quality of care decline.
“There was a rising public perception that doctors were just like everyone else: They’re just looking to make a buck,” said Dr. Matthew Wynia, a medical ethicist studying the ethics of managed care during this period. “The fear was that our sense of professionalism was being lost.”
In response, the council set out to define a set of general competencies: measurable outcomes that a resident needed to demonstrate before moving forward in the journey to becoming a physician.
Of the six competencies the council ultimately established, professionalism came closest to the heart of what it meant to be a doctor. “It is a set of promises about the trustworthiness of both the profession as a whole and the individuals practicing in it,” Dr. Leach wrote in 2014. Many believed that professionalism was key to helping medicine re-establish its values as an ethics-based altruistic profession — one committed to patients, not the bottom line.
Professionalism was also the vaguest competency on the list. The 1999 definition characterized professionalism as “a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.” Doctors were also expected to demonstrate an array of attributes in every interaction, including compassion, respect, humility, integrity, accountability.
Residency directors complained that, compared to things like patient care and medical knowledge, professionalism was squishy and difficult to measure. The concerns boiled down to, “I’m a really busy program director, so what the hell am I supposed to do?” recalled Dr. Leach.
The vagueness problem never went away, said Dr. Deborah Powell, a former executive dean at the University of Kansas School of Medicine, who was on the A.C.G.M.E. board at the time. In the 2000s, conversations about what constituted professionalism often devolved to focus on how doctors should dress. “You shouldn’t have beards, you shouldn’t have long hair, women should wear skirts,” Dr. Powell said. “It was crazy. We went overboard.”
Those conversations are still happening today. Dr. Londyn Robinson, now a resident at Duke University, learned the second definition of professionalism in 2020. While looking for tips on applying to residencies, she stumbled across an article in the journal Vascular Surgery titled “Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons.”
The authors had trawled the social media accounts of 500 surgery trainees and rated them for professionalism without their knowledge. By the authors’ definition, potentially unprofessional content included photos of residents holding alcoholic drinks, wearing Halloween costumes or “provocative posing in bikinis/swimwear.”
To Dr. Robinson, who is the first in her family to earn an M.D., the paper revealed that, for some, professionalism had been reduced to superficial attributes rather than to ethical behavior with patients. “Basically, they said the quiet part out loud,” she said.
A new ideal
As Dr. Robinson learned, professionalism now radiates beyond the clinic or classroom. Mr. Bervell’s instructors had cautioned him about the consequences of social media: Because medical students represented the profession at all times, they said, being a professional meant thinking twice before talking online about politics or hot-button issues like abortion.
Mr. Bervell didn’t exactly heed that warning. During the Covid-19 pandemic, he began making TikTok videos pointing out racial bias in medical tools like the pulse oximeter and lung function tests. (Both are less accurate for non-white patients, studies have found), earning him the moniker of “medical mythbuster.” His videos have been added to medical school syllabuses, drawn praise from the American Medical Association and earned him a seat on the White House’s Healthcare Leaders in Social Media Roundtable.
By the standards of his own school, Mr. Bervell said, his social media activism could be seen as unprofessional. But, he added, he saw challenging health care’s gaping racial disparities is part of his role in changing medicine — and, maybe, giving doctors something better than “Grey’s Anatomy” as a model for how to be a professional.
The vagueness of professionalism can pose a challenge not only for students of color but for anyone who falls outside the historical stereotype of a doctor. Dr. Robinson noted that the people being judged for their swimwear in the Vascular Surgery paper were more often women than men.
In 2020, incensed by the paper, she posted a photo of herself in a bikini top and shorts on X, formerly known as Twitter, with the hashtag #MedBikini. “I’ll say it: I wear bikinis. I am going to be a doctor,” Dr. Robinson wrote. By the next day, her post had gone viral, and the paper was formally retracted.
In an apology, the editors of the journal acknowledged that “professionalism has historically been defined by and for white, heterosexual men and does not always speak to the diversity of our work force or our patients.”
As the face of medicine changes and platforms like TikTok and Twitter transform the way that medical knowledge is shared, the original architects of professionalism still believe that the core tenets of the term will remain central to medicine
For Dr. Leach, the definition is simple. “Are you discerning and telling the truth? Are you putting the patient’s interests ahead of your own? And are you developing practical wisdom that can incorporate the best science with the particulars of this particular patient to come up with a creative clinical decision?” he said. “If you’re doing those three things, then you’re professional.”
He added: “And a dress code is so far and away from those three things.”
https://www.nytimes.com/2024/03/19/health/medical-students-professionalism.html
U.S. prescription drug market in disarray as ransomware gang attacks
Millions of Americans have been affected by delays in obtaining medicine or having to foot the bill without insurance
by Joseph Mann and Daniel Gilbert - Washongton Post - March 1, 2024
A ransomware gang once thought to have been crippled by law enforcement has snarled prescription processing for millions of Americans over the past week, forcing some to choose between paying prices hundreds or thousands of dollars above their usual insurance-adjusted rates or going without lifesaving medicine.
Insurance giant UnitedHealthcare Group said the hackers struck its Change Health business unit, which routes prescription claims from pharmacies to companies that determine whether patients are covered by insurance and what they should pay. The hackers stole data about patients, encrypted company files and demanded money to unlock them, prompting the company to shut down most of its network as it worked to recover.
Change Health and a rival, CoverMyMeds, are the two biggest players in the so-called switch business, charging pharmacies a small fee for funneling claims to insurers.
“When one of them goes down, obviously it’s a major problem,” said Patrick Berryman, a senior vice president at the National Community Pharmacists Association.
A notorious Russian-speaking ransomware ring known as ALPHV claimed responsibility for the Feb. 21 breach, capping a string of attacks that included several hospitals.
The lasting issues underscore the continued fragility of critical infrastructure nearly three years after a ransomware attack on Colonial Pipeline prompted a shutdown of the biggest network of fuel pipelines in the United States. Service stations, particularly in the eastern half of the country, ran short of fuel as consumers rushed to gas up.
Since then, U.S. officials and their international partners have announced a series of operations that have included hacking the gangs, taking over their chats with business associates and, in some cases, making arrests. ALPHV was targeted in a December takedown that proved short-lived.
U.S. pharmacies reported a wide range of impacts, with independent stores experiencing some of the worst problems.
UnitedHealth estimated that more than 90 percent of the nation’s 70,000-plus pharmacies have had to alter how they process electronic claims as a result of the Change Health outage. But it said only a small number of patients have been unable to get their prescriptions at some price.
At CVS, which operates one of the largest pharmacy networks in the nation, a spokesperson said there are “a small number of cases in which our pharmacies are not able to process insurance claims” as a result of the outage. It said workarounds were allowing it to fill prescriptions, however.
Many pharmacies have started routing claims through CoverMyMeds, which posted a notice online Feb. 22: “No outages here.” The company, owned by McKesson, did not respond to a request for comment Thursday.
For pharmacies that were not able to quickly route claims to a different company, the Change Health outage left pharmacists to try to manually calculate a patient’s co-pay or offer them the cash price.
Compounding the impact, thousands of organizations cut off Change Health from their systems to ensure the hackers did not infect their networks as well.
UnitedHealth’s own pharmacy services company, Optum Rx, said it, too, disconnected but that it would not penalize pharmacies that made their best efforts to tell whether a given drug was covered for a patient. Optum said in a letter to those pharmacies that it was “committed to reimbursing all claims that are appropriate and filled with the good faith understanding that a medication should be covered.”
The attack on Change Health has left many pharmacies in a cash-flow bind, as they face bills from the companies that deliver the medication without knowing when they will be reimbursed by insurers.
Some pharmacies are requiring customers to pay full price for their prescriptions when they cannot tell if they are covered by insurance. In some cases, that means people are paying more than $1,000 out of pocket, according to social media posts.
The outage has also created havoc for patients who use drugmaker coupons to get their prescriptions at a discount. Some reported being told that the coupon system also relies on Change Health.
Amy Ginsburg, a Bethesda resident, said her local CVS wasn’t able to process a coupon she uses for her diabetes medication.
“Normally, it would be a $25 co-pay, but it will actually be a $250 co-pay,” she said. Ginsburg, 62, still has some medication left and plans to wait for the refill until next week, hoping the situation will be resolved by then.
“If I didn’t have sufficient quantity to tide me over, it could lead to serious consequences,” she said. “Not everyone has an extra $250 they weren’t expecting to spend.”
The situation has been “extremely disruptive,” said Erin Fox, associate chief pharmacy officer at University of Utah Health.
“At our system, our retail pharmacies were providing three-day gratis emergency supplies for patients who could not afford to pay the cash price,” Fox said by email. “In some cases, like for inhalers, we had to send product out at risk, not knowing if we will ever get paid, but we need to take care of the patients.”
Axis Pharmacy Northwest near Seattle is “going out on a limb and dispensing product with absolutely no inkling if we’ll get paid or not,” said Richard Molitor, the pharmacist in charge. “Probably the biggest impact has been with our hospice clientele, whose claims aren’t going through at all.”
The Change Health outage has been particularly tough on independent pharmacies, because they can only see prescriptions that a patient filled at their pharmacy — and not ones that the patient filled at others. The “switch” connects independent pharmacies to insurers or pharmacy-benefit managers, who have a more expansive view.
This means small pharmacies wouldn’t know if a drug they dispense interacts with another drug a patient received at a different pharmacy or whether a patient is trying to fill a controlled substance from multiple pharmacies.
“They’re flying blind when it relates to prescriptions filled at other pharmacies,” said Berryman, the National Community Pharmacists Association official.
ALPHV is one of the largest groups performing “ransomware as a service,” splitting extortion money with affiliates that do the actual hacking and then install ALPHV’s BlackCat ransomware encryption program. ALPHV then handles the threats and negotiations.
The group has collected more than $300 million this way, hitting such high-profile targets as Caesars Palace in Las Vegas.
In December, the Justice Department said it and partner nations had hacked ALPHV, recovering hundreds of decryption keys so that victims could get their data back without paying, and some analysts predicted the group would not recover from the internal penetration.
But as the past week has shown, ALPHV was hardly disabled. ALPHV reappeared on another site within days and announced it would exact revenge. It invited its affiliates to break into more sensitive American targets.
“These law enforcement-led disruptions are most effective when they are paired with an arrest or identifying information about individuals,” said Adam Meyers, senior vice president of intelligence at security company CrowdStrike.
Groups open to affiliates are especially resilient unless the trust among the criminals is broken, said Chris Krebs, former head of the U.S. Cybersecurity and Infrastructure Security Agency.
“If you want permanent, long-lasting impacts, it is going to require taking some of these guys off the playing field,” Krebs said. “But there’s more guys waiting in the wings.”
https://www.washingtonpost.com/technology/2024/03/01/prescription-drug-hack-alphv/
How Big Pharma is fighting Biden’s program to lower seniors’ drug costs
In court cases nationwide, drug companies are trying to block a new law that would cut prices on drugs for high blood pressure, heart disease, cancer and diabetes
by Tony Romm - Washington Post - March 11, 2024
Pharmaceutical giants are mounting a vigorous legal battle against President Biden’s plan to lower seniors’ prescription drug costs, urging federal judges here and around the country to invalidate a new program that aims to reduce the price of medications for high blood pressure, heart disease, cancer and diabetes.
In a flurry of lawsuits, these drugmakers have blasted the government initiative as unconstitutional, defended their pricing practices and warned that regulation could undermine future cures — even as millions of older Americans say they are struggling to afford essential treatments.
The legal wrangling appears primed to reach the Supreme Court, which could carry lasting implications for the government’s ability to regulate health-care prices broadly. The stakes are also enormous for Biden, who ran in 2020 on a pledge to fulfill a longtime promise — made by both parties — to ease a key financial strain on older Americans.
The pharmaceutical industry specifically seeks to block a new law that enables Medicare to negotiate the price of select drugs under its prescription benefit, known as Part D. The idea is modeled after similar systems internationally, which have helped lower costs in other countries even as Americans face sky-high prices for some of the same treatments.
Enacted in 2022 as part of Biden’s signature economic package, the Inflation Reduction Act, the law requires the administration to identify an initial set of 10 drugs to negotiate. The list was unveiled in August and includes the blood-thinner Eliquis, the heart-failure medication Farxiga and the diabetes pill Jardiance.
While manufacturers have since engaged in price discussions with the administration, they have also unleashed a blitz of legal challenges meant to upend the entire system. The intensity of their opposition was on display Thursday, as four pharmaceutical giants urged a federal judge in New Jersey to terminate the program before seniors would see any change to their drug costs.
Lawyers for Bristol Myers Squibb, Janssen, Novartis and Novo Nordisk offered an array of objections to the program, arguing that it constituted an illegal taking of their drugs, for example, and wrongly carried the threat of steep financial penalties. Some companies also claimed that merely signing a contract would be unconstitutional because it would force them to acknowledge in public that a lower price is a fairer one.
“This program would have a debilitating effect on plaintiffs’ ability to compete and innovate,” said Kevin King, a lawyer for Janssen, which makes Xarelto, an anti-blood-clot medicine, and Stelara, prescribed for psoriatic arthritis. Both are subject to negotiation.
Over roughly five hours of arguments, the judge in the case — Zahid Quraishi, a Biden appointee — frequently pressed the industry about its claims, noting at one point that the drug companies seemed to be portraying themselves as “Mother Theresas” that “develop drugs for free.”
The lawyers’ criticisms of the program echoed years of attacks from industry lobbyists, who signaled anew this month that they are committed to preventing the Biden administration from striking agreements to lower prices under Medicare.
“We feel confident that ultimately justice will prevail here, and we’ll keep pushing along,” said James Stansel, the general counsel of PhRMA, the industry’s leading lobbying group.
The legal campaign offers the most immediate test for one of Biden’s prized legislative accomplishments, which relaxed a longtime prohibition against Medicare negotiating drug costs directly with manufacturers. Hours after court arguments concluded in Trenton, the president called on Congress to preserve and expand the very program that pharmaceutical giants are trying to unwind.
“Americans pay more for prescription drugs than anywhere else,” he said during his State of the Union address. “It’s wrong, and I’m ending it.”
Generally, Americans do pay more for prescription drugs: Among the 10 medications that the United States has targeted for negotiation, prices can range from three to eight times higher than in Canada, Japan and other industrialized countries, according to a January report from the Commonwealth Fund, a research nonprofit, which studied 2021 data.
Historically, these costs have forced some of the poorest families to choose between lifesaving treatments and other needs like food and housing, while adding to the price of Medicare as U.S. debt skyrockets. But drugmakers have defended their practices, stressing that the cost of developing a new drug ranges into the billions of dollars — often involving an expensive trial-and-error process in which many ideas never come to market.
More than a year after Democrats adopted the Inflation Reduction Act over Republican opposition, PhRMA’s top lawyer said there already had been “lots of announcements [from] companies that have ended programs,” particularly affecting research on cancer treatments.
“If your product is going to be price-controlled two years from now,” Stansel asked, “are you going to spend $400 million on a clinical trial that probably won’t even be finished before the drug is price-controlled?”
Supporters of the law point to the industry’s sky-high profits, generous executive compensation packages and lucrative stock buyback programs. Last year, Bristol Myers Squibb posted $45 billion in revenue, Merck reported about $60 billion in sales, and Johnson & Johnson raked in more than $85 billion, which includes drugs sold by Janssen, according to earnings reports.
“Pharmaceutical companies are doing well right now,” said Kelly Bagby, vice president at AARP Foundation Litigation, which has filed legal briefs in support of the Biden administration. “They want to make sure their historical profitability is maintained, and not changed, while at the same time trying to delay everything.”
Under siege in Washington, the drug industry has focused its attention on the courts: Since last year, companies and lobbying groups have filed nine lawsuits in Delaware, Ohio, New Jersey, Texas and the District of Columbia. While pharmaceutical giants have so far failed to score a victory, they have signaled they do not plan to waver in their campaign.
In July, for example, the U.S. Chamber of Commerce joined local organizations in urging a federal judge in Ohio to issue an emergency halt to the negotiations. The Chamber’s members include AbbVie, which markets Imbruvica, one of the initial 10 drugs targeted by Medicare. The court in September rejected that petition on procedural grounds, but the broader case is still underway.
The lobbying group PhRMA helped bring another lawsuit in Texas, arguing in the summer that the Medicare negotiation program risks “drastically slowing innovation, reducing drug availability, and worsening patient outcomes.” A judge later ruled in favor of the Biden administration, prompting the industry to begin an appeal on Wednesday.
And lawyers for AstraZeneca, the maker of Farxiga, told a federal judge in Delaware that the law was like a “gun to the head,” forcing the company to accept the government’s price or a massive blow to its bottom line. As in other cases, the company urged the court to toss out the entire drug-pricing program.
Under the Inflation Reduction Act, drug companies that engage in negotiations but refuse to accept the final price have a choice: They can pay a massive tax, or they can withdraw from Medicare entirely, denying medicines to seniors and losing a major source of revenue.
This month, Colm F. Connolly, chief judge for the U.S. District Court in Delaware, rejected AstraZeneca’s arguments. Appointed by former president Donald Trump in 2018, he described the negotiations as an “economic opportunity that AstraZeneca is free to accept or reject,” because the government is not required to buy drugs at prices it isn’t willing to pay.
Last week, AstraZeneca said in a statement that it is evaluating its next steps, which could include an appeal. It declined to comment on the record for this article.
The legal challenges are part of a wider-ranging offensive by the pharmaceutical industry, long seen as one of the most powerful political forces in the nation’s capital. Since 2022, drugmakers and other companies have spent more than $761 million to lobby lawmakers and regulators, according to data from OpenSecrets, a money-in-politics watchdog.
Over that same period, the industry’s political action committees, along with its executives and employees, have also donated more than $77.5 million to federal office-seekers, the figures show. The tally does not include sharply critical ads run by groups like PhRMA targeting supporters of the Inflation Reduction Act.
The effort helped the industry whittle down Democrats’ original plans in 2022 to negotiate a wider range of drugs on a more aggressive timeline. Since then, major drugmakers have also supported a slew of Republican-led efforts to weaken or repeal Medicare’s new powers. The sustained opposition has raised the stakes entering the 2024 election: A GOP takeover of Congress and the White House could result in the termination of Biden’s negotiation program.
“The drug companies are going to full-court press through all the avenues they have influence,” said Steve Knievel, a health policy expert at Public Citizen, which has filed briefs supporting the administration.
In the meantime, legal experts said the drug industry hopes to create conflict among different courts nationwide. That could raise the odds that the negotiation program comes to a halt before the government can finalize and implement new, lower prices starting in 2026. It could also attract attention from the Supreme Court, which is more likely to hear a case on which federal judges disagree. (One of the lawyers advising the drug companies is Noel Francisco, a solicitor general under Trump.)
“It can only take one judge, or one panel of judges, to get some sort of nationwide relief,” said Zachary Baron, a director of the Health Policy and the Law Initiative at the O’Neill Institute at Georgetown University.
For four of the nation’s largest pharmaceutical companies, that gambit played out Thursday at a federal courthouse in New Jersey: One by one, they urged the judge to strike down the pricing program.
Yaakov Roth, a lawyer for Bristol Myers Squibb, likened the negotiations to a homeowner facing eviction: “It’s like the government saying, ‘We didn’t take your house, we just said we would put you in jail if you didn’t hand over the keys.’”
Ashley Parrish, who appeared on behalf of Novo Nordisk, said the Biden administration had run amok in implementing the law. “There are no procedures in place to ensure what the agency is doing is within constitutional bounds,” he told the judge.
And Samir Deger-Sen, representing Novartis, said the company would face a staggering tax for the “simple act of failing to agree with what the government says is the maximum fair price.”
Lawyers for the Justice Department repeatedly contested those claims, but the drug giants continued to press their case aggressively: They even argued that any deal with the government over prescription prices might violate their First Amendment rights.
“The program is effectively requiring manufacturers to indict themselves on the charges of price gouging,” Roth argued.
https://www.washingtonpost.com/business/2024/03/11/pharma-drug-priding-biden-negotiations/
Editor's Note
The following post is from "Gooznews", an online newsletter written by Merrill Goozner - March 4, 2024
-SPC
CMS finally proposes a small cut in privatized Medicare
The comments are in. Now the lobbying begins. Will the agency stick to its guns?
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