#big health

[dosesofcommonsense]

[porterdavis]

...the intermediaries—insurers, pharmacies, drug distributors and pharmacy-benefit managers (pbms)—sitting between patients and their treatments. In 2022 the combined revenue of the nine biggest middlemen—call them big health—equated to around 45% of America’s health-care bill, up from 25% in 2013.

Why do they even exist?

[storyvoice]

Health

Illness that is of a chronic nature has a huge impact on individuals separately, as well as within the context of family systems. Health care systems, being “systems”, have an inability to care for patients on an individual basis. While this impersonal method of heath care is promoted as cost effective, it increases costs in the long run by not holistically treating the client. Impersonal health…

[reasonsforhope]

"The Biden Administration last week [early December, 2023] announced it would be seizing patents for drugs and drug manufacturing procedures developed using government money.

A draft of the new law, seen by Reuters, said that the government will consider various factors including whether a medical situation is leading to increased prices of the drug at any given time, or whether only a small section of Americans can afford it.

The new executive order is the first exercise in what is called “march-in-rights” which allows relevant government agencies to redistribute patents if they were generated under government funding. The NIH has long maintained march-in-rights, but previous directors have been unwilling to use them, fearing consequences.

“We’ll make it clear that when drug companies won’t sell taxpayer funded drugs at reasonable prices, we will be prepared to allow other companies to provide those drugs for less,” White House adviser Lael Brainard said on a press call.

But just how much taxpayer money is going toward funding drugs? A research paper from the Insitute for New Economic Thought showed that “NIH funding contributed to research associated with every new drug approved from 2010-2019, totaling $230 billion.”

The authors of the paper continue, writing “NIH funding also produced 22 thousand patents, which provided marketing exclusivity for 27 (8.6%) of the drugs approved [between] 2010-2019.”

How we do drug discovery and production in America has a number of fundamental flaws that have created problems in the health service industry.

It costs billions of dollars and sometimes as many as 5 to 10 years to bring a drug to market in the US, which means that only companies with massive financial muscle can do so with any regularity, and that smaller, more innovative companies can’t compete with these pharma giants.

This also means that if a company can’t recoup that loss, a single failed drug can result in massive disruptions to business. To protect themselves, pharmaceutical companies establish piles of patents on drugs and drug manufacturing procedures. Especially if the drug in question treats a rare or obscure disease, these patents essentially ensure the company has monoselective pricing regimes.

However, if a company can convince the NIH that a particular drug should be considered a public health priority, they can be almost entirely funded by the government, as the research paper showed.

Some market participants, in this case the famous billionaire investor Mark Cuban, have attempted to remedy the issue of drug costs in America by manufacturing generic versions of patented drugs sold for common diseases."

-via Good News Network, December 11, 2023

[politijohn]

Source

Source

[claybooots]

Chop chop chop

[wardingshout]

Little visit

[solardrake]

Delivering mail to the furthest corners of the server ✉✈

[bluerosefox]

Drake Siblings

Have I read this prompt somewhere or was this a fever dream from my bored mind.

What if, now hear me out.

What if we bring up Dana Winters-Drake (whose confirmed to at least be alive in the DC verse but no one knows where she actually is)

What if instead of when she had a mental breakdown and getting committed to an Bludhaven clinc she wandered away before anyone noticed and by the time Tim or anyone did notice a lot of stuff started happening at once in both Gotham and Bludhaven (Steph dying, The Bludhaven crisis, etc etc)

Tim still tries to find her though but even with best resources it was like she just disappeared into the wilderness and the stress of trying to handle more and more problems get worse.

So when out of the blue, a couple of years later, he gets a call from an unknown number. On his private, only for friends and family, phone and when he answers he meet with a young girls voice on the other end.

A very young, maybe six or seven, girl who informs him about his apparently half-brother Danny Drake-Fenton. And how she loves Danny so, so, so much but knows her home is dangerous for him to be in.

Tim is stunned and before he could question her, she says Danny is Dana and Jack's baby and that her parents had adopted him years ago and put Dana's stuff that the hospital had away for him to look at when he was older but she just had to fight off their lunch from eating her brother and she knows he needs a better place to live and so she snooped around and found Dana's diary and that she had to unscramble the nonsense Dana wrote and found Tim's number with the words 'tell him about his brother Danny' hidden in it. And-

But before she could keep rambling she hears Danny screaming "JAZZY THE MILK WENT BAD AGAIN AND HISSED AT ME!"

Tim is left with silence after hearing Jazz yell to Danny to lock the fridge and step out of the kitchen as she gets the bat.

[dosesofcommonsense]

Follow the science…well, not that science. That science is bad for business.

[the-upper-shelf]

"The intruder"

[lookingforcactus]

A big cost and concern for many seniors in the U.S. is the price of prescription drugs and other healthcare expenses—and this year, thanks to The Inflation Reduction Act, their costs may go down dramatically, especially for patients fighting cancer or heart disease.

I learned about the new benefits because my ‘Medicare birthday’ is coming up in a couple months when I turn 65. I was shocked that there were so many positive changes being made, which I never heard about on the news.

Thousands of Americans on Medicare have been paying more than $14,000 a year for blood cancer drugs, more than $10,000 a year for ovarian cancer drugs, and more than $9,000 a year for breast cancer drugs, for instance.

That all changed beginning in 2023, after the Biden administration capped out-of-pocket prescriptions at $3,500—no matter what drugs were needed. And this year, in 2024, the cap for all Medicare out-of-pocket prescriptions went down to a maximum of $2,000.

“The American people won, and Big Pharma lost,” said President Biden in September 2022, after the legislation passed. “It’s going to be a godsend to many families.”

Another crucial medical necessity, the shingles vaccine, which many seniors skip because of the cost, is now free. Shingles is a painful rash with blisters, that can be followed by chronic pain, and other complications, for which there is no cure

In 2022, more than 2 million seniors paid between $100 and $200 for that vaccine, but starting last year, Medicare prescription drug plans dropped the cost for shots down to zero.

Another victory for consumers over Big Pharma affects anyone of any age who struggles with diabetes. The cost of life-saving insulin was capped at $35 a month [for people on Medicare].

Medicare is also lowering the costs of the premium for Part B—which covers outpatient visits to your doctors. 15 million Americans will save an average of $800 per year on health insurance costs, according to the US Department of Health and Human Services.

Last year, for the first time in history, Medicare began using the leverage power of its large patient pool to negotiate fair prices for drugs. Medicare is no longer accepting whatever drug prices that pharmaceutical companies demand.

Negotiations began on ten of the most widely used and expensive drugs.

Among the ten drugs selected for Medicare drug price negotiation were Eliquis, used by 3.7 million Americans and Jardiance and Xarelto, each used by over a million people. The ten drugs account for the highest total spending in Medicare Part D prescription plans...

How are all these cost-savings being paid for?

The government is able to pay for these benefits by making sure the biggest corporations in America are paying their fair share of federal taxes.

In 2020, for instance, dozens of American companies on the Fortune 500 list who made $40 billion in profit paid zero in federal taxes.

Starting in 2023, U.S. corporations are required to pay a minimum corporate tax of 15 percent. The Inflation Reduction Act created the CAMT, which imposed the 15% minimum tax on the adjusted financial statement income of any corporation with average income that exceeds $1 billion.

For years, Americans have decried the rising costs of health care—but in the last three years, there are plenty of positive developments.

-via Good News Network, February 25, 2024

[reasonsforhope]

"The Biden administration on Thursday [August 15, 2024] released prices for the first 10 prescription drugs that were subject to landmark negotiations between drugmakers and Medicare, a milestone in a controversial process that aims to make costly medications more affordable for older Americans. 

The government estimates that the new negotiated prices for the medications will lead to around $6 billion in net savings for the Medicare program in 2026 alone when they officially go into effect, or 22% net savings overall. That is based on the estimated savings the prices would have produced if they were in effect in 2023, senior administration officials told reporters Wednesday.

The Biden administration also expects the new prices to save Medicare enrollees $1.5 billion in out-of-pocket costs in 2026 alone.

“For so many people, being able to afford these drugs will mean the difference between debilitating illness and living full lives,” Chiquita Brooks-LaSure, administrator for the Centers for Medicare & Medicaid Services, told reporters. “These negotiated prices. They’re not just about costs. They are about helping to make sure that your father, your grandfather or you can live longer, healthier.”

It comes one day before the second anniversary of President Joe Biden’s signature Inflation Reduction Act, which gave Medicare the power to directly hash out drug prices with manufacturers for the first time in the federal program’s nearly 60-year history.

Here are the negotiated prices for a 30-day supply of the 10 drugs, along with their list prices based on 2023 prescription fills, according to a Biden administration fact sheet Thursday.

What Medicare and beneficiaries pay for a drug is often much less than the list price, which is what a wholesaler, distributor or other direct purchaser paid a manufacturer for a medication before any discounts...

The administration unveiled the first set of medications selected for the price talks in August 2023, kicking off a nearly yearlong negotiation period that ended at the beginning of the month.

The final prices give drugmakers, which fiercely oppose the policy, a glimpse of how much revenue they could expect to lose over the next few years. It also sets a precedent for the additional rounds of Medicare drug price negotiations, which will kick off in 2025 and beyond. 

First 10 drugs subject to Medicare price negotiations

Eliquis, made by Bristol Myers Squibb, is used to prevent blood clotting to reduce the risk of stroke. 

Jardiance, made by Boehringer Ingelheim and Eli Lilly, is used to lower blood sugar for people with Type 2 diabetes. 

Xarelto, made by Johnson & Johnson, is used to prevent blood clotting, to reduce the risk of stroke.

Januvia, made by Merck, is used to lower blood sugar for people with Type 2 diabetes.

Farxiga, made by AstraZeneca, is used to treat Type 2 diabetes, heart failure and chronic kidney disease. 

Entresto, made by Novartis, is used to treat certain types of heart failure.

Enbrel, made by Amgen, is used to treat autoimmune diseases such as rheumatoid arthritis. 

Imbruvica, made by AbbVie and J&J, is used to treat different types of blood cancers. 

Stelara, made by Janssen, is used to treat autoimmune diseases such as Crohn’s disease.

Fiasp and NovoLog, insulins made by Novo Nordisk.

In a statement Thursday, Biden called the new negotiated prices a “historic milestone” made possible because of the Inflation Reduction Act. He specifically touted Vice President Kamala Harris’ tiebreaking vote for the law in the Senate in 2022.

Harris, the Democratic presidential nominee, said in a statement that she was proud to cast that deciding vote, adding there is more work to be done to lower health-care costs for Americans.

“Today’s announcement will be lifechanging for so many of our loved ones across the nation, and we are not stopping here,” Harris said in a statement Thursday, noting that additional prescription drugs will be selected for future rounds of negotiations."

-via CNBC, August 15, 2024

[avoidghost]

[PREORDER] Dratchrod Acrylic Charm ❤️‍🔥🚑⚔️

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Finally can open my merch store! Not much on there yet, but I have plans for the coming months for stickers and prints and more stuff :3

[zephyrartz-owo]

Mental Health Tip! Don't skip meals lest you be fighting demons

[mostlysignssomeportents]

America’s richest Medicare fraudsters are untouchable

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/11/13/last-gasp/#i-cant-breathe

"When you're famous, they let you do it": eight words that encapsulate the terrifying rot at the heart of our lived experience, a world where impunity for the powerful trumps the pain of their victims.

"Populism," is shorthand for many things: rage, despair, distrust of institutions and a desire to destroy them. True populism seeks to channel those totally legitimate feelings into transformative change for a caring and fair society for all. So-called "right populism" exploits those feelings, using them to drive a wedge between different groups of victims, turning them against each other, so that elites can go on screwing the squabbling factions.

The far-right parties that are marching to victory through a series global elections are different in many ways, but they all share one trait: they appeal to mistrust of institutions, claiming that the government has been captured by elites who serve them at the expense of the governed. This has the benefit of being actually true, and while the fact that far-right parties are owned by these government-capturing elites might erode their credibility, the fact that so many "progressive" parties have stepped in to defend the institutional status quo leaves an open field for reactionary wreckers:

https://www.politico.com/blogs/2016-dem-primary-live-updates-and-results/2016/02/hillary-clinton-donald-trump-slogan-219908

Why would voters turn out to support a "Department of Government Efficiency," run by a bully whose career has been defined by abusing the people he is in charge of? Maybe they're turkeys voting for Christmas, but they also have personal, traumatic experience with government departments that protected the abusive corporations that preyed on them.

Today on Propublica, Peter Elkind tells the incredible story of Lincare, the nation's leading supplier of home oxygen, a repeat-offender fraudster and predator that has made billions in public money without any real consequences:

https://www.propublica.org/article/lincare-medicare-lawsuit-settlements-oxygen-equipment

Lincare has been repeatedly found guilty of defrauding Medicare; in this century alone, they have been put on probation four times, with a "death penalty" provision that would permanently disqualify them from ever doing business with the federal government. In every case, Lincare committed fresh acts of fraud, but never faced that death penalty.

Why not? Lincare is far too big to fail. In America's bizarre, worst-in-class, world-beatingly expensive privatized health care system, even public health provision (like Medicare) is outsourced to the private sector. Lincare has monopolized oxygen, a famously very important molecule for human survival, and if it were disqualified from serving Medicare, large numbers of Americans would literally asphyxiate.

Lincare clearly knows this. Too big to fail is too big to jail, and too big to jail is too big to care. They are the poster children for impunity, repeat offenders, multiply convicted, and still offending, even today. Lincare has been convicted of fraud under the administrations of GW Bush, Obama, Trump and Biden, and they're still in business.

What a business it is! Elkind takes us to the asbestos-poisoned town of Libby, Montana, where more than 2,000 of the 2.857 population suffer from respiratory diseases from the open-pit mine that operated there from 1963-1990. The elderly, dying population of this town rely on Medicare and Medicare Advantage oxygen concentrators to draw breath, and that means they rely on Lincare.

That means they are prey to Lincare's signature scam: charging Medicare (and 20% co-paying patients) to rent an oxygen concentrator every month, until they have paid for it several times over. This is illegal: under federal rules, patients are deemed to have bought their oxygen concentrators after 36 months and contractors are no longer allowed to charge them. Lincare doesn't give a fuck: the bills keep coming, and Lincare patients who survive long enough have paid the company $16,000 for a $799 gadget.

When Brandon Haugen, a local Lincare customer service rep, noticed this and queried the company's home office in Clearwater, Florida (home to Scientology and the Flexidisc), he was given the brushoff. After multiple attempts to get company leadership to acknowledge that this was illegal, he quit his job, along with his colleague and childhood friend Ben Montgomery. Between them, Haugen and Montgomery had 14 children who depended on their Lincare paychecks. Despite this, they both quit and turned whistleblower, with no job lined up. Eventually, Lincare paid $29m to settle the claim, with $5.7m to the whistleblowers and their lawyers. For Lincare, this was part of the cost of doing business and the fraud rolls on.

Lincare doesn't just defraud Medicare, they also have a high-pressure commissioned sales force that has repeatedly been caught defrauding Lincare customers – overwhelming sick, poor, elderly people. Patients are pressured to accept auto-billing, then Lincare piles medically dubious gadgets onto their monthly bills, as well as useless, overpriced "patient monitoring" services. Customers with apnea machines are mis-sold ventilators by salesmen who falsely claim these are medically necessary.

Salespeople illegally auto-shipped parts and consumables for Lincare machines to patients, then billed them for it. To satisfy the legal requirement that they telephone patients before placing these orders, sales agents would call patients, put them on hold, then part the call until the patient hung up.

Salespeople are motivated by equal parts greed and terror. Make quota and you can get up to $8,000 per month in bonuses. Miss that punishing quota and you're out on your ass (which is why one salesperson ordered a medically unnecessary ventilator).

Lincare also habitually ignores requests to pick up medically unnecessary equipment, because so long as the equipment is on the patient's premises, they can continue to bill for it. As one Ohio manager wrote to their staff: "As we have already discussed, absolutely no pick-ups/inactivation’s are to be do[ne] until I give you the green light. Even if they are deceased." Execs send out company-wide emails celebrating regional managers who have abandoned pick-ups, like a Feb 2022 "Achievement Rankings" email that touted the fact that most regional centers had at least 150 overdue pickups.

Lincare represents a deep, structural rot in American society. They are too big to punish, and too powerful to regulate. A 2006 law meant to curb oxygen payments was gutted by industry lobbyists. Today, Congress is weighing legislation, the SOAR (Supplemental Oxygen Access Reform) Act, which will allow Lincare to bill the public for hundreds of millions more every year, raising rates and eliminating competitive billing. The bill is supported by patient advocates who are rightly interested in getting oxygen to patients who have been locked out of the system, but the cost of that inclusion is that Lincare will be even more firmly insulated from its corruption.

The Trump Administration will doubtless crack down on some of America's worst companies, and the furious voters who elected the only candidate who campaigned on the idea that America was rotten will cheer him on. But Trump has made it clear that he will select the targets of his administration based on whether they are loyal to him or stand in his way, without regard to whether they harm his supporters:

https://pluralistic.net/2024/11/12/the-enemy-of-your-enemy/#is-your-enemy

Companies like Lincare, repeatedly caught paying illegal kickbacks, know how to play this game.

Image: p.Gordon (modified) https://commons.wikimedia.org/wiki/File:Smoke_bomb_with_burning_fuse.jpg

CC BY 2.0 https://creativecommons.org/licenses/by/2.0/deed.en