We’re number 28! We’re number 28!

❝ Every study ranking nations by health or living standards invariably offers Scandinavian social democracies a chance to show their quiet dominance. A new analysis published this week — perhaps the most comprehensive ever — is no different. But what it does reveal are the broad shortcomings of sustainable development efforts, the new shorthand for not killing ourselves or the planet, as well as the specific afflictions of a certain North American country.

❝ Iceland and Sweden share the top slot with Singapore as world leaders when it comes to health goals set by the United Nations…

The massive study emerged from a decade-long collaboration focused on the worldwide distribution of disease. About a year and a half ago, the researchers involved decided their data might help measure progress on what may be the single most ambitious undertaking humans have ever committed themselves to: survival. In doing so, they came up with some disturbing findings, including that the country with the biggest economy…ranks No. 28 overall, between Japan and Estonia…

❝ The U.S. scores its highest marks in water, sanitation, and child development. That’s the upside. Unsurprisingly, interpersonal violence (think gun crime) takes a heavy toll on America’s overall ranking. Response to natural disasters, HIV, suicide, obesity, and alcohol abuse all require attention in the U.S.

Also noteworthy are basic public health metrics that America. doesn’t perform as well on as other developed countries. The U.S. is No. 64 in the rate of mothers dying for every 100,000 births, and No. 40 when it comes to the rate children under age five die…

It may come as a surprise to Americans; but, most of the world considers healthcare a necessity and a right. I had to feel the pain viewing a discussion on economics when a leading Danish economist had to laugh when asked a question about American insurance companies and their control over Congress.

He replied, “the United States is the only industrial nation in the world where healthcare is still considered a privilege.” He was right of course.

The EpiPen tale illustrates how broadly greed is part of the pharma industry

❝ The EpiPen pricing controversy is enough to trigger mental anaphylactic shock. First, Mylan raised the list price of EpiPens to more than $600 a pair. When protests predictably erupted, Chief Executive Officer Heather Bresch went on TV to say that if she cut the price of EpiPens, some people wouldn’t be able to get them anymore. Which is weird, because usually a lower price makes things easier to get. Then, on Aug. 29, Mylan announced it will sell a generic version of EpiPens at half the price — but keep selling the identical brand-name version at full price. Because, um, some people will be happy to spend twice as much as everyone else for their EpiPens?

❝ None of this, including the original price hike, makes sense if you think of brand-name pharmaceuticals as normal products whose prices are set by the forces of supply and demand. It does start to make sense if you picture drug pricing as a multisided, Machiavellian, long-running, high-stakes Game of Thrones involving drugmakers, insurance companies, pharmacies, pharmacy benefit managers, Congress, presidential candidates, and somewhere, down there in the smoke and dust, the children with life-threatening allergies who need to bring EpiPens to school this fall.

❝ This system has never worked well, but it’s working even less well now because of the profusion of high-deductible health insurance plans. Many ordinary Americans who haven’t reached their deductible limits are being exposed to high list prices that were intended to be no more than a starting point for negotiations between powerful institutional sellers and buyers. In other words, a price that was basically fake has become all too real. This is what Bresch argued in an interview on CNBC on Aug. 25: “It was never intended that a consumer, that the patients, would be paying list price, never. The system wasn’t built for that.”

❝ The EpiPen episode is a small part of the very big problem of high and rising drug prices. But even this small problem is kind of intractable. “Everyone in the system has built their economics and contracts on the list price that exists. It’s incredibly difficult to unwind that structure,” says Pembroke Consulting’s Adam Fein. “I can’t tell you there’s a simple solution. That’s why I’m not a politician.”

If we ever get serious about electing politicians who represent the needs of the great body of American citizens, ordinary folks, we might initiate a revision of the whole process. Put essential economics back into the loop. At least the threat of regulation and oversight might prompt industrywide action, reform.

Poisonally, I trust industry executives – especially the insurance industry – about as far as I can throw them uphill into a heavy wind. I think we’ll end up needing to reform the pharmaceutical industry as much as we need to continue to reform healthcare in general in this land.

Thanks, Barry Ritholtz

Life expectancy vs. health expenditure in the Greatest Land on Earth – or so we are told


Click to enlargeThe visual capitalist

Understand and appreciate one thing: our politicians, liberal, conservative and populist nutball all prate about the wonders of American-style capitalism. When, frankly, there’s a lot going on where we suck. On the largest scale – being the leading economy no matter the decay – means that we can bring down most of the world when we get caught out as in the recent Great Recession. The inanities of reactionary and racist history dear to the hearts of the class warriors running the show distort every aspect of our lives – from the dream of equal opportunity to classifying healthcare as a privilege not a right.

Our healthcare system and crap results are an outlier on the face of global political economy. Someday, somehow, the broad populace of this nation will wake up, stand up and shake off this foolishness and the pimps selling it to us.

Thanks, Barry Ritholtz

Any good reasons why Florida hasn’t allowed in the CDC’s emergency response team to fight Zika?


Reuters/Paulo Whitaker/file photo

The state of Florida, the first to report the arrival of Zika in the continental United States, has yet to invite a dedicated team of the federal government’s disease hunters to assist with the investigation on the ground, health officials told Reuters.

Coordination with the U.S. Centers for Disease Control and Prevention since the state reported possible local Zika transmission on July 19 has been conducted largely at a distance, they said. That is surprising to some infectious disease experts, who say a less robust response could lead to a higher number of infections.

While Florida has a strong record of battling limited outbreaks of similar mosquito-borne viruses, including dengue and chikungunya, the risk of birth defects caused by Zika adds greater urgency to containing its spread with every available means, they say. Other states have quickly called in CDC teams to help track high-profile diseases.

You only have a small window. This is the window” to prevent a small-scale outbreak from spreading, said Dr. Peter Hotez, dean of the National School of Tropical Medicine…who expressed impatience with the pace of the Florida investigation.

Florida on Friday said that four cases of Zika in the state were likely caused by mosquito, the first sign that the virus is circulating locally, though it has yet to identify mosquitoes carrying the disease.

Florida Governor Rick Scott said the state health department was working with the CDC as it continues its Zika investigation…Dr Marc Fischer, a CDC epidemiologist, has gone to Florida at the state’s request.

But the state has not invited in the CDC’s wider emergency response team of experts in epidemiology, risk communication, vector control and logistics…

CDC spokesman Tom Skinner said the agency has several teams ready for when states request help with Zika, including Florida…

“Florida does what Florida does,” said one public health expert familiar with the investigation. “If I were health commissioner, I would have asked for their (CDC’s) help immediately.”

Still Floriduh, ain’t it. Even more so with Rick Scott in charge.

Our government may soon announce decriminalizing marijuana — or not

When President Richard Nixon signed the Controlled Substances Act in 1970, the federal government put marijuana in the category of the nation’s most dangerous drugs, along with LSD, heroin and mescaline.

In legal parlance, pot is a Schedule 1 drug, with a high potential for abuse and no medical purpose.

Forty-six years later, the law might soon change, as the Obama administration prepares to make what could be its biggest decision yet on marijuana.

Suspense is mounting after the U.S. Drug Enforcement Administration missed its self-imposed June 30 deadline to decide whether to reschedule the drug and recognize its potential therapeutic value. Twenty-six states already have legalized its medical use…

Voters in Washington state and Colorado became the first in the nation to legalize recreational marijuana in 2012…

With the Obama administration adopting a policy to “just look the other way” in states with recreational marijuana, Gregoire said it would be hard for the DEA to justify keeping marijuana on the Schedule 1 list.

Opinions differ on what exactly might happen when the DEA responds to the petition, but a move to reschedule marijuana would be a major milestone in the decades-long push to legalize pot.

Among other things, it could pave the way for pharmacies to fill marijuana prescriptions and allow universities and others to conduct more medical research.

Many pot entrepreneurs hope that Congress would respond by helping marijuana businesses, allowing them to deduct their expenses from their federal taxes and giving them access to banks so they can phase out their all-cash operations.

Someone mail me a penny postcard when Congress decides on bipartisan validation of science less than a century out-of-date, when health and well-being is treated as more important than death and destruction — by that herd of ignoranus conservatives in Congress whose sole function is to stand in the way of anything that smacks of progress.

Obamacare is costing trillions – yes, trillions – less than forecast

The United States is spending trillions — yes, trillions — less on health care than government forecasters expected when Obamacare passed in 2010.

Back then, the Congressional Budget Office estimated that the United States would spend $23.7 trillion on health care between 2014 and 2019.

But the forecasting agency has regularly and repeatedly revised spending estimates downward over the past six years. In 2015, it estimated that health care would cost the United States $2.6 trillion less over that same five-year period, a new analysis from the Urban Institute and the Robert Wood Johnson Foundation shows…

This isn’t to say that the health care law caused health costs to grow slower than expected. The authors of the report make it clear that while the Affordable Care Act may have played some role, it is far from the main contributor.

Rather, the figures show that the Affordable Care Act hasn’t exploded the federal budget, as critics charge. Quite the opposite — health costs have risen modestly as the uninsured rate has dropped to the lowest level on record.

Medicare alone has cost $455 billion less than expected

One remarkable fact about the lower-than-expected health costs is that they stretch across the entire health care sector. Medicare spending has come in lower than expected…

So has Medicaid spending…

And so has private insurance.

But, hey, if you want to listen to your favorite Republican beancounter – and liar – that’s your problem. Look at all the wonders they have delivered in recent years – from the Middle Eastern wars to the greatest financial crash since the Great Depression. No doubt, you don’t mind that you will be paying for those for decades to come.

Calls for single-payer system includes physicians

In an editorial and proposal published recently in the American Journal of Public Health, 2,231 physicians called for a single-payer national health program to replace the current private insurance model of financing healthcare.

While the Patient Protection and Affordable Care Act has increased access to healthcare services for millions of people, many physicians still have grave concerns over patients’ ability to get the care they need, said Steffie Woolhandler, MD, a co-author of the editorial and proposal…

Physicians are supporting a single-payer system, Woolhandler said, because they know that “lives are literally at stake.”

“I think doctors are seeing lots of patients who can’t get the care they need despite improvements that have come from the ACA. There are still 26 million to 30 million uninsured people, depending on the source, and there is no prospect of that going down because the ACA is almost fully implemented. Many patients will die because they can’t get the preventive or primary care they need,” she said. “Doctors see this in their practice. They also see patients all the time who are underinsured. They have insurance but still can’t afford the care they need … Many doctors feel the ACA has not solved the problems around access to care.”

Among the main points outlined in the national health program are:

Patients could choose to go to any doctor and hospital.

Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHP to cover all operating costs.

Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals, or clinics.

The program would be paid for by combining current sources of government health spending into a single fund with modest new taxes that would be fully offset by reductions in premiums and out-of-pocket spending.

Co-pays and deductibles would be eliminated…

“Once you have a single-payer system, you have to decide how much you are willing to spend. Our group would say, at least initially, to spend what we are spending now for the first few years to avoid disruption, but over time there would be huge administrative savings,” she said.

RTFA for some discussion and debate. Most industrial, educated nations have some sort of single-payer national health service. Many provide better care than that received by most Americans. They all cost taxpayers and consumers less than our current system.

So-called administrative costs are where insurance companies hide their biggest lies. They claim to need 14-24% of costs for administration. Social Security and Medicare function well with less than 3% charged off to admin.

South Dakota warehouses thousands with manageable disabilities in nursing homes


No, the fight ain’t new — it ain’t over either

When patients in South Dakota seek help for serious but manageable disabilities such as severe diabetes, blindness or mental illness, the answer is often the same: With few alternatives available, they end up in nursing homes or long-term care facilities, whether they need such care or not.

In a scathing rebuke of the state’s health care system, the Justice Department said on Monday that thousands of patients were being held unnecessarily in sterile, highly restrictive group homes. That is discrimination, it said, making South Dakota the latest target of a federal effort to protect the civil rights of people with disabilities and mental illnesses, outlined in a Supreme Court decision 17 years ago.

The Obama administration has opened more than 50 such investigations and reached settlements with eight states. One investigation, into Florida’s treatment of children with disabilities, ended in a lawsuit over policies that placed those children in nursing homes. With its report Monday, the Justice Department signaled that it might also sue South Dakota.

While the administration has received widespread attention for investigating police abuses and supporting the rights of gay and transgender people, the Justice Department has also steadily made these cases part of its civil rights agenda. The government says that those efforts have allowed more than 53,000 Americans with disabilities to leave institutions or avoid them altogether. It is a small number compared with the 250,000 working-age people who are estimated to be needlessly living in nursing homes, but advocates say the federal campaign has had significant effects.

With help, the Justice Department said, such people could live at home, hold jobs and lead productive lives. Instead, they are confined and segregated from society. Many cannot leave the grounds of their institutions without supervision or perform tasks such as shopping for groceries or cooking meals. One resident told investigators that when friends visited to take him for a car ride, “they have to sign me out, like a kid.”…

Paternalism, patriarchal practices – social and medical – reflect a society unwilling to move to best practices. Modernism is viewed as heresy by some, radicalism by others in the wonderful world of conservative beancounters.

Unless pressure is mounted, locally or through federal oversight, the cost of doing business as usual – defined by 19th Century minds – overrules what should be systems that help folks lead better lives.

The worst creeps in Congress want to privatize the VA — Vets are pissed!

Some members of the commission established by Congress to evaluate the Department of Veterans Health Administration have proposed drastically reducing the size of the VHA by closing its health facilities and transferring the care of the nation’s millions of military veterans to the private sector. But in a letter sent to the chair of the Commission on Care, leaders of eight of the country’s most prominent veterans’ advocacy organizations blasted the proposal.

“We are greatly alarmed by the content of [the proposal] that was developed and drafted outside the open Commission process by seven of the Commission’s fifteen members — without the input or even knowledge of the other Commissioners,” they wrote in a letter signed by senior leaders of the Disabled American Veterans, the American Legion, the Military Order of the Purple Heart, the Vietnam Veterans of America, the Veterans of Foreign Wars, the Paralyzed Veterans of America, AMVETS, and the Iraq and Afghanistan Veterans of America.

The plan — known as the “Strawman Document” — was floated in March by seven members of the 15-member Commission on Care…the report, which echoes VA privatization efforts that have been backed by the Koch brothers, says “bold transformation” is needed for the VA to address the needs of its enrolled veterans, and that the system is “seriously broken” with “no efficient path to repair it.” The plan calls for closing many “obsolete” VA facilities and moving toward a model where veterans can seek taxpayer-funded care at private health care facilities. A process similar to the Base Realignment and Closure system — used by the military since the end of the Cold War to decide which bases to close — would be used to evaluate which VA medical facilities would close. Under the plan, there would be no new facilities or major renovations of the existing VA facilities.

The plan also called for private doctors to be reimbursed at 5 to 10 percent higher than the Medicare rate, so they would have a greater incentive to participate…

Those who opposed the plan agree the VA needs to be improved, but they argue that essentially privatizing it would force veterans to search for care at private facilities that might not be trained or equipped to serve veterans suffering from the long-range effects of combat, such as spinal cord injuries “and the Polytrauma System of Care.” The authors add that the proposal ignores recent research, some commissioned by Congress itself, that found that VA care is often better than care in the private sector…

…Suzanne Gordon notes that…the supporters and drafters of the “strawman” proposal include conservatives and several hospital executives “who stand to benefit financially from [VA medical] privatization.”

That, of course, is a general rule of all privatization attempts by Republicans and other right-wing profiteers who want an end to real public service.

At the simplest level of theft these clowns increase administrative costs from the less-than-3% average of systems like Medicare and Social Security up to numbers ranging from 16-25% that corporate insurance barons tout as necessary. Necessary, perhaps, to pay country club dues – they haven’t a damned thing to do with providing consistent quality care to American citizens, veterans or otherwise.

Then you can add in inflated paybacks to Big Pharma – the most corrupt profit-based pharmaceutical industry on this silly old planet.