Number One of the top ten profiteers and dysfunctional in healthcare

Good commentary by Merrill Goozner. I subscribe to his site. He, I and others have gotten together and talked. Today? Merrill calls attention to the Lown Institute which publishes a list of the top ten baddies of profiteering and dysfunction in healthcare. Martin Shkreli made number one for 2023.

I did ask if I can publish Lown’s top ten examples of profiteering and dysfunction in health care. Waiting for an answer.

This group makes my spidery senses tingle. Rather ask than get a reprimand. Got that one time and I knew who did it. It backfired on them and they were dropped by their host. Good writer and I was posting their commentaries on Angry Bear for a good while. A win-win.

Martin Shkreli’s legacy, GoozNews, Merrill Goozner.

The Lown Institute “honors” the top ten examples of profiteering and dysfunction in health care with an award in his name. Plus a few other items that caught my eye.

Remember Martin Shkreli, the “Pharma Bro” who bought up the rights to the anti-parasitic drug Daraprim and raised its price from $13.50 to $750 a pill? Though convicted of securities fraud, he served just four years of his seven-year sentence. Most recently, he violated parole by appearing on the Tucker Carlson show on X, the social media platform formerly known as Twitter.

Though banned forever from the pharmaceutical industry, Shkreli’s legacy lives on courtesy of the Lown Institute, which each year notes the Top Ten worst examples of profiteering and dysfunction in health care from the previous year. Number ten on the list, which was released this week, took place at Lehigh Valley Health’s Cedar Crest hospital in Allentown, Pa.

After an undocumented immigrant became comatose after surgery, the hospital threatened to deport the patient to the Dominican Republic if her family failed to pay the $500 daily charge for the equipment needed to care for her at home, the Philadelphia Inquirer reported. Only protests by immigration advocates forced her transfer to another hospital.

Commented judge Gary Schwitzer, an adjunct professor of public health at the University of Minnesota and one of the Shkreli Awards judges (full disclosure: I’m a judge, too): “If we could, we’d ship all of our sickest somewhere else. Give us elective surgeries or give us death!”

It gets worse from there. You can see the full list of this year’s Top Ten Shkreli Award “winners” with a synopsis of their depredations on the Lown Institute website.

I’m traveling this week. But here are a few other stories that caught my eye as I headed out of town:

Interns and residents are organizing unions. Will doctors soon follow?

The New England Journal of Medicine’s national correspondent, Dr. Lisa Rosenbaum, offers her take on the rapid growth of unionization among hospital house staff. Rosenbaum points out that as of “October 2023, the Committee of Interns and Residents (CIR), the largest union for house staff (residents and fellows), represented 31,000 trainees, up from about 16,000 in 2019. … Although the proportion of physicians represented by unions has been traditionally low (about 5.9% in 2021), now that 50 to 70% of us are employed by corporate entities (up from 5.6% a decade ago), trainees are leading a charge that may resonate with many employees of “Big Med” who feel similarly voiceless,” she wrote.

After describing the usual complaints about long hours, low pay and the failure of training hospitals to accommodate the needs of the more than 50% of trainees who are women, many of them already with young families, she turned to Dr. Milton Packer, a cardiologist at Baylor University Medical Center who helped form one of the first intern unions at New York’s Jacobi Hospital in the mid-1970s, for perspective on the issue. “’Sigmund Freud, he said, thought the meaning of life was sex. Alfred Adler thought it was power. And Viktor Frankl thought it was relevance. …I always thought Frankl was right,’ Packer said.”

Rosenbaum concluded: “After describing the erosion of trainees’ sense of their own relevance as they’ve come to be treated as an expendable labor source — and the predictable result that they view medicine as a job — Packer remarked that I was probably surprised by his leap. But I understood. Having spent a year dissecting the factors shaping trainees’ perceptions of their work environments, I find that the meaning-of-life question looms large.”

Rosenbaum promises a series of articles on the prospects and role of unions in medicine.

Taxing soda pop = declining consumption and better health

New research in JAMA from a half dozen scientists (led by Scott Kaplan, Ph.D., of the U.S. Naval Academy) found that the higher taxes imposed by five cities on sugar-sweetened beverages (by an average of 33.1%) cut consumption by a third. The cities that raised taxes were Boulder, Philadelphia, Oakland, San Francisco and Seattle.

“The observed price increase and corresponding volume decrease immediately followed tax implementation, and both outcomes were sustained in the months thereafter,” the research found. While the authors did not track health outcomes in those cities, previous studies have found that increasing taxes on sugar-sweetened beverages reduces heart attacks, strokes, diabetes and obesity and produces significant savings in health care costs.

“The findings have important implications for the potential efficacy of sugar-sweetened beverage taxes across larger geographic jurisdictions and at the national level,” the researchers concluded. “Scaling sugar-sweetened beverage excise taxes across the U.S. would likely generate significant population health benefits and medical cost savings.

Some positive health news: EV market share rising sharply

If you think the EV vehicle revolution isn’t a health care issue, think again. Air pollution is one of the major causes of asthma, which affects 1 in 13 Americans, caused over 2 million children to miss nearly 8 million school days in 2018, and hospitalizes nearly 200,000 people annually, according to the American Lung Association. Fossil-fuel burning vehicles and power plants are the leading causes of air pollution.

While the financial press has been filled with stories about a slowdown in electric vehicle adoption, The American Prospect’s Ryan Cooper reports the EV share of new car purchases increased from 1.8 percent in 2020, to 3.2 percent in 2021, to 5.2 percent in 2022, to an estimated 9.8 percent in 2023. Plug-in hybrid vehicles increased from 0.5 percent to 2 percent of all new vehicles over the same period.

In other words, the EV share of new cars increased more than fivefold in three years, while the share of plug-in hybrids quadrupled. At that pace of acceleration, EVs will make up half of new car sales by 2026 or so. These two developments reduced the emissions of the vehicle fleet by roughly 6 percent in 2022, and perhaps 11 percent in 2023, Cooper reports.

Having a job with better pay generates positive health outcomes, too

James Fallows in his Breaking the News substack reports the economy under President Joe Biden is “doing better than for any other modern president in a re-election run.” Inflation, whose rapid rise generated an endless number of negative headlines last year, is now just a shade above the Federal Reserve Board’s 2% annual target, while job creation remains extremely strong with unemployment standing at 3.7 percent, which is actually below the rate generally considered full employment.

Remember the dreaded misery index (measured by adding the unemployment rate to the inflation rate)? The misery index today is nearly as low as it was just before the pandemic. It has fallen by nearly 10 points in the past 18 months.

Moreover, some of the biggest wage gains during Biden’s first term have been achieved by the nation’s lowest paid workers, who for decades have lagged well behind white collar, college-educated workers. As the Wall Street Journal reported at the beginning of the new year when 22 states raised their minimum wage, most workers in the bottom 10% of the wage scale wouldn’t even notice since their average wage was already 50% above the minimum. “That is the largest gap between actual pay and minimum pay in a decade,” the paper reported.

As the Robert Wood Johnson Foundation noted in an issue brief over a decade ago, “unemployed Americans face numerous health challenges beyond loss of income. Laid-off workers are far more likely than those continuously employed to have fair or poor health, and to develop a stress-related condition, such as stroke, heart attack, heart disease, or arthritis.”

Should the good numbers on employment and wages hold up through election day, the president will have a lot of good economic news to brag about on the campaign trail.