Category: Public Health

Yeah, a Big F%$#ing Deal

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Joe Biden has issued a rule banning surprise medical billing. 

I’m surprised, particularly its application to emergency services, where private equity has made surprise billing a central part of their profit generation strategies.  (Biden has a lot of PE types in the administration)

This is an very good, at least in the context of an executive order: (We really need a law to ban this)

The Biden administration on Thursday unveiled the first in a series of rules aimed at banning surprise billing.

The interim final rule bars surprise billing for emergency services and high out-of-network cost-sharing for emergency and non-emergency services. It also prohibits out-of-network charges for ancillary services like those provided by anesthesiologists or assistant surgeons, as well as other out-of-network charges without advance notice.

………

While public health insurance programs like Medicare and Medicaid already prohibit balance billing, people with job-based coverage or individual health plans frequently and unknowingly accept care from an out-of-network provider before they are slapped with a surprise medical bill. The new rule aims to put a stop to that.

………

This first round of regulation applies to providers, air ambulance providers, group health plans, health insurance issuers and Federal Employees Health Benefits Program carriers. The rule takes effect in 60 days, but most provisions don’t apply until January 1. Providers and insurers have until September 1 to submit comments.

Air Ambulance providers have been charging insane rates over the past few years as PE has snapped up more services.

The private equity model of medicine is to drastically overcharge people in situations where they have no choice.

Under the new rule, health plans that cover emergency services cannot use prior authorization for those services and must pay for them regardless of whether the clinician is an in-network provider or emergency facility. Likewise, insurers can’t charge their enrollees higher out-of-pocket costs for emergency services delivered by an out-of-network provider. They also have to count beneficiaries’ cost-sharing for those emergency services toward their in-network deductible and out-of-pocket maximums.

………

The Biden administration is still working out the details about how the dispute resolution process will work. But Congress laid out the broad-brush strokes in December’s No Surprises Act, which passed as part of its end-of-year spending package. Providers and insurers will have 30 days to agree to a price for the medical services delivered. And if they don’t settle, they’re supposed to enter arbitration, during which each side will present a final offer and make their case for why their recommendation is best. The arbitrator must then pick one of the two offers. But they can’t split the difference.

MY guess is that the PE parasites will still find a way to rat-f%$# people, it’s king of their “thing”, but it looks to be significantly harder now.

Personally, I favor a government owned National Health Service as a solution, but this is a positive move.

Everyone Hates Their Health Insurance Companies

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And all you have to do is read United Healthcare’s latest which is that they will be doing deep dives on all ER visits with an eye to denying payouts.

All insurance companies are bastards, and any policies to fix healthcare in the United State that involved them are doomed:

Doctors and hospitals are condemning plans by UnitedHealthcare—the country’s largest health insurance company—to retroactively deny emergency medical care coverage to members if UHC decides the reason for the emergency medical care wasn’t actually an emergency.

In the future, if one of UHC’s 70 million members submits a claim for an emergency department visit, UHC will carefully review what health problems led to the visit, the “intensity of diagnostic services performed” at the emergency department (ED), and some context for the visit, like the member’s underlying health conditions and outside circumstances. If UHC decides the medical situation didn’t constitute an emergency, it will provide “no coverage or limited coverage,” depending on the member’s specific insurance plan.

Emergency medical doctors and hospitals were quick to rebuke the plan. They say it sets a dangerous precedent of requiring patients to assess their own medical problems before seeking emergency care, which could end up delaying or preventing critical and even lifesaving treatment.

The policy was initially set to take effect July 1. But in an email to Ars Thursday, UHC now says it is delaying the rollout amid the criticism—at least until the end of the pandemic.

They are implying that if you have symptoms that look like a heart attack, and it turns out that it’s heart burn, you will be facing thousands of dollars that they won’t cover, because they are evil bastards.

Doctors are having none of this:

………

The delay is unlikely to ease critics’ concerns. After the policy was first announced last week, doctors were quick to note that assessing the necessity of emergency care before it’s actually given is nearly impossible. Many serious conditions have symptoms that overlap with nonserious conditions. For instance, chest pain may simply be a symptom of acid reflux or a panic attack, but it could also be a sign of a life-threatening heart attack. A bad headache could just be a bad headache, or it could signal a dangerous brain bleed.

In a 2018 analysis published in JAMA Open Network, researchers found that up to 90 percent of the symptoms that prompted an adult to go to the emergency room overlapped with symptoms of nonurgent conditions, which may be denied coverage in the future. But those same symptoms could also be linked to life-threatening conditions.

That analysis was spurred when the second-largest insurance company, Anthem, instituted a similar policy to UHC’s and began denying ED coverage.

In an accompanying editorial, one of the authors of the analysis—Maria Raven, chief of emergency medicine at the University of California, San Francisco—noted how problematic it is to retroactively evaluate emergency medical care. “My colleagues and I examined whether a patient’s symptoms at presentation to the ED could be labeled reliably as a non-emergency based on the discharge diagnosis—the diagnosis that Anthem is currently using to determine medical necessity,” she wrote. “We found it was impossible.”

It’s more than evil, it’s a public health disaster.

A significant proportion of vaccination reticence in the United States is driven by people believing that the medical-insurance complex will f%$# them like a drunk sorority girl whatever promises are made by the US government.

Our system is beyond broken.

Not Enough Bullets.

NFL Was Doing What?

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The NFL has been engaging in “Race Norming” in evaluating players for brain damage from concussions.

To the uninitiated, race norming means that the Football league was assuming that Black people were stupid when evaluating players for impairment from chronic traumatic encephalopathy (CTE).

Gee, racism much?

The NFL and the lead attorney for about 20,000 former players on Wednesday both promised to end “race-norming” — a controversial practice that curves Black players’ cognitive test scores with data that assumes a lower level of function — as part of the payout process in the $1 billion-plus settlement of class-action concussion litigation against the league.

The statements from the NFL and attorney Chris Seeger came as the practice of race-norming in the settlement payout process, first brought to public attention last year in a lawsuit by two former players, has drawn heightened scrutiny in the courts and media.

………

The NFL, in its statement, maintained that no discrimination had occurred in the administration of the settlement, finalized in 2017, which has paid more than $800 million to more than 1,000 former players diagnosed with dementia, Alzheimer’s, and other brain-related diseases. But U.S. District Judge Anita Brody, who has overseen the settlement, has been so troubled by the revelation of race-norming that she took the unusual step of appointing a mediator earlier this year to investigate.

………

The use of race norms in the NFL’s concussion settlement payouts first came to light last August, when two former players accused the league in a lawsuit of discriminating against hundreds — and potentially thousands — of Black former players. In their suit, former players Najeh Davenport and Kevin Henry alleged that race-norming prevented them from getting settlement payouts. In Davenport’s case, he claimed that a doctor initially diagnosed him with dementia, but the NFL appealed and demanded his test scores get curved using race-normed data, which resulted in a reversal of the diagnosis.

Clearly the goal here was to maximize profits at the expense of black players.

Come to think of it, “Maximize profits at the expense of black players,” could be the motto for the NFL.

About Bloody Time

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The Center for Disease Control and Prevention (CDC) has finally bowed to reality and admitted that it can be transmitted as an aerosol, as opposed to just the larger droplets.

This has been obvious for months, but public health authorities have been steadfast in their opposition to this mode of transmission since the beginning of the pandemic.

It makes dealing effectively with the virus more difficult, but more effective than ignoring reality:

Federal health officials on Friday updated public guidance about how the coronavirus spreads, emphasizing that transmission occurs by inhaling very fine respiratory droplets and aerosolized particles, as well as through contact with sprayed droplets or touching contaminated hands to one’s mouth, nose or eyes.

The Centers for Disease Control and Prevention now states explicitly — in large, bold lettering — that airborne virus can be inhaled even when one is more than six feet away from an infected individual. The new language, posted online, is a change from the agency’s previous position that most infections were acquired through “close contact, not airborne transmission.”

As the pandemic unfolded last year, infectious disease experts warned for months that both the C.D.C. and the World Health Organization were overlooking research that strongly suggested the coronavirus traveled aloft in small, airborne particles. Several scientists on Friday welcomed the agency’s scrapping of the term “close contact,” which they criticized as vague and said did not necessarily capture the nuances of aerosol transmission.

………

The new focus underscores the need for the federal Occupational Safety and Health Administration to issue standards for employers to address potential hazards in the workplace, some experts said.

This is probably one reason that both WHO and the CDC have been loath to support airborne transmission: It requires more extensive, and more costly measures to deal with the problem.

………

The new information has significant implications for indoor environments, and workplaces in particular, Dr. Michaels said. Virus-laden particles “maintain their airborne properties for hours, and they accumulate in a room that doesn’t have good ventilation.”

Yet more cost and disruption, particularly for things like reopening schools.

Aggressive action, and not reopening too soon, are required to deal with this even with vaccine rates well above 50%, and it’s going to be inconvenient as hell.

I’ve Been Saying this for HOW Long?

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As I have been saying for a while, it has been obvious to anyone watching excess deaths data that Covid-19 deaths are at least 50% higher than reported. 

It appears that the University of Washington’s University of Washington’s Institute for Health Metrics and Evaluation (IHME) has come to the same conclusion, though their number is about 100% more than reported, or about 6.9 million deaths with a total world population of about 7.88 billion.

By way of comparison, the death toll from Spanish Influenza was somewhere between 20 and 50 million with a population of 1.80 billion.

A new analysis of the toll of the Covid-19 pandemic suggests 6.9 million people worldwide have died from the disease, more than twice as many people as has been officially reported, with the under reporting being highest in less developed nations.

The numbers are grim:

In the United States, the analysis estimates, 905,000 people have died of Covid since the start of the pandemic. That is about 61% higher than the current death estimate from the Centers for Disease Control and Prevention, 561,594. The new figure also surpasses the estimated number of U.S. deaths in the 1918 flu pandemic, which was estimated to have killed approximately 675,000 Americans.

The analysis was conducted by scientists at the University of Washington’s Institute for Health Metrics and Evaluation.

“We’re probably not yet at the global toll of Spanish flu and certainly not at the death rate from Spanish flu. But given what’s unfolding in India right now, given our expectation of continued deaths, Covid is going to rival Spanish flu at the global level in terms of the count, likely, before we see the end of this epidemic,” the institute’s director, Christopher Murray, told reporters in a briefing.

………

The estimates are of deaths directly related to Covid, and do not include deaths that resulted from the pandemic’s disruption of health care — for example, people who did not seek care for heart attacks because they were afraid to go to Covid-swamped hospitals.

You can find the study here.

It’s a lot worse than the official numbers.
 

Frau Merkel (Horses Whinny) Is at It Again

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The day after the Biden Administration said that it supported suspending IP rights on the Covid Vaccine, Angela Merkel comes out against this.

I think that her motivation is pretty simple:  Covid response is going pear-shaped in Germany, with Covid cases spiking, and by ginning up a controversy, she can avoid scrutiny of her handling of the pandemic.

This is not the first time that she has done this, it’s behind the whole policy of “othering” southern Europeans and spreading misery throughout the EU during and after the financial crisis.

She knows that if she’s seen as doing something, anything, with the argument that she is protecting Germans from the undeserving “other” she, and her CDU Party, can benefit, even if it provides no benefit to Germans, and may kill hundreds of thousands of people around the world.

Merkel is despicable:

The US and Germany are at odds on the issue of waivers for patents on Covid-19 vaccines, as Berlin argued that a waiver would not increase production and would inhibit future private sector research.

The disagreement is the first major rift between the two economic powers since Joe Biden took office, and threatens to deadlock discussions at the World Trade Organization (WTO) and sour relations within the G7 group of major industrialised democracies.

Any WTO decision on a waiver would have to be by consensus, so Germany opposition is a major obstacle to intellectual property rights on vaccines being suspended.

The Biden government’s announcement on Wednesday that it would back a waiver on vaccine patents was welcomed by the World Health Organization (WHO) as a step towards greater global equity at a time when poor countries have little access to vaccines and south Asia has been hit by a devastating outbreak. India accounted for 46% of the new Covid-19 cases recorded around the world over the past week, and there are signs the wave is spreading to Nepal, Sri Lanka and other neighbouring states.

But Angela Merkel’s government came out against a waiver on Thursday.

“The US suggestion for the lifting of patent protection for Covid-19 vaccines has significant implications for vaccine production as a whole,” a government spokeswoman said.

“The limiting factors in the production of vaccines are the production capacities and the high-quality standards and not patents,” she added, arguing that the companies were already working with partners to boost manufacturing capacity.

This argument about the difficulty of vaccines is patently false, as I noted yesterday. 

You can mass produce mRNA viruses in a space smaller than the file room necessary to store the quality control documents, and Angela Merkel knows this; she got her PhD in Quantum Chemistry.

Unfortunately, there is no one in politics in Germany who is willing to call her out on her lies.

I am Gobsmacked

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But in a good way.

In a moved that surprised me the Biden administration has announced that it favors waiving Covie vaccine patents. 

I had hoped that they would eventually do this, but I expected that there would be 6 months of denials and alibis until the moral outrage forced them to take this move.

Happy to be wrong:

The Biden administration on Wednesday threw its support behind a controversial proposal to waive intellectual property protections for coronavirus vaccines, with liberals framing it as a necessary bid to speed the shots to billions in the developing world, while the drug industry warned of devastating effects to vaccine production.

U.S. Trade Representative Katherine Tai said the United States will now move forward with international discussions to waive the protections for the duration of the pandemic. U.S. officials helped block a World Trade Organization proposal that was introduced last year to stop enforcing patents for coronavirus-related medical products. Dozens of developing countries have pushed for the proposal, arguing that it would allow them to rapidly produce their own generic vaccines, rather than wait months or years for sufficient doses.

………

The decision to go forward with the waiver after weeks of internal deliberations was finalized at a White House meeting on Tuesday with President Biden, said senior administration officials who spoke on the condition of anonymity to describe the deliberations. Staff at the meeting included Tai, national security adviser Jake Sullivan, coronavirus coordinator Jeff Zients, and Bruce Reed, deputy chief of staff for policy, all of whom supported the decision. But Commerce Secretary Gina Raimondo, who had concerns about the waiver, was not included in the meeting, the people said. The Commerce Department declined to comment.

Of course Gina Raimondo wasn’t involved.  She’s a complete corporate stooge, and she would always take the side of whoever is closest to Wall Street, much as she self-dealt to herself and her Wall Street buddies as Governor of Rhode Island.

………

Administration officials have acknowledged their uncertainty about whether the waiver will actually speed up production of coronavirus vaccines across the world. The mRNA vaccines, made by Pfizer-BioNTech and Moderna, require special technology that most countries do not have access to, raising questions about which countries will actually have the technological capacity to manufacture the complicated vaccines.

The reporter clearly doesn’t know the technology, as Cory Docterow observes, mRNA vaccines can pack most a whole vaccine factory in the space of a closet: 

So, is it a lie? MRNA vaccines are super-new tech. Maybe their manufacture is so esoteric that only the richest, most powerful countries can make them?

Nope.

“Rapid development and deployment of high‐volume vaccines for pandemic response” (DOI: 10.1002.amp2.10060) is an open access, peer-reviewed paper in the American Institute of Chemical Engineers’ Journal of Advanced Manufacturing and Processing:

https://aiche.onlinelibrary.wiley.com/doi/full/10.1002/amp2.10060

Its co-authors are an interdisciplinary team of chemical engineers, infectious disease specialists and vaccine specialists from Imperial College London and the International AIDS Vaccine Initiative.

The authors aren’t specifically addressing themselves to the question of global development of mRNA vaccine production, but are instead concerned with any kind of generic rampup in production — either in response to a new virus, or because of an mRNA-based vaccine breakthrough for an existing virus. They reason that any kind of annual covid shot will occupy the majority of existing mRNA vaccine production facilities, so any new global vaccination project will require that new production sites be built.

 ………

I know, I just blockquoted all of that, so it would be redundant to bullet it below, but JESUS F%$#ING HOLY GODDAMNED SH%$BALLS, does this ever bear repeating:

  • New facilities will be 99–99.9% smaller than conventional vaccine facilities
  • They will be 95–99.7% cheaper than conventional vaccine facilities
  • You could use a single room in a conventional vaccine factory to make more vaccine doses of mRNA vaccines than the entire output of the rest of the factory
  • New vaccines can be made 1,000% faster than previous vaccines

There’s more, like the fact that you only need part of the facility to be a high-spec clean-room, and the rest can be built on more conventional lines.

For $20m, they say they can build a facility where, for $100m/year, they can turn out 1b doses/year, using a single 5L bioreactor.

(%$# mine)

Run the numbers there.  That’s a cost of $0.12/dose. 

Add in the cost of regulatory compliance, packaging, maintaining a cold chain while shipping it a few hundred (as opposed to a few thousand) miles, and tracking lots, and you are still below $10/dose.

The Pharma powers that be are opposed to any sort of relaxation of IP regulations not because duplicating their instrumentality is hard, but because it is trivially easy, and said technology is publicly developed and publicly funded.

They want to continue to extract their rents and keep their ill-gotten gains, because they want another yacht to water-ski behind.

This is How You Weed Out the Militia Types

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Once again making a joke of, “Protect and Serve,” police are some of the public servants least likely to get a vaccine.

This is a good thing:  It is a canary in a coal mine.

When you tell a police officer, get a vaccine, or you are suspended, and they take the suspension, 9 times out of 10, they are right wing militia types who have infiltrated the police.

These are the cops who generate your problems with brutality, racism, and million dollar judgement.

Let them go:

Police officers were among the first front-line workers to gain priority access to coronavirus vaccines. But their vaccination rates are lower than or about the same as those of the general public, according to data made available by some of the nation’s largest law enforcement agencies.

The reluctance of police to get the shots threatens not just their own health, but also the safety of people they’re responsible for guarding, monitoring and patrolling, experts say.

At the Las Vegas Metropolitan Police Department, just 39 percent of employees have gotten at least one dose, officials said, compared to more than 50 percent of eligible adults nationwide. In Atlanta, 36 percent of sworn officers have been vaccinated. And a mere 28 percent of those employed by the Columbus Division of Police — Ohio’s largest police department — report having received a shot.

“I think it’s unacceptable,” Joe Lombardo, the head of Las Vegas police and sheriff of Clark County, said of the meager demand for the shots within his force.

………

Police hesitancy also means officers may be vectors of spread to vulnerable people with whom they interact during traffic stops, calls for service and other high-contact encounters. That could thwart efforts to restore community trust in a moment of heightened scrutiny after last month’s conviction of ex-officer Derek Chauvin in the killing of George Floyd.

“Police touch people,” said Sharona Hoffman, a professor of law and bioethics at Case Western Reserve University. “Imagine having a child in the car who’s not vaccinated. People would want to know if a police officer coming to their window is protected.”

Make it mandatory and fire the cops who refuse.  They are refusing to support public health.

You will end up with a better police force.

Continue Pushing

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If Joe Biden has a virtue as President, it is that he will do the right thing if he has no alternative, a characteristic that he does not share with his three predecessors. 

That being the case, the continuing efforts by Democrats in Congress to push Medicare expansion should continue:

Congressional Democrats are planning to pursue a massive expansion of Medicare as part of President Biden’s new $1.8 trillion economic relief package, defying the White House after it opted against including a major health overhaul as part of its plan.

The early pledges from some party lawmakers, led by prominent members of its liberal wing, threaten to create even more political tension around a package that is already facing no shortage of it. The expansion push comes as Biden on Wednesday stressed in his first address to Congress that he is still committed to making health care more affordable.

They specifically aim to lower the eligibility age for Medicare to either 55 or 60, expand the range of health services the entitlement covers and grant the government new powers to negotiate prescription drug prices. Party lawmakers say their approach could offer new, improved or cheaper coverage to millions of older Americans nationwide.

………

The early efforts reflect a broader belief among congressional Democrats that they must more aggressively seize on their narrow but powerful majorities to push policies that long have been stalled in Washington — no matter their cost. Many party lawmakers have pushed Biden at times to spend sky-high sums, sometimes even more than the president himself says he supports, arguing that they have a political mandate to pursue vast economic change.

Also, let us not forget, lowering the age of Medicare eligibility is also exquisitely good policy. It creates a 25% savings right off the back.

But health-care revisions are likely to present a significant challenge, threatening to open rifts not just between the two parties but within the Democratic caucus itself. In an early sign of trouble, Sen. Joe Manchin III (D-W.Va.) told The Washington Post on Wednesday that he opposes expanding Medicare eligibility even as he supports broader adjustments to the Affordable Care Act.

Of course Manchin opposes expanding Medicare.  He’s an evil hypocrite.

………

For many Democrats, the most enticing target is Medicare, as they try to deliver on their 2020 campaign promises to make health insurance affordable and available. Biden himself endorsed a policy report after the party’s presidential primaries — part of a “unity” effort among Democratic contenders, including Sanders — that called for lowering the Medicare enrollment age and expanding the health services it covers.

Make Manchin vote against this.  Make Sinema vote against this.  Make the rest of them vote against Medicare expansion.

Make them pay the cost for being narcissistic amoral assholes.

A Stopped Clock Moment

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The 2nd worst Democrat in the Senate, Joe Manchin, has announced his support for IP waivers for generic Covid vaccines.

Of course, this might have something to do with his Kid’s business, as Heather Bresch probably still has outstanding stock options with the now a part of  Upjohn, Mylan.

Mylan is/was a generic drug manufacturer :

Sen. Joe Manchin expressed support for the World Trade Organization proposal to temporarily suspend enforcement of patent and intellectual property enforcement for Covid-19 medical treatments.

The waiver request, led by India and South Africa and backed by a coalition of countries, would allow more widespread global production and distribution of generic coronavirus vaccines, tests, and treatments.

Asked about the waiver proposal on Thursday, Manchin said it sounded like a good idea.

“I’ve always been a supporter of generics coming on,” said Manchin, speaking to The Intercept on Capitol Hill.

I really don’t care what his motivation is, it lends a some “Centrist” cred to the effort to place limits on the reach of IP.

The West Virginia Democrat referenced the fact that the U.S. government financed the research, development, and domestic deployment of coronavirus vaccines. He noted that the drug companies “shouldn’t” generate profits from a product sponsored by taxpayers.

This qualifier applies to every major pharmaceutical development over the past few decades.

Big pharma has devolved into an orgy of rent-seeking.  (Which seems to be my theme for tonight)

Unleash the Free Market

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New: This is a stunning chart.

The amount it costs to provide health care to people with employer insurance rises steadily with age.

Then, people turn 65 and go on Medicare, and the cost of health care drops precipitously.https://t.co/2HhgSvKrZr@matthew_t_rae @jcubanski pic.twitter.com/5kFiBllkj9

— Larry Levitt (@larry_levitt) April 27, 2021

This graph explains how the American healthacre system is failing.

If the market worked, healthcare costs would continue to increase, but they don’t.

Referring to the linked article, here are the money quotes:

  • Average health care spending per person per month for enrollees ages 60-64 in large employer plans ($1,061) is 38% higher than average monthly spending for traditional Medicare beneficiaries ages 65-69 ($770) (Figure 1). This comparison understates the savings that could be realized by shifting 60-64 year olds to Medicare, since one would expect 65-69 year olds to have roughly 20-25% higher spending, because health needs rise with age.
  • Average monthly health care spending for large employer plan enrollees ages 60-64 is similar to that of traditional Medicare beneficiaries in their early 70s, who tend to use more health care services than people in the younger age cohort.

The New York Times Catches Up With Me

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Worse than Spanish Influenza

I’ve been talking about how excess deaths is the best measure of Covid-19 mortality, (see here and here) and now the New York Times has discovered the statistical measure.

It only took them a year, though the graph surprised me.

It turns out that Covid is worse than the Spanish Influenza epidemic: 

A surge in deaths from the Covid-19 pandemic created the largest gap between the actual and expected death rate in 2020 — what epidemiologists call “excess deaths,” or deaths above normal.

Aside from fatalities directly attributed to Covid-19, some excess deaths last year were most likely undercounts of the virus or misdiagnoses, or indirectly related to the pandemic otherwise. Preliminary federal data show that overdose deaths have also surged during the pandemic.

………

In 2020, however, the United States saw the largest single-year surge in the death rate since federal statistics became available. The rate increased 16 percent from 2019, even more than the 12 percent jump during the 1918 flu pandemic.

These numbers are really f%$#ing scary.

I Guess Nancy Wants those Donations from the Insurance Industry

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In yet another “Democrats in Disarray” story, the Washington Post notes that there friction between Nancy Pelosi and Bernie Sanders, because Pelosi wants to make Biden’s subsidies to Obamacare permanent, and Sanders wants to expand Medicare. 

This is really pretty simple, making the Obamacare subsidies permanent is a subsidy for the insurance companies, and not of people in need, while expanding Medicare helps everyone.

Pelosi wants to keep feeding money to the insurance companies because she wants to keep raising campaign donations from the insurance companies:

The White House is facing diverging pressure from two powerful allies — House Speaker Nancy Pelosi (D-Calif.) and Senate Budget Committee Chairman Bernie Sanders (I-Vt.) — over whether to use an upcoming spending package to strengthen the Affordable Care Act or expand Medicare eligibility.

Pelosi’s office is pushing the White House to make permanent a temporary expansion of Affordable Care Act subsidies that were included in the $1.9 trillion stimulus legislation last month, according to a senior Democratic aide who spoke on the condition of anonymity to describe internal conversations.

Sanders said in an interview that he is arguing for lowering the age of Medicare eligibility to 55 or 60 and expanding the program for seniors so it covers dental, vision and hearing care.

The contrasting visions for the next phase of President Biden’s legislative agenda reflect divisions within the Democratic Party about how Biden should further overhaul health insurance in the United States. Pelosi is looking to double down on the ACA, which has become more popular in recent years as it offers insurance subsidies to people well above the poverty line. Sanders, meanwhile, is looking for an opportunity to make progress on his longtime efforts to make government health insurance universal.

Lowering the Medicare age is better policy, because it puts more pressure on expanding the program in the future, while Obamacare, while better than what went before us, still sucks wet farts from dead pigeons.

Also, I would note that expanding Medicare is better policy, because older people vote in higher percentages than younger ones.

My prediction:  Biden goes with expanding subsidies to insurance companies, because, he’s always been a creature of the finance and insurance industries.

We Live in Bizarro World

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Did not Expect This

I never thought that I would agree with Elmer Gantry wannabee Franklin Graham, but his support for vaccines is unequivocally correct.

Needless to say, his wacko, my parents are first cousins, X-Files wannabe, black helicopter, tinfoil hat wearing, stupid, dim-witted, thinks pro wrestling is real* fellow travelers, were not so sanguine about his statement. (By that I mean that they went nuts)

So, Franklin Graham was right about a matter of both public health and the overall public good.

I cannot believe that I just said that.

*Sorry, I think that I just channeled the comedian Denis Leary.

Remarkably Toxic Individuals

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It turns out that only 12 people are responsible for the overwhelming majority of anti-vaxx content online.

It really is amazing what a few horrible people can do:

They’ve been dubbed the “Disinformation Dozen”: 12 individuals or organizations are tied to up to 65 percent of anti-vaccine content circulating on major social media networking sites, according to an analysis of popular anti-vaccine content on Facebook and Twitter.

………

The report accuses Robert F. Kennedy Jr. — who was banned from Instagram last month — Joseph Mercola, Ty and Charlene Bollinger — whose Twitter accounts were briefly suspended at the beginning of the pandemic — Sherri Tenpenny, Rizza Islam, Rashid Buttar, Erin Elizabeth, Sayer Ji, Kelly Brogan, Christiane Northrup, Ben Tapper and Kevin Jenkins of spreading disinformation and claims that their social media accounts “have repeatedly violated Facebook and Twitter’s terms of service agreements.” And the CCDH has receipts — the report is full of screenshots of “example violations” that range from misleading to antisemitic.

It’s not a surprise.  The past few years have shown us the potential effects of a few toxic individuals in the right (wrong?) places.

It Just Gets Better and Better

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People don’t fear Andrew Cuomo any more, and so more and more people are dropping a dime on his corrupt behavior. Case in point, people are now telling reporters that Cuomo arranged for family members and close associates to get special access to Covid-19 testing.

We are going to see more and more of this: 

As the coronavirus pandemic swept through New York early last year, Gov. Andrew Cuomo’s administration arranged for his family members and other well-connected figures to have special access to state-administered coronavirus tests, dispatching a top state doctor and other state health officials to their homes, according to three people with direct knowledge of the effort.

As part of the program, a state lab immediately processed the results of those who were tested, the people said, even as average New Yorkers were struggling to get tested in the early days of the pandemic because of a scarcity of resources. Initially, the lab was capable of running only several hundred tests a day for a state with 19 million residents.

The use of state resources to benefit people close to the governor raises serious ethical questions, experts said. New York law prohibits state officials from using their positions to secure privileges for themselves or others.

Drip, drip, drip. 

Cuomo’s career is toast, and only bad thing about this is that it did not happen a decade ago.

Well, This Explains a Lot

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It turns out that over the past 70 years, many medical conditions that were considered normal are not considered pathologies that require aggressive treatment.

There is a lot of money in this, which raises the obvious question, “cui bono?”

As many as 16 million Americans are prone to screaming and pounding on the dashboard when someone cuts them off in traffic. Another 7 million are fully capable of devouring a whole box of cookies in front of the TV.

There are 14 million men with low testosterone, 9 million women with low sexual desire — and tens of millions of people with bladders that are too active and blood sugar that’s a little too high.

The common thread: All have non-life-threatening conditions that for most of the 20th century were not considered a part of mainstream medicine. Some did not exist at all as formal disorders.

Each of the conditions, from intermittent explosive disorder to overactive bladder disorder, is the product of a new or expanded definition. These definitions come from medical societies or researchers who get money from drug companies.

Not to worry though, I’m sure that the invisible hand of the market, and the “skin in the game” required by Obamacare, will fix all this.

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Purdue Pharma, best known as the manufacturer of the opiate Oxycontin, has been fighting tooth and nail to keep their marketing tactics from the public, but today a judge ordered those records unsealed:

Purdue Pharma, the maker of OxyContin, lost a legal battle Wednesday to keep records and testimony about its bestselling and widely abused painkiller secret.

A judge in Pike County, Kentucky, a region hard-hit by prescription painkiller abuse, granted a motion by a news outlet to unseal records from a lawsuit by the state accusing the company of fraud, conspiracy and negligence in the development and marketing of the drug.

Purdue settled that suit in December for $24 million without any admission of wrongdoing.

Circuit Judge Steven Combs granted the request of Boston Globe-affiliated investigative health news outlet STAT to unseal the documents, writing: “The Court sees no higher value than the public (via the media) having access to these discovery materials so that the public can see the facts for themselves.”

The judge said the order would not take effect for 32 days, allowing Purdue time to appeal.

Let’s be here:  Purdue has been aware of its potential for abuse and its addictive properties for a very long time, and it is clear that they used these to increase sales.

They are no different from the corner drug pusher, and seeing their marketing exposed to the light of day, with the resulting social pressure and prosecutions, would please me no end.