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arbtoon-245x300When older Americans suffer major injury or illness, their loved ones may find themselves under the gun, making expensive and complex decisions about their care. They’re likely to be slammed, too, with stacks of paperwork from caregiving facilities. It’s tough stuff to take in — and it too often ask them to sign documents that will boot them from constitutional protections of the civil justice system and into the secretive, private system of forced arbitration.

The U.S. Supreme Court—loaded with appointees from a business-friendly party—has backed “corporate controlled” arbitration systems in several rulings, further arming them with bans on class-action lawsuits. This has led to burgeoning injustices, cases in which “corporate wrongdoers … completely escape any legal accountability,” according to the Center for Justice & Democracy at New York Law School, Public Citizen, and the National Consumer Law Center.

The groups have amassed representative cases showing how forced arbitration forecloses plaintiff’s pursuit of remedies from harms in the civil justice system, as the Constitution guarantees.

cdchepc-300x279Big Pharma has given baby boomers, members of under-represented communities, and American taxpayers rare and promising good news about a product price cut: A drug used in a highly effective multi-course treatment for hepatitis C will see its sky-high price continue to plunge.

Gilead Sciences Inc., facing steep competition from other makers and innovations from non-profits, has decided to sell cheaper, just as potent versions of its hep C fighting drugs Epclusa and Harvoni. The company’s “authorized generics” will be sold for $24,000 for a regimen of care that has been shown to  clear the once lethal hepatitis virus in patients. The new medications’ costs also compare to launch list prices of their branded predecessors: $94,500 for Harvoni and $74,760 for Epclusa.

Those drugs had generated huge profits for Gilead, boosting its market valuation to almost $100 billion. At the same time, critics assailed the company for profiteering, leading to congressional hearings. Gilead also found itself embroiled in a market competition, with drug makers AbbieVie and Merck introducing alternative and cheaper products that slashed into profits of the Foster City, Calif., company that broke ground in hep C treatment.

gottliebAfter critics called President Trump’s long-awaited plan to rein in Big Pharma’s rapacious prices disappointing, his administration launched a much-tried tactic against the industry: “naming and shaming.” The federal Food and Drug Administration issued a list of drug makers and the complaints against them about their expensive “shenanigans,” their efforts to undercut potentially cost-cutting competition by stalling the creation of generic counterpart medications.

As the New York Times reported, Uncle Sam and Big Pharma have battled for some time over generics, which FDA Commissioner Scott Gottlieb has made a new cost-controlling priority. These drug alternatives, which don’t carry patent protections and pricey branding, marketing, and advertising, are supposed to be cheaper and equally safe and effective for patients.

But their makers need large batches of Big Pharma samples to work with to develop generics  ─ and more than three dozen major firms like Johnson & Johnson’s Actelion Pharmaceuticals, Celgene, Gilead Life Sciences, Novartis, Pfizer, and Valeant have balked at providing requested products.

An ugly truth about malpractice lawsuits is that some of the most indefensible violations of patient safety are covered up by hospitals, clinics and doctors with the complicity of the lawyers representing the injured patients.  This happens when settlements are entered into that require the patient to keep confidential everything that happened, and sometimes to even pretend it never happened.

USA Today has a big takeout today that describes a particularly egregious example: the prestigious Cleveland Clinic covered up a rape allegation against one of its surgeons by settling the patient’s claim and requiring the patient to sign a settlement document promising to remain silent about the episode. Eventually the surgeon resigned quietly and moved onto another health care institution, which of course knew nothing about the allegations until informed recently by the newspaper.

Everybody is familiar by now with how secret settlements have allowed sex abusers in the entertainment and media world – Harvey Weinstein, Bill Cosby, Bill O’Reilly and the rest of the gallery of shame – to buy off their accusers and go onto perpetrate harms against others.

CRO-Candy-counts3-10-17-112x300You and the kids may decide to splurge a little, devouring some Halloween candy. (Know that just a few of these morsels pack a load of unhealthy excess calories and sugar — see the great infographic from Consumer Reports.)

So here’s the penitent-tradeoff: While muching on a choice few bites of candy, please also take the time to sign up for your 2018 health insurance. Many of you will get tons of information from your employer because you get coverage at work.

If you qualify for insurance on exchanges created under the Affordable Care Act, aka Obamacare, the big news is, yes, the program still exists. It can benefit many, but they need to review their options and get aboard during the program’s Nov. 1-Dec. 15 open enrollment period. The Trump Administration has made some of this process more challenging, decreasing the support for public outreach and shortening the qualifying time.

Republican leaders just can’t seem to help themselves. As they flounder in their assault on the Affordable Care Act, aka Obamacare, they have moved from the inaccurate and counter-factual, beyond partisan buzzwords and talking points, and into a territory where they keep uncorking one howler after another about American health care and the ACA.

Two health care experts just put out a list of seven questions that Congress needs to answer about its replacement for the Affordable Care Act. The list is simple and useful for all of us in any contacts we have with lawmakers. Here it is:

1. How many millions of Americans will lose coverage?

2. Will people over 55 pay higher health premiums for the same coverage?

3. Will the new plan let insurers charge women higher premiums than men while offering them less coverage?

4. What other services are likely to be cut?

5. Will the new plan let insurers reinstate annual or lifetime limits on coverage?

6. What will happen to the more than 130 million Americans with pre-existing conditions?

7. How much more will those with costly illnesses or injuries have to pay in out-of-pocket costs?

For more details about what the possible answers might be, read the op-ed in the New York Times that this list came from, by Harold Pollack of the University of Chicago and Timothy Jost of Washington and Lee University.

And if any readers of this blog feel moved to pick up the phone and call your Representative or Senator, here’s a website that has a dedicated phone line that will patch you through to the right member of Congress representing you.

Or just call: 866-426-2631.

braintraumaIt may sound macabre. But advocates say a critical step to address important gender disparities in the care and research on concussions’ harms may rest in convincing more women to donate their brains to science. This has already  helped to prove the debilitating and deadly effects of head trauma among men in pro sports.

In contrast to the many and growing number of male athletes (especially pro football players) and their families who have allowed post-mortem brain studies, far fewer elite female players have agreed to similar research. Stat, the online health information site, says soccer stars Brandi Chastain, Abby Wambach, and Megan Rapinoe are among the public few.

Autopsies are often the only way, for now, for experts to definitively diagnose debilitating conditions like chronic traumatic encephalopathy (CTE) that result from repeated head trauma (concussions).

CRO_Health_CROH_July_Medical_Bill_05-15Surprise! California lawmakers waited until the very end of their legislative session before joining an increasing number of states in protecting patients from unexpected out-of-network medical charges. As many as 70 percent of patients staggered by these often hefty bills say they didn’t know they were receiving out-of-network care when it was given.

Gov. Jerry Brown is expected to approve the surprise medical bill legislation, which was bitterly opposed by providers. The measure won bipartisan support in providing that “patients who received care in in-network facilities would have to pay only in-network cost sharing” and only in instances of non-emergency care. As the industry publication Modern Healthcare describes it:

Emergency physicians in California already are barred from balance billing patients. The bill’s provisions [do not apply] to self-insured employer health plans, which are shielded from state regulations by the federal Employee Retirement Income Security Act. Health plans would pay non-contracting physicians the plan’s average contracted rate or 125% of the Medicare rate, whichever is greater. Doctors could appeal that through a binding independent dispute resolution process, which the state Department of Managed Health Care will establish.

gwuhospitalMore than 3,600 hospitals across the United States have taken a star turn. Many aren’t happy about it, and the same may be true for some members of Congress. Whether patients benefit is still murky. But federal officials, who have been planning a new and expanded hospital rating system for a long time now, have gone ahead with it because they say it will clarify for consumers some critical issues of safety, quality, and cost in health care.

Uncle Sam took 64 ratings it already publishes on its Hospital Compare website on measures like emergency room wait times and hospital acquired infection rates, and, summarized these into overall scores for institutions large and small. The Centers for Medicare and Medicaid Services, grouped them, weighted them, and, ultimately, converted the data into stars, from a low of one to a high of five.

Federal officials say this rating system, more common with restaurants and on review apps for the young, like Yelp, gives patient-consumers a fast, easy, clear, convenient way to start to deal with the complex, difficult issue of whether a hospital’s any good or not. The hospitals disagree, strongly, and some members of Congress have sided with them, and against the star ratings.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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