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khnocarechart-300x183Insurers feast on uncertainty the way most of us attack a holiday spread. They can relish risk because they know it can mean higher premiums and profits for their dealing with clients’ risks. This is one point to keep in mind while reading the abundant coverage of the latest step in Republicans’ decade-long assault on the Affordable Care Act, aka Obamacare.

A federal appeals court has struck down the zero-penalty piece of Obamacare, what many call a key part of the ACA (which, effectively, didn’t exist anyway). The judges also sent back this ACA challenge to their extremist colleague in Texas to parse which parts of Obamacare he thinks can stand up now that the sweeping health care law no longer has its “unconstitutional” individual mandate — the legal requirement that Americans must carry health insurance.

In response to a lawsuit filed against the ACA by 20 Republican attorneys general — and supported by the flip-flopping Trump Administration through the Justice Department — “U.S. Judge Reed O’Connor of the Federal District Court in Fort Worth struck down the entire law [almost a year ago], saying the individual mandate could not be severed from the rest of the Affordable Care Act because it was ‘the keystone’ of the law, essential to its regulation of the health insurance market,” the New York Times reported.

With back-to-back-to-back incidents of mass gun violence killing almost three dozen children, women, and men, can this nation muster the political courage to treat this lethal scourge as a public health menace?

Can it, finally, green light and fund rigorous research that could inform public policies that both could protect Americans’ Second Amendment rights while also reducing the estimated 40,000 or so firearm deaths that occurred in 2018 alone?

For what it is worth, there is considerable and (what should be) convincing evidence that:

bloodcellsred-300x200Iron poor blood? For many of a certain age, mere mention of that phrase conjures the major advertising campaigns of yore for a popular, over-the-counter nostrum called Geritol. The tonic is still around and sells for less than what a first-run movie ticket costs.

Which leads to a different question that may burn many patients: Why are doctors and hospitals peddling Injectafer, a new and hot treatment for iron deficiency that happens to cost $14,000 per vial? The drug also must be given intravenously by trained medical personnel at additional cost in a doctor’s office, a clinic, or hospital.

Shefali Leuthra reported for the Kaiser Health News Service and NPR that doctors are ordering Injectafer and other pricey prescription drugs like Feraheme for big numbers of patients, particularly seniors because they suffer a common condition:

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.

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