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There Is No Safe Haven for Patients in the Privatized U.S. Health Care System.

Posted on | January 6, 2021 | 1 Comment

Mike Magee

TIME correspondent Karl Vick, in an article titled “What Happens When Amazon Takes on Health Care”, in February, 2018, wrote:  “The U.S. health care system is the antithesis of Silicon Valley.” But is it really? 

Vick was referring then to the formation of a new, as yet unnamed non-profit joint venture between Jeff Bezos (Amazon). Warren Buffett (Berkshire Hathaway), and Jamie Dimon (JP Morgan Chase) The triad was joining ranks, they said, to finally bring efficiency and quality to American health care. It would be another nine months before they could settle on a name for the venture – Haven (as in safe haven for their 1.3 million combined employees).

The very public collapse of Haven this week left it unclear whether they were public-spirited crusaders or simply predatory investors in one of the most profitable segments of our national economy.

Analysts have wasted no time piling on. As one said, “Haven had a rocky three years, running up against vague marching orders, a lack of direction, and obstacles inherent to the healthcare landscape.” Another analyst added,  this “is a reminder that the U.S. healthcare sector is incredibly resistant to makeovers…” 

Insiders pointed to an absence of organizational cohesiveness. All three partners were also pursuing independent ventures in the health care space, and were continually running into proprietary roadblocks.

Amazon, in particular, had its own agenda. Their wearable health tracker, Amazon Halo, augmented by Alexa features, was now joined by virtual and in-person Amazon Care clinics for its own employees. Those employees have access to premium priced prescription drugs after the company purchased PillPack for $753 million in June, 2018.

Other analysts noted a lack of momentum. The first market forays – like their new no-deductible insurance policy – was slow to come and not overwhelmingly embraced by the 30,000 JP Morgan employees. There were also rumors that Amazon in particular was about to pull its financial support.

And yet, it is useful to ask why none of the Triad seem to have regrets. 

Jamie Dimon said, “Haven worked best as an incubator of ideas, a place to pilot, test and learn—and a way to share best practices across our companies. Our learnings have been invaluable.”

Warren Buffett said previously, that this was a “a first step in what is bound to be a long journey.“

And a Bezos spokesperson noted, “The venture’s backers found Haven was a good venue to test new ideas and best practices that could be better implemented individually.”

With the election of Rev. Raphael Warnock and Jon Ossoff in Georgia, and the shift of Senate control to the Democrats, will health services continue to be an investment darling?

McKinsey & Company this week offered a qualified yes in a report titled,  “The future of healthcare: Value creation through next-generation business models.” 

With a straight face, they begin: “The healthcare industry in the United States has experienced steady growth over the past decade while simultaneously promoting quality, efficiency, and access to care.” 

But in their next breath comes a yellow caution: “The next three years are expected to be less positive for the economics of the healthcare industry, as profit pools are more likely to be flat.”

Where does McKinsey & Company see profit? They flag information technology, telehealth, and virtual services and delivery as opportunity areas saying, “In the provider vertical, the rapid acceleration in the use of telehealth and other virtual care options spurred by COVID-19 could continue. Growth is expected across a range of sub-segments in the services and technology vertical, as specialized players are able to provide services at scale (for example, software and platforms and data and analytics).”

That should make the Triad smile, but cause patients to shudder. 

How Is Your State Doing With The Covid Vaccine?

Posted on | January 6, 2021 | No Comments

Access Spread Sheet HERE

Data Source: Washington Post

CDC Interactive State Covid Vaccine Map.

Posted on | January 2, 2021 | No Comments

First Post of 2021 – The Pledge and Allegiance.

Posted on | January 1, 2021 | No Comments

 

Access Image HERE
Data Source – Washington Post

Mike Magee

Our new year has arrived. And Covid has more than confirmed the central tenet of “Code Blue” – there is no national health system in America, and little evidence of one “indivisible” nation. Rather we rely on a profit-driven Medical Industrial Complex that is committed to integrating its various guilds and their government relations strategies to maintain and extend financial control.

That is the reality in 2021. The historic conceit – defeat disease, and health will be left in its wake. According to this myth, there is no need for national planning or an integrated public health infrastructure. The silver bullets of discovery and innovation will rescue us “just in time.” That is our silver lining.

Code Blue” laid out how we got here, and how we might confront and correct it. But in the meantime, Covid appeared, and here we are. Where is that exactly?

Well, we have multiple highly effective vaccinations, but limited capacity to effectively vaccinate our citizens en masse to avoid further disaster. Azar’s promise of 100 million doses by year end, first shrunk to 40 million, then 20 million, but ended the year as only 3 million injections (and that’s a first installment on a double-dose regimen).

Trump washed his hands of the whole mess some time ago. No sense crying over spilt milk, or giving him a moment more of our time. Azar’s team will soon be gone, too. But they’ve already placed the onus on the states – transferring responsibility without funding.

Theoretically, Biden’s team will help a bit, but the reality is rather stark:

  1. There is no integrated national plan to address this deadly pandemic that has no geographic boundaries in these disunited United States.
  2. You cannot build public health infrastructure overnight. It takes people, and talent, and money, and data, and systems, and a lot of hard work.

Most of us will survive this calamity of course. We will track the numbers above – comparing one state’s performance to another – tapping into our competitive spirit once again to find the energy to overcome the chaos we’ve inflicted on our own citizens.

But the reality is, as a nation, we need to grow up fast. We need to address our historic inequities, redistribute our wealth among our citizens, explore the meaning of forward planning, sharing and solidarity, and reject cruel and predatory profiteering.

To conquer Covid and heal our nation, even the most cynical of us increasingly realize that we must now create a national and universal health plan. It is the equalizer, the mobilizer, and the stabilizer that is missing and essential. Without it, there will never be “one nation, under God, indivisible, with liberty and justice for all.”

Last Post of 2020: Making Sense of the 70 Million Trump Voters.

Posted on | December 30, 2020 | 4 Comments

Mike Magee

On this final day of 2020, I continue to struggle with this 70 million Trump voter issue.

On the surface, it feels like a broad recrimination of the goodness and intelligence of nearly half of American voters – rendering us “unexceptional” at best.

Even if you grant targeted voters against abortion, or for state’s rights, or concerned about budget deficits, this requires that we accept a remarkable reliance on situational ethics: that you could accept evil, degeneracy, selfishness, and cruelty in a clearly unstable leader if you were able to get what you wanted in the bargain.

While there may be elements of truth in that, I think it’s too simple an explanation. There are other contributors.

We are a consumer society (aka greedy).

We are an individualistic society (aka no tradition of solidarity).

We are a gullible society (aka naive enough to embrace fantasies).

We are an entertainment society (aka easily distractible).

We are a young society (aka immature and quick to discard our elders).

We are Americans (aka vulnerable to someone exactly of the size and dimensions and character of Trump).

The good news, as we enter 2021, is – we are other things as well – innovative, creative, energetic, mostly immigrants, hopeful, and loving (sometimes).

This time around, good conquered evil – barely.

Now we must demonstrate that we know how to use the power to move the needle in favor of our better selves.

How do we make America healthy – in body, mind, and spirit?

That is the question for 2021.

Truth and Trust in 2021.

Posted on | December 29, 2020 | 2 Comments

Mike Magee

Exactly three years ago, veteran Health Policy expert, James A. Morone, Ph.D., made an interesting argument for single payer health care in the NEJM. In proposing a sweeping change that would directly address “the American patchwork”, assert “the norms of communal decency”, promote planning and efficiency, and empower “a righteous band of reformers, deeply committed to a cause, pushing against all odds”, he did not sidestep higher taxes on the rich.

Rather he sold into them, presenting high taxes on the rich in return for universal health coverage as “on a short list of available policies designed to push back on inequality.”

His argument boiled down to the fact that a central element of the national crisis we called “Trump” was populist anger grounded in remarkable income inequality. In roughly a half-century, our separation between rich and poor which used to mirror France and Japan, now aligns with Mexico and Brazil.

Three years later, with Covid ravaging us unabated, we’re a mess, and our citizens are pretty fed up. And why shouldn’t they be? Our top 1% controls roughly 40% of all wealth, while the bottom 90% manages a paltry 23%. If you’re a white family in America, you were born lucky. On average, your family is about 10 times as wealthy as your black family counterpart.

Back in December of 2017, Morone reminded us that major policy changes can, and have, flipped on a dime in the past. As he wrote then, “Disruptive populism ended past American gilded ages, and it shows signs of challenging the current one.” With better health delivery, and more equality and social justice, we might also redirect the course of American politics and American politicians.

In the same issue of NEJM,  Henry J. Aaron, Ph.D., explored a different road to reform, raising legitimate concerns about the unintended consequences of disrupting existing insurance holders, and arguing for a more cautious incremental approach including extending availability of Medicare and Medicaid to others, and shoring up ACA exchanges. He wondered then how far and how fast Americans were willing to go?

That same week, New York Times columnist, Thomas Friedman, presciently shared his view. He didn’t pull punches when he accused Trump of intentionally undermining the two critical pillars of American society, truth and trust. And here we are today.

Interestingly, in the careful analysis of these two health policy experts above, both identified an embattled and epic American struggle over how to topple the health care status-quo, a Medical-Industrial Complex controlled and directed by members of the 1%, and a debate that currently hangs on whether we – the citizens – are able to discern fact from fiction.

The key question for health reform and for the future of America: Do we trust a government “of, by, and for the people” to assure that each of its citizens has the right to “life, liberty, and the pursuit of happiness?”

Trump is all but gone -rejected, dejected, marginalized and soon-to-be ignored. It is now on us. If a majority of Americans can move to “yes” on truth and trust, we will find a way to embrace each other equally through health reform. And the quality and durability of that embrace will be determined by these Code Blue principles:

1. Universality: Comprehensive health coverage is a right of citizenship.

2. Public Administration: Administration of basic health coverage is organized in the most cost-efficient manner possible with central oversight by the government. 

3. Local Control of Delivery: The actual delivery of services is provided by health professionals and hospitals at the local and state levels.

4. National Health Planning and Coordination is a Priority:  Creating healthy populations is a high priority on the federal and state levels. (Covid disaster – never again!)

5. Transparency: Providers submit bills. Government ensures payment of bills. Patients focus on wellness or recovery.

2021 is the year to do right by each other and take care of each other!

Lundberg’s Words: “System-shaking, even convulsing.”

Posted on | December 28, 2020 | No Comments

Mike Magee

Last week, Medscape’s editor-at-large, George Lundberg, wrote, “In 2017, I published a Medscape column that asked, “How many books will it take?” listing several titles that were intended to provoke repairs or rebuilds. Still nothing happened. Then came COVID, adding massive insult to injury of our already overpriced, overworked, bloated, inefficient, ineffective megalith American procedure-driven medicine.”

Is it possible, as Lundberg suggests, that America has reached a tipping point on health reform?

Exactly two years ago, in the middle of Trump’s caging of immigrant infants and children, the Washington Post ran the headline, “Our agents did everything they could.” The article captured the performance of Kevin McAleenan, head of the U.S. Customs and Border Protection defending his agencies oversight of the death of a second migrant child in the week after Christmas. His exact  words: “Our agents did everything they could as soon as these children manifested symptoms of illness to save their lives.”

As wicked and depressing as this performance, these were not isolated actions or even outliers. The Covid spotlight has revealed our weaknesses – especially for the most vulnerable. And the knife cuts deep as an indictment of the U.S. Health Care system at large. 

As 2020 draws to an end, Lundberg suggests that we as a nation must finally confront the lie that “we did all that we could.” As yet, we have not. 

Our problems are long standing. When I set out to write the 70 year history of the rise of the Medical-Industrial Complex in America, the glaring absence of fundamental national health planning appeared and reappeared year after year. No one across those many years asked the fundamental question, “How do we make America and all Americans healthy?” 

In his review of my book, Code Blue, Lundberg writes, “…in order to redesign a system to achieve different results, it would be helpful to understand how the system became the way it is.”

In the reading, you can sense that Dr. Lundberg ultimately found what he was looking for, and admires what he labels  “the Herculean task of explaining all this intertwining stuff so that readers can understand how we got here… What Magee does, perhaps better than anyone else in a single location, is name the people, the organizations, the dates, the decisions, the supporters, and the enablers, as well as the victims and the beneficiaries…”

History can go just so far before someone asks, “Where’s the beef?” Dr. Lundberg completes his review by asking, “What to do?”

His answer:  “Magee provides a succinct but detailed list of basic steps to reform the medical industrial complex. Five actions involve medical education, seven involve clinical research, five involve publications, and six regard marketing. Incremental, to be sure, but in aggregate, system-shaking, even convulsing.

I welcome your reviews of Code Blue in the Comments section HERE.

Wishing You a Hopeful and Safe New Year!

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