Of The Manifold “Unintended Consequences” Of 45’s Attack On Expanded Health Coverage (Under the ACA of 2010)

December 11, 2017 - Leave a Response

The for-profit model, for all larger US hospital groups, is increasingly under siege. Increasingly, the not for profit, or non-profit hospitals are consolidating, and developing purchasing power that will soon eclipse the largest for-profit chains’ bargaining power.

Here late on Sunday night, there is word of a truly outsized, mega-deal — in the non-profit (Catholic charities) sector — one that would overnight eclipse the Frist-family built for-profit hospital empire. . . called HCA. For decades, HCA has been the largest hospital/provider group in the United States (for-profit, or not so). No more, it would seem. And the fact that CVS and Aetna are talking tie-up deals should be of perhaps even greater concern in Nashville. The old paradigm of more than half of all hospitals losing money is shifting — the few surviving larger US chains will soon become at least break-even, and that will put tremendous price pressure on the for profit hospital model, in my estimation.

Afterall, if the Catholic mega-systems are willing to provide the same level of care — but at “break-even” pricing, we should rightly wonder (longer term, with reduced insurance coverage and ever increasing costs — for drugs and doctors), just how HCA will be able to extract (or fold-in, more charitably) a profit layer ON TOP of that “break-even” pricing offered by the mega non-profit chains. That’s going to be an increasingly significant fly in Nashville’s ointment.

Do go read this well-put together and timely Modern Healthcare article — on the pending deal talks. In passing, I’ll quote below a few recently announced deals — also mentioned (and linked) in the article. Nashville’s HCA HQ should be moderately to significantly-concerned:

. . . .On Thursday, Catholic Health Initiatives and Dignity Health announced that they had signed a definitive agreement to align their systems. The new health system would include 139 hospitals, more than 159,000 employees and 25,000 physicians and other advanced practice clinicians. The combined revenue would total $28.4 billion.

On Dec. 3, CVS and Aetna proposed a $69 billion merger. That would be the year’s largest and would leverage CVS’s pharmacy benefits management business.

Earlier in the week, Downers Grove, Il.-based Advocate Health Care announced it would cross state lines to merge with Aurora Health Care Network in Wisconsin. That merger would create the 10th-largest not-for-profit health system in the country. . . .

These will indeed be interesting times — but if one believes 45’s rhetoric about reducing the cost of drugs, and of delivery of health care, generally, the for-profit HCAs of the world are now increasingly facing the sharp tip, of that spear — and it will increasingly be wielded by those non-profit, or not-for-profit providers (albeit perhaps unintentionally), as they offer much the same service, but at break-even pricing. . . . Fascinating, and. . . g’night!

नमस्ते

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In Which Martin Shkreli Thinks “He Won” — And He’ll “Be Out Soon”… Hah!

December 11, 2017 - Leave a Response

True enough: it is merely a tangent, as to this blog’s narrative arc, at this point — but I am on record ( and repeatedly so) that the convict Martin Shkreli is likely to draw a decade in jail, as his sentence, come this January. This morning, we learn that he’s done some more “jailhouse creative writing“, to increase the odds that I will be right about that. So, without any additional ado — from another property I curate:

Billy has alerted us to a new Shkreli jailhouse missive. Kudos, to his keen eyes, here. . . . click it to enlarge — and laugh — as we see that “denial isn’t just a river in Egypt. . . .”

Apparently Ms. Christie Smythe became aware of it yesterday — on a Sunday. Since all correspondence from inmates at the Brooklyn MDC is read by the prison guards prior to being sealed in an envelope, and posted, we may safely assume that this one — imaged at right — is already in the hands of the Brooklyn AUSAs.

There is no way for us to know exactly when it was written, but it is clearly post-incarceration. And I am pretty sure the AUSAs have already accurately dated it — via Brooklyn MDC mail-log records.

An “exclamation point“-handled commenter asked about Marty’s expectations of privacy, as apparently some Twitter users have castigated the addressee of Marty’s letter, for making it public (assumedly without Marty’s express written consent).

However, Marty well-knows none of his correspondence is private. His lawyers likely advise him of this each time they meet with him — only in person, because good defense lawyers (with high profile incarcerated clients) don’t trust that even “Attorney/Client” marked mail might not also be opened and scanned, or read. Likewise, his phone calls.

So, any complaints about the letter being seen in public, on Twitter, strike me as… silly. Marty has essentially no rights of privacy, as a three time convicted (but not yet formally sentenced) felon, writing from inside a prison, when he comments about his case. These are party admissions, and the letter will be used by the AUSAs — at sentencing. It establishes that, even as late as five weeks in front of his sentencing date, and after more than two months in a harsh lock-up, Marty still cannot accept responsibility for his crimes.

It is always someone else’s fault, in Marty’s mind. And Ms. Smythe as much as said so. She is right. He is effectively increasing his likely sentence — with each letter.

It almost seems like Marty wants to get sentenced to ten years or more, on the inside.

[Ironically, it was exactly nine years ago this very morning, in Manhattan, that Bernie Madoff was taken into custody — on a perhaps $18 billion, multi-decade Ponzi scheme.]

Onward; and I’m off for a walk, toward the trains — to enjoy those gracefully floating, soft and large wheeling flakes, now falling here. . . . Smile.

नमस्ते

116 Years Ago, Tonight — The First Nobel Prizes Were Awarded, In Sweden…

December 10, 2017 - Leave a Response

The Nobel Prizes are once again being awarded at a ceremony in Sweden. . . . [My personal favorite of this year’s batch is going to Kip Thorne, and two others — for physically detecting Einsteinian gravity waves, via monster facilities Dr. Thorne conceived of in 1977, and others built in the ensuing dacades — in Louisiana, and Washington State.]

But this early snowy Sunday dawn, I write to remind us of the very first Nobel. It was awarded 116 years ago, tonight — to Emil Adolph Von Behring (though other contemporaries also showed much of the same work), for essentially inventing the entire field of serum vaccination, of humans as a disease prevention protocol. He showed that the concept worked for diptheria. . . and one of his godsons was studying with Madame Marie Curie at the time. Here’s a bit, from the Nobel website:

. . . .In 1900, Emil von Behring introduced serum from immune horses into human hosts as a method to cure and prevent diphtheria. . . .

Emil von Behring and other researchers showed that by means of blood plasma, or serum, antibodies could be transferred from one person or animal to another person, who also then became immune. . . .

Putting aside the later appropriation (long after his death) of his legacy — by the Nazis in 1940, it is only right to remark that his life’s works saved hundreds of millions of human lives. Onward, as ever — with a sweet little one now snoozing peacefully, at my side. . . . soon it will be time for oatmeal, orange juice and apple-sauce. And lots of books. letters and blocks — smile. Maybe even some finger painting. . . . inspire a discovering mind. . . right?

नमस्ते

Next Mandamus Stop, At Supremes — On Dreamers — Is Wednesday.

December 9, 2017 - Leave a Response

Once again, this is no finding on any merits, related to the case.

We now await the filing of the Dreamers’ lawyers. Please read Justice Breyer’s dissent.

I think, in the end, his view will prevail. We are only at the curtain of Act I, in a three act play, before the Supremes, on DACA. Here are (to my eye) the most salient bits:

. . . .Indeed, judicial review cannot function if the agency is permitted to decide unilaterally what documents it submits to the reviewing court as the administrative record. Effective review depends upon the administrative record containing all relevant materials presented to the agency, including not only materials supportive of the government’s decision but also materials contrary to the government’s decision. See Motor Vehicle Mfrs. Assn. of United States, Inc. v. State Farm Mut. Automobile Ins. Co., 463 U.S. 29, 43–44 (1983).

Otherwise, the reviewing court cannot engage in the “thorough, probing, in-depth review” that the APA requires. Overton Park, 401 U.S., at 415–416. A court deprived of a full administrative record could not consider, for example, whether the decision was based on the consideration of irrelevant factors, id., at 411–412; whether it considered the relevant factors, id., at 416; whether the decision was “arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law. . . .”

I do not see how we can restrain by mandamus an order that the Government merely fears that the District Court might enter in the future. . . .

And here is where things stand — in the trial court in the Northern District of California. So onward, to Wednesday, at 4 PM EST. So it goes — with a sweet baby sleepover, in a few hours, now. . . adios!

नमस्ते

[U] In An Hour: Oral Argument On Muslim Ban 3.0…

December 8, 2017 - Leave a Response

UPDATE: Mr. Trump’s lawyer is being buried alive by the Fourth Circuit — as he was in the Ninth, two days ago. He is 55 minutes into his duly alotted 30 minute grilling. Stick a fork in him — he’s done. Smile. End, update.

You may listen in here, starting at 9 AM EST — courtesy of the en banc panel of the US Fourth Circuit Court of Appeals.

And here is that lineup:

. . . .Chief Judge Roger L. Gregory, Judge Paul V. Niemeyer, Judge Diana Gribbon Motz, Judge William B. Traxler, Jr., Judge Robert B. King, Judge Dennis W. Shedd, Judge G. Steven Agee, Judge Barbara Milano Keenan, Judge James A. Wynn, Jr, Judge Albert Diaz, Judge Henry F. Floyd, Judge Stephanie D. Thacker and Judge Pamela A. Harris. . . .Busy Friday morning — clear and cold — ahead. To be certain, I’ll be listening for. . . the ping. Two pings, actually — both the Fourth, and the Ninth Circuits will shortly rule Mr. Trump out of bounds, once again. Then it is on to the Supremes. Onward. Ever onward.

नमस्ते

50 More North Carolina Merck Controllers Unit Employees Hear They Will To Lose Jobs — In December

December 8, 2017 - Leave a Response

This is never easy. [H/T — Anon., in comments, yesterday. . . .] And this is in addition to the 1,800 US salespeople who learned in later 2016 — that their jobs would end just a month from now — in January 2018.

But December is an especially tough time to learn that the holidays will need to be lean, for the foreseeable future. We might talk here about better, more rational incentives than the abomination of these proposed tax packages — to discourage off-shoring — to Ireland, and elsewhere, but the truth is (like GE’s 12,000 employee layoff announcement in its power unit, earlier this week). . . there is not a whole lot that can (reasonably, and swiftly) be done about it, with a paralyzed (but nominally single-party controlled) Congress, and an utterly clueless President (and therein lies the biggest obstacle).

Here is the local report, on Kenilworth’s subsidiary in North Carolina:

. . . .A subsidiary of Merck & Co. Inc. plans to lay off 50 employees and shutter its south Charlotte facility.The dismissals will happen at Merck Sharp & Dohme Corp.’s Charlotte Service Center between mid-February and June 2018 as it discontinues its global controllers unit at 8050 Microsoft Way in Charlotte.

Those to be laid off include eight employees of the human resources unit, which is also housed in the Charlotte Service Center. An undisclosed number of employees remaining in the human resources unit will be transferred to another Charlotte Merck facility. The location of that second facility also wasn’t disclosed. . . .

“The planned actions are expected to be permanent,” Lee writes in the Dec. 5 letter to the N.C. Department of Commerce. Lee notes that the notice was written as required by [WARN,] the federal Worker Adjustment and Retraining Notification Act. . . .

This is truly unfortunate news, for a Friday. My sincere and empathetic thoughts and meditations are with the affected families. Even so, onward. . . still — as a final oral argument looms (this time in the Fourth Circuit) before the heading to the Supremes — on Muslim Ban 3.0 this morning.

नमस्ते

Bitcoin Bubble — And Marty Shkreli — On My Mind…

December 7, 2017 - Leave a Response

Hmmm. . . My daily train rides are rarely quite this “interesting“. . . but today’s was. I mentioned this in comments on another property I curate, where we were discussing the crazy Bitcoin bubble.

It will soon burst. But Bitcoin (just as is true with the accomplices in the below video), and Marty both rely, and relied, on willing shills. Inside helpers, that are made to look like independent “outsiders” assessing value.

So do keep your Benjamins in your pockets, on the trains, this Christmas:

The above actually happened on my train ride in this very morning. Crazy world — sleep well, one and all. . . .

नमस्ते

The Ninth Circuit Just Promised A Very Fast Decision — On Muslim Ban 3.0

December 6, 2017 - One Response

The panel specifically mentioned the Supremes’ admonition — for a speedy opinion.

There is almost no doubt in my mind, having carefully listened to the arguments, that the Ninth Circuit will hold that President Trump has violated the INA’s non-discrimination scheme, as to nationality, in his attempt at Ban No. 3.

So it is on to the Supremes — with a stop in the Fourth Circuit, this Friday, where I expect to hear much the same, as I heard in the Ninth, just now. No images, tonight. Just facts. This Ban No. 3, in fact, violates the law. Out.

नमस्ते

Kenilworth’s UK Arm Partners With Wayra UK — But Real Story (Beneath The Story) Is… Name Spat?

December 6, 2017 - Leave a Response

So. . . it is laudable that MSD in the UK is partnering with Wayra UK — to provide incubator funding to two lucky winners — in digital healthcare/IT.

But I mention it primarily because I think this “placed” story appeared today across the pond, as a retort, of sorts to the GERMAN Merck putting out a presser (which was naturally picked up by US outlets) on Monday, in which German Merck used the full “Merck” name, and simply ran a by-line saying “not intended for US and Canadian audiences“. Cheeky.

This marks an escalation in the battle over the name. As we all by now remember, US Merck has the exclusive right to the full Merck name in the US and Canada. The German entity has it in the rest of the world. Fascinating. In any event, here is the UK presser from “our” Merck:

. . . .Merck Sharp and Dohme will once again be offering support to digital healthcare start-ups through a partnership with Wayra UK.

The pharmaceutical company is allying with the Wayra UK accelerator organisation to launch the third annual Velocity Health scheme, which aims to accelerate start-ups creating technology to address healthcare challenges facing the NHS.

This year, the partners are specifically looking for up-and-coming businesses creating digital innovations to support disease and illness prevention, with a particular focus on start-ups utilising artificial intelligence and machine learning.

Two start-ups will be chosen to take up a ten-month accelerator programme, giving them access to funding of 68,000 pounds each, as well as a network of mentors, coaches and investors who will nurture their entrepreneurial talent and technological expertise. . . .

Entertaining. Onward — to the Ninth Circuit arguments on Muslim Ban 3.0, at 4 PM CDT today.

नमस्ते

Sweet “Hidden Figures” Trivia: What Is Being Calculated, Here — And Why?

December 6, 2017 - Leave a Response

I’ll come back to this in a few weeks. . .

But this matters, to a certain launch date, upcoming.

See if you can guess as to why.

And see if you can guess what it depicts. Smile. . . .