Category Archives: Health Policy

Administration Considers Reopening Economy, Over Health Experts’ Objections

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The president is questioning whether stay-at-home orders have gone too far. But relaxing them could significantly increase the death toll from the coronavirus, health officials warn.

As the United States entered Week 2 of trying to contain the spread of the coronavirus by shuttering large swaths of the economy, President Trump, Wall Street executives and many conservative economists began questioning whether the government had gone too far and should instead lift restrictions that are already inflicting deep pain on workers and businesses.

Consensus continues to grow among government leaders and health officials that the best way to defeat the virus is to order nonessential businesses to close and residents to confine themselves at home. Britain, after initially resisting such measures, essentially locked down its economy on Monday, as did the governors of Virginia, Michigan and Oregon. More than 100 million Americans will soon be subject to stay-at-home orders.

Relaxing those restrictions could significantly increase the death toll from the virus, public health officials warn. Many economists say there is no positive trade-off — resuming normal activity prematurely would only strain hospitals and result in even more deaths, while exacerbating a recession that has most likely already arrived.

The economic shutdown is causing damage that is only beginning to appear in official data. Morgan Stanley researchers said on Monday that they now expected the economy to shrink by an annualized rate of 30 percent in the second quarter of this year, and the unemployment rate to jump to nearly 13 percent. Both would be records, in modern economic statistics.

Officials have said the federal government’s initial 15-day period for social distancing is vital to slowing the spread of the virus, which has already infected more than 40,000 people in the United States. But Mr. Trump and a chorus of conservative voices have begun to suggest that the shock to the economy could hurt the country more than deaths from the virus.

On Monday, Mr. Trump said his administration would reassess whether to keep the economy shuttered after the initial 15-day period ends next Monday, saying it could extend another week and that certain parts of the country could reopen sooner than others, depending on the extent of infections.

“Our country wasn’t built to be shut down,” Mr. Trump said during a briefing at the White House. “America will, again, and soon, be open for business. Very soon. A lot sooner than three or four months that somebody was suggesting. Lot sooner. We cannot let the cure be worse than the problem itself.”

Similar views are emanating from parts of corporate America, where companies are struggling with a shutdown that has emptied hotels, airplanes, malls and restaurants and sent the stock market tumbling so fast that automatic circuit breakers to halt trading have been tripped repeatedly. Stocks have collapsed about 34 percent since the coronavirus spread globally — the steepest plunge in decades — erasing three years of gains under Mr. Trump.

Lloyd Blankfein, the former chief executive of Goldman Sachs, wrote on Twitter that “crushing the economy” had downsides and suggested that “within a very few weeks let those with a lower risk to the disease return to work.”

Even Gov. Andrew M. Cuomo of New York, whose state has emerged as the epicenter of the outbreak in the United States, has begun publicly floating the notion that, at some point, states will need to restart economic activity and debating how that should unfold.

“You can’t stop the economy forever,” Mr. Cuomo said in a news conference on Monday. “So we have to start to think about does everyone stay out of work? Should young people go back to work sooner? Can we test for those who had the virus, resolved, and are now immune and can they start to go back to work?”

Any push to loosen the new limits on commerce and movement would contradict the consensus advice of public health officials, risking a surge in infections and deaths from the virus. Many economists warn that abruptly reopening the economy could backfire, overwhelming an already stressed health care system, sowing uncertainty among consumers, and ultimately dealing deeper, longer-lasting damage to growth.

The recent rise of cases in Hong Kong, after there had been an easing of the spread of the virus, is something of an object lesson about how ending strict measures too soon can have dangerous consequences. Yet places like China, which took the idea of lockdown to the extreme, have managed to flatten the curve.

“You can’t call off the best weapon we have, which is social isolation, even out of economic desperation, unless you’re willing to be responsible for a mountain of deaths,” said Arthur Caplan, a professor of bioethics at NYU Langone Medical Center. “Thirty days makes more sense than 15 days. Can’t we try to put people’s lives first for at least a month?”

For the last four days, some White House officials, including those working for Vice President Mike Pence, who leads the coronavirus task force, have been raising questions about when the government should start easing restrictions.

Among the options being discussed are narrowing restrictions on economic activity to target specific age groups or locations, as well as increasing the numbers of people who can be together in groups, said one official, who cautioned that the discussions were preliminary.

Health officials inside the administration have mostly opposed that idea, including Dr. Anthony S. Fauci, an infectious diseases expert and a member of the White House coronavirus task force, who has said in interviews that he believes it will be “at least” several more weeks until people can start going about their lives in a more normal fashion.

Dr. Deborah L. Birx, the White House coronavirus response coordinator, said the United States had learned from other countries like China and South Korea, which were able to control the spread of the virus through strict measures and widespread testing.

“Those were eight- to 10-week curves,” she said on Monday, adding that “each state and each hot spot in the United States is going to be its own curve because the seeds came in at different times.”

Dr. Birx added that the response “has to be very tailored geographically and it may have to be tailored by age group, really understanding who’s at the greatest risk and understanding how to protect them.”

Other advisers, including members of Mr. Trump’s economic team, have said repeatedly in recent months that the virus does not itself pose an extraordinary threat to Americans’ lives or the economy, likening it to a common flu season. Some advisers believe the White House overreacted to criticism of Mr. Trump’s muted actions to deal with the emerging pandemic and gave health experts too large a sway in policymaking.

On Monday, Mr. Trump echoed those concerns, saying that things like the flu or car accidents posed as much of a threat to Americans as the coronavirus and that the response to those was far less draconian.

“We have a very active flu season, more active than most. It’s looking like it’s heading to 50,000 or more deaths,” he said, adding: “That’s a lot. And you look at automobile accidents, which are far greater than any numbers we’re talking about. That doesn’t mean we’re going to tell everybody no more driving of cars. So we have to do things to get our country open.”

Mr. Trump has watched as a record economic expansion and booming stock market that served as the basis of his re-election campaign evaporated in a matter of weeks. The president became engaged with the discussion on Sunday evening, after watching television reports and hearing from various business officials and outside advisers who were agitating for an end to the shutdown.

Casey Mulligan, a University of Chicago professor who served as chief economist for Mr. Trump’s Council of Economic Advisers, said on Monday that efforts to shut down economic activity to slow the virus would be more damaging than doing nothing at all. He suggested a middle ground, one that weighs the costs and benefits of saving additional lives.

“It’s a little bit like, when you discover sex can be dangerous, you don’t come out and say, there should be no more sex,” Mr. Mulligan said. “You should give people guidance on how to have sex less dangerously.”

Many other economists say the restrictions in activity now are helping the economy in the long run, by beginning to suppress the infection rate.

“The idea that there’s a trade-off between health and economics right now is likely badly mistaken,” said Jason Furman of Harvard University, a former chairman of the Council of Economic Advisers under President Barack Obama. “The thing damaging our economy is a virus. Everyone who is trying to stop that virus is working to limit the damage it does to our economy and help our eventual rebound. The choice may well be taking pretty extreme steps now or taking very extreme steps later.”

Mr. Furman and other economists have pushed Mr. Trump and Congress to ease the economic pain by offering trillions of dollars in government assistance to affected workers and businesses. As lawmakers tried to negotiate an agreement on such a bill Monday, an influential business lobbying group, the U.S. Chamber of Commerce, said it supported restrictions on the economy to slow the virus.

“Our view is, when it comes to how you contain the virus, you do everything the public health professionals say to contain the virus,” said Neil Bradley, the chamber’s executive vice president and chief policy officer.

The president’s suggestion that the response may be an overreaction plays into doubts already held by some Americans suffering the economic consequences. Among the self-quarantined, some have questioned the purpose of isolating themselves if the virus is already circulating widely. Students sent home from college have wondered whether they are more likely to infect higher-risk older adults at home.

Dan Patrick, Texas’ lieutenant governor, said Monday on Fox News that he was in the “high-risk pool” but would be willing to risk his life to preserve the country for his children and grandchildren.

“We are going to be in a total collapse, recession, depression, collapse in our society,” said Mr. Patrick, who turns 70 next week. “If this goes on another several months, there won’t be any jobs to come back to for many people.”

But public health officials stress that there would be consequences to ending the measures too quickly. In a tweet on Monday morning, Thomas P. Bossert, the former homeland security adviser who for weeks has been vocal about the need for the U.S. government to take stricter measures, said: “Sadly, the numbers now suggest the U.S. is poised to take the lead in #coronavirus cases. It’s reasonable to plan for the US to top the list of countries with the most cases in approximately 1 week. This does NOT make social intervention futile. It makes it imperative!”

Mr. Trump’s interest in potentially easing some of the restrictions met with pushback from one of his close allies, Senator Lindsey Graham, Republican of South Carolina, who himself self-quarantined after a potential exposure. “President Trump’s best decision was stopping travel from China early on,” Mr. Graham tweeted on Monday. “I hope we will not undercut that decision by suggesting we back off aggressive containment policies within the United States.”

Health officials remain largely united in defense of sustaining the restrictions.

“There is a way to think through how and when to start reopening our economy and society, and it’s important to get this right,” said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention.

Dr. Tom Inglesby, the director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, pointed to the experience of countries like Italy, which did not institute aggressive measures to stop the spread of the virus and saw infection rates and deaths soar as a result.

The United States will need “a couple weeks” to see positive effects from its measures, Dr. Inglesby said, and abandoning them would mean “patients will get sick in extraordinary numbers all over the country, far beyond what the U.S. health care system will bear.”

 

 

 

 

Everybody wants a piece of the stimulus

Posted on by • Posted in 2020 Election Issues, Coronavirus, Economic Crisis, Economic Stimulus, Economy, Health Policy, Health System, Hospital, Hospital Industry, Medicare, Pandemic, Physician • Leave a comment

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Image result for axios vitals Everybody wants a piece of the stimulus

Lobbyists are racing to grab a piece of the stimulus package lawmakers are still trying to hammer out on Capitol Hill, Bob writes.

Driving the news: Hospitals and physicians want at least $100 billion and significant Medicare payment hikes, partially because they’ve had to cancel lucrative elective procedures.

  • Hotels, airlines, restaurants, casinos, manufacturers and other service industries that have been battered by the coronavirus spread are angling to get hundreds of billions in loans and other funding.
  • A coalition of major employers is lobbying Congress for payroll tax credits and coverage subsidies for people who lose their jobs.

The intrigue: The chance for federal bailouts has motivated small players to make bigger investments, and some nontraditional parties are spending their first lobbying dollars.

 

 

 

 

The Huge Coronavirus Gamble

Posted on by • Posted in 2020 Election Issues, Accountability, Coronavirus, Health Policy, Infection Control, Infectious Virus, Leadership, Mortality, Pandemic, Public Health, Public Safety, Shortsightedness • Leave a comment

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President Trump is eager to ease off of stringent coronavirus mitigation steps “soon,” he said yesterday, but that would have a calamitous impact on Americans’ health — and it’s not clear how much it would help the economy, either.

Why it matters: For now, the only way to avoid large numbers of deaths is to keep people away from each other to stop the virus’ spread. And as long as the coronavirus is spreading, it’s likely to hurt the economy.

Driving the news: “This is a medical problem. We are not going to let it turn into a long-lasting financial problem,” Trump said in a press conference yesterday.

Between the lines: Missing from Trump’s rhetoric is any real acknowledgement that the situation is going to get worse in the near term.

“A policy of returning people to work too soon should be called the ‘let old people die already’ policy,“ a former Trump administration official told me.

  • If Trump decides to release the brakes in a week — and if states follow suit — the number of coronavirus cases would likely skyrocket far beyond anything the health care system can handle.

The big picture: The number of confirmed U.S. cases is still rising at an alarming rate — and that’s not counting the thousands who have it but are unable to get tested.

  • That number is expected to continue to rise.

Reality check: The choice between saving lives and saving the economy may not even be a real one.

  • If the virus’ continued spread causes people to still be concerned for their health, and they don’t start spending money again in droves, then service workers may be putting their health back on the line for weak demand and a lackluster rebound.

 

 

 

 

KHN’s ‘What The Health?’: The Affordable Care Act Turns 10

Posted on by • Posted in 2020 Election Issues, ACA, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, Medicaid, Medicaid Expansion, Preexisting Conditions, Underinsured, Uninsured • Leave a comment

https://khn.org/news/khn-podcast-what-the-health-the-affordable-care-act-turns-10/

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Can’t see the audio player? Click here to listen on SoundCloud.

The past decade for the health law has been filled with controversy and several near-death experiences. But the law also brought health coverage to millions of Americans and laid the groundwork for a shift to a health system that pays for quality rather than quantity.

Yet the future of the law remains in doubt. Many progressive Democrats would like to scrap it in favor of a “Medicare for All” system that would be fully financed by the federal government. Republicans would still like to repeal or substantially alter it. And the Supreme Court recently accepted another case that could invalidate the law in its entirety.

In this special episode of KHN’s “What the Health?” host Julie Rovner interviews Kathleen Sebelius, who was secretary of Health and Human Services during the development, passage and implementation of the health law.

Then Rovner, Joanne Kenen of Politico and Mary Agnes Carey of Kaiser Health News, who have all covered the law from the start, discuss the ACA’s past, present and future.

Among the takeaways from this week’s podcast:

  • Although the creation of the ACA is often attributed to the Obama administration and the Democratic Congress at the time, work on a health care plan actually began well before then with small-group meetings among stakeholders, congressional hearings across the country and efforts by Sen. Ted Kennedy to galvanize interest. Much of those interactions were bipartisan and included industry leaders too.
  • Despite the vehement Republican opposition to the ACA and its many critical junctures (the death of Kennedy and his replacement by Republican Scott Brown; two tight Supreme Court decisions; and the calamitous debut of the marketplace website, among other issues), the law has proved popular. When Republicans gained control of the White House and Congress, their efforts to repeal the law helped focus consumers’ interest on the law and safeguard it.
  • How will the November election affect the law? If President Donald Trump is reelected, he is unlikely to renew the effort to repeal the law, but that doesn’t mean the assault on the law is over. Efforts to change the ACA could continue through the courts and through administrative rulemaking.
  • If a Democrat is elected, modifications to the law are generally expected to be incremental and perhaps deal with changes such as expanding the number of people getting subsidies and fix some glitches in the law.

 

 

 

Another week on the exponential curve

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As efforts to increase testing for COVID-19 ramped up this week, the number of cases in the US rose exponentially, and the number of deaths increased sharply as well. Early but incomplete data from the Centers for Disease Control and Prevention (CDC) indicated that the virus was impacting younger people in greater numbers than had been seen in China and Italy, and concerns grew that asymptomatic but infected people could be spreading the virus to those with compromised health status. In response, many cities and states moved aggressively to put in place stricter measures to keep people in their homes to mitigate spread.

Several flashpoints have emerged across the healthcare system. Supplies of personal protective equipment (PPE) are in short supply, raising concerns about putting healthcare workers at risk. Testing supplies—particularly collection swabs—are also running low in many places, forcing some newly-launched testing locations to close after just a few days. Hospitals across the country began to gear up for a wave of patients, with the number of potential cases likely to far exceed existing capacity of hospital beds, intensive care beds, and, in particular, ventilators.

In response, the President invoked the Defense Production Act, which will allow the government to direct private sector production of critically needed equipment. Hospital leaders have been advised by the government to cancel elective surgeries and minimize non-emergency utilization of healthcare resources, to preserve supplies and capacity for the coming wave of cases.

The Centers for Medicare and Medicaid Services (CMS) loosened several key regulations to allow more care to be delivered virtually, in an attempt to relieve pressure on the system (more on that below). By week’s end, hospitals in several areas—including Seattle, San Francisco, New York, and New Orleans—were reporting that they were perilously close to being overwhelmed.

As many have pointed out, we are faced with a decision of which curve we want to be on: one that looks like Italy, which responded late with mitigation and suppression efforts and has found their healthcare system collapsing under the volume of hospitalizations; or one that looks like South Korea, where aggressive measures to suppress spread, including extensive testing, strict social distancing, and isolation of infected people, seem to have “flattened the curve”.

The next two weeks will be critical in determining what the next year looks like in America.

 

 

 

How the coronavirus pandemic differs from the flu

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Health Policy, Incubation Period, Infection Control, Infectious Virus, Influenza, Mortality, Pandemic, Vaccine, World Health Organization (WHO) • Leave a comment

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Image result for axios How the coronavirus pandemic differs from the flu

The COVID-19 pandemic is caused by a virus humans haven’t encountered before — meaning our bodies have no built-in immunity to it and researchers are frantically working to learn more about it.

Why it matters: While there are important lessons to be learned from other pandemic flus and even seasonal flu outbreaks, the coronavirus pandemic is new and not exactly comparable, making predictions, policies and treatments all the more difficult.

The latest: The coronavirus is spreading throughout the U.S., with at least 35,224 confirmed cases and 471 deaths early Monday morning, per Johns Hopkins’ Center for Systems Science and Engineering.

  • Meanwhile, the Centers for Disease Control and Prevention estimates the 2019-2020 seasonal flu has caused at least 38 million illnesses, 390,000 hospitalizations and 23,000 deaths so far this season.

What they’re saying: Anthony Fauci, who’s served as director of the National Institute of Allergy and Infectious Diseases since 1984, told a JAMA podcast he’s worked on multiple infectious disease crises “but nothing of the magnitude of this.”

  • One of the problems, he said, is that without strong containment and mitigation efforts, it hits society and its health care system “all of a sudden — boom! It starts to skyrocket.”
  • The World Health Organization on Friday warned against dismissing the coronavirus as just a bad outbreak of the flu, saying overwhelmed health systems are “collapsing” around the world.
  • “This is not normal. This isn’t just a bad flu season,” WHO’s Mike Ryan said.

While both seasonal flu and COVID-19 cause similar respiratory illnesses, there are key differences between the viruses.

  • Influenza has an incubation period of roughly 2-3 days, whereas the coronavirus incubates longer (5-6 days on average) before symptoms appear, possibly allowing more people to unknowingly spread the virus.
  • On average, 1.3 people catch the flu from an infected person versus 2-3 for the coronavirus.
  • There’s a flu vaccine and multiple effective treatments, so many exposed to the flu will have lessened symptoms. There’s no vaccine or treatment yet approved for COVID-19.
  • Children appear to be more susceptible to severe complications from this seasonal flu than from COVID-19, with the CDC reporting the highest number of influenza-associated deaths (149) at this point in the season, with the exception of the 2009 flu pandemic.
  • But, the overall mortality rate for COVID-19 is between 10 and 40 times higher than the average 0.1% mortality rate for the seasonal flu.

The U.S. can learn from both Asia and Europe, which experienced cases of COVID-19 earlier than the U.S., Julie Fischer of Georgetown University’s Center for Global Health Science and Security tells Axios.

  • China is providing data showing what measures are working better than others, and is conducting treatment tests on patients, which will be valuable, she said.
  • In South Korea, robust diagnostic testing using creative measures like drive-thrus combined with strong health care followup shows the importance of isolating the right people early enough to limit the spread, Fischer says.
  • Italy tried to do a widespread but unfocused social distancing. There’s been some success in stemming the outbreak in certain areas that tested a large number of people, tracing and quarantining those who have been in contact with positive cases. But, it wasn’t early enough or sufficiently extensive, and many parts of Italy are now overwhelmed.

Longer term lessons can be drawn from prior pandemics, like the Spanish flu of 1918, Fischer says.

  • Comparing Philadelphia’s response with that of St. Louis is quite striking, Fischer says. Philadelphia decided to hold a 200,000-person parade to boost morale — but this led to widespread infections. In contrast, St. Louis rapidly battened down the hatches and reported a smaller epidemic.
  • Another lesson from the Spanish flu was that closing schools early on was “one of the most beneficial” non-pharmaceutical interventions.

The bottom line: “This is not an ‘abandon all hope, ye who enter here,’ scenario,” Fischer says. “We can focus our strategy and become much more aggressive” in diagnostics testing and social distancing measures until scientists make advancements on vaccines and treatments.

 

 

COVID-19 threatens to overwhelm hospitals. They’re weighing how best to ration care.

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The coronavirus outbreak is forcing the U.S., a nation largely unaccustomed to scarcity, to have tough conversations about how to allocate limited medical resources as hospitals warn its only a matter of time before they’re inundated with COVID-19 patients.

Across the country, hospital officials are discussing ethical dilemmas and attempting to draft policies about rationing care when patients needing ventilators and other resources dwarf the supply, several hospital ethicists told Healthcare Dive. In addition to issues of mortality, questions also are being raised about whether medical workers can opt out of treating patients with COVID-19, particularly if they don’t have the right personal protective equipment.

“They are having these conversations at the policy level,” Kelly Dineen, director of the health law program at Creighton University and a member of COVID-19 Ethics Advisory Committee at the University of Nebraska Medical Center​, told Healthcare Dive.

Ethical dilemmas are usually tackled by a hospital’s ethics committee, which, in an ideal scenario, encompasses a variety of workers from across the hospital, including clinicians, ethicists and social workers. 

No federal mandate exists requiring hospitals to have such committees. However, many do to meet accreditation standards that require facilities to have some sort of mechanism for ethics conflicts and decision making. Many choose to meet that standard by having an ethics committee, though not all do, according to one expert.

Hospitals are at risk of not having the capacity to care for a surge of COVID-19 patients if an outbreak similar to Wuhan or Italy occurs here. New York Gov. Andrew Cuomo has pleaded with the federal government to allow the Army Corps of Engineers to build back-up facilities as the COVID-19 rapidly spreads through areas of the hard-hit state. Similarly, California Gov. Gavin Newsom has requested a Navy hospital ship and two mobile hospitals to address a surge in patients.

Federal officials are urging Americans to do their part by retreating to their homes to socially distance themselves from others in an effort to hamper the disease’s reach. CMS also last week urged hospitals to put off non-essential elective surgeries to prepare for an onslaught of cases. Years of culling hospital beds in a shift to outpatient care has the nation’s facilities short of meeting expected demand under some prediction models.

The concern about scarce resources is not unfounded. Italy’s healthcare system has been pushed to the brink and many see parallels in terms of the trajectory of the spread. Overwhelmed with sick patients, Italy’s society of anesthesiology and intensive care published recommendations on how to prioritize patients and not just serve the first in the door.

China, the first country to report cases of the disease, feverishly began building hospitals to meet demand.

And the U.S. has far fewer hospital beds per 1,000 residents than China or Italy.

It’s important facilities across the country start having conversations about allocating resources now before clinicians are pushed to their limits, ethicists said.

“Any time you have that kind of pressure and load … it’s going to be hard to also be thinking about all of the ethical implications and what that means in a way that might otherwise not be so hard,” Dineen said.

The struggle will be effectively communicating those policies throughout a system or hospital, Erica Salter, associate professor and program director of the doctorate program for healthcare ethics at St. Louis University, told Healthcare Dive.

“It’s wise to anticipate failures of communication and protect against those,” Salter said.

Ultimately, those policies will vary by institution, though ethicists said it’s important to be proactive rather than reactive. And hospitals should also be prepared to be held to account for decisions that are made, Dineen said.

Patients and their loved ones will want to know there was a process and that it was fair, not arbitrary. 

“There’s no reason we can’t be prepared with a process, even if we don’t necessarily have a better answer,” she said.

Still, despite the most well-intentioned plans it will always be the doctor’s call, Arthur Caplan, head of the division of medical ethics at NYU School of Medicine, told Healthcare Dive.  

“You’re going to see variation in what is decided floor to floor, doctor to doctor, hospital to hospital,” Caplan said.

Still, some hospitals are hesitant to issue overly broad guidance because of the liabilities that might come later. However, depending on the state, emergency orders issued during a pandemic may help shield providers or systems from liability as standard of care decisions were made during a unique situation.

And, though Americans may struggle to talk about the end of life and mortality, the medical profession is used to tough conversations about scarce resources.

For example, when dialysis machines were first developed, the technology was not widely available for everyone with end-stage kidney failure. A decision had to be made about which patients were granted access to the lifesaving treatment and which ones were not. It’s a conversation that continues today for those needing transplants.

“The principles guiding these decisions are not new,” Salter said. “We’ve been dealing with issues of scarce resources for many decades.”

 

 

 

 

Hospital leaders plead for financial help, warn of closures, missing payroll

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https://www.healthcaredive.com/news/hospital-leaders-plead-for-financial-help-warn-of-closures-missing-payrol/574625/

Hospital executives from across the country sounded the alarm Saturday about the dire need for federal financial aid as their cash on hand continues to erode amid the coronavirus pandemic.

“We’ll exhaust all avenues to make payroll in the next few weeks,” Scott Graham, CEO of Three Rivers and North Valley Hospitals in rural Washington said of Three Rivers during a call with reporters Saturday morning.

The American Hospital Association is urging lawmakers on Capitol Hill to consider deploying at least $100 billion to aid hospitals fight against the outbreak of the novel coronavirus. The relief package would fund medical personnel, supplies and infrastructure, and expenses related to COVID-19, Rick Pollack, CEO of AHA, told reporters.

Without a relief package, Pollack warned it “could mean that many hospitals won’t survive.” The pleas came as Congress debates a stimulus package this weekend.

American life has ground to halt as experts urge the public to distance themselves from others in an attempt to slow the spread of the virus. Many states closed bars and restaurants with virtually all group events canceled. Likewise, hospitals have been asked — or required in some locales — to halt all elective procedures to free up resources for an expected surge of patients.

But hospitals rely on those typically lucrative procedures to drive revenue. Some hospitals are starting to wonder how they’ll keep the lights on after facing the reality of canceled procedures and the need to increase staff and supplies to combat the pathogen.

On top of that, hospitals are unable to get much needed supplies as some vendors are requiring payment on delivery, funds they do not have.

There is no time to waste, hospital leaders warned, citing less than two weeks cash on hand.

“We need to get this done now,” Pollack said of an emergency funding package from the federal government.

Despite the dire financial strain, hospitals are still preparing to increase capacity to meet a surge in demand. It’s unclear whether they will be reimbursed for all expenses related to increasing the amount of beds, capacity and supplies.

Some areas were already facing a shortage of nurses and physicians before the outbreak and anticipate that to become worse.

“In spite of our existing financial challenges, we are planning to increase capacity because that is what we must do,” LaRay Brown, CEO of One Brooklyn Health System in New York, said Saturday. One Brooklyn​ operates three hospitals, nursing homes and community health centers in New York, serving about 2 million.

Brown said all hospitals in New York were asked Friday by state health officials to submit plans for the upping of capacity by 50% of existing bed count.

Brown anticipates receiving some support from the state of New York but seemed wary of the state’s future financial footing as it battles the pathogen as well, and with a weakened tax base as businesses have shuttered.

“This is why I’m on this call,” Brown said. “We need immediate cash relief from the federal government.”

 

 

 

BANKS PRESSURE HEALTH CARE FIRMS TO RAISE PRICES ON CRITICAL DRUGS, MEDICAL SUPPLIES FOR CORONAVIRUS

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Banks Pressure Health Care Firms to Raise Prices on Critical Drugs, Medical Supplies for Coronavirus

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IN RECENT WEEKS, investment bankers have pressed health care companies on the front lines of fighting the novel coronavirus, including drug firms developing experimental treatments and medical supply firms, to consider ways that they can profit from the crisis.

The media has mostly focused on individuals who have taken advantage of the market for now-scarce medical and hygiene supplies to hoard masks and hand sanitizer and resell them at higher prices. But the largest voices in the health care industry stand to gain from billions of dollars in emergency spending on the pandemic, as do the bankers and investors who invest in health care companies.

Over the past few weeks, investment bankers have been candid on investor calls and during health care conferences about the opportunity to raise drug prices. In some cases, bankers received sharp rebukes from health care executives; in others, executives joked about using the attention on Covid-19 to dodge public pressure on the opioid crisis.

Gilead Sciences, the company producing remdesivir, the most promising drug to treat Covid-19 symptoms, is one such firm facing investor pressure.

Remdesivir is an antiviral that began development as a treatment for dengue, West Nile virus, and Zika, as well as MERS and SARS. The World Health Organization has said there is “only one drug right now that we think may have real efficacy in treating coronavirus symptoms” — namely, remdesivir.

The drug, though developed in partnership with the University of Alabama through a grant from the federal government’s National Institutes of Health, is patented by Gilead Sciences, a major pharmaceutical company based in California. The firm has faced sharp criticism in the past for its pricing practices. It previously charged $84,000 for a yearlong supply of its hepatitis C treatment, which was also developed with government research support. Remdesivir is estimated to produce a one-time revenue of $2.5 billion.

During an investor conference earlier this month, Phil Nadeau, managing director at investment bank Cowen & Co., quizzed Gilead Science executives over whether the firm had planned for a “commercial strategy for remdesivir” or could “create a business out of remdesivir.”

Johanna Mercier, executive vice president of Gilead, noted that the company is currently donating products and “manufacturing at risk and increasing our capacity” to do its best to find a solution to the pandemic. The company at the moment is focused, she said, primarily on “patient access” and “government access” for remdesivir.

“Commercial opportunity,” Mercier added, “might come if this becomes a seasonal disease or stockpiling comes into play, but that’s much later down the line.”

Steven Valiquette, a managing director at Barclays Investment Bank, last week peppered executives from Cardinal Health, a health care distributor of N95 masks, ventilators and pharmaceuticals, on whether the company would raise prices on a range of supplies.

Valiquette asked repeatedly about potential price increases on a variety of products. Could the company, he asked, “offset some of the risk of volume shortages” on the “pricing side”?

Michael Kaufmann, the chief executive of Cardinal Health, said that “so far, we’ve not seen any material price increases that I would say are related to the coronavirus yet.” Cardinal Health, Kaufman said, would weigh a variety of factors when making these decisions, and added that the company is “always going to fight aggressively to make sure that we’re getting after the lowest cost.”

“Are you able to raise the price on some of this to offset what could be some volume shortages such that it all kind of nets out to be fairly consistent as far as your overall profit matrix?” asked Valiquette.

Kaufman responded that price decisions would depend on contracts with providers, though the firm has greater flexibility over some drug sales. “As you have changes on the cost side, you’re able to make some adjustments,” he noted.

The discussion, over conference call, occurred during the Barclays Global Healthcare Conference on March 10. At one point, Valiquette joked that “one positive” about the coronavirus would be a “silver lining” that Cardinal Health may receive “less questions” about opioid-related lawsuits.

Cardinal Health is one of several firms accused of ignoring warnings and flooding pharmacies known as so-called pill mills with shipments of millions of highly addictive painkillers. Kaufmann noted that negotiations for a settlement are ongoing.

Owens & Minor, a health care logistics company that sources and manufactures surgical gowns, N95 masks, and other medical equipment, presented at the Barclays Global Healthcare Conference the following day.

Valiquette, citing the Covid-19 crisis, asked the company whether it could “increase prices on some of the products where there’s greater demand.” Valiquette then chuckled, adding that doing so “is probably not politically all that great in the sort of dynamic,” but said he was “curious to get some thoughts” on whether the firm would consider hiking prices.

The inquiry was sharply rebuked by Owens & Minor chief executive Edward Pesicka. “I think in a crisis like this, our mission is really around serving the customer. And from an integrity standpoint, we have pricing agreements,” Pesicka said. “So we are not going to go out and leverage this and try to ‘jam up’ customers and raise prices to have short-term benefit.”

AmerisourceBergen, another health care distributor that supplies similar products to Cardinal Health, which is also a defendant in the multistate opioid litigation, faced similar questions from Valiquette at the Barclays event.

Steve Collis, president and chief executive of AmerisourceBergen, noted that his company has been actively involved in efforts to push back against political demands to limit the price of pharmaceutical products.

Collis said that he was recently at a dinner with other pharmaceutical firms involved with developing “vaccines for the coronavirus” and was reminded that the U.S. firms, operating under limited drug price intervention, were among the industry leaders — a claim that has been disputed by experts who note that lack of regulation in the drug industry has led to few investments in viral treatments, which are seen as less lucrative. Leading firms developing a vaccine for Covid-19 are based in Germany, China, and Japan, countries with high levels of government influence in the pharmaceutical industry.

AmerisourceBergen, Collis continued, has been “very active with key stakeholders in D.C., and our priority is to educate policymakers about the impact of policy changes,” with a focus on “rational and responsible discussion about drug pricing.”

Later in the conversation, Valiquette asked AmerisourceBergen about the opioid litigation. The lawsuits could cost as much as $150 billion among the various pharmaceutical and drug distributor defendants. Purdue Pharma, one of the firms targeted with the opioid litigation, has already pursued bankruptcy protection in response to the lawsuit threat.

“We can’t say too much,” Collis responded. But the executive hinted that his company is using its crucial role in responding to the pandemic crisis as leverage in the settlement negotiations. “I would say that this crisis, the coronavirus crisis, actually highlights a lot of what we’ve been saying, how important it is for us to be very strong financial companies and to have strong cash flow ability to invest in our business and to continue to grow our business and our relationship with our customers,” Collis said.

The hope that the coronavirus will benefit firms involved in the opioid crisis has already materialized in some ways. New York Attorney General Letitia James announced last week that her lawsuit against opioid firms and distributors, including Cardinal Health and AmerisourceBergen, set to begin on March 20, would be delayed over coronavirus concerns.

MARKET PRESSURE has encouraged large health care firms to spend billions of dollars on stock buybacks and lobbying, rather than research and development. Barclays declined to comment, and Cowen & Co. did not respond to a request for comment.

The fallout over the coronavirus could pose potential risks for for-profit health care operators. In Spain, the government seized control of private health care providers, including privately run hospitals, to manage the demand for treatment for patients with Covid-19.

But pharmaceutical interests in the U.S. have a large degree of political power. Health and Human Services Secretary Alex Azar previously served as president of the U.S. division of drug giant Eli Lilly and on the board of the Biotechnology Innovation Organization, a drug lobby group.

During a congressional hearing last month, Azar rejected the notion that any vaccine or treatment for Covid-19 should be set at an affordable price. “We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest,” said Azar. “The priority is to get vaccines and therapeutics. Price controls won’t get us there.”

The initial $8.3 billion coronavirus spending bill passed in early March to provide financial support for research into vaccines and other drug treatments contained a provision that prevents the government from delaying the introduction of any new pharmaceutical to address the crisis over affordability concerns. The legislative text was shaped, according to reports, by industry lobbyists.

As The Intercept previously reported, Joe Grogan, a key White House domestic policy adviser now serving on Donald Trump’s Coronavirus Task Force, previously served as a lobbyist for Gilead Sciences.

“Notwithstanding the pressure they may feel from the markets, corporate CEOs have large amounts of discretion and in this case, they should be very mindful of price gouging, they’re going to be facing a lot more than reputational hits,” said Robert Weissman, president of public interest watchdog Public Citizen, in an interview with The Intercept.

“There will be a backlash that will both prevent their profiteering, but also may push to more structural limitations on their monopolies and authority moving forward,” Weissman said.

Weissman’s group supports an effort led by Rep. Andy Levin, D-Mich., who has called on the government to invoke the Defense Production Act to scale up domestic manufacturing of health care supplies.

There are other steps the government can take, Weissman added, to prevent price gouging.

“The Gilead product is patent-protected and monopoly-protected, but the government has a big claim over that product because of the investment it’s made,” said Weissman.

“The government has special authority to have generic competition for products it helped fund and prevent nonexclusive licensing for products it helped fund,” Weissman continued. “Even for products that have no connection to government funding, the government has the ability to force licensing for generic competition for its own acquisition and purchases.”

Drug companies often eschew vaccine development because of the limited profit potential for a one-time treatment. Testing kit companies and other medical supply firms have few market incentives for domestic production, especially scaling up an entire factory for short-term use. Instead, Levin and Weissman have argued, the government should take direct control of producing the necessary medical supplies and generic drug production.

Last Friday, Levin circulated a letter signed by other House Democrats that called for the government to take charge in producing ventilators, N95 respirators, and other critical supplies facing shortages.

The once inconceivable policy was endorsed on Wednesday when Trump unveiled a plan to invoke the Defense Production Act to compel private firms to produce needed supplies during the crisis. The law, notably, allows the president to set a price ceiling for critical goods used in an emergency.

 

 

 

 

To solve the economic crisis, we will have to solve the health-care crisis

Posted on by • Posted in 2020 Election Issues, Clinical Research, Clinical Research Funding, Coronavirus, Crisis, Crisis Management, Demand Shock, Health Policy, Infection Control, Infectious Virus, Leadership, Pandemic, Pharmaceutical Industry, Public Health, Public Safety, Supply Shock, Vaccine • Leave a comment

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In Washington, the focus has now turned to the economic response to the coronavirus pandemic, with experts and politicians proposing their preferred policy tools — ranging from tax cuts to corporate bailouts to direct payments of cash. Each is worth debating, but the focus is misplaced. This is not an economic crisis; it is a health-care crisis.

The distinction may sound academic. But understanding it is actually vital to designing the policies that should follow.

In an economic crisis, you could imagine a situation in which people lose their jobs and are unable to spend money. That’s called a demand shock, which is what happened during the global financial crisis of 2008. Or producers could raise prices (for various reasons), making it harder to buy their goods. That’s a supply shock, and it describes the oil crises of 1973 and 1979. But what is happening now cannot be addressed primarily by economic responses, because we are witnessing the suspension of economics itself.

Today, even if you have money, increasingly you cannot go into a shop, restaurant, theater, sports arena or mall because those places are closed. If you own a factory that hasn’t already closed for health reasons, you may still have to shut it down because you can’t get key components from suppliers or you can’t find enough stores open to sell your goods.

In these conditions, cash to consumers cannot jump-start consumption. Relief to producers will not jump-start production. This problem is on a level different and far greater than the recession of 2008 or the aftermath of 9/11. If it were to go on for months, it could look worse than the Great Depression.

This is not an argument against any of the economic measures being proposed. People need to be able to eat, buy medicine and pay their bills. New York Times columnist Andrew Ross Sorkin has canvassed experts and concluded that the best approach would be a zero-interest “bridge loan” to all businesses and self-employed people as long as they keep most of their workers on staff. It is probably the right course of action, massively expensive but cheaper than a full-blown Great Depression.

But even that might not work if we do not recognize that first and foremost the United States faces a health crisis. And that crisis is not being solved. China is now reporting no new domestic infections. South Korea, Taiwan and Singapore have also made progress in “flattening the curve” — the phrase of the year — because they have prioritized dealing with the health-care crisis over enacting a grand economic stimulus.

The United States is still dangerously behind the curve. A headline in Thursday’s Wall Street Journal is, “Coronavirus Testing Chaos Across America.” The article details how the country still has “a chaotic patchwork of testing sites,” with testing proceeding “far slower than experts say is necessary, in part due to a slow federal response.” The U.S. testing rate remains shockingly low, well behind the rates of most other rich countries and far behind those of the Asian countries that are handling this crisis best. Across the United States, hospitals are warning of a dire shortage of beds, medical equipment and supplies. And the worst is yet to come. With infections doubling every two to three days, the U.S. health-care system will face what New York Gov. Andrew Cuomo correctly described as a “tsunami.”

The Trump administration is still acting slowly and fitfully. Experts predicted weeks ago that cities would need thousands more hospital beds, and yet the Navy is still performing maintenance on two hospital ships and figuring out staffing. The president says he will invoke “defense production” powers only if necessary. What is he waiting for? He should direct firms to start production of all key medical equipment in short supply. The armed forces should be deployed immediately to set up field testing and hospital sites. Hotels and convention centers should be turned into hospitals. The federal government should announce a Manhattan Project-style public-private partnership to find and produce a vaccine. After decades of attacks on government, federal agencies are understaffed, underfunded and ill-equipped to handle a crisis of this magnitude. They need help, and fast.

And here’s another idea: President Trump could forge an international effort to unite the world against this common threat. If the United States, China and the European Union worked together, prospects for success — on a vaccine, for example — would be greater. China in particular produces most of the supplies and medical ingredients the world needs. Trump should remove all of his self-defeating tariffs so that American consumers don’t have to pay more for these goods and China can ramp up production. This is a war, and in a war you try to find allies rather than create enemies.