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Vaccine mayhem, and other news this week
A roundup of interesting healthcare news from the week of January 4
This week, the United States hit yet another new peak of misery: 4,000 people died of Covid-19 on January 7th, the highest one-day total so far. Over 369,000 people have died of the disease so far. This figure doesn’t include those who have died from non-Covid illnesses that went untreated because of the pandemic, and the figure itself may be an undercount.
Here’s a selection of other healthcare news you might have missed this week. (And make sure to check out my posts from this week: An interview with a hospice social worker, and an investigation into one hospital chain’s lobbying spending.)
The state of Maryland announced a special health insurance enrollment period on its exchange, allowing people in the state to sign up for insurance without the “qualifying life event” that’s usually required to enroll in the exchange outside of the regular enrollment period, because of the pandemic. The state had a special enrollment period last year, too, from March until December 15th. (Sort of makes you wonder why we can’t do it this way all the time, doesn’t it?) The average lowest-cost silver plan in Maryland this year is $342 per month.
You may be aware of the ridiculous situation in New York, where Governor Andrew Cuomo proposed on Monday making it a crime for healthcare providers to vaccinate anyone outside the current priority group, even as hospitals were having to throw out expiring vaccine doses instead of shooting them into any human available. By Friday, he had expanded eligibility for the vaccine to include anyone over 75, starting on Monday the 11th. The New York Times reported that just 34 percent of available doses had been administered in New York City. (My friend Alex Pareene wrote an excellent piece about the mindset behind these failures yesterday.)
Other states are even further behind than New York, though. In Georgia, only 19 percent of available doses have been used. In California, where record numbers of people are dying from the virus and ambulances are being turned away from hospitals, just 25 percent of doses have been used. A Los Angeles Times article reported that many people were skipping the line, ahead of healthcare workers, including a guy who repeatedly told the administrators that “he had a lung condition and a signed note from his doctor that qualified him for an early vaccine.”
Meanwhile, some healthcare settings report “alarmingly low” numbers of nurses and staff willing to get the vaccine; “North Carolina’s top public health official estimated more than half were refusing the vaccine there,” reports the AP.
In Florida, the Washington Post reported on a nursing home that offered vaccines to its “to board members and those who made generous donations to the facility.” It’s truly hard to imagine anything more inevitable about America’s rollout of the vaccine than that wealthy board members of nursing homes would get the shot before people with lung conditions living in the current epicenter of the pandemic. (And that those lucky rich fucks would be in Florida.) The CEO of the nursing home in question made over $3 million from the home and related organizations in 2019.
Also in Florida, one journalist at the Tallahassee Democrat ended up acting as a one-woman helpline for dozens of people who wanted help getting the vaccine. Her paper “has an editorial staff of just 19.”
The Biden administration may push to administer more “first-dose” vaccines, even at the expense of people getting their second shot. Experts seem divided on whether this will be beneficial (more people getting even a little bit of immunity) or dangerous (the science isn’t clear on whether this actually ‘works’), which you always love to see. Either way, it’s evidence that we are making horrible decisions that we shouldn’t have had to make because of how disastrously things are being handled.
The Trump administration has issued a last-minute approval for Tennessee to switch to a Medicaid block grant, which is a conservative plot to reduce Medicaid spending. (This is something Biden may be able to move to reverse, but the administration is trying to “handcuff” him from doing that.) You can tell it is a very bad thing because it is something the Trump administration and Seema Verma in particular really want. Block grants allow states more leeway to not cover certain programs or drugs. For example, as Kaiser Health News explained last year, “a state could ask to cover just one drug per class for most conditions.” That means if you take a drug that works for you, the state could force you to take a different one that doesn’t work as well.
This gets to an interesting point about government-provided health insurance. As the New York Times explained, Tennessee “will be allowed to renegotiate prices with drugmakers and can decline to cover drugs if it deems the prices too high.” Doesn’t Medicare for All empower the government to negotiate with drug companies? Don’t we all want the government to be able to negotiate these outrageous prices, which means being willing to be walk away and not cover the drug? Yes, but: This is exactly why having a separate program for the poor and disabled is a bad idea. The government has much more incentive to be stingy about what it covers on Medicaid because it simply does not care about poor people and it is easier to get away with letting them die. Letting Republican states like Tennessee do this will inevitably lead to drugs that are actually medically valuable and better than their competitors (which not all drugs are!) being cut, because they don’t want to pay for poor people.
This is where “everybody in, nobody out” is so powerful. When those decisions affect everyone, not just marginalized and poor people who already are disenfranchised and far less likely to vote, politicians have more to worry about. But it’s also just a reminder that even if we had Medicare for All, the fight wouldn’t end. We’d still have to push the government to cover necessary services and drugs, and to make those decisions fairly and equitably. Countries with single-payer systems routinely still make dumb, evil, austerity-minded decisions about things like this, and it requires an active and energized left to push back against it. (Like my mum did!) It’s just much easier to do that when we’re all getting our insurance from the same place, not from 3,000 different plans and companies that are not accountable to anyone. Make sure to read the KHN piece if you want to learn more about what block grants would mean.
Pour one out for Haven, the healthcare venture by Amazon, Berkshire Hathaway and JPMorgan Chase that dissolved this week. What was it for, you wonder? Truly, I do not know, and it seems neither did they; it had a vague goal of reducing healthcare costs using Technology, which you might have noticed did not work. But as Michael Hiltzik of the Los Angeles Times wrote:
As I wrote then, the problem of healthcare costs in the U.S. boils down to political will and political power. The healthcare lobby comprises hospitals, physicians, pharmaceutical companies, device manufacturers and health insurers. All have an interest, individually and combined, to fight efforts to cut their take of the pie.
The end of Haven suggests that Buffett, Bezos and Dimon never took on the political forces that govern the American system of healthcare. These three billionaires certainly had the combined heft to have stood up to the healthcare interests.
This is exactly correct. Haven was trying to solve a problem using tech that only politics—and, specifically, a mass movement to defeat the powerful healthcare companies that influence our politics—can hope to address. You can’t make American healthcare costs anywhere close to reasonable just by making it a bit easier for people to book primary care appointments with an app instead of over the phone. You have to force hospitals to accept less money than they currently enjoy getting from private insurers; you have to force drug companies to charge less for drugs; you have to abolish private insurance, which will never control costs. You need single-payer. Please give me one billion dollars, Jeff Bezos, and I will tell you this.
Make sure you read this Vice story on how a “union avoidance” firm compiled information on hospital employees, including their “personality, temperament, motivations, ethnicity, family background, spouses' employment, finances, health issues, work ethic, job performance, disciplinary history, and involvement in union activity.” (The employees later “overwhelmingly voted” to unionize. Owned.)
That’s it for this week, and what a week it was. See you on Tuesday.