Quote of the day

 The thing I am always saying

Luigi Mangione, the suspect in the killing of UnitedHealthcare CEO Brian Thompson who is facing a slew of charges in Pennsylvania and New York arrived to court Tuesday, yelling.

Mangione is now in court awaiting his extradition hearing.

Mangione could be heard yelling, in part, “it’s completely out of touch and an insult to the intelligence of the American people. It’s lived experience!”

Anyway, it's not on any of us to apologize for or reconcile with the fact that a guy who would shoot someone dead in the street isn't a perfect gentleman with entirely coherent politics.  That's not how anything in this country works.  At the same time, it's not hard to have some sense of solidarity with the notion that Americans have been extorted and left to die as a cold matter of course by a health insurance mega bureaucracy for decades. 

Corrupt politicians may shrug their shoulders at it all they want, but most of us would say this is a deeper matter than a "policy difference."

Update:  No need to go scouring the guy's social media or interview his high school classmates for clues. This seems pretty straightforward.

Turns out they will have to figure in a way to bribe the legislators too

At first they didn't think they'd have to.  Technically the legislature doesn't have direct authority over whether or not the sale goes through. But the way lawmakers were talking before the hearing was starting to make everybody feel back. So, back to the drawing board. For now, anyway. 

Hours before regulatory hearings in Baton Rouge were set to begin Wednesday, Blue Cross and Blue Shield of Louisiana officials said they were shelving plans for a controversial $2.5 billion sale to Elevance Health.

In a statement early Wednesday, the Louisiana Department of Insurance said, “Late yesterday evening, Blue Cross notified the LDI that it has chosen to withdraw its Plan of Reorganization. The hearing scheduled for today and tomorrow is therefore canceled."

It’s the second time in less than a year that the Baton Rouge-based nonprofit has tabled its plan to sell itself to the for-profit Elevance, one of the nation’s largest insurers, amid steep opposition from doctors, hospitals, some policyholders and state lawmakers.

I'm sure they'll be back. 

Shut up, go back to work, do not ask any questions

As we've already noted, the sale of Blue Cross Louisiana to a notorious for-profit corporation is a terrible deal. Even your also notorious Louisiana Legislature seems to understand this. 

Legislators, who came prepared with detailed questions about every aspect of the complex transaction, returned repeatedly throughout the marathon hearing to Elevance’s track record in other states. The company has racked up more than $26 million in regulatory fines for violations that included denying coverage of needed medical care, failing to cover preventive service like immunizations and breast cancer screening, and failing to pay claims in a timely manner.

Louisiana, where Elevance administers the Healthy Blue Medicaid plan, was among the seven states where the company has incurred fines.

But, because the deal also grants the new Governor and Commissioner of Insurance seats on the board of the new entity the sale will create, and sway over how some of the proceeds are spent, it will likely gain the approval of both. The Governor, in fact, has already made a public endorsement.  

There appears to be public momentum gathering against the sale. Note the skeptical legislators above and, here, even our reactionary Treasury Secretary John Fleming is militating against it today.  In the meantime, though, let's look at Jeff Landry's stated reasons for accepting his bribe lending his support. To begin with, he says it's a good excuse to boot people off of Medicaid.

Landry’s strongest comments in favor of the Blue Cross sale centered on the nonprofit foundation, Accelerate Louisiana Initiative, that will funded with the bulk of sale proceeds and surplus Blue Cross reserves, for a total of more than $3 billion.

The foundation will seek to operate as a nonprofit public-private trust, a designation that will require a change of state law. It is to have four focus areas, all centered on poverty and health outcomes. Landry praised the first pillar, which supposedly would move people from dependence to independence.

“In other words, we’re going to be able to have an organization that is going to work towards trying to move those people off of Medicaid,” the Republican governor said.

It used to be, you had to just pull the inference out of the policy choice itself and explain how hostile the intent was.  Nowadays, they just come out and say what they are doing.  

The other thing they've given up on pretending to anymore is the notion that there are fiscally "conservative principles" at work here. It's about being cruel for the sake of being cruel.

That federal government-sponsored health insurance program for poor people was dramatically expanded under Landry’s predecessor, Democrat John Bel Edwards. Almost half the state’s population is now on Medicaid, most of which is paid for by the federal government.

Landry said Accelerate money will also be used to help get the state’s “safety net programs” working in sync. He used the example of a hypothetical patient with Type II diabetes, a chronic health condition that leads to other health problems. Landry said the patient might receive a “shiny brochure” from her doctor telling her to eat healthy and lose weight to help her condition.

“Then, she puts it in her purse, goes to Piggly Wiggly and goes down the aisle to the soda, chips, cookies, and then she goes to the cash register with her Louisiana Purchase card,” said Landry, using an old trope that criticizes welfare recipients. “How about if we had an organization that helps the government start to integrate the food stamp program with the Department of Health, so instead of getting a fancy brochure we could give her $100” if she engages in healthy lifestyle choices,” he said.

“When else are we going to get that opportunity again?” he said. “Those are the things we will do.”

Poor people deserve to be bullied and shamed by the state.  It's the only way to keep the help in line.  And that is, in fact, all they are good for. Landry is saying that out loud as well. 

The plans for the foundation, which were changed late last year as Blue Cross sought approval from state regulators for the deal for a second time, now specifically prohibit research money for health outcomes from going to higher educational institutions — except for the LSU-affiliated Pennington Biomedical Research Center in Baton Rouge.

Landry said that giving the money to other Louisiana research institutions, a list that would include LSU and Tulane University, would be wasteful.

“I don’t want money going to higher education. I want the money used in our workforce because everywhere I go, people are telling me they don’t have skilled labor. And I’ve seen these deals around the country and all the money gets sucked up by the universities and we got nothing,” Landry said.

When we consider this is how the Governor view his people; not so much as humans with human appetites for joy and knowledge and experience to be nurtured, but only as a "workforce" to be disciplined; then it's easier to understand why he's keen to sell their health care off to capitalist vultures at the nearest opportunity. It's an extremely efficient way of liquidating lives into profits.  

It's called a bribe

Appreciate the legislators asking very good questions about all of this. But, at the end of the day, it will be Tim Temple and, to a lesser extent, Jeff Landry (via bully pulpit agenda setting) who will make the decision.*  So... the deal guarantees Temple a seat on the board of the new entity created by the sale.  And Landry gets this.

They called special attention to a curious provision in the plan to create Accelerate Louisiana, which will be a $3 billion foundation focused on addressing poverty and health inequity in the state. The provision prohibits the foundation from giving money for health research purposes to any higher education institution in the state except the Pennington Biomedical Research in Baton Rouge.

“You have $3.1 billion and the only institution that can receive funding is Pennington?” asked Sen. Adam Bass, R-Bossier City. “Why is that?”

Tim Barfield, a former Blue Cross member who is now board chair of the Accelerate Louisiana Initiative, said the stipulation was a condition imposed by Gov. Jeff Landry and his staff.

“That was a requirement of the attorney general, now governor,” Barfield said.

*Blue Cross policy holders also have to vote on the sale but that may be, in the bag, so to speak.  

Lawmakers also grilled Blue Cross about potential irregularities in the voting process and the way proxies are being collected. Under questioning, Blue Cross officials acknowledged that the same outside firm tabulating proxy votes is also soliciting members by phone to make sure they vote.

“The same group that can take a proxy vote over the phone is the same group calling to say, ‘Did you get your ballot?’” said Republican Sen. Thomas Pressly of Shreveport. “I am blown away.”

The bribes have been negotiated and they are surprisingly small

I think I said this around this time last year, but I really have got to get back to posting here (or writing longer form in some other way) more often. It's the only way I'm going to be able to keep track of the things that happen and hold them in my mind for any longer than it takes to flush them down Elon's Twitter toilet. 

For example, yesterday when I read this story about the deal Elevance and Blue Cross are offering Jeff Landry and Tim Temple so that they will bless the non-profit insurer's sale to the for-profit company, I thought, oh look, all it took was a just a couple of little bribes. They really bought them off cheap.

Many of the major elements of the proposed acquisition are largely unchanged from the original proposal announced in January. The sale price remains the same, as does the percentage of the sale's proceeds that will go to Blue Cross' 92,000 official policyholders.

But the new deal includes changes to the nonprofit foundation that will be formed as part of the transaction and is set to receive 91% of the sale's proceeds. The Accelerate Louisiana Initiative will now have an expanded board of directors that includes an appointee of Gov.-elect Jeff Landry. It will also include a nonvoting "observer" appointed by newly elected Insurance Commissioner Tim Temple.

But it took me a while to be reminded that I'd already flagged this in September when the writing was on the wall about Landry and Temple's intentions prior to the election.  This happens to me all the time now. If I don't deliberately stop and write about something, I'm liable to lose it. I try to keep little notes in draft but it's not the same. There's something about completing the thought here that makes it stick. There's just been less time lately to finish thoughts. That can't be good.

Anyway, this isn't supposed to be a post about me. Elevance is about to take over the state's largest insurer in a deal that will make some very wealthy administrators even wealthier. Meanwhile, Blue Cross policyholders are facing a precarious future. But hey, I'm sure that $3,000 will make up for it. 

Blue Cross first announced the deal with Elevance nearly a year ago. But as the deal came under closer scrutiny before its approval by regulators, critics expressed concerns about the effect of the sale on customers and questioned the structure of the foundation.

Two reports by independent consultants prepared for state regulators raised questions about some of the deal assumptions. More recently, a Metairie attorney has filed a suit in federal court seeking class action status on behalf of the 92,000 policyholders, arguing that as members of the mutual indemnity company who have paid into it over the years, they, not the foundation, are entitled to the sale proceeds.

Under the terms of the current deal, policyholders will split some $276 million, receiving approximately $3,000 each.

All clear for profit taking

 Election's over. No longer any reason to pretend anyone will stand in the way of Elevance. 

Baton Rouge-based Blue Cross officials notified the Louisiana Department of Insurance in late September it was withdrawing its application for the necessary state approval of the deal. The pause came amid growing concerns from policyholders, local politicians and Louisiana Attorney General Jeff Landry, who is now governor-elect.

At the time, the company said it would refile its application with the state later this year or in early 2024.

Landry had expressed concerns about whether the deal was in the best interest of the policyholders and had said he thought the incoming Commissioner of Insurance, Tim Temple, a new governor and a new crop of state legislators should be in office before a deal of such magnitude is approved.

More than 1.9 million people in Louisiana have some form of Blue Cross health insurance. Of those, some 92,000 are policyholders.

Good luck, everybody!

So what is it all about?

There isn't much to say about this that isn't already in the text of the dissent. So let's highlight a few things. (full opinion can be found here)

And no one should be confident that this majority is done with its work. The right Roe and Casey recognized does not stand alone. To the contrary, the Court has linked it for decades to other settled freedoms involving bodily integrity, familial relationships, and procreation. Most obviously, the right to terminate a pregnancy arose straight out of the right to purchase and use contraception. See Griswold v. Connecticut, 381 U. S. 479 (1965); Eisenstadt v. Baird, 405 U. S. 438 (1972). In turn, those rights led, more recently, to rights of same-sex intimacy and marriage. See Lawrence v. Texas, 539 U. S. 558 (2003); Obergefell v. Hodges, 576 U. S. 644 (2015). They are all part of the same constitutional fabric, protecting autonomous decisionmaking over the most personal of life decisions. The majority (or to be more accurate, most of it) is eager to tell us today that nothing it does “cast[s] doubt on precedents that do not concern abortion.” Ante, at 66; cf. ante, at 3 (THOMAS, J., concurring) (advocating the overruling of Griswold, Lawrence, and Obergefell). But how could that be? The lone rationale for what the majority does today is that the right to elect an abortion is not “deeply rooted in history”: Not until Roe, the majority argues, did people think abortion fell within the Constitution’s guarantee of liberty. Ante, at 32. The same could be said, though, of most of the rights the majority claims it is not tampering with. The majority could write just as long an opinion showing, for example, that until the mid-20th century, “there was no support in American law for a constitutional right to obtain [contraceptives].” Ante, at 15. So one of two things must be true. Either the majority does not really believe in its own reasoning. Or if it does, all rights that have no history stretching back to the mid19th century are insecure. Either the mass of the majority’s opinion is hypocrisy, or additional constitutional rights are under threat. It is one or the other.

We start with Roe and Casey, and with their deep connections to a broad swath of this Court’s precedents. To hear the majority tell the tale, Roe and Casey are aberrations: They came from nowhere, went nowhere—and so are easy to excise from this Nation’s constitutional law. That is not true. After describing the decisions themselves, we explain how they are rooted in—and themselves led to—other rights giving individuals control over their bodies and their most personal and intimate associations. The majority does not wish to talk about these matters for obvious reasons; to do so would both ground Roe and Casey in this Court’s precedents and reveal the broad implications of today’s decision. But the facts will not so handily disappear. Roe and Casey were from the beginning, and are even more now, embedded in core constitutional concepts of individual freedom, and of the equal rights of citizens to decide on the shape of their lives. Those legal concepts, one might even say, have gone far toward defining what it means to be an American. For in this Nation, we do not believe that a government controlling all private choices is compatible with a free people. So we do not (as the majority insists today) place everything within “the reach of majorities and [government] officials.” West Virginia Bd. of Ed. v. Barnette, 319 U. S. 624, 638 (1943). We believe in a Constitution that puts some issues off limits to majority rule. Even in the face of public opposition, we uphold the right of individuals—yes, including women—to make their own choices and chart their own futures. Or at least, we did once.

The majority would allow States to ban abortion from conception onward because it does not think forced childbirth at all implicates a woman’s rights to equality and freedom. Today’s Court, that is, does not think there is anything of constitutional significance attached to a woman’s control of her body and the path of her life. Roe and Casey thought that one-sided view misguided. In some sense, that is the difference in a nutshell between our precedents and the majority opinion. The constitutional regime we have lived in for the last 50 years recognized competing interests, and sought a balance between them. The constitutional regime we enter today erases the woman’s interest and recognizes only the State’s (or the Federal Government’s).

And one more thing to share just to drive home the point.

The criminalization of a woman’s right to choose is only the precursor to states removing other freedoms based in privacy. As one freedom is removed from the table, a myriad of others become jeopardized by future government overreach- to which, set by this dangerous precedent,

— del (@so_del_icious) June 24, 2022

Okay and one more in case we want to know what Democrats are doing about it.

As protesters can be heard in the back chanting outside SCOTUS, House Democrats sing “God Bless America.” pic.twitter.com/MjW0cSZ6nY

— Farnoush Amiri (@FarnoushAmiri) June 24, 2022

What's it all about, then? Well, it's about denying basic healthcare to millions of women and putting their lives in danger. It's about denying Americans' fundamental right to privacy insofar as it is understood by anyone born after the Fourteenth Amendment was passed. But one thing it can't possibly be about is holding the middle managers our broken political system entrusts with defending any of this responsible. Why would anyone think that? I mean, aren't the Republicans really the problem?

to me it's like being in New Orleans during Katrina, and shit is flooding, and there's nowhere to go and no help coming, and yelling at the hurricane about it. The Republicans are the hurricane in this analogy for any democratic strategists reading this

— tinybaby (@tinybaby) June 24, 2022

What would single payer health care look like in the US?

You might think it's not possible but I'm here to tell you that it is.  It's just not possible as the thing you are thinking about. Instead it's this. 

The fragmentation of American health care has kept Big Data from being fully harnessed as it is in other industries, like online commerce. But Optum’s acquisition of Change heralds the end of that status quo and the emergence of a new “Big Tech” of health care. With the Change data, Optum/UnitedHealth will own the data, providers, and the network through which people receive care. It’s not a stretch to see an analogy to Amazon, and how that corporation uses data from its platform to undercut third parties while keeping all its consumers in a panopticon of data.

The next step is up to the Department of Justice, which has jurisdiction over the acquisition (through an informal agreement, the DOJ monitors health insurance and other industries, while the FTC handles hospital mergers, pharmaceuticals, and more). The longer the review takes, the more likely it is that the public starts to realize that, as Dartmouth health policy professor Dr. Elliott Fisher said, “the harms are likely to outweigh the benefits.”

It's not politically possible to get the benevolent One Giant Public Health Behemoth controlling costs and care on behalf of patients.  So we will have to settle for the One Giant Private Health Behemoth controlling everything on behalf of executive profits. But at least it will be a "market-driven" solution that gets us there so it must be good. 

Best healthcare system in the world

It's possible that over the weekend, some people may have noticed a news item or two indicating that President Trump had checked into Walter Reed hospital where he was treated for COVID-19.  It's okay if you missed it. But it's something that people were talking about. 

Anyway one of the things that got some attention was the President's treatment regime.  He tweeted this afternoon that it involved some "really great drugs and knowledge."  Unfortunately the information coming from his doctors is not exactly clear. But, as far as we know, here is some of what that might have entailed. 

Trump got one dose of Regeneron's monoclonal antibody cocktail -- a combination of two lab-engineered proteins designed to home in on the coronavirus. He also had received the first infusion of a five-day course of remdesivir, Gilead Science's experimental antiviral drug.

Conley indicated the Walter Reed team was giving Trump a variety of therapies -- an approach many doctors are taking in treating coronavirus patients, who suffer a wide range of symptoms.

"Remdesivir works a little bit differently than the antibodies. We are maximizing all aspects of his care. Attacking this virus in a multipronged approach," Conley said.

"If there was any possibility that it would add value to his care and expedite his care, I wanted to take it."

It's not surprising, said Dr. Seema Yasmin, director of research and education at Stanford University's Health Communication Initiative. 

"This is the President of the United States -- he is going to have the kitchen sink thrown at him," Yasmin told CNN.

Multipronged, kitchen sink approach involving all these cutting edge treatments.  We really can do remarkable things in health care here in the good ol US of A. It's sure great to the be the President of this country. 

It's less great to be in jail in Orleans Parish, though.  They treat the COVID differently there, apparently. 

And Dixon wasn’t the only one who felt the effects of the pepper spray. It dispersed throughout the rest of the tier, which at the time was housing around a dozen other detainees who had tested positive for coronavirus. 

“Yeah it got into our cells,” said the detainee. “All of us were all beating on the doors telling the people we can’t breathe, to open the outside door where they have a rec yard so it can air out.  We were telling them we can’t breathe, they were telling us we can’t go outside and air out.”

“By inhaling that stuff, it’s so strong,” he said. “We tested positive for the corona, and it was getting in our system. We were coughing and gagging in our cells.”

Following the incident, according to Dixon and the other inmate, Dixon was returned to his cell on the COVID tier and kept there for several days without being given the opportunity to shower or make any phone calls. 

“They put me in the cell with no shower, nothing to clean it off me,” Dixon said. 

The only medical attention he received, Dixon said, was being given Tylenol to help with his wrist and ankles, which had become swollen from the cuffs and shackles.

Nowhere to wash off the pepper spray... not even a kitchen sink.

A world restored

Trying to come up with a pithier explication of Super Tuesday than this and failing to find one.

Dow surges more than 600 points at the open as Biden Super Tuesday victories boost health care stocks https://t.co/RfHHB5XY84 pic.twitter.com/CZzbCxlzcL

— CNBC Now (@CNBCnow) March 4, 2020

Anyway on to the long death march, now.  I don't want to go on at length about the 2020 primary because what is the point of putting any more of that #content on the internet right now?  I mean I think there are probably one or two things I could say that not many other people around me are saying today.. maybe?

But I already did a tweets about that.

Actually it adds zing to the barbecue sauce

They say he had no use for it but I don't think they know.

Horn, a Saints standout and fan favorite who retired from the NFL after the 2007 season, admitting paying off co-defendants Vanover and Caldwell and others who helped him submit the false claims, according to court records.

Among those claims was reimbursement for a $52,000 cryosauna, a machine that uses nitrogen vapor to create freezing temperatures for body therapies. But Horn didn’t need the machine and never received it, prosecutors said.

It's the quick-freeze that really locks the flavor in.



Joe Horn Barbecue Sauce. Try some on your Beefy Mac 

If you live long enough, all of your heroes become Uncle Rico, I guess.

Anyway it's a shame this happened.  NFL retirees have had to fight pretty hard to get the league to do anything at all to help with the health care costs incurred after a career in pro football destroys their bodies. Ripping that fund off, in particular, is, as they say, not a very good look.

Of course, under a nationalized single payer health care system, none of this would even matter. But that's another conversation. 

Feed them all to Ochsner

Eventually there will just be one hospital.

In a move that would result in the largest health system in the Gulf South, Lafayette General Health System announced Wednesday it is seeking a merger with Ochsner Health System.

The board of trustees of both health systems signed a letter of intent for the merger Wednesday morning, Lafayette General announced. Both organizations will now enter into a period of due diligence and seek required regulatory approvals, which could take several months.

Why does this keep happening? The answer is classic disaster capitalism.

There's a perpetual ebb and flow in Louisiana where Bobby Jindal type grifters wreck the state budget followed by John Bel type bi-partisan dads who stabilize things by institutionalizing the damage to basic services.  First the disaster, then the normalization of its destruction.   Following along in the wake of these shocks is Ochsner which appears to be on pace to eat every hospital in the state.  By the time it arrives on the scene, though, it looks to everyone like a savior. 

The move was partially prompted by a "wake up call" after last year's state budget situation. A reduction in state funding forced Lafayette General to consider reducing services at University Hospitals and Clinics, to include possible closure of the hospital.

Lafayette General operates University Hospitals and Clinics as part of a public-private partnership that stopped it from being closed in 2012. Callecod said the merger will allow LGH to negotiate with the state for funding from a much stronger position.

"We very much as a system are at the whim of the legislature, and so certainly we do everything we can to make folks understand the great work we do there, but the reality is that this merger will allow us to be in a better position with the state as we're having those conversations because of Ochsner's reach throughout the state," Callecod said

In the public health department

Let's see what day was this?  It was a long weekend and I have no idea what I did with most of it.  Was it Friday?  I think it was Friday.  Anyway I went to see Tim Faust speak at Garden District Book Shop.  The book he's promoting is called Health Justice Now: Single Payer and What Comes Next.  I'm sure it's very good. I did buy a copy but it's at the bottom of a pile quite similar to if not worse than this one from the middle of the summer. I'll get there eventually.  If you've seen, read or heard any of Faust's work advocating for a better health care system than the nightmare we live and die at the hands of today, then, well, this talk was very much like that.

In his talk, Faust says the US is "the most dangerous place to be sick the most dangerous place to be poor, the most dangerous place to be black or brown, the most dangerous place to be disabled, the most dangerous place to be queer..." There is a mutually reinforcing relationship between poverty and illness. The so-called "health-wealth gap" in the United States adds up to a 20 year difference in life expectancy between the richest and poorest. All of these states of precariousness are direct reflections of an unjust health system. 

By that, he means the US health care delivery apparatus is fraught with such waste and unfair distribution that the negative health outcomes compound upon each other. "In the US all prices are fake," says Faust. The costs of primary and preventative care are grossly inflated as large corporate providers force smaller health clinics out of business in order to charge hospital rates for everything. And, of course, insurance companies can only profit by denying patients care when they need it. 

Unjust wealth allocation leads to unequal health outcomes in all sorts of ways.  Faust travels all over the country talking to people about health care and gave a few examples. In Houston the prisons have become warehouses for people with untreated mental illness. In Memphis environmental racism has led to a situation where black children die at 20 times the rate of white children.  When Indiana Governor Mike Pence inhibited needle exchange programs during the height of an opioid crisis, it  resulted in "one of the biggest HIV outbreaks in decades."  These are all essentially questions of resource allocation.

The day after I saw Faust talk, I read in the Advocate that the state has finally responded to public pressure at least to the point of agreeing to study the effect of the Denka neoprene plant on cancer rates in St. John Parish. As we know, the State of Louisiana subsidizes the proliferation of plants like Denka to the tune of billions of dollars each year.  Poor Louisianians are subsidizing the profits of the petrochemical industry with their very bodies.

The US spends over $3.6 trillion annually on health care. According to Faust at least 1/3 of that is "waste." It would cost approximately 10 percent less to implement a single payer system. And the savings can be applied to giving people better housing, better transit, better food access, a fairer criminal justice system etc. all of which support better health outcomes.  So the fight for health justice really is at the center of a struggle for a radical societal overhaul.  Efforts to combat the problem at the margins via schemes like Obamacare or Medicaid as we know it are not good enough. It is in Faust's words a question of giving people "insurance or emancipation."

Which is why the expansion of Medicaid under Obamacare that John Bel Edwards' reelection campaign touts as a major accomplishment doesn't get us where we want to go. In Louisiana, Medicaid is privatized. And the MCO contracts, in addition to just being inefficient means of shoveling money to for-profit insurers and providers, amount to one of the biggest slices of political patronage a Governor can hand out. This year, the dispute over those contracts has left over half a million Medicaid patients in a wholly unnecessary state of uncertainty just as the start of open enrollment for next year looms. 


Finally, Faust fielded a few skeptical questions from audience members about whether or not a single payer system would garner support from doctors, some of whom, at least, might find certain aspects of their practices less profitable. But, while that isn't really true for most doctors,  the question did remind me that a professional association of Louisiana doctors has endorsed Ralph Abraham for Governor.

The Louisiana Medical PAC hasn't issued an endorsement in the most recent governor's races, but jumped at the chance to endorse one of their own.

“It’s been a number of years since we decided to take a position in the governor’s race, but we have one of our own running,"  Dr. Robert Bass, chairman of the PAC, said in a statement. "We believe that physicians supporting physicians is important, and when you have a candidate like Dr. Abraham, it’s very easy to make this decision.

"Dr. Abraham has a wealth of knowledge that is critical to helping Louisiana improve healthcare outcomes."

That's interesting. As it happens, this week the Bayou Brief provides us with an example of one health outcome Dr. Abraham has used his "wealth of knowledge" to bring about.

“Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug overdose deaths,” states the CDC. “Opioids were involved in 47,600 overdose deaths in 2017. A staggering 67.8% of all drug overdose deaths are due to opioids, and while nationwide these numbers have declined, Louisiana is one of a handful of states in which deaths from opioid overdoses have increased.

During the past year, overdose deaths went up by 4.7% in Louisiana.

“Louisiana also ranks among the top 10 states with the most opioid prescriptions written per capita, according to its state’s lawsuit against 17 companies, including Purdue Pharma,” according to a report published yesterday by APG Wisconsin. “Since 2007, the state has spent at least $677 million ‘for treatment of opioid use and dependence.’”

During the seven-year timeframe, Abraham’s pharmacy in Winnsboro doubled the number of opioids it dispensed to patients; opioid prescriptions filled at his pharmacy in Mangham, which is located near his former medical clinic, surged a staggering 67%.

In Mangham (2017 population: 638), Abraham’s pharmacy supplied enough opioid medication to provide every man, woman, and child 6.1 doses every year (or 43 pills in total) for seven consecutive years; his pharmacy in Winnsboro (2017 population: 4,652) could have provided every resident 4.4 doses per year (or 31 in total). (Note: Annual doses per person were based on Census estimates, not the most recent American Community Survey).

If a single payer system focused on health justice for all means a less profitable pill pushing scheme for Dr. Feelgood that's just something we are going to have risk.

Some of the ends are coming aloose

Just last week, we noted that John Bel was gearing up for reelection by paying off Gayle Benson with a sweetheart deal for Superdome renovations right before he paid off Jim Bernhard with this Energy Partners/Johnson Controls deal. So far so good.

But the largest contracts let by the state are with the managed care firms who administer the state's privatized Medicaid program. Altogether these contracts total something close to $8 billion. The current deals were negotiated during the Jindal administration (that process was not without its controversies) and were kept in place by John Bel even after the state accepted the Medicaid expansion.

Those contracts are up for renewal now and, for whatever reason... just ahead of election time... John Bel has decided to shake things up a bit. The new deal brings the number of contractors down from five to four. It also replaces another of the existing companies.  Humana has been cut in while Aetna and Louisiana Healthcare Connections are out. Which means we have to ask who is John Bel paying off here and what is their relationship with Humana? 

We don't know the answer to that yet. But we do know LHCC has a friend in Cedric Richmond's orbit.

U.S. Rep. Cedric Richmond, D-New Orleans, penned a letter Friday to Edwards raising concerns about the decision to drop Louisiana Healthcare Connections from the state’s managed care system. He warned of lost jobs in his district and said 84,000 of his constituents receive health care through LHC’s network, raising the possibility of patients losing access to their providers with the change.

Today LHCC and Aetna have filed some sort of appeal.  And a joint legislative committee will begin considering the new contracts sometime in September. Again, right in the middle of election season. Can't imagine anybody there would be up to making any mischief for any reason.

The non-serious "serious" candidate

My theory as to why Kamala is dropping all of these obviously bad policy proposals this week is that she's not actually serious about them.  You could say this for any candidate's "plans," really.   Electing a person President doesn't automatically enact that person's campaign platform into law.  Most people understand this. (Ok, maybe not every people.. ahem.. Warren voters.. but most people.) 

What the policy pages on a candidate's website are supposed to do, however, is communicate something about the campaign's values.  Sure, some of it can actually be earnest thoughts on the governing agenda. But that's a secondary purpose at best. These are campaign websites. Everything that appears on them should be considered a campaign ad.  The policy sesctions say, "Here are the things this campaign believes in."  Or, at least, these are the things we would like to be perceived as believing in at the moment.  Of course all of that demands further interpretation and context but that's not important right now. Suffice to say these proposals are political messages that may or may not have anything to do with actual policy down the road.

It's quite possible Kamala Harris really is okay with these untennable, unhelpful, plans to not really forgive anyone's student loans and boost the privatized section of Medicare.  But the only reason to publicize these bad ideas during a campaign is to show right wing voters and/or Democrats who believe the only way to win an election is by making right wing voters happy that you are someone they should take seriously. 

Right now those people take Joe Biden seriously.  Harris's strategy is to be the next choice once Joe Biden drops out, which is still what most people expect to happen even if they arent' saying it out loud.

"It makes sense" to govern as a rump junta

Republicans in the legislature are throwing another fit over the scandalous notion that poor people might receive health care.

Several Louisiana House Republicans took advantage Tuesday of a hearing on the Department of Health’s $15 billion budget to sharply question the agency’s leaders on issues like Medicaid fraud and eligibility problems in the wake of critical audits of the agency.

It's exhausting that we even have to take a momement to engage with these bad faith allegations of "fraud" coming from parties whose aim has always been to kick as many people off of benefits as possible.  You know, what, actually let's do ourselves a favor and igore it altogether this time.  It's done enough damage already.

There are quotes in this article from Rebekah Gee and John Bel Edwards where we see they've been intimidated into touting a new eligibility system that "provides more detailed information about enrollees."  It's a side point in the story so it doesn't get explored much further. But to get an idea of how much this already concedes, take a look at how stricter, more intrusive intake systems for social services are brutalizing poor people all over the country.

In the fall of 2008, Omega Young got a letter prompting her to recertify for Medicaid.

But she was unable to make the appointment because she was suffering from ovarian cancer. She called her local Indiana office to say she was in the hospital.

Her benefits were cut off anyway. The reason: "failure to cooperate."

"She lost her benefits, she couldn't afford her medication, she lost her food stamps, she couldn't pay her rent, she lost access to free transportation to her medical appointments," Virginia Eubanks tells NPR's Ari Shapiro. Eubanks is the author of a new book, Automating Inequality: How High-Tech Tools Profile, Police and Punish the Poor.

"Young died on March 1, 2009," Eubanks says. "The next day, she won an appeal for wrongful termination and all of her benefits were restored the day after her death."

Pick up Eubanks's book if you get a chance, by the way. It's a good recommendation for anyone who isn't quite depressed enough about the current state of the hellworld we live in.

Anyway,  we already know it's not above John Bel to be shitty to Medicaid recipients.  He's only recently dropped his support to saddle them with work requirements because a federal court has ruled against that.

But does it make political sense in Louisiana?  Certainly these Republicans thinks so.  And Bernie Pinsonat agrees.

The comments by Republicans echoed similar lines of attack made by GOP gubernatorial candidates at a recent forum, where they criticized the Edwards’ administration handling of Medicaid.

Pollster Bernie Pinsonat noted Republicans’ base of support in Louisiana is generally opposed to the Affordable Care Act and Medicaid expansion, which is why the Medicaid issue will likely continue to come up this election year.

“Republicans know when they go back home, attacking Medicaid expansion or attacking Obamacare, it makes sense,” Pinsonat said.

Maybe it makes some sense with regard to the Republican base... but just barely.  According to this year's Reilly survey, the Medicaid expansion in Louisiana garners 47 percent support among Republicans. That's down from 51 percent last year so it's trending downward. But, still, hovering at or near 50 percent with the base doesn't really mean a thing is unpopular.  And when you figure in the fact that 69 percent of all respondents of either party approve, then you have to wonder what it is about that one half of the Republican base that gives it such outsized influence over positions taken by the House GOP caucus and even the causes John Bel to handle it with such caution.  Why are we being governed by this rump minority?

I guess they must think that's a bad thing?

It took me a while to figure it out yesterday but the general consensus out there is that this NYT article was intended as a criticism of single-payer health care. It's confusing because, of course, we ought to guarantee health care to every person as a basic human right. Only a monster would think otherwise.  All they're really pointing out here is doing that will be hard for us because there is so much wealth tied up in.. not doing it.

But doing away with an entire industry would also be profoundly disruptive. The private health insurance business employs at least a half a million people, covers about 250 million Americans, and generates roughly a trillion dollars in revenues. Its companies’ stocks are a staple of the mutual funds that make up millions of Americans’ retirement savings.

Such a change would shake the entire health care system, which makes up a fifth of the United States economy, as hospitals, doctors, nursing homes and pharmaceutical companies would have to adapt to a new set of rules. Most Americans would have a new insurer — the federal government — and many would find the health insurance stocks in their retirement portfolios much less valuable.

And, okay, that's a fair point. Single-payer healthcare (currently branded as "Medicare For All") is a revolutionary project in scope.  It is a call to break up entrenched institutions controlling vast stores of wealth and power.   The CEO of United Healthcare makes 298 times as much per year as its median employee salary. That sounds like an industry in profound need of disruption. But NYT is saying that like it would be a bad thing. 


It's true that fulfilling this moral imperative to free people from the fear and debt machine that is private health insurance, not to mention save hundreds of thousands of lives in the process is going to be a heavy lift. It's such a heavy lift, in fact, that Hillary Clinton's admonition that it was "never ever" going to happen, as cynical and hopeless as it sounds, is still the most sober assessment.  That's no reason not to try, of course. It's just that doing the right thing in politics almost always means failure and Hillary has had a very long and successful career in politics.  

She's mostly out of the way for now but that doesn't mean there aren't other successful Democrats on hand to waver on Medicare for All and whittle away its purpose.  

House Democrats plan to unveil health-care legislation on March 26 aimed at lowering costs and protecting people with pre-existing conditions, according to an advisory from the office of Speaker Nancy Pelosi.

The bill, broadly timed to coincide with the 9th anniversary this weekend of Obamacare being signed into law, would “reverse the Trump administration’s health-care sabotage, and take new measures to lower health premiums and out-of-pocket costs for families,” according to the statement.

The measure is set to be proposed as more than 100 Democrats in the House back a “Medicare for All” bill introduced in February by Progressive Caucus co-chair Representative Pramila Jayapal of Washington state. The legislation, which right now has no chance of becoming law in a divided Congress, would create a universal, single-payer health program. Pelosi and a number of party moderates have resisted the idea.

Strictly speaking, this proposal to patch up some of the holes the Republicans have blown in Obamacare in recent years doesn't have to be at cross purposes with the larger project of passing single-payer. Not immediately, anyway.  Eventually the latter measure should render the former moot, though. So it's fair to assume that Democrats who are not among the 100 cosponsors of Jaypal's bill but do support more insurance-friendly bill's like what Pelosi is introducing tomorrow are making an explicit choice to support the industry over the needs of patients.

Cedric Richmond is the only Democratic member of the Louisiana congressional delegation. Which side is he on? 

If only we were better at means testing

You know what might make a problem like this go away?  See if you can guess.

Legislative Auditor Daryl Purpera's office found problems with the agency's infrequent use of wage data from the state labor department to determine eligibility.

The report says since Gov. John Bel Edwards expanded the state's Medicaid program in July 2016, the department has relied on Medicaid recipients to self-report changes in their paychecks in the 12-month period between the initial application for Medicaid and coverage renewal.

Auditors suggested more frequent checks using available state wage data should be used to ensure Medicaid recipients aren't earning more than allowed to qualify. Pennsylvania, Wisconsin and other states do quarterly reviews to check eligibility against income data, the report says.

The report also found errors in the work done by health department caseworkers. In addition, auditors said the agency didn't double-check income information when federal officials determined people who applied for individual marketplace insurance coverage through the Affordable Care Act were instead deemed eligible for the Medicaid expansion program. Those federal officials don't have access to state wage data, the report says.

"Without a sufficient process to determine recipient eligibility, LDH cannot ensure that Medicaid dollars are spent appropriately," Purpera wrote to legislative leaders in the audit.

Imagine if we could just give people health care without a convoluted process for determining whether or not they are eligible. What if... everybody was eligible?  That's crazy talk, though, right?

Universal social programs are based on the principle, as single-payer health care advocate Dr Quentin Young would later put it, of “Everybody in, nobody out.” The goal is to establish a sense of mutual accountability and mutual benefit across society. The method is to enshrine cooperation and solidarity in the institutions by which the state distributes public resources.

Oh hey speaking of crazy talk, Senator Kennedy also has some comments.

Kennedy says: "Actions ought to have consequences. If this was in the private sector, Dr. Gee would have been fired an hour after that report." #lalege #lagov https://t.co/KnGTtiYlPI

— Melinda Deslatte (@MelindaDeslatte) November 14, 2018

John knows that Medicaid operates through private health providers, right? I mean, apart from the contracting and means testing role of the health department, we're very much in the "private sector" already. 

Anyway none of that is his point.  His point is, John is still seriously considering running for Governor next year. We should have his decision in a week or so.

They call it a career in public service

Which is just a fancy way of saying take em for all they're worth coming and going.

Former Gov. Bobby Jindal, who made his opposition to Medicaid expansion in Louisiana a cornerstone of his gubernatorial platform and a talking point in his 2016 campaign for president, has joined the board of directors of WellCare Health Plans, Inc., a Florida-based company that "focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans."

Medicaid gets cut. Medicaid gets expanded or shot through with bewildering rules and mechanisms designed to benefit private insurers and drug companies.  All of this jerking around can mean stability or banruptcy or even life or death for millions of people. For amoral grifters like Bobby Jindal, though,  it's all the same. Always another way to make a little money.

According to a filing with the U.S. Securities & Exchange Commission (SEC), Jindal will be serving on the company's Audit, Finance and Regulatory Compliance Committee and the Information Technology Oversight Committee. Wellcare board members receive $90,000 per year, the filing says, with additional annual retainers of $12,000 and $8,000 for the two committee positions. Jindal also will receive 405 shares of Wellcare common stock, which was trading at $307.48 on the New York Stock Exchange at day's end, making the compensation package worth more than $230,000.

Okay well maybe not just a little money. 

All the leverage

Amazing what you can get away with when you don't actually care if things get funded.

Louisiana House Speaker Taylor Barras, R-New Iberia, wants the Senate to approve a state budget bill and other legislation -- though he was vague about what those other bills might be -- before he agrees to end the Legislature's regular session early.

"It will depend on how fast we get out House bills back from the Senate," Barras said in interview with reporters Monday evening (April 30).

The budget, such as it is, is unacceptable and already wreaking havoc.  Barras doesn't actually care if that happens. It just feeds the Republican "We're trying to end Huey Long style government"  rhetoric.  Meanwhile the resulting chaos can only hurt the Governor's reelection effort. So, sure, why not keep putting the squeeze on?  They can't lose.