To take one example: at least in my state, Maryland, Tricare, if it pays at all, compensates clinicians like me far less for mental healthcare than Medicaid (government medical assistance for low-income Americans). It also misleads military patients by referring them to me even after Tricare has acknowledged that I’m unable to take more of them. Other healthcare plans serving Americans go months without reimbursing me for services they authorized.

Over the years, I’ve written for TomDispatch about many things that military families go through — most similar to what other Americans experience, although almost invariably a little more so. That includes the struggle to feed their families and stay out of debt, the search for childcare, a growing sense of loneliness and pain, and, of course (to mention something so many other Americans haven’t experienced) exposure to the violence of war and its weaponry.

Private companies — and not just medical ones — shape the contours of American life in so many ways, even if we don’t know those companies’ names. Take arms contractors who have contributed so much to the spillover of military-grade weaponry into the hands of civilian killers. Just as all too many Americans, including schoolchildren, have found themselves forced to stare into the barrel of an AR-15 rifle, so have distressed soldiers stared into the “barrels” of companies few of us have heard of that can decide whether they’ll ever get the opportunity for therapy.

Sadly, in my world, greed all too often shapes how we live, just as it’s shaped the world of… yes, the Supreme Court. And for that you can thank the magnates who so generously gifted lavish trips and perks to Justices Clarence Thomas and Samuel Alito while they handed down morally devastating decisions on so many issues, gun control and abortion among them, that will determine the nature of life and death in this country.

In a moment, I’ll tell you a bit about my own experiences as a clinician. But let me start by saying that, for me, as a therapist, wife, and mother, nowhere is the relationship between corporations and everyday life more impactful than in the ways our government allows health insurance companies of every kind to avoid truly paying for the care Americans need. (Ask me, for instance, whether Tricare paid for my family to get flu shots this year. I’ll bet you can guess the answer to that one.)

Americans, who are getting sicker, sadder, and ever more anxious, are so often unable to access necessities like healthcare because all too many legislators, judges, and administration officials refuse to hold large companies accountable to the rule of law — when, that is, significant laws related to such corporations even exist.

An Uphill Battle to Provide Affordable Mental Healthcare

As a therapist, I accept most major insurance plans in the Washington, D.C., area, where I operate a small private practice out of my rural home. I set out to make care accessible to middle- and lower-income Americans, particularly those who fought in America’s wars, were impacted by them, or grew up in a military family — groups where suicide rates are significantly higher than in the general population and where depression, anxiety, and violence are rampant.

I have a social science PhD that has helped me figure out how complicated systems work, yet our insurance system (if it can even be called that) confounds me. I find myself turning away dozens of people every month because I can’t afford to lose more time and income dealing with the complications of their insurance.

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My standard line for those who come to me seeking care is too often: “I’m so sorry, I wish I could help, but I’m unable to take any new patients with [insert here major healthcare plan, most of them state-sponsored or, in the case of Carefirst, D.C.’s version of Blue Cross Blue Shield, contracted by the federal government for its employees].” I then wonder what will happen to that suicidal three-times-deployed Afghanistan and Iraq veteran with young kids at home, who’s been referred to me by this country’s downsized, on-base healthcare system; or the single mother whose State Department job is supposed to offer her an insurance plan to help her manage the stress of aid work in combat zones; or unnerved asylum seekers from Russia, Ukraine, and so on (and on and on and on).

Meanwhile, in a separate area of my mind, I’m starting to try to lay the groundwork for a time when my own ability to support my family won’t suddenly be thwarted because one link in some part of our country’s fragile chain of companies that finance health care breaks for months on end.

The Change Healthcare Outage

Most people I talk to around my affluent town aren’t aware that, in late February of this year, the U.S. healthcare system suffered a major setback: BlackCat, a ransomware group, hacked into Change Healthcare, a subsidiary of the corporate behemoth UnitedHealth Corporation, which (until recently at least) processed about 40% of the nation’s healthcare claims annually, including from therapists. For months after that, some major insurance companies lacked a clear route to receive medical claims from providers like me. They also lacked a way to transfer money from their own banks to doctors. Other claims payment systems take weeks or months to establish, because you have to make sure they’re in sync with the chain of companies you work with in healthcare (if you accept insurance). There’s your encrypted patient data system, your payment-processing system, the insurance company itself, and maybe a company you hire to help you with your billing. In short, the Change outage left many providers like me without a way to get paid for what we do.

Nationally, over these months, more than 90% of hospitals and many group practices (especially smaller ones) lost money — to the tune of somewhere between hundreds of millions of dollars and $1 billion daily. Tens of millions of dollars in insurance payments to providers were delayed indefinitely. Doctors, nurses, and therapists were forced to close their doors, cut staff, forego needed supplies such as chemotherapy drugs, for example, or stop seeing patients. A survey by the American Medical Association of 1,400 medical practices found that 80% had lost revenue, 55% had to use their own personal funds to cover practice expenses, and about a third were unable to pay staff. Eighty-five percent of those practices had to commit extra time to the revenue cycle. The only reason I was able to see patients is because I have a spouse with a job that covers some of our bills (as well as our mounting credit card debt).

I had a particularly difficult time getting the insurance companies that are supposed to cover the healthcare of our troops to cough up funds. Tricare took three months to begin paying me because the requirements of its subcontractor, Humana, Inc., to enroll with a new payment system were opaque even for my professional biller. Then, it took weeks more after they figured it out for Tricare to formally approve the new arrangement.

Johns Hopkins Family Health Plan, another insurance plan for military families sponsored by the Department of Defense, didn’t start paying me the thousands of dollars it owed me in backpay until late June. Maryland Medicaid went weeks or even months without covering services for three of my patients. (Lest anyone think this is unrelated to the way we treat our military families, note that Medicaid serves millions of troops, in addition to many other populations.) The only reason those patients of mine continued to receive care was because I volunteered to do it, a choice that a medical professional living in the largest economy on Earth shouldn’t have to make. A country of wealthy healthcare corporations enabled by the government, who let clinicians choose between volunteer work or turning sick people away is its own kind of banana republic.

Should we be surprised? Not in a for-profit healthcare system, where companies stand to gain by hoarding premiums long enough to garner yet more interest on them. Why would any of them feel compelled to fix such an outage in a timely fashion unless someone made them do it? — and no one did.

The Devil’s in the Details (and There Are So Many Details)

After the Change Healthcare outage, UnitedHealth’s CEO Andrew Witty testified before Congress for the first time in 15 years — a noteworthy (if insufficient) first step in raising public awareness and pressuring companies to improve their data security and prevent disruptions to healthcare. What I didn’t see was any significant discussion of why Americans need little-known companies like Change to begin with.

Change’s role is essentially to take the notes saying what we did that therapists and doctors like me write after we see patients and pass them on to insurance companies like Tricare/Humana, Medicaid/Optum, or D.C. Medicare (administered by the Pennsylvania-based Novitas, Inc.) in a format those payers are most likely to accept. If you ask me, were Change the character in the 1990s parody Office Space asked by downsizing consultants, “What would you say you do here?,” instead of responding, “I deal with the customers so the engineers don’t have to,” it might say, “I deal with the insurance companies so the providers don’t have to.” Essentially, Change takes my notes and sends them to the computer systems of insurers, which then (maybe) pay me. For a company that electronically dispatches healthcare claims from providers to payers, it’s done remarkably well. It was the most profitable of UnitedHealth’s thousands of subsidiaries and UnitedHealth was itself one of the Fortune 500’s top 25 companies in 2023.

So many cooks in the kitchen amount to confusion and lack of accountability for providers like me.

Prior to the Change outage, the reasons companies didn’t pay out to medical workers were often as arbitrary and unrelated to health care as you could imagine. UnitedHealth went months without paying me for therapy I did with several of its members because I wrote the number “11,” not “10,” on claim forms to indicate that I saw patients online. No matter that both numbers stood for the same thing. Worse yet, its representatives refused to tell me that this was the problem until government officials intervened on my behalf. Honestly, I don’t think we live in a “deep state” as much as in (and yes, I would capitalize it!) Deep Corporate America.

Deep Corporations

Much is said these days by folks on the far right about the “deep state” and Donald Trump’s plans to gut it should he return to the White House in 2025. Speaking from the bowels of the healthcare industry, I’d say that what we have on our hands are many layers of companies (like those beneath Tricare, Medicaid, and Medicare) that decide whether and how to administer funds in ways too complicated and inhuman to truly explain. Consider it an irony then that, in 2022, the healthcare version of all of that was deepened by — yes! — a Trump-appointed judge who struck down a Justice Department lawsuit attempting to prevent UnitedHealth from acquiring Change.

Many failed states rot from the inside before they collapse, when people get so fed up with not having their basic needs met that they take to the streets. Maybe before something akin to another January 6th happens in America, more people should begin to question the assumption that private is better, that billionaires are the embodiment of the American dream, and that government, on principle, is not to be trusted. Instead, isn’t it time to hold the feet of government officials to the fire and begin a genuine crackdown on corporate greed in this country?

If that doesn’t happen, our healthcare system will prove to be just one disastrous layer in a genuine American house of cards. Unless our public officials begin to place our human rights and the rule of law first, count on one thing: somewhere along the line that house of cards, medical or otherwise, is headed for collapse.

Copyright 2024 Andrea Mazzarino

Via Tomdispatch.com

Such heat poses increasing health hazards for many groups: the old, the very young, those of us who don’t have access to air conditioning. One group, however, is at particular risk: people whose jobs require lengthy exposure to heat. Numbers from the Bureau of Labor Statistics show that about 40 workers died of heat exposure between 2011 and 2021, although, as CNN reports, that’s probably a significant undercount. In February 2024, responding to this growing threat, a coalition of 10 state attorneys general petitioned the federal Occupational Safety and Health Administration (OSHA) to implement “a nationwide extreme heat emergency standard” to protect workers from the kinds of dangers that last year killed, among others, construction workers, farm workers, factory workers, and at least one employee who was laboring in an unairconditioned area of a warehouse in Memphis, Tennessee.

Facing the threat of overweening government interference from OSHA or state regulators, two brave Republican-run state governments have stepped in to protect employers from just such dangerous oversight. Florida and Texas have both passed laws prohibiting localities from mandating protections like rest breaks for, or even having to provide drinking water to, workers in extreme heat situations. Seriously, Florida and Texas have made it illegal for local cities to protect their workers from the direct effects of climate change. Apparently, being “woke” includes an absurd desire not to see workers die of heat exhaustion.

And those state laws are very much in keeping with the plans that the national right-wing has for workers, should the wholly-owned Trump subsidiary that is today’s Republican Party take control of the federal government this November.

We’ve Got a Plan for That!

It’s not exactly news that conservatives, who present themselves as the friends of working people, often support policies that threaten not only workers’ livelihoods, but their very lives. This fall, as we face the most consequential elections of my lifetime (all 71 years of it), rights that working people once upon a time fought and died for — the eight-hour day, a legal minimum wage, protections against child labor — are, in effect, back on the ballot. The people preparing for a second Trump presidency aren’t hiding their intentions either. Anyone can discover them, for instance, in the Heritage Foundation’s well-publicized Project 2025 Mandate for Leadership, a “presidential transition” plan that any future Trump administration is expected to put into operation.

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As I’ve written before, the New York Times’s Carlos Lozada did us a favor by working his way through all 887 pages of that tome of future planning. Lacking his stamina, I opted for a deep dive into a single chapter of it focused on the “Department of Labor and Related Agencies.” Its modest 35 pages offer a plan to thoroughly dismantle more than a century of workers’ achievements in the struggle for both dignity and simple on-the-job survival.

First Up: Stop Discriminating Against Discriminators

I’m sure you won’t be shocked to learn that the opening salvo of that chapter is an attack on federal measures to reduce employment discrimination based on race or sex. Its author, Jonathan Berry of the Federalist Society, served in Donald Trump’s Department of Labor (DOL). He begins his list of “needed reforms” with a call to “Reverse the DEI Revolution in Labor Policy.” “Under the Obama and Biden Administrations,” Berry explains, “labor policy was yet another target of the Diversity, Equity, and Inclusion (DEI) revolution” under which “every aspect of labor policy became a vehicle with which to advance race, sex, and other classifications and discriminate against conservative and religious viewpoints on these subjects and others, including pro-life views.”

You may wonder what it means to advance “classifications” or why that’s even a problem. Berry addresses this question in his second “necessary” reform, a call to “Eliminate Racial Classifications and Critical Race Theory Trainings.” Those two targets for elimination would seem to carry very different weight. After all, “Critical Race Theory,” or CRT, is right-wing code for the view that structural barriers exist preventing African Americans and other people of color from enjoying the full rights of citizens or residents. It’s unclear that such “trainings” even occur at the Labor Department, under CRT or any other label, so their “elimination” would, in fact, have little impact on workers.

On the other hand, the elimination of “racial classifications” would be consequential for many working people, as Berry makes clear. “The Biden Administration,” he complains, “has pushed ‘racial equity’ in every area of our national life, including in employment, and has condoned the use of racial classifications and racial preferences under the guise of DEI and critical race theory, which categorizes individuals as oppressors and victims based on race.” Pushing racial equity in employment? The horror!

Berry’s characterization of CRT is, in fact, the opposite of what critical race theory seeks to achieve. This theoretical approach to the problem of racism does not categorize individuals at all, but instead describes structures — like corporate hiring practices based on friendship networks — that can disadvantage groups of people of a particular race. In fact, CRT describes self-sustaining systems that do not need individual oppressors to continue (mal)functioning.

The solution to the problem of discrimination in employment in Project 2025’s view is to deny the existence of race (or sex, or sexual orientation) as a factor in the lives of people in this country. It’s simple enough: if there’s no race, then there’s no racial discrimination. Problem solved.

And to ensure that it remains solved, Project 2025 would prohibit the Equal Economic Opportunity Commission, or EEOC, from collecting employment data based on race. The mere existence of such “data can then be used to support a charge of discrimination under a disparate impact theory. This could lead to racial quotas to remedy alleged race discrimination.” In other words, if you can’t demonstrate racial discrimination in employment (because you’re enjoined from collecting data on the subject), then there’s no racial discrimination to remedy. Case closed, right?

By outlawing such data collection, a Republican administration guided by Project 2025 would make it almost impossible to demonstrate the existence of racial disparity in the hiring, retention, promotion, or termination of employees.

Right-wingers in my state of California tried something similar in 2003 with Ballot Proposition 54, known as the Racial Privacy Initiative. In addition to employment data, Prop. 54 would have outlawed collecting racial data about public education and, no less crucially, about policing. As a result, Prop. 54 would have made it almost impossible for civil rights organizations to address the danger of “driving while Black” — the disproportionate likelihood that Black people will be the subject of traffic stops with the attendant risk of police violence or even death. Voters soundly defeated Prop. 54 by a vote of 64% to 36% and, yes, racial discrimination still exists in California, but at least we have access to the data to prove it.

There is, however, one group of people Project 2025 would emphatically protect from discrimination: employers who, because of their “conservative and religious viewpoints… including pro-life views,” want the right to discriminate against women and LGBTQ people. “The President,” writes Berry, “should make clear via executive order that religious employers are free to run their businesses according to their religious beliefs, general nondiscrimination laws notwithstanding.” Of course, Congress already made it clear that, under Title VII of the Religious Freedom Restoration Act of 1993, “religious” employers are free to ignore anti-discrimination laws when it suits them.

But Wait, There’s More

Not content with gutting anti-discrimination protections, Project 2025 would also seek to rescind rights secured under the Fair Labor Standards Act, or FLSA, which workers have enjoyed for many decades. Originally passed in 1938, the FLSA “establishes minimum wage, overtime pay, recordkeeping, and child labor standards affecting full-time and part-time workers in the private sector and in Federal, State, and local governments,” according to the Department of Labor.

Perhaps because the federal minimum hourly wage has remained stuck at $7.25 for a decade and a half, Project 2025 doesn’t launch the typical conservative attack on the very concept of such a wage. It does, however, go after overtime pay (generally time-and-a-half for more than 40 hours of work a week), by proposing that employers be allowed to average time worked over a longer period. This would supposedly be a boon for workers, granting them the “flexibility” to labor fewer than 40 hours one week and more than 40 the next, without an employer having to pay overtime compensation for that second week. What such a change would actually do, of course, is give an employer the power to require overtime work during a crunch period while reducing hours at other times, thereby avoiding paying overtime often or at all.

Another supposedly family-friendly proposal would allow workers to choose to take their overtime compensation as paid time off, rather than in dollars and cents. Certainly, any change that would reduce workloads sounds enticing. But as the Pew Research Center reports, more than 40% of workers can’t afford to, and don’t, take all their paid time off now, so this measure could function as yet one more way to reduce the overtime costs of employers.

In contrast to the Heritage Foundation’s scheme, Senator Bernie Sanders has proposed a genuinely family-friendly workload reduction plan: a gradual diminution of the standard work week from 40 to 32 hours at the same pay. Such proposals have been around (and ridiculed) for decades, but this one is finally receiving serious consideration in places like the New York Times.

In deference to the supposedly fierce spirit of “worker independence,” Project 2025 would also like to see many more workers classified not as employees at all but as independent contractors. And what would such workers gain from that “independence”? Well, as a start, freedom from those pesky minimum wage and overtime compensation regulations, not to speak of the loss of protections like disability insurance. And they’d be “free” to pay the whole tab (15.3% of their income) for their Social Security and Medicare taxes, unlike genuine employees, whose employers pick up half the cost.

Young people, too, would acquire more “independence” thanks to Project 2025 — at least if what they want to do is work in more dangerous jobs where they are presently banned. As Berry explains:

“Some young adults show an interest in inherently dangerous jobs. Current rules forbid many young people, even if their family is running the business, from working in such jobs. This results in worker shortages in dangerous fields and often discourages otherwise interested young workers from trying the more dangerous job.”

The operative word here is “adults.” In fact, no laws presently exclude adults from hazardous work based on age. What Berry is talking about is allowing adolescents to perform such labor. Duvan Tomás Pérez, for instance, was a 16-year-old who showed just such an “interest” in an inherently dangerous job: working at a poultry plant in Mississippi, where he died in an industrial accident. The middle schooler, a Guatemalan immigrant who had lived in the United States for six years, was employed illegally by the Mar-Jac Poultry company. If there are “worker shortages in dangerous fields,” it’s because adults don’t want to take the risks. The solution is to make the work less dangerous for everyone, not to hire children to do it.

We’re Gonna Roll the Union Over

Mind you, much to the displeasure of Project 2025 types, this country is experiencing a renaissance of union organizing. Companies that long thought they could avoid unionization, from Amazon to Starbucks, are now the subject of such drives. In my own world of higher education, new unions are popping up and established ones are demonstrating renewed vigor in both private and public universities. As the bumper-sticker puts it, unions are “the folks who brought you the weekend.” They’re the reason we have laws on wages and hours, not to speak of on-the-job protections. So, it should be no surprise that Project 2025 wants to reduce the power of unions in a number of ways, including:

• Amending the National Labor Relations Act to allow “Employee Involvement Organizations” to supplant unions. Such “worker-management councils” are presently forbidden for good reason. They replace real unions that have the power to bargain for wages and working conditions with toothless pseudo-unions.

• Ending the use of “card-checks” and requiring elections to certify union representation. At the moment, the law still permits a union to present signed union-support cards from employees to the National Labor Relations Board and the employer. If both entities agree, the union wins legal recognition. The proposed change would make it significantly harder for unions to get certified, especially because cards can be collected without the employer’s knowledge, whereas a public election with a long lead time gives the employer ample scope for anti-union organizing activities, both legal and otherwise.

• Allowing individual states to opt out of labor protections granted under the Fair Labor Standards Act and the National Labor Relations Act.

The measures covered here are, believe it or not, just the highlights of that labor chapter of Project 2025. If put into practice, they would be an historically unprecedented dream come true for employers, and a genuine nightmare for working people.

Meanwhile, at the Trumpified and right-wing-dominated Supreme Court, there are signs that some justices are interested in entertaining a case brought by Elon Musk’s SpaceX that could abolish the National Labor Relations Board (NLRB), the federal entity that adjudicates most labor disputes involving federal law. Without the NLRB, legal protections for workers, especially organizing or organized workers, would lose most of their bite. Despite the court’s claim to pay no attention to public opinion, its justices would certainly take note of a resounding defeat of Donald Trump, the Republicans, and Project 2025 at the polls.

A New “Contract on America?”

The last time the right wing was this organized was probably back in 1994, when Newt Gingrich published his “Contract with America.” Some of us were so appalled by its contents that we referred to it as a plan for a gangster hit, a “Contract on America.”

This year, they’re back with a vengeance. All of which is to say that if you work for a living, or if you know and love people who do, there’s a lot on the line in this year’s election. We can’t sit this one out.

Copyright 2024 Rebecca Gordon

Via Tomdispatch.com

Just 57 companies and nation states were responsible for generating 80% of the world’s CO₂ emissions from fossil fuels and cement over the last seven years, according to a new report released by the thinktank InfluenceMap. This finding suggests that net zero targets set by the Paris climate change agreement in 2015 are yet to make a significant impact on fossil fuel production.

The report uses the Carbon Majors database, established in 2013 by Richard Heede of the Climate Accountability Institute, to provide fossil fuel production data from 122 of the world’s largest oil, gas, coal and cement producers.

The InfluenceMap report tells a sobering but informative story of the state of production in these high-emitting industries. Cement and fossil fuel production has reached unprecedented levels, with most of the emission growth traceable to a relatively small number of large companies.

The troubling reality is that the lack of progress of these large fossil fuel companies means the world will need to undertake ever more stringent and steep decarbonisation trajectories if countries are to meet the Paris agreement goal of keeping warming well below 2°C.

The Carbon Majors database highlights how critical it is for companies and countries to be held accountable for their lack of progress on emission reductions. Companies need to define exactly how best to align with the Paris goals, and then monitor and track their progress.

To address this need, our team of researchers from the Universities of Queensland, Oxford and Princeton developed a framework that outlines strict science-based requirements for tracking the progress of companies against Paris-aligned pathways.

By applying this framework to the Carbon Majors database in a follow-up study, our team mapped production budgets for 142 fossil fuel companies against several Paris-aligned global scenarios of the Intergovernmental Panel on Climate Change.

“Surreal Oil Rigs,” Digital, Dall-E, 2024.

We considered the “middle-of-the-road” future scenario whereby business carries on as usual – this is commonly used by investors to evaluate a company’s climate risks. With this scenario, we found that between 2014 and 2020, the coal, oil and gas companies produced 64%, 63% and 70% respectively more than their budgets allow. Further details can be found on the Are You Paris Compliant? website.

Transparency is crucial

Over the seven-year period covered by the InfluenceMap report, nation states and state-owned companies are responsible for most of this growth. It is not yet clear whether such government-run companies will move towards improved reporting against climate standards, but further interventions by governments will clearly be required to meet stated national emission-reduction goals.

Fortunately, more transparency will be available for investor-owned companies. In 2023, a non-profit that aims to standardise global accounting, the International Financial Reporting Standards Foundation, released new climate-related disclosure standards. These should provide investors, politicians and the public with access to more transparent and consistent data, making it much easier for them to accurately judge companies’ climate performance – or lack thereof.

It will be interesting to read the climate reporting of the 57 companies identified by InfluenceMap in coming years. The release of the Carbon Majors data, along with the new climate-related disclosure standards, will hopefully make a huge difference. Companies being more accountable for their emissions should help reduce greenwashing in corporate sustainability reports.

Quantifying fossil fuel and cement production, and associated emissions, is a crucial step. But companies also need to act. Achieving net zero by reducing the emissions of a relatively small number of companies will be much easier than persuading 8 billion people to take collective action on climate.

Such drastic reductions in fossil fuel production must also be matched by investment in abundant and increasingly cheap sources of clean renewable energy. Without these steps, the Paris goals will be unachievable – and that’s very risky for all of us.

Matthew Carl Ives, Senior Researcher in Economics, University of Oxford; Belinda Wade, Industry Professor, School of Business, The University of Queensland, and Saphira Rekker, Senior Lecturer in Sustainable Finance, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

( Commondreams.org ) – The United States health care system—more costly than any on earth—will become ever more so as Wall Street increasingly extracts money from it.

Private equity funds own approximately 9% of all private hospitals and 30% of all proprietary for-profit hospitals, including 34% that serve rural populations. They’ve also bought up nursing homes and doctors’ practices and are investing more year by year. The net impact? Medical costs to the government and to patients have gone up while patients have suffered more adverse medical results, according to two current studies.

The Journal of the American Medical Association (JAMA) recently published a paper which found:

Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line–associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections.

This should not come as a surprise. Private equity firms in general operate as follows: They raise funds from investors to purchase enterprises using as much borrowed money as possible. That debt does not fall on the private equity firm or its investors, however. Instead, all of it is placed on the books of the purchased entity. If a private equity firm borrows money and buys up a nursing home or hospital chain, the debt goes on the books of these healthcare facilities in what is called a leveraged buyout.

To service the debt, the enterprise’s management, directed by their private equity ownership, must reduce costs, and increase its cash flow. The first and easiest way to reduce costs is by reducing the number of staff and by decreasing services. Of course, the quality of care then suffers. Meanwhile, the private equity firm charges the company fees in order to secure its own profits.

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in.

An even larger study of private equity and health was completed this summer and published in the British Medical Journal (BMJ). After reviewing 1,778 studies it concluded that after private equity firms purchased healthcare facilities, health outcomes deteriorated, costs to patients or payers increased, and overall quality declined.

Photo by Towfiqu barbhuiya on Unsplash

One former executive at a private equity firm that owns an assisted-living facility near Boulder, Colorado, candidly described why the firm was refusing to hire and retain high-quality caregivers: “Their position was: We are trying to increase our profitability. Care is an ancillary part of the conversation.”

Medicare Advantage Creates Wall Street Advantages

Congress passed the Medicare Advantage program in 2003. Its proponents claimed it would encourage competition and greater efficiency in the provision of health insurance for seniors. At the time, privatization was all the rage as the Democratic and Republican parties competed to please Wall Street donors. It was argued that Medicare, which was actually much more efficient than private insurance companies, needed the iron fist of profit-making to improve its services. These new private plans were permitted to compete with Medicare Part C (Medigap) supplemental insurance.

In 2007, 19% of Medicare recipients enrolled in Medicare Advantage plans. By 2023 enrollment had risen to 51%. These heavily marketed plans are attractive because many don’t charge additional monthly premiums, and they often include dental, vision, and hearing coverage, which Medicare does not. And in some plans, other perks get thrown in, like gym memberships and preloaded over-the-counter debit cards for use in pharmacies for health items.

How is it possible for Medical Advantage to do all this and still make a profit?

According to a report by the Physicians for a National Health Program, it’s very simple—they overcharge the government, that is we, the taxpayers, “by a minimum of $88 billion per year.” The report says it could be as much as $140 billion.

In addition to inflating their bills to the government, these HMO plans don’t pay doctors outside of their networks, deny or slow needed coverage to patients, and delay legitimate payments. As Dr. Kenneth Williams, CEO of Alliance HealthCare, said of Medicare Advantage plans, “They don’t want to reimburse for anything — deny, deny, deny. They are taking over Medicare and they are taking advantage of elderly patients.”

Enter Hedge Funds

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in. They have bought large quantities of stock in the healthcare companies that are milking the government through their Medicare Advantage programs. They then insist that these healthcare companies initiate stock buybacks, inflating the price of their stock and the financial return to the hedge funds. Stock buybacks are a simple way to transfer corporate money to the largest stock-sellers.

(A stock buyback is when a corporation repurchases its own stock. The stock price invariably goes up because the company’s earnings are spread over a smaller number of shares. Until they were deregulated in 1982, stock buybacks were essentially outlawed because they were considered a form of stock price manipulation.)

United Healthcare, for example, is the largest player in the Medicare Advantage market, accounting for 29% of all enrollments in 2023. It also has handsomely rewarded its hedge fund stock-sellers to the tune of $45 billion in stock buybacks since 2007, with a third of that coming since March 2020. Cigna, another big Medicare Advantage player, just announced a $10 billion stock buyback.

These repurchases are also extremely lucrative for United Healthcare’s top executives, who receive most of their compensation through stock incentives. CEO Andrew Witty, for example, hauled in $20.9 million in 2022 compensation, of which $16.4 million came from stock and stock option awards.

Those of us fighting for Medicare for All have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks.

A look at the pharmaceutical industry shows where all this is heading. Between 2012 and 2021, fourteen of the largest publicly traded pharmaceutical companies spent $747 billion on stock buybacks and dividends, more than the $660 billion they spent on research and development, according to a report by economists William Lazonick and Öner Tulum. Little wonder that drug prices are astronomically high in the U.S.

And so, the gravy train is loaded and rolling, delivering our tax dollars via Medicare Advantage reimbursements to companies like United Healthcare and Big Pharma, which pass it on to Wall Street private equity firms and hedge funds.

It’s Not Just Healthcare

In researching my book, Wall Street’s War on Workers, we found that private equity firms and hedge funds are undermining the working class through leveraged buyouts and stock buybacks. When private equity moves in, mass layoffs (just like healthcare staff cuts and shortages) almost always follow so that the companies can service their debt and private equity can extract profits. When hedge funds insist on stock repurchases, mass layoffs are used to free up cash in order to buy back their shares. As a result, between 1996 and today, we estimate that more than 30 million workers have gone through mass layoffs.

Meanwhile, stock buybacks have metastasized throughout the economy. In 1982, before deregulation, only about 2% of all corporate profits went to stock buybacks. Today, it is nearly 70%.

Those of us fighting for Medicare for All, therefore, have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks. Every fight to stop a mass layoff is a fight against the same Wall Street forces that are attacking Medicare and trying to privatize it. Creating a sane healthcare system, therefore, will depend on building a massive common movement to free our economy from Wall Street’s wealth extraction.

To take the wind out of Medicare Advantage and Wall Street’s rapacious sail through our healthcare system, we don’t need more studies. It’s time to outlaw leveraged buyouts and stock buybacks.

Technological innovation in the last couple of decades has brought fame and huge wealth to the likes of Elon Musk, Steve Jobs, Mark Zuckerberg and Jeff Bezos. Often feted as geniuses, they are the faces behind the gadgets and media that so many of us depend upon.

Sometimes they are controversial. Sometimes the level of their influence is criticised.

But they also benefit from a common mythology which elevates their status. That myth is the belief that executive “visionaries” leading vast corporations are the engines which power essential breakthroughs too ambitious or futuristic for sluggish public institutions.

For there are many who consider the private sector to be far better equipped than the public sector to solve major challenges. We see such ideology embodied in ventures like OpenAI. This successful company was founded on the premise that while artificial intelligence is too consequential to be left to corporations alone, the public sector is simply incapable of keeping up.

The approach is linked to a political philosophy which champions the idea of pioneering entrepreneurs as figureheads who advance civilisation through sheer individual brilliance and determination.

In reality, however, most modern technological building blocks – like car batteries, space rockets, the internet, smart phones, and GPS – emerged from publicly funded research. They were not the inspired work of corporate masters of the universe.

And my work suggests a further disconnect: that the profit motive seen across Silicon Valley (and beyond) frequently impedes innovation rather than improving it.

For example, attempts to profit from the COVID vaccine had a detrimental impact on global access to the medicine. Or consider how recent ventures into space tourism seem to prioritise experiences for extremely wealthy people over less lucrative but more scientifically valuable missions.

More broadly, the thirst for profit means intellectual property restrictions tend to restrict collaboration between (and even within) companies. There is also evidence that short-term shareholder demands distort real innovation in favour of financial reward.

Allowing executives focused on profits to set technological agendas can incur public costs too. It’s expensive dealing with the hazardous low-earth orbit debris caused by space tourism, or the complex regulatory negotiations involved in protecting human rights around AI.

So there is a clear tension between the demands of profit and long-term technological progress. And this partly explains why major historical innovations emerged from public sector institutions which are relatively insulated from short-term financial pressures. Market forces alone rarely achieve transformative breakthroughs like space programs or the creation of the internet.

Excessive corporate dominance has other dimming effects. Research scientists seem to dedicate valuable time towards chasing funding influenced by business interests. They are also increasingly incentivised to go into the profitable private sector.

Here those scientists’ and engineers’ talents may be directed at helping advertisers to better keep hold of our attention. Or they may be tasked with finding ways for corporations to make more money from our personal data.

Projects which might address climate change, public health or global inequality are less likely to be the focus.

Likewise, research suggests that university laboratories are moving towards a “science for profit” model through industry partnerships.

Digital destiny

But true scientific innovation needs institutions and people guided by principles that go beyond financial incentives. And fortunately, there are places which support them.

“Open knowledge institutions” and platform cooperatives are focused on innovation for the collective good rather than individual glory. Governments could do much more to support and invest in these kinds of organisations.

If they do, the coming decades could see the development of healthier innovation ecosystems which go beyond corporations and their executive rule. They would create an environment of cooperation rather than competition, for genuine social benefit.

There will still be a place for the quirky “genius” of Musk and Zuckerberg and their fellow Silicon Valley billionaires. But relying on their bloated corporations to design and dominate technological innovation is a mistake.

For real discovery and progress cannot rely on the minds and motives of a few famous men. It involves investing in institutions which are rooted in democracy and sustainability – not just because it is more ethical, but because in the the long term, it will be much more effective.

Peter Bloom, Professor of Management, University of Essex

This article is republished from The Conversation under a Creative Commons license. Read the original article.

( ProPublica) – Ever since he was a medical student, Dr. Neil Martinson has confronted the horrors of tuberculosis, the world’s oldest and deadliest pandemic. For more than 30 years, patients have streamed into the South African clinics where he has worked — migrant workers, malnourished children and pregnant women with HIV — coughing up blood. Some were so emaciated, he could see their ribs. They’d breathed in the contagious bacteria from a cough on a crowded bus or in the homes of loved ones who didn’t know they had TB. Once infected, their best option was to spend months swallowing pills that often carried terrible side effects. Many died.

So, when Martinson joined a call in April 2018, he was anxious for the verdict about a tuberculosis vaccine he’d helped test on hundreds of people.

The results blew him away: The shot prevented over half of those infected from getting sick; it was the biggest TB vaccine breakthrough in a century. He hung up, excited, and waited for the next step, a trial that would determine whether the shot was safe and effective enough to sell.

Weeks passed. Then months.

More than five years after the call, he’s still waiting, because the company that owns the vaccine decided to prioritize far more lucrative business.

Pharmaceutical giant GSK pulled back on its global public health work and leaned into serving the world’s most-profitable market, the United States, which CEO Emma Walmsley recently called its “top priority.” As the London-based company turned away from its vaccine for TB, a disease that kills 1.6 million mostly poor people each year, it went all in on a vaccine against shingles, a viral infection that comes with a painful rash. It afflicts mostly older people who, in the U.S., are largely covered by government insurance.

Importantly, the shingles vaccine shared a key ingredient with the TB shot, a component that enhanced the effectiveness of both but was in limited supply.

From a business standpoint, GSK’s decision made sense. Shingrix would become what the company calls a “crown jewel,” raking in more than $14 billion since 2018.

But the ability of a corporation to allow a potentially lifesaving vaccine to languish lays bare the distressing reality of public health vaccine creation. With limited resources, governments have long seen no other option but to team with Big Pharma to develop vaccines for global scourges. But after the governments pump taxpayer money and resources into the efforts, the companies get control of the products, locking up ownership and prioritizing their own gain.

That’s what GSK did with the TB vaccine. Decades ago, the U.S. Army brought in GSK to work on a malaria vaccine and helped develop the ingredient that would prove game-changing for the company. It was an adjuvant, a substance that primed the body’s immune system to successfully respond to a vaccine for malaria — and, the company would come to learn, a variety of other ailments.

GSK patented the adjuvant and took control of the supply of the ingredients in it. It accepted government and nonprofit funding to develop a TB vaccine using the adjuvant. But even though it isn’t carrying the vaccine to the finish line, it isn’t letting go of it entirely either, keeping a tight grip on that valuable ingredient.

As TB continued to rage around the globe, it took nearly two years for GSK to finalize an agreement with the nonprofit Bill & Melinda Gates Medical Research Institute, or Gates MRI, to continue to develop the vaccine. While the Gates organization agreed to pay to keep up the research, GSK reserved the right to sell the shot in wealthy countries.

The trial that will determine whether the vaccine is approved won’t begin until 2024, and isn’t expected to end until at least 2028. “We just can’t operate like that for a disease that is this urgent,” said Thomas Scriba, a South African scientist and TB expert who also worked on the study.

GSK pushes back against the premise that the company delayed the development of the TB vaccine and says it remains dedicated to researching diseases that plague underserved communities. “Any suggestion that our commitment to continued investment in global health has reduced, is fundamentally untrue,” Dr. Thomas Breuer, the company’s chief global health officer, wrote in a statement.

The company told ProPublica that it cannot do everything, and it now sees its role in global health as doing early development of products and then handing off the final clinical trials and manufacturing to others. It also said that a vaccine for TB is radically different from the company’s other vaccines because it can’t be sold at scale in wealthy countries.

Though a good TB vaccine would be used by tens of millions of people, it has, in the parlance of industry, “no market,” because those who buy it are mostly nonprofits and countries that can’t afford to spend much. It’s not that a TB vaccine couldn’t be profitable. It’s that it would never be as profitable as a product like the shingles vaccine that can be sold in the U.S. or Western Europe.

Experts say the story of GSK’s TB vaccine, and its roller coaster of hope and disappointment, highlights a broken system, which has for too long prioritized the needs of corporations over those of the sick and poor.

“We don’t ask for a fair deal from our pharma partners,” said Mike Frick, a director of the tuberculosis program at Treatment Action Group and a global expert on the TB vaccine pipeline. “We let them set the terms, but we don’t ask them to pick up the check. And I just find it frankly a little humiliating.”

Steven Reed, a co-inventor of the TB vaccine, brought his idea to GSK decades ago, believing that working with a pharmaceutical giant was essential to getting the shots to people who desperately needed them. He’s disillusioned that this hasn’t happened and now says that Big Pharma is not the path to saving lives with vaccines in much of the world. “You get a big company to take it forward? Bullshit,” he said. “That model is gone. It’s failed. It’s dead. We have to create a new one.”

Gaining Control

In the early 1980s, the U.S. Army was desperate for a way to keep troops safe from the parasite that causes malaria. Military scientists had some promising ideas but wanted to find a company that could help them develop and manufacture the antigen, the piece of a vaccine that triggers an immune response. They called on SmithKline Beckman, now part of GSK, which had a plant outside of Philadelphia committed to the exact type of antigen technology they were researching.

For the company’s part, working with the Army gave it access to new science and, importantly, the ability to conduct specialized research. The Army had laboratories for animal testing and ran clinical trial sites around the world. It’s also generally easier to get experimental products through regulatory approval when working with the government, and Army scientists were willing to be infected with malaria and run the first tests of the vaccine on themselves.

Col. Carl Alving, then an investigator at the Walter Reed Army Institute of Research, said he was the first person known to be injected with an ingredient called MPL, an adjuvant added to the vaccine. Today, we know that adjuvants are key to many modern vaccines. But at the time, only one adjuvant, alum, had ever been approved for use. Alving published promising results, showing that MPL boosted the shot’s success in the body.

Company scientists took note and began adding MPL to other ingredients. If one adjuvant was good, maybe two adjuvants together, stimulating different parts of the immune system, might be even better.

Image by Arek Socha from Pixabay

It was an exciting development, bringing the multiple adjuvants together, Alving said in an interview. But then he learned that the company scientists had filed a patent for the combinations in Europe, which put limits on what he and his colleagues could do with MPL. “The Army felt perhaps a little frustrated by that because we had introduced Glaxo to the field.”

Still, the Army wanted the malaria vaccine. Military personnel started comparing the adjuvant combinations on rhesus monkeys at an Army facility in Thailand and ran clinical trials that tested the most promising pairs in humans and devised dosing strategies.

The Army found that one of the combinations came out on top: MPL and an extract from the bark of a tree that grows in Chile. The bark extract was already used in veterinary vaccines, but a scientist at one of the world’s first biotech companies had recently discovered you could purify it into a material that makes it safe enough for use in humans.

Alving said that at the time, he didn’t patent the work he and his colleagues were doing or demand an exclusive license for MPL. “It’s a question of the Army being the Army, which is not a company,” Alving said. (This was actually the second time the government failed to secure its rights over MPL. Decades earlier, the ingredient was discovered and formulated by scientists working for the Department of Veterans Affairs and a National Institutes of Health lab in Montana. One of the scientists, frustrated that his bosses in Bethesda, Maryland, wouldn’t let him test the product in humans, quit and formed a company, taking the research with him. Though his company initially said it thought MPL was in the public domain and couldn’t be patented, he did manage to patent it.)

Experts say drug development in the U.S. is littered with such missed opportunities, which allow private companies to seize control of and profit off work done by publicly funded researchers. Governments, they say, need to be more aggressive about keeping such work in the public domain. Alving has since done just that, recently receiving his 30th patent owned by the military.

It’s an open secret in the pharmaceutical world that companies participate in global health research because it’s where they get to try out new technologies that can be applied to other, more lucrative diseases.

At an investor presentation in 2016, a GSK executive used the malaria vaccine example to explain the benefit of such work. “Of those of you who think this is just philanthropy, it is not,” Luc Debruyne, then president of vaccines at GSK, told the group. He explained that it was through the malaria work that the company invented the adjuvant that is now in its blockbuster shingles vaccine. And, he explained, vaccines are high-volume products that make a steady stream of money over time. “So doing good business, innovating and doing well for the world absolutely can get married.”

As the Army’s research on the combination of MPL and the bark extract evolved — and its market potential became clear — GSK moved to vacuum up the companies that owned the building blocks to the adjuvant.

In 2005, it bought the company that owned the rights to MPL for $300 million. In 2012, it struck a deal for the rights to a lion’s share of the supply of the Chilean tree bark extract.

The company was now in full control of the adjuvant.

Picking a Winner

GSK eagerly began to test its new adjuvant on a number of diseases — hepatitis, Lyme, HIV, influenza.

Steven Reed, a microbiologist and immunologist, had come to the company in 1994 with an idea for a tuberculosis vaccine. An estimated 2 billion people are infected with TB globally, but it’s mainly those with weakened immune systems who fall ill. A century-old vaccine called BCG protects young children, but immunity wanes over time, and that vaccine does little to shield people from the most common type of infection in the lungs.

Reed had just the background and resources to attempt a breakthrough: An adjunct professor at Cornell University’s medical school, he also ran a nonprofit research organization that worked on infectious diseases and had co-founded a biotech company to create and market products.

He and his colleagues were building a library of the proteins that make up the mycobacterium that causes TB. He also had access to a blood bank in Brazil, where TB was more prevalent, that he could screen the proteins against to determine which generated an immune response that prevented people from getting sick.

At the time Reed pitched the vaccine, the company’s decision over whether to take him up was made by researchers, said Michel De Wilde, a former vice president of research and development at the company that partnered with Reed and later became part of GSK. Today, across the industry, finance units play a much stronger role in deciding what a company works on, he said.

GSK signed on, asking Reed to add the company’s promising new adjuvant to his idea for a TB vaccine.

Reed and his colleagues used more than $2 million in federal money to conduct trials from 1995 to 2005. GSK also invested, but NIH money and resources were the key, Reed said. As the vaccine progressed into testing, the Bill & Melinda Gates Foundation pitched in, as did the governments of the United Kingdom, the Netherlands and Australia, among others.

Amid all that, in 2003, GSK started testing the adjuvant in its shingles vaccine, according to annual reports, but at a much faster speed. With TB, it performed a small proof-of-concept study to justify moving to a larger one. There’s no evidence it did so with shingles. By 2010, GSK’s shingles vaccine was in final trials; in 2017, the FDA approved it for use.

To employees and industry insiders, GSK was making its priorities clear. The company built a vaccine research facility in Rockville, Maryland, to be closer to the NIH and the Food and Drug Administration; at the same time, it was retreating from TB and other global public health projects, according to former employees of the vaccine division.

All the while, the adjuvant was limited. GSK struggled to ramp up production of MPL, according to former employees there; it relies on a cumbersome manufacturing process. And it wasn’t clear whether there was sufficient supply of the Chilean tree that is essential to both vaccines.

After researchers learned of the TB vaccine’s successful proof-of-concept results in 2018, GSK said nothing about what was next.

“You would have thought people would have said: ‘Oh shit, this is doable. Let’s double down, let’s quadruple down,’” said Dr. Tom Evans, former president and CEO of Aeras, a nonprofit that led and paid for half of the proof-of-concept study. “But that didn’t happen.”

Scriba, who was involved in the study in South Africa, said he never imagined that GSK wouldn’t continue the research. “To be honest it never occurred to us that they wouldn’t. The people we worked with at GSK were the TB team. They were passionate about TB,” Scriba said. “It’s extremely frustrating.”

But Reed said that when the shingles vaccine was approved, he had a gut feeling that GSK would abandon the tuberculosis work.

“The company that dropped it used similar technology to make billions of dollars on shingles, which doesn’t kill anyone,” Reed said.

Those in the field grew so concerned about the fate of the TB vaccine that the World Health Organization convened a series of meetings in 2019.

Breuer, then chief medical officer for GSK’s vaccine division, explained that the pharmaceutical giant was willing to hand off the vaccine to an organization or company that would cover the cost of future development, licensing, manufacturing and liability. If the next trial went well, they could sell the vaccine in the “developing world,” with GSK retaining the sales rights in wealthier countries.

GSK would, however, retain control of the adjuvant, Breuer said. And the company only had enough for its other vaccines, so whoever took over the TB vaccine’s development would need to pay GSK to ramp up production, which Breuer estimated would cost around $200 million.

Dr. Julio Croda was director of communicable diseases for Brazil at the time and attended the meeting. He said he was authorized to spend significant government funds on a tuberculosis vaccine trial but needed assurances that GSK would transfer technology and intellectual property if governments paid for its development. “But in the end of the meeting, we didn’t have an agreement,” he said.

Dr. Glenda Gray, a leading HIV vaccine expert who attended the meeting on behalf of South Africa, said she wasn’t able to get a straight answer about the availability of the adjuvant.

The year after the WHO meeting, after what a Gates representative described as “a lot of negotiation,” GSK licensed the vaccine to Gates MRI, a nonprofit created by the Gates Foundation to develop drugs and vaccines for global health issues that for-profit companies won’t tackle.

GSK told ProPublica that it did not receive upfront fees or royalties as part of the arrangement, but that Gates MRI paid it a small incentive to invest in the company’s global health endeavors. GSK and Gates MRI declined to comment on the amount.

Gates MRI tax documents show a payment designated as “royalties, license fees, and similar amounts that allow the organization to use intellectual property such as patents and copyrights” the year the agreement was finalized. Among available tax documents, that is the only year the organization has made a payment in that category.

The amount: $10 million.

An Uncertain Future

In June of this year, the Gates Foundation and the Wellcome Trust announced they were pledging $550 million to fund the phase 3 trial that will finally show whether the vaccine works. They’ve selected trial locations and are currently testing it on a smaller subset of patients, those with HIV.

Jeremy Farrar, chief scientist at the WHO, said he’s more optimistic than he’s ever been in his career that we’ll have a new TB vaccine this decade.

Gates MRI and GSK declined to say who had the rights to sell the vaccine in which countries, but Gates MRI said it will “work with partners to ensure the vaccine is accessible for people living in high TB-burden lower- and middle-income countries,” and GSK acknowledged that its rights extend to South America and Eastern Europe, two regions with significant pockets of TB.

As expected, Gates MRI will be reliant on GSK to supply the adjuvant, which concerns vaccine hopefuls because of the lack of transparency surrounding its availability. One of the key ingredients, the bark extract, comes from a tree whose harvest and export has been controlled by the Chilean government since the 1970s because of overexploitation. A megadrought and forest fires continue to threaten native forests today. The main exporter of the bark says it has resolved previous bottlenecks, and GSK said it is working on a synthetic version as part of its long-term plan.

In response to questions about why it retained control of the adjuvant, GSK said it was complicated to make, would not be economical to produce in more than one place, and was a very important component in many of the company’s vaccines, so it wasn’t willing to share the know-how.

The adjuvant is only growing in value to the company, as it adds yet another lucrative vaccine to its portfolio that requires it. In May, the FDA approved a GSK vaccine for the respiratory virus known as RSV. Analysts project that the shot will bring in $4 billion annually at its peak. GSK continues to study the adjuvant in additional vaccines.

GSK strongly insists that it has enough of the adjuvant to fulfill its forecasted needs for the RSV, shingles, malaria and TB vaccines through 2035.

The company and Gates MRI said their agreement includes enough adjuvant for research and the initial supply of the TB vaccine, if it is approved. The organizations declined, however, to specify how many people could be vaccinated. GSK also said it was willing to supply more adjuvant after that, but further negotiations would be necessary and Gates MRI would likely need to pay to increase adjuvant manufacturing capacity. For its part, Gates MRI said it is evaluating several strategies to ensure longer term supply.

Several experts said that Gates MRI should test other adjuvants with the vaccine’s antigen. That includes Farrar, who said it would be “very wise” to start looking for a new adjuvant. He is one of the few people who has seen the agreement between Gates MRI and GSK as a result of his previous role as director of the Wellcome Trust. Farrar is now helping to lead a new TB Vaccine Accelerator Council at the WHO and said he believes one of the group’s roles would be to find solutions to any future problems with the adjuvant.

Gates MRI declined to answer when asked if it was considering testing other adjuvants with the vaccine’s antigen. GSK, along with several other scientists and regulators that ProPublica spoke with, expressed that using a new adjuvant would require redoing all of the long and expensive clinical trials.

U.S. government officials, meanwhile, are working to identify adjuvants that aren’t already tied up by major pharmaceutical companies.

For a corporation, the primary concern is “what is this adjuvant doing for my bottom line,” said Wolfgang Leitner, who began his career working at Walter Reed Army Institute of Research on the malaria vaccine as a consultant for GSK. Now the chief of the innate immunity section at the National Institute of Allergy and Infectious Diseases, his job is to encourage the development of new adjuvants and to make sure that researchers have access to ones that aren’t tightly controlled by individual companies.

The WHO has also been helping to build a global network of vaccine manufacturers who can develop and supply vaccines to less wealthy countries outside of the shadow of Big Pharma; it is using a technology debuted during the COVID-19 pandemic called mRNA, which deploys snippets of genetic code to trigger an immune response. Reed, an inventor of GSK’s TB vaccine, co-founded the company at the center of that effort, Afrigen, after growing concerned about the fate of the vaccine he made for GSK.

Reed helped create a second TB vaccine, which Afrigen has the rights to manufacture for sale in Africa. But that vaccine has yet to start a proof-of-concept trial.

Over the past five years, an average of just $120 million a year has been spent on all TB vaccine research globally, including money from governments, pharmaceutical companies and philanthropic organizations, according to annual surveys conducted by the Treatment Action Group. For perspective, the U.S. alone spent more than $2 billion developing COVID-19 vaccines from 2020 to 2022. At a special UN meeting on tuberculosis in 2018, the nations of the world pledged to ensure $3 billion was spent on TB vaccine research and development over the next five years. Just 20% of that was handed out.

While that mRNA hub holds promise, it will be years before an mRNA TB vaccine enters a proof-of-concept trial, according to people involved. The pharmaceutical companies that made successful COVID-19 vaccines have refused to share the technology and manufacturing techniques that make mRNA vaccines work. One company, Moderna, has said it won’t enforce its patents on mRNA vaccines Afrigen creates for COVID-19, but it’s not clear what it’ll do if Afrigen applies those techniques to a disease like TB. (Paul Sagan, board chairman of ProPublica, is a member of Moderna’s board.)

To date, the GSK tuberculosis vaccine — which does not use mRNA technology — is the only one that meets a set of characteristics the WHO believes are necessary for a viable TB vaccine.

The phase 3 trial is set to begin early next year. In the time between the two trials, approximately 9 million people will have died from TB.

ProPublica

( Tomdispatch.com ) – The depths of depravity into which unvarnished capitalism can plunge mortal souls is incalculable. It should come as no surprise then that oil company executives and the officials of petrostates like Saudi Arabia have so assiduously lied to us about the catastrophic effects of climate change. After all, the executives of tobacco firms have been perfectly content to sell consumers a product long known and virtually guaranteed to cut their lives short, while lying about its harmful effects for decades. Likewise, the courts have now made the pharmaceutical industry’s responsibility for and grasp of the opioid crisis that killed half a million people all too clear.

In both instances, state attorneys-general played an important role in seeking redress. Now, Rob Bonta, California’s attorney general, has filed a 135-page lawsuit against five major oil companies — ExxonMobil, Shell, Chevron, ConocoPhillips, and BP — which could prove an inflection point in the battle against human-caused climate change.

On announcing the lawsuit, Bonta said, “Oil and gas companies have privately known the truth for decades — that the burning of fossil fuels leads to climate change — but have fed us lies and mistruths to further their record-breaking profits at the expense of our environment. Enough is enough.” 

Born in the Philippines to an American father and a Filipina mother, Bonta spent his early years near Keene, California, where the United Farm Workers had established its headquarters. There, both his father Warren and his mother Cynthia helped organize Filipino-American and Mexican-American laborers. Bonta went on to get a Yale law degree and ultimately entered politics, being elected to the California State Assembly in 2012.

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His background clearly impressed upon him the special vulnerability of working-class groups to climate change. “We will meet the moment and fight tirelessly on behalf of all Californians,” he pledged, “in particular those who live in environmental justice communities.”  As he explained in a footnote in his brief for that lawsuit: “’Frontline communities’ are those that are and will continue to be disproportionately impacted by climate change. In many cases, the most harmed are the same communities that have historically experienced racial, social, health, and economic inequities.” 

The destructive impact of human-caused climate change on California has, in fact, unfolded before our eyes. Eleven of the 20 largest California wildfires have taken place since 2018. Unusually frequent, wide-ranging, and ever fiercer wildfires have even chased from their homes some of the Golden State’s most famous celebrities, leaving behind just glowing cinders. The now-seemingly annual rampages of those increasingly massive conflagrations can cause us to forget how remarkable the damage has been in these years.

In 2018, pop singer Miley Cyrus announced that the Malibu home she shared with her then-fiancé Chris Hemsworth had been devoured by flames, writing on social media, “Completely devastated by the fires affecting my community. I am one of the lucky ones. My animals and LOVE OF MY LIFE made it out safely & that’s all that matters right now. My house no longer stands but the memories shared with family & friends stand strong . . . I love you more than ever, Miley.”  That year, Orlando Bloom, Bella Hadid, Lady Gaga, Kim Kardashian, and Gerard Butler suffered similar losses.

Well-heeled celebrities, however, have the resources to get through such crises. Farm laborers who must harvest crops while breathing soot-filled air risk adverse health effects, including respiratory and heart disease. Others have lost their jobs and incomes entirely when wildfires encroached on fields and orchards. Not getting paychecks thanks to raging fires at their worksites can, in turn, cause such workers to miss mortgage payments and lose their homes. And sometimes, of course, their own homes, like those of the stars, have been torched.

Connecting the Dots

In 2021, wildfires almost entirely razed the town of Paradise, California. Swedish climate activist Greta Thunberg visited the aftermath. On hearing one man’s devastating account of how he and his family barely escaped their fiery, collapsing home, she said, “We see all of these things repeating themselves over and over again. People die, and people suffer from it. But we completely fail to connect the dots.”

Her evident frustration at the time should be considered significantly more consequential than it might seem. A team of Norwegian researchers has found that, of all the emotions provoked by human-caused climate change, the one most associated with activism against it is anger. Anger at politicians or CEOs who have played key roles in enabling the phenomenon that causes such destruction animates many climate protesters. As they suggested, Thunberg’s vivid speeches are but one example of the righteous anger provoked by those who could have but haven’t moved to mitigate the effects of global warming.

For his part, Attorney General Bonta isn’t in any doubt about where to lay the blame. As he put it, “With our lawsuit, California becomes the largest geographic area and the largest economy to take these giant oil companies to court. From extreme heat to drought and water shortages, the climate crisis they have caused is undeniable. It is time they pay to abate the harm they have caused.” By focusing on five major oil companies, he and California Governor Gavin Newsom have given the state’s environmentalists a target for their anger.  

Delaware, Massachusetts, Minnesota, New Jersey, and Rhode Island are already pursuing similar legal actions and small wonder why. When it comes to California, for instance, scientists have recorded a fivefold increase in the summer burned areas in forests stretching from the middle of the state north during the past two and a half decades. And that devastatingly large burn area is anything but just the result of cyclical droughts. In fact, researchers demonstrated this summer that almost all of it has been caused by the human production of carbon dioxide through the burning of gasoline, natural gas, and coal. Worse yet, their projections suggest that ever larger and more devastating burn areas will be part of our landscape in the decades to come as humanity pumps out yet more carbon pollution.

The heat and long-term drought that’s gone with it have transformed California’s northern forests into so much tinder.  After its wildfires of 2020, leading climate scientist Michael Mann observed, “These are known as compound drought and heat wave (CDHW) events and refer to situations wherein a region experiences both prolonged hot temperatures and a shortage of water.”  His team predicts that such events will more than double in number and in duration, while quadrupling in intensity, if carbon pollution continues to be produced at its current rate.

Atmospheric Rivers

Worse yet, California now faces a double whammy — not just vastly increased wildfires and drought in some regions but major flooding in others. And in drought-stricken areas, sudden, massive rainfall simply runs off desiccated soil, adding to the risk of overflowing waters.

As it happens, human-made global warming hasn’t just heated up lands across the planet, but the oceans, too. In fact, this summer, ocean water temperatures broke all previous heat records and that also puts more moisture into the atmosphere. Worse yet, climate change has heated the atmosphere itself and warmer air holds more moisture. That change has, in turn, made the “atmospheric rivers” carrying moisture from the tropics to the temperate zone far more destructive.

Not surprisingly, then, on the last day of 2022, 5.5 inches of rain deluged downtown San Francisco, while putting all six lanes of Highway 101 to its south under water. A week later, Governor Newsom watched as sheets of rainfall, driven by 70-mile-an-hour winds, knocked out power to 345,000 people in the state capital, Sacramento.

This summer, the giant State Farm and Allstate insurance companies, ever more aware of the toll climate change was taking on their bottom lines in California, announced that they would no longer accept new customers there. As an explanation, State Farm cited “rapidly growing catastrophe exposure.” Take a moment to let that sink in. The situation humanity has created is now so calamitous that insurance companies are no longer willing to take on the once-safe bet that most houses will continue standing unharmed for decades.

If California were an independent country, it would have the fifth-largest economy in the world. As Attorney General Bonta notes, it has the deep pockets to take on the oil companies. And significantly, that state’s government is already among the world’s most forward-looking in combating climate change. In 2020, Governor Gavin Newsom issued an executive order requiring that all cars sold in California by 2035 be battery-electric or hybrid vehicles. The plan has spurred similar actions by six other states.

In the past five years, electric vehicles as a percentage of new vehicle registrations in the Golden State have indeed skyrocketed from 2% to 22%. No less impressive, around 60% of the state’s electricity is now generated by low-carbon sources like wind and solar. To smooth out the transitions between solar and wind generation, California has put in 5 gigawatts of battery power, the most of any state, to forestall blackouts and avoid the necessity of using natural gas to fill the gap.

They Lied. They Deceived.

The attorney general’s filing against the oil companies asserts their culpability: “Oil and gas company executives have known for decades that reliance on fossil fuels would cause these catastrophic results, but they suppressed that information from the public and policymakers by actively pushing out disinformation on the topic.” This duplicity, the suit argues, was itself grounds for seeking redress.  “Their deception,” it continues, “caused a delayed societal response to global warming. And their misconduct has resulted in tremendous costs to people, property, and natural resources, which continue to unfold each day.” 

In an interview with KCAL television, Bonta pulled no punches: “They must pay for their own actions… They lied. They deceived. They falsely advertised. They undermined the science and made claims that were counter to the truth. We’re holding them accountable for that.” When challenged by the interviewer, who warned the attorney general that he would need a “smoking gun” showing that the corporations were deceitful, Bonta didn’t hesitate: “We have smoking guns. Multiple. We have one from the 1960s. We have others in the decades that have followed. It is a very clear trend.”

His complaint is, in fact, festooned with such damning pieces of internal evidence, including a 1982 memo by Exxon scientist Roger Cohen, which admitted “a clear scientific consensus” on the expected effects of atmospheric carbon dioxide on the climate and suggested that doubling greenhouse gasses in the atmosphere would result in roughly a 3° Celsius (5.4° Fahrenheit) average global temperature rise, bringing about “significant changes in the earth’s climate, including rainfall distribution and alterations in the biosphere.”  

In 1800, as the industrial revolution began, there were just 282 parts per million (ppm) of carbon dioxide in the atmosphere. Today, in part because of energy industry foot-dragging, there are about 420 ppm of CO2 and we’re speeding toward the 564 ppm that Cohen predicted would radically change our very biosphere. Climate scientist Michael Mann has pointed out in his new book Our Fragile Planet that, during the Pliocene era, 3.5 million years ago, that kind of ramp-up of carbon dioxide in the atmosphere produced a tropical world with ocean waters 30 feet higher than they are now.

Despite the warnings of Cohen and others, in 1989, Exxon joined other oil companies in forming the Global Climate Coalition, which combated attempts to reduce fossil-fuel consumption, while assuring journalists and politicians that “the role of greenhouse gases in climate change is not well understood.” Some of those companies like Exxon even funded climate denialism when they knew perfectly well that it was a lie. 

In the 1990s and thereafter, the oil companies, the California lawsuit alleges, went on to use organizations like the American Legislative Exchange Council lobbying group to pressure Washington to do nothing about carbon pollution. At the same, they attempted to convince concerned Americans that climate change either wasn’t happening or, if it was, had nothing to do with burning fossil fuels.

In a distinctly overheating world, where heat records of all sorts are now regularly being broken, the denialism of Big Oil and its henchmen, including today most of the Republican Party, is already a crime of the first order.  The California suit is cleverly crafted.  If there is one thing you can’t do in societies like ours, where property rights are so central, it’s damage someone’s property knowingly and under the cover of deception.

The internal memos of scientists that have surfaced in such abundance from the very bowels of the petroleum corporations could be their biggest Achilles heel. They demonstrate that the injuries they have inflicted on the Earth are not simply an unforeseen side effect of their product but, at least in part, the result of a deliberate cover-up.

At last, Greta Thunberg’s hope that someone, especially someone with the power to do something, would finally get mad and connect the dots is being fulfilled. Let’s hope that California succeeds in both setting a meaningful precedent and making those companies pay in a big way, ending impunity for the most dangerous and deceitful assault on our environment in human history.

Copyright 2023 Juan Cole

Featured image: Photo by Ross Stone on Unsplash

Via Tomdispatch.com

Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American healthcare,” says a new report from Physicians for a National Health Program.

Jake Johnson

( Commondreams.org ) – A report published Wednesday estimates that privately run, government-funded Medicare Advantage plans are overcharging U.S. taxpayers by up to $140 billion per year, a sum that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare’s prescription drug program.

Physicians for a National Health Program (PNHP), an advocacy group that supports transitioning to a single-payer health insurance system, found that Medicare Advantage (MA) overbills the federal government by at least $88 billion per year, based on 2022 spending.

That lower-end estimate accounts for common MA practices such as upcoding, whereby diagnoses are piled onto a patient’s risk assessment to make them appear sicker than they actually are, resulting in a larger payment from the federal government.

But when accounting for induced utilization—”the idea that people with supplemental coverage are likely to use more health care because their insurance pays for more of their cost”—PNHP estimated that the annual overbilling total could be as high as $140 billion.

“This is unconscionable, unsustainable, and in our current healthcare system, unremarkable,” says the new report. “Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American healthcare, siphoning money from vulnerable patients while delaying and denying necessary and often lifesaving treatment.”

Even if the more conservative figure is accurate, PNHP noted, the excess funding that MA plans are receiving each year would be more than enough to expand traditional Medicare to cover dental, hearing, and vision. Traditional Medicare does not currently cover those benefits, which often leads patients to seek out supplemental coverage—or switch to an MA plan.

The Congressional Budget Office has estimated that adding dental, vision, and hearing to Medicare and Medicaid would cost just under $84 billion in the most costly year of the expansion.

“While there is obvious reason to fix these issues in MA and to expand traditional Medicare for the sake of all beneficiaries,” the new report states, “the deep structural problems with our healthcare system will only be fixed when we achieve improved Medicare for All.”

Bolstered by taxpayer subsidies, Medicare Advantage has seen explosive growth since its creation in 2003 even as it has come under fire for fraud, denying necessary care, and other abuses. Today, nearly 32 million people are enrolled in MA plans—more than half of all eligible Medicare beneficiaries.

Earlier this year, the Biden administration took steps to crack down on MA overbilling, prompting howls of protest and a furious lobbying campaign by the industry’s major players, including UnitedHealth Group and Humana. Relenting to industry pressure, the Biden administration ultimately agreed to phase in its rule changes over a three-year period.

Leading MA providers have also faced backlash from lawmakers for handing their top executives massive pay packages while cutting corners on patient care and fighting reforms aimed at rooting out overbilling.

As PNHP’s new report explains, MA plans are paid by the federal government as if “their enrollees have the same health needs and require the same levels of spending as their traditional Medicare counterparts,” even though people who enroll in MA plans tend to be healthier—and thus have less expensive medical needs.

“There are several factors that potentially contribute to this phenomenon,” PNHP’s report notes. “Patients who are sicker and thus have more complicated care needs may be turned off by limited networks, the use of prior authorizations, and other care denial strategies in MA plans. By contrast, healthier patients may feel less concerned about restrictions on care and more attracted to common features of MA plans like $0 premiums and additional benefits (e.g. dental and vision coverage, gym memberships, etc.). Insurers can also use strategies such as targeted advertising to reach the patients most favorable to their profit margins.”

A KFF investigation published last month found that television ads for Medicare Advantage “comprised more than 85% of all airings for the open enrollment period for 2023.”

“TV ads for Medicare Advantage often showed images of a government-issued Medicare card or urged viewers to call a ‘Medicare’ hotline other than the official 1-800-Medicare hotline,” KFF noted, a practice that has previously drawn scrutiny from the U.S. Senate and federal regulators.

PNHP’s report comes days after Cigna, a major MA provider, agreed to pay $172 million to settle allegations that it submitted false patient diagnosis data to the federal government in an attempt to receive a larger payment.

Image by OsloMetX from Pixabay

Dr. Ed Weisbart, PNHP’s national board secretary, toldThe Lever on Wednesday that such overpayments are “going directly into the profit lines of the Medicare Advantage companies without any additional health value.”

“If seniors understood that the $165 coming out of their monthly Social Security checks was going essentially dollar for dollar into profiteering of Medicare Advantage, they would and should be angry about that,” said Weisbart. “We think that we pay premiums to fund Medicare. The only reason we have to do that is because we’re letting Medicare Advantage take that money from us.”

But with corporations insistent on squeezing more profits no matter the cost, strikes are inevitable — and necessary.

Sonali Kolhatkar

Sonali Kolhatkar is the host of “Rising Up With Sonali,” a television and radio show on Free Speech TV and Pacifica stations. This commentary was produced by the Economy for All project at the Independent Media Institute and adapted for syndication by OtherWords.org.

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