Archive for December, 2018

Bulletin: Dog Catches Bus. Appears Confused.

Tuesday, December 18th, 2018

 

After Sen. John McCain’s dramatic “no” vote in July 2017 that kept the ACA alive, Newsweek found at least 70 Republican-led attempts to repeal, modify or otherwise curb the Affordable Care Act since its inception as law on March 23, 2010. All of those attempts failed. But what the Republican-controlled congress couldn’t do in 70 attempts over eight years, a single federal judge from Texas my have done with the stroke of his pen.

In February, a Texas-led coalition of 20 states sued the federal government to end the health care law in its entirety, arguing that after Congress in December 2017 gutted one of its major provisions, a financial penalty for not having health insurance known as the “individual mandate,” the rest of the law was unconstitutional. Last Friday, Fort Worth-based U.S. District Judge Reed O’Connor sided with Texas, ruling that without the individual mandate the entire Affordable Care Act is unconstitutional.

In a not unprecedented, but certainly rare, move earlier in the year the justice Department had announced it would not defend the suit, prompting a counter-coalition of states, led by California, to step in to argue the case.

There will be appeals – first to the full District Court and, if that fails, to the Supreme Court. Until those appeals are exhausted, the law will remain in place. Judge O’Connor’s ruling stands a pretty good chance of being overturned by the higher courts. According to the Texas Tribune, Timothy Jost, an emeritus professor at Washington and Lee University who has studied Obamacare and its legal battles extensively, called Friday’s ruling “an ideological opinion” that is “unmoored in law.” Regardless, democrats, who retook the House last month by making the threat that republicans were set to throw the ACA’s pre-existing condition protections, as well as a number of other Obamacare provisions voters love, on the dust heap of history, are now even more ammo’d-up for 2020.

And what about those bus-catching republicans, who have, at least for the moment, been given the thing they’ve wanted most for the last eight years? Well, to put it as kindly as these circumstances allow, they appear to be clueless. Republican leaders, although having the last eight years to come up with one, have yet to advance even the tiniest plan for what to do if the ruling is upheld. About the most we can say for them is this:

They’re women and men,
who want to go back to 2010
and start the health care war all over again.

President Trump called it “a great ruling” and tweeted “Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!” Right.

As of this writing, however, Trump’s troops do not appear eager to follow their Commander in Chief as he, unarmed, storms the health care barricades. Meanwhile, all the ACA-haters seem to be able to do is gloat. This whole thing is getting better than kicking back on a Saturday afternoon with a bag of popcorn watching the adventures of the Keystone Cops.

Let us pray sanity prevails.

 

Check out the holiday Health Wonk Review & other news of note

Friday, December 14th, 2018

There’s a new December Health Wonk Review posted by Peggy Salvatore at Health System Ed Blog – check out Have a Holly, Jolly Health Wonk Holiday from Health Wonk Review. There are entries from many of the regulars – catch up on the latest & greatest.

 

 

 

 

In other news that has caught our attention

Chemical Safety Board Asks for Combustible Dust Input – The Chemical Safety Board continues to investigate five combustible dust incidents. A comprehensive combustible dust standard still does not exists, and the Chemical Safety Board (CSB) is seeking further input to put one in place. The federal agency has extended its deadline for comment to December 31 from companies, regulators, inspectors, safety training providers, researchers, unions, and the workers of dust-producing operations.

A fire, a frantic search and the loss of one of Worcester’s bravest: How the scene unfolded in the death of Firefighter Christopher Roy. Here at Lynch Ryan, we have a connection to the Worcester MA community and know that December has proven to be a cruel month for the Worcester Fire Department. We recently lost a firefighter in the same month that saw 6 deaths in the Cold Storage warehouse fire some 19 years ago, and another fatality in 2011. We salute brave and dedicated firefighters everywhere for putting their lives on the line.

And in this holiday season, we are mindful of all the workers who won’t be celebrating with their families because they died on the job. All of us in the workers’ compensation industry should remember that at the heart of what we do, it is about keeping workers safe on the job. We thank Jordan Barab for continuing on with his Weekly Toll posts, a sad ongoing commemoration of people who die on the job – a reminder that we need to continue to work to greater safety. See his most recent posts, Weekly Toll: Three Weeks of Death on the Job  and Weekly Toll: Human Statistics Who Won’t Be Coming Home.

Missed the 2018 National Workers’ Compensation & Disability Conference? In addition to recaps at Risk & Insurance, the event sponsor, some other places we turn to for updates are Joe Paduda’s blog and Safety National’s Conference Chronicles.

Ohio Business Owner Sentenced to Prison for $425K Workers’ Comp Fraud  It’s not all that often that we see jail time for workers’ comp fraus, but the owner of Employers Choice Plus LLC payroll services company convicted in June on wire fraud and money laundering charges after BWC and IRS investigators discovered a scheme he concocted to short BWC on the insurance premiums he received from employers and pocket the difference.

How Exoskeletons Can Solve Safety and Productivity Issues – Encroaching automation. The skills gap. The opioid epidemic. These are real problems the first legitimate power-amplifying exoskeleton could take on when it’s released in a little over a year.

Temporary Workers and Lockout/Tagout—Guidance for Employers

How Climate Change Is Challenging American Health Care

Shame, Scandal Plague Healthcare Providers In 2018

And in the workplace of the future department:

Will Amazon Make Human Workers Obsolete?

AI in the workplace: Everything you need to know – How artificial intelligence will change the world of work, for better and for worse.

Robots in the workplace – As new technologies bring robots side by side with human workers, what are the safety implications?

Meet AnyMal. This robot recently autonomously performed various inspection tasks of the world’s largest offshore converter platforms in the North Sea in a one-week pilot installation, making it the world’s first autonomous offshore robot.

What Price Life? Part Two

Wednesday, December 12th, 2018

Part Two

“Insulin is my gift to mankind” – Frederick Banting

In Part One, we noted the critical need for daily insulin injections to keep Type 1 Diabetics (T1Ds) alive. We described how Frederick Banting’s team of himself, Charles Best and James Collip recovered and purified insulin from the fetal pancreases of cows and pigs in 1922, how they successfully tested it on humans, how Banting won the Nobel Prize the following year for his discovery, how the team sold the patent for the discovery to the University of Toronto for $3.00 and how they and the University agreed to license the manufacturing rights to pharmaceutical companies royalty-free, because, in Banting’s words, “Insulin is my gift to mankind.” The team and the university wanted to incentivise drug companies to improve on the Banting team’s discovery, so the University and Banting agreed to allow the companies to improve Banting’s formulation if they could and patent any new discoveries that arose. Their hope was that drug companies would share their vision of making it possible for T1Ds to live high-quality lives and to keep insulin prices low to help them do it.

Immediately after the sale of the patent to the University of Toronto, the University licensed the manufacturing rights for insulin to Eli Lilly and Company, located in Indianapolis, Indianna, and Nordisk Insulin laboratorium in Copenhagen. Meanwhile, a few kilometers away in Copenhagen, Novo Terapeutisk Laboratorium succeeded in producing a stable liquid insulin product which it called Insulin Novo. Decades later, in 1989, these two companies would merge to become Novo Nordisk.

In the beginning, the pharmaceutical companies had the best of intentions. After all, they were manufacturing and marketing the world’s first “life-saving” drug.

Over time, the “best intentions” became the quarterly bottom line and shareholder value. The emphasis was now on next generation patents, which would stifle competition and prevent the emergence of insulin generic drugs. To this day, there isn’t one.

It is not an exaggeration to say insulin made Eli Lilly and Company and Novo Nordisk two of the top pharmaceutical companies in the world. It also hasn’t hurt the bottom line of Sanofi, the company that rounds out the insulin producing triumvirate and is the world’s fifth largest pharma by sales.

In the last 20 years, these insulin producing companies have become swept up in the craziness of U.S. health care, where prices are on a rocket ride to the moon. During that time, the list price of insulin has increased more than 700%. Of course, T1Ds who have employer sponsored health insurance don’t pay list price. The price they pay, which is much lower, is  negotiated by their insurance company or Pharmacy Benefit Manager. This also applies to T1Ds who have secured insurance either through the expansion of the Affordable Care Act or some other means. They find their insulin relatively affordable, unless they have a prescription deductible which forces them to pay the full amount for insulin until they reach the deductible total. Finally, diabetics on Part D must pay 45% of list price when they fall into the infamous “donut hole.”

But children without insurance are in a very bad place, and there are a lot of them – 3.9 million in 2017 under the age of 19 (300 thousand more than 2016).

This situation is worse, twice as worse, in states that have not expanded Medicaid through the Affordable Care Act.

Kids with Type 1 Diabetes make up about .05%, of the uninsured group. That’s 195,000 children. And then there are the young, T1D adults who can no longer be on their parents insurance plan, because they are over the age of 26. Recently, we have learned of  T1Ds who have been forced to ration their insulin. This has resulted in tragic deaths. Parents and guardians have begun to protest at pharmaceutical company gates, some carrying the ashes of their dead children. Think about that.

So, here’s a question: Should anyone in the United States who requires a daily drug just to stay alive be forced to come up with the money to pay for it? Or, should that be a government-sponsored, health care right, as in the Declaration Of Independence’s “self-evident…unalienable right…to life.”

While you ponder that, I’ll leave you with this. Banting, Best and Collip would be tremendously gratified that their “gift to mankind” has enabled millions upon millions of Type 1 diabetics to lead productive, fulfilling lives. But they would be horrified that the drug’s price is now exacting a human price of obscene proportions.