Posts Tagged ‘health care’

Single-payer would be death on NY’s best hospitals

October 22, 2018

The debate about a proposed single-payer health plan for New York has mostly focused on what it would cost (between $92 billion and $226 billion per year, according to various projections) and where the money would come from (massive, unprecedented tax hikes).

Less discussed, but just as important, is how single-payer would compensate providers — doctors, nurses, hospitals, pharmacies, etc. At stake is not only the quality of care for 20 million New Yorkers, but also the fate of a fifth of the economy and the livelihoods of 1.2 million health workers.

Disconcertingly, the single-payer bill pending in the state Legislature, the New York Health Act, says almost nothing about reimbursement — other than a vague promise that fees will be “reasonably related to the cost of efficiently providing the health care service.” To fill in the blanks, our forthcoming report explores how single-payer reimbursement methodologies would affect hospital revenues.

It finds that such systems would dramatically change the financial outlook for many institutions — both for the better and the worse — with some of state’s best-known and best-regarded hospitals paying an especially heavy price.

By Bill Hammond and Chris Pope

New York Post

Hospitals now collect their revenue from dozens of health plans, each of which pays different amounts. The fees from Medicare and Medicaid are generally lower and determined by government officials, while fees from private insurers are generally higher and subject to negotiation.

Under this system, hospitals with reputations for top quality or dominant market positions can attract more privately-insured patients and command higher rates. This is how flagships such as New York-Presbyterian and Memorial Sloan Kettering can afford top-notch personnel and cutting-edge equipment.

Under single-payer, by contrast, patients in all walks of life would be covered by the same plan, at the same level of reimbursement. This would likely therefore radically redistribute resources: Hospitals now serving poorer patients with government-funded coverage would generally gain revenue, while ones now serving wealthier, better-insured patients would generally see their revenue diminished.

To approximate this shift, our study assumed a state-run system would resemble Medicare rates — which are designed to account for variation in the cost of delivering services across the state. Drawing from financial reports for 2015, we estimated how a switch to a Medicare-based reimbursement system would affect hospital revenues.

In one scenario, we assumed hospitals would be reimbursed for all patients at current Medicare levels. (This is how Sen. Bernie Sanders’ “Medicare for All” bill would work.) The result: 77 percent of the state’s hospitals would lose money; 23 percent would gain. Overall statewide hospital funding would be slashed by 17 percent, or $10 billion a year.

In New York City, the city-owned Lincoln Medical Center would see a revenue boost of $122 million, but New York-Presbyterian and NYU Langone, two of the state’s best-regarded hospitals, would lose about $730 million each.

In a second scenario, we assumed the state would boost Medicare rates enough to keep total hospital funding level — a spending-neutral variation on Medicare for All. The result: Two-thirds of hospitals come out ahead. But a third of hospitals would still be worse off, including 22 institutions that would lose more than 15 percent of revenue.

In New York City, losers in this scenario include NYU Langone ($537 million), Kings County ($339 million) and the Hospital for Special Surgery ($284 million).

In either scenario, hospitals taking the largest losses would face significant layoffs, reduced quality of care and the possibility of closing completely.

Lawmakers could try to cushion these cuts by sending extra money to the hardest-hit providers. But that would raise costs by billions, atop already-mammoth tax hikes.

These gains and losses are approximations based on hypotheticals. But they highlight a very real fact: By its nature, single-payer would redistribute resources in wrenching ways.

Single-payer wouldn’t just flatten reimbursement, but flatten quality — which would be good for some hospitals but bad for others. Could New York’s best hospitals maintain their high standards of quality? Could the state continue to recruit and retain the best doctors?

These are questions that state lawmakers must think through before they take such a giant and costly gamble with New Yorkers’ health care.

Bill Hammond is the health policy director at the Empire Center for Public Policy. Chris Pope is a Manhattan Institute senior fellow.


Midterm Elections: Trump Wants To Energize Republicans on Migrants, Immigration

October 19, 2018

So far, GOP candidates’ ads don’t emphasize issue, and Democrats say it alienates independents

Image result for Migrant Caravan, October 2018, photos
Migrants, who have fled violence-prone Central America and are heading toward Mexico and the U.S., boarded a truck in Guatemala City on Thursday. President Trump called them an “onslaught.” PHOTO: JOHN MOORE/GETTY IMAGES

WASHINGTON—President Trump is elevating the issue of immigration, which drove his 2016 campaign, with the aim of animating Republican voters in a midterm election that threatens to derail his agenda if Democrats retake the House.

Mr. Trump’s latest comments came Thursday as he warned about an “onslaught” of migrants reaching the southern U.S. border with Mexico and threatened to deploy the military if the caravan isn’t stopped.

Accusing Democrats of wanting “open borders and existing weak laws,” Mr. Trump foreshadowed a message he is likely to carry into a Western campaign swing on Friday in Arizona, a hotbed for immigration issues.

Mr. Trump and Republicans are working to build on momentum tied to the confirmation fight over Supreme Court Justice Brett Kavanaugh. “The president realizes he needs to keep that momentum going,” said Matt Moore, a GOP strategist in South Carolina and former chairman of the state party. “Illegal immigration animates the Republican Party base like few other issues.”

Democrats say the focus on immigration is backfiring by motivating progressives and independent voters.

A recent Washington Post/ABC News poll showed that among Democrats, 26% say it is one of the single most important issues, compared with only 13% of Republicans who said the same. A September Wall Street Journal/NBC News poll showed that, by a 61% to 28% margin, voters said immigration helps the U.S.

“He’s so polarized and racialized this debate that a lot of people for whom immigration was a secondary issue are really angry about what Trump is doing,” said Frank Sharry, executive director of America’s Voice, which seeks an overhaul of immigration policies. He cited the policy of separating families at the border as an example sparking anger.

At the same time, tougher immigration stances remain popular among Mr. Trump’s intended audience. A June Quinnipiac poll showed that while 66% of American voters oppose the family separation policy, Republican voters support it 55% to 35%. Voters in general oppose a border wall, the poll showed, but Republicans support it by 77%.

Immigration has bedeviled Republicans since Mr. Trump launched his campaign by calling Mexican immigrants criminals and demanding construction of a border wall. The GOP-controlled Senate and House this year rejected multiple immigration bills, including one backed by Mr. Trump that would have combined border-security funding with other measures sought by the Democrats.

On Thursday, White House chief of staff John Kelly and National Security Adviser John Bolton engaged in an “explosive” shouting match outside the Oval Office, according to people familiar with the matter. The argument was prompted by a recent report that said border crossings had increased in the past month, for which Mr. Bolton criticized Homeland Security Secretary Kirstjen Nielsen, a Kelly ally, according to one of the people.

Migrant Caravan Heads Toward Border

Migrant Caravan Heads Toward Border

A caravan of some 3,000 migrants fleeing Honduras is continuing to walk north to the U.S. border, as Trump threatened to deploy the military and close the U.S.-Mexico border. Photo: Reuters

Mr. Trump’s emphasis on immigration also coincides with reports of the migrant caravan from Honduras working its way toward the U.S. southern border.

Later Thursday, Mr. Trump called on his supporters to focus on the plight of the southern border, dubbing the 2018 midterms “an election of the caravan.”

“As you know, I’m willing to send the military to defend the southern border if necessary,” he said at a rally in Missoula, Mont. He blamed “the illegal immigration onslaught brought on by the Democrats, because they refuse to change the laws.”

Mr. Trump suggested the Democrats do little to prevent the caravan and other immigrants from crossing the border because they “think that everyone coming in is going to vote Democrat.” He also warned of “hardened, bad people” crossing into the U.S., and told the crowd of Montana voters that it is up to them to reverse course.

The caravan is the latest in a steady flow of people fleeing violence in Latin America and seeking to call attention to the problem. A record number of asylum-seeking families have recently overwhelmed border agents and immigration authorities.

Border Patrol facilities are crowded with newly arrived families, bed space at family detention centers in Texas is at a premium, and immigration-court backlogs are growing. Unrelenting violence in the region was widely accepted as having sparked the first wave of roughly 70,000 immigrant families, and nearly as many unaccompanied children, in 2014. Those flows have fluctuated in recent years.

On the border wall, Mr. Trump had a message Thursday night for Congress: “Give us the money and we’ll do it fast.”

Despite Mr. Trump’s focus on the issue, it is barely registering in political advertising by GOP candidates. Less than 11% of all ads in Senate, House and governor races through Tuesday had an anti-immigration message, according to Kantar Media/CMAG, a political ad tracker. GOP candidates have been playing up tax cuts and the economy.

“He clearly views it as one of the reasons for his political success,” GOP pollster David Winston said of Mr. Trump’s focus on immigration. “But it’s still all about the economy and jobs.”

Mr. Trump’s messaging could help some GOP Senate candidates who need his base to show up on Election Day. Its impact on House races seems more unpredictable, as most of the competitive seats are in suburban districts where his family-separation policies drew opposition from suburban woman, while a focus on threats of higher crime may resonate with voters, polls show.

Immigration as an issue has gained steam in a number of key House and Senate races, with Republicans calling opponents weak on crime and highlighting some liberal demands to “abolish ICE,” the U.S. Immigration and Customs Enforcement.

Rep. Barbara Comstock, a vulnerable Republican who represents the Virginia suburbs of Washington, has played up the threat of the MS-13 gang. “Barbara Comstock is fighting for our families,” says an ad featuring TV news reports about the gang and highlighting bipartisan legislation she has sponsored.

Some vulnerable Democrats are using the issue as well. Sen. Joe Donnelly (D., Ind.) has run ads promoting his support for Mr. Trump on immigration, including building a border wall, while taking a shot at the “radical left” over calls to abolish ICE.

David Bergstein, a spokesman for the Democratic Senatorial Campaign Committee, said that the No. 1 issue remains health care, and that Mr. Trump’s emphasis on immigration could hurt some GOP candidates, such as Martha McSally, who is running for the Senate in Arizona, a state that continues to diversify and become more politically competitive.

“It shows just how desperate Republicans are to talk about everything except the way their health-care agenda hurts working families,” Mr. Bergstein said.

Even some Republican groups are concerned that Mr. Trump isn’t advocating solutions, such as protecting young people brought illegally to the U.S. by their parents and securing more funding for the border wall.

“Bringing up immigration as an issue for elections has been done for far too long by Republicans and Democrats. We need real action and real solutions,” said Wadi Gaitan, a spokesman for the LIBRE Initiative, a pro-immigration group funded by the conservative brothers Charles and David Koch.

Write to Alex Leary at

Appeared in the October 19, 2018, print edition as ‘Trump Uses Immigrants to Energize GOP.’

The Price of BernieCare

October 12, 2018

Democrats object that Republicans are telling voters the truth about single payer.


Senate Minority Leader Chuck Schumer speaks after the Democratic policy luncheon on Capitol Hill, Washington, D.C., Oct. 10.
Senate Minority Leader Chuck Schumer speaks after the Democratic policy luncheon on Capitol Hill, Washington, D.C., Oct. 10. Photo: Alex Brandon/Associated Press

Chuck Schumer declared this week that health care is the issue that will define the November elections, and the Senate Minority Leader may be right for the wrong reason. Democrats could end up paying a big political price for signing up en masse for Bernie Sanders’s government-run health-care agenda.

Republicans are running ads slamming Democrats on single-payer health care, and President Trump framed the issue this week in a USA Today op-ed that said “Democrats would gut Medicare with their planned government takeover of American health care.” Democrats claim this is unfair because not every candidate has endorsed single payer, but if they now want to repudiate it they should say so.


Mr. Trump is referring to the Bernie Sanders bill known as Medicare for All, which has been endorsed by 16 Senators, including almost all of the left’s leading 2020 presidential contenders (Cory Booker, Kamala Harris, Kirsten Gillibrand, Elizabeth Warren).

A companion House bill has attracted more than 120 co-sponsors, which is nearly two-thirds of the current Democratic caucus. Other devotees include the Democratic nominees for Governor in California (Gavin Newsom) and Florida (Andrew Gillum) and dozens of other candidates around the country. Did Democrats think they could endorse this to please their progressive base but then have no one notice?

Medicare for All would finance health care through taxes instead of insurance premiums, deductibles and co-pays. All care would then be “free” in the Venezuelan sense of the word. Government would dramatically cut the reimbursement rates doctors receive for providing services. All this would lower administrative costs and make health care more efficient, or so we’re told. And we’re not supposed to call this “government-run health care,” though who do you think would make the payment decisions?

Mr. Trump noted in his op-ed that the plan would cost the federal government $32.6 trillion over 10 years. That figure is from an analysis by the Mercatus Center’s Charles Blahous, a respected researcher and a former Social Security and Medicare trustee who sometimes writes for us. His findings are in the ballpark of every serious analysis.

That spending figure amounts to 10.7% of GDP in 2022 when the plan kicks in and then up from there. National defense—routinely derided as too expensive and wasteful—is a mere 3% of GDP today. And brace yourself: “Doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan,” Mr. Blahous says.

Liberals are griping that these estimates overlook what would be a decline in overall health spending, but Mr. Blahous goes out of his way to credit savings that would probably be illusory such as lower drug costs. As in every socialist system, the real “savings” would come from price controls and wait lists for many health-care services. Have a cold? Come on in. A hip replacement or breast reconstruction? Get in line.

And that’s the good news. The truth is that BernieCare would essentially blow up the entire current health system. The Sanders bill would eliminate employer-sponsored insurance, which now covers some 150 million Americans. The sales pitch for that should be: If you like your health-care plan, we won’t let you keep it.

BernieCare would also blow up Medicare as we know it by creating a new health system that young and old would have to join. We don’t like to see Republicans defending current Medicare as a perfect system, since it has many shortcomings and needs reform like premium support that Paul Ryan has proposed. But compared to BernieCare, Medicare is the Mayo Clinic for everyone.

Maybe Democrats should have looked at the results in Vermont when Bernie’s home state tried to set up single payer. A Democratic Governor abandoned the idea in 2014 once he was looking at an 11.5% payroll tax, plus a 9.5% income tax, and more increases to come. Progressives couldn’t even get single payer up and running for about 625,000 people in a state with a decent health profile. In 2016 nearly 80% of voters rejected a referendum to set up single payer in Colorado.


The charges of distortion from Democrats are especially rich given that they have spent tens of millions of ad dollars this year accusing Republicans of wanting to deny chemotherapy to cancer patients who lack insurance. The truth is that the GOP last year debated more rational ways to cover folks with pre-existing conditions other than mandates that raise the cost of premiums for everyone in ObamaCare. The GOP ideas that would cover pre-existing conditions include high-risk pools that subsidize tough-to-insure patients directly.

Republicans are inept at defending themselves, and their failure to repeal ObamaCare has made them vulnerable to attack. But in dissecting single payer, the GOP is providing voters with crucial information about what Democrats want to do on health care when they next take power. ObamaCare was merely a down payment on BernieCare.

Appeared in the October 12, 2018, print edition.

Democrats’ ‘socialism’ prescription is a war on the poor

October 10, 2018

The most striking difference between Democrats and Republicans is not their views on #MeToo, affirmative action or the Supreme Court: It’s how they view the economy. Republicans deplore socialism. But more than half of Democrats view socialism favorably, according to Gallup.

The Democratic Party’s left flank is turning the midterm elections into a referendum on capitalism. Sens. Bernie Sanders and Elizabeth Warren, New York congressional candidate Alexandria Ocasio-Cortez and dozens of other federal and state candidates protest that our economic system is unjust and needs an overhaul.

They demand radical changes like giving workers control of 40 percent of corporate-board seats, and making boards serve vague goals like social justice instead of maximizing profits. They’re also pushing for huge minimum-wage hikes.

By Betsy McCaughey
New York Post

These changes will tank the economy and hurt the very workers the party claims to represent. The Democrats’ extreme proposals are handing Republicans a powerful election counterattack. At a weekend rally in Kansas City, President Trump slammed Democrats as “an angry left-wing mob” pushing for socialism “Venezuela”-style.

The left is revving up attacks on capitalism just as workers on the bottom rungs are beginning to benefit from the booming US economy. According to last week’s jobs report, unemployment is at its lowest level since 1969. Wages in blue-collar industries, such as construction and maintenance, are rising faster than for white-collar workers. Pay for people without a college education jumped almost 6 percent since last year — triple the overall wage gain.

Last week, the stock market, up by 42 percent since Trump was elected, reached record highs. Over half the nation owns stock or rides the market indirectly through their retirement plans. We’re a nation of shareholders more than a beleaguered proletariat.

Tell that to Sanders. He waged a blistering PR attack against Amazon and its subsidiary, Whole Foods, until last week, when the giant retailer buckled and announced a minimum $15 hourly wage for all workers.

Don’t worry about Amazon. The giant retailer can pass its costs on to consumers.

But Amazon employees lose. Amazon canceled performance bonuses and stock awards for hourly workers to offset the wage hike. That replaces a culture where employees who work hard can share in the company’s success with an adversarial situation pitting labor against owners. Just what Sanders and the left prefer.

The biggest losers are low-skilled job-seekers priced out of the market. Large minimum-wage hikes result in lost entry-level job opportunities, research shows. Minorities are hit hardest. Having a $10-an-hour job and relying on Medicaid and food stamps to get by isn’t a perfect life, but it’s a start. Far better than having no job.

On the other hand, Trump is getting tough on wages where they hurt American workers the most: in foreign countries. Trump’s revised trade agreement with Mexico stipulates that over 40 percent of auto-manufacturing work must be done by workers who earn $16 an hour. Former US presidents bought into the notion that outsourcing production to poor countries promotes global prosperity and equality. True, but low foreign wages undercut American workers. No more.

Meanwhile, Democratic presidential wannabe Elizabeth Warren has introduced the Accountable Capitalism Act, which would give workers control of 40 percent of corporate-board seats and a veto over many decisions. It would also compel boards to focus on murky “community and societal factors” instead of maximizing profitability. Investors won’t put their money into an enterprise under those conditions.

Warren’s legislation would cause the stock market to plummet, taking down millions of people’s retirements and wiping out the capital needed to create future growth and jobs. Shockingly, this woman wants to be president.

Democrats in favor of socialism need to take a hard look at the results in Venezuela and Cuba. Is that what they want for America?

Betsy McCaughey is a senior fellow at the London Center for Policy Research.


Opinion: Break up Amazon before it does any more damage to America

October 10, 2018

Outer space aside: Amazon wants to feed, treat, entertain, educate and medicate America — and that’s just what it’s told us. Nothing Orwellian here, right?

When Jeff Bezos announced that Amazon would be raising its minimum wage to $15 an hour last week, the reception was rapturous. The Seattle Times called it “the just thing.” “Good for them,” said President Trump’s chief economic adviser Larry Kudlow. “I’m in favor of higher wages.” Bloomberg called it proof that “an even higher minimum wage is probably safe for big, productive cities.” Senator Bernie Sanders, a chief Bezos antagonist, called it “enormously important.” “Unequivocally good news,” said The Washington Post.

The latter is owned by Jeff Bezos, an all-too-easily forgotten point these days. Because for all the questions to follow this announcement — Why now? What is Amazon eliminating to pay for this? How much praise does Bezos, recently crowned the World’s Richest Man, deserve while paying, as of 2017, a median Amazon income of $28,446? — we are not asking the real one.

When did we become The United States of Amazon?

By Maureen Calloway
New York Post

Author, entrepreneur and NYU business professor Orwellian has emerged as one of Amazon’s fiercest critics. At last month’s Recode Code Commerce, Galloway gave a 45-minute talk on the future of retail that savaged Amazon and warned of the threats the company poses not just economically but philosophically and morally.

“I believe our society is effectively going through this very uncomfortable transition that is bad for our youth, bad for America and bad for the planet where we no longer worship at the altar of character and kindness,” he said. “We worship at the altar of innovators and billionaires.”

Galloway calls this “a perversion” that has occurred without our true realization. And Amazon, he says, is more responsible than any other tech giant.

In his best-selling book “The Four: The Hidden DNA of Amazon, Apple, Facebook and Google,” Galloway cites some arresting statistics: Far fewer U.S. households have a gun than Amazon Prime, by 30 to 64 percent. More Americans have Prime than voted in 2016 (55 percent), or earn $50,000 or more a year (55 percent), or go to church (51 percent). He calls Amazon’s ability to woo Prime subscribers at a $119 yearly cost the equivalent of “entering into a monogamous relationship” with its consumers, who as of 2016 spent, on average, $193 per month. (Non-Prime members average $138 per month.)

From 2006 to 2016 Amazon’s stock price growth surged by 1,910 percent, destroying Sears, J.C. Penney, Kmart, Best Buy, Macy’s, Nordstrom, Target and Walmart.

Perhaps most importantly: Since the Great Recession, Amazon has paid just $1.4 billion in corporate taxes compared to Walmart’s $64 billion.

“We have institutionalized a regressive corporate tax structure at the hands of our idolatry of innovators and Amazon,” Galloway says. In 2017, Amazon paid nothing in federal tax.

The company is now on pace to become the largest clothing retailer in the country by 2021 and has become the most valuable company on the planet without ever posting substantial profit.

Think about that. Perhaps no other publicly traded company aside from Tesla has convinced the markets and investors of future profitability with such lopsided margins.

And Amazon has made itself such an indispensable part of the supply chain that it sets the price points of just about everything. If you are someone who makes something or sells something, from books to fire pits to flat- screen TVs, Amazon tells you what the market — its market — will bear. Its limitless supply of cash means it can undercut any other retailer in any space it wants to dominate.

In a world where so much is now controlled by so few — there are five big book publishers left, five Hollywood studios, five large health insurers, four phone providers and four cable companies — and this summer AT&T bought Time Warner — Amazon’s reach is terrifying.

Its ostensible search for the next city to house its second headquarters has become “the Olympics on steroids,” Galloway says, with state and local governments promising tax breaks that would starve funding for schools, police and fire departments. We have a new national holiday, Amazon Prime Day. Alexa and Echo, Amazon’s cloud-based voice-operated systems, sit in an estimated 40 million homes and spy on us, reporting our moods, tastes, wants, needs and fears back to HQ.

Yet we don’t fear Alexa.

Bezos has even greater ambitions. His acquisition of Whole Foods, which plunged competitor Kroger’s stock from $31 to $22 per share, is but one step in dominating what and how we eat. Amazon is spending $5 billion on original programming this year and is on pace to outspend Netflix by 2022.

Think about that, Galloway says: A retailer in Seattle as content king. And after announcing a vague health care initiative back in January, stock prices for major health care insurers plummeted — such is Amazon’s power that the mere hint of market entry damages long-standing competitors.

That’s not all. Bezos’ company Blue Origin, with a mission statement that goes not just to colonizing the planet but outer space — “Earth, in all its beauty, is just our starting place” — plans to launch the first private manned spaceflight by next year. Bezos also says he’s going to establish free preschools in low-income areas based on the Montessori method.

Outer space aside: Amazon wants to feed, treat, entertain, educate and medicate America — and that’s just what it’s told us. Nothing Orwellian here, right?

Galloway says that Amazon’s new $15 hourly wage needs to be viewed through a much more cynical lens. “Jeff Bezos doesn’t do anything that’s not the smart thing to do,” he says. “When Amazon raises their wages so publicly, other people are forced to do so” — thus starving out the competition. It’s our new Cold War, he says, and Amazon won’t stop at retail. It will outspend every other entity in pursuit of global domination.

And if we ever hope to stop it, we need to understand how we got here.

Our tectonic shift, Galloway believes, was the death of Steve Jobs in 2011. We were already on the path of technology replacing religion, but Jobs, in dying young, “became our Christ, Apple our religion, and the iPhone the cross,” says Galloway.

If you find this theory blasphemous, push through. Think, Galloway says, of Apple’s refusal to unlock the iPhone used by a terrorist in the 2015 San Bernardino mass shooting, despite the FBI’s pleas.

“Apple waves a finger and the majority of Americans support it,” Galloway says. “What if a terrorist had a Blackberry? The next day there would have been legislation. But the iPhone is sacred. It embodies the perversion of our culture.”

In little more than a decade, we have put full faith in these companies, all operating in shadow. Take Facebook’s insistence that there was no way to prevent Russian troll farms from hacking in 2016. One huge lie, says Galloway. “Big Tech uses the word ‘impossible,’ ” he says, “and all of media has bought it. We’re not talking about the realm of the possible. We’re talking about the realm of the profitable. If The New York Post said Russian trolls manipulated content and advertising in key areas or swing states unknowingly, I think the paper would have been shut down the next day. But not Facebook.”

We have become equally complacent while technology mauls our economy, he says. “We seem to be comfortable, at least in tech, with the 8,000 people who work at headquarters splitting $80 billion in revenue,” while lower-wage workers struggle to get by. Business Insider reported that as of this year, Amazon was among the top companies whose employees relied on food stamps. And that $15 minimum wage? In exchange, the company quietly cut monthly bonuses and stock options.

Meanwhile, Amazon is shedding the need for human workers at a rapid clip. In 2012, the company paid $775 million for robotics firm Kiva Systems and as of June had over 100,000 robots fulfilling online orders. A higher minimum wage for human workers doesn’t make Amazon suddenly moral. It just makes it smart.

So what do we do? Galloway says the future is in voice recognition — a future that once belonged to Apple and Siri. Today it’s Amazon. Tomorrow it might be Google. This should alarm us, he says, because Big Tech, “running out of excuses to abuse the commonwealth, will start saying, ‘But wait — if you do anything to us, the Chinese are going to take over with AI,’ ” Galloway says. Not so. China doesn’t innovate and hasn’t figured out how to launch a global product. If anything, he says, China has become America’s 3-D printer.

This complicated problem, he says, has a simple answer: Break up Big Tech.

“The key to competitive markets is that no one entity has too much control of the marketplace,” he says, adding that no other company has violated anti-trust over the past 100 years as Amazon and its ilk. Bezos’ recent support for a universal basic income is alarming, Galloway writes, because it means he sees a near future in which Big Tech permanently puts people out of work.

“Ma Bell couldn’t have been easy to break up, and we unleashed 30 years of incredible innovation,” Galloway says. “Teddy Roosevelt broke up the railroads. If the Department of Justice hadn’t moved in on Microsoft [in 1998], do you think we would have Google? We don’t break companies up because they’re evil or take jobs or don’t pay taxes. We do it because it’s time.”


Why China is going all out to invent new, stronger, cheaper drugs

October 8, 2018

China’s big ambitions to become a powerhouse of pharmaceutical innovation is as much about the well-being of its people as it is about narrowing the gap with the West

South China Morning Post

PUBLISHED : Monday, 08 October, 2018, 11:00pm
UPDATED : Monday, 08 October, 2018, 11:00pm

China, home of Tu Youyou, winner of the 2015 Nobel laureate prize for medicine, is not known for its prowess in drug innovation.

This is despite it being the world’s second largest pharmaceutical market and owner of the second highest number of biotechnology and pharmaceutical intellectual property rights.

Since Tu and her team made their groundbreaking discovery of an anti-malaria medicine in 1972, only a few domestically developed inventive new drugs have won government approval to be marketed.

In the first 10 months of last year, out of 35 new drugs which received Chinese regulatory approval, just one was developed by a domestic firm, according to a report by business consultancy McKinsey. Three of the 11 drugs given the marketing green light in 2015 and 2016 were developed by local firms.

In the United States – the world’s biggest and most advanced pharmaceutical market – of the 46 new drugs given consent for marketing by regulators last year, 28 were developed by US firms and the realisation of all but four of the rest were led by European firms. None was Chinese.

“Drug innovation is still nascent in China but, following sweeping regulatory reform, it has been moving rapidly in that direction in the past couple of years,” said Marietta Wu, managing director of private equity firm Quan Capital and a co-founder of Shanghai-based drugs developer Zai Lab, which listed on the US’ Nasdaq market last year.

“Compared to the US, the innovation gap is still significant.”


Beijing is determined to change that.

Its “Made in China 2025” strategy unveiled in 2015 laid out specific five and 10-year targets for domestic firms on drugs innovation, export market development and import substitution.

Being able to produce better drugs domestically is key to China’s ability to lower costs and improve accessibility of medicines – especially for life-threatening cancers – and help shore up social cohesion amid the widening wealth gap between urban and rural people.

The popularity of the tear-jerking film Dying to Survive in July – based on the real-life story of a Chinese leukaemia patient who smuggled cheap but unproven cancer medicine from India for some 1,000 Chinese cancer patients – saw Premier Li Keqiang renew his call on officials to speed up price cuts for cancer treatment.

The elimination of tariffs and drastic cuts to value-added tax on imported cancer drugs in May and June this year reduced drug costs in the short term, but greater self-sufficiency and intellectual property ownership are the longer term answers.

China’s nascent research into cutting edge cancer drugs is attracting global attention and investment. Photo: Bloomberg

Some domestic firms have already achieved partial breakthroughs on innovative drugs development for cancers that have received endorsement from their industry peers overseas.

When Nanjing-based Genscript Biotech announced in December that US health care giant Johnson & Johnson’s offshoot Janssen Biotech had agreed to pay Genscript US$350 million upfront to co-develop a blood cancer treatment, it generated a buzz in Hong Kong’s stock market.

The investment deal saw Genscript’s share price jump 31 per cent on the day of the announcement, before surging almost 60 per cent in the next five weeks.

Janssen sent 90 people to Nanjing to examine Genscript’s data in a five-month due diligence exercise before proceeding with the investment in its experimental chimeric antigen receptor T-cell (CAR-T) technology, currently undergoing clinical trials.

Genscript’s innovation last year cured American Craig Chase’s life-threatening multiple myeloma disease, after six weeks of treatment in a Nanjing hospital, according to provincial news portal

Chase volunteered to become the first foreign patient to try the experimental treatment in a Chinese institution after three years of conventional methods in the US had failed. He was the sixth patient to be successfully treated with CAR-T therapy in the hospital, the report said.


This success has not changed the fact that China is a latecomer in drug innovation.

Two of only a handful of drugs to make it past the industry watchdog in decades were Shenzhen ChipScreen Biosciences’ treatment for relapsed T-cell lymphoma in 2014, and Jiangsu Hengrui Medicine’s breast cancer novel treatment in August this year.

The size of China’s patient pool is key to its potential as a future power in the biopharmaceutical industry. Photo: Bloomberg

Last month another approval was announced, by Hong Kong tycoon Li Ka-shing’s Hutchison China MediTech, which has ploughed US$590 million since 2000 into its mainland drug research projects, together with partners including international giants Eli Lilly and AstraZeneca.

The London and New York-listed firm’s capsules won unconditional approval to help extend the lives of colorectal cancer patients, who have failed at least two prior therapies and have an average life expectancy of six months, by an average 3.7 months. It aims to get three of its 11 cancer drug candidates to the market within three years.

China MediTech chief executive Christian Hogg said the sheer size of China’s patient pool – with a third of the world’s cases of colorectal cancer, half for gastric cancer and 40 per cent for lung cancer – is key to its potential as a future power in biopharmaceutical industry development.

“Cancer is extremely clever, it mutates very quickly,” Hogg said. “You try to shut off one switch [to stop cancer cells growth], but they will find another pathway to multiply.

“The future of oncology drugs development is all about combinations of targeted therapies, including those that shut down the blood flow to cancer cells, and immunotherapies which activate the immune system to attack the cancer cells.”

The challenge for drug developers was finding the “really clean” treatments that had the fewest unwanted side effects, he said.

Beijing is keen for its nascent biotechnology industry to take on such challenges, and has not been coy about its ambition.

As part of the “Made in China 2025” national strategy, Beijing wants the Chinese industry to develop 10 to 20 innovative drugs by 2020 and commercialise 20 to 30 by 2025.

It also wants to see at least 100 pharmaceutical firms gaining US, EU, Japanese and World Health Organisation certification.

By 2020, Beijing wants registration completed for five new biological drugs so they can be marketed in developed nations, rising to 10 by 2025.

Other objectives include breakthroughs in 10 to 15 “major core technologies” by 2020, and the ability to produce generic versions of 90 per cent of blockbuster drugs after their international patents expire.


To accelerate the industry’s transformation from almost exclusively generic drugs manufacture to an increasingly innovation-driven model, and to address the huge unmet demand for better drugs, Beijing has announced an unprecedented scale of reforms in the past three years.

They include measures to greatly accelerate new drug approvals through more regulatory manpower and streamlined procedures.

To close the incentive gap with Western nations for drug innovation, Beijing announced in April this year that it would grant patent extensions of up to five years on innovative drugs seeking marketing approval, both in China and abroad.

Patents usually afford owners 20 years of sales exclusivity protection from the filing date and an extension provides key additional incentives, according to Hogan Lovells’ patent and trademark lawyer Andrew Cobden.

That was because the latter part of the exclusivity period was usually when manufacturers made the greater share of their revenue in the drug commercialisation process as their products gained recognition and market share, he said.

Another policy to encourage innovation was the establishment, almost four years ago, of specialised intellectual property courts.

These had enabled more intellectual property (IP) owners to get redress, Cobden said, adding that IP owners were reportedly successful in about 80 per cent of infringement cases decided by the Beijing IP court in its first 2½ years.

Previously, Chinese court decisions tended to favour local defendants compared to other nations, particularly in cases involving foreign IP owner plaintiffs, he said.

As part of the Made in China 2025 national strategy, Beijing wants industry to develop 10 to 20 innovative drugs by 2020 and commercialise 20 to 30 by 2025. Photo: Reuters

China’s pharmaceutical firms have spent a combined US$7.2 billion on research and development in 2016, according to a report by Washington-based non-profit public policy organisation the Brookings Institution.

While modest compared to the US$156 billion spent globally by pharmaceutical firms and the US$93.6 billion outlay of the world’s top 20 drug developers – mostly based in Western nations – China’s spending has jumped 44-fold from US$163 million in 2000.

“There has been a dramatic growth in Chinese R&D – now close to EU levels – indicative of Chinese efforts to become an innovation nation and position itself as a potential first mover in the biotech and green energy fields,” said a report on US technology development strategy by Washington-based international affairs think tank the Atlantic Council.

“The world is now much more competitive, and the United States and European countries risk losing their edge, which has negative national security implications.”


Western nations’ concern that China may one day catch up or surpass them in biotechnology development is not unfounded.

The global market share of mainland Chinese biotechnology and pharmaceutical patent applications has grown just over three times, to 32 per cent, in the decade to 2016, even though the share of patents granted rose to only 18 per cent from 10 per cent, according to data from World Intellectual Property Organisation and calculations by the South China Morning Post.

In the same time frame and in the same sectors, the US share of patent applications fell from 35 per cent to 28 per cent. US share for patents granted slid only marginally, from 32 per cent to 30 per cent.

China has also made great strides in developing some of the world’s cutting edge cancer treatments, one of a small number of pharmaceutical research areas in which it appears to be neck-and-neck with the developed world.

Of the just over 400 CAR-T clinical trials being conducted globally in late March, 166 were in China, just ahead of 165 in the US, according to a Guosen Securities report that cited data from

China’s advancement in the area is remarkable, considering the country had just 24 CAR-T clinical trials under way in February 2016, exactly half the number taking place in the US at that time.


But it is still too early to say who has the upper hand, as it is the quality of, and results from, clinical trials that count.

“Quantity doesn’t necessarily mean quality, the rapid emergence of a large number of players in a way indicates the industry is still emerging … many aspects of the ecosystem are still being established,” Wu of Quan Capital said.

One such aspect is the number of high quality clinical trial sites that can meet the needs of drug developers. There were just over 50 in China, compared to hundreds in the US, Hogg said.

Chen Li, chief executive of diabetes drugs developer Hua Medicine and a former China chief scientific officer of Swiss pharmaceutical giant Roche, said that while China’s basic medicine research capability had been improving, its scientists had been publishing in leading journals, mostly about non-human research.

There had been only a limited, albeit increasing, number of research papers on clinical trials for human diseases written in China, trailing far behind the West, he said.

Helen Chen, head of LEK Consulting’s China biopharmaceuticals and life sciences practice, agreed there was still much catching up to do.

“As an emerging innovative industry, the achievements in terms of actual output is still limited [even as] China has been rapidly ramping up the number of IP filings and the amount of money spent on R&D,” she said.

Private Businesses Built Modern China. Now the Government Is Pushing Back.

October 4, 2018

The comments were couched in careful language, but the warning about China’s direction was clear.

China grew to prosperity in part by embracing market forces, said Wu Jinglian, the 88-year-old dean of pro-market Chinese economists, at a forum last month. Then he turned to the top politician in the room, Liu He, China’s economic czar, and said “unharmonious voices” were now condemning private enterprise.

“The phenomenon,” Mr. Wu said, “is worth noting.”

Mr. Wu gave rare official voice to a growing worry among Chinese entrepreneurs, economists and even some government officials: China may be stepping back from the free-market, pro-business policies that transformed it into the world’s No. 2 economy. For 40 years, China has swung between authoritarian Communist control and a freewheeling capitalism where almost anything could happen — and some see the pendulum swinging back toward the government.

State-controlled companies increasingly account for growth in industrial production and profits, areas where private businesses once led. China has stepped up regulation of online commerce, real estate and video games. Companies could face higher taxes and employee benefit costs. Some intellectuals are calling for private enterprises to be abolished entirely.

By Li Yuan
The New York Times

Beijing’s permissiveness with private businesses has ebbed and flowed over the years, and some in China say that longstanding tension between authoritarianism and the free market has reached a critical point. Credit Gilles Sabrié for The New York Times

Dissenters in China these days must walk a careful line. But a sense of urgency — fueled in part by China’s slowing growth and rising pressures from President Trump’s trade war — has driven a growing number of officials and economists to speak out on the government’s changing stance on private business.

Private enterprises are plagued by concerns and “dissatisfaction,” said Ma Jiantang, the top party official at the Development Research Center, a high-level government think tank, at the same forum, according to a transcript.

“If a trend forms and no one dares to criticize it,” wrote Hu Deping, a retired minister, “the consequences will be terrible.”

Wu Jinglian, one of China’s most prominent pro-market economists, in 2009. At a forum last month, he voiced worry that China may be stepping back from the free-market, pro-business policies that transformed it into the world’s No. 2 economy. Credit Gilles Sabrié for the New York Times

The debate has gone all the way to the top. On Thursday, President Xi Jinping, the country’s leader, sought to reassure private entrepreneurs that Beijing would still support them. But he also offered a full-throated defense of the country’s big state-controlled companies, which many economists believe crowd out private businesses.

“Such statements as ‘there should be no state-owned enterprises’ and ‘we should have smaller-scale state-owned enterprises’ are wrong and slanted,” Mr. Xi said during a visit to a facility owned by China National Petroleum Corporation, a major state-controlled oil company.

China’s leadership turned to entrepreneurs in the late 1970s, after the government had led the economy to the brink of collapse. Officials gave them special economic zones where they could open factories with fewer government rules and attract foreign investors. The experiment was an unparalleled success. When extended to the rest of the country, it created a growth machine that helped make China second only to the United States in terms of economic heft.

Today, the private sector contributes nearly two-thirds of the country’s growth and nine-tenths of new jobs, according to the All-China Federation of Industry and Commerce, an official business group. So pressures on private businesses could create serious ripples.

“The private sector is experiencing great difficulties right now,” wrote Mr. Hu, the retired minister, who as the son of a former top Communist Party leader is often a voice for reform in China, in an essay posted online last Thursday. “We should try our best not to replicate the nationalization of private enterprise in the 1950s and the state capitalism.”

The Chinese president, who has sought greater party control over the military, the media and civil society, is now focusing on business. The government is considering taking direct stakes in the country’s big internet companies. Regulators have stepped up existing requirements that businesses, even foreign ones, give Communist Party committees a greater role in management.

Leftist scholars, bloggers and government officials are providing theoretical and practical support. In January, Zhou Xincheng, a professor of Marxism at Renmin University in Beijing, declared that private ownership should be eliminated.

A hospital in Shanghai. China must find ways to pay for increasing ambitious social programs like universal health care. It is also trying to curb problems caused by business run amok, like pollution and years of companies dodging taxes. Credit Gilles Sabrié for The New York Times

Last month, Wu Xiaoping, then an unknown blogger, wrote that the private sector should be ended now that it had accomplished its historic mission of achieving growth. Mr. Wu’s blog went viral.

Also last month, Qiu Xiaoping, a vice minister of human resources and social security, urged “democratic management” of private enterprises, saying that they should be jointly run by business owners and their employees.

Some of the government’s efforts stem from necessity. Beijing must find ways to pay for increasing ambitious social programs like universal health care. It is also trying to curb problems caused by business run amok, like pollution and poor treatment of workers, as well as years of companies dodging taxes.

But entrepreneurs say the pace of change in Chinese taxes — already among the world’s highest — gives them little time to prepare. For example, next year China will step up efforts to collect social-benefit payments and shift the way they are calculated, resulting in higher costs. Stricter social security tax collections could erode China’s corporate profits by 2.5 percent, according to Lu Ting, an economist at Nomura Securities in Hong Kong.

That could particularly hurt smaller companies, which tend to be privately owned and often have thin profit margins. Chinese officials have promised to cut overall taxes, but the details have been scant.

Beijing’s efforts to wean the economy from its dependence on borrowing have made it harder and more expensive for many private businesses to get money. At the same time, the state-owned enterprises have little problem getting new loans. Even Li Keqiang, China’s premier, recently acknowledged what he called the “hidden line” between public and private access to bank loans.

Tech workers in Beijing in May. China has taken steps to put greater control over its technology sector, which flourished largely free from government influence. Credit Gilles Sabrié for The New York Times

Some struggling entrepreneurs are doing what was once considered unthinkable: selling out to the state. So far this year, 46 private companies have agreed to sell shares to state-controlled firms, with more than half selling controlling stakes, according to the Shanghai Securities News, an official government newspaper. While the number is small considering the vast Chinese economy, it reverses a two-decade trend of state companies selling shares to private entrepreneurs.

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India: Modi Ends National Medical Council to Implement “Modicare” — Criticizes Corruption in Medical Education, “Mafia” of Indian Medical System

September 28, 2018
Narendra Modi’s plan to dissolve the Medical Council of India (MCI) was so confidential that people in the council did not even see it coming. The Cabinet meeting was to be held on Wednesday — it was known to all, but it even took ministers present in the Cabinet by surprise when such a sudden decision was taken. The prime minister inaugurated the Jan Arogya Yojana on 23 September to provide healthcare to all. But forming a new board of governors after disintegrating the MCI is one of the key precedents in the series of daring decisions by Modi.

The prime minister categorically put the necessity of the Ordinance before his Cabinet colleagues and after getting the Cabinet nod, it was immediately sent to the president for its promulgation. At the Cabinet meeting, Modi spoke about the reason for the dissolution of the MCI and how it would bring about a change in healthcare services. The prime minister expressed the need to open one-and-a-half lakh primary healthcare centres, so that the healthcare-for-all scheme could come to fruition. The prime minister emphasised on the effective steps to be taken to fulfil the shortage of doctors and medical professionals, to successfully deliver a healthy India.

Further, Modi also expressed his concerns about the corruption in medical education and stressed on the need to disintegrate the MCI to rein in the mafia in the council.

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In fact, the last Monsoon Session of Parliament was abuzz with the passing of the National Medical Council Bill and because of the non-passage of this bill, the government started facing various charges. It was alleged that the Gujarat lobby directly or indirectly had its clout in the MCI. And this was the reason the government did not pass the bill to support the council. Doctors were divided on the issue of the bill. But the promulgation of the Ordinance by the president with such alacrity meant that all the rumours about the government were swiftly deflated.

Presently, the MCI stands disintegrated and it will function with the help of a board of governors. According to the press release, seven names on the board of governors are globally recognised in their respective work areas. These are:

1) Dr VK Paul, who is a member of NITI Aayog and will be taking over as the chairman of the council.
2) Dr Randeep Guleria, who is at present the director of AIIMS.
3) Dr Jagat Ram, who is the director of PGIMER, Chandigarh.
4) Dr BN Gangadhar, who is the director of NIMHANS, Bengaluru.
5) Dr Nikhil Tandon, who is a professor in endocrinology and metabolism.
6) S Venkatesh, who holds the position of director-general, health.
7) Dr Balram Bhargav, who is director-general of the Indian Council of Medical Research.

By choosing such experts, the government seems to be seeking to give a fitting response to the rumours doing the rounds against the National Medical Council Bill. It was alleged that the institution of doctors was to be replaced by the bureaucrats.

The background behind the disintegration of the MCI

Due to out-of-pocket expenditure on healthcare, 66 lakh people have been pushed below the poverty line. This is a big challenge to the government. To cope with this, the government is preparing to open one-and-a-half lakh primary healthcare and wellness centres. And the target to achieve it has been fixed for the year 2022. Thirty-one states have already agreed to be part of the Ayushman Bharat Yojana. Meanwhile, 26 states have already started the process of its implementation.

According to government data, 2,300 healthcare and wellness centres are operational and by the end of this year, the target has been fixed at 15,000 new centres in total. The scarcity of capable healthcare professionals has let to difficulties in achieving the targets of universal healthcare coverage, sustainable development goals and the national health policy. And the main reason for this failure seems to unchanged medical education and massive corruption in the field.

The government wants and improvement in the quality of tertiary healthcare. In order to achieve this goal, there are plans to open 14 AIIMS in various parts of the country. After the opening of all these, the total number of AIIMS in the country will be 22. There are plans to open super specialty blocks in 54 medical colleges for which a sum of Rs 9,000 crore has been earmarked.

Further, at an expense of Rs 16,000 crore, there is a plan to open 82 medical colleges in backward areas, under the sponsorship of the Centre. Therefore, without the reformation in medical education, implementation of such a vast project was very difficult. It is obvious that the need of doctors and health professionals for such a large project is a major challenge. That is why the government believes that the need of the hour is a change in medical education.

The government had to take this step because the National Medical Council Bill was prepared on the basis of a report by the parliamentary committee in 2016 under the chairmanship of late Ranjit Roy Chaudhary and it was tabled in the Lok Sabha on 29 December, 2017. The bill stressed on the need to increase the numbers of undergraduates and postgraduates, and a reform in medical education was also proposed in the bill. The draft spoke of the formation of four boards which must ensure the best integrity and professionalism of its members. The draft was again sent to the parliamentary committee for advice. This bill was passed by the Cabinet on 28 March this year and was tabled in the Lok Sabha for its passage, but is still pending.

A second oversight committee was formed at the end of 2017. But on 6 July, 2018, the oversight committee complained about its lack of authority through a letter to the Ministry of Health and all members handed in their resignations.

The government believes that when the order of the Supreme Court was surpassed and the MCI began taking decisions without taking the oversight committee into confidence, it was then imperative to replace the MCI. The National Medical Council Bill is pending in the House and for better medical education and to provide better health services, the government has made its intentions clear by taking effective steps.

Updated Date: Sep 28, 2018 11:00 AM

Tags : AIIMS, BN Gangadhar, ConnectTheDots, Jagat Ram, Medical Council Of India, Narendra Modi, National Health Policy, National Medical Council Bill, Nikhil Tandon, Randeep Guleria, S Venkatesh, VK Paul


The problem with single-payer? Eventually, you run out of other people’s money

September 27, 2018

Democrats have made a complete government takeover of the healthcare system the linchpin of their pitch to voters in this fall’s elections.

Former President Obama, who supported single payer before he was against it when promoting Obamacare, is now for it again. In a September 7 speech at the University of Illinois at Urbana-Champaign, he said, “Democrats are running on some good new ideas this year — like single-payer.”

Gubernatorial candidates in Maryland, Florida, Colorado, and California are calling for single-payer health care in their states. New York congressional candidate Alexandria Ocasio-Cortez, an avowed Democratic Socialist and rising star in the party, has preached the gospel of Medicare for All at rallies all over the country. In Massachusetts, Boston City Councilwoman Ayanna Pressley, a supporter of single-payer, defeated 10-term incumbent Michael Capuano in the Democratic primary for Massachusetts’s 7th congressional district. The Pied Piper of single-payer, Sen. Bernie Sanders, has continued to stump for single-payer on television and at campaign events nationwide.

Free health care is a potent rallying cry. But eventually, single-payer’s champions will run out of other people’s money.

By Sally C. Pipes
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Congressional nominee Alexandria Ocasio-Cortez shocked the Democratic political community after an upset win against Representative Joe Crowley in the New York Democratic primary. (Photo by Spencer Platt/Getty Images)

The single-payer plan advocated by Ben Jealous, the Democratic candidate for governor in Maryland, would run $24 billion a year. That would increase the state budget by more than 50 percent. An analysis of the plan from the state’s Department of Legislative Services floated a new 10 percent payroll tax and a $2,800 per-person fee to cover its cost.

In California, Lt. Gov. Gavin Newsom is promising that he’ll deliver universal coverage if voters give him the state’s top job. A single-payer bill cleared the state Senate in June 2017 but has since stalled in the Assembly. It would cost $400 billion a year, according to the state Legislative Analyst’s office.  That’s more than double the state budget.

Those sums pale in comparison to the cost of Sen. Sanders’s Medicare for All Act, which he introduced last year. In a study released last month, Charles Blahous — a scholar at the Mercatus Center at George Mason University and a former trustee for Social Security and Medicare — pegged the bill’s cost at $32.6 trillion between 2022 and 2031.

Doubling the amount of money the federal government collects in individual and corporate income taxes would not be enough to cover that tab.

And Blahous’s estimate may be low. Sanders’s Medicare for All bill posits that making the federal government the country’s sole insurer will deliver $83 billion in administrative savings. Those savings are likely fictitious.

For starters, think of the army of new government employees that would be required to process payments. Health care — brought to you by the folks behind the DMV and the Post Office.

Sanders points to the current Medicare program’s low level of administrative costs, about 4 percent of total spending. But that ratio is so low because overall Medicare spending is so high; after all, seniors use more health care than the general population.

Further, a significant share of private insurers’ administrative costs go toward policing fraud. The federal government seems content to waste taxpayer dollars instead. In 2016, Medicare and Medicaid made $96 billion in improper payments, according to the Government Accountability Office.

The Sanders plan also assumes the government will get away with paying healthcare providers at Medicare’s current rates, which are 40 percent less than those for private insurance. In dollar terms, the plan envisions $385 billion in cuts to doctors and hospitals and $61 billion in cuts to drug makers in the first year.

Doctors are likely to respond to those cuts by working fewer hours, leaving their current practices, or even leaving the profession entirely, whether by retiring early or switching careers.

If Medicare for All’s proposed cuts don’t materialize, Blahous figures the bill’s cost to be about $38 trillion over a decade.

His study is only the latest to detail the fiscal impossibility of Medicare for All. A 2016 Urban Institute study concluded that the version of Medicare for All Sanders touted on the presidential campaign trail would cost $32 trillion between 2017 and 2026.

Emory University health policy professor and former Clinton administration health official Kenneth Thorpe ran his own calculations on the Sanders plan in 2016 — and found that it would cost $25 trillion over that same ten-year period.

The numbers don’t lie. America can’t afford single-payer health care. And, they won’t like the inevitable long waits, rationed care, higher taxes, and shortage of doctors to treat them.

Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The False Promise of Single-Payer Health Care (Encounter). Follow her on Twitter @sallypipes.


‘Modicare’: India’s PM promises free health care for half a billion

September 25, 2018

Indian Prime Minister Narendra Modi has launched the world’s biggest healthcare program, with the rollout of free coverage for an estimated half a billion of India’s poorest citizens ahead of national elections early next year.

The ambitious program, dubbed “Modicare,” was unveiled in the federal budget earlier this year and launched at the weekend. It is designed to offer an estimated 100 million “poor and vulnerable” families, or equivalent to an estimated 500 million people, free hospital treatment costs of up to 500,000 rupees ($7,800) per year.
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Indian Prime Minister Narendra Modi addresses the media at Parliament House in Delhi earlier this year.
“Such an initiative is unparalleled in terms of scale and extent,” Modi tweeted on Sunday. “It shows our unwavering commitment to create a healthy India.”
But while the program has raised hopes for better treatment for India’s poorest, critics say the announcement was timed to elicit a pre-election boost and questioned Modi’s ability to deliver on his promise.

A “game changer”

Research unit Capital Economics said the funds for Modicare are “prohibitively small,” observing that only 200 billion rupees, or 0.2% of gross domestic product, have been allocated each year.
“Better provision of health care can bring several benefits, from both an economic and wider perspective,” Capital Economics said in an August 17 note. “But we doubt that Modicare will have much of an impact.”
India spends only about 1% of its GDP on public health.
If the program is fully taken up, it would cost close to $780 billion, a huge sum for India’s $2.4 trillion economy.
Access to healthcare is a major problem in India. Public hospitals are few in number and often underfunded and understaffed. The issue of healthcare is likely to feature heavily in India’s forthcoming national election, which is expected before May 2019.
India has just over 1 million registered doctors and fewer than 15,000 state hospitals for its 1.3 billion people, according to government data released last year.
“I’m skeptical because I don’t think enough thought is given to recruitment and training, the institutional mechanisms to ensure that you have the right workers. There’s also the massive challenge of the quality of care. What we do know about India’s public health system is that the quality of care provided is questionable,” Yamini Aiyar, president and chief executive of the the Delhi-based Center for Policy Research think tank, told CNN.
But despite the obstacles, the program has also won applause from senior health officials.
“It is going to be a game changer,” Dr. K.K. Aggarwal, former president of the Indian Medical Association, told CNN. “Health is a fundamental right and it is the state’s responsibility to look after the health of people who can’t afford it.”
Total spending on healthcare in India averaged $267 per person in 2014 — the latest year for which data is available — compared to $9,403 in the United States, $3,377 in Britain and $731 in China, according to the World Bank.

“Large country with diverse needs”

Many Indians have no choice but to use private hospitals, where treatment is unaffordable for someone earning the average annual wage of less than $2,000.
The government is already trying to bring healthcare closer to rural Indians by establishing 150,000 “health and wellness centers,” a separate program with $190 million in the budget.
The scale of India, in both population and geography, will be a challenge.
“The government would like us to believe that this is like some version of Obamacare with the twist to the name…but anything that we do in India in terms of context and size is on a magnitude much larger than in other parts of the world,” said Aiyar.
“The classic problem with India, which is not particular to this unique government, is that we get the design but the question of implementation is where the challenge lies. Are we going to be able to put in the massive investments and state capacity needed to get this right? This is a large country with diverse needs. There is no such thing as a one size fits all,” she added.
Conceding that Modicare was “an ambitious and laudable goal,” Rajiv Lall and Vivek Dehejia of the IDFC Institute think tank said in a column for Mint online that the program covers only the costs of treatment and hospitalization at the secondary and tertiary levels.
“Modicare does not extend to primary healthcare, which, we believe, is the weakest link in the provision of public health in India,” they said.

The politics of healthcare

Opposition parties have slammed the program.
Four states — Telangana, Odisha, Kerala and Punjab — and the union territory of Delhi have opted out of the nationwide program, citing concerns over infrastructure, funding and the potential for corruption.
All five regions are ruled by parties not affiliated with Modi’s ruling Bharatiya Janata Party.
In a statement released on Twitter, Delhi’s ruling Aam Aadmi (Common Man) Party described the program as “another white elephant in the making,” adding that it has been designed in a manner “bound to fail.”
Kerala Finance Minister Thomas Isaac labeled it a “hoax” in an interview with the Indian Express.