November, 15 2020, 11:00pm EDT
New Study--Hospitals Hike Charges by Up to 18 Times Cost
Highlights threat to patients amid Covid-19 pandemic surge.
WASHINGTON
With the Covid-19 pandemic continuing to explode across the country, a new study documents that hospitals jack up charges by as much as 18 times over their costs, a substantial contributor to the growing health care crisis for patients and families.
Overall, the 100 most expensive U.S. hospitals charge from $1,129 to $1,808 for every $100 of their costs. Nationally, U.S. hospitals average $417 for every $100 of their costs, a markup that has more than doubled over the past 20 years. The full study is available here.
"There is no excuse for these scandalous prices. These are not markups for luxury condo views, they are for the most basic necessity of your life: your health," said Jean Ross, RN, president of National Nurses United, which conducted the study. It is based on Medicare cost reports for 4,203 hospitals in fiscal year 2018, the most recent data available.
"Unpayable charges are a calamity for our patients, too many of whom avoid -- at great risk to their health -- the medical care they need due to the high cost, or they become burdened by devastating debt, hounded by bill collectors or driven into bankruptcy," said Ross.
Many patients avoid hospital care due to high costs
Surveys have found that 78 percent of adults have avoided hospital visits and, in 2018, 44 percent skipped medical care due to the cost. About 30 percent said they had to choose between paying for medical bills or basic necessities like food or housing. Last year 137.1 million people in the United States reported struggling with medical debt.
High hospital charges also drive up Covid-19 treatment costs. One study found that average charges for a Covid-19 patient requiring an inpatient stay can range from $42,486 with no or few complications to $74,310 with major complications. A Commonwealth Fund survey found that 68 percent of respondents said that "potential out-of-pocket costs would be very or somewhat important in their decision to seek care if they had symptoms of the coronavirus."
Another open question is the fate of the Affordable Care Act. If the ACA is thrown out by the Supreme Court, the 23 million people in the United States who either buy insurance through the ACA exchanges or are covered by the expansion of Medicaid would lose coverage. Further, as many as 133 million people under age 65 who have preexisting conditions, plus the 11 million people, and counting, infected by Covid-19, would all once again be subject to insurance denial for coverage, and higher out-of-pocket costs.
Other study highlights include:
* Hospital charges play a major role in mounting health care costs, with health expenditures closing in on one-fifth of the gross domestic product (GDP). The United States far exceeds the rest of the world in per capita costs, though lags behind many other wealthy countries in a variety of health outcomes.
* Higher charges generate big profits. Pushed upward by increasing charges, hospital profits have mushroomed by 411 percent since 1999 to a record $88 billion in 2017.
*The rise in charges coincides with growing hospital mergers and acquisitions by large systems. The result is increased market consolidation, which leads to higher profits and increased charges, not savings for patients as hospital systems often claim.
* Of the 100 hospitals with the highest charges over their costs, for-profit corporations own or operate 95 of them, led by HCA Healthcare, the largest hospital system in the United States, which by itself owns or operates 53 of the top 100.
How high hospital charges are passed on to patients
Hospitals sometimes maintain that the charge master price, essentially a list price to bargain over reimbursements from insurers, does not reflect how much insurers actually pay since negotiations between insurers and hospitals are confidential, the report notes.
However, a 2017 study found that for each additional dollar increase in list price, insurers paid an additional 15 cents to hospitals. Hospital executives have conceded that the goal of the charge master is profitability. And when the insurers pay more, their cost is typically passed along to employers, their employees or individual patients in higher premiums, deductibles, and co-pays.
Uninsured patients have the least negotiating power when slammed with the full charge, a major reason why medical bills have sparked a huge leap in medical debt lawsuits. Once the hospitals win a favorable court judgment, they often file liens against patients' homes, or garnish their bank accounts or wages. Increasingly, hospitals sell the debt to bill collectors to hound patients, yet another reason medical debt is a leading cause of personal bankruptcy.
In Maryland, a rare state to make the data publicly accessible, hospitals have filed more than 145,000 medical debt lawsuits over the last 10 years, seeking $268.7 million in payments from patients.
As in so many other areas of society, there is a racial disparity in the impact of the high charges. In 2019, Latinx and Indigenous people were three times, and Black people nearly twice as likely, to be uninsured as white people. Similarly, 19 percent of communities of color, compared to 15 percent for whites, had medical debt in collections.
Hospital partnerships with other health care industry sectors, such as physician staffing firms, often result in "out-of-network" surprise medical bills and supplemental charges such as "trauma" or "facility" fees, which intensify the crisis for patients. Studies show that up to four of every 10 ER trips result in surprise medical bills, in some cases with hospitals sharing the higher profits. Similarly, hospitals have increased the practice of big hikes in routine, supplemental fees, an 87 percent jump over six years in trauma fees.
While some hospitals claim they will lower those charges for these patients, or mitigate the burden through charity care, hospitals have steadily reduced the amounts of financial assistance and charity care offered to patients around the country.
How to rein in high hospital charges
Medicare is the most effective system at limiting price gouging through its bulk purchasing power to set the price it will pay. "The most viable solution to slowing the growth in hospital charges and the continued inflation of hospital prices, is to bring all health care purchasers together, under a public, nationwide single-payer plan," the report notes.
"Nurses know that the best way to rein in these outrageous charges that create such grievous harm for our patients is with Medicare for All, as other countries have proven," said Ross.
"Medicare for All will not only guarantee health care coverage for every person in the United States, it will end medical bankruptcies, medical debt lawsuits, and the health insecurity faced by millions who make painful choices every day about whether to seek the care they desperately need," Ross said.
National Nurses United, with close to 185,000 members in every state, is the largest union and professional association of registered nurses in US history.
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Pro-Genocide Mob Attacks Nonviolent Encampment, Beats Students at UCLA
Encampment organizers called the assault "nothing less than a horrifying, despicable act of terror."
May 01, 2024
A pro-Israel mob violently attacked a Gaza solidarity encampment at the University of California, Los Angeles overnight Tuesday, hurling fireworks at the structure and beating demonstrators as campus security and city police stood by.
Los Angeles Times higher education journalist Teresa Watanabe reported that members of the pro-Israel mob used explicitly genocidal language as they ripped down encampment barriers, yelling, "Second Nakba!"—a reference to the forced displacement of hundreds of thousands of Palestinians from their homes in 1948.
Pro-Israel counterprotestors started tearing down @UCLA encampment barriers and screamed "Second nakba!" referring to the mass displacement & dispossession of Palestinians during the 1948 Arab-Israeli war. Per @latimes @safinazzal on the scene with another video: pic.twitter.com/zSplnd1bYO
— Teresa Watanabe (@TeresaWatanabe) May 1, 2024
At one point, a student stepped out from behind the encampment walls to confront the mob, which quickly swarmed the student and brutally attacked him while he was on the ground attempting to shield his face from the blows.
200+ pro-Israel counterprotestors are attacking the @UCLA pro-Palestinian encampment. They started beating on one student and stomped another under a plywood board per @latimes @safinazzal on the scene. Where is UCLA security? pic.twitter.com/zjYNFWSK7r
— Teresa Watanabe (@TeresaWatanabe) May 1, 2024
Organizers of the UCLA encampment, which—like others on campuses across the U.S.—is aimed at pressuring the university to divest from companies profiting off Israel's war on Gaza, said in a statement that the attack was "nothing less than a horrifying, despicable act of terror" and condemned the university for doing nothing to keep students safe.
UCLA administrators have deemed the encampment "unlawful" and threatened participants with suspension or expulsion.
"For over seven hours, Zionist aggressors hurled gas canisters, sprayed pepper spray, and threw fireworks and bricks into our encampment," organizers said. "They broke our barriers repeatedly, clearly in an attempt to kill our community."
They added that campus security officers left the scene of the violence "within minutes" and "external security the university hired for 'backup' watched, filmed, and laughed on the side as the immediate danger inflicted upon us escalated."
"Law enforcement simply stood at the edge of the lawn and refused to budge as we screamed for their help," the statement continued. "The only means of protection we had was each other. We keep each other safe."
The passivity of campus security and Los Angeles police in the face of violence from the pro-Israel mob at UCLA drew comparisons to the occupied West Bank, where Palestinians are regularly harassed and attacked by settlers as Israeli soldiers watch—and often participate.
The Daily Bruin, which had student reporters on the scene, reported that "security and UCPD both retreated as pro-Israel counter-protesters and other groups attacked protesters in the encampment."
"There has been a minimal police presence on campus despite multiple events of counter-protesters antagonizing the encampment since Thursday," the newspaper added. "UCPD Chief of Police John Thomas said to The Daily Bruin that the force only had around five to six officers on duty. Officers came under attack while trying to help an injured person, and so they left."
The inaction of UCLA security and local police contrasts sharply with the vicious crackdowns on nonviolent pro-Palestinian demonstrators at universities across the country, including Columbia University in New York City late Tuesday.
Early Wednesday, The Daily Bruin published an editorial denouncing Chancellor Gene Block for doing so little "to ensure the protection of students who exercise their rights."
"The world is watching. As helicopters fly over Royce Hall, we have a question. Will someone have to die on our campus tonight for you to intervene, Gene Block?" the editorial asks. "The blood would be on your hands."
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"The U.S. government and institutions like Columbia are showing that they would rather brutalize students than divest from apartheid and genocide."
May 01, 2024
Hundreds of New York City police officers descended on Columbia University Tuesday night to arrest dozens of pro-Palestinian student protesters and dismantle a Gaza solidarity encampment that inspired campus protests across the United States, with demonstrators calling on their schools to divest from companies profiting off Israel's devastating war.
Police, some wearing riot gear, entered Columbia's campus at the request of the university's president, Minouche Shafik, who authorized the NYPD to "clear all individuals from Hamilton Hall and all campus encampments."
Video footage shows officers entering a campus building that students occupied hours earlier, renaming it "Hind's Hall" after a 6-year-old girl who was killed by Israeli forces earlier this year. The Columbia Daily Spectator, the university's student newspaper, reported that "as they entered the building, officers threw down the metal and wooden tables barricading the doors and shattered the glass on the leftmost doors of Hamilton to enter with shields in hand."
"Several officers drew their guns, according to footage posted by NYPD Deputy Commissioner of Operations Kaz Daughtry," the newspaper added. "At around 9:37 pm, officers led dozens of protesters out the entrance of Hamilton. The protesters' hands were zip-tied behind their backs. The arrested individuals chanted, 'Free, free Palestine' as they were led away from the building."
Footage of NYPD tactical teams raiding and clearing Columbia University. pic.twitter.com/roUe9Dp7Vb
— Moshe Schwartz (@YWNReporter) May 1, 2024
Other footage shows NYPD officers forcing their way through students who locked arms in front of the occupied campus building. One cop is seen kneeing a student on the ground.
Students reported that police used tear gas, which is banned in war, on demonstrators.
"Tonight, my university called in a militarized police force—armed in riot gear, with guns drawn, deploying weapons banned under international law—to attack teenagers," Lea Salim, a student member of Jewish Voice for Peace-Columbia/Barnard, said in a statement. "All because Columbia refuses to divest from the Israeli military and its genocidal campaign on the people of Gaza."
NYPD just raided the Columbia campus and broken into the Hamilton building making dozens of violent arrests against students both outside and those occupying inside. pic.twitter.com/7wMp3EctZF
— Gerard (@GerardDalbon) May 1, 2024
As police set up barricades around the perimeter of the campus, onlookers gathered and chanted, "Let the students go!" in solidarity with the arrested demonstrators.
Rep. Jamaal Bowman (D-N.Y.) said he was "outraged" by the police presence at both Columbia and the City College of New York, writing on social media that the "militarization of college campuses, extensive police presence, and arrest of hundreds of students are in direct opposition to the role of education as a cornerstone of our democracy."
"I call upon the Columbia administration to stop this dangerous escalation before it leads to further harm," Bowman added, "and allow the faculty back onto campus so that all parties can collectively come to a solution that centers humanity over hate."
“Let the students go.”
Crowds gather outside the police barricade surrounding Columbia University to demonstrate solidarity with student protesters.
Police have arrested multiple pro-Palestinian demonstrators after entering the campus. pic.twitter.com/0Ut6HHPWhB
— Middle East Eye (@MiddleEastEye) May 1, 2024
In a letter to the New York City Police Department on Tuesday, Shafik—who is facing mounting calls to resign—requested that officers maintain a presence on Columbia's campus "through at least May 17, 2024 to maintain order and ensure encampments are not reestablished."
The police crackdown on Columbia students is part of a broader wave of repression against campus protests that have emerged across the country in recent weeks as Israel's assault on and forced starvation of Gaza civilians continues with no end in sight.
Police actions, approved by the leaders of some universities and cheered on by right-wing government officials, have drawn international rebukes. In a statement Tuesday, United Nations High Commissioner for Human Rights Volker TĂĽrk said he is "concerned that some of law enforcement actions across a series of universities appear disproportionate in their impacts."
"U.S. universities have a strong, historic tradition of student activism, strident debate and freedom of expression and peaceful assembly, "TĂĽrk said. "It must be clear that legitimate exercises of the freedom of expression cannot be conflated with incitement to violence and hatred."
Observers were quick to note the parallels between the police crackdown on civil rights and anti-war protests at Columbia in 1968 and Tuesday's raid.
The Columbia Spectator, New York, Tuesday, April 30, 1968: https://t.co/4sNEDQ38Ks pic.twitter.com/2GO9MwUdx7
— philip lewis (@Phil_Lewis_) May 1, 2024
Stefanie Fox, executive director of Jewish Voice for Peace, said in response to the police invasion of Columbia Tuesday that "the U.S. has funded and supported the Israeli government's oppression of Palestinians for decades, with private institutions across the country profiting from the same."
Organizers have specifically demanded that Columbia divest its nearly $14 billion endowment from Caterpillar, Hyundai Heavy Industries, Hewlett Packard Enterprise, Elbit Systems, Mekorot, Hapoalim, Boeing, and Lockheed Martin.
"These students are saying: enough," said Fox. "As Prime Minister Netanyahu prepares to launch a ground invasion on Rafah—now home to one million displaced Palestinians—the U.S. government and institutions like Columbia are showing that they would rather brutalize students than divest from apartheid and genocide."
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"We can no longer tolerate Novo Nordisk charging the American people $969 for Ozempic when that same exact drug can be purchased for just $155 in Canada and $59 in Germany while it costs less than $5 to manufacture."
Apr 30, 2024
U.S. Sen. Bernie Sanders on Tuesday lauded the Biden administration for expanding its "campaign against pharmaceutical manufacturers' improper or inaccurate listing of patents" for a wide range of drugs including Novo Nordisk's Ozempic.
"Let me commend the Federal Trade Commission, under the leadership of Chair Lina Khan, for taking bold action today against the bogus patents Novo Nordisk has filed to prevent Americans struggling with diabetes from receiving a generic version of Ozempic at a much lower price," Sanders (I-Vt.) said in a statement.
Sanders—who leads the Senate Health, Education, Labor, and Pensions (HELP) Committee—stressed that "Novo Nordisk must not be allowed to make billions in profits by delaying generic competition for Ozempic by unlawfully filing junk patents that have nothing to do with the drug itself, but the injection pen."
"Last week, the HELP Committee, that I chair, launched an investigation into the outrageously high prices Novo Nordisk is charging for Ozempic and Wegovy in the United States," he noted. The former name is used when the patient is taking the medication for Type 2 diabetes and the latter is used when it is prescribed to treat obesity in adults with at least one weight-related comorbidity.
"In my view, we can no longer tolerate Novo Nordisk charging the American people $969 for Ozempic when that same exact drug can be purchased for just $155 in Canada and $59 in Germany while it costs less than $5 to manufacture," said the senator. "I look forward to working with the Biden administration to take on the greed of Novo Nordisk and substantially reduce the price of Ozempic and other prescription drugs."
After disputing more than 100 patents in the Food and Drug Administration's (FDA) Orange Book in November, the FTC on Tuesday sent warning letters to 10 companies and notified the agency that it challenges the accuracy or relevance of over 300 listing across 20 different brand name products.
In addition to Denmark-based Novo Nordisk, the FTC sent letters to Amphastar Pharmaceuticals, AstraZeneca, Boehringer Ingelheim, Covis Pharma, Glaxo-Smith Kline, Novartis Pharmaceuticals, Teva Pharmaceutical Industries, and some subsidiaries for asthma, chronic obstructive pulmonary disease (COPD), diabetes, and weight loss drugs.
"By filing bogus patent listings, pharma companies block competition and inflate the cost of prescription drugs, forcing Americans to pay sky-high prices for medicines they rely on," said Khan. "By challenging junk patent filings, the FTC is fighting these illegal tactics and making sure that Americans can get timely access to innovative and affordable versions of the medicines they need."
Sanders was not alone in praising the commission and its leader—an appointee of President Joe Biden—for the ongoing efforts to battle Big Pharma's greed.
Public Citizen's Access to Medicines program advocate, Steve Knievel, said that "it's becoming harder for drug corporations to use patent shenanigans to thwart competition, thanks to the FTC and Chair Lina Khan."
"Improperly listing patents in the FDA Orange Book stymies generic competition, which is proven to dramatically lower prescription drug prices, saving patients and the public billions of dollars," he said, echoing Khan. "Today's letter is yet another demonstration from the Biden-Harris administration that Big Pharma business-as-usual monopoly abuses and price gouging will not be tolerated."
"The FDA should supplement FTC's action by clarifying guidelines for patents that can be listed in the Orange Book," he continued, noting that such action has been proposed by Sen. Elizabeth Warren (D-Mass.) and Rep. Pramila Jayapal (D-Wash.). "The government should also explore using licensing authorities to overcome pharmaceutical monopoly abuses, leaving no option off the table."
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