How “Single-Payer” Socialized Medicine Works for American Indians

(p. A1) EAGLE BUTTE, S.D.—Kate Miner walked into the Indian Health Service hospital, seeking help for a cough that wouldn’t quit.

An X-ray taken of Ms. Miner’s lungs that day, Oct. 19, 2016, found signs of cancer.

What exactly the IHS doctor said to Ms. Miner about her exam remains in dispute. Notations in her medical file indicate the doctor told her to come back for a lung scan the next day. Her family says they never were given such instructions and weren’t told of the two masses the X-ray revealed.

What is clear is that no further tests were done. And no IHS provider followed up when Ms. Miner returned twice more to the hospital, the only one on the Cheyenne River Reservation, over the next six months, medical records show.

Finally, on May 7, 2017, as the 67-year-old Ms. Miner lay crumpled on a hospital cot, the right side of her body shaking, a physician assistant ordered a CT scan, after her family insisted, according to the records and family members.

“You have two very large masses in your right lung. It’s probably a malignancy,” Ms. Miner’s daughter Kali Tree Top recalled the physician assistant saying.

Ms. Miner reached for her daughter’s hand and started to cry.

Ms. Miner’s encounters with the IHS, and her family’s repeated efforts to get her help there, illustrate how the federal agency can fail the patients who need it most.

For the full story, see:

Dan Frosch. “A Tragic Journey Through the Indian Health Service.” The Wall Street Journal (Tuesday, December 24, 2019): A1 & A8.

(Note: the online version of the story was updated December 23, 2019, and has the title “Kate Miner’s Tragic Journey Through the U.S. Indian Health Service.”)

Opposed by China and WHO, Trump Administration Declared Covid-19 Public Health Emergency on January 31, 2020

(p. A1) The U.S. imposed entry restrictions on foreign nationals and quarantines on Americans returning from the Chinese province at the center of the coronavirus outbreak, as markets tumbled over fears about the impact on global growth.

Health and Human Services Secretary Alex Azar declared a public health emergency Friday [Jan. 31, 2020]. He said foreign citizens who have traveled anywhere in China within the past 14 days would be denied U.S. entry, while Americans who visited Hubei province would be quarantined for up to two weeks.

. . .

(p. A8) “Many countries have offered China support in various means. In sharp contrast, certain U.S. officials’ words and actions are neither factual nor appropriate,” Chinese Foreign Ministry spokeswoman Hua Chunying said. “Just as the WHO recommended against travel restrictions, the U.S. rushed to go in the opposite way.”

For the full story, see:

Alex Leary and Brianna Abbott. “U.S. Curbs Entry to Combat Virus.” The Wall Street Journal (Saturday, February 1, 2020): A1 & A8.

(Note: ellipsis, and bracketed date, added.)

(Note: the online version of the story has the date January 31, 2020, and has the title “U.S. Imposes Entry Restrictions Over Coronavirus.”)

Wasteful Administrative Health Care Costs

The study quoted from below suggests that the main cure for wasteful administrative costs is a “single payer” system, which is a politically correct euphemism for socialized medicine. I suggest that a better cure would be to eliminate the government middle-man, and make the patient be the payer. The patient as payer would seek and buy low-cost cures or therapies, which would shift efforts at healthcare innovation toward lower cost innovations. As has been suggested for education, vouchers could provide poor patients with the means to pay for basic care.

(p. B4) Even a divided America can agree on this goal: a health system that is cheaper but doesn’t sacrifice quality. In other words, just get rid of the waste.
A new study, published Monday [October 7, 2020] in JAMA, finds that roughly 20 percent to 25 percent of American health care spending is wasteful. It’s a startling number but not a new finding. What is surprising is how little we know about how to prevent it.

. . .

Teresa Rogstad of Humana and Natasha Parekh, a physician with the University of Pittsburgh, were co-authors of the study, which combed through 54 studies and reports published since 2012 that estimated the waste or savings from changes in practice and policy.

. . .

The estimated waste is at least $760 billion per year. That’s comparable to government spending on Medicare and exceeds national military spending, as well as total primary and secondary education spending.

. . .

The largest source of waste, according to the study, is administrative costs, totaling $266 billion a year. This includes time and resources devoted to billing and reporting to insurers and public programs. Despite this high cost, the authors found no studies that evaluate approaches to reducing it.

For the full commentary, see:

Austin Frakt. “THE NEW HEALTH CARE; Up to 25% of Health Costs Called Wasteful.” The New York Times (Tuesday, October 8, 2019): B4.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the commentary has the date Oct. 7, 2019, and has the title “THE NEW HEALTH CARE; The Huge Waste in the U.S. Health System.”)

The print version of the academic article in JAMA mentioned above is:

Shrank, William H., Teresa L. Rogstad, and Natasha Parekh. “Waste in the Us Health Care System: Estimated Costs and Potential for Savings.” JAMA 322, no. 15 (Oct. 15, 2019): 1501-09.

WHO “Expert” Committee Took Four Months to Endorse Widespread Mask-Wearing

(p. A1) GENEVA—Sylvie Briand landed in China looking for answers. Nearly a month had passed since word of a mysterious pneumonia had emerged. It was now late January and the World Health Organization was struggling to learn more about it.

Frustrated with mounting cases and limited information from China, the WHO’s top brass, including Dr. Briand, flew to Beijing to resolve a burning question: How easily did this new disease spread?

They met with President Xi Jinping. They had a phone call with local WHO staff just back from the Wuhan epicenter, quarantined after one developed a cough. Dr. Briand, the agency’s director of global infectious hazard preparedness, drew up a list of questions for Chinese health officials.

By the time the WHO received answers, the Covid-19 pandemic was stumbling into emergency rooms on three continents. Its spread around the world had already begun on Jan. 30 [2020] when the WHO declared a global public-health emergency, its one and only level of alert.

. . .

(p. A10) “Now is the moment for all countries to be preparing themselves,” Director-General Tedros Adhanom Ghebreyesus declared on Feb. 4, when the WHO reported more than 20,600 cases in 25 countries.

But that same day, the WHO also asked nations not to close borders—following its standard protocol, as such restrictions might discourage governments from reporting outbreaks. Within weeks, the virus landed on the agency’s doorstep, turning Geneva into a hot spot.

. . .

To write its recommendations, the WHO solicits outside experts, which can be a slow process. It took those experts more than four months to agree that widespread mask-wearing helps, and that people who are talking, shouting or singing can expel the virus through tiny particles that linger in the air. In that time, about half a million people died.

. . .

A review of the WHO’s initial response to the pandemic, based on interviews with current and former WHO staff, public-health experts advising it and officials who work with it, suggests that the agency’s bureaucratic structure, diplomatic protocol and funding were no match for a pandemic as widespread and fast-moving as Covid-19.

. . .

On Jan. 3 [2020], representatives of China’s National Health Commission arrived at the WHO office in Beijing. The NHC acknowledged a cluster of pneumonia cases, but didn’t confirm that the new pathogen was a coronavirus, a fact Chinese officials already knew. That same day, the NHC issued an internal notice ordering laboratories to hand over or destroy testing samples and forbade anyone from publishing unauthorized research on the virus.

China’s failure to notify the WHO of the cluster of illnesses is a violation of the International Health Regulations, said Lawrence Gostin, professor of global health law at Georgetown University who has advised the WHO on international health regulation matters. “Once a government knows that there is a novel virus that fits within the criteria, which China did, it’s obliged to report rapidly,” he said.

China also flouted the IHR by not disclosing all key information it had to the WHO, said David Fidler, an expert on global health and international law at the Council on Foreign Relations. The regulations call for member states to provide the WHO with “timely, accurate and sufficiently detailed public health information available to it on the notified event.”

For the full story, see:

Betsy McKay and Drew Hinshaw. “Doctors Split on Best Way To Treat Coronavirus Cases.” The Wall Street Journal (Saturday, August 29, 2020): A1 & A10.

(Note: ellipses, and bracketed years, added.)

(Note: the online version of the story has the date August 28, 2020, and has the title “How Coronavirus Overpowered the World Health Organization.”)

Young Doctor “Taken Aback” by Deaths Under Nationalized Medicine

(p. 26) Westaby’s book will be a balm to the hearts of curmudgeons everywhere. Sidestepping the contemporary hand-wringing about the lack of empathy in medicine, Westaby, a British surgeon, positions empathy as a threat to the surgical career: “Heart surgery,” he writes, “needs to be an impersonal, technical exercise.”

. . .

The deaths that truly madden him are those that could have been prevented by available technologies not then funded by the British National Health Service (N.H.S.), his employer.

. . .

As a young doctor who imagines nationalized medicine as a way toward comprehensive care for all my patients, I was taken aback.

For the full review, see:

Rachel Pearson. “SHORTLIST; Medical Memoirs.” The New York Times Book Review (Sunday, July 2, 2017): 26.

(Note: the online version of the review has the date June 27, 2017, and has the title “SHORTLIST; Four Timely Memoirs from the Halls of Medicine.”)

The book under review is:

Westaby, Stephen. Open Heart: A Cardiac Surgeon’s Stories of Life and Death on the Operating Table. New York: Basic Books, 2017.

Trump Administration Pushed FDA to Allow Citizens to Choose Vaccines Sooner

(p. A7) On Sept. 23 [2020], Dr. Stephen M. Hahn left a virtual meeting of the White House’s coronavirus task force to take a call from the president’s chief of staff, Mark Meadows.

Mr. Meadows was angry with Dr. Hahn, the head of the Food and Drug Administration, for pushing new guidelines for vaccine developers, according to two senior administration officials familiar with the call who requested anonymity because they were not authorized to discuss it. The F.D.A. wanted to require two months of follow-up data to make sure a vaccine was safe and effective, all but ensuring one would not be ready by Election Day as President Trump had promised.

Mr. Meadows told the commissioner the White House would not sign off on the guidance because it was unnecessary and would delay vaccine approval, so he should drop it, the officials said.

. . .

Mr. Meadows, Jared Kushner, the president’s son-in-law and senior adviser, and the president himself have called Dr. Hahn directly to urge him to speed up emergency authorization of vaccines and treatments, according to the two senior administration officials.

But despite the White House refusal to approve the new vaccine guidance document, the F.D.A. published the guidelines in briefing materials to an advisory committee that will discuss them on Thursday [October 22, 2020], effectively making them official.

For the full story, see:

Sheila Kaplan, Sharon LaFraniere, Noah Weiland and Maggie Haberman. “How the F.D.A. Stood Firm Against White House Pressure.” The New York Times (Wednesday, October 21, 2020): A7.

(Note: ellipsis, and bracketed dates, added.)

(Note: the online version of the story has the date Oct. 20, 2020, and has the title “How the F.D.A. Stood Up to the President.”)

Costs and Difficulties of Clinical Trials Delay “Most Promising Experimental Drugs”

(p. A6) As the coronavirus pandemic continues to wreak havoc in the United States and treatments are needed more than ever, clinical trials for some of the most promising experimental drugs are taking longer than expected.

Researchers at a dozen clinical trial sites said that testing delays, staffing shortages, space constraints and reluctant patients were complicating their efforts to test monoclonal antibodies, man-made drugs that mimic the molecular soldiers made by the human immune system.

As a result, once-ambitious deadlines are slipping. The drug maker Regeneron, which previously said it could have emergency doses of its antibody cocktail ready by the end of summer, has shifted to talking about how “initial data” could be available by the end of September [2020].

And Eli Lilly’s chief scientific officer said in June that its antibody treatment might be ready in September, but in an interview this week, he said he now hopes for something before the end of the year.

“Of course, I wish we could go faster — there’s no question about that,” said the Eli Lilly executive, Dr. Daniel Skovronsky. “I guess in my hopes and dreams, we enroll the patients in a week or two, but it’s taking longer than that.”

For the full story, see:

Katie Thomas. “Clinical Trials of Drugs For Virus Are Delayed By a Swamped System.” The New York Times (Saturday, August 15, 2020): A6.

(Note: bracketed year added.)

(Note: the online version of the story has the date Aug. 14, 2020, and has the title “Clinical Trials of Coronavirus Drugs Are Taking Longer Than Expected.”)

W.H.O. Helped Authoritarian Communist Chinese Leaders Conceal Origin of Covid-19

(p. A1) GENEVA — On a cold weekend in mid-February [2020], when the world still harbored false hope that the new coronavirus could be contained, a World Health Organization team arrived in Beijing to study the outbreak and investigate a critical question: How did the virus jump from animals to humans?

At that point, there were only three confirmed deaths from Covid-19 outside China and scientists hoped that finding an animal source for the coronavirus would unlock clues about how to stop it, treat it and prevent similar outbreaks.

“If we don’t know the source then we’re equally vulnerable in the future to a similar outbreak,” Michael Ryan, the World Health Organization’s emergency director, had said that week in Geneva. “Understanding that source is a very important next step.”

What the team members did not know was that they would not be allowed to investigate the source at all. Despite Dr. Ryan’s pronouncements, and over the advice of its emergency committee, the organization’s leadership had quietly negotiated terms that sidelined its own experts. They would not question China’s initial response or even visit the live-animal market in the city of Wuhan where the outbreak seemed to have originated.

Nine months and more than 1.1 million deaths later, there is still no transparent, independent investigation into the source of the virus. Notoriously allergic to outside scrutiny, China has impeded the effort, while leaders of the (p. A8) World Health Organization, if privately frustrated, have largely ceded control, even as the Trump administration has fumed.

. . .

. . . , the health organization pushed misleading and contradictory information about the risk of spread from symptomless carriers. Its experts were slow to accept that the virus could be airborne. Top health officials encouraged travel as usual, advice that was based on politics and economics, not science.

The W.H.O.’s staunchest defenders note that, by the nature of its constitution, it is beholden to the countries that finance it. And it is hardly the only international body bending to China’s might. But even many of its supporters have been frustrated by the organization’s secrecy, its public praise for China and its quiet concessions. Those decisions have indirectly helped Beijing to whitewash its early failures in handling the outbreak.

. . .

China’s authoritarian leaders want to constrain the organization; President Trump, who formally withdrew the United States from the body in July, now seems intent on destroying it; and European leaders are scrambling to reform and empower it.

The search for the virus’s origins is a study in the compromises the W.H.O. has made.

. . .

The W.H.O. has repeatedly said that investigations are underway but has done little to clarify the uncertainty. Chinese health and diplomatic officials did not respond to repeated interview requests and have been publicly silent on what happened.

“This is part of the Chinese psyche — to demonstrate to the world that they do the very best science,” said Peter Daszak, a disease ecologist and president of EcoHealth Alliance in New York. “But in this case, it didn’t work. And I think that is the reason why we don’t know much more.”

. . .

. . . Dr. Tedros, . . . decided against declaring an international emergency after convening a committee to advise him.

What was not publicly known, though, was that the committee’s Jan. 23 decision followed intense lobbying, notably by China, according to diplomats and health officials. Committee members are international experts largely insulated from influence. But in Geneva, China’s ambassador made it clear that his country would view an emergency declaration as a vote of no confidence.

China also presented data to the committee, portraying a situation under relative control.

Half the committee said it was too early to declare an emergency. The outcome surprised many countries, as did Dr. Tedros when he publicly praised both Mr. Xi and China’s pneumonia surveillance system.

“It was that system that caught this event,” he said during a news conference.

That was wrong. China’s surveillance system had failed to spot the outbreak, a failure that experts now say allowed its spread to accelerate.

. . .

(p. A9) On the origins of the virus, the experts mostly shifted the onus to China, asking the government to prioritize a “rigorous investigation.” But they also assured people that numerous investigations were underway.

“It was an absolute whitewash,” said Lawrence O. Gostin, a professor of global health law at Georgetown University. “But the answer was, that was the best they could negotiate with Xi Jinping.”

. . .

In January, Dr. Tedros had announced that China had agreed to share biological samples. Nothing ever came of it.

Then the thesis about the origin of the outbreak suddenly pivoted.

Dr. Gao, the director of China’s C.D.C., told the journal Science in March that the virus may not have originated at the market. Maybe, he said, it “could be a place where the virus was amplified,” meaning it began elsewhere but spread wildly there.

Then Dr. Gao told a local TV station that animal samples from the market did not contain the virus. That indicated at least that samples had been taken from animals. Yet the details remained concealed.

For the full story, see:

Selam Gebrekidan, Matt Apuzzo, Amy Qin, and Javier C. Hernández. “W.H.O. Ceded Control to China In Murky Hunt for Virus Origin.” The New York Times (Tuesday, November 3, 2020): A1 & A8-A9.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story has the date Nov. 2, 2020, and has the title “In Hunt for Virus Source, W.H.O. Let China Take Charge.”)

Expense of Clinical Trials Reduce the Incentive to Re-Purpose Old, Cheap, Off-Patent Vaccines

(p. A5) “Retrospective studies are great and they provide some hints, but there are caveats,” said Dr. Shyam Kottilil, a professor of medicine with the Institute of Human Virology at the University of Maryland School of Medicine. “It’s very difficult to establish causality.”

Interest in the cross-protective effects of vaccines has led to efforts to repurpose old vaccines that may have potential to provide at least transient protection against the coronavirus until a specific vaccine against SARS-CoV-2 is developed and proven safe and effective, he said.

“But nobody knows whether this approach will work unless we test them,” Dr. Kottilil said. “To endorse this, you need to do really good randomized clinical trials.” There is little incentive for private companies to invest in expensive trials because the old vaccines are cheap and off-patent, he added.

For the full story, see:

Roni Caryn Rabin. “Are Past Vaccinations a Shield? It’s Doubtful.” The New York Times (Thursday, July 30, 2020): A5.

(Note: the online version of the story has the date July 29, 2020, and has the title “Old Vaccines May Stop the Coronavirus, Study Hints. Scientists Are Skeptical.”)

“The F.D.A. and the Drug Houses Were in Bed Together”

(p. A22) Dr. John S. Najarian, a groundbreaking transplant surgeon who made headlines for taking on difficult cases, and who weathered a different type of headline when he was accused, and then exonerated, of improprieties related to a drug he had developed, died on Aug. 31 in Stillwater, Minn., east of Minneapolis.

. . .

In November 1982, Dr. Najarian performed what may have been his highest-profile surgery. The patient was Jamie Fiske, who became the youngest successful liver transplant recipient when Dr. Najarian performed the operation a few weeks before her first birthday. Her parents had made a widely publicized appeal for a donor.

“They were told that she wouldn’t survive that kind of an operation,” Dr. Najarian said in an oral history recorded in 2011 for the University of Minnesota’s Academic Health Center. “I’m not the kind of guy that takes that lightly. So I told them, ‘If a liver becomes available, we’ll transplant it, and it will work’ — a pretty brash statement, but it did.”

Dr. Najarian’s success with transplants was aided by a drug he developed in 1970, a type of antilymphocyte globulin known as Minnesota ALG, which addressed the biggest problem with early transplants: the rejection of the new organ. He said the drug, which he began using around 1970, gave the Minnesota transplant teams notably better results than other surgical centers were getting with a product offered by a pharmaceutical company.

“Everybody thought we were lying,” Dr. Najarian said, “because we could take patients and we could transplant them, and 65 to 70 percent of them did extremely well, whereas they were lucky to have 50 percent with the commercially available product from Upjohn.”

Other transplant centers began asking for the product, and it turned into a multimillion-dollar business for the university. But in 1992, the Food and Drug Administration, which had approved ALG as an investigational drug but not for interstate sale, stopped the program, and the federal authorities began an investigation. The university turned on Dr. Najarian, pressuring him to resign, and in 1995 he was charged with violating drug safety laws and other crimes.

Dr. Najarian maintained that the case was an attempt by the pharmaceutical industry and its friends in the F.D.A. to squash a successful treatment that was costing drug companies money by besting their products.

“The F.D.A. and the drug houses were in bed together,” he said bluntly in the oral history.

His trial in federal court in St. Paul, Minn., in 1996 provided vindication. Judge Richard Kyle threw out six of the charges, and a jury acquitted him of the other 15. The judge then took the extraordinary step of blasting the F.D.A. and the prosecutors.

“I have some questions as to why we were here at all,” Judge Kyle said.

The F.D.A., he added, “was certainly aware of what was going on, and yet they came in here as a witness to testify that somehow they were hoodwinked by this defendant and his colleagues and other people at the university.”

“We had a program here in Minnesota,” the judge added, “which, for all its problems and shortcomings, was a good program, literally saved thousands of lives.”

For the full obituary, see:

Neil Genzlinger. “John Najarian, 92, Revered Transplant Surgeon Who Took Tough Cases, Dies.” The New York Times (Monday, September 29, 2020): A22.

(Note: ellipsis added.)

(Note: the online version of the obituary was updated Sept. 19, 2020, and has the title “John Najarian, Pioneering Transplant Surgeon, Dies at 92.”)

California Energy Shortage Partly Due to Government Mandated Price Ceiling on Energy Imported from Out-of-State

(p. B9) As California keeps facing electricity shortages, the discussion around its grid often veers to extremes.

. . .

Should California . . . have shut down less natural gas and nuclear power? That is definitely part of the issue, and future shutdowns might need to slow.

. . .

. . . at least some of the shortage is addressable through market rules.

For example, California has a hard import bid cap of $1,000 per megawatt hour. Christopher DaCosta, regional director of western power markets at Wood Mackenzie, says that surrounding areas have a softer cap and are able to pay more. During this summer, that meant power plants often rerouted electricity to higher bidders than California.

For the full commentary, see:

Jinjoo Lee. “To Keep Lights On, California Needs Power Play.” The Wall Street Journal (Thursday, September 17, 2020): B9.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sep. 16, 2020, and has the title “How to Keep the Lights On in California.”)