Friday, March 16, 2018

The VA Is the Closest Thing We Have to Single Payer. Now Trump Wants to Privatize It

Aaron Hughes, who was deployed to Kuwait and Iraq in 2003 and 2004, now has a serious, very rare lung condition. But he told In These Times he gets “really outstanding care” at the nearby Jesse Brown VA Medical Center. “The doctors are at the top of their class,” he said.
Because his condition is so rare, Hughes has been sent to a hospital outside of the Department of Veterans Affairs (VA) for specific tests. And his taste of the private healthcare system has been sour. “As soon as I went there, all hell broke loose,” he said, explaining there were problems with sharing records between the two institutions.
“With the VA system, when you do tests, it’s all integrated.” Every doctor Hughes sees is aware of all the other treatment he gets, from vision to mental health. The private hospitals, on the other hand, often refuse to send the records back to the VA.
“The private sector isn’t about sharing your information,” Hughes explained. “It’s not about healthcare, it’s about ownership of care.”

Hughes thinks these problems could get worse if efforts to fully privatize the VA are successful. President Donald Trump has supported privatizing the system, and has called to make permanent the Veterans Choice Program, an experiment Congress launched in 2014 that gives vouchers to veterans to see private doctors, while cutting other parts of the agency. These developments have provoked concerns that Trump will usher in a full private sector takeover. 

“I worry that my care will become a profit motive,” Hughes said. “And that means it’s not about me anymore, it’s about making money.”

Now Hughes’ organization, About Face: Veterans Against the War, has joined other veterans’ groups, unions and healthcare advocates to launch a campaign to stop the privatization of the VA. After several months of building the coalition, the mobilization now includes Veterans for Peace, Service Employees International Union, the American Federation of Government Employees (AFGE) and National Nurses United. Healthcare advocacy groups including the Illinois Single Payer Coalition and the Democratic Socialists of America Healthcare Working Group have also joined the campaign. When the organizations came together on March 1 to hold a panel event in Chicago, more than 100 people showed up.

The combination of unions and veterans’ groups is potent. “We as veterans can argue and demand things and raise issues that the unions can’t, and the unions can inform us about issues that we don’t understand,” Hughes said. “We’re seeing outside, and they’re seeing inside of the system. We’re able to have this inside/outside strategy that I think is really a winning strategy.”

Organizers believe the time is right to invest in that teamwork now. “It came to our attention last fall that things under the Trump administration have been getting really bad,” Roberto Clack, an organizer with the Right to Heal VA Campaign, told In These Times.

“There are problems with the VA, but the VA works,” Clack said. “It provides quality care for the people that use it, and it saves lives.” A 2016 RAND Corporation analysis found that the VA provides good quality care compared with other health systems, usually in a timely manner. Private providers, on the other hand, could expose veterans to lower-quality care, longer wait times and doctors who aren’t familiar with military service.

“We agree that it could be better,” Clack said, “but the way to make healthcare better is to have a fully supported VA, funded VA, and staffed VA.”

Privatizing the VA wouldn’t just risk veteran’s healthcare, however. It could also threaten the unionized public sector employees who work for it. AFGE represents more than 700,000 federal workers, 250,000 of whom work at the VA. It would be “a serious death knell for unionization in this country,” said Anne Lindgren, president of AFGE Local 789.

Privatization is “absolutely the wrong response,” Clack said. “Privatization’s not going to make anyone’s healthcare better.”

But the idea that the VA doesn’t work has become embedded many media reports and the general public. “What we’re really up against is debunking the narrative that it’s just this broken system,” Clack said.

So while the long-term goal is to block the privatization of the agency, the short-term goal is to raise more awareness. “We recognize that [stopping privatization] is a big elephant, and you can’t eat an elephant in one bite, you need to eat it in small bites,” Lindgren said.
“For that to happen we need to educate and organize the public.”

After the launch event, the groups held a call-in day to have people contact their members of Congress and urge them to oppose a currently bill that would expand the Choice program. Next will be actually visiting members of Congress. “Frankly we’re going to take this to the streets and let not only Republicans know, but also Democrats who are vacillating on this issue, you have to have a firm ‘no’ on privatization efforts,” Clack said.

Participants also hope to create an organizing model that can be replicated in other cities and communities across the country. “We’re not going to win this fight if it’s just a Chicago fight,” Clack said. “We definitely want to see this organizing spread to other parts of the country.”

The goal is also to move their efforts beyond just saving the VA from privatization to making a proactive argument that the VA should be expanded and itself serve as a model for the whole country. “I believe our community of veterans organized has the potential to not just fight for our healthcare, but healthcare for everyone in this country,” Hughes said.

That’s why the launch event included activists who are focused on universal healthcare and a single-payer system. “The VA really resembles the closest thing there is to a single payer system in our country,” Clack said. It’s not just the largest hospital system and healthcare provider in the nation, but it’s also the only system that negotiates directly with pharmaceutical companies over drug prices, and it’s also a one-stop-shop for veterans seeking all kinds of care, from mental health to physical issues to social work.

“We really want to make a case that the public sector provides quality services,” Clack said. “The VA’s a great example of the public sector working.”

Corbyn Smeared as ‘Russian Stooge’ for Requesting Evidence on Poisoned Spy

How the Iraq War Destabilized the Entire Middle East

MARCH 15, 2018

As we approach the fifteenth anniversary of the unwarranted invasion of Iraq, which we are still paying for in so many ways, it is important to remember the misuse of intelligence that provided a false justification for war.  It is particularly important to do so at this time because President Donald Trump has talked about a military option against North Korea or Iran (or Venezuela for that matter).  Since there is no cause to justify such wars, it is quite likely that politicized intelligence would once again be used to provide a justification for audiences at home and abroad.

In 2002 and 2003, the White House, the Department of Defense, and the Central Intelligence Agency collaborated in an effort to describe the false likelihood of a nuclear weapons program that had to be stopped.  In the words of Bush administration officials, the United States was not going to allow the “smoking gun to be a mushroom cloud.”  On September 8, 2002, Vice President Cheney and national security adviser Condi Rice used that phrase on CNN and NBC’s “Meet the Press,” respectively, to argue that Saddam Hussein was “using his procurement system to acquire the equipment he needs to enrich uranium to build a nuclear weapon.”

In October 2002, the CIA orchestrated a national intelligence estimate to argue falsely that Iraq was acquiring uranium from Niger for use in a nuclear weapon.  Senior officials throughout the intelligence community knew that the so-called Niger report was a fabrication produced by members of the Italian military intelligence service, and several intelligence officials informed Congressional and White House officials that they doubted the reports of Iraqi purchases of uranium from Niger.  Nevertheless, the national intelligence estimate spun a fictitious tale of a clear and present danger based on false reports of alleged stockpiles of chemical and biological weapons; nuclear weapons; unmanned aerial vehicles; and ties between Iraq and al Qaeda that were nonexistent.

In December 2002, President George W. Bush found the CIA’s case for war inadequate and asked for “something that Joe Public would understand or gain a lot of confidence from.”  Bush turned to CIA director George Tenet and remarked, “I’ve been given all this intelligence about Iraq having WMD and this is the best we’ve got?”  Instead of being truthful, Tenet replied, “Don’t worry, it’s a slam dunk!”  Several days later, Alan Foley, the chief of the Weapons Intelligence, Proliferation and Arms Control Staff, told his analysts to prepare a briefing for the president.  “If the president wants intelligence to support a decision to go to war,” Foley said, “then it is up to the agency to provide it.”  In early January, CIA Deputy Director John McLaughlin gave the phony “slam dunk” briefing at the White House.

The Pentagon’s Office of Special Plans distributed the unsubstantiated and flawed intelligence that not even the CIA would vouch for.  The Undersecretary of Defense for Policy Douglas Feith supplied bogus intelligence to the White House on Iraqi WMD and links to terrorist organizations to make the case for war, and then “leaked” this intelligence to key journalists such as Judith Miller at The New York Times. Miller had a front page article in the Times on September 8, 2002, citing administration officials claiming that Saddam was seeking “specially designed” aluminum tubes to enrich uranium, the so-called “smoking gun.”  Several days later, President Bush inserted the Times’  claim in his speech to the United Nations General Assembly.

The aluminum tube issue was central to Secretary of State Colin Powell’s speech to the UN in February 2003, which was based on the phony CIA estimate from October 2002.  As Powell’s chief of staff, Lawrence Wilkerson wrote in The New York Times in February 2018, the secretary’s “gravitas was a significant part of the Bush administration’s two-year-long effort to get Americans on the war wagon.  It was CIA Deputy Director McLaughlin who lied to Secretary of State Powell about the reliability of the intelligence in Powell’s speech. McLaughlin was the central advocate for the phony intelligence on mobile biological laboratories that ended up in that speech.
President Bush would have gone to war with or without intelligence, and once again we are confronted by a president who might consider going to war with or without intelligence. Fifteen years ago, we had a CIA director from Capitol Hill who was loyal to the president and unwilling to tell truth to power.  Once again, we have a CIA director, Gina Haspel, who is a White House loyalist and cannot be counted on to tell truth to power.  She was one of the Agency’s leading cheerleaders for torture and abuse, and sent the message that order the destruction of the torture tapes.  And former CIA director Mike Pompeo, a neoconservative hardliner, is now secretary of state, who earned his new position by being a total loyalist who would never tell truth to power.  Is there a voice for moderation left in the White House?

Bush’s war destabilized the entire Middle East.  Any Trump war could lead to the use of nuclear weapons that would destabilize the entire world.

US Senate Democrats who are puppets of the big banks

Yesterday, over a dozen Senate Democrats voted in favor of an atrocious bill to deregulate the vast majority of our nation’s big banks, leaving consumers and taxpayers vulnerable to another economic disaster.

If this bill becomes law, many of the big banks who orchestrated the 2008 financial crisis will no longer be subject to strict oversight. Even worse, it would repeal most of the reporting requirements that aim to prevent racist lending practices, such as charging people of color higher fees when buying a home.

These Senate Democrats claim they voted for it because they’re facing competitive reelection campaigns. We call bullshit.

The vast majority of voters, regardless of party, don’t want the Big Banks to destroy the economy again. They don’t want to lose their retirement, their homes, or their jobs again. And they don’t trust these banks to behave without stringent regulation.

The only reason to vote for this bill is to please Wall Street donors, and we’re disgusted that Senators from our own party would choose profit over people.

The Sick Paying for the Healthy: How Insurance Companies Drive Up Drug Prices

Thursday, March 15, 2018

By Mike Ludwig, Truthout | Report

Faced with angry consumers and impending political reforms, the massive corporations that shape the way we pay for medicine are clamoring to preserve their public image, profit margins and political clout -- often by pointing the finger of blame at each other. The poster child for the debate is insulin, a hormone replacement drug that many people with diabetes need to stay alive. As Truthout has reported, the market price of popular insulin products has skyrocketed in recent years. Some people with diabetes go broke paying for their medicine. Others have died while attempting to ration dosages.

Despite public outrage over insulin prices, three of the largest insulin manufacturers have refused to seek a settlement in a class action lawsuit filed against them on behalf of diabetes patients. The drug makers Eli Lilly, Novo Nordisk and Sanofi-Aventis asked a federal judge in New Jersey to dismiss the case and suggested that the plaintiffs turn their attention to insurance companies instead, according to briefs filed last Friday.

Court records show that plaintiff attorneys and advocates for people with diabetes have sparred over how to proceed with the case and whether to include insurance companies and their pharmacy benefit managers (who negotiate drug prices) as defendants in the lawsuit. Currently, only manufacturers are named as defendants.

Food and Drug Administration (FDA) Commissioner Scott Gottlieb has also put insurers on notice. In a speech before an insurance industry conference last Wednesday, Gottlieb said that current pharmaceutical pricing agreements between insurers and drug manufacturers have saddled people living with serious or long-term illnesses (such as diabetes) with the cost of keeping premiums lower for everyone else.

"But sick people aren't supposed to be subsidizing the healthy," Gottlieb said. "That's exactly the opposite of what most people thought they were buying when they bought into the notion of having insurance."

Gottlieb was referring to the system of "rebates" that currently controls the price of pharmaceuticals. Under this system, drug makers pay billions of dollars to insurance companies in order to sell drugs to people enrolled in health plans. It's a system that benefits people who can afford expensive insurance coverage, but for many working people, this system is a total failure. To understand why, we must consider how the different industry players use the money that flows in from drug manufacturers.

Patient advocates say this system creates perverse incentives that push the price of drugs like insulin through the roof.

In his speech, Gottlieb applauded insurance giant UnitedHealth for announcing plans to pass savings secured by lavish rebates it receives from drug manufacturers directly to members when they buy drugs at the pharmacy, rather than using the money to pad its central coffers and lower premiums across the board.

These rebating agreements are at the center of the drug pricing system that a growing chorus of advocates and policy makers say must change.

High drug prices are usually blamed entirely on pharmaceutical companies because they make the drugs and set the prices. However, these manufacturers do not set prices in a vacuum: They say they shape prices around the costs of rebate payments they're required to make to insurance companies in exchange for selling prescription drugs to their members.

Yes, this means that insurance companies are making secret deals with drug manufactures, and that's why people with health coverage don't pay full price for drugs at the pharmacy. These "kickbacks," as advocates call them, raise an important question: Are insurance companies giving customers what they pay for?

The Sick Subsidizing the Healthy

Here's how the system works: Pharmacy benefit managers (PBMs) work with insurers to decide which drugs will be covered by their health plans. This provides PBMs with considerable leverage over drug makers. In 2017, the three largest PBMs -- Express Scripts, OptimaRx and CVS/Caremark -- controlled access to about 72 percent of the drug market, according to the Drug Channels Institute. This explains why individual insurance plans cover certain types or brands of medicines and not others.

Using this leverage, PBMs make secret agreements with manufacturers like Novo Nordisk and Eli Lilly to place their drugs on health plans in exchange for large discounts and rebate payments. The PBM keeps a percentage of the rebate, and the insurance company takes the rest.

This gives drug companies access to millions of customers in exchange for billions of dollars in discounts and rebates that can significantly lower costs for people with health coverage, depending on how insurance companies share the savings. The Drug Channels Institute estimates that drug companies spent $127 billion on rebates, discounts and price concessions in 2016 alone.

PhRMA, the industry group representing major drug makers, estimates that one third of the original price of all brand name drugs is rebated back to insurers and other members of the supply chain. Some drugs are more heavily rebated than others. Insulin, for example, secures rebates for insurers at rates of up to 75 percent of the original market price of the drug, or "list price," according to diabetes advocates.

Insurers and PBMs tend to include higher-priced drugs that bring bigger rebates on the list of drugs they cover, rather than including cheaper generics and biosimilars.
Patient advocates say this system creates perverse incentives that push the price of drugs like insulin through the roof. Insurers can use hefty rebates from commonly used drugs to lower premiums and attract new customers, and the demand for steeper rebates pushes manufacturers to set their list prices higher and higher. As result, many pharmacy benefit plans operate like "reverse insurance," according to Drug Channel Institute CEO Adam Fein.

"The sickest people taking medicines for chronic illnesses generate the majority of manufacturer rebate payments," Fein wrote last week at Drug Channels, his oft-cited blog. "Today, these funds are used to subsidize the premiums for healthier plan members."

People who can afford robust insurance plans may not notice the price increases, but those buying medicine with cheaper plans do. Insurance companies often calculate coinsurance and deductibles with the original list price of a drug, not the after-rebate "net price" they actually pay. That means cheaper health plans with high out-of-pocket costs require patients to pay all or part of the inflated list price until deductibles are paid off. In the case of insulin, that list price could be hundreds of dollars higher than what the insurer pays after rebates.

High out-of-pocket costs are a leading reason why patients don't take their medication, which can lead to medical problems that increase the cost of health care for everyone, according to Steven Knievel, an access to medicines advocate at Public Citizen.

"The practice of raising the list price [to increase the size of rebates] benefits the drug companies and the PBMs. Both come out winners," Knievel said. "But the consumer is the loser."

Meanwhile, insurers and PBMs tend to include higher-priced drugs that bring bigger rebates on the list of drugs they cover, rather than including cheaper generics and biosimilars. (The FDA is currently promoting generics as competitive solutions to high drug prices, but that solution seems unlikely to take hold without serious changes to the pricing system.) Major PBMs are increasingly merging with insurance companies, a sign that their interests have long been aligned.

"Patients shouldn't be penalized by their biology if they need a drug that isn't on formulary," Gottlieb said, referring to a health plan's list of covered drugs. "Patients shouldn't face exorbitant out-of-pocket costs and pay money where the primary purpose is to help subsidize rebates paid to a long list of supply chain intermediaries, or is used to buy down the premium costs for everyone else."

It's a system of profit built on the backs of sick people. Faced with lawsuits from insulin users, proposed rebating reforms for Medicare and angry members of Congress, the major players in the drug supply chain have consistently blamed each other for it.

"The manufacturers point the finger at the PBMs and say, 'The rebates that you are demanding are so large that we have to raise our prices to maintain a reasonable rate of returns,'" said Patricia Danzon, a professor of health care management at the University of Pennsylvania, in an interview. "The PBMs say the drug companies are the ones that set the prices, and we are only trying to get the best prices for our customers."

The Court of Public Opinion

The result is an opaque blend of public relations messaging and raw economics. For example, manufacturers claim to be unfairly singled out by a growing number of state-level drug-pricing transparency laws, and they are eagerly promoting research suggesting that insurers are not passing savings from drug rebates on to their customers.

If lawmakers agree, they may pass transparency legislation requiring insurers to report the rebates they receive, or at least disclose the actual net cost of prescriptions to their customers. Once this information is disclosed, it's only a matter of time before consumers demand insurers pass the rebate savings on to them directly.

"The manufacturers could in theory benefit from the pass-through of the rebates to patients through co-payments," Danzon said. "This could make rebates visible. In theory, if manufacturers in any industry know how much their competitors are rebating, this visibility makes it easier for them to keep their prices in line without illegally colluding with each other."

PBMs and insurers, however, argue that rebates must remain secret in order to maintain the negotiating advantage and competitive bidding that brings prices down. Plus, if two manufacturers of a specialty drug know each other's price, they can tacitly collude to raise it. Danzon said this is why the Congressional Budget Office (CBO) has assumed in their analysis of legislative proposals that making rebates fully transparent could increase costs for programs like Medicare.

"The argument for transparency is very intuitive, people understand that, but the fact the CBO has consistently come out against full transparency -- that has economic argument behind it," Danzon said.

Meanwhile, Ben Wakana, executive director of Patients for Affordable Drugs, told Truthout that consumers would benefit from more transparency in the rebating system -- if not a different system altogether -- but rebates are not the only factors pushing up drug prices. In the United States, drug manufacturers enjoy patent exclusivity on new drugs for years, allowing them to charge monopoly prices. They also spend huge amounts of money on advertising and influencing politicians.

"Drug companies can claim they have to raise drug prices to pay PBM rebates, but ... they could take those terrible ads off the air and stop paying their CEOs a hundred million dollars," Wakana said. "It's a murky system and patients need to know where their money is going, but drug corporations have to lower their prices."

Wakana supports allowing the government to negotiate drug prices with the buying power generated by millions of Medicare members, a proposal supported by progressives in Congress. Perhaps if drug prices came down, then insurers would not be so reliant on rebates to control costs. Still, the question of whether consumers are getting what they pay for from insurance providers remains, and that's exactly how drug makers like it.

There are profiteers standing on all sides of the drug pricing equation. Consumers are stuck in the middle, shelling out monthly premiums along with rising out-of-pocket costs at the pharmacy. However, the more light we shine on this system, the more we see it beginning to crumble under its own weight -- and the weight of public opinion.

As Haspel Nomination Reopens Dark CIA Chapter, Liz Cheney Leads Pack of Torture Apologists

As lawmakers and former intelligence officials defend Trump's CIA pick, civil libertarians argue she "should be in jail."

President Donald Trump's decision this week to nominate Gina Haspel—an intelligence official civil libertarians argue "should be in jail" for her role in the Bush administration's torture regime—as the next CIA chief has illuminated something of a spectrum of torture apologists among America's political elite.

Placing herself firmly on the far-right end of this spectrum on Tuesday was Rep. Liz Cheney (R-Wy.), daughter of former Vice President Dick Cheney, who tweeted a proud defense of the CIA's euphemistically-named torture program at Sen. John McCain (R-Ariz.), who argued the Senate should closely scrutinize Haspel's role in overseeing the torture of detainees at U.S. black sites overseas.

In openly praising the Bush torture regime and the "brave men and women" who carried it out, Cheney differentiated her position from that of many Washington establishment figures who have defended Haspel's role in overseeing the Bush torture program this week, on the grounds that she was merely "following orders."

For instance, former CIA director Michael Hayden wrote in an op-ed for The Hill on Wednesday that Haspel's "role in CIA's counterterrorism program" should not be cause for concern, as she was merely doing "nothing more and nothing less than what the nation and the agency asked her to do."

Highlighting several similar examples in an articlefor The Intercept on Thursday, Jon Schwartz argues the defense of Haspel offered by Hayden, former Obama officials, and some lawmakers is precisely the defense Nazis used during the Nuremberg trials following the Second World War.

While Nuremberg judges rejected the "Nuremberg defense" as illegitimate, "many members of the Washington, D.C. elite are now stating that it, in fact, is a legitimate defense for American officials who violate international law to claim they were just following orders," Schwartz writes.

In a tweet on Thursday, Trevor Timm, executive director of the Freedom of the Press Foundation, summarized the principal narratives of torture apologists—all of which serve to undermine all attempts to hold those who oversee violations of international law accountable for their actions.

The rush among the intelligence establishment to defend Haspel's past comes as civil liberties groups are ramping up efforts to stop her confirmation. As The Daily Beast's Spencer Ackerman notes, these groups "spent Barack Obama's presidency loudly warning that without prosecutions for torture, it will be a matter of time before torture returns."

Now that the U.S. has a president who campaigned on bringing back torture, the effort to block Haspel is "a fight [rights groups] feel compelled to wage," Ackerman writes.

"Gina Haspel dishonored our country and disgraced herself by participating in the CIA torture program and the destruction of criminal evidence," Wells Dixon of the Center on Constitutional Rights, told The Daily Beast. "We do not believe she should be director of the CIA. Rather, she should be in jail."

Hitchcock at his most Marxist