Enjoy the $how, readers:
"MIT professor apologizes for remark on voters; House panel rips MIT’s Jonathan Gruber" by Noah Bierman, Globe Staff December 09, 2014
WASHINGTON — Jonathan Gruber, the MIT economist who once said passing President Obama’s health law depended on “the stupidity of the American voter,” endured a humiliating four-hour congressional hearing on Tuesday and apologized for remarks that he acknowledged were demeaning.
“I am embarrassed and I am sorry,” Gruber, who helped craft the Massachusetts law and was a consultant on the federal law, said at a House Oversight and Government Reform Committee hearing.
Gruber denied repeated requests by the committee to confirm or deny that he had been paid at least $2.5 million to help eight state governments implement the federal health law, prompting a threat from several members of the committee to subpoena the information after Gruber referred them to his lawyer.
Gruber called his comments, made during a series of academic conferences between 2011 and 2013 but only released in recent months, “glib, thoughtless, and sometimes downright insulting.”
He said he made them to make himself feel smarter and important but that they were “conjecture” and beyond his area of expertise and that he hoped they would not reflect negatively on the process used to pass the law. Gruber attempted to play down his role in crafting the health law, using the technical term — “economic microsimulation modeling” — to describe his chief contribution. He was paid $400,000 as a consultant on the federal law.
Gruber’s prior comments included assertions that the federal law was “written in a tortured way” to deceive voters about taxes it imposes, and that it amounted to “a very clever, you know, basic exploitation of the lack of economic understanding of the American voter.”
But the words helped bolster Republicans’ arguments that the health law was passed deceptively, while at the same time outraging lawmakers of both parties.
“Professor Gruber is often said in Washington to be the definition of a gaffe. That is somebody who accidentally tells the truth,” said Representative Darrell E. Issa, a California Republican who chairs the committee and is an opponent of the federal health law.
One after another, Republicans berated Gruber for insulting their constituents and used his comments to make the case that the Obama administration has repeatedly lied to Americans about the law. Democrats chastised him for handing Republicans a “political gift,” obscuring the law’s success in reducing the number of Americans who are uninsured.
“As far as I can tell, we are here today to beat up on Jonathan Gruber for stupid, I mean absolutely stupid comments, he made over the last few years,” said Representative Elijah Cummings, the top Democrat on the panel. “This may be good political theater but it will not help a single American get health insurance.”
Critics of the law also tried to seize on some of Gruber’s prior comments to add weight to a pending Supreme Court challenge that could hobble it. But Gruber refused, for the most part, to engage.
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The day marked a stunning transformation for Gruber, from respected academic and consultant to prominent symbol for opponents of the health law. One Republican lawmaker said he had received more interest from his constituents regarding Tuesday’s hearing than for any that he had attended.
Governor Deval Patrick, a Democrat, declined a demand made last week from Massachusetts state Senate Republicans to remove Gruber from the board of the Massachusetts Health Connector.
Gruber made an ideal target for congressional Republicans trying to build the case that Democrats who wrote the law were looking down their noses at voters, forcing them to buy health coverage and deceiving them about how the law would affect those who already have it. When one lawmaker asked if Gruber had earned his PhD at MIT, he corrected him: “No, my PhD is from Harvard.”
“Do you understand fully why it was so insulting? You patronized them,” said Representative Thomas Massie, a Kentucky Republican and MIT graduate who said it had “been a bad couple of months” for the school because of Gruber. “I submit to you my constituents are not your children and they have the right of self-determination.” Gruber could only look forward and repeat his statements of contrition.
“Do you feel bad for taking all this money for Obamacare from people you called stupid?” asked Representative Blake Farenthold, a Texas Republican.
Gruber responded that he was being paid as a consultant for economic modeling.
One Republican congresswoman, Cynthia Lummis of Wyoming, told the story of her husband’s recent death from a heart attack to illustrate the real-life consequences of health policy. She said she was not blaming the health law, but noted that he had declined to take a test that was not covered under his plan. Then she glared at Gruber with contempt. “So get over your damn glibness,” she said.
They seem like a quarrelsome lot at bottom.
Gruber was not permitted to respond. But Marilyn Tavenner, who heads the Centers for Medicare and Medicaid Services and was also testifying, expressed condolences and said she would look into the case. (Tavenner was forced to apologize for telling the committee in September that 7.3 million people had enrolled in health exchanges, conceding that about 400,000 of those people were double-counted because they were also enrolled in dental plans.)
If Gruber was hoping for defense from his home-state lawmakers, he got none. Representative John F. Tierney, the outgoing congressman from Salem, left the hearing before waiting his turn to speak. Representative Stephen P. Lynch of South Boston said that he did not vote for the health law, and used his allotted time to spar with Gruber over the so-called Cadillac tax on certain health plans that he said was hurting union construction workers.
In fact, the only time Democrats were able to score a point in the hearing was when they pointed out that Gruber had been a key consultant for the Massachusetts health plan under former Republican governor Mitt Romney. After Republicans on the panel said they might subpoena documents Gruber may have shared with the Obama administration and state governments, Representative Gerald E. Connolly, a Virginia Democrat, suggested including Gruber’s work for Romney.
“Do we have documents from the Romney period?” Connolly asked. “I certainly want to see whether this is a pattern.”
Actually, NO, we DO NOT!!
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Related: Ready For Renrollment?
Also see: Connector board members show support for Gruber
How's that working up here anyway?
"Audit finds flaws in MassHealth spending" by Kay Lazar and Travis Andersen, Globe Staff December 11, 2014
The Massachusetts Medicaid program spent $35 million on questionable claims for health care provided to low-income immigrants, according to a critical report released Wednesday by state Auditor Suzanne Bump.
Most likely illegals, although the agenda-pu$hing pre$$ won't say it.
The findings reflect “serious weaknesses” in the agency’s claims processing system, Bump concluded, and illustrate the need for tighter controls.
The audit found that the state’s Medicaid agency, known as MassHealth, routinely paid for nonemergency medical care for roughly 45,000 immigrants from July 2011 through December 2012. The review identified 270,167 questionable or unallowed claims for services such as speech therapy, fluoride treatment, and physical therapy.
Bump’s report concluded that “with any government program, public confidence is essential to the success and continued support . . . Therefore, MassHealth must have effective controls in place.”
The state’s Executive Office of Health and Human Services, which oversees Medicaid, defended its practices, saying in a statement that the program in question provides “basic lifesaving services to some of Massachusetts’ most vulnerable residents.”
Look, I don't even like the costs of caring for the illegals that pour into this sanctuary state (including all the kids Obama sent that we were told didn't come); however, I note this tightening of health care during the lame duck se$$ion as rather odd, all things con$idered.
Bump’s office examined Medicaid’s Limited Program and its payment of medical bills for this pool of immigrants, who are entitled to emergency medical services under the program’s rules. The auditors said they believe that roughly 89 percent of the immigrants were in the United States illegally during the time of the audit.
Of course, our leaders tell us that is not true and to inconveniently point it out makes you a racist.
The American citizen is getting $crewed royally right now, and every day I pray with fervent devotion that this may be the day the U.S. economy finally collapses before more damage is done by this government.
The $35 million in question represents nearly half of the total spent by MassHealth during that period in the Limited Program, the auditor said. But it represents less than 1 percent of MassHealth’s total spending during that span on health care services for about 1.4 million low- and moderate-income Massachusetts residents.
Since April 2013, MassHealth has adopted cost-saving measures within its claims system to better identify and deny some of the bills in question, the audit found, and these changes should save the state about $2.4 million a year.
But the Executive Office of Health and Human Services disputed much of the auditor’s findings regarding its coverage of medical treatments for immigrants.
It's a knee-jerk kind of thing.
“We respectfully disagree with the state auditor’s definition of emergency services, which would preclude coverage under this program for critical medical conditions including kidney failure, broken bones, ectopic pregnancy, appendicitis, aortic aneurysms, insulin for diabetics, and other life-threatening injuries and conditions,” the agency said in a statement.
“MassHealth is required under both state and federal law to cover these emergency services for families and children who would otherwise be eligible for Medicaid but for their immigration status,” the agency’s statement said.
This while the American citizen and taxpayer is being asked to pay more in premiums and accept global payments (rationed care) for their own.
The agency also said that it relied on physicians to determine whether the services provided to patients in the Limited Program were for emergency conditions.
The auditor said the agency’s attitude toward the findings proved troubling.
“Their disagreement with our audit finding reflects the potential for further misspending in the future,” Bump said.
I would expect nothing less of this government. Let's hope Baker does a better job than the last guy.
Patient advocates criticized the report, saying it inflated a problem that has largely been fixed.
Sigh. I guess there is no limit to what they think we will believe despite all the deceptions.
“This is a very minuscule amount of the overall MassHealth budget, under a tenth of one percent,” said Amy Whitcomb Slemmer, executive director of Health Care for All, a Massachusetts advocacy group. “We feel confident that the accounting issues have been fixed.”
Yup.
Slemmer also noted that most of the insurance bills in question would have been paid anyway out of a different pool of money known as the Health Care Safety Net, which is an account largely funded through a surcharge on hospital and health insurers.
Ever notice government always has pools of money lying around as they slash services?
The auditor’s report acknowledged that point, noting that immigrants who need medical care not covered under the Limited Program have access to free or low-cost clinics in the community.
Joshua Archambault, a senior fellow at the Pioneer Institute, a conservative Beacon Hill think tank, said the report’s findings are a cause for concern.
“This is just another example of some of the mismanagement in the Medicaid program,” Archambault said.
He highlighted a federal audit released in October that found the US government made nearly $106 million in excess Medicaid payments to Massachusetts, and recommended that the state be ordered to refund the money.
Medicaid is a joint federal and state program run by the states. The earlier report found that the Massachusetts Medicaid program had incorrectly calculated the amount it sought to be reimbursed by the federal government through claims submitted between October 2008 and December 2010.
Yeah, $ure, but if true, why should we trust them to, collect taxes, say?
They can't do basic math or plug numbers into a formula?
“It’s a sad state of affairs that we keep getting reports of mismanagement of taxpayers’ money in millions of dollars, and that translates to less money for education, or public safety, or other public priorities,” Archambault said.
Oh, those are getting unilaterally cut by the outgoing governor despite an economic boom.
“It will be interesting to see whether the federal government says, ‘Hey, wait a second. These [latest auditor findings] were improper payments and you have to pay us back.’ ”
Tran$lation: expect even more budget cuts later. Think of it as Deval's going away gift.
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Related:
New York tells insurers to cover transgender treatment
Many sign up for Mass. health insurance, but few have paid
Like most Americans, I gue$$.
They are not the important ones anyway:
"Neighborhood’s ills give pain to Partners" by Steven Syre, Globe Staff December 09, 2014
I’m sure it sounded like a good idea at the time.
Boston hospital giant Partners HealthCare made a splash just two years ago by acquiring Neighborhood Health Plan, a nonprofit health insurer that covers lots of lower-income people on Medicaid. But the insurance company has been losing buckets of money — about $100 million a year at the current rate — and now Partners is brainstorming ways to get out of the fix.
That process, known inside Partners as — I’m not kidding — Project Panther, is focused on three possible solutions: convince the state to boost Medicaid reimbursements, find a new financial partner to get involved with the insurance operation that covers 325,700 people, or get someone to take over the business entirely and be done with it. Expect a decision next month.
Partners is best known as the owner of Massachusetts General and Brigham and Women’s hospitals. It’s also waging an increasingly uphill campaign right now to win the state’s blessing for proposed acquisitions of more suburban hospitals.
So how is that going to play out politically if Partners tries to exit the business of insuring poor people as it continues to plead its case to take over hospitals that care for relatively affluent patients?
Peter Markell, chief financial officer at Partners, said he believes Neighborhood Health has a good argument for more Medicaid money and is negotiating with state officials. Markell said turning Neighborhood Health over to some other company or organization is “not our desire and the last step on the option ladder.”
The Medicaid mess has entangled many health care players, but Partners is the biggest loser by far in Massachusetts this year. Other private insurers, particularly Boston Medical Center HealthNet, have also sustained significant losses. They’ve complained about inadequate state reimbursements and expensive problems created by the earlier Massachusetts Health Connector website meltdown. A costly new hepatitis C drug that came on the market and became hugely popular almost overnight also contributed to losses.
Insurers also reported an influx of customers who generated higher-than-expected costs in 2014.
I thought I was a patient, and that whole mind$et coming from the reporter pretty much $peaks for it$elf when it comes to the way they view our "health."
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The Massachusetts Association of Health Plans sent the incoming Baker administration a white paper last week outlining the state Medicaid system’s problems and suggesting ways to deal with them. Lora Pellegrini, the association’s president, calls the ongoing insurer losses “unsustainable.”
The math is actually worse than it first appears at Partners.
What are the CEOs and VPs making?
As an insurer, Neighborhood Health is required by regulators to maintain a certain amount of risk-based capital — it provides a financial cushion that can absorb trouble in the future. Actual losses this year at Neighborhood Health required Partners to set aside $86 million in additional risk-based capital over the first nine months of its fiscal year, according to Markell. That’s on top of the millions of dollars in outright losses.
They look like a ba.... nk.
Amid the fiscal bleeding, Neighborhood Health chief executive Deborah Enos said last month that she would leave the insurer early next year. She has since become cochairwoman of the Baker administration’s health care transition team.
Oh, part of the "New" Leader$hip coming in.
Related: "Walker was a cofounder of Next Street, a merchant bank that offers capital to entrepreneurs in urban markets. He is also a director of Emerson College, and he previously held executive posts at Sovereign Bank and Fleet Financial Group. Two years ago, Governor Deval Patrick officiated at Walker’s wedding."
He's our new labor $ecretary.
On Friday, Partners is scheduled to disclose its financial projections for Neighborhood Health covering the year ahead and the amount of added capital it expects the insurance arm will require.
At this point, you might be wondering: Why did Partners want to get into the insurance business in the first place?
No, not really. I a$$ume it was the u$ual, if not only, rea$on.
Markell and other executives have always pointed to Neighborhood Health as a resource to help Partners learn how to improve the medical management of high-risk and high-cost patients.
Like an.... experiment?
Others believe Partners, in possession of an insurance license, eventually planned to move beyond Neighborhood Health’s Medicaid roots to cover many more patients — giving it a powerful negotiating advantage with other insurers.
Oh, they were only looking after their own health.
No matter what the goals, Neighborhood Health has proven to be a very expensive investment for Partners so far.
I love the "no matter what the goals."
Yeah, who really cares about $uch things, right?
And as they say in the health care business, a “good outcome” is in doubt.
I'm wondering how they can make it end so.
I mean, their first loss in 15 years was because of poor people.
That's the problem with healthcare in AmeriKa these days: it's a bu$ine$$.
The Red Herring
Local investment firms were the biggest winners when Merck & Co. struck a $9.5 billion deal Monday to acquire Cubist Pharmaceuticals Inc. of Lexington. The news boosted Cubist shares by 35 percent.
Fidelity Investments was the biggest Cubist stockholder as of Sept. 30, owning 12.4 percent of the company. Putnam Investments owned nearly 11 percent, and Wellington Management Co. held about 4.5 percent.
About 6.8 million Cubist shares held in mutual funds run by Putnam’s David Glancy — last year’s Boston Capital fund manager of the year — appreciated by a whopping $178 million Monday.
If you want to take a quick look.... at lea$t $omeone is healthy!
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Related:
"A merger would link two nonprofit hospitals that both treat many low-income patients and have endured financial struggles. BMC, the state’s largest “safety net” hospital, has an especially high number of patients on Medicaid, the government health insurance program for the poor. Tufts has tried to carve a place for itself in a city rich with world-renowned hospitals."
It's a medical arms race, folks.
"In $9.5b deal, giant Merck buying Lexington’s Cubist" by Robert Weisman and Jack Newsham, Globe Staff and Globe Correspondent December 08, 2014
The battle against emerging “superbugs” is producing a new generation of antibiotics. Now it has also produced a giant payout for a Lexington biotech on the front lines of the effort to take on increasingly potent bacteria.
Cubist Pharmaceuticals Inc., which is amassing a portfolio of drugs for bacterial strains that prove stubbornly resistant to today’s antibiotics, said Monday that it accepted a $9.5 billion buyout offer from pharmaceutical goliath Merck & Co.
The deal, which drove Cubist’s stock up by more than 35 percent, is the latest play by a global drug company in the Boston area’s booming biomedical cluster, where researchers are working on everything from cancer drugs to rare disease therapies to antibiotics.
Cubist, founded in 1992, has become the world’s leading antibiotics developer at a time when many larger companies have scaled back research and development in the field.
Because they cure infections quickly — and therefore patients no longer need drugs — antibiotics have been less profitable than medicines for chronic conditions such as heart disease and multiple sclerosis. But with the rise of new bacterial infections, leading to epidemics such as one affecting tens of thousands of newborns in India, that calculation may be changing.
I don't know if I saw anything on that or not, but if so it couldn't have been much of a scroll.
“This is a recognition that the antibiotics space is becoming more important,” Cubist president Robert J. Perez said of the Merck buyout. “This move signals that large companies appreciate the importance of innovations in that area.”
Barry R. Bloom, professor of immunology and infectious diseases at Harvard School of Public Health, said the overuse and inappropriate use of antibiotics has fueled the emergence of antibiotic-resistant superbugs.
“We’re just out of drugs,” Bloom said. “When you see the degree of resistance in India, as well as some place like China, you see this is an overwhelmingly serious problem that is only going to get worse. The economics don’t incentivize antibiotics.”
Merck’s acquisition of Cubist could spur further moves by drug makers scrambling to reenter the antibiotics field, said pharmaceutical analyst Seamus Fernandez, managing director at Boston health care investment bank Leerink Partners.
“They let the little guys do the heavy lifting, and then pick up the assets that end up being most promising,” Fernandez said.
The robber barons of old alive and well.
Cubist has about 1,000 employees worldwide, including 600 at its Lexington headquarters and research center, where the company spent $300 million on antibiotic drug research last year.
Merck, which is based in Whitehouse Station, N.J., and has about 71,000 workers globally, has been one of the few large pharmaceutical companies that have maintained an antibiotics pipeline, though it spent less on antibiotics research last year than Cubist.
“This deal is about growth,” Merck chief executive Ken Frazier said in a conference call with stock analysts. Merck has not said how many of Cubist’s employees will be retained, or whether it will keep the Lexington campus, but Frazier said the immediate focus would be on making Cubist grow, not cutting costs.
Still, the Cubist name will go away, according to Merck spokeswoman Lainie Keller.
Under terms of the deal, Merck will pay $8.4 billion for Cubist shares, a 37 percent premium to Friday’s closing price. The company will also assume $1.1 billion in Cubist debt.
Cubist is the second major Massachusetts company Merck has purchased this year. In June, it paid $3.8 billion for Idenix Pharmaceuticals Inc., a Cambridge biotech developing drugs to treat hepatitis C. Merck also runs an 11-story research tower in Boston’s Longwood Medical Area, where more than 450 scientists, chemists, and biologists work in the fields of cancer, inflammation, diabetes, genetics, and neuroscience.
I failed to appreciate how $ickne$$ was such big bu$ine$$ in Ma$$achu$etts.
Merck expects the Cubist deal to generate more than $1 billion of revenue for it next year, and to significantly add to corporate profits in 2016 and beyond.
The pace of life sciences mergers and acquisitions has picked up in the past several years as major pharmaceutical and medical technology firms eager to expand their pipelines of drugs have been snapping up smaller biotechs and other companies.
It's called con$olidation, and it has never meant good things for an economy.
In June, medical device maker Medtronic Inc. agreed to pay $42.9 billion for health care supplies company Covidien PLC, which has its US headquarters in Mansfield. An even bigger deal — AbbVie Inc.’s plan to spend $54 billion for drug maker Shire PLC, which has its US base in Lexington — collapsed last month when the US government moved to restrict the tax benefits the takeover would have reaped for AbbVie.
Start at the top.
Related: Lawsuit alleges kickback scheme by fired Sanofi chief
Merck telegraphed its interest in acquisitions in May when the company hosted its first investor presentation at the company’s Boston research lab. Merck had just agreed to sell its consumer care business to German drug maker Bayer AG for about $14.2 billion, and executives said they might use the money from the sale to buy companies with promising experimental treatments, particularly in biotechnology.
In an interview Monday, Frazier would not say whether Merck was considering other acquisitions, but said the company had “a strong balance sheet and cash flow.”
Frazier said Merck sales are up in the company’s product class that includes antibiotic and antifungal drugs. It is an area that Merck “has had intense interest in,” he said.
Cubist has several drugs in development. An antibiotic that treats urinary tract and intra-abdominal infections has the potential to reach a huge market. The FDA granted the experimental drug priority review in June and is scheduled to decide by Dec. 21 whether to approve it.
The company’s flagship antibiotic, Cubicin, is used to prevent bacterial skin infections and treat blood and heart infections. It accounts for annual sales of more than $1 billion globally. But the drug is expected to face competition from low-priced generics starting in 2018. A rival drug maker, Hospira Inc., has also filed court challenges to Cubicin patents.
“Our portfolio dovetails very nicely with Merck’s antibacterial portfolio,” said Cubist chief executive Michael W. Bonney.
Jason Kantor, biotechnology analyst with financial firm Credit Suisse in San Francisco, said antibiotics will “never be a big needle-moving franchise” for drug makers. But with the fight against superbugs getting attention, he said, the business is likely to become more profitable than in the past — particularly if companies like Cubist continue to develop effective treatments.
“Pharma and biotech companies are driven by meeting unmet medical needs,” Kantor said. “This is an area of very dire unmet needs.”
Why did Ebola just enter my mind?
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Also see: Merck committed to Cubist after patent losses
Did they get hacked, too?
Here is some more inside dope on Merck -- if you can get it down, ladies.
UPDATE: Benjamin Edelman, Jonathan Gruber show dangers of arrogance
See: Slow Saturday Leftovers
