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<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Wed, 30 Apr 2025 07:27:00 +0000</pubDate>
<category><![CDATA[Medical Practice]]></category>
<category><![CDATA[Parkinson's Disease]]></category>
<category><![CDATA[Wojciech Wasilewski]]></category>
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<description><![CDATA[By WOJCIECH WASILEWSKI Dear Reader, if you’re looking for something soft and easy, please buy a different book. This one isn’t here to comfort you — it’s here to shake your lazy<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/30/to-beat-parkinsons-you-must-stand-on-your-head/">Continue reading...</a>]]></description>
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By WOJCIECH WASILEWSKI
Dear Reader, if you’re looking for something soft and easy, please buy a different book. This one isn’t here to comfort you — it’s here to shake your lazy world, to shock you, to drag you out of the same lethargy I was trapped in for years after being diagnosed. If you feel anger, rebellion, or even a surge of motivation while reading, then it was worth writing <a href="hthttps://www.amazon.com/dp/B0F4538CQC">this </a><a href="https://www.amazon.com/dp/B0F4538CQC.">book</a>, each and every hour. Parkinson’s isn’t polite — and I won’t be either. This is my war manifesto against Parkinson’s.
Throughout <a href="https://www.amazon.com/dp/B0F4538CQC">this book</a>, I use the word “Parkinson” as shorthand for Parkinson’s disease, not as a reference to James Parkinson, the doctor who first described it. If that feels like an oversimplification — I apologize. But trust me, it’s the least important thing here.
People today are searching for real stories — not textbook definitions, sterile medical jargon, or sugar-coated tales of suffering. You won’t find any of that here. What you’ll find instead is something far more valuable: the truth. Raw, unfiltered, sometimes brutal, sometimes even vulgar. Why? Because that’s what this disease really is. That’s the kind of relentless fight you’ll need if you don’t want Parkinson’s to steal your life, piece by piece. I’m not afraid of that fight — and this is exactly what this book is about. I want you to stop being afraid and to believe you can get into this fight too.
This is not a scientific book. I’m not a doctor. I don’t have a PhD. I’m not an “expert” who appears on morning TV. I’m just a patient — like you. Someone who heard the diagnosis and, instead of quietly accepting it and waiting for the end, chose to fight back. And the most important part? After years of struggle, I’m living proof that it can be done. This isn’t theory — it’s my sweat, my pain, my setbacks, and my comebacks. If you want to read the story of someone who curses Parkinson’s out loud every day and refuses to let it win — you’re in the right place.
If you want to hear the voice of someone who tests every possible method to claw back one more day of normal life from this disease, someone who isn’t afraid to speak the truth and take risks — this book is for you. This is my declaration of war on Parkinson’s. And if you’re ready to join me in this fight — come on board. Because to live well with Parkinson’s, you have to completely change your lifestyle. That’s exactly what this book is about.
PARKINSON’S AFFECTS THE YOUNG
I’m talking to you — the person who typed into Google: “Parkinson’s and physical activity,” “diet and Parkinson’s,” “how to stop Parkinson’s,” “can you recover from Parkinson’s,” or “can young people get Parkinson’s.” If you’ve landed here, you’re searching for answers. I’m no miracle worker. I don’t have magic pills or secret formulas. I do have something better though — real strategies that work for me. Not just for me.
This isn’t an academic thesis. This is a battle guide. A survival manual. It’s about resisting this disease, outsmarting it, slowing it down, exhausting it. It’s about clawing back one more day of normal life — and doing it all over again tomorrow.
You know what annoys me the most? That the majority of people still think Parkinson’s is a disease of old men sitting on benches outside their apartment buildings. That’s just not true. More and more young people — people who should have their whole lives ahead of them — are being diagnosed. And then what? Fear. Panic. The crushing feeling that everything is over. Doctors rarely have time to explain what’s really going on. And the internet? It hits you with nightmare scenarios — videos of people shaking so violently they can’t even lift a spoon. Nevertheless, that’s not the full truth about Parkinson’s.
For younger people, Parkinson’s is a completely different fight — a different tempo, a different pressure, a different kind of war. They are the ones who this book is for. For people in their 30s, 40s, and 50s, with families, careers, dreams, and plans — all of which Parkinson’s is trying to rip away. We don’t have to let it happen. We can fight back.
WORDS OF CRITICISM FOR THE CRITICS
I can already hear the noise — the mocking, the scoffing, the eye-rolling. Critics saying there’s no scientific proof, that maybe something did work for me but won’t work for anyone else, that it’s all clichés and empty words. Maybe my Parkinson’s is ‘defective,’ they’ll say. Or maybe I don’t even have it. Or I just got lucky and ended up with the soft version — you know, Parkinson’s Lite.
To all the critics who will claim that nothing in this book works, I have only one thing to say: Keep on clucking.
When I first decided to fight Parkinson’s, my condition was declining fast. I had muscle rigidity. I could barely walk. My left arm didn’t swing. I felt that heavy-leg fatigue, and my tremors were intense. I passed out twice — both times collapsing in the bathroom. Then I underwent the FUS procedure, and it significantly reduced the tremor in my left hand. That was the moment I realized I had to change my life. And so began a slow but powerful transformation.
I HAVEN’T WON THE WAR
Let’s be clear, dear Reader: I haven’t won the war against Parkinson’s — not even close. Writing this book, after working full-time as an analyst for eight hours a day, takes a toll on me. Sitting at the computer for hours temporarily worsens my symptoms. Just this morning, I woke up in pain — arms, legs, back, everything.
And what did I do? First I went for a light three-kilometer run. Next I took a freezing cold shower. Then I had a healthy breakfast. These simple steps and just like that — my body came back to life.

Now let me ask you, dear Critics: what would you have done if you had woken up feeling the way I did this morning? Would you have popped another painkiller? Slapped on a pain patch? Maybe relied on a pump delivering dopamine straight into your intestines?
Tell me — which one of you can give me a straight answer about what my life will look like in five, ten, or twenty years? None of you can because modern medicine doesn’t think long-term. It treats symptoms — not causes — and it deals with them only now, not tomorrow. So how long will I last on this ‘dopamine from the pump’? I’ve been living with Parkinson’s for almost a decade. How quickly does my body develop tolerance to each new dose? What are the long-term side effects?
Will I end up like my friend with advanced Parkinson’s — so overmedicated he sees animals on his bed and suffers from terrifying hallucinations? What happens to me in twenty years if I follow your playbook of escalating doses and stronger meds that treat nothing but mask everything?
Some of you might say, ‘What about DBS?’ Well, here’s the truth: Deep Brain Stimulation helps some symptoms, but it worsens others. Speech? Memory? They often get worse. DBS is outdated, invasive, and — at least in Poland — poorly maintained. So no, it’s not the silver bullet either.
MY BODY AS THE PROOF
My body is the best proof I have — however unscientific — that lifestyle change can be a powerful tool in this fight. The difference between how I used to feel and how I feel now is reason enough to share my story.
Before anyone thinks about stem cell therapy or gene editing — treatments that might help but could just as easily harm — why not try something available to everyone? Physical activity. A lifestyle overhaul. Because this disease hates movement. It thrives on stillness, dependency, and inactivity.
Yes, someone might quote a study claiming physical activity doesn’t always deliver. Maybe that’s true in some cases. Even so in animal models, it helps. What about studies on humans? Let’s be real — they’re limited and not entirely reliable. Why? Because you can’t force someone who’s severely ill to follow a strict, demanding exercise regimen. But I did. And it changed everything.
THE HONEYMOON PERIOD IS OVER
Now let me say something that might surprise a few and piss off the rest: even though my so-called ‘honeymoon period’ — that golden phase when meds work like magic — ended long time ago, I’m still doing well. In fact, I’m in better shape than many newly diagnosed patients.
How is that possible?
Because instead of crying over the lost ‘honey,’ I got to work. I stopped chasing miracles and realized the only miracle I can count on is the one I create myself. No pill will ever replace a liter of sweat spilled in training, a deep breath of clean air, or a plate of real food.
The honeymoon is over — but I’m not. As long as I can move my arms, my legs, and what’s left of my dopamine system, Parkinson’s will not win. So if you think that after those early ‘golden years,’ it’s all downhill — you’re dead wrong. This is when the real battle begins. It’s up to us whether we crash or climb.
At the end of this book, I’ve included a quick and practical guide how to manage some of Parkinson’s symptoms at home — simple tools, habits, and actions that can make a real difference.
MY STORY THE WASTED EARLY PHASE
I used to weigh 130 kilograms. I lived on junk food and spent most of my time lying on the couch, glued to the TV. Then Parkinson’s came along — and flipped my world upside down.
I was diagnosed with Parkinson’s disease at the age of 36 or 37 (I’m 45 now). At first, I didn’t believe it. I thought the doctors had made a mistake. I kept hoping it was something else — anything else. But the diagnosis was confirmed by a DaTSCAN. There was no doubt.
One of Poland’s leading neurologists, Professor Andrzej Friedman — in my opinion, an outstanding expert on Parkinson’s — confirmed it: I had young-onset Parkinson’s disease (YOPD), affecting the left side of my body.
So what did I do with that information? Nothing. For the first four years, I wasted time. I sat on the couch, I cried, I did nothing but watch TV. I let my dosage of levodopa–carbidopa increase while my health slowly declined. I was stuck — physically, mentally, and emotionally.
SEARCHING FOR INSPIRATION
Then came a moment of reflection. I had two choices — give up or fight. I chose to fight. Looking at the example of Michael J. Fox and others living with Parkinson’s, I realized something important: the road to success is long, winding, and full of obstacles. You can have all the money in the world, access to the best doctors — and still lose to this disease.
In my view, the only real way forward is to completely overhaul the harmful, self-destructive habits that are breaking down your body. That’s what I set out to do. I began searching for knowledge, for inspiration — for something to hold onto.
One of the first things I came to understand was that obesity and Parkinson’s disease are a terrible combination. I was simply eating my sadness, eating my depression. I didn’t have the knowledge or the time — or maybe just the strength — to follow a proper diet. There was always that magical phrase: ‘I’ll start tomorrow.’
THE TURNING POINT
One day, I realized I couldn’t keep postponing the hard decision to change my lifestyle. So I started — with weight loss. Because honestly, it felt like the easiest place to begin with. I kept it simple. I reduced the calorie content of my meals and introduced something called a ’feeding window’. One basic rule: eat less than 2,000 calories a day, only between 8 a.m. and 3 p.m. That was it. I didn’t cut out any food groups. I didn’t give up sweets — I just ate them in moderation. On top of that, I started walking and doing yoga. The results were staggering: within a year and a half, I went from 130 kg to 80 kg.
THANKS TO PARKINSON’S, I HAVE NO OTHER DISEASES
Strange as it may sound — I’m grateful to Parkinson’s for this transformation. It may have saved me from diabetes, heart disease, and all the other health problems related to severe obesity. After that breakthrough, I kept going. I kept experimenting with my own body, gradually introducing more and more changes. I changed everything — my diet, my physical activity, my sleep, even my mental approach to life. Was it easy? No. It was brutally hard.
Yet today, after eight years of living with Parkinson’s, I’m in better shape than many people who were diagnosed more recently. In fact, I’m in better shape than I was years ago.
My condition hasn’t progressed. I haven’t increased my medication dosage in years. I currently take three tablets of Nakom 250 mg during the day and two tablets of Madopar HBS 100 +25 mg at night. Maybe I’ll even be able to reduce that relatively high daily dose and still feel good.
Every day, I make the same choice: it’s me — not Parkinson’s — who runs my life. And if I can do it — so can you. Everyone has their own version of ’Parkinson’s.’ It’s not just about illness. Everyone has something that holds them down — some fear, some burden, some invisible weight. If you can overcome Parkinson’s, you can overcome anything.
WHAT IS PARKINSON’S DISEASE?
Most people think Parkinson’s is simple: lack of dopamine — give dopamine — problem solved. Nonsense. That’s like looking at a burning house and saying, ‘Just pour water on it, and everything will be fine.’ However, what you don’t see is that the gas exploded in the basement, the wiring is fried, and the foundation is collapsing. Parkinson’s is not just about dopamine. It’s a full-body energy crisis that affects every cell — not just the brain. Every cell in your body — from your brain to your muscles to your heart — relies on one thing to function: mitochondria. These tiny power plants create the energy (ATP) that fuels every movement, thought, and heartbeat. The more healthy mitochondria you have, the more energy (ATP) your body can produce. And the more ATP you have, the more strength, focus, and vitality you feel.
PARKINSON’S DAMAGES MITOCHONDRIA
But then Parkinson’s creeps in like a thief and begins sabotaging these power plants. In the bodies of people with Parkinson’s, mitochondria are damaged and weakened. They produce less energy and age faster. That means your cells are running on empty. Less energy means less movement, less clarity, less life. You feel it as chronic fatigue, that lead-like heaviness, brain fog, the inability to get off the couch. It’s not laziness — it’s mitochondrial failure. And it gets worse. Damaged mitochondria also produce toxic waste: free radicals. These unstable molecules attack healthy cells like smoke flooding from a broken engine. Your body gets poisoned from within. This sets off a vicious cycle: free radicals destroy more mitochondria, which then produce even more toxic waste, accelerating cell death — especially in the brain. Parkinson’s doesn’t begin in your hands or feet. It starts deep inside your cells, where your mitochondria — the engines of life — start breaking down. That’s why dopamine medication alone isn’t enough. You can flood your system with dopamine, but if your cells don’t have the power to use it, it won’t take you far. It’s like pouring premium fuel into a car with a cracked engine block. The pistons might move a little, but you’re not going anywhere.
Scientific research backs this up. A Danish-German team found that damage to mitochondrial DNA (mtDNA) plays a key role in the development of Parkinson’s disease. They discovered deletions in the mtDNA of patients, especially in brain areas responsible for cognition. In lab experiments on mice, they confirmed that mitochondrial damage leads to the same pathological changes seen in Parkinson’s. This could lead to new diagnostic tools, biomarkers, and eventually better treatments. In short, mtDNA is the genetic blueprint of your mitochondria. When it gets damaged, everything begins to break down — and Parkinson’s is just one possible outcome. These disruptions hit nerve cells the hardest, because they need huge amounts of energy to survive. When that energy vanishes, the cells begin to die. That’s when neurodegenerative diseases like Parkinson’s start to take hold.
These disorders are especially damaging to nerve cells, which need massive amounts of energy to function. When that energy supply breaks down, neurons begin to degenerate — and that’s what leads to neurodegenerative diseases like Parkinson’s.
LIFESTYLE CHANGES CAN REPAIR MITOCHONDRIA
Diet, movement, sleep, toxin elimination — all of these have a direct impact on energy production at the cellular level. Your mitochondria aren’t static. They can regenerate, multiply, and become stronger — but only if you give them a reason to. That reason is physical effort, deep breathing, clean nutrition, and intermittent fasting, which activates a powerful cellular process called autophagy (we’ll come back to that later in the book).
Parkinson’s isn’t just a brain disease — it’s a total war, fought in every single cell of your body. Every step you take, every conscious breath, every drop of sweat sends a signal to your system: “We’re still in the fight. We need energy. Start rebuilding.”
What if you sit still and complain? Your mitochondria get a very different message: ‘We’re done here. No need to produce anything. Shut it all down.’
And if there’s one thing mitochondria truly hate — it’s sugar. Sugar clogs them, weakens them, and slowly destroys their ability to function. It’s the ultimate enemy of your cellular engines. This book is not about hope — it’s about action. If you’re tired of waiting for miracles, start making your own. 
<a href="https://www.amazon.com/dp/B0F4538CQC">To Beat Parkinson’s, You Must Stand on Your Head</a> is available now.
Wojciech Wasilewski is a Polish author and equity analyst living with Parkinson’s disease — and fighting it with radical lifestyle change.
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<item>
<title>Bloom is Off the Rose at UnitedHealth Group</title>
<link>https://thehealthcareblog.com/blog/2025/04/29/bloom-is-off-the-rose-at-unitedhealth-group/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Tue, 29 Apr 2025 09:08:00 +0000</pubDate>
<category><![CDATA[The Business of Health Care]]></category>
<category><![CDATA[Jeff Goldsmith]]></category>
<category><![CDATA[United HealthGroup]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109215</guid>
<description><![CDATA[By JEFF GOLDSMITH A Forty Year Growth Saga is Coming to an End After market close Wednesday April 16, UnitedHealth Group reported its First Quarter 2025 earnings. UNH missed their expected 1Q<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/29/bloom-is-off-the-rose-at-unitedhealth-group/">Continue reading...</a>]]></description>
<content:encoded><![CDATA[
By JEFF GOLDSMITH
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A Forty Year Growth Saga is Coming to an End
After market close Wednesday April 16, UnitedHealth Group reported its First Quarter 2025 earnings. UNH missed their expected 1Q earnings by 9 cents a share, but the firm also lowered its full year 2025 earnings estimate by 12%. On Thursday opening, investors reacted with an unbridled fury, and stripped UNH of more than a hundred billion in market capitalization in a matter of hours. In the glare of hindsight, UNH was priced for perfection at a pre-crash trailing Price Earnings ratio of 38, six points higher than Amazon and eight points higher than Microsoft, which might account for the savagery of the correction.
Definitive answers to the question–what is happening to United’s sprawling mass of businesses–are impossible because the company is an $400 billion black box. The main United businesses–health insurance, care delivery, pharmacy benefits management and business intelligence/services–are so intertwined with one another that only United CFO John Rex and a few other senior managers actually know from whence United’s earnings actually flow. What follows is some speculation on the root causes of United’s earnings problem.
First, a major driver of the last two decades of United’s earnings growth has been using a big chunk of its astonishing monthly cash flow (which was approaching $3 billion a month) buying other companies. This party might be over. United has historically spent about half their accumulated wealth on dividends and share buybacks, that is, paying off shareholders to remain shareholders.
However, a big and undisclosed contributor to UNH earnings growth has been <a href="https://prospect.org/health/2023-12-20-building-a-giant-unitedhealth/">acquisitions</a>, which have occurred in a nearly unbroken string for forty years. From 2019 to 2023, United spent an astonishing $118 billion buying other companies, nearly all of which ended up in Optum. Thanks to great discipline by UNH Executive Chair Stephen Hemsley and CFO-now-President John Rex, United almost invariably bought profitable firms in transactions that were accretive to earnings.
United appears to be running out of accretive transactions. With the dearth of major new transactions, United’s $81+ billion horde of cash and short term investments (larger than Exxon Mobil) is likely to plump up yet more. This will cause folks to wonder why United is raising their rates to employers or shaking down providers for deeper discounts when they are sitting on a growing mountain of cash.
United cannot buy more health insurers (both CIGNA and Humana been for sale for years) because federal antitrust enforcers will stop them. There are no more accretive risk-bearing physician group deals. <a href="https://www.ama-assn.org/about/ama-research/physician-practice-benchmark-survey">Hospitals presently employ more than a third of practicing physicians</a> in the US (a very unhappy state affairs for both parties). But these hospital acquisitions have limited the universe of available physician transactions for United.

United’s <a href="https://www.statnews.com/2024/06/28/optum-steward-physician-deal/">passing</a> on acquiring bankrupt Steward Healthcare’s physician group (Stewardship) showed us they are leery of buying hospital owned groups, most of which are losing buckets of money. UNH has also steered clear of investor-owned physician groups like Envision or Team Health that service , i.e. vampire-ize, hospitals. FTC/Justice have raised <a href="https://www.statnews.com/2024/11/12/doj-antitrust-suit-unitedhealth-3-3-billion-acquisition-amedisys/?matchtype=&keyword=&cid=21980845176&agid=&device=c&placement=&creative=&target=&adposition=&utm_source=google&utm_medium=cpc&utm_campaign=pmax-articles-only&utm_term=&utm_content=&hsa_acc=5862992171&hsa_cam=21980845176&hsa_grp=&hsa_ad=&hsa_src=x&hsa_tgt=&hsa_kw=&hsa_mt=&hsa_net=adwords&hsa_ver=3&gad_source=5&gclid=EAIaIQobChMI6rbQiYP7jAMV-2NHAR3-dS8eEAAYASAAEgKD2vD_BwE">the red flag</a> about UNH buying home health companies after their two multi-billion dollar deals during the pandemic–LHC Group and Amedisys.
When OptumHealth was a quarter of its present size, just seven years ago, it was a 10% margin business. Since then, OptumHealth’s margins have declined by more than 25%. As cost cutting and multiple leadership changes decimate OptumHealth’s corporate culture, expect a wave of resignations and union activity to sweep through OH’s physician groups, further damaging both Optum Health’s and UNH’s overall margins.
OptumInsight–United’s business intelligence and corporate services business- was nearly a 28% margin business before the hasty and reckless acquisitions of Equian, Change and naviHealth during the pandemic. Now it is a 16.5% margin business. OptumInsight and United were badly damaged by the February 2024 <a href="https://www.healthaffairs.org/content/forefront/change-healthcare-incident-change-health-care">Change Healthcare hack</a>.
Change, which used to process a staggering $1.5 trillion, or one-third of all US medical claims, lost a lot of angry customers after they discovered that Change actually was a steaming mass of poorly guarded and barely integrated roll-ups whose security failures damaged their own businesses’ cash flow and operating costs. UNH would be foolish to buy more data businesses since the Change episode proved conclusively that they cannot run them safely.
So UNH’s two biggest businesses, health insurance and health services, both of which have seen operating margin declines in the last five years, cannot be rescued by more accretive transactions. United remains steadfastly disinterested in owning hospitals. Rather, UNH has worked diligently to surround and cannibalize hospitals.
Second, the kindness of strangers has run its course. One strategic challenge posed by OptumHealth’s growth was that when United bought large risk bearing physician groups like Healthcare Partners, Atrius and Kelsey Seybold, it also bought profitable risk contracts with competitors of United’s health insurance businesses. Nearly <a href="https://www.unitedhealthgroup.com/content/dam/UHG/PDF/investors/2024/UNH-Q4-2024-Form-10-K.pdf">$23 billion of OptumHealth’s revenues</a> (more than a fifth) , and likely a higher percentage of its profits, came from large Medicare Advantage contracts with the likes of Blue Shield of California, Blue Cross Blue Shield of Massachusetts, etc.
Since the pandemic, OptumHealth has been experiencing the very same cost problems as all those hospitals–rampant nursing and physician expenses from turnover and temp agencies, supply costs, etc, It is likely that a lot of their “partners” finally said “nyet” to contract increases that would enable OptumHealth to recover those costs.
OptumHealth cannot terminate contracts with competing health insurers without stirring up more bad publicity and possibly triggering anti-trust inquiries. So UNH has serious leverage problems in negotiating with their competitors. Almost certainly, inadequate Medicare Advantage contract renewal rates for its owned medical groups cut OptumHealth MA margins. Those competing health plans are unlikely to make maintaining United/Optum’s margins a priority.
And like the rest of the industry, United awaits further reductions in Medicaid managed care enrollment, and almost certain payment reductions from the new administration. The earnings outlook for Optum as a whole is grim. Long term deterioration in Optum’s margins, which fell from 8.1% in 2018 to 6.1% in 1Q25, have done real damage to United’s overall earnings. Optum’s growth was the principal contributor to United’s remarkable earnings growth. That exceptional growth streak is likely over.
Third, the cold hearted strategy of managing care remotely through AI driven algorithms has reached a point of diminishing returns. In the aftermath of <a href="https://www.nytimes.com/2024/12/06/nyregion/unitedhealthcare-brian-thompson-shooting.html">Brian Thompson’s appalling assassination</a> and brutal exposes in <a href="https://www.statnews.com/denied-by-ai-unitedhealth-investigative-series/">STAT</a> and the <a href="https://www.wsj.com/health/healthcare/unitedhealth-medicare-payments-doctors-c2a343db?mod=article_inline">Wall Street Journal</a> on UNH’s enthusiastic denials and coding practices, some analysts have speculated that UNH may have dialed down the denial machine that was fattening their margins by niggling patients and physicians out of payment for medical services, including for services covered by regular Medicare.
Giving lie to this speculation, <a href="https://www.unitedhealthgroup.com/content/dam/UHG/PDF/investors/2025/UNH-Reports-Q1-2025-Results-Revises-Full-Year-Guidance.pdf">UNH’s health insurance margins actually rose</a> in 1Q25, to 6.1% vs. 5.2% for all of 2024. However, claims denials to care providers are killing UNH politically. They will lead directly to a lot more cancelled contracts by providers, lawsuits and continued mediocre consumer satisfaction ratings. United has a <a href="https://www.comparably.com/brands/unitedhealth-group">minus 12 net promoter score</a>, suggesting that UNH is not delighting the its tens of millions of customers.
We should expect Sir Andrew Witty to stop pretending to be UNH’s CEO and return to England to tend his flock and fly fish. It has been a <a href="https://www.youtube.com/watch?v=vjQAcWy1_dQ">sorry and unconvincing performance</a>. And the 25% market cap loss after the Q1 earnings call has damaged President/CFO John Rex’s virtually odds-on chances to succeed him. United’s brilliant and reclusive Executive Chairman Stephen Hemsley, who has done a remarkable job of growing this company since he succeeded Bill McGuire in 2006, has a devil of a succession challenge. The greatest growth story in the history of US corporate health enterprise appears to be coming to an end. I have been a shareholder in this remarkable company on multiple occasions but am no longer, having lost faith in this ambitious managed care project. As we await the <a href="https://www.kff.org/medicaid/issue-brief/putting-880-billion-in-potential-federal-medicaid-cuts-in-context-of-state-budgets-and-coverage/">Medicaid bloodletting</a> from Trump47 and the unlucky Republican Congress, it is difficult to discern a reason to invest in UnitedHealth Group. Actually turning United from a gigantic pile of acquired healthcare assets into a real business may prove to be an impossible management challenge.
Jeff Goldsmith is a veteran health care futurist, President of Health Futures Inc and regular THCB Contributor. This comes from his <a href="https://jeffgoldsmith.substack.com/subscribe">personal substack</a>
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<title>Pope Francis Links to Scalia on Due Process: The Case Made by a Skadden Litigator</title>
<link>https://thehealthcareblog.com/blog/2025/04/25/pope-francis-links-to-scalia-on-due-process-the-case-made-by-a-skadden-litigator/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Fri, 25 Apr 2025 07:36:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Due Process]]></category>
<category><![CDATA[Kilmar Abrego Garcia]]></category>
<category><![CDATA[Mike Magee]]></category>
<category><![CDATA[Pope Francis]]></category>
<category><![CDATA[Scalia]]></category>
<category><![CDATA[Skadden]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109205</guid>
<description><![CDATA[By MIKE MAGEE The Pope’s passing interrupted an epic battle between Trump and the rest of the civilized world over whether America remains a society “under the law.” Critical to the rule<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/25/pope-francis-links-to-scalia-on-due-process-the-case-made-by-a-skadden-litigator/">Continue reading...</a>]]></description>
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<figure class="alignright size-full"><img decoding="async" width="230" height="273" src="https://thehealthcareblog.com/wp-content/uploads/2019/03/849660338_medium-dr-mike-magee.jpg" alt="" class="wp-image-96080" srcset="https://thehealthcareblog.com/wp-content/uploads/2019/03/849660338_medium-dr-mike-magee.jpg 230w, https://thehealthcareblog.com/wp-content/uploads/2019/03/849660338_medium-dr-mike-magee-126x150.jpg 126w" sizes="(max-width: 230px) 100vw, 230px" /></figure></div>
By MIKE MAGEE 
The <a href="https://www.nytimes.com/live/2025/04/21/world/pope-francis-updates-vatican">Pope’s passing</a> interrupted an epic battle between Trump and the rest of the civilized world over whether America remains a society “under the law.” Critical to the rule of law is the principle of “Due Process,” as described in not one, but two Amendments to our Constitution. 
The Fifth Amendment states that no inhabitant shall be “deprived of life, liberty or property without due process of law.” 
The Fourteenth Amendment, ratified after the Civil War and Emancipation, uses the same eleven words, called the “Due Process Clause,” to describe a legal obligation of all states. 
In arrogantly ignoring any pretense of “Due Process” last week by deporting accused (but not proven) alleged gang member <a href="https://www.nytimes.com/article/abrego-garcia-trump-deportations-el-salvador.html">Kilmar Abrego Garcia</a> to an El Salvador top security prison along with 220 others, and ignoring a court order to return the planes while still in flight, Trump basically thumbed his nose at America’s legal system. This was <a href="https://thehill.com/homenews/senate/5257862-senator-john-kennedy-trump-court-orders/">a bridge too far,</a> even for some of his political supporters in Congress.
With that case still in litigation, the Administration tried to repeat the publicity stunt with another group of accused aliens this past weekend and was slapped down by the <a href="https://www.cbsnews.com/news/supreme-court-temporarily-blocks-new-deportations-under-alien-enemies-act/">Supreme Court </a>in an unanimous decision. 
What Trump is learning the hard way is that without “Due Process” the law profession might as well hang up its shingle. Trump thought he had Chief Justice Roberts in his pocket when he purposefully allowed himself to be caught on a hot mic as he passed the Chief Justice on his way to deliver the 2025 State of the Union Address. <a href="https://www.msnbc.com/deadline-white-house/deadline-legal-blog/trump-speech-congress-thanked-supreme-court-john-roberts-rcna194892">His words</a> for the camera, “Thank you again. Thank you again. Won’t forget it.”  were intended to signal to the world, He owes me big time, and I own him.
A common “Due Process” thread connecting these two current events (the Pope’s death and the illegal deportation of Kilmar Albrego Garcia)  includes another Supreme Court Justice – Antonio Scalia. Catholic and trained by Jesuits, he shared a common lineage with Pope Francis, the first Jesuit ever to lead the Catholic Church. Other Justices also share this Jesuit educational parentage including Clarence Thomas, Brett Kavanaugh, and Neil Gorsuch. 
But Francis and Antonin have a second historical connection. Pope Francis, the day before the 2025 State of the Union address, publicly labeled the immigration policies of the incoming President and Vice President, “a disgrace.” More recently, the Vatican spoke out in opposition to last weeks El Salvador imprisonments. Part of criticism tracks back to the lack of “Due Process.” 
Glaringly obvious today, this was<a href="https://www.brennancenter.org/our-work/analysis-opinion/project-2025s-plan-criminal-justice-under-trump"> just one arm </a>of an aggressive Project 2025 campaign against America’s Legal Profession. By late March,<a href="https://thehill.com/regulation/court-battles/5211686-trump-administration-targets-law-firms/"> multiple DC based law firms</a> pledged allegiance to the Trump Administration to avoid being barred from entering Federal buildings to represent their clients. Some members of the targeted firms resisted. For example, Skadden associate, Rachel Cohen, resigned from her firm in protest, stating, “It does just all come around to, is this industry going to be silent when the president operates outside the balance of the law, or is it not?”

<a href="https://www.commoncause.org/wp-content/uploads/2025/04/Skadden-Alumni-Letter-Finalv2.pdf">Former Skadden alumni</a> spoke out in mass along with Rachel this week. Eighty plus former associates of the firm signed on to a letter of public protest that stated in part, “As alumni of Skadden, we write to express our profound disappointment and deep outrage regarding the firm’s recent agreement with President Donald Trump. At a time when rule of law, freedom of speech, and the adversarial system collectively face existential threat, Skadden’s agreement with President Trump emboldened him to further undermine our democracy.”
As it turns out, one current Skadden Associate’s voice, from 9 years ago when she was still a student at Harvard Law, has brought legendary conservative justice, Antonin Scalia, into the mix. Back then <a href="https://www.skadden.com/professionals/d/dicksmireaux-lucy">Lucy Dicks-Mireaux </a>described herself as <a href="https://journals.law.harvard.edu/crcl/justice-scalia-in-the-fight-for-due-process/">“a liberal, minority woman” </a>who believed that “many of Justice Scalia’s opinions set equality back several decades—further back than his three decades on the Court would suggest.”
But she wrote in the<a href="https://journals.law.harvard.edu/crcl/justice-scalia-in-the-fight-for-due-process/"> May 4, 2016 issue </a>of the “Harvard Civil Rights-Civil Liberties Law Review,” that she had a partial change of heart “when I read Justice Scalia’s dissent in <a href="https://supreme.justia.com/cases/federal/us/542/507/dissent.html">Hamdi v. Rumsfeld</a> (and found) that I agree with him.”  
As Dicks-Mireaux went on to explain at the time: “In Hamdi, the U.S. military detained Hamdi, a U.S. citizen, in the United States as an ‘<a href="https://supreme.justia.com/cases/federal/us/542/507/opinion.html">enemy combatant</a>‘ without a trial. The military believed Hamdi to be working with the Taliban, but did not bring a criminal suit against him. Hamdi’s father filed a writ of habeas corpus, a petition asking Hamdi to be delivered to the court or released absent a trial. The majority opinion curtailed Hamdi’s due process right by allowing him to be detained with a meager showing by the government of evidence that they had a reason to hold Hamdi. The tribunal before which Hamdi would be afforded a chance to rebut these allegations would not be a court of law, but a neutral decision maker. Hearsay evidence would be allowed. Hamdi would be presumed guilty until proven innocent.”
In a prescient remark that followed, we see how relevant her analysis a decade ago is to the current battle to return Kilmar Albrego Garcia. She states, “I was very disturbed by the extent to which the Court would curtail an essential constitutional right—due process—in the face of vague national security concerns.” 
To her surprise, so was Justice Scalia. As <a href="https://journals.law.harvard.edu/crcl/justice-scalia-in-the-fight-for-due-process/">she explained</a>, “The voice of reason came from an unexpected source: Justice Scalia. Arguing that the government could not hold citizens unless the government prosecuted them, Justice Scalia would have granted habeas corpus (fundamental protection against unlawful detention). Justice Scalia would have required that the government either promptly bring charges against Hamdi in a court of law, or Congress would have to suspend habeas corpus. I could not believe that Justice Scalia was advocating for the little guy, but here he was, in black and white, writing that Hamdi deserved better than what the court had offered. Hamdi deserved better because the law required it.”
Attorney Dicks-Mireaux joined Skadden after graduating from Harvard Law School in 2018. She is an Associate in their Litigation Department, and in 2023, she received “High Honors” by the <a href="https://www.dccourts.gov/sites/default/files/2023_Pro_Bono_Honor_Roll_Individual.pdf">DC Courts</a> for her “Pro Bono” work. Will her skills be put to Trump’s use in the future? 
As many top lawyers in the United States, and religious leaders within the Catholic Church and beyond well understand, human rights are not only God-given, but also intended to be vigorously defended under the “Due Process Claus” of our Constitution. If we fail in this regard, we can hardly claim to be just citizens of these United States. As St. Ignatius Loyola said, and his disciple Pope Francis embodied to the very end, “If our church is not marked by caring for the poor, the oppressed, the hungry, we are guilty of heresy.”
Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of<a href="http://www.codeblue.online/"> CODE BLUE: Inside America’s Meddcal-Industrial Complex</a>. (Grove/2020)
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<title>Roon – the Demo and Interview</title>
<link>https://thehealthcareblog.com/blog/2025/04/24/roon-the-demo-and-interview/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Thu, 24 Apr 2025 06:25:00 +0000</pubDate>
<category><![CDATA[Health Tech]]></category>
<category><![CDATA[Matthew Holt]]></category>
<category><![CDATA[THCB Spotlights]]></category>
<category><![CDATA[Medical Content]]></category>
<category><![CDATA[Rohan Ramakrishna]]></category>
<category><![CDATA[Roon]]></category>
<category><![CDATA[Vikram Bhaskaran]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109208</guid>
<description><![CDATA[I was a little surprised that in the days of limitless content, AI, and all types of medical information being online a company could raise $15m to create a platform where actual<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/24/roon-the-demo-and-interview/">Continue reading...</a>]]></description>
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<span style="font-size: 11.5pt; font-family: Roboto, sans-serif; color: rgb(13, 13, 13); font-style: italic; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; vertical-align: baseline;">I was a little surprised that in the days of limitless content, AI, and all types of medical information being online a company could raise $15m to create a platform where actual doctors could answer specific questions that patients might have. Vikram Bhaskaran, the CEO is ex Pinterest and knows the consumer world well. Rohan Ramakrishna is a neurosurgeon who is worried about the level of misinformation that he saw showing up in his clinic daily. So Roon is trying to build what might be the impossible, a free personalized (mostly video) guide for health powered by the world’s best experts. They gave me a tour of what they have built so far, and it’s both impressive, ambitious and has a way to go. It’s an interesting demo and it raises some interesting questions about how that knowledge will be shared in the very near future–<span style="font-size: 11.5pt; font-family: Roboto, sans-serif; color: rgb(13, 13, 13); font-weight: 700; font-style: italic; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-variant-position: normal; font-variant-emoji: normal; vertical-align: baseline;">Matthew Holt
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<iframe loading="lazy" title="Roon - the Demo and Interview" width="639" height="359" src="https://www.youtube.com/embed/sU1wD_h9Ts0?feature=oembed" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe>
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<title>Fair Warning: There Won’t Be Fair Warnings</title>
<link>https://thehealthcareblog.com/blog/2025/04/23/fair-warning-there-wont-be-fair-warnings/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Wed, 23 Apr 2025 09:44:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[DOGE]]></category>
<category><![CDATA[EPA]]></category>
<category><![CDATA[FDA]]></category>
<category><![CDATA[Kim Bellard]]></category>
<category><![CDATA[Musk]]></category>
<category><![CDATA[NIH]]></category>
<category><![CDATA[Trump]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109202</guid>
<description><![CDATA[By KIM BELLARD Perhaps you are the kind of person who acts as though that the food in the grocery store somehow magically appears, with no supply chain vulnerabilities along the way.<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/23/fair-warning-there-wont-be-fair-warnings/">Continue reading...</a>]]></description>
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<figure class="alignright size-full"><img decoding="async" loading="lazy" width="256" height="256" src="https://thehealthcareblog.com/wp-content/uploads/2020/01/1_nqqfyFoqgU0fwhWi8cOHbQ.jpg" alt="" class="wp-image-97379" srcset="https://thehealthcareblog.com/wp-content/uploads/2020/01/1_nqqfyFoqgU0fwhWi8cOHbQ.jpg 256w, https://thehealthcareblog.com/wp-content/uploads/2020/01/1_nqqfyFoqgU0fwhWi8cOHbQ-150x150.jpg 150w, https://thehealthcareblog.com/wp-content/uploads/2020/01/1_nqqfyFoqgU0fwhWi8cOHbQ-120x120.jpg 120w" sizes="(max-width: 256px) 100vw, 256px" /></figure></div>
By KIM BELLARD
Perhaps you are the kind of person who acts as though that the food in the grocery store somehow magically appears, with no supply chain vulnerabilities along the way. You trust that the water that you drink and the air you breathe are just fine, with no worries about what might have gotten into them before getting to you. You figure that the odds of a tornado or a hurricane hitting your location are low, so there’s no need for any early warning systems. You believe that you are healthy and don’t have to worry about any pesky outbreaks or outright epidemics.
Well, I worry about all those, and more. Say what you will about the federal government – and there’s plenty of things it doesn’t do well – it has, historically, served as the monitoring and warning system for these and other potential calamities. Now, under DOGE and the Trump Administration, many of those have been gutted or at least are at risk.
But, at the end of the day, the thing at risk is us.
Here is a not exhaustive list of examples:
FDA: Although HHS Secretary Kennedy has vowed he will keep the thousands of inspectors who oversee food and drug safety, it has<a href="https://www.reuters.com/world/us/us-fda-suspends-food-safety-quality-checks-after-staff-cuts-2025-04-17/"> already suspended</a> a quality control program for its food testing laboratories, and<a href="https://www.npr.org/sections/shots-health-news/2025/04/18/nx-s1-5364544/fda-inspections-layoffs-food-and-drug-supply-less-safe"> has cut support staff</a> that, among other things, make arrangements for those inspectors to, you know, go inspect.  Even before recent cuts, a<a href="https://www.gao.gov/products/gao-25-106775"> 2024 GAO report</a> warned that the FDA was already critically short on inspectors.
The FDA<a href="https://www.cbsnews.com/news/fda-lays-off-bird-flu-leadership-among-steep-cuts-to-senior-veterinarians/"> has already laid</a> off key personnel responsible for tracking bird flu, including virtually all of the leadership team in the Center for Veterinary Medicine’s office of the director. Plus: “The food compliance officers and animal drug reviewers survived, but they have no one at the comms office to put out a safety alert, no admin staff to pay external labs to test products,” one FDA official, who was not authorized to speak publicly, told CBS News.
Even worse, drafts of the Trump budget proposal would further slash FDA budget, in part by moving “routine” food inspections to states.  
CDC: Oh, gosh, where to start? Cuts<a href="https://www.washingtonpost.com/health/2025/04/18/cdc-layoffs-rfk-jr-sexually-transmitted-diseases/"> have shut down</a> the labs that help track things like outbreaks of hepatis and antibiotic-resistant gonorrhea. We’re having a hard time tracking the current measles outbreak that started in Texas and<a href="https://www.nbcnews.com/data-graphics/track-measles-outbreak-cases-us-map-rcna198932"> has now spread to over half the states</a>.
The White House<a href="https://www.nytimes.com/2025/04/21/us/politics/trump-birthrate-proposals.html"> wants to encourage</a> more people to have babies, but<a href="https://www.washingtonpost.com/health/2025/04/19/cdc-cuts-maternal-mortality-fertility/"> has cut back</a> on a national surveillance program that collects detailed information about maternal behaviors and experiences to help states improve outcomes for mothers and babies. It helped, among other things, compare IVF clinics. “We’ve been tracking this information for 38 years, and it’s improved mothers’ health and understanding of mothers’ experiences,” one of the statisticians let go<a href="https://www.washingtonpost.com/health/2025/04/19/cdc-cuts-maternal-mortality-fertility/"> told The Washington Post</a>.
The Office on Smoking and Health was effectively shuttered, in what one expert<a href="https://www.statnews.com/2025/04/14/cdc-closing-office-smoking-health-called-gift-to-big-tobacco-by-former-osh-director/"> called</a> “the greatest gift to the tobacco industry in the last half century.”  CDC cuts<a href="https://www.reuters.com/business/healthcare-pharmaceuticals/us-consumer-safety-agency-stop-collecting-swaths-data-after-cdc-cuts-2025-04-16/"> will force</a> the Consumer Product Safety Commission (CPSC) to stop collecting data on injuries that result from motor vehicle crashes, alcohol, adverse drug effects, aircraft incidents and work-related injuries.
And if you’re thinking of taking a cruise, you should know that the CDC’s cruise ship inspections<a href="https://www.cbsnews.com/news/cdc-cruise-ship-inspectors-layoffs-outbreaks-norovirus/"> have all been laid off</a> – even though those positions are paid for by the cruise ship companies, not the federal government.
EPA: Even though EPA head Lee Zeldin “absolutely” guarantees Trump cuts won’t hurt either people or the environment, the EPA<a href="https://www.propublica.org/article/trump-epa-greenhouse-gas-reporting-climate-crisis"> has already announced</a> it will stop collecting data on greenhouse gas emissions, is shutting down all environmental justice offices and is ending related initiatives, “a move that will impact how waste and recycling industries measure and track their environmental impact on neighboring communities.”
The EPA<a href="https://www.theguardian.com/us-news/2025/mar/19/trump-epa-pollution-regulation-cuts"> has proposed</a> rolling back 31 key regulations, including ones that limit limiting harmful air pollution from cars and power plants; restrictions on the emission of mercury, a neurotoxin; and clean water protections for rivers and streams. Mr. Zeldin called it the “greatest day of deregulation our nation has seen” and declared it a “dagger straight into the heart of the climate change religion.” But, sure, it won’t hurt anything.

The EPA<a href="https://www.ehn.org/epa-plans-to-ease-coal-ash-rules-as-industry-pushes-to-cut-costs"> is also proposing</a> to loosen rules about coal ash storage and disposal. Most of us don’t know much about coal ash but Environmental Health News<a href="https://www.ehn.org/epa-plans-to-ease-coal-ash-rules-as-industry-pushes-to-cut-costs"> warns</a>: “Coal ash is one of the largest industrial waste streams in the United States, containing toxic elements such as arsenic, mercury, and lead.” Meanwhile, sister agency NIOSH<a href="https://www.washingtonpost.com/climate-environment/2025/04/21/coal-miners-health-safety-cuts/"> has laid off</a> two-thirds of the staff who do black lung screening for coal miners, despite President Trump’s purported love of coal miners.
NIH: what’s happening to the NIH deserves and article on its own, some of which I’ve<a href="https://medium.com/@kimbellard/goodbye-american-science-4a9ae85b0b27"> covered before</a>. The Trump Administration has frozen much research in its track, laid off a generation of young scientists, is severely cutting the amount of overhead funding that research universities have come to rely on, and is now using NIH grants for political extortion (take that, Columbia ad Harvard!).
Its proposed budget<a href="https://www.science.org/content/article/trump-proposes-massive-nih-budget-cut-and-reorganization"> would cut</a> NIH’s budget nearly in half and consolidate its 27 agencies into eight. “This is going to completely kneecap biomedical research in this country,” Jennifer Zeitzer, deputy executive director at the Federation of American Societies for Experimental Biology,<a href="https://www.science.org/content/article/trump-proposes-massive-nih-budget-cut-and-reorganization"> told Science</a>.
I could go on with other agencies, I would be remiss if I didn’t note that cuts at the<a href="https://www.latimes.com/california/story/2025-04-17/californias-national-weather-service-offices-reduce-services-amid-trump-admin-cuts"> National Weather Service</a> and<a href="https://www.pbs.org/newshour/nation/as-noaa-braces-for-more-cuts-scientists-say-public-safety-is-at-risk"> NOAA</a> will mean “<a href="https://www.nytimes.com/2025/04/16/climate/national-weather-service-forecast-doge-trump.html">degraded operations</a>” that, mark my words, will come back to haunt us.
————-
ProPublica<a href="https://www.propublica.org/article/trump-doge-data-collection-hhs-epa-cdc-maternal-mortality?utm_source=bluesky&utm_medium=social&utm_campaign=propublica-bsky&utm_content=1"> calls</a> the Administration’s efforts as a “war on measurement”:
In agency after agency, the government is losing its capacity to measure how American society is functioning, making it much harder for elected officials or others to gauge the nature and scale of the problems we are facing and the effectiveness of solutions being deployed against them.
It goes on to assert: “Looked at one way, the war on measurement has an obvious potential motivation: making it harder for critics to gauge fallout resulting from Trump administration layoffs, deregulation or other shifts in policy.”
The efforts are also a war on science. Climate change deniers and vaccine deniers are examples of how we’ve entrusted our lives and health to people who reject well-established science in favor of their own personal beliefs, especially when that will make more money for big donors.
This is a crisis. This is a catastrophe. This is our future, and we won’t know some of it is happening until it is far too late to do anything about it.   
Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented <a href="http://tincture.io/">Tincture.io</a>, and now regular THCB contributor
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<title>Residency and Parenting Are Incompatible</title>
<link>https://thehealthcareblog.com/blog/2025/04/22/109197/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Tue, 22 Apr 2025 07:20:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Medical Practice]]></category>
<category><![CDATA[child care]]></category>
<category><![CDATA[Emily Johnson]]></category>
<category><![CDATA[hospital]]></category>
<category><![CDATA[Medical Education]]></category>
<category><![CDATA[Medical residency]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109197</guid>
<description><![CDATA[By EMILY JOHNSON Being a parent during residency requires one or more of the following: ●     Family and/or friends nearby who are willing and able to provide free childcare ●<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/22/109197/">Continue reading...</a>]]></description>
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<figure class="alignright size-full is-resized"><img decoding="async" loading="lazy" width="683" height="1024" src="https://thehealthcareblog.com/wp-content/uploads/2025/04/EmilyJohnson2021-1-683x1024-1.jpg" alt="" class="wp-image-109199" style="aspect-ratio:0.6669921875;width:227px;height:auto" srcset="https://thehealthcareblog.com/wp-content/uploads/2025/04/EmilyJohnson2021-1-683x1024-1.jpg 683w, https://thehealthcareblog.com/wp-content/uploads/2025/04/EmilyJohnson2021-1-683x1024-1-200x300.jpg 200w, https://thehealthcareblog.com/wp-content/uploads/2025/04/EmilyJohnson2021-1-683x1024-1-100x150.jpg 100w" sizes="(max-width: 683px) 100vw, 683px" /></figure></div>
By EMILY JOHNSON 
Being a parent during residency requires one or more of the following:
●     Family and/or friends nearby who are willing and able to provide free childcare
●     A stay-at-home spouse/co-parent
●     A spouse/co-parent who is willing to let their own career to be a distant second priority beneath family responsibilities and the resident’s career
●     Significant amounts of generational wealth that allow you to outsource household and childcare obligations with money you didn’t personally earn
●     High levels of financial risk tolerance and willingness to incur extraordinary levels of debt above and beyond<a href="https://educationdata.org/average-medical-school-debt"> average medical school debt</a> ($234k!). 
Because medical residency in the United States is incompatible with being a parent.
It is a Sunday evening, and I am writing this as I wait for my husband to get back from the hospital. He was “on call” today, which, in lay terms means his work hours were “all day.” He was out the door before I woke up, and it is now 9:30pm and Find My shows that he is still at the hospital. So that means he’s on hour 15 or 16 of his workday, and he could be leaving in a few minutes, or he could be there for another few hours (and I have no idea which).
I do know he got at least a 15-minute break today, because our toddler and I went to the hospital today to have lunch with him. Why interrupt his workday, drag a toddler across town right before nap time (thereby risking the loss of my cherished mid-day downtime because of the dreaded car nap), and pay for parking and mediocre cafeteria food on a Sunday? Because if I hadn’t, I truly don’t know when my son would have seen his dad next.
This pattern – out before the family wakes up, back after bedtime- is the rule, not the exception. An “early” day might mean he gets out before 7pm – but that doesn’t guarantee that he’ll see our toddler, who goes to bed between 7 and 7:30pm.  
As a medical spouse with a young child, of the most infuriating comments I ever hear is among the lines of “but don’t they cap work hours now?” Or even worse – the occasional insinuation that perhaps today’s residents have it “too easy” because of work hour restrictions. Because the answer is yes –<a href="https://psnet.ahrq.gov/primer/duty-hours-and-patient-safety"> work hours are technically capped at 80 hours/week</a> – but let’s talk about that: 
First, here’s what an 80 hour/week schedule looks like, in case you haven’t worked one lately:
<figure class="wp-block-table"><table><tbody><tr><td> </td><td>Mon</td><td>Tues</td><td>Weds</td><td>Thurs</td><td>Friday</td><td>Sat</td><td>Sun</td></tr><tr><td>Start</td><td>6:45am</td><td>6:45am</td><td>6:45am</td><td>6:45am</td><td rowspan="3">OFF(but studying for upcoming board exam)</td><td>6:45am</td><td>6:45am</td></tr><tr><td>End</td><td>8pm</td><td>6pm</td><td>5:30pm</td><td>8pm</td><td>8pm</td><td>10pm</td></tr><tr><td>Total Hours</td><td>13+</td><td>11</td><td>11</td><td>13+</td><td>13+</td><td>16 (and counting)</td></tr></tbody></table><figcaption class="wp-element-caption">Total: 77 + study time (Bingo! No problems here! Under 80 hours/week)</figcaption></figure>
Second, from a caregiving perspective, an 80/hour week cap is laughable, because you can still miss 100% of a toddler’s waking hours most days of the week on an 80 hour/week schedule.

And third, the fine print on work-hour restrictions for residents is that it is averaged over a 4-week period, so they could’ve kept him there even longer if there were a few lighter days sometime over the next few weeks. 
There are several challenges of being a parent in residency, but the most fundamental one is just the math. No day care centers are open 24/7, so if you don’t have family nearby, a stay-at-home spouse, or a spouse working a different and much more flexible career, your only childcare option would be finding a nanny who can align their work hours with yours. 
The rate in our area for a nanny with experience is at least $20/hour, before taxes. Let’s bump that up to at least $25/hour, because you will need to find a nanny who is willing to align with your schedule, meaning they will oftentimes not know their schedule until a few weeks beforehand, do not know when their shift will end each day, and are willing to work any day of the week and any hour of the day, as well as weekends and holidays. Ha! Just bear with me. 
In Minnesota, you are required to pay nannies hourly and required to pay overtime for any hours worked over 40. So, you’re either looking at shelling out significant amounts of overtime pay or hiring (and coordinating!) two nannies to split coverage.
The first-year salary for a resident at the University of Minnesota where my husband works is<a href="https://med.umn.edu/gme/education/current-residents-fellows/employment-related-information"> about $69,000</a>. At an average of 60 hours/week (which is conservative), that’s about $22/hour, before taxes. There is no overtime, no overnight pay differentials, and no holiday pay. 
You do the math. It’s not possible to make this work unless you have local family, a spouse with a different and secondary career, inherited wealth, or the willingness to incur extraordinary levels of debt. And even if you do have one or more of those things, it can still be a nightmare. 
You might think: just wait until you’re done with residency to have kids. 
Most medical schools are 4 years, and residency ranges<a href="https://www.ama-assn.org/medical-students/specialty-profiles/medical-specialty-choice-should-residency-training-length"> from 3-7 years</a> depending on which specialty you choose. The average age of<a href="https://www.ama-assn.org/medical-students/preparing-medical-school/going-directly-college-medical-school-what-it-takes"> medical school matriculants is 24</a>. So residents are typically finishing their training between ages 31-35 (later if they took any gap years for research or completed a fellowship). The American Academy of Obstetricians and Gynecologists says that<a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/03/female-age-related-fertility-decline"> fertility begins to decline around age 32</a>.
So for many doctors, waiting until after residency isn’t just a personal sacrifice – it may be biologically risky or impossible.
But here’s the kicker: not only does my husband love being a dad, it has also made him better at his job. He has told me this on numerous occasions, citing specific examples each time. 
We went through the ringer with pregnancy, delivery, and postpartum, which educated him about the process and experience of creating and birthing human life in ways well beyond what his textbooks and OBGYN rotation could offer. 
He now understands much more about child behavior, child development, and what it is like to be a caregiver, rather than a physician, in a clinic setting. 
And most crucially, he now understands what it is like to be a parent, which is an experience shared by<a href="https://news.gallup.com/poll/511238/americans-preference-larger-families-highest-1971.aspx"> nearly 70% of US adults</a> – helping him empathize and develop rapport more easily with the patients he works with and cares for every day.  
Until recently I have been embarrassed to admit how much we are struggling, because we’re some of the lucky ones:
●     My parents are retired, live 5 minutes away, and provide an immense level of (free) help
●     I have a flexible job that allows me to step away for every pediatrician’s appointment or sudden illness. I can work from home if we have a blizzard or a -20 degree day that disrupts our childcare arrangements.
●     We both come from upper-middle-class families that have given us a huge financial leg-up, most notably the lack of undergrad student loans to tack onto our medical school loans. 
What right do we have to complain, when so many other resident families have it much, much worse? I’m looking at you,<a href="https://www.ama-assn.org/medical-residents/medical-resident-wellness/why-doctors-marry-doctors-exploring-medical-marriages#:~:text=Two%2Dphysician%20families%20often%20face,perspective%20and%20passion%20for%20medicine."> two-resident couples</a>.
But I’ve come to realize that’s precisely the reason I do need to say this out loud: even with all that support, we are still struggling mightily to make this arrangement work. And “making it work” is a generous way to put it when our toddler spends much of his time asking about daddy, pretending to go see daddy at work via his Cozy Coupe, and possessively screaming “No! My daddy! MY DADDY!!!!” whenever someone else interacts with my husband on his singular day off each week.
If we want physicians in this country to have children, and to actually see those children, the system needs to be designed to make that possible.
Right now, it isn’t.
Emily Johnson, MHA, is a healthcare strategist exploring the fine line between personal experience and professional responsibility in the world of healthcare leadership.
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<title>How Using Opioids for Acute Pain is Like Burning Coal for Energy</title>
<link>https://thehealthcareblog.com/blog/2025/04/21/how-using-opioids-for-acute-pain-is-like-burning-coal-for-energy/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Mon, 21 Apr 2025 08:51:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Coal]]></category>
<category><![CDATA[Fentanyl]]></category>
<category><![CDATA[Matt McCord]]></category>
<category><![CDATA[Opiods]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109194</guid>
<description><![CDATA[By MATT McCORD Using opioids to treat acute pain is a lot like burning coal to power our homes. Both are legacy solutions from an earlier era. Both were once celebrated as<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/21/how-using-opioids-for-acute-pain-is-like-burning-coal-for-energy/">Continue reading...</a>]]></description>
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By MATT McCORD
Using opioids to treat acute pain is a lot like burning coal to power our homes. Both are legacy solutions from an earlier era. Both were once celebrated as breakthroughs. And both have since proven to be dirty, dangerous, and incredibly costly to clean up. Despite this, we continue to rely on them, even as safer, smarter alternatives sit right in front of us.
Coal fueled the Industrial Revolution—but it did so at a steep price: polluted air, poisoned water, caused respiratory illness, and climate instability. It was never a clean solution, just a convenient one. Similarly, opioids became the go-to solution for pain not because they were ideal, but because they were easy. They blunt pain quickly, require no special skill to administer, and were aggressively marketed to physicians as safe and effective. We now know the truth: opioids for acute pain can ignite a chain reaction that leads to dependence, chronic pain, disability, and even death.
Short-Term Relief, Long-Term Consequences
The similarities run deep. Coal gives you power today but saddles society with pollution and disease tomorrow. Opioids offer pain relief in the moment but often leave patients worse off in the long run. In both cases, what’s convenient in the short term creates massive long-term externalities—not for the industries that profit, but for the workers, families, and communities left to clean up the mess.
Systemic Pollution
Coal pollution clogs lungs and chokes rivers. Opioids pollute something more intimate—the brain’s natural ability to regulate pain.
Acute use of opioids disrupts normal pain modulation, leading to a phenomenon called opioid-induced hyperalgesia—a worsening sensitivity to pain. It’s like installing a furnace that makes your house colder over time, requiring more fuel just to maintain baseline comfort. That’s the trap many patients fall into after routine surgery or injury.
Hidden Costs and Broken Systems
Coal seems cheap—until you calculate the health consequences, environmental damage, and regulatory burden. The same is true for opioids. The prescription may be covered by insurance, but the downstream effects—addiction treatment, emergency room visits, lost productivity, broken families, foster care placements, criminal justice costs, and overdose deaths—are paid for by the rest of us. And the price is staggering. Like coal, opioids externalize their costs, masking the true price we all pay.
Entrenched Interests and Resistance to Change
Just as coal was propped up by powerful lobbies and outdated infrastructure, opioids have persisted because of habit, inertia, and industry influence. For decades, pharmaceutical companies promoted opioids with junk science and aggressive marketing. Today, the pharmaceutical industry continues to shape public perception—not just through lobbying, but through the media itself. Pharmaceutical companies are among the largest advertisers on television, particularly during news programming. This significant advertising presence may influence media narratives, potentially downplaying the role of prescription opioids in the opioid crisis.
As a result, the public is often fed a new narrative: that fentanyl is the problem, not prescription opioids. 

But this is dangerously misleading. According to the National Institute on Drug Abuse, approximately 75% of people with opioid use disorder began with a legally prescribed opioid. It’s only when we fail to taper appropriately or offer effective alternatives that patients turn to illicit drugs—now increasingly laced with fentanyl. This shift in blame masks the root cause and perpetuates a dangerous cycle.
We Have Better Alternatives
The good news is that better pain solutions exist. Just as solar, wind, and even modern nuclear energy are reshaping the power economy, modern pain care is increasingly multimodal, non-opioid, and personalized. Safer, smarter options are already available—from nerve blocks and anti-inflammatory care to non-addictive medications like ketamine and gabapentin, along with physical therapy and proven mind-body approaches like cognitive behavioral therapy. These techniques don’t just relieve pain—they do it more effectively, with less risk, greater long-term success, and without disrupting the body’s natural pain-regulating systems. They don’t just cover up pain—they treat its causes.
Quitting Coal Healed Our Environment
The air cleared, the water got cleaner, and entire communities began to thrive. The same will be true for opioids. When we stop overprescribing them for acute pain, we’ll see fewer addictions, fewer deaths, and a stronger, more resilient society. But that future won’t come on its own. Like coal, opioids won’t disappear quietly—they must be replaced. The coal era is over. It’s time the opioid era was too.
Matt McCord, MD is Cofounder and Executive Director of <a href="https://opioidfreesolutions.com/">Opioid Free Solutions</a>
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<title>How Health Systems are Losing Contact with their Clinicians</title>
<link>https://thehealthcareblog.com/blog/2025/04/18/how-health-systems-are-losing-contact-with-their-clinicians/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Fri, 18 Apr 2025 07:27:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Health system change]]></category>
<category><![CDATA[Hospitals]]></category>
<category><![CDATA[Jeff Goldsmith]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109191</guid>
<description><![CDATA[By JEFF GOLDSMITH Jeff wrote this article for Hospitals & Health Networks in the July 5, 1998 edition. He republished it this week on his substack calling it a “27th anniversary edition”.<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/18/how-health-systems-are-losing-contact-with-their-clinicians/">Continue reading...</a>]]></description>
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By JEFF GOLDSMITH
Jeff wrote this article for Hospitals & Health Networks in the July 5, 1998 edition. He republished it this week on his substack calling it a “27th anniversary edition”. It’s an enlightening piece, but as you read it please ask yourself. What, if anything, has changed, and did anything get better?–Matthew Holt
It is hard not to be impressed by the sweep of change, both in the capabilities of the American health system and in health care organizations, over the last 20 years. In the space of a single generation, health services have evolved from a cottage industry into a substantial corporate enterprise. A breathtaking array of new technologies has been added to the hospital’s diagnostic and therapeutic capability. Hospitals have also managed-though not always gracefully-the transition to a more ambulatory and community-based model of care.
Through all these changes, the hospital has remained a central actor in the health system — and despite periodic political challenges, its economic position has significantly strengthened. But this success has come at a terrible price: the increasing alienation of professionals who are the lifeblood of health care and who bear most of the moral risk of the health care transaction.
As organizations have integrated structurally, they have disintegrated culturally. Not merely physicians, but also nurses, technicians, and social workers have seen themselves transformed into commodities and marginalized by the corporate ethos of health services. Professional discontent has intensified as physician practice has become increasingly incorporated into the hospital and as health systems have begun rationing care through captive health plans.
The gulf between managers and professionals — and even between senior and middle management — has widened into a chasm. At its peak financial strength and amid a record economic expansion, the health field has grown ripe for unionization. In fact, the labor climate among health professionals has become so hostile toward management that organizing health services could single-handedly revive the dying union movement in the United States.
Some of this tension is a by-product of the pressure to reduce the excess hospital capacity that health systems have inherited. To move from the present concentration of ownership to consolidation of excess capacity will inevitably mean workforce reductions or redeployment. The fact that little actual reduction in hospital workforce capacity has taken place so far doesn’t mean that the pressure to cut jobs and improve productivity isn’t real and tangible — or that it won’t increase in the future.
But the origin of workforce problems in hospitals and health systems runs deeper than the pressure to consolidate. In little more than a generation, management of hospitals has moved from a passive, custodial, and largely benign “administrative” tradition to an aggressive, growth-oriented entrepreneurial management framework. 

It’s hard to dispute the economic success of these growth strategies. Since 1978, hospitals’ net revenues have increased almost five-fold, from $71 billion to more than $350 billion. Despite the challenges of managed care, hospital profitability soared to a record level in 1997.
At the same time, operations — the critical interface between technology, professionals, and patients – have taken a back seat to deal-making and “positioning” relative to managed care in most executive suites. This migration didn’t occur overnight. Over the past two decades, in breathless sequence, hospitals have reorganized, diversified, consolidated, “integrated,” built regional health care networks, evolved captive financing vehicles, and incorporated an astonishing array of new technologies and services.
The resulting modem enterprise is often a billion dollars large. Health systems, without realizing it, have grown to the point where they dwarf both the patient and caregiver who must work within them. However powerful their capabilities, many health care enterprises have grown beyond human scale and have lost their focus on the daily life-and-death struggles occurring within their walls.
The focus on growth also has led to a failure to develop or encourage the culture of operational excellence needed to run health systems thoughtfully, efficiently, and safely. Only recently have health service researchers begun tallying the cost of using our increasingly complex health system.
In the past 20 years, the hospital nosocomial infection rate has risen 36 percent. Up to 180,000 Americans die in hospitals each year of treatment-related causes, and about half those deaths are preventable. Adverse drug reactions are thought to kill 100,000 patients a year in U.S.hospitals. In many metropolitan areas, as much as a fivefold variation in mortality risk for common surgical procedures exists among hospitals, Given our health system’s capabilities, the human cost of using it is unacceptably steep.
Most Americans understand neither the magnitude nor the type of risk they run. They believe that some invisible force-the government, perhaps-has created a uniformly high-quality standard that protects them when they use the health system. But the illusion is dissolving, replaced by heightened consumer vigilance.
The variation in quality provides a marvelous strategic segue for managed care firms under siege for allegedly interfering with the practice of medicine and damaging quality of care. The best way for health plans to change their image from consumer adversaries to advocates is to become “transparent” to the substantial quality and cost variation in the nation’s health care system. By giving patients both information and economic incentives to select the highest-value providers that pose the lowest risk, managed care plans can help families make intelligent use of the choice they have demanded.
Mastering health care operations and instilling a culture of continuous clinical quality improvement can provide the critical missing ingredient in health systems. Fostering operational excellence is the logical next step in the evolution of health system management. Creating a culture intolerant of avoidable systemic medical error and setting up a collaborative framework for defining what constitutes best medical practice will help reintegrate professionals and managers, specialists and primary care providers, supervisors and caregivers.
After all, as everyone ages, they inevitably use the health system. Efforts to achieve a higher standard of excellence will have measurable benefits for individual patients and for society as a whole. Hospital and health system executives privately applaud the public’s increasingly hostile view of managed care -but they fail to see that the same brush tars them.
The American people do not like the new corporate face of medicine. They do not distinguish between for-profit and not-for-profit health care or, amazingly, between managed care plans and provider conglomerates. Americans believe increasingly that money, not meeting their care needs, is the driving force of the new health care enterprise.
This is not an image problem. It is a reality problem. Addressing it should be an urgent priority for health care managers and trustees. Health care enterprises large and small are stewards of community health. Restoring a human scale and human values to the health system is vital for those who manage our health enterprises. Unless those enterprises can organize to provide measurable value to consumers, and unless managers can unify their organizations to improve the lives and well-being of those in their communities, the management revolution in health services will prove short-lived.
Reconnecting with health care professionals and reconciling professional and managerial values inside hospitals and health systems are essential pre-conditions for creating a safer, more responsive health system.
Jeff Goldsmith is a veteran health care futurist, President of Health Futures Inc and regular THCB Contributor. This comes from his <a href="https://jeffgoldsmith.substack.com/subscribe">personal substack</a>
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<title>Saving U.S. Manufacturing: Think Biotech, Not Cars</title>
<link>https://thehealthcareblog.com/blog/2025/04/16/saving-u-s-manufacturing-think-biotech-not-cars/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Wed, 16 Apr 2025 07:11:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Health Tech]]></category>
<category><![CDATA[Biotech]]></category>
<category><![CDATA[Chine]]></category>
<category><![CDATA[Kim Bellard]]></category>
<category><![CDATA[Manufacturing]]></category>
<category><![CDATA[Technology]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109183</guid>
<description><![CDATA[By KIM BELLARD Amidst all the drama last week with tariffs, trade wars, and market upheavals, you may have missed that the National Security Commission on Emerging Biotechnology (NSCEB) issued its report:<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/16/saving-u-s-manufacturing-think-biotech-not-cars/">Continue reading...</a>]]></description>
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By KIM BELLARD
Amidst all the drama last week with tariffs, trade wars, and market upheavals, you may have missed that the <a href="https://www.biotech.senate.gov/">National Security Commission on Emerging Biotechnology</a> (NSCEB) issued its report: <a href="https://www.biotech.senate.gov/final-report/chapters/">Charting the Future of Biotechnology</a>. Indeed, you may have missed when the Commission was created by Congress in 2022; I know I did.
Biotechnology is a big deal and it is going to get much bigger. John Cumbers, founder and CEO of SynBiobeta, <a href="https://www.synbiobeta.com/read/biotech-is-americas-to-win-if-we-choose-to-lead">writes</a> that the U.S. bioeconomy is now already worth $950Bn, and quotes McKinsey Global Institute as <a href="https://www.mckinsey.com/industries/life-sciences/our-insights/the-bio-revolution-innovations-transforming-economies-societies-and-our-lives">predicting</a> that by 2040, biology could generate up to 60% of the world’s physical inputs, representing a $30 trillion global opportunity. Not an opportunity the U.S. can afford to miss out on – yet that is exactly what may be happening.
The NSCEB report sets the stakes:
We stand at the edge of a new industrial revolution, one that depends on our ability to engineer biology. Emerging biotechnology, coupled with artificial intelligence, will transform everything from the way we defend and build our nation to how we nourish and provide care for Americans.
Unfortunately, the report continues: “We now believe the United States is falling behind in key areas of emerging biotechnology as China surges ahead.”
Their core conclusion: “China is quickly ascending to biotechnology dominance, having made biotechnology a strategic priority for 20 years.<a href="https://www.biotech.senate.gov/final-report/chapters/executive-summary/#reference-1">1</a> To remain competitive, the United States must take swift action in the next three years. Otherwise, we risk falling behind, a setback from which we may never recover.”
NSCEB Chair Senator Todd Young elaborated:
The United States is locked in a competition with China that will define the coming century. Biotechnology is the next phase in that competition. It is no longer constrained to the realm of scientific achievement. It is now an imperative for national security, economic power, and global influence. Biotechnology can ensure our warfighters continue to be the strongest fighting force on tomorrow’s battlefields, and reshore supply chains while revitalizing our manufacturing sector, creating jobs here at home.
“We are about to see decades of breakthrough happen, seemingly, overnight…touching nearly every aspect of our lives—agriculture, industry, energy, defense, and national security,” Michelle Rozo, PhD, molecular biologist and vice chair of NSCEB, <a href="https://www.genengnews.com/topics/translational-medicine/national-commission-outlines-six-ways-to-turbocharge-u-s-biotech-innovation/">said</a> while testifying before the April 8 House Armed Services Committee Subcommittee on Cyber, Information Technologies, and Innovation. Yet, she continued, “America’s biotechnology strengths are atrophying—dangerously.”

Paul Zhang, a partner at Bluestar BioAdvisors, which advises drugmakers on commercial strategies, including seeking business in China, <a href="https://www.wsj.com/tech/biotech/china-biotech-industry-research-threat-e91dddd6?mod=tech_lead_story">explained to The Wall Street Journal</a> how China’s manufacturing aims have evolved: “Initially it was how to do shoes and sneakers faster and cheaper and better. Then it was how to build iPhones faster and better. Now it’s how to build biotech and AI faster and better,”
If you think NSCEB is being alarmist, Julie Heng, writing for the Center for Strategic & International Studies (CSIS), <a href="https://www.csis.org/analysis/understanding-national-security-commission-emerging-biotechnology-report">notes</a>:
Over the past decade, China has dramatically increased its biotech investments, with biopharma R&D growing <a href="https://www.labiotech.eu/in-depth/china-biotech-industry/">400-fold</a> and the market value of biotech firms surging <a href="https://www.state.gov/wp-content/uploads/2024/12/ISAB-Report-on-Biotechnology-in-the-PRCMCF-">100-fold</a> between 2016 to 2021, now reaching a collective value of $300 billion…Notably, 79 percent of U.S. pharmaceutical companies now <a href="https://www.bio.org/gooddaybio-archive/bio-survey-revealsdependence-chinese-biomanufacturing">depend</a> on Chinese contract firms for manufacturing. Furthermore, China is continuing a whole-of-government effort to support its domestic industry with financing, regulatory streamlining, and diplomatic support, <a href="https://www.globalxetfs.com.hk/content/files/China_Government_Initiatives_in_Biotechnology.">building out</a> over 100 biotech research parks and 17 <a href="https://cset.georgetown.edu/publication/chinas-industrial-clusters/">industrial clusters</a>.
It’s worse than just being out-manufactured. The Commission “has every reason to believe that the CCP will weaponize biotechnology,” and describes some scary scenarios, including genetically enhanced “super soldiers,” using microbes to degrade wood and concrete in our buildings and infrastructure, or developing pathogens to only attack crops grown in the U.S. If those don’t scare you, I don’t know what does.
Thus, the Commission says, “if the United States fails to act, the future of biotechnology could be catastrophic.”
The Commission does suggest a plan. The report lays out six “pillars” and makes 49 recommendations. The six pillars are:
<ul>
<li>Pillar 1: Prioritize biotechnology at the national level</li>
<li>Pillar 2: Mobilize the private sector to get U.S. products to scale</li>
<li>Pillar 3: Maximize the benefits of biotechnology for defense</li>
<li>Pillar 4: Out-innovate our strategic competitors</li>
<li>Pillar 5: Build the biotechnology workforce of the future</li>
<li>Pillar 6: Mobilize the collective strengths of our allies and partners</li>
</ul>
The Commission’s goal is not to “out-China China,” but to “lean into our inherent strengths.” Their key recommendation is to invest a minimum of $15b over the next five years, in hopes of attracting even more private capital into the field. It also calls for a National Biotechnology Coordination Office to help drive government strategy.
With all that is at stake, $15b hardly seems like enough. Let’s hope DOGE doesn’t find out.
I should probably note that David Wainer, <a href="https://www.wsj.com/tech/biotech/biotech-industry-trump-tariffs-rfk-jr-62a3cfc1?mod=tech_lead_pos2">writing in WSJ</a>, points out: “The U.S. biotech sector had already been through a brutal few years before the latest market crash… More investors are even wondering if the whole model—risky science, costly funding, political uncertainty and long waits for payoffs—is simply broken. For many of the nearly 200 companies trading below their cash value, it probably is.” Not a market that is inspiring a flood of new investment – at least, not in the U.S.
Dr. Cumbers urges:
We have the Rust Belt and the Bible Belt—now let’s build a Bio Belt: a nationwide network of regional biomanufacturing hubs. These hubs wouldn’t just drive innovation—they’d power economic renewal, especially in rural and industrial regions. While some jobs will go to scientists and engineers, many more will go to tradespeople, factory workers, and high school graduates trained to run and maintain next-gen biofacilities.
And he warns: “If we fail to build the capacity to make what we invent, we’ll watch the returns on American innovation.” We’ve seen that movie too many times, in other sectors, and it doesn’t end well for us.
We definitely do need to make biotechnology a priority,. The federal investment and national coordinating office seem like sound recommendations. The problem is, we need the same in A.I. and in robotics, just to name two other key emerging industries. The current Administration is so focused on bringing back 20th century industries like <a href="https://www.reuters.com/business/energy/trump-sign-executive-orders-boost-coal-industry-sources-say-2025-04-08/">coal mining</a> and <a href="https://www.whitehouse.gov/fact-sheets/2025/03/fact-sheet-president-donald-j-trump-adjusts-imports-of-automobiles-and-automobile-parts-into-the-united-states/">auto manufacturing</a> that I have to wonder: who is looking ahead, not behind?
Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented <a href="http://tincture.io/">Tincture.io</a>, and now regular THCB contributor
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<title>We Need to Nationalize to Prevent Fraud</title>
<link>https://thehealthcareblog.com/blog/2025/04/15/we-need-to-nationalize-to-prevent-fraud/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Tue, 15 Apr 2025 05:28:17 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Matthew Holt]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109187</guid>
<description><![CDATA[By MATTHEW HOLT Two weeks ago I wrote an April Fool’s piece that claimed that Elon Musk and DOGE were going to nationalize American health care to save some money. That piece<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/04/15/we-need-to-nationalize-to-prevent-fraud/">Continue reading...</a>]]></description>
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<figure class="alignright size-full"><img decoding="async" loading="lazy" width="256" height="256" src="https://thehealthcareblog.com/wp-content/uploads/2019/07/Matthew-Holt-1.png" alt="" class="wp-image-96571" srcset="https://thehealthcareblog.com/wp-content/uploads/2019/07/Matthew-Holt-1.png 256w, https://thehealthcareblog.com/wp-content/uploads/2019/07/Matthew-Holt-1-150x150.png 150w, https://thehealthcareblog.com/wp-content/uploads/2019/07/Matthew-Holt-1-120x120.png 120w" sizes="(max-width: 256px) 100vw, 256px" /></figure></div>
By MATTHEW HOLT
Two weeks ago I wrote an <a href="https://thehealthcareblog.com/blog/2025/04/01/musk-moves-us-to-socialized-medicine/">April Fool’s piece that claimed that Elon Musk and DOGE were going to nationalize American health care</a> to save some money. That piece was half-joking but full-serious. 
If you look at what Musk is complaining about there are two major areas of “waste, fraud and abuse” in government spending. 
One is people directly employed by government agencies. Most of the people I’ve ever met in government work damn hard and for much less money than they’d get in the private sector. But you can of course find stories about <a href="https://www.washingtontimes.com/news/2023/jun/29/ex-chemical-safety-agency-chief-misused-90k-on-tri/">useless government bureaucrats, who don’t do any work and pad their expense accounts</a>. Those stories are probably about as true as <a href="https://www.slate.com/articles/news_and_politics/history/2013/12/linda_taylor_welfare_queen_ronald_reagan_made_her_a_notorious_american_villain.html">Reagan’s pink Cadillac driving welfare queen</a> in that there is some basis in reality for there being a tiny minority of bad actors, but the politics has far outrun the truth. (BTW that Welfare Queen article by Josh Levin in Slate is remarkable and very long!)
The other major area where Musk claims to be finding fraud is in work contracted out. There are of course lots of types of government work contracted out. If, like me, you’re old enough to remember the Iraq war, you probably are thinking of beltway bandits like Halliburton supplying any number of services to the military. (Remember when the Cheneys were baddies?). Another is the Blue Cross & Blue Shield plans who were the original contractors processing Medicare & Medicaid claims. Funnily enough they couldn’t actually deliver on that so in turn they outsourced it to Ross Perot at EDS and others like ACS, later Conduent. But there’s a ton more across every agency.
Musk & DOGE have been running around in the most ham-fisted way imaginable, axing both actual employees–including 20,000 of the 80,000 working at HHS– and allegedly slashing $150 billion in contracts. Of course on closer examination, many of the “contracts” <a href="https://www.nytimes.com/2025/02/18/upshot/doge-contracts-musk-trump.html">were already over</a>, or <a href="https://www.nytimes.com/2025/04/13/us/politics/doge-contracts-savings.html">were made up</a>. DOGE has been a pathetic piece of performance art that would be funny if it hadn’t ruined so many <a href="https://thehealthcareblog.com/blog/2025/03/18/109055/">careers of people doing great work</a>, or <a href="https://firstfocus.org/update/doge-and-the-white-house-have-turned-their-backs-on-orphans-and-vulnerable-children/">killed so many desperately poor children in poor countries</a>.
The clever people at Brookings, (<a href="https://www.brookings.edu/people/elaine-kamarck/">Elaine Kamarck</a> and <a href="https://www.brookings.edu/people/paul-c-light/">Paul Light</a>) in a <a href="https://www.brookings.edu/articles/is-government-too-big-reflections-on-the-size-and-composition-of-todays-federal-government/">detailed piece on the topic</a>, came up with an estimate of the ratio between direct employees and contractors. 

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<figure class="alignright is-resized"><img decoding="async" src="https://lh7-rt.googleusercontent.com/docsz/AD_4nXenvzxraWEgYsDRfkg9LX8dHp2H7mPdsg8NkPukQ_MCXGupcfGe--770RXgGO4yIffUYDZ1S9IASQXVykyGsnUshYERFOLjwChPlAuD_nMw_uKfwkAd_-DWWwfmID_YXRWxi9Nx4Q?key=qc-TCS7AluS82sttmhszYDdl" alt="" style="aspect-ratio:1.25;width:644px;height:auto"/></figure></div>
As you can see the number of civil servants (actual employees) has stayed about 2m for nearly 15 years. The amount of contractors has bounced around but been nearly 2.5 times that number. 
For the 4-5m jobs in the contract sector GAO has estimated that the 2023 cost was a tad under $800 billion a year, with 60% of that going to Defense.
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<figure class="alignright is-resized"><img decoding="async" src="https://lh7-rt.googleusercontent.com/docsz/AD_4nXc5cbdMXmGPxg5HUxm6gl3qqlu79N0_ObvjoHlwBDblZ4fsHo56hSL_OJOAm0hAJT21YMjFVd_HcAgU5I8EiZrQSUaymRW-bhRi2pQyRN7w-wjxAUdxEIw8UZyEtkumBXPBKAu6gA?key=qc-TCS7AluS82sttmhszYDdl" alt="" style="aspect-ratio:0.8753086419753087;width:533px;height:auto"/></figure></div>
However, there is a third category of government “contractors”. These are private companies providing services to private individuals for whom a third party is paying. Sometimes the third party is the government, like CMS paying Medicare claims. Sometimes it’s a private entity like an employer paying another one, like a hospital–but the costs are subsidized on both sides by the government. Or sometimes the same transaction is both paid for by the government and a private individual, such as Medicare paying for some costs while a private Medigap plan pays for the rest.
Musk and DOGE have basically ignored this.
You can see where I am going here. 
These are not “contracts” and they don’t show up in the GAO’s analysis. If they did the total would be well over $2 trillion in health care alone. But they do represent government spending.
And every day in health care there is news about ways that private companies are being “over- compensated” for what they provide for that spending. 
I’m not even going to talk about United HealthGroup and Medicare Advantage here. After all, even the <a href="https://www.statnews.com/2025/04/03/unitedhealth-medicare-advantage-fraud-case-doj-urges-judge-move-forward/">Trump DOJ seems to think they’re guilty</a> of upcoding and fraudulent risk adjustment. 
But there’s plenty of other examples
Caught with its hand in the cookie jar last month was the nation’s biggest Medicaid plan, Centene. Medicaid is a state-based program, so if someone moves from one state to another, the state and Federal government are supposed to stop paying the Medicaid plan in one state, and instead pay the plan in another. Centene of course knows this, but the WSJ found out that it <a href="https://archive.ph/46HWB">was telling its local plans not to inform the state that its members had moved away</a>.
One Centene supervisor urged some of the company’s case managers in February to keep Medicaid recipients enrolled after they moved. “Please DO NOT close cases when you learn a member has moved out of state,” the supervisor said in a Microsoft Teams message. “If the member shows eligible and are out of state, they can still can [sic] utilize some of the benefits.” Centene’s spokesman said the company is required to maintain coverage for members until the state decides whether to disenroll a beneficiary.
Centene was collecting about $150m a year for those patients who weren’t even living in its coverage area, and lying to the taxpayer about it. The WSJ makes clear that they weren’t alone. United, AetnaCVS, Molina and Elevance were all doing the same thing. Nice pure profit if you can get it!
In semi-related news, some of the more corrupt states are joining in. For instance, Centene paid a $67m fine in Florida for overcharging Medicaid for its PBM services. Presumably that money should have gone back to the Florida taxpayer, but the regime in Florida<a href="https://www.tampabay.com/news/florida-politics/2025/04/09/hope-florida-desantis-casey-centene-settlement-donation/"> told Centene to give $10m of that money to a dark money public “charity”</a> that is the pet project of its founder, a Ms. Casey DeSantis. Who apparently is married to the governor of Florida and would like to be the next one!
Look I know you’re all shocked that Florida Republicans and their friendly lapdog corporations are involved in this type of corruption, but it’s possible that something not too dissimilar is happening in the blue collar Democratic stronghold of Pittsburgh, PA.
There we find another type of government “contractor”, the University of Pittsburgh Medical Center. UPMC has been building an empire for decades. I’ve written about <a href="https://thehealthcareblog.com/blog/2024/07/29/non-profit-health-systems-driving-income-inequality/">its major league baseball style executive salaries</a>, and others have <a href="https://www.wtae.com/article/upmc-jet-florida/62283165">exposed its corporate jets</a>. But while UPMC has all the affectations of a massive for-profit corporation, Beckers reports that 70% of its revenue comes from government programs. But what advantage does being a non-profit bring for UPMC that the rest of Pittsburgh citizens don’t receive? Yup, no need to pay property tax. On the $2.1 billion-worth of land they own.
So when the <a href="https://www.levernews.com/paging-dr-land-baron/">mayor of Pittsburgh comes asking for the city’s share</a>, UPMC isn’t exactly taking the high road.
To protect its status, the hospital giant is putting its thumb on the scale in Pittsburgh’s hotly contested <a href="https://www.publicsource.org/pittsburgh-mayoral-primary-2025-candidate-highlights-achievements-endorsements-democrat-republican/">mayoral race</a>, in which the democratic primary election is taking place on May 20. The incumbent, Ed Gainey, was elected in 2021 and has been a vocal critic of the medical center’s <a href="https://www.wesa.fm/politics-government/2024-03-27/pittsburgh-gainey-upmc-more-nonprofit-tax-exemption-challenges">growing portfolio of tax-exempt properties</a>, alleging that the center is misusing its nonprofit status by granting tax exemptions to ineligible properties. The progressive mayor is facing a stiff challenge from County Controller Corey O’Connor, who is running as the <a href="https://www.publicsource.org/pittsburgh-mayor-election-2025-oconnor-gainey-developers-walnut-capital/">top choice</a> of the Pittsburgh development and real estate communities, raking in cash from local real estate moguls, longtime Republican <a href="https://www.thenation.com/article/politics/pittsburgh-mayoral-race-ed-gainey-trump/">donors</a>, and notably, hospital board members. That includes board members of the University of Pittsburgh Medical Center and its associated Children’s Hospital Foundation. All together, these members and their families have contributed at least $25,000 toward O’Connor’s mayoral campaign so far this year, according to <a href="https://www.pittsburghpa.gov/files/assets/city/v/1/bac/documents/ehb/campaign-finance/corey-oconnor-for-mayor-january-2025.pdf">campaign finance</a> <a href="https://www.pittsburghpa.gov/files/assets/city/v/1/bac/documents/ehb/campaign-finance/new-folder/corey-oconnor-for-mayor-february-2025.pdf">records</a>.
This doesn’t strike me as the behavior of a worthy neutral charitable organization, and frankly neither does the behavior of many other major health care systems. <a href="https://thehealthcareblog.com/blog/2024/07/29/non-profit-health-systems-driving-income-inequality/">To quote myself</a> (yeah, yeah, I know its still plagiarism),
Over the last 30 years America’s venerable community and parochial hospitals merged into large health systems, mostly to be able to stick it to insurers and employers on price. Blake Madden put out a <a href="https://9pyxo.r.ag.d.sendibm3.com/mk/cl/f/sh/1t6Af4OiGsHMDzDz4ivmOHP33H2yYf/F_tKe6qdFzf1">chart of 91 health systems</a> with more than $1bn in revenue this week and there are about 22 with over $10bn in revenue and a bunch more above $5bn. You don’t need me to remind you that many of those systems are guilty with extreme prejudice of <a href="https://9pyxo.r.ag.d.sendibm3.com/mk/cl/f/sh/1t6Af4OiGsHoYhQPT51hYXSsR61iGj/G-ASS3099YN5">monopolistic price gouging</a>, screwing over <a href="https://9pyxo.r.ag.d.sendibm3.com/mk/cl/f/sh/1t6Af4OiGsDhf94ikpLZDh0FHRBNSP/gAmtcwwn3dU2">their clinicians</a>, suing <a href="https://9pyxo.r.ag.d.sendibm3.com/mk/cl/f/sh/1t6Af4OiGsE9zrH99BRUNx44fGA7AT/66-0goLDRmNU">poor people</a>, managing <a href="https://9pyxo.r.ag.d.sendibm3.com/mk/cl/f/sh/1t6Af4OiGsEcKZTZXXXPYD7u358qsX/NB17MtSmNKuq">huge hedge funds</a>, and <a href="https://9pyxo.r.ag.d.sendibm3.com/mk/cl/f/sh/1t6Af4OiGsF4fHfzvtdKiTBjQu7aab/zJA1TkTo1TZ4">paying dozens of executives</a> like they’re playing for the soon to be ex-Oakland A’s. A few got <a href="https://9pyxo.r.ag.d.sendibm3.com/mk/cl/f/sh/1t6Af4OiGsFWzzsQKFjFsjFYoj6KIf/elbWzaNkqByW">LA Dodgers’ style money</a>.
Particularly galling is the amount of money sloshing around in their hedge funds. I have made a very, very rough estimate that there’s probably $500 billion in the “reserves” of the big hospital systems and the non-profit Blues plans, but it might be $1 trillion.
So what’s my answer?
Nationalize the lot of them.
If the hospitals and doctors were part of government agencies like the VA or the US Marine Corps, all of this theft and corruption would either disappear, or be managed by OIGs and others. 
There’d be no need for them to have those hedge funds. Or the payments to private insurance companies. That money could be used for good rather than profit.
Salaries could be adjusted to reflect those paid to high paid public sector employees. If the President of the USA gets $400k a year, why does the CEO of a regional medical center need $14m? For that matter a <a href="https://www.va.gov/OHRM/Pay/2022/PhysicianDentist/PayTables_20220102.pdf">clinical service line head at the VA</a> can make up to $400k a year, which doesn’t sound crazy low. Obviously there would have to be a ton of adjustments which would probably include making medical school free, but overall being a physician would still be a high paid profession–as it is in the rest of the world. And we could return to them a ton of power and autonomy that has been stolen from them by health plans and administrators.
Now I know this will come as an anathema to most Americans. They will correctly say that SpaceX (despite Musk being its nominal CEO) was able to <a href="https://nstxl.org/reducing-the-cost-of-space-travel-with-reusable-launch-vehicles/">put rockets in orbit much cheaper than NASA did</a>.That may be true in many areas of the economy but it’s not true in health care. We spend way, way more per head than countries with government-delivered systems. 
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Finally, a nationalized health system would enable us to remove some of the biggest inequities and idiocies in our current government based insurance system. Exhibit A is Medicaid. Having one Federal government program for people over 65 and the disabled (Medicare) and an entirely different state-based one (Medicaid), which spends 1/2 of its money on people who are over 65 and disabled and who are also in the Federal program is plain stupid and always has been.
A nationalized system would remove the second class status of the ⅓ of our citizens who don’t have Medicare or good private insurance, and would enable our clinical professionals to practice medicine the way they wanted to when they were young and idealistic. 
Obviously getting American health care from here to there via nationalization–a British word from the 1940s that barely has any meaning here–is close to impossible.
But tell me it isn’t the right thing to do. Even if you only care about reducing waste, fraud and corruption.
Matthew Holt is the Founder, Publisher and an Author at THCB
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