Investing in Hope, Fighting Wealth Over Health

By Rhiannon Collette, Communications Manager

Higher costs for patients. A growing prevalence of predatory billing practices. Widespread cuts to staffing and resources. Early evidence shows that the private equity model of health care seems to value profits over patients, exploiting loopholes to make money. We take a deep dive into the impacts of private equity on the health industry in this three-part series:

• Private equity’s expansion into sectors such as hospitals, physician practices, and nursing homes often comes with the promise of increased efficiencies and improved care — but evidence supporting these claims is limited, and some research suggests the opposite is true: higher costs for patients, predatory surprise medical billing, and disinvestments in health care infrastructure. Read Part 1 >
   
• Nursing homes — hotspots for COVID-19 deaths — have long been targeted and gutted by private equity. Pre-pandemic, private equity-owned long-term care facilities were short-staffed and provided a lower quality of care. The disproportionate toll of the coronavirus on these facilities exposes the need for better policies to care for individuals with complex care needs. Read Part 2 >
   
• Private equity has aggressively worked to limit patient protections against surprise medical billing, one of its most egregious money-making tactics. As legislation languishes amid a pandemic, expensive surprise medical bills keep rolling in. Read Part 3 >

Bottom line: As Congress seeks to offer families protection from financial harm during the pandemic and economic crisis, they could start with surprise medical billing legislation. “Action on their part is overdue,” says Mark Miller, AV's Executive Vice President of Health Care. “They can act now and close this loophole that has been exploited by private equity — that saddles families with debt and raises the cost of health care for everyone.”
 

Related: More Proof that Health Care Prices are Irrational
 

Related: Surprise Medical Billing Remains a Threat to Patients Amid Health, Economic Crisis
 

Related: Analysis: U.S. Pays Substantially More than Australia for the Same Prescription Drugs

A 2003 paper by Susan Tucker and Eric Cadora studied the then-$54 billion the United States spent annually on prisons, and argued that our country’s public safety goals could be better served by funding areas like education, housing, health care, and jobs — all of which have a direct impact on crime rates — rather than expanding incarceration.

By 2007, a public-private partnership called the Justice Reinvestment Initiative was established to help state governments assess their public safety policies and spending and come up with more effective ways to improve recidivism rates and overall public safety. The majority of the eventual 35 participating states moved portions of their funding away from corrections and into community-based services and support.

The results? The Urban Institute reported that, between 2010 and 2016, 28 states saved or averted a total of $1.1 billion in costs attributable to reforms; the total incarceration rate among the 35 JRI states has dropped by 11 percent, and recidivism has declined. 

Why it matters: At a moment when protestors nationwide are demanding that public officials rethink how we approach public safety — forcing policymakers from New York to Minneapolis to Seattle to grapple in particular with the idea of diverting police budgets to programs that better serve communities of color — the experience of justice reinvestment is worth revisiting.

Bottom line: The successes and shortcomings of the Justice Reinvestment Initiative offer important lessons for those who wish to see criminal justice funding redirected toward community groups and hard-hit neighborhoods.

Related: New Polling Finds Extraordinary Bipartisan Support for Policing Reforms

Related: Video: How to Reform Policing in America

“The New York Times Presents: The Killing of Breonna Taylor,” a bone-chilling look at what happened the night police burst into the Louisville, Kentucky apartment of Breonna Taylor’s boyfriend, exchanged gunfire, and killed the 26-year-old EMT. This documentary draws on a wealth of resources — including 911 calls and over 1,500 pages of police records — to investigate what happened and why. Warning: This is difficult to watch, so take care of yourself and make the viewing decisions that are right for you.

By Stuart Buck, Vice President of Research

Taking a break from the overwhelming wave of bad COVID-19 research, this week I’d like to mention a new study on contraceptives. The study claims to have discovered brain alterations in women who started using oral contraception as a teenager that would help explain “the increased vulnerability to mood-related mental illness in women.”

It does no such thing.

The study involved two groups of college-age women: 75 who had a brain MRI (27 were oral contraceptive users, and 12 of those started as a teen), and 140 who did a stress test (58 were oral contraceptive users, and 26 of those started as a teen).

Already we can see that this isn’t a large sample of women who use contraceptives at all, let alone those who started as teenagers. 

Worse, this wasn’t a random assignment study or anything close to it: Women weren’t randomly assigned to use contraceptives or when to start. Women who make radically different choices might already be somewhat different. Indeed, if you look at the table of descriptive statistics, the two groups of women (users and non-users) were very different from the outset. For example, 80-85% of the users were white, compared to only 35% of the non-users (who were mostly Black and Asian). We don’t know how different the teenage users were, because the researchers don’t bother to say.

Even worse, the researchers took too many measurements to list: hormones in saliva, memory tests, stress tests, and activity in literally every area of the brain. They then report a staggering number of correlations that overwhelm the reader.

For example, while there were no differences in estrogen or cortisol levels, non-users “in the luteal phase of the menstrual cycle showed higher salivary progesterone levels” compared to users. Also, users’ brains had more white matter volume in the left parahippocampal gyrus (whatever that is). The study goes on like this for several pages.

At least the researchers told the reader about many of these (likely meaningless) correlations, but then they made a fateful choice: to selectively highlight a few of them.

That is, among all the possible correlations, the researchers “found” that within users, there was a “blunted cortisol response” after the stress test in women who began using contraceptives as a teen, which they take to mean that “there may be long-term effects” that can “be a risk factor for depression.”

That stark conclusion isn’t justified at all. Among the relative handful of college students who responded to participate in this study in the first place, there’s no telling why a particular subset of them might have different hormonal or brain response to stress tests.

It makes a good headline, though: Teenage use of contraception leads to depression. Never mind if it’s true.