NEWS AND VIEWS
TODAY'S ARTICLES CONCERN THE EXTENT OF THE ECONOMIC AND SOCIAL BURDEN ON OUR SOCIETY CAUSED BY THE COMPOUNDING OF MEDICAL DEBT ON THOSE WHO, UNFORTUNATELY, ARE NOT BILLIONAIRES.
SEPTEMBER 14 WAS THE DAY OF A RATHER SHOCKING EVENT AT
A SANDERS RALLY. IT CAME JUST BEFORE THE NEW SANDERS PROPOSAL THIS LAST WEEKEND FOR RELIEF FROM
MEDICAL DEBT. THIS MAN CAME PREPARED WITH HIS HOSPITAL BILL TO SHOW SANDERS. SEE
BELOW.
‘I’m going to kill
myself:’ A veteran tells Sanders he’s drowning in medical debt
September 14, 2019
John Weigel, a
58-year-old Navy veteran, was desperate to tell Sen. Bernie Sanders (I-Vt.) his
story.
So on Friday
afternoon, he folded his $139,000 hospital bill into his pants pocket and took
the city bus to the Democratic presidential candidate’s town hall at the Carson
City community center.
Sanders, who’d lost
his voice earlier in the week, offered an abridged version of his typical
Medicare-for-all speech, instead opening the floor to anyone who wanted to
share stories about the U.S. health-care system.
Weigel had found a
seat near the front. When Sanders turned to the audience, Weigel waved his
medical bill in the air. A campaign aide took the paper from Weigel and slipped
it to the senator, who eventually called on Weigel to speak.
The veteran stood
shakily. He hadn’t eaten in hours and he was weak from his illness. Through
slurred words, a symptom of his advanced-stage Huntington’s disease, Weigel
told Sanders that he had somehow lost his veterans health coverage and was tens
of thousands of dollars in medical debt.
“John, I’m looking at
a bill that says account balance $139,000. What is that about?” Sanders asked.
“It’s because somehow
after the fact they claim that my Tricare, I chose to end it, which I didn’t,”
Weigel said. “They’re saying that I didn’t re-sign it or something.”
“So how are you going
to pay off?” Sanders asked.
“I can’t, I can’t,”
Weigel said. “I’m going to kill myself.”
“Hold it, John,”
Sanders said firmly. “Stop it. You’re not going to kill yourself.”
That emotional moment
was quickly shared across social media. Since the town hall, Sanders has
tweeted several times about Weigel, holding him up as an example of a broken
health-care system.
“Some in Washington
say I am too angry about our broken health care system. I hear stories like
this every day in America. My question is: why aren’t they angry about it?”
Sanders wrote on Twitter Friday night.
Then Saturday he
shared a video produced by his campaign of their exchange: “This is painful to
hear. But there are millions of people like John facing an unimaginable burden
due to the cost of medical care. This is why we fight for Medicare for All.”
Reached at his home
Saturday afternoon, Weigel said he spoke to Sanders and his wife, Jane Sanders,
after the event and they told him they would help, though they didn’t say how.
Later Saturday, the
Sanders campaign said it had “already reached out to a Nevada senate office for
case work help.”
Weigel, a Sanders
supporter, said he appreciated that the candidate “didn’t blow me off” like so
many others had in his life.
“Hearing his voice,
that was really powerful. It was a wake-up call,” Weigel said. “I know he
cares. He’s always cared about veterans.”
Weigel, who served
overseas in the first Gulf War and in Somalia, signed up for Tricare health
insurance when he retired from the military at the end of 2002, expecting to
have coverage for life. Less than four years later he was diagnosed with
Huntington’s disease, a degenerative brain disorder.
In December 2018 he’d
been experiencing chest pains and went to the emergency room and needed stents.
He later received a bill in the mail for $139,701 and another for the ambulance
for $1,555. When he called Tricare he said he was told that his insurance had
been canceled because he hadn’t re-enrolled. In years past his coverage renewed
automatically, he said.
What Weigel didn’t
share with Sanders is that he’s also had to pay for his anti-depressants and
heart medications out of pocket, one month forgoing them because it was getting
too expensive.
Weigel is back on his
Tricare insurance as of June, but still doesn’t know how he was ever kicked off
and is kept up nights worrying about those outstanding bills he can’t afford to
pay.
“In the Navy we say we
don’t leave our people behind and here it is and there’s nobody here for me,”
Weigel said, his voice breaking.
Chelsea Janes
contributed to this story from Carson City, Nevada.
BERNIE'S MEDICAL DEBT PLAN
Bernie Sanders’s
plan to eliminate medical debt, explained
Bernie Sanders wants to eliminate $81 billion in medical
debt and set up a public credit registry.
BERNIE SANDERS
SPEAKING Ethan Miller/Getty Images
Americans go bankrupt
every year because of unpaid medical bills.
Now Sen. Bernie Sanders (I-VT), one of the leading progressives in the 2020 presidential
race, says he wants to eliminate all Americans’ medical debt. Sanders released a plan on Saturday to pay off $81 billion in existing
medical debt, reform the 2005 bankruptcy reform bill, and set up a public
credit registry.
“I am sick and tired
of seeing over 500,000 Americans declare bankruptcy each year because they
cannot pay off the outrageous cost of a medical emergency or a hospital stay,”
Sanders said recently, while teasing the plan he has now formally laid out.
Under the Sanders
plan, the federal government would negotiate and pay off unpaid medical
obligations that have already been put out to debt collection agencies. He
would also place restrictions on how aggressive health care providers and debt
collectors could be in collecting payments from patients. Through a proposed public credit registry, which would replace credit reporting agencies like
Equifax, Sanders would prohibit debts from medical care from counting against a
person’s credit score.
It’s another big
health care promise from Sanders, who campaigns on Medicare-for-all, a national
health insurance program that would cover every American. He has also, because
he regularly cites the 500,000 medical bankruptcies figure, reignited a
longstanding debate about the actual scale of the medical bankruptcy problem.
The Washington Post’s in-house fact-checkers dinged him for saying 500,000 people go bankrupt
because of medical debt every year, stirring up an old scholarly fight that
originated with a 2005 paper co-authored, in a fun twist, by Sanders’s
now-rival Elizabeth Warren.
Academics have been
debating since that 2005 paper’s publication how many people actually go
bankrupt in the United States because of medical bills. It is a debate about
causation and study design that frankly won’t matter to most people. It also
risks losing sight of the underlying problem.
There is no denying
that thousands of Americans go bankrupt entirely or partly because of medical
debt. And even if they don’t go bankrupt, millions more people struggle with
this type of debt on their personal ledgers, making it harder for them to
borrow money and stay financially stable. Millions of Americans still lack
health insurance, and they’re fully liable for their medical bills if they get
sick or have an accident. But even health insurance does not always provide
security against financial stress because poor health takes its toll in other
ways, such as lost wages.
Bernie Sanders has
put out a plan to eliminate $81 billion in medical debt
There is certainly
some level of agreement that medical debt is a problem unusually endemic in the
United States and our safety net should be better structured to address it.
“Health insurance
still leaves Americans exposed to much more economic risk from poor health,”
Amy Finkelstein, an economics professor at MIT who has studied medical debt,
told me, especially compared to other countries with social insurance that
better protect their citizens from the economic loss in the event of sickness
or injury. “Even people with health insurance are not insured against the
economic consequences of poor health.”
And this is part of
what Sanders is targeting with his proposal. Here are the highlights:
- The
federal government would negotiate settlements for $81 billion in existing
past-due medical debts and pay off the balance on behalf of patients
- Restrictions
would be placed on debt collectors: contacts with patients with past-due
bills would be capped and there would be limits on the assets that could
be seized and wages that could be garnished in collection
- Various
provisions of the “disastrous” (in Sanders’s words) 2005 bankruptcy bill
(which Sanders notes was supported by then-Sen. Joe Biden) would be
changed, making it easier for medical debts to be discharged and
prohibiting evictions, utility interruptions, wage garnishments, and other
practices that can inhibit day-to-day life for people facing debt
collection
- A public
credit registry would be established to replace for-profit credit
reporting agencies, providing a report on creditworthiness that would exclude
medical debt from consideration
Sanders is making a
bet that he is appealing to voters who understand the need to right a kind of
moral wrong in the US economy.
“In the United States
of America, your financial life and future should not be destroyed because you
or a member of your family gets sick,” Sanders said. “That is unacceptable.”
There is a serious
problem of medical debt in the United States
Medical debt is a
serious problem in the United States. Here are the raw statistics:
- The
Consumer Financial Protection Bureau reported in 2014 that 43
million Americans had unpaid medical debts on their credit reports.
- Americans
accrued an estimated $88 billion in medical debt in 2018, according
to a study by Gallup and the
nonprofit group West Health.
- Nearly
half of Americans fear a major medical event could lead to their
bankruptcy, Gallup found.
- One in
four people said that sometime in the past year they had skipped medical
treatment because of concerns about cost.
Health care far
outpaced other obligations in the number of Americans who’d had a debt pursued
by collectors in 2014, according to the CFPB.
CFPB
Amy
Finkelstein’s 2018 paper co-published
with Carlos Dobkin, Raymond Kluender, and Matthew Notowidigdo in the American
Economic Review found that people with health insurance who were
unexpectedly hospitalized saw an 11-point drop in their likelihood of being
employed and an average loss in labor earnings of $9,000, a 20 percent decline.
What must be said here
is America is unusual in this degree of medically driven insolvency and
economic loss. Not only is the United States the only developed economy with
such a high number of uninsured people (still over 10 percent), but the
government does not provide the same level of financial protection to people
who get sick or hurt and lose income because they can’t work that other
countries do.
The Finkelstein et al.
paper used the notable example of Denmark, a socialist boogeyman for
conservatives. They cited a Danish study showing that Danes who have nonfatal
heart attacks and strokes lose about the same amount of income as Americans,
but that 50 percent of their losses were then covered by government disability
or sick leave programs.
The US doesn’t have
such programs, and Americans only saw about 10 percent of their losses covered
if they were not eligible for Social Security’s retirement benefits. The
researchers also found that the drop in income for people in America is not
offset by an increase in earnings by their spouse or partner.
In other words,
medical bankruptcy is a problem uniquely pervasive in the United States. As
T.R. Reid wrote in his tour of international health care systems from last
decade:
I asked the health
ministry of each country how many citizens had declared bankruptcy in the past
year because of medical bills. Generally, the officials responded to this
question with a look of astonishment, as if I had asked how many flying saucers
from Mars landed in the ministry’s parking last week.
The academic debate
about how many people actually go into medical bankruptcy, briefly explained
That doesn’t mean it’s
easy to measure the exact size of the medical bankruptcy problem in a country
and system as unwieldy as that of the United States. A seminal attempt came in
2005 by Elizabeth Warren and, among others, Dr. David Himmelstein, now a
professor in the CUNY School of Public Health.
Himmelstein led an
updated version of the survey and used a similar methodology as the studies in
2005 and 2009. The researchers sent questionnaires to people who had filed for
bankruptcy, and two-thirds said they had medical debt or had lost income
because of injury or illness. Take two-thirds of the 750,000 people who file
for bankruptcy every year and you get 500,000, which is Sanders’s number. It’s
this number that the Washington Post saw fit to give three out of four
Pinocchios for lacking a strong enough empirical foundation.
Some economists have
long been skeptical of the methodology and study design deployed by Himmelstein
and Warren in their previous studies. Part of it is they don’t consider the
survey model reliable; they also question what the proper context should be
when most Americans who have medical debt don’t file bankruptcy in a given
year. (Himmelstein, for his part, says some of his critics have gotten industry
support and that there is a difference in philosophy between doctors and
economists on trusting subject responses about issues like bankruptcy.)
Critics will actually
cite Finkelstein’s 2018 paper in contrast to the previous iterations. Those
researchers also sought to estimate how many people go bankrupt because of a
medical crisis — specifically, a hospitalization. They found just 4 percent of
bankruptcies could be traced back to an acute event that put somebody in the
hospital.
That is obviously a
much lower number than the 60-some percent Himmelstein found. The Post cited
the Finkelstein paper in its fact-checking column that accused Sanders of
“cherry picking.”
Himmelstein and
co-author Steffie Woolhandler responded with their own questions about the
Post’s evaluation, saying in summary:
Rather than checking
facts, the Post has chosen one side in an ongoing and unsettled scholarly debate,
and labeled those on the other side (and public figures who cite their
research) “liars”.
The Week’s Ryan
Cooper pointed to some other studies that found roughly 25 percent of bankruptcies could
be blamed on medical debt. But this fact-check drama is at a standstill, with
the Post standing by its rating. You can read more of the back-and-forth here. (Margot Sanger-Katz at the New York Times has also covered these issues and this research quite
a bit.)
Whatever the exact
number, Sanders thinks he has a plan to eliminate the problem for good.
IN THIS STORYSTREAM
- Bernie Sanders wants to put credit reporting
companies like Equifax out of business
- Bernie Sanders’s plan to eliminate medical debt,
explained
- Bernie Sanders’s housing-for-all plan, explained
FOR SANDERS MEDICAL DEBT PLAN, SEE CBS 9/23/19 ON
"SURPRISE" MEDICAL BILLS: https://www.cbsnews.com/live/
A RELATED PRINT STORY IS BELOW. "NEW CBS
INVESTIGATION ON WHY PRICES ARE NOT TRANSPARENT." ALSO, ESTIMATE YOUR
COSTS ON A PROCEDURE BY GOING TO CBS NEWS.COM'S HEALTH COSTS PROGRAM, PUT YOUR
LOCATION IN AND GET THE COST. GO TO THE WEBSITE TO USE THE "MEDICAL PRICE
ROULETTE" TOOL.
CBS NEWS September 20, 2019, 10:10 AM
Medical Price
Roulette: CBS News investigates the lack of transparency in America's health
care system
Medical bills are a
major frustration for many Americans who wonder what explains the prices and
why they end up paying so much.
On Monday, CBS News
will air the first of a three-part series called "Medical Price
Roulette," which investigates the lack of transparency in health care
pricing. The series is produced in partnership with ClearHealthCosts.
"CBS This
Morning" consumer investigative correspondent Anna Werner will dig into
why costs charged by hospitals and other providers often vary dramatically,
even within the same city.
Click here to share
your story and search prices
On Monday, we talk to
one man who needed emergency back
surgery to avoid being paralyzed —
and then faced hundreds of thousands of dollars in bills. On Tuesday, a woman
talks about the surprise medical bills she incurred after a tragic miscarriage.
And on Wednesday, we meet a 27-year-old chronic care patient who faces dramatically
changing costs for her infusions.
"Most of our
viewers, I think it would be fair to say, don't understand the bills that they
get, don't understand why the price was so high," Werner said. She asked
Dr. Aaron Carroll, a pediatrician and health services researcher, "Is
there transparency in health care pricing?"
"Oh my God,
no," Carroll replied. "I'm laughing only in the sense that you think
patients are the only ones that think there's no transparency. I mean,
people working in the system don't often know what the price is. When my
patients ask me what the price is, I don't have an answer for them … Nothing about the United States' health
care system really makes sense."
We'd like to know
what you paid for medical procedures. Share your story and learn how you can search ClearHealthCosts'
database of prices in our sample markets. You can also email us at healthcosts@cbsnews.com.
© 2019 CBS
Interactive Inc. All Rights Reserved.
"SURPRISE" MEDICAL BILLS
Between the lines of Bernie Sanders' plan to eliminate
medical debt
Caitlin Owens SEPTEMBER 23, 2019 15 hours ago
Illustration: Sarah
Grillo/Axios
Sen. Bernie Sanders released his
2020 plan to cancel $81 billion in existing medical debt,
reform collections practices and change bankruptcy rules this weekend.
Why it matters: The proposal speaks directly to the issues of
surprise medical bills and hospitals' lawsuits against patients — issues
that have only recently entered the political lexicon.
The big picture: It also, of course, is a simple solution to the problem
of unaffordable health care costs, a top issue for voters and one that has only
become more prominent with the rise of deductibles and other forms of
cost-sharing.
Yes, but: It's not hard at all to imagine how this will play with
those who already think Sanders has made ludicrous financial proposals.
Between the lines: Sanders would have the federal government
"negotiate and pay off past-due medical bills in collections that have
been reported to credit agencies," per the plan.
But medical debt often
doesn't get paid, so collectors will sell it for cheap. Craig Antico, founder
of the nonprofit charity R.I.P. Medical Debt — which buys and absolves health
care debt in bulk — told NYT that
the market price for $81 billion in debt could be as low as $500 million.
How it works, via Axios' Orion Rummler:
Have the IRS review
billing and collection practices of nonprofit
hospitals.
Replace for-profit credit reporting agencies
with a "secure public credit
registry."
Stop requiring the
disclosure of medical debt discharge on
housing and loan applications.
What we're
watching: Sanders' embrace of
"Medicare for All" has transformed the Democratic party, pulling it
much further left on health care. It's unclear if his stance on medical debt
will play the same way, and how the rest of the 2020 field will respond.
ABOUT THOSE "CRACKS," THERE ARE AT LEAST 5 OR 6
ARTICLES ON THIS SUBJECT AND USING THE SAME WORDS. I HAVE CHOSEN THIS ONE
BECAUSE "COMMUNITY ONCOLOGY" LOOKS TO ME TO BE A LIKELY ORIGIN.
THE CONDITION OF HOSPITALS POUNCING PARTICULARLY HARD ON
THOSE WHO SHOULD BE GIVEN LESSER CHARGES BECAUSE THEY ARE RELATIVELY POOR IS
NOT NEW. THERE WAS A STORY WITHIN THE LAST SEVERAL YEARS OF A GROUP OF
HOSPITALS IN THE MIDWEST OWNED BY THE SAME CORPORATION -- CAN'T REMEMBER ANY
DETAILS UNFORTUNATELY -- THAT WAS BEING SUED FOR THIS PRACTICE. IT SHOULD BE A
CRIME, NOT MERELY A SIN, AS IT SEEMS TO BE. IT'S TOO COMMON, ACCORDING TO
ARTICLE. LET'S GET BERNIE ON THE JOB, AND MAYBE SOME LAWS WILL BE WRITTEN TO
MAKE THAT PRACTICE GROUNDS FOR REMOVING THEIR LICENSING TO PRACTICE AS DOCS AND
AS HOSPITALS. A SIMPLE FINE WOULDN'T BE EFFECTIVE ENOUGH BECAUSE THEY HAVE TOO
MUCH MONEY FOR THAT TO GET THEIR ATTENTION.
WHENEVER I HEAR ABOUT "FOR PROFIT HOSPITALS"
AND "FOR PROFIT PRISONS," IT MAKES ME CRINGE -- AND THEN LEAP OUT IN
ANGER. IF AMERICA IS ABOUT ANYTHING, IT SHOULD BE ABOUT PREVENTING THESE THINGS
FROM HAPPENING, AND MAKING THE ABUSE OF THE POOR A FELONY, NOT WHITE COLLAR
CRIME. THIS REFERENCE TO "CRACKS IN OUR SYSTEM" IS JUST ONE SENTENCE
LONG, BUT THE WEBSITE IS APPARENTLY A SORT OF WATCHDOG, LIKE
"COPBLOCK." IT IS PRODUCED BY "COMMUNITY ONCOLOGY ALLIANCE -- DEDICATED TO ADVOCATING FOR COMMUNITY
ONCOLOGY PATIENTS AND PRACTICES."
Hospital Lawsuits Unearth “Cracks in our System”
September 4, 2019
Low-income patients
often face steeper out-of-pocket costs — and that means they’re also more
likely to be sued by hospitals when they can’t pay their bills.
Hospital lawsuits unearth "cracks in our
system"
Caitlin Owens Sep 4, 2019
Data: Peterson-Kaiser Health System Tracker; Chart: Axios Visuals
Low-income patients
often face steeper out-of-pocket health care costs — and that means they're
also more likely to be sued by hospitals when they can't pay their bills.
Driving the news: The New York Times yesterday reported on Carlsbad
Medical Center's prolific use of lawsuits to collect its patients' medical
debts, which often leads to wage garnishment or property liens.
- The
hospital is the only one in town and has filed nearly 3,000 lawsuits
against patients since 2015, NYT found.
- Its
practices were first profiled in an upcoming book by Marty Makary, a
doctor at Johns Hopkins, titled "The Price We Pay."
- "The
health insurance deductibles so often discussed in our health policy
circles may seem inconsequential to wealthy people and to decision makers
in the policy world, but they are crushing many Americans," Makary
writes.
Not only are
patients facing more out-of-pocket
spending than ever before, but hospitals — including Carlsbad Medical
Center — often greatly inflate their prices compared to Medicare rates.
- Some of
the hospitals suing patients — like Memphis' Methodist Le Bonheur Healthcare — are
nonprofits.
- "Hospitals
want to get all the perks of their nonprofit status…but really rake
patients through the coals with their billing practices," Yale's Zack
Cooper told me.
The bottom line: "There's a space for folks who are vulnerable
to get caught in the cracks of our system ... [such as] higher cost sharing and
out-of-pocket costs, skimpier health insurance plans, and more aggressive
collection practices by hospitals and providers," Cooper said.
Drew Altman,
Kaiser Family Foundation Jun 25, 2019
The only health care prices that matter to consumers
Illustration: Aïda
Amer/Axios
The most important
detail to watch in the regulations for President Trump's executive order on price transparency for hospitals: will they
require that insurers give consumers information on out of pocket costs in a
timely and usable way?
Why it
matters: That kind of timely
information will be needed in the regulations — which have yet to be written
— so consumers can shop based on the costs they will actually pay.
The big
picture: One big reason general
information on prices has only limited utility to consumers is that what they
most want to know is not the price of an MRI, or a knee replacement of any
other service at this hospital or that, but what they will have to pay for it
themselves out of pocket under their insurance plan.
Some insurance
companies have tools consumers can use to figure this out, but that information
is not easily available to consumers today. As a recent Kaiser Family Foundation/Los Angeles Times survey shows:
- 67% of the
American people say it is somewhat or very difficult for them to figure
out what a treatment or procedure will cost them.
- 44% said
they had difficulty determining what they would actually have to pay.
- 40% had
problems figuring out what was even covered.
Even with the right
information, larger medical expenditures generally occur when people are in a
medical crisis of some kind, in anything but shopping mode, and generally
dependent on their physicians to direct them to hospitals, specialists or tests
they need. This is why price transparency and shopping is helpful for some services
but not a panacea.
- It’s not
entirely clear whether low rates of price shopping today reflect the lack
of price and quality information, or larger barriers to shopping in health
care. Just 17 percent of people with typical deductibles shop today,
and 21% with high deductible plans.
More price transparency will drive these numbers up, but how much is
unknown.
- On the
other hand, there is some evidence that people want to shop when they can:
47%, for example, asked for a generic drug to save money in the past year;
and 36% checked with a provider or health plan on the cost of an office
visit.
- But just
23% used an online tool to compare provider costs. All told, 70% reported
some shopping-like behavior in the survey.
It's important to add
that the ability to shop based on price is not equally distributed throughout
the population. If you are in a rural area, limited to a narrow network of
providers, or dependent on emergency rooms or clinics, you may have very
limited options to shop around.
The bottom
line: Like putting price
information in drug ads, the executive order may not have much impact in terms
of actually lowering prices, but it will focus greater attention on high
medical prices. That is likely the main reason for industry resistance, and
potentially its greatest contribution.
UNDER THE HEADING OF "RELATED INFORMATION" IS
ANOTHER PAINFUL SHOCK. SEE BELOW.
Hospitals earn greater profit from physician-administered
meds than drugmakers, study finds
Alia Paavola - Thursday, September 19th, 2019 Print | Email
Hospitals earn a
greater profit from physician-administered drugs than pharmaceutical
manufacturers themselves, according to a recent analysis by
the Partnership for Health Analytic Research.
The analysis from the
physician-led consultancy firm found that for every $100 spent on
physician-administered drugs in the outpatient setting, the hospital retained
$58, while the drugmaker retained $42.
"This suggests
that hospitals are earning more from administering medicines than the
manufacturers who created the medicines and is consistent with recent research
published by the Moran Company, which found that in the commercial market,
hospitals retain 2.4 times their acquisition cost for a basket of 20 brand-name
medicines," the researchers wrote.
Additionally, the
report compared how much of the gross profit of physician-administered drugs
physician offices retained in comparison to hospital outpatient settings.
The
study found that while physician offices and hospital clinics treat a similar
number of patients in the commercial market, hospitals received a larger share
of the gross profit. In particular, hospitals retained 91 percent of the gross
profit margin, compared to physician offices, which retained just 9
percent.
This discrepancy
indicates that commercial payers reimburse hospital clinics at a higher rate,
researchers said. In addition, the discrepancy may be explained by the fact
that hospital clinics are eligible for discounts not offered to physician
clinics, including the 340B program.
More articles on
pharmacy:
Carcinogen concerns prompt Sandoz to halt global distribution of heartburn drug
DEA raids some West Coast Kaiser Permanente pharmacies
California biotech files for bankruptcy
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