Progressively getting back online/to using Bsky- come hear me yap with my friends TONIGHT about how much private ISPs suck and what we can do to achieve universal broadband access & build collective forms of governance over the future of our internet!
RSVP here: actionnetwork.org/events/techa...
Excited to collab with some incredible folks across disciplines to bring this workshop to @facct.bsky.social next week and Alt-FAccT in NYC!
There’s limited space in both, sign up asap!
Screenshot from the prior quoted google doc, of the Doctor's Council statement: Several unfair labor practices (ULP) filed by the union are pending with the National Labor Relations Board. These ULPs include refusal to bargain over key areas of compensation, and an unlawful premature declaration of impasse and unilateral implementation of an offer the vast majority of Doctors Council bargaining committee members found unacceptable. "We do not take the decision to strike lightly," said Frances Quee, a pediatrician at H+H Gotham Health, Blevis and President of Doctors Council SEIU." But we have been negotiating in good-faith for over a year to reach an agreement that addresses the crisis of dedicated doctors leaving our hospitals, but it's clear our employers are not prioritizing the long-term health of these hospitals or our communities. Our patients deserve the highest quality care, and we need a contract that supports the doctors who are integral in providing it."
"Without a fair contract, our communities will continue to face a critical shortage of doctors, and patients will ultimately bear the brunt of the system's failure." Dr. Joplin T. Steinweiss, a primary care physician at Jacobi.
Members of @doctorscouncilseiu.bsky.social are striking after over 15 months of fighting for a fair contract at NYC's safety net hospitals, take a look at their announcement below!
docs.google.com/document/d/1...
Counterpoint- it should be made an example of, and then its abolition should be celebrated and remembered as a warning for aspiring war criminals hoping to one day reimagine new forms of violence.
Tbh I could use a new Judgement at Nuremberg movie/series/week in review newsletter
If we don't confront the underlying political economy of healthcare, any attempt at regulation will invariably fall short of protecting patients.
As the new CMS head plans to fully privatize Medicare, we must instead abolish Medicare Advantage with haste.
ash.harvard.edu/resources/me...
Quote from the article: Resisting Predatory Al There is nothing inherent in the logics of computation that demands the innovation and deployment of such predatory models. However, under the imperative to shareholders, payers will overwhelmingly orient technologies toward obfuscating and maximizing the extraction of surplus value from health care, accumulating capital and increasing market share. Market dominance translates into political power to reinforce a favorable regulatory landscape while constraining the possibilities for reform. Technologies are political in both their design and deployment, and to anticipate and understand the political economy of Al, one must first confront the material reality of the industry as it functions today.
Article screenshot continued: It is no surprise that every major MA payer has been accused of fraud by the U.S. government or whistleblowers. The dominant MA payer strategies, augmented by algorithms, overwhelmingly demonstrate their framing of patients and care providers as financial assets whose purpose is to facilitate the ever-increasing extraction of taxpayer dollars. After 20 years of reactive and incremental reforms attempting to protect patient health, we must recognize the failure of MA and abolish it with haste. If we hope to ideate alternative technologies that support human flourishing, we must critically examine and challenge underlying power relations that shape the environment for any computational infrastructure. Only then can we hope to reorient the politics of AI toward a future that is more equitable and beneficial for all.
"Technologies are political in both their design and deployment, and to anticipate and understand the political economy of AI, one must first confront the material reality of the industry as it functions today."
6/
To illustrate this extraction:
🚨 Taxpayers paid MA plans 23% more per beneficiary- for the same level of acuity- than FFS Medicare in 2023.
🚨 Since 2007, this has cost taxpayers an extra $612 Billion, siphoned off by private health insurance companies to shareholders instead of to patient care
5/
"The dominant MA payer strategies, augmented by algorithms, overwhelmingly demonstrate their framing of patients and care providers as financial assets whose purpose is to facilitate the ever-increasing extraction of taxpayer dollars."
Hence DOJ Task Force on Health Care Monopolies and Collusion
4/
Growing market power both enabled and benefitted from a range of financial engineering approaches.
The development of algorithms has catalyzed and concealed these practices, increasing profit extraction while leaving patient populations to suffer.
Medicare Advantage is exemplary here.
3/
What frames how algorithms are developed & deployed?
After 20+yrs of payer consolidation across PBMs, post acute care, pharmacies, physician groups, etc, we know mergers =/= market efficiencies.
Instead, we saw decades of regulatory arbitrage ➡️ skyrocketing costs and worse health outcomes.
2/
Article header: Medicare Advantage as Asset Management: The Pretense of Care Under Logics of Extraction
Its been up for a couple weeks, but given the last few days, I figured it's finally time to share my thoughts on Algorithms, Medicare Advantage, and the political economy of AI in Healthcare.
🚨 TL;DR: we need to abolish Medicare Advantage now 🔨
1/
ash.harvard.edu/resources/me...
Mexican Independence Day car caravan going south on Michigan Avenue
View of the Chicago river from the marina tower, during the daytime, facing west.
Night shot of Chicago river from Wolf Point- the confluence of the North, South, and Main branches of the River- facing South
Also, I will forever praise Chicago. It's the most beautiful city in this country, and it holds a special place in my heart.
Standing with Karl Lauterbach (center), Germany's Federal Minister of Health and member of the Social Democratic Party of Germany, as well as Professor John McDonough (Harvard Chan health policy professor), standing outside of the Senate HELP Committee (Health, Education, Labor & Pensions) before discussing Germany's AMNOG program and drug pricing reform.
Illinois State Medical Society text: There was supportive testimony on the intent of this resolution, and speakers appreciated the Board's interest in ensuring that patients not be harmed as a result of physician collective action. There was concern that the language approved by the Board would remove options from resident and fellow physicians in their collective bargaining efforts by effectively preventing them from organizing or participating in strike activity. It was noted that it is possible for physicians to engage in strike activity in ways that do not harm patients or patient care, but still effectively demonstrate the necessity of striking professionals to optimize care delivery. Your reference committee recommends the following substitute language: RESOLVED, that the ISMS supports the rights of physicians, residents and fellow physicians to exercise collective bargaining techniques that do not jeopardize patient care; and be it further RESOLVED, that the ISMS rescind the following existing policy: "Physicians in collective bargaining units should not participate in actions against their employers that would withhold care from patients."
Front page of the April 2024 issue of Chicago Medicine- Headline states, "Employed Physicians Saying 'YES!' to Unions. As Burnout, Consolidation and Insurer Hassles Intensify, Hundreds of Physicians Organize"
Taking the medical students and residents from Illinois State Medical Society to Springfield, IL, to meet with state legislators. On the right is IL State Senator Pat McGuire (43rd district)
I cut my teeth in advocacy through Organized Medicine, having worked at the county, state, and federal level to advocate for structural healthcare reform, as well as shaping the policy of state medical societies to support Residents and Fellows in their collective bargaining agreements.
Department of Internal Medicine, Highland Hospital, Alameda Health System Grand Rounds lecture: Hidden Inequities in Data: Using an Anti-Racist Lens to Reassess Race in Clinical Algorithms
My presentation to AMDIS (Association of Medical Directors of Information Systems) in June 2023 on health equity in medical device procurement
My presentation to the California Telehealth Resource Center: The Digital Divide: Histories of Exclusion and Barriers Beyond Connectivity.
After a decade w/health-tech startups, non-profits, think tanks, and more, witnessing the extractive abandonment during COVID19 magnified my interest in a justice-oriented framing, seeking new approaches to understanding historical inequities in medical devices and the digital divide.
Victory At Highland! By taking action through our union, we've won $2000 in hazard pay for all CIR residents and full-time AHS employees who were at Highland last academic year Over 100 residents took multiple actions, and now we've won our demand!
CONGRATS HIGHLAND HOSPITAL RESIDENTS! - 19.5-21.4% increases to total compensation from Dec. '22 to Dec. '24 - Right to honor other AHS unions' picket lines! - 8 weeks paid parental leave - Enforceable commitment from AHS to negotiate fertility benefits in August - Call pay: $60 an hour if reassigned from elective (IM & EM) or if off duty (everyone) - Increase Diversity fund from $14k to $30k! - $2000 a year for education, licenses covered, $2000 travel stipend for presenting at conferences
Photo of me at the podium during one of our events- a Unity break outside of the hospital
Group photo of members of the AHS residency programs standing outside in the rain at the unity break
Labor organizing with CIR/SEIU was one of my most cherished memories during my residency training at Oakland's county hospital. From fighting for hazard pay for all employees, to negotiating a huge contract win after a sweep (98.4% yes) Unfair Labor Practice Strike Authorization Vote.
Hey! I'm a physician and public health informaticist, I study how technologies intermediate our health, and how we can build democratic forms of governance. Grew up in Iowa, learned health activism in Chicago, and labor organizing in Oakland.
Bits from the highlights reel below ⬇️, lets chat!
