As a former state attorney general, Senator Kamala D. Harris, the Democratic nominee for vice president, has received significant scrutiny of her record on law enforcement, facing questions and criticism about uneven prosecutions of killings by police officers.
But she is less known for another role she took on, opposing the consolidation of institutions in the health care industry, which has become a major force driving the cost of medical care higher for consumers. She challenged proposed mergers between industry behemoths and anti-competitive behavior by powerful hospital systems and drug makers.
She oversaw multimillion-dollar settlements with major health care corporations like Quest Diagnostics and McKesson, which were the subjects of whistle-blower lawsuits accusing them of fraud against the state Medicaid program.
And she took the lead among state attorneys general in opposing an anti-competitive merger between a big hospital group and a large physician practice. She joined the Justice Department lawsuit that stopped two of the nation’s largest health insurers, Anthem and Cigna, from joining together.
Ms. Harris and Vice President Pence are scheduled to debate on Wednesday evening, at a time when the coronavirus pandemic has put a spotlight on access to health care, high medical bills and drug prices.
“She will be as she has historically been a very strong advocate for consumer protection,” said W. Kenneth Marlow, a health care lawyer with Waller Lansden Dortch & Davis in Nashville who represents for-profit businesses seeking to buy hospitals. If the Democrats win the White House, he predicted her presence in a Biden administration would lead to close scrutiny of health care deals.
Consolidation among major hospital systems has plateaued in recent years, but has continued at a pace that still alarms health policy experts. Recent studies including the RAND examination of prices for hospital and outpatient treatment have made the case that mergers and acquisitions have led to some mega-networks charging two-and-a-half to three times more than Medicare does for patient care.
As the California attorney general from 2011 to 2017, Ms. Harris used her powers to protect consumers and to prosecute fraud or antitrust violations in pursuit of health care industry players she accused of maximizing profits at the expense of patients.
The daughter of a medical researcher, Shyalama G. Harris, who died of cancer in 2009, Ms. Harris took on those big companies in a state with the some of the most sprawling hospital systems in the country.
The Biden campaign declined to make Ms. Harris available for an interview. A statement from Sabrina Singh, a campaign spokeswoman, said that she “had a strong track record of taking on powerful corporations and special interests on behalf of the people of California.”
As attorney general, “she decided that health care was a big priority for her,” said Richard Scheffler, a professor of health economics at the University of California, Berkeley, whose work on the effect of big health systems on prices has been cited by the attorney general’s office. He helped write an analysis of her tenure in a blog for Health Affairs, an academic journal. “A lot of A.G.’s don’t do that,” he said.
Ms. Harris’s predecessor in the job, Jerry Brown, the former governor, was among those Democratic attorneys general who did not make health care a major focus of his tenure.
Ms. Harris’s aggressive stance has drawn criticism. In a Wall Street Journal editorial last August, she was accused of preventing the sale of a hospital group to win support from a heath care union and “to punish a business she didn’t like.” The accusations were outlined in an unsuccessful lawsuit by the thwarted buyer, and the subsequent bankruptcy of the hospital group raised questions about her decision.
Concern over the lack of competition in health care markets is shared by the Trump administration, said Brian Blase, a former White House aide. During his first year in office, President Trump signed an executive order asking federal officials to look closely at hospital mergers and other actions that could lead to higher prices and less choice for consumers.
“It’s an issue that we spent a lot of time addressing and expressed significant concern about,” Mr. Blase said. Earlier this year, administration officials released a report, recommending continued oversight and eliminating state laws that require approval to build or expand medical facilities. Top health officials have also pushed for more transparency in what hospitals charge for various surgeries and services.
But Mr. Blase acknowledged that the administration’s other health care priorities, including legal efforts to overturn the Affordable Care Act and addressing high drug prices, have frequently taken precedence. Neither party has given the topic sufficient attention, he said.
The agencies charged with oversight, the Federal Trade Commission and the Justice Department, have continued to review mergers and other kinds of anti-competitive behavior, including looking at some of the same issues Ms. Harris tackled during her tenure in California. The Trump administration allowed two of the nation’s largest health insurers to combine with the largest pharmacy benefit managers, approving them despite concerns that the mergers would harm competition.
But antitrust experts say Ms. Harris’s experience could come at a particularly important time. The pandemic has inflicted significant economic damage on smaller hospitals and physician practices that may be unable to survive, resulting in a health care landscape with fewer and fewer patient options.
“These dominant players in health care markets could become even more powerful and entrenched,” said Martin Gaynor, a health economist at Carnegie Mellon University.
California’s major legal battle against hospital giant Sutter Health is often cited as an example of Ms. Harris’s record. She is credited for laying the groundwork for investigations into major hospital groups that led Xavier Becerra, the current state attorney general, to sue Sutter Health for using its power to demand higher prices and broker deals with insurers that forced them to include all of their medical centers. Mr. Becerra reached a $575-million settlement with the hospital chain last December.
Ms. Harris’s antitrust efforts also extended to drug makers. She used both federal and state courts to challenge what are called pay-for-delay agreements in which drug manufacturers pay competitors to delay the introduction of generics to replace brand-name drugs.
It is not unusual for regulators to focus on the actions of pharmaceutical companies, said Michael A. Carrier, a professor at Rutgers Law School. “State attorneys general know high prices cause all of their constituents to suffer,” he said.
Ms. Harris was involved in both federal and state legal challenges to Bayer Corporation’s agreements protecting its antibiotic Cipro. After federal cases were dismissed, Ms. Harris turned to the California Supreme Court. “California has been on the forefront on this,” Mr. Carrier said.
Her expertise could potentially shape a Biden administration stance on antitrust cases, although critics worry her close ties to the tech titans in Silicon Valley could hamper efforts to oversee those giants.
The Biden campaign has received significant contributions from the health care industry, including unions representing health care workers. He has raised some $25 million from the health care sector overall, compared to $14 million by President Trump, according to the Center for Responsive Politics, which tracks donations. Many see him as a safe bet to protect the status quo, especially during the current tumultuous period.
Ms. Harris’s oversight of hospital mergers included some criticisms that her actions against businesses were politically motivated. Prime Healthcare, a for-profit hospital operator that sought to buy hospitals owned by the Daughters of Charity Health System, sued Ms. Harris after she insisted the company consent to a series of conditions if it went ahead with the purchase.
In the lawsuit, Prime claimed that she conspired with a union to prevent the transaction so that the labor group would “financially contribute to her campaign for U.S. Senate without regard to the merits of Prime’s proposal.” The lawsuit was dismissed, and union officials say Ms. Harris acted appropriately in trying to prevent any new owners from slashing services and laying off staff. Prime subsequently settled a Justice Department lawsuit accusing it of Medicare fraud.
“Our experience with Attorney General Harris was she was an honest broker and did a good job regulating nonprofit health care systems,” said the union’s president, Dave Regan.
The company, Prime Healthcare, said in a statement, that it is “hopeful that Senator Harris will be a strong advocate for health care providers, patients and health systems while strengthening and expanding the Affordable Care Act to ensure care for all.”
The Daughters of Charity hospitals were eventually sold to a hedge fund, and the system filed for bankruptcy in 2018. Prime is buying one of the hospitals.
As a U.S. senator, Ms. Harris supported Senator Bernie Sanders’ Medicare for all legislation in 2019, although her views on abolishing private health insurance shifted during her presidential campaign to a lengthier transition to a Medicare-like program. She also co-sponsored legislation on drug pricing and introduced legislation addressing the high maternal mortality rates among Black women.
Consumer advocates say Ms. Harris played a critical role in identifying how powerful hospitals are a driver of ever-higher prices. Any administration that wants to deal with health care costs will have to tackle hospital consolidation and anti-competitive practices, said Anthony Wright, the executive director of Health Access California, a consumer group that favors strong oversight of the state’s hospitals.
“Harris was attorney general at a time when this was emerging as an issue,” he said, describing her as someone who understood how anti-competitive behavior affects consumers. “It is a very useful view from the White House or the Naval Observatory,” where the vice president resides.
Senate Bill Would Outlaw Bank Discrimination for the First Time
Democrats in Congress have introduced legislation that would make it illegal for banks and other financial firms to discriminate against their customers because of their race, religion, sexual orientation and other characteristics — an effort meant to close a loophole in the Civil Rights Act highlighted in a New York Times report in June.
The Fair Access to Financial Services Act, introduced on Wednesday by members of the Senate Banking Committee, would explicitly outlaw discrimination against bank customers. Currently, it is legal for banks and some other businesses to treat some customers differently as long as those customers eventually receive the services they are seeking. That means, in practical terms, that banks can racially profile their customers and delay their transactions, or ask them to take extra steps to prove their legitimacy, without risking penalties as long as they eventually do business with those customers.
The loophole stems from the specificity of the Civil Rights Act of 1964, which lists the kinds of businesses — including movie theaters, restaurants and hotels — where discrimination is prohibited. Courts have ruled that the law does not apply to any businesses not on the list. That leaves customers who say they have been mistreated with little recourse, especially in states like Georgia, where there are no statewide anti-discrimination laws.
The bill stipulates that “all persons shall be entitled to the full and equal enjoyment of the goods, services, facilities, privileges and accommodations of financial institutions.” It is sponsored by Senators Sherrod Brown of Ohio, Tina Smith of Minnesota, Cory Booker and Robert Menendez of New Jersey, Elizabeth Warren of Massachusetts and Chris Van Hollen of Maryland.
The bill was written after The Times described the ways in which Black bank customers have been treated with suspicion and hostility while trying to do basic banking business. In one instance, a man seeking to withdraw cash from his Wells Fargo account to buy a car was turned away by a manager who threatened to call the police. In another, Wells Fargo employees called the police on a woman trying to cash a $200 check.
Because of the loophole in federal law, customers who experience discrimination can rely only on state protections when they seek justice.
“Too many Black and brown Americans experience racial profiling and unequal treatment when trying to access services at banks and other financial institutions,” Senator Brown said in an announcement of the bill emailed to The Times. “Victims of discrimination are not even able to hold financial institutions accountable — it is shameful.”
The two-and-a-half page bill lays out what bank customers who experience discrimination can do about it: Ask a federal court to order the bank or financial institution to cease the mistreatment and recoup lawyers’ fees from the institution if the court rules in their favor.
“Our legislation would be a clear and comprehensive statement that discrimination has no place in our financial system,” Senator Smith said in the announcement.
The bill has been endorsed by civil rights groups like the N.A.A.C.P., UnidosUS and the National Urban League, according to the announcement.
Two Democrats on the House Financial Services Committee, Representatives Hank Johnson of Georgia and Joyce Beatty of Ohio, will introduce a complementary bill, according to the Senate announcement.
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8 Lessons in Entrepreneurship From the Greatest Inventor of All Time
October 21, 2020 8 min read
Opinions expressed by Entrepreneur contributors are their own.
If you’ve ever read Harry Potter, The Odyssey or any traditional folk tale, you’ll be familiar with the hero’s journey. They all (and countless others) follow the same template. It was literature professor Joseph Campbell who, in 1949, published the book that described and analyzed this structure: The Hero with a Thousand Faces. This book has inspired writers across a range of genres including films, novels, plays and gaming.
In my new book, The Entrepreneur Journey, A Strategic Blueprint for Market Domination, I explore the idea that the mythological hero journey mapped out by Campbell might also provide a framework for the journey undertaken by entrepreneurs.
To illustrate the different phases in the entrepreneur’s journey, I have started each chapter with an episode from the life of one of the most prolific innovators of all time, Thomas Edison. Edison will forever be associated with the phrase “a light bulb moment,” a flash of blinding intuition that apparently comes out of nowhere, but the reality was very different. I hope these stories will highlight the complexities behind his invention, the teamwork and effective delegation needed, the extent of collaboration, the detailed planning and ceaseless cycles of testing and improvement.
According to Campbell, there are 17 steps on the hero’s journey. I have narrowed these down to eight.
The journey starts when the entrepreneur, immersed in the world sensing their surroundings, is visited by inspiration and feels an urge to make a change. This call prompts a step away from everyday life, whatever the form of inspiration. For Edison, this came when he visited inventor William Wallace’s workshop in Ansonia, Connecticut, and saw his Telemachon, or new dynamo. It was at that moment he saw the solution to the problem of developing a system to supply cheap, abundant electric light.
Articulating this idea, expressing it, so it can be shared and understood by others takes a certain amount of dedication and even courage, particularly if the entrepreneur is operating in an environment in which individualism and personal growth are not prized. In Edison’s case, this meant returning to his own workshop at Menlo Park and inspiring his own muckers to invest in the project. This took conviction and passion, daring and an enduring sense of clarity and purpose
Those who have decided to proceed to the otherworld — the external world of the collective and teamwork — face their first initiation: crossing the threshold from the second phase to the third to present their idea to a group of peers such as investors, programmers and engineers. It is here that the entrepreneur must partner up with these collaborators, and they all need to reorient themselves to work together harmoniously and embark on the adventure of collaborative work and building the product. In this context, Edison’s habit of leaving his notebooks lying around constituted an open invitation to all his workers to engage with his ideas and give him their honest opinion. He also fostered collaboration by staying up all night socializing with his colleagues and workers.
Now the team must come to a decision as to what exactly they are going to build and bring to market and how they are going to achieve that. They must draw up the best plan together: There are many considerations (market forces and the nature of the competition) to take into account, and the task can be much tougher than they expect, especially if delays and internal conflict hinder progress. The entrepreneur might be tempted to abandon their internal call and initial purpose and proceed to build a product that does not resonate with their needs.
For Edison to complete his task, he was going to have to spend most of the little money he had leftover from the initial investment on the latest equipment. Menlo Park had to be the most comprehensive facility in the world for conducting electrical research. He was also going to have to hire new staff: men skilled in the arts of machining and glass blowing. The laboratory would now be a special-purpose facility. As Edison explained to his employee Theodore Puskas (who would go onto invent the world’s first telephone exchange), Menlo Park was going to need “all the means to set up and test more deliberately every point of the electric light, so as to be able to meet and answer or obviate every objection before showing the light to the public, or offering it for sale either in this country or Europe.”
With their plan in hand, the team now starts to execute and actually create a system in the physical world, developing this system in the form of a service or product. There are threats to overcome — dragons to be slain — at this stage: tight budgets, unexpected setbacks, quality maintenance and compliance with legislation. Many iterations might be needed at this stage to emerge triumphant. But if you get through this stage, you’ll have passed the point of no return. In theory, there is always an option to pull back, but you may, as in the hero’s journey, find that you have gone too far to be able to abandon the quest and must see it through. Within two weeks of creating a miracle light filament that could burn for 13-and-a-half hours, Edison and his team had improved on this design and applied for a patent. It was not until several months after the patent was granted, the following year, that they came up with a bulb capable of lasting 1,200 hours.
Now the work to develop a whole system — dynamo, lamps, connecting wires — could really begin. Again, Edison quite spontaneously adopted an approach entirely consistent with modern management in dividing the work between a number of multi-functional teams, each with its own goals, that briefed him on their progress every evening.
The prize as we move into the next stage is a product or system that is proven, through vigorous testing and experimentation, to function — an offering robust enough to fulfill the expectations, and indeed the aspirations, of those who use it. When John Kreusi, Edison’s chief machinist, remarked on the sheer quantity of the offers to build power stations that they were receiving, Edison looked at him and said “Do nothing. We’re not ready yet. We have carried out an experiment, that’s all. Yes, it was successful and the concept is there. We showed that. But that is not enough for a project such as this. We have to test every part of this system — not just for faults and improvements but for longevity. It has been shown to work, but we have to show it functions — not just once, but over a long period of time. If there’s a failure in the system we must discover it before anyone else does.”
It’s time to take your product to market, and there you will need to engage with potential users to make them aware that your offering can solve their problem — or even a problem they weren’t aware they had. (Bear in mind that the entrepreneur might still be pursued by guardians from the other world, in the form of revised regulation, for example, which might require a retreat to an earlier stage.) Developing your networks is a worthwhile activity, giving you far greater access to information, expertise and maybe even partnership. You will have a much better chance of success if you surround yourself with the right people from the beginning, such as marketers who will actively want to partner with you.
Although the Paris Electrical Exhibition of 1881 might have been an international scientific and trade conference rather than a marketing one, the presence of Edison’s team there enabled him to enrich his networks and size up the opposition.
Finally, the entrepreneur will begin to receive feedback from the users — some positive, confirming that they have made the right decisions; some critical, signaling the need for improvement. As in a video game where you pass to the next level, the journey begins again, this time with new challenges, but with the benefit of hindsight.
When Edison was presented with complaints from customers who were more than a mile from his stations and so unable to enjoy the benefits of his lighting system, he listened and went back to the drawing board and invented the three-wire system. In researching Edison’s story I was struck by the fact that although more than a century has passed since his Edison Illuminating Company was formed, the entrepreneur journey itself has not changed much.
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