Athens: Nicos Anastasiades, outgoing President of Cyprus, urged a functional and viable solution to the Cyprus problem during his visit here on Wednesday.
Anastasiades, who is not a candidate in the presidential elections this Sunday, thanked Greece for its steady support to efforts to resolve the long-standing problem.
“I think we have adequately shielded Cyprus, so that it can negotiate a solution that is functional and viable,” he said during his meeting with Greece’s Prime Minister Kyriakos Mitsotakis, the country’s national news agency AMNA reported.
Nicosia sought a solution that would be beneficial to both the Greek and the Turkish Cypriot communities, “thus contributing to peace prevailing,” he said.
Cyprus was partitioned when Turkey sent troops to intervene in the island’s northern part in 1974 in response to a coup staged by the military rulers of Greece at the time, Xinhua news agency reported.
Several UN-led efforts to negotiate an agreement for the divided island have been inconclusive to date.
The two leaders also visited Mati, a coastal resort near Athens that was scorched by a wildfire in July 2018, which left more than 100 dead and hundreds homeless.
Cyprus has donated 10 million euros ($10.91 million) for the construction of some 100 apartments, as well as the creation of a park. Works are still underway there.
“Working closely together in solidarity we support each other,” Anastasiades said.
Mitsotakis thanked him “for this gesture, which contributes to efforts to heal the wounds caused by this huge catastrophe”. (1 euro = $1.09)
This has been a long time coming. Antitrust policymakers failed to halt the rapid consolidation of hospital markets in part because many judges and health policy leaders used to believe, falsely, that hospital consolidation led to efficiencies and better care delivery, and it took years of painstaking academic research to arrive at this updated understanding of the market. Although hospital systems continue to consolidate, policymakers are now armed with better analytical techniques and a wealth of evidence that can be used to stop the most egregiously anticompetitive mergers.
But if we’ve started succeeding in preventing further consolidation in hospital markets, we have invested far less thought into developing meaningfully competitive and innovative markets. It is folly to think that antitrust policy should solely consist of stopping bad things like additional hospital mergers. We also need to use the antitrust laws to usher in the benefits of genuine competition.
As the U.S. emerges from the pandemic, the timing for a renewed push to increase competition is ideal. The 20th century model of health care delivery, in which patients get in-person care at designated brick-and-mortar facilities from licensed professionals, is reaching a turning point. Telemedicine, at-home care, and other delivery innovations — many of which achieved prominence when the pandemic struck — are offering new alternatives to hospitals, and data analytics are informing insurers how to better manage patients with chronic illness. Together, these innovations might forge a transformation away from a hospital-centric delivery system and towards an age of digital medicine.
But hospital monopolies, like all monopolies, harm markets not only by charging prices. They also impede innovation, and today’s hospital monopolies are working hard to endanger the arrival of this new age of medicine.
They are doing this through a variety of well-tested techniques. One is using their dominance to impose “all-or-nothing” contracts, which require insurers to pay for all of a hospital system’s services or drop out of the market altogether. This strategy prevents insurers from contracting with select providers — creating so-called “narrow networks” — that can direct patients to higher-value providers and stimulate competition between rival facilities. Hospital monopolists bundle their services together, which forces patients to pay for a system’s costly services if they want to rely on their critical services; for example, in order to have access to the only trauma center in town, patients must also commit to the hospital system’s oncologists and cardiologists, practices that would be vulnerable to competition from other providers and telemedicine companies. And hospital monopolists work to squeeze out small, nimble providers that might offer lower-cost alternatives to the multi-specialty giants; and if they fail to drive them out, they purchase them.
None of this is casual. Dominant hospitals are well aware of the threats that innovations pose to their business model. They know the health care market of the future puts less primacy on inpatient care and more on virtual care. They know that health care services are provided at higher quality and lower costs at facilities that do not suffer from the overhead and governance burdens of costly multispecialty centers. And they know that telemedicine and hospitals-at-home companies pose existential threats to their dominance.
Innovation in the health sector, though sorely needed, is unlikely to emerge without effective antitrust enforcement. But thus far, antitrust approaches in the health sector have remained stale, in part because competition law in the health sector has only expressed opposition to consolidation. It hasn’t yet said what it is for.
Better antitrust policy to combat hospital dominance means understanding the dysfunction of the current market and the benefits of certain innovations. It is not a blanket hostility to size or mergers but instead a targeted attention to where specific structural changes would bring transformational benefits.
If these insights into innovation were to guide our competition policy in the health sector, we would focus on activities that have not yet attracted the attention they deserve. Here are three of them.
Protect Independent Physicians
Policymakers should pay renewed attention to physicians as a competitive threat to hospital dominance.
Hospitals have been acquiring physician practices at a rapid rate, a trend that accelerated since the Covid pandemic, and nearly three-quarters of America’s physicians are now employed by hospitals or corporate entities. Current antitrust policy considers hospital acquisitions of physician practices as “vertical” mergers that are largely innocuous because they do not increase the concentration in either hospital or physician markets. But mounting evidence has shown that these acquisitions lead to higher costs, probably because many of these transactions are better described as mergers of substitutes rather than compliments.
In other words, many outpatient clinics offer similar services as those offered in hospitals, so when hospitals acquire physician practices, they eliminate competition. Worse, outpatient care is less costly than similar services offered inside hospitals, and medical advances continually expand what can be done in outpatient settings. The loss of the independent physician practice means the loss of the often better and almost always less expensive alternative.
The dynamic consequences of these acquisitions — the harm to innovation — are probably even more costly. Controlling physicians means controlling referrals, and hospitals rely on referrals for their most lucrative services. Reciprocally, the biggest threat to hospital dominance is if physicians direct their patients elsewhere, and the current market now offers real alternatives to traditional hospital care: specialty providers, regional providers with telemedicine follow-ups, hospital-at-home care and even physician practices that expand into secondary care. Moreover, many of these new practice models are built atop digital analytics, virtual technologies and innovative financing that have the potential to produce new care models that might upend hospital monopolies altogether.
Perhaps what is most frightening to hospitals is that many of these innovations are designed to promote population health such that people are kept out of the hospital, i.e., they are intended to drastically reduce our need for hospitals altogether. So, when hospitals acquire the source of these potential innovations, they don’t merely enshrine their monopoly position, they also engineer a future in which we continue our dependence on them.
Encourage New Business Models
Antitrust policy should help new business models for both hospitals and insurers. Too frequently, dominant hospitals and insurers work to foreclose the market to newcomers.
Conventional wisdom suggests that dominant insurers and dominant hospital systems would be at loggerheads over the price of medical services. In fact, these large entities often collude with each other to keep out other competitors. By promising each other that they won’t give smaller entities more favorable terms — these arrangements are commonly called most-favored-nation, or “MFN” contracts — giant payers and giant providers secure each other’s dominance. (This collusion-among-giants was discovered and challenged in Massachusetts and Michigan, but quiet cooperation between dominant payers and providers is widespread.)
Many large insurers pursue similar strategies with insurance brokers, demanding that they market their products either exclusively or on favorable terms. (An important case involving this conduct recently took place in Florida.) These efforts prevent new insurers and upstart providers, those most likely to introduce news business strategies and care models, from gaining traction in the marketplace. Victims of this market “foreclosure” usually are innovators: insurers with new price transparency features, physician-led ambulatory surgical centers that offer specialty care, and behavioral health providers that use new virtual technologies. Low-cost and high-value “centers of excellence,” which encourage patients to travel to destinations with specialized experts, also are harmed.
Antitrust laws can challenge this conduct as well. Although merger policy has been the primary antitrust instrument in the health sector, antitrust laws also prohibit monopolistic conduct that forecloses competition. The antitrust laws do not outlaw monopolies per se — and many rural regions cannot sustain more than one provider — but they do constrain a monopolist from leveraging its power to impede entry. Antitrust policy needs to recognize the potential of new business models, especially those that direct resources away from traditional hospital care, and preempt efforts to foreclose the market to them.
Protect Digital Startups
Finally, and related to both strategies above, antitrust enforcers must prevent the industry giants from consuming the world of digital startups. Perhaps today’s top competition policy concern is that Google, Facebook, and other dominant platforms have hijacked the entirety of Silicon Valley’s startups, such that few products reach the market without being purchased by one of the internet goliaths. The same is taking place in the health sector, as health care startups developing new diagnostics, therapies and delivery models are being purchased by market leaders.
It is hard to overstate the long-term harm this causes. When dominant hospitals purchase innovative in-home care companies, they remove their greatest threat. When insurance giants purchase start-ups with innovative digital analytics, care management platforms, or virtual capabilities, they extend the viability of their 20th century business model. These purchases are executed under the theory that the giants are adopting new technologies and are engineering change. The truth is that the opposite is happening: Change is halted, and the prevailing delivery model persists. They are the health sector’s version of catch-and-kill.
Current antitrust laws can help this smothering of innovation, but it won’t be easy. These acquisitions are products of voluntary agreements, and many start-up companies — including a recent rash of primary care practices — focus their efforts and garner investments precisely so they can be acquired by either a large insurer or health system. Industry leaders in pharmaceuticals and electronic health records are also frequent purchasers of start-ups.
The difficulty for antitrust law is to distinguish between socially beneficial acquisitions, such as those in which the start-up’s technologies are used fruitfully by the purchasing giants, from those that erase potential competition and sustain market power. This difficulty is not unique to the health sector, nor is it an easy one to navigate, but typical responses are either to allow or disallow all such acquisitions. The better approach is to scrutinize the underlying technologies and the potential they offer. Perhaps, in these particular questions, the complexity of health care should be addressed head-on.
The potential that antitrust policy can play in the health sector is illustrated by what might be the field’s crowning achievement in the modern era: the case against Microsoft in the 1990s. Contrary to the popular narrative, that case was not about stopping Microsoft from carving out a monopoly for Internet Explorer, its web browser. Instead, DOJ recognized that Microsoft was trying to prolong the centrality of its monopoly in desktop computing, and that its illegal maneuvers were aimed at preventing the emergence of new alternatives to Microsoft’s operating system. Those alternatives, once they were permitted to enter the marketplace, unleashed the world of internet-based platforms, mobile devices and a new generation of digital services.
The case was a victory for antitrust law because policymakers understood that Microsoft was inflicting harm far beyond the monopoly prices it charged. The real danger came from Microsoft’s efforts to impede transformational innovations. The suit wasn’t merely designed to beat back Microsoft’s economic power; it was to prevent Microsoft from asserting its control over a particular platform and to allow market innovators to usher in a new era of computing. In other words, the best way to stem the market power of Microsoft was to encourage the emergence of Google.
Like Microsoft, today’s hospital monopolies are the platforms that provide access to assorted medical services, and they are acting to prevent the growth and onset of physician practices, telemedicine companies, and other nimble and innovative providers that offer the path to new delivery paradigms. Antitrust policy needs to recognize not just the harm from hospital monopolies but the potential from new delivery innovations. Like policymakers demanding changes from Microsoft, today’s leaders must pursue an antitrust agenda that can facilitate a more affordable, more effective delivery system.
Today’s exuberance for antitrust enforcement is to be applauded, but antitrust is at its best when it is for something, not just against something, when it is visionary and not merely reactionary. Health care antitrust policy should be driven not by a generic aversion to concentration but by a careful understanding of how health care markets can work in this new digital era. The more policymakers know about where the market can go, the more effective and transformative antitrust policy will be.
Health care antitrust must be about more than combatting traditional mergers and instead should commit itself to nurturing a dynamic market, one that encourages entry, creativity, and innovation. The lessons of the Microsoft case tell us that if we can stop the monopolists from halting innovation, we will soon be able to usher in a new market paradigm, one that promises to increase competition and — finally — slow our spiraling health care costs.
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( With inputs from : www.politico.com )
Democratic Rep. Marie Gluesenkamp Perez was a stunning winner in the 2022 midterms. The millennial auto shop owner flipped a Washington district that both the state and national Democratic parties considered unwinnable.But then incumbent Jamie Herrera Beutler, who had voted to impeach Donald Trump, came in third in the state’s open primary. Suddenly, Gluesenkamp Perez, 34, was facing off against a Donald Trump-backed Republican in the solidly red district. Despite the long odds that national pundits and pollsters gave her throughout the campaign, she beat Joe Kent, an election-denier and regular guest on Tucker Carlson, by less than one point.Her district stretches more than 230 miles across (about the distance from D.C. to New York) — from remote beach communities on the Pacific Coast to timber towns in the Cascade mountains, and south past dairy and berry farms to the rapidly growing city of Vancouver. It’s a middle-class district where about a quarter of residents are college graduates, and the median income is just under the national median household income of $70,784.
I met up with Gluesenkamp Perez for lunch at Charlie Palmer Steakhouse in D.C. — its white tablecloths and suit-clad patrons casting a stark contrast with the antler-forward decor and outdoor gear of the other Washington’s eateries. I wanted to learn more about how she plans to represent her largely middle-class district (where I had grown up) and what Democrats could learn from her unexpected win. Over a steak salad — rare — Gluesenkamp Perez gave a bracing critique of her party’s deeply out-of-touch approach to the middle class, why the party’s leaders seem to be making that problem worse, not better, and how closing the widening gap between the party’s brain trust and its blue-collar roots can be accomplished by reconnecting Americans with our lost ability to “fix your own shit.”
This conversation has been edited for length and clarity.
Natalie Fertig: You’re part of a 200-plus person Democratic caucus. How do you see yourself creating an understanding of the middle class in that caucus and getting middle-class laws passed?
Marie Gluesenkamp Perez: It feels like the Democratic Party, especially wealthy leadership in the Democratic Party, has taken it upon themselves to be champions of the poorest of the poor. And I think that’s great, but I think that it has left a lot of people in the middle class feeling like people don’t understand the issues we’re facing. I think it’s left unaddressed a lot of really critical things that are not glamorous, lionized issues, but that beat the hell out of people’s will to persist. The indignity of supply chain problems. Catalytic converter theft. Bad infrastructure. Shit roads.
Fertig: I’m laughing at the catalytic converter theft, because I feel like that’s like all my dad was talking about when I was home over the summer.
Gluesenkamp Perez: Oh, yeah. I replaced hundreds of catalytic converters last year. It’s like $40 worth of platinum, and it’s a $1,300 repair. That just eviscerated so many people’s emergency funds all across the district.
Fertig: Crime was something that so many people [in District 3] talked about, and is something that you talked about. Why do you think that was an important issue in this election?
Gluesenkamp Perez: It’s relevant to our lives. I had my [shop] windows broken four times last year. So yeah, I’m pissed off. I’m going to talk about it, you know? It’s a grind, and it gets expensive and demoralizing. I think that for a lot of people that sort of live in these silos, they are not as cognizant of it. And I think maybe that’s why it was not more of a campaign issue for more people.
Fertig: What do you mean by people living in silos?
Gluesenkamp Perez: A lot of candidates are self-funded people with trust funds.
Fertig: I see that, too. Like, what is it like to pay student loans? Even amongst my colleagues here in D.C. — not everyone has the same experiences.
Gluesenkamp Perez: Yeah. Like, “<a href="https://www.youtube.com/watch?v=Nl_Qyk9DSUw&ab_channel=heyitsadriann" target="_blank" link-data="{"linkText":"It‘s a banana, Michael","link":{"target":"NEW","attributes":[],"url":"https://www.youtube.com/watch?v=Nl_Qyk9DSUw&ab_channel=heyitsadriann","_id":"00000185-d1ed-d674-abbd-d9ff40d20000","_type":"33ac701a-72c1-316a-a3a5-13918cf384df"},"_id":"00000185-d1ed-d674-abbd-d9ff40d20001","_type":"02ec1f82-5e56-3b8c-af6e-6fc7c8772266"}”>It’s a banana, Michael, what could it cost? $20?”
Fertig: So, we talk a lot about the great relocation of Democrats to cities and Republicans to rural areas, but you just flipped a district that is majority rural. Carolyn Long tried this twice [in 2018 and 2020] and failed. What was different this time around?
Gluesenkamp Perez: I think I look more like the district. I live like the district. [And] obviously not running against Jamie [Herrera Beutler] was a huge part of it, you know?
I don’t think that your traditional pedigreed Democrats are the solution to Trump extremism. I think that a lot of these traditional Democrats, the m.o. is to go into a community and start explaining shit. Nobody likes that. I’ve heard that so often: I’ll go to an urban community, and people will be like, “Oh, like this candidate was amazing. They are so smart.” And then I’ll go to a rural community and talk to them about the same candidate. And they’ll say: “Yeah, they’re pedantic and they don’t understand. They didn’t listen to us.”
Fertig: Do you feel like the things that made success in your district are very specific to you and your district, or do you think there’s a model there that Democrats could use in other rural districts?
Gluesenkamp Perez: We need more and more normal people to run for Congress. We need more people that work in the trades.
When I was thinking about running, I interviewed some jackass, fancy consultant. I told him about myself, and he was like, “Well, I’ve worked with worse.” When I said I had a son, he chortled, and was like, “Hope you don’t want to see your kid again.”
He told me to talk to the governor and see if I could get appointed to some committee on aging and disability, or something like that, and build up a resume that would allow me to run successfully later on.
I’m just like, “How many other women has that happened to, you know these jackass men telling them not to run?” And I’m like, “Well, I guess you’re the expert, you’re wearing the suit.”
Fertig: I know that the DCCC didn’t give you any money. I know that the state party basically didn’t notice [you] until after the primary. What are they missing — besides normal candidates — what are they missing about those voters who are in those districts?
Gluesenkamp Perez: Frankly, I think there’s a lot of lip service to wanting people in the trades, rural Democrats. They say it because it sounds good, but I’m not sure that there is an actual commitment to it.
Fertig: What would that look like? Would that be going out and recruiting candidates like that?
Gluesenkamp Perez: Recruitment is certainly part of it, but the things that would get you on the radar are not the same things that make you relevant to voters.
Fertig: What do you think are the things that get someone on the radar?
Gluesenkamp Perez: Being a good fundraiser. Being from the right family. Living in the right city. I think self-recruitment is important.
Fertig: Why did you decide to run?
Gluesenkamp Perez: I saw Jamie not making it through. When I thought I was gonna have to run against Jamie for a few days after the primary, I was moping around the house. I got in this race to stop a fascist. And because I believe in public service. It’s not that I think I’m God’s gift to politics. I just think I had the community resources to run. I think I have a compelling narrative, a good perspective.
I just want more tradespeople in Congress. I run into people here, I’m like, “Oh, your bio says you’re a small business owner. What’s your business?” They’re like “Oh, we have a family real estate brokerage firm.” Oh, okay. Sure. Yeah, technically, you have less than 500 employees. So you are a small business.
Fertig: You mentioned that you really were not excited about the premise of running against [Herrera Beutler]. Why?
Gluesenkamp Perez: Because I was not going to win that race, and it would be a huge investment of time and energy pointed at someone that I don’t think was the problem.
Fertig: Obviously, you and [Herrera Beutler] have different perspectives on things like abortion. Even despite that, why do you not think she was the problem?
Gluesenkamp Perez: Well, because Jamie and I share a basic reality of facts. Which increasingly is hard to find.
Fertig: Which facts?
Gluesenkamp Perez: Who our elected president is. What it means to be a traitor.
Fertig: What are those issues that you see being the key ones that people are responding to that Congress can do?
Gluesenkamp Perez: We have to start rebuilding the American workforce. We’re all part of the generation where the best trade schools got turned into computer programming schools. Now we’re all on waitlists to see an electrician, plumber or carpenter. Those are the jobs that can’t get offshored — that’s the long-term economic health of our country. So, support for career and technical education programs is key. Ensuring that you can use Pell Grants not just for two- and four-year colleges, but also for apprenticeship programs.
That is one of the key elements of “right to repair” [laws]. You have to have stuff to fix. I think this is actually one of the most critical things you can do right now. Because you nip this in the bud, and you can prevent decades of work [erosion].
Fertig: Tell me a little bit more about “right to repair” laws and how they affect District 3 specifically.
Gluesenkamp Perez: Auto manufacturers have started installing, almost like governor chips on their tractors. So if you don’t have the digital key to unlock it, and you mess with the engine, they can lock you out. And there was a specific model of tractor that all had this, and it was a relatively new technology at the time, and all these tractors broke down at the same time. And the problem, specifically in agriculture, is that you only have a couple of days to cut hay when it’s maximally nutritive. Then the seed head starts falling off of it and the hay is worthless at that point. So these tractors all break down, there are not enough dealerships to service these tractors, and millions of dollars in hay are lost. And understandably, these farmers come out with pitchforks.
Fertig: Literally and metaphorically.
Gluesenkamp Perez: Correct. And so that’s kind of the genesis of “right to repair.” But it’s not just ag equipment. It’s also like your iPhone. You should be able to replace the battery in your phone without breaking the whole thing. I think it’s a much broader cultural issue of like, “Are Americans gonna be disempowered from understanding the technology they rely on?” We’re more and more surrounded by these black boxes that we have no influence over.
I think it’s the American ethos that we know how to fix shit. DIY is part of our DNA.
[We’re] becoming increasingly disenfranchised from the technology we rely on, being pointed more and more towards a permanent class of renters and not ownership. And it’s really terrible for the middle class. I’ve never bought a new car in my life. I rely on people having maintained their cars. And the new BMWs, for instance, don’t even have a dipstick. It’s like “Don’t worry about it, just buy a new one,” and it’s terrible for the planet. It’s terrible for the middle class. And I think it’s bad for our identity.
Fertig: Energy is obviously a big issue [with the] Columbia River, hydro-power and climate change. But how does that boil down for the district and middle-class people?
Gluesenkamp Perez: We’ve turned environmentalism into another brand of consumerism. Go buy a Tesla, you’re an environmentalist. I think being an environmentalist is being able to fix your own shit, like stopping an oil leak from going in the river, getting 500,000 miles out of your Honda Civic. The middle class has kind of been made to feel like [environmentalism is] a luxury good. That if you’re wealthy, you can have good air quality, and you can afford to breastfeed your baby instead of using formula.
One of the things that I’m really concerned about, that I think is relevant to my district, is microplastics. They’re everywhere. Literally, they’re finding them in placentas. And I believe that the solution to microplastics in many cases is cardboard and paper. We have to start replacing plastic products with cardboard, paper, wood — especially with packaging. We happen to make a lot of paper and cardboard in southwest Washington. The woods are a hot mess, we need to thin out the woods. That is not lumber, that is what you make paper out of.
Fertig: Right. My parents were in the evacuation zone [for the Nakia Creek fire] for a hot second in October, and that was really freaky.
Gluesenkamp Perez: I was over in Pacific County, which is as far as I can get from my house and still be in the district. I gave a speech, and I get an emergency alert on my phone: “It’s time to leave.” So I was like, “Oh, fuck!” and everyone just looks at me.
Fertig: Did you end up evacuating?
Gluesenkamp Perez: We packed up, but we didn’t end up leaving. You could see the glow. My husband — who’s very chill — was like, “It’s a ridge away, we don’t need to evacuate.” I’m like, “I don’t want to evacuate the baby at two o’clock in the morning.”
Fertig: I enjoyed your campaign ads when you were putting firewood [in the stove]. That was very relatable.
Gluesenkamp Perez: For our district. But for so many people — it’s like, you feel like a spectacle all the time. “Look at this rural woman with her baby, chopping.”
Fertig: I know you are surprised that people are focusing on your district. Do you think there’s a big takeaway for the Democratic Party?
Gluesenkamp Perez: Support normal people. People are hungry for a Congress that looks like America. It’s not rocket science. It’s about listening to your district. It’s a rebuke of facile allegiance to statistics. Numbers on their own represent nothing without an understanding of the landscape.
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( With inputs from : www.politico.com )
