Times Square back to the bad old days

 You’re not in Disney anymore.

Times Square is looking a lot like its bad old self, with vagrants, boozy migrants, junkies, and scofflaws making the Crossroads of the World look more like the third world, infuriating those who played an important role in its cleanup.

On three separate days over the past week, The Post saw junkies brazenly smoking crack pipes on West 43rd Street, drug dealers peddling their wares within eyeshot of cops, hobos conked out wherever they can find a spot, and scores of aimless migrants loitering the day away.

“A lot of people are worried about [Times Square] collapsing. And unless they start getting it together for a rebuild, it might actually collapse,” said William Bratton, the NYPD commissioner who helped then-Mayor Rudy Giuliani clean up the area in the 1990s.

“We had a lot more to work with than the current commissioner and the mayor have in 2023,” Bratton added. “There was a lot more of a criminal justice system back then. The courts, district attorneys, and the police were pretty much united about doing something about crime in Times Square. So you had a collaboration that is not in place today.”

By contrast, “we [now] have a number of district attorneys not wanting to deal with a lot of … the so-called ‘broken windows’,” signs of social disorganization and lead to crime, he explained — referring to the far-left, soft-on-crime Manhattan District Attorney Alvin Bragg, who critics say is pushing “reforms” which favor criminals instead of victims.

“Until we get better collaboration between various elements of government, we’re not going to see it improve dramatically,” Bratton warned. 

The lawlessness, vice, and depravity that ruled Times Square since the 1960s came to a screeching halt in the mid-90s, when Giuliani cracked down on crime and closed down the area’s notorious sex shops and peep shows.

The redevelopment plan then accelerated in the 2000s under billionaire former Mayor Michael Bloomberg, who helped lure national store and restaurant chains to the new-look area and complete its “Disneyfication,” as some critics whined at the time.

Since the pandemic, there’s been “a lot of change for the worse,” in Times Square, said Raymond Kelly, the city’s police commissioner from 1992 to 1994 under then-Mayor David Dinkins, and again from 2002 to 2013 under Bloomberg.

Since the pandemic, there’s been “a lot of change for the worse,” in Times Square, said Raymond Kelly.

Stephen Yang

“We [now] have a number of district attorneys not wanting to deal with a lot of … the so-called broken windows,” Bratton said.

Stephen Yang

“You can feel it when you walk through there.”

New Yorkers and tourists alike said they were mortified the city’s brand has turned into something out of “Taxi Driver.”

“It’s so bad around here. There are homeless and crazy [people] and [they’re] doing drugs and everything,” said Sidek Mohammad, 55, who has sold nuts at a kiosk on the corner of 42nd Street and Eighth Avenue for 16 years.

“It’s not safe here,” agreed Syed Hossain, the owner of a newsstand on 42nd Street and Seventh Avenue, who recently watched a disheveled man aggressively shove a small child “very hard” in broad daylight. 

“Anytime, that kind of thing can happen here,” Hossain, 53, said. “I feel bad because I know it’s not supposed to be that way.”

“It’s so bad around here. There are homeless and crazy [people] and [they’re] doing drugs and everything,” said Sidek Mohammad.

Stephen Yang

In the last two years, major crime has rocketed 50% in the NYPD’s Midtown South precinct – which encompasses Times Square, Grand Central Terminal, Madison Square Garden, and the Port Authority Bus Terminal – and is up 28% compared to 13 years ago, according to NYPD data.

Tourist Sylvana Kulscar from Alberta, Canada, expected the pristine Times Square she sees on TV – but was shocked by the reality. 

“We saw a man today and the only thing he had on was a garbage bag around his waist. He didn’t know where he was going and it was just bad. We had this expectation of Times Square, and then to come here and see it,” said Kulscar, 35, shaking her head.

New Yorkers and tourists alike said they were mortified the city’s brand has turned into something out of “Taxi Driver.”

Stephen Yang

Roxanne Fleury, a 26-year-old from Quebec City, said a “creepy man” tried to lure her and her friend to an unknown place while they were in Times Square on Wednesday. 

“He was like, ‘Do you want to come with us someplace?’ It was strange,” she recalled, adding that the conditions in Times Square were “very different” than those in Soho, where they were staying.

Adding to the seedy new tableau are the thousands of migrants being housed by the city in three nearby hotels-turned-shelters – who constantly loiter and cause issues, according to a doorman at the New Amsterdam Theater on West 42nd Street. 

“All of the drinking and delinquency out here, all of these immigrants, they’re changing things. Their trash is everywhere,” he griped. 

Mobs of migrants staying in nearby hotels-turned-shelters loiter around Times Square at all hours.

Stephen Yang

The Candler Building on West 42nd Street, the Row Hotel on Eighth Avenue, and Hotel Mela on West 44th Street are all now being used to house migrants as they flood into the city.

The nonprofit responsible for the upkeep and improvement of Times Square recently pushed for the managers of the nearby migrant shelters to increase their outdoor security patrols — and to take out their own trash.

“We’ve been working with NYC Health + Hospitals — the folks that manage [The Candler Building] — and been trying to make sure they increase their outdoor patrols of the area, which I’ve heard from several businesses in the area that they have,” said Tom Harris, president of the Times Square Alliance.

“Until we get better collaboration between various elements of government, we’re not going to see it improve dramatically,” Bratton warned. 

Stephen Yang

“It’s a sh-thole around here,” Joe Massaro, 39, said.

Stephen Yang

But the amount of trash the shelters produce, and who has to deal with it, are still prevalent problems.

“They’re are making a lot of money catering to this crisis, and they need to make sure that they maintain their building. It’s not the city’s responsibility to make sure that the outside of these buildings is clean, it’s the building manager’s,” Harris said.

Long Island native and Lower East Side resident Joe Massaro, 39, didn’t mince words when summing up the current state of Times Square: “It’s a sh-thole around here.”

https://nypost.com/2023/08/26/times-square-overrun-by-squalor-crime-its-a-sh-thole/

Time to Reform the Mysterious PBM System

 I'm drinking coffee and eating cereal when yet another TV ad about pharmacy benefit managers (PBMs) comes on. These commercials are so frequent I'm starting to think election season has come early.

In a way, it has. PBMs play an outsized role in determining prescription drug prices so the companies are spending a lot of money defending themselves from their detractors.

I will admit: even though I'm a seasoned physician, my understanding of PBMs was limited before I began teaching in the University of North Carolina's business school. My clinical expertise lies in patient care, which extends from diagnosis to prescription to hopeful treatment, but once a patient departs the clinical space, I don't have much visibility into what happens. Can they get the medicine prescribed? Can they afford it? Will there be a pre-authorization delaying and complicating care?

The answers to these questions are not always clear, and they have become more opaque because of PBMs and their outsized influence.

What Are Pharmacy Benefit Managers?

PBMs are healthcare middlemen who play a pivotal role in managing prescription drug benefits for health insurance plans, employers, and government programs like Medicare Part D.

These companies negotiate pricing and discounts with drug manufacturers, establish formularies (lists of covered medications), and collaborate with pharmacies to process claims. PBMs also are the companies that determine the drug copay cost for patients. PBMs are meant to leverage their scale to secure favorable pricing for medications, which helps control costs for payers and, theoretically, patients.

In short, PBMs determine what medications patients can take for a specific condition and what they will pay for them.

These companies are rewarded handsomely for this work. In fact, PBMs generally earn more than $315 billionopens in a new tab or window annually.

Who Owns PBMs?

While PBMs claim their mission is to enhance affordability and access for patients, their primary goal is profit. That goal is legitimate, but their practices have faced scrutiny, including regarding transparency.

There also are some conflicts of interest because of who owns most PBMs.

Cigna, one of the largest U.S. health insurers, purchased Express Scripts, a PBM, in 2018. CVS Caremark, another PBM, is owned by CVS, and CVS owns Aetna, a health insurer. Optum Rx, yet another PBM, is owned by UnitedHealth Group, another insurer. These three PBMs, each ultimately owned by health insurers, control more than 79%opens in a new tab or window of the market. The top six PBMs control 96% of the market share. Five of those six are owned by the nation's largest insurance companies and pharmacies.

In other words: Insurers and pharmacies have indirect control over what medications PBMs allow patients. The incentive to choose by price point or profit, as opposed to efficacy or what is right for the patient, is embedded in the system.

How Do PBMs Make Money?

PBMs generate revenue through various mechanisms within the pharmaceutical supply chain. As alluded to, their profit model involves negotiating prices, managing formularies, processing claims, and providing various services to health plans, employers, and government programs.

When a PBM includes a medication on its formulary or list of covered drugs, manufacturers may offer rebates as an incentive for preferred placement. These rebates are typically based on market share, volume, and other contractual arrangements. While rebates and discounts are a critical component of PBMs' profits, consumers and the government have little to no insightopens in a new tab or window into how much profit from rebates is retained.

There's more: the higher the drug price and the higher the rebateopens in a new tab or window, the more PBMs retain a portion of these rebates as revenue. The incentive pushes drug prices higher.

In addition to making money from rebates, PBMs often engage in "spread pricingopens in a new tab or window," a practice by which PBMs charge health plans and employers more for a medication than they reimburse pharmacies for dispensing it. The difference, or "spread," between the two prices contributes to PBMs' revenue.

Again, the higher the price, the bigger the spread and the bigger the profit for a PBM. And from an accounting perspective, a higher "cost" for the health insurer. (More on that in a moment.)

Outraged? I've got even more for you.

Why Insurers and Pharmacies Love PBMs

The integration of insurer and PBM also distortsopens in a new tab or window the medical loss ratio, which allows for greater profits for the health insurer parent companies and skirts requirements in the Affordable Care Act. Currently, payments made to PBMs are considered an insurance company "cost" even though insurers are just moving profitability to a less regulated entity.

Furthermore, the financial incentives for PBMs and their owners, health insurers and pharmacies, are perverse. Sure, health insurers want lower drug costs for patients since that means they (the insurer) spend less and keep more of the premiums. But they also want a more significant spread price to generate greater profits.

Health insurers also don't necessarily want to pass back those savings and rebates to beneficiaries. In companies where their success is determined by profitability, benevolence generally is not the driver of decision-making.

Consumer advocates and lawmakers have criticized the lack of transparency about how PBM rebates are passed on to health plans, employers, and patients. These criticisms have led to concerns that some rebates may not benefit the people who pay for prescription medications.

On the other hand, some researchers have concluded that without PBMs' ability to negotiate prices on behalf of payers and patients, drug prices could be higheropens in a new tab or window. While that may be true, the system's financial incentives and vertical integration of payers-PBMs-pharmacies and, yes, even providers, create an ever-growing cycle of profitability for health insurer parent companies and result in higher costs and less choice for patients.

Fortunately, Congress may be stepping in.

Congress Must Reform the PBM System

In a surprisingly bipartisan fashion, federal lawmakers have rallied against PBMs. But fixing the problem will not be easy and will require an approach that addresses healthcare industry vertical integration.

My prescription for this broken system is:

• Enhance Rebate Transparency: Federal and state policymakers must seek increased rebate transparency from PBMs. More comprehensive rebate data could shed light on pharmaceutical spending trends, guiding potential reforms.
• Prohibit Spread Pricing: Policymakers should ban spread pricing, safeguarding patients and employers from potential overpayments for prescription drugs.
• Mandate Rebate Pass-Through: To maintain negotiation leverage with drug manufacturers, PBMs should be required to funnel a large percentage of their rebate savings to payers, passing through rebates directly to patients. Implementing this requirement is particularly important for Medicare Part D recipients.
• Limit Vertical Integration: The vertical integration of PBMs with national pharmacies, the nation's largest health insurers, and the largest provider groups creates an anti-competitive environment and market distortions. These distortions harm patients, small businesses, and taxpayers.
• Enforce the Medical Loss Ratio More Broadly: Health insurer parent companies shouldn't be exempt from adhering to the medical loss ratio and shouldn't be able to utilize inter-company eliminations to hide profits. This can help ensure that patients and enrollees derive the value they deserve from care.

The system that sets drug pricing and availability is complicated and opaque, but it is clear PBMs and their vertically integrated healthcare conglomerates are using this murkiness to their advantage.

It's time for a serious campaign for PBM reform.

N. Adam Brown, MD, MBA,opens in a new tab or window is a practicing emergency medicine physician, founder of ABIG Healthopens in a new tab or window, and a professor of practice at the University of North Carolina's Kenan-Flagler Business School. Previously he served as president of emergency medicine and chief impact officer for one of the nation's largest national medical groups.

https://www.medpagetoday.com/opinion/prescriptionsforabrokensystem/106054

Ukraine Declares Philip Morris An 'International Sponsor Of War'

 The Ukrainian government has labelled two tobacco giants "international sponsors of war," condemning Philip Morris and Japan Tobacco for continuing to conduct business in Russia and paying taxes to the country's government.

Thursday's declaration from the National Corruption Prevention Agency (NCPA) adds the two companies and Bermuda-based Bacardi Limited to a list of Ukraine's corporate enemies that already includes Procter & Gamble alongside many other companies headquartered in Europe, Asia and elsewhere. 

There appear to be few real-world implications of Ukraine's declaration. According to Ukrainska Pravda, a Ukrainian online outlet, "The NACP has sent letters to the heads of international companies from the list of war sponsors, inviting them to visit Ukraine and see the aftermath of Russian aggression with their own eyes."

In a statement that oddly sounds like an testimonial to Western sanctions' failure to damage the Russian economy, the NCPA said, "Having confidence in the economic potential of Russia, [Philip Morris] is implementing a large-scale long-term investment program.” Philip Morris enjoyed an 8% jump in Russian revenue in the first year of Putin's so-called "special military operation" in Ukraine. 

As of 2019, Philip Morris brands accounted for 30.1% of the Russian tobacco market, while Japan Tobacco has a nearly 35% market share.  Philip Morris operates two factories in Russia, one near Leningrad and another in Krasnodar, a region east of the Crimean Peninsula.

"Notably, at the beginning of Russia's full-scale invasion of Ukraine, Philip Morris announced its intention to dispose of its Russian business in order to preserve its reputation," said NCPA (sometimes amusingly abbreviated as NAZK). "However, all 'attempts' to sell the Russian operation seem to have been failures, and the corporation still remains one of the largest taxpayers to the Russian treasury."

"I'd rather keep this whole thing": Philip Morris International CEO Jacek Olczak says divesting would contravene his duty to shareholders

In February, Philip Morris CEO Jacek Olczak, citing a duty to shareholders to recover his firm's $2.5 billion in Russia-situated assets, told the Financial Times a sale was proving impractical in the face of Russian rules. "I cannot just lose the patience and I leave it. It's their money. It's not my money, I'm managing this for them. If I had a buyer who could execute the transactions, yes we would do it -- but it doesn't exist...there is no hope...so then I'd rather keep this whole thing." 

Philip Morris International shares barely budged on the news, edging down 24 cents to $94.08 at Thursday's close, but then rising nearly a dollar in after-hours trading. Behind powerful brands like Marlboro, Parliament, Chesterfield and L&M, the company sells tobacco and other products in more than 180 countries, and currently yields north of 5%.  

In a country that has ranked 122nd-worst in a global corruption ranking, you'd think Ukraine's "National Corruption Prevention Agency" might want keep an internal focus rather than propagandizing against foreign companies engaged in honest international commerce.

https://www.zerohedge.com/geopolitical/ukraine-declares-philip-morris-international-sponsor-war

BP urges more oil, gas investment while speeding energy transition

 Global oil major BP said the world must invest in the production of oil and gas to avoid to sharp price spikes while accelerating the energy transition to combat greenhouse gas emissions.

Global gas prices surged seven-fold last year as 3% of global gas supplies were hit following Russia's invasion of Ukraine, forcing countries to boost energy spending and shift to coal, BP CEO Bernard Looney said in New Delhi.

"We need to do both. We need to invest in today's energy system responsibly and, at the same time, we must invest in accelerating energy transition," Looney told the B20 conference.

Energy transition has to be orderly to maintain its pace as emission levels have risen since the Paris conference on climate change in 2015, despite global efforts, he said.

The Paris-based energy watchdog International Energy Agency expects global oil demand to hit a record 2.2 million barrels per day this year.

Looney said his company would invest 40% of its capital on energy transition projects by the middle of this decade and 50% by the end of the decade. "We will invest between $55 and $65 billion as BP this decade in energy transition growth engines," he said.

BP, investing in energy projects in India along with its partner Reliance Industries Ltd, has set up about 3,000 electric vehicle charging points to date, up from 750 in January. The two have set up 300 battery swapping stations.

BP has invested in India's gas sector, and its venture arm has bought a stake in electric ride-hailing startup BluSmart.

"I have every expectation that we will do more in India in years to come," Looney said. 

https://www.marketscreener.com/quote/stock/BP-PLC-9590188/news/BP-urges-more-oil-gas-investment-while-speeding-energy-transition-44707129/

FTC suspends challenge to block Amgen's $27.8 bln deal for Horizon Therapeutics

 The U.S. Federal Trade Commission (FTC) has suspended its challenge of Amgen's $27.8 billion purchase of Horizon Therapeutics, allowing the FTC to consider whether the agency should settle the case, a filing late on Friday showed.

The pause is effective until Sept. 18.

The FTC filed a lawsuit on May 16 aimed at stopping the transaction in a rare move to block a large pharmaceutical deal.

The FTC had said it opposed the deal because of concern that Amgen would leverage its big selling drugs to pressure insurance companies and pharmacy benefit managers to give favorable terms for Horizon's two key products - the fast-growing thyroid eye disease treatment Tepezza and gout drug Krystexxa.

The Thousand Oaks, California-based company announced plans to buy Horizon in December last year, saying that its rare disease drugs would offer it some protection from the drug pricing provisions of the Inflation Reduction Act, which are aimed at drugs most widely used by the government's Medicare health plan.

https://www.marketscreener.com/quote/stock/AMGEN-INC-4847/news/US-FTC-suspends-challenge-to-block-Amgen-s-27-8-bln-deal-for-Horizon-Therapeutics-44707541/

No real fix to the sharp rise in public debt loads: Jackson Hole economists

 The steep jump in public debt loads over the past decade and a half, as governments borrowed large amounts of money to battle the Global Financial Crisis and the fallout from the COVID-19 pandemic, is probably irreversible.

That's the unhappy conclusion of a research paper being presented on Saturday to some of the world's most influential economic policymakers at the Kansas City Federal Reserve's annual central banking symposium in Jackson Hole, Wyoming.

Since 2007, worldwide public debt has ballooned from 40% to 60% of GDP, on average, with debt-to-GDP ratios even higher in the advanced countries. That includes the United States, the world's biggest economy, where government debt is now more than double the nation's yearly economic output. U.S. debt was about 70% of GDP 15 years ago.

Despite mounting worries about the growth-crimping implications of high debt, "debt reduction, while desirable in principle, is unlikely in practice," Serkan Arslanalp, an economist at the International Monetary Fund, and Barry Eichengreen, an economics professor at the University of California, Berkeley, wrote in a paper.

That's a change from the past, when countries have successfully reduced debt-to-GDP ratios.

But many economies will not be able to outgrow their debt burdens because of population aging, and will in fact require fresh public financing for needs like healthcare and pensions, the authors argued.

A sharp rise in interest rates from historically low levels is adding to the cost of debt service, while political divisions are making budget surpluses difficult to achieve and more so to sustain.

Inflation, unless it surprises to the upside over an extended period, does little to reduce debt ratios, and debt restructuring for developing countries has become more elusive as the pool of creditors has broadened, Arslanalp and Eichengreen wrote.

"High public debts are here to stay," they wrote. "Like it or not, then, governments are going to have to live with high inherited debts."

Doing so will require limits on spending, consideration of tax hikes, and improved regulation of banks to avoid costly blow-ups, they wrote.

"This modest medicine does not make for a happy diagnosis," they wrote. "But it makes for a realistic one."

https://www.marketscreener.com/news/latest/No-real-fix-to-the-sharp-rise-in-public-debt-loads-economists-say--44707504/