Happy Monday, readers. I hope you kept cool over the weekend.

This morning, Fortune released its latest Global 500 list—a collection of the 500 largest companies in the world by revenues.

My colleagues who made this fascinating, informative issue possible point to the rise of China on the list (this is the first year when the number of Chinese and American firms were at near-parity in Global 500 dominance, with China actually taking the lead if you count a number of Taiwanese companies). And several Chinese health firms made their way into the top 200.

Of the 500 analyzed companies, the top six slots among health care firms still belong to the U.S.—UnitedHealth Group at number 14, drug distributor McKesson at 17, CVS Health at 19, followed by several other distribution and insurance giants.

But then Hong Kong-based China Resources, whose parent firm operates, among many other arms, a large pharmaceutical business, rang in at number 80. Drug developer Sinopharm is at 169.

DIGITAL HEALTH
Livongo raises IPO price target. Livongo, the digital chronic disease management startup, has raised the expected pricing range for its upcoming public offering (likely to be priced later this week). The company is taking the range up from $20 to $23 per share to $24 to $26 per share with an offering of 10.7 million shares, which would take the firm’s IPO-time value up to about $2.3 billion—which, in turn, would be one of the biggest digital health IPOs of all time.
INDICATIONS
Celgene’s Otezla approved—again. Biotech giant Celgene has received a third Food and Drug Administration (FDA) approval for its anti-inflammatory drug Otezla, which is used to treat forms of psoriasis and arthritis—this time, for the treatment of mouth ulcers associated with a rare disease. The blockbuster treatment has been one of Celgene’s most reliable cash cows. However, it’s slated to be spun off in order to facilitate the company’s mega-deal acquisition by drug giant Bristol-Myers Squibb. (pharmaphorum)
THE BIG PICTURE
Congo health minister resigns over Ebola vaccine spat. Oly Ilunga, the health minister of Congo—certainly one of the most difficult and critical jobs public health jobs in the world amidst a devastating Ebola outbreak—resigned on Monday. Ilunga’s resignation follows a spat involving Johnson & Johnson’s experimental Ebola vaccine, which was slated to be used in conjunction with an existing vaccine from Merck; however, the health minister wrote in his resignation letter that it would be “fanciful to think that the new vaccine proposed by actors who have shown an obvious lack of ethics by voluntarily hiding important information from medical authorities, could have a significant impact on the control of the current outbreak.” The J&J vaccine consequently was not used (the company denied safety issues to Reuters). Global health agencies had endorsed the use of the second vaccine in conjunction with Merck’s, creating tension between Ilunga and other authorities.

This firm and uniform standpoint towards illegal immigration is necessary to avoid a universal health care system from crumbling down and to maintain a sustainable ratio between those who pay into the system and those who benefit from it.
The working middle class that would be the backbone to pay into the system would not only face that their existing health care is halved in its service value – but most likely face higher cost of health care as they will be the ones to pick up the bill.
The universal health care system would have maybe 60 million to 70 million “free riders” if based on wage taxes, and maybe half if based on fees, that will not pay anything into the system. We already know that approximately 60 million Americans pay no taxes as adults add to that the estimated 10-15 million illegal immigrants.
There is no way that a universal health care system can be viably implemented unless America creates a population registry that can identify the entitlements for each individual and that would have to be designed from scratch to a high degree as we can not rely on driver’s license data as the quality would be too low – too many errors.
Many illegal immigrants have both social security numbers and driver’s licenses as these were issued without rigorous control of status before 9/11. The alternative is that you had to show a US passport or a valid foreign passport with a green card to be able to register.
Another problematic task is the number of points of registration. If the registration is done by hospitals – and not a federal agency – then it is highly likely that registration fraud would be rampant. It would be very easy to trespass the control of eligibility if it is registered and determined by a hospital clerk. This supports that the eligibility has to be determined by a central administration that has a vast access to data and information about our lives, income, and medical history. If one single registration at a health care provider or hospital would guarantee you free health care for life and there is no rigorous and audited process – then it is a given that corruption, bribery, and fraud would be synonymous with the system.

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