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Category: Health Policy

Matthew’s health care tidbits

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

For my health care tidbits this week, I am featuring the the Urban Institute report on the uninsured that’s released today. “Between March 2019 and April 2021 the percentage of U.S. adults reporting they had employer-sponsored coverage declined from 65% to 62.3%, a decrease of approximately 5.5 million adults. The share of adults reporting public coverage increased from 13.6% to 17.5% percent, an increase of approximately 7.9 million adults”. So like it or not we are slowly becoming a public health plan nation–of course the public health plan picking up the slack is Medicaid. And that in practice means we are 2 nations. “In April 2021, the uninsurance rate in non-expansion states was more than double that of expansion states (18.2% versus 7.7%)”.

Which means that Texas & Florida (the two big non-expansion states) really don’t care about their people’s health. And taking a look at their governors’ current attitudes towards COVID, you would not be surprised.

It takes a pandemic: Mental Health parity may finally have its day!

By EMILY EVANS

Emily Evans is the health policy guru at equity research company HedgeEye. She sends out these reports in emails to her clients regularly but (since I asked nicely) she allowed me to publish this one from late last week on THCB. You can catch Emily in person on the “How Much Are These Companies Really Worth? The IPO & SPAC Panel” at Policies|Techies|VCs–What’s Next for Health Care, the conference Jess Damassa & I are chairing on September 7-8-9-10 — Matthew Holt

Politics. President Biden is going to have more important things to do this week than worry about the mask/vaccine wars. At some point though, probably soon, Biden will need a scapegoat at the CDC. Several reversals on guidance around masks for the vaccinated and the unvaccinated have left local governments confused and people, most notably, parents of school age children, angry. The spread of the Delta variant isn’t helping matters.

While there may be political motivations for some of CDC Director, Dr. Rochelle Walensky’s guidance. A better approach, this last week anyway, would be never assign to cunning that which can be explained by incompetence.

Bringing a large, sprawling bureaucracy into line after a decade or more of being considered irrelevant is not a simple matter. It is made particularly difficult by the agency’s remote location in Atlanta to which Dr. Walensky commutes. 

For the time being eclipsed by a messy exit in Afghanistan, the CDC’s failures are still being noted by longstanding supporters of the agency like former Food and Drug Commissioner, Scott Gottlieb. As the Delta variant follows the same summer path as Alpha from south to north and break-through infections become identified as more common than previously thought (though mild for the vaccinated), the pressure to get the CDC reorganized will grow.

The good news, notwithstanding the vitriol over mask wearing and vaccine mandates, is the assumption underlying the CDC’s guidance on masks/vaccines is that children will be going to school and college students to class. It is, we can all hope, the first step in recognizing that there is no Zero-COVID; no magic bullet; just adaptation and adjustment, something at which humans excel.

Policy. Last week, the Department of Labor simultaneously filed and settled a lawsuit against UNH for violations under the Mental Health Parity and Addiction Equity Act of 2008. The dollar value of the settlement was immaterial but United HealthGroup (UNH) agreed to take corrective action which will be substantive.

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Matthew’s health care tidbits

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

In this week’s health care tidbits, we are talking about medical debt. Oh, not all medical debt. No, not that debt being garnished from the wages of health care workers by their own employers. Today we are just discussing the debt that has already gone to collections. Yes, the debt sold off by doctors and hospitals for pennies on the dollars so that debt collectors can hound people until they pay or despair.

This week a Harvard/Stanford team reported that the total in collections is $140 Billion! Way more than anyone thought, Nearly ONE in SIX Americans currently has a medical bill in collections. No prizes for guessing that those most likely to be being pursued are living in the poorest zip codes in the country and even more likely to be in a southern state that never expanded Medicaid.

Glad we are all proud to be American.

Matthew’s health care tidbits

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

In this week’s health care tidbits, Shannon Brownlee and her fellow rebels at the Lown Institute decided to have a bit of fun and compare which non-profit hospitals actually made up for the tax-breaks they got by providing more in community benefit. A bunch of hospitals you never heard of topped the list. What was more interesting was the hospitals that topped the inverse list, in that they gave way less in community benefit than they got in tax breaks. That list has a bunch of names on it you will have heard of!

Given how many of that list run sizable hedge funds and then do a little health care services on the side, perhaps it’s time to totally re-think our deference to these hospital system monopolies. And I don’t just mean making it harder for them to merge and raise prices as suggested by Biden’s recent Executive Order.

Community Health Plans Are Serious: Support Major Federal Action to Reduce Rx Drug Costs

By CECI CONNOLLY

Equal treatment under the law. A foundational pillar of American life. Except when it comes to drug makers who benefit from favorable treatment by the federal government.

For far too long, prescription drug companies have profited immensely under a system that affords them monopolistic powers to set prices devoid of government or public scrutiny.

Even during the pandemic, while much of the economy took a beating, the pharmaceutical industry continued to benefit from the high prices they charge. In fact, 9 of the 10 biggest profit margins recorded last summer belonged to drug companies.

As the nation’s economy sputters back, Big Pharma continues to raise prices and block patient access to lower-cost alternatives. It is beyond time to tame the soaring prices of prescription drugs once and for all.

For years, health care players have skirted around concrete actions to truly impact drug prices. Efforts to cut costs for consumers have translated to higher costs for health plans, resulting in a cost shift instead of a cost reduction. We, as private, nonprofit insurers, believe in the ambition and innovation possible in a free market – but the  market has failed in this instance and it’s time for the government to take action.

That is why the Alliance of Community Health Plans (ACHP) is putting its support behind reforms that can make a real, lasting impact for consumers and the entire health system. For the first time, a national health care payer organization is stepping up and supporting pragmatic and progressive reforms that can truly begin to rein in the price of prescription drugs.

This includes backing the dramatic step to grant the Secretary of Health and Human Services the power to negotiate lower prices for the highest-priced medications for which there is no competition, in addition to other actions.

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Matthew’s health care tidbits

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! (And yes, this week’s is a tad late!) –Matthew Holt

In this week’s health care tidbits, you may be wondering what happened to health policy under Joe Biden. He said no to Medicare for All because instead he was going to create a public option and lower the Medicare age to 60. Yet both those two policies seem to have vanished into the night. Presumably that’s because they think they’re a hard political sell and maybe that’s right. But why? This past week a massive study of American consumers shows that Medicare recipients are much happier with their experience than people with employer-based coverage. And employer based coverage is no better than Medicaid! To wit, the study showed:

Compared with those covered by Medicare, individuals with employer-sponsored insurance were less likely to report having a personal physician and were more likely to report instability in insurance coverage, difficulty seeing a physician because of costs, not taking medication because of costs, and having medical debt. Compared with those covered by Medicare, individuals with employer-sponsored insurance were less satisfied with their care.

Compared with individuals covered by Medicaid, those with employer-sponsored insurance were more likely to report having medical debt and were less likely to report difficulty seeing a physician because of costs and not taking medications because of costs. No difference in satisfaction with care was found between individuals with employer-sponsored private health insurance and those with Medicaid coverage.

I guess the new AHIP slogan is, “we’re just as good as Medicaid!” But you have to wonder, why are the rest of us being forced to consume an inferior product?

Secular Stagnation – An Economic Argument for Universal Health Care Now

By MIKE MAGEE

John Maynard Keynes, the famous British economist, was born and raised in Cambridge, England, and taught at King’s College.  He died in 1946. He is widely recognized today as the father of Keynesian economics that promoted a predominantly private sector driven, market economy, with an activist government sector hanging in the wings ready to assume center stage during emergencies.

Declines in demand pointed to recession. Irrationally exuberant spending  signaled inflationary increases in pricing, eroding the value of your money. Under these conditions, Keynes encouraged the government and central bank to adjust fiscal and monetary policy to dampen the highs and lows of the business cycles.

Keynesian economics were popularized in America in the 1930’s by a University of Minnesota economist who would go on to become Chairman of Economics at Harvard. For this, he is often referred to as “The American Keynes”, and was highlighted this week in the New York Times by Nobel economist, Paul Krugman, for his association with another tagline, “Secular Stagnation.”

When that economist, Alvin Hansen, first described the condition, he was working on FDR’s Social Security Plan. He defined it as “persistent spending weakness even in the face of very low inflation.”  Krugman’s modern-day description?  “What we’re looking at here is a world awash in savings with nowhere to go.”

Krugman is not the only economist sounding the alarm. Larry Summers, Harvard economist and Treasury Secretary under Bill Clinton, recently wrote, “The relevance of economic theories depends on context.” On the top of his list of current environmental concerns restricting investment and growth is the strong belief that the number of available workers is in steep decline.

Just days ago the CDC added fuel to the fire when they reported a 2020 birth rate in the U.S. of 55.8 births per 1,000 women ages 15 to 44. That was 4% lower than in 2019, and the lowest recorded rate since we started collecting these numbers in 1909. Our lower birthrate is further aggravated by declines in numbers of immigrants and a flattening of the movement of women into the workforce. Add to this the general aging of our population. To put it in perspective, Americans over 80 now outnumber Americans 2 and under.

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We Are the Ever Given

By KIM BELLARD

The Ever Given is free

Admit it: you’ve been following the story about the huge container ship stuck in the Suez Canal.  It’s about the size of the Empire State building laid flat, and somehow ended up blocking one of the busiest waterways in the world. 

As serious as this was for global shipping and all of us who depend on it, much hilarity ensued.  Memes exploded, using this as a metaphor for almost everything, healthcare included.  Once there started to be hope for getting the Ever Given free, people started new memes that it should be “put back.” 

Well, I’m a sucker for a funny meme and a good metaphor too.  Our healthcare system is that canal, and we’re the unfortunate ship.  Only it doesn’t look like we’re getting unstuck anytime soon.

The Ever Given got stuck a week ago.  It is one of the world’s largest container ships, but high winds, poor visibility (due to a dust storm), and, perhaps, human error caused things to go sidewise, literally.  It got stuck on the banks.  Over 300 other ships have been blocked as a result; alternative routes add several thousand miles to the trip, making it a tough choice between waiting/hoping and rerouting. 

The Suez Canal carries about 10% of worldwide maritime traffic, worth as much as $10b daily.  It has been around since 1869 – far longer than the similarly important Panama Canal – and has been widened/deepened several times since.  Ships keep getting bigger and bigger, carrying more and more cargo, as globalization has created boom times for shipping (or, rather, shipping created boom times for globalization). 

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And You Thought Health Insurance Was Bad

By KIM BELLARD

I spend most of my time thinking about health care, but a recent The New York Times article – How the American Unemployment System Failed – by Eduardo Porter, caught my attention.  I mean, when the U.S. healthcare system looks fair by comparison, you know things are bad.

Long story short: unemployment doesn’t help as many people as it should, for as much as it should, or for as long as it should. 

It does kind of remind you of healthcare, doesn’t it?

The pandemic, and the associated recession, has unemployment in the news more than since the “Great Recession” of 2008 and perhaps since the Great Depression.  Last spring the unemployment rate skyrocketed well past Great Recession levels, before slowly starting to subside.  Still, last week almost a million people filed for unemployment benefits, reminding us that unemployment is still an issue.

Keep in mind that unemployment rates do not tell the full story, as they don’t count those only “marginally attached” to the workforce – people who would like to work but have given up – and counts part-time workers who would like to work full time as “employed.”  The “true” unemployment rate is reckoned to be much worse than the official rate.

Congress has enacted several COVID relief measures, including in late December, to extend duration, amount, and applicability of unemployment benefits, but our unemployment systems remain predominantly state designed and administered.  The shortcomings of these systems have been severely exposed over the past few months: neither the processes nor the actual technologies supporting them proved robust enough for the volume of applicants.  Last December Pew Trusts reported that “unemployment payments were weeks late in nearly every state.” 

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Evaluating President-Elect Biden’s Healthcare Plan | Part 2

By TAYLOR J. CHRISTENSEN

In Part 1 of this series, I reviewed the relevant context of our post-ACA healthcare system to show why President-Elect Joe Biden’s healthcare plan is perfectly reasonable. In this part, I will critically evaluate that plan to show what he got right and what he got wrong or missed altogether.

Joe Biden plans to get rid of the current limit (400% of the federal poverty level) on who qualifies for health insurance premium subsidies and instead convert it to a flat percentage of income (8.5%), which means anyone whose health insurance is going to cost more than 8.5% of their annual income would qualify for a subsidy. And those subsidies would be more generous, being based on a gold-level insurance plan’s price rather than a silver-level insurance plan. He also plans to create a new government-run health insurance company to offer an insurance plan—a “public option”—on the private market, which would be available to private market health insurance shoppers and some other groups as well.

Ok, now for some evaluation of all that.

First, let me frame how I am going to evaluate Joe Biden’s plan.

There are three problems healthcare reformers are usually trying to solve. They want to (1) increase access to care, (2) decrease healthcare prices, and (3) improve the quality of care.

But if we merge the last two goals into one, we can say they want to (1) increase access, and (2) improve the value of care (Value = Quality / Price). We will take these one by one.

Goal 1: Increase Access

How will Joe Biden’s plan do at increasing access?

There are three things to consider when evaluating access-increasing policies. The first is how many people will be covered. The second is how much it will cost. And the third, almost universally forgotten, is how much it will interfere with efforts to accomplish the second goal to improve the value of care.

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