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Category: Health Policy

We Cannot Let RFK Jr Lead Us Backwards in Health

By ARIEL FRISTOE

As the artistic director of Out of Hand Theater, an arts organization that promotes anti-racism, social activism and health equity, I believe the recent appointment of Robert F. Kennedy, Jr. (RFK) as Secretary to the Department of Health and Human Services is beyond concerning. RFK is not a doctor, nor is he a scientist, yet he has been very vocal about his vaccine skepticism and has promoted misinformation about vaccine safety. Now, along with the removal of scientific information and warnings from the Centers for Disease Control (CDC) website, RFK’s appointment could lead to major increases in preventable and serious illnesses, outbreaks and deaths.

COVID-19 and its various mutations are still very much part of our daily landscape. According to the World Health Organization (WHO), more than 7 million COVID-related deaths have been reported since 2020 worldwide, nearly 2 million deaths were recorded in 2020 alone. The first vaccines were developed and became available by November 2020 and reported deaths from the last 28 days is 3,872, which is a 98.7% decrease from the onset of the pandemic. Vaccines work and save lives!

Diseases like smallpox and the bubonic plague were wiped out because scientists developed vaccines. Currently, with the “anti-vax” rhetoric being embraced and misinformation being so commonplace, reports of measles went from 4 cases in 2023 to 285 in 2024. Nine of these cases required hospitalization. The affected individuals include six children under four years old, 16 individuals aged 5-17, and two adults over 18 – the numbers rise as the days go by with 124 cases in in Texas in 2025 alone. We cannot and should not be going backwards where medicine is concerned.

Health experts are concerned that increasing nonmedical vaccine exemptions among schoolchildren could lead to more frequent outbreaks. Declining vaccination rates are worrisome as measles can cause serious illness, including hospitalization and brain swelling. I am not a doctor nor a scientist, but I place my trust in the actual doctors and scientists who have the greater good in mind when developing medicines to combat and prevent diseases. Why does this matter to me? Through our Equitable Vaccines program, we use art, information and conversation to encourage vaccine confidence and educate the community about resources so that we can create a healthier community, and we’re proud to have helped deliver 650 vaccines across Georgia. A healthy community is a strong community – and to me, that is the most valuable commodity over what is imported and exported.

As a woman, as a mother, as a human, I worry about our health and our children’s future with RFK Jr leading the Department of Health and Human Services.  I implore that all of us contact our local and state representatives to express our concerns over RFK’s Department of Health and Human Services appointment. We cannot go backwards when we have the resources available to us to create a safe and healthy place for every citizen to thrive. We must prioritize our communities’ health and allow proven data to guide our most important decisions that impact those that are most precious to us.

Ariel Fristoe is the Artistic Director at Out of Hand Theater

What would a rational DOG(gi)E do(o)?

By MATTHEW HOLT

DOGE, or Doggie as Kara Swisher has been calling it, has gone from being a meme about Shiba Inus to a crypto scam to a group tearing the Federal government apart.So I thought I would use the title of this piece to make a joke. Like Musk’s humor it’s puerile and not funny. What’s also not funny is what Musk’s team has done to small government agencies, like USAID & CFPB that really help people, not to mention the irrational firing of thousands of government employees that appear to be screwing up the NIH, the National Parks, the FAA and much more. But it’s all got me thinking, what in health care should an effort to quickly rationalize government spending do?

Now I’m not proposing that there’s anything OK with the way Musk and his team have been blundering around the Federal government, telling lies about what it does and indiscriminately firing the people who have the most important responsibilities and then desperately trying to get them to come back. This has been pure ignorance theater, and it would be hilarious if it wasn’t so damaging. Equally importantly the places DOG(gi)E has started are stupid because they don’t spend much money. But the government spends a lot on health care –between two and three trillion dollars, depending on how you count it.

So if you wanted to save some money and potentially change the system, what would you do? First you’d take a deep breath and get some real data, and improve your understanding about what is actually happening. There are some areas in health care where the issues are well understood and the data is clear and there are others where it’s less obvious.

Let’s start with a relatively small one–spending on Federal Employees health benefits. Chris Deacon’s Linkedin posts are a constant source of fun and games, and she has been highlighting screwups in the FEHBP administration for a long time. Essentially the government via the OPM pays lots of different insurance companies to manage Federal employees’ health care. There is very poor oversight of what happens in those programs and when the OPM’s OIG points that out, not much happens. The plans (including Horizon Blues in NJ and BCBSNC and many others) have been caught being sloppy or fraudulent but not much has happened. All DOG(gi)E needs to do is read the report on the audits, or look at what GOA said about $1bn being spent on ineligible members in 2022 and apply their recommendations.

Next let’s get into something that requires a little more investigation. In America we buy (and sell) drugs in a mind-bogglingly complex way.

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Goodbye, American Science

By KIM BELLARD

Many people don’t realize it, but a hundred years ago America was something of a scientific backwater. Oh, sure, we had the occasional Nobel laureate, but the center of science was in Europe, particularly Germany. Then in the early 1930’s the Nazis decided that “purity” – of political ideas, of blood – was more important than truth, making life uncomfortable at best and deadly at worst for their scientists. So hundreds of them fled, many of them ending up in the U.S. And – voila! – American science came of age and hasn’t looked back.

Until now. Now, I fear we’re going to suffer what Germany did, a brain drain that will bode well for some other country’s scientific fortunes.

Once of the first chilling announcements from the Trump Administration was that it was freezing NIH grants in order to ensure they were in compliance with Trump’s executive order banning DEI-related efforts. That froze some $1.5b in grant funding.

Piling on, the Administration announced that NIH grants would limit indirect costs to 15%. Sounds reasonable, you might say, but the vast machinery of U.S. biomedical research uses these “indirect” costs to fund the infrastructure that makes the research possible. Numerous state Attorney Generals immediately filed a lawsuit to block the cuts, claiming:

This research funding covers expenses that facilitate critical components of biomedical research, such as lab, faculty, infrastructure and utility costs. Without it, lifesaving and life-extending research, including clinical trials, would be significantly compromised. These cuts would have a devastating impact on universities around the country, many of which are at the forefront of groundbreaking research efforts – while also training future generations of researchers and innovators.

Oh, and on top of all this, as many as 1,500 NIH employees are in line to be laid-off.  

Katie Witkiewitz, a professor at the University of New Mexico, lamented to The New York Times: “The N.I.H. just seems to be frozen. The people on the ground doing the work of the science are going to be the first to go, and that devastation may happen with just a delay of funding.”

Universities are similarly frozen, not sure when or how much money they can expect. The University of Pittsburgh has paused all Ph.D. admission, until it can better understand its funding future. One has to suspect it won’t be the only such program to do so, and we may never know how many would-be Ph.D. students will simply decide a future in U.S. science is too bleak to risk.

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How hard is it to prove you have coverage?

A friend of mine who wants to stay anonymous (for now at any rate) had a crazy waste of time proving that he was eligibile for a medication on his plan. I thought his story might trigger a few of you! And yes Optum is of course part of United HealthGroup–Matthew Holt

Here is the ridiculous situation I had with filling a prescription through COBRA a few weeks back.

I spent 33 minutes on the phone on January 8th, 2025 before I finally navigated the maze that is American healthcare to the extent that a medication that has been prescribed for me by my doctor regularly for several years could be delivered to her office in time for my next appointment. OK, there is a need to verify health insurance coverage, but one might expect this to be a simple matter of checking eligibility->coverage->currency-with-premiums, and something that can be done asynchronously. Not so. Optum needed to verify the “paid-through date.” I pointed out that I’d already made four attempts to resolve this situation since December 19th, including on the last occasion by providing details of my COBRA policy to the Optum agent so that she could follow up with them to verify whatever it is they needed to verify. Apparently she hadn’t bothered, so here we were again.

What was required to resolve this in the end was literally a four-way conference call, which of course is absolutely ridiculous in the Information Age. With the primary Optum agent on the line, I conferenced in the COBRA hotline, but the automated voice confirming my “paid-through date” was not good enough for her to be able to vouch for me. I needed to get a human agent on the line. Meanwhile, the primary Optum agent conferenced in someone from their payments division. With all four of us on the phone, I did the introductions, then the second Optum agent asked the COBRA agent to repeat the paid-through date, give his name and a confirmation number, and that was enough information for the Optum payments person. The primary agent and I twiddled our thumbs on the line for another 5-10 minutes until the payments agent came back online to tell us that she had completed her work–at least for the coverage part.

But wait. There’s more. Now I needed to confirm my consent to the terms and conditions, which the agent had to read out to me in full, taking several minutes of her reading the small print, before I confirmed that I accepted. The final stage was for me to wait on hold again while she set up overnight delivery and then reconfirmed my appointment with my doctor. In the end, this was successful, but it cost me nearly 35 minutes in a process that is absolutely unnecessary.

Delay, Deny, Defend were the words inscribed on Luigi Mangione’s bullets. This was his point. They haven’t gotten the memo.

No More ‘Dabbling’: It’s Time to Embrace Value-Based Care

By ALEX AZAR

Presidential transitions are always a time of great change, but few leaders have ushered in a shift as sweeping as the rewiring of one-seventh of the U.S. economy. President Trump has the opportunity to do just that by doubling down on the health transformation achievements of his first term.
 
A key to success is continuing the shift from a fee-for-service (FFS) healthcare model to value-based care (VBC). The current FFS model continues to deliver higher costs and greater utilization of healthcare resources—but not better outcomes for patients. By contrast, a VBC model ties provider payments to quality patient care that incorporates prevention and coordination. 
 
As a country, we’ve been dabbling with value-based models for decades. Now, the time has come to rip off the proverbial Band-Aid and embrace system-wide changes. 
 
We actually have more evidence than most people realize in favor of alternative care delivery and payment models. 
 
Significant positive changes have already occurred in the primary care space through programs like the Medicare Shared Savings Program (MSSP).

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Patients Are NPCs

By KIM BELLARD

I found a new way to think about patients in an opinion piece by Ezra Klein: they’re NPCs. For those of you unfamiliar with gaming, NPCs are those characters in video games that aren’t controlled by live players; they’re part of the game, serving as background for the actions the actual players take.

Not a very flattering metaphor.

Mr. Klein’s article is neither about healthcare nor gaming, but about politics: The Republican Party’s NPC Problem — and Ours. Conservatives, Mr. Klein explains, accused liberals of being NPCs — passive, conformists, deferential – whereas they were the live players, willing to take chances and make things happen. He goes on to explain why this is not at all accurate, especially in the Congress, but this paragraph is what really struck me:

It’s a genuine failure of Democrats that they didn’t put more energy into making the government faster and better when they were in charge. How did the Biden administration pass $42 billion for broadband in 2021 and have basically nothing to show for it by November of 2024? How did it get $7.5 billion for electric vehicle chargers but build only a few hundred chargers by the end of the term?

i.e., Democrats had some good ideas, took action to try to make them happen, but failed in the delivery. Good intentions matter, but are necessary, not sufficient.

Marc J. Dunkelman makes a similar argument in The Atlantic: How Progressives Broke the Government (an adoption of his new book Why Nothing Works: Who Killed Progress–And How to Bring It Back). Here are a couple of the relevant passages, aimed at the Progressive movement:

Progressives are so fearful of establishment abuse that reformers tend to prefer to tighten rather than loosen their grip on authority. The movement discounts whatever good the government might do in service of ensuring that it won’t do bad. And that’s driven well-intentioned reformers to insert so many checks into the system that government has been rendered incompetent.

At present, progressives are too inclined to cut public authority off at the knees. And that’s why they so often feel like they can’t win for losing. Their cultural aversion to power renders government incompetent, and incompetent government undermines progressivism’s political appeal.

America can’t build housing. We can’t deploy high-speed rail. We’re struggling to harness the promise of clean energy. And because government has failed in all these realms—because confidence in public authority has waned through the years—progressives have found it difficult to make a case for themselves.

What does any of this have to do with healthcare, much less NPCs? It’s this: we talk a good game about health care, especially Democrats, but we consistently fail to deliver. Pick your poll: Americans are critical of the healthcare system in general, of the quality of care, and especially its costs.  Americans hate Big Pharma, we hate health insurers, and our trust in doctors and hospitals has plummeted, especially since COVID.

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Disruption For the Sake of Disruption Is Not Innovation

By MIKE MAGEE

“The technological leaps of the 1900s — microelectronics, antibiotics, chemotherapy, liquid-fueled rockets, Earth-observing satellites, lasers, LED lights, disease-resistant seeds and so forth — derived from science. But these technologies also spent years being improved, tweaked, recombined and modified to make them achieve the scale and impact necessary for innovations.”    Jon Gertner, author of “The Idea Factory.”

The Idea Factory is a history of Bell Labs, spanning six decades from 1920 to 1980. Published a decade ago, the author deliberately focused on the story inside the story. As he laid out his intent, Jon Gertner wrote “…when the drive to invent has become a mantra, Bell Labs offered us a way to enrich our understanding of the challenges and solutions to technological innovation. Here, after all, was where the foundational ideas on the management of innovation were born.”

One of the scholars Gertner likes to reference is Clayton Christensen. As a professor at Harvard Business School, he coined the term “disruptive innovation.” The Economist magazine loved him, labeling him in 2020 “the most influential management thinker of his time.”

A process thinker, Christensen deconstructed innovation, exploring “how waves of technological change can follow predictable patterns.” Others have come along and followed in his steps.

  1. Identify a technologic advance with a potential functional market niche.
  2. Promote its appeal as a “must have” to users.
  3. Drop the cost.
  4. Surreptitiously push aside or disadvantage competitors.
  5. Manage surprises.

Medical innovations often illustrate all five steps, albeit not necessarily in that order. Consider the X-ray. Its discovery is attributed to Friedrich Rontgen (Roentgen), a mechanical engineering chair of Physics at the University of Wurzburg. It was in a lab at his university that he was exploring the properties of electrically generated cathode rays in 1896.

He created a glass tube with an aluminum window at one end. He attached electrodes to a spark coil inside the vacuum tube and generated an electrostatic charge. On the outside of the window opening he placed a barium painted piece of cardboard to detect what he believed to be “invisible rays.” With the charge, he noted a “faint shimmering” on the cardboard. In the next run, he put a lead sheet behind the window and noted that it had blocked the ray-induced shimmering.

Not knowing what to call the rays, he designated them with an “X” – and thus the term “X-ray.” Two weeks later, he convinced his wife to place her hand in the line of fire, and the cardboard behind. The resultant first X-ray image (of her hand) led her to exclaim dramatically, “I have seen my death.” A week later, the image was published under the title “Ueber eine neue Art von Strahlen” (On A New Kind of Rays).

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NYU Langone Super Bowl Ad Claimed “We’re #1,” But Where’s Scorecard?

By MICHAEL MILLENSON

When the Philadelphia Eagles thrashed the Kansas City Chiefs 40-22 in Super Bowl, no one disputed that they sat at the peak of professional football. In contrast, NYU Langone Health’s multi-million-dollar Super Bowl ad claiming “#1 for quality care in the U.S.” gave viewers just 2 seconds to read the very small print at the bottom of the screen providing an obscure justification for that championship status.

It read: “2024 Vizient Quality and Accountability Ranking. Ranked #1 out of 115 participating comprehensive academic medical centers.” Huh?

I’ll discuss in a moment what that attribution – meaningless to even most in health care, much less to any significant slice of the 127 million people watching the game – actually signifies. But perhaps the most salient signal of the misplaced focus of U.S. health care is that online and media reaction focused exclusively on the non-profit system paying an estimated $8 million for the 30-second spot. Yet if the data actually support NYU Langone’s assertion that it’s “the best health system,” as the ad trumpeted, shouldn’t they be praised for competing on the quality of patient care rather than the quality of the pull-on-the-emotions advertising typical of most hospitals?

I reached out multiple times to NYU Langone and Vizient in order to dig more deeply and didn’t hear back from either, so let’s examine the information that’s publicly available.

While many Americans know of the hospital rankings by U.S. News & World Report, Vizient plays an insider game. Its roots are as a group purchasing organization; i.e., a membership group hospitals join to secure volume discounts on supplies and other purchases. However, Vizient has evolved to provide a heavy dose of member consulting services ; it now calls itself “the nation’s leading healthcare performance improvement company.”

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THCBGang Revisited: Ian Morrison

Ian Morrison died yesterday. 4 years ago in one of the early THCB Gang’s, we had a rash of late cancellations. So I talked to Ian solo about his journey, and his views about health care. I re-listened to it this morning and thought you might enjoy it

Ian Morrison

I got the very sad news today that Ian Morrison died peacefully at home yesterday. He had been sick and in hospice for some time but a few months back he told me that he was going for Jimmy Carter’s record. Ian was my first boss in American health care when I worked for him at Institute for the Future and he was as kind and lovely as he was funny and knowledgeable. I was very glad that when I started THCBGang during the pandemic that he was a regular member.

Ian spent decades working with everyone across health care in American and internationally, but as he used to say essentially was paid to insult people. That he did it so humorously and usefully was the reason he kept being invited back. Any Ian Morrison keynote at a big health care conference was both a chance to learn something and laugh hysterically.

He also never ignored the chance to help those trying to make health care fairer and more equitable, serving on the boards of Martin Luther King Jr hospital, the California Healthcare Foundation and many others. He remained a jovial Glaswegian socialist at heart.

Ian liked to say that he went from Scotland where death was imminent, to Canada where death was inevitable, to California where death was optional. Sadly that last crack wasn’t quite true.

My heart goes out to his wife Nora and their children and grandchildren. There’ll be a more formal obituary and a celebration of his life in the days and weeks to come–Matthew Holt