Tag Archives: conflict of interest

Health Policy Updates: November 4 2017

The newly-reported results of the ORBITA clinical trial caught my eye this week. Patients with chronic, stable angina with severe coronary blockages were randomized to angioplasty+stenting vs. ongoing medical therapy alone. Interestingly, the medical therapy patients also received a “sham” cardiac procedure, so the patients were blinded to whether or not they had actually received PCI. There was no significant improvement in angina symptoms with PCI, as measured by exercise duration. Does this mean that the huge number of stents placed annually in the US for angina symptoms is not money well-spent?
Continue reading Health Policy Updates: November 4 2017

Health Policy Updates: May 6 2017

In an interview with CBS, Donald Trump was noted to tell several blatant lies about the contents of the current version of the AHCA:

  1. Pre-existing conditions will continue to be required to be accepted for insurance.
  2. Premiums will be lowered by the law.
  3. That the bill includes the popular conservative idea to allow interstate insurance markets.

This article, with excerpts from interview the interview, is quite revealing. It’s almost as if the president doesn’t know anything about health care, or is very comfortable lying about it. Or, both.

“This part of the interview is a bit bizarre…Now Trump appears to be saying that he’s ready to reverse course, that this part of the Republican bill is currently “changing.” So either Trump is announcing a big policy shift that would likely lead to Freedom Caucus opposing the bill — or he’s misunderstanding what is actually in the bill. From the interview, its hard to know.”

Continue reading Health Policy Updates: May 6 2017

Health Policy Updates: January 21 2017

News surfaced this week raising serious conflict-of-interest and corruption concerns regarding Trump’s nominee to head the department of Health and Human Services, Tom Price. It seems that he bought shares in a device manufacturer immediately before introducing legislation to protect reimbursement for the use of such devices, maintaining demand for the company’s products.

“After Price offered his bill to provide Zimmer Biomet and other companies relief from the CMS regulation, the company’s political action committee donated to the congressman’s reelection campaign…The issue has become a major liability for the congressman after The Wall Street Journal reported last month that he traded roughly $300,000 in shares over the past four years in health companies while pursuing legislation that could impact them.”

Margot Sanger-Katz of the NYTimes walks through exactly what the ACA/Obamacare does, which provisions are likely to go or stay if repeal happens, and what that would mean.

“When Republicans talk about repealing Obamacare, they tend to focus on the parts of the law that expanded insurance coverage and regulated health insurance products, not these ancillary parts. That means that portions of the Affordable Care Act that people don’t associate with the word “Obamacare” are likely to endure.”

Donald Trump continues to double-down on promises to “cover everyone” with his health insurance plan, and also drastically lower drug prices. This is in contrast to the leading Republican plans for ACA replacement, which do neither of these things.

“The objectives of broadening access to insurance and lowering health-care costs have always been in conflict, and it remains unclear how the plan that the incoming administration is designing — or ones that will emerge on Capitol Hill — would address that tension.”

The Congressional Budget Office has run the numbers on Obamacare repeal and found that it would add an additional 23 million Americans to the uninsured roles over the next 10 years. Will whatever “replacement” plan that ends up surfacing be able to make up that difference?

“The agency put up a blog post that said it won’t let Republicans count especially skimpy coverage as health insurance. It argued that health insurance needs to provide ‘financial protection against high medical costs’ for CBO to count the people who buy it as covered. Republicans hadn’t even submitted a replacement plan yet, at least not publicly. So it seems notable that CBO proactively decided to go ahead and lay down the ground rules for scoring in a very public way.”

A slew of papers came out in JAMA journals last week, focusing on the issue of conflicts of interest in medicine. Propublica summarizes.

“‘The very way we all think about disease — and the best ways to research, define, prevent, and treat it — is being subtly distorted because so many of the ostensibly independent players, including patient advocacy groups, are largely singing tunes acceptable to companies seeking to maximize markets for drugs and devices,’ researchers Ray Moynihan and Lisa Bero wrote in an accompanying commentary.”


Health Policy Updates: August 14 2016

A large part of the ACA/Obamacare was to expand Medicaid; many (though not all) states elected to do so. New data out this week in JAMA Internal Medicine suggests that patients are benefiting. Compared to states that did not expand Medicaid, previously uninsured patients who have now gained access to Medicaid coverage do better on many metrics, including better access to outpatient care, increased diabetes screening, and reduced non-compliance due to cost.

The Oregon Medicaid experiment from a few years ago left Medicaid skeptics with some reason to be agnostic as to whether Medicaid actually improves people’s health. These data lessen the foundation for such skepticism, and should  thus should help move the conversation forward. Continue reading Health Policy Updates: August 14 2016

Health Policy Updates: July 2 2016

This week, an update on the future of the federal budget and health care’s role in it.

To summarize, health care spending is still a major problem. The federal government is going to add almost $1 trillion in spending over the next decade, and the bulk of that will be in increased health care spending. Health care still threatens to strain federal balance sheets in coming decades. Interestingly, the vast majority of this increase is coming from Medicare spending; Medicaid and the ACA exchanges are projected to have a much smaller impact.

“Turning to the economy more broadly, for every additional dollar of real GDP per capita expected 10 years from now, 20 cents will go just to support the rise in federal health insurance programs costs…health care continues to eat up a very large fraction of economic growth.” Continue reading Health Policy Updates: July 2 2016