Tag Archives: Don Taylor

Health Policy Updates: February 5 2017

With each news story being rapidly overshadowed by the next, discussion of ACA/Obamacare repeal has given way to rapid developments ensuing from executive actions on immigration. If you are a reader of this blog, you certainly do not need me to explain what these actions are. Actions do have unintended (are they unintended?) consequences, however, which I will highlight here (links in the text):

“The American Association for the Advancement of Science, the world’s largest general science society, also issued a statement warning that the ban would prevent the international collaboration that characterizes most science today, and would hurt the United States’ ability to attract talented researchers from around the world.”

As the story of a Cleveland Clinic doctor forced to leave the U.S. thanks to the Trump White House’s move swept the nation, hospitals and academic medical centers braced for potential damage to future staffing and recruiting of medical researchers, educators and clinicians.”

“Since the restrictions, some institutions, including the University of Pennsylvania and the University of California system, have advised students or faculty members from Iran, Iraq and the other affected countries not to travel overseas until further notice…The order could prevent many foreign researchers from making short-term trips to attend conferences and other scientific meetings overseas for fear of not being able to return.”

Continue reading Health Policy Updates: February 5 2017

Health Policy Updates: January 7 2017

In the big health policy news of the week, the Republican-controlled congress has taken its first – expected – steps towards repealing the ACA/Obamacare by means of the budget reconciliation process.

“The concurrent resolution also establishes a “reserve fund for health care legislation,” which is intended to pocket any savings from repeal for subsequent replacement legislation, as well as a “deficit neutral reserve fund” to revise allocations within the budget resolution and adjustments to the pay-as-you-go ledger in the Senate to ensure that repeal legislation does not violate budget requirements. The reserve fund would allocate $2 billion of savings from the repeal toward reducing the deficit, but hold the rest for eventual replacement legislation.”


Meanwhile, away from the partisan circus of Congress, some leading conservative health policy thinkers are having serious concerns about the repeal-and-delay strategy:

“Antos and Capretta’s piece goes into much more detail on the technical problems of repeal and delay, and is worth reading in full. But they avoid the fundamental issue animating the whole strategy: Republicans don’t know how to replace Obamacare, and they don’t know how to force themselves to figure it out.”

Full details of Joseph Antos’ and James Capretta’s concerns about repeal-and-delay can be found here.

“We do not support this approach to repealing and replacing the ACA because it carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying to finance their health services, and because it is unlikely to produce a coherent reform of health care in the United States. The most likely end result of “repeal and delay” would be less secure insurance for many Americans, procrastination by political leaders who will delay taking any proactive steps as long as possible, and ultimately no discernible movement toward a real marketplace for either insurance or medical services.”


Meanwhile, with all the commotion about whether and how to dismantle the ACA, the law itself continue to truck along, providing insurance to some 20 million Americans. Sarah Kliff of Vox.com has some pretty charts showing this.

The uninsured rate is at an all-time low. The federal government announced in September that 8.6 percent of Americans lacked health insurance. That’s a big decline from 2010, when the health care law passed and the uninsured rate was 16 percent.”


In some local North Carolina health policy news, incoming governor Roy Cooper has announced plans to expand Medicaid in the state. Don Taylor of Duke shares his thoughts on how this may play out.


From Aaron Carroll at The Incidental Economist, in which the adjective “crazypants” is used to describe US health care spending.

“Between 1996 and 2013, more than $30 trillion was spent on personal health care. Let that sink in for a minute or two. Over that time period, spending increased between 3% and 4% annually for most age groups.”


The prices for drugs are going up. A lot. And not just in cancer, as I’ve written about many times, but for multiple sclerosis as well.


The 21st Century Cures act that President Obama just signed into law, which both funded the cancer “Moonshot” and weakened FDA regulatory power, is not universally loved. Drs. Aaron Kesselheim and Jerry Avorn share their thoughts in this JAMA commentary.

“Among the most concerning sections of the new law are components that address the types of data that manufacturers will be able to use to gain FDA approval of new products or additional indications for existing products…When biomarkers used as the basis for drug approval are not rigorously validated, they may not actually predict patient benefit, can mislead physicians about whether a drug works, and have the potential to expose patients to poorly effective treatments or unanticipated adverse effects.”


 

 

 

Health Policy Updates: August 8 2015

New research out this week on how much Medicare, semi-private Medicare Advantage plans, and private insurers pay doctors and hospitals. I was surprised to see how big of a gap there is; private insurance pays a LOT more.

“With one exception of a hospital reporting being paid commercial rates of 105–112 percent of traditional Medicare, commercial rates were reported to be at least 130 percent those of Medicare Advantage. Commercial rates averaging 175 percent, 250 percent, 300 percent, and even 350 percent of the MA rate are cited” Continue reading Health Policy Updates: August 8 2015

Health Policy Updates: July 6 2014

For everyone on this list who is new to North Carolina, this post will go a long way to catching you up on the status of Medicaid in this state. Briefly, NC is one of the states that has opted NOT to expand its Medicaid program as intended by the ACA (Obamacare), but with the stated intention of “reforming” Medicaid on our own terms. The ongoing issue is that no one know exactly what “reform” means:
I have no idea what will happen. I hate to invest lots of blogging on this because it keeps changing and getting less specific over time.”
(Also, this blogger, Don Taylor, is a Duke professor, and is the best source for “local news” in health policy that I have found)
Are MDs or MBAs better at running hospitals? I was quite surprised at the direction that this research suggested:
M.D. C.E.O.’s are more likely to prioritize patients because patient care is at the heart of their education and working life as a physician,’’ she said. “When it comes to making hard budgetary decisions or rationing choices, M.D. C.E.O.’s may be able to make more informed decisions.”
Hat tip to Eric Yoder
At least one columnist out there is skeptical of the emerging “consensus” that we have all been hearing in the media, that the ACA (“Obamacare”) is now “here to stay” and past the point that a repeal effort would be successful:
Whoever Republicans choose as their nominee, their favored replacement will become the de facto alternative Republican plan which party leaders and elected officials will all be expected to defend. And should the Republican candidate win, it is inconceivable that they will not have run on making the replacement of Obamacare a top priority for the first 100 days in office. Republicans are not going to back off their efforts for repeal. It is a top priority for their national base, for their donors, and for their constituents.”
From Vox.com, a quick course on what exactly that term “single payer,” which we hear a lot in health care reform debates, means. Does it necessarily imply a socialized system such as the NHS in the UK?
http://www.vox.com/cards/single-payer/what-is-single-payer-health-care
The term “single payer” describes a method of paying for health care. What it does not say anything about is ownership of the rest of the health-care system. It’s possible, for example, for a single-payer system to contract with doctors who are employed by private companies.”

Health Policy Updates: April 19 2014

The ins and outs of drug pricing, from the new Vox.com:
http://www.vox.com/2014/4/11/5601562/how-can-one-pill-cost-1000

Also from Vox – are healthcare prices starting to jump up again, after a few years of slower growth?
Uh-oh. I had been hopeful for a long-term cool-off…
http://www.vox.com/2014/4/15/5612900/health-spending-growth-fast
But it also present challenges for the government. More than a quarter of the federal budget already goes towards health programs. That number could rise if health care costs started growing faster than the rest of the economy again.”

Duke’s Don Taylor is interviewed on NPR’s Here and Now to discuss the new release of Medicare Part B data:
http://hereandnow.wbur.org/2014/04/09/medicare-spending-data

On the high price of cancer drugs:
http://www.nejm.org/doi/full/10.1056/NEJMp1400104
The high price of cancer drugs is unsustainable, and the need for less costly alternatives is greatest in cases where the benefit of new therapies is marginal (i.e., the cost-effectiveness ratio is mostly unfavorable). The five comparisons that we highlight suggest an underappreciated consequence of the prices themselves: high prices protect a drug’s market share, precluding challenges from cheaper alternatives.”

As we know, there is huge geographic variation in the practice of medicine – things that are the standard of care in some centers and not done at all in other parts of the country. The recently release of Medicare data has brought this out further:
http://www.washingtonpost.com/business/economy/cost-of-drugs-used-by-medicare-doctors-can-vary-greatly-by-region-analysis-finds/2014/04/09/69ac93f0-c024-11e3-b574-f8748871856a_story.html?hpid=z1
The data reflect what appears to be an astonishing variety in how and when physicians in different parts of the country use drugs. For example, Medicare spends far more on drugs administered by physicians in some areas than in others, leading to questions about whether pharmaceuticals may be overused in some areas or underused in others.”