The Alexander-Murray bill, a bipartisan compromise to try to stabilize the Obamacare insurance markets, already faced some big hurdles, such as ambiguous support from the White House. This week, an alternative “stabilization” bill emerged, this one entirely Republican, which seems to look a little bit more like Obamacare repeal than simply an insurance market patch.
“Hatch-Brady adds explicitly partisan objectives that Democrats will likely reject: the cuts to the Obamacare mandates and the introduction of anti-abortion restrictions to the CSR payments…Hatch and Brady have now introduced two of the most divisive issues in health policy — the individual mandate and abortion — to the Obamacare stabilization talks. Their plan is more akin to a slightly skinnier version of ‘skinny repeal’ from the summer than an Obamacare stabilization package that both parties would likely support.”
Continue reading Health Policy Updates: October 28 2017
There were a couple of great articles in JAMA Internal Medicine this week on cancer drug development and pricing.
The first, discussed in this NYTimes article, did a thorough job of tallying the total R&D cost to bring a new cancer drug to market. The study authors ended up with a significantly lower number than has been reported in the past.
“Following approval, the 10 drugs together brought in $67 billion, the researchers also concluded — a more than sevenfold return on investment. Nine out of 10 companies made money, but revenues varied enormously. One drug had not yet earned back its development costs.”
Continue reading Health Policy Updates: September 16 2017
What would it take to make the US health care system the best in the world? We already spend more money (by far) on health care than any other country, but our results are middling (see the figure below). Recent thoughts on what the US might do in order to translate our huge financial investment in health into better results, in the NEJM.
“The first challenge the U.S. health care system must confront is lack of access to health care…Affordable and comprehensive insurance coverage is fundamental. If people are uninsured, some delay seeking care, some of those end up with serious health problems, and some of them die.
The second challenge is the relative underinvestment in primary care in the United States as compared with other countries…In contrast to the United States, a higher percentage of these countries’ professional workforce is dedicated to primary care than to specialty care, and they enable delivery of a wider range of services at first contact…” Continue reading Health Policy Updates: August 19 2017
A very detailed, and very good, piece in Politico about the ongoing cost problem facing the ACA/Obamacare. Fewer young and healthy people have signed up than anticipated, leaving the average costs higher for everyone else. As a result, insurance companies are losing money, and are raising their prices to try to catch up. Trends like this are concerning that we may be seeing the early stages of a “death spiral,” in which prices continue to rise higher than more and more people are able to afford.
I found this article to cover both the successes and the problems of the ACA in a fair and comprehensive way, and recommend it highly.
“A close look at what’s really keeping the exchanges underwater suggests that some of the problems are self-inflicted wounds by Obama and his administration; others are the handiwork of Republican saboteurs, who undercut the safeguards intended to help companies weather the uncertainty of the new law…None of the problems are insurmountable, but if they aren’t fixed, the law could find itself in a mounting crisis—what observers call a “death spiral”—in which competition vanishes, costs skyrocket, and a dwindling pool of insurers offer policies so expensive that health insurance is as out of reach as it ever was.” Continue reading Health Policy Updates: July 24 2016
After this study made the news several years ago, it became common knowledge that “doctors die differently” from the rest of us. Having been behind the scenes in providing care to dying patients, the story went, doctors know how ineffective and truly painful such care can be. As a result, they are more interested in Hospice care, and they forgo such interventions such a CPR when they finally reach the end. If only everyone knew what doctors know, then they could be spared the agony and indignity of dying in a hospital!
In contrast, a more recent study finds that doctors really don’t differ from everyone else. It seems like they spend just as much time in the hospital, and in the ICU. I was surprised by this finding; if true, it makes me more pessimistic about the ability of more information or education to help people to avoid painful, costly, low-value care at the end of life.
“They found that the majority of physicians and non-physicians were hospitalized in the last six months of life and that the small difference between the two groups was not statistically significant after adjusting for other variables. The groups also had the same likelihood of having at least one stay in the ICU during that period”
Continue reading Health Policy Updates: June 11 2016