Category Archives: Price of U.S. healthcare

Drug prices rise 5.8% on average in 2020, Obamacare and True Economics and the opinions of Delaney!

The Holidays are finally over and Rudolf was just arrested for assaulting his teammate reindeers for calling him names and laughing at him. Was this a hate crime??? Oh, how sensitive these days!! Poor, poor Rudolf!

As I was picking up a prescription today I was reminded of this article, one copy sent to me by a friend, I then went to pay for the prescription with my GoodRx card though which I was given an 80% discount. This brings up the question how will we all be able to pay for the future drugs with their outrageous prices? 

It also brings up the question, how do organizations like GoodRx and Singlecare give people the discount. And what is the true value of prescription drugs and what prices should be charged in order for the always-profitable pharmaceutical companies to make an acceptable profit and what is an acceptable profit?

Consider this report published in MarketWatch by Jared S. Hopkins.

Pharmaceutical companies started 2020 by raising the price of hundreds of drugs, according to a new analysis, though the increases are relatively modest this year as scrutiny grows from patients, lawmakers and health plans.

Pfizer Inc. led the way, including increasing prices by over 9% on more than 40 products. The drug industry traditionally sets prices for its therapies at the start of the year and again in the middle of the year.

More than 60 drugmakers raised prices in the U.S. on Wednesday, according to an analysis from Rx Savings Solutions, which sells software to help employers and health plans choose the least-expensive medicines. The average increase was 5.8%, according to the analysis, including increases on different doses for the same drug.

The average is just below that of a year ago, when more than 50 companies raised the prices on hundreds of drugs by an average of more than 6%, according to the analysis.

Pfizer said that 27% of the drugs Pfizer sells in the U.S. will increase in price by an average of 5.6%. More than 90 of the New York-based company’s products rose in price, according to the Rx Savings Solutions analysis. Among them are Ibrance, which sold nearly $3.7 billion globally through the first nine months last year, and rheumatoid arthritis therapy Xeljanz.

A Pfizer spokeswoman said that nearly half of its drugs whose prices went up are sterile injectables, which are typically administered in hospitals, and the majority of those increases amount to less than $1 per product dose.

Pfizer’s largest percent increases, 15%, are on its heparin products, which are generic blood thinners typically administered in hospitals.

Pfizer said the heparin increases are to help offset a 50% increase in the cost of raw materials and expand capacity to meet market demand. The company said it is monitoring the global heparin supply, which has been challenged by the impact of African swine flu in China, as the drug is derived from pig products and disruption could lead to a shortage. Pfizer said that its U.S. heparin supply is not sourced from China.

Overall, the increases by drugmakers Wednesday affect “list prices,” which are set by manufacturers, although most patients don’t pay these prices, which don’t take into account rebates, discounts and insurance payments. Drugmakers have said prices are increased in conjunction with rebates they give to pharmacy-benefit managers, or PBMs, in order to be placed on the lists of covered drugs known as formularies.

In fact, drugmakers have said that their net prices have declined because of large rebates to PBMs, which negotiate prices in secret with their clients, such as employers and labor unions.

Pfizer said its price increases will be offset by higher rebates paid to insurers and middlemen. The company said the net effect on revenue growth in 2020 will be 0%, which is the same percentage expected for 2019. The company said the average net price of its drugs declined by 1% in 2018.

In 2018, Pfizer was assailed by President Trump after the company raised the prices on some 40 drugs. Pfizer temporarily rolled back the increases, but raised prices again later.

In Washington, Republicans and Democrats in the U.S. Congress have drawn up proposals for lowering drug costs, while the Trump administration recently introduced a plan for importing drugs from Canada.

“Prices go up but demand remains the same,” said Michael Rea, CEO of Rx Savings Solutions. Clients of the Overland Park, Kan., company include Target Corp. and Quest Diagnostics Inc. “Without the appropriate checks and balances in place, this is a runaway train. Consumers, employers and health plans ultimately pay the very steep price.”

While some increases in his firm’s analysis were steep, most product prices rose by less than 9%.

AbbVie Inc. raised the price of rheumatoid arthritis treatment Humira, the world’s top-selling drug, by 7.4%, according to the analysis. Through the first nine months of 2019, Humira sales totaled nearly $11 billion.

AbbVie didn’t respond to a request for comment.

GlaxoSmithKline PLC raised the prices on more than two dozen different therapies, although none by more than by 5%. That includes its shingles vaccine, Shingrix, which sold about $1.7 billion globally in the first nine months of 2019.

A Glaxo spokeswoman confirmed the increases and said net prices for its U.S. products fell about 3.4% on average annually the past five years.

Other major companies that raised prices included generic drugmaker Teva Pharmaceutical Industries Ltd., which raised the price of more than two dozen products, but none by more than 6.4%, according to the analysis. Sanofi S.A. raised prices on some of their therapies, but none by more than 5%, while Biogen Inc. took increases that didn’t exceed 6%, including on multiple-sclerosis therapy Tecfidera.

Teva didn’t respond to requests for comment.

A Sanofi spokeswoman confirmed the increases and said that the changes are consistent with its pledge to ensure price increases don’t exceed medical inflation. A Biogen spokesman confirmed the price changes and said adjustments are made to products for which it continues to invest in research, and otherwise increases follow inflation.

In addition to Pfizer’s increases on heparin, companies increased prices for several therapies by more than 10%, according to the analysis.

Cotempla XR-ODT, which is approved in the U.S. to treat attention-deficit hyperactivity disorder in children between 6 and 17 years old, increased by more than 13% to $420 for a month supply. The therapy is sold by Neos Therapeutics Inc., based in Grand Prairie, Texas.

Representatives for Neos didn’t respond to requests for comment.

Democrats ask U.S. Supreme Court to save Obamacare

Lawrence Hurley of Reuters reported that the Democratic-controlled U.S. House of Representatives and 20 Democratic-led states asked the Supreme Court on Friday to declare that the landmark Obamacare healthcare law does not violate the U.S. Constitution as lower courts have found in a lawsuit brought by Republican-led states. 

The House and the states, including New York and California, want the Supreme Court to hear their appeals of a Dec. 18 ruling by the New Orleans-based 5th U.S. Circuit Court of Appeals that deemed the 2010 law’s “individual mandate” that required people to obtain health insurance unconstitutional. 

The petitions asked the Supreme Court, which has a 5-4 conservative majority, to hear the case quickly and issue a definitive ruling on the law, formally called the Affordable Care Act, by the end of June. 

Texas and 17 other conservative states – backed by President Donald Trump’s administration – filed a lawsuit challenging the law, which was signed by Democratic former President Barack Obama in 2010 over strenuous Republican opposition. A district court judge in Texas in 2018 found the entire law unconstitutional. 

“The Affordable Care Act has been the law of the land for a decade now and despite efforts by President Trump, his administration and congressional Republicans to take us backwards, we will not strip health coverage away from millions of Americans,” New York Attorney General Letitia James said. 

Obamacare, considered Obama’s signature domestic policy achievement, has helped roughly 20 million Americans obtain medical insurance either through government programs or through policies from private insurers made available in Obamacare marketplaces. Republican opponents have called it an unwarranted government intervention in health insurance markets. 

Congressional Republicans tried and failed numerous times to repeal Obamacare. Trump’s administration has taken several actions to undermine it. 

In 2012, the Supreme Court narrowly upheld most Obamacare provisions including the individual mandate, which required people to obtain insurance or pay a financial penalty. The court defined this penalty as a tax and thus found the law permissible under the Constitution’s provision empowering Congress to levy taxes. 

In 2017, Trump signed into law tax legislation passed by a Republican-led Congress that eliminated the individual mandate’s financial penalty. That law means the individual mandate can no longer be interpreted as a tax provision and therefore violates the Constitution, the 5th Circuit concluded. 

In striking down the individual mandate, the 5th Circuit avoided answering the key question of whether the rest of the law can remain in place or must be struck down, instead sending the case back to a district court judge for further analysis. 

That means the fate of Obamacare remains in limbo. The fact that the litigation is still ongoing may make the Supreme Court, which already has a series of major cases to decide in the coming months, less likely to intervene at this stage. 

John Delaney: On health care, bold vision with pragmatism is what America needs

Pulitzer prize winning editor, Art Cullen noted that in living rooms and coffee shops across all of Iowa’s 99 counties, I am forever reminded that health care is the paramount issue facing Americans. Our current system is deeply broken, and our country needs a bold vision and a pragmatic approach for improving health care. In many ways, a candidate’s approach to health care defines their governing and leadership style. It answers important questions about their values, vision, pragmatism and management style. 

The Democratic Party should have as its true north universal access — where every American has health care coverage as a right of citizenship. We should support plans that encourage innovation — curing diseases like cancer and Alzheimer’s — and that create a framework for getting costs under control. My Better Care Plan uniquely achieves all of these goals.

Universal access needs to be realistic

Currently, only three candidates have detailed plans for universal access — Sens. Elizabeth Warren and Bernie Sanders and I. Universal access is the right answer, both morally and economically. The plans advocated by Warren and Sanders, however, call for an extreme “single-payer” system, where the government is the only provider of coverage. 

Aside from the extraordinary practical, fiscal and political issues associated with eliminating and replacing over 180 million private insurance plans, a single-payer system will massively underfund the health care system. Today, government reimbursement is dramatically less than reimbursements paid by insurance companies. Making the government the only payer in health care would underfund hospitals, particularly in rural America, resulting in hospital closures, practitioners closing up shop, and a reduction of investment in innovation.  

On the other hand, most other candidates are advocating for a “public option” as our way forward. This is a modest proposal, insufficient for the challenges of our broken health care system. A public option is simply another insurer that is government-run. It will have co-payments, deductibles, and premiums. And it relies on people choosing to sign up. While it would provide more options than are currently available in the marketplace, undoubtedly helping many, it would not address the tragedy of the uninsured in our country.

Under BetterCare we achieve the ambition of universal coverage without the negatives of a single-payer system. 

Under BetterCare, Medicare is left alone, because it works, and every American from birth to 65 (seniors are on Medicare) is auto-enrolled in a free federal health care plan that covers basic health care needs. This ensures every American has health care coverage. But unlike the single-payer Medicare for All, Americans could still choose private insurance. They could “opt out” of the BetterCare plan and buy private insurance or receive insurance from their employer. If they “opt out” they would receive a health care tax credit to offset the cost of health care they purchase or that their employer provides. 

Alternatively, they could use the BetterCare plan and enhance it with supplemental plans, similar to how Medicare beneficiaries acquire supplemental plans. BetterCare is like Medicare. It provides guaranteed coverage but allows our seniors to have supplemental plans or “opt out” and accept a Medicare Advantage Plan.  

BetterCare is similar to the plans of most developed nations that have universal coverage. As Art Cullen wrote, it provides “universal coverage while not eliminating private insurance.” By providing universal access, choice, protecting provider reimbursements, and encouraging innovation, BetterCare is bold, ambitious, practical and a political winner. Importantly, it can be fully paid for by applying the Obamacare subsidies and current federal and state Medicaid payments and by eliminating the corporate deductibility of health care.

It is bold, yet practical, and reflective of my approach to governing. As a former entrepreneur, CEO of two public companies and member of Congress, I bring a unique approach and real leadership experience, which is why I respectfully ask for your support. 

Use Simple Economics to Contain Health Care Costs

Gary Shilling wrote for Bloomberg and makes so much sense when he looked at health care costs in terms of simple economics. (Bloomberg Opinion) — Spending on U.S. health care is out of control, expanding steadily from 5% of GDP in 1960 to 18% in 2018.  There are, however, ways to curb the explosion in costs from both the demand and the supply side.

Health care costs per capita in the U.S. are almost double those of other developed countries, but life expectancy is lower than many, even South Korea, according to the CIA and Eurostat. Without restraint, costs will accelerate as more and more postwar babies age. The nonpartisan Congressional Budget Office projects Medicare spending alone will leap from 3% of GDP to 8% by 2090.

Medical costs are understandably high since the system is designed to be the most expensive possible for four distinct reasons. First, with the constantly improving but increasingly expensive modern technology, the best is none too good when your life or mine is at stake. Also, few patients have the knowledge to decide whether a recommended procedure will be medically much-less cost-effective. The medical delivery system encourages a gulf between the providers who supposedly know what’s needed and their patients who don’t.

Second, patients are quite insensitive to costs since their employers or governments pay most health care bills. And those who are privately insured want to get their money’s worth from their premiums, especially since Obamacare does not allow insurers to set premiums on a health risk basis.

Third, the pay-for-service system encourages medical providers to over-service. After my dermatologist burned off the pre-cancerous growths on my face, he wanted me back in two weeks to be sure, but also to bill another office visit.

Finally, domestic training programs and facilities for medical personnel are inadequate. As a result, many MD residents and nurses come from abroad, while medical schools of dubious quality in the Caribbean train U.S.-born physicians.

To control costs on the demand side, use the appeal of money. The importance of their health to most Americans means they will spend proportionally more on medical services than other goods and services, but they’ll think twice if it’s money they otherwise can keep. Increasing deductibles and co-payments are moving in that direction. In 1999, employees on average paid $1,500, or 22%, of $6,700 in family health coverage premiums, according to the Kaiser Family Foundation. The total rose to $26,600 in 2019, but employees’ share has climbed to $6,000, or 29%.

Medical savings accounts also make patients more aware of costs. Companies give employees a set amount of money and they can keep what they don’t spend on health care. 

Accountable Care Organizations, now authorized by Medicare, attack the fee-for-service problem. The medical providers who participate are encouraged to be efficient since they can retain part of any savings due to cost controls as long as they provide excellent care.

To increase the supply of medical personnel, American medical and nursing schools can be expanded with government help. Also, shortening the whole training process would save time and get huge student debts under control. Does a physician need a four-year bachelor’s degree before beginning medical school?

Cartels among hospital medical specialties can be attacked. Now, physicians in, say, the general surgery department limit competition by controlling who has the privileges to use their institution’s facilities.

In another development, the entrepreneurial model of a small group of MDs operating a practice is fading in the face of high costs of medical record-keeping and other regulatory requirements. Over half of physicians now work for hospitals, either on their main campuses or in satellite facilities. This may shift the emphasis of many from money to medicine. 

Limiting malpractice insurance premiums, a major outlay for medical providers, can also cut medical costs. Texas placed a $250,000 cap on non-economic damages, i.e., pain and suffering, in 2003. Texas Department of Insurance data reveals that medical malpractice claims, including lawsuits, fell by two-thirds between 2003 and 2011, and the average payout declined 22% to $199,000.

Also, average malpractice insurance premiums plunged 46%, according to the Texas Alliance for Patient Access, a coalition of health care providers and physician liability insurers. And physicians were then attracted to Texas. The Texas Medical Association reports that in the decade since malpractice awards were capped, 3,135 physicians came to the Lone Star State annually, 770 more than the average in the prior nine years.

At present, Americans basically pay the development costs of new drugs while other countries with centralized pharmaceutical-buying skip the expenses of R&D, field trials, etc., and only pay the much-lower marginal cost of production. Allowing Medicare to join Medicaid to negotiate drug prices could reduce costs if foreigners can be convinced to share development costs. Otherwise, new drug development would be curtailed. The Trump administration’s new rules that force health insurers and hospitals to publish their negotiated prices may force costs to the lowest level.

One approach that doesn’t work in easing the burden on consumers of medical costs is increasing overall government subsidies. They tend to be offset by higher costs, much as higher college tuition and fees often dissipate more scholarship aid. Ever notice that the most modern, prosperous institutions in town tend to be hospitals, hugely subsidized by governments?

Health care is critical, but that doesn’t mean its costs aren’t subjected to supply and demand. Then how do we assess the value as well as the costs and cost limitations? Are drug companies as well as insurance companies making way too much in profits by taking advantage of we the honest patients?? 

There many parts of the eventual answer to our need for a health care program which can service all at reasonable costs and each “part” needs thorough investigation and real solutions and that just addressing only one or two of these “parts” will never be sustainable!!

Physicians Get Weed Killer; Administrators Get Miracle-Gro And neither is helping, Obamacare Funding Suggestions, Andrew Lang, Year in Review and Google Searches

Last week Suneel Dhand reported that compared to a couple of years ago, very little has changed in the hospital medical community. 

In fact, I’m sure the divergence of the curves has only grown bigger, as more and more administrators are added to the ranks of healthcare. Look at what happened in Chicago where one of the fairly large hospitals fired 15 of their physicians and replaced them with 15 nurse practitioners last year, and in Texas 27 pediatricians at a chain of clinics in the Dallas area lost their jobs and were replaced by nurse practitioners. 

Quite often in life, the answers to some of the biggest questions we have, are staring us right in the face and incredibly simple. Healthcare can never be fixed unless we radically simplify everything and strip away the unnecessary complexities in our fragmented system. The divergence of the above lines, however, actually represents so much more than just an obnoxious visual. It actually symbolizes what happens when any organization, system, or even country, becomes top-heavy and loses sight of what is happening at the front lines. And in the end, it eventually collapses under its own weight.

When this happens in America, we cannot predict, but consider this: The amount we spend on healthcare would be the 4th largest economy in the world if it stood alone (at $3.5 trillion, only China and Japan have a higher total GDP). With an aging population, increasing chronic comorbidities, and expensive new treatments, if costs are not reined in, healthcare expenditure could account for a third of the entire GDP in about 25 years. A figure that will quite simply destroy the American economy.

It would be one thing if all the administration and bureaucracy was actually resulting in an improved and more efficient healthcare system. But look around you folks. Acute physician shortages now plague every state. Millions of people find it impossible to find a primary care doctor. Certain specialties are now booking out appointments months in advance. ERs and hospitals are overflowing. And in the end, patients are still facing soaring out of pocket expenses.

The last 20 years have witnessed the consolidation and corporatization of the entire U.S. healthcare system. Sold initially as a way to reign in costs, I am yet to see any evidence that it’s done anything other than dramatically increase costs (please feel free to forward me any financial analysis if I’m wrong). And why should that be a surprise to anyone?

I’ll leave you to stare once again at the above graph for a minute or two, and take in a comment that a distinguished physician colleague of mine recently made: “It’s like the physicians have been given weed killer and the administrators have been given Miracle-Gro.”

Affordable Care Act funding in question after health insurance taxes repealed

The Cadillac Tax, Health Insurance Tax and Medical Device Tax were recently repealed, raising questions over how the Affordable Care Act will be funded in the future. Yahoo Finance’s Anjalee Khemlani joins Adam Shapiro, Julie Hyman and Dan Howley during On the Move to break it all down.

Andrew Yang Has The Most Conservative Health Care Plan In The Democratic Primary

Daniel Marans of the Huff Post pointed out that Entrepreneur Andrew Yang has had unexpected staying power in the Democratic presidential primary thanks in part to the enthusiasm for his plan to provide every American with a basic income of $1,000 a month.

But the boldness of his signature idea only serves to underscore the unambitiousness of the health care plan he released earlier this month.

In fact, Yang’s health plan, which he bills as an iteration of the left’s preferred “Medicare for All” policy, is more conservative than proposals introduced by the candidates typically identified as moderate. 

Former Vice President Joe Biden, South Bend, Indiana, Mayor Pete Buttigieg and Sen. Amy Klobuchar of Minnesota all at least call for the creation of a public health insurance option that would be available to every American. (Sen. Bernie Sanders of Vermont and Sen. Elizabeth Warren of Massachusetts favor Medicare for All, which would move all Americans on to one government-run insurance plan ― though the two senators disagree on the timeline for implementing the idea.)

In terms of expanding health insurance coverage, Yang says on his website merely that he would “explore” allowing the employees of companies that already provide health insurance the chance to buy into Medicare. 

“We need to give more choice to employers and employees in a way that removes barriers for businesses to grow,” Yang writes.

Under Yang’s plan, people employed by businesses that do not provide insurance, or who are self-employed, would continue to purchase coverage on the exchanges created by former President Barack Obama’s Affordable Care Act.

The decision not to focus on expanding coverage distinguishes Yang dramatically from his competitors. And in the foreword to his plan, he explains that that is a deliberate choice, since enacting single-payer health care is “not a realistic strategy.”

“We are spending too much time fighting over the differences between Medicare for All, ‘Medicare for All Who Want It,’ and ACA expansion when we should be focusing on the biggest problems that are driving up costs and taking lives,” he writes. “We need to be laser focused on how to bring the costs of coverage down by solving the root problems plaguing the American healthcare system.”

When asked about how Yang plans to expand health insurance coverage ― 27 million Americans remain entirely uninsured and millions more have insurance that is so threadbare they do not use it ― Yang’s campaign referred HuffPost to his website. 

Yang would increase health care access through reforms designed to reduce the health care system’s underlying costs, according to his campaign. On his website, he divides those reforms into six categories: bringing down the cost of prescription drugs through bulk negotiation; investing in waste-saving health care technologies; realigning medical providers’ “incentives” away from waste and abuse; increasing investment in preventive and end-of-life health care; making the provision of health care more “comprehensive”; and reducing the influence of lobbyists on the political system.

Yang implies that his rivals have sacrificed cost control in the name of expanding coverage. But when it comes to the specifics, Yang’s competitors have already gotten behind many of the ideas he is proposing ― and sometimes take them a step further. 

For example, Buttigieg has a provision in his health care plan that would prohibit “surprise billing” ― the practice of providing unwitting patients with a large bill after a medical procedure when a doctor who performed it is not in the hospital’s insurance network. Yang does not mention the practice in his health care plan.

One provision of Yang’s plan that genuinely sets him apart is his plan to encourage the replacement of the fee-for-service billing model for doctors with salaries. The latter model is supposed to cut back on duplicative practices and foster more holistic care. Other elements of his plan, such as “incentivizing” gym memberships, healthy eating and bike commuting as a form of preventive health care, have drawn eye rolls from leftists who regard the ideas as paternalistic.

First and foremost, though, many progressives are likely to find fault with Yang’s plan, because they consider his use of the term “Medicare for All” misleading. 

For months on the campaign trail, Yang claimed that he supported Medicare for All, though not the provision of Sanders’ bill ― and its companion in the House ― requiring people with private insurance to enroll in an expanded Medicare program. 

He even aired a television ad casting his commitment to the policy as a reflection of his experience as the father of a special needs child.

Yang says on his campaign website that he is still firmly committed to the “spirit” of Medicare for All. But now that he has introduced a plan of his own, that claim is harder to defend.

Yet the Yang campaign is plowing full-steam ahead with its appropriation of the term in a new 30-second ad, “Caring.”

“If my husband, Andrew Yang, is president, he’ll fight for Medicare for All with mental health coverage,” Yang’s wife, Evelyn, says in the ad. 

Fate of Obamacare uncertain amid tax repeals, lawsuits and Medicare-for-all push consider that Democrats seize on anti-Obamacare ruling to steamroll GOP in 2020

Alice Miranda Ollstein and James Arkin reported that a court ruling last week putting the Affordable Care Act further in jeopardy may provide the opening Democrats have been waiting for to regain the upper hand on health care against Republicans in 2020.

At the most recent Democratic presidential debate, candidates largely avoided discussing the lawsuit or Republicans’ years-long efforts to dismantle Obamacare, and instead continued their intra-party battle over Medicare for All.

But Senate Democrats, Democratic candidates and outside groups backing them immediately jumped on the news of the federal appeals court ruling — blasting out ads and statements reminding voters of Republicans’ votes to repeal the 2010 health care law, support the lawsuit and confirm the judges who may bring about Obamacare’s demise.

“I think it’s an opportunity to reset with the New Year to remind people that there’s a very real threat to tens of millions of Americans,” Sen. Brian Schatz (D-Hawaii) said in an interview. “We Democrats are always striving to improve the system, but, at a minimum, the American people expect us to protect what they already have.”

In 2018, Democrats won the House majority and several governorships largely on a message of protecting Obamacare and its popular protections for preexisting conditions. This year continued the trend, with Kentucky’s staunchly anti-Obamacare governor, Matt Bevin, losing to Democratic now-Gov. Andy Beshear.

The landscape in 2020 may be more challenging for Democrats than it was in 2018, when Republicans had more recently voted to repeal the Affordable Care Act. Republicans also say they now have more ammunition to push back on Democrats’ arguments with the party’s divisions over single-payer health care, which would replace Obamacare, shaping the presidential race.

Moreover, the appeals court’s ruling — which in all likelihood punted any final disposition on the case until after the 2020 elections — eliminates what some Republicans saw as a nightmare scenario: If the court had embraced a lower court ruling striking down the law in its entirety, it would have put the issue before the Supreme Court during the heat of the election, putting tens of millions of Americans’ health insurance at risk.

Still, Democrats believe they can win the political battle over health care, especially in Senate races. At least a half-dozen GOP senators are up for reelection, and Democrats need to net three seats to win back control of the chamber if they also win back the presidency. Democratic strategists and candidates are eager to run a health care playbook that mirrors that of the party’s House takeover in 2018, and say Republicans are uniquely vulnerable after admitting this year that they have no real plan for dealing with the potential fallout of courts striking down Obamacare.

Within a day of the ruling, the pro-Obamacare advocacy group Protect Our Care cut a national TV and digital ad featuring images of Sens. Susan Collins (R-Maine) and Cory Gardner (R-Colo.), warning that if the lawsuit succeeds, “135 million Americans with preexisting conditions will be stripped of protections, 20 million Americans will lose coverage and costs will go up for millions more.”

Other state-based progressive groups told POLITICO they’re readying their own ads going after individual Senate Republicans over the 5th Circuit’s ruling.

Protect Our Care director Brad Woodhouse predicts that it’s just a preview of the wave of attention the issue will get in the months ahead, as Democratic candidates and outside groups alike hammer the GOP on the threat their lawsuit poses to Obamacare.

“If there is one issue in American politics that is going to flip the Senate from Republican to Democratic in 2020, it’s this issue,” he said. “Our message is simple: President [Donald] Trump and Republicans are in court right now, suing to take away the ACA, take away your health care. And if Cory Gardner or Thom Tillis or any of them don’t think that’s an indefensible position, they should ask the 40-plus House Republicans who lost their seats in 2018.”

More than a dozen Republican state attorneys general, backed by the Trump administration, have been arguing in federal court for more than a year that Congress rendered the entire Affordable Care Act untenable when they voted as part of the 2017 tax bill to drop the penalty for not buying insurance down to zero. A district judge in Texas sided with them last year in a sweeping ruling declaring all of Obamacare unconstitutional.

Last week, an appeals court agreed that the elimination of the penalty made the individual mandate unconstitutional, but sent the case back down to the district court to decide whether any of the law could be separated out and preserved. The move all but guarantees the case won’t reach the Supreme Court until after the election, but it maintains the cloud of uncertainty hanging over the health law that experts say drives up the cost of insurance.

Though no one is in danger of losing their health coverage imminently, Democratic challengers in nearly every Senate battleground race, including Arizona, North Carolina, Maine and Iowa, jumped on the court ruling as an opportunity to attack Republicans on health care.

“Democrats have been in the fight to ensure that people across this country have access to affordable health care,” said Sen. Catherine Cortez Masto of Nevada, the chair of the DSCC. “This opinion does not help the Republicans.”

Sara Gideon, Democrats’ preferred candidate in Maine to take on Collins, called the lawsuit a “direct threat to the protections countless Mainers and Americans depend on. She has been reminding voters that Collins’ vote on the 2017 tax reform law triggered the ACA lawsuit in the first place, and she voted to confirm one of the 5th Circuit judges that recently sided with the Trump administration’s arguments against the law.

Unlike the vast majority of her GOP colleagues in the upper chamber, Collins has spoken up against the lawsuit. She has written multiple times to Attorney General Bill Bar, urging him to defend the ACA in court. Collins told POLITICO the day after the ruling that it was “significant” that the 5th Circuit judges were clearly “very uneasy with the thought of striking down the entire law” and instead sent the case back down to the lower court for reconsideration. Collins’ campaign spokesman both emphasized that she believes the government should defend the law and criticized Democrats for defending the unpopular individual mandate.

Tillis, the vulnerable North Carolina senator, said the lawsuit gave Republicans “breathing room” to find a viable replacement for Obamacare and attempted to flip the attack on Democrats by tying them to their presidential contenders.

“I think the fact that they all raised their hands and said we need Medicare for All is also raising their hands and saying the Affordable Care Act has failed,” Tillis said.

Though most of the 2020 presidential candidates have come out against Medicare for All, and more Democratic voters favor a choice between private insurance and a public option, the single-payer debate has given Republicans a potent line of attack that they’re turning to more than ever in the wake of the court’s ruling.

“Obamacare failed to lower health care costs for millions of Americans, and now Democrats want a complete government takeover of our health care system,” said Jesse Hunt, a spokesman for the National Republican Senatorial Committee. “They spent all of 2019 defending their socialist plan to eliminate employer-based health care coverage, and those problems will not subside anytime soon.”

The effectiveness of the GOP attacks will depend largely on the Democratic nominee for president — if it is someone who backs Medicare for All, it will be much more difficult for Senate candidates who don’t support the policy to separate themselves from it. But Democratic activists say they’re confident the GOP’s actions in court will sway voters more than their claims about Medicare for All.

“We can prepare for and counter those attacks by reminding voters that [Republicans are] fighting actively to take health care away,” said Kelly Dietrich, the founder and CEO of the National Democratic Training Committee, which coached more than 17,000 candidates for federal and state office in 2019. “Republicans’ ability to use fear as a tool to win elections should never be underestimated. But the antidote is to fight back just as hard.”

Year in Review: Lots of talk, not a lot of action in healthcare politics

Rachel Cohrs noted that lawmakers and regulators talked big on tackling high drug prices and surprise medical bills in 2019, but agreement on the bipartisan policies remained elusive. Some healthcare policy could be attached to a potential budget deal in December, but it is still unclear whether lawmakers will resolve funding disputes by the end of the year.

Despite major bipartisan legislative packages spearheaded by senior Senate Republican leaders, disputes over details and intense lobbying efforts have so far stalled progress in Congress. Drug makers are fighting a provision in the Senate Finance Committee’s drug pricing bill that would require them to pay back Medicare for drug price hikes faster than inflation, and providers and insurers are warring over how out-of-network medical bills should be handled.

Competing approaches to address surprise medical billing came to a head in December when a bipartisan, bicameral compromise proposal on addressing surprise medical bills emerged, but a key Senate Democrat involved in the negotiations had not signed on as of press time. Despite provider-friendly tweaks, providers still oppose the legislation and it is unclear whether House and Senate leadership have an appetite to include it in must-pass legislation.

Health reform 3.0: Early in the year, Senate health committee Chair Lamar Alexander and ranking Democrat Patty Murray released a wide-ranging plan to lower costs that addresses surprise medical bills; contract reform provisions; cost transparency; and boosting generic competition for Rx drugs. The year ended with a bipartisan, bicameral bill emerging, but at deadline it lacked Murray’s endorsement.

Reducing drug prices: Addressing drug prices was the other issue that dominated the policy landscape. Competing plans emerged, and the House passed a bill in mid-December on a party-line vote.

Grinding to a halt: House Speaker Nancy Pelosi announced a formal impeachment inquiry into President Donald Trump, which soured the prospects of a grand bargain between Trump and Pelosi on drug pricing and complicated the timeline for passing major healthcare policy.

Drug pricing was also a top priority for the Trump administration, but several marquee policy ideas have been stopped by the courts, abandoned, or are forthcoming. The White House decided to retract a prominent initiative that would have required insurers to pass manufacturer rebates directly to patients at the pharmacy counter, and a rule that would have compelled drug makers to include list prices in television advertisements is tied up in court. House Democrats passed a partisan government drug price negotiation bill, but it almost certainly will not become law.

The administration could at any time release a regulation outlining a process to allow states to import prescription drugs from Canada or move forward with a demonstration that would tie payments for physician-administered drugs in Medicare to international drug prices, but it has not yet acted on either proposal.

The 10 most-searched questions on health Reported by Sandee LaMotte of CNN

There were more questions that had people Googling in 2019.

The full list of the most-searched health questions in the United States this year also included questions about the flu, kidney stones and human papillomavirus or HPV:

  1. How to lower blood pressure
  2. What is keto?
  3. How to get rid of hiccups
  4. How long does the flu last?
  5. What causes hiccups?
  6. What causes kidney stones?
  7. What is HPV?
  8. How to lower cholesterol
  9. How many calories should I eat a day?
  10. How long does alcohol stay in your system?

NYU started to answer one of the big questions in the design of a fair healthcare system when they decided to declare their medical school tuition free. If all medical schools were tuition free the graduating doctors wouldn’t have the huge debt and they could have the opportunities to chose primary care and provide care to underserved rural and poorer communities. 

One step at a time and maybe next year Congress can really improve the health care system of our U.S.A.

And to all you interested readers out there Happy New Year! Maybe those in control will start the process of improving the delivery of affordable health care to all and not worry about their future political aspirations. What a change that would be!

US Health-Care Prices Are Off the Charts, Pros and Cons of Public vs Private healthcare and possible Financing of Medicare for All

After listening to the debates and the House debating and finally voting to approve the Articles of Impeachment I can actually say that I am embarrassed for we Americas and our Country. We all look like such fools! I say this because I have read critically the transcripts of the phone call that President Trump made to the President of Ukraine, listened to the witnesses in the case and have found no credible data to support an Impeachment. But how can one argue with the Hate of the party that lost the 2016 election? But on to discuss additional information on healthcare.

Michael Rainey of the Fuscal Times reported that a CT scan of the abdomen typically costs more than $1,000 in the U.S., but the same procedure in the U.K. costs $470, while in the Netherlands it costs just $140. Those numbers come from a new report, released Tuesday by the Health Care Cost Institute and the International Federation of Health Plans, that compares private insurance health-care prices in the U.S. to those in a sample of other wealthy countries – and finds that the U.S. is just about always the most expensive.

“The median prices paid by private insurance for health care services in the United States was almost always higher than the median prices in the eight other countries included in the iFHP study,” the report says. “Figure 1 [below] shows the prices paid for medical services in each country as a percent of the US price.”

Note that U.S. prices are marked by the red dots. In almost every case, the prices in other countries are just a fraction of the U.S. price. (Avoid getting cataract surgery in New Zealand, apparently.) 

The report also looks at drug prices, and finds that with only one exception, prices in the U.S. are the highest in the group. Harvoni, used to treat hepatitis C, costs $4,840 in South Africa and $12,780 in the Netherlands, but it costs more than twice that ($31,620) in the U.S. Similarly, a Humira pen, used to treat arthritis, costs $860 in the U.K., but $4,480 in the U.S.

“Drug prices for most countries were less than half the US price for most of the administered and prescription drugs included in the study,” the report says.

Writing about the report Tuesday, Vox’s Dylan Scott said that high medical prices in the U.S. have many causes, but one in particular stands out: “The US is still the wealthiest country in the world. It’s home to the world’s leading biopharmaceutical industry. It tends to have the most cutting-edge treatments. All this contributes to higher prices here than elsewhere. But one big and unavoidable culprit is the lack of price regulation.”

American health care is a farce

Rick Newman reported that the cost of private health insurance is skyrocketing. Medicare will run short of money soon. About 28 million Americans still lack health insurance.

Are your elected officials on it? NOPE! Why should they be. They get generous coverage through a choice of plans and enjoy taxpayer subsidies covering most of the cost. So they’ve taken care of themselves, which is the only thing that matters in Washington.

Wait, that’s not quite correct. Republicans are also determined to keep hacking away at the Affordable Care Act, now in place for 9 years. A GOP lawsuit—backed by the Trump administration—claims the entire ACA is unconstitutional, because in 2017 Congress repealed the penalty for people who lack insurance. It’s a convoluted argument, yet an appeals court recently upheld part of the case and sent the rest back to a lower-court judge, to assess which other parts of the ACA to kill. The law isn’t dead yet, and it might ultimately survive, but it could take the Supreme Court to rescue the ACA from its third or fourth near-death experience.

So here’s the story: There’s a health care crisis in the United States, with millions of people lacking care and many millions more facing costs that are rising far faster than their incomes. Health care costs are devouring both the family and the federal budget. And many workers stay in jobs they’re not suited for simply for the health benefits. Yet Republicans are trying to take care away from about 18 million Americans, and repeal the ACA’s prohibition against denying coverage to people with preexisting coverage. Their answer to giant problems of access and affordability is to make coverage even harder to obtain and drive up costs even more.

The Democrats have answers! Presidential candidates Bernie Sanders and Elizabeth Warren want to annihilate the private insurance system and create a government program, Medicare for All, which would be 15 times larger than the ACA Republicans hate so much. Sure, that’ll work. In response to obstinate political opposition, peddle a fantasy plan that generates even more furious resistance. And tell voters you refuse to compromise because it’s more important to stand for the right thing than to actually accomplish something that could improve people’s lives.

There are better ideas out there. Democrats such as Joe Biden, Pete Buttigieg and Amy Klobuchar favor enhancements to the ACA and a new public option that would provide coverage to nearly all the uninsured while leaving private insurance in place, for those who want to stick with that. It will never get Republican support, since Republicans favor the law of the jungle over government aid. But a Bidenesque plan could happen in the unlikely event a few reddish states grow momentarily sensible and elect a few pragmatic Democrats, including a majority in both the House and Senate.

If that doesn’t happen, we can look forward to posturing on both sides that will fool some voters into thinking politicians care, without accomplishing anything likely to help. The Trump administration is pushing a new plan that would allow states to import prescription drugs from Canada, which enforces price controls that make drugs cheaper. Great idea, as long as Canada has no problem diverting drugs meant for Canadians back to America, where many of the drugs come from in the first place. Why doesn’t America just impose its own price controls? Because pharmaceutical companies own Senate Majority Leader Mitch McConnell and many other members of Congress, who won’t let it happen. So Trump is hoping more principled Canadian legislators will help Americans gets cheaper drugs made in America by American companies.

At least you’ll be free of all these worries once you turn 65, and Medicare kicks in. Except Medicare is going to run short of money starting in 2026, and will eventually be able to pay only about 77% of its obligations. So here’s the real health care plan: Don’t get sick until you turn 65, and then, get just 77% as sick as you would have otherwise. Or just move to Canada.

Pros and cons of private, public healthcare

A study by Flinders University found that the rising cost of private health cover and public hospital standards raise concerns among heart patients to obtain the best outcomes.

In one of the few direct comparisons, medical researchers in South Australia have analyzed data from pacemaker and defibrillator implant surgeries in all public and private hospitals in New South Wales and Queensland between 2010 and 2015 to make an assessment of medical safety outcomes, including infection levels and mortality.

Overall the outcomes were quite similar, says lead researcher Flinders cardiologist and electrophysiologist Associate Professor Anand Ganesan, who joined other Flinders University and University of Adelaide researchers in a new article just published in the Royal Australasian College of Physicians Internal Medicine Journal.

“There is growing community interest in the value of private health insurance and, to date, there are few head-to-head studies of the outcomes of care in public and private hospitals to compare the same service with adjustments for differences in patient characteristics,” says Associate Professor Ganesan, a Matthew Flinders Research Fellow and National Heart Foundation Future Leader Fellow.

“We believe our results are of community interest for patients to assess the value and benefit of private health insurance, as well as for policymakers who decide on resource allocations between the public and private healthcare systems.”

He stressed that further “head-to-head” studies are needed across all major medical procedures to provide patients and clinicians in both the public and private system with the most up-to-date safety information.

The population level study of pacemaker complications found few key differences in overall major safety issues, although there were slightly higher infection rates in public hospitals but slightly lower acute mortality rates compared to the private hospital system.

This could be connected to the greater number of older, frail patients relying on private health cover—and greater number of people in the public system—although further studies were needed to explain these differences.

Associate Professor Ganesan says more regular comparative assessments of public versus private hospital care quality are very important, particularly for Australian health consumers.

Australia’s hospitals account for more than 40% of healthcare spending with a cumulative cost exceeding $60 billion per annum. Hospital care in Australia is delivered by a combination of 695 public (or 62,000 beds) and 630 private sector hospitals (33,100 beds).

The research paper, “Complications of cardiac implantable electronic device placement in public and private hospitals” has been published in the Internal Medicine Journal.

Budget watchdog group outlines ‘Medicare for All’ financing options

So, one of my oppositions to the program Medicare for All has been the question as to financing the program. The Committee for a Responsible Federal Budget (CRFB) on Monday released a paper providing its preliminary estimates for various ways to finance “Medicare for All,” as the issue of how to pay for such a health plan has taken center stage in the Democratic presidential primary.

“Policymakers have a number of options available to finance the $30 trillion cost of Medicare for All, but each option would come with its own set of trade-offs,” the budget watchdog group wrote. 

The issue of how to pay for Medicare for All — single-payer health care that eliminates premiums and deductibles — has become a key discussion topic in the Democratic presidential race.

Sen. Elizabeth Warren (D-Mass.), one of the top tier 2020 hopefuls, recently said that she would release a financing plan for her Medicare for All proposal after being criticized by some of her rivals in the primary race for refusing to give a direct answer about whether she’d raise taxes on the middle class to pay for the massive health care overhaul. 

CRFB said most estimates find that implementing Medicare for All would cost the federal government about $30 trillion over 10 years.

“How this cost is financed would have considerable distributional, economic, and policy implications,” the group wrote.

CRFB provided several options that each could raise the revenue needed to pay for Medicare for All. These included a 32 percent payroll tax, a 25 percent surtax on income above the standard-deduction amount, a 42 percent value-added tax, mandatory premiums averaging $7,500 per capita, and more than doubling all individual and corporate tax rates.

The group estimated that Medicare for All could not be fully financed just by raising taxes on the wealthy.

CRFB also estimated that cutting all nonhealth spending by 80 percent, or by more than doubling the national debt, so that it increased to 205 percent of gross domestic product, could finance Medicare for All.

The group said that the financing options it listed could be combined, or that policymakers could reduce the cost of Medicare for All by making it less generous.

“Adopting smaller versions of several policies may prove more viable than adopting any one policy in full,” CRFB wrote. 

CRFB said that most of the financing options it listed would on average be more progressive than current law, but most of the financing options would also shrink the economy.

Out-of-pocket costs for Medicare recipients will rise in the New Year

Dennis Thompson reviewed the future costs of Medicare since the Democratic primary discussion seems to point to Medicare or All. He noted that the standard monthly premium for Medicare Part B would rise $9.10, to $144 a month, the U.S. Centers for Medicare and Medicaid Services (CMS) announced.

The annual deductible for Part B also will increase $13 to $198 per year, CMS said.

Both increases are relatively large compared to 2019, when the Part B premium rose $1.50 a month and the deductible $2 for the year.

“This year there’s an unusual tick up in the Part B premium that could be a real concern for people living on a fixed income,” said Tricia Neuman, director of the Henry J. Kaiser Family Foundation’s Program on Medicare Policy.

The Part B premium increase will affect people enrolled in original Medicare as well as those who are covered under Medicare Advantage, said David Lipschutz, associate director of the Center for Medicare Advocacy.

“One thing I definitely wanted to make clear is that the increase in the Part B premium itself also applies to everyone on Medicare Advantage,” he said. “People on Medicare Advantage have to continue to pay the part B premium.”

Some, but not all, Medicare Advantage plans cover the Part B premium as part of their package, Lipschutz added.

The annual inpatient hospital deductible for Medicare Part A is also increasing to $1,408 a year, up $44. In 2019, the increase was $24.

These cost increases will wipe out much of the 1.6% cost-of-living (COLA) increase for Social Security benefits in 2020, CBS News reported. The COLA amounts to about $24 extra a month for the average retiree.

Medicare Part A covers inpatient hospital stays, nursing facility care and some home health care services. Part B covers doctor visits, outpatient hospital treatment, durable medical equipment, and certain home health care and medical services not covered by Part A.

Unless Congress acts, the prescription benefit in Medicare Part D also will start drawing a lot more money out of the pockets of seniors taking pricey drugs, the experts added.

The Affordable Care Act (ACA) included a provision that limited how much a senior with Part D would pay out-of-pocket after reaching a “catastrophic coverage” threshold, Neuman and Lipschutz said.

Once they reach that threshold, seniors pay 5% of their prescription costs. Until then, they pay 25% of the costs for brand-name drugs and 37% of generic drug costs.

But that ACA provision expires this year. When that happens, the catastrophic coverage threshold will jump $1,250, the Kaiser Family Foundation estimates. People will have to pay $6,350 out-of-pocket before reaching the threshold.

“There will be a jump up in the threshold, which means that people with high drug spending will have to pay more before they can get this extra help,” Neuman said.

Both the Senate and the House of Representatives have bills in the works that could address this Part D increase, but it’s hard to predict whether Congress will be able to cooperate on a solution, Neuman and Lipschutz said.

“No matter what your allegiances are, everyone agrees something should be done about the high cost of prescription drugs,” Lipschutz said.

It’s not all bad news, however.

Folks with Medicare Advantage are expected to pay lower premiums, even with the increase in Part B, according to the CMS.

On average, Medicare Advantage premiums are expected be at their lowest in the past 13 years, and 23% lower than in 2018, the CMS said.

Medicare Advantage enrollees also will have more plans to choose from. The Kaiser Family Foundation estimates that the average beneficiary will have access to 28 plans, compared with a low of 18 in 2014.

Original Medicare is the traditional fee-for-service program offered by the federal government, while Medicare Advantage plans are an alternative provided through private insurance companies.

Medicare beneficiaries spent an estimated $5,460 out-of-pocket for health care in 2016, according to the Kaiser Family Foundation. About 58% went to medical and long-term care services, with the remainder spent on premiums for Medicare and supplemental insurance.

So, the ultimate question is :

Equal health care for all: A philosopher’s answer to a political question

The University of Pennsylvania staff asked the question-Should access to health care, especially in life-threatening situations, depend on whether you can afford it? Absolutely not, says Robert C. Hughes, Wharton professor of legal studies and business ethics, who compared health care systems in the U.K., Canada, and Australia. He writes about this question and other issues in a recent paper titled, “Egalitarian Provision of Necessary Medical Treatment.”

Hughes identifies two key features of an egalitarian health care system. First, he argues, it would protect people’s liberty to ensure that access to money does not decide if people get the health care they need. Second, it would promote stability and encourage people to be law abiding. “The central finding of [my research] is that it’s morally necessary to make sure that people’s finances don’t affect their ability to get truly medically necessary treatment,” he says.

Hughes favors universal health care coverage in the U.S. Further, in order to ensure that everybody has access to the medical care they need, he says one option is to eliminate private health insurance for coverage provided under “Medicare for All,” the solution that Democratic presidential candidates Elizabeth Warren and Bernie Sanders have proposed. Hughes explores what legislators, the pharmaceutical industry, and other health care providers could do to ensure a fair health care system where private parties don’t get to decide who is eligible for what treatments.

I mentioned my embarrassment and disappointment in our political system we all have to give thanks for all the good things in our lives. As Christmas approaches we all should reflect on the good in our lives and enjoy the Holiday including family and friends. Merry Christmas, Happy Hanukkah, and Happy Kwanzaa! And I hope Santa leaves coal in all the stockings of our politicians who can’t even do the job that we the voters asked them to do when we voted them in. Oh, how you are making a mockery of the system in the games that you all are playing!

I have been avoiding the discussion regarding single payer system, what it is, how it would work and what are the consequences, etc.? More to come!