Today's News

About the public’s health:

Here’s How Trump’s Shutdown Fight With Democrats Could Play Out: What happens to federal healthcare programs if a budget agreement fails? Nothing. Six government departments, including HHS are funded through September 30, 2019, i.e., the end of the next fiscal year.

Read about what will be affected by a government shutdown

Sustainability of Blood Pressure Reduction in Black Barbershops: Sometimes the best solutions are the most obvious and not exorbitantly costly. Researchers from Cedars-Sinai Medical Center placed pharmacists in 52 barber shops in LA County that cater primarily to African American men. Coordinating care with their primary care physicians, the pharmacists were able to significantly and sustainably reduce blood pressure of hypertensive participants compared with a control group.

About hospitals:

Ratings agencies: No immediate impact on hospitals' credit from Texas ruling: The debt-rating agencies are not changing their evaluations based on Judge O’Connor’s ruling on the ACA (see Sunday’s posting). One rater speculated about the financial repercussions from an increase in the uninsured because of removal of Medicaid expansion.
Medicaid is NOT part of the discussion. The 2012 Supreme Court decision already clarified this issue- Medicaid expansion is voluntary. Further, Medicaid expansion has nothing to do with the individual mandate.

Read more about this issue

About pharma:

FDA Approves Celltrion and Teva's Trastuzumab Biosimilar, Herzuma: This post is not a product endorsement but I use the occasion to act as a reminder that many very expensive biotech drugs are ending their patent lives and face generic competition. This one is a variant of Herceptin, used to treat HER2-positive breast cancer.

Read the announcement

About health insurance:

Taking Surprise Medical Bills to Court: How much does a patient have to pay for care they receive for non-elective services from providers outside their insurance’s network? Hospitals claim that patients owe whatever they are charged, less any insurance company payments. Now some lawyers are using principles from contract law to claim that patients should not have to pay these inflated charges. “…contract law rests on the centuries-old concept of ‘mutual assent,’ in which both sides agree to a price before services are rendered… Thus, many states require, and consumers expect, written estimates for a range of services before the work is done — whether by mechanics and plumbers or lawyers and financial planners.”
Since insurance regulations are state-specific, this tactic for addressing “surprise medical bills” will need to be used in each locality. Of course, laws can be passed in each state to address this issue.
Read more about this novel approach

8 Medicare and Medicaid reforms that would have the biggest impact on federal spending: This article summarizes the Congressional Budget Office’s suggestions for reducing federal spending by changes to Medicare and Medicaid. Among these changes are capping Medicaid spending and reducing matching amounts, and increasing Medicare eligibility to age 67. None of the suggestions are new, and none are probably politically feasible given each of their stakeholders’ interests. However, it is still informative to see how much could be saved with some bold bipartisan action.

Read the analysis

Gallup: 29 percent of Americans delay healthcare because of cost: Out of pocket healthcare costs still present problems for patients- even if they have health insurance. According to this report, “Gallup's annual Health and Healthcare survey found 29 percent postponed treatment for the cost. It said more than half of them reported a serious or somewhat serious medical illness or condition -- a figure equivalent to 19 percent of all U.S. adults.” How much should patients pay to prevent unnecessary utilization and defray premium costs while not impeding access to necessary care? THAT is the question most plaguing insurers and public policy experts. Should we do what France does and link coinsurance with severity of diagnosis? (For example, patients will pay proportionately more for seeing a doctor for a “cold” than a heart attack.) The answer is as much a social solution as a financial one.

Read the announcement

Health insurance on demand? Some are betting on it: I am still trying to understand this article. Here’s how the concept is described: “People with health insurance often pay for coverage they never use… A startup wants to shake that up. It’s a radical idea: On-demand insurance that lets customers buy some of their coverage only if and when they need it, similar to how TV viewers might rent a new release from Amazon instead of paying every month for a pricey cable package they rarely use… Here’s how it works. Under Bind’s [the name of the product] plan, customers pay a base monthly premium that can be as much as 40 percent cheaper than other options their employer offers, the company says.
That covers most care, like doctor visits, hospital stays, maternity care, cancer treatment and prescriptions.
A patient can then buy additional coverage for some procedures that aren’t urgent like a knee surgery or hip replacement. In these cases, the patient has time to plan for the care and look at different options for who performs it.
The additional coverage comes with an extra premium and possibly a copayment, depending on the care provider and what is being purchased. In these cases, patients might get stuck paying more than $1,000 in additional costs.”

My first comment is that it is insurance, not pay per view. Insurance’s purpose is to indemnify against catastrophic loss not provide on-demand entertainment. Second, how will they control for moral hazard- the principle that behavior changes in the presence of insurance coverage?

Read this article and make sense of it- if you can