Why are so few people getting the latest Covid-19 vaccine?

“Experts say the public’s disinterest in the latest Covid shots is likely a combination of poor messaging from authorities, a diminishing fear about a virus that three years ago was wholly unknown, and the political polarization of the pandemic itself. But whatever the reasons, that vaccine ambivalence still poses a health threat.
Elderly people and very young infants continue to have a higher chance than the rest of the population that they will be hospitalized with Covid-19. Vaccination rates have fallen off for the former group, who are also most likely to die from an infection, and they were never strong to begin with for the latter”

“The known unknowns for the future, which could spur another round of investment and interest in updated Covid-19 vaccines, are biological. The virus has been evolving and will continue to evolve and could, in theory, reach a point where the current vaccines are ineffectual.

The other question mark is inside of us. The reason many people still enjoy protection from serious illness is because our body’s T-cells are familiar with the virus and can activate when they detect it. They may not be able to stop an infection entirely (that is the role of antibodies, which are quicker to fade) but they can stamp out the virus before a person becomes too sick.

What we don’t know today is how long our T cells’ memory will last, and how durable that immunity really is. The only way to find out is for more time to pass.”

https://www.vox.com/policy/2023/11/17/23964294/covid-19-vaccine-2023-us-vaccination-rates

Patients don’t know how to navigate the US health system — and it’s costing them

“Research has shown that people will skip necessary care if they have even a small cost to pay, and recent surveys find one in three Americans say they have postponed medical treatment in the last year due to the cost.”

“The Perry Undem survey, which polled nearly 2,700 Americans on behalf of the American Cancer Society’s Cancer Action Network, the Leukemia and Lymphoma Society, and RIP Medical Debt, also detected widespread struggles to afford health care. About 7 in 10 people say they have received a medical bill that they could not afford, it found, and more than 60 percent of Americans said they had made some kind of sacrifice — delaying care, skipping appointments, changing the food they buy at the grocery store, etc. — in order to afford health care in the past two years.”

“About 40 percent of people said they were always or frequently unsure how much their medical services would cost after they received care, according to the Perry Undem survey; another 30 percent said they were uncertain about the costs at least some of the time. Nearly two-thirds of US patients said they were at least sometimes unsure how much their insurance plan would cover after being treated.”

“About 6 in 10 Americans said they had experienced a problem using their health insurance in the past year, according to KFF.”

https://www.vox.com/policy/2023/11/3/23943349/health-care-costs-medical-bills-debt-relief-forgiveness-insurance

The prices hospitals post online can be wildly different than what they tell patients over the phone

” The new study..compared the prices hospitals posted online (as required under new federal regulations) with the prices obtained in phone calls conducted by the team posing as potential patients.

They contacted 60 hospitals across the country, a mix of top-ranked facilities, hospitals that primarily serve low-income people, and the other hospitals in between. They asked about two procedures for which comparison shopping is more common: vaginal childbirth and a brain MRI.”

“It was rare for the advertised price on the web to be the same as the price quoted over the phone. Less than 20 percent of hospitals provided the same price through an online price estimator as they did when someone spoke to a member of the billing department. In many cases, the disparity was significant, with more than a 50 percent price difference depending on whether you checked on a website or called for a quote.
And in a handful of cases, the price more than doubled depending on how you asked. At two hospitals, MRIs were listed online at $2,000, but “patients” were given a price of more than $5,000 when they called. Five hospitals offered a price of $10,000 for vaginal childbirth over the phone, but the price posted online were twice that much.

There didn’t seem to be a clear pattern of which quotes were higher. Sometimes they were higher over the phone, sometimes higher on the website.

The researchers said they took pains to make sure they were getting apples-to-apples comparisons, going so far as to give specific billing codes during their scripted calls with hospital staff. It didn’t matter.”

“Research had already found prices for the same services vary wildly at different hospitals. The top-line findings of this new study reveal that it can be difficult to even determine what the price for a given service is at a given hospital. That is a problem both for the 10 percent of the US population that is uninsured as well as people enrolled in high-deductible health plans, which are becoming more common.”

“the researchers made one other note in their study: They found poor correlation between brain MRI and vaginal childbirth prices within an individual hospital. In other words, some facilities would have high MRI prices compared to others but low prices for delivering babies — with no discernible economic reason for that disparity. It’s chaos.”

https://www.vox.com/policy/23892276/us-hospital-prices-transparency-study-mark-cuban

Fake Sudafed Is Bullshit, Just As You Suspected

“Two decades ago, it became clear that Congress was intent on trying to curtail illicit methamphetamine production by restricting access to pseudoephedrine, a meth precursor that was also widely used as a decongestant in cold and allergy remedies such as Sudafed. Pfizer, the manufacturer of Sudafed products, responded by announcing that it would start selling alternatives containing a different active ingredient: phenylephrine.”

“The main problem with phenylephrine: When taken orally, it is so thoroughly metabolized in the gut that almost none of it ends up in the bloodstream. “The new data appear compelling that the monographed dosage of oral [phenylephrine] results in no meaningful systemic exposure or evidence of efficacy,” says an FDA briefing document that was presented to the advisory committee. “Furthermore, the review suggests that higher doses…have also not shown efficacy. These findings are supported by in vitro and in vivo clinical pharmacology data showing that orally administered phenylephrine undergoes high first-pass metabolism resulting in less than 1% bioavailability.”

Legal restrictions on pseudoephedrine sales, in short, gave us reformulated products, including pseudo-Sudafed, that not only do not work as well but apparently do not work at all”

“Legal restrictions on pseudoephedrine, by contrast, took it off the shelves and put it behind the pharmacy counter, whence it can be retrieved only under certain conditions.”

“Restrictions on pseudoephedrine did affect the illicit methamphetamine trade, primarily by shifting production from small-scale U.S. operations toward large-scale Mexican traffickers. But by no means did that crimp the supply.”

https://reason.com/2023/09/13/fake-sudafed-is-bullshit-just-as-you-suspected/

The Real Reason Drugs Cost So Much — and Do Too Little

“Until 2003, Medicare covered most hospital and doctor visits for the elderly, but it did not cover the ever-growing costs of prescription medications. Former President George W. Bush changed that when he signed a law adding prescription drug coverage to Medicare.
But there was a catch.

At drug companies’ behest, the Republican-controlled Congress banned Medicare from using its market power to drive down drug prices. The prohibition was controversial at the time — Nancy Pelosi, then the House Minority Leader, called it “unconscionable.” Critics saw the prohibition as the government’s abandonment of the single most effective tool for restraining drug costs.

In the years since, the prices for brand-name prescription drugs have skyrocketed, and the prohibition on negotiation has become even more controversial. Higher prices mean larger co-payments for drugs for some seniors, many of whom live on fixed incomes. It’s also a major budgetary problem: From 2018 to 2021, Medicare spending on the 10 top-selling drugs jumped from $22 billion to $48 billion, far outpacing the program’s overall cost growth over the same period.

That’s why, in last year’s Inflation Reduction Act, President Joe Biden and congressional Democrats partly undid the prohibition. Under the law, Medicare will pay a much-reduced price for drugs that consume a disproportionate share of Medicare spending, ultimately saving an estimated $100 billion over the next ten years.”

“Although the Inflation Reduction Act marks the most substantial change in how we pay for drugs in two decades, it doesn’t change the fact that drug companies will still be rewarded for bringing a drug to market and selling as much of it as they can — whether or not the drug works very well.

Medicare could pave the way toward smarter drug development by paying more for more effective drugs and less for drugs that are less effective. That would send the right signals about where drug companies should target their research investments. The Inflation Reduction Act isn’t that law. We’ll spend less on prescription drugs because of it, and that’s all to the good, but we won’t be spending any smarter.”

“Some drugs are (literally) worth their weight in gold. Think of Sovaldi and Harvoni, which were approved a decade ago and can cure Hepatitis C, a deadly viral disease that once afflicted between 3 and 5 million Americans. Paying a lot for cures encourages drug companies to invest in developing drugs with curative potential.

But most drugs aren’t cures. Drug companies generally earn more, in fact, on drugs that patients take over an extended period. That helps explain why fully one quarter of all drug approvals are for cancer drugs. They’re really profitable, even though they often don’t work very well.”

“How we pay for drugs, in short, sends the wrong signals to the market about the kind of innovation we value. The good news is we can fix that. As law professor Rachel Sachs has argued, Medicare and Medicaid (and to some extent private insurers as well) are required by law to cover all FDA-approved drugs, whatever their value to human health. That linkage can be severed. We could give CMS the authority not only to drive down the prices of the most expensive drugs, as the IRA does, but also give it the power to pay less for, or even exclude coverage for, drugs of marginal efficacy.

Connecting payment to value would be complicated, and there’s no perfect way to do it. It would also be controversial: Paying less for some novel therapies would likely restrict access to therapies that some patients desperately want. But we’d send much smarter signals to drug manufacturers about where to target their investment dollars. And the benefits of better-targeted innovation would accumulate over time, vastly improving human health in the long run.

The IRA was meant to save the taxpayers’ money, not to improve their health. That was worth doing. But the next reform to payment policy ought to aim higher.”

https://www.politico.com/news/magazine/2023/08/27/medicare-drug-price-value-00111346

EU capitals propose Chips Act for medicines

“The EU capitals point out that 40 percent of all pharmaceutical ingredients globally are sourced from China, and that production for many of these products is concentrated in just a handful of manufacturing sites. “As a result, Europe (and the world) depend on a few manufacturers for a large bulk of their medicines supply,” notes the paper.”

Millions of people are about to get kicked off Medicaid

“Perhaps the greatest success of the American health care system these last few benighted years is this surprising fact: The uninsured rate has reached a historic low of about 8 percent.
That’s thanks in part to the pandemic — or, more precisely, the slew of emergency provisions that the government enacted in response to the Covid crisis.

One policy was likely the single largest factor. Over the past three years, under an emergency pandemic measure, states have stopped double-checking if people who are enrolled in Medicaid are still eligible for its coverage. If you were enrolled in Medicaid in March 2020, or if you became eligible at any point during the pandemic, you have remained eligible the entire time no matter what, even if your income later went up.

But in April, that will end — states will be re-checking every Medicaid enrollee’s eligibility, an enormous administrative undertaking that will put health insurance coverage for millions of Americans at risk.

The Biden administration estimates upward of 15 million people — one-sixth of the roughly 90 million Americans currently receiving Medicaid benefits — could lose coverage, a finding that independent analysts pretty much agree with. Those are coverage losses tantamount to a major economic downturn: By comparison, from 2007 to 2009, amid the worst economic downturn of most Americans’ lifetimes, an estimated 9 million Americans lost their insurance.”