“On abortion, on health care for transgender people, even on mental health care, the candidates were comfortable flexing governmental authority to dictate the terms of medical treatment.
But when it comes to using that same authority to protect people during a global pandemic or providing health coverage to people with low incomes, they don’t want the government getting involved.”
“in hundreds of communities, the doctor shortage isn’t a distant concern; it’s happening. America doesn’t have enough physicians practicing in certain parts of the country and in critical specialties. There are not enough primary care doctors in small towns and poor city neighborhoods alike. There are not enough obstetricians in rural practices. There are not enough psychiatrists almost anywhere.
The vast majority of rural America, 80 percent, is considered by the federal government to be medically underserved. About 20 percent of the US population lives in rural communities, but only 10 percent of doctors practice there.
These localized shortages — call them doctor deserts — are not inevitable. They are, in part, the result of policy choices. Doctors tend to spend their careers near the place they spent their residencies, several additional years of training they undergo after medical school. These residencies are paid for by the federal government, through Medicare, and virtually all are at big, academic medical centers, rather than in the places where people most need care right now.
If the US wants more doctors practicing in small towns, then it needs to put residencies there.”
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“The answer to “does America have enough doctors overall” is complicated and arguably somewhat unclear. The US has significantly fewer doctors per capita than some other wealthy nations, such as Germany and Sweden. But US numbers are actually about the same as a number of other developed countries — Canada, the United Kingdom, Japan, France — that still generally rank better on measures of health care quality than the US does.
Groups like the Association of American Medical Colleges continue to project long-term workforce shortages. Demographic trends, including an aging patient population and boomer-generation doctors reaching retirement age, may lead to more overall pressure on the US health system’s capacity.
But the more acute shortages are already happening in individual communities and specialties.”
“A federal court has permanently struck down Arkansas’ ban on gender transition procedures for minors. The law violated the rights of Arkansas children and their parents, as well as the rights of health care providers, held the court, finding that the ban went against the Constitution’s Equal Protection Clause, Due Process Clause, and First Amendment.”
“Later this year, the federal government is supposed to start a serious attempt to rein in drug prices: For the first time, Medicare will negotiate with pharmaceutical companies over the prices it’s willing to pay for a short list of drugs. It’s a long-awaited change that is supposed to save the government and patients billions of dollars over time.
But the drug industry is now launching a legal fight aimed at stopping Medicare’s negotiations over prescription drug prices before they begin. The stakes are higher than just a drug price reform: The case could set an important precedent for the government’s authority to try to constrain health care prices.”
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“The Merck lawsuit focuses on the Constitution’s takings (or compensation) clause in the Fifth Amendment, which protects private owners from having property taken without “just compensation” by the government. It also raises First Amendment claims centered on the law’s requirements that drugmakers not disclose information they receive from the government as part of the negotiations. The Chamber of Commerce’s case rests on a constitutional right to due process, arguing that, because the Medicare negotiations are exempt from review by the courts under the IRA, drugmakers are being denied due process.
Taken together, the lawsuits give any judges predisposed to side with private industry over the federal government a few options for a legal foundation upon which to base a decision in pharma’s favor.
A number of legal experts say they are skeptical of these arguments. Merck’s takings clause case turns on defining a patent — an issuance from the government — as private property subject to the just compensation clause, said Robin Feldman, a law professor at UCSF, a difficult assertion. She also said the premise present in both cases — that the federal government as a health care purchaser through Medicare can’t say no to the companies it purchases drugs from and can’t dictate prices as the consumer — is “problematic.”
“It can’t be that the government as a buyer has to pay whatever a seller wants to charge,” she said. “That the government could be forced to spend itself into bankruptcy.”
Regarding the chamber’s due process claim, several legal experts have pointed out that Medicare’s various contracts with health care providers are already often generally exempted from judicial review. It is understood that this is necessary to allow the program to function; the government, as the administrator of the program, needs that authority without each of its decisions being subject to litigation.”
“Starting your own medical practice is hard. In some states, it’s almost impossible due to the monopoly power of politically connected hospital associations. Independent doctors and patients tried for 10 years in South Carolina before finally scoring a victory last month.
On May 16, South Carolina Gov. Henry McMaster signed legislation to repeal most of the state’s medical certificate of need (CON) laws. A CON is a government permission slip that health care providers must obtain before they can launch or expand services. Spending money to provide safe, affordable care is illegal without this piece of paper.
Big hospitals love the red tape. Instead of competing with would-be rivals on a level playing field, they can claim their turf and defend it using government interference on their behalf. Many states even allow established providers to object to rival CON applications, giving them something like veto power.
If McDonald’s had the same authority, local franchisees could block mom-and-pop burger joints from opening nearby. The Home Depot could block family hardware stores. And LA Fitness could block independent gyms.”
“A federal judge delivered a stinging rebuke to Florida Gov. Ron DeSantis and the Republican-controlled Legislature over rules and a new state law that banned minors from receiving “puberty blockers” and other types of gender-affirming care.
U.S. District Judge Robert Hinkle on Tuesday blocked the state from applying the ban to three minors whose parents are part of an ongoing lawsuit, saying they would “suffer irreparable harm” if they were not allowed to continue access to hormones and other types of treatment.”
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“The American Academy of Pediatrics and the American Medical Association support gender-affirming care for adults and adolescents. But medical experts said gender-affirming care for children rarely, if ever, includes surgery. Instead, doctors are more likely to recommend counseling, social transitioning and hormone replacement therapy.”
“Pharmacy benefit managers are companies that, behind the scenes, determine what patients have to pay for medications. They manage insurance benefits for prescription drugs, dictating which drugs are covered by insurers and what costs patients will face when they fill their prescriptions.
To do that, they negotiate discounts, or rebates, with drug manufacturers and afford privileged status to the companies that give them the best deals.
And over the past few decades, as the prescription drug market has evolved and become more lucrative, so have PBMs. They run their own mail-order and specialty pharmacies. More recently, they have begun merging with health insurers, creating behemoth companies with the power to determine where and how billions of dollars are spent within the US health system.
Pharmacy benefit managers have become known as the mysterious middlemen of the pharma trade — and as a useful scapegoat for drug companies seeking to deflect blame from their own pricing practices.
Now the Senate, as part of forthcoming prescription drug legislation, appears poised to impose new rules on them. The committee overseeing health care debated last week a slew of measures requiring PBMs to be more transparent about their business and cracking down on some of their moneymaking practices.”
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“Experts generally agree that these companies play a role in driving up drug costs for some US patients, even as they negotiate discounts with drugmakers that benefit others, and that the amount of secrecy about their financial arrangements warrants scrutiny.
But reforms to the PBM industry aren’t a cure-all for making drugs more affordable: Sanders said the PBM measures being considered in the Senate would not meaningfully lower the cost of medicine for most people, even if they would bring more accountability and transparency to the sector.”
“Hundreds of thousands of Americans lost their Medicaid benefits in April, as emergency pandemic provisions that kept people enrolled over the past few years began to end. The coverage losses are going to only grow.
In Florida, nearly 250,000 people lost Medicaid coverage in April, as states began a process to check whether everyone currently enrolled in Medicaid still meets the eligibility criteria. About 73,000 people were also deemed ineligible in Arkansas. Another 53,000 had their coverage terminated in Indiana and 40,000 were removed from Medicaid in Arizona.
Policy experts and advocates warned before the eligibility checks began that people who are still eligible for Medicaid could lose their insurance due to administrative problems, such as not receiving mail from the state or not returning documentation to confirm they are still eligible. Now the early evidence suggests that’s exactly what is happening.”