” In most rich countries, people don’t have to worry about sifting through a dozen different health plans — and they don’t live in fear of losing their health care after losing a job, and they receive more affordable, higher-quality care than Americans do. The paradox of the world’s wealthiest nation having one of the weakest health systems among developed nations has long been a vexing policy problem — without an easy solution.”
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“American health insurance, as we think of it today, started to take shape in the 1920s, as the medical profession was being standardized and modern hospitals were being built. Some employers started offering payments for hospital-based services as a perk for their workers. Companies had large groups of employees, some in good health and some in bad, to spread the risk and make the finances work much like modern-day insurance does.
This system soon became entrenched enough that President Franklin D. Roosevelt bypassed plans to include national health insurance as part of the New Deal. Then came World War II, along with government-mandated wage controls for employees in the private sector to keep the war machine moving. Barred from offering raises to motivate their workers, companies started pumping up their health benefits — and the government agreed to exempt those benefits both from wage controls and taxes.
By the 1950s, employer-sponsored insurance had become popular among those who received it and progressive labor unions urged the government to make the tax exemption permanent. Congress agreed, enshrining in 1954 the subsidy for company health plans in federal law. Doctors and hospitals, whose industry was growing into the leviathan that it is today, became accustomed to working with private insurers rather than with the government directly.
Today, these work-based health plans still cover roughly half of all Americans.”
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“The problem with the employer-based system was it left out too many people because they didn’t work or didn’t have a job that offered health insurance. To start filling in the gaps, in 1965, Congress created Medicare and Medicaid to cover two of the biggest groups of people who lacked coverage: seniors and people in poverty.
After that expansion, we had a system that covered most Americans — which made it hard to change, because people feared losing what they had.
Those fears, supported by the medical industry’s campaign against “socialized medicine,” doomed the health care overhauls proposed by presidents Richard Nixon and Bill Clinton that would have consolidated most Americans into a national insurance scheme. Certain tendencies in American culture — consumerism and trust in private markets — made it easier to persuade the public that they’d lose under a government-run health plan.
Meanwhile, the US health care system still had obvious holes. Rather than threaten the status quo, policymakers added new patches.
CHIP was approved in the 1990s, covering children of working-class families whose incomes were not low enough to get Medicaid. (Their parents, however, were often left without any coverage at all.) The 2010 Affordable Care Act, also known as Obamacare, was designed to fill that gap by covering people who didn’t receive health insurance through their jobs but didn’t qualify for Medicaid.
Yet even after a half-dozen rounds of incremental health reform over five decades, about one in 12 people in the US lack health coverage and Americans are much more likely than people in other developed nations to say they skip medical care because of the cost.”
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“Other countries built their health care systems more deliberately.
After World War II, the United Kingdom sought to extend medical security to all its citizens, creating the National Health Service; many other European governments followed suit.
A half-century later, another wealthy island nation made the same choice. Taiwan, building a modern democracy after decades of authoritarian rule, scrapped a fractured, inequitable health system to set up a national insurance program that would cover everyone. It was a proclamation of solidarity after a tumultuous military dictatorship had come to an end.
Not all countries have opted for a single government program, but their systems are still simpler than America’s and cover the entire population. In 2006, the Netherlands opted to trade a dysfunctional two-tiered insurance system for a universal program that relied on private coverage but was nevertheless designed to insure everybody. The uninsured rate there today is less than 1 percent (some people opt out).
But the US? We’ve never paused to build a fairer, simpler, uniform health system.”
“RFK Jr. is not a scientifically literate, fact-based, competent, experienced, or measured person. He is wrong about HIV/AIDS; linking vaccines to autism; and the purported danger of thimerosal. On some things, he is correct: The COVID regime and the “noble lies”—which are still lies!—spread to the American public by our purported health authorities are despicable. We still need accountability. Considering which endocrine disruptors might exist in our environment and what unintended consequences might stem from SSRIs are valid research questions to which RFK Jr. has brought attention. Also, raw milk is great.
But in order to actually administer these programs, you need more than the ability to just ask questions and spread theories about what could be happening. You need some amount of competence. Perhaps RFK Jr. can take a pickax to the government waste that stems from certain companies being in bed with their overseers, but don’t count on it”
“The NIH is the world’s largest public funder of biomedical and public health research, with a budget of $47 billion, most of which is used to support research at universities and academic medical centers. The agency has long been criticized for being way too risk-averse when it comes to choosing which research projects to fund.”
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“Being informed by the best information is certainly the right goal. But RFK Jr.’s long history of anti-vaccination agitation suggests he is not a source of the best information for the safety and efficacy of modern vaccines. This includes false assertions that vaccines cause autism; that they are not tested using placebo-controlled trials; and, contradicting the previous claim, that COVID-19 vaccines killed more people than did a placebo.
Again, the CDC needs fixing, but RFK Jr.’s skepticism about the safety and efficacy of modern vaccines would further undermine what should be the CDC’s main focus: the prevention of the spread of dangerous infectious diseases.”
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“Four years into the post-COVID era, most research has found that ivermectin and hydroxychloroquine provide no treatment benefit for the infected. In April, the Journal of Infection published a report about a randomized controlled trial that concluded, “Ivermectin for COVID-19 is unlikely to provide clinically meaningful improvement in recovery, hospital admissions, or longer-term outcomes.””
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“Giving drug development and infectious disease an eight-year break seems inadvisable. After all, the death rate for cancer has continued to drop from 2016 to today, partially as a result of lower incidence stemming from lifestyle changes, but also because of better and more widely available pharmaceutical treatments. Recent calculations show the value of medicines to patients far outweigh the profits the drug companies rake in. And, as ever, infectious diseases lurk in the background waiting for us to lower our guards or seeking just the right mutation to enable them to jump into the human population.”
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“RFK Jr.’s solution to stemming the tide of chronic illnesses is better diets and physical fitness. History suggests government interventions will have little effect on either. After all, the federal government has been periodically issuing dietary guidelines since 1979 and promoting physical fitness since 1956. The Lancet authors agree with RFK Jr.’s aspirations but suggest in the meantime that “regulations need to be put in place to eliminate barriers to accessing new-generation obesity clinical treatments, ensuring the availability and affordability of these options to the broader population.””
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“The FDA needs streamlining to speed biomedical innovation, the NIH needs greater risk-taking in research, and the CDC needs to be laser-focused on preventing infectious diseases. None of these appear to be high on the agenda of possible incoming secretary of health and human services.”
“An estimated 12 people die every day while waiting for a kidney transplant. At least some of those deaths are preventable, and monopoly government contractors shoulder most of the blame.
“Monopolies don’t work and government-funded monopolies are even worse,” says Jennifer Erickson, a former Obama White House staffer who now works as a senior fellow at the Federation of American Scientists.”
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” All told, more than 17,000 kidneys (as well as thousands of other organs) are going to waste each year instead of finding their way to dialysis patients who need a replacement. That’s a tremendous opportunity cost. And because there’s no competition between OPOs, if you’re unlucky enough to need an organ and you live in an area where there’s a poor-performing OPO, you might never get one.”
“By compiling and analyzing a huge amount of government data, environmental economist Eyal Frank, the study’s sole author, discovered that in regions with outbreaks of white nose syndrome, a wildlife disease that kills bats, the rate of infant mortality increased by nearly 8 percent relative to areas without the disease.
There’s a clear reason for this, according to the paper. Most North American bats eat insects, including pests like moths that damage crops. Without bats flying about, farmers spray more insecticides on their fields, the study shows, and exposure to insecticides is known to harm the health of newborns.”
“This updated version of the vaccine does not target the now-dominant KP.3.1.1 strain, and instead focuses on that variant’s immediate predecessors, including a strain known as KP.2. That strain was more prevalent when work began on the new formulation; long development times make it difficult for drug makers to pivot to target each new variant.
“Evolution doesn’t stop and let us catch up,” Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, told Vox. “Evolution is always moving, and there’s some unpredictability of where the virus may go.”
Still, scientists believe the new drug will provide the public with at least some increased measure of protection against severe sickness, including against the latest variants. And it could offer some protection against infection since it targets the close relatives of the current dominant variant.”
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“The CDC recommends that everyone age 6 months and up get one dose of the new vaccine, regardless of their previous vaccination status, and has stressed the importance of high-risk individuals keeping up with the latest vaccines. Other countries like Canada and the UK recommend that only those with high risk of hospitalization, serious illness, or death from the virus get inoculated.”
“People are already losing trust in vaccines: Only 40 percent of Americans believe it is extremely important for parents to get their children vaccinated, down from 64 percent in 2001. It is perhaps the most worrying trend in public health right now.
We have the tools to stop many infectious diseases — if we take advantage of them. Trump’s words are making it less likely that people will.”
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“Meanwhile, measles cases in the US matched their 2023 total over just the first few months of 2024. A local outbreak in Oregon has seen nearly two dozen cases since June; at least two people have been hospitalized.
A disease that was once effectively eradicated in the US — and which school mandates helped to stamp out — is mounting a comeback.
Donald Trump could choose to wield his tremendous influence to try to restore people’s faith in vital public health measures. He did it, if half-heartedly, during the pandemic and it had the desired effect. Instead, he’s stoking doubts about the value of vaccines, and courting the dangers vaccine hesitancy brings.”
“Many other developed countries with established pharmaceutical industries such as Japan, Canada, and the UK have implemented or are working to roll out their own incentives to spur antibiotic development. The Pasteur Act dwarfs these. This could potentially drive pharmaceutical companies to flock to the US market to make drugs deemed important there and not in other places.
“The size of the Pasteur Act is going to be so large that it ultimately draws developers to only focusing on the United States, only developing the drug so that it can be used appropriately in the United States, and only registering the drug in the United States, because that’s ultimately going to be sufficient revenue and incentive for what otherwise is not a very profitable market,” explained Rohit Malpani, a senior policy advisor at the Global Antibiotic Research and Development Partnership, or GARDP.
Cirz added that with a steady influx of Pasteur Act funds, pharmaceutical companies may be less interested in investing additional funds to figure out ways to manufacture their antibiotics more cheaply. Usually companies would continue investing so they can increase their profit margins by lowering manufacturing costs, but if profit margins are set by the US government, then there’s less incentive to make an approved drug cheaper, when it can divert attention to making even more drugs. Without that innovation for affordable production, the act may unintentionally prohibit developing countries such as India from being able to independently manufacture the drug.
Finally, while Americans with federal health insurance plans are guaranteed access to antimicrobials that receive support from the act, the proposed legislation does not provide any stipulations or guidance for ensuring global access to these drugs. Pharmaceutical companies are left to make decisions regarding pricing, manufacturing, and distribution of whatever antibiotics might be funded by the program, argued Ava Alkon, global health advocacy and policy adviser at Doctors Without Borders.
“What the act doesn’t do is attach any meaningful conditions to facilitate affordable access to people outside of those federal programs, and certainly not outside of the US,” said Alkon.
“From our years of work on access issues around the world, this generally results in products being sold to the highest bidder and being inaccessible in many contexts where they’re needed,” she said.”
“The US does have significantly fewer doctors per capita than some other wealthy nations, such as Germany and Sweden. But America’s physician-to-patient ratio is actually about the same as other developed countries — Canada, the United Kingdom, Japan, France — that still generally rank better on measures of health care quality than the US does. So aggregate numbers alone are not enough to explain the access problems that patients face, and experts disagree over whether we need to boost the overall supply of providers in the short term.
The bigger problem is misallocation in the US physician workforce, Coffman told me last year. We know that we don’t have enough doctors in certain important specialties: primary care, obstetrics, and psychiatry, for example. We also don’t have nearly enough providers in a broad swath of specialties practicing in rural and other low-income communities. Between 2010 and 2017, while large urban counties added 10 doctors per 100,000 people on average, rural counties lost three. As a result, metro regions had 125 doctors per 100,00 patients, while rural areas had 60.
America is littered with doctor deserts, areas where there are not enough primary care providers, much less specialists or hospital-level services. The federal government estimates that 80 percent of rural Americans live in medically underserved communities.
In the long term, the US will undoubtedly need more doctors in rural and urban areas alike. Groups like the Association of American Medical Colleges continue to project long-term workforce shortages, as boomer-generation doctors reach retirement age and the population of seniors requiring medical care swells.”