“”who makes our public health policy. The judiciary – a 35-year-old unelected judge – or the CDC and the Department of Health and Human Services?””
“The Biden administration is betting that Covid infections for most people are now so mild that it’s safe for much of the country to go maskless, a strategy helping the White House avoid political backlash against stricter safety requirements.
But that strategy comes with the risk that millions of Americans, including the healthy and vaccinated, could suffer long-term health effects from Covid infections.
The policy could leave millions with a lifetime of little understood disease or medical complications. Those who get infected are at higher risk of brain shrinkage, blood clots, heart disease, strokes and diabetes, studies show. A separate post-viral syndrome called long Covid can cause a range of debilitating symptoms from cognitive dysfunction to extreme fatigue, according to federal estimates.”
“This is why many public health experts say the Biden administration’s focus on preventing hospitalizations over infections is a poor strategy, one that ignores the potential of millions of newly sick or disabled Americans further straining the health care system and potentially worsening the labor shortage.”
“Some public health experts agree with the administration’s approach, noting that for most people, vaccines provide strong protection against severe illness and death, and individuals should manage their own risk.
The country is averaging more than 37,000 infections per day, up about 45 percent over the last two weeks, according to the Centers for Disease Control and Prevention. Those figures are likely undercounted given the prevalence of rapid tests, which aren’t often reported to health departments.”
“Among other priorities, the plan includes funding for: creating vaccine candidates for each of the 26 families of viruses known to infect humans; developing antiviral medications that can work against a broad spectrum of viruses; building out manufacturing capacity for vaccines, antivirals, tests, and other countermeasures; deploying genomic sequencing as a way to track outbreaks; developing broadly useful diagnostic technologies and better regulatory processes for approving and disseminating plentiful rapid tests; and improving security in laboratories dealing with dangerous viruses.
The White House, to its credit, has already proposed funding around this level. Most recently, in its 2023 budget proposal, the Biden administration asked for $88.2 billion in funding over five years on pandemic preparedness. That includes $40 billion for the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services to “invest in advanced development and manufacturing of countermeasures for high priority threats and viral families, including vaccines, therapeutics, diagnostics, and personal protective equipment (PPE),” as well as $12.1 billion in research funding for the National Institutes of Health for vaccine, therapeutics, and diagnostics development.
Bumb notes that the Biden proposal actually drew on the original Apollo plan put out by the bipartisan commission. That’s part of why the new commission report is so notable: This is a group that’s capable of driving policymaking at high levels.
That said, Congress has yet to appropriate money at the commission’s desired level to prevent the next pandemic. It’s barely interested in further funding response to the current, ongoing pandemic, which is still killing hundreds of Americans a day. A group of senators recently cut a deal for $10 billion to fund Covid-19 response, after slashing funding the White House wanted to help fight the pandemic abroad — only to have Republicans block the deal on the Senate floor over separate immigration concerns. Even if the funding eventually passes, it’ll have to wait until after the Easter recess ends on April 22.”
“Health care policy researchers Erin C. Fuse Brown and Elizabeth McCuskey tracked the number of unique single-payer bills introduced in state legislatures across the country from 2010 to 2019, finding a sharp uptick in bills introduced since 2017. During each of those three years, at least 10 single-payer proposals were introduced, according to Brown and McCuskey’s research, for the first time since 2013. In total, state legislators proposed more single-payer bills from 2017 to 2019 than in the previous seven years combined. And for 2021, we’ve identified 10 single-payer bills that legislators introduced across the country, from liberal states like California and Massachusetts to more conservative ones including Iowa and Ohio.1
What do all these proposals have in common? They’ve all universally failed. In fact, Vermont, the only state that managed to pass single-payer health care in 2011, ended up shelving its plan three years later.”
“passing single-payer health care at the state level is next to impossible, as states are particularly limited in how they can allocate federal and private health care funds. There is, however, evidence that Americans may have an appetite for a public option, or government-run health insurance that people can opt into at the state level. Three states (Colorado, Nevada and Washington) have already passed a public option. It’s not single-payer health care reform, but it’s possible that we might see more states adopt their own public-option reforms.
One big reason single-payer proposals haven’t caught on at the state level is because finding a reliable way to pay for such a program is challenging. Single-payer advocates originally envisioned a federal proposal that would cover all Americans under a more generous version of a preexisting program — that is, Medicare, but now for all. Doing this state-by-state would require each state to apply for waivers to divert federal funds used for Medicare, Medicaid and Affordable Care Act exchanges to be used for their own single-payer plans. And that’s tricky because the Department of Health and Human Services has wide discretion to approve or deny states’ requests, which makes any proposal highly dependent on the national political climate.”
“Employer-sponsored health insurance plans, which cover 54 percent of Americans, are another hurdle for states trying to pass single-payer health care. Federal law largely prevents states from regulating employer-provided health insurance, so states can’t just stop employers from offering their own health care benefits. The exact scope of this law has been litigated for decades, but suffice it to say that it’s successfully put the kibosh on many statewide health care reforms. Single-payer health insurance is particularly tricky as there’s no way to get everyone onto the plan without first changing how private insurance works. States have tried to address this through measures like increasing payroll taxes or restricting providers’ ability to accept reimbursement from private insurance plans. But the more elaborate these mechanisms get, the more complicated it becomes to implement — and the more people that could slip through the cracks.
Finally, another big financial barrier is that state governments have far less leeway than the federal government to increase budgetary spending. That means tax increases, which come with their own political challenges, are often necessary for states to secure the funding they need.”
“All of this creates a daunting picture for statewide single-payer health care.”
“The roughly $10 billion in pandemic aid the Senate is preparing to vote on after a weekslong impasse will keep the nation’s testing, treatment and vaccination programs afloat for only a couple months, lawmakers, Biden administration officials and public health experts warn.”
“This round of funding — if it can pass the House and Senate — would help restart key Covid-19 programs that recently ran out of resources, including the development of future variant-specific vaccines and federal government purchases of drugs for people at risk of hospitalization.
But the package was whittled down from more than $30 billion federal officials originally argued was needed to $22.5 billion the White House pitched to Capitol Hill last month to $15.6 billion congressional leaders tried to attach to the 2022 spending bill.
Now, $10 billion is on the table and the money for the global vaccination effort and for testing, treating and vaccinating the uninsured was dropped, all but guaranteeing the Biden administration will shortly need Congress to do this all over again.”
“Public health leaders warn that these short-term bursts of cash are creating gaps in preparedness, leaving millions vulnerable to a new Covid surge.”
“with no global money in the current deal, policymakers fear the disruption to the U.S.’ pandemic work overseas will continue indefinitely.
“Doing nothing to slow the global spread of COVID-19 is foolhardy,” Senate Appropriations Chair Patrick Leahy (D-Vt.) warned Monday. “As the virus continues to mutate and wreak havoc overseas, more Americans will become sick and die.”
For months, officials at the U.S. Agency for International Development have warned lawmakers that they would soon run out of money to help facilitate vaccinations in low- and middle-income countries, and advocated for at least $19 billion for the global Covid fight.”
“On the domestic front, the funding delays have forced the federal government to halt purchases of enough additional booster doses for all Americans and slash the purchase and distribution of monoclonal antibody treatments and antiviral pills for high-risk Covid patients. It has also disrupted research into new treatments and cut off reimbursements to doctors around the country for testing, treating, and — as of Tuesday — vaccinating the uninsured. Even if Congress manages to approve the funding this week, public health experts say, there’s a good chance all of these threats will reemerge in just a few months, damaging the stability and continuity of their fight against the virus.”
“The United States health system, more than any other in the developed world, forces patients to manage their health care on their own. They pay a lot of their own money for medical care. They have to make sure their specific doctor is covered by their specific insurer. And even if their doctor believes they need a certain treatment, patients must follow rules set by their health insurer, or risk delays in treatment or ultimately having their insurance claims denied.
Patients run into these obstacles all the time — with serious consequences for their well-being. A recurring finding in health care research is that when patients run into any friction, whether high cost-sharing, limited access to providers, or something else, they tend to receive less timely and appropriate care. Over time, that will make people more likely to develop serious health conditions and, ultimately, die younger than they would with proper care.
It starts with the sheer cost of health care to US patients. Out-of-pocket spending per person is higher in the US than in any other wealthy country save Switzerland, and roughly twice as much as in countries like the UK, the Netherlands, and Japan. Recent research has found that even small cost obligations, as little as $10 for a prescription, can discourage patients from taking their medicine as prescribed. A third of Americans have reported in public opinion surveys that they skip medications or other necessary medical care because of the cost.
But the US health system puts up other, subtler hurdles. Insurers don’t cover care at every doctor’s practice or hospital; they instead contract with certain providers to create provider networks, within which their patients must seek care for their treatment to be covered. These networks put the onus on patients to figure out where they can go for care, at the risk of incurring huge medical bills if they get it wrong. That problem came to the forefront in the recent debate over surprise billing: Many people were going to the hospital for an emergency, only to find out after the fact that either the hospital or a doctor who treated them was not covered by their insurer.
That has been a common experience for American patients: About one in four heart attacks lead to the patient being charged for out-of-network care in the emergency department or if they are admitted.
Networks also make shopping for health insurance more difficult. Patients have to try to figure out in advance whether their existing primary care doctor or specialists, or the local hospital, will be covered by their new plan.”
“Patients can run into the same kind of problem with drug formularies, a list of approved drugs that health plans use to prioritize coverage for certain medications. If a drug is not on a plan’s formulary, customers must pay more of their money than they would for approved drugs. Sorting out which drugs are covered or preferred under a health plan’s formulary can be a headache, and research has shown that such restrictions lead to patients using fewer medications.”
“Before the pandemic, the flu alone could sometimes push hospital systems into crisis mode, where they cancel elective procedures and limit other kinds of care. Now there’s Covid-19, which has done the same thing on its own.
Suddenly conjuring more hospital capacity every winter to handle the expected surges of flu and Covid-19 is not going to happen. Thousands of additional hospital beds are not coming in the next few years, and the US would not have the doctors and nurses to staff them anyway. It will take much longer — years or maybe decades — to improve the gaps in America’s health care infrastructure and workforce that have been exposed during Covid-19.
This means the imperative to “flatten the curve,” to limit the spread of these viruses to stop hospitals from being overwhelmed, will be with us for a long time. But the makeup of the curve will change, measuring multiple diseases instead of one.”
“Vaccination is the best way to stop a bad Covid-and-flu season before it starts.”
“Surveillance is critical, starting with early-warning systems. Public health institutions have long monitored the flu and they are already tracking Covid-19 in a similar manner. Monitoring the amount of virus detected in local wastewater has proven to be a reliable leading indicator of new Covid-19 waves during the pandemic. And widespread, reliable testing will be essential — including at-home tests for both Covid-19 and the flu.”
“Frequent testing lets people know that they should isolate. If they are at higher risk of severe illness, they can get on antivirals quickly. The current therapies are most effective at stopping serious symptoms that could require hospitalization if they are taken within the first few days of an illness. Research in the last decade has found that flu antivirals are too often underprescribed for patients who would benefit most; improving prescription rates is only more critical now that the health system will be contending with both the flu and Covid-19 going forward.”