“Researchers at Harvard University and the University of California Berkeley examined what happened when Medicare beneficiaries faced an increase in their out-of-pocket costs for prescription drugs. They found that a 34 percent increase (a $10.40 increase per drug) led to a significant decrease in patients filling their prescriptions — and, eventually, a 33 percent increase in mortality.
The rise in deaths resulted from people indiscriminately cutting back on medications when they had to pay more for them, including drugs for heart disease, hypertension, asthma, and diabetes.
“We find that small increases in cost cause patients to cut back on drugs with large benefits, ultimately causing their death,” the authors — Amitabh Chandra, Evan Flack, and Ziad Obermeyer — wrote. “Cutbacks are widespread, but most striking are those seen in patients with the greatest treatable health risks, in whom they are likely to be particularly destructive.””
“This finding challenges an important assumption embedded in American health care policy. In the 1970s and ’80s, the RAND Health Insurance Experiment concluded that small copays encouraged patients to use fewer health care services without leading to worse health outcomes. That helped establish a new economic argument for insurers to ask their customers to put more “skin in the game”: it would encourage more efficient use of health care services with no downside.
But that premise presumed people would be rational. For example, if they are being asked to pay more money for prescription drugs, they would cut back on less-valuable medications first. The Harvard/Cal study didn’t detect any such rationality. When costs went up, people just stopped filling their prescriptions for statins — high-value drugs that are effective in preventing heart attacks.
The researchers explained it like this: The way patients behaved when faced with higher out-of-pocket costs would suggest that they placed very little value on their lives. They literally stopped taking high-value drugs because of the price.”
“If patients can’t make good value judgments, the economic argument for cost-sharing starts to crumble, and it starts to seem like eliminating cost-sharing — increasing the likelihood patients will continue to take the medications they need to stay alive — would be a cheap way to “buy” people more health. As the researchers wrote, “improving the design of prescription drug insurance offers policy makers the opportunity to purchase large gains in health at extremely low cost per life-year.””
“Eliminating out-of-pocket costs would come with a price: Insurers would likely charge higher premiums to offset the loss of the copays and coinsurance that currently reduce their direct costs. But if the goal is better health outcomes, that is arguably a price worth paying.”
“According to the BBC, a minimum of 350,000 illegal abortions occur annually in Argentina, a figure that some activist groups feel is undercounting the real number. Illegal abortions can lead to health complications and even death for the people who experience them — the World Health Organization estimates that up to 13.2 percent of maternal deaths worldwide can be attributed to unsafe abortions.
Argentina has seen adherence to Catholicism decline in recent years, according to a study from the National Scientific and Technical Research Council (CONICET). The Buenos Aires Times reports that in 2019, 62.9 percent of the population identified as Catholic, a 13.6 percentage point drop since 2008. Simultaneously, while evangelicals gained new adherents, the share of people identifying with no religion grew the most, reaching nearly 20 percent of the population.”
“While Argentina is still a largely Catholic country, this decline could explain why Pope Francis’s comments opposing legalizing abortion did not have an overwhelming effect on the outcome of this vote. Francis, who was born and worked in Argentina for much of his life, has referred to abortion as being part of a “throwaway culture” and has rooted his opposition to the medical procedure as being based in science, according to Crux, a Catholic online newspaper.
According to France 24, Catholics weren’t alone in opposing the measure; they joined forces with the country’s growing evangelical wing to mobilize against abortion. They will likely fight to overturn this measure, especially as this change exposes Argentina’s religious fault lines.
But the victorious activists are the abortion rights feminists who have spent years fighting for abortion legalization.”
“Argentina became the biggest country in Latin America to legalize elective abortion”
“This fall and winter, health experts expect two types of deadly viruses to be circulating widely in the US. But they don’t yet know what the extent of the damage will be when the two collide.
In the absence of a coherent federal response, the novel coronavirus continues to spread across the country, with several states still battling active outbreaks. Experts estimate it could continue to hospitalize thousands and kill hundreds of people a day into September — likely with more spikes in the coming months.
We’re also now staring down the annual flu season, which typically starts in October and burdens the health care system even in normal years. The 2018–2019 flu season in the US, for example, resulted in about half a million hospitalizations and more than 34,000 deaths. The previous season, deaths were double that. And communities of color, which have already been disproportionately impacted by Covid-19, historically have also been more likely to have chronic health conditions that put them at higher risk of influenza-related complications.”
“One problem is that because influenza and Covid-19 are both respiratory viruses, severe cases will be treated on much of the same limited medical equipment, like ventilators. And because they can have overlapping symptoms, figuring out whether someone has the flu or Covid-19 — or neither — will be tricky but also important.
Fortunately, we already have a safe vaccine for the flu, and nearly 200 million doses are slated to be available in the coming months.”
“The Centers for Disease Control and Prevention (CDC) says that everyone 6 months and older (with very rare exceptions, like a life-threatening egg allergy) should get a flu shot. And this year, it is more crucial than ever to get one, experts say, to reduce the spread of the virus and keep the health care system from being overtaxed with continued surges of Covid-19.”
“Doctors, nurses and caregivers at smaller and poorer hospitals and medical facilities across the country are still struggling to obtain the protective gear, personnel and resources they need to fight the coronavirus despite President Donald Trump’s repeated assertions that the problems are solved.
Health care workers at all types of facilities scrambled for scarce masks, gloves and other life-protecting gear at the beginning of the pandemic. The White House was letting states wage bidding wars against one another, rather than establish a central national manufacturing, supply and distribution chain.
But now, health care workers say a clear disparity has emerged and persisted. Larger and richer hospitals and practices outbid their smaller peers, sometimes for protective gear, sometimes to fill in staffing gaps. And some of those having the hardest time are precisely where the virus is spreading.”
“Black women are disproportionately impacted, dying in childbirth at three to four times the rate of white women.”
“Many factors contribute to overall maternal mortality in the US, from underlying conditions like diabetes to a lack of adequate health insurance. All of these disproportionately impact Black women — Black Americans, for example, are 60 percent more likely than whites to be diagnosed with diabetes. And 11.5 percent of Black Americans were uninsured as of 2018, compared with just 7.5 percent of whites.”
“For Black women, “even when we get prenatal care,” Crear-Perry explained, “even when we are normal weight and not obese, even when we have no underlying medical conditions, we are still more likely to die in childbirth than our white counterparts.” In New York City, for example, a 2016 study found that Black patients with a college education were more likely to have pregnancy or childbirth complications than white patients who hadn’t graduated from high school.”
“Part of the issue is that providers treat Black patients differently from white ones. Black women and other women of color often aren’t listened to when they express pain or discomfort, Jamila Taylor, director of health care reform at the Century Foundation, told Vox.
Racist beliefs about people’s bodies and their ability to experience pain are shockingly widespread: Half of the white medical students and residents surveyed in one 2016 study, for example, believed at least one myth about racial differences in pain perception, such as the idea that Black people’s nerve endings are less sensitive than white people’s. The more myths someone believed, the more likely that person was to underestimate a Black patient’s pain.”
“Advocates have long been calling for greater access to non-hospital births, whether at a birthing center or at home, as a way to combat the discrimination Black patients and other patients of color can face in hospital settings. “Other countries that have better outcomes than we do create a system and a network of birth centers and home births that allow for people to make choices based upon their needs,” Crear-Perry said.”
“The single largest tax expenditure in the United States is for employer-based health insurance. It’s even more than the mortgage interest deduction. In 2017, this exclusion cost the federal government about $260 billion in lost income and payroll taxes. This is significantly more than the cost of the Affordable Care Act each year.”
“Let’s take a hypothetical married pediatrician with a couple of children living in Indiana who makes $125,000 (which is below average). Let’s also assume his family insurance plan costs $15,000 (which is below average as well).
The tax break the family would get for insurance is worth over $6,200. That’s far more than a similar-earning family would get in terms of a subsidy on the exchanges. The tax break alone could fund about two people on Medicaid. Moreover, the more one makes, the more one saves at the expense of more spending by the government. The less one makes, the less of a benefit one receives.
The system also induces people to spend more money on health insurance than other things, most likely increasing overall health care spending. This includes less employer spending on wages, and as health insurance premiums have increased sharply in the last 15 years or so, wages have been rather flat. Many economists believe that employer-sponsored health insurance is hurting Americans’ paychecks.
There are other countries with private insurance systems, but none that rely so heavily on employer-sponsored insurance. There are almost no economists I can think of who wouldn’t favor decoupling insurance from employment.”
“The House bill — H.R.3 — has a few mechanisms for reducing prescription drug prices, but most notably, it would allow the US health department to directly negotiate the prices it will pay for up to 250 drugs every year. The Congressional Budget Office (CBO) has estimated the bill would save Medicare up to $450 billion over 10 years because of those new negotiating powers. CBO has also projected about eight fewer drugs (out of an expected 300 over 10 years) would come to the market in the next decade because of the decrease in revenues for drug makers.
Despite Trump’s promises on the 2016 campaign trail that he would support proposals allowing Medicare drug negotiations, the White House threatened to veto the House plan. They called it a plan to institute government “price controls,” and said it would limit access to medicine, a favored talking point of the pharmaceutical lobby.
Even without this veto threat, H.R.3 is expected to be dead-on-arrival in the Senate. Senate Majority Leader Mitch McConnell has shown no interest in taking up the bill.”
“Instead, Trump has aligned himself more with Republican Sen. Chuck Grassley, who has advanced a narrower set of reforms from his perch as the Senate Finance Committee chair. (Grassley has also accused McConnell of sabotaging his bill, which moved out of Grassley’s committee with bipartisan support.)
His committee sent a bill to the full Senate in the fall, though it has languished there in the months since. It’s unclear if Trump’s quasi-endorsement — he did not call out Grassley’s bill directly Tuesday night, instead praising the senator generally for his individual work on the issue — will provide any new momentum for the plan. Grassley’s bill, as the Brookings Institution documented, achieves pricing reform through a mix of technical changes to the rebates that drug makers pay under Medicare and Medicaid as well as provisions to cap out-of-pocket drug costs for seniors.
Right now, neither of the bills seems on a fast track to anywhere. Part of this is because Trump’s interest in drug pricing has been scattershot at best, and many Republicans are reluctant to place too many new regulations on an innovation industry.”
““Cutting Medicaid — yeah,” Davidson said. “The head of CMS [the Centers for Medicare and Medicaid Services] announced the plan to let states file for waivers so they could get block grants, so that would essentially cut the amount of money going to states. So that would cut federal Medicaid funding.””
“”I think it comes down to that for the people I take care of all the time,” responded Davidson. “People I see in the emergency department that can’t get primary care doctors, [but] once they got Medicaid they could get primary care doctors. They stay out of the ER, they actually work more, they actually contributed to our community more.”
“Now, if you tell those people, ‘Sorry, you don’t get your health care’ — that’s going to be a real negative in their lives,” Davidson continued.”
“The two scientists from the Texas Children’s Hospital Center for Vaccine Development had developed the vaccine against another coronavirus, SARS — but that epidemic ended before their vaccine was ready. And once the crisis was over, most of their funding dried up.”
“That was a big missed opportunity. They and other scientists say SARS should have been seen as a coronavirus warning shot, not an isolated outbreak, and it should have triggered federal investments like the billions sunk into flu vaccines a decade or so earlier. They want the federal government to act rapidly now to declare a public health emergency, get a vaccine developed, have it approved by the FDA and ready to slow the Wuhan virus’ march across China and globe.
Based on past experience, though, the chances of all that falling into place fast enough to turn the tide aren’t great, many scientists say.”
“Compiled by the Trevor Project in a research brief, study after study has shown that affirming trans and gender-diverse kids in their self-exploration improves mental health and lowers suicide risk. The affirming model, which allows children to explore their gender identities at their own pace and can include puberty blockers, has been recommended by nearly every major American medical association, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the Endocrine Society, the World Professional Association for Transgender Health, and the American College of Obstetricians and Gynecologists.”
“The state now threatens to insert itself into the most basic decisions of body and identity, all to drive a handful of votes from the conservative base to win in an election year. Lost in the conservative rush to tamp down the trans rights movement are the very real lives of trans kids who simply want to transition and move on to adulthood.”