By George W. Chapman
The US belongs to the Organization for Economic Cooperation and Development (OECD). Most of the economically advanced countries in the world are members. The OECD tracks costs, morbidity, access and outcomes among member nations. (Spoiler alert: The US has historically underperformed in most categories.) In a recent study of women’s health, in age group 19-49, involving the top 11 countries by income, the US placed last in most metrics covered. (Notably, the US is the only country in the top 11 without universal healthcare.) The US ranked last in the death rate from avoidable causes like pregnancy-related complications. The US maternal mortality rate was three times the 11-country average. US women have the highest out-of-pocket costs of all 11 countries in the study which can account for delayed, postponed or put off care. Fifty percent of US women said they had trouble paying a bill versus an average 10% in the other countries surveyed. The US ranked last in meeting mental health needs. US women have the highest rate of multiple chronic conditions. Finally, US women are least likely to have a regular provider. The US did manage to retain its No. 1 ranking in per capita cost of care.
Affordable Care Act: Fixing the Glitches
Also referred to as Obamacare, the ACA became law 12 years ago after intense negotiations with stakeholder trade associations representing commercial insurers, physicians, hospitals and the 50 states. All stakeholders agreed to participate in the ACA with the notable exception of drug manufacturers. At the time, more than 50 million people lacked health insurance. They typically earned too much to qualify for Medicaid and not enough to afford expensive commercial insurance. The ACA has survived more than 60 politically motivated attempts to repeal it. The unanswered question was always “so what is the problem?” Promises to replace the ACA with something better were just talk. The goal of critics was simply to repeal it. Today, a record 31 million people are covered by the ACA through either expanded Medicaid eligibility or by purchasing discounted commercial insurance online. Individuals who must spend more than 9.5% of their income on employer provided insurance may opt to purchase more affordable commercial insurance (discount based on income) through an exchange. The problem has been that while it helped the individual, it didn’t help their dependents. Five million families were negatively impacted. A proposed rule that will fix the “family glitch” has recently been introduced. The entire household will be eligible for discounted insurance if employer family coverage exceeds 9.5% of family or household income.
Medicare Premium Increase
After several years of nominal increases, CMS is proposing an 8.5% premium increase for Advantage plans (Part C) and drug plans (Part D) for 2023. The rate increase reflects more claims than normal during the pandemic and overall inflation. Skeptics believe the higher rates may have been influenced by commercial carrier upcoding in Advantage plans. Upcoding, which is technically fraud, occurs when a commercial carrier claims that their members are sicker than the average Medicare member, so the carrier requires higher payments from Medicare to operate. About 50% of seniors are enrolled in an Advantage plan versus traditional Medicare. To be fair, Advantage plans do offer more services than traditional Medicare.
All-purpose Clinics: Walmart At It Again
Is this the future of healthcare? Like it not, Walmart will open five new clinics in Florida later this year. The retail giant already operates 20 full service clinics in Georgia, Arkansas and Illinois. Walmart is capitalizing on its high foot traffic to offer health services under one roof including: in-person primary care, telemedicine, dentistry, pharmacy, durable medical equipment and basic medical supplies. Walmart claims its all-purpose clinics are typically located in underserved areas. Allowing Walmart to solve healthcare inequities in cost, access and quality, is either laudable or scary.
There are more than 30 million diabetics in the US and about 7.5 million rely on insulin. By a vote of 232-193, Congress recently passed the Affordable Insulin Now Act. Unbelievably, 193 of our representatives voted no! Why? The bill caps out-of-pocket costs for Part D Medicare members at $35 per month or 25% of the negotiated price. Since drug manufacturers consistently refuse to negotiate prices, it looks like the $35 cap will apply. This is hardly a victory for taxpayers. While welcome relief for seniors by capping out of pocket costs, the bill does absolutely nothing to reduce the actual cost of insulin to the Medicare program. Again, our representatives continue to kowtow to the drug industry with this rather harmless bill. As of this writing, it is remains uncertain if Congress will finally pass a bill that minimally allows Medicare to negotiate prices (versus set prices) with drug manufacturers. Without any compunction, Congress has no problem setting prices for physicians and hospitals.
Birth rate down again
It’s not just the US. It’s worldwide. Our birthrate has been declining since 2008. In 2020 there were 3,376,000 deaths and 3,605,000 births for a net gain of just 229,000 people, which is just a fraction of 1% of our 332 million people. The net is being impacted from both ends. There has been an increase in preventable deaths among younger people (drug overdoses, suicides, gun violence) combined with increasing reluctance among younger people to procreate because of climate change, the economy, cost and availability of childcare, the pandemic, a rapidly morphing job market and general anxiety. This trend worries health planners because as our average age increases, so do the costs of healthcare. There are fewer healthy, younger people not only to offset or subsidize the cost of caring for the elderly but to literally provide care to the elderly.