The CDC still recommends we get the updated vaccine, but advises us to not jump the gun and wait until later fall.
The protection afforded by the vaccine wanes after a few months so you don’t want this to happen during winter months when COVID-19 tends to peak. Thankfully, as more of us are immunized, deaths and hospitalizations are rarer. There were about 2,000 COVID-related deaths this past July compared to 26,000 deaths in July 2020. Virologists suggest the current variant may be less virulent this year, but still recommend getting vaccinated. Waste water analysis shows that, currently, COVID is worse in western and southern states. The CDC recommends annual updated shots because of the ever-evolving variants.
Drug Prices and Politics
The vote in the Senate to pass the Inflation Reduction Act, which authorized Medicare to finally negotiate drug prices on behalf of its 40 million members, passed by just one vote. Not one Republican voted to pass the IRA. Not one. Vice president Harris had to cast the deciding vote. However, the “good” news is that both presidential candidates are in favor of controlling drug prices. Consequently, drug manufacturers have hedged their bets. Historically, prior to the IRA, the drug lobby has fended off all attempts by Medicare to negotiate prices. While most of our elected representatives on both sides of the aisle accepted money from drug lobbyists, three to four times more money went to Republican reps than Democratic reps. This year, however, total contributions to members of the two parties are just about even.
Impact of Drugs on Premiums
Over the past several decades, drug costs have increased from 3% of the total cost of care to almost 10% of the total cost of care. The trend can be attributed to our increasing dependence on drugs (most per capita in the world) and to unregulated costs versus physician and hospital costs which are set. GLP-1 drugs used to treat diabetes and weight like Ozempic, Jardiance and Wegovy are having a significant impact on our premiums and copays be they Medicare, commercial or private or on the government exchange. Any of these drugs could be on Medicare’s “hit list” for 2026 but will remain uncontrolled for private insurers. 57 million people or 40% of those covered by their employer could potentially be eligible for GLP-1 drugs. The eventual economic impact on premiums and copays for employees will ultimately be determined by the plan your employer selects and by arbitrary coverage limitations. Initially developed to treat diabetes, only 5% of GLP-1 drugs are prescribed to treat just diabetes. Forty-two percent of these drugs are prescribed to treat obesity. The balance of prescriptions are for other conditions. Medicare spent $57 million on GLP-1 drugs in 2018. Spending jumped to a staggering $5.7 BILLION in 2022, due to a combination of price gouging and treatment of obesity. Employees, unfortunately, are virtually locked into the plan their employer selects and are subject to whatever drug coverage attached to that plan. On the other hand, Medicare beneficiaries and those on the government exchange can use navigators to help them find a plan with the best coverage of a particular drug they are on. CMS has granted $100 million to navigators who can assist seniors select an advantage plan or individuals not covered at work select a plan on the exchange.
Cell Phones in School
There is little disagreement among parents, teachers and legislators that smartphones have negatively impacted student learning, student mental health and even teacher retention. Student cyber bullying, loneliness, anxiety, depression, body dissatisfaction, eating disorders have approached epidemic proportions. Numerous studies found 50% of all students spend more than four hours a day on their phone. It’s basically an addiction and rehab will not be easy. 90% of schools report cyberbullying and 40% report the negative impact on learning when smartphones are unchecked. Seven states have banned smartphone use in schools with some exceptions for emergencies. They are Florida, Indiana, Louisiana, Minnesota, Ohio, South Carolina and Virginia. It is too soon to draw conclusions, but it is still worth gathering evidence. Once results are in, implementing any kind of restriction or total ban will be difficult. Teachers now have to worry about guns and cell phones. New York state was way ahead of the game but lifted a ban in 2015. As with regulating drug costs, fortunately, both political parties are in sync when it comes to the negative impact of smartphones on student mental health and that something has to be done. Overlooked if not lost in the discussion surrounding the impact of smartphones on students is the impact on teacher morale and retention especially in districts serving predominantly underprivileged students.
Continuing Nursing Shortage
By 2030, just six years from now, 42 of our 50 states will face a severe nursing shortage. Interestingly, of the eight states that expect to be alright, six are in the northeast: Vermont, Rhode Island, Maine, Pennsylvania, Connecticut and New Hampshire. Rural hospitals are most vulnerable to a shortage of nurses which can be a major factor leading to an outright closure. About 300 rural hospitals are on the brink. 10% are in Texas and Kansas, both states with large rural populations. The closure of a rural hospital, many hundreds from the nearest hospital, impacts far more than access to acute care. More than likely, unless affiliated with or supported by another healthcare system, physicians, pharmacists and other health professionals may abandon the community as well. The lack of a local hospital will also impact schools and local businesses. The local chamber of commerce will have a difficult time attracting new businesses. Half of nurses leave their job within two years as compared to four years for all industries. A study of 50,000 nurses found that on any given day, more than half of all nurses feel a sense of depletion, emotional exhaustion or fatigue. The double whammy of the pandemic and our aging population has exacerbated the shortage. Thousands of applicants to nursing schools have to be rejected every year because there are not enough professors in the schools to teach. Since the pandemic, most health care providers (well, the smart ones anyway) are much more attuned to their cultures, working environment and stresses facing their staff. Hopefully resulting in far less turnover and dissatisfaction. Nurse salaries have increased considerably since the pandemic. Nursing schools are receiving subsidies helping them attract and retain professors. Finally, 18% of healthcare workers are immigrants. Legal immigrants. That’s almost one in five employees. So, as in many other industries, staff shortages would be FAR worse without the steady flow of immigrants.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.