By George W. Chapman
OK. I’m both confused and exasperated. (First, let’s ignore the President Trump’s claim he will reduce drug prices by 1,000%. Math clearly is not his strong point. But let’s give him credit for the sentiment.) Undoubtedly, we pay more for drugs than just about every country in the world. So, Trump issued a letter to 17 of the largest drug manufacturers demanding we get what’s called “favored nation pricing.” In other words, we will pay no more for a drug than the lowest price out there in the world market. This surely must make the evil all-pervasive drug lobby nervous. Currently, by law, Congress is allowed to negotiate a mere 15 drug prices a year. If all it takes is a threatening letter, why hasn’t this been done 40 years ago? The skeptic in me thinks those letters are in the corporate wastebasket of recipients. Adding to the confusion and exasperation is that the so-called “Big Beautiful Bill” actually delays our ability to negotiate the price of some of Medicare’s most costly drugs like Keytruda and Darzelex. For now, if they are on the list of 15, Medicare can’t touch them. Pardon my French but WTF? Let’s see who is more effective at controlling drug prices: a letter from the President or the ubiquitous and nefarious drug lobby?
Vaccine Skepticism, Confusion
The Health and Human Services Department has not made it clear, as of this writing, as to what age groups (at most risk) should get a COVID-19 booster this fall and whether or not your insurance should pay for it. Up until now insurers have paid for it. If they don’t pay for it, (but why wouldn’t they?) vaccine skeptics will be far more likely to refuse the booster. An extensive survey by the Kaiser Family Foundation found that six of 10 respondents “do not expect” to get the COVID-19 booster this fall. Yet the very same people say any changes to historic vaccine policy “will make us less safe.” The other four of 10 respondents said they “definitely will not” get the fall booster. We need 95% compliance with any vaccine to achieve herd immunity. Kennedy is quickly becoming the bane of emergency room physicians as his non-science-based policies create visits to overtaxed emergency rooms by the unvaccinated. As with the COVID-19 pandemic five years ago, ER docs are frustrated as the majority of visits by the unvaccinated with serious symptoms were preventable.
Kennedy’s Anti-science Purge
He’s at it again. In the continuing purge of scientists, researchers and physicians from the Health and Human Services Department, CDC and NIH Kennedy wants to fire all 16 members of the U.S. Preventive Services Task Force. They are responsible for recommending the preventive services that should be covered by all insurers with no out-of-pocket cost to members. Currently, the preventive services include: screening for colon, breast and lung cancer; screening for anxiety and depression in children; and screening for cardiovascular disease. The task force is anything but political. So why is Kennedy even considering this? The preventive services that have been in force since 2010 (the year ACA became law) have saved countless lives and literally hundreds of millions for insurers that avoid expensive treatments for undetected ailments down the road.
Mommy Makeovers
That is what one of the sketchy cosmetic surgery chains is calling “body reshaping” operations for “only” $20,000. (And, no, insurance doesn’t cover it). There are now enough of these centers (and victims) to grab the attention of regulators. Lawyers see blood in the water as malpractice and negligence cases for disfigurement, injuries, mental stress and even death proliferate. Plaintiffs have found these mills often employ grossly under-qualified physicians and use high pressure sales tactics without regard for safety. Many of these chains are backed by private equity money, which should be banned from healthcare. It is highly recommended that you do your research before doing business with any pop-up cosmetic surgery center. Your primary care provider can guide you to reputable providers if cosmetic surgery is on your bucket list.
Bill of the Month
(Or another example of why we need a national system.) “Jane” was just laid off at work. She declines continuing insurance coverage through COBRA thinking she’s young, in good health and will have another job soon. Whoops. While vacationing in Arizona she is bitten by a bat. What are the odds? Her physician dad tells her to get to a hospital. But before she does, she goes online and buys a policy. Then she heads to a hospital in Flagstaff that begins a series of rabies shots. Not being from there, she gets her subsequent shots at clinics in Colorado and in her hometown in Massachusetts. Now comes the bills totaling more than $20,000. Her insurance won’t pay because, as with most insurance policies, coverage begins the first day of the month after you sign up. (Not the day you sign up.) The Affordable Care Act covers pre-existing conditions so that didn’t help. Jane now has a job with insurance but learned a $20,000 lesson. Like most of us, Jane isn’t an expert on insurance. And a little naive. My point is the healthcare insurance marketplace is a nightmare. And until we have a universal coverage system, her story is not uncommon.
Random Stuff
• Tennessee courts have ruled that a death row inmate can be executed despite having a pacemaker. His lawyers argued that the implanted device would try to revive him with sharp painful electrical charges during lethal injection.
• Junk food can cause lung cancer. Yes, lung. Individuals in the highest quartile of self-reported ultra processed food (junk) consumption had a 41% more likelihood of lung cancer a decade later than their counterparts in the lowest quartile.
• A bad diet causes more illness and death than smoking. The Alzheimer’s Association found that those on SNAP (Supplemental Nutrition Assistance Program) experienced slightly lower cognitive decline than eligibles who did not enroll. So, in the long run, a cost-effective benefit. By the way, SNAP does not cover junk food.
• Researchers have long been fascinated by animals that hibernate. They gain huge amounts of fat, become insulin resistant and then literally rewire their metabolism to reverse ill effects of fat with no effect on their well being. Researchers are looking to unlock our “natural super power.” I just can’t see hibernating for months on end, except for winter months.
George W. Chapman is a retired healthcare business consultant who worked exclusively with physicians, hospitals and healthcare organizations. He used to operate GW Chapman Consulting based in Syracuse.