By George W. Chapman
First, some background: Americans account for 4% of the world’s population. We consume 50% of drugs worldwide. Yes, 50%. Only two countries allow TV advertising: USA and New Zealand. We have almost 350 million people (who use a lot of drugs!) yet we pay far more than most countries with far fewer people. Up until recently, it was illegal for Congress (Medicare) to use our vast purchasing power to negotiate prices with drug manufacturers. Yep. Illegal. Got to hand it to the drug lobby. Our attempts at reducing drug prices are uncoordinated, feeble and seemingly cowardly. What are we afraid of? The Inflation Reduction Act “permits” Medicare to negotiate 15-20 drug prices. There are more than 30,000 drugs. Meanwhile, TrumpRx offers around 200 drugs at a discount. Problem is, it’s on a cash only basis and your insurance won’t credit your annual deductible. Drug manufacturers are simply placating Trump so he won’t say screw all this and finally let Medicare loose to negotiate all drug prices. As far as I know, the drug manufacturers don’t have nuclear weapons. There will never be any substantial savings to the government and ultimately to the consumer until the government stops kowtowing to drug manufacturers and pussy–footing with our lame attempts to reduce prices. Ready for this? Roche has actually accused us of using “heavy handed tactics” when it comes to lowering prices. Heavy handed? Are they serious? Roche has threatened to increase their prices in Europe if we don’t cooperate. (You would think Roche is Iran for crying out loud.) Again, what are we afraid of when it comes to reducing drug costs?
Right to Die
On June 9 of last year, the NYS Assembly joined several other states by passing the Medical Aid in Dying Act (physician–assisted suicide). Gov. Hochul signed it into law this past February. It takes effect in August. Oregon was the first state to pass such a law almost 30 years ago. Currently, 13 states have right–to–die laws. Support for physician suicide crosses all political and religious groups. A recent New York survey revealed 54% of the public is in favor of the law. Any physician, hospital or healthcare system can legally refuse to provide aid in dying. Opponents fear people with severe disabilities will be discriminated against in that they might be pressured. So far, the average number of assisted deaths is less than 1% of all deaths.
Cheaper GLP-1
Effective July 1, Medicare beneficiaries with Part D coverage can receive a weight loss drug for $50 a month. It can now be prescribed specifically for weight loss. GLP-1 drugs normally cost close to $1,000 a month. The $50 deal won’t last forever. It is being offered as a demonstration and terminates in December 2027. Depending on the results of the demonstration, it could become a permanent deal.
Junk Food
Pretty much everyone acknowledges it is bad for you. It’s addicting too. Secretary Kennedy Jr. has set his sights on the junk food industry and he’s got a lot of support. About 77% of Republicans, Democrats and independents are in favor of the HHS getting tougher on the junk food industry and are calling for large warning labels on all packages of ultra–processed foods (UPFs). According to the American Journal of Public Health, 70% of consumers want UPF ads banned from children’s TV. And 87% favor government testing on all lab–made chemicals long before they can be used in any food. The consumer-oriented website FED UP! provides a lot of information on UPFs. The site address is FedUPMovement.org.
Measle Outbreaks
This virus was literally eliminated from circulation in 2000, but cases are on the rise lately. Per the CDC, just halfway through the year there have been more than 2,000 reported cases matching the total cases all of last year. The majority of cases are children and teens with 6% hospitalized. Surprise: 92% were not vaccinated. Meanwhile, Trump has signed off on HHS recommendations to reduce the number of required vaccines for children citing concerns of religious liberty and parental authority. Reducing required vaccines will ultimately drive up already costly healthcare premiums.
Obstetric Care
For decades, OB-GYNs were paid an all-inclusive or bundled payment for prenatal, delivery and postpartum care. That included an arbitrary one–size–fits–all 13 prenatal visits regardless of the needs of the particular mother or any complications. Starting in January, insurers will go to a fee–for–service model. The obstetrician will be paid per prenatal visit (be there nine, 13, 16 or whatever visits); per the severity of the delivery and per the amount of postpartum care. No more universal-bundled payments. It remains to be seen if this becomes more costly than the bundle and if outcomes were better.
Artificial intelligence in medicine
There is no doubt that AI will be a tremendous tool in curing diseases and designing effective drugs with fewer side effects. But surveys show consumers are understandably skeptical of AI when it comes to their physicians. According to the AMA, 80% of physicians employ some sort of AI in their practices. That will probably hit 100% sooner than later. Patients are skeptical of AI when it goes beyond mundane administrative tasks like scheduling and into billing, diagnosing and critical decision making. On the other hand, physicians see AI as a tool to maximize efficiency, lower costs, reduce administrative burdens, to spend more time with patients and assist in difficult diagnoses and treatments. (I agree.) A survey conducted by Sogolytics found a growing tension between provider acceptance and patient trust. Only 37% of respondents were comfortable with AI–assisted diagnosis (which will assuredly increase over time) while 35% said they didn’t trust AI–assisted billing (which I get.) Half of the respondents suggested that practices maintain human oversight of billing. Medical insurance and billing ARE complicated so defaulting to a real human voice when things get dicey is a winning strategy.
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.