Why the U.S. Spends So Much More Than Other Nations on Health Care
Studies point to a simple reason, the prices, not to the amount of care. And lowering prices would upset a lot of people in the health industry.
by Austin Frakt and Aaron Carroll - NYT - January 2, 2018
The United States spends almost twice as much on health care, as a percentage of its economy, as other advanced industrialized countries — totaling $3.3 trillion, or 17.9 percent of gross domestic product in 2016.
But a few decades ago American health care spending was much closer to that of peer nations.
What happened?
A large part of the answer can be found in the title of a 2003 paper in Health Affairs by the Princeton University health economist Uwe Reinhardt: “It’s the prices, stupid.”
The study, also written by Gerard Anderson, Peter Hussey and Varduhi Petrosyan, found that people in the United States typically use about the same amount of health care as people in other wealthy countries do, but pay a lot more for it.
Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute, studies how health systems from various countries compare in terms of prices and health care use. “What was true in 2003 remains so today,” he said. “The U.S. just isn’t that different from other developed countries in how much health care we use. It is very different in how much we pay for it.”
A recent study in JAMA by scholars from the Institute for Health Metrics and Evaluation in Seattle and the U.C.L.A. David Geffen School of Medicine also points to prices as a likely culprit. Their study spanned 1996 to 2013 and analyzed U.S. personal health spending by the size of the population; its age; and the amount of disease present in it.
They also examined how much health care we use in terms of such things as doctor visits, days in the hospital and prescriptions. They looked at what happens during those visits and hospital stays (called care intensity), combined with the price of that care.
The researchers looked at the breakdown for 155 different health conditions separately. Since their data included only personal health care spending, it did not account for spending in the health sector not directly attributed to care of patients, like hospital construction and administrative costs connected to running Medicaid and Medicaid.
Over all, the researchers found that American personal health spending grew by about $930 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion (amounts adjusted for inflation). This was a huge increase, far outpacing overall economic growth. The health sector grew at a 4 percent annual rate, while the overall economy grew at a 2.4 percent rate.
You’d expect some growth in health care spending over this span from the increase in population size and the aging of the population. But that explains less than half of the spending growth. After accounting for those kinds of demographic factors, which we can do very little about, health spending still grew by about $574 billion from 1996 to 2013.
Did the increasing sickness in the American population explain much of the rest of the growth in spending? Nope. Measured by how much we spend, we’ve actually gotten a bit healthier. Change in health status was associated with a decrease in health spending — 2.4 percent — not an increase. A great deal of this decrease can be attributed to factors related to cardiovascular diseases, which were associated with about a 20 percent reduction in spending.
This could be a result of greater use of statins for cholesterol or reduced smoking rates, though the study didn’t point to specific causes. On the other hand, increases in diabetes and low back and neck pain were associated with spending growth, but not enough to offset the decrease from cardiovascular and other diseases.
Did we spend more time in the hospital? No, though we did have more doctor visits and used more prescription drugs. These tend to be less costly than hospital stays, so, on balance, changes in health care use were associated with a minor reduction (2.5 percent) in health care spending.
That leaves what happens during health care visits and hospital stays (care intensity) and the price of those services and procedures.
Did we do more for patients in each health visit or inpatient stay? Did we charge more? The JAMA study found that, together, these accounted for 63 percent of the increase in spending from 1996 to 2013. In other words, most of the explanation for American health spending growth — and why it has pulled away from health spending in other countries — is that more is done for patients during hospital stays and doctor visits, they’re charged more per service, or both.
Though the JAMA study could not separate care intensity and price, other research blames prices more. For example, one study found that the spending growth for treating patients between 2003 and 2007 is almost entirely because of a growth in prices, with little contribution from growth in the quantity of treatment services provided. Another study found that U.S. hospital prices are 60 percent higher than those in Europe. Other studies also point to prices as a major factor in American health care spending growth.
There are ways to combat high health care prices. One is an all-payer system, like that seen in Maryland. This regulates prices so that all insurers and public programs pay the same amount. A single-payer system could also regulate prices. If attempted nationally, or even in a state, either of these would be met with resistance from all those who directly benefit from high prices, including physicians, hospitals, pharmaceutical companies — and pretty much every other provider of health care in the United States.
Higher prices aren’t all bad for consumers. They probably lead to some increased innovation, which confers benefits to patients globally. Though it’s reasonable to push back on high health care prices, there may be a limit to how far we should.
Want to cut health-care costs? Start with the obscene amount of waste.
A year of investigating revealed a staggering amount of supplies and drugs are simply thrown away.
by Marshall Allen - The Washington Post - December 28, 2017
Unused medical supplies sit in storage at a Partners for World Health facility in Portland, Maine, on Feb. 18, 2017. Partners for World Health is a Maine-based nonprofit that collects medical supplies, ranging from rubber gloves, to sutures, to anesthesia machines, that are discarded from medical facilities and redistributed overseas to people and medical facilities in need. (Tristan Spinski, special to ProPublica)
In Maine, there’s a warehouse the size of a middle school gymnasium, stuffed with brand-new medical supplies and gently used medical equipment. Several pallets are piled with boxes of surgical sutures, still in their shrink wrap, each box worth hundreds of dollars. Tubs overflow with diabetes supplies and surgical instruments that may run hundreds of dollars apiece. There are bins of bandages and gauze and saline and ostomy bags and every other medical supply you can imagine. These materials, unexpired, could easily stock any hospital or clinic. But each item has actually been thrown away by a local medical facility.
The cost of health care has been rising for decades, and Americans are paying the price. In a recent Gallup poll, people cited the high cost of care as their No. 1 financial concern. It’s an enormous problem, and trying to solve it all at once brings on panic and paralysis. But after reporting for a year on the ways the medical industry blows through our money, I have one idea: Let’s end the egregious waste that’s draining our health-care system.
The National Academy of Medicine has estimated the health-care system wastes around $765 billion a year — about a quarter of what we spend. Eliminating all the waste could allow us to insure 150 million Americans, the Academy of Medicine said, and saving half of it could provide groceries for every household in the country for a year. Eliminating the waste would also stop our rising health-care costs from eating up our wage increases. My premiums go up 9 percent next year. Same thing happened last year. Odds are your costs are rising, too.
It’s hard to downplay what I found when I began investigating the issue. Hospitals throw out so many valuable supplies that a cottage industry of charities has sprung up to collect this stuff and ship it to the developing world — otherwise, all those goods in that Maine warehouse would be headed for a landfill.
Nobody tracks how much hospitals waste rather than donate, and I couldn’t track down where each item came from. But experts told me when hospitals change vendors for a type of supply, they often toss the old stuff. Or, if they take over a clinic or facility, they get rid of the items that come with it, even if they are unused and unexpired.
The operating room is a major source of wasted spending. One hospital tracked the value of unused items that went to waste during neurosurgery procedures in a single year. The total: $2.9 million — for one type of surgery at just one hospital. In that case, the surgeons hadn’t updated their system of telling the staff which supplies to prep for each operation. They were opening many items they didn’t need, which then had to be thrown away even though they were unused. The hospital updated its approach to make sure they aren’t setting up for operations with excess supplies.
I learned that nursing homes throw away hundreds of millions of dollars’ worth of valuable medication every year. They typically dispense drugs a month at a time for patients, and often have them discontinued if the patient dies or transfers. The excess drugs get trashed, incinerated or even flushed down the toilets, contaminating our water supply. The chief executive of a pharmacy that serves nursing homes in Florida told me that his company alone throws away about $2.5 million a year in valuable medication.
In Iowa, the state government funded a program to recover these castoff nursing home meds and donate them to needy patients, for free. This year, they’re on pace to recover and redistribute $6 million in medication. My story led policymakers in Florida and New Hampshire to introduce legislation to try to replicate the Iowa program.
Drugs are a huge source of waste, partly because drug expiration dates don’t mean what we think they mean. The Food and Drug Administration makes pharmaceutical companies show their medication is safe and effective until its expiration date. It doesn’t make them find out how long they actually last.
Studies show it’s common for a drug to be safe after its expiration date. The FDA runs a program that tests and then extends expiration dates on drugs in the federal government’s stockpiles. Those same drugs get thrown away in pharmacies when they “expire,” even though many of them are in short supply. How much of our money does it waste? One midsize hospital in Boston throws away about $200,000 worth of drugs a year that hit their expiration date. If that’s true for other hospitals, the total would be about $800 million a year for hospital pharmacies alone.
Meanwhile, drug companies are making eyedrops two or three times larger than what the eye can even contain. We are paying for the wasted medicine running down our cheeks. I spoke to the former head of research for Alcon Laboratories, a global leader in the eye care industry now owned by Novartis. He told me that in the early 1990s his team created a “microdrop” that eliminated the waste. The microdrops were effective and reduced the burning caused by larger drops. But Alcon’s leaders killed the project because they were worried it could reduce sales.
Vials of cancer drugs are also made too large, which one study said wastes about $1.8 billion a year in the valuable medication. Earlier this year, one drug company switched from a multiuse vial, which could be shared by patients, to a single-use vial that could not be shared, thereby increasing the amount of wasted cancer medication. The change would make the supply chain more reliable worldwide, the company said. But one cancer center calculated that the change would cost each patient an average of $1,000 in waste per infusion. Imagine: You’re fighting cancer and then get billed an extra thousand dollars for medication they toss in the trash. Two U.S. senators responded to my story by introducing legislation to solve the problem of oversized eyedrops and cancer drug vials.
These are not isolated examples or small sums being squandered. Let’s say my reporting identified about $10 billion in wasted spending. That’s a rough estimate because no one is actually tracking how much we’re wasting. What else could we be doing with that money? The Kaiser Family Foundation says it costs an average of $6,690 to pay one person’s insurance premium in 2017. At that rate, the $10 billion saved could insure about 1.5 million people for a year. Tell those people it isn’t important to reduce our wasted health-care spending.
The Academy of Medicine did something smart when it reframed our health-care overspending as waste. We may be a wasteful country, but we still teach our kids to eat everything on their plates. “Waste not, want not,” is baked into our cultural DNA. It’s a powerful concept because it’s a moral one. It’s wrong to squander the hard-earned dollars Americans are paying into the health-care system and then demand they pay more.
We can’t be naive and think it will be easy to fix this problem. Our wasted spending represents revenue and profit for the medical industry. But our health-care spending should not be an entitlement program for the medical industrial complex. I put together a prescription for reducing the wasted spending I identified. Our policymakers should stand up to the medical industry and stamp out the waste.
Pharma, under attack for drug prices, started an industry war
by Carolyn Johnson - The Washington Post - January 2, 2018
It’s not easy to get Americans mad at a behind-the-scenes industry they’ve barely even heard of, but pharmaceutical companies have spent most of this year trying.
“Who decides what you pay for your medicines? Not who you might think,” a concerned woman’s voice says in a radio spot airing in the District last month. “More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers.”
With national and state advertising campaigns, white papers and cartoon infographics, the powerful and well-funded drug industry lobby spent 2017 working to redirect public anger about drug prices to pharmacy benefits managers (or PBMs): links in the supply chain that sits invisibly between the patient and the drugmaker — in the process bringing a long-simmering feud between two big health-industry players into the open.
Nearly a year ago, President Trump put drug companies on notice, accusing them of “getting away with murder.” Lawmakers, too, seemed ready to take on pharmaceutical prices, after a year bookended by outrage over EpiPen’s rising cost and the smirks of “pharma bro” Martin Shkreli, a former hedge fund manager who became notorious for taking a 5000 percent price increase on an old drug used by cancer and AIDS patients.
But the drug companies’ fight with PBMs and insurers has helped thwart any real action — splintering the problem into a multi-industry echo chamber of accusations that’s hard to comprehend, much less solve.
“This has been a year of finger-pointing,” said Steven Pearson, president of the Institute for Clinical and Economic Review, a nonprofit organization that receives funding from insurance and drug companies. “They’re flooding the zone — with ‘they’ being pharma — with efforts to diffuse and deflect the focus on their role in drug pricing. Part of the policy challenge is they have a point.”
PBMs are for-profit companies that negotiate drug price discounts on behalf of insurers and employers. They include giant companies like Express Scripts Holding and CVS Health.
They make money from fees paid by insurers and employers and by taking a cut of the rebates they negotiate. Drug companies have argued that the need to give larger and larger rebates to PBMs is what’s driving the list prices of drugs up.
The PBMs say they typically pass along 90 percent of the savings they negotiate to customers, point to data showing no link between drug price growth and rebates — and point out drug companies are the one raising prices.
The nut of the dispute rests on an odd fact: a “drug price” is not one number. Drugs do carry published list prices, but few pay them. Instead, drug companies and pharmacy benefit managers (PBMs), working on behalf of different employers and insurers, establish an agreed price through negotiations that are hidden from consumers. How much the patient pays at the pharmacy counter depends on their insurance plan.
“It is so convoluted and so complicated,” said Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health. “The PBMs have grown in power and profitability over the last 10 years, and are becoming a huge force. The drug companies, they’re the ones that raise prices. It’s definitely a synergistic relationship. We’ve got two bad actors, we don’t have one.”
To hear PBMs tell it, their industry will save $654 billion in prescription drug spending for employers, consumers and the government over the next decade.
Pharma points out that consumers in high deductible plans never see that benefit and pay the inflated list price.
Meanwhile, pharma companies say they take big risks to invent lifesaving medicines, while PBMs are part of a tier of middlemen that slurp up — and keep — a big chunk of the drug’s list price.
“It’s our view you can’t effectively address this issue unless you diagnose the problem correctly. And we long believed the rhetoric around prescription drug costs hasn’t matched the reality of what’s really happening in the marketplace,” said Robert Zirkelbach, an executive vice president at PhRMA, the pharmaceutical lobby.
PBMs fire back that the vast majority of the savings they negotiate are passed on to their clients.
“Pharma wants rebates at the pharmacy counter — not because it lowers the price of the drug. It allows them to continue to charge a high price. It just gets the patient off their back,” said Steve Miller, chief medical officer of Express Scripts Holding, the country’s largest PBM.
The intra-industry conflict has meant that 2017 — a year when it seemed as if concerns about the affordability of drugs might translate into action — has been consumed with an effort to try to unravel what’s happening in the supply chain.
The federal government has moved forward on technical policy fixes that largely spare the drug industry. But the kind of sweeping changes people were girding for — importing cheaper drugs from abroad or allowing the government to negotiate drug prices — never came. As the drug-price problem began to look more like a Matryoshka doll with many nested layers, the potential solutions became less clear.
“The pharmaceutical industry’s efforts to change the discussion to the breadth of the supply chain has, to an extent, seemed to slow down a discussion of pricing,” said M. Nielsen Hobbs, executive editor of the Pink Sheet at Informa Pharma Intelligence. “For the past year, they’ve played fantastic defense.”
The success of this strategy was on view at a congressional hearing Dec. 13, when 10 witnesses from different industries stretched across a long table — from the drug companies on one end, through insurer, distributors, doctors, pharmacists, PBMS, hospitals and the patient.
To make it even more confusing, companies along the supply chain have formed a dizzying array of alliances. Health insurance plans side with PBMs — to the extent of coming together under one roof, as with the $69 billion deal announced last month for CVS Health to buy Aetna.
The National Community Pharmacists Association, meanwhile, accuses PBMs of driving independent pharmacies out of business with fees. They held an outreach day to lawmakers in early December and have for months been circulating a comic depicting the industry as a sinister blue dog with blazing red eyes, sharp teeth and collar labeled “PBM.”
“They’re right here in the middle, and everyone is kind of dropping a coin in their bucket. Most people have no idea that’s how it works,” said Douglas Hoey, NCPA’s chief executive.
A number of physician and patient organizations, some of which receive financial support from the pharmaceutical industry, have also formed alliances opposing PBMs.
Pharma has begun highlighting how the hospital industry marks up the cost of drugs.
Meanwhile, two of the country’s largest PBMs and employers, public sector employees and unions came together at the beginning of 2017 in the Coalition for Affordable Prescription Drugs.
Without a clear direction coming from government, the players are working toward their own solutions for the high cost of drugs.
A number of drug companies reacted to public scrutiny of prices by vowing to limit their price increases on existing drugs, and many informally followed suit last year.
Pharmaceutical companies have started to link the price of some drugs to how well they work, for example, offering rebates to insurance companies if a cholesterol-lowering drugs fails to prevent a heart attack.
CVS Health recently announced it would provide real-time information to physicians writing prescriptions about the specific cost of that drug to patients. The goal is to avoid sticker shock and to prod doctors to make the most cost-effective choices for their patients.
Other changes may start to come from employers.
Pacific Business Group on Health, which includes some of the West Coast’s largest employers, is studying the possible pros and cons of drafting its own formulary, the list of covered prescription drugs. That could transform employers’ relationships with PBMs and how they are paid — although the work is still in exploratory stages.
“The escalating cost of drugs hit the radar for employers, which means employers started asking a lot of questions — to pharma, to PBMs,” said Lauren Vela, senior director of member value for the Pacific Business Group on Health. “Of course, they’re all pointing fingers at each other. What has happened is they got caught — the entire industry got caught — making a lot of money, in ways that people didn’t fully understand.”
This old drug was free. Now it’s $109,500 a year.
by Carolyn Johnson - The Washington Post - December 18, 2017
For decades, Don Anderson of Seattle has been taking the same drug to help control the temporary bouts of immobility and muscle weakness caused by a rare and frightening genetic illness called periodic paralysis.
“It's like putting a 50-pound pack on your back and standing up at the dinner table,” Anderson, 73, said. “It's like wearing lead shoes around all the time.”
The drug Anderson has been taking all these years was originally approved in 1958 and used primarily to treat the eye disease glaucoma under the brand name Daranide, its price so unremarkable that he can't quite remember how much it cost at the pharmacy counter.
But the price has been on a roller coaster in recent years — zooming from a list price of $50 for a bottle of 100 pills in the early 2000s up to $13,650 in 2015, then plummeting back down to free, before skyrocketing back up to $15,001 after a new company, Strongbridge Biopharma, acquired the drug and relaunched it this spring.
“I'm constantly hearing that public pressure, public shaming will be sufficient to curb these bad actors in these industries. It often feels if you take your attention off of them, even for a second, they'll revert to these old ways,” said Rachel Sachs, an associate law professor at Washington University in Saint Louis. “It’s just another example of how the system has some problems that need to be fixed.”
The zigzagging trajectory of the price of Daranide, now known as Keveyis, shows just how much freedom drug companies have in pricing therapies — and what a big business opportunity selling extremely-rare-disease drugs has become. It also illustrates how well-intentioned policy to help spur the development of “orphan” drugs for very rare diseases can have unintended consequences.
Daranide was approved half a century ago, often used to treat glaucoma. Some people with the rare neuromuscular condition, periodic paralysis, began taking it off-label to help control their disease. With a list price of $50 for 100 pills in 2001, it wasn't a drug people remember as hard to obtain. (Pricing data was obtained from Truven Health Analytics, part of the IBM Watson Health business.)
In the early 2000s, Daranide was discontinued by Merck. Other glaucoma treatments were available, but a small group of periodic paralysis patients who had found that it controlled their symptoms better than other drugs were left with few options. They found ways to get the drug, importing it from Europe or South Korea. Anderson recalls the expense as about $250 or $300 a month.
In 2008, a family affected by the disease that also owned Taro Pharmaceutical Industries, a generic pharmaceutical company, decided to acquire Daranide from Merck. The goal was to make the drug reliably available to patients at a reasonable cost, Barrie Levitt, the former chairman of the company, and his son Jacob told The Post in 2016.
Jacob suffers from periodic paralysis, and although he took a different drug to control his disease, he became aware from his work in the patient advocacy community that Daranide had been discontinued, forcing patients to look for alternatives or find sources to import. He said Taro spent less than half a million dollars to acquire the old drug.
But another generic company, Sun Pharmaceutical Industries, took a controlling interest in Taro in 2010. When the drug was approved in 2015 as a rare-disease treatment for periodic paralysis, it got a new name, Keveyis, and a new price: $13,650 for 100 pills. Although Keveyis is actually a decades-old drug, its federal approval for periodic paralysis came with a seven-year period of exclusive marketing rights.
In 2016, after The Washington Post asked questions about the high price of the drug, Sun Pharmaceutical said it would give the drug away free. Sun said that the timing was coincidental and reflected the fact that the company had made less than $1 million on the drug; not enough to recoup the investment the company had made in marketing and patient support services.
But the story doesn't end there. Late last year, Sun agreed to sell Keveyis to a biotech company, Strongbridge Biopharma, for $8.5 million. In April, Strongbridge relaunched the drug — and in August, it jacked the list price from $13,650 to $15,001 for a bottle of 100 pills.
In a PowerPoint presentation for investors, Strongbridge Biopharma estimated that the annual price of treatment for the drug, Keveyis, would range from $109,500 to $219,000, depending on the dosage the patient took. One slide shows that the drug is covered broadly by insurers. In November, the company announced $2.5 million in sales over the last quarter — a 67 percent increase over the previous quarter's $1.5 million in sales. It said it would expand its sales force, and executives said in a conference call that the company's medical affairs team had met with 75 medical leaders and was training speakers to lead “peer-to-peer educational programs.”
Lindsay Rocco, a spokeswoman for Strongbridge Biopharma, declined to answer questions about why the company increased the price of the drug earlier this year. Instead, she issued a company statement saying that periodic paralysis affected only 5,000 people in the United States and the drug could provide benefits for those people.
“Strongbridge is committed to serving the unmet needs of the primary periodic paralysis and other rare-disease communities,” the statement said.
Sun Pharmaceutical did not answer questions about why the company sold the drug after dropping the price to zero.
For patients, this is a double-edged sword. The company is selling the drug in the United States — a big improvement over the years when it wasn't available at all or had to be imported. And like nearly every drug company with a high-priced treatment, it offers patients support in navigating their insurance or help in paying for the drug.
Anderson, for example, pays nothing. Anderson said Keveyis is not on his insurer's list of covered drugs, but he gets it free without a co-pay. Providing help to patients in affording drugs by paying co-pays, helping overcome insurance barriers and even giving it away free helps individual patients, but also insulates the drug company from criticism of its price.
“If your insurance doesn't cover it or if you don't have insurance, they will provide it free,” said Anderson, who added he is grateful to the company. “I don't understand how much it's costing some insurance companies.”
Strongbridge has launched free genetic testing for the disease and is expanding its sales force, moves that will help it identify more people who could become customers.
“It's either: People get ripped off, but they live, or they don't get ripped off, and they die. It's a little bit of a blackmail situation,” said Jacob Levitt, who has watched the price hikes with dismay. “The business model is a little bit taking advantage of making a cheap drug very expensive.”
Levitt said that Strongbridge has given $250,000 to the patient organization that he heads, which helps support a conference. That's a valuable resource for patients; he notes it's an even more lucrative investment for the company, which can use the event to get in front of people with the disease and identify new patients.
“What they have done is found the mechanism for making a lot of money off of a drug they didn't have to make a lot of money off of,” Levitt said.
Out-of-pocket health spending in 2016 increased at the fastest rate in a decade
by Carolyn Johnson - The Washington Post - December 6, 2017
U.S. health care spending increased to $3.3 trillion in 2016, with out-of-pocket health care costs borne directly by consumers rising 3.9 percent — the fastest rate of growth since 2007.
The findings, published Wednesday by Health Affairs, are considered the authoritative breakdown of American health care spending and are prepared each year by the Centers for Medicare and Medicaid Services.
The overall rate of increase in health care spending experienced a slight slowdown over the previous year, driven in part by the expected moderation in growth after the expansion of insurance coverage through the Affordable Care Act. There was also a sharp decrease in the growth of prescription drug expenditures, as hepatitis C treatment costs have declined and fewer patients are receiving them.
But even as spending growth slowed, health expenditures swallowed a greater part of the economy, with health expenditures making up 17.9 percent share of gross domestic product in 2016.
The slowdown in spending growth — a 4.3 percent increase in 2016, following a 5.8 percent growth the previous year — stemmed from changes in a broad array of health care sectors.
That ranged from slower growth in Medicaid spending after the surge in enrollment caused by the Affordable Care Act expansion, to a marked slowdown in prescription drug spending growth that had been pushed higher by the approval of a new, expensive treatment for hepatitis C in 2013.
A shift toward insurance plans that transfer more of the burden of health care costs onto patients helped fuel the rise in out-of-pocket costs. In 2016, 29 percent of people who receive insurance through employers were enrolled in high-deductible plans, up from 20 percent in 2014. The size of the deductibles also increased over this time period, a 12 percent increase in 2016 for individual plans, compared with a 7 percent increase in 2014.
Out-of-pocket spending grew the most on medical equipment and supplies and decreased slightly for prescription drugs, according to the analysis.
The most noticeable change was a big slowdown in prescription drug spending growth, which made up 10 percent of the total spending, or $328.6 billion. (That spending number does not include drugs administered by physicians or hospitals.)
That decrease highlights the effect that expensive new treatments used by large numbers of people can have on national spending. A new generation of expensive hepatitis C drugs drove national drug spending 12.4 percent higher in 2014 and 8.9 percent higher in 2015. In 2016, the prescription drug spending increased by 1.3 percent, closer to the rates in the years before the new drugs were approved.
The authors of the report attributed that trend not just to hepatitis C drugs. There were also fewer new, brand name drugs approved in 2016 — 22 new drugs, compared with 45 the previous year. Another factor was a slowdown in the growth of spending on insulin, a lifesaving drug for people with diabetes, in Medicare.
Insulin prices have been under intense scrutiny as drugmakers have increased the list prices of insulin while claiming the true cost to patients has remained flat due to discounts and rebates
Health care spending has been buffeted by unusual changes during the past decade. There was a historic slowdown in growth due to the Great Recession, and then the Affordable Care Act's expansion of health insurance coverage fueled spending.
The authors said this year's trend of slower growth could be a sign that things were returning to normal.
“Future health expenditure trends are expected to be mostly influenced by changes in economic conditions and demographics, as has historically been the case,” the authors wrote.
Proposal To Bar Petitions From Polling Places Could Hobble Maine Ballot Campaigns
by Steve Mistler - Maine Public - December 29, 2017
At first glance, a new bill from Maine’s secretary of state contains mostly a list of minor housekeeping changes to state election laws. But tucked inside is a big change that could make it much harder for groups pushing citizen initiatives onto the state ballot.
The proposal comes at a time when both Democrats and Republicans in the Legislature are eyeing ways to curb an explosion in ballot initiatives.
Getting a citizen-initiated question on a ballot requires the signatures of over 61,000 registered Maine voters. The easiest way to collect those signatures is on Election Day, right at polling places. That’s why it’s common for voters to cast their ballot and then encounter campaign workers asking them to sign petitions, which can propose anything from raising the minimum wage and legalizing recreational marijuana to changing Maine tax law.
“This is a tradition that has been how Maine democracy has worked for decades,” says Anna Kellar, the director for Maine Citizens for Clean Elections and the League of Women Voters of Maine.
Kellar says a provision in the secretary of state’s bill would eliminate that easy access to voters. It bans the collection of signatures for ballot initiatives inside polling places and moves it outside — way outside — to at least 51 feet from the entrance of a polling place and from the pathway between the parking lot and the entrance to the building.
It’s a significant change — one that Kellar says eliminates a key tool for ballot campaigns to obtain the signatures they need to propose laws to voters.
“So without the ability to do that it would make it much harder for more citizen initiatives to get on the ballot, and it would give an advantage to groups that have a lot of money at the beginning, so groups that are funded usually from big donors out of state,” she says.
Kellar says the proposal would tilt the playing field to favor campaigns that pay petition circulators a lot of money for each signature they collect. That’s because well-funded campaigns may be able to withstand the polling place ban by simply paying more per signature over a longer period of time, while a volunteer-based campaign may not have the cash or the manpower.
Kellar also notes that the proposal comes at time when lawmakers are increasingly frustrated with citizen-approved laws, but have so far been unable to pass any restrictions.
“We’ve seen more and more efforts to try different angles to make it harder for groups to get on the ballot. And this is probably the most extreme of those,” she says.
“No, this is not really designed to address those concerns at all. This is not coming from the legislators,” says Maine Secretary of State Matt Dunlap.
Dunlap insists that his proposal is not an attempt to appease lawmakers in both parties who have so far been unable to curb use of ballot initiatives. He says it’s designed to address concerns municipal election officials, and the public, have raised about an uptick in petition activity in and near polling places.
“It’s from voters. You know, voters have complained for years about running the gauntlet in the polling place. And depending on how zealous people are about gathering signatures it makes a lot of extra work for the wardens trying to police things and keep things orderly in the polling place,” he said.
Dunlap says the complaints have been spurred by signature collections, campaigning by candidates, exit polling by news organizations and groups opposing ballot initiatives — all of which would be banned from within the proposed 50-foot buffer area.
“I would agree that this is a major change, but it’s one that’s worth discussing because we do get a lot of complaints from voters about running the gauntlet in the polling station,” he says.
Dunlap’s office has supported such changes in the past, but none have passed the Legislature. And given the anticipated pushback from interest groups that see the initiative process as a critical tool, he isn’t overly confident that this one will become law, either.
Ranked Choice Voting Maine, the group that successfully convinced voters to approve an overhaul of its election system in 2016, says the proposal is another attack on Maine’s direct democracy law.
In the fall, the Legislature voted to delay implementation of the overhaul because the Maine Supreme Judicial Court says part of the voter-approved law is unconstitutional. The group is now attempting gather signatures to overturn the Legislature’s decision.
“This year, our Legislature has overthrown the results of a free and fair election by blocking all four of the November 2016 citizen-approved referenda,” the group said in a statement. “Now with this latest bill, they are trying to stop the people from exercising our right to petition our government by blocking our access to the polls.
“The only bright spot is our constitutionally protected right to the People’s Veto. Right now, in subzero temperatures, thousands of Maine people are working together to gather the 61,123 signatures to stop the legislature’s undemocratic actions.”
The Legislature’s Veterans and Legal Affairs Committee will hold a public hearing on the proposal on Wednesday.
A New Year's Day Parade for 'Medicare for All' Signals Energized Battle Ahead in California
"People are hip to faux solutions and incrementalism and are not buying it. They want Medicare for All—and they want it now."
by John Queally - Common Dreams - January 2, 2017
In the immediate wake of Monday's Rose Parade—which takes place annually on New Year's Day in Pasadena, California—hundreds of residents and advocates took over the parade route with a march of their own as they called for 'Medicare for All' and demanded passage of a bill currently stalled in the state legislature that would provide every Californian with healthcare coverage.
"People should pay attention to California because it is the example, the model, the bellwether, for what is possible and as California has set the trend for the rest of the country on a myriad of other important issues, it is and will set the trend on guaranteed, single-payer healthcare for all." —RoseAnn DeMoro, CNA/NNUThose who marched, reports the Pasadena Star-News, waved large banners reading "Medicare for all" and "Public health not corporate wealth" as they sang songs, danced along the streets, and emphasized to onlookers the need for a universal healthcare system that excludes nobody.
"What we’re saying is health care for all, rich, poor, and no matter what race you are," Sam Schwiner, a local resident and one of the marchers, told the newspaper.
"SB... 5... 6... 2!" chanted members of the parade. "It's good for me! It's good for you!"
As Common Dreams has reported, the progress of SB 562—the proposed bill that would establish a single-payer system in California, the nation's most populous state—was derailed in June of 2017 when Assembly Speaker Anthony Rendon, a Democrat, decided to pull the plug on its progress by shelving it for the legislative session.
Though Rendon received plenty of criticism from the major backers of the bill, including the California Nurses Association/National Nurses United (CNA/NNU) and the Healthy California campaign, its supporters have continued to push for its passage, sweeping the state with a tireless door-to-door campaign and vowing to see it brought back before state lawmakers in 2018.
According to RoseAnn DeMoro, CNA/NNU's executive director, support for the single-payer cuts across ideological divisions and remains extremely popular across the state.
The parade on Pasadena on Monday "signifies the ongoing popularity of the issue among all facets of our society," DeMoro told Common Dreams in an email.
"There is nothing more mainstream in California than the Rose Parade and to see this level of turnout, enthusiasm and commitment in the early morning of a New Year's Day is impressive," she continued.
Despite the ongoing hostility from its opponents—which DeMoro identified as "establishment Democrats" and financial donors from the insurance and pharmaceutical industry, for-profit hospitals, right-wing operatives, and corporate interests—she says support for SB562 is only getting stronger.
Quoting longtime organizer Bill Moyer—who once said that "movements succeed when they win over ever-greater levels of public support for their cause and undermine the pillars of support" of the status quo—DeMoro says that is precisely what's happening in California's ongoing battle for single-payer.
"People should pay attention to California because it is the example, the model, the bellwether, for what is possible and as California has set the trend for the rest of the country on a myriad of other important issues, it is and will set the trend on guaranteed, single-payer healthcare for all," she said. "And people are hip to faux solutions and incrementalism and are not buying it. They want Medicare for All—and they want it now."
The time for Medicare for All, she said, has finally come.
Articles on soaring prices are a good reminder of why single payer movement should not fixate exclusively on insurance industry. The problem of profit-driven medicine goes much deeper than that--prices are soaring because there are too many pigs at the trough.
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