Choosing, using, and losing your health care: A policy first-aid kit
https://www.bostonglobe.com/opinion/special-reports/health-care/
Editor's Note -
The
link above is to an interesting series of articles on health care
reform in the Boston Globe that is worth reading. I have clipped a couple of the sections of the series for
this blog.
-SPC
Universal, affordable, health insurance access for all Americans is the way forward.
Editor's Note -
The following article is a clear demonstration that in a market-driven health care system products that actually cure diseases are good medicine, but a bad business strategy.
- SPC
W.H.O. Warns That Pipeline for New Antibiotics Is Running Dry
In
two new reports, the global health agency says only government
intervention can fix the broken market for new antimicrobial drugs.
by Andrew Jacobs - NYT - January 27, 2020
With the pipeline for new antibiotics slowing to a trickle
and bankruptcies driving pharmaceutical companies from the field, the
World Health Organization on Friday issued a fresh warning about the global threat of drug-resistant infections.
Some 700,000 people die each year because medicines that once cured their conditions are no long effective. Yet the vast majority of the 60 new antimicrobial products in development worldwide are variations on existing therapies, and only a handful target the most dangerous drug-resistant infections, the agency said in a report.
“We urgently need research and development,” said Sarah Paulin, technical officer of Antimicrobial Resistance and Innovation at the W.H.O. and an author of two reports on the subject issued Friday. “We still have a window of opportunity but we need to ensure there is investment now so we don’t run out of options for future generations.”
Without government intervention, the United Nations estimates that resistant infections could kill 10 million people annually by 2050 and prompt an economic slowdown to rival the global financial crisis of 2008.
Some 700,000 people die each year because medicines that once cured their conditions are no long effective. Yet the vast majority of the 60 new antimicrobial products in development worldwide are variations on existing therapies, and only a handful target the most dangerous drug-resistant infections, the agency said in a report.
“We urgently need research and development,” said Sarah Paulin, technical officer of Antimicrobial Resistance and Innovation at the W.H.O. and an author of two reports on the subject issued Friday. “We still have a window of opportunity but we need to ensure there is investment now so we don’t run out of options for future generations.”
Without government intervention, the United Nations estimates that resistant infections could kill 10 million people annually by 2050 and prompt an economic slowdown to rival the global financial crisis of 2008.
[Read our series on drug resistance, Deadly Germs, Lost Cures.]
In the two reports — one that analyzed products being tested on patients and another that looked at therapies in the early stages of development — the W.H.O. cited the grim economic realities that have been shutting down investment in the field by major pharmaceutical companies and strangling the few remaining small companies that have come to dominate development of antimicrobial therapies.
Unlike drugs that treat chronic conditions and are taken for years, antibiotics save lives, but are taken for just a week or two, diminishing their profitability for drugmakers.
The sense of crisis has mounted in recent months as a number of American drug companies with promising new products have gone belly up. Among them are Melinta Therapeutics, which declared bankruptcy three weeks ago after failing to turn a profit on the four antibiotics it has on the market. Two other antibiotic start-ups, Achaogen and Aradigm, also went out of business last year.
Drug company executives, public health experts and advocates for patients — groups often at odds with one another — have been united in urging Washington to enact new policies and programs that would help shore up the finances of ailing antibiotic companies and lure pharmaceutical giants back to the field.
“Without such incentives, I’m worried these innovative companies developing new medicines will struggle to obtain the resources they need to fully develop them and bring these breakthroughs to patients,” said Greg Frank, director of Working to Fight AMR, an advocacy group funded by the pharmaceutical industry.
In the two reports — one that analyzed products being tested on patients and another that looked at therapies in the early stages of development — the W.H.O. cited the grim economic realities that have been shutting down investment in the field by major pharmaceutical companies and strangling the few remaining small companies that have come to dominate development of antimicrobial therapies.
Unlike drugs that treat chronic conditions and are taken for years, antibiotics save lives, but are taken for just a week or two, diminishing their profitability for drugmakers.
The sense of crisis has mounted in recent months as a number of American drug companies with promising new products have gone belly up. Among them are Melinta Therapeutics, which declared bankruptcy three weeks ago after failing to turn a profit on the four antibiotics it has on the market. Two other antibiotic start-ups, Achaogen and Aradigm, also went out of business last year.
Drug company executives, public health experts and advocates for patients — groups often at odds with one another — have been united in urging Washington to enact new policies and programs that would help shore up the finances of ailing antibiotic companies and lure pharmaceutical giants back to the field.
“Without such incentives, I’m worried these innovative companies developing new medicines will struggle to obtain the resources they need to fully develop them and bring these breakthroughs to patients,” said Greg Frank, director of Working to Fight AMR, an advocacy group funded by the pharmaceutical industry.
The
outlook isn’t entirely grim. In its report on potential innovative
therapies, the W.H.O. identified 252 agents in development that target 12 pathogens the health agency has declared grave threats to humanity. They include multidrug-resistant E. coli, salmonella and the bacteria that cause gonorrhea.
Nearly 80 percent of these products are being developed by drug companies, the vast majority of them in Europe and North America, and they include a number of novel therapies like phages and antimicrobial peptides that offer the possibility of treating infections without a reliance on traditional antibiotics.
“It is very encouraging to see a wide variety of new innovative approaches in the preclinical pipeline,” the study said. “Nonetheless, many scientific challenges are yet to be overcome.”
The report on drugs in the later stages of development was less sanguine. Only eight new antibiotics have been approved since 2017, it said, and most are derivatives of existing drugs. The majority of them do not treat pathogens on the W.H.O.’s list of urgent threats.
Of the 50 new antibiotics being tested in clinical trials, only two are active against the most worrisome class of bugs, called gram negative bacteria, that can prove deadly for newborns, cancer patients and those undergoing elective procedures like hip and knee replacements.
It can take ten years and cost more than $2 billion to develop a new antibiotic and bring it to market, and much of that expense is for the failures along the way. Congress has been considering a bill that would shore up the market for antibiotics but it has yet to advance, despite bipartisan support.
In the meantime, many experts worry that the few remaining start-ups in the field may not survive.
“We can’t have more companies going bankrupt,” said Dr. Helen Boucher, an infectious disease specialist at Tufts Medical Center and a member of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria. “If the pipeline remains this anemic, that’s going to have real implications for our patients.”
https://www.nytimes.com/2020/01/17/health/antibiotics-resistance-new-drugs.html?algo=identity&fellback=false&imp_id=928953192&imp_id=438480464&action=click&module=Science%20%20Technology&pgtype=Homepage
Nearly 80 percent of these products are being developed by drug companies, the vast majority of them in Europe and North America, and they include a number of novel therapies like phages and antimicrobial peptides that offer the possibility of treating infections without a reliance on traditional antibiotics.
“It is very encouraging to see a wide variety of new innovative approaches in the preclinical pipeline,” the study said. “Nonetheless, many scientific challenges are yet to be overcome.”
The report on drugs in the later stages of development was less sanguine. Only eight new antibiotics have been approved since 2017, it said, and most are derivatives of existing drugs. The majority of them do not treat pathogens on the W.H.O.’s list of urgent threats.
Of the 50 new antibiotics being tested in clinical trials, only two are active against the most worrisome class of bugs, called gram negative bacteria, that can prove deadly for newborns, cancer patients and those undergoing elective procedures like hip and knee replacements.
It can take ten years and cost more than $2 billion to develop a new antibiotic and bring it to market, and much of that expense is for the failures along the way. Congress has been considering a bill that would shore up the market for antibiotics but it has yet to advance, despite bipartisan support.
In the meantime, many experts worry that the few remaining start-ups in the field may not survive.
“We can’t have more companies going bankrupt,” said Dr. Helen Boucher, an infectious disease specialist at Tufts Medical Center and a member of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria. “If the pipeline remains this anemic, that’s going to have real implications for our patients.”
https://www.nytimes.com/2020/01/17/health/antibiotics-resistance-new-drugs.html?algo=identity&fellback=false&imp_id=928953192&imp_id=438480464&action=click&module=Science%20%20Technology&pgtype=Homepage
Medicare for All 'Is What Patients Need': New Harvard Study Shows Even Those With Private Insurance Can't Afford Care
"When
so many people can't get the care they need even when they have
insurance coverage, it says that insurance is not doing what it is
supposed to do: ensure that healthcare is affordable when you need it."
by Jake Johnson - Common Dreams - January 27, 2020
The for-profit U.S. healthcare system is so broken that a growing number of people who are fortunate enough to have private insurance coverage are still unable to afford doctor visits and other essential services due to soaring costs—leaving a larger number of Americans with unmet medical needs today than there were two decades ago.
That's a central finding of a new study by Harvard University researchers published Monday in the peer-reviewed journal JAMA Internal Medicine, examining 20 years of government data between 1998 and 2017.
The study found that despite a major expansion of insurance coverage in the U.S. during that period—most significantly through the 2010 Affordable Care Act (ACA)—"most measures of unmet need for physician services have shown no improvement, and financial access to physician services has decreased." The study's authors noted that the rise of "narrow networks, high-deductible plans, and higher co-pays" has contributed to the growth of unmet medical needs in the U.S. since the 1990s.
"Our findings call into question the value of private health insurance today."
—Dr. Laura Hawks, Harvard
Dr. Laura Hawks, a Harvard research fellow and lead author of the study, said the research poses fundamental questions about the viability of the private health insurance system at a time when presidential candidates, members of Congress, physicians, nurses, and much of the U.S. public support a transition to a single-payer system like Medicare for All.
"Our findings call into question the value of private health insurance today," Hawks, a primary care physician, said in a statement. "When so many people can't get the care they need even when they have insurance coverage, it says that insurance is not doing what it is supposed to do: ensure that healthcare is affordable when you need it."
The study found that, overall, the share of adults aged 18-64 who were unable to afford to see a doctor rose by nearly a third—from 11% to nearly 16%—between 1998 and 2017. Among adults with health insurance, there was a 60 percent increase—7% to nearly 12%—in inability to afford a doctor visit.
"Inability to see a physician because of cost also became more
frequent among most clinical risk groups, especially those with
coverage," the study found. "In 2017, the proportion of persons with
cardiovascular disease who were unable to afford a physician visit was
25.6%, 5.9 percentage points... higher than in 1998."
"A single-payer reform like Medicare for All that eliminates financial barriers to care is what patients need."
—Dr. David Himmelstein, City University of New York's Hunter College
Compared to other wealthy nations, the U.S. healthcare system has left significantly more of its population unable to meet medical needs due to prohibitive costs, according to the analysis.
"The current level of unmet health needs in the U.S. that we found far exceed those of similar countries," the study's authors wrote. "In Canada, only 1% of adults 45 years old or older with a chronic disease reported a cost-related unmet health need—compared with 18.7% of adults with a chronic medical condition in our U.S. sample."
Dr. Steffie Woolhandler, a study co-author and co-founder of Physicians for a National Health Program (PNHP), said in a statement that the findings demonstrate the dire need for a healthcare system that is both "universal—covering everyone—and comprehensive—paying in full for all medically necessary care."
Another study co-author and PNHP co-founder, Dr. David Himmelstein, said a single-payer system like Medicare for All would meet those standards by providing comprehensive coverage to everyone—including the 30 million people currently without insurance—and eliminating premiums, co-pays, and deductibles.
"Some aspects of healthcare are improving, but death rates are actually rising and we are mostly moving backwards on the health and healthcare of working-age adults," said Himmelstein. "A single-payer reform like Medicare for All that eliminates financial barriers to care is what patients need."
https://www.commondreams.org/news/2020/01/27/medicare-all-what-patients-need-new-harvard-study-shows-even-those-private-insurance
Private equity firms, which buy up businesses with the goal of turning a profit, have been heavily criticized in recent months for embodying the worst of modern capitalism. From housing to retail to nursing homes, critics argue these firms suck the value out of the companies they purchase at the expense of workers and consumers.
“Workers have been abused by many facets of today’s American capitalism. But if you see a company with particularly brutal layoffs, pay cuts, and scams to loot pension funds, the owner is often a private equity firm,” the American Prospect’s Robert Kuttner explains.
Webb recounts how after decades of nonprofit and local government provided service, private equity firms began buying up ambulance companies in the wake of the 2008 recession. Since then, quality of emergency medical service has declined while costs have soared. “Under the new paradigm of private equity, poorly maintained ambulance services siphon profit from vulnerable patients,” writes Webb.
A 2017 GAO report showed that the median price for air ambulance services doubled, from $15,000 to $30,000, between 2010 and 2014, and reached over $36,000 by 2017. “Between 2007 and 2016, the average price charged by one air ambulance company for a transport rose from $13,000 to $50,000,” according to Axios. Two of the three biggest air medical transport companies are private equity-owned, and another study found that almost 85 percent of air ambulance crashes between 1998 and 2012 were operated by for-profit companies.
Private equity-owned air ambulance companies frequently fail to make deals with insurance companies, leaving the majority of patients out of network and “likely indicating that the air ambulance providers are purposely refusing to negotiate with insurers, preferring to instead bill patients exorbitantly,” according to Webb. The arrangement allows for “surprise bills,” where patients are hit with huge bills their insurers won’t cover. Congress has recently targeted air ambulances in its’ attempts to regulate surprise billing, with the industry working to fight back.
“The air ambulance industry has become big business in America,” writes Dr. Makary, who argues that around 80% of flights aren’t for emergencies, but instead for routine transfers. Makary attributes this in part to the efforts of ambulance companies to forge cozy relations with in-hospital staff and 911 operators. He offers an example of one air ambulance company bringing pizza to exhausted ER personnel, in an arrangement Webb writes appears “uncomfortably reminiscent of the pharmaceutical salesman/doctor relationships in the nascent stages of the opioid epidemic.”
“What is inarguable is that the current emergency medical transportation system represents a market failure. What was once a community service, provided at little or no charge to the patient, has become a financialized moneymaker for the wealthy,” writes Webb. “Patients in their most vulnerable state should not be forced to pay monopoly rents to private equity firms. Policymakers, entrepreneurs, and citizens should be outraged at the abusive prices being charged and take action to rectify the problem.”
WATERLOO, Iowa — Presidential candidates can’t stop talking about insulin.
At a campaign stop here on Sunday, Sen. Amy Klobuchar retold the now-familiar story of Alec Smith, whose highly publicized death from insulin rationing in 2017 sparked nationwide outrage. Sen. Elizabeth Warren, who has vowed to lower the drug’s price on her first day in office, lambasted Eli Lilly, one of just three U.S. insulin manufacturers, at an Iowa rally the day before. And since July, when Sen. Bernie Sanders joined a highly publicized “insulin caravan” seeking cheaper prices in Canada, he has flooded this state with television ads that picture him brandishing an insulin vial in outrage.
Even in a primary dominated by broader health care issues, insulin has emerged as particularly alluring campaign fodder for Democrats. Unlike more perplexing topics like health insurance reform or the cost of drug research, candidates have a plain and simple rallying cry for insulin: That it’s corporate profiteering.
“Everything is coming together,” said Lija Greenseid, a Minnesota-based advocate working to push insulin into the political mainstream. “We’ve finally caught the attention of people in power.”
While insulin has existed for a century, American voters have taken notice of backbreaking price hikes that drug companies have imposed in recent decades as some insulin products have grown more technologically advanced and more effective. One recent poll showed that allowing the U.S. government to manufacture insulin is the single most popular element of progressive candidates’ entire 2020 agenda. And it has made for a ready opportunity for Democrats to attack President Trump: His health secretary, Alex Azar, spent five years as a top executive at Eli Lilly prior to joining the administration.
The focus on insulin is a rare point of consensus among candidates who have otherwise bickered over health care matters. It is a testament, too, to how the issue is clearly stirring voters. Even the Trump administration is beginning to signal an interest in addressing insulin specifically, after years of a broader effort to lower drug prices that has had mixed success.
“Access to affordable insulin is a life-and-death matter,” said Maura Calsyn, the managing director of health policy at the Center for American Progress. “Insulin is one of the clearest examples of drug manufacturer price-gouging, and grassroots groups have done a really phenomenal job explaining the issue and outlining why insulin is a real problem.”
But in the early primary states of Iowa and New Hampshire, and at campaign events across the country, a growing advocacy network is pushing candidates to be bolder, and to use insulin as a catch-all example of America’s health care ills. As the 2020 campaign shifts into high gear, virtually every Democratic candidate has listened.
Janelle Lutgen drove 92 miles on Sunday to present Klobuchar with a tiny gift: an empty insulin vial, spray-painted gold, barely an inch tall.
Following a Waterloo town hall appearance in front of 250 prospective caucus-goers, Klobuchar accepted her present somberly. But it was the accompanying story that got the senator’s attention: Lutgen had also lost a child to insulin rationing.
Ever since her son, Jesse, died nearly two years ago after struggling to afford treatment for his type 1 diabetes, Lutgen has used his story to launch an advocacy campaign that has pushed elected officials who run the gamut from Democratic presidential candidates to Republican state lawmakers to spotlight insulin. For months, Lutgen and her 32-year-old daughter, Theresa, have spent weekends waking up at the crack of dawn with the singular mission of hand-delivering insulin vials to presidential candidates.
The mother-daughter pair has orchestrated handoffs to almost every major contender. Lutgen has exacted a sympathetic hug from Joe Biden, a photograph from Elizabeth Warren, an impassioned speech on the need for lower drug prices from tech entrepreneur Andrew Yang, and a brief interaction with Pete Buttigieg, the former mayor of South Bend, Ind.
With each handoff, Lutgen tells a horror story that mirrors a tale being told by advocates across the country. Jesse was first diagnosed at 12, she tells candidates, after suffering from flu-like symptoms for days. His symptoms escalated, and Jesse was eventually airlifted to a hospital in Iowa City. His family learned to manage his care, buying insulin and needles and blood-glucose monitors again and again. Janelle had health insurance through the federal government then, thanks to her job at the United Postal Service. Her copays for Jesse’s treatment were low, sometimes zero.
As a young adult, however, Jesse had trouble paying for his health care. He couldn’t afford insurance, Lutgen said — the cheapest Affordable Care Act plan available cost $300 per month and carried a deductible of several thousand dollars. Insulin, which Americans with type 1 diabetes rely on daily, can cost well over $1,000 per vial before discounts, though most patients with insurance pay far less.
Like most Americans, Jesse didn’t have the flexibility to pay $10,000 a year for prescription drugs — a distinct possibility in light of the insulin price hikes that occurred during his lifetime. A patient paying roughly $175 for a vial of insulin 15 years ago might pay nearly $1,500 for the same dose today, according to an Elsevier database. Costs for Americans with diabetes often reach into the thousands, or tens of thousands, annually.
He would occasionally ask his mother to borrow money. Once, she recalled, she brought him two vials of Lantus, the Sanofi insulin product, back from a trip to Washington state — leftovers from a friend of a friend who’d recently died.
It wasn’t the formulation that Jesse used, she reasoned, but they might prove useful anyway. Days after Jesse died, Lutgen said, she found the two Lantus vials in his apartment, empty. He hadn’t asked to borrow money.
“That kind of hit me, too,” Lutgen said. “Why didn’t he ask me for help? And then when I found out how much insulin cost, I thought: How do you ask your mom for $1,300 a month, every month, for you don’t know how long?”
Advocacy campaigns like Lutgen’s have helped to elevate insulin from a health care obscurity to a central element in each Democratic candidate’s health policy agenda.
Sanders has spent $5.5 million on television ads in Iowa alone, according to FiveThirtyEight — many of which spotlight his “caravan” to Canada or images of a patient drawing a syringe from an insulin vial.
Warren, whose proposal to let the federal government manufacture insulin and other generic drugs is a signature campaign plank, also orchestrated an investigation in which Senate aides called nearly 400 pharmacies around the country to ask whether they stocked a cheaper generic product from Eli Lilly, introduced in the wake of price criticisms. (Only 17% of pharmacies said they carry the product.)
Former Vice President Joe Biden, in interviews, has cited insulin as a key example of how Americans are getting “ripped off” on drug prices. Tom Steyer, the billionaire hedge fund manager and environmentalist, complains that drug companies “charge Americans 10 times what they charge Canadians” for insulin. And Klobuchar, in 2019, invited Nicole Smith-Holt, the mother of Alec Smith, as her guest for Trump’s State of the Union address. When she declared her candidacy a week later, she retold Alec’s story. Her message quickly caught fire, even spurring an impassioned tweet from the pop icon Cher.
On Monday, Michael Bloomberg, the former New York City mayor, became the latest candidate to excoriate the Trump administration and Azar for their lack of success lowering drug prices and for the perceived conflict of hiring a former pharmaceutical executive to lead that effort.
“The Trump administration is full of pharmaceutical executives,” Tim O’Brien, a Bloomberg adviser, said on a call with reporters. Azar, he added, “in his work for Eli Lilly, prior to joining the administration, doubled the price of its top-selling insulin product over a five-year period.”
Caitlin Oakley, a spokeswoman for Azar, said the criticism was “old news,” and that Azar has prioritized lowering drug costs more aggressively than any prior health secretary.
“In fact,” she said in a statement, “it is his deep knowledge about the opaque drug pricing system that has driven this administration priority forward.”
Even in the campaign’s early stages, long-shot candidates spotlighted their own insulin bona fides. Eric Swalwell, the California congressman, whipped an insulin vial out of his pocket during a CNN town hall, telling a national audience that he had carried the medication on his person for three months after a constituent gifted it to him.
“When you run for president, you can’t go a couple of days without talking to somebody who’s describing someone they love who’s dependent on insulin or some medication,” Buttigieg told a STAT reporter at a recent meeting with the Boston Globe’s editorial board.
One particular example, Buttigieg said, remained top of mind.
“A lady gave me an insulin vial the other day that she had spray-painted gold,” he said. “The tag on it said: This is worth its weight in gold, and it shouldn’t cost that. You see what people are up against, and it requires action.”
Lutgen’s advocacy represents just a tiny slice of the fast-growing nationwide effort to draw attention to insulin prices. Her efforts fall under the umbrella of the Gold Vial Project: a loosely organized group co-founded by Greenseid and another Minnesota-based advocate, Meghan Mateuszczyk.
One affiliated advocacy network, the insulin-focused nonprofit T1 International, has grown to encompass chapters in 34 states.
The growing “Insulin for All” campaign has orchestrated regular insulin “caravans” to Canada, a protest at Eli Lilly’s U.S. headquarters, and a “die-in” at the Cambridge, Mass., offices of another insulin manufacturer, Sanofi. (In a statement, an Eli Lilly spokesman said that 95% of patients using Humalog pay under $100 monthly and touted the company’s half-priced generic, Lispro. The spokesman faulted health insurers and pharmacies for failing to cover or stock the cheaper medication.)
Lutgen’s enthusiasm, and her proximity to the Iowa caucuses, has earned her star status within the Gold Vial Project, which aims to reach elected officials at all levels and gift them both a vial and the message that Buttigieg referenced: To people with diabetes, insulin is worth its weight in gold — but that’s not what it should cost.
So far, Gold Vial advocates have delivered vials to six presidential candidates — in addition to Janelle’s handoffs, there has been a California delivery to Bloomberg and a New Hampshire presentation for Yang — as well as 11 more to members of Congress and 18 to state lawmakers and local government officials.
Soon, the Insulin for All movement could even have a lawmaker born of its own ranks: Quinn Nystrom, a longtime insulin advocate and Democrat running to represent Minnesota’s 8th Congressional District on a largely health care-centric platform.
The informal grassroots groups have also enjoyed increasing backup from national organizations more closely tied to the political mainstream. Health Care Voter, the left-leaning group founded in 2017 to oppose repeal of the Affordable Care Act, recently announced a new spinoff organization: Affordable Insulin Now.
“We had so many conversations with advocates and patients across the country who knew there was a void that needed to be filled,” said Rosemary Enobakhare, the group’s director. “We decided to take this on not just at the local level but at the federal level, to make sure they know that people are literally pleading with them.”
At a meeting of the Iowa T1 chapter in a library basement just outside Iowa City, Janelle and Theresa Lutgen were celebrating a more local victory. The previous week, state lawmakers had introduced legislation capping copays for insulin at $100 per month, an effort to prevent Jesse’s story from playing out even for Iowans with health insurance.
Despite the chance for a major victory in the state legislature, however, it was Lutgen’s success contacting the national political figures campaigning for the Democratic nomination that fueled the discussion.
John Tagliareni, the Iowa chapter leader, summed up her success in simple terms: “How do you not listen to a mom who lost her child to corporate greed?”
Lutgen, however, won’t let herself be swayed by any of the sympathetic overtures the Democratic candidates make when they hear her story. As the chair of the Jackson County Republican Party, she plans to vote for Trump come Election Day.
But she has relished the opportunity to ensure that even a Democratic president would address the issue dearest to her heart. Access to insulin, she says, shouldn’t be partisan.
“If I had to choose,” she said, “I liked what Andrew Yang had to say on drug prices.”
And while she is a committed Republican, even Lutgen admitted she had reservations about Trump’s efforts on drug pricing. He should be pushing Congress harder to pass a drug pricing bill, she said, citing the Senate package authored by Sen. Chuck Grassley, the Iowa Republican.
The more time passes without real reform, the more Lutgen has begun to doubt whether Azar, the former Eli Lilly executive, is likely to fix the problems that contributed to her son’s death.
“I’m starting to have my doubts,” she said. “Maybe it would be better to have a doctor — somebody who has the patients in mind first, and not pharmaceutical companies.”
https://www.statnews.com/2020/01/28/insulin-pricing-becomes-top-issue-for-democrats/?utm_source=&utm_medium=email&utm_campaign=27304
by Jake Johnson - Common Dreams - January 27, 2020
The for-profit U.S. healthcare system is so broken that a growing number of people who are fortunate enough to have private insurance coverage are still unable to afford doctor visits and other essential services due to soaring costs—leaving a larger number of Americans with unmet medical needs today than there were two decades ago.
That's a central finding of a new study by Harvard University researchers published Monday in the peer-reviewed journal JAMA Internal Medicine, examining 20 years of government data between 1998 and 2017.
The study found that despite a major expansion of insurance coverage in the U.S. during that period—most significantly through the 2010 Affordable Care Act (ACA)—"most measures of unmet need for physician services have shown no improvement, and financial access to physician services has decreased." The study's authors noted that the rise of "narrow networks, high-deductible plans, and higher co-pays" has contributed to the growth of unmet medical needs in the U.S. since the 1990s.
"Our findings call into question the value of private health insurance today."
—Dr. Laura Hawks, Harvard
Dr. Laura Hawks, a Harvard research fellow and lead author of the study, said the research poses fundamental questions about the viability of the private health insurance system at a time when presidential candidates, members of Congress, physicians, nurses, and much of the U.S. public support a transition to a single-payer system like Medicare for All.
"Our findings call into question the value of private health insurance today," Hawks, a primary care physician, said in a statement. "When so many people can't get the care they need even when they have insurance coverage, it says that insurance is not doing what it is supposed to do: ensure that healthcare is affordable when you need it."
The study found that, overall, the share of adults aged 18-64 who were unable to afford to see a doctor rose by nearly a third—from 11% to nearly 16%—between 1998 and 2017. Among adults with health insurance, there was a 60 percent increase—7% to nearly 12%—in inability to afford a doctor visit.
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"A single-payer reform like Medicare for All that eliminates financial barriers to care is what patients need."
—Dr. David Himmelstein, City University of New York's Hunter College
Compared to other wealthy nations, the U.S. healthcare system has left significantly more of its population unable to meet medical needs due to prohibitive costs, according to the analysis.
"The current level of unmet health needs in the U.S. that we found far exceed those of similar countries," the study's authors wrote. "In Canada, only 1% of adults 45 years old or older with a chronic disease reported a cost-related unmet health need—compared with 18.7% of adults with a chronic medical condition in our U.S. sample."
Dr. Steffie Woolhandler, a study co-author and co-founder of Physicians for a National Health Program (PNHP), said in a statement that the findings demonstrate the dire need for a healthcare system that is both "universal—covering everyone—and comprehensive—paying in full for all medically necessary care."
Another study co-author and PNHP co-founder, Dr. David Himmelstein, said a single-payer system like Medicare for All would meet those standards by providing comprehensive coverage to everyone—including the 30 million people currently without insurance—and eliminating premiums, co-pays, and deductibles.
"Some aspects of healthcare are improving, but death rates are actually rising and we are mostly moving backwards on the health and healthcare of working-age adults," said Himmelstein. "A single-payer reform like Medicare for All that eliminates financial barriers to care is what patients need."
https://www.commondreams.org/news/2020/01/27/medicare-all-what-patients-need-new-harvard-study-shows-even-those-private-insurance
Administration Offers Plan for Medicaid Block Grants, Long a Conservative Goal
States
will be able to cap a portion of spending for the safety-net program, a
change likely to diminish the number of people covered by the health
program.
by Abby Goodnough - NYT - January 30, 2020
WASHINGTON — The Trump administration said Thursday that it would start allowing states to seek fixed amounts of money for most poor working-age adults who
receive Medicaid coverage, a major shift that would limit federal
contributions to a portion of a program that has always been an
open-ended entitlement.
Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said that states that sought the arrangement — an approach often referred to as block grants — would have broad flexibility to design coverage for the affected group under Medicaid, the state-federal health insurance program for the poor that was created more than 50 years ago as part of President Lyndon B. Johnson’s Great Society.
The announcement by Ms. Verma, who often speaks of wanting to “transform” Medicaid, comes as her efforts to allow states to require poor adults in Medicaid to work or train for a job in order to receive benefits is mired in court battles.
“Data shows that barely half of adults on the Medicaid program report getting the care they need,” Ms. Verma said in a morning news release. “This opportunity is designed to promote the program’s objectives while furthering its sustainability for current and future beneficiaries, and achieving better health outcomes by increasing the accountability for delivering results.”
Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said that states that sought the arrangement — an approach often referred to as block grants — would have broad flexibility to design coverage for the affected group under Medicaid, the state-federal health insurance program for the poor that was created more than 50 years ago as part of President Lyndon B. Johnson’s Great Society.
The announcement by Ms. Verma, who often speaks of wanting to “transform” Medicaid, comes as her efforts to allow states to require poor adults in Medicaid to work or train for a job in order to receive benefits is mired in court battles.
“Data shows that barely half of adults on the Medicaid program report getting the care they need,” Ms. Verma said in a morning news release. “This opportunity is designed to promote the program’s objectives while furthering its sustainability for current and future beneficiaries, and achieving better health outcomes by increasing the accountability for delivering results.”
But Democrats, health
care providers and consumer groups warned that capping federal funding
for adult beneficiaries and giving states more freedom to decide who and
what Medicaid covers would jeopardize medical access and care for some
of the poorest Americans. A legal challenge is almost certain.
“A transition to block grants could transform Medicaid from a safety net program, designed to meet basic health needs for low-income Americans, to a program with funding limits that drive care rationing for the most vulnerable,” said Dr. Howard A. Burris III, president of the American Society for Clinical Oncology.
Although the option will technically be available to all states, it appears to be targeted to the 14 states that have not yet expanded Medicaid, as a more conservative way to move forward in covering poor adults.
Medicaid has always provided unlimited federal matching payments to states based on whatever they want to spend. Some of what the program covers is mandatory — emergency and hospital care, for example — but states can also choose to provide optional benefits, such as dental care or prescription drugs. No matter how much a state’s enrollment or spending rises, the federal share of funding rises with it.
But under the waiver program Ms. Verma is proposing, a state could decide upfront how much it wants to spend on its adult Medicaid population, then get the federal share in either a predetermined lump sum or a fixed amount for each beneficiary. Critics said this could backfire if more people became eligible for Medicaid because of a recession or natural disaster, for example, or if costs went up because a lot of enrollees needed an expensive new medicine.
“A transition to block grants could transform Medicaid from a safety net program, designed to meet basic health needs for low-income Americans, to a program with funding limits that drive care rationing for the most vulnerable,” said Dr. Howard A. Burris III, president of the American Society for Clinical Oncology.
Although the option will technically be available to all states, it appears to be targeted to the 14 states that have not yet expanded Medicaid, as a more conservative way to move forward in covering poor adults.
Medicaid has always provided unlimited federal matching payments to states based on whatever they want to spend. Some of what the program covers is mandatory — emergency and hospital care, for example — but states can also choose to provide optional benefits, such as dental care or prescription drugs. No matter how much a state’s enrollment or spending rises, the federal share of funding rises with it.
But under the waiver program Ms. Verma is proposing, a state could decide upfront how much it wants to spend on its adult Medicaid population, then get the federal share in either a predetermined lump sum or a fixed amount for each beneficiary. Critics said this could backfire if more people became eligible for Medicaid because of a recession or natural disaster, for example, or if costs went up because a lot of enrollees needed an expensive new medicine.
The plan — called “the Healthy
Adult Opportunity” — comes after Ms. Verma and other Trump
administration officials spent months trying to figure out how they
could legally approve an alternative to the open-ended federal funding
that the Medicaid statute requires. The population affected by the new
approach includes adult beneficiaries younger than 65 who aren’t
eligible on the basis of a disability or their need for long-term care,
and for whom Medicaid coverage is optional for states. Pregnant women
are not included in the group.
The plan would allow states to cover fewer drugs for enrollees in the demonstration program, while still requiring a minimum set of benefits.
Republicans have proposed block grants in various forms for decades, going back to the Reagan administration. One such effort provoked a political uproar in 1995, when Congress passed legislation to give each state a fixed amount of federal money for Medicaid, only to see President Bill Clinton veto it.
More recently, Republicans’ bills to repeal and replace the Affordable Care Act in 2017 proposed giving states a choice between a fixed annual sum per Medicaid recipient or a block grant, both of which would have almost certainly led to major cuts in coverage over time. Concerns from moderate House Republicans about the potential of deep cuts to Medicaid — which now serves more than 71 million people, or more than 1 in 5 Americans — helped doom the repeal effort.
Conservatives say Medicaid spending, which consumes a major and growing portion of the federal and states’ budgets — it cost about $620 billion in 2018, and accounted for 9.5 percent of the federal budget — needs to be reined in. The current system of unlimited federal matching funds, they say, has encouraged states to milk as much as they can, sometimes wastefully. Capping funding, their argument goes, would make Medicaid more efficient and ensure it can continue to help the sickest and most vulnerable Americans.
Although the federal government generally pays between 50 and 77 percent of a state’s total Medicaid costs, depending on the state’s wealth, it covers much more — 90 percent of the costs — for the adults who became eligible for Medicaid under the Affordable Care Act. While most adults who qualified for Medicaid in the past were disabled, pregnant or extremely poor parents of small children, the newly eligible group — more than 12 million people in 35 states, according to federal data — includes adults who may be healthy and childless and have somewhat higher incomes.
Ms. Verma has often suggested that adding healthy working-age adults to the program has threatened its viability for more fragile populations, like children, the elderly and the disabled. She did so again on Thursday, saying in a call with reporters that Medicaid “was not originally designed for this group” and that many states had been “far too lax” in verifying whether people are even eligible for the program.
The plan would allow states to cover fewer drugs for enrollees in the demonstration program, while still requiring a minimum set of benefits.
Republicans have proposed block grants in various forms for decades, going back to the Reagan administration. One such effort provoked a political uproar in 1995, when Congress passed legislation to give each state a fixed amount of federal money for Medicaid, only to see President Bill Clinton veto it.
More recently, Republicans’ bills to repeal and replace the Affordable Care Act in 2017 proposed giving states a choice between a fixed annual sum per Medicaid recipient or a block grant, both of which would have almost certainly led to major cuts in coverage over time. Concerns from moderate House Republicans about the potential of deep cuts to Medicaid — which now serves more than 71 million people, or more than 1 in 5 Americans — helped doom the repeal effort.
Conservatives say Medicaid spending, which consumes a major and growing portion of the federal and states’ budgets — it cost about $620 billion in 2018, and accounted for 9.5 percent of the federal budget — needs to be reined in. The current system of unlimited federal matching funds, they say, has encouraged states to milk as much as they can, sometimes wastefully. Capping funding, their argument goes, would make Medicaid more efficient and ensure it can continue to help the sickest and most vulnerable Americans.
Although the federal government generally pays between 50 and 77 percent of a state’s total Medicaid costs, depending on the state’s wealth, it covers much more — 90 percent of the costs — for the adults who became eligible for Medicaid under the Affordable Care Act. While most adults who qualified for Medicaid in the past were disabled, pregnant or extremely poor parents of small children, the newly eligible group — more than 12 million people in 35 states, according to federal data — includes adults who may be healthy and childless and have somewhat higher incomes.
Ms. Verma has often suggested that adding healthy working-age adults to the program has threatened its viability for more fragile populations, like children, the elderly and the disabled. She did so again on Thursday, saying in a call with reporters that Medicaid “was not originally designed for this group” and that many states had been “far too lax” in verifying whether people are even eligible for the program.
But
the popularity of Medicaid — the threat posed to it by Republican
efforts to repeal the Affordable Care Act in 2017 helped Democrats
retake the House in the 2018 midterm elections — raises the question of
why Mr. Trump would sign off on a block grant program heading into his
re-election campaign. One answer is that if it is taken up by states
that have not yet expanded Medicaid at all, Mr. Trump could point to it
as a new expansion of health coverage.
“Trying to get to the bottom of the politics of this is hard,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. “I assume that they are trying to look like they are helping poor people, without in any way extending the entitlement. It’s one of these sleights of hand where you’re trying to figure out exactly what’s at work.”
It was not immediately clear how Ms. Verma would determine the amount of federal funding a participating state would receive, and how it would compare to the amount that the 36 states that already expanded Medicaid under the health law get.
Enrollment in Medicaid peaked in 2015, around the time a number of states expanded their programs to include childless adults, and it has tapered each year since, according to the Kaiser Family Foundation. States largely attribute the enrollment drops to an improving economy, although as the administration has encouraged states to verify the incomes of Medicaid beneficiaries more often, there is evidence that the added paperwork has contributed to fewer children, in particular, receiving government coverage.
https://www.nytimes.com/2020/01/30/health/medicaid-block-grant-trump.html?action=click&module=Top%20Stories&pgtype=Homepage
“Trying to get to the bottom of the politics of this is hard,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. “I assume that they are trying to look like they are helping poor people, without in any way extending the entitlement. It’s one of these sleights of hand where you’re trying to figure out exactly what’s at work.”
It was not immediately clear how Ms. Verma would determine the amount of federal funding a participating state would receive, and how it would compare to the amount that the 36 states that already expanded Medicaid under the health law get.
Enrollment in Medicaid peaked in 2015, around the time a number of states expanded their programs to include childless adults, and it has tapered each year since, according to the Kaiser Family Foundation. States largely attribute the enrollment drops to an improving economy, although as the administration has encouraged states to verify the incomes of Medicaid beneficiaries more often, there is evidence that the added paperwork has contributed to fewer children, in particular, receiving government coverage.
https://www.nytimes.com/2020/01/30/health/medicaid-block-grant-trump.html?action=click&module=Top%20Stories&pgtype=Homepage
How Private Equity Exploited Ambulances and Vulnerable Patients
Peter Castagna - Citizen Truth - October 3, 2019
“Under the new paradigm of private equity, poorly maintained ambulance services siphon profit from vulnerable patients.”
Wall Street investment firms are behind soaring ambulance costs, according to a Thursday article by the American Prospect’s Olivia Webb and a new book by John Hopkins’ surgeon Martin Makary.Private equity firms, which buy up businesses with the goal of turning a profit, have been heavily criticized in recent months for embodying the worst of modern capitalism. From housing to retail to nursing homes, critics argue these firms suck the value out of the companies they purchase at the expense of workers and consumers.
“Workers have been abused by many facets of today’s American capitalism. But if you see a company with particularly brutal layoffs, pay cuts, and scams to loot pension funds, the owner is often a private equity firm,” the American Prospect’s Robert Kuttner explains.
Webb recounts how after decades of nonprofit and local government provided service, private equity firms began buying up ambulance companies in the wake of the 2008 recession. Since then, quality of emergency medical service has declined while costs have soared. “Under the new paradigm of private equity, poorly maintained ambulance services siphon profit from vulnerable patients,” writes Webb.
A 2017 GAO report showed that the median price for air ambulance services doubled, from $15,000 to $30,000, between 2010 and 2014, and reached over $36,000 by 2017. “Between 2007 and 2016, the average price charged by one air ambulance company for a transport rose from $13,000 to $50,000,” according to Axios. Two of the three biggest air medical transport companies are private equity-owned, and another study found that almost 85 percent of air ambulance crashes between 1998 and 2012 were operated by for-profit companies.
Private equity-owned air ambulance companies frequently fail to make deals with insurance companies, leaving the majority of patients out of network and “likely indicating that the air ambulance providers are purposely refusing to negotiate with insurers, preferring to instead bill patients exorbitantly,” according to Webb. The arrangement allows for “surprise bills,” where patients are hit with huge bills their insurers won’t cover. Congress has recently targeted air ambulances in its’ attempts to regulate surprise billing, with the industry working to fight back.
“The air ambulance industry has become big business in America,” writes Dr. Makary, who argues that around 80% of flights aren’t for emergencies, but instead for routine transfers. Makary attributes this in part to the efforts of ambulance companies to forge cozy relations with in-hospital staff and 911 operators. He offers an example of one air ambulance company bringing pizza to exhausted ER personnel, in an arrangement Webb writes appears “uncomfortably reminiscent of the pharmaceutical salesman/doctor relationships in the nascent stages of the opioid epidemic.”
“What is inarguable is that the current emergency medical transportation system represents a market failure. What was once a community service, provided at little or no charge to the patient, has become a financialized moneymaker for the wealthy,” writes Webb. “Patients in their most vulnerable state should not be forced to pay monopoly rents to private equity firms. Policymakers, entrepreneurs, and citizens should be outraged at the abusive prices being charged and take action to rectify the problem.”
https://citizentruth.org/how-private-equity-pilfered-exploited-ambulances-and-vulnerable-patients/
It’s the insulin, stupid: How drug pricing’s simplest case study became a top issue for 2020 Democrats
At a campaign stop here on Sunday, Sen. Amy Klobuchar retold the now-familiar story of Alec Smith, whose highly publicized death from insulin rationing in 2017 sparked nationwide outrage. Sen. Elizabeth Warren, who has vowed to lower the drug’s price on her first day in office, lambasted Eli Lilly, one of just three U.S. insulin manufacturers, at an Iowa rally the day before. And since July, when Sen. Bernie Sanders joined a highly publicized “insulin caravan” seeking cheaper prices in Canada, he has flooded this state with television ads that picture him brandishing an insulin vial in outrage.
Even in a primary dominated by broader health care issues, insulin has emerged as particularly alluring campaign fodder for Democrats. Unlike more perplexing topics like health insurance reform or the cost of drug research, candidates have a plain and simple rallying cry for insulin: That it’s corporate profiteering.
“Everything is coming together,” said Lija Greenseid, a Minnesota-based advocate working to push insulin into the political mainstream. “We’ve finally caught the attention of people in power.”
While insulin has existed for a century, American voters have taken notice of backbreaking price hikes that drug companies have imposed in recent decades as some insulin products have grown more technologically advanced and more effective. One recent poll showed that allowing the U.S. government to manufacture insulin is the single most popular element of progressive candidates’ entire 2020 agenda. And it has made for a ready opportunity for Democrats to attack President Trump: His health secretary, Alex Azar, spent five years as a top executive at Eli Lilly prior to joining the administration.
The focus on insulin is a rare point of consensus among candidates who have otherwise bickered over health care matters. It is a testament, too, to how the issue is clearly stirring voters. Even the Trump administration is beginning to signal an interest in addressing insulin specifically, after years of a broader effort to lower drug prices that has had mixed success.
“Access to affordable insulin is a life-and-death matter,” said Maura Calsyn, the managing director of health policy at the Center for American Progress. “Insulin is one of the clearest examples of drug manufacturer price-gouging, and grassroots groups have done a really phenomenal job explaining the issue and outlining why insulin is a real problem.”
But in the early primary states of Iowa and New Hampshire, and at campaign events across the country, a growing advocacy network is pushing candidates to be bolder, and to use insulin as a catch-all example of America’s health care ills. As the 2020 campaign shifts into high gear, virtually every Democratic candidate has listened.
Janelle Lutgen drove 92 miles on Sunday to present Klobuchar with a tiny gift: an empty insulin vial, spray-painted gold, barely an inch tall.
Following a Waterloo town hall appearance in front of 250 prospective caucus-goers, Klobuchar accepted her present somberly. But it was the accompanying story that got the senator’s attention: Lutgen had also lost a child to insulin rationing.
Ever since her son, Jesse, died nearly two years ago after struggling to afford treatment for his type 1 diabetes, Lutgen has used his story to launch an advocacy campaign that has pushed elected officials who run the gamut from Democratic presidential candidates to Republican state lawmakers to spotlight insulin. For months, Lutgen and her 32-year-old daughter, Theresa, have spent weekends waking up at the crack of dawn with the singular mission of hand-delivering insulin vials to presidential candidates.
The mother-daughter pair has orchestrated handoffs to almost every major contender. Lutgen has exacted a sympathetic hug from Joe Biden, a photograph from Elizabeth Warren, an impassioned speech on the need for lower drug prices from tech entrepreneur Andrew Yang, and a brief interaction with Pete Buttigieg, the former mayor of South Bend, Ind.
With each handoff, Lutgen tells a horror story that mirrors a tale being told by advocates across the country. Jesse was first diagnosed at 12, she tells candidates, after suffering from flu-like symptoms for days. His symptoms escalated, and Jesse was eventually airlifted to a hospital in Iowa City. His family learned to manage his care, buying insulin and needles and blood-glucose monitors again and again. Janelle had health insurance through the federal government then, thanks to her job at the United Postal Service. Her copays for Jesse’s treatment were low, sometimes zero.
As a young adult, however, Jesse had trouble paying for his health care. He couldn’t afford insurance, Lutgen said — the cheapest Affordable Care Act plan available cost $300 per month and carried a deductible of several thousand dollars. Insulin, which Americans with type 1 diabetes rely on daily, can cost well over $1,000 per vial before discounts, though most patients with insurance pay far less.
Like most Americans, Jesse didn’t have the flexibility to pay $10,000 a year for prescription drugs — a distinct possibility in light of the insulin price hikes that occurred during his lifetime. A patient paying roughly $175 for a vial of insulin 15 years ago might pay nearly $1,500 for the same dose today, according to an Elsevier database. Costs for Americans with diabetes often reach into the thousands, or tens of thousands, annually.
He would occasionally ask his mother to borrow money. Once, she recalled, she brought him two vials of Lantus, the Sanofi insulin product, back from a trip to Washington state — leftovers from a friend of a friend who’d recently died.
It wasn’t the formulation that Jesse used, she reasoned, but they might prove useful anyway. Days after Jesse died, Lutgen said, she found the two Lantus vials in his apartment, empty. He hadn’t asked to borrow money.
“That kind of hit me, too,” Lutgen said. “Why didn’t he ask me for help? And then when I found out how much insulin cost, I thought: How do you ask your mom for $1,300 a month, every month, for you don’t know how long?”
Advocacy campaigns like Lutgen’s have helped to elevate insulin from a health care obscurity to a central element in each Democratic candidate’s health policy agenda.
Sanders has spent $5.5 million on television ads in Iowa alone, according to FiveThirtyEight — many of which spotlight his “caravan” to Canada or images of a patient drawing a syringe from an insulin vial.
Warren, whose proposal to let the federal government manufacture insulin and other generic drugs is a signature campaign plank, also orchestrated an investigation in which Senate aides called nearly 400 pharmacies around the country to ask whether they stocked a cheaper generic product from Eli Lilly, introduced in the wake of price criticisms. (Only 17% of pharmacies said they carry the product.)
Former Vice President Joe Biden, in interviews, has cited insulin as a key example of how Americans are getting “ripped off” on drug prices. Tom Steyer, the billionaire hedge fund manager and environmentalist, complains that drug companies “charge Americans 10 times what they charge Canadians” for insulin. And Klobuchar, in 2019, invited Nicole Smith-Holt, the mother of Alec Smith, as her guest for Trump’s State of the Union address. When she declared her candidacy a week later, she retold Alec’s story. Her message quickly caught fire, even spurring an impassioned tweet from the pop icon Cher.
On Monday, Michael Bloomberg, the former New York City mayor, became the latest candidate to excoriate the Trump administration and Azar for their lack of success lowering drug prices and for the perceived conflict of hiring a former pharmaceutical executive to lead that effort.
“The Trump administration is full of pharmaceutical executives,” Tim O’Brien, a Bloomberg adviser, said on a call with reporters. Azar, he added, “in his work for Eli Lilly, prior to joining the administration, doubled the price of its top-selling insulin product over a five-year period.”
Caitlin Oakley, a spokeswoman for Azar, said the criticism was “old news,” and that Azar has prioritized lowering drug costs more aggressively than any prior health secretary.
“In fact,” she said in a statement, “it is his deep knowledge about the opaque drug pricing system that has driven this administration priority forward.”
Even in the campaign’s early stages, long-shot candidates spotlighted their own insulin bona fides. Eric Swalwell, the California congressman, whipped an insulin vial out of his pocket during a CNN town hall, telling a national audience that he had carried the medication on his person for three months after a constituent gifted it to him.
“When you run for president, you can’t go a couple of days without talking to somebody who’s describing someone they love who’s dependent on insulin or some medication,” Buttigieg told a STAT reporter at a recent meeting with the Boston Globe’s editorial board.
One particular example, Buttigieg said, remained top of mind.
“A lady gave me an insulin vial the other day that she had spray-painted gold,” he said. “The tag on it said: This is worth its weight in gold, and it shouldn’t cost that. You see what people are up against, and it requires action.”
Lutgen’s advocacy represents just a tiny slice of the fast-growing nationwide effort to draw attention to insulin prices. Her efforts fall under the umbrella of the Gold Vial Project: a loosely organized group co-founded by Greenseid and another Minnesota-based advocate, Meghan Mateuszczyk.
One affiliated advocacy network, the insulin-focused nonprofit T1 International, has grown to encompass chapters in 34 states.
The growing “Insulin for All” campaign has orchestrated regular insulin “caravans” to Canada, a protest at Eli Lilly’s U.S. headquarters, and a “die-in” at the Cambridge, Mass., offices of another insulin manufacturer, Sanofi. (In a statement, an Eli Lilly spokesman said that 95% of patients using Humalog pay under $100 monthly and touted the company’s half-priced generic, Lispro. The spokesman faulted health insurers and pharmacies for failing to cover or stock the cheaper medication.)
Lutgen’s enthusiasm, and her proximity to the Iowa caucuses, has earned her star status within the Gold Vial Project, which aims to reach elected officials at all levels and gift them both a vial and the message that Buttigieg referenced: To people with diabetes, insulin is worth its weight in gold — but that’s not what it should cost.
So far, Gold Vial advocates have delivered vials to six presidential candidates — in addition to Janelle’s handoffs, there has been a California delivery to Bloomberg and a New Hampshire presentation for Yang — as well as 11 more to members of Congress and 18 to state lawmakers and local government officials.
Soon, the Insulin for All movement could even have a lawmaker born of its own ranks: Quinn Nystrom, a longtime insulin advocate and Democrat running to represent Minnesota’s 8th Congressional District on a largely health care-centric platform.
The informal grassroots groups have also enjoyed increasing backup from national organizations more closely tied to the political mainstream. Health Care Voter, the left-leaning group founded in 2017 to oppose repeal of the Affordable Care Act, recently announced a new spinoff organization: Affordable Insulin Now.
“We had so many conversations with advocates and patients across the country who knew there was a void that needed to be filled,” said Rosemary Enobakhare, the group’s director. “We decided to take this on not just at the local level but at the federal level, to make sure they know that people are literally pleading with them.”
At a meeting of the Iowa T1 chapter in a library basement just outside Iowa City, Janelle and Theresa Lutgen were celebrating a more local victory. The previous week, state lawmakers had introduced legislation capping copays for insulin at $100 per month, an effort to prevent Jesse’s story from playing out even for Iowans with health insurance.
Despite the chance for a major victory in the state legislature, however, it was Lutgen’s success contacting the national political figures campaigning for the Democratic nomination that fueled the discussion.
John Tagliareni, the Iowa chapter leader, summed up her success in simple terms: “How do you not listen to a mom who lost her child to corporate greed?”
Lutgen, however, won’t let herself be swayed by any of the sympathetic overtures the Democratic candidates make when they hear her story. As the chair of the Jackson County Republican Party, she plans to vote for Trump come Election Day.
But she has relished the opportunity to ensure that even a Democratic president would address the issue dearest to her heart. Access to insulin, she says, shouldn’t be partisan.
“If I had to choose,” she said, “I liked what Andrew Yang had to say on drug prices.”
And while she is a committed Republican, even Lutgen admitted she had reservations about Trump’s efforts on drug pricing. He should be pushing Congress harder to pass a drug pricing bill, she said, citing the Senate package authored by Sen. Chuck Grassley, the Iowa Republican.
The more time passes without real reform, the more Lutgen has begun to doubt whether Azar, the former Eli Lilly executive, is likely to fix the problems that contributed to her son’s death.
“I’m starting to have my doubts,” she said. “Maybe it would be better to have a doctor — somebody who has the patients in mind first, and not pharmaceutical companies.”
https://www.statnews.com/2020/01/28/insulin-pricing-becomes-top-issue-for-democrats/?utm_source=&utm_medium=email&utm_campaign=27304
American Life Expectancy Rises for First Time in Four Years
Life
expectancy, the most basic measure of the health of a society, rose
slightly in 2018, after a rare and troubling decline driven by the
opioid epidemic.
by Sabina Taverneses and Abby Goodnough - NYT - January 30, 2020
WASHINGTON
— Life expectancy increased for the first time in four years in 2018,
the federal government said Thursday, raising hopes that a benchmark of
the nation’s health may finally be stabilizing after a rare and
troubling decline that was driven by a surge in drug overdoses.
Life expectancy is the most basic measure of the health of a society, and declines in developed countries are extremely unusual. But the United States experienced one from 2015 to 2017 as the opioid epidemic took its toll, worrying demographers who had not seen an outright decline since 1993, during the AIDS epidemic. An uptick in what have become known as “deaths of despair” — younger people dying from overdoses, suicide and alcoholism — has drawn considerable attention from politicians and policymakers.
The 2018 data, released in a report on Thursday, confirmed the first decline in drug deaths in 28 years, an important improvement after decades of rises.
The increase in life expectancy it helped produce was small — just over a month — and demographers cautioned that it was too early to tell if the country had turned the corner with opioid overdoses, which have claimed nearly 500,000 lives since the late 1990s.
Life expectancy is the most basic measure of the health of a society, and declines in developed countries are extremely unusual. But the United States experienced one from 2015 to 2017 as the opioid epidemic took its toll, worrying demographers who had not seen an outright decline since 1993, during the AIDS epidemic. An uptick in what have become known as “deaths of despair” — younger people dying from overdoses, suicide and alcoholism — has drawn considerable attention from politicians and policymakers.
The 2018 data, released in a report on Thursday, confirmed the first decline in drug deaths in 28 years, an important improvement after decades of rises.
The increase in life expectancy it helped produce was small — just over a month — and demographers cautioned that it was too early to tell if the country had turned the corner with opioid overdoses, which have claimed nearly 500,000 lives since the late 1990s.
“It’s
good news, but we don’t know yet if it’s the beginning of a new trend,”
said Elizabeth Arias, a demographer at the National Center for Health
Statistics, which released the report.
Still, the rise was welcome news in states like Ohio, which in 2018 had the biggest decline in overdose deaths in the country.
“It’s literally like coming out of a fog,” said Andrew Wright, 34, who has been drug-free since August 2018, when he entered treatment at the Counseling Center in Portsmouth, Ohio. Medicaid, the government insurance program, covered his care. “It’s like I’m 22 and I’ve finally made it out of my parents’ house, embracing life for the first time. I’m learning how to live.”
The last time life expectancy in the United States flatlined for several years was in the 1960s, when the mass habit of smoking, particularly among men, began showing up in the mortality statistics, said Dr. Samuel Preston, a demographer at the University of Pennsylvania. But from 1968 to 2010, life expectancy went up by an average of about two years a decade, he said, a substantially slower rate than in European countries, but twice as fast as the increase in 2018.
Life expectancy at birth rose to 78.7 years in 2018 from 78.6 the previous year. It peaked at 78.9 in 2014, but has fallen or been flat since then.
Still, the rise was welcome news in states like Ohio, which in 2018 had the biggest decline in overdose deaths in the country.
“It’s literally like coming out of a fog,” said Andrew Wright, 34, who has been drug-free since August 2018, when he entered treatment at the Counseling Center in Portsmouth, Ohio. Medicaid, the government insurance program, covered his care. “It’s like I’m 22 and I’ve finally made it out of my parents’ house, embracing life for the first time. I’m learning how to live.”
The last time life expectancy in the United States flatlined for several years was in the 1960s, when the mass habit of smoking, particularly among men, began showing up in the mortality statistics, said Dr. Samuel Preston, a demographer at the University of Pennsylvania. But from 1968 to 2010, life expectancy went up by an average of about two years a decade, he said, a substantially slower rate than in European countries, but twice as fast as the increase in 2018.
Life expectancy at birth rose to 78.7 years in 2018 from 78.6 the previous year. It peaked at 78.9 in 2014, but has fallen or been flat since then.
Dr.
Preston pointed out that the small rise in 2018 merely put the country
back where it was in 2010, amounting to nearly a decade of stagnation,
rare for a wealthy country.
Improvements in cancer mortality rates represented the single largest share of the life expectancy gain in 2018, about 30 percent. Next came the decline in so-called unintentional injuries, which include deaths from car accidents and drug overdoses. That category accounted for about 25 percent of the gain, a change that was driven almost entirely by a decline in drug deaths, Dr. Arias said.
Recent widespread efforts to expand access to opioid addiction medications, clean needles and naloxone — the drug used to revive people overdosing on opioids — may be having an impact.
“Good things are happening that hadn’t before, like sheriffs, hospitals and others who now use naloxone telling me, ‘We saved a life,’” said Shane Hudson, president and chief executive of CKF Addiction Treatment in Salina, Kan. His clinic is treating 117 people with medication for opioid addiction, up from 35 two years ago.
Improvements in cancer mortality rates represented the single largest share of the life expectancy gain in 2018, about 30 percent. Next came the decline in so-called unintentional injuries, which include deaths from car accidents and drug overdoses. That category accounted for about 25 percent of the gain, a change that was driven almost entirely by a decline in drug deaths, Dr. Arias said.
Recent widespread efforts to expand access to opioid addiction medications, clean needles and naloxone — the drug used to revive people overdosing on opioids — may be having an impact.
“Good things are happening that hadn’t before, like sheriffs, hospitals and others who now use naloxone telling me, ‘We saved a life,’” said Shane Hudson, president and chief executive of CKF Addiction Treatment in Salina, Kan. His clinic is treating 117 people with medication for opioid addiction, up from 35 two years ago.
Deaths from overdoses dropped by 4.1 percent in 2018, to
67,367 from 70,237 in 2017. The decrease was largely driven by a dip in
deaths from prescription opioid painkillers, which set off the opioid
epidemic in the late 1990s before heroin and, later, fentanyl moved in. Provisional data suggests those deaths continued to fall in 2019, likely in part because of restrictions on prescribing.
But the death rate from fentanyl rose by 10 percent in 2018, and early data suggests it kept rising last year, though not as sharply as before. There were more overdose deaths in 2018 than in any year on record except 2017, and nearly 70 percent involved opioids.
But the death rate from fentanyl rose by 10 percent in 2018, and early data suggests it kept rising last year, though not as sharply as before. There were more overdose deaths in 2018 than in any year on record except 2017, and nearly 70 percent involved opioids.
A
separate federal report, also released Thursday, found that the rate of
drug overdose deaths dropped in 14 states in 2018, climbed in five and
stayed about the same in the rest. The five states whose rates climbed
were California, Delaware, Missouri, New Jersey and South Carolina. Ohio
saw the biggest drop, to 3,980 overdose deaths in 2018 from 5,111 in
2017.
With the fentanyl death rate still climbing, along with deaths involving cocaine and psychostimulants like methamphetamine, it is not clear whether the overall drop will be sustained.
Mr. Wright, of Delaware, Ohio, developed an opioid addiction when he was 23, starting with prescription pills and moving to heroin. He said he spent years, on and off, sleeping in his car, under bridges and on his parents’ screened porch in the winter under a table so his father wouldn’t see him.
But he has now stayed off drugs for the longest period in his adult life, he said, a fact he attributes to his treatment program together with a change in the attitudes of the people in his town. A small grooming products company, Doc Spartan, hired him to make beard oil and grenade-shaped soap. Someone sold him a cheap car. Others helped him start sorting out his life — getting driver’s license, dealing with his unpaid bills and getting treatment for hepatitis C.
“I literally feel like I’m a soldier in this war, and I really like it,” said Mr. Wright, who now works as a trainer at PSKC, a CrossFit gym, and at a halfway house.
Another bright spot in Thursday’s data was cancer mortality. The overall cancer death rate dropped by 2.2 percent in 2018, a substantial decline.
Rebecca Siegel, the scientific director of surveillance research at the American Cancer Society in Atlanta, said the new data appeared to extend gains from 2017, when the overall cancer mortality rate drop was the largest since record-keeping began around 1930.
With the fentanyl death rate still climbing, along with deaths involving cocaine and psychostimulants like methamphetamine, it is not clear whether the overall drop will be sustained.
Mr. Wright, of Delaware, Ohio, developed an opioid addiction when he was 23, starting with prescription pills and moving to heroin. He said he spent years, on and off, sleeping in his car, under bridges and on his parents’ screened porch in the winter under a table so his father wouldn’t see him.
But he has now stayed off drugs for the longest period in his adult life, he said, a fact he attributes to his treatment program together with a change in the attitudes of the people in his town. A small grooming products company, Doc Spartan, hired him to make beard oil and grenade-shaped soap. Someone sold him a cheap car. Others helped him start sorting out his life — getting driver’s license, dealing with his unpaid bills and getting treatment for hepatitis C.
“I literally feel like I’m a soldier in this war, and I really like it,” said Mr. Wright, who now works as a trainer at PSKC, a CrossFit gym, and at a halfway house.
Another bright spot in Thursday’s data was cancer mortality. The overall cancer death rate dropped by 2.2 percent in 2018, a substantial decline.
Rebecca Siegel, the scientific director of surveillance research at the American Cancer Society in Atlanta, said the new data appeared to extend gains from 2017, when the overall cancer mortality rate drop was the largest since record-keeping began around 1930.
These
improvements were driven largely by a decline in the mortality rate for
lung cancer, the leading cause of cancer death. Continued drops in the
country’s smoking rate and advances in treatment, such as more precise
tumor classification, better surgical techniques, and improved drug
therapies, contributed to the progress, Ms. Siegel said.
Despite this good news, the United States lags far behind most European countries in life expectancy. John Haaga, a demographer who retired from the National Institute on Aging in December, said that when he first started his job in 2004, life expectancy in the United States was about equal to that of Portugal, a much poorer country. Over his career, Portugal gained four years while the United States gained only one. He pointed out that life expectancy was longer in Costa Rica, Cuba and Slovenia.
The increase in life expectancy might have been greater if not for rising mortality due to influenza and pneumonia — the death rate grew by 4.2 percent — as well as suicide and nutritional deficiencies. But while there has been increased concern about suicide as a public health crisis, the growth in reported cases — to 48,344 in 2018 from 47,173 in 2017 — was relatively small. The suicide rate grew by 1.4 percent overall, with a larger rise for men than women.
Jill Harkavy-Friedman, a vice president at the American Foundation for Suicide Prevention, said the nation needed to invest far more in research to understand emerging patterns.
“I’ve been a researcher in this area for 30 years and I can tell you the conversation and the funding has definitely changed,” she said, “but it’s still nowhere near the level of funding for any other public health problem of this scope.”
A federal report last fall found that the suicide rate among adolescents was at its highest level in 20 years, although the total number of teenagers who died by suicide in 2017 was fewer than 2,500. Jane Pearson, chairwoman of the Suicide Research Consortium at the National Institute of Mental Health, said there was no definitive explanation as of yet for the climbing suicide rate.
“We are worried about adolescents in particular showing increases in depression and anxiety, and trying to understand what’s driving all of this,” she said. “We can’t measure a lot of things that we would like to.”
Despite this good news, the United States lags far behind most European countries in life expectancy. John Haaga, a demographer who retired from the National Institute on Aging in December, said that when he first started his job in 2004, life expectancy in the United States was about equal to that of Portugal, a much poorer country. Over his career, Portugal gained four years while the United States gained only one. He pointed out that life expectancy was longer in Costa Rica, Cuba and Slovenia.
The increase in life expectancy might have been greater if not for rising mortality due to influenza and pneumonia — the death rate grew by 4.2 percent — as well as suicide and nutritional deficiencies. But while there has been increased concern about suicide as a public health crisis, the growth in reported cases — to 48,344 in 2018 from 47,173 in 2017 — was relatively small. The suicide rate grew by 1.4 percent overall, with a larger rise for men than women.
Jill Harkavy-Friedman, a vice president at the American Foundation for Suicide Prevention, said the nation needed to invest far more in research to understand emerging patterns.
“I’ve been a researcher in this area for 30 years and I can tell you the conversation and the funding has definitely changed,” she said, “but it’s still nowhere near the level of funding for any other public health problem of this scope.”
A federal report last fall found that the suicide rate among adolescents was at its highest level in 20 years, although the total number of teenagers who died by suicide in 2017 was fewer than 2,500. Jane Pearson, chairwoman of the Suicide Research Consortium at the National Institute of Mental Health, said there was no definitive explanation as of yet for the climbing suicide rate.
“We are worried about adolescents in particular showing increases in depression and anxiety, and trying to understand what’s driving all of this,” she said. “We can’t measure a lot of things that we would like to.”
