"The stupidest ... bill I've ever seen:" Orin Hatch's healthcare legacy
Friday Pulse Check
Good morning everyone and happy Friday.
This is the Friday Pulse Check, which is typically a weekly newsletter sharing some of the most interesting health and healthcare news stories from the past week.
In the news:
Medicare Advantage plans are denying eligible and necessary care
The inspector general’s office for the US Department of Health and Human Services this week released a report finding that tens of thousands of seniors with Medicare Advantage plans have had improper denials of coverage. The IG estimates that as many as 85,000 requests for prior authorization were improperly denied in 2019 and that MA plans refused to pay roughly eighteen percent of legitimate claims. Most frequently denied were MRIs and CT scans.
We will likely have more analysis on this story next week.
Moderna submits an emergency use authorization request for its COVID-19 vaccine for young children
The dose size of the children’s vaccine is about a quarter of that which adults would receive and in clinical trials it was demonstrated to be effective at protecting against symptomatic COVID-19 infections. It could be available as early as next month, and it is for children ages six months to six years. Pfizer is also expected to submit data on its third COVID-19 vaccine dose as well.
GOP healthcare policy evolution as demonstrated by the late Sen. Orin Hatch
The former Utah Republican had an interesting history of public health policy positions. He helped create the Hatch-Waxman Act which allowed the approval of generic versions of drugs. He helped develop the Americans with Disabilities Act. While he opposed a federalized healthcare system and called the Affordable Care Act “the stupidest, dumb-ass bill that I've ever seen” (which he later apologized for saying), he also helped develop the Children’s Health Insurance Program. You can read more about him and his healthcare legacy from Kaiser Health News and NPR.
The Anatomy of Big Insurance
This week on the podcast, Ron and I discussed the omnipresent “Big Insurance.” Like Big Tech, Big Pharma, and Big Banks, Big Insurance is not going anywhere any time soon. I often hear, especially during election years, about the need to break up Big Insurance, reform it, or outright abolish it and replace it with another system. Unfortunately, without completely destroying what we already have and building from scratch, I don’t think that is possible.
Some might argue that building from scratch isn’t such a bad idea. Well, perhaps in the real world they are right. In the world of Big Government, however, it could prove catastrophic. We couldn’t count on DHHS to set up an online portal for No Surprises Act disputes by a January 1 deadline. How are we supposed to rely on the Federal Government to have a completely new healthcare and insurance structure set up on time, much less all the necessary details to make it work (ID cards, websites, patient portals, provider portals, claims processing systems, etc)? I know we have Medicare, but to expand it to everyone in the country who has private health insurance (or not) is a big undertaking. So, I believe Big Insurance is here to stay for a while.
Now, it is no secret that healthcare costs a lot, and Big Insurance, in many ways, plays a role in that cost. Ron and I discussed some potential prescriptions to bring the costs down in healthcare. I pulled these from a 2018 article by economist and historian John Steele Gordon. He proposes three things that I ran by Ron and we discussed.
1. Mandate transparent pricing (Gordon argues this would force competition, which would bring down prices)
2. Reform malpractice lawsuits (Gordon says we should adopt the common-law rule that the loser pays for the entire thing)
3. Ensure that patients care about the cost of healthcare (hey, that kinda sounds like one of the points of the FLATLINING Podcast and the Friday Pulse Check)
4. Recognize that there isn’t a cure for old age
These are all interesting ideas that can and should be debated. With the opposition virus still running rampant in Washington, I don’t think we can expect any discussion on these soon. You can hear some discussion, however, on the FLATLINING Podcast and if you want to hear Ron’s novel idea on how to reform malpractice law, you should take a listen.
We also want to hear your ideas. What do you think about Gordon’s proposals for lowering the cost of healthcare? Does your practice publish prices on your website? Do you have other ideas for how to lower costs in your specialty? Let us know in the comments below, send us an email at firstname.lastname@example.org, or Tweet me or Ron Howrigon.
On Thursday, President Biden requested another $33 billion aid package for Ukraine. This will have to be approved by Congress and I expect at least most of it will. One question that gets asked and not usually answered is where does all that money go? A lot of it goes to things you would expect for war aid (weapons, military vehicles, communications systems, satellite imagery services, etc). In the 21st century, however, a lot also goes to humanitarian aid. The Hill (via Yahoo News) broke down just how much money has gone where from the US government in Ukraine (including a surprising amount for antiretroviral drugs).
Thank you to all who have subscribed and read the Friday Pulse Check each week. Be sure to forward it and share it with your friends so we can continue to grow and expand this newsletter and website. Thanks to everyone who also subscribes to the FLATLINING Podcast. Ron and I are excited and humbled that anyone would take the time to listen to us talk for an hour each week. We hope it is a good service to you and that if you like it, you will also pass it along.
Have a good weekend,