Latest Blog Posts & Articles


Party First, Ideology Later

We think of political parties as being ideological homes. If you embrace conservative ideas, you gravitate to the Republican party, and so on.

But probably just as often, people have party homes (“My dad was a Dem, and so am I”), in which whatever the party embraces magically fits their ideology. Consider the following picture of people’s attitudes towards free trade. Long a conservative (thus Republican) favorite, now that Trump dislikes free trade, so do many Republicans:

Too often people believe first and think later!

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Burdened by High Medication Costs? Your Boss May Be Able to Help

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Pharmaceutical companies have been charging way too much for way too many of their products. Both Donald Trump and Hillary Clinton complained about drug prices during the election campaign, but neither political party has taken action since November to tackle the problem. Insurance companies aren’t doing much about this problem either, despite having a huge incentive to tackle high prices.

But there is someone who appears to be up to the challenge – employers. According to a recent study in the New England Journal, a consortium of 55 Catholic organizations decided to redesign their employee healthcare benefits in 2013. Before that time, these organizations provided their employees with tiered co-pays for their medications. Under formulary tiers, a patient might pay $10 a month for generic drugs, $25 a month for brand-name drugs, and $100 or more per month for expensive specialty drugs and biologics. Tiered formularies are designed to motivate patients to use less expensive medications, because they carry lower co-pays. But such formularies are usually blunt motivational instruments. They might convince a patient to choose a generic medication rather than a brand-name cholesterol pill, but the patient will have no further incentive to choose the least expensive generic medication. Similarly, a patient with rheumatoid arthritis will face a significant co-pay for a biological therapy, but that co-pay won’t change from one biologic drug to another, even if those drugs have very different price tags.

That’s where reference pricing comes in, a topic I have written about before. The Catholic organizations got together and looked at different categories of medication, and decided how much they would pay for drugs within each category, with the understanding that patients would pick up the rest of the tab. For example, medications for stomach reflux range in price from $26 a month to almost $300 a month. The employers promised to cover $26 of the cost of whichever reflux medications patients chose to take. Similarly, patients who wanted to take $400 nasal inhalers for their allergies could go ahead and do that, but the insurer would only cover $34 of that price, given that an equally effective inhaler was available at that price.

(To read the rest of this article, please visit Forbes.)

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Love This Picture

I had the great pleasure of talking about out-of-pocket healthcare costs at Periodic Tables: Durham’s Science Café, a speaker series run by The Program for Science and Society at Duke University. The crowd was absolutely awesome, and much larger than I expected, given that I was speaking at the same time that Duke’s number one rated men’s basketball team was taking on Michigan state’s number two ranked team.

I also love the advertisement they put together for the program. I wonder if I should use this art on my next book.

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Obesity Nation!

Here is a picture, courtesy of the Financial Times, showing obesity rates among OECD nations. Only 5% of people living in Korea and Japan qualify as obese. Yet obesity rates are drastically higher in the United States; if someone’s in American, there is practically a 4 in 10 chance they are obese.

Not something to be proud of.

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Why Investing in Better Primary Care Failed to Save Money

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We have a huge healthcare problem in the U.S., spending way more than other wealthy countries, expenses that not only burden state and federal governments, but that also take money out of American pockets.

Some people hope that better primary care will reduce U.S. healthcare spending. They point out that a small number of chronically ill patients—super-utilizers—account for half of healthcare spending. The hope is that taking better care of these super-utilizers, with more robust and improved care coordination, will improve their health and reduce healthcare spending.

Or perhaps not. When the Palo Alto VA tested an intensive primary care program for its super-utilizers, healthcare spending and utilization didn’t budge. One iota. Except for primary care utilization which, unsurprisingly, rose significantly among people receiving intensive primary care.

The Palo Alto study was well-designed. The researchers targeted patients who were in the top 5% of healthcare utilization. These patients were typically elderly, and on average had 10 chronic health conditions. Two-thirds carried mental health diagnoses, and a quarter had a history of homelessness. The population included people I am very familiar with from my almost 20 years in the VA: older men with PTSD and anxiety; hypertension, diabetes, coronary artery disease, congestive heart failure, emphysema, and a touch of renal failure; recent hospitalizations for pneumonia, leg wound infections, or maybe a mild stroke.

(To read the rest of this article, please visit Forbes.)

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Generic Doesn‘t Mean Affordable

Generic meds are supposed to be relatively cheap; multiple companies can make the same molecule, leading to price-lowering competition.

But that’s not always what happens in the US market. Look at the prices of these generics, in the US vs Canada:

We need to take regulatory or legislative steps to reduce the price of generic medications.

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Got a Big Belly? (Why Big Sugar Is to Blame)

Growing up Republican, I have long believed in personal responsibility. In junior high school, when I observed close relatives who struggled with obesity, I vowed to never let myself get out of shape. (“Junior high” is what we called middle school back in the day.) When hip surgery gone wrong dramatically reduced my level of physical activity two and a half years ago, I cut back on what I ate to keep from gaining weight. In fact, I believe that much of our nation’s obesity epidemic comes down to personal responsibility—if people ate less and exercised more, we’d be a healthier nation.

But there is another culprit who deserves blame for American obesity—the sugar industry, which, for decades, bamboozled the American public about the dangers of its product .

My ire at big sugar was stoked by a study published in JAMA Internal Medicine analyzing correspondence from the Sugar Research Foundation (SRF) in the 1960s and 70s. In the late 50s, the sugar industry recognized that people’s concerns about the connections between cholesterol and heart disease provided them with an opportunity to tout the “no fat” benefits of sugar. By 1962, however, the industry recognized that high sugar intake could increase cholesterol levels, too.

(To read the rest of this article, please visit Forbes.)

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The Biggest Problem with Obamacare? People Didn’t Know What the Law Accomplished!

Obamacare dramatically reduced the number of people in United States who lack health insurance. Reduced as in: brought the proportion down to historical lows. Yet very few Americans knew this about the law, which is part of the reason why so many people didn’t like Obamacare. Here’s evidence to back up that connection, from the Kaiser Family Foundation:

Hard to like a law that hides its best features.

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What do people want Trump to do with our healthcare system?

Here’s a picture from the Kaiser Family Foundation from late last year, showing what people want done to improve the US healthcare system:

Plenty of work to do!

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Medical Malpractice – Who’s Being Sued and What Is It Costing

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A baby is born. The delivery was rocky, with the infant’s heart rate showing occasional signs of distress. Later, the parents learn that their child has cerebral palsy, and may never walk normally. Was the obstetrician to blame and, if so, should the parents sue?

American medical care is burdened by a flawed and expensive malpractice system. Too many doctors are being sued not because they make mistakes, but because their patients experience bad outcomes.

A fascinating study lays out recent trends in malpractice, offering good and bad news for physicians. First, the good news: malpractice claims are declining. The rate of paid claims, in fact, went down more than 50% from the early 90s until now.

(To read the rest of this article, please visit Forbes.)

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