from a policy standpoint, Medicare-for-All is probably the hardest way to get there. In fact, a number of experts who tout the benefits of single-payer systems say that the Medicare-for-All proposals currently on the table may be virtually impossible to enact. The timing alone would cause serious shocks to the system. Conyers’s House bill would move almost everyone in the country into Medicare within a single year. We don’t know exactly what Bernie Sanders will propose in the Senate, but his 2013 “American Health Security Act” had a two-year transition period. Radically restructuring a sixth of the economy in such short order would be like trying to stop a cruise ship on a dime.
Unleashing the technology of health care is another salient argument for repealing Obamacare. In “The Patient Will See You Now: The Future of Medicine in Your Hands” (2015), Eric Topol (also interviewed in this compelling EconTalk podcast by Russ Roberts) describes the revolutionary changes in health care driven by the democratization of data, a veritable “Gutenberg Moment” in which people are empowered with information through their smartphones just as they were with books from the printing press. Presently the government is in the center of health care, but it should be the individual consumer instead.
The National Business Group on Health said Tuesday the percentage increase large companies will see next year is similar to 5% cost increases employers have experienced for five years. In its annual survey of large employers, NBGH says per employee costs are projected to increase 5% to $14,156 in 2018 compared to $13,482 per employee this year . Since employers generally cover about 70% of worker costs, employees’ 30% share next year will be nearly $4,400, which includes premium and out-of-pocket expenses
Drug Channels: Follow the Dollar Math: How Much Do Pharmacies, Wholesalers, and PBMs Make From a Prescription?August 8, 2017
Yesterday,The Wall Street Journal published an intriguing article by Jonathan Rockoff titled Behind the Push to Keep Higher-Priced EpiPen in Consumers’ Hands.
The article includes a graphic attributed to me (cited as Pembroke Consulting). It shows that the drug channel—pharmacy benefit managers (PBMs), wholesalers, and pharmacies—receive more than $37 in gross profit for a brand-name drug with a $300 list price. PBMs capture about half of this amount.The WSJ article doesn’t describe how I arrived at the figures. But now you, Drug Channels reader, will get the inside scoop.
We find that where a doctor received his/her initial training matters in terms of predicting how likely they are to prescribe opioids: physicians trained at the lowest ranked US medical schools prescribe nearly three times as many opioids per year as physicians trained at the top medical school. This striking inverse relationship reflects two factors: (1) physicians from lower ranked medical schools are more likely to write any opioid prescriptions; and (2) conditional on being an opioid prescriber, physicians for lower ranked medical schools write more opioid prescriptions on average. This prescribing gradient is particularly pronounced among GPs. Our results demonstrate that if all GPs prescribed like those from the top ranked school, we would
have had 56.5% fewer opioid prescriptions and 8.5% fewer deaths over the period 2006 to 2014.
Full text: http://www.nber.org/papers/w23645.pdf
Anthem announced it will back out of Nevada’s ObamaCare market next year, leaving most rural Nevada counties without a single ObamaCare insurer in 2018.
The insurance company also plans to cut its Georgia presence in half, and has already withdrawn from Ohio, Indiana, Wisconsin, and much of California.
“This is a significant blow to the state’s individual market,” Nevada Gov. Brian Sandoval (R) said in a statement. He added that he is “frustrated and disappointed” by Anthem’s “surprise and abrupt decision to leave the healthcare exchange.”
As many as 868,000 people nationally could lose coverage next year if the insurance companies planning to leave the Affordable Care Act markets do so. Seventeen counties nationally, 14 of them in Nevada will completely lose options in the Affordable Care Act next year.
On health care, the president has made it clear that he does not care what is in a bill to repeal and replace Obamacare, so long as he can say he achieved that goal. At various points, he was for the House repeal-and-replace plan, for the clean “repeal-and-delay” bill that Republicans passed in 2015, and for Senator Mitch McConnell’s last-ditch “skinny repeal” plan, which really was just a repeal of the tax penalties enforcing the Affordable Care Act’s individual mandate. When the Senate bill failed last week, it was clear that even if a bill did ever emerge from a House-Senate conference, it couldn’t pass in the Senate with major Medicaid reforms or with any real replacement of the major subsidy provisions of the ACA. Republicans are now saying “we were so close” to achieving victory, but the “skinny repeal” plan was the only thing that came close. And that shows the GOP is not, in fact, close to agreement on a workable plan to replace the ACA.