Coping with "Medicare for all"

Yikes! I had no idea that things had gone to that level of insanity, except in California. It seems that people, in need of “meaning”, will do anything to stand out/be special. When I grew up, “being special” apparently means the same thing as it does today.

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By continuing the government “covid health emergency”, the current admin is keeping large numbers of possibly ineligible people in the Medicaid rolls (instead of having them get ACA coverage or whatever). They aren’t checking Medicaid eligibility and are automatically continuing benefits.

Much of [states] con­cern fo­cuses on Med­icaid, which pro­vides health cov­er­age for the low-in­come and unin­sured. Con­gress ap­proved ex­tra fed­eral funds to states for the pro­gram dur­ing the pan­demic, but states had to agree not to oust any­one from Med­icaid dur­ing the pub­lic-health emer-gency. Typ­i­cally, there is lots of churn in Med­icaid as en­rollees move in and out of the pro­gram due to fluc­tu­at­ing in­comes. The dis­en­roll­ment pro­hi­bi­tion has helped drive Med­icaid en­roll­ment to a record 85 mil­lion peo­ple, an in­crease of 19% since the start of the pan­demic.

“By keep­ing the pub­lic-health emer­gency ex­tended, they’ve made the prob­lem worse,” said Brian Blase, pres­i­dent of Paragon Health In­sti­tute, which an­a­lyzes gov­ern­ment health pro­grams and poli­cies. “It’s a huge amount of gov­ern­ment waste in spend­ing.”

An es­ti­mated 8% of en­rollees in West Vir­ginia could be ousted, based on a Kaiser Fam­ily Foun­da-tion sur­vey, and as many as 30% of en­rollees in Hawaii.

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That sounds like a great campaign slogan. At least he’s not claiming credit for creating it. :smile:

Here’s some commentary on political rumblings in drug pricing. PBMs are basically middlemen between the insurance / drug companies and the pharmacies, and have been used by bigger companies as a vertically integrated step in the drug supply chain where they can extract excess profits without having to share that with the pharmacies (not all of whom are owned by the larger company that owns the PBM).

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key Congressional members have doubled down on their call for the FTC to investigate the Pharmacy Benefit Manager (PBM) industry in recent days. “PBMs are really concerned,” a government relations official in the PBM industry told CTFN.

The same official explained that due to Democrats’ failures in their drug pricing efforts in recent years, they appear to now be looking at what executive agency options are available to provide some sort of win to point to ahead of midterm elections.

Of course

On May 24, Senators Charles Grassley (R-IA) and Maria Cantwell (D-WA) introduced the “Pharmacy Benefit Manager Transparency Act of 2022” which would provide the FTC the authority to require and enforce reporting from PBMs, as well as the authority to seek civil penalties for violations.

With greater bipartisan Congressional momentum around the issue, the chances of an FTC investigation into the industry has increased, according to an FTC official who spoke with CTFN.

An FTC 6(b) study of PBMs, which failed to pass the commission in February with a 2-2 vote, would require companies to turn over pertinent information to the agency –– something FTC Chair Lina Khan has stated is a “top priority” during her tenure.

The government relations official suggested a current lack of transparency in the industry leaves Congress unable to successfully pass meaningful PBM drug pricing reform.

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Review of CBO’s comments on Medicare for All.

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I am so perplexed about how prescription drug pricing and insurance works. I swear there is no way to make sense of it as a consumer.

Here’s a nice 5 min video that explains it.

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Didn’t help. Doesn’t explain why I get better drug prices with free goodrx vs my high deductible health insurance from anthem.

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It’s maddening to me that we could all be in line at CVS for the same drug but each pay different prices. That may be ok with hotels or airlines, but it seems sinister for a lifesaving medicine.

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My most recent maddening experience went like this. This is all for the same drug:

  • Pay $119.82 at CVS or Kroger with Anthem - Blue Cross Blue Shield HDHP ($450/mo for family coverage)
  • Pay $57.89 at CVS with GoodRX Free or $55.03 with GoodRX Gold ($10/mo)
  • Pay $42.75 at Kroger with GoodRX free or $30.29 with GoodRX Gold
  • Pay $210.56 at Kroger with GoodRX Gold or $119.77 with Anthem because they abruptly stopped accepting GoodRX
  • Pay $50.40 at Publix with GoodRX free (no further discount for Gold)

These price changes and switches all happened over the course of 5 months.

Cash prices at Costco are often cheaper than using my Bronze ACA plan.

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I see that in the GoodRX app. $44.27 at costco for the same meds, no GoodRX card needed, but you do get $5 off on your first fill with GoodRX. Wish Costco was closer and a membership was worth it.

I understand the demon that is a PBM, and this probably won’t make you feel better, but …

A daily Spiriva inhaler costs over $430/month thru HDHP and most discounted drug plans/cards. That same exact Spiriva inhaler costs ~$40/month when purchased in Canada. I mean from a real Canadian pharmacy, and not one that advertises as a Canadian pharmacy, but ships from India, Pakistan, Ukraine, China, etc.

At those prices, it makes sense to rent a car, drive to Canada, see a Canadian doctor for the prescription, fill it at Costco, and drive home.

CA priorities - crime not so much, encouraging more illegal immigration makes the cut to the tune of $3B/year.

The allocation will give an estimated 764,000 people free healthcare coverage for $2.7 billion annually beginning 2024 under the budget provision’s expanding of the state’s Medi-Cal coverage.

Across the country, federal and state governments currently provide free healthcare to low-income residents through Medicaid, but it excludes illegal immigrants. Newsom’s provision will make California the only state to offer free healthcare regardless of citizenship status.

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It will give Medical tourism a new meaning for the rest of the world. :slight_smile:

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The values of Diversity and Incompetence are infesting the medical schools, their students and their classes, and driving out qualified students in favor of activists. Testing standards are being waived or drastically lowered for favored minorities.

Backup link

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In June 2020, the journal Nature identified itself as one of the “white institutions that is [sic] responsible for bias in research and scholarship.”

And I’m sure they did the “responsible” thing and immediately hired black people to take each of their jobs.

The testing issues are a real concern, and I feel sorry for my descendants, as well as the students who are being told that they are good enough, or as Charles Osgood might say, pretty good.

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Regression to the mean. Achieve health equality by teaching doctors to be something other than doctors, so that everyone’s health outcomes become equally bad. If you cant treat and get the same results everyone, then treat no one.

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Get ready for higher drug prices if you’re not on Medicare. They get the price controls / subsides, you get the shaft.

Democrats who passed the Schumer-Manchin bill on Sunday voted to raise drug costs and health premiums for 220 million privately insured Americans. That isn’t hyperbole. It’s the inevitable economic result of Medicare drug price controls after the Senate parliamentarian this weekend struck the bill’s inflation rebates. If drug makers must give Medicare steep discounts on certain drugs, they will compensate by increasing prices in the commercial market

Democrats know their Medicare take-it-or-leave-it drug “negotiations”—i.e., price controls—could have spill-over effects on the commercial market. This was one argument they made to the Senate parliamentarian for keeping the bill’s requirement that drug makers pay Medicare rebates if they raise prices in the commercial market higher than inflation.

More on that topic, on the costs of non-drug-development due to the bad incentives created.

Democrats would impose a 95 percent excise tax on prescription drugs unless drug manufacturers accept government price controls.

In reality, all drug manufacturers would accept the price controls or stop selling the drug in the U.S. market entirely rather than pay the 95 percent tax.

This provision would restrict U.S. medical innovation and limit the supply of new medicines.

Price controls never work because they cause supply shortages. CBO warned the reduction in manufacturers’ revenue could be as high as $1 trillion over the next ten years and would “lower spending on research and development and thus reduce the introduction of new drugs.”

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Disparities in competence in med school

analyzed faculty evaluations of internal medicine residents in such areas as medical knowledge and professionalism. On every assessment, black and Hispanic residents were rated lower than white and Asian residents. The researchers hypothesized three possible explanations: bias in faculty assessment, effects of a noninclusive learning environment, or structural inequities in assessment.

University of Pennsylvania professor of medicine Stanley Goldfarb tweeted out a fourth possibility: “Could it be [that the minority students] were just less good at being residents?” Goldfarb had violated the a priori truth. Punishment was immediate.

Admissions aren’t racist enough

medical schools use wildly different standards for admitting black and white applicants. From 2013 to 2016, only 8 percent of white college seniors with below-average undergraduate GPAs and below-average MCAT scores were offered a seat in medical school; less than 6 percent of Asian college seniors with those qualifications were offered a seat, according to an analysis by economist Mark Perry. Medical schools regarded those below-average scores as all but disqualifying—except when presented by blacks and Hispanics. Over 56 percent of black college seniors with below-average undergraduate GPAs and below-average MCATs and 31 percent of Hispanic students with those scores were admitted, making a black student in that range more than seven times as likely as a similarly situated white college senior to be admitted to medical school and more than nine times as likely to be admitted as a similarly situated Asian senior.

But MCATs are too racist, since the wrong minorities do well on them and the right minorities do poorly. This after years of anti-racist scouring of the MCAT for biased questions failed to turn up or change outcomes.

MCAT questions with the largest racial variance in correct answers are removed. External bias examiners, suitably diverse, double-check the work of the internal MCAT reviewers. If, despite this gauntlet of review, bias still lurked in the MCATs, the tests would underpredict the medical school performance of minority students. In fact, they overpredict it—black medical students do worse than their MCATs would predict, as measured by Step One scores and graduation rates. (Such overprediction characterizes the SATs, too.) Nevertheless, expect a growing number of medical schools to forgo the MCATs, in the hope of shutting down the test entirely and thus eliminating a lingering source of objective data on the allegedly phantom academic skills gap.

Noticing that bad candidates make bad doctors be racist, and at the point they’re admitted, at least with these wildly unqualified standards, it’s too late to have them catch up during medical training.

The academic skills gap, confirmed in every measure of knowledge before and during medical school, does not close over the course of medical training, despite remedial instruction. Yet the lower representation of blacks throughout the medical profession is solely attributed to racism on the part of the profession’s gatekeepers.

Your tax dollars will pay for unqualified minority doctors, faculty, and research grants.

The NIH and the National Science Foundation are diverting billions in taxpayer dollars from trying to cure Alzheimer’s disease and lymphoma to fighting white privilege and cisheteronormativity. Private research support is following the same trajectory. According to the NIH, leadership of cancer labs should match national or local demographics, whichever has a higher percentage of minorities. The HHMI program and others like it amplify the message that doing basic science, if you are white or Asian, is not particularly valued by the STEM establishment. How many scientific breakthroughs will be forgone by such signals is incalculable.

In May 2022, a physician-scientist lost her NIH funding for a drug trial because the trial population did not contain enough blacks. The drug under review was for a type of cancer that blacks rarely get. There were almost no black patients with that disease to enroll in the trial, therefore. Better, however, to foreclose development of a therapy that might help predominantly white cancer patients than to conduct a drug trial without black participants… If race does not exist, as received wisdom now has it, then the racial makeup of clinical trials should not matter.

Conclusions

The proponents of the systemic racism hypotheses are making a large bet with potentially lethal consequences. In accordance with the idea that racism causes racial health disparities, they are changing the direction of medical research, the composition of medical faculty, the curriculum of medical schools, the criteria for hiring researchers and for publishing research, and the standards for assessing professional excellence. They are substituting training in political advocacy for training in basic science. They are taking doctors out of the classroom, clinic, and lab and parking them in front of antiracism lecturers. Their preferential policies discourage individuals from pariah groups from going into medicine, regardless of their scientific potential. They have shifted billions of dollars from the investigation of pathophysiology to the production of tracts on microaggressions.

The evidence is clear - if you can’t get an old doctor, before the medical admissions and licensing standards were corrupted, at least get a white or asian one who is statistically likely to be much more qualified. Thanks to the anti-racist zealots, if you’re not being racist in selection of your doctor, you’re getting substandard care.

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