I can’t make up this stuff.
I am on several listservs that publish medical news items. I understand that there are probably several staffers that contribute to the daily blasts, not knowing what the others are doing. But I assume there is still some sort of editor that makes sure the entire message has some coherence. These messages appeared in one recently, with these 2 articles coming one right after the other:
There is no transition. There is no recognition that faster access to drugs and devices in the second article will adversely impact the cost of healthcare mentioned in the first article. There is no recognition that many of the therapies that will likely be fast tracked in the second article will be later found to be ineffective. Dr. Vinay Prasad conducted a great analysis showing how this is often the case with cancer drugs, which will assuredly be some of the “innovative therapies” whose approval will be fast tracked.
Five percent health insurance inflation is roughly double the general inflation and wage growth rate of about 2.5%. The cost problem keeps getting worse and CMS continues to be part of the problem. However, with the ridiculous toxicity of Washington politics these days, there is probably little the administrators of CMS can do about this.
Sad, very sad.
Glad you referenced Vinay Prasad. I’m a big fan and particularly liked the recent edition of his podcast “Plenary Session” where he interviewed Bishal Gyawali. I think you’d relate to how they talk about some things are just common sense (like what you said above about rising costs) yet go unrecognized.
I also liked their talking about a “cancer groundshot.” It’s just horrible that effective cancer strategies that DON’T cost hundreds of thousands a year are so unavailable in low and middle-income countries and to so many in our high-income country.
But our system effectively maximizes what it cares about, profits. Its architects don’t care if the profits are for ineffective drugs and they don’t care if it eats up all other spending.
The two articles are not at all incongruous. If the portion payed by an employer is static, the consumer will pay the difference, meaning more if higher. The aggregate cost of care is not capped. Most employer sponsored plans have a sum cap on copays and deductibles. There is an insurance component that deals with catastrophic costs, much like auto or homeowners insurance does.
Medicare’s intent when enacted in 1965 was to minimize poverty among people unable to work due to age or health limitations and it has served that purpose, though at a high price. There has always been divided opinion over what should or should not be paid. Vision, hearing, and chewing are important health needs but are severely limited in benefits. What is worth paying for, especially in large amounts, also has some divided opinion. The first and to this day only universal health insurance in America has been for End Stage Renal Disease. How much innovation is considered worthwhile changes. Everyone gets lens implants. I’ve not seen a keyhole iris or aphakia lenses since I was a resident. Colon cancer screening is no longer a finger putting a specimen on a guiac card with each hospital h&p. Whether expensive immunotherapy for certain malignancies should be included when the lifespan extends by a few months seems to be partly a medical branch point and partly an ethical one, but there have always been payments for toxic chemotherapy of limited value.
You’re right that they are actually connected. I’m sure you understood my point that even people who report or synthesize health system information don’t seem to be able to connect the dots.