Unbiased Analysis of Today's Healthcare Issues
According to a paper by Garrison and Towse (2023) in Health Affairs Forefront the answer is ‘no’. I agree with them. Here is the rationale: …this request for R&D cost information reflects a fundamental misunderstanding of the economics of the regulated US and global pharmaceutical marketplace. Writing in this journal in 2004 on the pros…
That is the topic of a Health Affairs Forefront article (Sullivan et al. 2021) out today which is addresses the topic. The issue is particularly relevant as the Inflation Reduction Act (IRA)’s has a de facto ban on QALYs for use in setting a drug’s maximum fair price (MFP). The authors discuss some alternatives: The…
That is the summary takeaway I had form reviewing the 91 page CMS guidance on the Inflation Reduction Act (IRA) maximum fair price (MFP) negotiation released about 10 days ago. Below, I summarize some of the key findings. SELECTING DRUG FOR PRICE NEGOTIATION Unsurprisingly, CMS is looking for the highest cost drugs among the 10…
Medicare Part D has had a very odd benefit structure. First, you have a deductible with no coverage; then you get some coverage, then there is a coverage gap or “donut hole” with no coverage and finally there is very generous coverage in the ‘catastrophic phase’. This structure was espeically problematic for patients with high…
Part of the Affordable Care Act mandated a medical loss ratio (MLR) for health plans in the individual and small group markets. What this means is that if the MLR is 80% and insurers charge $100 in premiums, plan enrollees must receive $80 in services on average. If they do not (say they only receive…
Since its inception in 2006, Medicare Part D beneficiaries had to contend with the dreaded “doughnut hole”. The “doughnut hole” is a coverage gap during which patients were required to pay 100% of treatment cost. To help defray some of these costs, the Patient Protection and Affordable Care Act (ACA) implemented provisions to reduce the…
According to a recent paper by Kim and Koh (2022), the answer is ‘yes’. Using data from BRFSS and PSID, the authors use a difference-in-difference strategy which identifies the impact of health insurance on subjective well being using two policy changes: (i) the Massachusetts health insurance mandate implemented in July 2007 and (ii) the Affordable…
A paper by Lurie et al. (2021) provides the answer. They reach four conclusions from their analysis: First, the actual penalty paid per uninsured month is less than half the statutory amount. Second, nonetheless, we find visually clear and statistically significant responses to both extensive margin exposure to the mandate and to marginal increases in…
No, that is not a typo. The cost of Bernie Sanders Medicare-for-All (M4A) plan is $13 trillion dollars. How does this stack up to other candidates? The Committee for a Responsible Federal Budget does the math. Whereas Mr. Sanders plan would cost $12.95 trillion between 2021 and 2030, Mrs. Warren’s plan would cost $6.1 trillion,…
A nice overview is provided by Johnson, Kishore and Berwick (2020). They review the HR13841 and S 1129.8 in detail [Note: HR 1384 and S 1129 were also proposed in the last Congressional session and they have an overview of that as well] HR 1384 and S 1129 both establish a single payer federal insurance…