The Sleeper Health Cost Policy

In this Axios column, Drew Altman unpacks President Biden’s recent executive order on promoting competition, exploring its significance for new efforts to control health costs by addressing consolidation in the health care industry.

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Why Drug Price Negotiation Has Staying Power

In this Axios column, Drew Altman looks beyond Medicare to what’s at stake for employers and workers in the debate about the government negotiating drug prices.

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Persistent Vaccine Myths

With news that the country has now vaccinated half of its population with at least one dose, This Drew Altman Axios column highlights the persistent COVID-19 vaccine myths that are believed by a substantial portion of the unvaccinated population and discusses the options to address vaccine misinformation.

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We aren’t getting a national vaccine ‘passport.’ So let’s use the next best thing: CDC vaccination cards.

In this op-ed for The Washington Post, Drew Altman suggests a way out of the heated debate about a COVID-19 vaccination passport to help provide clarity about who is vaccinated and who still ought to wear masks in public spaces or the workplace by using something that already exists– CDC vaccination cards.

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Corporate Leaders Are Getting Bullish On Government Action On Health Care Costs

In this Axios column, Drew Altman explores whether the long struggle with rising health costs has caused the tide to turn in corporate leaders’ attitudes towards government involvement in controlling health spending and whether it is part of a larger shift in comfort with government action to solve problems.

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Why Doctors and Nurses Can Be Vital Vaccine Messengers

In this Axios column, Drew Altman examines why doctors and nurses are such critical messengers in the effort to build vaccine confidence.

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                    [post_content] => A shorter version of this column has been published by Axios.

Presidents Biden’s Executive Order instructing agencies to develop policies to promote competition in the economy hasn’t received much attention, but could lead to new efforts to control health costs if his administration and Congress respond with measures to stem consolidation in the health care industry and promote competition to drive down prices.

The research is clear that consolidation in the hospital industry drives up costs, in some cases by as much as fifty percent. Perhaps surprisingly consolidation generally does not  improve quality of care. Insurers and employers are not in a position to bargain for lower prices with hospitals or to establish narrower networks they believe deliver greater value when one or two hospital systems are the only games in town and own most of the medical practices.

Mergers led to more consolidation even before COVID hit, with two thirds of hospitals in a system, and most metropolitan areas already deemed highly concentrated hospital markets. Private equity firms were behind many of the mergers. The pace of mergers is likely to pick up with the bigger fish eating the smaller ones as COVID has made smaller and rural hospitals and smaller medical practices more fragile.  With the cat party out of the bag on market consolidation there isn’t a lot of time to waste.

The FTC and the DOJ’s Anti-Trust Division lack the staff to examine most mergers and in some cases the authority needed to ensure that markets remain competitive. While they can review mergers, they do not generally have the authority to intervene, for example, to stop non-competitive practices by non-profit hospital systems.  Fifty seven percent of all hospitals are technically non-profit, including some of the largest health systems in many parts of the country.  FTC also lacks the authority to monitor the hospital acquisitions of large numbers of smaller practices which individually fall under the threshold for requiring notification of the FTC. States face a similar array of limitations to their authority.

The Executive Order establishes a White House Competition Council, but it is vague on what actions might follow in health. Either it or a private effort could productively review FTC, D0J and state authority and capacity and make recommendations for administrative and legislative actions. HHS Secretary Xavier Becerra made his name in health, in part, by going after Sutter Health for its anti- competitive pricing practices as Attorney General in California and could play a central role in such an effort.

Of course, the hospital industry would fiercely resist any effort to beef up anti-trust action and promote competition to drive down prices. Hospitals have been sitting on the sidelines happily watching policymakers go after drug costs. But drugs represent ten percent of health spending while hospitals represent thirty four percent.

A more aggressive policy aimed at anti-competitive mergers and consolidation in the hospital industry would aim right at high hospital prices that drive up health spending. And while the industry would resist it, it might appeal to both Democrats who favor regulation and Republicans who favor competitive markets. Depending on follow through, the Biden executive order could be a sleeper health cost policy.
                    [post_title] => The Sleeper Health Cost Policy
                    [post_excerpt] => In this Axios column, Drew Altman unpacks President Biden’s recent executive order on promoting competition, exploring its significance for new efforts to control health costs by addressing consolidation in the health care industry.
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A shorter version of this column has been published by Axios.
  The fact that prescription drugs represent just 10% of national health spending may make it seem like not an especially important target for health care cost containment efforts. But the idea keeps coming back and is in the spotlight on Capitol Hill right now. One reason is the 10% number doesn’t tell the full story. Retail drug spending represents 18% of health benefit costs for large employers, even after taking rebates from drug manufacturers into account. They also represent 19% of out of pocket costs for Medicare beneficiaries and 17% of out of pocket costs for workers. Especially hard hit are people in fair or poor health who use more drugs. 49% of that group say they have difficulty paying for their drugs. There’s been much focus in Washington on how much Medicare negotiation of drug prices could save the federal budget, and what those savings could be used to pay for. Yet, what makes drug price negotiation a powerful idea – with bipartisan support from more than 80% of the public – is not the budgetary savings policymakers covet. It’s the potential to lower costs for patients and businesses paying for health benefits. HR 3 and the principles for drug cost legislation recently released by Senator Wyden would give employer plans and privately insured people access to government negotiated prices, in addition to Medicare and its beneficiaries. Polling shows that criticisms made by industry that drug price negotiation could reduce the availability of drugs and research and development on new drugs could erode support. But those criticisms have been made for years and have not sunk in. The staying power of the idea and the number of people who would benefit continues to drive many Democrats to try to get drug price negotiation passed. That’s also why PhRMA will oppose these proposals with everything at its disposal. Meanwhile there is one incidental winner from the current debate about drug costs, America’s hospitals. They represent 31.4% of health spending and the focus on drug costs keeps them out of the crosshairs.
[post_title] => Why Drug Price Negotiation Has Staying Power [post_excerpt] => In this Axios column, Drew Altman looks beyond Medicare to what’s at stake for employers and workers in the debate about the government negotiating drug prices. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => why-drug-price-negotiation-has-staying-power [to_ping] => [pinged] => [post_modified] => 2021-06-25 05:49:30 [post_modified_gmt] => 2021-06-25 09:49:30 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=526561 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 523549 [post_author] => 36621681 [post_date] => 2021-05-26 05:00:39 [post_date_gmt] => 2021-05-26 09:00:39 [post_content] => A shorter version of this column has been published by Axios. Big myths about COVID vaccines are showing real staying power among Americans who are not vaccinated. They are not the only factor fueling vaccine hesitancy, but they are a continuing problem the media, health leaders and trusted messengers ought to be able to chip away at to get more people vaccinated. With social media rife with misinformation, large shares of unvaccinated Americans have latched on to misbeliefs about the vaccines. One big myth with legs is that the vaccines themselves cause COVID. 36% of unvaccinated adults either believe this or are not sure, and 41% of unvaccinated Blacks do. Another myth is that the vaccines cause infertility. 29% of unvaccinated adults believe that or don’t know, as do 31% of Republicans. 34% of Republicans also say the vaccines contain fetal cells or are not sure if they do. About the same shares of unvaccinated adults believe the vaccines change your DNA and that you should not get vaccinated if you have had COVID. All told 67% of unvaccinated adults cling to one of the major myths about vaccines we asked about in our KFF Vaccine Monitor. A significant misconception among unvaccinated Latinos is that getting vaccinated will cost them money, with 52% believing it will. Practical obstacles to vaccination such as this or worries that they will not be able to get time off from work to get their shots or deal with side effects weigh heavily on unvaccinated Latinos, many of whom want to get vaccinated. Unvaccinated adults don’t all get their information from social media. Their top sources of information on vaccines are cable tv, network and local tv news, and friends and family. But their misconceptions could still mostly be coming from social media, which is a top information source on vaccines for 18-29 year olds. Leaders from President Biden on down can keep hammering away at the facts. So can the media. That should help dispel myths even as trust in government and media has declined. The persistence of vaccine myths also underscore the need to do a better job policing misinformation about vaccines on social media that affect life and death decisions. One big opportunity jumps out. Doctors, nurses, community health workers and pharmacists are both important sources of information for unvaccinated Americans and trusted messengers. They have a special role to play in their communities clearing up the myths about vaccines that remain among the most hesitant groups. [post_title] => Persistent Vaccine Myths [post_excerpt] => With news that the country has now vaccinated half of its population with at least one dose, This Drew Altman Axios column highlights the persistent COVID-19 vaccine myths that are believed by a substantial portion of the unvaccinated population and discusses the options to address vaccine misinformation. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => persistent-vaccine-myths [to_ping] => [pinged] => [post_modified] => 2021-05-26 08:36:04 [post_modified_gmt] => 2021-05-26 12:36:04 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=523549 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 523456 [post_author] => 36621681 [post_date] => 2021-05-25 09:01:46 [post_date_gmt] => 2021-05-25 13:01:46 [post_content] =>
In an op-ed for The Washington Post, Drew Altman suggests a way out of the heated debate about a COVID-19 vaccination passport to help provide clarity about who is vaccinated and who still ought to wear masks in public spaces or the workplace by using something that already exists-- CDC vaccination cards. He writes, “the idea of vaccine passports has been discarded prematurely here. Using the CDC vaccination cards is far better than doing nothing, which leaves unclear who can safely go unmasked. This is the most feasible option, and it can be put into widespread use without any government requirements."
[post_title] => We aren’t getting a national vaccine ‘passport.’ So let’s use the next best thing: CDC vaccination cards. [post_excerpt] => In this op-ed for The Washington Post, Drew Altman suggests a way out of the heated debate about a COVID-19 vaccination passport to help provide clarity about who is vaccinated and who still ought to wear masks in public spaces or the workplace by using something that already exists-- CDC vaccination cards. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => we-arent-getting-a-national-vaccine-passport-so-lets-use-the-next-best-thing-cdc-vaccination-cards [to_ping] => [pinged] => [post_modified] => 2021-05-25 09:04:31 [post_modified_gmt] => 2021-05-25 13:04:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=523456 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 520692 [post_author] => 36621681 [post_date] => 2021-04-29 05:00:09 [post_date_gmt] => 2021-04-29 09:00:09 [post_content] => A shorter version of this column has been published by Axios. In an apparent break with the past, a surprising share of corporate leaders are now willing to support government efforts to tame health spending. Historically Republican-leaning and weary of government, only a tiny share oppose regulation. The test of how serious they are will be whether they lend their support to legislation in Congress or state legislatures to tame health and drug costs. That’s one takeaway from a new survey of over 300 large private employers with 5,000 employees or more we conducted at KFF with the Purchaser Business Group on Health, supported by the West Health Institute. Notably, we surveyed corporate leaders, not benefits officers, including forty CEO’s. + What’s motivating the change: 87% of the corporate officers we surveyed in big companies said they believed the cost of health benefits will become unsustainable over the next 5-10 years, and 85% said there was a need for a greater government role on costs and providing coverage. + 78% expressed some level of support for government action on hospital prices where there is limited competition. And perhaps more significantly coming from what has always been an anti-regulatory crowd, less than five percent opposed it. Similar numbers supported and opposed government limits on drug prices. + 65% expressed some level of support for a public option for their own workers while again, similarly small numbers opposed the idea. There was similar support for lowering the age of Medicare eligibility as well. Corporate leaders surveyed say they will continue to pursue value-based payment, raise cost sharing, and do all the things they have been doing to try to control their health costs. But they don’t have the market clout to do much about health costs on their own. The returns from the payment and delivery reforms which have recently been in vogue have been modest for them. They saw the highly touted Amazon, Berkshire Hathaway, JP Morgan Chase health cost initiative collapse. The back story: corporate America appears to be more progressive than it was in the days when it was led by manufacturing and banking giants, with leaders like Walter Wriston at Citibank and Lee Iacocca at Chrysler speaking out about health costs but almost never supporting regulation. It is now led by tech and consumer industries who, pushed by shareholders and sometimes more progressive CEO’s, are taking on causes like voting rights. More of its leaders are comfortable with government action to solve problems. As the nation comes out of the pandemic health spending is also starting to rise again. Employers may soon forget the heroic actions of local hospitals when high prices hit their bottom lines. Some are also learning that many of their local hospitals did just fine during the pandemic, aided by government relief checks. Yes but: corporate America has talked a big game about health costs for decades and consistently failed to support legislation that would address it. Corporate leaders are on hospital boards, know the top doctors where they live and can sometimes be persuaded that policies aimed at reducing costs will compromise the medical institutions they care about. Congress does listen to CEO’s. If they add their weight to legislative debates about health costs and drug prices, it could make a real difference and they seem more inclined to do it. [post_title] => Corporate Leaders Are Getting Bullish On Government Action On Health Care Costs [post_excerpt] => In this Axios column, Drew Altman explores whether the long struggle with rising health costs has caused the tide to turn in corporate leaders’ attitudes towards government involvement in controlling health spending and whether it is part of a larger shift in comfort with government action to solve problems. 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A shorter version of this column has been published by Axios. “Your doctor and your nurse trusts the COVID-19 vaccine; you can too.” It’s one of the most important messages vaccine reluctant Americans can hear. They trust their doctors and their nurses and almost all of them have been vaccinated or plan to get vaccinated. By the numbers:
  • Throughout the coronavirus pandemic, majorities of U.S. adults have said their doctors and nurses were their most trusted sources of information about the coronavirus and eight in ten have said their doctors are the ones they will turn to when deciding whether or not to get a COVID-19 vaccine.
  • Nearly nine in ten physicians (and nurses with graduate degrees) report either already being vaccinated or plan to get a vaccine.
  • A majority of all the other health care professionals who diagnose and treat patients say they are already vaccinated or plan to be (those with bachelor’s degree: 86%; associates degrees: 68%).
Frontline health care workers who provide other forms of care, such as assisting patients with bathing, housekeeping, or clerical work, have lower levels of vaccine uptake and report the same concerns of the public generally including concerns over the possible side effects or wanting to wait and see how it works for other people. Similar to the public overall, the share of these workers who are waiting to see how the vaccine works for others will likely shrink as more of their colleagues get vaccinated. Because they are such trusted messengers doctors and nurses are in a special position to put their voices where their arms have already been. They can get the word out to their communities that they have been vaccinated and encourage community members to get vaccinated too. This is why together with the Black Coalition Against COVID we created The Conversation, a campaign by Black doctors and nurses for Black people, soon to be followed by a similar campaign for the Latino community.
[post_title] => Why Doctors and Nurses Can Be Vital Vaccine Messengers [post_excerpt] => In this Axios column, Drew Altman examines why doctors and nurses are such critical messengers in the effort to build vaccine confidence. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => why-doctors-and-nurses-can-be-vital-vaccine-messengers [to_ping] => [pinged] => [post_modified] => 2021-04-05 05:49:31 [post_modified_gmt] => 2021-04-05 09:49:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.kff.org/?post_type=perspective&p=518028 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 528254 [post_author] => 36621681 [post_date] => 2021-07-22 05:00:07 [post_date_gmt] => 2021-07-22 09:00:07 [post_content] => A shorter version of this column has been published by Axios. Presidents Biden’s Executive Order instructing agencies to develop policies to promote competition in the economy hasn’t received much attention, but could lead to new efforts to control health costs if his administration and Congress respond with measures to stem consolidation in the health care industry and promote competition to drive down prices. The research is clear that consolidation in the hospital industry drives up costs, in some cases by as much as fifty percent. Perhaps surprisingly consolidation generally does not  improve quality of care. Insurers and employers are not in a position to bargain for lower prices with hospitals or to establish narrower networks they believe deliver greater value when one or two hospital systems are the only games in town and own most of the medical practices. Mergers led to more consolidation even before COVID hit, with two thirds of hospitals in a system, and most metropolitan areas already deemed highly concentrated hospital markets. Private equity firms were behind many of the mergers. The pace of mergers is likely to pick up with the bigger fish eating the smaller ones as COVID has made smaller and rural hospitals and smaller medical practices more fragile.  With the cat party out of the bag on market consolidation there isn’t a lot of time to waste. The FTC and the DOJ’s Anti-Trust Division lack the staff to examine most mergers and in some cases the authority needed to ensure that markets remain competitive. While they can review mergers, they do not generally have the authority to intervene, for example, to stop non-competitive practices by non-profit hospital systems.  Fifty seven percent of all hospitals are technically non-profit, including some of the largest health systems in many parts of the country.  FTC also lacks the authority to monitor the hospital acquisitions of large numbers of smaller practices which individually fall under the threshold for requiring notification of the FTC. States face a similar array of limitations to their authority. The Executive Order establishes a White House Competition Council, but it is vague on what actions might follow in health. Either it or a private effort could productively review FTC, D0J and state authority and capacity and make recommendations for administrative and legislative actions. HHS Secretary Xavier Becerra made his name in health, in part, by going after Sutter Health for its anti- competitive pricing practices as Attorney General in California and could play a central role in such an effort. Of course, the hospital industry would fiercely resist any effort to beef up anti-trust action and promote competition to drive down prices. Hospitals have been sitting on the sidelines happily watching policymakers go after drug costs. But drugs represent ten percent of health spending while hospitals represent thirty four percent. A more aggressive policy aimed at anti-competitive mergers and consolidation in the hospital industry would aim right at high hospital prices that drive up health spending. And while the industry would resist it, it might appeal to both Democrats who favor regulation and Republicans who favor competitive markets. Depending on follow through, the Biden executive order could be a sleeper health cost policy. [post_title] => The Sleeper Health Cost Policy [post_excerpt] => In this Axios column, Drew Altman unpacks President Biden’s recent executive order on promoting competition, exploring its significance for new efforts to control health costs by addressing consolidation in the health care industry. 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