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The tax-reform provision repealing the penalty on those who refuse to participate in ObamaCare has freed millions of Americans to escape a system that exploits them. But while Americans can escape ObamaCare, they still can’t buy insurance in the individual market independent of ObamaCare because private insurers are prohibited from selling it. If this prohibition can be removed through the granting of state waivers by the Department of Health and Human Services, or by the passage of a new federal statute, ObamaCare will collapse into a high-risk insurance pool for the seriously ill rather than become a stepping stone to socialized medicine. (Phil Gramm, 3/15)

To call Veterans Affairs Secretary David Shulkin “embattled” over the last few weeks is an understatement. While the tide of public opinion has ebbed and flowed with respect to Shulkin’s fate for myriad reasons, one thing is certain: What’s good for the Department of Veterans Affairs appears to be the last thing on President Trump’s mind. (Joe Chenelly, 3/15)

Before sentencing notorious pharmaceutical executive Martin Shkreli to seven years in prison, the federal judge presiding over his criminal trial ordered him to turn over "Once Upon a Time in Shaolin," the Wu-Tang Clan album of which only a single copy exists. Shkreli paid $2 million for the album, an extravagance he could afford after making a fortune by jacking up the prices of prescription medications. Seizing the album and other assets worth a total of $7.4 million may seem like karma, but it will do nothing to tame drug costs. Indeed, it is entirely legal to raise generic drug prices (which explains why Shkreli was convicted of securities fraud, not healthcare fraud). The problem is that government has made it far too easy for pharma companies to gain a national monopoly on the supply of drugs that no longer are patent-protected. Rather than make an example of Shkreli, the solution to outrageous drug prices is to embrace globalization. (3/15)

Before the election, Republicans wanted voters to think of (Connor) Lamb as too liberal to support. Afterward, they wanted to buck up Republican morale by saying that he had run to the right. The new spin is not grounded in reality. Lamb is not a conservative, and not a Republican in the wrong party. He ran against most of the Republican economic agenda, including the recently enacted corporate tax cuts and the reforms to Social Security and Medicare that (Paul) Ryan has long advocated. (Lamb objects when Ryan, like much of the press, calls these programs, to which senior citizens are entitled by law, “entitlements.”) He’s for tweaking rather than replacing Obamacare. ...Lamb says he “believes life begins at conception,” but also abortion should be legal even after the 20th week and disavows the label “pro-life.” (Ramesh Ponnuru, 3/15)

Dozens of biotechnology start-ups across the country are investing in the research and development that Big Pharma has stopped funding. Clementia, for instance, is zeroing in on rare bone diseases. Catabasis Pharmaceuticals is focused on amyotrophic lateral sclerosis and other terrible neurological conditions. Quanterix and others are developing blood-based diagnostic tests to help doctors offer more targeted cancer treatments, for example. (3/15)

In a detailed analysis of health care spending in the United States and 10 other high-income, mainly European, countries, the authors found that the United States spends approximately twice as much on medical care and that the “[p]rices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost.” (Ezekiel J. Emanuel, 3/13)

In short, the claim from many scholars, think tanks, and policy makers is that the US citizen is not getting good care for the money spent on health care. The authors approach this claim with a much more focused analysis than in the past that seeks to identify more tangible root causes and provide insights for strategic and perhaps even tactical policy options for the United States to maximize its health dollar. While (Irene) Papanicolas et al have taken care and scholarship in addressing this complex topic, they have not fully mapped out all the important factors that drive this issue. (Stephen T. Parente, 3/13)

The authors compared spending and various aspects of the US health care system with those in 7 European countries, Canada, Australia, and Japan and report that in 2016, health care spending in the United States accounted for 17.8% of gross domestic product and that annual per capita health care spending in the United States was nearly double that in the other countries ($9403 in the United States vs a range of $3377 to $6808 in the other countries). However, decomposing differences in health care spending into price and quantity is more difficult than it might seem, and there are important challenges in drawing policy inferences from such analyses. (Katherine Baicker and Amitabh Chandra, 3/13)

In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes. Contrary to some explanations for high spending, social spending and health care utilization in the United States did not differ substantially from other high-income nations. Prices of labor and goods, including pharmaceuticals and devices, and administrative costs appeared to be the main drivers of the differences in spending. ...Efforts targeting utilization alone are unlikely to reduce the growth in health care spending in the United States; a more concerted effort to reduce prices and administrative costs is likely needed. (Irene Papanicolas, Liana R. Woskie, and Ashish K. Jha, 3/13)

Despite the important and increasing role of Medicare Advantage plans, there is fairly little insight into the relative value Medicare Advantage provides to beneficiaries or the funder, the US taxpayer. This is attributable mainly to a lack of access to comprehensive claims- or encounter-level data regarding the Medicare Advantage program for researchers, or even more aggregated information that could be made available to the general public. ... in June 2017, the CMS abruptly cancelled the Medicare Advantage data release, citing concerns about data quality, but with very little explanation. This abrupt shift is troubling for a number of reasons. (Niall Brennan, Charles Ornstein and Austin B. Frakt, 3/13)

The vaccine article struck serious chords in the medical community, and doctors took some sharp jabs at the piece. Many physicians chimed in that the medical community couldn’t care less about a non-medical person’s views on one of the most remarkable worldwide public health successes in history. It’s enough of challenge for physicians to explain the safety and effectiveness of vaccines to patients and families, let alone having to answer the claims of movie stars. Others expressed dismay that a mainstream parenting magazine provided yet another stage to some of the most powerful anti-vaccination voices, one of whom has lately played a key role in the anti-vaccination movement. (Nina Shapiro, 3/15)

There is broad agreement that fee-for-service reimbursement does too little to encourage the provision of efficient, high-value care. Consequently, Medicare and other payers are increasingly moving toward alternative payment models (APMs), which disrupt the fee-for-service system by incorporating quality and cost targets into reimbursement. ...In the best-case scenario, clinicians will respond to APMs’ incentives by improving care coordination and integration, which may particularly benefit vulnerable populations with higher-than-average medical and social needs. On the other hand, there may be incentives for clinicians to avoid caring for these groups, who are at risk for high costs or poor outcomes in part because of factors beyond clinicians’ control. Understanding APMs’ potential consequences for vulnerable populations is critical if we wish to maximize benefits and reduce harms. (Karen Joynt Maddox, 3/14)

When I read that the American Academy of Pediatrics has called for universal screening for depression for children 12 and up, it seemed exceedingly welcome and pragmatic news, given the prevalence of teenage depression. After all, 20 percent of teens reportedly encounter depression. Suicide is the second leading cause of death for people ages 10 to 24. Each day, sees an average of over 3,470 attempts by young people in grades nine to 12. I want my pediatrician to assess my children’s overall well-being, thank you. (Sarah Werthan Buttenwieser, 3/15)

In January, the U.S. Department of Health and Human Services (HHS) announced the creation of its Conscience and Religious Freedom Division, explaining that it will allow HHS’s Office of Civil Rights to “more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom” and will ensure that “no one is coerced into participating in activities that would violate their consciences, such as abortion, sterilization or assisted suicide.” Responses were as expected: religious conservatives hailed the new division as a needed intervention; public health and clinical leaders and advocates decried it, worrying about its impact on access to care and harm to patients. HHS leaders’ comments to date suggest that they are uninterested in discrimination against health care providers whose consciences compel them to provide care, and uninterested in injuries to patients caused by care refusals. This framing makes conscience yet another issue dividing Americans, largely along partisan lines. Conscience, however, is not inevitably divisive. (Lisa Harris, 3/14)

Gov. Ralph Northam (D) is confident Virginia legislators will give him a budget that includes Medicaid expansion. In his monthly interview on Richmond’s WRVA, Northam said Medicaid expansion was the right thing to do, both from a business and a moral perspective. But he also mentioned the real reason expansion, or something like it, gets done: politics. “What legislators need to realize is that on Nov. 7 Virginia spoke,” Northam said. (Norman Leahy, 3/15)

On Sunday, we learned that Anthem refused to cover the full $32,000 bill for a South County boy airlifted to a St. Louis hospital because the helicopter ambulance was “out of network.” Meanwhile, Anthem reported in late January that its fourth-quarter profits for 2017 had increased by 234 percent to $1.2 billion over the fourth quarter of 2016. Part of that was $1.1 billion in savings from the federal tax reform bill. Anthem paid an effective tax rate of 3.1 percent in 2017. America’s second-largest health insurer, with 39 million members, Anthem is making a lot of money and skating on a fair share of taxes. Premiums are higher and benefits are harder to get. (3/15)

The American population is aging and becoming more diverse. Combating social isolation among older Americans is a public health imperative that will only become more critical in the years ahead. It is undeniable that poverty is a critical factor in social isolation and poor health, and a severe problem for many older Americans, with over 25 million Americans over 60 living in poverty. But according to the National Council on Aging, that should not prevent us from examining community-based options for supporting healthy aging that connect individuals to the resources they need. (Janet Golden, 3/16)