Boosted!

There’s been plenty of recent data that, although J&J is way better than not being vaccinated, it’s also clearly notably less effective than the two mRNA shots.  Thus, the recommendation for all J&J folks to get another shot.  Also, plenty of data that you get way stronger antibody response by boosting with mRNA, and the most with Moderna.  So, with this information and policy change out there, it was time for me to take action  I called the administrator of my J&J trial and they told me I could come on in and get J&J shot number 2 and stay in the trial.  Though I believe in doing my part for science, I had decided that the there’s so little knowledge to be gained from my ongoing participation that I was going to get Moderna even if that meant I had to leave the trial.  A little asking around and I ended up with a win-win.  As long as I got the Moderna (or Pfizer) on my own, I could stay in the trial.  Hooray!  So, went and boosted both me and my J&J firstborn today.  And my antibody levels and other effects will still be monitored in the trial.  

And as I type, 14 hours of administration, just very mild side effects so far.  J&J side effects hit pretty hard after about 10 hours.  Hopefully it stays like this.  

Your intrepid blogger and his firstborn with their Moderna shots.

The way to hold down medical costs it to hold down medical costs

I’m in the midst of grading public policy midterms.  So far, my students are totally nailing it on the 50-point health care policy question, which makes me feel great.  They’ve learned that all those countries that outperform the US on healthcare while spending way less money.  Every last one of them does this, in substantial part, by using the power of government to literally hold down costs by placing limits on what doctors, hospitals, etc., can charge.  In America, not so much.  A summary from a 2021 report:

Abstract

• Issue: No two countries are alike when it comes to organizing and delivering health care for their people, creating an opportunity to learn about alternative approaches.
• Goal: To compare the performance of health care systems of 11 high-income countries.
• Methods: Analysis of 71 performance measures across five domains — access to care, care process, administrative efficiency, equity, and health care outcomes — drawn from Commonwealth Fund international surveys conducted in each country and administrative data from the Organisation for Economic Co-operation and Development and the World Health Organization.
• Key Findings: The top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.
• Conclusion: Four features distinguish top performing countries from the United States: 1) they provide for universal coverage and remove cost barriers; 2) they invest in primary care systems to ensure that high-value services are equitably available in all communities to all people; 3) they reduce administrative burdens that divert time, efforts, and spending from health improvement efforts; and 4) they invest in social services, especially for children and working-age adults.

There’s nobody better writing about American health care than Elisabeth Rosenthal, and her latest shows us how Maryland has actually been successful holding down costs, European style– that is, hard price caps, “A $1,775 Doctor’s Visit Cost About $350 in Maryland. Here’s Why.”

Players in the health care world — from hospitals to pharmaceutical manufacturers to doctors’ groups — act as if the sky would fall if health care prices were regulated or spending capped. Instead, health care prices are determined by a dysfunctional market in which providers charge whatever they want and insurers or middlemen like pharmacy benefit managers negotiate them down to slightly less stratospheric levels.

But for decades, an independent state commission of health care experts in Maryland, appointed by the governor, has effectively told hospitals what each of them may charge, with a bit of leeway, requiring every insurer to reimburse a hospital at the same rate for a medical intervention in a system called “all-payer rate setting.” In 2014, Maryland also instituted a global cap and budget for each hospital in the state. Rather than being paid per test and procedure, hospitals would get a set amount of money for the entire year for patient care. The per capita hospital cost could rise only a small amount annually, forcing price increases to be circumspect.

If the care in the Baltimore-based Johns Hopkins Medicine system ensured my recovery, Maryland’s financial guardrails for hospitals effectively protected my wallet.

During my months of treatment, I got a second opinion at a similarly prestigious hospital in New York, giving me the opportunity to see how medical centers without such financial constraints bill for similar kinds of services.

Visits at Johns Hopkins with a top neurologist were billed at $350 to $400, which was reasonable, and arguably a bargain. In New York, the same type of appointment was $1,775. My first spinal tap, at Johns Hopkins, was done in an exam room by a neurology fellow and billed as an office visit. The second hospital had spinal taps done in a procedure suite under ultrasound guidance by neuroradiologists. It was billed as “surgery,” for a price of $6,244.38. The physician charge was $3,782.

I got terrific care at both hospitals, and the doctors who provided my care did not set these prices. All of the charges were reduced after insurance negotiations, and I generally owed very little. But since the price charged is often the starting point, hospitals that charge a lot get a lot, adding to America’s sky-high health care costs and our rising insurance premiums to cover them.

It wasn’t easy for Maryland to enact its unique health care system. The state imposed rate setting in the mid-1970s because hospital charges per patient were rising fast, and the system was in financial trouble. Hospitals supported the deal — which required a federal waiver to experiment with the new system — because even though the hospitals could no longer bill high rates for patients with commercial insurance, the state guaranteed they would get a reasonable, consistent rate for all their services, regardless of insurer.

I don’t know how Maryland pulled this off, but, getting something like this done on a national level will be really, really hard.  You know who likes high prices?  Doctors, hospitals, medical device manufacturers, etc., and they will lobby like hell against anything that threatens American’s ongoing extreme overpayment.  That’s the sad reality of trying to reform American health care.  It’s not the insurance companies.  It’s a bunch of medical providers that get a lot of money that would rather not see a substantial dent in that.  But, then again, pretty much every other country has managed to pull it off to a greater or lesser degree.  We need to, too.