The media storm that erupted over huge price increases for the Epipen, a medication delivery device that provides an automatic injection of epinephrine to an individual suffering a severe allergic reaction, had everything a muckraking editor, or ambitious politician, could hope for: The manufacturer is a highly profitable pharmaceutical company, Mylan, led by a highly… Continue reading Epipen, the Story Behind the Story
As Aetna Exits the Obamacare Exchanges
In the beginning, insurers were prepared to balk at entering the exchanges. Without the ability to adjust for the extra expense associated with patients who have poor health histories, and the unknown quantity of the pool of patients in the healthcare.gov plans, insurance companies feared the exchanges would be a losing proposition. The Obama Administration… Continue reading As Aetna Exits the Obamacare Exchanges
Who’s Controlling the Cost of Prescription Drugs?
A recent headline in the business section of my local newspaper’s website reported that a large pharmacy benefit manager (PBM) had listed a number of drugs it would not cover in 2017. The accompanying article cited a press release in which the company explained it was acting in order to better control healthcare costs to employers and… Continue reading Who’s Controlling the Cost of Prescription Drugs?
Medicare for All?
The 2016 presidential election season has produced its share of surprises, none quite as interesting as the contest in the Democrat Party primary, where a long-term member of Congress, not even a member of the party, has shown surprising strength against the heir apparent, Hillary Clinton. Vermont Senator Bernie Sanders has garnered a lot of… Continue reading Medicare for All?
Defining Value in Healthcare
There’s a vigorous debate in the country re the cost, and availability, of healthcare. Unfortunately, there’s little discussion of the value of the product patients receive. Mostly, staggering national costs are reported, with cries of pending collapse of the system if allowed to continue. Seldom is a voice raised that questions whether patients are getting… Continue reading Defining Value in Healthcare
Defining Terms in the Healthcare Debate
There’s a weekly talk radio show in St Louis that airs every Saturday morning. The host is a practicing physician, and on a recent show, he took a call from a listener who roundly criticized Obamacare. Given the unpopularity of the President’s signature domestic policy agenda, that type of call is hardly news. The good… Continue reading Defining Terms in the Healthcare Debate
Big Pharma: Panacea, or Bad Medicine?
With the opening of the 2016 election campaign, incumbents, and attention-seeking challengers, are on the hunt for trophies to mount on the wall of political expediency. Combine that with the on-going battle over healthcare costs, and it’s pretty much guaranteed that some folks are going to be under intense scrutiny for at least the foreseeable… Continue reading Big Pharma: Panacea, or Bad Medicine?
Can We Get Back to Kansas, Toto? If the Affordable Care Act is Repealed, Then What?
Ever since the United States Supreme Court ruled in the 2012 Sebelius decision that requiring individuals to purchase health insurance was constitutional, opponents have vowed to repeal the Affordable Care Act (ACA, or, as more popularly known, Obamacare). Even after the 2015 King v Burwell decision, when the Court upheld government subsidies underwriting premiums in states that had not… Continue reading Can We Get Back to Kansas, Toto? If the Affordable Care Act is Repealed, Then What?
“And Then There’s Statistics”—The Hospital Readmissions Reduction Program
Reducing readmissions to hospitals is sound medical and administrative policy. No one who’s been admitted for surgery, illness, or injury wants to return shortly after discharge because of an infected incision or some other complication. These readmissions are also costly, and the Center for Medicare/Medicaid Services (CMS) was tasked with reducing Medicare Fee-for-Service readmission rates.… Continue reading “And Then There’s Statistics”—The Hospital Readmissions Reduction Program
Preventive Care -Don’t Assume You’re Covered
One of the selling points of the Affordable Care Act was the promise of free preventive care. Indeed, a reading of the Explanation of Benefits (EOB) from your health insurance policy most likely lists a fully-covered annual “well” visit for individuals and family members, with women usually granted an additional visit covered at 100% with… Continue reading Preventive Care -Don’t Assume You’re Covered