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Jun 19, 2019

Axios Vitals

Good morning.

Today's word count is 820 words, ~3 minutes.

1 big thing: Even Democrats prefer more moderate "Medicare for All"
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Data: Navigator; Chart: Andrew Witherspoon/Axios

Allowing people to buy into Medicare is more popular than establishing a single-payer health care system — including among Democrats, according to a recent Navigator poll.

Why it matters: Bernie Sanders made "Medicare for All" a popular concept, but even its supporters have different ideas about what it entails. And more moderate versions have the upper hand.

Between the lines: Most people don't have a nuanced understanding of health policy, and even within the same poll, different ways of describing the same policy yielded different results.

By the numbers: Even a majority of Republicans said that they would support a Medicare buy-in, when given a choice between that or single-payer.

  • In another section of the poll, though, a 40% plurality of Republicans said "expanding Medicare" was a bad idea, and 59% said that "Medicare for anyone who wants it" is a bad idea.

Yes, but: A version of Medicare for All that eliminates private insurance is still supported by a majority of both Democrats and independents.

  • 76% of Democrats said that a "'Medicare for All' program" is a good idea, and 52% said that a "single payer health care system" is a good idea.

What they're saying: Polling aside, "I think Medicare for All is what the American people want and need," Sanders said in a brief interview.

  • "I think the vision of a simple, seamless system of health care where you have the care that you need, your loved ones have the care that they need ... is very, very appealing. Many ideas are being presented for how do we get to that," said Sen. Jeff Merkley, who has a Medicare buy-in proposal.

The bottom line: There's plenty of opportunity to sway the health care debate, but moderate Democrats seem to have the most popular ideas right now.

2. The $6 billion boondoggle in Medicare Advantage

The current system that rates the quality of care in Medicare Advantage plans is "flawed" and needs to be overhauled, the Medicare Payment Advisory Commission said in its annual June report.

Why it matters: The federal government pays out roughly $6 billion in bonus money to Medicare Advantage insurers every year for a system that doesn’t do a good enough job measuring the most important health outcomes for seniors and the disabled, my colleague Bob Herman reports.

Where it stands: MedPAC commissioners didn't mince words on the flaws.

  • Medicare Advantage companies can easily get quality bonuses "even if their performance is uneven and results for outcome measures are below bonus-level performance." 
  • Insurers have merged low-quality contracts into high-quality ones as a way to game the system and get more bonus dollars, which the Wall Street Journal profiled last year.
  • Star ratings disadvantage companies that enroll more low-income members.
  • The program isn’t budget-neutral, and penalties have been neutered.

The bottom line: MedPAC listed ways the Medicare Advantage quality bonus system could be redesigned (summarized on page 265 for the diehards), but the insurance industry wouldn’t take kindly to most of the proposals because they would cut funding.

3. Generation Z's suicide epidemic
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Data: Centers for Disease Control and Prevention; Chart: Axios Visuals

The suicide rate for Americans aged 15–24 years old — the older half of Generation Z — is the highest it's been since at least 1999, according to Centers for Disease Control data.

The big picture: The overall suicide rate for this age group has risen by 51% over the past decade, Axios' Stef Kight reports. This has been accompanied by increased social media use, anxiety, depression and self-inflicted injuries among young adults and teens, according to a newly released study in the Journal of the American Medical Association.

  • Young men still have significantly higher suicide rates than women of the same age, but over the last decade, suicide rates for women aged 15–24 have risen faster than for men.
  • Suicide rates for Gen Z men have risen 45% since 2007, compared to 87% for women.

Between the lines: The rise in suicide rates could be a result of more accurate reporting, with Americans more willing to label a death as suicide, according to the JAMA study. It could also be driven by changes in the use of opioids or the increased prevalence of depression in young people.

Go deeper: Deaths by suicide, drugs and alcohol reached an all-time high in 2017

4. Vaccine injuries are very rare

Since 1988, a federal program has compensated only about 6,600 people for harm that they said was caused by vaccines, NYT reports. Americans have received billions of doses of vaccines over that time period.

  • About 70% of these awards were settlements in cases where officials hadn't found sufficient evidence that a vaccine caused the harm.
  • Hundreds of thousands of deaths — at least — have simultaneously been prevented by vaccines.

Yes, but: $4.15 billion has been paid out through the program, fueling vaccine skeptics' argument that vaccines aren't harmless.

  • But public health experts say that the small number of claims is proof of vaccine safety.
5. New carcinogen found in popular drug

A fourth cancer-causing chemical was found in valsartan, a commonly used heart pill made by several drug companies, Bloomberg reports.

  • The carcinogen was found by an online pharmacy in valsartan that is still on the market in the U.S., and was reported to the FDA.
  • "The findings could complicate the agency's efforts to pull tainted drugs from pharmacies while informing doctors and patients which medications are safe," Bloomberg writes.

Have a great Wednesday!