Feb 20, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. Hope everyone enjoyed last night's brawl.

Today's word count is 744, or a short 3-minute read.

1 big thing: Democrats' quiet proposals to cut health care costs

Illustration: Eniola Odetunde/Axios

Yet again, the 2020 Democrats debated last night without devoting much attention to their very interesting ideas for controlling health care costs. But whether they talk about it or not, they've laid out a broad range of ideas for this incredibly pressing issue.

The big picture: Democrats' ideas run the gamut, from taking control over all health care purchasing to plans that would directly regulate a slice of the market, attempting to put pressure on the rest of it.

The newest entrant to the debate stage, Mike Bloomberg, has proposed a plan that is similar to Pete Buttigieg's.

How it works: Bloomberg and Buttigieg's plans would only directly regulate how much providers can charge patients whose insurance they don't accept. They would only allow out-of-network charges up to 200% of the rates Medicare pays.

  • "Caps on out of network prices would sort of nudge the whole system to make it more affordable," said the Kaiser Family Foundation's Larry Levitt. "It's kind of price controls lite."
  • Today, providers use the threat of big out-of-network bills as leverage to get better rates from insurers. These proposals would flip those incentives, giving insurers more leverage.

Details: Bloomberg's cap is limited to hospital charges, while Buttigieg's applies to most health care providers.

  • This kind of cap would likely have more of an impact on emergency rooms, where many big out-of-network bills come from, experts said.
  • "This type of policy could drive a significant reduction in prices for a moderate-sized slice of health care spending," Brookings' Matt Fiedler said.

Moderate Democrats have also proposed a public insurance option, competing alongside private insurance.

Then there's Medicare for All, which would make the federal government the only entity that pays for health care, giving it complete control over how much all providers get paid.

2. Millions of medical crowdfunding donations

An estimated 50 million Americans have donated to crowdfunding campaigns for medical expenses, according to a new study.

The big picture: People without insurance often have to shoulder enormous bills all on their own, and out-of-pocket expenses are a burden even for people with insurance, Axios' Marisa Fernandez writes.

By the numbers: NORC at the University of Chicago estimates that 8 million people have started a crowdfunding campaign for their own medical expenses, 12 million have started one for a friend or family member, and 50 million have donated to one.

  • Those figures are based on a survey of 1,000 people.
  • Overall, 20% of Americans reported donating to a medical crowdsourcing campaign.
  • 61% had donated to a relative, co-worker or acquaintance; 46% had donated to a friend's campaign; and 35% donated to a stranger.

Go deeper: GoFundMe's place in the health care system

Methodology: The self-funded poll was conducted Nov. 8–16, 2019, with 1,020 interviews of Americans 18 and older with a margin of error ±4.06%.

3. A slightly less bad year for CHS

After the stock market closed yesterday, Community Health Systems disclosed it lost $675 million in 2019, still has $13.4 billion of long-term debt and will sell even more hospitals than it already has, Axios' Bob Herman reports.

The intrigue: The company's stock was up 12% in after-hours trading.

  • That's because CHS expects 2020 to be better — but still lose upwards of $150 million.

The bottom line: CHS owns a lot of hospitals in rural and small communities. Putting aside CHS' specific business flops, it's become tougher to operate hospitals in areas where the population is stagnating or declining because hospitals still rely on filling their clinics and beds.

Go deeper: The collapse of Community Health Systems

4. Unintended consequence of turning 80

Illustration: Sarah Grillo/Axios

Having already turned 80 could be a huge deal for patients who have heart attacks, according to a new study in the New England Journal of Medicine and reported on by STAT.

Details: While 7% of Medicare enrollees who were a few weeks shy of their 80th birthday and who had been admitted to the hospital with heart attacks received bypass surgery, only 5.3% of patients who had just turned 80 did, the study found.

Between the lines: "To arbitrarily — and perhaps, unknowingly — fixate on the threshold at which patients pass from their 70s into their 80s seems like an example of what's called the 'left-digit bias' — our tendency to pay more attention to the digit we read first," STAT writes.

  • The concept is similar to when we think $4.99 is a much better deal than $5.01.
5. Some bad coronavirus news

Two passengers from the Diamond Princess cruise ship have died from novel coronavirus, Japan's health ministry confirmed Thursday lunchtime local time.

Why it matters: These are the first deaths among the 600+ people who had been infected aboard the vessel, Axios' Rebecca Falconer writes.

  • The deaths come after the CDC raised concerns Tuesday that "there may be additional confirmed cases of COVID-19 among the remaining passengers on board the Diamond Princess."
  • Hundreds of people have already left the ship, with hundreds more expected to leave in the coming days.

By the numbers: 621 people among some 3,700 passengers and crew members have been infected with the virus aboard the vessel, quarantined at Yokohama.

  • 100+ American passengers in Japan face a two-week travel ban as a health precaution, the CDC said.

Go deeper: Diamond Princess exodus begins as CDC raises health concerns

Caitlin Owens