Axios Vitals

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February 14, 2020

Good morning. It's Valentine's Day, so either good luck making it through or have fun.

  • Situational awareness: Can confirm that in the year of 2020, some cross-country flights are still plagued by broken WiFi.
  • Also, Vitals will be off on Monday for Presidents Day.

D.C. readers: Join Mike Allen Tuesday at 8am ET for conversations on the future of STEM education and digital learning. 

  • He'll sit down with of Girl Scouts USA CEO Sylvia Acevedo; former NASA administrator Maj. Gen. Charles F. Bolden, Jr.; EVERFI founder and CEO Tom Davidson; and Smithsonian Science Education Center director Dr. Carol O'Donnell.
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Today's word count is 881, or a 3-minute read.

1 big thing: Medicare for All is probably a pipe dream

Photo illustration of Bernie Sanders.

Illustration: Aïda Amer/Axios. Photo: Joe Raedle/Getty Staff

Bernie Sanders has risen to the top of the Democrats' 2020 pack on the appeal of his far-left idealism and promises of a "revolution" — but he'll have a hard time turning revolution into reality if he gets the chance, Axios' David Nather reports.

Between the lines: Just because Sanders has surged doesn't mean the politics of Medicare for All have changed, and the politics have always rendered it very unlikely to become law.

The big picture: Even with the expanding power of the presidency, Sanders would need Congress to approve the most ambitious ideas he's known for — including Medicare for All — and that's unlikely to happen even under the strongest elections scenarios for House and Senate Democrats in November.

Medicare for All is divisive even among Democrats, the debates have shown. So it's hard to see its path to passage in the Senate.

  • "He's not gonna get that," said Sen. Joe Manchin of West Virginia, one of the moderate Democrats whose support Sanders would need, said of Sanders' proposals.

It's not just Medicare for All. Sanders wants the federal government to pay the $81 billion in unpaid medical debt reported to credit agencies.

  • Though the price tag may be a tough sell for Democrats, debt can often be purchased for pennies on the dollar. Craig Antico of RIP Medical Debt, a charity that buys medical debt and forgives it, says his group might only need $800 million to buy $100 billion of debt.
  • The problem, he says, is that the total amount of unpaid medical debt in the U.S. far exceeds $81 billion — and a lot of it is not for sale. His group estimates the total amount of unpaid medical debt is as high as $1.1 trillion — including hundreds of billions of dollars owed to hospitals and other health care providers.

Go deeper.

2. What we've learned about Medicare for All so far

Reproduced from Kaiser Family Foundation; Chart: Axios Visuals
Reproduced from Kaiser Family Foundation; Chart: Axios Visuals

Speaking of Medicare for All ... Health care was voters' top issue in both Iowa and New Hampshire, and it benefited Sanders as well as his more moderate rivals, the Kaiser Family Foundation's Drew Altman writes in today's column.

The big picture: Sanders has emerged as a national front-runner thanks in part to a base that’s deeply committed to his Medicare for All plan, even as polling data indicate that more moderate ideas like a public option have a broader base of support.

By the numbers: 37% of voters in the New Hampshire exit poll said health care was their top issue, placing it ahead of climate change, income inequality or foreign policy. Results were similar in Iowa entrance polls.

  • A majority (61%) of New Hampshire primary voters supported both a public option and a Sanders-style single-payer plan.
  • Just 6% support only single-payer, and not a public option, according to a Kaiser Family Foundation analysis of AP VoteCast data, while 26% support a more moderate plan but not single-payer.

"Single-payer or bust" voters overwhelmingly supported Sanders, while the "public option or bust" group was split among Pete Buttigieg (35%), Amy Klobuchar (34%) and Joe Biden (12%).

Drew's thought bubble: The hardcore single-payer fans are a small group, even among Democrats. 

Yes, but: Even among those Democratic voters in New Hampshire who said health care was the most important issue, more said it's very important to have a candidate who can beat President Trump (89%) than one who has the best policy ideas (60%).

3. Prices are still rising faster than utilization

Employers, workers and families continued to spend a lot more on health care in 2018, but that wasn't because people used more services, according to the latest annual spending report from the Health Care Cost Institute, which analyzes commercial health insurance claims.

The bottom line: Higher prices remain the main culprit for exploding spending among those with private health insurance, Axios' Bob Herman reports.

By the numbers: Annual per-person spending among the commercially insured, after accounting for inflation and drug rebates that help reduce premiums, grew by an average of 3.8% between 2014 and 2018, according to HCCI.

  • Three-quarters of that rise was attributed to hospitals, doctors, drug companies and others raising prices.

The intrigue: Two small pieces of data stick out within the report.

  • The average out-of-pocket price for emergency room visits jumped 37%, from $368 in 2014 to $503 in 2018 — a reflection of surprise billing tactics.
  • The average price of drugs administered in doctors' clinics soared 73% from 2014 to 2018. These infusion medicines overseen by doctors are driving up drug spending by a lot, and they don't usually come with rebates.

Go deeper: HCCI is getting a new health insurance partner to submit data

4. More testing for the coronavirus emerges

Scientists and doctors are exploring whether existing treatments for HIV, Ebola and malaria could combat the novel coronavirus, the Los Angeles Times reports.

Driving the news: The antiviral remdesivir protected monkeys from MERS, another coronavirus, both before and after exposure, the National Institute of Health announced Thursday.

The medication, made by Gilead, has been used in experiments to fight Ebola, and has also been used to keep SARS from replicating in animals, Axios' Marisa Fernandez writes.

  • Two other drugs for Ebola and malaria are being used on Chinese patients — one to disrupt COVID-19's genetic material and the other to keep the coronavirus from penetrating cells, respectively.
  • Doctors are also looking at HIV medication that could block an enzyme the virus needs to mature, per the Times.

Why it matters: An anti-viral or immunotherapy that's already been proven safe could be a faster solution to slowing down infections. But their effectiveness against the coronavirus still has to be tested.

Go deeper: Vaccine candidate for coronavirus on track for human trials

5. Weight-loss drug is pulled

Drugmaker Eisai is withdrawing its weight-loss pill Belviq after the FDA found an increased risk of cancer among people who took the drug, Bob writes.

Between the lines: Belviq never really caught on after its approval in 2012 because it was barely better than a placebo, STAT notes. Anyone who prescribes or takes Belviq should dump it out now.