Axios Vitals

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October 15, 2019

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Today's word count is 886 words, or ~3.5 minutes.

1 big thing: Questions for a better Democratic debate

Sen. Bernie Sanders, Former Vice President Joe Biden and Sen. Elizabeth Warren.
Sen. Bernie Sanders, former Vice President Joe Biden and Sen. Elizabeth Warren. Photo: Win McNamee/Getty Images

If tonight's Democratic debate is anything like the earlier ones, it will feature an extended back-and-forth about whether to eliminate private health insurance, and then move on from health care. But there's a whole lot more that's also worth asking about, Axios' Sam Baker writes.

The big picture: We basically know what the candidates will say about the question of private insurance, because they've said it all before. So here are four other questions that might also help illuminate the choice voters face on such a deeply personal, wildly complex topic.

Between the lines: Health insurance — whether it's a single-payer program or a private plan — pays health care bills. And one distinct feature of the U.S. health care system is that those bills are very high.

The big questions:

  1. We’ve heard a lot of criticism of drug companies and insurance companies, but the single biggest chunk of U.S. health care spending goes to hospitals — about $1 trillion a year. Is that too much? How will you cut it?
  2. If Medicare gains more power to set drug prices, as you've proposed, how should it decide what a new drug is worth? What would that decision-making process look like?
  3. Hospitals are closing across rural America. They're expensive to run, they don't bring in much money, and doctors are hard to recruit. None of that seems likely to change, so how are rural Americans ever going to get sustainable, affordable in-person care?
  4. Many of the things that make people sick are not the fault of bad health care — they're social factors like poverty, low-quality housing, etc. Should it be part of the health care system's job to address them?

2. What voters want from the debate

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

It's not just us — voters also want to hear more from the Democratic candidates about health care topics that have been neglected during the debates, according to a new poll by the Kaiser Family Foundation.

My favorite stat: A public option is much more popular than the Affordable Care Act, with 73% favoring the former and only 51% favoring the latter, Kaiser found. "Medicare for All" is also viewed favorably by 51% of the public.

  • Keep in mind that a public option was deemed too liberal to be included in the ACA before it passed in 2010.
  • The ACA is equally as popular as "Medicare for All."
  • Don't think about this too long. Your mind may explode.

3. Health care stocks aren't having a great year

Data: FacetSet; Chart: Axios Visuals
Data: FacetSet; Chart: Axios Visuals

The stock prices of major health care companies have not kept pace with the broader market so far in 2019, even though the industry is flush with cash, Axios' Bob Herman writes.

The bottom line: "Medicare for All" and other health care reforms floated by Democratic presidential candidates, as well as higher-than-expected medical costs at health insurance companies, have made investors nervous about the future.

What's next: Companies are ready to roll out third-quarter reports.

  • Politics will continue to hang over how investment firms trade health care stocks, but Wall Street has a short attention span.

Follow along: The Axios health care earnings tracker has been updated with third quarter details and also includes large not-for-profit hospital systems.

4. Genetic testing could prevent some ER visits

Researchers at the University of Virginia are developing genetic testing to keep children with undiagnosed Type I diabetes out of emergency rooms, NPR reports.

Why it matters: Almost 50% of all children who develop Type 1 diabetes end up hospitalized in a coma because they didn't know they had the autoimmune disease, per the report.

Type I diabetes is difficult to track genetically because no single gene is responsible, but scientists have identified all the variants and about 90% of the known genetic risk, Axios' Marisa Fernandez writes.

  • The genetic test was used to find people at highest risk, followed by periodic blood tests to look for the troubling antibodies. Of the roughly 2,000 kids tested to date, about 60 carry the higher genetic risk.

Yes, but: Most kids with positive Type 1 diabetes results won't get Type 1 diabetes, and half of those who do will not have been detected by a genetic test, due to nongenetic risk factors.

Go deeper: Tech companies are looking to help people manage their diabetes

5. Hospitals' outpatient testing gravy train

The gap between what hospitals and physician offices were paid by fee-for-service Medicare for outpatient cardiovascular tests increased between 2005 and 2015, as did the proportion of these tests that took place in hospitals, according to a new study in JAMA Internal Medicine.

Between the lines: When payment rates depended on where the tests were performed, there was a shift in volume toward the more expensive location.

  • The same didn't happen within a comparison group of 3 health maintenance organizations, for which reimbursement wasn't tied to the testing location.

By the numbers: Traditional Medicare paid hospitals 1.05 times more than doctors' offices for testing in 2005. This increased to 2.32 times more in 2015.

  • Meanwhile, the proportion of hospital-based testing increased from 21.1% in 2008 to 43.2% in 2015. In the control group, the proportion decreased from 16.6% to 15.2%.
  • This shift to the hospital setting cost an estimated $661 million in 2015.

Why it matters: Hospitals have fought fiercely against measures to create site-neutral payments, which the Trump administration proposed last year. The rule was recently overturned in court.

  • Advocates of site-neutral payments say they save taxpayers and seniors money.
  • "Site-neutral payments may offer an incentive for testing to be performed in the more efficient location," the authors of the study write.

Go deeper: Why Medicare is going after hospital outpatient rates