Jan 8, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. If you're in the mood to read something heartbreaking, here you go.

Today's word count is 641, or a 2-minute read.

1 big thing: Medicare for All's missing mental health discussion

Illustration: Aïda Amer/Axios

America's mental health care system is in dire need of an overhaul, but the real specifics are largely missing from the 2020 debate about health care.

Why it matters: Suicide and drug overdose rates continue to rise, and the U.S. faces a shortage of mental health providers and a lack of access to treatment.

The big picture: Private insurance is plagued with holes in mental health coverage. Even even though insurers are legally required to cover behavioral health the same way as physical health, they don't.

Yes, but: "Medicare to All" may not solve the problem, Mental Health America president and CEO Paul Gionfriddo told me.

  • "Medicare would need to be redesigned significantly," he said.
  • Medicare has its own coverage flaws. It would also be crucial to design a system that encourages preventive and early identification services rather than just post-crisis care.

There's also a shortage of mental-health providers. Paying mental health providers more could help address this, but care delivery would also need to be redesigned, Gionfriddo said.

  • Rural areas, for example, would likely still struggle to attract and support these providers because of their remoteness and population size.
  • "The big wild card is how many mental health providers would participate in a Medicare for all program or opt out of insurance entirely," said the Kaiser Family Foundation's Larry Levitt.

For Democrats who support Medicare for All, highlighting how it could help mental health care could have a political upside.

  • "Talking about mental health care needs humanizes the candidates, indicts the shortcomings of private insurance and provides rationale for the need for significant reforms around the current system," Democratic health consultant Chris Jennings said.

Go deeper: Mental health coverage is getting worse

2. The U.S. administrative bloat

Illustration: Sarah Grillo/Axios

In 2017, U.S. insurers and providers spent $2,497 per capita on administration — nearly 5 times more than the $551 spent per capita in Canada, which has a much more heavily socialized system, according to a new study in Annals of Internal Medicine.

Why it matters: We're all paying this through our premiums, out-of-pocket costs and taxes.

By the numbers: Administrative spending makes up 34.2% of national health expenditures in the U.S. and 17% in Canada.

  • U.S. hospitals spent $933 per capita on administration, and insurers $844.

The bottom line: Our health care system charges the highest prices in the world, and then tacks on these administrative costs before handing over the bill to patients.

3. Quote du jour
"Physicians are a giant rent-seeking conspiracy that's taking money away from the rest of us, and yet everybody loves physicians. You can't touch them."
— Angus Deaton, senior scholar at Princeton University

Deaton is an advocate of the idea that rising health care costs are a form of "poll tax." The Washington Post has more on that theory if you're interested.

4. Hospitals in hot water over referrals

New lawsuits allege that large hospital systems have illegally billed federal health care programs after making improper financial deals with doctors as a way to control where patients get care, Axios' Bob Herman reports.

Why it matters: Hospitals that own physician practices capture more referrals and therefore more money than their competitors — but potentially skirt federal law and inflate the cost of care for everyone in the process.

Driving the news: The former CFO of Community Health Network, a hospital system in Indiana, alleged the system employed physicians with "excessive" salaries well above fair market rates as a way to secure those physicians' referrals, and then bill higher rates for hospital services.

  • The Justice Department intervened in the case, which often means the feds believe the case has merit. CHN said in a statement that this was a "waste of the government's time and resources to pursue these meritless claims."

An orthopedic surgeon in Florida alleged in a newly unsealed whistleblower case that Orlando Health pressured doctors to conduct surgeries and imaging tests only at facilities owned by Orlando Health.

  • He says he was fired because he was still seeing patients at competing hospitals.
  • The Justice Department declined to intervene in the case for now. Orlando Health did not immediately comment.
  • Read the full complaint.

Go deeper: "The hidden system that explains how your doctor makes referrals," via the Wall Street Journal.

5. New study gives good news to J&J

Women who used talc or other powders aren't significantly more likely to develop ovarian cancer, according to a new JAMA study. Johnson & Johnson is facing thousands of lawsuits over these products.

Why it matters: "While the research won't eliminate the company's legal exposure, it may help bolster J&J's argument that the link between talc and ovarian cancer found in some previous studies isn't beyond dispute," Bloomberg writes.

Go deeper: Johnson & Johnson's legal bills keep mounting

Caitlin Owens