Oct 31, 2018

Axios Vitals

Good morning ... Happy Halloween! If, by chance, you're worried about how to sell your house even though it's haunted, Curbed has some practical tips: At least in New York, "if a seller has 'claimed to the public at large' that house is haunted, it is required to disclose this to the buyer. But if this is just a private belief of the seller, it is not required to be disclosed."

The more you know ...

1 big thing: What the public wants from "Medicare for All"
Expand chart
Data: Survey Monkey online poll conducted Oct. 24-26, 2018 among 2,949 U.S. adults. Poll methodology; Chart: Harry Stevens/Axios

Democratic candidates in the midterm elections, and many of the party’s top 2020 prospects, have endorsed “Medicare for All,” but have significantly differing views of what that policy should actually look like. Turns out, the public is in pretty much the same situation.

In our latest Axios/SurveyMonkey poll, we asked respondents two related questions: What they think candidates mean by “Medicare for All” and what they want that policy to mean, if they support it at all.

By the numbers: Overall, 52% of those surveyed said they think “Medicare for All” refers to a single, government-run health care program covering everyone.

  • Republicans were more confident in that assessment than Democrats: 61% of Republicans said "Medicare for All" is single-payer, compared with 51% of Democrats.
  • A plurality of independents — 42% — said they don’t think candidates are talking either single-payer or an optional program that would compete with private insurance.

Voters were more divided over what they want “Medicare for All” to be, given the same choices.

  • 34% said they would favor a single-payer system; 33% said they would prefer an optional public plan alongside private insurance; 30% wanted neither.
  • Unsurprisingly, Democrats were far more open to a single-payer system than Republicans and independents.

The bottom line: Add it all up, and most people — 67% — seem to be on board with either single-payer or a public option, suggesting that “Medicare for All” is popular, but that's partly because of its multiple meanings.

My thought bubble: In the midterms, there are so many candidates running for so many offices, it’s no surprise they’re able to describe different policies under one banner.

  • The 2020 Democratic primary will be far more effective in organizing Democrats around a shared sense of what does or doesn’t qualify as “Medicare for All.”
2. Medicare Advantage audits may recoup billions

The Centers for Medicare & Medicaid Services is ready to charge ahead with broad audits of Medicare Advantage plans, which could result in companies paying back billions of dollars to the federal government, Axios’ Bob Herman reports.

How it works: The federal government pays MA companies monthly amounts based on how sick their enrollees are. Insurers code the conditions people have, and the more health problems someone has, the more insurers get paid.

  • But regulators are conducting "risk adjustment data validation" (RADV) audits that compare patient medical codes submitted by health insurers with the actual codes that doctors put in patient medical records.
  • The goal is to see if MA insurers are exaggerating people's health conditions to get higher payments.
  • An investigation from the Center for Public Integrity detailed how the industry has manipulated these so-called "risk scores."

The threat of these federal audits has existed for several years, but the audits haven't led to large clawbacks yet. CMS now has an estimate of those improper payments to insurers: almost $14.4 billion in 2017, or 7% of MA spending from that year.

  • Health insurers have long been frightened of RADV audits — every major publicly traded insurer lists the audits as a top "risk factor" in their annual filings to investors.
  • "CMS has a strong requirement to ensure accuracy of payments because of the magnitude of dollars flying around," says Jessica Smith, a consultant at Gorman Health Group who studies risk adjustment.

Go deeper.

3. Medicaid and the midterms

Up to 2.7 million people could gain access to Medicaid as a result of next week's elections, according to new estimates from Avalere Health.

Medicaid expansion is on the ballot in 3 states: Idaho, Nebraska and Utah.

  • And some large non-expansion states, namely Florida and Georgia, have competitive governors' races.
  • If Democrats win those races and make gains in state legislatures at the same time, then Medicaid expansion could become a real option in those states. And some gubernatorial candidates, including Stacey Abrams in Georgia, have made Medicaid expansion a top campaign priority.

Flashback: It's a good thing you read Vitals, where we've been hammering away at this point for over a year. The governors' races are the main event in the midterms and you'll never convince me otherwise.

4. Picking a color for prescription drugs

Don't pretend you don't recognize this drug. Photo: Wodicka/ullstein bild via Getty Images

Viagra is blue. Nexium is purple. Those color schemes have been integral to the drugs’ marketing, and thus their sales, and thus the billions of dollars they’ve made for their manufacturers. And those colors weren’t an accident.

“We typically select a brand’s colors palette and logo years before launch, based on deep customer insights," Eli Lilly told BioPharma Dive for this thorough exploration of the color-selection process.

Several factors affect drugmakers’ dye decisions, according to the report:

  • Drugmakers don’t want their products to be the same color as a competing product.
  • The color of the pill itself integrates into the drug’s overall marketing scheme.
  • Regulatory requirements limit certain ingredients, which limits color options.
  • Different colors have different meanings in different parts of the world.
  • As with any other design choice, colors like red and orange suggest stimulus, while shades of blue imply serenity. So the color depends on what the drug does.

"If you have a product for, let's just say a dermatology product for psoriasis, you're not going to make the color red because that reminds people of inflammation. You're not going to use the color yellow for something treating an infection because that reminds you of puss," Dave Traini, the creative director at a health care advertising agency, told BioPharma Dive.

5. 1 fun thing: TB gave us modern architecture

Alvar Aalto's Paimio Sanatorium. Photo: Getty Images

Well, obviously tuberculosis isn't fun. But this history is: Modernist architecture and design apparently owe a lot to the treatment systems for tuberculosis.

"In their designs for workers’ housing, early Modernists in Europe such as Bruno Taut and Peter Behrens drew on sanatoria for inspiration. Behrens designed an apartment block that 'was directly inspired by the model of the sanatorium,'" bioethicist Elizabeth Yuko writes in a fascinating history lesson at CityLab.

Treatment for tuberculosis was largely environmental, focusing on giving patients easy access to fresh air and natural light, often in purpose-built buildings.

  • Not only did Modernism adopt some of those same principles, but early Modernist architects were directly influenced by sanatorium design,
  • Finnish architect Alvar Aalto designed the Paimio Sanatorium, with numerous balconies and a flat roof to accommodate a terrace.
  • Aalto's Paimio chair was designed specifically for that facility, to help patients' breathing and easy cleanup, before becoming one of his most famous mass-produced furniture designs.

Some of those principles — namely, easy exposure to nature — are still a big part of health care architecture.

  • "Visit many newer hospitals today and you’ll see instances of integrating nature into the healing process, whether it’s an atrium full of natural light or patient rooms overlooking a green space," Yuko notes.