Mar 4, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning.

Situational awareness: Vice President Mike Pence announced yesterday evening that, effective immediately, "any American can be tested" for the coronavirus, subject to a doctors' orders, without restrictions.

Today's word count is 852, or a 3-minute read.

1 big thing: Coronavirus could expose our health system's worst parts

Illustration: Aïda Amer/Axios

The coronavirus may soon become a high-stakes reminder of the flaws in the U.S. health care system.

Why it matters: Our expensive, inaccessible health care system could easily make it harder to control the virus' spread, failing individual patients and putting more people at risk in the process.

  • "You could see uninsured or underinsured patients, just like they do for other conditions, skipping necessary treatment because they believe they can't afford it," Avalere's Chris Sloan said.

Between the lines: A public health issue like the coronavirus isn't just another health care problem to add to the list of health care problems. Rather, all of those other issues directly complicate the response to the virus.

  • If we end up with a widespread outbreak, these big issues will "not even bubble up — they would really explode out into much more plain view," said Jen Kates of the Kaiser Family Foundation.

The uninsured: Nearly 28 million Americans don't have insurance.

  • Uninsured people are more likely to rely on the emergency room. During a pandemic, that can overburden ERs and increase the risk of exposure for uninfected patients waiting to receive care, Kates said.

Affordability: Even for patients who have insurance, deductibles and other out-of-pocket costs have been steadily rising. A hospital stay often comes with the risk of a big bill, and emergency rooms are some of the biggest sources of surprise bills — often for thousands of dollars.

What's next: The Trump administration appears to be taking these concerns seriously. It's considering using a national disaster program to pay providers for the care of uninsured people who have the coronavirus, WSJ reported yesterday.

  • Although a treatment or vaccine for the coronavirus is still a long ways off, concerns have already been raised about whether they'll be affordable (and thus accessible).
2. What Biden's big night means for health care

Illustration: Axios Visuals

Health care has become the framework that defines the broader ideological and stylistic divisions within the Democratic primary — a contest between political revolution and Medicare for All vs. bipartisan compromise and a public option, Axios' Sam Baker writes.

Yes, but: It's kind of a false choice. Passing either of those health care plans would require a knock-down, drag-out party-line brawl just as intense as the fight over the Affordable Care Act.

Why it matters: No single issue has highlighted the differences among the Democratic candidates more efficiently — or more often — than health care, and Medicare for All, specifically.

  • It’s more than simple policy differences; in some cases, the policies aren’t even all that different. It has, instead, become a core extension of each candidate’s bigger political identity — whether they wanted it to or not.
  • Bernie Sanders and Joe Biden have already clashed over Medicare for All vs. a public option that Biden brands as "building on Obamacare," and that surely will continue after Biden's strong showing last night.

Ultimately, though, any Democratic president would run into many of the same brick walls trying to get any of these health care plans passed.

  • The health care industry, led by hospitals, has already poured millions of dollars into ads in key primary states opposing not only Medicare for All, but also a public option and even the narrowest proposals to let some people buy into Medicare.
3. Hospitals have an infection problem

Hospitals have been preparing, to varying degrees, to treat more patients who have the coronavirus, Axios' Bob Herman writes.

Yes, but: Many hospitals have really bad track records of infection control, and "this raises concerns that they could become hotbeds for disease, putting patients at risk and rendering infected workers unable to care for others," according to a new ProPublica analysis of federal inspection reports.

  • Numerous hospitals have been cited in recent years for inadequate hand-washing, short staffing, contaminated supplies and overall high rates of patients catching new infections while hospitalized.
  • One nurse told ProPublica he and colleagues are "resigned to the fact that we're all going to get the coronavirus." 

Go deeper: The poor state of U.S. hospital quality

4. Yes, *net* prices of drugs have increased
Expand chart
Reproduced from Hernandez et. al, 2020, "Changes in List Prices, Net Prices, and Discounts for Branded Drugs in the US, 2007-2018"; Chart: Axios Visuals

The price of brand-name prescription drugs went up by 60% between 2007 and 2018, after accounting for rebates and discounts, according to a new study in JAMA.

Why it matters: Drugmakers often argue that the uproar over drug prices is overblown, saying it focuses too much on list prices instead of the discounted prices insurance plans end up paying. But this study shows that those prices, too, are rising.

  • And patients who are uninsured or haven't yet met their deductible are exposed to the list price of a drug, not its discounted rate.

By the numbers: The average Medicaid drug discount increased from 40% in 2007 to 76% in 2018, the study found.

  • Discounts to other payers increased from 23% to 51%,
5. Pharma pushes targeted Facebook ads

Facebook users are seeing more targeted ads from pharmaceutical companies — an ethical gray area for patient data and privacy, the Washington Post reports.

Why it matters: Drug companies don't need to know your medical history to target you for a a drug, and seeing a surprisingly relevant medical ad can feel invasive, Axios' Marisa Fernandez writes.

How it works: Drug companies can use your browsing history, along with your age, gender and location, to figure out health issues you may have and market their treatment.

By the numbers: Pharmaceutical and health care brands spent nearly $1 billion dollars last year on Facebook mobile ads. Their spending has nearly tripled over two years, according to Pathmatics, an advertising analytics company.

Health privacy laws like HIPAA don't address this intersection of drug companies, data brokers and social media networks.

Go deeper: Big Tech's enormous access to patients' health data

Caitlin Owens