Nov 19, 2019

Axios Vitals

Good morning. We're back to a manageable 785 words today, or a 3-minute read.

1 big thing: Health industry expects little change from heart study

How a stent works. Photo: BSIP/Universal Images Group via Getty Images

A new federal study said stents and bypass surgery are no more effective than drugs for treating blocked arteries, but the health care industry and its investors aren't banking on major changes to heart care as a result, Axios' Bob Herman reports.

The big picture: Placing stents and performing bypasses are two of the most common operating room procedures.

  • Science continues to say we don't need to be doing them so often, but overhauling that standard of care isn't easy — in part because hospitals and device makers make a lot of money from them.

What they're saying: Cardiologists and researchers across the world widely praised the trial's methods and results, and heart care leaders have said the diminished value of stents and bypass surgery would be incorporated into standard care guidelines.

Yes, but: "Established practices die hard, especially when there is a substantial culture, mindset and financial structure reinforcing that behavior," said Vikas Saini, a cardiologist and president of the Lown Institute, who said the trial's results matched up with decades of research.

  • Mike Mahoney, CEO of Boston Scientific, one of the largest makers of stents in the world, told investors in October that if the trial presented a dim view of stenting, the company would lose, at most, $40 million in sales next year as physicians reconsider their practices — a blip within the company's $4 billion cardiovascular business.

The bottom line: The prices of individual stents range anywhere from several hundred to several thousand dollars, and the surgeries tack on tens of thousands more for hospitals, which have been pretty dedicated to keeping their beds full whenever possible.

2. Health care hiring is recession-proof

Health care hiring is driving the labor market, and it's so robust that it likely would be safe even during a recession or political upheaval, CNN Business reports.

Between the lines: No matter what happens, the population is aging and will need care.

  • Payment models may change, but the demand for care will still be there — meaning that the demand for people to deliver that care will remain, as well.

The big picture: Health care has added more net jobs to the economy over the past decade than any other sector, and today employs 11% of the workforce.

  • The number of jobs is projected to keep growing. Teachers for health subjects, home health aides and nurses are among the 10 fastest-growing jobs until 2028, according to the Bureau of Labor Statistics.

My thought bubble: Many of the health jobs that are going to be in high demand are relatively inexpensive, but they're not free, and we're still going to have to come up with a way to pay for them.

Go deeper:

3. Flu shots exemplify pricing dysfunction

Insured patients don't directly pay anything for flu shots, but they can be expensive — and these costs vary widely, California Healthline reports with Kaiser Health News.

Why it matters: It's well-documented that the prices of health care services vary widely by location, but the price discrepancy among flu shots — which are cheap — drives home how inconsistent and arbitrary the system can be.

  • Even if patients aren't paying these prices out of pocket, we all pay for inflated costs via higher premiums.

Case in point: KHN found that what its insurer paid for KHN employees' flu shots varied dramatically; the insurer paid $85 to one facility in Sacramento and $32 at a drugstore in Washington, D.C.

  • In D.C., Medicaid pays $15 for a flu shot.
4. A glimpse into the hospital of the future

Recently opened Stanford Hospital, located in Silicon Valley, serves both as an example of what futuristic hospitals look like and an experiment into whether they'll save money, STAT reports.

The big picture: The jury's still out as to whether health tech will end up reducing health care costs through more efficient and higher-quality care, or whether all of this expensive technology will just end up increasing patients' premiums.

What they're saying: Stanford says its cost model isn't changing as it transitions from its old hospital to its new, high-tech one.

  • The system's philosophy is "not to do technology for technology's sake — but to do it to reduce the burden on the patient, on the physician, on the nurse, on the pharmacy tech," Gary Fritz, Stanford health system’s chief of applications, told STAT.
  • "If it's possible to automate something so it takes a routine function off someone's agenda so they can work on higher-value activities, we did so," he added.
5. Dems like Medicare for All, swing voters don't

Illustration: Eniola Odetunde/Axios

New polling from the Kaiser Family Foundation and the Cook Political Report confirms that while Democratic voters like the idea of "Medicare for All," it would be a risk in a general election, KFF's Drew Altman writes in today's column.

Between the lines: This poll was conducted in the formerly "blue wall" states of Pennsylvania, Minnesota, Michigan, and Wisconsin.

By the numbers: 62% of Democratic voters in those states say a "Medicare for All" plan that eliminates private insurance is a good idea — while 62% of swing voters in these battleground states say it's a bad idea.

Yes, but: The poll suggests that 2020 is a referendum on President Trump, not on health policy.

  • By wide margins, Democrats and independents said defeating Trump was their main motivator. Keeping him in office was Republicans' top factor.

The bottom line: If the Democratic nominee comes to be defined by the idea of "Medicare for All," that could be a political problem in key battleground states.