Tuesday, July 21, 2026
Monday, July 13, 2026
Why Do Democrats Hate Medicare Advantage?
It’s the best program in the entire U.S. healthcare system, including even employer-sponsored plans
By John C. Goodman. Excerpts:
"Medicare has already had a competing public option for more than two decades. It’s called traditional Medicare, and it has been losing the competition. More than half of all Medicare enrollees are in private plans."
"What Mr. Doggett calls the “giant private insurance companies that profiteer off Medicare” are mostly the same companies that are administering Medicaid."
"78% of [Medicaid] enrollees are in private managed care plans, or MCOs."
"enrollees are normally required to join an MCO. Yet it’s rare to hear a congressional Democrat advocate less spending on “giant” MCOs “profiteering” off care for the poor."
[Medicare Advantage] "is the only program in our entire healthcare system in which a doctor who discovers a patient’s previously unknown health problem can send that information to the insurer"
"Medicare Advantage plans are the only plans in our healthcare system that actually want sick people as enrollees."
"for sick people in [ObamaCare] marketplace plans, the out-of-pocket exposure is the highest found anywhere."
"Significantly more low-income beneficiaries were enrolled in Medicare Advantage plans (68% vs. 32%) in 2023. In 2021, such plans were also the preferred choice of black (59%) and Hispanic (67%) enrollees relative to whites (43%)."
"Medicare Advantage is the only program in our healthcare system in which health plans can specialize in the treatment of specific conditions"
"Medicare Advantage plans make money by keeping people healthy."
"Medicare Advantage plans make insulin available free in special-needs plans for diabetics."
"Most employer plans and exchange plans haven’t done the same because free or cheap insulin would attract diabetic enrollees"
"In traditional Medicare . . . “20% percent of diabetes patients routinely get ulcers and 20% of those ulcers turn into amputations.” In Medicare Advantage, the number of amputations is a tiny fraction of that."
Friday, July 10, 2026
Single-payer health care systems are looking worse all the time
"That is the theme of my latest Free Press piece, here is one excerpt from it:
Government-run systems often (not always) do a perfectly fine job setting a broken arm or administering a long-standing, well-known medication. They do much less well when it comes to developing, financing, and delivering a new immunological approach to fighting cancer, personalized to your individual genome at a cost of hundreds of thousands of dollars. In our rapidly arriving biomedical future, innovation capacity will matter above all else. And though they may not see it today, the people with the most life ahead of them will reap nearly all of the benefits of a dynamic system, or suffer the consequences of a paralytic one.
Thirty years ago, it was often debated whether the Canadian or British healthcare systems were better than what we have in the U.S. After all, they offered a kind of guaranteed access to health services. The details could differ, but often the healthcare had no upfront price or only a low user fee. In America, in contrast, healthcare was more expensive, there were many millions of uninsured people, and dealing with sometimes rapacious insurers and hospitals could involve significant emotional trauma.
But over time the British and Canadian systems look worse and worse. The queues and rationing have increased, as giving healthcare away for free makes it hard to satisfy demands in a timely manner. In Canada, for instance, the median wait time has risen from 9.3 weeks in the early 1990s to 28.6 weeks today. In the British National Health Service, only 65.3 percent of patients start treatment within 18 weeks.
Worse yet, both of those systems are undercapitalized. In Britain, healthcare is badly understaffed and underfunded. Yet the country already has high taxes, high debt, and slow economic growth, so it is not clear where the new money will come from to recapitalize the system.
And this sentence:
This entire dynamic will be intensified as the pace of medical innovation picks up.
Your life may depend on it."
Wednesday, June 10, 2026
After 40 Years, No One Has Produced a Workable Single-Payer Health Care Plan
Vermont passed single-payer legislation in 2011 and abandoned the plan after three years of failure. Why?
By Veronique de Rugy. Excerpts:
"Brookings Institution economist Jessica Riedl has spent years waiting for one [a workable legislative proposal for single payer]. Her challenge is simple: Show us a progressive bill that specifies (a) a provider payment system that actually saves money under America's existing, already expensive health infrastructure, and (b) a financing mechanism to replace the roughly $32 trillion in private premiums and out-of-pocket costs that would need to be covered by federal taxes over the next decade."
"Despite hundreds of legislative proposals and multiple presidential campaigns built around the issue, no one has met the challenge."
"the proposals are only aspirational. They enumerate generous new benefits with great enthusiasm and then instruct the secretary of Health and Human Services to figure out the rest. The phrase "The Secretary shall" appears 62 times in the Sanders bill alone."
"European countries built modest, government-controlled health infrastructures from the ground up over several decades. They contained costs—meaning, among other things, they rationed care—as they expanded access. America did the opposite.
We built the most expensive, technologically advanced, sprawling health system in human history, which consumes nearly 20 percent of gross domestic product (GDP), under mostly private incentives and market pricing. As Riedl puts it, "We cannot simply pay European prices for the more vast American health infrastructure that exists."
The central theory of single-payer savings has always been this: Slash payments to providers to offset the surge in the use of universal, no-cost-at-point-of-service coverage. The Congressional Budget Office (CBO) took a serious look at this fantasy. Its conclusion was that national health expenditures might actually rise, and demand for care would outrun supply. The final result would be European-style rationing, delays, and forgone services, all leading to worsening health care.
Then there's the inconvenient question of how to get the tax revenue needed for a single-payer system to replace private health care premiums, out-of-pocket expenses, and state health programs. Although neither Sanders nor Jayapal has an answer, the Committee for a Responsible Federal Budget does. Financing a Sanders-style system would require a new 32 percent payroll tax, a 25 percent income surtax, or a 42 percent value-added tax, more than doubling every individual and corporate income-tax rate.
The CBO found that such a system would reduce GDP by 6 percent to 10 percent by 2030. From a movement that claims to care about working Americans, that number deserves more than silence.
The state-level record confirms what the nasty arithmetic and voters' disgust tell us. Vermont passed single-payer legislation in 2011 and assigned an expert commission to make the numbers work. After three years of failure, Gov. Peter Shumlin abandoned the plan, admitting that the required 11.5 percent payroll tax per company plus the 9.5 percent income tax per Vermonter (with small businesses paying both) would be politically unsurvivable even in Sanders' home state. Colorado voters rejected their single-payer initiative in 2016 after analysis showed that even tripling taxes wouldn't cover the costs.
Back in California in 2022, the state's nonpartisan legislative analyst estimated that the proposed single-payer system created by the California Guaranteed Health Care for All Act would cost between $494 billion and $552 billion annually. Imagine the taxes needed to more than double that state's spending overnight.
After the bill died without a vote, Assemblymember Ash Kalra (D–San Jose) reintroduced it in February 2026, and it failed to advance again a few months later. California has now killed single-payer twice in four years."
Thursday, June 4, 2026
Health Insurance Affordability: The Trump Administration Overthinks a Short Putt
"Last Friday, the Trump administration quietly moved a little closer to granting temporary relief from Obamacare. That action is not useless, but it does appear to signal a wasted opportunity.
The administration is preparing a regulation to change how the federal government interprets the law governing so-called “short-term limited duration insurance,” or STLDI. Only a few million people enroll in STLDI plans. The market has outsized importance, however, because it is one of only two kinds of health insurance that are exempt from Obamacare’s costliest health insurance regulations, the other being health insurance in US territories. Unlike territorial plans, STLDI is exempt from both Obamacare and nearly all other federal health insurance regulations. That is why STLDI plans can offer comprehensive health insurance to many or most Obamacare enrollees at premiums 60 percent (Congressional Budget Office) to 66 percent (Kaiser Family Foundation) below the lowest-price Obamacare plans.
Trump’s greatest health care victory was a 2018 regulation that provided relief from Obamacare by adding consumer protections to these plans. In 2016, President Obama tried to force reluctant consumers into overpriced, low-quality Obamacare plans by arbitrarily limiting STLDI plans to three months. The Obama rule tossed patients out of their coverage after they got sick, leaving them with nothing. In 2018, Trump clarified that it was perfectly consistent with federal law for STLDI contracts to last 12 months, for insurers to renew the initial contract for up to 24 additional months, and for insurers to issue separate renewal guarantees—so that when consumers reached the 36-month limit, they could enroll in a new STLDI plan at healthy-person premiums, even if they had fallen seriously ill. Trump clarified, and two federal courts affirmed, that federal law effectively leaves this market enough freedom to offer consumers long-term health insurance protection.
The Trump rule was a success. Premiums for comprehensive coverage fell. Consumers could purchase health insurance free from Obamacare’s quality-reducing regulations. Obamacare premiums did not spike and enrollment did not fall, as critics predicted. Instead, while the Trump rule was in place from 2018 to 2024, Obamacare premiums stabilized and enrollment increased.
Nevertheless, in 2024, President Biden rescinded the Trump rule. Like Obama, Biden wanted to force reluctant consumers into overpriced, low-quality Obamacare plans. He limited STLDI plans to four-month contracts and prohibited all renewals—federal court rulings notwithstanding.
The only flaw in the Trump rule is that it was not permanent. While it clarified that insurers were free to offer renewal guarantees, the fact that it came from administrative rulemaking rather than legislation meant that the next president could take that freedom away at the stroke of an autopen. So insurers did not have sufficient incentive to invest in renewal guarantees.
For months, the Trump administration has been debating how to promote health insurance affordability. On one side are those who support a regulation-only strategy by which the administration reissues the 2018 rule, even though the new rule may last as little as two years. This side is apparently unaware that tremendous gains in freedom and affordability would come from codifying the Trump rule, that they are sitting on a winning messaging strategy, and that experience with the Trump rule has already negated critics’ fearmongering. The savvier side of this debate advocates for a legislative strategy by which Trump pushes Congress to make his greatest health care victory permanent and pursues regulation only as a backup.
Unfortunately, the regulation-only side appears to be winning. The president’s Great Health Care Plan doesn’t mention STLDI, much less demand that Congress codify the Trump rule. I have seen no indication from the administration that it plans to push Congress to do its job.
It is a tremendous waste of an opportunity. The administration can reissue the 2018 rule. It can even improve on that rule. But any relief it provides would disappear with the next Democratic administration.
President Trump needs to push legislators to legislate. I’ve already provided the arguments, data, talking points, polling, poster child, graphs, and legislative language the administration needs.
People are still struggling under the high cost of Obamacare. They need permanent relief."
Tuesday, June 2, 2026
Expanding 340B Won’t Fix a Broken System
Including community practices in the discount drug program would make a bad problem worse
"Regarding “Is the 340B Discount Drug Program Working?” (Letters, May 13): The American Society of Clinical Oncology’s proposal to expand 340B drug discount program eligibility to community practices will only worsen existing problems with the program.
What began in 1992 as a modest safety-net program intended to help vulnerable patients has evolved into a multibillion-dollar institutional revenue stream that too often benefits hospitals and health systems more than patients.
Expanding participation in a flawed program isn’t reform. It simply broadens access to the same distorted financial incentives that have fueled consolidation, higher costs and migration of cancer care into more expensive hospital settings.
The problem with 340B isn’t that too few institutions can profit from it. It’s that hospitals and covered entities can purchase drugs at steep discounts while receiving reimbursement from commercial payers, often without demonstrating that savings directly reduce costs for financially vulnerable patients.
Discounts should follow patients in need—not institutions. If a patient is uninsured, underinsured or financially vulnerable, the value of the discount should be directly tied to that patient’s care through lower out-of-pocket costs, financial assistance and improved access to treatment. That’s what Congress intended.
Ted Okon and Lucio Gordan, M.D.
Community Oncology Alliance and
Fla. Cancer Specialists & Research Inst."
Monday, May 25, 2026
Who Is Benefiting From the 340B Program?
"Your editorial (“The Great 340B Healthcare Grift,” May 8) is exactly right. 340B drug discounts are fattening the coffers of large hospitals and pharmacies at the expense of patients—and it’s a scandal. The judge correctly called it a “coordinated collusion” that’s exploiting “Congress’s inattention to a federal program.”
A growing wealth of data show that profits are soaring for so-called charity-care hospitals, and that 340B hospitals with the highest share of cancer patients pursue aggressive medical-debt collection tactics against those the program was created to support. Yet state lawmakers continue to propose and pass reforms at the behest of hospitals to protect this unintended windfall.
Anyone who lives in a city with a significant hospital presence has likely noticed the steady expansion of hospital names and buildings—often concentrated in affluent communities rather than areas with large numbers of uninsured or low-income patients. States should stop bolstering a broken program, and Congress must bring transparency to 340B to close the loopholes that continue to harm patients.
Sally Greenberg
CEO, National Consumers League"
Saturday, May 23, 2026
Almost 50% of Preventable Cancers Linked to Just Two Lifestyle Habits
By Carly Cassella of ScienceAlert. Excerpts:
"According to a recent analysis from the World Health Organization (WHO), more than a third of all cancer cases globally are preventable.Lung, stomach, and cervical cancers make up nearly half of those cases.This means that millions of deadly cancers every year could be prevented through medical intervention, behavior changes, reducing occupational risks, or tackling environmental pollutants.""n 2022, there were nearly 19 million new cases of cancer. Roughly 38 percent of those diagnoses were related to 30 changeable risk factors.""These included tobacco smoking, alcohol consumption, high body mass index, insufficient physical activity, smokeless tobacco (like chewing tobacco), a traditional stimulant known as areca nut""The number one preventable factor associated with cancer? Smoking tobacco. It was linked to 15 percent of all cancer cases that year.""After tobacco smoking, the runner-up among changeable lifestyle factors was drinking alcohol. It accounted for 3.2 percent of all new cancer cases (approximately 700,000 cases).""smoking tobacco and drinking alcohol account for almost half (around 48 percent) of all cases of preventable cancer."
Related posts:
Physical exercise and a nutritious diet can fight dementia (2025)
Can weight-lifting promote empathy? Can aerobic exercise improve memory? (2025)
Facing a Cancer Diagnosis? Exercise and Diet Could Make a Difference (2025)
Does Exercise Improve Survival After a Cancer Diagnosis? An Encouraging New Study (2024)
Even Short Runs Have Major Health Benefits (2023)
What if the Most Powerful Way to Live Longer Is Just Exercise? (2023)
Exercise Helps Blunt the Effects of Covid-19, Study Suggests (2023)
How lifestyle changes can reduce the risk of dementia (2019)
Good health begins with individual decisions (2018)
Nearly half of U.S. cancer deaths blamed on unhealthy behavior (2017)
Thursday, May 21, 2026
The Feudal Economics of Modern Healthcare: How Regulation Turned Medicine into a Fiefdom
By Richard Menger. He is currently the Chief of Complex Spine Surgery at the University of South Alabama and is on the faculty of the neurosurgery and political science departments. Excerpt:
"Medicine once mirrored this liberalizing trend. Post-World War II, most physicians owned or partnered in independent practices. They controlled their schedules, negotiated directly with patients and insurers, and bore the risks and rewards of their craft. Private property in medical practice — autonomy over one’s office, staff, and patient relationships — fostered competition and innovation. That world is vanishing. Today, nearly 78 percent of US physicians are employees of hospitals, health systems, or corporate entities. Private practice has collapsed into a shrinking remnant.
The new lords are sprawling tax-exempt “non-profit” health systems. These entities enjoy at least $37 billion annually in federal and state tax breaks — property, income, and sales tax exemptions — while operating with margins and executive compensation packages that rival for-profit corporations. Many run massive investment portfolios and for-profit subsidiaries. Their community-benefit spending often falls short of the value of their exemptions when measured rigorously; some profitable systems deliver minimal charity care relative to their tax windfall.
Government policy supplies the moat around these castles. Rule after rule and regulation after regulation favors the big conglomerates. The regulatory reach adds to the lords’ dominion.
By Richard Menger. Richard Menger He is currently the Chief of Complex Spine Surgery at the University of South Alabama and is on the faculty of the neurosurgery and political science departments. Excerpts:
"Certificate-of-need (CON) laws are still on the books in about 35 states plus DC, requiring regulatory approval before new hospitals, surgery centers, or even MRI machines can open. Incumbent systems predictably oppose competitors’ applications, turning state boards into tools of rent-seeking protection. Without CON, independent physicians and ambulatory centers could challenge hospital dominance. With it, local monopolies flourish.
Once entrenched, these systems wield two powerful economic weapons: the 340B Drug Pricing Program and site-of-service payment differentials. Enacted in 1992 to help safety-net providers serve low-income patients, 340B allows qualifying hospitals to purchase outpatient drugs at steep discounts — often 20-50 percent or more — then bill insurers or Medicare at full list price. In 2024, covered entities purchased $81.4 billion in 340B drugs. But studies and reports show the windfall frequently funds facility expansion, acquisitions, and executive pay rather than expanded charity care for the intended populations. Contract pharmacies amplify the arbitrage. The program has become a hidden tax on patients, employers, and manufacturers, with limited transparency on how savings reach the vulnerable.
Site-of-service differentials complete the trap. Medicare — and many commercial payers — reimburse the identical service at dramatically higher rates when performed in a hospital outpatient department (HOPD) instead of a physician’s independent office. A clinic visit, imaging study, or minor procedure in an HOPD can command 125 to 300 percent more reimbursement. Hospitals therefore acquire physician practices, rebrand them as HOPDs, and capture the facility-fee markup. Patients are sometimes seeing the same doctor in the same building but for twice as much.
Physicians are increasingly likely to be employed by these healthcare entities — not because they want to, but because the structure and rules are tilted that way.
The physician receives a salary or production bonus but loses ownership. The patient pays higher coinsurance. Independent practices cannot compete on price because the payment rules themselves favor the hospital flag. Vertical integration explodes. Horizontal mergers compound the effect. Markets once served by several competing hospitals see them consolidate into single dominant systems: one or two health systems control the entire market for inpatient care in half of American cities. Research consistently shows that such mergers raise prices five to 20 percent or more — with little or no improvement, and sometimes deterioration, in quality. Cross-market mergers demonstrate similar price effects after several years.
The physician-vassal’s daily reality reflects the bargain. A neurosurgeon or cardiologist may receive a competitive base salary, malpractice coverage, and administrative relief from his affiliation with a hospital. In return, the doctor must (directly or indirectly) refer patients only within the system, meet RVU targets that prioritize volume over value, and accept corporate dictates on electronic health records and formulary restrictions. They must accept care pathways optimized for margins, rather than patient outcomes. Dissent risks contract non-renewal, often triggering noncompete clauses.
True entrepreneurship — opening an ambulatory surgery center or cash-pay spine clinic — requires profound courage and near-inevitable litigation within the framework of CON. The independent doctor who once embodied the free professional has become a salaried cog in a revenue-extracting machine.
Reversing neofeudalism in medicine demands restoring property rights and competition — the very forces that ended medieval feudalism. Policymakers should repeal CON laws nationwide, as several states already have with measurable price reductions and new market players. Implement full site-neutral Medicare payment for outpatient services, leveling the field so independent practices can survive. Reform 340B with transparency mandates, patient-definition tightening, and caps on windfall profits unrelated to charity care. Stop the unnecessary ban on physician-owned hospitals that provide better care at cheaper costs. Antitrust enforcement must scrutinize both horizontal and vertical mergers with renewed vigor. Tax-exempt status for hospitals should be performance-based, tied to verifiable charity care and community benefit exceeding the exemption’s dollar value."
Sunday, May 17, 2026
Is the 340B Discount Drug Program Working?
"Your editorial “The Great 340B Healthcare Grift” (May 8) highlights a program that has strayed far from its original mission. While drug therapies are essential to cancer care, access to these medications is increasingly entangled in the 340B discount drug program—an initiative in desperate need of reform.
The American Society of Clinical Oncology recently published a policy statement detailing how to make the program more transparent and accountable. Essential reforms include requiring participating entities to meet select federal nonprofit charity care standards and implementing strict rules to ensure savings are used for direct patient care rather than unrelated hospital acquisitions or construction projects. Transparent financial reporting should demonstrate measurable improvements in care for underserved areas, backed by financial penalties for noncompliance.
Reform must also allow community-based nonhospital providers, which form the backbone of oncology in rural and underserved areas, to participate if they meet established thresholds for treating Medicaid and uninsured patients.
The 340B program is so embedded in our healthcare system that complete elimination risks harm to vulnerable patients. Instead, oncologists and policymakers must reform it.
Clifford Hudis, M.D., FASCO, FACP
American Society of Clinical Oncology
Alexandria, Va."
Tuesday, April 21, 2026
Dr. Makary and Mr. Hyde at the FDA
The agency kills a therapy for melanoma despite the evidence of progress against deadly tumors
WSJ editorial. Excerpts:
"Patients with metastatic melanoma who stop responding to other immunotherapies typically die in less than a year. In Replimune’s trial, tumors shrank in nearly all patients and vanished in one of six. About a third went into remission. FDA staff were so impressed by the results that the agency designated RP1 a “breakthrough therapy” in November 2024 to expedite its review."
"As we’ve reported, Dr. Prasad last summer overruled career staff to reject RP1. The agency’s main criticism was that its trial lacked a control arm, though this would be unethical in late-stage patients who failed to improve on other therapies."
"Start with the claim that the tumor-shrinking effects of RP1 could not be disentangled from that of another immunotherapy that patients were taking concurrently. But all patients had previously relapsed or failed to respond to other immunotherapies. RP1 is intended to help these refractory patients by boosting their response to other therapies."
"cancer in responding patients advanced after a median 30.6 months when they also got RP1, versus 4.4 months of being treated with other immunotherapies."
"The FDA implicitly concedes that the RP1 results are impressive by contriving ridiculous reasons to argue they could be exaggerated."
Sunday, April 19, 2026
Around 14% of Enrollees in ACA Plans Failed to Make Payments, Data Shows
Decline in January payments is driven by loss of federal Affordable Care Act subsidies
By Anna Wilde Mathews of The WSJ. Excerpts:
"Normally, the rate of falloff in ACA plan membership early in the year is in the midsingle-digit range.
ACA enrollment was already declining."
"Many ACA policyholders saw their insurance bills mushroom after expanded federal subsidies that started during the pandemic lapsed at the start of January, when insurers were already implementing major rate hikes largely because of rising health costs."
"When health-insurance prices rise, younger, healthier people are more likely to drop coverage, leaving a greater proportion of sicker people who are costlier for insurers.
Among people who signed up with the same ACA insurers in 2026 that they had last year, Wakely data showed that those who made their initial premium payments were about 10% less healthy, based on an estimate of their expected healthcare costs, than those who didn’t pay their January bills.
When healthier people leave a market, insurers project higher average healthcare costs per enrollee and raise their premiums to cover them. That happened this year, when insurers made steep rate increases, but it couldn’t yet be determined if they correctly gauged the pattern—or if they will raise premiums again next year partly as a result of the ever-costlier pool of enrollees."
"some of the HealthCare.gov states saw rapid growth of low-income enrollees after the introduction of enhanced subsidies in 2021, with many on plans that didn’t require any premium payments. That expansion might now be melting away."
Sunday, April 12, 2026
The ObamaCare Crisis That Isn’t
The large coverage losses and premium hikes haven’t happened
WSJ editorial. Excerpts:
"Remember when Democrats claimed that Congress’s failure to extend the pandemic ObamaCare subsidies would cause masses of Americans to lose insurance and premiums to skyrocket? It hasn’t happened, as new data from the Centers for Medicare and Medicaid Services (CMS) show.
Some 23.1 million consumers signed up during this year’s open-enrollment period. That’s 1.2 million fewer than last year, but still 6.8 million more than in 2023 and nearly twice as many as in 2021. Many who dropped out of ObamaCare had previously been improperly enrolled or received subsidies they didn’t qualify for."
"CMS says it cancelled subsidies for “nearly 1.5 million people found to be ineligible”"
"The pandemic-era subsidies encouraged people to understate income to qualify for bigger subsidies"
The Democrats’ ObamaCare Quagmire
Their solution to the law’s disastrous effects is simply more of the same
By Chris Jacobs. Jacobs is founder and CEO of Juniper Research Group, a policy consulting firm. Excerpts:
"To “make health care simpler for families,” the lawmakers would “make sure people can get the insurance they are eligible for through a one-stop shop,” and “simplify and standardize plans and benefits.” ObamaCare already created government-run exchanges to shop for coverage—years after private companies had created comparison-shopping tools online. The law also standardized benefits, imposing new coverage requirements that more than doubled individual insurance premiums in ObamaCare’s first four years. Why are Democrats suggesting policies they enacted in 2010?"
"Democratic lawmakers appear to want to regulate ObamaCare off-ramps like short-term limited-duration plans and catastrophic insurance out of existence."
"Democrats want to enact stronger so-called consumer protections that eliminate any exit from the ObamaCare morass."
"insurers have bought up pharmaceutical benefit managers and other healthcare entities to shift revenue from insurance products—where ObamaCare’s medical loss ratio caps their profits—to business areas where profits remain uncapped."
"In 2008, Barack Obama pledged that his healthcare plan would lower premiums by $2,500 a year for the typical family. But Sen. Peter Welch, who signed the Wyden letter, conceded last fall that “we did fail to bring down the cost of healthcare.”"
Thursday, April 9, 2026
Shellfish, Typhoid, and Private Control of Disease
"According to a recent study, early 20th c. London fishmongers provided a creative solution for the problem of foodborne typhoid transmission (the study says "Industry-led efforts to mitigate contaminated shellfish reduced typhoid deaths in London from about 1.5 to 0.1 per 10,000 people between 1900 and 1920").
The issue was that shellfish
acted as vectors for waterborne diseases … Once the connection was understood, consumers alone could have substantially reduced typhoid deaths by consuming far fewer shellfish.
Instead, a prominent fishmonger company
used the Billingsgate [fish] market to help high-quality sellers signal the quality of their products by sampling and testing harvest sites, banning sales from known contaminated areas, and requiring vendors to purchase shellfish cleaning services.
This strategy meant that
consumers who were willing to risk their own quality control could purchase shellfish for a lower price from traders who did not transit through Billingsgate, while those willing to pay a premium for third-party quality control purchased shellfish through Billingsgate.
Profit-motivated companies can create public goods."
Saturday, April 4, 2026
Medical wait times cost Canadian patients over $4.2 billion in lost wages and productivity last year
By Mackenzie Moir of The Fraser Institute.
The Private Cost of Public Queues for Medically Necessary Care, 2026
- One measure of the privately borne cost of wait times is the value of time that is lost while waiting for treatment.
- Valuing only hours lost during the average work week, the estimated cost of waiting for care in Canada for patients who were in the queue in 2025 was over $4.2 billion. This works out to an average of about $3,043 for each of the estimated 1,386,286 Canadians waiting for treatment in 2025.
- This is a conservative estimate that places no intrinsic value on the time individuals spend waiting in a reduced capacity outside of the work week. Valuing all hours of the week, including evenings and weekends but excluding eight hours of sleep per night, would increase the estimated cost of waiting to $12.9 billion, or about $9,336 per person.
- This estimate only counts costs that are borne by the individual waiting for treatment. The costs of care provided by family members (the time spent caring for the individual waiting for treatment) and their lost productivity due to difficulty or mental anguish are not valued in this estimate. Moreover, non-monetary medical costs, such as increased risk of mortality or adverse events that result directly from long delays for treatment, are not included in this estimate.
Friday, April 3, 2026
Taxing Medicines Is Bad Medicine
"President Trump has announced he will impose a 100 percent tax (tariff) on imports of both on-patent medicines and active ingredients for domestic production of such medicines. He will lower the tax rate to 20 percent if the manufacturer presents the administration with a plan to relocate the manufacturing to the United States. He will further knock the tax rate down to 0 percent if the manufacturer also submits to the president’s price controls.
The president has determined that the patented medicines and the active pharmaceutical ingredients that go into the domestic production of on-patent medicines “are being imported into the United States in such quantities or under such circumstances as to threaten to impair the national security.” A foreign spy is a threat to national security. The medicine that cured your kid is not.
This tax scheme will make US citizens poorer and make critical medicines—for “cancer, rare diseases, autoimmune disorders, infectious diseases, and other critical health challenges”—more expensive and scarce. It will raise prices on many of the 53 percent of on-patent drugs that US buyers purchase from abroad and raise prices for many of the rest by increasing input prices.
The new taxes will increase prices for insulins, statins (e.g., Atorvastatin, the single most frequently prescribed drug in the United States), some second-generation antihistamines, pain-relieving opioids, pseudoephedrine, monoclonal antibodies (which treat cancer, autoimmune disorders, and other diseases), and antidepressants. The last time the federal government imposed unnecessary restrictions on non-sedating second-generation antihistamines, those restrictions caused airplanes to fall from the sky.
If producing these drugs and inputs domestically could deliver the same or greater quantity and/or at the same or lower cost, manufacturers would already be doing so. The fact that the president must force them to do it indicates that domestic production will be costlier and will make these medicines more expensive and scarce. Even where manufacturers fully comply and avoid the administration’s explicit taxes, consumers will still pay a hidden tax in the form of higher prices for medicines and health insurance."
Wednesday, March 25, 2026
Cuban infant mortality and longevity: health care or repression?
Gilbert Berdine, Vincent Geloso & Benjamin Powell. Excerpts:
"Centralized planning has disadvantages. Physicians are given health outcome targets to meet or face penalties. This provides incentives to manipulate data. Take Cuba’s much praised infant mortality rate for example. In most countries, the ratio of the numbers of neonatal deaths and late fetal deaths stay within a certain range of each other as they have many common causes and determinants. One study found that that while the ratio of late fetal deaths to early neonatal deaths in countries with available data stood between 1.04 and 3.03 (Gonzalez, 2015)—a ratio which is representative of Latin American countries as well (Gonzalez and Gilleskie, 2017).2 Cuba, with a ratio of 6, was a clear outlier. This skewed ratio is evidence that physicians likely reclassified early neonatal deaths as late fetal deaths, thus deflating the infant mortality statistics and propping up life expectancy.3 Cuban doctors were re-categorizing neonatal deaths as late fetal deaths in order for doctors to meet government targets for infant mortality."
"physicians who worried that a mother’s behavior might lead to missing the centrally established targets will prescribe the forceful internment in a state clinic (casa de maternidad) so that they may regulate her behavior.4 Physicians often perform abortions without clear consent of the mother, raising serious issues of medical ethics, when ultrasound reveals fetal abnormalities because ‘otherwise it might raise the infant mortality rate’"
"Coercing or pressuring patients into having abortions artificially improve infant mortality by preventing marginally riskier births from occurring help doctors meet their centrally fixed targets. At 72.8 abortions per 100 births, Cuba has one of the highest abortion rates in the world.6 If only 5% of the abortions are actually pressured abortions meant to keep health statistics up, life expectancy at birth must be lowered by a sizeable amount. If we combine the misreporting of late fetal deaths and pressured abortions, life expectancy would drop by between 1.46 and 1.79 years for men."
"car ownership is heavily restricted in Cuba and as a result the country’s car ownership rate is far below the Latin American average (55.8 per 1000 persons as opposed to 267 per 1000) (Road Safety, 2016). A low rate of automobile ownership results in little traffic congestion and few auto fatalities."
"The maternal mortality ratio of Cuba in 2015 was higher than in Latin American countries like Barbados, Belize, Chile, Costa Rica, Mexico and Uruguay (Trends in Maternal Mortality 1990 to 2015, 2015). In terms of healthy life expectancy, Cuba ranked behind Costa Rica, Chile, Peru and Bermuda and marginally surpassed Uruguay, Puerto Rica, Panama, Nicaragua and Colombia"
Tuesday, March 10, 2026
Retiring the Nation’s Doctor
Congress should dissolve the office of the surgeon general
"I watched the surgeon general confirmation hearings and couldn’t help but wonder why, in the 21st century, we still rely on an 18th-century relic to play the nation’s doctor (“A Vaccine Skeptic for Surgeon General,” Review & Outlook, Feb. 26).
The office of surgeon general has drifted far from its original role as an apolitical supervisor of medical personnel. Successive administrations have transformed it into a political megaphone opining on gun control, social media, housing and other contentious issues only tangentially related to public health.
Meanwhile, the surgeon general oversees the more than 6,000-member Public Health Service Commissioned Corps—a uniformed service whose deployment is slower and more costly than civilian alternatives. A 2010 Health and Human Services report found corps officers cost roughly 15% more than comparable civilian employees.
Congress should dissolve the office of the surgeon general and the Commissioned Corps, transfer legitimate public health functions elsewhere and end the politicization of public health.
Jeffrey A. Singer, M.D.
Senior fellow, Cato Institute"
Monday, February 23, 2026
Medicare Advantage Saves Taxpayer Dollars
Studies show that the Medicare Advantage program costs less than traditional Medicare
"When It comes to the Medicare Payment Advisory Commission (MedPAC), Matthew Fiedler and Benedic Ippolito get it wrong in “The Higher Price Tag on Medicare Advantage” (Letters, Feb. 18).
In claiming that the Medicare Advantage program costs taxpayers 20% more than if the same patients were in traditional Medicare, MedPAC makes no attempt to separate out the different kinds of enrollees. For example, many people in traditional Medicare are also in an employer plan. (Those people are probably relatively healthy.) Some Medicare Advantage enrollees are in special-needs plans. (Those people are less healthy.)
A true apples-to-apples comparison would separate out 16 categories of enrollees and compare the taxpayer cost for each. Yet for that to happen, the government has to do something it has never done: release the data.
Rep. Aaron Bean (R., Fla.) has introduced a bill in Congress that would force that very kind of disclosure. In the meantime, a rigorous study by Milliman estimates that taxpayers save $576 per enrollee per year when an enrollee joins a Medicare Advantage plan. This is consistent with an industry-financed study by Elevance Health.
The Elevance study also found that as Medicare Advantage penetration in a market increases, all doctors in the area begin to practice more efficient medicine. Owing to these “spillover effects,” a 10% increase in market share by Medicare Advantage plans leads to an average decrease in spending on all Medicare beneficiaries of between $105 and $127 per person per year.
John C. Goodman
President and CEO, Goodman Institute for Public Policy Research"