Black Friday for retailers is the gateway to their year-end financial results. In the 26-day 2024 shopping season, retailers anticipate sales of $979 to $989 billion (19% of total annual sales)—a 2.5-3.5% increase but below their pre-pandemic average of 5.1% annual growth. Notably, online sales are expected to increase 8-9% ($295-$298 billion) this year reflecting the steady growth of e-commerce and continued decline of traditional retail channels. In retailing, seasonality matters, technologies are enabling a shift in their competitive landscape and market growth has slowed due to consumer fear about inflation and prices.
The parallels to healthcare are important: there are four:
First, healthcare is not a “consumer” aka B2C market like retailing. It’s a B2B market in which transactions between suppliers, providers and middlemen are negotiated with secondary concern for consumer prices and affordability. In most organizations, consumers are referenced as users, enrollees, patients or members; they’re not individuals with the “willingness, opportunity and resources” to buy a service directly. Thus, consumer preferences and values have been important but secondary considerations in most healthcare organizations.
Second, healthcare is less seasonal than retailing. 30% of total out-of-pocket (OOP) health spending by consumers occurs in the 4th quarter: 75% for medical services (physicians, hospitals, et al) and 25% for products (prescription drugs, devices, eyeglasses et al). Utilization of the health system is impacted by seasonality for a minority of its services: its economics are more a result of population change, volume, capacity, supply and labor costs. Thus, “Black Friday” forecasting in healthcare is less significant unless the result of a mass shooting, uncontrolled outbreak or Black Swan event. But that also facilitates more predictable plans for staffing and utilization.
Third, consumer healthcare OOP costs are relatively low except for low-and-middle-income households. Consumer OOP healthcare spending is 11.1% of total healthcare spending (down from 13% a decade ago) so the health economy has become less dependent on OOP payments by consumers. Third party payments through insurance, Medicare, Medicaid and others makes up the rest. But OOP obligations in low-and-middle income households have reached as high as 20% of their discretionary spending (vs. 8% overall) lending to growing housing insecurity, poor health and financial anxiety. In healthcare, OOP obligations correlate with under-served populations more than the entire population and open a wide range of societal policy-considerations related to income disparities, social determinants of health and more. Segmentation in healthcare is more complicated.
Fourth, like retail, the competitive landscape in healthcare is shifting in response to new technologies that consumers embrace. Retail sales will top $5.9 trillion this year in the U.S.; healthcare spending will reach $4.8 trillion. Both industries are big, high-profile industries in the economy. Both are adapting to technologies that enable consumers to compare features, benefits and prices specific to their needs and wants. But unlike retail, the regulatory environment for innovations in healthcare is challenging and embedded special interests often resistant. Nonetheless, healthcare consumers in all income, age and health status cohorts are embracing technologies that enable price comparisons, televisits, access to their medical records, brand comparisons for drugs, outcome and user-experience comparisons for hospitals and physicians, self-care diagnostics and much more. In retail and healthcare, consumers are playing more direct roles by embracing technologies that enhance their purchase experiences.
The Trump administration attributes its 2024 election win to support from working class voters worried about what they pay for gas, fuel, housing and healthcare. Healthcare can ill afford to discount consumer concern about its affordability nor the new Administration’s foundational belief that price transparency is the necessary means to that end.
It behooves Boards and management teams in every sector of healthcare—especially those most inclined to discount consumerism—to re-visit assumptions about the role and scope individuals will play in healthcare’s future.
Though there are limited “Black Friday” opportunities in healthcare compared to retail, there are abundant opportunities to engage consumers more directly and intelligently.
Paul
Resources
Holiday retail sales in the United States 2000-2024 | Statista
Center on Budget and Policy Priorities.
U.S. Health Care Coverage and Spending Congressional Research Service March 20, 2024
Americans’ Challenges with Health Care Costs | KFF
A Discussion of Recent Research on Health Care Prices: Prescription Drugs, Hospitals’ Services, and Physicians’ Services CBO April 2022
The impact of housing prices on residents’ health: a systematic review | BMC Public Health t
The impact of housing prices on residents’ health: a systematic review | BMC Public Health
Sections in today’s Report
- Quotables
- Economy
- Hospitals
- Insurers
- Management
- Prescription Drugs
Quotables
Re: BPC on Make America Healthy Again challenge: “Make America Healthy Again” is the incoming administration’s pledge. Talking about it is one thing; making it happen is another—especially in a society addicted to/afflicted by bad behavior that’s funded by powerful corporate interests.
Americans know that what they eat, whether they exercise, stressful relationships at home or work, excess drinking, smoking and clean air and water influence their health. Affording that or prioritizing it in lifestyles and choices– are the challenges.”
Bipartisan Policy Center The Rural Emergency Hospital Model: Year Two results October 2024bipartisanpolicy.org/download/?file=/wp-content/uploads/2024/10/Final_BPC_Rural_Emergency_Hospital_2024.pdf
Re: Summers on economy: Speaking at a New York Economic Club last week: “There is a very substantial risk that the president will attempt to implement what he talked about. If he does, the consequences are likely to be substantially greater inflation than what was set off by the excessive Biden stimulus.”
Re: Churchwell on Primary care: “Primary care is at the tip of the spear. If we were depending upon cardiologists, we come in actually somewhere in the middle of the story. Primary care should be at the beginning of the story.
The primary care physician is the person who’s going to write the prescription for blood pressure medication or follow the patient for their diabetes care. And actually, as the GLP-1s have actually continued to expand throughout the community, that’s where many of the initial prescriptions are going to be written.”
Keith Churchwell, MD, President, American Heart Association November 18, 2024, Lewis A. Conner Presidential Lecture: Keith Churchwell, AHA President November 17, 2024
AHA president looks to ‘good conversation’ with next White House
Re: The Economist on Trump domestic agenda: “With luck, the most consequential part of Mr. Trump’s domestic agenda will lie elsewhere: in a programme to deregulate and reinvent the machinery of government, from drug regulation to military procurement. These reforms will determine how quickly America adopts and diffuses cutting-edge technologies including biotech and AI. Elon Musk will be in charge. His promise to slash the federal budget by $2trn is absurd. But the idea that America needs government reform to maintain its lead in radical new technologies is surely right.
If Mr. Trump truly wants to make America great, this is where his administration should focus. It would be ironic if the man who loves tariffs led the charge to accelerate technologies that may eventually reshape or replace many American jobs. But extending America’s lead in AI would do far more to ensure its future prosperity and military security than any other part of the MAGA agenda. Over to you, Elon. “
The three forces that will shape 2025: Watch the interplay between Donald Trump, technology and radical uncertainty The Economist November 18, 2024
Re: Trilliant on consumerism in healthcare: “Forced consumerism in healthcare, driven by patients having increased “skin in the game,” has not generated tangible systemic value but has led to fragmentation. Patients face increasingly expensive choices for potential treatment paths without clear guidance on the quality or value of those options. This information asymmetry forces patients to navigate a complex web of providers and services to discover the most affordable option within the constraints of provider networks and referral patterns. They also face the added challenge of evaluating direct-to-consumer options, which may be more affordable but often exist outside of the “traditional” healthcare system. The complexity of this task is further compounded by the lack of price transparency in the U.S. healthcare system.”
Forced Consumerism Due to Cost Shifting in Healthcare
Re: Madden on primary care business opportunities: “There’s plenty of positive activity still happening in primary care, and none of it is toxic. Direct primary care is picking up steam as a viable option for many entrepreneurial minded physicians and those with established practices on the tail end of their careers.
AI-enabled solutions like K Health will bring administrative support to provider organizations, allowing them to do more with less and allow physicians to work at the top of their license.
Others like Greater Good Health are scaling NP-led practices empowered by technology and physician oversight. Finally, don’t forget about the enablers in 2024 – Privia, ApolloMed, Aledade, agilon, Pearl, Lumeris, GuideHealth, etc. – providing physicians and clinicians with technology, alleviating administrative burden, and helping physicians build their careers.
Nobody said it was going to be easy. Two steps Forward, one step back!”
Blake Madden, Hospitalogy Articles – Hospitalogy
Re: Allen Institute on Open sourcing AI: “We don’t know enough about these technologies, and we’re depriving the brain power that exists in the industry, in research labs, in startups, that could contribute to close these technology gaps, by keeping the technology behind closed doors…
Do we want “a world in which the technology is widely distributed and we’re now facing a hypothetical threat, but only a handful of people can fix it? Or a world where we actually have millions of experts who can jump on the call and solve the problem?”
Allen Institute CEO Ali Farhadi says AI industry has “broken trust” with the public
Re: Seth Joseph on Epic strategy: “Having grown organically since 1979 and only in the past decade becoming the leader in EHR, it’s possible that Epic’s insular culture blinds it to its own market strength and influence in adjacent markets.
If so, it may behoove Epic to reflect on issues involving fellow tech giants who leveraged dominant market positions in one business to unfairly and illegally advantage themselves when facing technology shifts and changing consumer behavior…
In Epic’s case, the company holds a dominant position as the hospital’s operating system. By removing existing APIs and interoperability resources to consumer-facing companies and changing fee structures, it is making it more cumbersome and expensive for hospitals to select alternative patient-facing technologies, making MyChart the default path forward. One outcome is the perception that its tactics are exclusionary in nature and foreclose on innovation in an emerging market. Another result, also problematic for Epic, is reduced consumer choice and increased direct costs (to hospitals) and indirect costs (to competitors and consumers).
Yet, Epic arguably does not need to employ these tactics to win. MyChart seems well-positioned to end up as the most robust, seamless and compelling ecosystem for consumers as a result of Epic’s trusted relationships with hospitals, dominant market share and existing (and growing) network effects.
Epic’s Consumer Strategy Is Bold. Its Tactics Push The Boundaries. – The Health Care Blog
Re: Lancet on Obesity policy-setting: “Existing policies have failed to address overweight and obesity. Without major reform, the forecasted trends will be devastating at the individual and population level, and the associated disease burden and economic costs will continue to escalate. Stronger governance is needed to support and implement a multifaceted whole-system approach to disrupt the structural drivers of overweight and obesity at both national and local levels. Although clinical innovations should be leveraged to treat and manage existing obesity equitably, population-level prevention remains central to any intervention strategies, particularly for children and adolescents.”
Orgvue CEO on transformation: “Our research suggests that transformation fatigue has the C-suite in its grip. We think this is for two reasons: only 23% of transformation projects succeed; and many organizations are forced into crisis-response or event-based transformations.”
Organizations are taking the wrong approach to transformation, creating anxiety around these large, arduous, risky projects that invariably don’t return the cost savings they promise. Encouragingly, the research shows there’s a cohort of CEOs that see transformation in a different way and they’re more willing to lead major restructuring programs as a result. They see transformation as a continuous, iterative process that takes the pain out of organizational change and makes it more sustainable.”
Study finds CEOs reluctant to lead workforce transformation https://itbrief.asia/story/study-finds-ceos-reluctant-to-lead-workforce-transformation
Economy
CPI: Healthcare prices: Comparisons across key categories for the last 12 months: All items +2.6%, Medical services +3.8, Medical products +1.0 vs transportation +8.2, shelter +4.9, and food away from home +3.8,
For October, 2024, the medical care index increased 0.3% over the month after increasing 0.4% in September. The index for physicians’ services increased 0.5% in October and the prescription drugs index rose 0.2% over the month.
The index for all items less food and energy rose 3.3% over the past 12 months. The shelter index increased 4.9% over the last year, accounting for over 65%of the total 12-month increase in the all items less food and energy index. Other indexes with notable increases over the last year include motor vehicle insurance (+14.0%), medical care (+3.3%), education (+3.8%), and personal care (+2.5%).
Bureau of Labor Statistics www.bls.gov
Report: Population shift to non-urban and rural communities: “In the years leading up to the election, young people flocked from urban areas to rural counties at record rates — but they didn’t necessarily bring their big-city politics with them. In fact, nine of the top 10 counties to which Americans aged 25 to 44 moved between 2020 and 2023 voted for Trump this year. All of those top counties are classified as rural or have under 250,000 residents.
Millennials and Gen Zers — both represented in that 25 to 44 group — have swung more to the right…
While turnout of voters aged 18 to 29 rose in 2020, it fell again in 2024. Those who did vote went more conservative. In 2024, 46% of young voters voted for Trump, compared to 36% in 2020, an analysis from the nonpartisan Center for Information & Research on Civic Learning and Engagement found.”
How Young Americans Moving to Rural Areas Impacted the Election – Business Insider
Altarum: November 2024 Health Sector Economic Indicators:
“Monthly GDP decline causes increase in health spending vs GDP growth gap:
- In September 2024, national health spending was 7.5% higher than in September 2023 and represented 17.7% of GDP.
- Nominal GDP in September 2024 declined from the previous month and was 4.3% higher than in September 2023, growing 3.2%more slowly than health spending.
- Personal health care spending growth in September was 7.8%, year over year, with utilization growth continuing to outpace price growth.
- Growth among major spending categories continued to be highest for home health care, at 10.7%, year over year. Spending growth for hospital care grew the slowest, at 6.2%.
Health care prices continue to rise faster than economy-wide inflation
- The overall Health Care Price Index (HCPI) increased by 2.6% year over year in October, down 0.4 % from last month’s revised value.
- Year-over-year growth in the overall Consumer Price Index (CPI) increased by 0.2% points to 2.6% and growth in the Producer Price Index (PPI) increased 0. %to 2.4%.
- Among the major health care categories, prices for nursing home care (4.5%), dental care (3.8%), and hospitals (3.0%) were the fastest growing, while physician services price growth was the slowest (1.5%).
- For major payers, year-over-year Medicaid price growth (5.4%) exceeded services price growth for private insurance (3.5%) and Medicare patients (1.2%), continuing a trend beginning in June of 2022.
- The implicit measure of health care utilization growth was 4.7% year over year in October, down from the revised September value of 5.0%.
- Home health care utilization increased 9.6% year over year. While this was the fastest-growing category this month (as it has been since August of 2023), it is now sitting below its 3-, 6-, and 12-month moving averages. This category was followed by physician and clinical services (7.7%) and prescription drugs (5.8%), while hospital care and trailed the other categories at 2.5%.
Health care job growth offsets job losses in all other industries combined
- In October 2024, health care industry employment increased by 52,300 jobs while non-health care industries lost 40,300 jobs.
- October’s health care job growth was led by ambulatory health care services, which added 35,600 jobs, followed by nursing and residential care facilities, which added 8,800 jobs. Hospitals added a below-average 7,900 jobs.
- The hiring rate was 3.4% and the total separates rate was 2.9% in September 2024. The job openings rate in September 2024 was 5.4%, the lowest rate since September 2020, when the openings rate was 5.3%.
- The unemployment rate was 4.1% in October 2024, approximately equal to the rate in September.
- Nominal health care wage growth in September 2024 was 3.6% year over year, with growth rates of 3.8% in ambulatory health care services and nursing and residential care facilities, and 3.6% in hospitals.
Altarum November 2024 Health Indicators https://altarum.org/news-and-insights/november-2024-health-sector-economic-indicators-briefs
Bureau of Labor Statistics: Projected growth in occupations 2023-3033:
- Jobs in renewable energy, technology, and healthcare are projected to have the most growth by
- Nurse practitioner ranks third among the fastest-growing jobs — and it’s one of eight healthcare roles in the top 20. The median income for this role was just over $126,000.
- The home health and personal care aides profession is expected to more than double the jobs of any other occupation, with potentially 820,500 new positions by 2033. Last year, these roles had an average median salary of $33,530.
- Computer and information systems manager is the highest-paying role among those growing occupations. These professionals earned a median salary of just under $170,000 in 2023.
Bureau of Labor Statistics www.bls.gov
Hospitals
AER Study: Hospital consolidation results in increased prices: Per the American Economic Review analysis:
- There have been 1,164 mergers among health systems between 2000 and 2020, and a recent study foundthose transactions increased prices by 5.2%.
- Operating costs dropped 4% to 7% on average at acquired hospitals following a deal and quality remained the same or declined after mergers
- An estimated 53 hospital mergers that occurred between 2019 and 2015 raised health spending on the privately insured by $204 million in the following year alone.
- 90% of hospital markets are highly concentrated.
- Mergers in rural regions with lower incomes and higher poverty rates generated larger average price increases, most often in outpatient services. This could be because those regions have fewer freestanding clinics that offer surgical and imaging services that compete with hospitals
- “The FTC challenged 13, or 1%, of those mergers. However, the agency could have flagged 238, or 20%, of mergers as likely to reduce competition and increase prices based on the standard screening tools available during that time.” per the study authors. “Since 2000, hospital prices have grown faster than prices in any other sector of the economy. The average price of an inpatient admission is now nearly $25,000.” The researchers found that mergers the FTC could have challenged between 2010 and 2015 eventually led to price increases of 5% or more.
Note: “The American Hospital Association’s general counsel, Chad Golder, told the Journal that the study was incomplete because it did not include prices for some large insurers. However, the study did include claims from CVS Health’s Aetna, UnitedHealth’s UnitedHealthcare and Humana.”
Is There Too Little Antitrust Enforcement in the U.S. Hospital Sector? American Economic Review https://www.aeaweb.org/articles?id=10.1257/aeri.20230340
Insurers
Study: Marketplace premium price comparison: “Numerous studies show that employer plans pay providers significantly more than Medicare, but less is known about prices in nongroup plans sold both on and off the Marketplaces established by the Affordable Care Act (ACA), where narrow networks and low-cost insurers are more prevalent. We estimated prices for three market segments (Marketplace nongroup, off-Marketplace nongroup, and employer small group) and three types of services (professional, outpatient hospital, and inpatient hospital) relative to a Medicare benchmark… Findings:
In aggregate, in 2021, Marketplace prices were 152% of Medicare prices, whereas the prices paid in small-group employer plans were 179% of Medicare prices. Comparing across market segments, relative to employer small-group plans, Marketplace professional prices were 6.9% lower, inpatient prices were 13.3% lower, and outpatient prices were 26.3% lower. Off-Marketplace prices fell between Marketplace and employer small-group prices. The finding that nongroup prices were significantly lower than prices paid by employer small-group plans—more so than indicated by prior research—is important for understanding federal subsidies and affordability for nongroup coverage and evaluating policies such as a nongroup public option with prices capped at a percentage of Medicare prices.”
CMS analysis: Fiscal Year 2024 Improper Payments:
- The Medicare Fee-for-Service (FFS) estimated improper payment rate was 7.66%, or $31.70 billion, vs. 7.38% in 2023.
- The Medicare Part C estimated improper payment rate was 5.61%, or $19.07 billion vs. 6.01% in 2023.
- The Medicare Part D estimated improper payment rate was 3.70%, or $3.58 billion. In FY 2023, CMS implemented several methodology changes, and FY 2024 establishes a baseline.
- The Medicaid improper payment rate (comprised of reviews in 2022, 2023, and 2024) was 5.09%, or $31.10 billion vs. 8.58% in 2023.
- The Children’s Health Insurance Program (CHIP) improper payment rate (comprised of reviews in 2022, 2023, and 2024) was 6.11%, or $1.07 billion vs. 12.81% in
- The fiscal year (FY) 2024 improper payment rate for the Advance Payments of the Premium Tax Credit (APTC) program for the Federally-facilitated Exchange (FFE) for Benefit Year 2022 (January 1 to December 31, 2022) was 1.01% or $562.93 million.
Fiscal Year 2024 Improper Payments Fact Sheet | CMS November 15, 2024
Mercer: Percentage Change in Per Employee Health Benefit Cost, 2019-2024
| Year | Prescription Drug Cost Change | Total Health Benefit Cost Change |
| 2019 | +4.9 | +3.0 |
| 2020 | +6.4 | +3.4 |
| 2021 | +7.1 | +6.3 |
| 2022 | +6.4 | +3.2 |
| 2023 | +8.4 | +5.2 |
| 2024* | +7.2 | +5.2 |
Mercer, National Survey of Employer-Sponsored Health Plans (preliminary results), September 2024
Study: Veterans in Medicare Advantage Plans: “Medicare Advantage (MA) plans are increasingly enrolling veterans… The recent growth of MA plans that disproportionately enroll veterans could further exacerbate such wasteful spending. Using national data, we found that veterans increasingly enrolled in MA between 2016 and 2022, including in a growing number of MA plans in which 20% or more of the enrollees were veterans. Notably, about one in five VHA enrollees in these high-veteran MA plans did not incur any Medicare services paid by MA within a given year—a rate 2.5 times that of VHA enrollees in other MA plans and 5.7 times that of the general MA population. Meanwhile, VHA enrollees in high-veteran MA plans were significantly more likely to receive VHA-funded care. In 2020, the Centers for Medicare and Medicaid Services paid more than $1.32 billion to MA plans for VHA enrollees who did not use any Medicare services, with 19.1 percent going to high-veteran MA plans.
ProPublica investigation: Provider directory accuracy: “Most states haven’t fined a single company for publishing directory errors since 2019. When they do, the penalties have been small and sporadic. In an average year, fewer than a dozen fines are issued by insurance regulators for directory errors, according to information obtained by ProPublica from almost every one of those agencies. All those fines together represent a fraction of 1% of the billions of dollars in profits made by the industry’s largest companies. Health insurance experts told ProPublica that the companies treat the fines as a “cost of doing business.”
Insurers acknowledge that errors happen. Providers move. They retire. Their open appointments get booked by other patients. The industry’s top trade group, AHIP, has told lawmakers that companies contact providers to verify that their listings are accurate. The trade group also has stated that errors could be corrected faster if the providers did a better job updating their listings.
But providers have told us that’s bogus. Even when they formally drop out of a network, they’re not always removed from the insurer’s lists.
The harms from ghost networks are real
In late 2020, Congress passed the No Surprises Act, which aimed to cut down on the prevalence of surprise medical bills from providers outside of a patient’s insurance network. Since then, the Centers for Medicare and Medicaid Services, which oversees the two large public health insurance programs, has reached out to every state to see which ones could handle enforcement of the federal ghost network regulations.
At least 15 states responded that they lacked the ability to enforce the new regulation. So, CMS is now tasked with watching out for errors in directories used by millions of insurance customers in those states.
But since the requirement went into effect in January 2022, CMS hasn’t fined any insurer for errors.”
Why Health Insurance Regulators Have Failed to Curb Ghost Networks — ProPublica
Farrah Report: Profitability, Managed Medicaid Segment, 2Q24
- Health premiums earned: $152,890,246,340 (-2.0% change from 2Q23)
- Health care services incurred: $137,938,547,207 (1.2% change from 2Q23)
- Med expense ratio: 90.2%
- Member months: 271,264,463 (-15.6% change from 2Q23)
- Premiums PMPM: $564 (16.0% change from 2Q23)
- Medical expenses PMPM: $509 (19.9% change from 2Q23)
Mark Farrah Associates, Second Quarter 2024 Health Insurance Segment Profitability, October 2024
Management
Orgvue study: CEO views on corporate transformation strategy: Orgvue surveyed 700 senior decision makers from organizations with more than 1,000 employees. Findings:
- Two in five CEOs would prefer to quit rather than lead a large-scale workforce transformation.
- 29% are willing to lead a major restructuring.
- The main barriers faced by CEOs during business transformations include a lack of shared vision (35%), executive resistance to change (30%), and the leadership’s resistance or inability to “do the hard thing” (29%).
- The research also highlights a disconnect in the C-suite, with 24% attributing unsuccessful workplace transformations to poor communication between senior management.
Study finds CEOs reluctant to lead workforce transformation https://itbrief.asia/story/study-finds-ceos-reluctant-to-lead-workforce-transformation
Prescription Drugs
340B Legal Action by Drug Companies :”An industry fight against lucrative drug discounts for hospitals is intensifying as another drugmaker joins the battle: Sanofi.
The pharmaceutical company plans to change its policy on how it gives discounts to certain hospitals. Sanofi will require institutions to provide pharmacy and medical claims information before receiving federally mandated discounts…
The French company’s plan, which would take effect early next year, comes as the industry escalates its efforts to rein in the federal program known as 340B. Eli Lilly and Johnson & Johnson this month filed separate lawsuits against the federal government for rejecting the companies’ plans to tighten the way they provide the discounts to hospitals in the program.
Congress created the drug-savings program in 1992, requiring drugmakers sell outpatient drugs at a discount to hospitals and clinics that serve low-income and uninsured patients.
Like Lilly and J&J, Sanofi wants to provide the required discounts via a new method. Under its plan, certain hospitals covered by 340B would order drugs at full price from a wholesaler. Only after submitting claims data—information related to the drug’s order, a patient’s hospital visit and a drug’s dispensing—to Sanofi demonstrating eligibility under 340B, would the hospitals receive a credit from the company.
Currently, drugmakers typically provide 340B discounts at the time of purchase.”
Exclusive | Sanofi Plans to Change Hospital Drug-Discount Program – WSJ
Study: Obesity, overweight prevalence: “In 2021, an estimated 15·1 million children and young adolescents (aged 5–14 years), 21·4 million (20·2–22·6) older adolescents (aged 15–24 years), and 172 million (169–174) adults (aged ≥25 years) had overweight or obesity in the USA….The prevalence of obesity has outpaced the increase in overweight over time, especially among adolescents. Between 1990 and 2021, the percentage change in the age-standardised prevalence of obesity increased by 158·4%) among male adolescents and 185·9%among female adolescents (15–24 years). For adults, the percentage change in prevalence of obesity was 123·6%in males and 99·9% in females. Forecast results suggest that if past trends and patterns continue, an additional 3·33 million children and young adolescents (aged 5–14 years), 3·41 million older adolescents (aged 15–24 years), and 41·4 million adults (aged ≥25 years) will have overweight or obesity by 2050. By 2050, the total number of children and adolescents with overweight and obesity will reach 43·1 million (37·2–47·4) and the total number of adults with overweight and obesity will reach 213 million (202–221). In 2050, in most states, a projected one in three adolescents (aged 15–24 years) and two in three adults (≥25 years) will have obesity. “
Re: IRA drug discount results: “In completing the first round of Medicare price negotiation, the federal government has proven that it can navigate the difficult, time-intensive process of identifying drugs for price negotiation, gathering and analyzing key information required under the IRA, and negotiating with manufacturers. Although manufacturers and other industry-aligned groups continue to fight the program in federal courts, the government has prevailed in all decisions up to this point.5
The next 15 drugs subject to price negotiation will be announced by February 2025. Congress could expand the framework established under the IRA, including allowing price negotiation to occur sooner after new drugs are approved. It could also extend negotiated prices to help lower costs for the millions of Americans with commercial insurance, although doing so would require a filibuster-proof Senate majority.
The successful negotiation of Medicare prices represents a seismic shift in U.S. prescription-drug–pricing policy. There is now a clear pathway for leveraging federal price negotiation to substantially lower spending and translate associated savings into reduced out-of-pocket costs for Part D beneficiaries to improve medication affordability and access. Medicare negotiation is an important step, but addressing high prescription-drug costs remains a key policy priority in the United States.”
