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The Keckley Report

Drug Manufacturers are Fighting their Holy War on Three Fronts

By March 14, 2022March 1st, 2023No Comments

Throughout the pandemic, U.S. drug manufacturers have taken center stage in combatting the pandemic at home.  The industry has received accolades for its response to Operation Warp Speed claiming 279,000 lives saved as a result of its new vaccines and medicines. Concurrently, it has waged war against its most formidable detractors as drug prices draw heightened attention.

Per the Washington Post‘s analysis of Open Secrets data: “The industry’s focus on drug pricing has increased dramatically in recent years as the issue became more top-of-mind for voters. In 2012, lobbyists registered to work on the issue of ‘drug prices’ 69 times for 20 different clients. In 2021 so far, they have filed to lobby on the issue 1,192 times for 242 different clients.”

Game on. Each major sector in the U.S. health system is poised to defend its turf against encroachment by private-equity backed disruptors and unwelcome regulations in states and at the federal level (FDA, HHS, USDA, DOJ, FTC, et al). Prices, costs and affordability are the issues each must address.

For drug manufacturers, it’s a holy war to defend its US business which generates $363 billion (9% of total 2020 US spending), employs 811,000 and generates per capita spending for prescription drugs that’s 104% higher than the 38-country OECD median. Understandably, they spend big to fend-off unwelcome intrusion in their pricing strategies:

·        From 1998 to 2021, the Pharmaceuticals/Health Products industry spent $5,066,805,717 on its lobbying activity—more than any other industry and 56% more than #2 insurers, 145% more than hospitals and nursing homes (#8) spending) and 191% more than health professionals (#12).

·        In 2021, the pharmaceutical industry spent $353,940, 506 on its lobbying activity for 546 companies employing 1746 lobbyists—58% of who previously worked for the government—to garner favor from lawmakers.

The conundrum facing the drugmakers is this: insurers, clinicians, regulators and consumers believe prescription drugs work reasonably well—they trust the safety, efficacy and effectiveness of prescription drugs. But voters (83%) think drug prices are inexplicably too high, suspecting manufacturers of systemic price gauging and greed. And policy proposals tying US prices to international comparisons are gaining momentum: per the Government Accountability Office (GAO), retail prices that U.S. consumers paid for 20 brand-name prescription drugs in 2020 were 2.82 times higher than in Canada, 4.25 times higher than in Australia, and 4.36 times higher than in France. Pricing is opaque and under increased pressure.

In response, drug manufacturers have escalated their war against price constraints on three fronts as they adjudicate their defense to Congress and state legislatures:

Pharma vs. PBMs and Middlemen: Using 2007-2018 net pricing data on branded pharmaceutical products in the US, list prices increased by 159% and net prices increased by 60%. Discounts increased from 40% in 2007 to 76% in 2018 in Medicaid and increased from 23% to 51% in other payers, offsetting 62% of increases in list prices for drugs. PhRMA points out that 77% of PBMs manage more than 77% of all prescriptions filled in the United States: PBM discounts, rebates and other price concessions have more than doubled in size since 2012 ($187 billion in 2020) representing “nearly half of U.S. spending on brand medicines went to the supply chain and other entities in 2018, and not to the biopharmaceutical companies that research, develop and manufacture the medicines.”

The claim: Retail drug prices are misleading. They do not account for discounts enjoyed widely nor account for the dubious business practices of middlemen who are responsible for more than half of the prices while adding only marginal value.  

Pharma vs. Health Insurers: In numerous media outlets, PhRMA is promoting its “new poll showing Americans would like to see Congress focus more on reducing the overall costs of health care coverage such as premiums, deductible, and copays (71%) over reducing the costs of prescription drugs (29%). This extends across party lines; 73% of Democrats and 64% of Republicans would like to see Congress focus on reducing overall costs of coverage.” (Caveat: The Ipsos questionnaires did not include hospitals, medical care or other options where consumer sentiment about prices and costs have been shown relevant.)

“We need to make the cost of medicine more predictable and affordable. Government price setting is the wrong way. The right way means covering more medicines from day one, making out-of-pocket costs more predictable and sharing negotiated savings with patients at the pharmacy counter.”

The claim: Health insurers are complicit in drug price discontent since they design restrictive formularies and own and operate pharmacy benefits mangers (PBMs) that accrue benefits to the plan’s shareholders rather than its policyholders (enrollees).

Pharma vs. Hospitals: PhRMA asserts that “Protecting the safety net by maintaining coverage of medicines for vulnerable patients served by Medicaid and driving greater oversight and transparency of the 340B program to ensure that hospitals and other entities are using the discounts manufacturers provide to serve needy patients, not siphoning resources away from patients.” Thus, drugmakers have sought to reduce hospital participation in the 340B drug program maintaining premium pricing for and buffering criticism vis a vis “benevolent use” programs…At the same time, hospitals, which represent the largest share of health care spending in the United States, mark up the cost of medicines nearly 2.5 times, on average, driving up cost sharing and premiums across the country.”

The claim: Hospitals control patient care but inappropriately limit access to necessary medicines using restrictive formularies and step therapies lacking while profiting from medicines, especially those administered intravenously.

My take:

Drug manufacturers are bracing for increased scrutiny of their prices at a time when public opinion toward their trustworthiness is being tested. The negative attention to Purdue (opioid abuse), Mallinckrodt (Medicaid overcharges), J & J (talc, Pa. prison study) and others reinforces resentment and suspicion. Declining faith and confidence in institutions of the federal government lend to disinformation and antipathy and substantial business relationships in Russia (Pfizer, Johnson & Johnson, Novartis, Abbott, AstraZeneca, Merck, et al) complicate matters for pharma in the near term.

What’s clear is that drug prices elicit strong reaction that’s bipartisan and growing. States like Maryland, Nevada, Oregon and Washington are tackling constraints on their own, and Civica is advancing affordable medicines backed by major health systems.

It’s a holy war for drug manufacturers. They’re fighting back.



“Big Pharma Spent ‘Horrifying’ Sums of Money to Weaken Drug Price Reform” November 5, 2021

Open Secrets. “Industry Profile: Pharmaceuticals/Health Products.”

The Public Weighs In On Medicare Drug Negotiations Kaiser Family Foundation October 12,2021

“PRESCRIPTION DRUGS U.S. Prices for Selected Brand Drugs Were Higher on Average than Prices in Australia, Canada, and France” Government Accountability Office March 2021

Common Dreams

Building a Better Health Care System | PhRMA

OECD Health Statistics 2021

“Changes in List Prices, Net Prices, and Discounts for Branded Drugs in the US, 2007-2018”JAMA March 3, 2020;323(9):854-862. doi:10.1001/jama.2020.101

“Insurers, pharmacists at odds over CMS proposal to curb clawbacks” Modern Healthcare March 8,

“Which Companies Aren’t Exiting Russia? Big Pharma” Kaiser Health News March 10, 2022 rent-exiting-russia-big-pharma

“In New York appearance, CMS administrator pushes for Congress to act on drug prices” March 11, 2022

“Which Companies Aren’t Exiting Russia? Big Pharma” Kaiser Health News March 10, 2022

Industry Trade Association Revenues

Revenues (Form 990 2019) for Major Trade Groups:

·        Pharmaceutical Research and Manufacturers Association (PhRMA) $526,601,050

·        American Medical Association (AMA) $354,569,109

·        American Hospital Association (AHA) $142,840,228

·        America’s Health Insurance Plans (AHIP) $68,697,254

IRS Form 990 for 2019


Study: At home covid testing lends to misinterpretation: 360 participants were given 1 of 3 instruction types and were presented with 1 of 4 risk scenarios. Participants were paid $5 and had a median survey completion time of 8.7 minutes. Data analyses were performed from June to July 2021.This randomized clinical trial found that a substantial proportion misinterpreted the negative results of at-home self-tests by failing to consider the implications of a high pretest probability of infection and ignoring the federal self-quarantine recommendations. Decision science−based instructions may increase the contribution of at-home self-test kits to public health.

Woloshin et al Assessing How Consumers Interpret and Act on Results From At-Home COVID-19 Self-test Kits A Randomized Clinical Trial JAMA Intern Med. January 31, 2022;182(3):332-341. doi:10.1001/jamainternmed.2021.8075

During pandemic, industries that can leverage virtual solutions fared well: With the world relying on virtual meetings, ecommerce and delivery services, the information technology and financial services sectors grew rapidly, increasing their value by 68.5% and 61.9% respectively followed by healthcare 59.8%. That translates to a $143.2 billion increase in the value of European and North American VC-backed financial services companies and a whopping $1.7 trillion for IT.

How VC-backed company valuations rose and fell during the pandemic Pitchbook March 4, 2022

2021-22 seasonal flu vaccine efficacy disappointing: Per the CDC, for the 2021-2022 season, vaccine effectiveness against medical visits for acute respiratory infections (ARIs) related to the predominant influenza strain, A(H3N2), landed at a non-significant 16%. Among the positive tests, 41% had received the 2021-2022 influenza vaccine, versus 50% of those who tested negative. Documented flu vaccinations among the participants ranged from 31-64% across the seven sites, and mostly relied on self-reporting.


Healthcare Investing

Private equity had banner year in 2021: Per Pitchbook, across all industries, PE funds completed 8,625 deals vs. 5709 (+51%) in 2020 with $1.237.5 trillion net proceeds vs $689.6 billion in 2020 (+80%). More deals. Bigger deals.

“Our data shows that capital deployment dipped only modestly in mid-2020. More importantly, GPs were motivated by the availability of debt, the wave of sellers coming to market to avoid anticipated tax hikes, and the urge to deploy capital quickly in order to return to the fundraising market.”


Insurtechs on path to acquisition by traditional plans: Oscar Health, Clover Health, Bright Health Group and Alignment Healthcare, the “insurtechs” that are supposed to transform the health insurance industry, lost $2.5 billion last year and valuations fell $22.9 billion during the same period. Notes:

·        Clover Health notched the biggest per-member loses among the trio at more than $4,500 apiece for its 130,000 Medicare Advantage and Direct Contracting customers.

·        Alignment Healthcare, a Medicare Advantage-focused insurer with 86,100 members, appears like an exception among the upstart insurers. The company nearly broke even on a per-enrollee basis and reported a comparatively small net loss of $178 million.

·        Bright Health Group lost $1.17 billion last year and will lose another $1.4 billion this year, according to an analysis by Cowen and Company. It ran out of cash at the end of 2021 and received a $550 million bailout from Cigna.

“Insurtechs’ big losses overshadow 2021 revenue growth” Modern Healthcare March 10, 2022

The Economy

February Consumer Price Index: The Consumer Price Index for All Urban Consumers (CPI-U) increased 0.8 % in February on a seasonally adjusted basis after rising 0.6% in January, the U.S. Bureau of Labor Statistics reported last week. Over the last 12 months, the all-items index increased 7.9% before seasonal adjustment.

Increases in the indexes for gasoline, shelter, and food were the largest contributors to the seasonally adjusted all items increase. The food index rose 1.0% as the food at home index rose 1.4%; both were the largest monthly increases since April 2020.  The medical care index rose 0.2% in February. The index for prescription drugs rose 0.3%, but the indexes for hospital services and for physicians’ services both declined 0.1%.

US Department of Labor

Economy: stocks down due to Ukraine war: All three indexes finished the week in the red after Friday’s selloff. The Dow industrials closed down about 2% for the period, its fifth consecutive weekly loss. The S&P 500 and Nasdaq Composite lost 2.9% and 3.5%, respectively, for the week, capping the fourth weekly loss in the past five weeks for both indexes. Of the three major indexes, the tech-heavy Nasdaq Composite is down the most so far this year, falling 18% through Friday’s close.

Stocks Turn Lower to Finish the Week Wall Street Journal March 11, 2022

Medical debt impacts one in 10 Americans: A Census Bureau analysis on medical debt at the household level found 17% of households owed medical debt in 2019. Peterson KFF analyzed data from the Survey of Income and Program Participation (SIPP) to gauge medical debt at the individual level for adults who reported owing over $250 in unpaid medical bills as of December 2019. Finding:

·        23 million people (nearly 1 in 10 adults) owe significant medical debt representing $195 billion in medical debt.

·        16 million people (6% of adults) in the U.S. owe over $1,000 in medical debt and 3 million people (1% of adults) owe medical debt of more than $10,000.

·        People with disabilities, those in worse health, and poor or near-poor adults, Black Americans, and people living in the South or in Medicaid non-expansion states were more likely to have significant medical debt.

Related: the average single person HH has $3K in median liquid assets but a maximum out of pocket obligation of $7.9K for their health coverage. For all families, $5K and $15K.

“The burden of medical debt in the United States” Peterson-KFF Health System Tracker March 10, 2022

Gas prices at 14-year high: The average price per gallon of gasoline crept slightly above $4 on Sunday for the first time since July 2008, according to AAA data. The climb continued into Monday, with the nationwide average edging higher to $4.065 for regular-grade gas. That’s up $0.455, or nearly 13%, from levels seen just one week ago.

Several risks stand to drive costs even higher. Though the US, UK, and European Union haven’t yet targeted Russia’s energy sector with their sweeping sanctions, the Biden administration is mulling whether to ban Russian oil imports without allies’ participation.

The average US gas price leaps above $4 per gallon for the first time since 2008 Business Insider March 8, 2022

Alternative Payment Models

Study: Transportation benefits do not lower health costs for ACOs: Researchers conducted a mixed-methods evaluation of a nonemergency medical transportation benefit offered to members of a Medicare accountable care organization (ACO). Participation in the transportation program was associated with a greater number of per person per year outpatient visits (9.2) and higher outpatient spending ($4,420) than in a comparison group. However, there was no difference in inpatient admissions or emergency department visits, and the program was not cost saving. “These findings suggest that although transportation programs are commonly introduced as ways to contain health care spending, it may be better to think of them as programs to improve health care access for people facing difficult circumstances.”

Berkowitz et al Evaluating A Nonemergency Medical Transportation Benefit For Accountable Care Organization Members Health Affairs March 2022


Study: hospital prices unrelated to patient outcomes: There was no observed correlation between higher-priced hospitals and higher quality of care in certain markets, a study by the National Bureau of Economic Research found. Researchers analyzed the connection between hospital prices and patient outcomes using from June 2007 to June 2014 from the Health Care Cost Institute data for individuals aged 18 through 64 with employer-sponsored insurance provided by Aetna, Humana, or UnitedHealthcare between 2007 and 2014.

“Do Higher-Priced Hospitals Deliver Higher-Quality Care?” National Bureau of Economic Research February 2022

Study: For profit hospitals offer fewer unprofitable services: Nonprofit, for-profit, and government hospitals are all more likely to offer services when they are relatively profitable than when they are relatively unprofitable. However, for-profit hospitals are considerably more likely than others to provide services based on profitability. After hospital and market characteristics are adjusted for, nonprofit hospitals offer relatively unprofitable services more than for-profit hospitals and less than government hospitals. Profitable services typically exhibit the opposite pattern. For-profit hospitals are also more likely to adopt or discontinue services consistent with changes in service profitability than are nonprofits, which in turn are more likely to do so than government hospitals.

Hospital Service Offerings Still Differ Substantially By Ownership Type Health Affairs March 2022

Altarum: Hospital prices up 2.9% last year, drug prices up 1.3%: “Overall Health Care Price Index (HCPI) growth remained the same as the month prior, at 2.4% in January, staying within its tight range near 2.0% year-over-year growth, the trend seen since April 2021.

·        Health care price growth remains lower than expected given rapid increases in economywide inflation—January CPI growth was 7.5% and PPI growth was 9.7%, each a near series-record rate.

·        Prices paid by private insurance for health care services increased somewhat in January to 3.2% year-over-year, while Medicare and Medicaid price growth was significantly slower, at 1.1% and 1.6% respectively.

·        Hospital care prices were the fastest growing major category, at 2.9% year over year, while prescription drug prices increased 1.3% after a long period of zero and negative price growth throughout 2021.

February 2022 Health Sector Economic Indicators Briefs | Altarum

 Public Opinion

Pew: Three quarters of voters think the U.S. healthcare system needs complete overhaul: In a report released in October, the Pew Research Center surveyed 17 advanced economies and found that a median of 56% believe their political system needs major changes or needs to be completely reformed. About three-quarters of Americans and Greeks say their health care system needs major changes or needs to be completely reformed.

% who say the ___ system needs to be completely reformed/needs major change:

·        Political system: US 85%, Overall Median 56%, Lowest New Zealand 24%, Highest Italy 89%

·        Economic System: US 66%, Overall Median 51%, Lowest New Zealand, Sweden 28%, Highest: Italy 85%

·        Health System: US 76%, Overall Median 45%, Lowest Australia 25%, Highest Greece 77%

Citizens in Advanced Economies Want Significant Changes to Their Political Systems Pew March 3, 2022

Morning Consult: trust in government down: the share of U.S. adults who answered that they have “a lot” or “some” trust in specific institutions within the U.S. The latest results are based on a survey conducted Mar. 3-6, 2022, among 2,200 U.S. adults. (Change since November 2020):

·        US Government: 42% (-6%)

·        Your State Government: 53% (-6%)

·        Your Local Government: 57% (-6%)

·        US Congress: 38% (-5%)

·        US Supreme Court: 56% (-6%)

·        US Electoral System: 49% (-3%)

·        The Healthcare System: 59% (-6%)

·        The Scientific Community: 67% (-9%)

·        The Public Education System: 56% (-6%)

Other notable findings:

·        The scientific community is trusted by 82% of Democrats but only 54% of Republican voters

·        Trust in the healthcare system increases with age: 43%-Gen X, 54%-Millennials, 55%-Gen X and 71%- Baby Boomers

Trust in Institutions Morning Consult March 10, 2022

Trust in the CDC dependent on news source: From 63 waves of the Axios/Ipsos Coronavirus Index over the past two years:

  • Within weeks, of the start of the pandemic (March 2020), that trust was plunging among Americans who mostly watch Fox News or other conservative outlets, as well as those who cited no source.

  • By the end of last month, just 16% of those who said they get most of their news from Fox or other conservative outlets still said they trust the CDC — compared to 77% of those who favor network news and major national newspapers, and 87% of those who primarily watch CNN or MSNBC.

“Snapshot of America at the two-year pandemic mark” Ipsos March 11, 2022


AMA report: physician malpractice costs increasing: Per the report from the American Medical Association (AMA) Medical Liability Monitor:

·        In 2021, 7.5% of all premiums increased by 10% or more — up from 3.9% in 2018 and 3.6% in 2019.

·        The largest premium increases ranged from 10% in Idaho and Washington, to 35.3% in Illinois, with physicians there seeing nearly 60% of premiums increasing 10% or more in 2020 to 2021.

·        Of note, insurance premium rates were increasingly stable from 2012 through 2018, with about 81% remaining the same as the previous year.

American Medical Association Medical Liability Monitor

Medscape: majority of physicians have been sued: Related: Per Medical Economics’92nd Physician Report,” Medscape’s “2021 Physician Malpractice Report” and a 2020 report by Coverys, a provider of medical professional liability insurance:

·        51% of physicians and 77% of surgeons have been named in a malpractice lawsuit. 

·        Change in malpractice premiums from 2019-20: Increased: (22%), Stayed the same: (61%), Decreased: (6%) and Don’t know: (11%).

·        Malpractice allegations related to surgery, procedure or diagnosis account for 57% of all allegations accounting for 59% of indemnity paid.

Medscape Malpractice Report 2021 November 5,

Federal Budget

Federal spending bill likely to be signed this week: The $1.5 trillion omnibus spending bill funds the federal government through September 2022 and includes $730 billion in nondefense funding, a $46 billion increase over fiscal 2021, and $782 billion in defense funding, an increase of $42 billion and earmarks for the first time in 10 years adding $9.7 billion for almost 5,000 projects promoted by members of Congress for pet projects.

Key health related provisions in the $1.5 trillion spending bill that passed both houses of Congress to cover discretionary items through September 2022 last week:

·        HHS will receive $108.3 billion in discretionary funding, an increase of $11.3 billion over its fiscal 2021 budget. $1 billion to establish ARPA-H within the Department of Health and Human Services (HHS).

·        $45 billion for the National Institutes of Health, an increase of $2.25 billion over the previous year. The NIH funding includes $194 million for President Biden’s “cancer moonshot” initiative

·        $8.5 billion for the CDC, up $582 million from 2021. The CDC funding includes $100 million to “modernize public health data surveillance and analytics,” according to a bill summary from the Senate Democrats

·        $6.5 billion for the Substance Abuse and Mental Health Services Administration. That funding includes $102 million to support the nationwide “988” suicide lifeline, expected to launch this summer. It also includes $3.9 billion for substance use treatment and $218 million for substance abuse prevention

·        $8.9 billion for the Health Resources and Services Administration to establish the Pediatric Subspecialty Loan Repayment Program ($5 billion) and $375 million for children’s hospitals graduate medical education

·        $845 million to fund the Strategic National Stockpile, an increase of $140 million for fiscal 2021

·        $300 million for combatting pandemic influenza

·        $5 million for KidneyX— “a public/private partnership to accelerate the development and adoption of novel therapies and technologies to improve the diagnosis and treatment of kidney diseases,”

·        Temporary relief on eligibility criteria for the 340B Drug Pricing Program for hospitals

·        Authorization for FDA regulation of synthetic nicotine products

·        A five-month extension to telehealth flexibilities created during the pandemic

What’s not in the bill:

·        Additional money to be distributed through the Provider Relief Fund, which has no funding left as the Phase 4 general distribution wraps up.

·        Relief on the Medicare payment sequester, which kicks in at 1% starting April 1 before increasing to 2% on July 1

·        Relief on the repayment terms for Medicare advance payments

House Committee on Appropriations March 9, 2022

PCORI funding payer-provider collaboration projects: Eligible health plans and health systems must file their Notice of Intent to apply by March 29. Final applications are due July 26. The agenda will guide funding that closes evidence and equity gaps, relieves system and consumer burden, deploys data and partnership to create evidence-based interventions, integrates science, focuses on social determinants of health, and makes evidence accessible and actionable.  $50 million to be awarded up to max of $500,000 per awardee. 

Health Systems Implementation Initiative (HSII)


Study: Diet quality declining for older Americans: Scored based on the 50-point American Heart Association (AHA) 2020 Strategic Impact Goals for diet, the average primary score dropped by 7.9% from 2001 to 2018 (from 19.84 to 18.28). Findings:

·        This average AHA diet score — which takes into account consumption of fruits and vegetables, whole grains, fish and shellfish, sugar-sweetened beverages, and sodium — dropped from 19.84 to 18.28 over this time period (out of a total of 50 points).

·        The proportion of older adults who were classified as having a “poor diet quality” jumped from 50.9% to 60.9%. This was defined as less than 40% adherence to the AHA goals. At the same time, the proportion of older adults with only an “intermediate” diet quality (40% to 79.9% adherence) dropped from 48.6% to 38.7%.

·        Using the 100-point Healthy Eating Index-2015, which measures how diet quality aligns with the U.S. Department of Agriculture 2015-2020 Dietary Guidelines for Americans — there was another significant decrease in score from 2001 to 2018 dropping an average of 5.4%, this from 47.82 to 45.25.

·        Non-Hispanic white older adults had the biggest drop in diet quality. And not surprisingly, older adults with lower income levels and lower attainment of education consistently saw poorer diet quality.

Related: Across the 10-year period, food insecurity increased significantly from 5.5% to 12.4% among older adults 60+; this increase was more pronounced among lower-income older adults.

Related: Former Senate majority Leader Bill Frist, former Surgeon General Jerome M. Adams and Jerold Mande adjunct professor of nutrition at the Harvard T.H. Chan School of Public Health and former senior adviser to the FDA commissioner and deputy undersecretary at the U.S. Department of Agriculture. are founders of Nourish Science, a nongovernmental organization focused on solving the country’s current nutrition crisis.

“America’s Seniors Eating Junkier Diets” MedPage March 11, 2022

“Food Insecurity Among Older Adults: 10-Year National Trends and Associations with Diet Quality” Journal of the American Geriatrics Society, January 5, 2021

Economist’ commentary: US response to Covid among world’s least effective: The World Health Organization declared COVID-19 a global health emergency on January 30, 2020, and a global pandemic on March 11, 2020. Nationwide, the 7-day moving average of deaths is at its lowest since January 2nd; that of reported cases is at its lowest since the Delta variant began surging in July 2021. Per the CDC, over 950,000 people have died from the virus (though The Economist estimates that the actual count is 1.1m-1.3m) and America has the highest death rate among rich countries: nearly double the average.

The U.S. “has struggled to vaccinate its people: 65% are fully vaccinated, compared with 72% in Britain, 73% in the European Union, 81% in Canada and 95% in the United Arab Emirates. America also fell behind on detection. Last year it ranked 36th in the world in sequencing SARS-Co V-2, hindering early recognition of new variants. The country also lagged behind in testing. Whereas Britons have had access to free rapid tests for over a year, Americans received their first round only last month. Lab tests were hard to come by, too: queues and waits for results were long.”

“Planning for the future should involve a frank look at the country’s poor performance over the past two years” The Economist March 10, 2022

CMS: U.S. health care spending increased 9.7% to reach $4.1 trillion in 2020 vs. +4.3% in 2019: faster Gross Domestic Product (GDP) declined 2.2% in 2020, leading to a sharp increase in the share of the overall economy related to health care spending—from 17.6% in 2019 to 19.7% in 2020.

Retail Prescription Drugs (8% of spending) increased 3.0%  to $348.4 billion in 2020, a slower rate than in 2019 when spending increased 4.3%. The slowdown was a result of a 4.2% decline in out-of-pocket expenditures, which resulted from slower overall utilization and an increased use of coupons, which lower point-of-sale expenditures for consumers.

National Health Expenditure Data