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The Keckley Report

Has U.S. Healthcare reached its Tipping Point?

By March 11, 2024No Comments

Last week was significant for healthcare:

  • Tuesday, the, FTC, and DOJ announced creation of a task force focused on tackling “unfair and illegal pricing” in healthcare. The same day, HHS joined FTC and DOJ regulators in launching an investigation with the DOJ and FTC probing private equity’ investments in healthcare expressing concern these deals may generate profits for corporate investors at the expense of patients’ health, workers’ safety and affordable care.
  • Thursday’s State of the Union address by President Biden (SOTU) and the Republican response by Alabama Senator Katey Britt put the spotlight on women’s reproductive health, drug prices and healthcare affordability.
  • Friday, the Senate passed a $468 billion spending bill (75-22) that had passed in the House Wednesday (339-85) averting a government shutdown. The bill postpones an $8 billion reduction in Medicaid disproportionate share hospital payments for a year, allocates $4.27 billion to federally qualified health centers through the end of the year and rolls back a significant portion of a Medicare physician pay cut that kicked in on Jan. 1. Next, Congress must pass appropriations for HHS and other agencies before the March 22 shutdown.
  • And all week, the cyberattack on Optum’s Change Healthcare discovered February 21 hovered as hospitals, clinics, pharmacies and others scrambled to manage gaps in transaction processing. Notably, the American Hospital Association and others have amplified criticism of UnitedHealth Group’s handling of the disruption, having, bought Change for $13 billion in October, 2022 after a lengthy Department of Justice anti-trust review. This week, UHG indicates partial service of CH support will be restored. Stay tuned.

Just another week for healthcare: Congressional infighting about healthcare spending. Regulator announcements of new rules to stimulate competition and protect consumers in the healthcare market.  Lobbying by leading trade groups to protect funding and disable threats from rivals. And so on.

At the macro level, it’s understandable: healthcare is an attractive market, especially in its services sectors. Since the pandemic, prices for services (i.e. physicians, hospitals et al) have steadily increased and remain elevated despite the pressures of transparency mandates and insurer pushback. By contrast, prices for most products (drugs, disposables, technologies et al) have followed the broader market pricing trends where prices for some escalated fast and then dipped. While some branded prescription medicines are exceptions, it is health services that have driven the majority of health cost inflation since the pandemic. UnitedHealth Group’s financial success is illustrative: it’s big, high profile and vertically integrated across all major services sectors. In its year end 2023 financial report (January 12, 2024) it reported revenues of $371.6 Billion (up 15% Year-Over-Year), earnings from operations up 14%, cash flows from operations of $29.1 Billion (1.3x Net Income), medical care ratio at 83.2% up from 82% last year, net earnings of $23.86/share and adjusted net earnings of $25.12/share and guidance its 2024 revenues of $400-403 billion. They buy products using their scale and scope leverage to  pay less for services they don’t own less and products needed to support them. It’s a big business in a buyer’s market and that’s unsettling to many.

Big business is not new to healthcare: it’s been dominant in every sector but of late more a focus of unflattering regulator and media attention. Coupled with growing public discontent about the system’s effectiveness and affordability, it seems it’s near a tipping point.

David Johnson, one of the most thoughtful analysts of the health industry, reminded his readers last week that the current state of affairs in U.S. healthcare is not new citing the January 1970 Fortune cover story “Our Ailing Medical System”

 “American medicine, the pride of the nation for many years, stands now on the brink of chaos. To be sure, our medical practitioners have their great moments of drama and triumph. But much of U.S. medical care, particularly the everyday business of preventing and treating routine illnesses, is inferior in quality, wastefully dispensed, and inequitably financed…

Whether poor or not, most Americans are badly served by the obsolete, overstrained medical system that has grown up around them helter-skelter. … The time has come for radical change.”

Johnson added: “The healthcare industry, however, cannot fight gravity forever. Consumerism, technological advances and pro-market regulatory reforms are so powerful and coming so fast that status-quo healthcare cannot forestall their ascendance. Properly harnessed, these disruptive forces have the collective power necessary for U.S. healthcare to finally achieve the 1970 Fortune magazine goal of delivering “good care to every American with little increase in cost.”

He’s right.

I believe the U.S. health system as we know it has reached its tipping point. The big-name organizations in every sector see it and have nominal contingency plans in place; the smaller players are buying time until the shoe drops. But I am worried.

I am worried the system’s future is in the hands of hyper-partisanship by both parties seeking political advantage in election cycles over meaningful creation of a health system that functions for the greater good.

I am worried that the industry’s aversion to price transparency, meaningful discussion about affordability and consistency in defining quality, safety and value will precipitate short-term gamesmanship for reputational advantage and nullify systemness and interoperability requisite to its transformation.

I am worried that understandably frustrated employers will drop employee health benefits to force the system to needed accountability.

I am worried that the growing armies of under-served and dissatisfied populations will revolt.

I am worried that its workforce is ill-prepared for a future that’s technology-enabled and consumer centric.

I am worried that the industry’s most prominent trade groups are concentrating more on “warfare” against their rivals and less about the long-term future of the system.

I am worried that transformational change is all talk.

It’s time to start an adult conversation about the future of the system. The starting point: acknowledging that it’s not about bad people; it’s about systemic flaws in its design and functioning. Fixing it requires balancing lag indicators about its use, costs and demand with assumptions about innovations that hold promise to shift its trajectory long-term. It requires employers to actively participate: in 2009-2010, Big Business mistakenly chose to sit out deliberations about the Affordable Care Act. And it requires independent, visionary facilitation free from bias and input beyond the DC talking heads that have dominated reform thought leadership for 6 decades.

Or, collectively, we can watch events like last week’s roll by and witness the emergence of a large public utility serving most and a smaller private option for those that afford it. Or something worse.


P.S. Today, thousands will make the pilgrimage to Orlando for HIMSS24 kicking off with a keynote by Robert Garrett, CEO of Hackensack Meridian Health tomorrow about ‘transformational change’ and closing Friday with a keynote by Nick Saban, legendary Alabama football coach on leadership. In between, the meeting’s 24 premier supporters and hundreds of exhibitors will push their latest solutions to prospects and customers keenly aware healthcare’s future is not a repeat of its past primarily due to technology. Information-driven healthcare is dependent on technologies that enable cost-effective, customized evidence-based care that’s readily accessible to individuals where and when they want it and with whom.

And many will be anticipating HCA Mission Health’s (Asheville NC) Plan of Action response due to CMS this Wednesday addressing deficiencies in 6 areas including CMS Deficiency 482.12 “which ensures that hospitals have a responsible governing body overseeing critical aspects of patient care and medical staff appointments.” Interest is high outside the region as the nation’s largest investor-owned system was put in “immediate jeopardy” of losing its Medicare participation status last year at Mission. FYI: HCA reported operating income of $7.7 billion (11.8% operating margin) on revenues of $65 billion in 2023.


DOJ-FTC-HHS HCC RFI – 03.04.24 – FINAL.pdf (

White House turns to health care in Biden’s latest move against ‘corporate greed’ – POLITICO

UnitedHealth Group Reports Fourth Quarter and Full Year 2023 Financial Results – UnitedHealth Group

Hospitals and PBMs seem to have dodged big federal reforms — for now (

Private equity in healthcare under scrutiny from FTC, DOJ, HHS | Modern Healthcare

State of the Union 2024 | The White House

David Johnson: Fortune telling healthcare’s dismal future | HFMA

Axios Vitals March 8, 2024

Change Healthcare update: CMS to provide financial flexibilities | Modern Healthcare

Private equity in healthcare under scrutiny from FTC, DOJ, HHS | Modern Healthcare



  • Quotables
  • Congress
  • Courts
  • Employers
  • Insurers
  • Nursing Homes
  • Physicians
  • Polling
  • Population Health
  • Prescription Drugs
  • Regulators


Re: Biden State of the Union Thursday: “Americans pay more for prescription drugs than anywhere else. It’s wrong and I’m ending it.  With a law I proposed and signed and not one Republican voted for we finally beat Big Pharma!  Instead of paying $400 a month for insulin seniors with diabetes only have to pay $35 a month!  And now I want to cap the cost of insulin at $35 a month for every American who needs it…

That will not only save lives it will save taxpayers another $200 Billion!  Starting next year that same law caps total prescription drug costs for seniors on Medicare at $2,000 a year even for expensive cancer drugs that can cost $10,000, $12,000, $15,000 a year.  Now I want to cap prescription drug costs at $2,000 a year for everyone!

Folks Obamacare, known as the Affordable Care Act is still a very big deal. Over one hundred million of you can no longer be denied health insurance because of pre-existing conditions.  But my predecessor and many in this chamber want to take that protection away by repealing the Affordable Care Act I won’t let that happen!  We stopped you 50 times before and we will stop you again! In fact, I am protecting it and expanding it. “

State of the Union 2024 | The White House

Re: FTC private equity investigation: “When private equity firms buy out healthcare facilities only to slash staffing and cut quality, patients lose out. Through this inquiry the FTC will continue scrutinizing private equity roll-ups, strip-and-flip tactics, and other financial plays that can enrich executives but leave the American public worse off.”

“When private equity firms buy out healthcare facilities only to slash staffing and cut quality, patients lose out. Through this inquiry the FTC will continue scrutinizing private equity roll-ups, strip-and-flip tactics, and other financial plays that can enrich executives but leave the American public worse off.”

FTC Chair Linda Khan DOJ-FTC-HHS HCC RFI – 03.04.24 – FINAL.pdf (

Re: federal budget deals leave hospital, PBM funding intact: “The big congressional spending deal that was unveiled this week with health policy attachments largely keeps the status quo for the two powerful industries, potentially leaving patients exposed to higher health costs. The must-pass package was viewed as the likeliest vehicle for big policy changes before the elections. Barring a surprise, any debate will be punted to a lame-duck session toward year’s end.

The combination of industry lobbying and dysfunction in Congress have conspired to stop anything from happening” on proposals to change how Medicare pays the providers or impose new price transparency requirements, said Larry Levitt, executive vice president of health policy at KFF…

The American Hospital Association boosted its lobbying by $3 million, up to over $25 million, from 2022 to 2023. PCMA, the trade group for PBMs, almost doubled its spending in that time period, from $8.7 million to $15.4 million.”

Hospitals and PBMs seem to have dodged big federal reforms — for now (

Re: AHA on Change Healthcare cyberattack impact: ““We cannot say this more clearly — the Change Healthcare cyberattack is the most significant and consequential incident of its kind against the U.S. health care system in history. For nearly two weeks, this attack has made it harder for hospitals to provide patient care, fill prescriptions, submit insurance claims, and receive payment for the essential health care services they provide.

The magnitude of this moment deserves the same level of urgency and leadership our government has deployed to any national event of this scale before it. The measures announced today do not do that and are not an adequate whole of government response…Rest assured, the AHA will continue to work with Congress on meaningful solutions to preserve 24/7 access to care. If limitations exist for an appropriate government response, it is incumbent upon the executive branch to propose the necessary legislation and authorities to ensure the provider network in this nation is not further compromised.”

Letter to Congressional Leaders from Rick Pollack, President and CEO, American Hospital Association March 4, 2024

Re: UnitedHealth Group and Change Healthcare cyberattack: “Still, much has been made of UHG’s 2022 acquisition of Change Healthcare for $13B – the implication that you can’t have one company in charge of this many transactions because it could cause the whole system to collapse. Consequence or cause? The actual problem here is that we do not have adequate defenses to bad actors who live in their mother’s basement and know how to use computer codes to extort money from people. Maybe get Cookie Monster to reach out: the coders are probably watching Sesame Street while they’re hacking away.”

Julie Barnes Only What Matters on Health Information Policy ( March 8, 2024

Re: physician workforce shortages: “The National Center for Health Workforce Analysis predicts that by 2036 the industry will have shortages of more than 68,000 primary care physicians, 62,400 psychologists, 42,100 psychiatrists, 6,600 obstetrician-gynecologists and 33,100 family medicine physicians, in addition to deficits of other specialties.”

Why physician, nursing shortages persist and what can be done | Modern Healthcare

Re: HSAs: “For years, Americans have been using tax-free dollars from health savings accounts to cover a wide variety of health and wellness items, including eyeglasses, tampons, massage devices, acupuncture and even fitness equipment deemed medically necessary by a doctor.

But now the IRS says some companies are misleading consumers about what is and is not eligible under the rules of these Health Savings Accounts (HSAs) and Flexible Savings Accounts (FSAs), which allow consumers to use pretax dollars for various health needs.

At the heart of the issue are companies that provide consumers with “letters of medical necessity” — essentially a doctor’s note — to purchase health-related items, such as nutritious meal plans, gym memberships, fitness trackers and dietary supplements.

Even though these notes are written by doctors, the IRS is questioning the validity of their advice.”.

Why the IRS is challenging how you spend your tax-free HSA, FSA dollars – The Washington Post

Re: PBMs: “I genuinely believe that CEOs do not understand how their healthcare costs work, particularly as it applies to the rebates, they receive from their PBMs. They tend to look at rebates as cash paid by the drug manufacturers. Nothing could be further from the truth. The reality is that the rebates are not paid for by the drug manufacturers. The rebates are paid for by these companies’ sickest and oldest employees.”

Mark Cuban on PBMs at White House March 4, 2024 FTC’s Lina Khan and Mark Cuban headline White House listening session to rail against PBMs – Endpoints News ( March 5, 2024

Re: consumer sentiment: “In February, concerns about inflation decreased slightly from the previous quarter, which helped consumer optimism about the US economy reach its highest level in almost two years. Although US consumers felt less pressure to save for an eventual rainy day, 20 percent were still pessimistic about the economy—but this represented the lowest reported pessimism rate since June of 2022 (although consumers were still more pessimistic than they were at the beginning of the COVID-19 pandemic). The following five charts highlight the findings from our latest ConsumerWise research in the United States.”

The state of the US consumer spending | McKinsey February 29, 2024


Highlights: March 8 Health spending deal results:*

  • FDA: funding closely in line with previous levels at $6.7 billion. (Neutral)
  • VA: topline funding at $307 billion, a $24 billion boost when accounting for funding under the debt-ceiling deal related to toxic exposures. (Winner)
  • Physicians: The legislation provides a 1.68% boost in Medicare pay for doctors. The amount, combined with the 1.25% increase Congress provided for them in the 2023 year-end package, results in a 2.93% payment bonus for 2024 but doesn’t mitigate the full 3.4% pay cut that the Biden administration finalized last fall through a mandated formula. (Neutral)
  • Community health centers: funding to the beginning of the fiscal year, bringing community health center funding to an annualized rate of $4.27 billion a year, a $270 million increase over the previous year. (Winner)
  • Substance use disorder: includes legislationto permanently require state Medicaid plans to cover medication-assisted treatment and  legislation to create a permanent state Medicaid option allowing treatment of substance use disorder at institutions. (Neutral)
  • PBMs:A bipartisan bid to rein in pharmacy benefit managers didn’t make the cut. (Winner)
  • ‘Poison pill’ riders:The package is largely devoid of new controversial policy riders related to abortion that had bogged down talks. (Winner)
  • Opioid treatment:The legislation doesn’t reauthorize the sweeping package aimed at addressing the opioid epidemic that expired in September. (Loser)

*Funding for HHS, other healthcare programs set to expire March 22.

House Approves Six Spending Bills, Leaving Six Still to Go – WSJ


Preventive health oral argument: Last Monday, the Fifth Circuit Court of Appeals heard oral arguments in Braidwood v. Becerra. Background: In September 2022, a lower court ruled that nonprofit Christian-owned Braidwood Management should not be required to cover PrEP drugs for HIV as it violates their rights under the Religious Freedom Restoration Act. The lower court decision was appealed by the federal government in March 2023. While the lower court’s ruling is not yet in effect, the Fifth Circuit’s decision later this year could spell trouble for one of the most critical aspects of the ACA.

ACA under threat: Previewing Braidwood oral arguments (


Centivo Report: Employer-sponsored health benefits: Highlights:

  • Health insurance premiums as % of worker earnings: 3.9% for workers in the top 5% of the workforce vs. 28.5% for workers in the lowest 20% of the workforce.
  • Over the last 3 decades, rising health premiums have cost the average worker $125, 340 in lost earnings.
  • 83% of employers think their employees are satisfied by the health benefits they receive vs. 61% of employees who are actually satisfied.
  • Employer health costs are expected to increase 29.5% to $2.28 trillion by 2030: +28.0% to $1.19 trillion for private employers and +31.3% to $01 trillion among public employers.
  • Access for insured workers who earn less than $50K/year: 21% have a PCP but used a hospital ED for routine care in the last year due to costs, 43% skip necessary care due to costs and 32% say they struggle to pay their medical bills.

Breaking Down & Through Healthcare’s Affordability & Access Crisis (

E Health analysis: small employer group health coverage cost per employee: Among survey respondents offering group health plans, amount paid each month per employee toward group health coverage:

  • Less than $200: 19%
  • $200-$300: 22%
  • $300-$400: 16%
  • $400-$500: 15%
  • $500-$600: 10%
  • $600-$700: 7%
  • $700-$800: 4%
  • More than $800: 8%

eHealth: Small Business Health Insurance Insights, February 2024


eHealth Medicare Index Report for March 2023: Highlights

  • Average premium for Medicare Advantage plans is unchanged year over year: $9 is the average monthly premium among Medicare Advantage selected by eHealth customers during the AEP for 2024 coverage, a figure unchanged from the previous year.
  • Demand for $0-premium Medicare Advantage plans is stable: For the second year in a row, 84% of those selecting Medicare Advantage plans at eHealth during AEP chose plans with a $0 monthly premium.
  • Average deductible for Medicare Advantage plans drops below $100: For the first time since eHealth began tracking it, the average annual deductible for Medicare Advantage plans selected by eHealth customers during AEP fell below $100 (to $95).
  • Average Part D plan premium is down but average deductible is up: $29 is the average monthly premium for stand-alone Medicare Part D plans selected by eHealth customers during AEP, down 9% from the year prior ($32); meanwhile the average deductible for Part D plans increased 14%, from $389 to $445.
  • Average premium for Medicare Supplement plans is up this year: Though enrollment in Medicare Supplement (Medigap) plans is not governed by AEP, the average premium for plans selected by eHealth customers during this period is up 9% year over year, from $173 to $189 per month

PowerPoint Presentation (

Chartis study: 2024 MA enrollment growth: “Half of Medicare-eligible individuals are now in Medicare Advantage plans. The market grew by 1.7 million beneficiaries (+5.4%), slowing down from the previous year’s record growth of 2.7 million (+9.4%). Notably, for-profit carriers like United, Humana, and Aetna collectively captured 1.4 million new members: 86% of the total market’s growth….

For the first time, more than half of the country’s Medicare population is enrolled in a Medicare Advantage plan. This reflects growth of nearly 1.7 million total beneficiaries (+5.4%) since 2023, bringing the total Medicare Advantage enrollment up to 33 million total beneficiaries out of 65.9 million Medicare-eligible individuals…

Meanwhile, Original Medicare enrollment contracted by 515,000 beneficiaries, a net effect of an additional 1.2 million total Medicare beneficiaries, below historic average overall growth.”

Mounting headwinds in Medicare Advantage market haven’t stopped growth | Chartis

Study: Home care access in Medicare Advantage: based on a review of about 285,000 patients who had care between 2019 and 2022:

  • MA patients got fewer home health visits from nurses, therapists and other classes of providers except social workers — and nearly two fewer days of service between admission and discharge.
  • Their odds of having improved mobility afterward were 3% lower than patients with similar needs in traditional Medicare, while the odds of improved self-care were 4% lower.
  • MA patients also had higher rates of being discharged to the community, which combined with lower functional improvement could limit their independence and increase the burden on caregivers.

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage | Health Policy | JAMA Health Forum | JAMA Network

Nursing Homes

Study: Nursing home ownership: “One-third of PE and fewer than one-fifth of REIT investments identified in the proprietary Irving Levin Associates and S&P Capital IQ investment data were present in Centers for Medicare and Medicaid Services (CMS) publicly available ownership data. Similarly, we obtained different results when searching for the ten top common owners of nursing homes using CMS data and facility survey reports of chain ownership. Finally, ownership percentages were missing in the CMS data for 82.40% of owners in the top ten chains and 55.21% of owners across all US facilities… Transparent ownership data are fundamental to understanding the adequacy of public payments to provide patient care, enable policy makers to make timely decisions, and evaluate nursing home quality.”

New CMS Nursing Home Ownership Data: Major Gaps And Discrepancies | Health Affairs


Study: PE Ownership of Practices: UC Berkeley researchers analyzed PE acquisitions from 2012-2021 linking data on PE acquisitions to physician data for ten specialties at the Metropolitan Statistical Area (MSA) level. Findings:

  • PE-acquired physician practice sites increased from 816 across 119 MSAs in 2012 to 5,779 across 307 MSAs in 2021.
  • Single PE firms had significant market share, exceeding 30%in 108 MSA specialty markets and exceeding 50% in 50 of those markets. The findings raise concerns about competition and call for closer scrutiny by the Federal Trade Commission, state regulators, and policy makers.
  • Some of the most concentrated markets were in the South and Northeast, including the Dallas-Fort Worth area and around Baltimore.

Private Equity–Acquired Physician Practices And Market Penetration Increased Substantially, 2012–21 | Health Affairs

Medscape: Workplace Measures to Ease Physician Burnout:

  • Increase compensation: 48%
  • Add support staff: 47%
  • Make work schedules more flexible: 46%
  • Increase physician control/autonomy: 41%
  • More respect from administrators/employees, colleagues, staff: 35%
  • Lighten patient loads: 33%
  • Make counseling available/check in with physicians: 9%
  • Other: 9%
  • Offer different jobs: 4%

Medscape via Becker’s Hospital Review, January 2024


Pew: Voter issue priorities: These are among the highlights of Pew Research Center’s annual policy priorities survey, conducted Jan. 16-21, 2024, among 5,140 adults who voluntarily participate in the American Trends Panel. Highlights:

“No single issue stands out after the economy. Nearly three-quarters of Americans (73%) rate strengthening the economy as a top priority. That is considerably larger than the shares citing any other policy goal.” The top 5 issues:

  • Strengthening the economy: 73%
  • Defending against terrorism: 63%
  • Reducing influence of money in politics: 62%
  • Reducing healthcare costs: 60%
    • Party preference: 49% GOP, 70% Dem
    • Race:57% white, 62% black, 62% Hispanic, 72% Asian
    • Age: 58% 18-29, 59% 30-49, 61% 50-64, 61% 65+
  • Improving education: 60%

Stronger Economy is Americans’ Top Policy Priority for 2024 | Pew Research Center February 29, 2024

KFF Poll: Views on abortion vary widely: Key Takeaways from KFF Health Tracking Poll conducted February 20-28,2024, online and by telephone among a nationally representative sample of 1,316 U.S. adults in English (1,226) and in Spanish (90):

  • Voters who say abortion is the “most important issue” in their 2024 vote (12% of all voters) are disproportionately made up of Black voters, Democratic voters, women voters, and the youngest voting bloc – voters ages 18 to 29.
  • Half of voters say they think the elections for president, Congress, and state legislatures will have a “major impact” on access to abortion, rising to two-thirds of Democratic voters and seven in ten voters who say abortion is their most important voting issue. About four in ten voters overall say the same about the perceived impact of the elections on access to contraception, though there are stark partisan divides on this outlook. At least half of Democratic voters say they think the elections will have a “major impact” on access to contraception, whereas three in ten or fewer Republican voters say the same.
  • Less than half of adults (45%) say they consider the right to contraception a “secure right likely to remain in place,” about one in five (21%) adults consider the right to use contraception a threatened right likely to be overturned, and an additional third (34%) are “not sure” if the right is threatened or secure. Views on this topic diverge widely by partisanship, with Democrats nearly four times more likely to say they view the right to use contraception as threatened than are Republicans (38% vs. 10%).
  • Two-thirds of the public, including majorities of Democrats (86%) and independents (67%), support a law guaranteeing a federal right to abortion. Yet, this is opposed by nearly six in ten Republicans (57%). In addition, while among the public overall about six in ten (58%) oppose a 16-week abortion ban, a majority of Republicans (63%) adults support this proposal, while most Democrats (75%) and independents (59%) oppose it.

KFF Health Tracking Poll March 2024: Abortion in the 2024 Election and Beyond | KFF

Population Health

Study: association of medical debt and population health: Researchers analyzed the associations of medical debt with health status, premature death, and mortality in the U.S. at the county level based on 2018 data from the Urban Institute Debt in America project and mortality data from the National Center for Health Statistics. Findings:

On average, 19.8% (range, 0%-53.6%) of the population had medical debt. After adjusting for county-level sociodemographic characteristics, a 1–percentage point increase in the population with medical debt was associated with 18.3 more physically unhealthy days and 17.9 more mentally unhealthy days per 1000 people during the past month, 1.12 years of life lost per 1000 people, and an increase of 7.51 per 100 000 person-years in age-adjusted all-cause mortality rate. Associations of medical debt and elevated mortality rates were consistent for all leading causes of death, including cancer (1.12), heart disease (1.39) and suicide (0.09) per 100 000 person-years. Similar patterns were observed for associations between the median amount of medical debt and the aforementioned health outcomes.

Associations of Medical Debt With Health Status, Premature Death, and Mortality in the US | Health Policy | JAMA Network Open | JAMA Network

Opioid settlements: The Helios Alliance proposed to assist states in the allocation of its opioid settlement funds using its predictive analytics platform. In 39 states, opioid abatement councils determine their use. Issues facing the alliance are (1) challenges that the statistical methodology is inaccurate/incomplete and (2) public access to the data.

Statistical Models vs. Front-Line Workers: Who Knows Best How to Spend Opioid Settlement Cash? – KFF Health News

CDC Study: Hearing loss prevalence: “Bilateral hearing loss (permanent hearing loss in both ears) is a highly prevalent condition, associated with negative health and social consequences across the lifespan. In children, hearing loss impacts speech and language development, educational achievement, and elevates family stress.” Key findings:

  • “For 2019, we estimated a total of 24.9 million people with mild hearing loss/a prevalence rate of 7.6%; 13.0 million people with moderate or worse hearing loss/a prevalence rate of 4.0% and 37.9 million Americans with any bilateral hearing loss/ 11.6%.
  • The states with the highest prevalence were West Virginia, Maine, Montana, Wyoming, Vermont, New Mexico, Oklahoma, Kentucky, Arkansas, and Oregon, each with a prevalence rate of any hearing loss of 14.0% or higher. Rates of any hearing loss varied widely by county, even within states.”

national-indicator-report-on-hearing-loss_final2024-compressed-(1).pdf (

Study: Primary care shortage and use of emergency surgical services in Medicare: Researchers evaluated the rates of elective versus emergency surgery for patients with three access-sensitive surgical conditions living in primary care Health Professional Shortage Areas during 2015–19. Findings:

“Medicare beneficiaries in more severe primary care shortage areas had higher rates of emergency surgery compared with rates in the least severe shortage areas (37.8% versus 29.9%). They were also more likely to have serious complications (14.9% versus 11.7%) and readmissions (15.7% versus 13.5%). When we accounted for areas with a shortage of surgeons, the findings were similar. Taken together, these findings suggest that residents of areas with greater primary care workforce shortages may also face challenges in accessing elective surgical care. As policy makers consider investing in Health Professional Shortage Areas, our findings underscore the importance of primary care access to a broader range of services.”

Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage Areas, 2015–19 | Health Affairs

Prescription Drugs

RAND: Drug prices: “Comparisons of drug prices in the United States and other high-income countries based on 2022 data and presents results for specific types of drugs, including brand-name originator drugs and unbranded generic drugs:

  • Except for unbranded generics, manufacturer gross drug prices in the United States were substantially higher than those in other countries.
  • Across all drugs, U.S. prices were 278% of other countries’ prices.
  • S. gross prices for brand-name originator drugs were 422% of prices in comparison countries.
  • After applying an adjustment for rebates paid by manufacturers, U.S. net prices for brand-name originator drugs were relatively lower but still over three times as high as prices in other countries.
  • The United States had lower prices for unbranded generics than most countries. Unbranded generics accounted for 90% of U.S. prescription drug volume—a much larger share than the 41 % for the comparison countries—but only 8% of U.S. prescription drug spending at manufacturer gross prices (compared with 13% in other countries).
  • In contrast, brand-name originator drugs accounted for only 7% of U.S. prescription drug volume and 87% of U.S. prescription drug spending (compared with 29% of volume and 74% of spending in other countries).”

International Prescription Drug Price Comparisons: Estimates Using 2022 Data | RAND

Study: opioid deprescribing among seniors: Researchers analyzed the experiences of older adults and primary care practitioners (PCPs) in use of opioids for treatment of chronic pain and discussing opioid deprescribing.

Findings:  In this qualitative study analyzing responses to a semi structured interview by 29 older adults prescribed long-term opioids and by 18 PCPs, there was consensus on the use of opioids as a last resort to improve quality of life and that deprescribing conversations were often unsuccessful. There was disagreement on the perceived risks associated with long-term opioid use and the barriers to deprescribing conversations.

Older Adult and Primary Care Practitioner Perspectives on Using, Prescribing, and Deprescribing Opioids for Chronic Pain | Geriatrics | JAMA Network Open | JAMA Network

Regulator Announcements from Last Week

White House: Per Nielsen, Thursday’s State of the Union (SOTU) was viewed by 32.2 million, up 18% from 2023 of (27.3 million) vs.26.9 million in 2021 and 38.2 million in 2022 days after the Russian invasion of Ukraine. Highlights:

  • 74% of live TV viewers were 55 and older, about the same proportion as last year’s speech.
  • Fox News attracted 5.8 million viewers on Thursday, the largest live audience of any network. ABC was watched by about 5.2 million people, leading the three biggest broadcasters. NBC was the top-ranked network among viewers ages 25 to 54, the most important demographic for advertisers in the TV news industry.

Ratings Jump 18% for Biden’s Feisty State of the Union – The New York Times (

DOJ: The Justice Department, Federal Trade Commission, and Health and Human Services Department announced a probe on the impact of investments and acquisitions by private equity or corporate-investor backed companies on health care businesses

FDA decisions last week:

  • approved Opill as an over-the-counter birth control medication. The pills will be sold in one-month and three-month packs, at $19.99 and $49.99, respectively.
  • authorized Dexcom to sell its glucose monitor, Stelo, to adults who don’t use insulin. It’s aimed at people with type 2 diabetes — and anyone who wants to know how diet and exercise affect their blood sugar levels. Paired with a smartphone app, the device gives readouts every 15 minutes.
  • Based on results of its 17,600 patient Select Trial, the FDA approved semaglutide (Wegovy) to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and either obesity or overweight. It recommended it should be used in conjunction with a reduced calorie diet and increased physical activity.

Labor: The economy added 275,000 jobs in February, while the unemployment rate rose to 3.9% from 3.7%. In January, there were 229,000 jobs added — 124,000 fewer than initially estimated. December job gains were revised down to 290,000 from 333,000. The labor force participation rate, or the share of the population with or looking for a job, held at 62.5%. Average hourly earnings, a measure of wage growth, rose 0.1% in February — or 4.3% over the year.

CMS: The Centers for Medicare & Medicaid Services (CMS) enrollment report released February 29, 2024:

  • Medicaid and the Children’s Health Insurance Program (CHIP) was approximately 85.8 million in November 2023, a decrease of 1.5 million from October 2023.
  • Medicare enrollment was 66.8 million, up 154,255 from October 2023, including 32.6 million in Medicare Advantage plans. More than 12 million Medicare-Medicaid dual eligibles are counted in both programs.

CMS Releases Latest Enrollment Figures for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) (