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KFF Health News reported on California's successful effort to bring its own branded insulin to market. "Seven months after the launch of its own low-cost insulin brand, state health officials said California has distributed more than 120,000 five-pen packs of insulin glargine priced at $55 each, significantly less than the $89 to $411 that the state says most popular brand names charge before any retail markups or consumer discounts."

The volume sounds low, potentially because "patient advocates said many people with diabetes aren't aware it's an option." It is also unclear how widespread insurance acceptance of this new option is, and how much the out-of-pocket cost differences are for patients with insurance. Nevertheless, it is at least symbolically meaningful that the state was able to establish this as an option for diabetic patients. It would be interesting to know how much the state has had to spend on this effort, and whether the investment will pay off in the long-term.

Continuing with last week's theme, KFF Health News published another story about how shopping around for health care (this time with a driving radius of a few hours) can yield dramatic price differences (e.g. $16,000 vs $40,000). While both prices exceed the out-of-pocket maximum that insured patients would generally need to pay, the health insurance plans would pay different amounts, meaning that patients who visit the more expensive providers will contribute to higher health insurance premiums. This article specifically noted that mergers of health systems have contributed to higher prices by forming monopolies ("anyone who pays for health insurance pays a price for hospital monopolies, as insurers boost premiums as medical costs rise").

While the Federal Trade Commission (FTC) was formed to protect against anti-competitive mergers, the article cites a paper that found that "the FTC intervened in only about 1% of such cases from 2002 to 2020 to stop a hospital merger." In addition to the suspected higher prices, research has sadly found "that the quality of care declines when hospitals have little competition."

Medical tourism is when a patient travels outside of his or her local vicinity to receive care elsewhere. Generally, people think of medical tourism as visiting a foreign country, but KFF Health News published an article about someone in the US traveling to another state (from Maine to Maryland). One of the patient's local option estimated a cost near $23,000 to treat his hernia. The patient ended up selecting a surgery center and ended up paying less than $5,000 (including travel costs). One difference between the two options is that the local option would have been performed laparoscopically, and "Laparoscopic procedures generally cost more because surgeons use more advanced tools." Nevertheless, that patient "was fully recovered within two weeks," so the benefit of laparoscopy might not have made much functional difference in this case.

Many in the country do not shop for medical procedures because they have health insurance and the difference in out-of-pocket costs might not be substantial. However, as health insurance premiums rise, more people will be tempted to do as what the patient profiled in this article did.

KFF Health News published a disturbing article about how the current White House administration "has effectively shut down most of the Agency for Healthcare Research and Quality's activities, closing the spigot on federal funding estimated to have saved thousands of lives and billions of dollars over the past 27 years by improving medical practice." In particular, "[a]ll of AHRQ's grant managers have been fired, so there would be no way for AHRQ to directly oversee future grants." This is despite "the agency's noncontroversial focus on patient safety and its overall alignment with [the current White House administration]."

There are many problems with the current healthcare system, but industry leaders seem to have little incentive to change the status quo. Although the impacts can be slow to roll out, government-funded research seems helpful in establishing ways to change the current sytem.

Much has been noted about the new work requirements that will be imposed on Medicaid enrollees. Understandably, there is an exemption for those who are unable to work or volunteer. However, KFF Health News reported on complications presented by the requirements for enrollees to get a medical waiver.

Notably, doctors may not feel qualified to determine if patients are too "medically frail" to work, especially since no firm guidelines have been published. The article notes that doctors who might be asked for these assessments "are not necessarily trained in occupational medicine." There is concern that incorrect assessments might incur punishments in the future. Beyond that, "The country is short thousands of primary care providers, and it could be hard for people seeking an exemption to find a clinician to help them document that they're too sick to work," with one doctor asking "How could an applicant who doesn't have health coverage get a doctor's note?" Hammering out the policy and logistical details for a seemingly simple phrase can actually be quite complicated.