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The federal government has looked at various ways of reducing prescription drug costs, including allowing Medicare to negotiate with pharmaceutical companies. KFF Health News reported on an effort by the federal government to invalidate patents held by drug manufacturers.

The federal government has looked at various ways of reducing prescription drug costs, including allowing Medicare to negotiate with pharmaceutical companies. KFF Health News reported on an effort by the federal government to invalidate patents held by drug manufacturers.

Before this effort, competitors (e.g. generic drug manufacturers) needed to pay to challenge patents protecting medicines that they wanted to produce. Apparently, in those cases, challenging some medication patents would automatically trigger a delay for the challenger's FDA approval process. It is unclear why that delay was made into policy. Theoretically, by invalidating some of these patents, the federal government is lowering the cost for makers of generics to offer more affordable alternatives.

KFF Health News published a follow-up article on a patient's frustration with the practice of prior authorization. The article gives the background that "Prior authorization was conceived decades ago to rein in health care costs by eliminating duplicative and ineffective treatment. Not only does overtreatment waste billions of dollars every year, but doctors acknowledge it also potentially harms patients." However, the practice can also be abused to the benefit of insurers by denying legitimate medical care. Unfortunately, it seems that patients have little recourse when denied medical care, other than to appeal to the court of public opinion.

KFF Health News published a follow-up article on a patient's frustration with the practice of prior authorization. The article gives the background that "Prior authorization was conceived decades ago to rein in health care costs by eliminating duplicative and ineffective treatment. Not only does overtreatment waste billions of dollars every year, but doctors acknowledge it also potentially harms patients." However, the practice can also be abused to the benefit of insurers by denying legitimate medical care. Unfortunately, it seems that patients have little recourse when denied medical care, other than to appeal to the court of public opinion.

KFF Health News had previously reported on the federal government's effort to reform the practice, in part by reducing the time that insurers have to respond to prior authorization requests. However, it seems that there should probably be an independent agency or panel which includes medical expertise to help adjudicate differences in opinion on what constitutes legitimate medical care.

KFF Health News published an article with some surprising statistics about the prevalence of misdiagnosis. According to one study published in BMJ Quality & Safety, "rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers." Additionally, "an estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis."

KFF Health News published an article with some surprising statistics about the prevalence of misdiagnosis. According to one study published in BMJ Quality & Safety, "rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers." Additionally, "an estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis."

The article focuses on racial and gender disparities with regards to misdiagnoses, reporting that "women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis." Even when controlling for racial differences in access to healthcare, a study "found that Black kids with appendicitis were less likely than their white peers to be correctly diagnosed, even when both groups of patients visited the same hospital." One explanation for this disparity is that medical textbooks have centered around treating white males (e.g. "Only 4.5% of images in general medical textbooks feature patients with dark skin"), leading physicians to be less confident in their diagnoses of patients in other groups, leading to worse outcomes (e.g. waiting to see if symptoms worsen before ordering tests or prescribing treatment). There are likely other causes at play as well, but it seems that there are no quick fixes to the general problem.

Enough people were upset by surprise medical bills that Congress passed the No Surprises Act in 2020, meant to eliminate instances of patients going to a facility that is in-network, but receiving a bill from an out-of-network provider. However, KFF Health News published an article recounting how one patient was surprised by an out-of-network bill when opting for a remote visit with her usual health system.

Enough people were upset by surprise medical bills that Congress passed the No Surprises Act in 2020, meant to eliminate instances of patients going to a facility that is in-network, but receiving a bill from an out-of-network provider. However, KFF Health News published an article recounting how one patient was surprised by an out-of-network bill when opting for a remote visit with her usual health system.

One issue appears to be that the No Surprises Act might not have anticipated remote visits, since it seems to apply to specific facility types (and not all facilities). The legislation allows for out-of-network service, provided that the patient gets advanced notice, and another issue in this particular case appears to be that the consent forms were "signed" by the patient after the consultation (the patient does not remember signing such forms). A third issue is the cost of the visit came out to be $660 (for a visit that was between 49 minutes and 59 minutes), when the patient recalls the visit actually only being five minutes. A fourth issue is that the patient saw a cost of $60.

It also seems that requiring sick patients to read and understand fine print when they are trying to book an urgent appointment is less than fair. Overall, this surprise bill seems like a terrible customer experience and is reminiscent of what lead to the No Surprises Act in the first place.

Medicare Advantage health insurance plans are touted as the same as traditional Medicare, but operated by private insurance companies. As such, Medicare Advantage plans are often pitched with extras, such as a regular allowance that can be spent on qualified medical expenses (such as toothpaste or glasses) or a gym membership. However, KFF Health News published an article about seniors discovering some important differences: Medicare Advantage enrollees lack guaranteed eligibility in Medigap plans (in most states) and more limited acceptance by providers.

Medicare Advantage health insurance plans are touted as the same as traditional Medicare, but operated by private insurance companies. As such, Medicare Advantage plans are often pitched with extras, such as a regular allowance that can be spent on qualified medical expenses (such as toothpaste or glasses) or a gym membership. However, KFF Health News published an article about seniors discovering some important differences: Medicare Advantage enrollees lack guaranteed eligibility in Medigap plans (in most states) and more limited acceptance by providers.

Medigap plans (also known as Medicare supplemental plans) are private plans that help cover holes (or "gaps") in Medicare coverage in exchange for an additional premium. The article explains "In traditional Medicare, enrollees pay a monthly premium and, after reaching a deductible, in most cases are expected to pay 20% of the cost of each nonhospital service or item they use. And there is no limit on how much an enrollee may have to pay as part of that 20% coinsurance if they end up using a lot of care." For patients who have chronic conditions that require much care, Medigap can save meaningful amounts. Enrollees in traditional Medicare are guaranteed eligibility in Medigap plans, but enrollees in Medicare Advantage plans can have their premiums priced according to patients' medical histories. It seems that even patients who switch back from Medicare Advantage to traditional Medicare are not guaranteed the favorable pricing.

This disparity in the Medigap eligibility and pricing guarantee seems to give traditional Medicare an advantage. It is unclear if the disparity is intentional, and four states have extended the guarantee to Medicare Advantage plans. Since patients frequently do not know upfront whether they would use Medigap insurance, it seems that patients would benefit if they all had the same Medigap guarantee, regardless of whether they are enrolled in traditional Medicare or in Medicare Advantage.

Something else that would make it easier for patients to compare traditional Medicare and Medicare Advantage plans would be published metrics of acceptance by providers. If patients have a difficult time finding providers that accept their insurance plans, that meaningfully changes the quality of the insurance.

Both of these changes seem pertinent, especially as recent years have seen significant growth in enrollment in Medicare Advantage plans.