The Host
Julie Rovner
KFF Well being Information
Julie Rovner is chief Washington correspondent and host of KFF Well being Information’ weekly well being coverage information podcast, “What the Well being?” A famous knowledgeable on well being coverage points, Julie is the creator of the critically praised reference e book “Well being Care Politics and Coverage A to Z,” now in its third version.
Incoming President Donald Trump’s inauguration is Monday, but the brand new GOP-led Congress is already dashing to work his priorities into laws, eyeing cuts to Medicaid to pay for brand new tax and immigration priorities. However even in its waning days, the Biden administration continues to make huge coverage strikes, together with a attainable order for tobacco corporations to dramatically lower the quantity of nicotine in cigarettes.
In the meantime, the fires in Los Angeles are drawing new consideration to the well being risks of not simply smoke from natural matter, but additionally poisonous substances launched by burning plastic and different man-made supplies — in addition to the menace posed to each air and water high quality.
This week’s panelists are Julie Rovner of KFF Well being Information, Anna Edney of Bloomberg Information, Joanne Kenen of the Johns Hopkins College Bloomberg Faculty of Public Well being and Politico Journal, and Sandhya Raman of CQ Roll Name.
Panelists
Anna Edney
Bloomberg
Joanne Kenen
Johns Hopkins College and Politico
Sandhya Raman
CQ Roll Name
Among the many takeaways from this week’s episode:
- Republican lawmakers are weighing choices to chop federal spending on Medicaid, the almost $900-billion-a-year authorities program that covers 1 in 5 Individuals. They may use the financial savings to bolster Trump priorities, resembling extending the 2017 tax cuts. The GOP made splashy however unsuccessful makes an attempt to chop Medicaid when Trump first took workplace and the get together held a bigger Home majority — although the get together appears extra aligned with Trump right now than it was then.
- Congress has gotten right down to enterprise on messaging payments: It superior laws this week that might ban trans athletes from women’ college sports activities and, individually, a measure to detain and even deport immigrants who’re residing within the U.S. with out authorized standing and have been charged with, although not convicted of, minor crimes resembling shoplifting.
- The Supreme Courtroom has agreed to listen to a case later this yr in regards to the U.S. Preventive Companies Job Power — an impartial physique of consultants that points suggestions in illness prevention and drugs. A ruling in opposition to its authority might strip protection for key preventive well being providers from not simply these with Reasonably priced Care Act protection, but additionally these on employer-sponsored well being plans. The query stands: If not this activity power, who would make the determinations about what preventive care must be coated?
- And the outgoing Biden administration issued a slew of well being laws this week, together with a ban on the dye Pink No. 3 in meals and different ingested merchandise, in addition to an early regulation limiting the quantity of nicotine in tobacco merchandise. The incoming Trump administration might upend these and extra laws, although some do align with its coverage pursuits.
Additionally this week, Rovner interviews Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month” characteristic, a couple of colonoscopy that got here with a a lot bigger price ticket than estimated. You probably have a mystifying or outrageous medical invoice you’d wish to share with us, you are able to do that right here.
Plus, for “additional credit score,” the panelists counsel well being coverage tales they learn (or wrote) this week that they assume it is best to learn, too:
Julie Rovner: KFF Well being Information’ “Can Medical Faculties Funnel Extra Docs Into the Main Care Pipeline?” by Felice J. Freyer.
Anna Edney: Bloomberg Information’ “It’s Not Simply Sunscreen. Poisonous Merchandise Line the Drugstore Aisles,” by Anna Edney.
Joanne Kenen: The Atlantic’s “A Secret Means To Battle Off Abdomen Bugs,” by Daniel Engber.
Sandhya Raman: Nature’s “New Weight problems Definition Sidelines BMI To Concentrate on Well being,” by Giorgia Guglielmi.
Additionally talked about on this week’s podcast:
Click on to open the transcript
Transcript: Whats up, Trump. Bye-Bye, Biden.
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Whats up and welcome again to “What The Well being.” I’m Julie Rovner, chief Washington correspondent for KFF Well being Information, and I’m joined by a few of the greatest and smartest well being reporters in Washington. We’re taping this week on Thursday, Jan. 16, at 10 a.m. As all the time, information occurs quick and issues might need modified by the point you hear this. So, right here we go.
Immediately we’re joined by way of videoconference by Anna Edney of Bloomberg Information.
Anna Edney: Hello, all people.
Rovner: Sandhya Raman of CQ Roll Name.
Sandhya Raman: Good morning, everybody.
Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg Faculty of Public Well being and Politico Journal.
Joanne Kenen: Hello, all people.
Rovner: Later on this episode we’ll have my interview with Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month,” a couple of affected person whose colonoscopy invoice was rather a lot larger than he anticipated. However first, this week’s information.
So we at the moment are 4 days from the second swearing-in of Donald Trump as president, and discussions are already selecting up on Capitol Hill about rolling the brand new president’s total agenda into, quote, “one huge, lovely invoice,” as Trump has put it. There are many variations of opinions between Republicans which can be nonetheless to be labored out, however one goal for cost-cutting is fairly clear, and that might be Medicaid. Sandhya, we’re beginning to get an image of the chances of how they may wish to do this. What are a few of the fundamental issues which can be on the desk?
Raman: So the reconciliation talks are very a lot underway, and we’ve made slightly progress however on the identical time we simply didn’t additionally make plenty of progress. The top of, -ish, final week we received a menu of things that Republicans are type of contemplating as issues they might use to offset a few of the issues that they’d wish to do by means of reconciliation.
Rovner: Like proceed the tax minimize?
Raman: Sure, for the tax cuts and for border safety. So what we have now on the Home facet is plenty of issues which can be very health-oriented. About half of that checklist is health-oriented, and plenty of it’s Medicaid. And so a few of the issues they’ve been floating round are some issues we noticed within the first Trump administration, them making an attempt to do. We’ve per-capita caps on Medicaid spending, work necessities for Medicaid, altering the federal match for Medicaid growth, and issues like altering the general public cost rule to again the way it was within the Trump administration.
Rovner: Remind individuals what the general public cost rule is.
Raman: The general public cost rule type of limits a few of the social applications for folk that aren’t residents to utilize issues like Medicaid, SNAP [the Supplemental Nutrition Assistance Program], and different applications like that.
Rovner: And people are for people who find themselves right here legally?
Raman: Sure. So this week, Tuesday, we had our first assembly from the Home Power and Commerce Republicans to look over not less than the well being a part of that menu. And speaking to each Power and Commerce Chairman Brett Guthrie and Buddy Carter, who heads the well being subcommittee, it’s simply the beginning. Discussions have been fairly good, however it’s so early.
Carter stated that he nonetheless needs to get the PBM [pharmacy benefit manager] language from final yr that didn’t make it throughout the end line in there. And Guthrie has stated that a few of the numbers that we’ve seen of how a lot cash from Medicaid they may probably save are actually in flux due to how they work together with the entire different provisions in there. Some issues are beneath Methods and Means jurisdictions. Some issues, for those who do one and never the opposite, the numbers would change.
In order that they’re nonetheless fairly early within the course of, and we don’t know if we’re going to do the “one huge, lovely invoice” or type of what the Senate needs, with two payments, and that might simply type of change what could be executed earlier versus later. However we do have slightly bit extra of a timeline now in what they’re making an attempt to do.
Rovner: I really feel prefer it’s value remembering that they tried taking a whack out of Medicaid in 2017, once they had a a lot larger Republican majority within the Home, they usually couldn’t get it over the end line. What makes them assume they’re going to be extra profitable this time?
Raman: I feel a part of it’s that — that is nonetheless early on. Once you ask them the suggestions that they’ve gotten from Republican governors — most Republican states have had Medicaid growth at this level. We nonetheless have solely the ten holdout growth states. So, I feel, actually, as we get nearer, if they appear like they’re angling to incorporate a few of these in no matter automobile we have now, we’ll in all probability hear extra.
And I imply, for those who have a look at this state-level already, plenty of states are type of couching their bets with Medicaid, simply fascinated by how they will do issues otherwise in case their Medicaid federal funding modifications over the course of this yr or subsequent yr. So, I feel it actually depends upon what suggestions they’re going to get within the coming weeks and months.
Rovner: Joanne wished so as to add one thing.
Kenen: Yeah, I imply, the great thing about reconciliation for those who’re the bulk get together, however a slender majority, which is what’s happening now, is you’d solely want 51 votes within the Senate. You don’t want 60. So on one stage, that appears like they’ve received 53. It’s a slam dunk, proper? But it surely’s not, as a result of reconciliation, it’s a seize bag. You set a lot stuff in there, and all you want is one provision that this particular person gained’t vote for or that particular person gained’t vote for.
So this seemingly easy slam dunk for a narrow-majority Senate is definitely a giant, difficult mess. Then again, in comparison with the primary Trump administration, it is a extra conservative, or a extra populist, or a extra method — I imply, the ideology or worldview of the Republicans in Congress is nearer to Trump than it was in 2017.
However yeah, they failed at what they thought was going to be straightforward. They thought repealing the ACA [Affordable Care Act] and altering, which included plenty of Medicaid stuff, they thought it was a slam dunk. And as an alternative, it was a year-long slog that failed. So is Medicaid going to look the way in which it seems proper now? No, it’ll change. How a lot will it change is actually an open query.
Keep in mind, there’s some issues they will do by means of waivers. Work necessities they will do by means of waivers. Though prior to now, the courts have blocked them. The courts have modified. We don’t know the place the courts will come down. However actually it’s greater than a headache. It’s like a headache and a stomachache.
Rovner: Yeah, nicely, so reconciliation, finances, all of these things continues to be approach TBD. Nonetheless, the Republican Congress is getting off to a quick begin, not less than by way of messaging laws. The Home this week handed a invoice to ban transgender athletes from girls’s college sports activities, and the Senate’s debating a Home-passed invoice that might enable the deportation of undocumented people who find themselves accused however not but convicted of violent crimes.
In West Virginia, the brand new governor, who’s additionally a former Capitol Hill well being aide, [Patrick] Morrisey, issued govt orders making it simpler for folks to ship their kids to high school with out being vaccinated. General, it appears the Republicans are type of coalescing round an idea referred to as “medical freedom,” which to me appears similar to a rejection of public well being typically. Or am I lacking one thing? Is there one thing extra to this?
Edney: No, I feel that it’s all the time been round, however I feel that actually this resurgence in it’s coming from the truth that individuals didn’t belief science throughout the pandemic. They have been fed up. Communication wasn’t dealt with very nicely, and it nonetheless isn’t dealt with very nicely. I don’t assume individuals have found out speak about these items in measured methods.
I might advocate if somebody listening hasn’t learn, Dr. Paul Offit wrote an op-ed within the New York Occasions a couple of days in the past on vaccination that I believed was actually good as a result of he’s like: Hear, I’m a vaccine skeptic. Like, R.F.Okay. Jr. [Robert F. Kennedy Jr.] is a vaccine cynic. There’s the distinction, and right here’s what it’s. And he laid it on the market. And he’s a pediatrician, and he additionally serves on FDA’s [the Food and Drug Administration’s] advisory committee for vaccines.
So I feel that plenty of that is stemming from misinformation and miscommunication, and it resonates with individuals. I imply, the Republican Celebration picked up plenty of followers in far-left progressives by speaking about this. So I feel they see that as a possibility, too. So it could not simply be grassroots. It might be slightly little bit of a possibility they see.
Kenen: Anti-vaccination sentiment has been round so long as vaccines. It truly goes again to smallpox. There has all the time been a specific amount of worry, skepticism, no matter. It had been historically amongst Democrats and Republicans. It truly modified. It started to alter two or three years earlier than the pandemic.
Some state legislatures — and this was the medical freedom, this was on the precise — began making an attempt to water down mandates for colleges. At that time, I don’t assume something huge received by means of. However we started to see this emergence of a deeper politicization of vaccination. And it was on the precise, and it’s what we now speak about as medical freedom.
So as an alternative of being one thing that’s throughout the political spectrum, it’s now a politicized motion, on a libertarian Authorities can’t inform me what to do. And we noticed this throughout the pandemic. And neither administration, neither the Trump administration within the first yr of the pandemic nor the Biden administration within the ensuing years, actually managed to clarify the distinction between particular person alternative and the truth that for those who get sick, you may survive however you could possibly endanger any person else.
You don’t know who the particular person on the bus subsequent to you is. You don’t know who the child in your classroom is. You don’t know who you’re standing subsequent to on the grocery retailer. They may very well be actually susceptible. And that this complete sense of “my physique, my alternative,” doesn’t fly when you could possibly kill any person else unintentionally. And that form of has been misplaced, or individuals don’t care.
Rovner: Yeah, I imply we’ve seen that with tobacco over what number of generations. It’s like, you wish to put stuff in your lungs, that’s your corporation. However you don’t actually get the precise to place stuff in different individuals’s lungs since you wish to smoke.
In the meantime, persevering with with the Republican agenda, my former KFF Well being Information colleague Anna Maria Barry-Jester has a very good story this week about what Nationwide Institutes of Well being director candidate Jay Bhattacharya may take note of for the company, together with de-emphasizing infectious illness analysis and focusing extra on persistent illness.
On condition that the largest institute at NIH is already the Nationwide Most cancers Institute, which focuses on a persistent illness, is that this simply Republicans’ approach of punishing the Nationwide Institute of Allergy and Infectious Ailments that was for therefore lengthy headed by the now retired Dr. Tony Fauci?
Raman: I feel in an element that may be a big driving issue, whenever you have a look at a few of his feedback and R.F.Okay. Jr.’s feedback about holistic approaches to well being, that basically whenever you have a look at what one thing like NIAID does, which is so infectious-disease-driven, versus the issues like with most cancers and different issues.
However I feel on the identical time, this has type of been effervescent up earlier than, once we even appeared to final yr. Earlier than we had any of those nominees, earlier than we even knew the result of the election, we had a push inside Congress from the pinnacle of the Home Labor-H Appropriations subcommittee and former Power and Commerce Chairwoman Cathy McMorris Rodgers making an attempt to reform NIH that approach.
We didn’t get that far with it. It was included in a few of the appropriations payments that didn’t go anyplace but. However I feel it’s simply a part of a broader dialogue that there’s, type of going again to what we have been saying earlier than, a few of the wanting extra management of what you see, by way of medical freedom, and that they wish to know extra about what’s taking place.
So I feel that, regardless, we’re going to see extra of this. However I feel one factor that was actually fascinating in what she’d been writing was simply the NIH is a lot larger than simply NIH, you recognize? It’s so lots of the individuals which can be benefited by it, which can be working with this grant cash, are states nationwide. And it’s simply the medical analysis is for a world understanding of medical analysis, and simply how lots of the medication that we see come from NIH cash. So even when there’s a broader push for reform, that it’s very delicate into how broad of an impact that might have.
Rovner: And I might level out, as a result of I reside up the road from NIH, that the majority of what NIH does doesn’t occur on the NIH campus. It’s, as you stated, it’s cash that goes out to each single congressional district. There’s an unlimited quantity of backing.
I might additionally level out that, sure, NIH has gotten type of sprawling with, I feel there’s 27 institutes now. Each single a type of has been added by Congress. NIH can’t create its personal institutes. Solely Congress can do this. So, Congress has form of made NIH the sprawl that it’s. I feel there’s been bipartisan settlement that NIH possibly wants a brand new look.
I suppose the query is simply form of what route that’s going to take and whether or not a few of it will be punitive or whether or not they’re truly going to have a look at it in a matter of what would profit the nation, as a result of it will get some huge cash, and that’s additionally been bipartisan.
Kenen: Proper. What we’re not listening to but, or not less than — and possibly Anna, who covers pharma, can inform me if I’m incorrect — however we’re not — NIH additionally does the essential, fundamental, fundamental mobile first-step science that ultimately results in the work that drug corporations do to develop medication. They do the essential, what they name bench, science.
I’m not listening to the drug corporations converse out. The ambivalence Individuals have about drug corporations, which is hating the costs however liking the medication, I haven’t heard pharma — Perhaps it’s simply too early. Perhaps they’re weighing in quietly, and possibly Anna can inform me I’m incorrect and they’re and I simply didn’t discover. However that’s additionally an enormous constituency, an enormous, highly effective constituency. As a result of with out the NIH, we wouldn’t have lots of the medication that preserve us and our aged kin alive, together with plenty of the good points — we haven’t cured most cancers, however we’ve made good points on most cancers. That wouldn’t have occurred. It’s not simply the premier analysis institute in America. It’s the premier analysis institute on the planet, and as Julie stated, a giant driver economically of each single county, each medical college, each public well being, you recognize, it has been an financial powerhouse in addition to a data powerhouse.
Edney: And I wouldn’t inform you you’re incorrect. I feel that you just’re proper. I haven’t heard the pharma corporations speaking about it. I feel they’re speaking about plenty of issues that they need executed to profit them, and so I’m certain that they’ve made their priorities. We’ll see if this reaches form of a boiling level, the place they do find yourself weighing in. And I additionally simply wish to say, NIH, I do know they wish to concentrate on persistent illness. It does plenty of that. So possibly that’s not being communicated: It’s not being minimize or left off the desk as a result of we’re doing this. We will do two issues. We will stroll and chew gum.
Rovner: Sure, I do know, and that was the purpose I used to be making an attempt to make. It’s like, there’s an unlimited quantity of persistent illness analysis that occurs from the NIH, a lot of it dictated by Congress already. They spend plenty of time, particular person members, telling NIH what it’s they need to be finding out, which is a complete different subject that we’ll get to a different time.
However I wish to keep on the subject of drug costs, as a result of that’s a very huge query mark for the incoming administration. This week, the CEO of drugmaker Eli Lilly informed a Bloomberg reporter that it’s going to ask the Trump administration to, quote, “pause” the Medicare drug value negotiation program, which in fact is simply getting underway.
In fact, that’s taking place whilst Lilly encourages the incoming HHS [Department of Health and Human Services] to not cancel a Biden administration resolution to have Medicare start masking its costly new weight reduction medication.
In the meantime, on its approach out the door, the Biden administration’s Federal Commerce Fee dropped a report that discovered that the nation’s three largest PBMs, which collectively management about 80% of the U.S. prescription drug market, drove up drug costs by an estimated $7.3 billion from 2017 to 2022.
I noticed someplace this week, and I feel, Sandhya, you talked about this, a suggestion that Republicans may attempt to resurrect the PBM invoice that was dropped from that year-end 2024 spending invoice and put it within the subsequent spending invoice that Congress goes to should do in March. Probably? Potential? Will this report have any impression? Or is there simply an excessive amount of different information this week and no one’s going to recollect?
Raman: I feel it’s positively being talked about rather a lot. We talked to the management of Power and Commerce. It’s a precedence for each of them, each for Carter and for Guthrie, as a result of they labored so intently on it earlier than. It was included in a bipartisan deal that we had earlier than we received the CR [continuing resolution] that we voted into regulation. It simply received dropped alongside the way in which.
Rovner: When Elon Musk stated the invoice was too huge?
Raman: Yeah. So I feel we type of have two pathways, the place each of them wish to get it executed regardless. I feel that it would rely whether or not they’re able to piece it away and do it as one thing stand-alone, which they wish to get it executed sooner slightly than later.
But it surely relies upon slightly bit extra on the management stage, if there are financial savings from utilizing that invoice for use later down the road once they get reconciliation at a later stage. So I feel that’s what we’re ready on. Would they should put that there? Or would they be capable of go forth with that now?
Rovner: True. So, it’s a bipartisanly widespread provision that additionally saves cash, in order that makes it type of enticing to lawmakers who’re placing collectively issues which may, as Joanne would say, embody spinach.
Anna, what extra broadly do you see because the outlook on drug costs?
Edney: Nicely, I feel the very first thing I consider with that program is, it saves some huge cash for those who’re giving Medicare the power to barter. And so, I simply surprise how that matches into this agenda for those who cease it and make it extra favorable in direction of the drugmakers. The place does that slot in with slicing spending and lowering the deficit and all of these issues?
So, I feel that, possibly they’ve slightly little bit of an uphill battle in making their case on that entrance. All of this, for me, hinges on whether or not Trump actually means what he says. And I feel everyone knows that we simply have to attend and see what truly occurs.
Rovner: Yeah, plenty of shrug emojis coming.
Edney: Precisely.
Rovner: Nicely, in the meantime, throughout the road from Capitol Hill, the Supreme Courtroom has agreed to listen to that preventive well being care case out of, altogether now, Texas. The case challenges the necessities within the Reasonably priced Care Act that insurance coverage cowl, with out copay, preventive providers like immunizations, most cancers screenings, contraception, and, the topic of this explicit case, medicine to stop HIV.
What occurs if the courtroom guidelines with the plaintiffs on this case who argue that the CDC’s [Centers for Disease Control and Prevention’s] Preventive Well being Companies Job Power doesn’t have the authority to find out what providers must be on this checklist? Which in fact is the entity that now determines which providers must be on this checklist.
Edney: Nicely, it appears like, then, lots of people don’t get their preventive care coated. As KFF wrote, there may be some that might be nonetheless coated, the mammographies, however not the HIV preventative medicine. Different most cancers screenings included in that as nicely. And so, it appears to throw a wrench, I suppose, form of simply asking this of the panel, that businesses then must go make these determinations? Does Congress should make the determinations on what’s coated then?
Rovner: Nicely, that’s in fact the large query. Or, would the secretary, him or herself? Who is allowed? I feel the argument is as a result of the Preventive Well being Companies Job Power isn’t Senate-confirmed, they will’t make these choices.
And naturally, the way in which it really works, they don’t make these choices. They advocate them, after which the secretary form of ratifies them. So it’s exhausting to inform from this whether or not it actually would go away, or whether or not Congress must step in, or whether or not the secretary might simply do it. I really feel like this creates as many questions because it might solutions.
Kenen: It’s a very broad array of advantages that — it’s not simply the HIV PrEP preventive drugs. And I learn completely different tales about this, they usually had completely different lists, together with some ldl cholesterol stuff. And I don’t know, because the lists have been so completely different, I’m unsure precisely which of them are in or which of them have been out. But it surely’s not simply HIV medication. It’s plenty of stuff.
So it will actually intestine one thing that individuals rely on now. I imply these are free not slightly below an ACA plan however for those who get protection by means of a job, these necessities additionally apply. So, lots of people would now not have free entry to plenty of what we take into account preventive care.
Rovner: We’ll be watching this case. They haven’t scheduled oral arguments. They simply determined to take it. So, this might be a later in 2025 case. Nicely, the flip facet of an incoming administration are all of the issues the outgoing administration tries to slide by means of on its approach out of city, and this week has seen a bunch of these.
Most of these items may very well be pretty simply undone by incoming officers, however not with out some public ache, which typically is why administrations wait till the final minute to do them, to be slightly passive aggressive, or possibly in a few of these circumstances rather a lot passive aggressive. A number of of those last-minute modifications come from the Meals and Drug Administration, an company focused for giant modifications beneath Trump 2.0.
In simply the final 48 hours, the FDA has introduced a coverage that might require dramatic reductions in nicotine in cigarettes to render them, quote, “minimally addictive or nonaddictive.” It moved to ban Pink Dye No. 3, a controversial additive already banned in lots of different international locations which has been proven to trigger most cancers in rodents. And it proposed a serious change in meals labels to require them to indicate on the entrance of packaging whether or not the meals’s sodium, sugar, and saturated fats ranges are low, medium, or excessive. Do any of those proposals reside on for greater than one other week?
Edney: I feel the Pink No. 3 might. We all know that R.F.Okay. Jr.’s talked about meals dyes and eager to get them out of, he particularly stated, cereal, however they’re in plenty of issues. So, I see that one.
I feel the business noticed that coming from distant and has been switching already, in fact typically to a different problematic, doubtlessly, meals coloring. However I don’t assume that is one thing you’re going to see them struggle tremendous exhausting for to alter. The nicotine is far more iffy. Large Tobacco continues to be an enormous power, and Trump will get funding for his marketing campaign and issues from corporations who’ve a stake on this.
And a few of that might align with this concept of not essentially medical freedom however, form of, we will select what we put in our our bodies. If we wish to be hooked on nicotine, that’s our alternative. So, the opposite one, the labels, I’m unsure. They’re not notably highly effective or something. I believed they appeared … Once I checked out it, I used to be like, That is complicated and simply seems just like the again, however it’s a little completely different. So, I don’t know. Perhaps it survives. I’m unsure how a lot the business is engaged on this.
Rovner: [Sen.] Bernie Sanders of all individuals excoriated the meals labels, saying we don’t placed on cigarette packages whether or not the cancers they trigger are low, medium, or excessive. Why ought to we do that? I imply, that is principally one other effort to go after ultra-processed meals. I used to be stunned at how indignant he was at this.
Kenen: I feel he needs them in neon.
Rovner: I feel he needs R.F.Okay. Jr. to have fewer ultra-processed meals obtainable. I feel that’s going to be form of the large takeaway from all of this, I suppose.
Kenen: Proper. However we additionally don’t perceive what an ultra-processed meals is, as a result of there’s some meals that aren’t ultra-processed which can be unhealthy for you. And there’s some meals that do have some type of minimal processing that, I imply, we’ve come to lump this collectively and I couldn’t inform you. There’s some issues which can be, quote, “ultra-processed” that basically aren’t that processed, don’t have plenty of components. They’ve one thing.
So the entire categorization wants extra work, each for public understanding and political understanding. There’s no one who’s going to say that Individuals have a very nutritious diet and that meals components … R.F.Okay. Jr. has identified to the meals additive, the place the businesses should get to self-certify, Yeah, that is protected. So, is that one thing that he might get widespread assist on? Sure, however there’s a complete lot of different issues that he says that individuals weren’t going to agree with.
Rovner: And I’ll remind that we not solely don’t know if R.F.Okay. Jr. might be confirmed, however they nonetheless don’t also have a date for his affirmation listening to, as a result of they’re nonetheless ready on the paperwork. All proper, transferring on.
As we taped this morning, there are nonetheless a number of fires burning within the Larger Los Angeles space. We’ve talked in regards to the well being results of fireplace earlier than. It’s not precisely information that fireside and smoke are unhealthy for human well being, however what appears to make these fires completely different is that they’re not largely bushes and brush and different bits of nature which can be burning however a number of poisonous substances which can be polluting not simply the air but additionally the ingesting water.
Are we going to have to start out fascinated by hearth and well being in a a lot completely different approach if not simply distant areas however total suburbs at the moment are liable to burning up on account of our altering local weather?
Edney: It would make us consider plenty of issues in numerous methods, and notably well being care, when there’s issues like excessive benzene ranges floating within the air. We all know that a lot of our inside environments are made with issues that include excessive ranges of formaldehyde, issues like that.
I feel the expectation is that may create a long-term subject, but additionally it could possibly within the second create extra deaths simply on the time, not as a result of it straight kills but when you have already got a difficulty and you’ve got a respiratory drawback or a coronary heart drawback that may be exacerbated by these fires.
Yeah, I feel there’s a ton to consider. Even ingesting water might be impacted extra so when you might have energy outages and issues within the areas the place you’re possibly cleansing that water after which issues like that. So, I feel that’s going to be — masks, N95s could be coming again for a very completely different motive.
Rovner: Nicely, N95s are usually not sufficient. I imply, I feel that was the factor that type of jumped out at me. In the event you watch the information protection of it, the reporters aren’t carrying N95s anymore. They’re carrying what appeared like old-style fuel masks. I imply, you want form of the following stage of masking as a result of N95s don’t filter out a few of these poisonous substances that at the moment are floating within the air. I imply, they do filter out the kind of the particular smoke from wooden and whatnot, however it’s fairly scary.
I imply, much more individuals than ever earlier than have N95s hanging round their home, however they actually don’t have these next-level respirators, which is what I preserve listening to docs calling for.
Kenen: And the article you — I feel it was the one that you just despatched round yesterday that principally that all the things in our home is, our couches are principally cubes of plastic wrapped in fabric and harmful once they’re burned. However I imply, I feel that was the article that additionally stated that a few of these issues which can be burning produce like a cyanide type of fuel, that the firefighters can’t even be uncovered. They will’t stand in entrance of a home with a hose for a very long time.
It may very well be killing or injuring firefighters. So, it additionally hampers — they’re not simply making an attempt to place a hose on a burning tree.
Rovner: Yeah. Much more issues to consider, which is simply what we would have liked. Nicely, turning to abortion, keep in mind all these states final yr that voted to guard abortion rights? Evidently was removed from the ultimate phrase.
We’re seeing courtroom case after courtroom case to find out which abortion restrictions can keep and which might’t on account of passage of these poll measures. That is taking place notably in Missouri, the place Deliberate Parenthood clinics are nonetheless not providing the process after a decide invalidated some however not the entire state’s restrictions.
This appears to be the inevitable results of what we have now seen in different elections, the place the identical voters endorse abortion rights however then flip round and vote for candidates, together with judges, who don’t. Is the gridlock right here on function or by chance? And Sandhya, what’s going to occur?
Raman: I don’t know that it will be on function. I feel that these voters that vote for the candidates, if abortion isn’t their high subject, they’re nonetheless going to vote in the way in which that type of allies with them. However then in the event that they’re different insurance policies, they’re going to vote for these candidates.
And Missouri, I feel, is fascinating as a result of it has lengthy been, I feel, one of many take a look at circumstances for a lot within the abortion house, of making an attempt out new restrictions and what’s going to follow the wall. And I feel that we’re going to see extra of those type of lengthy, drawn-out battles, provided that the decide stated that some restrictions have been struck down due to the constitutional modification however then others, just like the licensing for abortion services, which we’ve seen for years, can keep. And that simply makes it in order that they will’t actually function.
Rovner: Yeah. They’ve issues like how broad the hallways must be, I imply, guidelines that have been created to discourage them from providing abortions, not as a result of they have been truly wanted for security and well being.
Raman: Yeah. These guidelines solely apply to the abortion services. They’re not parallel within the different forms of clinics and hospitals. So it’s focused to them. I feel it’s simply one other instance of it being type of an uphill battle for them, as a result of now, I imply, even prior to now few years we’ve seen a lot extra consideration on state supreme courtroom races, which I really feel like a couple of years in the past that was not one thing that might get nationwide consideration for one state or one other.
However, provided that, as they’re type of litigating these and seeing how can we implement the regulation in order that these clinics can open beneath the constitutional modification, it depends on them, and simply how a lot cash that’s being fueled to have the ability to not come down on the opposite facet in order that they will type of function. So I feel that’s one thing to positively watch, as a few of these states are type of litigating these items, however it’s going to be a protracted, drawn-out battle, even when it’s already been a number of months since seven out of 10 states final yr voted in favor of abortion rights.
Rovner: Yeah, this continues, and naturally, we’ll wait and see what occurs on the federal stage, when the Trump administration will get going. Nicely, lastly this week, we have now one other entry in our recurring section, “This Week in Medical Misinformation.” I wished to speak about a little-noted story from the medical information web site MedPage Immediately in regards to the American Board of Inner Drugs pulling the board certification of a Texas heart specialist who made controversial and unfaithful claims about covid and the covid vaccine, together with that vaccine had killed tens of hundreds of individuals.
What’s troublesome about this story, although, is that the ABIM wouldn’t touch upon particular person physicians, though it did checklist this explicit physician on his web site as not being licensed. How ought to specialty boards take care of docs who specific views which can be, let’s assume, not in step with medical proof? And the way clear ought to they be about telling sufferers once they sanction certainly one of their very own, which is principally what occurred right here?
Kenen: Nicely, they did put out a press release, I feel it was the New England Journal of Drugs a couple of yr and a half in the past, saying that they have been going to crack down on this. I’m unsure if there’s, for any of the boards, if there’s a mechanism for telling sufferers, as a result of how do you even know who all of the sufferers or potential sufferers are?
Rovner: However after I say telling sufferers, I imply telling the general public.
Kenen: Proper. However I don’t know that any of the boards do this in any — it’s a giant can of worms about decertification and the way sometimes it occurs.
So ABIM did put out a press release, I feel it was two years in the past now, and there’s been a course of for a couple of, however not rather a lot. And it doesn’t imply they don’t have a license anymore. It means they don’t have board certification. So except the state medical board, which is actually the group that pulls a license — that is saying that you just’re not a board-certified no matter your specialty is beneath ABIM.
However Lauren [Weber of The Washington Post], who is usually on the web site, had a superb piece a few months in the past about how few state boards have acted to sanction docs who say incorrect issues about vaccines. And that goes again approach earlier than covid. The medical occupation doesn’t do plenty of self-policing.
Rovner: Sure, and I’ve been doing this lengthy sufficient to have coated the creation of the Nationwide Practitioner Information Financial institution, when docs who’d had their licenses pulled might simply go to a different state, and there was no approach for that state to simply discover out that that physician had had his or her license revoked.
And that was often not for saying issues however for doing issues that ended up with having the physician decreed not certified to observe drugs anymore. So, I imply, this is a matter that goes again a protracted methods.
Kenen: And you’ll assume they might be the other. You’ll assume that the state boards, when any person can be a unhealthy man or a nasty gal, you’ll assume they might say, “We cease them!” Like, “We’re defending your well being.” And as an alternative, it’s been very secretive and really rare.
It’s extra the state licensing board. I imply, certification is vital, however actually the ability to de-license any person is within the state boards.
Rovner: Yeah, nicely, the entire argument that professions police their very own, what we’ve found is that professions don’t do an excellent job of policing their very own. However we’ll preserve watching. All proper, that’s the information for this week. Now, we’ll play my “Invoice of the Month” interview with Harris Meyer. Then we’ll come again and do our additional credit.
I’m happy to welcome to the podcast Harris Meyer, who reported and wrote the most recent KFF Well being Information “Invoice of the Month.” Harris, welcome to “What the Well being?”
Harris Meyer: Thanks very a lot, Julie. Glad to be right here with you.
Rovner: So, inform us about this month’s affected person — who he’s, the place he’s from, what sort of medical care he received.
Meyer: OK, Julie, it is a story about excessive costs, complicated payments, and lack of value transparency for a quite common process. The affected person is Tom Contos, a 45-year-old well being care guide who lives in Chicago. Final spring, Tom seen blood in his stool. He went to see his household doctor at Northwestern Drugs.
The physician referred him for a diagnostic colonoscopy due to the bleeding and due to his household historical past of significant colon points. Then in June, he went in for a colonoscopy at Northwestern Memorial Hospital, which is a giant educating hospital in downtown Chicago.
A Northwestern gastroenterologist carried out the process, which took lower than an hour. He discovered and eliminated two polyps, which a pathologist later discovered weren’t cancerous. The gastroenterologist concluded that Tom’s rectal bleeding was as a consequence of a big hemorrhoid.
Rovner: So, simply to be clear, it’s screening colonoscopies, these for individuals with no signs, which can be presupposed to be free as preventive care beneath the Reasonably priced Care Act. Diagnostic colonoscopies like this one can require a affected person to satisfy deductible and copay necessities, proper? That’s one thing vital for individuals to know?
Meyer: Sure. There’s plenty of confusion about this. I received plenty of feedback on my Washington Submit article that expressed confusion. Sure, diagnostic colonoscopies like Tom’s are executed when there are signs like bleeding or ache. In distinction, screening colonoscopies are really helpful beginning at age 45, even when there are not any signs, to stop colon most cancers or different critical situations.
The Reasonably priced Care Act requires well being insurers to cowl screening colonoscopies for gratis to sufferers. However for a diagnostic colonoscopy, sufferers might should pay a deductible and copayment, though that process equally can forestall colon most cancers. It doesn’t—
Rovner: It may be complicated.
Meyer: It’s complicated, yeah.
Rovner: So he has a process, which discovered some minor indications that have been taken care of, after which, as we are saying, the invoice got here. How a lot was it?
Meyer: Yeah, Northwestern’s whole cost was a mind-boggling $19,000. Tom’s insurer, Aetna, had a negotiated price with Northwestern of a nonetheless vital about $6,000. When he received his insurance coverage rationalization of profit assertion, he noticed that he owed about $4,100, with the insurer paying about $2,000.
He was bewildered as a result of he had requested Northwestern for an estimate of how a lot he would owe in whole and he was informed that he would owe about $2,400. My exterior billing knowledgeable stated $4,100 is sort of a excessive out-of-pocket invoice, although common for educating hospitals.
Rovner: And he was charged for 2 colonoscopies, proper?
Meyer: Sure. That was a serious motive that the invoice was so excessive. Northwestern billed him for 2 colonoscopies, which Tom didn’t perceive, since he had solely acquired one. It seems that suppliers routinely invoice for 2 procedures if the gastroenterologist removes and biopsies two polyps in two other ways throughout the identical process.
The second process is billed at a reduced price. Now, this appears unusual to laypeople, however that is how suppliers receives a commission for the additional work of eradicating two polyps slightly than one.
Rovner: Which, as you identified originally, it’s not like it is a several-hour surgical procedure. This can be a pretty fast process.
Meyer: That’s proper. It’s at most an hour, typically lower than that.
Rovner: So what occurred ultimately with the invoice?
Meyer: Nicely, Tom appealed the invoice to Northwestern and Aetna and was informed that it was appropriate. He had already paid about $2,400 of the almost $4,100 he owed, however he informed Northwestern that its invoice was, quote-unquote, “ridiculously excessive” and he wasn’t going to pay the remaining $1,700 or so and that they may take him to collections.
Northwestern stated that’s what they have been going to do, and Tom determined to now not use Northwestern or its docs sooner or later.
Rovner: Though I assume he did pay the quantity that they stated he owed.
Meyer: No, he stated: Take me to collections. I’m not paying it. My credit score is sweet, and — I gained’t repeat a few of the issues that he stated to them.
Rovner: Thanks. This can be a household podcast. How can others keep away from falling into this entice? I imply, he received an estimate. He had an thought of what he was going to be charged, and but he was nonetheless charged significantly greater than that estimate.
Meyer: Yeah, he’s a well being care guide, however lots of people get confused by this course of, together with him taken without warning. He solely appeared on the estimate after he had had the process however earlier than he received the ultimate invoice. So, like lots of people, he received confused and he didn’t proceed essentially as effectively as he might need. However that’s widespread and never stunning.
Rovner: Even for any person who’s principally within the well being care cost enterprise.
Meyer: Sure, that’s appropriate.
Rovner: So be vigilant. Is that principally the takeaway?
Meyer: Nicely, how are you going to keep away from falling in the identical entice? Sadly, not simply. Sufferers needing a diagnostic colonoscopy ought to try freestanding endoscopy facilities or ambulatory surgical procedure facilities that aren’t related to a hospital, as a result of they are often cheaper they usually can present good high quality of care.
To cost-shop forward of time, sufferers can have a look at the hospital’s value web site and their insurer’s price estimator web site to get a way of how a lot a diagnostic colonoscopy might price. In addition they can search for a so-called good religion estimate of the money value, that means the process may very well be cheaper in the event that they pay money, slightly than going by means of insurance coverage.
Plus, there are free web sites resembling Turquoise Well being and Honest Well being for checking costs for colonoscopies and different procedures. Now, as soon as they get a value estimate from the supplier, there’s yet one more wrinkle. Sufferers ought to ask whether or not that value contains the additional providers, if the gastroenterologist finds and has to take away and biopsy a number of polyps. At the least 40% of colonoscopies do discover polyps.
Now, consultants say it’s unlucky that getting a diagnostic colonoscopy might be so costly and complicated billing-wise, however don’t hesitate, as a result of it may be a lifesaving process for many individuals.
Rovner: All wonderful recommendation. Harris Meyer, thanks a lot.
Meyer: Thanks, Julie.
Rovner: OK, we’re again, and it’s time for our extra-credit section. That’s the place we every acknowledge the story we learn this week we predict it is best to learn, too. Don’t fear. In the event you miss it, we’ll put the hyperlinks in our present notes in your cellphone or different cellular system. Anna, why don’t you go first this week?
Edney: I wished to speak about one I wrote final month, and the headline is “It’s Not Simply Sunscreen. Poisonous Merchandise Line the Drugstore Aisles.” I type of wished to place in a single place speaking about plenty of these contamination points which have come up, however notably additionally simply present that, whereas the issues with merchandise continue to grow — certainly one of them that I identified that’s new on this piece is dandruff shampoo containing benzene — the FDA is getting form of slower on plenty of these items. They’re digging in, they usually’re not making an attempt to speak to the general public in regards to the points which have come up. They’ve had since final March of 2024 issues dropped at them about benzene and pimples merchandise.
They’ve stated nothing to the general public. They simply preserve saying, We’re it. And that’s very completely different from when this primary type of began taking place on a bigger scale, the place it was like, growth, recollects. Now it’s simply form of this struggle to possibly not have recollects. I don’t know what’s happening of their head.
However there are also some points in there with the tampons have been discovered to include plenty of heavy metals, FDA additionally slow-walking there. So I wished to level out that piece I wrote if anyone missed it.
Rovner: Sure. Thanks, Anna, on the “all the things you thought could be protected is definitely harmful” beat.
Edney: I’m the life of each get together.
Rovner: There you go. Joanne.
Kenen: I’m unsure if that is an additional credit score or a public service announcement, however there’s a nice piece in The Atlantic by Daniel Engber. Nicely, everyone knows there’s a ton of abdomen bugs and norovirus going round, and it’s fairly extreme this yr. And the headline is “A Secret Approach to Battle Off Abdomen Bugs,” and the reply is wash your fingers with cleaning soap.
But it surely’s a very well-written — it truly makes you chortle about abdomen bugs. It’s a really well-written, good story. And no, for this bug, hand sanitizers don’t work.
Rovner: Sandhya.
Raman: My additional credit score this week known as “New weight problems definition sidelines BMI to concentrate on well being,” and it’s by Giorgia Guglielmi for Nature. And it takes a have a look at — we had a revised definition of measuring and diagnosing weight problems within the Lancet Diabetes & Endocrinology this week.
So, as an alternative of BMI [body mass index], which is weight- and height-linked, they’re suggesting a few alternate options: preclinical weight problems, which is an individual with additional physique fats however their organs are nonetheless functioning usually, and scientific weight problems, so when you might have that extra physique fats that it’s harming your organs. And there’s extra within the piece on simply other ways clinicians are this globally.
Rovner: Yeah, it’s actually fascinating as a result of, clearly, each physician says that BMI is a silly and imprecise strategy to measure this, after which all people makes use of BMI as a result of, in the mean time, it’s all we have now. My additional credit score this week is a KFF Well being Information story from Felice Freyer. It’s known as “Can Medical Faculties Funnel Extra Docs into the Main Care Pipeline?” and it’s about an issue I’ve been following for some time and which doesn’t appear to be getting higher.
Whereas the U.S. has opened a number of new medical colleges over the previous decade and has launched a raft of applications aimed toward getting extra graduating docs to enter major care, approach too many are nonetheless pursuing specialty care as an alternative. We’ve tried, as a society, free tuition and mortgage reimbursement applications, however it doesn’t appear that medical training debt is the largest drawback.
We’ve additionally tried coaching docs in additional primary-care-centric areas, i.e. in neighborhood clinics slightly than in hospitals, however that’s not made an enormous dent, both. Moderately, to cite one of many household drugs consultants within the story: “It’s not the medical colleges which can be the issue; it’s the job. The job is simply too poisonous.”
In different phrases, it’s probably not interesting to see too many sufferers for too little time and do tons of preventing with insurance coverage corporations and digital medical data. Till we as a society begin making major care much more of a satisfying job, it’s not going to matter how a lot it pays. We’re nonetheless going to have a critical scarcity.
All proper, that’s this week’s present. As all the time, for those who benefit from the podcast, you’ll be able to subscribe wherever you get your podcasts. We’d admire it for those who left us a overview. That helps different individuals discover us, too. Particular thanks once more this week to our non permanent manufacturing crew, Taylor Prepare dinner and Lonnie Ro, in addition to our editor, Emmarie Huetteman.
As all the time, you’ll be able to e mail us your feedback or questions. We’re at [email protected], or you’ll be able to nonetheless discover me sometimes at X, @jrovner, and more and more at Bluesky, @julierovner.bsky.social. The place are you guys hanging out today? Anna?
Edney: On X, @annaedney, after which on Bluesky, @annaedney.bsky.social.
Rovner: Joanne.
Kenen: I’m on Bluesky, @joannekenen.bsky.social, very sometimes on X nonetheless, @JoanneKenen.
Rovner: Sandhya.
Raman: On X, @SandhyaWrites, and on Bluesky, @sandhyawrites.bsky.social.
Rovner: We might be again in your feed subsequent week. Till then, be wholesome.
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Audio producer
Lonnie Ro
Audio producer
Emmarie Huetteman
Editor
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