The main article in this issue, on national health spending projections, I have already covered in two posts. I don’t bother with the DEI drivel that the publication insists on printing in every issue. What else did we learn. That the highest earning Americans have the highest health spending and spending growth in recent years; as they do in every spending category for any good and service. The authors note that this is based on self-reported survey data, including on income level. It is interesting because generally higher income is correlated with more education and better health. But the fact is that wealthier people choose to spend more on health, as shown by the differences being largely in outpatient care and prescription drugs. Whether they achieve better outcomes is not well studied.
Changes to Medicare’s prescription drug benefit and the level of reinsurance from the federal government led to fewer plans offering those benefits and higher premiums. Supposedly non-profit hospitals are making huge amounts of profit, which they are putting into investments in the stock and bond markets, instead of lowering prices and giving free care to lower-income people. Supposedly people in Medicare Advantage plans with high levels of prior authorization requirements are more likely to disenroll or switch plans, but I wonder if the prior authorization requirements are really at fault or if these plans simply have higher levels of out-of-network services that require prior authorization.
Black patients were less likely than white patients to be diagnosed with the fake long CV-19, which supposedly is a bad thing. To me just shows they are less likely to be malingering. Newly-aged Americans are beginning to require more care than the groups before them as they became elderly. States vary in their levels of palliative care and hospice locations and workers, but unexplored in the study is the role of fraud. California has lots of hospices, apparently all fraudulent. We train a lot of foreign physicians, and I wonder how many actually end up working in the US. Not clear to me why given concerns about the adequacy of physician supply we would be training foreign physicians who aren’t going to work here. Another study looks at patterns of clinician supply, finding a likely large increase in nurse practitioners and relatively steady physician supply.
