Health Policy Happenings, 9.10.21

Health Policy Happenings, 9.10.21

After taking last week off while out of town, we’re back again for another roundup of what’s going on in the health policy world! You can check out past HPH here.

Congress is currently considering proposals in the reconciliation bill to reign in the cost of prescription drug costs, including allowing Medicare to negotiate drug prices and a plan put forward by the Biden Administration. The $3.5T bill aims to significantly address health care and other social determinants of health.

This article was very helpful in outlining why drugs cost so much and the various stakeholders in the current conversation.

Continue reading “Health Policy Happenings, 9.10.21”

Health Policy Happenings, 8.27.21

Health Policy Happenings, 8.27.21

Every time I see an interesting article related to health policy or public health, I store it in a (now very long) note to remember to share it later. Pandemic notwithstanding, there is a lot going on in the policy world that we should be following. Let’s get to it.

In the U.S., our public health and health care delivery systems are separate, but in Costa Rica they merged starting in the 1970s with serious evidence of improvement in many health metrics. You don’t want to miss this piece by Atul Guwande.

There are more than 4 million direct care givers and nearly 42 million family members who provide informal support to someone 50 or older. How we support paid and family member caregivers for the challenging work they do is disgraceful.

New research quantifies how we spend differently in health care by race and ethnicity. It found that White individuals used more ambulatory care and pharmaceuticals while Black individuals used more inpatient and emergency department services, indicating the possibility of delayed health care-seeking, potentially due to lack of access

Medicare enrollment continues to rise as our population ages, as does Medicare spending. Medicare Advantage programs were created with the intent to lower the cost of providing Medicare services, but that isn’t the reality on the ground – spending for MA enrollees was actually $321 higher than spending for enrollees in traditional Medicare in 2019.

More consumers have been shopping at dollar stores during the pandemic in an attempt to make a limited income meet all their needs. This trend has further highlighted the growing problem of neighborhoods lacking affordable or accessible grocery stores, often called “food deserts,” although that is somewhat of a misnomer.

Tori Cooper, the director of community engagement for the transgender justice initiative at the Human Rights Campaign, is the first Black transgender woman selected to serve on the Presidential Advisory Council on HIV/AIDS.

I knew that the cost of services varied wildly between hospitals but I had no idea how much your insurance plan could impact what a service costs within the same hospital. We really need hospitals to comply with price transparency regulations and then we need to find a way to make it accessible and useful for consumers.

There are serious health impacts from heat, which are often felt disproportionately by Black and Hispanic communities as a result of decades of disinvestment.

Medicare bears some blame for why drug prices keep increasing, especially in the case of the new Alzheimer’s drug Aduhelm which is priced at $56,000 annually.

Estimates have shown that the cost of COVID-19 hospitalizations among the unvaccinated in June and July 2021 (the majority of which would have been preventable hospitalizations with vaccination) was over $2 billion.

There has been an infusion of funds over the course of the pandemic to help health care providers offset the financial impact of delayed and cancelled care. This brief lays out where the money came from and where it went.

The House has taken a significant step in two funding bills to remove restrictions that limit access to abortion care. This is the result of decades of advocacy from members of Congress and advocates, but it faces a less than welcoming future in the Senate.

Health insurers alone cannot fix health disparities but they do have a role to play.

Even though there have been job losses during the pandemic, leading to loss of employer sponsored health insurance, there has not been an overall increase in the number of uninsured due to improved access to public coverage options like Medicaid and Marketplace plans.

Yet another consequence of underinvestment in public health – states have heavily relied on consultants during the pandemic with little evidence of their performance.

Some say FDA approval of the Pfizer vaccine was too slow, other say too fast. But what if it was just right?

In the 1990s, Oregon expanded access to health care for the working poor through managed care and focused on primary and preventive care to keep costs low. While this approach minimized expensive hospitalizations, it did not prepare the state to handle an influx of patients during a crisis that requires intensive, inpatient care.

The lack of centralized oversight of VA nursing homes contributed to devastating outcomes from COVID-19 among residents.

See you next Friday for more happenings!

Why you should care about public health

Why you should care about public health

Sometimes we don’t value what we can’t see. It’s why I have to remind patients to keep taking their blood pressure medication even through they “don’t feel a difference.” Trust me, you will if you don’t keep it under control. Public health is much like continuing to take your medication; the work it does is often unseen because it prevents bad outcomes and therefore, doesn’t get the value or appreciation it deserves.

While many Americans likely believe that we are the healthiest nation in the world, we actually have the lowest life expectancy at birth among comparable countries – 78.6 years vs. 82.3 years. And compared to other high-income countries, we trail in nearly all health metrics. Nearly 50% of Americans have a preventable, chronic medical condition yet we only 3% of our health care spending is on prevention and public health programs.

What is the mission of our public health system? The Institute of Medicine articulated it as the, “fulfillment of society’s interests in assuring the conditions in which people can be healthy.” This is a broad, sweeping statement but one that we should have be a strong interest in achieving – and that can only happen when we have both an understanding of what public health is (and isn’t) and adequately fund that work. Because we know that access to health care services isn’t enough.

What is public health?
Continue reading “Why you should care about public health”

Books I’ve Loved Lately

Books I’ve Loved Lately

I have always loved to read. One of my biggest regrets in life is losing a summer book reading contest in elementary school. I lost by one book to the librarian’s daughter (which, come on, not fair!). All jokes aside, I really do love to read and got back into my voracious habit during the quarantine months thanks to Becca and Grace of Bad on Paper podcast. I’ve got stacks of books all over the apartment that I’m working my way through. I’ve been updating my Goodreads (feel free to follow me!) but thought I would share some of my book highlights of the past few months. It’s been a lot of rom coms, royal-themed reads, and breezy books that don’t require too much thought but definitely leave you feeling attached.

Continue reading “Books I’ve Loved Lately”

The Friday Five 11.27.20

The Friday Five 11.27.20

I hope you had a safe and fulfilling Thanksgiving yesterday! I stayed in my bubble to enjoy some delicious food, watch the Thanksgiving Day Parade (my favorite part is always the Broadway performances!), and relax with my latest read. Instead of a traditional Thanksgiving meal (which I hope we can all agree is not traditional based on the realities of 1620…), I created a menu of Asian-inspired dishes from the Dining In and Six Seasons cookbooks. Throw in some good wine and conversation, and it was the recharge I needed after spending my days on my psychiatry rotation. Here are some things that caught my eye this week!

Continue reading “The Friday Five 11.27.20”

Two Interviews On My Journey to Medicine

Two Interviews On My Journey to Medicine

I had such a fun time talking about my journey to medicine with Jenn on the “How Did You End Up There?” podcast the other week! It’s definitely not typical to start out in politics and end up a (almost) physician, but I can’t imagine any other path. I learned many valuable lessons along the way and had the opportunity to delve into interests that I might not have as a pre-med at 18 or as a medical student in my early 20s. We sacrifice a lot to find the time to learn all we can to save and improve lives. You can listen to the episode here – be sure to check out all of the other episodes too! It’s so interesting to get glimpses into other winding career paths.

I was also interviewed by my medical school magazine about my interest in public health and advocacy as a medical student and future physician. As I mention in the article, it is so important for medical students (and all health professionals) to see beyond the four walls of the clinic. Our patients exist in vibrant communities and we have a responsibility to understand how their social interactions and environments impact their health. It’s the main reason I started this blog – to educate and empower the next generation of physicians to do the most good for their patients.

You can read more about my career change here!

What is Public Health?

What is Public Health?

Let’s start out by dispelling the misconception that physicians are trained in public health and therefore should be consulted as experts during public health crises. For the most part, this is NOT TRUE. Physicians are trained to provide medical care – to diagnose, treat, and manage individual health problems. While some medical schools do teach epidemiology (the science of public health), it is not enough to head out into the world as a public health professional. If you’re a physician with a Master of Public Health (like I will be!), then you certainly have more credibility to speak on matters of public health as a physician. And the reverse is true as well – experts in public health who did not go to medical school are not doctors! The medical and public health professions need to work together beyond times of crisis and both need to be consulted by policy makers. Doctors alone should not be asked how to contain a pandemic – simply put, we are not trained to give that advice.

So, let’s get into it. What exactly is public health?

Continue reading “What is Public Health?”

The Friday Five 11.20.20

The Friday Five 11.20.20

Happy Friday! We made it to the end of another week! I spent a few days finishing up child psychiatry and then started adult psychiatry. There is so much to learn to best help these patients manage their mental illnesses and I am doing my best to stay on top of the studying. And of course, it’s almost Thanksgiving! I know there is a lot of extra stress and anxiety around how to see family safely or if to see them at all. I listened to this podcast episode with Dr. Fauci and it gave me a lot to think about in terms of how we continue to protect ourselves and our loved ones. And here are a few (well, five) other things I enjoyed this week!

Continue reading “The Friday Five 11.20.20”

We’ve Got to Stop Meeting Like This

We’ve Got to Stop Meeting Like This

And by this, I mean every six months.

But then again, we’ve never lived through a global pandemic for months on end while trying to still live our lives, so I hope you’ll forgive me.

Since I was last here, a lot has happened. I moved back to Miami to start my third year of medical school and after months sitting at home studying for Step 1 (so long, farewell forever!), I was finally able to be in the hospital seeing patients! I started with 10 weeks of internal medicine and hopped between two general inpatient rotations, outpatient primary care, hepatology (liver) clinic, and the cardiology inpatient service. I learned the bread and butter of medicine during those 10 weeks — heart failure, hypertension, hyperlipidemia, infectious disease, liver failure…you name it, I probably saw at least one patient with it. The shift from learning for a multiple choice test to applying it to real patients was a struggle. One minute you have to pick the correct anti-hypertensive for your fake vignette patient, the next it’s a real patient with financial concerns, comorbidities, and a history of medication side effects. All in all, I am happy I started my year off with internal medicine. It offered such a breadth of experiences caring for patients admitted to the hospital, patients needing clinic follow-up for chronic conditions, or specialty care. It set me up perfectly for my next rotation, family medicine.

Continue reading “We’ve Got to Stop Meeting Like This”