• The Supreme Court, the ACA, and COVID-19 Walk into a Bar

    As countless news stories have now described, Justice Ginsburg’s death and her likely replacement by Judge Amy Coney Barrett have raised the odds that the Supreme Court will hold invalid all or part of the Affordable Care Act. In the New York Times last week, Andy Slavitt and I discussed what that should mean for the coming election:

    Republicans don’t want to talk about health care in this election. The topic typically ranks as the single most important issue for voters, who view Democrats more favorably on it. Indeed, Republican losses in the 2018 midterms were widely attributed to the party’s stance on health reform.

    But President Trump’s support for a dangerous Supreme Court case offers a simple, clear way to explain to voters that Republicans are lying when they say they support protections for people with pre-existing conditions. The explanation will land with particular force in a country suffering from a botched response to the coronavirus pandemic.

    Keeping health care in the news will also focus attention on all the other ways that the Trump administration has worked to make Americans feel less secure: imposing onerous paperwork requirements on Medicaid beneficiaries; crippling the health care exchanges; and sowing discord in the insurance markets. The percentage of Americans without health insurance has ticked up every year since President Trump took office.

    The details are complicated. But the Supreme Court case is mercifully easy to grasp. The lawsuit poses an existential threat to the nation’s health care system, and President Trump should be judged for recklessly supporting it.

    If you’re playing the odds, the case is still probably a loser. The Chief Justice has twice rejected much stronger challenges to the law and Justice Kavanaugh may supply the fifth vote to turn the case away. Kavanaugh is a standing hawk and the plaintiffs, as I’ve argued, don’t have standing. He has written recently of the importance of salvaging as much of a congressional statute as possible, even when it contains a constitutional flaw. And when the first Obamacare case came before him when he sat on the D.C. Circuit, then-Judge Kavanaugh stayed his hand and voted to dismiss the case on jurisdictional grounds.

    But no justice’s vote is assured, and the ACA’s supporters are right to be nervous about the possibility of a calamitous outcome. In particular, Andy and I flagged a suggestion that Richard Primus and I made nearly two years ago: that Congress could pass a one-sentence law that would make the case evaporate. As Andy and I explained, “Democrats could put all of this nonsense to an end — but only if they win big in the election.”

    I also had the chance to go on Andy’s podcast, In the Bubble, to discuss the whole mess. (I stole the headline for this blog from the show’s producer.) I’m probably Andy’s least illustrious guest—he’s interviewed Governor Gretchen Whitmer, Andrew Yang, two former FDA administrators, and the science writer extraordinaire Ed Yong—but I tried to keep up. As I told to Andy, adding Judge Barrett to the Supreme Court means there’s a bigger margin for crazy. “If you had Judge Barrett on the court” back in 2012, I told him, “the ACA would be gone already.”

    I also spent last Thursday grousing on twitter about President Trump’s latest stunt of trying to use an executive order to claim that he’s protecting people with preexisting conditions. No, I explained, “calling something an executive order does not make it law.”  Instead, issuing the executive reflects a presidential effort to confuse the American public about the extraordinarily high stakes of the coming election.

    @nicholas_bagley

     
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  • How other countries balance drug prices and innovation (part 1)

    The idea that patients in the US shouldn’t pay more for prescription drugs than patients in comparable countries around the world has broad-based political appeal. That’s why lawmakers on both sides of the aisle have proposed legislation to base what Medicare pays for drugs on prices in other countries with comparable GDPs and make it easier to import drugs from Canada. But before we put US drug pricing levels at least partly in the hands of non-US policymakers, it’s worth taking a look at how other countries approach drug pricing and how much emphasis their policymakers place on the competing priorities of patient access to drugs (which is facilitated by lower prices) and drug innovation (which is facilitated by higher prices).

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  • COVID-19 Pandemic Leads to Decrease in Emergency Department Wait Times

    For years, public health and medical professions have been worried about the impacts of long emergency department (ED) wait times. Emergency departments are routinely crowded, and the long wait before receiving care can have serious consequences on patient outcomes. As areas became impacted by COVID-19, ED visits plummeted, creating a new problem: patients forgoing emergency […]

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  • Covid-19 and Long-term Recovery

    Most of the world has been working on the assumption that when a person recovers from Covid-19, everything just goes back to normal. As the pandemic progresses though, we’re learning about some patients who experience long-term complications from the disease.   @DrTiff_PhD

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  • Why can’t we have nice(r) things? Google Nest Protect edition.

    I’ve had Google Nest Protect smoke/CO detectors for about 10 months now. Here’s an update to my prior post about them and how they could be better. When the story left off, I had noticed some annoyances upon initial installation and routine troubleshooting. What I didn’t write about is that after a few more weeks […]

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  • COVID-19 and Convalescent Plasma

    The FDA recently issued an emergency use authorization for convalescent plasma to treat Covid-19. The idea is that plasma from a donor who has recovered from Covid-19 has antibodies that can help treat patients who are now in the early stages of infection. Does this work? Are there any downsides to this emergency approval? Let’s […]

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  • Radiation therapy for cancer: Two weeks left

    To remind you: I am undergoing radiation treatment for an oropharyngeal squamous cell carcinoma. I have now completed 26 radiation sessions, and there are just 9 more to go. Treatment will end on Friday, September 18th. I am going to get through this, but it is not enjoyable. Here are some notes on what it […]

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  • The Disasters That Built the FDA and Where We Go From Here

    Transparency, integrity, and rigorous evaluation of drug safety and efficacy are the bedrock of the FDA. Diverging from these tried-and-true principles, such as by issuing an emergency use authorization for a Covid-19 vaccine candidate without clear emerging evidence of its benefits outweighing its risks, would jeopardize both the public health and the public’s trust in the agency. 

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  • Rethinking Testing for Covid-19

    PCR tests for Covid-19 are pretty accurate, but supplies can be scarce and results sometimes aren’t available in time to be useful. Faster tests are available, but are less accurate, so some have argued against their use. We disagree because, in a pandemic, frequency and speed of testing matter more than pinpoint accuracy. As we […]

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  • Childcare During a Pandemic

    Zoe Bouchelle, MD, is a Pediatrics Chief Resident at the Children’s Hospital of Philadelphia. Irit Rasooly, MD, MSCE, is pediatric hospital medicine physician and researcher in the Departments of Pediatrics and Biomedical & Health Informatics at the Children’s Hospital of Philadelphia and a fellow of Society to Improve Diagnosis in Medicine in Diagnostic Excellence. Tara Bamat, […]

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