I similarly found this confusing.

From US perspective, the evidence to date makes it pretty clear the benefits of boosters now outweigh costs.

The parameter I don't have a good sense of is to what degree a trade-off exists in practice bet boosters & doses to other countries.
Given the "why not both" option if the US were willing to pay high prices for doses then donated to other countries & US-first focus of US policy, I'm skeptical the practical effect on doses donated to other countries is large.

But curious how others think about this ...
The other key parameter here is that we're almost certainly going to need boosters at some point in the not-too-distant future, thus further minimizing any potential trade-off.
Certainly on a personal decision level in the US, the case seems pretty clear that especially people over 65 or at higher risk should go ahead and get boosters now if you can (even more so if you got J&J originally).
Correcting my "US perspective" framing above if there is a substantial trade-off bet booster shots in the US & doses sent abroad since (as @SarahKarlin rightly corrected me) we care about stopping future variants.

Question about the size/existence of such a trade-off remains.
Now certainly I think this all makes a good case for the US spending large sums of money buying doses to donate to other countries, both for the US benefit but even more for the lives saved abroad.

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More from @LorenAdler

14 Sep

Even if political constraints keep drug savings to $150-$200B over 10 yrs, Dems have other big-ticket offsets available:

~$150B from site-neutral Medicare payments

~$200B from reducing MA overpayments

~$80B from reducing PAC overpayments

+ ~$150B from rebate rule

The Trump Administration (following MedPAC recs) laid out a path forward to pay the same price for physician services that can be performed safely in the office setting even if they take place in a hospital outpatient department or hospital-owned physician’s office.

CBO estimate here: cbo.gov/system/files/2…

More detail on why more site-neutral payment in Medicare is good policy even irrespective of the need for offsets:

Read 8 tweets
5 Jan
New paper in @Health_Affairs looking at arbitration over surprise bills in NJ, w/ @BenChartock, Bich Ly, @ErinLDuffy1, & Erin Trish.

It's not good.

Arbitration awards appear to be based on charges, averaging *5.7 times* prevailing in-network prices.

Moreover, arbitration awards >25x median in-network prices were not uncommon.

New Jersey, similar to New York, illustrates the danger of basing an arbitration system on unilaterally-set provider charges.

Such an approach is destined to unnecessarily increase health costs.
However, it's important to disentangle the benchmark from the mechanism. Arbitration in it of itself is not necessarily the problem in New Jersey (or NY). The problem is basing decisions on the 80th %-tile of provider charges, an extremely high amount untethered by mrkt forces.
Read 6 tweets
21 Dec 20

Today’s surprise billing fix is a huge win for consumers!

As of 1/1/2022, it will be illegal nationwide for an out-of-network provider to surprise bill a patient for more than their standard in-network cost-sharing obligations.

THREAD based on the final language

The protections from surprise billing will apply in all emergency situations (w/ lone exception of ground ambulance rides) & for non-emergency out-of-network physician services received at in-network facilities.

Helpful rundown of the protections: healthaffairs.org/do/10.1377/hbl…

These are arguably broader than the protections in any state law and will be difficult to game.

Patients can now feel safe they won't get a surprise bill from the emergency room or from an anesthesiologist or assistant surgeon involved in their elective surgery.
Read 17 tweets
16 Dec 20
27 Senators sign a bipartisan letter supporting inclusion of the recently-announced surprise billing agreement in the year-end spending legislation: cassidy.senate.gov/imo/media/doc/…
Unfortunately, the AMA is opposing the bipartisan surprise billing legislation.

Interestingly, they previously seemed to support the Neal/Brady bill (left), and the new bill is identical other than a couple concessions to provider lobbying.

The way this is written, you’d think AMA and other provider groups weren’t the ones pushing arbitration (and the administrative headache that goes along with it) this whole time.
Read 4 tweets
12 Dec 20

Today's bipartisan, bicameral surprise billing legislation isn't perfect, but it's a clear improvement over the status quo

Leg text: energycommerce.house.gov/sites/democrat…

Section-by-section: energycommerce.house.gov/sites/democrat…
Surprise billing would be prohibited for all OON emergency services (& post-stabilization), much OON care at in-network facilities, & air ambulances.

Out-of-network payment can be challenged to an arbitration process that's instructed to mainly consider median in-network rates.
Arbitration can be a bit clunky & opaque (& adds administrative cases), but the legislation does a pretty good job placing guardrails on the process to prevent abuses.

1) There's a strong anchor to median contracted rates

2) It prohibits consideration of billed charges

Read 16 tweets
11 Dec 20
While the debate has largely broken down as benchmark vs. arbitration, much more important is how generous the out-of-network payment mandate ends up being.

E.g., arbitration based on Medicare rates would be more consumer-friendly than a benchmark based on charges.
Or to take concrete state examples, CT's surprise billing law that uses an OON benchmark payment mandate at the 80th percentile of charges for emergency services is just as bad for consumers as NY's that relies on arbitration to get to the same end state.

Or in a more consumer-friendly fashion, NH's law that strongly anchors their arbitration process to median in-network rates ends up pretty similar to CA or OR laws that get to a similar place through a benchmark.
Read 10 tweets

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