"Treatable Mortality" -- i.e. deaths potentially preventable via medical care -- is much higher in the US than 4 "peer" nations. Moreover, we've stopped making progress in the past 10 years, widening the divide.
Meanwhile, blood pressure control — a big way modern medicine saves lives — has been deteriorating over this same period for the general US population.
Similarly, among adults with diabetes, both glycemic control and blood pressure control are worsening.
Meanwhile, while a feared and predicted 2020 surge in uninsurance did not come to fruition (for a number of reasons, including aggressive policy), the number of insured has gradually risen since 2016 according to three benchmark federal surveys:
Uninsurance and underinsurance among children rose from 2016-2019:
To be clear, I'm emphasizing the worsening trends in blood pressure and glycemic control as a failure of the healthcare system — we're doing something wrong.
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We have an article just up in @thenation on Medicare "Dis-Advantage": on the waste and inequities that Medicare Advantage imposes on our healthcare system.
With @swoolhandler & David Himmelstein.
A Brief 🧵.
There is not too much controversy at this point that Medicare Advantage bilks taxpayers.
MedPAC, Congress' nonpartisan Medicare advisory board, in March estimated some $83 billion in overpayments.
A New York Times 2022 expose shed some light on insurers' dodgy maneuvers.
But here's the thing: if it were simply a matter of overpayments, we could give insurers a haircut in payments and just move on.
As we argue , however, the problems with Medicare Advantage are far more fundamental — they undermine Medicare's very foundations.
Maybe we need more trials, but this must not be waved away & deserves attention: intensive blood pressure lowering reduces major vascular events per new RCT in the @TheLancet, & also all-cause mortality (as a secondary outcome).
I understand caution or even skepticism about such findings, but we need to take a step back & look at the big picture: for decades, RCTs again & again show major benefits of medical blood pressure reduction. SPRINT & now ESPRIT show benefits of more intense lowering.
2/6
I understand methodological critiques - but at the very least burden of proof has now shifted to those who favor less intensive lowering, not the other way around.
I also want to make a point also about our orientation towards blood pressure treatment culturally/socially.
3/6
Pfizer's EPIC-SR study is (finally) published (what took this so long?).
1: Primary finding: No benefit from Paxlovid on symptom alleviation among vaccinated or unvaccinated people.
2: Not a significant difference, but 0.8% of those who got paxlovid and 1.6% of those who got placebo had a COVID-19 hospitalization or death from any cause. Underpowered for this outcome & not really high-risk group (e.g. a single death from any cause among 1,288 participants).
Given this, should not extrapolate to truly high-risk patients, e.g. an octogenarian with severe emphysema.
UK-based PANORAMIC study, which enrolled almost 30,000 people may have something more to say about effects for truly high-risk people. But no idea when.
First, to be clear, there is zero question that social goods like housing are critically important for health, usually more than medical care — it is an urgent social and political prerogative to realize them.
That's not what's up for question to my mind.
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What's up for question is instead three-fold: (1) the role of medical institutions in providing access to these goods; (2) whether Medicaid should be the funding source; (3) the likelihood that there will be "returns on investment" in form of reduced medical spending.
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As a general principle, if the reproductive number largely determines the share of a population that will be infected before a respiratory viral wave ends, then only those behavioral/interventional changes that permanently change the reproductive number will reduce ...
the share of the population infected in a wave.
So the term "wave" can be misleading in this context because it suggests that waves eventually "pass through" a population with time: instead, they (typically) end because of the rise in population immunity.
In this context, reducing social contacts / reproductive number would be expected to only reduce the number of infections if such changes are permanent. For those seriously interested in altering respiratory viral epidemiology this reality needs to be honestly acknowledged,
We modeled health outcomes from three 2022 Supreme Court Decisions with major ramifications for health, finding that they could lead to nearly 3,000 deaths over a decade and many other adverse health outcomes.
> NFIB v. OSHA, which voided COVID-19 workplace protections
> NYS Rifle and Pistol Association v. Bruen, which invalidated state laws restricing hand-gun carry
> Dobbs v. Jackson Women's Health Organization, which overturned Roe v. Wade
Our research group brought to together experts on firearm injuries, abortion policy, and COVID-19 from multiple institutions, including David Himmelstein, Samuel Dickman, Caitlin Myers, David Hemenway, Danny McCormack, and @swoolhandler.