Life expectancy figures are out for 2023.

As expected, they show further rebound.

Life expectancy now approaching (but still below) pre-pandemic level

78.4 in 2023
77.5 in 2022
78.8 in 2019

A few observations. (1) This is exactly as expected because, fortunately, cases of severe COVID fell sharply after 2022 — very evident from death certificate data (and certainly observable for those of us in the ICU).

This doesn't mean all is well with US health however — far from it

There's growing convergence of opinion that "moral hazard"-based healthcare policies (i.e. skin-in-the game copays & deductibles) are harmful or at least unnecessary, including from some of the nation's leading health economists.

This is good, but also begs a question: Why did it take so long? Many nations built healthcare systems premised on providing care free (or nearly so) at point of use generations ago. Ted Kennedy's first single-payer bill from early 1970s eschewed cost-sharing, as did PNHP's single-payer proposal dating from late 1980s

In wake of last week's dustup over Anthem's pullback from its proposed anesthesia policy, I have a piece today at @MSNBC that responds to articles by @EricLevitz & @Noahpinion, & comments by @mattyglesias & @dylanmatt, & the question: who is to blame for our healthcare mess? The above have argued that private insurance is not the real problem — the problem is those who provide healthcare. They contend the primary savings from Medicare for All-type system is not via reduced insurer waste, but lower hospital funding & clinician reimbursement.

It is true that there is a shortage of doctors in the US — primary care doctors. We have far fewer that of other wealthy nations as seen below.

However, we have similar to higher numbers of specialists — much more than France or Canada but fewer than outlier Germany.

https://twitter.com/ArmandDoma/status/1864744992063000643

This often goes unstated, I believe, because it undercuts the idea that "supply side" solutions would bring US healthcare costs in line with other nations, which is not true. We do need a PCP:specialist physician rebalancing. But the interesting thing is that increasing supply...

This is incorrect -- the Congressional Budget Office's Medicare for All cost study projected **$400 billion** in savings annually from reduced insurance overhead.

It projected total provider payments falling by much less, or going up by much more, depending on assumptions.

https://twitter.com/mattyglesias/status/1864746856955154508

And that doesn't account for provider-side administrative savings: Canadian hospitals spend half what US hospitals do on administrative **as a share of total revenue**

acpjournals.org/doi/10.7326/M1…

Here is the thing about RFK Jr.

Even if you ignore his crank beliefs about WiFi & vaccines & ivermectin etc etc (not that you should), he’s also not going to do anything useful about “chronic diseases”.

Take the environment, which RFK Jr. purports to care about … … and which can drive morbidity from chronic disease (e.g. air pollution > asthma).

Well, last time around Trump shredded a 100 environmental regulations, and worsened air quality. He’s going to do the same thing again.

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.

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).

Brief thread.

1/6

thelancet.com/journals/lance… 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

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).

Great reporting by @rmc031 on how some states are using Medicaid funds to help cover housing costs for some, i.e. "a prescription for housing."

I have some thoughts on the issue —  concerns, from a Left perspective.

1/X

vox.com/2024/2/13/2406… 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.

2/X

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.

Our new study just up in @JAMANetworkOpen :

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.

jamanetwork.com/journals/jaman… We examined:

> 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

People made giant sacrifices during the pandemic to reduce viral spread, including many who did it not for themselves but for others — like barely seeing family and friends for months or even years on end.

Life is short: this was sacrifice, for a good end. People who say: "we never really had lockdowns in the US" are discounting the massive personal sacrifices that people made, and that bothers me.

Sacrifice isn't something bad: rather, it is something painful but worthwhile.

During the heated debate over the approach to COVID-19 vaccine prioritization, some worried that age-based prioritization would be inequitable — and consequently embraced an approach that prioritized essential workers. I sympathized with that view, but worried that it ... ... would save less lives, and so argued for an age-based scheme along with other measures, e.g. targeted outreach programs to improve delivery to disadvantaged communities, along with bolstered UI, M4A, etc.

usatoday.com/story/opinion/…

You can say masks should be used even if RCT evidence is lacking for plethora of reasons (observational data, basic science, minimal risk, global pandemic, can’t wait, etc.) without undermining case for RCTs more broadly. This article draws a bright line… scientificamerican.com/article/masks-… … between medicine and “engineering,” with the claim that RCTs are fundamentally the *wrong* tool to study interventions in the latter category. But that could presumably be used to justify use of all sorts of medical devices in people without RCT data. And notion that …

The implication of the "mystery", which will be immediately understood by his followers, is that a giant worldwide surge in strokes is due to COVID-19.

But if you trace back the links you get statistics referring to 1990 - 2019, or a NEJM paper published in 2018.

1/3

https://twitter.com/TRyanGregory/status/1654840715850002432

It shouldn't need to be said: severe COVID, manifested as overwhelming pneumonia, is as ghastly as described, the cause of horrifying surges in deaths and a once-in-a-century pandemic.

2/3

We have a new study out in @AMJPublicHealth examining risk of COVID-19 in 2020-21 in the US by workers' occupation and industry.

A quick thread ...

ajph.aphapublications.org/toc/ajph/0/0 Many studies have identified workplaces as important site of COVID spread. And national data show disparities in death by occupation — although death risk can also reflect differences in health status, & death-certificate data may not account for many confounding factors.

This study has been years underway — I'm happy to see it published today in the Milbank Quarterly.

"Century-Long Trends in the Financing and Ownership of American Healthcare."

A short thread. Using numerous historical & current data sources, we examined public vs. private financing AND ownership of US healthcare over the past 100 years.

First, financing. It's well known that an increasing share of health spending is taxpayer-financed, e.g. Medicaid & Medicare.

There is not some magic about a "social insurance model" that provides more resources than a national health service model. If resources are lacking than more resources need to be invested.

ft.com/content/b03dda… Fundamentally the reason why cost control happens in most nations with national health insurance OR national health service systems is the same: single-source public financing (a point made by Robert Evans some years ago), which effectively creates the political *means* &

A couple of thoughts on the new BMJ post-COVID complication study. I remain rather hesitant about electronic health record data analyses — specifically use of diagnostic codes — for the assessment of symptoms; they certainly say little if ...

bmj.com/content/380/bm…

1/4 ... anything about the mechanisms of symptoms. That said, a strength of this analysis vs. VA EHR studies is the use of a test-negative design: investigators had access to all PCR test results nationwide, and controls were those with *negative* results. Diagnostic codes ...

2/4

Paxlovid associated with reduced risk of hospitalization AND death among those 50 years and older — including the vaccinated — in a new observational study in @AnnalsofIM.

A few thoughts...

acpjournals.org/doi/10.7326/M2… Observational studies of treatments can be hopelessly confounded, and so not informative. But notably, here, those prescribed paxlovid were:
(1) older
(2) had more chronic illness &
(3) more likely to be vaccinated.

Despite that, hospitalization/death risk was...