Democrats have been campaigning for 30 years on promises they’d let Medicare directly negotiate the cost of prescription drugs. Now, after the majority of voters want reduced costs for their prescription drugs, the bill seems ready to pass despite record pharma lobbying.

According to Axios, “the Senate’s reconciliation bill would only open up negotiations for a small number of drugs, but even that is a threshold Democrats have never been able to cross before. And it opens the door to more aggressive policies in the future”.

Anyone who thought this would never happen is living in a fantasy land. There will still be a lot more to come.

The Media Promotes Weight Loss Drugs But…

The headlines are all over social media. “New weight loss drugs help patients lose significant weight,” but very few are telling the whole story.

However, there are essential things to know about all of these medications. They can be expensive and have serious side effects. Plus, sometimes they aren’t covered by insurance and don’t always work for everyone. When they do work, it’s often because they are combined with diet and exercise. And it’s not clear if there’s an end in sight for people taking the drug, who may regain the weight after stopping the medication. As is the case with most chronic conditions, some experts believe people with health issues related to their weight will require care, management, and possibly a prescription indefinitely.

Some insurance companies won’t cover some GLP-1 agonists. For example, Medicare and most insurance companies won’t cover Wegovy, according to GoodRx. An app called Calibrate offers personalized coaching and access to physician-prescribed GLP-1 agonists for $1,649 per year or $138 per month. That is in addition to the cost of medications, but on its website, Calibrate claims to work with users’ insurance companies to get them covered. It also guarantees weight loss of 10% or more.

Beware of Private Equity

With the U.S. population rapidly aging, hospice has become a booming industry. Medicare — the federal insurance program for people 65 and older, which pays for the vast majority of end-of-life care — spent $22.4 billion on hospice in 2020, according to a Medicare Payment Advisory Commission report to Congress. That’s up from $12.9 billion just a decade earlier. The number of hospices billing Medicare over that time grew from less than 3,500 to more than 5,000, according to the report.

The ability to turn a quick profit in caring for people in their last days of life is attracting a new breed of hospice owners: private equity firms. The rapid growth of hospices has many hospice veterans worried that the original hospice vision might be fading. Those capital investment companies’ demand for return on investment and the debt load they force hospices to bear are hurting patients and their families.

Many of these transactions are driven by the motive of a quick profit. I’m very concerned that you’re harming not only the dying patient but the family whose memory will be of a loved one suffering because they didn’t get adequate care

 Dr. Joan Teno, an adjunct professor at Brown University School of Public Health

According to a 2021 analysis, the number of hospice agencies owned by private equity firms soared from 106 of 3,162 hospices in 2011 to 409 of the 5,615 hospices operating in 2019. Over that time, 72% of hospices acquired by private equity were nonprofits. And those trends have only accelerated into 2022. Private equity-owned hospice companies counter that their model supports growth through investment, which benefits the people in their care.

According to the Medicare Payment Advisory Commission, for-profit hospices had Medicare profit margins of 19% in 2019, compared with 6% for nonprofit hospices. A 2019 report by the Milliman consulting firm found that 31% of nonprofit patients had cancer, while 15% had dementia. At for-profit hospices, 22% of patients had cancer, and 22% had dementia, said the report, funded by the National Partnership of Hospice Innovation, a trade group of nonprofit hospices.

Patients in nonprofits had more nursing, social worker, and therapy visits. For-profit hospices, the report found, had longer lengths of stay by patients, discharged more patients before death, and had profit margins nearly seven times higher. Other studies have found that for-profit hospices have higher rates of complaints and deficiencies, provide fewer community benefits, and have higher rates of emergency room and other hospital use.