Most Americans Have Difficulty Paying for Health Care. That's a Problem for Everyone.

I don’t think there is a whole lot of analysis needed on the Commonwealth Fund’s look at the impact of high health care costs on consumers. A majority of the 8,000 people included in the Commonwealth poll said they had difficulty affording health care costs.

Bang. That’s it. That’s the story.

But if you want more: thirty-eight percent have skipped care for cost reasons. And, of those who skipped care, 57% said their health got worse. Almost one in three Americans carry some sort of medical debt.

You can probably spin various explanations for why the numbers are high, and it seems like there is some vagary that might inflate things. (Are there people at any income level who are like: “Yup: $1,200 for a root canal? No problem!”?)

But at a minimum, the survey is a glimpse into how people perceive health care costs. And they perceive them as a big problem.

And that’s a big problem.

Since I last rapped at ya, Merck, BMS, AbbVie, and Sanofi all announced earnings. None of them talked about policy issues at all. Add that to the silence from Roche and Novartis and the single, brief aside from J&J, and there’s a clear trend here.

I’ll explore this more, probably in a LinkedIn piece in a week or so, but I think the sudden quiet around the issue is noteworthy.

My impression is that we’re at a point where there’s no great advantage to an individual company talking about any of the big issues.

The IRA, in particular, seems to be perceived as a messaging liability, which is ironic given that the pro-IRA forces are beginning to realize that their messages on the topic are also problematic.

Indeed, the most interesting quote this week came from this Fortune piece, in which Harvard’s Aaron Kesselheim -- arguably the most influential defender of the IRA -- admitted that the lack of real patient benefit under the new law “will be a challenge in messaging for Medicare.”

Kesselheim isn’t wrong. The fact that patients (in general) aren’t going to fly the W when the IRA is fully implemented is absolutely an issue. It’s just not an issue for pharma, at least not as far as earnings calls go.

• This is a really smart story from STAT about the historical unwillingness of lawmakers -- particularly Democrats -- to go after hospitals … and how that may (or may not!) be changing.

• It sure looks like Monica Bertagnolli is going to win Senate confirmation and lead the NIH. That’s prompting a new meta-narrative that her success marks a failure by Bernie Sanders to extract drug-pricing concessions from the White House.

• The Wall Street Journal made the argument that pharma companies are going all-in on antibody-drug conjugates as an IRA workaround. I think that might be an overly facile way of looking at it, but the assertion has a certain compelling logic to it.

• RSV vaccines are too expensive, according to a KFF Health News piece that does precious little -- beyond a phone interview with a Belgian economist -- to back its conclusion with data.

• I have to be honest: I’m not convinced that the insulin market in the U.S. ought to be a high priority for government intervention. Whatever the past problems might have been, it feels like the safety net is far more secure and that new layers of bureaucracy are probably not going to fix the remaining holes. But I’m probably in the minority, as evidenced by Bloomberg’s 1,300-word piece on what’s next for insulin regulation.

• Sen. Mike Braun wants to create a whole new regulatory structure to allow experimental drugs to be temporarily approved, and he held a whole hearing about it yesterday that received coverage from STAT and Endpoints. It’s not clear to me that many people think that the FDA is overly stingy with approvals, but there has always been -- and will always be -- a market for less regulation.

• There’s an interesting study out that makes a data-driven case that oncologists who receive money from drugmakers are more likely to provide low-value care. The research looked at four metrics of low-value care and found that docs who had received payments were more likely to engage in three of the four behaviors. But the one where money had the opposite effect was the use of generic drugs: industry-affiliated physicians were more likely to forgo brand-name drugs. An author on the paper suggested it was due to confounding (those who received money were more likely to be at institutions with strict formularies), but even that opens an interesting question of what other confounders might be at play.