Our healthcare system is broken. As a healthcare practitioner for the last 38 years, I’ve seen the system deteriorate right before my eyes. We can do remarkable things in the operating room we couldn’t do forty years ago, but we can’t seem to deliver high quality care consistently with a personal touch like we used to.

ObamaCare has made it easier for low-income families to get healthcare insurance, but they still can’t afford the deductibles and co-pays that are necessary to actually receive treatments, especially surgery. Hospital systems are hiring physicians more and more which eliminates much of the independent private competition that thrived on providing high-quality, attentive healthcare. Now you’re likely stuck with whoever the hospital provides.

These are just a couple of examples of the decline in healthcare. But it could get much, much worse. If we ever actually go to socialized medicine, which Democrats are pushing, you’ll be lucky if you get hospitalized at all. Rationing of care is a fundamental of socialized medicine. If you’re too old, you may be denied the care you need. “Too expensive for someone your age.”

What’s the alternative to socialized medicine? Republicans have been trying to abolish ObamaCare and prevent socialized medicine, but what ideas do they have? Former Louisiana Governor Bobby Jindal, writing in The Wall Street Journal, says he has some answers to that question. Gindal says the time is now for Republican state legislatures to advance federalism while also strengthening consumer-based healthcare. He proposes several specific policies Republicans should champion and expand:

Require more price transparency

He advocates states to build on the Trump administration’s rules requiring price transparency for health plans and hospitals by including more providers, including physicians; beefing up enforcement to ensure compliance; and compiling data online in a format that allows for easy comparisons. At least nine states have built price-comparison websites for consumers, and many have or are bu8ilding all-payer claims databases for payers and employers. This will allow consumers to shop for the best healthcare values. Employers can also use this information to set reference prices for procedures, allowing comparison shopping and creating incentives for providers to become more efficient. Price transparency also increases pressure on intermediaries like health plans, third-party administrators, and pharmacy benefit managers to negotiate more effectively on behalf of their customers.

Expand scopes of practice, repeal certificate -of-need requirements, and promote cross-border licensing.

 Legal scopes of practice should be expanded so that doctors, nurses, pharmacists, therapists and other professionals can provide services up to their training and competence. What particular providers are currently allowed to do varies by state, with many restrictions unsupported by evidence of adverse outcomes. Many restrictions are dated and intentionally difficult to update to reflect advances in training, technology and research.

Certificates of need (CON) require government permission before new facilities can be built, so that such decisions are based on politics rather than market demand. New Hampshire repealed its CON program in 2016, and Florida partly did so in 2019. State-specific licensing requirements have impeded the ability of providers, especially in mental health, to care for patients remotely. As Covid expedited federal payment reforms to encourage telehealth, states should enact automatic reciprocal licensing and other arrangements to allow providers to treat patients across state lines.

Incorporate patient-based Medicaid reforms

States have been aggressive in enrolling healthier beneficiaries in private managed-care plans, but they can do more to ensure their programs are giving patients access to mainstream medical services rather than creating a separate public infrastructure. Conservatives in Washington have long fought for block grants to give states more flexibility over Medicaid, but state Republicans should maximize the flexibility they already have to try new delivery systems, cost-sharing arrangements and benefit designs.

Simplified Medicaid enrollment and renewal requirements have increased program participation, but states should encourage beneficiaries to use sliding-scale subsidies to obtain and retain affordable private coverage rather than forcing them into one-size-fits-all, all or nothing government coverage. States should adopt aggressive premium support and anti-crowd-out policies, combined with more-flexible wraparound benefit requirements, rather than unnecessarily replacing private dollars with taxpayer subsidies. The goal is to get people off Medicaid, especially as their circumstances improve.

Enforce antitrust laws to counter overconsolidation among hospitals, physicians, payers, and other healthcare entities.

Mergers in fragmented markets can result in efficiencies and quality improvements, but many markets are already dominated by three or fewer health systems. Larger systems are more able to comply with increasingly complicated and costly government regulations, but also more likely to become dependent on government funding and less entrepreneurial. These large systems are becoming “too big to fail,” developing unhealthy codependent relationships with the government agencies that pay the, regulate them, and depend on them to deliver essential program benefits.

These are just a few suggestions for improving our healthcare system. Since Democrats seem determined to push socialized medicine, it remains for Republicans to advocate more consumer-oriented reforms through their state legislatures now, and on the federal level if they regain control of Congress.

What are “death panels?” The phrase came into popular use with the passage of the Affordable Care Act (ObamaCare) in 2010. One of the provisions of this healthcare legislation was the formation of a medical advisory board, called the Independent Payment Advisory Board (IPAB). IPAB was to be composed of 15 individuals appointed by the President who will be given significant power to cut Medicare spending in the future if there are cost over-runs. In other words, this advisory board would have the power to ration care if they thought it was too costly.

It was former Governor of Alaska and Vice-Presidential candidate Sarah Palin who first referred to this IPAB as a “death panel.” She meant that the decisions of this board could amount to a death sentence if life-saving or prolonging treatments were denied to seniors because they were deemed to be too expensive. This concept of rationing care “for the good of the whole” is a common feature of socialized medicine systems.

While the IPAB was never actually formed, as the ObamaCare legislation planned, the concept of rationing care based on the perceived value to society, rather than the individual, has not died. It is rearing its ugly head once again in the debate over the treatment of Alzheimer’s disease.

In an earlier post called Alzheimer’s Hope Arrives I reported on the Food and Drug Administration (FDA) approval of a new treatment of Alzheimer’s disease called aducanumab or Aduhelm. It is the first drug that has shown significant effectiveness in the removal of the amyloid plague buildup in the brain associated with the disease.

The approval of Aduhelm has been controversial. A randomized controlled clinical trial showed a high-dose of the treatment removed 71% of the amyloid plague buildup after 18 months and significantly slowed disease progression, as rated by care-givers and doctors. Another trial also showed amyloid clearance but failed to demonstrate a significant impact on disease progression.

The Wall Street Journal editorial board says the manufacturer, Biogen, then made a mistake by halting both trials early. But it later worked with the FDA on a post-hoc review to understand the discordant results. One major discrepancy: Patients in the second trial received less treatment. The longer patients in both trials received a high-dose of the drug, the less they deteriorated.

Critics of Aduhelm, largely on the public-health left, claim that the successful trial was likely a false positive since other experimental monoclonal antibody treatments have failed to show an effect on amyloid or disease progression. Some neurologists also believe clearing amyloid is ineffective because Alzheimer’s has other causes.

Despite these criticisms, Aduhelm is the first drug to show a meaningful effect on disease progression in early-stage patients. It has the potential to extend the time that patients can live independently and spend with their loved ones, while researchers work on other therapies that target different disease pathways. The costs associated with Alzheimer’s disease in the U.S. are estimated at $277 billion a year. You would think this alone would be a large incentive to pursue any treatments that might mitigate these costs, let alone relieve some of the suffering of these patients and their families.

Yet the critics have not let up even though the FDA approved the drug. They urged the FDA to require another large clinical trial before granting approval. When they lost this argument, they switched to obstructing payment of treatment by Medicare. They lobbied CMS – the Centers for Medicare and Medicaid Services – to restrict Medicare coverage. Although CMS has almost always covered FDA-approved drugs, they flinched with Aduhelm. Now CMS says Medicare will only pay for Aduhelm, and any future Alzheimer’s amyloid-targeting monoclonal treatments approved by the FDA, if patients enroll in a randomized controlled trial. In other words, CMS is overruling the FDA and doctors who may wish to prescribe these drugs to their patients.

There are other drugs in the development phase that also target amyloid. Three trials of other monoclonal treatments by Eli Lilly, Roche, and Biogen-Eisai have also shown positive results in early trials, some stronger than Aduhelm. But even though these drugs may obtain accelerated approval from the FDA, under CMS’s proposal, Medicare will only pay for them if patients enroll in duplicative trials in which they could be assigned a placebo, instead of the real drug.

Furthermore, it seems the CMS is also pushing for “wokeness” by saying, “the diversity of patients included in each trial must be representative of the national population diagnosed with AD.” WSJ says this is a bow to liberal criticism that the Aduhelm trials included too few blacks, who are twice as likely to develop dementia than whites. Yet these restrictions on trials will only further delay the approval of drugs that would disproportionately benefit blacks.

The real reason for the criticisms of these drugs is cost. Liberals warn Medicare spending will explode if seniors get access to Aduhelm, which costs $28,200 annually. WSJ says, “This is the real reason the Biden Administration wants to pre-emptively restrict Medicare coverage of all amyloid-targeting monoclonals. Progressives want to expand Medicare benefits to win senior votes, then ration treatments to contain government spending. Alzheimer’s drugs won’t be the last rationing target.”

Sounds like death panels by a different name.

Long Covid was mocked when first reported in 2020. I confess to posting a critical article about a year ago (Fake Science Behind Long Covid Symptoms) that reported on the work of Dr. Jeremy Devine, a psychiatry resident at McMaster University in Hamilton, Ontario. He believed there was no scientific basis for the condition. However, he did say it deserves serious study.

The National Institutes of Health devoted $1.15 billion to research the “prolonged health consequences” of Covid-19 infection. That research may be proving a good investment as new studies are helping advance our understanding of the biology behind long Covid, and providing clues to potential treatment.

Long Covid is characterized by a range of symptoms including fatigue, brain fog, and racing heart rates that persist months after an initial Covid-19 infection. Sumathi Reddy, writing in The Wall Street Journal, says scientists have identified four risk factors for which they tested upon a patient’s initial diagnosis.

• Autoantibodies
• Epstein-Barr virus
• Type 2 diabetes
• Genetic material of Covid-19 in the blood

The first of these risk factors was the presence of certain autoantibodies, which are antibodies that mistakenly attack the body in autoimmune conditions such as lupus. Researchers found the autoantibodies in about 60% of the patients who developed long Covid. Most patients didn’t have a diagnosed autoimmune disease, but rather had very low levels of autoantibodies associated with various autoimmune diseases.

A second risk factor was reactivated Epstein-Barr virus (EBV). EBV is associated with mononucleosis and infects about 90% of people, usually in their teens. Normally, the virus remains dormant afterward, but may become reactivated in some people for various reasons, including those who later developed long Covid.

Dr. Jim Heath, senior author of the study and president and professor of the Institute for Systems Biology in Seattle, says, “Your immune system is probably doing a reasonable job of keeping EBV in check and with a SARS-CoV-2 (Covid-19) infection you lose that brake. It seems to happen very early in an infection.”

Two other risk factors were Type 2 diabetes (adult onset) and the detection of genetic material from SARS-CoV-2 in the blood, which means the virus escaped the lungs and is spreading to other parts of the body. The researchers collected and analyzed blood and swab samples from more than 200 Covid-19 patients up to two to three months post-infection. The majority of patients were hospitalized for Covid, but the tests were replicated on a separate group of roughly 100 patients with mostly mild Covid-19 infections. The tests were also conducted on about 460 healthy people in a control group.

In a separate new study in Nature Communications, researchers in Switzerland found five different factors that they concluded will help predict who will develop long Covid. Those five factors include:

• Lower levels of two immunoglobulins – IgM and IgG3 (antibodies)
• Older age
• History of asthma
• Symptoms of fever, fatigue, cough, difficulty breathing and G.I. issues during an acute Covid-19 infection (people with long Covid had at least 3 of these)

What treatment is available for long Covid?

Identifying treatments for long Covid is the goal of this research. One possibility is treating those with the virus in the blood with one of the new Covid antiviral drugs. Researchers also found that some long Covid patients have very depleted levels of cortisol, resulting in Addison’s disease, which has symptoms such as fatigue and muscle aches. Addison’s patients are often treated with cortisol replacement therapy.

More research is needed to accurately predict and effectively treat those who develop long Covid.