Latest news with #SallyPipes
Forbes
07-07-2025
- Health
- Forbes
A Promising New AIDS Drug Highlights The Dangers Of Price Controls
"The progress that science has made against HIV/AIDS is nothing short of remarkable," writes health ... More policy expert Sally Pipes. The U.S. Food and Drug Administration approved a shot last month that effectively prevents HIV. At-risk people simply need to receive the injection every six months. The new drug, called lenacapavir, comes almost exactly 44 years after the first case of AIDS was reported by what's now known as the Centers for Disease Control and Prevention, or CDC. The progress that science has made against HIV/AIDS is nothing short of remarkable. For much of the last four decades, a diagnosis of HIV/AIDS was a death sentence. At the peak of the AIDS crisis in 1995, the death rate for HIV/AIDS was just over 16 for every 100,000 people. By 2019, it had fallen to just over one per 100,000. This progress was due almost entirely to advances in pharmaceutical treatment, which turned AIDS from a deadly plague to a chronic condition. Some 16.5 million lives were saved by AIDS drugs between 2001 and 2021. According to the World Health Organization, in 2023 around 72% of people living with HIV/AIDS had a suppressed viral load—meaning the disease was undetectable and mostly untransmittable, thanks to medication. And now, lenacapavir has been shown to provide 'a near-perfect shield against HIV infection,' as the New York Times put it. But the drug was not invented overnight. It's been in the works for 20 years, the product of countless scientists engaging in costly, high-stakes research. The fact that lenacapavir will soon be available to patients is a testament to the strength of America's biopharmaceutical sector. Unfortunately, lawmakers are working to upend the very system that makes drugs like lenacapavir possible. Democrats have long sought to impose European-style price controls in the United States. Republicans—including President Trump, who has expressed enthusiasm for price controls on prescription drugs—are embracing similar plans in increasing numbers. Researchers first isolated the molecule that would become lenacapavir in 2016. That discovery was itself the end result of two decades of research. It would take another 10 years for researchers to bring that molecule to market. As Dr. William Pao noted in a recent STAT News piece, 'Lenacapavir breaks all of [the] rules' of HIV/AIDS treatment. By the time it was isolated, there were already a number of effective HIV/AIDS treatments on the market. Developing a new, unconventional treatment didn't make much sense. But, as Pao notes, '[E]very challenge can be turned into an opportunity for innovation with some creative thinking, and that is exactly what Gilead did.' Bringing a new drug from the lab to the market—even one less innovative than lenacapavir—is risky and expensive. It takes between 10 and 15 years and costs around $2.6 billion, on average. Of every 100 drugs that enter clinical trials, fewer than eight ever make it to pharmacy shelves. Drug companies use the money from successful drugs to offset the cost of failures. And they're willing to take a chance on new projects precisely because they know that, in the United States, they will have an opportunity to recoup and earn a return on their investments. The economic reality in countries that impose price controls on pharmaceuticals is different. Those price caps limit drug companies' potential return on novel medicines. So they tend to delay entry into those markets. One study found that, as of October 2022, patients in Canada had access to just 45% of drugs launched worldwide between 2012 and 2021. For patients in the United Kingdom, the corresponding figure was just 59%. In the United States, patients had access to 85% of those drugs. Yet American lawmakers are still working to implement price controls here. The Trump administration recently revived the 'most favored nation' policy from 2020, which would link the U.S. prices of drugs to the lowest price paid in other developed countries. If this system had been in place 20, 10, or even five years ago, it's possible that lenacapavir never would have made it to market—to say nothing of the countless other drugs for AIDS and other diseases that have been developed in recent years. For future patients' sake, let's hope lawmakers abandon their plans to impose price controls—and allow a healthy market for pharmaceuticals to flourish.
Forbes
23-06-2025
- Health
- Forbes
Physician-Assisted Suicide Is A Bigger Problem Than We Realize
"We may seem a long way from legalizing physician-assisted suicide in the United States," writes ... More health policy expert Sally Pipes. "But it wasn't very long ago that such a thing seemed unthinkable in Canada, too." Dovie Eisner was born with a rare genetic condition called nemaline myopathy. He requires a wheelchair and has a host of other health problems. Last year at one point, he stopped breathing, passed out on the street, and was taken to the emergency room. 'I was alive—thanks to the determination of law enforcers and local medical personnel to keep me that way,' Eisner wrote recently in UnHerd. But, he warns, a law being considered in his home state of New York 'threatens to undo this presumption in favour of lifesaving' that motivated first responders to keep him alive. The bill, called the Medical Aid in Dying Act, would allow mentally competent adults with six months or less to live 'to obtain a prescription that would put them to sleep and peacefully end their lives.' New York is not alone. Seventeen states—including Florida, Massachusetts, and Pennsylvania—are considering so-called 'death with dignity' laws. Eleven states and the District of Columbia already have them on the books. Advocates say these laws spare the terminally ill from unnecessary suffering. But a closer look at Europe and Canada—where physician-assisted suicide has been legal and common for years—paints a darker picture. Far from providing peace to terminal patients, these laws are often used by government-run healthcare systems to nudge sick patients toward ending their lives. The United States may not have a completely socialized system of medicine yet. But the government covers nearly half of all healthcare expenditures in this country. Over the past 40 years, its share of the nation's health bill has been growing, slowly but surely. At some point, it may have a financial incentive in hastening people toward their demise. Around 8,700 Americans have died by assisted suicide since 1997, when Oregon became the first state to legalize the practice. That's around 300 people annually. For comparison, some 3 million Americans die every year. In other countries, assisted suicide is a much more common cause of death. In the Netherlands—the first country to legalize the process, in 2002—more than 5% of annual deaths are due to medically-assisted suicide. In Canada, more than 15,000 people died by physician-assisted suicide in 2023—4.7% of total deaths. Canada only legalized physician-assisted suicide in 2016. Until last year, the rate of assisted suicide north of the border rose around 31% annually. The majority of Canadians choosing 'medical assistance in dying' are between 65 and 80. But the number of Canadians aged 18 to 45 opting to end their lives by MAiD has been increasing each year. There were just 34 in 2017—but 139 in 2021. Those numbers are likely to grow as Canada continues to expand the pools of people eligible for physician-assisted suicide. The government has already expanded the law to include those who are not terminally ill but living in circumstances they themselves deem 'intolerable.' Now, the United Kingdom is considering similar legislation. Last week, the House of Commons greenlit a bill that would allow terminally ill adults in England and Wales to take their own lives with a physician's help. The legislation is moving on to the House of Lords. Proponents of these policies may characterize them as compassionate. But it's impossible to ignore the Canadian government's financial interest in having one less person who needs government-funded health care. The Canadian government certainly acts on that interest in other ways—most notably by denying access to cutting-edge prescription drugs. Just 45% of new drugs launched worldwide between 2012 and 2021 were available in Canada as of October 2022. Eighty-five percent were available in the United States. The Canadian government's calculus could apply on this side of the border. The federal government already pays for Medicare coverage for 68 million people. That number will grow as the population ages. And Medicare has shown that it will restrict access to some forms of care, through its Coverage with Evidence Development framework. Some 22 devices, services, and therapies are subject to these restrictions, as of 2023. Medicare defends those restrictions by saying it needs more evidence of clinical benefit. But some of those restrictions have been in place for a decade or more. A skeptic might reasonably wonder whether Medicare is holding back because of unspoken concerns about cost. There's no doubt that medical assistance in dying will be effective—if the goal is to save the government money caring for the elderly. We may seem a long way from legalizing physician-assisted suicide in the United States. But it wasn't very long ago that such a thing seemed unthinkable in Canada, too. Let's hope lawmakers stateside change course before it's too late.
Forbes
09-06-2025
- Health
- Forbes
This Groundbreaking Insurance Reform Is Buried In The Big, Beautiful Bill
"The legislative package would codify and expand Individual Coverage Health Reimbursement ... More Arrangements, which the first Trump administration introduced in 2019," writes health policy expert Sally Pipes. There are more than 40 healthcare provisions in the One Big Beautiful Bill Act (OBBBA) that passed the House of Representatives by a one-vote margin last month. One, in particular, deserves more attention than it is getting. The legislative package would codify and expand Individual Coverage Health Reimbursement Arrangements, which the first Trump administration introduced in 2019. ICHRAs allow employers to give workers untaxed dollars, which they can use to purchase health insurance on the individual market. In many ways, ICHRAs are the health insurance equivalent of retirement accounts to which employers make defined contributions. These accounts have the potential to make health insurance more accessible and affordable for not just employees but employers, too. As the Manhattan Institute's Chris Pope notes in a recent study on ICHRAs, 117 million Americans between the ages of 19 and 64 received insurance from employers in 2023. Just 16 million bought insurance on the individual market. In some ways, this makes sense. Employer-sponsored health insurance is familiar. Enrolling in an employer plan spares workers the hassle of having to navigate the individual market. But today, health insurance is actually cheaper on the individual market than when purchased by employers. So employers embracing ICHRAs could save themselves and their employees a lot of money. And by putting individuals in charge of their own health insurance needs, ICHRAs can unleash the kind of market forces that help drive down costs and improve value in every other sector of the economy. People are more responsive to market signals when they are enrolled in individual market plans. One study found that a 1% premium increase leads to a 1.7% drop in individual market plan enrollment. By contrast, a 1% premium increase in the employer market causes enrollment to drop by between 0.2% and 0.8%. This finding reveals one of the main problems with employer-sponsored insurance—it obscures the cost of health coverage. Employees have no incentive to seek out more affordable providers or services when someone else is paying the bill. Providers are aware of this market dynamic, which means they are constantly, as Pope puts it, 'needlessly inflating costs.' That's why, he goes on to note, 'Starbucks spends more on health care for its workers than it does on coffee.' Increased adoption of ICHRAs would disrupt this status quo. Employers' costs would decline. Employees spending their ICHRA money would have a strong incentive to pick a health plan that suits their needs and budget, rather than the one-size-fits-all plan that most employers offer now. And by putting consumers in charge of their own healthcare dollars, ICHRAs could foster the kind of competition among both insurers and providers that drives down costs and improves value over the long term. One study found that expanding the number of plan options for employees can provide benefits equal to 13% of premiums. Decoupling health insurance and employment has a number of downstream benefits for workers of all stripes. For instance, it encourages entrepreneurship by giving people the security to leave their jobs without fear of losing health coverage. And it offers a suitable coverage option for part-time workers, only 26% of whom currently receive health insurance from their employers. ICHRAs could also make it more financially realistic for small businesses to offer health benefits. Just 56% of those who work for firms with fewer than 50 employees get an offer of insurance through their jobs. Cost is typically the chief impediment. ICHRAs would help remove that barrier. These accounts have only been around for five years. But Americans are waking up to their benefits. Around 500,000 people were enrolled in ICHRAs in 2023. The nonpartisan Congressional Budget Office estimates that around 2 million workers will be enrolled in these plans by 2032. And that's if nothing else changes. If the big, beautiful bill passes as written, it will rebrand ICHRAs as CHOICE plans—a less confusing acronym that experts hope will encourage more businesses to adopt them. After codifying Trump's ICHRA rule in law, lawmakers could consider something like Pope's proposal for a Worker's Choice ICHRA, which would allow employers to offer both ICHRAs and traditional insurance plans by guaranteeing coverage parity between the options. Americans deserve more choice in their health benefits. Expanding access to ICHRAs would give it to them.
Forbes
28-04-2025
- Business
- Forbes
Obamacare Is Killing Small Business. Here's How To Fix It.
"Small employers are increasingly responding to the rising cost of health insurance by dropping it ... More altogether," writes health policy expert Sally Pipes. Obamacare was back on trial this month, as the U.S. Supreme Court heard a challenge about the constitutionality of the panel that determines which preventive care services health plans must cover. According to the Commonwealth Fund, 'The case has consequences for the Affordable Care Act's guarantee of coverage for a wide range of free preventive care.' Preventive care is not free, even if Obamacare attempts to paint it as such. We all pay for mandated benefits in the form of higher premiums and out-of-pocket costs. And a new report from the JPMorganChase Institute shows that small employers are increasingly responding to the rising cost of health insurance by dropping it altogether. One-third of businesses with fewer than 50 employees drop health insurance coverage year over year largely because of rising insurance costs, the financial firm's research outfit found. Restaurant employees were hit the hardest. Thirty-six percent dropped insurance coverage between 2018 and 2019. Thirty-five percent of repair and maintenance businesses dropped coverage in that window, as did 34% of construction firms. The JPMorganChase study found that a 10% hike in monthly premiums increases the probability that a firm will drop health insurance coverage by just over 1%. For restaurants, a 10% premium increase raises that probability by 5.5%. And while some small businesses stop offering health insurance coverage as they prepare to close their doors, the study found 'most small businesses that stopped paying health insurance premiums continued to operate in the following years.' That's bad news not just for American workers but for the country. As the JPMorganChase study notes, 'inconsistent health insurance coverage can hinder the success of small businesses by potentially stifling entrepreneurship, with implications for aggregate job and economic growth.' Fortunately, there are several things lawmakers can do to help businesses struggling to provide health coverage to their employees. Namely, they can expand access to two types of health insurance plans that are exempt from Obamacare's costly rules and regulations—and as such are considerably Health Plans allow small businesses to join with self-employed individuals and independent contractors in their industry and purchase health plans in the large-group market. Because associations function like large employers, they have more leverage to negotiate with insurers. More importantly, AHPs are exempt from Obamacare's mandates. That gives them the freedom to tailor their offerings to members' needs—offering bare-bones catastrophic coverage to a group of young waiters, for instance—which in turn lowers costs for enrollees. In 2018, the Trump administration relaxed Obama-era restrictions on association health plans in an effort to expand access to them. Under the 2018 rules, employers could form associations with any small business in their geographic area, regardless of whether they were in the same industry. The Biden administration reversed those rules shortly before President Trump returned to the White House. Now that he's back, the president has a chance to reimpose his earlier guidance. The Trump administration could also loosen Biden-era restrictions on short-term, limited-duration insurance. These health plans are also exempt from Obamacare's cost-inflating mandates and so are much more affordable than the coverage for sale on the exchanges, with premiums that can be half as much. During his first term, President Trump green-lit rules that extended the maximum term for these plans to 364 days and allowed insurers to renew them for up to three years. Biden also rolled back those rules, capping short-term plans at 90 days with an option for a one-month renewal. It's time for a return to the Trump 1.0 regulation of short-term plans. Doing so would expand access to affordable coverage—something that would be particularly valuable to the increasing number of small-business employees whose employers have discontinued coverage. Whether by expanding options for small businesses or for individuals, lawmakers have plenty of avenues to relieve the burden of the increasingly expensive insurance coverage brought about by Obamacare. For workers' sakes—and for the good of the American economy—let's hope they seize the moment.
