The Health 202: The coronavirus pandemic has hurt Medicare’s hospital program

The CBO now expects Medicare Part A — the part of the program that pays for hospital care for seniors — to become insolvent by 2024, two years earlier than previously expected. That’s the closest to insolvency Medicare has been since 1971, when its trustees projected a two-year insolvency window.

The pandemic and the resulting economic impact are largely the reason for Medicare’s diminished financial outlook. Payroll tax revenue, which flows into the hospital trust fund, has taken a nose dive amid widespread layoffs, yet the Medicare population is expected to continue growing at the same rate.

The trend isn’t affecting just Medicare, either; the CBO said Social Security’s insurance trust fund and the funds dedicated to the government’s military and civilian personnel retirement programs are also taking a hit from reduced payroll taxes.

The trend might not be great news for Democrats who want to expand Medicare’s benefits to more Americans.

The party’s primary contest was dominated by arguments over whether Medicare-for-all is a good route to take. Biden was the strongest opponent of this approach, instead focusing on his central idea of making a government-run “public option” plan available to everyone. He defended that approach when pressed by President Trump during Tuesday’s debate — although he severely bungled his description of how it would work.

But Biden did embrace the idea of lowering the Medicare eligibilty age to 60 after winning the nomination. It was viewed as a concession to supporters of Sen. Bernie Sanders (I-Vt.), who were sorely disappointed the candidate most opposed to Medicare-for-all nabbed the Democratic nomination.

Lowering the Medicare age could cost $200 billion over a decade.

That’s according to an estimate by the Committee for a Responsible Federal Budget, which analyzed Biden’s health-care proposals and estimated their potential costs. 

If those numbers hold, pegging the Medicare enrollment age to 60 would increase the program’s annual spending by roughly 3 percent. That’s not a huge figure, but it would be a cost a Biden administration and Congress would have to grapple with should they find themselves in a position to advance such a policy.

Kavita Patel, who worked on health policy in the Obama administration, said her sense from talking to Biden’s team is the nominee would ask Congress to supply the extra funds needed instead of drawing from trust fund dollars — although she acknowledged any discretionary dollars would eventually run out.

“I think it’s very clear that we don’t have enough money to just put more people in Medicare,” Patel told me.

Presidential debates often include discussions about Medicare solvency — but not the Tuesday’s face-off.

Had Trump been more interested in policy, he might have questioned Biden about proposing to add more people to the Medicare rolls even as the program falls in tougher financial straits.

Instead, the president hammered Biden over his public option proposal and even sought to paint him as a Medicare-for-all proponent, even though Biden has argued against a single-payer system on many occasions.

After Biden noted his plan would allow private insurance to continue, Trump shot back: “That’s not what you’ve said and it’s not what your party has said.”

“That is simply a lie,” Biden responded.

“Your party doesn’t say it,” Trump insisted. “Your party wants to go socialist medicine.”

“Right now, I am the Democratic Party,” Biden answered.

“And they’re going to dominate you, Joe, you know that,” Trump responded.

Ahh, oof and ouch

AHH: Former White House Domestic Policy Council chief Joe Grogan is “troubled” by the attacks of senior administration officials on public health experts.

Grogan, who left the White House in May, told our colleague Jacqueline Alemany it’s not a mistake to expose Trump to dissenting views from people like Scott Atlas, a neuroradiologist who joined the White House as a pandemic adviser in August. But Grogan said he’s concerned about “unfounded” attacks “from within senior leadership ranks” on Centers for Disease Control Director Robert Redfield, top infectious disease expert Anthony Fauci, and Deborah Birx, the White House coronavirus response coordinator. 

“Who they want to get up there and speak is one thing,” Grogan said, referring to briefings for the public. “But who is in the Oval Office debating issues? Is Atlas in there alone? Or in there with Birx, Redfield and other scientists who have spent their lives devoted to fighting infectious diseases?” 

OOF: Talks between Pelosi and Mnuchin over a new economic stimulus package will continue.

“House Speaker Nancy Pelosi and Treasury Secretary Steven Mnuchin met Wednesday to discuss an economic-relief deal, and although they did not reach a final deal, House Democrats agreed to postpone a vote on a more partisan bill to give the bipartisan talks more time,” Erica Werner, Jeff Stein and Rachael Bade report.

“Secretary Mnuchin and I had an extensive conversation and we found areas where we are seeking further clarification. Our conversations will continue,” Pelosi (D-Calif.) said in a statement after a 90-minute meeting, the first in-person discussion between the two since bipartisan talks over a deal collapsed in August.

Democrats put on hold plans for vote for a $2.2 trillion stimulus bill that has no chance of passing given opposition by congressional Republicans, in favor of pursuing a compromise. It remains unclear whether the sides will reach a deal and whether Senate Republicans would even fall behind a package negotiated by Mnuchin and Pelosi. 

“But after weeks in which talks had stalled completely, Wednesday’s developments offered a glimmer of hope that Congress and the administration might come together after all to agree on new economic relief ahead of the election,” Erica, Jeff and Rachael report.

OUCH: An often-overlooked variable may be crucial in understanding how the novel coronavirus spreads.

Many people have focused on R0 — the average number of people infected by one person with a disease — but the Atlantic’s Zeynep Tufekci writes that the focus on averages obscures a potentially much more important variable, known as k. This variable is a measure of dispersion: “it’s simply a way of asking whether a virus spreads in a steady manner or in big bursts, whereby one person infects many, all at once,” Tufecki writes.

Recent research has underscored that the coronavirus is what’s known as an “overdispersed pathogen,” which means it tends to spread in clusters.

“There are COVID-19 incidents in which a single person likely infected 80 percent or more of the people in the room in just a few hours. But, at other times, COVID-19 can be surprisingly much less contagious,” Tufecki writes. “A growing number of studies estimate that a majority of infected people may not infect a single other person.”

This makes the coronavirus different from the flu, which tends to spread in a fairly steady manner. It also makes it harder to draw conclusions by comparing the relative trajectories of different cities or countries, given that a few unlucky super-spreading events can dramatically change the course of a disease. 

There are, however, practical takeaways for combating an overdispersed pathogen. When it comes to contact tracing, public health officials probably will get far more bang for their buck doing backward tracing — trying to discover the source of an outbreak, which may be a superspreading event — rather than spending scarce resources trying to warn everyone who may have come into contact with a given positive individual. Likewise, less sensitive antigen tests for the virus or tests of wastewater to identify outbreaks could be crucial tools in catching and controlling clusters. 

While we still don’t know all the factors that lead to superspreader events, we do know that they are likely to occur in places “where the three C’s come together—crowds in closed spaces in close contact,” Tufecki writes. Countries that have prioritized preventing outbreaks in these settings have often done better at controlling the virus.

Hopes are high for monoclonal antibodies, despite limits in global capacity.

More than 50 companies and academic teams are working on developing monoclonal antibodies for the coronavirus. The hope is that these laboratory-made antibodies could help prevent the disease in people who have been exposed or serve a treatment that reduces the severity and duration of covid-19, Carolyn Y. Johnson reports.

The biotechnology firm Regeneron reported on Tuesday that its drug appeared to reduce viral load and relieve symptoms in people recently diagnosed with covid-19 who were not in the hospital.

The problem is that, even if monoclonal antibodies prove effective, there won’t be enough.

“Unlike conventional pills, these are expensive, injectable drugs synthesized by living organisms in specialized reactors, at a biological cadence that can’t be rushed,” Carolyn writes. 

Companies are scrambling to increase their manufacturing capacity. Even so, to create enough medication to treat everyone diagnosed with covid-19 so far, the entire global capacity for producing monoclonal antibodies — now largely geared toward making essential medicines for people with cancer or autoimmune diseases — would have to become solely dedicated to producing coronavirus antibodies, according to an analysis conducted for The Washington Post by the BioProcess Technology Group at global accounting firm BDO.

Race for a vaccine

Pfizer is making a high-stakes gamble with its promise of a vaccine by October.

“Right now, our model — our best case — predicts that we will have an answer by the end of October,” Pfizer’s chief executive, Albert Bourla, told the “Today” show in September. 

“Dr. Bourla’s statements have put his company squarely in the sights of President Trump, who has made no secret of his desire for positive vaccine news to boost his chances on Election Day, Nov. 3,” the New York Times’s Katie Thomas reports.

Other vaccine competitors have shied away from mentioning October, with good reason, according to experts. Pfizer will not have completed Phase 3 trials by the end of October, and even if an interim analysis — set to be conducted after 32 people in either the placebo group or the vaccine group fall ill — shows promise, it will still be too early to judge whether it is safe and effective.  The FDA has told vaccine makers they need to track at least half of patients for two months after they received their final shot to ensure the safety of the vaccine.

By repeating a date that leading public health officials have dismissed as unrealistic, Pfizer is engaged in a “high-stakes gamble,” Katie writes. A vaccine that hasn’t been thoroughly vetted could pose a safety threat or fail to gain public trust.

“But there is a significant upside, to the tune of billions of dollars, in being first to the U.S. market with a vaccine. And staying in the president’s good graces — particularly when he keeps talking about ways to lower drug prices — might not be a bad thing for a company that brought in nearly $40 billion in 2019 from sales of high-priced, brand-name drugs,” Katie writes.

Coronavirus latest

  • Top infectious-disease doctor Anthony Fauci accused Trump of taking his statements on masks out of context during Tuesday’s presidential debate. Trump said during the debate that Fauci had initially opposed masks. In an interview that will air today on ABC News’s “Start Here” podcast, Fauci disputed that claim, saying that, while there had been initial concerns about the public rushing to buy masks and creating a shortage for health-care workers, scientists have been advocating for “months and months” that people wear masks, ABC News reports.
  • Weekly coronavirus cases jumped 55 percent among 18- to 22-year-olds nationally between Aug. 2 and Sept. 5, the period of time when colleges and universities opened across the country. The findings come from a report released Tuesday by the Centers for Disease Control and Prevention, Susan Svrluga reports.
  • The White House has blocked a new CDC order that would keep cruise ships docked until mid-February 2021, instead allowing them to return to the seas after Oct. 31. Scientists have warned that cruise ships could become viral hot spots, the New York Times’s Sheila Kaplan reports.

Elsewhere in health care

  • The House Oversight Committee released two reports Wednesday blasting drugmakers Celgene and Teva for repeated price hikes that appeared to be motivated by a desire to hit revenue goals for shareholders. The reports are the result of an 18-month investigation based on internal documents, which shed light on how the companies raised prices of their blockbuster drugs revlimid and copaxone, even as they sought to keep lower-cost alternatives out of the market, Stat News’s Nicholas Florko reports.

Rep. Katie Porter (D-Calif.):

  • A series of reports from the Urban Institute analyzed insurance rates for young children and their parents since the passage of the Affordable Care Act. The reports find that while the ACA was crucial in expanding insurance access, insurance coverage has stagnated or decreased for some groups in recent years. After children’s uninsurance reached a historic low in 2016, the progress has reversed since 2017, with the number of uninsured children increasing by 370,000 between 2016 and 2018. Similarly, gains in the rates of insurance coverage for parents of young children stalled in 2015, leaving 4 million uninsured parents of young children, according to data from 2017 and 2018.
  • During Tuesday’s presidential debate, Trump boasted that he made insulin so cheap, “it’s like water.” Americans with diabetes and medical experts say that this isn’t true. Insulin prices have skyrocketed over the past 20 years, including under the Trump administration, with many Americans shelling out hundreds of dollars a month, Ben Guarino reports.

In other news

Trump responded to a new study from researchers at Japan’s Yokohama National University that suggests a chemical found in McDonald’s french fries could be a cure for baldness:

Sugar rush