Appreciate this piece and your voice in your writing very much.

Expand full comment

Thorough overview on the "bloating" Medicare expenditures. There may be bipartisan opportunities in the next two years to put in some fixes to save the Medicare program. You are right, making legislation and policy for the benefit of the taxpayer/beneficiary should be the objective of Congress and DHHS.

Expand full comment

"How does one reconcile the fact that we mandate a better deal for business than we do for taxpayers?"


This is easy. Just look at campaign contributions to Congress.

If we want to reduce undue corporate influence of Congress, there is only one solution - REMOVE MONEY FROM POLITICS!

The only way to do this to completely and totally fund political campaigns from public funds. Due to the finite limit of such funds (which would likely have to be collected via a new tax assessment on everyone), political campaigns would have to be reduced in time to perhaps no longer than 8-12 weeks with hard spending limits imposed.

Corporate and PAC contributions to politicians or on behalf of them would have to be completely banned and individual contributions would need to be capped at a low level (less than $500/person?).

This would throw a big wrench into the current politician election horserace business model and would, of course, be strongly resisted by all those who profit from the current arrangement - from corporations to politicians to the media.

But doing this would solve the problem of corporate ownership of our politicians and allow politicians to make decisions based on the merits, rather than who gave them the most money..

Expand full comment

Recently retired hospital pharmacy executive here. I agree 340b has gone beyond its original scope for disproportionate care. Any reform to healthcare finances must not make access to care and medications worse than it currently is for patients not lucky enough to have Cadillac level insurance.

Some perspective on the Humira (really, all 340b eligible drugs) - it is considered an outpatient treatment so it is not reimbursed by most insurance for inpatient use. Hospitals can't use the 340b price for inpatient use.

Also, while there is a benefit to hospitals/pharmacies on 340b eligible patients/drugs, there are more cases in which Medicare/Medicaid reimburse at a rate lower than the acquisition cost or the overall cost of care. The intent of 340b was to try and provide relief to the hospitals that provide care to a large population of Medicare/Medicaid or uninsured patients (disproportionate share or DHS) for which they loose money. I agree though that Health System have gamed the process by expanding contract pharmacies and patient eligibility well beyond the DSH concept.

Healthcare finances are very broken and a bipartisan approach is needed to make slow, incremental changes that will not completely break healthcare and will increase access of care to all.

Expand full comment

Thanks for this post.

Expand full comment

Fascinating piece Chris. Just wondering about the reference to the drug priced at $84k that has cost of $.12. What is that? Thanks

Expand full comment

340B is an illogical program as is Medicare and Medicaid both of which pay well below the cost of inpatient and outpatient institutional care. Until the government corrects the cost of care issue, health systems need illogical patchwork programs like 340B to correct the underpayment problems. You are too quick to criticize health systems for finding loopholes to patch the underfunding problem.

Expand full comment

While there is much I agree with here you fail to mention that legitimate nonprofit providers of care to the uninsured like fqhc's also benefit from 349b...and these benefits are often used to provide better care to there communities

Expand full comment