Politics. It takes a certain amount of hubris to think you can save people from themselves. In Washington you can find the highest concentration of such vanity than anywhere on Planet Earth. In fact, as the beautiful city of Washington depopulates, prideful people appear to have overtaken lawyers on a per capita basis.
You know them by how they start a sentence.
“No one should have to….”
Sometimes varied with the prefix “In the wealthiest country on earth…”
It is bipartisan. Sen. Lindsey Graham is just as likely to bring home the bacon as Sen. Amy Klobuchar. Afterall, who runs for office to do nothing? The very pretext for the grueling process of campaigning and serving is all the great things you will “get done for the American people.”
There was a time – mostly during the last period of populism, 1ish, when the federal government was called upon and delivered such things as a social safety net and consumer protection.
Today, federal governance’s power to move the needle on the quality of American life has shrunk to the point that problems are concocted, and stories told that only matter to an increasingly small number of people. (See the myth of value-based care.)
Not that problems are going away. They are not. What is becoming increasingly obvious is that even the federal government has to admit, when it comes to health care, there are limits on what a government can do other than whip out the checkbook.
Policy. In 2020, when the Centers for Disease Control and the Food and Drug Administration made testing for COVID available without a doctor’s order, we once and for all defined self-care in a new and more expansive way.
The widespread access to a diagnostic test for COVID was preceded by the Obama administration’s decision to end REMS for mifepristone and make it available via telehealth.
In both cases, political expediency was the motive. The Trump administration was under pressure to “test more.” The Obama White House was counter detailing new state laws restricting abortion.
Last week the Food and Drug Administration approved for Over-the-Counter use, DXCM’s Continuous Glucose Monitor. The approval is important because there does not appear to be any obvious political motive. Rather, the Food and Drug Administration is following a policy that encourages over-the-counter availability of products that pose no serious safety concern.
The policy encourages more personal control of a critical health metric – glucose level. It also recognizes that in this world of fluid information and access, a CGM is about as far away as eBay.
The COIVD generation of 20-30 somethings is not waiting around for a doctor to tell them what their point-in-time glucose level is. They are going to figure it out for themselves.
Power. Not everyone in Washington agrees that your average American can figure out how to take care of themselves. Although the Food and Drug Administration and the Centers for Medicare and Medicaid are making nice in public, the missiles fly between the Humphrey Building and Bethesda.
The latest incoming is the Food and Drug Administration’s label expansion for Wegovy last week. The drug may be prescribed for cardiac disease in people that are overweight or obese. The prospect of Medicare coverage remains unclear. Part D plans may exclude drugs for weight loss by law.
As CMS is under extreme pressure to demonstrate the drug price control provisions in the Inflation Reduction Act worked, the coverage challenge presented by the Food and Drug Administration’s label expansion is unwelcome news.
They have the precedent of highly controlled coverage of Alzheimer’s drugs especially since the long-term benefits of Wegovy are not yet known. Ironically NOVO may concur. Widespread use of Wegovy would put it on the Medicare drug negotiation list in a heartbeat.
Of course, in the world of self-care, semaglutide is but a 1-800 number away according to the signs in the right of way near my house.
Have a great rest of your weekend.