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PaperclipPerfector  5d ago (text post)   18133 thread views

Culture War Roundup for the week of August 11, 2025

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Federal Medicaid cuts in the OBBA are hitting NC in two months and they're pretty severe. The effects of this funding cut will slash a lot of things that I think most people right or left wing would agree are useful to have.

First every provider gets at least a 3% rate cut. Then due to the share of spending, a much larger rate reduction of 10% is on inpatient and residential medical institutions. This includes acute care hospitals, nursing homes, PTRFs (basically the mental hospitals/modern asylums), and intermediate care facilities (these are for intellectual/developmentally disabled people who need intermittent nursing).

The rate reductions will see an already stretched mental health system in the state need to cut back on access more. For an admin that claims to want more institutional treatment of the mentally ill, addicts, etc, this will ironically be one of the biggest deinstitutionalization effects in the state.

Another effect is the removal of GLP-1 drug coverage for obesity. I don't think I need to prove that they're very effective at weight loss, and obesity is a major health issue so a lot of people finally finding themselves losing weight are going to be hurting in the next few months as their prescriptions get cut. While GLP-1 medications isn't yet a net positive financially, the impact it has on people's health can not be ignored.

This also will likely hurt their ability to ensure proper compliance with the program.

Sangvai also indicated administrative cuts ahead, including ending or reducing contracts, letting temporary employees go, and ending some quality control and compliance functions. “These cuts will significantly impair NC Medicaid’s ability to be responsive to emerging needs and inquiries, monitor services for quality and compliance, and continue making timely operational improvements,” he wrote.

And as they point out

“Despite careful efforts to minimize harm, the reductions now required carry serious and far-reaching consequences. Most immediately, reduced rates and the elimination of services could drive providers out of the Medicaid program, threatening access to care for those who need it most,” Sangvai wrote. “NCDHHS remains hopeful that additional appropriations can be made to prevent these reductions.”

Medicaid reimbursement rates are already lower than commercial insurances tend to be and plenty of providers won't take it for that reason already.. This will likely get even worse, as poor and disabled people struggle to find providers.

This is especially going to hurt the poor rural areas (ones that voted Trump in) that are already struggling financially and don't benefit as much from economy of scale like the local areas.

About a week ago The Asheville Citizen Times did a report on the nearby rural Mitchell county and their upcoming fears over the cuts.

For example, they're worried that the already tight financials of the Blue Ridge Regional might be forced to close

During a June 19 special meeting of the Mitchell County Board of Commissioners, Jeff Harding, chair of the all-Republican board, said the hospital’s closure “could be devastating to our small community” and urged residents to contact their elected officials.

At the meeting, commissioners passed a resolution in support of the hospital, calling it a “vital resource,” one that saved lives during Helene, which devastated Mitchell and the surrounding counties the hospital serves.

Immediately after the storm hit, the hospital became a hub for relief efforts. It wasn’t just where people could go if they were severely injured and needed care, it was the one place where nonprofits, the federal government and others could show up and help, Kimmel said.

Blue Ridge Regional is the hospital of Spruce Pine, a town you might recognize from coverage of last year's storm as being one of the only places in the world with high quality quartz. It's still important to have some people in the surrounding region for this work (and other work providing for the quartz industry and workers) but their small size as mentioned before doesn't benefit from economy of scale and impact of automation has had a toll on their wealth too. Still they're very important to have around, making up anywhere from 80-90% of the high quality quartz used in the world. And sometime soon, they may be without a hospital, a hospital that was pretty useful during Helene.

So that's the issues my state is going to be facing soon. How is it going to impact your state Motte users?

Another effect is the removal of GLP-1 drug coverage for obesity. I don't think I need to prove that they're very effective at weight loss, and obesity is a major health issue so a lot of people finally finding themselves losing weight are going to be hurting in the next few months as their prescriptions get cut. While GLP-1 medications isn't yet a net positive financially, the impact it has on people's health can not be ignored.

Here is a fun idea maybe the junk food producers lobbied to get the coverage removed. It is a net positive in cost for everyone except those who profit to keep people eating pseudo-food and selling medications to fix the symptoms caused by obesity.

I just googled "medicare GLP-1 costs", and found this article:

Trump wants Medicare to pay for your Ozempic treatment. Taxpayers may foot the bill for billions in fraud

I am happy to hate Trump because he cuts of GLP-1 for millions. I could probably be persuaded to hate Trump because he wastes billions of dollars on GLP-1 drugs.

Unfortunately, I can not help but notice that both reasons to hate him seem mutually exclusive. While it is nice to know I can hate him no matter what he ends up doing, until he moves out of that superposition of bad options, I am stuck in a state of cognitive dissonance.

The annual US revenue of Novo Nordisk (Semaglutide) seems to be 45G$, while that of McDonalds is 25G$. Likely, NN's profit margin is a bit higher, so they could afford to out-lobby fast food.

--

The question if GLP-1 drugs are a net positive financially for the medical system is extremely cynical. Given that the lifetime patient costs mostly occur in their last years, it basically reduces to of the obese cost more before croaking than the non-obese or not. From a purely financial consideration, the most effective intervention (short of killing them outright) would probably be to offer free base-jumping courses and equipment to medicare patients. The government might spend 10k$ per death caused, which would be a lot cheaper than bypass surgeries, chemotherapy or keeping a dementia patient alive for a decade.

The compassionate, EA-ish metric would be cost per quality adjusted life-year (QALY). Both measles vaccines and doing a full-body MRI scan for tumors once a month are interventions which would boost the QALY of the median patient. But the former is pretty cheap and pretty effective and the latter is very expensive and not very effective, so we pay for one and not for the other.

For GLP-1 agonists, a lot depends on the cost per month.

That fortune article with their moral panic about fraud mentions:

The government recently estimated that covering GLP-1 drugs for obesity would cost Medicare alone $35 billion from 2026 to 2034.

What they forget to mention is that this is peanuts. If half of the patients enrolled with medicare get GLP-1 drugs, that is 35M patients. So the cost per patient per year would be 200$. That is a factor of 60 less than the sticker price of 1000$ a month! If somehow every obese American defrauded the US government into paying 200$ per year for GLP-1 drugs, that would be even better.

I do not think that this is happening, though. I recently turned to biopiracy to knock a few points of my BMI (I will write an article about my experiences on LW at some point), and I will likely spend north of 100$/year on peptides from China. Of course, the medical system will not have patients reconstitute peptides in their kitchen and inject what they think is the correct dose using insulin syringes with no medical or pharmaceutical oversight. Even weekly subcutaneous injections of saline would probably cost 500$ a year.

Yeah, this whole thread, I'm thinking, "someone mention that the costs are too high", and you got the closest. If you showed this thread to Trump, he'd probably argue that he's working on pressuring the drug companies to bring prices down. How likely that is to work is another matter entirely.

I suspect that, if prices don't come down, this will mean budget cuts for my workplace, and that will almost certainly result in some unpleasantness with supplies and their quality.

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