Category: Policy and politics

Delay = Death. We must speed up COVID-19 vaccinations

published date
December 30th, 2020 by

Israel is proceeding nearly 10x as fast as the US on COVID-19 vaccination. We need to accelerate dramatically right now in order to save tens of thousands of lives over the next several weeks. Use all the supply we have now, don’t hold it back at the federal, state or hospital level! Go 24×7.

I’m quoted in the Boston Globe (Biden, public health critics slam slower-than-promised pace of US COVID-19 vaccination rollout. “This should be D-Day right now,” said one expert. But it’s not.)

“Speed is what matters,” said David Williams, president of Health Business Group, a Boston management consulting firm. “This should be D-Day right now. But what’s happening nationally is it’s just being done in a bureaucratic manner and it’s not being done with the urgency you’d do in a civil defense or war-time exercise.”

Williams cited Oxford University data showing Israel, with a population not much bigger than Massachusetts, already has administered 5.68 doses per 100 people compared to the US total of 0.64 per 100.

Let’s get going!

By healthcare business consultant David E. Williams, president of Health Business Group

Why is Massachusetts failing at COVID-19 vaccination?

published date
December 28th, 2020 by

Israel (population 9M) has already vaccinated 200,000 people against COVID-19 with the Pfizer/BioNTech vaccine and expects to be injecting over 100,000 per day shortly.

Massachusetts (population 7M)  has injected only 35,000 so far. Here, as in many other states, half the doses are being saved as boosters and not injected out of fear that a future supply glitch could delay dosing from a supposedly magical 21 or 28 day target time.

In Israel, senior residences had multiple stations manned by the local equivalent of the Red Cross, and military personnel with medical training are being used as well. Israel is prepared to ramp up to a 24/7 vaccination schedule if needed. They are treating it as an emergency, which it clearly is.

In Israel, the teams are equipped with epinephrine to handle the occasional severe reaction, which seems to be an issue with both the Pfizer and Moderna vaccines.

Meanwhile, what is the actual logistical plan in Massachusetts? It seems pretty vague. I’ve heard from friends at Boston teaching hospitals (and read in the press) that distribution is a mess. There is general talk of drugstores like CVS and Walgreens providing shots. Are they going to be ready with epi-pens or just call 911?

And what about the idea of giving one shot instead of two if supply is tight? We might get to herd immunity faster if we applied creative approaches such as this one.


By healthcare business consultant David E. Williams, president of Health Business Group

Niall Brennan brings data to the healthcare party

published date
November 19th, 2020 by

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HCCI CEO, Niall Brennan

Niall Brennan isn’t one to pull punches. From his perch as CEO of the Health Care Cost Institute he uses data to call out the moral and ethical failures of the US healthcare system. Insulin pricing, air ambulances, surprise billing, the pandemic. Whatever the topic, Brennan brings his sharp wit and deep reservoir of healthcare knowledge.

Before HCCI, Brennan was Chief Data Officer for the Center for Medicare and Medicaid Services and a staffer at Brookings, MedPac, the Congressional Budget Office and the Urban Institute. So his is the perspective of someone who knows what he’s talking about.

For reading, Niall recommends Say Nothing by Patrick Radden Keefe about the ‘Troubles’ in Northern Island and Let’s Go (So We Can Get Back), an autobiography by Wilco lead singer Jeff Tweedy.

The HealthBiz podcast is available on SpotifyApple PodcastsGoogle Podcasts and  many more services. Please consider rating the podcast on Apple Podcasts. Doing so helps the podcast reach more listeners.

Below is a rough (AI generated) transcript of the episode. Click on a word if you want to start the podcast from a particular spot.

By healthcare business consultant David E. Williams, president of Health Business Group

ICER founder Dr. Steve Pearson explains COVID-19 remdesivir pricing model

published date
November 12th, 2020 by

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Dr. Steve Pearson

Drug pricing is the hottest topic in healthcare, and ICER founder Dr. Steve Pearson is the coolest person to discuss it with.

In this episode of the HealthBiz podcast, Steve describes how the Institute for Clinical and Economic Review (ICER) compiles and analyzes clinical evidence to estimate the fair value of treatments for cancer and other serious illnesses. ICER has been especially active during the pandemic, developing a pricing model for remdesivir and other COVID-19 therapies that’s being used in the United States and by health technology assessment agencies around the world.

For fun, he has been reading Paradise Lost by John Milton.

This is the second episode I’ve recorded on COVID-19 drug pricing. Check out the first one: Remdesivir powers activate! with Dr. Surya Singh.

The HealthBiz podcast is now on SpotifyApple PodcastsGoogle Podcasts and  many more services, making it easy to subscribe.

Below is a rough (AI-generated) transcript of the episode.


By healthcare business consultant David E. Williams, president of Health Business Group


Obamacare is about more than pre-existing conditions

published date
September 29th, 2020 by
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I swear to uphold pre-existing condition protections

The Affordable Care Act (aka Obamacare) is a comprehensive law that affects every corner of the healthcare system. It’s unreasonable to expect voters to grasp every nuance of the law, but it is useful to go a step beyond the current public discussion that says, essentially, individual mandate: bad, coverage for pre-existing conditions: good.

Bottom line: opponents can’t simply get rid of Obamacare, declare pre-existing conditions covered and call it a day.

Consider the example of a family friend whose  son was diagnosed with an auto-immune disorder in his early teens. It’s kept under control with a biologic drug that costs over $100,000 per year. There are other costs for diagnostic tests, specialist appointments, and the potential need for hospitalization and surgery. The parents are self-employed; they pay Blue Cross about $30,000 per year for insurance.

In a free market, the family would be uninsurable –or the “pre-existing condition” wouldn’t be covered and the family would face financial ruin. My guess is Blue Cross pays out $100,000 to $200,000 per year for this family –guaranteeing a big loss on the $30,000 premium!

It actually makes sense from the insurance company’s perspective to reject people with pre-existing conditions. After all, you can’t buy life insurance if you’re at high risk of death, you can’t buy homeowners insurance if your house is on fire, and you can’t buy auto insurance to cover a crash you just had.

Under Obamacare we decided as a country that pre-existing conditions would be covered. That wasn’t the consensus before.

But there’s more to Obamacare than just requiring insurance companies to pay for the treatment of pre-existing conditions. Consider some related protections that would evaporate if Obamacare were repealed or ruled unconstitutional.

Obamacare prohibited insurers from doing a lot of other things they used to do. Under the law:

  • You can’t be charged a higher premium because of pre-existing conditions
  • Your premium can’t go up and your policy can’t be canceled because you got sick
  • Insurers cannot impose an annual or lifetime cap on medical expenses

In order for such a system to work, everyone needs to have insurance. That’s where the mandates for employers and individuals to buy insurance come in. The mandates are not about taking away the freedom to decide whether to buy insurance, they are about making sure there are enough healthy people in the system to cover the costs of those who get sick.

The likely alternative to Obamacare isn’t a “free” market. People won’t stand for it. Rather it’s some version of Medicare for All.


By healthcare business consultant David E. Williams, president of Health Business Group