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The Obamacare Dilemma in One Infographic

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The future of Obamacare is uncertain, to say the least.

President-elect Donald Trump has consistently called to repeal or replace the Affordable Care Act throughout his campaign, but many pundits see this as being a catch-22 for the incoming administration.

America’s healthcare system is already a global outlier (in a bad way), with disproportionate amounts of money being spent for very little return on life expectancy. For that reason, many people see the additional coverage of 20 million new people through Obamacare as a crucial step forward.

However, this new coverage hasn’t come without major challenges. Obamacare is plagued by soaring premiums, insurers leaving the program, and coverage monopolies in certain states. This puts America’s healthcare at an inflection point, and no one really seems to know how to solve it.

The Obamacare Dilemma

The following infographic from Healthgrad sums up the most recent metrics on Obamacare, as well as showing the double and triple digit rises in premiums that some states are facing.

The Obamacare Dilemma Infographic

As the infographic notes, the cost of healthcare has continued to escalate year after year, outpacing both inflation and wage growth. Obamacare has not been immune from this trend, and premiums are now being hiked because of low enrollment, mispriced plans, a dwindling pool of insurers, decreased competition in exchanges, and sicker patients than expected.

Despite only 25% of Americans supporting the outright repeal of Obamacare, it’s looking more and more likely that the healthcare system of tomorrow won’t look quite like it does today.

The Post-Obamacare Era

Right now, nobody knows quite what the future holds for U.S. healthcare.

Repealing or replacing Obamacare is fraught with at least six major issues, but perhaps the most significant one is a lack of decisiveness within the Republican party itself. What would Obamacare be replaced with, and how would that change be implemented?

Interestingly, there are at least seven Republican plans that have been tabled to replace Obamacare. Within that group, two of the more prominent ones come from Georgia Rep. Tom Price and House Speaker Paul Ryan.

Tom Price, who is Trump’s pick as the incoming secretary for the Department of Health and Human Services (HHS), has already published his consumer-driven healthcare model, and it already exists in legal language. In additional, Paul Ryan released his own proposal in the form of the A Better Way plan earlier this year, which also touches on other issues such as poverty, national security, and the economy.

Despite the number of options, the problem is that no one can agree on a particular solution. The party is heavily divided, and Trump is already receiving heavy blowback from the Tea Party faction for telegraphing potential delays in repealing or replacing the act.

Yes, the future of U.S. healthcare is murky – even to Trump and the GOP. However, what is clear is that with most chips stacked in the Republicans favor over the coming years, it is unlikely that they will miss the opportunity to initiate the post-Obamacare era in some shape or form.

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Healthcare

Infographic: Which Rare Diseases Are The Most Common?

Rare diseases affect upwards of 350 million people worldwide. This infographic breaks down their types and prevalence, and estimated related drug sales.

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Infographic: Which Rare Diseases Are The Most Common?

Pharmaceuticals have come a long way since the apothecary days of prescribing cocaine drops for toothaches, or dispensing tapeworm diet pills.

Today, medical breakthroughs like antibiotics and vaccines save millions of lives, and contribute to the industry’s mammoth size. Yet even with rapid advancements, a select group of rare diseases still fly under the radar — and together, they affect over 350 million people worldwide.

What Are Rare Diseases?

Today’s infographic from Raconteur breaks down occurrence rates of notable rare diseases, and their collective impact on pharmaceutical drug sales. But first, let’s look at how they’re defined.

Diseases are considered rare, or “orphan” if they affect only a small proportion of the population. In general, it’s estimated that 1 in 17 people will be afflicted by a rare disease in their lifetime. At the same time, as many as 7,000 rare diseases exist, with more discovered every year.

A report by the global investment bank Torreya looks at the most common types of rare diseases that are a focus for therapeutic companies around the world:

  • Multiple sclerosis emerges above all others, at 90 patients per 100,000 people.
  • Narcolepsy—intermittent, uncontrollable episodes of sleepiness—affects 50 patients per 100,000.
  • Primary biliary cholangitis, the damage of bile ducts in the liver, affects 40 people in 100,000.
  • Rounding out the top five orphan diseases are Fabry disease (30 patients per 100,000), and cystic fibrosis (25 patients per 100,000).

One catch behind these stats? There’s actually no universal definition of what constitutes a rare disease. This means prevalence data like the above is often inconsistent, making it difficult to record the precise rate of natural occurrence.

The Cost of Rare Diseases

This gap in knowledge comes at a price—many rare diseases have constrained options for treatment. Orphan drugs are often commercially underdeveloped, as their limited end-market usage means they aren’t usually profitable enough for traditional research.

In the United States, government-backed incentives such as tax credits for R&D costs and clinical trials are speeding up the pathways from drug to market. Other places like the EU, Japan, and Australia are also following suit.

In total, it’s estimated that pharma companies focused on rare diseases are worth about half a trillion in enterprise value, roughly equal to 17.5% of the value of Big Pharma:

  • Non-oncology value: $315.7B
  • Oncology value: $193.1B
  • Total enterprise value: $508.8B

Source: Torreya Report. Market values are for the top 31 pure play rare disease therapeutic companies.

The average cost of an orphan drug per U.S. patient annually can climb to near $151,000 (a whopping 4.5 times that of a non-orphan drug, at $34,000). That’s why the pharma industry is urgently advancing rare disease therapeutics across different categories.

Dominant Orphan Drug Sales

According to other estimates, orphan drugs are set to capture over one-fifth of global prescription sales by 2024. Blood, central nervous system, and respiratory-related drugs are currently the top therapeutic categories and are expected to keep this status into the future.

The figures below break down global orphan drug sales by therapy category, and their present and estimated future market share. Note that oncology-related orphan drug sales are excluded from this table.

Therapy Category2018 SalesMarket Share2024E SalesMarket ShareChange in Market Share
Total Sales$67.9B$118.5B
Blood$21.3B31.4%$33.1B27.9%-3.4%
Central nervous system (CNS)$11.1B16.3%$20.3B17.1%0.8%
Respiratory$7.8B11.5%$13.6B11.5%0%
Immunomodulators$7B10.3%$12.5B10.5%0.2%
Cardiovascular$6.7B9.9%$8.5B7.2%-2.7%
Endocrine$3.8B5.6%$5.6B4.7%-0.9%
Musculoskeletal$3.5B5.2%$11B9.3%4.1%
Systemic anti-infectives$3.1B4.6%$4.2B3.5%-1%
Gastro-intestinal$2.9B4.3%$6B5.1%0.8%
Genito-urinary$0.6B0.9%$1.5B1.3%0.4%
Sensory organs$0.1B0.1%$1.5B1.3%1.1%
Dermatology$0B0%$0.7B0.6%0.6%

Source: EvaluatePharma. Industry sales are based on the top 500 pharma and biotech companies.

Much is still unknown about rare diseases in the health community. Frequent misdiagnosis, and up to an average of 8 years for an accurate diagnosis, continue to be a problem for patients.

There are two sides to the situation. On one, tech giants like Microsoft are providing digital health solutions to speed up diagnosis, through machine learning and blockchain-based patient registry.

On the other, many skeptics question whether the industry is interested in finding cures for rare diseases at all, especially when they account for a significant portion of industry revenues.

Is curing patients a sustainable business model?

Goldman Sachs

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Demographics

Visualizing Over A Century of Global Fertility

Global fertility has almost halved in the past century. Which countries are most resilient, and which have experienced the most dramatic changes over time?

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Visualizing Over A Century of World Fertility

In just 50 years, world fertility rates have been cut in half.

This sea change can be attributed to multiple factors, ranging from medical advances to greater gender equity. But generally speaking, as more women gain an education and enter the workforce, they’re delaying motherhood and often having fewer children in the process.

Today’s interactive data visualization was put together by Bo McCready, the Director of Analytics at KIPP Texas. Using numbers from Our World in Data, it depicts the changes in the world’s fertility rate—the average number of children per woman—spanning from the beginning of the 20th century to present day.

A Demographic Decline

The global fertility rate fell from 5.25 children per woman in 1900, to 2.44 children per woman in 2018. The steepest drop in this shift happened in a single decade, from 1970 to 1980.

In the interactive graphic, you’ll see graphs for 200 different countries and political entities showing their total fertility rate (FTR) over time. Here’s a quick summary of the countries with the highest and lowest FTRs, as of 2017:

Top 10 CountriesFertility rateBottom 10 CountriesFertility Rate
🇳🇪 Niger7.13🇹🇼 Taiwan1.22
🇸🇴 Somalia6.08🇲🇩 Moldova1.23
🇨🇩 Democratic Republic of Congo5.92🇵🇹 Portugal1.24
🇲🇱 Mali5.88🇸🇬 Singapore1.26
🇹🇩 Chad5.75🇵🇱 Poland1.29
🇦🇴 Angola5.55🇬🇷 Greece1.3
🇧🇮 Burundi5.53🇰🇷 South Korea1.33
🇺🇬 Uganda5.41🇭🇰 Hong Kong1.34
🇳🇬 Nigeria5.39🇨🇾 Cyprus1.34
🇬🇲 Gambia5.29🇲🇴 Macao1.36

At a glance, the countries with the highest fertility are all located in Africa, while several Asian countries end up in the lowest fertility list.

The notable decade of decline in average global fertility can be partially traced back to the actions of the demographic giants China and India. In the 1970s, China’s controversial “one child only” policy and India’s state-led sterilization campaigns caused sharp declines in births for both countries. Though they hold over a quarter of the world’s population today, the effects of these government decisions are still being felt.

Population Plateau, or Cliff?

The overall decline in fertility rates isn’t expected to end anytime soon, and it’s even expected to fall past 2.1 children per woman, which is known as the “replacement rate”. Any fertility below this rate signals fewer new babies than parents, leading to an eventual population decline.

Experts predict that world fertility will further drop from 2.5 to 1.9 children per woman by 2100. This means that global population growth will slow down or possibly even go negative.

Africa will continue to be the only region with significant growth—consistent with the generous fertility rates of Nigeria, the DRC, and Angola. In fact, the continent is expected to house 13 of the world’s largest megacities, as its population expands from 1.3 billion to 4.3 billion by 2100.

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