There's just little if any engagement for me on this site. I hardly ever add followers. There isn't much engagement on Twitter either anymore (and I don't like X), but at least there's some. I bid farewell to my very few followers here on Bluesky. I just can't waste my time posting into the void.

Health savings accounts are in vogue, at least in Republican circles. Though a useful addition to insurance for some, the financial risks for patients with HSAs (coupled with high-deductible or limited benefit plans) are large should they become ill. www.forbes.com/sites/joshua...

Medicare Advantage's rise in popularity appears to have peaked. And now plans face unprecedented headwinds from both large increases in medical costs and greater scrutiny by the federal government along with lower reimbursement rates. www.forbes.com/sites/joshua...

Media outlets reported that the U.S. was willing to pay a lump sum of up to $100,000 to each Greenlander to persuade them to break away from Denmark and join the U.S. Here, I explain why that's not an attractive offer. www.forbes.com/sites/joshua...

The White House released a healthcare framework that's more of a call to action than a plan. It offers few specifics and raises more questions than answers on each point of the 1½-page document. www.forbes.com/sites/joshua...

Here's my perspective on the third round of pharmaceuticals selected for Medicare price negotiation. www.forbes.com/sites/joshua...

The Trump administration has said that while it is pushing for lower pharmaceutical prices in the U.S. drugmakers will be able to make up the difference by charging higher prices abroad. Here, I explain why this is unlikely to occur. www.forbes.com/sites/joshua...

Puzzled by the strong emphasis in the new U.S. dietary guidelines on animal-based products at the expense of predominantly plant-based diets. Pushing meat and animal-based products while underplaying plant-based vegetarian options strikes me as unbalanced. www.forbes.com/sites/joshua...

Discontinuing obesity medicines means the weight comes back for many and people lose the cardiovascular and metabolic benefits conferred by the drugs. www.forbes.com/sites/joshua...

New dietary guidelines dropped this week. While they say that “saturated fat consumption should not exceed 10% of total daily calories,” the new food pyramid features red meat, cheese and whole milk at or near the top. RFK Jr said "we're ending the war on saturated fats." undark.org/2026/01/09/d...

Expiration of Affordable Care Act enhanced subsidies is leading to a surge in premiums. The problem of ACA premium affordability is symptomatic of a much larger, systemwide problem in U.S. healthcare. Comprehensive reforms are needed. www.forbes.com/sites/joshua...

Launch of the Wegovy pill may improve patient adherence and persistence. The convenience of a pill may be critically important for some patients. This may expand the market but also improve patient persistence and therefore sustainability of long-term outcomes. www.forbes.com/sites/joshua...

Childhood Vaccine Schedules Among Most U.S. Peers Differ Only Slightly via @forbes.com @joshuapcohen.bsky.social www.forbes.com/sites/joshua...

Differences between the U.S. and peer nation vaccination policies illustrate the importance of context, not only with regard to distinct healthcare systems but also concerning the stance on vaccines taken by public health officials. www.forbes.com/sites/joshua...

Differences between US and peer childhood vaccine schedules are quite minor. Where key policy differences have emerged, however, is that unlike in the US public health officials in peer nations don't make false assertions about vaccines and sow doubt among the public. www.forbes.com/sites/joshua...

Despite the cost burden to the federal government, the increase in Medicare spending on prescription drugs is a good thing, particularly for those taking (often) lifesaving medications. www.forbes.com/sites/joshua...

Mehmet Oz's "just be healthy" narrative to counter the flu is odd. While it isn’t wrong to tell people to lead healthier lives, misinforming the public on the flu jab and appearing to downplay the disease’s impact aren’t in the interests of public health. www.forbes.com/sites/joshua...

As health insurers drop coverage of weight loss drugs, access worsens for low-income folks who may have a disproportionate need for them. www.forbes.com/sites/joshua...

Some predictions for the new year (on the economy, public health, and healthcare): www.forbes.com/sites/joshua...

It's a sign of dysfunction that Congress can't get its act together and come up with compromise legislation to extend enhanced ACA subsidies temporarily while introducing reforms to the program. www.forbes.com/sites/joshua...

There is a lot more than meets the eye regarding the U.S.-U.K. trade deal involving eliminating tariffs on British exports of pharmaceutical products and increasing the nation's spending on new prescription drugs. www.forbes.com/sites/joshua...

For more than 15 years, there's been a push for increased availability of over-the-counter meds in therapeutic classes for which no OTC options currently exist. But the results have been meager. Will FDA Commissioner Makary's call for changes in policy fall flat? www.forbes.com/sites/joshua...

The entire vaccine ecosystem is under threat, prompted less by evidence than a seeming desire to upend a system that has worked well for the American population for decades. www.forbes.com/sites/joshua...

Changes in hepatitis B vaccine guidance may be laying the groundwork for an overhaul of the entire childhood vaccine schedule. www.forbes.com/sites/joshua...

Science isn't settled on the role male infertility may be playing in falling birth rates. In a word or two: It's complicated. undark.org/2025/12/03/m...

Trump may have a healthcare plan, but part of it (temporary extension of Obamacare premium subsidies) has apparently been rebuffed by fellow Republicans. www.forbes.com/sites/joshua...

Artificial intelligence to guide use of oft-criticized prior authorization in Medicare demonstration project, starting next month. www.forbes.com/sites/joshua...

On the public health front, good news is hard to come by these days. But progress in the fight against malaria is unequivocally a positive thing. Public-private partnerships established 30 years ago have paid dividends in terms of better treatments and vaccines. www.forbes.com/sites/joshua...

Centers for Medicare and Medicaid Services revealed important details regarding the most-favored nation approach to drug pricing being pursued by the Trump administration. Despite more clarity, many questions remain unanswered. Here for @Forbes I explain. www.forbes.com/sites/joshua...

The Trump administration revealed prices it negotiated for 15 top-selling drugs in Medicare's outpatient pharmacy benefit. The 44% drop in price is impressive. But there's more to it than meets the eye. Here, for @Forbes I explain. www.forbes.com/sites/joshua...

6yrs ago the hub’s cousin was fighting for his life on ECMO. He then got a lung transplant. Today, we did a 5K as a family. Sometimes lung transplant is just amazing. Tis the season to be thankful. Happy thanksgiving.

The cost-effectiveness threshold used by the National Institute for Health and Care Excellence in Britain may soon be raised. Here, I describe what's going on and what the implications may be for prescription drug spending. www.forbes.com/sites/joshua...

As we've entered open enrollment season, there's sticker shock in both the ACA/Obamacare and commercial health insurance markets. www.forbes.com/sites/joshua...

The price deals cut on obesity drugs will have a negligible effect on Medicare beneficiary access. Same holds for other patients. And the agreement raises a series of unanswered questions which we won't find answers to, given the confidential terms of the negotiations. www.forbes.com/sites/joshua...

Republicans appear to have more than just "concepts of a plan" on healthcare. A GOP plan taking shape to redirect Obamacare subsidies to individuals who can use them for health savings accounts could erode the foundation of the Affordable Care Act. www.forbes.com/sites/joshua...

The Trump administration's announced price cuts for weight loss drugs are certainly interesting. But what's been released to the public raises more questions than answers. www.forbes.com/sites/joshua...

As states form coalitions to counter what they view as detrimental public health policy emanating from the Trump administration, I'm reminded of one of our nation's founding principles: Federalism. This piece is about that, using the state alliances as an illustration. www.forbes.com/sites/joshua...

The British government is considering raising the level of a cost-effectiveness threshold used as a benchmark to determine whether a healthcare intervention provides value for money for the National Health Service. www.forbes.com/sites/joshua...

Democrats introduced a bill that would repeal the orphan-only drugs exemption included in the One Big Beautiful Bill. As is almost invariably the case with legislation, this repeal effort as well as the orphan-only drugs exemption itself entail tradeoffs. www.forbes.com/sites/joshua...

Biosimilar access in the U.S. is improving. But barriers have prevented these lower-priced versions of originator biologics from truly flourishing. FDA is addressing approvals, but two often bigger hurdles - patent disputes and payer reimbursement - remain. www.forbes.com/sites/joshua...

I sense some skepticism in the commentary around the health insurer Cigna's policy announcement this week. While I'm not sold on the idea that this heralds the end of rebates that don't get passed through to patients, it's a step in the right direction. www.forbes.com/sites/joshua...

On health insurance, the media and politicians in Washington DC tend to focus on federal government spending in programs such as Medicaid and Obamacare. This ignores, however, the much larger subsidies given in the commercial sector. www.forbes.com/sites/joshua...

Like many Americans, I found out this morning how large the spike in health insurance premiums will be in 2026. In my case, 16% (over $100 per month more than in 2025). Americans are paying much more in premiums each year for worsening coverage. It's absurd. www.forbes.com/sites/joshua...

It's that time of year again: Open enrollment, when many Americans select health plans for the upcoming year. Across the Obamacare exchanges, monthly premiums are rising by as much as 30% on average. And this doesn't account for the expiring subsidies. www.forbes.com/sites/joshua...

Direct-to-consumer advertising of prescription medications is ubiquitous. The Trump administration is addressing what it sees as a "public health crisis." But will things change with respect to these commercials? undark.org/2025/10/27/d...

On this rainy day in Boston, my piece on the sun (its benefits), sunscreen (its protective properties), and the anti-sunscreen movement, is out. undark.org/2025/10/13/a...

Kennedy’s repeating refuted (or at least disputed) links isn’t a one-off. He has often done this regarding exposure to substances such as acetaminophen, thimerosal and aluminum salts that he thinks are tied to autism. www.forbes.com/sites/joshua...

Without critical details, it's hard to evaluate the impact of Trump's most favored nation initiative on drug pricing for patients and Medicaid. www.forbes.com/sites/joshua...

Is Trump's most favored nation initiative consequential? Well, not for the vast majority (>90%) of U.S. patients. It could be meaningful for Medicaid payers, but even that remains to be seen. For now, the impact on Medicaid is shrouded in opacity. www.forbes.com/sites/joshua...