First down the chimney is David Williams at Health Business Blog. Let’s see what he is pulling out of his sack…hmmmm, this look like an interesting package. Partners HealthCare is the 800-pound gorilla in the Massachusetts healthcare market and as such gets a lot of scrutiny. So, Partners is excited that a 700-pound gorilla —in the form of BI-Lahey— has arrived on the scene to take away some of the focus. That’s enabling Partners to move forward with a plan to open lucrative outpatient centers. By the way, David is quoted on the topic in the Boston Globe.

Next out of the bag is a post from Tom Lynch at Workers’ Comp Insider about the prohibitive cost of pharmaceuticals and what hangs in the balance when patients can’t pony up. Tom Lynch asks What Price Life?  He talks about a chronic disease requiring medication, which, if not taken every day, guarantees death within two weeks.  But the problem is that over the past 20 years prices for that medication have risen anywhere between 800% and 1,175%.

With prices skyrocketing, Hank Stern at InsureBlog talks about a solution to copays, deductibles and coinsurance that can make health insurance unaffordable, even when the premiums are paid. Henry Stern introduces us to The Zero Card, whereby all deductibles, co-pays and co-insurance are waived – and this is available for at least a fraction of the market. Read the blog for the details and fine print.

More good news in health insurance. Louise Norris at Colorado Health Insurance Insider is here with a gift for people who think they earn too much to qualify for ACA subsidies. She says, ” We talk a lot around here about the subsidies provided by the ACA.  In Colorado, people with household incomes up to 138% of poverty (133% plus the built-in 5% income disregard) are eligible for Medicaid.  If your household income is between 138% and 400% of poverty, you most likely qualify for a subsidy to help cover the cost of a private plan purchased through the exchange; a family of four can earn more than $100,000 in 2019 and still be eligible for premium subsidies!”

On the other hand, you might want to look that ACA gift horse in the mouth. Andrew Sprung at XPostFactoid says that some of the protections of the ACA may be going away. In Will your state waive goodbye to ACA’s protections? Andrew looks at how ACA innovation proposals that conform to the “waiver concepts” recently issued by CMS might affect people with pre-existing conditions as well as low income and older marketplace enrollees. It also questions whether proposals conforming to the “concepts” could survive legal challenge.

Joe Paduda at Health Care Matters believes he has found the root of the healthcare problem and is recommending coal for Capitalism’s stocking. “Capitalism will not solve Healthcare because Capitalism is the problem with healthcare,” he says. And he backs up his opinion with lots of examples. “California’s dialysis mess, pharmacy pricing, and pretty much every other sub-sector of healthcare provides ample evidence of why the free market is the driver of our lousy and wildly expensive healthcare.”

Meanwhile, Jessica Williams, PhD MA at The Medical Care Blog sheds light on ways people are trying to control the cost of  care and improve outcomes, in this case through obesity and diabetes research. This post explores the questions: What research questions in obesity and diabetes should be prioritized? Which topics matter most to people with those conditions? Recent research from the Patient-Centered Outcomes Research Institute (PCORI), published in Medical Care’s October supplement, revealed 8 important topics for research from the perspective of researchers, clinicians, and people with diabetes and/or obesity – two of the largest drivers of healthcare expenditures.

Ah, but the 2018 holiday season does not end the 2016 political season. Roy Poses tackles a thorny issue with From Russia with Money – Harvard Medical School Accepts $200 Million from Russian Emigre with Ties to Russian Oligarchs and Putin, and Who Is Under Investigation for US Election Meddling. The details are riveting, and I encourage you to spend time looking at all the angles that Roy presents in this post at HC Renewal.

Let’s wrap up this holiday edition with a big red bow. Here’s the CareTalk Podcast, #CareTalk: Bipartisan Breakthroughs on Health Policy with hosts John Driscoll (CEO of CareCentrix) and David Williams (President, Health Business Group). In this month’s episode of #CareTalk youtube.com, David Williams (Health Business Group) and John Driscoll (CareCentrix) discuss how the outcome of the 2018 mid-term elections will impact healthcare moving forward. This is always an enjoyable presentation of serious material. During these 12 minutes, you get to see a Red Sox World Series Championship cap and hear what I thought may have been a suggestion for Alex Cora to manage the healthcare system.

Dash away, dash away, dash away, all!

Seasons come and seasons go. Yes, in healthcare, too. We’ll open this week’s HOT Health Wonk Review looking at an enduring issue as Roy Poses of Health Care Renewal very nicely summarizes pharmaceutical marketing tactics and their effect on physicians and patients as it pertains to opiates. Some practices just keep coming around again.

Hope in a Bottle: Components of Purdue Pharma Stealth Marketing Campaign for Oxycontin Revealed by Legal Documents from Tennessee

The return of the good old days, sort of: a legal filing from the Tennessee Attorney General’s lawsuit against Purdue Pharma revealed multiple internal Purdue documents showing elements of the company’s stealth marketing campaign for Oxycontin.  These included: implied psychological manipulation of vulnerable physicians; perverse incentives for sales representatives; and use of third-party strategies (including creation of “astroturf” organizations) and miscellaneous deceptions.  More awareness and better understanding of such integrated, but deceptive marketing campaigns enables better resistance to them, and hence hopefully better professional decision making leading to better patient outcomes.  Previous stealth marketing campaigns have been revealed through litigation by the US government.  The Trump administration seems uninterested in pursuing corporate health care’s bad actors, but at least the baton has now been picked up by some state law enforcers.  Read more from Roy here.

While We’re Talking about Opioids…

Louise Norris of HealthInsurance.org tells us this year there has been an abundance of discussion about our national opioid abuse crisis and about strategies for addressing that challenge. But was the Affordable Care Act already helping address that crisis? Louise looks at how that ACA improved mental health coverage – including dramatically expanded access to additional treatment in some of the states hardest hit by the opioid crisis.

#CareTalk Podcast: Wry Healthcare Commentary with David Williams and John Driscoll

Podcast time, today our hosts David Williams and John Driscoll opine about the Right to Try law. “A great impulse and a dumb law,” says Carecentrix CEO John Driscoll. David Williams of Health Business Group agrees, “Right to try…who could argue with it, but it is a pretty cynical law.” It is redundant with compassionate use, and just removes the FDA to “take the smartest people out of the way,” says John. Lots of good stuff here as they look at a few other ways politics uses healthcare as a football. Watch, listen, learn right here.

High Deductible Health Plans: A Blunt Instrument that Doesn’t Work

High deductible health plans don’t work, so says Joe Paduda of Health Strategy Associates. Hear about why Joe calls high deductible plans “the bluntest of instruments” that has lots of nasty side effects and doesn’t reduce costs or improve care. Joe wonders “why the health plan industry is still selling these crappy plans.” Read more at Managed Care Matters where Joe talks about the ill effects of this health plan variant.

Much Ado About a Rounding Error? Looking at Sharing Ministries

Henry Stern of Insureblog channels Shakespeare while he questions if the faith-based ACA-compliant alternatives to ObamaPlans – now topping 1 million members – are such a good idea for people who need the assurance and reassurance of insurance or reinsurance. He’ll explain it all at this link.

Exploring Ethics: Is the Cost of Dying Worth It? Research Says Yes

Jason Shafrin at the Healthcare Economist asks if we are spending too much on end of life care and puts a new spin on the answer backed by research. He says we recognize that end of life care is expensive.  Conventional wisdom holds that we are spending too much on end of life care and we should just let people die at home in peace with hospice.  If only things were so simple.  The Healthcare Economist reviews new research that shows that end of life healthcare interventions may, in fact, by worthwhile. Paddle over to Jason’s blog at this link for a good discussion on an important topic.

Brush Up on Your Latin: Quo Vadis, Kentucky?

Tom Lynch of Workers’ Comp Insider recently attended a forum where he heard a presentation on the work requirements for Medicaid beneficiaries, a program called Kentucky HEALTH. Tom offers his perspective on the plan. It should be noted that a federal judge subsequently ruled the plan unlawful, but three other states are still developing plans for work requirements and other states are waiting in the wings. And this entire issue begs the question, where are we going, America? Is healthcare a right for all or privilege for those who can afford it? Tom kicks this football around a bit – on his private beach right here.

So now it’s time, dear Wonkers, to kick back, read the healthcare blogs and enjoy this summer day.

Photo by Anton Karatkevich on Unsplash

Here’s Joe:

“Blog posts!

Health Wonk Review returns to the inter-webs after a holiday hiatus. Refreshed, renewed, and revitalized, we bring you the best from the brightest!”

Thanks much for kicking off the new year, Joe!

Summer of 2017 is fading quickly into the memory books, but some of the happenings on the healthcare scene will be with us to bemoan, analyze and reform for years to come. Now that’s summer fun that lasts!

Let’s start with the philosophical underpinnings of the ongoing political healthcare debate – free market or socialism? Nobody is better equipped to take this on than David Williams of the Health Business Group who is a self-professed free market fan knee deep in the business of healthcare. With his background in economics and an MBA, as well as entrepreneurship, he acknowledges there are some limits to the free market. The healthcare system is one place where capitalism is tested. “Capitalism has a place in healthcare, but in developing policies we should also recognize the limits of free market approaches and be open to the benefits of socialist ideas,” David says. In this post, What Free Market Healthcare Really Looks Like, David walks us through a payment example and explains how a socialized medicine system fashioned on the Medicare model avoids some of the costs and shell games that happen in a free market model. Definitely take this one in.

Who really needs the social safety net public option solution anyway? Maybe the very people who oppose it, suggests Harold Pollack at HealthInsurance.org. In this entry, Who Really Needs the Public Option? Trump Country, Harold says Trump Country is most in need of a way to bypass the ACA marketplaces entirely. Democrats’ favorite policy option – the public option – would be most valuable in precisely the deep-red areas that went most fervently for Republicans and the President. Come for Harold’s great analysis. Stay for his groovy cartograms. Get it all here.

More guest blogging gems, this time from InsureBlog where Henry Stern pulled in guest blogger Patrick Paule who wrote about The Creation of ObamaCare’s Individual Market Mess. Patrick traces the history of the decline and fall of ObamaCare, letting no one – and we mean *no one* – off the hook in the process. Go here to get the full scoop.

And for those who wonder how the free market health insurance programs work, Louise Norris gives us a very cogent explanation of actuarial value in her guest blog for Verywell this week, What is Actuarial Value and What Does it Mean for My Health Insurance? She discusses what is actuarial value, how it is calculated and what it means for the individual member. Catch her explanation here.

Meanwhile, the health care reform debate in the US – which has really been about health insurance and specifically whether to repeal and/or replace the Affordable Care Act – is currently on hiatus. Roy Poses tells us, “This gave me a chance to list some of the major issues and causes of health care dysfunction which we have gone on about on Health Care Renewal but which rarely appear in polite conversation.” His list of issues includes: threats to the integrity of the clinical evidence base (which has had little public attention), deceptive marketing, distortion of health care regulation and policy making, and bad leadership and governance (which have had much less attention), concentration of power, abandonment of health care as a calling, perverse incentives putting money ahead of patients, education and research, the cult of leadership, managerialism, impunity enabling corrupt leadership, and taboos. Roy says true health care reform requires ending the taboos on discussing all of the above, and then addressing the real causes of health care dysfunction. Roy makes a very good start in that direction in What the US Healthcare Reform Debate Did Not Address here at Health Care Renewal.

Sometimes medicine is lost in the policy debates in healthcare. Joe Paduda turned over the blogging reins to David Deitz MD, PhD, who wrote a guest post on a subject with which he is quite familiar – opioids. David unpacks the National Academy of Sciences, Engineering and Medicine’s report to give us his perspective, and he draws a conclusion. Simply put, opioid exceptionalism means that the FDA, as well as other public agencies, should go beyond the risk/benefit paradigm they currently use for new drug approvals that is based on individual patients and consider the implications of an individual opioid to patients’ families and society. Read his rationale in Opioid Exceptionalism: Why These Drugs are Different Than All Others at Managed Care Matters here.

Tom Lynch at Workers’ Comp Insider poses the question, Medical Care Experts: Where Would We Be Without Them? Tom notes that in recent years, workers’ compensation cost control has focused mainly on lowering medical costs, which is almost always an outsourced function. Consequently, many employers have relinquished control over their workers’ comp program, migrating away from best practices that are at the heart of true workers comp cost control. Read the full blog here.

Hospitals have reduced length of stay about as much as possible, and now it is time to take the longer view on the total cost of patients who are discharged to post-acute care. In this post, Bradley Flansbaum shares some data and discusses that a new measure, home-to-home care, will come to reframe the LOS debate as the total cost of home-to-home care becomes a measure of true cost. Read more in You Have Lowered Length of Stay. Congratulations. You’re Fired at The Hospital Leader.

Photo by Eddie Kopp on Unsplash

Just when you thought things can’t get any weirder, they do. Combine staunch opposed ideologies held by fierce political warriors, and we find ourselves under the ancient curse of living in interesting times.

It seems our nation is transitioning from a government run on compromise – remember Ronald Reagan working with Tip O’Neill or Bill Clinton reaching across the aisle to Newt Gingrich? – to one run on diametrically opposed ideologies duking it out in unceasing, heated political and legislative battles. Maybe people will pull back the throttle on the ideological thrusters and land this thing safely. For now, both clearly defined sides in this fight seem to have refined the act of demonizing the opponent to an art form. But this isn’t art. It’s life, and it’s happening in real time. Welcome to interesting times.

Now, off to the land where hyperbole and rancor take a back seat to reason.

Let’s hear from the more tempered voices of the HWR crew’s civilized, balanced and informed debate.

Kicking off the discussions this week, we turn to the Health Affairs Blog where Timothy Jost presents a detailed analysis of the Republican legislation on the table to replace the ACA. In Examining the House Republican ACA Repeal and Replace Legislation, he compares the relatively lengthy ACA draft process to the 3-week run-up to the ACHA legislation. He points out what changes (mostly Medicaid), what doesn’t (pre-existing condition protections, coverage guarantees, etc) and looks at the revenue implications.

The ACA has been an employment driver, so repeal will hurt employment. Joe Paduda breaks out the math for us here at Managed Care Matters. Making healthcare more efficient will cost jobs and reduce incomes for a large segment of the economy. Joe asks, will this affect policymakers’ priorities?

Henry Stern at InsureBlog tells us that, if measured in numbers of lives saved, patients are faring worse under ObamaCare. In fact, InsureBlog reports that the ACA’s success regarding actual lives saved is a big goose egg.  Here’s the story at The ObamaCare Success Story: Zip, nada, and zilch.

Linda Bergthold, writing for Health Insurance.org, provides a dictionary to help decode the meaning behind the politicians’ words, a difficult task under any circumstances. In Decoding Republicans’ Language of Repeal, she cautions readers that seemingly innocuous language such as “patient-centered”, “access to care”, “freedom” and “choice” may not deliver on those promises quite as presented. She said much of the GOP language masks “ideas that are old and tired” that are being recycled. Read more here and decide for yourself.

Over at XPostFactoid, Andrew Sprung is a man looking for a compromise and a way out that saves face for everyone, something that might include a couple of frills like, say, oh, coverage for the vulnerable. In his post, Psst, Democrats: Help Republicans Out of the Repeal Box via Cassidy-Collins, he looks at the Patient Freedom Act as an alternative to the ACA and the AHCA. Read XPostFactoid here.

Over at Health Access California, Anthony Wright pays tribute to 94-year-old health care advocate Dorothy Rice who passed away this week. Of RIP Dorothy Rice, Pioneer in Health, Anthony says, “Rice was a lead economist in the Johnson Administration who made the case for Medicare. For an encore, she had a second career as a world-renowned academic where she dealt with issues from health reform to aging to tobacco control. We were pleased to work with her on our board during the effort to pass and then implement the ACA, providing a historical perspective to remind us these policy fights are not new – although she always thought after the passage of Medicare that the next reform to cover the rest of the population would come a lot sooner than it did.” This tribute details her considerable accomplishments.

Roy Poses at Health Care Renewal questions the integrity of Trump cabinet nominee for Labor Secretary based on some of his rulings as a former U.S. Attorney regarding pharmaceutical companies that favored the corporations. Roy asks, “What sort of swamp drainage process is this?” as he explores the decisions of the cabinet nominee “who had an important role in enabling the impunity of leaders of top health care organizations…he presided over three major settlements with pharmaceutical corporations. In none of them did any individual who enabled, authorized, directed, or implemented the alleged bad behavior suffer any negative consequences. The suits were settled by payments made by the companies.” The details of these cases are in the Health Care Renewal blog here.

David Harlow at HealthBlawg recently hosted a cybersecurity webinar with government experts. To view the webinar, click on this link to view the Second Annual Cybersecurity and Health Care Panel Discussion with Government and Industry Experts. This blog post includes David’s notes from his introductory remarks as well as the 1 hour and 21 minute presentation. Grab a cup of coffee and listen to this in-depth discussion.

After taking in the webinar, you can jump over to David Williams’ Health Business Blog and click on his podcast where he interviews iCardiac Technologies CEO Alex Zapesochny about his electronic clinical outcomes assessment platform. Electronic clinical outcomes assessment platforms collect data from patients, clinicians and caregivers to make clinical trials more efficient and accurate. In this 14 minute interview, they discuss some of the trends in clinical drug development and how they impact platforms such as eCOA.

At Healthcare Economist, Jason Shafrin discusses the evolving methods for evaluating cancer care. Shafrin asks, “How do you measure the quality of care patients with cancer receive? How long they live? Avoiding side effects? Patient satisfaction? Process measures?” The Healthcare Economist investigates here.

Finally, we’ll visit an issue that has begun to cross the ideological divide. At Worker’s Comp Insider, Tom Lynch reports on a recent study on the therapeutic use of medical marijuana as a treatment for chronic pain – and the impending clash between the states and federal government stances on legality.  Read the discussion in more detail here at Who Knew? Medical Marijuana Works (at least for chronic pain).

I also want to add my mea culpa that I have not been a good corporate HWR citizen and contributed lately. Writer’s Block? Actually, it’s been Writer’s Overwhelm…there is just so much I am still figuring out where to start. In the meantime, let’s all be thankful that the HWR crew remains faithfully on the job.

In this week’s health policy roundup, Brad Wright posts Health Wonk Review: The Game 7 of Politics Edition  at Wright on Health. His post skillfully ties two of America’s favorite and most contentious pastimes together: sports and politics. Something here for everyone.

And next Tuesday, don’t forget to “Play Ball!”  

An educated populace is the bedrock of a sober and productive small “d” democratic society. Our Health Wonk Review contributors are doing their part to keep democracy alive. Let’s start by reading this positive post by our friends at Health Affairs about  opportunities for continued progress in the U.S. health care system that are not necessarily dependent on the outcome of the election.

Health Affairs Blog this week discusses What Bipartisan Opportunities Will the Next Congress and President Have to Improve Health Policy? by Anand Parekh, Ashley Ridlon, Katherine Hayes, Janet Marchibroda, Lisel Loy and William Hoagland of the Bipartisan Policy Center. In it, we learn that while larger ideological questions divide the two major parties regarding whether the Affordable Care Act should stand and how payments for programs should be structured, voters across party lines may still look forward to progress on issues that directly affect the quality of patient care such as the move to value-based care, the steady advance of technology, and the emergence of care coordination. The article’s introduction tells us that “there will be several potential opportunities for bipartisan agreement to further advance the health of the American public” and concludes, “Whether the political will exists to reach across the aisle and work together remains to be seen. If so, bipartisanship may very well contribute to having a positive impact on the nation’s health.”

Technology: The Promise and the Dark Side

Julie Ferguson at Workers Comp Insider also brings some heartening news on the potential for catastrophically injured workers to be enabled with new functionality via exciting new assistive technologies. See her post Cyborgs and Workers Comp where she defines the term “cyborg” to orient her readers to the promise of technology: A cyborg (short for “cybernetic organism”) is a being with both organic and biomechatronic body parts.

More on the promise of technology as David Williams asks Is Radiology Doomed? In this article, David explains that captured radiologic images may be delivered directly to the patient record completely bypassing a human radiologist. That prediction begs the question: Is machine learning going to replace radiologists? He says, “Eventually yes, unless radiologists figure out how to be diagnostic quarterbacks.”

Next, Roy Poses tells us that not all wonder drugs are all that wonderful. In his entry at Health Care Renewal, Not So Wondrous Drugs: New Warnings about Severe Adverse Effects of New, Heavily Marketed Drugs for Hepatitis C, Roy digs down into the clinical trial data of recently approved Hepatitis C cures. Roy discusses whether trial results really support claims for pricey and highly-touted Sovaldi. He concludes saying, “The skepticism [evidence-based medicine] should engender could lead to health care that is more about patients and their outcomes, and less about hype ideology, hype, and hucksterism. If only such skepticism were easier to find.”

Speaking of Evidence-Based Medicine

Another blogger this week is also questioning the evidence, or lack of same, from another quarter, and that is the legitimacy of a 30-day readmission rate as a quality benchmark for hospitals. In The Hospital Leader, Brad Flansbaum shows us data that reveals a hospital’s influence on a patient’s post-discharge condition falls off a cliff after about a week, at which point the readmission rate is influenced far more by factors outside the hospital’s control. Read more as The Hospital Leader considers ways this issue can be handled to the advantage of patient outcomes and a hospital’s liability for them.

Paying for Care – Proven and Unproven

You’ll never know whether a treatment works if you can’t pay for it. Several bloggers this week turn their attention to whether the nation’s Affordable Care Act is, indeed, affordable.

Hank Stern at Insure Blog submitted a blog written by his colleague Patrick Paule that looks at a shell game where taxpayers funded a non-profit health plan to participate as an Obamacare co-op in the state health exchange to the tune of $65 million under the condition that it remain a non-profit. However, as one of the few co-ops that have remained standing – albeit on wobbly legs – it just announced its acquisition by a private equity group and conversion to a for-profit entity – moves that create a dilemma for the Obama administration. Read details here about this political sticky wicket that catches 38,000 patients in its grip.

Another blogging HWR regular, Louise Norris, also digs into a detail of the ACA that snags another small subset of patients. In this two-part series at Healthinsurance.org , Louise analyzes the data on who is actually impacted by rising insurance rates. She concludes that while rates are going up, only a small sliver of the U.S. population are “being crushed by rate increases”. For those who are part of the non-subsidized, median-income crushed, she offers advice for dealing with premium hikes.

In a separate blog at Health Insurance Colorado , Louise Norris tells readers that while Colorado rates are rising an average of 20 percent for the combined subsidized and unsubsidized individual markets, the people of Colorado will be getting more for their Obamacare premiums. Specifically, benchmark plans for 2017 will include chiropractic care, bariatric surgery and fertility treatments.

Back to the Voting Booth

We will wrap up this edition of Health Wonk Review by revisiting the voting booth. Our contributor, Shalvi Prasad, writes for Health Access: California’s Health Consumer Advocacy Coalition asking readers in California to push the lever for Proposition 56 that would add $2 to each pack of cigarettes to fund smoking cessation programs and boost funding for Medi-Cal. Find details on Prop 56 in Health Advocates Protest Big Tobacco’s Lies at Health Access.

And don’t forget to eat your peas!

I only open with that slight bit of hyperbole to underline the fact that this is not a corner of the world where you might expect to find a discussion about the value of the public option or a single-payer healthcare system as a solution to what is becoming a completely out-of-control sector of the economy. But in this political season, where vicious verbal spitballs are tossed at opponents with nary a care for veracity, perhaps it’s time for each of us to take a step back and look at point of view we haven’t really considered before. Just to set an example to the flamethrowers in Cleveland and Philadelphia, of course.

Not Just Too Expensive, But Too Complicated

The loud political rants about healthcare focus on the exorbitant costs of hospitals, nursing homes, drugs, doctor’s salaries – if you are reading this you are already familiar with the litany of complaints. Drugs running more than $100,000 a year are hitting the pharmacy shelves with increasing frequency.  Health insurance premiums are skyrocketing  to pay for it, with patients bearing much higher deductibles just so they can feel a bit of the consequence of their choices – both in taking responsibility for maintaining their health and for the treatments they select. 

Within the last year, I’ve seen a proposal that patients be allowed to take out what amounts to a mortgage to pay for some of the higher-priced treatments. That means as you begin to pay off your college debt sometime around the age of 50, you can start to look forward to assuming another big bill to stay on this side of the grass. Ouch!

Patients aren’t the only ones feeling the pinch. Health insurance companies are sinking under the weight of regulations and requirements so onerous that they can no longer operate under a legitimate business model – meaning one that might result in a profit. (“Heaven forfend any private entity make a profit,” – thus spoke Attila’s little sister sarcastically.) Instead, we saddle the insurance companies with so many competing requirements (medical loss ratios and basic plan standards, for example) that not even Houdini could get out alive.

Since I have spent much of my career consulting in the pharmaceutical industry, I might let this particular sleeping dog lie. Suffice to say, patients and other payers in the United States pay the brunt of the cost of drugs mostly because we can. We just can’t for much longer. In most of the rest of the world, drug prices are capped or some places are just so poor the drug companies give it to them. Expect that to change as the economic balance in the world shifts. It’s an industry that is shifting its business model because the old one is not sustainable.

Let’s Talk Complicated

If you couldn’t sink our healthcare system with ridiculous costs, including more indigent patients, you might be able to poke the last hole in the boat by saddling all the stakeholders with an increasing amount of paperwork and regulation. At some point, the players just give up.

Doctors, hospitals, health plans, patients, biopharmaceutical and device manufacturers all now live under so many regulations and requirements to do business, that doing business in a rational way is becoming increasingly impossible.

That is not hyperbole. That is reality. Think Meaningful Use.

At tax time, patients have to prove they have health insurance or pay a penalty.

Physicians are required to prove they meet quality measures which change all the time, are incomplete or just plain un-meetable. In order for physicians and hospitals to qualify to be paid by Medicare and Medicaid, they have to meet so many constantly changing rules, regulations and requirements with shifting deadlines that some have thrown up their hands and want to opt out of taking public money completely. But not so fast. If you are a physician or a hospital, most of your patients are over 65 and have Medicare or are indigent, disabled or in some way unable to work and are on Medicaid. It isn’t that easy to just opt out.

I’ve already discussed the difficult rock and hard place in which health insurance companies find themselves.

Would Single Payer Just Be Easier?

What does all this have to do with the public option or a single payer system? A lot. At some point, the focus needs to return to a simple transaction between a patient and a healthcare provider where the only issue on the table is the patient’s health. Perhaps the only way to make that happen is to remove business from the business of healthcare and provide a universal option. Because simply, if government needs to regulate business to the point where it is almost impossible to conduct it in a rational way, perhaps it’s time to get out of the business altogether and just concentrate on providing healthcare where payment is off the table completely for most patients.

Attila’s little sister could argue against that previous paragraph all day long because every word comes with a caveat. None of the aforementioned is as simple as I’ve stated it, but in the end, it seemed important enough to look at how other people see the problem. The problem is getting healthcare to people who need it, and a lot of effort and money is spent doing anything but getting doctors and patients together in the interest of the patient’s well-being.

I really do invite all kinds of comments and disputes to my facts and my reasoning. It’s a political season, and it seems like a good time to look at a political solution to a growing monstrosity of a problem high on the agenda of both parties.