Hi there. Welcome back to the Weekly Muse. I write about the 5 biggest, trending healthcare stories from the last 7 days. Today’s edition covers the week of January 25, 2019.

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5 Big Stories

1. Medicare For All

Buzzworded to Death. Get used to the phrase ‘Medicare For All.’ You’re gonna be hearing a lot about it, especially if you follow healthcare news even a little. The concept, named and popularized by then-candidate Bernie Sanders, involves creating a single-payer healthcare system for the US where the government, in the form of Medicare, covers everything. As the presidential election and campaign trail unfolds this year, Medicare for all is all but GUARANTEED to be at the forefront of every major democratic candidate’s 2020 campaign message. A recent poll indicated that 56% of the public supports Medicare for All. I find that a bit fishy, though, considering another poll indicates that 46% of people haven’t even heard of Medicare for All. Maybe we just shouldn’t pay attention to polls? More interestingly, people’s support for Medicare for All drastically decreased when they learned that it would result in…ahem…higher taxes.

The heck is Medicare For All? As we’ve talked about before, Medicare for All means different things to different people. Basically, a lot of politicians have varying views as to what Medicare for All actually looks like – from a fully-fledged universal, single payer system 100% run by Uncle Sam (think Bernie Sanders, socialists) to simply making Medicare more widely accessible. For instance, popular proposed alternative to a full-on healthcare policy assault currently would lower the Medicare eligibility age to say, 50.

What does this mean for us? Nobody really knows what the TRUE cost of Medicare for All would be, but that hasn’t stopped some from guessing. Current estimates for Bernie Sanders’ Medicare for All would amount to $32.6 trillion over 10 years. But that’s before offsetting costs from removing the current system. Still, the report shows that the economics of such a drastic shift in healthcare policy is just way too difficult to estimate. All we know is that any such policy would most definitely mean higher taxes for, well, everyone.

Is this actually gonna happen? Considering that Republicans and the healthcare industry as it stands today also exist, a fully baked single payer system probably won’t happen anytime soon. At the absolute most, it would probably be phased in incrementally over a very, very long period of time. The issue remains – is it possible at all to create a healthcare system where a single public program funds everything, but delivery is still controlled by privately managed doctors and hospitals?

2. The Netflix of Healthcare

Or maybe Amazon Prime. A spattering of articles have come out recently about various healthcare providers starting a subscription-like service for primary care. Basically, patients pay a flat rate to these providers, and receive a certain number of visits, or a certain spectrum of care. The most recent company to implement this strategy is 98point6, a cleverly named (seriously – well done), on-demand primary care app backed by investors with some SERIOUS clout (Larry Fink, the CEO of BlackRock, for one).

Disruption? It’s yet another example of a start-up trying to disrupt the status quo of healthcare – this time, through the type of reimbursement provided to primary care providers. It’s hard to imagine this kind of business breaking through beyond physician visits, though. Since surgeries and other healthcare services vary widely in cost, it would be nigh on impossible to charge patients a flat rate for these kinds of services. Still, interesting to keep a note on the various ways that start-up capital is trying to break into healthcare, especially in primary care – which appears to be ripe for investment.

3. Optum Playing Hardball

You can’t have him. Speaking of Amazon, we’ve all heard about the infamous un-named healthcare joint venture between Amazon, Berkshire Hathaway, and JP Morgan known as “Company ABC.” Well, apparently they’re trying to hire an Optum executive away from UnitedHealth. UnitedHealth said “no sir, we’re not having any of that,” and sued to block the move, claiming that Company ABC was just trying to steal trade secrets away from them.

Threatening. Now, it’s all tied up in court and getting pretty heated. If anything, the move to block the hiring signals that United perceives this joint venture as an existential threat to their current status as the overlord of healthcare.

4. Surprise Medical Bills

Getting along for once. Add surprise medical bills to the short list of things that politicians agree on. This week, President Trump held a chat with patients and experts on surprise medical billing, where patients are charged with the brunt of a medical bill after insurers say “we won’t cover this.” Trump and many members of Congress are seeking ways to end the practice of surprise billing after hearing countless stories of people getting hit with huge medical bills over seemingly simple medical procedures.

It’s everywhere. You can Google “surprise medical billing” and see that it’s become a pretty big issue in healthcare. The current administration is striking an aggressive tone over the issue, and we could see this be one of the few healthcare related issues passed through Congress this year.

5. A Kinda Sad Story

Ending on a sad note. This week, a superintendent was charged with health insurance fraud, which is considered a felony. The background? She was seeking medical care for a student at one of her schools whom she met with regularly. When he didn’t show up for school one day, she sought him out and took him to get care. After being denied care initially for not having insurance, she decided to take matters into her own hands and claimed the boy was her son (he wasn’t). Now, she’s being tried for fraud. While she definitely won’t face any jail time for this act and probably could have just paid for the care out of pocket rather than going through insurance, it’s still a bit sad to hear. Was this a problem with the healthcare system, or was this simply a poor choice by someone who knew better?

Quick Hits

• Big Pharma is considering drug price caps on Medicare drugs. They also spent a record $27.5 million on lobbying in 2018.
• Private equity is boosting jobs in the healthcare sector
• Civica Rx is still making moves and plans to offer 20 generic drugs this year – UP from the expected 16 originally planned for 2019
• Walgreens/Microsoft and CVS/Aetna could potentially squeeze hospitals for patients
• For whatever reason, MedPAC still wants to cut payments to Home Health

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