Selling the Same Thing for a Different Price is Normal Market Behavior

 

Understanding the price of ketchup may go a long way towards explaining why mainstream health reformers give such bad reform advice.

Per capita health spending varies a great deal. It varies by geography, it varies by health status, it varies by demographics, and it varies by individual patient characteristics. Academics and government officials decry this variation. They think that health care spending and utilization should be the same everywhere. Despite ritual hand waving about the importance of clinical differences, their policy recommendations generally attribute variation to inefficiency, overuse, and waste.

One Fifth of States Join Interstate Medical Licensure Compact

 

StethoscopeIowa has become the tenth state to enact the Interstate Medical Licensure Compact, which will ease the licensing of physicians outside their home states. This is a great achievement for the medical profession and state sovereignty. For almost a year now, I have been supporting this effort and I am glad to see it succeeding.

On June 24, I attended a briefing conducted in the wake of the compact hitting seven members. This started the wheels turning to establish a commission that will actually execute and administer the interstate licensing of physicians. At the meeting I learned a few things, a couple of which surprised me:

Zeke Emanuel Hammers Obamacare Again

 

Obamacare’s best frenemy, Dr. Ezekiel Emanuel, and his colleagues at the Center for American Progress, gave up on Obamacare last year. In yesterday’s Wall Street Journal, he and Topher Spiro emphasizes that Accountable Care Organizations, which Obamacare established to co-ordinate care and lower costs in Medicare, are failing to achieve either goal:

Caution: 21st Century Cures Act Has A Suspicious Payment Plan

 

prescription-drugs(A version of this Health Alert was published by Investors Business Daily.)

The House of Representatives is scheduled this week to consider the 21st Century Cures Act (H.R. 6), a health policy bill designed to improve the economic incentives and streamline the process for inventing new medicines.

We applaud the act. It will go a long way to solving the crisis in pharmaceutical innovation. But we caution against the mandatory funding proposal in the bill and urge Congress to authorize and appropriate the funds instead of creating a new, mandatory spending program.

Rock Health: $2.1 Billion in Digital Health Funding Q2

 

Rock LogoRock Health has published its account of 2015 Q2 funding of digital health ventures. According to Rock Health, funding so far this year is keeping pace with 2014.

What is especially interesting about Rock Health’s report is that it compares venture funding of digital health to other areas and concludes that digital health is growing at a significantly faster rate than other areas, especially biotech and medical devices.Rock

Digital Health Market is Maturing

 

StartUp LogoStartUp Health has published its analysis of 2015 Q2 digital health funding. Covering a somewhat broader portfolio than Mercom Capital does, StartUp Health reports $1.7 billion in new funding.

By far the biggest deal discussed in the report was Zenefits’ $500 million raise. Zenefits, I get. The deal I don’t get is Oscar, which comes a distant second with $145 million raised. Oscar is the only health insurer in America that actually wants to enter Obamacare’s exchanges. What are they thinking? I can’t figure it out, but Goldman Sachs is an investor, and it’s not a good idea to bet against Goldman Sachs.StartUp IPO

The report also notes that there have been some significant IPO’s in digital health, providing liquidity and some transparency in valuations.

Telehealth Has Best Funding Quarter Ever

 

MercomVenture funding of health IT deals in 2015 Q2 amounted to $1.2 billion in 138 global deals, according to Mercom Capital Group. This was smaller than 2014 Q2, which saw $1.7 billion raised in 159 deals.

However, telehealth and mobile health continue to blow the doors off. Two of the top four deals were $50 million each for Doctor on Demand and MDLIVE. (Mercom Capital also reports public equity financings, but I do not believe this Q2 report includes the successful IPO of Teladoc, which went public on July 1.)

Although I cannot claim to have studied every deal, it appears that the ones which raised the most money are focused on the employer-based market. If the technologies they deploy really do engage employees to lower health costs, that is good news. What would also be beneficial is these tools being deployed in the individual market. Perhaps that will come as the space becomes more competitive.

Obamacare is Reducing Competition

 

Novel concepts—whether practice-management companies, home health care or the first for-profit HMO—almost always have come from entrepreneurial firms, often backed by venture capital.

That venture capital has been drying up since ObamaCare was passed. Instead, the biggest wagers in health-care services are being placed by private equity, which is chasing opportunities to roll up parts of the existing infrastructure. For instance, there were 95 hospital mergers in 2014, 98 in 2013, and 95 in 2012. Compare that with 50 mergers in 2005, and 54 in 2006. Cheap debt and ObamaCare’s regulatory framework almost guarantee more consolidation. That will mean less choice for consumers.

(Scott Gottlieb, “How the Affordable Care Act Is Reducing Competition,” Wall Street Journal, July 5, 2015.)

What King v. Burwell Means for California’s Obamacare Exchange

 

(A version of this op-ed was published by the Orange County Register.)

It is usually not a good idea to take the risk of predicting what politicians and bureaucrats will do, but here’s a shot: California will decide to wind down the failing Covered California Obamacare exchange and transfer its operations to healthcare.gov, the federal exchange. That won’t solve any of the fundamental problems of Obamacare itself, but at least it will relieve the state of a problem child.

California established Covered California because the Affordable Care Act, passed in 2010, only allows tax credits to be paid to health insurers in exchanges established by states. These tax credits are the only way to make the expensive Obamacare plans affordable to beneficiaries. All but 16 states and D.C. rejected Obamacare and declined to establish exchanges. That did not stop the federal government, which set up healthcare.gov to funnel tax credits to health insurers in the majority of states without exchanges.

On June 25, the U.S. Supreme Court decided King v. Burwell, rewriting the law to allow the federal government to continue to pay tax credits through healthcare.gov. Although a disappointment for the rule of law, the decision gives California an off-ramp from the exchange business.

Obamacare 2016 Rate Hikes Still Double Digits

 

When the first wave of Obamacare’s 2016 double-digit rate hit, defenders insisted that these were outliers. Well, those rate hikes keep coming, especially from insurers with large market share:

Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected. Federal officials say they are determined to see that the requests are scaled back.

Blue Cross and Blue Shield plans — market leaders in many states — are seeking rate increases that average 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee and 54 percent in Minnesota, according to documents posted online by the federal government and state insurance commissioners and interviews with insurance executives.

(Robert Pear, “Health Insurance Companies Seek Big Rate Increases for 2016,” New York Times, July 3, 2015)