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We plan on installing some operating system updates this Friday, June 9th. This site is expected to be unavailable as early as 10 AM PST and as late as 6 AM, Saturday, June 10th.

Noted in several publications, the California Senate voted for the state government to become the single payer for healthcare in the state. The bill will go to the California Assembly for additional discussion. According to The Mercury News, even one of the bill's sponsors dubbed the bill "a work in progress." Significantly, the bill omits key details, including a way for paying for the system. The California Nurses Association apparently commissioned a study that finds that the healthcare costs can be paid for with a payroll tax and a gross receipts tax.

It will be interesting to see how the details of the legislation gets filled in over time. Kaiser Health News previously reported that the system would largely rely on fee-for-service, a reimbursement system that rewards healthcare providers for volume and is widely blamed for at least part of the rapid growth in healthcare costs. The rest of the country has been moving away from fee-for-service.

Regardless of whether the legislation gains traction, that the bill has passed the California Senate (especially missing the key details that it did) signifies the general discontent with the current healthcare system. Other states that have seriously considered single-payer health include Vermont and Colorado.

Previously, FDA has generally taken the stance that its role has been to ensure safety and efficacy of medications. Sometimes, the FDA would address issues of availability (e.g. in the case of rare diseases), but it has eschewed drug pricing. The Wall Street Journal reports that the new FDA commissioner is changing tack by proposing policies that will encourage competition. Among the proposals is to accelerate the review of generics. It also sounds like the plan is to make it easier for a manufacturer to prove equivalence, including generic equivalents of Mylan's EpiPen.

These proposals sound promising, but as most other cases, the details matter a lot. It'll be interesting to see if, over time, people are still shocked at high prices of medications that have generic equivalents.

Often times, we might think it's better to "be safe than sorry" and in the medical context, that could mean ordering unnecessary tests. California Healthline reported on the financial costs of unnecessary tests (estimated by some to be at least $200 billion) and in some cases, the health costs of excessive testing.

Fortunately, some payers and even some providers are trying to address the issue of unnecessary tests. The efforts seem early-stage and experimental so far; nevertheless, that both payers and providers are giving consideration to the issue is encouraging. The article cited a particularly interesting case of one medical center eliminating a testing requirement before a procedure and patients on average being able to undergo the procedure six months earlier.

In light of the passage of the American Health Care Act in the House of Representatives, there has been substantial outcry regarding the anticipated effects on people with pre-existing conditions and on those with lower incomes. Less commonly heard are voices (outside of politics) in support of the bill. It's interesting that The New York Times decided to publish a story representing those voices. Related to the cost of health care, Kaiser Health News published a piece on how under the version of the bill passed by the House, some states might need to dial back on patient protections in light of reduced federal subsidies.

The Affordable Care Act and the American Health Care Act try to answer questions of whether there should be patient protections and whether there should be subsidies for expensive health care. Neither legislation meaningfully address the question of whether healthcare costs can be reduced, and if so, how. The financial burden for health care can shift between government and individuals, but if the underlying growth in cost is not addressed, simply answering the question of who pays will be insufficient.