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Illustration: Sarah Grillo/Axios

Health care executives gave no indication to bankers and investors at this year's J.P. Morgan Healthcare Conference that their pricing practices would change any time soon.

Why it matters: That sentiment comes the same week when three of the original authors of an influential 2003 article — which studied why health care is so expensive in the U.S.— published an update. Their conclusion was the same: "It's still the prices, stupid."

The big picture: The U.S. spends far more than other industrialized countries on health care. But Americans, on a per-person basis, don't go to the doctor or hospital more than people in other wealthy nations. There are also fewer doctors, nurses and hospital beds, per capita, in the U.S.

  • That means the U.S. spends more because hospitals, doctors, pharmaceutical companies, device manufacturers and others charge higher prices, and health insurers aren't negotiating good enough deals.
  • "Lowering prices in the U.S. will need to start with private insurers and self-insured corporations," the authors wrote in this week's update, published in the journal Health Affairs.

Reality check: Health care companies, even not-for-profits like hospitals that don't have typical investors, have prioritized meeting revenue and profitability goals, and that short-term thinking compromises reform, according to interviews with people who attended the J.P. Morgan event.

  • Many executives continue to tout different ways of getting paid, like "value-based" pricing, but there's no evidence those models will save money.
  • Drug companies are still focused on raising prices or buying lucrative biotechs, while providers find more ways to maximize what they get paid from insurers. As a result, insurers and employers raise premiums or deductibles for taxpayers and employees, which affects everyone's paychecks.
  • One example: Dennis Dahlen, the chief financial officer of Mayo Clinic, told attendees how his academic medical center is building its own "five-star" hotel and is expanding proton beam therapy, even though that expensive treatment has limited or no clinical benefit.
  • "This is about money and [investors] getting a return," said Stephen Buck, founder of cancer tech app Courage Health.

Yes, but: Some in the industry realize they need to act.

  • Marc Harrison, CEO of Intermountain Healthcare, said in an interview his hospital system has lowered the "cash price" of some services, like normal vaginal childbirth, to help people who have high deductibles — although services like childbirth often cost a lot more than the deductible.
  • Intermountain also has negotiated with insurers, with the exception of one unnamed company, to hold patients harmless if they get a surprise out-of-network bill, Harrison said.
  • Stephen Ubl, CEO of the Pharmaceutical Research and Manufacturers of America, acknowledged in an interview that "the status quo is not acceptable. We understand the system needs to change."
  • However, he continued to argue for changes in what people pay out of pocket, instead of changing the patent system or how companies price their products. Ubl described the Trump administration's proposal to index the prices of some Medicare drugs to lower rates in other countries as "fruit of the poisonous tree of government price-setting."

What to watch: Democrats are using "Medicare for All" and price-setting as a litmus test for 2020 candidates, and Democrats in Congress are proposing Medicare negotiation for drugs — an idea that Trump supported in the past. Regulatory or legislative changes to pricing are not completely out of the question if the industry fails to act.

Go deeper

Updated 28 mins ago - World

State Department orders evacuation of U.S. diplomats' families from Ukraine

From left, Under Secretary for Political Affairs Victoria Nuland, Secretary of State Antony Blinken and U.S. Chargés d'Affaires in Ukraine Kristina Kvien during a meeting with Prime Minister of Ukraine Denys Shmyhal in Kyiv. Photo: Yevhen Liubimov/ Ukrinform/Barcroft Media via Getty Images

The State Department will begin evacuating families and non-essential staff from the U.S. Embassy in Kyiv this week, according to a travel advisory published Sunday evening.

Why it matters: The move underscores U.S. fears that a Russian invasion could destabilize Ukraine and threaten embassy's ability to assist Americans.

Perfect storm brewing for extreme politicians

Data: Axios research; Table: Jacque Schrag/Axios

Redistricting and a flood of departing incumbents are paving the way for more extreme candidates in this year's midterm elections.

Driving the news: At least 19 House districts in 12 states are primed to attract such candidates — hard partisans running in strongly partisan districts — according to an Axios analysis of districts as measured by the Cook Political Report's Partisan Voter Index (PVI).

Updated 56 mins ago - Politics & Policy

Omicron dashboard

Illustration: Aïda Amer/Axios

  1. Health: Fauci: "Confident" Omicron cases will peak in February — FDA OKs antiviral drug remdesivir for non-hospitalized COVID patients — Walensky: CDC language "pivoting" on "fully vaccinated".
  2. Vaccines: Annual COVID vaccine preferable to boosters, says Pfizer CEO — Team USA 100% vaccinated against COVID ahead of Beijing Olympics.
  3. Politics: Arizona governor sues Biden administration over COVID funds tied to mandates — Biden concedes U.S. should have done more testing — Arizona says it "will not be intimidated" on anti-mask school policies.
  4. World: Beijing Olympic Committee lowers COVID testing threshold ahead of Games — Beijing officials urge COVID-19 "emergency mode" before Winter Olympics — Austria approves COVID vaccine mandate for adults.
  5. Variant tracker