Good morning. Axios' Mike Allen and I will be interviewing Health and Human Services Secretary Alex Azar this morning at The Showroom in D.C., beginning at 8am ET. We'd love to see you there!
Today's word count is 940, or ~3.5 minutes.
Americans pay higher out-of-pocket costs than most other wealthy countries, a byproduct of having the most expensive health care system in the world, according to the Organization for Economic Co-operation and Development (OECD).
Why it matters: Health care costs are at the heart of today's most explosive health care debates, including "Medicare for All," prescription drug prices and surprise medical bills.
"Medicare for All" has been offered by some Democrats as the solution to these issues of expense, but the version proposed by Sens. Bernie Sanders and Elizabeth Warren "would leapfrog all these other countries in terms of generosity," said the Kaiser Family Foundation's Larry Levitt.
The bottom line: Other countries — even those with private insurance — pay lower prices than the U.S. to doctors, hospitals and drug companies.
Small biotechs are worried that House Speaker Nancy Pelosi's drug pricing bill would dry up the venture capital funding that they need to survive, STAT reports in a story worthy of your time.
Why it matters: These companies turn basic research into new drugs, and conduct 70% of clinical trials, according to data from BIO.
Between the lines: Small biotechs often don't even have drugs on the market — they're still experimenting to find new treatments and cures, dependent on venture capital to fund their endeavors.
The other side: While progressive experts admit that the bill would reduce biotech investment, they disagree on the extent and whether the changes would be all negative.
What we're watching: It's looking increasingly unlikely that Pelosi's bill will become law before the 2020 election, but most of the leading Democratic presidential candidates are running on similar ideas.
Go deeper: How Democrats want to limit drug prices
Diplomat Pharmacy, which sells medications to people with complex conditions and acts as a drug benefit middleman, is a shell of itself. The company was worth more than $3 billion in its heyday in 2015, but is now worth a little more than $200 million after a disastrous third quarter.
The bottom line: Larger specialty drug players — owned by Cigna, CVS Health and UnitedHealth Group — have crushed Diplomat with their size, Axios' Bob Herman reports.
By the numbers: Diplomat's main business, which distributes high-cost infusion drugs and other medicines that you don't find at your typical pharmacy, is still lucrative.
The pharmacy benefit manager business, which Diplomat just got into a couple years ago, has been a mess.
What to watch: Diplomat executives will have to spell out their plans for a full or partial sale before the end of the year.
The Centers for Medicare and Medicaid Services hired about 40 former Trump White House and campaign employees for a $2.25 million annual contract to do work traditionally handled by CMS' own communications department.
Why it matters: "The arrangement allowed the Trump allies to cycle through the federal government's opaque contracting system, charging hefty fees with little public oversight or accountability," Politico reports.
Details: Multiple sources confirmed the authenticity of 200 pages of billing documents that Politico obtained from Health and Human Services in a congressional oversight request, Axios' Marisa Fernandez writes.
What they're saying: Politico reported that CMS insisted in a statement "that it followed standard government contracting procedures and that CMS routinely relies on thousands of contractors for 'critical day-to-day operations.'"
The HHS Office for Civil Rights has opened an inquiry into “Project Nightingale," Google's effort with Ascension to collect millions of patients' health information, WSJ reports.
What they're saying: The office "will seek to learn more information about this mass collection of individuals’ medical records to ensure that HIPAA protections were fully implemented," office director Roger Severino said in a statement to WSJ.
News of the project quickly raised questions about patient privacy. Neither doctors nor patients were informed of the arrangement.