Good morning ... Hardly anyone is free of sin in the age of the social media pile on, including me. This is a good reminder to step back and have some empathy before making fun of a stranger. Life is hard enough.
Large hospital systems don’t command high prices just because patients like them, or just because they have strong market share. There's also another big reason: their contracts with insurance companies actively prohibit the sort of competitive pressures a free market is supposed to support.
“The free market has been distorted in an unhealthy way,” health care consultant Stuart Piltch told the Wall Street Journal’s Anna Wilde Mathews for this deep dive into hospitals’ pricing practices.
On top of that, per WSJ: Hospitals’ deals with insurance companies “use an array of secret contract terms to protect their turf and block efforts to curb health-care costs.”
The other side: Hospital executives told the Journal that mergers don’t drive higher prices, and reiterated their position that hospitals have to collect higher payments from private insurance to make up for the lower rates they get from Medicare and Medicaid.
My thought bubble: High-deductible health plans are increasingly popular, in part, because of the idea that patients will use their purchasing power to drive a more efficient system overall.
California Insurance Commissioner Dave Jones filed a multibillion dollar lawsuit yesterday against drugmaker AbbVie, accusing it of illegally marketing Humira through a program that Jones described as an elaborate system of kickbacks.
Why it matters: Humira is the best-selling drug in the world and in the U.S., where it carries a $38,000 price tag, and AbbVie has worked hard to keep potential competitors off the market.
Jones' lawsuit accuses AbbVie of "a far-reaching scheme including both 'classic' kickbacks—cash, meals, drinks, gifts, trips, and patient referrals—and more sophisticated ones."
What they're saying: "We believe the allegations are without merit. AbbVie operates in compliance with the many state and federal laws that govern interactions with healthcare providers and patients," the company said in a statement, adding that its support services are helpful for patients and "in no way replace or interfere with interactions between patients and their healthcare providers."
A bipartisan group of senators wants the House to prevail on a key difference between the two chambers' opioid legislation, my colleague Caitlin Owens reports.
Driving the news: Republican Sen. Rob Portman and Democratic Sens. Dick Durbin, Ben Cardin and Sherrod Brown introduced a bill yesterday to lift Medicaid's so-called "IMD exclusion" — a ban on federal Medicaid funding for mental health treatment facilities with more than 16 beds.
The new Senate bill actually goes further than the House-passed measure.
Yes, but: A more generous bill would cost more money. The Senate bill doesn't say how it's paid for. And that's been a sticking point in the House.
This economically significant regulation, which is expected to come out this month, will address how hospitals, doctors and IT vendors can make patients' health care records more easily accessible.
The bottom line: This is part of the federal 21st Century Cures Act intended to get rid of the incentives that encourage providers and companies that make electronic health record systems not to share patient data freely.
New payment startup Ooda Health has raised $40.5 million on the premise that its technology will make sure patients never get another bill from a hospital or doctor, Axios' Bob Herman reports.
Big-name venture capitalists are on board (Oak HC/FT and DFJ led the funding round), and large health insurers and providers are also investors.
How it works: Health insurance companies pay Ooda Health an administrative fee and a risk-sharing payment.
Yes, but: Ooda Health can eliminate a bill from your doctor, but not the fact that you owe them money. And streamlining those bills through an insurance company won't eliminate the (often very high) bills that come directly from providers who aren't in your insurance network.