The nation’s largest medical specialty association, the American College of Physicians, has endorsed single-payer national health insurance as “one pathway” to universal medical coverage. The association represents specialists in internal medicine, and has 124,000 members. The endorsement came after the group reviewed the health systems in 12 other countries.

ACP has advocated universal coverage for Americans since 1990, and even floated its own proposal for reform, with a pluralistic perspective, in 2002. This is the first time the group has endorsed single-payer national health insurance, however.

“There’s really only one choice for universal health care at a cost we can afford, and that’s single-payer Medicare for all,” says Marcia Angell, MD, former editor-in-chief of the New England Journal of Medicine, and a master with the ACP, an honorary title bestowed for a distinguished career. “There is simply no way to cover everyone in a pluralistic system and control costs.”

In the position paper “Achieving a High Performance Health Care System with Universal Access: What the U.S.A. Can Learn from Other Countries,” published on the Annals of Internal Medicine Web site, the group says its recommendation is based on a large and growing body of evidence that the U.S. health system is performing poorly compared to nations with single-payer national health insurance.

The white paper states that “Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per-capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access.”

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.