Three years ago this month, as alarms were sounding across the country about the over-prescription of opioid painkillers, the federal government issued course-correcting guidelines for primary care doctors. But in a letter sent to the Centers for Disease Control and Prevention on Wednesday, more than 300 medical experts, including three former White House drug czars, contend that the guidelines are harming one group of vulnerable patients: those with severe chronic pain who may have been taking opioids for years, without becoming addicted, so they can function in daily life and work. The leaders say the guidelines are being used as cover by insurers to deny reimbursement and by doctors to turn patients away.  

The sudden resignation of Scott Gottlieb, the commissioner of the Food and Drug Administration, leaves a giant hole atop an agency that oversees a quarter of the U.S. economy. Which, of course, leads to an equally big question: Who will replace him? Top contenders include Amy Abernethy, formerly the chief medical officer at health data firm Flatiron Health, who became Gottlieb’s principal deputy commissioner early this year. Another contender is Ned Sharpless, director of the National Cancer Institute since October 2017, who would bring a deep knowledge of biotech to an FDA stint. And another is Brett Giroir, the current HHS assistant secretary for health, with experience in government, academia, and industry.

Connecticut, Nevada, Illinois and Minnesota are looking at schemes that would allow anyone to buy into Medicaid. Washington State governor Jay Inslee and his allies in the state legislature plan to introduce a bill that would create a state-sponsored health plan—or public option—to compete against private insurers. Medicaid buy-ins and public options are little more than stepping stones to a complete government takeover of the health care system. They’d gradually put private insurers out of business. In the end, Americans would be left with low-quality government-sponsored insurance that forces them to pay higher taxes and endure long waits for treatment.

Democratic lawmakers in Connecticut introduced legislation Thursday that would create a public option for health-care coverage, allowing individuals and small businesses to buy insurance through the state. Under the proposal, Connecticut would create multiple plans that small businesses and their employees could buy starting in July, leveraging the state’s existing purchasing power to lower costs. And in 2021 Connecticut would begin offering a new health-insurance option that any state resident would be able to join. The public insurance would offer coverage options for small businesses and individuals who don’t qualify for subsidies through the Affordable Care Act, officials said.

Put simply, there is nothing like Medicare for All anywhere in the industrialized world. Socialized medicine proposals, like the House version introduced last month by Rep. Pramila Jayapal, (D-WA), would offer everyone living in the United States comprehensive coverage with no deductibles and no copayments. Jayapal claims, “This is not a particularly ambitious plan, in the sense that so many others have done it.” But no industrialized nation has tried anything so sweeping. Not one provides soup-to-nuts government-paid insurance that covers everything without any cost-sharing from patients. None. Even so-called single-payer systems rely on some forms of private insurance.

Other reports show Democratic leaders are not as enthusiastic as Jayapal, et al.  House Speaker Nancy Pelosi in an interview with Rolling Stone said moving to a single-payer system was the simplest way to bring about universal health care, but then noted an estimated $30 trillion cost. “That is, administratively, the simplest thing to do, but to convert to it? Thirty trillion dollars. Now, how do you pay for that?” Pelosi said.

The CMS is asking the public for ideas and advice on how to make it easier for health insurers to sell policies across state lines. The agency issued a request for information on Wednesday for recommendations on eliminating barriers and enhancing insurers’ ability to sell individual insurance coverage from state-to-state. The request, which the CMS said is meant to promote competition and choice for consumers, follows President Trump’s October 2017 executive order on cost and competition in the health sector. CMS said it is interested in feedback about how states could use Section 1333 of the ACA, which allows insurers to enter into a “healthcare choice compact,” to sell out-of-state coverage if state regulators agree.

The Trump administration is sounding out an idea to require that hospitals, doctors and other medical providers publicly disclose the “secretly-negotiated” prices they charge insurance companies for services, a move that proponents say would expose for the first time the actual cost of care. [Some are skeptical that anyone in the health sector knows the actual cost of care.] Hospitals and insurers negotiate pricing contracts which are generally bound by confidentiality. HHS is seeking public comment on whether patients have a right to see the discounted prices in advance of obtaining care. 

In response to a request from Sen. Lamar Alexander (R-TN), chairman of the Senate Committee on Health, Education, Labor, and Pensions, health policy experts at the American Enterprise Institute and the Brookings Institution worked together to compile a list of policy options to slow the rate of increase of health care costs and attract bipartisan support. Among the key policy proposals:

  • Limit the tax exclusion of employer-sponsored insurance
  • Ensure effective anti-trust enforcement
  • Discourage state governments from inhibiting free market competition
  • Prevent surprise out-of-network billing
  • Encourage the use of more generic drugs in Medicare Part D

Access to quality, affordable medical care should be something all elected officials can agree to work on because it’s something we all believe in, Rep. Westerman (R-AR) writes. The Fair Care Act has two primary goals: to increase the number of people with health insurance coverage and to decrease per person health spending. It’s a fair solution covering pre-existing conditions, tackling the cost of insurance premiums and increasing consumer flexibility.  Highlights:

  • Title 1: Private Sector Health Insurance Reforms
  • Title 2: Medicare and Medicaid Reforms that Promote Solvency and Increase Access to Health Insurance Plans
  • Title 3: Promote Transparency and Competition to Lower Prescription Drug Costs
  • Title 4: Increase Competition and Lower Costs by Discouraging Provider Monopolies
  • Title 5: Digital Health Care Reforms

The sales pitch for Medicare for all is appealing—universal coverage, free access to doctors and hospitals, and no insurance premiums, copayments or deductibles. But then come the tradeoffs: Everyone would be required to give up private health insurance, and taxes could double to finance $32 trillion in added government spending over the next decade.  Washington bureaucrats would decide what services are covered and how much doctors and hospitals would be paid. Rationing and waiting lines are inevitable. The American people don’t want such a major upheaval. The right solution is to give people more choices of more affordable health coverage and have states, rather than the federal government, target resources to those who need help.