No, Healthcare Is NOT Brat

Until last week, I thought “brat” referred to an obnoxious child. I was vaguely aware of Charli XCX, but I wasn’t aware that earlier this summer she’d dropped a new album with that name, or that the cultural zeitgeist subsequently declared this to be Brat Summer. Then last weekend in the space of a day, Joe Biden dropped out of the Presidential race, Vice President Harris became the presumptive Democratic presidential nominee, and Charli XCX tweeted “kamala IS brat.”

Credit: Charli XCX

V.P. Harris’s campaign exploded. Most of us had kind of been dreading the campaign between two eighty-year-old white guys, and then suddenly we had a mixed heritage woman as a candidate, who even at 59 seemed positively youthful by comparison. And brat to boot!

It’s been hilarious to watch people like Stephen Colbert or Jake Tapper try to explain brat to their viewers. Charli XCX herself described it on TikTok as:

That girl who is a little messy and likes to party, and maybe says dumb things sometimes, who feels herself but then also maybe has a breakdown but parties through it. It’s very honest; it’s very blunt—a little bit volatile, does dumb things, but, like, it’s brat. You’re brat. That’s brat.

It’s been taken much further than that, of course. An article in The Guardian described it: “Because, as we all know by now, brat – inspired by Charli’s most recent album – is more than a name, it’s a lifestyle. It is noughties excess, rave culture. It’s “a pack of cigs, a Bic lighter, a strappy white top with no bra”. It’s quintessentially cool.”  Shirly Li, in The Atlantic, opined: “The essence of “brat” is not defining people as such; it’s being simultaneously provocative and vulnerable.”

But, more to the point, Xochitl Gonzalez, also writing in The Atlantic, made clear how we should think about brat: “If you don’t know what that means, it doesn’t matter.” After all, if you’re not in on the joke, you are the joke.

The Harris campaign is all in on the joke. It fully embraced the appellation, even changing its campaign logo on social media to the easily identifiable lime green of the Brat album cover. The KHive is busy creating memes, posting TikTok clips, and filling the world with coconut emojis (long story). Some have claimed that brat summer is already over, but maybe not so fast.

Whether it is the brat effect or simply a honeymoon period for Ms. Harris, her favorability and enthusiasm ratings have soared, and the Presidential race polls again show a dead heat, after President Biden’s polls had tanked following his disastrous debate performance earlier this month. The simple fact that the Dems have a candidate who can become a cultural meme, in a good way, feels refreshing, especially in a campaign that heretofore had evoked more dread and resignation than enthusiasm.

I wish healthcare was brat.

It’s not brat to sit in your doctor’s waiting room. It’s not brat to be stuck in a telephone queue with your health insurance company. It’s not brat to get a healthcare bill that is confusing at best and terrifying at worst. It’s not brat to not be able to afford your medications, especially knowing that in other countries you’d pay much less for them. It’s not brat that we’re dying younger and have way more chronic illnesses than we once did. It’s really not brat that we’re particularly terrible at safeguarding the health of mothers and babies.  

AI in healthcare should be brat, if we don’t mess it up (and I fear we will). 3D printing of organs and tissues is brat, although it’s not mainstream yet. Nanorobots should be brat, if we can get to where we’ve been promised for years. Genetic therapy should be brat, although so far it seems like another way for pharmaceutical companies to charge us outrageous amounts.  Neural implants could be brat, although I’m worried Elon will Cybertruck it.  

It was pretty brat that we developed a COVID-19 vaccine so early in the pandemic, but not brat at all how it became politicized and, indeed, that people are turning away from vaccines generally. Cancer screenings should be brat, but, as anyone who has had a colonoscopy or mammogram can tell you, they’re not.

Being a doctor once might have been considered kind of brat, but now it just seems like kind of a sucker’s bet: all those years of training, all those debts that ensue from that, and then all the hassles once in practice. Who needs it? No wonder most medical students don’t really want a career that involves treating patients.

Health insurance most definitely is not brat (Oscar Health’s promises not withstanding). ACA made it less terrible, but there’s not too many people posting TikTok videos about how happy they are with their health insurance. It’s not brat at all that so many people remain without coverage, and that GoFundMe is a go-to for people dealing with huge medical bills.

I wish we had a healthcare system that I was excited about. According to a recent Harris poll, more than 70% of American’s feel our healthcare system fails them in some way. A Commonwealth Fund survey found 82% of Americans thought it should be fundamentally changed or completely rebuilt.

No, that’s not brat at all.

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I think of our healthcare system kind of like how I thought about Joe Biden running for President again. Nice guy, done a lot of good, means well, but, gosh, so 20^th century, so frail, and too fragile to count on being there for several more years. I want the brat version, the one that generates enthusiasm, excitement, the one that makes people want to post on social media about how it has helped them, the one that causes people to create memes praising it and the people working in it.

I want the 22^st century healthcare system, or at least a 2050 one, but I want it now. Amaze me, excite me, delight me. That’d be brat.

Vote, for Health's Sake

If you had on your political bingo card that our former President Trump would survive an assignation attempt, or that President Biden would drop out of the race a few weeks before being renominated for 2024, then you’re playing a more advanced game than I was (on the other hand, the chances that Trump would get convicted of felonies or that Biden would have a bad debate almost seemed inevitable). If we thought 2020 was the most consequential election of our lifetimes, then fasten your seat belt, because 2024 is already proving to be a bumpier ride, with more shocks undoubtedly to come.

Voting does matter. Credit: Bing Image Creator

I don’t normally write about politics, but a recent report from the Commonwealth Fund serves as a reminder: it does matter who you vote for.  It is literally a matter of life and death.

The report is the 2024 State Scorecard on Women’s Health and Reproductive Care. Long story short: “Women’s health is in a perilous place.” Lead author Sara Collins added: “Women’s health is in a very fragile place. Our health system is failing women of reproductive age, especially women of color and low-income women.”

The report’s findings are chilling:

Using the latest available data, the scorecard findings show significant disparities between states in reproductive care and women’s health, as well as deepening racial and ethnic gaps in health outcomes, with stark inequities in avoidable deaths and access to essential health services. The findings suggest these gaps could widen further, especially for women of color and those with low incomes in states with restricted access to comprehensive reproductive health care.

"We found a threefold difference across states with the highest rates of death concentrated in the southeastern states," David Radley, Ph.D., MPH, the fund's senior scientist of tracking health system performance, said in a news conference last week. "We also saw big differences across states in women's ability to access care."

Joseph R. Betancourt, M.D., Commonwealth Fund President, said: “Where you live matters to your health and healthcare. This is having a disproportionate effect on women of color and women with low incomes.” Dr. Jonas Swartz, assistant professor of obstetrics and gynecology at Duke Health in Durham, North Carolina agreed, telling NBC News: “Your zip code shouldn’t dictate your reproductive health destiny. But that is the reality.”

The study evaluated a variety of health outcomes, including all-cause mortality, maternal and infant mortality, preterm birth rates, syphilis among women of reproductive age, infants born with congenital syphilis, self-reported health status, postpartum depression, breast and cervical cancer deaths, poor mental health, and intimate partner violence. To measure coverage, access, and affordability, it looked at insurance coverage, usual source of care, cost-related problems getting health care, and system capacity for reproductive health services.

There are, as you can imagine, charts galore.

The lowest performing states – and I doubt these will be a surprise to anyone -- were Mississippi, Texas, Nevada, and Oklahoma. The highest rated states were Massachusetts, Vermont, and Rhode Island.

Just to round out the bottom ten states, they were Arkansas, Georgia, Alabama, Arizona, Tennessee, and Wyoming. You will, perhaps, notice that almost all are red (purple for Arizona and Nevada) states, and there is a significant overlap with states that did not expand Medicaid under ACA.  

"It's hard to stress how critical a source of coverage Medicaid is for pregnant women," Dr. Radley said. "Medicaid covers approximately 42% of all births in the US." Even though non-expanded Medicaid does offer more coverage for pregnant women, Dr. Collins noted that wasn’t enough: “It means that women enter their pregnancy having had less access to healthcare, particularly if they’re poor or low income. It’s pretty clear that having health insurance that’s adequate… is really necessary to access the healthcare system.”

Equally concerning, the report found that states with abortion restrictions “tend to have the fewest number of maternity care providers.” It details:

Of these 24 states, 21 have the fewest number of maternity care providers relative to the number of women who might need them. In 2023 and 2024, fewer medical school graduates applied to residency programs in states that banned abortion, both in obstetrics and gynecology and across all specialties, compared to states without bans.

Dr. Radley lamented: "Approximately 5.6 million women live in counties that are considered maternity care deserts."

It is worth noting that just three months ago the Commonwealth Fund issued another state-by-state report, focusing on racial and ethnic heath disparities, with many of the same low performing states showing up on that list as well. An overlay of poverty would track as well.

“These inequities are long-standing, no doubt,” Dr. Betancourt at the media briefing. “But recent policy choices and judicial decisions restricting access to reproductive care have and may continue to exacerbate them.”  I.e., the Dobbs decision overturning Roe v. Wade and subsequent state actions to restrict abortion access, which the authors say “significantly altered both access to reproductive health care services and how providers are able to treat pregnancy complications.”

It would be easy, and not entirely wrong, to blame all these on underlying social determinants of health (SDoH), but coverage of the Commonwealth Fund’s report introduced me to a related term that I think is equally to blame: “political determinants of health.” That term, as espoused by Daniel E. Dawes, points the finger directly at legislative and policy decisions.

“When you think of the structural conditions that many folks find themselves in, there is an underlying policy – political action or inaction – that has determined those conditions and structured the resources that has enabled those conditions to exist,” Professor Dawes told The Guardian.

The report grimly concludes:

Ongoing judicial action at the federal level, along with the potential for a policy reversal under the next administration, raise further concerns over the future of women’s health… Our findings suggest that urgent action by Congress and state policymakers is necessary to ensure women have timely access to complete health and reproductive care, regardless of who they are, what they earn, or where they live.

These findings, and a host of other reports on state-by-state disparities, shouldn’t just be of concern to women, or to people of color, or to low-income families. They’re not just something for clinicians to address. These are political issues that can impact us all.

SDoH can take decades to reverse, but political determinants of health get influenced in every election. It’s up to us to vote thoughtfully. So vote like your health depends on it – or like your mother’s, sister’s, or daughter’s health does.

Google Hopes Nobody Beats This Wiz

When I saw the Wall Street Journal article about Alphabet being in “advanced talks” to buy cybersecurity firm Wiz for an eye-popping $23b, I must confess that – never having previously heard of the company – my thoughts flashed back to the Seinfeld episode (“The Junk Mail”) where Elaine dates a man whose job turns out to be an outlandish mascot for electronics store The Wiz, whose motto he gleefully repeats: “Nobody beats The Wiz!”  That firm is long gone but this Wiz is alive and well, enough so that the acquisition would be Alphabet’s largest ever.

Credit: Gizchina

The Wiz was only founded in 2020, by four ex-Israeli military officers (they reportedly all originally worked together at Israel’s equivalent of the NSA). They had previously founded cloud cybersecurity firm Adallom in 2012, which they sold to Microsoft in 2015 for its Azure cloud computing firm. Wiz also specializes in cloud cybersecurity, and, according to WSJ, its clients include 40% of the Fortune 500 companies as customers, including Barclay’s, Mars, Morgan Stanley, and Slack. Other notable customers include BMW, DocuSign, EA, and Salesforce.

Pretty impressive for a four-year-old start-up.

Credit: Wiz

Alphabet’s cloud business – Google Cloud Platform (GCP) -- badly trails leaders AWS (Amazon) and Azure (Microsoft), although last year GCP’s revenue’s rose 26% and it recorded its first operating profit. It’s Q1 2024 revenue was up 28%. By the way, Wiz lists both AWS and Azure as partners, along with GCP, Oracle Cloud Infrastructure, VMware, and Alibaba Cloud.  

Alphabet had bought security company Mandiant two years ago for $5.4b, as well as Siemplify, another Israeli cloud cybersecurity company, that same year, and evidently sees these acquisition as a way to bolster its cloud business.

For some perspective, just this past May Wiz raised $1b in a funding round that gave it a $12b valuation. Its annual recurring revenues are estimated at $500 million, so Alphabet’s offer is a 46 multiplier. By contrast, WSJ notes that competitor CrowdStrike has a market capitalization that is 25 times annual recurring revenues. “This could be one of the largest and fastest returns ever for a private security company in tech history,” Alex Clayton, a general partner at Meritech Capital, told WSJ.

“There are two advantages of Google acquiring Wiz,” Ray Wang, principal analyst and founder of Constellation Research, told CSO. “One, cloud security is hot and allows Google to cut into AWS and Azure clients, and two, having Wiz would give them some consistently large workloads to monetize.”

If you’re wondering why cloud security is hot, I need only mention AT&T, which recently disclosed that the records of “nearly all” of its cellular customers had been breached. Well, those records came from its cloud provider Snowflake -- and that was not the first time Snowflake has been attacked and possibly breached. Azure has also suffered some serious breaches, and has been accused of “repeated pattern of negligent cybersecurity practices.” AWS has had its share of data breaches as well.

So, yeah, a cloud service better have good cybersecurity.

The Independent praised Wiz’s “innovative interface,” which “provided visual displays that use graphs and charts to illustrate a company’s entire cloud security architecture, making it straightforward to identify threats and potential weaknesses.” (The Independent also had the headline I wished I’d thought of: Gee Wiz).

Display of Wiz Cloud Detection and Response (CDR). Credit: Wiz

Bank Info Security reported that “Wiz in January got the highest "current offering" rank from Forrester in cloud workload defense,” although “a weak cloud workload security strategy meant Wiz's total score came in fourth behind CrowdStrike, Palo Alto Networks and Microsoft.”  Wiz was also named the top rated cloud security company on the 2023 Forbes Cloud 100.

Pareekh Jain, CEO and lead analyst at Pareekh Consulting told CSO. “GCP is lagging behind AWS and Microsoft in the cloud and this acquisition could create a much-needed differentiator for GCP. There have been many cybersecurity incidents in the recent past and strong cloud security credentials could be a differentiator and deciding factor for enterprises considering their movement to cloud.”

“This was the missing piece in Google’s portfolio and helps them provide cybersecurity as a service bundled with their cloud offerings,” Neil Shah, VP for research and partner at Counterpart Research, also told CSO.

Much has been made of potential antitrust scrutiny of the deal, due to its size and the fact that Google is already being accused of being a monopoly. WSJ – which had another headline I wished I’d thought of (Google’s Wiz Deal Won’t Ease on Down the Road) – but Bank Info Security, for one, called those concerns “overblown”:

Despite Google being in the crosshairs of regulators on both sides of the Atlantic Ocean, antitrust probes are unlikely to sink a potential purchase of Wiz. Neither Google nor Wiz ranked among the seven market share leaders in cloud workload security in 2022, according to IDC, which said control of the market was in the hands of Trend Micro, Palo Alto, Microsoft, CrowdStrike, Check Point, Broadcom and Trellix.

It may take a while (less if Trump is reelected), but Google is likely to prevail. That being said, I expect that AWS, Azure, and GCP will end up getting spun-off or divested eventually, because they’re getting big enough to rival Amazon’s, Microsoft’s, and Alphabet’s core businesses. So, go ahead, power up the cybersecurity.  

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Look, I’m no cybersecurity expert, and I know even less about the cloud business. But I am an AT&T customer, not to mention a Ticketmaster one, and a United Healthcare one. For heaven’s sake, my local hospital system – which only serves my community – has been breached. So if GCP wants to spend $26b strengthening the security of its cloud business, I say more power to them, and I hope the other cloud companies follow suit.

Whatever worrying we’ve been doing about cybersecurity is nothing to how much we should be worrying about it once AI gets involved. “AI and Cybersecurity are the two biggest areas customers are investing their technology dollars,” Mr. Wang told CSO. “Google seeks to play in both areas.”

We’ve seen how much attention has been paid to A.I. companies, and how much investment is going to them, and we better see the same with cybersecurity.

Healthcare Needs a 21st Century Infrastructure

Matthew Holt is going to tell me I’ve been thinking about infrastructure too much lately (e.g., cybersecurity of them, backup plans for them), but if you don’t have infrastructure right, you don’t have anything right.

Healthcare infrastructure can be like that. Credit: Bing Image Creator

And healthcare most definitely does not have its infrastructure right.

We’re spending between 15-30% of our healthcare dollar on administration, and no one views our healthcare system as efficient or even particularly effective. We have numerous intermediaries like PBMs, billing services, revenue cycle management vendors, and all sorts of digital health solutions. There are layers upon layers upon layers, each adding its costs and complications.

In some ways, healthcare’s infrastructure has changed remarkably in the last two to three decades. Most transactions – e.g., claims or eligibility – are sent, and often processed, electronically. Most physicians, hospitals, and other health care clinicians/organizations have electronic health records. You can find out the expected cost for prescription drugs at point-of-sale. You can do a virtual visit with your doctor. There are vast amounts of health information available online. AI is coming to health care, and, in some cases, is already here.

But: we’re still sending faxes. We’re still filling out paper forms, repeatedly. We still make innumerable phone calls, usually spending long waits in queue. Everyone hates provider directories, which are never up-to-date and often inaccurate. Talk of interoperability notwithstanding, there are far too many data silos, leading to at best us lugging around disks with our downloaded records to at worst physicians acting with incomplete information for us. Healthcare has had far too many data breaches, and cyberattacks have held patient data hostage (e.g., Ascension) or put a halt to those electronic transaction (e.g., Change Healthcare). And we’re not at all sure how to govern AI.

The amount of medical literature has been growing exponentially for decades, and the volume of health care data is growing much, much faster. Physicians once guarded health information like the guild they are, but the Internet has democratized health information – while doing the same for misinformation. If anything, we have too much information; we just can’t use it as effectively as we should (e.g., it can take 17 years for evidence to change physician practice).

This is not an infrastructure that is not coping well with the 21^st century.

I recently read Deb Chachra’s How Infrastructure Works, and among its many insights I was struck by her calls for reshaping infrastructure for the future. Infrastructure, she argues, needs to build in more robustness, redundancy and resiliency, through more diversity and decentralization. She predicts that infrastructure systems of the 21^st century will be more diffuse, diverse, and distributed.

That’s what healthcare needs to be preparing for – now.   

I’ll suggest a few basic building blocks for healthcare’s 21^st century infrastructure:

Information: we’re drowning in health care information; some of it good, some of it bad, some of it groundbreaking, some of it conflicting. We need mechanisms that help curate and make available that information, so both patients and clinicians can easily discover what the latest, most credible information is. No more doing Google searches and hoping for the best. No more waiting weeks, months, years for the best information.

Such information should have a layered presentation, with a high level one accessible to all and more detailed ones for those with more clinical knowledge.  In line with Professor Chachra’s thinking, this should not be a single database/website; it needs to be robust, redundant, and resilient, so that it can survive cyberattacks and not become polluted with false information.

Data: The data apocalypse is upon us. We’re all generating massive amounts of health data, both from “traditional” sources as well as from newer ones. Yet we have limited ability to understand anyone’s health history, much less detect a community outbreak in real time. We can’t tell which clinicians are treating who for what, or how well they’re doing that. We can’t even link a person to all the sources of data that exist about them.

We need unique person identifiers. We need unique health care practitioner identifiers. We need to have consolidated views of patients and clinicians, and the ability to analyze at an individual, health system, community, regional, and national levels. Again, not a single database, but data that can be queried and analyzed in real time, while remaining – you guessed it -- robust, redundant, and resilient. And strong privacy protections must be baked in at every level.

Insurers: I worked in the health insurance industry for many years, and I still believe it has a critical role. But it’s insane that each company has its own interfaces, its own credentialling, its own provider networks, its own medical necessity and preauthorization requirements, its own set of exclusions and limitations. ACA standardized some elements of health plans, as did HIPAA before that (certain transactions). But the hundreds of insurers/third party administrator/self-funded plans are a drag on the system that cannot be tolerated.

I’m not calling them to be abolished, but if they can’t agree on common infrastructures that alleviate pain points for everyone else, they will be.  

Artificial intelligence: AI is the technology of the 21^st century. It is going to impact every job, every industry, every business interaction. Healthcare will not be an exception.   

Right now there are many independent efforts to develop and use A.I. in health care. Right now we’re still exploring point solutions for A.I. in health care. Right now there are no overarching rules for how to train or deploy A.I. in health care. Right now there is no common vision about how A.I. can or should transform health care.

All that must change. We need to thoughtfully build A.I. into healthcare’s infrastructure, making them more effective, efficient – and robust, redundant, and resilient.  

AI will be part of healthcare's infrastructure. Credit: Bing Image Creator

I’m sure there are several more components I’m missing, but let’s start the discussion with those.

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We’ve seen healthcare systems be overwhelmed by climate change, in the form of hurricanes or power outages. We’ve seen healthcare organizations brought to a halt by cyberattacks. We’ve all gotten caught up in healthcare red tape.  We know our healthcare system is way too expensive while being way too ineffective.

These are failures of infrastructure. These are failures of imagination. Changing infrastructure is a long, expensive, and complex effort, but it’s like the old proverb about planting a tree: the best time is twenty years ago. The second best time is now.

It’s 2024, and if we don’t start reworking our healthcare infrastructure for the 21^st century now, it will soon be the 22^nd century.

Where Are Healthcare's Value Meals?

If you’re anything like me, you’ve noticed that food costs have been increasing. Whether it is food from the grocery or at a restaurant, the bill can be eye-opening compared to a few years ago. Blame the pandemic, blame corporate greed, blame the President – take your pick. But the bottom line is, you have to eat. You can buy lower priced options, you can go out less often, you can skimp on non-food spending, but you’re going to buy food. The other thing you can do is to complain.

Health care bills do that to you. Credit: Bing Image Creator

Well, the fast food industry, for one, is listening to those complaints, and many leading fast food companies have launched a variety of “value meals” to reduce the pain consumers feel. Evidently they are still capable of feeling shame, or at least of recognizing that consumers have choices.

I just wish the healthcare industry was capable of doing the same.

Let’s be clear: the fast food industry has brought this on themselves. The Wall Street Journal reports that prices of food eaten away from home rose 30% since 2019, according to labor Department statistics, and that prices for a Big Mac increased 21% over the same period. McNugget meals were up 28% over the same period.

McDonald’s recognized the problem. It announced a $5 meal bundle in mid-May, targeting a June 25 launch date. For those of you craving a McD’s fix, the deal includes McDouble or McChicken sandwich, small fries, small soft drink and a four-piece Chicken McNuggets. “I’ve been in our restaurants. I’ve sat in focus groups,” Erlinger said on the Today show, touting the new deals.

It didn’t take long for other fast food chains to offer their own version. KFC introduced its $4.99 value menu back in April, even before McDonald’s announcement. Wendy’s has a $3 breakfast deal, Burger King has a $5 Your Way Meal, Taco Bell has something it calls a Luxe Craving Box for $7, Starbucks has a new Pairing Menu priced between $5-$7, Jack in the Box has a $4 munchies Meal, and Sonic now offers a $1.99 menu it calls “Fun.99,” which it says will be permanent, not a time limited promotion. I’m sure there are others.

“It still holds true that imitation is the sincerest form of flattery,” Burger King North American president Tom Curtis said in a May email to restaurant operators. “We know the competition is doing that. So we will be in that game,” Jack in the Box Chief Executive Darin Harris said. 

Lest anyone be worried about hurting the fast food companies’ margins, R.J. Hottovy, head of analytical research at Placer.ai, told Yahoo Finance: “It really comes down to … repeat visits after the fact. You're not making money on the value menu. You're making menu money on the other products, the more premium products, the dessert products, the beverage products that go along with that.”

Health care is like food in that almost anywhere you go you can probably find it. There are fast food restaurants seemingly on every corner, but there also are drugstores and doctors’ offices somewhere near those fast food restaurants. Health care may not quite be omnipresent, but it’s pretty present.

Unlike food, you may not need health care every day -- but you are going to need it at some point. It may be a simple visit, it may be a pill a day for a few days, but it could be a mind-boggling array of tests, medications and procedures you never imagined or lifelong care.

In a fast food restaurant, you look at the menu, pick what you want and how much you are willing to pay, but with health care you don’t have such a menu. Someone else is usually telling what you need and dictating how much you’ll pay for it. After numerous “price transparency” efforts in these last few years, you might be able to find some set of prices, but if anyone has ever successfully been able to use them for anything other than the simplest of interactions, I’d like to know about it.  

Credit: KFF

Fast food is extremely competitive, and you’d think that health care, with all of our options, would be a fiercely competitive market as well. Most health care organizations would tell you that it is. But most healthcare markets have become highly concentrated. Those consolidations lead to higher prices, and those higher prices lead to lost jobs and lower wages in the local economy.  “The harm from these mergers really falls squarely on Main Street,” said Zack Cooper, an associate professor of economics at Yale University.

Professor Cooper added: “That’s one of the, I think, incredibly subtle but sinister consequences of rising health spending. It leads individuals to lose their job.”

Consumers have been complaining about health care prices for as long as I’ve been involved in healthcare, which is longer than I care to admit (hint: I remember when health care spending was under 10% of GDP). What I don’t remember is health care organizations ever lowering prices, even temporarily.

Look at insulin. It’s absolutely critical for those who need it. It was invented decades ago, and should have been cheap long ago. But it took a federal law to limit what consumers had to pay for it – against the drug companies’ vigorous lobbying efforts. And, of course, the only thing that was actually reduced was how much consumers paid out-of-pocket – not the total price.

The same law that enacted the limit on insulin out-of-pocket costs also allowed Medicare to negotiate some prescription drug prices, again against the continued opposite from pharmaceutical companies. The only way, it seems, to get healthcare organizations to lower prices is to legislate it (and if you think those healthcare organizations are going to suffer from such negotiations, look at pharmaceutical stocks).

Maybe I shouldn’t wish for healthcare organizations to try to lure in more customers through “value” pricing offers (especially knowing they’d just try to make it up on other services). Maybe health care is truly too complex for such simple solutions. Maybe the fast food industry is never a good model for health care.

But I sure wouldn’t mind if I saw more evidence that health care organizations felt consumers’ pain from high health care costs, and sought to do their part to reduce it.