ObamaCare has been bad for doctors, and many patients who have to pay for their own premiums, but it’s been good for hospitals. New hospital construction is booming where I live and I suspect where you live, too. Hospitals are purchasing more and more physician practices as they bring these formerly independent medical practices under their own umbrella. That means more control over the way doctors practice medicine, which means more control over healthcare dollars.

This has led to consolidation of large hospitals and smaller hospitals into large hospital and health systems. In my town, what used to be called Florida Hospital is now called Advent Health. What used to be called Orlando Regional Medical Center is now called Orlando Health. Both hospital systems are growing by leaps and bounds and each seems determined to outgrow the other into more and more remote locations.

Grace-Marie Turner, writing for Galen.org, says this consolidation of large hospitals and health systems is on the political and policy radar screens of both Republicans and Democrats, offering a rare opportunity for action in a polarized Congress. Ninety percent of the nation’s hospital markets were considered “highly concentrated” in 2017, with many more mergers since then. This cuts costs for hospitals but the savings rarely are passed along to consumers.

Hospital prices go up 6 to 20 percent when one merges with or acquires another, according to Janet Trautwein, who heads the National Association of Benefits and Insurance Professionals. She says that leads to higher premiums but not a coincident increase in the quality of care.

The bureaucratization of medicine makes it extremely difficult and risky for physicians to remain in independent practice. Three out of four doctors now are employed by large hospital systems or health plans. They turn over scheduling, billing and negotiations with insurers to these conglomerates in exchange for a salary and some support staff.

Medical blogs show how this is decimating physician morale as they are forced to see eight or more patients an hour with the “system” recommending tests like vascular studies and abdominal ultrasounds they don’t necessarily believe are needed.  Instead of having a nurse on staff to answer patient calls, the calls may be rerouted to call centers overseas and to having patients directed to urgent care centers (which the systems also own).

I wrote of this dilemma in a series of earlier posts called Doctors Facing a Moral Crisis – Parts I-IV. This has significant ramifications for the practice of medicine as well as the quality of healthcare delivered in our system.

It is a monumental problem that will take the best minds and the work of politicians to solve. Grace-Marie Turner says, “There is no silver bullet solution to reform how $4.3 trillion in private and public money is spent on health care every year. But it is important to begin. Three key House committees have been working all summer to hash out details of an important health reform bill to be introduced today, the “Lower Cost, More Transparency Act.”

The House Energy and Commerce, Ways and Means, and Education and the Workforce committees have negotiated a package that focuses on health care price transparency, site-neutral payments, extending funding set to Community Health Centers, the graduate medical education program, and other health programs.

Fortunately, there are signs of agreement across the legislative aisle. The Third Way, for example, has a new report that explains: “Out-of-control hospital prices are part of a vicious cycle where hospital consolidation drives up prices and subverts the competition needed to keep costs in check. In turn, higher costs undermine the adequacy of Medicare payments to hospitals, which leads more hospitals to consolidate.”

And the Progressive Policy Institute also has launched a new center on Competition Policy to be headed by Dr. Diana Moss, an expert in anti-trust policy whose mission is “to advocate for strong competition enforcement and policy.” While we don’t always agree on solutions, agreeing that hospital consolidation is a major cost driver that is impacting the entire health system is an important start.

It’s time to remember healthcare should be all about delivering the best quality healthcare, not delivering the highest profits.

Modern technology has made it possible to transplant many failed organs. We now transplant kidneys, livers, lungs, and even hearts. In 2022, more than 42,800 organ transplants were performed in the U.S., according to the United Network for Organ Sharing (UNOS). This is a record, an increase of 3.7 percent over the previous record in 2021.

Also, for the first year ever, more than 25,000 kidney transplants were performed in the United States. The total of 25,498 marked an increase of 3.4 percent over 2021. In addition, annual records were set for liver (9,528), heart (4,111) and lung (2,692) transplants.

“In a year that we commemorated one million transplants performed nationwide, we are glad to mark accelerated progress toward the next million,” said Jerry McCauley, M.D., M.P.H., president of the UNOS Board of Directors. ”We thank all the living and deceased organ donors, as well as the loved ones of deceased donors, who have provided a lifesaving gift. We also honor all the clinicians and professionals involved in organ donation and transplantation, who work tirelessly to make as many transplants happen as possible every day. We also should rededicate ourselves to meeting the continuing need,” added Dr. McCauley. “Many people still wait anxiously for a life-giving transplant. We must continue to improve in our capabilities to give them this vital opportunity by ensuring use of as many donated organs as possible.”

With all this progress in making organ transplants available to more and more Americans, you would think we would be doing everything possible to make these transplants a long-term success. Alas, this is not the case.

The Wall Street Journal editorial board says, “Government spending on healthcare often leads to rationed care owing to rising costs. Think of the waiting lists in Canada and new price controls on U.S. drugs. Another mistake is playing out in care for organ-transplant patients denied coverage for blood tests that detect problems.”

In March, MolDX, a program run by Medicare contractor Palmetto GBA to make coverage decisions on molecular lab tests, changed its guidance for when certain blood tests can be used. The tests, which use molecular technology to catch signs of organ rejection, are often ordered for patients who had kidney, heart or lung transplants. Under the contractor’s new policy, the tests can no longer be used as part of routine monitoring care for most patients.

The tests are expensive. Blood tests for kidney and heart rejection can cost $2,800-$3,200 each. To be most useful, they have been administered regularly to help doctors monitor the body’s response to a new organ. The tests pick up how failing organs shed donor DNA into the bloodstream, catching problems early. By the time a patient shows up with a fever, organ rejection is often advanced.

Stanford pediatric nephrologist Ken Sutha told WSJ that doctors must often walk a tightrope with transplant patients. The patients take immuno-suppressant drugs to prevent organ rejection. But if they get sick, their doctors must back off the suppressants to let their bodies fight the illness.

Blood tests are critical during that time for monitoring early signs of organ rejection. Dr. Sutha knows this as a practitioner and patient. He received a kidney donation from his father when he was 24, but lost it when the rejection wasn’t controlled. The alternative to the blood tests is an invasive biopsy that is also expensive and may be done too late to save the organ. Palmetto’s MolDX program answers to the federal Centers for Medicare and Medicaid Services (CMS).

This is a classic example of how government-controlled healthcare sacrifices the health of its beneficiaries in favor of saving government money. It is essentially rationing of care by another name. Unless you are wealthy, you cannot afford the tests so your life expectancy is jeopardized.

The American Society of Transplant Surgeons, the International Society for Heart and Lung Transplantation and the American Society of Transplantation have written letters to the contractor explaining the need for the tests. The surgeons’ group notes the change makes no sense when CMS itself has “clearly acknowledged that transplantation is the best, and most cost-effective, treatment option.”

A bipartisan letter from 12 members of Congress, including Rep. Michael Burgess(R., Texas) and Rep. Anna Eshoo (D., Calif.), to CMS administrator Chiquita Brooks-LaSure has asked for coverage to be restored. They note that MolDX’s policy may especially harm poor communities that have “less access to specialized transplant centers, making non-invasive diagnostic tests even more critical for their ongoing post transplant care.”

Remember those famous words of terror: “I’m from the government and I’m here to help!”

Regular readers of this blog know that when I’m not writing about healthcare-related subjects, school choice is my next most favorite topic. The reason is simple – school choice is the key to a good education for children of all socioeconomic levels. And a good education is the key to a productive future for everyone.

Former Secretary of State Condoleeza Rice has called school choice “the civil rights issue of our times.” Low-income families of all races have discovered that school choice allows their children to escape poverty and achieve the American dream. That issue alone is convincing more and more Democrats into voting Republican.

The biggest obstacle for advocates of school choice is the teachers unions. The teachers unions realize school choice is an existential threat to their livelihoods. So it’s no surprise they fight back against school choice with every fiber of their being. What is a surprise, however, is when they send their own children to private schools.

Chicago Teachers Union President Stacy Davis Gates has been at the forefront of the battle against school choice. The Wall Street Journal editorial board says she has called school choice racist and made it her mission to kill an Illinois scholarship program for low-income children.

WSJ says, “So how did Ms. Gates try to explain herself this week after press reports that she has enrolled her son in a private Catholic high school? “Dear Union Sibling,” began her email to fellow teachers. She said that black students have “limited” options on the city’s south and west sides: “It forced us to send our son, after years of attending a public school, to a private high school so he could live out his dream of being a soccer player while also having a curriculum that can meet his social and emotional needs.”

In other words, “Public school for thee, but not for me!” Oh, the hypocrisy! It’s no surprise that she would desire to do what’s best for her child – that’s what every parent should want! But how can she justify doing this for her child but opposing measures like school choice that make it possible for everyone’s child?

The school where her son is enrolled reportedly costs her $16,000 a year. What about those who can’t afford such a school? Illinois’ Invest in Kids program funds about 9,000 scholarships, and last year it had 31,000 applications. But the program is scheduled to sunset, and that’s exactly what the teachers unions have demanded.

She seems to understand the problem. Her own email says, “Here is the truth: If you are a Black family living in a Black community, high-quality neighborhood schools have been the dream, not the reality.” Yet she won’t be a part of the solution – advocating school choice – because her union job demands she oppose school choice. For some schools on the south side of Chicago, the percentage of students who can read or do math at grade level is in the single digits. But then Gates insists, as the teachers unions always do, that the answer is spending yet more money to “undo the decades of systemic underinvestment.”

WSJ tells us the operating budget for the Chicago public schools has grown to $8.5 billion in 2024, from $6.3 billion in 2020, according to the Illinois Policy Institute. Yet enrollment is down 80,000 students from a decade ago, and many schools are underutilized.  Clearly, throwing more money at a failed system is no solution.

The problem is failing public schools and teachers unions are a big part of that problem. The solution is school choice, and most states are realizing this and making it more available. Florida recently passed legislation that permits every Florida student, regardless of their economic status, to have school vouchers worth $8,000 to use to pay for private or parochial schools.

Ms. Gates understands the problem, but her job makes her blind to the solution. Maybe it’s time she looked a little closer in the mirror.