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The shortage of primary care doctors has been years -- if not decades -- in the making. KFF Health News reported on the percentage of doctor visits that are for primary care declining from 62% in 1980 to 38% in 2013. Many people blame the reimbursement system for valuing specialty care over primary care, and therefore attracting more medical school graduates into specialty fields. At the same time, many feel that primary care is valuable because it can identify and address issues before they become severe enough to warrant the more expensive specialty care. The article also pointed out how current payment structures essentially force primary care providers to squeeze patients into a much tighter schedule, leading to less satisfied patients and likely worse quality of care.

The shortage of primary care doctors has been years -- if not decades -- in the making. KFF Health News reported on the percentage of doctor visits that are for primary care declining from 62% in 1980 to 38% in 2013. Many people blame the reimbursement system for valuing specialty care over primary care, and therefore attracting more medical school graduates into specialty fields. At the same time, many feel that primary care is valuable because it can identify and address issues before they become severe enough to warrant the more expensive specialty care. The article also pointed out how current payment structures essentially force primary care providers to squeeze patients into a much tighter schedule, leading to less satisfied patients and likely worse quality of care.

Theoretically, prices paid for doctors' services would fluctuate in a free market and self-correct such that scarcity of primary care would drive prices up, attracting more doctors to the field. However, health care is not a free market. Relative values of one procedure compared to another procedure are determined by a committee, and the payers (health insurance companies) are dominated by large players, making it difficult for small provider offices to negotiate and switch. Even still, if it is indeed true that primary care can save the overall system money, it seems that some payers would figure out how to capitalize on the current trends and perform better than some other competitors. For now, the industry is watching Medicare try out value-based care, which probably better recognizes the value of primary care compared to the older fee-for-service model.

The Inflation Reduction Act allows the federal government to negotiate prices that Medicare pays, and the current administration has released its list of first ten targets. Up until the Inflation Reduction Act, Medicare was prohibited from negotiating drug prices. KFF Health News published an informative piece about this milestone. Negotiated prices are slated to take effect in 2026.

The Inflation Reduction Act allows the federal government to negotiate prices that Medicare pays, and the current administration has released its list of first ten targets. Up until the Inflation Reduction Act, Medicare was prohibited from negotiating drug prices. KFF Health News published an informative piece about this milestone. Negotiated prices are slated to take effect in 2026.

Understandably, pharmaceutical companies (or associations on their behalf) have filed lawsuits to stop the legislation from taking effect. The legislation requires that manufacturers not only negotiate, but also furnish data relevant to the negotiation. The extent to which manufacturers can refuse a price that Medicare asks for seems unclear. If a manufacturer is able to refuse a price, it will be interesting to see if Medicare will end up caving to public pressure for the coverage of specific medications.

In the US, licenses to practice medicine are granted at the state level by state licensing boards. Therefore, state licensing boards also tend to be responsible for investigating and adjudicating complaints about malpractice or unprofessional behavior. KFF Health News published an article describing some of the struggles that the California Medical Board is experiencing: "The board opened only about 1,000 investigations out of nearly 10,000 complaints last year." Perhaps more telling: "Critics have complained for years that the medical board doesn't hold doctors accountable often enough. Families that file complaints against doctors frequently go years without updates on the status of investigations, and often aren't told why when their complaints are rejected."

In the US, licenses to practice medicine are granted at the state level by state licensing boards. Therefore, state licensing boards also tend to be responsible for investigating and adjudicating complaints about malpractice or unprofessional behavior. KFF Health News published an article describing some of the struggles that the California Medical Board is experiencing: "The board opened only about 1,000 investigations out of nearly 10,000 complaints last year." Perhaps more telling: "Critics have complained for years that the medical board doesn't hold doctors accountable often enough. Families that file complaints against doctors frequently go years without updates on the status of investigations, and often aren't told why when their complaints are rejected."

Apparently, the issue is a lack of funding: "The simple reality is that the board is not able to pay its bills," the board said in a statement. The medical board has had to borrow $18 million from the Bureau of Automotive Repair. The $79 million budget sounds like a fair amount, but the board has pointed out that it has "little control over staffing costs. Its 169 employees work for the state and are covered by labor agreements negotiated by statewide employee unions."

A legislator has proposed raising licensing fees, along with some other changes. The California Medical Association has objected to the extent of the fee increase. Devising an ideal solution is difficult since, without knowing more details, it is unclear if the board is efficiently spending its funds. It is not difficult to imagine a bureaucracy that grows more when it is fed more. Nevertheless, the status quo does not inspire a tremendous amount of confidence.

During the previous White House administration, hospitals were required to post prices of common procedures online in a machine-readable format. However, people who tried to consume the data found them difficult to ingest. KFF Health News has reported that the current White House administration seeks to "further standardize the required data, increase its usefulness for consumers, and boost enforcement."

During the previous White House administration, hospitals were required to post prices of common procedures online in a machine-readable format. However, people who tried to consume the data found them difficult to ingest. KFF Health News has reported that the current White House administration seeks to "further standardize the required data, increase its usefulness for consumers, and boost enforcement."

Regulation for insurers to post pricing information online appears to be more standardized and therefore easier to ingest, so this effort might lead to more organizations being able to make use of this data. Details remain to be seen. Interestingly, the federal government "sent more than 900 warning letters to hospitals about their posted data, with most resolving those concerns," suggesting that hospitals might be responsive when deficiencies in this area are pointed out.

KFF Health News published an informative perspective on the consolidation of hospitals and medical practices. "75% of markets are now considered highly consolidated — [which] decreases patient choice, impedes innovation, erodes quality, and raises prices. Apparently, judges have previously ruled in favor of these hospital mergers frequently enough (citing their non-profit status) that the Federal Trade Commission (FTC) opted to not challenge many of these mergers in previous decades.

KFF Health News published an informative perspective on the consolidation of hospitals and medical practices. "75% of markets are now considered highly consolidated — [which] decreases patient choice, impedes innovation, erodes quality, and raises prices. Apparently, judges have previously ruled in favor of these hospital mergers frequently enough (citing their non-profit status) that the Federal Trade Commission (FTC) opted to not challenge many of these mergers in previous decades.

Although the current administration has ordered the FTC to be more aggressive about hospital mergers, the current landscape seems problematic (even if consolidation does not get worse). Legally forcing some of these systems to break apart and have different parts compete against each other seems difficult. Additionally, the perspective pointed out that these large health systems employ many people and now have political clout that can help them avoid scrutiny. A few states were listed as protecting the health system mergers from regulatory oversight.