Paying physicians fee-for-service ensures access, especially for procedural care. It aligns incentives the same way every other service-based industry does. Want a plumber, electrician, lawyer, coder? You pay for the service rendered. Simple. Transparent. Effective. Naturally emerging alternatives like DPC can work well because they’re voluntary and market-driven. No central bureaucrat mandated it. But top-down “value-based” payment models are a bureaucratic fantasy. They add layers of documentation, create perverse incentives to game metrics, and shift focus from caring for patients to pleasing administrators. The problem isn’t FFS. It’s the central planners who think they can outsmart price signals and redesign medicine with spreadsheets and buzzwords.

"If there are any other moral cowards who haven't yet left this hall, please do so now." ⠀ Israeli Prime Minister Benjamin Netanyahu opens his address to the United Nations General Assembly in New York with a sharp rebuke as delegates walk out of the hall in protest of his speech.

NEW: Analysis found that Big Pharma spends 3x more on profits, advertising and corporate overhead than they invest in R&D. More:

NEWS: NIH launches new resource accessible through PubMed to strengthen research replication and reproducibility. Read the full story ➡️ bit.ly/4y7rXtA

‘A real threat to patient safety.’ As @TheBMA releases a report cataloguing hundreds of doctors’ concerns about the use of advanced practitioner (AP) staff, association chair @thomasdolphin calls on NHS leaders to wake up and take action. 🧵[1/6] thedoctor.bma.org.uk/article…

🚨 Wow. Apparently all but one of Parkview Health’s new class of internal medicine residents in Indiana are foreigners here on J-1 visas. America should do whatever it takes to recruit and train Americans for these critical jobs not rely on imported labor

Good write-up of some of the issues with the No Surprises Act and how to fix them. For non-emergency services, in particular, the contract regulation approach they outline continues to offer a number of advantages. cato.org/regulation/fall-202…

Never forget that in New York they eliminated the literacy exam in 2017. And this exam wasn't for students - it was the literacy exam for TEACHERS. Only 61% could pass it!

I do see a forthcoming trend where more health plans could declare bankruptcy. Watching this closely.

ERIC and partners urge DOL to finalize default e-delivery for health plan communications and extend it to all ERISA welfare plans. James Gelfand: the proposal "takes the important step of modernizing outdated regulations." Read press release here: bit.ly/4rpmP1v

“Can I have a copy of the transcription?” The answer is actually no

I, also, suspect the hospital lobby and large health systems love the proposed corporate practice of medicine ban. It reinforces the regulatory favoritism they already benefit from. Despite what @DGlaucomflecken implies… MSOs are used by private equity AND by independent physicians. For independent practices, they allow practices to pool resources, share administrative services and reduce overhead. This is critical for many independent practices in the current environment. No, the bill doesn’t ban MSOs outright. But, It does restrict their contracts and management relationships, with no blanket exemption for physician owned MSOs. Requirements for independent advisers and fair market value compensation add compliance obligations. Meanwhile, hospitals and hospital affiliated clinics are exempt from the core ownership prohibition. Honestly, they are exempt from many of the regulations that apply to physicians. To be clear, I don’t have an issue with people who object to private equity owning medical practices. My objection is to leveraging the corporate boogie man to restrict a tool physicians also use to remain independent while preserving the hospital ownership pathway. The predictable consequence is more legal expense, more compliance risk and greater difficulty operating an independent practice. That gives hospitals another competitive advantage, packaged as protection for physician independence.

Innovation, Prices, and Centralized Forecasts "Prices are signals. They tell suppliers whether to enter, expand, invest, open a new site, adopt a new tool, run a trial, or develop a future treatment. Payment rules therefore become production rules. A lower price produced through competition is a supply-side achievement. It means entry, productivity, innovation, lower-cost sites, or better organization have reduced the real resources required to deliver care. A lower price imposed by command is different. It can reduce the posted price while making supply less attractive, which can lead to exit, shortages, delayed innovation, quality tradeoffs, or budget-window savings that reappear later as less care or less innovation. This distinction matters because many health-care price controls are largely invisible to patients. DRG rates, CPT-based physician fee schedules, Part B reimbursement, and IRA drug price controls do more than move money among payers and providers. They shape capacity, sites of care, investment decisions, quality, and the future supply of treatments. Affordability requires lower real resource costs, not merely lower displayed prices. The danger of centralized supply control is that one forecast can become a national rule." Full ASPE Report "Producing Health: Capability, Capacity, and Competitive Discovery in the Health Economy," by HHS Chief Economist and Chief Regulatory Officer Dr. Casey B. Mulligan: aspe.hhs.gov/reports/produci… @HHSGov @CMSGov @HHSResponse @HHS_ASPE