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In the early days of the American automobile industry, consumers could buy a Model T in any color they wanted, so long as it was black. Such will be the "service and selection" to be expected in the United States if a single-payer system, where the government pays for all medical treatment, is implemented for health care.

A single-payer system will cause the health care sector to implode, with profound implications for Iowa, the United States and the world's economy.

First, the IRA contains provisions aimed at minimizing negative impacts on innovation as a whole. The law directs Medicare drug price negotiations towards innovator small-molecule and biologic drugs that have been on the market for many years without generic or biosimilar competition in an effort to provide companies with time to recoup their investments and earn competitive returns. This commitment is backed by the factors that Medicare must consider during the negotiation process once a drug is selected, including the innovator manufacturer's research and development (R&D) costs for the drug and “the extent to which the manufacturer has recouped research and development costs.”4

Putting the negotiation structure in context, for drugs that have been on the market nine to eleven years and twelve to fifteen years, respectively, the IRA requires minimum discounts of 25% and 35% (although larger discounts can be negotiated). Recent CBO analyses estimate that average rebates in Medicare Part D (which primarily governs those medications seniors obtain at a pharmacy, rather than those that are administered by physicians or in a hospital setting) for brand-name drugs are approximately 35%.5 Recent research on the financing of cancer drugs also helps illustrate why these IRA provisions serve as protection for innovations that result in high cost prescription drug products. For example, one study found that those products experience a median time to recovery of R&D investments of five years.6

The threat of terrorists using biological agents exists but is very limited. The fear of nonstate actors using biological agents rose with Aum Shinrikyo’s 1995 failed efforts to spread botulinum and anthrax in Japan. Fears of bioterror reached its most recent crescendo with the 2001 anthrax letter mailings, coming as they did within weeks after the 9/11 attacks. The threat of further bioterror attacks, however, never materialized.

Despite the fact that terrorist biological weapons attacks have not materialized since the Amerithrax scare, some continue to argue that the supposed ease and lower cost of biological weapons development, production, and use along with the societal disruption of COVID-19 has incentivized bad actors to adopt biological weapons. These concerns have been echoed by others who assume that misuse is inevitable and following the COVID-19 example will result in mass casualties and crippling political, societal, and economic repercussions.

Could COVID have changed the equation? Aum and its ilk aside, terrorists haven’t shown a great deal of interest in bioweapons. But could the pandemic have changed their views? Certainly, many analysts and media organizations have explored this concern. For example, Vox recently ran a lengthy piece on “Why experts are terrified of a human-made pandemic” arguing that COVID is a warning of what’s to come: pathogens enhanced with gain-of-function research and DNA synthesis improving access to pathogenic material. Axios wrote about how the coronavirus reawakened bioweapons fears. An op-ed in the Los Angeles Times argued that COVID shows world leaders the harm bioweapons can cause.

The fears are well-justified in at least one regard: Thanks to scientific advances, the technical barriers to bioterrorism are going down. But COVID isn’t playing a big role there.

Prophets of doom have been telling us for decades that a deadly new pandemic — of bird flu, of SARS or MERS coronavirus, and now of Ebola — is on its way. Why are we still listening?

If you look back at the furor raised at many distinguished publications — Nature, Science, Scientific American, National Geographic — back in, say, 2005, about a potential bird flu (H5N1) pandemic, you wonder what planet they were on. Nature ran a special section titled — “Avian flu: Are we ready?” — that began, ominously, with the words “Trouble is brewing in the East” and went on to present a mock aftermath report detailing catastrophic civil breakdown.

The emergence of AIDS led to a theory that other viruses would spring from tropical rain forests to wreak revenge on humankind for its ecological sins. That, at least, was the implication of Laurie Garrett's 1994 book, The Coming Plague: Newly Emerging Diseases in a World Out of Balance. The most prominent candidate was Ebola, the hemorrhagic fever that starred in Richard Preston's The Hot Zone, published the same year. Writer Stephen King called the book "one of the most horrifying things I've ever read." Right on cue, Ebola appeared again in the Congo in 1995, but it soon disappeared. Far from being a harbinger, HIV was the only new tropical virus to go pandemic in 50 years.

In the 1980s British cattle began dying from mad cow disease, caused by an infectious agent in feed that was derived from the remains of other cows. When people, too, began to catch this disease, predictions of the scale of the epidemic quickly turned terrifying: Up to 136,000 would die, according to one study. A pathologist warned that the British "have to prepare for perhaps thousands, tens of thousands, hundreds of thousands, of cases of vCJD [new variant Creutzfeldt-Jakob disease, the human manifestation of mad cow] coming down the line." Yet the total number of deaths so far in the UK has been 176, with just five occurring in 2011 and none so far in 2012.

Hospitals are scouring shelves for supplies of a drug that reverses lead poisoning and for a sterile fluid needed to stop the heart for bypass surgery. Some antibiotics are still scarce following the winter flu season when doctors and patients frantically chased medicines for ailments like strep throat. Even children’s Tylenol was hard to find.

Hundreds of drugs are on the list of medications in short supply in the United States, as officials grapple with an opaque and sometimes interrupted supply chain, quality and financial issues that are leading to manufacturing shutdowns.

Part of Angela Sandlin’s job as a pharmacy director has been to keep a list of the drugs that are in short supply, which, over the years, have run the gamut — from contrast agents used for X-rays and other scans, to blood pressure medications and antibiotics.

But the shortages lately have gotten worse and pharmacists are “trying to walk a tightrope,” Sandlin said.

Drug shortages reached a five-year peak at the end of 2022, impacting almost 300 pharmaceutical products including basic treatments such as IV saline and antibiotics, according to a new Senate report.

The shortages pose threats to patients, with some facing "devastating consequences" including medication errors and treatment delays, according to the Wednesday report from Democrats on the U.S. Senate Committee on Homeland Security & Governmental affairs.

Small-business owners are warming to the idea of single-payer health care. Kaiser Health News recently profiled a number of employers who are fed up with the high cost and administrative hassle of providing health insurance to their workers.

For these folks, Medicare for All might seem like a welcome reprieve. But a closer look reveals that a government-run healthcare system would be no less difficult to deal with than the status quo—and would actually raise costs for employers and employees.

Senate Budget Committee Chairman Bernie Sanders (I‑Vt.) has announced that as early as next week, his committee will hold a hearing “on the need to pass a Medicare for All single‐​payer program.”

Sanders gets an “A” for passion, but an “F” in compassion.

Interoperable exchange of health information or “interoperability” is critical for delivering appropriate care, reducing health care costs, and making health care more efficient (1-3). ONC is executing on a number of health IT provisions from the 21st Century Cures Act, such as the Trusted Exchange Framework and Common Agreement (TEFCA) and Information Blocking provision that seek to advance interoperability (4- 5). As these provisions are implemented, it is important to monitor interoperable information exchange to evaluate present policies and undertake future actions to advance interoperability. This data brief presents the state of interoperability among hospitals, as of 2021. We present trends on information exchange and the availability and use of information at the point of care, while also highlighting key barriers to interoperability. Additionally, we highlight the methods hospitals used to exchange health information and their participation in national networks and health information exchanges (HIEs).

HIGHLIGHTS

Intel Newsroom (IN) 18, Intel’s front-facing news platform; 7-3-2018, “U.S. healthcare leaders expect widespread adoption of artificial intelligence by 2023”, originally from Intel Newsroom, https://www.telecomtv.com/content/ai-ml/u-s-healthcare-leaders-expect-widespread-adoption-of-artificial-intelligence-by-2023-31523/, BEJJP-ATJ [6-27-2023]

SANTA CLARA, Calif., July 2, 2018 – Today, Intel Corporation revealed the findings from a new study conducted in partnership with Convergys Analytics that surveyed 200 U.S. healthcare decision-makers in April 2018 on their attitudes about artificial intelligence (AI) and perceived barriers to adoption in the industry. AI today is already being applied behind the scenes to detect drug interactions and predict which patients are most at risk for readmissions or experiencing a hospital-acquired condition. We know the promise of AI is much greater: It has the potential to improve clinical effectiveness, reduce cost and increase the quality of patient care.

Healthcare — one of the largest sectors of the U.S. economy — is among the many industries with significant opportunities for the use of artificial intelligence (AI) and machine learning (ML), says Salveen Richter, lead analyst for the U.S. biotechnology sector at Goldman Sachs Research.

“We are in an exciting period when we are seeing the convergence of technology and healthcare — two key economic sectors — and we have to assume it will result in significant innovation,” she says. We spoke with Richter, one of the authors of our in-depth Byte-ology report, which includes contributions from Goldman Sachs’ healthcare and technology research teams, about the integration of AI/ML into healthcare, the most promising applications for this technology and the landscape for venture capital funding in the field of “byte-ology.”

The emergence of artificial intelligence (AI) in healthcare has been groundbreaking, reshaping the way we diagnose, treat and monitor patients. This technology is drastically improving healthcare research and outcomes by producing more accurate diagnoses and enabling more personalized treatments. AI in healthcare’s ability to analyze vast amounts of clinical documentation quickly helps medical professionals identify disease markers and trends that would otherwise be overlooked. The potential applications of AI and healthcare are broad and far-reaching, from scanning radiological images for early detection to predicting outcomes from electronic health records. By leveraging artificial intelligence in hospital settings and clinics, healthcare systems can become smarter, faster, and more efficient in providing care to millions of people worldwide. Artificial intelligence in healthcare is truly turning out to be the future – transforming how patients receive quality care while mitigating costs for providers and improving health outcomes.

It all began with IBM's Watson artificial intelligence system, which was developed to answer questions accurately and quickly. Articles on artificial intelligence in healthcare mention IBM’s launch of a healthcare-specific version of Watson in 2011 that focused on natural language processing—the technology used to understand and interpret human communication. Today, alongside IBM, other tech giants like Apple, Microsoft and Amazon are increasingly investing in AI technologies for the healthcare sector.

In their analytic essay “Health Justice: A Framework for Mitigating the Impacts of HIV and COVID-19 on Disproportionately Affected Communities” (p. 194), Alang and Blackstock propose a health justice framework for understanding and responding to the inequalities exposed and exacerbated by recent pandemics including HIV and COVID-19. Redressing inequitable distributions of power and resources is seen as a pathway toward liberation and advancement of traditionally oppressed communities, and a range of structural interventions are proposed for advancing this work.

This framework, specific to HIV and COVID-19, resonates with the previous work of Benfer et al. on health justice more broadly as well as their recent COVID-19–specific analyses.1,2 Indeed, although health justice has been variably defined, the notion of redistribution of power and resources is often central.3–5 Aligned with previous conceptualizations of health justice, Alang and Blackstock focus on the specificities regarding two recent pandemics and how responses to them might be strengthened.

Shifts in profit pools will accelerate, spurring likely business model changes in three areas—diversification, vertical integration, and new business building.

Two years of the COVID-19 pandemic have shifted the dynamics in the US healthcare value chain. The years from 2020 through 2021 were challenging for payers and providers. At the same time, innovation and growth continued unabated in services. Prospects over the next few years seem favorable, although persistent inflation in consumer prices could dent the outlook. Recovery in profitability partly explains this positive outlook. Another reason for optimism is the potential for scaling up innovation that was prompted by pressure the pandemic put on the healthcare system. Also, acceleration of value-based care models and increasing application of technology across the healthcare industry are likely to continue in the long term.

Healthcare services and technology: Long-term growth supported by software and platforms

The HST segment has been a long-term growth story. HST continued its growth trajectory during the pandemic, with profit pools rising from $45 billion in 2019 to $50 billion in 2021. The outlook continues to be positive. We estimate that the segment will grow at an 8.2 percent CAGR between 2021 and 2025, to about $70 billion by 2025. That would likely make it bigger than the payer profits pool by 2025.

Yet over a million people travel to the US every year for their medical care, including heads of state, the wealthy and elite, who presumably could have received care in their home country or anywhere else in the world. The numbers cited above do not even include the millions who are cared for by the international satellite campuses of the Mayo Clinic, Cornell, Harvard and Johns Hopkins systems, to name just a few, that have been established to bring American health care to the rest of the world.

Around 100,000 Canadians, whose nationalized health system is rated above the United States, are likely to cross the border each year for medical care. These medical tourists recognize that, on the whole, health care in the US is the best in the world.

Hospitals are scouring shelves for supplies of a drug that reverses lead poisoning and for a sterile fluid needed to stop the heart for bypass surgery. Some antibiotics are still scarce following the winter flu season when doctors and patients frantically chased medicines for ailments like strep throat. Even children’s Tylenol was hard to find.

Hundreds of drugs are on the list of medications in short supply in the United States, as officials grapple with an opaque and sometimes interrupted supply chain, quality and financial issues that are leading to manufacturing shutdowns.