Maine could save $1 billion if it adopts a single-payer health care system, according to a new study — but some health care executives remain skeptical about the feasibility of such a switch.

That savings could be achieved by 2008, according to a study unanimously approved by the Health Care System and Security Board, a state legislative panel formed in 2001 and charged with assessing whether a single-payer system would work.

Mathematica Policy Research, the health policy research company that examined the report's analysis, concludes that health care spending in the state will rise to nearly $8.4 billion by 2004. That's a 27-percent increase from 2000.

Despite what amounts to a favorable review of the single-payer system, the legislative panel stopped short of recommending the approach. It did, however, conclude that the current system cannot endure much longer.

The board is comprised of members of business groups, hospitals, health insurers, labor unions, and both major political parties.

Gov. John Baldacci, for the time being, favors incremental reform. Richard Wexler, MD, the physician representative on the state advisory board, thinks that's all well and good, though he hopes that Baldacci does not rule out a complete overhaul at some point.

"There has been a lot of work done on this plan," Wexler tells the Portland Press Herald. "It's important not to drop the ball."

However, slow may be best, says Bill Cohen, a spokesman for Anthem Blue Cross and Blue Shield, who claims that insurers would rather see the current system fixed.

Besides, a single-payer system would mean that the federal government would have to change how it allocates funds for Medicare and for Medicaid, and that's not likely.

"The governor's office is dealing with things with a sense of reality," Cohen tells the newspaper. "At least he's focusing on how to fix what's here and not create this new bureaucracy."

The single-payer approach would reap savings by slashing administrative costs and eliminating insurance profits, proponents of the system claim.

The newspaper reports that "The most practical benefit plan... would require $50-a-day copayments for hospital visits, cap families' out-of-pocket expenses at $2,000 annually, and provide preventive care."

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.