An All Lightning Round ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale

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Frank and Nic internalize their travel issues and try to get to grips with some of the recent stories from healthcare land. Among the stories we discuss are the UK Information Commissioner’s report on the Royal Free – Google DeepMind trial, US-EU competition policy (another Google case), a class action in Alaska involving a DTC genetic service that is butting heads with a very strongly worded state statute, the opioid crisis seen through a litigation lens, and our latest thoughts, rants, and questions about health reform/repeal including the latest on the three-legged stool and cost-sharing subsidies.

As for Google DeepMind, we start with a discussion of how Google DeepMind trial failed to comply with data protection law. We discuss Google’s larger problems with the EU Competition and Franks’s response to US skepticism about the case.

In cyberhealth, we take on an Alaskan class action against a genetic testing lab,and the latest ransomware attack.

Our opioid epidemic coverage continues: the White House opioid crisis commission missed the due date for preliminary report, and Oklahoma sued opioid drugmakers, while New Hampshire pressed an epidemic probe. Meanwhile, a not-so-enlightened Ohio legislator has proposed a “3 opioid overdoses and you’re out” eliminationistpolicy with some potential EMTALA implications. Meanwhile, the new administration is pursuing a struthious strategy reminiscent of Harper.

Finally, the main event: health reform/deform/repeal. Leaving aside the clear tax cut paid for by Medicaid evisceration… where are the policies? The bottom line appears to be that many architects of GOP health policy don’t believe in Medicaid as an entitlement, or perhaps even that the healthy should be in the same pool as the sick–especially given the growing popularity of the Cruz option to stratify risk pools.

We discuss how the predictable death spirals resulting from such policies may have a “squeeze the balloon” quality: under the cost-shift hydraulic, the uninsured may reduce hospital margins, leading them to raise prices for the still-insured. If that occurs, the end-effect of the GOP plan may be to shift more of the cost of care from the top 1%, to those in employer-sponsored insurance. Given obviously inadequate funding for risk pools under current proposed legislation, the insurers of last resort will be crowdfunding or bankruptcy courts.

Meanwhile, Medicaid cuts will hurt schools so badly that even red-state school leaders in rural areas are venting frustrations. They say Medicaid funding cuts would hamper their ability to serve low-income and special education students. Of course, we can predict the likely policy response from DC: slash “unfunded mandates” to serve the disabled. Ironically, the rural core of the current reigning coalition may be hurt the most.

As the Overton Window, wall, and house in health care policy have been drafted to Oz by the Trump tornado, it looks like the the biggest winner in the current health-care debate is single-payer. Some links compare its popularity to that of McConnellcare, and to various state efforts at reform.

Finally, and with great trepidation we raise the wisdom of single-payer care only to uncover a new policy position taken by one of your hosts, who worried about a different kind of “death spiral” in 2013.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at Apple Podcasts, listen at Stitcher Radio Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on Twitter @nicolasterry @FrankPasquale @WeekInHealthLaw

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