{"id":1073,"date":"2026-07-17T18:01:45","date_gmt":"2026-07-17T18:01:45","guid":{"rendered":"https:\/\/valutednews.com\/?p=1073"},"modified":"2026-07-17T18:01:45","modified_gmt":"2026-07-17T18:01:45","slug":"coffee-break-health-care-digest","status":"publish","type":"post","link":"https:\/\/valutednews.com\/?p=1073","title":{"rendered":"Coffee Break: Health Care Digest"},"content":{"rendered":"
\"Coffee<\/div>

<\/p>\n

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Part the First: Profit in Medicine.<\/strong>\u00a0 In a report that will tug at the heartstrings of everyone, STAT tells us that HCA warns of lower profits in its future as more patients go uninsured<\/strong><\/a> because ObamaCare subsidies have gone by the wayside:<\/p>\n

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The country\u2019s biggest hospital chain lowered its 2026 profit outlook on Tuesday after treating more uninsured patients than expected in the second quarter.<\/p>\n

Many of those uninsured patients had dropped their Affordable Care Act plans after losing enhanced subsidies, HCA Healthcare said, an early indicator of the fallout from the expiration of ACA enhanced premium tax credits in January.<\/p>\n

All in, HCA now expects the increase in uninsured patients stemming from the end of those subsidies to lower its income by between $1 billion and $1.2 billion this year, up from an earlier projection of a $600 million to $900 million hit.<\/p>\n

HCA still expects to generate nearly $15.8 billion in adjusted earnings before interest, taxes, depreciation, and amortization \u2014 a form of profit known as EBITDA \u2014 this year at the midpoint, but that\u2019s down from the $16 billion it had projected in January. The company\u2019s stock price fell roughly 7% midday following the early morning announcement<\/a>, which included a preview of HCA\u2019s second-quarter earnings.<\/p>\n

\u201cWe remain confident in our ability to navigate through this dynamic environment, maintain our focus and investments on improving patient care, and execute on our strategic plan to digitize and grow our healthcare networks,\u201d HCA CEO Sam Hazen said in a statement.<\/p>\n<\/blockquote>\n

No one disputes that medical care in not free, but those of us of a certain age see something we never thought would happen.\u00a0 Back in the day, those with health insurance (a category mistake that is now coming home to roost) had very little to worry about.\u00a0 And those without still received the care they needed.\u00a0 As a close colleague who is a physician put it, back then doctors got paid 90% of the time, and when we didn\u2019t that didn\u2019t matter.\u00a0 And the public<\/strong> hospital overseen by the local Hospital Authority composed of business and civic leaders certainly did not go after the poor people who couldn\u2019t afford their hospital bills.\u00a0 Members of the Authority knew these people, or just as likely they remembered family members in the same situation.<\/p>\n

Here is a recent ranking of 105 health care systems by annual revenue<\/strong><\/a>.\u00a0 They include nominal non-profit, public, and private systems.\u00a0 My family is currently involved of necessity with one of the Top-10.\u00a0 For what should be a simple surgery, the health system will bill the employer health plan ~$100,000, depending on how non-simple the surgery turns out to be this morning.\u00a0 As I wrote Wednesday, our contribution is not insignificant to us and seems to be growing.\u00a0 We are privileged to be able to pay our part.\u00a0 But if this had happened to a data clerk in the bursar\u2019s office, not so much, because what we have paid would be one month or more of that salary.\u00a0 Some of you will remember my previous quotation(s) from Aneurin Bevan<\/a>, who organized the National Health Service in less than two years immediately after WWII, when Great Britain was still rationing food: \u201cThe field in which the claims of individual commercialism come into most immediate conflict with reputable notions of social values is that of health.<\/strong>\u201d<\/p>\n

Not much more to be said about that, except to remember Herb Stein<\/a> again: If something cannot go on forever, it will stop<\/strong>.\u00a0 Mr. Stein was one of the good guys who served in the Nixon Administration.\u00a0 There were actually more than a few of those.\u00a0 The question is what happens next, universal health care (public; no cost at the point of delivery) or further hardening of Lambert\u2019s Laws of Neoliberalism: (1) Because markets! (2) Go die!<\/p>\n

Part the Second: Don\u2019t Mess with Chris Deacon<\/strong>.\u00a0 More on the Blue Cross Blue Shield in our modern world, This whistleblower took on a health insurance giant and a political machine. She\u2019s not stopping there<\/strong><\/a>:<\/p>\n

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It should have been a triumphant moment for Chris Deacon.<\/p>\n

Last November, Horizon Blue Cross Blue Shield, the insurance giant that manages health benefits for 750,000 New Jersey state workers, family members, and retirees, paid $100 million to wipe away allegations that it knowingly overpaid hospitals and doctors and fraudulently won its state contract.<\/p>\n

At the press conference, then-New Jersey Attorney General Matthew Platkin touted it as a \u201chistoric\u201d action. \u201cToday\u2019s settlement makes a very clear statement: We send a message to Horizon and to the entire insurance industry that they cannot take advantage of the state,\u201d Platkin announced from the dais<\/a>, surrounded by his staff. \u201cThey cannot make us all illegally pay more for health care.\u201d<\/p>\n

Deacon was a driving force behind the settlement. She caught Horizon\u2019s alleged behavior as the top official overseeing New Jersey\u2019s health plan.<\/p>\n

But rather than celebrate, she was torn apart by a mix of emotions as she watched Platkin and his team from her home office. She felt some satisfaction that a public display of justice was unfolding. But she also felt disgust, anger, and sadness as officials completely erased her role in uncovering the misconduct and glossed over their own culpability in allowing it to happen.<\/p>\n

\u201cYou try to do the right thing, and this is what happens,\u201d Deacon said. \u201cI\u2019m at peace with it. But to be not even a footnote was like their final \u2018fuck you\u2019 to me.\u201d<\/p>\n<\/blockquote>\n

As the story is told, the settlement was contingent upon Chris Deacon being left out of the settlement.\u00a0 But she is now in independent lawyer and consultant.\u00a0 The big health plans might have f*cked up:<\/p>\n

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People at the highest levels of government and the private sector are noticing. Deacon has testified in front of Congress twice in the past year, advised leaders on state health care legislation, and inspired more employers to scrutinize their insurance contracts.<\/p>\n

\u201cI\u2019m a huge fan,\u201d Mark Cuban told STAT in an email. The billionaire and former \u201cShark Tank\u201d\u00a0investor has turned into a regular critic of health insurance companies and pharmacy benefit managers and urged his 8.4 million LinkedIn followers to read what Deacon has to say. \u201cShe is fearless, focused, and does the work to have an impact. Which she is having.\u201d<\/p>\n<\/blockquote>\n

One health system at a time, until she runs out of time.<\/p>\n

Part the Third: The Future of Robotic Surgery.\u00a0 <\/strong>Modern medicine has gotten better as technology has improved: X-ray versus MRI and CT scan, scalpel and retractors versus a camera and loop plus a cauterization needle.\u00a0 A simple cholecystectomy (gall bladder removal) is frequently an outpatient procedure with a recovery time measured in days.\u00a0 Not so long ago it was an invasive procedure that left a substantial scar and required weeks for a full recovery.\u00a0 This was also true of an appendectomy.\u00a0 I have seen more than a few of those scars in a lifetime in locker rooms and they are not small.\u00a0 Today they are unnoticeable.<\/p>\n

Aur\u00e9lien Gu\u00e9roult has written Surgery and the limits of the robotic ideal<\/strong><\/a> for Engelsberg Ideas:<\/p>\n

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Clinical medicine is perhaps the most literally \u2018human\u2019 profession. Surgeons aim first to understand, and then manipulate human biology. Will medicine and surgery be the final frontier for full robotic automation?<\/p>\n

Robotic surgery, or more accurately robot-assisted<\/em> surgery, has been used for around 20 years and is routinely practised worldwide, including in the UK National Health Service (NHS)<\/a>. In the 1990s, robotics scientists developed machines with the ability to translate continuous input from an operator into movement in real-time. This opened the door for the development of surgical robots, which replicate with high fidelity the movements of a surgeon\u2019s hand during operations. The US-developed da Vinci<\/em> surgical robotic system is one of the pioneers in the field (FDA-approved in 2000), although equivalent Chinese and EU systems have been released to market. These robots are not autonomous, and the operating surgeon remains in full control of the three or four robotic arms, which they manipulate through a console.<\/p>\n

Surgical robots\u2019 role in routine clinical practice remains restricted to very specific operations. Throughout the latter half of the 20th century, all surgical specialities have strived to make operating as minimally invasive as possible, reducing risk of surgery and shortening post-operative recovery times. Cue video-assisted \u2018keyhole\u2019 operating. This has been a game changer and, in many cases, has superseded the original \u2018open\u2019 techniques. Many specialities have embraced keyhole techniques, virtually a revolution in clinical practice, partly because of patient preference, partly because of faster recovery. Internal camera video \u2018stacks\u2019 are commonplace in the theatres of abdominal, thoracic and gynaecological surgeons; cardiologists and vascular surgeons similarly deploy devices such as stents inside the heart and blood vessels through incisions barely a centimetre across under X-ray guidance.<\/p>\n<\/blockquote>\n

Dr. Gu\u00e9roult\u2019s conclusion, stated in the tagline, is that \u201cRobot-assisted surgery is already routine practice. But the dream of a machine operating alone underestimates the practical judgement, learned over decades, that makes a surgeon a surgeon.<\/em>\u201d\u00a0 He is correct.\u00a0 The precision afforded by a surgical robot maintained by an excellent technical representative and controlled by a competent surgeon is revolutionary.\u00a0 But over-reliance on the technology is only the extension of the flawed engineering ideal of biology to clinical medicine.\u00a0 I wrote of my conversations with Dr. B earlier this week.\u00a0 He is an engineering graduate and seems enamored with ChatGPT\u2019s apparent ability to \u201cmake\u201d a diagnosis from a lab report.\u00a0 The problem is that the lab report is not the patient, or even a reasonable facsimile thereof, sitting before the physician or surgeon in real time.\u00a0 That which is spewed by ChatGPT cannot see the patient and therefore cannot know the patient.\u00a0 This is not a difficult concept, except for a madding crowd that would astonish the Thomases Gray<\/a> and Hardy<\/a>.<\/p>\n

I\u2019m reminded of a saying I hear in medical schools: \u201cThe surgeon knows nothing and does everything, while the internist knows everything and does nothing.\u201d<\/em>\u00a0 I am not a clinician, but this has superficial validity at the margin, and surgeons, internists, and medical students laugh at it.\u00a0 But, all art and all science require deep knowledge, the intuition that comes out of that knowledge, and technique appropriate to the problem or project<\/strong>.\u00a0 There can be no shortcuts here.\u00a0 Any given eructation of ChatGPT is information (of uncertain provenance) but it is not knowledge, however much it appears to be, and the information depends on the training set (usually stolen and used uncritically) and the LLM\/AI prompt.\u00a0 The surgical robot, despite its precision, will remain dangerous without intuition and knowledge of what \u201clooks right\u201d and what doesn\u2019t.\u00a0 Despite the hype, AI as currently known will not \u201ctake over\u201d any human discipline.\u00a0 The question is whether the powers that be, including various and sundry screeching tech bros and their acolytes, physicians, scientists, and politicians recognize this before it\u2019s too late. \u00a0This is at best only a 50:50 proposition.\u00a0 Artists rightfully have no doubt about correct answer.<\/p>\n

Part the Fourth: The War on USAID and Its Consequences<\/strong>.\u00a0 The United States Agency for International Development (USAID) was created during the first year of the American Camelot, the Kennedy Administration.\u00a0 It was an appurtenance of the deep state and had a Kiplingesque \u201cwhite man\u2019s burden\u201d tinge, but at the same time it was the legitimate extender of American soft power throughout the world.\u00a0 There is no doubt USAID did good things where needed despite its underlying political, imperial, and military uses.\u00a0 There is also no doubt there was a bit of \u201cwaste, fraud, and abuse\u201d within USAID.\u00a0 However we should put to its final rest the idea that \u201cwaste, fraud, and abuse\u201d was the purpose of DOGE.\u00a0 Like the dog that didn\u2019t bark, DOGE was content to go after USAID and the National Science Foundation (with a contract security guard at the door) rather than the Pentagon<\/a>, where there are sergeants armed with an M4 carbine<\/a> or equivalent at each door.\u00a0 The New Yorker<\/em> can be, well, as provincial as any outlet in flyover country, but David Remnick has interviewed Atul Gawande about USAID and what it did in the world in The Cost of Doge\u2019s WAR on U.S.A.I.D.<\/strong><\/a>:<\/p>\n

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In 1988, Richard Rhodes, a historian and a journalist who wrote a definitive study of the creation of the atomic bomb, published an article in the Journal of the American Medical Association<\/em> called \u201cMan-made Death: A Neglected Mortality<\/a>.\u201d Rhodes argued that demographers and public-health officials ought to take greater care to account for deaths caused by war, neglect, privation, and other effects of policy. His emphasis was on deliberate acts\u2014artificially induced famines, for example, and the willful dismantling of public-health aid and infrastructure.<\/p>\n

Atul Gawande, who was a leading administrator at U.S.A.I.D.<\/a> until the Trump Administration\u2019s DOGE<\/em> initiative, led by Elon Musk<\/a>, set about defunding and destroying the agency, is a surgeon and a longtime New Yorker<\/em> contributor. In our latest conversation for The New Yorker Radio Hour<\/a>, Gawande uses Rhodes\u2019s concept to help describe the colossal human cost that Musk and DOGE<\/em> have exacted on the world. Gawande, backed up by recent academic studies, says that the decimation of U.S.A.I.D. around the globe has been responsible for some seven hundred thousand deaths, and that number will likely ascend into the seven figures. The policy is not only immeasurably cruel, Gawande argues; it is also stupid, badly undermining what remains of American soft power and prestige, from Africa to Latin America.<\/p>\n<\/blockquote>\n

Elon Musk, former trillioinaire, disputes the numbers of deaths that have and will result from the DOGE obliteration of USAID.\u00a0 But Mr. Musk is mistaken.\u00a0 The archived link is worth the read in its entirety.\u00a0 One thing that is not covered if I remember correctly is how USAID and its contacts on the ground could have sounded the alarm early about the current Ebola outbreak<\/a> in Central Africa.<\/p>\n

What, me worry?\u00a0 Alfred E. Neuman<\/a>, apparently he is immortal.<\/p>\n

Part the Fifth: The Secretary of War and Testosterone<\/strong>.\u00a0 Or, I can\u2019t even.\u00a0 In an effort to make our war fighters even more lethal<\/a>, the current Secretary of War (the projection, it burns) wants soldiers, sailors, airmen, and Marines under 30 to be tested for Low-T, while Henry L. Stimson<\/a> continues to spin at 300 rpm in his grave.\u00a0 It occurs to me that I have not seen one of those Low-T commercials<\/a> in ages (NSFW; \u201creal commercial\u201d here<\/a>), and since I rarely watch only sports on TV, they must have disappeared?\u00a0 Anyway, come to learn that Hegseth announces new policy to test troops for low testosterone<\/a>.\u00a0 This is completely daft, but it certainly fits in with the MAHA zeitgeist.<\/p>\n

The reasoning behind this is that \u201cnormal\u201d testosterone levels are essential, according to Secretary Hegseth, for a soldier to be, well, a soldier.\u00a0 Of course, normal testosterone levels are essential, period.\u00a0 As are estrogens.\u00a0 In men and women.\u00a0 At some level one cannot help but wonder if this story is related to Secretary of War\u2019s testosterone initiative: Opportunities Narrow for Women as Hegseth Blocks More Promotions<\/a>.\u00a0 Women do generally have less testosterone than men, after all, but explaining endocrinology\u2026never mind.<\/p>\n

Perhaps a more \u201ceffective\u201d policy would be to go all-in and back to the future with nandrolone<\/a>. Be done with it and let the roid rage loose.\u00a0 I digress, but when I was a teenager, isometric exercises were said to be the best way to improve strength and muscle mass.\u00a0 According to my anthropology teacher who was the expert in the Indians of Southeastern North America, native American infants who are carried in cradle boards walk earlier than those who are not.\u00a0 So, isometrics do work, and especially well with anabolic steroids, which were the key in those particular gyms of my youth.<\/p>\n

Or we could just stop with our all-war-all-the-time jones to be the one hegemon in the unipolar world of our nationalistic fever dreams and achieve the country<\/a> we have yet to become, but could.<\/p>\n

Thanks for reading!\u00a0 Comments, criticism, and snark welcome.\u00a0 I hope you enjoyed Bastille Day earlier this week: Libert\u00e9, \u00c9galit\u00e9, Fraternit\u00e9<\/em>.\u00a0 See you next week.<\/p>\n

<\/a><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Part the First: Profit in Medicine.\u00a0 In a report that will tug at the heartstrings of everyone, STAT tells us that HCA warns of lower profits in its future as more patients go uninsured because ObamaCare subsidies have gone by the wayside: The country\u2019s biggest hospital chain lowered its 2026 profit outlook on Tuesday after…<\/p>\n","protected":false},"author":1,"featured_media":1074,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"fifu_image_url":"https:\/\/cdn.printfriendly.com\/buttons\/print-button-gray.png","fifu_image_alt":"","footnotes":""},"categories":[19],"tags":[470,334,469,2183,62],"class_list":["post-1073","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-economy","tag-break","tag-care","tag-coffee","tag-digest","tag-health"],"_links":{"self":[{"href":"https:\/\/valutednews.com\/index.php?rest_route=\/wp\/v2\/posts\/1073","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/valutednews.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/valutednews.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/valutednews.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/valutednews.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1073"}],"version-history":[{"count":0,"href":"https:\/\/valutednews.com\/index.php?rest_route=\/wp\/v2\/posts\/1073\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/valutednews.com\/index.php?rest_route=\/wp\/v2\/media\/1074"}],"wp:attachment":[{"href":"https:\/\/valutednews.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1073"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/valutednews.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1073"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/valutednews.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1073"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}