Markets need rules. And when they fail to protect patients, policy should step in.
New piece in the Boston Globe with Dr. Irene Papanicolas — part 4 of my Cost Cures series.
You can read it for free on my substack:
amomentinhealth.substack.com/p/when-marke...
Vermont and Indiana are already doing parts of this
Other states can too
One key issue: if insurers are also consolidated, lower provider prices don't automatically get passed to consumers
Insurers can just pocket the difference. Provider caps need to be paired with insurer oversight too
RAND data is striking: health systems get paid 2.5x Medicare rates on average by commercial insurers
In some states, the average is over 3x
Washington doesn't need to micromanage. States can act
Cap commercial prices at 300% of Medicare, then bringing that down to 200% over five years
Germany has private insurers and broad patient choice — and negotiated national fee schedules.
Switzerland is one of Europe's most market-oriented systems — and still sets price boundaries.
The U.S. is the outlier. American families pay for that every month.
Most wealthy countries have an answer: price guardrails
Not government takeover
Not socialized medicine
Just limits on how far prices can stray from value when there's no competition to do that work
American health policy has long bet on competition to keep prices in check
In too many places, that bet hasn't paid off
Health systems consolidated, competition eroded, and prices went up anyway
In earlier pieces in this series, I laid out how competition can be restored
But what if that fails?
Same surgery. Same city. One hospital charges $22K. The other charges $11K.
The difference often isn't about quality but market power
This is what happens when healthcare markets fail to function
My newest piece on what to do in this instance out in @bostonglobe.com with Irene Papanicolas
Piece #3: End the policies that protect monopolies
amomentinhealth.substack.com/p/end-the-po...
Piece #2: Bigger isn't always better:
amomentinhealth.substack.com/p/competitio...
Here are the three pieces:
Piece #1: Fighting the wrong war
amomentinhealth.substack.com/p/we-are-fig...
The answer:
Price guardrails. It's not radical. It's just what works
Some states (red and blue ones) already are doing it
Most high income countries with private insurance systems do it
We can too!
Dropping tomorrow in the @bostonglobe.com
Three pieces into my Cost Cures series in @bostonglobe.com
Tomorrow, piece #4
The arc so far: we misdiagnosed the problem → consolidation killed competition → government policy made it worse
Tomorrow, with Irene Papanicolas: what to do when competition can't save you
"I expected ChatGPT to echo what I already knew about potential diagnoses and care options," @ashishkjha.bsky.social writes.
"Instead, it pushed me to think more broadly about what approaches to take." https://wapo.st/3MpDl1y
So grateful to the Brown SPH community for having the privilege to serve as your Dean for the past 5 years
I continue to believe that the future of public health is bright
Every day that I worked at Brown SPH reinforced that for me
Thank you for joining us in honoring Dean @ashishkjha.bsky.social and his legacy at @brown.edu!✨ Please also join us next week for a Farewell Gathering for the Dean on Dec. 17th! RSVP and details⤵️ https://docs.google.com/forms/d/e/1FAIpQLSeQmzXpHJcLTq_8TAM0Y7njU-j_p4LZk6Z8l4SzAN-o3njcGA/viewform
Flu’s link to cardiovascular disease shows why vaccination is essential www.nature.com/articles/d41... @ashishkjha.bsky.social
"...we now have clear evidence that flu vaccination significantly reduces the risk of heart attack and stroke, and death owing to cardiovascular disease..."
#VaccinesWork
After 5 transformative years, Dean @ashishkjha.bsky.social is stepping down.
Join us in thanking Dean Jha for navigating #BrownSPH through an extraordinary period and for building our school into one of the best! Gratitude also to Dr. Francesca Beaudoin, who leads #BrownSPH as Interim Dean in 2026.
Over 5 extraordinary years, Dean @ashishkjha.bsky.social grew #BrownSPH by 4 new research centers, beginning with the @pandemiccenter.bsky.social in 2022!
Learn more about Dean Jha's research legacy @brown.edu https://sph.brown.edu/research
Our #TrackingReport was highlighted by @ashishkjha.bsky.social in the @bostonglobe.com.
Our newsletter started as a tool for transparency and now is used by local health departments and communities to stay informed with timely, reliable data.
More here
www.bostonglobe.com/2025/11/24/o...
"On Tylenol and #autism, one thing is clear: There is no credible evidence that the former causes the latter. What we do know is that fear and misinformation can cause real harm."
Keep reading Dean @ashishkjha.bsky.social's latest @bostonglobe.com opinion.⤵️
🎧On the latest episode of A Moment in Health, Dean @ashishkjha.bsky.social takes on Tylenol. What does the data tell us? And how does his guest, @elizabethlangenmd.bsky.social of @umich.edu, think about balancing the risks medications may pose with the risks of uncontrolled disease? Listen now!
How bad was Trump's Tylenol presser?
@ashishkjha.bsky.social, physician and former White House COVID-19 response coordinator, tells @citizencohn.bsky.social it was the worst public health briefing since the bleach moment.
"There is no new science here," Dean @ashishkjha.bsky.social says. "Bobby Kennedy said that he wanted to get to the root cause of autism by September—he's found what I think is a convenient scape goat. But the harm is going to be for pregnant women across the country."
In my weekly podcast, I had a fabulous conversation with a brilliant Obstetrician about how she advises pregnant women about the risks and benefits of taking a medicine
Dr. Elizabeth Langen is really good
This is worth your time
How should we think about the data and evidence on Tylenol during pregnancy? On this week's episode of @amomentinhealth.bsky.social, @ashishkjha.bsky.social and Dr. Elizabeth Langen discuss how to weigh the risks and where to go from here.
podcasts.apple.com/us/podcast/w...
Dr. @ashishkjha.bsky.social, who led Biden’s coronavirus response, on what the Trump administration’s MAHA report leaves out.
www.bostonglobe.com/2025/09/12/o...
"The number one cause of death for kids in America is gun violence, a fact that the MAHA report makes no mention of," Dean @ashishkjha.bsky.social writes in a @bostonglobe.com opinion. It gets some things right, he says, but "offers no real path to a healthier America."
The #CDC “no longer has any credibility as a public-health entity,” Dean @ashishkjha.bsky.social says. “States have to do it themselves.”
"This amounts to a very dark moment for public health. . . The department needs leadership that respects evidence and allows CDC to operate free from political interference. Without that, it is hard to see how the agency can recover."
Read more from Dean @ashishkjha.bsky.social in @statnews.com⤵️
There is a destruction of leadership at the CDC. The newly confirmed Director is out
Most of the top leaders who run key centers have resigned en masse
Wholesale implosion
All because of @SecKennedy leadership
What a disaster
