Few movies can match The Princess Bride, Rob Reiner’s 1987 jewel, for the volume of great quotes taking out of context and applied broadly to everyday conversations.

Guy cuts you off in traffic? Simply roll down your window and calmly state, ‘Hello. My name is Inigo Montoya. You killed my father. Prepare to die.’

Billy Crystal’s brief, but memorable, appearance as Miracle Max the Wizard will help frame up why we want to talk about a piece of legislation in California that did not make it out of the assembly and died earlier this month without a vote.

Yes, I am writing about a state bill that never even got a vote in the state legislature.  Max will explain.

As we discussed last week, the California Attorney General already had the power to review, alter or block the sale of non-profit health systems to for-profit owners  This bill would have extended that power to all sorts of merger and acquisitions all across the healthcare industry – for profit and not; hospitals, physician practices and most every other type of provider.  Any deal over $1 million in value would have been subject to the AG’s approval authority.

The bill’s laudable goal was to protect consumers/patients from the ills of anti-competitive behavior – loss of access, price increases, lower quality. Specifically, ‘private equity groups’ and ‘hedge funds’ are named repeatedly as evil villains trying to make a buck off healthcare.

Side note worth noting – ‘Private equity group was defined to mean ‘an investor or group of investors who engages in the raising or returning of capital and who invests, develops, or disposes of specified assets.’ Thus, the boy in my neighborhood who buys and sells rare basketball shoes…he’s a ‘private equity group.’

As we noted when we began this little foray into the policies of politics, most of us accept that a robust economy requires both market forces and some level of governmental refereeing to prevent abuse.  We are now just debating where to draw the line between the two.

There is a lot of room between ‘too much’ and ‘not enough.’  Theoretically, that is why we have elections, in part to debate where we, collectively, want these types of lines drawn.

I would be an intellectual hypocrite if I did not acknowledge that frequently in this space I have asked why the anti-competitive regulators sleep as hospital system consolidation is allowed to progress unchecked, leaving us with dominant monopolies that harm consumers.

But, in my humble view, California SB-977 proposed to go way, way too far.  The market side of the equation would be effectively shackled and impotent.

It failed to even make it to the floor for a vote before the session ended, so why am I worried?

One of Miracle Max the Wizard’s great lines was:

‘Turns out your friend here is only MOSTLY dead. See, mostly dead is still slightly alive.’

You think this idea is not coming back around?

INCONCEIVABLE!

There is so much about the long-term health issues from COVID that we do not know.  The Big Ten Conference canceled fall sports because of the possibility that the coronavirus could cause myocarditis, an inflammation of the heart, though they are reconsidering because canceling football does cause alumni donor angina, a proven health problem.

Today I am more focused on the prospect of cognitive damage from the virus.  Some report having ‘brain fog,’ which, of course, is impossible to diagnose in Washington DC because how would you ever distinguish the experimental subjects from the control group?

I am personally worried that I have been infected and could have some far-reaching issues.  I say that because I think it time to write a few posts on politics.

What? What rational person would make such a decision, especially this election cycle?

Like a big nasty rattlesnake laying in the middle of a mountain trail, give that subject a wide berth and don’t think about touching it.

This blog is up to me.  Healthcare is a big world. I could write about anything I chose, but I am willfully wading into this morass.

See why my family is worried?

But, as regular readers know, we do not always choose the smart and safe path here.  Fortunately, processing subscription refunds is easy if you are disgruntled.

Looking back at 2016, we talked politics quite a bit in the run-up to the election.  Healthcare was, as always, an important topic.  The name mentioned most was not even on the ballot, but the guy about to retire, because his name was on the central legislation being debated.

One side was going to tear it all down and transport the pieces to Texas to be used on a big wall with his name on it.  The other (what was her name again? how quickly we move on) would not only continue the legacy of her rival turned boss, but, a hundred years before had architected her husband’s healthcare overhaul before that effort got aborted by the mid-term elections.  Surely, she had some big ideas about healthcare reform, v 2.0.

Looking back, there is a lesson for looking forward, one that we noted then though not clearly enough.  We all get caught up in the big stories, the massive pieces of legislation that may or may not come off the Hill and roll down Pennsylvania Avenue for a signature.

Various administrative actions, especially when taken together, are more important, though not sexy enough to make the evening news.  They are important because of how they signal, nudge, restrict and cajole the most significant, most critical force of all in healthcare – the market.

So that is where we will start this dangerous foray.  And to make things interesting, we’ll poke the snake right in the eye straight out of the gate. We’ll start with the intersection of Kamala Harris and hedge funds.

Should be fun.