One of Shakespeare's characters in "Henry VI" famously said, "The first thing we do, let's kill all the lawyers." That vow seems turned on its head in health care today, converted to what many Americans may consider the truly terrifying prospect of hiring all the lawyers -- to lead major technology and payer organizations. 
Reminds me: Did you hear the one about the three lawyers . . .
It started last July when drug giant Pfizer named former General Counsel Jeff Kindler as CEO. As if in reply, Wellpoint, one of the largest health benefits companies, then slated its General Counsel, Angela Braly, to become CEO June 1. And in medical devices, major orthopedic manufacturer Zimmer last week announced that its top lawyer, David Dvorak, has taken over the CEO's reins. What's going on here?
Conventional wisdom has long held that lawyers are particularly suited for CEO slots in heavily regulated industries. Thus, for example, it's been widely speculated that the 2002 Sarbanes-Oxley statute was at least a contributing factor in Citigroup's decision a few months later to name General Counsel Charles Prince as CEO. It may be that health care is experiencing a nascent version of this same phenomenon.
True, no obvious SOX-like measures dot health care's horizon. Proposals for converting the health system to the kind of centrally consolidated public utility that so manifestly puts legal skills in demand -- like a recently introduced Kennedy-Dingell bill that makes Medicare a cradle-to-grave program -- are little more than curiosities, at least at this point. But other forces are also at work:
- First, there's the sheer regulatory momentum of the usual suspects: continued OIG scrutiny of business practices and the resultant culture of compliance; the new Medicare Part D drug benefit; and other complex cost-cutting regimes in public programs, such as recently announced DRG proposals.
- Second, new connective tissue is forming between the objectives of payers and those of the business community. Just yesterday, a major payer-business group, the Coalition to Advance Health Care Reform, began an outreach campaign on behalf of a Schwarzeneggeresque agenda for helping the uninsured while taming health care costs. More broadly, observers hint at a grand bargain in which business supports the federalization of care in return for shifting of costs to Washington.
- Finally, public-private mutual dependence is increasingly evident in health care's fine circuitry. For example, as Medicare conditions provider payments on attainment of quality standards that the private sector has helped develop, consensus swells for an independent entity to put new drugs, devices, and procedures through head-to-head comparative-effectiveness wind sprints, with public and private interests together holding the stop watch.
None of this comprises a rigid centralized system, but it does suggest an evolving public-private regulatory symbiosis. How much real-world heft does this carry? Hard to say. But if lawyers are leading indicators of anything, it's probably not less regulation.
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