Unpacking Healthcare: How Payment Policies Impact the Very Physics of Life

By Victor Mejia

Published on July 28, 2025

Have you ever considered that the complex world of healthcare policy, often discussed in terms of budgets and regulations, could directly impact the most fundamental biological processes of human life? A thought-provoking article, published as a Health Affairs Branded Post, delves into this profound connection: “Payment Systems Violate the Physics of Life: How ESRD Bundle Policies Disrupt Biological Order in Minority Communities“.

Authored by Frita Fisher, MD; Chad Worz, Pharm.D., BCGP, FASCP; Janice Desir, MD, MPH, CHCQM; and William Poirier, MBA, RN, this piece published on July 27, 2025, unpacks how specific healthcare financing decisions can inadvertently disrupt the precise biochemical balance essential for human survival.

The Biological Imperative: When Policy Meets Life

The human body operates like a finely tuned machine, with systems maintaining exact concentrations of minerals, removing toxins, and producing hormones—all within narrow ranges required for cellular function and life itself. When disease disrupts this delicate balance, medical treatments are meant to restore these precise conditions. However, the authors argue that healthcare financing policies, particularly the End-Stage Renal Disease (ESRD) Prospective Payment System, or “ESRD bundle,” can sometimes prioritize financial benchmarks over these critical biological imperatives.

This prioritization, they reveal, creates “systematic disorder” that disproportionately affects vulnerable communities, especially minority populations. For instance, Black Americans are 3.5 times more likely to develop kidney failure, comprising 35% of dialysis patients despite being only 13% of the population, and are less likely to receive kidney transplants. Hispanics also face significantly higher risks of type II diabetes, a leading cause of ESRD, and nearly twice the rates of kidney failure as non-Hispanic Whites.

Introducing the Physical Laws Framework (PLF)

To understand and analyze these disruptions, the article introduces the National Minority Quality Forum’s Physical Laws Framework (PLF). This scientific methodology views healthcare policies through the lens of fundamental biological laws, recognizing that effective healthcare systems must align with principles such as:

• Conservation of Biological Order: Ensuring interventions preserve or restore the molecular organization essential for life.

• Equilibrium Restoration: Guiding biological systems back to stable states.

• Temporal Alignment: Respecting biological timing and disease progression.

When healthcare financing policies violate these core principles, they introduce measurable disorder, which manifests most severely in communities already experiencing health disparities.

A Case Study in Disruption: The ESRD Bundle

The article provides compelling examples from ESRD management:

• Successful Alignment: The inclusion of erythropoiesis-stimulating agents (ESAs) in the bundle is highlighted as a success, aligning payment incentives with scientific evidence for appropriate hemoglobin targets (10-12 g/dL) and improving patient outcomes.

• Violations: In stark contrast, the inclusion of calcimimetics created “systematic violations of Equilibrium Restoration principles”. When a more effective intravenous calcimimetic, etelcalcetide (Parsabiv), was moved into the bundle, its utilization plummeted, forcing patients to try less effective treatments first and leading to increased parathyroidectomy rates. Black patients, facing higher rates of secondary hyperparathyroidism, experienced even more severe consequences.

• The Phosphate Crisis: Most recently, the January 1, 2025, inclusion of oral-only phosphate-lowering therapies (PLTs) in the bundle is presented as a potentially harmful violation of PLF principles. This policy threatens access to innovative treatments like XPHOZAH (tenapanor), which offers a more efficient way to maintain life-sustaining phosphate levels. Requiring these medications to be dispensed only at dialysis centers, instead of pharmacies, creates significant access barriers and disrupts consistent medication regimens, directly preventing the restoration of precise biochemical balance.

Toward Healthcare Justice and Asymptotic Freedom

The authors argue that these bundle policies create “systematic medical underservement” by prioritizing financial considerations over biological necessities, particularly for Black and Hispanic ESRD patients who face compounded challenges. This isn’t just a legal or administrative debate; it’s a fundamental challenge to whether healthcare systems will honor the biological laws that sustain human life. The article proposes that by embracing the scientific foundation of the Physical Laws Framework, healthcare leaders can unlock “asymptotic freedom”—unprecedented therapeutic capabilities that emerge from working with rather than against biological imperatives

Dive Deeper!

If you’re eager to understand how healthcare financing can either support or undermine the very “physics of life,” and how this impacts health equity for millions of Americans, this article is essential reading. It provides a clear blueprint for grounding healthcare financing in immutable biological laws, ultimately leading to superior outcomes and genuine equity.

Read the full article: “Payment Systems Violate the Physics of Life: How ESRD Bundle Policies Disrupt Biological Order in Minority Communities“.

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