It’s not that nothing can be done.

When Commonwealth Court Judge Robert Simpson issued his decision in Josh Shapiro’s plea for a stay of execution in the UPMC-Highmark consent decree, he didn’t throw the Pennsylvania attorney general a lifeline.

Simpson’s ruling might be read as helpless when he says, “this Court lacks the power or authority to modify the termination date of the Consent Decree.” Judges, after all, can be as hamstrung by the law as they are able to manipulate it.

But right behind that, he gets to the heart of the problem. He couldn’t do anything “without the consent of the parties, even if it were in the public interest to do so.”

As the two locomotives that are the billion-dollar medical providers and insurers continue to barrel full-steam toward the June 30 expiration date, it becomes more and more clear that this is no more a legal issue than it is a medical issue.

It is a business issue.

Highmark-insured Medicare Advantage users and cancer patients face being separated from their doctors or the hospitals who could best provide service through up-front payment for treatment which UPMC could easily bill to Highmark as they have for years — and as they do and will continue to do for other insurance companies like Aetna and UnitedHealth.

The consent of the parties and a renegotiation of the terms of the consent decree could keep that from happening. But that’s unlikely to happen by choice because these two trains have been heading for this collision since 2014, and they’ve just stoked the fires and run out the clock.

Shapiro says he intends to take this to a higher court, and Simpson did find that the AG has standing to modify the decree for the good of the public and declined to dismiss the petition.

So it’s not that nothing can be done. It’s that nothing can be forced to be done — except patients being forced to give up their doctors or pony up cash ahead of treatment.

But if the two parties really care about helping people and providing high-quality service, no one would need to push them to a resolution. They would do more than consent.

They would volunteer.

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