PNHP

Health care needs a higher priority

Health care needs a higher priority

Vast numbers of Americans support Medicare for All. The new president should, too.

By Belinda McIntosh, M.D. and Toby Terwilliger, M.D.
The Atlanta Journal-Constitution, Jan. 26, 2025

America is more polarized today than it has been at nearly any point in its history. Again, President Donald Trump has capitalized on this division to rise to the most powerful office in the land. As he enters his final term in office, he has a historic opportunity to bridge this divide and heal our fractured nation.

Though we remain deeply divided on most political matters, there is one issue that most Americans agree upon: the U.S. health care system is broken.

A 2024 Gallup Poll found that Americans are more dissatisfied with our health care system today than at any point during the poll’s 24-year history. Importantly, the dissatisfaction crosses party lines, with only 30% of Democrats and 25% of Republicans rating our health care system favorably.

This disdain for U.S. health care is well-founded.

The average family spends more than 11% of its income on health care, and 41% of Americans carry some degree of medical debt, which accounts for two-thirds of personal bankruptcy filings. Insurance behemoths are recording record profits, with the five highest-paid chief executives earning more than $20 million a year, while the average American employee faces unyielding wage stagnation.

The rising cost of health insurance forces employers to forgo payroll increases for their employees and puts heightened financial pressure on small- and medium-sized businesses. For workers and families, this might be the difference between a comfortable middle-class life and scraping to get by.

Fortunately, there is a solution that is widely popular among both political parties: universal health care.

A 2018 Reuters-Ipsos poll found that 85% of Democrats and 52% of Republicans support a single-payer health care system, such as that in the Medicare for All Act proposed by Sen. Bernie Sanders, I-Vt. A single-payer system would benefit lower- and middle-class families, many of whom turned out in huge swathes to reelect Trump. A single-payer system would eliminate all out-of-pocket costs for routine and emergency medical care, and it would ensure that no man, woman or child would go without care because of the inability to pay.

Medicare for All is not a zero-sum game; there are no losers. An ultra-wealthy class of elites would finally be paying its fair share, and the rest of America would pay less for their health care.

Trump has flirted with the idea of universal health care before.

When asked how he envisioned replacing the Affordable Care Act, Trump stated “I have concepts of a plan.” Though this plan has yet to materialize, we can look at his past statements for clues.

In 2017, Trump praised the Australian health care system, a hybrid public-private system that operates similarly to that proposed by the Medicare for All Act. In 2015, he spoke admiringly about the Scottish health care system, which is one of the purest forms of nationalized health care in the world.

Most famously, in his 2000 book, “The America We Deserve,” Trump expressed his full-fledged support for a single-payer system stating:

“I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by health care expenses. We must not allow citizens with medical problems to go untreated because of financial problems or red tape. … We need, as a nation, to reexamine the single-payer plan.”

Recent events have made Trump’s nod to single-payer health care even more prescient.

The tragic shooting of UnitedHealthcare’s CEO has ignited a national conversation — not just about violence but about the anger and desperation felt by many who are trapped in a health care system that prioritizes corporate profits over people.

As a nation, we must unequivocally condemn all forms of targeted violence. At the same time, we must acknowledge the overwhelming consensus that has become apparent: Americans, regardless of political affiliation, are fed up with a system that often denies care, burdens families with insurmountable costs and enriches corporate elites.

This shared frustration presents Trump with a unique opportunity to align his actions with the populist message that won him the presidency. If Trump truly stands for the working class, he will lead the charge for Medicare for All.

Not only would this fulfill his unyielding promise to “drain the swamp,” but it would also secure his legacy as the president who finally fixed America’s broken health care system.

Belinda McIntosh is an Atlanta-based physician who served as chair for Georgians for a Universal Health Program and now sits on the Board of Directors of Physicians for a National Health Program.

Toby Terwilliger is an Atlanta-based physician who serves as cochair of Georgians for a Universal Health Program and sits on the Board of Directors of Physicians for a National Health Program.

https://www.ajc.com…

‘It’s a death sentence’: US health insurance system is failing, say doctors

Firms including United Healthcare have denied basic scans and taken months to reconsider, physicians say

By Michael Sainato
The Guardian, Jan. 26, 2025

American doctors are accusing US health insurance giants of causing deadly delays to vital medical procedures and care – and putting profits ahead of their patients’ health.

Firms including United Healthcare have denied basic scans, and taken months to reconsider, according to physicians who spoke to the Guardian.

“There’s good evidence that these kinds of delays literally kill people,” said Dr Ed Weisbart, former chief medical officer for Express Scripts, one of the largest prescription benefits managers in the US. “For some people, this isn’t just an inconvenience and an annoyance and an aggravation.

“It’s a death sentence, and the only reason the insurance companies do that is to maximize their profits. The fact that they might be killing you is not in the equation of what they care about.”

Americans spend the most on healthcare in the industrialized world – an estimated $4.9tn in 2023 – but have the worst health outcomes, according to analysis by the Commonwealth Fund.

The fatal shooting of UnitedHealthcare CEO Brian Thompson last month prompted an outpouring of public anger toward the healthcare industry. While private insurers report billions in profits every year, many patients – and their doctors – struggle to navigate a complex financial system to get what they need.

Lobbyists for the insurance firms insist they are “working to protect” people from higher costs, and stress that everyone in the space, including doctors, are responsible for making the US healthcare system care more affordable and easier to navigate.

But in a series of interviews, medical professionals described their frustration with a powerful industry which had prevented them from helping patients.

‘We’re stuck in this terrible, vicious circle’

Dr Cheryl Kunis, a board member at the Physicians for a National Health Program and nephrologist in New York City, still thinks about what happened when one of her patients needed a PET scan. He had a tumor, and before deciding on how to treat it, Kunis and her colleagues wanted to establish if it had spread.

“The surgeon was very honest that he only wanted to operate if the tumor was localized, and without the PET scan, he really would not be able to make that decision,” said Kunis. “The surgeon and his office, as well as my office, spent hours on the phone. We were speaking to somebody who was sitting at UnitedHealthcare in front of a computer screen who was really not knowledgeable on the underlying medical problem or the test that we are asking for the patient to have.”

After an initial denial, the patient’s appeal for the scan was ultimately approved six months later. By that the time, the patient had died.

“We assume that if he had been diagnosed earlier, he may have been able to do better,” said Kunis. “There’s no way of proving it, but there was a reasonable chance he would have been in better shape had there not been a six-month delay in getting the scan.”

The healthcare system is “just really stuck in this terrible, vicious circle”, she said, “of prices constantly going up, lack of regulation and the insurance companies unfortunately having leverage over the patients who are trying to receive the care”.

‘It’s both demoralizing and insulting’

Health insurance companies often require “peer to peer” reviews, where doctors are required to speak with a medical representative from a health insurance company to justify treatment. But the insurance representatives are often far less experienced, according to physicians who spoke to The Guardian, and may not even have training in the specific field they are weighing in on.

“When I have engaged in ‘peer to peer’ review, the peer is never a physician that has my training,” said Dr Philip Verhoef, an Intensive Care Unit physician based in Honolulu, Hawaii, and former president of Physicians for a National Health Program. “It’s kind of a farce to even call it ‘peer to peer’. I’ve never had a ‘peer to peer’ conversation that was actually with a real peer.”

Instead, the representatives are “second-guessing our judgment as clinicians”, he claimed. “To be totally clear, I don’t have a financial incentive to admit patients to the ICU. It’s both demoralizing and insulting when a bureaucrat somewhere looks at a submitted claim from the hospital and says, ‘The decision to admit to the ICU was wrong.’”

Verhoef said he often sees patients coming into the intensive care unit for preventable illnesses caused by health insurance company denials, such as refusing to cover required medication, like insulin, or an inhaler for asthma.

“When people need to use their private health insurance, it actually fails them,” he added. “Insurance is supposed to be there to cover you from financial calamity, when unfortunate things happen, and the current system that we have based on private health insurance has really failed everyone. I don’t think that we’re going to regulate our way out of this mess.”

Much of the friction patients encounter when seeking medical care or assistance is fundamental to the insurance firms’ business models, according to Weisbart. “They don’t care about you, and they see you as an expense, not someone whose health needs to be improved,” he said. “The healthier you are, the more they want you to have them as their insurance, and the sicker you are, the more comfortable they are with you being dissatisfied with them and searching for a different insurance company.

“Once they have that money, every time somebody has to get health care, that’s just an expense that they don’t want to let go of.”

The insurance industry’s profits revolve around delaying and denying medical care, Weisbart claimed. “When they delay your care by a day, by a week, by a month or totally deny it, it’s not a random event,” he said. “It’s a calculated business strategy to maximize their profits.”

‘Problem getting much worse’

Many doctors have recently expressed similar issues with private insurers. Physicians are “forced to become insurance experts on top of our medical expertise, spending countless hours on paperwork instead of patient care,” Dr Bayo Curry-Winchell of Nevada wrote in an article for Katie Couric Media, while Dr Claudia Fagan, chief medical officer of Cook County Health, wrote in an article for Common Dreams that she had “seen patients suffer and die in order to pad the bottom lines of corporate health insurers – and in recent years I have seen this problem getting much worse.”

UnitedHealthcare did not respond to multiple requests for comment. AHIP, a lobby group for the industry, said in an emailed statement: “In the fragmented and heavily regulated healthcare system, health plans, providers and drugmakers share a responsibility to make high-quality care as affordable as possible and easier to navigate for the people we collectively serve. Health plans are working to protect patients from the full impact of rising costs while connecting them to care that is safe, evidence-based and coordinated.”

Doctors who spoke to the Guardian suggested fixing problems with the US healthcare system will require more than tinkering at the edges.

Both Weisbart and Verhoef argued the solution would require moving away from private health insurance, toward a single payer healthcare system, similar to other wealthy countries that provide healthcare to all.

“The solution is effectively to overhaul the system entirely and then start from scratch with the national health insurance system,” said Verhoef. “Solutions that depend on trying to regulate the private insurance industry are simply going to fail.”

There is “no way to modestly reform a fundamental flaw in a business model”, added Weisbart. “Their business model is designed on delaying, denying and redirecting healthcare We know a much better way: the much better way is to build a system on the traditional Medicare program. Fix the things that are wrong with Medicare … and then simply provide that to everybody.”

Moving to a single-payer, universal healthcare system would likely cost less than current national healthcare expenditure, according to a 2020 academic analysis – and save tens of thousands of lives each year.

https://theguardian.com…

Ambitious Reforms of Current System: A Path to Single Payer?

Prominent health policy experts propose an ambitious set of reforms to improve coverage and affordability, streamline payment, bolster primary care, and reduce the corrosive influence of profits. But without fundamental reform, can these changes succeed? Can they lead us to single payer?

From Laggard To Leader: Why Health Care In The United States Is Failing, And How To Fix It, Health Affairs, Jan. 22, 2025, by Donald M. Berwick, et al.

Health care in the United States is among the most technologically advanced in the world, but it is largely failing to meet the needs of the nation. The US can claim international excellence in important areas of care, such as cancer treatment, and it leads the world in biomedical innovation and building a well-prepared and dedicated clinical workforce. However, Americans are faced with staggering health costs, inadequate access to care, pervasive health inequities, and lagging life expectancy compared with other developed nations. In this article, we propose bold national goals: affordable and equitable care for all, an additional decade of health after retirement, elimination of racial and ethnic disparities in health, substantial reduction in health care expenditures, and, most important, improved health outcomes. To achieve these goals, we recommend changes to ensure coverage for all, invest in primary care and social determinants of health, create financing to incentivize population health, and improve transparency and accountability. Major systemic transformation of the US health care system is not just required; it is a moral and economic imperative.

Yielding to pragmatism, we have based the following principles and action agenda on several key assumptions: First, we assume that the private market for health insurance will continue to exist, with many competing private health plans, and second, we assume that employer-sponsored health insurance will continue to be the largest source of coverage in the private sector. We also assume sufficient political will to enable a substantial increase in regulation of the health care market, as well as much stronger governmental leadership in the health care sector than exists today. Given the urgency of the need for change, we dare to hope for bipartisanship.

Principle 1

Our first principle is that all Americans should have access to affordable, comprehensive health coverage and care. We propose eliminating all medical debt.

Congress should create a Medicare-Plus public option available to all Americans, including those with employer-sponsored coverage. Premiums, deductibles, and copays would be set on the basis of income, no family paying more than 5 percent of income on health care.

Principle 2

Our second principle is that integrated primary care should provide an anchor for the health and well-being of all Americans. This requires a massive restructuring.

Principle 3

Our third principle is that improvements in health outcomes should be incentivized through population-based payment. Payers should minimize fee-for-service payment and substitute payment for care of populations. To reduce overuse and underuse of services, physicians should be, as much as possible, salaried.  Congress should empower CMS to lead an all-payer effort to rebalance payment levels for primary and specialty care.

Principle 4

Our fourth principle is that social determinants of health and health equity should be prioritized.

Principle 5

Our fifth principle is that financing should be simplified to minimize administrative complexity and enhance efficiency. Market-based pricing has failed in the commercial market, and payment complexity continues to exploit patients and breed waste. Financing and administrative operations should prioritize simplicity and uniformity. Americans should not be guessing how much they may be charged based on where they seek care. Hospital pricing should be standardized, transparent, and, within reason, uniform. … CMS should also create a mandatory Medicare Advantage administrative contractor to provide, on a uniform basis, all preauthorization, claims adjudication, and claims review activities.

Principle 6

Our sixth principle is that transparency and organizational professionalism should serve as foundations for accountability. Leaders of medical organizations, such as hospitals, health systems, and group practices, including executives and governing boards, should affirm and adhere to the ethical mandate of putting patients’ needs first.

Principle 7

Our seventh principle is that health systems should embrace data-driven decision making and a culture of continuous learning.

Principle 8

Our eighth principle is that robust governance and accountability measures are necessary to protect the health and needs of communities. Without much stronger accountability to patients and the workforce, fragmented, siloed systems, with varying costs, levels of access, and quality will continue to plague Americans seeking care.

From the Conclusion

Our proposed path forward is impossible unless Americans take equally seriously the need to stamp out price gouging and waste. Administrative pricing will need to be more actively used, high prices for specialty services will need to be reconsidered, health plan games such as upcoding in Medicare Advantage will need to be ended, predictable global payments will need to replace much of fee-for-service payment, useless administrative complexity will need to yield to simplification, and much more thorough price transparency will be required so that authentic competition can emerge. Profiteering in its many forms must be made unacceptable and, indeed, illegal.

Americans spend by far the most in the world but do not have the best care as a result – not even close. Incremental reform has failed in the past and will not work in the future. Only a systemic transformation can achieve the goals of equitable, accessible, affordable, and high-quality health care for all Americans. Why should Americans not, as a nation, have health and health care that stand as a model of excellence for the world?

Comment:

By Jim Kahn, M.D., M.P.H. and Don McCanne, M.D.

Donald Berwick – a hero of ours for his decades of focus on patient well-being – and his colleagues shine much-needed light on the problems with our health care system and propose various measures to improve it. Their recommendations align reasonably with the policies which we single payer supporters have pursued for so long. We agree with administrative simplification, expanding primary care, limiting health care costs for financially struggling families, and shifting the system focus from profits to patients.

It is long past time that the nation listens to and adopts these ideas so that we can all have superior, comprehensive health care at a price that each of us can afford.

However, we are skeptical that the proposed changes can succeed in their goals within the current fragmented system. For example, a public option is notoriously vulnerable to attracting sicker and more expensive patients, which increases prices, which leads to insolvency. Many will remain uninsured. Efforts to standardize hospital prices sacrifice the administrative efficiency gains of hospital global budgets, and don’t address pricing outside hospitals. Effective control of gaming (e.g., diagnostic upcoding and risk selection) within capitated systems like Medicare Advantage have dismally failed, because the extremely competent profit-seeking financial intermediaries defeat regulatory efforts.

Thus, unfortunately, the proposals would leave in place the fragmented approach that underlies the problems that we have. We can’t solve these problems without fundamental simplification of our stunningly complex structure and processes, combined with a (not-for-profit!) government payer – as we would have in a well-designed single payer system.

Still, most of the article’s proposals constitute meaningful steps toward the high-performance health care system that we need. Perhaps we can arrive at specific policies and wrangle the politics that will be required to implement them as intended. Indeed, this may foster enactment and implementation of our ideal system: meaningful defragmentation and radical simplification may open an easier pathway to the less expensive and higher-performing single payer system. Let’s take their suggestions seriously, with the ultimate goal always in mind.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Private Equity Harms Patients & Providers

Profit-driven provider ownership compounds the harm from profit-driven insurance. We must pursue a 3-step action plan: educate the public; persuade legislators; and implement universal public insurance with community-orientated providers.

Changes in Patient Care Experience After Private Equity Acquisition of US Hospitals, JAMA, Jan. 9, 2025, by Anjali Bhatia, et al.

Conclusions and Relevance: Patient care experience worsened after private equity acquisition of hospitals. These findings raise concern about the implications of private equity acquisitions on patient care experience at US hospitals.

A Private Equity Hospital Gets a True-Crime Twist, The American Prospect, Jan. 14, 2025, by Maureen Tkacik

Another looted carcass of a for-profit hospital chain filed for Chapter 11 bankruptcy protection over the weekend, just days after it was the subject of an infuriating Senate Budget Committee report. Perhaps more pertinently, the filing comes ten weeks after the Pennsylvania attorney general sued its two founders and the private equity firm Leonard Green & Partners to claw back around $650 million in dividends they extracted from the company while clinicians were laid off en masse, ambulance drivers were forced to pay for their own gas, and rates of bedsores, sepsis, and other hospital-acquired conditions soared to some of the worst in the country.

Private Equity in Health Care Shown To Harm Patients, Degrade Care And Drive Hospital Closures, Sen. Chuck Grassley, Jan. 7, 2025

Today, Sens. Chuck Grassley (R-Iowa) and Sheldon Whitehouse (D-R.I.), in their respective categories as Ranking Member and Chairman of the Senate Budget Committee during the 118th Congress, released a bipartisan staff report on the findings of their investigation into ways in which private equity investment in health care has negative consequences for patients and providers.

Grassley said, “A dependable health care system is essential to the vitality of a community. As always, sunshine is the beast disinfectant. This report is a step toward ensuring accountability, so that hospitals’ financial structures can best serve patients’ medical needs.”

Whitehouse said, “As our investigation revealed, these financial entities are putting their own profits over patients, leading to health and safety violations, chronic understaffing, and hospital closures.” “Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns and communities to pick up the pieces.”

Comment:

By Don McCanne, M.D.

For a great many years now, we’ve thought that we could simply improve Medicare by expanding its benefits, eliminate the waste of the private insurance industry, and include everyone so that we would end up with a truly altruistic health care system capable of controlling costs by eliminating wasteful spending and improving performance. We would then have a health care system that would be the envy of all other nations.

While we have been busy trying to convince voters and legislators that this would be the route to take, private interests have been increasingly directing the mission of our health care system from providing the best care for patients to creating greater wealth for administrators and investors. Perhaps the most obvious is shifting the goals of private insurance from paying for optimal health care services for patients to insurance products designed specifically to divert health care dollars to profits, resulting in higher costs and poorer performance.

Another example of how our health care dollars are diverted to corporate interests is the growth of private equity investment in providers. Investor organizations purchase components of our health care delivery system, drain them of assets, and then place them into bankruptcy or simply shut them down when they are no longer capable of providing care because of financial insolvency.

Sadly, our task is no longer simply to improve and expand Medicare, but also to seek greater regulation and even ownership of providers. Many believe that this would be best accomplished by increasing community control and ownership.

This also means that political control must be in the hands of individuals who insist that patients should come before profits. These views have been strongly held by progressives who have been sidelined by neoliberals and conservatives. When conservatives gained control in Canada and in England, the services of their respective single payer and national health service systems deteriorated, primarily due to longer wait times due to inadequate public funding. Wouldn’t it be nice if set aside political divisions and agreed that this should be about policies that work for everyone?

So now we not only have the task of installing a financing system that would enable everyone to have access to comprehensive health care through single payer (improved Medicare for All), but now we also must gain control of private funding of the health care delivery system. Since we have a new government that wants to further reduce taxes for the very wealthy and pay for that by reducing beneficial government services for the rest of us, you can see that a very difficult task awaits us.

We can do it with a three-step process. The first is labor intensive: we must educate the public of the great benefits that will ensue by making these changes. To do this, we must simplify the communication of the concepts so that everyone will understand clearly why we have to do this. Second, we must join together, as individuals and organizations, in a political process that will convince legislators that this is the solution that we have all been waiting for. With overwhelming public demand, they will have to lead us to the third phase – enacting and implementing our vision for universal, patient-oriented financing and care.

We do have an inkling of good news. We now have politicians from both major parties, Sen. Grassley and Sen. Whitehouse, who have brought before Congress, through the Senate Budget Committee, the fact that problems in our health financing system are serious enough that it requires the attention and action of Congress.

So now all we have to do is flesh out the three-step action plan. Let’s get to work!

(Later this week: Review of the policy landscape.)

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Growth of Private Equity and Hospital Consolidation in Primary Care and Price Implications

By Yashaswini Singh, Ph.D., M.P.A.; Nandita Radhakrishnan, B.A.; Loren Adler, M.S.; and Christopher Whaley, Ph.D.
JAMA Health Forum, Jan. 17, 2025

Abstract

Importance: Consolidation of physician practices by hospitals and private equity (PE) firms has increased rapidly. This trend is of particular importance within primary care. Despite its significance, there is no systematic evidence on the emerging trends in ownership affiliation of primary care physicians (PCPs) and its association with prices paid for physician services.

Objective: To describe trends in hospital affiliation and PE affiliation in primary care and examine variation in negotiated prices paid by commercial insurers to hospital-affiliated, PE-affiliated, and independent PCPs.

Design, Setting, and Participants: Data from PitchBook and IQVIA were used to examine hospital and PE affiliation PCPs. PCPs and their affiliations were linked to novel cross-sectional Transparency in Coverage data. A total of 226.6 million negotiated prices were analyzed for evaluation and management office visits (Current Procedural Terminology codes 99202 to 99205 and 99212 to 99215) across 4 national insurers (Aetna, Blue Cross Blue Shield, Cigna, and United Healthcare). Linear regressions were used to examine the association between hospital-affiliated, PE-affiliated, and independent PCPs and cross-sectional prices paid for physician services, with fixed effects for service, state, and insurers. Data were collected from January to June 2024, and data were analyzed from July to October 2024.

Main Outcomes and Measures: The proportion of PCPs that are affiliated with hospitals and PE from 2009 to 2022. Using cross-sectional data from 2022, negotiated prices paid to physicians (physician professional fee) for office visits.

Results: A total of 198 097 PCPs were analyzed. PCPs affiliated with hospitals increased from 25.2% (28 216 of 111 793) in 2009 to 47.9% in 2022 (82 890 of 172 964). Over the same period, 1.5% (2483 of 172 964) of PCPs became affiliated with PE firms. Relative to independent PCPs, negotiated prices for office visits were $14.91 (95% CI, 8.92-27.64) or 10.7% (95% CI, 10.1-11.4) higher for hospital-affiliated PCPs (P < .001) and $9.56 (95% CI, 2.24-14.55) or 7.8% (95% CI, 4.7-10.8) higher for PE-affiliated PCPs (P < .001).

Conclusions and Relevance: In this cross-sectional study, nearly one-half of all PCPs were affiliated with hospitals, while PE-affiliated PCPs were growing and concentrated in certain regional markets. Relative to PCPs in independent settings, hospital-affiliated PCPs and PE-affiliated PCPs had higher prices for the same services.

full investigation: https://jamanetwork.com…

Americans Angry about Flawed Health Insurance

The progressive physician voice is essential in health reform. A long-time leader of Physicians for a National Health Program comments on how the US public’s reaction to the murder of an insurance executive highlights the terrible human cost of insurance shortfalls, and calls for a public, national health program.

Americans Are Angry About Their Health Insurance – With Good Reason, Common Dreams, Jan. 1, 2025, by Claudia Fegan, MD (National Coordinator, PNHP)

As a physician, I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers – and in recent years I have seen this problem getting much worse.

How should we react when a man is shot to death on the street on his way to work? Our humanity tells us that we should be shocked and horrified.

So why did hundreds of thousands of people have the exact opposite reaction when UnitedHealthcare’s CEO was executed in New York City? Because Americans are furious with health insurance corporations – and they have every right to be.

In the immediate aftermath of the shooting, many Americans took to social media to celebrate. Sympathetic statements were met with rancor – and in the case of UnitedHealth Group’s own statement, over 70,000 “laugh reactions” before the company made that tally private.

As a physician who’s treated countless victims of gun violence, and whose life’s work is to care for all of my patients, I found this response to be deeply unnerving.

For decades, health insurance corporations like United have been taking in as much money as possible in premiums and paying out as little as possible in medical claims. They have tried everything from requiring “prior authorization” of care, to excluding high-quality providers from their networks, to imposing a Byzantine series of charges including ever-growing copays, coinsurance and deductibles. When all else fails, many insurers simply deny claims.

Behind each of these practices are millions of Americans who are made to suffer. I hear these stories routinely in my practice, and they never become easier to stomach. I have seen patients with aggressive cancer who avoided seeing a doctor for months because they feared bankruptcy; patients with chronic conditions like diabetes who are denied treatments that would improve their quality of life; and gunshot victims whose fight to recover and gain a semblance of normalcy is complicated by their health plans saying no, no, and no again.

I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers – and in recent years I have seen this problem getting much worse.

Are we listening? And what are we going to do about it? Both the Affordable Care Act and the Medicare Advantage program have only succeeded in ballooning the profits of firms like United – without improving Americans’ health or sparing their wallets.

What would help is a proven reform proposal that is long overdue: a single-payer national health program. Such a system would provide universal coverage and comprehensive benefits – with zero out-of-pocket costs.

Americans are crying out in pain. We should listen to those cries and we should finally, after decades of delay, do something about it.

Comment:

By Don McCanne, M.D.

I started in practice before Medicare and Medicaid were implemented. What a relief it was to see seniors finally able to receive care without facing significant financial barriers to that care. And others living in poverty were also able to receive care since their financial barriers were removed, and Medicaid did cover overhead, allowing dedicated physicians to practice without worrying about negative cash flows.

But there were still too many patients who remained uninsured or whose employer-sponsored plans were shifting more expenses to the patient through higher premiums and cost sharing, while limiting patient choices through managed care manipulations.

With my growing dissatisfaction with our health care system, it was in 1989 that I read an article in JAMA, written by Steffie Woolhandler and David Himmelstein, co-founders of Physicians for a National Health Program, that described a single, tax-funded national health program that they supported. That was it! Precisely what we needed! I immediately became affiliated with their organization. Claudia Fegan became one of my mentors, leading me through the early stages of my involvement. She has been an inspiration to me ever since.

Her article explaining how the defects in our health care financing system only continue to grow certainly resonates with me. We now have the most expensive health care system which performs worse than all other modern nations. We recently estimated in HJM as many as 200,000 deaths each year due to insurance problems like those described by Dr. Fegan. You can see why I am absolutely elated to see her article as she continues to fight for the cause of health care justice for all.

The tragedy of the assassination pains us all, but the enormity of the public reaction to the injustice that the private insurers inflict upon the American people suggests that there is hope that we will finally fix the system. If our legislators and administration do not respond to the current protests, it means that we need to raise our voices even louder (while refraining from assassinations and Jan. 6-type events, since, in our mission, we revere life).

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

The greater paradox

By Johnathon Ross, M.D., M.P.H.
JAMA Network Open, Comment, Jan. 4, 2025

A recent editorial in the Journal of the American Medical Association decries the fact that caregiver burnout seems to arising from systemic causes:

“The crisis of physician burnout has serious implications for every aspect of health care delivery. That physicians who work the hardest to meet vulnerable patients’ needs are more susceptible to experiencing burnout highlights the need for systemic reforms that allow physicians to connect with meaningful work in ways that support rather than exhaust them.”

Yes, it is paradoxical that physicians and other caregivers are burning out from their most meaningful roles. There is an even greater paradox that stares caregivers in the face every day. That paradox is how the wealthiest nation in the world can spend nearly twice as much per capita on health care as any other rich nation and still have the worst health outcomes. (See the OECD reports and the Mirror, Mirror reports from the Commonwealth Fund.)

U.S. caregivers see the enormous waste and profiteering, and the neglect of our most vulnerable fellow citizens by our sickness care non-system. It is dominated by PHARMA, the insurance industry, the device makers, and hospital systems that put profits and greed before patients in need. How are we as physicians supposed to respond to such a cruel and unjust system that leaves nearly 30 million with no coverage, and nearly half of us self-rationing our own care due to unaffordable co-payments and deductibles that are supposed to control costs by putting “skin in the game,” but have clearly failed to control costs or improve care. We see who is getting skinned and it is not a game.

Those of us at Physicians for a National Health Program believe that an improved, expanded Medicare for all can achieve this goal. We already have the best caregivers, the best facilities, and the best research, and already spend enough money to create the best health system in the world. Those who are benefitting from the current failing sickness care non-system are wealthy, powerful enemies of this type of change. They will not go away without a struggle.

What we lack is the political will to kick these moneychangers out of the Temple of Medicine. We have the power to bring about the needed change. The cure for our health care blues is for caregivers to become activists who seek the system change that will allow us to focus on the care of our patients. Caregivers are the DNA. Without us they cannot create the next generation of caregivers. Without caregivers there is no system. We have the power. We must organize the struggle.

“Power concedes nothing without a demand. It never did and it never will. If there is no struggle, there is no progress.” – Frederick Douglass

Dr. Johnathon Ross is a past president of Physicians for a National Health Program.

https://jamanetwork.com…

‘Dismissed!’

When politicians and everyday citizens become dismissive of others' opinions, the results are all too predictable and tragic.

By Jay D. Brock, M.D.
FXBG Advance (Fredericksburg, Va.), Jan. 3, 2025

Some years ago I had an acquaintance who was career military. A no-nonsense kind of guy, conversations with him could sometimes be a challenging experience: once he had gotten his point across, and without hearing your response, he had a habit of simply walking away. You could almost hear his command: “Dismissed!”

His apparent indifference to other viewpoints comes to mind in the context of several recent issues, both locally and nationally, in the news lately.

In a local county, the Board of Supervisors recently came up with and passed a new vision and mission statement—without any public input at all. When pressed on this, the Supervisor who wrote and then pushed the statement through the Board responded, “We were elected by the citizens to provide a mission and vision statement and that’s what I’m doing.” Another Supervisor added, “Is this not what the citizens want? It appears that it is from everything I know in my core.”

As Advance Editor Martin Davis wrote at the time, the supervisor “may know it in his ‘core,’ but he’s oblivious to the sizable population of people in (the county) who don’t share his…confidence.”

Message to county voters: “Dismissed.”

Residents of a local city have had similar experiences. Their questions to City Hall about growth and the problems it brings have sometimes gone unanswered. This includes both staff and occasionally City Council members, whose unresponsiveness on certain matters is at least as much a concern as issues raised about growth problems.

Message to city voters: “Dismissed.”

On a national level, take healthcare. Healthcare think tank KFF reported last year that unaffordable healthcare costs were a very close second to inflation as the major issues the voters wanted the presidential candidates to discuss in the campaign. Yet there was very little discussion of this issue during the campaign. Yes, Democrats touted their lowering the price of Insulin and a handful of medications for a small sliver of Medicare enrollees. During the campaign, Kamala Harris proposed adding some home health care to those on Medicare. And Donald Trump offered that, after eight years of considering unaffordable healthcare issues, he had finally come up with the “concept” of a plan. But there was no real discussion of how to fix a failed health insurance system that leaves one in four Americans either with no health insurance or insurance they cannot afford to use; and where three out of four Americans worry they cannot afford to pay their medical bills if they get sick.

Message to voters: “Dismissed.”

A large number of Americans are covered by for-profit health insurance companies that require prior authorization for many medications and other treatments. Physicians and their office staff waste untold time and resources in dealing with these companies in begging them to pay for care that in their professional opinion would benefit their patients. The process is demeaning to the medical profession, and extremely anxiety-provoking for patients (as well as to the medical professionals responsible for patient care). Yet the instances of care that is delayed and especially denied are legion, with real medical harm as a consequence.

Message to patients (and the medical professionals responsible for patient care): “Dismissed.”

The reactions to the shooting late last year of the CEO of a major for-profit health insurance company was an eye-opener. While condemnation for the murder was genuine, so was the social media support for the alleged shooter among what seems to be a significant proportion of Americans. National and local media are focusing on this response, frequently with a surprising sympathy for why so many Americans consider the alleged shooter to be a folk hero: he stood up to a hugely important American institution—a mega, for-profit health insurance company widely despised for its indifferent denial of care even if it will result in patient harm.

These Americans might not agree with the murder, but they can certainly identify with the likely reasons behind it.

Americans are angry. Their genuine problems and concerns are much too often too readily dismissed by the people and the institutions they should be trusting to do the right thing by them. The system is obviously working extremely well for those at the very top: it’s apparent to all that if you’re wealthy, your questions get answered and your concerns get resolved. But for too many Americans, the “system” just isn’t working for them, and they know it.

There has to be a better way. Obviously, violence is not the answer. What is clearly needed: individuals and institutions with the power to resolve issues important to everyday people that become much more readily responsive.

These individuals and institutions know who they are. We’re waiting to see how and when they respond.

Or if we’re simply “Dismissed.”

https://fxbgadvance.com…

Americans Are Angry About Their Health Insurance—With Good Reason

As a physician, I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.

By Claudia Fegan, M.D.
Common Dreams, Jan. 1, 2025

How should we react when a man is shot to death on the street on his way to work? Our humanity tells us that we should be shocked and horrified—and feel that something is deeply wrong with such a brazen act of murder. Ideally, we would do what we could to help sooth the survivors, condemn the violence, and bring the perpetrator to justice.

So why did hundreds of thousands of people have the exact opposite reaction when UnitedHealthcare CEO Brian Thompson was executed in New York City last month? Because Americans are furious with health insurance corporations—and they have every right to be.

In the immediate aftermath of the shooting, many Americans took to social media not to mourn, but to celebrate. Caustic posts about prior authorization and denied medical claims were common. Sympathetic statements were met with rancor—and in the case of UnitedHealth Group’s own statement, over 70,000 “laugh reactions” before the company made that tally private. Even verbose political figures like Elon Musk and President-elect Donald Trump declined to comment for days. This shooting touched a raw nerve.

As a physician who’s treated countless victims of gun violence, and who’s life’s work is to care for all of my patients, I found this response to be deeply unnerving. But I also can’t waive it away with simple explanations like online radicalization or trolling. Something much deeper is at play.

For decades, health insurance corporations like United have been growing more powerful and more profitable. How do they generate these profits? By taking in as much money as possible in premiums and paying out as little as possible in medical claims. Over time, they have tried everything from requiring “prior authorization” of care, to excluding high-quality providers from their networks, to imposing a Byzantine series of charges including ever-growing copays, coinsurance, and deductibles. When all else fails, many insurers simply deny claims.

Behind each of these practices are millions of Americans who are made to suffer. I hear these stories routinely in my practice, and they never become easier to stomach. I have seen patients with aggressive cancer who avoided seeing a doctor for months because they feared bankruptcy; patients with chronic conditions like diabetes who are denied treatments that would improve their quality of life; and gunshot victims whose fight to recover and gain a semblance of normalcy is complicated by their health plans saying no, no, and no again.

I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.

These are the stories that Americans are sharing in this fraught moment. We have to ask ourselves: Are we listening? And what are we going to do about it?

Insurers like UnitedHealthcare will have their own responses. Their PR teams will no doubt work overtime to marginalize aggrieved voices and to highlight what they consider to be the “value” of their health plans. Expect to see glossy commercials and towering billboards touting the “peace of mind” that Americans should enjoy knowing that their medical needs are “covered.” But the health insurance industry doesn’t have a communications problem, it has a profiteering problem—and no amount of marketing will convince people who have already been burned.

Behind the scenes, corporate insurers will no doubt lobby for the preferential treatment they have come to expect. Our newly elected Congress may acquiesce, or they may decide that the industry needs to be regulated—a strategy that has failed to live up to its promise.

Republicans and Democrats have made separate attempts to combine federal requirements with federal largesse in order to make corporate health insurers play nice. But both the Affordable Care Act and the Medicare Advantage program have only succeeded in ballooning the profits of firms like United—without improving Americans’ health or sparing their wallets.

It’s also clear that violence is not the answer, both on a purely human level and because corporate insurers will simply not be moved. UnitedHealthcare will have a new CEO in short order, and it will be that person’s responsibility to boost profits and make shareholders wealthier. Responding to patients’ cries will not serve these ends, so it is not in the cards.

What would help is a proven reform proposal that is long overdue: a single-payer national health program. Such a system would provide universal coverage and comprehensive benefits—with zero out-of-pocket costs. It could be easily implemented given the gargantuan sums we spend on healthcare in this country, and it would be a boon for those who are suffering, and for those who are fearful.

Americans are crying out in pain—and are recognizing that they are not alone in their pain. We should listen to these cries and we should finally, after decades of delay, do something about it.

https://commondreams.org…

Shareholder Dreams or Health Justice?

Corporate stock buybacks on top of hundreds of billions in profits favored by shareholders, versus government-run universal health insurance as favored by two in three adults. It’s time to be “politely stern” in favor of health care coverage for all.

Health Insurers Gave $120 Billion To Shareholders While Denying Your Claim, The Lever, Dec. 11, 2024, by Veronica Riccobene

As rising health care costs and inadequate insurance coverage have one in three Americans saddled with medical debt, the nation’s top health insurers have dumped billions into enriching their executives and top shareholders through lucrative stock buybacks.

All in all, the country’s largest health insurers have invested over $120 billion into repurchasing their own shares since the passage of the Affordable Care Act in 2010. These include UnitedHealth Group; Cigna; Elevance Health, the parent company of Anthem Blue Cross Blue Shield; and CVS Health, which acquired Aetna in 2018.

These companies, along with Kaiser Permanente, a nonprofit health care organization, control over half of the commercial market share of the U. S. Health insurance industry. Since 2010, they’ve raked in a combined $9 trillion in revenue, netting more than $371 billion in profits.

Meanwhile, one in four Americans say they’ve avoided seeking health care in the past year because of the cost. Half of all U.S. adults say they’d be unable to afford an unexpected $500 medical expense, and medical bills account for 40 percent of U.S. bankruptcies.

Major insurers have abandoned patients for shareholder enrichment, according to former health insurance executive Wendell Potter. “Health insurers corrupted the concept of managed care and turned it into something that has really been more of managing cost, but also depriving people of the care that they need,” said Potter. “There’s no other country in the world that has a system like this that enables middlemen to siphon off so much money from middle-class and working-class folks that need health care,“ he added.

Nearly two in three Americans now say they believe health care should be the government’s responsibility, according to polling organization Gallup.

Data shows buybacks soared after Congressional Republicans and the Trump administration slashed corporations’ tax burden through the Tax Cuts and Jobs Act of 2017. Proponents of the Trump tax cuts argued that corporations would reinvest their savings into research and workers – but instead, buybacks exploded. Corporate buybacks are on track to surpass $1 trillion annually by 2025.

Comment:

By Don McCanne, M.D.

Remember, this is only one game that corporations play to move our health care dollars to their own profit line. Their combined maneuvers to reduce health spending on us as they boost their own profits is what has made the health care system in the United States the most expensive and poorest-performing system of wealthy nations.

This is certainly not news to those of us who have now worked decades to try to bring us the model of health care reform that would enable everyone to have access to comprehensive health care without increasing the total health care spending in the U.S., and that model is a single payer system that would be similar to an improved version of Medicare that covered everyone. Many studies have now shown us that this is precisely the reform that we need to provide health care for everyone without creating any personal financial hardship.

The problem is that we still have too many politicians and members of the media that respond in a rote manner with phrases such as, “We can’t afford that” (we can), or “The people don’t want the government involved” (countered by numerous surveys), or “But that’s socialized medicine” (not a bad concept when it is applied to our traditional Medicare as well), or etc., etc.

The solution is that we can no longer accept any of these phrases that tend to reject the concept when we know that single payer is exactly what we need. Now, in such instances, we need to be emphatically but politely curt as we immediately reject the negative comment whenever it is brought up and replace it with politely stern corrections, with special attention to the true facts (“politely stern”: are we creating a new, more appropriate communication standard?).

Anyway, no more passive dismissals. We need to enact and implement a system that works well for all of us, and we need to do it now. We must bring an end to the decades of delay: Health Care Justice for All – NOW and FOREVER!

PEACE AND CHARITY BE WITH US.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Medical resident Joey Ballard is fighting the good fight

An Arm and a Leg Podcast, KFF, Dec. 30, 2024

A few weeks ago, a listener sent us a note with a link to a news article about a new resolution that had recently been adopted by the American Medical Association – the largest group representing doctors in the US.

The resolution said: hospitals need to do more to guarantee charity care to patients who qualify. Legislators and regulators should make them.

Our listener was the author of that resolution, and he told us he first learned about charity care through our work on this podcast.

His name is Joey Ballard and he’s an internal medicine resident at the University of Illinois-Chicago (UIC).

We talked with him about his early organizing as a medical student, bringing the resolution to the AMA, and the optimism he feels bringing the fight for charity care to the hospital he works at now.

Here’s a transcript of this episode.

Send your stories and questions. Or call 724 ARM-N-LEG.

https://armandalegshow.com…