PNHP

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

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…

Estimated US Deaths Associated with Health Insurance / Access to Care

The US has far higher mortality than other wealthy nations. Yet the fraction associated with health insurance issues and impaired access to care is difficult to estimate, due to elevated disease risk factors. This analysis estimates 200,000 annual deaths after adjustment for high-burden US diseases, potentially representing insurance-related mortality.

This week, a careful reader asked me to justify this estimate from November 2021: “The US excess mortality age 20-64 is about 1.4 per 1000 per year. Some of that is due to non-insurance factors. If 1.0 per 1000 is attributable to insurance, applied to the 190 million in this age range, that’s 190,000 extra deaths per year.”

In 2021, I was making a rough estimate by assigning most of the inter-country difference among adults 20-64 to health insurance. Perhaps I didn’t sufficiently emphasize the uncertainty of that estimate. Today, to “triangulate,” I took a different approach. I looked up death rates for major risk factors and diagnoses more common in the US than in other wealthy nations. This is not yet sufficiently refined for academic publication, but it’s a solid first cut, so I’m sharing it with HJM readers.

This finding of 195,032 annual deaths not explained by risk factors and diseases more common in the US is close to my prior estimate of 190,000. As noted, several of the totals may actually have medical insurance as a contributing cause – e.g., medical debt forcing people into poverty, or suicides associated with insurance worries or lack of access to mental health care. Thus, the 195,032 is likely a low estimate of insurance-related deaths.

To me, this high mortality burden is consistent with our fragmented and flawed insurance system, with half of adults experiencing financial barriers to care in any given year, often with reported health consequences. Growing rates of care denials are likely increasing the human toll, based on both reports of personal experiences and national surveys of physicians.

These kinds of estimates are imprecise, and indeed the uncertainty bounds are hard to specify. However, they are meaningful despite uncertainty. Whether the excess deaths due to insurance gaps total 195,000 per year, or 220,000, or 170,000, that’s hundreds of thousands too many deaths. The 45,000 estimated in 2009 for those lacking insurance altogether (ignoring under-insurance) is also too much, inexcusable.

We need universal public insurance providing broad benefits to everyone, to save lives and money.

https://healthjusticemonitor.org…

Sources:

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.

Health care in U.S. must be better

By Richard Bruning
The Baltimore Sun, Letters, Dec. 27, 2024

People are justifiably angry at the health insurance industry and the recent article highlighting their practices (“Luigi Mangione murder case draws scrutiny of health claim denial rates, with three of Maryland’s top insurers higher than average,” Dec. 17) validates those concerns. However, focusing on the failures of UnitedHealthcare and others distracts us from the overarching problem: our profit-driven health care system is broken.

The United States is the only developed country that does not guarantee health care to its populace. In 2022, 27.6 million were uninsured (8.4% of the population) and many more millions were underinsured. The United States spends 40% more than any other country in the world yet ranks 42 in health care outcomes.

In an op-ed piece in the New York Times, Andrew Witty ($25.2 million in salary/benefits), the CEO of UnitedHealth Group said he was “willing to partner with anyone … to find ways to deliver high-quality care and lower costs.” He should consult with Physicians for a National Health Program (PNHP) and Healthcare-NOW. For years, they have supported Improved Medicare for All. This program would guarantee every American continuous coverage from birth to death for all medically necessary services, regardless of income, employment status, pre-existing conditions or where they live. Because everyone would be in the same plan, administrative costs would plummet creating massive savings. PHNP estimates that 95% of all households would save money under this plan.

There is a solution to our healthcare morass but only if we have the courage to fight for the change we need.

https://baltimoresun.com…

Insurance CEO Murder Exposes Deep Anger at US For-Profit Healthcare

Interview with Dr. Phil Brewer

Politics, Policy, and Planet Podcast, WPKN, Dec. 19, 2024

PNHP-CT chair Dr. Phil Brewer discusses his views on the recent wave of public anger and frustration regarding our nation’s failing health insurance industry set off by the murder of UnitedHealthcare CEO Brian Thompson, as well as Physicians for a National Health Program’s ongoing campaign for the implementation of a universal, single-payer health care system in the U.S.

Dr. Brewer characterizes the American system of financing—and denying—health care as “not fair, not right, and definitely not the best health care.”

https://btlonline.org…

Readers Write: Government efficiency

MedPAC’s estimate that Medicare Advantage insurers are overpaid by 22%, while shocking, is way too low.

By Kip Sullivan
The Minnesota Star Tribune, Letters, Dec. 18, 2024

I really appreciated Jill Burcum’s column on the jaw-dropping overpayments to so-called Medicare Advantage plans (“Will Musk have the guts to take on insurers?” Strib Voices, Dec. 15). Donald Trump’s unofficial budget cutters, Elon Musk and Vivek Ramaswamy, should immediately focus on eliminating those mammoth overpayments. Burcum reported that the Medicare Payment Advisory Commission (MedPAC) estimated that Medicare Advantage insurers are overpaid by 22%, far more than they need to cover their 15% overhead and make a buck without delaying and denying health care, which they do with gusto.

Sad to say, MedPAC’s estimate, as shocking as it is, is way too low. MedPAC took into account only two factors that create overpayments — favorable selection and upcoding. MedPAC estimated favorable selection (enrolling healthier-than-average beneficiaries) raised payments by 9%, and upcoding (adding false or inappropriate diagnoses to patient medical records to make them look sicker) added another 13% (for a total of 22%). Four other factors — favorable deselection (sicker people leaving Medicare Advantage and returning to the original Medicare program), bonuses for scores on a worthless “quality measure,” pointless bonuses for selling insurance in rural counties, and an “induced utilization” subsidy that is too complicated to explain here — raise the overpayments to about 40%. Forty percent overpayment translates into about $150 billion in excess payments in 2024. To put that sum in context, consider that the Congressional Budget Office estimates that adding dental, hearing and vision coverage to traditional Medicare would cost roughly $80 billion annually.

Kip Sullivan is a member of the Health Care for All Minnesota policy committee.

https://startribune.com…