Health Care Costs In America

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Hundreds of Hospitals Sue Patients or Threaten Their Credit, a KHN Investigation Finds. Does Yours?​

By Noam N. LeveyDECEMBER 21, 2022

Despite growing evidence of the harm caused by medical debt, hundreds of U.S. hospitals maintain policies to aggressively pursue patients for unpaid bills, using tactics such as lawsuits, selling patient accounts to debt buyers, and reporting patients to credit rating agencies, a KHN investigation shows.

The collection practices are commonplace among all types of hospitals in all regions of the country, including public university systems, leading academic institutions, small community hospitals, for-profit chains, and nonprofit Catholic systems.

Individual hospital systems have come under scrutiny in recent years for suing patients. But the KHN analysis shows the practice is widespread, suggesting most of the nation’s approximately 5,100 hospitals serving the general public have policies to use legal action or other aggressive tactics against patients.

Full article here:

Hundreds of Hospitals Sue Patients or Threaten Their Credit, a KHN Investigation Finds. Does Yours?

An examination of billing policies and practices at more than 500 hospitals across the country shows widespread reliance on aggressive collection tactics.
khn.org
 
From the link:

Two-year-old Zion Gastelum died just days after dentists performed root canals and put crowns on six baby teeth at a clinic affiliated with a private equity firm.

His parents sued the Kool Smiles dental clinic in Yuma, Arizona, and its private equity investor, FFL Partners. They argued the procedures were done needlessly, in keeping with a corporate strategy to maximize profits by overtreating kids from lower-income families enrolled in Medicaid. Zion died after being diagnosed with “brain damage caused by a lack of oxygen,” according to the lawsuit.

Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties - KFF Health News

Private equity firms have shelled out almost $1 trillion to acquire nearly 8,000 health care businesses, in deals almost always hidden from federal regulators. The result: higher prices, lawsuits, and complaints about care.
khn.org
 

Why For Profit Healthcare Is Giant, Bloodsucking Tick On The Working Class…​

Thom Hartmann Pr
Jan 10, 2023

9:07

Republicans have taken control of the House of Representatives, and already have their sights set on forcing major cuts to “entitlements” like Social Security, Medicare, and Medicaid.

We are literally the only developed country in the world with an entire multi-billion-dollar for-profit industry devoted to parasitically extracting money from us to then turn over to healthcare providers on our behalf. The for-profit health insurance industry has attached itself to us like a giant, bloodsucking tick.
 

John F Kennedy JFK argues for universal healthcare​

JFK makes an argument for universal health care at Madison square garden, NY. 2:06
 
A 2 yr old doesn't need any of the above 'operations' especially on baby teeth!
 
In Pennsylvania, private insurance companies don’t have to pay for a patient’s virtual check up with their own physician, or cover any health care services provided without an in-person visit.

The state is one of just seven that doesn’t require insurers to cover telehealth, according to the National Consortium of Telehealth Resource Centers, a collection of national and regional resource groups focused on expanding access to telehealth.

 

How Medicare And Medicaid Fraud Became A $100B Problem In The U.S.​

Mar 9, 2023

9:14

In an exclusive investigation, CNBC takes you inside how fraudsters are stealing Medicare and Medicaid funds through a wide variety of criminal operations. Special agents from the Office of Inspector General (OIG) show us how brazen these schemes have gotten from burying stolen Medicare funds in PVC pipes under a home to setting up a fraudulent business in the same building as the OIG. A convicted fraudster who served time for health care-related crimes says it’s “very easy” to make millions and stay under law enforcement’s radar because the fraud is so rampant. In a Miami shopping mall that’s been the targeted of OIG investigations, CNBC finds a medical supply company that’s billed Medicare more than $2 million in a small glass-enclosed office with someone sitting at desk, which investigators say is typical about fraudulent operations are set up. Annual Medicare and Medicaid fraud is estimated at more than $100 billion.
 
FOR PROFIT

medical
water department
electricity generators
sewer

this wasn't supposed to happen, they once said so


now i read this and it appears we've lost our way by beginning to believe universal health care / welfare / etc, that all these are the solutions

i argue, they're not

those programs are just shifting the costs over to where we can't see them spending our money, but they're still gonna take it and ultimately it's gonna cost us even more



they lied, we died
 
May 9 (Reuters) - Some of the world’s biggest drugmakers are laying legal groundwork to fight the U.S. plan to negotiate drug prices for its Medicare health coverage, including the argument that a ban against speaking about these talks violates constitutional rights, according to six industry sources.

Drugmakers set strategy for legal fight against US pricing regulation

Some of the world’s biggest drugmakers are laying legal groundwork to fight the U.S. plan to negotiate drug prices for its Medicare health coverage, including the argument that a ban against speaking about these talks violates constitutional rights, according to six industry sources.
www.reuters.com
 
Long but good.

Medical practitioners and providers paid $26.8 billion over the past decade to settle federal allegations including fraud, bribery and patient harm, a Reuters investigation found. Paying up means staying in business and, for some, avoiding prison. U.S. prosecutors helped them do it.

How doctors buy their way out of trouble​


When federal enforcers alleged in 2015 that New York surgeon Feng Qin had performed scores of medically unnecessary cardiac procedures on elderly patients, they decided not to pursue a time-consuming criminal case.

Instead, prosecutors chose an easier, swifter legal strategy: a civil suit. Qin agreed to pay $150,000 in a negotiated settlement and walked free to perform more cardiac surgeries at his new solo practice in lower Manhattan.

Qin faced no judge or jury. He did not admit to wrongdoing. He maintained his license to practice. What’s more, neither Qin nor government officials were required to notify patients who purportedly were subjected to vascular surgical procedures they didn’t need. Those included fistulagrams to spot issues like narrowed blood vessels or clots, and angioplasties to open clogged coronary arteries.

How doctors buy their way out of trouble

Hundreds of physicians accused of wrongdoing have paid hefty civil settlements to the U.S. government to keep working and, in some cases, avoid jail time.
www.reuters.com
 
NEW YORK, June 6 (Reuters) - Merck & Co (MRK.N) sued the U.S. government on Tuesday, seeking to halt the Medicare drug price negotiation program contained in the Inflation Reduction Act (IRA), which it argues violates the Fifth and First Amendments to the U.S. Constitution.

This is the first attempt by a drugmaker to challenge the law, which the pharmaceutical industry says will result in a loss of profits that will force them to pull back on developing groundbreaking new treatments.

Merck sues US government to halt Medicare drug price negotiation

Merck & Co sued the U.S. government on Tuesday, seeking to halt the Medicare drug price negotiation program contained in the Inflation Reduction Act (IRA), which it argues violates the Fifth and First Amendments to the U.S. Constitution.
www.reuters.com
 
June 9 (Reuters) - The Biden administration on Friday announced it would impose inflation penalties on 43 drugs for the third quarter of 2023, having fined 27 earlier this year, in a move it said would lower costs for older Americans by as much as $449 per dose.

Drugmakers hiked the price of these 43 drugs by more than the rate of inflation and are required to pay the difference of those medicines to Medicare, the federal health program for Americans over age 65.

U.S. government sets penalties on 43 drugs over price hikes

The Biden administration on Friday announced it would impose inflation penalties on 43 drugs for the third quarter of 2023, having fined 27 earlier this year, in a move it said would lower costs for older Americans by as much as $449 per dose.
www.reuters.com
 

Hospitals' latest "innovation": "patient-centric payment capabilities"​


As America’s health insurers keep increasing the amount of money their customers must pay out of pocket before their coverage kicks in, more and more patients are unable to pay their hospital bills. As Chris Deacons writes below, hospital administrators are taking a range of actions to collect as much from those patients as possible, often before admitting them.

More:

https://wendellpotter.substack.com/p/hospitals-latest-innovation-patient?
 

Cigna Sued Over Algorithm Allegedly Used To Deny Coverage To Hundreds Of Thousands Of Patients​

Cigna, the healthcare and insurance giant, was hit with a lawsuit on Monday that alleges the company systematically rejects claims in a matter of seconds, thanks to an algorithmic system put in place to help automate the process—further raising questions about how technology could harm patients as more healthcare organizations look to embrace AI and other new tools.

The suit, which was filed in California and is seeking class action status, was brought forth by a pair of plaintiffs who were denied coverage by Cigna. One plaintiff, Suzanne Kisting-Leung, was referred for an ultrasound because of a suspected risk of ovarian cancer. Another, Ayesha Smiley, had been tested for a vitamin D deficiency at the order of her doctor.

The health insurer’s digital claims system, called PXDX, is an “improper scheme designed to systematically, wrongfully, and automatically deny its insureds medical payments owed to them under Cigna’s insurance policies,” the complaint alleges.

More:

Cigna Sued Over Algorithm Allegedly Used To Deny Coverage To Hundreds Of Thousands Of Patients

The software system allows claim rejections without doctors ever opening patient medical records, according to the lawsuit.
www.forbes.com
 
An opinion piece posted as food for thought.

Government Health Financing for All, Not Insurance

To achieve universal health coverage, all people need access to public healthcare. This should be an entitlement for all, regardless of means, requiring adequate long term sustainable financing.
jomodevplus.substack.com
 
From the link:

America’s pharmaceutical giants are suing this summer to block the federal government’s first effort at drug price regulation.

Last year’s Inflation Reduction Act included what on its face seems a modest proposal: The federal government would for the first time be empowered to negotiate prices Medicare pays for drugs — but only for 10 very expensive medicines beginning in 2026 (an additional 15 in 2027 and 2028, with more added in later years). Another provision would require manufacturers to pay rebates to Medicare for drug prices that increased faster than inflation.

Those provisions alone could reduce the federal deficit by $237 billion over 10 years, the Congressional Budget Office has calculated. That enormous savings would come from tamping down drug prices, which are costing an average of 3.44 times — sometimes 10 times — what the same brand-name drugs cost in other developed countries, where governments already negotiate prices.

A Peek at Big Pharma’s Playbook That Leaves Many Americans Unable to Afford Their Drugs

Brand-name drug prices in the U.S. — more than three times the price in other developed countries — are related neither to the amount of research and development required to bring them to market no…
kffhealthnews.org
 
From the link:

AUG 23, 2023

A Swiss pharmaceutical company announced this month that it could slow-walk bringing a potentially life-saving drug to market — in order to reduce the time that it could be subject to President Joe Biden’s recently enacted federal price regulations.

Those comments were made by the CEO of Genentech, whose parent company, Roche, has reaped as much as $10 billion from Trump’s 2017 tax cuts, seeing its net income go up by an average of more than 50 percent, while its spending on research and development has increased by just 25 percent.

Pharmaceutical giants like Roche are earning huge sums of money on record-breaking price increases, reporting historic profits — and yet they’re launching an all-out legal, media, and lobbying assault against the modest drug pricing restrictions implemented by Biden’s 2022 Inflation Reduction Act.

More here:

Pharma Giant Threatens To Delay Drugs Over New Price Controls

A pharmaceutical company could slow-walk research on medicines Americans need in response to Biden’s recently enacted federal price regulations.
www.levernews.com
 

How a Big Pharma Company Stalled a Potentially Lifesaving Vaccine in Pursuit of Bigger Profits​


Ever since he was a medical student, Dr. Neil Martinson has confronted the horrors of tuberculosis, the world’s oldest and deadliest pandemic. For more than 30 years, patients have streamed into the South African clinics where he has worked — migrant workers, malnourished children and pregnant women with HIV — coughing up blood. Some were so emaciated, he could see their ribs. They’d breathed in the contagious bacteria from a cough on a crowded bus or in the homes of loved ones who didn’t know they had TB. Once infected, their best option was to spend months swallowing pills that often carried terrible side effects. Many died.

So, when Martinson joined a call in April 2018, he was anxious for the verdict about a tuberculosis vaccine he’d helped test on hundreds of people.

The results blew him away: The shot prevented over half of those infected from getting sick; it was the biggest TB vaccine breakthrough in a century. He hung up, excited, and waited for the next step, a trial that would determine whether the shot was safe and effective enough to sell.

Weeks passed. Then months.

More than five years after the call, he’s still waiting, because the company that owns the vaccine decided to prioritize far more lucrative business.

More:

How a Big Pharma Company Stalled a Potentially Lifesaving Vaccine in Pursuit of Bigger Profits

A vaccine against tuberculosis, the world’s deadliest infectious disease, has never been closer to reality, with the potential to save millions of lives. But its development slowed after its corporate owner focused on more profitable vaccines.
www.propublica.org
 
Nov 7 (Reuters) - Sage Therapeutics (SAGE.O) has priced the oral postpartum depression (PPD) pill it developed with partner Biogen (BIIB.O) at $15,900 for a full 14-day course of treatment, the company said on Tuesday, months after the drug was approved by the U.S. health regulator.

The companies had sought U.S. approval for Zurzuvae to treat clinical depression, a much larger market, and postpartum depression, but the Food and Drug Administration in August approved it only for PPD.

Biogen-Sage Therapeutics postpartum depression pill priced at $15,900

Sage Therapeutics has priced the oral postpartum depression (PPD) pill it developed with partner Biogen at $15,900 for a full 14-day course of treatment, the company said on Tuesday, months after the drug was approved by the U.S. health regulator.
www.reuters.com
 

Facing Financial Ruin as Costs Soar for Elder Care​

Margaret Newcomb, 69, a retired French teacher, is desperately trying to protect her retirement savings by caring for her 82-year-old husband, who has severe dementia, at home in Seattle. She used to fear his disease-induced paranoia, but now he’s so frail and confused that he wanders away with no idea of how to find his way home. He gets lost so often that she attaches a tag to his shoelace with her phone number.

Feylyn Lewis, 35, sacrificed a promising career as a research director in England to return home to Nashville after her mother had a debilitating stroke. They ran up $15,000 in medical and credit card debt while she took on the role of caretaker.

Sheila Littleton, 30, brought her grandfather with dementia to her family home in Houston, then spent months fruitlessly trying to place him in a nursing home with Medicaid coverage. She eventually abandoned him at a psychiatric hospital to force the system to act.

More:

Facing Financial Ruin as Costs Soar for Elder Care - KFF Health News

The United States has no coherent system of long-term care, leading many to struggle to stay independent or rely on a patchwork of solutions.
kffhealthnews.org
 
Nov 17 (Reuters) - Booming demand for newer weight-loss and diabetes drugs is expected to accelerate the rise in medical expenses for employers in the United States next year, staff health benefits consultant Mercer said on Friday.

GLP-1 medications approved by the U.S. Food and Drug Administration could contribute between 50 and 100 basis points to the trend, Mercer's Chief Health Actuary, Sunit Patel, told Reuters in an interview.

Boom in weight-loss drugs to drive up US employers' medical costs in 2024 - Mercer

Booming demand for newer weight-loss and diabetes drugs is expected to accelerate the rise in medical expenses for employers in the United States next year, staff health benefits consultant Mercer said on Friday.
www.reuters.com
 

Extra Fees Drive Assisted Living Profits​

Assisted living centers have become an appealing retirement option for hundreds of thousands of boomers who can no longer live independently, promising a cheerful alternative to the institutional feel of a nursing home.

But their cost is so crushingly high that most Americans can’t afford them.

These highly profitable facilities often charge $5,000 a month or more and then layer on fees at every step. Residents’ bills and price lists from a dozen facilities offer a glimpse of the charges: $12 for a blood pressure check; $50 per injection (more for insulin); $93 a month to order medications from a pharmacy not used by the facility; $315 a month for daily help with an inhaler.

Read the rest:

Extra Fees Drive Assisted Living Profits - KFF Health News

The add-ons pile up: $93 for medications, $50 for cable TV. Prices soar as the industry leaves no service unbilled, out of reach for many families.
kffhealthnews.org
 

‘Literally Impossible:’ Labcorp Workers Say Productivity Goals Are Pushing Them to the Brink​


Somewhere in the bowels of a Labcorp drug testing facility in Madison, Wisconsin, which one worker described to me as “the bunker,” is a severed human finger encased in wax. The finger, which workers presume was once attached to a former Labcorp worker at that location, was kept in the office of a “post-life” department supervisor who showed it to many new employees as part of their safety orientation.

Two workers in this part of the lab said that the finger was trotted out as a kind of warning. Workers in the “post life” department process dead animals Labcorp tests drugs on by slicing them into thin sections, a technique known as microtomy. The workers said that, to meet productivity goals, they had to perform precise work at a fast pace, slicing off sections of dead dogs, rats, and monkeys preserved in pungent formalin, embedding them in wax, and then slicing them into micrometer-thin sheets that are mounted to slides that can be examined under a microscope. Workers who exceeded their goals were considered for promotions, while workers who didn’t meet them were chided by managers.

‘Literally Impossible:’ Labcorp Workers Say Productivity Goals Are Pushing Them to the Brink

Ten Labcorp workers told 404 Media that Amazon-like productivity goals at the clinical lab giant are squeezing them for profits in a way that could put patients at risk.
www.404media.co
 

“Dying Broke” Reporters on Long-Term Care: “It’s Only Going to Get Worse” | Amanpour and Company​

Dec 1, 2023

End-of-life care in the United States is an emotional topic. Many are pushed into financial ruin by the imperatives of long-term care. Reporters Reed Abelson (New York Times) and Jordan Rau (KFF Health News) talked to dozens of families and experts about the reality of caring for the aged and dying in a country with no coherent elder care system. Hari Sreenivasan spoke to Abelson and Rau about their New York Times series, “Dying Broke."

18:26
 

Doctors With Histories of Big Malpractice Settlements Work for Insurers, Deciding If They’ll Pay for Care​

Dec. 15, 6 a.m. EST

When Shawn Murphy’s wife died in 2009 after a botched gallbladder surgery, he presumed the doctor who performed the operation would be forced out of medicine for good.

Dr. Pachavit Kasemsap, a former Air Force surgeon, had cut Loretta Murphy’s aorta during that common procedure, according to a database of malpractice payments kept by Florida insurance regulators. She never left the hospital and died just shy of her 40th birthday. Shawn Murphy was left to raise their two daughters, then 13 and 17, on his own.

During the weeks that Murphy prayed for his wife to recover and the months that he fought Kasemsap in circuit court in Brevard County, Florida, he didn’t know that other families had complained that their loved ones had suffered under the same doctor’s care.

More here:

Doctors With Histories of Big Malpractice Settlements Now Work for Insurers

Doctors working for health insurers can rule on 10,000 or more requests for care a year. At least a dozen were hired by major insurance companies after being disciplined by state medical boards or making multiple or outsized malpractice payments.
www.propublica.org
 
Look into Pharmacy Benefit Management companies for the scam on prescriptions. It's such a scam that they formed a something and are now running radio ads to reform the industry.

They basically decide what they want and months later chargeback the pharmacies whatever they want. It's a giant kickback scheme. And often people end up with cheaper meds by paying cash, even though they've also paid for an "insurance" policy.
 

If We Can Cover Catastrophic Bank Failures, We Can Cover Catastrophic Health Costs​

Another month, another bank rescue. Seven weeks after the government rescued the depositors of Silicon Valley Bank, it swept in to keep First Republic Bank from freefall early on the morning of May 1, brokering a sale to JPMorgan Chase while absorbing most of its losses. It’s what we expect the government to do: step in to reassure the public that the nation’s political and economic might are there to prevent outsized risk from turning into wider catastrophe. When the magnitude and systemic character of the risk are more than private institutions can reasonably bear, the government takes over—even, in the case of Silicon Valley Bank, protecting depositors who held more than the Federal Deposit Insurance Corporation insurance limit.

Yet when the cost of medical catastrophes is more than ordinary Americans’ insurance coverage can sustain, the United States fails to reinsure their health plans. The runaway costs of outlier health events famously drive up insurance premiums and lead insurers to deny benefits covering the most desperately needed and expensive treatments. Rather than absorbing and spreading these costs, this country leaves families and employers exposed to denials, even bankruptcy, and allows these individual catastrophes to destabilize systemwide access to private health coverage.

I have worked on or written about U.S. health policy for a quarter of a century now, and whenever I point out that Americans should enjoy the right to state-guaranteed absorption of ruinous medical costs, I can count on some version of the following response: “Indeed we should, but it is just not politically realistic to expect the government to guarantee a claim to economic resources, when the U.S. has only ever viewed rights as freedom from the heavy hand of the state.” But the events surrounding the recent bank runs, and the long American tradition of government reinsurance in which they are embedded, reveal otherwise.

More:

 

The CEO of a company that makes a lifesaving drug refused to commit to lowering its price in the US​

Feb 8, 2024

Eliquis, a medicine that helps prevent strokes, costs $7,100/year in the U.S. vs. $900/year in Canada.
Today, the CEO of the company that makes this lifesaving drug refused to commit to lowering its price in the U.S.
UNACCEPTABLE. To me and the American people.

1:32
 
From the link:

Below we are featuring a compact and highly readable study by the Private Equity Stakeholder Project, How Private Equity Gets Its Cut from Medicare Advantage, by Mary Bugbee (mary.bugbee@pestakeholder.org). We have had to omit the cover page so the document would be small enough to upload.

This paper is useful since it describes some of the Medicare Advantage abuses, explaining how various rentiers game the program, including outright fraud. After explaining the common types of extractive behavior, and making clear they are serious. Improper payments, according to the CBO, approximately 10% of total payments to Medicare Advantage Organizations, as in insurers that have contracted with Medicare to offer Medicare Advantage plans. And as the study explains, this isn’t the only place fraud occurs. Broker schemes to get paid well over their supposedly regulated commissions and mis-selling of plans are also common abuses.

The post points out that private equity is not at the heart of this ecosystem; giant health insurers dominate. But private equity has a solid and growing toe-hold in providing some Medicare Advantage services to insures, and also operating in niche insurance markets, mainly by running HMOs in geographically distinct markets.

A Look at Private Equity’s Medicare Advantage Grifting​

 
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