Vermont for Single Payer

11/04/2024

11/03/2024

“What are the fastest-growing occupations in the United States? No surprise, there are a lot of tech jobs: Data scientist and information security analyst, for example, both rank in the top five and pay a median salary in the low six figures.
“But neither career is as fast-growing or as high-paying as nurse practitioner, an occupation that’s rapidly reshaping American health care. The number of nurse practitioners has nearly quadrupled since 2010, and the profession’s meteoric rise will likely continue. The Bureau of Labor Statistics projects the number of nurse practitioners will grow 40 percent between 2023 and 2033.”

Increasingly, nurse practitioners are doing work that doctors have historically done, leading to tension between the groups over training, experience, and pay.

11/02/2024

“One surprising risk [for falling into medical debt]: living in a community where hospitals have consolidated — an increasingly common development as health systems merge or large systems gobble up smaller hospitals.
“That’s according to a new report shared exclusively with KFF Health News by the Urban Institute, a nonprofit that has been tracking medical debt across the United States for years and worked with KFF Health News on our Diagnosis: Debt project.
“It’s already well-documented that hospitals raise prices when they gain market power, which can happen when systems get bigger or competitors close. So researchers at Urban wondered if market concentration could also leave more patients in debt.
…
”To explore the impact of consolidation, researchers first looked at hospital concentration in every U.S. county.
“They then looked at credit bureau data to see the share of county residents with an unpaid medical bill on a credit report, which is one measure of medical debt in a community.
“Nationally, the share of people with a medical bill on a credit report has been declining. But the researchers noticed that the declines were less pronounced in counties where hospitals had become more consolidated, even after accounting for other factors.”

If you get sick in America, there’s a good chance you’ll end up in debt. Four in 10 U.S. adults have some form of health-care debt, KFF has found. One surprising risk: living in a community where hospitals have consolidated — an increasingly common development as health systems merge or large...

11/01/2024

Chain Pharmacies Compensated Exponentially More than Small Independent Pharmacies for Same Drugs
“The analysis early this year showed chains were paid well beyond the family business for many of the same medications: For example, the chains received an average of nearly $54 for the antidepressant bupropion, while Bell’s Family Pharmacy in Tate, Georgia, got $5.54, the analysis said. For a drug used to treat blood pressure, amlodipine, chain pharmacies received an average of $23.55, while Bell’s got $1.51.
“Bell’s Family Pharmacy closed earlier this year.”

Criticism of prescription drug middlemen has intensified recently in the wake of a federal agency’s actions and legislative reform attempts. Georgia Republican Gov. Brian Kemp, though, vetoed a related bill that would have helped independent pharmacies, citing the unfunded cost of the move.

10/31/2024

Welcome to the World...of Debt
“The Hurleys are one of several families who spoke to NBC News about the medical debt they faced after childbirth, even though they had private insurance. The families shared more than 180 documents that detailed a maze of bills and claims. They all found it nearly impossible to be certain of what they owed and why.
“Debt has threatened their ability to stay afloat, putting strain on their marriages, making it difficult to afford clothing and toys and encouraging them to avoid medical visits.
“’It prevents me from going to the doctor because I’m afraid of what bills I might get,’ Jessica said. ‘I go if I absolutely need to.’”

Some families with private insurance have been left behind by the major health care reforms of the last few years, putting them at risk of high medical bills after having babies.

10/31/2024

Medicare Advantage Insurers Took Billions of Medicare Dollars to which They Likely Weren't Entitled
“A federal watchdog found that Medicare Advantage insurers led by UnitedHealth Group collected billions of dollars in dubious payments from Medicare by using home visits and medical chart reviews to diagnose patients with conditions for which they received no follow-up care.
“Insurers collectively received an estimated $7.5 billion in payments last year from health risk assessments (HRAs) and related reviews of medical records performed in 2022, a report released Thursday by the Office of Inspector General for the Health and Human Services Department concluded. The diagnoses added during those assessments were not found in any of the patients’ other medical records that year, suggesting that they were either inaccurate or that patients did not get potentially necessary care for serious conditions, the report found.
“A single company — UnitedHealth Group — accounted for $3.7 billion of the questionable payments, or almost half of the total. The findings mirror an investigation by STAT that found UnitedHealth used its unrivaled network of physicians to pack patients’ charts with diagnoses to reap larger payments from Medicare.”

Insurers diagnosed patients with serious conditions, but they sometimes received no followup care, HHS OIG found.

10/31/2024

https://www.youtube.com/watch?v=rhlwJeeDWZA
Dr. David Belk on How The Health Care Industry Scams Americans

This video is about the Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda Have Exploded Healthcare Costs in the United States

10/30/2024

“Leslie Boyer, a doctor and toxicology researcher, helped found a group that was instrumental in developing Anavip, as well as the other available snake antivenom, CroFab, which dominated the market for decades. In 2015, she published an editorial in the American Journal of Medicine breaking down the “true” cost of antivenom. (Boyer declined to comment for this article.)
“Using cost data collected from factory supervisors, animal managers, hospital pharmacists and other sources, Boyer developed a model for a hypothetical antivenom, at a final cost of $14,624 per vial. She found the cost of venom, included in that total, was just 2 cents. Manufacturing accounted for $9 of the $14,624 total.
“More than 70% of the price tag — $10,250 — is attributable to hospital markups, her research showed.”

For snakebite victims, antivenom is critical — and costly. It took more than $200,000 worth of antivenom to save one toddler’s life after he was bitten by a rattlesnake.

10/30/2024

Just Imagine What That Healthcare Plan Would Be....
House Speaker Mike Johnson promises 'massive reform' of hralthcare if Trump wins
“The Republican speaker said at an event in Pennsylvania that overhauling health care would be a major focus and that “Trump’s going to go big” if he takes the presidency.”

The Republican speaker said at an event in Pennsylvania that overhauling health care would be a major focus and that “Trump’s going to go big” if he takes the presidency.

10/29/2024

What a Regional Healthcare Monopoly can Do
“Over more than a decade, Parkview Health has demanded that the people of north-eastern Indiana and north-western Ohio pay some of the highest prices of any hospital system in the country – despite being headquartered in Fort Wayne, Indiana, which currently ranks as the No 1 most affordable metro area to live in the United States. For 10 of the last 13 years, Parkview hospitals on average have been among the top 10% most expensive in the country, a Guardian US analysis of cost estimates based on data submitted to the Centers for Medicare and Medicaid shows.
“Parkview’s steep prices are the product of a more than two-decade campaign by hospital executives to establish market dominance in Fort Wayne and to squeeze revenue from a pool of patients and employers who feel they have no better alternatives, according to interviews with more than 40 current and former Parkview employees, patients, local business leaders, lawmakers and competitors, as well as leaked audio recordings of meetings and hundreds of internal billing, patient and policy documents obtained by the Guardian.
“During this period, Parkview has taken over six former rival hospitals and built up a network of almost 300 sites for its physicians and providers, forming a ring around its gleaming regional center, which some staff refer to in private as the ‘Big House’ or ‘Emerald City’ for its ritzy amenities and green corporate branding.
“This consolidation, former employees say, has allowed Parkview to control referral flows, routing primary care patients to their own costly specialists and facilities, even if those patients could get the same services elsewhere for less. It has also increased Parkview’s leverage in negotiations with health insurance companies, as they bargain over procedure prices on behalf of employers that offer the insurers’ health plans to their workers.”

In the nation’s most affordable metro area, getting hurt or sick is expensive

10/28/2024

https://www.medpac.gov/wp-content/uploads/2024/03/Mar24_Ch12_MedPAC_Report_To_Congress_SEC.pdf
Medicare Advantage has ALWAYS Cost the Medicare Fund More than Original Medicare

The Medicare Advantage program: Status report
“When risk-based payment for private plans [Medicare Advantage]was first added to Medicare in 1985, payments to private plans were set at 95 percent of FFS [original Medicare] payments because it was expected that plans would share savings from their efficiencies relative to FFS with taxpayers. But private plans in the aggregate have never been paid less than FFS Medicare because of policies that have increased payments to MA above FFS.”

10/27/2024

Healthcare Raises the Cost of Everything
“University officials said overall health care costs are driving the tuition increase. Health care expenses are expected to increase by 17% over the next year, according to budget documents.
“Those and other rising expenses are adding greater pressure to the university’s $931 million operating budget. The school is filling a $10 million budget gap in the current fiscal year with excess reserve funds, Donald McCree, a board of trustees member, said at the meeting. ”

It marks the first time the university has raised in-state tuition since 2019.

10/26/2024

Medicare Advantage (MA) "extra benefits" cost Medicare $2,500 per MA enrollee
“A report detailing flaws with the "extra benefits" Medicare Advantage (MA) plans offer generated passionate debate Thursday during a meeting of the Medicare Payment Advisory Commission (MedPAC), with many commissioners questioning the value of spending $83 billion -- $2,500 per MA enrollee -- of taxpayer money for them each year.

Services cost Medicare an extra $83B in 2024; are debit cards and groceries really healthcare?

10/25/2024

“In the first eight months of 2024, more than 2,000 pharmacies across the U.S. closed, according to research conducted by Ben Jolley, a fellow at the American Economic Liberties Project (where, disclosure, I am on staff). That number is almost evenly divided between independent pharmacies and corporate chains, with rural America hit particularly hard.”

Pharmacies large and small make money in two ways. Both are under threat.

10/24/2024

“insurance companies…often outsource medical reviews to a largely hidden industry that makes money by turning down doctors’ requests for payments, known as prior authorizations. Call it the denials for dollars business.
“The biggest player is a company called EviCore by Evernorth, which is hired by major American insurance companies and provides coverage to 100 million consumers — about 1 in 3 insured people. It is owned by the insurance giant Cigna.
“A ProPublica and Capitol Forum investigation found that EviCore uses an algorithm backed by artificial intelligence, which some insiders call “the dial,” that it can adjust to lead to higher denials. Some contracts ensure the company makes more money the more it cuts health spending. And it issues medical guidelines that doctors have said delay and deny care for patients.
…
“EviCore says it scrutinizes requests to make sure that procedures recommended by doctors are safe, necessary and cost-effective. “We are improving the quality of health care, the safety of health care and, by very happy coincidence, we’re also decreasing a significant amount of unnecessary cost,” an EviCore medical officer explains in a video produced by the company.
“But EviCore’s cost-cutting is far from coincidental, according to the investigation.
“EviCore markets itself to insurance companies by promising a 3-to-1 return on investment — that is, for every $1 spent on EviCore, the insurer would pay out $3 less on medical care and other costs. EviCore salespeople have boasted of a 15% increase in denials, according to the investigation, which is based on internal documents, corporate data and dozens of interviews with former employees, doctors, industry experts, health care regulators and insurance executives. Almost everybody interviewed spoke on condition of anonymity because they continue to work in the industry.”

When companies like Aetna or UnitedHealthcare want to rein in costs, they turn to EviCore, whose business model depends on turning down payments for care recommended by doctors for their patients.