Health and financial security – Page 3

How to make America healthy again

Adam Gaffney writes for In These Times about how to make America healthy again: A universal single-payer system. President-elect Donald Trump and the Republican-led Congress is set to defund many health care programs and policies, including making large cuts to Medicaid and possibly eliminating income-based subsidies for people receiving coverage through the Affordable Care Act.

To “Make America Healthy Again” (MAHA), Robert F. Kennedy, Jr., president-elect Trump’s pick to head the US Department of Health and Human Services (HHS), is planning a number of initiatives that will only make us sicker, writes Gaffney. He agrees with Trump and Kennedy that the US health care system is flawed in a variety of ways, leading to lower life expectancy than every other wealthy country, an opioid epidemic, as well as millions of uninsured Americans and unaffordable health care for tens of millions more Americans.

One in four working Americans cannot afford their health care. Twenty-five million Americans are uninsured. In total, nearly half of working-age Americans are either uninsured or underinsured. But, the upcoming Trump administration is hell-bent on a path forward that is most likely to boost profits for UnitedHealth and other big health corporations, drive up health care costs, and increase the number of Americans who cannot afford their health care, while contaminating the air we breathe and the water we drink.

Americans who oppose this path should support “a bold, populist progressive healthcare vision.” RFK Jr. continues to promote an anti-vaccine agenda that is likely to be seriously harmful to people around the world; he also denies AIDS. He appears to support a healthy eating agenda, but that is less likely to have legs in the next administration.

RFK, Jr. claims that seed oils are “poisoning” Americans. But, there’s no data to support his claim. On the other hand, air pollution is responsible for 48,000 needless deaths each year in the US. And, if Trump sticks to his first-term agenda, he will allow weaker automobile emission standards and power plant pollution standards. The Environmental Protection Agency projects that weakening standards could add as many as 1,200 needless deaths and 1,900 asthma cases each year.

Childhood poverty is another serious issue in the US, leading to childhood obesity and disease. Policy reforms are critical, but they are not on the Trump administration agenda. Instead of improving the nutritional value of school lunches, the first Trump administration permitted fewer fruits and vegetables and an increase in poor quality food.

RFK Jr. wants to end direct-to-consumer advertising of prescription drugs, which is a good idea. But, it is unlikely the Supreme Court would allow this, supporting what the Supreme Court will claim are the first amendment rights of pharmaceutical companies over the value of consumer protections. RFK Jr. also correctly called out the malfeasance of the FDA for approving drugs that have little or no benefit to mollify industry. But, again, Trump is unlikely to address this issue, and RFK’s views on certain drugs are unfounded in science and dangerous to the public health.

As bad as RFK Jr., Jim O’Neill, a biotech investor whom president-elect Trump has proposed as deputy secretary of HHS, does not believe the FDA should weigh drug efficacy when deciding whether to approve drugs. And, Mehmet Oz, whom Trump has proposed to head the Centers for Medicare and Medicaid Services (CMS), has a history of promoting supplements and other products that have no value whatsoever. Oz’s own Columbia University colleagues have condemned his views, expressing “dismay” that he is on the faculty there.

Advances in health care treatments are only beneficial for those who can afford them. The Trump administration is ready to make these treatments even less affordable than they already are, among other things, planning to cut the Medicaid budget dramatically. Such a move will mean tens of thousands more preventable deaths. During his first presidency, President Trump attempted to repeal the Affordable Care Act. Had it succeeded, it would only have increased the number of preventable deaths.

As Sen. Bernie Sanders has proposed, what we need to “Make America Healthy Again” is a very different agenda from Trump’s–one that promotes guaranteed affordable access to care, clean air and clean water.

Here’s more from Just Care:

January 15, 2025

Will UnitedHealth stop denying care inappropriately or simply deny doing so?

Shareholders at UnitedHealth are proposing that the company study and report publicly on the financial and public health consequences of its policies that lead to delays and denials of health care. These shareholders want people to vote on their request at UnitedHealth’s annual meeting, reports Rylee Wilson for Becker’s Payer.

Specifically, the shareholders want UnitedHealth to report on the frequency of delays of care and foregone care, as well as harm to patients, resulting from UnitedHealth’s prior authorization requirements. Put differently, they want the company to disclose how its prior authorization requirements affect access to treatment.

UnitedHealth claims it will respond to these shareholders once it schedules its annual meeting in June. The shareholders, represented by the Interfaith Center on Corporate Responsibility, represent more than 300 institutional investors. (UnitedHealth has more than 5,000 institutional investors.)

The shareholders argue that these inappropriate delays and denials might boost short-term profits, but they risk hurting the UnitedHealth brand.

Wendell Potter, head of the Center for Health and Democracy, explains that the inappropriate care denials harm more than patients. UnitedHealth defends its behavior saying that it pays 90 percent of claims, which might be true. The problem is that the 10 percent of claims it denies are often for coverage of expensive life-saving or otherwise critical care.

Meanwhile, UnitedHealth is poised to announce big year-end profits. Some say UnitedHealth will have more than an eight percent year-over-year earnings growth. Fourth-quarter earnings are projected to be about $6.72 a share. If so, it would be a 9.1 percent increase from last year’s fourth quarter.

Here’s more from Just Care:

January 15, 2025

Portugal’s health care system focuses on primary care and public health

Portugal spends much less than the US on health care for its citizens, but it focuses on primary care. So, when it comes to health, the Portuguese live longer and fare better than Americans, reports Usha Lee McFarling for Stat News.

The Portuguese health care system is not modern. You won’t see fancy hospitals with marble atria. But, the data show that the Portuguese on average live four years longer than people in the US. And, the country spends 80 percent less on health care per person than we do. Yep. It spends 20 percent of what we spend on health care per person with far superior health outcomes.

The 2021 Global Security Index looks at a country’s ability to respond to a pandemic and provide its citizens access to affordable care. Portugal was at the very top of the list of 195 countries, ranking third. The United States was at the very bottom, ranking 183rd.

Portugal’s national health care system gives every resident free or low-cost health care. Access to health care is not based on ability to pay. Everyone is guaranteed access, though there is a shortage of primary care doctors, as in the US, and people need to wait to get needed care.

A million Portuguese do not have a designated primary care physician, but they are cared for. Portugal has primary care neighborhood clinics and regional public health systems. It can track sickness as well as where people are not getting health care. New medical treatments are not always available, but the focus on prevention and primary care is keeping the people healthy at low cost.

The Portuguese health care system uses data to monitor the population individually and collectively. The government also engages in “social prescribing,” using home visits to learn about patients’ social issues that can undermine their health and finding community resources to assist them.

In 2022, the US spent $4.5 trillion on health care or $13,500 a person. But, the US ranks 60th relative to other countries on life expectancy. Our average, life expectancy in the US is 78.5 years, on a par with Turkey and Ecuador, not other similarly wealthy nations. In Switzerland and Japan, life expectancy averages 84 years. Portugal spends about $2,700 a person on health care, and life expectancy averages 82.3 years.

The US might innovate on the health front, but its health care system is dysfunctional. Portugal, Costa Rica and Thailand get better results through their investments in primary care and community health.

Here’s more from Just Care:

January 13, 2025

Medicare prices for all?

It’s as yet unclear what the Trump administration and the Republican Congress will do to Medicare. The Heritage Foundation’s Project 2025, if adopted, would appear to let traditional Medicare wither on the vine and force new Medicare enrollees into Medicare Advantage. But, that’s a politically fraught agenda that would also drive up Medicare spending significantly, as Medicare Advantage costs a lot more than traditional Medicare.

If Republicans are looking for ways to fund their massive tax cuts, they could address the massive overpayments in Medicare Advantage, which are projected to cost more than $1.4 trillion over the next decade. Republican Senators Cassidy, Blackburn and Braun all see the need for this reform. Taking some of the savings to put an out-of-pocket cap in traditional Medicare would help level the playing field between Medicare Advantage and traditional Medicare and promote competition–but strengthening traditional Medicare is likely a bridge too far for Republicans.

If Republicans want to lower health care costs and raise wages for Americans, without hurting industry, they might consider Phil Longman’s proposal this week in the Washington Monthly–Medicare prices for all. The idea is simply to have employer-sponsored health plans pay providers Medicare prices–not the current average of 254 percent of Medicare. And, then, Longman would require corporations to share the savings with their workers in the form of higher salaries.

Of course, hospitals and specialists would push back. But, the data suggests that they would suffer little as a result, according to Longman. Most hospitals are non-profit and could manage on Medicare rates.

Medicare prices for all would neither raise taxes nor require people to give up their private insurance. It would simply eliminate predatory health care prices to the benefit of Americans. Is there a Republican in Congress who would support it?

Here’s more from Just Care:

January 8, 2025

2025: Could Americans be getting healthier?

For as long as I can recall, Americans have ranked well below dozens of other countries on life expectancy. We are also more likely to die as a result of gun killings, drug overdoses and automobile accidents than people in other wealthy nations. And, we have a 50 percent greater rate of obesity than Europeans. In a piece for The Atlantic, Derek Thompson refers to the US as a “rich death trap.”

Still, Thompson notes that we have seen some good news in the health department. Last year, three percent fewer people died of a drug overdose. Automobile accidents fell, even though people drove more. The US obesity rate fell one point six percent. And, murder rates across the nation fell.

This is a first in a while. Perhaps the best data we have seen in decades. Though it’s not clear that these rates continue to decline, because the data lags by a bit, it’s also not clear why these rates are down.

With regard to overdose death declines, declines are large and focused on the East. Were these declines the product of good policy? The explanation could simply be that more people who would have died somewhat later, died during the Covid pandemic. Or, it could be that street fentanyl is not as strong as it has been.

Ozempic and Mounjaro could be in part responsible for the decline in the rate of obesity. One in 16 Americans reportedly are now taking one of these appetite-suppressing drugs. Or, perhaps, we have reached the limit of Americans who could be obese.

Violent crime has also dropped for reasons that are not fully understood. Some think that public outrage at the police for their conduct reduced police activity, causing more violent crime. But, as police activity increased, violence fell. Another theory is that as the Covid pandemic was ending, violent crime fell when the school year began.

How could public policy have contributed to these declining rates? It’s possible that the American Rescue Plan, which delivered hundreds of billions of dollars to states and cities, enabled local governments to boost law enforcement activities, which kept violent crime and dangerous driving at bay.

Where do we go from here? If you ask Elon Musk, counselor to the incoming president, “Nothing would do more to improve the health, lifespan and quality of life for Americans than making GLP inhibitors super low cost to the public.” RFK Jr. argues that lifestyle is what drives better health, not technology. It’s all about our behaviors–getting people to eat healthily and exercise.

Many Republican policymakers in Congress do not support Medicare coverage of weight-loss drugs. And, the Republicans in Congress are poised to cut Medicaid significantly. It’s hard to believe that we will continue to see health improvements over the next four years.

Here’s more from Just Care:

January 7, 2025

Millions of adults still carry significant student debt

The Biden Administration tried to eliminate some student debt. But, a federal appeals court stopped the Saving on a Valuable Education Plan (SAVE) from moving forward, while it considers its legality. Instead the eight million people who had enrolled in SAVE still face considerable debt. Oyin Adedoyin reports for the Wall Street Journal on the likely future for these people during a second Trump administration.

Millions of Americans are burdened by student loans, including nearly three million older adults. Older adults also owe more than $54 billion in medical debt. But, relief is nowhere in sight for them or for tens of millions of other Americans with student debt or medical debt.

People with student debt are at a loss as to what to do. Many are part of a public-service loan forgiveness initiative. They expected the balances on their loans to be eradicated once they had made 120 monthly payments. And, they had planned for that future.

People who are part of the SAVE program are in limbo at the moment. They need not pay anything on their loans, and they will not be penalized for doing nothing. But, until the lawsuit ends, they are stuck.

Around a million public-service workers in SAVE thought their monthly loan repayments would come down around $1,000 a year, on average, and, for some, go away entirely. Instead, at least for now, the Biden Administration is only able to help 55,000 public service workers through the Public Service Loan Forgiveness Program.

Many Republican policymakers in the states challenged the SAVE program on the grounds that it is expensive and illegal. Trump has called the program a “catastrophe.”

People in SAVE who have worked in public service for at least 120 months, but who have not made 120 loan repayments yet, could be able to “buy back” the right to loan forgiveness. They might have to pay in more. Or, they could sign up for a different repayment plan based on income.

Here’s more from Just Care:

January 6, 2025

Some of UnitedHealth’s many abuses in a nutshell

In a New York Times fluff piece, the head of the UnitedHealth Group, Andrew Witty, attempts to make the case that his company does not deserve to be maligned. (Here’s my letter to the New York Times in response. The American Economic Liberties Project has been tracking the publicly recorded illegal and wrngful conduct of UnitedHealth Group, including patient abuses, provider abuses and retail pharmacy abuses. UniteHealth Group (UHG) is the conglomerate that owns UnitedHealth insurance as well as more than 2,300 other companies. It is the biggest health care corporation in the country.

The types of companies that UHG owns include pharmacies, health insurers, pharmacy benefit managers, primary care and mental health providers, surgery clinics, home health and hospice agencies. Optum, one of UHG’s subsidiaries, employs 90,000 physicians, more than any other company. It is also one of the three biggest PBMs, which design formularies for insurance companies, choosing the drugs and patient copays.

UHG’s ownership of all these lines of business allows it to game the health care system in all sorts of ways to maximize profits and squeeze smaller companies out of business.

What types of abuses has UHG subsidiaries been found to engage in?

Overcharging: The Medicare Payment Advisory Commission (MedPAC), the Committee for a Responsible Federal Budget (CRFB), and many other organizations have reported that each year UHG and other large insurers charge the government more than they should for the services they deliver. This year alone, overcharges amounted to somewhere between $83 billion and $140 billion. UHG has a history of upcoding–submitting medical codes to federal programs for more serious and more expensive diagnoses or procedures than what was necessary, diagnosed, or performed. As a result, UHG overbills the federal government, wasting billions in taxpayer dollars.
Denials of care: The data show that UHG denies one out of every three requests for coverage, keeping patients from getting the care they and their treating physicians believe they need. They overrule their own network physicians in order to spend less on care and maximize profits.
Anticompetitive behaviors: Because UHG owns so many health-related companies, it can and does steer patients and physicians to the products and services their companies deliver.
Patient privacy violations: UHG uses patient data without patient consent, violating patient privacy.

Over the last seven year, UHG has been charged with engaging in these activities:

Eight reports and three lawsuits for overcharging the federal government.
10 reports and five lawsuits for denying patient care because of the cost rather than medical necessity.
Eight reports and seven lawsuits for steering patients and providers to companies that UHG owns.
Three reports of corrupt practices.
Two reports and one lawsuit for violating patient privacy.

For more information on UHG abuses, visit violationtracker.org.

Here’s more from Just Care:

December 18, 2024

What will happen to ACA subsidies in 2025?

The Trump administration, in partnership with the next Congress, will determine whether or not subsidies will continue for people getting health insurance through the state health insurance exchanges under the Affordable Care Act. Axios reports on the state of play.

Republicans in Congress, who will be the majority in both the House and the Senate, will spark a lot of rage among millions of people in the state health insurance exchanges, if they do not extend the subsidies. They will force millions of people to lose their insurance because, without the subsidies, they won’t be able to afford it. Without subsidies, the Republicans will force others to pay far higher health insurance premiums. Of note, the premium subsidies are most helpful to residents of Republican states that have not expanded Medicaid. So, Republicans in Congress could pay a big price if they eliminate the subsidies.

But, as of now, the Republicans are not biting. They would not agree to a Democratic proposal to extend the ACA subsidies for one year.

The Senate Finance Committee’s new Chairman, Mike Crapo (R-Idaho), is considering whether to include the subsidies in the budget reconciliation process that will happen in early 2025. He has not taken the subsidies off the table.

However, Republicans in the House are saying that they do not support the subsidies. Jodey Arrington, who chairs the House Budget Committee, does not see an extension of the subsidies in the future. His response, when asked about extending the subsidies, was “hell no.” But, who knows?

What would be the consequences of not extending the subsidies? Without the ACA subsidies in 2026, 2.2 million Americans are projected to lose their health insurance. In 2027, 3.8 million would lose their health insurance. People in the state health insurance exchanges would see their premiums rise 4.3 percent in 2026 and 7.7 percent in 2027.

As of yet it is unclear what the Republicans in Congress would do for the millions of uninsured Americans, particularly if they end the ACA subsidies.

Here’s more from Just Care:

December 17, 2024

Americans are not getting their money’s worth from our health care system

Elon Musk, the billionaire whom Trump has nominated to head the Department of Government Efficiency (DOGE) in his administration, asked on X why Americans are not getting their money’s worth from our health care system. Congresswoman Pramila Jayapal and Senator Bernie Sanders have an answer: If we want a cost-effective system, we need single-payer, one government-administered health care system for everyone. It’s that simple.

For years, Sanders and Jayapal have been outspoken in their critique of the US for-profit health care system. They welcomed Musk’s criticism of the current system that leads to out-of-control health care costs. And, they have asked him to support Medicare for all. Each year, they have introduced legislation to enact Medicare for all, but the needed support for the legislation is not yet there.

Most Americans agree with Musk that they are not getting their money’s worth. Insurer administrative costs alone for each American is now well over $1,000 a year. That’s more than three times higher than administrative costs in Canada, Japan, South Korea, and every European country. In Japan, administrative costs per person are $82. In the United Kingdom and Sweden, they are $97. In Germany, they are $306, higher than every other country except the US. Average administrative costs are $194 per person.

On top of exorbitant insurance premiums, insured Americans spend an average of $1,132 a year on out-of-pocket health care costs. Deductibles, coinsurance and copays are high.

In 2020, in the final year of the last Trump Administration, a Congressional Budget Office report found that a government-administered health insurance system would save the US about $650 billion each year.

Here’s more from Just Care:

December 10, 2024

Poll: Few Americans are happy with health care quality

Who could possibly be happy with the quality of care in the United States? Almost no one. A recent Gallup poll should raise alarm bells.

The cost of health insurance is insane. Insurer restrictions on the physicians and hospitals they will cover is limited and, with deceptive provider directories, misleading. Insurer requirements for preapproval of costly procedures is burdensome. Delays in prior authorization are often harmful to people’s health. And, copays can be exorbitant.

Findings from a December 6, 2024 Gallup poll underscore the degree of American dissatisfaction with our health care system. Notwithstanding the Affordable Care Act and high levels of insurance coverage, people in the US believe that the quality of care is the worst it has been since 2001, when Gallup first began asking the question.

1. 89 percent of Americans did not consider US health care to be “excellent.”

2. One third of Americans (33 percent) consider health care quality “good;” in 2020, 43 percent said it was good.

3. Nearly four in ten Americans (38 percent) said quality is “only fair.”

4. Sixteen percent of Americans consider health care quality to be “poor.”

5. Only about half of Democrats have a positive view of health care quality. Eight percent fewer Republicans had a positive view.

6. Americans think less of health care coverage in the US than health care quality. Not even one in three Americans (28 percent) rated health care coverage as “excellent” or “good.” People polled consider health care coverage worse by four points than in 2001.

7. As for health care costs, not even two in ten Americans (19 percent) were satisfied. People polled consider health care costs worse by three points than in 2001. Nearly one in four Americans (23 percent) said costs were the top health care problem. Health care access was the second biggest (14 percent) health care problem.

Here’s more from Just Care:

December 9, 2024

Category: Health and financial security