JustCare

Category: What’s Buzzing

  • Want to live longer? Genes and lifestyle matter

    Want to live longer? Genes and lifestyle matter

    Dana G. Smith reports for The New York Times on the extent to which you control how long you live. How much does a healthy lifestyle help and how much do your genes determine your fate?

    For sure, we know about smokers and drinkers, people who eat junk food, as well as people who never exercise, who have lived long and relatively healthy lives. But, the data suggest that these people are the exceptions. If you want to live a long healthy life, you’d better change your lifestyle.

    According to the evidence, your behaviors will likely dictate whether you live until you’re 90. Indeed, one recent study found that you can add 24 years to your life if you: 1. eat healthy, 2. exercise, 3. get adequate sleep, 4. don’t smoke, 5. don’t drink excessively, 6. don’t take opioids, 7. manage stress and 8. engage socially. These healthy behaviors should help you to live to around 87.

    There’s little you can do to help ensure you will live to 100. But, 87 is pretty good relative to most Americans. In the US today, the average life expectancy is 78.5.

    At the end of the day, whether you live a long life depends to the greatest extent on your lifestyle, your daily habits. Genes are responsible only for about 25 percent of your longevity. Living to 100 is far more about your genes than your lifestyle.

    There are plenty of people who live very long lives without particularly healthy habits. They smoke and don’t exercise. Because of their genes, they still are not as likely to have chronic conditions, such as heart disease or cancer or dementia.

    For example, you are better off carrying the APOE2 gene if you are going to avoid an Alzheimer’s diagnosis. If you have the APOE4 gene, you are more likely to be diagnosed with Alzheimer’s. For another example, having the FOXO3 gene can keep you from getting a variety of diseases that generally come with old age.

    Unfortunately, fewer than one in 100 people have these genes. Not surprisingly, fewer than one in 100 people live to 100.

    Here’s more from Just Care:

  • Oncologists report excessive deaths from prior authorization

    Oncologists report excessive deaths from prior authorization

    A new survey from the American Society of Radiation Oncology illustrates the dangers of prior authorization. Prior authorization kills an “inordinate number” of people and harms others. Insurers often deny care to the detriment of patients when physicians first ask for authorization; when denials are appealed, insurers then approve care the vast majority of the time.

    About 225 of the 750 radiation oncologists polled reported adverse health outcomes from prior authorization.  Their patients ended up in the emergency room or hospitalized or with a permanent disability. One in fourteen of the oncologists polled said that one or more of their patients had died as a result of prior authorization.

    Prior authorization can have benefits, particularly in cases in which physicians are not well trained. Prior authorization can ensure physicians are treating patients appropriately, based on evidence. Prior authorization can also keep costs down.

    But, insurers use prior authorization without regard to its effects on quality of life for patients. And, while prior authorization can help protect against unnecessary treatment, there is no one protecting patients from insurers that use prior authorization inappropriately, in ways that harm patients.

    The oncologists polled suggested insurers’ use of prior authorization is only increasing. Moreover, it increases staff burnout.

    • More than nine in ten oncologists (92 percent) reported treatment delays from prior authorization and nearly seven in ten (68 percent) reported delays of at least 5 days;
    • More than eight in ten oncologists (82 percent) blamed prior authorization for patients receiving less than the best care;
    • Nearly six in ten (58 percent) oncologists said prior authorization kept them from following recommended guidelines;

    Those polled made clear that it’s critical to appeal prior authorization denials because more than 70 percent are reversed on appeal. But, patients and physicians sometimes do not have the resources to appeal. In some instances, the tradeoffs of appealing care denials, in terms of time spent, means physicians are unable to do their jobs.

    Moreover, insurers still have 72 hours to review an expedited appeal. For some patients with health insurance, the harm from such a delay is significant.  One doctor said that in that time, “I’ve had patients who’ve literally had a tumor growing out of their chest. Waiting 3 days for an appeal means there’s more cancer to treat, even just in the time between when I made the plan for them initially, and when I actually get to start their treatment. Sometimes it means the plan has to change because the tumor has gotten that much bigger in that time period. Every day matters.”

    Insurers shouldn’t be allowed to continue doing prior authorization for treatments that are virtually always approved on appeal.

    Here’s more from Just Care:

  • How to make America healthy again

    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:

  • The cap on Social Security contributions must go

    The cap on Social Security contributions must go

    During the first week of January, billionaires in the US received an early Valentine. They stopped paying into Social Security for the rest of 2025 because they had hit the cap on payroll contributions, even though the vast majority of working Americans pay in to Social Security throughout the year. To bring fairness to Social Security payroll contributions, Congress should end the cap on Social Security contributions.

    Michael Hiltzik writes in an opinion piece for the LA Times that Tim Cook met his Social Security tax obligations at 2p on January 1, and Elon Musk met his obligations even earlier that day. But, 94 percent of Americans will contribute to Social Security throughout the year.

    Unlike most Americans, the wealthiest Americans also are able to shelter a lot of their income from Social Security contributions. They do not pay Social Security taxes on any income they earn above $176,100 this year. (Last year it was $168,600.) That means that people who earn $10 million this year, pay Social Security taxes on just .11 percent of their income. This inequity is only increasing.

    Our tax system works best for the wealthiest American. The Social Security tax is exclusively on wages, tips, bonuses and commissions. Unearned income, such as interest income, dividends and capital gains, are not subject to the tax.

    Social Security is the most successful government program in history, lifting millions of older and disabled Americans out of poverty, supported by Democrats and Republicans alike. But, less wealthy Americans shoulder most of its costs. They contribute 6.2 percent of their income to Social Security.

    The Social Security tax is regressive, though poor retirees receive a greater share of lifetime earnings from the program.

    For years, Democrats in Congress have proposed raising or ending the payroll tax cap. Interest income and capital gains also should be considered earnings that are subject to Social Security taxes. If these earnings were taxed, it would extend the life of the Social Security Trust Fund by 35 years. It would also allow for higher benefits.

    Today, Social Security contributions represent 12.4 percent of gross wage income. Employers and their employees each pay half, up to the cap. Each pay as much as $10, 918 this year. If you are self-employed, you pay the full amount.

    In addition, employees and employers contribute 2.9 percent or 1.45 percent each in Medicare contributions, up to the cap. And, wealthy taxpayers must also pay 3.8 percent tax on some investment income into the Medicare Part A Trust Fund.

    Here’s more from Just Care:

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

    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.

  • Prices for top Medicare drugs are up a lot

    Prices for top Medicare drugs are up a lot

    The prices for brand-name drugs have been rising much faster than the rate of inflation for tens of years, reports Leigh Purvis for AARP. Older and disabled Americans with Medicare feel these price increases, especially when they take as many as four or five prescription medicines every month and generally must pay a percentage of the cost of their drugs out of pocket.

    In the first two days of this year, NPR reports that drugmakers hiked up the price of 575 drugs by around three to four percent. That price hike is lower than in past years when drug price increases could easily be 10 percent, but higher than the rate of inflation. Because of the Inflation Reduction Act (IRA), drugmakers will face government penalties for these hikes, but they likely expect to offset the cost of those penalties with greater profits from people in the commercial market.

    About 20 percent of people with Medicare say that they manage the cost of their drugs by not filling prescriptions or not taking full doses. The AARP Public Policy Institute analyzed what’s happening with the 25 brand-name drugs that Medicare Part D spends the most on and that are not subject to Medicare drug price negotiation. Medicare spent about $50 billion on these drugs in 2022. Seven million people used these drugs.

    The Public Policy Institute found that the list prices for these 25 drugs nearly doubled since they first came to market, well above the rate of inflation. More than 40 percent of the brand-name drugs’ list prices today stem from price increases since they came onto the market.

    Purvis concludes that the IRA goes a long way to stop these huge price increases. Not only does it allow Medicare drug price negotiation, but it forces pharmaceutical companies to pay stiff penalties if they raise the price of their drugs above the rate of inflation. The IRA helps to ensure that people with Medicare can afford to fill their prescriptions and to promote good health outcomes.

    As of this year, because of the IRA, you should pay no more than $2,000 out-of-pocket for drugs covered through your Medicare Part D drug plan.

    Here’s more from Just Care:

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

    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:

  • UnitedHealth physicans help boost insurers’ Medicare payments

    UnitedHealth physicans help boost insurers’ Medicare payments

    UnitedHealth now employs or contracts with about 10 percent of the physicians in the US. It’s one way UnitedHealth maximizes Medicare Advantage profits, report Anna Wilde Mathews, Christopher Weaver and Tom McGinty for the Wall Street Journal. UnitedHealth incentivizes its physicians to include additional diagnoses codes on Medicare Advantage patient records, which enables UnitedHealth to receive higher Medicare payments.

    UnitedHealth advises its physicians to check their Medicare Advantage patients for certain diagnoses. So, in Eugene, Oregon, one physician explained that before he could move from one patient to another, he must enter into a software system whether his patient had any of a list of diagnoses. In many cases, the diagnoses had nothing to do with the patient, such as hyperaldosteronism, which is a hormone condition related to high blood pressure.

    Rather than ensuring their doctors focus on treating Medicare Advantage patients for the conditions these patients are reporting, UnitedHealth is focused on having its doctors document as many conditions as possible that will increase the company’s Medicare payments.

    UnitedHealth does nothing to ensure its doctors document additional conditions for their patients in traditional Medicare. That’s not surprising.  Because of the way Medicare pays insurers in Medicare Advantage, adding diagnoses codes to traditional Medicare patient records would hurt UnitedHealth financially.

    The Wall Street Journal found that patients leaving traditional Medicare for Medicare Advantage in the three years ending 2022 had many more diagnoses in their medical records once they were in Medicare Advantage. Their “sickness scores” typically increased 55 percent. To put it succinctly, once in Medicare Advantage, from a sickness perspective, patients effectively had HIV and breast cancer.

    While UnitedHealth does more than other insurers to raise sickness scores for its Medicare Advantage patients, other insurers raised scores by 30 percent for new patients in Medicare Advantage. There is no evidence whatsoever that entering more diagnoses into Medicare Advantage enrollees’ medical records benefits patients in any way. In fact, UnitedHealth doctors do not use the company’s diagnoses software for patients outside of Medicare Advantage.

    By the Wall Street Journal’s calculations, United’s Medicare Advantage enrollees who saw UnitedHealth physicians had such high sickness scores that UnitedHealth benefited financially to the tune of $4.6 billion over three years.

    This insurer gaming of the Medicare payment system must end. Among other things, it is gouging taxpayers, depleting the Medicare Trust Fund, and driving up Medicare Part B premiums.

    Here’s more from Just Care:

  • Medicare prices for all?

    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:

  • 2025: Could Americans be getting healthier?

    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: