JustCare

Tag: Health care

  • Poll: Costs remain a major barrier to care

    Poll: Costs remain a major barrier to care

    When you’re looking at people’s opinions about health care, it’s important to keep in mind that 85 percent of adults in the US say that their health is good or better than good. These people tend to be satisfied with their health insurance because they use it relatively little. Still, a lot of Americans remain concerned about high health care and prescription drug costs and medical bills, according to recent Peterson-KFF polling.

    Forty-five percent of adults in the US are worried about their ability to pay medical bills. Twenty-eight percent of adults said that they delayed or went without care because of the cost. Eleven percent struggled to pay medical bills. And, 11 percent said that they did not have a usual source of care.  

    Adults who were uninsured, in poorer health, Black adults, and Hispanic adults, were much more likely to forego or postpone care because of the cost than others. Thirty-six percent of Hispanic adults, 32 percent of Black adults and 25 percent of white adults said they delayed or went without care because of the cost, underscoring health care inequities.

    Of course, the uninsured generally face higher out-of-pocket costs than people with health insurance. And, people with lower incomes struggle more than people with higher incomes to cover insurance deductibles and copays. 

    Twenty one percent of adults said they went without dental care because of the cost. Sixteen percent said they went without mental health care, drugs or medical care because of the cost. 

    Likely because Medicare tends to provide better financial protection from health care costs than employer coverage and coverage on the state health insurance exchanges, fewer older adults delayed or went without care than adults under 65. One in five adults over 65 said they delayed or went without care because of the cost. Three in ten adults under 65 said they delayed or went without care because of the cost.  

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  • How much profit should shareholders reap from health care?

    How much profit should shareholders reap from health care?

    A group of Yale researchers looked at where all the profits from the health care industrial complex flow. They found that the vast majority of money earned by pharmaceutical corporations, for-profit hospitals, health insurers and other publicly traded companies went to corporate shareholders, reports Sujata Srinavasan for Connecticut Public Radio.

    In the 21 years between 2001 and 2022, the researchers found that $2.6 trillion went to shareholders. Their study is published in JAMA Internal Medicine. The number is shocking for at least three reasons. First, the $2.6 trillion represents 95 percent of the profits. Second, only five percent of the money went to medical research and development, improved hospitals or pharmaceutical research. Third, the returns to shareholders more than tripled over that period.

    Given how much Americans pay for health care and the burden of medical debt on millions of us, it’s time for the government to rein in the prices we are being charged or, at the very least, limit corporate profits with the goal of lowering costs. Today, about 12 percent of adults in the US owe more than $10,000 in medical debt. Should there be a limit on corporate profits to reduce health care costs?

    With increasing vertical integration in health care, e.g. UnitedHealth owning providers, a pharmacy benefit manager, claims processing centers, insurance companies and more, unless there is a limit on corporate profits, it’s more than likely that health care costs will continue to mount. Health care corporations are not putting patients first.

    Corporate shareholder returns are not the only funds being stripped out of our health care system and driving up costs. The researchers did not look at the $1 trillion that private equity firms invested in health care over the last decade. These companies have destabilized a large number of hospitals, taking out profits and leaving them in major debt. They have also profited wildly from investments in home care agencies at the expense of older adults.

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  • Who’s your health care buddy?

    Who’s your health care buddy?

    There are many benefits of being “all in it together,” but many of us still prefer the “every man for himself” way of life. Whatever your preference, there’s no question that having a buddy can do wonders for your health.

    The evidence suggests that having someone to talk, walk, shop and/or dine with offers mental, physical, emotional, social and psychological support. Take note: People who live in relative isolation have as high a risk of dying early as people who smoke.

    Even spending time with the postman or the grocer–casual buddies–is good for your health. The more people you spend time with the more likely you will fare better. Why? It’s not clear. But, it could be that people who engage with others are more inclined to care for themselves.

    When it comes to health care, having a buddy–be that person a spouse, a sibling, a child or a parent–is really important. The greater your health care needs, the more important it is for you to have a buddy. Buddies can be a second set of eyes and ears for you at the doctor’s office and can also help coordinate your care.

    Especially if you have one or more chronic conditions, ask your buddy to go to the doctor’s office with you. It’s always dizzying and stressful to be alone with a doctor. It’s hard to listen, ask questions and take notes about all the things you need to do. That’s what a buddy can help with.

    It’s even more important to bring a buddy with you to the hospital. Hospitals are often understaffed and unable to focus on your needs all the time. A buddy can help ensure your needs are met. A buddy also can help prevent or reduce the chance of medical mistakes and delirium when you’re moving from one care facility to another.

    Your buddy can ensure you get any new prescriptions filled and that you understand how to care for yourself after you leave. Ideally, your buddy can help you with any questions or concerns you have and, if necessary, speak to your doctor on your behalf.

    When it comes to your health and quality of life, buddies matter. Do your best not to go it alone. If you don’t have a buddy, consider making it your mission to find one. Perhaps you can be a buddy for a friend or neighbor and have that friend or neighbor be your buddy.

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  • Will Trump give his supporters the lower health care costs they want?

    Will Trump give his supporters the lower health care costs they want?

    As we know, Trump supporters, like most Americans want to see lower prices on basic necessities, like gas and eggs. They also want to see lower health care costs, reports Noam Levey for NPR.

    What could Trump do? He could lower the out-of-pocket maximum on health care costs for working people. But, that would also likely drive up people’s premiums. And, the Republicans opposed the new $2,000 a year maximum on outpatient prescription drug costs for people with Medicare.

    But, the polls indicate that, unlike 10 or 15 years ago, a lot of Trump supporters now want more government involvement to rein in health care costs. People recognize that the “free market” for health care is not their friend. People no longer think that government should stay away.

    In fact, Republicans want the government to step in and limit drug prices and hospital charges. They also want the government to regulate and restrict health care providers from going after medical debt according to recent polls. More than eight in ten support a $2,300 annual cap on medical debt collection.

    Republicans still don’t support Medicare for all. In fact, that would do most to lower their health care costs and ensure they received the health care they needed. One size fits all means that it works for everyone. Other options will not work for people in some or more instances, and there’s no telling when you buy insurance whether that restriced insurance coverage will work for you over time.

    Republicans also overall support Medicaid. Medicaid is especially critical for lower and middle income older adults who need long-term nursing home care. Yet, the House Budget resolution puts in place a plan that will likely slash Medicaid spending and with it push many people off Medicaid.

    Today, Republicans more often hold corporate health insurers, pharmaceutical companies and hospitals responsible for high costs than the government. They see the greed and profiteering in our corporate health care system.

    One poll shows that 75 percent of people who voted for Trump want the government to limit hospital charges. They also want the Trump administration to do more Medicare drug price negotiation, not less.

    Right now, Republicans in Congress are not focused on any of their supporters’ cost-cutting health care priorities. They are poised to slash Medicaid and end subsidies for plans in the state health insurance exchanges, both of which will drive up health care costs for millions.

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  • 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.

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

    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.

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  • Poll: Few Americans are happy with health care quality

    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.

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  • Americans are extremely angry about US health care

    Americans are extremely angry about US health care

    The murder of UnitedHealthcare CEO, Brian Thompson, has revealed extraordinary anger among Americans over our health care system. Will Congress finally act to guarantee people access to needed care and prevent insurers from inappropriate delays and denials of care? Likely not.

    Tens of thousands of people on social media reacted unsympathetically to the killing. ““When you shoot one man in the street it’s murder,” one person posted on the social media site X. “When you kill thousands of people in hospitals by taking away their ability to get treatment you’re an entrepreneur.”

    Wendell Potter, a former Cigna exec and whistleblower, explains on CNN how the CEO’s murder happened just ahead of a shareholder and investor meeting of UnitedHealthcare. UnitedHealthcare satisfies its investors through restricting access to care. That’s how UnitedHealthcare maximizes profits.

    Potter explained that “There’s a lot of just pent-up outrage at this company and other companies that are middlemen that are standing between a patient and his or her doctor or hospital.” For their part, Minnesota physicians report excessively high denial rates by UnitedHealthcare.

    As a result of insurance company practices, people are not getting the medically necessary care they need. The casings on the bullet of the gunman who killed Thompson echo the practices of the insurers: “delay” and “deny.”

    According to the Minnesota Star Tribune, United Healthcare also has been accused of relying on a claims process, supported by artificial intelligence, that had a 90% error rate in determining whether a requested treatment was medically necessary.”

    The Star Tribune further reports on UnitedHealthcare’s insanely high denial rates. In 2021, “UnitedHealth’s qualified health plans in Arizona denied almost 39% of in-network claims.” UnitedHealthcare is the largest health insurer in the US. Another 16 smaller insurers had denial rates that were above 30%.

    Only a few days ago, Anthem decided not to go forward with a proposal to limit anesthesia coverage for certain surgeries and other procedures. It appeared to act in response to massive outrage at the policy. Had Anthem moved forward with the proposal, it would have driven up health care costs for Americans and maximized profits for the insurer.

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  • Trump reelected: What happens to health care?

    Trump reelected: What happens to health care?

    With Donald Trump on his way back to the White House, we can be sure that our health care system will change dramatically over the next four years. Sarah Owermohle reports for StatNews on ways in which Trump could restructure US health care.

    As Trump said in his victory speech, Robert F. Kennedy Jr. is likely to be in charge of “mak[ing] America health again.” It’s not at all clear what that means. Americans appeared less focused on health care this election and more focused on the economy. However, health care costs are part of the economy and have always been a large concern for Americans.

    This go round, Trump claims he won’t try to end the Affordable Care Act. He says he simply wants to reduce costs. That could mean lower costs for healthy people and higher costs for people who need care. It could also mean health insurance options that are not comprehensive, for example, insurance that does not cover prescription drugs.

    Tax credits that help people with low incomes afford insurance premiums could not be extended at the close of 2025, when they expire. Republicans in Congress don’t support them.

    Trump says he will not support a law that bans abortion in American. He intends to prevent funding for gender-affirming care and prohibit it for minors entirely. He will protect employers’ right to refuse to cover birth control based on their religion.

    What will Trump do with Medicare? During his last presidency he ultimately decided not to support lower drug prices. Will he try to undo Medicare drug price negotiation for high-cost drugs?

    Both Medicare and Medicaid are on the table. He might try to do away with traditional Medicare. Although Medicare Advantage has cost the Medicare program significantly more than traditional Medicare, Republicans in Congress still look to the corporate insurers offering Medicare Advantage plans to contain costs. Trump left open the possibility that he would cut spending on Medicare and Medicaid. In his first presidency, he gave states permission to put work requirements on some people with Medicaid.

    Trump says he wants a commission to look at the growth of chronic illnesses in America. Who knows what that will lead to. To date, he has not embraced RFK Jr.’s notion that vaccines are responsible for chronic diseases. RFK Jr. will not lead the Department of Health and Human Services, according to a Trump spokesperson, but he still could have significant authority over recommended vaccines.

    On a brighter note, Trump has said he will ensure access and insurance coverage of in vitro fertilization.

    Trump says he supports tax credits to help with the costs of  America’s 53 million plus caregivers. He has yet to offer details as to what that would look like. Health savings accounts, which tend to be of little help to people when they need costly care, is one way he might go.

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  • Doctors and hospitals face increasing claims denials

    Doctors and hospitals face increasing claims denials

    The big health insurers are destroying our health care system, while profiting wildly. They cannot rein in costs, so Americans with insurance often cannot afford their care. Moreover, the insurers don’t appropriately reimburse physicians and hospitals for the services they deliver. Jeff Lagasse reports for Healthcare Finance on a new report revealing the increasing rate of claims denials health care providers are facing.

    In his review of The State of Claims 2024 report by Experian, Lagasse points out that providers do not have the technology to contest insurers’ claim denials efficiently. The report also focuses heavily on provider concerns about insurer preauthorization rules and policy changes that prevent them from getting paid appropriately.

    Our government allows corporate health insurers to hold all the cards. They decide what health care services to pay for and when, second-guessing treating physicians on what services are medically necessary. And, they are rarely accountable for failing to cover services they are supposed to cover or for delaying payment. Rather, they are accountable to Wall Street to increase profits, which creates a powerful incentive for them to deny and delay care and provider reimbursements.

    Policy changes, claims denials and payment delays are three ways insurers are increasingly profiting at the expense of providers:

    • 77 of providers say that insurer policy changes are occurring more frequently.
    • 73 percent say that insurers are denying claims more frequently.
    • 67 percent say that insurers are delaying payment more often.

    Nearly four in ten providers (38 percent) say that insurers are denying claims ten percent of the time or more. More than a third of the time, insurers refuse to authorize care. The rest of the time, insurers claim that data is missing from provider claims.

    The rate of Medicare Advantage denials is increasing with each passing year. The Kaiser Family Foundation recently reported that in 2022, Medicare Advantage insurers denied 7.4 percent of prior authorization requests, up from 5.8 percent in 2021 and 5.6 percent in 2020. It’s no wonder that this year alone more than 24 health systems have cancelled their Medicare Advantage contracts.

    Lagasse cites a 2017 report revealing that health care organizations several years ago lost $262 billion on claim denials out of $3 trillion in claims submitted, in a single year. After appealing, at a cost of $8.3 billion, the providers recouped 63 percent of that money. Insanity.

    Maybe AI can deliver greater efficiencies for health care providers and increase their revenues, as some suggest. But, you have to imagine that the insurers will always be at least one step ahead.

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