Health care – Page 2

Nearly half of Americans can’t afford their health care

Time passes and health care costs rise, as do the number of Americans who can’t afford their health care, according to a new Gallup and West Health poll, reports Aimee Picchi for CBS News. Not surprisingly, people of color are struggling most to pay for their care, as are people in their 50’s and early 60’s, who are not yet eligible for Medicare. But, eight percent fewer people over 65 are able to afford their care now than just two years ago.

Only about 55 percent of Americans between the ages of 50 and 64 are “cost secure.” They can afford care and prescription drugs. But, that percentage is dwindling quickly. Two years ago, 61 percent reported being “cost secure.

Even with Medicare, just 71 percent of people are cost secure, down from 79 percent in 2022. Younger adults are the least cost secure. Fewer than half of them (47 percent) can afford their health care, down five percent from two years ago.

The new poll found that 45 percent of respondents reported skipping care or not filling their prescriptions because of the cost or an inability to get them. Eight percent of those people said that if they needed care now, they would not be able to get it at an affordable cost. Gallup termed these people “cost desperate.”

Around one in three U.S. adults, more than 72 million people, said that they had not got care they needed in the past three months because of the cost. Of those 72 million, more than eight million are 65 or older.

Black and Hispanic Americans are increasingly cost desperate. About one in seven Hispanic adults and one in nine Black adults are cost desperate. Seven percent of White adults are cost desperate.

What’s causing this increase in the number of Americans who can’t afford their care? Inflation has driven up health care costs. And, doctors and hospitals can charge pretty much what they please, with little accountability. Moreover, insurers keep increasing their deductibles, the amount people must pay out of pocket before their insurance coverage kicks in.

In 2022, the typical insurance deductible for a family was $3,800. That deductible reflects more than a 50 percent increase ($1,300) from 2013.

Overwhelmingly, Americans believe that health care costs too much and they are not getting bang for their buck. But, they are not advocating for Medicare for all or even a government-regulated system that sets prices for health care services, which would bring their costs down.

People are eating less to pay for their prescription drugs. We don’t know how many are dying prematurely because they can’t afford their heart and other medicines, but it’s a good bet thousands are each year.

Today, the average annual cost of health care in the US per person is $12,555. In Germany, Italy and France, the average annual cost is around $6,651, almost half of what we spend.

Insurers are keeping people from getting the health care they need. They deny and delay care inappropriately. They refuse to pay for medically necessary services.

Here’s more from Just Care:

July 23, 2024

Congress focuses on health care mergers and Medicare payments

As hospital systems and insurers continue to buy up medical practices and grow ever larger, the consequences for patients and the health care system writ large are serious. In Congress, the House Budget Committee is looking at how these mergers affect cost, access to care, and health outcomes. Republicans and Democrats agree that consolidation in the health care space must stop before health care costs escalate even more, reports Rebecca Pifer for HealthCareDive.

To bring down Medicare spending, Republicans and Democrats appear to support ensuring that Medicare payments are the same for the same services, whether they are performed at a physician’s office or a hospital-owned outpatient facility. This fix would seem like low-hanging fruit for Congress, but Congress has failed to address this small issue for a very long time.

Health care prices keep going up overall. Republican Congressman Ron Estes, captured the sense of the members: “We just can’t afford to have this continued increase in prices.” Substantial evidence indicates that consolidation in the healthcare marketplace is driving up costs.

Equally substantial evidence shows that consolidation is not improving quality of care. In 2022, Rand studied the data and found hospital consolidations lead to price increases of as much as 65% percent.

To be clear, consolidation in the health care market is not happening because physicians are asking for it. In fact, most physicians don’t want it. Physicians usually have no choice but to sell their practices to private equity firms and insurers if they want to continue to treat patients.

The hospitals and health systems buying physician practices want more power to secure higher prices from insurance companies and Medicare. For their part, physicians need help handling all the bureaucratic obstacles insurers impose on them. Not surprisingly, between 2005 and 2022, 15 percent more community hospitals had joined a health system, up from 53 percent to 68 percent. In the 10 years between 2012 and 2022, 12 percent more physicians moved from independent practices to working at a hospital, from 29 percent to 41 percent.

Here’s more from Just Care:

June 11, 2024

How other wealthy countries deliver superior health care coverage to the US

Aaron Carroll, President and CEO AcademyHealth, writes about our broken health care system on the Commonwealth Fund blog and explains how other wealthy countries do better for their citizens and offer them near total protection from health care costs. He suggests that if we look to other countries, we can find ways to fix our health care system without moving to single-payer or keeping things as they are. Hmmmm….

Carroll points out that insurance is designed to pool resources so that we share the cost of unforeseen health needs. With insurance, we should be able to afford our care and not face financial ruin. In the US, even with the Affordable Care Act, we have 26 million uninsured Americans. Every other wealthy and many middle and low-income countries have universal coverage.

In Switzerland, Carroll says that there is no program like Medicare or Medicaid but rather private insurance only throughout the course of each citizens’ life. They have insurance independently of their employment. Insurers are prohibited from profiting from this “basic” insurance. People have high out-of-pocket costs. It’s not clear from Carroll’s description whether the government mandates these costs. Insurers can profit from supplemental insurance.

Singapore offers its citizens catastrophic coverage to protect them against financial ruin. People largely pay for doctors’ visits and other outpatient care themselves. They are required to contribute some of their earnings to health savings accounts, which they can then use to cover their outpatient care. For inpatient services such as hospital care, Singapore offers different insurance coverage levels. The basic level is relatively inexpensive to ensure essential health care needs are met. For a higher cost, you get better coverage, such as faster access to care.

Canada covers everyone directly through the government; it’s a single-payer system called Medicare. Taxes cover most costs. The government sets the rules of coverage. Medically necessary inpatient and outpatients services, as well as dental services are covered, but not prescription drugs or vision care.

Australia, like Canada, covers everyone directly for citizens who use the public delivery system. It’s a single-payer system that is also called Medicare. It covers most inpatient and outpatient care as well as preventive care and community services. However, people can forego public care in favor of private care, better care access, and improved benefits such as vision care, at additional cost; about one in three Australians do. Taxes, based on income, along with copays, cover the costs of the single-payer system.

New Zealand offers government coverage, much like Australia, though it focuses more on community-based care and public health initiatives. It covers inpatient and outpatient care and prescription drugs. Taxes cover most costs, along with copayments. People can opt for a private system that delivers speedier access to non-urgent care as well as improved benefits; about one in three New Zealanders do.

France offers government coverage of inpatient and outpatient services as well as long-term care and prescription drugs. It’s system is called Social Security. Payroll taxes and other taxes cover the cost. Regional health agencies are charged with arranging coverage and care delivery. Patients pay coinsurance, copayments, and physician charges above what the government covers. Virtually everyone buys private supplemental insurance, mostly from nonprofit companies, which pick up a lot of the out-of-pocket costs. Supplemental insurance also covers dental, hearing, and vision care.

England‘s National Health Service (NHS) offers health care to all residents. It covers inpatient and outpatient services with no out-of-pocket costs. Taxes cover most costs and there is a global health care spending budget. No one is at risk of bankruptcy.

Here’s more from Just Care:

May 13, 2024

States address prior authorization denials, while Congress fears to tread

People across the country are facing increasing numbers of treatment denials from insurers, even after their insurers have approved these treatments for extended periods. Shalina Chatlani reports for Medical Express on how some states are addressing these prior authorization denials that are undermining patients’ continuity of care and causing them serious hardship. Meanwhile, Congress has been unwilling to act in meaningful ways.

One patient suffering from chronic pain had been getting monthly infusions for pain relief. Then, Medicaid refused to cover these infusions. After many months, the corporate insurer administering Medicaid benefits decided to overrule the patient’s treating physician and deem the treatment medically unnecessary.

Prior authorization denials keep health care spending down. They also enrich the insurers that contract to deliver Medicare and Medicaid services as well as coverage for working people. They are generally paid a fix rate upfront. What they don’t spend, they are largely able to keep for themselves, so they have an incentive to deny care or delay care. It helps to maximize their profits.

Insurers leave patients without needed treatments, often to the detriment of their health and sometimes their lives. States have been stepping in to reduce the number of prior authorization delays and denials. Nine states have laws in place now to protect patients.

New Jersey addresses insurer delays of care by requiring insurers to make determinations as to whether care is covered within 72 hours of a request. In Texas, doctors whose requests to provide care are approved 90 percent of the time receive a “gold card” that eliminates their need to seek prior authorization. But, to date, only three percent of doctors in Texas have gold cards.

Washington has a law that ensures insurers make swift prior authorization determinations. Michigan ensures that insurers use only prior authorization processes that are peer-reviewed and approved. Arizona is considering a law that would require insurers to honor their own, or another insurer’s prior authorization determination if someone switched insurers, within 90 days of the determination. But, it would not apply to Medicaid patients.

What’s insane is that our federal government effectively trusts insurers to implement prior authorization rules that are evidence-based and appropriate, with little oversight to ensure that is the case, even though mountains of evidence indicate that it is not. Moreover, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare and Medicaid, has little ability to hold insurers accountable when they violate prior authorization regulations.

A new CMS rule is intended to speed up insurer prior authorization decisions for medical services. It goes into effect in 2026. But, it has no meaningful enforcement mechanism. As well, inexplicably, it does not apply to insurer determinations as to whether a drug is covered.

State laws, for the most part, only apply to private health insurance that is state-regulated. Consequently, people in ERISA plans, who work for companies that self-fund their health insurance, are not protected by state laws. These laws also generally do not protect people with Medicaid.

One recent study found that one in five people with cancer are denied care their treating physicians recommend. The American Medical Association found that patients often experience “serious adverse event(s)” as a result of prior authorization processes.

Even when states are able to detect violations by insurers and hold them accountable, the penalties generally are so small as not to be a deterrent for the large insurers. One expert suggested holding insurance company medical directors accountable for wrongful prior authorization determinations; medical directors could be sued for malpractice. Oklahoma is considering a law that would do that.

Here’s more from Just Care:

April 23, 2024

Poll: Health care concerns rank high, embedded in concerns about immigration, government and the economy

A new Gallup poll on top issues for likely voters could suggest that voters are far less focused on health care as a dominant concern than immigration, government leadership, the economy, the high cost of living and poverty. As Robert Pearl, MD reports for Forbes, health care now ranks 16th, down from being listed as a top concern. But, Pearl makes a compelling case that health care remains a big concern of Americans; it is embedded in their top concerns.

Health care ranked as an explicit top concern in 2018, 2020 and 2022, as Pearl points out. Here’s the share of Americans who ranked other issues ahead of health care in this recent poll: “Immigration (28%), the government (20%), the economy in general (12%), inflation (11%), poverty, hunger and homelessness (5%), unifying the country (4%), crime/violence (4%).”

But, as the Kaiser Family Foundation found last month, health care costs are a top economic priority for voters. And, voters today say that the economy is their third top concern.

Health care is now interwoven in other concerns. In addition to health care being part of voters’ concerns about the economy, health care is response for the high cost of living and poverty. Think about how Covid-19 has affected our country–our government, our economy, and our health. Covid has also affected government investment and inflation.

Health care costs are now tied to pressures on the economy, such as high housing, food and gasoline costs. Covid-19 affected our incomes and resources as well as our mental health. It bred social isolation, loneliness and more. It undid whatever social solidarity we felt as a nation and promoted greater fissures, including fear of immigrants.

Covid-19 fostered a lack of trust in government leadership. Mixed messages about how to protect yourself from Covid; the government’s inability to protect people; the high number of Covid deaths; ever-changing Covid policies; shortages of Covid test kits; lack of bi-partisan agreement on Covid policy reforms, all led voters to lose faith in government. Voters now feel a strong desire to unify our nation.

Pearl sees the Gallup poll results revealing “the extent to which the pandemic unraveled the social fabric and collective psyche of our nation.” Voters are not happy with our health care system. Nearly three in four of them (73 percent) say that it is not meeting their needs–mental, physical and economic.

Here’s more from Just Care:

April 3, 2024

Life expectancy in US remains lower than all other wealthy nations

Brett Wilkins reports for Common Dreams on new data from the federal government on life expectancy in the US. We continue to live shorter lives than people in every other developed nation. Advocates for a government-run national health care system argue that it’s time that the our government moves away from for-profit health care and guarantees health care for all Americans under one single system.

Life expectancy in the US is up 1.1 years according to the Centers for Disease Control (CDC). It was 77.5 in 2022, the most recent year for which we have data. It’s still significantly lower than dozens of other countries.

Cancer, heart disease, injuries and Covid-19 were most common causes of death in 2022. We lost 1.2 million lives to Covid-19. With guaranteed universal health care, we might have cut that number down by 338,000 to fewer than 900,000 lives, according to one study.

In 2020 and 2021, US life expectancy fell, in large part as a result of Covid-19. But, in 2019, life expectancy was 1.3 years higher than it was in 2022, 78.8 years. It should go without saying that the US spends significantly more per person on health care than other wealthy countries. Every other wealthy nation has guaranteed health care for all its citizens.

For-profit health care is not good for patient health. Eagan Kemp of Public Citizen advocates: “We must keep making the point that profit-driven healthcare is not only worse for patients—it’s a national embarrassment. Our leaders must act to kick insurance companies to the curb and enact Medicare for All now.”

Not only does guaranteed health care for all deliver longer life expectancies and better patient outcomes overall, it costs a lot less than our profit-driven health care system. The Congressional Budget Office determined that guaranteed health care for all would cost as much as $650 billion less than we currently spend, back in 2020. It also found that without healthcare coverage, 68,000 people in the US die every year. Our health care system also drives millions of families into medical bankruptcy and financial distress.

In the words of the chair of the Congressional Progressive Caucus, Congresswoman Pramila Jayapal: “There is a solution to this health crisis—a popular one that guarantees healthcare to every person as a human right and finally puts people over profits and care over corporations. That solution is Medicare for All—everyone in, nobody out.”

Here’s more from Just Care:

March 26, 2024

People with Medicare spend twice as much on healthcare as other people

People with Medicare spend twice as much on healthcare as other people, according to a new Kaiser Family Foundation report. On average, people with Medicare spend $7,000 a year or 13.6 percent of their total household spending a year. People under 65 spend about 6.5 percent of their income or $4,900 a year.

Higher spending for Medicare population is not surprising. People with Medicare on average have lower incomes than younger working people. Annual average household income for working people is $74,100 as compared with $51,800 for people with Medicare. And, of course, people with Medicare use significantly more health care services than younger working people.

These healthcare expenses for people with Medicare represent a bigger portion of their income than health care expenses for younger working people. What’s noteworthy is that as a share of total household spending, people with Medicare’s health care expenses are about the same in 2022 as they were in 2013.

The Inflation Reduction Act could lower people with Medicare’s out-of-pocket healthcare costs somewhat. It caps prescription drug costs under Medicare Part D at $2,000 a year for covered drugs, beginning in 2025. And, it brings down the costs of some high-cost drugs beginning in 2026. It will also be easier for people to qualify for extra help paying their prescription drug costs as Congress has expanded access to these subsidies.

People with Medicare still need to buy supplemental coverage to fill gaps in traditional Medicare unless they have Medicaid or subsidized employer retiree coverage. If they are in a Medicare Advantage plan, they can pay as much as $8,700 a year in out-of-pocket costs for in-network care alone, though on average Medicare Advantage plans cap their costs at around $5,000 a year for in-network services (about twice the cost of Medicare supplemental coverage.)

Here’s more from Just Care:

March 19, 2024

Poll: Health care costs are a top economic priority for voters

As you’ve likely been reading, voters continue to have negative views about the US economy. High health care costs (and inflation, which is actually in check) feed into that view, with voters saying they are big concerns. The Kaiser Family Foundation’s latest poll finds that voters want to hear President Biden and former President Trump discuss these issues.

Americans believe that their cost of living, including housing, is rising; health care costs also represent a piece of that expense. They do not seem to consider that unemployment is low and the stock market has been climbing. Almost three in four Americans are concerned about paying unexpected medical bills; more than half are worried that they won’t be able to afford their prescription drugs and nearly half express concern about paying their health insurance premiums.

What’s particularly noteworthy is that even though former President Trump would likely cut some of the benefits voters enjoy and President Biden has worked hard to boost them, nine in ten Republicans say they would vote for former President Trump. Curiously, Republican voters believe that former President Trump did more to address high health care costs than President Biden, although not enough. Nearly six in ten Republicans (59 percent) say Trump did enough to address health care costs, whereas only one third (33 percent) of Democrats say Biden has done enough.

Voters who say they support Trump recognize that he does not have a vision for replacing the Affordable Care Act, only for ending it. But, they don’t appreciate that President Biden was the Vice President when the ACA was passed and played a significant role in its passage.

The ACA is not well understood, likely because only a fraction of the population benefits from it today. Most people don’t appreciate the protections it offers people who lose their employer coverage or who are self-employed, particularly those who have pre-existing conditions, and why it needs to be strengthened. Many Republicans suggest they would be happy to see it cut or repealed.

Here’s more from Just Care:

March 6, 2024

Oregon moves toward restricting private equity from owning physician practices

Most states have laws prohibiting corporate interference in the practice of medicine. But, corporations and private equity firms have been getting around these laws, buying up primary care and specialty practices, by enlisting physicians to run their businesses. Amelia Templeton writes for OPH.org that Oregon is working to prevent some of this activity because it is benefiting corporations at the expense of patients.

The opposition is fighting back, dragging out the standard arguments that any law preventing corporate ownership of physician practices will kill innovation and business. The question the Oregon lawmakers must ask is whether concerns about the health and well-being of their constituents resulting from the corporate ownership of medical practices should be paramount.

As it is, nursing homes, health systems and hospitals are not likely to be covered under any new law in Oregon, even though their corporate ownership raises serious patient safety, health care access and health care cost concerns. Corporate owners can direct physicians to spend less time with patients or to see fewer Medicaid patients.

Private equity ownership of medical practices is almost always a short-term play. The private-equity firm takes as much money out of the business as possible or implements ways to generate more revenue and then tries to flip it for a profit. Patient care is at best a secondary concern after profits.

Right now, some types of corporations must abide by a loosely written Oregon law that requires physicians to have a majority stake in any medical practice that is corporate-owned. Oregon legislators are looking to broaden that to extend to more health care corporate entities.This Oregon law does not apply to hospitals and nursing homes.

If passed, the new legislation would still allow corporate-owned medical practices to exist for the next seven years. After seven years, they would need to have transitioned to a different ownership structure. Sadly, that’s plenty of time for the corporate owners to lobby the Oregon legislature to repeal the legislation if it is passed.

Here’s more from Just Care:

February 26, 2024

United Health now controls 1 in 10 physicians

Steph Weber reports for Medscape that UnitedHealthcare’s owner, UnitedHealth Group now controls–either owns or otherwise works with–one in ten physicians. Concerns are mounting about corporate control of health care. Treating physicians are no longer in full charge of patient care as insurers increasingly overrule their treating decisions.

Legally, insurers are not allowed to interfere in the practice of medicine. But, what does that really mean? It apparently does not prevent insurers from telling physicians how much time to spend with their patients or who to refer them to if they need to see a specialist–anti-competitive behavior. It also does not stop insurers from providing financial incentives to their physicians to withhold or otherwise delay costly care.

UnitedHealth now controls around 90,000 of the 950,000 physicians in the US. It is adding multispecialty physician groups in large numbers. These physicians all work for Optum Health, a subsidiary of UnitedHealth.

UnitedHealth’s ownership or control of these physicians is endangering people’s health. There’s no good independent data to evaluate the consequences of UnitedHealth’s ownership of these physicians. Based on the horror stories reported in the press–from insurer use of AI to conduct massive denials of care without regard to particular patient needs, to inappropriate withholding of payment to hospitals and “ghost” networks–UnitedHealth is interfering in the practice of medicine to the detriment of its enrollees.

Some experts suggest that there could be some good in what UnitedHealth is doing. But without data to conduct independent assessments and with mountains of horror stories, these experts are likely dreaming. Insurer control of physicians means putting profits ahead of patient needs, with potentially horrific consequences.

One recent study published in JAMA finds that private equity ownership of physician groups has driven up health care prices. That study looked at dermatology, gastroenterology, and ophthalmology practices. Several other studies have had similar findings, including one on private equity ownership of dental practices. Nursing homes, emergency medicine, urology and cardiology practices are all being taken over by private equity and corporations.

The Biden administration has focused some attention on anti-trust issues, but it seems that the anti-trust train left the station a long time ago and undoing the damage that has already been wrought would be a very heavy lift. Moreover, when insurers hire physicians, rather than acquiring them, they are not subject to anti-trust laws.

The dangers to patient health from the corporatization of healthcare are potentially massive, with costly care particularly hard to come by. Insurer ownership or control of physician practices is hurting physicians as well. They may no longer be able to practice the medicine they think is in their patients’ interest.

Recently, UnitedHealth and Humana have been sued for using AI algorithms to deny patient care, overruling treating physicians, and overlooking the particular needs of their enrollees in Medicare Advantage plans.

Here’s more from Just Care:

December 18, 2023

Tag: Health care