Going all the way back to Truman every Democrat President that significantly expanded healthcare or put up a good fight to do so won a 2nd term.Expanding healthcare should be every Democrats top priority when they take office. I voted for Jill Stein but as bad as Biden was I would have voted for him a 2nd time(or Harris) if he had gotten a medicaid option for all,that alone would have been enough to have gotten my vote. Biden did promise a medicaid option for all when running in 2020,it was a lie just like every progressive promise he made.Thats why he's a one term president who will be going down in history as one of the worst presidents ever.
US health reform is tough to pass. Can the brazen killing of a CEO change that? With partisan gridlock and special interests more powerful than ever, it’s difficult to know how to move forward https://www.theguardian.com/us-news/2024/dec/11/health-reform-brian-thompson-shooting Rage, frustration and bitterness – all were on display in social media comments following the fatal shooting of the UnitedHealthcare CEO, Brian Thompson. Thompson was brazenly murdered in midtown Manhattan just before the company’s annual investor conference, leaving behind a widow and two sons. Many Americans struggled to find sympathy for a man they viewed as complicit in denying or deferring what they saw as needed care – rage that one prominent policy expert can understand. “Dissatisfaction – in the sense that the system isn’t working, it’s broken – is at an all-time high,” said Ezekiel Emanuel, one of the architects of the law better known as Obamacare, and a professor of health policy at the University of Pennsylvania’s Perelman School of Medicine. “Everyone hates the system now more than when we passed the Affordable Care Act.” Police said the suspect they arrested this week, 26-year-old Luigi Mangione, was also in possession of a kind of manifesto – a “handwritten three page document” that professed “ill-will toward corporate America” – including references to healthcare. Last week, police said shell casings recovered at the scene were scrawled with the words “deny”, “depose” and “defend” – words many Americans associate with health insurance denials – and recovered a backpack potentially connected to the shooting filled with Monopoly money. The incident has caused alarm for researchers of violence, who said the killing represents an extension of political violence into the commercial realm, and has shaken corporate executives. UnitedHealth Group, for instance, pledged to harden its campus, the CEO told employees. “No matter how deep our grievances or how righteous our anger may feel, violence has no place in our society,” wrote Wendell Potter, a former health insurance executive turned advocate for reform, in his weekly newsletter. Still, he added, “this corporate assassination is a symptom of a nation buckling under the weight of systemic dysfunction”. Passed in 2010, Obamacare was arguably the most ambitious health reform law in a generation. The ACA prevented insurers from discriminating against sick people, brought health insurance to millions more people, and held the total cost of healthcare (usually expressed as a percentage of gross domestic product) relatively stable. “This really is a paradox,” said Emanuel, going through a list of progressive changes that have taken root since the ACA went into effect. “That doesn’t mean the system is working well. That’s hardly how we experience it.” Instead, he said, consumer experience of the law is often typified by “prior authorization, inability to find a doctor, shortages of common medications like amoxicillin and asthma stuff people need”, and the “burnout level” of doctors and nurses still typify the American health system, said Emanuel. The health industry has consolidated heavily over the decade, leading to higher prices and even more powerful special interests that lawmakers would have to face for any reform – no matter how incremental. Thompson worked as the head of the insurance division at UnitedHealth Group. The corporation is now ranked as the fourth-largest US company, behind only Walmart, Amazon and Apple, according to Fortune – a fact mentioned by Mangione himself in his so-called “manifesto”. UnitedHealth Group is also ranked as the eighth-largest company on Fortune’s global index – ahead of ExxonMobil, Shell, Google parent company Alphabet, Volkswagen, GM and JPMorgan Chase. That’s up from 10th globally in 2023 and way up from 63rd in 2012, one year after the passage of Obamacare. Other healthcare giants also rank in the top companies in the US and world: CVS, a pharmacy that now also owns the health insurance company Aetna and pharmacy benefit manager Caremark, is the sixth on the US list. “No entity in history, certainly not a company traded on the New York Stock Exchange where profit margins are all that matter – has been in a position to deny or delay essential health care on a scale that UnitedHealth does day in and day out,” Potter wrote this week. With partisan gridlock and entrenched special interests, such as health insurers, now more powerful than ever, he added, it was difficult to know how to move forward. “One of our problems at the moment is it’s not clear what the comprehensive reform of the American health system would be,” said Emanuel. “People have not figured that out,” he adding, saying that it was not the fault of the public but “policy experts like me”. In some cases, overwhelmingly popular policies seem to go nowhere – like the Vermont senator Bernie Sanders’ proposal to add vision, dental and hearing benefits to Medicare, the public health insurance program for older adults. Polls suggest that the policy enjoys support from 84% of the public. But it has not advanced significantly in part, Sanders argues, because of industry opposition. “I don’t have to tell you that the insurance companies, the drug companies have zillions of lobbyists here in Washington,” Sanders told the Guardian in May. He later added: “The function of our healthcare system is not to provide high-quality care, but to make huge profits for drug companies and insurance companies.” The ACA required the federal government to track insurance company denial rates, data that was supposed to be shared with state insurance commissioners. Yet, “to date, such information-gathering has been haphazard and limited to a small subset of plans, and the data isn’t audited to ensure it is complete”, an editorial from KFF Health News reported in 2023. Now, there is little data to support patients’ suspicions that they are being denied at higher rates, an issue that has only become more urgent as insurers employ artificial intelligence to deny claims in batches. In some cases, issues have persisted despite legal reform. California enacted one of the first laws against “ghost networks” – inaccurate and misleading insurance networks that make it appear there are more providers than actually participate in the network. In spite of the new law, only one insurance plan has been fined $7,500, according to reporting by ProPublica. “People feel like the system is not working for them, and in some ways it reminds you of the experience of the Biden team, [when] Bidenomics is working,” said Emanuel. Big-picture data shows things are moving in the right direction, he added, but “the American public is saying: ‘We’re not buying any of it’”.
“ 9. Pay out of pocket for healthcare costs. Cash paying customers are able to negotiate substantial discounts, according to some, up to 80% off. Eighty percent off can be the equivalent of a copay. This may be roughly equivalent to what healthcare used to cost, adjusting for inflation, since ACA was first enacted. Administrators and doctor's regulatory loads of 30% of productivity are not going to pay for themselves, right?” Cash patient $70 office visit min(Non specialist.) Insurance paid $40. Doctor refused to go below $70. I dated a office manager and a hospital billing accountant, that 80% not gonna happen unless you’re going BK. Try navigating cancer on cash, you’ll blow through $200k pretty quickly. Do you think negotiating with a lot of these services would be easy while you’re fighting cancer? I knew many healthy people who had unlucky genes. “ Medical expenses of cancer treatment Try to learn as much as you can about your cancer treatment before it starts. Remember that each person's experience and treatment is different. Asking questions will help you learn what you might expect. It can also help you plan for and deal with the costs related to your care. Medical expenses for people with cancer can include: : Visits with your cancer care team Lab tests Procedures (for diagnosis or treatment, which can include room charges, equipment, different doctors, and more) Imaging tests (like x-rays, CT scans, and MRIs, which may mean separate bills for radiologist fees, equipment, and any medicines used for the test) Radiation treatments (external radiation, internal radiation, or both) Medicine costs (medicines that treat your cancer or manage side effects of your treatment) Clinic visits for treatment Hospital stays (which can include many types of costs such as medicines, tests, and procedures as well as nursing care, doctor visits, and consults with specialists) Rehabilitation, such as physical therapy Surgery (surgeon, anesthesiologist, pathologist, operating room fees, equipment, medicines, and more) Home care (can include equipment, medicines, visits from specially trained nurses, home care aides, and more) Specialist referrals (other specialty doctors, physical therapy, and others) Transportation costs (might include the cost of travel to receive treatment by car, airplane, train, cab, or bus. In some hospitals or clinics, you may have to pay for parking). Some people with cancer might need a place to stay if they live far from where treatment is given. The American Cancer Society might be able to help if you need lodging closer to treatment. https://amp.cancer.org/cancer/finan...aging-costs/the-cost-of-cancer-treatment.html
Congress (Democrats and Republicans) are in the back pockets of those powerful Healthcare lobbyists in Washington D.C. A reminder, Healthcare is a trillion-dollar industry in America, often focusing on financial incentives over health or science. America is naive to think that the killing of a healthcare CEO is going to change the decline (it's not improving) in healthcare in the United States that has left many in the world to scratch their heads about what's wrong in the U.S. ??? We have the best doctors, best medical schools, and best hospitals but 68 countries have better healthcare than the United States. The U.S.A. is one of my favorite countries but they're last on my favorite list with Canada, France, and South Korea far above the United States on the global healthcare rankings. On top of the physical aspects of healthcare...we have a growing mental illness problem with mental healthcare (mental illness) that exploded from the COVID-19 pandemic. We've been talking about this since the beginning of the Pandemic especially in the U.S.A. Congress talks about it, social media talks about it, and other countries are now viewing the U.S.A. as a land of crazies that no longer understands and respects "law and order". More chaos is coming and the rich and those in Congress get richer at the expense of America. RFK Jr. will only go after the little guys (e.g. Flouride) while those trillion-dollar lobbyists with all the power and their congressional members will direct their new puppet (worm man) to continue going after the little guy so that America maintains the illusion of improving its healthcare system when in reality it will continue declining or show very little improvement. In contrast, CEOs in the healthcare industry will get bodyguards like other celebrities and take threat alerts more seriously instead of ignoring them. Hopefully, it will not result in bombings or attacks on their family members...worst there will be more attacks on those Congressional members in bed with the healthcare lobbyists. It's why we had a shitty Covid-19 performance in the Pandemic. The Pandemic was a warning to all the countries with a crappy healthcare system. America is fucked wrbtrader
Insurance companies have negotiated set rates with medical practices. We find that cash rates are usually MUCH higher -- usually three times or greater than the negotiated insurance company rate for the total bill. So if you pay out of pocket then you are not only being screwed by missing insurance coverage but by much higher medical payments in most areas of the U.S. There may be a few small practices -- primarily general practitioners -- who offer low cash rates (we have one in Apex, N.C.). However if you ever need treatment from a specialist (e.g. for knee surgery) then you are going to be completely screwed if you pay cash. The negotiated cost from the insurance company is likely to be about $25K which you will pay somewhere between $1K to $3K of under your health insurance. If you show up wanting to pay cash for knee surgery then your payment is likely to be $75K to $100K.
“I Can’t Afford My Oxygen”: The Human Toll of For-Profit Insurance A veteran physician explains how America’s health system leaves us sicker and poorer. https://www.motherjones.com/politic...-mangione-physicians-national-health-program/
“ Mark Cuban Says, 'I Don't Know Cars Or Rockets,' But Schools Elon Musk On How American Health Insurance Works” When Elon Musk took to X to question why Americans aren't “getting their money's worth” despite the United States leading the world in health care administrative costs, Mark Cuban stepped in with some tough truths. Cuban, known for his straight talk and deep dive into health care reform, gave Musk and other CEOs a crash course on how their decisions directly impact health care costs and quality in the U.S. "The key is the contracts CEOs of self-insured companies sign," Cuban wrote in response to Musk's tweet. He explained that many of these contracts, especially with Pharmacy Benefit Managers (PBMs), are at the root of spiraling costs and poor care….” https://www.yahoo.com/finance/news/mark-cuban-says-dont-know-173037242.html
Taking a look at an insurance company's scheme to deliberately deny care. ProPublica Drops Damning Expose on Leaked UnitedHealthcare Report About Limiting Child Healthcare Services To Cut Costs https://www.mediaite.com/news/propu...iting-child-healthcare-services-to-cut-costs/ A leaked report reveals UnitedHealth Group, the nation’s largest insurer, systematically limiting access to critical autism therapy by culling providers and leaving families and advocates outraged. The damning internal documents obtained by ProPublica reveal that the company has implemented cost-cutting measures targeting applied behavior analysis (ABA), a widely recognized therapy for children with autism. UnitedHealth’s report acknowledges ABA as the “evidence-based gold standard treatment” but outlines strategies to reduce its availability. These include removing providers from their network and denying therapy hours requested by clinicians. The strategy primarily targets those children who are the poorest and most vulnerable, covered through the company’s state-contracted Medicaid plans. One bullet point in the documents suggests terminating “cost outliers,” even in regions with long waitlists. The strategy has already impacted up to 19 percent of patients receiving ABA therapy in some states, ProPublica found. UnitedHealthcare and Optum declined ProPublica’s request for an on-the-record interview about their behavioral health care coverage, a request made over a month ago. Questions emailed 11 days ago remain unanswered, with the company citing the December 4 killing of UnitedHealthcare’s CEO Brian Thompson as the reason. In an emailed statement, a spokesperson replied: “We are in mourning” and said they could not engage with a “non-urgent story during this incredibly difficult moment in time.” Despite being offered extra time to respond, the companies did not agree to a deadline for comment. ProPublica presented the case of Sharelle Menard, a single mother from Louisiana who has been fighting to secure sufficient ABA therapy for her son, Benji, who is severely affected by autism. Once unable to speak, Benji made remarkable progress with intensive therapy, but UnitedHealth recently began denying the full 33 weekly hours his clinicians deem necessary. Menard is now terrified of losing the gains her son has made. “They’re cutting and denying an unethical amount,” said Whitney Newton, Benji’s behavior analyst. Speaking with the publication, Karen Fessel, an advocate for autism care, labeled the company’s tactics as “unconscionable and immoral.” She criticized UnitedHealth for shrinking its network while knowing there was an urgent need for services. Experts echoed her concerns, with Tim Clement of Mental Health America describing the moves as “a blunt instrument to chase after excessive costs.” Deborah Steinberg, an attorney with the Legal Action Center, noted to ProPublica that insurers like UnitedHealth must comply with the federal mental health parity law, which mandates equal access to mental and physical care. As Menard braces for an appeal hearing next month, she hopes for a reversal of the insurer’s denial. “They’re denying kids access to medically necessary care,” said president of the Autism Legal Resource Centre and attorney Dan Unumb, “and that’s a terrible solution.”
I will related my personal experiences with healthcare and that of a friend. I have always paid out of pocket, for healthcare, including visits to specialists. I have ordered and paid for my own bloodwork and urinalysis's. Now while I've always paid my healthcare expenses in full and before the due date, there have been several instances where I called to verify total changes and was met with an immediate, unsolicited offer of a 50% bill reduction with a repayment schedule. This happened after an knee surgery with a major provider of services to a prominent football team and a dental visit. It seems billing departments are so used to cash customers trying to negotiate they automatically assume in advance what a call is about. The reason why I turned down the offer of free money is I believe in maintaining good relationships with competent healthcare providers. I have visited three specialists in my life, after thinking I've isolated a problem and figured it would be more efficient to bypass a general practitioner. While my concerns were never medically significant, I learned valuable information and two out of three specialists said they wouldn't feel right about charging me. I paid all three with cash, in full, at time of service. The only time I negotiated with an insurance company was when I had an at-fault auto accident without insurance. I admitted fault, as I hit the other vehicle as we were both backing out of our parking spaces. Ironically, it was the parking lot of a courthouse I just paid a speeding ticket. I was contacted by the other party's insurance company for recovery. I questioned the amount the insurance comany was demanding as unreasonably high. They said I admitted fault and I countered with, "It did not make me liable for seemingly arbritrarily high charges". The auto insurance company reduced their recovery request by 50%, which I agreed to and paid promptly. As far as my 75% off comment, that was based upon a comment someone else said. The veracity of their comment I can't confirm. My Insured friend has extensively used healthcare providers. He had issues related to a misdiagnosed bacterial infection with related issues, acquired from a ski trip in Canada, heart related issues, and a newly acquired allergy. He feels his coverage encouraged his healthcare providers to give him the runaround with unnecessary visits and treatments. My friend is quite adept at research and is an engineer by trade. I will address your cancer question as a response to your later post. Based upon the above, some conclusions and questions seem to stand out. 1. Healthcare costs seemed reasonable to me before ACA. I have not had significant healthcare expenses after ACA. Just dental, a visit to a specialist, and self-ordered blood work. 2. Heathcare costs are easily negotiable by the uninsured. We are talking 50% off unsoliticted offers here, without even considering possibilities of futher reductions via a counteroffer. 3. There appears to be large potential of systemic abuses by healthcare providers, by patients, and by insurance companies, and in practice, this appears to happen regularly. 4. Those paying out of pocket may get better, more efficient care than when a third party payer is involved. Especially if the patient has some knowledge and can ask intelligent questions. In conclusion, our healthcare system needs to be reformed. Beyond that, it seems many patients themselves need to step up their game in their role in a healthy system through informed expectations and fulfillment of their obligations.