The US Healthcare Mass Debate

[Tero]

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Insulin is expensive in the United States for many reasons, including:
Lack of competition: The three largest insulin manufacturers, Eli Lilly, Sanofi, and Novo Nordisk, control over 90% of the market. They can raise prices in lockstep and buy up potential competitors.
Evergreening: Drug companies make small improvements to their products to extend the life of their patents. This discourages generic drugs from being developed.
Pharmacy benefit managers (PBMs): PBMs negotiate prices with drug manufacturers on behalf of insurance carriers. They place drugs higher or lower on their tier of preferred drugs, which incentivizes high list prices.
Medicare: Medicare is the largest buyer of drugs in the United States, but it's barred from negotiating drug prices.
Supply chain: Supply chains have become more complicated, which has increased costs.
Innovation and research: Insulin manufacturers claim that high prices are necessary to spur innovation and investment in research and development.
Lack of transparency: There's a lack of transparency in the insulin supply chain.
Some possible solutions include:
Enforcing more stringent requirements for patent extensions

[L'Emmerdeur]

Dabbing some anti-wart ointment on a patient = surgery 'because the ointment penetrates the skin.' It's billed as such, which results in a charge of well over $400. Nice work if you can get it.

'Removing a Splinter? Treating a Wart? If a Doctor Does It, It Can Be Billed as Surgery'

When George Lai of Portland, Oregon, took his toddler son to a pediatrician last summer for a checkup, the doctor noticed a little splinter in the child’s palm. “He must have gotten it between the front door and the car,” Lai later recalled, and the child wasn’t complaining. The doctor grabbed a pair of forceps — aka tweezers — and pulled out the splinter in “a second,” Lai said. That brief tug was transformed into a surgical billing code: Current Procedural Terminology (CPT) code 10120, “incision and removal of a foreign body, subcutaneous” — at a cost of $414.

“This was ridiculous,” Lai said. “There was no scalpel.” He was so angry that he went back to the office to speak with the manager, who told him the coding was correct because tweezers could make an incision to open the skin.

When Helene Schilders of Seattle went to her dermatologist for her annual skin check this year, she mentioned her clothing was irritating a skin tag she had. The doctor froze the tag with liquid nitrogen. “It was squirt, squirt. That’s it,” Schilders told me. She was “floored” by an explanation of benefits that said the simple treatment had been billed as $469 for surgery.

Assuming the bill was a mistake, she called the doctor’s office and was told that surgery had indeed occurred — because the skin was broken in the process. Hence surgical CPT code 17110, “destruction of 1-14 benign lesions.”

Schilders complained to her insurer, who provided a document informing her that “surgery is classified as something entering the body, such as a Q-tip entering the ear canal or a scalpel during surgery.”

[L'Emmerdeur]

It should be a great comfort to Trumpists to learn that their glorious idol will exercise his stable genius to determine which vaccines need to be eliminated from US government health agency requirements. No silly, he's not going to just do it on his own, he's going to consult with that famous vaccine expert Robert Kennedy Jr.

'"Bad Idea": Trump’s Plan to Cut Vaccines He Deems "Dangerous" Met With Concern by Experts'

Saying he will be the one to decide—in consultation with anti-vaccine activist Robert F. Kennedy Jr.—which vaccines the federal government should cut, Donald Trump on Thursday again invoked the false and widely debunked conspiracy theory that links autism to the life-saving drugs. The President-elect’s remarks were met with concern and condemnation.

“When asked in an interview for TIME’s 2024 Person of the Year whether he would approve of an end to childhood vaccination programs, Trump said he would have a ‘big discussion’ with Robert F. Kennedy Jr.,” TIME magazine reported Thursday, noting Trump has nominated RFK Jr., an attorney who has no medical training or experience leading a massive organization, to run the U.S. Department of Health and Human Services (HHS).

“The autism rate is at a level that nobody ever believed possible,” Trump told TIME, which debunked his remarks in its reporting. “If you look at things that are happening, there’s something causing it.”

[Sean Hayden]

This is maddening.

[Svartalf]

Americans are crazy, this place has been crackpotland since 1620

[L'Emmerdeur]

ProPublica has an article about UnitedHealthCare creating a policy to deny care to autistic children. This is an example of how UnitedHealth and other American health care insurance companies ensure a fat profit for their shareholders. When ProPublica approached UnitedHealthCare for their side of the story the company said essentially, 'we're in mourning for our executive, can't talk now.'

'UnitedHealth Is Strategically Limiting Access to Critical Treatment for Kids With Autism'

• Secret Playbook: Leaked documents show that UnitedHealth is aggressively targeting the treatment of thousands of children with autism across the country in an effort to cut costs.
• Critical Therapy: Applied behavior analysis has been shown to help kids with autism; many are covered by Medicaid, federal insurance for poor and vulnerable patients.
• Legal Questions: Advocates told ProPublica the insurer’s strategy may be violating federal law.

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ProPublica has obtained what is effectively the company’s strategic playbook, developed by Optum, the division that manages mental health benefits for United. In internal reports, the company acknowledges that the therapy, called applied behavior analysis, is the “evidence-based gold standard treatment for those with medically necessary needs.” But the company’s costs have climbed as the number of children diagnosed with autism has ballooned; experts say greater awareness and improved screening have contributed to a fourfold increase in the past two decades — from 1 in 150 to 1 in 36.

So Optum is “pursuing market-specific action plans” to limit children’s access to the treatment, the reports said.

“Key opportunities” are outlined in bullets in the documents. While acknowledging some areas have “very long waitlists” for the therapy, the company said it aims to “prevent new providers from joining the network” and “terminate” existing ones, including “cost outliers.” If an insurer drops a provider from its network, patients may have to find a new clinician that accepts their insurance or pay up to tens of thousands of dollars a year out of pocket for the therapy. The company has calculated that, in some states, this reduction could impact more than two-fifths of its ABA therapy provider groups in network and up to 19% of its patients in therapy.

The strategy targets kids covered through the company’s state-contracted Medicaid plans, funded by the government for the nation’s poorest and most vulnerable patients. To manage Medicaid benefits, states often pay private insurers a fixed amount of funds per patient, regardless of the frequency or intensity of services used. When companies spend less than the allotted payment, they are typically allowed to keep some or all of what remains, which federal investigators and experts acknowledge may be incentivizing insurers to limit care.

United administers Medicaid plans or benefits in about two dozen states and for more than 6 million people, including nearly 10,000 children with autism spectrum disorder. Optum expects to spend about $290 million for ABA therapy within its Medicaid plans this year, and it anticipates the need increasing, documents show. The number of its Medicaid patients accessing the specialized therapy has increased by about 20% over the past year, with expenses rising about $75 million year-on-year.

So Optum — whose parent company, UnitedHealth Group, earned $22 billion in net profits last year — is “heavily investing” in its plan to save millions by limiting access to such care.

In addition to culling providers from its network, the company is scrutinizing the medical necessity of the therapy for individual patients with “rigorous” clinical reviews, which can lead to denials of covered treatment. Optum has developed an “approach to authorizing less units than requested,” the records state.

Mental health and autism experts and advocates reviewed ProPublica’s findings and expressed outrage over the company’s strategy. Karen Fessel, whose Mental Health and Autism Insurance Project helps families access care, called the tactics “unconscionable and immoral.”

“They’re denying access to treatment and shrinking a network at a time when they clearly know that there is an urgent need,” she said.

[Tero]

The complaint about Democrats not doing anything for the working class may be true, but on the other hand voters have given them very slim majorities. In the case of health care, there were probably Democrats bought by insurance. The ACA was the best they could do.

If they had pushed through Univeral care. The Repuiblicans the next 4 years would have just cut off all funding. Then two years later repeal it because it was not working.

[Tero]

Hips and knees: done.
Now cancer.
Alzheimer? Install brain worms in all.

[pErvinalia]

The lunatics are running the asylum.

[Tero]

UHC calls surgeon. She is operating. The surgery is approved but she cannot stay overnight. Which they thought was important enough to interrupt surgery.
https://www.threads.net/@thequeenwhispe ... 9VgY6W-P_Q

[L'Emmerdeur]

Not a big surprise here.

'Patient care declines after private equity buys hospitals, study finds'

In a paper published in JAMA, health policy experts at Beth Israel Deaconess Medical Center (BIDMC) report that patient care experience worsened after private equity (PE) acquisition of US hospitals, as did patient-reported staff responsiveness.

Rishi Wadhera, MD, MPP, Anjali Bhatla, MD, and colleagues demonstrated that patient care continued to worsen at PE-acquired hospitals with each additional year following acquisition relative to non-acquired hospitals, suggesting that profit-driven changes made by PE may have downstream effects that accumulate over time.

...

"The relative decline in overall patient care experience scores after PE acquisition was large," said Bhatla, a research fellow at the Smith Center. "Poor patient experiences are associated with slower recovery from illness, medication nonadherence, and greater health care utilization."

"The evidence to date suggests that when private equity takes over a hospital, things generally get worse for patients," said Wadhera, who is also an Associate Professor at Harvard Medical School.

"As private equity's presence in health continues to grow, there's a pressing need for greater transparency, monitoring, and regulatory oversight, to ensure that patients are protected."

I believe the Conservative Party in the UK is still in favor of moving toward privatising the NHS, as if they didn't have a glaring example across the Atlantic of what a ridiculously stupid and harmful idea that is.

[Tero]

Medicaid to be cut unless you work, but...

TragicMonkey explained it to me.

Missouri, for example, cuts off your Medicaid for a single adult if they make more than $20,030. For a household of two that generously increases to $27,185. The minimum wage in Missouri is now $13.75. So these employed Medicaid recipients can't work full-time without losing their Medicaid. So this is not going to work as an "incentive" to encourage them to get good jobs and work their way out of poverty...it's going to push them into working bad jobs with no benefits and low pay and limited hours, and keep them there.

It's not about saving taxpayor dollars or lifting people out of need, it's about maintaining an underclass of exploitable workers to make businesses more money. It will not trickle down.

We need a term for trickle up.

[Woodbutcher]

Medicaid to be cut unless you work, but...

TragicMonkey explained it to me.

Missouri, for example, cuts off your Medicaid for a single adult if they make more than $20,030. For a household of two that generously increases to $27,185. The minimum wage in Missouri is now $13.75. So these employed Medicaid recipients can't work full-time without losing their Medicaid. So this is not going to work as an "incentive" to encourage them to get good jobs and work their way out of poverty...it's going to push them into working bad jobs with no benefits and low pay and limited hours, and keep them there.

It's not about saving taxpayor dollars or lifting people out of need, it's about maintaining an underclass of exploitable workers to make businesses more money. It will not trickle down.

We need a term for trickle up.

Slurp.

[Brian Peacock]

Troughing.

[L'Emmerdeur]

Yeahbut what about autism? No mention in this article of whether the autism rate has declined alongside declining vaccination rates. THEY don't want you to consider that, but Kennedy Jr. is on the case.

'US Measles Outbreak Surges Towards 100 Cases'

An outbreak of measles in the US is approaching 100 cases as it spreads into more heavily populated areas, predominantly affecting children and adolescents.

First detected in late January as two schoolchildren were hospitalized for the disease in Gaines County, Texas, the highly infectious virus has since crossed state borders into New Mexico and Georgia, leading to fears of missing cases.

A list of current exposure sites in West Texas can be found here.

At least 23 of the 93 known cases have been hospitalized so far. More than 80 percent of cases are individuals under the age of 19, leading to the shutdown of several private schools.

...

There is no specific treatment for the disease, but vaccination programs have successfully suppressed the spread of measles for decades, leading to an official elimination of the disease in the US at the turn of the century. Prior to the vaccine's development, some 48,000 hospitalizations and around 500 deaths occurred each year as a direct result of infections.

...

Most of those who have been infected in the current US outbreak are unvaccinated. Gaines County is an area with one of the lowest vaccine rates in Texas. Almost 20 percent of parents of young children have filed for vaccine exemptions in the region.

Health officials in Texas are running mobile testing units in schools and pop-up vaccine clinics to attempt to get ahead of the disease, while also facing increasing health policy obstacles [PDF] to widescale vaccination.