US Hospital Money Machine

Summary: US hospitals use aggressive business models (mergers, high prices, & marketing of lucrative services) to drive up revenues. For-profit hospitals benefit investors, but even not-for-profits act similarly, with huge financial rewards for participants. Single payer’s hospital global budgeting would remove these perverse incentives. Hospital Billing Is a Crime Against American Patients The American Prospect November 22, 2022 By Robert Kuttner Most hospitals in the U.S. are either for-profits, or nominal nonprofits like large teaching hospitals that behave just like for-profits. Their goal is to maximize market share, particularly for the most lucrative specialized procedures. That means they spend a great deal of capital, not just on acquisitions but on construction of new facilities (that may be redundant in many cities) and on new costly equipment. U.S. hospitals have triple the capital costs of Europe’s hospitals. Meanwhile, every major European nation not only spends far less on health care but has much better outcomes in terms of every major health indicator. Medicare could save taxpayers a lot of money. Why are they so timid? Because hospitals in many areas are the largest and most politically powerful local employers, even more so when they are teaching hospitals connected to universities. One of the many regulatory failures of antitrust in the U.S. is the nearly complete failure to challenge hospital mergers and acquisitions, which have created monopoly power and degraded services in city after city. Even worse, many of these merger binges are by hospital systems that are nominal nonprofits. There is no direct price regulation in the U.S., so hospitals are free to charge what they think the market will bear. Hospitals also overuse specialists, who can bill at higher rates. Executive pay is also exorbitant. A variety of market-friendly techniques were devised to contain costs. Hospitals proved expert at gaming all of them. Until recently, advocates of single-payer health care have focused on comprehensive coverage but less so on the abuses of profit-maximizing medicine. If we went to Medicare for All but did not reform these billing practices and did not end the system of profit-maximizing medicine entirely, these excess costs would simply be piled onto taxpayers. Rep. Pramila Jayapal’s current Medicare for All bill does best at addressing these abuses, and Bernie Sanders’s latest version is more attuned to them than his earlier bills. Under Jayapal’s bill, co-sponsored by about half of the House Democratic caucus, the system would keep some elements of fee-for-service medicine and diagnosis-related coding, but hospitals would operate under “global” budgets. That is, they would receive an annual flat sum from the government that would be adjusted regularly to reflect caseloads. Medical education—one of the ways that teaching hospitals pad bills—would be its own separate budget item. Capital outlays and staffing ratios would be regulated. Incentive compensation aimed at gaming the system would be prohibited. There would be much greater emphasis on primary care. This legislation, which merely reflects common practices in most European nations, is at the outer fringe of what is even debated in the U.S. It is a reminder of how inefficient as well as unjust is market-led medicine, and how incremental reforms can never repair our broken health system. Comment by: Don McCanne Although we have the most expensive health care system in the world, it performs very poorly by international standards. We have far too many who are uninsured or underinsured and thus suffer financial hardship, and our system has too many features designed to direct health care dollars to the wealthy rather than to the patients where the need is so great. This article by Robert Kuttner demonstrates that another defect is in one of the most basic elements of our health care system: our hospitals! Hospitals have not escaped much of the fragmented and dysfunctional design defects that characterize our health care system. As a glaring example, our nominally nonprofit hospitals, which should be dedicated to providing health care to the most needy, frequently engage in activities that make the rich (e.g., prodigiously paid CEOs and procedural specialists) richer as unmet community care needs should make us cry out for universal insurance. Yet where are our reform activities directed? Our current government, which is supposedly more progressive than the alternative, has been busy converting our public Medicare program into private insurance plans, via heavily marketed but optional Medicare Advantage and now involuntary Direct Contracting through the REACH program. Meantime, ownership of the actual health delivery system is passing to private investors through private equity and other innovative business constructs designed to siphon off the massive pool of health care dollars that we have but are not using in the high performance system that our nation deserves. What is wrong with us? For decades we have known that a well-designed single payer system, using an improved version of Medicare, would serve all of us well. As we have stalled and deferred, allowing inadequate, dysfunctional, incremental measures to substitute for reform, we have allowed our health care system to feed the injustice of wealth inequities such that we now have a much greater legislative problem than merely establishing a universal public health insurance program. That makes it all the more urgent to act now. The shift of wealth to the top is a rapidly accelerating process. We are not talking about some vague population in the future. We are talking about our grandchildren and even our children. Look around at the medical needs that our aging friends face. How can we be so callous as to not ensure that those needs will be met for all of us in the future. Now is when we have to act! Dammit, now!

Red vs Blue - sent from Joel Clemmmer

https://hartmannreport.com/p/if-you-want-to-die-young-take-the?utm_source=post-email-title&publication_id=302288&post_id=85778050&isFreemail=true&utm_medium=email "Talk radio commentator and amateur researcher Thom Hartmann summarizes a political/geographic perspective on public health. The numbers are stark and tell a clear and compelling story. That said, i'm not with Hartmann on claiming that non-profit status makes such a big difference in health organization behavior. Minnesota's non-profits seemed to recklessly pursue revenue, as well. Sidebar: there is a story to tell about states like Montana, South Dakota and North Dakota where there are such stark differences among adjacent counties. I'm guessing the presence of reservations and/or oil boom territory." - Joel *** If You Want To Die Young - Take the Red Pill As giddy as Republicans are about “owning the libs,” the citizens they govern pay a tragic price for the sport Thom Hartmann Nov 21 Image by Septimiu Balica from Pixabay Share If dying young appeals to you, here’s a simple bit of advice: move to a state or county controlled by Republicans. At first glance, the images below appear to be political maps. And in the most real sense of the word they are: the county-by-county differences shown by the map from Jeremy Ney’s brilliant American Inequality Substack newsletter and the state-by-state screen shot from the CDC’s NCHS below it. Both reflect, in large part, decades of regional policy differences. Long-lived parts of America have generally embraced progressive policies dating back to FDR’s New Deal; the early-death parts of our country most often reflect conservative opposition to everything from the working-class wealth that unionization and higher minimum wages bring, to the availability of healthcare through Medicaid expansion. https://substackcdn.com/image/fetch/w_1456,c_limit,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Feb553faf-565e-477b-948f-f746b7480c81_1240x1042.png Source: American Inequality by Jeremy Ney on Substack 2019 Life Expectancy by State — Source: National Center for Health Statistics of the Centers for Disease Control To zoom out ever farther, since many conservative policies affect the entire country, consider what happened to the health of our nation in the 1980s with the Reagan Revolution. It’s particularly visible when you compare the outcomes of our healthcare system with other developed countries. Our World In Data lays it out starkly, as you will see below. Prior to the neoliberal Reagan Revolution — following a bill Nixon signed in 1973 that opened the door to for-profit HMOs — most hospitals and health insurance companies were non-profits. The non-profit Blue Cross/Blue Shield controlled much, perhaps most, of the US health insurance market until that era. Reagan also, in 1983, ordered the DOJ, FTC, and SEC to essentially stop enforcing anti-trust laws dating back to the 1891 Sherman Act, resulting in the “Mergers & Acquisitions Mania” that characterized the 1980s and inspired the “greed is good” movie Wall Street starring Michael Douglas. Health insurance companies, hospitals, and pharmaceutical manufacturers all morphed from regional and competitive organizations into giant, monopolistic predators. Their profits exploded and our lifespans collapsed. Every year now, they spread hundreds of millions of dollars around Washington DC and state capitols to prevent regulation and maintain the status quo. We are, quite literally, the only country in the world with a corrupt Supreme Court that has legalized this kind of a vicious attack on its citizens by a bought-off political party and their morbidly rich donors. The Republicans on the Supreme Court call it “free speech” but every other nation in the world knows it’s simply naked, criminal, political bribery. Le vs health exp 2020 version Source: Our World in Data As you can see above, the average American spends more than twice as much on healthcare every year as do the citizens of any other developed country in the world. And, as the Reagan Revolution really bit hard in the 1980s and 1990s, our average lifespans collapsed while corporate healthcare profits exploded. And it’s not just death by lack of healthcare that skews these statistics: if you’re concerned about being murdered, it’s also a good idea to avoid states run by conservatives. As the centrist Third Way think tank noted last month: “In 2020, per capita murder rates were 40% higher in states won by Donald Trump than those won by Joe Biden. “8 of the 10 states with the highest murder rates in 2020 voted for the Republican presidential nominee in every election this century.” It’s true of Red cities as well. Again, from Third Way: “For example, Jacksonville, a city with a Republican mayor, had 128 more murders in 2020 than San Francisco, a city with a Democrat [sic] mayor, despite their comparable populations. “In fact, the homicide rate in Speaker Nancy Pelosi’s San Francisco was half that of House Republican Leader Kevin McCarthy’s Bakersfield, a city with a Republican mayor that overwhelmingly voted for Trump.” And don’t even think about having sex in Red states: they generally lead America in sexually transmitted diseases, presumably because most have outlawed teaching sex education in their public schools. The five states with the highest rates of Chlamydia infections are Alaska, Louisiana, Mississippi, South Carolina, and New Mexico. The highest rates of Gonorrhea are in Mississippi, Alaska, South Carolina, Alabama, and Louisiana. Speaking of schools, the states with the lowest educational attainment in the nation are entirely Red states. Ranked from terrible to absolutely worst, they are: Idaho, Indiana, Oklahoma, Alabama, Nevada, Louisiana, Kentucky, Arkansas, Mississippi, and West Virginia. As giddy as Republicans are about “owning the libs,” the citizens they govern pay a tragic price for the sport. They are literally dying as conservative politicians revel in their ability to cut taxes for the rich and suppress wages and healthcare for everybody else. Republicans are about to take over the House of Representatives and begin their “investigations” into, well, anything that will distract from these terrible statistics. In the meantime, Americans, particularly those in Red states and counties, will continue to die at rates considered obscene by the standards of every other developed nation in the world. Our next chance to put America back on track will be in two years, and we damn well better get ready.

Medicare, Medicare Advantage, Medical Assistance expansion, OR Single Payer

Article link: https://buffalonews.com/lifestyles/health-med-fit/a-traumatic-brain-injury-and-500k-in-medical-debt-it-feels-unbearable-sometimes/article_d87cf454-fcba-582e-8a13-79f8ccfafcbe.html   We need to keep sharing these stories/facts about the need to stop this in the USA and join all the modern countries that don’t allow this to happen. “Mais isn’t alone. One in every five people in Texas has medical debt that is in collections, one of the highest rates in the U.S.; medical debt has become a nationwide crisis, with 13% of U.S. adults impacted by past-due medical bills, according to data collected by the Urban Institute, a Washington, D.C., public policy think tank.” After I read that article I saw this column in our local small-town daily: "Healthful Hints: Medicare, Medicare Advantage plans: Basic differences" https://www.winonadailynews.com/news/local/column/healthful-hints-medicare-medicare-advantage-plans-basic-differences/article_4df87355-1852-50d8-95f9-339d36a0b161.html   Then I submitted this LTE to the paper: Health Care Access Thank you so much for the front page article Sunday (11/13/22) about medical debt. That is a problem for so many in this country. We need to learn from other developed countries about how to avoid this problem. We have been brainwashed to think that inability to pay for unexpected medical costs is somehow a personal weakness and a way of begging other citizens to pay our bills. Big-money corporations have been responsible for our lagging behind the rest of the modern, caring world. Most of that money is with for-profit insurance companies who are now taking over more and more of our actual medical providers. (BTW – insurance companies DO NOT provide care – they make money by not caring). Then on page 5 of the 11/13 edition, you had the Dr. Bures column. This time he talked about Medicare. He does not take sides but he does show the difference between Medicare and Medicare Advantage. I have been retired and covered by Medicare for many years. I am so grateful to the insurance agent who years ago recommended regular Medicare with a supplemental plan of my own instead of the Advantage plan offered by insurance companies. It provided me with freedom of choice and has worked well. Insurance companies give millions to members of congress and spend millions on advertising to keep making more and more money off of our need for medical care. I don’t want a for-profit company between me and my medical providers. We need to do what so many countries have done and make a simple single-payer medical care payment system part of how we treat our citizens. It should be treated like public schools, public roads, fire departments, police departments, etc. The government pays our private providers. Our access to health care without the risk of bankruptcy should NOT be in the hands of for-profit companies. Craig Brooks

A traumatic brain injury and $500k in medical debt: 'It feels unbearable sometimes'

Article about just how unbearable it is and that it should be for our country to allow this to happen to so many. Link to article "Mais isn’t alone. One in every five people in Texas has medical debt that is in collections, one of the highest rates in the U.S.; medical debt has become a nationwide crisis, with 13% of U.S. adults impacted by past-due medical bills, according to data collected by the Urban Institute, a Washington, D.C., public policy think tank."

Private Equity is Not Good for Your Health