Over the past few days, both CVS/Aetna and Humana admitted to Wall Street that their Medicare Advantage plans are not nearly as profitable as those insurers had predicted a year ago.
Nearly one-hundred years ago, Supreme Court Justice Louis Brandeis said: "We can have democracy in this country, or we can have great wealth concentrated in the hands of the few, but we can't have both." The ensuing century did little to change this country's ongoing trajectory toward the latter, at the expense of the former.
Today's "healthcare providers" and "health insurers" are modern-day robber-barons, pilllaging government coffers funded by We The People - the very people these thieves are denying Healthcare to, and endangering with their callous, sociopathic pursuit of profit. We need to cut them out of the "body politic." They are a cancer on our democracy.
Right on Squid about health insurers, but health care providers are your doctors and PAs and NPs and we are all definitely in this with yall patients. We are also being pillaged- we are not the pillagers.
These advantage plans take advantage of both patients and providers, and the only way out of this is to gang up together. It’s us against them, and together (if we go Blue again) we can craft a system like the rest of the damn modern world has done. It’s not reinventing the wheel.
It doesn’t have to be this way if patients and doctors band together to elect people who will listen.
I don’t see the Democrats ever fixing healthcare. Bernie was the last to try. All we will get from them is little fixes here and there for the ACA. Kamala Harris made it very clear that she does not support Single Payer Healthcare.
Hey Doc -- My reference to "health care providers" should have perhaps been more specific, as I know that physicians are often "victims" of this totally depraved healthcare system, just as much as their patients. I am directing that phrase at "Hospital Systems" and their affiliated clinics, both for-profit and so-called "non profit" in nature. They are both/all about the bottom-line, and the ones operating under the guise of a "charitable" 501(c)3 are frequently as bad, or worse, than the for-profit entities.
As an example, the only Hospital System in my local vicinity, the Land of Enchantment --and disenchantment with so-called "healthcare" -- is CHRISTUS Health System (operates in several SW states, and is headquartered in corporation-loving Texas, land of the crooked AG Ken Paxton, who aids-and-abets corporate theft, as embezzlement is in his own personal wheelhouse). CHRISTUS Health's CEO, Ernie Sadau, makes a cool 20 million a year (14 mil. salary, plus about 6,8 million in "other benefits.") He is one of the highest paid CEOs for a "non-profit" in the entire country, and that annual compensation headlines a roster of several other executive-suite players also making 8-figure annual salaries. How can a "charity" afford those exorbitant pay-packages? Well, of course, it is off the backs/pocketbooks of their patients, who often pay triple and quadruple the bluebook established rates for healthcare procedures. Many people in this poor state forego healthcare entirely, due to the overwhelmingly high fees charged.
So, no, I wasn't slandering doctors, so much as their profit-loving overlords. If I were a Catholic and/or Christian, as CEO Ernie Sadau claims to be, I would be inclined to quote the Bible to him -- specifically Luke 18:25. "It is easier for a camel to go through the eye of a needle, than for a rich man to enter the Kingdom of Heaven." Ol' Ernie is all about padding his wallet in the here-and-now. The hypocrisy is appalling.
Oh I love the way you think Squid! And a buncha y’all can really crystallize the issues well. Love reading here.
Christus having Christ in its name is positively Orwellian, isn’t it? So is Ascension Health Care! Nonprofit my ass!
I live in Austin, and you are so right about the Abbott/Paxton/Patrick crew that welcomes these corporations, but prevents any progress toward improving Texas’ dismal health care statistics, or the lives of actual Texans.
I can tell we would have great conversations on this topic if we could hold a salon as in the Age of Enlightenment France.
Would love to hear Benjamin Franklin and Alexander Hamilton hold forth on health care today!
I know right? It should be all over the media,but no one even knows because it’s hardly covered. To be fair, the health care economy is so byzantine and boring to explain that it even puts other doctors to sleep!
But looks like Lina Khan at FTC may get to continue her good work in 2025 with the Kamalamentum we got going, and maybe after the election this important topic can be broadcast more widely. Everyone is a patient, so everyone has a story of health care injustice.
We need you thinkers and writers to dive into this and help craft the message more succinctly so we can reach more people. Raise the awareness.
Because I think their plan (the INSCOs) will be to just dump it all and abandon insurance entirely if push comes to shove and they no longer make usurious profits. After all, they’re just financial industries anyway and they got their trillions already. They just squeezing the last dregs out of the bag.
They’re gonna leave we the people holding the bag.
It’s what private equity is doing in medicine on the microcosm. It’s their M.O.
We need to look hard at the German system and put some restrictions on these monopolies with their vertical consolidation of the entire health care economy.
Writers, help us who advocate for change make the messaging more understandable so we can go on the attack🐛🦋
I would like to see underwriting removed for MA participants who want to switch to traditional Medicare and a supplement after the first-year deadline. Several states have barred underwriting. Why can't Congress include that in any reforms they develop?
Besides just getting rid of Underwriting, it would be great if Medicare covered 100% Instead of just 80%. Medigap insurance for plan G would not be affordable for a lot of seniors.
National single-payer universal health care is the obvious solution to these profiteering problems, yet it seems to have lost favor with the Democratic establishment. How do we get it back into the platform? At the very least, the State Based Universal Health Care Act (HB 6270 and S 4817) should be front and center, as the practical application of this 2020 Democratic platform statement: "Democrats will also empower the states, as laboratories of democracy, to use Affordable Care Act innovation waivers to develop locally tailored approaches to health coverage, including by removing barriers to states that seek to experiment with statewide universal health care approaches" (p. 28).
The Congress MUST step in and enable Medicare Advantage patients to transfer back to Traditional Medicare with all the benefits, but without price gouging on the supplemental packages or resorting to the discriminatory policy of pre-existing conditions. These big health carriers have failed American seniors who cannot afford the greed of private insurers who are only concerned with their corporations bottom-line. Congress is to blame for allowing the privatization of Medicare to the detriment of Senior’s Rights to a dignified retirement and quality healthcare. Corporate healthcare is an abysmal FAILURE, and it is high time that we Americans own up to these mistakes and fix the system instead of sitting around and allowing the cruel exploitation of Medicare recipients.
How many more Medicare Advantage patients are going to Die because our politicians are in bed with Corporate Insurers who are unscrupulously exploiting patients. Who are these politicians supposed to Represent, Corporate Greed or the citizens of the United States of America.
Many people do not know Part C is private for profit health insurance companies. Many people do not know that CMS (aka taxpayers) hand over at least $12,000 annually for every person sold a part C (aka disadvantage plan).
Also these for profit private insurance companies have infiltrated State Retirement Systems
WTF they can just dump the patients that are too expensive and leave them hanging? These assholes totally took “advantage” of our seniors and now they can abandon them? How can that be allowed- they got federal Medicare dollars from us! Who decided that was legal? They’re our elders for Gods sake!
No other country does this to their elders.
Y’all look on Wikipedia at German health care system and German longterm care and see what is possible. They pay taxes, we pay premiums and taxes, but got no safety net. Even for our elders.
These should not be on the stock market. Making money off of denying care to people is appalling. We need nonprofit health care. The bloat in MA plans with all their bureaucracy and spin and then execs making millions is truly unethical
Is it possible that this is part of the current lobbying campaign by MA companies to prevent CMS from stopping the over-payments? I see signs of a manufactured grassroots letter-writing campaign in letters to the editor pleading to protect their Medicare Advantage plans from “cuts.”
While I was still in teh work force and had a solid relationship with my Doctor the practice switched to a concierge set up and I was priced out of continuing and had to look elsewhere. It seemed very selective and costly but I am curious as to how such "selective groups" have fared in the Medicare and Medicare advantage world. As I recall the membership cost was 150.00 a month and then you could start paying for medical services and access to offered providers. I was lucky to see my Primary Care physician for 15 minutes a year, so I felt the program was a club I could not afford.
Interesting article Wendell. However, what is your solution to the problem? If you say that government should take over all healthcare for Americans, then the government will decide on how healthcare when and how is delivered. What the government givith the government takith. As costs continue to rise and there is not enough funding the government will assuredly reduce access and care. It’s happened in every country that controls healthcare.
Read TR Reid’s the healing of America. Germany and France have systems that work. Even our EMRs gouge us. Lots of parasites in healthcare business. Maybe there is a role for Ivermectin after all
That may be true. However, their systems were developed decades ago and so they have grown organically during that time. Also, and to the best of my knowledge, France and Germany pay for medical education so those wishing to be doctors don't come into the profession with education debt. Regardless, France and Germany do ration care. I noticed that no one is citing England or Canada.
All this being said, there is no doubt that the US could do a much better job overall with primary care. Also, the best example is the Austrian public/private partnership. This partnership allows private insurance to work along side the government healthcare.
When government controls healthcare (as it does education and to a increasing extent housing), bureaucrats start making decisions on what they think is best for the population, and many times they will be influenced by politics. We all know what happens when politics are involved.
Does the prevalence of GLP-1's play a role in this? Could someone help me understand how Aetna/CVS sets their formulary for those drugs for the MA population? If they wanted to shift more of the cost burden to patients, how would they go about doing that, and how quickly can they make that change?
Can someone run this by the Magic Translation Box:
On the inpatient (hospital admissions)…we do within our utilization management programs, have what we call a frontend review process. So we are reviewing those authorizations in real-time as they come in for things like medical necessity and site of service effectively…There is also activity that we do after the claim comes in, which we call a postpay review, where there are some incremental opportunities to just review, again the more specificity on that claim to make sure it's appropriate and we get value from both sides of that.
Nearly one-hundred years ago, Supreme Court Justice Louis Brandeis said: "We can have democracy in this country, or we can have great wealth concentrated in the hands of the few, but we can't have both." The ensuing century did little to change this country's ongoing trajectory toward the latter, at the expense of the former.
Today's "healthcare providers" and "health insurers" are modern-day robber-barons, pilllaging government coffers funded by We The People - the very people these thieves are denying Healthcare to, and endangering with their callous, sociopathic pursuit of profit. We need to cut them out of the "body politic." They are a cancer on our democracy.
Right on Squid about health insurers, but health care providers are your doctors and PAs and NPs and we are all definitely in this with yall patients. We are also being pillaged- we are not the pillagers.
These advantage plans take advantage of both patients and providers, and the only way out of this is to gang up together. It’s us against them, and together (if we go Blue again) we can craft a system like the rest of the damn modern world has done. It’s not reinventing the wheel.
It doesn’t have to be this way if patients and doctors band together to elect people who will listen.
I don’t see the Democrats ever fixing healthcare. Bernie was the last to try. All we will get from them is little fixes here and there for the ACA. Kamala Harris made it very clear that she does not support Single Payer Healthcare.
Hey Doc -- My reference to "health care providers" should have perhaps been more specific, as I know that physicians are often "victims" of this totally depraved healthcare system, just as much as their patients. I am directing that phrase at "Hospital Systems" and their affiliated clinics, both for-profit and so-called "non profit" in nature. They are both/all about the bottom-line, and the ones operating under the guise of a "charitable" 501(c)3 are frequently as bad, or worse, than the for-profit entities.
As an example, the only Hospital System in my local vicinity, the Land of Enchantment --and disenchantment with so-called "healthcare" -- is CHRISTUS Health System (operates in several SW states, and is headquartered in corporation-loving Texas, land of the crooked AG Ken Paxton, who aids-and-abets corporate theft, as embezzlement is in his own personal wheelhouse). CHRISTUS Health's CEO, Ernie Sadau, makes a cool 20 million a year (14 mil. salary, plus about 6,8 million in "other benefits.") He is one of the highest paid CEOs for a "non-profit" in the entire country, and that annual compensation headlines a roster of several other executive-suite players also making 8-figure annual salaries. How can a "charity" afford those exorbitant pay-packages? Well, of course, it is off the backs/pocketbooks of their patients, who often pay triple and quadruple the bluebook established rates for healthcare procedures. Many people in this poor state forego healthcare entirely, due to the overwhelmingly high fees charged.
So, no, I wasn't slandering doctors, so much as their profit-loving overlords. If I were a Catholic and/or Christian, as CEO Ernie Sadau claims to be, I would be inclined to quote the Bible to him -- specifically Luke 18:25. "It is easier for a camel to go through the eye of a needle, than for a rich man to enter the Kingdom of Heaven." Ol' Ernie is all about padding his wallet in the here-and-now. The hypocrisy is appalling.
Oh I love the way you think Squid! And a buncha y’all can really crystallize the issues well. Love reading here.
Christus having Christ in its name is positively Orwellian, isn’t it? So is Ascension Health Care! Nonprofit my ass!
I live in Austin, and you are so right about the Abbott/Paxton/Patrick crew that welcomes these corporations, but prevents any progress toward improving Texas’ dismal health care statistics, or the lives of actual Texans.
I can tell we would have great conversations on this topic if we could hold a salon as in the Age of Enlightenment France.
Would love to hear Benjamin Franklin and Alexander Hamilton hold forth on health care today!
Right on and write on y’all 🪶
Spot on! Why isn’t this making front page news?
I know right? It should be all over the media,but no one even knows because it’s hardly covered. To be fair, the health care economy is so byzantine and boring to explain that it even puts other doctors to sleep!
But looks like Lina Khan at FTC may get to continue her good work in 2025 with the Kamalamentum we got going, and maybe after the election this important topic can be broadcast more widely. Everyone is a patient, so everyone has a story of health care injustice.
We need you thinkers and writers to dive into this and help craft the message more succinctly so we can reach more people. Raise the awareness.
Because I think their plan (the INSCOs) will be to just dump it all and abandon insurance entirely if push comes to shove and they no longer make usurious profits. After all, they’re just financial industries anyway and they got their trillions already. They just squeezing the last dregs out of the bag.
They’re gonna leave we the people holding the bag.
It’s what private equity is doing in medicine on the microcosm. It’s their M.O.
We need to look hard at the German system and put some restrictions on these monopolies with their vertical consolidation of the entire health care economy.
Writers, help us who advocate for change make the messaging more understandable so we can go on the attack🐛🦋
I would like to see underwriting removed for MA participants who want to switch to traditional Medicare and a supplement after the first-year deadline. Several states have barred underwriting. Why can't Congress include that in any reforms they develop?
Besides just getting rid of Underwriting, it would be great if Medicare covered 100% Instead of just 80%. Medigap insurance for plan G would not be affordable for a lot of seniors.
They could but won’t because evil
National single-payer universal health care is the obvious solution to these profiteering problems, yet it seems to have lost favor with the Democratic establishment. How do we get it back into the platform? At the very least, the State Based Universal Health Care Act (HB 6270 and S 4817) should be front and center, as the practical application of this 2020 Democratic platform statement: "Democrats will also empower the states, as laboratories of democracy, to use Affordable Care Act innovation waivers to develop locally tailored approaches to health coverage, including by removing barriers to states that seek to experiment with statewide universal health care approaches" (p. 28).
The Congress MUST step in and enable Medicare Advantage patients to transfer back to Traditional Medicare with all the benefits, but without price gouging on the supplemental packages or resorting to the discriminatory policy of pre-existing conditions. These big health carriers have failed American seniors who cannot afford the greed of private insurers who are only concerned with their corporations bottom-line. Congress is to blame for allowing the privatization of Medicare to the detriment of Senior’s Rights to a dignified retirement and quality healthcare. Corporate healthcare is an abysmal FAILURE, and it is high time that we Americans own up to these mistakes and fix the system instead of sitting around and allowing the cruel exploitation of Medicare recipients.
How many more Medicare Advantage patients are going to Die because our politicians are in bed with Corporate Insurers who are unscrupulously exploiting patients. Who are these politicians supposed to Represent, Corporate Greed or the citizens of the United States of America.
The politicians work for their Big Donors and the Big Donors want our Healthcare System to stay as it is - Private and For Profit.
Agree wholeheartedly! Corporate health care is an abysmal failure….how do they capitalize on illness and injury? Where the profit? In our CMS funds!
Actually health care is an expense- and the profit is in health and longevity.
Many people do not know Part C is private for profit health insurance companies. Many people do not know that CMS (aka taxpayers) hand over at least $12,000 annually for every person sold a part C (aka disadvantage plan).
Also these for profit private insurance companies have infiltrated State Retirement Systems
And George W Bush
WTF they can just dump the patients that are too expensive and leave them hanging? These assholes totally took “advantage” of our seniors and now they can abandon them? How can that be allowed- they got federal Medicare dollars from us! Who decided that was legal? They’re our elders for Gods sake!
No other country does this to their elders.
Y’all look on Wikipedia at German health care system and German longterm care and see what is possible. They pay taxes, we pay premiums and taxes, but got no safety net. Even for our elders.
This should be headline news. Thank you for keeping us up to date!
These should not be on the stock market. Making money off of denying care to people is appalling. We need nonprofit health care. The bloat in MA plans with all their bureaucracy and spin and then execs making millions is truly unethical
Can you explain how they jettison these enrollees? Increase the price to make it unsustainable for them, or what?
My experience is that stop their coverage rather abruptly - it is horrible
Is it possible that this is part of the current lobbying campaign by MA companies to prevent CMS from stopping the over-payments? I see signs of a manufactured grassroots letter-writing campaign in letters to the editor pleading to protect their Medicare Advantage plans from “cuts.”
While I was still in teh work force and had a solid relationship with my Doctor the practice switched to a concierge set up and I was priced out of continuing and had to look elsewhere. It seemed very selective and costly but I am curious as to how such "selective groups" have fared in the Medicare and Medicare advantage world. As I recall the membership cost was 150.00 a month and then you could start paying for medical services and access to offered providers. I was lucky to see my Primary Care physician for 15 minutes a year, so I felt the program was a club I could not afford.
Interesting article Wendell. However, what is your solution to the problem? If you say that government should take over all healthcare for Americans, then the government will decide on how healthcare when and how is delivered. What the government givith the government takith. As costs continue to rise and there is not enough funding the government will assuredly reduce access and care. It’s happened in every country that controls healthcare.
Look at Germany
Read TR Reid’s the healing of America. Germany and France have systems that work. Even our EMRs gouge us. Lots of parasites in healthcare business. Maybe there is a role for Ivermectin after all
That may be true. However, their systems were developed decades ago and so they have grown organically during that time. Also, and to the best of my knowledge, France and Germany pay for medical education so those wishing to be doctors don't come into the profession with education debt. Regardless, France and Germany do ration care. I noticed that no one is citing England or Canada.
All this being said, there is no doubt that the US could do a much better job overall with primary care. Also, the best example is the Austrian public/private partnership. This partnership allows private insurance to work along side the government healthcare.
When government controls healthcare (as it does education and to a increasing extent housing), bureaucrats start making decisions on what they think is best for the population, and many times they will be influenced by politics. We all know what happens when politics are involved.
Does the prevalence of GLP-1's play a role in this? Could someone help me understand how Aetna/CVS sets their formulary for those drugs for the MA population? If they wanted to shift more of the cost burden to patients, how would they go about doing that, and how quickly can they make that change?
Can someone run this by the Magic Translation Box:
On the inpatient (hospital admissions)…we do within our utilization management programs, have what we call a frontend review process. So we are reviewing those authorizations in real-time as they come in for things like medical necessity and site of service effectively…There is also activity that we do after the claim comes in, which we call a postpay review, where there are some incremental opportunities to just review, again the more specificity on that claim to make sure it's appropriate and we get value from both sides of that.