Today in HEALTH CARE un-covered, Wendell Potter writes:
"One of those weaknesses – at least from investors’ point of view – is the company’s continuing inability to keep many of the 45 million people enrolled in its health plans from getting the care they need. The company’s medical loss ratio – the share of premiums that actually goes to pay medical claims – was significantly higher during the past quarter compared to the same quarter last year.”
The shareholder model is the very reason patients cannot access the medical care they need. Denial of Care Harm-for-Profit is the business model.
Elevance’s shareholders are either will-fully or naively ignorant regarding the role they each play in the company’s continuing choice to keep our premium-paying fellow American citizens who are enrolled in its investment bank float scam from accessing the medical care they need.
Elevance’s crime rap sheet is long.
On June 1st, Arizona Attorney General Kris Mayes filed a major lawsuit accusing the “healthcare pricing” grifter MultiPlan and eight of the nation's largest commercial health insurance investment banks of working together to artificially slash what doctors and hospitals get paid for out-of-network care. That is not a victimless crime.
Attorney General Mayes announced the legal action against MultiPlan and the largest commercial health insurance investment banks including Aetna, Cigna, UnitedHealthcare, Humana, Elevance, Molina, Centene, and Health Care Service Corporation during a press conference standing side-by-side with physicians who articulated the harm the long-running crime imposed on their patients and practices.
The complaint filed in Maricopa County Superior Court alleges the companies spent years building and operating a system that used a shared algorithm to determine reimbursement rates. This is a collusion and price-fixing crime architected to obstruct and impede medical care.
The ethics and morals bar is now so low for commercial health insurance investment bank executives and shareholders, they purport to believe they are investing in providing medical care, when in fact, they are investing in securities, real estate, bonds, private equity and other investments.
This premise—that shareholders are “punishing” a company by dumping—is next level Pollyannaism. We must change this enabling dialogue. We must stop perpetuating and rationalizing Denial of Care Harm-for-Profit as a business model. We must expect better from one another.
It is time to disempower commercial health insurance investment banks (and their greedy shareholders) by honestly speaking out about how they operate and how much preventable harm and death they cause.
In fact, it is time to “punish” shareholders who have generated personal wealth from the Denial of Care Harm-for-Profit business model. It is time to pass Senate Bill 1506/HR 3069—Single Payer Universal Healthcare / National Improved Medicare for All.
Since the Potter post above does mention both the ACA on-exchange cuts (that already happened) and the ACA expanded Medicaid cuts that are mostly ahead of us, after the midterms at the start of next year, I guess I will put up my latest summary of the coverage-dropping numbers, as well as the very substantial propaganda effort to cover up the damage.
Note this is similar to a post yesterday, which covered the same information, but re-ordered.
I will run through a pair of Washington Post editorials from Jeff. One from just two days ago 7/14/26, the other 7/10/26. They are both vacuous but effective as propaganda in the way vacuous things can be effective as propaganda.
There are other new things as well. The "Let Them Eat Pancakes" initiative. Other stuff. Let me lay them out.
1) THE 7/14/26 WASHINGTON POST EDITORIAL
entitled
“Medicaid Fraud Control Units aren’t doing enough to control fraud Indictments and convictions are down, despite a surge in funding.”
The editorial continues in the logically vacuous style of the prior one, apparently attempting to have people just see “ACA—FRAUD—BAD—STUPID DEMOCRATS WHO LET EVERYONE CHEAT”, which a certain class of minds take as equivalent to airtight reasoning.
So, that approach seems to be most evident at the very end, with, in the last paragraph:
“Targeting waste and abuse is necessary but not sufficient to save Medicaid, whose costs have ballooned in unsustainable ways because of the Affordable Care Act.”
This may need an explainer—as to why Medicaid costs have gone up—”ballooned in unsustainable ways” is, of course, wording chosen for the benefit of those who get mixed up between words and actual content):
Medicaid costs have gone up quite a bit with the Affordable Care Act, because a new part of Medicaid was added, expanded Medicaid.
Expanded Medicaid is part of the ACA, and covers about 20 million people now. It is the way people without other health coverage, such as from an employer, who are below 138% of the Federal Poverty Level (FPL), get coverage. (There is no asset test—people below 138% of FPL get it regardless of assets—done to make the system airtight and leave no one out.) So, they get expanded Medicaid. (Without the expanded Medicaid, they would not have coverage unless they dropped down to being dirt poor in BOTH income and assets to qualify for traditional, pre-ACA Medicaid, which still exists.) The expanded Medicaid people cannot get subsidized on-exchange coverage, as the ACA structure prohibits them from doing that. This provision of the ACA was done as a cost-saving measure, to keep the lower-income group getting services paid for by the government at the lower Medicaid reimbursement rates.)
Beyond the “fraud” and “ballooned in unsustainable ways” wording to manipulate the less-analytically-discerning, which is the apparent purpose of the editorial,
NOTE THESE:
BIG ONE, in the quoted text: “but not sufficient”!!!
More fully: “Targeting waste and abuse is necessary but not sufficient”.
Do you see that? Thinking caps, the logically capable. Those cuts from OBBB. (Not in effect yet. They go into effect right after the midterms. Coming. Sure to bring chaos and uninsurance to many.)
Begging the question here on “not sufficient” (in the old fashioned logic meaning—not the newer “raises the question” sense.)
Also:
We don’t see much in dollar amounts of the fraud. Keeping dollar amounts out of perspective is a repeated technique of these guys. A millions, a billion, a trillion—what’s the difference—they all rhyme, after all?
and I don’t have a dollar number on tax loopholes, which would be separate. And I wonder how much the administration is doing about that. (It would be Scott Bessant, not Dr. Oz.)
2) The 7/10/26 Washington Post Editorial, which I find so problematic I have a full POST on it. It has a $5.898 number from the "Paragon Health Institute" in it which I am proud to say I was able to trace the origin of quickly owing to my work on a graph (which I'm pretty sure is wildly off or intentionally deceptive) from same Paragon entity, used to justify the non-extension of the ACA expanded subsidies 8 months ago.
My post on that 7/10/26 editorial, where I found a problem or two, and a vacuousness, here
you can get back to the Paragon graph of 8 months ago-- which was on the exact same data--if you are interested in that.)
3) The “phantoms” in both CMS and Paragon Health Institute reports taken to questionably indicate massive "fraud"; they had to switch to “ghosts” because they may have figured too many of those targeted didn’t know what the word “phantom” means, explored here:
5) Then you’ve got the huge and increasing coverage number drops are supposed to all be from stopping the fraud. This is a place with the "phantoms" term. (Baloney:
But I have two extra bonus reasons to have cancelled if you want them.
1) Within my item (6), there is referenced a leak from CMS that a misrepresentation that the complete cause of large coverage drop numbers on the ACA exchanges is the administration's successful crackdown on fraud. This false claim from CMS actually did wind up happening (in my item (5)).
The leak was here: https://www.notus.org/healthcare/aca-healthcare-dropped-insurance-numbers-subsidies , which is a NOTUS report by Paige Winfield Cunningham. Ms. Cunningham was a health-system reporter before the Washington Post, who my guess is (I don't know for sure), was removed from the Post in the large recent trimming back of its staff.
2) This thing, which I spotted in the Washington Post recently:
entitled "Why health insurance premiums are set to skyrocket in 2027."
Those who are Washington Post subscribers (not you, Nancie!), will observe, if you click on it, it is behind a special additional paywall.
Which it says is:
"The Washington Post's newest suite of services providing senior executives with the insights and connections they need to navigate critical issues."
So, you see, we have pretty basic information needed to participate in our political process, and Jeff decided to put it behind a special paywall to keep himself from draining out all of his money which would happen very quickly if he didn’t put the special paywall 😊. (I haven’t checked the cost, but it’s for "senior" executives. Not just "executives". "Senior" executives.)
Yesterday republicans prevailed 50-46 S.J. 198in favor of unqualified wiser of Oz. Continuing an illegal 10 year pilot program in six states to deny care to people on beloved traditional Medicare. This will pay AI ventures to allow profit over seniors.
Today in HEALTH CARE un-covered, Wendell Potter writes:
"One of those weaknesses – at least from investors’ point of view – is the company’s continuing inability to keep many of the 45 million people enrolled in its health plans from getting the care they need. The company’s medical loss ratio – the share of premiums that actually goes to pay medical claims – was significantly higher during the past quarter compared to the same quarter last year.”
The shareholder model is the very reason patients cannot access the medical care they need. Denial of Care Harm-for-Profit is the business model.
Elevance’s shareholders are either will-fully or naively ignorant regarding the role they each play in the company’s continuing choice to keep our premium-paying fellow American citizens who are enrolled in its investment bank float scam from accessing the medical care they need.
Elevance’s crime rap sheet is long.
On June 1st, Arizona Attorney General Kris Mayes filed a major lawsuit accusing the “healthcare pricing” grifter MultiPlan and eight of the nation's largest commercial health insurance investment banks of working together to artificially slash what doctors and hospitals get paid for out-of-network care. That is not a victimless crime.
Attorney General Mayes announced the legal action against MultiPlan and the largest commercial health insurance investment banks including Aetna, Cigna, UnitedHealthcare, Humana, Elevance, Molina, Centene, and Health Care Service Corporation during a press conference standing side-by-side with physicians who articulated the harm the long-running crime imposed on their patients and practices.
The complaint filed in Maricopa County Superior Court alleges the companies spent years building and operating a system that used a shared algorithm to determine reimbursement rates. This is a collusion and price-fixing crime architected to obstruct and impede medical care.
The ethics and morals bar is now so low for commercial health insurance investment bank executives and shareholders, they purport to believe they are investing in providing medical care, when in fact, they are investing in securities, real estate, bonds, private equity and other investments.
This premise—that shareholders are “punishing” a company by dumping—is next level Pollyannaism. We must change this enabling dialogue. We must stop perpetuating and rationalizing Denial of Care Harm-for-Profit as a business model. We must expect better from one another.
It is time to disempower commercial health insurance investment banks (and their greedy shareholders) by honestly speaking out about how they operate and how much preventable harm and death they cause.
In fact, it is time to “punish” shareholders who have generated personal wealth from the Denial of Care Harm-for-Profit business model. It is time to pass Senate Bill 1506/HR 3069—Single Payer Universal Healthcare / National Improved Medicare for All.
You said, "This is a collusion and price-fixing crime architected to obstruct and impede medical care."
Nobody should profit from denying care.
Denying care along with vertical systems that inflate prices and prevent competition is the foundation for the FOR PROFIT healthcare industry.
VIVA
Since the Potter post above does mention both the ACA on-exchange cuts (that already happened) and the ACA expanded Medicaid cuts that are mostly ahead of us, after the midterms at the start of next year, I guess I will put up my latest summary of the coverage-dropping numbers, as well as the very substantial propaganda effort to cover up the damage.
Note this is similar to a post yesterday, which covered the same information, but re-ordered.
I will run through a pair of Washington Post editorials from Jeff. One from just two days ago 7/14/26, the other 7/10/26. They are both vacuous but effective as propaganda in the way vacuous things can be effective as propaganda.
There are other new things as well. The "Let Them Eat Pancakes" initiative. Other stuff. Let me lay them out.
1) THE 7/14/26 WASHINGTON POST EDITORIAL
entitled
“Medicaid Fraud Control Units aren’t doing enough to control fraud Indictments and convictions are down, despite a surge in funding.”
and is here:
https://www.washingtonpost.com/opinions/2026/07/14/medicaid-fraud-control-units-arent-doing-enough-control-fraud/ .
The editorial continues in the logically vacuous style of the prior one, apparently attempting to have people just see “ACA—FRAUD—BAD—STUPID DEMOCRATS WHO LET EVERYONE CHEAT”, which a certain class of minds take as equivalent to airtight reasoning.
So, that approach seems to be most evident at the very end, with, in the last paragraph:
“Targeting waste and abuse is necessary but not sufficient to save Medicaid, whose costs have ballooned in unsustainable ways because of the Affordable Care Act.”
This may need an explainer—as to why Medicaid costs have gone up—”ballooned in unsustainable ways” is, of course, wording chosen for the benefit of those who get mixed up between words and actual content):
Medicaid costs have gone up quite a bit with the Affordable Care Act, because a new part of Medicaid was added, expanded Medicaid.
Expanded Medicaid is part of the ACA, and covers about 20 million people now. It is the way people without other health coverage, such as from an employer, who are below 138% of the Federal Poverty Level (FPL), get coverage. (There is no asset test—people below 138% of FPL get it regardless of assets—done to make the system airtight and leave no one out.) So, they get expanded Medicaid. (Without the expanded Medicaid, they would not have coverage unless they dropped down to being dirt poor in BOTH income and assets to qualify for traditional, pre-ACA Medicaid, which still exists.) The expanded Medicaid people cannot get subsidized on-exchange coverage, as the ACA structure prohibits them from doing that. This provision of the ACA was done as a cost-saving measure, to keep the lower-income group getting services paid for by the government at the lower Medicaid reimbursement rates.)
Beyond the “fraud” and “ballooned in unsustainable ways” wording to manipulate the less-analytically-discerning, which is the apparent purpose of the editorial,
NOTE THESE:
BIG ONE, in the quoted text: “but not sufficient”!!!
More fully: “Targeting waste and abuse is necessary but not sufficient”.
Do you see that? Thinking caps, the logically capable. Those cuts from OBBB. (Not in effect yet. They go into effect right after the midterms. Coming. Sure to bring chaos and uninsurance to many.)
Begging the question here on “not sufficient” (in the old fashioned logic meaning—not the newer “raises the question” sense.)
Also:
We don’t see much in dollar amounts of the fraud. Keeping dollar amounts out of perspective is a repeated technique of these guys. A millions, a billion, a trillion—what’s the difference—they all rhyme, after all?
So, note total federal spending on health care is about $1.9 trillion a year. That would be 1,900 billion. (From https://www.kff.org/medicaid/what-does-the-federal-government-spend-on-health-care/ )
Meanwhile, I don’t see any dollar amounts in this thing: https://thefga.org/research/americas-medicaid-fraud-control-units-are-failing-their-mission/ that the Wa Po editorial refrenced from this “Foundation for Government Accountability” think tank that they reference.
They also seem to have left off a comparator, that tax evasion in the U.S. is about $700 billion a year https://siepr.stanford.edu/news/mapping-maze-where-irs-could-find-billions-unpaid-taxes
and I don’t have a dollar number on tax loopholes, which would be separate. And I wonder how much the administration is doing about that. (It would be Scott Bessant, not Dr. Oz.)
2) The 7/10/26 Washington Post Editorial, which I find so problematic I have a full POST on it. It has a $5.898 number from the "Paragon Health Institute" in it which I am proud to say I was able to trace the origin of quickly owing to my work on a graph (which I'm pretty sure is wildly off or intentionally deceptive) from same Paragon entity, used to justify the non-extension of the ACA expanded subsidies 8 months ago.
My post on that 7/10/26 editorial, where I found a problem or two, and a vacuousness, here
https://normspier828307.substack.com/p/washington-post-editorial-71026-i , and, from there,
you can get back to the Paragon graph of 8 months ago-- which was on the exact same data--if you are interested in that.)
3) The “phantoms” in both CMS and Paragon Health Institute reports taken to questionably indicate massive "fraud"; they had to switch to “ghosts” because they may have figured too many of those targeted didn’t know what the word “phantom” means, explored here:
https://substack.com/@normspier828307/note/c-288953391
4) Then you’ve got Dr. Oz, with his four wild deceptions, on the National Mall, as part of the new “Let Them Eat Pancakes” campaign:
https://substack.com/@normspier828307/note/c-289373653
5) Then you’ve got the huge and increasing coverage number drops are supposed to all be from stopping the fraud. This is a place with the "phantoms" term. (Baloney:
https://normspier828307.substack.com/p/the-administrations-claim-in-the
based on the same CMS report as the Jonathan Cohn post as the one that included the Trump Death Panels:
https://www.thebulwark.com/p/donald-trump-is-bringing-back-death-panels (note this one behind a Bulwark Substack paywall)
6) Then you’ve got the earlier leak from CMS that the false due-to-fraud explanation was coming
https://normspier828307.substack.com/p/loss-of-aca-coverage-after-republicans
kind of similar in content to the Jonathan Cohn Post on phantoms:
https://www.thebulwark.com/p/obamacare-phantom-menace-aca-fraud-trump-oz-insurance-coverage (again, behind a Bulwark Substack Paywall)
Thanks for reminding me why I cancelled my subscription to the Washington Post.
O.K.
But I have two extra bonus reasons to have cancelled if you want them.
1) Within my item (6), there is referenced a leak from CMS that a misrepresentation that the complete cause of large coverage drop numbers on the ACA exchanges is the administration's successful crackdown on fraud. This false claim from CMS actually did wind up happening (in my item (5)).
The leak was here: https://www.notus.org/healthcare/aca-healthcare-dropped-insurance-numbers-subsidies , which is a NOTUS report by Paige Winfield Cunningham. Ms. Cunningham was a health-system reporter before the Washington Post, who my guess is (I don't know for sure), was removed from the Post in the large recent trimming back of its staff.
2) This thing, which I spotted in the Washington Post recently:
https://wpintelligence.washingtonpost.com/topics/health-care/2026/07/08/why-health-insurance-premiums-are-set-skyrocket-2027/
entitled "Why health insurance premiums are set to skyrocket in 2027."
Those who are Washington Post subscribers (not you, Nancie!), will observe, if you click on it, it is behind a special additional paywall.
Which it says is:
"The Washington Post's newest suite of services providing senior executives with the insights and connections they need to navigate critical issues."
So, you see, we have pretty basic information needed to participate in our political process, and Jeff decided to put it behind a special paywall to keep himself from draining out all of his money which would happen very quickly if he didn’t put the special paywall 😊. (I haven’t checked the cost, but it’s for "senior" executives. Not just "executives". "Senior" executives.)
Yesterday republicans prevailed 50-46 S.J. 198in favor of unqualified wiser of Oz. Continuing an illegal 10 year pilot program in six states to deny care to people on beloved traditional Medicare. This will pay AI ventures to allow profit over seniors.
what a disgrace and its will continue on and on
M4A is economic justice. Medicare for ALL acts cover ALL.
“care their doctors say they need”
Private for-profit commercial health insurance industry is not aware of that truth.