Interested in health care? This is what you should be reading.

I had a bumper sticker on my old Wrangler that told folks, “If you’re not outraged, you’re not paying attention.” It made me feel so smug. Unlike the masses, yours truly was paying attention and feeling pretty lonesome in my outrage about the outrageous expense and unfairness of healthcare in the United States.

It finally dawned on me that almost no one had the insider knowledge I had about how big insurance companies really operate, and very few even had access to the research reports and articles I saw every day–thanks to my former Cigna colleague Dave MacHenry.

I met Dave when he was a senior researcher in the Cigna library and reached out to him many times during my 15 years at the company. Dave knew where to find just about anything my team and I assumed existed but couldn’t get our hands on. We knew that If it was out there, Dave would find it. We called him Wonderful Dave.

As it turned out, Dave left Cigna around the same time I did. When I started writing Deadly Spin, I tracked him down and asked him to help me find facts and figures, articles, and historical information I knew I would need. Deadly Spin would not have happened without Dave’s help. 

That was in 2010. Dave has been an essential part of my team ever since. He gets up before the crack of dawn every day to hunt for articles, commentaries, and research that had been published over the previous 24 hours. 

Starting today and once a week from now on, I’m going to share some of what Dave comes across with you all. Much of what I’ll include will be about the business practices and ever-increasing profits of health insurers, made possible by, among other things, their ever-increasing premiums and out-of-pocket requirements and their ongoing plundering, in broad daylight and with most of Congress looking the other way, of the Medicare Trust Fund. 

Over time, you’ll see why I launched the Lower Out-of-Pockets NOW Coalition, and how the privately operated Medicare Advantage program has become an unprecedented fleecing of American taxpayers. You’ll learn more about the many barriers insurers have erected to make it less likely you’ll get the care your doctors know you need. And you’ll see how insurers shower politicians with money (your money), and how they spend even more of your money on propaganda campaigns to protect their massive profits.

Let me know what you think and if you have any suggestions. Here’s the first report:

Out-of-Pockets

More and more, patients with insurance are skipping doctor visits and walking away from the pharmacy counter without their medications. And more and more, people with insurance are turning to GoFundMe to beg for money from strangers to cover their out-of-pocket expenses. 

In a recent study, researchers at the University of Pennsylvania and the University of Virginia found that “the top reason people resort to GoFundMe is inadequate health insurance.” Not because they are uninsured but because they are, for all practical purposes, functionally uninsured. 

As if that weren’t sad enough, it’s even sadder when you learn that very few health care GoFundMe campaigns succeed (unless you are young, white, and male). Dr. Jules Lipoff, a senior fellow at the Leonard Davis Institute of Health Economics and an assistant professor of clinical dermatology at Perelman School of Medicine at the University of Pennsylvania, wrote in The Hill that those most likely to succeed are the most privileged and connected: young white men. This means that this supposedly democratic fundraising strategy may paradoxically worsen disparities, instead of giving people with the greatest need more access.”

And it is not just a few of us with insurance who are walking away from CVS and Rite Aid without the medications our doctors prescribed for us. BenefitsPro reported on research that found that last year an estimated 81 million prescriptions were abandoned at the pharmacy, “with the abandonment rate over one in three for prescriptions above $75 in out-of-pocket cost, especially for high-cost specialty medicines that treat cancer and immunology.”

Guess which hard-working Americans are getting slammed the hardest by high-deductible plans. Those of us making $75,000 or less, according to a study published on May 9 in the American Journal of Managed Care. Becker’s reported on that study under the headline, High-deductible health plans may discourage routine medical care, study finds. 

And there is this, from the U.K.’s Independent: “GoFundMe as health insurance: Why so many Americans turn to crowdfunding for medical care.” 

Meanwhile, among those of us who make a tad more than $75,000 a year is my former Cigna colleague David Cordani, who now runs the company. As STAT’s Bob Herman reported this week, “Cigna CEO David Cordani took home more than $91 million in 2021, the most of any insurance executive. He’s registered $366 million since 2012. Cigna did not respond to requests for comment.” 

While David has become one of America’s top-paid CEOs, many of the people enrolled in Cigna’s health plans, like cancer patient Jill Eicher, are turning to GoFundMe. 

Speaking of cancer and high out-of-pocket requirements, take a look at a new study in the New England Journal of Medicine that details how some older Americans diagnosed with cancer can face unlimited out-of-pocket spending for prescription drugs under the current structure of the Medicare Part D benefit. The analysis “illustrates how the current design of Medicare’s prescription drug benefit program can cost people without subsidies more than $10,000 for one year of treatment. In fact, across the 10 drugs studied, each of these drugs would cost Medicare beneficiaries over $3,000 for just the first month’s fill.”

Next week, I’ll share some of the important reporting on recent research and investigations that show just how big of a scam Medicare Advantage has become. Stay tuned.