American Healthcare continues to go backward

[Stillwater Townie]

This vid is 10 minutes long (can be watched at higher speed), but it is critical to understand why drugs cost so much. In essence, manufacturers are incentivized to raise prices so that they can offer the PBM a bigger kickback. If they try to lower the price, they can't pay the kickback so get dropped from the formulary. PBMs, unlike doctors and pharmacists, were excluded from Federal anti-kickback legislation ($$$)

https://twitter.com/x/status/1758178833407082732

Yes, something screwy and unjust has got to be going on. I came down sick with covid last week and went to the doctor for it. Prescribed for my treatment was 5 days of Paxlovid. The cost for it was nearly $1700!! Thankfully, I felt much better after two days, and my insurance paid for all of it. Anyway, the high price of it surely reflects how there is some kind of a totally legal bribery scheme going on and driving up drug prices in America. Nothing else can explain it, especially if the price of Paxlovid is considerably cheaper in Europe and Mexico.

Think of the people with covid but no insurance for the high cost of Paxlovid. They have to suffer longer with the illness with some risk of it getting worse. Your coughing muscles soon get sore from having covid and so you'd like to get over covid as soon as possible.

 

[Stillwater Townie]

I'm all for changing over to Medicare For All. If Republicans don't like it because it would be single payer, then try to compromise with them by having a Medicare For All Advantage. That why private health insurance companies would not be forced to go out of business from them being allowed to offer their own eligible plans under Medicare For All Advantage. Long time political activist Ralph Nader would absolutely not approve of doing it that way, but it's better than continuing to do nothing.

Maybe the problem is we mainly only elect politicians who are in great health and can't relate to people who can't say the same. It makes them susceptible to accepting bribes from lobbyists representing health insurance companies. Maybe to counterattack we need to elect people in wheelchairs. I could be wrong, though, since Gov. Abbot is far more interested in fighting culture wars than big corporate wars on our health. But then surely Gov. Abbot is much richer and better taken care of than the average man in a wheelchair.

 

[steross]

https://twitter.com/x/status/1761591915391152530

 

[steross]

I wonder who in Congress got paid a lot to keep the legalized bribes going...........

Congress punts on PBM reform efforts

Congress has abandoned its attempt to reform how PBMs operate in an upcoming package to fund the federal government, 11 sources said.

www.statnews.com

POLITICS

Congress punts on PBM reform efforts​

• By Rachel Cohrs and John Wilkerson Feb. 26, 2024

WASHINGTON — Congress has abandoned its attempt to reform how pharmacy middlemen operate in an upcoming package to fund the federal government, 11 lobbyists and sources following the talks told STAT.

It’s a missed opportunity to pass one of the health care priorities that has attracted the most bipartisan interest and activity this Congress, though lawmakers could revive the negotiations on the issues in the future.

Reforming how pharmacy benefit managers operate has been a top lobbying priority for the pharmaceutical industry since Democrats passed a major package aimed at lowering the costs of medicines in 2022. Pharma and PBMs have taken up a very public battle on the airwaves.

 

[steross]

I realize that doctors not making as much money as the used to (unless they own a surgery center etc) this graph does show the power of lobbying.

 

[steross]

https://www.wsj.com/health/healthcare/u-s-launches-antitrust-investigation-of-healthcare-giant-unitedhealth-ff5a00d2?st=c67zp7uqqiq04vu&reflink=desktopwebshare_permalink

U.S. Opens UnitedHealth Antitrust Probe​

Investigators question industry officials who compete with the healthcare giant​

The Justice Department has launched an antitrust investigation into

UnitedHealth, owner of the biggest U.S. health insurer, a leading manager of drug benefits and a sprawling network of doctor groups.


The investigators have in recent weeks been interviewing healthcare-industry representatives in sectors where UnitedHealth competes, including doctor groups, according to people with knowledge of the meetings.

During their interviews, investigators have asked about issues including certain relationships between the company’s UnitedHealthcare insurance unit and its Optum health-services arm, which owns physician groups, among other assets.
Investigators have asked about the possible effects of the company’s doctor-group acquisitions on rivals and consumers, the people said.

 

[steross]

https://twitter.com/x/status/1762287873942864110

 

[steross]

https://twitter.com/x/status/1762892872389386684

 

[steross]

https://twitter.com/x/status/1762895595319255153

 

[Duke Silver]

What about Obamacare?

 

[steross]

https://twitter.com/x/status/1763041486080205309

 

[steross]

What about Obamacare?

You tell me. This is United Healthcare. The bottom of the graph is stock price. And, sure, you could say that it was just a bull market. But, the top graph is UNH divided by SPY- the S&P 500. So, UNH did nearly 250% better than the total market. Gee, I wonder who won with Obamacare? Are your premiums 250% better? Is your care quality 250% better?

Their earnings per share have increased 3 fold since 2017. I'm guessing your earnings have not done that.

And for anyone thinking "Well, you took the leader of the insurance world" well here is Cigna. Same chart. Basically same result. Obamacare did such a great job bringing down costs and getting us quality, affordable healthcare yet somehow these vultures were able to increase at 2.5 times the 500 largest companies during a huge bull market?


We are being ripped off for billions of dollars a day and it is killing us. Nobody will do anything about it:

 

[Vakarian74]

You tell me. This is United Healthcare. The bottom of the graph is stock price. And, sure, you could say that it was just a bull market. But, the top graph is UNH divided by SPY- the S&P 500. So, UNH did nearly 250% better than the total market. Gee, I wonder who won with Obamacare? Are your premiums 250% better? Is your care quality 250% better?
View attachment 3810
Their earnings per share have increased 3 fold since 2017. I'm guessing your earnings have not done that.View attachment 3813

And for anyone thinking "Well, you took the leader of the insurance world" well here is Cigna. Same chart. Basically same result. Obamacare did such a great job bringing down costs and getting us quality, affordable healthcare yet somehow these vultures were able to increase at 2.5 times the 500 largest companies during a huge bull market?
View attachment 3812

We are being ripped off for billions of dollars a day and it is killing us. Nobody will do anything about it:
View attachment 3811

This is why I was never a fan of the ACA. All it did was insure the insurers profit more. Now I will say there were a couple of things that got cut/struck down that were supposed to help curb that. I don’t think it would have made that much of a difference though. Insurance all forms has always come of as a legalized protection racket.

 

[steross]

'My most vulnerable patients are picking up these plans': 5 leaders' thoughts on Medicare Advantage

ASC and spine leaders are increasingly concerned with Medicare Advantage, citing prior authorization denials and slow payments.

www.beckersasc.com

'My most vulnerable patients are picking up these plans': 5 leaders' thoughts on Medicare Advantage​

Patsy Newitt - Updated Friday, January 5th, 2024

ASC and spine leaders are increasingly concerned with Medicare Advantage, citing prior authorization denials and slow payments.
Here are five leaders' recent thoughts on Medicare Advantage:

Harel Deutsch, MD. Co-director of the Rush Spine Center (Chicago): [Medicare Advantage] has gotten much, much worse [than it was a year ago]. It was bad back then, but now it's five times worse. Every time I turn on the TV, I see ads for Medicare Advantage and basically Medicare Advantage, they'll disapprove any surgery you apply for. A lot of times I have to tell patients, look, you have to wait until you can unenroll and then do that. Then you can have your surgery.

 

[GOGETUMPOKE]

'My most vulnerable patients are picking up these plans': 5 leaders' thoughts on Medicare Advantage

ASC and spine leaders are increasingly concerned with Medicare Advantage, citing prior authorization denials and slow payments.

www.beckersasc.com

'My most vulnerable patients are picking up these plans': 5 leaders' thoughts on Medicare Advantage​

Patsy Newitt - Updated Friday, January 5th, 2024

ASC and spine leaders are increasingly concerned with Medicare Advantage, citing prior authorization denials and slow payments.
Here are five leaders' recent thoughts on Medicare Advantage:

Harel Deutsch, MD. Co-director of the Rush Spine Center (Chicago): [Medicare Advantage] has gotten much, much worse [than it was a year ago]. It was bad back then, but now it's five times worse. Every time I turn on the TV, I see ads for Medicare Advantage and basically Medicare Advantage, they'll disapprove any surgery you apply for. A lot of times I have to tell patients, look, you have to wait until you can unenroll and then do that. Then you can have your surgery.

It's an absolute crap show.

 

[Stillwater Townie]

'My most vulnerable patients are picking up these plans': 5 leaders' thoughts on Medicare Advantage

ASC and spine leaders are increasingly concerned with Medicare Advantage, citing prior authorization denials and slow payments.

www.beckersasc.com

'My most vulnerable patients are picking up these plans': 5 leaders' thoughts on Medicare Advantage​

Patsy Newitt - Updated Friday, January 5th, 2024

ASC and spine leaders are increasingly concerned with Medicare Advantage, citing prior authorization denials and slow payments.
Here are five leaders' recent thoughts on Medicare Advantage:

Harel Deutsch, MD. Co-director of the Rush Spine Center (Chicago): [Medicare Advantage] has gotten much, much worse [than it was a year ago]. It was bad back then, but now it's five times worse. Every time I turn on the TV, I see ads for Medicare Advantage and basically Medicare Advantage, they'll disapprove any surgery you apply for. A lot of times I have to tell patients, look, you have to wait until you can unenroll and then do that. Then you can have your surgery.

The above is largely why Ralph Nader doesn't like Medicare Advantage. He wants Medicare For All period.

 

[DxCowboy]

You tell me. This is United Healthcare. The bottom of the graph is stock price. And, sure, you could say that it was just a bull market. But, the top graph is UNH divided by SPY- the S&P 500. So, UNH did nearly 250% better than the total market. Gee, I wonder who won with Obamacare? Are your premiums 250% better? Is your care quality 250% better?
View attachment 3810
Their earnings per share have increased 3 fold since 2017. I'm guessing your earnings have not done that.View attachment 3813

And for anyone thinking "Well, you took the leader of the insurance world" well here is Cigna. Same chart. Basically same result. Obamacare did such a great job bringing down costs and getting us quality, affordable healthcare yet somehow these vultures were able to increase at 2.5 times the 500 largest companies during a huge bull market?
View attachment 3812

We are being ripped off for billions of dollars a day and it is killing us. Nobody will do anything about it:
View attachment 3811

An even simpler example: We have a cash price of $650 for an MRI. A patient can walk in a simply pay that, then pay the Radiologist fee for the report. Want to use your insurance? $9000.

 

[steross]

https://twitter.com/x/status/1763599024194453528

Contrary to the lie the insurance company says, this is a very important lab test. At my cash pay clinic, it is $30.
How the lab got a $800 charge for it to fight with the insurance company about is what is criminal. And, that isn't all the lab's fault to let the insurance companies off the hook. Insurance creates these inflated charges then fights with them. Insurance wants higher prices, so that they can massage profits to meeting their Obamacare maxes.

But, either way, I highly recommend getting this checked, at least just once. While it is difficult to change the amount of LP(a) as it is mostly genetically determined, knowing how much you have can help you assess risk and how much intensity you put into other factors. Heart disease is still the number one killer.

In Europe, they check it and have created a calculator to assess how much it adds to risk.
Article:

Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement

Abstract. This 2022 European Atherosclerosis Society lipoprotein(a) [Lp(a)] consensus statement updates evidence for the role of Lp(a) in atherosclerotic cardio

academic.oup.com

Calculator:

www.lpaclinicalguidance.com/

But, better to pay the $15-$40 dollars yourself rather than insurance fighting over $800.

 

[GratefulPoke]

https://twitter.com/x/status/1763599024194453528

Contrary to the lie the insurance company says, this is a very important lab test. At my cash pay clinic, it is $30.
How the lab got a $800 charge for it to fight with the insurance company about is what is criminal. And, that isn't all the lab's fault to let the insurance companies off the hook. Insurance creates these inflated charges then fights with them. Insurance wants higher prices, so that they can massage profits to meeting their Obamacare maxes.

But, either way, I highly recommend getting this checked, at least just once. While it is difficult to change the amount of LP(a) as it is mostly genetically determined, knowing how much you have can help you assess risk and how much intensity you put into other factors. Heart disease is still the number one killer.

In Europe, they check it and have created a calculator to assess how much it adds to risk.
Article:

Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement

Abstract. This 2022 European Atherosclerosis Society lipoprotein(a) [Lp(a)] consensus statement updates evidence for the role of Lp(a) in atherosclerotic cardio

academic.oup.com

Calculator:

www.lpaclinicalguidance.com/

But, better to pay the $15-$40 dollars yourself rather than insurance fighting over $800.

That is a really good price for this test at your clinic.

 

[Vakarian74]

https://twitter.com/x/status/1763599024194453528

Contrary to the lie the insurance company says, this is a very important lab test. At my cash pay clinic, it is $30.
How the lab got a $800 charge for it to fight with the insurance company about is what is criminal. And, that isn't all the lab's fault to let the insurance companies off the hook. Insurance creates these inflated charges then fights with them. Insurance wants higher prices, so that they can massage profits to meeting their Obamacare maxes.

But, either way, I highly recommend getting this checked, at least just once. While it is difficult to change the amount of LP(a) as it is mostly genetically determined, knowing how much you have can help you assess risk and how much intensity you put into other factors. Heart disease is still the number one killer.

In Europe, they check it and have created a calculator to assess how much it adds to risk.
Article:

Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement

Abstract. This 2022 European Atherosclerosis Society lipoprotein(a) [Lp(a)] consensus statement updates evidence for the role of Lp(a) in atherosclerotic cardio

academic.oup.com

Calculator:

www.lpaclinicalguidance.com/

But, better to pay the $15-$40 dollars yourself rather than insurance fighting over $800.

I had a testosterone test done about 10 years ago and had to have another one after the first because the first wasn’t truly the test they needed but showed the other test was needed. Why not just do the one that went straight to the issue in question? Effing stupid.