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$100 Not For Bribing Politicians

Deadly, Unfair American Health Care

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Deamont Driver, a 12-year-old boy whose family had no insurance, died when a tooth infection spread to his brain.

  • His family couldn’t afford an $80 tooth extraction that doctors say would have saved his life.
  • As a result, he had to have 2 operations and 6 weeks of hospital care before he died.
  • This cost us taxpayers $250,000.

Frederick Holliday and his wife Regina had two small children but couldn’t afford health insurance despite working 6 part-time jobs.

  • By the time Fred found a full-time job with health insurance and went to a doctor for pain, he had kidney cancer that had spread to his stomach, bones, and lungs.
  • He died at 39 years old.

Nearly 45,000 people die every year in the US because they can’t afford health care.

  • More than 1 out of every 8 adult Americans know at least one friend or family member who died in the last 5 years after not getting needed medical treatment because they couldn’t pay for it.

Millions more end up disabled because of poor care or late diagnoses.

Sadly, the wealthy in America have great health care but few others do.

Nearly half of Americans say it is very difficult to pay for basic health care.

Because of the cost, 33% of Americans and 43% of low-income Americans say they:

  • didn’t fill a prescription
  • didn’t get a recommended medical test or treatment
  • didn’t see a doctor when they were ill

Americans with medical bills often have to:

  • spend all their savings
  • declare bankruptcy
  • move
  • take another job
  • work more hours
  • take in roommates
  • search for help from a charity

Now the biggest business for collection agencies is medical bills.

Each year, approximately 500,000 Americans go bankrupt because of medical bills.

  • Of all the people who declare bankruptcy due to health problems, ¾ of them actually HAD health insurance when they got sick or injured.
  • Many of them only lost their health insurance when they could no longer work.

But even people WITH employer-based insurance aren’t at all happy about their skyrocketing premiums, deductables, and out-of-pocket costs.

  • Out of all Americans with health insurance, 4 in 10 report their families had problems paying medical bills.

Our greedy health industry lobbies more than any other industry to preserve their lucrative status quo.

  • Last year, they spent four times as much as the next contender—the military industrial complex.

Massive Waste

Our health is incredibly important in our economy, yet we waste a massive amount of money on:

  • twice as many health insurance workers as doctors providing care
  • unnecessary paperwork
  • marketing
  • massive executive salaries
  • lobbyists
  • insurance profits
  • pharmaceutical profits

Private insurance companies waste up to 30% of your health care dollars on administrative costs, while Medicare only spends 2% on such costs.

And Medicare does this while taking care of the sickest people—the elderly and people with disabilities.  Covering the rest of us is easier and cheaper.

Why should health care CEOs make up to $26 million a year?  Studies show CEO pay at hospitals has no relationship to the quality of care or even profits.

Certainly doctors are more valuable and their average pay ranges from only $200,000 to $440,000 in various specialties.

Why should pharmaceutical CEOs make up to $58 million while desperately sick people go without needed medicines because of their price gouging?

In Germany, laws restrict the pay of healthcare executives to a reasonable level.

No Free Market with Health Care Fraud, Unexpected Bills

The free market doesn’t work at all in health care.  In an emergency, you don’t have time to research and compare prices or the skills or ratings of providers.

After a car accident, an ambulance might bring you to the hospital unconscious.  But you’ll get a bill for the ambulance and your medical treatment.

And we have no access to price information while facing far more unpredictable billing in health care than in any other industry.

Our hospitals charge arbitrary, often wildly inflated and incredibly unfair prices that are basically fraud and should be illegal.  For example:

  • The lipid panel, basic blood work measuring cholesterol, costs anywhere from $10 to $10,169 in California!
  • The basic metabolic blood panel in California varied from $35 to $7,303!
  • The cost of an appendectomy with no complications in hospitals in California ranged from $1,529 to $186,955.
  • One hospital in Dallas treats simple pneumonia for $14,610, while another one there charges over $38,000.
  • Replacing a joint averages $5,300 at a hospital in Ada, Oklahoma but averages $223,000 at a hospital in Monterey Park, California.

With no easy access to prices and insane billing, we don’t benefit from competition in our health care market at all.

Even if you have insurance, troubling complications can arise.

First, people often have to fight with their insurance companies to get a procedure or medicine covered.

Even after you verify that a hospital or procedure is covered, you can still get a surprise medical bill.  They might later declare they don’t cover certain

  • doctors
  • departments
  • devices
  • drugs
  • implants

Unexpected medical bills are a huge problem.

  • In 2016, nearly 43% of emergency room visits resulted in a surprise medical bill, with the average bill at $628.00.
  • A doctor in New York city gave a woman with a sore throat blood work, a throat culture, and an antibiotic. To her shock, the lab processing the throat culture wasn’t covered, her doctor had ordered testing it for many things, and the lab sent her a bill for $28,000.
  • Most states don’t require hospitals to inform you if their medical staff are not covered by your insurance.
  • Very often, when you go to the hospital, you won’t know which specialists will work with you.
  • And even your doctor doesn’t know what is covered.
  • Even large insurance companies often don’t have any in-network emergency room doctors in their in-network hospitals.

Even if you are lucky enough to live in a state with decent laws about surprise medical bills, it can be incredibly difficult to get wrongful charges covered.

  • Very often, insurance companies and providers will blame each other, telling you to back and forth to the other for a solution.
  • While you try to fight for payment or reimbursement, they often lose the necessary paperwork or you end up in never-ending voicemail systems.

In this crazy, rigged system, there is effectively no free market.

Sadly, those least able to pay—the working poor— very often pay or owe far more than the hospitals would charge Medicare or insurance companies. These people are shut out of insurance systems because they:

  • don’t qualify for Medicaid
  • can’t afford insurance
  • or can only afford insurance with poor coverage

People with insurance who have exceeded their limits also pay or owe far more than Medicare or insurance companies pay.

Deaths for Profits

Insurance companies make rules that exclude coverage and kill many people in order to make huge profits for the CEO, senior executives, and stockholders.

They might call a test or procedure “not indicated.”  Why should health insurance CEOs make an average of $20 million for often refusing care?

  • Even with great health insurance, pharmacy benefit managers often use company policy guidelines to reject doctors’ prescription orders.
  • These company rules can override a doctor’s clinical judgment just because it didn’t follow a standard protocol sequence of medicines or procedures, without even seeing you or knowing your medical history.
  • In thousands of documented cases, this causes dangerous delays or even organ damage, hurting patients with very serious health issues like cancer.
  • In one case, the insurance company refused a cancer medicine, saying they had to remove the kidney first, even though the patient was too sick for surgery.
  • Doctors can’t even find out who in the insurance bureacracy created the rules.

In Japan, laws ban profits at both health insurance companies and hospitals.  France and Germany also ban profits at health insurance companies.

In America, even nonprofit hospitals often make massive profits.  They pay their CEOs salaries up to $21 million a year.

Despite nonprofit hospitals paying no taxes as a charity, they often sue poor patients for their medical bills.

Medicare Advantage Scams

Many insurance companies make massive profits from contracts with Medicare Advantage or Medicaid using billions of government dollars but refuse to participate in the less lucrative individual health insurance Affordable Care Act (ACA) exchanges.

We could follow New York’s lead and require private insurers that bid on Medicare or Medicaid contracts to participate in the ACA.

Medicare Advantage companies game our system to avoid sicker people and make massive profits.

  • They put extremely expensive medicines into special categories that require a 25% or 33% copay, so that sicker people won’t be able to afford it and won’t sign up.
  • They often offer free gym memberships or advertise with free meals at restaurants without wheelchair access, knowing that sicker people won’t benefit and would be less likely to sign up.
  • Our government has found widespread and persistent problems with denials of care and payment in Medicare Advantage programs.
  • Common problems include early hospital discharges and denial of care in a skilled nursing facility or home health care.
  • They use prior authorization, narrow provider networks, and denials of large bills requiring arguments or appeals to eliminate many claims, knowing many members don’t appeal to fight denials.
  • They often upcode—inflate their billing charges by using codes that make patients seem sicker than they really are.
  • Our government found $6.7 billion in Medicare Advantage billing for diagnoses like diabetes, heart conditions, or cancer not supported by patient medical records in 2017 alone, with this fraud in 99.3% of patient chart reviews.
  • With internet companies gathering massive information on all of us, Medicare Advantage companies will surely target their marketing and outreach to cherrypick healthier customers and avoid sicker ones.

Medicare Advantage programs have higher overhead costs than traditional Medicare.

 

 

 

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