Cost Overruns
COVID-19 Deaths
The official US pandemic death tally as of this writing is around 1,040,000, though the real number is certainly much higher. We’re number one by a mile - second place Brazil has 300,000 less deaths in a country two thirds our size.
What made the virus so much more deadly in the US compared to its peers? A new study estimates that if we had universal health care in this country we could have prevented at least 338,000 deaths during the worst stages of the pandemic:
According to findings published on Monday in Proceedings of the National Academy of Sciences USA, from the pandemic’s beginning until mid-March 2022, universal health care could have saved more than 338,000 lives from COVID-19 alone. The U.S. also could have saved $105.6 billion in health care costs associated with hospitalizations from the disease—on top of the estimated $438 billion that could be saved in a nonpandemic year.
These might be surprising numbers to the politicians and health industry lobbyists who insist we have the best system of healthcare in the world. In fact, our privatized for-profit system so heavily incentivizes emergency treatment over regular, preventative care that Americans without insurance are far more likely to suffer from comorbidities that increased their risk of death from infection:
People who do not have insurance usually do not have a primary care doctor, which means they are more likely to suffer from preventable diseases such as type 2 diabetes. They also tend to wait longer to see a doctor when they fall ill. These two factors already contribute to higher mortality rates in nonpandemic years, and they compounded the impacts of COVID-19. Comorbidities exacerbate the risk of the disease, and waiting to seek care increases the likelihood of transmission to other people.
As the study finds, not only would a universal care system have saved a third of a million lives during the pandemic, the failures of our health system cost us at least a hundred billion dollars in waste. We’ve talked about why American health care is so expensive, and how our government’s attempts to prop up failing hospitals may only have kicked the can not all that far down the road. The entire system is broken from top to bottom - we spend more to get less, and when we needed our system the most, it failed us on a scale not seen anywhere else in the world, rich or poor.
Medicare Advantage
One popular proposal to bring something resembling universal health care to America is Medicare For All. The public largely believes that Medicare is good quality health coverage, managed by the federal government. They’re nearly right - many Medicare plans are actually administered by private, for-profit insurers at the behest of the government, who pays them via a complicated web of reimbursements and fees.
Often we think of Medicare fraud as hospitals and doctors overbilling for services - like the time former Florida Governor and current United States Senator Rick Scott’s company plead guilty and paid $1.7 billion in fines for doing so. Since then, thanks to Republican efforts to privatize parts of Medicare, providers are defrauding the government in new and exciting ways:
The point of larding the medical records with outdated and irrelevant diagnoses such as cancer and stroke — often without the knowledge of the patients themselves — was not providing better care, according to a lawsuit from the Justice Department, which investigated a whistleblower complaint Ormsby filed. It was to make patients appear sicker than they were.
Since it’s become more difficult to make up illnesses and treatments out of whole cloth, companies are ‘data-mining’ patient records to include illnesses they may not have anymore, or that may be irrelevant to their health:
The government said its investigation confirmed that Palo Alto Medical and Sutter Health systematically added false diagnoses to patient records. In a sample of hundreds of cases Ormsby audited, the government’s lawsuit said, she discovered 90 percent of diagnoses for cancer were invalid, as were 96 percent for stroke and 66 percent for fractures.
Invalid cancer or stroke diagnoses can be a big problem for a patient - they are entered into their medical record and can interfere with future care. The reason for these diagnoses is that Medicare offers higher payouts for additional ‘risk’ adjustment codes under its Advantage plans. So providers tack on things like stroke or cancer while failing to offer additional treatment, and maximize their payouts. It’s a lucrative business:
The higher cost, what MedPAC labels “excess payments,” reached $12 billion in 2020 out of total program costs of $350 billion and are projected to top $16 billion next year, MedPAC said in March.
The problem is, unlike fabricated patients or procedures that don’t harm anyone, these risk adjustments can cause real damage:
That could unnecessarily stigmatize patients who were improperly deemed obese, or malnourished, or mentally ill. It introduces potential phantom influences on treatment decisions, critics say.
Advantage has been around for less than two decades and it’s already standard industry practice to game it:
Several doctors interviewed by The Washington Post said it was common practice for insurance companies and medical systems to search or data-mine the histories of patients covered by Medicare Advantage. Health systems were known to advise doctors on the most lucrative billing strategies, cajole them to document the maximum number of illnesses, and grade and rank them among their peers based on how they coded patients, they said.
Imagine how much better our care could be if insurance companies and doctors didn’t spend their time coming up with ways to steal money from the government. They might have more time to treat patients!
Insurance companies spend billions a year promoting these quasi-private plans - I marketed them at my last job - and as a result, nearly half of Americans are on an Advantage plan as of 2021. While the idea of Medicare for All sounds nice, it’s important to realize that profiteers have already perverted the system, and its in dire need of reform.
Medical Debt
Even if we were to awake in a magical dreamland where everyone in America had some form of health coverage, further action would need to be taken to help those struggling under huge amounts of medical debt:
In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found.
A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.
New data reveals how pervasive medical debt has become. And how, at a time when corporate profits are at record highs, millions of Americans are drowning:
The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found.
[…]
Debt from health care is nearly twice as common for adults under 30 as for those 65 and older, the KFF poll found.
Like student loans, the burden of medical debt is falling on younger generations, many of whom don’t ever expect to pay it off. It’s also limiting access to care:
About 1 in 7 people with debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll. An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.
Some of those 338,000 preventable COVID-19 deaths can likely be linked directly to medical debt and the uniquely American mindset - that medical care is a privilege, not a right, and something we can ration or forego altogether if it means going further into debt.
Not to worry, though, predatory lenders are cashing in too:
Now, a highly lucrative industry is capitalizing on patients’ inability to pay. Hospitals and other medical providers are pushing millions into credit cards and other loans. These stick patients with high interest rates while generating profits for the lenders that top 29%…
1 in 5 Americans are paying off medical bills through an installment plan. 1 in 6 are using credit cards. This is untenable.
Our care is expensive, mercilessly capitalized and financialized by for-profit vultures, and trying to stay healthy can be ruinous for families. Wholesale change is needed, or the next crisis will be even worse than this one.
Short Cons
WaPo - “Alexander is accused of working for the three companies that allegedly defrauded investors by dangling promises of high returns on their investments in rare wines and whiskeys.”
NBC News - “Former President Donald Trump's team orchestrated a plot to overturn the 2020 election by organizing slates of alternate "fake electors" in seven pivotal states, according to testimony and documents presented Tuesday by the House Jan. 6 committee.”
ABC News - ““I can tell you that this is the most terrible discrimination that a human being deprived of his liberty can suffer,” he added.”
CNBC - “A group of lawmakers are urging Google to clamp down on misleading search results that allegedly steer people searching for abortion services to crisis pregnancy centers that oppose it.”
Tips, thoughts, or medical debt jubilees to scammerdarkly@gmail.com