Thom Hartmann provides a brief history of the power of the for-profit healthcare industry, which has successfully blocked a national Medicare-for-All system. Please open the link and read it all. The industry’s current push is to get people transferred from Medicare to for-profit Medicare Advantage plans. Under Medicare, seniors can choose their own doctors and do not have to seek permission for costly procedures. under Medicare Advantages, patients may see only in-network doctors and may be denied permission for treatment. That’s where the profit is: denying treatment. About half of all seniors are on a Medicare Advantage plan, because they were wooed by prescription drug coverage or a free gym membership.
Hartmann begins:
Republicans have taken control of the House of Representatives, and already have their sights set on forcing major cuts to “entitlements” like Social Security, Medicare, and Medicaid.
One of the promises McCarthy made to become speaker was to force a vote on dialing back 2023/2024 spending back to 2021 levels — and there’s been a 7% inflation increase in costs/expenses since then. In other words, they want massive cuts.
His Republican colleagues have already outlined the starting point for their demands, as reportedby Yahoo News:
“The Republican Study Committee proposed a budget for fiscal 2023 that would gradually increase the eligibility ages for Social Security and Medicare, and change the Social Security benefit formula for people 54 and younger…”
In that, they’re going to have a hell of a fight on their hands, as Senator Bernie Sanders is taking over leadership of the Senate Health Committee, which oversees Medicare and Medicaid. He’s already promising “a lot of subpoenas” will be arriving at the offices of healthcare and big pharma CEOs.
Most Americans have no idea that the United States is quite literally the only country in the developed world that doesn’t define healthcare as an absolute right for all of its citizens.
That’s it. We’re the only one left. Were the only country in the developed world where somebody getting sick can leave a family bankrupt, destitute, and homeless.
A half-million American families are wiped out every year so completely that they must lose everything and declare bankruptcy just because somebody got sick. The number of health-expense-related bankruptcies in all the other developed countries in the world combined is zero.
Yet the United States spends more on “healthcare” than any other country in the world: about 17% of GDP.
Switzerland, Germany, France, Sweden and Japan all average around 11%, and Canada, Denmark, Belgium, Austria, Norway, Netherlands, United Kingdom, New Zealand and Australia all come in between 9.3% and 10.5%.
Health insurance premiums right now make up about 22% of all taxable payroll (and don’t even cover all working people), whereas Medicare For All would run an estimated 10% and would cover every man, woman, and child in America.
How and why are Americans being played for such suckers?
We are literally the only developed country in the world with an entire multi-billion-dollar for-profit industry devoted to parasitically extracting money from us to then turn over to healthcare providers on our behalf. The for-profit health insurance industry has attached itself to us like a giant, bloodsucking tick.
And it’s not like we haven’t tried to remove that parasite.
Presidents Theodore Roosevelt, Franklin Roosevelt, Harry Truman, Jack Kennedy and Lyndon Johnson all proposed and tried to bring a national healthcare system to the United States.
Please open the link and read the rest of this important post.
Diane Ravitch's blog 
Not surprising…like so many other ‘for profit’ adventures…$$$ comes first and foremost. Freedom to fleece the public at will and government(s), supposedly to protect us, looking the other way and partaking in this $$$ making. It is called FREEDOM!!!
Much better to have stolen wealth and divert minimal public resources devoted to killing, maiming, and permanently terrorizing innocent people and disrupting world stability. Is that a part of your definition of FREEDOM???
Recently went through a medical procedure and my physician was about as republican as you can get these days, the cynical variety who believes “they all do it” as a justification for this party’s behavior. In private he admitted to me that looking back the mid-90s, Hilary got it right. We laughed when I replied, “well, speaking as a dyed-in-the-wool liberal, you’d be surprised that I blame Hilary for not getting something back then. She took an all-or-nothing position and lost. As we all have. Obama’s time should have been a time to refine and fix glitches, not start all over again.
Unfortunately, starting Jan. 3, 2023, teachers in Illinois are now being put on Aetna Advantage PPO. Aetna Advantage is owned by CVS pharmacy. CVS bought the plan to make more money.
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From Fred Klonsky’s blogs:
Kaiser Health News reports:
A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.
The audits, the most recent ones the agency has completed, sought to validate payments to Medicare Advantage health plans for 2011 through 2013.
As KHN reported late last month, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans.
One of the biggest complaints about Medicare Advantage plans (aside from the hard sell marketing) has been the misuse of the power of pre-authorization.
Even when our own doctors and medical teams recommend a procedure or medication, MA plans can deny payment….
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As KHN reported late last month, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans.
The hardship requests, together with other documents obtained by KHN through the lawsuit, shed light on the secretive audit process that Medicare relies on to hold accountable the increasingly popular Medicare Advantage health plans — which are an alternative to original Medicare and primarily run by major insurance companies.
Reacting to the audit findings, Sen. Chuck Grassley (R-Iowa) called for “aggressive oversight” to recoup overcharges.
“CMS must aggressively use every tool at its disposal to ensure that it’s efficiently identifying Medicare Advantage fraud and working with the Justice Department to prosecute and recover improper payments,” Grassley said in a written statement to KHN.
Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people.
But federal officials rarely demand documentation to verify that patients have these conditions, or that they are as serious as claimed. Only about 5% of Medicare Advantage plans are audited yearly.
When auditors came calling, the previously hidden CMS records show, they often found little or no support for diagnoses submitted by the Advantage plans, such as chronic obstructive pulmonary disease, diabetes, or vascular disease. Though auditors look at the records of a relatively small sample of patients, they can extrapolate the error rate to the broad population of patients in the Medicare Advantage health plan and calculate millions of dollars in overpayments.
Overall, CMS auditors flagged diagnostic billing codes — which show what patients were treated for — as invalid more than 8,600 times. The audits covered records for 18,090 patients over the three-year period.
In many cases, auditors found that the medical credentials of the health care provider who made the diagnosis were unclear, the records provided were unacceptable, or the record lacked a signature as required. Other files bore the wrong patient’s name or were missing altogether.
The rates of billing codes rejected by auditors varied widely across the 90 audits. The rate of invalid codes topped 80% at Touchstone Health, a defunct New York HMO, according to CMS records. The company also was shown to have the highest average annual overcharges — $5,888 per patient billed to the government.
By contrast, seven health plans had fewer than 10% of their codes flagged…
Payment errors continue to be a drain on the government program. CMS has estimated net overpayments to Medicare Advantage plans triggered by unconfirmed medical diagnoses at $11.4 billion for 2022.
Can you tell that having an Aetna Advantage PPO bugs me? Carol
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CVS Health Completes Acquisition of Aetna, Marking the Start of Transforming the Consumer Health Experience | CVS Health November 28, 2018
Woonsocket, RI – CVS Health (NYSE: CVS), a company that is leading the transformation of health care, today announced that it has completed its acquisition of Aetna (NYSE: AET), establishing CVS Health as the nation’s premier health innovation company.
“Today marks the start of a new day in health care and a transformative moment for our company and our industry,” declared CVS Health President and Chief Executive Officer Larry J. Merlo. “By delivering the combined capabilities of our two leading organizations, we will transform the consumer health experience and build healthier communities through a new innovative health care model that is local, easier to use, less expensive and puts consumers at the center of their care.”
Added Merlo, “As the front door to quality health care, our combined company will have a community focus, engaging consumers with the care they need when and where they need it, will simplify a complicated system and will help people achieve better health at a lower cost. We are also leading change in health care by challenging the status quo with new technologies, business models and partnerships. In doing so, we will continue to deliver on our purpose of helping people on their path to better health.”
The combined company will connect consumers with the powerful health resources of CVS Health in communities across the country and Aetna’s network of providers to help remove barriers to high quality care and build lasting relationships with consumers, making it easier for consumers to access the information, resources and services they need to achieve their best health…
https://www.cvshealth.com/news-and-insights/press-releases/cvs-health-completes-acquisition-of-aetna-marking-the-start-of#.Y2o7ZpZ4YBs.gmail
For reasons I don’t understand, the major unions are pushing their retirees to give up Medicare and switch to Medicare Advantage, which operates for-profit. Retirees will not be able to use the doctor of their choice unless he or she is in network. And they cannot have major procedures without getting pre-approval.
Some unions pay for the Medigap policies of retirees. These unions have made a deal to transfer retirees over to Medicare Advantage to save money in exchange for health care concessions for the active members. I think these retirees can still receive traditional Medicare, but they will likely have to pay for the Medigap themselves. Medicare covers 80%, and the remaining 20% must be paid by the patient or a Medigap policy whose rates continue to rise. I don’t blame retirees for being upset about the loss of coverage that they believed would be there according to their agreement when they retired. Lower income retirees may have no other option than to accept the Medicare Advantage substitute. At least, this is my understanding of the problem. If I am wrong, please correct me.
…As a result of the acquisition, shareholders are expected to benefit from a number of outcomes, including enhanced competitive positioning; the delivery of more than $750 million in synergies in 2020; and a platform from which to accelerate growth. The roadmap for value creation over the longer term has the potential to deliver substantial incremental value through the development of products and services that provide the opportunity to generate significant new growth opportunities aimed at reducing medical costs, growing membership and enhancing revenues….
Investor Contact:
Mike McGuire
401-770-4050
Michael.McGuire@CVSHealth.com
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I am a retired teacher (NJ) . In 2019 when I retired, Aetna Advantage PPO became the insurance plan for us.
Unfortunately, many more employers are replacing traditional Medicare coverage with Medicare Advantage in order to reduce their costs and liability. This is one of the main reasons Medicare Advantage is increasing by leaps and bounds. It is cheaper for the employer, but much worse for the Medicare Fund and the retiree who will have less choice of doctors and much greater liability for catastrophic illnesses. Medicare Advantage is a parasite that overbills Medicare by billions of dollars on wasteful testing and procedures to drive up their profits. https://www.kff.org/medicare/issue-brief/medicare-advantage-coverage-is-rising-for-the-declining-share-of-medicare-beneficiaries-with-retiree-health-benefits/
NoT sure this is relevant Carol, but of the various healthcare providers my husband’s employer switched us to over his 40+ yr career, Aetna was by far the worst. We also had Aetna POS [😉] [Denying claims right off the bat, reqg continual paperchase & perseverance by claimant for months or years (sometimes even having to appeal to co mgt to intervene), & swifter premium rises/ coverage-lowering than others.] Blue Cross/ Blue Shield was middling. The best we ever had was Cigna [real people immediately on the line, assigning a nurse-advocate to your case, & more].
Now that he is officially retired but still working 1/4- 1/3 time for same co as needed, he is classified as a “casual” employee, which offers a policy very similar to ACA [low premium, high deductible] run by United Healthcare. We can switch to full Medicare whenever, but with supplemental coverage will raise moly cost from $200 to $500, & so far [3 yrs] have no issues w/United Health. Not as good as Cigna, but better than others we’ve had; sons have also had god experience with them via ACA mktplace.
The problem in this country is that both parties serve corporate interests and billionaires instead of the people. Both parties defend the corporate narrative that blocks a single payer public option from becoming a reality. We can expect the right to further extort demands from the left. Unless the democrats hold firm, the result will further hurt the bottom line for seniors as conservatives seek to make Medicare and Social Security a bargaining chip in debt ceiling negotiations. On a positive note Bernie takes over as the the incoming chairman of the Senate’s Health, Education, Labor and Pensions Committee, but what he will be able to accomplish depends on funding. The right wing led House controls the purse strings. He has bold plans that he outlined in a recent speech. https://www.sanders.senate.gov/press-releases/prepared-remarks-sanders-delivers-state-of-the-working-class-speech/
Unless the public can get some relief from greedy corporations, we will continue to be a nation that pays twice as much for health care with worse results. Medicare Advantage will continue to plunder Medicare funds with even greater potential for disaster under another corporate scheme called ACO Reach, which allows corporations to reach into seniors’ Medicare and extract value by denying needed services. The only winners in that scenario are the corporations.
Good News today, in spite of all the hype the percentage of workers in Unions dropped to 10.1% of the workforce a record low. What the absolute number of workers in Unions is, I don’t know. Unions added 259,000 members whether that is from a post pandemic low or a recent pre pandemic high I didn’t check.
Why is that good news. It really isn’t but remember those “GREAT UNION HEALTHCARE PLANS ” that changed the discussion in the Democratic debates. Those great plans Tim Ryan pointed to, precipitating a full frontal assault from the “Liberal “Media( I don’t give a crap about Right wing Media ) and the for profit medical industry on the Democratic candidates who mostly supported M4All. An assault that left only 2 remaining in support and licking their wounds. Great plans if you can keep them. Unions should be in the forefront of the push for M4All not a cog in the wheel. The Idea that these great Union Plans are the reason people should join Unions dates back to an era even before Health Insurance existed. An era when Unions or employers had their own in house medical services. Mine still does along with a plan that costs employers $22 an hour for every hour worked to fund it. The idea is ludicrous as Union density drops year after year including in my industry in the most Unionized city in the Country. As has been pointed out several times on this blog many Union Healthcare plans are getting diminished year after year. Both for retirees and active members.
Unions will grow when they and THEIR MEMBERS are in the forefront of the Social Justice movement and M4All should be front and center of that movement.
In 1975 the teachers in my district went on strike. Both the AFT and NYSUT were fierce back then instead of trying to play along with the power mongers. The union had our backs. A side note was that Randi Weingarten’s mother was one of the teachers in the district on strike.
1975-79 was near the the peak of union membership Nationwide. Even as the percentage of Union workers in the workforce was already dropping. It was being driven by huge increases in Public Sector Unions as Blue collar private sector Union membership was declining in Several Major sectors, ie. coal, auto , garment and construction.
Then came Reagan and a war on the working class. A war that many in the working class gladly participated in.
Tick seems a proper description.
In Central Tennessee, according to a student I knew at MTSU in the 70s, there is a geographical are known to biologists as the “tick triangle” where there were more ticks than anywhere else.
And now, after all these years, we have Gov Lee
Speaking of Mexican avocados and parasites, apparently the drug cartels have now gotten into avocado ranches as a source of profit and money laundering. A thing to consider with your avocado toast.
Like?
No, it’s not like, it is.
Here’s a real life example why some US citizens may choose death over health care to avoid bankruptcy and homelessness.
On December 16, I called the VA advice nurse at the VA medical facility I go to, because of severe, crippling neck pain that I woke up with on December 13. I couldn’t stand it anymore and finally decided to reach out for medical help. The only reason I have this health care through the VA is because of a service-related disability linked to my year serving in combat.
After answering the VA advice nurse’s questions, he said I had to go to the ER ASAP.
My reply, Where do I go to check in? I don’t know where the ER location is at the VA medical facility I go to.
VA Nurse, We don’t have an ER. You have to go to one of our private sector partners, the nearest one to you. Give me your zip code and I’ll tell you where to go.
My reply, I can’t do that. I don’t want to go bankrupt and maybe lose my house and my ability to live independently. I’d rather die.
VA Nurse, You won’t pay anything. The VA will cover the cost of your visit to that ER.
So, I went to a private sector, for profit hospital, and spent the rest of the day, about 7 hours, being tested, tested, tested, and tested some more.
Long story shortened, when the cost of that ER visit arrived the first page said “THIS IS NOT A BILL.” On the back there were three columns. The first column listed all the tests I had and what that hospital charged for them.
That total was more than $16,000.
The next column revealed what the VA agreed to pay
That was about $1,300 – I repeat, the number the VA paid was about $1,300. That is not a typo and neither is the $16,000.
The third column had one short phrase at the top that basically said “The veteran pays nothing.”
Since I have a thin trust factor built in to my thinking, I’m waiting for that hospital to send bill collectors after me, my bank account, my house, my car, while hoping what the VA nurse said is true, that I won’t have to pay anything.
The right is trying to privatize the VA as well. Matt Gaetz would like to give Veterans a card that will allow them to go to a private doctor instead of a VA facility. This will, of course, will work to either defund the VA or shift the costs to the veteran.
Lloyd, I’m just guessing, but the hospital will have to eat the rest of the costs. Why not call the billing department and ask what’s up? Or maybe you are right to wait it out and not poke the angry dog, so to speak. In any case, best of luck with the bills and your health.
Lloyd, Your statement sounds much like those sent to Medicare recipients. The approved Medicare reimbursement amount is often much less than the provider charge. From your description, the hospital cannot balance bill you.
Hope your health issue was resolved.
I recently had cataract surgery and the total bill was $75 which was for transpiration and the $10 co-pay. Thank you Medicare, actually Aetna-Medicare. As for the dentist, I’m at more than $1,010 and still counting. I have dental insurance which is very finicky and will only cover up to $1,500 per annum.
Correction: TRANSPORTATION NOT transpiration.
I had dental insurance for a year but dropped it when my dentist told me that the cost of coverage would always be more than the bills.
Ditto, Diane. Dental is a third rail most don’t like to even talk about. I inherited my bio dad’s bad teeth– back in his Navy days [WWII] they pulled out all his & gave him dentures at age 25. I don’t know how my small-biz parents managed; I remember spending one aft/wk throughout jrhi in the dentist’s chair. Thanks to my & husband’s decent incomes over the yrs I still have most of my own teeth in my head. But thanks to an accident on a slide at 6yo, one front tooth had to become an implant a few yrs ago. The same yr, my husband’s ’60s brass-knuckles beat-down by block-busting gang kids [which had already cost him $plenty over the yrs] became 2 implants/ bridge: we could have bought a nice model compact car for the dental expenses that year. And now my other front tooth [as warned probable by my dentist back then] has started loosening…
p.s., I resist the temptation to get them all pulled & go to dentures as my stepdad did at my age, & consider myself lucky I don’t have to. I’ll never forget greeting him at my door when he visited a few months after: he’d lost at least 20 #, & still could barely eat…
The author of the post, Thom Hartmann, summarizes a must-read study (Alternet, 1-19-2023, “Opinion- New Report Details Why Wealthy Really Oppose Democracy”). The summary outlines the plans put in place chronologically to rob Americans of democracy and the motivations.
Here is some interesting news that comes from Fred Klonsky’s Substack posting.
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Teaching race. When Aetna sold insurance policies to slave owners on those who were enslaved.FRED KLONSKYJAN 22
…I was interested in learning about Aetna so I Googled it and discovered that Aetna company history can be traced back to slavery.In fact, Aetna sold insurance policies to slave owners on the lives of the human beings they enslaved.
In 2000, the issue of Aetna paying reparations was raised by Deadria Farmer-Paellmann, who, through her research, discovered that Aetna used to issue insurance policies for the lives of slaves, which would reimburse slave owners when their property died.
Farmer-Paellmann contacted Aetna requesting more information on the subject from their archives. Aetna sent her copies of two policies, which confirmed that the company was selling the insurance deals for at least four years from 1854 to 1858. Maybe longer. They uncovered one policy was dated February 1854 and another dated November 1858.
Aetna assured Farmer-Paellmann that they would make a formal apology and pay reparations.
Gwen Houston, the head of diversity at Aetna at the time and later Global Diversity and Inclusion Manager at Microsoft, said to her that “they would make an acknowledgement apology, not an apology per se. And they would enhance scholarships to university and college students, and that would be the form of restitution that they were going to pay.
”Two days after that, Aetna apparently changed their mind again, saying they would publicly apologize, but that there would be no restitution.None was ever paid.
It turns out that Aetna was not the only one in the slave insurance business.Aetna, NY Life, AIG, Penn Mutual and other northern insurance companies all made money by selling similar slave insurance policies.
Some quit the business because so many enslaved people died that they were paying out more than they were collecting…
The original sin of our nation has never been atoned for.