Usually, when I write a blog post, I start with something
that has happened or is happening, try to develop it and point out the
relationships between it and other things that are happening. Toward the end I
make an effort to form a conclusion, and, perhaps even make suggestions as to
how the problem(s) might be addressed. However, today I think I’ll lead with
the conclusion, so folks do not have to read too far:
All of the US healthcare industry (not system) is run by corporations that are effectively evil.* They function for only one purpose: to suck as much money, in the form of profits, stock price, and executive salaries (the executives, who are people, are of course evil) from our economy under the false flag of providing health care. They care not one whit about the health of people, society, or community, nor about decency. They include insurance companies, large hospital systems and provider groups (often owned by insurance companies and -- the exemplar of morality-free rapacious profit -- private equity), pharmaceutical companies and device companies, the large pharmacy chains (e.g., Walgreen’s, CVS) and the PBMs (pharmacy benefits managers) that control drug distribution.
*[I do not believe that corporations are people, despite the scandalous Citizens United decision that decided that they were and that money is speech, so are without human characteristics.]
I could end it there, and say “if you have any questions,
read my previous blogs, and the references I cite”, but I will go to talk about
a few recent events and actions that bolster this case. First, however, I want
to talk about people, the people who work in health care, the people who the
other people (called “patients”) seeking health care actually run into. Almost
uniformly, they are not the problem. From the higher-paid physicians and other
clinicians, including nurses, who provide clinical care, to the pharmacists and
pharmacy assistants who dispense medications, to those who answer the phones,
schedule appointments, take questions to be transmitted to the clinicians, and
even collect money, these are overwhelmingly hard-working people trying to do a
good job of serving you. They are almost all employed, however; even about 75%
of physicians (and growing) are employed by corporations. If your doctors seem
rushed and not to have enough time for you, if they are focused on computer screens,
if they don’t quickly call you back, this is not their choice, it is the mandate
of the corporation that employs them. It is essentially the same as the
traditional “speed up” for assembly line workers: to be “more efficient”, a euphemism
for “making more money for the corporation”. The same is true for the clerks
who may take a lot of time to answer the phone, or who are “unwilling” to cut
you some slack on your bill (when really they do not have the power to), or the
pharmacist who takes “too long” to fill a prescription or provide you with the
information that you need. These are, by and large, good people trapped in a
heartless system.
And, yet, because these are the people –physicians, nurses, pharmacists, clerks – whom we, as patients, see and interact with, they are the ones on whom we take out our frustrations when we feel we are not being treated as we should be. When we are denied care when we are late because the bus was delayed, or because we had to get our children off to school but the early appointment was the only one available, or because we don’t get off work until 4:15 but the 3:30 appointment was the last available. Yes, like the rest of us, all these people in healthcare want to work reasonable hours and get home on time, but the rules that they are required to enforce are not made by them. They are made by the corporate executives, those who have sold their souls, the CPAs and MBAs (and occasionally MDs and RNs, but usually those also have MBAs) whose expertise is in making money for the corporation, not in serving you, and who are handsomely rewarded for it. They are the people who are responsible and to whom your anger should be directed, but good luck getting to them. Maybe you can reach the CEO of a small rural hospital (who will almost never be the real CEO, since it is probably owned by a large hospital corporation) but not the heads of the insurance companies and pharmaceutical companies and massive health systems and private equity owners of all of these. More than the highest Mafia dons, they are protected by layers and layers of others who keep them from having to interact with you. But they ARE the evil people (even if, like those Mafia dons, they are nice to their children), creating, maintaining, and expanding an industry designed to extract as much money as possible from the economy and mis-label it “health care”.
The idea that this skates close to the edge of what is legal
is disingenuous. It is often illegal; a huge part of the industry
regularly acts illegally. We want there to be laws against such abuse, but even
when there are they are irregularly, even rarely, enforced largely due to inadequate
funding for the regulators. This is on purpose; those huge corporations have
the money to buy – I mean donate to – congresspeople and also offer high-paid
jobs to former regulators who “behaved” in the revolving door system. And when
the rules are enforced, the fines are relatively low, and are just written off
as a “cost of doing business”
Examples?
How about “Whistleblower Accuses Aledade, Largest US Independent Primary Care Network, of Medicare Fraud”, KFF Health News (March 5, 2024)? Using a practice known as “upcoding”, the company employs large numbers of people to add additional diagnoses to the one for which the person is being treated, increasing the reimbursement. This practice results in greater fee-for-service payment, but is even better (for the company) in increasing the “capitated payment” that they get for a particular “covered life”, both in general managed care and in Medicare Advantage programs. In this case, and in many hospitals, it is the provider who is fiddling the data to get more money from the insurer (which, in the case of Medicare Advantage, as well as Medicaid and some other programs, is the government – that is, you, the taxpayer).
But let’s not cry for the poor insurance companies, although they would like you to think it is the doctors and hospitals who are at fault for milking them. Even when something very bad happens, like the recent cyberattack at the largest health insurer, UnitedHealth, in which they may have paid a $22M ransom, it is the providers who are not getting paid. UnitedHealth is doing just fine, thank you. Not only is $22M not that much for them, but as pointed out by former insurance executive and current whistleblower Wendell Potter in his substack
Keep in mind that while the company is unable to pay thousands of the country’s doctors and hospitals for who knows how long because of the hack, UnitedHealth will be able to hold on to billions of dollars in premium income longer, and that will boost its investment income, which is considerable on any day of the week.
They have the system covered from all angles. UnitedHealth has moved into owning practices directly, through Optum, a very large provider and the source of a big percent of their profit. Along with their Medicare Advantage products.
Indeed, as providers and insurers point the finger at each other, and as pharmacies buy up the PBMs that control utilization, increasing vertical integration, and as private equity companies buy up all of these, there is one thing that you can be sure of: the benefit to the customer, consumer, patient, person, society is the one thing not being considered. We are the collateral damage in the fights among these amoral (at least, really immoral) behemoths.
What can we do? It often seems like there is not much. Our feeble cries are drowned out by the corporate contributions to our congresspeople. But we can let our elected representatives know that we are on to the abuses by those companies, and that we hold them responsible for holding (or not holding) the corporations responsible. We can, for example, demand something specific, that they sign on to the Patients over Profits pledge (initiated by National Nurses United, NNU, and now sponsored by many patient and community groups):
I pledge to put patients over profits and not take contributions over $200 from the executives, lobbyists, and PACs affiliated with the corporate health care industry, including private insurers, pharma corporations, and private hospitals who are organizing to take over our health care system.
They won’t if just a few of us ask. But if LOTS of us do, they just might.
And that’s a start.
No comments:
Post a Comment