I do love that you are doing the math and comparing what happens if we lower Medicare age to 50.
Some questions/points:
-"no longer needing to pay premiums"? most people pay a premium for Medicare Part B and some for Part A. Part D has its own premium.
-The government subsidizes these medicare premiums (813 billion in 2023) and It's ⬆️ . See pic which is from CBO report here cbo.gov/publication/59…
-Most people don't have standard medicare, over 50% have bought into an advantage program to get more 'coverage' which is often now not covering and is being manipulated by big insurers to defraud the government of billions per year through a trick called 'up-coding'.
-The biggest up-coder has a CMS contract to help prevent fraud waste and abuse, yet both @SenWarren and @DrOz defined this up-coding as 'fraud' in Dr Oz's confirmation hearings
-In the 1960's, when Medicare was created, the estimates were that it would cost USA $11 billion by 1980. Instead it cost $111 billion
-Americans were promised that if they paid into this program, it would all be 'free' in our twilight years. Makes one think that we cannot trust the government with our tax dollars.
-In the 1960's the president of the AMA gave a speech of why he did not want Medicare to pass. It was eerily predictive, I'll link it in the thread below.
-side point is that the TOTAL subsidies the government pays into health 'insurance' Is an amount equal to 7-8% of our GDP. Wow. How can we afford that? 🧵1/6 (Hey, it's Sunday, grab some coffee and join me. If you know something to read about more important than figuring out how to spend less so our children have a shot at the American 🇺🇸 dream, let me know! )
In this @WSJ bit of ⭐️ reporting it was exposed that insures sent nurses to patient homes after bribing them with gift cards and made fraudulent (sometimes anatomically impossible) diagnoses in order to collect in excess of $50 billion. hey call this 'up-coding'. I call it fraud, but hey, if you give it a cutsie name, maybe America🇺🇸 won't notice. wsj.com/articles/medic… 2/6 🧵
"Patricia Greene had spent a month recovering from a devastating stroke when her Medicare Advantage insurer, a unit of UnitedHealth Group, decided to stop paying for her nursing home." This was not an isolated case, it's a pattern.
So after coverage was subsidized by our tax $$ to go to the insurers, the patient was forced to flee to standard Medicare when she needed coverage the most.
It seems that United HC thinks the old axiom 'you get what you pay' for doesn't apply to them
What kind of sickies are we allowing to sit on top of the food chain of American HC? 3/6🧵
@WomenAreReals @IWF @joeroganhq @SharylPodcast @LPNational @GeBaiDC @Lily4Liberty @OIGatHHS @MattWalshBlog @mtaibbi Here's a gem:
Be sure to read the comments, they are delightful as well. 4/6 🧵
United HC owns Optum and all its subsidiaries, including Optum serve who as pointed out above, contracts with @CMSGov to 'help them reduce waste fraud and abuse'. But United is being investigated for fraud. The tax 💵 transfer to United took off right after HITEC act when HC IT systems were mandated. Then there was a YUGE bump in United/Optum contract with CMS when Obamacare was getting launched. Optum serve Code Shop, QSSI-UNH Has a huge contract too, I believe it is separate from the $1.7 billion to Optum Serve.
BTW, United Optum also employ 10% of 🇺🇸 physicians, a PBM, a specialty pharmacy and Change HC, the clearing house for billing govtribe.com/vendors/qualit… 5/7 🧵( I just extended the thread with a banger of piece!!!... is that the correct use of the word 'banger'?)
In 2012, United HC(UHC) bought Quality Software Services (QSSI), a software services company.
At the time of its purchase, QSSI had a $144.6 million government contract to build a federal data services center for the new health insurance exchange (HealthCare.gov.. aka ACA exchange). Holy conflict-of-interest!!! UHC was acquiring a key contract for the ACA exchange.
After the disastrous launch of the ACA website in 2013, QSSI was given a key role in coordinating the repair efforts. Make a mess, then get to get paid to clean it up while laughing all the way to the bank much? Here is a fab article in @TheProspect by Sara Sirota detailing all of UHC acquisitions. I think the early 2020's with the Lewin Group and others are crucial to understand. prospect.org/2023/12/20/202… 6/7 🧵
Back when the AMA represented physicians and was watching out for everyday Americans and not it's own pocketbook, they rented Madison Square Garden in order that the then AMA president could give the rebuttal to then President Kennedy regarding the King Anderson bill (which became Medicare).
His words were prophetic, as he pointed out it wasn't really an insurance program, and wasn't going to be used by only those who had economic need, but the wealthy as well. Intro by Dr @AlietaEck youtube.com/watch?v=hqVkOl… 7/7 🧵
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USA needs to 👀 at the 340B program.
Here's a ⭐️ piece in @nytimes
-Cancer patient gets a drug from a non-profit 340B hospital. List price for drug is $2700
-Hospital bills insurance $22K for drug, insurance pays $10K
-Hospital bills cancer patient $2500, and sends her to collections when she won't pay
-Pt moves to free-standing Oncology who billed much less, pt charged nothing.
-Reporter discovers a little-known middleman named Apexus has been cashing in working behind the scenes to supercharge the #340B program
Let's learn more about Apexus.
You can learn the most about 340B from @DrDiGiorgio
He's an uber expert. 1/ 5🧵 nytimes.com/2025/01/15/us/…
@nytimes @Free2care wrote about 340B in our last paper
👀 here, start on p 19, it's brief 2/5 🧵 free2care.org/files/report.p…
From the times article on 340B,
-the feds have given apexus an exclusive contract for the 340B program for 20 years
- Apexus has profit margins above 80 percent
-HRSA an agency within H.H.S. that oversees the program, declined to answer detailed questions from @nytimes
-A decade ago, sales of 340B drugs were $12 billion. In 2023, they reached a high of $66 billion.
-Apexus is allowed to collect a fee for almost every drug sold under the program, giving the company an incentive to help hospitals and clinics capture as many prescriptions as possible 3/5🧵
I am happy that the out of pocket costs for this person ( @Crimsontider ) are low.
But what is Medicare paying for these prescriptions?
If Medicare is paying far too much ( they are) the system is unsustainable for our kids and grandkids.
So to ONLY worry about your copay is to ignore the plight you are leaving behind for kids and grandkids.
A thread 1/? 🧵
Let’s use a real life example. This coverage statement was shared by the caretaker of a special-needs person with seizures who is on a Medicare plan. Let’s call the patient ‘Elle’. Caretaker was shocked at how much money Medicare ‘covered’ for Elle’s Fintelpa. She’s a smart cookie this caretaker and knows that Fintelpa is half of the old diet drug FenFen so it’s years and years old. Should be cheap
Even though Elle paid nothing in co-pay, her caretaker was shocked to see that for a months worth of a decades old drug, Medicare paid $12,000. 2/5 🧵
From our example, our special needs patient Elle tried and failed on seizure med Fintepla, which should be inexpensive, but Medicare paid $12,000 in one month for. They were required to use a specialty pharmacy.
From Elle’s caretaker:
“We don’t have trouble accessing meds and we don’t pay much in copays. I am just appalled at the cost to taxpayers. I think everyone making money see our Elle as a cash cow.”
How sad that industry is profiting off the sick at the expense of taxpayers. 3/5🧵
The millions in conflict of interest the AARP has with United healthcare makes it very problematic that AARP has time and again supported PBM kickbacks.
Here is whole article in @GoErie 2/4🧵 goerie.com/story/opinion/…
@GoErie These non profits like AARP, often have many people profiting handsomely. 3/4 🧵
There is nothing free-market about the BIG #PBM
-They are consolidated both horizontally and vertically with the big insurers like United/Aetna/Cigna, and with big box pharmacies.
-Because they collect #kickbacks (legally per our government) they create monopolies or near monopolies of many medications, including insulin, and they make more 💰 when they choose a more expensive med for the formulary. ⬆️cost for 🇺🇸
-Because PBM control $$ flow to pharmacies, they have been shortchanging mom and pop pharmacies, while functionally helping themselves to $ from Medicaid, and putting Indie pharmacies outta business, in a practice called 'the spread'
NOT passing PBM reform is a windfall for BIG insurance, BIG PBM and harm for patients that I and every other physician pharmacist and nurse faces.
@nataliegwinters I ask you to read this thread and learn what I have learned over 8 years in advocating for PBM reform 1/5 🧵
2/5🧵From a 2021 piece in #BucksCounty @CourierTimes
I grew up here in bucks and served for 7 years on the editorial board of this paper.
I learned a LOT about the media while writing and on the board , that I'd love to tell you, @nataliegwinters ! Would make a super podcast about modern journalism. phillyburbs.com/story/opinion/…
3/5🧵Here is a pictorial demonstrating that #PBM are responsible for 80% of the increased cost of insulin. The bottom line is the net price, what pharma is making from insulin, the top line, the list price is what pharma makes, PLUS what PBM get in kickbacks and other 'price concessions'.
This happens for MANY drugs. Ask rheumatologists, pulmonologists and others
The root of the problem is kickbacks which should be repealed. Why would we allow any company the right to collect kickbacks?
But it is how we are getting monopolies of medications, why 3 big pharma companies made most of the insulin instead of having competition.
Let the PBM unchecked and they will keep minting 💰 at the expense of Americans. Pic is from this presentation I did for LA health commission In 2022 .
I came in from a shift, pulled a jacket over my scrubs at 11 pm and had at it. hat fun! youtube.com/watch?v=WfVV1p…
Pull up a seat for another multipart thread, this one is regarding #PBM pharma middlemen
as Congress is poised for PBM reform...
But, PCMA, the PBM lobby group is teaming up with the Competitive Enterprise Instutite and former Senator Toomey to tell us that PBM are 'market based".....in fact....
1/5🧵
We are all busy shopping and visiting and cooking up fab (hopefully healthy) meals, so I will make this shorter than last week's @voxdotcom thread
It's tough for me to see PCMA, CEI and Sen Toomey calling PBM 'market based', when they help themselves to medicaid money, through something called the 'spread', collect kickbacks (also non transparent) which creates a monospony ... a series of monopoies among pharmaceutical products, and cause the shutdown of independent pharmacies.
Last time I checked in the Bible of free market capitalism, monopolies, kickbacks and anticompetitive behavior were not Included 2/5 🧵
Here is article in #BucksCounty Courier Times where pic is from phillyburbs.com/story/opinion/…
I know about PCMA, the lobby group for PBM, but I did not know about The Competitive Enterprise Institute (CEI), who are also defending PBM as 'free market' so I did some looking. They are a non profit who has lobbied with $2million over the last several years and collects $10 million in revenue each year, from what I could find 100% is from contributors.
Who contributes? 3/5🧵..... cei.org/wp-content/upl…
Pull up for a long thread about this @voxdotcom article with the subtitle "What the fight between @AnthemBCBS and anesthesiologists was really about." 1/12 🧵 @anesthesianews vox.com/policy/390031/…
I'm a pediatrician. For 15 years I did hospitalist work. That meant I went to difficult deliveries where mom and baby were sick, I saw sick patients in the ER that needed to be intubated, some had critical airways or hard to get IVs.
In these and many more cases, the patient NEEDED the anesthesiologists... the physicians that slept in the hospital to make sure the patient had an airway or IV access. They are the docs that the surgeons rely on to keep their patients alive while they cut into bodies to save lives. 2/12 🧵
Here is a slide from the study that the vox article referenced that indicates what anesthesiologists find hard about their job.
Besides the long hours and endless glut of regulations, it is 💯 true that despite a fair surprise medical billing law, anesthesiologists and other docs have to fight tooth and nail to get paid for work done because @HHSGov favored the insurers in the implementation of the law . They are fighting the 3rd party payers who were ALREADY paid by the patients.
It's not the docs who are abrogating their duty to patients, it's the 3rd party payers who are, including our government . 3/12🧵