Why Healthcare is broken.
7 of the current top 11 lobby groups are HC related
A thread. 🧵1/6
@WallStreetApes @OccupyWallSt @WillCainShow @AAPSonline @newtgingrich @CharlieK_news @NanHayworth @ehlJAMA Here is the historical list of top lobbyists. Chamber (insurance related) Hospitals, Pharma, AMA (insurance related) BCBC and AARP ( insurance related) have been there for years 2/6 🧵
@WallStreetApes @OccupyWallSt @WillCainShow @AAPSonline @newtgingrich @CharlieK_news @NanHayworth @ehlJAMA 3/6🧵Here is a piece I wrote a few years back that points out how the very people who lobby the most are the ones who profitted the most from Obamacare.
Funny how that worked. goerie.com/story/opinion/…
4/6 🧵full text of article
The New York Times reports that there is unity of thought in certain circles about how the reach of the Affordable Care Act (ACA, aka “Obamacare”) should be expanded.
That’s unsurprising. Parasitic, special interests will tend to think alike when it comes to sucking nutrition from a host.
The profiteers of Obamacare — for example, gigantic health insurance companies and increasingly monopolistic, regional, health systems — never lose sight of their objective of increasing profits or of the need to bend lawmakers in a direction that serves that objective.
When it comes to understanding this perverse feature of America’s healthcare economy, the public is decidedly not “woke.”
The complexity of “the system” deters most people from even thinking about where all the money is going.
Consider:
1.) The very design of the ACA, misnamed because of its emphasis on coverage — not affordability and not care — has produced a windfall for the alpha parasite among the special interests, the insurers represented by AHIP (America’s Health Insurance Plans), a lobbying organization known for the generous donation of its “influence” among politicians on both sides of the aisle.
2.) Also enjoying big increases in profit after implementation of the ACA were certain hospitals. Curiously enough, hospitals categorized as “non-profit” did quite well, sometimes at the expense of the indigent patients they claim to serve. By the way, the AHA (the American Hospital Association), is another of Washington’s heavyweight lobbyists.
Note to dozing America: there are CEOs among the nation’s top “non-profit” hospitals whose annual income is close to $20 million. Feeling “woke” yet?
Most Americans view hospitals and the physicians who staff them as a single entity. Yet in recent years, there is a growing divide between the “suits” and the “scrubs,” the executive-administrative class on one hand and those who actually practice medicine on the other. With slightly more than half of America’s physicians now being hospital employees, few speak out against what they’re seeing and the direction in which things are headed. Hospitals like it that way; each year, they net an average of $2.4 million for each doctor they employ.
The AMA (American Medical Association) long ago ceased representing practicing physicians. Less than 15% of them are members, and the dues collected in 2018 were 10% of the AMA’s $332 million in revenue. By developing other revenue streams, the AMA has made common cause with the parasitic coalition to survive.
Yes, everyone agrees with the platitude cited by the New York Times in its report: “Americans deserve a stable health care market that provides access to high-quality care and affordable coverage for all.”
But the ACA did nothing toward that end, nothing to reduce costs or the forces that drive them upward, a fact that is nothing if not monumentally awkward.
Will “expanding the ACA” change that?
Of course not.
Over the decades, our legislators have woven together legislation that relentlessly favors members of the parasitic coalition. The result? Consumers pay more for less time with a physician, assuming that they can meet with one.
The profiteering special interests that dominate the warped economy of heath care in America are already leaning on the new administration in Washington. Most people want transparency in the pricing of services. The entrenched special interests oppose it. It’s their “jam.”
The same interests pursue consolidation in the direction of near-monopoly power. We shall see how well the new Secretary of Health and Human Services, Xavier Beccera, lives up to his reputation by resisting their efforts and reversing damage that has already been done.
Perhaps Congress can reverse its headlong plunge to the bottom in public opinion polls by listening to different voices — physicians who actually care for patients. Absent a change of “influence,” Congress will reverse that plunge to the bottom when pigs sprout wings.
America, who do you trust to make the ground rules for a better system of health care — a system defined by (1) easy access to medical care at (2) reasonable cost, and (3) relationships between physicians and patients that are unburdened by the sapping effects of an entire class of parasite?
Do you trust the business interests, like the million-dollar CEOs of the parasitic coalition?
Do you trust the politicians who look to the parasitic coalition for the funding to keep their jobs?
Or would you consider hearing what a grassroots movement of fed-up physicians, people who swore an oath to protect you, has to say?
Forget “Utopia.” Simple sanity will do.
Marion Mass, M.D. is a pediatrician, co-founder of Practicing Physicians of America, and leadership in the Free2Care organization.
5/6 🧵Here is a Dr Seuss-style poem I wrote in a whimsical moment.
"You and loved ones will suffer and some will die.
While CVS, Centene, Blue Cross and Practice Fusion gobble more of the juicy healthcare pie.
What happens when the last doc, the last good nurse Falls?
Are corporate middlemen going to care for you all?
There will be blood on their hands and splattered on the wall.
It’s been over 50 years of our government sanctioning medicines poison: The corporate pill.
When will you stand up against this vile swill?" practicingphysician.org/how-to-save-am…
@WallStreetApes @OccupyWallSt @WillCainShow @AAPSonline @newtgingrich @CharlieK_news @NanHayworth @ehlJAMA 6/6🧵
When you enter the exam room and see👀 a patient's pain due to our dysfunctional system, and you keep giving past when it hurts as some do; when you 👀 docs who peddle the corporate swill, and try to knock you outta the game because you speak truth to power.... keep going.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
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🧵
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…