According to the Supreme Court murder and mayhem were the founders desire. This happens again and again and again only in the United States of America. Every other industrialized country seems to understand that it’s not the doors or mental health or high criminality or not enough hopes and prayers. It’s the guns and everyone knows it
Medicynical Note: Families devastated, lives lost and the Republican Party is concerned only with voiding any limit to gun ownership. Every day again and again and again until we get it right.
The murder abetting Republican dominated Conservative Supreme Court sits above it all with some members in hiding because someone near their homes might be legally carrying a weapon or because of their own personal, open for all to see, corruption (yes Justice Thomas, you). They blame it all on the slave owning founders. Amazing what has become of the once civil society of America.
It’s hard to believe he’s still in congress. He lied about literally everything during his election campaign and was still elected to the U.S. House of Representatives. This was known at the time of his installation as a member of the house but the Republican leader of the house allowed him to be seated. While somewhat shocking it should not come as a surprise as the leaders of his party regularly suborn perjury and encourage lies whether speaking of the outcome of the 2020 election, the January 6 attempted insurrection, the previous president’s performance, or the causes of the budget deficit.
Medicynical Note: Not only is he still a congressman but he is running for re-election. And the Republican Party………. missing inaction.
Medicynical Note: A citizen of three countries (Canada, South Africa and the the U.S.) Elon, the good capitalist, is only loyal….. to himself. In the midst of the American vs Chinese economic wars he hedges his bets and expands in China. I guess he doesn’t buy into this made in America and hiring Americans stuff. His interest as always is doing well rather than doing good.
“Before she went from the U.S. House of Representatives to the U.S. Senate, Sinema was party to an early effort by the banks to undo the provisions of the 2010 Dodd-Frank Wall Street Reform and Consumer Protection Act that was passed in the wake of the 2007-2008 financial crisis.”
She also voted for the Trump loosening of the Dodd-Frank banking regulations in 2018. “After Trump became president, Sinema and a majority of the House Financial Services Committee supported the far more extensive Economic Growth, Regulatory Relief, and Consumer Protection Act of 2018. Sinema sponsored unrelated accompanying measures protecting children from identity theft and seniors from scammers. The immediate effect was to divert attention from the bill’s ultimate intention, which was to let the banks do whatever they want.”
So after voting for the deregulation of the industry and encouraging bankers to take more risk she’s back. Wondering what happened.
Medicynical Note: We’re watching the slow disintegration of democracy.
A Supreme Court that is supremely unconcerned about voting rights; that appears to support a state religion; that wants to reinstitute the laws of 1776 rather than adjust to the 21st century.
An octogenarian president who, while in my view is an upgrade from the last guy, wants re-election. Someone in their mid 80’s leading the country? Not a good idea.
We also have a House of Representatives led by (third in line for the presidency) a hapless compromised speaker who sold his soul to the most radical conservative faction of his party and who supported the Jan. 6 attempt to overthrow the election.
And now a self proclaimed independent, one of the prime movers to deregulate banking , wonders what caused two banks to fail over the weekend and wants accountability. With such a feckless leadership what could possibly go …………right?
Understanding health care coverage and costs requires a PhD. The folks in today’s health care fiasco bought coverage from a company that for two years doesn’t cover “pre-existing” problems…. and got burned.
‘The plans are often faith-based, whatever that means, and have surged in popularity in recent years because they can be cheaper than traditional insurance — the Kings said their plan cost $534 a month, plus an additional $118 a month to join a direct primary care medical practice.”
“But the sharing plans offer fewer protections than insurance and come with provisos. The Kings said their plan did not fully cover preexisting conditions like Jeff’s heart condition for the first two years of coverage — and he needed the surgery after 16 months.”
In this case the couple found they were liable were for the entire $160,000 billing.
Medicynical Note: Healthcare has become worse than buying a used car, in part because the car purchase is discretionary while in health care one’s very existence may be involved……..and, in part because the amount of money involved in healthcare is so much more.
The article notes: “Hospital charges are generally understood by health economists to bear little resemblance to the actual prices that are typically paid. Instead, they are more of an opening salvo in the high-stakes negotiations between hospitals trying to get as much money as they can for providing care and insurance companies trying to pay as little as possible.”
In this case after billing $160,000 the hospital knocked off $107,000 from their original pricing. This for a non-surgical Cath-lab procedure that probably required only an overnight stay. And FYI the hospital involved had a net revenue of over 800 million dollars and net income (2020) of over 57 million dollars. Not bad for a “non-profit.”
It’s sadly true in America that in America healthcare companies are more interested in income than outcomes.
America has a system of revenue generation that it calls healthcare. Many of it’s “healthcare” corporations work more diligently to improve revenue and income than on improving patient access, affordability and outcomes. That’s American private healthcare even if the company involved is supposedly “non-profit.” This article documents some of the actions of a large non-profit church run hospital system. In reality it is a cash cow that launders hospital income into huge privately held investments.
As noted in the article “But The Times this year has documented how large chains of nonprofit hospitals have moved away from their charitable missions.”
“Some have skimped on free care for the poor, illegally saddling tens of thousands of patients with debts. Others have plowed resources into affluent suburbs while siphoning money from poorer areas.’
And: “Today, Ascension operates in 19 states, mostly in the South and the Midwest. It serves about six million patients.”
“By many measures, Ascension is rich.”
“In addition to its billions in cash, it runs an investment company that manages more than $41 billion. Last year it paid its chief executive, Joseph Impicciche, $13 million.”
“Because of its nonprofit status, Ascension avoids more than $1 billion a year in federal, state and local taxes, according to the Lown Institute, a health care think tank.”
Medicynical Note: In large areas of the country, because of the tax advantage from their non-profit and church related status, hospitals like Ascensions’ have become the only provider of health care, dominating both inpatient and outpatient services. Besides scrimping on staffing and services to maximize return they also enforce health care religious proscriptions on their non-practicing patients and staff.
In the end America has a revenue generating rather than a health generating system of care. It’s interest is more in income than outcomes. Sad but true.
I’ve previously talked about the manipulation of medical prices through price gouging and medical code game playing. What follows is an example. Not unusual. It happens every day in the U.S. of A.
“Total Bill: $73,812 for the two shots ($35,414 for the first, $38,398 for the second), including lab work and physician charges. United Healthcare’s negotiated rate for the two shots plus associated fees was $27,568, of which the insurer paid $19,567. After Hinds haggled with the hospital and insurer for more than a year, his share of the bills was determined to be nearly $7,000.”
Medicynical Note: Almost everything on this bill is a manipulation of the system. First, the pricing of the lab tests. Each are inflated probably several times the actual cost of doing the test or the price of the test done for outpatients. Next, the cost of the medication leuprolide $35,000 (gasp!). This, for a drug developed in 1973 and priced at a few hundred dollar just a few years ago and costing $250 or less in overseas healthcare systems. Current pricing in various locales here. And lastly the use of codes to increase the billing i.e. separating the office visit fee from an “evaluation and management” fee. Both events, of course, happened simultaneously. Or consider the over $500 fee for a quick, less than a 1 minute, administration of a drug that has almost no immediate side effects. The nurse administering the drug didn’t even have to find a syringe to draw up the medication as it comes ready to go in a syringe.
Healthcare pricing has little to do with actual costs. This patient had insurance and paid a “negotiated” reduced but still excessive amount. But if he had no insurance he would have been billed and held accountable for the full amount, unless maybe he could claim poverty or was a skilled negotiator.
The finances of healthcare in the United States are worse than going to a used car lot and dickering for a car……and more expensive. When you understand that the CEOs’ of so-called health-care companies major concern is income not outcomes than you understand why we pay so much.
An encounter with our health care system is worse than going to a used car lot. In the latter case you more or less know before the purchase what your cost will be, albeit the route to the final price is galling.
“Laub opted for the methotrexate injection. After getting the shot, patients need certain follow-up blood tests for several weeks to confirm that the pregnancy is ending or has ended. Laub returned to the emergency department for bloodwork and an ultrasound three days after the shot. She returned again three days later and was given a second shot of methotrexate since the pregnancy hadn’t terminated. The following week, she repeated the treatment in two more follow-up visits. On July 20, after 12 days and five emergency department visits, Laub was scheduled for laparoscopic surgery to remove her fallopian tube.”
“The total charges to date for the medical treatment: an eye-popping $80,000. Because her health plan had negotiated discounted rates with the hospital and the other providers, all of whom were in her provider network, Laub’s out-of-pocket cost will be a fraction of that total. It now appears Laub will owe a little more than $4,000.”
Medicynical Note: When I lived in a third world country years ago, little kids would approach me at the open market and ask for baksheesh. Every time, every single time. They’d ask whether or not I gave.
Our healthcare system is a rabbit warren of rules and regs a little like that open market. Providers always ask for the gift and diligently game the system to maximize billings. Hospitals hide prices and years ago learned that they made more by itemizing every little thing and overcharging for each item rather than by providing a comprehensive price for a service. Adding to the confusion, prices charged insurers vary widely are often tiny fractions of that charged to customers without insurance.
And yes, the multimillionaire CEO’s of healthcare companies and health insurers could care less whether you get affordable care or whether you survived your encounter with the healthcare system For them it’s the company’s income not patient outcomes that is important. That’s America.
In Eastern Europe after WWII the Soviets consolidated power by undermining countries monarchies and fledgling democracies by subverting elections, the judiciary, police authorities and political parties. This strategy was termed salami tactics—undermining by a thousand cuts.
We are now facing a similar Republican/Trumpian strategy. They are literally taking apart our elections, Judiciary and soon our political structure with a thousand cuts. And sadly the Supreme Court seems a key part of this undoing.
This article from Slate explained salami tactics in 2019……its even worse now. Call it what you like our Democracy is threatened and maybe by this point finished as we know it.
Medicynical Note: Our republican friends are attempting to subvert the election process in states in which they control the legislatures; they are gerrymandering beyond all previous such actions; inhibiting the vote in areas where the opposition resides; not recognizing the validity of fully validated elections (they lost by millions) and are openly supporting violent insurrection. It’s happening now in the U.S.
Procuring and paying for healthcare in the U.S. is an exercise more opaque and yes, potentially even more expensive than buying a new car. Ever try and get a firm price for healthcare services? You’ll find that no one can give a total price and guarantee that’s what you’ll be charged.
We have a system of revenue generation not healthcare. Your doctor in modern America is an employee and has little to no control over his office. And doctor’s fees it turns out are only a small part of the total cost.
Medicynical Note: I’m an elderly retired M.D. and am well covered by insurance. This year so far my Medicare/Medicare Advantage policy was billed $5,954 for services. Because they have agreements with providers they paid only $2,210.34 for the services with me paying a very modest $10/visit co-pay. Not a bad deal if you have the coverage.
If I were one of the un-insured the providers would charge the entire $5,954……ironically or perhaps by design charging those least able to pay, the most. It’s really an absurd way of paying for health care and is the only such faux health care system/revenue generation system in the industrialized world.
Health care costs in the U.S> are among the leading causes of bankruptcy. Such bankruptcies are unknown in other parts of the world.