The hottest Healthcare Costs Substack posts right now

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Insurance companies aren't the main villain of the U.S. health system

Noahpinion • 56706 implied HN points • 09 Dec 24
🏥 Health Politics Healthcare Costs Policy Solutions Public Perception
  1. Insurance companies are not the real problem in the U.S. healthcare system. The high costs mainly come from medical providers, like hospitals and doctors, who charge a lot for their services.
  2. Americans often experience frustration with insurance because they feel it denies their claims or doesn't cover costs. However, the insurers are only a small part of why healthcare is so expensive.
  3. To make healthcare more affordable, the focus should be on reducing the high prices set by healthcare providers, not just blaming the insurance companies.

The Dirty Trick Health Insurers Are Playing That You Don’t Know About

HEALTH CARE un-covered • 1199 implied HN points • 03 Sep 24
🏥 Health Politics Insurance Regulation Consumer Rights Healthcare Costs Health Reform
  1. Health insurers use a measurement called the medical loss ratio (MLR) to determine how much of your premiums go to actual medical care versus overhead costs. They should spend at least 80-85% on care, but many find sneaky ways to get around this.
  2. Big insurance companies manipulate what counts as 'quality improvement' to make it look like they're spending more on healthcare than they actually are. They might include things like software upgrades or marketing instead of just patient care.
  3. By buying up doctors' offices and clinics, insurers can steer patients to their own services without MLR rules applying. This way, they keep more money for themselves instead of lowering premiums or improving coverage for you.

OPINION: The GOP Plan to Right-Size the NIH and Provide Oversight Does Not Go Far Enough

Popular Rationalism • 693 implied HN points • 05 Oct 24
🏥 Health Politics Public Health Chronic Disease Medical Research Healthcare Costs Policy Reform
  1. The GOP wants to cut the number of NIH disease centers and add political oversight, but that won't fix deeper problems. Chronic diseases are a big issue, and the focus needs to shift towards prevention, not just treatment.
  2. NIH spends a lot on traditional pharmaceutical research, but it often ignores integrative medicine, which could really help with chronic illnesses. More research into things like diet and lifestyle changes can make a big difference.
  3. #PlanB suggests decentralizing research by creating many independent labs that can focus on local health needs. It prioritizes prevention and transparency, aiming to better address the long-term health problems facing the country.

As it Turns Out, Health Insurance Executives Are Really (Really) Good at Their Jobs

HEALTH CARE un-covered • 799 implied HN points • 01 Jul 24
🏥 Health Politics Healthcare system Insurance Issues Patient Care Healthcare Costs Corporate Governance
  1. Health insurance executives are focused on making their shareholders happy, which often means keeping costs low for employers, not necessarily improving services for patients.
  2. In health insurance, the customer who pays for the insurance and the consumer who uses it are different, creating conflicts of interest that can harm patients.
  3. Insurance companies often make it difficult for those who need the most care to access it, which is counterproductive for the patients who genuinely need help.

The "cost" of COVID-19

Independent SAGE continues • 699 implied HN points • 25 Mar 24
🏥 Health Politics Public Health Vaccination Long Covid Healthcare Costs Economic Impact
  1. COVID-19 is still an economic issue, and the impact of Long Covid needs to be considered in vaccine decisions. Vaccination helps prevent Long Covid, but we don't fully understand how long this protection lasts.
  2. Many people are unable to access vaccines, especially children. In contrast, other countries widely vaccinate kids, while the UK has limited offers.
  3. Long Covid can significantly affect people's ability to work and has a heavy economic burden. This includes healthcare costs and loss of income, which could impact the economy in the long run.
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How Employers Can Easily Bend the Rx Cost Curve

HEALTH CARE un-covered • 259 implied HN points • 24 Apr 24
🏥 Health Politics Healthcare Costs Prescription drugs Insurance Legislation
  1. Employers can save money on prescription drugs by creating a competitive environment for pharmacy benefit management (PBM) contracts. This means they should compare prices from various PBMs to find the best deal.
  2. Using objective pricing metrics helps employers understand exactly how much they are paying for drugs. By focusing on all costs including fees and ensuring transparency, they can cut down unnecessary expenses.
  3. Employers should keep track of their spending regularly and adjust as needed. This ongoing management can lead to significant savings for both the employer and employees without limiting access to necessary medications.

Private Medicare blitz: for-profit health insurers are pressing hard for new enrollees in their taxpayer-supported Medicare businesses in 2024

HEALTH CARE un-covered • 519 implied HN points • 20 Nov 23
🏥 Health Politics Medicare Insurance Healthcare Costs Consumer Rights
  1. Private Medicare plans are trying hard to gain new members, often using appealing offers like gym memberships and grocery cards to entice seniors.
  2. Many seniors who switch to these plans may face unexpected costs, like high deductibles, and risk being denied coverage for essential medical services.
  3. It's important for seniors to carefully consider the long-term impact of switching to private Medicare plans, especially if they have serious health needs.

Six annoying steps that reduced my prescription drug costs by $2000 per year

Neeloy’s Substack • 59 implied HN points • 21 Jun 24
🏥 Health Politics Healthcare Costs Prescription drugs Insurance Issues Patient Advocacy Health economics
  1. You can save money on prescription drugs by asking for generic versions. A simple request to your doctor might cut costs significantly.
  2. Checking websites like goodrx.com for coupons can make a big difference. It's worth taking the time to search for discounts at different pharmacies.
  3. Don't hesitate to communicate with your pharmacist and doctor. Asking questions and exploring alternatives can lead to much lower medication costs.

Cigna’s Q2 earnings put Wall Street on edge despite huge PBM business revenues

HEALTH CARE un-covered • 599 implied HN points • 08 Aug 23
🏥 Health Politics Insurance Issues Healthcare Costs Profit Margins Corporate Practices Market Trends
  1. Cigna plans to raise health insurance premiums for many customers by about 23% next year, which could leave small businesses and individuals struggling to afford their coverage.
  2. Despite earning more money overall, Cigna's profits fell due to higher medical costs and this disappointed investors, causing their stock price to drop.
  3. Cigna is focusing on its pharmacy benefit manager business, which now accounts for a large share of its revenue, even while prioritizing stock buybacks over customer relief.

An epidemic of medical debt is devastating American families as health insurers ratchet up out-of-pocket demands

HEALTH CARE un-covered • 439 implied HN points • 20 Oct 23
🏥 Health Politics Medical Debt Insurance Healthcare Costs Consumer Advocacy Public Health
  1. Many American families are struggling with medical debt because health insurance companies are making them pay more out of pocket before they get any help. This leaves lots of people feeling like they don't have any insurance for most of the year.
  2. The rise in medical costs is leading to serious financial problems, with a large number of people owing money due to health care expenses. This debt crisis affects millions, and many people feel they might never fully pay it off.
  3. The way healthcare is organized forces people to pay higher costs for their care, often putting them in tough situations where they can't afford necessary treatments. Despite promises of affordable care, the system still seems to favor higher spending on healthcare.

Health insurers find new way to drain the bank accounts of Americans with chronic conditions

HEALTH CARE un-covered • 459 implied HN points • 26 Sep 23
🏥 Health Politics Insurance Legislation Chronic Conditions Healthcare Costs Patient Advocacy
  1. Health insurers are changing rules that make it harder for people with chronic illnesses to pay for their medications. This is causing patients to spend much more money out-of-pocket.
  2. Copay accumulators are a new tactic where insurance companies do not count discounts from drug manufacturers towards patients' out-of-pocket limits, making medications even more expensive.
  3. Legislation is being introduced to help protect patients. Bills are being considered at both state and federal levels to ensure that all payments count towards out-of-pocket expenses.

After missing mid-year financial expectations, here are the ways big health insurers are going to get back into Wall Street's good graces

HEALTH CARE un-covered • 399 implied HN points • 14 Sep 23
🏥 Health Politics Healthcare Costs Policy Changes Market Trends
  1. Big health insurers are planning to cut costs and increase profits by negotiating harder with hospitals and cutting payments to doctors. This might mean less money for patient care.
  2. There may be layoffs and job losses as companies try to streamline operations and boost their financial performance. Together with potential cuts in benefits, employees could face job insecurity.
  3. Health insurance costs are expected to rise for consumers, along with reduced access to care. Insurers are looking to increase prices and tighten coverage to please investors on Wall Street.

Health insurers have spent over $141 billion buying back their own shares since 2007 while premiums and deductibles have skyrocketed

HEALTH CARE un-covered • 619 implied HN points • 04 May 23
🏥 Health Politics Healthcare Costs Insurance Industry Corporate ethics Legislation
  1. Health insurers have spent about $141 billion on buying back their own shares since 2007. This means money that could help lower premiums is going to make executives richer instead.
  2. As health insurers buy back shares, premiums and deductibles for customers have gone up a lot. Many people are struggling with high medical debts while companies focus on profits.
  3. There are efforts to change laws around stock buybacks, but so far, nothing has passed. Many believe that these buybacks hurt workers and families instead of helping them.

NEWS UN-COVERED: health insurer rate hikes and Medicare Advantage ads in 2024

HEALTH CARE un-covered • 239 implied HN points • 27 Sep 23
🏥 Health Politics Healthcare Costs Insurance Issues Government Policy Consumer Rights
  1. Medicare Advantage ads are misleading, and there is an effort by the government to make them more transparent. Consumers need to be careful and do their research before signing up for these plans.
  2. In 2024, health insurers are planning significant rate hikes that could affect employers and consumers. This could lead to higher overall healthcare costs and impact inflation.
  3. There is increasing pushback from employers against these rate hikes. They are using new transparency rules to negotiate better deals with health insurers.

BIG INSURANCE 2022: Revenues reached $1.25 trillion thanks to sucking billions out of the pharmacy supply chain – and taxpayers' pockets

HEALTH CARE un-covered • 539 implied HN points • 27 Feb 23
🏥 Health Politics Insurance Medicare Pharmaceuticals Government programs Healthcare Costs Regulation
  1. Big insurance companies made a lot of money in 2022, reaching $1.25 trillion in revenue. They mainly got this money from managing drug benefits and government health programs.
  2. Pharmacy Benefit Managers (PBMs) are becoming really important for these insurers, as they now make up a huge portion of their profits. They control a lot of the drug pricing and decide which pharmacies patients can use.
  3. Most growth for these companies is coming from government programs like Medicare, while their commercial insurance business is struggling. Many people are now finding it harder to afford their healthcare costs.

How (Not) To Prevent Youth Suicide

Mental Disorder • 235 implied HN points • 01 Sep 23
🏥 Health & Wellness Mental health Healthcare Costs Public Health
  1. Many suicide prevention programs are not evidence-based or effective in reducing suicide rates.
  2. Suicide interventions often focus on raising awareness and talking, but the best way to reduce suicide is to change the environment to limit access to means.
  3. Simple actions like building barriers to prevent jumping from bridges and restricting access to guns can be effective in preventing suicides.

The choice between traditional Medicare and Medicare Advantage? It’s easier than you think. (PART 2)

HEALTH CARE un-covered • 419 implied HN points • 07 Mar 23
🏥 Health Politics Medicare Health Insurance Healthcare Costs Policy Analysis Patient rights
  1. Traditional Medicare can be expensive upfront due to high out-of-pocket costs, especially if you need supplemental coverage. Many people choose Medicare Advantage for its lower immediate costs and out-of-pocket limits.
  2. Companies often push retirees into Medicare Advantage plans because they save money and get better benefits for these groups. However, retirees might lose important access to doctors and hospitals by switching.
  3. Medicare Advantage plans may advertise extra benefits, but these can come with hidden costs. People often struggle to access the care they need due to strict rules and limited provider networks.

"Confessions of a Former Carrier Executive": my keynote address at the 2023 YOU Powered Symposium

HEALTH CARE un-covered • 279 implied HN points • 17 Feb 23
🏥 Health Politics Health Insurance Policy Making Public Health Healthcare Costs Corporate ethics
  1. Big health insurance companies mainly focus on making their shareholders richer, often at the expense of patients.
  2. The speaker shared personal experiences from a career in the industry, highlighting the luxury lifestyle financed by policyholders and taxpayers.
  3. Despite record profits for insurance companies, many American families remain uninsured or underinsured.

UnitedHealth, CVS/Aetna, Cigna pulled in close to a trillion dollars last year, mostly as drug middlemen

HEALTH CARE un-covered • 279 implied HN points • 09 Feb 23
🏥 Health Politics Pharmaceuticals Insurance Healthcare Costs Market Dynamics Public Policy
  1. Three major companies, UnitedHealth, CVS/Aetna, and Cigna, are now making most of their money from being middlemen in the prescription drug market rather than from selling health insurance. This means they control a big part of how much patients pay for their medications.
  2. In 2022, these companies earned over $492 billion from their pharmacy benefit management (PBM) services, showing that this part of their business is growing much faster than their health insurance offerings.
  3. These companies are expanding into primary care services, like buying healthcare centers, as they face slower growth in their health insurance segments. This shift suggests they are looking for new ways to make profits amid tougher competition.

Consolidations and profiteering: the relentless rise of hospital expenditures

HEALTH CARE un-covered • 199 implied HN points • 02 Mar 23
🏥 Health Politics Healthcare Costs Health Policy Pharmaceuticals
  1. Hospital expenditures are rising quickly, with costs expected to reach $2.2 trillion by 2030. This growth is leading to financial burden on patients and families.
  2. Many factors contribute to these rising costs, including wasteful administrative expenses and high-priced medicines. Administrative costs alone can make up 15-30% of the health-care spending.
  3. One big reason for higher hospital prices is consolidation through mergers, which leads to less competition and price increases. Most areas now have only a few hospital options which can drive prices up by over 20%.

NYC mayor’s misguided and dangerous plan to move city retirees into a private Medicare replacement plan dealt another blow

HEALTH CARE un-covered • 219 implied HN points • 18 Jan 23
🏥 Health Politics Health Policy Medicare Public Health Healthcare Costs
  1. New York City retirees are fighting against a plan to move them to a private Medicare replacement that could limit their healthcare options. Many retirees feel this plan is risky and unnecessary.
  2. Recent opposition resulted in the city council not voting on the mayor's proposal, showing that collective action can influence decision-makers. The retirees are determined to continue their fight, even if it means taking legal action.
  3. The mayor's plan could lead to increased healthcare costs and less choice for retirees. There are suggested ways for the city to save money without cutting benefits, like conducting audits and improving its own systems.

Here is what you need to know in healthcare this week.

HEALTH CARE un-covered • 279 implied HN points • 20 May 22
🏥 Health Politics Healthcare Costs Insurance Issues Medicare Policy Impact Public Health
  1. Insulin prices have skyrocketed, and many diabetics are struggling to afford it. In fact, out-of-pocket spending for insulin doubled from 2007 to 2019 for those on Medicare.
  2. High-deductible health plans are making it harder for low-income workers to get preventative care. People earning less than $75,000 a year often avoid necessary medical check-ups due to high costs.
  3. Private insurers are paying much more for healthcare services than Medicare, which leads to higher premiums for consumers. This shows that privatizing healthcare isn't necessarily better for controlling costs.

Wall Street to Elevance (formerly Anthem) Executives: Stop paying medical claims... or else.

HEALTH CARE un-covered • 219 implied HN points • 22 Jul 22
🏥 Health Politics Healthcare system Insurance Issues Healthcare Costs
  1. Insurance companies are increasing out-of-pocket costs to avoid paying medical claims. This means patients end up paying more, making healthcare less affordable.
  2. Wall Street puts pressure on insurers to keep profits high, which can lead to practices like denying claims or raising premiums. This can hurt many people who need insurance.
  3. Many Americans with insurance are still in medical debt because of high out-of-pocket expenses. Even those with coverage can find it hard to get the care they need without facing huge bills.

HOW IRONIC: Corporate health insurance consultants blame high medical costs on our "bad habits" and "overuse" of system.

HEALTH CARE un-covered • 139 implied HN points • 21 Oct 22
🏥 Health Politics Healthcare Costs Insurance Issues Medical Debt Patient Advocacy
  1. Health insurance consultants often blame people's bad habits for rising medical costs, while huge insurance companies are making record profits. This seems very unfair to the average person trying to access affordable care.
  2. Many insured Americans are still struggling with medical debt and high out-of-pocket expenses. It's tough when even people with insurance can't afford their medications or treatments.
  3. The focus should be on the greed of insurance companies rather than blaming individuals. Insurers could help lower costs, but they often choose profit over patient care, leaving many people in financial trouble.

IT'S JUST SPIN: UnitedHealth Group touts out-of-pocket savings that patients will never see.

HEALTH CARE un-covered • 159 implied HN points • 19 Jul 22
🏥 Health Politics Healthcare policy Insurance Public Health Pharmaceuticals Healthcare Costs
  1. Only a small percentage of UnitedHealth policyholders will actually benefit from announced out-of-pocket savings, making the impact very limited.
  2. The company's marketing creates a misleading impression that many will save money, but most won't qualify for these benefits.
  3. UnitedHealth seems more focused on boosting profits and shareholder returns than on genuinely helping patients with affordable medications.

How Big Insurance, PBMs, the FDA, Congress and AstraZeneca made me pay so much for my inhaler.

HEALTH CARE un-covered • 139 implied HN points • 25 May 22
🏥 Health Politics Healthcare Costs Pharmaceuticals Insurance Legislation Regulation
  1. The cost of inhalers in the U.S. has been rising, mainly due to a lack of generic options and practices by insurance companies and manufacturers that keep prices high.
  2. Most inhalers approved since the 1980s are brand-name drugs, and companies use tactics like patent extensions to block generic versions, resulting in long periods of high costs.
  3. People can save money on medications by ordering from countries like Canada or New Zealand, where prices are often much lower and generics are more readily available.

As big insurance announces record profits, skyrocketing out-of-pockets (finally) take center stage.

HEALTH CARE un-covered • 99 implied HN points • 01 Aug 22
🏥 Health Politics Insurance Political Response Public Perception Healthcare Costs
  1. Insurance companies are making big profits, but many families can't afford their healthcare costs. This is making people push for change.
  2. High out-of-pocket expenses, like deductibles, are making it hard for people to use their health insurance. They often avoid seeking care because of these costs.
  3. Voters are worried about rising healthcare costs, especially out-of-pocket payments, and they want to see candidates make this a priority.

The $140 billion the New York Times says Americans owe in medical debt is just the tip of the iceberg.

HEALTH CARE un-covered • 99 implied HN points • 21 Jul 21
🏥 Health Politics Medical Debt Insurance Issues Patient Advocacy Healthcare Costs Public Policy
  1. Americans owe $140 billion in medical debt, but this number is likely much larger. Many people are also using credit cards to cover healthcare costs, which adds to the debt.
  2. A significant amount of medical debt comes from insured people, not just the uninsured. High deductibles make it hard for many to afford care even with insurance.
  3. High-deductible health plans can be risky, as they can lead to big out-of-pocket costs when people get sick. This situation needs more attention from lawmakers to protect individuals from financial ruin.

Congress must cap increasingly lethal Medicare out-of-pocket requirements

HEALTH CARE un-covered • 39 implied HN points • 25 Oct 21
🏥 Health Politics Medicare Insurance Healthcare Costs Legislation
  1. Medicare costs are rising, making it harder for seniors to pay for care. Many people with Medicare can face high out-of-pocket expenses that lead to debt or avoiding necessary treatment.
  2. Congress should put a cap on out-of-pocket costs for Medicare. This could help seniors save money and get the care they need without falling deep into debt.
  3. Medicare Advantage plans often seem attractive, but they can have hidden costs that can be very high. Seniors need to be careful in choosing their plans to avoid surprises.

The dream of universal health care is haunted by the reality of aging

Demodexio • 0 implied HN points • 24 Feb 24
🏥 Health Politics Aging Healthcare Costs Specialization Accountability
  1. Extending human life is becoming increasingly expensive due to the Law Of Diminishing Returns, especially with advancements in medical treatments and technology.
  2. National health care systems, even in countries with universal health care like Canada and Britain, are facing strain and challenges in controlling costs, especially with an aging population.
  3. Addressing the rising costs in healthcare will require a focus on reducing bureaucracy, controlling technology investments, and finding innovative ways to combine the expertise of diverse specialists in healthcare settings.