SUBSCRIBE TO OUR FREE NEWSLETTER
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
5
#000000
#FFFFFF
5
#000000
#FFFFFF
for profit healthcare
New Reporting on Insurance Claim Denials Highlights 'Scam' of For-Profit Healthcare
"Private insurance companies, including Medicare Advantage plans, are designed to generate profit. How do they do that? Take our money and then deny our care."
Jun 28, 2023
A pair of new stories examining the increasingly common but shadowy U.S. insurance industry practice of refusing to pay for certain treatments drew outrage Wednesday from patient advocates and Medicare for All proponents, who said the reporting further reveals the harms of for-profit healthcare.
The investigative outlet ProPublicafocused its attention on the "galling" secrecy around insurance companies' claim denials, which frequently leave patients with massive medical bills and little clarity as to why their claims were rejected.
"How often insurance companies say no is a closely held secret," ProPublica's Robin Fields reported. "There's nowhere that a consumer or an employer can go to look up all insurers' denial rates—let alone whether a particular company is likely to decline to pay for procedures or drugs that its plans appear to cover."
"In 2010, federal regulators were granted expansive authority through the Affordable Care Act to require that insurers provide information on their denials. This data could have meant a sea change in transparency for consumers," Fields added. "But more than a decade later, the federal government has collected only a fraction of what it’s entitled to. And what information it has released, experts say, is so crude, inconsistent, and confusing that it's essentially meaningless."
The data that is available indicates claim denials are on the rise. According to a February KFF study of Affordable Care Act plans, "nearly 17% of in-network claims were denied in 2021."
Elisabeth Rosenthal of KFF Health News wrote in a column last month that declining to pay for patients' treatments is "a handy way for insurers to keep revenue high."
"Millions of Americans in the past few years have run into this experience: filing a healthcare insurance claim that once might have been paid immediately but instead is just as quickly denied," Rosenthal wrote. "If the experience and the insurer's explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims—sometimes bundles at a time—without reviewing the patient's medical chart. A job title at one company was 'denial nurse.'"
ProPublica noted Wednesday that "some advocates say insurers have a good reason to dodge transparency."
Citing Wendell Potter, a former Cigna executive who now supports Medicare for All, ProPublica reported that "refusing payment for medical care and drugs has become a staple of their business model, in part because they know customers appeal less than 1% of denials."
"That's money left on the table that the insurers keep," Potter told the outlet.
With their companies' profits booming, the CEOs of the top seven private health insurance giants in the U.S. took home a combined $335 million in compensation last year.
Medicare Advantage providers—private insurers paid by the federal government to cover patient care—have become notorious for denying claims for medically necessary treatments as enrollment in the program continues to surge.
As The Lever's Matthew Cunningham-Cook reported Wednesday, "Medicare Advantage insurers are threatening the foundational premise of the government's healthcare safety net for seniors and people with disabilities: that people in Medicare should get the care that is recommended by a doctor."
"A 2022 investigation by the inspector general of the Department of Health and Human Services found that in 2019, 13% of the total prior authorization requests denied by Medicare Advantage plans would have been covered under traditional Medicare, leading to an estimated 85,000 additional care denials," Cunningham-Cook wrote. "That year, Medicare Advantage plans also wrongly denied 18% of payment claims—covering an estimated 1.5 million claims—reducing the likelihood that doctors will recommend the costliest yet often most effective care, for fear of not being paid."
Social Security Works, a progressive advocacy group that backs Medicare for All, tweeted in response to the new reporting Wednesday that "private insurance companies, including Medicare Advantage plans, are designed to generate profit."
"How do they do that? Take our money and then deny our care," the group added.
Cunningham-Cook opened his piece with the story of Jenn Coffey, a former Republican state representative in New Hampshire "who, like many GOP faithfuls, believed private insurers could solve the healthcare crisis if they were allowed to do things like sell policies across state lines."
But Coffey's views were shaken when UnitedHealth, her ultra-profitable Medicare Advantage provider, "constantly rejected or second-guessed the care options her doctors suggested for her cancer recovery and for a rare and painful secondary disease that has no standard treatment plan," Cunningham-Cook reported.
“Now I've realized that you can't fix or repair the system,” Coffey told The Lever. "The insurance companies don't offer anything. They serve as a roadblock."
"The only way forward," she added, "is Medicare for All."
Keep ReadingShow Less
Oxfam Reveals How Rich Nations Are Helping For-Profit Health Industry Exploit Poor Patients
Development finance institutions run by wealthy countries have fueled "a free-for-all of private greed over public good," the humanitarian group shows in a new report.
Jun 26, 2023
An Oxfam investigation published Monday reveals how development finance institutions controlled by the governments of France, the United Kingdom, Germany, and other rich nations have funded private healthcare corporations that are systematically abusing patients in the Global South, driving up prices, denying emergency care, and even imprisoning people who fail to pay their bills.
The humanitarian group's new report, titled Sick Development, found that 56% of healthcare investments that European development finance institutions (DFIs) made in Global South nations such as India, Kenya, and Nigeria between 2010 and 2022 went to private corporations.
Since 2010, the report notes, the U.K.'s British International Investment (BII), Germany's Deutsche Investitions-und Entwicklungsgesellschaft (DEG), the European Union's European Investment Bank (EIB), and France's Proparco have "invested at least $2.4 billion in health, both directly and indirectly via health-specific financial intermediaries (FIs). They invested a further $3.2 billion in multi-sector FIs, which invest in health among other sectors."
Oxfam raised concern that "at least 81% of the European DFI health investments" that it identified over the course of the investigation "made indirectly via a complex, unaccountable and often invisible web of tax-avoiding FIs, mostly private equity funds."
"These out-of-sight investments are mostly undisclosed and certainly unscrutinized," Oxfam lamented.
What the group was able to glean after following the money is alarming.
"One of the leading private hospital chains in Kenya, the Nairobi Women's Hospital (NWH), regularly imprisoned patients until their bills were paid," the report notes. "One newborn baby was reportedly held for at least three months, and a schoolboy for 11 months. Bodies of those who have died have been held for up to two years."
Oxfam found that Nairobi Women's Hospital has been funded by BII, Proparco, DEG, and the U.S.-dominated World Bank's International Finance Corporation (IFC).
The group also cited interviews with patients who said they were barred from using government-issued health insurance cards at the privately run Narayana and CARE hospitals in India, leaving them with exorbitant bills.
India's private healthcare sector is currently worth around $236 billion, thanks in part to investments from the World Bank's IFC.
Additionally, Oxfam found that private healthcare providers funded by major public development institutions used the Covid-19 pandemic as an opportunity to jack up prices and pad their bottom lines.
"During the pandemic in Uganda, Nakasero Hospital in Kampala reportedly charged $1,900 per day for a Covid-19 bed in intensive care. The bill for one patient who died from the virus at TMR Hospital came to an extraordinary $116,000," the report says. "Nakasero Hospital is funded by France's Proparco, the E.U.'s EIB, and the World Bank's IFC. TMR Hospital is supported by the U.K.'s BII and France's Proparco."
"The big winners are the super-rich investors and owners of healthcare corporations, and the losers being the masses facing rising poverty, sickness, discrimination, and human rights abuses."
Anna Marriott, Oxfam International's health policy lead, said Monday that massive infusions of public funds into private hospitals and other healthcare corporations in developing nations "has proved to be an evidence-free, rich country bankers' guide to global healthcare—a free-for-all of private greed over public good—where the big winners are the super-rich investors and owners of healthcare corporations, and the losers being the masses facing rising poverty, sickness, discrimination, and human rights abuses."
Among the winners highlighted in Oxfam's report are the billionaire brothers Malvinder and Shivinder Singh, who founded one of India's largest corporate hospital chains, and billionaire Jorge Moll Filho, president of the Brazilian hospital chain Rede D'Or.
"Half the world's population can't get essential healthcare," said Marriott. "Every second, sixty people are plunged into poverty by medical bills. Donor countries and development banks have long promised that they can drive down healthcare costs for people living in poverty by investing taxpayers' money into the private sector. Instead, costs are rocketing up and causing harm."
The report calls on all development finance institutions to immediately halt all direct and indirect funding for private healthcare providers in the Global South and take steps to "remedy any harms resulting from their investments including human and patient rights violations identified."
"It is more urgent than ever that governments stop this dangerous diversion of public funds to private healthcare and instead deliver on aid and other public funding promises in order to strengthen public healthcare systems that can deliver for everybody," Marriott said. "Global South governments should also step up and be more assertive in directing foreign public investments into better health outcomes for their people."
Keep ReadingShow Less
In New York Times Op-Ed, US Physician Blasts 'Lucrative System of For-Profit Medicine'
"Doctors' sense of our complicity in putting profits over people has grown more difficult to ignore."
Feb 05, 2023
A U.S. physician took to the op-ed pages of The New York Times on Sunday to offer a scathing condemnation of the country's for-profit healthcare system and his profession's historical complicity in campaigns against universal coverage.
"Doctors have long diagnosed many of our sickest patients with 'demoralization syndrome,' a condition commonly associated with terminal illness that's characterized by a sense of helplessness and loss of purpose," wrote Eric Reinhart, a physician at Northwestern University. "American physicians are now increasingly suffering from a similar condition, except our demoralization is not a reaction to a medical condition, but rather to the diseased systems for which we work."
"The United States is the only large high-income nation that doesn't provide universal healthcare to its citizens," Reinhart continued. "Instead, it maintains a lucrative system of for-profit medicine. For decades, at least tens of thousands of preventable deaths have occurred each year because healthcare here is so expensive."
The coronavirus pandemic accelerated that trend and spotlighted the fatal dysfunction of the nation's healthcare system, which is dominated by a handful of massive corporations whose primary goal is profit, not the delivery of care.
According to one peer-reviewed study published last year in the Proceedings of the National Academy of Sciences, a universal single-payer healthcare system could have prevented more than 338,000 Covid-19 deaths in the U.S. from the beginning of the crisis through mid-March 2022.
"In the wake of this generational catastrophe, many healthcare workers have been left shaken," Reinhart wrote Sunday. "One report estimated that in 2021 alone, about 117,000 physicians left the workforce, while fewer than 40,000 joined it. This has worsened a chronic physician shortage, leaving many hospitals and clinics struggling. And the situation is set to get worse. One in five doctors says he or she plans to leave practice in the coming years."
"To try to explain this phenomenon, many people have leaned on a term from pop psychology for the consequences of overwork: burnout. Nearly two-thirds of physicians report they are experiencing its symptoms," he added.
But for Reinhart, the explanation lies more in "our dwindling faith in the systems for which we work" than in the "grueling conditions we practice under."
He explained:
What has been identified as occupational burnout is a symptom of a deeper collapse. We are witnessing the slow death of American medical ideology.
It's revealing to look at the crisis among healthcare workers as at least in part a crisis of ideology—that is, a belief system made up of interlinking political, moral, and cultural narratives upon which we depend to make sense of our social world. Faith in the traditional stories American medicine has told about itself, stories that have long sustained what should have been an unsustainable system, is now dissolving.
During the pandemic, physicians have witnessed our hospitals nearly fall apart as a result of underinvestment in public health systems and uneven distribution of medical infrastructure. Long-ignored inequalities in the standard of care available to rich and poor Americans became front-page news as bodies were stacked in empty hospital rooms and makeshift morgues. Many healthcare workers have been traumatized by the futility of their attempts to stem recurrent waves of death, with nearly one-fifth of physicians reporting they knew a colleague who had considered, attempted, or died by suicide during the first year of the pandemic alone.
Although deaths from Covid have slowed, the disillusionment among health workers has only increased. Recent exposés have further laid bare the structural perversity of our institutions. For instance, according to an investigation in The New York Times, ostensibly nonprofit charity hospitals have illegally saddled poor patients with debt for receiving care to which they were entitled without cost and have exploited tax incentives meant to promote care for poor communities to turn large profits. Hospitals are deliberately understaffing themselves and undercutting patient care while sitting on billions of dollars in cash reserves.
Acknowledging that "little of this is new," Reinhart wrote that "doctors' sense of our complicity in putting profits over people has grown more difficult to ignore."
"From at least the 1930s through today, doctors have organized efforts to ward off the specter of 'socialized medicine,'" he wrote. "We have repeatedly defended health care as a business venture against the threat that it might become a public institution oriented around rights rather than revenue."
Confronting and beginning to solve the myriad crises of the U.S. healthcare system will "require uncomfortable reflection and bold action," Reinhart argued, and "any illusion that medicine and politics are, or should be, separate spheres has been crushed under the weight of over 1.1 million Americans killed by a pandemic that was in many ways a preventable disaster."
"Doctors can no longer be passive witnesses to these harms," he concluded. "We have a responsibility to use our collective power to insist on changes: for universal healthcare and paid sick leave but also investments in community health worker programs and essential housing and social welfare systems... Regardless of whether we act through unions or other means, the fact remains that until doctors join together to call for a fundamental reorganization of our medical system, our work won’t do what we promised it would do, nor will it prioritize the people we claim to prioritize."
Reinhart's op-ed came as the prospects for legislative action to transform the U.S. healthcare system appear as distant as ever, despite broad public support for a government guarantee of universal coverage.
With the for-profit status quo deeply entrenched—preserved by armies of industry lobbyists and members of Congress who do their bidding—the consequences are becoming increasingly dire, with tens of millions uninsured or underinsured and one health crisis away from financial ruin.
In a study released last month, the Commonwealth Fund found that "the U.S. has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates" among rich countries, even as it spends far more on healthcare than comparable nations both on a per-person basis and as a share of gross domestic product.
"Not only is the U.S. the only country we studied that does not have universal health coverage," the study added, "but its health system can seem designed to discourage people from using services."
Keep ReadingShow Less
Most Popular