Lone Candle
Champion of Truth
RFK Jr.’s massive cuts stun staff, leave senior employees scrambling
https://www.politico.com/news/2025/03/27/very-few-people-know-whats-happening-rfk-jr-cuts-surprise-and-alarm-00254822
Dying In America Is Too Expensive
https://www.youtube.com/watch?v=WTBKxyfOLmc
“this particular fight was not actually about putting the interests of patients against those of rapacious corporations. Anthem’s policy would not have increased costs for their enrollees. Rather, it would have reduced payments for some of the most overpaid physicians in America. And when millionaire doctors beat back cost controls — as they have here — patients pay the price through higher premiums.”
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“the avarice and inefficiencies of private insurers are not the sole — or even primary — reasons why vital medical services are often unaffordable and inaccessible in the United States. The bigger issue is that America’s health care providers — hospitals, physicians, and drug companies — charge much higher rates than their peers in other wealthy nations.”
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“In 2023, the average physician salary in the United States was $352,000. In Germany, that figure was $160,000; in the United Kingdom, it was $122,000; in France, it was $93,000.
This discrepancy is partly explained by the fact that those European nations have more socialized health care systems, in which the government imposes more cost controls on medical providers. In the past, progressives have emphasized that a Medicare-for-all system would reduce overall health care costs by forcing providers to accept lower payments.
With its new policy, Anthem was attempting to do precisely this: force anesthesiologists to accept lower rates of reimbursement.
And the case for forcing down payment rates for anesthesiologists is especially strong. According to Medscape’s 2024 Anesthesiologist Salary Report, the average salary for an American anesthesiologist in 2023 was $472,000. This represented a $70,000 increase over the field’s average salary in 2022. This puts anesthesiology in the top 10 highest-paid physician specialties in the United States.
If we want America’s health care system to treat more patients — while charging us all less money for coverage — then there is no alternative to forcing myriad specialists to accept lower payment rates.”
https://www.vox.com/policy/390031/anthem-blue-cross-blue-shield-anesthesia-limits-insurance
“Physicians elsewhere do not bear the same financial burden. I traveled in 2019 to the Netherlands, Australia, and Taiwan, which have three distinct health care systems that still manage to cover all of their citizens: universal private insurance, a public-private hybrid, and single payer, respectively.
In the Netherlands, physicians take three years of undergraduate studies, three years of master’s studies, and complete a one- to two-year internship before being licensed; certain specialties then require further training. Dutch university students typically graduate with much less debt (less than 25,000 euros on average, or about $26,200) than their American counterparts. In Australia, the training requirements would look familiar to US doctors — a decade or so of education and then on-the-job training — but the tuition would not, with annual medical school costs capped at less than $10,000 per year. Taiwanese doctors likewise spend significantly less money on their education, even relative to differences in cost of living, than US doctors.
What all of those countries have in common is more robust public support for higher education and generous loan repayment programs. The high cost of college is a longstanding issue in the US, and that contributes to the prohibitive cost of a medical education for reasons that have little to do with health care itself.”
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“There is another way in which the US health system places an unusual burden on doctors: the headaches of health insurance paperwork. As left-leaning policy analyst Matt Bruenig wrote on the recent brouhaha over insurers and doctors after the killing of Brian Thompson, at least some of the excess pricing of US medical services can be attributed to the administrative costs that providers incur while dealing with private insurers.
The demands of insurance claims on doctors’ time and attention not only make for a less pleasant working experience, they also take them away from patients, which can contribute to worse health outcomes.
Here is perhaps the most telling statistic, from the Commonwealth Fund’s 2024 international survey of doctors: 20 percent of US doctors said they spend “a lot” of time on paperwork or disputes over medical bills. That was nearly double the rate in the country with the next highest share; 12 percent of Swiss doctors said the same working in their country’s system, which also relies on private insurers to oversee benefits.
Only 5 percent of Dutch doctors and 9 percent of Australian doctors said paperwork and billing took up a large chunk of their time.
This wasteful activity affects both the cost and quality of our health system. Among wealthy countries, US patients have the fewest number of consultations with a doctor in a given year, with the exception of Sweden, and spend the least time with their physicians. Time and money spent on administrative work, for both insurers and providers, account for about 30 percent of the excess medical spending in the United States.”
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“The average physician salary in the US ranges from about $260,000 (for endocrinologists and pediatricians) to $550,000 (for certain surgeons). The most elite providers earn more than $1 million annually.
Dutch general practitioners, by contrast, make about 120,000 euros ($126,000). Even senior hospital surgeons typically earn about 250,000 euros. Australia, with a more robust private market, can be more generous: While primary care doctors earn between AUD$100,000 and $150,000 ($60,000 to $93,000) on average, senior practitioners make more and specialized surgeons can rake in as much as AUD$750,000 ($460,000) — much closer to the American norms.
Doctors in Taiwan — where, it should be noted, nationwide average incomes are about half of what you find in the United States — can make between $60,000 and $100,000 per year. The policy experts I spoke to there agreed that doctors are underpaid relative to the high number of patients they see, substantially more than a typical American physician will see in a day.
Whatever complaints American physicians may have, doctors in those countries feel undercompensated.”
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“The blame game between insurers and doctors is ultimately a distraction. Other countries have private health plans and private providers and yet don’t experience nearly the same waste and out-of-control price increases as the US has. The whole system — the prices and how they’re paid — will need to be addressed in the long run. As one landmark health economics paper put it 20 years ago: “It’s the prices, stupid.””
https://www.vox.com/future-perfect/391483/us-health-care-doctors-salary-medical-school
Medicare Advantage: Good? Or Bad? Part Six: Did Medicare Advantage Achieve its Goals?
https://youtu.be/17Xx8VNNEjU
Medicare Advantage: Good? Or Bad? Part Five: Spillover, Switchers, Health Outcomes, Why people choose Advantage, and Insurers Game Reforms
https://youtu.be/KAY6DQMuRGM
“the shooting came at a time when health care seemed to be experiencing a bit of a surge in importance among Americans after the election. The share of registered voters who named it as the most important issue facing the country in YouGov/The Economist tracking polls had gradually declined from around 10 to around 7 percent throughout 2024, and even fewer, 4 percent, said it was the top issue specifically in determining their vote in the election. But after the election, that number has gone back up to between 8 and 11 percent.
A YouGov poll last week also found that more Americans, 49 percent, had an unfavorable view of the American health care system than the 42 percent who had a favorable one. Other polling suggests that Americans are as unhappy as they ever have been in recent years with the current state of health care. And while many Americans pointed fingers at the opposing party for the problems they see, more than 6 in 10 overall agreed that pharmaceutical and health insurance companies, as well as corporate executives like Thompson, were to blame for problems in the American health care system.
The U.S. remains unique among its peer nations in relying on a for-profit health insurance system and, as Mangione’s own writings alluded to, many Americans have expressed rage at a system that can deny coverage for people’s medical treatments while making shareholders and CEOs very rich. Despite decades of presidents trying to ensure universal access to health insurance, about 8 percent of Americans remained uninsured as of last year, and a higher percentage, about a quarter of American adults, said they or a family member had struggled to afford health care over the past year, whether they were insured or not.
By and large, Americans are unhappy with the costs of care and often find their insurance difficult to use. The share who rated the quality of health care in this country as “excellent” or “good” was just 44 percent in Gallup’s annual health and health care survey, conducted Nov. 6-20, its lowest point since 2001, when Gallup began asking the question. Even fewer, 28 percent, said the same about health care coverage — i.e., what insurance programs do — the lowest it has been since 2008″
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“A growing share of Americans in Gallup’s surveys seem to want the government to take action to improve health care access: 62 percent said it was the federal government’s responsibility to ensure all Americans have health care, the highest it’s been since 2007. Republicans are the least likely to agree with this sentiment — 32 percent said so, compared to 90 percent of Democrats and 65 percent of independents — but those numbers have increased by around 20 percentage points among all three groups over the past decade or so.
Perhaps surprisingly, YouGov polling found that around two in three Americans are at least somewhat satisfied with their health insurance plans — but that topline figure doesn’t capture a lot of nuance. For example, 89 percent of those with Medicaid were satisfied with their health coverage, compared to 75 percent who are covered by an employer-sponsored plan. Unsurprisingly, those who had had an insurance claim denied were also more likely to be dissatisfied with their coverage.
And despite many being mostly satisfied with the plans they have, a high number of Americans still experience problems using them. KFF, a nonprofit health policy research organization, found in a survey last year that 58 percent said that they had at least some trouble using their insurance in the previous year — including issues like denied claims or difficulty accessing in-network providers — and nearly half of whom said their biggest problem was not resolved to their satisfaction. Overall, 18 percent of Americans with health insurance had experienced a denied claim, and those were more common among people with private or employer-sponsored insurance. Around a quarter of those who’d had a claim denied suffered serious consequences, like a decline in health or not receiving recommended medical care.”
https://abcnews.go.com/538/americans-unhappy-state-health-care-insurance/story?id=116775693
Medicare Advantage: Good? Or Bad? Part Two: Medicare Advantage Costs the Taxpayer More
https://www.youtube.com/watch?v=UFkm7WMxIc8
A main point to having private versions of Medicare ran by for-profit health insurance companies as an alternative option to Traditional Medicare is to save the taxpayer money by taking advantage of efficiencies gained in private competition and private flexibility while also