In Defense of Our Boys

 In 2017, after Trump was inaugurated the 45^th President of the United States despite the scandalous sexual harassment evidence of his odious behavior towards females, the MeToo Movement exploded in America and spread throughout the World. I walked in the Seattle Women’s March, part of the five million women who stood up and said, “We are not going to take it anymore!” Women effectively used social media to build a platform for public reforms in the attitudes and behavior of many males towards females. As I commuted into Seattle two hours a day by ferry, there was ample opportunity to discuss current events with my bike buddies on the boat. Men under the age of forty were surprised that women had experienced such direct assaults in the workplace and in their personal lives. With each commute on the Cathlamet or Chimacum, my salon of younger men sat in my booth or adjacent to it and asked questions. For these were males who understood how adverse older men had made the lives of their mothers, wives, sisters, and girlfriends. They wanted to know the facts so they could be better men for all of the women in their lives. They were also concerned about a potential backlash towards them because of the message these leaders were sending.

 Fast forward five years, Biden has been president for two years, and though public discourse has improved towards females, very little improvements have been made in the lives of women. The United States is the only major industrial country which lacks mandatory paid maternity (family leave), affordable child care, and universal health care. The dialogue may have improved, but the circumstances for families, especially working-class families have changed little. Harms done to the families from lack of affordable childcare, adequate health care, and paid family leave hurt the children even more than their parents. Youth are our most precious resource for they represent our investment (or lack thereof) in our collective future. Boys suffer just as much as girls when their mothers can’t find work, are home alone as latch-key kids at far too tender ages, go hungry, are unable to access health care, and all manor of social circumstances that harm their physical, social, and emotional development.

 As a feminist mother I realized that our zeal to change public discourse into a more egalitarian society has now become an over correction harming the other half, our boys and men. It is now assumed that girls are better students and boys must take medicine to “behave like the girls in school.” This attitude has resulted in fewer boys believing they can go to college and master academic work than in the past. Young boys coming of age have much less confidence now than their fathers. There are so many positive messages for young girls now, but fewer for boys. It is just assumed that boys will work and fulfillment of their dreams is not mentioned with as much urgency. Girls are now told they can choose between motherhood and a career, but what choice do men have? Boys are expected to grow into stoic hard-working men, to serve society without complaint, regardless of the difficulty of the task. Yet, boys and men are constantly assaulted with negative messaging about men. It has to be exhausting to constantly feel under attack regardless of one’s individual character. We must change this trend to become more inclusive to the feelings and perspectives of our boys as they become men.

 In 2022, I pursued conversations with men of all ages about their experiences, as fathers and as single men, in today’s environment and here are some of their observations;

 Male aged 25- “There may not have been economic parity for older women, but women are much more likely to earn wages equal to men for similar work now. This changes the power dynamic for dating, men are not expected to pay for everything.”

 Male aged 25- “Women have all the power in obtaining and consenting to sex. Men just put themselves out there and hope to be selected. Men must deal with a lot of rejection to find a woman.”

 Father aged 47- “My son deals with reverse discrimination now, for being male and white. It is no longer assumed that his future is as bright as his was. Young men have to deal with much greater complexities social-emotionally than their fathers.”

 Single father aged 49- “The courts have changed so much, tilted in favor of women. Even if the mother is a bad mother, it is very difficult for a father to be given custody of his children. My lawyer has said there is no hope that I can retain full custody.”

 Married mother of a 16-year-old son- “My son said to me, Mom, it is so much more complicated now than when you were in high school. All you needed was a car and you could get a date. The level of permissions and scrutiny is much greater for our sons. Everything is geared toward the protection of our daughters but what about our sons? “

 Married 70-year-old retired master carpenter- “We are made to feel like we aren’t worth as much if we don’t go to college. This is wrong we need people working in the trades, craftsmen are dying out in this country.”

 Musician-in his forties- “It is hard to be a man now, thank you for your words.”

 The vast majority of men and boys are not the problem, but if we are to have a successful pluralistic society we need to train and support all of our children to communicate in a respectful manner, which means being heard, having empathy, and not making assumptions of inherent value. Harming half of the population will not make for a great society. The truth is, we need each other for different but complimentary purposes, as we always have. We have made much progress in our new way of seeing the male female paradigm, but we still have work to do.

 The Better Men’s Club™ started as a response to misogynistic actions by men in power, but let’s put that into perspective and recognize that we have created many better men already, in our sons, partners, friends, and even fathers. I would not have been able to achieve many of the milestones in my life without those good men and for them I am grateful. As we seek peace and understanding in the new year, I hope we can listen to all voices with equal respect and empathy.

 And this is the healthpolicymaven signing off wishing you informed healthcare decision making through better transparency and public resources.

 Roberta Winter is a health policy analyst and freelance journalist who has continuously published this column since 2007, when her brother died from complications of type I diabetes. She is the author of a guidebook to the US healthcare system that was published by Rowman & Littlefield in 2013.

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

 

 

Health Insurance Premium Refunds Under the Affordable Care Act

 One of the consumer-friendly provisions of the Patience Protection and Affordable Care Act (ACA) provides refunds to the individual participants in the health insurance exchanges whose insurer spent less than 80% of all collected premiums providing actual benefits to participants. In 2021, some of the insurance companies who participated in the exchanges, were required to refund over one billion dollars to the enrollees in the insurance exchange plans. Over six hundred million was distributed to those enrolled in individual plans and the remainder to small employer plans in 2022. The average refund, which was provided via check or digital deposit was $141. I personally received a refund and this is the second time I have received a refund from my ACA plan. For the 2021 plan year over eight million participants received refunds. Since inception, the Affordable Care Act has paid out nearly twenty billion dollars in premium refunds to individuals and small group plans (SHOP) because of this provision. The rule uses a three-year loss ratio average to determine if an insurer overcharged insurance exchange participants. This provision protects the insurance companies from shock loss years and allows a smoothing of participant claim utilization over time. Without the government mandate insurance companies would pocket the extra premiums as reserves, if they are nonprofits or profits. Insurance companies can always elect to lower rates or charges to their customers, but this is rare, especially for individual health insurance. It is also important to note that only a few insurers each year are required to refund excess premiums, most meet the 80%-of-premiums-must-be-spent-paying-benefits-to-the insured rule.

 Money Refunded to Insurance Exchange Participants since 2012 (Norris, 2022)

2021-$2,100,000,000

2020-$2,460,000,000

2019-$1,370.000.000

2018-$   707,000,000

2017-$   447.000,000

2016-$   397,000,000

2015-$   469.000,000

2014-$   332,000,000

2013-$   504,000,000

2012-$1,100,000,000

 The Kaiser Family Foundation found that prior to the Affordable Care Act mandate of spending at least 85% of insurance premiums to provide benefits for the health exchange SHOP group plans and 80% for individual plans, most group plans met the threshold but only half of the individually insured plans did. This meant that people buying individual medical insurance overpaid for what they received and the insurer kept the profits. (Cynthia Cox, 2013)

 Of course, the insurance industry was not happy to have to reveal profitability to a government agency and worse yet, refund overcharged premiums to their customers. Due to pressure from the insurance industry many states were granted waivers from this minimum loss ratio rule, with the argument it would force insurance companies out of their marketplaces. This has not been the case and both insurance companies for which I received premium refunds since 2012 are still in business in Washington State, a semi-rural state. Insurance companies are very conservative when calculating their premium charges for their contracts, based on actuarial science. The data for predictive health impacts has only grown stronger and the behemoth insurance industry has more tools at its disposal to maximize profitability.

 During the pandemic, the Biden Administration provided additional financial subsidies to help people obtain healthcare insurance through the insurance exchanges through the American Rescue Plan.

 Clearly, millions of Americans have benefited by the government mandates in the insurance exchanges, which use an ingenious method of advancing tax credits to make medical insurance more affordable to individuals, families, and small businesses. It is always good to be reminded of the benefits we receive from our government, especially during an election year. 

 And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when submitting to inpatient medical procedures, do stipulate that for which you agree and decline.

 Roberta Winter is a freelance journalist and health policy analyst. She accepts no payment from any sector of the US healthcare system. Her guidebook to the US healthcare system was published by Roman & Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

  

References

Cynthia Cox, G. C. (2013). Beyond Rebates: How Much Are Consumers Saving from the ACA’s Medical Loss Ratio Provision? Kaiser Family Foundation. Retrieved November 13, 2022, from https://www.kff.org/health-reform/perspective/beyond-rebates-how-much-are-consumers-saving-from-the-acas-medical-loss-ratio-provision/

Norris, L. (2022). Billions in ACA rebates show 80/20 Rule’s impact. Health insurance.org. Retrieved November 16, 2022, from https://www.healthinsurance.org/obamacare/billions-in-aca-rebates-show-80-20-rules-impact/

Opportunistic Practices Based on Profits Not Patients in U.S. Hospitals

Hospital corporations are misusing subsidized patient care programs to generate profits at the expense of the public. There are many methods that huge hospital groups like Providence use to generate profits, which unlike their advertisements, are not wholly plowed back into the communities they serve, but into its venture capital fund which had 300 million in 2019. (Reed, 2019) Saturday’s New York Times had not one but two articles on mercenary and unethical practices used by hospital corporations seeking greater profits. (Katie Thomas, 2022)  This article addresses some of the primary methods hospital groups pad their revenues at the patient’s and public’s expense, while highlighting what some states have done to combat egregious behavior by healthcare corporations.

Discouraging Development in High-need Low-income Locations

Large hospital groups use a variety of long-term profit driven methods to reduce their footprints in low-income locations and move clinics, practices, and facilities to areas with higher private-sector insurance reimbursement rates. Typically, a campaign is developed explaining why the existing community hospital, often built with public dollars is obsolete, which is preceded by an aggressive build out of clinics and facilities in wealthier areas. Case in point, Bremerton, Washington a city of 38,000 had its hospital closed after operations were moved to an unincorporated suburb. Bremerton has the highest concentration of low-income residents in the county, many of whom are veterans, in part because of previous county legislation mandating the financially disenfranchised live in that community. And the community hospital was built with public funding, but acquired and then closed by St. Michaels Hospital Group. The New York Times front page featured Bon Secours hospital in Richmond, Virginia, built specifically for the Black population which was acquired by Mercy Healthcare and subsequently bled of resources. Death via hospital closure ensued following a slow strangulation of the intensive care unit, maternity ward, and cardiac care. (Katie Thomas, 2022)

 Noncompliance With Charitable Care Standards

People of low to moderate incomes are eligible for free or reduced care at hospitals in the United States, but this standard has not been routinely enforced. Case in point, behemoth hospital group Providence, hired McKinsey Group to aggressively reduce its charitable (free or reduced cost) care in order to generate more profits. (Katie Thomas, 2022) As a result of the thug-like bill collecting tactics, where hospital employees went to patients in their hospital beds to extract money, Providence reduced its charitable care from the industry standard of 2% to 1%. Keep in mind these nonprofit hospitals receive federal and state funding for patient care, pay no taxes, and generate huge profits, for a measly 2% of aid.  Providence is by no means the only hospital group that pursues profits this way. Some states have interrupted this opportunism by enacting laws standardizing what income level and family size engenders eligibility for free or reduced cost charitable care. Even in the face of this, Providence still abused the state standards and was charged by Bob Ferguson, Washington Attorney General, for which it settled with a twenty-four million dollar fine. (Hagar, 2022) Another Catholic Hospital-St. Josephs in Tacoma was also sued by Washington State for failure to offer financial aid and predatory collection practices. (Bosco, 2021)

 Promotion of Procedures Linked to Financial Incentives as Opposed to Patient Care

There are many examples of financial incentives gone awry, but include procedures, especially in geriatric patients that do not improve health but generate revenue. For example, the Washington State Attorney General’s case against Providence Hospital for unnecessary neuro procedures at St. Mary’s Hospital, which resulted in two surgeons losing their privileges after an internal whistleblower reported the practice. Not only were the procedures dangerous and harmful, the propensity for these types of surgery were directly related to a financial incentive program which paid executives handsomely for increased volume in the complex surgeries. (Winter, 2022)

 Misuse of Federal Programs to Generate Profits

The federal government established the 340-B drug program which provides reduced drug costs to hospitals in urban areas, like public hospitals and trauma centers. The idea was to provide lower costs to those facilities and their patients, which provide services to the vulnerable. But, the financial gurus in the hospital corporations figured out they could acquire a public hospital, get the federally subsidized 340-B drug prices and then have an affiliated hospital in a wealthier suburban location also have access to the discounted drugs. The hospital would then charge the private sector companies a multiplier for the same medications, resulting in profits of $40,000 per patient for one drug. (Katie Thomas, 2022) In the case of Bon Secours Mercy Hospital in Richmond, Virginia, Mercy acquired the facility and used the urban designation of a 340B facility to buy discounted drugs and gouge the private sector for payments. This is a classic example of how profit making in healthcare is not in the best interests of the public or the patients.  

 What You Can Do to Avoid Opportunistic Behavior by Hospital Groups

1.  Know your rights, do not sign blanket releases when agreeing to procedures.

2.  Ask for an estimate of the cost of the procedure in advance and understand what you are expected to pay. Be careful about signing installment payments which can have unfavorable terms.

3. Know what your state’s standards are for charitable or reduced cost health care.

4. Write to your elected representatives to let them know about your concerns over treatment at a healthcare facility, especially financially.

Ths table shows existing state laws of elegibility for lower cost or free health care for which hospitals must comply.

State	State Mandates for Charitable Care at Hospitals (Bosco, 2021)
California	Families without medical insurance, those with high medical costs, and people within 400% of the federal poverty rate are eligible for financial assistance.
Colorado	A 2022 law strengthens protections from medical debt and requires all hospitals to provide medical assistance.
Connecticut	Requires all hospitals to screen for financial aid, but only mandates aid consideration for persons not covered on Medicare, Medicaid, or other coverage and whose income is below 250% of the federal poverty rate.
Illinois	Hospitals must offer financial assistance to families within 600% of the poverty rate, free care is mandated for those within 200% of the poverty rate, and hospitals are prohibited from collecting more than 20% of a patient’s income for payment in a twelve-month period.
Massachusetts	Families whose incomes are within 200% of the federal poverty rate are eligible to receive financial assistance.
New Jersey	Specifies families without medical insurance and those with low reimbursement from insurance plans are eligible for charity care. Also stipulates that healthcare providers can only collect a portion of patient income for repayment and the law stipulates what that payment ceiling is based on income.
Oregon	Requires hospitals provide full financial aid for those within 200% of the federal poverty rate and a sliding fee scale for those within 400% of the poverty rate.
Texas	Requires financial aid for those within 21%-200% of the federal poverty rate.
Washington	Families with incomes below 100% of the federal poverty rate must receive free care; families within 200% of the poverty rate are eligible for financial assistance.

 A 2015 study by Rutgers University found that only 44% of hospitals are informing patients of their rights for financial assistance nationwide (Susan Singer, 2022). Even worse, in states with no regulations for offering charity care, like Virginia or Tennessee, up to 40% of people carrying medical debt were eligible for financial assistance, but the hospital did not offer it to them. And of course, the twelve states that did not expand Medicaid eligibility with the passage of the Affordable Care Act are denying state residents access to federally subsidized free health care.  It is time for regulatory reform for hospitals, distinguishing the community based public hospitals from the behemoth hospital groups for tax exemptions. Now do your part to get what you deserve in the inequitable US healthcare system by understanding your state laws and demanding access to publicly mandated benefits to reduce the cost of your care. Patients should not be concerned about profits for hospitals, but of their health and wellbeing.

 And this is the healthpolicymaven signing off. Roberta Winter is a healthcare analyst and freelance journalist who accepts no money for this column. Opinions here are her own and are not meant to provide medical advice. She is the author of a guidebook to the US healthcare system, which was published by Rowman & Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972 

References

Bosco, A. B. (2021). An Ounce of Prevention-A Review of Hospital Financial Assistance Policies In the States. National Consumer Law Center. Retrieved September 24, 2022, from chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.nclc.org/images/pdf/medical-debt/Rpt_Ounce_of_Prevention.pdf

Hagar, S. (2022, September 24). More details emerge on Providence St. Mary Medical Center's $22.7 million insurance fraud settlement. Union Bulletin. Retrieved April 13, 2022, from https://www.union-bulletin.com/news/courts_and_crime/more-details-emerge-on-providence-st-mary-medical-centers-22-7-million-insurance-fraud-settlement/article_9ef81200-bab2-11ec-9bf3-03450d16ba13.html

Katie Thomas, J. S.-G. (2022, September 24). Profits Over Patients-How a Hospital Chain Used a Poor Neighborhood to Generate Huge Profits. The New York Times. Retrieved September 24, 2022, from https://www.nytimes.com/2022/09/24/health/bon-secours-mercy-health-profit-poor-neighborhood.html

Reed, T. (2019, January 18). Providence St, Joseph Health Announces New 150 Million Health Care Fund. Fierce Health.com. Retrieved September 25, 2022, from https://www.fiercehealthcare.com/hospitals-health-systems/providence-ventures-closes-150m-healthcare-fund

Susan Singer, E. W. (2022). Understanding Required Financial Assistance in Medical Care. Consumer Financial Protection Bureau, United States Government. Retrieved September 24, 2022, from https://www.consumerfinance.gov/data-research/research-reports/understanding-required-financial-assistance-in-medical-care/#6

Winter, R. (2022, April 14). Nonprofit Hospital Defrauds State of Millions. Straight Talk On Health Care. Retrieved from https://healthpolicymaven.blogspot.com/2022/04/nonprofit-catholic-hospital-group.html

 

 

 

 

Pregnancy in the US Just Got More Dangerous-Post Dobbs v Jackson Decision

 

Pregnancy in the US Just Got More Dangerous-Maternal Mortality

 A woman in the U.S. is more likely to die from maternity now than her mother. (Ritchie, 2013) The United States has the worst maternal mortality rate of the industrialized nations, ranked 57^th, tied with Latvia with 19 deaths per 100,000 live births. By contrast, the countries with the lowest maternal mortality rates including; Iceland, Norway, Japan, and Singapore have less than 2 maternal deaths per 100,000 births. If this metric isn’t poor enough, women are far more likely to die from complications of childbirth in the US since the overturn of Roe-v-Wade in the Dobbs v Jackson Women’s Health Organization Supreme Court decision. The wrongly decided ruling actually interferes with physician’s ability to treat their patients. There are many reasons why maternities are not carried to term, including fetal failure to develop, life threatening health complications for the mother, and unfortunately, lapses in the health system. This article reviews political trends in reproductive health care in the United States and impacts on maternal health.

Top reasons for Maternal Mortality in the United States

Hemorrhage

Blood clots

Hypertension

Pre-eclampsia and eclampsia

Infections

Obstructed labor

 Comparison of maternal outcomes in states which have near total bans on abortion

Researchers at Tulane University used data from the National Center for Health Statistics for thirty-eight states and the District of Columbia and ranked eight abortion restricting mandates by state.  The criteria included: gestational limits for abortion, reduction in the number of Planned Parenthood Clinics, state mandated counseling, mandatory waiting periods, mandatory ultrasound, mandatory parental involvement, denial of abortion coverage in private insurance plans, restrictions on public funding for abortion.

Findings for state health policy decisions to maternal mortality: (Vilda, 2021)

 1.  States with higher scores for abortion restrictions had an overall increase of 7% for maternal deaths

 2. States that refused to expand state Medicaid benefits when the Affordable Care Act was passed had a      29% higher total maternity mortality rate

           3.  States with a licensed physician requirement (versus nurse practitioner, physician’s assistant) had a       51% higher total maternal mortality rate than those without the mandate

        4.  Gestational limits for abortion had a 38% increase in maternal mortality

 The evidence clearly shows more women are dying preventable deaths due to pregnancy in the United States, than other peer industrialized countries. Given the political climate in this dystopian nation, Kevin McCarthy or some other politician will have the power to decide which women have access to health care and by virtue of that, who lives and who dies. Meanwhile the minority view of the evangelical religious right is congratulating themselves. Surely this will not stand.

 And this is the healthpolicymaven signing off encouraging you not to sign blanket medical releases when you agree to inpatient procedures, do stipulate that for which you agree and decline. Opinions expressed are those of Roberta Winter, a freelance writer and do not give medical advice. She is the author of a guidebook to the US medical system, which was published by Rowman & Littlefield in 2013.

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

 Works Cited

Ritchie, M. R. (2013). Maternity Mortality. OurWorldinData.org. OurWorldinData.org. Retrieved August 26, 2022, from https://ourworldindata.org/maternal-mortality#citation

Vilda, D. W. (2021). State abortion policies and maternal death in the US, 2015-2018. American Journal of Public Health, 111, 1696-1704. doi:https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2021.306396

Winter, J. (2022, August 12). Why a Life-Threatening Pregnancy Complication Is on the Rise. The New Yorker. Retrieved August 26, 2022, from https://www.newyorker.com/science/annals-of-medicine/why-a-life-threatening-pregnancy-complication-is-on-the-rise?utm_source=nl&utm_brand=tny&utm_mailing=TNY_Daily_081222&utm_campaign=aud-dev&utm_medium=email&utm_term=tny_daily_digest&bxid=62c6ee59096ac1a

 

 

Women No Longer Have Equal Protection Under the Law and What to do about it

 

The Supreme Court of the United States ruled abortion, a legal health care practice in the nation for fifty years, was not guaranteed in the constitution as of June 24, 2022. Of course, this is upsetting to the vast majority of Americans, but not apparently as much as AK-15 ownership. However, for the sentient whom are my readers, this article is devoted to legal and scholarly tactics available to restore female autonomy. Not as a legal scholar but as a nonfiction reviewer for a decade for The New York Journal of Books, my review on the brilliant Elie Mystal’s, Let Me Retort-A Black Guy’s Guide to the Constitution was published in January before its release.[1] This blueprint for possible remedies to the current court which does not represent the majority of voters, is drawn from his inciteful chapter on abortion.

 Facts of the Supreme Court’s Dobbs v Jackson Ruling (The New York Times, 2022)

 The court’s overarching ruling on originalism-Of course, the right to contraception and abortion are not in the 1776 United States Constitution, as women were not considered full citizens at that time, merely appropriated by men. Women did not gain the right to vote until 1920. Black men were only considered to be equal to three fifths of white men at that time and interracial marriage was of course illegal, which should make Justice Thomas pretty uncomfortable.

The ameliorating comments by Kavanaugh-This is not meant to throw out all constitutional amendments, yet Thomas is clear in his opinion that ALL decisions made under the precedent must be reviewed. This is unambiguous and applies to whom you can marry, with whom and how you may have sexual relations, your right to privacy, and many other equal protections.

 The framers of the constitution, many wealthy slave-owners, did not give a thought to unborn or living children, which is why there is no mention of protections for them, especially when it came to child labor. Children were seen as a utility or something with which to trade. Only as the country became wealthier and developed a middleclass did the church(es) try to assert their dominion over this issue.

 Constitutional Protections that Do Extend to Women

 Mystal adroitly asserts that the constitution misses one important point, “Women are people. Full equal people.” (Mystal, 2022) As such, women, as people, are protected under the Fourteenth Amendment which states, “No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws." 

 The right to privacy was first recognized by the court in 1965 with Griswold v Connecticut, a case which concluded that handing out condoms and spermicide was protected, and thus a form of birth control sanctioned by the courts.

 How to Fix this Mess

Remedies are available to restore full representation for the citizens of this country and here is my short list, informed by the brilliant and acerbic-witted Mystal.

1.  The power of our Supreme Court to unilaterally abolish the laws of the land is uncommon in democracies. Restructuring and reforming the court is possible and includes; Article III of the Constitution which leaves the structure of the federal judiciary to Congress. This may include adding more members to the court, for example, there are 13 federal districts so this has been discussed.

2.   It is possible to limit the terms of the members of the court administratively by forcing them to take senior status after eighteen years on the bench. This means the court members are still in service, hence meeting the constitutional requirements, no longer writing opinions for the high court, but are rotated down to the lower court, available to serve the higher court as pinch-hitters.

 3.  The Supreme Court needs to be treated as a subservient branch that can be corrected by our elected Congress.

 In conclusion, this article is of course about women’s health and the health of her children, who are actually born, not fictional ones and therefor meets the standards of my moniker, Straight Talk on Heath Care. All women deserve equal access to basic health care and in the 21^st Century in America we are still fighting for that right. Female autonomy is not a privilege granted by men.

 And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when you agree to inpatient procedures, do stipulate that for which you agree and decline.

 Roberta Winter is a healthcare analyst and journalist who accepts no money from any sector of the U.S. healthcare system. 

References

Mystal, E. (2022). Allow Me To Retort-A Black Guys Guide To The Constitution. The New Press. Retrieved January 2022

The New York Times. (2022, June 24). The Dobbs v Jackson Decision, Annotated. The New York Times. Retrieved June 25, 2022, from https://www.nytimes.com/interactive/2022/06/24/us/politics/supreme-court-dobbs-jackson-analysis-roe-wade.html?action=click&module=RelatedLinks&pgtype=Article

 

---

[1] https://www.nyjournalofbooks.com/book-review/allow-me-retort

Nationwide-Hospital Lawsuits for Overcharging

 American patients have little control over the hospital bills they receive after consenting to ambiguous admission forms before surgery. This article examines lawsuits against a plethora of hospitals across the country, for overcharging patients and insurance companies for services. And it’s not just the unfortunate folks without insurance who are being charged the inflated chargemaster prices, but fully insured people are also getting ripped off. The chargemaster is a list of prices that each hospital develops as a negotiating point with the Centers for Medicare and Medicaid and private insurers and is not based on actual reimbursements. 

Location	Hospital	Basis of the Lawsuit
California	Sutter Health, a nonprofit entity	575 million-settlement with the Attorney General of CA for overcharging (Office of the Attorney General California, 2021)
Colorado	St. Anthony North Hospital, a nonprofit entity	Patient sues under reasonableness clause for nonnetwork charges & hospital failure to disclose true cost before admission (Levenson, 2022)
Florida	North Okaloosa Medical Center, a nonprofit entity and 19 others	A 2015 review of the 50 hospitals which overcharged the uninsured the most reveals 20 sited in Florida (Post, 2015)
New York	Foundling Hospital, a nonprofit entity	Attorney General has prevailed in many lawsuits against hospitals, but the most egregious may be the 250 million settlement by Foundling Hospital for overbilling Medicaid (New York State Office of the Attorney General Press Release Archives, 2014)
North Carolina	Vidant Health, a nonprofit entity	Patient sues for being overcharged for common imaging procedures (Paavola, 2022)
Ohio	One of the state’s largest hospital groups, so either Ohio Health Corp or the Cleveland Clinic, both nonprofit entities	Supreme Court is hearing a suit brought by uninsured patients contesting the “reasonableness” clause in common-law for hospital charges (The Eisen Law Firm Co. L.P.A.)
Tennessee	Team Health, a nonprofit entity Mission Hospital-HCA, a for profit entity	Team Health sued by United Healthcare for overcharging-100 million (Healthcare Finance News.com, 2021) Mission Hospital-HCA sued for monopoly power & reduction in services
Washington	St. Mary’s, Providence Health, a nonprofit entity	Sued by WA Attorney General for unnecessary procedures which resulted in overcharging and a 22 million settlement (New York Times, Seattle Times, Walla Walla Union-Bulletin)

 Since 2004, dozens of lawsuits have been filed on behalf of patients contesting the reasonableness clause and hospitals overcharging patients, especially the uninsured, so the Supreme Court of Ohio’s reasonableness ruling will be keenly watched by consumer groups. Don’t expect hospitals to lower their price gouging charges though, the behemoth hospital corporations will just rejigger their formulas so that we pay for their legal settlements. And so it goes, as the American public continues to be abused by its pay-to-play healthcare system instead of adopting much less expensive national healthcare programs like the rest of industrialized countries.

 And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when you consent to procedures, do stipulate that for which you agree and what you decline.

 Roberta Winter is an independent healthcare analyst and journalist who accepts no money from any sector of US healthcare. This monthly column has been in continuous publication since 2007. In 2013 her guidebook to the US healthcare system was published by Rowman and Littlefield and an entire chapter was devoted to the price gouging of hospitals for the uninsured. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

 References

Healthcare Finance News.com. (2021, October 29). UnitedHealth sues TeamHealth, saying it overpaid $100 million in claims. (S. Morse, Ed.) Healthcare Finance News.com. Retrieved May 22, 2022, from https://www.healthcarefinancenews.com/news/unitedhealth-sues-teamhealth-saying-it-overpaid-100-million-claims

Levenson, M. (2022, May 21). She Was Told Surgery Would Be About $1,300 Then The Bill Came: $229,000. The New YorkTimes. Retrieved May 22, 2022, from https://www.nytimes.com/2022/05/21/us/colorado-hospital-lisa-french.html

New York State Office of the Attorney General Press Release Archives. (2014, February 5). Retrieved from https://ag.ny.gov/press-release/2014/ag-schneiderman-announces-250k-settlement-ny-foundling-hospital-overbilling

Office of the Attorney General California. (2021, August 27). Attorney General Bonta Announces Final Approval of $575 Million Settlement with Sutter Health Resolving Allegations of Anti-Competitive Practices. Office of the Attorney General Press Release. Retrieved May 22, 2022, from https://oag.ca.gov/news/press-releases/attorney-general-bonta-announces-final-approval-575-million-settlement-sutter#:~:text=The%20settlement%20requires%20Sutter%20to,%2C%E2%80%9D%20said%20Attorney%20General%20Bonta.

Paavola, A. (2022). Patients Are Coming After Hospital Prices. Becker Hospital Review. Retrieved May 22, 2022, from https://www.beckershospitalreview.com/legal-regulatory-issues/patients-are-coming-after-hospital-prices.html

Post, L. (2015, June 8). 50 hospitals charge uninsured more than 10 times cost of care, study finds. The Washington Post. Retrieved May 22, 2022, from https://www.washingtonpost.com/national/health-science/why-some-hospitals-can-get-away-with-price-gouging-patients-study-finds/2015/06/08/b7f5118c-0aeb-11e5-9e39-0db921c47b93_story.html

The Austin Trial Lawyer.com. (2015, April). The Austin Trial Lawyer.com. Retrieved from The Austin Trial Lawyer.com: https://www.theaustintriallawyer.com/2015/04/in-federal-case-insurance-company-sues-texas-hospital-for-tortious-interference/

The Eisen Law Firm Co. L.P.A. (n.d.). Lawsuit Alleges Hospitals Overchared Uninsured Patients. Retrieved May 22, 2022, from https://www.malpracticeohio.com/lawsuit-alleges-hospitals-overcharged-uninsured-patients-part-1/

Yates, D. (2016, June 22). Federal judge rejects Aetna’s $225M fraud claim, finds for North Cypress. Retrieved from https://setexasrecord.com/stories/510933779-federal-judge-rejects-aetna-s-225m-fraud-claim-finds-for-north-cypress

 

 

Nonprofit Catholic Hospital Group Defrauds State of Millions

 Yesterday, I read multiple articles about my local community nonprofit hospital defrauding Washington State Medicaid and the federal government for millions of dollars. This hospital encouraged neurosurgeons to perform unnecessary spinal surgeries in order to generate higher revenues for five years. (Hagar, 2022)These practitioners put patient’s health at risk for financial gain. Spinal surgeries are one of the riskiest and most controversial of all procedures with a high failure rate. One of the neurosurgeons charged in this scheme earned four million dollars in one year in a rural farming community of 38,000 people. Doesn’t sound right, does it? But the head of the hospital, St. Mary’s-Providence earned ten million dollars in the same year. That to me, was mind boggling. And these doctors are not the only ones guilty of fraud in the U.S. healthcare system, which places volume ahead of health.

To give you an idea of the scale, St. Mary-Providence only has 142 beds, which is a small hospital, by comparison, Providence Hospital in Spokane has 674 beds, which is considered large by U.S. standards. The head of a much larger hospital earned less than the head of this tiny hospital, because of the Providence incentive system which rewards increased volume in complex procedures. Not comforting to know your doctor works on a lucrative bonus plan versus the best evidence-based practices.

The overbilling occurred over a five-year-period at St. Mary’s ending in 2018, when the unethical and abusive neurosurgeons were forced to resign. But Providence did not report them to the Attorney General, for that would have ensnared them in the overbilling scheme as well. The corporate financiers were content to keep raking the money in, despite patient health risks, and higher costs for all consumers.

Fortunately, the former administrator for the neuro unit became a whistleblower and got the case started with the Washington State Attorney General, Bob Ferguson’s Office. Because of the excellent work of his team, Providence has been found guilty of fraud, will pay a twenty-two million dollar fine, and will be on a five-year-probationary review. Imagine if we looked at all of Providence’s hospitals in all seven states, how much overbilling would we find? Afterall when the Affordable Care Act passed, Providence made so much money it created its own venture capital fund rather than lower its fees for services.

Providence Hospitals named in the lawsuit: Providence Centralia Hospital, Providence St. Joseph Hospital, Providence Mount Carmel Hospital, Providence Regional Medical Center, Providence St. Peter Hospital, Providence Holy Family Hospital, Providence Sacred Heart Medical Center, Providence St. Mary Medical Center, Swedish First Hill Campus, Swedish Cherry Hill Campus, Swedish Ballard Campus, Swedish Issaquah Campus, Swedish Edmonds Campus, and Kadlec Regional Medical Center. Providence also operates hospitals in Alaska, Montana, Oregon, and California.

The most galling are the finance people working in hospital corporations who create these schemes and see nothing wrong with paying someone an exorbitant compensation package in a tiny rural hospital. This is one of the problems with nonprofit hospital groups, their compensation packages are often opaque, because there are no shareholders and disclosure is limited. The executive of St. Mary Medical Center is no exception in the Providence compensation, many of their executives earn ten million a year. (National Union of Healthcare Workers, 2022) And where do these finance gurus who cut clinical staff and put patients at risk come from, Amazon and Microsoft.

Providence Health was also found guilty of deceptive billing practices, because the nonprofit hospital did not make patients aware of their charity care options. In other words, the nonprofit Catholic hospital saw nothing wrong with bilking low-income people for care, as long as their venture capital fund was doing well. (Gamble, 22)

 In a previous post, I wrote about a Pennsylvania judge ruling that another nonprofit hospital group did not deliver enough uncompensated care to qualify as a nonprofit entity. [i] This is a national healthcare problem, which can only be cured by further government interventions in regulation of pricing, financial disclosure, and enforcement.

Imagine how many more nurses and mental health specialists we could have actually helping patients if we had a healthcare system which is not based on profits. The only way this abuse is ever going to end is when Americans wake up and adopt a national healthcare system and yes, that will mean hospital administrators won’t be making ten million dollars a year. And that would be better for all of us.

And this is the healthpolicymaven signing off encouraging you not to sign blanket release forms for procedures, do stipulate that for which you agree and decline.

Roberta Winter is an independent healthcare analyst and journalist who accepts no money from any sector of the U.S. healthcare system. She has been interviewed on publicinterestpodcast.com and is the author of a guidebook to the U.S. healthcare system, published by Rowman and Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

References

Gamble, M. (22, February 24). Beckers Hospital Review. Retrieved from Beckers Hospital Review.com: https://www.beckershospitalreview.com/legal-regulatory-issues/washington-sues-providence-over-collection-tactics.html

Hagar, S. (2022, April 13). More details emerge on Providence St. Mary Medical Center's $22.7 million insurance fraud settlement. Retrieved from Union Bulletin: https://www.union-bulletin.com/news/courts_and_crime/more-details-emerge-on-providence-st-mary-medical-centers-22-7-million-insurance-fraud-settlement/article_9ef81200-bab2-11ec-9bf3-03450d16ba13.html

National Union of Healthcare Workers. (2022, April 14). Providence St. Joseph Watch. Retrieved from NUHW.org: https://nuhw.org/providence-st-joseph-watch/executive-salaries/

 

 

---

[i] https://healthpolicymaven.blogspot.com/2022/03/should-your-hospital-get-nonprofit.html

 

 

 

Financial Conflicts Among Nonprofit Advocacy Groups-Who Can You Trust

The battle between the drug-industry-controlled Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid (CMS) over its’ decision to provide only clinical trial reimbursement for Biogen’s Aduhelm, has highlighted the tentacles of the drug development pipeline in nonprofit advocacy organizations. To refresh your memory, Aduhelm, an aducanumab drug was approved by the FDA under the emergency-fast-track-approval process, without the lengthy normal vetting process for new pharmaceuticals. Biogen’s motivation for this was profit, by capturing the market for a promising, but as yet unproven drug for Alzheimer’s. This is the proverbial pants-wetter for big pharma, like Viagra, the ubiquitous male libido enhancer with universal reimbursement. This articles reviews nonprofit organizations which participate in healthcare advocacy and their funders. Only nonprofit entities are reviewed because it is assumed all for-profit advocacy is conflicted, such as lobbyists paid by their clients. This table shows nonprofit advocacy groups, their funders, and their positions on the Aduhelm approval.

 Who Can You Trust-Who Pays For The Advice?

Organization	Funding Source	Recent Positions
American Geriatrics Society (American Geriatrics Society, 2022)	Professional fees from its 6,000 clinician members	Submitted a letter to CMS against the approval of Aducanumab for treatment of Alzheimer’s
Alliance For Aging Research (Butler, 2022)	100% funded by pharma; 50% of annual budget designated for marketing	ACT-AD-for accelerated approval of aducanumab or similar Alzheimer’s treatments
Alzheimer’s Association (Belluck, 2022)	$485,000 from Biogen in 2021, the developer of Aduhelm; 1.6 million from other drug companies; a small portion of gross annual budget	Wants aducanumab approval for all Alzheimer’s patients even those with mild symptoms, despite scant evidence it works
National Council on Aging (Cameron, 2022)	Nonprofit funded through grants and donors	Advocate for evidence-based treatments; adopted the position that Aduhelm should be used with caution in clinical trials, against accelerated approval
Pharmed Out (PharmedOut.org, 2022)	A Georgetown University advocacy group, funded through individuals and grants	Educates individuals on the medical concerns about Aduhelm, against accelerated approval; advocates for increase rigor and value analysis before approval of drugs
Right Care Alliance (Right Care Alliance, 2022)	Mostly funded by private donors, also Resist Foundation and Ben and Jerry’s	Sponsor of petition to withdraw approval of Aduhelm, against accelerated approval for drug

 Facts

The U.S. government is the largest funder of scientific research through these National Institutes of Health Agencies: National Institute on Aging, National Institute of Mental Health, National Institute of General Medical Sciences, and National Center for Advancing Translational Science. Other federal funding comes from the National Science Foundation, Veterans Administration, Food and Drug Administration, and the Center for Medicare and Medicaid Services.  This conclusion was drawn from a scientific literature review and meta-analysis conducted in 2018 (Cummings, 2018). Though drug companies do conduct their own less risky brand research, it is on the backs of early publicly funded mostly university-led research.

Significant concerns about the FDA working too closely with the drug developer Biogen have resulted in the following investigations; congressional committees, the Health and Human Services department’s inspector general, the Federal Trade Commission and the Securities and Exchange Commission.  Such concerns reflect the process by which this drug received accelerated approval despite scant evidence it works, manipulation of research data after it was rejected by the expert review at the FDA, and the director of the FDA’s personal relationship with the drug developer. A drug which had not even completed clinical trials and has been shown to kill patients was put on a direct path to market it as an Alzheimer's cure to the public. This resulted in clinical outcry, outright banning of the use of the drug by most major medical centers, and a public movement to draw attention to the concerns, as previously published.[1] [2] As a result, the independent government agency, the Centers for Medicare and Medicaid called for and received thousands of public comments on the concerns about this drug. Additionally, CMS only approved provisional payment for this drug for patients in clinical trials, which appears prudent. This decision infuriated big pharma because they assumed anything that could be hornswoggled through the FDA was a guarantee of payment by CMS, and thus, the giant wallet of the US government, which would be responsible for most of the cost.

Conclusion, since the government conducts most of the early scientific research, shouldn’t it, as the largest purchaser of pharmaceuticals, have a right to review drug approvals, for this is exactly what private insurance companies do with their pharmacy schedules. It is not in the best interest of tax paying Americans to waste money on specious treatments and CMS is doing all of us a favor by slowing down the approval of Biogen’s Aduhelm. The pharmaceutical industry should consider this a shot across the bow as the American public is awake and livid over the continual pillaging of our pocketbooks for their profits.

References

American Geriatrics Society. (2022, April 6). Where We Stand-Letter to CMS Commissioner on Aducanumab. Retrieved from https://www.americangeriatrics.org/: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/viewer.html?pdfurl=https%3A%2F%2Fwww.americangeriatrics.org%2Fsites%2Fdefault%2Ffiles%2Finline-files%2FAmerican%2520Geriatrics%2520Society_Letter%2520to%2520FDA%2520Biogen%2520Drug%2520for%2520Alzheimer%

Belluck, P. (2022, April 6). Inside a Campaign to Get Medicare Coverage for a New Alzheimer’s Drug. Retrieved from https://www.nytimes.com/2022/04/06/health/aduhelm-alzheimers-medicare-patients.html?smid=url-share

Butler, J. (2022, April 5). The Alliance For Aging Research-Fronting For Pharma. PharmedOut.org. Retrieved April 6, 2022, from https://mailchi.mp/georgetown/april-2022-newsletter-update

Cameron, K. (2022, April 6). What you need to know about aduhelm. Retrieved from National Council on Aging: https://www.ncoa.org/article/what-you-need-to-know-about-aduhelm

Cummings, J. R. (2018, June 13). The price of progress: Funding and financing Alzheimer's disease drug development. doi:https://doi.org/10.1016/j.trci.2018.04.008

PharmedOut.org. (2022, April 6). Aduhelm. Retrieved from PharmedOut.edu: https://georgetown.edu/pharmedout/advocacy/aduhelm?authuser=0

Right Care Alliance. (2022, April 6). Withdraw Approval of Aduhelm Petition. Retrieved from Right Care Alliance: https://rightcarealliance.org/

 And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when you agree to inpatient treatments, do stipulate that for which you agree and that you decline.

 

Roberta Winter is an independent healthcare analyst who accepts no money from any sector of the U.S. healthcare system. She is the author of a guidebook to the healthcare system which was published in 2013 by Rowman and Littlefield. https://healthpolicymaven.blogspot.com/2021/09/is-fda-too-politicized-to-make-sound.html

 

 

---

[1] https://healthpolicymaven.blogspot.com/2022/01/high-cost-of-single-unproven-drug.html

 

[2] https://healthpolicymaven.blogspot.com/2021/09/is-fda-too-politicized-to-make-sound.html