The Problem With U.S. Healthcare Is It Is Designed To Deliver Reimburseable Interventions-Not Health

Healthcare in the United States is largely designed for reimbursement based on medical interventions that are not necessarily linked to creating health. Though the nation has excellent critical and specialty care facilities, the system fails to adequately account for critical factors impacting health including environmental, socio-economic, and access to care. These are fundamental contributors for health, but the hectic and excessively expensive health system of the U.S. doesn’t include them in most metrics of performance. The message is that the nation has chosen to treat late-stage chronic disease, provide for critical care, and accept mortality rates that are some of the worst in the industrialized world for suicide, gun deaths, and maternal deaths.

For example, the maternal mortality rate in the United States is four times as high compared to European nations. And this metric has not improved in over a decade. Women die because of complications from childbirth, which is largely preventable, and most of these deaths occur after discharge from the birthing facility. The Commonwealth Fund, a Massachusetts nonprofit health systems research group published a maternal mortality report in 2024 confirming the areas where the US is an outlier in maternal health. (Munira Z. Gunja, 2024) The article reviewed metrics which contribute to maternal health and mortality for nations with high income and national health programs, including Europe as well as Chile, Korea, and Japan. The rate of c-section births is much higher in the U.S. compared to most of these countries as well. (Joan Stephenson, 2022) Two thirds of the deaths in the United States occurred in the first forty-two days following childbirth and reflect a gross inadequacy of post-natal care. And most appalling, the maternal mortality rate for black women in the U.S. is 49.5 deaths per 100,000 births. That ranks with developing countries with poor access to health care. Clearly there is a lack of patient follow-up care for mothers in the United States.

Maternal Mortality Metrics	Best Nation	USA Rank
Maternal Deaths per 100,000 live births	Norway-less than 1 death per 100,000 live births	22 per 100,000 live births
Number of C-sections	Norway-160 per 1,000 live births	320 per 1,000 live births
Access to pre- and post-natal care	Korea provides home post-natal visits for up to 2 years for vulnerable families	Healthcare system does not guarantee maternity coverage, based on the state Medicaid plans and private insurance standards
Number of OB Gyns	Germany-27 per 1,000 mothers	12 per 1,000 mothers
Number of Midwives	Chile-80 per 1,000 mothers	4 per 1,000 mothers
Federally Mandated Paid Maternal Leave	Norway-86 days paid leave	None, 25% of women have private employer paid leave

 Tulane University ran a study that reviewed maternal mortality and restrictive abortion laws for 38 states and the District of Columbia and found the deaths of mothers increased by 7%. (Winter, Pregnancy in the US Just Got More Dangerous-Post Dobbs v Jackson Decision, 2022) Where is the outcry for this  travesty of preventable deaths?

How the Health System Does Not Align with Creating Health

Financialization of Healthcare Without Requirements to Generate Health

The financialization of healthcare by hedge funds to maximize profits without actually delivering care. This is the opposite of what public goods should do. Health should be a goal for our nation’s people and the most efficacious way to identify methods to improve health should be a mandate, not merely an option for investors. The hedge funds purchasing include; behavioral health facilities, medical devices, biotechnology, and physician practices. Hedge funds are buying healthcare-delivery assets, to make profits, not to generate health. In fact, if more people are chronically overweight, depressed, addicted, there will be more customers to buy their weight loss medicine, take the wonder drugs, enroll in specious behavior modification programs, and require medical interventions, which will add revenues to their medical device companies and specialty practices which generate lots of profits in targeted surgeries. Never mind that these procedures may be costly for patients and the health system and the health results short lived.

Purchasing healthcare assets may cause disruption in services, for example, treating the delivery of health care as a commodity, rather than a public health property can reduce the availability of care when physician practices are consolidated. This is rarely to the advantage of patient care but is marketed as an improvement to regulators. For example, when Harrison Hospital was purchased by a Catholic hospital group, the first thing it did was expand urgent care clinics and facilities in wealthier areas and ultimately close the hospital in Bremerton, Washington, which provided care for many veterans, low-income residents, and persons with mental health and addiction issues. (Winter, Hospital Closures and the Impact on Health Services, 2016)This too was billed as nondisruptive, but when a community of 39,000 people loses its hospital, this is disruptive. The message-a disruption in services to the less wealthy is not a significant concern to the healthcare group. Take-a-way-from the boardroom-why deliver services in a poorer area, when the company can make more money by serving the wealthier, bonuses all around.

Nonprofit Hospitals Which Have Converted to For-profit Megaliths

First, why is shaving money off the top for shareholders a good technique for improving health care, and how will this contribute to affordability? The most affordable health care program in the U.S. is Medicare, a government run program for seniors and disabled persons, which has the lowest administrative cost (6%) of any program public or private. Steward Hospitals is an example of a private equity deal from the purchase of the nonprofit hospital Caritas Christi in Massachusetts. The hedge fund then sold off the assets of the hospitals (land) and created a second company for lease revenues from the hospitals which now paid rent to the hedge fund owners. True to form, those investors made all of their money in the first three years and spun off Steward to a physician group and walked away with leaseholds. The physician group, made up of some of the original members of the hospitals, started to lose money and within a decade the hospitals were auctioned off to other entities, but two failed to survive, Carney Hospital and Nashoba Valley Medical Center. The patients in rural Massachusetts and inner-city Boston have had to scramble to find care. (Brownstein, 2024) This seems more like the casualties of war, people treated as detritus in the machinery of for-profit healthcare-health entities operated without concern for the people they are supposed to serve. I wonder how many people died who couldn’t get to a hospital in their area?

Ninety percent of private equity deals in the health care sector are never reviewed for public interest or unintended consequences. Private equity funds are short-term profit driven and not geared to long-term investments in healthcare infrastructure. In 2022, according to DealBook, there were 863 healthcare deals in private equity. Only Oregon and Massachusetts have state laws which monitor private equity healthcare transactions. (The Growth of Private Equity in US Health Care: Impact and Outlook, 2025)

Reimbursement Policies Mostly Geared Toward Volume and Not Quality of Health Produced

Medicare Demonstration Projects have attempted to include quality metrics and reimbursement incentives linked to procedures for health measures, especially in the realm of cardiac care, stroke treatment, and reduction in hospitalizations from improved patient care for infection control. The Patient Protection and Affordable Care Act attempted to invigorate preventive care and wellness through mandated annual physical and well-child-care. However, the ability of middle-class people to afford medical insurance is tenuous, the reimbursement policies vary by state and insurance plan, and immigrants without permanent residency status are denied access to the federally subsidized health insurance programs. Several states have elected to change their Medicaid plans under 1115 waivers, which affords greater flexibility in benefit design and program allocation. Washington State is designing a Medicaid program that provides additional nutritional food support, housing assistance coordination, and medical transportation services. (Washington State Healthcare Authority, 2025)This is a good example of how the metrics are being modified to look at the larger picture of health creation. Afterall, it is hard to stay healthy if you are homeless, lack adequate food, and transportation to medical services.

U.S. Does Not Coordinate or Require National Investments in Creating Population Health

Because the U.S. healthcare system is geared to insurance reimbursement, many of the other factors that contribute to health are often not included in performance metrics. For example, adequate nutrition for children is a fundamental necessity in their physiological development, yet the Trump Administration has chosen to minimize funding for a Supplemental Food Program for families, at the same time, making tax cuts for billionaires permanent. This makes no sense at all for a nation which has an embarrassment of food stocks, where farmers are paid not to grow certain crops, and agribusiness receives all kinds of subsidies. Further, this cruel decision is exacerbated by the administration’s decision to limit funding for school lunches. There are literally silos of unused food in the country going to waste.

Removal of Scientific Data from Public Resources About Environmental Problems

Another important aspect of health is an environment which is safe and free from poisons, yet the Trump Administration has defunded the Environmental Protection Agency and ceased to report on environmental hazards which impact public health, like forever chemicals[RW1] . The TrumAdministration is being sued by multiple groups for loosening the reporting and safety requirements for chemical manufactures which produce the following:  ethylene oxide, chloroprene, benzene, 1,3-butadiene, ethylene dichloride, and vinyl chloride, all known carcinogens. Why is it even a political decision to reduce harmful substances that endanger our health- there should be a national mandate for this. The first rule of a nation is to do no harm to its people, especially to the vulnerable.

Health and Welfare of Our Children is Being Ignored by Short-term Public Policy Decisions

An aspect of health is safety is the provision of reliable affordable childcare, without this people choose not to have children, and the country will not be able to support its aging population. For many families, children are unsupervised for long periods of time. This problem was recognized in the eighties while I served as the finance chair for a Campfire group, where we made the decision to sell the camp property and set up a fund to support the Latchkey Program, which was a recognition of the dearth in childcare in the country. This was a resource targeted for school-age children who were home after-school for extended periods before their moms returned home from work. I remember finding my son, a second grader, shivering on the steps of our home because he had forgotten his coat, while I trudged up the hill from the bus stop. After that, we came up with a plan where he would push the garbage can against the back gate, climb up, open the gate latch, go to the back door, and access the key under the mat. By the time he was in third grade he wore a lanier with the house key around his neck. I raised him to survive in a world where we were on our own. The travesty is this was our best recourse in a wealthy city in America.

Discriminatory Policy Decisions Which Harm Families and Contribute to The Unaffordability of Health Care

Further, those of us who have medical insurance, are still stuck with co-insurance liabilities that are completely unaffordable, $13,000 for co-insurance after deductibles per year? The annual burden for medical insurance for a family in the U.S. is $27,000 according to the nonprofit Kaiser Family Foundation. (Kaiser Family Foundation, 2024) The Patient Protection And Affordable Care Act(ACA) created a government cost neutral method for low-income and middle class people to obtain federally subsidized medical insurance by advancing tax credits. This provided medical insurance and access to treatment for thirty million people, including me. Further, the standardization of preventive care benefits, elimination of the pre-existing condition exclusion clause, and the requirement that insurance companies use at least 85% of insurance premiums to pay for medical services, has resulted in less costly care for the participants. Now, the Trump Administration wants to nullify the ingenious tax credit funding of the ACA.

Lack of Regard for the Mental and Emotional Health of the Nation’s People

The U.S. has one of the highest suicide rates in the industrialized world, especially for children and youth. Suicides outnumber homicides 2 to 1. A Harvard study found that states with fewer gun restrictions have higher suicide rates and Wyoming has the nation’s highest rate at 28 people per 100,000 lives. The global suicide rate is 8.9 deaths per 100,000 people and the U.S. has the highest rate of all industrialized countries, 14.2 suicides per 100,000 people. (The Commonwealth Fund) This metric is a glaring condemnation  of the nation malaise and insufficient support for its people.

For every dollar invested in wellness, through nutrition, maternal and child health services, and environmental cleanup, we save over $5 per person. In 2008, The Trust for America’s Health found an investment of $10 per person in community-based health programs would save $5.60 in medical expenses per head. (Trust for America's Health.org, 2008)  This table shows a statewide analysis of the return on investment of the community based health initiatives.

State	Potential Annual Savings	Return on Investment
Alabama	$250 million	5.6 to
Alaska	$47 million	7.2 to 1
Arizona	$242 million	4.2 to 1
Arkansas	$139	5 to 1
California	$1.7 billion	4.8 to 1
Colorado	$232 million	5 to 1
Connecticut	$231 million	6.6 to 1
Delaware	$57 million	7 to 1
Washington, D.C.	$57 million	9.9 to 1
Florida	$1 billion	6.2 to 1
Georgia	$426 million	4.8 to 1
Hawaii	$70 million	5.6 to 1
Idaho	$62 million	4.5 to 1
Illinois	$708 million	5.6 to 1
Indiana	$343 million	5.5 to 1
Iowa	$165 million	5.6 to 1
Kansas	$155 million	5.7 to 1
Kentucky	$248 million	6 to 1
Louisiana	$234 million	5.2 to 1
Maine	$98 million	7.5 to 1
Maryland	$332 million	6 to 1
Massachusetts	$476 million	7.4 to 1
Michigan	$545 million	5.4 to 1
Minnesota	$316 million	6.2 to 1
Mississippi	$150 million	5.2 to 1
Missouri	$334 million	5.8 to 1
Montana	$51 million	5.5 to 1
Nebraska	$102 million	5.8 to 1
Nevada	$115 million	5 to 1
New Hampshire	$76 million	5.9 to 1
New Jersey	$543 million	6.3 to 1
New Mexico	$88 million	4.7 to 1
New York	$1.3 billion	7 to 1
North Carolina	$473 million	5.6 to 1
North Dakota	$39 million	6.2 to 1
Ohio	$685 million	6 to 1
Oklahoma	$183 million	5.2 to 1
Oregon	$193 million	5.4 to 1
Pennsylvania	$791 million	6.4 to 1
Rhode Island	$73 million	6.8 to 1
South Carolina	$233 million	5.6 to 1
South Dakota	$42 million	5.5 to 1
Tennessee	$351 million	6 to 1
Texas	$1 billion	4.7 to 1
Utah	$89 million	3.7 to 1
Vermont	$43 million	7 to 1
Virginia	$385 million	5.2 to 1
Washington	$343 million	5.5 to 1
West Virginia	$124 million	6.9 to 1
Wisconsin	$337 million	6.2 to 1
Wyoming	$29 million	5.8 to 1

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These wellness programs included education and resources for improved nutrition, smoking cessation, and increased exercise. Not very sexy, but low-cost interventions that do provide long term benefits, including reductions in strokes, heart bypass surgeries, incidence of type II diabetes, and several typesof cancers. Not to mention a reduction in kidney failure, neuropathy, and other chronic disease comorbidities.  Another example of the positive impact of preventive healthcare is in Hawaii. The Hawaii State Medical Plan conducted an economic study of 166,000 members over a four-year-period which found it saved $350 in healthcare treatment for every investment of $10 in wellness programs. (Steven M. Schwartz, 2013)

US Spends More Money Than Any Other Nation-Where Does the Money Go

Using data for 2023 from the Centers for Medicare and Medicaid and other government agencies, these charts show where the healthcare dollars are spent by sector, who actually pays for the services, and how it looks on the consumer-end, for health services purchased. United States healthcare consumed 4.9 trillion dollars in 2023 and the breakdown of the cost of the programs was: Medicare and Medicaid consumed 2 billion, private insurance 1.5 billion, individual plans 490 billion, and third party entities the rest. The Who Pays pie chart shows which entities paid for the actual services and illustrates that private insurance plans only paid 18% of the total, despite the fact this is portrayed as the primary way residents of the U.S. obtain their medical insurance. The reality is the federal government pays 32% of all of the services, individuals pay 27%, state and local governments  pay 16%, and other private sources pay for 7% of the services.  The US Healthcare Expenses table shows how the services were split for hospital, clinical, prescription drugs, and other medical treatments. 

 

 

Source

Centers for Medicare & Medicaid

Notes

The RX or prescription drug budget is for retail scripts, not infusions or other applications

Other health care includes care through schools, residential treatment facilities for mental health, drug treatment, and community centers

Nondurable medical means-retail healthcare products, like surgical dressings, blood pressure cuffs, over the counter medicines

Durable Medical products means-contacts, eyeglasses, hearing aides

Other Professional Services means optometry, podiatry, chiropractic

Unspecified miscellaneous may include: weight loss counseling, ayruvedic health care, acupunture, massage, health retreats

Mental health care estimates includes; all behavioral health intervention according to the Substance Abuse and Mental Health Services Administration

 Analysis and Close

The United States spends more than any other nation on health care, but it doesn’t generate better health outcomes than nations which spend 40% less. In 2024, the average industrialized nation spent $7,371 and the United States spent $14,885 per person for health care. (Peter G. Peterson Foundation.org, 2025) Yet life expectancy is lower in the U.S. than in Japan and most European nations. Even more egregious is life expectancy for the working population is reducing. Our young people are dying at earlier ages than their parents.

One of the reasons for the disparity is the U.S. spends far more on administration with terribly inefficient 50-state standards for private and government run health plans. Other nations use the money collected from taxes and private payers to actually pay for services. For example, long term care administration in the U.S. cost $1,079 versus $339 in France in 2023.

The United States of America, a nation for which my grandfather fought in the Revolutionary War to create, is failing to generate health for our children and those who work to pay for it. Yet, the Trump Administration is systematically gutting medical research, tax subsidies for the Affordable Care Act, government reporting on quality measures, and oversite for government and private sector agencies. A nation which starves its people is a nation in decline. If you aren’t familiar with the robber baron era, look it up, for the current administration wants to make us serfs in lifetime penury to the ultra rich.

And this is the healthpolicymaven signing off encouraging you not to sign blanket releases for inpatient procedures, do stipulate that for which you agree and decline. This article was written by independent journalist and healthcare analyst, Roberta Winter, who received no compensation from anyone in healthcare.

References

(n.d.). The Commonwealth Fund.

Brownstein, M. (2024, December 16). Private Equity's Appetite For Hospitals May Put Patients At Risk. Harvard, TH Chan School of Public Health. Retrieved November 3, 2025, from https://hsph.harvard.edu/news/private-equitys-appetite-for-hospitals-may-put-patients-at-risk/

Joan Stephenson, P. (2022, July 22). Rate of First Time Cesarean Deliveries On The Rise In The U.S. JAMA Health Forum, 2022;3;(7):e222824. doi:doi:10.1001/jamahealthforum.2022.2824

Kaiser Family Foundation. (2024, October 9). Annual Family Premiums for Employer Coverage Rise 7% to Average $25,572 in 2024, Benchmark Survey Finds, After Also Rising 7% Last Year. Retrieved November 5, 2025, from Kaiser Family Foundation-Health Affairs: https://www.kff.org/private-insurance/annual-family-premiums-for-employer-coverage-rise-7-to-average-25572-in-2024-benchmark-survey-finds-after-also-rising-7-last-year/

Munira Z. Gunja, E. D. (2024, June 4). Insights into the U.S. Maternal Mortality Crisis: An International Comparison. The Commonwealth Fund Issue Brief. Retrieved November 9, 2025, from https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison

Peter G. Peterson Foundation.org. (2025, October 7). How Does the U.S. Healthcare System Compare to Other Countries? Peter G. Peterson Foundation Brief. Retrieved November 10, 2025, from https://www.pgpf.org/article/how-does-the-us-healthcare-system-compare-to-other-countries/

Steven M. Schwartz, C. I. (2013). The Economic Value of a Wellness and Disease Prevention Program. Population Health Management, 13, 309-3017. doi:1942-7891

The Growth of Private Equity in US Health Care: Impact and Outlook. (2025). Retrieved from NIHCM.org: https://nihcm.org/publications/the-growth-of-private-equity-in-us-health-care-impact-and-outlook

Trust for America's Health.org. (2008). Prevention for a Healthier America. Trust for America's Health. Retrieved November 8, 2025, from https://www.tfah.org/report-details/prevention-for-a-healthier-america/#:~:text=The%20report's%20conclusions%20include:%20*%20An%20investment,ways%20we%20could%20reduce%20health%20care%20costs

Washington State Healthcare Authority. (2025, November 9). Section 1115 Medicaid Waiver-Foundational Community Supports Program. Retrieved from Washington State Healthcare Authority: https://www.hca.wa.gov/about-hca/programs-and-initiatives/medicaid-transformation-project-mtp/foundational-community-supports

Winter, R. E. (2016, September 3). Hospital Closures and the Impact on Health Services. Straight Talk On Healthcare. Retrieved November 7, 2025, from https://healthpolicymaven.blogspot.com/2016/09/hospital-closures-in-united-states-and.html

Winter, R. E. (2022, August 26). Pregnancy in the US Just Got More Dangerous-Post Dobbs v Jackson Decision. Retrieved November 10, 2025, from healthpolicymaven.blogspot.com: https://healthpolicymaven.blogspot.com/2022/08/pregnancy-in-us-just-got-more-dangerous.html

 

 

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 [RW1] https://www.edf.org/media/community-health-and-environmental-groups-sue-stop-president-trumps-unlawful-toxic-air

Trump Guts Healthcare on Global Scale

The Trump Administration while busy guilding everything in sight with gold and expanding the White House ballroom, has still managed to cause a massive curtailment in public health resources. Here is the list of his administration’s actions in order of priority, which are most deleterious to global health.   

Cutting billions in grants for medical research causing public universities and research groups to layoff thousands of scientists. These cuts include 16 billion in economic losses and 60,000 in jobs. Some of the research programs have been in existence for fifteen years and the lead investigators will take their programs to other countries to continue their work. France, Switzerland, and Canada are all global research centers. It is estimated the loss of these experts, value of medical technology and treatments generated by medical research will cause a permanent four percent reduction in GDP for the United States.

      Stopping the funding of USAID destined for disease prevention and treatment in the developing world, and demonically highlighted by the Trump Administration’s order to burn 9.7 million dollars of birth control products in Belgium, on August 7, 2025. This despite a U.S. based nonprofit’s offer to distribute the IUDs. hormonal implants, and birth control pills for free within the United States. Apparently, people in the Trump Administration are still confused on basic birth control, as none of these products were abortifants, the reason cited for their destruction. And where were these often life saving devices destined, to Africa, where lack of basic maternal health is rife and loss of life for mother and child is common. Albeit, thanks to the originalist conclusions of the U.S. Supreme Court, maternal deaths are on the rise here too. A further curtailment of Medicaid funding will only worsen the access for prenatal and postnatal care. Many maternal deaths occur after discharge from a hospital, where follow-up care is limited. When a tree falls in the forest and no one hears it, does it make a sound?

          Removal of clinical and scientific experts on the Food and Drug Agency (FDA) review board for approval of medical interventions, including drugs, which will result in more specious, extremely expensive, and dangerous treatments offered without due diligence in the United States. In June, HHS Secretary Kennedy fired all seventeen experts on the review board for vaccines, which were replaced by eight persons, including vaccine skeptics. (Mandavilli, 2025) This action undermines the credibility of the FDA for drug and treatment standards, which has been considered the gold standard globally.

      Direct cuts to public health programs including vaccine development, disease surveillance, and access to care will result in the closure of many clinics and hospitals in rural areas. The Trump Administration’s One Big Beautiful Bill Act (BBBA) disqualifies legal immigrants from Medicaid benefits eligibility and makes draconian cuts to Medicaid which will eviscerate coverage for 16 million people. (Mia Ives-Rublee, 2025) The crowning achievement of permanent tax breaks for the rich and claw-backs for the poor cuts Medicaid by a trillion dollars and only offers rural hospitals fifty billion in subsidies, which are not guaranteed and are subject to new constraints. Further the rural hospital subsidies are only budgeted for five years. Any state that reimburses more than the miserly Medicaid cap determined at the federal level will face funding cuts, further limiting resources and access to care. This is just another way for the Republicans to kill the Medicaid Expansion under the Patient Protection and Affordable Care Act, which has been adopted by 41 of the states. (Kaiser Family Foundation.org, 2025) It appears healthcare has been brought to its knees by nine predominately southern outlier states.

Republicans who voted for the bill essentially are ripping off their own people. It is estimated that 700 hospitals, about a third of all rural facilities will close. Here is a statewide list of rural hospitals that have the most at risk because of the shortsightedness of the Trump Administration Medicaid cuts. (Data is current as of July 2025)

 In this analysis, several states had no hospitals at risk of closure because of the BBBA.

 (Center for Healthcare Quality and Payment Reform, 2025)

Stopping the approval and funding of the highly effective Rna vaccines, which were developed quickly and saved thousands of lives during the Covid Pandemic, which was of course, preceded by appointing the anti-vaxer, with no medical background, Robert Kennedy, Jr. as Secretary of Health & Human Services. (Manadivilli, 2025)

          Further restrictions on access to birth control, reproductive rights, and maternal and child health, with a patchwork of state laws since the Trump appointed-Catholic dominated-Originalistic-Supreme Court overturned Roe-v-Wade in 2022. Women forced to fly outside their state of domicile to obtain urgent medical care during pregnancy complications, even those which are life threatening. Doctors are refusing to provide care for fear of losing their medical license in Idaho, Texas, and other states.

      Eviscerating healthcare savings to taxpayers if the healthcare entity donated to the Trump Campaign; case in point, overriding the Centers for Medicare and Medicaid decision not to reimburse for some of the outrageously costly and no more effective skin coverings for diabetic wound care. Because some of these products come under the biologic rulings, they are considered a new treatment and are more-or-less allowed to charge whatever they want, because the Medicare rules stipulate reimbursement at 6% of whatever the medical device company charges. Diabetic foot ulcers represent 16% of the total Medicare population, but the cost just for the skin coverings is over 10 billion annually for taxpayers. (Pinder, 2025) The Medicaid payment system does need reform, but allowing lobbyists in the medical supply sector to decide that outcome is not in the best interest of the nation. Other countries assess both the efficacy and the price of a medical treatment, weighed against what is currently available, for potentially less money before approval of a treatment device or drug. The U.S. government and the workers who contribute payroll taxes to pay for Medicare and Medicaid programs are not obligated to provide profitability for medical device, pharmaceutical, or medical supply companies. If the United States wants to reduce the cost of Medicare, it must adopt the evidence-based-practice recommendations for the most clinically and financially practical applications. Everyone does not drive a Rolls Royce or a Rivian and the government should not be expected to supply medical devices or applications that are unaffordable. Having a market rate reimbursement system saps resources from other primary health care needs, and for treatments which already have adequate substitutes.

 This article was written by independent journalist, Roberta Winter who received no compensation and is not intended to provide medical advice. Except, when agreeing to medical treatments of an inpatient variety, do stipulate that for which you consent and which you decline. If you do not have a medical directive or a POLST, get one. And this is the healthpolicymaven signing off.

References

Center for Healthcare Quality and Payment Reform. (2025). Rural Hospitals At Risk of Closure. Center for Healthcare Quality and Payment Reform. Center for Healthcare Quality and Payment Reform.org. Retrieved August 7, 2025, from ruralhospitals.chqpr.org

Kaiser Family Foundation.org. (2025, May). https://www.kff.org/statedata/collection/measures-to-identify-states-at-greater-risk-if-federal-medicaid-spending-is-reduced/. Retrieved August 7, 2025, from https://www.kff.org/affordable-care-act/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0&selectedDistributions=status-of-medicaid-expansion-decision&sortModel=%7B%22colId%22:%22Location%22,%22sort%

Manadivilli, A. (2025, August 7). On Vaccines, Kennedy Has Broken Sharply With the Mainstream. The New York Times. Retrieved August 7, 2025, from On Vaccines, Kennedy Has Broken Sharply With the Mainstream

Mandavilli, A. (2025, June 24). Vaccine Panel Gutted By Kennedy-Loses Member Ahead of First Meeting. The New York Times. Retrieved August 7, 2025, from https://www.nytimes.com/2025/06/24/us/politics/rfk-jr-cdc-vaccine-panel.html

Mia Ives-Rublee, K. M. (2025, July 3). The Truth About the One Big Beautiful Bill Act’s Cuts to Medicaid and Medicare. Progress.org. Retrieved August 7, 2025, from https://www.americanprogress.org/article/the-truth-about-the-one-big-beautiful-bill-acts-cuts-to-medicaid-and-medicare/#:~:text=The%20bill%20will%20put%20rural%20hospitals%20at%20risk&text=Rural%20hospitals%20have%20some%20of,risk%20when%20rural%20hospita

Pinder, J. (2025, July 21). https://clearhealthcosts.com/blog/2025/07/in-turnaround-administration-proposes-limits-on-skin-substitute-industry/. Clear Cut Costs. Retrieved August 7, 2025, from https://clearhealthcosts.com/blog/2025/07/in-turnaround-administration-proposes-limits-on-skin-substitute-industry/

 

USA Role as a Financial Safe Haven Is Over-What the Trump Budget Busting Bill Really Means

 

The Trump Republicans, who won the Senate and Congressional majorities in November just passed the largest deficit for the federal budget at three trillion, dwarfing anything the Democrats did. (Katie Edmondson, 2025)This article focuses on the long-term financial ramifications for the country and especially for our children and grandchildren. The Senate bill actually went further than the House bill to throw millions more under the bus for healthcare, access to food, and other basic needs, creating a mutually compounding effect of cruelty. The Congressional Budget Office estimates the savings from throwing nearly 12 million people off Medicaid plans to be worth a trillion dollars. (Sanger-Katz, 2025)

The actions of the Trump Congress will cause 11.8 million low-income and working-class people to lose their medical insurance through the insurance exchanges and Medicaid expansion under the Affordable Care Act. This is approximately a third of all the enrollees. For most of these people, the insurance exchanges are the only way they can obtain medical insurance. Without medical insurance, many of these people will cease to receive care, regardless of their health. The United States does provide hospital treatment for people in urgent need, which is dependent on the location one lives, and how well resourced their healthcare safety nets are maintained.

Even if throwing nearly 12 million people under the bus does not bother you, the strain on the national economy should and here is your basic lesson in economics. The United States is a debtor nation, which means it needs investors from other nations to buy our bonds, which are a debt instrument, to keep US currency strong and to pay the interest on our national debt. The national currency has lost over 10% of its value since January, an unprecedented slide which continues. In the past, the purchase of American bonds from foreign nationals has been considered a safe investment in a world of risk. The Trump Administration has destroyed that impression through his inefficient and historic levels of tariffs and other aggressive actions which undermine financial security for all of us. The Trump Administration has stepped back from a position of global leadership, with gargantuan cuts to USAID, a program championed by Republican and Democratic presidents, as well as the Foreign Service, and other programs which reflected well on the United States. This vacuum has been filled by China, in Asia and now, because of the Trump Administration’s closing of US Embassies in Africa as well. In financial terms, the US can expect to pay higher interest rates to bondholders because of the perceived increased risk in the national currency. This will have a compounding effect of increased budget constraints, which will require higher taxes or program cuts. Many Republicans would love to cut Medicare and Social Security and the Social Security funding is only adequate until 2035. These programs are essentially the only safety net for working class people in America. It appears that Trump has assured the current generation of “robber barons” tax breaks into perpetuity while the other 90% will be groveling for scraps, left to serve the needs of the uber wealthy.

And this is the healthpolicymaven signing off encouraging you not to sign blanket releases for healthcare facilities, do specify which lifesaving procedures for which you consent and those which you decline.

Roberta Winter is a freelance journalist who received no money for this post. This healthcare and public policy blog has been in continuous publication since the fourth quarter of 2007, for those of you who still read.

 References

Katie Edmondson, K. H. (2025, July 1). Trump Administration Live Updates: Senate Passes Trump’s Signature Policy Bill. The New York Times. Retrieved July 1, 2025, from https://www.nytimes.com/live/2025/07/01/us/trump-bill-news

Sanger-Katz, M. (2025, June 29). G.O.P. Bill Has $1.1 Trillion in Health Cuts and 11.8 Million Losing Care, C.B.O. Says. The New York Times. Retrieved July 1, 2025, from https://www.nytimes.com/2025/06/29/us/politics/trump-policy-bill-health-insurance-cuts.html

 

 

Journalistic Integrity Lost Directly Due to Trump Tariffs

 Dear readers,

Trump terrorizes us all, gouging away at the fragile economy, impacting our wallets, and our livelihoods. As you know it is increasingly difficult for independent writers to find space in the publishing vortex and we are often told, "your following is not large enough." Since 2011, I am been an unpaid reviewer for The New York Journal of Books, and occassionally I have featured some of my reviews here. I have been fortunate to become acquainted with best-selling incredible writers, including Robert Pelton and Katherine Holstein,  Today, I received notice that NYJB is shutting down because of the increase in costs for hosting and site security coupled with the reduction in secondary sales from site visits because of  the Trump tariffs. Of course, a reduction in sales will also mean job loss for many directly and indirectly tied to commerce. For your pleasure, I am featuring some of my favorite reviews before they are lost in the ether.

My most recent post about the Portable Feminist Reader is humorous yet shows a true comparison of the stilted autonomy American women enjoy compared to other nations

https://www.nyjournalofbooks.com/book-review/portable-feminist-reader

And this antidote for heartbreak, Love Prodigal.

https://www.nyjournalofbooks.com/book-review/love-prodigal

https://www.amazon.com/Love-Prodigal-Traci-Brimhall-ebook/dp/B0D3KF7KYY/ref=tmm_kin_swatch_0?_encoding=UTF8&dib_tag=se&dib=eyJ2IjoiMSJ9.-vHg1-y0maG2jjCmTg2QRVdFFMD244Y7DdmvLanySul33hqCacJ2fywdfMFx62osLT_fMkjKlZewk4xdYTJ38rO3EB7QFJPajquyq0Io8FbmPeDH2I-hEZ889cel7sgnpSMAFt29n8f00G3HGSawdtDkI-Ryu0rN-N1-7dL1671tlHQ6HZFXoqXBchPEmd2hQmSi15NqPazPFMJrzDNMz4FfkMhq_U08jKd_-VIcZ24.Xfx4cw0WR_jWovTMcUc2982YoFVSWjmOewV3W7jo_88&qid=1747424835&sr=1-1

This review of Medical Gaslighting illustrates the suffering a woman with a chronic disease endured trying to obtain care. The agent, who represents her is marvelous example of someone who chooses calling over purely commercial projects.

https://www.nyjournalofbooks.com/book-review/medical-gaslighting-how-get

https://www.amazon.com/Medical-Gaslighting-Deserve-System-Makes/dp/1637745397/ref=sr_1_1?crid=1N855L4BECKZE&dib=eyJ2IjoiMSJ9.CpNFZkhruQ8vgtFtbCzLdg.wYZnJxQPI2-UGFzRYERtVP2aepTP9Ia0FgjKKqFDJuU&dib_tag=se&keywords=medical+gaslighting%2C+how+to+get+the+care+you+deserve&qid=1747424710&s=books&sprefix=medical+gaslighting%2C+how+to+get+the+care+you+deserve%2Cstripbooks%2C182&sr=1-1

Atomic Days reveals the culpability of the U.S.government, including current administrations in the environmentally poor methods of securing nuclear waste from bomb making during WW II at the Hanford site. Further, Bectel,the contractor is no closer to containment security than it has ever been, yet taxpayers continue  to pay as the leakage of nuclear waste becomes closer to incursion in one of our nation's greatest rivers,the mighty Columbia.

https://www.nyjournalofbooks.com/book-review/atomic-days-untold-story

https://www.amazon.com/dp/1642598828/?bestFormat=true&k=atomic%20days&ref_=nb_sb_ss_w_scx-ent-pd-bk-d_de_k0_1_11&crid=25SFXUZNFW1S2&sprefix=atomic%20days

Eli Mystal's Let Me Retort, A Black Guys Guide to the Constitution, should be mandatory reading in highschools. FYI-This book was published by a nonprofit group. Which can be found on Amazon.

https://www.amazon.com/Allow-Me-Retort-Black-Constitution/dp/162097763X/ref=sr_1_1?crid=EAI6XFEUWZTV&dib=eyJ2IjoiMSJ9.EwByr6IxSUbv-uS4jTJvBw.eHWaADHTL6mXygyce3sdLTw58lPmkJecGIXw-SDMSh4&dib_tag=se&keywords=elie+mystal%2C+a+guide+to+the+constitution&qid=1747422347&s=books&sprefix=elie+mystal%2C+a+guide+to+the+constitution%2Cstripbooks%2C383&sr=1-1

Eric Edstrom'ssearing memoir,  A Soldier's Reckoning Of Our Longest War, (Afghanistan of course), was purchased for all of the sons of my friends and family. And it can be purchased here:

https://www.amazon.com/American-Soldiers-Reckoning-Our-Longest-ebook/dp/B07QRTYFKC/ref=tmm_kin_swatch_0?_encoding=UTF8&dib_tag=se&dib=eyJ2IjoiMSJ9.XtShaQrz-iqNYYm2ixrJLeGFfBK74sJHJeMRmqmdDfzGjHj071QN20LucGBJIEps.ybNy-t_-3xI8IbGVfA13EZ-GoPy_18uDEB9ufGEpOxA&qid=1747422913&sr=1-1

Shadow On The Mountain, by  Katherine Holstein and Jeffrey Shaker is a searing memoir of what happened to the Yahidzi people in Syria when Bashear took over and America left our allies on the ground. It can be purchased here:

https://www.amazon.com/Shadow-Mountain-Yazidi-Memoir-Resistance/dp/0306922835/ref=sr_1_1?crid=1WDSILED332CI&dib=eyJ2IjoiMSJ9.sRqYP9uVOHYOngbyrlzzAIFMFV5OGuVwbEvKAlfOhqc.jQJjL6HmHyOW_DfHhvOFxrvq0ugMo58dhz3vyDDiBAw&dib_tag=se&keywords=shadow+on+the+mountain%2Ca+yazidi+memoir&qid=1747423375&s=books&sprefix=shadow+on+the+mountain%2Ca+yazidi+memoir+%2Cstripbooks%2C191&sr=1-1

The first review I ever wrote was, Licensed To Kill: Hired Guns In The War On Terror by the man who created embedded journalism, the esteemed Robert Pelton,  author of the Most Dangerous Places series.Robert is both brillian and kind, and he read and wrote a positive review for my first book. You may find his books on Amazon and listen to him on his new podcast. 

https://teamneverquit.com/podcast/robert-young-pelton-worlds-dangerous-places-author-last-interviewer-ahmed-shah-massoud-bestselling-author-worlds-interesting-manfor-real/

https://www.amazon.com/Licensed-Kill-Hired-Guns-Terror/dp/1400097827/ref=sr_1_1?crid=1TTHO5LHRGALO&dib=eyJ2IjoiMSJ9.Xf0TWY75pt051PELgQztO5JfA_s0iRXSQOF6k0FiEAk.dz2ebRl4ULHSCvG0kgTB411XFBS7ksuzebhWpuK0FMk&dib_tag=se&keywords=licensed+to+kill%3A+hired+guns+in+the+war+on+terror&qid=1747423667&s=books&sprefix=licensed+to+kill+hired+guns+in+the+war+on+terror%2Cstripbooks%2C283&sr=1-1

We live in very uncertain times and in my estimation the only way forward is an embrace of the Dalai Lama's Ethics For The New Millenium. 

Thanks for reading.

Roberta

Results from Scientific Studies Are Not Synomymous With Actual Value In Healthcare Practices

 

Results from scientific inquiry do not necessarily create value in health care practices. Read this article to understand why and what we should be doing differently to build population health and economic value.

Scientific studies and clinical trials do not necessarily equate to actual value in clinical practices for patients and health systems. Scientific inquiry is of course necessary, as are clinical trials, but even if these avenues of inquiry demonstrate statistical significance and adequate patient safety, there are other factors that must be considered to create value for population health and for each practice and unique patient. The most important thing in research to improve our health is to ask the right questions. Currently, in scientific inquiry, once an investigation question is identified, it is called the hypothesis, and methods are chosen for controls, measures, and reporting of the data. A randomized control trial is held to the highest standard for this inquiry process, with excellent controls, attempts to eliminate bias, and recognized quality standards. Following this process, if the science finds merit to conduct a clinical trial on patients, this is the next step. This all sounds good, except scientific studies and clinical trials do not reflect real world variables in medical care. There is a field of study, called Real World Effectiveness (RWE) which has been under research for several decades, and there are now improved methods to assess actual effectiveness before a health system adopts a new intervention in health care and it has nothing to do with profits.  Briefly, here are the reasons the current study methods do not provide the information patients and health systems need to optimize efficacy of treatment. (Porzsolt, 2024) (Franz Porzsolt M. W., 2024) Efficacy means the efficiency and the treatment or evidentiary value of an intervention.

1.  Scientific findings of statistical significance are not synonymous with value in the real-world practice of medicine.

2.  Scientific studies do not necessarily include patient populations which are similar in a medical practice, because patients may have multiple co-morbidities, which may exclude them from study participation.

3. Clinical trials attempt to show actual treatment effectiveness, but there is also bias in the patient selection for clinical trials, because the drug company or medical device manufacturer want to show their product works. Thus, clinical trials cherry-pick patients who will conform to the methodology restrictions, and not include a lot of other issues such as health comorbidities.

4. Real world medical practices have many more variables than clinical trials. This is primarily due to the intimate relationship the clinician has with the patient and the customized approach he or she may use to meet the best treatment paradigm for her patients. This phenomenon makes it nearly impossible to make uniform strategies for all the risk profiles.

Thankfully, there is a method for identifying real world impacts of treatments, which would allow health systems and most importantly, the patient, to identify whether a drug, medical device, or procedure is worth it. Just like anything else which informs a decision, the individual weighs risks, potential benefits, proven reliability, and the cost. Unfortunately, unless you work in medical research, are a clinician, or some policy expert, you will not have this information to inform your treatment process.  In many healthcare systems today, the person has more information up front on the vehicle they purchase, then a health care intervention. This practice needs to change and I outline how RWE works and can be applied in real clinical settings here.

The Cochrane strategy, which is the international standard for the highest degree of efficacy in research includes these three questions: (Franz Porzsolt, 2024) The first question is called the principle of proof (POP)and means, can the intervention work. The second question is does the intervention work and what is the real-world effectiveness (RWE) through pragmatic (clinical trial) or observational study (used where clinical trial is not an appropriate study method). Further study will either demonstrate effectiveness or not. But the third question that needs to be asked is does this intervention demonstrate enough value given other treatments currently available. All too often this is swept aside so that the new drug or treatment will supplant existing more economical ones, because of monetary incentives. The third question needs to be applied to any patient health intervention so that the best use of resources for each patient is considered. Currently, in the United States this comes into play based on the type of insurance a person has, because everything is driven by reimbursement, and volume of care. Providing more expensive care to people who can afford it does not mean their outcomes are necessarily better, especially from a population health standpoint. Benefiting a few outliers does not mean large populations would necessarily benefit. The solution is to observe the actual outcomes of care in a medical practice, which is somewhat like the Centers of Medicare and Medicaid Innovation Grant Programs. Unfortunately, there is often a rush to bring a drug or medical device, or practice into approval and adoption before the actual patient effectiveness has been vetted. This results in wasted money and patient harm in many instances, because organizations feel pressured to show their idea works and to receive recognition and of course financial remuneration.

Finally, why do we care about further refinement of experimental results and treatments, because we can treat more people optimally for less money if we include the question, Is it worth it, in our final decision model before adoption of the treatment. This requires decisions to be made at a systemic level, in clinical practice, and as an informed patient.  Only by including the last question and comparing results will we learn what is actually the best treatment for various patient groups. People are not a one-size-fits-all and we should not be using science to justify treatments for some as appropriate for all.

And this is the healthpolicymaven signing off, encouraging you not to sign blanket release forms when you have medical procedures, do stipulate that for which you agree and for which you decline. Also, it is a good idea to get a POLST document in place with your health system, which states your wishes for interventional treatment to extend your life. And this is not the same as a medical power of attorney, whom you have chosen, but it alerts EMT's and others in the care continuum.

Roberta Winter is a freelance journalist who accepts no money from health care entities for this column. Opinions expressed here are her own. Her guidebook to the U.S. healthcare system was published by Rowman & Littlefield in 2013. https://rowman.com/ISBN/9781442222977/Unraveling-U.S.-Health-Care-A-Personal-Guide

References

Franz Porzsolt, M. P. (2024). The Front-End Processor Developed By Engineers-A Useful Tool for Describing the Quality and Quantity of Progress in Healthcare. Qeois-Open Peer Review, 1-19.

Franz Porzsolt, M. W. (2024). Applying the Rule of Designers and Architects "Form Follows Function (FFF) Can Reduce Misinterpretations and Methodical Shortcomings in Healthcare. Trends in General Medicine, 2(1), 1-7. Retrieved September 2024, 2024

Porzsolt, F. (2024). An Evidence-based Hypothesis: Doctors Do Not Make Decisions Randomly but Based on Individual Patient's Risk Profiles. Private Research Insitute of Economics (PRICE), Ulm, Germany, 1-11.

 

 

Overturn Of the Chevron Doctrine And The Impact on Health Care

 

The overturn of the Chevron Doctrine is the worst Supreme Court decision yet, making effective administration impossible for federal agencies which are charged with regulating public safety laws for air pollution, water quality, food, and healthcare safety. The Chevron Doctrine gave administrative power to federal regulators to make rulings to run their agencies. The Chevron Ruling is cited in 17,000 lower court and 70 previous Supreme Court Decisions (Nielsen, 2024). This includes scientists who decide how to assess pollution damages, water quality, air quality, and other environmental protections to keep the public safe. This also includes medical research and other experts who decide which drugs are safe and should receive Food and Drug Administration (FDA) approval. Further the FDA, oversees health standards for food, and those will become subject to myriad lawsuits, and incompetent rulings in smaller courts by nonexperts. Even worse than that, medical devices, cardiac implants, various surgical treatments will proliferate and be brought to the public based on specious science due to diminished oversite. We all know there is enormous fraud in healthcare, anti-trust activity in big agriculture, and serious conflicts of interest with the oil and gas industry. These industries will now have an outsized influence on the air you breath, the water you drink, whether the soil is contaminated where you live, the safety of the food you eat, and the validity of new drug and medical devices. Huge corporations in pharmaceuticals, oil and gas, and agriculture will now be able to power their way through local, state, and federal courts to create wealth at the expense of public health and safety. And thanks to the Citizens United Decision, corporations are treated as voters.

Ramifications for Health Care

 For the purposes of this analysis, I will focus just on the healthcare ramifications of the overturn of Chevron. Briefly, here are major programs whose existence will be threatened under the new wild west environment with the high court:

  Government’s Ability to Promote Innovation Will Be Hindered-Centers for Medicare and Medicaid demonstration projects, which are incentivized voluntary clinical efforts to improve health care will be hindered and possibly stop.

 Millions of working-class people may lose their health care-Eligibility standards for Medicaid may be changed for the Affordable Care Act expansion, of which all but eight states have adopted, which provides millions of people with subsidized medical insurance.

 Patient Safety is At Risk-If there is limited federal regulation then states can decide how far they wish to go in minimizing staffing ratios at nursing homes and other health care facilities thus endangering patient health. 

Ability to Assure Acceptable Health Care Standards is At Risk-Government payments from Medicare and Medicaid must currently meet standards of care including; staffing ratios, accreditation, and quality of care and the enforcement of these critical provisions are now in question.

Fraud Prevention-The Justice Department has its own division for health care fraud which reviews government billings and prosecutes fraud. In 2023, it charged 193 clinicians with 2.75 billion of fraudulent claims. (United States Department of Justice Press Release, 2024) The federal Department of Justice is the only authority powerful enough to go after abuses by pharmaceutical corporations, insurance companies, medical device manufacturers, mega hospital groups, and third-party administrators like pharmaceutical benefit managers. Who will look out for the American people if their ability to regulate and bring fraud charges is muted?

 Children’s Health Insurance Coverage-Families receive insurance subsidies based on their income according to a federal formula and this will be challenged.

 Increased Cost of Public Program Administration-Slower approval process and more court actions for any government regulation which will make administration by public agencies more expensive not less.

Government agencies are created to serve the people and none could be closer than Health & Human Services (HHS). Briefly these are things HHS does for us:

 1. Finances much of the medical research in the United States through the National Institutes of Health, awarding nearly two trillion dollars in grants 

 2. Creates health care quality standards through the Agency for Healthcare Research and Quality (AHRQ)

 3. Oversees vaccine production and supply as well as pandemic controls for public safety

4.  Is the repository for the National Library of Medicine, essential for medical research and policymaking

5,  Establishes health care treatment and reimbursement standards through the Centers for Medicare and Medicaid

6. Targets specific health interventions like treatment for opioid addiction and suicide prevention efforts

 Health and Human Services used its authority for public health during the Covid-19 pandemic when it was able to rapidly coordinate with the pharmaceutical industry to create effective vaccines to avert more loss of lives. The Centers for Medicare & Medicaid (CMS) deployed its authority for public good when the agency refused to approve reimbursement for aducanumab, an unproven treatment for Alzheimer’s. The approval for this drug application was later repealed by the Food and Drug Administration (FDA), because of a public outcry led by the Right Care Alliance and the scientific community. (Winter, 2022) This is an example of effective administration which saved the public millions from an unproven and specious drug application. The independent decision-making authority of this agency, separate from the FDA is essential for public health and safety. All these actions are for the health and welfare of the people of the United States.

 Given the spate of bad news in 2024, the sweeping aside of the Chevron doctrine will do the most lasting damage for hundreds of years. We are basically watching the collapse of this once great nation, Putin and Xi Jinping must be laughing their buts off.

 And this is the healthpolicymaven signing off, encouraging you not to sign blanket releases when you have medical procedures, do specify that for which you consent and which you decline. This column is published without remuneration from any healthcare entity and the opinions expressed here are those of health policy analyst and journalist, Roberta Winter, whose guidebook to the U.S. healthcare system was published in 2013. https://rowman.com/ISBN/9781442222977/Unraveling-U.S.-Health-Care-A-Personal-Guide 

References

Melissa Quinn, J. R. (2024, 24 22). What is Project 25-What To Know About the Conservative Blueprint For A Second Trump Administration. Retrieved 9 2, 2024, from CBS News: https://www.cbsnews.com/news/what-is-project-2025-trump-conservative-blueprint-heritage-foundation/

Nielsen, M. (2024, July 12). Impact of Supreme Court Decision on Health Policy. Retrieved September 3, 2024, from Milbank blog.org: https://www.milbank.org/2024/07/impact-of-supreme-court-chevron-decision-on-health-policy/#:~:text=In%20addition%20to%20the%20numerous,health)%2C%20and%20patients'%20data

United States Department of Justice Press Release. (2024, June 27). National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 Billion in False Claims. Retrieved September 3, 2024, from Justice.gov: https://www.justice.gov/opa/pr/national-health-care-fraud-enforcement-action-results-193-defendants-charged-and-over-275-0

Winter, R. E. (2022, January 27). https://healthpolicymaven.blogspot.com/2022/01/high-cost-of-single-unproven-drug.html. Retrieved from Straight Talk On Healthcare. healthpolicymaven.blogspot.com: https://healthpolicymaven.blogspot.com/2022/01/high-cost-of-single-unproven-drug.html

 

 

 

 

Common Anxiety Shown To Reduce Life Expectancy By 8 Years

 Excising our internal anxieties is an essential aspect of wellness. Relief from internal strife and stress is a key component for health. In The Lancet’s published study on all-cause-loss-of-years-of-life attributable to mental illness, men were found to have lost fifteen years and women, thirteen. To arrive at these conclusions, the researchers analyzed 35,865 studies and found 109 which were similar for inclusion in their meta-analysis of 12,171,909 patients with mental disorders. (Joe Kwun Nam Chan, 2023) This is a type of statistical analysis called meta-analysis, where high quality studies which are similar in hypothesis and population, are analyzed to find a pattern and to draw conclusions on the study findings from a much larger population sample. Conclusions from meta-analysis studies are very valuable for health policy planning and funding for interventions in public health. Statistically when the studies are of high quality, with confidence intervals in the 90^th percentile and represent a larger population, the findings are more reliable than smaller studies for informing systemic changes in healthcare. A confidence interval is a statistical measure to determine the likelihood of the same result being generated using similar data. It is a validator for the quality of the study methods and analysis. What makes the conclusions so urgent is even a benign diagnosis of anxiety or neurosis showed a reduction in life expectancy of eight years. It was no surprise the study found those suffering from substance abuse disorders had a reduction in life expectancy of twenty years. People with eating disorders were found to have a loss of sixteen years in life expectancy. Intriguingly those suffering from schizophrenia showed fewer years of lost life than the eating disorder group. Please note this study was only for patients seeking treatment, when untreated mental illness is a global problem and some would say crisis.

 Youth Suicide

The United States has one of the highest youth suicide rates in the industrialized world with 11.5 deaths per 100,00 persons between the ages of 19 and 24, second only to Australia and tailed by Canada. (Cristopher Doran, 2020) The National Institutes of Health study on global youth suicides found that for youths between nineteen and fifteen years, the mean suicide rate was 7.4 deaths per 100,000. In other words, the rate of youth suicide in the U.S. is 35% higher than the rate elsewhere in the world. Males showed much higher suicide rates at 10.5 to females of 4.1 per 100,000 of their peers. This study reviewed data from ninety countries and alarmingly found the suicide rate for females was increasing and the overall suicide rate for men and women was also increasing, except in Europe. Information was drawn from the World Health Organization Mortality database. (DANUTA WASSERMAN, 2005) Young people killing themselves is a public health crisis of immense proportions and is indicative of poor primary care, the limited availability of qualified mental health clinicians, and the lack of funding for adequate treatment.

 The point is what you spend your time thinking about and how that impacts your nervous, circulatory, and immune systems are indelibly linked. Thankfully, there are many more tools today to help people redirect their thoughts and make changes in negative practices. Virtual therapy allows those in rural areas to access high quality therapy, as well as busy working parents to be able to do it from their home or office. The advent of smart phones means many more people in the world have access to the internet and this is empowerment. Health and Human Services has invested thirty-five million dollars in expanding community mental health services and suicide prevention. (Substance Abuse and Mental Health Services Administration, 2022) The total mandatory spending for healthcare in the United States Budget for 2024, which was approved on March 23^rd, designated 4.2 trillion in mandatory allocations and 1.9 trillion for discretionary programs like this. As you can see, the amount mental health services are receiving in the federal budget allocation is tiny compared to the overall investment.

US Government Investment in Targeted Mental Health Services-2024 Budget

 Currently, there are three federal government initiatives to increase access to care for mental health services: shared Savings Programs through the Accountable Care Organizations (Health & Human Services, Centers for Medicare and Medicaid, 2012), targeted funds for health care in rural America, and the expansion of state Medicaid programs which decrease the likelihood of rural hospitals closing by half. (United States Department of Health and Human Services, 20232) The Accountable Care Act was created in 2010, along with the Accountable Care Organization Shared Savings Program and has been instrumental in creating financial rewards for health care organizations to target key health outcome criteria, based on evidence-based planning and medical research. Though the expansion of Medicaid under the Affordable Care Act was good for increasing the number of people whom can obtain affordable medical insurance, it did little to increase access to the availability of mental health services, as most mental health practitioners do not accept the Medicaid reimbursement level. Under the Accountable Care Act, which is administered by the Centers for Medicare and Medicaid, as of January 2024 there is additional funding allocated for rural hospitals to help them obtain advance payments to fund mental health workers. The Biden-Harris Administration allocated twenty-eight million in direct funding for health care for rural entities and another sixteen million for technical support in the 2024 budget. (United States Department of Health and Human Services, 20232) The goal is to expand the rural health care workforce and increase access to care for the sixty million people who live in rural areas. However, the implementation of these programs will be determined after the 2024 presidential election.  We can only hope this is supported by both parties.

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

 This column does not purport to give medical advice and all opinions are those of Roberta Winter, an independent healthcare analyst and journalist who accepted no reimbursement for its contents.

 

References

Cristopher Doran, I. K. (2020, May 19). Economic and epidemiological impact of youth suicide in countries with the highest human development index. PLOS One. PLOS One.org. doi:https://doi.org/10.1371/journal.pone.0232940

DANUTA WASSERMAN, 1. Q.-X. (2005, June 4). Global suicide rates among young people aged 15-19. World Psychiatry(June 4 (2) 114-120). World Health Organization. doi:PMID: 16633527

Health & Human Services, Centers for Medicare and Medicaid. (2012, April 10). First Accountable Care Organizations Under the Medicare Shared Savings Program. CMS.gov. Retrieved June 1, 2024, from https://www.cms.gov/newsroom/fact-sheets/first-accountable-care-organizations-under-medicare-shared-savings-program

Joe Kwun Nam Chan, a. C. (2023, October 31). Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis. The Lancet.com, Volume 65. London, England/United Kingdom. doi:https://doi.org/10.1016/j.eclinm.2023.102294

Substance Abuse and Mental Health Services Administration. (2022, May 9). HHS Announces Nearly $35 Million To Strengthen Mental Health Support for Children and Young Adults. SAMSA.gov Press Release. United States. Retrieved May 27, 2024, from https://www.samhsa.gov/newsroom/press-announcements/20220309/hhs-announces-35-million-strengthen-mental-health

United States Department of Health and Human Services. (20232, November 3). The Biden-Harris Administration is taking actions to improve the health of rural communities and help rural health care providers stay open. Health & Human Services News. Washington, District of Columia, United States. Retrieved May 30, 2024, from https://www.hhs.gov/about/news/2023/11/03/department-health-human-services-actions-support-rural-america-rural-health-care-providers.html