U.S. Healthcare

[Elvis]

U.S. healthcare is in crisis.



https://www.youtube.com/watch?v=ZAMtgCtq1oU



https://www.youtube.com/watch?v=nG6ppzJwPYU



https://www.youtube.com/watch?v=6JMf-U75fTg

[Elvis]

Long article, with graphs, more case histories, etc. Some highlights:

100 Million People in America Are Saddled With Health Care Debt

“Debt is no longer just a bug in our system. It is one of the main products,” said Dr. Rishi Manchanda, who has worked with low-income patients in California for more than a decade and served on the board of the nonprofit RIP Medical Debt. “We have a health care system almost perfectly designed to create debt.”

The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found.
...

Medical debt is piling additional hardships on people with cancer and other chronic illnesses. Debt levels in U.S. counties with the highest rates of disease can be three or four times what they are in the healthiest counties, according to an Urban Institute analysis.

The debt is also deepening racial disparities.

And it is preventing Americans from saving for retirement, investing in their children’s educations, or laying the traditional building blocks for a secure future, such as borrowing for college or buying a home. Debt from health care is nearly twice as common for adults under 30 as for those 65 and older, the KFF poll found.

Perhaps most perversely, medical debt is blocking patients from care.
...

About 1 in 7 people with debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll. An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.

“It’s barbaric,” said Dr. Miriam Atkins, a Georgia oncologist...


Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the federal Medicare Payment Advisory Committee. Many hospitals thrived even through the pandemic.
...

Patient debt is also sustaining a shadowy collections business fed by hospitals ― including public university systems and nonprofits granted tax breaks to serve their communities ― that sell debt in private deals to collections companies that, in turn, pursue patients.

“People are getting harassed at all hours of the day. Many come to us with no idea where the debt came from,” said Eric Zell, a supervising attorney at the Legal Aid Society of Cleveland. “It seems to be an epidemic.”
...

As of last year, 58% of debts recorded in collections were for a medical bill, according to the Consumer Financial Protection Bureau. That’s nearly four times as many debts attributable to telecom bills, the next most common form of debt on credit records.

But the medical debt on credit reports represents only a fraction of the money that Americans owe for health care, the KHN-NPR investigation shows.
...

Sherrie Foy, 63, and her husband, Michael, saw their carefully planned retirement upended when Foy’s colon had to be removed.

After Michael retired from Consolidated Edison in New York, the couple moved to rural southwestern Virginia. Sherrie had the space to care for rescued horses.

The couple had diligently saved. And they had retiree health insurance through Con Edison. But Sherrie’s surgery led to numerous complications, months in the hospital, and medical bills that passed the $1 million cap on the couple’s health plan.

When Foy couldn’t pay more than $775,000 she owed the University of Virginia Health System, the medical center sued, a once common practice that the university said it has reined in. The couple declared bankruptcy.

The Foys cashed in a life insurance policy to pay a bankruptcy lawyer and liquidated savings accounts the couple had set up for their grandchildren.

“They took everything we had,” Foy said. “Now we have nothing.”

https://khn.org/news/article/diagnosis- ... ical-debt/

[Elvis]

More boring death & disease. What's in people's pants is more exciting, and we don't have to think about the ongoing mass murder perpetrated by insurance and private equity firms. Still worth a read:

Private equity firms now control many hospitals, ERs and nursing homes. Is it good for health care?

Private equity firms are buying up hospitals, nursing homes and ER operations. The drive for profits can run counter to helping patients, critics say.


ay 13, 2020, 2:55 AM PDT
By Gretchen Morgenson and Emmanuelle Saliba

In March, as the coronavirus gripped the nation, veteran emergency room doctor Ming Lin was growing concerned. Lin felt his facility, PeaceHealth St. Joseph Medical Center in Bellingham, Washington, was unprepared for the pandemic, so he went to his superiors for help.

Frustrated by their response, Lin took to social media, criticizing the hospital's operations in a series of posts.

Days later, the hospital removed Lin from the rotation in the emergency department. He had worked at PeaceHealth for 17 years.

Under typical medical industry practice, Lin's case would have been subject to peer review, experts said. But Lin's employer wasn't PeaceHealth. It was TeamHealth, a physician practice and staffing company that provides the hospital with emergency room services. TeamHealth is owned by Blackstone Group, a finance giant.

When a private staffing firm teams up with a hospital, the right to due process can disappear. Lin's case was never heard.

"One of the objectives is to point out any deficiencies in the system that may harm the patient," Lin told NBC News. "Because private equity has taken over health care, it has made that difficult."

Blackstone, which bought TeamHealth in 2016 for $6.1 billion, is what's known as a private equity firm, a type of financial entity that buys companies and hopes to sell them later at a profit.

Over the past decade, private equity firms like Blackstone, Apollo Global Management, The Carlyle Group, KKR & Co. and Warburg Pincus have deployed more than $340 billion to buy health care-related operations around the world. In 2019, private equity's health care acquisitions reached $79 billion, a record, according to Bain & Co., a consulting firm.

Private equity's purchases have included rural hospitals, physicians' practices, nursing homes and hospice centers, air ambulance companies and health care billing management and debt collection systems.

Partly as a result of private equity purchases, many formerly doctor-owned practices no longer are. The American Medical Association recently reported that 2018 was the first year in which more physicians were employees — 47.4 percent — than owners of their practices — 45.9 percent. In 1988, 72.1 percent of medical practices were owned by physicians.

In some parts of the health care industry, private equity firms dominate. For example, TeamHealth, owned by Blackstone, and Envision Healthcare, owned by KKR, provide staffing for about a third of the country's emergency rooms.

This has been a seismic shift. During the 1900s, most hospitals were owned either by nonprofit entities with religious affiliations or by states and cities, with ties to medical schools. For-profit hospitals existed, but it wasn't until recently that they became nearly ubiquitous.

For the past 20 years, private equity has been a source of immense wealth for the executives overseeing the entities. Most of those who head major private equity firms are reported to be billionaires, like the two men atop Blackstone: Stephen Schwarzman, a close adviser to President Donald Trump, and Hamilton "Tony" James, a major donor to Democrats.

The impact private equity has had on employees and customers of the companies it has taken over, however, isn't always beneficial. To finance the purchases, private equity owners typically load the companies they buy with debt. Then they slash the companies' costs to increase earnings and appeal to potential buyers down the road.

In the business of health care, the drive for profits can run counter to the goal of helping patients and protecting workers, critics say.

Research shows, for example, that when private equity firms acquire nursing homes, the quality of care declines markedly. And when COVID-19 hit, hospitals associated with private equity firms were early to cut practitioners' pay and benefits because the operations could no longer generate profits on elective surgical procedures postponed during the pandemic. The heavy debt loads typically associated with private equity-owned businesses hinder their ability to withstand profit downturns.

Finally, some medical professionals say, private equity's growing involvement in health care in recent years has contributed to shortages of ventilators, masks and other equipment needed to combat COVID-19, because keeping such goods on hand costs money. And to private equity, that's like putting dollar bills on a shelf.

Private equity firms have jumped into health care with both feet. Apollo Global Management, a $330 billion investment firm overseen by Leon Black, owns RCCH Healthcare Partners, an operator of 88 rural hospital campuses in West Virginia, Tennessee, Kentucky and 26 other states. Cerberus Capital Management, a $42 billion investment firm run by Steve Feinberg, owns Steward Health Care; it runs 35 hospitals and a swath of urgent care facilities in 11 states.

Warburg Pincus, overseen by former Treasury Secretary Timothy Geithner, owns Modernizing Medicine, an information technology company that helps health care providers ramp up profits through medical billing and, to a lesser degree, debt collections. The Carlyle Group owns MedRisk, a leading provider of physical therapy cost-containment systems for U.S. workers' compensation payers, such as insurers and large employers.

Private equity's laser focus on cost cutting and operational efficiencies can benefit consumers, economists say, if lower costs are passed on to end users. Problems arise, however, when the push for profits reduces quality. That can be especially harmful in health care, in which patients' lives are on the line and it is difficult for consumers to comparison shop by analyzing quality of care.

Mark Reiter is residency program director of emergency medicine for the University of Tennessee and past president of American Academy of Emergency Medicine, an advocacy group for practitioners. "Private equity-backed health care has been a disaster for patients and for doctors," he told NBC News. "Many decisions are made for what is going to maximize profits for the private equity company, rather than what is best for the patient, what is best for the community."

Representatives of every firm identified in this article declined to respond to broad criticisms of private equity in the health care arena.

As for PeaceHealth St. Joseph Medical Center, spokeswoman Bev Mayhew said it removed Ming Lin from the emergency department rotation because "his actions were disruptive, compromised collaboration in the midst of a crisis and contributed to the creation of fear and anxiety among staff and the community." She said his case wasn't subject to peer review because he still has privileges at the hospital.

A TeamHealth spokesman said it continues to employ Lin and had offered to place him "in another contracted hospital anywhere in the country."


'Physician Extenders'

Private equity firms have targeted health care investments for an array of reasons, most having to do with their potential profits.

First, health care drives a huge part of the nation's economic output — almost 20 percent of gross domestic product. In addition, health care is a fragmented business with many small operators like physicians; private investors often find outsize gains in industries in which they can create economies of scale through consolidation.

Ever on the hunt for efficiencies, private equity has brought changes to traditional health care practices, experts say. One example: the use of so-called physician extenders, like nurse practitioners, to see patients instead of actual doctors.

Because such extenders have less training under their belts, their costs are well below those associated with physicians. In general, employing three extenders equals the cost of one physician, said Robert McNamara, professor and chairman of emergency medicine at Temple University and chief medical officer of Temple Faculty Physicians.

Private equity-owned firms also use practitioners with less experience or training to save money, say doctors associated with the American College of Emergency Physicians and the American Academy of Emergency Medicine.

In February, a patient arrived at the Calais Regional Hospital emergency department in Calais, Maine, near the Canadian border. He required intubation — the insertion of a breathing tube down his throat — but the doctor was unable to perform the procedure and had to call in local paramedics for help. The patient recovered.

The doctor worked for Envision Physician Services, the KKR-owned company that had taken over staffing of the emergency department two weeks before the incident.

DeeDee Travis, the hospital's spokeswoman, said that the doctor is no longer in rotation at the hospital but that his move had nothing to do with the incident. She said rural medicine requires the use of all resources, including local paramedic staff.

Assessing the impact of private equity on the overall quality of care has been difficult, in part because ownership by the firms is relatively new. But in February, four academics at the University of Pennsylvania, New York University and the University of Chicago published an in-depth study analyzing care at private equity-owned nursing homes. The findings were stark.

"In the nursing home setting," the study said, "it appears that high-powered profit maximizing incentives can lead firms to renege on implicit contracts to provide high quality care, creating value for the firms at the expense of patients."

Looking at data from 2000 to 2017 from over 18,000 nursing homes, the academics found "robust evidence of declines in patient health and compliance with care standards" after private equity concerns bought facilities. And when private equity firms' purchases of nursing homes were compared with those bought by other for-profit entities, such as nursing home chains, the private equity-owned properties resulted in greater quality declines, the study concluded.

On April 2, well into the COVID-19 crisis, Steward Health Care, owned by Cerberus Capital, created a firestorm. It suspended intensive care unit admissions at Nashoba Valley Medical Center, a hospital in rural northeastern Massachusetts, and redeployed equipment and staff elsewhere to meet COVID-19 demand, according to a memo from the president of the facility. Hospitals aren't supposed to close such units without first notifying state authorities and holding community hearings.

Audra Sprague, a longtime registered nurse at the facility, said the move "completely took out an entire level of service. Anybody that needed ICU care, we didn't have one, we couldn't keep you."

Darren Grubb, a spokesman for Steward, said that the suspension has "not impacted patient care" at the facility and that state officials had "validated that the ICU at Nashoba Valley remains adequately staffed and equipped to care for clinically appropriate patients."

Sprague said she is proud to serve patients in the same hospital where her grandmother was a nurse. She said that the facility had previously been owned by a private company but that patient safety and staff treatment had worsened since Steward took over. So she joined the nurses' union.

"Even when you say something is unsafe, there's little change that comes out of it," she said. "They're not going to do a single thing that doesn't benefit them first and foremost."

Grubb called Sprague's view a "baseless, selective, hyper-generalized claim."

For more than a century, company ownership of doctors' practices was barred under the Corporate Practice of Medicine doctrine, which was enshrined in most state laws. The doctrine and the laws hold that only individual physicians should be licensed to practice medicine, not corporations. But in the years leading up to COVID-19, the laws were rarely enforced.

"The states realized a long time ago that this is a real problem — fiduciary duty to shareholders rather than patients," Reiter said. "These corporations are not taking an oath to do what's best for their patients, and they thought it would be better if doctors owned their own practices."

In response to the laws, private equity firms have structured their health care investments with physicians as owners, but in name only, McNamara said. Staffing companies like TeamHealth, for example, use what he called sham professional associations with doctors to get around prohibitions against the corporate practice of medicine.

McHenry Lee, TeamHealth's spokesman, said the company's "organizational structure is fully compliant with long established laws and precedents." Referring to the American Academy of Emergency Medicine, Lee said the company has prevailed while facing judicial scrutiny "initiated or funded by AAEM, where Dr. McNamara has made identical charges."

In a typical emergency room, McNamara said, the usual physician group charges three to four times the Medicare rate. TeamHealth is charging six times, he said.

Last fall, United Healthcare, the giant insurer, canceled coverage at 500 hospitals with TeamHealth-run emergency rooms, largely because of high costs, a company spokeswoman said.

"A small number of providers are driving up the cost of care for the people and customers we serve," she said. "This is particularly evident with private equity-backed physician staffing companies like TeamHealth."

United Healthcare provided NBC News with examples of TeamHealth costs far exceeding median charges for specific emergency department procedures. A patient visiting an emergency department with chest pains, for example, would face a median charge of $340, United Healthcare said, versus a TeamHealth bill for $976. Stitches on a minor cut would be $200 at the median rate, compared with $888 from TeamHealth. And the median rate for a broken arm is $665, while TeamHealth's charge is $2,947.

Lee of TeamHealth declined to comment on the figures.

Envision Healthcare is a physician staffing, emergency medicine and billing services company bought for almost $10 billion by KKR in 2018. Envision's website says it provides emergency medicine at 650 facilities in 40 states.

Before the acquisition, Envision acknowledged in a 2014 securities filing that its contracts with physician groups might run afoul of laws barring the corporate practice of medicine, as well as fee-sharing arrangements between doctors and companies. It could be subject to civil or criminal penalties, and its contracts with affiliated physician groups "could be found legally invalid and unenforceable," Envision said in the filing.

A flurry of such cases didn't arise. But today, Envision's business has collapsed, again a result of postponed elective operations. Carrying $7.5 billion in debt, the company recently hired restructuring advisers and may file for bankruptcy.

Aliese Polk, a spokeswoman for Envision, said the company is experiencing the same financial problems that many other health care providers are and is "focused on fighting the COVID-19 pandemic, deploying significant resources to front-line clinicians caring for sick patients." She declined to discuss its previous warnings about possible legal violations in its business model.


Congress and private equity health care

Even before the COVID-19 crisis, private equity-owned health care operations had come under criticism from members of Congress and outsiders.

TeamHealth, for example, was featured last year in a report by MLK50 and ProPublica for aggressively suing poor patients who had been unable to pay their emergency room bills. After the report, TeamHealth said it would stop the practice. The TeamHealth spokesman didn't respond to a question from NBC News about why it sued patients.

Surprise emergency care medical bills have also emerged as a problem at private equity-run Envision. Patients can be ambushed by such bills when they visit an emergency department in a hospital that is in their insurance network but whose doctors work outside the network, charging separately for their services.

Polk of Envision declined to comment on the company's role in surprise billing.

Congress tried to address the problematic practice with legislation last year. But as the bill gained traction, Envision and TeamHealth quietly backed a purported grass roots organization called Doctor Patient Unity to advocate against the legislation, according to The New York Times. Doctor Patient Unity funded a $28 million media blitz against the bill, the report said, which didn't pass.

Doctor Patient Unity didn't respond to an email seeking comment. Representatives from TeamHealth and Envision accused insurance companies of causing problems for patients seeking emergency care and said they didn't support the legislation because it would have benefited insurers at the expense of patients.

Emily Maddoff and Chet Waldman, lawyers at Wolf Popper LLP, are fighting surprise medical bills in six class-action lawsuits in state and federal courts across the country. A unit of Envision is a defendant in three of the cases.

A class-action case involving a patient in California has a final settlement hearing scheduled for June. If approved, the deal would provide 100 percent relief to the plaintiffs.

"We should not be running our health care system as a profit-making operation on steroids," said Eileen Appelbaum, an authority on private equity and co-director of the Center for Economic and Policy Research, a left-leaning think tank in Washington, D.C. "Health care is not so much anymore about taking care of patients. It's way more about making money."


https://www.nbcnews.com/health/health-c ... s-n1203161

Has UnitedHealthcare killed anyone you know?

[Elvis]

healthcare is infrastructure.png

[Elvis]

“We have a health care system almost perfectly designed to create debt.”

This is something that can be fixed.

https://khn.org/news/article/diagnosis- ... ical-debt/

100 Million People in America Are Saddled With Health Care Debt

By Noam N. Levey
June 16, 2022

Elizabeth Woodruff drained her retirement account and took on three jobs after she and her husband were sued for nearly $10,000 by the New York hospital where his infected leg was amputated.

Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.

Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.

“I wanted to be a mom,” she said. “But we had to have the money.”

The three are among more than 100 million people in America ― including 41% of adults ― beset by a health care system that is systematically pushing patients into debt on a mass scale, an investigation by KHN and NPR shows.

The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.

To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF for this project. The poll was designed to capture not just bills patients couldn’t afford, but other borrowing used to pay for health care as well. New analyses of credit bureau, hospital billing, and credit card data by the Urban Institute and other research partners also inform the project. And KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.

The picture is bleak.

In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found.

A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.

“Debt is no longer just a bug in our system. It is one of the main products,” said Dr. Rishi Manchanda, who has worked with low-income patients in California for more than a decade and served on the board of the nonprofit RIP Medical Debt. “We have a health care system almost perfectly designed to create debt.”

The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found.

Health Debt sacrifices.png

Medical debt is piling additional hardships on people with cancer and other chronic illnesses. Debt levels in U.S. counties with the highest rates of disease can be three or four times what they are in the healthiest counties, according to an Urban Institute analysis.

The debt is also deepening racial disparities.

And it is preventing Americans from saving for retirement, investing in their children’s educations, or laying the traditional building blocks for a secure future, such as borrowing for college or buying a home. Debt from health care is nearly twice as common for adults under 30 as for those 65 and older, the KFF poll found.

Perhaps most perversely, medical debt is blocking patients from care.

About 1 in 7 people with debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll. An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.

“It’s barbaric,” said Dr. Miriam Atkins, a Georgia oncologist who, like many physicians, said she’s had patients give up treatment for fear of debt.

Patient debt is piling up despite the landmark 2010 Affordable Care Act.

The law expanded insurance coverage to tens of millions of Americans. Yet it also ushered in years of robust profits for the medical industry, which has steadily raised prices over the past decade.

Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the federal Medicare Payment Advisory Committee. Many hospitals thrived even through the pandemic.

But for many Americans, the law failed to live up to its promise of more affordable care. Instead, they’ve faced thousands of dollars in bills as health insurers shifted costs onto patients through higher deductibles.

Now, a highly lucrative industry is capitalizing on patients’ inability to pay. Hospitals and other medical providers are pushing millions into credit cards and other loans. These stick patients with high interest rates while generating profits for the lenders that top 29%, according to research firm IBISWorld.

Patient debt is also sustaining a shadowy collections business fed by hospitals ― including public university systems and nonprofits granted tax breaks to serve their communities ― that sell debt in private deals to collections companies that, in turn, pursue patients.

“People are getting harassed at all hours of the day. Many come to us with no idea where the debt came from,” said Eric Zell, a supervising attorney at the Legal Aid Society of Cleveland. “It seems to be an epidemic.”


In Debt to Hospitals, Credit Cards, and Relatives

America’s debt crisis is driven by a simple reality: Half of U.S. adults don’t have the cash to cover an unexpected $500 health care bill, according to the KFF poll.

As a result, many simply don’t pay. The flood of unpaid bills has made medical debt the most common form of debt on consumer credit records.

As of last year, 58% of debts recorded in collections were for a medical bill, according to the Consumer Financial Protection Bureau. That’s nearly four times as many debts attributable to telecom bills, the next most common form of debt on credit records.

But the medical debt on credit reports represents only a fraction of the money that Americans owe for health care, the KHN-NPR investigation shows.


- About 50 million adults ― roughly 1 in 5 ― are paying off bills for their own care or a family member’s through an installment plan with a hospital or other provider, the KFF poll found. Such debt arrangements don’t appear on credit reports unless a patient stops paying.

- One in 10 owe money to a friend or family member who covered their medical or dental bills, another form of borrowing not customarily measured.

- Still more debt ends up on credit cards, as patients charge their bills and run up balances, piling high interest rates on top of what they owe for care. About 1 in 6 adults are paying off a medical or dental bill they put on a card.


How much medical debt Americans have in total is hard to know because so much isn’t recorded. But an earlier KFF analysis of federal data estimated that collective medical debt totaled at least $195 billion in 2019, larger than the economy of Greece.

[GRAPH]

The credit card balances, which also aren’t recorded as medical debt, can be substantial, according to an analysis of credit card records by the JPMorgan Chase Institute. The financial research group found that the typical cardholder’s monthly balance jumped 34% after a major medical expense.

Monthly balances then declined as people paid down their bills. But for a year, they remained about 10% above where they had been before the medical expense. Balances for a comparable group of cardholders without a major medical expense stayed relatively flat.

It’s unclear how much of the higher balances ended up as debt, as the institute’s data doesn’t distinguish between cardholders who pay off their balance every month from those who don’t. But about half of cardholders nationwide carry a balance on their cards, which usually adds interest and fees.


Which Large Counties Have the Worst Debt Problems?

Among the 20 most populous counties in the U.S., the share of people with medical debt is highest in Texas counties (to the right) and lowest in New York and California (to the left). The size of the circles denotes the median amount of debt held by residents in each county. Hover or tap on the circles for more detail.

[GRAPH]


Debts Large and Small

For many Americans, debt from medical or dental care may be relatively low. About a third owe less than $1,000, the KFF poll found.

Even small debts can take a toll.

Edy Adams, a 31-year-old medical student in Texas, was pursued by debt collectors for years for a medical exam she received after she was sexually assaulted.

Adams had recently graduated from college and was living in Chicago.

Police never found the perpetrator. But two years after the attack, Adams started getting calls from collectors saying she owed $130.68.

Illinois law prohibits billing victims for such tests. But no matter how many times Adams explained the error, the calls kept coming, each forcing her, she said, to relive the worst day of her life.

Sometimes when the collectors called, Adams would break down in tears on the phone. “I was frantic,” she recalled. “I was being haunted by this zombie bill. I couldn’t make it stop.”

Health care debt can also be catastrophic.

Sherrie Foy, 63, and her husband, Michael, saw their carefully planned retirement upended when Foy’s colon had to be removed.

After Michael retired from Consolidated Edison in New York, the couple moved to rural southwestern Virginia. Sherrie had the space to care for rescued horses.

The couple had diligently saved. And they had retiree health insurance through Con Edison. But Sherrie’s surgery led to numerous complications, months in the hospital, and medical bills that passed the $1 million cap on the couple’s health plan.

When Foy couldn’t pay more than $775,000 she owed the University of Virginia Health System, the medical center sued, a once common practice that the university said it has reined in. The couple declared bankruptcy.

The Foys cashed in a life insurance policy to pay a bankruptcy lawyer and liquidated savings accounts the couple had set up for their grandchildren.

“They took everything we had,” Foy said. “Now we have nothing.”

About 1 in 8 medically indebted Americans owe $10,000 or more, according to the KFF poll.

Although most expect to repay their debt, 23% said it will take at least three years; 18% said they don’t expect to ever pay it off.


Medical Debt’s Wide Reach

Debt has long lurked in the shadows of American health care.

In the 19th century, male patients at New York’s Bellevue Hospital had to ferry passengers on the East River and new mothers had to scrub floors to pay their debts, according to a history of American hospitals by Charles Rosenberg.

The arrangements were mostly informal, however. More often, physicians simply wrote off bills patients couldn’t afford, historian Jonathan Engel said. “There was no notion of being in medical arrears.”

Today, debt from medical and dental bills touches nearly every corner of American society, burdening even those with insurance coverage through work or government programs such as Medicare.


Who Has Health Care Debt?

Share of adults who have had health care debt in the past five years:

[GRAPH]

Nearly half of Americans in households making more than $90,000 a year have incurred health care debt in the past five years, the KFF poll found.

Women are more likely than men to be in debt. And parents more commonly have health care debt than people without children.

But the crisis has landed hardest on the poorest and uninsured.

Debt is most widespread in the South, an analysis of credit records by the Urban Institute shows. Insurance protections there are weaker, many of the states haven’t expanded Medicaid, and chronic illness is more widespread.


Where Medical Debt Hits the Hardest in the US

The share of people with medical or dental bills in collections varies widely from one county to another

[GRAPH]

Nationwide, according to the poll, Black adults are 50% more likely and Hispanic adults 35% more likely than whites to owe money for care. (Hispanics can be of any race or combination of races.)

In some places, such as the nation’s capital, disparities are even larger, Urban Institute data shows: Medical debt in Washington, D.C.’s predominantly minority neighborhoods is nearly four times as common as in white neighborhoods.

In minority communities already struggling with fewer educational and economic opportunities, the debt can be crippling, said Joseph Leitmann-Santa Cruz, chief executive of Capital Area Asset Builders, a nonprofit that provides financial counseling to low-income Washington residents. “It’s like having another arm tied behind their backs,” he said.

Medical debt can also keep young people from building savings, finishing their education, or getting a job. One analysis of credit data found that debt from health care peaks for typical Americans in their late 20s and early 30s, then declines as they get older.

Cheyenne Dantona’s medical debt derailed her career before it began.

Dantona, 31, was diagnosed with blood cancer while in college. The cancer went into remission, but when Dantona changed health plans, she was hit with thousands of dollars of medical bills because one of her primary providers was out of network.

She enrolled in a medical credit card, only to get stuck paying even more in interest. Other bills went to collections, dragging down her credit score. Dantona still dreams of working with injured and orphaned wild animals, but she’s been forced to move back in with her mother outside Minneapolis.

“She’s been trapped,” said Dantona’s sister, Desiree. “Her life is on pause.”


What Kind of Health Care Debt Do Americans Have?

Share of adults who have the following types of health care debt:

Bills past due or bills they can't pay 24%
Payment plan with a medical provider 21%
Owe a bank, collection agency, or other lender 17%
Credit card they are paying off over time 17%
Owe family member or friend 10%

Total who have some kind of health care debt 41%


Barriers to Care

Desiree Dantona said the debt has also made her sister hesitant to seek care to ensure her cancer remains in remission.

Medical providers say this is one of the most pernicious effects of America’s debt crisis, keeping the sick away from care and piling toxic stress on patients when they are most vulnerable.

The financial strain can slow patients’ recovery and even increase their chances of death, cancer researchers have found.

Yet the link between sickness and debt is a defining feature of American health care, according to the Urban Institute, which analyzed credit records and other demographic data on poverty, race, and health status.

U.S. counties with the highest share of residents with multiple chronic conditions, such as diabetes and heart disease, also tend to have the most medical debt. That makes illness a stronger predictor of medical debt than either poverty or insurance.

In the 100 U.S. counties with the highest levels of chronic disease, nearly a quarter of adults have medical debt on their credit records, compared with fewer than 1 in 10 in the healthiest counties.


More Disease, More Debt

Counties with a large share of people with multiple chronic conditions (in red) tend to have higher levels of debt than counties with less illness (beige). Each dot represents a county.

[GRAPH]

The problem is so pervasive that even many physicians and business leaders concede debt has become a black mark on American health care.

“There is no reason in this country that people should have medical debt that destroys them,” said George Halvorson, former chief executive of Kaiser Permanente, the nation’s largest integrated medical system and health plan. KP has a relatively generous financial assistance policy but does sometimes sue patients. (The health system is not affiliated with KHN.)

Halvorson cited the growth of high-deductible health insurance as a key driver of the debt crisis. “People are getting bankrupted when they get care,” he said, “even if they have insurance.”


Washington’s Role

The Affordable Care Act bolstered financial protections for millions of Americans, not only increasing health coverage but also setting insurance standards that were supposed to limit how much patients must pay out of their own pockets.

By some measures, the law worked, research shows. In California, there was an 11% decline in the monthly use of payday loans after the state expanded coverage through the law.

But the law’s caps on out-of-pocket costs have proven too high for most Americans. Federal regulations allow out-of-pocket maximums on individual plans up to $8,700.


Debt Hits Even High-Income and Insured People

Share of adults who have had health care debt in the past five years:

[GRAPH]

Additionally, the law did not stop the growth of high-deductible plans, which have become standard over the past decade. That has forced many Americans to pay thousands of dollars out of their own pockets before their coverage kicks in.

Last year the average annual deductible for a single worker with job-based coverage topped $1,400, almost four times what it was in 2006, according to an annual employer survey by KFF. Family deductibles can top $10,000.

While health plans are requiring patients to pay more, hospitals, drugmakers, and other medical providers are raising prices.

From 2012 to 2016, prices for medical care surged 16%, almost four times the rate of overall inflation, a report by the nonprofit Health Care Cost Institute found.

For many Americans, the combination of high prices and high out-of-pocket costs almost inevitably means debt. The KFF poll found that 6 in 10 working-age adults with coverage have gone into debt getting care in the past five years, a rate only slightly lower than the uninsured.

Even Medicare coverage can leave patients on the hook for thousands of dollars in charges for drugs and treatment, studies show.

About a third of seniors have owed money for care, the poll found. And 37% of these said they or someone in their household have been forced to cut spending on food, clothing, or other essentials because of what they owe; 12% said they’ve taken on extra work.

The widespread burden of medical debt has sparked new interest from elected officials, regulators, and industry leaders.

In March, following warnings from the Consumer Financial Protection Bureau, the major credit reporting companies said they would remove medical debts under $500 and those that had been repaid from consumer credit reports.

In April, the Biden administration announced a new CFPB crackdown on debt collectors and an initiative by the Department of Health and Human Services to gather more information on how hospitals provide financial aid.

The actions were applauded by patient advocates. However, the changes likely won’t address the root causes of this national crisis.

“The No. 1 reason, and the No. 2, 3, and 4 reasons, that people go into medical debt is they don’t have the money,” said Alan Cohen, a co-founder of insurer Centivo who has worked in health benefits for more than 30 years. “It’s not complicated.”

Buck, the father in Arizona who was denied care, has seen this firsthand while selling Medicare plans to seniors. “I’ve had old people crying on the phone with me,” he said. “It’s horrifying.”

Now 30, Buck faces his own struggles. He recovered from the intestinal infection, but after being forced to go to a hospital emergency room, he was hit with thousands of dollars in medical bills.

More piled on when Buck’s wife landed in an emergency room for ovarian cysts.

Today the Bucks, who have three children, estimate they owe more than $50,000, including medical bills they put on credit cards that they can’t pay off.

“We’ve all had to cut back on everything,” Buck said. The kids wear hand-me-downs. They scrimp on school supplies and rely on family for Christmas gifts. A dinner out for chili is an extravagance.

“It pains me when my kids ask to go somewhere, and I can’t,” Buck said. “I feel as if I’ve failed as a parent.”

The couple is preparing to file for bankruptcy.

About This Project

“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on the “KFF Health Care Debt Survey,” a poll designed and analyzed by public opinion researchers at KFF in collaboration with KHN journalists and editors. The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses.

Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

[stickdog99]

A Midwestern Doctor

...

The Ghosts of Medicine

As best as I can tell, since the 1700s (and likely earlier), the medical profession has been defined by aggressively pushing toxic pharmaceuticals of dubious value onto the public and then denying any harm could have arisen from the drug. Frequently after the fact, the drug is widely accepted to be inappropriate to administer, but there is always an inability by the medical field to believe any of the drugs presently in use are like those of the not-too-distant past that are now widely recognized as quackery.

Mercury for instance was in use well before the 1700s and throughout its use, severely injured countless numbers of people. Nowadays mercury is viewed as one of those silly remedies from the past that medicine, by virtue of its continual scientific progress, discarded. This history is important to remember because Western medicine will always insist that quackery could have only happened in the past. This is particularly ironic since mercury still retains a few “safe” medical uses such as for dental fillings and multidose vaccines which have persisted to the present day because an economically viable substitute has not yet been found for them.

Whenever I review historical accounts of patients being severely injured by these medications, I immediately notice how similar they are to everything I see occurring in the present day. Likewise, in the same way the COVID-19 vaccines have been dishonestly labeled as safe and effective while all of their severe reactions are covered up, I have also seen the same occur throughout my life with many other drugs. In most cases, the public never becomes aware of this body count, but because of just how many have been harmed by the COVID-19 vaccines, this forgotten side of medicine has at long last reached the public’s awareness.

So, in trying to answer the question of why many doctors push dangerous drugs on patients, we must consider what could have also created the same motivation so far back in the past.

At this point in time, I believe there are three explanations to consider:

1. The same psychological needs inherent to the human condition have been possible to meet in each era by pushing pharmaceutical drugs.

2. Relatively similar external incentives to push pharmaceutical drugs have existed in each era.

3. Some type of collective consciousness has emerged within allopathy that will always fanatically support the use of pharmaceuticals.

Medical Blindness

In most cases, a doctor will not prescribe a medication to a patient if they believe the risk of the medication outweighs the benefit. Given that it is often quite easy to tell (both from anecdotal experiences and a literature review) if the risk of a toxic medication outweighs its benefits, this begs the question of "Why can doctors never see this?"

Many in my life have had disastrous medical injuries known to be associated with a specific pharmaceutical and yet over and over, have been told by almost every medical professional they spoke to that their injury was without question, not related to the drug. Because this is a personal issue for me (medical gaslighting is horrific to experience), I wrote a series on the topic I would recommend those of you who have direct experiences with medical gaslighting to read. I would particularly recommend article below as it expands upon many of the themes covered today:

Why Do Doctors Close Their Eyes to Medical Injuries?

The key points of the series are as follows:

•Most doctors are well-intentioned human beings who have been acclimated to a system that conditions this harmful behavior and fosters an inability to recognize anything is wrong with it. I often repeat this theme and it is not to defend my profession, but rather to emphasize that any of us could become a gaslighter if we went through that same medical education.

•Our religion of science conditions people to doubt their own observations and instead defer to “scientific evidence.” I would instead argue that provided one can distinguish a strong correlation from a weak correlation (e.g. in one day seeing three people who had a severe or fatal reaction following COVID-19 vaccination versus meeting one person who developed a sore throat after the vaccine), strong correlations must be treated as demonstrating a causal relationship until it is proven that they do not. Unfortunately, by the current societal convention, the burden is instead placed on proving causality, and because of this, an impossible-to-meet standard is created that results in many things that are clear as day being dismissed as claims that are “without evidence” by a corrupt scientific establishment.

•Since there is so much information out there you need to use in your day-to-day practice of medicine, it is nearly impossible to sufficiently research the safety and efficacy of each medication you use. To address this challenge, doctors will typically default to trusting authoritative guidelines produced by corrupt groups whose assessments always ignore the harms of pharmaceuticals while exaggerating their benefits. Although widespread corruption exists, there is still a lot of good evidence in the scientific literature, but almost all of it gets filtered out by guideline committees. Additionally, many penalties exist for doctors who deviate from the recommendations of those committees, making it even harder to go against them.

•Because of how complex the human body mind and spirit are, that complexity is almost always overwhelming for the human mind to fully perceive or sensibly comprehend. To address this challenge, each medical system throughout history has developed models to simplify the practice of medicine to something comprehensible its members can utilize to treat disease. Unfortunately, no model can encompass everything, so conditions will always exist that are outside the scope of each model. In Western medicine for example, it is very common for patients to present with signs of an illness the doctors were never trained to look for, and as a result, in most cases, the doctors cannot “see” the illness (instead it blends into the incomprehensible complexity of the human body). The origins of medical blindness are further discussed here.

•Doctors have strong psychological motivations to dismiss the possibility of a medical injury occurring. I believe the primary reason is that they do not want to believe the art of medicine, they worked so hard to learn to help the world could have directly harmed their patients. This is a response I would expect almost anyone to exhibit, especially those with a strong psychological need to help others; the humility to recognize you made a profound mistake that violates your values is rare to come across. Additionally, there are many legal and financial incentives to deny the possibility that a medical injury occurred. The reasons doctors close their eyes to medical injuries are further discussed here.

However, while the inability of doctors to recognize medical injuries helps to explain how a well-intentioned doctor could decide to push an unsafe treatment on a patient, it does not explain what motivates them to do so. If I had a patient who did not want to take a treatment, I believed they should take, I would tell them the consequences of their actions were on them and leave it at that. In some areas like lifestyle medicine (e.g. smoking cessation, exercising, or having a better diet) we do just that, but in the case of pharmaceuticals, we go a step further and compulsively demand the patient take them. Why is this?

Conflicts of Interest

Many of the colleagues I spoke with believed conflicts of interest needed to be taken into account when considering this question. Blatant conflicts are easier to understand, so we will start there, but it must be remembered that these only apply to a portion of physicians in practice.

The way physicians are currently compensated is a historic abnormality. In the past, doctors and most other professionals received a fraction of what doctors receive now (nonetheless this much more meager amount was still sufficient to convince the medical profession to abandon their skepticism of the unproven smallpox vaccine and aggressive push a disastrous vaccine they were paid to administer onto the entire world). Doctors in the current era believe they are paid as much as they are because they “deserve” it, whereas I believe it is a product of them serving as the figureheads of the medical industry (prior to the catastrophic mishandling of COVID-19, doctors were the most trusted professionals in the United States).

Because doctors serve as the trustworthy figureheads of this massive industry, there is an immense amount of lobbying behind the scenes to ensure they retain this status and to structure the medical system so that doctors can lavishly fund it. For example, we currently operate under a fee-for-service model where doctors are “paid” based on how many billable procedures they perform each day, and in almost all cases, the amount each doctor is paid is proportional to how much profit the profiteers of the health care systems also receive from that procedure being performed (e.g. with surgeries, although the surgeon is paid well, most of the money goes to parties besides the surgeon).

Doctors hence are incentivized to compete for medical specialties with the highest reimbursement per procedure and once board certified, to do as many of those procedures as possible, regardless of the harm they create. Fortunately, most doctors do not end up in these specialties, and those who do often conduct their practice with integrity. Nonetheless, there are also many cases of doctors who prioritize trying to perform as many surgeries as possible at the expense of patient safety (e.g. a colleague knew this victim of a deliberately overbooked neurosurgeon), and in most cases, their conduct is protected by the hospitals they work for since they generate so much money for the institution.

Because direct bribery of physicians was outlawed within the United States, most bribery is instead directed at financially incentivizing the procedures themselves and paying off the expert physicians other members of the specialty defer to. For example, oncologists make 60-70% of their salary from selling marked-up chemotherapy drugs and enormous amounts of money is spent to lobby the academic “experts” of each medical specialty to recommend pharmaceuticals to their specialty. For those wishing to learn more, this is an excellent account of how these perverse incentives distort the practice of medicine, and I can cite quite a few times in my life I witnessed a doctor aggressively push a bad drug that he was clearly being paid off to sell.

In a recent series on medical ethics within the context of abortion, I argued that the one consistent principle within medical ethics seems to be whatever results in a billable procedure is the ethical choice. For example, pediatrics argues the choice to vaccinate is always ethical regardless of who objects to it. Simultaneously, a conventional pediatrician’s practice cannot sustain itself unless it sells a lot of vaccines, which is the reason why parents are always badgered to bring their children in for well-child visits.

These visits consist of a few quick checks of the child, weighing them (using charts made by formula companies that erroneously label children as being underweight so they can be started on extremely unhealthy infant formula), and giving numerous vaccines at each visit. One consequence of those vaccinations is sudden infant death syndrome, and when the COVID-19 lockdowns paused the nonessential well-child visits, it was predicted that would lead to a historic drop in both vaccination and infant mortality, which was exactly what happened.

Most fields of medicine that do not provide these extravagant billable procedures have been forced to adopt a model of very short patient visits so that at least 20 (and sometimes 30) can be billed per day to make up for the loss of the more lucrative procedures. A major consequence of this model is that it is almost impossible to make a tangible impact on many illnesses in such a brief period (some doctors can, but they are rare).

However, while it is impossible to do very much that is helpful in 15 minutes, it is possible to make a cursory diagnosis and write a prescription. Rather than feeling cheated in these situations, patients typically will feel that they got their money’s worth from the visit, whereas were a drug not to be given, the patient would instead feel upset nothing was “done.” This dilemma is especially true in psychiatry where the allotted visit time does not allow for talk therapy so providing a highly dangerous psychiatric medication becomes the only option available.

In addition to the pressure to prescribe from patients, every administrator also puts pressure on physicians working within a clinic or hospital to maximize their productivity and shorten their visit times. Many insurance companies (and medicare) have come up with metrics to improve the “quality of care,” and not surprisingly, many of these metrics reflect what proportion of their practice doctors can convince to take certain pharmaceuticals (e.g. statins or flu shots). Administrators in turn penalize doctors who fail to meet these metrics because they did not effectively push these “essential” medications on their patients.

In short, the modern practice of medicine forces physicians to be boxed into a model of selling prescribing pharmaceuticals to their patients; if they don’t, they can’t make a living—there often is no time in the current practice model to address the underlying causes of a patient’s illness. In my own practice, I never prescribe (excluding a few medications I order directly and provide at cost). My patients do well with this safer approach to medicine, which to me argues against the current model of overprescribing and focusing on each disease rather than cultivating health.

However, while these systemic (and I would argue deliberately engineered) conflicts of interest can explain the external motivations doctors face to prescribe and many of my colleagues endorsed this explanation, many others did not. This is because they recognize the majority of doctors are compassionate human beings who genuinely want the best for their patients and would not willingly choose financial interests over the well-being of their patients.

I Don’t Know

When a patient asks me a question, I frequently answer “I don’t know,” and explain my best guess to answer the question or propose a strategy for how I may be able to find the answer. What has always surprised me is how often after I say this, the patients in turn remark that I am the first doctor who has ever admitted their lack of knowledge and that my doing so significantly increases their trust in me.

Initially, I viewed this to be a consequence of knowledge making you humble; the more you know, the more you realize you don’t know. Conversely, the Dunning-Kruger Effect shows that the less people know, the more they believe with absolute certainty that they are right (this sadly explains a great deal about our society).

As I began to see how differently others related to the world in comparison to me, I realized that for many, their identity is based upon projecting to others that they are “right” and “know.” This is particularly easy to see with individuals in positions of authority, as they will always dig their heels in to avoid admitting fault or ignorance so that they can protect their status.

For example, throughout my life, I have seen many individuals within the alternative communities attract a following and then become trapped by the “truth” they created a following with, which prevents them from ever admitting a belief they had previously espoused was wrong. In recent times, I have seen many members of this movement (e.g. Alex Berenson refusing to consider ivermectin works, or leading virus debunkers refusing to consider evidence viruses exist) fall into this same trap. From the day I first observed this phenomena, I have always felt quite sad for these individuals and the shackles they had placed upon themselves.

For me, true personal freedom is one of the most important things in life. A key reason why I write anonymously is so that I am both free to speak what I believe and more importantly to admit when I was wrong. I try quite hard to avoid espousing falsehood and to be transparent in my uncertainty, but at the end of the day, unless you are omnipotent, it is almost impossible to not be wrong about something on a regular basis.

To some extent, you can avoid ever being wrong by refusing to commit yourself to a position on something (which colleagues have confided to me they do for precisely that reason). Alternately, if one follows the opinion of a crowd, people rarely remember what you said when the crowd is later proven wrong.

To share an example of hiding in the crowd: in the early days of Vioxx (an unsafe advil-like drug that was pulled from the market after it killed approximately 50,000 Americans), my friend went to the VA for back pain. His doctor offered him a prescription of Vioxx which my friend declined because he had a gut feeling it was not safe, leading to her belligerently berating him for the rest of the appointment and leaving a nasty note about him in his medical record about his non-compliance (this is the actual term doctors use). A few years later when Vioxx was pulled from the market, he saw the doctor again and asked her if she recalled how aggressively she had pushed him to take a potentially lethal medication. She denied this had ever happened, so he requested for her to pull up the chart where she had documented her conduct. At that point, she sheepishly dodged the subject and never discussed it again.

I suspect we will see many very similar things with the mRNA vaccines in the future as their harm comes out into public view. This is a key reason why I believe it is important to hold the people responsible for COVID-19 accountable; otherwise the crowd-seeking behavior will repeat long into the future.

More Drugs

One of the more common derisive slogans I hear directed against doctors is “M.D. stands for More Drugs,” and for many doctors, since most of the therapeutic knowledge for Western medicine base revolves around prescribing drugs, that is what they will do regardless of the fact it often cannot help the patient before them. Just as a surgeon must always cut to practice their craft, prescribing drugs is central to the identity of a doctor. “To a man with a hammer, everything looks like a nail,” and in many cases, doctors have nothing they can offer besides drugs and the faith that they will work.

Since the medical industry makes sure physicians are placed on a pedestal, it is immensely difficult for them to admit they are wrong or do not know an answer to something. In clinical practice, doctors must quickly do something that creates a measurable effect (pharmaceuticals excel at creating both good and bad effects).


...

Ego and Identity

As I continued exploring my question, everything kept on coming back to asking why doctors are so bothered when someone does not want the drug they recommend rather than just letting the whole thing go. As I examined this question, I realized the outbursts I had seen at patients and the ways doctors got knotted up inside when a prescription is challenged were identical to what I had learned throughout my life to associate with someone having their identity be directly challenged.

Becoming a doctor requires making a massive investment of 12 years of your life, and because of both that investment in becoming an “expert” and the social mythology that has been crafted around being a doctor, it is understandable that doctors often have large egos. Because of the incestuous relationship between big pharma and medicine, medical training largely revolves around prescribing pharmaceuticals and not surprisingly, a doctor’s ego is frequently tied to the wonders of pharmacology.

A key belief underlying modern medicine is that doctors are the experts that patients must seek out for advice, and as a result, if a patient rejects that advice, it challenges the doctor’s expertise and in turn their identity. Having a patient tell the doctor they don’t buy what the doctor is selling and reject the doctor’s prescription can be a bitter pill for those doctors to swallow. As a result, doctors often double down on their prescriptions to assert their expertise and show they know best when their advice is challenged.

Consider this example shared by a mentor:

I have treated numerous physicians with complex issues none of their conventionally trained colleagues could address through using alternative modalities like homeopathy and I have had numerous times where the doctor completely cut me off once I got them better. The existence of efficacious therapies outside their body of knowledge is very threatening; it makes the doctors feel diminished, and from what I’ve seen they often default to acting like the whole ordeal was a bad dream that never happened rather than to consider the possibility that their model is incomplete.

...

The Church of Medicine

Many organized religions expect blind obedience to their faith (“just trust us, the vaccines are safe and effective”), and when their authority is challenged, hostility is always directed towards the heretic. Many have made the case that Western medicine is our society’s religion (M.D. is also sometimes associated with “Minor Deity”), and as the classic Confessions of Medical Heretic shows, Western medicine has been structured to contain the key components of the previous faiths (e.g. white coats are its priest’s robes, vaccines are its holy waters).

This is often difficult to spot since Western medicine hides behind a veneer of credibility bestowed by its evidence. However, when that evidence is critically examined, it is inevitably discovered to rely upon a large amount of inaccurate, non-replicable, or fraudulent research that is selected just as arbitrarily as the dictates of faith (hence why it is almost impossible to study or publish the overwhelming evidence of vaccine harm).

When I discussed my original question with colleagues, the religious aspects of medicine often came up as they felt the fanaticism with prescribing was just a part of the ideological culture of medicine. Those discussions then circled back to how complex the human body is, how difficult it is to know anything about it with certainty, and our distrust of anyone who claims they know everything (e.g. I remember one instance of a surgeon saying “I know everything about the mind” to sell a surgery to his patient). We all shared the belief our profession needs to let go of its religious zeal that causes our members to continually claim they understand the nature of reality solely based on the authority they believe the status of being a doctor grants them.

...

Conclusion

Acupuncturists like to share that in ancient China, acupuncturists worked on an economic model of being paid only if their patients stayed healthy, and not while they were ill. Although I am not sure if this would be economically viable in the current era, I do believe it represents part of the shift that needs to be imagined if we are to move away from the disastrous fee-for-service model (direct primary care is presently the best bridge we have).

The perversity of the fee-for-service model is ingrained into each doctor throughout our training. I genuinely believe most doctors start off as well-meaning and gifted individuals, but the entire educational process is remarkably well designed to break them down into automatons who internalize that it’s much easier to accept the status quo than question anything. Additionally, many of those who go into medicine carry decades of trauma and (particularly within psychiatry) are seeking a way to heal themselves, so they often project their own issues onto their practice of medicine. The attachment to “fixing” someone is incredibly alluring (“if my patient would only take this mRNA vaccine he could be saved”), but it is not spiritually sound or helpful.

I and many of my teachers believe the ideal mindset when practicing medicine is to do the best you can with the tools you have, recognize your limitations, and accept what ultimately happens to your patient. It is fine to look for other tools if it’s clear your tools won’t do the job, but once you cross the line to believing you are the being who can control the patient’s fate, an important line is crossed that should not be crossed.

I had an older patient I was quite attached to who was developing severe issues from smoking I knew would eventually be fatal. Although we saw eye to eye on many issues and he respected my judgment, he was not willing to give up his habit, and I while I never gave up on trying to change his mind, I also did not feel it was my place to berate him since he had repeatedly heard my point and clearly understood it. Recently, while I was out of the area he was hospitalized for an acute complication of smoking and after about a week passed away. I am presently in transit to visit the widow and looking back on this situation, I repeatedly question if I should have pushed him more or if the way I handled the situation was appropriate.

Although I disagree with many of the premises the church of pharmaceuticals is founded upon, I also must recognize that doctors regularly see challenging patients who subsequently die from conditions that may have been possible to prevent with the medication the doctor wanted them to take. As my own story and this article illustrate, finding the appropriate balance on how aggressively to advocate for your patient’s wellbeing is often an extremely difficult task to navigate and I do not know if there are any “right” answers to it.

Finally, the first thought that likely comes to many readers from reading this is that these financial incentives are the driver behind the COVID-19 vaccination program. Although these incentives exist (e.g. the media received a lot of money to promote the vaccines), at a provider level they are relatively small (40 dollars per injection from medicare plus a slight bonus for at home administration or a 17% salary increase in England). I thus do not believe it can be argued reimbursements were the driving force behind the fanaticism to vaccinate. Conversely, the hospitals did receive a massive financial incentive to diagnose patients with COVID-19, administer remdesivir rather ivermectin or hydroxychloroquine and to place patients on ventilators. Here, I do believe the payoff was large enough to argue it influenced medical decision making.

[stickdog99]

The corporate capture of the nutrition profession in the USA: the case of the Academy of Nutrition and Dietetics

Abstract

Objective: The involvement of unhealthy commodity corporations in health policy and research has been identified as an important commercial determinant contributing to the rise of non-communicable diseases. In the USA, health professional associations have been subject to corporate influence. This study explores the interactions between corporations and the Academy of Nutrition and Dietetics (AND), and their implications for the profession in the USA and globally.

Design: We conducted an inductive analysis of documents (2014–2020) obtained through freedom of information requests, to assess key AND actors’ dealings with food, pharmaceutical and agribusiness corporations. We also triangulated this information with publicly available data.

Setting: The USA.

Results: The AND, AND Foundation (ANDF) and its key leaders have ongoing interactions with corporations. These include AND’s leaders holding key positions in multinational food, pharmaceutical or agribusiness corporations, and AND accepting corporate financial contributions. We found the AND has invested funds in corporations such as Nestlé, PepsiCo and pharmaceutical companies, has discussed internal policies to fit industry needs and has had public positions favouring corporations.

Conclusion: The documents reveal a symbiotic relationship between the AND, its Foundation and corporations. Corporations assist the AND and ANDF with financial contributions. AND acts as a pro-industry voice in some policy venues, and with public positions that clash with AND’s mission to improve health globally.

much more at link, including ...

Donna Martin, an influential AND member who has encouraged corporate connections, has served in several positions for the Academy: as treasurer (2013–2015), president-elect (2016–2017) and president (2017–2018). In 2015, she agreed to endorse Kraft Singles, despite their poor nutritional value. Additionally, when commenting on a CFO’s report about the AND investment portfolio, she mentioned to another Academy’s executive member:

Everything looks good to me. The only flag that I saw was that PepsiCo is one of our top ten stocks (in which AND has invested). I personally like Pepsico and do not have any problems with us owning it, but I wonder if someone will say something about that. Hopefully they will be happy like they should be! I personally would be OK if we owned Coke stock!! (Donna Martin, email, 3rd January 2014)

Another AND director, Milton Stokes, was an employee at Monsanto in 2014, and from 2014 to 2020 he was the Global Lead, Public Affairs and Issues Management at Bayer Crop Science (a subsidiary of Bayer, which now owns Monsanto). Monsanto has donated at least $395 000 to the AND and worked closely with the AND, especially after Stokes joined Monsanto. For instance, in 2015 Monsanto contributed $175 000 for the Foundation’s ‘Future of Food Initiative’. The same year, Monsanto established an advisory group with fourteen former AND board members and had several AND/ANDF members as spokespeople ‘to serve on a two-year contractual basis as communication advisors’ (Milton Stokes, 11th December 2014). In 2017, he emailed several members of the AND leadership team mentioning that Monsanto has committed to support the Academy financially, and recruited AND members ‘to raise the visibility of the nutrition and dietetics community with Monsanto’ and arrange ‘a visit for the AND’s scientific officer to learn about Genetic Modified Organism (GMO) use in Nairobi, and Kenya’. ...

In 2017, as an employee of Monsanto, Stokes contacted two leaders to further collaborate with the AND to align agendas around sustainable diets, mentioning other

The Academy’s corporate financial contributions and its corporate investments

The AND has maintained financial ties to food, pharmaceutical and agribusiness corporations, despite criticism and the potential reputational risks identified by some ex-Academy members(32). We found three main types of financial ties. First, FOI documents revealed the corporate financial contributions to the AND for the years 2011, and 2013 to 2017 (Table 1). In 2011, the AND received more than US$300 000 from Hershey Co., a chocolate manufacturer, and nearly US$300 000 from the National Dairy Council (NDC), Conagra, Coca-Cola and Aramark, a company providing food services. Abbott, a pharmaceutical company selling infant formula, as well as General Mills and Cargill each donated more than US$100 000 in 2011 and maintained substantial donations from 2013 to 2017. Food and beverage companies such as Nestlé, Coca-Cola and PepsiCo, with the exception of General Mills, reduced their contributions over time. Nevertheless, contributions from companies such as Pharmavite-Nature Made and Abbott increased substantially during this same period. Overall, contributions shrunk by more than US$600 000 in 2015 and by more than US$500 000 in 2016, in respect to previous years.

Second, FOI documents showed large corporate donations to the ANDF from 2011 to 2015, listed in Table 2. Between 2011 and 2014, the Foundation received more than US$2 million each year from corporations, representing approximately a third of its total revenues for that period. In 2015, the corporate funding dropped under US$2 million, but corporate funding still represented more than 62 % of the ANDF’s revenues.

...

Lastly, internal AND documents from 2015 to 2016 show that AND invested its funds in the stock of several pharmaceutical companies such as Abbott, Johnson & Johnson, Perrigo Co., Pfizer Inc., Allegra, Merck & Co., and some food and beverage companies such as PepsiCo, Nestlé and J.M. Smucker’s Company.

Corporate co-opting of nutritionists and dietetic professionals through the Academy of Nutrition and Dietetics/Academy of Nutrition and Dietetics Foundation

The AND certifies US professionals and develops content for continuing professional education as a ‘requirement for’ certification and ‘to build’ knowledge and advance nutritionists’ careers(34). Also, the AND provides a toolkit for individual or organisational members to build their own workshops with continuing professional education credits. Some of the topics of such continuing professional education resources were sponsored or aligned to industry’s interests. For example, ‘Whole Grain Product: Menuing and Getting Kids to Like Them’ was sponsored by General Mills (DM email, 12th June 2015). The ‘Certificate of Training in Childhood and Adolescent Weight Management’ and ‘Changing the Way We Look at Agriculture’ were supported by the National Dairy Council.

The AND also publishes the Journal of the Academy of Nutrition and Dietetics, a monthly peer-reviewed scientific journal. The journal has become a means for the AND to publish its official positions on certain topics(Reference Lipscomb and Brown35). For example, the AND has published controversial positions that have been amended over time and appear to be aligned with corporate interests. For instance, in 2017 the AND CEO mentioned to some directors she received an email from the president of the National Dairy Council, concerned about the AND position on vegetarian diets published in the journal(Reference Melina, Craig and Levin36). The Council’s president indirectly questioned the science behind the public statement mentioning that the National Dairy Council was funding the AND. According to the AND CEO:

[I] Heard an earful yesterday on the phone from Jean as President of Dairy (NDC) about our Vegetarian position paper (six months later?) that has a line in it about dairy and meat. Nothing in the paper says don’t eat dairy or meat or be a vegetarian or vegan but she was saying that Dairy is helping us with funding to elevate the Academy’s science and evidence and it’s so disappointing. I resented the correlation of the sponsorship. (Patricia Babjak, 28th April 2017)

The original position paper on vegetarian diets published in 2015 was retracted at the request of the AND’s Academy Positions Committee, as they ‘became aware of inaccuracies’ and a new version was made public in December 2016, eliminating any mention of specific animal source foods(Reference Melina, Craig and Levin36). These actions resonate with the commitments to ‘return specific rights and benefits’ to AND/ANDF sponsors, as mentioned in internal documents (JS email, 6th July 2015) but contradict AND’s principle of ‘non-influence’ (point 4, Fig. 2)(37). ...

Academy of Nutrition and Dietetics allowed companies to purchase rights and benefits

According to AND/ANDF internal communications, AND distinguishes its ‘sponsors’ from its ‘supporters’. Corporate sponsors ‘pay a fee, and in return the Academy provides a right or a benefit’ (JS email, 6th July 2015). Corporate ‘supporters’ provide ‘a charitable contribution with no (explicit) expectation of a commercial return’ (JS email, 6th July 2015). We found several cases when AND has legitimised some corporate positions, which may relate to corporations procuring rights or benefits.

First, we found that the AND established a GMO Task Force in 2017 to work on the AND’s position on GMO. The task force’s report supported the National Academy of Science report, leaning to a critical view of GMO, that would have been a direct criticism of the products of some sponsors, including Monsanto, as discussed by three members of the AND’s BOD (Patricia Babjak, CEO, 8th September 2017). These directors tried to delay the report’s delivery after the September 2017 board meeting, where corporate funding opportunities were to be discussed. Some of the potential sponsors were Abbott, General Mills and Nestlé, and these partners would have had ‘representation in the Board of Directors’ and they ‘will accelerate their organisational nutrition commitments and global public health’ (Paul Mifsud, CFO, 8th September 2017). Thus, there was the intention to delay any potential criticism about GMO.

Second, we found that in 2016 the AND engaged with the American Society for Nutrition, the Institute of Food Technologists and the International Food Information Council (funded by corporations) to put together a ‘Food and Nutrition Science Solutions Task Force’. They also agreed to write a commentary for a special issue of the Journal of Public Health, criticising the NOVA classification of foods, based on their level of processing showing that the consumption of ultra-processed food lead to ill health. At least two of the authors of the proposed papers had ties with the food industry at the time. One was part of the Gerber Foundation and the other was part of the General Mills speaker’s bureau. This group never published the paper, but one of the authors who was an AND member published a criticism of the NOVA classification in a different journal in 2018.

In a final example, in June 2017, the AND CEO emailed other directors that AND had been invited by the US Agriculture Secretary to join the USDA’s new Sodium Awareness Initiative. The goal of this initiative was to reduce sodium in school meals. One director questioned the decision to engage in that initiative, saying that ‘although this is a tremendous HONOR, we do seem to be talking out of both sides of our mouth in regards to sodium’, and recognised that ‘I am well aware that the sodium restrictions in school meals cannot be achieved without industry help, and I am PROUD that we are at the table’. This member pointed out some inconsistencies with AND’s previous actions. In 2015, the AND indeed asked for the US Dietary Guidelines Committee to ‘reconsider the sodium recommendation of 2300 mg/day (considered too low)’, as ‘there is a distinct and growing lack of scientific consensus on making a single sodium consumption recommendation for all Americans, owing to a growing body of research suggesting that the low sodium intake levels recommended by the DGAC are associated with increased mortality for healthy individuals’.

much more ...

[Grizzly]

^^^
Yep.
The Conspiracy to Keep You Sick (It’s NOT What You Think) 2022

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it's official: Bret Weinsten is crazy

[Elvis]

Pandemics are emergencies. Healthcare is something people need every day as a normal course of living.

[stickdog99]

https://arstechnica.com/science/2023/01 ... e-country/

US still has the worst, most expensive health care of any high-income country

US health care has lagged peers for years, and the pandemic made things worse.

Americans spend an exorbitant amount of money on health care and have for years. As a country, the US spends more on health care than any other high-income country in the world—on the basis of both per-person costs and a share of gross domestic product. Yet, you wouldn't know it from looking at major health metrics in years past; the US has relatively abysmal health. And, if anything, the COVID-19 pandemic only exacerbated the US health care system's failures relative to its peers, according to a new analysis by the Commonwealth Fund.



Compared with other high-income peers, the US has the shortest life expectancy at birth, the highest rate of avoidable deaths, the highest rate of newborn deaths, the highest rate of maternal deaths, the highest rate of adults with multiple chronic conditions, and the highest rate of obesity, the new analysis found.

"Americans are living shorter, less healthy lives because our health system is not working as well as it could be," Munira Gunja, lead author of the analysis and a senior researcher for The Commonwealth Fund’s International Program in Health Policy and Practice Innovation, said in a press statement. "To catch up with other high-income countries, the administration and Congress would have to expand access to health care, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population."

Dying young

Overall, the analysis paints a grim picture of how much catching up the US has to do. In terms of life expectancy, the US has trailed its peers for years but took a nosedive during the pandemic, while other countries fared better. In 2020, the average life expectancy at birth in the US was 77 years, three years lower than the average for high-income countries. The next lowest life expectancy among high-income countries was from the UK, which had a 2020 life expectancy at birth of 80.4 years.

Provisional data for 2021 suggests US life expectancy fell nearly a full year further, from 77.0 years to 76.1 years. Relatedly, the US had the highest rate of deaths from COVID-19 in 2020 compared with its high-income peers and was among the lowest of its peers in rates of COVID-19 vaccination.

In a particularly shameful set of statistics, the US continues to have the highest infant and maternal mortality rates of any other high-income country. In 2020, there were 5.4 infant deaths per 1,000 live births in the US, while the average among high-income countries was 4.1 infant deaths. In Norway, there were 1.6 deaths per 1,000 live births. The health care system is also failing mothers. In 2020, there were 24 maternal deaths per 100,000 live births, about 2.5 times higher than the average for high-income countries. The country with the next highest maternal mortality rate was New Zealand with 13.6 per 100,000 live births.



With many US states now rapidly turning back the clock on reproductive rights and maternity care, the US's appallingly high rates of infant and maternal deaths are expected to worsen.

Beyond pregnancy, Americans are dying from other conditions that are treatable or preventable at a rate far higher than those seen in all other high-income countries. In 2020, 336 US deaths per 100,000 people were avoidable, while the average among high-income countries was just 225 deaths per 100,000. The rate of avoidable deaths has been rising in the US since 2015, the analysis notes.

Sicker

That tracks with the finding that Americans are more likely than their high-income-country peers to have multiple chronic conditions. In 2020, 30.4 percent of US adults said that they had previously been diagnosed with two or more chronic conditions in their life. Among other high-income countries, no more than a quarter of adults reported having two or more chronic conditions. America's high obesity rate may play into that discrepancy. The US has a higher obesity rate than any other high-income country. In fact, it's nearly two times higher than the average of its peers.

While Americans are dying young from avoidable conditions, they're also spending an exorbitant amount on health care. The US spent 17.8 percent of its GDP on health care in 2020, nearly twice as much as the average of 9.6 percent among high-income countries. On a per-person basis, it outspent its peers, paying nearly $12,000 per person via government insurance programs, private insurance coverage, and out-of-pocket costs. The country that came the closest to US spending was Germany, with a little over $7,000 per-person spending.

The data hints that these high prices are discouraging Americans from getting the care they need, potentially feeding into the country's high rates of chronic conditions and avoidable deaths. In the analysis, the US had among the lowest rate of doctor visits, with just four per year. The average was 5.7. The US also has one of the lowest rates of practicing physicians per 1,000 people—2.6 per 1,000, while the average is 3.7.

The US was the only high-income country in the analysis that does not guarantee health coverage. People in most other high-income countries have guaranteed health coverage with the option of buying supplemental private coverage.

[stickdog99]