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12/13/2024 Paul Kesselman, DPM
Assassination of UHC CEO
The murder of the CEO of UHC is reprehensible and
violence is no way to resolve the problems with
the UHC or any insurance company. Many of my
colleagues and I have suggested this was bound to
happen given our society and the way all insurance
(not just health insurance) treat their
policyholders. So we understand why it happened
but in no way does anyone I have spoken with
support this disastrous cowardly act. What I have
read in Medical Economics over the past really
saddens me. Apparently many physicians of all
specialties have commented that they show no
empathy for Mr. Thompson. This despite that he was
a human being first as well as a father, son,
estranged husband, etc.
Likely all of us have had difficulties both in our
professional and personal life dealing with
various types of insurance companies. This is
not limited to our professional liability
carriers, but also to office premises insurance,
cyber security, homeowners, flood, health,
disability, automobile, life and other insurance
policies. These companies are all too quick to
take our premiums but make us jump over almost
insurmountable hurdles to collect on a claim. And
then they cancel you. Certainly that should make
all of us livid!
Part of the problem is that there is rampant
insurance fraud committed at so many layers that
the insurance companies fight back, again not to
support their efforts which are also criminal.
When it comes to personal health insurance it
really hits home. Almost all of us, if we have
lived long enough, know a loved one or perhaps
ourselves who has had some financial difficulties
and frustrations imposed on them due to lack of
coverage at their most vulnerable moments.
This horrible event reminds me of the scene from
the movie Network when Howard Beale uttered, "I'm
as mad as hell and I'm not going to take this
anymore”
Over the coming days, weeks and months and years
we can hopefully learn the motives that caused the
accused to act in the way he did. Perhaps only
then can we learn what really is needed to
overhaul the insurance industry. This is no doubt
long overdue.
Paul Kesselman, DPM, Oceanside, NY
Other messages in this thread:
12/21/2024 Joseph Borreggine, DPM
Assassination of UHC CEO ( Paul Kesselman, DPM)
The assassin who needlessly shot the UHC CEO did
so for what reason I do not personally know since
I have not read his manifesto, but I can only
surmise that it was based on corporate greed and
corruption. I have not delved deeply into this
that much, but from what the media has reported he
committed this heinous crime because he opined
that a family member did not receive the care that
they needed due to the denial of services by UHC.
I believe that was the primary concern and the
rooted disgruntlement of the previously mentioned
corporate greed and corruption.
This individual made a judgment to make an example
of the CEO so that others in the same line of
business would be on notice that things need to
change. I am sure they do, but this was not the
way to do it. I understand that many applaud what
he did and are supporting him with defense fund
support along with touting their opinions on
social media. They are sorely mistaken as far as I
am concerned. I also disagree with certain DC
politicians who say that murdering someone in cold
blood is wrong, but then go on to say that this
situation was coming one way or another. This
rhetoric is also uncalled for since it does
nothing, but fuel the fire of discontent.
But if we dig deeper into how the wick was lit
that started this fire, then we have to go back to
the passing of "Obamacare" back in 2008. There is
verbiage in that law that states "Community
Rating" and " Guaranteed issue". These policies
look good on paper, but in reality were the
impetus to corporate greed and corruption. Yes,
these policies eliminated the unfair and biased
issue of "pre-existing condition" riders that were
baked into insurance policies that did not allow a
beneficiary to receive benefits for these ongoing
health conditions which led to increased morbidity
and mortality. There was also the removal of the
lifetime benefit caps which certainly reduced the
tremendous financial liability on beneficiaries
that occurred with traumatic and terminal illness.
This was all good until it was not.
These policies unfortunately created tremendous
profits for insurance companies that had never
seen before. Think about it, "Community Rating"
leveled the insurance premium that everyone paid
regardless of age. That is the 20-year-old healthy
individual who rarely sees a doctor is paying the
same premium as a much older individual with
multiple medical issues. Again, sounds good on
paper, but in reality, it was a financial ticking
time bomb. The ability to collect these same
premiums regardless of age or health status
increased the coffers of the insurance companies
to secure tremendous profits which quelled the
losses created by eliminating pre-existing
condition riders and restrictions on lifetime
benefits.
The "Guaranteed Issue" policy states "Guaranteed
issue is provided to applicants regardless of
health, race, age, or income status". This was a
troublesome issue for most trying to obtain health
insurance, but once it was truly enforced
insurance companies could no longer limit who
could have health insurance. Again, this is good
on paper, but this gave insurance companies the
ability to overcompensate for this requirement by
precipitously increasing their premiums. Insurance
premiums are much higher than over 20 years ago
and will not drop anytime soon.
So, those who supported a type of government-run
healthcare and are now mad at what the result is
need to think again about allowing the federal
government to be allowed in anything because the
result is always the same. Look at Medicare and
Social Security and the trillions in the deficit
they are both in currently. The insolvency of
these programs was predicted to occur in 2026, but
now it looks like with the planned printing of
money from the U.S. Treasury this will not occur
until 2039.
Joseph S. Borreggine, DPM, Fort Myers, FL
12/19/2024 Paul Kesselman, DPM
Assassination of UHC CEO ( Stephen M. Pribut, DPM)
Once again, the insurance industry has sent the
exact wrong message to the public. Rather than
take this murder as a wakeup call to them to
respond to the public's need for more
transparency, they have chosen to insulate
themselves even more. As Kevin O'Leary from Shark
tank said, "Putting up fences around headquarters
and providing their executives with more security
is not the message the public needs to see".
As for my friend and colleague Jon Purdy's comment
regarding Medicare losing money and allowing
people to save money on their own to use for
health care, fat chance that will work. Most
people are not that disciplined that they can do
that and that was the whole purpose for Social
Security and Medicare in the first place. To
ensure that people in later life would have a
safety net to provide to them.
The problem is that Medicare was not set up to be
a profitable entity, but the Medicare Part C plans
were set up to attempt to be that, but recent
studies have shown that they too are a failure.
In particular a new study by Kaiser and reported
on Becker's details how much more Traditional Fee
for Service Medicare (TFFS) saves in dollars for
patients who have been on TFFS for years vs. those
who were on Medicare Part C plans and then
transfer onto Traditional FFS Medicare. It turns
out that for the year or two after they leave MCR
Part C TFFS Medicare costs skyrocket and this is
because as the study believes, that the patients
were not receiving the care they needed all along.
Hence they need to catch up and likely don't.
This likely is due to greed on the part of private
replacement plans to deny coverage and also the
discount they pay to providers, resulting in the
better providers shunning these replacement plans.
Medicare and Social Security were never set up to
be profitable but to be benefit plans for the
aged.
However, the private plans were set up in an
attempt to take the government out of the risk of
providing insurance to the most vulnerable
patients. And now those private plans having
sucked the premiums away from the younger
beneficiaries for a decade or two are now facing a
tsunami of much older beneficiaries who require
more care. Hence the increased costs beyond their
ability to pay and their need to reduce fees (% of
allowed Medicare fees has gone from 150% to in
some cases < 50%), increased audits, prior
authorization and risk adjustment fraud schemes.
Privatizing Medicare will not work under the
current system so long as the politicians alone
have the ear of the insurance industry and can
contribute large sums of money to politicians
either at the state or Federal level. So as long
as the industry formulates policy on cost basis
and their boards answer primarily to the
stockholders, we will continue in this state of
disarray.
Why did the assassin target a private insurance
official and not a Medicare or CMS official?
Because Medicare and CMS base their policies, as
sometimes archaic as they may be, based for the
most part on evidence-based medicine and not
solely on cost. Medicare contractors don't cheat
the govt, but Medicare Part C programs are ripe
with fraud. Ask yourself when you last saw a
Medicare Part C official get sanctioned by the
gov't and go to jail for fraud? Yet there have
been many stories here and in the lay press.
Medicare cannot be run as a for-profit program and
the current picture proves it! And unfortunately,
the masses are for the most part not capable of
saving their money for old age to bankroll their
healthcare.
Paul Kesselman, DPM, Oceanside, NY
12/17/2024 Stephen M. Pribut, DPM
Assassination of UHC CEO (Jon Purdy, DPM)
Dr. Purdy raises a provocative critique of
Medicare, arguing that it is fiscally
unsustainable and fundamentally flawed in design.
However, his suggestion that individuals would be
better off saving and investing the money that
goes toward Medicare taxes is deeply flawed and
fails to address the realities of healthcare
costs, financial behavior, and the role of social
safety nets. Furthermore, the increasing
privatization of Medicare through Medicare
Advantage plans has introduced additional
challenges, including denials of care,
administrative burdens, and profit-driven
practices that harm both patients and
practitioners. Let's examine these issues in
depth.
Medicare's Purpose and Evolution
Medicare was created in 1965 to address a dire
need: millions of older Americans lacked access to
affordable healthcare. Before Medicare, the
private market largely failed to serve this
population, leaving many seniors without coverage
or care. Over nearly six decades, Medicare has
significantly improved healthcare access, quality,
and outcomes for older Americans, reducing poverty
and increasing life expectancy among this
demographic.
However, Medicare's sustainability has always been
a concern, and its evolution has introduced new
complexities. The introduction of Medicare
Advantage (MA) plans, which allow private insurers
to manage Medicare benefits, was intended to
foster competition and innovation. Unfortunately,
as private insurance's role in Medicare has grown,
so have its negative effects on patients,
providers, and the healthcare system.
The Myth of "A Million Dollars for Healthcare"
Dr. Purdy's argument that individuals could save
and invest the equivalent of Medicare taxes to
create a $1 million healthcare fund by retirement
is appealing in theory but unrealistic in
practice. Several critical issues undermine this
assumption:
1. Healthcare Costs Are Unpredictable and Often
Catastrophic
Health needs are not confined to old age. Many
people face significant healthcare expenses in
their 20s, 30s, or 40s due to accidents, chronic
illnesses, or other unexpected events. Without a
safety net like Medicare, these costs could
deplete savings long before retirement. For
example, a major car accident or cancer diagnosis
can generate medical bills of hundreds of
thousands of dollars--expenses that most young
adults could not cover.
2. Rising Healthcare Costs Outpace Savings Growth
While savings might grow over time through
investment, healthcare inflation often outpaces
standard inflation. The rising cost of treatments,
medications, and long-term care can erode the
purchasing power of saved funds. This makes it
unlikely that even disciplined savers would
accumulate enough to cover the full range of
healthcare needs.
3. Many Americans Struggle to Save
Behavioral economics shows that individuals are
not always rational or disciplined savers. Social
Security is a case in point: it was created
because many Americans failed to save adequately
for retirement. Today, nearly 25% of Americans
have no retirement savings, and many others have
insufficient funds. Expecting individuals to
reliably save for healthcare--an unpredictable and
often overwhelming expense--ignores these
realities.
4. Insurance Is Designed to Pool Risk
One of the core principles of insurance is risk-
pooling, where the healthy subsidize the sick and
the young subsidize the old. This collective
approach ensures that everyone has access to care
when they need it. Eliminating Medicare in favor
of individual savings would leave each person
bearing their own risk, potentially leading to
devastating outcomes for those who experience
early or costly health crises.
Challenges with Medicare Advantage
The privatization of Medicare through Medicare
Advantage plans has compounded the system's
challenges. While MA was intended to increase
efficiency and choice, its implementation has
created new problems:
1. Denial of Care and Dropping Clients
Medicare Advantage plans often prioritize profits
over patient care. Reports of denied medically
necessary treatments and dropping high-cost
clients are troubling and undermine the trust that
patients place in the system. Traditional
Medicare, by contrast, does not engage in such
practices to the same extent.
2. Administrative Burdens
Private insurers impose excessive chart requests,
audits, and documentation requirements on
practitioners, creating an administrative burden
that diverts time and resources away from patient
care. This inefficiency frustrates providers and
reduces the quality of care delivered.
3. Up-charging Medicare Without Practitioner
Rewards
MA plans frequently up-code patient diagnoses to
receive higher reimbursements from Medicare, but
these additional funds often do not benefit
providers or patients. Instead, they inflate
insurer profits while practitioners face
increasing financial strain.
4. Market Distortion and Reduced Transparency
Medicare Advantage removes millions of
beneficiaries from traditional Medicare, reducing
its negotiating power and creating distortions in
the healthcare market. Unlike traditional
Medicare, MA plans often impose restrictive
networks and opaque billing practices, limiting
patients' access to care.
Broader Impacts of Eliminating Medicare
Dr. Purdy's proposal to eliminate Medicare would
have far-reaching consequences:
1. Young Adults Would Struggle to Afford Care
Without Medicare or private insurance, individuals
in their teens, 20s, and 30s would face
significant financial hardship when confronted
with urgent healthcare needs. Many would forgo
care, leading to worse health outcomes and higher
long-term costs.
2. Healthcare Costs Would Bankrupt Many
Even diligent savers could see their funds wiped
out by a single catastrophic health event. Those
with chronic conditions or high-cost illnesses
would be disproportionately affected, potentially
leaving millions destitute.
3. Health Disparities Would Worsen
Eliminating Medicare would exacerbate existing
health inequities, as low-income individuals and
those with limited financial literacy would be
least able to save for healthcare. This would
deepen disparities and strain other social
services.
4. Economic Instability
The absence of Medicare would destabilize private
insurance markets, driving up costs and reducing
access. Employers and individuals alike would
struggle to navigate a fragmented and inequitable
system.
Toward a Better Solution: Reforming Medicare
Rather than dismantling Medicare, we should focus
on reforming it to address inefficiencies, promote
equity, and ensure sustainability. Key reforms
include:
1. Reducing Administrative Costs
Streamlining Medicare's bureaucracy and reducing
wasteful practices could free up funds for patient
care and lower overall costs.
2. Negotiating Drug Prices
Allowing Medicare to negotiate directly with
pharmaceutical companies could lead to significant
cost savings, as demonstrated by other countries.
3. Improving Oversight of Medicare Advantage
Stricter regulations are needed to ensure that MA
plans prioritize patient care over profits. This
includes reducing care denials, expanding
networks, and holding insurers accountable for
upcoding practices.
4. Strengthening Traditional Medicare
Preserving and enhancing traditional Medicare's
benefits--such as by adding dental, vision, and
hearing coverage--would make it more competitive
with MA plans and provide better care for
beneficiaries.
5. Promoting Preventive Care
Encouraging healthier lifestyles and investing in
preventive care can reduce long-term healthcare
costs and improve population health.
The idea that individuals could save their way to
healthcare security is an attractive but flawed
concept. Healthcare needs are unpredictable, costs
are often catastrophic, and many people struggle
to save even for predictable expenses like
retirement. Programs like Medicare exist because
they address these realities, providing a safety
net for all Americans.
Medicare is not without its flaws, particularly
with the growing privatization through Medicare
Advantage. Which I and many others feel is flawed
and corrupt. However, the solution is not to
eliminate Medicare, but to reform it. By
addressing inefficiencies, holding private
insurers accountable or eliminating Medicare
Advantage entirely, and prioritizing patient-
centered care, Medicare can continue to fulfill
its mission as a cornerstone of America's
healthcare system.
Stephen M. Pribut, DPM, Washington, DC
12/17/2024 Stephen M. Pribut, DPM
Assassination of UHC CEO (Jon Purdy, DPM)
Dr. Purdy raises a provocative critique of
Medicare, arguing that it is fiscally
unsustainable and fundamentally flawed in design.
However, his suggestion that individuals would be
better off saving and investing the money that
goes toward Medicare taxes is deeply flawed and
fails to address the realities of healthcare
costs, financial behavior, and the role of social
safety nets. Furthermore, the increasing
privatization of Medicare through Medicare
Advantage plans has introduced additional
challenges, including denials of care,
administrative burdens, and profit-driven
practices that harm both patients and
practitioners. Let's examine these issues in
depth.
Medicare's Purpose and Evolution
Medicare was created in 1965 to address a dire
need: millions of older Americans lacked access to
affordable healthcare. Before Medicare, the
private market largely failed to serve this
population, leaving many seniors without coverage
or care. Over nearly six decades, Medicare has
significantly improved healthcare access, quality,
and outcomes for older Americans, reducing poverty
and increasing life expectancy among this
demographic.
However, Medicare's sustainability has always been
a concern, and its evolution has introduced new
complexities. The introduction of Medicare
Advantage (MA) plans, which allow private insurers
to manage Medicare benefits, was intended to
foster competition and innovation. Unfortunately,
as private insurance's role in Medicare has grown,
so have its negative effects on patients,
providers, and the healthcare system.
The Myth of "A Million Dollars for Healthcare"
Dr. Purdy's argument that individuals could save
and invest the equivalent of Medicare taxes to
create a $1 million healthcare fund by retirement
is appealing in theory but unrealistic in
practice. Several critical issues undermine this
assumption:
1. Healthcare Costs Are Unpredictable and Often
Catastrophic
Health needs are not confined to old age. Many
people face significant healthcare expenses in
their 20s, 30s, or 40s due to accidents, chronic
illnesses, or other unexpected events. Without a
safety net like Medicare, these costs could
deplete savings long before retirement. For
example, a major car accident or cancer diagnosis
can generate medical bills of hundreds of
thousands of dollars--expenses that most young
adults could not cover.
2. Rising Healthcare Costs Outpace Savings Growth
While savings might grow over time through
investment, healthcare inflation often outpaces
standard inflation. The rising cost of treatments,
medications, and long-term care can erode the
purchasing power of saved funds. This makes it
unlikely that even disciplined savers would
accumulate enough to cover the full range of
healthcare needs.
3. Many Americans Struggle to Save
Behavioral economics shows that individuals are
not always rational or disciplined savers. Social
Security is a case in point: it was created
because many Americans failed to save adequately
for retirement. Today, nearly 25% of Americans
have no retirement savings, and many others have
insufficient funds. Expecting individuals to
reliably save for healthcare--an unpredictable and
often overwhelming expense--ignores these
realities.
4. Insurance Is Designed to Pool Risk
One of the core principles of insurance is risk-
pooling, where the healthy subsidize the sick and
the young subsidize the old. This collective
approach ensures that everyone has access to care
when they need it. Eliminating Medicare in favor
of individual savings would leave each person
bearing their own risk, potentially leading to
devastating outcomes for those who experience
early or costly health crises.
Challenges with Medicare Advantage
The privatization of Medicare through Medicare
Advantage plans has compounded the system's
challenges. While MA was intended to increase
efficiency and choice, its implementation has
created new problems:
1. Denial of Care and Dropping Clients
Medicare Advantage plans often prioritize profits
over patient care. Reports of denied medically
necessary treatments and dropping high-cost
clients are troubling and undermine the trust that
patients place in the system. Traditional
Medicare, by contrast, does not engage in such
practices to the same extent.
2. Administrative Burdens
Private insurers impose excessive chart requests,
audits, and documentation requirements on
practitioners, creating an administrative burden
that diverts time and resources away from patient
care. This inefficiency frustrates providers and
reduces the quality of care delivered.
3. Up-charging Medicare Without Practitioner
Rewards
MA plans frequently up-code patient diagnoses to
receive higher reimbursements from Medicare, but
these additional funds often do not benefit
providers or patients. Instead, they inflate
insurer profits while practitioners face
increasing financial strain.
4. Market Distortion and Reduced Transparency
Medicare Advantage removes millions of
beneficiaries from traditional Medicare, reducing
its negotiating power and creating distortions in
the healthcare market. Unlike traditional
Medicare, MA plans often impose restrictive
networks and opaque billing practices, limiting
patients' access to care.
Broader Impacts of Eliminating Medicare
Dr. Purdy's proposal to eliminate Medicare would
have far-reaching consequences:
1. Young Adults Would Struggle to Afford Care
Without Medicare or private insurance, individuals
in their teens, 20s, and 30s would face
significant financial hardship when confronted
with urgent healthcare needs. Many would forgo
care, leading to worse health outcomes and higher
long-term costs.
2. Healthcare Costs Would Bankrupt Many
Even diligent savers could see their funds wiped
out by a single catastrophic health event. Those
with chronic conditions or high-cost illnesses
would be disproportionately affected, potentially
leaving millions destitute.
3. Health Disparities Would Worsen
Eliminating Medicare would exacerbate existing
health inequities, as low-income individuals and
those with limited financial literacy would be
least able to save for healthcare. This would
deepen disparities and strain other social
services.
4. Economic Instability
The absence of Medicare would destabilize private
insurance markets, driving up costs and reducing
access. Employers and individuals alike would
struggle to navigate a fragmented and inequitable
system.
Toward a Better Solution: Reforming Medicare
Rather than dismantling Medicare, we should focus
on reforming it to address inefficiencies, promote
equity, and ensure sustainability. Key reforms
include:
1. Reducing Administrative Costs
Streamlining Medicare's bureaucracy and reducing
wasteful practices could free up funds for patient
care and lower overall costs.
2. Negotiating Drug Prices
Allowing Medicare to negotiate directly with
pharmaceutical companies could lead to significant
cost savings, as demonstrated by other countries.
3. Improving Oversight of Medicare Advantage
Stricter regulations are needed to ensure that MA
plans prioritize patient care over profits. This
includes reducing care denials, expanding
networks, and holding insurers accountable for
upcoding practices.
4. Strengthening Traditional Medicare
Preserving and enhancing traditional Medicare's
benefits--such as by adding dental, vision, and
hearing coverage--would make it more competitive
with MA plans and provide better care for
beneficiaries.
5. Promoting Preventive Care
Encouraging healthier lifestyles and investing in
preventive care can reduce long-term healthcare
costs and improve population health.
The idea that individuals could save their way to
healthcare security is an attractive but flawed
concept. Healthcare needs are unpredictable, costs
are often catastrophic, and many people struggle
to save even for predictable expenses like
retirement. Programs like Medicare exist because
they address these realities, providing a safety
net for all Americans.
Medicare is not without its flaws, particularly
with the growing privatization through Medicare
Advantage. Which I and many others feel is flawed
and corrupt. However, the solution is not to
eliminate Medicare, but to reform it. By
addressing inefficiencies, holding private
insurers accountable or eliminating Medicare
Advantage entirely, and prioritizing patient-
centered care, Medicare can continue to fulfill
its mission as a cornerstone of America's
healthcare system.
Stephen M. Pribut, DPM, Washington, DC
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