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Dear reader,

Over the past fifty years, our health care system has steadily
shifted into the model we see today, where private corporations receive
public dollars to make a profit off of patients. This model is largely
due to the long career of one bureaucrat turned private equity tycoon
you may not have heard of: Tom Scully, the man behind Medicare
Advantage, physician payment plans, Medicare Part D, and more.

I've watched and listened to virtually every scrap of tape of Scully
over the last 35 years, and I conducted a long interview with him in
June. I think his beliefs are sincere. He thinks government
price-setting doesn't work, and that empowering private insurers that
put their own money at risk leads to better and more efficient care. He
believes poor people should be covered generously, but all other
patients exposed to cost to reduce overutilization. And he wants the
best hospitals and nursing homes and clinics to be paid more than the
worst, to force advances in quality.

His ideology has created the predicament we are currently in, where we
spend more per patient than any country in the world despite shocking
inequities in accessibility of care. He has created a lifetime position
for himself as one of the few people who can navigate and exploit the
maddeningly complex jumble. Our health care system has become a bonanza
for private corporations looking to profit from public money, as long as
they hire armies of specialists to navigate miles of red tape-people
like Tom Scully. The public isn't so lucky.

You can read the entire story on the website today.
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This story is part of our ongoing series on the business of health
care-the inner workings of the monopolies and cartels extracting
ever-greater sums for ever-lousier outcomes, and the policies and
protocols pushing doctors and nurses to the brink-and increasingly
into labor unions. You can read our entire series on the business of
health care as it is released here.
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READ ABOUT THE BUSINESS OF HEALTH CARE >>
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Thanks for reading,

David Dayen
Executive Editor, The American Prospect

 

 

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