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Skip the Last Two Paragraphs—and Other Time-Saving Tips for Healthcare News Consumers John Canham-Clyne ([link removed])


A year ago, I returned to journalism after 26 years working in the labor movement. The most surprising aspect of the job change has been discovering how many healthcare stories are nearly indistinguishable from those written or broadcast 10, 20 or 30 years ago.
Atlantic: The Great Big Medicare Rip-Off

Like many healthcare investigative reports, this Atlantic story (12/22 ([link removed]) ) focuses on a problem that was identified decades ago (Healthcare Financing Review, Fall/93 ([link removed]) ).

The recent avalanche of medical debt coverage (FAIR.org, 5/8/23 ([link removed]) ) simply rehashes 20-year-old award-winning coverage. Many other issues that consume media attention—facility fees (News and Observer, 12/16/12 ([link removed]) ; Axios, 4/7/23 ([link removed]) ), overpayments to private insurers by Medicare (Healthcare Financing Review, Fall/93 ([link removed]) ; Atlantic, 12/22 ([link removed]) ), Wall Street exploitation of physician practices (Fortune, 6/21/99 ([link removed]) ; Bloomberg, 5/20/20
([link removed] wall) )—are presented as shocking recent scandals, when they’re not.

Private health insurance is a 90-year-old failed social experiment. Media coverage of it has been failing for nearly as long, primarily because of an unwillingness to bluntly dismiss meaningless policy solutions.

The fragmented, money-driven US healthcare industry keeps itself in power and profit by exploiting dozens of lucrative regulatory and market loopholes. They let politicians wet their beaks in the resulting spoils, through campaign contributions, feel-good attendance at a constant stream of industry-sponsored media events and conferences ([link removed]) , and the promise of lucrative jobs on the other side of the revolving door. The politicians then spend lots of time furrowing their brows about particular narrow loopholes and proposing unenforceable regulatory tweaks for them. The net result is to legitimize the underlying system as functional.

Key academic and think tank sources for reporters and pundits grind out hundreds of thousands of words and powerpoint slides every year about particular abuses, the details of which make for shocking reading or viewing. The experts earnestly propose the minor regulatory tweaks that politicians want to spend time on.

When enacted, after years of study and debate, those tweaks rarely make a difference. When they do, the industry simply picks up the other dozen tools at its disposal to maim, kill and steal from us.

Most healthcare outrages follow an easily recognizable pattern. Public exposure of an abuse is met with consumer notice and complaint-driven regulations, followed years later by recognition that those regulations had failed, and abolition of the narrow "problem." By which time, of course, several new, egregious corporate behaviors will have captured the attention of the public and policymakers, starting the cycle over again.

On the 500-year road to universal healthcare: The life cycle of useless healthcare consumer regulation

This endless cycle is essential to the preservation of the most deadly and wasteful ([link removed]) healthcare financing system among the world’s wealthy nations. It’s why, as FAIR (5/8/23 ([link removed]) ) reported last year, if we continue on the path of incremental “progress” begun by the Affordable Care Act, Americans can expect everyone to have health insurance that covers our medical needs without the threat of bankruptcy in about 500 years.


** Cut your healthcare reading time
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Stat: Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

Stat (3/13/23 ([link removed]) ) sounds the alarm that denial of needed medical care to seniors may be done by computers rather than by bureaucrats.

FAIR readers spend a lot of time consuming media. As a public service, we’ve compiled a few tips on how best to absorb media reporting on healthcare issues. If you follow these rules, you can cut the amount of time you spend reading healthcare coverage, and more clearly identify the issues that matter.
1. Assume the problem is at least 20 years old: We’ve suffered four years of hysteria about private equity firms “taking over” US healthcare. When it comes to acute care hospitals and physician practices, it’s bunk (FAIR.org, 1/16/24 ([link removed]) ). The current wave of private equity purchases of physician practices is indistinguishable from a similar Wall Street buyout boom in the late 1990s. Then as now, it collapsed in a wave of bankruptcies. The big winners, then as now, are the big “charitable” hospital systems affiliated with churches and universities that dominate healthcare.

Congress may pass, eventually, private equity transparency laws. Those laws will be useless when Wall Street lawyers create some other corporate structure to use for looting medicine a decade or two from now, once doctors have forgotten how lousy their lives became the last time Wall Street came knocking. There’s nothing new under the corporate-theft sun.
2. Ignore technology, whether panic or hype: The latest example of the cycle is “OMG Medicare Advantage AI!.” According to widespread reporting, private insurance companies are now using AI to illegally deny claims for Medicare patients, triggering a series of lawsuits (Stat, 3/13/23 ([link removed]) ; Axios, 12/13/23 ([link removed]) ).

Yeah, and? For over 50 years, privatized Medicare managed care—stretching back decades before the current “Medicare Advantage” brand—has cost the government hundreds of billions of dollars (American Prospect, 1/24/22 ([link removed]) ), and denied claims to ensure their profits. Why should patients care whether insurers kill them with AI or by having underpaid, medically illiterate bureaucrats pull requests for prior authorization off of the last fax machines in the country and deny claims? How about just stopping the mass killing?

The same holds true for breathless speculation about AI transforming medical practice for the better (e.g., Business Insider, 12/23/23 ([link removed]) ; Orlando Business Journal, 12/14/23 ([link removed]) ; Axios, 1/2/24 ([link removed]) ). Fifteen years ago, electronic medical records promised to give doctors seamless access to coordinate care across specialties. That fantasy quickly crashed against the realities of the fragmented corporate control of US healthcare. After hundreds of billions of dollars in subsidies, and hundreds of billions more in software installation and management contracts—further subsidized by tax exemptions when “nonprofit” hospitals are buying the medical records software—the primary result of electronic medical records has been
to add administrative work and accelerate physician burnout, according to a review of an extensive body of academic literature (BMJ Open, 8/19/22 ([link removed]) ).

Unless the technology in a story is a specific advance in surgical or diagnostic technique, or is used to further exploit healthcare workers, it can safely be ignored.
3. Skip the last two paragraphs: Most stories about problems with healthcare financing end with comically inadequate suggestions for policy responses. From focusing on hospital charity care instead of universal health insurance (KFF, 11/3/22 ([link removed]) ), to restrictions on facility fees (Fox31 Colorado, 2/22/23 ([link removed]) ) or private equity transparency and restrictions on arcane real estate deals (Atlantic, 10/28/23 ([link removed]) ), healthcare media specialize in identifying non-solutions to the ongoing crises of un- and under-insurance, extreme costs and systemic inequity. For the moment, you can safely skip the last two paragraphs of an exposé, and assume that reporters are chronicling the latest stream of squid ink from
their political sources. When the headlines and leads change to “Politicians Still Wasting Time on Distractions so the Healthcare Industry Can Continue Looting,” it may be worth starting to read to the end again.


** Giving the game away
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Congressional letter on Medicare Advantage: "We appreciate your efforts to improve consumer protections in the Medicare Advantage (MA) program."

A congressional letter (11/3/23 ([link removed]) ) to the Biden administration asked for a multiyear study of one aspect of a problem identified at least 17 years ago.

A recent letter ([link removed]) to the Biden administration from 26 Democratic House members offers a clear example of this persistent mismatch between problems and proposed solutions. The administration was finalizing rules governing Medicare Advantage, and the letter signers expressed concern “that the new rule might not adequately address MA plans’ increased reliance on artificial intelligence (AI) or algorithmic software to guide their coverage decisions.”

They urged the Biden administration to study (“assess”) the guidance generated for insurance decisions by AI tools compared to third-party clinical guides, and the extent to which AI tools adjust their algorithms based on successful patient appeals or changes in patients’ conditions. They added that insurers should be required to report data on prior authorizations, and promise (“attest”) that their coverage guidelines aren’t more restrictive than traditional Medicare.

The letter’s second paragraph gives the game away. It cites a report by the Department of Health and Human Services inspector general that found “widespread and persistent problems related to denials of care and payment in Medicare Advantage.” According to the report, MA plans’ own internal appeals processes overturned 75% of claims denials, which “raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided.”

The OIG report is six years old. It cites a 2007 review that found similar results. So the authors asked for a multiyear data and analysis project that would examine only one of several techniques used by Medicare Advantage insurers to refuse to pay for healthcare, a problem identified at least 17 years ago.


** Covered with a straight face
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Common Dreams: 'This Should Be a National Scandal': For-Profit Medicare Advantage Plans Using AI for Denials

Common Dreams (11/3/23 ([link removed]) ) covered the congressional request to change the name of the program that allows private insurers to loot Medicare.

This is all covered with a straight face, even in some alternative news outlets. In a story on the letter, Common Dreams (11/3/23 ([link removed]) ) noted that Progressive Caucus members Mark Pocan (D-Wisc.), Ro Khanna (D-Calif.) and Jan Schakowsky (D-Ill.) have proposed renaming Medicare Advantage the “alternative private health plan.”

The move defies satire. Medicare Advantage is at least the fourth name ([link removed]) for private Medicare managed care in 50 years (“risk contracting,” “Medicare+Choice,” “Medicare Part C”). Each name change erases the program’s track record of failure and abuse.

The letter’s signers don’t even dare propose just getting rid of AI in Medicare Advantage coverage decisions, never mind abolishing Medicare Advantage altogether and fully funding original Medicare so that elderly and disabled Americans will actually have decent insurance coverage (Healing and Stealing, 10/11/23 ([link removed]) ). Common Dreams failed to note this, or to remark on the obvious political reason for the timidity.

The leadership of both political parties is committed to allowing private insurers to loot Medicare. It’s an election year, and Democratic politicians don’t want to embarrass their White House leader by mentioning this fact. So readers are left with a report on how private insurers are abusing patients, met by actions by political figures that simply kick the can down the road for years of "study."

Watching Congress and the administration waltz to the tune of regulating the use of AI by Medicare Advantage contractors may hold a perverse fascination, like a good horror movie. But it’s part of a cycle of useless reform that keeps advocates and politicians on the five-century slog to universal coverage. Media should stop enabling this phenomenon.
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