I never met Brian Thompson. His senseless death is first and foremost a human tragedy.
Second, it’s a business story that continues to unfold. Speculation about the shooter’s motive and whereabouts runs rampant. But media attention has seized on a larger theme: the business of health insurance and its role in U.S. healthcare. Headlines like these illustrate the storyline that has evolved in response to the killing: health insurance is part of a complicated industry where business practices are often geared to corporate profit.
- Is Murdering Healthcare CEOs Justified? – WSJ
- Killing of UnitedHealthcare CEO brings resentment of the health care system to the fore StatNews
- UnitedHealth Backlash Signals Possible Shift in Washington and on Wall Street WSJ
- What the Murder of the UnitedHealthcare C.E.O. Means to America | The New Yorker
- Opinion | The Rage and Glee That Followed a C.E.O.’s Killing Should Ring All Alarms – The New York Times
- Some on Social Media See Suspect in C.E.O. Killing as a Folk Hero New York Times
In this coverage and social media postings, health insurer denials are the focal point: journalists and commentators have seized on the use of Artificial intelligence-based tools used by plans like United, Cigna, Aetna and most others to approve/deny claims and Thompson’s role as CEO of UHG’s profitable insurance division. The bullet-casing etchings “Deny. Defend. Depose” is now a T-shirt whistle to convey a wearer’s contempt for corporate insurers and the profit-seeking apparatus in U.S. healthcare. Laid bare in the coverage of Brian’s death is this core belief: the majority of Americans think the U.S. health system is big business and fundamentally flawed.
As noted in last week’s Gallup Poll, and in previous polling by Pew, Harris, Kaiser Family Foundation and Keckley, only one in three Americans believe the health system performs well. Accessibility, costs, price transparency and affordability are dominant complaints. They believe the majority of health insurers, hospitals and prescription drug companies put their financial interests above the public’s health and wellbeing. They accept that the health system is complex and expensive but feel helpless to fix it.
This belief is widely held: its pervasiveness and intensity lend to misinformation and disinformation about the system and its business practices. Data about underlying costs and their relationship to prices are opaque and hard to get. Clinical innovation and quality of care are understood in the abstract: self-funded campaigns touting Top 100 recognition, Net Promoter Scores are easier. The business of healthcare financing and delivery is not taught: personal experiences with insurers, hospitals, physicians and drugs are the basis for assessing the system’s effectiveness…and those experiences vary widely based on individual/household income, education, ethnicity and health status.
The majority accept that operators in every sector of healthcare apply business practices intended to optimize their organization’s finances. Best practices for every insurer, hospital, drug/device manufacturer and medical practice include processes and procedures to maximize revenues, minimize costs and secure capital for growth/innovation. But in healthcare, the notion of profit remains problematic: how much is too much? and how an organization compensates its leaders for results beyond short-term revenue/margin improvement are questions of growing concern to a large and growing majority of consumers.
In every sector, key functions like these are especially prone to misinformation, disinformation and public criticism:
- Among insurers, provider credentialling, coverage allowance and denial management, complaint management and member services, premium pricing and out-of-pocket risks for enrollees, provider reimbursement, prior authorization, provider directory accuracy, the use of AI in plan administration and others.
- Among hospitals, price setting, employed physician compensation, 340B compliance, price and cost transparency, revenue-cycle management and patient debt collection, workforce performance composition, evaluation and compensation, integration of AI in clinical and administrative decision-making, participation in gainsharing/alternative payment programs, clinical portfolio and others.
- And across every sector, executive compensation and CEO pay, Board effectiveness, and long-term strategies that balance shareholder interests with broader concern for the greater good.
The bottom line: the public is paying attention to business practices in healthcare. The death of Brian Thompson opened the floodgate for criticism of health insurers and the U.S. healthcare industry overall. It cannot be ignored. The public thinks industry folks are shrewd operators and they’re inclined to conclude they’re screwed as a result.
Paul
Sections in this Report
- Quotables: Brian Thompson
- Quotables: Industry
- Care Management
- Hospitals
- Insurers
- Physicians
- Polling
- Prescription Drugs
- Workforce
Quotables: The Murder of Brian Thompson
StatNews:“The targeted killing of UnitedHealthcare CEO Brian Thompson has become a defining moment in the zeitgeist of American health care.
The attack was a tragedy that adds to the country’s grim tally of gun deaths. But instead of eliciting sympathy, it opened the floodgates for an outpouring of rage, captured across social media and online forums, over the health care system — one that charges people the highest prices in the world, erects financial and bureaucratic barriers to getting care, and has plunged millions of people into debt.
Social media posts have ranged from mournful to apathetic to joyful, including morbid celebrations of Thompson’s death. That deluge has forced people across the country to grapple with two heavy subjects at once: the callousness of a slaying, and an undercurrent of deep-seated anger at a health care industry that makes a lot of money by exploiting Americans…
The public’s dissatisfaction has never been higher. Recent polling data show the health care system is as unpopular now as it was before the Affordable Care Act went into effect 15 years ago — a time when insurers could decline to cover people if they had any number of pre-existing health conditions and nearly 49 million people lacked insurance. A survey from Gallup released Friday reveals that “Americans’ positive rating of the quality of health care in the U.S. is now at its lowest point” since 2001. ”
Killing of UnitedHealthcare CEO: Reaction shows anger at health care industry
WSJ: “America’s social-media culture is often debased, but it reached a new low this week with the online jubilation over the murder of UnitedHealthcare CEO Brian Thompson. The moral perversity is a sign of the ugly times—all the more so because it targets private insurers for problems largely caused by government.
The unidentified shooter’s motive still isn’t known, but he may have dropped a hint with the words “deny, defend, depose” on his bullet casings. This mantra was popularized by trial lawyers suing private insurers for denying claims more than a decade ago. Social media mobs are exploiting the tragedy and proclaiming that Thompson had it coming.”
Is Murdering Healthcare CEOs Justified? – WSJ
New Yorker: “Thompson’s murder is one symptom of the American appetite for violence; his line of work is another. Denied health-insurance claims are not broadly understood this way, in part because people in consequential positions at health-insurance companies, and those in their social circles, are likely to have experienced denied claims mainly as a matter of extreme annoyance at worst: hours on the phone, maybe; a bunch of extra paperwork; maybe money spent that could’ve gone to next year’s vacation. For people who do not have money or social connections at hospitals or the ability to spend weeks at a time on the phone, a denied health-insurance claim can instantly bend the trajectory of a life toward bankruptcy and misery and death. Maybe everyone knows this, anyway, and structural violence—another term for it is “social injustice”—is simply, at this point, the structure of American life, and it is treated as normal, whether we attach that particular name to it or not…
Reading this, I thought about the statistic, from 2018, that health-care workers account for 73% of all nonfatal workplace injuries due to violence. Nurses, residents, aides, specialists—they are asked to absorb the rage and panic induced by the American health-care system, whose private insurers generate billions of dollars in profit and pay executives eight figures not despite but because of the fact that they routinely deny care to desperate people in need…”
What the Murder of the UnitedHealthcare C.E.O. Means to America | The New Yorker
WSJ “Health insurers were looking forward to an improved political environment in the Trump administration. Things might not turn out to be so simple…. Yet the negative feelings on display toward health insurers can’t be ignored, including by policymakers, the companies themselves and their shareholders. At the very least, they underscore the widespread anger over the perceived dysfunction of the American healthcare system, and expose it as even more deep-seated than how it previously might have been understood…
But this stance could prove complacent. The full consequences of the shooting won’t be fully understood for some time. But the outpouring of negative sentiment toward insurers has at the very least made things more complicated for them, and for Republicans hoping to deregulate them. “
UnitedHealth Backlash Signals Possible Shift in Washington and on Wall Street
New York Times: “I’ve been studying social media for a long time, and I can’t think of any other incident when a murder in this country has been so openly celebrated.
The conditions that gave rise to this outpouring of anger are in some ways specific to this moment. Today’s business culture enshrines the maximization of executive wealth and shareholder fortunes, and has succeeded in leveraging personal riches into untold political influence. New communication platforms allow millions of strangers around the world to converse in real time.
But the currents we are seeing are expressions of something more fundamental. We’ve been here before. And it wasn’t pretty…
And the fraying of the social contract is getting worse. Americans express less and less trust in many institutions. Substantial majorities of people say that government, business leaders and the media are purposely misleading them. In striking contrast to older generations, majorities of younger people say they do not believe that “the American dream” is achievable anymore. The health insurance industry likes to cite polls that show overall satisfaction, but those numbers go down when people get sick and learn what their insurer is and is not willing to do for them…
The concentration of extreme wealth in the United States has recently surpassed that of the Gilded Age. And the will among politicians to push for broad public solutions appears to have all but vanished. I fear that instead of an era of reform, the response to this act of violence and to the widespread rage it has ushered into view will be limited to another round of retreat by the wealthiest. Corporate executives are already reportedly beefing up their security. I expect more of them to move to gated communities, entrenched beyond even higher walls, protected by people with even bigger guns. Calls for a higher degree of public surveillance or for integrating facial recognition algorithms into policing may well follow. Almost certainly, armed security entourages and private jets will become an even more common element of executive compensation packages, further removing routine contact between the extremely wealthy and the rest of us, except when employed to serve them.
We still don’t know who killed Brian Thompson or what his motive was. Whatever facts eventually emerge, the anger it has laid bare will still be real, and what we glimpsed should ring all the alarm bells.”
Quotables: Industry News
Re: RFK on corporate influence on food supply: “On the campaign trail and as part of his Make America Healthy Again movement, Kennedy spoke passionately about how large-scale, industrial agriculture operations and major multinational pharmaceutical companies are making Americans sicker and poorer. He railed against big corporations repeatedly, which resonated with a public reckoning with a byzantine healthcare system, strangled access to healthy food and a sense of powerlessness to do anything about it. “
Is RFK Jr. going mainstream? – POLITICO
Re: Food insecurity: “Food insecurity is rooted in socioeconomic disparities, compromises health through chronic diseases, mental health issues, and obesity, while existing support systems often prove inadequate, necessitating a multifaceted approach involving policy, community engagement, and improved food distribution to foster healthier communities…
Various factors like income, employment status, race/ethnicity, and disabilities can influence food security and determine whether it is long-term or temporary. By 2020, 28.6% of low-income households were food insecure compared with the 10.5% national average. The same year, food insecurity prevalence was an estimated 21.7% among Black American households and an estimated 17.2% in Latino/Hispanic households.2 Both of these percentages were higher than the estimated 13.5% prevalence.
Food insecurity is largely uncontrollable by the affected individuals, often determined by geographical location, income and assets, food prices, and directly limited access to healthy food choices. Food insecurity is a national public health crisis because inadequate access to nutritious food can harm the health of many Americans and worsen existing food and nutritional insecurity, as well as other social factors affecting health.”
Addressing Food Insecurity to Improve Physical, Mental Health Outcomes
Re: Experian on patient experience in revenue cycle management: “As competition intensifies with new providers and disruptive technologies entering the market, patient satisfaction will no longer be optional — it will define success in 2025. Investing in digital patient access tools gives patients the autonomy, choice and convenience they crave as modern digital consumers. Simplifying and streamlining access will not only help meet and exceed patient expectations, but will help providers future-proof their operations and build a sustainable revenue cycle for the years ahead.”
3 ways to improve the patient experience in 2025 – Healthcare Blog
Re: KFF’ Leavitt on possible healthcare spending cuts: “With many tax cuts from the 2017 Tax Cuts and Jobs Act expiring at the end of 2025, a high-profile Congressional debate over extending those tax reductions and enacting new ones is likely. There will be pressure from some in Congress for spending cuts to help pay for those tax cuts. Trump has said that Social Security and Medicare cuts are off the table, and defense reductions are unlikely as well. That means almost half of federal spending would be protected from cuts, leaving Medicaid, which is the next largest source of federal spending, and the ACA as prime targets for spending cuts. The math is inescapable.”
Re: Affordability in AHA Environmental Scan 2025: “An important factor influencing health care consumers is the issue of affordability. Almost a third of consumers say affordability is most important to their health care experience. Affordability, as well as convenience, can lead consumers to seek care at alternative sites like urgent care and retail health clinics. The AHA and its members are committed to strategies that increase patient engagement, improve the health care experience and deliver the right care at the right place and at the right time.” P.26) “Affordability” (p. 30):
Re: drug prices and R&D: “The inevitable pushback to this article will be that we are suggesting interfering with the market. The fact is the pharmaceutical market has already been interfered with and has been tilted towards the accumulation of private wealth over public benefit. Our call to policymakers is to enable the market, to make it work better for the public while continuing to reward scientists and investors reasonably. The public needs to debate where that balance lies. We applaud the research and therapeutic advances industry has made, especially by its biopharma sector, but correcting the imbalance in the ‘new’ R&D ecosystem is urgent work that requires a deeper understanding of contemporary R&D, intellectual property rights, and the industry’s increasingly unchecked pricing power.”
The Real Reasons Drug Prices Are So High Health Affairs Forefront December 2, 2024 https://www.healthaffairs.org/content/forefront/real-reasons-drug-prices-so-high
Re: NIH nominee policy changes: “President-elect Donald Trump’s nominee to lead the National Institutes of Health wants to take on campus culture at elite universities, wielding the power of tens of billions of dollars in scientific grants.
Dr. Jay Bhattacharya, a Stanford physician and economist, is considering a plan to link a university’s likelihood of receiving research grants to some ranking or measure of academic freedom on campus, people familiar with his thinking said.
Among Bhattacharya’s other plans are funding studies to replicate the work of other scientists to help root out scientific fraud. He would also create a scientific journal that would publish studies alongside comments by named reviewers, to encourage more open discussion of scientific ideas.
He has proposed dialing back the amount of NIH grant money that pays for publication in journals. And he would seek to pause so-called gain-of-function research that engineers viruses with new, potentially dangerous, traits to study them.
He would like to institute term limits for the scientists running the NIH’s various research institutes and centers and would assess a congressional Republican proposal to reduce the number of institutes and centers to 15 from 27, according to people familiar with his thinking.
The proposals are likely to stir opposition from people inside and outside the NIH, including officials at institutions that can get grants worth hundreds of millions of dollars each year to fund research.
Exclusive | Trump NIH Pick Jay Bhattacharya Wants to Take On ‘Cancel Culture’ Colleges – WSJ
Re: AEI on RFK role: “The leader of the Republican Party and our country’s next president has tapped a pro-choice scion of the country’s most famous Democratic dynasty to lead the Department of Health and Human Services. In keeping with the bewildering dynamics of today’s negative partisanship, conservative groups such as the Heritage Foundation have cheered the selection of Robert F. Kennedy Jr., while liberals have near categorically denounced him.
Mr. Kennedy’s transformation from left-wing vaccine skeptic to potential Republican cabinet member overseeing America’s vast health apparatus represents a profound shift not only in the character of the American right but also in the politics of science more generally. The emergent MAGA science policy agenda, driven by skepticism and anti-elitism, blends familiar conservative and libertarian ideas with a suspicion of expert power once more associated with the left. The result is a uniquely American brand of populism that has the potential to fundamentally reshape national politics.”
The MAGA Science Agenda Reveals America’s Future Anthony Mills November 27, 2024 https://www.aei.org/op-eds/the-maga-science-agenda-reveals-americas-future/
Care Management
Study: supplements and mortality: “With as many as 1 in 3 US adults using multivitamin supplements, the question as to whether these supplements reduce mortality is an important public health issue. Results: “Confirming the mostly negative results of prior studies, multivitamin supplementation was not associated with a mortality benefit. On the contrary, mortality risk was 4% higher among multivitamin users, compared with nonusers, in the initial years of follow-up.
Refocusing nutrition interventions on food, rather than supplements, may provide the mortality benefits that multivitamins cannot deliver…Considerable evidence now shows that, apart from the aforementioned roles for vitamin supplementation, there is little health rationale for the use of multivitamin supplements. Micronutrients come most healthfully from food sources. When supplementation is required, it can often be limited to the micronutrients in question.
Study: weight loss and spending: Researchers analyzed the association of different levels of body mass index (BMI) and health care spending for adults with employer-sponsored insurance and Medicare. Findings:
“In this cross-sectional study of 17 209 adults, among those with employer-sponsored insurance… adults with employer-sponsored insurance with a weight loss of 5% were estimated to spend a mean of $670 (95% CI, $654-$686) less on health care (8% less), and those with a weight loss of 25% spent an estimated mean of $2849 (95% CI, $2783-$2916) less on health care (34% less). Among adults with Medicare who had 1 or more comorbid conditions, a 5% weight loss was estimated to reduce spending by $1262 and a 25% weight loss was estimated to reduce health care spending by a mean of $5442.”
Study: antibiotics in meat supply: “A handful of the 20 largest restaurant chains across the U.S. received failing grades when it came to adopting policies for restricting the overuse of antibiotics in the meat they serve, according to an analysis by a nonprofit that tracks the issue in food-producing livestock.
The five chains — Olive Garden, Dairy Queen, Arby’s, Little Caesars, and Sonic — were cited because they lack public policies to ensure their meat suppliers comply with U.S. Food and Drug Administration regulations to address antibiotic resistance. All 20 chains examined were graded based on policies and actions concerning antibiotic use in beef, turkey, pork, and chicken.
The analysis found the vast majority of the chains have no publicly available policy governing antibiotic use by their beef, pork, or turkey suppliers. By contrast, 15 chains did implement “meaningful policies” for chicken suppliers, but only two — Chipotle and KFC — received an A+ for implementing policies to restrict the use of medically important antibiotics for treating of sick animals for all meat served.
Big restaurant chains get an ‘F’ for antibiotic use in their meat supplies StatNews December 2, 2024 https://www.statnews.com/pharmalot/2024/12/02/antibiotics-livestock-mcdonalds-panera-kfc-beef-pork-turkey-chicken-pig-fda
NYT Investigation: Acadia clinics: “Every day at dawn, tens of thousands of people begin lining up at Acadia Healthcare’s addiction clinics to get a cup of methadone. The daily dose staves off opioid withdrawal and keeps many from turning to dangerous street drugs like fentanyl.
The for-profit chain of 165 methadone clinics — the country’s largest — has generated more than $1.3 billion in revenue since 2022. It is “a business that we continue to feel great about,” Acadia’s chief executive told investors this year.
That business has been built in part on deception, a New York Times investigation found.
Methadone is a narcotic, and the clinics are heavily regulated by federal and state governments. In addition to handing out methadone, the clinics are required to provide counseling and other services, like drug testing.
But Acadia often fails to provide that counseling, according to five dozen current and former employees in 22 of the 33 states where the company has clinics. Instead, employees at times falsify the medical records that Acadia uses to bill insurers, according to the employees and internal emails.”
Acadia Healthcare’s Methadone Clinics Face Fraud Complaints – The New York Times
Hospitals
Study: Hospital pay caps for state employee health plans: “State employee health plans are consuming an ever-larger portion of state budgets because of rising health insurance premiums. Often the largest purchaser of commercial health insurance in their state, state employee health plans possess a unique opportunity to implement cost containment strategies. This study estimated potential savings from hospital payment caps among state employee health plans and the impact on commercial hospital operating margins. Using data from 46 states and Washington, D.C., we estimated that payment caps set at 200% of Medicare rates would have saved state employee plans an average of $150.2 million per state in 2022 (0.3% of state expenditures), leading to aggregate savings of $7.1 billion nationally. Commercial hospital operating margins would remain healthy under this cap, falling from an average of 42.7% to 41.7%. Payment caps are a promising purchasing strategy for states to generate substantial reductions in health care spending.”
Patient Rights Advocate 7th Annual Hospital Price Transparency Report (November 2024): “Our latest review, conducted nearly four years after the rule took effect, analyzed the websites of 2,000 U.S. hospitals and found only 21.1% of them (421) to be fully compliant with all requirements of the rule, a significant decrease from our last report’s compliance finding of 34.5% and from the highest observed rate in July 2023 of 36.0%. The widespread noncompliance of 78.9% of hospitals is due to files not having prices clearly associated with payer and plan names and not following required formats. All of the hospitals reviewed for this report posted a machine-readable file, though 532 hospitals’ files failed the Centers for Medicare & Medicaid Services (CMS) Validator Tool.”
Seventh Semi-Annual Hospital Price Transparency Report — PatientRightsAdvocate.org
Study: Hospital upcoding: “Diagnosis-based payment systems can create incentives to upcode patients to a higher level of severity to increase payment. In some instances, upcoding can be a form of fraud if providers code patients to a higher complexity than is appropriate, whereas in other instances, upcoding can accurately reflect patient acuity. We estimated the increase in Medicare Severity Diagnosis-Related Group (MS-DRG) upcoding during the period 2011–19, using all-payer discharge-level data from five states. During this period, the number of discharges with the highest MS-DRG coding intensity increased by 41%. Adjusting for changes in patient characteristics, length-of-stay, and hospital characteristics, we estimated that the increase would have been 13% in the absence of changes in coding behavior. We estimated that in 2019, the increase in upcoding (relative to 2011 coding practices) was associated with $14.6 billion in hospital payments, including $5.8 billion from private health plans, $4.6 billion from Medicare, and $1.8 billion from Medicaid. These findings can contribute to the growing body of evidence supporting the design of payment models that limit distortions in payment and resource allocation.”
Study: financial precarity among low-income seniors after hospitalization: Researchers analyzed the financial impact of hospitalization-associated deductibles on Medicare beneficiaries with incomes greater than 100% to 400% or less of the federal poverty level. The focus: financial precarity “defined as having insufficient funds to pay the deductible, examined across 4 scenarios that considered checking and savings account balances, total liquid assets (with a reserve for future living costs), and supplemental insurance.” Results:
“Among 4881 beneficiaries 45.0% had insufficient funds in checking and savings accounts to pay the Medicare hospital deductible. Financial precarity was more prevalent among Black and Hispanic versus White beneficiaries (73.5% and 76.2% vs. 36.2%), those with less versus more than high school education (70.0% vs. 37.1%), and those with 3 or more versus 2 or fewer chronic conditions (49.2% vs. 39.1%). In defining financial precarity to include beneficiaries with insufficient liquid assets to pay the deductible while maintaining a $5000 reserve for future living expenses, 50.7% were financially precarious. Building off this definition to assume supplemental insurance covered the deductible, 39.0% remained financially precarious.”
Risk for Financial Precarity from Hospitalization: Implications for Targeting Financial Assistance in Medicare https://pubmed.ncbi.nlm.nih.gov/39467295/
ProPublica Investigation: St. Peter’s, Montana: ProPublica’s 10,500-word investigative report on the hospital’s handling of an impaired physician is essential reading. Worthwhile reading.
A Montana Hospital Let Dr. Thomas Weiner Continue Practicing Despite Concerns — ProPublica
Insurers
Case study: AI-driven denials: “When Megan Rothbauer suffered a heart attack at work in Wisconsin, she was rushed to hospital in an ambulance. Given the medical emergency — 30-year-old Ms Rothbauer would end up spending 10 days in a medically induced coma — she was whisked to the nearest available facility…
Although the hospital reduced the bill by 90%, the incident laid bare the expensive complexity of the American healthcare system with patients finding that they are uncovered, despite paying hefty premiums, because of their policy’s small print.
In many cases the grounds for refusal hinge on whether the insurer accepts that the treatment is necessary and that decision is increasingly being made by artificial intelligence rather than a physician…
It is leading to coverage being denied on an industrial scale…
The controversy over coverage denials was brought into sharp focus by the gunning down of UnitedHealthcare’s chief executive Brian Thompson in Manhattan…
KFF, a nonprofit health policy research, polling and news organization, found that six out of 10 Americans ran into problems when they tried to claim on their insurance. They either had claims turned down, faced delays getting prior authorization for treatment, or found that their approved network of doctors and hospitals was inadequate. Worst hit was those who either got their insurance from their employer, or the marketplace set up by Obamacare.”
Inside the shady world of health insurers — and the 1.2 seconds it takes them to deny claims
Physicians
Bain: Primary Care market in 2030:
- “Nontraditional providers will help transform primary care in the US, accounting for about one-third of the market in 2030.
- Population-focused models will be especially well positioned to take on the risk of value-based care, but headwinds exist.
- Retailers will need to address three main considerations if they hope to advance in this space: building the right model, investing to evolve their brand, and ensuring that the right healthcare expertise exists within their organizations.”
Bain: Physician Net Promoter Scores 2017 vs. 2024: Physician-led Practices vs Health-System-Led Practices
| Year | Physician-led practices | Health-system-led practices |
| 2017 | 36 | 11 |
| 2020 | 56 | 16 |
| 2022 | 40 | 6 |
| 2024 | 54 | 19 |
Bain & Company, Boosting Physician Satisfaction: Lessons from Physician-Owned Practices, October 2024
Polling
Gallup: Opinions about the U.S. health system: Per Gallup’s annual Health and Healthcare poll conducted Nov. 6-20, 2024:
“Americans’ positive rating of the quality of healthcare in the U.S. is now at its lowest point in Gallup’s trend dating back to 2001.
The current 44% of U.S. adults who say the quality of healthcare is excellent (11%) or good (33%) is down by a total of 10 percentage points since 2020 after steadily eroding each year. Between 2001 and 2020, majorities ranging from 52% to 62% rated U.S. healthcare quality positively; now, 54% say it is only fair (38%) or poor (16%).
As has been the case throughout the 24-year trend, Americans rate healthcare coverage in the U.S. even more negatively than they rate quality. Just 28% say coverage is excellent or good, four points lower than the average since 2001 and well below the 41% high point in 2012.
In addition to registering subpar ratings of the quality and coverage of healthcare in the U.S., few Americans — 19% — say they are satisfied with its cost. This reading is unchanged from last year and toward the low end for the measure, which has averaged 22% since 2001. The high point in satisfaction was 30% in 2020, during the COVID-19 pandemic. This spike was largely due to an increase in satisfaction among Republicans…
Americans’ largely negative views regarding healthcare coverage and quality in the U.S. likely contribute to the widespread perception that the overall healthcare system has major problems (54%) or is in a state of crisis (16%). The seven in 10 Americans now holding these views is in line with the trend average of 69%. 25% of U.S. adults say the system has minor problems, and just 3% think it has no problems.
View of U.S. Healthcare Quality Declines to 24-Year Low
Commonwealth: Senior views on health and costs: The Commonwealth Fund conducted its survey of seniors in 10 countries — Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States — to explore how financial factors affect older adults’ health care decisions. Key findings:
- Out-of-pocket costs are high. Nearly one in four older adults in the U.S. spent at least USD 2,000 out of pocket on health care last year. In contrast, less than 5% of older adults in France and the Netherlands spent that much. Switzerland was the only survey country where older adults reported spending more.
- Older adults are delaying care because of costs. Delaying medical treatment can worsen health conditions. Although less than 10% of older adults across countries reported skipping needed care or forgoing medical treatment because of costs, older Americans did so at the highest rate.
- One-third of older U.S. adults facing cost-related barriers reported being in fair or poor health. People are skipping dental care. One in five older adults in the U.S., Australia, and Canada skipped needed dental care because of costs. By comparison, 5% or fewer of older adults in the Netherlands and Germany went without dental care.
NEW INTERNATIONAL SURVEY: Older Adults in U.S. Struggle with Health Care Costs More Than Those in Other Nations December 4, 2024 https://www.commonwealthfund.org/press-release/2024/new-international-survey-older-adults-us-struggle-health-care-costs-more-those
US seniors face greater affordability challenges, study finds https://www.fiercehealthcare.com/regulatory/us-seniors-face-greater-affordability-challenges-study-finds
Empower: Gen Z financial aspirations: “Gen Z’s lofty salary goal of nearly $600,000 a year underlies a generational shift to the political right. Young voters were already moving away from a liberal worldview, but if these attitudes hold, the implications for the next few election cycles are profound. Financial services company Empower surveyed more than 2,200 Americans in September and the Gen Z respondents — born between 1997 and 2012 — said they would need to make more than $587,000 a year to be “financially successful.” That’s roughly three times to six times what any other age group said they would need. It’s almost nine times the average U.S. salary, according to the Social Security Administration.
There are a number of factors at play that have a cumulative effect on Gen Z’s financial attitudes.
- Angst:“Many people feel they’re coming up short — with half believing they’re less financially successful compared to others around them…
- Persistently high costs:“Sure, groceries, student loan payments, the cost of going out to restaurants and bars all matter — but ‘feeling successful’ when you have to have a roommate to afford rent undermines all capacity for consumption,”
- The influence of influencers:”. Influencers portray false versions of reality that suggest wealth building being easy and hard work being outdated…It is widely known that comparison is the thief of joy, and this leads the next generation to feel discouraged, setting higher and higher bars as a prerequisite for happiness.”
- Mismatched expectations: “They’re concerned about increased costs of living, hyper-aware that their money isn’t going as far as it used to even few years ago. Our hypothesis is this is having a major impact on what they think it takes to be ‘financially successful’
What Gen Z’s salary goals say about their political move to the right
Prescription Drugs
Study: Drug prices after IRA: In August 2024, Medicare published the negotiated prices for the first 10 drugs selected for negotiation per the Inflation Reduction Act. Researchers analyzed negotiated prices in the US compared with net prices before negotiation, ceiling prices, and list prices in 6 other high-income countries. Findings:
“Negotiated prices were 8% (dapagliflozin) to 42% (sitagliptin) lower than net prices before negotiation. For example, the price of dapagliflozin decreased from $193.80 to $178.50 per 30-day supply; that of sitagliptin, from $195.60 to $113.00.
For etanercept, ibrutinib, and ustekinumab, negotiated prices matched the ceilings, which were 33% to 40% lower than estimated net price. For insulin as part, the negotiated price was close to the list price of the product after the manufacturer (Novo Nordisk) introduced a price cut in 2024.5 For all other products, negotiated prices fell below the ceilings, with ceilings for 5 of the 6 drugs set at initial net prices.
Apart from insulin, which had a voluntary price reduction in 2024, all products remained more expensive in the US than in other countries. For example, the price negotiated by Medicare for ustekinumab ($4695.00 per 30-day supply) was higher than prices in other countries, which ranged from $1219.92 in France to $2503.99 in Germany. However, the gap between US and non-US prices narrowed for all drugs…
CMS estimated that if negotiated prices had been implemented in 2023, net spending would have been reduced by 22%.”
Drug Prices Negotiated by Medicare vs US Net Prices and Prices in Other Countries JAMA Network December 2, 2024 https://jamanetwork.com
340B in 119th Congress: “The federal drug discount program for safety-net hospitals and clinics has been a perennial source of disputes among powerful health industries. And with time running out for Congress to act on changes to the program this year, some states are taking the lead…
The federal 340B program may not command many headlines, but it’s one of the biggest government drug programs. It is also growing at a rapid clip, with discounted drug purchases hitting a record of $66.3 billion in 2023. Lawmakers have taken several recent cuts at reforming the program but will probably have to pick up where they left off next year. Then, incoming Senate Majority Leader John Thune (R-S.D.)— who’s long been involved in the issue — will be in charge of the upper chamber’s schedule.
With the stakes high and court cases piling up, 340B reform will loom large in the 119th Congress, experts predict. With Sen. Thune as majority leader and [Sen. Bill] Cassidy as health committee chair, there will be a greater push to make 340B reform happen in the next Congress,” said Darbin Wofford, a senior health policy adviser at Third Way. We’ve seen exponential growth in the program over the past decade, and lawmakers are looking to make improvements.”
Axios Vitals 1 big thing: Searching for drug discount fixes Axios
Workforce
BLS November 2024 Jobs Report:
- The U.S. added a seasonally adjusted 227,000 jobs in Novemberin line with expectations.
- The unemployment rate rose to 4.2% from 4.1%.
- Average hourly earnings rose 4% from a year earlier vs. expected gain of 3.9%.
- Leisure and hospitality added 53,000 jobs, healthcare added 54,000, transportation equipment manufacturing sector gained 32,000 and increase of 33,000 government jobs; retail sector shed 28,000 jobs.
Hiring Bounced Back With 227,000 Jobs Added Last Month – WSJ
