Source: https://www.sensible-med.com/p/the-entire-healthcare-system-is-broken

My comment > The assassination of the Insurance CEO last week did trigger a firestorm of reactions, and Prof Vinay Prasad's analysis that the entire US Healthcare system is broken is correct.  It has become a system in which its prime purpose of preserving health of people has been totally wiped away and has become a money-generating system that provides little value to health and prefers expensive and harmful treatments over effective ones.

 

= = =

 

The American health care system is profoundly broken. We spend more than any peer nation, and have worse outcomes. Worse, for what we pay, the system is not even user friendly. I am a practicing oncologist, health policy expert and professor, and I have difficulty navigating the complex world of in-network, co-pays and billing. Toss on training modules and EPIC, and I get pissed off trying to provide care, receive care, and study health care. That’s the trifecta.

Who is at fault?

Here is the thing: everyone is at fault.

Pharmaceutical firms - Pharma firms routinely run seeding or uninformative trials and ram through unproven medical products. Because of how they have lobbied, they ensure that Medicare and insurance will reimburse for these things. They drive up health care spending.

PBMs - these middlemen often exploit inequities in the market, and collect a pretty penny for little added value.

FDA/ CMS - these government officials live through the revolving door. They often have little incentive to be a tough regulator because they benefit (in terms of future employment from lowering the bar). Lately, under Marks/ Califf, they have done a particularly <deleted> job: exondys, lartruvo, aducanumab, covid boosters, paxlovid, melflufen, selenexor the list goes on and on.

Insurance companies - make no mistake, insurers would love to see not 20, but 50% of US GDP spend on health care. What people don’t realize is that insurers make more TOTAL PROFITS the more we spend on healthcare, not the less we spend. The Affordable care act caps their profit on revenue, depending on the plan, at 15-20%. In other words, insurers can only take this maximal percentage of all the money that passes through them. (currently, they are often lower than this).

While they do want to control year to year variability— through annoying things like denials and prior auth— that is mostly to make behavior predictable. In the long run, they want health care spending to grow. If we go out to pizza and I say: you can only eat 20% of the pie, what size should I buy? What do you think you will say?….. extra large.

Hospitals/ academic centers - the behavior of hospitals is predatory, and they swallow the most cash in the entire system. They use their academic names to hide that they are working as prostitutes for pharma, running unethical trials. They gobble up small practices to consolidate market share. They charge ridiculous rates, and engage in deceptive practices. How often do we discharge a patient after chemo to get Neulasta in clinic, so we can bill it as an outpatient? Places like UPMC are 4 billion dollar juggernauts which are more akin to a leech sucking the blood out of the catchment area than a medical center.

Doctors - sorry, doctors are completely complicit in the broken system. They order unnecessary tests, they consult for Pharma companies, they push for unproven things— like a double lung transplant in a person with Stage IV cancer. This was what Vandy advocated for— totally insane medicine, and worse, they want to tax plumbers and janitors to pay for their experimental science.

Doctors don’t want to learn evidence based medicine. They are entirely unwilling to self-regulate. Yes, we are often treated poorly, and certainly the glory days are gone, but we are entirely complicit in the high and unsustainable price of health care. Let me be crystal clear: A lot of health care that doctors want to give, but insurers don’t want to cover is 100%, complete and total bu11<deleted>.

This is the system. It is broken. Worse, no one will fix it. Prior FDA commissioners and CMS directors are spineless jellyfish, worried more about their future consulting than reforming the system. The American People are rightly frustrated. The voted for Trump with RFK Jr at his side because they know that, unlike the typical sell-out (think Scott Gottlieb), RFK Jr is the most likely to make a lot of changes. And even if 3 out of 10 changes is harmful, Americans will accept it, in the hope 7 are good. And if some changes make the system worse or break it entirely, perhaps, they think, so be it, that only means reform must come sooner.

Against this backdrop, you have doctor influencers and others who choose to point the finger at one entity. An easy scapegoat is the insurance industry because they issue denials and make our life harder. And don’t get me wrong, I hate prior auth just like all my friends because I don’t want to explain myself to a m0r0n, and that is who is on the other end of the line, but this is a classic scapegoat. An innocent made to take the blame for a broader problem.

The SYSTEM is broken, and insurance companies are not the SOLE villain. Also, imagine for a moment, if we made a law saying insurers could NOT decline any service. First, several would go bankrupt in a stochastic way. The ones that happen to have docs who are insane and order a lot of useless <deleted> first will go bankrupt. But those who survive the initial earthquake will crank up their premiums.

They will obliterate you with their premiums. You will drown in those premiums. You will be eating canned tuna like the apocalypse is here, but have access to prenuvos and a rectal MRI and sequencing your literal <deleted>. GDP spending on health care will explode. The US will likely collapse as Rome did before. In the Roman city before the fall 50% of days were holidays— we will collapse when 50% of GDP is on health care. Doctors who advocate for this are ignorant and typically online influencers, perhaps even comedians, who know very little, and stoke popular flames.

 

> The above is the jist of the article with Prasad's imo correct analysis, and you can read the remainder of the article that addresses the assassination of the Insurance CEO and the task of RFK jr to change course of the system, here > https://www.sensible-med.com/p/the-entire-healthcare-system-is-broken

It's mess for sure. As for being broken? That suggests it wasn't before.

All run by the money people. A sick person is a customer; maybe for life. A well person is no good to Big Pharma.

The whole idea of capitalism, and thus private companies offering health care, is that they compete and the competition forces prices down. So, why have prices risen? One reason may be the companies realize people are stuck and have to pay what they demand or not get medical treatment. Inefficiencies mean they don't have collective bargaining with pharma companies (too socialist) so pharma companies realize the insurance companies are again stuck with whatever prices they want to charge for medicines people need. Prices rise instead of falling because everyone in the system wants to be rich and make more profits for shareholders. This isn't going to change without some farsighted leadership from whichever government is smart enough to realize that fixing the problem will keep them in power longer.

The greedy insurance companies broke the health care system.

Let's be clear. The Republicans are the reason we in the USA can't have nice things like universal health care coverage. Sure the Democrats are bad also, but against great odds, they often try.

1 hour ago, ricklev said:

Let's be clear. The Republicans are the reason we in the USA can't have nice things like universal health care coverage. Sure the Democrats are bad also, but against great odds, they often try.

Disagree, as healthcare & insurance was a lot cheaper before ACA. ACA did solve a couple things, theoritcally, but at a high cost to everyone else.

4 hours ago, KhunLA said:

Disagree, as healthcare & insurance was a lot cheaper before ACA. ACA did solve a couple things, theoritcally, but at a high cost to everyone else.

6 hours ago, ricklev said:

Let's be clear. The Republicans are the reason we in the USA can't have nice things like universal health care coverage. Sure the Democrats are bad also, but against great odds, they often try.

6 hours ago, JimHuaHin said:

The greedy insurance companies broke the health care system.

On 12/18/2024 at 1:41 PM, Red Phoenix said:

''It has become a system in which its prime purpose of preserving health of people has been totally wiped away and has become a money-generating system that provides little value to health and prefers expensive and harmful treatments over effective ones."

Broken!?

The elephant in the room, the villain in the shop window is the 'Germ Theory'. But the germ theory is man-made; you say. And so it is. It was made up a long time ago. It was a theory, that greedy people visualised could make them big money. Money!? Yes indeed! There was serious money to be made from insisting it was medical and human 'truth'. In fact, it is as far from the 'truth' as it's possible to get. It is anti-nature. Anti-nature is anti-truth.

It really took off during the first two decades of the 1900s. And why was that? Well, in a nut-shell, the almighty $$$, and people's greed. And also wanting to be in the new club of hospitals and Rockefeller teaching establishments. Why would the health establishments want that? $$$ grants and funding.

By 1920 the only game in town was bad germs. And, of course the new medicines that could conquer them. Enter the virus. Viruses are special germs. There were viruses everywhere. Behind buildings. In the trenches. Under logs in the forest. In bats and chickens; just waiting to leave their hosts and jump onto humans. They emerged after WW2 big time. Causing Polio, AIDS. Deformed babies (oops not that one). Vioxx (sorry; not that one either). And of course COVD-19. That little sortie, allowed military deep states all over the world to force lock-downs. And health regimes to highly recommend the 'safe n effective' experimental jabs to prevail over nutritious food and sunshine, in order to curtail the pandemic's march; and to flatten the curve. Save Grannie also (almost forgot that one).

By most white-coat accounts, as of 2026, they still are a'coming, and wreaking terrible havoc.

If you think the above 100, or so words, wouldn't be out of place on April 1st; you are right.

Here's the truth: There are no such things as viruses. They obviously can't then cause disease. If they don't exist, what does cause disease? Well nothing 'causes' disease. There is illness for sure. But the 'illness' is the body doing what it is designed to do; getting itself back to optimum health. The illness is the symptoms of the body ridding itself of impurities and getting back to balance. Diseases are made up by the white-coats.

So! As there are no viruses. No diseases. And as a recent essay points out; no immune system. What might vaccines, and indeed, the list of monstrous drugs, that the know-nothing white-coats push onto their patients, be for? Masquerading as safe n effective cures for diseases that don't exist. Why? It's that crafty $$$ again I reckon.

Can there be changes. I've often said that us human's biggest enemies are ignorance and apathy. But! For them to dissipate, there has to be open truth. An awakening. Truth - for all to see - can only be achieved if there is transparency. Secrets! Dossiers! Files! Vids! You listening Kennedy? You out there Trump? Dear me! We, the people of the world, must insist on truth and transparency. Only then, can we humans achieve our true destiny.

Just one final thought about nature:

A giant tree was once a nut/seed that held it's ground.