#american health care costs

[seabeck]

"dull knives aren't safe they're more dangerous than a sharp knife!"

tell that to my now 5+ scars from ultra sharp fillet knives

[batboyblog]

Things the Biden-Harris Administration Did This Week #31

August 9-16 2024

President Biden and Vice-President Harris announced together the successful conclusion of the first negotiations between Medicare and pharmaceutical companies over drug prices. For years Medicare was not allow to directly negotiate princes with drug companies leaving seniors to pay high prices. It has been a Democratic goal for many years to change this. President Biden noted he first introduced a bill to allow these negotiations as a Senator back in 1973. Thanks to Inflation Reduction Act, passed with no Republican support using Vice-President Harris' tie breaking vote, this long time Democratic goal is now a reality. Savings on these first ten drugs are between 38% and 79% and will collectively save seniors $1.8 billion dollars in out of pocket costs. This comes on top of the Biden-Harris Administration already having capped the price of insulin for Medicare's 3.5 million diabetics at $35 a month, as well as the Administration's plan to cap Medicare out of pocket drug costs at $2,000 a year starting January 2025.

President Biden and Vice President Harris have launched a wide ranging all of government effort to crack down on companies wasting customers time with excessive paperwork, hold times, and robots rather than real people. Some of the actions from the "Time is Money" effort include: The FTC and FCC putting forward rules that require companies to make canceling a subscription or service as easy as signing up for it. The Department of Transportation has required automatic refunds for canceled flights. The CFPB is working on rules to require companies to have to allow customers to speak to a real person with just one button click ending endless "doom loops" of recored messages. The CFPB is also working on rules around chatbots, particularly their use from banks. The FTC is working on rules to ban companies from posting fake reviews, suppressing honest negative reviews, or paying for  positive reviews. HHS and the Department of Labor are taking steps to require insurance companies to allow health claims to be submitted online. All these actions come on top of the Biden Administration's efforts to get rid of junk fees.

President Biden and First Lady Jill Biden announced further funding as part of the President's Cancer Moonshot. The Cancer Moonshot was launched by then Vice-President Biden in 2016 in the aftermath of his son Beau Biden's death from brain cancer in late 2015. It was scrapped by Trump as political retaliation against the Obama-Biden Administration. Revived by President Biden in 2022 it has the goal of cutting the number of cancer deaths in half over the next 25 years, saving 4 million lives. Part of the Moonshot is Advanced Research Projects Agency for Health (ARPA-H), grants to help develop cutting edge technology to prevent, detect, and treat cancer. The President and First Lady announced $150 million in ARPA-H grants this week focused on more successful cancer surgeries. With grants to Tulane, Rice, Johns Hopkins, and Dartmouth, among others, they'll help fund imaging and microscope technology that will allow surgeons to more successfully determine if all cancer has been remove, as well as medical imaging focused on preventing damage to healthy tissues during surgeries.

Vice-President Harris announced a 4-year plan to lower housing costs. The Vice-President plans on offering $25,000 to first time home buyers in down-payment support. It's believed this will help support 1 million first time buyers a year. She also called for the building of 3 million more housing units, and a $40 billion innovation fund to spur innovative housing construction. This adds to President Biden's call for a $10,000 tax credit for first time buyers and calls by the President to punish landlords who raise the rent by over 5%.

President Biden Designates the site of the 1908 Springfield Race Riot a National Monument. The two day riot in Illinois capital took place just blocks away from Abraham Lincoln's Springfield home. In August 1908, 17 people die, including a black infant, and 2,000 black refugees were forced to flee the city. As a direct result of the riot, black community leaders and white allies met a few months later in New York and founded the NAACP. The new National Monument will seek to preserve the history and educate the public both on the horrible race riot as well as the foundation of the NAACP. This is the second time President Biden has used his authority to set up a National Monument protecting black history, after setting up the Emmett Till and Mamie Till-Mobley National Monument on Emmett Till's 82nd birthday July 25th 2023.

The Department of The Interior announced $775 million to help cap and clean up orphaned oil and gas wells. The money will help cap wells in 21 states. The Biden-Harris Administration has allocated $4.7 billion to plug orphaned wells, a billion of which has already been distributed. More than 8,200 such wells have been capped since the Bipartisan Infrastructure Law passed in 2022. Orphaned wells leak toxins into communities and are leaking the super greenhouse gas methane. Plugging them will not only improve the health of nearby communities but help fight climate change on a global level.

Vice-President Harris announced plans to ban price-gouging in the food and grocery industries. This would be a first ever federal ban on price gouging and Harris called for clear "rules of the road" on price rises in food, and strong penalties from the FTC for those who break them. This is in line with President Biden's launching of a federal Strike Force on Unfair and Illegal Pricing in March, and Democratic Senator Bob Casey's bill to ban "shrinkflation". In response to this pressure from Democrats on price gouging and after aggressive questions by Senator Casey and Senator Elizabeth Warren, the supermarket giant Kroger proposed dropping prices by a billion dollars

[silverwoodgelfling]

Y'all. If you need basic medical care or dental care see if there is a rural health program in your driving range. Especially if they offer a sliding scale fee system.

I have been having dental issues, slowly getting things done over the last 6 months or so. Because my state changes some insurance stuff I didn't realize in time that my health +dental insurance had dropped the dental coverage. I had to go in today as uninsured and the initial estimate was $174. With a sliding scale fee I only paid $84 out of pocket. For reference with insurance the same procedure was $46. It was still more than I hoped to pay but saved me half of the estimate price.

Long story is I have a strong aversion to anything dental thanks to mental trauma from a parent. Not afraid of the dentist more the disappointed looks. I completely changed dental locations to not have to see people I basically grew up with and that has meant that I was able to have a couple abscessed teeth extracted and I am scheduled for a normal cleaning and some fillings.

I still need to find a specialist for a root canal and an implant and I will eventually get both the implant and partial dentures but at least my chronic pain from very badly broken down teeth is mostly going away.

[passengerpigeons]

becoming largely chill about most things. but i give myself permission to be mad about car infrastructure, car dependence, and cars flagrantly ignoring pedestrian right-of-way and generally endangering beings of flesh. because this is one of the few truly moral axis of this world

[ihavenoideahowtodream]

I just stood in line at the pharmacy for a whole hour. Thankfully the last half I was able to sit in a chair. There was a lady in front of me who had waited 4 hours to get her daughter’s meds so her body wouldn’t reject her kidney transplant. Another lady had been here 4 days in a row and the line was too long for her to wait. Another lady left half way through the line telling her friend that she hadn’t taken the meds for three days a fourth wouldn’t hurt her.

I’m so goddamn tired. Especially sitting there thinking at least it’s warm unlike my house where my furnace was fucked cause my landlord never serviced the damn thing.

America needs health care reform so fucking bad.

There was one tech working there.

[thebookewyrme]

So, I have finally realized, I think what's putting me in the hole every month is physical therapy. It's $25 a week, which amounts to a $100 a month. Like, there have been other things too, from being committed to too many things probably. But I think a big part is PT. Which has been helping so much! I can almost walk completely pain free now! But I think I'm gonna have to quit soon, and that's making me mad. Our medical system is so fucked.

[nidamae-spedmom]

Not exactly ADHD, autism, etc related but kids are kids.

Ok so my kid had an ear infection, right? As kids often do.

The doctor scraped out a bit of earwax to have a better look inside.

I was sent a bill for $200 PER EAR for this 5 second procedure which I did not give permission for them to do.

That was key- they did not ASK me if they could do this "procedure". And, as I OWN a medical practice (it's me. The medical practice is me, sitting in my house on video calls) I knew to call them when this bill came in to be like "You did not obtain informed consent for this procedure, and it was not en emergency procedure. You had full ability to gain my consent and didn't. I'm not paying."

And the massive hospital who owned the bill said "yuh-huh you do have to pay."

And I said "I own a practice. I know these laws. I do not owe you money for this."

And they conducted an "internal review" and SURPRISE! Decided I totally owed them money and they had never done anything wrong ever.

And so I called my state's Attorney General office, and explained the situation because, as I mentioned, I know the law. The AG got in touch within a couple days to say they were taking the case and would send the massive hospital conglomerate a knock it off, guys letter.

Lo and Behold, today I have a letter where said hospital graciously has agreed to forfeit the payment.

"How not to get screwed over by companies" should be part of civics class.

Know your rights and know who to call when they're infringed on. This whole process cost me $0 and honestly less effort than I would have expected.

May this knowledge find its way to someone else who can use it.

[sadbicth]

elon musk did a nazi salute twice at the inauguration, and republicans are defending him.

trump revoked executive order 11246, which prohibited discrimination.

trump put all dei employees on leave to be fired.

trump blamed the dc plane crash on dei.

trump banned all lgbtq+ flags from being hung in government buildings.

trump ordered the pentagon to cancel celebration of mlk jr. day, black history month, women's history month, holocaust remembrance day, asian american pacific islander heritage month, lgbtq+ pride month, juneteenth, women's equality day, national hispanic heritage month, national disability employment awarenessmonth, and national american indian heritage month.

trump rolled back biden’s executive order to lower prescription drug costs for people using medicare and medicaid.

trump rescinded the $35 cap on insulin, and prices are expected to rise to $1500 a month.

trump ordered the national institutes of health to cancel their review panels on cancer research.

trump ended the guidelines to prevent ai misuse. the guidelines prevent many things, but notably it prevents production of ai child pornography.

when sean hannity asked trump about the economy, he said “i don’t care”, after campaigning with the economy as his main talking point.

trump has withdrawn the us from the world health organization.

trump is ordering health agencies to stop reporting on bird flu and halt publications of scientific reports.

trump has pardoned over 1500 people who stormed the capitol on january 6th.

trump changed mount denali back to mount mckinley.

trump signed an executive order to rename the gulf of mexico to gulf of america.

trump shut down cbp one, an app which granted legal entry to 1 million+ immigrants.

trump is allowing ice raids at churches and elementary schools.

trump announced plans to declare a national emergency at the us-mexico border.

trump signed an executive order to expand the use of the death penalty.

trump disbanded the school safety board that works to prevent school shootings. it was comprised of survivors, educators, and gun violence prevention advocates and formed after the school shooting in parkland.

trump withdrew from the paris climate act.

trump revoked all protections for transgender troops in the us military.

trump rescinded executive orders made by biden that benefited and protected women, lgbtq+ people, black americans, hispanic americans, asian americans, native hawaiians, and pacific islanders.

trump is attempting to make it legal to refuse to hire or fire pregnant women.

multiple state legislators are drafting bills to allow the punishment for abortion to be the death penalty.

trump pardoned 23 individuals convicted under the freedom of access to clinic entrances (FACE) act for their anti-abortion activism, including oftentimes violent protests at abortion clinics.

trump signed an executive order allowing deportation of foreign students who they believe express support for hamas or hezbollah.

trump announced that the us government will from here on out only recognize male and female as sexes. intersex is not legally recognized anymore.

trump refused to swear on the bible during his inauguration. (i’ve gotten some comments about this specific point. i didn’t include it because i’m christian, because i’m not. i’m agnostic. i included it because he’s the first president in history to refuse to swear on ANYTHING, bible or not. in the bible it teaches that the only person who cannot touch the bible is the antichrist, yet that on TOP of everything else will never convince his followers that he’s unfit.)

the trump administration paused health communications to prevent the fda from announcing food recalls.

andy ogles drafted a constitutional amendment to allow trump to be president for a third term.

georgia republican congressman mike collins called for the deportation of new jersey born mariann budde, the bishop who urged trump to “have mercy” on the lgbtq+ community and immigrants during a service at the national cathedral.

six states (arizona, idaho, iowa, kansas, mississippi, and north dakota) are planning on challenging obergefell v. hodges, which would end same-sex marriage nationwide. about a dozen more states have representatives are also considering filing similar resolutions.

amazon revoked protections for lgbtq+ and black employees.

the cdc has removed their hiv prevention page.

the united states state department has officially changed its “travelers with special conditions” page which previously said “lgbtqi+ travelers” to “lgb travelers”, completely getting rid of the tqi+.

every single republican told us we were overreacting. trump swore he had nothing to do with project 2025 yet continues implementing details outlined in it. not a single person has the right to tell us we’re being dramatic anymore.

hope “cheaper eggs and gas” was worth it.

[boreal-sea]

Look.

I have made you a chart. A very simple chart.

People say "You have to draw the line somewhere, and Biden has crossed it-" and my response is "Trump has crossed way more lines than Biden".

These categories are based off of actual policy enacted by both of these men while they were in office.

If the ONLY LINE YOU CARE ABOUT is line 12, you have an incredible amount of privilege, AND YOU DO NOT CARE ABOUT PALESTINIANS. You obviously have nothing to fear from a Trump presidency, and you do not give a fuck if a ceasefire actually occurs. You are obviously fine if your queer, disabled, and marginalized loved ones are hurt. You clearly don't care about the status of American democracy, which Trump has openly stated he plans to destroy on day 1 he is in office.

EDIT:

Ok fine, I spent 3 hours compiling sources for all of these, you can find that below the cut.

I'll give at least one link per subject area. There are of course many more sources to be read on these subject areas and no post could possibly give someone a full education on these subjects.

Biden and trans rights: https://www.hrc.org/resources/president-bidens-pro-lgbtq-timeline

Trump and trans rights: https://www.aclu.org/news/lgbtq-rights/trump-on-lgbtq-rights-rolling-back-protections-and-criminalizing-gender-nonconformity

The two sources above show how Biden has done a lot of work to promote trans rights, and how Trump did a lot of work to hurt trans rights.

Biden on abortion access: https://www.cnn.com/2022/07/08/politics/what-is-in-biden-abortion-executive-order/index.html

Trump on abortion access: https://apnews.com/article/abortion-trump-republican-presidential-election-2024-585faf025a1416d13d2fbc23da8d8637

Biden openly supports access to abortion and has taken steps to protect those rights at a federal level even after Roe v Wade was overturned. Trump, on the other hand, was the man who appointed the judges who helped overturn Roe v Wade and he openly brags about how proud he is of that decision. He also states that he believes individual states should have the final say in whether or not abortion is legal, and that he trusts them to "do the right thing", meaning he supports stronger abortion bans.

Biden on environmental reform: https://www.whitehouse.gov/briefing-room/statements-releases/2021/10/07/fact-sheet-president-biden-restores-protections-for-three-national-monuments-and-renews-american-leadership-to-steward-lands-waters-and-cultural-resources/

Trump on environmental reform: https://www.nytimes.com/interactive/2020/climate/trump-environment-rollbacks-list.html

Biden has made major steps forward for environmental reform. He has restored protections that Trump rolled back. He has enacted many executive orders and more to promote environmental protections, including rejoining the Paris Accords, which Trump withdrew the USA from. Trump is also well known for spreading conspiracy theories and lies about global climate change, calling it a "Chinese hoax".

Biden on healthcare and prescription reform: https://www.hhs.gov/about/news/2023/06/09/biden-administration-announces-savings-43-prescription-drugs-part-cost-saving-measures-president-bidens-inflation-reduction-act.html

Trump on healthcare reform: https://www.cnn.com/2024/01/07/politics/obamacare-health-insurance-ending-trump/index.html

I'm rolling healthcare and prescriptions and vaccines and public health all into one category here since they are related. Biden has lowered drug costs, expanded access to medicaid, and ACA enrollment has risen during his presidency. He has also made it so medical debt no longer applies to a person's credit score. He signed many executive orders during his first few weeks in office in order to get a handle on Trump's grievous mishandling of the COVID pandemic. Trump also wants to end the ACA. Trump is well known for refusing to wear a mask during the pandemic, encouraging the use of hydroxylchloroquine to "treat" COVID, and being openly anti-vaxx.

Biden on student loan forgiveness: https://www.ed.gov/news/press-releases/biden-harris-administration-announces-additional-77-billion-approved-student-debt-relief-160000-borrowers

Trump on student loan forgiveness: https://www.forbes.com/sites/adamminsky/2024/06/20/trump-knocks-bidens-vile-student-loan-forgiveness-plans-suggests-reversal/

Trump wants to reverse the student loan forgiveness plans Biden has enacted. Biden has already forgiven billions of dollars in loans and continues to work towards forgiving more.

Infrastructure funding:

I'm putting these links next together because they are all about infrastructure.

In general, Trump's "achievements" for infrastructure were to destroy environmental protections to speed up projects. Many of his plans were ineffective due to the fact that he did not clearly outline where the money was going to come from, and he was unwilling to raise taxes to pay for the projects. He was unable (and unwilling) to pass a bipartisan infrastructure bill during his 4 years in office. He did sign a few disaster relief bills. He did not enthusiastically promote renewable energy infrastructure. He created "Infrastructure Weeks" that the federal government then failed to fund. Trump did not do nothing for infrastructure, but his no-tax stance and his dislike for renewable energy means the contributions he made to American infrastructure were not as much as he claimed they were, nor as much as they could have been. Basically, he made a lot of promises, and delivered on very few of them. He is not "against" infrastructure, but he's certainly against funding it.

Biden was able to pass that bipartisan bill after taking office. The Bipartisan Infrastructure Plan that Trump tried to prevent from passing during Biden's term contains concrete funding sources and step by step plans to rebuild America's infrastructure. If you want to read the plan, you can find it here: https://www.whitehouse.gov/build/guidebook/. Biden has done far more for American infrastructure than Trump did, most notably by actually getting the bipartisan bill through congress.

Biden on Racial Equity: https://www.npr.org/sections/president-biden-takes-office/2021/01/26/960725707/biden-aims-to-advance-racial-equity-with-executive-actions

Trump on Racial Equity: https://www.axios.com/2024/04/01/trump-reverse-racism-civil-rights https://www.bbc.com/news/av/world-us-canada-37230916

Trump's racist policies are loud and clear for everyone to hear. We all heard him call Mexicans "Drug dealers, criminals, rapists". We all watched as he enacted travel bans on people from majority-Muslim nations. Biden, on the other hand, has done quite a lot during his term to attempt to reconcile racism in this country, including reversing Trump's "Muslim ban" the first day he was in office.

Biden on DEI: https://www.whitehouse.gov/briefing-room/presidential-actions/2021/06/25/executive-order-on-diversity-equity-inclusion-and-accessibility-in-the-federal-workforce/

Trump on DEI: https://www.msn.com/en-us/news/politics/trump-tried-to-crush-the-dei-revolution-heres-how-he-might-finish-the-job/ar-BB1jg3gz

Biden supports DEI and has signed executive orders and passed laws that support DEI on the federal level. Trump absolutely hates DEI and wants to eradicate it.

Biden on criminal justice reform: https://time.com/6155084/biden-criminal-justice-reform/

Trump on criminal justice reform: https://www.vox.com/2020-presidential-election/21418911/donald-trump-crime-criminal-justice-policy-record https://www.theatlantic.com/politics/archive/2024/05/trumps-extreme-plans-crime/678502/

From pardons for non-violent marijuana convictions to reducing the federal government's reliance on private prisons, Biden has done a lot in four years to reform our criminal justice system on the federal level. Meanwhile, Trump has described himself as "tough on crime". He advocates for more policing, including "stop and frisk" activities. Ironically it's actually quite difficult to find sources about what Trump thinks about crime, because almost all of the search results are about his own crimes.

Biden on military support for Israel: https://www.nbcnews.com/politics/national-security/biden-obama-divide-closely-support-israel-rcna127107

Trump on military support for Israel: https://www.vox.com/politics/353037/trump-gaza-israel-protests-biden-election-2024

Biden supports Israel financially and militarily and promotes holding Israel close. So did Trump. Trump was also very pro-Israel during his time in office and even moved the embassy to Jerusalem and declared Jerusalem the capitol of Israel, a move that inflamed attitudes in the region.

Biden on a ceasefire: https://www.usatoday.com/story/news/world/2024/06/05/gaza-israel-hamas-cease-fire-plan-biden/73967659007/

Trump on a ceasefire: https://www.nbcnews.com/politics/donald-trump/trump-israel-gaza-finish-problem-rcna141905

Trump has tried to be quiet on the issue but recently said he wants Israel to "finish the problem". He of course claims he could have prevented the whole problem. Trump also openly stated after Oct 7th that he would bar immigrants who support Hamas from the country and send in officers to American protests to arrest anyone supporting Hamas.

Biden meanwhile has been quietly urging Netanyahu to accept a ceasefire deal for months, including the most recent announcement earlier in June, though it seems as though that deal has finally fallen through as well.

[bj-freeplay]

Also! Let’s be clear! Folks HATE our insurance here. Which- like- the world is now aware of considering recent events. It’s not like Americans enjoy the system or are entirely complacent about it. It’s just been so engrained into our society over the decades ppl don’t know *what* to do here.

Universal health care is scary to folks partially bc they’re misinformed over the value of our drugs and medical procedures for sure; but a lot of ppl don’t like the idea of long wait times that come with systems like the NHS over in England. Many folks I’ve talked to over the years are incredibly thankful for how specialized their care can be with privatized health care and think the idea of Universal will remove their ability to have options. It’s a very “all or nothing” conversation over here, which is not a likely way we would go about transitioning. It’s hard to communicate that Universal Health care will not remove privatized health care here. And having that divide will not have earth shattering taxes for those who rely on it even if you don’t.

It’s not dissimilar to how our university tuition problem has become what it is either. We’re a very individualist nation, and it’s not uncommon to hear the argument of “I had to earn my life so so should you” when speaking about abusive structures of power. This mindset has been confidently verbalized inside Congress as an argument against lower tuition rates and cancelling student debt. So how do you argue for the best interests of the general population against folks who think like that? They’re aware it’d be a net positive, but think there’s some arbitrary way it has to be earned by an individual with no empathy toward difference in life circumstances.

Insurance stealing our lives is a big part of our culture struggle here. Health care is just one massive aspect of that, but it’s not the only one abusing its power. When it’s so normal in so many aspects of your life it’s easy to become blind to the fact that these systems that are robbing you blind, not actually providing a service that’s goal is to actually help you, are not some inevitable option.

A lot of us also have a mistrust to the ways in which our taxes are used too. Which Really doesn’t help. Government funding for our education is placed in horrifying locations that honestly feel like blatant abuses of powers. Such as transporting a single portable building in my district would have cost 10 million dollars. Just to move it down the street for a different local school, less than a mile away. Why? Bc the board refuses to use any other transportation company than one, blatantly monopolizing the market and allowing them to up charge to what I would consider an illegal degree. All while teachers are making dirt off the exact same tax dollar being allocated through the department of education. Ppl don’t trust our government funding that comes through our tax dollars, sometimes for very good reason. So when you’re trying to argue that it CAN actually help people sometimes it feels like a herculean undertaking. 

All this mistrust, corruption, and misinformation make for a very bad cocktail. And the cocktail you’re trying to convince them to drink looks remarkably similar in ways it’s hard to avoid.

Blogging this tweet because this explains SO MUCH about the mindset of pretty much all the folks I’ve known who’re against single-payer, it’s not even funny…

[snorfbin]

god i hope all the health insurance horror stories come to an end with brian thompson

[jcmarchi]

Study: Hospice care provides major Medicare savings

New Post has been published on https://thedigitalinsider.com/study-hospice-care-provides-major-medicare-savings/

Study: Hospice care provides major Medicare savings

Hospice care aims to provide a health care alternative for people nearing the end of life by sparing them unwanted medical procedures and focusing on the patient’s comfort. A new study co-authored by MIT scholars shows hospice also has a clear fiscal benefit: It generates substantial savings for the U.S. Medicare system.

The study examines the growth of for-profit hospice providers, who receive reimbursements from Medicare, and evaluates the cost of caring for patients with Alzheimer’s disease and related dementias (ADRD). The research finds that for patients using for-profit hospice providers, there is about a $29,000 savings to Medicare over the first five years after someone is diagnosed with ADRD.

“Hospice is saving Medicare a lot of money,” says Jonathan Gruber, an MIT health care economist and co-author of a paper detailing the study’s findings. “Those are big numbers.”

In recent decades, hospice care has grown substantially. That growth has been accompanied by concerns that for-profit hospice organizations, in particular, might be overly aggressive in pursuing patients. There have also been instances of fraud by organizations in the field. And yet, the study shows that the overall dynamics of hospice are the intended ones: People are indeed receiving palliative-type care, based around comfort rather than elaborate medical procedures, at less cost.

“What we found is that hospice basically operates as advertised,” adds Gruber, the Ford Professor of Economics at MIT. “It does not extend lives on aggregate, and it does save money.”

The paper, “Dying or Lying? For-Profit Hospices and End of Life Care,” appears in the American Economic Review. The co-authors are Gruber, who is also head of MIT’s Department of Economics; David Howard, a professor at the Rollins School of Public Health at Emory University; Jetson Leder-Luis PhD ’20, an assistant professor at Boston University; and Theodore Caputi, a doctoral student in MIT’s Department of Economics.

Charting what more hospice access means

Hospice care in the U.S. dates to at least the 1970s. Patients opt out of their existing medical network and receive nursing care where they live, either at home or in care facilities. That care is oriented around reducing suffering and pain, rather than attempting to eliminate underlying causes. Generally, hospice patients are expected to have six months or less to live. Most Medicare funding goes to private contractors supplying medical care, and in the 1980s the federal government started using Medicare to reimburse the medical expenses from hospice as well.

While the number of nonprofit hospice providers in the U.S. has remained fairly consistent, the number of for-profit hospice organizations grew fivefold between 2000 and 2019. Medicare payments for hospice care are now about $20 billion annually, up from $2.5 billion in 1999. People diagnosed with ADRD now make up 38 percent of hospice patients.

Still, Gruber considers the topic of hospice care relatively under-covered by analysts. To conduct the study, the team examined over 10 million patients from 1999 through 2019. The researchers used the growth of for-profit hospice providers to compare the effects of being enrolled in non-profit hospice care, for-profit hospice care, or staying in the larger medical system.

That means the scholars were not only evaluating hospice patients; by evaluating the larger population in a given area where and when for-profit hospice firms opened their doors, they could see what difference greater access to hospice care made. For instance, having a new for-profit hospice open locally is associated with a roughly 2 percentage point increase in for-profit hospice admissions in following years.

“We’re able to use this methodology to [analyze] if these patients would otherwise have not gone to hospice or would have gone to a nonprofit hospice,” Gruber says.

The method also allows the scholars to estimate the substantial cost savings. And it shows that enrolling in hospice increased the five-year post-diagnosis mortality rate of ADRD patients by 8.6 percentage points, from a baseline of 66.6 percent. Entering into hospice care — which is a reversible decision — means foregoing life-extending surgeries, for instance, if people believe such procedures are no longer desirable for them.

Rethinking the cap

By providing care without more expensive medical procedures, it is understandable that hospice reduces overall medical costs. Still, given that Medicare reimburses hospice organizations, one ongoing policy concern is that hospice providers might aggressively recruit a larger percentage of patients who end up living longer than six additional months. In this way hospice providers might unduly boost their revenues and put more pressure on the Medicare budget.

To counteract this, Medicare rules include a roughly $29,205 cap on per-patient reimbursements, as of 2019. Most patients die relatively soon after entering hospice care; some will outlive the six-month expectation significantly. But hospice organizations cannot exceed that average.

However, the study also suggests the cap is a suboptimal approach. In 2018, 15.5 percent of hospice patients were being discharged from hospice care while still alive, due to the cap limiting hospice capacity. As the paper notes, “patients in hospices facing cap pressure are more likely to be discharged from hospice alive and experience higher mortality rates.”

As Gruber notes, the spending cap is partly a fraud-fighting tool. And yet the cap clearly has other, unintended consquences on patients and their medical choices, crowding some out of the hospice system.

“The cap may be throwing the baby out with the bathwater.” Gruber says. “The government has more focused tools to fight fraud. Using the cap for that is a blunt instrument.”

As long as people are informed about hospice and the medical trajectory it puts them on, then, hospice care appears to be providing a valued service at less expense than other approaches to end-of-life care.

“The holy grail in health care is things that improve quality and save money,” Gruber says. “And with hospice, there are surveys saying people like it. And it certainly saves money, and there’s no evidence it’s doing harm [to patients]. We talk about how we struggle to deal with health care costs in this country, so this seems like what we want.”

The research was supported in part by the National Institute on Aging of the National Institutes of Health. 

[ohello0]

Someone on the radio just talked about the growing industry of ppl capitalizing off of our neglectful and collapsing healthcare system and told ppl to “get their hustle up” by starting up a POSTPARTUM DOULA RETREAT BUSINESS???

[batboyblog]

Things the Biden-Harris Administration Did This Week #39

October 18-25 2024.

President Biden issued the first presidential apology on behalf of the federal government to America's Native American population for the Indian boarding school policy. For 150 years the federal government operated a system of schools which aimed to destroy Native culture through the forced assimilation of native children. At these schools students faced physical, emotional, and sexual abuse, and close to 1,000 died. The Biden-Harris Administration has been historic for Native and Tribal rights. From the appointment of the first ever Native American cabinet member, Secretary of the Interior Deb Haaland, to the investment of $46 billion dollars on tribal land, to 200 new co-stewardship agreements. The last 4 years have seen a historic investment in and expansion of tribal rights.

The Biden-Harris Administration proposed a new rule which would make contraceptive medication (the pill) free over the counter with most Insurance. The new rule would ban cost sharing for contraception products, including the pill, condoms, and emergency contraception. On top of over the counter medications, the new rule will also strength protections for prescribed contraception without cost sharing as well.

The EPA announced its finalized rule strengthening standards for lead paint dust in pre-1978 housing and child care facilities. There is no safe level of exposure to lead particularly for children who can suffer long term developmental consequences from lead exposure. The new standards set the lowest level of lead particle that can be identified by a lab as the standard for lead abatement. It's estimated 31 million homes built before the ban on lead paint in 1978 have lead paint and 3.8 million of those have one or more children under the age of 6. The new rule will mean 1.2 million fewer people, including over 300,000 children will not be exposed to lead particles every year. This comes after the Biden-Harris Administration announced its goal to remove and replace all lead pipes in America by the end of the decade.

The Department of Transportation announced a $50 million dollar fine against American Airlines for its treatment of disabled passengers and their wheelchairs. The fine stems from a number of incidences of humiliating and unfair treatment of passages between 2019 and 2023, as well as video documented evidence of mishandling wheelchairs and damaging them. Half the fine will go to replacing such damaged wheelchairs. The Biden administration has leveled a historic number of fines against the airlines ($225 million) for their failures. It also published a Airline Passengers with Disabilities Bill of Rights, passed a new rule accessible lavatories on aircraft, and is working on a rule to require airlines to replace lost or damaged wheelchairs with equal equipment at once.

The Department of Energy announced $430 million dollars to help boost domestic clean energy manufacturing in former coal communities. This invests in projects in 15 different communities, in places like Texas, West Virginia, Pennsylvania, Tennessee, Kentucky, and Michigan. The plan will bring about 1,900 new jobs in communities struggling with the loss of coal. Projects include making insulation out of recycled cardboard, low carbon cement production, and industrial fiber hemp processing.

The Department of Transportation announced $4.2 billion in new infrastructure investment. The money will go to 44 projects across the country. For example the MBTA will get $400 million to replace the 92 year old Draw 1 bridge and renovate North Station.

The Department of Transportation announced nearly $200 million to replace aging natural gas pipes. Leaking gas lines represent a serious public health risk and also cost costumers. Planned replacements in Georgia and North Carolina for example will save the average costumer there over $900 on their gas bill a year. Replacing leaking lines will also remove 1,000 metric tons of methane pollution, annually.

The Department of the Interior announced $244 million to address legacy pollution in Pennsylvania coal country. This comes on top of $400 million invested earlier this year. This investment will help close dangerous mine shafts, reclaim unstable slopes, improve water quality by treating acid mine drainage, and restore water supplies damaged by mining.

Data shows that President Biden's Inflation Reduction Act (passed with Vice-President Harris' tie breaking vote) has saved seniors $1 billion dollars on out-of-pocket drug costs. Seniors with certain high priced drugs saw their yearly out of pocket costs capped at $3,500 for 2024. In 2024 all seniors using Medicare Part D will see their out of pocket costs capped at $2,000 for the year. It's estimated if the $2,000 cap had been in effect this year 4.6 million seniors would have hit it by June and not have had to pay any more for medication for the rest of the year.

The Department of Education announced a new proposed rule to bring student debt relief for 8 million struggling borrowers. The Biden-Harris Administration has managed despite road blocks from Republicans in Congress, the courts and law suits from Republican states to bring student loan forgiveness to 5 million Americans so far through different programs. This latest rule would take into account many financial hardships faced by people to determine if they qualify to have their student loans forgiven. The final rule cannot be finalized before 2025 meaning its fate will be decided at the election.

The Department of Agriculture announced $1.5 billion in 92 partner-driven conservation projects. These projects aim at making farming more susceptible and environmental friendly, 16 projects are about water conservation in the West, 6 support use of innovative technologies to reduce enteric methane emissions in livestock. $100 million has been earmarked for Tribal-led projects.

[glittering-jellyfish]

Americans this year are like "I didn't feel festive this year, I think it's the weather!" And that's part of it. Or, now just hear me out, it could also be the active decay of our country. Just a thought

[lets-steal-an-archive]

By Bernie Sanders | July 13, 2024

I will do all that I can to see that President Biden is re-elected. Why? Despite my disagreements with him on particular issues, he has been the most effective president in the modern history of our country and is the strongest candidate to defeat Donald Trump — a demagogue and pathological liar. It’s time to learn a lesson from the progressive and centrist forces in France who, despite profound political differences, came together this week to soundly defeat right-wing extremism.

I strongly disagree with Mr. Biden on the question of U.S. support for Israel’s horrific war against the Palestinian people. The United States should not provide Benjamin Netanyahu’s right-wing extremist government with another nickel as it continues to create one of the worst humanitarian disasters in modern history.

I strongly disagree with the president’s belief that the Affordable Care Act, as useful as it has been, will ever address America’s health care crisis. Our health care system is broken, dysfunctional and wildly expensive and needs to be replaced with a “Medicare for all” single-payer system. Health care is a human right.

And those are not my only disagreements with Mr. Biden.

But for over two weeks now, the corporate media has obsessively focused on the June presidential debate and the cognitive capabilities of a man who has, perhaps, the most difficult and stressful job in the world. The media has frantically searched for every living human being who no longer supports the president or any neurologist who wants to appear on TV. Unfortunately, too many Democrats have joined that circular firing squad.

Yes. I know: Mr. Biden is old, is prone to gaffes, walks stiffly and had a disastrous debate with Mr. Trump. But this I also know: A presidential election is not an entertainment contest. It does not begin or end with a 90-minute debate.

Enough! Mr. Biden may not be the ideal candidate, but he will be the candidate and should be the candidate. And with an effective campaign taht speaks to the needs of working families, he will not only defeat Mr. Trump but beat him badly. It’s time for Democrats to stop the bickering and nit-picking.

I understand that some Democrats get nervous about having to explain the president’s gaffes and misspeaking names. But unlike the Republicans, they do not have to explain away a candidate who now has 34 felony convictions and faces charges that could lead to dozens of additional convictions, who has been hit with a $5 million judgment after he was found liable in a sexual abuse case, who has been involved in more than 4,000 lawsuits, who has repeatedly gone bankrupt and who has told thousands of documented lies and falsehoods.

Supporters of Mr. Biden can speak proudly about a good and decent Democratic president with a record of real accomplishment. The Biden administration, as a result of the American Rescue Plan, helped rebuild the economy during the pandemic far faster than economists thought possible. At a time when people were terrified about the future, the president and those of us who supported him in Congress put Americans back to work, provided cash benefits to desperate parents and protected small businesses, hospitals, schools and child care centers.

After decades of talk about our crumbling roads, bridges and water systems, we put more money into rebuilding America’s infrastructure than ever before — which is projected to create millions of well-paying jobs. And we did not stop there. We made the largest-ever investment in climate action to save the planet. We canceled student debt for nearly five million financially strapped Americans. We cut prices for insulin and asthma inhalers, capped out-of-pocket costs for prescription drugs and got free vaccines to the American people. We battled to defend women’s rights in the face of moves by Trump-appointed jurists to roll back reproductive freedom and deny women the right to control their own bodies.

So, yes, Mr. Biden has a record to run on. A strong record. But he and his supporters should never suggest that what’s been accomplished is sufficient. To win the election, the president must do more than just defend his excellent record. He needs to propose and fight for a bold agenda that speaks to the needs of the vast majority of our people — the working families of this country, the people who have been left behind for far too long.

At a time when the billionaires have never had it so good and when the United States is experiencing virtually unprecedented income and wealth inequality, over 60 percent of Americans live paycheck to paycheck, real weekly wages for the average worker have not risen in over 50 years, 25 percent of seniors live each year on $15,000 or less, we have a higher rate of childhood poverty than almost any other major country, and housing is becoming more and more unaffordable — among other crises.

This is the wealthiest country in the history of the world. We can do better. We must do better. Joe Biden knows that. Donald Trump does not. Joe Biden wants to tax the rich so that we can fund the needs of working families, the elderly, the children, the sick and the poor. Donald Trump wants to cut taxes for the billionaire class. Joe Biden wants to expand Social Security benefits. Donald Trump and his friends want to weaken Social Security. Joe Biden wants to make it easier for workers to form unions and collectively bargain for better wages and benefits. Donald Trump wants to let multinational corporations get away with exploiting workers and ripping off consumers. Joe Biden respects democracy. Donald Trump attacks it.

This election offers a stark choice on issue after issue. If Mr. Biden and his supporters focus on these issues — and refuse to be divided and distracted — the president will rally working families to his side in the industrial Midwest swing states and elsewhere and win the November election. And let me say this as emphatically as I can: For the sake of our kids and future generations, he must win.

Bernie Sanders is the senior senator from Vermont.