{"id":2325120,"date":"2024-08-15T13:57:01","date_gmt":"2024-08-15T17:57:01","guid":{"rendered":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/lawmakers-must-confront-the-1000-pound-healthcare-gorilla\/"},"modified":"2024-08-15T14:06:13","modified_gmt":"2024-08-15T18:06:13","slug":"lawmakers-must-confront-the-1000-pound-healthcare-gorilla","status":"publish","type":"post","link":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/lawmakers-must-confront-the-1000-pound-healthcare-gorilla\/","title":{"rendered":"Lawmakers Must Confront the 1,000-Pound Healthcare Gorilla"},"content":{"rendered":"<aside class=\"mashsb-container mashsb-main mashsb-stretched\"><div class=\"mashsb-box\"><div class=\"mashsb-count mash-medium\" style=\"&quot;\"><div class=\"counts mashsbcount\">14<\/div><span class=\"mashsb-sharetext\">SHARES<\/span><\/div><div class=\"mashsb-buttons\"><a class=\"mashicon-facebook mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/www.facebook.com\/sharer.php?u=https%3A%2F%2Fwww.conservativenewsdaily.net%2Fbreaking-news%2Flawmakers-must-confront-the-1000-pound-healthcare-gorilla%2F\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Facebook<\/span><\/a><a class=\"mashicon-twitter mash-medium mash-nomargin mashsb-noshadow\" href=\"https:\/\/twitter.com\/intent\/tweet?text=&amp;url=https:\/\/www.conservativenewsdaily.net\/breaking-news\/?p=2325120&amp;via=ConservNewsDly\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Twitter<\/span><\/a><a class=\"mashicon-subscribe mash-medium mash-nomargin mashsb-noshadow\" href=\"#\" target=\"_top\" rel=\"nofollow\"><span class=\"icon\"><\/span><span class=\"text\">Subscribe<\/span><\/a><div class=\"onoffswitch2 mash-medium mashsb-noshadow\" style=\"display:none\"><\/div><\/div>\n            <\/div>\n                <div style=\"clear:both\"><\/div><\/aside>\n            <!-- Share buttons by mashshare.net - Version: 4.0.47--><p>The article \u2063discusses widespread dissatisfaction among Americans with\u200c the healthcare system, despite the high levels of spending per capita compared to other OECD \u200dcountries. \u200dOver 70% of U.S. adults feel that the healthcare system is not meeting their needs, primarily due to the confusing \u2062and opaque nature of\u2062 health\u200d insurance. This complexity is exacerbated by rising premiums, which \u2063have increased nearly 60% since 2010 \u2063and are projected to reach\u2062 record highs in 2024, while consumers are seeing little \u2063improvement in\u200b coverage or quality of care. The article highlights how insurance companies often deny legitimate claims, which\u200d deters Americans from seeking necessary medical\u200c care.<\/p>\n<p>Additionally, the financial struggles and\u200d closures of rural hospitals have led to <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/talking-turkey-thanksgiving-travelers-set-to-clog-skies-and-roads-in-historically-busy-travel-season\/\" title=\"Talking turkey: Thanksgiving travelers set to clog skies and roads in historically busy travel season\">longer travel times<\/a> for patients, \u2062especially in emergencies, aggravating health disparities in \u2064these communities. Despite these challenges, insurance companies\u2064 continue to generate record profits, raising concerns about the consolidation of the <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/white-house-releases-list-of-president-trumps-accomplishments-and-it-is-historic\/\" title=\"White House Releases List of President Trump\u2019s Accomplishments \u2013  And It Is Historic!\">health insurance market<\/a> and its impact on consumer choice and competition. The author calls for reforms\u200c that would ensure fair \u200bpayments to healthcare providers and reasonable profits for \u200dinsurance companies, ultimately aiming to create a more balanced and efficient healthcare system that serves the needs of patients.  <\/p>\n<p class=\"readmore\">\n    <button onclick=\"showReadMore()\" id=\"readmorebtn\">Read more&#8230;<\/button>\n<\/p>\n<hr id=\"line\">\n<span id=\"more\"><\/p>\n<p><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><?xml encoding=\"utf-8\" ?><\/p>\n<section>\n<p>Americans by and large believe the healthcare system is failing them.<\/p>\n<p>Despite spending <a href=\"https:\/\/www.healthsystemtracker.org\/chart-collection\/health-spending-u-s-compare-countries\/\" target=\"_blank\" rel=\"noopener\">more money per capita<\/a> on healthcare than any other Organization for Economic Cooperation and Development country in the world, a <a href=\"https:\/\/www.aapa.org\/research\/patient-experience\/\" target=\"_blank\" rel=\"noopener\">recent poll<\/a> found that more than 70 percent of U.S. adults feel that one way or another it is not meeting their needs.<\/p>\n<p>One of the major drivers of this dissatisfaction is our confusing and opaque <a href=\"https:\/\/www.westernjournal.com\/biden-administration-makes-rule-change-give-taxpayer-funded-health-insurance-100000-illegal-immigrants\/\" target=\"_blank\" rel=\"noopener\">health insurance<\/a> system, which poses challenges for many patients. Its complexity, high costs, and gaps in coverage have led nearly <a href=\"https:\/\/www.ipsos.com\/en-us\/mdvipipsos-poll-shows-americans-are-struggling-healthcare-system\" target=\"_blank\" rel=\"noopener\">two-third of Americans<\/a> to believe that health insurance providers are not transparent about what they cover, as well as left them feeling lost when it comes to navigating co-insurance payments and deductibles.<\/p>\n<p>Private health insurance premiums have increased <a href=\"https:\/\/www.americanprogress.org\/article\/health-insurance-costs-are-squeezing-workers-and-employers\/\" target=\"_blank\" rel=\"noopener\">nearly 60 percent<\/a> since 2010 and are predicted to reach a <a href=\"https:\/\/www.prnewswire.com\/news-releases\/private-health-insurance-premiums-reach-a-record-high-of-7008year-in-2024-302019327.html\" target=\"_blank\" rel=\"noopener\">record high in 2024<\/a>. Yet despite the dramatic cost increase, consumers are not getting their monies worth in the form of better coverage, access, or quality of care. In fact, health insurance companies excel in finding ways and all sorts of reasons to deny claims for medical care. This includes requiring prior authorization or &ldquo;advanced notification&rdquo; to <a href=\"https:\/\/apnews.com\/article\/health-insurance-law-illinois-step-therapy-97d8a8845645f2ce4ad8be01fa153003\" target=\"_blank\" rel=\"noopener\">treat mental health crises<\/a> and for procedures designed to save lives, like <a href=\"https:\/\/www.cnn.com\/2023\/06\/01\/health\/unitedhealthcare-colonoscopy-requirements\/index.html\" target=\"_blank\" rel=\"noopener\">early cancer screenings<\/a>. As a result, many Americans have delayed or skipped care for fear of what the bills may amount to, defeating the very purpose of health insurance. Regardless of the reason, this practice must be addressed, as these companies have no excuse for denying, underpaying, or improperly processing legitimate claims submitted by patients and providers.<\/p>\n<p>Such measures have limited access to care for Americans in other ways, as well. Providers, which have been struggling to bear the financial burden of skyrocketing equipment and labor costs, are now grappling with under payments by insurers that sometime fail to cover even the minimum cost of patient treatment. Rural <a href=\"https:\/\/www.westernjournal.com\/corporate-hospital-systems-buy-medical-practices-nationwide-many-now-demanding-payment-upfront-procedures\/\" target=\"_blank\" rel=\"noopener\">hospitals<\/a> have been hit especially hard and many have been forced to close.<\/p>\n<p>  <script> \t\t\t\tif( ! getCookie( 'ff_subbed' ) ) if( typeof FFADS.replace_ict !='undefined' ) if( FFADS.replace_ict ) eval( FFADS.replace_ict ); \t\t\t<\/script> <\/p>\n<p>For the <a href=\"https:\/\/www.census.gov\/library\/stories\/2017\/08\/rural-america.html\" target=\"_blank\" rel=\"noopener\">60 million Americans<\/a> that rely on such facilities for healthcare this can mean significantly longer drive times to reach the next nearest hospital. This increased distance can have serious consequences, especially in emergency situations where every minute counts. Longer travel times may delay critical care for conditions like heart attacks, strokes, or severe injuries, potentially leading to worse health outcomes. For routine care and chronic disease management, the added travel burden can discourage patients from seeking timely medical attention, leading to missed appointments and delayed treatments. This situation can exacerbate health disparities in rural communities, particularly affecting elderly, low-income, or disabled individuals who may have limited transportation options.<\/p>\n<p>But as patients, hospitals, and healthcare workers have struggled to get by, insurance companies have continued to pull in record revenues. In 2023, the top six health insurers generated almost <a href=\"https:\/\/www.beckerspayer.com\/payer\/big-payers-ranked-by-2023-profit-beckers.html\" target=\"_blank\" rel=\"noopener\">$1.1 trillion in revenue<\/a>, diverting billions away from patient care and all the while finding new and crafty ways to increase their profits.<\/p>\n<p>Many of these issues stem from the health insurance oligopoly has been created in the wake of Obamacare&rsquo;s passage.<\/p>\n<p>Under current federal guidelines, 73 percent of MSA-level health insurance markets were <a href=\"https:\/\/www.ama-assn.org\/press-center\/press-releases\/ama-identifies-market-leaders-health-insurance\" target=\"_blank\" rel=\"noopener\">considered highly concentrated<\/a> in 2022 leaving consumers with little choice. Now insurance companies like United Healthcare have undertaken a number of acquisitions in recent years to further consolidate their pricing power. As they gobble up doctor groups, surgery centers, health data and technology units, and one of the largest pharmacy-benefits managers, the question becomes, what are the effects on rivals and consumers?<\/p>\n<p>Investigators are now <a href=\"https:\/\/www.wsj.com\/health\/healthcare\/u-s-launches-antitrust-investigation-of-healthcare-giant-unitedhealth-ff5a00d2\" target=\"_blank\" rel=\"noopener\">looking into these relationships<\/a> and how it may affect compliance with federal rules, but it may not be enough. For too long the Federal Trade Commission provided health insurance companies carte blanche while conversely preventing hospitals and health systems from engaging in necessary mergers to level the playing field &mdash; despite the fact that they <a href=\"https:\/\/arizonadailyindependent.com\/2023\/03\/21\/private-sector-solutions-can-increase-health-care-access-in-arizona\/\" target=\"_blank\" rel=\"noopener\">expand access to care and <a href=\"https:\/\/www.conservativenewsdaily.net\/breaking-news\/fda-approves-alzheimers-drug-for-first-time-in-years\/\" title=\"FDA Approves Alzheimer\u2019s Drug For First Time In Years\">improve patient outcomes<\/a><\/a>. This has <a href=\"https:\/\/www.aamcresearchinstitute.org\/our-work\/data-snapshot\/why-market-power-matters\" target=\"_blank\" rel=\"noopener\">resulted in a scenario<\/a> where three largest group insurers now hold nearly twice the market  of the largest health systems in each state, providing insurers with the pricing power and leverage to raise premiums and provide lower reimbursements to providers.<\/p>\n<p>The has all happened to the detriment of the broader healthcare system. The question now is, how we can correct this imbalance? In order to have a fair and functional system that provides the best care to patients, makes fair payments to providers, and offers reasonable profits to insurance companies, our lawmakers need to address this disparity. It is time to confront the 1,000-pound gorilla in the room and find solutions to create balance and fairness and to ensure the long-term stability of the American healthcare system.<\/p>\n<\/p>\n<p><i><b>The views expressed in this opinion article are those of their author and are not necessarily either d or endorsed by the owners of this website. If you are interested in contributing an Op-Ed to The Western Journal, you can learn about our submission guidelines and process <a href=\"https:\/\/www.westernjournal.com\/submitop-ed\/\">here<\/a>.<\/b><\/i><\/p>\n<div style=\"position: relative;\">\n<div class=\"ff-fancy-header-container\">  <\/div>\n<div class=\"entry-submit-correction inner-content\">\n<div class=\"correction-form\">\n<form style=\"display: none;\">\n<div class=\"sc-name-field\"> <label>* Name<\/label> <br \/> <input type=\"text\" name=\"name\" required> <\/div>\n<div class=\"sc--field\"> <label>* <\/label> <br \/> <input type=\"text\" name=\"\" required> <\/div>\n<p> <label>* Message<\/label> <br \/> <textarea name=\"message\" required><\/textarea>  <\/p>\n<div class=\"required-message\" style=\"display: none; padding-bottom: 15px;\">* All fields are required.<\/div>\n<p> <input type=\"submit\" value=\"Submit\" onclick=\"event.preventDefault(); firefly_sc();\">  <\/p>\n<div class=\"firefly-sc-confirm\" style=\"display: none;\">Success!<\/div>\n<\/p><\/form>\n<\/p><\/div>\n<\/p><\/div>\n<p> <script> \t\t\tfunction firefly_sc() { \t\t\t\tif( typeof window.captchaPublicKey==typeof undefined ){ \t\t\t\t\tconsole.error('window.captchaPublicKey is not defined'); \t\t\t\t} \t\t\t\tgrecaptcha.execute( window.captchaPublicKey, { action: 'submit_correction' } ).then( function( token ) { \t\t\t\t\tvar opts={ \t\t\t\t\t\taction:    'firefly_sc_submit', \t\t\t\t\t\tname:      document.querySelector( '.entry-submit-correction [name=\"name\"]' ).value, \t\t\t\t\t\t:     document.querySelector( '.entry-submit-correction [name=\"\"]' ).value, \t\t\t\t\t\tmessage:   document.querySelector( '.entry-submit-correction [name=\"message\"]' ).value, \t\t\t\t\t\tpost_id:   firefly_post_id, \t\t\t\t\t\tcap_token: token \t\t\t\t\t}  \t\t\t\t\tvar inputs=[ 'name', '', 'message' ];  \t\t\t\t\tfor( var i=0; i <inputs.length; i++ ) if( ! ( opts[inputs[i]]=document.querySelector( '.entry-submit-correction [name=\"' + inputs[i] + '\"]' ).value ) ) { \t\t\t\t\t\tdocument.querySelector( '.entry-submit-correction .required-message' ).style.display='block'; \t\t\t\t\t\treturn; \t\t\t\t\t}  \t\t\t\t\tdocument.querySelector( '.entry-submit-correction input[type=\"submit\"]' ).style.display='none'; \t\t\t\t\tdocument.querySelector( '.entry-submit-correction .firefly-sc-submitting-img' ).src=firefly_loading_gif_url; \t\t\t\t\tdocument.querySelector( '.entry-submit-correction .firefly-sc-submitting-img' ).style.display='inline-block';  \t\t\t\t\tconsole.log( 'ma subbing' );  \t\t\t\t\tif( firefly_post_id ) opts['post_id']=firefly_post_id;  \t\t\t\t\t\/* Send the data using post with element id name and name2*\/ \t\t\t\t\tvar posting=jQuery.post( firefly_ajax_url, opts );  \t\t\t\t\t\/* Alerts the results *\/ \t\t\t\t\tposting.done( function( response ) { \t\t\t\t\t\tif( response.success ) { \t\t\t\t\t\t\tconsole.log( response.data ); \t\t\t\t\t\t\tdocument.querySelector( '.entry-submit-correction .firefly-sc-submitting-img' ).style.display='none'; \t\t\t\t\t\t\tdocument.querySelector( '.entry-submit-correction .firefly-sc-confirm' ).style.display='block';  \t\t\t\t\t\t\tdataLayer.push( { 'event': 'submit-correction' } ); \t\t\t\t\t\t} \t\t\t\t\t}); \t\t\t\t}); \t\t\t} \t\t<\/script>  <\/div>\n<div class=\"ff-fancy-header-container\">  <\/div>\n<style> \t\t\t \t\t\t.insticator-unit.type-commenting{margin: 0 10px 25px 10px}@media screen and (max-width:1060px){#div-insticator-ad-cmt-1, #div-insticator-ad-cmt-2, #div-insticator-ad-cmt-3, #div-insticator-ad-cmt-4{margin: 0 auto 25px auto !important;}}#div-insticator-ad-cmt-1, #div-insticator-ad-cmt-2, #div-insticator-ad-cmt-3, #div-insticator-ad-cmt-4{height: 280px !important; width: 336px !important} \t\t<\/style>\n<div class=\"insticator-unit type-commenting\">\n<div class=\"insticator-ads\">   <script data-cfasync=\"false\" type=\"text\/javascript\"> \t\t\t\t\tif ( ! getCookie( \"ff_subbed\" ) ) { \t\t\t\t\t\tInsticator.ad.loadAd(\"div-insticator-ad-cmt-1\"); \t\t\t\t\t\tInsticator.ad.loadAd(\"div-insticator-ad-cmt-2\"); \t\t\t\t\t} else { \t\t\t\t\t\tdocument.getElementById(\"div-insticator-ad-cmt-1\").remove() \t\t\t\t\t\tdocument.getElementById(\"div-insticator-ad-cmt-2\").remove() \t\t\t\t\t} \t\t\t\t<\/script> <\/div>\n<div class=\"insticator-ads additional\">   <script data-cfasync=\"false\" type=\"text\/javascript\"> \t\t\t\t\tif ( ! getCookie( \"ff_subbed\" ) ) { \t\t\t\t\t\tInsticator.ad.loadAd(\"div-insticator-ad-cmt-3\"); \t\t\t\t\t\tInsticator.ad.loadAd(\"div-insticator-ad-cmt-4\"); \t\t\t\t\t} else { \t\t\t\t\t\tdocument.getElementById(\"div-insticator-ad-cmt-3\").remove() \t\t\t\t\t\tdocument.getElementById(\"div-insticator-ad-cmt-4\").remove() \t\t\t\t\t} \t\t\t\t<\/script> <\/div>\n<\/p><\/div>\n<\/section>\n<p><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Many Americans feel that the healthcare system is not serving them well. A recent survey revealed that over 70% of U.S. adults believe the system fails to meet their needs, despite the fact that the country spends more on healthcare per person than any other member of the Organization for Economic Cooperation and Development (OECD). A significant factor contributing to this dissatisfaction is the complicated and unclear health insurance system, which creates obstacles for patients. The complexity, high costs, and coverage gaps have led nearly two-thirds of Americans to think that health insurance providers lack transparency regarding their coverage options, leaving many confused about co-insurance payments and deductibles.<\/p>\n<p>Since 2010, private health insurance premiums have surged by almost 60%, with projections indicating they will reach an all-time high in 2024. However, consumers are not receiving better coverage or quality care in return for these increased costs. Health insurers often find various reasons to deny claims for medical services\u2014sometimes requiring prior authorization even for critical treatments like mental health interventions or life-saving procedures such as early cancer screenings. Consequently, many Americans postpone or avoid necessary care due to concerns about potential expenses, undermining the purpose of having health insurance.<\/p>\n<p>This issue also affects healthcare providers who are struggling with rising equipment and labor costs while facing underpayments from insurers that sometimes do not cover even basic treatment expenses. Rural hospitals have been particularly impacted; many have had to shut down operations entirely. For approximately 60 million Americans who depend on these facilities for care, this means longer travel times to access medical services\u2014a situation that can be dire during emergencies when every second counts.<\/p>\n<p>In addition to emergency situations where delays can worsen outcomes from conditions like heart attacks or strokes, longer travel distances can deter patients from seeking routine care or managing chronic illnesses effectively\u2014leading to missed appointments and delayed treatments. This exacerbates existing health disparities in rural areas where elderly individuals or those with low incomes may struggle with transportation issues.<\/p>\n<p>While patients and healthcare workers face these challenges daily, insurance companies continue reporting record profits; in 2023 alone, the top six insurers generated nearly $1.1 trillion in revenue while diverting billions away from patient care through various profit-increasing strategies.<\/p>\n<p>Many of these problems stem from a concentrated market created after Obamacare&#8217;s implementation; as of 2022, around 73% of MSA-level health insurance markets were classified as highly concentrated\u2014leaving consumers with limited choices. Companies like United Healthcare have pursued numerous acquisitions recently aimed at consolidating their pricing power further by acquiring doctor groups and surgery centers among others.<\/p>\n<p>Investigations into how these relationships might affect compliance with federal regulations are ongoing but may fall short without significant changes being made at a regulatory level\u2014the Federal Trade Commission has historically allowed insurers considerable freedom while restricting hospitals&#8217; ability to merge despite evidence suggesting such mergers could enhance access and improve patient outcomes.<\/p>\n<p>Currently dominated by just three major group insurers holding nearly double the market share compared to each state&#8217;s largest hospital systems gives them substantial leverage over premium rates while lowering reimbursements offered back to providers\u2014all detrimental effects on overall healthcare quality across America.<\/p>\n<p>To restore balance within this system so it fairly serves patients\u2019 needs while ensuring adequate compensation for providers alongside reasonable profits for insurers requires legislative action addressing current disparities head-on\u2014it\u2019s time we confront this pressing issue directly if we want sustainable improvements within our nation&#8217;s healthcare framework moving forward<\/p>\n","protected":false},"author":1,"featured_media":2325121,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mo_disable_npp":"","fifu_image_url":"https:\/\/www.westernjournal.com\/wp-content\/uploads\/2024\/08\/Health-Care.jpg","fifu_image_alt":"","footnotes":""},"categories":[],"tags":[5533,4606,3673,38235],"class_list":["post-2325120","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","tag-challenges","tag-healthcare","tag-lawmakers","tag-policy-reform"],"fifu_image_url":"https:\/\/www.westernjournal.com\/wp-content\/uploads\/2024\/08\/Health-Care.jpg","_links":{"self":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2325120","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/comments?post=2325120"}],"version-history":[{"count":0,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2325120\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media\/2325121"}],"wp:attachment":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media?parent=2325120"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/categories?post=2325120"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/tags?post=2325120"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}