Tag Archives: healthcare

High-deductible health plans were never going to solve high healthcare costs

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Sixteen years ago, I was answering the phone for a member services line at Anthem Blue Cross and Blue Shield. One day, my manager asked me to answer a different phone number. Instead of the PPO plans I had worked with, this phone number dealt with their new high-deductible health plans.

After a brief training session on how these plans worked, I was off and running.

The people who called me on this new line often had plans with deductibles of $5,000 per person or even higher, accompanied by health savings accounts: a tax-advantaged vehicle that allowed them to pay for the full cost of their expenses before they met their deductible. That is, before their insurance paid a penny for their claims.

It didn’t take long for me to see why their employers put them on these plans. It wasn’t to empower them, as promised. It was simply for their employers to save premium costs and transfer the risks onto their employees. Many people didn’t understand how these plans were designed and were shocked that they had to pay the full cost of their doctor visits out of their health savings accounts, assuming they were funded. Failing that, they just had to pay these large bills out of pocket.

This long experiment has objectively failed to keep its promises to bring down healthcare costs. Instead, it has saddled more Americans with medical debt despite those Americans technically being insured. Healthcare costs have continued to rise.

High-deductible health plans are already extremely common in the Healthcare.gov exchanges (particularly the bronze plans), yet premiums even for those plans have continued to skyrocket despite consumers having plenty of skin in the game.

Yet conservatives continue to double down on this failed experiment, simply because they are unwilling to do what it would take to actually solve the problem. That would mean addressing the unusually exorbitant prices for healthcare services, prescription drugs, medical devices, and health insurance itself in the USA compared to other rich countries that provide universal healthcare.

“Do not resuscitate” scheme by UnitedHealth Group shows private health insurance companies are the real death panels

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Remember when Sarah Palin’s “death panels” conspiracy theory almost sunk the Affordable Care Act?

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society.'” — Gov. Sarah Palin (R-AK), August 7, 2009

People were understandably upset with the idea that people’s healthcare, and therefore their lives, could be taken away because they had become too costly. Of course, it was complete nonsense. There was initially a provision in one of the health care reform bills to pay physicians to discuss end-of-life care with their patients and write down their decisions, but that was removed because of Palin’s fearmongering. It would have saved a great deal of money.

Fast-forward to 2025, and we’re finding out who is actually doing death-panel things: private health insurance companies.

The Guardian reported that health insurer UnitedHealth Group paid nursing homes to change some of their residents’ status to “do not resuscitate” or “do not intubate” in order to prevent costly hospital admissions.

Internal emails show, for example, that UnitedHealth supervisors gave their teams “budgets” showing how many hospital admissions they had “left” to use up on nursing home patients.

The company also monitored nursing homes that had smaller numbers of patients with “do not resuscitate” – or DNR – and “do not intubate” orders in their files. Without such orders, patients are in line for certain life-saving treatments that might lead to costly hospital stays.

Two current and three former UnitedHealth nurse practitioners told the Guardian that UnitedHealth managers pressed nurse practitioners to persuade Medicare Advantage members to change their “code status” to DNR even when patients had clearly expressed a desire that all available treatments be used to keep them alive.

End-of-life care is expensive and often does not generate value in terms of quality-adjusted life years (QALYs). According to Kaiser Familly Foundation, “In 2014, beneficiaries who died at some point during the year accounted for 4% of all beneficiaries in traditional Medicare, but 13.5% of traditional Medicare spending.”

But patients deserve to make their own healthcare decisions about end-of-life care and not to have anyone — the government or private health insurance companies — make it for them.

It’s not clear whether any patient was actually denied lifesaving care as a result of UnitedHealth’s practices, but if anyone did die as a result of this status being flipped, I would recommend charging everyone involved with first-degree murder.

Trump’s Big Beautiful Bill will mean big healthcare costs for citizens, hospitals

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As reported in KFF Health News, the reconciliation bill recently signed into law by President Trump reduces federal health spending by about $1 trillion. That might be good news for the government (although the tax cuts passed will reduce revenue by significantly more than the spending cuts in the bill), but it’s bad news for Americans who have been helped by this government spending.

“The bill, passed in both the House and the Senate without a single Democratic vote, is expected to reverse many of the health coverage gains of the Biden and Obama administrations. Their policies made it easier for millions of people to access health care and reduced the U.S. uninsured rate to record lows, though Republicans say the trade-off was far higher costs borne by taxpayers and increased fraud.” — KFF Health News, July 3, 2025

Most of the cuts impact Medicaid, including work requirements for beneficiaries and provider taxes that increase reimbursements to hospitals and other institutions to make up for low Medicaid reimbursements. This will have a particularly acute effect on rural hospitals with high Medicaid populations.

Many of the provisions in this bill roll back provisions in the Patient Protection and Affordable Care Act (also known as Obamacare) that expanded Medicaid eligibility and reduced the number of uninsured Americans.