Salve Lucrum: The Existential Threat of Greed in US Health Care

Yves here. I do my tiny bit to try to lower my health care costs by refusing some tests and arbitraging test costs (for instance, MRIs are way cheaper in Alabama and I don’t buy orthopedist whinging that they like a particular imaging center, when one wonders if they have a stake in it. If the center has a honking big pretty state of the art machine, it will do just fine. And a lot of tests are cheaper if you pay out of pocket and then get reimbursed, but most people don’t want to deal with the hassle). But gaming and upcoding are not anything the patient can control when the MD bills directly to the insurer. And notice how Medicare Advantage plans are huge abusers.

We could solve this problem by paying whistleblowers big bounties (like at least enough for them to retire at a not terrible level of income, best clawed out of executive and director deferred comp schemes), plus big additional payouts for workplace harassment and retaliation. But the massive US pro-corporate bias means whistleblower schemes are eyewash.

By run75441. Cross posted from Angry Bear

The biggest driver of healthcare cost is simply “pricing” increases reflected in hospitals, pharmaceuticals, and healthcare insurance. It was Dr. Donald Berwickwhile head of Medicare and Medicaid during the 1st half of the Obama administration has said, repeatedly, that at least 1/3 of Medicare dollars ware wasted on unnecessary tests, procedures and drugs that provide no benefit for the patient.

Here is Dr. Berwick again discussing healthcare costs in the United States. It is a good read. I have included his footnotes and our own commentary.


Salve Lucrum: The Existential Threat of Greed in US Health Care” | Health Care Economics, Insurance, Payment, JAMA | JAMA Network, Donald M. Berwick, MD, MPP

In the mosaic floor of the opulent atrium of a house excavated at Pompeii is a slogan ironic for being buried under 16 feet of volcanic ash: Salve Lucrum, it reads, “Hail, Profit.” That mosaic would be a fitting decoration today in many of health care’s atria.

The grip of financial self-interest in US health care is becoming a stranglehold, with dangerous and pervasive consequences. No sector of US health care is immune from the immoderate pursuit of profit, neither drug companies, nor insurers, nor hospitals, nor investors, nor physician practices.

Rapidly increasing pharmaceutical costs are now familiar to the public. Pharmaceutical companies have used monopoly ownership of medications to raise prices to stratospheric levels, and not just for new drugs. Flaws in US patent laws leave loopholes allowing profiteering drug companies to gain control of some simple and long-known medications and to raise prices without constraint. Eye-popping prices for new, essential biological and biosimilar drugs, enabled by the failure of any serious drug price regulation, have yielded enormous profits for drug companies even though much of the basic biological research funding has come from governmental sources.

Particularly costly has been profiteering among insurance companies participating in the Medicare Advantage (MA) program. Originally intended to give Medicare beneficiaries the choice of access to well-managed care at lower cost, MA has mushroomed into a massive program, now about to cover more than 50% of all Medicare beneficiaries and costing far more per beneficiary than traditional Medicare ever has.1

By gaming Medicare risk codes and the ways in which comparative “benchmarks” are set for expected costs, MA plans have become by far the most profitable branches of large insurance companies. According to some health services research, MA will cost Medicare over $600 billion more in the next 8 years than would have been the case if the same enrollees had remained in traditional Medicare.2 Opinions differ about whether MA enrollees experience better care and outcomes than those in traditional Medicare, but the weight of evidence is that they do not.

Hospital pricing games are also widespread. Hospitals claim large operating losses, especially in the COVID pandemic period, but large systems sit on balance sheets with tens of billions of dollars in the bank or invested. Hospital prices for the top 37 infused cancer drugs averaged 86.2% higher per unit than in physician offices.3 A patient was billed $73 800 at the University of Chicago for 2 injections of Lupron depot, a treatment for prostate cancer, a drug available in the UK for $260 a dose.4 To drive up their own revenues, many hospitals serving wealthy populations take advantage of a federal subsidy program originally intended to reduce drug costs for people with low income.5

Recent New York Times investigations have reported on nonprofit hospitals’ reducing and closing services in poor areas while opening new ones in wealthy suburbs and on their use of collection agencies for pursuing payment from patients with low income.6 The Massachusetts Health Policy Commission reported in 2022 that hospital prices and revenues increased during a decade at almost 4 times the rate of inflation.7

Windfall profits also appear in salaries and benefits for many health care executives. Of the 10 highest paid among all corporate executives in the US in 2020, 3 were from Oak Street Health, and salary and benefits included, reportedly, $568 million for the chief executive officer (CEO). Executives in large hospital systems commonly have salaries and benefits of several million dollars a year.8 Some academic medical centers’ boards allow their CEO to serve for 6-figure stipends and multimillion-dollar stock options on outside company boards, including ones that supply products and services to the medical center.

Avarice is manifest in mergers leading to market concentration, which, despite pleas of “economies of scale,” almost always raise costs. That is what is happening as hospital consolidations proceed largely unchecked in many urban markets9 and as physician practices are purchased by for-profit firms. Mergers, acquisitions, and public offerings have been occurring throughout health care, often at valuations that defy logic. Oak Street Health, an innovative primary care company that employs physicians and plays heavily in MA, had a $15 billion initial public offering in 2022, equivalent to $196 000 per patient in their panel.

Profit may have its place in motivating innovation and higher quality in health care, as in any industry. But kleptocapitalist behaviors that raise prices, salaries, market power, and government payment to extreme levels hurt patients and families, vulnerable institutions, governmental programs, small and large businesses, and workforce morale. Those behaviors, mostly legal but nonetheless wrong, have now accumulated to a level that poses an existential threat to a sustainable, equitable, and compassionate health care system.

For individuals, the costs can be extremely painful.

A total of 41% of US adults, 100 million people, bear medical debts. One of every 8 individuals owes more than $10 000. In Massachusetts, 46% of adults say they skip needed care because of costs. As of 2021, 58% of all debt collections in the US are for medical bills.10 Health insurance premiums in Massachusetts have gone up more than 200% in 2 decades and now cost more annually per family than a car. People of lower income must choose high-deductible plans; they cannot afford more complete coverage. In no other developed nation on earth is deep medical debt as present a threat as in the US.

Greed harms the cultures of compassion and professionalism that are bedrock to healing care. Health care executives and board members who know better nonetheless feel compelled to play the games of pricing, acquisition, and revenue maximization that others do. Professionals find themselves trapped in record keeping, coding behaviors, and productivity imperatives that belie the reasons many went into health care in the first place. “Moral injury” is the harvest, with demoralization and disengagement to follow.

US health care costs nearly twice as much as care in any other developed nation, whereas US health status, equity, and longevity lag far behind. Unchecked greed is not the only driver of that failure, but it is a major one. Few, if any, other developed nations tolerate the levels of avarice, manipulation, and profiteering in health care that the US does. Salve lucrum is the wrong answer.

What to do about greed? No answer is easy, not least because of the political lobbying might of individuals and organizations that are thriving under the current laxity. The cycle is vicious: unchecked greed concentrates wealth, wealth concentrates political power, and political power blocks constraints on greed.

Perhaps the demoralization of professionals, the conflicted consciences of many executives, and the anger of the public represent potential political energy that, with proper leadership, can become kinetic.

First, health care professionals in all disciplines need to become noisier about the conflict between unchecked greed and the duty to heal. Extortionate drug prices, exploitation of market consolidation, coding games, excessive executive compensation, and promulgation of unnecessary care ought not to be met with silence. Silence is assent.

Second, health care professionals should insist that their guilds and trade organizations demote the pursuit of higher payment among their priorities. They should insist that resources flow to the neediest in our society. The protection of patients—all patients—is the first and highest calling, and that includes protection against onerous medical debt and bankruptcy.

Third, health care leaders and professionals should lobby Congress to pass legislation to rein in greed. Reforming patent laws, changing coding and billing rules, strengthening antitrust enforcement, expanding price transparency, and accelerating global budgets for the care of populations are agendas that have languished without strong action in Congress for years because the money of incumbents drowns out the greater public interest.

Fourth, health care professionals should insist that their organizations invest actively in improving the true social influences on health. America’s hospitals should bring a fair share of their resources to mitigating the actual causes of illness, injury, and disability.

The glorification of profit, salve lucrum, is harming both care and health. Health care should not be an engine for excessive private gain.


1. Gilfillan  R, Berwick  DM. Medicare Advantage, direct contracting, and the Medicare “money machine,” part 1: the risk-score game. Health Affairs blog. September 29, 2021. Accessed January 24, 2023.

2. Kronick  R, Chua  FM.  Industry-wide and sponsor-specific estimates of Medicare Advantage coding intensity.  Published November 17, 2021. SSRN. Accessed January 24, 2023.

3. Fronstin  P, Roebuck  MC, Stuart  BC. Location, location, location: cost differences for oncology medications based on site of treatment. EBRI Issue Brief. January 16, 2022:No. 498.

4. Allen  A. $38,398 For a single shot of a very old cancer drug. Kaiser Health News. Bill of the Month. October 26, 2022. Accessed January 24, 2023.

5. Conti  RM, Bach  PB.  The 340B drug discount program: hospitals generate profits by expanding to reach more affluent communities.   Health Aff (Millwood). 2014;33(10):1786-1792. doi:10.1377/hlthaff.2014.0540PubMedGoogle ScholarCrossref

6. Silver-Greenberg  J, Thomas  K. They were entitled to free care: hospitals hounded them to pay. New York Times. September 24, 2022. Updated December 15, 2022.

7. Massachusetts Health Policy Commission. 2022 Health care cost trends report and policy recommendations. Published September 2022. Accessed January 24, 2023.

8. Saini  V, Garber  J, Brownlee  S. Nonprofit hospital CEO compensation: how much is enough? Health Affairs Forefront. Published February 10, 2022. Accessed December 24, 2022.

9. Schwartz  K, Lopez  E, Rae  M, Neuman  T. What we know about provider consolidation. Kaiser Family Foundation. Published September 2, 2020. Accessed December 24, 2022.

10. Levey  NN. 100 Million people in America are saddled with health care debt. Kaiser Health News. June 16, 2022.

Other Information

The market economy fails when applied to healthcare,” Angry Bear

Medicare Advantage has Overcharged FFS Medicare by Billions for Years,” Angry Bear

While Considering Medicare For All: Policies For Making Health Care In The United States Better,” Angry Bear

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  1. Carla

    Although I have been a dues-paying supporter of and advocate for Physicians for a National Health Program for more than 20 years, and am familiar with Donald Berwick’s stature in the single payer movement, I only this morning read his congressional testimony from 2019 — just as germane now as then:

    P.S. If you don’t already belong, please consider supporting the premiere single payer group in the country with an “ally” membership for only $50/year:

    P.P.S. Thanks, Yves, for this excellent cross-post from Angry Bear.

  2. Paul Art

    Physicians lost any respect they once had accrued from notions of “we know medicine best”. We should hold Physicians responsible primarily for the ‘Greed is good’ situation in Healthcare today.

    1. Piotr Berman

      I have more regard for professional knowledge, and I can do my own checks, internet etc., to ponder my choices, so far, nothing more dramatic than timing of dental procedure or advise on vaccines (which I followed, so far, so good).

      But there is a worry that if a test etc. is recommended, is it because of my benefit, or financial benefit of the medical group I am dealing with? But with more complicated health issues (or even simple but acute, like broken limb, or a medication that is suddenly needed), the interaction with American medical system is confusing and frustrating.

  3. jackiebass

    The problem I see with doctors is they aren’t independent. They are employees of health care systems. I would bet they are encouraged to have patients use more of their services.There is very little real competition. In my area there are two systems and the operate with the same business plan. If you have a problem outside normal hours or on the weekend you have to use the emergency room . This is a very expensive option.The bottom line is there is NO competition to help control prices for services.This is probably the US health care system is the most expensive in the world.

    1. Yves Smith Post author

      I still travel to NYC to see doctors for that reason. My MDs there are all solo practitioners (the ones at the Hospital for Special Surgery seem to have storefronts in the HSS empire). It’s hard even in NYC to be a GP as a lone operator. Mine does it by having her practice consist about half of services outside the insurance paradigm (despite not being a derm, she does Botox and some other non-surgical cosmetic treatments. I don’t get those but appreciate that they cover her overhead). Also due to NYC being a very directness-favoring town, it’s much easier to communicate with MDs. They are used to opinionated patients.

      1. Rubicon

        “Yves” be glad you keep in touch with NYC folks. Yes, when we visit New York, one can easily find a large variety of “opinionated folks.” :)

        The exact opposite is the minor enclave of little Vancouver, WA State. A population of about 330K. The natives here are tight-lipped, very uncomfortable around out-of-state citizens and remain barricaded in their little provincial mentalities.
        If you question them about their provincial nature, you are automatically shunned from their society. After all, what else do the females here do: they’ve built a gossip network to keep them from living the reality that MOST Americans experience and discuss openly.

        Sorry to be off-topic.

  4. LAS

    People are choosing Medicare Advantage b/c traditional Medicare is now burdened with complication: having to choose a private insurer Medigap plan and a private insurer Part D drug plan. If you don’t choose them, you are threatened with risking higher costs later. In a way, it’s less work to choose ONE MA plan than have to choose TWO private insurer plans (one each for gap and drugs).

    In some of my recent work, we had occasion to do outreach to persons classified with heart disease in the administrative databases of an insurerer providing Medicare and Medicaid plans. The insurance members we were contacting were classified as having heart disease (and maybe they all did have) however that was not always what the patient believed. When they were contacted in the outreach, roughly 12% of those with this heart disease classification said they did not have heart disease and some were shocked that we thought so; at least they had not been diagnosed with heart disease in plain terms to their understanding. Possibly in their patient history they had once taken a drug associated with a heart disease regime and were, through some administrative algorithm, swept up into the heart disease classification by the insurance company.

    It is my understanding that insurers get paid a higher capitation for persons with certain chronic conditions, including heart disease, and it would be in their interest to find more members with these conditions than not. It is troubling that more attention was paid to processing insurance members as agents of a financial exchange than as patients who had something to learn about their health condition.

    Another thing that struck me in working with the insurer is that they were not particularly careful in the transmission of sensitive data compared to the government institution I was working under, which had many more safety prototocols we had to follow. And more, all the insurance companies I visited during this work had offices within a few blocks of Wall Street where I had to go.

    My personal conclusion is that it’s not bunk these companies are in the financial industry and they are not adding much if anything to medicine/health care; it’s quite true.

    1. Yves Smith Post author

      You don’t really need a Medigap plan. I think that is oversold.

      I admittedly have the luxury of having a very old plan which covers treatments outside the US, is Medicare D creditable coverage, and also fills some gaps. But the big reason to get Medicare D is if you are or might be on a pricey drug, and even then horrible Medicare D plans are spotty on pricey drug coverage. If you were really confident you’d be on only comparatively cheap drugs, the GoodRx cards offer >60% discounts.

      My mother was on a Medicare Advantage plan, and her co-pays on her few sort of pricey drugs like her inhaler, were pretty bad, over 50%. It would have been cheaper on a GoodRx card, but if you are on any Medicare drug plan, the pharmacy has to bill to Medicare and present you only with the co-pay.

      1. antidlc

        “You don’t really need a Medigap plan. I think that is oversold. ”

        Medigap or part D?

        1. Kris Alman

          I would agree that Medicare Part D is overrated and oversold, but an individual would be in financial ruins without a Medigap plan when going the traditional Medicare route.

          In Oregon and Washington, we can get discounted FDA approved drugs through the Oregon Prescription Drug Program which can be used at over 65,000 pharmacies nationally and over 600 in Oregon. Savings of 80% on generic drugs and up to 20% off brand-name drugs and the discount card is FREE and available to any resident in the state of Oregon. No membership fees, age or income limits, drug lists or formularies!

      2. Oh

        Yves, I value your opinion. Could you explain why one doesn’t need a Medigap plan. I would appreciate it.

  5. TomDority

    “What to do about greed? No answer is easy, not least because of the political lobbying might of individuals and organizations that are thriving under the current laxity. The cycle is vicious: unchecked greed concentrates wealth, wealth concentrates political power, and political power blocks constraints on greed.”
    It all comes down to the laws and the legislators who favor, in legislation, the unchecked profits and absurd give-aways that paves this process in many industries to the benefit of the rentiers. You have all this blame going to those who became billionaires after starting a legit real world business … but due to the structuring of our laws and tax system favoring the rentier class – the legislators who complain about this corporate greed have enabled the greed and concentration to occur through their own work. If you are able to make more money easier through financial engineering than through real work… and you have laws that may cause negative legal consequences for not making that money most efficiently and tax efficiently… well you get what you have. Not to speak for Elon Musk but.. I would assume he started out not with the priority of becoming a billionaire but of producing some good engineering and product.. he became a billionaire on paper because all that tax advantaged and remote asset (stock) inflation and wild speculation went on outside in its financial engineered legislatively enabled way. But some folks like that Fried Crypto guy or many in the financial end of things or Elizabeth Holmes ..they started out with the intent of becoming a billionaire and did not posses the legal and (sadly) political skill to avoid the pitfalls…well the big guys did.
    The great sore spot in our modern commercial life is found on the speculative side. Under present laws, which foster and encourage speculation, business life is largely a gamble, and to “get something for nothing” is too often considered the keynote to “success”. The great fortunes of today are nearly all speculative fortunes; and the ambitious young man just starting out in life thinks far less of producing or rendering service than he does of “putting it over” on the other fellow. This may seem a broad statement to some: but thirty years of business life in the heart of American commercial activity convinces me that it is absolutely true.
    If, however, the speculative incentive in modern commercial life were eliminated, and no man could become rich or successful unless he gave “value received” and rendered service for service, then indeed a profound change would have been brought in our whole commercial system, and it would be a change which no honest man would regret.- John Moody, Wall Street Publisher, and President of Moody’s Investors’ Service. Dated 1924

  6. antidlc

    “By gaming Medicare risk codes and the ways in which comparative “benchmarks” are set for expected costs, MA plans have become by far the most profitable branches of large insurance companies.”
    UnitedHealth, CVS/Aetna, Cigna pulled in close to a trillion dollars last year, mostly as drug middlemen
    The three companies’ PBM businesses now collectively generate more profits than their health insurance units.

    We still think of those three companies – UnitedHealth Group, CVS/Aetna, and Cigna – as health insurers. I certainly did when I worked at Cigna. But a few years ago, all three realized there is a lot more money to be made as a middleman between you and drug makers than selling health insurance.

    1. Tim

      Would this still happen with our kleptocratic government version of single payer?

      It’s the ultimate question isn’t it?

      Would the single payer truly defend us like in other countries, or would it let itself be taken advantage through our current political and legislative process that takes guidance from the profiteers?

  7. The Rev Kev

    I don’t think that the present system can be reformed. And the reason is that the US medical system evolved through the general corporate culture that prioritizes profits over all other considerations. An effect of Neoliberlism. So even if you burned down the whole medical establishment, what would take its place would be near identical because of the corporate culture still being in place. So trying to fix the medical system would be akin to treating the symptoms rather than the root causes.

    1. Felix_47

      The current system is not workable because it is for profit. We saw the power of the health insurance lobby in the South Carolina primary. Most of the Democratic voters are getting government coverage be it Medicaid if poor, or VA, or Tricare or other government coverage since the big employer for these voters is the federal government. There are many military bases, government contractors and veterans in South Carolina. So for democratic voters health care and its cost is not much of an issue. The private sector with private or no insurance is largely Republican and has little influence on presidential selection at the primary level and the Repubs are in such disarray that they have no idea what they want. Voting in SC is largely racial and cultural so the state usually goes Repub no matter who. Sanders was a huge financial threat to the democratic leadership especially South Carolina. Breaking the democratic insurance rice bowl is not acceptable. But there is a model that would make sense. Britain has had the NHS and its problem recently boils down to underfunding. We could simply adopt the NHS model and fund it better. Put providers on government salary. That would cut unnecessary care by 30 percent (using Berwicks numbers and 50 using my clinical impression). Rationing by expected outcomes as determined by a doctor would seem to work better than rationing by paperwork and bureaucracy which we now have. Putting providers on salary makes sense if we are to consider health care a right of all residents of the US to be funded by Uncle Sugar. That would be like fire protection, police, the military, the VA system. England has worked out a lot of the issues with the NHS already. As long as there is fee for service with Uncle Sugar paying the bill we will have upcoding (insurance fraud), arcane rules made to make insurance and pharma rich, and poor quality outcomes and research. Most doctors would be happier as well. However the presidential primary in 2020 tells us where the obstacles are.

  8. DTK

    I’ve spent much of my working life adding to the profits of health insurers. Making this seem right and natural is the real success of these firms.

    1. earthling

      That’s a profound truth. Maybe it starts in childhood when we play board games and other games, and You Have To Follow The Rules. Then in school, same thing. Then you take a job, where because of some accident of history your medical insurance is tied to your job, and you have to follow the rules to get care.

      The insurers put out these long unreadable documents full of gotchas, and when you need care, they fail to cover this and that, and it’s all because of ‘the rules’ they set up and we must agree to, or die in a hospital lobby.

    2. Tim

      “I don’t want an education system that creates thinkers. I want an education system that creates workers.”
      Founding funding provider of modern education in the US.

      One piece of the reason. We are definitely not taught how to look out for our best interest.

  9. Mildred Montana

    So, not only is healthcare riddled by greed, it is also rife with incompetence.

    From today’s links: The Profession Formerly Known As Medicine American Mind (Dr. Kevin)

    Way back in the days of yore (1950s to 90s) my father was a general practitioner in Canada, most of that time in its single-payer medicare system. Although he certainly ordered tests, he also took a detailed history and did a thorough physical if the patient was new to him. A visit could sometimes last half-an-hour. His waiting room was packed, often way past closing, to the consternation of some patients. I know, I worked as his receptionist for a few weeks.

    Today? I rarely visit doctors but when I do, no matter my issue, the first thing they’re likely to do is slap the blood-pressure cuff on my arm. I guess that qualifies as “care” and it certainly doesn’t consume much of the physician’s time. Then the inevitable sheets of tests are printed out on the computer as he barely looks at or listens to me (see the link for a similar tale). If he suggests a prescription drug just to be rid of me, I politely accept the “script” and then, as often as not, ignore it. I have a healthy respect for the possibility of iatrogenic blunders. (See: medical incompetence)

    Back to my father. When was the last time a doctor examined your skin, looked at your hands, and even—yes—smelled your breath? My father did all those things if he was doing a physical. He developed a reputation as an excellent diagnostician. I wonder why?

    He died in 1997 after many years of practice, leaving an estate of approximately $400,000.

  10. Clark Landwehr

    All reforms or tweaks of the current system will fail. I believe that our health problems are the consequence of a socially toxic civilization. We have created a “behavioral sink.” And now have run out of fingers to plug the holes in the dike. Just the coming global tsunami of diabetes alone will overwhelm the system in short order.

  11. antidlc

    Insurer Humana lays out employer-sponsored coverage exit

    The health insurer Humana will stop providing employer-sponsored commercial coverage as it focuses on bigger parts of its business, like Medicare Advantage

    The health insurer Humana will stop providing employer-sponsored commercial coverage as it focuses on bigger parts of its business, like Medicare Advantage.

    The insurer said Thursday it will leave the business over the next 18 to 24 months. It includes medical coverage provided through private companies and for federal government employees.

  12. Tim

    “What to do about greed? No answer is easy, not least because of the political lobbying might of individuals and organizations that are thriving under the current laxity. The cycle is vicious: unchecked greed concentrates wealth, wealth concentrates political power, and political power blocks constraints on greed.”

    Kleptocracy in a nutshell am I right?
    And sorry Gordon, greed is not good.

  13. Hayek's Heelbiter

    Am I imagining things?
    I searched every keyword I could think of, but I couldn’t find a link to an insightful NC article on Eli Lilly bumping the low coupon price of Mounjaro up to $13k MONTH, and obese people fighting with diabetics, as well as an Eli Lilly spokesperson bragging about how Mounjaro will become the best selling drug in history and might well earn the company a trillion dollars.
    Could some stat wonk out there in the NC commentariat calculate how many financially insecure obese people and diabetics are going to die prematurely in this latest triumph of medical capitalism.

  14. Sue inSoCal

    Thanks for this Yves. I have thrown my hands up. If IRRC, there is a move to crack down (somewhat?) on greed in certain industries (though I cast a jaundiced eye) via proper implementation of antitrust. But, note, the Medical Industrial Complex is exempt! Hmm. I’ve said previously, I’m in a wealthy area that eschews Medicare and takes cash or private. When they do take Medicare, many have no clue how to bill Medicare gap. I’m sure I’m not alone. Unfortunately, with chronic conditions, a gap policy is needed, and I needed D immediately for some spendy meds or I was threatened with a lifetime penalty. The reason for the gap is that these services now are extremely expensive. They add up. As far as I’m aware, you must enroll in a gap policy (and D) within a specific period of time or forever hold your peace.

    I have real issues with this “penalty” stuff. I had to prove I was covered by “other insurance” when I was forced on Medicare or, again, face a lifetime penalty. What happened to just signing up for Medicare? End of?

    Folks I know in the UK with the NHS tell me they are demoralized. I have buddies with the same chronic illness there that are pulling their hair out there from the cuts, strikes and proposed privatization. Here? I have little hope at all.

  15. gcw919

    We never hear (and probably never will) Joe Biden advocate for Universal Health Care, or MediCare for All. He is of course too beholden to his corporate handlers. But as it looks like he’s running again, and has a very good chance of losing, it is bewildering that the Democrats, many of them corporate-Dems, don’t recognize that advocating for Universal Health Care could be the focus of winning back those voters who have become justifiably disenchanted with the whole political system. Its been reported that some 70% of the electorate favor Universal Health Care. 70% in any election would be called a landslide. Or am I missing something?

  16. Fastball

    This reads like a Robert Reich post. Particularly this:

    “Perhaps the demoralization of professionals, the conflicted consciences of many executives, and the anger of the public represent potential political energy that, with proper leadership, can become kinetic.”


    “The glorification of profit, salve lucrum, is harming both care and health. Health care should not be an engine for excessive private gain.“

    Uh. Huh. Perhaps we should all sing songs to lift our spirits, as well.

    1. Willie

      Perhaps we could embed a universal health care proposal in an Omnibus Bill.
      Tack on some post office name changes to Rachel Levine. Have insurance lobbyists involved in authorship. Vote on it to see what’s in it. Turn the printing press up to BRRRR!

      “Tell Micheal (Corleone) it wasn’t personal. It’s just legislation.”

  17. Phichibe

    I’m on Obama-Care (Pelosi-Care, if you ask me) and just had a busy February. Two cataract surgeries and double hernia repair. Beyond being grateful to live in country with advanced medicine, I am and remain furious that America’s healthcare system is an exclusive club that denies care to tens of millions of people, mostly the working poor who don’t get health insurance with their (underpaid) jobs.

    I have been a single-issue voter on Universal Healthcare since 1988 when I left graduate school and discovered that I had less than a month to find new coverage. Individual insurance policies were very difficult to find and I only got covered when my business partner and I qualified for a business policy for our (two person) startup. It was a scary period and I’ve flirted without insurance at times since. Next time you see a homeless person or even a gig-economy worker (or someone working at Walmart!) think of the precarious existence these poor souls live. It’s not just barbaric but it’s cost-inefficient. The laissez-faire dogmatists have let their ideology trump (pardon the expression) their devotion to the bottom line, which is saying something.

    Having thought about this problem for decades, I believe the critical issue in health care costs (and the same for higher education costs) is that a market where demand is inelastic, providers have almost unlimited latitude to gauge consumers. If you had a sick child, what price wouldn’t you pay to get them the best treatment you could? I’m not antagonistic to market-based economies, I mean I’ve started three companies since leaving grad school. But not every market works well, and where they don’t we need monopsonistic (single payer) solutions. I don’t want laissez-faire approaches to public safety and I definitely don’t want it for matters of life and death, or even basic human decency. To paraphrase the late Douglas Adams, “Come on people!”



  18. Ep3

    So what about sports athletes? If I am a sports athlete, an MRI is done within 24 hours, I see a top doctor in the country, regardless of where I live or my team calls home, and often end up in surgery by the end of the week. Then there’s PT & rehab that not only focuses on the specific body part, but is a whole health regime (don’t forget I don’t have work pushing for me to return or else I lose my job & benefits, and I don’t have to worry about going broke while recovering).
    Contrast this with us regular poor people.
    All of this weighs on the overall cost of health care.

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