#healthcare

U.S. vaccination rates have dropped and the share of children with exemptions has reached an all-time high, according to federal data. At the same time, rates of diseases that can be protected against with vaccines, such as measles and whooping cough, are rising across the country.

During his Senate confirmation testimony last year, Kennedy told lawmakers that a closely scrutinized 2019 trip he took to Samoa, which came before a devastating measles outbreak, had “nothing to do with vaccines.”

But documents obtained by The Guardian and The Associated Press undermine that testimony.

Public health experts also criticized the president for making unfounded claims about highly politicized health issues. During a September Oval Office event, Trump asserted without evidence that Tylenol and vaccines are linked to a rise in the incidence of autism in the United States.

Most of the deals, however, don’t affect what people with private insurance or Medicare pay for the drugs. People with Medicaid — who typically have minimal or no copays for prescriptions — already pay very little.

“Generally speaking, most people with insurance coverage will continue to be better off using their insurance to obtain medications rather than purchasing through the TrumpRx direct-to-consumer portal,” said Juliette Cubanski, deputy director of the program on Medicare Policy at KFF, a nonpartisan health policy research group.

The website asks customers to confirm that they are not enrolled in “any government, state, or federally funded medical or prescription benefit programs.” Those with both commercial and government-funded plans are considered to be on government insurance and are not permitted to participate in TrumpRx.

The US has one of the most expensive health systems in the world, with spending on health care estimated to reach $5.9tn (£4.3tn) in 2026, according to the Centers for Medicare and Medicaid Services. But despite spending twice as much per capita on healthcare compared with wealthy nations of a similar size, the US has a lower life expectancy than those other nations, according to health research nonprofit KFF.

Large publicly-traded health companies have tripled their profits over the last two decades, paying out shareholders over $2.6tn from 2001 to 2022, according to a study in the Journal of the American Medical Association. "We are the only major [health] system in the world that allows the free market to run loose," said John McDonough, Harvard TH Chan School of Public Health professor.

Roughly one in five Americans covered by private health insurance reported their provider refused to pay for care recommended by a doctor in 2023, according to a survey by KFF.

The number of overlapping health care systems in the US - Medicare, Medicaid, the marketplace, employer-sponsored insurance and veteran's health, among others - creates a confusing and sometimes wasteful system, said McDonough. "We have so many, each of them with their own set of rules, their own system, their own bureaucracy," he said. "We really do need some system consolidation."

In 2019, differences in diagnostic coding caused Medicare to pay MA plans $9 billion more than it would have spent if the same beneficiaries had been enrolled in FFS Medicare.

Excess payments to MA plans may benefit enrollees in the MA program (when used to increase the value of extra benefits offered rather than increase profits) but cost taxpayers more than if these enrollees were covered in FFS Medicare. Further, excess payments to MA plans increase fiscal pressure on the Hospital Insurance (Part A) Trust Fund as well as on the taxpayers, beneficiaries, and state Medicaid programs who pay premiums to finance the Part B program.

The Medicare Payment Advisory Commission We are a nonpartisan independent legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program.

Fascinating that Medicare Advantage a private company healthcare plan rather than a government one where current political banter beats the drum about fraud. So these are private companies committing fraud and not government run plans.

Medicare Advantage plans offer seniors a private alternative to original Medicare. The insurance plans have grown dramatically in recent years and now enroll about 34 million members, more than half of the people eligible for Medicare.

In court filings, the government argued the health plan “pressured” doctors in Colorado and California to add diagnoses “regardless of whether these conditions were actually considered or addressed by the physician during the patient visits,” policies that violated Medicare requirements.

From 2009 through 2018, KP added roughly half a million diagnoses that generated about $1 billion in improper payments to the health plan, according to the complaint.

The KP settlement comes on the heels of a Senate report this month that accused UnitedHealth Group of “gaming” the Medicare Advantage payment system, which is called “risk adjustment.”

“My investigation has shown UnitedHealth Group appears to be gaming the system and abusing the risk adjustment process to turn a steep profit,” Sen. Chuck Grassley (R-Iowa) said in a statement accompanying the report’s release.

The report cited several medical conditions that have repeatedly been linked to overbilling by Medicare Advantage plans, such as coding for opioid dependence disorder in patients who are taking their medications as directed for pain.

The updated vaccines have not been specifically tested for safety in people, just as flu vaccines are not tested in people every year with a strain change. The safety of the shots, however, has been well established in the original trials and through surveillance of billions of highly similar doses.

The main serious safety risk of each of the vaccines is inflammation of the heart muscle or its surrounding tissue, known as myocarditis and pericarditis, respectively. The conditions are rare, most commonly affecting young men after a second dose.

Studies have shown that for most people, myocarditis is much more likely following a COVID-19 infection than a COVID-19 vaccine. Infection-related myocarditis is also more severe and linked to worse outcomes.

U.K. health officials analyzed preliminary flu data and predicted that subclade K may spread more easily than other versions. The researchers estimated that the reproduction number of subclade K is 1.4, meaning that each infected person spreads the virus to 1.4 other people on average. Typically, the reproduction number of the flu is closer to 1.2.

While there will be more flu cases this year, so far, there is no evidence that this new flu version will cause more severe cases, hospitalizations or deaths. Health officials have already recorded many more cases this year than at the same time last year, about 4.5 million cases compared to 1.9 million in 2024. But of those nearly two million cases last year, 1.2% were hospitalized and 0.05% died from their infections. So far in 2025, the rate of hospitalization is 1.09% and the mortality rate is 0.04%.

The CDC has not yet commented on the effectiveness of this year’s flu vaccine in the U.S. But U.K. health officials previously estimated that their vaccine, which is different from the one used in the U.S., reduced hospitalizations by about 70-75% in kids and by about 30-40% in adults.

The recent firing of the director of the U.S. Centers for Disease Control and Prevention (CDC) and new restrictions from leaders at the U.S. Food and Drug Administration (FDA) about who will be eligible to get COVID-19 vaccines have sparked confusion among the public and concern from health experts, who say it’s critical to protect as many people as possible from respiratory viruses like flu and COVID-19.

To answer some of your top questions about the 2025-2026 COVID-19 and flu vaccines, we consulted with infectious disease expert, Dr. Michelle Barron.

You can get both shots at the same time, and the exact timing doesn’t matter. So if you’re able to get the updated 2025-2026 COVID-19 and flu vaccines sometime in the next couple of months, Barron encourages as many people as possible to do so.

The panel originally had been scheduled to vote on the COVID-19 vaccine recommendations in June. But that month, Health and Human Services Secretary Robert F. Kennedy Jr. dismissed the committee and installed new members of his choice. The CDC director, who had just been confirmed by the Senate, was fired in August, and other top officials resigned. Meanwhile, Kennedy has repeatedly made false or misleading claims about COVID-19 vaccines this year.

This year, the recommendation by the Centers for Disease Control and Prevention is narrower. Although the vaccines are broadly recommended for adults 19 and older, they are no longer recommended for healthy pregnant people or for healthy children 6 months through 17 years old.

Kennedy announced the changes in a video in May, citing safety risks for young people and pregnant people as justification.

But his claims have been widely disputed by experts in vaccines, pediatrics, and women’s health. An analysis by FactCheck.org found that the secretary “misrepresented scientific research to make unfounded claims about vaccine safety for pregnant people and children.”

The measles, mumps and rubella vaccine is safe and provides 97% protection against the disease after two doses. Most children in the U.S. are required to get the shot to attend school. But vaccination rates have declined as more parents waive the shots or have fallen behind on recommended vaccination schedules.

Healthcare spending is driven by utilization (the number of services used) and price (the amount charged per service). An increase in either of those factors can result in higher healthcare costs. Despite spending nearly twice as much on healthcare per capita, utilization rates for many services in the United States is lower than other wealthy OECD countries. Prices, therefore, appear to be the main driver of the cost difference between the United States and other wealthy countries.

The U.S. spends twice as much as comparable countries do on health, driven mostly by higher payments to hospitals and physicians.

"Private insurance companies in this country spend between 12 and 18 percent on administration costs," Sanders said on NBC’s Meet the Press on Sept. 17. "The cost of administering the Medicare program, a very popular program that works well for our seniors, is 2 percent. We can save approximately $500 billion a year just in administration costs."

Is the gap between private and public health insurance providers’ administrative costs really that high? Most experts agreed the numbers looked about right. But because of key differences between Medicare and private insurance, the trade-off isn’t as simple as Sanders suggests.

If "the numbers looked about right", then why is it "half truth"?

Experts told us we could safely assume private insurance costs, on the other hand, are much higher, though actual spending estimates vary.

Aah... So it's a "half truth" because Bernie understated how much cheaper medicare is than private insurance companies.

Historically, administrative expenses were much higher in the commercial market because insurers did a lot of underwriting, or using the health status of individuals or groups to determine their premiums. The Affordable Care Act was designed to curb that spending.

On top of that, experts explained that unlike Medicare, private insurers take on more responsibility than simply paying claims or occasionally going after fraud. Before a claim is even filed, they check its appropriateness, assess whether it is medically necessary, and whether it can be done in a cheaper way (outpatient versus inpatient care, for example).

"Medicare has been trying in fits and starts to look a little more closely at how it pays claims but generally speaking, it is passive in processing claims," Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University.

And private companies, deny more claims, which makes it more expensive.

Health expenditures per person in the U.S. were $13,432 in 2023, which was over $3,700 more than any other high-income nation.