#healthcare + #politics

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."

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.