Millions of Americans were outraged to see videos of the cold-blooded murder of United Healthcare executive Brian Thompson in New York. Yet some are actually happy to watch an insurance executive be executed and are cheering for the alleged murderer. How can we explain such behavior in a civilized society?

John C. Goodman, healthcare economist writing for Forbes, tells us a post on X wishing that the killer would never be caught racked up 95,000 likes. United Healthcare’s own bereavement message online was cruelly mocked by 77,000 laughing responses. How can people react this way?

Before we analyze what’s wrong with the American system of health insurance, let’s consider what’s right. Despite a popular misconception, a KFF (Kaiser Family Foundation) survey finds that more than two-thirds of Americans rate their health insurance as “good’ or “excellent.” And that holds for all kinds of insurance: employer plans, (Obamacare) marketplace plans, Medicare and even Medicaid.

Even among people who say they are not in good health (and who, presumably, need medical care), a substantial majority give positive ratings to their health plans. The KFF survey’s other two descriptive options for health insurance are “fair” and “poor.” Yet only a tiny percent of the public gives their health insurance the bottom rank of “poor.” That includes only 5% of people with health problems.

Goodman tells us in general, people view health insurance as different from other types of insurance, and that perception is accurate. You can see evidence of that difference by merely looking at the advertisements that appear on television and in print. In a free market, all sellers of goods and services know that the key to making a sale is to convince potential customers you can meet their needs. In fact, meeting a buyer’s needs is usually a more important selling point than the price. Casualty insurers, for example, sell their products by emphasizing the risks of bad things happening and assuring potential customers that their insurance is ideal protection.

In a free market you make money by finding people who have problems and meeting their needs. In that sense, the casualty insurance market is just like any other market. By contrast, when is the last time you saw a health insurance ad that says you will be “in good hands” if you get cancer, or heart disease, or if you need a hip or knee replacement? I bet you haven’t.

There is a reason for that. Under federal law, health insurers are not allowed to make a profit by meeting the needs of people with medical problems. In fact, they are required to charge the same premium to otherwise similar enrollees—regardless of their medical problems.

Goodman tells us the brutal reality this creates: “With one exception described below, no insurer in our health care system wants a sick person. No employer. No commercial insurer in the marketplace. No Medicaid managed care plan. And no safety net institution. Every time someone with an expensive medical problem enters one of these plans, the organization loses money. If the patient leaves the plan (for whatever reason) the plan makes money. If the plan develops a reputation for being really good at handling serious medical problems, it will attract more sick people and incur more losses. Given the horrible economic incentives that government regulation has created, the surprise is not that some patients experience mistreatment. The surprise is how few there are.”

What can be done about this situation? Is there a better way?

(For more on this subject, tune in next time for Part II.)

 

How accurate are your blood pressure readings? If you’re taking your own blood pressure at home, or even if you only have it taken at your doctor’s office, there are several mistakes that can be made that will give inaccurate readings. Inaccurate readings may lead to too much blood pressure medication, or too little. Either way your health is compromised, so getting an accurate blood pressure reading is very important.

Sheramy Tsai, writing for The Epoch Times, tells us a 2021 study in the American Journal of Preventive Cardiology suggest that we should be wary of trusting the quick blood pressure checks at the doctor’s office. Only one in five cardiologists—excluding preventive cardiologists, who manage heart disease risk factors before they worsen—follow the recommended guidelines for taking blood pressure despite having confidence in their technique.

A 2019 position statement from the Lancet Commission on Hypertension Group echoed these concerns, revealing that inaccurate blood pressure readings lead to mismanagement in 20 to 45 percent of cases in clinical settings. This is often caused by outdated techniques or limited training. Even a 5-point error can shift a reading into the hypertensive range, potentially affecting up to 84 million people worldwide.

The problem may be due to medical staff rushing in a busy doctor’s office. Or it may be due to poor training of medical technicians or support staff, who may receive less formal training than nurses or doctors. But it may also be due to patients using home cuffs without complete education. This may lead to overdiagnosis and unnecessary medication.

The study identified 5 causes of inaccurate blood pressure readings:

Causes of Inaccurate Blood Pressure Readings

1. Wrong Arm Position

Where you place your arm during a blood pressure check can make a big difference between a normal reading and a hypertension diagnosis, according to a recent Johns Hopkins study published in JAMA Internal Medicine. Using electronic blood pressure readings, researchers tested three common arm positions—supported at heart level, resting on the lap, and hanging unsupported—and found significant discrepancies in readings. The researchers found that when the arm rests on the lap, systolic and diastolic readings (the first and second numbers, respectively, in a blood pressure reading) can be nearly 4 mm Hg higher than the recommended position of being supported at heart level. An unsupported arm at the side led to even greater increases.

2. Wrong Cuff Size

One of the simplest factors in blood pressure measurement that is often overlooked is cuff size. For an accurate reading, the cuff must correctly fit the patient’s arm. A cuff that’s too small can overestimate blood pressure, while one that’s too large may underestimate it. The association recommends the inflatable part of a blood pressure cuff, called the bladder, wrap around at least 80 percent of your upper arm. Even if the cuff looks like it fits, the bladder inside might be too small or too big. Studies show incorrect sizes are often used in clinics—particularly for patients with larger or more muscular arms.

A 2023 study published in JAMA Internal Medicine highlights the issue. It found that using a regular-sized cuff on patients needing a larger one led to inflated readings—by nearly 5 mm Hg for a patient needing a large cuff and as much as 19.5 mm Hg for one who needs an extra-large cuff.

3. Crossing the Legs

Crossing your legs during a blood pressure check may seem minor, but research shows that it can significantly change the reading. A study in the Journal of Hypertension found that when participants crossed one ankle over the knee, their systolic blood pressure rose by an average of 11.4 mm Hg, and diastolic pressure increased by 3.8 mm Hg, compared with readings with feet flat on the floor.

This leg position affects blood pressure because it increases cardiac output—the volume of blood the heart pumps each minute. With more blood flowing, pressure in the arteries rises. However, because peripheral resistance, or the natural resistance in blood vessels, doesn’t adjust to offset this increase, the overall blood pressure spikes. Crossing the legs at the ankles doesn’t have the same effect on readings.

4. Full Bladder

It turns out that needing a bathroom break can do more than just make you uncomfortable—it can also raise your blood pressure. Researchers found that middle-aged women holding a full bladder showed an average increase of 4.2 mm Hg in systolic blood pressure and 2.8 mm Hg in diastolic pressure compared with after they’d relieved themselves. The effect was most noticeable after three hours, though the increase didn’t continue to rise with longer durations. This suggests that although a full bladder can temporarily boost blood pressure, it’s the discomfort and tension, rather than time, that has the biggest effect.

5. White Coat Hypertension

For up to a third of patients, simply visiting the doctor’s office can spike blood pressure readings—a phenomenon known as white coat hypertension. This temporary increase, often caused by anxiety, can elevate systolic readings by as much as 20 mm Hg. Dr. Evan Levine, a cardiologist and health care author, manages white coat hypertension by giving patients time to relax and repeating measurements. Studies support this approach, showing that allowing time between readings can reduce anxiety-related spikes. Levine often takes a second reading after the exam, allowing patients to settle down and ensuring more accurate results.

 

This last cause is one I can certainly identify with, even as a doctor myself. This highlights the importance of taking your own blood pressure at home regularly where you are relaxed and can repeat the test often for more accuracy.

 

Most veterans get their healthcare through the Veterans Affairs healthcare system or VA. But what if they have a Medicare Advantage program funded by the taxpayers as well?

Bruce Kitt is one of the Medicare Advantage industry’s most lucrative customers. The federal government pays his private Medicare Advantage insurer thousands of dollars a year to cover the cost of doctor visits, hospitalizations and other medical care that the 74-year-old retired aircraft mechanic might need.

But Kitt, an Air Force veteran who served in Thailand during the Vietnam War, gets almost all of his healthcare outside the Medicare system, through the Minneapolis VA Medical Center. The taxpayer-funded Department of Veterans Affairs health system provides low-cost or free care to Kitt and about nine million other qualifying veterans.

Mark Maremont, Christopher Weaver, and Tom McGinty expose this scandal in The Wall Street Journal.  They tell us Kitt’s Medicare Advantage insurer, an affiliate of CVS Health’s Aetna unit, pays for almost nothing other than a $100 monthly cash-like rebate to Kitt as an incentive to keep him on its rolls. The government paid the insurer at least $6,000 to cover him in 2022, the year he joined the plan.

“I don’t think I’ve used my Medicare in years,” said Kitt, who lives in Eden Prairie, Minn. When he needed some eye tests, the VA, not his Medicare Advantage plan, paid for him to go to an outside clinic. “I’m pretty happy with the VA,” he said. “I look at the Medicare plan as a backup.”

A Wall Street Journal analysis of Medicare and VA data found that Medicare Advantage insurers collected billions of dollars a year in premiums to provide medical coverage for about one million veterans like Kitt, even though they go to the VA for some or all of their healthcare needs. The analysis found the insurers paid far fewer medical bills for those veterans than for typical members. About one in five members of Medicare Advantage plans that enroll lots of veterans didn’t use a single Medicare service in 2021, the Journal found. That compares with 3.4% of members of other Medicare Advantage plans.

The federal government paid insurers an estimated $44 billion from 2018 through 2021 to cover Medicare Advantage-plan members who were also users of VA services, based on average payments for all members of those plans. The VA spent $46 billion on the same group’s medical care, according to VA data reviewed by the Journal. The figures exclude pharmacy costs, which many Medicare Advantage plans focused on veterans don’t cover.

Under the decades-old law that created Medicare, the VA can’t bill Medicare Advantage insurers for services it provides their members. The result is that the federal government sometimes effectively pays twice to cover the health needs of veterans—once in premiums for their Medicare Advantage insurers, then again for the VA to provide actual healthcare services.

The VA encourages veterans to sign up for some form of Medicare, even if they have access to VA health, in part because Medicare gives them the choice of going to a non-VA doctor or hospital. Medicare Advantage plans are attractive to many veterans because they offer perks that go beyond what Medicare requires, ranging from the dental benefits to gym memberships.

Medicare Advantage, the privatized form of the federal health program for seniors and disabled people, was expanded about two decades ago in an effort to deliver care more efficiently. The insurers get paid a lump sum every month to cover members’ healthcare, with higher payments for patients diagnosed with more serious health conditions. The private plans now cover more than half of Medicare recipients. The program has proved popular, but also has cost taxpayers far more than traditional Medicare coverage, according to the Medicare Payment Advisory Commission, a congressional agency. One reason for this I discussed in a series of earlier posts, Home Nursing Visits Bilking Medicare for Billions – Parts I and II.