Aaron Plotke

Congress has let drug companies rip off Americans for decades. Lobbyists, campaign cash, and a system that protects industry profits. But it doesn’t have to be this way.

Large hospital systems are profiting off Medicare rules that pay them more for the same service than independent practices. That means a senior in my district can pay MORE for an X-ray at a hospital than at a local doctor’s office -- and the hospital makes MORE too. Today I asked hospital system CEOs a simple question: should we equalize payments to lower costs and expand access? They said no. Americans deserve affordable care, not a system that rewards higher prices.

Large hospital systems are profiting off Medicare rules that pay them more for the same service than independent practices. That means a senior in my district can pay MORE for an X-ray at a hospital than at a local doctor’s office -- and the hospital makes MORE too. Today I asked hospital system CEOs a simple question: should we equalize payments to lower costs and expand access? They said no. Americans deserve affordable care, not a system that rewards higher prices.

AOC: We know they’re lying through even their mechanisms. They are upcoding—they are telling us, the public, the government, Medicare, our systems—that people are sicker than they are so that they can get more money. They’re lowering their reimbursement rates. They’re increasing denials. So we know that these folks are lying. We know that they’re bad actors. And if I’m hearing you correctly, we are giving them more money because they’re saying that they need it?

One of the reasons is the perverse and recursive incentives of hospitals, health systems, and insurance companies. The truth is that insurance companies rely upon hospitals and health systems increasing costs year over year. Otherwise, due to their regulated MLR, their margins would stay stagnant. Therefore, the only way for an insurance company to make more money is for hospitals and health systems to continually increase costs. The main driver of cost is hospitals and health systems. In fact, when you look at NHE (with no additional attribution) hospitals and health systems are - far and away - the largest recipient of the healthcare dollar.

What if there was a bank account available, that required you to deposit monthly, what you would have paid an insurance company in premiums, for an ACA silver plan. So for a family of 5 about $2100. The amount would then be used for Stop Loss Insurance set at $30k dollars. About $300. Another $200 would be used for local Direct Primary Care for your family The balance would be in YOUR bank account. Like an HSA, It could only be used for approved medical expenses. If you never have any medical expenses, you will get to keep the money plus checking act level interest, when you turn 65 If you have a medical event that is more than what you have saved, your bank will loan you the money you need to pay for it, up to the $30k stop loss trigger You would repay that amount using the monthly $1600 net deposit. Once the loan is paid off, the deposits start to accrue to you again. This is not insurance. It’s a specially designed bank account that gives you control, support, a doctor to work with and catastrophic financial protection. Lots of work and issues to be addressed. But I was curious what people think Let me know !