A pilot program in six states will use a tactic employed by private insurers like United HealthCare that has been heavily criticized for delaying and denying medical care.
Similar cold-blooded algorithms used by health insurers like UHC have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities. The AI companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections. Congratulations Republican voters for being the engine of our destruction. When the hospitals in your rural areas begin to close or when Medicare denies you or a loved one treatment, who will you blame? Bill Clinton? Joe Biden? Which liberal or Democrat? Who?
#6: Racism underlies why the US is the only developed nation in the world not to have universal healthcare for its citizens.
Link: www.nytimes.com
Now comes AI rationing and cruel triage into Medicare so contractors can make money.
"A problem with ACA is it didnt address run away medical expenses."
But it did, based on Medical Loss Ratio. Some consumers (including me) got a rebate.
www.healthinsurance.org
Again, you don't know what you're talking about. The trajectory of Medical Inflation was bent toward sanity under the ACA. That's basic math.
Lower Costs, Better Care: Reforming Our Health Care Delivery System (2014)
www.cms.gov
... Fixing America's health care system doesn't stop with guaranteeing that everyone has coverage. To address the rising costs of health care, we must improve the way that health care is delivered, including the coordination and safety of care.
The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly mistakes and readmissions, keeping patients healthy, rewarding quality instead of quantity, and building on the health information technology infrastructure that enables new payment and delivery models to work. ...
Already we have made significant progress:
Health care spending is slowing
According to the annual Report of National Health Expenditures, total U.S. health spending grew 3.7 percent in 2012. This marks the slowest four years on record in overall health expenditures and for the second straight year, overall health costs grew slower than the economy as a whole. ...
There is only one person brave enough to address runaway medical expenses and he is currently awaiting trial for the assassination of the psychopath and mass murderer CEO of United HealthGroup.
#42 | POSTED BY SNOOFY A
Obama isn't currently awaiting trial for an assassination.
Everyone knows that ObamaCare was a setup to make the health insurance industry rich.
It never was designed to bring down prices or improve coverage.
Anyone who claimed this is an idiot.
How as this ...
media.washtimes.com
Transformed into this
media.washtimes.com
Going to save money?
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Article "Medicare Will Require Prior Approval for Certain Procedures" - NYT, 2025-08-28, has no reference to Medicare "rationing" services, and for good reason - neither "traditional" Medicare (even with Medigap) nor Medicare Advantage, which already enrolls more than half of Medicare recipients and becoming more popular, ever provided all-you-can-eat services. **
Article also acknowledged that: "... There are clear-cut examples where Medicare has wasted billions on questionable medical care. The agency came under scrutiny earlier this year for spending billions of dollars on expensive "skin substitutes" of dubious value. ... A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients."
"Prior approval" may prevent costly, unnecessary procedures and a lot of Medicare fraud, which is a well-known issue that cost CMS and law enforcement billions.
AI is being thrown right and left (see "AI Startup Once Worth $1.5 Billion Now Worthless" - drudge.com), but you could write these "screening tools" in COBOL, if you had to - most of them just compare the procedure request with the patient's plan tables of allowed/disallowed - whitelist/blacklist codes.
The "use of 'AI' for prior approval" resulting in high(er) rate of denials by UHC, Cigna and Humana was much discussed last year - the reason is that most were allowed after appeal when request was corrected and properly re-filed (e.g., often by providers/doctors not familiar with particular plan), which was in ~82% of the cases.
This research has a lot of data and charts:
www.kff.org - Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023 - KFF, 2025-01-28
|------- Prior authorization requirements are intended to ensure that health care services are medically necessary by requiring approval before a service or other benefit will be covered. Medicare Advantage insurers typically use prior authorization, along with other tools, such as provider networks, to manage utilization and lower costs...
This analysis uses data submitted by Medicare Advantage insurers to the Centers for Medicare and Medicaid Services (CMS) to examine the trends in the number of requests for prior authorization determinations, denials, and appeals for 2019 through 2023, as well as differences across Medicare Advantage insurers.-------|
US Healthcare insurance companies directly employ less than 900,000 people (not counting free-lancers/brokers) and are currently managing about 54% of Medicare, their average net profit margin is ~1.4% (outside of AARP's fav UnitedHealth which owns PBM, at ~3.5-5.0%) - exactly the reason government outsources some Medicare, VA and other healthcare services to them to increase efficiency and reduce costs, which includes limited plans that deny "unnecessary" - IOW, "unapproved" or not pre-approved proocedures - thus making THEM "bad guys," not the government.
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** Not even "single-payer" / "universal" medical insurance systems are the exception, e.g., even The Guardian (and Labour gov't) had to admit that British NHS is "broken" (inadequate funding and long wait times for routine procedures):
www.theguardian.com - Wes Streeting to axe thousands of jobs at NHS England after ousting of chief executive - 2025-02-25
www.theguardian.com - The Guardian view on Labour and the NHS: there is no miracle cure for a struggling health system - 2025-03-04
|------- Wes Streeting is building a team of reformers, but ingrained weaknesses in the health service will be hard to fix.
... But the conditions in which he must do this are hugely challenging. The UK has an ageing and increasingly ill population, and a health system which... has ingrained weaknesses. Some of these are to do with the workforce, with shortages in some areas and dissatisfaction with pay that makes further strikes likely.
Long-term underinvestment means technology and infrastructure are not what they should be. ... many of the problems are the same - notably long waiting lists and population health issues, including obesity. ...
It is one thing to endorse this as a concept. But with hospitals under huge pressure from waiting lists, restive staff and a lack of investment ... -------|
Does UK "universal" healthcare system "ration" services?
Maybe having the option to change insurance plan or company if their support center not responsive is not all that bad?
Attempts in several US states (CA, VT, CO) to find a version of government-provided healthcare insurance like "Single-payer" or "Medicare for All" (which guaranteed the "right" to healthcare yet wouldn't bankrupt the state) ran into funding problems and failed bigly, but differently:
www.latimes.com - Single-payer healthcare meets its fate again in the face of California's massive budget deficit - LAT, 2024-05-16
en.wikipedia.org - Vermont health care reform
cohealthinitiative.org - What's going on with universal health care in Colorado? - 2019-02-16
|------- "An insurance card doesn't necessarily guarantee you access either" ... Vermont, a state that spent years working on a single-payer health care system, serves as a cautionary tale. ... Likewise, the cost of Amendment 69 was estimated at $36 billion per year, more than the entire state budget. -------|
www.vox.com - Colorado single-payer initiative failure - 2017-09-14
|------- ... voters rejected ... single-payer system by... 79 percent to 21 percent -------|
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