Glug, glug
News flash—system is not working
DO NOT RESUSCITATE #452
24 JUL 2026
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It’s hard to keep up with the multiple ways in which our current way of organizing and financing healthcare delivery is deteriorating. I could put together a report like the one that follows three times a week instead of just once. That said, I think each failing shows, perversely, how we could be doing things differently, at less cost, with improved outcomes. They are—or could be—guideposts for organizing a better way.
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Doctors as hall monitors
Sam Whitehead, “Doctors ‘cringe’ at possibility of documenting which Medicaid enrollees too sick to work,” KFF Health News/Washington Post, Jul 20, 2026
One aspect of the punitive new Medicaid work rules that isn’t getting enough attention is how they will turn doctors into cops. Who else is going to be saddled with the task of determining and documenting who is too “medically frail” to work? Aside from the paperwork headache, most providers aren’t trained to assess that. Says one MD, “What does that even mean? I don’t know, and I’ve been doing this for 25 years.” The dilemma of trying to answer honestly while knowing that the patient sitting across from you may lose coverage as a result will be another blow to the practice of medicine. But from his corner office in Washington, Dr Oz was all smiles: “Documentation should be relatively easy to provide,” he said in a press call. Another question: How will a person applying for Medicaid find a clinician to give them a note that they’re too sick to work? Patients will also start dissembling or even faking illnesses they don’t have.
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Maya Kaufman & Katelyn Cordero, “Massive health insurance upheaval leaves New Yorkers with big new bills,” Politico Pro, Jul 15, 2026
“New York offers a preview of the upheaval expected to ripple through the U.S. next year when the biggest changes go into effect.” We got an early start because the state cut back a special program that covered people with slightly higher incomes than Medicaid allows, and the cuts took effect July 1. Now, someone previously with a very low-cost plan is facing hundreds in monthly premiums and hefty copays. A half million people are affected: some will pay the high costs; others will go uninsured. Customer services are reportedly bad: one quoted user says, “I’m just so burnt out on calling them. I can’t really deal with it right now emotionally.”
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We promise to reduce prior authorization—honest!
Lauren Sausser & Renuka Rayasam, “Insurers hedge on Trump-backed pledge to improve denials process,” KFF Health News, Jul 17, 2026
Trump loves to make bombastic announcements of his great deals, but the outcomes don’t match the rhetoric. (Maybe we need a degree from Trump University to understand better.) “One year after the Trump administration announced that dozens of health insurers had signed a six-part pledge promising to reduce barriers to doctor-recommended care, some insurers now say they won’t implement all the promised initiatives.” What a shocker—voluntary measures don’t stick.
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Medicare Advantage waaaah, not fair!
Rebecca Pifer Parduhn, “‘The system is undeniably broken’: More insurers sue CMS over Medicare Advantage stars,” Healthcare Dive, Jul 13, 2026
MA operators worry they aren’t making enough profit. Several insurers are suing to “hike their Medicare Advantage quality scores” after not getting an A+ in their evaluations. The ratings game is how MA companies get extra cash and fatten margins after they’ve kept as much of the premiums as they can.
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Medical tourism
Brianna Holt, “Faced with inadequate US healthcare, Black women fly to South Korea: ‘It could save your life,’” The Guardian [U.K.], Jul 18, 2026
Lots of people travel overseas to get healthcare for a fraction of the U.S. price even when adding the cost of the trip. A new destination is South Korea where, according to this article, Black women feel particularly welcome. They can get a thorough diagnosis with “same-day imaging, comprehensive panels, and specialist review that would take months and significant out-of-pocket cost to assemble in the US—if they could access it at all.” They are especially happy with screenings for gynecological, thyroid, and cardiovascular issues, the conditions where Black women in the U.S. “face the steepest disparities and the most documented gaps in clinical attention.” The Korean approach overall is more prevention focused than curative, which apparently means lots of clinics are set up for this kind of fly-in visit.
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Poo alert
Judy Stone, “It’s the water, not produce, likely driving cyclospora outbreaks,” Forbes, Jul 16, 2026
We’ve all heard of the outbreak of cyclospora poisoning our food supply. One bit of relevant TMI is that this particular pathogen could only reach us through, um, human feces. It’s not transmitted by animals, and it’s not contagious through casual contact. That means we could only be ingesting it because somebody pooped in the punchbowl, and the most compelling scenario is farmworkers who don’t have decent working conditions—well, imagine the rest. OSHA requires adequate hand-washing and toilet facilities for food harvesters, but who’s monitoring that system and enforcing it? Another theory is that our agriculture relies heavily on irrigated surface water that is easily contaminated from “leaking septic and sewer systems.” Eew.
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Tara C. Smith, “Cyclospora cases are spreading. Why don’t we know more about it?” MSNow, Jul 17, 2026
Trump dissolved the CDC’s Division of Parasitic Diseases and Malaria and removed the requirement to report cyclospora from our food surveillance system last year. Could that be related to the outbreak? The parasite also has a long lag time between infection and symptoms, which makes it hard to track even if we still had epidemiologists working on it. Smith: “This all makes diagnosis a, um, crapshoot.” HAHA. It also might help if the CDC had a director.
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Rural hospitals
Gwen Dilworth, “Pregnant woman’s roadside death triggers push to reopen Mississippi Delta hospital,” KFF Health News/Mississippi Today, Jul 20, 2026
This sad tale of a woman who died on the way to the hospital because the one near her home was shut down shows how an extra 25 miles can be fatal in an emergency. The community wants to revive their closed hospital, but getting one back after it closed is even harder than keeping a money-losing hospital open. (Question: why should ANY hospital have to break even? Rural hospitals should be a subsidized public service.) A hundred rural hospitals in the U.S. have shut down in the last two decades, and many more are teetering. Many of them were built in the post-war period when we still believed in financing people’s needs instead of worshiping markets and neoliberal dogma.
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Hating on immigrants
Nathaniel Weixel, “White House revives rule to deny green cards to migrants who use safety net programs,” The Hill, Jul 16, 2026 and Trump Admin revives rule that could deny green cards to immigrants who use Medicaid,” Associated Press, Jul 17, 2026
This is the “public charge” Catch-22: you are eligible for Medicaid as a legal non-citizen, but if you use it, we’ll deny you permanent residence. (Government-financed universal coverage would eliminate that entire issue.) What is often missed in this discussion is the many mixed-status families with children who are U.S. citizens. Non-citizen parents may decide not to take advantage of things that will help kids thrive because getting food stamps or whatever could prejudice their own shot at legal permanence.
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Give it to everyone
Christine Mai-Duc, “In California governor’s race, voters face stark choice on immigrant healthcare,” KFF Health News/Los Angeles Times, Jul 6, 2026
The election of a new governor in Californians will generate a lot of debate about state spending on healthcare for non-citizens. Plenty of people will be pissed that they have to go broke paying for insurance while low-income newcomers get a free ride. You can’t blame them—so, how about establishing a universal coverage system where nobody has to turn over their firstborn if they get sick? Problem solved, and without mounting a big xenophobic campaign that feeds the nativist meatheads. People without legal status make up 8% of the California workforce.
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Immigrants
Jude Joffe-Block, “ICE shared Medicaid data it wasn’t supposed to have with Palantir,” NPR, Jul 18, 2026
HHS officials colluded with ICE to dig around in private medical data, got caught, apologized, did it again. What’s wrong with this picture? “After Medicaid officials improperly shared data about millions of people in January with immigration officials, ICE then shared that data with the data analytics firm Palantir,” the company that ICE uses to find legal noncitizens to kidnap. Nice circular procedure. Twenty state DAs are suing. When confronted, ICE dudes said they asked Palantir to delete all the files, and Palantir promised they would. Problem solved! What a relief!
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Whiny sore loser
Jonathan Chait, “You don’t need to vote for socialists to get universal health care,” The Atlantic, Jul 15, 2026
The liberals are really alarmed at DSA’s success in playing by the rules and winning, and The Atlantic is one of their main nastygram platforms. Chait thinks Democrats who hang the “progressive” label on themselves and support “reforms” are just like socialists and M4A advocates, so we should all go home and let the adults negotiate reasonable things with the Republicans. This is so hilariously clueless that you wonder what rock the guy has been living under. “Restore the subsidies that Democrats enacted under the Biden administration,” says Chait, and problem solved without all this needless socialism talk putting off voters. How did that work out the first time around? Chait: Dems now have a big electoral advantage—if DSA doesn’t blow it for us! Yeah, everyone should leave criticism of Trump to the party that paved the way for him. They’ll hit back hard with “sternly worded letters.”
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Long-term care conundrum
Paula Span, “A new option for long-term care costs,” KFF Health News/New York Times, Jul 10, 2026
Another disaster-prone area is long-term care, especially now that Trump is kicking out thousands of foreign-born health aides, driving up costs to even more astronomical levels. Washington State is taxing people for a state fund that could defray some elder-care expenses, and other states are interested. The New York Health Act would fold that into the universal system and doesn’t leave these issues to piecemeal changes.
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Consolidation
Reed Abelson & Rebecca Robbins, “Lawmakers target the power of health insurance giants,” New York Times, Jul 8, 2026
Both parties now say something has to be done to rein in the healthcare Godzillas that have spread out to occupy every point along the care continuum. Too bad the Rs didn’t support Lina Khan at the FTC trying to do exactly that but immediately moved to dismantle her initiatives as anti-business. When Arkansas and Tennessee passed laws to break up the cartels co-ownership of PBMs and pharmacies, they fought back, “filed lawsuits, deployed lobbyists, pestered customers with texts, and blanketed the airwaves with advertisements.” The three biggest health conglomerates rank among the largest 15 U.S. public companies by revenue, which is a fairly recent development. Major breakups aren’t likely yet, but federal proposals like the Break Up Big Medicine Act reflect a dangerous trend for them.
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Fraud and anti-fraud fraud
Emily Olsen, “Bankrupt Omnicare reaches $440M deal with DOJ in fraud case,” Healthcare Dive, Jul 10, 2026
Omnicare, owned by CVS Health, got caught defrauding the government for 8 years and faced a fine of nearly $1 billion. It declared bankruptcy and only had to pay half. (CVS, the parent company, is far from bankrupt.) Omnicare will be acquired by GenieRx, “a partnership between private equity firm Milrose Capital and healthcare investment and management company Integro Asset Management.” Plus ça change. . .
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Detectable fraud
David Maimon, “The data to find Medicaid fraud already exists, but no one is using it,” The Hill, Jul 18, 2026
The author is an academic specializing in fraud detection and says inspectors could nail scams much more quickly. He describes tracking down an agency that already had received $11 million in Medicaid reimbursement but appeared not to exist. “We visited in person and found an office with cubicles but no intake process and no available caregivers. We left our number, but no one called back.” When states (or the Feds) leave easy fraud-detection unperformed, it opens the door for opportunistic “anti-fraud” campaigns like the Trump team’s current one designed to cover up for the brutal cuts to the safety net. It’s almost as if allowing frauds to continue is politically useful.
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Fraudulent anti-frauds
Bob Herman, “Insurance whistleblower says employers are not helpless bystanders,” STAT, Jul 7, 2026
This story exposes how often state officials collude with fraudulent operators because everyone enjoys looting public coffers and getting away with it. A lawyer in the New Jersey attorney general’s office blew the whistle on a massive health scam involving state workers benefits, got nowhere inside the office, and went public with the proof. The state fined the company, then turned around and awarded it a new contract. Oh, and they also threatened to prosecute the woman criminally for exposing the scam. “Officials completely erased her role in uncovering the misconduct and glossed over their own culpability in allowing it to happen.” Yeah, because they plan to keep doing it. The reporter couldn’t find a soul in the entire state government who would go on the record about the case.
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Fraud as cover
Amanda Chu & Robert King, “Fraud investigations are crumbling this state’s Medicaid system,” Politico, Jul 15, 2026
More appalling tales of the impact of the brutal Trump cuts and political blackmail in holding up Medicaid payouts to blue states. “Looking across her farm in rural Minnesota, Heather Wright takes stock of what she’s lost. Six months ago, she had a herd of 60 cattle and a full staff on her farm providing therapy for children with autism. Those cows have since been sold off, along with company cars, and several employees have left for steadier jobs at a convenience store.” Multiply by thousands of health care providers across the state—lawsuits may eventually succeed, but the damage will be irreparable. “Minnesota was only the start of a fraud-busting campaign the administration is now taking nationwide.”
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RFK Jr & the Quackocracy
“Inside RFK Jr.’s push to dismantle decades of U.S. vaccine policy,” Reuters, Jul 16, 2026
Turns out RFK Jr had even more ambitious goals to wreck our entire vaccination tradition and isn’t giving up despite his increasing unpopularity. The plan was to completely abolish all federal vaccine endorsements, including polio, though he had to back off that one. Meanwhile, he’s set to spend billions to find that elusive link between vaccines and autism. He has already scared enough people off from vaccinating their children to ensure that we will have multiple outbreaks of once-controlled contagious diseases and destroyed the mRNA research that could provide us with treatments for future epidemics. In addition, Kennedy wants to rejigger the vaccine injury system to make it easier to sue manufacturers. That seems extreme, but who knows these days—if successful, it would probably cause most domestic vaccine producers to quit the business.
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Peptides
Rachel Roubein, “FDA raised conflict of interest concerns ahead of new peptide panel,” Washington Post, Jul 17, 2026
RFK Jr believes in peptides, and think you should, too. To that end, he is following his usual playbook: stack an advisory panel with people who sell the stuff, claim that they know “science,” and produce pre-determined conclusions so that business can boom. Then criticize his predecessors for being corrupt and in the pocket of pharmaceutical companies. “In documents posted ahead of next week’s two-day meeting, FDA career scientists said there wasn’t enough evidence on safety and effectiveness” on the substances in question. Good chance they’ll be overruled.
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Pollute away!
Zahra Hirji, “EPA proposes to relax air pollution standards for buses, trucks,” Bloomberg, Jul 9, 2026
Who needs clean air anyway? The EPA will loosen toxic emissions standards for buses, garbage trucks, and semis, which would result in “lower costs for truck manufacturers” and nastier air for everybody. The Trump gang generates a half dozen of these stories about undermining environmental protection weekly, all with happy dances by the polluters.
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Iowa cancer
Tom Philpott & Nina B. Elkadi, “‘Cancer doesn’t care what party you belong to’: Poisoned water is turning this rural state bluer,” Politico/Food & Environment Reporting Network, Jul 19, 2026
Iowa has enjoyed a relentless focus on its booming agribusiness industry, duly elects Republicans to all major offices whose philosophy is hands-off/low regulation, and now has a cancer epidemic because all that hog poop, fertilizer runoff, and glyphosate herbicides have thoroughly poisoned the state’s water supply. Some residents don’t want to die young of kidney, brain, and ovarian cancer, but given the monetary stakes, they may have to. Iowa’s cancer rates are the second highest in the nation and rising while in almost other states they’re falling. “Historically, candidates for state-wide office in Iowa, Republican or Democrat, have avoided criticizing the agriculture industry, opting instead for platitudes about how Iowa’s farms “feed the world.” That’s finally changing. A candidate for ag secretary is openly basing his entire campaign on reducing toxic chemicals in agriculture. His opponent used to be a PR flak for glyphosate-producer Monsanto, so that should be highly clarifying about Iowans’ priorities. The industry is huge—Iowa is second only to California in food sales and has eight times more hogs than people.
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Let’s not learn anything
Jessie Hellmann, “HHS research agency ends funding for dozens of health studies,” Roll Call, Jul 17, 2026
The Trumpians continue their march through the federal bureaucracy, slashing and burning as they go. The latest is the abrupt termination of dozens of health research grants by declaring that they want to study other things like autism. These are approved projects funded by Congress under Article I, the budget power, and lawsuits may someday overturn the cuts when it is far too late to save the work. The Soviet commissar rule pending at OMB would legalize this ideological coup and probably get Supreme Court approval. The attack this time is on the Agency for Healthcare Research and Quality, a tiny HHS unit, that studies “how health care delivery can be safer and better for patients.” It also managed training grants for the next generation of researchers. At this rate, we won’t have one.
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Systemic suicide
Joy Evers, “My husband’s suicide shows there’s something very wrong with the U.S. insurance industry,” STAT, Jul 20, 2026 and “A tragic, deadly denial,” KFF Health News, Jul 16, 2026
Finally this week, I noted two horror stories about how the system drove individuals to suicide, which struck me as a telling metaphor. Evers’s suicidal husband was doing well in a psych clinic when the insurance company pulled the plug. Within weeks, he had succumbed to paranoid delusions and psychosis. “Now, every time a patient asks me, ‘Will this be covered by my insurance?’ the feeling of panic returns.” The second story was a reader response to KFF about their reporting on prior authorization. Her husband’s pulmonologist had ordered two new prescriptions for his COPD, but the prior authorization process held everything up while he struggled to breathe. “That night he left a note saying that he hated to leave me but that he couldn’t keep living with the constant anxiety of not knowing when he wouldn’t be able to draw a breath.” The widow received a “welcome” packet with the requested medication two weeks later.
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