2/ Caveat: a news outlet reported some hours ago that this was the final text, but that doesn't mean it really was. None of the coverage I've seen so far from *after* the House vote has mentioned a telehealth extension. Most say the new CR is *only* farm & disaster aid & keeping the gov. lights on.

I spent twenty years in the US healthcare industry. The key insights I took away from those years are:

1. Hospital administrations have one focus and one focus only and that is maximizing revenue

2. Insurance companies are a major mechanism by which they do that

@kenklippenstein.bsky.social

3. Hospitals do not see patients as their customers. The customers are the insurance companies. To the insurance companies the hospitals are the customers

In no scenario are patients ever viewed by either hospitals or insurance companies as customers

The implications of this took me a while to understand

But the gist is that neither insurance companies nor hospitals make more money if patients are happy

Happy patients do nothing for a hospital or an insurers bottom line

There is NO monetary advantage to having patient satisfaction

4. A related issue is that fact that a large population of people who are chronically ill is an environment in which hospitals and insurance companies make money

While a healthy population makes it tough to make money

My final observation is that

5. Everyone in the system is miserable. Insurance companies, hospitals, doctors, nurses, patients

Why does it persist if it sucks so badly?

Money

For a very few people -- insurance company executives, hospital administrators, lobbyists and politicians

In other words, the very people with the power to define the status quo -- healthcare is enormously profitable

And they are not going to let go of that without a ferocious fight

The slides here are from a presentation I made a decade ago:

www.gregorytravis.com/resources/St...

The root cause is that we continue to believe that healthcare is not fundamentally different from selling used cars or coffee beans

i.e. something where supply and demand are easily met, regulated and rationed by the invisible hand/free market

This is a toxic fiction

People either need healthcare or they do not

It's not a discretionary purchase where they are free to walk away from the transaction if they don't like the terms

If your son or daughter has a malignant tumor, you can't shop around to get the best price like shopping for a car

12/ Telehealth Modernization Act of 2024 (HR 7623) which passed out of the House Committee on Energy and Commerce subcommittee on health last fall (but went nowhere since).

🔺️So: tell your Members of Congress to get this done NOW. If telehealth expansions expire on Dec. 31, they are NOT coming back.

You both are too smart for anyone’s good!

I love the "simply" here. "Elementary" would fit nicely too.

The majority of excess deaths from COVID in the United States are concentrated in the young so this is not a surpprise at all

www.gregorytravis.com/SARS-CoV-2/C...