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So reads a Wall Street Journal headline.
This begs the question, how do Americans want to pay for their health care?
Quite a conundrum isn’t it? No system in the world can deliver all that
Yes, dealing with an insurance company can be a hassle and frustrating. They do screw up as do providers submitting the claim. Insurance companies are other Americans doing their jobs, but they can never satisfy all the above criteria.
65% of working Americans with employer benefits are in a self-insured plan. It’s their employer concerned with costs, not an insurance company.
What are Americans willing to give up for what they want?
Between Medicare, Part D and Medigap coverage, Connie and I pay nearly $2,000 a month in premiums. Is that too much to ask?
The real issue is that people want health care, not health insurance.
I know many people think that they would have health care if we had a single-payer healthcare system in the US.
Well, I am here in England right now to visit my 92 year old dad, and on the day I arrived he was taken to the ER (A&E).
Almost every non-medical service is outsourced to the lowest cost provider, because no one wants to pay higher taxes. The result of using lowest cost providers is that the first blood test “didn’t work” because the provider claimed, wrongly, that there was not enough blood drawn. We saw the nurse take a full vial, and the test requires a drop. So a second blood draw is taken, this time by the doctor. Still apparently not enough to do a test.
By now the ER’s performance dashboard on the screens for the medical staff is showing 74% of normal, and is very red.
The result of that is dad gets released from the ER, the metric literally immediately goes to 76%, and my dad is in the “evaluation center”. Still no results from the blood.
It’s now been 8 hours, so the doctor sends my dad home, without those blood test results.
One thing most people think is that a single-payer healthcare system means great medical coverage! Absolutely not the case.
Did you know that the average Accountant in the UK makes more than the average NHS doctor?
Given the ER dashboard and the inability to get simple blood test results, would you believe that the above-average competency doctors tend to leave the NHS single-payer system for private practice.
So we have a two-tier healthcare system here in England. Everyone pays through their taxes for the NHS, and anyone who can afford it “goes private”.
A can’t-raise-taxes single-payer healthcare system means my brother-in-law waited 3 years for his first hip replacement, and 4 for his second. My other brother-in-law “went private” and got one done in 4 months.
People keep writing as if the UK model is the only alternative to the US system. Nothing could be further from the truth. Plus, the UK system has been starved of money by over ten years of Conservative Party rule, and of workers by Brexit. Even so, my niece, whose husband was diagnosed with inoperable bowel cancer a year ago, says that some of the care has been “brilliant”. Just not all.
If you want to see a functioning alternative look to France, generally held to have the best system in the world. Or Germany, with maybe the oldest. Or Switzerland, where people are required to buy basic health insurance
People don’t even make the distinction between universal coverage (Medicare) and a health care delivery system like the NHS. Not even a close comparison.
And it ain’t “free”. I was just looking at the funding and in the aggregate UK citizens pay 4.5% of their income to have NHS.
There seems to be a severe shortage of critical thinking in our society. That was made abundantly clear during the election campaign, and is especially true of social media. I believe it was Mark Twain that said, “There is nothing so uncommon as common sense.” I believe that is truer today than it ever was.
Don’t know if he said it, but I agree with you. Very limited critical even logical thinking. Often I read something and think, that makes no sense, it doesn’t add up, it’s not logical. Then I spend time researching trying to find the source and to confirm or not and get the full story.
It’s a lot easier to just accept and pass it along. My all time favorite, Congress stole the SS trust money and spent it on other things.
But hey, I’m old and retired and have time for thinking. Of course, Connie’s favorite phrase is “ are you on that iPad again?
Many on social media are also convinced that they are far wiser than both Einstein and Isaac Newton, and they are sure that the moon landings were all fake.
Really, they insist that they have found errors in Einstein’s theories, and disagree with Newton in that they feel rockets fail in the vacuum of space. And more.
They are also sure that a UFO , by definition, has to originate from an alien planet and species, many light years distant. They do not understand that the “U” part simply means ” Unidentified.”
Social media is filled with nonsense about the higher your income and/or net worth,the less income taxes you pay. Both as a percentage and in dollar amounts.They have loopholes, etc.
Really though, Isaac Newton created Calculus, and Einstein’s theories have been tested and proven many times over the last 120 years.
It is then not surprising to me that so many are vastly erroneous about health care, and so forth. I have totally given up on social media to save a lot of precious time and energy.
Finally, a quick update on the United Kingdom and its “free”, ahem, National Health Service. Last year, well over 120,000 people died while awaiting medical procedures. That is about 2,307 a week, 329 per day , 13 an hour, 1 every five minutes.
I hear ya R Quinn but can you take it easy on the CAPS?
I’m about to give up. Social media is so filled with nonsense about denying claims it unbelievable.
There is definitely a lot of nonsense out there about most things. Unfortunately that’s where most people get their information. These are the times we live in.
I listened to a podcast about this:
https://fighthealthinsurance.com/
very interesting and free for patients.
There is a federal law process for appeals and if it is employer coverage it is all outlined in the plan description.
Nothing like being sick and having your care denied and then having to search the plan description for how to appeal.
this website makes it easier to appeal by using AI.
You mean paying for care, not obtaining care, right? Nobody denies you care, at least not insurance.
If insurance won’t pay for care for most Americans that is a denial for care. Why do you think those without insurance don’t go forward with treatment.
Are you suggesting that denying payment for care isn’t effectively denial of care for many people?
The entire discussion about denying claims is out of control. Most of social media posts are as bogus as what was posted during the election. Necessary medical care is not routinely, intentionally denied.
There are many gray areas such as duration of a treatment like PT or other therapy. There is much room for disagreement on some treatment and others are clearly ineligible.
So, in most cases the insured could pay for denied care. We are not talking about major hospitalization or heart surgery.
Many people pay each year out of pocket for all their family care because they have a high deductible. Two of my children have deductibles of $5,000 and $7,000 and those are employer plans. In the absence of a major event, all care is out of pocket.
I have asked in a dozen physician offices (yeah I know weird), which insurance company is easiest to deal with. Answer was Medicare. Guess why? No questions asked, no claim review.
Thanks for an inciteful article Richard. IMO, a basic problem is that many, maybe most people, do not understand the medical/insurance system. I think this is especially true of Medicare, et al.
We need to be smart consumers of medical services.
That said, there are lots of issues with our system. Big pharma, inefficiencies in delivering medical services, and huge “non profit” medical providers that do not pay taxes.
One of my pet peeves is all of these advertisements for Medicare Advantage leading up to the 12/7 enrollment deadline every year. They seduce uninformed people to enroll in MA without understanding the ramifications.
However, I am grateful that I never have to wait in line to get treatment for critical diseases like the UK and Canada.
Readit is blowing up over this situation, guessing that the many physicians and patients writing in that feel they have stiffled by their insurance company unjustly is all BS. I would argue that they might not be wrong. As a country we need to revisit how medical care is managed, paid for and administered. What we have is inefficient and in many cases unfair to some.
I just read in The Wall Street Journal, that the British National Health Service is not the panacea that so many are convinced. Very often referred to as ” free”, which is not accurate, and, sadly, well over 120,000 sick people died last year, as they waited for treatments and procedures.
It seems that citizens of The United States have no issues paying way too much for so many common items and services, but, balk at virtually every single facet of health care. Mr. Quinn , I agree with you, 100 percent.
Water, sometimes as high as 160 a gallon, ( 20 bucks a pint at many venues), a single hot dog for 12 at the TD Garden. Useless tattoos and blue hair.
There are now so many people buying vehicles for 50,60, or 100 grand, then financing them for 8 years. A friend has a 1500 monthly payment or her Corvette,for 8 years at 8 percent, then whines about paying tiny co-payments at doctors visits and even smaller amounts for prescriptions. Her family has to pay zero monthly premiums for health insurance.
And, she also complains about having to buy premium fuel for the sports car, and she resides in Texas. Alas, she is lucky to get even 10 k miles from the tires, but she is fine with that.
So many expect health care to be perfect and “free”, and they also feel that fuel prices shall never rise, even as houses have soared 75 percent over the last 4 years, and just about everything else has gone up tremendously.
Last time I checked, the casinos were packed, the package stores are getting very busy, here in Massachusetts we spend the most per capita on lottery tickets at nearly 1000 bucks a year. Talk about a paradox, we have the highest percentage of college educated adults, yet, we spend the most on items that guarantee anywhere from a minus 30 to minus 50 percent return. Yet, we balk at every single facet of health care costs, procedures and so forth.
There are many great reasons why America has 63% of the global stock market cap, even though we are only 4% of the population. And why our treasuries are the gold standard for safety and liquidity. And our dollar is the worlds reserve currency.
And murdering anybody, for any reason, is an insane act, and it matters not what his or her job was. Killing an innocent CEO of a health care company has no place in a civilized society. I hope the cowardly , misguided individual is soon caught. And, no matter his punishment, it will not be adequate. Nothing will bring him back.
Consumers, pay your health care costs, the same as you buy tickets, and over priced food and drink, and tattoos, and body piercings, and the like.
Even if we had universal ( not “free”), coverage, I suspect those whom complain the loudest , would not be better off. They probably wouldn’t save and invest the savings, rather, it might be spent on trinkets and other non-essentials.
My wife and I are both on Medicare, our premiums are about 300 a month. Together we have had 3 major surgeries, our total cost was about 7500. The insurance paid $ 143,000.
Prior to age 65 , I had to pay my premiums for a few years, it was 854.00 monthly, which I gladly paid. No different from paying property and income taxes, home and auto insurance, grocery bills and car repairs and many more.
A recent trip to the vet with the dog was 500, car repairs recently $1825, work done to the 2 furnaces was 1900 bucks, and lawn mower services were 400. And Medicare 300. all good.
How about Americans’ taking responsibility for their own health by eating right and exercising regularly. That alone would save millions of people billions in healthcare expenses.
No Medigap to cover the 20% Medicare coinsurance and Part A deductible?
Mostly agree but there is no transparency in costs and why they vary so much. I just recently filled several prescriptions using Goodrx for a fraction of even my copay cost with my regular insurance. Why is that? There was an article I read recently about the range of prices Medicare pays for the same drugs across the country. Why is that?
I did the same for a steroid inhaler through Mark Cuban’s Cost Plus Pharmacy. The insurer/Pharmacy Benefit Manager only covered the most expensive brand, not any generics and wanted me to pay a $200 copay. I scanned what ones were available through Cost Plus and paid $75.
Very contentious post with political undertones. Much like reading political or debate.
Can you please be specific? List a few examples.
Nothing political about the post, just observations from dealing with people and their health benefits/care for nearly 50 years. Just the facts.
Wouldn’t a streamlined, click here or there to appeal our decision process, alleviate a ton of this bad energy. Perhaps include the need to upload something from a physician. Also, wouldn’t it work better if health insurers were required to completely explain the denial in layman’s terms?
Reduce the opaque nature of the system, you likely reduce complaints by 50% or more. Might even change the level of happiness people have with their insurance.
I once sat on a claim review board for a state agency. Our job was to review denied medical claims as the final arbitrator.
One time a man came before the board after all previous appeals were denied. He wanted a vasectomy reversal. He had a vasectomy after the birth of his son, an only child. Sadly at about age one the child died. Of course, he now regretted the procedure. To build his case for the board he presented a 3×5 foot photo of the little boy who had died. I can still see it.
What should the board have done? The self-insured plan clearly said a reversal was not an eligible procedure.
We denied his claim, but I can only imagine how the press, his friends and colleagues would think of our decision.
When asked at the meeting if he considered paying for the procedure, he dismissed it as not affordable. Yes, it was expensive but not prohibitively expensive for something so important to him and in the absence of insurance negotiable.
That’s how we tend to view paying for health care, with someone else’s money be it insurance, government/taxes or our employer and indirectly fellow workers.
You be the judge:
This letter is to inform you that UnitedHealthcare Insurance Company will be rebating a portion of your health insurance premiums through your employer or group policyholder. This rebate is required by the Affordable Care Act – the health reform law
The Affordable Care Act requires UnitedHealthcare Insurance Company to rebate part of the premiums it received if it does not spend at least 85 percent of the premiums UnitedHealthcare Insurance Company receives on health care services, such as doctors and hospital bills, and activities to improve health care quality, such as efforts to improve patient safety. No more than 15 percent of premiums may be spent on administrative costs such as salaries, sales, and advertising This is referred to as the “Medical Loss Ratio” standard or the 85/15 rule. The 85/15 rule in the Affordable Care Act is intended to ensure that consumers get value for their health care dollars. You can learn more about the 85/15 rule and other provisions of the health reform law at:
https://www.healthcare.gov/health-care-law-protections/rate-review/
80/20 I believe.except 85% for large group market, but that group is mostly self insured employers anyway.
Is there a “Medical Loss Ratio” for Medicare Advantage plan (Part C)?
Yes, 85% and if they fail for three years they are prevented from enrolling new members. https://bettermedicarealliance.org/wp-content/uploads/2020/06/BMA-MLR-Fact-Sheet.pdf
Is this also try of Medicare Medigap (supplement) insurance?
Thanks Plaul
That communication came directly from UHC. I’ve been on numerous medical plans over the last 35 years, never received a single letter from one stating they were out of compliance with mandatory minimum spending requirements for patient care.
Thank You Mr. Quinn for the article. It’s nice to know there is more to it than what we hear and see in the news and print. I have had UHC for 40 years working and 8 years in retirement and have never had a claim denied. I have always received the care needed and allowed to get 2nd opinions. Their network includes the most respected medical facilities in the country. Is it perfect, no, but it is far from needing an assassin to even the playing field.
I read that UHC is higher in denials than most companies because they deny about 30%. Consider yourself lucky.
R Quinn
another deep article ……..My wife and I are lucky or unlucky to be covered by the VA…….I am 100% P&T from exposure to Agent Orange and dealing with 4 Cancers…….we have had no problems with care if for some reason care is not covered by VA Community Care I use Medicare most time for small procedure and pay small co-pay……..my wife just shows her ChampVA card and is covered……that is my only complaint the system should be reversed but the is the VA…..when I get payment record the difference between billed/payment is about 80%…..if the Hosp bills $100 the VA or Medicare pays $20 the difference is put on their Tax Return as a loss against profit so they have lower Tax exposure…….a win win for everyone………..so for us the Gov is good……….we also pay $0 but I have paid for my Service and expose to the good bad and ugly
I wish only the best for you. You deserve the best coverage.
My best friend from age 4 succumbed to the affects of agent orange several years ago after three tours in Vietnam.
those of us who had boots on the ground are still suffering but not in silence are voices are being herd even though it may be slow times are changing ………thanks
My brother in law did three tours. He had no physical injury, but suffered for years from what no doubt was PTSD pretty much ignored at the time.
Over my decades in employee benefits I handled hundreds of health claim denials and appeals. I made the claim administrator explain the basis for a denial, assured that the reviewer was qualified and many times paid for an independent third party review.
Often there was no absolute right or wrong, often there were alternative treatments, sometimes the treatment requested was not an approved treatment for the stated condition.
Many times an error occurred because of procedure and diagnosis miscoding and some times just an error in claim processing.
Some times the procedure or service simply was not covered by our plans.
Nothing mattered, the employee/patient wanted everything paid because that’s what their doctor wanted and told them should happen and they certainly were not paying themselves.
Employees blamed the insurance company not understanding that (like nearly all large employers), we were self-insured. The insurance company processing claims had no financial stake in what was paid, but their employer footing most of the bill did.
An insurance company intentionally denying a valid claim is outrageous and illegal and short-sighted – you couldn’t stay in business doing that.
Like most things related to health care it’s not that simple.
The above article is a very one sided characterization of the current problem with healthcare in the USA. It puts all the criticism on the patients and recognizes none of the predatory practices being performed by major US health insurers. I believe a more balanced article would cite the recent reports documenting widespread and consistent insurance practices denying legitimate healhcare claims by major US health insurers. Here’s a couple references documenting the widespread problem with healthcare insurers in the USA:
2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf
Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials (OEI-09-16-00410; 09/18)
Thank you for the links. They are both persuasive and very troubling. For instance: “It suggests Medicare Advantage insurers are intentionally targeting a costly but critical area of medicine – substituting judgement about medical necessity with a calculation abut financial gain.
If Mr. Quinn has such faith in the Medicare Advantage insurers, why is he using Medicare plus Medigap instead? Medicare Advantage would surely be much cheaper.
The issue is not confined to Medicare Advantage – see here.
I never supported MA. I have urged people to avoid them. They are, after all, managed care, similar to HMOs and apply various techniques to manage costs. They may seem extreme, especially when compared with Medicare which does no managed care. They are also overpaid by Medicare. Managing care is never popular, but that does not mean it is wrong especially intentionally.
It’s all explained in my original post.
We used to hear all the same complaints when HMOs were popular to control costs.
People who jump into MA lured by the promise of extra benefits, low or zero premiums, even debit cards to spend on OTC rarely ask how they can afford to provide all that. Yet, they are popular and growing which seems to indicate that any denial issues affect a small segment of the population, mostly post hospital extended care which is also limited under Medicare.
Depends on what you mean by “managed” care. There are certainly limits on what Medicare will cover. Lots of into here.
No depends on what you mean involved. That is not managed care, that is defined covered services just like any insurance. Medicare is prevented by law from applying managed care procedures. Managed care is pre-certification, pre-approval, concurrent review. Medicare has some guidelines for things like PT and chiropractic care, but no managed care which by the way has been criticized by several government audits.
One of the most abused services is seniors having their toenails cut by a podiatrist. That is strictly limited tonrelated to medical conditions, but it doesn’t stop seniors and providers from obtaining the service or getting paid.
Who wants to pay for a pedicure?
What I wrote is very accurate and is what drives the actions of all aspects of the health care system including insurance. Tell me what is not accurate in any of the above.
The denial of claims that are valid and not questionable is not common. it is not a widespread problem – that is, denial of valid claims.
yes, what patients want or don’t want is exactly what drives our system.
Physicians themselves say about 25% of care provided is unnecessary.
If you were paying the bills what would you do? Simply pay every claim submitted automatically?
Read the reports I referenced and then tell me if you still believe major insurers aren’t denying legitimate claims simply to increase their profits. Sure, there’s some people that want something for nothing. But I believe most people are honest, realistic, and simply want to be treated fairly by their insurer.
Their profits based on claims paid versus premiums is limited by law.
Most people being honest has little to do with it. The patient rarely knows what claim for what has been submitted.
It is far more complicated, more subjective, unless by fairly you mean just pay any and all claims from providers without question.
Medical care is not exact, not even every physician will approach an issue in the same way.
I was once involved in a case with a young child. Her doctor insisted the treatment was necessary and appropriate. The third party expert I hired to review the case called it virtual child abuse.
But if you look at the data in IG report I cited above, a couple things stand out. First, only 1% of Medicare Advantage claim denials are appealed, but 75% of the appeals are upheld for the patient. So clearly insurance companies are denying legitimate claims, but since so few people appeal it’s a profitable strategy for the insurance companies.
And look at what the majority cited are for. Services very limited by Medicare
Anthem Blue Cross’s plan to put time limits on coverage for anesthesia is something I don’t think any of us thought we would ever see. The profit motive among heath care insurers is clearly out of control.
You are looking in the wrong place for profit, the loss ratio is limited by law. Profit comes from the volume of customers. Plus as I mentioned below profits of health insurers are not out of line.
FWIW – Anesthiologists have been abusers of surprise billing, often charging for time beyond what the surgery implies. This move by Anthem was to try to move them to Medicare style re-imbursement.
Surprise billing by anesthesiologists typically happens when the patient’s provider rejects their charges because they are out of network. A number of states, including NY where I live, have passed laws protecting against this kind of surprise billing.
If Anthem was simply trying to move to Medicare style re-imbursement it certainly went about it in an incompetent manner.
Medicare has a formula of allowable amounts per time unit for anesthesia reimbursement but I’m not aware that it caps the number of time units that anesthesiologists can bill for.
They and radiologist with little patient contact or care are the highest paid physicians or close to it.
Patient contact has never been a major factor in determining physician pay. In fact, PCPs (family and internal medicine) are among the lowest paid specialties. A recent survey found that neurosurgions have the highest pay while radiologists ranked 9th and anesthesiologists ranked 13th.
https://assets.doxcdn.com/image/upload/pdfs/doximity-physician-compensation-report-2024.pdf
And those rankings change over time with respect to supply and demand. In the mid-1980s anesthesia services were starved of providers by 1) government action and 2) the actions of a private anesthesia society. Anesthesia salaries skyrocketed as a result and competition went berzerk. Anesthesia moved into first place among all medical provider compensation. As talent follows the money, the #1 residency choice among graduating medical students was anesthesia which, over the next 8 years resulted in glut of providers and salaries stagnated or fell for some time thereafter.
This cyclical economic behavior is seen throughout a system based on capitalism.
As anesthesia is a service which you literally, “can’t live without”, Anthem was tickling the dragon’s tail with its payment limiting suggestion.
What I want is a system that isn’t based on the profit motive. People should not be making money off others’ health crises. Covering expenses, yes. Making big profits, no. Remember the fuss when the ACA was going to cap profits at 20%?
Other countries don’t have people driven into bankruptcy by medical bills. Other countries don’t have a lot of unnecessary procedures like Caesareans, hysterectomies, colonoscopies as a first line of defense, etc. Other countries have much lower overheads and therefore much lower costs. And yes, higher taxation, although when you add all the local taxes, I’m not sure how much higher.
I would be willing to pay higher taxes in exchange for a sensible system. I bet it would be less than I’m currently paying in premiums.
So, doctors shouldn’t make a profit or the people who make medical equipment?
The ACA requires a minimum loss ratio of 80% or premiums must be refunded.
UnitedHealth Group average net profit margin for 2023 was 6.07%, a 0.33% decline from 2022. That’s about half your average regulated electric utility. Gross profits can increase by volume of business, not just by lower loss ratios.
The organizations that pay Medicare claims earn a profit, in fact many are insurance companies.
You, better than most, should know what happens when a system is run on a non-profit basis.
Having said all that I still favor Medicare for All, but it would not be affordable unless it applied many of the claim oversight used by insurers today or in the UK for that matter. I have a friend in England who has been waiting for hip surgery for almost a year. They won’t do it until she loses weight. Would any insurance company in the US get away with that as logical as it may be?
No, doctors should not make a “profit”. That is the problem with stand alone surgical centers, etc. Doctors should earn a salary, just like nurses.
I have previously pointed out that the UK’s problem is the result of the Conservative government starving it of money, and Brexit starving it of workers. Rather than continually bringing up the UK I suggest you take a look at France. And Germany. And Switzerland…
I don’t think the UK is a good example. The NHS while excellent in many things it does in terms of clinical delivery has many inefficiencies and frustrations from use of GPs as gateways to care (when there is insufficient appointment capacity) to prolonged snail mail based appts. And part of the problem is being free at the point of use which leads to abuse in missed appts or for trivial things addressable over the counter at a pharmacy.
Plenty of European systems that combine state provision of services (hospitals etc) with a direct mandatory insurance scheme.
Even if people won’t see it the US system has grown the way it is because of a lack of regulation and government control. 3rd party insurers are just middlemen sucking juice out of the system to the detriment of citizens. They are never at real risk of a loss and one might challenge whether execs etc are really adding the same value that peers at more innovative companies do.
We could also question what sort of lifestyle do doctors and healthcare execs fund on their earnings relative to comparable countries.
I think blame the citizens for a system they didn’t create is a very harsh view. Of course the system is fiendishly complex, involves people taking risk and probability decisions they are simply not equipped for and it is tragic that a single misstep can lead to financial ruin or missing out on essential care.
I also think it leaves people indentured to employers for far longer than is necessary or even healthy.
Salary is just another form of profit. More and more doctors are part of medical groups and giving up private practice. The salaries paid must be based on the revenue generated by the practice. The revenue is prices and volume and reimbursement levels received.
Last month I read an article about AI making life-and-death decisions.
“An algorithm rejected more than 300,000 health insurance claims in just two months. It spent less than two seconds on each, leaving patients in the dark and lives at risk.”
I would ask, out of how many paid, how many rejections were clearly not justified? Based on what information provided by provider? We want efficiency, but we don’t. The law requires decision be paid within strict time limits. Many of the rejections I dealt with were caused by the inaccurate information from the provider. It’s not not as simple as people want to make the entire process.
I had the same thoughts that maybe the provider coded things incorrectly and will always be a problem. People make mistakes.
One can copy/paste the bolded headline and you’ll get AI concerns going back more than five years ago.
We want efficiency, but we don’t. How true that is!
Coding is out of control. One source I looked at said there are nearly 100,000 different codes. It is beyond ridiculous that you can get a degree in medical coding in this country.
I think some of your statements about what Americans want are extreme but some are valid. Speaking for myself, I would want a more transparent healthcare system that anyone regardless of income can access. Although that would be costly, many billions could be saved by eliminating all these companies that profit without adding any value like PBMs. My two cents.
Which do you see as extreme?