TMJ 'dysfunction' - Health implications

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PostPosted: Thu, 23 Jan 2025, 1:11 am 
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This gist of this article has been largely adapted from a video from the Tucker Carlson show.
"An unhealthy, over-medicated country means record profits for insurance companies. Brigham Buhler explains how they work to keep us sick and monetize chronic illness."

This article is also a warning for the British public: we are at great risk of surrendering control to very questionable American healthcare organisations.

Several months back, a health insurance executive lost his life in a brutal attack on Sixth Avenue in New York City. Disturbingly, 41% of young adults have shown support for this violent act, and a fundraising site has already gathered around $225,000 in defence funds. This event is both horrifying and tragic. We want to make it clear that we do not support any form of violence, and the loss of any life is deeply sorrowful. At the same time, it's important to note that 1.7 million Americans succumb to chronic diseases annually.

Prominent insurance companies contribute significantly to the worsening of the chronic disease epidemic that affects them. Meanwhile, the pharmaceutical sector exploits the corrupt environment in Washington to boost their earnings, leaving ordinary Americans burdened by steep medication costs. Over 12,000 Lobbyists spent 3.29 billion dollars to buy influence in congress in 2024.

In 2018, Americans shelled out $535 billion on prescription medications. Recent data suggests that these costs have only escalated, with multiple reports pointing to even higher expenditures in recent times. How can a nation that spends more on healthcare than any other country still finds itself ranked 40th globally?

American institutions are heavily influenced by corporate interests, particularly insurance companies. These entities are not just passively involved; they are likely key players in the ongoing prevalence of chronic illnesses that have somehow avoided examination for many years.

The concept of health insurance can be traced back to the early 20th century. In 1929, Baylor University Hospital in Dallas, Texas, introduced a plan for teachers that allowed them to pay a monthly fee in exchange for access to medical services. This was one of the first instances of what would become known as health insurance in the United States. In the 1960s, the healthcare system in the United States saw the development of Health Maintenance Organisations (HMOs), which were designed to provide comprehensive health services to members for a fixed, prepaid fee. The goal was to emphasise preventative care and manage healthcare costs.

Pharmacy Benefit Managers (PBMs) emerged in the 1970s, serving as intermediaries between insurers, pharmacies, and drug manufacturers to negotiate lower prices for prescription medications. They aimed to help reduce the cost of drugs for consumers and insurance providers.

However, their responsibilities shifted when the five largest insurance companies took control of them. The PBMs were quickly transformed into profit generators. Instead of working to reduce prescription drug expenses, they began increasing the costs. But why would they do this?

The insurance companies found that they could engage in significant profiteering. By collaborating with pharmaceutical companies through PBMs, they inflated prices to present higher costs to patients. Behind the scenes, they had arranged to receive rebates on the increased amounts.

For instance, the initial cost to the pharmacist might have been $300.00. This amount would be inflated to $600.00 in liaison with a PBM, which essentially would become the price for the patients. However, the pharmaceutical company had to return $300.00 to the insurance companies' Pharmacy Benefit Managers (PBMs) as a rebate. This arrangement was kept confidential. The drug manufacturer still pays the PBM $300 per month to secure a favourable contract with the insurance company, thereby boosting the drug's sales. Approximately 30% of the price of each prescription drug is due to this rebate given to the PBM.

UnitedHealth Care, generated $324 billion in revenue in 2022. A lot of that revenue probably came from their Pharmacy Benefit Manager, a holding company that nobody knows about. The insurance companies made a combined profit of $1.5 trillion. They're projecting that they'll do $1.9 trillion in revenue by the year 2029.

For a clearer understanding of the complex situation, Brigham Buhler provides an explanation:

"When it comes to Metformin for diabetes, if you visit my pharmacy and mention that you have say, UnitedHealth Care, I am legally prohibited from telling you that I could sell the medication for less than what your insurance is charging. The cost of Metformin for me is about $2.00 for a month's supply. I would have sold it to you for $4.00.

However, when you come in, and I swipe your card, I can't inform you of my price. The system prompts me to charge you $10.00 as your co-pay. So, I charge you the $10.00 co-pay. As the pharmacy owner, I don't get to keep this money. The Pharmacy Benefit Manager (PBM) collects this amount into their holding company, retaining $7.00. I receive only $3.00 from them. This means I don't even make as much as I would have if I sold the medication to you directly." In other words, the pharmacist loses $1.00 while the patient loses $6.00 not accounting for the premiums the patient has paid to remain medically insured.

And when they claim to negotiate on behalf of the public, it is simply false. The system is designed to exploit and make money from your illness. Financially, there's a greater benefit in keeping you unwell and on drugs rather than in helping you recover. Consequently, a significant portion of insurance companies' earnings stems from keeping you reliant on medications. When a surgical solution could cure your condition, they create obstacles to prevent you from undergoing surgery because it isn't as profitable for them. The United States government contributes approximately 60% of the pharmaceutical industry's profits.

Taxpayers finance the National Institutes of Health (NIH), which conducts much of the initial product research. The patents are then sold to pharmaceutical companies at a fraction of their value. These companies leverage their influence and lobbying efforts with the FDA to get these products approved and available to consumers at a much inflated price. Pharmaceutical companies often seek to increase their profits and keep a stranglehold by tweaking the molecular structure or delivery methods of their drugs, allowing them to refile patents. This strategy prevents competitors from entering the market with more affordable options.

Another pressing issue is the cost of insulin, which serves as a prime example. Insulin has been available for four decades, yet its price has increased sixfold since its introduction. Despite this hike, pharmaceutical companies aren't earning more from it than they did at its launch. In fact, Eli Lilly is currently making less profit per vial than ever before. So, where is the additional revenue going? It’s going to the pharmacy benefit managers.

UnitedHealth Care is the parent company of Optum, which functions as a pharmacy benefit manager. Optum negotiates rebates with pharmaceutical manufacturers. In the case of opioids, if Purdue Pharma sets a price of, say, $50.00, Optum might suggest inflating the price to $100.00 and then receiving a $50.00 rebate. Consequently, a fee of $100.00 is presented as the cost of the opioid to the patient.

What many don't realise is that 80% of health plans in the United States are provided by employers. Most individuals receive their health coverage through their workplace. At the end of the year, major insurance companies have meetings with employers and say:

Bobby Sue was on this opioid throughout the year, costing us $100.00 each month, totalling $1,200.00 annually. We need to increase your co-pays, deductibles, and out-of-pocket expenses because these costs are significantly impacting our budget. Consequently, the employer bears the financial burden. In the upcoming year, all those co-pay and deductibles will increase, and ultimately, you, the patient, will feel the impact.

Following the implementation of Obamacare, Medicare and Medicaid services have largely been handed over to major insurance companies. Consequently, 60% of health care profits by insurers are derived from Medicare and Medicaid. When it comes to setting prices for these services, they base their negotiations on the inflated average wholesale price in the United States.

When deciding which medications to include on a formulary, the primary consideration is not the effectiveness or what is best for the patient. Instead, it revolves around which pharmaceutical company offered the largest rebate. They encourage you to choose these drugs by reducing your co-pay and deductible for them. For opioids, this meant they were easily accessible due to the rebates. Conversely, obtaining a non-addictive option like a pain cream was made very challenging, and eventually, they stopped covering pain creams entirely, forcing patients to use opioids.

Picture a young child suffering from a spinal condition that causes a searing, fiery sensation in their hands, feet, and limbs. To make matters worse, many victims with this condition also experience intense burning in their genital area. Under the insurance plans, you are required to see a primary care doctor first, which can take up to two months. During this waiting period, the sufferer continues to endure constant pain and distress and is usually prescribed an opiate at the outset.

Now you get in with the primary care, they go, Whoa, got six minutes with you. This is out of my wheelhouse. I'm going to refer you to a specialist. You go to a specialist, that will take months. Often times you have to argue with the insurance, who try to deny, delay or depose your claim. You will argue with that insurance company, begging them to allow you to go to a specialist. Your primary care may even have to get on the phone and get a prior off and negotiate it for you. Now you finally get in with a specialist. The specialist says, I want to order an MRI.

Frequently, insurance companies either refuse payment or postpone it. Consequently, you'll face a prolonged dispute over the funds, adding another 3 to 4 months. In essence, most spine patients wait between 6 and 9 months before receiving any definitive response.

After negotiating to get into the surgery, you finally see a day on the calendar that promises relief with the operation you desperately need. Meanwhile, they've been prescribing opioids to manage your pain, as it's the only available option. When you finally receive approval, you think, I've found the best surgeon in the country. I want to go to this person. Unfortunately, it doesn't work that way. The insurance company dictates which doctors you can see and tells you that the top surgeon isn't in their network. Instead, they direct you to another doctor. This doctor then performs the surgery, but it goes terribly wrong. It wasn't the surgeon you wanted, and after waiting nine months, the procedure was botched. This is precisely what happened to this young man, Luigi. There are numerous images of his lower spine with multiple screws in the spine.

Can you fathom how he might have lost his sanity? Sadly, this is a daily reality for countless Americans. The situation is dire and heart-wrenching. No one should assume the roles of judge, jury, and executioner, yet that's precisely what the pharmacy benefit managers within insurance companies are doing. They're profiting immensely from the health struggles of Americans, making money from chronic conditions and medications while denying necessary surgeries.

Once individuals recognise the insurance fraud for what it truly is, the involvement of organised crime becomes evident. This criminal influence permeates every aspect of the system. They dictate coverage options, determine reimbursement rates, and control access to surgical procedures, deciding both the timing and eligibility for patients.

I was just as unaware as everyone else. I assumed that if you paid your hard-earned money, the insurance would support you when things went wrong. Trusting these insurance companies with your and your family's well-being means they'll find a way to profit from your long-term illness.

There's a significant profit being generated from chronic diseases, leading to a lack of motivation to find cures. The National Institute for Health, as I mentioned earlier, serves as the foundation from which innovations and drug developments emerge. However, their efforts are often guided by incentives that focus on treatments instead of cures. As a result, we end up introducing temporary fixes into the market instead of addressing the underlying issues.

In the medical field, it's understood that treating chronic disease requires identifying the root cause. This root cause is complex, pervasive, and has infiltrated our entire healthcare system, from the food we consume to the methods used in agriculture and food processing.

In the 1980s, major tobacco companies gained control over much of the food industry. They applied their marketing techniques and strategies to this new domain, resulting in food products that were more addictive, highly processed, and loaded with chemicals. As a consequence, people started consuming unhealthy foods, leading to a significant increase in ill health. Individuals are being driven toward chronic illnesses, allowing insurance companies to exploit the situation for profit over extended periods. Ultimately, the burden falls on employers, American citizens, and taxpayers, who end up paying for these harmful practices.

Reportedly, UnitedHealth Care introduced an AI algorithm that erroneously denied 90% of the claims, significantly boosting their profits. Over the past five years, their stock price has doubled. However, the focus is also on shareholder return on investment and stock performance. When examining ownership of the major insurance companies, the primary stakeholders are BlackRock, Vanguard, and State Street. The same entities hold substantial shares in leading pharmaceutical companies. Additionally, these firms have significant control over major media outlets. Clearly, a pattern is emerging. So, can you guess who provides the most funding and lobbying efforts? It's primarily the pharmaceutical companies, closely followed by the health insurance industry.

Our current approach rejects accepting insurance because this allows us to be transparent with patients about the actual costs. By eliminating the complexities and unclear pricing, we can straightforwardly inform patients about the true expenses and sell it at a fair price.

The major pharmaceutical companies have effectively taken control of the FDA, while the large insurance companies have conspired with the FBI and DOJ. They've also taken over our hospital systems and clinicians. Independent primary care practices have nearly disappeared because insurance companies have slashed their reimbursements, forcing doctors to become hospital employees. This consolidation has made it easier for powerful interests to dominate the healthcare landscape.

Physicians are now compelled to comply with directives or risk losing their jobs. Consequently, there are very few independent primary care providers operating within the insurance framework any more, with most having joined large HMOs. For instance, Blue Cross Blue Shield's acquisition of Kelsey-Seybold is a clear example of how these entities are vertically integrating and consolidating their hold on our healthcare systems.

Every aspect of medicine today seems overwhelmingly concentrated on pharmaceuticals. Although surgical procedures still generate significant revenue, they often act as a financial loss-leader for large insurance companies. Consequently, these companies create numerous barriers to access, making it difficult for patients to receive timely care. They force patients to navigate a series of obstacles before finally granting approval. For instance, UnitedHealth care is said to have denied over 30% of claims for crucial, life-altering treatments that individuals had already funded. Shockingly, only 10% of people challenge these denied claims.

That's why, when someone exclaims, Why was my MRI $6,000? it's because providers anticipate receiving only about a third of what they charge from insurers like United or Cigna. To compensate, they inflate the initial bill three times over. The insurance companies then set patients up for financial trouble by requiring the pharmacies to chase down the other £2000.00 -the unpaid amount. This leads many to face significant medical debt and, eventually, bankruptcy. Many lose their lifetime savings and their houses.

I've had UFC fighters, who are our clients, walk into Quest Diagnostics and present their insurance cards, only to be quoted $3,000 for our blood panel. They call me in shock, saying, They quoted me $3,000! I tell them, No, no, no. Give them our code. It's a $300 deal, and they'll bill me, not you. They often ask how it can be $300 when they're initially quoted $3,000. The reason is that once a panel is billed at a certain rate, by law, the patient must be billed at that rate too.

If I bill insurance $300.00 for a blood test, and I'm out of network, the insurance might only pay me $100. In that scenario, I lose $200.00. So, to ensure I get paid $300.00, I have to bill the insurance $900. If the insurance denies the claim, by law, I am required to pursue the patient for the additional $600.00. So, if they deny it, I have to charge the patient. Yes, I have to chase the patient down, but all I wanted was the $300.00 you owed me from the start!

Absolutely. It's best to keep your blood work private unless a major medical procedure is on the horizon. Otherwise, insurance companies may use artificial intelligence to exclude you from their coverage. (This is the worry for British patients if their records are shared with these outfits because any chronically sick will be discovered and coverage denied). Eliminating pharmacy benefit managers could significantly reduce the profit margins for insurance firms, thus removing their motivation to keep you reliant on prescription medications.

Let's consider insulin: the insurance company informs individuals that the average wholesale price for this medication in the United States is $1,000 per month. However, they never actually pay that amount; they only pay $500. Despite this, they claim it's $1,000 because they are the ones who establish the average wholesale price.

Wholesale pricing is a deception. As I mentioned before, there are liars, damn liars, and then there are statistics. They manipulate the starting point to steer the final result. Additionally, they influence co-pays and deductibles.

The third leading cause of death in America is medical misuse. And that's with us reporting less than 2% of adverse events. If you find yourself stuck in that controlled system, blindly following prescriptions and medications recommended to you, you are doing a disservice to yourself and your family.

This situation is far from a free market. My concern is that if insurance companies gain control, they might demand access to your data, which is not something you want. Unfortunately, this seems to be the direction we're headed. It's a concerning aspect of the whole situation. HIPAA offers little protection, really. It doesn't seem to benefit anyone, including the insured. Insurance companies will claim medical necessity and insist on evaluating you. In our current model, they often argue there’s no medical necessity and request access to patient records. They then have primary care providers, whom they pay, consult over the phone to find creative ways to deny your claim. It’s a complex issue. The bigger picture is even more troubling.

Here's where it gets alarming: pharmaceutical companies are spending $8 billion a year on advertising with media outlets. They pay these outlets to indirectly produce stories and articles that discourage people from considering cost-effective alternatives like compounding pharmacies.

Then they engage in discussions with the federal government for Medicare and Medicaid pricing. They propose a deal, suggesting that, as a partner, the government deserves a discount. They offer the drug at $800 per month, which is $200 less than the national rate. However, the actual cost to them was £500, netting them a profit of, deceptively obtained, $300 each month from the government.

In a wholly different aspect, consider a scenario where you experience a heart attack, and your insurance must cover your immediate treatment. However, you might face a copayment of $5,000 to $20,000 or 20% of the expenses.

In the United States, ambulance charges can reach from a few hundred up to $10,000 for a short trip to the hospital, especially if air transport is involved, which can be a heavy burden for the patient. Upon arrival, you'll encounter the high costs of the emergency room. Emergency room visits can cost up to $50,000 especially in extreme cases. Several cardiologists may attend to you, each billing your insurance around $1,800. An ECG could cost around $1,450, a chest X-ray might have a similar price, and a CT scan could add several thousand dollars more.

You might then be scheduled for a stent procedure, with the operating room and associated fees totalling perhaps more than $20,000. After the procedure, you could be admitted to a room costing some $5,000 per night, with frequent visits from cardiologists and ECGs at $1,400 each, adding to your bills. They also find ingenious ways of keeping you longer than necessary in the hospital to hike up their charges.

The struggle doesn't stop at that point. You're given a range of medications to take forever, regardless of whether they're genuinely essential, because you'll be assured of their importance. Additionally, you'll need to see a heart specialist for the remainder of your life.

Also note that the prices can vary 10-fold between hospitals so only visit hospitals who publish their prices,

When you're finally released from the hospital, your expenses could total upwards of $150,000.00. Even after your insurance co-pay, you might still face a $30,000.00 debt. You're frequently assured that you have access to the world's finest healthcare, unmatched elsewhere. However, this is far from true. Numerous European nations provide better medical services at no cost to the patient, with the government paying for all expenses, which could total approximately $20,000.00.

Here's the irony: it is likely that the costs in the USA are the same, i.e., $20,000.00. If you end up paying $30,000, your insurance company, which owns the hospital, just made $10,000.00 profit from your unfortunate heart attack. Your premiums are clear profit and go straight into their pockets and are never used. Each time you are sick, they actually make more money out of your illness!

Comment: Regular users of this forum are probably aware that many persistent illnesses necessitating prolonged medication are often deceptive. Medications cannot provide lasting relief or a cure. The origin and solutions lie in an entirely different domain. Check out this page and explore various other posts under different topics within this forum.

Please also read this article on "Gastric reflux disease" about the terrible indoctrination of patients into taking many dangerous drugs for this relatively and easily manageable problem without any drugs.

The public in the UK should be very cautious as this system is rapidly heading this way.

References:
1. The History of Health Insurance in the United States - Health Affairs
2. A Brief History of Health Savings Accounts and Other Account-Based Health Plans - National Center for Policy Analysis
3. The Emergence of Pharmacy Benefit Managers - National Library of Medicine:
4. Prescription Medication Spending in 2018: According to the IQVIA Institute for Human Data Science's report Medicine Use and Spending in the U.S., published in 2019, the total spending on prescription drugs in the United States reached approximately $535 billion in 2018.
5. Rising Costs of Prescription Medications: Reports from sources such as the Centres for Medicare & Medicaid Services (CMS) and various health policy think tanks indicate a continued upward trend in prescription drug costs in the U.S. The CMS National Health Expenditure data and reports from the Kaiser Family Foundation frequently highlight these trends.
6. U.S. Healthcare Expenditure: The U.S. consistently ranks as the country with the highest healthcare spending per person. According to the OECD (Organisation for Economic Co-operation and Development), the U.S. spends more on healthcare than any other nation, both in total and per person.
7. Global Health Ranking: The World Health Organisation (WHO) and other organisations have ranked healthcare systems worldwide, and while the U.S. spends significantly on healthcare, it often ranks lower in terms of efficiency, accessibility, and outcomes compared to other developed countries. For example, the Bloomberg Health Efficiency Index and the Commonwealth Fund have shown the U.S. lagging other nations in these areas.


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