Pigs Feeding at the Trough
Segment #663
Not all doctors, hospitals, insurance companies, or politicians will do the wrong thing for money. Like Biden and his family that had no other business than influence peddling, greed is everywhere and there are many that would hurt our country and its citizens for personal gain.
Doctor Payoffs
Overview of Financial Incentives from Pharmaceutical Companies to DoctorsPharmaceutical companies have historically used various financial incentives to encourage doctors to prescribe their drugs, often under the guise of educational or promotional activities. While direct commissions for prescriptions are illegal in the U.S. under the Anti-Kickback Statute (AKS), many indirect payments are permissible if disclosed. These relationships can create conflicts of interest, as studies show that even small payments (e.g., $20 meals) increase the likelihood of prescribing the paying company's drugs, favoring brand-name over generics and raising healthcare costs. The Physician Payments Sunshine Act (part of the Affordable Care Act) mandates public reporting of these payments via the CMS Open Payments database, which has tracked over $72.8 billion in payments to physicians from 2013–2022.
Data from Open Payments reveals that 57% of U.S. physicians received industry payments between 2013 and 2022, totaling about $12 billion (excluding research grants). lowninstitute.org Over 2,500 doctors received at least $500,000 each in the past five years, with more than 700 earning over $1 million. propublica.org These incentives persist despite scrutiny, as they deliver a strong "return on investment" for pharma companies through higher prescription volumes. fiercepharma.com
Hospital Payoffs
Financial Incentives for Ventilator Use and Remdesivir in COVID-19 TreatmentDuring the COVID-19 pandemic, the U.S. government, through the Centers for Medicare & Medicaid Services (CMS), implemented temporary reimbursement enhancements under the CARES Act (2020) to support hospitals facing revenue losses from elective procedure delays and increased COVID-19 care costs. These included a 20% add-on to standard Diagnosis-Related Group (DRG) payments for Medicare patients diagnosed with COVID-19, plus specific adjustments for high-acuity interventions like mechanical ventilation and new treatments like remdesivir. The goal was to cover elevated costs and encourage adoption of emerging therapies, but critics argued these created perverse incentives for overutilization, potentially prioritizing financial margins over optimal patient outcomes. While direct evidence of widespread fraud is lacking, studies and whistleblower accounts highlight correlations between payments and treatment patterns, with ventilator mortality rates reaching 45–84% in ventilated COVID-19 patients.These incentives applied primarily to Medicare (covering ~36% of U.S. hospitalizations) and influenced broader protocols, as hospitals often align care with reimbursement structures. Below, I discuss each specifically, drawing on CMS policies, clinical data, and critiques.Incentives for Ventilator UseMechanical ventilation—intubation and use of ventilator machines—was a cornerstone of early COVID-19 protocols for severe respiratory distress, but its high mortality and resource intensity drew scrutiny amid financial ties.
Reimbursement Structure:
Standard DRG payments for respiratory infections (e.g., DRGs 177–179 for COVID-19 pneumonia) averaged ~$13,000–$15,000 for non-ventilated cases in 2020, including the 20% COVID add-on.
Ventilator cases (e.g., DRG 003 for prolonged ventilation >96 hours) jumped to ~$39,000–$40,000, roughly 3x higher, due to bundled payments covering ICU stays, nursing, and equipment. This reflects higher resource use but incentivizes escalation to ventilation for revenue, especially in under-capacity hospitals where fixed payments reward volume.
Under the Inpatient Prospective Payment System (IPPS), hospitals retain surpluses if costs < payment, amplifying margins for high-DRG cases. The CARES Act's Provider Relief Fund added ~$100 billion in grants, but DRG boosts were tied to COVID coding.
Potential Impact and Data:
A 2020 analysis estimated ventilator DRGs generated $10,000–$20,000 more per case than non-invasive oxygen therapy, despite similar nursing needs, creating a "strong financial incentive to intubate early."
themedicalcareblog.com
Early protocols (e.g., NIH guidelines) pushed ventilation for oxygen saturation <92%, but alternatives like high-flow nasal oxygen often sufficed with lower risks.
Usage surged: U.S. hospitals ventilated ~60,000 COVID-19 patients in spring 2020, with New York reporting 60%+ mortality.
themedicalcareblog.com
A meta-analysis of 57,000 patients found 45% fatality on ventilation, rising to 84% in older adults.
medicalkidnap.com
Criticisms and Overprescription Concerns:
Whistleblowers, like medical coder Zowe Smith from an Arizona hospital, alleged executives met weekly to enforce ventilator protocols for bonuses, even when oxygen levels didn't warrant intubation, leading to unnecessary deaths.
childrenshealthdefense.org
She reported patients "trying to escape" post-intubation.
Fact-checks (e.g., PolitiFact, Snopes) debunked claims of outright fraud but noted the 3x payment disparity could subtly influence decisions in profit-driven systems.
politifact.com +1
A 2021 review criticized DRG bundling for disincentivizing less invasive care, as non-ventilator COVID cases reimbursed "disproportionately low."
themedicalcareblog.com
Broader ethical issues: Rationing guidelines (e.g., NEJM) prioritized younger patients for ventilators, raising equity concerns, but financial pressures exacerbated shortages (U.S. had ~160,000 ventilators pre-pandemic vs. 1M+ needed).
pmc.ncbi.nlm.nih.gov
Post-2023, as the public health emergency ended, these add-ons phased out, reverting to standard DRGs.Incentives for Remdesivir UseRemdesivir (Veklury), an antiviral nucleotide analog, received FDA Emergency Use Authorization (EUA) in May 2020 for hospitalized COVID-19 patients. It was positioned as a standard of care despite mixed trial data, with incentives aimed at offsetting its high cost (~$3,120/course) and promoting uptake.
Reimbursement Structure:
Bundled into DRG payments under IPPS, with the 20% COVID add-on covering acquisition and administration. For severe cases, it comprised 8–13% of total reimbursement (~$2,500–$5,000 add-on per course).
The New COVID-19 Treatments Add-On Payment (NCTAP), effective November 2020–September 2023, provided up to 65% of costs exceeding DRG thresholds (capped at $30,000 outlier), explicitly for remdesivir and similar therapies to "mitigate financial disincentives."
cms.gov +1
Outpatient use (post-2022 FDA expansion) reimbursed via Medicare Part B at ASP +6% (~$5.51/mg, or ~$3,300/course).
Hospitals billing for remdesivir triggered full DRG + add-ons if COVID-positive, with NDC codes required for tracking. CARES Act funds included $178 million for remdesivir procurement/distribution.
Potential Impact and Data:
Gilead shipped ~600,000 courses in 2020; U.S. spending hit $2.3 billion by mid-2021. ACTT-1 trial showed ~4-day recovery shortening in non-ventilated patients, but no mortality benefit overall.
kff.org
WHO's Solidarity trial (2020) found no reduction in ventilated patients' mortality or ventilation duration.
who.int
A 2022 meta-analysis linked it to lower mortality vs. supportive care, but subgroup benefits were limited to early, non-critical cases.
firstdraftnews.org
Criticisms and Overprescription Concerns:
Detractors, including former NIH consultant Dr. David Rasnick, called it a "failed drug" with kidney/liver risks (e.g., acute injury in 20–30% of cases), citing Ebola trials halted for >50% mortality.
medicalkidnap.com
Smith reported rapid kidney failure post-administration, with hospitals allegedly concealing vaccine interactions.
childrenshealthdefense.org
Financial motives: NCTAP bonuses (20% per dose) encouraged "remdesivir-first" protocols, even off-label outpatient use, inflating spending by billions without proportional outcomes.
kgns.tv +1
A 2021 Reuters report noted compensation claims for remdesivir harms via the Countermeasures Injury Compensation Program, though payouts were small ($48,000 avg. for severe cases).
reuters.com
Profit divergence: Gilead's pricing ($3,120 vs. estimated $1/day production) prioritized revenue over access, per a 2020 BMJ analysis, with public R&D funding (~$79 million from U.S. taxpayers) yielding private gains.
pmc.ncbi.nlm.nih.gov
IDSA guidelines now limit it to non-ventilated severe cases, reflecting evolved evidence.
idsociety.org
Combined Incentives and Systemic ImplicationsHospitals could stack incentives: A ventilated COVID-19 patient on remdesivir might yield $50,000–$100,000 total (DRG +20% + NCTAP), vs. $10,000 for non-COVID pneumonia.
medicalkidnap.com
Critics like the Association of American Physicians and Surgeons argued this "bounty" ($100K/patient) drove over-testing and protocol adherence, contributing to 84.9% mortality in prolonged Texas ventilator cases.
Health Insurance Companies and Politicians
Obamacare turned out to be a disaster that failed to fulfill its promises. The only way to hold it together was to subsidize the insurance companies that then made a bundle. These subsidies expire at the end of 2025 and Dems do not want this political disaster blamed on them., That’s why they are trying to push in beyond the midterms when they have a chance to re-take power.
Overview of ACA Insurance Company Lobbyists' Impact on PoliticsThe Affordable Care Act (ACA), signed into law in 2010, reshaped U.S. health insurance by expanding coverage to over 20 million Americans, mandating essential benefits, and regulating insurer practices. However, its passage and evolution were profoundly shaped by lobbying from health insurance companies and their trade groups, such as America's Health Insurance Plans (AHIP). These efforts, often secretive and massive in scale, aimed to protect profits by diluting reforms, blocking alternatives like a public option, and securing subsidies. Lobbyists' influence extended beyond the ACA's drafting to its defense against repeal attempts and ongoing tweaks, demonstrating a pattern of "stealth lobbying" through campaign donations, personal meetings, and revolving-door hires.This lobbying has created a feedback loop: Insurers fund politicians who preserve ACA structures benefiting them (e.g., premium subsidies), while public backlash grows over rising costs and denials. As of 2025, with subsidies expiring and a government shutdown tied to their extension, insurers' spending hit record highs—AHIP alone spent $13.1 million in the first nine months, more than all of 2024. Critics argue this entrenches a system where profits trump access, with studies showing lobbyists' donations timed to key legislative moments for maximum sway.Lobbying Spending and ScaleHealth insurance lobbying surged post-ACA, part of a broader 70% increase in sector spending from $358 million in 2000 to $714 million in 2020, peaking at nearly $700 million in 2021 amid drug pricing battles. Insurers (categorized as "payers") spent $81 million in 2020, with the top 10% of firms driving 70% of it. During ACA debates (2009–2010), the industry deployed over 4,500 lobbyists—eight per congressional member—spending $380 million on lobbying, ads, and contributions.
Data from OpenSecrets and JAMA Health Forum analyses show concentration: Giants like UnitedHealth and Anthem dominate, using PACs for bipartisan donations but leaning Democratic (e.g., 60%+ to Dems in 2024 cycles).Specific Impacts on ACA Politics1. Shaping the Original Legislation (2009–2010)
Blocking the Public Option: Insurers, via AHIP, lobbied fiercely against a government-run plan competing in marketplaces, deploying six lobbyists per congressperson. This succeeded; the Senate bill omitted it, influenced by $1.5M donations to key senators like Max Baucus (D-MT), who drafted much of the text with ex-WellPoint VP Liz Fowler. A White House "Faustian bargain" traded pharma/insurer neutrality for no price caps or public plans.
Diluting Regulations: Lobbyists blunted cost-controls, like Medicare Advantage cuts (reduced from $200B to $140B over 10 years) and medical loss ratios (MLR, requiring 80–85% of premiums on care). Studies show this preserved $100B+ in profits.
Secret Sabotage: While publicly endorsing the bill, AHIP funneled ~$100M to the U.S. Chamber of Commerce for anti-ACA ads, per National Journal reports—exposing duplicity.
2. Defending Against Repeal (2017)
Post-Trump election, insurers were "stunned" by rapid repeal pushes but lobbied quietly to avoid backlash. AHIP urged tweaks like high-risk pools over full repeal, fearing market collapse. Their muted response (e.g., narrow ads on "Obamacare taxes") helped stall efforts, as GOP bills failed amid public outcry. Donations to vulnerable Republicans ($10M+ in 2016 cycle) ensured some protections, like subsidies, survived.
3. Opposing Expansive Reforms (2019–Present)
Medicare for All Resistance: Facing progressive pushes, insurers mobilized 1,000+ lobbyists, arguing ACA "works reasonably well." They spent $50M+ in 2019 to kill single-payer, emphasizing employer plans (155M covered). This swayed moderates, preserving private dominance.
Subsidy Extensions: Enhanced ACA subsidies (from 2021 ARP/IRA) added 10M enrollees and $50B+ annual insurer revenue. In 2025, amid shutdowns, AHIP's $13M push secured phased extensions, benefiting high-income households ($600K+ eligibility). Critics call it a "jackpot," with denials up 33% at firms like UnitedHealth.
Medicaid and Medicare Tweaks: Lobbyists blocked deep ACA Medicaid cuts in Trump's 2025 bill, despite $900B program risks, by framing providers as ACA backers. They also rolled back Biden-era Medicare Advantage reforms, delaying overpayments ($12B/year) via phase-ins.
4. Revolving Door and Long-Term Ties
Ex-ACA architects like Marilyn Tavenner (CMS head to AHIP CEO) exemplify influence; ethics rules bar direct lobbying for two years, but "grass-tops organizing" via firms like Dewey Square builds Democratic bridges. From 2010–2020, 30+ HHS/staffers joined insurer lobbies, premium-priced for ACA expertise.
Broader Political and Societal RamificationsInsurers' lobbying has bipartisan reach but tilts Democratic, funding ACA defenders while extracting concessions. This entrenches inequities: ACA reduced uninsured rates (from 16% to 8%), but premiums rose 20–30% in non-subsidized markets, with 1-in-5 claims denied. Public advocates occasionally counter (e.g., offsetting business opposition in Medicaid expansion), but resource gaps persist—insurers outspend consumer groups 10:1.Recent X discussions highlight frustration: Users decry ACA's boost to insurance lobbies, reducing physician influence and enabling private equity dominance. Reforms like donation caps or transparency (e.g., expanding OpenSecrets) are proposed, but lobbyists' "stunning influence" via timed gifts endures.In sum, ACA lobbyists transformed a reform meant to curb insurer power into a profit engine, influencing politics through cash and access. As subsidies hang in balance, their role underscores money's sway in health policy. For details, check OpenSecrets.org.