Health
Health care costs up to 300% higher for privately insured patients than those with Medicare, report reveals
Most Americans — more than 65% — have private health insurance, but a new report has revealed a potentially very expensive drawback.
Patients who have private (commercial) coverage may end up paying significantly more for their medical care compared to those who have public health insurance, such as Medicare, according to recent data from RAND Corp. in Washington, D.C.
As of 2022, employers and private insurance companies paid an average of 254% more for medical services than what Medicare programs would have paid.
HEALTH CARE COSTS UP TO 300% HIGHER FOR PRIVATELY INSURED PATIENTS THAN THOSE WITH MEDICARE
Several states — California, Florida, Georgia, New York, South Carolina, West Virginia, and Wisconsin — had medical costs that were more than 300% higher than Medicare prices, the report stated.
The researchers analyzed medical claims data from a “large population” of privately insured patients who were treated at over 4,000 hospitals across the country between 2020 and 2022.
Patients who have private coverage may end up paying significantly more for their medical care compared to those who have public health insurance, such as Medicare. (iStock)
The report also included the names and prices of each hospital.
“Calculating 4,000-plus U.S. hospitals’ overall relative prices has never been done before this study, because it’s so difficult to collect the requisite data and to get permissions to publish the hospital and health system names associated with each relative price,” said Brian Briscombe, a health care analyst at RAND and one of the study authors, to Fox News Digital.
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“This is real price transparency — naming the hospitals and presenting their overall relative prices in a way that anyone could understand.”
The report gives employers a tool they can use to become “better-informed purchasers” of health care services, Peter Hussey, director of RAND Health Care in Santa Monica, California, noted in a news release.
“Hospitals account for the largest share of health care spending in the U.S., so this report also provides valuable information that may aid policymakers interested in curbing health care costs,” Hussey also said in the release.
The researchers analyzed medical claims data from a “large population” of privately insured patients who were treated at more than 4,000 hospitals across the country between 2020 and 2022. (iStock)
The wide variance of prices across hospitals is the most important takeaway, according to Briscombe.
“Within a single city, you can find a hospital that (on average across all its services) charges privately insured patients about twice as much as Medicare charges for those same services — but down the street, another hospital charges three times what Medicare charges,” he told Fox News Digital.
The difference in prices cannot be explained by differences in quality, he added.
“This is real price transparency — naming the hospitals and presenting their overall relative prices in a way that anyone could understand.”
Dr. Brett Osborn, a Florida neurologist and longevity expert, was not involved in the RAND study but said the findings are “concerning.”
“Hospitals bill private insurers multiples of the Medicare allowable,” he told Fox News Digital.
“The elevated costs are passed onto patients, resulting in higher premiums and out-of-pocket expenses.”
As of 2022, employers and private insurance companies paid an average of 254% more for medical services than what Medicare programs would have paid, according to a new study. (iStock)
And these costs are on the rise, Osborn warned.
“People accept job offers because the employer offers health insurance — otherwise, for many, the premiums would be unaffordable,” he added.
Osborn emphasized the significant price variations among states.
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“Hospitals in some states charge less than 200% of Medicare rates, while others exceed 300%,” he said.
“Due to its size, Medicare can negotiate lower payments — but private insurers lack this leverage.”
“This discrepancy is due to some hospitals’ market power, making it hard for employers to avoid them. Due to its size, Medicare can negotiate lower payments — but private insurers lack this leverage.”
The doctor also called for greater price transparency from hospitals.
The new report published the names and pricing models of more than 4,000 U.S. hospitals. (iStock)
“Despite a federal rule for price transparency, only 24.5% of hospitals comply — highlighting the need for informed health care purchasing and policy changes to manage costs,” he said.
“The system is fundamentally flawed, designed to profit from illness rather than promote health,” Osborn continued.
“It clearly favors hospital systems, not the patients, reinforcing the harsh reality: There is money in the sick.”
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Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, said the issue of price variations is complex.
“Sometimes these are hidden costs, and sometimes hospitals and other health organizations know they can get away with charging private insurers more while obscuring prices from both the insurer and the patient to help compensate for the shrinking reimbursements from public insurances,” Siegel told Fox News Digital.
“At the same time, more out-of-pocket costs are transferred to the consumer in terms of copays and deductibles, as middlemen take the profits.”
“The system is fundamentally flawed, designed to profit from illness rather than promote health.”
With the lack of price transparency, there is no way to introduce competition, Siegel said, as the true costs and prices are hidden.
The study did have some limitations, the researchers acknowledged.
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“We didn’t have sufficient claims data to publish all U.S. hospitals’ relative prices,” Briscombe told Fox News Digital.
“Some states in the U.S. don’t have All Payor Claims Databases (APCDs), so we have to collect claims from one data contributor at a time – usually from employers that operate in that location and whose employees and dependents use those hospitals.”
“Despite a federal rule for price transparency, only 24.5% of hospitals comply, highlighting the need for informed health care purchasing and policy changes to manage costs,” according to a doctor who spoke with Fox News Digital. (iStock)
Overall, he said, the researchers had a “sufficiently large sample of data” to estimate the overall relative price of each hospital and health system included in the report, Briscombe said, “but it would be nice to have even more claims data in order to publish the relative prices for all U.S. hospitals.”
Fox News Digital reached out to the Centers for Medicare & Medicaid Services and the American Hospital Association requesting comment.
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The onset of dementia can come as a shock, but various signs could predict the condition as long as 20 years before symptoms.
A new study published by the RAND Corporation in California identified several major predictors occurring around age 60 that are likely to lead to cognitive impairment and dementia in individuals by age 80.
Researchers evaluated 181 potential risk factors, including demographics, socioeconomic status, lifestyle and health behaviors, health history, psycho-social factors and more.
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Below are some of the strongest predictors at age 60 that indicate a higher chance of developing cognitive impairment and dementia, according to the report.
See the list of 14 predictors.
RAND researchers uncovered several surprising predictors of dementia risk, like never drinking and never working. (iStock)
1. Poor physical health
2. History of stroke
3. Genetics
4. Being born in the Southern United States
5. Not having private health insurance at age 60
6. Never working or only working for a few years
7. History of diabetes
8. Having a body mass index of 35 or more
9. Never drinking alcohol or drinking excessively
10. Never exercising
11. Scoring low on physical tests
12. Being less conscientious
13. Low engagement in hobbies
14. Low cognitive function and engagement
Parental health, family size, marital history and demographics were the weakest predictors, according to the research.
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In an interview with Fox News Digital, study co-author Peter Hudomiet, a RAND economist in California, shared details of the study, which worked with a large dataset and followed individuals “for decades.”
Parental health, family size, marital history and demographics were the weakest predictors, according to the research. (iStock)
“Overall, we found that risk factors had a similar effect in the short and long term, which reassured us that the findings from prior literature may hold in the long term,” he said.
“Nevertheless, we also had quite a few surprising findings.”
Digging into dementia drivers
The researcher said he was surprised to find that those who never exercised had a “substantially higher chance” of developing dementia than those who lightly exercised at least a few times per month.
“Exercising even more often (weekly or daily) had some additional benefits, but not that much,” he noted.
“In other words, the main risk factor for dementia was never exercising.”
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“These behavioral factors were more important predictors of dementia than having the right genes,” Hudomiet added.
While having a body mass index (BMI) over 30 at age 60 was a weak predictor of dementia, a BMI over 35 was a “powerful predictor.”
The risk of dementia is “about half as much among those who regularly exercise compared to those who never do,” said the researcher (not pictured). (iStock)
Never participating in cognitive activities offered a much higher risk of developing dementia compared to sometimes participating, as well as only having zero to 11 years of education compared to having high school or advanced degrees, said Hudomiet.
Another unexpected finding was the substantially higher dementia risk faced by Americans born in the Southeastern U.S. compared to the rest of the country.
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“This differential remained strong even when our statistical models accounted for differences in income, health, and other differences between regions,” the researcher noted.
“It is possible that the quality of education (which we could not measure in our data) was lower in the Southeastern part of the U.S., especially in the older cohorts we analyzed.”
“Less than 1% of health care dollars go toward educating the public on positive health care strategies,” according to a gerontologist. (iStock)
People not covered by a private health insurance plan at age 60 had an 11% higher chance of developing dementia than those who had coverage, Hudomiet added.
That’s “partly because private health insurance helps individuals remain healthy longer,” he suggested.
“The choices you make now will determine how you will live later.”
The study results suggested that “maintaining good physical and mental health is beneficial not just to staying in shape, but also to staying sharp and delaying cognitive decline,” Hudomiet told Fox News Digital.
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Gerontologist Dr. Macie P. Smith in South Carolina, who was not involved in the study, also reacted to the findings in a separate interview with Fox News Digital, saying the researchers are “spot on.”
“Having this researched information presented … brings about a heightened sense of responsibility to everyone who claims to be in the fight to end Alzheimer’s disease and related dementias (ADRD),” she wrote in an email response.
A person’s genetics are less of a risk factor than certain habits and behaviors such as exercise, a researcher noted. (iStock)
Smith said it is “pretty shocking” that never drinking alcohol increases dementia risk.
“This stands out to me because drinking alcohol excessively increases one’s risk significantly of brain deterioration and can lead to alcohol-induced dementia,” she said.
The expert suggested that self-reported data could have led to this finding — or red wine could have been factored in, as it’s been found to “contain brain-enhancing nutrients, such as resveratrol.”
Ways to reduce the risk
While cognitive decline is sometimes impossible to prevent, Hudomiet mentioned that some risk factors can be reduced through lifestyle changes.
These include exercising regularly, maintaining a healthy body weight, getting proper nutrition and engaging in challenging cognitive activities.
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“Health care providers and the government should consider promoting healthy behaviors in the adult population and strengthening individuals’ access to quality health care, which may decrease the prevalence of dementia and the burden of the disease in the future,” Hudomiet recommended.
“Understanding that what’s good for the heart is good for the brain and adopting healthy lifestyle practices puts people in control of their brain fate,” one expert said. (iStock)
Smith added that reducing dementia risk “doesn’t begin or end with medication.”
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For those who are middle-aged, paying attention to these early predictors is a “matter of life and death,” she stated.
“It is incumbent on everyone with a brain to take heed of the warning signs that your body gives you,” she said. “Your body always reminds you about what your brain sometimes ignores.”
“You have the power to take control over what your life looks like down the road,” she went on.
“The choices you make now will determine how you will live later.”
Heart failure has historically been irreversible, but the outcome of a new study suggests that could someday change.
At the University of Utah, scientists used a new gene therapy that was shown to reverse the effects of heart failure in a large animal study.
In the study, pigs with heart failure were found to have low levels of cardiac bridging integrator 1 (cBIN1), a critical heart protein.
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The scientists injected a harmless virus into the pigs’ bloodstreams to carry the cBIN1 gene into their heart cells, according to a university press release.
The pigs survived for the six-month duration of the study, while they would have been expected to die from heart failure without the gene therapy.
Senior study co-authors Robin Shaw, MD, PhD (left) and TingTing Hong, MD, PhD (right) are pictured in the lab. (Charlie Ehlert / University of Utah Health.)
In what the researchers called an “unprecedented recovery of cardiac function,” the IV injection appeared to improve heart function by increasing the amount of blood it can pump, which “dramatically improves survival.”
The pigs’ hearts also appeared to be “less dilated and less thinned out” after the therapy, “closer in appearance to that of non-failing hearts.”
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While previous attempts to treat heart failure improved function by just 5% to 10%, the gene therapy used in the new study resulted in 30% improvement, according to the researchers.
The study, which was funded by the National Institutes of Health, was published on Tuesday in the journal npj Regenerative Medicine.
Microscope images of failing heart cells (top) and heart cells that received gene therapy (bottom). Cell boundaries, labeled in magenta, are more organized after gene therapy, and the level of cBIN1 protein (green) is higher. (Hong Lab)
“Even though the animals are still facing stress on the heart to induce heart failure, in animals that got the treatment, we saw recovery of heart function and that the heart also stabilizes or shrinks,” said TingTing Hong, MD, PhD, associate professor of pharmacology and toxicology at the University of Utah, in the release.
“We call this reverse remodeling. It’s going back to what the normal heart should look like.”
“A possible new therapy to cure heart failure is on the way,” Hong told Fox News Digital in a statement.
“A possible new therapy to cure heart failure is on the way.”
The researchers were surprised to find that the gene therapy worked so well in large animals at such a low dose, Hong added.
Co-senior author Robin Shaw, MD, PhD, director of the Nora Eccles Harrison Cardiovascular Research and Training Institute at the University of Utah, said the “unprecedented” study ushers in a “new paradigm” for heart failure treatments.
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“Given our treatment efficacy, the complex multi-organ syndrome of heart failure can be reduced to a treatable disease of failing heart muscle,” he told Fox News Digital via email.
“The toxicity of gene therapy increases with dose, so our low dose suggests that our gene therapy approach will be safe for patients.”
While gene therapy has historically been used for rare diseases, the study results suggest that it could also be an effective approach for “acquired disease,” a researcher said. (iStock)
While gene therapy has historically been used for rare diseases, the study results suggest that it could also be an effective approach for “acquired disease,” according to Shaw.
The study did have some limitations, the researchers acknowledged.
“Dose escalation and toxicology studies are still needed for the therapy to move to the next step [toward FDA approval],” Hong noted.
It is also uncertain whether the gene therapy will work for people who have obtained a natural immunity to the virus that carries the therapy, the researchers said.
The toxicology study is currently underway, and the team plans to start human clinical trials in the fall of 2025, Hong said.
Cardiologists weigh in
Dr. Jasdeep Dalawari, interventional cardiologist and regional chief medical officer at VitalSolution, an Ingenovis Health Company based in Ohio, was not involved in the research but shared his reaction to the findings.
“Gene therapy, precision medicine and personalized health care is the future.”
“Research in the animal phase is always interesting, but the application to human test subjects is necessary in terms of understanding if this approach would have the same effect in humans,” he told Fox News Digital.
While previous attempts to treat heart failure improved function by just 5% to 10%, the gene therapy used in the new study resulted in 30% improvement, according to the researchers. (iStock)
“That said, there are many genetic modifications happening in different diseases, like cystic fibrosis and muscular dystrophy, that are looking at a similar intervention – injecting healthy genes in the hopes of finding cures,” he went on.
“Gene therapy, precision medicine and personalized health care is the future, and I look forward to learning more about this.”
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Dr. Johanna Contreras, advanced heart failure and transplant cardiologist at the Mount Sinai Fuster Heart Hospital in New York City, noted that conventional pharmacological interventions can help to alleviate cardiac stress and “systemic congestion,” but “for the most part, they do not address the pathogenic remodeling of failing heart muscle.”
About 6.7 million adults in the U.S. have heart failure, statistics show. (iStock)
“Gene therapy has emerged as a new modality that could interfere or modify the expression of several proteins, thus it could alter the pathologic remodeling of the heart muscle that exists in heart failure,” Contreras, who also was not involved in the study, told Fox News Digital.
For more Health articles, visit www.foxnews.com/health
Contreras reiterated that human trials are needed to determine whether this therapy will be effective outside animal models and to identify any “downstream effects.”
“I will look forward to learning more and eventually learning if this could one day be applied to humans with heart failure.”
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