The genetic paradox: Yesterday’s solutions are today’s problems. Can U.S. healthcare shift gear faster than our genes?

https://www.linkedin.com/pulse/genetic-paradox-yesterdays-solutions-todays-problems-can-pearl-m-d–r6mic/?trackingId=C3X2nlWPRe6yBwiHCcuWGg%3D%3D

In a world where change is the only constant, the swift currents of modern life contrast starkly with the sluggish pace of genetic evolution—and of American healthcare, too.

Two relatively recent scientific discoveries demonstrate how the very genetic traits that once secured humanity’s survival are failing to keep up with the times, producing dire medical consequences. These important biological events offer insights into American medicine—along with a warning about what can happen when healthcare systems fail to change.

The Mysteries Of Sickle Cell And Multiple Sclerosis

For decades, scientists were baffled by what seemed like an evolutionary contradiction.

Sickle cell disease is a condition resulting from a genetic mutation that produces malformed red blood cells. It afflicts approximately 1 in 365 Black Americans, causing severe pain and organ failure.

Its horrific impact on people raises a question: How has this genetic mutation persisted for 7,300 years? Nature is a merciless editor of life, and so you would expect that across seven millennia, people with this inherited problem would be less likely to survive and reproduce. This curiosity seems to defy the teachings of Charles Darwin, who theorized that evolution discards what no longer serves the survival of a species.

Scientists solved this genetic puzzle in 2011, illuminating a significant evolutionary trade-off.

People living with sickle cell disease have two abnormal genes, one inherited from each parent. While the disease, itself, affects a large population (roughly 100,000 African Americans), it turns out that a far larger population in the United States carries one “abnormal” gene and one normal gene (comprising as many as 3 million Americans).

This so called “sickle cell trait” presents milder symptoms or none at all when compared to the full disease. And, unlike those with the disease, individuals who with one (but not both) abnormal genes possess a distinct evolutionary advantage: They have a resistance to severe malaria, which every year claims more than 600,000 lives around the globe.

This genetic adaptation (a resistance to malaria) kept people alive for many millennia in equatorial Africa, protecting them from the continent’s deadliest infectious disease. But in present-day America, malaria is not a major public-health concern due to several factors, including the widespread use of window screens and air conditioning, controlled and limited habitats for the Anopheles mosquitoes (which transmit the disease), and a strong healthcare system capable of managing and containing outbreaks. Therefore, the sickle cell trait is of little value in the United States while sickle cell disease is a life-threatening problem.

The lesson: Genetic changes beneficial in one environment, such as malaria-prone areas, can become harmful in another. This lesson isn’t limited to sickle cell disease.

A similar genetic phenomenon was uncovered through research that was published last month in Nature. This time, scientists discovered an ancient genetic mutation that is, today, linked to multiple sclerosis (MS).

Their research began with data showing that people living in Northern Europe have twice the number of cases of MS per 100,000 individuals as people in the South of Europe. Like sickle cell disease, MS is a terrible affliction—with immune cells attacking neurons in the brain, interfering with both walking and talking.

Having identified this two-fold variance in the prevalence of MS, scientists compared the genetic make-up of the people in Europe with MS versus those without this devastating problem. And they discovered a correlation between a specific mutated gene and the risk of developing MS. Using archeological material, the researchers then connected the introduction of this gene into Northern Europe with cattle, goat and sheep herders from Russia who migrated west as far back as 5,000 years ago.

Suddenly, the explanation comes into focus. Thousands of years ago, this genetic abnormality helped protect herders from livestock disease, which at the time was the greatest threat to their survival. However, in the modern era, this same mutation results in an overactive immune response, leading to the development of MS.

Once again, a trait that was positive in a specific environmental and historical context has become harmful in today’s world.

Evolving Healthcare: Lessons From Our Genes

Just as genetic traits can shift from beneficial to detrimental with changing circumstances, healthcare practices that were once lifesaving can become problematic as medical capabilities advance and societal needs evolve.

Fee-for-service (FFS) payments, the most prevalent reimbursement model in American healthcare, offer an example. Under FFS, insurance providers, the government or patients themselves pay doctors and hospitals for each individual service they provide, such as consultations, tests, and treatments—regardless of the value these services may or may not add.

In the 1930s, this “mutation” emerged as a solution to the Great Depression. Organizations like Blue Cross began providing health insurance, ensuring healthcare affordability for struggling Americans in need of hospitalization while guaranteeing appropriate compensation for medical providers.

FFS, which linked payments to the quantity of care delivered, proved beneficial when the problems physicians treated were acute, one-time issues (e.g., appendicitis, trauma, pneumonia) and relatively inexpensive to resolve.

Today, the widespread prevalence of chronic diseases in 6 out of 10 Americans underlines the limitations of the fee-for-service (FFS) model. In contrast to “pay for value” models, FFS, with its “pay for volume” approach, fails to prioritize preventive services, the avoidance of chronic disease complications, or the elimination of redundant treatments through coordinated, team-based care. This leads to increased healthcare costs without corresponding improvements in quality.

This situation is reminiscent of the evolutionary narrative surrounding genetic mutations like sickle cell disease and MS. These mutations, which provided protective benefits in the past, have become detrimental in the present. Similarly, healthcare systems must adapt to the evolving medical and societal landscape to better meet current needs.

Research demonstrates that it takes 17 years on average for a proven innovation in healthcare to become common practice. When it comes to evolution of healthcare delivery and financing, the pace of change is even more glacial.

In 1934, the Committee on the Cost of Medical Care (CCMC) concluded that better clinical outcomes would be achieved if doctors (a) worked in groups rather than as fragmented solo practices and (b) were paid based on the value they provided, rather than just the volume of work they did.

Nearly a century later, these improvements remain elusive. Well-led medical groups remain the minority of all practices while fee-for-service is still the dominant healthcare reimbursed method.

Things progress slowly in the biological sphere because chance is what initiates change. It takes a long time for evolution to catch up to new environments.

But change in healthcare doesn’t have to be random or painfully slow. Humans have a unique ability to anticipate challenges and proactively implement solutions. Healthcare, unlike biology, can advance rapidly in response to new medical knowledge and societal needs. We have the opportunity to leverage our knowledge, technology, and collaborative skills to address and adapt to change much faster than random genetic mutations. But it isn’t happening.

Standing in the way is a combination of fear (of the risks involved), culture (the norms doctors learn in training) and lack of leadership (the ability to translate vision into action).

Genetics teaches us that evolution ultimately triumphs. Mutations that save lives and improve health become dominant in nature over time. And when those adaptations no longer serve a useful purpose, they’re replaced.

I hope the leaders of American medicine will learn to adapt, embracing the power of collaborative medicine while replacing fee-for-service payments with capitation (a single annual payment to group of clinicians to provide the medical care for a population of patients.) If they wait too long, dinosaurs will provide them with the next set of biological lessons.

Layoffs cool as hospital margins stabilize

Layoffs are slowing at hospitals and health systems as margins gradually improve, but CFOs continue to focus on controlling costs — particularly on the labor and supply fronts — to secure the long-term sustainability of their organizations.

Last year was characterized by hospital and health systems big and small trimming their workforces due to financial and operational challenges. 

From October 2022 through December 2023, Becker’s reported on more than 100 hospitals and health systems across the country that laid off workers, eliminated positions or reduced or closed certain facilities and services to help shore up finances. 

While layoffs have been reported at some hospitals this year, workforce cuts have been occuring at a slower rate compared to last year. 

Hospital revenues are up year over year as patient volumes continue to rebound. Operating margins have fluctuated in the last 12 months, from a -1.2% low in February 2023 to 5.5% highs in June and December, according to Kaufman Hall. In January, average operating and operating EBITDA margins dropped to 5.1%.

Kaufman analysts noted that too many hospitals are losing money and high-performing hospitals doing better and better, “effectively pulling away from the pack.” 

Fitch Ratings has described 2024 as another “make or break” year for a significant portion of the nonprofit hospital sector, which continues to battle an ongoing “labordemic.” However, the U.S. has also avoided a recession so far, partly due to a robust healthcare job market, according to The Wall Street Journal.

Where some COOs, CFOs are passing the baton

Nearly a quarter of health systems are appointing new executives to lead provider compensation — a function previously headed by COOs and CFOs, according to a recent report shared with Becker’s

That stat comes from the American Association of Provider Compensation Professionals, which recently surveyed 75 U.S. health systems and medical groups to learn more about their management methods. 

Health systems have been expanding their provider networks since the late 2000s and are continuing to work toward alignment, according to the report. Previously, COOs and CFOs might have led provider compensation strategy — but the arena has grown too complex and calls for an executive presence of its own. 

As such, a number of roles specific to provider compensation have emerged, from the executive director level up to the senior vice presidency. Nearly 25% of health systems surveyed have created a new executive position to develop and lead a provider compensation department; 93% of these departments have sole responsibility for their organization’s compensation design and 84% have full control of compensation strategy, from management of fair market value to contract management. 

“The core function of this new resource, department, and team was to build and manage compensation models developed for physicians. For many organizations, this expanded to include advanced practice providers,” the report says. “Over the years, organizations have understood the role to be much more strategic than initially proposed, which is why organizations across the country have developed roles [specific to provider compensation].”

UPMC back in the red with $198M operating loss, -0.7% margin

Pittsburgh-based UPMC reported a $198 million operating loss (-0.7% margin) in 2023, down from a $162 million gain (0.6% margin) in 2022, according to financial documents published Feb. 28.

UPMC attributed the swing from operating income to loss to various factors, including increased labor and supply costs, increases in medical claims expense due to higher utilization and certain legal settlements. 

Revenue for the health system increased 8.5% year over year to $27.7 billion and expenses rose 10% to $27.9 billion. Under expenses, labor costs increased 6.4% to $9.7 billion and supply costs were up 11% to $7.4 billion.

After accounting for nonoperating items, such as investment returns, UPMC ended 2023 with a $31 million net loss, compared to a $1 billion net loss the previous year. 

As of Dec. 31, UPMC had more than $9.5 billion in cash and investments, $3.2 billion of which was held by its regulated health and captive insurance companies.

Hospital expenses per inpatient day across 50 states

Below are the adjusted expenses for nonprofit, for-profit and government hospitals per inpatient day in 2022 in every U.S. state, according to the latest estimates provided by Kaiser State Health Facts. 

The figures are based on information from the 2022 American Hospital Association Annual Survey. They are an estimate of the expenses incurred in a day of inpatient care and have been adjusted higher to reflect an estimate of outpatient service volumes, according to the Kaiser Family Foundation. 

The foundation notes the figures are “only an estimate of expenses incurred by the hospital” for one day of inpatient care and do not substitute actual charges or reimbursement for care provided.

National average 
Nonprofit hospitals: $3,167
For-profit hospitals: $2,383 
State/local government hospitals: $2,857

Alabama
Nonprofit hospitals: $1,984
For-profit hospitals: $1,723
State/local government hospitals: $1,929

Alaska 
Nonprofit hospitals: $2,130
For-profit hospitals: $3,152
State/local government hospitals: $1,905

Arizona
Nonprofit hospitals: $3,430
For-profit hospitals: $2,746
State/local government hospitals: $2,833

Arkansas
Nonprofit hospitals: $2,082
For-profit hospitals: $1,942
State/local government hospitals: $4,263

California
Nonprofit hospitals: $4,719
For-profit hospitals: $2,655
State/local government hospitals: $4,338

Colorado 
Nonprofit hospitals: $3,862
For-profit hospitals: $3,408
State/local government hospitals: $2,528

Connecticut 
Nonprofit hospitals: $3,223
For-profit hospitals: $2,584
State/local government hospitals: $5,234

Delaware
Nonprofit hospitals: $3,399
For-profit hospitals: $1,429
State/local government hospitals: n/a

District of Columbia
Nonprofit hospitals: $4,272
For-profit hospitals: $3,081
State/local government hospitals: n/a

Florida 
Nonprofit hospitals: $3,063
For-profit hospitals: $2,301
State/local government hospitals: $2,884

Georgia 
Nonprofit hospitals: $2,556
For-profit hospitals: $2,312
State/local government hospitals: $814

Hawaii
Nonprofit hospitals: $3,551
For-profit hospitals: n/a
State/local government hospitals: $1,598

Idaho
Nonprofit hospitals: $4,570
For-profit hospitals: $2,944
State/local government hospitals: $2,406

Illinois 
Nonprofit hospitals: $3,168
For-profit hospitals: $2,403
State/local government hospitals: $3,862

Indiana
Nonprofit hospitals: $3,327
For-profit hospitals: $2,865
State/local government hospitals: $2,686

Iowa
Nonprofit hospitals: $1,847
For-profit hospitals: $1,596
State/local government hospitals: $1,942

Kansas
Nonprofit hospitals: $2,287
For-profit hospitals: $2,551
State/local government hospitals: $2,314

Kentucky
Nonprofit hospitals: $2,485
For-profit hospitals: $2,637
State/local government hospitals: $3,484

Louisiana
Nonprofit hospitals: $2,788
For-profit hospitals: $2,336
State/local government hospitals: $2,345

Maine
Nonprofit hospitals: $2,944
For-profit hospitals: $1,154
State/local government hospitals: $1,082

Maryland
Nonprofit hospitals: $3,617
For-profit hospitals: $1,734
State/local government hospitals: n/a

Massachusetts
Nonprofit hospitals: $3,670
For-profit hospitals: $2,559
State/local government hospitals: $2,545

Michigan
Nonprofit hospitals: $2,546
For-profit hospitals: $2,449
State/local government hospitals: $893

Minnesota 
Nonprofit hospitals: $2,813
For-profit hospitals: n/a
State/local government hospitals: $2,273

Mississippi
Nonprofit hospitals: $1,615
For-profit hospitals: $1,753
State/local government hospitals: $1,229

Missouri
Nonprofit hospitals: $2,864
For-profit hospitals: $2298
State/local government hospitals: $2,379

Montana
Nonprofit hospitals: $2,192
For-profit hospitals: $2,708
State/local government hospitals: $750

Nebraska 
Nonprofit hospitals: $2,832
For-profit hospitals: $4,769
State/local government hospitals: $1,765

Nevada 
Nonprofit hospitals: $2,771
For-profit hospitals: $2,127
State/local government hospitals: $2,972

New Hampshire
Nonprofit hospitals: $3,030
For-profit hospitals: $2,720
State/local government hospitals: n/a

New Jersey
Nonprofit hospitals: $3,415
For-profit hospitals: $2,361
State/local government hospitals: $2,451

New Mexico 
Nonprofit hospitals: $2,973
For-profit hospitals: $2,686
State/local government hospitals: $3,710

New York 
Nonprofit hospitals: $3,721
For-profit hospitals: n/a
State/local government hospitals: $3,675

North Carolina 
Nonprofit hospitals: $2,810
For-profit hospitals: $2,391
State/local government hospitals: $2,411

North Dakota
Nonprofit hospitals: $2,308
For-profit hospitals: $4,196
State/local government hospitals: n/a

Ohio
Nonprofit hospitals: $3,402
For-profit hospitals: $2,447
State/local government hospitals: $3,761

Oklahoma
Nonprofit hospitals: $2,450
For-profit hospitals: $2,580
State/local government hospitals: $1,964

Oregon
Nonprofit hospitals: $3,827
For-profit hospitals: $3,368
State/local government hospitals: $5,155

Pennsylvania 
Nonprofit hospitals: $3,045
For-profit hospitals: $2,251
State/local government hospitals: $1,609

Rhode Island 
Nonprofit hospitals: $3,102
For-profit hospitals: n/a
State/local government hospitals: n/a

South Carolina 
Nonprofit hospitals: $2,430
For-profit hospitals: $1,874
State/local government hospitals: $2,598

South Dakota 
Nonprofit hospitals: $1,673
For-profit hospitals: $4,275
State/local government hospitals: $780

Tennessee
Nonprofit hospitals: $2,960
For-profit hospitals: $2,133
State/local government hospitals: $2,019

Texas
Nonprofit hospitals: $3,291
For-profit hospitals: $2,325
State/local government hospitals: $3,768

Utah
Nonprofit hospitals: $3,550
For-profit hospitals: $3,232
State/local government hospitals: $3,542

Vermont
Nonprofit hospitals: $3,079
For-profit hospitals: n/a
State/local government hospitals: n/a

Virginia
Nonprofit hospitals: $2,813
For-profit hospitals: $2,194
State/local government hospitals: $4,208

Washington
Nonprofit hospitals: $3,753
For-profit hospitals: $3,696
State/local government hospitals: $4,079

West Virginia
Nonprofit hospitals: $2,447
For-profit hospitals: $1,206
State/local government hospitals: $1,500

Wisconsin 
Nonprofit hospitals: $2,796
For-profit hospitals: $3,055
State/local government hospitals: $3,641

Wyoming 
Nonprofit hospitals: $3,092
For-profit hospitals: $3,133
State/local government hospitals: $1,485

Sutter Health Oakland hospital could close by 2030

Oakland, Calif.-based Alta Bates Summit Medical Center, part of Sacramento, Calif.-based Sutter Health, could close by 2030.

“This closure would strain healthcare access in Berkely and send shockwaves across the region,” Jesse Arreguin, mayor of Berkeley, Calif., said in a Feb. 27 news release shared with Becker’s. “The impacts to EMS response times and service cuts for our most voluerable communities are simply unaccebtable.”

Amid the fear of closure, a spokesperson for Sutter Health told Becker’s in a statement that the health system is developing a comprehensive plan to meet the needs of the community.

This includes thoroughly evaluating how our patients use our services, including outpatient clinics, specialty care, hospital care, and emergency services, with a focus on identifying and addressing unmet community needs,” the spokesperson said. “It’s a major undertaking that has taken longer than anticipated; however, it’s important to emphasize that no final decisions have been made.”

The Berkeley City Council voted on Feb. 27 to allocate $300,000 from the Berkeley General Fund to help explore current or potential opportunities to secure future healthcare and hospital access for the community. 

“We cannot underestimate the repercussions of losing such a critical healthcare resource,” Sophie Hahn, a Berkeley City Council member, said in the release. “Beyond undermining our healthcare system, this closure would result in a profound loss of local jobs and impacts to our economy.”

Company behind Joe Namath Medicare Advantage ads has long rap sheet of misconduct

https://wendellpotter.substack.com/p/company-behind-namath-ads-has-long

Former New York Jets superstar Joe Namath can be seen every year during Medicare open enrollment hocking plans that tell seniors how great their life would be if only they signed up for a Medicare Advantage plan. From October 15 to December 7 last year alone, Joe Namath ads ran 3,670 times, according to iSpot, which tracks TV advertising.

But the company behind those ads, now called Blue Lantern Health, and their products, HealthInsurance.com and the Medicare Coverage Helpline, have an expansive rap sheet of misconduct, including prosecutions by the Securities and Exchange Commission and the Federal Trade Commission, and a recent bankruptcy filing that critics say is designed to jettison the substantial legal liabilities the firm has incurred. In September 2023, the company became Blue Lantern; before that, it was called Benefytt; and before that, Health Insurance Innovations. Forty-three state attorneys general had settled with the company in 2018, with it paying a $3.4 million fine. A close associate of the company, Steven Dorfman, has also been prosecuted by the FTC, in addition to the Department of Justice

Namath himself has a bit of a checkered past when it comes to his business associates—in the early 1970s, he co-owned a bar frequented by members of the Colombo and Lucchese crime families, according to reporting at the time cited in a 2004 biography.  Due to the controversy surrounding the bar, Namath was forced by the NFL Commissioner to sell his interest in it. Last year, it was revealed that Namath had employed a prolific pedophile coach at his football camp, also in the 1970s, and the 80-year-old ex-quarterback is now being sued by one of the coach’s victims. 

The Namath ads are the main illustration of the behemoth Medicare Advantage marketing industry, which is designed to herd seniors into Medicare Advantage plans that restrict the doctors and hospitals that seniors can go to and the procedures they can access through the onerous “prior authorization” process, and it costs the federal government as much as $140 billion annually compared to traditional Medicare. Over half of seniors—nearly 31 million people—are now in Medicare Advantage, and there is little understanding of the drawbacks of the program. Seniors are aware that they may receive modest gym or food benefits but typically do not realize that they may be giving up their doctors, their specialists, their outpatient clinics, and their hospitals in favor of an in-network alternative that may be lower quality and farther away.

How so many seniors are lured into Medicare Advantage

Blue Lantern—with its powerful private equity owner Madison Dearborn—may be the key to understanding how so many people have been ushered into Medicare Advantage—and the pitfalls that private equity’s rapid entrance into health care can create for ordinary Americans.

While Blue Lantern is just one company, it is a Rosetta Stone for everything that is wrong with American health care today—fraud, profiteering, lawbreaking, no regard for patient care—where only the public comes out the loser. 

Blue Lantern uses TV ads and, at least until regulators began poking around, a widespread telemarketing operation, being one of the main firms charged with generating “leads” that are then sold to brokers and insurers, as Medicare Advantage plans are banned from cold-calling. Court filings reviewed by HEALTH CARE Un-Covered allege that after legal discovery, Blue Lantern (then known as Benefytt) at minimum dialed seniors over 17 million times, potentially in violation of federal law that requires telemarketers to properly identify themselves and who they are working for—ultimately, in this case, insurers that generate huge profits from Medicare Advantage.

The Namath ads have been running since 2018 when the company was named Health Insurance Innovations—the same year the FTC began prosecuting Simple Health Plans, along with its then-CEO Steven Dorfman. The Fort Lauderdale Sun-Sentinel identified Health Insurance Innovations as a “successor” to Simple Health Plans. After five years of likely exceptionally costly litigation, for which Dorfman is represented by jet-set law firm DLA Piper, on February 9, the FTC won a $195 million judgment against Simple Health Plans and Dorfman. The FTC alleged in 2019 that Dorfman had lied to the court when he said that he did not control any offshore accounts. The FTC found $20 million, but the real number is probably higher. 

Friends in high places 

In February 2020, Trump’s Secretary of Health and Human Services, Alex Azar, said that the Namath ads might not “look or sound like the future of health care,” but that they represented “real savings, real options” for older Americans. 

In March 2020, Health Insurance Innovations (HII) changed its name to Benefytt, and in August 2020, it was acquired by Madison Dearborn Partners. Madison Dearborn has close ties to the Illinois Democratic elite, pumping over $916,000 into U.S. Ambassador to Japan Rahm Emanuel’s campaigns for Congress and mayor of Chicago.

In September 2021, HII settled a $27.5 million class action lawsuit. The 230,000 victims received an average payout of just $80.  

In July 2022, the SEC charged HII/Benefytt and its then-CEO Gavin Southwell with making fraudulent representations to investors about the quality of the health plans it was marketing. “HII and Southwell…told investors in earnings calls and investor presentations that HII’s consumer satisfaction was 99.99 percent and state insurance regulators received very few consumer complaints regarding HII. In reality, HII tracked tens of thousands of dissatisfied consumers who complained that HII’s distributors made misrepresentations to sell the health insurance products, charged consumers for products they did not authorize and failed to cancel plans upon consumers’ requests,” the SEC found, with HII/Benefytt and Southwell ultimately paying a $12 million settlement in November 2022. 

By August 2022, Benefytt had paid $100 million to settle allegations that it had fraudulently directed people into “sham” health care plans. “Benefytt pocketed millions selling sham insurance to seniors and other consumers looking for health coverage,” the FTC’s Director of Consumer Protection, Samuel Levine, said at the time. 

Bankruptcy and another name change

In May 2023, Benefytt declared Chapter 11 bankruptcy—where the company seeks to continue to exist as a going concern, as opposed to Chapter 9, when the company is stripped apart for creditors—in the Southern District of Texas. The plan of bankruptcy was approved in August. The Southern Texas Bankruptcy Court has been mired in controversy in recent months as one of the two judges was revealed to be in a romantic relationship with a woman employed by a firm, Jackson Walker, that worked in concert with the major Chicago law firm Kirkland and Ellis to move bankruptcy cases to Southern Texas and monopolize them under a friendly court. While the other judge on the two-judge panel handled the Benefytt case, Jackson Walker and Kirkland and Ellis were retained by Benefytt, and the fees paid to Jackson Walker by Benefytt were delayed by the court as a result of the controversy.

In September 2023, Benefytt exited bankruptcy and became Blue Lantern

The August approval of the bankruptcy plan was vocally opposed by a group of creditors who had sued Benefytt over violations of the Telephone Consumer Privacy Act (TCPA). The creditors asserted that Benefytt had substantial liabilities, with millions of calls made where Benefytt did not identify the ultimate seller—Medicare Advantage plans run by UnitedHealth, Humana, and other firms prohibited from directly contacting people they have no relationship with—and violations fined at $1,500 per willful violation. 

Attorneys for those creditors stated in a filing reviewed by HEALTH CARE Un-Covered that Madison Dearborn always planned “to steer Benefytt into bankruptcy,” if they were unable to resolve the substantial liabilities they owed under the TCPA. 

Madison Dearborn “knew that Benefytt’s TCPA liabilities exceeded its value, but purchased Benefytt anyway, for the purpose of trying to quickly extract as much money and value as they could before those liabilities became due,”

the August 25, 2023, filing stated on behalf of Wes Newman, Mary Bilek, George Moore, and Robert Hossfeld, all plaintiffs in proposed TCPA class action suits. The filing went on to say that the bankruptcy was inevitable “if—after siphoning off any benefit from the illegal telemarketing alleged herein—[Madison Dearborn] could not obtain favorable settlements or dismissals for the telemarketing-related lawsuits against Benefytt.”

Under the bankruptcy plan, Blue Lantern/Benefytt is released from the TCPA claims, but individuals harmed can affirmatively opt-out of the release, which is why the bankruptcy court justified its approval. Over 7 million people—the total numbers in Benefytt’s database, according to the plaintiffs—opting out of the third-party release is an enormous administrative hurdle for plaintiffs’ lawyers to pass, massively limiting the likelihood of success of any class-action litigation against Blue Lantern going forward. 

Their attorney, Alex Burke, stated in court that “[t]his bankruptcy is an intentional and preplanned continuation of a fraud.” His statement was before 3,670 more Namath ads ran during 2023 open enrollment. 

In response to requests for comment from HEALTH CARE un-covered, the Centers for Medicare and Medicaid Services did not answer questions about Benefytt and why the company was simply not barred from the Medicare Advantage market altogether. 

Corporations have used the bankruptcy process in recent years to free themselves from criminal and civil liability, with opioid marketer Purdue Pharma being the most prominent recent example. The Supreme Court is reviewing the legality of Purdue’s third-party releases currently, with a decision expected in late spring.

The role that private equity plays in keeping Benefytt going cannot be overstated.

Without Madison Dearborn or another private equity firm eager to take on such a risky business with such a long history of legal imbroglios, it is almost certain that Benefytt would no longer exist—and the Joe Namath ads would disappear from our televisions. Instead, Madison Dearborn keeps them going, suckering seniors into Medicare Advantage plans. 

This is part and parcel of the ongoing colonization by private equity into America’s health care system. Private equity is making a major play into Medicare Advantage.

It has pumped billions of dollars into purchasing hospitals. It has invested in hospice care. It is gobbling up doctors’ groups. It is acquiring ambulance companies. It is hoovering up nurse staffing firms. It is making huge investments into health tech. It is in nursing homes. And it is in health insurance. Nothing about America’s health care system is untouched by private equity.

That’s a problem, experts say.

“I’ve been screaming at the TV every time Joe Namath gets on—it is not an official Medicare website,” said Laura Katz Olson, a professor of political science at Lehigh University who has written on private equity’s role in the health care system.

“Private equity has so much money to deploy, which is far more than they have opportunities to buy. As such, they are desperately looking for opportunities to invest. There’s a lot of money in Medicare Advantage—it’s guaranteed money from the federal government, which makes it perfect for the private equity playbook.”

Eileen Appelbaum, the co-director at the Center for Economic and Policy Research, who has also studied private equity’s role in health care, concurred that private equity was a perfect fit for Medicare marketing organizations.

“I think basically the whole privatized Medicare situation is ready for all kinds of exploitation and misrepresentations and denying people the coverage that they need,” she said. “My email is inundated with these totally misleading ads. Private equity  took a look at this and said, “look at that, it’s possible to do something that’s misleading and make a lot of money.”

Madison Dearborn receives a large portion of its capital from public pension funds like the California Public Employees Retirement System (CalPERS) and the Washington State Investment Fund—people who are dependent on Medicare. Appelbaum said that the pension funds exercise little oversight over their investments in private equity. “Pension funds may have the name of the company that they are invested in, they’re told that it’s ‘part of our health care investment portfolio,’ but they don’t find out what they really do until there’s a scandal.

It is amazing that pension funds give so much money to private equity with so little information about how their money is being spent.”