At the Delaware Nationwide Guard facility named for his late son, a somber President Biden on Friday urged veterans to consider advantage of new overall health care options under laws he signed in August.
The law, known as the PACT Act, allows veterans get screened for publicity to poisons. Those people consist of Agent Orange, which was utilised for deforestation throughout the Vietnam War, and burn off pits, in which trash was wrecked on army bases in Iraq and Afghanistan.
TOPSHOT – US President Joe Biden speaks with Ray Firmani, a 101-calendar year-old Planet War II veteran, throughout a city corridor with veterans and veteran survivors in New Castle, Delaware, on December 16, 2022.
JIM WATSON/AFP through Getty Visuals
“There is certainly no technology in American background a lot more than this previous technology that have been deployed a lot more, that have offered much more than the technology represented by the people today we are gonna be on the lookout at and honoring these days,” the president said of veterans who served in the Middle East. “No one has been in a condition in which they present up for just one deployment, then two and a few and four and sometimes five and 6.”
The administration has been internet hosting scores of functions around the region to draw focus to the new rewards. Much more than 730,000 veterans have currently received screenings, in accordance to the White Household.
Veterans Affairs Secretary Denis Richard McDonough on Friday mentioned they will “not rest until each individual single veteran and survivor appreciates about this new law, realize what it means for them, and get the care and advantages they acquired.”
Beau Biden, the president’s elder son, served as a significant in the Delaware Nationwide Guard. He died of mind cancer in 2015, and the president has recommended that publicity to melt away pits on his base in Iraq may well have been the induce. The president noted that a number of company members who served with his son have been existing Friday.
“This is personalized to them, and it can be particular to all of us,” Mr. Biden said Friday. “It’s not distinctive to me and my relatives.”
Though the president is just not certain burn up pits prompted his son’s brain cancer, in his 2022 State of the Union tackle, the president pledged to “locate out all the things we can” and to defend veterans suffering illnesses linked to their support.
The legislation, the Honoring our Promise to Handle Detailed Toxics Act (PACT Act), was handed by Congress immediately after decades of advocacy by veterans. Prior to the regulation, about 3-quarters of disability claims involving burn up pit publicity were being denied by the governing administration.
“Ultimately, Congress did the proper thing,” claimed Delaware’s Democratic Sen. Tom Carper, the only current member of the Senate who served in Vietnam, all through Friday’s function.
The president claimed he “built it genuine apparent to the United States Congress that if they did not move this damn bill, I was likely to go on a holy war. “
In addition to the screenings, the law directs the Section of Veterans Affairs to believe that some respiratory ailments and cancers are linked to burn pits. This allows veterans to acquire incapacity advantages without having needing to demonstrate immediate causation.
The president urged all veterans of recent wars to visit VA.gov/PACT to get screened.
In January, the Veterans Affairs Office will get started processing all benefits promises linked to the PACT Act. The VA has by now began processing statements from terminally ill veterans and has said it will expedite processing claims submitted by veterans with cancer so they can receive treatment and benefits immediately.
Because the legislation expands eligibility to an approximated 3.5 million much more veterans, the VA has employed additional than 2,000 staff members to help administer benefits and ideas to use more in the coming months.
“Now as much more veterans and survivors apply for their PACT Act rewards, we do anticipate an improve to the inventory and the backlog in the short time period,” Joshua Jacobs, a senior official from the VA, told members of Congress in the course of testimony on Capitol Hill this month.
Beau Biden died as a end result of his most cancers in Might 2015. Sunday also marks the 50th anniversary of the demise of the president’s 1st wife, Neilia, and their youthful daughter, Naomi, who had been killed in a car accident in 1972.
Dr. Eckart Rolshoven examines a patient at his clinic in Püttlingen, a small town in Germany’s Saarland region. Although Germany has a largely private health care system, patients pay nothing out-of-pocket when they come to see him.
Pasquale D’Angiolillo for KHN
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Pasquale D’Angiolillo for KHN
Dr. Eckart Rolshoven examines a patient at his clinic in Püttlingen, a small town in Germany’s Saarland region. Although Germany has a largely private health care system, patients pay nothing out-of-pocket when they come to see him.
Pasquale D’Angiolillo for KHN
PÜTTLINGEN, Germany — Almost every day, Dr. Eckart Rolshoven sees the long shadow of coal mining in his clinic near the big brownstone church that dominates this small town in Germany’s Saarland.
The region’s last-operating coal shaft, just a few miles away, closed a decade ago, ending centuries of mining in the Saarland, a mostly rural state tucked between the Rhine River and the French border. But the mines left a difficult legacy, as they have in coal regions in the United States, including West Virginia.
Many of Rolshoven’s patients battle lung diseases and chronic pain from years of work underground. “We had an industry with a lot of illnesses,” said Rolshoven, a genial primary care physician who at 71 is nearing the end of a long career.
The Saarland’s residents are sicker than elsewhere in Germany. And like West Virginia, the region faces economic hurdles. For decades, German politicians, business leaders and unions have labored to adjust to the mining industry’s slow demise.
But this is a healthier place than West Virginia in many respects. The region’s residents are less likely to die prematurely, data shows. And on average, they live four years longer than West Virginians.
There is another important difference between this former coal territory and its Appalachian counterpart: West Virginia’s economic struggles have been compounded by medical debt, a burden that affects about 100 million people in the U.S. — in no state more than West Virginia.
In the Saarland, medical debt is practically nonexistent. It’s so rare in Germany that the federal government’s statistical office doesn’t even track it.
The reason isn’t government health care. Germany, like the U.S., has a largely private health care system that relies on private doctors and private insurers. Like Americans, many Germans enroll in a health plan through work, splitting the cost with their employer.
But Germany has long done something the U.S. does not: It strictly limits how much patients have to pay out of their own pockets for a trip to the doctor, the hospital or the pharmacy.
Rolshoven’s patients pay nothing when they see him. That not only bolsters their health, he said. It helps maintain what Rolshoven called social peace. “It’s really important not to have to worry about these problems,” he said.
German health officials, business leaders and economists say the access to affordable health care has also helped the Saarland get back on its feet economically, bolstered by the assurance that workers could get to the doctor.
“Without this, the Saarland would be dead,” said Beatrice Zeiger, managing director of the Arbeitskammer des Saarlandes, a regional labor group. “It’s unthinkable.”
While health costs rise in the U.S., Germany contains them
In West Virginia, whose wooded valleys and decaying industrial plants could be mistaken for the Saarland’s, access to health coverage has been important as the state weathered the decline of its mines.
A decade ago, state leaders moved to expand the Medicaid insurance program through the Affordable Care Act. And as of last year, just 6{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of state residents were uninsured, less than half the rate before the 2010 law.
But growing numbers of West Virginians without government insurance are in private health plans with deductibles that require they pay thousands of dollars out of their own pockets before coverage kicks in.
The typical individual health plan an American gets through work now comes with a more than $1,500 deductible, a particularly big sum in a state like West Virginia where residents often earn less than residents of other states.
That, in turn, is driving medical debt. A quarter of West Virginians with a credit report have medical bills in collections, almost twice the national rate, according to data compiled by the nonprofit Urban Institute. In several counties in the state, the rate is about a third.
And those figures likely understate the problem. Many more people put medical bills on their credit cards, borrow from family or enroll in installment plans with a hospital or other providers to pay off their bills.
“It’s a huge problem here,” said Jessica Ice, executive director of West Virginians for Affordable Health Care. “Folks with medical debt aren’t able to apply for loans to start a business or buy a starter home for their family. It’s really preventing people from climbing up the economic ladder.”
In German health plans, known as sickness funds, there aren’t typically deductibles.
Physician visits are almost always free for patients. Copays for most prescription drugs are capped at 10 euros or less, about $10. And people admitted to the hospital pay only 10 euros a day.
“Access to medical care with minimal costs for patients has been essential,” said Armin Beck, regional director of the Knappschaft Bahn See, of KBS, a health insurance plan whose roots stretch back to the 13th century, when miners set up a mutual aid society to protect one another in case of injuries or accidents. “This has been a foundation of our community,” Beck said.
‘So glad we don’t have to worry’
Along the Saar River in Germany, rusting steelworks and shuttered coal-fired power plants bear testament to the region’s economic struggles. Many towns like Püttlingen carry on in the shadow of hulking mounds of debris — Berghalde, as they are called — the detritus left behind as coal was separated from the rocky earth hauled up from underground.
The now-shuttered Bergwerk Saar coal mine in Germany’s Saarland closed in 2012, ending centuries of mining in the region. Coal from the Saarland helped fuel Germany’s industrialization and once employed tens of thousands of workers.
Pasquale D’Angiolillo for KHN
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Pasquale D’Angiolillo for KHN
The now-shuttered Bergwerk Saar coal mine in Germany’s Saarland closed in 2012, ending centuries of mining in the region. Coal from the Saarland helped fuel Germany’s industrialization and once employed tens of thousands of workers.
Pasquale D’Angiolillo for KHN
Today, new challenges confront the region. Ford, which has operated a car factory here for decades, plans to shutter the plant in a few years and move production to Spain.
But at Rolshoven’s clinic — a small set of offices tucked into a residential neighborhood — few patients can conceive of the burdens that medical bills put on Americans.
Andrea Fecht, 63, who has diabetes and came to see Rolshoven because recent tests revealed a concerning rise in her blood sugar, estimated she pays 120 euros a year, or about $125, to fill all six of her prescriptions, including her daily insulin.
In the U.S., the average price for insulin alone is nine times that in Germany, according to a recent report from Rand Corp., a research group.
Andreas Mang, a former miner who left the industry 20 years ago after a series of accidents, would likely pay even more out-of-pocket for his family’s drugs. Mang’s wife recently underwent a course of chemotherapy that would cost thousands of dollars if not for Germany’s limits on medical bills, Rolshoven said.
“I can’t imagine what it would be like not to have this support,” Mang said.
Christine Wagner said she’s had a glimpse of what Americans face. Wagner’s 18-year-old son, Jonas, has Down syndrome and has required more than 20 surgeries.
In global Facebook groups with other parents who have children with disabilities, Wagner said she’s amazed to see how much fundraising American parents do to pay family medical bills. “I’m so glad we don’t have to worry about that,” she said. “We have enough to do looking after Jonas.”
Countries where health care is actually affordable
International surveys underscore the difference Wagner observed between her experiences and those of American families.
In one recent study of health care in 11 high-income countries, the nonprofit Commonwealth Fund found that 44{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of Americans had out-of-pocket medical expenses that topped $1,000 in the previous year. Just 16{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of Germans reported paying that much. The rates were even lower in France, at 10{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f}, and Great Britain, where only 7{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} reported similar medical expenses.
U.S. patients were also more than twice as likely as patients in any of the 10 other countries studied to say they had serious problems paying medical bills.
“Many Americans may not understand how affordable health care is for patients in other countries,” said Reginald D. Williams II, who oversees international research at the Commonwealth Fund. “Medical debt is a largely U.S. phenomenon. It just doesn’t happen in other countries.”
Most wealthy countries in Western Europe, East Asia and elsewhere limit patients’ out-of-pocket costs.
In the Netherlands, where patients enroll in private health plans as they do in Germany, insurers typically cover all medical expenses after patients pay a standard deductible of 385 euros, or about $400. Physician visits are fully covered.
In Great Britain, where medical care that is “free at the point of service” has been a foundation of that country’s government-run National Health Service for almost 75 years, there are rarely any doctor or hospital bills.
When the government asked Britons who’d gone into debt about the causes, just 2{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} cited paying for medical treatment. A similar share attributed their debt to gambling or another habit.
In the U.S., 41{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of adults currently have debt from medical or dental bills, according to a KFF poll.
How Germany regulates hospital, doctor and drug prices
Germany’s strict limits on medical bills have periodically stoked concerns about patients overusing the health system.
But when health plans tried implementing a copay of 10 euros for physician visits, it was quickly rolled back amid criticism from patients and frustration among doctors, who didn’t like chasing after their patients for bills.
Germany’s limits on how much patients pay out-of-pocket at the doctor’s office have been critical to ensuring people get needed care, especially in a mining region where many battle lung diseases and chronic pain, says Dr. Eckart Rolshoven. “We had an industry with a lot of illnesses,” he says.
Pasquale D’Angiolillo for KHN
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Pasquale D’Angiolillo for KHN
Germany’s limits on how much patients pay out-of-pocket at the doctor’s office have been critical to ensuring people get needed care, especially in a mining region where many battle lung diseases and chronic pain, says Dr. Eckart Rolshoven. “We had an industry with a lot of illnesses,” he says.
Pasquale D’Angiolillo for KHN
At the hospital in Püttlingen, which is operated by the Knappschaft, Dr. Marion Bolte said asking patients to pay more isn’t worth the risk, even if it might bring in more money.
“It’s better to have 20 unnecessary visits than to have one patient get harmed because they didn’t come to the hospital because they were worried about how much it would cost,” said Bolte, the chief medical officer. “We don’t want patients to worry about money. We want them to worry about getting better.”
Nationally, German patients are less likely than Americans to die from conditions that can be treated with good access to medical care, such as heart attacks, diabetes, pneumonia and some cancers, according to regional data compiled by the Paris-based Organization for Economic Cooperation and Development.
Germans are also less likely than Americans to say they had to wait to see a doctor, surveys show.
Lower-cost health care that protects workers from going into debt has meant fewer concerns for the Saarland’s policymakers, as well. “All that our predecessors had to worry about was creating jobs,” said Oliver Groll, a senior official at IHK Saarland, the regional chamber of commerce. “Health care took care of itself.”
As mining jobs disappeared, the Saarland shifted toward other industries, such as auto manufacturing, which has been a major employer since Ford opened its factory in 1970, sparking the development of a robust auto parts sector. The chamber and other business leaders are now working to lure technology and pharmaceutical jobs to the region.
For Mang, the former miner whose wife had cancer, knowing that medical bills wouldn’t drive him into debt helped give him the peace of mind to switch careers. “I never had to think about how much health care would cost me,” said Mang, who is now a nurse.
Maintaining this system has required that Germany do something else that U.S. policymakers have historically eschewed. Germany, like most wealthy nations, regulates the prices that hospitals, doctors and drugmakers can charge. This regulation occurs through a highly structured system in which insurers negotiate collectively with physician and hospital groups to set prices.
American hospitals and other medical providers for decades have fiercely resisted limits on their prices, spending millions to fight government regulation.
Price regulation can put more financial pressure on providers, who, unlike their American counterparts, can’t just demand higher prices from insurers to bolster their bottom lines.
Mario Schüller, the hospital administrator who runs the Knappschaft hospital in Püttlingen, said hospitals must instead compete to attract patients with better care and better customer service. Those that can’t compete may close, he said.
But Schüller said he wouldn’t want to charge patients more, even if he could.
“If I had to bill patients and then try to collect from them, I’d have to pay for all that,” he said. “We’d need new staff, who would have to get paid. And if we used collections companies, they’d have to be paid, too. It becomes a devil’s bargain.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
I can vaguely recall how it felt to be my 21-calendar year-previous, energetic, large-eyed self the 12 months I started graduate faculty. I was commencing a doctoral program targeted on overall health and developmental psychology and I was heading to modify the globe. I was guaranteed that I could do investigation that would ultimately enable teens to adopt healthier behaviors if they just understood far better.
(Anastasia Pelikh/iStockphoto)
Due to the fact most of you looking through this are almost certainly more mature than 21, you have gathered sufficient lifestyle knowledge to discover my previous naïveté laughable. In my protection, I did increase up in the midst of the “Just Say No” and “Just Do It” strategies. I knowledgeable a childhood complete of oversimplified adult voices. Why would not I assume that it is merely as quick as telling individuals what they require to do to be healthy? Once you know, you know. Ideal?
Creating Healthy Food items Choices
A handful of decades later I recognize that this understanding-deficit strategy to science interaction – just deliver information so persons can make the “right choice” – is deeply flawed. Of course, sharing information is critical to maximize comprehending about challenges that persons really don’t at present have an understanding of. On the other hand, the know-how-deficit viewpoint assumes that folks really do not have whichever knowledge they (supposedly) don’t have in the initially position.
What does this have to do with food items labels? The Foods and Drug Administration has just lately explained new requirements for identifying no matter if or not a food can be labeled wholesome. These criteria have not been revised because 1994, so they’re overdue for thing to consider. The labeling scheme would enable all fruits and veggies to be labeled healthier. No. They are not all at present labeled wholesome.
So that’s … development? It also assumes that most folks really don’t by now know that fruits and vegetables are balanced. Hmmm.
The new Food and drug administration labeling plan also necessitates limits on sugar, sodium and saturated fats ahead of a box or offer of anything at all can be labeled healthful. Foods must incorporate enough of a food items group (if not fruits and veggies than grains, protein or dairy) to wear the new label. The Food and drug administration claims the conclusion-target is “to show that a food’s degree of nutrients may aid people retain healthful dietary procedures by helping them realize a whole diet program that conforms to dietary suggestions.”
In other terms, labeling foodstuff – pretty much, often with stickers and brightly colored imagery – is intended to guideline shoppers towards creating “the suitable decision.” But it turns out that foodstuff and drugs are not similar whilst just expressing no to medications is generally a good idea, foodstuff is a each day requirement. And food is not only required but complicated. Realizing that some food items are nutrient dense or “nutritious” does not automatically guide us to decide on these food items.
A current analyze that reviewed earlier investigation on entrance-of-package labels on food items will make this very clear. The analyze authors located that labels have a quite modest impact on shoppers’ purchases. They could direct persons to grab much more nutrient-dense food items occasionally, but reasonably hardly ever.
A further study suggests that this could be for the reason that food stuff labels in basic are not often effortlessly recognized by people. What specifically is a portion? What does “low-fat” mean? How is a consumer’s cultural context related to these determinations? Occasionally labels elevate a lot more thoughts than solutions.
What Helps make Foodstuff Healthful?
Alli Spotts-De Lazzer, a therapist who treats clients with consuming and overall body image worries, talked with me about the new labeling plan and prompt that “for those people who experience a absence of fresh new, available, affordable foodstuff, the ‘healthy’ labels could assistance notify their possibilities. For example, if two merchandise are on the shelf and equally priced, a ‘healthy’ label could quite possibly support a parent decide on the seemingly healthier, more nutrient-dense choice for their family members. Regretably, on the other hand, ‘healthy’ labels may also lead to disordered eating, orthorexia and eating conditions among the some.”’
I would not go as far as to say that the provision of nutritional information and facts should be abandoned all collectively. I come across it valuable at periods to use nutritional information and facts as a tough information in earning conclusions about food buys. Even so, maybe labeling food items as “healthy” or, by default, “not healthy” is oversimplifying issues a little bit way too substantially? Under no circumstances head, that most individuals can make these wide assessments on their have, without having a label. It is not a deficiency of expertise that’s foremost folks to decide the fries about the aspect salad, it is for the reason that the fries taste far better!
A Healthier Connection With Foodstuff
Oona Hanson, an educator and mum or dad mentor specializing in ingesting disorder recognition, avoidance and recovery implies “there is so substantially about food that could in no way be entirely captured on a diet label – specifically something as oversimplified as ‘healthy’ and ‘unhealthy.’ Creating a healthier romantic relationship with food stuff is what we ought to be advertising in our public overall health messages rigid principles and labels actually interfere with that course of action.”
Open the website of Workit Health, and the path to treatment starts with a simple intake form: Are you in danger of harming yourself or others? If not, what’s your current opioid and alcohol use? How much methadone do you use?
Within minutes, patients looking for online treatment for opioid use and other addictions can complete the assessment and book a video visit with a provider licensed to prescribe suboxone and other drugs.
But what patients probably don’t know is that Workit was sending their delicate, even intimate, answers about drug use and self-harm to Facebook.
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A joint investigation by STAT and The Markup of 50 direct-to-consumer telehealth companies like Workit found that quick, online access to medications often comes with a hidden cost for patients: Virtual care websites were leaking sensitive medical information they collect to the world’s largest advertising platforms.
On 13 of the 50 websites, STAT and The Markup documented at least one tracker — from Meta, Google, TikTok, Bing, Snap, Twitter, LinkedIn, or Pinterest — that collected patients’ answers to medical intake questions. Trackers on 25 sites, including those run by industry leaders Hims & Hers, Ro, and Thirty Madison, told at least one big tech platform that the user had added an item like a prescription medication to their cart, or checked out with a subscription for a treatment plan.
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The trackers that STAT and The Markup were able to detect, and what information they sent, is a floor, not a ceiling. Companies choose where to install trackers on their websites and how to configure them. Different pages of a company’s website can have different trackers, and this analysis did not test every page on each company’s site.
All but one website examined sent URLs users visited on the site and their IP addresses — akin to a mailing address for a computer, which can be used to link information to a specific patient or household — to at least one tech company. The only telehealth platform that the analysis did not find sharing data with outside tech giants was Amazon Clinic, a platform recently launched by Amazon.
Health privacy experts and former regulators said sharing such sensitive medical information with the world’s largest advertising platforms threatens patient privacy and trust and could run afoul of unfair business practices laws. They also emphasized that privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA) were not built for telehealth. That leaves “ethical and moral gray areas” that allow for the legal sharing of health-related data, said Andrew Mahler, a former investigator at the U.S. Department of Health and Human Services’ Office for Civil Rights.
“I thought I was at this point hard to shock,” said Ari Friedman, an emergency medicine physician at the University of Pennsylvania who researches digital health privacy. “And I find this particularly shocking.”
In October and November, STAT and The Markup signed up for accounts and completed onboarding forms on 50 telehealth sites using a fictional identity with dummy email and social media accounts. To determine what data was being shared by the telehealth sites as users completed their forms, reporters examined the network traffic between trackers using Chrome DevTools, a tool built into Google’s Chrome browser.
On Workit’s site, for example, STAT and The Markup found that a piece of code Meta calls a pixel sent responses about self-harm, drug and alcohol use, and personal information — including first name, email address, and phone number — to Facebook.
The investigation found trackers collecting information on websites that sell everything from addiction treatments and antidepressants to pills for weight loss and migraines. Despite efforts to trace the data using the tech companies’ own transparency tools, STAT and The Markup couldn’t independently confirm how or whether Meta and the other tech companies used the data they collected.
After STAT and The Markup shared detailed findings with all 50 companies, Workit said it had changed its use of trackers. When reporters tested the website again on Dec. 7, they found no evidence of tech platform trackers during the company’s intake or checkout process.
“Workit Health takes the privacy of our members seriously,” Kali Lux, a spokesperson for the company, wrote in an email. “Out of an abundance of caution, we elected to adjust the usage of a number of pixels for now as we continue to evaluate the issue.”
“Advertisers should not send sensitive information about people through our Business Tools,” Dale Hogan, a spokesperson for Meta, wrote in an email.
Patients may assume that health-related data is always protected by privacy regulations including HIPAA. Workit, for one, begins its intake form with a promise that “all of the information you share is kept private and is protected by our HIPAA-compliant software.”
“The very reason why people pursue some of these services online is that they’re seeking privacy,” said David Grande, a digital health privacy researcher at the University of Pennsylvania.
But the reality online is more complex, making it all but impossible for the average user to know whether the company they’re entrusting with their data is obligated to protect it. “Individually, we have a sense that this information should be protected,” said Mahler, who is now vice president of privacy and compliance at CynergisTek, a health care risk auditing company. “But then from a legal and a regulatory perspective, you have organizations saying … technically, we don’t have to.”
Rather than providing care themselves, telehealth companies often act as middlemen connecting patients to affiliated providers covered by HIPAA. As a result, information collected during a telehealth company’s intake may not be protected by HIPAA, while the same information given to the provider would be.
“All the privacy risks are there, with the mistaken but entirely reasonable illusion of security,” said Matthew McCoy, a medical ethics and health policy researcher at the University of Pennsylvania. “That’s a really dangerous combination of things to force the average consumer to deal with.”
In response to questions for this story, representatives of Meta, Google, TikTok, Bing, Snap, and Pinterest said advertisers are responsible for ensuring they aren’t sending sensitive information via the tools. Twitter did not respond to requests for comment.
“Doing so is against our policies and we educate advertisers on properly setting up Business tools to prevent this from occurring,” wrote Meta’s Hogan. “Our system is designed to filter out potentially sensitive data it is able to detect.”
LinkedIn’s tracker “collects URL information which we immediately encrypt when it reaches our servers, delete within 7 days and do not add to a profile,” Leonna Spilman, a spokesperson for the company, wrote in an email.
Nevertheless, three of the seven big tech companies also said they had taken action to investigate or stop the data sharing.
Google is “currently investigating the accounts” in question, spokesperson Elijah Lawal wrote in an email.
“In response to this new information, we have paused data collection from these advertisers’ sites while we investigate,” Snap spokesperson Peter Boogaard wrote in an email.
Pinterest “offboarded the companies in question,” spokesperson Crystal Espinosa wrote in an email.
A boom industry on the edge of the law
Together, the companies in this analysis reflect an increasingly competitive — and lucrative — direct-to-consumer health care market. The promise of a streamlined, private prescription process has helped telehealth startups raise billions as they seek to capitalize on a pandemic-driven boom in virtual care.
Hims & Hers, one of the largest players in the space, is now a publicly traded company valued at more than $1 billion; competitor Ro has raised $1 billion since its founding in 2017, with investors valuing the company at $7 billion. Thirty Madison, which operates several telehealth companies focused on different medical needs, is valued at more than $1 billion.
The industry’s rapid growth has been enhanced by its ability to use data from tools like pixels to target advertisements to increasingly specific patient populations and to put ads in front of users who have visited their site before. The companies we analyzed mostly provide care and prescriptions for conditions like migraines, sexual health, or mental health disorders rather than comprehensive primary or urgent care — making browsing their websites inherently sensitive.
In the same way visiting an opioid use disorder treatment center can identify an individual as an addiction patient, data about someone visiting a telehealth site that treats only one condition or provides only one medication can give advertisers a clear window into that person’s health. Direct answers to onboarding forms could be even more valuable because they’re more detailed and specific, said McCoy. “And it’s more insidious because I think it would be all that much more surprising to the average person that information that you put in a form wouldn’t be protected. It’s both worse and more unexpected.”
Consider the form for Thirty Madison’s Cove, which offers migraine medications. It prompts visitors to share details about their migraines, past diagnoses, and family history — and during our testing sent the answers to Facebook and Google. If a user added a medication to the cart, detailed information about the purchase, including the drug’s name, dose, and price, were also sent to Facebook, along with the user’s hashed full name, email, and phone number.
While hashing obscures those details into a string of letters and numbers, it does not prevent tech platforms from linking them to a specific person’s profile, which Facebook explicitly says it does before discarding the hashed data.
A Google tracker collects answers to medical screening questions on Cove’s website.
A tracker tells Facebook when a user adds a medication to the cart. It also sends the user’s hashed name, email, and phone number.
“It’s a pure monetization play,” said Eric Perakslis, chief science and digital officer at the Duke Clinical Research Institute. “And yes, everybody else is doing it, it’s the way the internet works. … But I think that it’s out of step with medical ethics, clearly.”
In particular, experts worry that health data could be used to target patients in need with ads for services and therapies that are unnecessary or even harmful.
The big tech platforms that responded for this story say they do not allow targeted advertising based on specific health conditions, and some telehealth companies said they only use the data collected to measure the success of their advertising. However, as The Markup has previously reported, advertisers may still be able to target ads on Facebook using terms that are close proxies for health conditions.
On 35 of the 50 websites, STAT and The Markup found trackers sending individually identifying information to at least one tech company, including names, email addresses, and phone numbers.
That presents patients with a Catch-22. “It requires anyone that wants to take advantage of telehealth … to expose a lot of the same information that they would reveal within a protected health care relationship,” said Woodrow Hartzog, a privacy and technology law professor at Boston University — but without the same protections.
In recent months, regulators have begun cracking down on the indiscriminate collection and sale of personal health data.
After issuing a warning to businesses about selling health information in July, the Federal Trade Commission sued data broker Kochava, alleging that the company put consumers at risk by failing to protect location data that could reveal sensitive details about people’s health, such as a visit to a reproductive health clinic or addiction recovery center. Kochava has asked for the case to be dismissed and countersued the FTC.
The increased attention reflects growing fears about how health data may be used once it enters the black boxes of corporate data warehouses — whether it originates from a hospital, a location tracker, or a telehealth website.
“The health data market just continues to kind of spiral out of control, as you’re seeing here,” said Perakslis.
But thanks to their business structures, many of the companies behind telehealth websites appear to be operating on the outskirts of health privacy regulations.
‘It does seem deceptive’
When users visit Cerebral, a mental health company whose prescribing and business practices came under federal investigation this year, they are required to answer a series of “clinically tested questions” that can cover a wide range of conditions, including depression, anxiety, bipolar disorder, and insomnia. During testing, with every response — such as clicking a button to indicate feeling depressed “more than half the days” over the last two weeks — a pixel sent Facebook the text of the answer button, the specific URL the user was visiting when clicking the button, and the user’s hashed name, email address, phone number.
At a doctor’s office, that kind of detail collected on an intake form would likely be subject to HIPAA. But as with most of the telehealth companies in this analysis, Cerebral Inc. itself doesn’t provide care; its website connects patients with providers like those employed by Cerebral Medical Group, P.A. and others. While those medical groups are HIPAA-covered entities that cannot share protected health information with third parties except under narrow circumstances, Cerebral claims in its privacy policy to be a go-between that is not covered by HIPAA — except in limited cases when it acts as a business associate of a medical group, pharmacy, or lab.
Cerebral did not answer detailed questions that would clarify what these cases might be. But in a Nov. 30 email, spokesperson Chris Savarese said the company would adjust its use of tracking tools. “We are removing any personally identifiable information, including name, date of birth, and zip code from being collected by the Meta Pixel,” he wrote.
However, when STAT and The Markup tested Cerebral’s website again on Dec. 7, reporters found that a Meta Pixel was still sending answers to some intake questions and hashed names to Facebook, and trackers from Snap and Pinterest were also collecting hashed email addresses.
A Facebook tracker collected answers from a Cerebral intake form during an October test by STAT and The Markup.
During a December test, a Facebook tracker was still collecting Cerebral’s intake form answers.
The telehealth companies that responded to detailed queries said their data-sharing practices adhered to their privacy policies. Those kinds of policies commonly include notice that some — but not all — health data shared with the site is subject to HIPAA. Many companies responded that they were careful to ensure that data shared via third-party tools was not considered protected health information.
But the structure of the companies’ businesses — and the inscrutable language in their privacy policies and terms of use — make it difficult for consumers to know what data would qualify as protected, and when.
“There is so much intransparency, and that makes it complex and maybe even deceptive for consumers,” said Sara Gerke, a professor of health law and policy at Penn State Dickinson Law.
Several telehealth companies claimed that the information collected from their websites was not personally identifiable because it was hashed. HIPAA allows health information to be shared when it has been de-identified. However, hashing does not anonymize data for the tech platforms that receive it and match it to user profiles. And every data packet sent by a tech company’s tracker includes the user’s IP address, which is one of several unique identifiers that explicitly qualify health data for protection under HIPAA.
Further complicating decisions for patients, at least 12 of the direct-to-consumer companies examined in this investigation promise on their websites that they are “HIPAA-compliant.” That could encourage users to think all the data they share is protected and lead them to divulge more, said Hartzog. Yet the regulations apply to the websites’ data use only in limited cases.
Monument, a site that offers alcohol treatment, starts its intake form by saying, “Any information you enter with Monument is 100{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} confidential, secure, and HIPAA compliant.” Yet in its responses to STAT and The Markup, it said that it does not consider information transmitted to third parties from that form — including answers to questions like “In the past year, have you continued to drink even though it was making you feel depressed or anxious or adding to another health problem? or after having had a memory blackout?” — to be protected health information under HIPAA.
“If they’re not covered by HIPAA and they have a HIPAA-compliant badge, that seems like a case the FTC could bring,” said Justin Brookman, the director of technology policy for Consumer Reports and former policy director with the FTC, which has previously charged companies for deceptive use of HIPAA-compliant badges. “There’s an implication there that you’re regulated in certain ways, that your data is protected, and so it does seem deceptive.”
Such data sharing could be particularly damaging to patients seeking care for substance use disorders, said Jacqueline Seitz, senior staff attorney for health privacy at the Legal Action Center — especially if it enters opaque data brokerages where it can be resold and repurposed indefinitely.
Several companies in this analysis are capitalizing on federal waivers activated during the pandemic that allow controlled substances like suboxone, which is used to treat opioid use disorder, to be prescribed virtually. Under federal law, qualifying addiction treatment providers — including those that prescribe suboxone — are held to patient privacy standards even stricter than HIPAA. For example, Workit’s physician group states it is forbidden from acknowledging “to anyone outside of the program that you are a patient or disclos[ing] any information identifying you as a substance use disorder patient” except in narrow situations.
Nonetheless, STAT and The Markup found that Workit and other telehealth companies — in their role connecting patients to providers — share information that identifies a user as someone seeking addiction treatment. On Boulder Care’s website, a pixel sent Facebook our name and email when we joined a suboxone treatment program waitlist. And trackers on the website of Bicycle Health, another online suboxone provider, notified Google and Bing that our email address had been entered on an “enrollment confirmation” URL.
Boulder Care chief operating officer Rose Bromka said the company had started improving its “website hygiene” before being contacted for this article, and restricted the information sent by the Meta pixel after reviewing our findings.
However, Bromka added that Boulder still tracks some information about website visitors to guide its advertising.
“We are always looking to balance ensuring we are able to get the word out about options with holding to our value set,” she said.
Big tech’s black boxes
Meta, Google, TikTok, Bing, LinkedIn, Snap, and Pinterest say they have policies against using sensitive health data to help target advertisements.
“We clearly instruct advertisers not to share certain data with us and we continuously work with our partners to avoid inadvertent transmission of such data,” TikTok spokesperson Kate Amery wrote in an email, adding, “[W]e also have a policy against targeting users based on their individual health status.”
Meta and Google claim to have algorithmic filters that identify and block sensitive health information from entering their advertising systems. But the companies did not explain how those systems work or their effectiveness. By Facebook’s own admission to investigators from the New York Department of Financial Services in 2021, its system was “not yet operating with complete accuracy.”
To trace what happened to data collected by trackers, STAT and The Markup created dummy accounts logged into Facebook, TikTok, and Twitter while testing the telehealth websites. Reporters then used the platforms’ “download your data” tools in an attempt to determine whether any health information the trackers collected was added to our profiles.
The information provided by those tools was so limited, however, that STAT and The Markup couldn’t confirm how or whether the sensitive health information was used.
For example, a Meta Pixel on RexMD, which prescribes erectile dysfunction drugs, collected the name of the medication in our cart, our email, gender, and date of birth. Facebook’s transparency tool, however, only showed 10 “interactions” on RexMD’s website, with generic descriptions like “ADD_TO_CART.” It did not provide details about the specific data Facebook ingested during those interactions. A TikTok pixel collected some of that same information from RexMD, but TikTok’s report on our “usage data from third-party apps and websites” had just one line: “You have no data in this section.”
Our Twitter data showed that the company knew the dummy account user had selected a product on RexMD’s website and the exact URL on which that product was selected.
On some websites, users’ data was also being collected by “custom events,” meaning that a website owner deliberately created a custom tracking label that could have a phrase such as “checkout” in it but wouldn’t necessarily show up in the tech platforms’ transparency tools.
Only four companies answered whether they had ever been notified by Facebook of potentially sensitive health information. Monument and Favor had data flagged but said they determined it wasn’t sensitive. Lemonaid received a notification in error related to a promotional code, and Boulder Care had received none.
Telehealth websites should be held accountable for the trackers they install, said Hartzog, the Boston University law professor. But “big platforms that are deploying these surveillance technologies also need to be held accountable, because they’re able to vacuum up every ounce of personal data on the internet in the absence of a rule that tells them not to.”
The companies in this investigation said their services fill an important need. “The makeup of the traditional health care system has in many cases prevented people from accessing treatment for conditions that should be easy to treat,” Scott Coriell, a spokesperson for Hims & Hers, wrote in an email. Companies that serve patients with mental health or substance use disorders emphasized that long wait times to see in-person providers, and the stigma associated with seeking care, made virtual services especially valuable.
Marketing supported by third-party tracking is part of making that care accessible, some argued. “Monument uses online advertising platforms to raise awareness of our evidence-based treatment for alcohol use disorder, and get people the support and relief they deserve,” wrote CEO Michael Russell. “We transmit the minimum amount of data required to allow us to track the effectiveness of our advertising campaigns.” Favor spokesperson Sarah Abboud argued that calling standard industry practices into question could threaten trust in those services.
But health privacy and policy experts see a disconnect between the industry’s stated emphasis on privacy and its data-sharing practices. “Telemedicine providers should have realized from the get-go that if their entire business model is to seamlessly move people from marketing to care and the care will be online, then there’s going to be more personal identifiable information submitted and thus more privacy risk and thus more privacy liability,” said Christopher Robertson, a health law and policy professor at Boston University.
One problem may be that marketing teams don’t fully understand privacy regulations, and legal teams don’t have a handle on how the marketing tools work.
Sara Juster, privacy officer for the weight-loss telehealth company Calibrate, wrote in an email that the company doesn’t “send any health information collected in our eligibility flow back to platforms.” But a Meta Pixel on its site sent data including height, weight, BMI, and other diagnoses, like diabetes, to Facebook. Juster then clarified the pixel was a duplicate that should have been removed in a tracking audit earlier this year.
However, as of Dec. 7, a Meta Pixel was still present on the site and sharing hashed identifiers and checkout events with Facebook. The pixel appeared to have been reconfigured, though, to send less information than it had during our original testing.
Without updated laws and regulations, experts said patients are left to the whims of rapidly evolving telehealth companies and tech platforms, who may choose to change their privacy policies or alter their trackers at any time.
“It doesn’t make any sense that right now, we only have protections for sensitive health information generated in certain settings,” said McCoy, “but not what can be equally sensitive health information generated in your navigation of a website, or your filling out of a very detailed form about your history and your prescription use.”
This article was co-reported with The Markup, a nonprofit newsroom that investigates how powerful institutions are using technology to change our society. Sign up for its newsletters here.
For decades, western Europe’s national healthcare systems have been widely touted as among the best in the world.
But an ageing population, more long-term illnesses, a continuing recruitment and retainment crisis plus post-Covid exhaustion have combined, this winter, to create a perfect healthcare storm that is likely to get worse before it gets better.
“All countries of the region face severe problems related to their health and care workforce,” the World Health Organization’s Europe region said in a report earlier this year, warning of potentially dire consequences without urgent government action.
In France, there are fewer doctors now than in 2012. More than 6 million people, including 600,000 with chronic illnesses, do not have a regular GP and 30{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of the population does not have adequate access to health services.
In Germany, 35,000 care sector posts were vacant last year, 40{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} more than a decade ago, while a report this summer said that by 2035 more than a third of all health jobs could be unfilled. Facing unprecedented hospital overcrowding due to “a severe shortage of nurses”, even Finland will need 200,000 new workers by 2030.
In Spain, the health ministry announced in May that more than 700,000 people were waiting for surgery, and 5,000 frontline GPs and paediatricians in Madrid have been on strike for nearly a month in protest at years of underfunding and overwork.
Efforts to replace retiring workers were already “suboptimal”, the WHO Europe report said, but had to now be urgently extended to “improve retention and tackle an expected increase in younger people leaving the workforce due to burnout, ill health and general dissatisfaction”.
In a third of countries in the region, at least 40{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of doctors were aged 55 or over, the report said. Even when younger practitioners stayed despite stress, long hours and often low pay, their reluctance to work in remote rural areas or deprived inner cities had created “medical deserts” that were proving almost impossible to fill.
“All of these threats represent a ticking time bomb … likely to lead to poor health outcomes, long waiting times, many preventable deaths and potentially even health system collapse,” warned Hans Kluge, the WHO regional director for Europe.
In some countries the worst shortages are among GPs, with France in particular paying the price for previous planning errors. Back in 1971, it capped the number of second-year medical students through a so-called numerus clausus aimed at cutting health spending and raising earnings.
The result was a collapse in annual student numbers – from 8,600 in the early 1970s, to 3,500 in 1993 – and while intakes have since climbed somewhat and the cap was lifted altogether two years ago, it will take years for the size of the workforce to recover.
Even though 10{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of France’s GPs now work past retirement age, older doctors leaving the profession outnumbered newcomers entering it last year, when numbers were still 6{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} down on what they were even a decade ago. It could be 2035 before the country reaches a satisfactory ratio of doctors to inhabitants nationally.
Local provision, however, is another matter: GP ratios range from 125 or more per 100,000 people in some wealthier neighbourhoods to less than half that in remote rural France or deprived suburbs such as Seine-Saint-Denis.
“In fact, about 87{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of France could be called a medical desert,” the junior health minister Agnès Firmin Le Bodo said last month, pledging a “complete rebuild” of GP services through more multi-function health centres and remote consultations – but no obligation, as yet, on doctors to set up in poorly provisioned areas.
This winter’s flu epidemic, coming on top of Covid-19, had exposed the system’s failings, creating “a crisis not just for France’s hospital sector but for all of French healthcare”, said Arnaud Robinet of the French Hospitals Federation, warning that the service was “no longer capable of responding systematically” to emergencies.
An oximeter is arranged on a baby’s hand in Germany, where human respiratory syncytial virus (RSV) is pushing some hospitals to their limits. Photograph: Filip Singer/EPA
In Germany, which spends more on healthcare than almost any other country in the world, hospitals are a greater concern, with this winter’s wave of respiratory syncytial virus (RSV) in young children triggering alarm across the country.
Amid reports of overcrowded casualty departments and parents forced to sleep in hospital corridors or travel hundreds of kilometres for a child’s treatment, the Süddeutsche Zeitung said the country was witnessing “what it means when a system implodes … in scenes which for a long time might have seemed unimaginable”.
In a petition to parliament titled: “Alert level red – hospitals in danger”, the German Hospital Society (DKG) again highlighted a chronic lack of staff as the main problem, noting that many hospitals had had to temporarily close casualty departments due to a lack of doctors and nurses.
More than 23,000 posts remain unfilled in Germany’s hospitals after several years of low recruitment and recent mass resignations, particularly in intensive care and operating theatres, by staff citing a workload so extreme that some were unable to take even a short break or go to the toilet.
The health minister, Karl Lauterbach, has announced a €300m (£260m) aid package for paediatric clinics and an as yet unspecified “revolution in hospital care” putting “medicine first rather than the economics”, plus a plan to move nurses and doctors around to match demand that was dismissed as “absurd” by leading medics.
“The problem is we have no wards that could do without staff, because they’re all already only able to offer the minimum level of care,” said Christine Vogler of the German Council of Nursing (DPR). “This can only be called an act of desperation.”
Christoph Spinner, a consultant in infectious diseases at Munich’s University Clinic, said the country’s health system was “without doubt facing enormous challenges”, while a paediatrician, Nina Schoetzau, said the state of Britain’s NHS was “a taste of things to come” for Germany.
In Spain, the winter has already prompted overstretched frontline staff to take strike action. The healthcare crisis, laid bare during the Covid pandemic, follows decades of under-investment, competition between regions for medical staff, and the lure of better pay and conditions abroad.
Much of the discontent has focused on the Madrid region, where in mid-November at least 200,000 people took to the streets to defend public healthcare against creeping privatisation and to express concern over the regional government’s restructuring of the primary care system.
Ángela Hernández, a surgeon and general secretary of Madrid’s AMYTS medical association, said the situation in paediatric services was “practically desperate”, adding that it was also “about demand: no one is telling people that if resources are limited, services have to be used wisely”.
Politicians had a responsibility to “explain the situation to people”, Hernández said. “But because they do the exact opposite in Madrid and in Spain, they raise people’s expectations.”
The Metges de Catalunya (Doctors of Catalonia) union also plans a two-day strike next month to protest against “overload, disdain and precariousness”. Xavier Lleonart, its general secretary, said the pandemic was “the icing on the cake” but the current situation was as foreseeable as it was depressing.
Some Spanish doctors were so burned out they were taking early retirement, despite the hit to their pensions, he said, adding that the chief imperative was to make the profession more attractive to stop the “haemorrhage” of professionals.
“People say the best capital a company has is its human capital,” Lleonart said. “The problem is that in health the human capital has been systematically mistreated until it has said: enough’s enough.”
Italy’s public health service, too, faces serious staff shortages, compounded by the pandemic, which triggered an exodus of staff from the profession, taking early retirement, or switching to roles in the private sector.
Regional governments have signed contracts with freelance medics to cover hospital shifts where needed, highlighting the low salaries of Italy’s public health sector.
“There are holes that need to be filled everywhere, especially in emergency units,” said Giovanni Leoni, vice-president of an Italian doctors’ federation. “The issue is that freelances earn two to three times more – up to €1,200 for a 10-hour shift.”
Many medics had left public sector roles “before their time”, Leoni added. “They have found other types of jobs in the private sector – roles that mean they don’t have to do night shifts, or weekends.”
Italian medics are holding a demonstration of “the invisibles” later this week. “We’re invisible for the government,” said Leoni. “Salaries for Italian doctors need to be at the same level as those in Europe. Currently, they’re among the lowest.”
President Joe Biden’s administration will allow Washington state to provide health insurance to illegal immigrants within its borders by rolling back requirements for the Affordable Care Act (ACA).
The Department of the Treasury and the Department of Health and Human Services (HHS) approved the state’s request via a State Innovation Waiver, which was requested by Washington’s government in May.
WA GOV. INSLEE’S EQUITY SUMMIT TELLS STATE AGENCIES ‘OBJECTIVITY,’ ‘INDIVIDUALISM’ ROOTED IN ‘WHITE SUPREMACY’
Xavier Becerra, secretary of Health and Human Services, speaks during a news conference in Washington, D.C., on Tuesday, June 28, 2022. (Amanda Andrade-Rhoades/Bloomberg via Getty Images)
“Washington has requested a waiver in order to expand access to qualified health plans, stand-alone qualified dental plans, and a state affordability program to Washington residents regardless of immigration status,” HHS and Treasury said in a joint statement.
The statement continued, “The waiver will help Washington work towards its goals of improving health equity and reducing racial disparities by expanding access to coverage for the uninsured population through the state Exchange, all the while not increasing costs for those currently enrolled.”
BORDER OFFICIALS SEEING MASSIVE MIGRANT NUMBERS, LARGE GROUPS AHEAD OF TITLE 42’S END
The U.S. Treasury Department building viewed from the Washington Monument, Wednesday, Sept. 18, 2019, in Washington. (AP Photo/Patrick Semansky, File)
The ACA’s normal regulations explicitly exclude non-citizens living in the U.S. illegally from collecting the benefits of the program.
Washington’s successful campaign to expand coverage to illegal immigrants is the first of its kind since the ACA was introduced.
TEXAS LAUNCHES TASK FORCE WITH K9S, DRONES TO STOP ILLEGAL IMMIGRANT ‘GOTAWAYS’ AMID SPIKE IN NUMBERS
State Innovation Waivers are granted under the supervision of the HHS and Treasury for states seeking to modify existing ACA regulations to suit their specific needs.
Washington State Capitol (Dan Mihai/Getty Images)
“Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver (also referred to as section 1332 waiver) to pursue innovative strategies for providing residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA,” according to the Centers for Medicare and Medicaid Services.
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In their statement, the departments said that the approved modification of Washington’s ACA, contingent upon the state accepting “specific terms and conditions,” would be valid from 2024 through 2028.
Timothy Nerozzi is a writer for Fox News Digital. You can follow him on Twitter @timothynerozzi and can email him at timothy.nerozzi@fox.com
