Not so long ago, Kailua (the city of “two seas” as the name translates from Hawaiian) was known for its golden sandy beaches with turquoise water - a surfer's paradise! Also, Kailua was one of the residences of the kings - the rulers of Hawaii. Barack Obama, when he was president, moved his office here for the winter. Now the city, located just 20 minutes drive from the center of Honolulu, has become associated with the Russian Orthodox Church and its shrines, first of all - with the world revered by Orthodox people myrrh-flowing Iverskaya Montreal (Hawaiian) icon of the Mother of God.
The Mother of God in the altar was painted by Matushka Anna Kalinina from Moscow. Nectarius Youngson, the keeper of the myrrh-flowing icon, serves as a deacon in the temple. He shared with us the difficult history of his parish, told us about the miraculous discovery of the Hawaiian icon and about the miracles and healings that occur through prayers before this icon.
Deacon Nectarius Youngson
Islanders

• Fr. Nectarius, were you yourself born in Hawaii?
  
• My family is native Hawaiians, we have lived on the island of Oahu for many years. My great-great-grandfather came from China and married a Filipina. From that marriage, my great-grandfather was born. He married a Puerto Rican woman of Spanish descent. We did a genetic test and, in addition to Polynesian, there are many ethnic lines in our family, including Portuguese, Spanish, French, Filipino, Japanese, Chinese and, interestingly enough, Georgian and even Russian!
  

I was the first in my family to become Orthodox, having been baptized at the age of 12. Before that, all my relatives were Catholics

As far as I know, I was the first in my family to become Orthodox, having been baptized at the age of 12 (before that all my relatives were Catholics). One day my stepmother and her parents went to a Greek festival in Honolulu and bought a book called “The Orthodox Way” by Metropolitan Kallistos (Ware). So she became a parishioner of the Greek Church of St. Constantine and St. Helen. She invited me to the temple. I was interested and began to go to catechization classes. There was a wonderful priest there, Father Peter Salmas. He was going to baptize me, but then the Greek Archdiocese sent him to California. Then I began to go to the temple of the Russian Church Abroad. At that time it was a small mission that rented space in the Episcopal Church. When I first went to their service, it seemed to me that angels were singing, although there were only two people singing on the choir. I was charmed by the service itself, the atmosphere in the parish, and the kindness of the parishioners.
Father Seraphim Rolman was serving there at that time. He agreed to baptize me the following Friday and asked me what name I would like to be baptized with. I said that I had read about a wonderful man, St. Nectarius of Aegina, and I would like him to be my heavenly patron saint. “Oh!” exclaimed the priest, “this Friday is just his commemoration day".
So I was baptized on the day of the memory of St. Nectarius of Aegina according to the old style. For me it was a confirmation that I made the right choice and came to the church where I should be.
On Sunday I was blessed to read the Gospel, and I received Holy Communion for the first time. And after the service, Father Seraphim gave us everything we needed for services and told us that Archbishop Anthony (Medvedev) of San Francisco was sending him to serve in Montana, and for the time being there would be no priest in the parish.
By the way, in the same parish I met our future priest, Fr. Anatoly Levin, who was then a longtime subdeacon.
The parish received a professor as rector

• Father Nektarius, the history of your parish is the history of rent, of moving from one building to another; once you had a priest, once you did not, and you had to maintain the “breath and life” of the parish yourself....

I, 12 years old, began to ride my bicycle to the temple every Sunday, where I would lay out icons and read the Liturgy in layman's terms

• That's right! And at that time the future father Anatoly was teaching in Vladivostok, and I, 12 years old, began to ride my bicycle every Sunday to the temple, where I laid out icons, took out books and read the lay readings. The temple was empty, almost no one came because there was no priest. I would finish reading, pack everything in the closet, close the door of the temple and drive to the ocean. And no one knew if or when the priest would come.

Finally, a gifted pastor arrived from Jordanville - Hieromonk Averky (Moreno). He stayed on the island for a month and so came four times a year. When he came, many people gathered. He was our rector for several years.
In the meantime, our subdeacon Anatoly returned from Russia. Fr. Averky, knowing that we needed a permanent priest and that our subdeacon would make a worthy shepherd, began to persuade his Japanese wife Emiko to agree to ordain her husband. Fr. Anatoly was at that time a professor at the university in Honolulu, and after retirement he could devote all his time to the temple.
Priest Anatoly Levin
In 1984, Archbishop Anthony (Sinkevich) of Los Angeles came to us and told us that the Iveron Icon of the Mother of God had begun to myrrh-streaming in Montreal and brought us a copy of it. Vladyka suggested that we dedicate our parish to the Iveron Icon of Our Lady of Montreal. So our community became the first in the world to be dedicated to this icon.
Since 1986 we had Hieromonk Thomas (Delano; a former Hollywood actor who became a monk in 1978) serving us for five years, and then again for almost ten years there was no permanent priest.
But we were gradually building our parish. Sometimes I would get sad and call Fr. Averky in Jordanville and almost shout: “Why can't we just go to the Greek church?” But Fr. Averky told us to keep praying and that there should be more temples, not fewer; that the Mother of God would help us.
And so God sent us Fr. Anatoly. That's when we began to have a real regular liturgical life.
At that time we had only a few families who supported the parish: Russians, Ukrainians, Serbs, Romanians, local Hawaiians.

At that time we served in a tiny office converted for the church (only 18 square meters!)

Fr. Anatoly tried to tell as much as possible about the temple, and the parish gradually grew. We served then in a tiny office (only 18 square meters!) converted for the temple. But what a joyful atmosphere there was! I remembered the words of Vladyka John (Maximovich). When his congregation in Shanghai was deprived of its cathedral, they were forced to serve in a garage, and many people cried. And then the saint consoled them that this place is greater than any cathedral, because here is the Body and Blood of Christ. We felt the same way when we served in our little room. Ten years later we rented a bigger place in the center of Honolulu.
And the church we have now is a miracle!
Our iconostasis was made... 100 years ago
https://preview.redd.it/aomnuk3fik1d1.png?width=700&format=png&auto=webp&s=b0307ca9303589e9cad388640ba5fbc7175a4195

• Five years ago our long-time pastor gathered for retirement (now Fr. Anatoly is our rector emeritus and continues to serve to the best of his ability). We needed a younger priest. In 2016, I just went with an icon and several priests to Alaska. One priest I liked there was Fr. Athanasius Cohn. He had lived with his family on Kadyak Island in Alaska for many years, and he had an islander mentality.

Archbishop Kyrill of San Francisco and Western America considered him a good candidate for our temple and sent him to Hawaii. Our parish is mixed: now there are Russians, Serbs, Bulgarians, Ukrainians, Palestinians, believers from Alaska, and we needed a missionary priest who would be able to spread Orthodoxy on the island in the future, to bring people to faith, so that they would seek Christ and follow Christ to the temple.
Two years after Fr. Athanasius came to us, in 2018, we started looking for a new place for the parish. But we didn't have much money, especially since the parish decided to pay the rector a salary for the first time in more than 20 years so that he wouldn't have to work a secular job as well. After all, it is no secret that abroad almost all clergy, in addition to serving, also work. There are priests-computer scientists and priests-doctors, construction workers, truckers and even cleaners. And in Hawaii, life is expensive.
It took us a long time to find a suitable place to rent. We thought maybe we could buy it. We looked for two years, and one day we got a call that there was a former mission in Keilua, not far from Honolulu, that was moving to Texas. It was a Baptist congregation with a small church, a school that needed to be remodeled.
We liked the place. The pastor told us that Jehovah's Witnesses and other denominations wanted to buy the premises, but he wanted to sell it to a real Christian parish.
Temple in Keilua
Then we started looking for a bank that would help us with the money, but we couldn't find one. And then something interesting happened. We found an Orthodox bank that gave Orthodox churches money on credit for repairs, expansion, and remodeling, but had never before given money to buy a church. Father Athanasius and I applied to them, but before that we served a prayer service to the Mother of God. And they accepted our application! And the entire management of the bank, starting with its president, was very willing to help our mission. We launched a fundraising campaign, and people from all over the world sent money, which we were able to make as a down payment.
All of this was happening during the coronavirus pandemic. We bought the spaces of our future church in March 2020, Easter services were held at the old location, and my father, the contractor, began working on remodeling and remodeling the buildings.
Last year was a year of much work. And all along we had some obstacles that came up. But as soon as the obstacles came up, the solution came!
When we started to renovate the masonry on the outside of the church, the mason took the money for the work and disappeared. But on the same day another mason came and offered to help. He did everything in the best possible way, and even poured cement near the church where there had been earth before.
https://preview.redd.it/v80sf4jcjk1d1.png?width=700&format=png&auto=webp&s=debfe64f2242b30415ce08234fc5afd144b19aa2
And one day the headman of the Cathedral in San Francisco told me that he had an iconostasis that was eighty years old or more, and he asked: “Do you need an iconostasis?" We would have gladly taken it, because at that time we were just making an ambo in the church. But he didn't even know the exact dimensions. My father said to me: “Let's build the ambo, then we'll decide. Mother of God will help.”

We assembled the iconostasis given to us, and it turned out that it exactly fits our ambo!

The iconostasis was delivered by container to Hawaii. We assembled it, and it turned out to fit our pulpit exactly! As Fr. Anatoly said, the iconostasis was made 100 years ago just for us.
About a year ago we completed the reconstruction of the church building and the neighboring school building, kitchen, library, and began to serve in our new church.
Even though the new church is a 15-minute drive from the former church, the very thought of driving through the mountains proved psychologically difficult for some of our members who live close to downtown Honolulu. We have lost some families, but gained more. We have Sunday school, the children serve, and sing in the choir where my matushka practices with them.
On a personal
Matushka Iya

• Fr. Nektarius, people usually see you in churches, where you visit with your myrrh-flowing icon. But few people know about your secular life, about your mother in particular.....
• Blythe grew up in a not very church-going family, but she loved music and sang in the choir at the same Epiphany Episcopal Church in Honolulu, where our Orthodox liturgy began at the end of their service. But this we discovered later. In the mid-1990s, she converted to Orthodoxy and was given the name Iya in baptism. Interestingly, the same weekend that Blythe was baptized, I was tonsured a reader.

We married, and when I was ordained a deacon in 2018, Iya became a matushka. She is of Japanese descent, a math teacher by profession, and teaches at a Catholic high school. In the temple, she leads the choir and teaches the younger generation to read and sing.
Honolulu

• And what is your secular profession?
• I was a policeman, and after I was badly injured in the line of duty, I switched to investigative work. Almost at the same time, the icon became myrrh-flowing, and I had more opportunity to pilgrimage with it. On trips I take my computer with me and work. When there is a lot of work, one of the attendants is in the temple with the icon, and I work with documents - in the church office or in the car.

I love my job, but I still look forward to the time when I retire and can devote more time to the icon of the Mother of God and the temple.

• Have you counted how many temples and monasteries you have visited with the icon?
• This year it will be 15 years since I have been traveling with the Iveron of Montreal (Hawaii) Icon. As long as Brother Joseph Munoz has been traveling with the Montreal Icon. Only by car I travel more than 160 thousand kilometers a year, not counting flights from Hawaii to the continent and back!

The icon and I have visited over 1700 temples around the world

The icon and I have visited over 1700 temples around the world, in the US and Canada - over 1200 in almost every state except maybe one or two. And wherever I have traveled, I never have seen empty temples.
Very many I remember are either simple parishioners or students at Holy Trinity Seminary in Jordanville, St. Tikhon's Seminary and St. Vladimir's Seminary.
Some priests come up to me and ask, “Do you remember me? I was a seminarian and I was friends with a girl. Now I am a priest, she is my matushka, and we have four children!”
The icon was sent for sale, and it became myrrh-flowing
https://preview.redd.it/0p0tfx53lk1d1.png?width=700&format=png&auto=webp&s=500917549dc6315169d61b4c47bd523ba7cc52b2

• How did the icon begin to flow the myrro?
• It happened in 2007. In the late 1990s, Father Anatoly traveled to Toronto and bought a small icon from a church kiosk. It was sold at a sale for $20 because it was considered too dark. It was the last one, and the grandmothers argued over who would buy it. Matushka Nadezhda, who worked at the kiosk, said: “Let the icon go to Hawaii.” And Father Anatoly bought the icon. He brought it to the temple and gave it to me for my angel's day.

In 2006 my bride and I got married, we moved the icon to our new apartment and put it on the highest bookshelf.
In 2007, I began to feel an odor throughout the apartment. I told my cousin and she too sensed an odor similar to what the flowers of the macorange plant smell like (it's a mixture of rose and orange scents). I'm highly allergic to smells, and at the store, I can't even go near the shelves of cleaning products. But I wasn't allergic that time. Still, I asked my wife what it smelled like. And even joked, “Are you trying to get rid of me?” She confirmed that the air in the apartment was fragrant. The odor came and went.
Just about that time, I was injured on duty and taken to the surgical ward. I remember when I woke up from anesthesia after surgery, I immediately felt a familiar aroma. It smelled like roses again.
At home I had a small cross, I looked at it and saw drops of liquid on it. I thought, where did that come from? And again I smelled the same odor of roses.
Time went by. One day I was working at home in my office. There I had a red corner with icons. Suddenly I noticed our cat entered the room and came to the red corner. He stood on his hind legs just at the spot where the Iveron Montreal Icon of the Mother of God stood on the shelf. The cat started sniffing and was about to jump up on the shelf, which he had never done before. I went over to put him away, and then I smelled the aroma again - and so strong! It was October 6th.
I called my wife over and she again confirmed that it smelled like rose. We started looking for where the scent was coming from. I raised my hands and found that the shelf was wet and the smell of roses was coming from there. I picked up an icon and an oily liquid - myrrh - trickled out of it. The myrrh flowed right from under the dust on the icon. Then drops began to appear on the icon itself.
https://preview.redd.it/gk6898dzlk1d1.png?width=700&format=png&auto=webp&s=5e4d28b6d799c873f6fb30a0e3ea10db19d5eebb
We knew about the myrrh-flowing Iveron Icon of the Mother of God of Montreal because our parish is named after her, but I had never seen it myself, it had never come to Hawaii. I was told that Brother Joseph Munoz was going to come with the icon, but while he was living on earth, he was not able to do so. Perhaps after his martyrdom he was here with the icon.
We blotted the icon, but it kept getting wet again and again. Then I realized that the icon was myrrh-flowing. And the cross is also myrrh-flowing.
My godmother, a Serbian, advised me to tell the priest about it. We brought the icon and the cross to the church. Father Anatoly served a prayer service and said: “Now we have a myrrh-flowing icon of the Mother of God, and it will change all our lives.”
After Christmas, with the blessing of Vladyka Kirill, we brought the icon and the cross to the Radoste-Scorbiaschensk Cathedral in San Francisco and left them there for several months.
I returned to Hawaii, not knowing what would happen to the icon: maybe it would be left in the cathedral or given to some monastery.

The clergy noticed that when people prayed before the icon, it began to myrrh-flow more.

In 2008, the archbishop said that the icon was returning to Hawaii. I rejoiced. We have our own myrrh-flowing icon! The clergy at the cathedral told me how they had begun to notice that when they prayed before the icon, it began to myrrh-flow more.
On the Sunday of the Solemnity of Orthodoxy, the icon was first taken out of the altar for the faithful to worship. Before that it was in the altar, and its presence in the cathedral was kept in secret.
Vladyka Kirill told the priests to change the absorbent cotton inside the icon, but not to tell anyone that the icon was here. The faithful were anointed with ointment, even not everyone got absorbent cotton with ointment, but then people who were anointed with ointment began to come to the bishop and to the priests of the cathedral and say that they were healed! Some from cancer, some from other diseases.
During the Week of Triumph of Orthodoxy, the icon and the cross were placed in the cathedral so that people could pray and lay their hands on them, and soon we took them to Hawaii. The cross began to be kept permanently in the church as a blessing to the parishioners, and the icon of the Mother of God was assigned a keeper.
How I became an icon keeper

• A keeper is the person called an "iconophore" (icon keeper) in Greek. This Greek word was used by Pushkin in his works, but more often in Russia they used to say “icon bearer”.
• Yes. In a broad sense it is a person who takes care of church utensils and the temple as a whole. Vladyka Kirill told me that since the icon of the Mother of God is constantly myrrh-flowing, people should be witnesses to it. And not only to see the miracle with their eyes, but also to feel it with their hearts, so the icon should visit as many temples and monasteries as possible, and it should have a keeper who will take care of it and travel with it to the parishes.

I asked who would do all this and he pointed to me.
I was confused and began to say I have a wife, a job, a cat. I work every day, I pay my loan. So it should be someone else. “The Mother of God came to you and chose you. And She had a reason for that,” the Vladyka said. - "And you must answer Her call. Of course, you can refuse, but God doesn't offer that a few times in life, and there may never be another opportunity to serve Him. So make up your mind!” - and I agreed, putting all my hope in the Mother of God.
https://preview.redd.it/jrgd8gu9ok1d1.png?width=700&format=png&auto=webp&s=71883923a3342e08f053fc7f9b34ce573103d5cf
We brought the icon to the island, and since then it has been traveling around the world for almost 15 years, and millions of people in hundreds of churches pray to the Blessed Virgin Mary in front of this small icon. In one church in Georgia alone, where we were in 2014, more than 100,000 people came to worship her. The Georgian patriarch then told us that only in that small church two women were healed of cancer. They were healed during a prayer service, which the priest of that temple served for the family and their loved ones late in the evening. Among those praying were those two women.

The woman who had died five minutes earlier was placed an icon on her chest, she breathed, and her heart began to beat

It is noteworthy that in those days many possessed people were healed in Georgia and even a woman who had died five minutes ago. They put an icon on her chest, she breathed and her heart began to beat.
In one monastery I saw the healing of a girl. She wriggled in front of the icon, then a priest came out of the altar, prayed and anointed her with ointment. I had never seen an exorcism rite before, and for me what I saw then was the most frightening and at the same time spiritually strengthening.
People tried to hold her down, and at one point the girl screamed loudly. The Abbess asked if we could put the icon on her chest. At that moment I looked at her face - distorted and really “demonic”. We put the icon on the girl's chest, she raised her hands to the icon and tried to hug it like a child. And suddenly an incredible aroma began to emanate from the icon and penetrate all corners of the temple.
Later the Abbess told me that the girl was healed the same day and was playing quietly with the other children. It is unbelievable that they tried to drive out the unclean spirit from the girl for months and could not. And they anointed her with peace from the icon only once - and she was completely healed.
I know a priest in Washington, D.C., who is a Catholic priest. His friend, a Catholic priest-exorcist in Rome, told him how difficult it is for them to exorcise spirits there. And our priest sent him myrrh from our Hawaiian icon.
“What did you send us? - the exorcist from Rome wrote to him. - “People are being healed. Can you send more?” We sent him myrrh, of course. We send to anyone who asks.

• Do you visit temples of other denominations?
• As a rule, no. They don't ask. Catholics, Anglicans usually come themselves to the places where the icon is.

A non-Orthodox woman asked me to come with an icon to her son in the hospital - and he was healed

I can bring an icon home, to the hospital, if they invite me to visit a sick person. I even visited a sick Muslim girl. There was a case when a non-Orthodox woman asked me to come with an icon to her son in the hospital - and he was healed.
Some people are indignant and say that I should visit only the Orthodox with an icon. But everyone can come to the temple and ask for healing. You cannot forbid people to come to the Mother of God and ask for help.
One thing is sacraments, but it is unfair to close the icon for prayer from those who have not yet come to the right faith. You cannot separate some people from others. It is unmerciful!
One must be patient with God

• Fr. Nektarius, how do you choose where to go with an icon?
• I don't choose them myself. The Mother of God decides everything. And I receive certain signs. I feel, for example, that I need to go to Texas. Then I usually wait, because with God, as with people, you have to be patient. He is patient with us!

I'm waiting, praying, and all of a sudden I get a call from a minister in north Texas asking: “Can you come to Texas?” And then I get a call from a priest in Austin, from south Texas, who also invites me to come. And after him - regardless of those priests - I get a call from the abbess of a convent in Houston. And all this happens within a few days. And they offer dates close to each other, even though they had not even agreed. This is how the Mother of God guides me.
I have learned to read such signs and never force trips. I am like a humble “donkey” that stands by and waits to be taken and pulled in one direction or another.
In the beginning, I tried to force it, to initiate trips myself, but things didn't work out, things went wrong.
For example, a few years ago I was with an icon in a church in San Francisco, and I was offered to visit one of the monasteries. A group of clergy gathered and went with the icon in one car, and I went in another. Suddenly I noticed that I was falling asleep. I decided to stop at a coffee shop, bought coffee and saw a Woman at the car. “You need to go back,” She said. “How?” I asked. “You don't have to go any further. Go back.” I opened the car door and felt a strong odor of peace waft out of the car. But the icon wasn't there! I turned around - the Woman was gone. I realized that it was the Mother of God, so I went back.
A monastery as a gift

Nearby stood a Young Woman, “Get up, it's time to get on the plane,” She said. I took my things, and She disappeared

And this case is not the only one. Once I was flying from Honolulu to Fresno, California, with a layover in San Francisco. It was about two hours before landing, so I decided to take a nap and put the icon in its cover under my head. They announced boarding and I was still asleep. They were announcing my name on the loudspeaker, but I didn't hear. Suddenly someone patted me on the shoulder. A Young Woman was standing next to me. “Get up, it's time to get on the plane,” She said. I picked up my things and She disappeared.
In Fresno, the Abbess of the monastery, Mother Markella, and her sisters were waiting for me. I approached her, and she said, “Did the Mother of God appear to you?” - I said, “What do you mean?” - and I realized Who was the Young Woman who woke me up at the airport.
The Abbess told me that a family from Ukraine had come to the monastery and their daughter was very sick. She asked me to bless the girl with an icon and anoint her with holy ointment. And the girl was healed!
Her father, who worked in construction, was so happy that he rebuilt that monastery. This is a convent in honor of the icon of the Mother of God “Life-Giving Source”, one of the most beautiful women's monasteries.
https://preview.redd.it/cqlhubowhm1d1.png?width=700&format=png&auto=webp&s=fa68bd81fca2b1b9e34d6c0e814959ff990b6ce0
The man in the cloak

• October 31 marks the 25th anniversary of the tragic death in Athens of Brother Joseph Munoz-Cortez, who for 15 years was the keeper of the myrrh-flowing Iveron of Montreal Icon of the Mother of God. Have you ever felt fear while traveling?
• Once in Pittsburgh, Pennsylvania, I saw a man enter the church after a prayer service. The priest at that time was just anointing the people with ointment. The man was wearing a long cloak. And since I'm a police officer, I usually have an instinct that something is wrong. So I start watching.

The man knelt down and started crying. I realized that the Mother of God was now doing something with him, with his soul

The man approached the icon. I also approached and looked carefully at his hands. He knelt down and began to cry. He cried a lot. I realized that the Mother of God was doing something with him, with his soul.
The man approached the priest, he anointed him with myrrh, and the man came to me. He unzipped his cloak, pulled out a large hunting knife and handed it to me. He told me that he had come out of his office for lunch and then he saw a flyer that someone had put up, probably someone from the church - about the Hawaiian icon coming to their temple. And he heard a voice urging him to destroy the icon and kill the person who brought it. The voice in his head played over and over again. When he came to the temple to destroy the icon, he felt that someone hugged him from behind, started breathing in his ear and sort of kissed his neck like his mom used to do when he was a child. He felt his mom holding him in her arms, fell to the floor, and the voice disappeared.
This man later embraced Orthodoxy, but before that he knew nothing about the faith.
I always remember the words of our Archbishop Kirill - never to travel alone. The Mother of God in Her image is certainly a protector. But I remember what happened to Brother Joseph in Athens. And with the myrrh-flowing Iveron of Montreal icon that went missing and of which no trace has been found to this day. That is why I value every minute, every second, as long as a copy of it - our Hawaiian icon - is with us. Because at any moment it too may, God forbid, disappear.
Deacon Nektary Youngston.

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Good evening fellow Healthcare_Anon members
As previously discussed, we will go ahead and review a case study of the vertical integration of the various services of the healthcare industry, which if done correctly, does indeed post a very big beast and will be difficult to compete against. It will be like the multi-headed hydra within Greek Mythology, where failure of one head will have the support of another. This again ties into the post previously prepared:
https://new.reddit.com/Healthcare_Anon/comments/1culz57/medicare_advantage_capitation_model_prio
Which stemmed from a discussion post thanks to u/ Fabulous-airport-273:
https://new.reddit.com/Healthcare_Anon/comments/1ch5d36/your_thoughts_on_this_april_2024_policy_pape -> https://www.economicliberties.us/wp-content/uploads/2024/04/Medicare-Advantage-AELP.pdf
Since this paper will be quoted quite extensively, we will give full acknowledgement of the authors' work:
Rooke-Ley H, Brown E, Grumbach K, Hoffman A, Ryan A, Roy V, Grogan C, Appelbaum E, Lipschutz D. Medicare Advantage and Vertical Consolidation in Health Care. American Economic Liberties Project, April 2024. Available: https://www.economicliberties.us/our-work/medicare-advantage-and-vertical-consolidation-in-health-care/#, accessed 05/19/24 (for this subreddit post)
We thank our readers on sending us important topic papers, and we encourage others on submitting literature that could concern the future of healthcare.
Since this paper is indeed a beast, and we are discussing vertical integration within this post only, we will jump directly to page 17 of the paper titled: "A NEW FRONTIER OF CONSOLIDATION". We will discuss Neoliberal economics, capitation consensus (page 1-16), the RAND Insurance experiment, and other important topics AT A LATER DATE.
"These vertical acquisitions are frequently framed as value-based care (VBC) investments. In primary care alone, it is estimated that $50 billion has been invested by these corporate entities in recent years, with similar activity in home-based and post-acute care. And private equity is lubricating these rollups, increasing investment in VBC-aligned companies by more than 400% between 2019 and 2021. As one PE investor recently said, “All roads lead to Optum.”"
https://preview.redd.it/n09dbc62nh1d1.png?width=727&format=png&auto=webp&s=6cc7f68b677a98e509741a4bef885ed4cce79df9
As you can see from the above graph, UnitedHealth Group, CVS Health, Cigna, and Humana have very very similar graphs on their goals of vertical integration. All players uses an insurance to "funnel" the cash through their subsidiaries. I do not agree that the graph should look like a chain ring, as the funneling always STARTS with the insurance and then "trickles down" through the subsidiaries, but not always in a linear fashion. The overall "value" will be its earnings/profits. It is through the initial funneling that this produces the value added parts of subsection (or chain, in the graph). What this graph lacks, which the 10K and 10Q can furnish, is this: how much money do you think the funneling is occurring? I think we can answer that question with my own work - the Excel for 10K on UNH between 2021-2024:
https://preview.redd.it/gw71f3v1oh1d1.png?width=926&format=png&auto=webp&s=95180f582823e831fe870a7cbb7278506243b677
Sources available at: https://www.unitedhealthgroup.com/content/dam/UHG/PDF/investors/2023/UNH-Q4-2023-Form-10-K.pdf
https://www.unitedhealthgroup.com/content/dam/UHG/PDF/investors/2024/UNH_Q1-2024_Form-10-Q.pdf
Now, I want you all to look at something very interesting: There is a section called eliminations, what I think this means is that there is a revenue that is both reported within one segment of UNH that has to be "eliminated" since it is also reported within another segment. My guess is Optum and UHG is crossing over their revenues in certain spots, since UHG is referring patients to Optum, which is under the same umbrella as UNH.
As you can see, each year the eliminations is a higher percentage. In fact, it is now > 33% and approaching 40%. Or another way of saying this more clearly - we don't know why this is the case, but it seems UHG is having more and more patients being served by Optum, and so the eliminations revenue is higher % each year, which all goes under the parent company UNH. In fact, if you eliminate the eliminations, revenue of both UHG + Optum combined is higher than UNH - which cannot happen if the revenue comes from an outside source. We can even track its YoY trend.
Let us turn to the profits section. Again, very similar story. Between 2021-2023, UHG + Optum profit is greater than UNH profits, which indicates that UHG is directing a certain portion of the profits into Optum, but they have to cross each other out during reconciliation for UNH's earnings report. The only time this was an exception was during Q1 2024 durring the Change Healthcare cyberattack, where Optum Insight's profit dropped by ~ 8.5%. Therefore 24Q1 the added total earnings was exactly 100%.
What this means is that I personally think there is potential market crowding and market preference within the UNH group. We will need further conclusive proof from the DOJ antitrust investigation to ascertain whether there is a true market distortion practice occurring OR if Optum services are so good UHG must always choose Optum as their partner due to quality (OK, can I start laughing now??? HAHAHAHAHAHA).
Furthermore, we haven't even discussed Home Care. "UnitedHealth is also moving into in-home care, with both primary and post-acute providers. In 2021, it bought PE-backed Landmark Health for $3.5 billion and recently merged Landmark with Prospero Health, after acquiring it in 2022. UnitedHealth also acquired LHC Group for $5.4 billion in 2022 and is currently seeking to purchase Amedisys, a home health and hospice company, for $3.3 billion. These home-based assets complement UnitedHealth’s 2020 purchase of PE-backed NaviHealth, which is one of a handful of post-acute “conveners” that have emerged within capitation-based models, particularly MA."
If anyone forgot, NaviHealth was the healthcare AI that denied rehab care to patients on a scale so large it got its own lawsuit: https://www.statnews.com/2023/11/14/unitedhealth-class-action-lawsuit-algorithm-medicare-advantage/
Subsequent to page 23 the position paper discusses on the methods to how capitation invites capital distortions, which we will further delve into at a later date. This post is long and dense enough as it is, especially if you have to stare at the graphs and start piecing things together.
As a conclusion, I believe there is definitely a way to cross review some parts to this dense position paper via 10K/10Q, and this is reflected within the financials of UnitedHealth Group. We will delve into the failure of Bright Health Group, the struggles of CVS/Aetna + the struggles of Humana at a later date. Suffice to say, vertical integration is the name of the insurance game, and unless something breaks the equilibrium, this will be the standard model for health insurance companies based on UNH's template.
​

Hey all. I’m trying to save this photo carousel of photos I took while at a race in Ontario. Unfortunately I can’t seem to figure out how to actually save the slices once the document is sliced into 10 for an Instagram post.

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Hi everyone! Sharing some pictures we received in sneak peeks from our photographer because 1) I love them and 2) maybe some inspo for anyone out there still planning! I would really like to do a more in depth breakdown because I went through so much during wedding planning!
I got married in the DFW at The Hillside Estate.
1) Cake - Cake Daddy (he’s done many cakes for my family and is the absolute best)
2) Shoes - Betsy Johnson (these are the ones I ended up wearing down the aisle)
3) Charm for bouquet - Etsy shop: NowThatsPersonal (in honor of my dad who couldn’t be with me)
4) Menu - made on Canva using template from Etsy
5) Dress - designer: Milla Nova; shop: Bridal Boutique in Lewisville, Texas; alterations: Altar’d for the Altar
6) Reserved memorial sign - Etsy shop: EnlighteningLetters
7) Bar vendor - Mama’s Medicine (they were the only vendor we could use for this at the venue but they are rockstars and highly recommend)
8) Disco ball - Etsy shop: DiscoByBrodie (not pictured by photographer. This is from our photobooth)
9) Invitation suite - made on Canva from Etsy template; save the date - made on Canva; earrings - Amazon; ring box - Amazon; shoes - Betsy Johnson (didn’t end up wearing); perfume - Chloé
My photographer and number 1 vendor was Kendrick. His IG is @kendrickterrellphotography. He is an absolute joy! I’m still getting compliments from guests on how amazing he was to everyone. He travels also. He did my engagement shoot in Houston and our wedding in DFW.
I hope this helps someone!

I'll give you my address, Come on to my table..You need to be worried about your kids, & Improve that. Not trying to stand up for your idiot boyfriend who can't handle the truth of anything!