Summary: Insurance companies own hospital networks, hospitals, urgent care centers, and small doctor practices. This is a conflict of interest, results in higher health care costs and worse care for patients. Insurance companies should be forced to divest all ownership and control over both providers and pharmacies.
In response to the killing of United Healthcare (UHC) CEO Brian Thompson, the insurance industry has launched public relations campaigns in traditional media and social media blaming health care providers for the high cost of care and downplaying any role insurance plays in prices. These undisclosed paid shills are easy to spot, they will generally post some high cost of care, go out of their way to say insurance covered it, and point to low profit margins of insurance companies.
First, no one goes to social media to post about their health insurance covering care. Why would anyone celebrate coverage? It’s literally what is being paid for, not something to celebrate. Second, no one goes to social media to complain they think it’s unfair their multibillion dollar insurer isn’t making high enough profit margin. Have you ever gone to social media to complain a multibillion dollar middleman isn’t making enough money?
What isn’t being shared in any of this paid for PR fluff is that insurance companies own most of the providers in this country and insurance companies, not providers, set the rates.
As an example, UHC employs 90,000 physicians, that is 10% or 1 out of every 10 doctors in the US. When you have UHC insurance odds are you are getting care from a doctor employed by UHC. UHC uses this position as the employer of doctors to dictate how they treat patients to maximize their profit and minimize costs - having nothing to do with the best interest of the patient. If a doctor not employed by UHC doesn’t comply with the policy of minimizing UHC costs and maximizing their profits, UHC will drop those doctors from their networks.
A common example is chronic care patient with type 2 diabetes. Good care would generally consist of prescribing 30 day insulin and having the patient return to do a blood glucose check to refill the medication. That is expensive, so when a patient goes to fill the 30 day insulin, the big pharmacies gets a not in their software suggesting to change it to 90 day. Where does that note really come from? Insurance companies and in some cases like Medicare patients the pharmacy/pharmacist even gets a tip, or bonus, for faxing a request for change to the doctor and a 2nd tip/bonus if the doctors makes the change. It’s an easy sell to patients, “hey do you want me to ask you doctor for 90 days instead of 30? Sounds good to the patient, but insurance just interferes with the patients care, and in many cases risk of hospitalization goes up significantly when the doctor doesn’t see the patient for 90 days. This all happens so insurance only pays for 1 doctor visit instead of 3 in a 90 day period, because it’s cheaper if a few patients die and a few get hospitalized than the insurer paying for 3 doctors visits in the same time period.
Insurers/Medicare should not be paying tips/bonuses for requesting changes to patient prescriptions on behalf of insurance companies. Also doctors should not feel pressured to make those a changes, or practice care, based on what is most cost effective for their employer (the insurance company), or otherwise get dropped from insurance networks for not treating patients in a way that is best for the insurance companies.
The only way to make these changes and return to a system of care that is best for patients is by prohibiting insurance ownership/control over pharmacies & health care providers.