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CVS Is Said to Agree to Buy Aetna

nytimes.com

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Re: CVS Is Said to Agree to Buy Aetna

#141

Post by peg_leg »

throwaway13337 wrote: post #117
ropeladder wrote: post #114

The only real upside I see here is that, the more vertically and horizontally concentrated the private sector gets, the more absurd most arguments for privatized, profit-driven healthcare appear. Basically every other developed country has shown that the government can do as good of a job at half the cost. Socialize it all.

I agree in spirit but I'd also point out that our public spending on health care is already at about the same costs as western counties with socialized medicine. [1] Our tax dollars are already paying out as much as other countries do but their citizens get a lot more for their money. The solution to lowering the cost of medicine in the US has not a single solution but lies at every level of the system. [1] https://w…

Much of what we pay goes to Profit on several levels - insurance, provider, and medications, et al. That's where the American waste is.

Re: CVS Is Said to Agree to Buy Aetna

#142

Post by Broken_Hippo »

bartart wrote: post #35

Does this mean that many CVSs will become magnets for sick people as CVS tries to integrate more basic health services into its stores? I realize that most people going to an expanded minute clinic aren't going to be some sort of walking dead, but it seems that if CVS tries to make its stores too much like primary care with ill people going to get prescriptions from a doctor, then people will avoid buying things at i…

CVS is a pharmacy. That means it is already a magnet for sick people.

Allergies? Pharmacy. Long-term disease? Pharmacy. Cold or flu or want to try the natural meds for pinkeye? Pharmacy. And a slew of other infectious and non-infectious diseases, maladies, and injuries.

Re: CVS Is Said to Agree to Buy Aetna

#143

Post by Broken_Hippo »

ahh wrote: post #37

I wonder if this will lead to restrictions on the use of copay coupons [1]. Insurers hate them since they break my incentive to use cheaper drugs from their formulary, but pharmacies don't care (and probably are better off for me using them.) Since I mostly hate my insurer and want to help them towards bankruptcy by extracting as much coverage from my fixed premium as possible, I have no objection to using these coup…

That highly depends on your prescription insurance coverage and how much they have to pay compared to the generic.

For example, some simply won't cover the brand name if the generic works for you. Others will let you get the brand name, but will only cover the amount they would pay for the generic. In either of these situations, the coupon wouldn't matter to the insurance company.

With other plans, though, the insurer pays more with the coupon. And if yours does, you can "stick it to the man" using coupons.

Re: CVS Is Said to Agree to Buy Aetna

#144

Post by theklub »

IBM wrote: post #16

A big chunk of the health care industry is the oligopoly of distributors. There's only 3 of them: McKesson, AmerisourceBergen and Cardinal. If Amazon can bring much needed competition to that part of the healthcare market it'd help bring prices down. CVS is moving up the stack because they're afraid of Amazon entering the industry. They're combining a retailer, PBM and now a health insurer. Personally I think it shou…

What's interesting is there have been other Healthcare mergers that have gone under the radar. For example United buying a large physician group based in CT. So now you have an insurance company also providing the healthcare. This was a few years ago too... http://www.modernhealthcare.com/article/20151221/NEWS/151229...

Re: CVS Is Said to Agree to Buy Aetna

#145

Post by theklub »

throwaway0255 wrote: post #39
rsync wrote: post #28

I feel that perhaps healthcare is the ultimate triumph of capitalism. Every other avenue of runaway consumerism and overconsumption can obviously be pointed to as either indulgent or unnecessary. But not healthcare: it's your health, after all - your wellbeing. It's a fundamental right, right ? ... The received wisdom is that the aging of the baby boomer generation is driving expanded healthcare expenses as this larg…

> The boomers represent an irresistible pile of money. But they don't smoke. They don't have new households to start. They're getting wise to the whole sugar thing. What is left to tempt them with ? > What if there were a clear imperative on the part of a variety of industries to keep this population as unhealthy as possible - so they can stripmine their assets for "healthcare" ? It's not clear that living a healthy…

Actually that is a really good point, keep people healthy they live longer but are very reliant on healthcare for that last 20-30 years of their life.

Re: CVS Is Said to Agree to Buy Aetna

#146

Post by vilmosi »

chimeracoder wrote: post #88
Flammy wrote: post #66

Earlier quoted context omitted.

How would that not significantly harm the pharmaceutical companies? Don't they make a decent percentage of their revenue off of brands which are currently price protected via these tariffs?

> How would that not significantly harm the pharmaceutical companies? Don't they make a decent percentage of their revenue off of brands which are currently price protected via these tariffs? As lostapathy explained below, US prices are currently high because that's where pharmaceutical companies are capturing their profits. In fact, even European pharmaceutical companies make most of their revenue from sales in the…

>>> In fact, even European pharmaceutical companies make most of their revenue from sales in the US, not Europe. (This is why the US funds over 50% of R&D for the entire world, even though it only has 300 million people, and many of the largest pharmaceutical companies are based in Europe, not the US).

This just isn't true. Take Norvatis for example, one of the biggest pharmaceutical companies in the world. The US makes 35% of their revenue and Europe another 35%, with the rest of the world sharing the rest. [0]

I wouldn't call that "most of their revenue". In fact, I don't see anything out of the ordinary about revenue gained per customer, given the size and purchasing power of the US.

There's little evidence to suggest that higher drug prices actually help the drug companies.

[0] https://www.statista.com/statistics/294631/novartis-revenue-...

Re: CVS Is Said to Agree to Buy Aetna

#147

Post by quadrangle »

Consultant32452 wrote: post #87
greenyoda wrote: post #57

Earlier quoted context omitted.

But if just one of the people insured by Aetna ended up in the hospital due to complications from the flu due to not getting a flu shot, the amount of money they'd have to pay for the hospital stay would pay for hundreds of flu shots.

The insurance provider doesn't care how much it costs. The ACA states that the insurance provider must spend 80% on services. So as far as they're concerned, the higher the costs of healthcare the more money they get to keep. They just can't let costs skyrocket faster than they're able to increase your premiums.

The market is a horrible contrivance, and insurance is fundamentally unworkable in a market, unlike actual services and products where you know what you're getting and when you'll need it…

But that said, do you have even the tiniest bit of evidence that insurers actually do what you're saying in order to keep their costs up per ACA requirements??

There's all sorts of shenanigans in the industry, but your speculation sounds far-fetched. Remember Hanlon's Razor…

Re: CVS Is Said to Agree to Buy Aetna

#148

Post by mywittyname »

alphabettsy wrote: post #110
Spooky23 wrote: post #109

Earlier quoted context omitted.

The pharmacist “supervises” te process. Mail order has been doing this for 20 years. There used to two big ones... Caremark and Express Scripts. Now CVS, the Comcast of drugs, swallowed both up. Hospitals do this too. In some cases 2-3 pharmacists can cover 10-12 hospitals for off shift dispensing needs. With the black horse cavalry running the country, we’re going to see lots of M&A activity like this.

Pharmacists must directly supervise dispensing. Many hospitals use a central-fill pharmacy where the prescriptions are filled for many hospitals. The problem with these mergers is they allow health plans that further disadvantage other pharmacies or providers. Once those other options are eliminated we’ll see prices rise. Do people actually want the Home Depot’s of healthcare rather than the equivalent of the local h…

Optical insurance has been like this for a long time. For example, EyeMed is owned by Luxottica, who owns the majority of eye wear retailers in the USA.

Evidence suggests that they've used their monopoly to artificially inflate prices quite dramatically.

Re: CVS Is Said to Agree to Buy Aetna

#149

Post by mywittyname »

remarkEon wrote: post #135
maxerickson wrote: post #85

Earlier quoted context omitted.

The Minute Clinics are staffed by nurse practitioners and physician assistants https://www.cvs.com/minuteclinic/why-choose-us/our-practitio... To expand their services to all of their stores, they'd be looking at hiring 5 or 10 percent of the NPs and PAs in the country.

Or...the publically signaled demand for those relatively high paying jobs would encourage more people to seek training for those opportunities.

These aren't easy roles to get into. The educational requirements are pretty high (MS or PhD) and the courses are rigorous. The educational requirements are close enough to an MD that I'm sure most people considering being an NP from the onset also debate just getting an MD.

The minimum requirements of a RN is an Associates degree and successful completion of the NCLEX -- though, many hospitals require a person to also obtain a BSN after a few years to continue being employed. That's a big educational jump to make.

I don't think pay is a big motivator for nurses. There are so many better paying jobs out there that are easier to get, and don't involve dealing with the figurative and literal shit nurses deal with daily.

Re: CVS Is Said to Agree to Buy Aetna

#150

Post by aaavl2821 »

just1nn wrote: post #103
jrnichols wrote: post #76

Earlier quoted context omitted.

> treated for rashes or flus by nurses I sometimes think that's one of the things that's kept health care so expensive. Nursing salaries aren't cheap. A lot of the home health and basic clinic stuff could be handled by an LPN/LVN or even a Paramedic in many cases. Not everything needs an RN. There are plenty of available telemedicine options to put a provider in touch with a higher level of care if necessary.

"Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper. If you show up at an urgent care, just expect that you will be treated by a LPN and a PA or a NP. A Family Practice physician's salary is about comparable to a Sr. Engineer at many tech companies (~160k), and they can have significant malpractice insurance overhead and insane hours. A PA or NP still makes 6 figures, so the "savi…

"professional extenders" are often "profit extenders", as the supervising physician can enable his / her practice to see more volume and better match revenues and costs (ie have lower cost labor do lower revenue / acuity work). the "savings" from this often end up accruing to the owner of the practice. increasingly this owner is a large hospital system, but they take this delegation a step further, using lower cost primary care as a way to increase volume to higher acuity / reimbursed hospital procedures.
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