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UnitedHealth overcharged cancer patients for drugs by over 1,000%

fortune.com

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Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#171

Post by FireBeyond »

drawkward wrote: post #71

Why is my insurer (Aetna) allowed to own the only pharmacy (CVS) it covers? That seems like it should be some kind of violation of antitrust law, no?

And for a while, for fun, they also varied pharmacy coverage by state. I live in WA, was traveling in CA for a holiday, and needed to visit urgent care in a town I didn't know well. All good, and then they asked what pharmacy. "Oh, CVS should work if there's one nearby", because that's what I used with my insurer in Washington.

Roll up to the CVS in the Target, and they tell me "Aetna doesn't cover CVS in California at this time"...

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#172

Post by markdown »

cluckindan wrote: post #132
outworlder wrote: post #110

Earlier quoted context omitted.

There are plenty of countries with 'socialized' healthcare that had no wars in their territories.

And which countries would those be?

All the Pacific Island countries.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#173

Post by bloppe »

jandrese wrote: post #148
bloppe wrote: post #145

Earlier quoted context omitted.

I'm going to go ahead and defend them because private insurance is actually far from the most broken thing about US healthcare, yet they seem to shoulder all the blame. Average health insurance profit margin in US is ~3%. That's not a greedy profit margin. It's the health care that's expensive, not the insurance. Health care is much more expensive in the US than in similar countries. I'm not an expert on why, but the…

The army of middlemen the doctors and hospitals need to hire to deal with the insurance companies adds a lot to healthcare costs in the US. Not to mention the armies of middlemen hired by the insurance companies themselves. While every healthcare system has administrators, the US system with its thousands of different systems interacting with thousands of other individuals makes for a nightmarishly complex problem. D…

That may be true. I can only assure you that the army of government bureaucrats who do that work in countries with universal healthcare tend to be less efficient.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#174

Post by jiggawatts »

brightball wrote: post #26
porcoda wrote: post #7

Nothing is shocking about the insurance industry anymore since they’ve been pulling this kind of thing for years. To me the most shocking thing is the people who defend them. I understand the drive to make money and build huge businesses: what confuses me is that we treat human health the same as things that don’t directly impact the health of people. It seems to me that there are endless opportunities to get insanel…

Does anybody defend them? I’ve been on the selection side as an employer and several others will probably echo what I’m about to say. Virtually every insurance provider is going up 15-20% / year to the point that it’s completely unsustainable. United was quoted to me as almost 20% lower than current rate for our provider (before they are about to go up 20%). On premium alone they will save some people close to $500 /…

> $500 / month

What the actual f!?

That saving is double the total cost of my private health insurance in Australia!

This includes the “Medicare levy” tax I pay at the highest rate because I get an above average income.

Health insurance cost is something I just don’t think about.

My missus reminds me every few years to combine our plans because it might save us AUD 250 per… year. Maybe.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#175

Post by adamc »

acchow wrote: post #19
porcoda wrote: post #7

Nothing is shocking about the insurance industry anymore since they’ve been pulling this kind of thing for years. To me the most shocking thing is the people who defend them. I understand the drive to make money and build huge businesses: what confuses me is that we treat human health the same as things that don’t directly impact the health of people. It seems to me that there are endless opportunities to get insanel…

How do you respond to people that say the profit motive is what drives innovation, and in the long term we’d rather have better, novel treatments sooner

I'd say we have an unsustainable system, and innovation that makes it less sustainable is not particularly helpful.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#176

Post by bugglebeetle »

tptacek wrote: post #150
gedpeck wrote: post #116

Earlier quoted context omitted.

One should not profit from denying care. All health systems ration care. Doing so in a way that people profit from denying care is immoral.

If you believe that, you should have a bigger problem with what providers bill, because that's the ultimate origin of the constraints.

Your argument would be more convincing (well, not really because it’s typical bad faith contrarianism) if insurers weren’t also some of the largest hospital and clinic owners in the U.S. and use this to rob people blind on both ends.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#178

Post by lotsofpulp »

legitster wrote: post #109

> CVS Caremark, by comparison, argued the FTC was guilty of “cherry picking” its analysis by focusing on generics, which represent a tiny fraction of client spending over branded specialty drugs in an attempt to mislead. So it sounds like the report may be a bit misleading - what is being alleged here is that PBMs overpriced over the generics . So it's like if Coca-Cola set the price of their can at $50, and NoName a…

>It's not actually clear from the report that the PBMs actually profited from overcharging.

Even if they did profit, it is clear from their 10-Q and 10-K that the managed care organizations (MCO) did not tremendously profit.

https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...

This kind of profit margin (On the other hand, here are the profit margins for the companies that make medicine (20%+):

https://www.macrotrends.net/stocks/charts/LLY/eli-lilly/prof...

https://www.macrotrends.net/stocks/charts/NVO/novo-nordisk/p...

https://www.macrotrends.net/stocks/charts/NVS/novartis-ag/pr...

https://www.macrotrends.net/stocks/charts/PFE/pfizer/profit-...

https://www.macrotrends.net/stocks/charts/MRK/merck/profit-m...

Finally, search for the difference in rankings in market cap between pharmaceutical companies versus managed care organizations. There are at least 7 pharmaceutical companies in the top 100, and only 1 managed care organization. The next biggest MCO is #189.

https://companiesmarketcap.com

Edit to respond to below: It does not matter if UNH or any other MCO moves money from their right pocket to their left pocket, the SEC filed 10-Q and 10-K will reflect all revenue and expenses. Their low profit margin is evidence that the money is flowing out of the organization and away from the shareholders. If this business was as profitable as people claim, then its stock returns would indicate it, but they don't.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#179

Post by markdown »

bloppe wrote: post #145
porcoda wrote: post #7

Nothing is shocking about the insurance industry anymore since they’ve been pulling this kind of thing for years. To me the most shocking thing is the people who defend them. I understand the drive to make money and build huge businesses: what confuses me is that we treat human health the same as things that don’t directly impact the health of people. It seems to me that there are endless opportunities to get insanel…

I'm going to go ahead and defend them because private insurance is actually far from the most broken thing about US healthcare, yet they seem to shoulder all the blame. Average health insurance profit margin in US is ~3%. That's not a greedy profit margin. It's the health care that's expensive, not the insurance. Health care is much more expensive in the US than in similar countries. I'm not an expert on why, but the…

The only reason healthcare is so expensive is because a dysfunctional insurance industry exists.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#180

Post by herrkanin »

yadaeno wrote: post #139
porcoda wrote: post #7

Nothing is shocking about the insurance industry anymore since they’ve been pulling this kind of thing for years. To me the most shocking thing is the people who defend them. I understand the drive to make money and build huge businesses: what confuses me is that we treat human health the same as things that don’t directly impact the health of people. It seems to me that there are endless opportunities to get insanel…

Medical Loss Ratio (MLR) is capped at 85% in the US which means 85% of revenue must go to patients. This is roughly inline with other countries with universal healthcare (MLR ranges from 85-95%). The fundamental problem is that we don’t have enough resources to take care of everyone. Insurance companies are faced with the impossible task of allocating resources and making care/nocare decisions. I don’t get the “endle…

so by increasing the cost of patient care, they can take out more profits.
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