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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%

#191

Post by robbiewxyz »

There's such obviously fucked up incentives in this industry.

- When employers select insurance, providers will 100% of the time tend toward ignoring the interests of those who are insured: the incentives to do so are just too strong.

- When an insurance company also owns a pharmacy, it will 100% of the time tend toward overcharging: again all the incentives encourage this.

Unfortunately it seems most folks have little or no experience analyzing incentive structures when looking for levers to pull to improve outcomes. It'd be great to see popular discourse focus more on the environmental factors that incentivise these kinds of corporate abuse.

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

#193

Post by bloppe »

sssilver wrote: post #157
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 profit margin is just the shareholders' cut though. What about the CEO salary? What about his secretary? The rent they pay for the buildings they occupy? Going down that path, how much of the operational expenses of private insurance meaningfully improve patients' health?

Not having to worry about any of those details is the whole point of having a competitive market in the first place. Any company that isn't serious about avoiding overpayment (even to their own CEO) becomes obsolete. And yes, it's a very competitive market with thousands of players and Obamacare setting a ceiling on rates and a floor on coverage.

If the market is competitive, you can trust that you're getting what you pay for. If it's not, well then that's the problem.

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

#194

Post by regularization »

SpicyLemonZest wrote: post #101
btbuildem wrote: post #76

[flagged]

It's hard to imagine anything more toxic to the cause of healthcare reform than tying it to support for vigilante murder.

People have wanted health care reform in the US for over a century and it is farther away from ever. This carrot you are waving does not exist, which is why CEO Brian Thompson has filed his last claim denial.

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

#196

Post by awongh »

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…

I’m not an expert but I’m wary of anyone who has a simplistic view of what seems to be a complex system. This, plus looking at the profit margin of UHC paints a more nuanced picture (net profit margin is not that high. the dollar amount is high because the scale of the company is big). (Not that I want to make money from denying people healthcare, no matter how much internal logic there is to it…)

But it does seem like there’s a serious prisoners dilemma type situation going on in American health care. It’s easy to point fingers at someone else.

The situation is also coupled with a toxic political environment where a Trump voter can simultaneously be against “Obamacare” and think that Trump is going to improve access to healthcare, and a Harris voter can be pro Obamacare and ignore regulatory capture by pharmaceutical companies- e.g., both sides so convinced they’re right and the other side is wrong they won’t be seen to agree on anything common sense.

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

#197

Post by RunawayGalaxy »

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…

> If anything it’s the providers who are screwing over patients by gaming insurance and taking more than is necessary from the shared insurance pool of money.

If the 85% gets larger, so does the 15%. Both sides gain when the cost increases.

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

#198

Post by 100ideas »

NickC25 wrote: post #74
chis wrote: post #40

I think some critiques of American health insurance are simplistic, but this truly seems very bad. From the report: > "Higher markups can also result in larger internal transfer payments from health plans to affiliated pharmacies, which may allow vertically integrated PBM-pharmacy-insurer entities to retain revenue and profits while formally satisfying the insurers' medical loss ratio ("MLR" ) requirements, but witho…

>In other words. Health insurance firms have capped profits in the US. But in this case one conglomerate can own both an insurer and a PBM, so it can just overcharge consumers for insurance and then launder its profits through the PBM. Most insightful comment in this thread. THIS is the crux of the issue, and we've allowed the likes of UHC to buy PBMs and other pieces of the supply chain / customer lifecycle because…

You just answered my question:

Is it the case that UnitedHealth and Cigna each own (or control) one of the "big three" PBMs? If so, that is a just crazy - the control insurance premium pricing, benefit decisions, AND the pricing of covered medications?

yadaebo wrote below "Medical Loss Ratio (MLR) is capped at 85% in the US which means 85% of revenue must go to patients". Does controlling a big PBM allow an insurance company a loophole?

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

#199

Post by SketchySeaBeast »

baq wrote: post #53
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…

It shows that the US never had a world war on the continent. All the other countries treat health care as a matter of national security. The US’s primary concern is mark to market in pension funds.

I'm not sure I follow that argument - Canada shares a continent.

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

#200

Post by tptacek »

bugglebeetle wrote: post #176
tptacek wrote: post #150

Earlier quoted context omitted.

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.

Which hospital chains are you referring to?
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