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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%

#211

Post by ceejayoz »

tptacek wrote: post #200
bugglebeetle wrote: post #176

Earlier quoted context omitted.

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?

UHC is the largest single employer of doctors in the US.

https://www.statnews.com/2024/07/25/united-health-group-medi...

> It’s no secret that UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. And thanks to a series of stealthy deals, almost 1 in 10 U.S. doctors — some 90,000 clinicians — now either work for UnitedHealth or are under its influence, more than any major clinic chain or hospital system.

They purchase physician groups... and then pay themselves higher rates.

https://www.statnews.com/2024/11/25/unitedhealth-higher-paym...

> UnitedHealth Group is paying many of its own physician practices significantly more than it pays other doctor groups in the same markets for similar services, undermining competition and driving up costs for consumers and businesses, a STAT investigation reveals.

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

#212

Post by craigmccaskill »

tptacek wrote: post #205
craigmccaskill wrote: post #189

Earlier quoted context omitted.

Agree that it's not perfect, but I do feel that we could take 60-80% of the money we're currently spending and fix this and any other issues that come up and get in the way of improved outcomes like the rest of the world does. I don't know why what you're describing happens, but my money would be on some triage that needs to happen due to limited funding since so much of our spending goes into private healthcare solu…

I really just have two things to say on this subthread: * Medicare would not have 2% overhead if it served 30-year-olds. * Medicare is in fact the primary constraint on the supply of doctors in the US system.

Fair, don't think I disagree with you on these points. I just believe we can do significantly better. In a similar vein, I believe:

* For profit motives get in the way of cheap, effective healthcare. Maximizing shareholder value leads to higher prices, overutilization of expensive proceedures and prioritization of profit generating services vs. preventive care or basic health care needs and improved outcomes.

* Incentives are currently heavily skewed to the point that providers and insurers are more likely to treat symptoms rather than address root causes or preventive measures leading to a cycle of chronic illness and higher long term costs.

* Access to healthcare should not be tied to socioeconomic status. Employer sponsored insurance and high out of pocket costs create significant barriers for lower income individuals and families, dragging the average down (i.e. the system is fine if you can afford it).

* Administrative complexity in the current system massively inflates cost. The fragmented nature of private insurers, billing systems and out of network shenanigans results in massive inefficiencies and expenses that contribute nothing to patient outcomes. I am confident this comes out to more in savings than the %age profit that is referenced in other places in this thread.

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

#213

Post by ceejayoz »

tptacek wrote: post #204
ceejayoz wrote: post #185

Earlier quoted context omitted.

> And billing us 4x more for it than Europeans In part, because dealing with insurers is immensely costly in staff and time. (Other parts include the immense cost of twelve years of secondary education here; a million bucks in student loans isn't uncommon.) > a lot of that work is wasteful and unnecessary (see: spinal fusion surgeries, back imaging) Which makes the "insurers are there to reduce waste!" argument espec…

Doctors don't make 4x more here than in Germany because of insurance costs.

Healthcare here isn't 4x the price because of doctor costs, either.

https://www.washingtonpost.com/business/2023/08/04/doctor-pa... / https://archive.is/ZBRMx

> Polyakova and her collaborators find doctor pay consumes only 8.6 percent of overall health spending. It grew a bit faster than inflation over the time period studied, but much slower than overall health-care costs.

> “People have a narrative that physician earnings is one of the main drivers of high health-care costs in the U.S.,” Polyakova told us. “It is kind of hard to support this narrative if ultimately physicians earn less than 10 percent of national health-care expenditures.”

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

#214

Post by hn_throwaway_99 »

mattgreenrocks wrote: post #159
hn_throwaway_99 wrote: post #100

I think one of the things that deserves discussion here is the whole concept of pharmacy benefit managers in the first place. To start, can anyone give some good resources that really explain clearly what the role is that PBMs actually serve, and how the whole system even functions? I've tried to understand in the past but have always thought "Why do you exist???". Like the whole way companies like GoodRX can have a…

Or the fact that you can mail order some name brand prescription drugs from Canada for a fraction of what you'd pay here. Grift all the way down.

Well, at least that one I understand. That is, other countries have much stricter pricing controls on medications, while the US does not. So pharmaceutical companies argue that it's essentially the US that makes drug discovery worth it - they basically say that if the US had strict price controls too, then it means that drugs research wouldn't be viable to invest in in the first place. Not at all arguing that's true (I don't know), and even if it is true it just means the American customer for those medications is carrying the load for everyone else, which besides just being unfair doesn't seem sustainable in the long term.

But again, at least that one I theoretically understand. PBMs make no sense to me whatsoever.

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

#215

Post by ruthmarx »

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…

> I think some critiques of American health insurance are simplistic,

At it's core, details are not really needed to show how atrociously inequitable the system is.

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

#216

Post by fredrikholm »

throwway120385 wrote: post #32
NickC25 wrote: post #20

Earlier quoted context omitted.

UHC double-dips because they own Optum even though Optum is "independent". It's fucking disgusting. How they were allowed to buy Optum and didn't have every regulator in the country on the case is beyond me. I $truggle to think how $omething like thi$ wa$ allowed to happen. Bastards.

My wife had to quit seeing her doctor of many years a couple of years ago because as Optum has been devouring practices in our area, they stuck her with a surprise bill almost a decade ago and then fired her as a patient without providing even a statement. Now that they own her doctor she can no longer go to that practice even though she was a paying patient for many years.

> fired her as a patient

This is the most absurd set of words I've read in a while.

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

#217

Post by fellowniusmonk »

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…

Even using more accurate financial indicators like Operating Cash Flow and Free Cash Flow still leave lots of room to obfuscate egregious behavior.

I don't know, people who talk about profit margins as if they mean anything in this context are either financially naive or are trying to muddy the water.

I'm not sure a low profit margin is indicative of a company providing a moral degree of service to their insured. Certainly naive profit margin percentages don't show the terptitude of overcharging cancer patients.

For someone who doesn't get this, if a company like UHC buys an entire hospital group they can use that expenditure to legally "hide" profits by reducing their "profit margin" short term while decreasing competition in the space.

If a company acquires enough debt in a given year they can "hide" nearly unlimited profit margins legally.

On a larger scale, a company (UHC) can dump money into "external" money losing ventures that just serve to hold wealth and take that money off their balance sheet, once that entity takes on enough debt the same company (UHC) can acquire it taking on that debt and reducing their profit margin yet again.

GE Capital and Amazon are poster children for having done this process in a legal fashion.

As a beginners guide, if you have access to a talented accounting firm you can ask about these approaches to get started:

1. Management & Consulting Fee Arrangements (Especially with Related Parties)

2. Transfer Pricing (in Multinational Contexts)

3. Debt Pushdown & Thin Capitalization

4. Special Purpose Entities (SPEs) or Variable Interest Entities (VIEs)

5. Intellectual Property (IP) Holding Companies

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

#218

Post by MandieD »

ceejayoz wrote: post #208
jiggawatts wrote: post #174

Earlier quoted context omitted.

> $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.

Yeah, it's bad here. My health insurance premium (family of four) went from $3,000 US/month to $3,600/month on Jan 1. That doesn't cover everything, either - there's a deductible, and then there's copays, which means up to $9k/year out of pocket on top of those premiums.

Dear God. I pay a bit more than 400 EUR/mo, my employer pays a bit less than that, and my employer is delighted for me to take sick leave if I've got a cold because guess who pays my sick leave?

My health insurance.

(Germany, "public" insurance with one of the 150 or so "sickness funds" those of us in the 90% who have to be on public insurance can choose from)

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

#219

Post by awongh »

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?

Google says UHC made $370b gross revenue and $12b net revenue.

Not sure what the total exec team costs but if the ceo was paid $10 million that’s 0.03% of revenue and 0.1% of profit.

Not defending them but I do think that people hear $10 million but don’t quite realize how huge the pie is.

I don’t think healthcare should be for-profit, but since we do have that system, what do people expect the ceo of a company (any company) that grosses $370b to earn?

It’s a bit reductive to just say something like “he makes $10 million dollars a year denying patient life-saving treatment”, just like saying the ceo of ratheon makes money from the killing of innocent Palestinians.

In the end though, I increasingly feel like the only moral solution is to have a single payer fully socialized system.

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

#220

Post by maxerickson »

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…

No, it's saying that they bought the NoName for $0.20 and sold it for $20.

The PBMs are defending it, saying that coke costs $30.

The problem is that the insurer and thus the PBM are supposed to be working on behalf of the insured, but they pay their sibling pharmacy well above the reasonable market price.

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