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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%

#221

Post by bugglebeetle »

100ideas wrote: post #198
NickC25 wrote: post #74

Earlier quoted context omitted.

>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…

It gets even better (quoting from ceejayoz down-thread):

>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.

https://news.ycombinator.com/item?id=42717812

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

#222

Post by adamredwoods »

We have UnitedHealth, and my wife died of cancer. They denied a lot of things, but ultimately, they covered a lot when we rapidly soared past our deductible. We kept a running list of EVERY bill paid. It's a shame they put so much onus onto the family dealing with tragedy.

So while it was a pain to fight them on every bill, they did shell out for us.

Some of the biggest battles were with the hospital bill collectors.

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

#223

Post by theGnuMe »

100ideas wrote: post #198
NickC25 wrote: post #74

Earlier quoted context omitted.

>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…

Seems like it does. This is where the FTC needs to act.

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

#224

Post by Jimmc414 »

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?

Iceland New Zealand Australia Sweden Norway Switzerland Finland (winter war might count)

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

#225

Post by ceejayoz »

yoyohello13 wrote: post #137
jmyeet wrote: post #64

Just look at the per-capita spending on healthcare by OECD countries, basically all of which have universal healthcare except for the US [1]. So the US pays almost twice as much as #2 (Switzerland) for significantly worse outcomes and less coverage. The US healthcare system is an unmitigated disaster that is a cautionary tale in how capitalism only promotes rent-seeking and regulatory capture. It's done with a servic…

This is what blows my mind about the universal health care opponents in the US. We would literally be spending less for better health care. People just cannot stomach their money going to the government instead of an unelected mega corp.

When Elizabeth Warren was promoting Medicare for All, she kept being asked the "how will you pay for it?" question over and over and over again. Debates, reporters, critics...

People hear "X increase in tax, 3*X decrease in costs" as "X increase in tax!"

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

#226

Post by maxerickson »

lotsofpulp wrote: post #178
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://ww…

Yes, the profit flows into the pharmacy, which happens to have substantially the same owner.

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

#227

Post by [deleted] »

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…

[deleted]

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

#228

Post by [deleted] »

BugsJustFindMe wrote: post #4

https://archive.ph/cg4we I do not like UnitedHealth, I do not like our existing crop of health insurance executives, and I might even be viscerally glad at some level that the UnitedHealth CEO was killed in a world where justice clearly takes a back seat to greed, but I wish the headline didn't say "overcharged", because there's no established amount of markup that is the correct amount of markup other than what peop…

[deleted]

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

#229

Post by tptacek »

gedpeck wrote: post #209
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.

I take it then that we agree that for profit health insurance companies profiting from denying care is immoral. That there are other immoral actors is not germane to the discussion.

No, we don't agree. I think there are different values implicated in our system, in a system like the UK NHS, and a system like Australia's (for the record: I'd take Australia's over ours).

The UK does a good job of hiding economic concerns from its users, at a cost in availability of services, especially high-end and experimental interventions. The UK makes these rationing decisions knowing that some people are going to be denied life-saving care, but in exchange for that everybody else in the system will get predictable access to their care.

The American system does a good job of getting services delivered to customers; it does a better job of that than the NHS does, if you measure in interventions performed; it does such a better job at that that it's a real problem in our system: we overprescribe and overdeliver interventions that drive costs and decrease certainty as payers work out which things to cover and which not. The flip side of that is that everyone in that system can tell themselves that the system is doing what it can to gate delivery on whether care is truly needed and will be effective, and that it's not categorically denying care because of top-down mandates.

Neither set of values is totally benign. You can prefer one or the other.

I can go all 12 rounds on this topic, but if I keep writing about this I'm not going to write the work thing I'm supposed to write, so I'll leave it there.

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

#230

Post by fellowniusmonk »

bloppe wrote: post #173
jandrese wrote: post #148

Earlier quoted context omitted.

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.

Why provide personal assurances on the internet? That seems like a "trust me bro" approach.

So tell me, what is the relative cost efficiency of the U.S. Healthcare System vs France/GB/etc..?

People like to use the term government bureaucrat as a thought stopping term, when combined with trust me bro "assurances" it seems extremely hollow.

Give me a data/financial analysis instead of something that sounds like the advice two old dudes sitting in front of a five and dime pre-internet.

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