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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%

#261

Post by cameldrv »

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…

Yes. I have been trying to figure out for years why the PBM system is so convoluted and seemingly so much more central to healthcare than it was, and this seems like it must be the reason.

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

#262

Post by yalogin »

jrflowers wrote: post #17
yalogin wrote: post #8

I don’t understand how an insurance company can overcharge consumers. Isn’t their job to pay what pharmacies and hospitals charge? Do insurance companies get money if they approve the overcharged prices? If so how? I thought their revenue was the premiums which are fixed. Is the extra money because people are forced to pay everything after the little the insurance company pays?

UnitedHealth is not an insurance company. They own an insurance company as well as OptumRx, a pharmacy benefit manager, which is described at the very top of this article.

Looks like we need regulation to prevent a company to own the whole stack like this. Leads to exploitation of consumers as we see here. Of course there is no will to do this in our politicians when they get bought for pittance

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

#263

Post by inferiorhuman »

tptacek wrote: post #155
ceejayoz wrote: post #134

Earlier quoted context omitted.

> look at combined hospital and physician expenses compared to insurer expenses; it's pretty black-and-white I mean, yeah. They're doing all the work .

And billing us 4x more for it than Europeans, and, further: a lot of that work is wasteful and unnecessary (see: spinal fusion surgeries, back imaging). There were more MRI machines in Massachusetts in 2023 than there where in all of Canada .

No, they're billing insurance companies that much. For-profit insurance companies are incentivized to drive up the cost of care because of the cap on their profit margins. More expensive care equals more profits as a bigger pie means a bigger profit even if the percentage remains the same.

Medicare's rates are about a half to a third of what private insurers have managed to negotiate. Funny how that works.

Doctors are not the problem with American health care, for-profit insurance is.

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

#264

Post by nradov »

landryraccoon wrote: post #259
theteapot wrote: post #253

Earlier quoted context omitted.

Really apples and oranges comparison. But even so, if a certain App user is motivated to have the hostile App developer make a change that doesn't server their interest, they'll need to do better than cry "this app sucks".

It's even worse than you're saying actually, because health care has no price transparency, very little consumer choice, no negotiating power on the part of the user and even the services provided are extremely opaque. To be honest, I'm quite surprised you're siding with the provider here. Are you personally satisfied with healthcare pricing in the United States? Do you not share my intuition that in general, healthc…

Health care now has significant price transparency, although there are still some major gaps and it can be challenging to shop for the best option. Many consumers are still unaware of the tools available.

https://www.cms.gov/priorities/key-initiatives/healthplan-pr...

https://www.cms.gov/priorities/key-initiatives/hospital-pric...

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

#265

Post by inferiorhuman »

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.

  Medicare would not have 2% overhead if it served 30-year-olds.
Swing and a miss. Medicare does cover 30 year olds, you just have to be sick enough to qualify. So in fact Medicare covers the least profitable young folks.

Edit since responding to your prolific bad faith arguments got me throttled:

Your argument is that younger people would magically add to the overhead incurred by Medicare. My point is that Medicare's low overhead already includes younger people who are more likely to use expensive modes health care more frequently than the typical younger person. And even then Medicare denies claims at a much lower rate than for-profit insurance companies.

But somehow, adding more, healthier younger folks to Medicare would add to the overhead?

Nah.

Edit since I might as well address another bad faith argument:

  Medicare rate limits the number of new doctors allowed into the system
  every year, through the residency funding system.
Congress controls that funding. Medicare is the administrator. At best your phrasing is disingenuous.

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

#266

Post by inferiorhuman »

ceejayoz wrote: post #202
BugsJustFindMe wrote: post #167

Earlier quoted context omitted.

The trouble with this cascades as follows: 1) I don't know what Medicaid pays. 2) I don't know that what Medicaid pays is a just price until we define what a just price is on its own merits. Maybe Medicaid pays more than they should. 3) What Medicaid pays could change at any time for any reason unless what Medicaid pays is based itself on some metrics that define otherwise, in which case let's just look at those metr…

1. Unlike private insurance, this is publicly available. 2. If anything, it's a bit stingy. The negotiating power of government (and the predictability of it) helps keep reimbursements down here. 3. I mean, that's how they're set. They analyze how long and how much a particular procedure should take/cost. 4. Sure.

  The negotiating power
And the more predictable process. Private insurers (especially UHC) are notorious for changing up the minutiae of the claims process in order to increase the proportion of claims they deny. There's a cost associated with having to maintain a huge staff just to hassle with for-profit insurance companies.

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

#267

Post by nradov »

mattgreenrocks wrote: post #147
throwway120385 wrote: post #51

Earlier quoted context omitted.

It ceased to be a free market when we enshrined employer-provided plans into the law. If it were more like auto insurance where I can fire my insurance company and receive a pro-rated refund or renegotiate coverage in the middle of the year then it would be more free. But my employer negotiates for me on my behalf, and their needs are often at odds with my needs. And the whole "open enrollment" period thing creates a…

I never understood why health care had to be so tightly coupled to employment. All it does is tie people down, obfuscate costs, and give insurance companies more leverage over everyone, companies and employees alike.

This is an example of what economists call path dependence. In principle there's no good reason for access to health care to be coupled to employment and we wouldn't design the system that way if we were starting from scratch. Originally it started during WW2 when the federal government imposed wage controls to hold down inflation, so employers took advantage of a legal loophole to offer free employee benefits such as health insurance in order to attract workers. At that time healthcare was pretty cheap because it couldn't really do much. That system stayed after the war ended largely due to inertia. It probably benefits large employers because it gives them a cost advantage over smaller competitors but overall it's a terrible burden on the country.

A better approach would be to mandate that everyone purchase individual or family policies directly from insurers on open exchanges using pre-tax dollars, with subsidies for low-income consumers.

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

#268

Post by inferiorhuman »

MandieD wrote: post #218
ceejayoz wrote: post #208

Earlier quoted context omitted.

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)

Does your insurance also cover the rest of your family? As a single person I pay around $600/mo for insurance (a Kaiser silver HMO plan). Adding dependents will absolutely drive up cost here.

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

#269

Post by NegativeLatency »

jjk166 wrote: post #256
NegativeLatency wrote: post #149

Earlier quoted context omitted.

Admittedly not a ground war, but that's not entirely true: > In total, there were 97 air attacks on northern Australia, though air reconnaissance was carried out over the region by Axis Powers through much of 1944. https://en.wikipedia.org/wiki/Japanese_air_raids_on_Australi... and > German and Japanese surface raiders and submarines operated in New Zealand waters on several occasions in 1940, 1941, 1942, 1943 and 19…

If we're counting air attacks https://en.wikipedia.org/wiki/Attack_on_Pearl_Harbor

> on the continent

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

#270

Post by mindslight »

wat10000 wrote: post #257
mindslight wrote: post #250

Earlier quoted context omitted.

> Few will answer “yes.” And everything else flows from the "no." Everything else has flowed from the "no", but I do not think it needs to have. Imagine the government being a definitive payer of last resort, instead of this unfunded mandate where hospitals have to provide emergency service for free but then receive a bunch of regulatory capture to make up for it. That still leaves an avenue for hospitals to defraud…

I think there are two paths. Having the government be a payer of last resort for emergency services starts you down the road of paying for more and more things. You’ll start asking questions like, why are we paying massive amounts to stabilize a poor, terminal cancer patient who collapsed when we could have paid 10x less on screening and early treatment? Why aren’t we paying for procedures that allow people to work a…

I don't agree with this dichotomy. It asserts a monolithic top-down perspective, making it completely inapplicable to the dynamic I described in my last paragraph. It's "universal care" only in the sense that its universe has been defined to exclude most patient agency. Divergence from other possible patient-desired choices then tends to get rationalized away.

For example, perhaps having a follow up after 6 months only increases the expected value of the outcome by 0.1% and then multiplied/integrated by expected lifetime earnings it's not worth the economic cost of the system paying for that earlier follow up. But being my life, I should be able to spend my resources (including my time, which this current top-down model certainly doesn't account for) to achieve an outcome with much more utility to me personally than simply how much income (/taxes) I'm expected to produce.

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