Beth
#332
@DrFraser Yes, you DO help your patients save money!!! 
@RapAdmin, regarding your post on how good rx makes money,
That makes sense. I guess it’s similar to the Rakuten model (previously Ebates). You get cash back on your purchases, which is just a cut of the commissions they earn from the stores by sending you there.
FYI, everyone, I have used them for probably 15 years. By doing nothing more than accessing websites through their portal, I get hundreds back each year for buying what I would have bought without them anyway. There is really no trick and I don’t understand why it’s even a thing!!!
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Beth
#333
A good discussion about insurance companies
Starts at 31:26
KarlT
#334
(Reuters) - Shares of health insurers operating pharmacy benefit managers fell on Monday after U.S. President-elect Donald Trump called them middlemen who drive up costs and said he plans to eliminate their role.
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Healthcare has been one of the worst performing sectors of the stock market in 2024. Even the smart money smells the trouble.
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He Was Trump’s Surgeon General — And He’s Got Thoughts About the Reaction to the United Healthcare Killing
The shooting of CEO Brian Thompson has serious implications for a health care system already mired in politicization and distrust.
When individuals resort to violence, it signals a profound loss of confidence in structures that are meant to support and protect the public. This eroded trust leads to people feeling hesitant to seek care, fearing that they might not receive the treatment that they deserve, or that their concerns will not be taken seriously when they come in for care. It’s crucial that we are having this conversation and that we work to rebuild trust, through transparency, through accountability and through a commitment to patient-centered care.
Insurers absolutely cannot ignore this moment. Several things have to happen. Some actions are going to have to be taken by government, some by insurers, some by providers. But obviously in the crosshairs right now — that’s a terrible way of putting it, but it’s also a literal way of putting it — are the insurers.
You can’t ignore the fact that companies like United and Anthem are literally making billions of dollars of profit.
https://www.politico.com/news/magazine/2024/12/17/trump-surgeon-general-unitedhealthcare-killing-00194635
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Studies find that it is primarily the higher prices paid for services (especially doctors’ salaries) and drugs, followed by high administrative costs (complex multi-payer, multi-service provider mess), with secondary factors including demographics.
http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2017.15927
https://jamanetwork.com/journals/jama/article-abstract/2674671
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Beth
#339
Don’t get me started on them saying he was committing an act of terror.
If you are not a highly paid health insurance CEO, you are not feeling one bit threatened.
I’m not saying it was ok, and it was murder, but it was in no way an act of terror. I assume this is about all the money health insurance donates to the powers that be, which pisses me off even more
Could I be wrong about any of this, yes, I realize it’s possible.
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LaraPo
#340
No doubt that every one has a choice. However most ppl somehow make the wrong choice. IMO it’s not the shitty food but the shitty education.
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KarlT
#341
Hate to beat a dead horse but doctor’s salaries are not the cause of rising health care costs. As a physician, I have not had a pay raise in 17 years.
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AnUser
#343
By definition he is a domestic terrorist. Regardless what you think of what he did.
Domestic terrorism: Violent, criminal acts committed by individuals and/or groups to further ideological goals stemming from domestic influences, such as those of a political, religious, social, racial, or environmental nature.
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Beth
#344
@AnUser for clarity, I am in no way defending him, and am only saying it doesn’t seem to fit the definition of terrorism that I know.
The definition you found does seem to fit. Fyi, the definition that I am used to seeing, which is the one in NY, is the following:
Under New York law, such a charge can be brought when an alleged crime is “intended to intimidate or coerce a civilian population, influence the policies of a unit of government by intimidation or coercion and affect the conduct of a unit of government by murder, assassination or kidnapping.”
To me, this wouldn’t fit because he didn’t intimidate a population nor a government.
In my opinion, this the charge is an overreach because he shot a rich powerful white man. If he didn’t like the price of housekeeping, and he shot a housekeeper, we wouldn’t know about it.
And @adssx I’m just learning about PBMs this week for the first time and WHOA!
1 Like
AnUser
#345
That’s the FBI definition and I see no reason to disagree with it.
First, the principal question at issue was not the driver of increased healthcare costs, but how it can be that:
Second, obviously a simple comparison of secular trends is not a strong analysis (see consumption of organic food vs. autism diagnoses, etc.).
KarlT
#347
I have no idea what you’re talking about.
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amuser
#348
If pharmacy costs are 11-14% of total spending, how might they be ‘the culprit?’
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I suspect hospitals are the largest factor…an example from 2010 that is probably representative of today I suspect… Health Care Costs: A Primer 2012 Report | KFF
And some numbers from 2020:
https://www.nlm.nih.gov/oet/ed/stats/01-400.html
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A good report on United Healthcare by Stat News, a leading Medical / Pharma Industry publication:
A team of STAT journalists spent the last two years diving deep into how UnitedHealthcare’s parent company, UnitedHealth Group, operates and its impact on the health of Americans. In this video, our reporters distill what they’ve learned about the company and explain why STAT focused so singularly on it.
This year, in the ongoing series “Health Care’s Colossus,” STAT documented how UnitedHealth wielded its unrivaled physician empire to boost its profits and expand its influence. The year before, in the “Denied by AI” series, STAT exposed how UnitedHealth used an unregulated algorithm to override clinicians’ judgments and deny health care, highlighting the dangers of AI use in medicine.
STAT reporters Casey Ross, Bob Herman, Tara Bannow, and Lizzy Lawrence have reviewed thousands of pages of documents, pored over reams of data, and convinced dozens of clinicians to speak with them to reveal the untold costs of UnitedHealth’s dominance.
They show how UnitedHealth has turned health care into an assembly line that treats millions of patients as products to be monetized. And they chronicle how the $5 trillion American health care system came to be so broken.
See the full series here: Health Care's Colossus: Investigative series on UnitedHealth Group
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blsm
#351
My daughter sent me this article written by a former insurance executive about his experience which I found very interesting. I’m not promoting right v left wing politics (due to the source) I just enjoyed reading it.
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Agetron
#352
Wow… just wow… how United Healthcare buys interest in other agencies to deny on one hand and to approve non-essential treatments to boost profits. And, as a result provides service that hurts the under-treated and over-treated patient. All for bottom line profits for share holders.
Great investigation and excellent explanation.
We insured people… should be very worried about falling ill and needing care.
Our medical university had United Healthcare and switched to Anthem Blue Cross because cost was prohibitive.
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