UnitedHealth Group (UNH) had a banner quarter, as their 4th quarter earnings jumped to $1.7 Billion. Is this good news for UNH but bad news for healthcare consumers? With their total annual revenue approaching $200 billion, things are looking good for UNH executives and shareholders. But what does this mean for healthcare consumers?

For the past 12 years, as a business owner, I’ve paid for 100% of all my healthcare costs. This allows for a pragmatic view of the industry, regardless of political party rhetoric or politician promises. From my perspective the only constant has been increased premiums and reduced benefits. This was true under the Bush years and has not changed since. All the parties involved in our healthcare system, including hospitals, insurance carriers, pharmaceutical companies, and medical device manufacturers, are first and foremost seeking to increase profits. This includes many non-profit hospitals, which are actually extremely profitable, the profits are reinvested in facilities, technology, research and of course compensation. Little has been done to provide patient visibility into the rising costs. Then again, why should these parties work to lower costs or increase patient visibilty? Lower costs result in reduced revenue and profits, and these healthcare entities are motivated to earn compelling returns for their shareholders and executives. The same motivation as any business. More details please visit:-https://businesstag.org/ https://usaprimemagazine.com/ https://newsstolen.com/ https://newstimesusa.com/ http://www.inspirebulletin.com/ https://www.governmentofcanadajobs.com https://www.exinum.com/

How Much Does an X-ray Cost?

Let’s look at a real life example of the problem. I had a sore ankle and was referred by my primary care physician assistant ($50 Tufts copay) to an ankle specialist. The ankle specialist ($75 Tufts copay) directed me to get an X-ray. So I asked the front desk staff at the ankle specialist a simple question, how much would the X-ray cost? They said, “Your insurance will cover it.” Of course this is no longer true, as deductibles and copayments often apply, and even if my insurance did cover it, shouldn’t I know what they get charged? The physician’s staff then told me to ask the radiology department.

About 10 minutes later, I was in radiology, and asked their scheduler the same question about the cost. She had no idea and seemed surprised by the question, but said she would call the radiology billing department. The billing department told me (indirectly since she was on the phone speaking with the scheduler) that it depended upon my insurance company. I provided my Tufts insurance card and asked again, how much the X-Ray would cost. I was then told to speak directly with their billing specialist, who would help me determine the cost of the X-ray. After a 10 minute discussion, and twice being placed on hold, I was finally told what my carrier allowed and the likely range of costs, which she estimated to be about $100 to $150. It was an arduous journey to get what should be easily and immediately accessible from the hospital and insurance carrier, on a PC or on a smart phone app.

Many millions of X-rays are done in the U.S. every year and the costs should not take on a mystical property. If we can quickly learn the cost to add the most insignificant item to a new car (readily available online), or quickly determine the average cost paid for any model car, new or used, in any given area of the country, why should medical procedures be different? The simple answer lies with the providers, as hospitals, clinics, labs, etc. don’t want us to know. Keeping rates hidden, helps mitigate competition and limits patient insight into their costs. If “Hospital A” charged $200 for an ankle X-ray, and “Hospital B” which was 5 miles away charged $100, patients might choose the latter (assuming they were in your network which must also be checked). Look at this a different way, if you wanted to purchase some groceries and they would cost $200 at the convenience store around the corner, but only $100 five minutes away, would you drive the five minutes for the savings?

Fortunately, this is changing, albeit much too slowly. There are progressively more online sources and services to help determine the best quality of resources available at the best price. This includes pharmacy sites and apps (GoodRX) which compare drug costs by pharmacy within a specific area, physician (PriceDoc) and hospital quality and costs (LeapFrogGroup or even medicare.gov/hospitalcompare), surgical costs, and there are numerous sites to now compare dental fees. This is potentially good news for consumers, and the faster and more pervasive the better.

It’s all about the Profits

Now let’s get back to UnitedHealth specifically, and healthcare carriers in general. What happens when healthcare insurance companies are focused mainly on profits? Our capitalistic system is in many regards the most enviable model for the entire world. It’s typically efficient, often transparent, and open to most everyone (anyone can start a business in America). It fosters innovation in part because of the inherent competition. That’s pretty impressive. But when it comes to healthcare, the system seems to break down.

You may recall that in 2016 UNH was pulling out of certain markets relating to Obamacare. Forbes reported that, “UnitedHealth entered 2017 selling individual coverage under the ACA in just a handful of states after scaling back its Obamacare footprint significantly.” That said, UNH did see promise in offering coverage under Medicaid, which was expanded to 31 states under ACA. Why did they do this? Remember, their top priority is not about providing health insurance and caring for patients, it’s about making profits. And if $7 billion dollars in profits is insufficient for their shareholders, then UNH needs to go (or leave) and find a place they can make even greater returns. Granted, healthcare companies do need to make a profit in the current climate, the question is, how much profit and how do they make these profits.

Are profits derived from selling cars different than profits derived from saving (or not saving) lives? Before Obamacare, insurance companies could turn down people they deemed an unacceptable risk. For example, let’s say there was a 60 year old male we’ll call “Mike the mechanic”, who was changing jobs and moving to a new health plan. Mike was healthy for his entire adult life (almost 40 years from age 18 to 58), but then had a heart attack on his 59th birthday. Prior to Obamacare (ACA), this would be a preexisting condition, and even though Mike the mechanic really needed health insurance, and had been a net contributor for almost four decades, insurance companies could simply say no, or charge him dramatically higher rates. That doesn’t sound like a fair or equitable deal, and it leaves the insurance carriers holding all the cards.

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