Perspectives > > Prescriptions for a Broken System– Anti-competitive practices damage clients, suppliers, and the economy
by N. Adam Brown, MD, MBA, Contributing Writer, MedPage Today March 9, 2024
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N. Adam Brown is a practicing emergency situation doctor, business owner, and health care executive. He is the creator of ABIG Health, a health care development method company, and a teacher at the University of North Carolina’s Kenan-Flagler Business School. Follow
Almost $400 billion in earnings.
In January, UnitedHealth Group (UHG) launched its 2023 financials. It paints a vibrant photo– not simply of monetary success and wealth transfers– however of a health care Goliath relatively overlooking and managing all the levers of the market and possibly even the federal government.
In 2023, UHG generated a jaw-dropping $22.4 billion in earnings, with $5.5 billion in the 4th quarter alone. Profits? It was up by 14.6% to an unbelievable $371.6 billion. To put that in context, UHG’s incomes are greater than the private GDPs of Finland, the Czech Republic, Hong Kong, Greece, and another 132 areas or nations worldwide.
Together with its year-end monetary report, UHG revealed it anticipates in between $400 billion and $403 billion in income in 2024.
Remarkable? Definitely. Is UHG’s empire good for the health care system, clinicians, and clients? Here is where it gets fascinating– or worrying, depending upon your view.
This monetary windfall has actually come by means of rewording health care market practices through vertical combination. With its health care companies Optum and other acquisitions, vertical combination has actually enabled UHG to basically be a value-chain monopoly, managing whatever from medical insurance to medical services to health care information to pharmaceuticals.
Vertical combination may sound benign till you highlight the outcome: doubtful organization practices; less insurance coverage options for service providers, companies, and clients; even worse health results and greater expenses; and revenues that might be put to much better usage. It is a design that raises concerns: Are we taking a look at health care for lots of, or “wealthcare” for investors and insurance coverage executives?
UHG is not alone. 5 other prominent payers are extremely vertically incorporated: CVS Health, Cigna Healthcare, Humana, Elevance Health, and Kaiser Permanente. UHG simply occurs to be the most significant.
Is this the health care future we desire? One where giants like UHG determine regards to work for doctors (today, the business uses 10% of all U.S. doctors) and develop suspicious algorithms for client care choices? (A class action fit submitted last fall declared UHG unlawfully utilized expert system to reject corrective care to Medicare Advantage clients. Other comparable suits declaring rejection of care have actually likewise been submitted versus Aetna, Cigna, and Humana.)
Where have the regulators been, like the Federal Trade Commission, the Department of Justice (DOJ), or the brand-new HHS chief competitors officer who is expected to collaborate, recognize, and raise chances to promote competitors in health care markets?
UHG is forecasted to have more than $400 billion in earnings for 2024,