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Notes -
A Window Into How Health Insurance Companies Harm Consumers by Threatening to Deny Coverage
From the New York Times, we learn about how health insurance companies hire PBMs (Pharmacy Benefit Managers) to help them restrict access to doctor-prescribed drugs. For all the talk of insurance companies directly denying coverage, when it comes to pharmaceutical drugs, specifically, they're able to offload a significant amount of Delay, Deny, Defend onto third parties, in this case PBMs. By restricting coverage, insurance companies are able to reduce costs and increase profits. A bonus is that they don't even have to be The Bad Guy; they can pawn that off on a third party, who is ostensibly making the choices for them. They don't have to personally defend the decisions to deny; they can just obfuscate, wave in the direction of the third party, and let the complexity of The American Healthcare System stymie consumers.
The Times does a deep dive into a Good Guy Pharmaceutical Company and the lengths they have to go through to navigate this minefield to get their high-quality, purity-assured drugs into the hands of the market. Primarily, they've gotta give the PBMs a cut of the money, who in turn share it with the insurance companies and employers they represent. For a while, they were rebating 23% on average, allowing patients to access the drugs their doctors prescribed at prices that were reasonable to them, their employer, and their insurance company. One PBM reportedly wanted (and got) more - 60% rebate to keep prices low and avoid inflaming popular anger with denials. Of course, that still doesn't quite reach how good some Medicare plans were at 'negotiating'; they got about 70%!
The Good Guy Pharmaceutical Company knew how much people wanted its product; they knew that doctors were prescribing it; they knew how dangerous the alternatives could be for many in the market. They were offering a well-known, well-tested product, clean from any adulteration, and outrage would surely rule the populous if folks had to turn to alternative products or sketchier outlets, possibly with less-stringent quality control. So, they selflessly paid the toll to do the right thing, to get their product into the market, to save lives. NYT rightly applauds their admirable efforts to do what they could, at cost to their own bottom line, to protect consumers from the restrictive, denial-focused tactics of health insurance companies and their lackeys.
Oh wait. NVM. It's Purdue. It's Oxy. Flip everything 180 degrees. Apparently, nobody (other than Purdue and their supporters) thinks it's good to flood the market with high-quality, pharmaceutical grade opioids with well-known potency properties. They somehow don't think that this is preferable to folks getting funneled toward lower-quality, potentially dangerous alternatives. They're back to liking the gatekeeping of insurance companies and their lackeys, ya know, so long as they're doing so in keeping with their own political proclivities. Gatekeeping is Good and Right, so long as the folks who buy digital ink by the barrel can browbeat the gatekeepers into doing things the way they want it to be done. ...and they sure ain't even thinking about including libertarian politics on drugs in the list of their demands. Woke politics, tho? Sure, why not?
Health insurance companies have thin profit margins. If they want to get more money from them, they need to pay higher premiums. Why don't they? It seems like they're just buying cheap plans and complaining when they get cheap coverage.
This event has the potential of becoming a trigger of revolution and if this is the potential "tea party" this is the equivalent of going like "Well the profit margins on running the British Empire are low so we should be paying more taxes on that tea!". You can cue up all the technical differences with that situation is different from colonial taxation but the bigger picture is that both of these situation is extremely extractive institutions for the benefit of an elite, it never lasts forever and has potential to violently be ended by the subjugated.
How can it be extractive if they're profiting so little from it?
Insurance companies sell a service to individuals that the day that the individual needs healthcare they will pay the healthcare provider for that healthcare. So usually this is person is working and pays for that service of eventuality needing healthcare out of their salary, because in most cases if you need healthcare the person can't pay that premium(I hear that it is what is called). Now if that insurance company delays or even denies payment for that healthcare it means that the person can't get back to work to continue paying the premiums. It is more profitable for the insurance company to extract the money for a service and have people literally dying so they don't pay anymore for the service that possibly would have helped them survive.
They're obviously not doing this though because they don't profit very much and no one would buy their insurance if they did. I also don't see how it would hold up in court.
We are not in court. I'm just speculating that this would be a potential flashpoint for revolution with the reasoning that health insurance companies are extractive institutions and with historical example of the American Revolution that extractive institutions can be overthrown violently if they reach a breaking point of the "extracted". It is triggered by your "Let them eat cake!" moment! But for me the cost of being either right or wrong are extremely low, since I live in a country with a single payer health insurance.
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