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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?
I think it's even worse than this. Setting aside violence and just focusing on anger, it is absolutely amazing to me that people think a technical response is actually a strong rebuttal. People are mad precisely because the whole thing is utterly byzantine, impossible for someone with a double-digit IQ to understand, and they're aware that the guys at the top of making tens of millions of dollars on products that confuse and frustrate their customers.
I'm sure many people would still be frustrated if they couldn't afford medical care, but I think they'd be less frustrated if there was just a big fat sticker on the medical care, an accurate price that the patient just couldn't afford. Instead, you have patients that were under the impression that they'd done the right thing, gotten insured, and would be taken care of when they needed care. When they are surprised by a denial, they are understandable frustrated. No one told them this would happen! Yeah, sure someone has to determine what qualifies and what doesn't, it's all very complicated, there are tons of experts and if you don't like the experts, you can get a lawyer to talk to their lawyers, and maybe you'll even still be alive when it's eventually resolved.
That's what people are reacting against - that some rich fuck gets to make tens of millions of dollars on a product that they feel deceived by and he feels completely invulnerable because he's got an army of experts and lawyers, and you don't have shit. Then, when someone expresses this, some blogboi shows up to explain that actually you're too stupid to understand why the experts and lawyers are correct and the rich fuck should be completely invulnerable.
No, I don't think that's likely to assuage people's anger. I'll note that I'm only partially sympathetic to the anger - I actually have just about as much ire for the patients in a lot of examples as the system. Nonetheless, I can barely imagine an approach less productive than lecturing people about how it's all actually very complicated and they don't really understand.
It's complicated because of the perverse incentives created by bad regulations. The people running the insurance companies don't have a choice. This is proven by their low profit margins. They're not doing this to become unfairly profitable. They're doing that to survive.
See, this works unless you think the people writing the bad-incentive regulation and the people running the megacorps as the same people.
Same as the subprime mortgage crisis. "The government made me do it 😩," howls the voice with more influence over government policy than your family tree could ever dream of.
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