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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?
This seems like a misrepresentation or at least to have some logical leaps.
My objections:
I don't understand your first objection. There were a lot of "beliefs" hinted at in my post, not all of which I hold or think someone else holds.
Your second objection seems to entirely make my point. What counts as "beneficial" vs. "harmful" seems to significantly hinge on other politics. People select politics first, then determine "beneficial" or "harmful", and then decide whether something is 'corruption' or 'negotiation'... or whether it's 'righteous gatekeeping' or 'evil profit-seeking gatekeeping'. Your politics are baked in to your statements, which is why you think other politics can be just brushed aside and totally ignored. Moreover, because we've essentially nationalized policy (while retaining nominal private ownership), the entire arena is fundamentally a matter of confused national-scale politics, rather than distributed optimization to local and personal values.
Your third objection, and the responses it's already produced, absolutely seals my point. People are divided about the politics, which leads to all sorts of confusion in trying to 'design' a nationalized system with clear purpose and vision, instead leaving the matter ripe for all sorts of politicized framing effects.
I don't see the use in framing common disagreements between different groups as some sort of political contradiction. Wanting more government regulation of the border or guns, but also wanting fewer EPA requirements for food or DEI requirements isn't a contradiction or a gotcha, it's a valid expression of people's political desires. Similarly, wanting healthcare but not have addictive or unnecessary procedures or medicine pushed on you is totally acceptable. I reject the notion that it's just a matter of politics as a broad claim you've made. I concede there is a large amount of political finagling and ideology in many of these decisions (whether by doctors, congress, hospitals, the federal executive), but I also believe you could parse out 60-75% of policy as being harmful or helpful to individuals and have broad (over 75%) public agreement.
I have no idea what you're on about. I'm not claiming a contradiction or gotcha. I'm not claiming anything is invalid.
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