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PaperclipPerfector  5d ago (text post)   17229 thread views

Culture War Roundup for the week of December 29, 2025

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Retail pharmaceutical spending accounts for 10% of total health spending. It's not the reason for high costs.

The same thing happens with insurance-owned clinics

What fraction of healthcare spending goes through insurance owned clinics?

It's at least the reason for high drug costs.

If you look at UnitedHealth's 10-k, Optum (the provider network) made $253b in revenue, but $151b of that was 'internal eliminations' transfers from UnitedHealthcare (the insurance arm) to Optum.

https://www.unitedhealthgroup.com/content/dam/UHG/PDF/investors/2024/UNH-Q4-2024-Form-10-K.pdf

I don't see "internal eliminations" in that document.

Gemini suggests that the document says UHC got $290B in premium revenue and Optum Rx earned $80B and Optum health earned $64B primarily from UHC. I don't think the other Optum divisions could be considered patient care upon a cursory check.

That is a significant chunk of UHC premium revenue, so I take your point there. However, the money staying in the family like this would make UHC more likely to pay out claims than if it were going to a truly external company, and yet the common complaint is that they don't pay out enough.

It's on page 30 as 'eliminations'.

UHC pays its own doctors more, and in general insurance companies will steer customers towards their own, more expensive facilities, but there's limited studies on how it affects care in general. You'd think that it should increase the number of procedures done at least, but that's not so clear.

https://www.hks.harvard.edu/faculty-research/policy-topics/health/study-finds-vertical-integration-medicine-leading-higher

The study found that when independent physicians integrated with a hospital, they changed their care practices (for example, by reducing the number of patients they put under deep sedation) and increased their throughput (measured by the number of patients they treated). Specifically, the integrated physicians reduced their use of deep sedation by about 3.7 patients for every 100 treated. However, patients of integrated physicians experienced “a significant increase in both major post-colonoscopy complications such as bleeding (3.8 per 1,000 colonoscopies) and other complications such as cardiac or nonserious GI symptoms (5.0 and 3.3 per 1,000 colonoscopies, respectively).”

The researchers found that the reduced use of deep sedation “at least partially explains the increase in adverse outcomes” and that it was “driven mainly by hospitals no longer allocating expensive anesthesiologists to relatively unprofitable colonoscopy procedures.”

Moreover, integration increased the number of patients a physician was able to treat and elevated reimbursement per procedure—integrated doctors were reimbursed about $127 more per colonoscopy procedure than independent doctors, or about 48% more.

The $151B number is listed as "Eliminations" on page 28; the same number is broken out by segment as "Total revenues - affiliated customers" on page 66. (The missing $7B is Optum Insights, an IT vendor that seems to sell software to both UnitedHealthcare and the other Optums.)

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