The malevolence of all health care sectors
The fundamental attribute of nearly all the major health care sectors is the relentless pursuit of profit without consideration of the larger social consequences. Some may call that "amoral greed," but the reader can apply his/her own terms. Add to this reality the fact that some health care competitors also act in a manner that is clueless, while others exhibit varying levels of laziness, arrogance and spinelessness. Consider the payer segment of health care. These are mainly the public and private insurers and the self-funded employers that provide coverage for most Americans. An unstated but implicit message of several postings here is that unless pharma gets its strategic orientation in order and brings its public-be-damned pursuit of profit under control, the payers will give them a thrashing. That would seem to follow because the premise behind both Obamacare, as well as the private health care market, consists of giving payers de facto charge over system. The Affordable Care Act/Obamacare does it by requiring everyone to get health insurance. The thinking there was that this would oblige payers to justify their place in the system by controlling costs and improving quality as a result of constraining providers and manufacturers. Any lingering notion that an insurance/payer-driven approach could work in the U.S. now seems increasingly improbable because most private insurers decline to take the initiatives required of them if they are to push American health care toward an affordable, effective system. An example of that comes from sources at several large health insurers, including some Blue Cross/Blue Shield companies. They make the point that their managements either remain indifferent to pharma pricing or mistakenly see it as benign. Rather than actively managing their populations, their participating providers and the health care manufacturers, the insurers prefer to operate in the old, insurance sales mode of passively making money on the float while allowing costs to escalate. By and large, they feel their recourse lies in passing higher costs along to policy holders in the form of premium increases. A source at one BC/BS said his colleagues rarely even give any thought to pharma because they outsource that concern to their Pharmacy Benefits Management (PBM) company. Another health insurance manager related the astounding fact that his company's director of strategic planning actually considers pharma as a constructive force for controlling health care costs. This strategic planner told the people reporting to him that their company's absolute amount of “medical loss” over the past couple of years has remained fairly level. At the same time, the relationship among the factors contributing to those medical loss expenses has changed, so that hospital expenses have declined as a percentage of the total, while pharma costs have risen substantially. Demonstrating an incredible piece of fallacious, post hoc reasoning, the planning director then concluded that spending more on pharma decreases the larger amounts paid to hospitals. For that reason, he sees rising pharma expenditures as a good thing! Even those private payers not challenged by basic logic shrug…