Health Insurance Companies: The Hidden Virus

Where should I even start?

Should I start with the stories of Dr. Salerno, Dr. Wassef, or the hundreds of other doctors that health insurance giants are dropping?

Or should I start by highlighting how these insurance giants are monopolizing healthcare?

Or maybe how these companies are growing in profit while medically underserved regions and low- income patients are suffering for it?

To be honest, it doesn’t matter how I start, the fact that health insurance companies are ruining healthcare is not going to change. But I do have to start somewhere, though.

Let me tell you a story. In 2017, UnitedHealthcare recognized the efforts of a doctor in New Jersey. His name is Alexander Salerno. They praised him for delivering healthcare services consistently and innovatively. Two years later, in 2019, the doctor received a bonus of $130,000 from the UHC, again recognizing his exceptional work to patients. This seems all good, right? But, trust me, things are about to get really ugly.

The UHC is currently seeking to drop hundreds of doctors from its Medicaid network in New Jersey. Amongst the hundreds of doctors that will be affected by this is Dr. Alex Salerno. Yes, the same doctor the UHC praised and gave a $130,000 bonus just last year. What could possibly have gone wrong? Well, there’s a plot twist.

In 2018, Riverside Medical made an offer to Dr. Salerno to buy his group practice. He turned down the offer. This doesn’t sound dodgy at all, right? You just wait for it. Things become a little interesting when you consider that Optum owns Riverside Medical. Optum is a sister company of UHC, both of which are subsidiaries of which healthcare insurance company? You guessed it, UnitedHealth Group!

Get this. The UHC recognized the efforts of a doctor in 2017, they paid him a bonus in 2019, and now they are seeking to drop him in 2020. This doesn’t make sense in first viewing, but when you add in the fact that Riverside Medical – a subsidiary of UnitedHealth Group – made a futile effort to buy off Dr. Salerno’s group in 2018, things start to make sense. If you still don’t get it, I’ll spell it out for you: they either buy you off, or they cut you off.

The story of Dr. Salerno is not an isolated incident. The UHC is planning to drop off many other doctors the same way. This way, the UHC will ‘force’ patients to transfer to doctors it controls. And this is where problems arise. In medically underserved regions in states like New Jersey, many of the patients have built trust between themselves and their doctors. This trust dates back decades in some cases.

Let us consider the case of Dr. Wassef, who the UHC is also seeking to drop. She is a pediatrician. But the focus this time around is not going to be on Dr. Wassef, it’s going to be on Rasha Salama. Rasha Salama is a low-income patient living in Bayonne that has been taking her two kids to Dr. Wassef for five years now. Salama and Dr. Wassef have built a rapport because of the convenience in delivering healthcare services to her children. But now that the UHC is seeking to drop Dr. Wassef, Salama has to sever those ties and look for other pediatricians, who can offer the same services and at the same convenience levels, which is an arduous, if not impossible, task given her financial situation. Many other patients like Salama will be affected by this decision.

You may think that insurance companies separate from doctors all the time, so why should this be an issue? It’s simple. This time around the cause of the separation is the power thirst of insurance companies, UHC in particular. They want to control both the payers and the providers, see it as operating from both sides of the pendulum. They are creating a monopoly, and that is bad. Very bad. You need to understand that these insurance companies are not in themselves bad in insuring health, far from it. UHC for one is of the best, if not the best out there. But it seems their focus is starting to shift to profit. You know what, ‘starting’ is probably not the right term. Let’s say, their focus seems to be intensifying solely on profits now. Over the last decade, their status has changed from ‘profit-oriented’ to ‘aggressive profit-mongering.’ That’s more like it.

Let’s sprinkle a little bit of economics into this. There is something known as vertical integration in business. Don’t get confused, I’ll explain. Vertical integration is said to occur when a business enlarges by buying another business that operates before or after them in the supply chain. Consider this illustration. In the car industry, a company that deals with the manufacturing of cars may decide to buy a company that produces tires, or one that deals with the assembling of final parts of the car. That way, they are eliminating competition and controlling the market.

The same is what insurance companies are trying to do, but what makes this far worse is that human lives are on the line. They just don’t seem to care. While they are lining their pockets, emergency rooms are lining their beds. And I’m not exaggerating it one bit. UHC has seen its stock price and profit rise tenfold over the last ten years. Their revenues this year alone is set to pass the $260 billion mark. $260 billion! But at what cost?

The creation of a monopoly will lead to them controlling the healthcare market, throwing the relationships that many doctors and patients have taken years to build down the drain. The implication of this is the start of a vicious cycle. Patients will stop going to doctors, adherence to medications will be significantly reduced, cases that require proactive care like cancer, diabetes, hypertension will increase, leading to severe medical conditions, and this will cause the state to spend more in reactive medicines, apart from the obvious fact that those patients may lose their lives. It’s a very slippery slope from the onset of monopoly.

If these insurance companies have their way, it would be utterly devastating, especially to low-income patients and people in medically underserved regions. Dr. Salerno and Dr. Wassef understand this. They are championing lawsuits against UHC in a bid to restore some normalcy and sanity to the healthcare industry. They cannot do it alone, though. We all need to join the fight, one way or the other. Failure to do so may be signing the death of many people, and again, I am not exaggerating this. Don’t call me pessimistic; I’m not. I am just proactive, as we all should be.

We are in the middle of one the worst health crisis in a century, the Coronavirus, which has claimed hundreds of thousands of lives. But there is another virus no one is talking about. It’s the fact that health insurance companies are monopolizing healthcare and removing physicians from truly providing quality care to patients. No one foresaw the Coronavirus, and thousands have died. This doesn’t have to be the case with health insurance companies. It doesn’t have to.

I hope we win this fight. I’m not banking on it, though.

References

  1. https://www.nj.com/opinion/2020/01/health-insurer-is-eroding-decades-of-trust-built-between- doctors-and-longtime-patients-opinion.html
  2. https://www.oliverwyman.com/our-expertise/insights/2016/jun/oliver-wyman-_-altarum-institute- study.html
  3. https://dockets.justia.com/docket/new-jersey/njdce/2:2019cv18130/417030
  4. https://www.nj.com/healthfit/2020/02/an-insurance-titan-is-dropping-hundreds-of-nj-physicians-to- enrich-itself-doctors-and-patients-charge.html
  5. https://authenticmedicine.com/2020/03/private-insurers-quietly-controlling-us-health-care-as- everyone-focuses-on-sars-cov-2
  6. https://authenticmedicine.com/2020/02/united-health-group-revenues-expected-to-eclipse-260- billion-in-2020
  7. http://www.medhalt.com/blog/reasons-monopoly-health-insurance-us
  8. https://www.modernhealthcare.com/article/20170413/NEWS/170419935/monopolized-healthcare- market-reduces-quality-increases-costs

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