Insurers Win and Patients Lose… Again

While insurers grow more powerful, patients and doctors are losing control of medicine, says Kevin Campbell, MD

https://www.medpagetoday.com/blogs/campbells-scoop/81823

The country’s biggest health insurers earned more than $11 billion in profit in Q2 this year, and Kevin Campbell, MD, has had enough of the industry continuing to grow without a fight from patients and physicians.

The opinions expressed in this commentary are those of the author. The following transcript has been edited for clarity.

In an era where many Americans are not able to afford high-quality healthcare due to rising healthcare costs, I find it interesting that health insurers’ profits are growing — by billions of dollars just in the last year.

This week, an article in FierceHealthcare highlighted the steep increase in earnings realized by many major insurers over the second quarter of 2019. Much of this profit increase is thought to be due to the benefits of creating a much smaller competitive market through mergers and acquisitions.

For example, CVS posted a profit in Q2 2019 following its acquisition of Aetna, and Cigna — after purchasing Express Scripts — has seen its revenue climb from $11 billion to nearly $35 billion in just over a year. In many cases, insurers are partnered (or share ownership) with multiple stakeholders in the “healthcare pipeline” such as hospitals, pharmacy benefit managers, and entire healthcare systems.

While politicians criss-cross the country campaigning for your vote for president, and giving lip service to healthcare reform and making things better for patients, our nation’s health insurance industry has grown without much government interference. Regulators have allowed the creation of mega companies that in many cases can dictate prices and coverages. Some patients have little or no choice and in many markets there are only one or two options. These insurance conglomerates are able to negotiate contracts with hospitals and effectively lock out competitors from entire geographies. This raises prices.

The effect of limited competition is exactly what you would expect — higher prices, lower-quality service, and more limited product offerings. While insurers are growing stronger, more powerful, and larger, patients and doctors are losing control of medicine. Insurers can now dictate who a patient sees for care, where they see a particular provider, what access they have to advanced treatments, and ultimately if they receive care at all.

So, what can we do?

Unfortunately, we have all allowed this to happen while we were asleep at the wheel — or busy taking care of patients and dealing with wasteful and useless government-mandated electronic paperwork and EMR documentation. BUT — we must act NOW. We must demand more from our nation’s leaders in Washington. There must be more oversight and we must limit the ability of large insurers to hold both doctors and patients prisoner — all while lining their own pockets.

We must fight to preserve competition and allow both doctors and patients to have more choice in how, when, and where high-quality medical care is delivered. If we do not, insurance companies will continue to grow their profits, all on the backs of underserved and undertreated patients, not to mention overworked and burned out physicians.

Kevin Campbell, MD, is a cardiologist based in Raleigh, North Carolina, and Chief Innovation Officer at biocynetic. In addition to his weekly video analyses on MedPage Today, he is the official medical expert at WNCN in Raleigh and makes frequent guest appearances on other national media outlets such as Fox News and HLN.