There is an epidemic that is creeping through America's healthcare system today, one that no vaccination or scientific breakthrough can cure. It is called Greed.
The greed epidemic manifests itself in many ways, but it is undeniable. It's evident every time we go to the pharmacy to pickup a prescription, whenever a diabetes patient goes to buy insulin, whenever we go to the hospital, whenever we pay our health insurance premiums -- if we have health insurance.
It's also evident far beyond the doctor's examining room, the hospital e-r, the pharmacy counter, but as patients, we just don't realize it because much of it comes from actions in the corporate boardrooms within the healthcare industry.
In February 2017, Aetna and rival Humana terminated their attempts at a $34 billion merger, blocked by a federal court on antitrust grounds. Aetna had to pay Humana a $1 billion breakup fee.
Then, in May 2017, Anthem Health, the owner of Blue Cross and Blue Shield plans in 14 states, terminated a proposed merger with Cigna after the deal was blocked by federal courts, also on antitrust grounds. In doing so, Anthem refused to pay Cigna a $1.8 billion break-up fee.
You can guess who gets stuck eating those costs, and I assure you, it's not the companies' CEOs.
But those mergers, which had been strongly opposed by the American Medical Association, would have cost physicians who participate in those companies' insurance plans upwards of $500 million per year, according to Dr. Willie Underwood, a Buffalo, NY urologist who is a member of the AMA's Board of Trustees.
How is that?
“They would have had a monopoly and would have imposed contracts that would have reduced reimbursement rates to providers," explained Dr. Underwood. "It's all about making more money, not improving care. That's what these mergers are all about."
So if doctors get paid less for the procedures covered by health insurance policies, they would need to make up the difference. How? Most likely by billing you the difference, by squeezing in more patients to increase volume, which means less time spent with you and perhaps less attention to your care. By finding other ways to cut overhead. Some physicians might simply decide to hang it up and retire, which would hurt make it harder to find a doctor in the first place.
The AMA is working now to block yet another merger -- this one between CVS and Aetna, which is currently being held up by U.S. District Court Judge Richard Leon in Washington, DC.
“AMA brought together experts to show damage that merger would cause,” explained Dr. Underwood. “The judge is saying what the AMA is showing us is more than meets the eye…we’ll see what happens. That’s significant.”
AMA and its Council on Legislation, chaired by Dr. Underwood, brought together legal and academic experts and determined that the merger would have been anticompetitive and would have had “deleterious effects on both patients and physicians.”
So the next time you see a news report about a potential merger in the healthcare industry, don't let your eyes glaze over and forget about it. The chances are that you -- and your doctor -- could well feel the impact.