I'll assume that this is legitimate ignorance and not a bad faith attempt to muddy conversation, and I'll direct you to a few resources where you can read several years of extensive investigative reporting on the myriad ways the pay-vider structure enables acquisition and exploitation of market power:
I read through the first 3 and can't tell how they're related, so I'm not going to check the rest.
These only claims that united health is the "biggest", but that's not the same as having monopoly in a given market, which is needed for the scheme to work. Otherwise if you only have say, 30% market share, and your associated hospital charges sky high rates, you might be able to get slightly fatter margins on your insurance side, but you'll be losing money to other competitors that can out-compete you through greater economies of scale. I did a cursory search and their national market share in insurance is around 15%, which really seems tough to have the economics work out, especially given how capital intensive hospitals are.
What does "Medicare Fraud" have to do with the question that they're a monopoly or not?
This and the other links feels like trying to smuggle in a specific claim about what united health might be doing (ie. they're charging irrationally high prices just so they can pump their insurance margins), by pointing to a bunch of other shady stuff that they do.
You read through the first 3 links, including what... all 8 parts of the deep investigative work done by the leading healthcare publication with the subtitle "How UnitedHealth Group wields its unrivaled physician empire to boost its profits and expand its influence", and you came away thinking that this was unrelated to the topic at hand?
You read through all those 8 parts and didn't see how, for example, Part 5, titled "UnitedHealth pays its own physician groups considerably more than others, driving up consumer costs and its profits" is related to the question of whether or not they have and exploit market concentration to increase their profits?
And yes I can see how the Medicare fraud could seem unrelated to someone who demonstrably lacks curiosity while feigning it. But it's actually just a special variant of the exact same strategy someone else described at the top of this thread.
UHG takes on Medicare Advantage patients. Medicare pays UHG depending on the delta between the amount of care those patients are expected to receive versus the amount they actually receive.
The payer is incentivized to make their patients look sicker and to deliver less care to them. Traditionally, the provider has no such incentive and the payer has few levers to encourage them to do either behavior, but in this vertically concentrated model, they are the same entity and now the payer has tons of levers to get specific coding and care practices out of their owned providers.
Exact same dynamic as described in the very first comment, but under a VBC rather than fee-for-service model, and Medicare pays the bill.
I did a cursory search and their national market share in insurance is around 15%, which really seems tough to have the economics work out
Maybe cursory searches of national market share is not the best way to understand market dynamics in something as complex as the US healthcare system. This is not an industry in which "national market share" is the same as actual market power. Healthcare is intrinsically hyperlocal – obviously. There are thousands of distinct healthcare markets, and UHG and its ilk are systematically capturing them one by one. We are trending toward a situation where 5 payviders each own 20% of the national market, but 100% of actual markets are owned by one player.
You would be naive to look at the 20% figure and say "no monopoly here! No need for me to look further into this despite clear evidence of successful execution of strategies that, by my own admission, could only possibly work with excessive market power!"
Comments
I read through the first 3 and can't tell how they're related, so I'm not going to check the rest.
https://www.statnews.com/unitedhealth-group-investigation-he...
These only claims that united health is the "biggest", but that's not the same as having monopoly in a given market, which is needed for the scheme to work. Otherwise if you only have say, 30% market share, and your associated hospital charges sky high rates, you might be able to get slightly fatter margins on your insurance side, but you'll be losing money to other competitors that can out-compete you through greater economies of scale. I did a cursory search and their national market share in insurance is around 15%, which really seems tough to have the economics work out, especially given how capital intensive hospitals are.
What does "Medicare Fraud" have to do with the question that they're a monopoly or not?
This and the other links feels like trying to smuggle in a specific claim about what united health might be doing (ie. they're charging irrationally high prices just so they can pump their insurance margins), by pointing to a bunch of other shady stuff that they do.
You read through the first 3 links, including what... all 8 parts of the deep investigative work done by the leading healthcare publication with the subtitle "How UnitedHealth Group wields its unrivaled physician empire to boost its profits and expand its influence", and you came away thinking that this was unrelated to the topic at hand?
You read through all those 8 parts and didn't see how, for example, Part 5, titled "UnitedHealth pays its own physician groups considerably more than others, driving up consumer costs and its profits" is related to the question of whether or not they have and exploit market concentration to increase their profits?
And yes I can see how the Medicare fraud could seem unrelated to someone who demonstrably lacks curiosity while feigning it. But it's actually just a special variant of the exact same strategy someone else described at the top of this thread.
UHG takes on Medicare Advantage patients. Medicare pays UHG depending on the delta between the amount of care those patients are expected to receive versus the amount they actually receive.
The payer is incentivized to make their patients look sicker and to deliver less care to them. Traditionally, the provider has no such incentive and the payer has few levers to encourage them to do either behavior, but in this vertically concentrated model, they are the same entity and now the payer has tons of levers to get specific coding and care practices out of their owned providers.
Exact same dynamic as described in the very first comment, but under a VBC rather than fee-for-service model, and Medicare pays the bill.
Maybe cursory searches of national market share is not the best way to understand market dynamics in something as complex as the US healthcare system. This is not an industry in which "national market share" is the same as actual market power. Healthcare is intrinsically hyperlocal – obviously. There are thousands of distinct healthcare markets, and UHG and its ilk are systematically capturing them one by one. We are trending toward a situation where 5 payviders each own 20% of the national market, but 100% of actual markets are owned by one player.
You would be naive to look at the 20% figure and say "no monopoly here! No need for me to look further into this despite clear evidence of successful execution of strategies that, by my own admission, could only possibly work with excessive market power!"