Something has to change drastically in how medicine is organised because it's not working in its current iteration as the difficulty goes up and up.
Something has to change drastically in how medicine is organised because it's not working in its current iteration as the difficulty goes up and up.
They run pharmacy benefits management, health insurance and drug distribution.
The estimate is 4-5 Trillion flows throw these firms. Which is larger than the GDP of India. So this gigantic structure has emerged that doesn't really make too much profit btw (very similar to Amazon Platform Economics) but is layer upon layer upon layer of cash flow passing through middlemen.
Drastic change requires new ideas about what do we do about all these middlemen who shape the environment on top of which everything exists.
It's impossible to fix overly complex systems.
Simplify, simplify, simplify, and then the fixes become trivial.
In the US case, that means banning most of the middle-layers.
Banning the middle layers here (absent other changes) just means that the companies that replace their spots in the top 20 will be vertically integrated conglomerates that manufacturer, distribute, prescribe and provide insurance (i.e. payment plans) for pharmaceutical drugs.
Except these companies are already vertically integrated, to a large degree. All the biggest insurers have their own in-house PBMs.
CVS (the parent company of Aetna) has Caremark.
Cigna has Express Scripts.
Anthem (fine, Elevance) has CarelonRx.
UnitedHealth Group has Optum.
I don’t disagree that the system requires change and is extremely complex, however.
The real problem is that it’s nearly impossible to “scale” healthcare and keep it personalized, and people want personalized healthcare - because that’s shown to be more effective healthcare. Doctors can only see a limited number of patients a day, and they need to be paid some compensation commensurate with their skills and efforts. That alone makes it hard for everyone “healthy” to see a doctor often enough and for long enough to get deeply personal care. Most people realistically can pay out of pocket for preventative care. $100-200/yr for an American isn’t crazy. Even most drugs are super affordable out of pocket if the profit margins are kept low (which is started to be available, bits at a time).
The real complexity, of course, is the long-tail where a few people get cancer and car accidents and other serious conditions which swamp the costs of everything else.