WE ALL KNOW health insurance is complicated. A 2016 survey found that only four in 100 Americans could identify the basic terms relating to out-of-pocket liability. Just 39% were confident that they could choose the right insurance plan for their needs. This week’s deal between CVS and Aetna will blur the lines of understanding even further.
Only in our industry could the traditional buyer-seller model become so distorted, with a leading supplier merging with a major insurer. On the part of the companies concerned it is a genius move, creating a $69 billion medical giant (and making many people rich in the process). But for patients, who already struggle to negotiate a complex sector, this is a bad development for multiple reasons.
First, individuals are totally cut out of the process. Whatever the insurance plan, the patient doesn’t get to make a single decision about the supplies purchased. There is no say over manufacturer or price. Ironically, this deal has been justified under the banner of ‘choice’ when it actually marks a shift towards the supplier controlling who can access which products in their stores.
The power balance has shifted so far away from the patient that care is no longer delivered on the basis of medical need alone. Instead, clinicians are under pressure to get more patients through the door in less time, and incentivized to prescribe the most lucrative items.
The value-based model championed by CVS and Aetna, which is supposedly tied more closely to outcomes, puts control firmly in the hands of the insurance companies, who can block access to procedures, pharmaceuticals, equipment and supplies at the stroke of a pen if your insurance plan is maxed out. Like patients, hospitals and clinicians are unable to hold back the tide, because the power lies elsewhere.
Up to 40% of all premature deaths in the United States are preventable, with fatal instances of obesity, diabetes and heart disease on the rise. That has disastrous implications for our over-burdened system, not to mention the individuals themselves. We need people to start taking better care of themselves, and fast. But if patients do not have any real say in their healthcare, how can we expect them to look after their health?
The sheer amount of money involved in this deal means that it is likely to be the first of many – CVS is just the fastest out of the blocks – taking us down a dangerous path where suppliers are in control of insurers, who in turn have a hold over patients.
In the meantime, we can’t just sit back and watch. We need a collective effort to improve people’s understanding of the system, by giving patients better access to the information they need to take decisions about their health. That will not only take a commitment on the part of patients to educate themselves. It will mean companies like the new look CVS-Aetna playing fair on price, and making healthcare as easy to navigate as possible for the Americans who sustain them.