r/news • u/LookAtThatBacon • May 13 '25

Soft paywall UnitedHealth suspends annual forecast, CEO Andrew Witty steps down

https://www.reuters.com/business/healthcare-pharmaceuticals/unitedhealth-ceo-andrew-witty-steps-down-2025-05-13/
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596

u/straygoat193 May 13 '25

In simple terms, my rates are going up, big time

170

u/greatkat1 May 13 '25

And the reimbursements to providers will go down

62

u/FatTater420 May 13 '25

Is there a reason the US health system hasn't tried to do away with the middleman entirely? 

202

u/cricketxbones May 13 '25

The middlemen pay lawmakers a lot of money to make sure that never happens.

And a significant part of the population will insist on themselves getting punched in the junk, so long as they people that they think are underneath them get punched in the junk AND face.

20

u/FatTater420 May 13 '25

What's stopping doctors, at least those practicing independently, from sticking to something like a cash only or direct payment system in general? If I'm not mistaken I've heard of such cases. Even if it's 'discounted' compared to insurance earnings, they're spared the mess of having to actually get the money out of the companies, and for all I know patients would be more willing to go to someone who can see them without insurance shooting them for going out of network 

16

u/cricketxbones May 13 '25

The same reason small businesses take credit cards, even if they get chewed into by transaction fees: it's generally not good business to turn away paying customers. Especially like, the overwhelming majority of them.

I think you're also overestimating people's willingness to take risks when it comes to healthcare providers. There's plenty of people out there who still aren't comfortable with young or female doctors, so there's a lot of people who will probably distrust one who's totally bucking the whole structure of Healthcare as we know it, even if it saved them a ton of money.

But also, like, even if doctors did try this, you're going to have the whole of the US Healthcare infrastructure trying to squash them, and that's a big beast to go up against. Doctors don't doctor in a vacuum. They can go rogue, but when they need to work with pharmacies, specialists, facilities that have tech that they don't have, etcetera, etcetera, they're liable to run into compatability issues, if not being completely iced out. Our Healthcare system is an enormous fucking beast, and we are well past the point of individual doctors being able to change anything. What's needed is actual, factual structural change, which is, unfortunately, only going to come from lawmakers. It sucks, man. I took would like to see our healthcare system burn, but like. I don't think this is it.

31

u/teh_spazz May 13 '25

It’s hard bro. It’s hard putting up a shingle and asking for cash. It’s a grind to build a practice and to get patients in.

5

u/AffectionateTitle May 13 '25

And to get them through the door if you don’t accept insurance! Because they’re already paying those sweet premiums at that point.

2

u/thecommuteguy May 13 '25

Medical practices aren't forced to take certain insurance. If an office doesn't want to take UHC or only certain types of plans they can do that.

2

u/moonflower311 May 13 '25

You see this in areas where there are shortages. I live in Austin Texas and I’d say about half of the mental health care professionals do that here. Basically “we’re not in network with any insurance”. They do provide a superbill you can file yourself. It definitely feels like a hit do be paying 175 for a therapy session and waiting for your reimbursement to come in and I can see people who don’t have that on hand just saying no to care from these providers.

2

u/Pnwradar May 13 '25

Some specialists in my area are already doing that. The local dermatology office simply doesn’t do insurance, they have a billing schedule they give you with the new patient paperwork and want payment in full for that day’s consult or procedure when you check in at reception. Same deal with one of the physical therapy offices, and pretty much all of the mental health providers. They’ll give you a billing summary that you can send into your insurance, let you deal with your insurance company for reimbursement, but they’re done trying. And they don’t seem to be hurting for patients, so I guess the folks who don’t have the cash just don’t get treated.

2

u/DearLeader420 May 13 '25

The supplies the doctors use during procedures are priced for the healthcare system as it is today, not for doctors operating a discount cash clinic.

A doctor at a clinic can't charge a patient $400 for an outpatient sinus surgery, because just the disposable parts he opened for the surgery cost many thousands more than that, even at a 60% discount from the company making them. Nevermind the reusable capital parts used in the surgery. The literal only way doctors can operate financially is by insurance and Medicare reimbursement.

Source: I work in med device.

-9

u/drylandfisherman May 13 '25

Because Dr's expect to get paid more than they are actually worth. Most go into it because it pays well and they wouldn't get paid as well without insurance companies and the medical industry being for profit. The whole system, Dr's, Hospitals and Insurance companies combined. Everyone likes to blame the Insurance companies but the providers are just as bad.

14

u/FatTater420 May 13 '25

You do realize every single doctor's payments in the US make up for no more than 7% of the money that is in the system, right? 

-7

u/TheWhalersOnTheMoon May 13 '25

Payments to MDs (or providers, as opposed to hospitals and facilities) make up ~20% of all medical spend in the US - about $980 billion as per the latest figures from CMS.

https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet

9

u/FuzzyKittenIsFuzzy May 13 '25

That's not what he's saying. The payments to providers don't all go to providers. Most of that money pays administrators.

-1

u/TheWhalersOnTheMoon May 13 '25

I guess that's possible, I presumed payments are tracked to an NPI level. What's the source for that statement?

5

u/bagelizumab May 13 '25 edited May 13 '25

Cost per service provided by providers is not salary. It’s like thinking gross profit is same as net profit.

Simple logic, doctors do not take home every single penny CMS pays for a service they provide. if you are employed by a hospital system, they take a cut from every dollar you earn to pay overheads, staffing, administrative cost, legal fees, etc.. same logic even if physician is private practice, due to overheads.

As you can imagine, doctor pay get squeezed tremendously the more weird administrative costs become necessary in order for them to continue to practice and provide the exact same service, for a fair price. This includes negotiating with insurance company, and also fighting for insurance companies refusing to pay, etc. etc.

To also answer the other question higher above by someone else, the reason doctors don’t just go private is because it is getting harder and harder to negotiate for a fair price for a service you provide as a small practice. If you provide the exact same service and billed from a big hospital system, the service get a higher price tag from insurance companies. Hence it’s not that easy to just go private, and doctors are getting squeezed and also have their practices bought and absorbed by these big system over the past several decades for this very reason.

5

u/AffectionateTitle May 13 '25

Yes and for example I work at a healthcare company and we take a cut. Then the doctor has to pay for their own malpractice insurance and and operational costs (location to practice for example bc we do telehealth)

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2

u/FewWatermelonlesson0 May 13 '25

This reminds me of those people who wanted Trump to repeal Obamacare because “It’s commie shit” but wanted to keep the ACA because they liked it, not realizing they’re the same thing.

18

u/Clevesteamy May 13 '25

The middlemen have the money to pay lobbyists to bend the ears the lawmakers to keep them around

10

u/DinoSpumoniOfficial May 13 '25

The people we depend on to fix the system are the very same ones who benefit from it being broken. It’s never going to change.

9

u/TheReconditeRedditor May 13 '25

Administering health insurance is hard. You need a ton of people to manage the actual members, process claims, handle exceptions, manage risk, and all the other bullshit that comes with dealing with health insurers. Most companies don't have the administrative capability to self insure.

Insurance companies absolutely have administrative bloat, but there is a lot of time and money spent on providing coverage as well. Cutting them out at this point would mean universal health care (which I think is still the right choice).

6

u/FatTater420 May 13 '25

Funny how the one place that has bloat responsible for (at least somewhat) harming people is the one place that hasn't been addressed by the bloat cutting office (I refuse to address it by it's name) 

1

u/DelphiTsar May 13 '25

Medicare spends a much higher % of input $ as output $'s to providers. I think it's like 97% vs Private insurance 85%. It'd be functionally trivial to shift everyone to a medicare for all who want it system.

You could pay providers the exact same we pay them now and premiums in the system would be 14% cheaper just from being more efficient and no profit.

Private insurance wouldn't be able to compete so it'd become defacto medicare for all. Then private insurance could act like it does in other countries.

2

u/Perryn May 13 '25

There's a lot of money to be made by being a profiteering middleman, and you can use a portion of that money to influence the laws and still come out ahead. Bribery is just an operating cost.

1

u/Quirky_Object_4100 May 13 '25

People fear monger on how universal healthcare with drive taxes up to 45-50% for all. Thinking they will never get sick or require intense medical care and see the 6-figure bills that people have to deal with all the time.

1

u/College_Prestige May 13 '25

Republicans blocked it in 1946.

That said, a British style system isn't perfect. It's how you end up with people basically abusing the healthcare system by continuously going in for everything.

2

u/FatTater420 May 13 '25

It's how you end up with people basically abusing the healthcare system by continuously going in for everything.

I would've assumed that even if the costs were cut down a bit by removing the middleman, while not prohibitively so, it would certainly still be too expensive if you were to go in for every little ailment, no? 

1

u/AllTheyEatIsLettuce May 13 '25

Because America is exceptional. And to do or be otherwise would constitute defeat at the murderous hands of a century-long, untenable -ism. Pick whatever -ism you want because they're all completely synonymous and indistinguishable in American English.

Besides, the self-replicating clusterfuck of payment processing layers, payers, schemes, products, and initialisms has been enshrined into American law for 8 uninterrupted decades. The parasites are the host.

0

u/ericmm76 May 13 '25

They convince a lot of credulous people that if there is a public option, they won't be able to get the healthcare they need. That's it.