Friday, August 19, 2016

How Much More is Going on Here Than We Can Tell So Far in Aetna Merger Threat?

As the linked article below indicates Aetna has been trying to play a game of brinksmanship with the Government on getting its way for a merger deal with Humana; as in give us want we want or we won't participate in the Affordable Care Act any more. And of course they play the "we can't make money here" card because, if we're to believe them, people in the Act's market pool are a lot sicker than they anticipated.

Obviously, there may be at least some truth to that claim, but you have to ask yourself how likely it is that this one point is the whole story. And, as is usually the case, we don't get much in the way of related information in which to make any kind of more comprehensive sense of the situation.

One need only consider what has happened to drug prices in recent months to wonder if other aspects of the health care system are at play here, other than whatever faults the Affordable Care Act might have. Any more than we've been given a deeper view of Aetna's claim of why they are losing money. There were, in fact, reports earlier in the year that other payers (see here, and here), who began at the outset of the Act's creation to prepare for market pool membership, were doing just fine with it. Wouldn't it have been nice to have been given a contrast, given details of what those other payers were doing that Aetna wasn't, to see if it is only a case of the remaining deficiencies in the Affordable Care Act that is at fault here?

Let's be clear here. The Affordable Care Act was a "something is better than nothing" compromise; especially when you consider what a real single payer approach can do (as demonstrated by the advanced nations who are using it now). It undoubtedly still has problems that need to be addressed, but what doesn't within the healthcare system as a whole? Just considering the outrageous profiteering by drug companies, or the lack of pricing transparency with hospitals, is enough to make one sick with despair. And that doesn't even begin to put light on what the payers are doing with their ledger books when it comes to figuring costs, or what reasonable profit margins ought to be.

The bottom line here is this: when you see a news report you have to develope the habit of always asking deeper questions because one fact, whether true or not, without full context doesn't necessarily tell you very much as far as the bigger picture of what our priorities ought to be, or how we should address them.

Image for the news result