Choices...

[Gob]

Americans will have just three big companies to choose their health insurance from rather than five if the latest deals get the go ahead.

US healthcare firm Anthem said it would pay $54bn (£35bn) to buy smaller rival Cigna in a move aimed at slashing costs.

The biggest healthcare insurer in the US will be created by the historic deal, the largest in the sector.

The tie-up comes weeks after Aetna said it would buy rival Humana for $37bn.

If they are approved by regulators, the two mega-deals would transform the US healthcare industry, consolidating the country's five biggest health insurers to just three, including UnitedHealth.

Forrester analyst Alex Cullen said the deals are being driven by the "huge pressure" on healthcare firms to reduce costs.

"The landscape has changed completely. Firms are now competing to be the 'Amazon' of the healthcare sector. It's a much more consumer-orientated landscape, " he said.

The deal frenzy comes in the wake of rapid change, largely linked to "Obamacare" - President Obama's Affordable Care Act.

The 2010 law was aimed at extending health insurance care to all Americans, including those not covered by their employers, as well as the poor and the elderly.

But the conditions it has imposed on insurance firms, such as banning them from denying health coverage to people with pre-existing health conditions and allowing young people to remain on their parents' plans until the age of 26, is forcing them to become more efficient.

The law has also resulted in marketplaces - with websites akin to online travel and shopping sites - where individuals can compare prices as they shop for coverage, which have also added to pressure to minimise costs.

Merging will give the firms better negotiating powers with drug companies, but critics say the smaller number of providers mean that consumers could end up paying more.

"The business motives are relatively obvious, but we don't know yet if it's good for consumers," said Mr Cullen.

The US spent $2.5 trillion - or 17.4% of GDP - on health care in 2013, according to official figures. Per capita the figure has risen from $4,129 in 2000 to $7,826 in 2013.

[Long Run]

"The business motives are relatively obvious, but we don't know yet if it's good for consumers," said Mr Cullen.

[/quote]

Most metropolitan markets have multiple regional health insurers that usually dominate those markets. The big insurance companies (Cigna, Aetna, etc.), are available in most parts of the country, and grab some of the local markets, but usually are the choice for large employers who have multiple locations. Because of their size, they tend to be the most aggressive at negotiating discounted pricing from providers. This can lead to lower prices, but also less selection as more specialists, stronger hospital groups and practice groups say no thanks to lower payments. This can leave such carriers with the "left-side of the bell curve" providers.

[oldr_n_wsr]

"The landscape has changed completely. Firms are now competing to be the 'Amazon' of the healthcare sector. It's a much more consumer-orientated landscape, " he said.

How does fewer choices for the consumer lead to the conclusion of a more "consumer-orientated landscape"? I thought a greater number of choices led to a more "consumer-orientated landscape".

[MajGenl.Meade]

Single payer - single provider

The ultimate in choice.

[Sue U]

From what I've seen, a significant factor driving the health insurance mergers is to pick up bigger slices of the Medicare Advantage and Medicaid Managed Care markets. Over the last couple of months there has been a lot of maneuvering in the industry and a lot of speculation about who'd be taking over whom. Because these large insurers are all for-profit companies, market consolidation is almost guaranteed not to be good for consumers.

[Crackpot]

Price wise no. But customers will likly get a larger choice of healthcare providers.

[Sue U]

Not necessarily. That would depend on whether the merged companies are going to reorganize their HMOs, PPOs, EPOs and other provider networks, and there's certainly no guarantee of which providers are going to be in or out of any given network or which networks will be offered under which plans. As someone who has done extensive shopping for Affordable Care Act coverage the last two years, I can tell you that it can be quite confusing and quite a chore to figure out what docs are available under which plans and at what price. Even with consolidation, the system is way too complicated and way too expensive -- at least for those of us who can't get group coverage and who don't qualify for ACA subsidies or Medicaid.

[wesw]

when they get it down to zero, I ll be happy.

[oldr_n_wsr]

But customers will likly get a larger choice of healthcare providers.

Maybe it's me but please explain how the consolidation of insurance providers (aka fewer providers) leads to a larger choice of healthcare providers?

[Sue U]

"Insurers" are not "providers." "Providers" means doctors, dentists and other licensed healthcare professionals.

[Long Run]

But customers will likly get a larger choice of healthcare providers.

Maybe it's me but please explain how the consolidation of insurance providers (aka fewer providers) leads to a larger choice of healthcare providers?

Like Sue said, maybe yes, maybe no, depending on how the new big insurers arrange their plans. In theory, if there are fewer insurers, this will force more doctors, hospitals, etc. to sign up to be on more of the reduced number of insurance lists. The healthcare providers cannot be as selective as when there are more insurers.

[MajGenl.Meade]

Here's how that can work. In early May it was decided by my PCP (stupid initials) that I needed to consult a surgeon to get these knees replaced. The insurance provider's network has a #1 knee guy - and apparently just the one - and I can't get to see him until Sept 3. That's almost four months just to get a consult.

If my insurance provider had more health care providers on its list, then maybe I could have found one who was available in two months or (shock, horror) one.

In the meantime, I'm losing the use of both arms due to the long-term effects of having to haul my heavy ass out of chairs and onto and off toilets that are all too f-ing low. True, I now have a raised toilet seat extension and an elevating chair to stand up. But it's too late - the arms are killing me because I end up sleeping on one or the other or both sides for 105 minutes at a time and wake up with real trouble in elbows, shoulders, wrists and fingers.

I want a doctor! Ready for single payer/single provider.

[Gob]

You should move to a civilised country Meade.

[MajGenl.Meade]

True, they'd have been replaced in South Africa already.

[Gob]

With some nice nearly new ones a black non-white person was not using much at all.

[Joe Guy]

And because of the inherent nature of those non-white pre-owned knees they have the added benefit of allowing you to jump much higher than the average Caucasian.

[oldr_n_wsr]

"Insurers" are not "providers." "Providers" means doctors, dentists and other licensed healthcare professionals.

thanks for that. I missed the whole insurers vs providers.

[BoSoxGal]

Here's how that can work. In early May it was decided by my PCP (stupid initials) that I needed to consult a surgeon to get these knees replaced. The insurance provider's network has a #1 knee guy - and apparently just the one - and I can't get to see him until Sept 3. That's almost four months just to get a consult.

If my insurance provider had more health care providers on its list, then maybe I could have found one who was available in two months or (shock, horror) one.

In the meantime, I'm losing the use of both arms due to the long-term effects of having to haul my heavy ass out of chairs and onto and off toilets that are all too f-ing low. True, I now have a raised toilet seat extension and an elevating chair to stand up. But it's too late - the arms are killing me because I end up sleeping on one or the other or both sides for 105 minutes at a time and wake up with real trouble in elbows, shoulders, wrists and fingers.

I want a doctor! Ready for single payer/single provider.

Lose weight. Use a cane/crutches/walker. Your broken knees - broken in large part due to your abuse of them - do not constitute a medical emergency. Four months is not so terrible. Single payer would mean rationing just like this and it's perfectly acceptable.

Sorry you don't feel great but it's not exactly heart disease or cancer.

[Big RR]

Single payer would mean rationing just like this and it's perfectly acceptable.

I could, or it could mean that every provider would be accepting it and we would have a much wider choice of who to utilize. It certainly wouldn't mean having only one in-network specialist.