Lazarus: Patients' choices narrower, yet cost of insurance rises

He didn't hesitate.

"A single-payer system would definitely be best," Thompson said. "That would eliminate a lot of these problems."

Darrel Ng, an Anthem spokesman, said that buying specialty drugs in bulk and mailing them directly to people's homes will save money.

"We think this is important at a time when businesses and individuals are deciding whether they can afford to continue to maintain health benefits coverage," he said.

This is healthcare as practiced by Gordon Gekko: back-room negotiations and sweetheart deals. It may result in lower costs, but the patient is practically an afterthought in the equation, a line item on a business contract.

And we'll see more of this sort of thing as consolidation continues among healthcare companies, allowing fewer businesses to exert greater control over the market.

CuraScript, for example, is owned by Express Scripts, the country's biggest pharmacy benefits manager. Such companies serve as middlemen in helping insurers and employers handle prescription-drug programs.

Express Scripts acquired rival Medco Health Solutions last year for $29 billion. That deal followed similar buyouts of ValueRx, Diversified Pharmaceutical Services and National Prescription Administrators.

Express Scripts now accounts for almost 1 of every 3 prescriptions written in the United States.

Anthem Blue Cross, meanwhile, is owned by WellPoint, which runs Blue Cross or Blue Shield operations in more than a dozen states.

WellPoint, the country's largest private health insurer, acquired rival insurer Amerigroup for nearly $5 billion in July. Other recent purchases include contact-lens retailer 1-800 Contacts and CareMore, a provider of managed care for the elderly.

So let's return to Liberman's questions. "Who is Anthem to tell me where I have to buy my medicine?" he wanted to know. "Why should I have to buy it from some mail-order company instead of the drugstore that I have been going to for a long time?"

Anthem is a corporate behemoth whose parent earned $2.6 billion in profit last year by managing people's insurance claims while charging as much as possible in premiums and co-pays.

The company is now seeking an average 18% rate hike for more than 630,000 individual policyholders in California, with some customers facing increases of as much as 25%.

Liberman and others who need specialty meds have to use the drugstore of Anthem's choosing because, well, that's in Anthem's best interest. It's likely in the patients' best interest as well, at least as far as costs go.

But Liberman also is correct: Personal choice is important. When it comes to healthcare, nobody should have decisions forced upon them.

What will our healthcare system look like when we have even fewer options for coverage and prescriptions? Think about the cable industry and how that's turned out after decades of consolidation.

Bummer, huh?

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send tips or feedback to david.lazarus@latimes.com.

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