By Diane L. Marolla, LICSW, Marolla Consultants, MarollaConsultants@yahoo.com
“Control and manipulation of patient data is also a concern. Consumers should have the freedom to choose the providers that produce the highest quality health outcomes and cost-effectiveness, rather than being coerced into using certain physicians or pharmacies.”
“In short, bigger is not always better. A close examination of whether this acquisition will lead to higher drug prices and fewer quality and convenience options for consumers is warranted.”
— B. Douglas Hoey, CEO, National Community Pharmacists Association
I will be honest in sharing with you that my original article for January was to talk about getting and staying healthy in 2018. My plans for that article immediately changed when the news broke about the CVS/Aetna merger. This was and remains very big news. Should the merger go through, it will continue to change the landscape of how healthcare is delivered to consumers like you and me. Additionally, it is a game changer for “who” will be delivering care to you and me.
As consumers of health care services, we are in this position of having big companies trying to control our health for a multitude of reasons. There are a multitude of reasons as to why the healthcare industry has changed so dramatically over the years. Unfortunately, a major reason contributing to such changes is how consumers have been utilizing the systems available.
Additionally, Americans as a whole are not doing enough to stay healthy. I say this because as Americans, many chronic conditions are preventable. According to the Center of Disease Control’s (CDC) most current data:
About half of all adults in this country have one or more chronic health conditions
Obesity is a serious health concern with more than one third of adults in this country being obese
Half of the adults in this country do not engage in recommendations for physical exercise
90% of Americans over the age of two consume too much sodium
Cigarette smoking and drinking too much alcohol contribute to the chronic conditions of Americans
Doctors, hospitals, and our health insurance companies have all tried to change the behaviors of the average American. Doctors tell patients to lose weight and to stop smoking, yet their directions are not followed. Our health insurance companies have increased our premiums and deductibles in an effort to prevent inappropriate and over usage of emergency rooms and inpatient hospital stays. Employers purchase wellness programs to try and get their employees healthy in an effort to drive costs down and to prevent absenteeism in the work place. Thus far, all of the interventions have not worked. Healthcare costs are unaffordable and unmanageable which is why we now have the Aetna/CVS merger.
From a business perspective, the merger is genius on the part of CVS and Aetna. They are both for profit, so they will continue to make money hand over fist should this merger be approved. They will certainly tell consumers that this merger will be good for us (and of course, they already are), but ultimately, it will be good for them, their share holders, and their corporate executives. At the end of the day, a company does not spend 69 billion dollars on a merger unless there are huge profits to be gained. Corporate executives do not sit around and say “Gee, how can I make the life of Jenny Jones in Smithfield, RI better for her today?” Should the merger be approved, CVS/Aetna will be a huge force in dictating to consumers how their care will be managed and delivered. Consumers will have little say in who will be treating them and if the medication prescribed is really the best medication from a clinical perspective. CVS/Aetna will navigate care through their clinics to ensure their subscribers/members are receiving care in the cheapest setting.
In addition to this merger ensuring CVS/Aetna will continue to make huge profits, it will also lead to:
fewer choices for consumers in choosing their doctors or even getting treatment by a doctor since other professionals are now able to provide such care at a cheaper cost to the insurance companies
doctors will continue to lose the “doctor/patient” relationship
The seller of drugs (CVS) will be involved in dictating which drugs you will take more and more hospitals will struggle financially as they will have decreased traffic in their emergency rooms, and will have difficulty filling inpatient hospital beds. Most hospitals still rely on emergency room and inpatient bed costs for their bottom line. If hospitals cannot find other sources of revenue other than emergency room visits and inpatient hospital stays, you will see more hospital closures.
History has already proven to us that such mergers, like the proposed CVS/Aetna merger have not led to a decrease in costs to consumers. If we were to ask the executives at CVS and Aetna how much it will save consumers, trust me, they can’t give an answer. Better yet, if we asked them for a guarantee of a savings, they certainly would not commit to that.
Specific to this merger being good for us, over the past 30 years, other mergers in healthcare have occurred. Thus far, none of them have provided any savings to consumers at all. How do I know this? Well, if I ask you if anything in healthcare is better for you from a cost perspective, the majority of you would say no.