It’s wrong to state this as a binary. This isn’t mutually exclusive and all of the parties profiting from the status quo had a common interest in preventing reforms - those don’t overlap perfectly so the groups fissured on different lines but they lobbied independently and as part of joint groups like this one:

https://en.wikipedia.org/wiki/Partnership_for_America%27s_He...

There are significant generational issues, too. For example, older doctors who owned highly profitable private practices took a very different position from younger doctors who are employees of huge companies, and the pharmaceutical lobby wasn’t opposed to the ACA as long as it didn’t involve cutting their profit margin to what Medicare or the VA pay.

This is a factually incorrect statement, Joe Lieberman killed the public option not "doctors."

At least blame the right people.

Also FWIW every doctor I know supports universal healthcare, granted most of them are under the age of 40 but you're foolish if you all doctors believe the same thing.

> The ACA caps health insurers' profits. When you say "the healthcare industry", you're confusing insurers and providers, who are not allied.

I see you didn't look up the relationship between UnitedHealthcare (the single largest insurer in the country) and Optum (the single largest healthcare provider in the country), did you?

Hint: They're both owned by UnitedHealth Group.

I'm aware, they run the prescription side of my employer health plan. But if they denied care for me, that would actually be my employer doing it. Most employers self-insure and set how much they want to pay. The insurance company is more like a fall guy for them.

I of course have a nice tech employer plan, but they won't do early refills on medication which means I have to pay cash (well, GoodRX) for that anytime I travel for more than a week. Not a life changing expense but an annoying one. (Maybe my fault for choosing the HSA/HDHP plan?)

Also, I was talking about hospitals and don't believe Optum controls those. Here the plan that runs everything including hospitals would be Kaiser, and as far as I know people are happier with them, but I haven't tried it. Haven't tried ACA marketplace plans either.

Nope, you're not aware. The part running your prescription side is yet another part of the UHG business. That one is OptumRx.

Optum doesn't own hospitals specifically because they have strategically chosen to own almost every other type of clinic, including wiping out thousands of independent practices and small groups in just about every medical specialty (including primary care) that you can name.

Kaiser is an example of a much-less-bad version of this same pattern (called a pay-vider). They're non-profit so they don't have nearly the same incentive to leverage one side of their business to benefit the other.

Seriously: go do some research on how UnitedHealthcare, Optum, and OptumRx all coordinate to wipe out competition in local clinics and pharmacies.

I'll look into it if I get the time. Though, would be pretty easy to defeat monopolies in local clinics if we simply had a lot more local clinics, eg by increasing the supply of doctors to what other countries have.

> They're non-profit so they don't have nearly the same incentive to leverage one side of their business to benefit the other.

Most US hospitals are nonprofits, but that doesn't make them behave better. You can still earn and pay out a lot of revenue as a nonprofit.

I'm all for increasing supply of doctors but uhh yeah, you really don't understand the dynamics at play here if you think "would be pretty easy to defeat monopolies in local clinics."

Here's a quick primer: You're a doctor in Podunk, Pennsylvania. UnitedHealthcare is the largest insurer in your region, like it is in most regions. Optum wants to move into your town. UnitedHealthcare will cut your reimbursement rates by 70%, requiring you to see far more patients per day, cut your staff, downgrade your equipment, and generally run a shittier business. Once you're finally on the edge of burnout and fully strangled, Optum will come in with a buyout offer. After the buyout (or after you go bankrupt and they just replace you), suddenly UnitedHealthcare is able to restore rates mostly to where they were previously.

Ta-da!

Note if you take the buyout and then regret it and want to break free: too bad. This deal came with an extremely rigid non-compete clause that they will absolutely actually enforce. FTC tried to get rid of these, in large part for this specific use case, but thankfully the American people (read: megacorps) have the GOP looking out for them so that was struck down.

What exactly does marginal doctor supply fix in this particular scenario? Pretty much nothing. All of them have to accept insurance and the vast majority of their potential customers are insured by the same very few insurers.

Re non-profits: I didn't say it "makes them behave better." I said it subjects them to different incentives. Don't strawman. Kaiser in particular is an exceptionally strong organization in pretty much every way except its financial performance. If you think being non-profit isn't a factor, you're just playing dumb.

On that note, the NFL was a non-profit until fairly recently.

Non-profit doesn’t mean what it seems to imply.

Technically it caps profits but through Hollywood accounting it is no obstacle.