Health Insurance Diatribe

So lets say that the person in the example is me. It isn't. But lets say it is.

My Dr. switches me to a skin cream that is more expensive but better for me. When I go to the drive through pharmacy, they tell me that it needed prior approval? And because it doesn't have prior approval, I have to pay a $60 copay for it.

Prior approval? My doctor made the decision to prescribe it to me. No that isn't what she means. She means the insurance company had to approve it. But I don't go to the front door of an insurance company for my health needs?

And it gets better. The healthcare group that I am using is approved by my insurance company. And you can't get any better implication that therefore my doctor who works at that hospital/ healthcare group is also approved by my insurance company.

So the Doctor who prescribed the cream is approved. But whether or not the insurance ….

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So an insurance company mitigates risk by failing to cover anomalous conditions or novel expensive best treatments? If the insurance company, the middleman in this case, didn't mitigate risks by failing to insure prescribed treatments everyone's premium would go up? But what about the person who doesn't get the drugs because they are not covered and can't afford them? In effect they are not really insured?

So you would argue that people are only insured to a certain level of insurance?

I do not believe that a doctor should ever have to make a decision based on how much something costs and whether it is insured or not?

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Now I will add one more monkey wrench to the what is wrong with this. Now in the above paragraph lets fit this in. Let's say that in the analysis the Doctor receives kickbacks for drugs he promotes. You wouldn't think that a situation like that would fit very well into the prior authorization problem above would you?

Okay, now let's just say that you had some powerhouse pharma co companies and for some reason their drugs were always on the approved list?

Now lets say you had a small company makes a great drug. And would that drug be more likely to always be on the approved list if they were owned by a mega pharmaco company?

A lot of this is just conjecture.

But you start to ask why somebody has their hand in the cookie jar? And guess what, if they were not able to differentiate themselves everywhere they go by owning an expensive foreign car....

And I do stand back and ask, "Is the gestalt of this extortion."

© 2025 Thomas Paul Murphy

Now think of that last e word there.  If the rich don't pay "___" isn't that really extortion?