Day succeeded in persuading the health-care colossus to reduce her bill after weeks of telephone calls, letters and paperwork, ultimately paying $650 and abandoning her efforts to try to lower the bill further. The episode left a bitter taste, particularly after UnitedHealthcare became locked in a contracting fight and stopped covering care at South Carolina’s largest not-for-profit health system, threatening Day’s access to longtime physicians.
“They’ve made it so complicated that nobody can use this system,” Day said, drawing a lesson from her work trying to simplify companies’ supply chains. “Bigger is not always more efficient. Bigger is more convoluted.”
Tens of millions of Americans regularly interact with one or several of the company’s approximately 2,200 subsidiaries, including middlemen that handle payment processes and pharmaceutical prescriptions, often without realizing it. UnitedHealth ranks as the nation’s fourth-largest company by revenue this year, just behind Apple and ahead of tech giants Alphabet and Microsoft. In many parts of the country, a patient could be a UnitedHealth customer from cradle to grave, starting with obstetric care and ending with hospice services.
The company says its acquisitions have helped it “coordinate and align incentives” and deliver what industry leaders refer to as “value-based care,” with providers working together to achieve a shared goal of high-quality, low-cost health care.
Critics point to UnitedHealth’s $22 billion profit last year, saying the company’s focus is on benefiting itself while adding costs for consumers.
“They’ve grown too big for this country’s good, and for their own good,” said Don Berwick, a Harvard-affiliated physician who oversaw Medicare and Medicaid during the Obama administration. “Success for UnitedHealth is return for investors.”
For decades, UnitedHealth’s staggering growth attracted relatively little Washington scrutiny, particularly compared with drugmakers repeatedly summoned to Congress to testify on price increases. Federal antitrust officials also traditionally focused on blocking companies from gobbling up direct competitors, known as horizontal integration while being more permissive of the strategy practiced by UnitedHealth, which involves buying a stake in different sectors of the same industry, known as vertical integration.
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