The business of health care is broken for consumers and taxpayers in America, and we can expect to see more mergers, acquisitions and even large alliances in the coming months and years, all forming in the name of trying to control rising costs and taking better care of patients. The question is, will they? Unfortunately, the answer usually is generally no. Let's take a look at two recent headlines, starting with the CVS acquisition of Aetna.

While the CVS acquisition of Aetna makes financial sense for shareholders, the same can not be said for consumers. CVS and Aetna, which individually represent severe conflicts of interest, together create an even larger systemic problem. American consumers need health care intermediaries to clearly represent the interests of either the patient or provider — they can't do both.

Maybe we're suffering from amnesia because we've forgotten why the Pharmacy Benefit Manager (PBM) industry exists in the first place.  Years ago, insurers managed drugs themselves, however the conflict of interest and the resulting price gouging was so bad that the PBM industry took off in the 1980s and became the de facto broker (intermediary) for the drug industry.  Over the next three decades, the PBM industry 'evolved' and today the PBM business model looks worse than the insurance industry it once set out to fix.  Considering the conflicted business models involved, it seems highly ironic that today's largest PBM is buying one of the largest health plans. This was a bad idea 30 years ago and it's an even worse idea today.

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Emily Payne

Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.