Some Perverse Incentives in the Healthcare System

Perverse Incentives in the Healthcare System

By Paul Thomas MD

There are perverse incentives in the healthcare system. As a part of my mission to provide affordable and accessible health care in Detroit and beyond, it needs to be said that the middlemen in healthcare inflate the cost of the care that you receive.Anthem Revenue $104 Billion (2019)

Cigna Revenue $154 Billion (2019)
United Revenue $242 Billion (2019)
Aetna Revenues $69.6 Billion (2019)

Cigna CEO salary $18.9 million (2018)
United CEO salary $21.5 million (2018)
Aetna CEO salary $18.7 million (2017)

The total annual healthcare spending in the US is over $3.6 trillion annually.

  • Healthcare spending on administration: 34%
  • Healthcare spending on physician salary: 8.6%

When your doctor can’t get you the tests/imaging/procedures/surgery/medication you NEED, remind yourself that the middle management, the CEOs, the lobbyists for health insurance company did NOT swear an oath to put your health above money.

Your doctor did.


Doctors are missing sleep, skipping vacation, answering calls on weekend and holidays, missing important family events, and otherwise working tirelessly to keep you healthy.

All of that’s to say that I firmly believe in the power of the doctor-patient relationship and removing the middlemen from this equation.


3 Responses

  1. Excellent reminder. It’s a CEO-centric for-profit system grotesquely out of control and, if not confronted, hell-bent on self-immolation. Why isn’t 90% of that salary apportioned to employee retirement and other incentive funds? The excesses are appalling.


  2. Well said.


  3. Why does anyone think that publishing the prices for health care services is a bad thing?

    How do employer sponsored ERISA health plans know they are meeting their obligations as a plan fiduciary when they don’t know the prices they are paying?

    The Health Care PRICE Transparency Act Would Require Hospitals to:

    * Make public negotiated rates and charges, cash prices, etc. in a manner that is consumer-friendly and up-to-date.
    * Disclose on a public website their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers.

    Dr. David E. Marcinko MBA


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