American Prospect magazine: How decades of policy failures led to the ever-powerful UnitedHealth Group – “…Today, United is the fifth-largest public company in the U.S., bigger than JPMorgan Chase. Its insurance products serve 50 million members, more than the population of Spain, and its $186 billion health services division, Optum, has 103 million patients, more than Vietnam’s population. Earnings came to $28.4 billion last year, putting it in the top 30 of companies worldwide. We think of United as an insurance company, but it has never really been exactly that. It began as a health management company, and it is now also the largest employer of physicians in the country, with 70,000 doctors across 2,200 locations. Underneath its corporate umbrella are pharmacies, primary care clinics, surgical centers, urgent care centers, home health agencies, hospice agencies, mental health agencies, a pharmacy benefit manager, an IT division, and plenty more. United has so many subsidiaries that 25 percent of its total revenues come from itself. United even has a bank. Optum Bank is a way for consumers to manage health savings accounts, but the company’s latest financial service is a payday loan system called Optum Pay Advance for independent physician practices. While they wait for reimbursement from United for their claims but have to make payroll, doctors can get money from United to tide them over … with 35 percent interest. The other option is to succumb to the pressure and sell out to United, giving it an even greater margin. PR-tested slogans insist United’s reach across the industry allows it to support patients along the “full continuum of care.” But instead, United seems committed to maintaining a level of control to extract profits off the backs of patients, independent providers, and the government. This evolution into a health care supermarket with interlocking conflicts of interest happened slowly but deliberately, bolting on businesses to its core like a Transformer, each one slipping by the antitrust authorities. United is the master of the rollup, with at least 28 purchases of physician groups and providers since 2010; annual revenue in the past decade has grown by more than $100 billion. Other health care giants are imitating United’s vertical integration strategy. But it took time and practice for the company to perfect it, a function of policy adaptation, creativity, and ruthlessness…”