UnitedHealth Leads Payer Profitability Despite All That "Turbulence," PhRMA Learns the Hard Way That Voluntary Concessions Are Permanent, and Commercial Insurers Pay Doctors 50% of Their Costs Because They Can

Hey all,

Happy Thursday! It’s truly heartwarming to watch UnitedHealth Group navigate a "challenging" year by scraping together a mere $12 billion in profit, a feat of financial survival that must be difficult to process for the independent physicians currently being reimbursed at 40% of their actual operating costs. This charming dichotomy ensures that while payers treat medical loss ratios like a tragic natural disaster, the doctors actually providing the care are being "gig-ified" into a state of professional insolvency where the overhead costs more than the cure. Apparently, the modern healthcare blueprint is simple: we’ve built a system where the people processing the paperwork enjoy a feast of billions, leaving the people actually holding the stethoscopes to fight over the crumbs of a broken business model.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

[Fierce Healthcare] UnitedHealth Group Leads 2025 Payer Profitability Amid Industry Headwinds

UnitedHealth Group emerged as the most profitable and highest-earning healthcare payer in 2025, bringing in $12.05 billion in earnings despite a challenging fourth quarter marked by elevated medical costs and a high medical loss ratio. While most major insurers remained profitable for the year, the industry faced significant turbulence from rising utilization rates and policy uncertainty, leading to a substantial multi-billion dollar loss for Centene. These financial results underscore a year where insurers felt less like "good hands" and more like they were caught in a high-stakes game of financial Whac-A-Mole against rising medical costs and grumpy federal regulators.

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[Endpoints News] Pharma Resists Codification of Trump’s Drug Pricing Deals

The pharmaceutical industry is signaling an end to negotiations with the Trump administration as the President moves to codify voluntary "most favored nation" pricing agreements into permanent federal law. Industry leaders, led by PhRMA, argue that their initial concessions were intended to avoid such legislation and now warn that statutory price controls will fundamentally undermine American pharmaceutical innovation. It appears the industry's attempt to "compromise" their way out of trouble has backfired spectacularly, proving that in Washington, giving an inch usually just provides the government with a very accurate measurement of how much more they can take.

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[HEALTH CARE un-covered] The Economic Exploitation of Independent Physicians by Insurers

Independent primary care physicians face severe economic exploitation as commercial insurers frequently offer reimbursement rates significantly below Medicare benchmarks, sometimes as low as 40% to 50% of the actual cost required to maintain a practice. Data highlights that median commercial payments in states like New York and California fall well short of breaking even, forcing many providers to retire early or abandon independent practice entirely. Unless we fix these broken payment floors and outdated network standards, we’re heading for a massive doctor shortage where the "gig-ification" of medicine leaves us all waiting a month just to see a physician who’s being paid less for a check-up than your Uber driver makes for a surge-priced airport run.

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