Premiums and out-of-pocket expenses are forever on the rise in this country, while access to and quality of care continue to decline in many instances. And it’s all about putting profit before American health.

I worked for 20 years as a top communications director at two of the biggest for-profit health insurers, Humana and Cigna, and I now bear witness: Health Insurers willingly and knowingly mislead the public and elected officials in order to protect profits for shareholders.

Over those two decades, it was my job to create and carry out the public relations, media and propaganda campaigns aimed at making Americans believe we have the best health care system in the world and that big insurers were doing all they could to control costs.

Neither of these claims is true.

The more the cost of health care products and services go up, the more revenue insurers are able to take in by forcing you to pay more for their products. The more revenue they rake in, the more of your money they have to convert to profits for shareholders and CEO bonuses.

The United States is the last frontier for this kind of profiteering off human health needs, and as a result, we have the worst-ranked health care system among wealthy nations.

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Health Care Insanity: CEO Dough (Episode 1) from Tarbell Admin on Vimeo.

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Take a look at Axios reporter Bob Herman’s analysis of second quarter 2018 financial fortunes of for-profit health care companies. The list includes hospital companies, drug and medical supply manufacturers and distributors and health insurers. As a group, they are on track to make Wall Street especially happy this year.

“Company after company has posted profits that have exceeded Wall Street estimates, and most firms have raised profit estimates for the rest of 2018,” writes Herman, who keeps track of the financial filings of 147 publicly traded health care companies. Collectively, those companies have reported $47 billion in net profits on $545 billion of global revenue. (A few companies have not yet reported their second quarter earnings, so the final numbers will be higher.)

You’ll not be surprised to learn that Big Pharma was the big winner last quarter, both in terms of revenue and profit margins. No other health care sector comes close to pharmaceutical companies’ profit margins. Just one example: Gilead Sciences, the maker of hepatitis C drugs that cost more than $1,000 a pill, posted a profit margin of 41.7 percent.

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But what caught my attention is that one health insurer—UnitedHealth—is quickly becoming the biggest and most profitable of the whole bunch in terms of total revenue and net profits. Only drug distributor McKesson took in slightly more money in revenues this past quarter ($52.061 billion) than UnitedHealth ($50.322 billion). And only drug and medical-supply maker Johnson & Johnson posted higher profits ($3.76 billion) than UnitedHealth ($2.56 billion).

While UnitedHealth is by far the largest private health insurer, it is not alone in benefiting from health care providers’ unrelenting price hikes. The combined revenue of the five biggest for-profit insurance companies (Anthem, Aetna, Cigna, Humana and UnitedHealth) was $111.4 billon in the second quarter. Their profits totaled $5.2 billion. The CEOs of those companies have been handsomely rewarded for consistently exceeding Wall Street’s expectations. They’re now making far more these days than they did when I was still working for them.

Think insurers have an incentive to control health care costs? Think again. They neither can nor want to. Here’s the thing: If they did more than pay lip service to controlling costs, their revenue and profits would decline. That would not make their shareholders and Wall Street financial analysts happy. And take it from me, someone who handled financial communications for one of those big five insurers for 10 years, the two groups of people who must be kept happy at all costs are shareholders and Wall Street financial analysts.