Who Owns Your Care Choices?

George Orwell’s 1984 envisioned that Big Brother, our government, would be watching us and managing our lives by that year. We didn’t get there in 1984, but, that same year, two companies in the private sector were laying the groundwork to do just that. Forty years later, these companies are reaping the fruits of their vision and controlling significant aspects of our lives and health.

In 1985, I happened upon a 1984 annual report for National Medical Enterprises (NME). It was a shocker. The company trumpeted a growth model called vertical integration. NME intended to buy companies, procuring all goods and services a hospital needed. They would source goods and services from companies they owned, at prices they set. They bought psychiatric hospitals, rehabilitation centers, nursing homes, and acute care centers. They bought companies providing diagnostic equipment, hospital beds, lifts, wheelchairs, and linens.

1984 was also the year that NME moved into health plans, becoming the second largest investor-owned health care company. This enabled NME to control patients’ access to benefits and fees for medical insurance, as well as the price of everything the patients might need. But NME became mired in scandal. In the 1990s, it had to sell its specialty hospitals after its psychiatric hospitals committed fraud. It then rebranded as Tenet Healthcare, today capitalized at almost $17 billion, with assets of $8.3 billion.

But in this universe, $8.3 billion is small potatoes. Also in 1984, a relatively small company called United Health-care went public. Fast forward forty years. In 2025, United Health Group’s (UHG’s) revenues are $435 billion, up 10.48% over 2024. It ranks #3 on the Fortune 500 list of U.S. companies. UHG has swallowed up more than 2,700 companies.

It is Orwellian and very Big Brother. UHG has diversified its holdings to include whether we are eligible for care, what care we’ll receive, where we’ll obtain it, how much we’ll be charged, what information we’ll receive about our care, and how our data will be shared. And this strategic approach has landed UHG on Forbes’ List of Most Admired Companies for fifteen consecutive years.

Our data is a marketable asset for UHG. Wendell Potter, whose Sunlight Report on United Health Group analyzes UHG’s acquisitions, reports, “The company increasingly even controls much of the information we have available to us online about medical care and health insurance. One of its transactions created RVO Health, which is now a massive, privately held digital media and marketing company that reaches more than 300 million people every month, and manages more than 100 news and information sites.” Potter also notes that information sources appearing to be independent often are not; for example, UHG operates Health-markets, an online site that appears to provide unbiased insurance information, despite its inherent conflict of interest.

Vertical integration is hitting specialized caregiving industries, too. For example, Redwood Family Care Network (RFCN) provides residential programs, community homes, specialized home care, community supports, day programs, employment supports, and behavioral services. On a given day, a client might proceed from a community home to a day program, and then receive therapies and job coaching, all under RFCN’s umbrella, while appearing to receive services from discreet providers.

The rapid pace of consolidation affects service quality, as well as the bottom line. Since 2020, my family has experienced issues three times. My mother required caregiving in New York. A small agency provided aides, supervision, and medical coordination. Then the company was bought out. Mom’s care went sideways. A social worker, assigned to oversee her care, worked for a different agency under the same umbrella. My mother’s caregiving agency didn’t supervise the social worker, and the social worker wasn’t supervising Mom’s aides.

My daughter, who has disabilities, is in Supported Living, a DSHS program. Her service provider was bought out by a company offering diversified caregiving services. Staff turnover was astonishing. My daughter’s home had five managers in three months. She missed appointments. Her household supplies disappeared at an impressive rate, and the promised inventory system wasn’t implemented.

I transferred my daughter’s care to another provider. Within weeks, her new provider was bought out by yet another company for $835 million. The purchasing company added 14,000 to its client base of 50,000 in 40 states. The company tells us that nothing will change. But, actually, my experience is that it just takes the purchaser a while to implement changes. As for now? I’m waiting for the other shoe to drop.

Please join me for a deeper look at the impacts of vertical integration in health and caregiving industries in upcoming issues of The Advocate. If you have examples of your own that you’d like to share, please send them to organizer@psara.org and put Vertical Integration in the subject line.