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 Brian Thompson murderAnd the cluelessness among the wealthy is stunning. Check this out: “My wife was like, ‘Why would someone kill a C.E.O.?’ I’m like, any C.E.O. has people who don’t like them. C.E.O.s have to let people go. C.E.O.s have people competing with their business,” said Seth Besmertnik, chief executive of a software company whose office is also in Manhattan.“ Duh! It’s not because he fired people or competed with them! UnitedHealthCare has the highest instance of denials out of all major providers, refusing an estimated one-third of claims submitted. Meanwhile Thompson took home $11 MILLION last year. People died needlessly so he could take home more money. “ UnitedHealthcare, part of the giant conglomerate UnitedHealth Group, reported more than $16 billion in operating profits last year and employed roughly 140,000 people. The company is a frequent lightning rod for criticism over how it handles claims. Earlier this year, a Senate committee investigated Medicare Advantage plans denying nursing care to patients who were recovering from falls and strokes. It concluded that three major companies — UnitedHealthcare, Humana and CVS, which owns Aetna — were intentionally denying claims for this expensive care to increase profits. UnitedHealthcare, the report noted, denied requests for such nursing stays three times more often than it did for other services. (Humana had an even higher figure, denying at a rate 16 times higher.) UnitedHealthcare did not respond to a request for comment about its history of claim denial. Journalists have also scrutinized United’s denial practices. In January, the health news outlet Stat published a detailed investigation into how a UnitedHealthcare subsidiary, NaviHealth, used algorithms to deny care for seniors enrolled in the company’s Medicare advantage plan. The Stat investigation noted specific instances that troubled United employees, like when an older woman who had a stroke was only covered for half the nursing days typically required for recovery. UnitedHealthcare and its parent company now face a class-action lawsuit over its use of the algorithm. In response to the Stat article, the company issued a statement that “the assertions that NaviHealth uses or incentivizes employees to use a tool to deny care are false.” |
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Fairness |
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Over $4,000,000,000,000 |
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Apparently |
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Doesn’t this just We pay more for worse outcomes and people suffer and die needlessly to enrich insurance corporate execs and shareholders. It’s dehumanizing and a national disgrace. |
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A comparison This article sums up how I (and I suspect most of the civilised world) sees the condition of American healthcare. Perhaps many Americans, too. If so, it would go a long way to explaining the deep distrust of medical expertise in your country. Any system motivated by the profit incentive will automatically tilt towards self-interest rather than client interest. Here in Australia basic medical care is very cheap to the client; ten years ago you could see a doctor for free, the 'basic fee' being paid by the Commonwealth. Fewer doctors are providing that now, governments having frozen that service fee payment for so long; but there are still multi-doctor centres that share rent, admin costs, etc to keep their costs manageable if you are prepared to sit in a waiting room for perhaps an hour for your turn. I do this, and sometimes pass on my turn and stay at the head of the queue, waiting an extra ten minutes to see the specific doctor who is familiar with my history. It still costs time and inconvenience, so its not routinely abused. I recall that there was a comparison of medical costs here in Australia vs those in America. This was perhaps ten years ago, when our Medicare was more comprehensive than it is now; since then Conservative governments have cut funding and Labor governments have (by dint of world affairs) struggled to keep pace in the face of the WFC and the aftermath of COVID. So Medicare is not so generous now. But even so, that probably doesn't mean reduced spending on health; it just means it comes out of private pockets directly instead of via taxes. The article mentions that American "premiums are about $25,000 per family. On top of that, people face out-of-pocket costs, which could easily be in the thousands of dollars". This is the nub of the problem; Americans might scream in protest if governments imposed a $20,000 per family tax, but are accustomed to paying $25,000 PLUS MORE to private companies (if not directly, by loss of wages because their 'health plan' is effectively paid for out of their employment package). That comparison was that Australia spent 17% of GDP on medical and pharmaceutical. America, with a per capital GDP about 25% higher, spent 22% of GDP on the same categories. Combining these two, that means that per capita costs in America were 62% higher than in Australia. S comparison of outcomes for each quartile of the population showed that Australian outcomes were better, despite the lower costs, in EVERY quartile. This was attributed to people seeking treatment in the early stages of a problem when minimal intervention often suffices, instead of waiting for the problem to become serious. That probably understates the real cost; Australia's better outcome profile means that workers get back to work sooner, aiding national productivity; and less home care is required so parents/partners are not also pulled away from employment. If you want a comparison; the healthier you keep your slaves, the more cotton they can pick. It's not hard to see why this is so, provided the corporate governance is good. A for-profit organisation naturally tries to maximise money from whatever services they provide, but a not-for-profit tries to maximise the services they provide from whatever money they have. A radically different definition of 'efficiency'. But there is still scope for private insurance and private hospitals. The public system prioritises on the basis of need, regardless of whether someone has private insurance or not. This means that treatments like cosmetic surgery, breast enhancements, etc tend to be at the bottom of the list. Even matters such as transplants are allocated priorities on a clinical basis rather than insurance status. This leads to a waiting time for all but urgent cases, but a smart government provides enough funding to keep the waiting time tolerable. But for those who want 'luxury' treatment such as cosmetic surgery, or who want to jump the queue, there is the option of a private hospital and (if desired) private insurance to cover those extra costs. But with a robust public system, this competition keeps costs down even in the private system. An example of how a Free Market operates best when there is a 'socialist' competitor to keep the others honest. Is 'socialised medicine' affordable? The rest of the civilised world, and the direct comparison with Australia, says it's even cheaper than the Free Market can provide. It just gets paid via a different mechanism. There is a positive pressure on governments to make it both cheap and more client-friendly. |
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Bob We don’t care. It’s the principle of the thing - profits over people! Maga! |
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But We’ve utterly lost sight of what’s important. America is lost |
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This states it well What Doctors Like Myself Know About Americans’ Health Care Anger Dec. 8, 2024, 6:00 a.m. ET By Helen Ouyang Dr. Ouyang is an emergency physician and an associate professor at Columbia University. I rushed around the patient as he lay motionless with his eyes closed in the emergency room. He was pale and sweaty, his T-shirt stained with vomit. You didn’t have to be a health-care worker to know that he was in a dire state. The beeps on the monitor told me his heart rate was dangerously slow. I told the man that he was going to be admitted to the hospital overnight. After a pause, he beckoned me closer. His forehead furrowed with concern. I thought he would ask if he was going to be OK or if he needed surgery — questions I’m comfortable fielding. But instead he asked, “Will my insurance cover my stay?” This is a question I can’t answer with certainty. Patients often believe that since I’m part of the health-care system, I would know. But I don’t, not as a doctor — and not even when I’m a patient myself. In the United States, health insurance is so extraordinarily complicated, with different insurers offering different plans, covering certain things and denying others (sometimes in spite of what they say initially they cover). I could never guarantee anything. I didn’t say all this to the man, though, because I needed him to stay in the hospital and accept inpatient treatment. So instead I hedged. “You’re very sick,” I told him. “You shouldn’t worry about your insurance right now.” I should have been able to give him a better answer, under a better system. The killing of Brian Thompson, the chief executive of UnitedHealthcare, the country’s largest health insurer, has reignited people’s contempt for their health plans. It’s unknown if Mr. Thompson’s tragic death was related to health care, and the gleeful responses have been horrifying. But that reaction, even in its objectionable vitriol, matters for how it lays bare Americans’ deep-seated anger toward health care. Around the country, anecdotes were unleashed with furor. Sign up for the Opinion Today newsletter Get expert analysis of the news and a guide to the big ideas shaping the world every weekday morning. Among these grievances is the great unknown of whether a treatment recommended by a doctor will be covered. It’s critical for me as a physician to build trust with my patients by giving them clear answers. But the conversations we’re seeing now about health care remind me that insurance unknowns don’t just compromise the care I can deliver to my patients — they also undermine the fragile doctor-patient trust. It’s an unsustainable dynamic. Unsurprisingly, despite my platitudes, my patient did worry. Instead of resting on the stretcher, he and his wife began calling his insurance company. To keep him from leaving, I tried to be more persuasive, even though I didn’t know what kind of health plan he had: “I’m sure your insurance will pay. I’ll document carefully how medically necessary this admission is.” I added that social workers and other advocates could also assist in sorting out his insurance once he was admitted. And, worst-case scenario, if they couldn’t, I crossed my fingers that the hospital’s charity care would help. I said what I could to get him to stay, but I understood why he wanted to be certain. The average cost of a three-day hospital stay is $30,000. He had heard the health-insurance horror stories. Maybe he had lived through one himself. One of my first lessons as a new attending physician in a hospital serving a working-class community was in insurance. I saw my colleagues prescribing suboptimal drugs and thought they weren’t practicing evidence-based medicine. In reality, they were doing something better — practicing patient-based medicine. When people said they couldn’t afford a medication that their insurance didn’t cover, they would prescribe an alternative, even if it wasn’t the best available option. As a young doctor, I struggled with this. Studies show this drug is the most effective treatment, I would say. Of course, the insurer will cover it. My more seasoned colleague gently chided me that if I practiced this way, then my patients wouldn’t fill their prescriptions at all. And he was right. I’ve been on the other side of the American health insurance quagmire too, as a patient. Recently, my primary care physician recommended that I have additional testing to assess my risk for certain diseases. The patient in me instinctively asked if my insurance covered it, even though I knew she wouldn’t know the answer. “They should,” she said. “It seems most insurers are paying for it.” I recognized her response — it’s the same optimistic but vague one I often give. When doctors can’t give a straight or accurate answer, patients may lose faith in them. What’s more, when insurers reject claims, they usually blame the provider — the medical code used was wrong, the diagnosis wasn’t specific enough — which can further erode the relationship between patients and their doctors. I saw this happen with my mother. She got her annual flu shot, which is part of her preventive care — a proactive step we want patients to take — but her insurance said it wasn’t covered because her doctor supposedly used the wrong code. The clinic resubmitted the claim, but it continued to be denied. Each time my mother called her insurance company, an agent blamed her doctor. Eventually, my mother grudgingly returned to her physician for her annual exam, but her relationship with the primary care practice has frayed. She also no longer gets her vaccines there. My one family member with solid insurance is my dog. He got elective surgery recently, and I was astounded by the straightforward nature of his insurance. Once we meet the deductible, everything is simply covered by 80 percent. This is clearly described in a packet I received when I first signed him up. It’s an imperfect comparison to insurance for humans — I pay in full first, then get reimbursed — but it’s incredible to think that insurance for pets and possessions is easier to navigate and more consumer-friendly than insurance for people. The country is not heading toward a single-payer system, but that doesn’t mean we have to continue leaving patients and their doctors in the dark. I loathe the fact that patients can’t automatically get the care they need without thinking about costs. But they at least deserve clarity about what’s covered before they acquiesce to expensive tests and treatments. Health insurance shouldn’t be so opaque, up to the whim of different companies. Coverage shouldn’t be so convoluted, mired in rigid codes and obfuscating wording. I should be able to tell my patient in the E.R. if his hospital stay will definitely be paid for. I know exactly how much of my dog’s care will be covered; why can’t I know the same for my patients? In the end, my patient in the E.R. decided to go home that day. I reiterated how sick he was. I showed him the results that concerned me, even tried to tell him that he could possibly die if he left the hospital. But I’m not sure how much he trusted me after my overconfident assurances that his insurance would pay; when he finally got through to an agent, he was told coverage would depend on the specifics of his care. He couldn’t risk a big hospital bill right now, he told me, matter-of-factly. He promised to come back if he felt worse. Helen Ouyang (@drhelenouyang) is a physician, an associate professor at Columbia University and a contributing writer for The New York Times Magazine. She is also a fellow at the Type Media Center. |
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Suspect Arrested |
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Shiva Interesting expression |
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The man, Luigi Mangione, 26, was arrested and arraigned in Altoona, Pa., after being spotted at a McDonald’s. A criminal complaint said that he began shaking when an officer asked him if he had been to New York recently, and that his backpack held a 3D-printed gun and a silencer. |
