I watched TMZ last night and they were fascinated about the
homicide of Brian Thompson the CEO of United Healthcare in New York City the
night before. The hosts could not
approach that topic directly so they brought on Taylor Lorenz who they described as a social media
expert. She made some posts about healthcare
companies. She claims that the “entire
internet left and right” was united in celebrating the death of this CEO
because “Somebody stood up to this barbaric, evil, cruel violent system.” Her rational is that if you see a loved one
die because an insurance company denied care it is natural to want to see that person
dead and this is not advocating homicide. It is a justice fantasy. She went on to say that United Healthcare has
murdered tens of thousands of Americans by denying healthcare. She sees this as a revolution and it is a
problem that should be addressed without violence. She suggests letter writing and possibly politicians
and journalists getting a clue and seeking to correct this imbalance.
I have been aware of United Healthcare for at least 30
years. They are renowned in Minnesota
for their initial emphasis on not funding psychiatric care and moving on from
there. Physicians like me have been
railing against United Healthcare and other managed care companies for
decades. And nobody - and I mean nobody
cares. No politicians, nobody in the media, and nobody in physician professional
organizations. There has been an occasional
activist state Attorney General suing these companies into a temporary correction
that they can easily wait out. The American Medical Association just recently
came out against prior authorization one of the main forms of managed
care denial – just a few years ago. It
has been in place along with utilization review – the other main form of
denial for at least 40 years.
These business practices have transformed the practice of
medicine into a high productivity and low-quality enterprise where medical
judgment is replaced by the judgment of middle managers with no medical
training and company profit in mind. Physicians have been displaced in their
roles in managing the treatment environment and now it is staffed by business
people concerned only about the bottom line. If a company decides it is not
going to cover a medication or a procedure or a hospitalization – the general
message to the patient is “you are out of luck.” I worked at the same hospital for 22 years
and during that time we went from providing care to anyone who walked in the
door to care based on businesses telling us what to do. At one point to make things less contentious
(and after we were bought out by a managed care company) – the external review
was replaced by the same kind of decisions made by internal staff. Some physicians became "managed care friendly" in order to move up the corporate ladder.
How did these organizations get so much power over healthcare? A lot of it depended on lying to gullible
politicians. The original sales job was
that physicians were just too expensive.
They order too many tests. They
were going to close down or buy out the expensive specialists and
greatly expand primary care. That primary
care expansion would lead to more prevention and reduce the overall costs of
medicine. But once these organizations were granted all the power they wanted,
they began acquiring specialists and providing their own specialty care. They also greatly expanded middle management
to micromanage staff and basically tell them to work harder. The result is a system that is much more
expensive rather than more cost effective.
Shareholder profits and CEO salaries require a lot of denied care to
fund. This article about the
company is an indication of the amount of money that we are discussing. We
are talking about executives that are making tens of millions of dollars in an organization
that rations health care.
Of course, people are angry about the situation of rationed
health care. But it is more about how things are organized and all the
associated politics. I think we can all agree that there do not seem to be many
bright politicians out there and that low bar took an even more precipitous drop
in the last election. Even managed care companies know more than to ration
vaccines or give everyone hydroxychloroquine for COVID.
Politicians have
invented this system at every step of the way and made it impossible for the
average citizen to get any satisfaction when their health care is denied.
Federal and state governments both side with healthcare companies to support
the denial of care and (incredibly) indemnify them from liability when their
denials result in bad outcomes. Death is
just one of many bad outcomes.
The press does not get it. I am tired of writing about it
for physicians. The only bright idea
that group seems to have come up with is not contracting with these companies
and either charging cash or asking the patient to seek their own insurance reimbursement
after paying their bill. This obviously has limited application and doesn't work if the patient needs more resources like operating rooms or rehab facilities. So - Ms. Lorenz’s solution of writing letters certainly
will not work.
Some news services seemed to connect a policy reversal by Anthem Blue Cross/Blue Shield (ABCBS) to the homicide. Some of the original stories claimed that anesthesia time per procedure would be limited and the patient might need to pay the balance. Subsequent stories state that the insurance company planned to pay the time allotment indicated in the estimated relative value units (RVUs) for the surgery. They claim their reversal was based on misinformation. RVUs are another form of rationing – paying only a set amount irrespective of the complexity of the case. It is another way that psychiatric services were also rationed by reduced reimbursement. In some cases, it leads clinics to stop seeing all the patients from a particular insurer based on low reimbursement to the physicians and providers. Lorenz posted a caption of the ABBCBS story with the additional line: ‘And people wonder why we want these execs dead.'
This is the state of medicine in the US today. We have just
had an election that puts the most rational parts of the fragmented healthcare system
(the ACA or Obamacare, Medicare, and Medicaid) at risk. The party in power espouses gun extremism and
uses political tactics that direct violence and aggression toward specific
individuals or groups. The party in power favors the top wage earners rather
than production or knowledge workers. That includes large healthcare
conglomerates that all function by rationing care and access to medications and
procedures. And in that context, we have a social media expert claiming that we
now have bipartisan rage against these health care companies who have murdered
tens of thousands of people by denying their care. I certainly know many people who have been
harmed by the denial of care. In some cases,
I spent hours advocating for them and trying to get the care they needed but I
was simply ignored.
At this point, the crime is being analyzed like it is just
another true crime TV show. Endless analysis about the perpetrator’s behavior
and possible motivations. It is all
highly speculative but made as controversial as possible. All the analyses I have seen so far seem way
off the mark – but I am not going to add mine at this point. I am more than a little suspect about all the
social media rage. Is it real or just generated by a few provocative trolls? Will it lead to a typical Congressional show
hearing where members manufacture outrage and nothing changes. One thing is for
sure – the current state of events is not a good sign. It is a sign of just how corrupt, ignorant,
and not self-correcting the American political system is - and just how much those
politicians collude with businesses.
In the end, Americans end up paying top dollar for a healthcare
system that may refuse to treat them, an airline system that may refuse to fly
them, a financial system with excessive charges and minimal interest payments
on savings, and a system for workers that disproportionately pays the people
who do not do any of the brain or physical work. Is it any wonder that 4 people in the US
possess more wealth than 50% and that 50% are essentially left hoping for
changes that never come.
George Dawson, MD, DFAPA
References:
Jeremy Olsen. Shooting of UnitedHealthcare CEO revives criticism of company’s medical claim denials. Some mourn the shooting of chief executive but still have scorn for the insurance company he ran. StarTribune. December 5, 2024. https://www.startribune.com/why-unitedhealthcare-is-a-four-letter-word-to-critics/601191492
Addendum:
As any reader of this blog can attest – I do not consider homicide as a solution to any problem.
The two main features of homicide that I consistently observe on this
blog is homicide as a primitive value and a primitive solution. It has no place in civil society. In the anthropological
literature homicide as a solution dates to prehistoric times when minor conflicts escalated from
individuals to entire villages. Modern
man has not uniformly progressed very far as evidenced by every active war in the world right
now and ever. The shooting of Brian
Thompson is no exception. Given everything, I have listed in the above post –
it changes nothing. It was a cowardly,
immoral act, and unlawful act. I hope that the perpetrator is caught and
punished. I hope that the privacy of
Brian Thompson’s family is respected.
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