In Econ 101 in college, insurance is LITERALLY the textbook example of what economists call "market failure" (utilities are another example). Market failure refers to the fact that certain industries have unusual characteristics that make a competitive market impossible and they have to have government intervention on various levels. Our reality is exactly what the theory says would happen if you tried to run the insurance market with private companies competing. What this means is that our system isn't this way because of mistakes, or unforeseen problems, or because it's "broken". It's operating EXACTLY as it was set up and intended to run. They've always known it would be exactly as it is now.
You are witnessing the relief and gratitude of a population at seeing a predator, who has been terrorizing and killing them for fun and profit, brought down so that he can't harm any more of them. Brian Thompson was PERSONALLY responsible (he is the one who brought in the AI to deny claims with an error rate of 90%) for more death and torturous suffering of innocent people then all American serial killers and mass killers combined. Ossama Bin Laden had a family too. Ted Bundy was a great older brother. He forfeited his claim to "humanity" when he not only refused to stop killing us, he increased his killing. And stop shaming the public- the investors (who he defrauded billions of dollars from) went ahead and held their meeting anyway. They don't care about him any more than we do. Corporate media is spinning this story hard. The political and legal system in America has been taken over by the predator class, of who Brian Thompson was just one of them, so that those avenues are now closed for the rest of us as avenues to try to change the healthcare system. Our elected officials have almost unanimously sold us out and actively kept reforms from being undertaken. They have eliminated every peaceful, lawful means we have of protecting ourselves from their insatiable and entitled greed.
The corporate media is intentionally misrepresenting what the public is expressing to try to shame us for seeing the value of his life the same as he saw the value of our lives. The corporate media is basically telling us to go back to shooting schoolchildren, or strangers at Walmart, and don’t even think about killing another person whose life actually MATTERED EVER AGAIN. Piers Morgan and MSNBC and FOX News and the rest of the corporate media- you have spent more than a year now justifying the rampant slaughter of children with sniper rounds en masse, the bombing and burning and utter destruction of hospitals with patients inside of them including preterm infants, the genocide of tens of thousands of civilians, so don't dare to lecture us about not being horrified by murder. You are owned by the predator class and you think that if you do their bidding, that you are a member of their club. You are just as expendable to them as we are. They won’t hesitate to do to you what you are doing your best to convince us they aren’t actually doing to us.
Inside STAT's investigations of UnitedHealth Group
What United Healthcare Doesn’t Want You To Know
UnitedHealthcare began in 1977 with a new at the time model for providing healthcare- HMOs. In 1973, the Health Maintenance Organization Act required employers to offer their employees an HMO option and provided federal grants ($375 million). HMOs became highly profitable, but they completely failed in their ostensible mission to stop the escalating cost of health care in the US, which has obviously ballooned out of control since this time. UnitedHealthcare was hired to run an HMO that was itself a non-profit, but the doctors in the HMO threatened to unionize because they were barely able to get by with what UHC was paying them. It turns out that the same man who ran the non-profit hired his own for-profit company to run the non-profit creating a clear conflict of interest. The man's name was Richard Burke.
UHC was built by acquiring federally-subsidized insurance HMOs, and it turns out that one of the people behind the 1973 HMO Act that created these subsidized insurers was Richard Burke. Consolidation in the 90s reduced competition and prices for health insurance dramatically increased, as always happens with consolidation. A major part of this consolidation was for-profit companies like UHC and Anthem buying up non-profits. While markers of quality didn't improve and costs went up, another thing went up- denials of claims. What used to be rare became so common that in 2021 nearly 50 million claims were denied.
The denials are not just hurting patients, 41% of doctors now are taking out payday loans because of how hard it is for them to get paid. BUT- of course- UHC also owns a payday lender to take advantage of this market that they created called OPTUM. This isn't enough though- UHC (along with several other asset managers) are also buying up these distressed doctors practices at very low prices, furthering the consolidation. UHC now employs over 70,000 doctors in America and is the largest employer. UHC uses subsidiaries to appear as "outside influences" to reduce the rate that they are required to repay doctors or how to handle claims. All of this is illegal and violated anti-trust laws. UHC was allowed to acquire Change Healthcare, a company that gave them direct access to the information about what their competitors were paying for the same services and other proprietary information which they used to further undermine the market.
How UnitedHealth’s Playbook for Limiting Mental Health Coverage Puts Countless Americans’ Treatment at Risk
"Around 2016, government officials began to pry open United’s black box. They found that the nation’s largest health insurance conglomerate had been using algorithms to identify providers it determined were giving too much therapy and patients it believed were receiving too much; then, the company scrutinized their cases and cut off reimbursements.
By the end of 2021, United’s algorithm program had been deemed illegal in three states.
But that has not stopped the company from continuing to police mental health care with arbitrary thresholds and cost-driven targets, ProPublica found, after reviewing what is effectively the company’s internal playbook for limiting and cutting therapy expenses. The insurer’s strategies are still very much alive, putting countless patients at risk of losing mental health care."
Insurers Continue to Rely on Doctors Whose Judgments Have Been Criticized by Courts
"United’s approach, the judge said, essentially boiled down to “We’ll just gamble with her life.”
"The cases, ProPublica found, expose in blunt terms how insurance companies can put their clients’ health in jeopardy, in ways that some judges have ruled “arbitrary and capricious.” To do so, court records reveal, the insurers have turned to a coterie of psychiatrists and have continued relying on them even after one or more of their decisions have been criticized or overturned in court.
In their rulings, judges have found that insurers, in part through their psychiatrists, have acted in ways that are “puzzling,” “disingenuous” and even “dishonest.” The companies have engaged in “selective readings” of the medical evidence, “shut their eyes” to medical opinions that opposed their conclusions and made “baseless arguments” in court. Doctors reviewing the same cases have even repeated nearly identical language in denial letters, casting “significant doubt” on whether they’re independent."
An important detail that is mentioned in this article is that doctors aren't considered to be practicing medicine when they work for insurance companies reviewing cases and making recommendations, so they can't be sued for malpractice or on medical grounds, so they can't be held accountable. "Insurers have tried to defend against lawsuits by pointing out that multiple doctors all reached the decision to deny coverage. But judges have criticized doctors for rubber-stamping denials and for “multiple levels of deficient arbitrary and capricious determinations.” Just last year, a judge wrote that “three deficient denials considered together does not amount to substantial evidence to save any one of them.”
When families sue the insurance companies and their cases are sound,
they often settle out of court with confidentiality clauses because they
don't want to risk losing in court and getting nothing. The Employee Retirement Income Security Act governs a lot of insurance claims in court and doesn't allow for punitive damages, which means there's no real penalty or disincentive for insurance companies to stop their bad behavior. One federal judge said “They might have to pay 10 claims,” the judge said, “but if they can
avoid paying a thousand claims, then why would they change anything?” ANother judge, after likening the fraudulent language used by UHC to deny coverage, said "that it sometimes appears the insurer’s only duty is
to “preserve the plan’s financial assets rather than offering aid to
the plan’s human assets (its members and beneficiaries).” (Sometimes?? All the time)
Her Mental Health Treatment Was Helping. That’s Why Insurance Cut Off Her Coverage.
Insurers use both a lack of progress and making progress by a patient as reasons to cut off intensive treatment and cover only a lower, less expensive level. If the patient hasn't made adequate progress they may claim that the treatment isn't working, isn't appropriate, that the patient is sabotaging the care, or that the problem is chronic and that acute care won't help. This is done without concern for the length of time needed for the treatment to work or the fact that some conditions, such as bipolar, require life-long care. Paradoxically, when a patient is making care, they will then claim that the treatment has worked and is no longer needed. It's a lose-lose scenario for a lot of patients. In the case that this article focuses on, the woman was denied ongoing care that resulted in her needing far more care at a far higher cost and bringing on so much distress that it derailed her progress a number of times and placed in her serious danger many times.
Judges have found companies using guidelines as the sole basis for coverage, even though this goes against the law and the companies themselves deny it. They have also found in a number of landmark cases that insurance companies were violating a federal law that requires them to cover mental health and behavioral treatment the same as they cover physical health problems. Despite these rulings, the companies continue to follow the egregious practices. One judge wrote “The mere incidence of some improvement does not mean treatment was no longer medically necessary,”
Denied (The following is a script from "Denied" which aired on Dec. 14, 2014. Scott Pelley is the correspondent. Michael Rey and Oriana Zill-de Granados, producers.)
The shooter at Sandy Hook Elementary School had been denied mental health treatment by his insurer, which spurred an investigation into the aggressive and sometimes illegal tactics used by insurance companies to deny mental health coverage- especially serious cases that require long-term or intensive care. The investigation found that there are many instances in which this care is denied or cut off prematurely on little or no grounds, and that many of these cases end in tragedy that may have been avoidable if they had received the treatment that they needed.
These denials are made by doctors who haven't seen the patient and don't have knowledge of the case outside the case records. They call and harass doctors, sometimes multiple times a day, lookling for ways to cut off services. They go against the expert opinion of treating doctors, and in many cases, multiple treating doctors and facilities. Cases were found in which an insurance company doctor left several messages for a treating doctor, but then denied care after waiting only 22 minutes for a return call.
One person interviewed said "They're called managed care, but it's really managed cost." When asked why the insurance company was so aggressive about getting people, even children, out of long-term care and sending them home early, he replied "well, it's a lot cheaper in the short run. And if you're managing costs on a quarterly basis, you can understand why from a business point of view for that quarter it makes sense. For the sake of the child, for the sake of our society, for the sake of the child's future it doesn't make any sense." In speaking about a notorious doctor known as Dr Jack who earns $25,000 a month doing "reviews" at $45 each, he said "We spoke to 26 psychiatrists from across the country, and every one brought up Dr. Jack's name. Some called him "Dr. Denial." Some of the insurance company doctors that the writer looked into had denial rates between 92% and 100%.
He wanted to live. After his insurance rejected coverage, he died of a fentanyl overdose
A young man had himself taken to a treatment center that knew how to treat his Fentanyl addiction, but after only 3 days his insurance company refused to pay and he was sent home, where he died soon after from an overdose. The article finds that "the system for appealing mental health denials effectively remains broken." They found several commonalities including that the cases that were appealed were often decided by insurance plan doctors who were not trained in the criteria required by law, that many "appear to deny almost every appeal for behavioral health treatment they review", that data regarding denials is not shown to regulators or even kept, and that when regulators do get involved, they routinely side with patients, indicating that the denials were not correct most of the time.
Deny, Defend, Depose: UnitedHealthcare CEO’s Slaying Highlights Widespread Rage at Healthcare Industry
"there has been an outpouring of rage on social media directed at the health industry, with many sharing stories of having claims for vital care denied and losing precious time with loved ones during illness." Juan Gonzales, one of the hosts, points out that there are an average of 75 murders each day in America, but this one killing of such a wealthy and powerful person shines a light on how some of our lives are treated as much more valuable than others. One guest explains that the rage has been boiling just below the surface for many years, pointing out that "A hundred million Americans have medical — have medical debt, but most of those people have health insurance. But they can’t get their insurance companies to cover the care that they need."
"This company in particular (UHC) has a record of using prior authorization or refusing to pay for needed care far more than its competitors. But for-profit insurers, in general, have used this as a means of enriching their shareholders, of using fewer and fewer of our premium dollars to pay for the care that we need, so that more money can be made available to their shareholders." Brian Thompson ran Medicare Advantage for UHC.
Healthcare Is a Right: CEO’s Killing Ignites Calls for Reform Amid Trump’s Plan to Privatize Medicare
"Wendell Potter, now an advocate for reform, he says the murder of Thompson “was a horrible crime, but it is important to point out that violent crime is perpetuated by these companies in an anonymous way every single day when an untold number of Americans are told they are not going to get the care they need.” Some doctors have referred to this as a “moral injury” they face on the job. Potter urges lawmakers to seize the opportunity to move forward with far-reaching reforms." (This is ludicrous, lawmakers have sold us out to these health care companies. They work for the people who pay them, and that isn't us. We, The People, cna't begin to pay them what the private sector does. Reform has been proven to be no option at all.)
They discuss the case of 17-year-old Nataline Sarkisyan, who died when Cigna denied a necessary liver transplant. The company eventually agreed to cover it, under extreme pressure, but it was too late and Nataline died because of the delay.
Derrick Crowe, one of the guests, represents Care Over Cost (a campaign to help people get claims denials overturned). Wendell Potter, the other guest, is a former executive for the health insurance companies Cigna and Humana, executive editor of HEALTH CARE un-covered, author of the book Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans and Nation on the Take.
Denied: ProPublica Exposes UnitedHealth Profiteering OffLimiting Care for Children with Autism
Discusses ProPublica article exposing UHC/Optum for “strategically” moving to
cut off ABA therapy for kids with autism, especially those on Medicaid. UHC stands out as especially bad. Company has “secret, internal cost-cutting
strategy” – UHC/Optum calls it “the gold standard treatment”. They have developed “market plans”, “special
action plans” to limit access to care. They
are terminating contracts with existing providers and avoiding contracts with
new ones. The Mental Health Parity Act was passed in 2008 that says
that mental and behavioral health services must be offered at parity with
physical health services. This may also
violate Medicaid laws.
UHC took an old algorithm that was designed to identify patients at risk for suicide or substance abuse, they redesigned it to look for what they call “therapy overuse” and began aggressively targeting children with autism getting therapy. The providers were being aggressively questioned about the medical necessity of the therapy. They were investigated by 3 states and the Department of Labor for these practices, and told it was illegal and that they had to stop doing it in these jurisdictions. The way our healthcare system is set up, they could continue to do this in other states.
'Out of Control': Insurance Giant UnitedHealth Calls in Middle of Cancer Surgery to Question Necessity
This article discusses a video made by a doctor who was called out of surgery by UHC to justify the patient's inpatient status for the night following the surgery, to be questioned by someone who claimed not to know the patient's diagnosis or that she was in surgery, because that was a different department. UHC later claimed that they wouldn't call a doctor out of surgery, but they have no credibility.
OTHER HEALTHCARE COMPANIES
Debt in the dark: UCHealth sues patients daily and some have no idea why
UC Health, a Colorado company, claims that it's practice of suing patients who it claims "don't want to pay" is the industry norm- but an investigation showed that it is virtually the only health company in CO doing this. It is suing patients who have already paid off their bills and can prove it, patients who have a zero balance on their account, and others for no reason anyone can figure out. Two state legislators passed a law to try to stop this practice.
