To understand the fatal attack on UnitedHealthcare CEO Brian Thompson and the unexpected reaction on social media, you have to go back to the 1990s when managed care was in its infancy.
Very powerful essay. Unfortunately, there seems to be zero interest or political will to make Medicare for All a reality in the US. One of the major pushbacks from Canadians on Trump's wacky proposal to take over Canada is that Canadians like their healthcare and don't want to be stuck with ours. Maybe it should be Canada that should be seeking expansion.
As she said, "In 2019, U.S. medical debt totaled $195 billion, a sum larger than the economy of Greece. "
However, regarding Obamacare "passed" in 2010 without discourse provides a great benchmark to see how things have worked out in US Healthcare. Healthcare spending in 2010 was 2.5 TRILLION dollars PER YEAR, while a mere 14 YEARS LATER with all sorts of "helpful" government additions like:
1. MIPS (various years under a procession of different names since 2009)
2. HITECH Act (2009)
3. 21st Century Cures Act (2016):
4. GDPR (General Data Protection Regulation) (2018) (EU)
6. HITRUST CSF (Health Information Trust Alliance Common Security Framework) (Various years)
7. Information Blocking Rule (2021)
8. Interoperability and Patient Access Final Rule (2021)
in 2024 Healthcare spending was 4.5 TRILLION dollars PER YEAR, an increase of 2 TRILLION dollars in 14 years. In the same period of time, LIFE EXPECTANCY in the US DECREASED by 3 years! the first decrease in a century, and by a striking amount.
We can discuss all the reason why this might be the case (as I will below), but I think we can all agree that whatever we have been doing the last 2 decades is a complete and utter fail. To continue to double down on the same things we have been doing is insane.
As for how we got here... You alluded to the beginning of the slippery slope was likely managed care (I agree) which obfuscated a complex medical system, providing incentives to the wrong places, encouraged consolidation of health insurance companies and large health institutions into oligopolies with the power to influence government rule makers resulting in less transparency and more consolidation subsidized by government incentives (and enriching legislators, healthcare C-suites, and bureaucrats). The individual physician and patient was left entirely out of the equation, which has resulted in high cost and low quality. Shame on us.
The entire U.S. healthcare system--including the so-called regulatory agencies--operates to maximize investor profits. Nothing else matters. Certainly not actual science. There's no other way to connect all the dots. Greed gone off the rails.
As you said, "In 2019, U.S. medical debt totaled $195 billion, a sum larger than the economy of Greece. "
However, regarding Obamacare "passed" in 2010 without discourse provides a great benchmark to see how things have worked out in US Healthcare. Healthcare spending in 2010 was 2.5 TRILLION dollars PER YEAR, while a mere 14 YEARS LATER with all sorts of "helpful" government additions like:
1. MIPS (various years under a procession of different names since 2009)
2. HITECH Act (2009)
3. 21st Century Cures Act (2016):
4. GDPR (General Data Protection Regulation) (2018) (EU)
6. HITRUST CSF (Health Information Trust Alliance Common Security Framework) (Various years)
7. Information Blocking Rule (2021)
8. Interoperability and Patient Access Final Rule (2021)
in 2024 Healthcare spending was 4.5 TRILLION dollars PER YEAR, an increase of 2 TRILLION dollars in 14 years. In the same period of time, LIFE EXPECTANCY in the US DECREASED by 3 years! the first decrease in a century, and by a striking amount.
We can discuss all the reason why this might be the case (as I will below), but I think we can all agree that whatever we have been doing the last 2 decades is a complete and utter fail. To continue to double down on the same things we have been doing is insane.
As for how we got here... You alluded to the beginning of the slippery slope was likely managed care (I agree) which obfuscated a complex medical system, providing incentives to the wrong places, encouraged consolidation of health insurance companies and large health institutions into oligopolies with the power to influence government rule makers resulting in less transparency and more consolidation subsidized by government incentives (and enriching legislators, healthcare C-suites, and bureaucrats). The individual physician and patient was left entirely out of the equation, which has resulted in high cost and low quality. Shame on us.
Every politician needs to read this article. The subject of universal health care for Americans seems to be a subject of little interest to them.
Years ago, doctors dictated the care path for each patient based on the patient's needs. Now, managed care dictates to physicians what the care path is based on the masses. Deviation from the plan means there will be problems with coverage. The wait for pre-approval for most medical procedures is counterproductive to the patient's care. Outcomes may suffer, but the profit margin for the managed care companies gets fatter.
No other Western nation allows its citizens to go bankrupt because of medical care. Germany, France, UK, Canada, Japan, and Taiwan have passed the U.S. in the field of health care coverage. This needs to change. It can't always be about the money.
Many, many, many, Many years ago I was in life insurance and then later in liability. I was very young and new.
The first thing my companies did was give me a book and a test to educate me on insurance...how it started, it's purpose, and such.
Insurance was a good thing then, wide spread risk management.
How health insurance is different, or was different, I don’t know.
But somewhere along the lines America insurance got stupid.
I'm anxious to read information about other countries success with their insurance system, but I wonder if we have our own geniuses right here to fix this one? And that's an honest question.
I entered managed care in the early 1980s. I'd spent five years with a NYSE-listed psychiatric hospital corporation. From that experience, I learned the ins and outs of wallectomies; i.e., you admit through the business office based on the amount of insurance coverage available. Shameful money grabs abounded. In 1984, I joined one of the first disease-specific managed care companies, Preferred Health Care. We "managed" the abuse of mental health coverage. Inpatient psychiatric admissions for teenagers fell 90% between 1983-88. We went too far in denying care; but mind you, most of the care we denied was not "medically necessary." It was 2-wage earning parents putting 17-year old Johnny in a psych hospital for the summer because he was smoking too much pot after school. There was a time when pre-authorization and utilization management were appropriately constraining the bad behavior of greedy providers. But that was then.
I rewatched “Sicko,” Michael Moore’s 2007 movie about the US health insurance system with extensive interviews with doctors and patients in Canada, the UK and France among others,after he made it available on YouTube following the assassination of the United Healthcare CEO. At that time insurance companies could refuse to insure people with “preexisting conditions,” and could drop customers who got too sick/caused them too much. The Affordable Care Act addressed those issues and allowed one of my kids (“uninsurable”) to be covered. But we needed universal healthcare coverage in this country then and need it more now with pandemics more common. I think the Citizens United decision has doomed us to be profit centers for corporations that control healthcare, housing, energy and military spending. As a bankruptcy lawyer for over 40 years I am not surprised someone shot an insurance CEO. That company has caused massive suffering and deaths of its customers (one of the scenes in “Sicko” is a doctor testifying before Congress about how she denied claims and caused at least one person’s death).
Great article. Thank you for shedding light on what is truly going on with patients in health*care* specifically UHC and its price gouging, denying claims and basically hanging its clients out to dry.
we have UHC now and it was decent ins last year, however this year, they are absolutely abhorrent. I detest them and their service. I have no sympathy for anyone in that company.
They have increased the price of my husbands bloodthinner from $10 a month to now $1600 for 90 days. Their entire system is price gouging, out of control and ridiculous. He needs this medicine to live, he will die without it and even tho we have ins, we absolutely cannot afford his meds or to even use this ins this year. It is only Jan 10th. I know of other people that are experiencing the same thing with this med. UHC 's excuses are hot garbage. They increased ONLY this med, the rest of our meds did not increase.
The ACA and obamacare... those plans are SO unaffordable and the deductibles are so sky high that they are way out of our reach. I would never sign up for that. Health ins/Health care/Pharma has done nothing by skyrocket and service has depleted since government stepped in. I never ever want govt sponsored healthcare. I'd see a witch dr first.
I will be screaming this from the roof tops and posting on every platform i can to raise awareness. I hope they go bankrupt.
FYI... We currently have 38 days to find a solution. all other similar meds are the same price. Not a coincidence. What good are any medical innovations or new meds if the very people that need them...absolutley cannot afford them?
Read that again... its like a death sentence. My husband has 38 days left of meds to find a solution or risk death. Last time he was off a blood thinner for a mere 30 days and had a double saddle PE. I believe less than 1% of people (don't quote me, not exact number) actually survive this. We cannot afford to take chances.
These people that don't understand the anger at UHC, obviously have never had UHC basically put a death sentence on you or your loved one's lives with a price you cannot afford. Perhaps once they experience that they may have a different perspective. I know I certainly do.
@Holly Have you contacted the manufacturer to request help? I know that’s unappealing but I’ve heard that they will sometimes step up. Have you contacted your elected officials? What is the name and dosage of the medication? For information, l’ll look it up to see the cost in the EU for example.
It’s about him visiting many other countries exploring their medical systems. Every country started their medical system with the promise that every citizen was entitled to health care! Then they built the system to provide it. Many are private systems.
Ours is the most expensive. Millions of Americans have no insurance. Many pay medical debt when their insurance won’t pay. Our life expectancy is last on the list.
The words of your headline are forever associated with a murderous assassin. Frankly I think it is in extremely poor taste to use them in the wake of his heinous crime as it tends to glorify his onerous action.
The price gouging and claim denial of medically necessary treatments by UHC... Is heinous and beyond poor taste. They are killing Americans with no regard at all except to line their pockets with our blood money.
Managed care isn't killing anybody. Your accusations are hysterical.
See my comments below below for a more accurate assessment.
Luigi Mangione did kill Brian Thompson. He's a vicious, psychopathic murderer and I will oppose his glorification without quarter for as long as I live.
If you support Mangione, you in effect advocate the murder of all managed care employees based on your judgment that they they are murderers. Is that your position?
Should other self appointed judges/jurors/executionors follow suit? Should pro-life activists lynch Planned Parenthood personnel and physicians who perform D&C procedures?
Surely you can see what a dangerous path support for vigilante justice takes us down as a society.
Silent genocide is in poor taste also. How’s your insurance? Have you or a loved one been denied care or treatment by an insurance company? I find your comment evidence of your lack of awareness and a holier than thou attitude. There but for the grace of God go I.
Spare me the faux genocide hysteria. I get enough of that from Hamas supporters.
No I haven't experienced any of the issues you cite.
The explosion of third party payment since 1965 has created a constant struggle between gatekeepers and providers. There are incredible amounts of fraud in the system. Gatekeepers are demonized for their sometimes stupid policing actions. Patients are too often caught in the middle.
I have plenty of criticisms of managed care but I am violently opposed to glorifying a murderer who apoints himself judge, jury, and executioner against a husband and father who is simply going about his business. That's the road to anarchy.
Very powerful essay. Unfortunately, there seems to be zero interest or political will to make Medicare for All a reality in the US. One of the major pushbacks from Canadians on Trump's wacky proposal to take over Canada is that Canadians like their healthcare and don't want to be stuck with ours. Maybe it should be Canada that should be seeking expansion.
Nope! Canada is not thriving, much the opposite…
As she said, "In 2019, U.S. medical debt totaled $195 billion, a sum larger than the economy of Greece. "
However, regarding Obamacare "passed" in 2010 without discourse provides a great benchmark to see how things have worked out in US Healthcare. Healthcare spending in 2010 was 2.5 TRILLION dollars PER YEAR, while a mere 14 YEARS LATER with all sorts of "helpful" government additions like:
1. MIPS (various years under a procession of different names since 2009)
2. HITECH Act (2009)
3. 21st Century Cures Act (2016):
4. GDPR (General Data Protection Regulation) (2018) (EU)
5. CCPA (California Consumer Privacy Act) (2020) (California)
6. HITRUST CSF (Health Information Trust Alliance Common Security Framework) (Various years)
7. Information Blocking Rule (2021)
8. Interoperability and Patient Access Final Rule (2021)
in 2024 Healthcare spending was 4.5 TRILLION dollars PER YEAR, an increase of 2 TRILLION dollars in 14 years. In the same period of time, LIFE EXPECTANCY in the US DECREASED by 3 years! the first decrease in a century, and by a striking amount.
We can discuss all the reason why this might be the case (as I will below), but I think we can all agree that whatever we have been doing the last 2 decades is a complete and utter fail. To continue to double down on the same things we have been doing is insane.
As for how we got here... You alluded to the beginning of the slippery slope was likely managed care (I agree) which obfuscated a complex medical system, providing incentives to the wrong places, encouraged consolidation of health insurance companies and large health institutions into oligopolies with the power to influence government rule makers resulting in less transparency and more consolidation subsidized by government incentives (and enriching legislators, healthcare C-suites, and bureaucrats). The individual physician and patient was left entirely out of the equation, which has resulted in high cost and low quality. Shame on us.
The entire U.S. healthcare system--including the so-called regulatory agencies--operates to maximize investor profits. Nothing else matters. Certainly not actual science. There's no other way to connect all the dots. Greed gone off the rails.
As you said, "In 2019, U.S. medical debt totaled $195 billion, a sum larger than the economy of Greece. "
However, regarding Obamacare "passed" in 2010 without discourse provides a great benchmark to see how things have worked out in US Healthcare. Healthcare spending in 2010 was 2.5 TRILLION dollars PER YEAR, while a mere 14 YEARS LATER with all sorts of "helpful" government additions like:
1. MIPS (various years under a procession of different names since 2009)
2. HITECH Act (2009)
3. 21st Century Cures Act (2016):
4. GDPR (General Data Protection Regulation) (2018) (EU)
5. CCPA (California Consumer Privacy Act) (2020) (California)
6. HITRUST CSF (Health Information Trust Alliance Common Security Framework) (Various years)
7. Information Blocking Rule (2021)
8. Interoperability and Patient Access Final Rule (2021)
in 2024 Healthcare spending was 4.5 TRILLION dollars PER YEAR, an increase of 2 TRILLION dollars in 14 years. In the same period of time, LIFE EXPECTANCY in the US DECREASED by 3 years! the first decrease in a century, and by a striking amount.
We can discuss all the reason why this might be the case (as I will below), but I think we can all agree that whatever we have been doing the last 2 decades is a complete and utter fail. To continue to double down on the same things we have been doing is insane.
As for how we got here... You alluded to the beginning of the slippery slope was likely managed care (I agree) which obfuscated a complex medical system, providing incentives to the wrong places, encouraged consolidation of health insurance companies and large health institutions into oligopolies with the power to influence government rule makers resulting in less transparency and more consolidation subsidized by government incentives (and enriching legislators, healthcare C-suites, and bureaucrats). The individual physician and patient was left entirely out of the equation, which has resulted in high cost and low quality. Shame on us.
Every politician needs to read this article. The subject of universal health care for Americans seems to be a subject of little interest to them.
Years ago, doctors dictated the care path for each patient based on the patient's needs. Now, managed care dictates to physicians what the care path is based on the masses. Deviation from the plan means there will be problems with coverage. The wait for pre-approval for most medical procedures is counterproductive to the patient's care. Outcomes may suffer, but the profit margin for the managed care companies gets fatter.
No other Western nation allows its citizens to go bankrupt because of medical care. Germany, France, UK, Canada, Japan, and Taiwan have passed the U.S. in the field of health care coverage. This needs to change. It can't always be about the money.
Not related to issue - but..I'm trying to upgrade to a paid subscription. Help!
There should a button at the top of the page that says “Upgrade.”
Doesn't work. I enter my email, hit submit and then it goes back to the subscription menu. Very frustrating, I am a health access/policy wonk
You could try contacting Substack. There is a way to online chat. I have no other ideas.
Thanki you!
Many, many, many, Many years ago I was in life insurance and then later in liability. I was very young and new.
The first thing my companies did was give me a book and a test to educate me on insurance...how it started, it's purpose, and such.
Insurance was a good thing then, wide spread risk management.
How health insurance is different, or was different, I don’t know.
But somewhere along the lines America insurance got stupid.
I'm anxious to read information about other countries success with their insurance system, but I wonder if we have our own geniuses right here to fix this one? And that's an honest question.
I entered managed care in the early 1980s. I'd spent five years with a NYSE-listed psychiatric hospital corporation. From that experience, I learned the ins and outs of wallectomies; i.e., you admit through the business office based on the amount of insurance coverage available. Shameful money grabs abounded. In 1984, I joined one of the first disease-specific managed care companies, Preferred Health Care. We "managed" the abuse of mental health coverage. Inpatient psychiatric admissions for teenagers fell 90% between 1983-88. We went too far in denying care; but mind you, most of the care we denied was not "medically necessary." It was 2-wage earning parents putting 17-year old Johnny in a psych hospital for the summer because he was smoking too much pot after school. There was a time when pre-authorization and utilization management were appropriately constraining the bad behavior of greedy providers. But that was then.
I rewatched “Sicko,” Michael Moore’s 2007 movie about the US health insurance system with extensive interviews with doctors and patients in Canada, the UK and France among others,after he made it available on YouTube following the assassination of the United Healthcare CEO. At that time insurance companies could refuse to insure people with “preexisting conditions,” and could drop customers who got too sick/caused them too much. The Affordable Care Act addressed those issues and allowed one of my kids (“uninsurable”) to be covered. But we needed universal healthcare coverage in this country then and need it more now with pandemics more common. I think the Citizens United decision has doomed us to be profit centers for corporations that control healthcare, housing, energy and military spending. As a bankruptcy lawyer for over 40 years I am not surprised someone shot an insurance CEO. That company has caused massive suffering and deaths of its customers (one of the scenes in “Sicko” is a doctor testifying before Congress about how she denied claims and caused at least one person’s death).
Great article. Thank you for shedding light on what is truly going on with patients in health*care* specifically UHC and its price gouging, denying claims and basically hanging its clients out to dry.
we have UHC now and it was decent ins last year, however this year, they are absolutely abhorrent. I detest them and their service. I have no sympathy for anyone in that company.
They have increased the price of my husbands bloodthinner from $10 a month to now $1600 for 90 days. Their entire system is price gouging, out of control and ridiculous. He needs this medicine to live, he will die without it and even tho we have ins, we absolutely cannot afford his meds or to even use this ins this year. It is only Jan 10th. I know of other people that are experiencing the same thing with this med. UHC 's excuses are hot garbage. They increased ONLY this med, the rest of our meds did not increase.
The ACA and obamacare... those plans are SO unaffordable and the deductibles are so sky high that they are way out of our reach. I would never sign up for that. Health ins/Health care/Pharma has done nothing by skyrocket and service has depleted since government stepped in. I never ever want govt sponsored healthcare. I'd see a witch dr first.
I will be screaming this from the roof tops and posting on every platform i can to raise awareness. I hope they go bankrupt.
FYI... We currently have 38 days to find a solution. all other similar meds are the same price. Not a coincidence. What good are any medical innovations or new meds if the very people that need them...absolutley cannot afford them?
Read that again... its like a death sentence. My husband has 38 days left of meds to find a solution or risk death. Last time he was off a blood thinner for a mere 30 days and had a double saddle PE. I believe less than 1% of people (don't quote me, not exact number) actually survive this. We cannot afford to take chances.
These people that don't understand the anger at UHC, obviously have never had UHC basically put a death sentence on you or your loved one's lives with a price you cannot afford. Perhaps once they experience that they may have a different perspective. I know I certainly do.
@Holly Have you contacted the manufacturer to request help? I know that’s unappealing but I’ve heard that they will sometimes step up. Have you contacted your elected officials? What is the name and dosage of the medication? For information, l’ll look it up to see the cost in the EU for example.
It may not have been called Managed Health Care, but it was in the 1980’s that HMOs became the standard and everything needed preapproval.
T.R. Reid wrote The Healing of America
It’s about him visiting many other countries exploring their medical systems. Every country started their medical system with the promise that every citizen was entitled to health care! Then they built the system to provide it. Many are private systems.
Ours is the most expensive. Millions of Americans have no insurance. Many pay medical debt when their insurance won’t pay. Our life expectancy is last on the list.
Well worth reading!
Words are far from the problem, mostly poor and many people need care for their sickness or injuries.
We will have peace and less suffering with expanded and improved Medicare for all, single payer or the term you prefer.
The words of your headline are forever associated with a murderous assassin. Frankly I think it is in extremely poor taste to use them in the wake of his heinous crime as it tends to glorify his onerous action.
The price gouging and claim denial of medically necessary treatments by UHC... Is heinous and beyond poor taste. They are killing Americans with no regard at all except to line their pockets with our blood money.
Managed care isn't killing anybody. Your accusations are hysterical.
See my comments below below for a more accurate assessment.
Luigi Mangione did kill Brian Thompson. He's a vicious, psychopathic murderer and I will oppose his glorification without quarter for as long as I live.
If you support Mangione, you in effect advocate the murder of all managed care employees based on your judgment that they they are murderers. Is that your position?
Should other self appointed judges/jurors/executionors follow suit? Should pro-life activists lynch Planned Parenthood personnel and physicians who perform D&C procedures?
Surely you can see what a dangerous path support for vigilante justice takes us down as a society.
Silent genocide is in poor taste also. How’s your insurance? Have you or a loved one been denied care or treatment by an insurance company? I find your comment evidence of your lack of awareness and a holier than thou attitude. There but for the grace of God go I.
Spare me the faux genocide hysteria. I get enough of that from Hamas supporters.
No I haven't experienced any of the issues you cite.
The explosion of third party payment since 1965 has created a constant struggle between gatekeepers and providers. There are incredible amounts of fraud in the system. Gatekeepers are demonized for their sometimes stupid policing actions. Patients are too often caught in the middle.
I have plenty of criticisms of managed care but I am violently opposed to glorifying a murderer who apoints himself judge, jury, and executioner against a husband and father who is simply going about his business. That's the road to anarchy.