And he also appears to be shutting off any suggestion of introspection by his company and employees:
Looks like the “Deny” part of the three word mantra runs deep in the UnitedHealth corporate culture.
I think that’s a disastarous statement for the head CEO to put out.
As we’ve recently learned, there’s an easy fix for that.
It’s poorly worded, and he should have said unnecessary “treatments”, but that’s what health insurance companies do.
Yes, that’s why I referred to the quiet part out loud.
In the case of UnitedHealth Care, approximately 30% of health treatments recommended by doctors for their patients are unnecessary.
Here’s an interesting article, which talks about UnitedHealth’s reliance on an AI model, which has increased denials of claims, particularly for post-acute care. They’re facing a class action which accuses them of using an AI model that they know if flawed, while counting on the inability of most of the patients to be able to push back and get their claim approved.
(Yes, Fox News, but apart from the repeated emphasis that the report cited came from Democrats in Congress, it appears to be balanced.)
But inefficient and messy, what with all of the blood and the noise and the newsheads pontificating endlessly about motives and repeating obviously false ‘facts’ and factually disprovable theories. It is entertaining the public for the moment but such a story as little repeat value. Frankly, I think the time has come for a public airing of grievances, perhaps in the form of a competitive variety show involving price guessing contests, tests of intellectual and athletic prowess, and culminating in a ‘showcase showdown’ where the CEO contestants have to estimate the true costs of common medical procedures and treatments and whether their byzantine policies and review processes will classify them as “unnecessary care” while advanced upon by robots with large spinning blades as the whimsical tune “On The Franches Mountains” plays in the background. I call this pitch, “This Is The Price Of Your Life”, and dedicate it in the memory of the great screenwriter Paddy Chayefsky.
One wonders how we have gotten to the point that insurance company reviewers—who have never examined the patient, often spend just a few minutes reviewing the case file and incomplete medical history, and are rapidly being supplemented with chatbot “expert AI” of wholly unproven capability and a demonstrated lack of reliability in generally being able to demonstrate ‘common sense’ knowledge much less medical expertise—have become the default adjudicators rather than the physicians actually examining and treating the patient. It seems to me—a simple man who is not wise in the ways of fiduciary responsibility to the fiscal health of shareholders—that refusal of promised coverage for treatments authorized by physicians who have been approved by the insurance company to treat patients covered by their services should be by exception with the burden on the insurance company to demonstrate the lack of medical necessity rather than upon overworked physicians and patients that are stressed, ill, and struggling to pay ever-increasing premiums while the insurance companies declare record profits. But what do I know; I think water is wet.
Stranger
The fiduciary aspect has occurred to me as well. I don’t know US insurance law, but in Canadian insurance law, the insurer owes a fiduciary duty to the insured to provide benefits according to the contract. I’m curious whether there is an equivalent duty on US insurers? and if so, how the drive to reduce “unnecessary” health care by algorithm, and increase profits, is consistent with that duty?
Perhaps the class action will help to clarify that obscure point of insurance law.
Not that I’m disagreeing with you, but that’s the main sticking point between the ideological points of view.
One side views it as a fundamental human right, along the same lines as life, liberty, or the pursuit of happiness. The other views it as something else; maybe it’s not necessarily a “right” but a nice-to-have, or maybe the thresholds are different for what’s considered a “right”, or maybe it’s a matter of personal choice and responsibility to them (i.e. you are responsible for your own health; e.g. if you smoke, then you foot the bill, human right or not).
In a larger sense, this is the cause of most of our political divisions. Is a job a human right, or some sort of personal responsibility thing? Depends on who you ask.
A whole lot of the resistance to single-payer health care is centered around distrust of the government. For whatever reason, they prefer the idea that some nameless bunch of actuaries and accountants who work for the insurance company are deciding what treatments insurance plans will and won’t cover, rather than a similar set for the government, who’d at least have transparency as to why that’s the case.
Beyond that, there’s also a huge misunderstanding on what health insurance actually is. Despite what people think and assume, it’s still insurance. They’re still collecting premiums and paying claims, and they still reserve the right to “total” you, if it comes to that. Yet people get really mad at health insurance companies when they won’t fund experimental or unproven treatments for terminally ill people. Which to me points at a fundamental misunderstanding of what health insurance actually is.
Maybe progressive politicians would get more traction if they did what I just did and used the terminology of other insurance types and applied it to healthcare. People would see how not compassionate it is, and how it’s NOT what they assume it is. Then the next big lift will be conclusively pointing out that what people will get, and what they’ll pay won’t be less and more respectively than they already get from private health insurance. That’s the big hurdle- if that can’t be proven, then no number of appeals to compassion will be effective. Few people are going to agree to pay 10% more for 10% less just so some other person somewhere else in the country can go to the doctor. Most people will wonder what poor decisions that person made that would prevent them from paying their own way.
And if you look it up, health insurance started out exactly how I described it, and expanded during WWII as a way to circumvent wage controls during the war by offering something other than more money to entice employees in a tight labor market.
Sure - insurance companies are pretty horrible. However, I hesitate to simply defer to the opinion of every for-profit care provider concerned with potential liability, in defining what is “necessary.” Moreover, the fact that a treatment exists does not IMO mean that it ought to be provided - at little or no cost to the individual - to every patient who might derive some benefit from it.
That’s the system in Canada and it produces better outcomes at lower cost than in the US.
Kaiser Permanente of Ohio, an HMO, was the best health care ever. I had it for years before they sold off the Ohio division. It-was the least expensive of all the health insurances we had available. Kaiser owned the buildings. All the employees including doctors worked directly for Kaiser. They owned the pharmacies. There were NO BILLS. You just went to the doctor or had your procedure and picked up any prescriptions downstairs. They partnered with the Cleveland Clinic for advanced surgeries. I had my triple bypass in 2000 at the Clinic. Never even got a statement, let alone an invoice. The only downside I see was you had to select from their doctors. I guess if you had a long term doctor already it would not work out. When Kaiser of Ohio broke up I followed my urologist to his next location. Dr Love - great name for a urologist!
The next few years were a disaster. Kaiser sold everything to Healthspan who was clueless. First they closed the pharmacies. Imagine dozens or hundreds of trained pharmacists and staff out of work in the same area. I saw one pharmacist assistant crying. Then they dropped the doctors. They could not manage the business at all. They finally went out of business. They sold the buildings to Metro Health. Us members were traded once again, this time to University Hospitals. They were the highest cost of any insurance I have ever had, triple the cost of Kaiser. And they were increasing the fees by huge margins each year. When I finally made the jump to Blue Cross - Blue Shield the University fees were going up to $1300 per month for the basic plan. I had been paying less then $300 at Kaiser.
Missed the edit window: meant to add that under our tort system, medical malpractice suits are much less common than in the US, payouts are lower, and doctor premiums much lower than in the US. The main differences are that pain & suffering is capped, and punitive damages are rare.
Plus, in our system, if a doctor makes a mistake that requires further care, that is covered automatically through our single-payer system, so the financial costs to the patient are much lower, which reduces the incentive to sue. In the US, I assume that the insurance company for the patient will sue the doctor automatically to recoup the amounts paid out.
Here’s an article with a good summary:
I would quibble with the article where it says we have a less litigious culture than in the US, because that glosses over the role of an insurance company in the mix. Why do we have a less litigious culture?
In our system, it doesn’t matter why you need surgery, whether you were in a car accident, or you’ve got cancer, or the previous surgeon screwed up. You get the health treatment you need, which reduces the need to sue.
But add in an health insurance company, and the calculus changes immediately. You need surgery because your previous doctor screwed up? Hopefully your insurance witll cover it. But if it does, what happens next? The insurance company will try to sue the doctor to recoup its payout. That’s what insurance companies do; doesn’t matter if you’re hurt in a car accident or by medical malpractice.
If it’s a car accident, you car insurance company will likely try to sue the other driver, to recoup its payout. If is it’s medical malpractice, your health insurance company will likely try to sue the other doctor, to recoup its payout.
And if your insurance company won’t cover the remedial surgery, your only hope for coverage is by suing the previous doctor.
All that analysis is masked by “less litigious culture”. As with so much in this thread, the presence of a for-profit insurance company has a badly distorting effect.
This is literally the purpose of insurance companies; to distribute the costs such that patients can receive treatments that they could not individually pay for. Now, it is certainly the case that patients who have a chronic terminal illness should be counseled in consideration of their mortality and quality-of-life decisions instead of spending exorbitant amounts of money to keep them clinging onto any kind of life, but for many patients they have a clear and urgent need for life-improving treatments which can make them productive and contributing members of society for years or decades, and denying these treatments has a severe impact on that patient’s quality of life even though they have paid their premiums and are lawfully due to coverage that insurance companies can “delay, deny, defend” through their own internal arbitration processes which can override the treating physician’s judgement and can require years of expensive, exhausting litigation in order for insurance companies to be forced to provide necessary coverage and reimbursement that most individuals cannot hope to pay for and in many cases will not survive. Whether a treatment is “unnecessary” or not, whether the medical provider is overcharging or misrepresenting the condition for greater profit, the patient is caught in the middle with no effective way to assert their rights, get speedy fair judgement, or receive life-saving treatments for which the insurance carrier is legally obligated to cover. See this case investigated by ProPublica:
The problem with obfuscation of costs by large corporate medical providers is another massive problem with the for-profit medical industry, but the degree of proven fraud by individual physicians is so low as to be virtually negligible in terms of profits. This argument that insurance companies must defy every treatment plan they view as ‘questionable’ by default without even consulting with the treating physician falls along the same logic as the need for rigorous voter ID programs to prevent voter fraud; it is a bogus solution to an almost non-existent problem which covers the real purpose for such efforts.
I’ve had several problems with Kaiser Permanente of California (which despite the non-profit nature of the medical provider side is a for-profit on the ‘insurance’ side) but for what it is worth I have never been denied care that a physician designated as necessary. Going out-of-network is an enormous pain in the ass and can be quite costly but after a couple of years with Cigna I’m going back to KP even at higher costs (and clenching my jaw) because Cigna is just so obstructive even over approving basic, non-emergency preventative medical services that it literally isn’t even worth dealing with, and I’ve ended up paying costs of a few hundred dollars out of pocket because it just wasn’t worth the unending hassle of taking them to court for their blatant fraud and obstruction.
I don’t think people should be shooting CEOs in the street but it is not because I don’t think these fuckers don’t need a day of reckoning (that they will never see in a court or outcoming of a Congressional investigation beyond Katie Porter haranguing CEOs with her whiteboard and rapier wit); I just think that this isn’t actually going to have any effect beyond steeling the resolve of these companies to up their security and pass the costs only their ‘customers’ as administrative expenses.
Stranger
I anticipate insurance execs will now have “beast” cars, and travel in multi-car processions, similar to the Presidential beast. The car industries will profit!
My pro-national healthcare opinions on the subject have always been based on the fact the Health Insurance is unlike every other type of insurance.
If I understand the basic business model, Insurance is for an unlikely event.
It would be financially ruinous to most people if their house burned down. So the idea is, let’s get a million people to pay a little bit every year. We will research how often houses burn down. And we will hire people who are good at math to determine how much everyone needs to kick in every year so when X amount of houses to burn down, we can send the a check to replace peoples houses. Plus a tidy profit for ourselves. (A very oversimplified explanation)
Same with auto insurance and other types of insurance.
But the need for health care isn’t an unlikely event. Everyone will need it at some point. Sure maybe some people aren’t big on going to the doctor and use the system less than others. But we all get old and everyone dies of something. If every house eventually burned down or car got totaled, I don’t think home/auto insurance companies would be viable.
Everyone needs the roads to be repaired, we don’t have to buy insurance for it. That’s why we have a government.
I don’t even think we even should call it insurance.
I’m sure people have anecdotal stories about home/auto insurance companies being jerks, but overall I think they have a better reputation.
I’m having a problem believing ChatGPT on this. In the US you don’t pay taxes on gross salary, you pay taxes on income after deductions and exemptions. The tax rate for the equivalent of 28k in Euros might be 20%, but the person actually grossing $35k or whatever is going to pay a lot less than that.
I don’t know how the French tax system works, but you don’t want to know about the complexity of the US tax system.
A splendid example of the irrationality of American business. When I worked for the Bell System, which at least had good benefits, those who took no sick time for a year got a free lunch and a small gift certificate. Until someone figured out that this encouraged people who were close to the award and got sick to come in and spread their germs to others. I remember that at the start of Covid there was a problem with those who got it coming in because they had no sick time.
There is an excellent thread about why you should avoid Medicare Advantage plans. I’ve been on traditional Medicare for 8 years, with a very good supplemental plan, and have had zero problems. When my wife cut her hand while visiting our daughter in Indiana she could get care without worrying about if it was in network. No dental insurance, which is a bummer for me, but aside from that…
This may be where you and I differ. I am not sure “counseling” is sufficient if the patient has no skin in the game. IMO, some peoples’ lives simply are not worth the dollar amount of the care they are consuming. (Of course, calculating the cost of that care is problematic.).
you mean like their life?
Okay, if that is the hypothetical approach that insurance companies should take, then they should set out a table of cost versus productivity for an actuarial estimate of life expectancy, and publish that for their ‘customers’ so they understand what their life is ‘worth’ versus corporate EBITDA and the need to show shareholders that they are making record profits. That would be shitty but at least transparent about their aims.
But even making that kind of coldly fiscal calculation isn’t what these companies are doing; they are denying treatments—sometimes, basic, obviously necessary treatments—almost by default to minimize their outlays and maximize their profits regardless of whether they are satisfying their legal obligations to provide promised services, and then pushing the burden of ‘proof’ off onto health care providers and patients, most of whom do not have the copious personal time and financial resources to sue the companies in court to force them to provide the service paid for by premiums.
Every time I hear the arguments supporting these ‘poor little rich companies’ who are just struggling to show increasing profit margins in the face of implicitly corrupt doctors and nurses ripping them off by treating patients and customers scamming them by wanting payment for ostensibly-covered treatments it makes me wonder what kind of business these insurance CEOs think that they are in, because they seem to believe that the entire focus of their business should be growing their profit yields at the expense of all other concerns, including and especially the health and well-being of their ostensible ‘customers’ who are, it should be noted, paying in the premiums (along with employers for work-sponsored insurance) which form the entire basis of any profit these companies have at all.
Those poor, poor exploited insurance companies. Poor them. Poor CEOs only taking in low-eight figures. Hell, you can’t even afford a nice third vacation home on that paltry income. Poor, poor them!
Stranger
Not worth it to whom?