United Healthcare CEO shot to death in front of NYC investor meeting

The main differences between German and American health care is Germany has a highly regimented system and stronger insurance mandates. Germany regulates the prices hospitals, doctors and drug companies are allowed to charge. It happens via a structured system where insurers negotiate collectively with physician and hospital groups to set prices. There is no out of network concept in Germany because they use a standardized rate table for everyone involved in German health care.

If you're young and healthy in Germany you still pay for insurance. The American ACA mandate was repealed in 2017. Germans also use less health care than Americans. And health care workers in Germany make about a third to a half less than American health care workers.

American health care companies (hospitals, insurers, pharma, middlemen) are much more capricious. All of them, even non-profits. Industries that rely on capricious pricing (information asymmetry) deservedly struggle with public opinion, especially so when people exposed to that asymmetry are struggling with complicated health issues.

There isn't a health care system in the world that covers everything and never denies anything and pays doctors whatever they want and no one ever has to wait. Things are more straightforward in other Western countries, however. Every system, public or private, for profit or not, has an incentive to (and must) refuse to cover some therapies and treatments or they would go bankrupt.

In America we do it through chaotic information asymmetry. Chaos means the system is incentivized to generate more health care costs. Even if health insurance companies were non-profit and all of their executives worked for free as volunteers, the companies could still not pay for much more care than they do now. That's because by law they generate revenue through a "cost plus" model. The way insurance companies grow is for the cost of the treatments they cover to grow too so that they can charge higher premiums. The entire system is rigged against the people paying for it

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Originally Posted by dan_pdx

the "good man" argument, never acknowledging the bad shit that happened on his watch. .

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There is an argument to be made for some CEOs not being to blame for aspects of company operations if they had recently been hired from another company in a somewhat unrelated industry... the way that many C-suite execs job hop every 4-5 years. They have some deniability in not knowing how the sausage is made, or being a part of old policy decisions/company culture.

Thing is, Brian Thompson worked his way up at United for 17 years before becoming the CEO, and worked there for over 20 years total. To do that means he was one of the most profitable people at every level with the company... a company that profits off of denying and delaying claims at a rate far higher than industry standard. This guy WAS United, and WAS responsible for the way United operates. There is no deniability, or ability to separate himself from the negative parts of the company... there is no better representative of the United way, than Brian Thompson.

Good listen from Derek Thompson: “Why the American healthcare system is Broken”

https://open.spotify.com/episode/4aU...RPSd_X49KsU2Hg

Summarized:
- Despite public sentiment; Insurance company’s middling is only a small part of the issue.
- The closed market causes the spiraling inflation of costs
- The for-profit system promotes “overcare” - which leads to high premiums
- Insurance company’s have to ration care due to cost; in lieu of in a socialized medicine system where doctors and the government ration care due to availability
- Benefit of our fucked up system is better access to specialists, new tech, new drugs, and experimental care
- Single Payer is a pipe dream, price regulation is doable and would help.



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Originally Posted by nickwm21

Good listen from Derek Thompson: “Why the American healthcare system is Broken”

https://open.spotify.com/episode/4aU...RPSd_X49KsU2Hg

Summarized:
- Despite public sentiment; Insurance company’s middling is only a small part of the issue.
- The closed market causes the spiraling inflation of costs
- The for-profit system promotes “overcare” - which leads to high premiums
- Insurance company’s have to ration care due to cost; in lieu of in a socialized medicine system where doctors and the government ration care due to availability
- Benefit of our fucked up system is better access to specialists, new tech, new drugs, and experimental care
- Single Payer is a pipe dream, price regulation is doable and would help.



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This is consistent with the Attia interview I posted a couple of times earlier in the thread. To boil it down further, the three defining aspects of healthcare are quality, choice/access, and cost; pick two.

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Originally Posted by californiagrown

Thing is, Brian Thompson worked his way up at United for 17 years before becoming the CEO, and worked there for over 20 years total. To do that means he was one of the most profitable people at every level with the company... a company that profits off of denying and delaying claims at a rate far higher than industry standard.

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It may or may not be true that United is worse than its peers. We just don't know because there's no reliable data. The chart everyone passes around, and claims based on it, are unverified. Despite the many new stories saying "United Health Care Denies More Claims Than Other Insurers," at present it’s impossible to know exactly how many claims health insurers deny. United appears to deny a similar percentage as the overall industry, somewhere around 10-percent

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Originally Posted by Dantheman

This is consistent with the Attia interview I posted a couple of times earlier in the thread. To boil it down further, the three defining aspects of healthcare are quality, choice/access, and cost; pick two.

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Picking two does not describe the reality of the current system. There are many situations in which access and cost are both prohibitive.

I was not terrorized by Luigi’s actions.

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Originally Posted by Mazderati

Picking two does not describe the reality of the current system. There are many situations in which access and cost are both prohibitive.

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This is aggregate across the whole system. On the whole, Americans are largely unwilling to accept supply-side controls like longer wait times, older less effective drugs, etc. and that drives up cost (though it is certainly not the only factor).

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Originally Posted by Kevo

I was not terrorized by Luigi’s actions.

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FWIW, domestic terror is a legal term used to describe violent acts intended to influence or coerce a civilian population, or to influence the government

A few dozen insurance executives is not a civilian population nor the government (nominally). He's a murderer, not a terrorist. I think Bragg overcharged.

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Originally Posted by MultiVerse

It may or may not be true that United is worse than its peers. We just don't know because there's no reliable data. The chart everyone passes around, and claims based on it, are unverified. Despite the fact there many new stories saying "United Health Care Denies More Claims Than Other Insurers," at present it’s impossible to know exactly how many claims health insurers deny. United appears to deny a similar percentage as the overall industry, somewhere around 10-percent

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It's also a pretty hard metric to figure out. The below is not an uncommon scenario. Does this count as a paid or denied claim? How many? The member got the treatment and the provider go paid.

1. Patient Admission
A patient arrives at the hospital with acute symptoms that the emergency department physician believes warrant inpatient admission. The hospital admits the patient to an inpatient bed.
The hospital's utilization management (UM) team notifies the insurance company of the admission within the required timeframe, as per payer policies.
2. Initial Notification & Denial
Insurance Review: The insurance company reviews the notification and determines that the admission does not meet their criteria for inpatient care (e.g., based on InterQual, MCG, or proprietary guidelines). They believe the care could be managed on an outpatient basis or through observation.
Denial Issued: The insurance company issues a denial of inpatient level of care, offering to cover the claim as outpatient/observation instead. This is communicated to the hospital's UM team.
3. Concurrent Review and Initial Appeal
Hospital Response: The UM team reviews the denial and initiates a peer-to-peer (P2P) discussion with a physician from the insurance company, arguing the case for inpatient status based on:
Severity of illness (SI)
Intensity of services (IS)
Specific clinical indicators or standards of care
Insurance Upholds Denial: After the P2P, the insurer stands by their denial, reiterating that the care does not meet inpatient criteria.
4. Billing the Claim
The hospital proceeds to submit the claim under inpatient billing codes (DRG-based) to align with the services provided and the level of care documented.
The insurer adjudicates the claim and denies it, advising the hospital to rebill under outpatient codes.
5. Formal Appeal Process
Level 1 Appeal
The hospital submits a Level 1 appeal with supporting documentation, such as:
Detailed clinical notes
Physician progress notes
Any imaging/lab results justifying inpatient criteria
Industry-standard guidelines (e.g., InterQual, MCG)
Outcome: The insurance company denies the Level 1 appeal, citing the same rationale.
Level 2 Appeal
The hospital escalates to a Level 2 appeal, which often involves:
A more formal presentation of clinical evidence.
A review by a different team within the insurance company, potentially including external reviewers.
Outcome: Denial upheld again, with an emphasis on the insurer's policies and guidelines.
Independent External Review (Optional)
Depending on the payer and the state, the hospital might have the option to request an independent review. However, in this case, the provider opts not to proceed due to the costs and limited chances of success.
6. Decision to Accept Outpatient Payment
Facing multiple denials, the hospital evaluates the cost of continuing the appeals process versus rebilling as outpatient.
Provider Rebills: The hospital rebills the claim under outpatient/observation codes to secure some payment rather than risking no reimbursement.
Payment Received: The insurer processes the claim under outpatient rates, which may include:
Observation fee (APC-based or hourly rate)
Ancillary services (labs, imaging, etc.)
Lower overall payment compared to inpatient DRG.

Yeah, it's total chaos. It's also worth mentioning insurers employ tens-of-thousands of doctors and nurses to review claims

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Originally Posted by MultiVerse

It may or may not be true that United is worse than its peers. We just don't know because there's no reliable data. The chart everyone passes around, and claims based on it, are unverified. Despite the many new stories saying "United Health Care Denies More Claims Than Other Insurers," at present it’s impossible to know exactly how many claims health insurers deny. United appears to deny a similar percentage as the overall industry, somewhere around 10-percent

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That is a fair point. And also an argument that other health insurers would rather you not make....


Its is also fair to state that fundamentally health insurers profit when they pay out less in claims, than they bring in through premiums. Brian thompson was really good at being profitable at every level of the health insurer he worked for by ensuring they paid out less in claims than they brought in through premiums Health insurance is an industry that has a vested and fairly unregulated interest in suppressing claims to increase profit with many verified horror stories... It is simply not believable that a person who thrived so well in such an environment that he rose to the top, didnt do many shitty things along the way.

The Affordable Care Act requires insurance companies operating on the exchanges to report claims denial numbers. That’s the data that all the charts showing UHC at the bottom of the heap are using.

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Originally Posted by californiagrown

Its is also fair to state that fundamentally health insurers profit when they pay out less in claims, than they bring in through premiums. Brian thompson was really good at being profitable at every level of the health insurer he worked for by ensuring they paid out less in claims than they brought in through premiums Health insurance is an industry that has a vested and fairly unregulated interest in suppressing claims to increase profit with many verified horror stories... It is simply not believable that a person who thrived so well in such an environment that he rose to the top, didnt do many shitty things along the way.

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Even if it ends up true that argument still doesn't justify extrajudicial murder because it relies on a belief, not facts. And you should read my post #881 above (or at least the last paragraph). Denying claims is not the primary way insurance companies generate revenue. Insurance companies have more devious ways to rip you off.

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Originally Posted by J. Barron DeJong

The Affordable Care Act requires insurance companies operating on the exchanges to report claims denial numbers. That’s the data that all the charts showing UHC at the bottom of the heap are using.

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That's only for HealthCare.gov plans. There may be charts for United's HealthCare.gov plans but the main chart posted here and elsewhere is unsubstantiated

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Originally Posted by Dantheman

This is aggregate across the whole system. On the whole, Americans are largely unwilling to accept supply-side controls like longer wait times, older less effective drugs, etc. and that drives up cost (though it is certainly not the only factor).

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What defines a long wait time or older drugs? Generics are already the default when available.

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Originally Posted by Mazderati

What defines a long wait time or older drugs? Generics are already the default when available.

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6 months for an MRI or non emergency knee replacement. Pretty standard north of the border.

Americans already accept longer wait times than many parts of the world, commonly because alternatives are burdensome or do not exist.

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Originally Posted by RoooR

6 months for an MRI or non emergency knee replacement. Pretty standard north of the border.

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I'm part of a cross-border family. Per relatives, re: hernia surgery
- One year wait in Canada, but free.
- USA "how's Wednesday?" IIRC, the bill was just shy of 10 grand.

That podcast I linked had this example:

You tweak your knee playing tennis, it still hurts a week later, you head to the Dr.

In the US: They order an MRI and send you to an Ortho. Ortho says it’s a non-issue - Ice, wrap and Ibu. Your insurance is billed $[emoji639]k. You get hit with a copay and a coinsurance charge.

In the UK: They tell you to ice, wrap and Ibu. If it still hurts in a few weeks come back and maybe we will schedule an MRI for it.


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Originally Posted by MultiVerse

Even if it ends up true that argument still doesn't justify extrajudicial murder because it relies on a belief, not facts. And you should read my post #881 above (or at least the last paragraph). Denying claims is not the primary way insurance companies generate revenue. Insurance companies have more devious ways to rip you off.

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Im not justifying vigilante murder. But i am pointing out that it defies logic to say that Brian Thompson was a great guy who never did anything shitty during his career. That was the entire intent of my posts.

90% of Canadians live within 150 miles of the US border. And they can cross the border and pay cash for that hernia surgery to have it done immediately if they want - typical price will be around $5000 usd.

The Shouldice hospital in Canada only does hernia surgeries, does 7000 of them a year, and is no charge (except to travel there) unless you want a semi private room - then it’s $500 usd for 3 nights including meals and medications. Wait time is 2 months to get it booked.

You can get a private pay knee MRI in Canada tomorrow at the cost of $600 usd.

To be clear none of those facts excuse the barriers and inefficiencies that exist in Canada’s health care system - but the picture of patients in Canada being completely held hostage by wait times for treatment is more complicated than how people with a binary view of US vs Canada systems want it to seem - especially people who only get their opinions from echo chambers, some guy I know, and news articles.

The main thing to recognize is a lot of foreign health care systems once held up as exemplars haven't performed nearly as well over the past decade. Back in the 2000s when Obamacare was being debated it made more sense to argue single payer health care systems worked better than the American model. Now that isn't necessarily the case. Just look at how wait times (measured in weeks) changed over time in Canada:

Attachment 507763

That doesn't mean we can't learn from other health care systems. But it's important to acknowledge single payer systems are working far less well than they used to

It doesn’t matter what first world system you look at - fact is healthcare/medicine is night and day more complicated in 2024 than it was 30 years ago. Comparison can be made to how powerful an IBM desktop was in 1993 to your 2024 iPhone.

More people get diagnosed, more treatments available, those treatments are both more expensive and more time consuming to deliver, people are living longer, people/families are demanding more care during end of life etc etc etc.

This all happened while both the US and Canada decided - *in the 1990s* - that there were too many doctors and that medical school admissions needed to be drastically cut back. And they did that. Hard to imagine how they came to that conclusion.

The resulting shortage of doctors in the first 2 decades of this century is in part the ripple effect of that decision - and it happened while, as I described above, the practice of medicine got significantly more complex. Perfect storm. Or should I say perfect shitstorm.

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Originally Posted by Ted Striker

I'm part of a cross-border family. Per relatives, re: hernia surgery
- One year wait in Canada, but free.
- USA "how's Wednesday?" IIRC, the bill was just shy of 10 grand.

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I've had an ACL repair done when I lived in Vancouver and here in San Diego.

In Vancouver I had to see a family doctor to get a referral to an ortho surgeon. The one he wanted me to see turned out to be the Canucks team doctor, and there was an 11 month wait for earliest appt. Once I got in to see him and ACL tear was confirmed I had my choice of surgery dates, the earliest available being a couple weeks out. I never got an MRI. The surgeon just manipulated my knee and could tell the ACL was torn based on which directions he could bend/twist and which he couldn't. Surgery was no cost under Canada Health Act. What the act doesn't cover is hard goods like crutches. I had to pay $25 for those. And maybe $6 copay for percocet. One of my options was no surgery and get a $1000 brace that would give me 50% stability. The cost of the brace would not be covered. I also got had a couple months of physical therapy covered.

Should also mention when I originally tore it I went to the ER. There was no swelling, so they took an xray which of course didn't show anything. So they sent me home with a painkiller prescription and said go see a doctor if it isn't better in six weeks.


In San Diego there was no need for a referral, and I never went to ER or urgent care. I just called up a surgeon's office and made an appointment. He did the same sort of exam as the other surgeon. But insurance wouldn't improve surgery without an MRI to prove the ACL was torn. He wouldn't do surgery until the swelling had gone down so I had to wait a few weeks. Surgery was about 5 weeks after the tear. I got every bill in the mail from every provider. Total out of pocket was $4k. Insurance paid around $12-13k. Original amount of all the bills was over $60k. I had to fight it out with a few providers who screwed up billings and overbilled me out of pocket for costs before I'd hit the deductible. And the insurance company tried to deny part of the surgery bill that they claimed was not approved.

It was a lot of work to deal with and keep track of all the billings. Not sure how someone like a cancer patient or someone with a major injury with long recovery would be able to deal with it.


I had a couple other surgeries in BC. One for a broken wrist and one for a broken hand. I can confirm when you need surgery asap, you get it. Hand was next day, while wrist was a few days later. On the other hand my mom had both knees replaced a few years ago. She waited close to two years for the first one and another year (to allow for recovery time) for the second. I would probably have to wait longer for ACL surgery today. Is it worth dealing with wait time to not have to go out of pocket or deal with medical bills shuffled between providers and insurance companies who don't give a shit about you?

Anecdotes are always fraught, but for what it's worth here's a knee replacement horror story: Woman waits 6 years for knee replacement. Gets surgery but has complication. Has to wait 8 days for follow-up procedure because there are no beds. Because of delay, she now needs amputation:

https://www.cbc.ca/news/canada/manit...tion-1.7411886

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Originally Posted by bennymac

It doesn’t matter what first world system you look at - fact is healthcare/medicine is night and day more complicated in 2024 than it was 30 years ago. Comparison can be made to how powerful an IBM desktop was in 1993 to your 2024 iPhone.

More people get diagnosed, more treatments available, those treatments are both more expensive and more time consuming to deliver, people are living longer, people/families are demanding more care during end of life etc etc etc.

This all happened while both the US and Canada decided - *in the 1990s* - that there were too many doctors and that medical school admissions needed to be drastically cut back. And they did that. Hard to imagine how they came to that conclusion.

The resulting shortage of doctors in the first 2 decades of this century is in part the ripple effect of that decision - and it happened while, as I described above, the practice of medicine got significantly more complex. Perfect storm. Or should I say perfect shitstorm.

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Yeah, more complicated in part due to lots of improvements depending on specialty. Cancer survival rates have improved over time. Treating acute cardiovascular disease, in terms of cost efficiency, is vastly improved. Although we see little improvement treating mental illness, for example.

An important takeaway is spending more on health care doesn't get us much. Whereas spending more on health care R&D gets us a lot.

Evdog - was it Dr McConkey you saw in Canada about your knee?

No, it was Dr Regan. He's apparently still with the team. https://www.nhl.com/canucks/team/hockey-operations

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Originally Posted by MultiVerse

The way insurance companies grow is for the cost of the treatments they cover to grow too so that they can charge higher premiums. The entire system is rigged against the people paying for it

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Originally Posted by MultiVerse

Denying claims is not the primary way insurance companies generate revenue. Insurance companies have more devious ways to rip you off.

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Gross revenue, no. Net? Denial is very much the primary way it's generated, it just isn't simple to understand the accounting. By design.

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Originally Posted by MultiVerse

Yeah, it's total chaos. It's also worth mentioning insurers employ tens-of-thousands of doctors and nurses to review claims

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1) Insurance companies employing "tens-of-thousands of doctors and nurses" to do anything but provide care directly reduces supply. Insurers are obviously fine with that, meaning the net result reduces care but increases their bottom lines.

2) The rubber stamp brigade is partly "external" to the insurers in the sense that they only work for another subsidiary of the insurer's parent company (external =/= independent). So payments to that group are a "service" the insurer can use to reduce their own profits while their sister company kicks up the profit to the parent. That's why Brian was so popular with his parent company despite such a low on-paper profit margin--ostensibly much lower than the ACA allows. Luckily the shareholders own the parent company, which profits much more. Wink, nod, and pat Brian on the back, he's doing great!

Insurance accounting is a shell game. It's not even an open secret, it's just open. An employee of my insurer's external claim denial reviewer told me so directly--and triumphantly: "We're all Asuris!" IOW, don't bother complaining to my boss, he's good with it.

If you're going through insurance company accounting without looking at what they pay to all other subsidiaries of their parent you're just helping them lie to you.

Congress could reclassify any entity that owns equity in an insurer as the insurer under the ACA. CEOs, like drug dealers, prefer the risk. Play stupid games, win stupid prizes.

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Originally Posted by summit

DA Bragg: "He was trying to terrorize health insurance CEOs who have been busy strangling babys in their cribs for money, almost literally!"
Jury: .........

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Too much to hope that introducing terrorism charges opens a barn door for the defense to drive through all the reasoning that leads to nullification?

I think we agree on a lot, Jono, in the sense we're saying similar things. I.e. tens-of-thousands of doctors and nurses review claims, not provide care.

And I agree on the case for reclassifying these large vertically integrated companies. Where I disagree is how they generate most of their profits. For big insurers like United and Cigna health care delivery, not primarily denying claims, is where the money is. It's more than just an accounting trick. By providing health services, insurers can drive consumers into using their own providers, pharmacies, PBMs, their own labs, their own medical devices, and many other parts of the hospital system.

So, for example, rather than denying claims these companies can compel all sorts of medically questionable procedures & tests for Medicare patients and then bill state & federal governments. Screening tests, devices, and unusual diagnoses etc. are big money for vertically integrated insurer/providers:

https://www.wsj.com/health/healthcar...nosis-057dca8b

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Originally Posted by CarlMega

Basically Coreshot.

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I ain’t shooting nobody

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Originally Posted by m2711c

has he posted since the arrest?

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Shaking the tree boss

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Originally Posted by stealurface831

kaczynski has been awfully quiet since this shit unfolded.

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Read his manifesto. Very articulate and many good points. Ted, dude, you can’t blow people up and be taken seriously.

This handsome douche that women want to date in prison was smart. U penn. but what a fucking weak manifesto. I wouldn’t even call it that.

Amazed by people cheering this assassination

Yeah. Healthcare sucks at times. And the ceo was a douche. But it’s the system. Change the system.

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Originally Posted by MultiVerse

What's kinda nutty about that is the wide discrepancy from one source to next. His had a different ordering than mine which is more or less par for the course. Probably has to with looking at median vs average etc. USA today, for example, uses BLS data to show top U.S. occupation salaries with yet another ordering:

Neurosurgery: $920,500
Orthopedic surgery: $788,600
Dermatology: $655,200
Cardiac surgery: $607,300
Ophthalmology: $597,000

https://www.usatoday.com/story/money...y/75969535007/

https://www.bls.gov/ooh/highest-paying.htm

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I’m all for that pay. Except derm. What a snooze racket.
And optho is also overpaid.
GP gets paid Jack shit as does PEDS.
4 years college
4 years med
3 years residency
That’s gotta be worth something.

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Originally Posted by stealurface831

I’m already entirely outraged by the national weather service’s forecasting failures in the tragic tornado outbreak which will occur in a few weeks.


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https://www.mercurynews.com/2024/12/...scotts-valley/

just come to me if yall want to know what happens next.

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Originally Posted by Core Shot

I’m all for that pay. Except derm. What a snooze racket.

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Years ago I was smoking a joint with my cousin and, right out of the blue, he says, "Ya know, if I was gonna be a doctor, I'd be a dermatologist." I asked why, and he said, "Their patients never get better but they never die. It's a great racket."

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Originally Posted by stealurface831

just come to me if yall want to know what happens next.

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I'm kinda curious, honestly. Spill.

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Originally Posted by Core Shot

Yeah. Healthcare sucks at times. And the ceo was a douche. But it’s the system. Change the system.

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These companies are spending millions and millions of dollars to make sure that doesn’t happen.

If that money has been spent lobbying to change the system for good, instead of keeping the bad system in place, I’d have much more sympathy for the dead CEO.

ACA was the most expensive lobbying fight in human history. The winners were the insurance corps and hospital corps.

I think boeing and grumman entered the chat honestly.

Big Healthcare adopted its "cost plus" model from the defense industry

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Originally Posted by Core Shot

I ain’t shooting nobody

Shaking the tree boss

Read his manifesto. Very articulate and many good points. Ted, dude, you can’t blow people up and be taken seriously.

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Kaczynski just wanted to kill people. That's it, that's all there is to it: "he spent far more time tormenting his neighbors than he did on his grandiose plans to bring down industrial society. He killed dogs for their barking, strung razor wire across dirt bike paths and fantasized about murdering a neighboring toddler. The manifesto and its carefully constructed veneer of Luddite and anarchist philosophies were a con to lure others into his world of despair and hatred."

https://www.nytimes.com/2024/12/14/o...unabomber.html