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

[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: .........

[RoooR]

No, it doesn’t tell you shit

She fell and broke her hip while in Luxembourg on official US business. She was taken to a US Military hospital in Germany where US military docs did the surgery. Fun fact - members of Congress can get health care at military installations

https://www.pbs.org/newshour/politic...jury-from-fall

Germany isn't even single payer. It's one of the few countries in Europe where you can pay for care and thus one of the countries that other people from Europe go to when the government denies what they want.

[PNWbrit]

It's one of the few countries in Europe where you can pay for care

Almost all euro countries have private/pay for care as an option.

[dan_pdx]

The second degree connection of a second degree connection posted a memorial for Brian Thompson on LinkedIn, saying it was disgusting how the woke mob has reacted to his death.

Reading through that shitstorm was a pretty good way to kill half an hour. I remain amazed how Thompson's defenders keep leaning in on the "good man" argument, never acknowledging the bad shit that happened on his watch. If we're going to take that approach, then Luigi is an upstanding young man who just made one bad decision.

[PNWbrit]

Thompson's defenders keep leaning in on the "good man" argument, never acknowledging the bad shit that happened on his watch.

I Was a Health Insurance Executive. What I Saw Made Me Quit.

I left my job as a health insurance executive at Cigna after a crisis of conscience. It began in 2005, during a meeting convened by the chief executive to brief department heads on the company’s latest strategy: “consumerism.”

Marketing consultants created the term to persuade employers and policymakers to shift hundreds, and in many cases thousands, of dollars in health-care costs onto consumers before insurance coverage kicks in. At the time, most Americans had relatively modest cost-sharing obligations — a $300 deductible, a $10 co-payment. “Consumerism” proponents contended that if patients had more “skin in the game” they would be more prudent consumers of health care, and providers would lower their prices.

Leading the presentation was a newly hired executive. Onstage, he was bombarded with questions about how plans with high deductibles could help the millions of Americans with chronic conditions and other serious illnesses. It was abundantly clear that insurance companies would pay far fewer claims but many enrollees’ health care costs would skyrocket. After about 30 minutes of nonstop questions, I realized I’d have to drink the Kool-Aid and embrace this approach.[/QUOTE]


I left my job as a health insurance executive at Cigna after a crisis of conscience. It began in 2005, during a meeting convened by the chief executive to brief department heads on the company’s latest strategy: “consumerism.”

Marketing consultants created the term to persuade employers and policymakers to shift hundreds, and in many cases thousands, of dollars in health-care costs onto consumers before insurance coverage kicks in. At the time, most Americans had relatively modest cost-sharing obligations — a $300 deductible, a $10 co-payment. “Consumerism” proponents contended that if patients had more “skin in the game” they would be more prudent consumers of health care, and providers would lower their prices.

Leading the presentation was a newly hired executive. Onstage, he was bombarded with questions about how plans with high deductibles could help the millions of Americans with chronic conditions and other serious illnesses. It was abundantly clear that insurance companies would pay far fewer claims but many enrollees’ health care costs would skyrocket. After about 30 minutes of nonstop questions, I realized I’d have to drink the Kool-Aid and embrace this approach.

And I did, for a while. As head of corporate communications at Cigna from 1999 until 2008, I was responsible for developing a public relations and lobbying campaign to persuade reporters and politicians that consumerism would be the long-awaited solution to ever-rising insurance premiums. But through my own research and common sense, I knew plans requiring significant cost sharing would be great for the well-heeled and healthy — and insurers’ shareholders — but potentially disastrous for others. And they have been. Of the estimated 100 million Americans with medical debt, the great majority have health insurance. Their plans are simply inadequate for their medical needs, despite the continuing rise in premiums year after year.

I grew uneasy after the company retreat. But it took an impromptu visit to a free medical clinic, held near where I grew up in the mountains of East Tennessee, to come face to face with the true consequences of our consumerism strategy.

At a county fairground in Wise, Va., I witnessed people standing in lines that stretched out of view, waiting to see physicians who were stationed in animal stalls. The event’s organizers, from a nonprofit called Remote Area Medical, told me that of the thousands of people who came to this three-day clinic every year, some had health insurance but did not have enough money in the bank to cover their out-of-pocket obligations.

That shook me to my core. I was forced to come to terms with the fact that I was playing a leading role in a system that made desperate people wait months or longer to get care in animal stalls, or go deep into medical debt.

The tragic assassination of the UnitedHealthcare chief executive Brian Thompson has reinvigorated a conversation that my former colleagues have long worked to suppress about an industry that puts profits above patients. Over 20 years working in health insurance, I saw the unrelenting pressure investors put on insurers to spend less paying out claims. The average amount insurers spent on medical care dropped from 95 cents per premium dollar in 1993, the year I joined Cigna, to approximately 85 cents per dollar in 2011, after the Affordable Care Act restricted how much insurers can profit from premiums. Since then, big insurers have bought physician practices, clinics and pharmacy middlemen, largely to increase their bottom line.

Meanwhile, the barriers to medical care have gotten higher and higher. Families can be on the hook for up to $18,900 before their coverage kicks in. Insurers require prior authorization more aggressively than when I was an industry spokesman, which forces patients and their doctors through a maze of approvals before getting a procedure, sometimes denying them necessary treatment. Sure, the insurance industry isn’t to blame for all the problems with our health system, but it shoulders much of them. (In response to a request for comment, Cigna told The Times that Mr. Potter’s views don’t reflect the company’s and that Cigna is constantly working to improve its support for patients.)

At Cigna, my P.R. team and I handled dozens of calls from reporters wanting to know why the company refused to pay for a patient’s care. We kept many of those stories out of the press, often by telling reporters that federal privacy laws prohibited us from even acknowledging the patient in question and adding that insurers do not pay for experimental or medically unnecessary care, implying that the treatment wasn’t warranted.

One story that we couldn’t keep out of the press, and that contributed most to my decision to walk away from my career in 2008, involved Nataline Sarkisyan, a 17-year-old leukemia patient in California whose scheduled liver transplant was postponed at the last minute when Cigna told her surgeons it wouldn’t pay. Cigna’s medical director, located 2,500 miles away from Nataline, said she was too sick for the procedure. Nataline’s family stirred up so much media attention that Cigna relented, but it was too late. Nataline died a few hours after Cigna’s change of heart.

Nataline’s death affected me personally and deeply. As a father, I couldn’t imagine the depth of despair her parents were facing. I turned in my notice a few weeks later. I could not in good conscience continue being a spokesman for an industry that was making it increasingly difficult for Americans to get often lifesaving care.

One of my last acts before resigning was helping to plan a meeting for investors and Wall Street financial analysts — similar to the one that UnitedHealthcare canceled after Mr. Thompson’s horrific killing. These “annual investor days,” like the consumerism idea I helped spread, reveal an uncomfortable truth about our health insurance system: that shareholders, not patient outcomes, tend to drive decisions at for-profit health insurance companies.

[MultiVerse]

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

[californiagrown]

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

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.

[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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[Dantheman]

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.

[MultiVerse]

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.

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

[Mazderati]

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.

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

[Kevo]

I was not terrorized by Luigi’s actions.

[Dantheman]

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

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).

[MultiVerse]

I was not terrorized by Luigi’s actions.

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

[summit]

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.

[RoooR]

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

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.

[MultiVerse]

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

[californiagrown]

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

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.

[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.

[MultiVerse]

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.

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.

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.

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

[Mazderati]

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).

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

[RoooR]

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

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

[Mazderati]

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

[Ted Striker]

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

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.

[nickwm21]

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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