Healthcare CEO shot in America

Here we have a sort of hybrid system but we still have problems with waiting lists. Too many people, too few doctors. The NHS has always been wonderful but now the country is vastly overpopulated and the system can’t cope. It is the elephant in the room and if you complain then you are labelled as far right, a fascist and just a generally nasty person. Training up more doctors just seems to be beyond the capability of either my country or yours. We pay better wages but it is still hard because the young doctors have to pay back enormous University fees. Like thousands and thousands. I have 2 grandchildren in the medical profession, one a doctor and one a nurse and it is not encouraging for them.

petal53

This event has been reported for a couple of days now. The CEO of United Healthcare in America was killed in New York a couple of days ago. This has sparked a discussion about the state of healthcare in America, where it is said that people are frequently denied the healthcare they have paid for by the insurance companies. If reports are true, such as one where it was claimed that people are denied anaesthesia for essential surgery so they are forced to pay for it themselves or forego the surgery, then healthcare is in a dire position in America. Killing can never be condoned, but how angry must people be for this to have happened?

Respectfully, this why disinformation is dangerous. I happen to be on an unplanned visit to the US at this moment.

1. The actual motives behind the murder have not been officially established. The suspect has only just been arrested. Media speculation is all that currently exists regarding the ideological theory behind the killing.

2. Denied care and denied claims aren’t the same thing. A denied claim, which is what the rumours about the motive are currently centering around, is NOT the same thing as being denied care. You cannot submit claims, nor be paid for services they have not been rendered. All claim forms need a date of service. US medical documentation and laws are strict and complex. Every payer has a fraud unit. Providers who commit such fraud eventually get caught. It’s too risky for most. If a claim was submitted, the care was already rendered. Now, whether or not the patient is stuck with the bill post service is another issue entirely. Words matter, so please be careful with describing the situation.

3. As someone who spent 15 years in the US in their healthcare industry, it is far too complex for us here to scratch the surface of understanding. There is private insurance and there are public health plans such as Medicaid and Medicare. Most people have some sort of private insurance. 65 plus’ are covered under Medicare and supplemental plans if necessary. Medicaid is for low incomes, partially federally-funded, administered individually by the individual states. Many people are uncovered and are self-pay.

4. Healthcare facilities and providers are usually stuck with unpaid claims, not patients. Credit agencies can come after patients who aren’t on Medicaid, but it’s a futile effort if the patient cannot afford to pay.

4. Elective anaesthesia “surprise bills” are quite specifically the big fuss in US healthcare. This is much to do with the contracts of payers and anaesthesiologists , who often contract separately with specific payers than their institutions. Because of this, some patients get separate bills, which are expensive because those are the highest paid doctors in the US, which pays doctors far more than the UK can imagine. An “essential surgery” being forgone by the patient because they cannot afford the aneasthesia is misleading. Patients in the US can move more freely between providers. If you know your provider is not contracted ahead of time, you can find another provider who is by going through your payers list of contracted providers. All insurance companies have a provider search tool patients can use themselves, or call the insurance for. Surgery deemed ‘medically necessary’ doesn’t need to be scrapped all together. Not all patients are aware of how to navigate such situations, much to the delight of the insurance companies. It’s not a matter of no options, it’s a matter of intentionally not giving people the knowledge of their rights. Imo you have more options in the US if you’re not in the middle of nowhere and have a faint idea of how to find in-network doctors.

5. US healthcare, while completely inequitable and horrifically expensive imo is superior in the sense that even without money patients wait less in non-rural areas, and the care in the higher quality facilities is better than the UK. US Healthcare is less delegated. People receive more care from actual physicians. For example, pregnant women see OB’s there, not midwives. Their healthcare system is very capitalistic and poorer people and those in rural areas are forgotten. The best care is always where the wealthier people are. The system itself is so profit-driven than enough providers do abuse it and bill up a storm for unnecessary services. Physicians in the US are typically well off after a few years. So, the concept of utilization management has driven the bottom line for people like this murdered CEO. It has gone too far.

In summation, I don’t know what the answers are for US healthcare. I don’t like how undervalued trained physicians are in the UK, and I certainly do not love the wait times for basic services. But I do know that the profit-driven nature of US healthcare makes public health systems far more attractive. There wouldn’t be so much easy speculation on murders like this if not for the seedy, money hungry nature of their system.

Thank you imaround that's a lot of relevant information.

This article talks about the rate of under insured.

www.forbes.com/sites/joshuacohen/2024/01/01/us-healthcare-system-leaves-far-too-many-people-underinsured/

I forgot, here is a good list of what insurance looks like in the US.

www.pgpf.org/article/the-share-of-americans-without-health-insurance-in-2023-remained-low/

For those who ask if cancer patients stop being treated if they can not pay? Sometimes and it is complicated.

For those most part, the most indigent of people will have access to Medicaid if the state they live in has not expanded access. I think there are 22 states that have not.

The trouble lies where people make to much for Medicaid coverage and have no insurance, or are underinsured with very high deductible plans. These are the people going bankrupt. Yes they have insurance, but they have to pay the first $10,000 out of pocket cash before the insurance kicks in. They also likely have a 30% co-pay after the $10,000 deductible is paid.

Then there is the problem of drug companies and prescription benefit managers. They and they alone get to decide what prescriptions you are allowed to get. Your doctor may prescribe one, but it wont be covered, so the insurance forces you on to something else (cheaper, less effective)

There is so much more to it to be frank, so this is simply a high level look.

In the case of the United Health killer, I am not so sure after seeing the man they brought in for questioning, that this is anything more than another crazy man with a gun.

People in the USA NEED a hero right now, and this guy was the first one to grasp onto. UHC uses an AI software to deny claims and it is reported that the software has a 90% failure rate. A lawsuit was filed recently but to be honest I have not looked at it.

The reactions to this killing, no matter what the motive, is the symptom of income inequality in the US. Which is being made worse right now what with all the billionaires headed in in January who are already promising to dump safety net in the US. Sadly, the people worst affected by income inequality in the US are most likely to be Trump supporters.

This is going to get worse before it gets better, for the entire world in my opinion.

Luigi Mangione 26 years old, Ivy League graduate has been taken in for questioning. Sad times.

They still haven't caught him. One wonders if people are failing to come forward.

This article shows what happened when another, corrupt, healthcare company collapsed - and the CEO tried to evade justice.

www.pbs.org/newshour/nation/senate-approves-criminal-contempt-resolution-against-steward-health-ceo-for-failing-to-testify

Anyone believe Trump will make things better with Musk's 2 trillion cuts plan?

petra

How many people have died because of decisions made by board of directors of this company 😥

Exactly, Petra. Americans are sick of these insurance companies and the deaths and ailments caused by soaring medical costs. The insurance CEO received compensation for successfully balancing the fees the customers pay and the services the company pays. That is where the corruption implodes. It is a very broken system: hospitals, pharmaceutical companys and insurance companies. They are the cause of the suffering. To know that the CEOs receive bonus pay for the suffering is mostly an unspoken reality but someone finally spoke - with a "veterinarian gun".

US life expectancy dropping like a stone.

www.npr.org/sections/health-shots/2023/03/25/1164819944/live-free-and-die-the-sad-state-of-u-s-life-expectancy

But it’s better than being totally refused treatment because an insurance company told me they don’t want to pay

Hear, hear petal53 👏👏👏

It is.

I didnt want to come up with a half answer on the provision of cancer care if you run out of money or start off with low level insurance but found a report I think relevant as its published by the Cancer Society.

www.kff.org/wp-content/uploads/2013/01/7851.pdf

That is a good question petra.

How many people have died because of decisions made by board of directors of this company 😥

It is an absolute fallacy to believe that direct state spending on the NHS is a Bad Thing.

I don’t know how much different countries spend on their healthcare, but I do think the above statement is correct. I think that despite it’s shortcomings, of which there are many, our NHS, funded by taxation, and free for all at the point of need (including any emergency care needed by foreign visitors) is the right way to go, morally and ethically. I maintain that our NHS is underfunded and that is why I, and many others, are stuck on waiting lists despite very painful conditions, that will be helped by surgery/treatment. But it’s better than being totally refused treatment because an insurance company told me they don’t want to pay.

I understand that medical bills are the primary cause of bankruptcy in the U.S

Yet Nigel Farage says we in the U.K. should have a system similar to the U.S.

Would the oncologists truly just wash their hands of a sick patient undergoing treatment and say “sorry buddy”

I don’t know FGT. It’s really hard for us to imagine that isn’t it?

Perhaps one of our American GNetters could tell us?

Chocolatelovinggran

I understand that medical bills are the primary cause of bankruptcy in the U.S.
If one of the executives earns 10 million dollars a year, it's not surprising, is it?
I have spoken before about a relative of a friend of mine whose funding " ran out" half way through his cancer treatment. The family were obliged to rally round for him to continue with the regime.

That would frighten me to death. Just thinking of it terrifies me.

I’d have thought (hoped) that when the proscribed money ‘ran out’ that some kind of State care would pick up the slack.

Would the oncologists truly just wash their hands of a sick patient undergoing treatment and say “sorry buddy”?

Sorry . ...contributes to at least a third of GDP...

By all accounts Cuban healthcare is excellent, Freya

There is nothing wrong with the NHS model.

Direct state investment sustains lots of private enterprise and contributes to growth in the economy by employing people who spend their wages in privately run businesses and by using private enterprise to source a everything that is needed in the NHS. It is suggested that it contributes to at least a their of GDP.

Despite their insurance contribution models many EU countries directly spend more on their health services than the UK does.

It is an absolute fallacy to believe that direct state spending on the NHS is a Bad Thing. It just means that less is going to private company shareholders...

MaizieD

Perhaps we should start really listening to the US voices which continually tell us how dire the privatised, insurance model, healthcare is in the US. And stop supporting its apologists, like Nigel Farage who favours a similar model.

Who knows what motivated the shooting of the medical insurance company CEO, but given the extent of the misery caused by the US healthcare system and the US love of shooting each other I wouldn't be surprised if it was a very angry individual.

A"similar model", is used in the EU. Yes health care funded by Insurance with some Gov input. Wonder why the NHS model hasn't been taken up in any other country, well Cuba maybe.

I understand that medical bills are the primary cause of bankruptcy in the U.S.
If one of the executives earns 10 million dollars a year, it's not surprising, is it?
I have spoken before about a relative of a friend of mine whose funding " ran out" half way through his cancer treatment. The family were obliged to rally round for him to continue with the regime.

Its clear there was an organised "people movement" against this huge company, but of course it cannot ever excuse what happened.

I've got the book stashed away somewhere which details off what happened in at least some American hospitals during Covid and Lockdown. It lays bare just how much money these hospitals were being paid to "treat" patients the way the Government wanted them to!!!!! Including accounts of genuinely helpful medics having to help patients make their escape from these hospitals - to make sure they didnt wind up on ventilators and/or "treated" in other ways that would have killed them.

Many years ago before we were aware of how awful the US health system was/is I read a very disturbing book on this issue.
The story was that there were far too many people in hospitals with serious medical needs that were costing the insurers more than they wanted to pay out.
They hatched the idea of putting Drs with dodgy cv’s into the hospitals to kill these patients.
Would you hand on heart say no, that could never happen 🤔

The DM reported

"UnitedHealthcare's disturbing track record of rejecting claims has come under the spotlight after the insurance giant's CEO was shot dead in what is believed to have been a targeted attack in the heart of Manhattan. "

"UnitedHealthcare was being probed by the Department of Justice for alleged antitrust violations, while its parent company, UnitedHealthcare Group (UHG), has come under fire from angry patients who claim the insurer refused to cover their care."

"UHG is the nation's largest health insurance conglomerate. The company expected to bring in revenues of $450 billion in 2025, with Thompson believed to earn a salary in the region of $10million a year.

In July, more than 150 protesters from the People's Action Institute campaign group gathered outside UHG's headquarters in Minnetonka, Minnesota, in what became a fiery demonstration

There is a lot more, if you dont hit the paywall

www.dailymail.co.uk/news/article-14157577/unitedhealthcare-united-healthcare-rejecting-claims-ceo-brian-thompson-shot-protests.html