STAT: The tragic killing of UnitedHealth Group CEO Brian Thompson has drawn headlines, but what’s missing is a deeper look at the health insurance industry’s relentless prioritization of Wall Street over patient care. In my latest piece for STAT, I connect the dots between the industry’s profit-driven model, the barriers patients face to get the care they need, and how Big Insurance has used billions of premium dollars to fortify its dominance. As a former VP at Cigna, I’ve seen firsthand how these corporations have constructed a system designed to enrich shareholders, not help patients. Read more below:
An investment of $100,000 in United stock in January of 2000 would be worth over $60M today. UHC has done a fantastic job of helping their share holders. The question is how did they do that and at who's expense???
When healthcare dollars stay local, they circulate through the economy up to 10 times. The Healthcare Ownership Economy is already bigger than the U.S. video game industry. If one cares about the quadruple aim, the mega carriers/PBMs are irrelevant and don't deserve one's attention. Thankfully 1000s of employers have woken up to their irrelevance. Time to build the future. It's here. It's proven. Here's why it's time to own our health so we can restore hope and the American Dream: https://www.linkedin.com/pulse/time-own-our-health-chase-health-rosetta-discovering-archaeologist-lav9c
Wendell this article provides crucial insider perspective on the health insurance industry’s strategic goals and methodology. In the years since your time as you had described, I have cared for a number of patients who paid monthly insurance plan premiums and also then had a 10-12,000 “deductible” to cover before they could access even a single dollar of insurance coverage for their own or their family’s healthcare. It is hard to belief that such a cruel plan could be offered as actual insurance. How can physicians and patients work to fix this critical issue at the center of life in the United States?
We analyze 50 years of US healthcare data, compare it with the healthcare models from Canada, UK, and Germany, and show how a new healthcare model can deliver universal and affordable care at much lower costs ($1.6 trillion, instead of today's $4.8+ trillion). The Direct-Care Capitation Payment model provides assured revenues to the primary care providers (they don't have to act as collection agents), moves insurance from being the gatekeepers of community health to the middle between primary and specialized care (right-aligning market forces), and frees everyone from yearly enrollment nightmares and eliminates claims processing. Read more -- https://www.linkedin.com/posts/ranjitjohn_healthcare-medicare-sdgs-activity-7029902786729316352-8x6Q?utm_source=share&utm_medium=member_desktop
The analysts at Wall Street investment banks set the targets for earnings and other metrics that investors look for the company to meet or beat in order to make the stock either go up or hold tight. This is a relationship that creates a lot of pressure to perform for the short term and executives succumb to this pressure to not only keep their jobs but also to meet the targets that trigger their executive compensation via stock options. For healthcare we can see how this cycle creates an environment where an insurer will by hook or crook do what they can to meet these targets and creates a horrible experience for the end user. Hope it changes.
Wendell Potter What has truly been remarkable to me is the rapid assumptions made by the average healthcare consumer about the reasons for this tragic event. It speaks volumes about the state of health insurance in the US. Your experience is not unique. Plausible deniability is baked into just about every c-suite. I believe that one of the potential solutions is giving far greater accountability to clinical leadership at both the c-suite and BOD levels.
Great article, mate. And I think every point you made is something EVERYBODY knows. In fact, it's so obvious it's almost laughable if it wasn't so tragic. Unfortunately your article will likely only annoy those who stay awake every night worrying if they will be denied yet another claim, or if they will even be able to get decent care from a real doctor. The ONLY way your article will ever make a true impact is if the folks who have the power to change things (e.g., Congress, Boards of major Healthcare insurance companies, Rx drug companies etc.) suddenly lose their own cushy, extravagant healthcare plans that regular folks can only dream about.... let them be denied a treatment because it's experimental, let their child wait for months to get a new drug because it's not yet on the tiered approve drug list etc. Then we may see change. Until then, your article is sadly, just another passing tale that makes folks shake their head.... .
Ask yourself again, What's driving insane healthcare costs?” Pssst Bismarck Healthcare is the answer. Bismarck Makes insurers profit-capitated utilities instead of luxuries enabling access to quality affordable private FFS manufactured and private insured healthcare for all. Bismarck nations have more private hospitals and private insurers competing per capita and have better access for all citizens, clinical outcomes and costs than America’s insurer centric hybrid model with no medical bankruptcys. Read about Bismarck here: https://lnkd.in/ecUwsHWP
I cried listening to you on CNN yesterday, I'm losing my mom due to ONE medication that she can't afford. The for-profit greed is hitting the prescription world too..... I've contacted the maker, the main company as well. They have an automated message (regarding this one medication) to call another number. It's the Social Security Administration. I was on hold for over 1000 minutes to be disconnected as it hit their after-hours time.. But thank you for being you...... your conversation with Jake Tapper reminds me to keep fighting for my mom..
Retired
1wWhen a Company denies 1/3 of its claims and pays its executives $10 million a year and up there is clearly something very wrong and I am surprised something like this didn’t happen sooner. But I have little hope that anything will ever be done as long as the insurance companies continue to cross the palms of state legislators, members of Congress, and state and federal officials. I saw it up close as a regulator both at the state and federal levels. Nothing gets done without “running it by the industry,” an industry that does nothing that government doesn’t do far more efficiently with Medicare. If the murder of first graders didn’t move Congress to act on gun control. The murder of an insurance executive will not move them to reform healthcare.