United Health CEO Decries "Aggressive" Media Coverage in Leaked Recording
kenklippenstein.com
kenklippenstein.com
The mantle of populist, anti-establishment hero is up for grabs now that the group who campaigned as anti-establishment are the establishment. Their stated position is that private insurance companies are good, actually, and we should be moving more people out of government funded health care and into the waiting arms of UnitedHealthcare and other private insurers.
This shooting, and popular acclaim for it, are a bright red signal that there is a huge tailwind for anyone who campaigns to burn these companies down, and the new establishment is going to be forced into opposing that popular demand.
But no, they really seem to be complaining about the attention paid to policies that really should have gotten attention a long, long time ago.
He is right, though: refer journalists to the media department. If you're not authorized to speak on behalf of the company, don't. Even if you are, deflection is the safe thing to do, because the press is not your friend and dealing with them is best left to the people who make a living at it.
His company is going to get beat up for a few media cycles. And then it will go away. His media department knows this, because that's what they do.
Columbine inspired all sorts of copycats despite far worse social signals from the public and much quicker demise of the instigators.
Every health insurance executive is shitting bricks right now.
-Jefferson
> I provided their communications department with an opportunity to tell their side of the story, is that they simply didn’t respond
They have nothing to say in their defense. That says a lot.
And people who are fine with hundreds and thousands of people suffering horribly or even dying, so they can have some more money they have no real use for, draw the line at sexist bullying? Or is the issue is that he wasn't gloating behind closed doors, as professionals would? (note the "long laugh" bit)
https://www.propublica.org/article/unitedhealth-healthcare-i...
> On the 2021 phone call, which was recorded by the company, nurse Victoria Kavanaugh told her colleague that a doctor contracted by United to review the case had concluded that McNaughton’s treatment was “not medically necessary.” Her colleague, Dave Opperman, reacted to the news with a long laugh.
However, all it has done is incentive costs to up for them so they can charge higher premiums (since they have to now) and pocket the same percentage of premiums which is of course a larger number overall. How could an insurance company ever even consider lowering premiums by striking better deals with providers?
The dead CEO is a symbolic thing for people to direct their anger at, and with some justification (anger, but not wishing death), but really the frustration is with how bad policy and regulations of the healthcare industry in general is. There's a reason there's very few startups in the space as regulatory capture is all over the space. Between tort law, regulations, and poor policy it's no wonder the space is a mess.
Also accusations? of insider trading by CEO in the linked pages. And complaints these accusation's are not mentioned by most media
- Why are employment and insurance connected? - Why can't you select an insurance company? - Why are there no standardized 3 levels of insurance with a legal mandate for the coverage to be the same across all insurers (so they cant play games with denies). You can't have an efficient and competitive market if nobody understands what they are buying - Costs are inflated due to legal and administrative fees... - Costs are inflated due to high educational fees... - Why are we effectively subsidizing research and medicine for the rest of the world? - Food and health is a major part of what increases the costs
Hope someone fixes it one day
Laws were passed (in the 1990s I believe) to appease the public that banned the insurers from refusing to renew a policy just because the policy holder got sick. However, the law was a joke because it permitted the insurer to set the premium on the renewal at any price they wanted. So, it was effectively the exact same situation. You have insurance. You have a heart attack or get cancer, and when it comes time to renew your policy, the health insurance company raised the premium so high that nobody could possibly afford to renew. The policy would then lapse and the insurer would immediately offer the insured a brand new policy that excepted from coverage the medical condition in question.
It wasn't until the Affordable Care Act in 2010 that health insurers were finally required to keep offering the insured coverage after they got sick. They can no longer raise your rate just because you get sick (after all, what good is health coverage if it doesn't cover you when you get sick?).
But health insurers HATE the Affordable Care Act and are paying lots and lots of money to elected officials to change the Affordable Care Act so insurers can once again refuse to renew policies if the insured gets sick with an expensive illness. So, hold onto your hats everyone.
Given that for the four tax years for which there was an actual penalty associated with that provision, the average penalty paid ranged from less than half (2014) to less than double (2017) the average monthly cost of individual health insurance, it essentially did nothing of the sort, even for the brief period where it might superficially have seemed to if you didn’t examine the details much.
> Now that most employers have self-funded health plans
Most employers (either by count of employers, or by count of employees) do not have self-funded health plans. Most large (>500 employees) tend to have at least one self-funded health plan, but smaller employers generally don’t, and large employers employ only about 1/4 of the workforce.
Jay M. Feinman - Delay, Deny, Defend_ Why Insurance Companies Don't Pay Claim and What You Can Do About It (2010, Penguin Group US)
The rhetorical tactic is to make yourself the victim, always, all the time. If you're criticized or prosecuted or bad news comes out, you're being persecuted. You can see it all the time, yet few seem to notice the pattern.
It also fits other rhetorical tactics: 1) Always stay on the offensive, no matter what; keep the intiative. Attacking the critics is the offensive; responding to criticism is not. 2) Attack the opposition with your own weakness: If you're a liar, call them liars; if you persecute people, call them persecutors. This confuses the issue and disarms them.
Rationally and factually, the victim narrative is usually BS. There is all the difference in the world between bad news, etc. based on facts and that based on falsehoods, and especially there is all the difference between attacks on established powers and attacks on the vulnerable. Punching up is an essential social function, to protect society and hold the established powers accountable; punching down is oppression (and true victimization).
But the rhetoric works because everyone has embraced the post-truth way, abandoning post-modernism (which is fundamentally a distrust of power) and its tools, and have very effectively disarmed themselves.
It's not. Objectively, people get sick and die and there's often not anything that can be done about it. Throwing money at treatments that will not help does nothing but raise costs for everyone.
Individuals (understandably) get very emotional when grandma can't get the $100,000 therapy that might prolong her life for a few months because the big bad insurance company denied it, and it makes a great story to promote on social media. Do insurers sometime err in their denials? Probably. But so do public health plans, and there is no health care system in any country that does not draw the line at some point and say "no, we are not going to pay for that."
e.g. https://www.nytimes.com/2024/12/05/nyregion/delay-deny-defen...:
> The Stat investigation noted specific instances that troubled United employees, like when an older woman who had a stroke was only covered for half the nursing days typically required for recovery....
> A 2023 story from ProPublica dived deep into the experience of one United patient, a college student who racked up $2 million in medical claims a year to treat a severe case of ulcerative colitis. The story showed United disregarding an internal report finding the expensive treatment to be necessary. The patient eventually sued United and received an undisclosed amount in a settlement.
> Insurance denials are rarely appealed, with some studies finding appeal rates of roughly 1 percent.
I suggest you do some research before making such comments because it makes you look like an asshole.
Also, United Healthcare has no place in the incoming administration. Bobby Kennedy Jr is Trump's selection for Health Secretary, if anything is a spurn to the pharmaceutical companies and the insurance industry.
RFK will only be able to propose plans within what Trump will allow; the overlap between their ideas is only bad things. If he tries to go any further he'll just end up like Tom Price did, and resign in six months.
Though it sure would've added a lot to the media hype if the killer was wearing a MAGA hat.
For well over a decade, public sentiment has largely been against healthcare companies. They go to sleep at night knowing the populace hates them. And yet there's a complete inability to look inward.
Fascinating.
> They go to sleep at night knowing the populace hates them. And yet there's a complete inability to look inward.
is because they go to sleep thinking, "what are our customers going to do about it? They're a captive audience. We only have to treat them as well as we are legally obligated to." And they are wholly unprepared for how many Americans are currently thinking, "hmm, I suppose murder is something we could do about it."
As a non-American, this was indeed a big surprise when someone here recently replied to me to make that exact point.
All the disadvantages of a monopoly, none of the advantages of a free market.
Kinda like the UK rail network and water systems, neither of which the British hold in high regard.
Just wait until someone tells you about Comcast.
Yes. One thing I hate is the coupling of insurance and employment in the U.S. These things don't belong together. Most employers offer different "plans" but all through the same insurance company. A good question to ask in an interview is "who is your insurance provider?" Some really are better or worse. But again, it's wrong that this can even be a consideration in finding work.
I suppose the management contract probably won't really include terms about how aggressive the manager should be in rejecting terms (so you get what you get).
This is obviously incorrect. Simply being hated has never been cause for finding fault with oneself . Most people think they are misunderstood. Half of America hates the other half, and vice versa.
Health insurance in the US is like a twisted version of the stilted app that corporate IT forces on employees, only different in that if it breaks it could kill or maim you or one of your loved ones.
> is because they go to sleep thinking, "what are our customers going to do about it? They're a captive audience.
I doubt they go even that far. Most nights, if not all, they probably don't even think about whatever harm they're doing. People have massive capabilities for self-justification, cherry-picking, and avoiding uncomfortable thoughts. Their whole ego is working full-time to make themselves the good-guy hero of their story.
https://www.cms.gov/marketplace/private-health-insurance/med...
Most large employers now have self-funded health plans where they bear most of the financial risk and indirectly pay most of your claims. Thus HR departments have a major incentive to switch carriers to lower costs. Regence probably negotiated lower rates with their network providers.
But if you really think it's a scam then you're free to opt out of coverage during open enrollment.
They don't even do that. They only treat you as well as your state's AG is inclined to be interested in your situation.
One day it was completely replaced by a site extolling the virtues of National Semiconductor stock and the CEO, CFO, and the board. With smiling head shorts and bio's of each. WTF? A few months later the old site reappeared as a link down in the lower right corner.
The lesson. I thought of National Semiconductor as a company that designed and sold mixed signal semiconductors. And the CEO and Board thought of National Semiconductor as a company that sold stock. And they didn't care at all about the people buying semiconductors, they cared about their real customers.
I can see how they think they’re right. Our institutions built them to only equate success with income, and flooded their social networks with others of the same mind. They fought to join the ranks of the elites, and believe themselves to be deserving of every fortune and success associated with their status. Their entire world is an echo chamber, where money can - quite literally - isolate them from the rest of the world. They never have to see the people they fire, or know their hardships, or understand their grievances. They are, in effect, a completely different society separate from our own, yet dependent upon us and our sacrifice for their fortunes.
If it weren’t for the fact the ruling class are literally killing us to increase profits for themselves, I’d pity them for willingly staying within Plato’s cave, ignorant of how the real world works.
I'm sure the execs at health insurance companies feel like they are doing good work within the context of a for-profit business. The first thing to note is they acknowledge they are for-profit. And within that context they probably feel like they're trying to do the right thing against overzealous hospitals, doctors, fraud, and people don't sloppy work filing claims (even if not fraudulent).
I just don't see how you can't do trade-offs in a for-profit where costs can be almost effectively unbounded. So I think in aggregate all of these things can convince themselves that they're doing the best they can and the market will help ensure they do a good job.
Many commercial health insurers are non-profit. That includes such large organizations as many of the Blue Cross Blue Shield Association licensees, HighMark, EmblemHealth, etc. Their coverage and claim processing policies are pretty similar to the for-profit companies.
The health insurers are responsible for negotiating, checking and denying costs. If not them, you would have a state bureaucrat in charge of denying claims. Many will argue this is better, but it still isn't a blank check.
As you point out, health insurance companies make money as a percentage of bills approved, not bills denied. The vast majority of Americans don't understand this.
The completely different and more insidious problem is that this provides an incentive to approve claims, but drive their prices up, like any government regulated cost plus contractor.
Cost Plus contracting only works when there is a competitive market and high transparency.
Government laws tying healthcare to employers mean there is almost no competition, and healthcare costs are inherently opaque due to their complexity.
This may lend even more weight to them being able to sleep well at night -- their company behaves in a way consistent with notable non-profits, so you can't accuse them of profit mongering.
So long as they don't kill anyone or break any laws, we must let our local criminal justice systems perform their duties. Our criminal justice system here in America has all the processes we need to justly maintain society, where each person can be prosecuted for their crimes in an honest and honorable system without regard to station in society or wealth. That is all possible and it's the stated design.
Remember that until one decides to improve oneself's capability and desire to be compassionate, one only sees others in a predatory way, either with selfish desire or callous disregard. But we are not lions of the Serengeti, we are human beings with the capability for humanity, being a humanitarian, caring for others, as our highest human potential.
If only our economic system rewarded such people with positions of influence and power, then the world could change for the better, but under democracy -- the best system we know of -- the govts always reflect the amorality of the populace, often shrunk down to a very select group of citizens. I believe in a person having to earn my trust, just as I believe the same for me with respect to them.
It’s wild how much of the cyberpunk we read in the 80ies and 90ies are coming to pass though. This assassination was done in person, but how long will it take before someone flies a drone into their target instead?
In the short term at least, health insurance companies have no direct financial incentive to deny any claims. In fact, due to the minimum medical loss ratio imposed by the Affordable Care Act (Obamacare) they actually make more profit by approving more claims. The coverage policies which lead to denied claims, step therapy, and prior authorization are really set by employers in order to hold down their costs. In other words, health insurers are really just doing the bidding of their customers.
If you don't like your health coverage then the fault most likely lies with your employer's HR department. To explain it another way, if a large company wanted to they could ask a health insurer to offer a custom plan which would pay every claim for any service, no questions asked. This would be enormously profitable for the insurer, but no employer wants to pay that much.
This is one of the reasons why tying healthcare access to employment via tax incentives was a bad idea. Unfortunately, for historical reasons it's politically difficult to move away from that coverage model.
Can you walk me through, at what point the HR department has the power to delay and deny claims for medical care covered under the insurance contract?
It is my understanding the hatred doesn't extend so much in the denial of claims but rather the denial of claims for covered events.
Of course, sometimes health plans just make errors in claim processing and deny a claim that should have been approved. Or the provider makes an error and submits a claim with incorrect codes or lacking the necessary documentation to establish medical necessity as per coverage rules. Or there are gray areas where it's not always clear whether a certain service should be covered or not, and it comes down to a judgment call by a nurse or doctor employed by the insurer (medicine is still more art than science and the best treatment plan isn't always clear). This can be a huge hassle for patients dealing with serious medical conditions.
I have read anecdotal reports that people working in government roles with UHC insurance have switched to identical plans in the private sector and got much worse denial rates with UHC plans offering the same coverage.
This fuels a completely speculative view that UHC might shift the 85% required healthcare costs towards favoring places where they may gain more market share and really shafting hard in other parts of the market. They can shit-can something like 15% of premiums so unequal allocation of that could lead disproportionately to some very pissed off people, even working within a system where profit is bounded by accepted claims. All of this would fit in well with a profit optimization strategy.
Regular federal government employees are all on private insurance plans, unless they're in the military or old enough to be covered by Medicare. So your comment about "switched to identical plans in the private sector" makes no sense. But the different private insurance plans offered to federal employees do have different benefits and different claim processing policies.
https://www.beckersasc.com/anesthesia/private-equity-has-a-g...
Ultimately only a small percentage of the total money in the healthcare system goes to payer (insurance company) profits. Much larger portions flow to providers, pharmaceutical companies, and device manufacturers. So as far as reforming the system we can maybe get a little savings by squeezing insurers but it's not going to solve any of the fundamental problems.
One alternative approach is to shift away from the current fee-for-service payment model towards a value-based care model. Financial risk is shifted from employers and consumers to provider organizations who receive a fixed capitated payment per member per month from the insurance company. Then the provider org has to do whatever is necessary to care for those patients. The participating providers no longer need to submit claims for payment, just report on what they did for each covered patient that month. It's not clear yet whether this model will work at scale but pilot programs have been encouraging.
Their role in the system is to more or less to do rationing / make resource allocation decisions (or at least be the "administrative face" of rationing policies) and this is always going to be unpopular. While "look inward" is always good advice, I think these companies understand that some percentage of customers will hate them simply because that is the nature of the business.
They have to say "no" to some things. The more things they say "yes" to the higher your premiums are. If they say yes to way too many things (like public health care systems will tend to do) then you will see rationing by waitlist rather than price. They are also subject to the laws of large companies and so will make both random and systemic mistakes (just like every other large organisation) for the usual bureaucratic reasons.
Even if major systemic change is made, whatever entity is left with the responsibility of saying "no, you don't get that care" will still be hated.
Perhaps this is a sign that a health insurance company is inherently a poor way to provide health care to a country.
> Their role in the system is to more or less to do rationing / make resource allocation decisions
And they increase their profits by rationing more. And as is so often pointed out to me, the highest priority of a private company is profit.
https://www.cms.gov/marketplace/private-health-insurance/med...
Every country's healthcare system rations care. Demand is effectively infinite and resources are limited. Socialized systems tend to ration by restricting supply, forcing patients to wait for expensive treatments or simply not offering certain treatments at all. That might be a net improvement over private insurance but there are certainly some downsides.
It's just antithetical to capitalism to do things that way.
Why is there not more criticism and blame put on our legislators and regulators who have done so little for the suffering public?
Is there any area of the market where we would expect that participants will all routinely act against their own self-interest and for the benefit of others? Markets have to be structured and regulated so that participants are incentivized to behave well. The US has not done that.
The anger here on HN seems focused on the greed of the insurance companies, but that corporations tend to optimize for profit should surprise exactly no one. Where's the anger at our corrupt government?
To be be 100% clear, I'm not saying don't blame or criticize insurance companies executives. I'm saying that only blaming the insurance companies implicitly gives a free pass to our representatives who pass laws written by lobbyists. That is both unfair and counter productive, since the government is actually in a position to fix these issues.
I imagine the anger is on them because one of them was murdered this week. I think a lot of us recognize that this isn't a black-and-white issue and that there's a lot of blame to go around. But when something like this happens to a specific part of the issue, of course we're likely to hone in on that in the immediate short-term.
Of course that's not going to lead to introspection. Especially not immediately. Assassination is wildly inappropriate!
When was the last time you were egregiously, drastically wronged and thought to yourself "maybe they have a point"?
Sure, getting the top man assassinated isn't a reason to change what you do - it was one guy with a gun - but that no one is rushing to their defence is another matter.