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Americans Are Angry About Their Health Insurance—With Good Reason

Americans Are Angry About Their Health Insurance—With Good Reason

As a physician, I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.

By Claudia Fegan, M.D.
Common Dreams, Jan. 1, 2025

How should we react when a man is shot to death on the street on his way to work? Our humanity tells us that we should be shocked and horrified—and feel that something is deeply wrong with such a brazen act of murder. Ideally, we would do what we could to help sooth the survivors, condemn the violence, and bring the perpetrator to justice.

So why did hundreds of thousands of people have the exact opposite reaction when UnitedHealthcare CEO Brian Thompson was executed in New York City last month? Because Americans are furious with health insurance corporations—and they have every right to be.

In the immediate aftermath of the shooting, many Americans took to social media not to mourn, but to celebrate. Caustic posts about prior authorization and denied medical claims were common. Sympathetic statements were met with rancor—and in the case of UnitedHealth Group’s own statement, over 70,000 “laugh reactions” before the company made that tally private. Even verbose political figures like Elon Musk and President-elect Donald Trump declined to comment for days. This shooting touched a raw nerve.

As a physician who’s treated countless victims of gun violence, and who’s life’s work is to care for all of my patients, I found this response to be deeply unnerving. But I also can’t waive it away with simple explanations like online radicalization or trolling. Something much deeper is at play.

For decades, health insurance corporations like United have been growing more powerful and more profitable. How do they generate these profits? By taking in as much money as possible in premiums and paying out as little as possible in medical claims. Over time, they have tried everything from requiring “prior authorization” of care, to excluding high-quality providers from their networks, to imposing a Byzantine series of charges including ever-growing copays, coinsurance, and deductibles. When all else fails, many insurers simply deny claims.

Behind each of these practices are millions of Americans who are made to suffer. I hear these stories routinely in my practice, and they never become easier to stomach. I have seen patients with aggressive cancer who avoided seeing a doctor for months because they feared bankruptcy; patients with chronic conditions like diabetes who are denied treatments that would improve their quality of life; and gunshot victims whose fight to recover and gain a semblance of normalcy is complicated by their health plans saying no, no, and no again.

I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.

These are the stories that Americans are sharing in this fraught moment. We have to ask ourselves: Are we listening? And what are we going to do about it?

Insurers like UnitedHealthcare will have their own responses. Their PR teams will no doubt work overtime to marginalize aggrieved voices and to highlight what they consider to be the “value” of their health plans. Expect to see glossy commercials and towering billboards touting the “peace of mind” that Americans should enjoy knowing that their medical needs are “covered.” But the health insurance industry doesn’t have a communications problem, it has a profiteering problem—and no amount of marketing will convince people who have already been burned.

Behind the scenes, corporate insurers will no doubt lobby for the preferential treatment they have come to expect. Our newly elected Congress may acquiesce, or they may decide that the industry needs to be regulated—a strategy that has failed to live up to its promise.

Republicans and Democrats have made separate attempts to combine federal requirements with federal largesse in order to make corporate health insurers play nice. But both the Affordable Care Act and the Medicare Advantage program have only succeeded in ballooning the profits of firms like United—without improving Americans’ health or sparing their wallets.

It’s also clear that violence is not the answer, both on a purely human level and because corporate insurers will simply not be moved. UnitedHealthcare will have a new CEO in short order, and it will be that person’s responsibility to boost profits and make shareholders wealthier. Responding to patients’ cries will not serve these ends, so it is not in the cards.

What would help is a proven reform proposal that is long overdue: a single-payer national health program. Such a system would provide universal coverage and comprehensive benefits—with zero out-of-pocket costs. It could be easily implemented given the gargantuan sums we spend on healthcare in this country, and it would be a boon for those who are suffering, and for those who are fearful.

Americans are crying out in pain—and are recognizing that they are not alone in their pain. We should listen to these cries and we should finally, after decades of delay, do something about it.

https://commondreams.org…

Shareholder Dreams or Health Justice?

Corporate stock buybacks on top of hundreds of billions in profits favored by shareholders, versus government-run universal health insurance as favored by two in three adults. It’s time to be “politely stern” in favor of health care coverage for all.

Health Insurers Gave $120 Billion To Shareholders While Denying Your Claim, The Lever, Dec. 11, 2024, by Veronica Riccobene

As rising health care costs and inadequate insurance coverage have one in three Americans saddled with medical debt, the nation’s top health insurers have dumped billions into enriching their executives and top shareholders through lucrative stock buybacks.

All in all, the country’s largest health insurers have invested over $120 billion into repurchasing their own shares since the passage of the Affordable Care Act in 2010. These include UnitedHealth Group; Cigna; Elevance Health, the parent company of Anthem Blue Cross Blue Shield; and CVS Health, which acquired Aetna in 2018.

These companies, along with Kaiser Permanente, a nonprofit health care organization, control over half of the commercial market share of the U. S. Health insurance industry. Since 2010, they’ve raked in a combined $9 trillion in revenue, netting more than $371 billion in profits.

Meanwhile, one in four Americans say they’ve avoided seeking health care in the past year because of the cost. Half of all U.S. adults say they’d be unable to afford an unexpected $500 medical expense, and medical bills account for 40 percent of U.S. bankruptcies.

Major insurers have abandoned patients for shareholder enrichment, according to former health insurance executive Wendell Potter. “Health insurers corrupted the concept of managed care and turned it into something that has really been more of managing cost, but also depriving people of the care that they need,” said Potter. “There’s no other country in the world that has a system like this that enables middlemen to siphon off so much money from middle-class and working-class folks that need health care,“ he added.

Nearly two in three Americans now say they believe health care should be the government’s responsibility, according to polling organization Gallup.

Data shows buybacks soared after Congressional Republicans and the Trump administration slashed corporations’ tax burden through the Tax Cuts and Jobs Act of 2017. Proponents of the Trump tax cuts argued that corporations would reinvest their savings into research and workers – but instead, buybacks exploded. Corporate buybacks are on track to surpass $1 trillion annually by 2025.

Comment:

By Don McCanne, M.D.

Remember, this is only one game that corporations play to move our health care dollars to their own profit line. Their combined maneuvers to reduce health spending on us as they boost their own profits is what has made the health care system in the United States the most expensive and poorest-performing system of wealthy nations.

This is certainly not news to those of us who have now worked decades to try to bring us the model of health care reform that would enable everyone to have access to comprehensive health care without increasing the total health care spending in the U.S., and that model is a single payer system that would be similar to an improved version of Medicare that covered everyone. Many studies have now shown us that this is precisely the reform that we need to provide health care for everyone without creating any personal financial hardship.

The problem is that we still have too many politicians and members of the media that respond in a rote manner with phrases such as, “We can’t afford that” (we can), or “The people don’t want the government involved” (countered by numerous surveys), or “But that’s socialized medicine” (not a bad concept when it is applied to our traditional Medicare as well), or etc., etc.

The solution is that we can no longer accept any of these phrases that tend to reject the concept when we know that single payer is exactly what we need. Now, in such instances, we need to be emphatically but politely curt as we immediately reject the negative comment whenever it is brought up and replace it with politely stern corrections, with special attention to the true facts (“politely stern”: are we creating a new, more appropriate communication standard?).

Anyway, no more passive dismissals. We need to enact and implement a system that works well for all of us, and we need to do it now. We must bring an end to the decades of delay: Health Care Justice for All – NOW and FOREVER!

PEACE AND CHARITY BE WITH US.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Medical resident Joey Ballard is fighting the good fight

An Arm and a Leg Podcast, KFF, Dec. 30, 2024

A few weeks ago, a listener sent us a note with a link to a news article about a new resolution that had recently been adopted by the American Medical Association – the largest group representing doctors in the US.

The resolution said: hospitals need to do more to guarantee charity care to patients who qualify. Legislators and regulators should make them.

Our listener was the author of that resolution, and he told us he first learned about charity care through our work on this podcast.

His name is Joey Ballard and he’s an internal medicine resident at the University of Illinois-Chicago (UIC).

We talked with him about his early organizing as a medical student, bringing the resolution to the AMA, and the optimism he feels bringing the fight for charity care to the hospital he works at now.

Here’s a transcript of this episode.

Send your stories and questions. Or call 724 ARM-N-LEG.

https://armandalegshow.com…

Estimated US Deaths Associated with Health Insurance / Access to Care

The US has far higher mortality than other wealthy nations. Yet the fraction associated with health insurance issues and impaired access to care is difficult to estimate, due to elevated disease risk factors. This analysis estimates 200,000 annual deaths after adjustment for high-burden US diseases, potentially representing insurance-related mortality.

This week, a careful reader asked me to justify this estimate from November 2021: “The US excess mortality age 20-64 is about 1.4 per 1000 per year. Some of that is due to non-insurance factors. If 1.0 per 1000 is attributable to insurance, applied to the 190 million in this age range, that’s 190,000 extra deaths per year.”

In 2021, I was making a rough estimate by assigning most of the inter-country difference among adults 20-64 to health insurance. Perhaps I didn’t sufficiently emphasize the uncertainty of that estimate. Today, to “triangulate,” I took a different approach. I looked up death rates for major risk factors and diagnoses more common in the US than in other wealthy nations. This is not yet sufficiently refined for academic publication, but it’s a solid first cut, so I’m sharing it with HJM readers.

This finding of 195,032 annual deaths not explained by risk factors and diseases more common in the US is close to my prior estimate of 190,000. As noted, several of the totals may actually have medical insurance as a contributing cause – e.g., medical debt forcing people into poverty, or suicides associated with insurance worries or lack of access to mental health care. Thus, the 195,032 is likely a low estimate of insurance-related deaths.

To me, this high mortality burden is consistent with our fragmented and flawed insurance system, with half of adults experiencing financial barriers to care in any given year, often with reported health consequences. Growing rates of care denials are likely increasing the human toll, based on both reports of personal experiences and national surveys of physicians.

These kinds of estimates are imprecise, and indeed the uncertainty bounds are hard to specify. However, they are meaningful despite uncertainty. Whether the excess deaths due to insurance gaps total 195,000 per year, or 220,000, or 170,000, that’s hundreds of thousands too many deaths. The 45,000 estimated in 2009 for those lacking insurance altogether (ignoring under-insurance) is also too much, inexcusable.

We need universal public insurance providing broad benefits to everyone, to save lives and money.

https://healthjusticemonitor.org…

Sources:

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Health care in U.S. must be better

By Richard Bruning
The Baltimore Sun, Letters, Dec. 27, 2024

People are justifiably angry at the health insurance industry and the recent article highlighting their practices (“Luigi Mangione murder case draws scrutiny of health claim denial rates, with three of Maryland’s top insurers higher than average,” Dec. 17) validates those concerns. However, focusing on the failures of UnitedHealthcare and others distracts us from the overarching problem: our profit-driven health care system is broken.

The United States is the only developed country that does not guarantee health care to its populace. In 2022, 27.6 million were uninsured (8.4% of the population) and many more millions were underinsured. The United States spends 40% more than any other country in the world yet ranks 42 in health care outcomes.

In an op-ed piece in the New York Times, Andrew Witty ($25.2 million in salary/benefits), the CEO of UnitedHealth Group said he was “willing to partner with anyone … to find ways to deliver high-quality care and lower costs.” He should consult with Physicians for a National Health Program (PNHP) and Healthcare-NOW. For years, they have supported Improved Medicare for All. This program would guarantee every American continuous coverage from birth to death for all medically necessary services, regardless of income, employment status, pre-existing conditions or where they live. Because everyone would be in the same plan, administrative costs would plummet creating massive savings. PHNP estimates that 95% of all households would save money under this plan.

There is a solution to our healthcare morass but only if we have the courage to fight for the change we need.

https://baltimoresun.com…

Insurance CEO Murder Exposes Deep Anger at US For-Profit Healthcare

Interview with Dr. Phil Brewer

Politics, Policy, and Planet Podcast, WPKN, Dec. 19, 2024

PNHP-CT chair Dr. Phil Brewer discusses his views on the recent wave of public anger and frustration regarding our nation’s failing health insurance industry set off by the murder of UnitedHealthcare CEO Brian Thompson, as well as Physicians for a National Health Program’s ongoing campaign for the implementation of a universal, single-payer health care system in the U.S.

Dr. Brewer characterizes the American system of financing—and denying—health care as “not fair, not right, and definitely not the best health care.”

https://btlonline.org…

Readers Write: Government efficiency

MedPAC’s estimate that Medicare Advantage insurers are overpaid by 22%, while shocking, is way too low.

By Kip Sullivan
The Minnesota Star Tribune, Letters, Dec. 18, 2024

I really appreciated Jill Burcum’s column on the jaw-dropping overpayments to so-called Medicare Advantage plans (“Will Musk have the guts to take on insurers?” Strib Voices, Dec. 15). Donald Trump’s unofficial budget cutters, Elon Musk and Vivek Ramaswamy, should immediately focus on eliminating those mammoth overpayments. Burcum reported that the Medicare Payment Advisory Commission (MedPAC) estimated that Medicare Advantage insurers are overpaid by 22%, far more than they need to cover their 15% overhead and make a buck without delaying and denying health care, which they do with gusto.

Sad to say, MedPAC’s estimate, as shocking as it is, is way too low. MedPAC took into account only two factors that create overpayments — favorable selection and upcoding. MedPAC estimated favorable selection (enrolling healthier-than-average beneficiaries) raised payments by 9%, and upcoding (adding false or inappropriate diagnoses to patient medical records to make them look sicker) added another 13% (for a total of 22%). Four other factors — favorable deselection (sicker people leaving Medicare Advantage and returning to the original Medicare program), bonuses for scores on a worthless “quality measure,” pointless bonuses for selling insurance in rural counties, and an “induced utilization” subsidy that is too complicated to explain here — raise the overpayments to about 40%. Forty percent overpayment translates into about $150 billion in excess payments in 2024. To put that sum in context, consider that the Congressional Budget Office estimates that adding dental, hearing and vision coverage to traditional Medicare would cost roughly $80 billion annually.

Kip Sullivan is a member of the Health Care for All Minnesota policy committee.

https://startribune.com…

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

By Wendell Potter
The New York Times, Dec. 18, 2024

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.

Wendell Potter, a former vice president for corporate communications at Cigna, is president of the Center for Health and Democracy and writes the newsletter “Health Care un-Covered.”

https://nytimes.com…

CEO murder exposes growing anger with the corporate health system

Interview with Dr. Henry Abrons

KALW Public Media, Your Call, Dec. 17, 2024

On this edition of Your Call, we’re discussing the U.S. health insurance industry.

The recent killing of UnitedHealth Group CEO Brian Thompson has revealed the growing anger about the broken health care system. Since the passage of the Affordable Care Act, the country’s largest health insurers have raked in more than $371 billion in profits, according to The Lever’s Helen Santoro. She writes that more than 40 percent of that net income went to UnitedHealth Group, whose annual profits have skyrocketed by nearly 400 percent as the company now reportedly denies nearly one in three medical claims from its policyholders.

According to a Gallup survey, 62 percent of Americans say the federal government should ensure all Americans have health coverage.

Maureen Tkacik is investigations editor at the American Economic Liberties Project.

Dr. Henry Abrons is a physician, past-president of the California chapter of Physicians for a National Health Program, and advisory board member of Physicians for a National Health Program.

full audio: https://kalw.org…

The tricks and traps of Medicare ‘Disadvantage’ plans

By Brenda Gazzar
Code Wack Podcast, Dec. 16, 2024

Why are seniors between a rock and a hard place when choosing between various Medicare options? How do private Medicare plans, known as Medicare Advantage, limit patients’ options and why are they considered riskier than traditional Medicare? And what’s the ‘Medigap Trap?’

To find out, we spoke to Dr. Diljeet Singh, an integrative gynecologic oncologist and the incoming president of Physicians for a National Health Program [PNHP]. With more than 25,000 members across the United States, PNHP advocates for a universal, comprehensive, single-payer national health program.

Check out the Transcript and Show Notes for more!

https://heal-ca.org…

Ways to Fix the Health Insurance Debacle

By Diane Archer
The New York Times, Letters, Dec. 16, 2024

Re: “UnitedHealth Group C.E.O.: The Health Care System Is Flawed. Let’s Fix It,” by Andrew Witty (Opinion guest essay, nytimes.com, Dec. 13):

A recent Gallup poll shows Americans’ satisfaction with health care access, costs and coverage at an all-time low since polling began in 2000. Not surprising. Corporate health insurers have had free rein over our health care system, and it continues to deteriorate.

Yes, as Mr. Witty says, the killing of Brian Thompson, UnitedHealthcare’s chief executive, was unconscionable. So are the needless deaths of tens of thousands of Americans, the increased morbidity of millions more and the medical debt that 41 percent of Americans face.

UnitedHealth “succeeds” by impeding health care access, denying coverage and driving up costs. Mr. Witty knows that all too well. That’s how UnitedHealth maximizes profits.

If Mr. Witty really supports a health care system that works better for everyone, he should advocate Medicare for all — guaranteed affordable coverage — instead of blocking efforts for a government-administered system.

The writer is the president of Just Care USA and the founder and former president of the Medicare Rights Center.

https://nytimes.com…

Overhaul health care

By Patty Harvey and Corinne Frugoni, M.D.
San Francisco Chronicle, Letters, Dec. 16, 2024

California’s Office of Healthcare Affordability proposes to reduce health care costs by setting a 3% cap on cost growth, which, if violated by health plans and providers, will result in fines.

Such attempts at cost control only stick fingers in the dike of high costs and rampant hospital consolidation.

Fines to multibillion-dollar for-profit private companies are wrist slaps; attempts to control their profiteering cannot address finely honed, loophole acrobatics. Fines to physician practices will disrupt patient-clinician relationships.

By imposing fines, the state tacitly accepts middlemen who provide no medical care but do add to administrative complexity and waste.

Hayward’s St. Rose Hospital was saved from closure by herculean local efforts. Not all are so fortunate. According to the National Rural Health Association, 683 other rural hospitals are at risk of bankruptcy.

The misguided strategy of the state will not halt further closures.

A better solution, practiced by other industrialized democracies, is a universal, single-payer health care system, or Medicare for all, that protects hospital solvency and saves billions yearly.

Patty Harvey and Dr. Corinne Frugoni, co-chairs, Humboldt County chapters of Health Care for All-California and Physicians for a National Health Program.

https://sfchronicle.com…