Building Bridges, WBAI Pacifica Radio, August 5, 2024

PNHP national board secretary Dr. Ed Weisbart discusses his recent piece in Common Dreams, “To Win ‘Medicare for All,’ First Reclaim Medicare From Profiteers.”

Dr. Weisbart cites the corporate insurance industry’s indefensible overcharging of taxpayers—to the tune of up to $140 billion per year.

“If we could get that money back from them,” he says, “then we could use that money to help us pay for hearing, and vision, and dentistry for everybody in Medicare” along with other important health care priorities.

https://wbai.org…

By Amos Barshad
The Lever, August 2, 2024

On a chilly Monday night in January 2019, Kamala Harris was in Des Moines, Iowa for a CNN town hall. At the time, Harris was the junior senator from California and one of nearly 30 candidates vying to be the Democrats’ 2020 presidential nominee. A few minutes into the event, a self-employed local resident named Renee Welk asked a pertinent, inevitable question: “What is your solution to ensure that people have access to quality health care at an affordable price?”

Without hesitation, Harris answered, “We need to have Medicare For All.” Then, as the applause rang out, she riffed beautifully. “To live in a civil society, to be true to the ideals and the spirit of who we say we are as a country,” Harris said, “we have to appreciate and understand that access to health care” is not a “privilege” but a “right.”

“It is inhumane,” she continued, “to make people go through a system where they cannot literally receive the benefit of what medical science can offer because some insurance company has decided it doesn’t meet their bottom line in terms of their profit motivation. That is inhumane.”

This wasn’t Harris’s first time publicly backing universal government-sponsored health care: In 2017, she was one of the first co-sponsors of Sen. Bernie Sanders’ (I-Vt.) sweeping Medicare For All bill. But never before Des Moines had Harris spoken about the issue so forcefully, so passionately, and under such a bright spotlight.

When CNN’s moderator Jake Tapper pushed her on whether that meant she would “eliminate private insurance,” Harris seemingly stayed resolute. She described the painful process of filing an insurance claim, of dealing with all of the required paperwork, of facing delays in coverage, and then said: “Let’s eliminate all of that. Let’s move on.”

For supporters of universal health care, it was a stirring moment, a rousing defense from a senator whose state was then in the early stages of its ongoing fight for a single-payer system. For Harris, fighting to make herself known nationally, it was potentially definitive. On an issue of grave importance, she had spoken with a ringing moral clarity.

But within days, as opponents across the political spectrum launched attacks on her position, Harris and her campaign began walking it all back.

In confused, mealy-mouthed statements, campaign reps told the media that while Harris’s “preference” was Medicare For All, she was open to more than one “path” to providing universal coverage. By the summer of 2019, Harris had proposed a widely panned proposal that critics said would continue to enrich the private insurers who have fueled the country’s health care crisis.

Now that Harris is the Democratic Party’s presumptive 2024 presidential nominee, questions about her back-pedaling on Medicare For All have a new urgency. What does her retreat under pressure from powerful monied interests tell us about a potential Harris presidency’s agenda on issues that conflict with donors’ demands?

Medicare Privatization For All?

Throughout 2019, Harris stumbled repeatedly when prompted to express her views on Medicare For All. In May 2019, in another interview with CNN’s Tapper, Harris said that back in Iowa, when he’d asked her if she wanted to get rid of insurance companies and she said yes, that was actually “not what I meant.”

During a debate in June of that year, when the candidates were asked who would be in favor of eliminating all private health care insurance, Harris raised her hand. Days later, she again backed off the position. The next month, in a Medium post headlined “My Plan For Medicare For All,” Harris finally released the specifics of her health care plan.

“She called it Medicare For All,” said Adam Gaffney, an ICU doctor and the former president of the advocacy group, Physicians for a National Health Program. “But it really wasn’t. She did envision covering everyone and that is laudable and that is critical. But the plan maintained a central role for private insurers, and we’ve seen year after year is that private insurers are driving up the cost of care. They are a key problem in our crisis.”

Medicare For All is also known as single-payer health insurance because it would create one federal government entity that would oversee all health care spending. Its advocates believe the best way to provide health insurance to all Americans is by improving and expanding Medicare, a system that has successfully provided health care for millions of people for decades. Advocates also estimate a single-payer system would net $500 billion in savings by mimicking the efficiency of Medicare, which spends just two percent of costs on administrative tasks like billing.

Harris’s plan wasn’t a single-payer system. Instead, it aimed to give all Americans the choice of enrolling in Medicare while also likely expanding Medicare Advantage, the controversial for-profit insurance program subsidized by the federal government.

People choose Medicare Advantage because it’s cheap: The upfront premiums average less than $20 a month. What they don’t know is that actually receiving treatment with their Medicare Advantage plan is costly in other ways: Critics say that Medicare Advantage insurers profit by denying patients care.

The Journal of Clinical Oncology has found that, in part due to inferior care options, cancer patients in Medicare Advantage have higher mortality rates immediately after surgeries than traditional Medicare enrollees. Researchers studying one large insurer’s data found a 15 year increase in denials over a five year period. One in three Medicare Advantage enrollees are denied at least one claim annually. The programs are being investigated by the Department of Justice for fraud.

This privatized version of Medicare has existed in previous versions since at least the nineties. In 2003, it was renamed Medicare Advantage. Under Trump, it ballooned. In 2018, his administration’s Department of Health and Human Services sent physical letters to millions of Americans saying things like “See if you can save money with Medicare Advantage.” Under the Biden and Harris administration, its growth continued. Last year, around half of all eligible patients were in Medicare Advantage plans rather than traditional Medicare.

As The American Prospect wrote in 2019, “what’s so insidious about Harris’ approach” is that it “would expand the commercial part of the system, falsely branded as a variant of Medicare, and take us further away from true seamless and universal coverage.” While that’s not good for patients, it’s also not good for the federal budget. As The Lever recently reported, “The federal government is losing as much as $140 billion per year by subsidizing private Medicare Advantage plans.”

As far as the GOP is concerned, Medicare Advantage should get even bigger. Project 2025, a broad package of policy proposals being pushed by the Heritage Foundation as the blueprint for a second Trump administration, wants to set Medicare Advantage as “the default enrollment option” for Medicare.

It’s been fourteen years since the Obama administration passed the Affordable Care Act and in many ways America’s health care crisis is worse than ever, as health insurance companies have taken advantage of its many loopholes. This year, the prices of health insurance premiums are estimated to reach record highs. By 2026, the number of uninsured Americans is predicted to spike to over 30 million.

By the end of 2019, in the wake of her flailing around Medicare For All, and as her support waned, Harris quit the Democratic primaries.

In the summer of 2020, Joe Biden — who, during his own successful campaign for the Democratic nomination, explicitly said he’d veto any Medicare For All bill as president — named Harris his vice president.

How Harris “Abandoned” Medicare For All

When Harris first began talking about her support for Medicare For All, she often told the story of her own mother who died in 2009 at 70 years old, due to complications from colon cancer. In a 2018 New York Times op-ed, Harris wrote touchingly of cooking “elaborate meals for her, filling the house with the smells of childhood,” and of finding time outside of her then-job as San Francisco district attorney to hold her mother’s hand “through the misery of chemotherapy.” She wrote, “I am so grateful my mother had Medicare, and I will fight for it to be guaranteed to all.”

In the fall of 2019, Harris sat down for an interview with Ady Barkan, the Medicare For All advocate who died last year, at the age of 39, from complications of ALS. At that point, Harris had already released her Medicare Advantage-boosting health care plan.

At first, the two speak in generalities about the importance of health care over the kind of crescendoing instrumentals that would sound right on a motivational YouTube sports highlights compilation. Barkan asks Harris about her late mother; Harris breaks down in tears. Then, to his credit, Barkan doesn’t let the opportunity slip to push back on the specifics of Harris’s plan.

“You philosophically believe the insurance companies play a useful role and should continue existing?” he asks her, using the augmentative technological intervention he needed to communicate toward the end of his battle with serious degenerative disease.

“I believe that those who abuse the system should be held accountable, but I am not trying to get rid of all private insurance,” she answers. “The problem is they have been writing the rules and they have been taking advantage of consumers.”

Michael Lighty, a longtime Medicare For All advocate, worked as the health care constituency director for Sen. Sanders’ 2020 presidential campaign. He was also the longtime single-payer expert for the California Nurses Association/National Nurses Union organization, which represents over 150,000 nurses nationwide.

He recalls being initially impressed with Harris’s thoughts on Medicare For All, both during the Des Moines event and on previous occasions, “It was very passionate, very sincere. Her framing was ‘we’re not getting a good ROI on health care,’ which was certainly unique, but she definitely seemed committed to the issue.”

The context for Harris’s eventual retreat, Lighty said, was that support for Medicare For All was making the Sanders campaign a target for huge attack ad spending. “Bernie was getting hit with about a million-and-a-half dollars in Iowa” ahead of the 2020 caucus, Lighty says. Meanwhile Pete Buttgieg, then best known as the former Mayor of South Bend, Indiana, “was claiming he had a better plan, some kind of public/private combination.” Sen. Ellizabeth Warren (D-Mass.) “felt compelled to prove how we pay for it in order to distinguish herself, which was not a smart move politically,” Lighty said. “You don’t wanna talk about what it’s gonna cost you, you wanna talk about what it’s gonna save.”

Harris, he explained, was trying to find something to make herself stick out while avoiding the ad spending being directed against Sanders for his support of Medicare For All.

“A majority of voters want the option to keep their plans,” Lighty said. “Primarily that’s because the situation is so bad, they’re desperate to keep what they have.” Political consultants “will tell candidates, ‘you don’t want to be out there telling people you’re taking away their plans.”’

When Harris finally did release her so-called version of Medicare For All, Lighty explained, she “backed off the fundamental principle — a single, publicly-administered plan that would eliminate the power of the commercial insurance companies.” For the Sanders campaign, Lighty says, Harris’s plan felt like an opportunity. “So, fine. Not ‘fine’ from a policy perspective, because she’s wrong.” But it distinguished Sanders as the sole champion for a true Medicare For All proposal.

“She had abandoned support for Medicare For All,” Lighty concluded. “We saw it as exactly that.”

In the long fight for universal healthcare, 2019 was “a very exciting time,” said Gaffney, the ICU doctor. “Single-payer activism had been going on for decades, but for many years had really been on the sidelines” of the political discourse.

Sanders’ 2016 presidential run energized the issue; with the ongoing efforts of progressive activists, and the broader pushback to the Trump administration, Medicare For All suddenly had real momentum. And Harris in Des Moines was a significant moment in the groundswell.

But despite bipartisan support, the movement faltered. “I think many politicians responded to the energy of their progressive constituencies,” Gaffney said. “But it’s one thing to sign on. It’s another thing to stay on.”

“I’ve Never Encountered Kamala”

Alex Lawson is the executive director of the advocacy organization Social Security Works, which aims to expand Social Security and Medicare. He’s an advocate for Medicare For All and has helped draft single-payer legislation introduced in the House of Representatives.

Of the plan Harris proposed in 2019, he said, “I totally reject the idea that the policy is terrible.” He understands why people might be alarmed at the plan’s potential to expand Medicare Advantage. But he said, “Harris’s goal is really clear. It’s to not allow corporate insurers to delay and deny care.”

He doesn’t agree with the people criticizing her approach as an expansion of Medicare Advantage, saying that was not her intention: ”I can tell you, I was right there.” As an activist in close communication with both the Sanders and the Harris teams, he saw that “Harris and her staff were looking to guarantee health care for Americans.’”

In her 2019 proposal, Harris writes, “Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services. If they want to play by our rules, they can be in the system. If not, they have to get out.”

Lawson points to the Biden-Harris administration’s health care track record, which includes, he says, “the largest expansion of Medicare since the creation of Medicare,” and the creation of price caps on a select handful of drugs for Medicare patients. Harris should be judged on what her administration has done, Lawson argued: “They beat pharma! The unbeatable pharma!”

For Lawson, Harris’s walkback on Medicare For All in 2019 is not as telling as its critics believe it to be. “That episode is not nearly as clarifying as the totality of what she did before, during, and up to now,” he said.

As President, Biden was very cozy with the insurance industry: He welcomed its lobbyists to his very first fundraisers, and he took its cues when crafting emergency relief policies during the pandemic.

What kind of relationship Harris will look to build with insurers is not yet known. According to Open Secrets, Harris now has over $800,000 in donations from the health services sector, which includes insurance giants like UnitedHealth and Blue Cross Blue Shield. (Donations to Biden’s campaign before he dropped out will now be transferred to Harris’s campaign, and so are included in that number.)

The Harris campaign recently told The New York Times that Harris “no longer supported a single-payer health insurance program.”  In a statement to NBC News on July 31, a campaign official said, “The VP will not push single payer as president.” When reached for comment, a Harris campaign official confirmed that to The Lever, adding, “The VP won’t push her 2019 health care plan. She will continue to build on the successes of the Biden-Harris Administration — lowering prescription drug costs and making health care more affordable and accessible.” The campaign official declined to elucidate Harris’s vision any further than that.

On July 30 of this year, Harris commemorated the anniversary of the creation of Medicare, signed into law by Lyndon B. Johnson 59 years ago, with a post on X, formerly Twitter: “Trump’s Project 2025 plans to cut Medicare and roll back our progress on Medicaid. As Vice President, I have worked to expand these programs—and we are not going back.” Once, she was clear and bold on the issue; these days, she is a cipher.

RoseAnn DeMoro, the former executive director of National Nurses United, is widely known as one of the most effective union leaders in recent American history. Before retiring in 2018, she helped create real and ongoing momentum for single-payer health care in California and remains an activist for Medicare For All in the state and nationwide. When asked about Harris’s shifting positions on Medicare For All, she first offers a preamble: “I really want her to win, and I hope you say that. She has to win.”

Then she said of her former neighbor in the Golden State, “I’ve been in the political world forever. And I cannot tell you what she advocates. In all my years doing political work in California, in terms of our issues, I’ve never encountered Kamala.”

https://www.levernews.com…

The Attitude with Arnie Arnesen, August 1, 2024

PNHP national board secretary Dr. Ed Weisbart discusses his recent piece in Common Dreams, “To Win ‘Medicare for All,’ First Reclaim Medicare From Profiteers.”

Despite the need for improvements such as additional benefits and lower out-of-pocket costs, Dr. Weisbart reminds us that “Medicare is a spectacular public health program, [but] Medicare Advantage is completely different from that.”

After all, the corporate insurers that sell Medicare Advantage plans have financial priorities that are incompatible with public health. “Every time they spend money on our health care,” he says, “that’s a loss.”

https://www.podomatic.com…

By Adam Gaffney, M.D., M.P.H.
The Nation, July 31, 2024

President Biden’s exit from the Democratic ticket and Vice President Kamala Harris’s emergence as the presumptive nominee has, perhaps, escalated the stakes of the November election for healthcare. Trump’s schemes are, of course, unchanged: A unified Republican government could shred the nation’s healthcare safety net, accelerate the (ongoing) privatization of Medicare, and further restrict or even ban abortion nationwide. In contrast, like a second Biden administration would have, a Harris administration might mostly mean continuity—allowing her to consolidate some real gains (like Biden’s landmark Medicare drug negotiation reform) without confronting the broader injustices and galloping corporatization of US healthcare. But in some quarters, hopes are rising that a Harris administration could go a step beyond Biden—and even open the door to a progressive shift on health policy.

Harris has been to Biden’s left on abortion, supporting a measure in 2019 that would have gone beyond Roe by curtailing state-level abortion restrictions; she is also the first vice president to visit an abortion provider. As a California senator, she endorsed Senator Bernie Sanders’s landmark 2017 Medicare for All bill, a far more expansive reform than anything Biden has put his name on. Yet Harris backtracked on Medicare for All, and the political pressure her administration would face in any major reform effort from both right and center would be daunting, particularly without a powerful grassroots movement pushing the cause, once again, to center stage. Such a mobilization is precisely what we need regardless of the election’s outcome—to advance progressive reform if possible and to fight calamitous policies if necessary.

Forecasting the impact of a second Trump administration requires distinguishing his rhetoric from the reality of his rule. Recall that in the 2016 presidential primary, Trump ran on vaguely popularist promises to protect public health insurance programs, while maligning Obamacare and promising to replace it with something better. “They’re gonna cut Social Security, they’re gonna cut Medicare, they’re gonna cut Medicaid,” Trump said of his Republican primary competitors in 2015. “I’m the one saying that’s saying I’m not gonna do that!” He also famously accused pharmaceutical companies of “getting away with murder” in how they priced their products, causing pharma stocks to briefly tumble.

Given the popularity of Medicare and Social Security even among Republican voters, such claims may well have helped pave the road to the White House for Trump. But as we know, once in office, he governed as a hardened healthcare right-winger, joining congressional Republicans’ nearly successful campaign to dismember Medicaid and dismantle preexisting conditions protections. Even after the Obamacare repeal effort failed, Trump’s budgets continued to call for devastating Medicaid cuts.

A second Trump administration could well give us something of a rerun. As in the past, Trump continues to deride Obamacare, but his platform’s healthcare provisions are reminiscent of his prior popularist claims. “FIGHT FOR AND PROTECT SOCIAL SECURITY AND MEDICARE WITH NO CUTS,” it promises, along with nebulous words about competition and transparency and some virulent threats to “protect” Medicare from immigrants. But if history is any guide, once in office, Trump will again serve as a right-wing standard-bearer on healthcare. Indeed, though he has distanced himself from the Heritage Foundation’s Project 2025 blueprint, his administration’s actions seem more likely to be guided by this conservative wish list—whose contributors include numerous members of his last administration, including six cabinet secretaries—than by his hazy populism. The document calls for sweeping conservative change, including gutting cuts to Medicaid via block grants and lifetime caps on benefits (i.e., kicking people out of the program even if they remain poor) “to disincentivize permanent dependence.” The Center for American Progress estimated that as many as 18.6 million enrollees could be at risk of losing coverage if the latter provision were to become reality. Project 2025 also proposes making privatized Medicare Advantage the “default enrollment option” for seniors, which would no doubt be the death knell for public Medicare.

Yet if Trump’s designs seem plain as day, the meaning of a Harris administration for healthcare seems underdetermined. “We believe in a future…where every person has affordable health care,” Harris said at a recent speech, without further details. The party’s platform has yet to be released, and Harris’s prior stances on healthcare issues have varied significantly. Her aforementioned cosponsorship of Sanders’s 2017 Medicare for All bill was no small thing; the senator’s last single-payer bill prior to the 2017 bill was launched with precisely zero cosponsors. But the progressive energies unleashed by his campaign, years of single-payer activism, and the galvanizing effect of Trump’s ascent to the White House (along with his attack on Obamacare) brought not just Harris but a historic 16 senators on board for the 2017 bill. (Similarly, Representative Pramila Jayapal’s 2019 Medicare for All bill, reintroduced last year, was ultimately cosponsored by two-thirds of House Democrats.) Yet, after endorsing Sanders’s bill, Harris backtracked, putting out her own plan that would give insurance companies a major role in providing universal coverage—an approach many of us criticized at the time for its accommodation of corporate interests. On Wednesday, a Harris spokesperson told NBC News that “The VP will not push single payer as President.”

Those years were something of a high watermark for M4A: The arrival of the Covid pandemic and the end of the Democratic primaries saw the issue’s prominence fade. But as we look ahead to the November election, it’s critical to realize that the dynamics that drove it to the forefront of the national political discussion are no less pressing today. A Trump administration would cruelly degrade healthcare coverage for the sick and working class, while accelerating the corporate corruption of care. Yet, even without such a regressive shift, US healthcare remains deeply inequitable and under siege from corporate power: The number of uninsured fell during the pandemic but is predicted to rise 32.8 million by 2032; one in four adults go without needed medical care, and one in five without a prescription drug, because they cannot afford it; private equity firms are strip-mining the nation’s hospitals; private insurance companies are gobbling up Medicare; and vertically integrated insurer-pharmacy-provider behemoths like UnitedHealth are increasingly subordinating the healing mission of medicine to their corporate bottom lines.

Harris is no doubt aware of these issues: As attorney general of California, she helped block a merger between two massive insurance giants, and, though she backtracked, her endorsement of Medicare for All demonstrated that she was responsive to the progressive constituencies that mobilized behind it. A Trump victory, make no mistake, would be a deadly disaster for our nation’s health—and something we must be prepared to fight. But it is important to be clear-eyed about a Harris victory: It will be an opening if and only if a progressive grassroots movement is able, once again, to put real universal healthcare back on center stage.

Dr. Adam Gaffney is a critical care physician and an assistant professor at Harvard Medical School, and past president of Physicians for a National Health Program.

https://thenation.com…

By Ed Weisbart, M.D.
Common Dreams, July 30, 2024

Fifty-nine years ago today, President Lyndon Johnson signed Medicare into law—a high-water mark in the fight for universal healthcare that had started decades before and that continues to this day.

Ever since Medicare became law, it has been a shining example of what is possible in U.S. healthcare: a truly public, truly universal program that has saved countless lives and prevented untold financial ruin among America’s seniors. But alongside this success, corporate health interests have also grown immeasurably more powerful. Insurers like UnitedHealthcare and Blue Cross Blue Shield have erected cruel barriers to care and are laughing all the way to the bank.

If we want to build on the promise of Medicare—and win the best possible version of Medicare for All—then we’re going to have to grapple directly with the power of corporate health insurance. That starts with taking on the so-called “Medicare Advantage” program.

The Strategic Importance of Medicare Advantage

Single-payer advocates understand that there can’t be “Medicare for All” if there is no “Medicare.” And no, Medicare Advantage (MA) doesn’t count as Medicare. The health insurance corporations that run these plans have a business imperative to prioritize profits above all else; this is anathema to any public health program.

Physicians for a National Health Program (PNHP) has compiled overwhelming evidence that MA insurers are harming patients, physicians, and hospitals by delaying and denying care—harms that are virtually unseen in Traditional Medicare. Nor is this cruelty even a trade-off for lowering the cost of healthcare. In fact, these corporations are paid far more than what is spent for similar patients in Traditional Medicare—up to $140 billion per year, or as much as 35% above the funding levels of Traditional Medicare.

There is no road to Medicare for All that ignores this existential threat.

Thankfully, support for eliminating overpayments to MA extends far beyond those who are already committed to single payer. This fight builds our movement by mobilizing a wide range of people who understand, or can be educated about, the damage insurance companies are doing to patients. When we find common ground, we should walk together.

For that reason, PNHP is exposing MA overpayments and demanding a more fiscally responsible approach from policymakers. We are working closely with several organizations to change the national conversation and provide a badly needed counterweight to the lobbying might of big insurance.

When MA was created, way back in 2003, corporate insurers promised to reduce the cost of healthcare by improving care coordination and health outcomes. A healthier population, they claimed, would be less expensive. We should demand that MA corporations live up to these lofty promises without billions of dollars in overpayments.

We’d like to see them try.

Improved Medicare … for ALL

Winning back $140 billion in annual overpayments begs a tantalizing question: How can we use those funds to improve Medicare for all seniors?

Instead of the paltry benefits that MA plans offer, those funds would help us add robust hearing, vision, and dental benefits; totally eliminate Medicare Part B premiums; and fold in the Medicare Part D prescription drug benefit. Imagine the relief a senior on Medicare Advantage would feel when enrolling in a plan that actually covers the full range of dental care, while also freeing themselves from the narrow provider networks and prior authorization requirements imposed by MA plans.

Most critically, we need to establish a low out-of-pocket maximum for Medicare. Insurance corporations lure seniors and people with disabilities into the MA trap by selling lower up-front costs while hiding substantial barriers to care. It’s a classic bait and switch. Eliminating the need to purchase Medigap would level the playing field and allow everybody to remain in Traditional Medicare.

Well, not everybody—but that’s our ultimate goal. PNHP advocates for a national single-payer health insurance program, and what better way to get there than through an improved version of the already popular Medicare program?

Where we see middlemen standing between patients and the care they need, we should remove them. Where we see limited provider networks, we should expand them. Where we see piles of pre-authorization paperwork, we should shred them.

We should also expand benefits to include all medically necessary care, and ultimately eliminate out-of-pocket costs that deter people from seeing a doctor. Once these improvements are in place, we will have a program that’s truly worthy of the name Medicare for All.

The advocacy work for these priorities—ending MA overpayments, improving Traditional Medicare, and realizing our vision for single payer—overlap and build on one another.

Let’s work to build a movement of seniors, physicians, students, people with disabilities, and everybody else who cares about Medicare. Together, we can take on the corporate insurers that are wreaking so much havoc in our lives and lay the groundwork for winning a single-payer program that brings everybody in and leaves nobody out.

Dr. Ed Weisbart is a retired family physician in Missouri and board secretary of Physicians for a National Health Program.

https://commondreams.org…

By Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence
STAT News, July 25, 2024

UnitedHealth Group started out as a small, Minnesota health insurance company and has since morphed into a modern-day Standard Oil, exerting unmatched dominance over health care in the United States.

It’s no secret that UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. And thanks to a series of stealthy deals, almost 1 in 10 U.S. doctors — some 90,000 clinicians — now either work for UnitedHealth or are under its influence, more than any major clinic chain or hospital system.

But behind those statistics, there’s a lot UnitedHealth doesn’t want you to know. A STAT investigation reveals the untold story of how the company has gobbled up multiple pieces of the health care industry and exploited its growing power to milk the system for profit. UnitedHealth’s tactics have transformed medicine in communities across the country into an assembly line that treats millions of patients as products to be monetized.

Central to these tactics is UnitedHealth’s unrivaled leverage over physicians, whose diagnoses help determine how much private insurers get paid for covering older adults. Dozens of former doctors and employees at UnitedHealth medical practices told STAT how they became enmeshed in UnitedHealth’s strategy to make their patients seem as sick as possible. Doctors said the company had a fixation with medical coding to generate more revenue — encouraging clinicians through bonuses and performance reviews to identify more health problems in patients, even if those conditions seemed dubious.

By controlling doctors, UnitedHealth can lean on them to practice in ways that benefit the insurer, and use its insurance arm to funnel cash back to its clinicians — similar to how Standard Oil amassed power as both the buyer and seller in oil refining. Through these efforts, and by adeptly navigating the Medicare Advantage payment system, UnitedHealth has squeezed potentially tens of billions of extra dollars from taxpayers over the past decade, according to STAT estimations based on federal data. The relationship between UnitedHealth’s insurance company and physician practices is the focus of an ongoing Department of Justice antitrust probe.

Doctors interviewed by STAT said they were initially seduced by the company’s sales pitch that it would be hands-off and help them provide high-quality care, but they quickly became disillusioned. UnitedHealth has required some physicians to see as many as four patients per hour, a difficult task if any of those patients are new to a clinic, they said. Patients, meanwhile, are wondering why their doctors are rushing through their appointments — if they can get seen at all — and have expressed alarm when concerning diagnoses pop up in their medical records, many of which were never mentioned by their physicians.

Susan Baumgaertel experienced the shift firsthand. She is an internal medicine physician who spent 25 years — almost her entire career — at The Polyclinic, a large multispecialty group in Seattle. After UnitedHealth took over in 2018, Baumgaertel said the company pressured her and her colleagues to code patients for certain conditions, including some that the doctors didn’t think applied. She quit in 2021.

“We were not truly caring for patients anymore,” Baumgaertel said. “We were just micromanaging their care to bring in money. It just felt so unconscionable.”

She’s become an unofficial therapist for dozens of her colleagues who still work at UnitedHealth practices, dispensing advice and words of comfort over hours-long walks or coffee dates. Recently, Baumgaertel was on the phone with another physician who worked at a UnitedHealth-owned clinic at the time, and had just pulled up in front of her house.

“She was crying in her car. She said, ‘Susan, I can’t leave. I’m the breadwinner. I have to have insurance. My husband is a stay-at-home dad,’” Baumgaertel recalled. She could hear her friend’s kids knocking on the car window. “She felt trapped. I hear this over and over again.”

STAT’s reporting is based on interviews with more than two dozen current and former UnitedHealth doctors and executives conducted over the past six months. STAT also spoke with health policy experts and patients, examined court records, and read UnitedHealth’s 600-page medical coding bible. Many of the UnitedHealth doctors and executives, and even some patients, asked for anonymity — expressing concerns the company could take them to court, derail their careers, or alter their care.

Accounts from clinicians like Baumgaertel challenge UnitedHealth’s stated rationale for its increasing control over health care. The company says owning medical groups, while also being the insurer, will allow for better preventive care that is “value-based.” Why wait for people to show up in the emergency room with serious, costly issues when you can keep an eye on them in the clinic and intervene earlier?

UnitedHealth declined to make executives available for interviews and did not answer a detailed list of questions. In a statement to STAT, spokesperson Eric Hausman said the company’s “providers and partners make independent clinical decisions, and we expect them to diagnose and document patient information completely and accurately in compliance with [federal] guidelines. We provide training and other practice support to providers because it leads to better care management, coordination, and patient follow-up. Regulators routinely audit this documentation.”

From the start, the takeover of physician practices by the nation’s largest health care company has been carefully choreographed.

UnitedHealth’s leadership team is filled with people who have stayed at the company a long time, and have enriched themselves by doing so. Those executives have leveraged a system that has put patients’ medical charts at the center of how companies get paid. They have lobbied the government over policies that further entrench UnitedHealth’s market power. Several executives have held powerful federal health care positions of their own. And they have capitalized on the government nudging more older adults to enroll in privatized Medicare Advantage plans. UnitedHealth’s clinics and outpatient centers now provide care for about 103 million Americans, according to the company’s own estimates.

In 2007, at a Wall Street conference in a posh midtown Manhattan hotel, UnitedHealth’s then-CEO Stephen Hemsley telegraphed that UnitedHealth — already a rapidly expanding health care company — saw itself as much more than just an insurer. “I would ask you to begin to think about UnitedHealth Group and the construct of its business, its capabilities, its reach in the marketplace, as a health care system unto itself,” he said.

That same year, UnitedHealth struck a deal for an insurance company that owned Southwest Medical Associates, a group of clinics located throughout Nevada — the company’s first large medical group. This happened as the health care industry was on the cusp of its biggest transformation since the advent of Medicare nearly five decades earlier — changes that would ultimately reinforce UnitedHealth’s new direction and spur it to double down on doctors.