Insurers maximize profits by refusing to insure sick people, selling employers and individuals insurance they don’t need, and vigorously challenging claims.
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On June 28, 1914, a 19-year-old Bosnian, Gavrilo Princip, assassinated Archduke Ferdinand and his wife Sophie in Sarajevo. Europe was a tinderbox primed to burst into flames. The murders were the spark that led to the First World War.
On December 4, 2024, Luigi Mangione, a 26-year-old high school valedictorian and Ivy League-educated computer engineer, allegedly gunned down UnitedHealthcare (UHC) CEO Brian Thompson.
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This was no crime of passion or random killing; it was a premeditated assassination, with shell casings marked “deny,” “delay” and “depose” to mock the strategies used to deny health insurance claims in the United States.
Only mass killings and murders of celebrities make the news in the U.S. UHC is the biggest American insurer, but Thompson was hardly a household name. Yet his killing became a shot heard around the world.
To the commentators that flooded mainstream and social media before the shell casings had cooled, the murder was no mystery. It was an act of vengeance against a company notorious for its high rate of claims rejections.
No one with a functioning moral compass said Thompson had it coming, but nor was their shock that someone thought he had it coming. Among them were scores of physicians harbouring pent-up fury at care denied and Kafkaesque encounters with insurers.
There is widespread belief that insurers habitually deny life-saving care, causing numerous if uncounted deaths.
The victim was UHC’s CEO, but the target was the for-profit health industry. UHC plays, albeit more aggressively, by the rules of the profit-seeking game. Denying care is a feature, not a bug; it is essential to executive bonuses and shareholder returns.
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Insurers maximize profits by refusing to insure sick people, selling employers and individuals insurance they don’t need, and vigorously challenging claims. Obamacare outlawed the first practice, but the other two thrive and prosper.
The insurance industry’s co-dependent partner and antagonist is for-profit health care. It gooses profits by providing unnecessary services (excessive testing, dubious surgeries), jacking up prices and coding patients as sicker than they are to justify higher charges to insurers.
Insurers and providers know each other’s moves; it takes one to know one. Alert to the risks of fraud and over-servicing, insurers view providers as parolees whose clinical decisions require constant monitoring.
Hospitals and clinics master the procedural microaggressions that wring the biggest revenues out of insurers. It takes a huge bureaucracy to administer this grotesquerie. It is quite possibly the most expensively useless enterprise in world.
Canadian insurance CEOs don’t need to beef up security. Our private insurance market is limited to drugs, dental, rehabilitation and other services not paid for by medicare — about 15 per cent of total spending ($60 billion a year).
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Overall, there is little meddling in clinical decision-making. Abuse — mainly over-servicing people who haven’t used up their entitlements — accounts for maybe one per cent to two per cent of costs.
But even if it is not an ethical calamity, that does not make it fair or effective. There is a lot of tedious paper-shuffling. Premiums are a tax-deductible expense for employers and employees are not taxed on benefits.
Translation: people without insurance — retirees, the working poor, the self-employed — subsidize those who have it. Neither employers nor employees pay the full cost, so there’s little incentive to curtail overuse.
More ominous is the growing trend among some provincial governments to contract publicly financed care to shareholder-owned clinics and institutions. Like their American counterparts, these operators prosper by skimming off the easy and lucrative work and upselling patients on low-value-added care.
For-profit nursing homes provide less care per resident and have higher mortality rates than non-profits.
A profit-seeking, competitive market works for cars and computers. In health care, it erodes trust, rewarding insurers who second-guess doctors and treat patients callously, providers inclined to over-service, and facilities that stint on care. Anger is the inevitable byproduct of this toxic stew.
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Don’t bet on the Thompson assassination becoming for-profit health care’s Sarajevo moment in the U.S. But it’s a cautionary tale for Canada. Profit-driven care is an insidious virus in need of a public policy vaccine.
Like other viruses, it thrives in hosts who doubt its harms or let their guard down. Let’s hope Canada keeps its booster shots up to date.
Steven Lewis spent 45 years as a health policy analyst and health researcher in Saskatchewan. He can be reached at slewistoon1@gmail.com.
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