As shocking as the cold-blooded murder of UnitedHealthcare CEO Brian Thompson was, the reaction of many on social media may have been equally as shocking. Any expressions of sympathy were largely overshadowed by the torrent of hate directed at health benefit providers.
This is not exactly a new phenomenon. In the 1997 movie “As Good as it Gets,” Helen Hunt played a low-income single mother of a son with chronic health problems. When a doctor tells her that a simple allergy test that her health plan refused to cover might show the cause, she unleashes a torrent of expletives directed at her HMO.
In nearly every case, no matter where the film was being shown, the audience erupted in cheers.
But to be fair, there are two major players entangled in this issue. There are the health insurance companies and there are healthcare providers, whose bills are covered by the benefit plans.
The role of providers
Thomas Kluz, managing director of Venture Lab, which invests in healthcare, believes hospitals and providers bear a lot of responsibility for high premiums and limited coverage.
“Medical service providers determine prices for medical services, and those prices have a big impact on the rates that insurers must pay,” Kluz told ConsumerAffairs. “According to RAND Corporation’s hospital price transparency study, hospital prices for privately insured patients for the same procedures are, on average, twice to three times as much as Medicare rates for the same services.”
And therein may lie one of the big issues. A growing number of patients are covered by Medicare and Medicaid, government health insurance programs that generally pay less. Everyone else is covered by private health insurance.
“Health systems and other provider organizations are in a difficult position because they generally lose money on the growing part of their patient populations that are covered by Medicare and Medicaid, so they must cover these losses with commercially insured patients to remain financially viable,” said Web Golinkin, former CEO at FastMed.
“In addition, their labor costs have risen significantly since and partially because of, COVID, which has further squeezed their operating surpluses and in some cases produced losses.”
The profit motive
Which begs the question: should companies providing sometimes critical life and death services have to show a profit and be accountable to Wall Street? UnitedHealthcare is not only a profitable company, it earns billions of dollars in profit per quarter, which bolsters its stock price.
Jack Glasker, of Affordable Healthcare Solutions in Westfield, N.J., says some people find the idea of for-profit healthcare repulsive, while many others hate the idea of a government “single payer” system.
“Unfortunately though, the cost of major medical care has absolutely skyrocketed,” Glasker told us. “The reasons are multitudinous, including but certainly not limited to for-profit health insurance. The growing complexity of the system runs contrary to the motives of for-profit health insurance. That's primarily the reason for the angst many people seem to share.”
So, as medical costs rise and health insurance premiums rise and cover fewer services, patients often are left to fend for themselves. That led Holden Karau to co-found a company with the descriptive name Fight Health Insurance.
“I started the company after experiencing a lot of health insurance denials personally,” Karau told ConsumerAffairs.
With a background in artificial intelligence and machine learning, Karau developed tools to help patients develop effective appeals of their denied claims.
“We work by taking the patient's denial and asking them some questions and generating an appeal with an in-house large language model,” Karau said. “I would say in regard to the social media response, I’ve seen so much hurt and frustration from denials, including life-saving procedures and medications, I can understand why some folks turn to humor to cope.