American doctors are accusing the U.S. health insurance giant of causing deadly delays in critical medical procedures and care and putting profits ahead of patients' health.
According to doctors who spoke to the Guardian, companies including United Healthcare refused basic scans and took months to reconsider.
“There's good evidence that these kinds of delays literally kill people,” said Dr. Ed Weisbart, former chief medical officer of Express Scripts, one of the largest prescription benefit managers in the United States. “For some people, this is more than just an inconvenience and annoyance and aggravation.
“It's a death sentence and the only reason insurance companies are to maximize profits is to maximize profits. The fact that they might be killing you is not in the equation of what they care about.”
american spend the most About healthcare in the industrialized world – Estimation 4.9tn in 2023 $4.9tn – but has the worst health outcomes, according to analysis by federal funds.
Last month, the fatal shooting of UnitedHealthcare CEO Brian Thompson led to an outpouring of public outrage against the health care industry. Private insurance companies report billions in profits each year, but many patients and their doctors struggle to navigate the complex financial system and get what they need.
Insurance company lobbyists claim they are “working to protect” people from higher costs, making U.S. health care system care more affordable and easier for everyone in the space, including doctors. We emphasize that we have a responsibility to
But in a series of interviews, medical professionals described their frustration with a powerful industry that was preventing them from helping patients.
“We're stuck in this horrible, vicious cycle.”
Dr. Cheryl Kunis, director of Physicians and Nephrologists at the National Health Program in New York City, still thinks about what happened when one of her patients needed a pet scan. He had a tumor, and before deciding how to treat it, Kunis and her colleagues wanted to establish whether it had spread.
“The surgeon was very honest that he only wanted to operate if the tumor was localized. Without a PET scan, he really couldn't make that decision,” Kunis said. . “The surgeon and his office, and my office, spent hours on the phone. We really had no knowledge of the underlying medical issues or the tests we were asking our patients to have. I was talking to someone who was sitting in front of a computer screen at UnitedHealthCare.”
After an initial denial, the patient's appeal for a scan was finally approved six months later. By that time, the patient had died.
“The assumption is that if he had been diagnosed earlier, he might have been able to do better,” Kunis said. “There's no way to prove it, but there was a reasonable chance he would have been in better shape had there not been a six-month delay in getting the scans.”
The health care system is “really stuck in this horrible, vicious cycle,” she said, “taking advantage of ever-increasing prices, lack of regulation, and unfortunately patients trying to get care.”
“It's demoralizing and insulting.”
Health insurance companies often require “peer-to-peer” reviews. Here, your doctor will need to speak with your health insurance company's medical representative to justify the treatment. However, according to doctors who spoke with parents, insurance representatives are often not experienced and may not even have training in the specific area they are weighing.
“When I engaged in a 'peer-to-peer' review, my peers were not my trained physicians,” said the Honolulu, Hawaii-based intensive care unit physician and director of Physicians for National Health. said former President Dr. Philip Verkhoev. program. “It's kind of a travesty to even call it 'peer-to-peer.' I never had a “peer-to-peer” conversation where I was with an actual peer. ”
Instead, he argued, representatives are “second-guessing our judgment as clinicians.” “To be perfectly clear, I have no financial incentive to admit patients to the ICU. Somewhere, a bureaucrat will look at a claim submitted by a hospital and say, 'The decision to admit the ICU was wrong.' When you say that, it's demoralizing and insulting. ”
Verhoef said he often sees patients enter intensive care units for preventable illnesses caused by health insurance companies denying necessary medications such as insulin or asthma inhalers.
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“If people have to use private health insurance, it actually fails,” he added. “Insurance is supposed to be there to cover you from financial disaster when the unfortunate happens. And the current system we have based on private health insurance really doesn't work for everyone. We failed. I don't think we're going to regulate our way out of this mess.”
According to Weisbart, patients often friction when seeking medical care or assistance is fundamental to insurance companies' business models. “They don't care about you. They see you as an expense, not someone who needs to improve their health,” he said. “The healthier you are, the more they want you to have them as their insurance, and the sicker you are, the more frustrated they are with you and looking for another insurance company.
“Once they have that money, every time someone needs health care, it's just a cost they don't want to part with.”
The insurance industry's interests revolve around delaying and denying medical care, Weisbart argued. “When they deny you care for a day, a week, a month, or completely, it's not a random event,” he said. “It's a calculated business strategy to maximize their profits.”
“A problem that gets worse”
Many doctors have recently expressed similar concerns to private insurance companies. Physicians are “forced to become insurance experts on top of our medical expertise, spending countless hours on paperwork instead of patient care,” writes Dr. Bayo Curry-Winchell of Nevada. . article For Katie Couric Media, Dr. Claudia Fagan, Chief Medical Officer of Cook County Health, writes: article As much as she has seen “patients suffer and die to fill the bottom of corporate health insurance companies, in recent years I have seen this problem get even worse.”
UnitedHealthCare did not respond to multiple requests for comment. Industry lobby group AHIP said in an emailed statement: The people we collectively serve. Health plans are working to connect patients to safe, evidence-based, and coordinated care while protecting them from the full impact of rising costs. ”
Doctors who spoke to the Guardian suggested that the problem of fixing problems in the US healthcare system will require more than tinkering around the edges.
Both Weisbart and Verhoef argue that the solution requires a transition from private health insurance to a single-payer health care system, similar to other wealthy countries that provide health care for all. did.
“The solution is to completely overhaul the system and start from scratch with the National Health Insurance System,” Verhoef said. “Solutions that rely on trying to regulate the private insurance industry will simply fail.”
“There is no modest way to reform a fundamental flaw in a business model,” WeisBart added. “Their business model is designed to delay, deny, and redirect health care. We know a much better way. A much better way is to build a system into the traditional Medicare program. Fix what's wrong with Medicare…and just give it to everyone.”
Moving to a single-payer system, a universal health care system would likely cost less than current national health spending. 2020 Academic Analysis – and save tens of thousands of lives every year.
