Front Burner - ‘Deny’ ‘Delay’ and a health CEO’s murder

Episode Date: December 9, 2024

UnitedHealthcare CEO Brian Thompson was shot dead in New York City last week. In some communities online, like reddit and tik tok, Thompson’s killing has been met with encouragement and his killer has been lauded as a vigilante, a kind of folk hero. Part of the reason for that, is the deep dissatisfaction and anger with the state of healthcare in America. The murder has exposed a raw nerve and put renewed focus on troubling practices within the trillion dollar health insurance industry.For transcripts of Front Burner, please visit: https://www.cbc.ca/radio/frontburner/transcripts

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Jamie Poisson. A murder in Manhattan. It has been all over the news. UnitedHealthcare CEO Brian Thompson shot dead in New York City last week.

The identity and motive of his killer remains unknown. He's still at large, at least as of Sunday afternoon when I'm recording this. But here are some facts that we do know. Delay, deny, depose. Those are words written on the shells found at the scene. And UnitedHealthcare has a long history of being criticized for denying insurance claims. In some communities online, like Reddit and TikTok comment sections, Thompson's killing has been met with encouragement, while his killer has been lauded as a vigilante, a kind of folk hero. The shooter's face was partially revealed in video footage after he lowered his

mask to flirt with one of the staff in the hostel that he was staying in. Now that hostel is facing a flood of bad reviews and online criticism for being narcs, and some internet sleuths who often help crowdsource leads have gone decidedly silent. And part of the reason for that is the deep dissatisfaction and anger with the state of healthcare in America. The murder has exposed a raw nerve and put renewed focus on troubling practices within the trillion- dollar health insurance industry. And that's what we're going to take a look at today. How is it that American health care has gotten so bad that people are literally cheering on a murder?

To get into all of that, I'm speaking with Helen Santoro. She's a Colorado-based reporter who writes for The Lever, where she covers the American health care system quite extensively. Helen, hi. It's so great to have you on the show. Thanks so much for having me. So could we start with those three words, delay, deny, depose? To be clear, we still do not know why the shooter did what he did. But what comes to mind for you when you hear those kind of words were written on the shell casings? Yeah, it's really interesting how even before those words came about, the first thought I think many of us had here is, oh, UnitedHealthcare denial of health insurance

that has to be playing a role here. Police say Thompson may have been targeted. Delay, Deny, Defend is the title of a 2010 book about how insurance companies handle claims. The use of those words have led police to believe that the suspect may have a grudge with either UnitedHealthcare, Thompson, or the insurance industry. may have a grudge with either UnitedHealthcare or Thompson or the insurance industry. So for those words to be written so clearly, it sort of just reiterates the main thought I think a lot of Americans, including myself, had, which is these massive health insurance companies such as UnitedHealthcare are continuously denying healthcare coverage. And that's really putting a lot of Americans in a

super sticky financial situation where they're not getting the care that they deserve. UnitedHealthcare specifically, the company that Thompson was the CEO of, they're a major player in the health insurance industry, right? And just could you tell me a bit more about how many patients they insure, what kind of reputation they have compared to some of the others? Yeah, absolutely. UnitedHealthcare is, in fact, the largest health insurer in the United States, covering more than 50 million Americans. So a really massive chunk of the population is covered by them. And its parent company, which is UnitedHealth Group, is one of the largest corporations in the country that's like on par with major U.S. financial institutions and big tech institutions.

So it's interesting because we think of Wall Street, we think of big tech Silicon Valley as the big players in terms of profits in this country. But health insurance companies, particularly UnitedHealthcare, are right there along with them. And they're also known to be one of the biggest deniers of health insurance claims and trying to really skate their way out of coverage. There's been this chart going around a lot after the murder of the CEO that showed they deny around a third of claims that people submit. So it's a very large portion of claims that actually aren't getting covered. Is that comparable to what some of the other health insurers do too? I'm thinking of like the other big ones, right? Medica, Anthem, Blue Cross, Blue Shield. Yep.

So out of those big insurers, UnitedHealthcare is known, and according to this chart, has the largest denial rate. However, Anthem, Blue Cross, Blue Shield, which is the second largest health insurer in the United States and their parent company, Elevance Health, they cover about 40 million people, so about 10 million less than UnitedHealthcare. And according to that same chart, they deny about 23% of the claims they receive. So less than a third, but still not too far behind. These are two of the largest health insurers, and yet it's pretty well known just around the states that they're also known to be among the worst in terms of paying out claims. Right. And yeah, it's pretty astounding.

I want to get into with you like some specific examples of the denials. But just before we go any further, I just want to try to understand how this works because, you know, as I'm sure you know, our health care system here in Canada works much differently than in the United States. And I'm just trying to understand how the Affordable Care Act, otherwise known as Obamacare, fits into this landscape. So if I have this right, the ACA created this marketplace where people without insurance could more easily find it and purchase it more affordably, right? And it put in some rules around pre-existing conditions as well. But this is not a public option. People still have to sign up for private insurance with the system, right? Yes. So you're right.

So the Affordable Care Act was enacted in 2010 by former President Obama. Today, after almost a century of trying, today, after all the votes have been tallied, health insurance reform becomes law in the United States of America. And the whole purpose was to make insurance more affordable and available to more people. And when this exchange is up and running, millions of people will get tax breaks to help them afford coverage, which represents the largest middle-class tax cut for health care in history. That's what this reform's about.

So you go on to this online marketplace and you scroll through and you get to compare a bunch of plans to each other. And this is particularly good for individuals and families who might be within a certain income range where they don't qualify for our national insurance plan, Medicare, which is for lower income individuals, but maybe they don't have what's called an employer sponsored plan. So that's your employer providing you with a health insurance plan. So there's a lot of people that fit into this bucket. So you can go and scroll through plans by UnitedHealthcare, by Cigna, by Anthem, Blue Cross Blue Shield, and a bunch of the other ones and purchase it for a more affordable price for Americans. It would be interesting to see what Canadians think of those affordable prices, but a more affordable price than what we're accustomed to in the past. Okay. And then now walk me through, if I have insurance,

what are some of the ways that these insurance companies try to avoid paying for medical services? Yeah. So the really crazy thing that I think is important to note is that around 90% of folks throughout the United States have insurance, and yet we have crippling medical debt. And this comes from the fact that the reality that private insurance companies are denying claims as a means to increase their bottom line and the profit margins. There's not a lot of transparency around why and how these insurance companies deny claims. And actually, the Affordable Care Act tried to get more of that transparency, but it still is very much lacking. There's also not enough regulations around how these insurance companies are allowed to deny claims. Another thing that the Affordable Care Act has attempted and still not been 100 percent successful at.

So in the meantime, while a bunch of people either have their employer sponsored plans or these Affordable Care Act plans, we still have two out of five working age adults being charged for health services they thought was free or covered by insurance, getting these surprise bills. And it's a really complicated process that I believe insurance companies make intentionally cumbersome to then submit a claim to get these bills covered by insurance. So of the people getting these surprise bills, fewer than half actually challenge them because it is such a cumbersome process. Yeah. Are there some examples or anecdotes that come to mind for you of people who have been left with ruinous debt or impossible choices? Yeah, absolutely. So ProPublica, the investigative health news outlet here, does a really great job of covering these bills. Same with KFF Health News. And a really crazy example from ProPublica, it was a man who donated his kidney to his cousin,

this wonderful act of charity. And he ended up with a bill of over $13,000 from a company called Northstar Anesthesia. That's the firm that provided his anesthesia services for that surgery and provides those services for hospitals across the country. So he was left with this potentially ruinous, crippling medical bill for donating a kidney to his cousin. And I feel like stories like that are all too common across the states. I know you've done a bunch of reporting on new anesthesia policies that were being proposed in three states. And just tell me a bit about that reporting, what you found. Yeah, absolutely.

So we were looking into this policy that was sort of discreetly published on Anthem Blue Cross Blue Shield's website. And that's the thing, just as a side note about these policies, is they really are very discreetly posted. And, you know, who has the time to go and look at all of these very jargon filled policies on health insurers websites. And I think the insurers are relying on that a lot of the time so that policies such as this one that I'll explain are not challenged. So in this case, Anthem Blue Cross Blue Shield proposed a new policy with their anesthesia coverage that set an arbitrary time limit

as to when they would cover the anesthesia. So I spoke to the president of the American Society for Anesthesiologists, and he explained it this way, that if a particular surgery, for example, was estimated based on this new arbitrary time limit set by Anthem to take two hours and 10 minutes, and the surgery ended up taking two hours and 12 minutes, Anthem won't cover any of the anesthesia services provided. So not just that extra two minutes. What? Wow. Right. So that is obviously incredibly concerning. And the American Society for Anesthesiologists immediately asked for Anthem to revoke that policy. I understand there's been a movement there in the last week, right? And actually in the wake of the CEO's murder.

There has, there has. It was pretty incredible to see the amount of pressure that was put on Anthem. So this policy would have affected Connecticut, Missouri, and New York starting next February. The Lever and a local Connecticut news source also covered this story. And we were some of the first to break it. And that was just last week, a day afterwards. So this is a few days following the UnitedHealthcare CEO's murder. Anthem revoked the policy across all three states. Anthem revoked the policy across all three states.

This morning, Anthem Blue Cross Blue Shield is backing down after an uproar over its plan to limit coverage for anesthesia. Which was pretty incredible and really goes to show the pressure of the outrage that I think came from this policy and particularly from the CEO's murder. You know, this is really, as you mentioned, like hit a nerve with the American people that we're just a lot of people are tired of being taken advantage of and getting these surprise bills from insurers. And that pressure, luckily, very quickly led Anthem to, yeah, publicly revoke the policy across all three states. When you talk to these companies, what is their rationale for, you know, what so many people see as the great lengths they go to to avoid paying out? How do they defend themselves? Yeah, it's always really interesting waiting for their comment and seeing what they're going to say this time around. So for example, with the anesthesia and Anthem Blue Cross Blue Shield that I was just covering, after we wrote our initial story,

and then we were doing an update with regards to their pulling back their policy, And then we were doing an update with regards to their pulling back their policy. The response that Anthem gave me with why they were pulling back their policy is there was a bunch of, quote, misinformation spread about the policy. And they were just trying to set clearer standards as to why when they would cover anesthesia. They say, to be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines. You know, you speak to doctors, you speak to the president of the Society of Anesthesiologists, and they're like, that's just ridiculous. One of the whole issues with this policy is that it didn't make sense. These arbitrary time limits just did not

make sense and did not align with how surgeries actually work. So I feel like that's a big point. It's like, you don't understand. You don't understand the complexities of these policies. And we're just trying to help the patients and make things more efficient. That's something that I hear of a lot. coverage, they tend to point to how many people they have covered and how much they pay in covering these individuals. Very nicely avoiding noting their increasing profit margins and CEO salaries that are also very much increasing over time and their denial rates. So yeah, it's a lot of responses that skirt around the main issue and the foundation of their business practices, which are these are private businesses that want to make a profit. And that's really what it comes down to at the end of the day. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem.

Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income?

That's not a typo, 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. How much money are these insurance companies making? Yeah, it's when I was looking up for this story, even as you mentioned, I've covered this for a while. I was still astounded. I'm still astounded every time. So Elevance Health, so Anthem Blue Cross Blue Shield's parent company, brought in more than $170 billion in revenue last year.

billion in revenue last year. So it's important to note that revenue doesn't necessarily mean their profit because they'll be then paying out a lot of that revenue to hospitals, to doctors for the actual coverage that they're providing. But that's a lot of money. And the CEO of Elevance Health, including her base salary, stock awards, and other compensation made nearly $22 million last year. And that's very comparable to UnitedHealthcare. Yeah. I also wanted to ask you about the use of AI in this field. So in particular, UnitedHealthcare is being taken to court right now, right, for using an algorithm that's denied coverage to thousands of patients. Lawsuits have been filed against three of the largest health insurers, claiming they use AI to help make coverage determinations, a claim they deny.

The suit claims that Humana has been using an AI algorithm that systematically denies care to seniors that is recommended by their doctors. This development is a part of a growing scrutiny around how insurers are using artificial intelligence tools to make decision coverage. The plaintiffs are arguing that the algorithm was blatantly inaccurate. They point to evidence that in 90% of cases where a patient appealed, their coverage denial, the AI's decision was actually overturned. It really was interesting listening to you talk before about how a lot of people don't even bother appealing because it's so complicated and convoluted. What do court cases like this tell you about the future use of AI in health technology? Just how does that fit into the conversation that

you and I are having right now? Yeah, it's such a complicated issue because, especially in rural America, we're in such desperate need for more healthcare providers. There's a huge shortage. It's a very common thing to have to wait months to see a doctor, let alone a specialist here in the United States. So there is a need to help the doctors that are there treat their patients. However, AI, it's tricky because I think a lot of doctors who you speak to would say it's sort of another means of not actually focusing on the individual patient and just looking at these stats and numbers that aren't really going to be individualized and provide that proper individualized care and sometimes insurance coverage to these patients.

Investigative journalists at the non-profit ProPublica found that the health insurance company Cigna uses an automated system that allows it to instantly reject claims on medical grounds without even opening the customer's file. Some are accusing Cigna of using the system to help cut costs at the expense of the patients. if we start seeing more of them because, you know, these computer models, these AI models, you can set them up to look over so many claims at such a faster rate than an individual can. And it doesn't really surprise me that then there's this 90% error rate denying care. It sort of goes along with what insurance companies are already doing. And this is just another means for them to deny more care at a faster, more efficient rate. So this killing, it has unleashed this torrent of anger, as we've been talking about, directed towards this industry, the system.

But it does strike me that this was an issue that I heard, well, that I heard basically nothing about in the recent presidential election. And just why not? Seems like it was kind of ready for the taking, the opportunity to tap into this anger. You're absolutely right. Healthcare, really surprisingly, I was very surprised by this, was an issue that was largely left out of this presidential election. And that's really a contrast to years past. And that's really a contrast to years past. Like neither candidate, Kamala Harris or Trump, offered sort of their sweeping vision of health care reform, despite the fact that voters are really deeply concerned about medical care and its costs. As I mentioned before, so many people are in crippling medical debt, especially coming out of the COVID-19 pandemic. especially coming out of the COVID-19 pandemic. So there was a lot of need for it and yet not a lot of reform efforts or policies being spoken about. And honestly, I'm not quite sure

why it is that at least Harris, I have some of my own opinions about why Trump maybe wouldn't speak on this. In years past, during his last administration, he has decried the Affordable Care Act. Obamacare has wreaked havoc on the lives of innocent, hardworking Americans. Obamacare has broken our health care system. It's broken. It's collapsing. It's gone. And that's been something with Republicans in general, that when you tend to speak expanding health care coverage, they tend to be against such efforts. But I was really surprised that Harris wasn't sort of taking up the torch of Biden, President Biden's campaign during his last campaign when he was elected in 2020. There was a lot of focus on health care or a lot more focus on health care. Let's give Medicare the power to save hundreds of billions of dollars by negotiating lower drug prescription prices. hundreds of billions of dollars by negotiating lower drug prescription prices.

Health care should be a right, not a privilege in America. And it's not as if that issue has gone away, particularly given the pandemic. And yet she really leaned away from it. There was some talk about abortion accessing, as that's been a huge issue around the states, but not really in terms of expanding affordable health care. And I'm not honestly, I'm not quite sure why why that was a campaign strategy for Harris this election cycle. You know, I take your point that you were surprised. But like what what might be a reason for why she didn't seize on this issue? I know people talk about the power that this industry has quite a lot, right? The reality of how our electoral and campaign system goes in this country. It is very dominated by industries. And what I mean by that is behind

the scenes, there is tons of lobbying going on from companies such as UnitedHealthcare, from companies such as Anthem, and candidates, including Harris, are receiving that money. So, you know, from the outside, it seemed when you're seeing millions of dollars from health insurance industry going to Harris's reelection campaign. So to say that their profit margins and their desires as a business aren't influencing presidential campaigns in this country is just is completely false. presidential campaigns in this country is just is completely false. What are you thinking about when it comes to what we may be able to expect from the Trump administration? So I know that he has promised not to cut Medicare. He has talked about having

like concepts of a plan. I don't know what that means. He's also empowering people like Elon Musk and Vivek Ramaswamy to look into making sweeping cuts in the federal government. Ramaswamy in particular has a background in the biomedical field. And so what could potentially happen? Like, what are you guys kind of talking and thinking about? Yeah, there's definitely concern about what these cuts are going to look like for health insurance coverage for so many millions of Americans. J.D. Vance, the soon-to-be vice president, has even suggested, gone as far as to suggest that Trump and this new administration should place people in what's called insurance risk pools,

depending on their medical histories. So exactly the thing we were trying to move away from with the Affordable Care Act and covering people despite their pre-existing conditions. This proposal basically means that people with pre-existing conditions that are facing massive premiums or the cost that they're paying for their health insurance coverage will no longer be protected from their pre-existing conditions and have to pay potentially huge amounts more for their health care coverage. And that could mean, again, tons of Americans losing coverage and not being able to afford it, which again, in 2010, was the whole reason for the Affordable Care Act was to expand affordable coverage. And it looks like it's been

a continuation of the Republican mantra of walking back affordable health care. So it's definitely something myself and my colleagues at The Lever are keeping an eye on. And I can say for sure that I'm incredibly concerned about what affordable health care coverage is going to look like in the upcoming years. Helen, I want to thank you very much for this. This is great. It was wonderful to have you on. Thank you. Thank you so much for having me. All right. That is all for today.

I'm Jamie Poisson. Thanks so much for listening. Talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.