Letters from an American - December 5, 2024

Episode Date: December 6, 2024

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December 5th, 2024. Yesterday a gunman assassinated the chief executive officer of United Health Care, Brian Thompson, as he arrived at a meeting of investors in New York City. While authorities are still investigating, officials have released the information that the casings of the bullets that killed Thompson bore the words deny, defend, depose. All words associated with companies denial of health insurance taken from the longer phrases deny the claim, defend the lawsuit, depose the patient. While these clues could simply be a red herring,

depose the patient. While these clues could simply be a red herring, posters on social media have cheered what they seem to see as revenge against an abusive system in which people's lives are at the mercy of executives who prioritize profits. Health insurance companies have long been under scrutiny for their practices. For the past two years, ProPublica has run a long series exploring the different ways in which companies have developed systems to deny health care coverage to their policyholders. UnitedHealthcare has been no exception, either to such practices or to scrutiny. Its parent group, UnitedHealth, has a market valuation of $560 billion and was the eighth largest corporation in the world last year as measured by revenue. This year, UnitedHealthcare, Thompson's unit, is expected to bring in $280 billion in revenue. UnitedHealth is embroiled in a number of lawsuits.

Andrew Stanton of Newsweek reported that on November 14, 2023, families of two now-deceased patients sued UnitedHealthcare over denial of coverage for Medicare Advantage patients for nursing home stays prescribed by their doctors. Medicare Advantage is the private insurance alternative to Medicare that receives a flat fee from the centers of Medicare and Medicaid services. It is an enormously profitable industry, and UnitedHealth controls almost a third of it. The lawsuit alleges that UnitedHealthcare uses artificial intelligence to deny claims from Medicare Advantage policyholders.

The lawsuit claims that the company knowingly uses an algorithm that makes errors 90 percent of the time because it also knows that only about 0.2 percent of policy holders will appeal the decision to deny their claims. Last month, the Senate Permanent Subcommittee on Investigations hammered UnitedHealth for dramatic increases in their denial rates for post-acute care between 2019 and 2022 as it switched to AI authorizations. On the same day as the shooting, Anthem Blue Cross Blue Shield Insurance covering Connecticut, New York, and Missouri announced it would cover anesthesia during surgery or procedures only for a specific time period in order to make insurance more affordable by reducing overbilling. After an outcry both from anesthesiologists and the public,

the company today retracted its policy change, saying it had never intended to avoid medically necessary anesthesia, but meant simply to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines. Their explanation might have come the news cycle, but its suggestion that the insurance officials rather than doctors should determine what anesthesia is appropriate for a patient during surgery echoed the argument in the UnitedHealthcare lawsuit. Thompson's murder seems to be a cultural moment in which popular fury over the power big business

has over ordinary Americans' lives exploded. Maureen Tosik of the American Prospect noted, only about 50 million customers of America's reigning medical monopoly might have a motive to exact revenge upon the United Healthcare CEO. The shooter, whose actual motive remains unknown, is fast becoming a folk hero. Social media has exploded with users writing things like, this claim for sympathy has been denied, songs featuring the words deny, defend, and depose and recorded commentary condemning the healthcare insurance industry. United Health Group posted its sadness about Thompson's death on Facebook yesterday about 1 p.m.

36 hours later the post had 65,000 laughing emojis under it. Security expert Charlie Carroll expressed surprise to Josh Fiallo of the Daily Beast that Thompson did not have a security detail. We're living in a world where people are extremely disgruntled, Carroll said. When people lose trust in the system you start seeing more kidnappings and assassinations because they feel like they have to take matters into their own hands. In the wake of the shooting, UnitedHealthcare and several other insurance companies took

down from their websites the names and photographs of their officials. Billionaires Elon Musk and Vivek Ramaswamy were on Capitol Hill today where they met with lawmakers to explain their vision for the Department of Government Efficiency, the group designed to cut the U.S. budget. Neither they nor the lawmakers shared much with the press, although Fox Business played a video of Representative Ralph Norman, a Republican of South Carolina, saying that nothing is sacrosanct and that they're going to put everything on the table, including Social Security, Medicare and Medicaid. Representative Tom Tiffany, a Republican of Wisconsin, told Just the

News that cuts to the budget don't have to be just the discretionary spending. We can get at some of the mandatory spending also. Food stamps, some of those things. He continued, there may be more bang for the buck in terms of growing our economy, making regulatory changes, get the impediments out of the way, let those job creators and entrepreneurs really be able to go to work. In view of today's news about healthcare,

it's probably worth remembering that Musk has called for the elimination of the Consumer Financial Protection Bureau and that Project 2025 has called for the elimination of the Consumer Financial Protection Bureau, and that Project 2025 has called for making Medicare Advantage, the privatized Medicare in which UnitedHealth specializes, the default enrollment option for Medicare. This would essentially privatize Medicare for the 66 million people who use it.

But since Medicare Advantage costs taxpayers about 6% more than Medicare, this would not create the savings Musk is supposed to be finding. Andrew Perez of Rolling Stone reported today that election financial disclosures filed yesterday revealed that Elon Musk was the secret funder of the RBG PAC, a super PAC created just before the election that claimed Trump had the same position on abortion as the late Supreme Court Justice, Ruth Bader Ginsburg. Although Trump has bragged about overturning

the 1973 Roe v. Wade decision, recognizing the constitutional right to abortion, and the 2024 Republican platform supported the far right idea of fetal personhood, which would apply all the rights protected by the 14th Amendment from the moment a human egg is fertilized. The RBG PAC ran ads promising that Trump would not support a national abortion ban. Ginsburg's granddaughter called the comparison of Trump and her grandmother, nothing short

of appalling. The super PAC was created so late that it avoided disclosure before November 5th. It was funded by Musk with an injection of $20.5 million. Bridget Bowman, Ben Casimar, and Scott Bland of NBC News reported tonight that Musk spent at least $250 million to get Trump elected. In addition to the $20.5 million to the RBG PAC, he put $238 million into the America PAC. Musk also supported Trump through free advertising and commentary on his social media platform X. Today provided a snapshot of American society that echoed a similar moment on January 6th, 1872,

when Edward S. Stokes shot railroad baron James Fisk Jr. as he descended the staircase of New York's Grand Central Hotel. The quarrel was over Fisk's mistress, Josie, who had taken up with the handsome Stokes, but the murder instantly provoked a popular condemnation of the ties between big business and government. Fisk was a rich, flamboyant, and unscrupulous man about town, who was deeply entwined both

with railroad barons like Jay Gould, Daniel Drew, and Cornelius Vanderbilt, and with New York's Tammany Hall political machine and its infamous leader William Marcy Tweed. Tweed made sure the laws benefited the railroads and, the papers noted, snuck into the hotel to say goodbye to his friend in the hours it took for him to expire. After the Civil War, most Americans applauded the nation's businessmen for the support their growing industries had provided to the Union. But by 1872, the enormous fortunes the railroadmen had amassed had tarnished their reputation. At the same time, big operators were starting

to squeeze smaller enterprises out of business in order to control the markets, and popular anger simmered over their increasing control of the economy. Stokes' shooting was the event that sparked a popular rebellion. Newspapers covered every minute of the event and Fisk's demise, while sensational books about the murder rolled off the presses. Together, they redefined late 19th century industrialists with one painting Fisk as a representative businessman who, with just an hour's effort, could gather into his clutches a score of millions of other people's property, impoverish a thousand wealthy men, or derange the values and the traffic of a vast empire. Both those covering the murder and those reading about it

rejoiced in Fisk's misfortune. Letters from an American was produced at Soundscape Productions, Dedham, Massachusetts. Recorded with music composed by Michael Moss. ["The Sound of Music"]