Original article by Natalia Marques republished from peoples dispatch under a Creative Commons Attribution-ShareAlike 4.0 (CC BY-SA) license.

Slain health CEO Brian Thompson’s tenure was marked by skyrocketing prior authorization denials, leading to increased profits

The assassination of UnitedHealthcare CEO Brian Thompson on December 4 has sparked a reaction that few may have suspected. The perpetrator has received an outpouring of popular support, and a profound debate on the brutality of the US for-profit healthcare system has been sparked, with many accusing healthcare corporations of reaping their profits directly from human misery.

Thompson was shot and killed while heading to an investors meeting in Midtown Manhattan on December 4. Police have arrested 26-year-old Luigi Mangione in connection with the crime, who quickly has become a working class hero in the eyes of many in the US public, especially after his alleged manifesto revealed that he was motivated by outrage towards healthcare corporations. “A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy,” reads the alleged manifesto, which law enforcement claim to have found in his backpack. “It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty.”

The reactions to Thompson’s death show that this outrage is echoed by the US public. UnitedHealthcare had to remove a Facebook post mourning Thompson after it received over 42,000 laughing reactions. Comments on social media regarding Thompson’s death made insurance-related quips including “unfortunately my condolences are out-of-network,” and “thoughts and deductibles to the family.”

Health beyond the for-profit system

People in the US are increasingly demanding alternatives to the present for-profit healthcare system. A Gallup poll taken shortly before Thompson’s assassination shows that the highest percentage of US adults in over a decade believe it is the government’s responsibility to ensure that people have healthcare coverage—62%, as opposed to 36% who insist it is not the government’s responsibility. Gallup data also indicates that most in the US have a negative view of the healthcare industry. 

Data for Progress polling indicates that people across the political spectrum support policies that make healthcare more equitable, with 75% of both Democrat, Republican, and independent voters opposing allowing insurers to deny coverage or charge more based on pre-existing conditions. Also across party lines, 70% of voters oppose stopping Medicare (US public insurance) from being able to negotiate lower costs for drug prices.

The unpopularity of the healthcare insurance industry becomes obvious when one examines how exactly insurance companies wield their power over the healthcare system to extract profits from working people. 

Cost cutting through denial of service

Shortly before Thompson’s killing, another insurance corporation, Anthem Blue Cross Blue Shield, announced that it would not pay for the complete duration of anesthesia for surgical procedures. This move was denounced by the American Society of Anesthesiologists (ASA). “This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care,” said Dr. Donald E. Arnold of ASA. “It’s a cynical money grab by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care. This egregious policy breaks the trust between Anthem and its policyholders who expect their health insurer to pay physicians for the entirety of the care they need.” 

Following Thompson’s assassination and the subsequent outrage over the state of the healthcare industry, Anthem walked back this decision, with a company spokesperson stating that “there has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change.” 

Regardless of Anthem’s flip-flopping, the corporation was willing to cut anesthesia for patients mid-surgery simply to cut costs. This is only one example of how health insurance companies are able to reap their enormous profits from policies which maximize human misery. 

Under the current privatized healthcare system in the US, working people and their employers pay hundreds of billions of dollars to private insurance companies in the hopes of receiving adequate coverage when most needed. Insurance companies, which under a capitalist system exist only to make a profit, not to actually provide coverage, do whatever they can do to deny coverage to patients in their hour of need—enabling them to pocket the billions they receive from people in the US and increase their revenue. 

Companies such as UHC, which is the nation’s largest health insurer with over 15% of the market share, cut costs by denying coverage to patients, including through a process called prior authorization, a process which insurance companies utilize to determine if they will cover a prescribed procedure, service, or medication. Prior to  Thompson’s tenure as UHC CEO, which began in 2021, the rate of prior authorization denials was 8%. By 2022, the rate of denial had skyrocketed to 22.7%. According to personal finance platform ValuePenguin, UHC denies Medicare and non-Medicare insurance claims at a rate that is double the rate of the national average. 

UHC’s prior authorization denials increased so sharply that they prompted an investigation by media outlet ProPublica as well as the US Senate. ProPublica found that UHC had culled therapy expenses by using an algorithm to restrict mental healthcare coverage. A report by the Senate Permanent Subcommittee on Investigations found that UHC used artificial intelligence to deny claims at an increasing rate. In November of 2023, UHC was hit by a class action lawsuit filed by the families of two former UHC beneficiaries, which alleged that the company had illegally denied “elderly patients care owed to them under Medicare Advantage Plans” by utilizing an AI algorithm with a 90% error rate.

“The elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary medical care, all because [UHC’s] AI model ‘disagrees’ with their real live doctors’ determinations,” said the complaint.

These sharp increases in claim denials served a particular purpose: under Thompson’s leadership, UHC profits increased from USD 12 billion in 2021 to USD 16 billion in 2023. UnitedHealthcare Group, of which UHC is a part, is now the largest health insurance company is the US, with an annual revenue of over USD 189 billion.

Hey @UHC. Completed a hysterectomy yesterday afternoon, discharged her home in the evening (saving @UHC and everyone some money). Discharge medications included 12 Vicodin. (retail cost $30). Vicodin DENIED pending prior authorization. Patient in pain all night. Way to go.

— DrByronHapner (@DrByronHapner) December 10, 2024

As health insurance companies extract their enormous profits from those left without coverage, some are seeking to propose and organize alternatives to the for-profit healthcare system. Progressive demands for Medicare for All, a single-payer healthcare program in which the costs of essential healthcare for all US residents are covered under a public health plan that would replace almost all other existing public and private health plans, have reignited following Thompson’s assassination. Organizations such as Physicians for a National Health Program have advocated for such a policy. As PNHP outlines, under a single-payer program, “over $500 billion in administrative savings would be realized by replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer.”

“There is no justification for violence,” said California Representative Ro Khanna, who supports the policy. “But the outpouring afterwards has not surprised me.

Original article by Natalia Marques republished from peoples dispatch under a Creative Commons Attribution-ShareAlike 4.0 (CC BY-SA) license.