Killed United Healthcare magnate Thompson: Symbol of a greed-driven industry

NEW YORK—The death of United HealthCare CEO Brian Thompson, and arrest of Luigi Mangione as a suspect in his killing is prompting anger against the greed-driven health care industry, which already devours one-sixth of the U.S. gross domestic product of goods and services.

It’s an industry that puts profits before patients, that reaps millions for its bosses and billions for its shareholders at the expense of people’s paychecks, premiums, pocketbooks, health and lives, every year, by denying payment for needed care.

After an initial very brief delay, major media outlets conceded that the shooter was motivated specifically by Thompson’s role in the healthcare industry. With the issue of corruption in the U.S. healthcare system up front, even Thompson’s wife couldn’t deny her husband’s association with UnitedHealthcare’s abusive treatment of customers. She told NBC news that, “There had been some threats. Basically, I don’t know, a lack of coverage? I don’t know details. I just know that he said there were some people that had been threatening him.”

The message spelled out by the shooter on the bullet casings, “depose, deny, defend,” mentioned by the media soon after the news of the shooting broke, left no doubt about a connection between the killing and United Healthcare’s practice of denying or restricting coverage to customers while raking in hundreds of billions of dollars annually. Those practices were the subject of Jay Feinman’s book, “Delay, Deny, Defend,” the last chapter of which provides an outline of what might be done to disrupt their dangerous and deadly practices.

In the book he wrote 15 years ago he said, “First, give consumers the information they need to take a company’s claim practices into account when they shop for insurance. Second, make clear in the law that the rules of the road of claim handling are binding on insurance companies, and give regulators the power to enforce those rules. Third, make sure policyholders and accident victims filing claims have the ability to hold insurance companies accountable when the companies delay, deny, or defend.”

Much of the reaction after the shooting was disjointed in nature, missing the point: There was an announcement of mourning by failed Democratic Vice Presidential candidate Tim Walz for a “colleague,” and something approximating jubilee among those who have been subject to the humiliations of the for-profit healthcare industry. On line these days are celebratory claims that the executive deserved what he got.

As cathartic as Thompson’s death may or may not be, it will not change things for the better. UnitedHealthcare will get a new CEO, and that CEO will manage a company that will continue to defraud and exploit its customers at their most vulnerable. Individual acts of violence go nowhere.

Millions of Americans are struggling under this country’s for-profit healthcare system with many getting sicker and many dying. and something must be done. Needless to say, for-profit healthcare, and the market economy that engenders it, must be transformed.

No individual act of violence can effect this sort of change. Only those millions of Americans at the mercy of insurance companies like UnitedHealthcare, disciplined and acting in concert with one another, can depose profit and the market.

Individual violence not the answer

The thousands of young people on line who think that individual acts of violence are “revolutionary”  should look at what Lenin, the well-known revolutionary said on the matter more than 100 years ago:  “‘Each time a hero engages in single combat, this arouses in us all a spirit of struggle and courage,’ we are told. But we know from the past and see in the present that only new forms of the mass movement or the awakening of new sections of the masses to independent struggle really rouses a spirit of struggle and courage in all. Single combat however…has the immediate effect of simply creating a short-lived sensation, while indirectly it even leads to apathy and passive waiting for the next bout.”

In short, individual outbursts of violence work counter to their stated aims.

Much of the on-line cheering of the shooting actually detracts from spreading the word about the true extent of the damage United Health Care and other titans of the industry are actually doing to the people. Getting that information out would much more likely help encourage the mass action needed to change things for the better.

The incredible cost in lives and treasure caused by outfits like United Healthcare to the people of the United States are only the first of many outrages suffered due to the work of people like Thompson. Last year, the prominent British medical journal The Lancet calculated that if Congress enacted the most-prominent alternative—government-paid single-payer Medicare For All—the U.S. “would save some 68,000 lives per year simply by guaranteeing health care to all as a right.

“And a study by RAND found that moving to a Medicare-for-all system would save a family with an income of less than $185,000 about $3,000 a year, on average.”

No wonder the U.S. trails its peer nations in health care quality and far outpaces them both in healthcare spending per person—more than $11,000—and the overall bill to workers and taxpayers.

In response to the corruption and the chaos, MDs and RNs are turning to militant advocacy for their patients, through Medicare For All, unionizing or both.

Thompson was a symbol of the corporate greed, wrote Dr. John Hall, an MD who also holds a law degree and an MBA. In an on-line column in MedLearn Media, Hall reported Thompson was paid $10 million in salary alone last year, while his firm, United HealthCare, was the worst and largest of the nation’s Big Six health insurers. United “serves” almost 30 million patients.

This year, Hall calculates, United is turning down 32% of the millions of claims for post-acute care coverage that patients file. That’s double an industry-wide denial rate of 16%, or one of every six.

United reported $12 billion in 2021 profits and $16 billion last year. Its denial rate for post-acute care nearly tripled, compared to 2019, the last year before the coronavirus pandemic (8.7%), to nearly 23% in 2022.

It’s numbers like these that prompted the etchings on Mangione’s gun and that prompted the lack of personal sympathy for him and his family in the Twitterverse postings. One who expressed sympathy was reminded in a response that the death rate from insurers’ denials was reminiscent of Germany’s Nazi era.

On his way to report profits

And when he was shot, Thompson was on his way to a shareholders’ meeting where, Dr. Hall reported, “UHC was expected to announce expected sales for 2025 in excess of $450 billion. That’s the equivalent of $100/month for every person in the U.S. for a year.” The emphasis is his.

No wonder National Nurses United has been campaigning for single-payer government-run health care coverage—similar in some major ways to systems in place in in Scandinavia, the United Kingdom, Canada, the former German Democratic Republic (East Germany), and elsewhere—for three decades.

Single-payer, Medicare For All, while not a totally socialist national healthcare plan, would nevertheless abolish the private insurers, their denials of care, their high premiums and co-pays, their high profits and overhead and their high-paid CEOs all in one fell swoop.

Medicare’s overhead is 3%. And Medicare’s top officer is accountable to the U.S. people, through Senate confirmation and congressional hearings.

“The American people understand, as I do, that health care is a human right, not a privilege,” said lead Senate single-payer sponsor Bernie Sanders, Ind-Vt. “It is not acceptable to me, nor to the American people, that over 85 million people today are either uninsured or underinsured.

“There are millions of people who would like to go to a doctor but cannot afford to do so. That is an outrage. In America, your health and your longevity should not be dependent on your bank account or your stock portfolio.

“After all the lives that we lost to this terrible pandemic, it is clearer now, perhaps more than it has ever been before, that we must act to end the embarrassment of the United States being the only major country on earth to not guarantee health care to all.”

“This bill takes…the Medicare system, that is highly popular and provides health care to seniors across the country, and expands it to make sure every American is covered,” says Rep. Pramilla Jayapal, D-Wash., the Congressional Progressive Caucus chair and its lead House sponsor.

“For three decades now, we have been working tirelessly, at the state level, at the federal level, at the bedsides of our patients, in the streets wo make sure everybody has health care security. We’re never going to stop until we achieve it,” adds Bonnie Castillo, RN, NNU’s executive director.

“Every American has the right to health care, period,” says Rep. Debbie Dingell, D-Mich., whose father-in-law, Rep. John Dingell, Sr., D-Mich., first introduced Medicare in the U.S. House in the late 1940s. Her late husband, Rep. John D. Dingell, D-Mich., shepherded it through the House, working with LBJ, in 1965.

“If you’re sick, you should be able to go to the doctor without being worried about the cost of treatment or prescription medicine…The pandemic didn’t create the flaws in our health care system, but it brought to light many of the shortcomings that caused unnecessary and preventable hardship for countless American families for decades…Time to get this done.”

Castillo’s colleague, Irma Westmoreland, RN, warns the health care lobby is powerful and will throw dollars and more than a thousand lobbyists into the fray.

“Until we get to a point where our citizens demand it” Westmoreland said in the NNU video, “it’s not going to happen. Because the corporations just want to make money.” People “can’t afford their meds, or they can’t afford to go to the hospital.”

Battled it for a decade

The health care industry has battled Medicare For All for at least a decade, says OpenSecrets.org. When Congress passed the Affordable Care Act 15 years ago, the insurers’ lobbying had already stripped out a weaker form of Medicare For All, the public option, pushed by then-Rep. Dennis Kucinich, D-Ohio.

In 2018 alone, the Partnership For America’s Health Care Future, Big Pharma, the American Medical Association, the insurers and the Federation of American Hospitals spent a combined $143 million lobbying lawmakers, said the Center for Responsive Politics.

The insurance lobby supported the ACA, eventually, Harvard Health Professor John McDonough, a co-author of the concept, told OpenSecrets. They realized they’d gain from it, because it left them in place. Medicare For All is different, McDonough said.

OpenSecrets reported “It would likely create stricter regulation on drug prices, eliminate the need for some private insurers and cut the bottom line for hospitals that rely on private insurance reimbursement rates.”

“When you point a gun at somebody and say ‘We’re gonna kill you,’ don’t be surprised when they fight like it’s life or death,” McDonough said. “The ACA was not life or death for the insurance industry. Medicare For All is a death notice for a large chunk of the U.S. healthcare industry and they know it.”

The insurers are the biggest problem in the jerry-built messed-up U.S. health care system. They’re not the only one, however.

Another is the proliferation of for-profit hospitals and chains, whose own CEOs—usually paid seven figures or more—cater to the insurers at the expense of patient care, and over the screams and union organizing drives by RNs and doctors.

And a third is so-called Pharmacy Benefit Managers—private firms of bean-counters, few of them with health care expertise—whom the insurers employ to decide which medicines the insurers will pay for and which ones they won’t.

The choices are arbitrary but in favor of the insurers’ profits and the PBMs’ payments for being middlemen. The patients, some of whom have been on the same medication for years, get stuck with the higher bills, ineffective drugs, or both, when the PBMs “outlaw” their meds.

“If Brenda wants to negotiate against Pfizer for their drug, well, Pfizer’s got all the power, then Brenda can’t negotiate,” Dr. Ed Weisbart, Secretary of the Physicians for a National Health Program, told Code Wack, a recent podcast about health care issues.

“But if 330 million of us have the federal government negotiating against manufacturers on our behalf, yeah, we can get a pretty darn good price. And that’s exactly what every other modern country does.” Dr. Weisbart and Chicago-based PNHP, with its 25,000 members, campaign for Medicare For All, and for eliminating the pharmacy benefit managers, too.

“The fact we don’t do that is why we spend twice as much on prescription drugs, as does every other modern country because they all get together.”

Quickly saw problematic changes

“I quickly began to see concerning changes in our hospital,” Mission Hospital in Asheville, N.C., National Nurses United member Hannah Drummond, RN, told senators earlier this year, after the largest for-profit hospital chain, HCA HealthCare, bought it. The nurses’ response? Unionize.

Drummond and her colleagues “started to notice a decrease in the quality of supplies. Every time I went into the supply closet, there were shoddier supplies that often did not work. As time went on, hospital managers began cutting staff.

“For registered nurses, our staffing levels were reduced to unsafe levels, and we noticed cuts in other hospital staff, including translators and security personnel. When we brought these concerns to management, they ignored us. It became clear HCA management would interact with health care workers in a way that ignored our clinical education and expertise.

“As nurses, we quickly understood the danger our community faced after HCA Healthcare, a for-profit health care conglomerate, bought our hospital system. That prompted our decision to organize our workplace and join a union just weeks before the onset of the Covid-19 pandemic.”

HCA produced “an onslaught of union-busting tactics from hospital management. Meanwhile, the working conditions and patient care in our hospital continued to deteriorate because management refused to address critical issues.” The union won overwhelmingly among the 1500 RNs there.

The situation was so bad at Asheville during the pandemic that nurses “had to fight tooth and nail to get the appropriate Personal Protective Equipment.” Nurses and patients sickened, one RN died and “the North Carolina Department of Labor cited and penalized HCA Mission Hospital nearly $30,000.”

Increasingly, residents and MDs, especially at for-profit hospitals, have been unionizing, too. Unions won recognition among MDs, residents and interns in Minnesota, Washington, D.C. and elsewhere. The latest to join the unionizing parade are in Philadelphia.

Some 3,000 Philadelphia doctors filed for union elections in a citywide campaign. The Committee of Interns and Residents, a Service Employees sector, filed representation petitions with the regional National Labor Relations Board office on November 21.

The resident physicians and fellows toil at Children’s Hospital of Philadelphia (CHOP), Thomas Jefferson University Hospitals, Temple University Hospital, and the Einstein Healthcare Network. The same day, SEIU filed unionizing petitions for the support staffers at those hospitals.

The doctors told a press conference “how chronic understaffing, extreme working hours, and a lack of institutional support make it impossible to maintain their own well-being while providing high-quality care for their patients,” the union said.

“There are times where I’ve been expected to work over 12 hours per day for six days a week as the only first-call provider, caring for over 30 patients with cancer,” said Temple hematology and oncology fellow Dr. Tammarah Sklarz. “Unionizing is how we change things—not just for ourselves, but for our patients and for the health of our city.”

“CHOP residents and fellows are incredibly lucky to work at the nation’s oldest children’s hospital, caring for some of Philadelphia’s most vulnerable young people,” said Dr. Natalie LaBossier, a pediatric resident. “We are unionizing because we love caring for children. We also deserve to have a say in our working conditions and to take care of our own families and physical needs so we can give our incredible patients the care they deserve.”

One more obstacle

There’s one more obstacle, however, to massive and needed change in the chaotic, jerry-built and jury-rigged non-system that is U.S. health care.

Donald Trump.

The president-elect said in a campaign debate that “I have a concept of a plan” to replace the Affordable Care Act, but he wouldn’t say what it is. His platform, Project 2025, makes clear it is not Medicare For All. What his platform proposes would make a bad system worse, the Physicians for a National Health Plan says.

“States should be the primary regulators of the medical profession, and the federal government should not restrict providers’ ability to discharge their responsibilities or limit their ability to innovate through government pricing controls or irrational Medicare and Medicaid reimbursement schemes,” Trump’s platform declares.

“The federal government should focus reform on reducing burdens of regulatory compliance, unleashing innovation in health care delivery, ceasing interference in the daily lives of patients and providers, allowing alternative insurance coverage options, and returning control of health care dollars to patients making decisions with their providers about their health care treatments and services.

“Finally, America’s broken insurance system, run largely through confusing provider networks and third-party payers (employers), induces overconsumption of health care, limits consumer shopping, and hides true costs from patients,” it claims, without evidence.

Medicare Advantage, supposedly a provider of additional coverage where Medicare falls short, should “become the default option”—not Medicare itself—for seniors seeking health care coverage.

“Despite the overwhelming evidence showing that privatized Medicare does not serve our seniors’ best interests and wastes money, Project 2025 wants to take over all of Medicare by automatically enrolling seniors in corporate insurance plans without their full consent,” Dr. Diljeet Singh, a pediatric oncologist and president-elect of PNHP, wrote in October. The PNHP discussed the looming threat of Trump at their mid-November convention in Chicago.

“An estimated 24 million seniors in corporate ‘Advantage’ plans would face limited provider networks that exclude up to 70% of the doctors in their regions. And more than 15 million people would be considered underinsured due to reduced benefits available under privatized plans.

“Without the choice of sticking with real Medicare, our seniors would all be threatened by the health impacts of delayed and denied care.

“In 2024, so-called ‘Advantage’ plans, which more aptly should be called Medicare Disadvantage, overcharged the American people by as much as $140 billion—and provided less care with worse health outcomes. If this system of skimming funds were extended to all seniors, the Medicare trust fund would immediately begin deficit spending, leading to insolvency within five years. It would cost $1.5 trillion more than real Medicare over 10 years.”

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