Thanks for highlighting probably the most corrupt business in America, insurance.
Most major industrialized country have national health. But many Americans that I speak to say, that national health is socialism. So I tell them that the next time that their house is burning down I will tell the Fire Department to ask them for American Express before they put out the fire! The Fire Department is a national service for citizens and so should national health be.
My house in LA was broken into and they stole a lot of stuff. I told the insurance company it was a five thousand dollar loss. They offered three thousand!! When I repeated that it's $5000 they said $3000 or nothing, so I had to accept it! But when I was paying my premiums, I couldn't offer them 3/5 of the premium !!
A few months ago a Hertz rental car hit my car. I called the Hertz Insurance company Esis every week for five months and each time they said they had not assigned an adjuster to the case yet and had a back up of cases from last year that were not yet assigned. Eventually, I got really angry and so they asked if anyone was hurt in the accident. When I said no, they said that an adjuster will call me tomorrow! Because no one was hurt, they were willing to help!! So the adjuster sent me an email which I answered and I've called many times since then and no response. So I have been driving around with a huge dent in the side of my car which I cannot fix because I cant reach the adjuster.
We need to shut down these corrupt bastards and stop the CEOs of these companies making $10 million a year while the people suffer.
Native Wayne Jobson
Los Angeles.
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Thank you for sharing these stories about how our health insurance structure in the US seems to prioritize profit over health.
My story is much less dramatic, but I share it as an example of just how pennyante insurance companies are. I have a silver level Blue Cross plan via the ACA and they denied coverage for my shingles vaccine even though the plan specifies it is 100% covered. Why? Because I went to the CVS Minute Clinic a mere mile from my home (who also assured me that my insurance covered the service). It turns out the CVS Minute Clinic is incorporated in another state from mine so Blue Cross said that I had received care out of state and thus it wasn't covered.
You really can't make this sh*t up!
Elisabeth Piper
_________________________________
The basic issue here is capitalism v. socialism.
First, the mis/misinformation long fed the U.S. public is that, anything paid for by government is creeping socialism - which is bad per se.
So we are stuck with the private economy having to pay for services, the scope of which only the government can handle.
However, in our Cowboy Capitalistic system, anyone who espouses such common sense is branded a Socialist - or worse: Communist or Socialist.
Hasn't anyone noticed that our great Capitalist heroes, the millionaires and billionaires - and corporations - welcome government intervention in their major costs. It's the rest of us who have been fed the 'bill of goods' that, in order to be truly free, we must take the heavy lifting upon ourselves while the super-wealthy behave super practically, accepting all kinds of help from government.
Something seems super-wrong with this scenario…
Manny Freiser
_________________________________
"UnitedHealth Will Be a Top Beneficiary of Trump's Project 2025 - People's Action"
https://peoplesaction.org/unitedhealth-will-be-a-top-beneficiary-of-trumps-project-2025/
Keep up the great work Bob!
Michael Veitch
Woodstock NY
_________________________________
Honestly Bob, I truly feel for all the Americans that don't have access to
proper healthcare. I read quite a few of the responses to your letter and
it makes my heart ache. I live in Canada and am grateful every day for the access I have to healthcare. I believe it should be a fundamental right. A healthier population is better for everyone. We have some remote Indigenous communities that are still suffering without access to proper healthcare and I hope that the Canadian government can make bigger strides in the coming years for these people. I believe that no one in Canada should suffer needlessly.
I wonder what will happen when the masses in the U.S. decide enough is
enough.
Andrena
Langley B.C.
Canada
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We all agree that violence isn't the answer and is abhorrent. If some good is to come from this tragedy, however, I hope it is that what's accepted practice from health insurance companies is no longer permitted.
When my late wife was dealing with terminal ovarian cancer, she was on the phone with our insurance provider pleading with them to follow through on the promised reimbursement of thousands of dollars we desperately needed. She asked them if dragging their feet on payment was their corporate policy.
The representative said, "You need to understand. If your husband stops being independent and goes to work at someplace like Walmart, you'll have coverage, and we won't have to pay this."
In other words, we want to make this as painful as possible for you so we can get you out of our system. All said while Sheri was dealing with the biggest tragedy and overwhelming stress that she (and I) had ever encountered.
This is not only bad business — it's damned immoral. And this type of bullsh*t has to stop.
Scott McKain
_________________________________
Good thing a president was just elected who will stand up for the little guy against these evil health insurance companies.
Mark Towns
_________________________________
No one, theoretically, wants to have to use their health insurance. We want to stay healthy.
But when we need to use it, we expect it to be there for us. That's what we pay our premiums month in and month out.
Reading the below article just goes to show how far UHC and others will go to deny your claims. Just scary, when you see what happens behind the scenes.
"UnitedeHealthcare tried to deny coverage to a chronically ill patient. He fought back, exposing the insurer's inner workings"
https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis
Ty Velde
Needham, MA
_________________________________
I had a couple reactions while reading these replies:
1. "Insurance company halts plan to put time limits on coverage for anesthesia during surgery"
Do you know who broke the news that Anthem Blue Cross Blue Shield was considering putting a time limit on anesthesia coverage? The Lever. I previously sent you a link to their podcast, Master Plan. I hope you've checked it out.
2. For all those replies defending the CEO, particularly one that called him "innocent" and "by all accounts he was a nice guy," or whatever, I call bullsh*t. He was a monster. The amount of misery, suffering and death he's responsible for is immeasurable. He knew what he was doing was wrong, and he did it anyway.
Dave Nelson
_________________________________
The cardinal rule for a democracy to survive in a free market capitalist system is; do not privatize healthcare, energy, insurance, banking, pharmaceuticals, social security. They are too important to the well being of society. These cannot be 'for profit' sectors. Profits are not compatible with serving the basic needs of the populace. Corps and government have lost the faith of the people.
The people are angry as we have realized this past election. They are not taking it anymore. Mob violence is how revolutions start. But the anger, in this case, is not ideological in nature, it's extremely personal. The rule of law does not apply when you expect it to deter people from emotional violence. I don't know if we'll see a trend of shooters taking out big corp. executives, but it's not a stretch. In third world countries they all have bodyguards.
John Brodey
_________________________________
Bob, you wrote blunt, candid poetry, and most people felt it in their body and soul; health is the one currency we all are destined to lose.
Blue Cross Blue Shield just screwed Michigan teachers starting January 2025–double digit % of premium increases…
But a kindergarten shooting in California happens on the same day as the UnitedHealthcare CEO murder, and that school violence doesn't even make much news.
What would Allen Ginsberg have written about America, today?
"America, I've given you all and now I'm nothing."
Mike Vial
PS Tell that NYC musician I feel for him: teachers like me in Ann Arbor pay $600 a paycheck for medical, and it's going up to $800. I'm taking a risk with a new plan. Remember when teachers at least had good benefits? Not anymore—they get you, in any job.
_________________________________
Every time I see stories like this I thank the lord I get my health care from the VA. I've had several surgeries, a couple taking all day, and the only bill I get is minimal copays. I thank the American taxpayer every day.
Phil Brown
_________________________________
I'm assigning this post in my class today.
I'll be sure to credit you.
Todd Devonshire
_________________________________
Thompson's death, as the NYPD is throwing massive resources at the investigation. They are running DNA and fingerprint analysis on a candy wrapper found near the scene. A piece of garbage in midtown. You think Joe Citizen is getting this treatment? I got a bridge for sale…
Timothy Pistell
_________________________________
All CEO salaries and bonus compensation should be CAPPED.
The health insurance industry as it is should be eliminated and then universalized. All the billions we spend helping other countries and their wars should be spent here on that and maintaining Social Security. Period.
No one should have died over this…but this should be taken as a wake-up call.
—Rob Maurer
_________________________________
A lot of interesting and revealing responses here. Especially the one about maybe DOGE will fix it…talk about uninformed.
If Bernie Sanders was right about anything it was that we have to get money out of politics. As long as these corporations are able to continually pay politicians to do their bidding nothing will change. Especially considering the same politicians have managed to convince a large portion of the public that government run healthcare is pure socialism and/or communism.
It's a sad state of affairs.
Keep writing, Bob!
Brian Cooney
_________________________________
Oh my, Bob.
It almost sounds like folks are expecting "care" from a profit and loss model.
Not everything belongs in the marketplace.
Chris Mann
_________________________________
Delay… Deny... Defend
Health Insurance Company words to live by (and die by)
All the news coverage is on the killer, none on the perverse healthcare system of insurance companies who have nothing to do with care.
The villagers have started grabbing their pitchforks and are coming for the Frankenstein monsters.
The monsters are scared.
The oligarchs were surprised that their gun fetish had come back to bite them.
It's quite amazing we have been given a front-row seat at the demise of the American experiment.
We are watching the disease of end-stage Capitalism come to its logical end.
Are we finally getting to the root of the problem-- Class Warfare through Income Inequality?
You won't see it in the media. ("The Revolution will not be Televised" - Gil Scott-Heron)
Electing Republicans and Corporate Democrats got us here, now we get to see it play out.
I keep replaying the line from the New Riders of the Purple Sage song in my head--
"We all live in the Garden of Eden, yeah
Don't know why we wanna tear
The whole thing down"
Jeff Weicher
_________________________________
Hi Bob, you are the most calming and perceptive voice I read. I agree with you internally on almost everything. I feel like we are brothers, at least Iwish you were my brother rather than the one I have…
I bought records in the seventies at EJKorvettes in Port Chester.
I love your work.
Thank you.
Regards,
John Lynch
_________________________________
I have to disagree that this exec was "a genuinely good guy." I'm not sure what moral or ethical standards were used for that assessment, but in my book, a genuinely good person would
Recognize that a $10M compensation package is obscene in any context, unnecessary from a day-to-day living standpoint, and absolutely infuriating to UHC customers being denied the coverage for which they were paying a large percentage of their own much lower incomes.
Insist on a pay cut to something more reasonable – you know, a few hundred thousand instead of $10M – and then get to work on Day 1, publicly, boldly, and consistently, to make things right at UHC and with its customers.
Lest anyone think that such people don't exist, you're wrong. And not just among the highest flying execs. My wife works for a locally owned company that was immediately shut down by COVID due to the nature of the business. The two owners, a married couple, stopped paying themselves until things were back up and running and all the employees who wanted to come back had done so and were being paid. They took a 100% hit to their household income to make sure their employees had jobs to come back to.
But we're saying this exec, who accepted a $10M annual package effectively comprising blood money, was a genuinely good guy? Bullsh*t.
That's a shamefully low bar for ethical conduct, and I shouldn't have to qualify that with "even in business."
CK Barlow
_________________________________
Ignore Bob Ellis (I'm sure you will).
1. He's in trading, so inherently part of the system that's created and profited mightily from this goddamned mess; and
2. That executive was NOT an innocent man. If he was a true leader of any kind, he no doubt was a primary driver of the "profit-at-all-costs" business model that has caused people to suffer in our healthcare system. He was in a position to do something about it (THE position, in fact) and appears to have done nothing while their insureds lost loved ones. That smells guilty as hell to me.
Gwen Gayhart
_________________________________
To those who are saying the UHC CEO was an innocent guy, no he wasn't.
He was a serial killer whose decisions from the top down literally killed countless truly innocent people who were in desperate need of life saving health care and didn't get it because of him.
But of course, if you kill lots of people with the stroke of a pen in a suit and tie from behind a mahogany desk you're a "good man", whereas if you kill one with a gun in the street you're a cold blooded killer. Make no mistake, both are cold blooded killers.
If you go on the nursing subreddit, the nurses there are celebrating. Because they know and see first hand how patients are literally killed by the decisions and policies handed down by ghouls like this CEO. That's why the shooter is rapidly becoming a folk hero around the country.
To paraphrase from Chris Rock, I'm not saying the shooter should have done what he did, but I understand.
-Zach Ziskin
_________________________________
My very cynical thought is "we voted for guns everywhere" & we vote for a ruinous healthcare system.
Having had improvement in the past 15 years we have voted to dismantle that.
I know 2 neighbors who lost all to healthcare costs, they worked, did the right thing, paid into programs and in the end the houses which should have gone to family went to healthcare costs both real and "imagined".
And we have guns everywhere.
We have normalized firearms and the quick use of.
Gunshots now the leading cause of preventable teen deaths in my State- surpassing car accidents or drugs.
A recent teen shoots teen then shots himself ( both died) story on my local news did all the school mental health and blah blah blah but did not once mention or question the presence of multiple firearms in the possession of juveniles.
A State which does not detail storage for firearms.
That's our new found freedom.
The aggrieved start shooting
Cheers, TS
_________________________________
I'd be interested to see how many people want a single payer system and also voted for Trump. People don't seem to understand the consequences of their actions, or their votes.
Andrew Weinstein
_________________________________
Thanks for a great take.
Why doesn't the public rebel against our crappy health care system? Isn't this how it's supposed to be in a democracy? The voters have the ultimate say? But people don't pay attention to politics nor understand how government works and how it's supposed to reflect the will of the people.
Trump reigns because of ignorance.
David Rubien
_________________________________
I don't think I've ever read so much feedback to a Lefsetz letter as this one. By and large a great learning from your original letter and the many responses. Thanks for what you do!
Craig Carrick
Clarkston, MI
_________________________________
It looks like a fair number of your readers are afraid of the truth. You were 100% correct about the zeitgeist. This is just the tip of the iceberg. People are fed up with income inequality and the endless money grab both in the private sector and now polluting our federal government. The genie is out of the bottle. The sh*t has hit the fan. People can only take so much.
Harold Love
_________________________________
Between 1981 and 2009, our company - we are a small family-owned business - offered 100% paid health care benefits for employees and their families. We believed that by paying a living wage and offering real benefits we were investing in our people and therefore in the success of our business. It was one of the coolest things about working for our company. Piece of mind was part of the compensation package - we actually cared about the lives of the people we employed.
After the Great Recession our health care costs increased to the point where we couldn't afford to cover families anymore - no good deed goes unpunished. We still cover our employees but the costs are astronomical. I don't tell anybody (other than my CPA) how much we spend on health insurance - they would think I was utterly insane.
The argument that either we keep our current system or it's socialism time is where the discussion stalls for a lot of people. That's not only a false equivalence but intellectually lazy and obviously skewed. And in reality life is not a zero sum game. We can do better.
One of things I miss the most in 2024 America is people's ability to weigh opposing viewpoints in their heads without completely melting down. Nuance we hardly knew ye.
I don't want socialism in the US - besides all the famous communist countries have ended up becoming oligarchies anyway - but can't help but wonder if with all the brain power we have at our disposal there might be a better - more logical, more reasonable and more compassionate - approach to making sure all Americans live healthy lives and have access to the excellent healthcare that's available in the US.
Vince Welsh
President
Teacher Education Institute, Inc.
_________________________________
At the risk of piling on to the medical murder.
1. There is NO excuse for murdering a man in cold blood on a New York City street. Vigilantism has no place in a democracy, regardless of how popular it is in the movies.
2. I worked for a client for 4 years to build a medical billing company from the ground up - and learned first hand how the system works. We worked for doctors and hospitals to help them get paid what they were owed for services by the insurance companies. When we succeeded, the patient was also a winner because they didn't get stuck with a huge bill. It's a messy business all round with tons of inefficiencies. For patients and those in the system. Even though I've moved on to other clients, this company is still growing because it does such a good job fighting the insurance companies. It's hard work.
3. I have a rare perspective. I grew up in Canada and watched the country go through the wrenching move from insurance (or none) to "socialized" medicine. We arrived as immigrants, had no insurance, both my parents needed surgery and it took us 8 years in poverty to pay it off. Although it got better for a period of time, today the system in Canada is still imperfect. There are very long waits for some tests surgeries and many "new" treatments are just not available.
The secret to European and Canadian systems is that they share aggregated medical data to see what works and what doesn't. And they have 80% primary care doctors and 20% specialists, exactly the opposite of the U.S. where it's 20% primary care doctors and 80% specialists. Partly because it costs so much to go to medical school here.
Even though I pay more in the U.S., I get better care where I live because there are so many great medical options in the Northeast. But it does take a bite out of my retirement money for the doctors who are no longer taking insurance.
4. As a result of the mess of insurance, costs, paperwork, and retiring physicians, we are losing doctors. And nurses. Fast. The smart kids want to make quick money and don't want to go to medical school. Today, 70% of graduating doctors are women. Most want a salary and don't want to start a private practice. It's too stressful.
It is a massive crisis that is exacerbated by aging Baby Boomers. In 10 years, only the 1.5% will have great care because they can afford anything. It takes 20+ years to fix this and Americans have demonstrated consistently that they don't think further ahead than next week's football game.
5. For the fools who think Trump will "fix" anything, just look at his approach. Incompetents like RFK Jr. making decisions for all of us. Billionaires who have zero caring or empathy all excited about "slashing" costs without any other plans to build what's needed. The same people who dump employees without a thought now get to dump patients in the street. It will be a horror show. And they are excited by the pain they will cause. Just listen to their sick ideas and language. Look how excited they are by destroying rather than building. Slash. Cut. It sounds like war against the people.
We need thought, discussion, and even then it will be imperfect. But to run the VA the way Musk "ran" Twitter won't help at all.
6. A big part of our medical costs are because we don't take care of ourselves. Too fat. Not enough exercise. Eating unhealthy foods. Pollution and poisoned water so "industry" can make more money with "fewer regulations". Untreated mental illness because it's "too expensive", even when it leads to poor little children being shot dead in their classrooms while "macho" politicians and citizens walk around with machine guns at the mall. It's so crazy.
And under government plans in Canada, you can't have a hip replacement if you're too overweight - until you lose the weight. Because the data shows that they don't really get results. My friend's wife took a year to lose 50 pounds and then had the surgery. But paid $0. It's always a trade off.
7. Based on my experience and observations, health care can be reformed. But, in part, it requires that the super-rich help out a lot more. By paying taxes into the system. Would Musk or Bezos miss a few billion? No. But the Trumpers are going to CUT taxes for the rich. AGAIN. They are doing this to destroy the medical system we have (as imperfect as it is) because of their twisted ideology. They say so out loud!
8. One thing everyone has to deal with is the awful truth that every insurance based or socialized medical system has to make choices. Some people die because a rare (or uncommon) condition costs too much money that could be used to help 1000 mothers have safer pregnancies, etc. etc. Someone else makes the choice. Insurance or government employee. And if it affects us personally, we scream loud. That's one of the reasons things don't get fixed. The exception makes for great TV outrage while America is behind Botswana for maternal deaths in childhood.
It's complicated.
John Parikhal
_________________________________
In the 90s I worked as a Customer Rep for a managed care company/ network of doctors and hospitals. I was frontline for folks when they need pre-certifications for treatment, looking for doctors and I was also on the mental health line.
The stories go on for days with this but I will always remember these two:
1) Monday morning, I'm the first one logged on and my first call is with a suicidal dude in Georgia. He's already had most of a 12 pack of beer and is sitting there with a gun. I keep him on the line and talking while the person next to me tries to contact police and ambulance in his town. This takes a while because in this remote area the police are not exactly helpful to us calling first thing in the morning and tell us to call a different department and hang up. I was on the phone with him for near an hour before folks showed up to help him.
I was chastised by my supervisor for not getting this done quicker as it was going to make our numbers look bad.
2) Mother calls in to tell me she just found out that her husband (and pastor) had raped their 16 year old daughter and had been sexually abusing her for a while now. She needed someone to speak to that wasn't in their town or in their parish. Because their insurance was through their church - which required the insured to travel 200 miles if there was someone in network and wouldn't cover anything out of network below that threshold - I couldn't find her anything in her remote area of Texas. I was on the phone with her for about 45 minutes trying to help but more than anything I was someone to listen.
Again I was chastised by my supervisor for not getting her off the phone quicker as it was going to hurt our numbers.
I was a good customer service rep for patients but I was not a "good for investors" customer service rep.
This is all just the tip of managed care iceberg. That company got found guilty recently of denying more claims and getting kickbacks from the insurance companies.
It all looks terrible from the outside but if you're inside and have a heart - it will break it.
Bobbo
_________________________________
I'm a Brit so have no skin in the game but what seems clear to me is that US healthcare insurance companies exercise the power of life and death every day; indeed, choosing death for their policy holders is how they make such obscene profits — profits from which their senior executives pay themselves no less obscenely. Can it be any wonder that someone on the other side of the equation might also choose death too? Nor do I share the crocodile tears of so many of those responding to you: it's time that those who exercise the power of life and death over others, especially for money, are confronted with the reality that actions have consequences.
Yours, enjoying good healthcare in my pale pink socialist paradise,
Mat Snow
_________________________________
This is the most important piece you have ever put out.
Stay with it!!
Mike Murphy
_________________________________
As usual, Bob, you were ahead of the curve:
After a shocking shooting, Americans vent feelings about health insurance
https://www.npr.org/sections/shots-health-news/2024/12/06/nx-s1-5217736/brian-thompson-unitedhealthcare-ceo-social-media
Let's hope this leads us to better health care.
Carl Nelson
Woodstock, MD
_________________________________
If the first thing you thought of when you heard about the shooting was our broken health care system and the overcompensation of the people who run it, that's pretty sad...
William Nollman
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