No jury will convict the shooter, I suspect he’ll “resist arrest” and never make it to a court room for that reason.
UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
21–30 of 394 posts
Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
#22Earlier quoted context omitted.
Why not? Should he be caught it seems like an open and shut case with video evidence.
What I believe he is referring to is Jury nullification. I interpret your statement of open and shut case as you believe jury must convict if what they interpret to be facts of breaking a laws written by man. By a jury choosing not to convict there is another form of justice implied…
Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
#23Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
#24Earlier quoted context omitted.
>Companies providing medical Care have to spend 80% of their costs on actual medical care, not marketing and executive compensation. That requirement was imposed on insurers in response to already-exorbitant medical costs. It does create a perverse incentive, but it cannot be the root cause of the issue.
Well, before that (and continuing), the largest customer of drugs in the United States is prohibited from negotiating price for most drugs. The exorbitant costs arose with the provision of private medical insurance in the 1940s but only really took off when Medicare and Medicaid came in the 1969s with, essentially, a blank check for cost. Things weren't improved in the 1980s when emergency rooms were required to prov…
Note that this changed in 2022 for the most-bought drugs.
Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
#25No jury will convict the shooter, I suspect he’ll “resist arrest” and never make it to a court room for that reason.
Is the shooting related to this? I have not stumbled upon any resources linking them, but it would interesting to learn more! Saying that they are linked, then it is interesting that we are falling back on why we have a lot of regulations and protections. While you can make a legal system where exploitation is legal (as some would argue the US health care system is), there is a breaking point where it will result in…
But the CEO's wife has said that there were threats, possibly related to lack of coverage: https://www.cnn.com/2024/12/05/us/unitedhealthcare-ceo-kille...
> In an interview with NBC, Thompson’s widow, Paulette told the network that “there had been some threats” against her husband.
> “Basically, I don’t know, a lack of coverage? I don’t know details,” she said. “I just know that he said there were some people that had been threatening him.”
And the shooter wrote the words "deny", "defend", and "depose" on shell casings that were found at the scene: https://apnews.com/article/unitedhealthcare-ceo-shooting-del...
These words are reminiscent of the terms "delay, deny, defend", the title of a book about how the insurance company tries to avoid paying out on claims: https://en.wikipedia.org/wiki/Delay,_Deny,_Defend
So, one of the leading theories is that the shooter was motivated by some kind of case involving a denied claim. Obviously, there's not enough evidence yet to be sure of that, but that same frustration over insurers' failure to pay for necessary, life-saving treatments is part of why there's so much sympathy for the shooter and so little sympathy for the CEO who was shot.
Of course, there are also other competing theories out there; it's possible that the whole bullet casings thing is just a ruse to distract people. But anger about how health insurance companies rack in record profits by denying life-saving healthcare to people has become a large part of this story.
Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
#26Earlier quoted context omitted.
New Yorkers will surprise you.
As a New Yorker myself, I’m fairly confident.
Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
#27[flagged]
Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
#28No jury will convict the shooter, I suspect he’ll “resist arrest” and never make it to a court room for that reason.
Even if a jury does convict, he's in a state with no death penalty and the notoriety and nature of his crime will likely gain him support on the inside. Plus, all the press coverage of the trial gives him a podium...
I'd be stunned if he makes it to court.
Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
#29Horrifying. But also horrifying that treatment costs so much. Supposedly we have to let drug companies charge extravagant prices because it costs so much to discover new treatments, but there has to be a great deal of inefficiency there. Are we getting a 99% solution for $X when we could be getting a 95% solution for $X/10?
Unclear from the article, but it's quite possible that UHC was _forcing_ him to use the more expensive name-brand drugs due to an agreement that they made with their pharmacy benefits manager (PBM). Some name-brand manufacturers will see generics on the horizon and throw in a clause that obliges the PBM to continue exclusively covering the name-brand drug for X amount of time. UHC specifically fucked me over this way by refusing to cover a widely available generic drug, insisting that they'd only pay for the name-brand stuff, but no pharmacy on earth seems to carry the name brand stuff and couldn't even source it to order it, so UHC effectively denied me the drug altogether.
I feel for the guy in the article because the drug that UHC fucked me over about (mesalamine/Lialda) was keeping my Crohn's in check, and after the ensuing flare I had to switch to Remicade, which isn't totally working for me—I'll be switching to something else soon.
Obligatory link about PBMs and how they suck: https://www.thebignewsletter.com/p/inside-the-mafia-of-pharm...
And being on Remicade myself, albeit at a lower dose (and without Entyvio like he's also taking), I was curious enough to check the EOB for how much my current insurance pays for it. I have Anthem BCBS and here's the breakdown of my last infusion. For context, this is a drug where you have to go to an infusion clinic for administration because it's delivered intravenously.
Doctor/facility charges:
$21,420.70
Your discounts: -19,563.26
Due to your doctor/facility (max allowed): $1,857.44
Anthem paid: $1,857.44
So the "cost" was 20k for a single infusion, but Anthem negotiated that down to 2k. (I didn't pay anything since I'd met my out-of-pocket limit for the year.) Here's the itemized breakdown of that 20k cost: Drugs
Provider charges: 21,020.70
Plan discounts: 19,226.20
Anthem paid: 1794,50
Infusion center
Provider charges: 400.00
Plan discounts: 337.06
Anthem paid: 62.94
So the drug cost $1.8k, and they only paid $60 to have someone stick it in me.And for reference, that's name-brand Remicade too, because it's what Anthem's PBM requires. I'm on 7.5mg/kg every 8 weeks, and the highest approved dose is 10mg/kg every 4 weeks. So even if he was on, e.g., 20mg/kg every 4 weeks, that would be maybe $4k worth of drugs once a month, which is $48k a year. Unless Entyvio is way more expensive than I realized, I have no clue how that would add up to a million dollars a year in costs, unless they're sending him to an infusion center that charges crazy high prices (which, if it's part of UHC's Optum network rather than an independent clinic... maybe they do :P)
Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)
#30Earlier quoted context omitted.
>Companies providing medical Care have to spend 80% of their costs on actual medical care, not marketing and executive compensation. That requirement was imposed on insurers in response to already-exorbitant medical costs. It does create a perverse incentive, but it cannot be the root cause of the issue.
Well, before that (and continuing), the largest customer of drugs in the United States is prohibited from negotiating price for most drugs. The exorbitant costs arose with the provision of private medical insurance in the 1940s but only really took off when Medicare and Medicaid came in the 1969s with, essentially, a blank check for cost. Things weren't improved in the 1980s when emergency rooms were required to prov…
Too bad the hospitals don’t figure out some way of providing preventive care to the uninsured to reduce these costs.