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Loren Johnston of Scarborough is a retired educator and counselor who grew up with universal health care as a military dependent overseas.
The conversation in regards to the assassination of UnitedHealthcare’s CEO has descended into the distraction of the culture war with claims he was a good man doing his job and a victim of left-wing hatred of free enterprise. It is in the realm of possibility that they could be right.
The real story, however, is the performance of the company that he was a part of and the for-profit health care system in this country. UnitedHealthcare, and the health care services under the Optum brand, is the world’s ninth-largest company by revenue, posting an impressive $23 billion profit in the last year. It grew from $41 billion in assets in 2005 to more than $273 billion in 2023. It has achieved this remarkable growth by acquiring a variety of companies at all levels of the health care system. Currently it has 136 subsidiaries in the U.S. and 27 throughout the world.
The company has been accused of using algorithms to deny treatments and refusing coverage of nursing care to stroke patients. It has recently been involved in two class actions alleging the use of AI predictive tools to automate claim denials for necessary medical procedures, improperly denying health care coverage for medical services and overriding the medical determinations of their doctors.
The Office of Inspector General released a report in October, titled “Medicare Advantage: Questionable Use of Health Risk Assessments Continues To Drive Up Payments to Plans by Billions,” found that UnitedHealth reaped $3.7 billion in potentially inflated federal risk-adjustment payments in 2023 for diagnoses from in-home health risk assessments (HRAs) and HRA-linked chart reviews. According to the report, UnitedHealth and other insurance companies accepted these payments even though the patients did not receive any additional treatment or medical services following the new diagnoses.
Beyond business practices at the highest level of this company that have resulted in convictions of a company executive for insider trading and a lawsuit over Medicare fraud lies the question of the overall performance of the American private health care system. In addition to UnitedHealthcare’s $23 billion in profit, the seven major health care insurers in this country posted profits of $27 billion in the last fiscal year. So a total of about $50 billion not being reinvested in providing health care but dividends paid to stockholders.
Financially we are burdened by medical expenses being cited as the reason for 66 percent of bankrupt filings compared with 19 percent in Canada, which has universal health care.
Claims that we have the best health care system in the world, unless you are wealthy, are an illusion. What do we get for paying more than $4,000 more per person per year than any other high-income nation? Among these nations, we have the lowest life expectancies at birth, the highest infant and maternal death rates as well as the highest death rates for treatable conditions.
Who is responsible for the deaths of those people? Are their lives any less valuable than the CEO of a major corporation?
Remember Rick Santorum’s and Sarah Palln’s campaign lines about death panels in universal care countries? Or Rep. Spencer Bachus’ speech on the House floor opposing the Affordable Care Act in 2009 as “a disaster for patients, because a government-run system will always ration care, reduce quality, and raise costs. It will put a federal bureaucrat between you and your doctor.” The reality is that decisions by insurance companies to deny coverage lead to patient deaths and an insurance adjuster or an algorithm, both incentivized to maximize profits, come between us and our doctor.
The future of our health care is uncertain with a new administration and a Republican majority in both chambers of Congress. What is certain is that the for-profit health care system is exorbitantly expensive, produces poor results and does not have a plan for the future as our population continues to age. Imagine if that yearly $50 billion profit could be invested in providing health care to underserved rural areas, improving pre-natal care and mental health services or addressing the projections that, given current conditions, we will be short 122,000 physicians, 400,000 home health aides and 29,000 nurse practitioners by 2032. Just imagine.
