“I must remind you that starving a child is violence. Neglecting school children is violence. Punishing a mother and her family is violence. Discrimination against a working man is violence. Ghetto housing is violence. Ignoring medical need is violence. Contempt for poverty is violence.”
– Coretta Scott King
I don’t want to talk about the UnitedHealth CEO or the man who killed him. The media wants to talk about little else, least of all people’s health insurance horror stories. When children die from gun violence, we’re told their lives are a sacrifice for the cost of freedom (the same consideration never extends to bodily autonomy). When a CEO dies from gun violence, the media lectures people for not caring enough and prosecutors charge the killer with terrorism, a charge other shooters rarely receive despite a higher body count.
School shootings have become as innocuous as the countless lives lost to delays or denials of medically necessary care. And United Health is being sued for using AI to make it even easier.
I worked in healthcare administration for about five years. When I left, I had three jobs rolled into one: denial writer (preparing letters for medical directors), quality reviewer (investigating and correcting claims), and de facto team lead for prior authorization (all the duties, but not the title or pay). I didn’t mind the extra responsibilities. It kept me too busy to backup phone reps. Higher call volume was a direct consequence of inept management of too many plans with different rules and guidelines, delaying prior authorization and claims in a vicious cycle leading to more calls.
Job creation should improve outcomes, not perpetuate corporate bloat at the patient’s expense. People who oppose mainstream medicine cite how much Americans spend with worse outcomes than other countries, but we aren’t receiving more care or medicine. Most excess spending comes from the administrative costs of insurance or inflated drug prices. As for one tired defense I’ve seen of unethical – sometimes illegal – insurance practices, one person’s retirement fund should not depend upon ill-gotten gains from another person’s misappropriated healthcare fund.
Industry leaders decry unsafe, ineffective, or unnecessary care, which is a valid but ultimately disingenuous concern. A lot of times we received requests nurses weren’t authorized to approve, but the medical directors could, drawing from other literature – such as requests cancer treatments with demonstrated efficacy still considered experimental in the nurses’ outdated manual. One of the medical directors was a nepotism hire who stuck to the manual. Despite this, and the fact his denials had a 75% overturn rate (great job security for the Appeals department, bad usage of your insurance dollars), enough people were too sick, demoralized, or uninformed to appeal – meaning shareholders pocketed enough money to approve of his performance.
This private company – which the owner sold to Aetna to focus on a career lobbying politicians if I remember correctly – managed both commercial and Medicaid or Medicare plans. I bring this up because the reason some people oppose government regulations or improvements to our present healthcare system is because they don’t want someone else making decisions for themselves or their doctor. Not only does that already happen with private insurance, but it’s often the same exact people who make decisions for Medicaid or Medicare. The difference is people with Medicaid or Medicare have more legal protections from unjust denials.
And just as people have more protections under Medicaid or Medicare than commercial plans, Medicaid and Medicare are monitored more closely for fraud. I’m reminded of the infamous VIP list of commercial plan members who could get whatever they wanted, or the time I uncovered an ophthalmology office billing for cosmetic procedures – likely to recoup the expense of medical equipment. It’s possible I was mistaken, but it’s also possible the insurance company didn’t want to pick that particular battle.
Blatant discrimination provided another source of frustration. We often received requests for breast reduction surgery, including pages and pages of documentation about diet, exercise, back and neck pain, and pictures of everything from the breasts to bloody grooves in shoulders because sports bras provided inadequate support. And still the medical directors would say no, and recommend more exercise (how?) and less food (some patients were not ‘overweight’ and you can only safely restrict calories so much). Meanwhile, single page requests for men would always be approved, no photos or additional documentation needed. If they met medical necessity, why didn’t women with bloody shoulders and deteriorating spines? And why did medical directors only need to see the women?
As for Aetna, the bigger it gets, the worse it becomes. A few years after I left the original company, the IT department was sold to another company, who also sold them. Eventually the IT department was outsourced to call center representatives overseas who read from a script and re-directed requests instead of fixing problems, adding more obstacles and worsening an already vicious cycle. And somewhere a shareholder gets to pocket more money while someone else’s care gets further delayed.
Replacing employees with AI can save money, but shareholders won’t pass those savings on to members. Not only would we face more obstacles, we’d have even less recourse. I’d rather have access to affordable healthcare. And removing artificial barriers doesn’t have to lead to longer waits if the office staff, nurses, and doctors in healthcare administration returned to serving actual patients.
You can only subject people to so much pain before some reach a breaking point. Nobody is trying to replace culture wars with a class war. It’s ongoing. People in power use culture wars to strengthen hierarchies and influence people to punch down instead of lifting each other up.
