Brian Thompson, the CEO for United HealthCare. The editorial appears in the December 15th edition of The Santa Barbara Independent, a local left leaning newspaper, published once a week. The author is Nick Welch, who puts his spin on this story.
"PRE-AUTHORIZE THIS: A smart-ass Irish Catholic theologian named Fr. Herbert McCabe summed it up nicely. “If you don’t love, you’re dead,” he put it a few years back. “If you do,” he added, “they’ll kill you.”
I don’t know exactly what this has to do with the forced extravagance with which we are now celebrating the birth of the Baby Jesus, whose father would see fit to sacrifice his much-beloved newborn on a cross some 33 years later. Or even the flamboyantly irresistible murder of Brian Thompson, the square-jawed, onetime high school trombone player turned UnitedHealthcare CEO who last week found himself designated the unwitting sacrificial lamb for an industry that’s made access to health care an insidious variant of Russian roulette.
Somehow, these dots all connect.
In the meantime, however, the nation remains utterly transfixed by the operatic flair of 26-year-old Luigi Mangione, who painstakingly inscribed the words “deny,” “defend,” and “depose” on the casings of the bullets he used when he shot Thompson on the streets of New York City. Naturally, I found myself momentarily distracted by the fact that Mangione would choose to escape on an electric bike, to my mind an optimistic indicator that the e-bike industry has truly arrived.
Luigi Mangione — canary in the coal mine of America’s health care system — one part Patty Hearst, two parts Unabomber. “Frankly, these parasites had it coming.”
But the moment’s bigger message — obviously — has been the eruption of boundless rage and fury at the health care insurance industry as a whole. And that’s from those of us who are lucky enough to have insurance in the first place.
When the dust settles, no one will remember Thompson’s name, or that he reportedly advocated reforms within the industry that would have made access to the health care for which customers have paid much less a cruel and capricious roll of the dice. No, his assigned role in this passion play is that of designated stooge and fall guy for an industry that has it coming and a lot more.
How else to account for the outpouring of glee and rage that’s elevated Mangione to genuine folk hero status? To the extent he’s the canary in the coal mine of American health care, Mangione spent most of his days occupying an exceptionally gilded cage. His family owned a string of senior care facilities; multiple country clubs and golf courses; and at least one radio station, which provided a mass megaphone for the family’s conservative brand of Republicanism.
As such, Mangione emerges as a contemporary cross between newspaper heiress Patty Hearst — from her shoot-’em-up days with the Symbionese Liberation Army — and Unabomber Ted Kaczynski, whose cabin-in-the-woods critique of American techno-capitalism Mangione would describe in his own junior manifesto as “prescient.”
Hey, we’ve all been there.
Brian Thompson, CEO for United HealthCare, talked about making healthcare more accessible, but his company aggressively pioneered new technologies to more efficiently deny care. | Credit: Wikipedia
As nice and down-home as Thompson no doubt was — and in spite of the reforms he reportedly advocated — he was at the helm of a company that’s pioneered using algorithms and artificial intelligence to process — and deny — pre-authorization requests for treatment coverage.
UnitedHealthcare was among the most aggressive in using AI to say no to doctors and patients. The term for that is “Denials for Dollars.” Between 2020 and 2022, the denial rate for United Healthcare’s pre-authorization requests by Medicare Advantage enrollees spiked from 10.9 percent to 22 percent. Even in an industry with quasi-cannibalistic tendencies, these are startlingly aggressive numbers. Little wonder company profits jumped by $4 billion in that same time frame.
As we all know, medical treatment delayed is often medical treatment denied. If you read the fine print, you discover that roughly 90 percent of the time, people who appeal their denials prevail. But the same fine print reveals that only 10 percent of people who are denied file such appeals.
Deny. Delay. Depose.
A lot of times, it doesn’t get that far. Right now, I’m seeking pre-authorization for much-needed oral surgery I’ve been putting off far too long. My previous oral surgeon — he recently retired — flat-out refused to file a pre-authorization request on my behalf even though I had a doctor’s statement attesting to its medical necessity. It consumed too much of his staff time, my surgeon explained. And such requests were always turned down. He was a good surgeon. I liked him. And his decision was economically rational. I got it. Fortunately for me, his successor is not so rational.
But what if it was about cancer treatment?
What set Luigi Mangione off, we don’t know for sure. It sounds like he slipped on a piece of paper, thus exacerbating a pre-existing back problem. It sounds like he’s been in searing back pain for about six months. We will no doubt find out. But long before that, the issue of excessive pre-authorization denials — aided, abetted, and accelerated by AI and all its magical algorithms — had aroused serious concern from the American Medical Association, the American Hospital Association, and even the U.S. Senate.
We are told this is one of those rare issues capable of generating bipartisan support. That’s nice. But based on the mass upwelling of rage and vigilante support triggered by Thompson’s murder, I’d say that’s more than a few days late and more than a few billion dollars short.
Getting back to Herbert McCabe — our theological wise-ass — it turns out he died 23 years ago. I don’t know what camp that puts him in when it comes to his prescient formulation on the subject of love. Given McCabe’s delight in cutting off his nose to spite his face, I’d say both. It also turns out that McCabe spent a lot of time arguing with himself and atheists about the existence of God.
“God is no thing,” McCabe concluded, “but not nothing.”