The ENTIRE healthcare system is broken, not just health insurance companies. It is NOT HEROIC to assassinate insurance CEOs
The assassin is an "asshole that is going to die in prison," as Fetterman says
The American health care system is profoundly broken. We spend more than any peer nation, and have worse outcomes. Worse, for what we pay, the system is not even user friendly. I am a practicing oncologist, health policy expert and professor, and I have difficulty navigating the complex world of in-network, co-pays and billing. Toss on training modules and EPIC, and I get pissed off trying to provide care, receive care, and study health care. That’s the trifecta.
Who is at fault?
Here is the thing: everyone is at fault.
Pharmaceutical firms - Pharma firms routinely run seeding or uninformative trials and ram through unproven medical products. Because of how they have lobbied, they ensure that Medicare and insurance will reimburse for these things. They drive up health care spending.
PBMs - these middlemen often exploit inequities in the market, and collect a pretty penny for little added value.
FDA/ CMS - these government officials live through the revolving door. They often have little incentive to be a tough regulator because they benefit (in terms of future employment from lowering the bar). Lately, under Marks/ Califf, they have done a particularly shit job: exondys, lartruvo, aducanumab, covid boosters, paxlovid, melflufen, selenexor the list goes on and on.
Insurance companies - make no mistake, insurers would love to see not 20, but 50% of US GDP spend on health care. What people don’t realize is that insurers make more TOTAL PROFITS the more we spend on healthcare, not the less we spend. The Affordable care act caps their profit on revenue, depending on the plan, at 15-20%. In other words, insurers can only take this maximal percentage of all the money that passes through them. (currently, they are often lower than this).
While they do want to control year to year variability— through annoying things like denials and prior auth— that is mostly to make behavior predictable. In the long run, they want health care spending to grow. If we go out to pizza and I say: you can only eat 20% of the pie, what size should I buy? What do you think you will say?….. extra large.
Hospitals/ academic centers - the behavior of hospitals is predatory, and they swallow the most cash in the entire system. They use their academic names to hide that they are working as prostitutes for pharma, running unethical trials. They gobble up small practices to consolidate market share. They charge ridiculous rates, and engage in deceptive practices. How often do we discharge a patient after chemo to get Neulasta in clinic, so we can bill it as an outpatient? Places like UPMC are 4 billion dollar juggernauts which are more akin to a leech sucking the blood out of the catchment area than a medical center.
Doctors - sorry, doctors are completely complicit in the broken system. They order unnecessary tests, they consult for Pharma companies, they push for unproven things— like a double lung transplant in a person with Stage IV cancer. This was what Vandy advocated for— totally insane medicine, and worse, they want to tax plumbers and janitors to pay for their experimental science.
Doctors don’t want to learn evidence based medicine. They are entirely unwilling to self-regulate. Yes, we are often treated poorly, and certainly the glory days are gone, but we are entirely complicit in the high and unsustainable price of health care. Let me be crystal clear: A lot of health care that doctors want to give, but insurers don’t want to cover is 100%, complete and total bullshit.
This is the system. It is broken. Worse, no one will fix it. Prior FDA commissioners and CMS directors are spineless jellyfish, worried more about their future consulting than reforming the system. The American People are rightly frustrated. The voted for Trump with RFK Jr at his side because they know that, unlike the typical sell-out (think Scott Gottlieb), RFK Jr is the most likely to make a lot of changes. And even if 3 out of 10 changes is harmful, Americans will accept it, in the hope 7 are good. And if some changes make the system worse or break it entirely, perhaps, they think, so be it, that only means reform must come sooner.
Against this backdrop, you have doctor influencers and others who choose to point the finger at one entity. An easy scapegoat is the insurance industry because they issue denials and make our life harder. And don’t get me wrong, I hate prior auth just like all my friends because I don’t want to explain myself to a moron, and that is who is on the other end of the line, but this is a classic scapegoat. An innocent made to take the blame for a broader problem.
The SYSTEM is broken, and insurance companies are not the SOLE villain. Also, imagine for a moment, if we made a law saying insurers could NOT decline any service. First, several would go bankrupt in a stochastic way. The ones that happen to have docs who are insane and order a lot of useless shit first will go bankrupt. But those who survive the initial earthquake will crank up their premiums.
They will obliterate you with their premiums. You will drown in those premiums. You will be eating canned tuna like the apocalypse is here, but have access to prenuvos and a rectal MRI and sequencing your literal shit. GDP spending on health care will explode. The US will likely collapse as Rome did before. In the Roman city before the fall 50% of days were holidays— we will collapse when 50% of GDP is on health care. Doctors who advocate for this are ignorant and typically online influencers, perhaps even comedians, who know very little, and stoke popular flames.
Against this backdrop, some 26 year old kid, perhaps suffering from psychosis, assassinated the United CEO. Brian Thompson was the father to 2 kids, and by all accounts worked his way up through the industry. His father was a grain elevator operator. But, that is irrelevant, he shouldn’t have to prove a rags to riches story for you to know that he didn’t deserve to be assassinated. Only a fucking moron would think it is a good thing for CEOs of companies you don’t like to be assassinated. Some online lunatics call the assassin a hero. Those people are dangerous and wrong.
John Fetterman meanwhile is correct:
“He’s the a--hole that’s going to die in prison. Congratulations if you want to celebrate that. A sewer is going to sewer. That’s what social media is about this. And I don’t know why the media wants to turn that into a story, just with these trolls saying these kinds of things anonymously like that,”
Newspapers are even covering the killer’s thoughts on Japan. We are not supposed to cover the manifestos of crazy lunatic killers. I don’t give a shit what this guy thinks about Japan.
The take away from the response to a good man getting killed by a lunatic is that Americans are frustrated by health care. Sadly, the media has not taught them it is a systemic problem and not confined to insurers. They don’t know where to direct their hatred, and it is misdirected now.
What would productive change look like? The single best thing we can do is end the corporate capture of regulatory agencies like FDA and CMS. RFK Jr supports that, and might be the only HHS nominee in history (and history to come) who opposes the oversized role of industry in this space. FDA needs reforms. Insurance needs reforms. Pharma needs reforms. Doctors need reforms. Like this is a good one.
I am not sure that all changes will work as intended, but I am sure that people want changes to be made. We need to do so thoughtfully and collect data thereafter, and pivot when needed. But we have to be ok will telling a lot of people who are making a lot of money that you might end up poorer.
Finally, if you are frustrated by medicine and want to make tik-tok videos only portraying one party as a villain, I think you have an obligation to try to actually understand the entire system, not just count your likes. Misdirected criticism will not solve problems, it will create scapegoats.
Our society can not spend more on health care. It will crush us. It will take dramatic change to make sure that we pay for evidence based, cost effective care and not bullshit, and frankly I don’t see anyone championing this message. Instead they want to celebrate an asshole that is going to die in prison, and watch their premiums climb as companies pay for more executive security.