There is a wonderful Alfred Hitchcock film called To Catch A Thief (1955) starring Cary Grant and Grace Kelly, set in the French Riviera. In it, one scene sums up the idea of insurance. After it is found that a jewel thief has stolen $35,000 worth of jewels, character H.H. Hughson—who works for Lloyd’s of London—attempts to get Jessie Stevens to put her jewels in a safe. She replies, “And what do I do when I go out, wear the safe around my neck? It’s just that your insurance company goes into shock every time something’s stolen. If you haven’t any guts, why, you shouldn’t have taken my bet. Well, that’s what it was, a bet.”
She’s right! Insurance is nothing more than gambling. Companies are betting you will pay ever increasing premiums for service, and you are betting that insurance will cover any calamity. In truth, insurance companies are casino owners. The house always wins. You start paying lower premiums; yet, once the unexpected happens, premiums rise.
Insurance providers have their own mathematicians and statisticians to create actuarial tables, which help them figure out the likelihood of someone’s accident, illness, disability, natural disaster, or demise then charge accordingly. But, as with any statistics, there are always outliers.
As you have read previously, my stepmother fell and broke her hip eight months ago. It was the first time she had been hospitalized and had surgery. She has been healthy all 86 years of her life, which means that she has been paying for health insurance premiums for the majority of her life without having the need for it. Thus, her premiums have helped pay for others’ care. When she finally did need her insurance for the first time, surprisingly, it was there for her all the way. She owed nothing.
When she fell again around Easter and broke her other hip, I anticipated an easier time working with insurance. I felt a sense of confidence dealing with the process I had just gone through. We sailed through her hospitalization, surgery, and pharmaceuticals, which were covered. However, when it came time for her to go to acute care for her rehabilitation, UnitedHealth balked. They, against her doctor’s wishes, preferred a nursing home experience that last time was so horrible, she wound up back in the hospital for a week before being sent to Encompass, an acute care facility. All we wanted this time was to skip the nursing home altogether and go directly to Encompass. After all, my stepmom was more frail this time. She had one, mostly, healed hip on one side and one that had just had replacement on the other. If UnitedHealth had approved of this move, it would have actually saved them money.
Yet, no matter how many times her doctors contacted UnitedHealth and no matter how much paperwork we submitted, their “clinician” denied the claims. The hospital resubmitted paperwork, and it was denied. Encompass submitted paperwork, and it was denied. We are still in limbo waiting on another appeal process to find out if my father will be reimbursed for my stepmom’s stay at Encompass.
Additionally, at first, there were no reasons mentioned for the denials, but persistence pays off.
A UnitedHealth representative with the title “Service Escalation Account Manager/Government Consumer Operations-Escalation Team” let me know that she was being denied because Medicare didn’t approve. I was informed, “The reason your appeal was denied is because per Medicare your mom must meet all the rules for an inpatient rehabilitation facility (IRF) program and the rules were not met.” We were never told what rules she failed to meet. Regardless, if her own doctors were stating the reasons why she needed acute care, then how could a “clinician” who has never seen her deny their recommendations?
Moreover, Medicare may be the only insurance most elderly have. Yet, my stepmother has premium UnitedHealth as her secondary insurance. If Medicare denies payment, then UnitedHealth should pick up the slack. That’s how it appeared to work the first time. Besides, I can’t stress this enough, this is the second time in her lifetime that she has needed any hospitalization and rehabilitation. As Jessie Stevens would point out, UnitedHealth took the bet but were poised to welch on the deal.
I proceeded to do some digging and watched a YouTube video by More Perfect Union called This Company Makes Billions By Rationing Your Health Care, which describes not only how UnitedHealth became the largest healthcare company in America, but how it also cheats private practices and patients.
Not wanting to only base my opinions on a YouTube video, a Breitbart article entitled “The Massive UnitedHealth Hack Is Obamacare’s Fault And That’s No Lie” written by Americans for Limited Government, also, reinforced the information regarding the record profits of UnitedHealth, which last year alone was over $22 billion. With all of that money, Americans for Limited Government first wondered how UnitedHealth could have been hit with a huge cybersecurity breach. According to the article, the breach was so widespread that a hearing will be taking place next week in the Senate Finance Committee.
Nevertheless, beyond the hack lies a more pertinent query regarding how UnitedHealth has made their record profits. As the largest insurance company seemingly handpicked by our government to work with Medicare, UnitedHealth has become a monopoly eating up smaller private practices and using what is known as vertical integration.
Last year, Harvard’s Kennedy School conducted a study focused solely on colonoscopies and found that vertical integration not only gives the patient worse care but, also, drives up the cost of healthcare itself. “In theory,” wrote Robert O’Neill, “vertical integration in health care makes sense: when physicians work directly for hospitals, rather than in independent practices, there should be greater efficiencies through economies of scale, and better quality of care for patients through coordination and information sharing.” In actuality, doctors aren’t able to fight with insurance and their bosses simultaneously when everything is under one umbrella.
Simply, hospitals and the largest healthcare system in the United States have been rationing care. Americans for Limited Government found, “The company [UnitedHealth] used AI to systemically deny benefits to people through an intermediary called NaviHealth. Insurance monopolies like UnitedHealth are increasingly trying to control every step of patient care, and technology is making that easy for them.” So patients are being subjected to a computer to decide their fate.
The picture is crystal clear. The definition of socialized medicine is Obamacare. Rationing care and giving sweetheart deals to certain healthcare companies and pharmacies is how the game is played. All the while, cyberattacks release patient’s information to the highest bidder.
On top of all that, the government via Medicare negotiates the prices of prescription drugs to reduce consumer costs. It sounds great for the consumer. The tactics used, however, is intimidation. A provision in the Inflation Reduction Act, lobbied for by AARP, basically strong-arms Big Pharma into providing lower prices on certain pharmaceuticals or face “…pay[ing] taxes that start at 65% of the US sales of a product. The fines would increase by 10% every quarter, with a maximum of 95%” (bloomberglaw.com). Our government is choosing winners and losers in healthcare, and those that won’t comply face steep charges.
As our parents are getting older and needing more care, they should be able to count on health insurance that they have paid into for decades without jumping through hoops. They should also be able to rely on their doctors to give them unbiased facts about treatments.
Every person deserves to be treated with dignity and grace. Instead, the only ones that will be treated well are those that can pay out of pocket. Otherwise, in the case of the elderly and infirm, government will place them in substandard care facilities to save dollars, thus pushing them to die quicker. This is the opposite of how Obamacare was sold to the public.
Our elderly deserve better; and, our younger generation who believe Obamacare is the best way to treat everyone fairly need to really take a look at how nursing homes treat patients. They are understaffed and often let patients stay in untenable situations. When your parents or grandparents worked for benefits to support them in their retirement years but aren’t able to access what they paid for, it’s fraud.
Once again, we have an example of how government’s intervention is, in reality, a detriment. Anytime a new program is created for the benefit of Americans but our own government officials aren’t using it, there should be red flags. And, though I have focused on the problems of the elderly, this vertical integration system is in place for people of all ages. It, supposedly, streamlines care like Amazon for healthcare. One hospital system, one insurance network, doctors you presume are working for you, and one pharmacy all for your convenience.
It’s a gamble. Are you willing to bet your life on vertical integration and government-backed healthcare? I’ll place my bet that there is a better way.
This is so well written and so true. Obamacare WAS written to make healthcare monopolies LEGAL. It forced physicians to sell their practices and work for hospitals. It was a scam. But remember both political parties refuse to do anything about it NOW. Why? Because BOTH PARTIES are getting paid off by the insurance companies like United Health. NOT JUST THE LEFTIES BUT ALSO THE RIGHTIES. Citizens need to storm their elected officials offices and demand change for the better. But it won't happen because unless it affects them personally the public does nothing.
Your article needs to get published somewhere for wider circulation. Also, have you sent it to your local pols and other pols in Washington?
I hope your relative is doing well.
Tom Rudd, MS, MD
I read that article in the NYT, I think, about the 22 BILLION in PROFITS that UHC has made. It is a sin flat out. Immoral behavior on the part of
this”insurance”company. Insurance is about making their shareholders happy. I believe that UHC used to be HCA ( Healthcare America). My BIL said once at a family Thanksgiving that “it was the best stock he ever bought “. They also bought a hospital that I worked at as a nurse, stripped it to the bone of staff and equipment and then sold it 5 years later for twice the amount they purchased it for. I will NEVER insure with UHC.