aIn the wake of the murder of insurance giant United Healthcare CEO Brian Thompson, Americans are sharing heartbreaking stories of insurance denials that led to more serious illness and death.
Experts say the rise in practices such as prior authorizations and automatic insurance denials are making it more difficult for Americans to access health care, and that reforming these practices and building trust in the health care system is essential. He said urgent changes were needed to recover.
“Obviously, killing someone is morally reprehensible, and vigilante justice is not justice. But I'm not particularly surprised by the outrage expressed against America's health care system.” said Miranda Yaber, assistant professor of health policy and management at the University of Pittsburgh.
“When your life changes because you can't get tested for something that really bothers you, or you can't get medicine that actually solves the problem, it's a lot of frustration and anger and loss of self. It creates a sense of trust.
The killings in early December “became a flashpoint in the debate about corporate power and brought public discontent with the industry to the surface,” said Anthony Grasso, assistant professor of political science at Rutgers University-Camden. “There is very little accountability.”
When Deanna H.'s daughter was born in December 2016, doctors discovered that the baby had heart and lung problems and spent eight days in the neonatal intensive care unit.
Doctors wanted her vaccinated to prevent RSV (respiratory syncytial virus). This infectious disease can be fatal to children under the age of two, even those without pre-existing conditions.
However, Deanna said her baby was not born prematurely or with any special conditions, so she was not eligible.
Two weeks later, Deanna said, the newborn became infected with respiratory syncytial virus and developed respiratory failure. She was taken by ambulance to an intensive care unit three hours away.
“We almost lost her many times,” Deanna said.
Patients caught up in insurance denials speak of frustration and helpless anger that they have little recourse or recourse to get companies to do their jobs.
“I would be lying if I didn't feel a little happy knowing that I had to pay out hundreds of thousands of dollars because my insurance company chose not to spend thousands of dollars on preventative medicine,” Deanna said. spoke.
It's a small consolation, she said, but it's the closest to feeling like an insurance company was held accountable for a risky insurance policy.
She has been closely monitoring the reaction to Thompson's murder, and said that while it was “not something I would do,” she “could understand how someone could be driven to do something like that.” Ta.
She also suffered from a spinal injury, which may not have required major surgery had she received preventive treatment. “As soon as I saw that, I thought, 'I got it,'” said Deanna, who saw an X-ray of a spinal fusion surgery posted online by Luigi Mangione, the suspect in Thompson's murder. Inadequate medical care, pain, loss, feelings of being disrespected and ignored are dehumanizing things, and as a result, we act in dehumanizing ways. ”
A Gallup poll released last week found that less than a third (31%) of Americans said they had a positive view of the health care system, compared to 51% in 2020. % said the same.
Respondents said health care costs and access are among the most pressing health issues in the country, with people more likely to cite these issues than other health issues such as cancer or infectious diseases. . Approximately 79% of people said they were dissatisfied with medical costs in the United States.
While healthcare spending has increased 67% over the past decade, UnitedHealth Group, Elevance, and Cigna's profits have increased 262% during the same time. These ratios used to trend closely together until 2016, when they diverged markedly.
Inadequate medical care, pain, loss, disrespect and neglect are dehumanizing.
Deanna H
Support for health insurance is at its lowest level since Gallup began tracking the issue in 2001. The decline in satisfaction is occurring in tandem with an increase in insurance coverage denials.
Humana, Cigna, and United Healthcare are all the subject of class action lawsuits for allegedly using new AI tools to process and deny claims.
One lawsuit alleges that 90% of United Healthcare's initial AI denials were reversed on appeal, “a staggering number,” Yarber said.
California recently enacted legislation with bipartisan support to regulate such automated tools, requiring physician oversight based on patient records.
Nationally, a bill to expedite Medicare senior coverage decisions passed the U.S. House of Representatives in September 2022 and was recently reintroduced in the U.S. Senate.
“Even if we don't reduce the severity of denials, we can at least alleviate some of these delays,” Yarber said.
“Simply making it easier for people to move around could help repair what is broken without a wholesale rethinking of America's health care system,” she said.
Another area that could be reformed is the Employee Retirement Income Security Act (ERISA), which allows workers enrolled in certain employer-sponsored plans to pay insurance companies for damages and, in some cases, attorneys. This prevents them from filing lawsuits to claim costs. “There are no significant penalties and there is no real cost to false denials, which raises questions of accountability,” Yarber said.
Even if insurers lose lawsuits over treatment denials or are fined for regulatory violations, the costs can be passed on to customers by raising premiums.
“Much of what we have to do to hold executives accountable is simply absorbed as a cost of doing business,” Grasso said. “Strengthening penalties for illegal activities would be beneficial,” he added.
Grasso said there are also fundamental differences in how Americans understand and respond to harmful behavior.
“When someone is shot on the street, we define it as a crime. We have to punish that act of violence,” Grasso said. “But when we look at the harm caused by corporate decisions, such as denying life-saving medical care, we don't usually think of it as violence.”
But he said the shooting and the outpouring of responses are changing that perception.
“This is violence,” Deanna said of insurance companies denying life-saving care. “It's administrative violence.”
After a battle with RSV, Deanna's daughter recovered and is now a happy and healthy 8-year-old. Still, those early days linger in her mother's memory every time she coughs or sneezes.
There is a new highly effective vaccination to prevent RSV, and it is recommended for all newborns, not just premature babies with certain health conditions. There is also an RSV vaccine for pregnant women and the elderly.
Deanna hopes those drugs will make a difference and that they won't be subject to insurance denials.
“Hopefully… no one ever has to go through what we went through again,” she said.
