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UnitedHealth Group CEO Andrew Whitty said Friday in his first public appearance in response to the consumer outcry following the shooting death of one of his executives, that the U.S. health care system is “It's not perfect,” he said, adding that coverage decisions “are not well understood.”
“We know that our health care system is not working as well as we should, and we understand people's frustrations about it,” Whitty wrote in a guest essay for the New York Times. “No one would design a system like we have. And no one did. It's a patchwork built over decades.”
Mr. Whitty also defended the company's health insurance unit, UnitedHealthcare, but acknowledged that it bears some of the blame for a lack of understanding of medical decisions.
“We need to work with employers, governments, and others who pay for care to improve the way we explain what is covered and how decisions are made,” Whitty wrote. “Behind each decision is a comprehensive and continually updated body of clinical evidence focused on achieving the best health outcomes and ensuring patient safety.”
Whitty also praised Brian Thompson, CEO of UnitedHealthcare, who was killed in midtown Manhattan last week, noting that Thompson said, “Rather than just increasing testing and procedures, we need to focus on preventive health.'' We fought for quality health outcomes.”
UnitedHealthcare said in a statement Friday that there is “highly inaccurate and grossly misleading information in circulation about how our claims are handled,” adding that the company “has been unable to provide approximately 90% of the health care claims submitted.” % of all medical insurance claims,” he said, noting that “approximately half of all medical insurance claims are approved and paid.” 1% is for medical or clinical reasons. ”
Thompson's shooting death brought into sharp focus Americans' dissatisfaction with health insurance. Many have made their frustrations abundantly clear on social media.
Journalists have also documented efforts by insurance companies to twist the system to their advantage. STAT, a health care-focused news site, published a series of investigative articles about UnitedHealth. They include articles about how the nation's largest health insurance companies use computer algorithms to cut off rehabilitation care for Medicare enrollees and limit the discretion of clinical case managers.
It remains to be seen whether the public outcry will prompt adjustments at UnitedHealthcare and other insurers' practices, particularly in disparaged treatments and claim denials, or whether it will prompt lawmakers to force the industry to make changes. . Experts say that depends in part on whether patients continue to speak out.
Angry consumers have successfully reformed the health insurance industry in the past. In the 1990s, they railed against the restrictions of health maintenance organizations (HMOs), as depicted in the 1997 film As Good As It Gets. This has led insurance companies to offer more preferred provider organizations (PPOs), which are less restrictive but have higher costs.
But experts say changes to the country's complex health care system will not be easy and won't happen quickly. Many parties are involved, each with their own patient care concerns, financial interests, and lobbying funds to influence legislators.
Many patients and their advocates say that insurance companies deny care to inflate profits, but that the insurance industry protects consumers from high prices and unnecessary care. claims.
In an internal message to employees shortly after Mr. Thompson's murder, Mr. Whitty vowed to continue the insurer's mission to help “improve the system.”
“Our role is critical, ensuring that care is safe, appropriate and available to people when they need it,” Whitty said in a video message obtained by CNN. “And we protect ourselves from pressures to provide unsafe or unnecessary care that would make the whole system too complex and ultimately unsustainable. Therefore, we defend that claim. I plan to continue.”
“What we know to be true is that health systems need companies like UnitedHealth Group,” he continued.
UnitedHealthcare referred CNN to Witty's video on Thursday when asked if it would make any changes in response to public consumer complaints. While other major insurance companies did not respond to requests for comment or declined to comment, a major industry group said hospitals, health care providers, and employers all have a “direct impact on the cost and accessibility of health care services.” I am giving,” he said.
“In a fragmented and highly regulated health care system, health plans, health care providers, and pharmaceutical companies must make quality care as affordable as possible for the people we collectively serve. “We share the responsibility to make sure that the latest technology is readily available,” industry group AHIP said. statement. “Health plans are committed to protecting patients from the full impact of rising costs while connecting them to safe, evidence-based, and tailored care.”
But recent events may prompt insurance companies to examine their practices and make some changes, Morningstar senior equity analyst Julie Utterback said in an email to CNN. Ta. This is especially likely when there is a perceived risk to the business, such as when an employer threatens to leave an employee because determining coverage is too onerous for them.
Conversely, “the primary reason for not changing their practices is to maintain profitability while keeping broadly reasonable costs for clients and end users,” Utterback writes. .
Scott Galloway says anger directed at healthcare CEOs online is directed at the wrong people. Please ask me why.
Former President Bill Clinton's failed efforts to reform health care in the early 1990s increased concerns about health care costs. This sparked the growth of the HMO model, in which policyholders are allowed to see only certain doctors and require a referral from their primary care physician to see a specialist or receive certain tests or procedures. However, HMOs also typically featured lower premiums, low or no copays, and no deductibles.
Larry Levitt, executive vice president of health policy at KFF, a nonprofit health policy research group, said policyholders rebelled because they felt they weren't getting the care they needed.
Their concerns received extensive media coverage, and in the 1997 film As Good As It Gets, the boy's mother (played by Helen Hunt) tells the doctor (played by Harold Ramis) that the insurance company won't cover allergy testing. The scene where he said he wouldn't do it is depicted. Because of my son's asthma.
“Fuck you, HMO, fuck you,” Hunt says before apologizing.
“That's fine. Actually, I think that's the technical name,” Ramis replies.
Many states responded to complaints by passing patient bills of rights restricting HMO cost control practices in state regulatory plans. Employers, hearing workers' anger, began moving to PPOs. PPOs typically provide coverage to a wider range of physicians, but have much higher premiums, deductibles, and copays. PPOs currently largely overshadow managed care models.
But as health care costs continue to rise, Levitt said PPOs have adopted practices similar to HMOs, specifically requiring prior medical approval, known as a prior authorization.
Rodney Whitlock, vice president of the medical consulting group McDermott+ and a former health care policy advisor to the Senate Finance Committee under Republican Sen. Chuck Grassley, said, “If you think current health care costs are difficult, , imagine it without constraints.'' Iowa.
But health insurance companies sometimes backtrack when faced with severe headwinds. Earlier this month, Anthem Blue Cross Blue Shield canceled a plan to limit the length of time it would cover anesthesia used in surgeries and procedures after criticism from doctors and politicians. The insurance company says it aims to reduce overbilling and make health care more affordable.
Congress has worked for years to improve access to health care and reduce costs, but the U.S. costs less than its peers despite ranking last on key health measures. is much higher. Lawmakers are holding hearings and introducing bills, but other than a few key Medicare drug cost provisions included in the Inflation Reduction Act of 2022, the Affordable Care Act passed in 2010. Since then, no comprehensive reforms have been enacted.
An effort to improve the preauthorization process for Medicare Advantage plans failed to advance in the Senate in 2022 after the Congressional Budget Office estimated it would cost about $16 billion over 10 years.
But Wendell Potter, a former Cigna executive and vocal critic of the health care industry, said there is now more bipartisan appetite in Congress to enact reforms. Lawmakers reintroduced an earlier authorization bill, this time with zero cost estimates and a framework to establish so-called site-neutral payments in Medicare. Under this framework, Medicare would pay the same rate for services provided in a hospital's outpatient department. Outpatient surgery center or clinic.
Lawmakers are also considering reforming the pharmacy benefit management industry, which acts as an intermediary between health insurance companies, pharmacies, and drug manufacturers.
Whitlock said Republicans, who will control Congress starting in January, will seek cost cuts to offset the extension of the 2017 Tax Cuts and Jobs Act. This could encourage the passage of measures that save governments money, such as site-neutral payments.
Meanwhile, the murder of UnitedHealthcare's CEO will remain in the news as the case against Luigi Mangione makes its way through the courts. Potter said this would keep the public's dissatisfaction with health insurance companies in the spotlight, which could help advance the bill on Capitol Hill.
“It will be a years-long battle, but it will happen,” he said. “Some kind of reform is inevitable.”
