Full disclosure: I hate United Health Care and have hated them for thirty-five years since they bought out Ocean State Physicians Health Plan and became the second-largest health insurer in Rhode Island in the late 1980s. I think they are predatory and manipulative and leverage market power inappropriately in pursuit of profit, making a critical public health process into a profit-making engine in a way that hurts us all. Years ago, when I was in practice, I begged my partners to drop United because they were costing us money and time that we didn’t have to waste.
That said, I’m still heartbroken by the murder of Brian Thompson, the CEO of United Healthcare, the insurance arm of the United Health Care Group, and also saddened by the character of the huge and vitriolic public response via internet and social media, and by the public response via Op-Ed by Andrew Witty, the CEO of United Health Care Group, which was gutless and incredibly manipulative. But I’m somehow not shocked. This is what happens when you play money games with people’s lives when you conflate profit with the sanctity of human life.
My heart aches for the families of those involved in this disaster – for the family of Brian Thompson and of Luigi Mangione, who is accused of the murder. I don’t know anything about either one that I haven’t read in the press — but I worry about the moral integrity of people in the managed care industry, on the one hand, and about the mental health of anyone who thinks shooting someone in the back is a way to make political or social decisions. Understanding that there are something like 300 million guns in the US. In the hands of 25 million people. And if we use murder and mayhem to settle arguments, well, let’s just say a difficult time of decreased social consensus and intensifying partisan politics can get a zillion times worse than it is in a hurry. Unimaginatively worse. So everyone on both sides needs to grow up and act responsibly and put the public interest before their own income, profit, or even passions.
Let me pause here to reflect on the history of United Health Care in Rhode Island, some of which I remember. In the eighties, a number of physicians in Rhode Island started Ocean State Physicians Health Plan, to push back against Blue Cross and it’s control of the health care business here, which involved a very interesting relationship with the then leadership of our legislature, a relationship which would lead to charges and a $20 million settlement, not that I know who did what to whom, of course. Ocean State Physicians Health Plan was managed by United for a while. And then the founding physicians sold it to United, and each made more than a little money, if my memory is correct. So when it comes to the business of health insurance, even those health insurance companies doctors love to hate, no one is that pure.
Still murder isn’t any way to do health policy. United does only what we as a society have asked it to do, which is to manage cost, on the one hand, and to create profit, on the other hand, using the tools civil society has given it to work with, in a culture and a democracy that lacks the courage and discipline to create a health care system that provides needed and affordable healthcare services to all. That somehow can’t discriminate between primary care, which is an essential, effective and affordable service, and Ozempic and plastic surgery. So, we hire United to do that for us, and are shocked, shocked when they do it badly and advantage themselves because we didn’t watch or retain control.
But communities CAN do this for themselves, if those of us who study and know this world stand up and give communities the tools they need to do so, and the courage they need to get it done.
Like the great IWW organizer Joe Hill said on his deathbed after he had been convicted of murder on a trumped-up charge and was about to be executed, Don’t Mourn, Organize.
We can go on writing hand wringing OpEds or hire more security guards for the managed care profiteers — and watch health care get worse. Or we can organize ourselves in each of our communities and fix the mess.
Einstein said that doing the same thing over and over and expecting a different result is the definition of stupidity. I think Einstein was wrong. I think that’s the definition of insanity.
But it’s both stupid and crazy to sit back and watch as health care gets worse as we go to war with one another over it.
We can do better than this. We must.
