Will a shocking crime spur change in U.S. health care? Don’t count on it

Will a shocking crime spur change in U.S. health care? Don’t count on it

It’s hard to envision anyone celebrating the shooting death of a doctor. Or, for that matter, a hospital administrator, a pharma employee, an average U.S. politician or voter. 

But Luigi Mangione’s alleged act has revealed a wellspring of hatred for one specific actor among many in the U.S. health system: insurance companies.

How else to explain the 126,000 people posting laughing emojis on a Facebook page devoted to mourning U.S. health insurance exec Brian Thompson, who was shot to death on a Manhattan sidewalk last week. Meanwhile thousands more posted messages online praising his alleged killer.

Mangione, the alleged shooter, reportedly left a brief manifesto declaring that the greed of the health system is amply chronicled in works by filmmaker Michael Moore and Elisabeth Rosenthal, a trained physician and 22-year health reporter for The New York Times.

If you actually read Rosenthal’s book, one unmistakable takeaway is that myriad actors squeeze patients in myriad ways, pumping up prices, then haggling amongst themselves about how to split the proceeds.

But insurance companies are the most conspicuous actor. When the bill arrives, they’re the one rejecting the claim, hunting for excuses, now assisted by artificial intelligence.

“If this is related to the insurance industry, it was only a matter of time [before] something like this happened. It really was,” Rosenthal, who now works for KFF Health News, told a CNN podcast. 

“There’s anger at the executives. There’s anger when people see, ‘Oh, you didn’t pay for my $1,000 test, but you’re making $10 million a year.’ “

This interview took place before news that the alleged shooter’s manifesto included her name and Rosenthal later said that the murder was terrible, tragic and inexcusable.

But she also reiterated her ongoing frustration with the system — where 18 per cent of claims are denied by insurers, where 42 per cent of cancer patients exhaust their life savings. 

She cited horror stories she’s collected. Like struggling newborn babies getting rejected by insurance companies questioning whether they really needed that fourth night in the neonatal ICU. This, she says, is an example of a computer-assisted rejection.

“The [baby’s] first letter in life is a denial letter,” she said. “You know a human didn’t write that letter.” 

So why doesn’t the system get reformed?

Well, to some extent it does. Tiny reforms happen all the time. This year alone, 99 laws were enacted at the state level related to health costs: some states excused medical debt from credit reports, or gave tax exemptions for some non-profit care, or made things easier for patients by guaranteeing that one referral allows multiple specialist visits.

But big systemic change? That’s another story. 

The last major reform of the health system occurred under Barack Obama. It’s a complex system, and there’s no sign it’ll be updated in any major way with an incoming Republican-controlled Congress and White House.

If anything, health coverage could shrink. Trump and state-level Republican allies have periodically targeted the Medicaid program for the poor.

Americans tend to like their health plans

Here’s the inconvenient truth for anyone pursuing big reform: The political math works against it. That, and the truckloads of money in lobbying and party donations from the insurance industry.

It’s true that people say they want change. A strong and growing majority of Americans see universal health care that’s guaranteed by the government as a laudable goal. 

But that desire for change crashes up against a rampart for the status quo: The majority of Americans are happy with their current health plan. And they vote that way, judging from the results of recent party primaries and general elections, where an overhaul of the health system hasn’t been a winning issue.

It bears mentioning that Americans with quality insurance get some of the best health care in the world. Just compare the number of imaging machines per capita. Compared to Canadians, Americans have multiple times more access to CT scanners and MRI machines, and wait times to see a specialist are much shorter.

There’s a mountain of public-opinion polling indicating that Americans are pleased with their own plans. While a majority profess to want reform, an even stronger majority — up to 81 per cent — consistently tell pollsters they’re happy.  

Just this week, a survey found that Americans were satisfied with their own personal health insurance by a two-to-one margin.

That’s the math problem a politician runs into if attempting reform: You risk upsetting that majority.

Just ask Barack Obama. His party suffered the worst loss of seats since 1938, in no small part because his popularity collapsed during the health reforms of 2009-2010.

Or Bernie Sanders. One of the reasons he lost the 2020 presidential nomination was because younger progressives who wanted Medicare for all were outvoted by older voters, who, by the way, already have Medicare.

It’s a detail that bears repeating: The most active voting block in the United States, senior citizens, already has health care under the universal public plan for seniors.

In fact, nearly 40 per cent of Americans, overall, have public coverage; seniors have Medicare, poorer Americans have Medicaid, and there are programs for military personnel and veterans. 

Others fall through the cracks. Roughly eight per cent of the country has no insurance at all, a huge improvement from the pre-Obamacare days, when it was double that.

An even larger share have a poor insurance plan, increasing their risk of stressful disputes with insurance companies and medical providers.

Plan B: Incremental reform

“The American people are outraged and they’re rising up across our country demanding fundamental change to a broken health-care system. Enough!” Democratic congressman Ro Khanna said in the House of Representatives this week.

“Across our land, there is outrage at national health insurance companies … denying claims.” 

He urged three important changes. Requiring private insurers to cover medicines covered in the Medicare program for seniors; capping out-of-pocket costs so people aren’t bankrupted by an illness like cancer; and regulating the use of artificial intelligence to deny claims.

But, really, he added: “We need Medicare for all.” 

A number of Democrats support that, or a lesser version of that — like letting younger people pay into the Medicare program. In other words, letting people who want socialized medicine choose to pay the taxes required to fund it. 

That’s a dream for another day, with Donald Trump just over a month away from gaining control of Washington.

But Trump did flirt with lesser reforms in his first term. He signed an executive order requiring more transparency in how insurance companies set prices, which his successor Joe Biden said he would enforce, although it’s not clear he has.

More transparency would help people shop around for insurance plans, Rosenthal said. It would also force companies to compete on a more open playing field.

Companies are not reporting their denial rates because they’re not being forced to — despite existing federal law that lets the government demand it, Rosenthal said.

There’s some evidence that Thompson’s company, UnitedHealthcare Inc., was repeatedly shown to be one of the worst offenders when denying claims, Bloomberg reports.

Rosenthal’s book suggests other solutions — more regulations to require transparency in pricing; price limits for certain services; and single-payer care for essential services.

In the wake of this shocking crime, she told the podcast that she hopes insurance companies consider changes beyond hiring more security.

Some are reportedly scrubbing executive bios from their websites, and corporate spending on private security has already surged in recent years.

“Is the answer to increase security? Well, maybe,” Rosenthal said. 

But maybe, she said, an additional response is to be more thoughtful, more human, to use less automation in treating claims.

In a column for Bloomberg, health writer Lisa Jarvis said almost everyone has a story about being denied coverage. 

These include sadder ones, like some people being brought to tears while on the phone with an insurer; watching family members suffer without care; or feeling one’s stomach drop upon opening the mail.

“We’re hearing about how companies had beefed up security even before this event,” she wrote. “Those are rational changes to protect their employees. We have yet to hear whether they will make any changes to protect their customers’ access to care.”

Published at Wed, 04 Dec 2024 17:39:06 +0000

Electricity, a well-paid job and the freedom to walk around: Syrians share hopes and fears for the future

Syrians flooded into streets, markets and mosques on Friday celebrating the recent overthrow of Bashar al-Assad and attending the first Friday prayers since his ouster on Sunday.

CBC senior international correspondent Margaret Evans, producer Jason Ho and videographer David Iacolucci spoke with people in Damascus outside the Umayyad Mosque, which was built in the early 700s and is the city’s largest, and the nearby Al-Hamidiyah market about their hopes and fears for the future.

Islam Marouf, 38

(Jason Ho/CBC)

Marouf is a journalist from Al Hasakah, in the northeast of the country.

He said Syria faces many challenges, including food and oil shortages, uncertainty over Abu Mohammed al-Golani, who led the rebel advance that toppled Assad, and concern that a unified Syria with its various ethnic and religious groups may not hold.

“There is fear from the future,” Marouf said. “We celebrate a new situation in Syria, but all the people have fear, especially the tradespeople.”

He said seeing the rebels release members of the military without exacting revenge and adhere to some of the initial promises made by Golani reassured him, even though he’s from a region where Golani’s group, Hayat Tahrir al-Sham (HTS), is not well known.

“Now, we have peace here in Damascus, that’s good. There is [forgiveness]. Until now, everything is good.”

Still, he said, it will take a lot to maintain that peace and keep Syria whole.

“The people have to work hard to build Syria.”

Joud, 27

(Jason Ho/CBC)

Joud, who did not want to give her last name, studied finance and hopes that in a post-Assad Syria, she’ll be able to find work in her field, earn a higher salary and start a family. When CBC spoke with her, she was savouring the simple pleasure of being able to move freely around the city.

“I’m happy today,” she told Margaret Evans through a translator. “As I left home today, I can walk and go wherever I want…. I’m so happy I can go anywhere. No one is monitoring me.”

Joud said she’s not worried that a new Islamist government might impose restrictions on women.

“It won’t affect me as a woman or anyone else,” she said. “We are going to live as we are living now, and there’ll be no rules — no extra rules — on us, I hope.”

Inas al-Hanash, 25

(Jason Ho/CBC)

Hanash was out celebrating with her kids, and like many of those on the streets of Damascus on Friday, she flashed a hopeful if subtle peace sign as she posed for a photo while other children milled around nearby. She said she’s looking forward to economic stability and actually having things in stores to buy with her money.

“The Syrian lira [pound] will be much better, God willing. Not the same as before. Even if you had money, you couldn’t buy anything.”

Hanash said she also hopes a new government will mean that basic services, such as electricity, are maintained.

“The economic situation will be much better, and we will live in peace and safety,” she said.

Abu Ahmad, 22

(Jason Ho/CBC)

Ahmad said he is a member of Hayat Tahrir al-Sham, the rebel group that led the advance that toppled the Assad regime. Originally from Idlib, Ahmad said he fought with the rebels as they made their way to Damascus and is now helping maintain security in the capital.

“There are a lot of people who are still supporting the regime, and a lot of thieves in the city,” he said. “We hope that once we do all of this [secure the city], we’ll return home.”

Many inside and outside Syria are waiting to see what happens to those who propped up the regime and had an active hand in the repressive tactics it used to hold on to power.

Ahmad said holding people accountable for their actions under the past regime is a necessary part of the transition.

“If we let supporters of the regime who have blood on their hands go free, we would betray our martyrs,” he said. “In the case of someone in the army who was forcibly conscripted, he can go back home and we won’t do anything to him. As for people with blood on their hands, we will hold them accountable.”

Raed al-Saleh, 42

(Jason Ho/CBC)

Saleh heads up the group known as the White Helmets, first responders whose mission has changed significantly in recent days from helping civilians survive the violence and instability of a prolonged and deadly civil war to rebuilding the country.

One of the first tasks was to help search Saydnaya, the notorious military prison outside Damascus, looking for underground cells and trying to ensure that every corner of the prison was cleared.

“It was one of the most important missions for us,” Saleh said. “We were working very hard to get all the prisoners out.”

Now, they’ll turn to unearthing some of the mass graves where victims of the Assad regime were buried, he said. That will involve collecting DNA samples in hopes of providing answers to the loved ones of the thousands of people who disappeared over the course of 14 years of civil war.

“We have more than 100,000 missing people that we don’t have any information on right now,” Saleh said.

Despite the grim work ahead, Saleh said he’s hopeful.

“The past 14 years, we were suffering a lot. But today … we are in a new phase. We are going to build a new Syria. We will bring back all Syrians and make sure it’s only one country, only one community, and that Syrians are making the decisions in this country.”

Published at Sat, 14 Dec 2024 00:58:48 +0000