The (Many) Crimes of United Healthcare, Explained

so you might have seen that the CEO of United Healthcare the biggest Health insurer in the US was fatally shock just a matter of days ago and it goes without saying that you probably shouldn't go around shooting people but if there's one thing that's that's interesting about it is the way that it's brought people together because people have responded in an interesting manner I want to give you some context as to why people feel this way about United Healthcare because this reaction has like transcended barriers political social whatever barrier and it's caused other insurers to

respond as well for example Blue Cross which is another one of the biggest insurers in the US within a day of this happening reversed a change to their anesthesia coverage which would have put time limits on how long a patient could have received anesthetics while in hospital for many many years now reporters have written at length about the practices that United Healthcare carries out and it's not just the unwell or the medical staff that have being screwed over but the everyday regular Citizen and you know however you feel about it anything that brings people together

is interesting to me and I want to help you maybe understand some of the context behind United Healthcare because more than 26,000 Americans die each year because of the lack of health insurance more than twice as many as were murdered and that alone can give you at least a starting point right United Health Group which is the parent company of United Healthcare is the eighth biggest company in the world by revenues and infamously they say that you know with great power comes great responsibility except I don't think anyone told United cuz uh on average 16%

of insurance insurance claims are rejected in the healthcare space for United Healthcare it's a 32% meaning that around 1 in three paying customers has their claim rejected this just scratches the surface and we can go a little bit deeper and find out a little bit more given that the insurance industry rejects claims at such a high rate you would expect some of those savings to maybe have been passed on to the consumer and so I decided to check how have insurance deductibles and premiums changed over time relative to wages and inflation more broadly and the

answer was not well between 2010 and 2020 the cost of direct tables has more than doubled and the cost of family premiums the monthly payments increased by over 55% and today low-income families spend close to a third of their income on health insurance premiums it's not good just showing you numbers doesn't really capture the full picture cuz sometimes it can be easy to to get lost in the numbers and to understand how this actually translates into human impact and pruer just last month published an amazing article about United healthcare's Playbook when it comes to mental

health coverage and this will really help you understand how all of these numbers actually translated into human impact over the years United Health Group the parent company has seen their revenue grow by over 47 billion in the space of a year and to achieve such massive growth in an industry like healthcare you need to rely on the same Playbook that other Industries have relied on which is optimization through technology United Healthcare implements an algorithm called alert algorithm for Effective Rapport and treatment to determine whether or not a person undergoing mental health treatment has had too

much therapy if a therapist passes an arbitrary threshold they get contacted by what's called a care Advocate who will call them and Grill them for providing too much care to their patients the official term for this is the risk of overutilization of routine outpatient services what this looks like in practice is is pretty it's pretty crazy I think I want to give you a testimony from a patient who had their claim for mental health treatment denied she said that 2 years ago my therapist was denied payment for seven of my mental health sessions she provided

I tried to pay her even though I'm on a limited income and she wouldn't take the money if my provider in her professional opinion believed I needed those therapy sessions who is United Health to deny coverage and if you're curious about like what too much therapy actually looks like it is 30 sessions in 8 months this was the the threshold for initial flagging which uh if you fancy yourself as a mathematician is like a bit less than once a week and you know this might sound like an uncharitable description right like they they were hunting

down people for having too much therapy but it got to the point in New York where the attorney general actually sued them for it and they just recently settled for $13 million these $13 million covered around 34,000 therapy sessions that were missed and I I would just ask you to speculate on what you think the cumulative mental health impact of 34,000 Miss therapy sessions would be because it's it's not good and this algorithm remains in place place today in the vast majority of the US the algorithms that United Health have implemented over recent years are

officially said to be suggestions but leaked messages from whistleblowers have implied that workers are being told to stick within 1% of the algorithm's recommendation the AI That's used to evaluate these claims is notoriously faulty and they're currently undergoing a lawsuit which claims that it has a 90% error rate meaning that 90% of the claims that were rejected could be later overturned with an appeal however it's unreasonable to expect someone to appeal when they are unwell it's one of a number of pieces of evidence that the number one priority was not necessarily providing effective Healthcare unsurprisingly

actually however even if you're not medical staff or you're not a patient and you're just a healthy American adult you're actually still getting screwed over by them because United Health specifically exploits the Medicare Advantage plan Medicare Advantage is a healthcare plan that represents a public private partnership ship people get insurance with a private company and the company is later refunded by the government it allows Health insurers which have experience and have vast networks in the healthcare space to use that and it allows the government to not necessarily bear the cost of all the infrastructure that

they' need to provide medical services and if we understand how it works you realize that it's not necessarily as good of an idea as it my team at first there are some statistics that kind of like live rentree in my head specifically one about Healthcare spending per person because the US notably spends way more than any other comparable country the UK which has completely free at the point of service Health Care System spends less than half the amount per person on Healthcare and this was a number that just never really added up in my in

my head I didn't understand how the US was able to spend this much money and understanding the Medicare Advantage plan actually explains a little chunk of this figure a bit more to us you see Medicare Advantage works by giving an insurer a fixed amount of money for a healthy person and that amount of money varies depending on how sick the patient is so for example they may get an extra $2,300 if the person is midly obese an extra $2,000 for seizures an extra 1,200 for chest pain because the the logic is that it would incentivize

doctors to fully diagnose patients and to not miss any Corners with these Medicare Advantage patients it's also worth noting that not every extra diagnosis leads to an extra payment so for example cataracts are paid out but only if you contract them due to diabetes except there's always a loophole right because United Healthcare wasn't happy with the payouts that they were receiving and the Wall Street Journal wrote about a number of cases where United Healthcare would actually try and offer people extra money to get more diagnosis out of them if they felt that the patient's doctor

hadn't provided enough diagnosis for for the patient to be worth it they would call the patient and ask if they could send a nurse out to give them a checkup they would even offer a $50 gift card to encourage them to get this visit by by a United nurse this is completely separate from their actual medical center that they might visit on the regular and uh this led to the person mentioned in this article Gloria being diagnosed with a condition that she didn't actually have a condition that led to United Healthcare getting an extra $3,000

and led to her receiving a diagnosis for thumbing something that she didn't suffer from and this isn't just an isolated case if we look at the number of patients diagnosed with cataracts that were part of United Health they actually diagnosed at a raate 15 times times higher than traditional Medicare and the vast majority of these diagnoses are not done by the patient's doctor rather United Health just adds on diagnosis in order to extract more money out of this Advantage plan and when you look at conditions that don't lead to an increased payout you don't see

anything near this level to highlight like how egregious this actually is more than 66,000 Medicare Advantage patients were diagnosed with diabetic cataracts even though they'd already gotten surgery for it and it's interesting to consider the fact that you Health it is 15 times more likely to diagnose patients with this condition and yet around one in three paying customers has their claim rejected a plan was even hatched to reform the Medicare Advantage plan to prevent this kind of overbilling but it was shut down after what was described as strong industry opposition as usual it does come

down to to lobbying because United Health Group is a huge political donor they donated over $10 million in lobbying in 2023 I visited open Secrets just to have a look look at what their donations looks like and yeah you can see they literally give money to everyone it's not too hard to be surprised as to why the there's not been much push back on much mention of such insurers except by you know independent politicians when we take even just a brief glance at their list of donations the cost of Medical Care in the US is

like inflated at every step of the process and United Health did not become the eighth biggest company in the world by Revenue just through providing health insurance rather what they've done as well is they've systematically acquired all sorts of different parts of the healthcare stack so acquiring groups of doctors pharmacies nursing homes and adding those to the stack therefore they can effectively control how much you're charged at every step of the process and they can ensure that no matter where you are in your treatment you're being seen by United Health Group there are laws in

place that require insurers to take no more than around 15 to 20% of the premium for like profits but by acquiring other parts of the stack they were able to systematically inflate pric across the board and people have seen that reflected in higher medical costs and so it really feels like it's reached a boiling point there was only so far you can push people before they one of them eventually snaps however the thing is United Healthcare isn't necessarily an outlier it's simply the most like egregious example of an infamously quite broken healthc care system where

insurers are rewarded for not actually providing care for doing anything but providing Medical Care and the impact from a civilian perspective has been witnessing death injury and illness throughout their lives I think a lot of the reaction hasn't necessarily been sparked by knowledge of the specifics of the scale of the uh the criminal activities that they've engaged in over the years but it's about something much more visceral right about an understanding that their health has been effectively sold off to the highest bidder and you don't have to necessarily know about specific violations of Medicare Advantage

plans to be able to feel that nor do you have to know about how they treat doctors as well but rather you just have to know about how they treat you your family and your peers which appears to have been almost unanimously negative the lowest income people spend close to a third of their income simply servicing the cost of having health insurance which is extremely unlikely to pay in their moment of deepest need and you know while I can't necessarily like endorse anything anyone has done I can say that I am surprised that like this

hasn't happened sooner I think many people have a mental block where causing a death in a legal manner is seen as not being as bad as causing a death through an illegal Manner and it's you know it's it's not too much of surprised that it was a matter of time before someone felt like the legal system didn't adequately punish people who caused deaths in ways that were seen as being within the law that one person has come to like represent an idea that's way broader than just them it represents deep frustration that people have felt

for many years and it's only now being directed towards the people who have perpetuated the system which has caused them so much pain over the years and which has affected people across the nation in a way that most issues really don't don't [Music]