Deaths due to Willful Systemic Failings are Violent, Too

December 10, 2024

A Man Was Murdered in Cold Blood and You’re Laughing?
What the death of a health-insurance C.E.O. means to America.
The New Yorker
December 7, 2024
By Jia Tolentino

The C.E.O. of UnitedHealthcare, fifty-year-old Brian Thompson, was murdered on the street in midtown Manhattan …

The public reaction has been wild, lawless. The jokes came streaming in on every social-media platform, in the comments underneath every news article. “I’m sorry, prior authorization is required for thoughts and prayers,” someone commented on TikTok, a response that got more than fifteen thousand likes. “Does he have a history of shootings? Denied coverage,” another person wrote, under an Instagram post from CNN. On X, someone posted, with the caption “My official response to the UHC CEO’s murder,” an infographic comparing wealth distribution in late eighteenth-century France to wealth distribution in present-day America. The whiff of populist anarchy in the air is salty, unprecedented, and notably across the aisle. New York Post comment sections are full of critiques of capitalism as well as self-enriching executives and politicians (like “Biden and his crime family”). On LinkedIn, where users post with their real names and employment histories, UnitedHealth Group had to turn off comments on its post about Thompson’s death—thousands of people were liking and hearting it, with a few even giving it the “clapping” reaction. The company also turned off comments on Facebook, where, as of midday Thursday, a post about Thompson had received more than thirty-six thousand “laugh” reactions.  … 

The Norwegian sociologist Johan Galtung coined the term “structural violence” in 1969, in a paper that offers a taxonomy of violence—ways to distinguish between the forms that violence can take. … It can be manifest, or latent. Traditionally, our society fixates on only one version of this: direct physical violence committed by a person intending harm. … 

On this point, though, everyone’s really in agreement. It’s just a matter of where you locate the decay—in the killing, or in the response to it, or in what led us here. The only way to end up in a situation where a C.E.O. of a health-insurance company is reflexively viewed as a dictatorial purveyor of suffering is through a history of socially sanctioned death. … Nurses, residents, aides, specialists—they are asked to absorb the rage and panic induced by the American health-care system, whose private insurers generate billions of dollars in profit and pay executives eight figures not despite but because of the fact that they routinely deny care to desperate people in need. 

Of course, the solution, in the end, can’t be indifference—not indifference to the death of the C.E.O., and not the celebration of it, either. But who’s going to drop their indifference first? At this point, it’s not going to be the people, who have a lifetime of evidence that health-insurance C.E.O.s do not care about their well-being. Can the C.E.O. class drop its indifference to the suffering and death of ordinary people? Is it possible to do so while achieving record quarterly profits for your stakeholders, in perpetuity?

 

I Am Torn: Grappling With the Killing of UnitedHealthcare’s CEO
MedPageToday
December 10, 2024
by James Young, MD 

On the one hand, I shed no tears for Thompson. The man made millions off the suffering of others. More than $10 million last year, in fact. Likewise, every penny of the $22 billion in profit made by parent company UnitedHealth Group in 2023 was at the expense of the suffering of others.

I have no small amount of schadenfreude for what has happened to him. Sometimes, I even find myself wanting to crack jokes at his expense. Is Hell going to require a 2-night qualifying stay prior to admission? Does he have a skilled demonic need that would merit admission to Hell? Others have had similar reactions, posting online comments like, “Unfortunately my condolences are out-of-network,” and “Prior authorization is needed for thoughts and prayers.” …

I hate everything that Thompson stood for. I hate everything that his company stands for and will likely continue to stand for. I expect that the UnitedHealth Group PR and legal teams will use his death as an excuse to stifle any substantive debate or legitimate criticism about UnitedHealthcare with the mantra of, “We need to cool the temperature of the conversation,” or some similar, hollow PR statement.

And yet, I find myself troubled by jumping on the bandwagon of hate.

We need to take this opportunity to mourn the loss of another human being, taken by violence on our streets. We need to show compassion to his family.

We need to say with a single voice that we condemn the actions of Thompson and UnitedHealthcare as vehemently as we condemn the actions of his assassin. We need to warn that too many people — both patients and executives — will continue to suffer until insurance giants put the needs of the patient above those of the shareholder. While I don’t condone more killing or violence against health insurance executives, it’s not unlikely. In fact, it’s already happening. But it needs to be made clear that it’s not rhetoric or debate about insurance company malfeasance driving this action, but the companies’ own actions.

We as physicians need to be vocal, engaged, and seize this moment where the public is now engaged and the media watching, to make the case for why insurance in America is broken.

Ben Shapiro Fans TURN ON HIM Over United Health CEO Take
The Kyle Kulinski Show (on YouTube)
Dec 9, 2024

“It’s not left or right. It’s not black or white. It’s rich vs. poor.”

“Remember folks, Ben … knows exactly what he’s doing. He has more in common with the CEO than 99% of us. Radical change is not about the ‘left’ or ‘right”

 

Comment by: Jim Kahn

In my line of work – quantifying the health effects of health policies and programs – every death counts similarly. Death by illness, medical neglect, accident, or murder is … a death. So I bristle when people tell me that a specific death is particularly egregious. True – untimely, unexpected, avoidable deaths carry a particular emotional weight. And age at death can matter in our calculations. But, ultimately, our standard metrics mean that 100 deaths are, roughly, 100 times as bad as one death.

Thus, I resonated with the widespread response to an insurance CEO’s death. Yes it was a tragedy. It seems like he was a nice man, not deserving of this fate.

However, the job he did – CEO of the largest private insurance group in the United States – made him a symbol of what is wrong with our health insurance.

Indeed, our entire broken insurance approach, built on a foundation of private insurance, generates massive clinical harm. Annual deaths due to lack of insurance are estimated at 40,000 – 80,000. COVID deaths linked to uninsurance topped 300,000. Annual deaths attributable to under-insurance are substantial but much harder to estimate: about half of all adults skip or delay care. My own calculation in HJM based on international data estimates >190,000 excess deaths attributable to our fragmented insurance.

We know this, yet we don’t fix it. Why not? Opposition from corporations and the elected officials they support and lobby. That’s systemic violence.

One caveat: As suggested in the various comments and commentaries, what UHC does wrong is care denials. Certainly, those denials are painful, and symbolic of a lack of caring. Yet they are often clinically inconsequential. Much of what we do in medicine (perhaps 20%) is not effective or even harmful, according to the National Academy of Medicine. We are desperate to try every possible intervention to stave off death. Thus, most care denials probably generate little clinical harm. As reviewed above, the real problem is massive gaps in coverage and access.

How can we fix this? Abandon our for-profit corporate approach to health insurance. In favor of a single, not-for-profit public payer, covering everyone with excellent benefits. As many other wealthy nations demonstrate, this saves resources and prolongs life. Let’s protect individuals (CEOs and others), but most of all let’s protect our population.