The Life in My Years

“My thoughts & prayers were out of network.” ~ A Facebook post reacting to the shooting of Brian Thompson

The vitriol was swift and caustic. Not against the gunman, Luigi Mangione, but against the victim, UnitedHealthcare CEO, Brian Thompson. A Facebook post put up by UnitedHealthcare announcing the death of Thompson received 46,000 responses. UHC took the post down when it was discovered that 41,000 of those responses were laughing emojis.

Indeed, reading social media posts, one had to wonder who was the killer and who was the victim.

---

There’s something uniquely American about healthcare nightmares. The torments go something like this story seen on social media:
“My health insurance denied a PET scan for my husband,” wrote one woman on social media. “He had been diagnosed with a very rare cancer with possible metastatic spread. The first denial claimed it was because he hadn’t had a liver biopsy yet, which he had. The second denial claimed it was because PET scans hadn’t proven their efficacy (they were the ‘gold standard’ test for a decade at that time). The cancer metastasized, and he died six months after diagnosis. He was 51.”

The preceding story begs the question, does one have to pull a trigger to be deemed a killer? Writ large, our broken system is the killer, and it’s a serial killer that’s been at it for decades and decades. The weapons of choice have been, and continue to be, politicians, corporations, executives, courts, and shareholders. And frankly, ourselves. Ourselves for allowing it to go on for decade after decade while screaming about the inequity and cruelty of it all.

Do I condone the murder of a man because he’s the CEO of a healthcare insurer or a pharmaceutical company. No, but more so, I condemn the deaths and ruination of millions of lives in order to gain wealth and to satisfy faceless shareholders. One user on X summed up the quandary quite neatly, “When you shoot one man in the street it’s murder. When you kill thousands of people in hospitals by taking away their ability to get treatment you’re an entrepreneur.”

---

And while death by denial might not be the outcome of an insurance claim refused, or a procedure delayed for pre approval, the outcome is often financial ruin and/or diminished quality of life.

When Sara England discovered that her infant son, Amari Vaca, who had recently undergone open heart surgery, was in distress, she took the child to the emergency room at Natividad Medical Center in Salinas, California. The doctors, who had to keep the boy alive by putting a tube down his throat and manually pushing air into his lungs with a bag until he was stable enough to go onto a ventilator, told England that the boy needed immediate specialized care at the nearest hospital; care that Natividad was not equipped to provide. When the University of California-San Francisco Medical Center informed doctors that they could care for Amari, the boy was flown by small plane and transported between hospitals and airports on ground ambulances. When the bill for $97,599 was submitted to Cigna, the claim was denied on the grounds that air transport was not medically necessary. Link to full story, here.

David Cordani, the CEO of Cigna, has a net worth of $570 million dollars. He could figuratively pull 98 large out of his pocket, pick off the lint, say ‘keep the change,’ and then go and have a quick $200 dollar lunch at Benjamin Steakhouse Prime. In the meantime, Sara England will likely spend years, if not decades, making herself whole, all the while conserving and foregoing while Mr. Cordani indulges in whatever the fuck strikes his fancy.

---

Certainly Brian Thompson and David Cordani rarely, if ever, got involved with individual claim denials. And while from the proverbial 30,000 feet the individual cases might seem nonexistent, those floating in the corporate stratosphere aren’t ignorant of what’s happening on the ground. They know that their wealth comes directly from the misery of people who are struggling with health issues and the crushing financial burdens created by their company policies.

I wonder, while lounging on a white sandy beach in Bora Bora, do the CEOs of insurers and big pharma ever have the morality conversation with their spouses? Are they ever bothered by the idea that their companies are raking in billions in profits off of the backs of the proletariat? Do they think twice about the corporate decisions to streamline medical reviews of real people by using the dispassion of AI and other automated systems? (A ProPublica investigation, published in 2023, found that a system called PXDX allowed Cigna medical reviewers to sign off on 50 charts in 10 seconds. Link to full article here).

Or do they just shrug it off. “Oh waiter! Another mai-tai when you have a chance.”

My wife and I have had numerous discussions regarding the killing of Thompson, and of healthcare in general. Cora offered that she feels sorry for Thompson’s widow and the children. Maybe I was being too uncharitable by responding that I feel for the children but stop short of sympathy for Thompson’s widow who was living the best life that tainted money could buy. “Seriously,” I said. “Are the spouses of these CEOs any different from (the fictional) Carmela Soprano who’s comfy lifestyle came from Tony’s chosen profession?”

---

Do I think that the current wave of moral outrage is going to wash clean the wreckage that defines America’s healthcare system (and I use the word “system” loosely)? Hell no. Americans (at least the pathetically few who chose to take part) voted to elect a man who, at best, will, either by choice or more likely gross incompetence, leave the current woeful system in place. At worst, Trump and the Republicans will take another chainsaw to the ACA and then claim that the voters gave them, to use insurance terminology, “prior authorization.” Challenged in court, SCOTUS will, no doubt, give post-authorization.

For her part, Kamala Harris wasn’t about to be transformational. I suppose it was political expediency that caused her to take Medicare for all off the table after she’d championed it previously. Her 2024 proposal was for incremental change. What a disappointment. Incremental change. I remember that term from the 1960s when middle class white America proposed patience for Black America as an elixir for injustice. Sure worked out for them didn’t it?

---

I remember the wars over healthcare during the presidential campaigns of 2008 and 2012 and the arguments against a national healthcare plan:

You wouldn’t be able to choose your own doctor. Answer: I’m personally on Medicare and I’ve got a huge pool of doctors to choose from.

The government would set up “death panels.” Answer: As opposed to insurance company death panels? You know, the ones trying to keep the stock healthy, if not the patients.

It would make healthcare costs go up. Answer: That claim that has been widely debunked.

Insurance company employees would be out of jobs. Answer: Really? Boo-fucking-hoo. I hear Starbucks is hiring for baristas.

And of course there’s always the tried and true, “but it’s Socialism.” When all else fails unleash the Socialist kraken. It’s the domino theory that scares the bejesus out of Middle America and it goes something like:
Once you have socialized medicine, then they’ll (it’s always the demonic, unnamed “they”) crack down on Christianity, then they’ll outlaw Christmas and hamburgers, then every household will have to hang a picture of Lenin in their living rooms and then …

And then?

Well, then they’ll take away your guns. Bingo!

I’m 71 years old and the Socialism argument is older than me. When Harry Truman proposed a national healthcare system the American Medical Association screamed bloody Socialism.

---

I would love to believe that the death of Brian Thompson and the ruination of the lives of his family and the wasted life of Luigi Mangione who may spend most of his days in prison, will not be in vain, and will lead to a lasting, fruitful discussion on healthcare that will end with a meaningful national healthcare system that will finally put the United States on par with the rest of the civilized world.

My realistic fear is that this rising tide of outrage will ebb – just like all the other outrages du jour.

Meanwhile, in Idaho, Doctor Eunice Stallman has been battling the ghouls at Blue Cross who have denied a treatment for Doctor Stallman’s infant baby girl, Zoey, who is suffering from brain cancer. Link to full story, here.

I honestly don’t know how some people can look at themselves in the mirror.

---

Final note: I truly believe that there’s a worldwide reckoning that’s to come, one that I most likely won’t be alive to witness or be a part of, one that will span multiple issues, not just healthcare. That reckoning will occur when the middle class is on the brink of extinction, and the gap between what’s left, that is the rich and the just struggling to make it and the downright dirt poor, becomes so insurmountable as to be intolerable for the oppressed.