鬼百合
One day we will wake to his obituary :-)
‘It’s a death sentence’: US health insurance system is failing, say doctors
Firms including United Healthcare have denied basic scans and taken months to reconsider, physicians say
www.theguardian.com
Firms including United Healthcare have denied basic scans and taken months to reconsider, physicians sayMichael Sainato
Sun 26 Jan 2025 07.00 EST
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American doctors are accusing US health insurance giants of causing deadly delays to vital medical procedures and care – and putting profits ahead of their patients’ health.
Firms including United Healthcare have denied basic scans, and taken months to reconsider, according to physicians who spoke to the Guardian.
“There’s good evidence that these kinds of delays literally kill people,” said Dr Ed Weisbart, former chief medical officer for Express Scripts, one of the largest prescription benefits managers in the US. “For some people, this isn’t just an inconvenience and an annoyance and an aggravation.
“It’s a death sentence, and the only reason the insurance companies do that is to maximize their profits. The fact that they might be killing you is not in the equation of what they care about.”
Americans spend the most on healthcare in the industrialized world – an estimated $4.9tn in 2023 – but have the worst health outcomes, according to analysis by the Commonwealth Fund.
The fatal shooting of UnitedHealthcare CEO Brian Thompson last month prompted an outpouring of public anger toward the healthcare industry. While private insurers report billions in profits every year, many patients – and their doctors – struggle to navigate a complex financial system to get what they need.
Lobbyists for the insurance firms insist they are “working to protect” people from higher costs, and stress that everyone in the space, including doctors, are responsible for making the US healthcare system care more affordable and easier to navigate.
But in a series of interviews, medical professionals described their frustration with a powerful industry which had prevented them from helping patients.
‘We’re stuck in this terrible, vicious circle’
Dr Cheryl Kunis, a board member at the Physicians for a National Health Program and nephrologist in New York City, still thinks about what happened when one of her patients needed a PET scan. He had a tumor, and before deciding on how to treat it, Kunis and her colleagues wanted to establish if it had spread.Dr Cheryl Kunis
“The surgeon was very honest that he only wanted to operate if the tumor was localized, and without the PET scan, he really would not be able to make that decision,” said Kunis. “The surgeon and his office, as well as my office, spent hours on the phone. We were speaking to somebody who was sitting at UnitedHealthcare in front of a computer screen who was really not knowledgeable on the underlying medical problem or the test that we are asking for the patient to have.”
After an initial denial, the patient’s appeal for the scan was ultimately approved six months later. By that the time, the patient had died.
“We assume that if he had been diagnosed earlier, he may have been able to do better,” said Kunis. “There’s no way of proving it, but there was a reasonable chance he would have been in better shape had there not been a six-month delay in getting the scan.”
The healthcare system is “just really stuck in this terrible, vicious circle”, she said, “of prices constantly going up, lack of regulation and the insurance companies unfortunately having leverage over the patients who are trying to receive the care”.