Lenin is alleged to have said “There are decades where nothing happens; and there are weeks where decades happen.” Snopes.com says it’s not true. That Lenin never uttered the quote.
A similar version of the quote was published in 1908, during Lenin’s lifetime, although there is still no evidence to link it to Lenin himself. This version was published in “The Devil,” a novel by Dutch-American author Adriaan Schade van Westrum:
“There are years, centuries, in which nothing happens, and there are days, like yesterday, into which a whole lifetime is compressed.”
Van Westrum’s novel was based on the Hungarian playwright Ferenc Molnár’s 1907 play of the same name (in the original Hungarian, “Az Ördög”).
History often chugs along with no changes. Then suddenly there are seismic changes.
On December 4, 2024, the CEO of United Healthcare, Brian Thompson, was assassinated outside the NY Hilton, just before shareholders were scheduled to meet.
As this is being written:
“Deny,” “defend” and “depose” were written on the live rounds and shell casings discovered at the scene of Wednesday morning’s shooting – which detectives interpret as a possible message from the suspect.
It furthers their working motive that the suspect held a grudge against the insurance company. They are checking every dispute or contested denial of service brought against the company, as well as running down every threat made against the UnitedHealthcare CEO.
The killing unleashed the public’s fury. At insurance carriers.
In one stark example, a Facebook post by UnitedHealth Group expressing sadness about UnitedHealthcare CEO Brian Thompson’s death received 62,000 reactions – 57,000 of them laughing emojis. UnitedHealth Group is the parent company of UnitedHealthcare, the division that Thompson ran.
Almost immediately after news broke that Thompson had been killed, social media users began posting about their frustrations with UnitedHealthcare and other insurance companies.
UnitedHealthcare “denied my surgery two days before it was scheduled. I was in the hospital finance office in tears (when I was supposed to be at the hospital doing pre-op stuff),” one user wrote in an X post that received more than 70,000 likes. “My mother was flying out to see me. My surgeon spent a day and a half pleading my case to United when she probably should have been taking care of her other patients,” she added, before saying the surgery ended up going ahead but calling the process “torture.”
“My breast cancer surgery was denied” by a different insurance company, another X user posted. “Breast cancer. She asked me ‘well, is it an emergency?’ I don’t know- it’s (f***ing) cancer. What do you think? I had to appeal and luckily it went through. Evil to do that to people,” she said.
Their stories could not be independently verified by CNN.
TikTokker and anesthesiologist Brian Schmutzler said in a video that the shooting was “obviously tragic for him, tragic for his family, but this brought up some bigger issues.”
“From my perspective, we have a bigger issue with the insurance companies in general, who, essentially, it’s their job to make money, not to actually pay for health care,” he said.
In a blog post Thursday entitled “Why ‘we’ want insurance executives dead,” journalist Taylor Lorenz, who covers social media, analyzed the online responses: “No, that does not mean people should murder them. But if you’ve watched a loved one suffer and die from insurance denial, it’s normal to wish the people responsible would suffer the same fate.”
Lorenz’s post sparked a wave of backlash online.
More public outrage:
“Thoughts and deductibles to the family,” read one comment underneath a video of the shooting posted online by CNN. “Unfortunately my condolences are out-of-network.”
Supposedly, and ironically, Mr. Thompson was individually working to soften the harshness of the country’s largest health insurance carrier. He was given zero credit for that mission.
The author Joyce Carol Oates weighed in on social media… saying that the outpouring of negativity “is better described as cries from the heart of a deeply wounded & betrayed country; hundreds of thousands of Americans shamelessly exploited by health-care insurers reacting to a single act of violence against just one of their multimillionaire executives.”
In totally unrelated news of the week, Anthem BCBS back peddled on its recent update for paying anesthesiologists, or actually denying payment if the provision of anesthesia services lasted too long.
After sharp criticism from anesthesiologists, an insurance company is halting its plan to limit the amount of time it would cover anesthesia used in surgeries and procedures. Anthem Blue Cross Blue Shield said on Thursday it would no longer move forward with the policy change.
“There has been significant widespread misinformation about an update to our anesthesia policy. As a result, we have decided to not proceed with this policy change,” the company said in a statement. “To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.”
Anthem Blue Cross Blue Shield insurance representing Connecticut, New York and Missouri had previously said that, starting in February, it would deny any claims for anesthesia services that exceeded specific time limits set for surgeries and procedures.
Anthem had said the change was part of an effort to make health care more affordable by reducing overbilling for anesthesia.
I’m not sure what problem Anthem was trying to solve. Are anesthesiologists just sitting around passing gas (no pun intended) long after the surgeon has finished, just to collect more money? Really?
Anesthesiologist services are related to how long the surgeon takes to complete the case. Seriously. I didn’t know this point was controversial. Even if it were true, which it isn’t, the problem would self-correct. The next surgeon will be busting down the OR door to get his next case in the room.
Anyway, Anthem came to its senses, and properly read the room.
Wait, there’s more.
Earlier this year,
The state’s largest health insurer, Blue Cross Blue Shield of Massachusetts, [began] restricting the use of anesthesia during colonoscopies, triggering a backlash from doctors who argue[d] the change [would] discourage people from going through an already unpleasant but important procedure.
The dispute [wa]s over the level of sedation required for people getting colonoscopies and other similar procedures, known as endoscopies. Doctors often prefer to use anesthesia, also known as deep sedation, which puts patients to sleep. But Blue Cross officials sa[id] many patients at low risk of medical complications don’t need anesthesia and can be examined while they’re sedated, but awake, which is known as moderate or conscious sedation.
Blue Cross officials sa[id] they [would] no longer pay for anesthesia unless patients [met] certain criteria — for example, if they ha[d] chronic conditions or a documented fear of medical care.
The new rule, which took effect Jan. 1, represent[ed] a significant shift. Across Massachusetts, most patients — about 60% — are asleep for colonoscopies, and at some clinics, anesthesia [wa]s used for virtually every procedure.
The policy change likely [meant] that more patients with Blue Cross insurance [would] be asked to stay awake with moderate sedation for their procedures. In some cases, patients who receive anesthesia [would have been] be responsible for the cost, which [could] run in the hundreds of dollars or more.
After receiving pushback from the American Gastroenterological Association, and others, BCBS of Massachusetts folded.
On January 1, we began enforcing a longstanding policy intended to ensure that our members get the appropriate care when they undergo important gastrointestinal screening procedures such as colonoscopies.
Since then, it’s become clear to us that there is confusion about the policy and the reasons for it. The confusion stems from inaccurate information about our coverage for the different types of sedation available to members for these procedures.
The purpose of our action was to ensure that our members receive the type of sedation most clinically appropriate for them and consistent with national medical guidelines.
Given the confusion, we’ve decided to pause enforcement of this policy while we work to make sure our members understand all their options for colon cancer screening and sedation and that they feel confident they’re getting the care that’s best for them.
If BCBS Massachusetts wants to lift this “pause”, it should lead by example. Its C-suite officers should record videos of them undergoing screening colonoscopies without anesthesia. Show the public how to accept an Olympus scope with courage and a stiff upper lip.
As Nobel Laureate Bob Dylan once quipped, The Times They Are a-Changin’.
What do you think?
The elephant in the living room that few discuss is mentioned here: insurance companies make money by collecting more than they pay out. If they paid out nothing, they’d make nothing because no one would buy their product. If they paid out everything, same result, but for the opposite reason. So they have to find a sweet spot–pay enough so people will keep giving them money, but rig the system so that they still have some left over.
What no one says–but is obvious on its face–is that this creates the ultimate conflict of interest. And they don’t disclose it. While everyone reading this understands this point, most average Americans don’t. Which means that insurance companies’ actions are overtly fraudulent–they’re taking unfair advantage of most of their customers.
So, how to solve the problem? It’s not as difficult as it seems. If someone wants to work for a medical insurance company, they get a 7-year contract. That sets the salary, which cannot vary from what’s negotiated. No bonuses are allowed. No stock options. No incentives of any kind. The salary can be whatever the board of directors wants it to be, and it can increase annually, but not excessively. But that’s it. They can only be fired for cause, but they can quit. If they quit, though, the same salary is in effect for whoever comes next. And the guy leaving cannot work for another insurance company again. Ever. He can’t job hop to find a better salary until his contract expires. Golden handcuffs.
This removes incentives to increase profits. Insurance companies really have no business making profits in the first place, at least if they’re publicly traded. And why should medical insurance companies be publicly traded in the first place? How about requiring them all to go private with their profits? Then no one gets a bonus for screwing patients.
In a novel by Robin Cook from the 1980s–Mindbend–he ends the book with…
“AUTHOR’S NOTE “Since I graduated from medical school in 1966, I have heard the term “crisis in medicine” so often that it conjures up the allegory of the shepherd boy who cried wolf too many times. But until now the crises have all been voiced by particular interest groups and were often contradictory: too few hospital beds, too many hospital beds; not enough physicians, too many physicians. It was enough to make anyone confused and apathetic. “But now I have come to believe that “crisis in medicine” is applicable in a truly general sense. Unfortunately, because so many people have cried wolf in the past, the media have only just begun to take note of this very real crisis. What we are witnessing today is the gradual but quickening pace of the intrusion of business into medicine. It must be understood that the corporate mentality of the balance sheet is diametrically opposed to the traditional aspects of altruism that have formed the foundation of the practice of medicine, and this dichotomy augers disaster for the moral and ethical foundations of the profession. Big Business views the medical field as a high-cash-flow, high-profit, low-risk, and low-capital investment industry that is now particularly ripe for takeover.”
Pretty perceptive, nest-çe pas?
Unfortunately, today’s atmosphere, combined with Corporate Greed, has led to the near total corporate take-over of independent medical practices and, now catching up, dental practices. And more unfortunately, the recent graduates haven’t had the opportunity to work in private practice, so they only know the production driven corporate practice and think that grind is normal.
What is happening now, at least in dentistry, is that supply costs went up in the pandemic and are not coming back down (now that supply chain issues have resolved.) Corporations, because they order more, pay lower prices for everything than the small private practices. And insurance companies, for whatever reasons, reimburse the corporations at a far higher rate than the small private practices. In fact, insurance companies are actually cutting reimbursement to small private practices. We are, in essence, being squeezed out of business by both the greedy suppliers and the equally greedy insurance companies. As it is said, “Bend over.”
1)It is sad that a murder had to take place to focus national attention on the outrage of so many Americans, paying for prepaid health maintenance, not insurance. With insurance there is stratification for risk, which really no longer occurs in healthcare.
2)There is a genuine problem because health “insurance” companies deny care on a massive basis, based on the large number of stories that we hear and know about (not the thousands more that are not seen or heard, but never are acknowledged).
3)When I lived and practiced anesthesiology in central NY, we were reimbursed about 85% of what we billed by BCBS of Central NY, and we were non participating but the insurance company mailed us the checks. When I moved to Kentucky decades ago, my premiums for my own insurance doubled, and Anthem reimbursed 30% of what we billed.
4)Medicare cut anesthesia reimbursement in half in 1987. Today 35 years later, the reimbursement has still not made it back to what it was in 1987 before the cuts. It seems to me that everything else has more than doubled.
5)Colonoscopies are performed under sedation with propofol usually on an infusion pump. You can call it conscious sedation, but that is a fiction. The patients are not conscious and it is hardly just sedation. It is more appropriately IV general anesthesia. It makes the patients comfortable, and it allows the procedures to be done safely, without patient movement, and allows the procedures to be done faster.
6)We never see the numbers of denied claims in the US. Each insurance company should be required to publish the raw numbers of claims filed, and the numbers denied, and the % of such denials. The public would be astonished by how many claims are turned down. That leaves the patients to pay the bill themselves. HOWEVER, if patients protest, and protest again and again, eventually the insurance company pays the bill. Few patients know to do this.
7)Anesthesiology, as a specialty early in the life of the specialty decided that the fairest way to bill for a procedure was to bill a base # of units for the procedure, to cover basic set up work, risk, etc. and then charge time units typically in 15 minute increments since surgeons control the length of the procedure, and there was enormous variability in times. The unit had a $ figure attached to it that was set by the anesthesia group, or provider. BUT medicare insisted on setting the $/unit reimbursement rate, and set rates for each area.
Insurance companies have been trying to reduce the base units, and also the number of time units per procedure for decades. The insurance companies have practiced medicine by trying to tell physicians and hospitals what procedures they will and will not cover and how much they will pay for each procedure. By electing to set flat fees, insurance companies have driven hospitals and physicians deeper into a hole, that they can only make up with more volume.
8)The profit margin for most businesses is 5%. For healthcare it is 2%. Regulatory requirements, drive up needs for administrative staff. Hospitals have cut maintenance staff, and maintenance, and all other departments, including clinical departments to pay for administrative staff. This is why California mandated nurse patient ratios, because hospitals had cut clinical staff so much.
9)Medicine is the ONLY business, where business people (physicians) that do not control what prices are charged, and they do not control what is reimbursed.
In a business, you know what you are going to charge, and what you are going to collect.
Is there any wonder about why physicians have no autonomy and burnout rates are rising rapidly?
How do you solve a problem like Luigi? He’s become an Ivy League martyr for the young libertards, and a heart throb for all of the single Marios who are attracted to the bad-boy-type.
Let’s call a spade a spade. Nearly half of this country voted for democratic socialism with BHO twice, and again in the belly of the demented Trojan Horse. For 16 years, our citizens allowed our government to control healthcare AND education. The control of education is complete, but the capitalists still have a hold on healthcare. That led to an indoctrinated sociopath to have a delusional tantrum resulting in murder. I digress – After extradition and a stint at Riker’s, Lu won’t need any sedation for a 10mm Olympus.
We are about to renew our Horizon Omnia Silver plan for our family of 5, and the premium in 2025 is $41,000 for shit on a stick. UHC is $6,000 less, but since UHC is the lowest payor, fewer docs participate and that limits emergency care. What’s the solution? Pray.