Tim Ferriss

“A Man Was Murdered in Cold Blood and You’re Laughing? What the death of a health-insurance C.E.O. means to America” by @jiatolentino for The New Yorker. ​ I don’t love the main headline, but the writing and research are top-notch.

The following quote from the nonprofit People’s Action appears early on: “We know there is a crisis of gun violence in America. There is also a crisis of denials of care by private health insurance corporations including UnitedHealth.” ​ To be clear up front, I view the assassination of Brian Thompson, the CEO of UnitedHealthcare, as a tragedy on multiple levels. Murder is a crime and should not be condoned.

Celebrating killing will only lead to more killing, whose victims will eventually include people you support. ​ I would also like to share some thoughts on America’s healthcare system. As anyone living in the US knows, getting proper care can be unbelievably complex, expensive, and frustrating. More specifically and more personally, I, my family, and most of my closest friends have all experienced mind-boggling difficulties with insurance companies. These difficulties are by design and in service of a business model. Particularly following my last two years of severe chronic back pain, this has become undeniably clear. The deeper you dig, the uglier it gets. ​ Below are examples of what happens when lawmakers and policymakers are too permissive of oligopolies in healthcare that optimize for stock prices over patient outcomes. Excerpted from the piece: ​ ​In 2020, UnitedHealth acquired a company called NaviHealth, whose software provides algorithmic care recommendations for sick patients, and which is now used to help manage its Medicare Advantage program. A 2023 class-action lawsuit alleges that the NaviHealth algorithm has a “known error rate” of ninety per cent and cites appalling patient stories: one man in Tennessee broke his back, was hospitalized for six days, was moved to a nursing home for eleven days, and then was informed by UnitedHealth that his care would be cut off in two days. (UnitedHealth says the lawsuit is unmerited.) After a couple rounds of appeals and reversals, the man left the nursing home and died four days later. The company has denied requests to release the analyses behind NaviHealth’s conclusions to patients and doctors, stating that the information is proprietary. ​ At the same time that news was breaking about the NaviHealth algorithm, the company was fighting—ultimately unsuccessfully—a court decision that it had acted “arbitrarily and capriciously” in repeatedly denying coverage of long-term residential treatment to a middle-school-age girl who repeatedly attempted suicide, and has since died by suicide. Several years ago, government investigators found that UnitedHealth had used algorithms to identify mental-health-care providers who they believed were treating patients too often; these identified therapists would typically receive a call from a company “care advocate” who would question them and then cut off reimbursements. Though some states have ruled this practice illegal, it remains in play across the country. There is no single regulator for a private health-insurance company, even when it is found to be violating the law. For United’s practices to be curbed, mental-health advocates told ProPublica, every single jurisdiction in which it operates would have to successfully bring a case against it.​ ​ Dirty games and dirty players. How do these people rationalize things to sleep at night? ​​ Now, insurers certainly aren’t the only problem, and some smart people like @Noahpinion make interesting and contrarian counter-arguments, but I would suggest reading the comments on his post from MDs and others (what incredible engagement he has!) that highlight some of the issues with his general thesis. For instance: “I think Noah also is glossing over how much of the providers’ own costs are associated with maintaining a bureaucracy for dealing with insurers.” ​ Next, let’s move on to a personal ask. ​ I’m very interested in your thoughts on two things that have been bothering me for a while… ​ A little background first: A study by researchers at Harvard University published in the American Journal of Public Health in 2009 found that approximately 45,000 annual deaths in the United States were associated with lack of health insurance. Of course, this is prior to the Affordable Care Act, etc. and numbers may be smaller now, but… ​ ​Question #1: How might you attempt to estimate the number of people per year with health insurance who die as a result of denied claims? This seems challenging, as it would probably require the cooperation of the very companies denying coverage, but perhaps there is some data mining—or whistleblowing—that could shed some light. Any ideas? ​ Ideally, this would include not only deaths that are easily linked in acute cases (i.e., someone dies within, say, a month of coverage denial) but also those who die a year or more later from complications following the denial(s). I recognize this is probably wishful thinking, but there are a lot of data scientists and brilliant folks among you, so I’m throwing a Hail Mary. Perhaps you can simply come up with a better question that is answerable. ​ ​Question #2: What are plausible options for improving things? Something that could be done—big or tiny—that would apply pressure in the right places? I would love to hear your thoughts. Serious answers only, please. ​ In asking these questions, I don’t know what I can do, but I would like to do something.