When I was in solo private practice (a long time ago) I worked with an attorney who would help my patients file "bad-faith business practice" lawsuits against insurance companies who had denied payment of their claims. In a short time, the companies learned that it was less expensive to pay what I had billed, rather than fight a lawsuit. I don't know if the same tactic would work today. After all the company mergers, and after "managed care" became the norm, the health insurance industry is able to wield incredible power over both patients and their doctors. Isn't it about time for American physicians to unionize?
I would love to see some multi-billion dollar, class-action lawsuits against United, Cigna, Aetna, Humana. Basically every financial services business standing between physicians and their patients.
It's been heartening to see more residents and even some attending physician groups constructing labor unions. Practicing one of the greatest forms of service to humanity shouldn't be this hard.
Also, I deeply appreciated the article you posted about moral injury in medicine.
Thank you, as always, for your thoughtful contributions!
Glad the lawsuits helped. I've seen many comments in relation to the shooter along the lines of "I'm not happy about this. I don't want to live in a lawless society. Health insurers may be terrible but they are following the law." And I thought really? That seems improbable. Do they have no contractual obligations? Can they just deny claims willy nilly? No one to answer to for misrepresentation? Like when a representative assures you yes if you go get glasses at walmart they will be covered and then they are not covered and some other representative says well sorry that person was wrong.
There are certain businesses that are nuisance corporations. Verizon. Comcast. Customer dissatisfaction is guaranteed due to the way they handle the sales (bait and switch) and billing (unexpected fees) and customer support (the run around). That is the first thing I thought of when this news broke. The price of annoyance. The price of frustration.
If you reminded people that just 50 short years ago, hospitals were non-profit organizations usually founded by good citizen donors and supported by charities and the community, most wouldn’t believe you.
California is talking about creating a state-level public (non-profit) bank and insulin production capability, and already has a non-profit earthquake insurance system. Kaiser-Permanente is a non-profit health insurer/provider. States as the laboratory for democracy indeed!
On many occasions, I had to be the person who told 20+ year old patients with brain tumors that the best (> efficacious/ less toxic) chemotherapy was not approved by his/her policy. I would actually document the name of the physician who I had peer to peer discussion in the patient medical chart. Needless to say, this is the most heartbreaking part of my job not to be able to provide the best therapy when I know it works!
My best friend/roommate from residency is a pediatric neuro-oncologist at Stanford. Cancer is The Emperor of All Maladies (see Siddhartha Mukherjee) and an incredibly expensive condition to treat.
I've seen countless GoFundMe accounts attempting to fund cancer treatment and life expenses. The salt in the wound is that these accounts are taxed; so the IRS takes a cut of the funds that families are scrambling to raise as a result of an inadequate social safety net.
And the reason for denial is often the unavailability of Phase 3 Randomized Clinical Trial data on very rare neurological conditions. In those circumstances, we are relying on a patient assisted programs administered directly by manufacturers but there are no guarantees, and the process takes time. Meanwhile, the
This has to be priority one for the U.S. public. I guarantee the profit-making, insanely expensive healthcare is causing more harm to your life than immigration ever will!
I spoke with 2 US physicians about emigration this week. One is a family medicine doc who left the country in 2023 to practice in Canada. One is an anesthesiologist considering leaving to practice abroad.
Your story is a remarkable example of how our healthcare system actually works! The most interesting part for me is your theory of the the motivation behind the assassination - send a warning to those who might testify regarding the selling off stocks issue! Seems too frequently our members of Congress are caught selling off stocks because of insider information! You have undertaken a most worthwhile project! I’m going to reread to more fully all you have said! Congratulations and much luck doing what you see as a great need in this country! I just wish things could change so the escape to other countries by medical professionals would stop! You are so needed right here now! You must know I’m serious!
I'm a retired physician/psychiatrist/addictionist/stress researcher and recovered alcoholic-addict. I concur totally with the critique of the American medical industry, the worst medical care system in the developed world. I could write a book! Wait a minute, I did write a book: "Stress R Us", which is available for free from the Stanford e-library as a PDF. I have Medicare at 79yo and a supplemental policy, for $400/mo., and can only get care from a nearby family medicine residency program. I've survived a 15mo LONG COVID episode and 18mo's. of prostate cancer diagnosis and treatment, including chemical castration, on top of the symptoms of LONG COVID. BTW, I nearly died from cardiac involvement with LONG COVID, which left most of my organs scarred, but was 90% improved after two Pfizer vaxs. Did I mention that I wrote a free online book on stress diseases and the history of stress medicine? Thanks for your efforts! Have a blessed day and know that you are not alone! Gregg Miklashek, MD
think a lot of chronic disease has roots in the stress of living in a violent system without a social safety net. Epigenetics and stress hormones, combined with the toxic crap in our food supply, predisposes the human body to profound cellular damage.
It's obvious to me why Americans have a lower life expectancy than most of the developed world.
You're welcome and thanks for your efforts! My lifelong research and study has informed my understanding of the role of the chronic stress hormone "cortisol", with all its catabolic functions, worse with age, and the overactive sympathetic branch of the ANS wearing down the parasympathetic stabilizing reaction to the point where the stress response just drives on unopposed. Then, "stress diseases" result. It's all in "Stress R Us". Have a blessed day and evening! You are not alone and neither am I. Gregg
As a general pediatrician for the past 20 years, I can totally relate. I love my career and certainly didn’t choose pediatric medicine for the $$. Yet every day, I’m asked to see patients in 20 minutes and cover every aspect of their physical and mental health and development in that time. And God forbid if a parent brings up a concern at their child’s wellness visit, as the Optum billers will attach an additional “sick visit” charge to the bill that insurance typically won’t cover! And don’t even get me started on the whole “mid-level” issue…..
Before my injury, I worked in a clinic that required me to schedule patients every 10 minutes. It didn't matter if the kid had non-verbal autism; was a suicidal teenager with a plan; was a baby who spent the first 3 months of their life in the NICU. I was required to schedule 6 patients per hour. No wonder I was always running an hour late.
It's impossible to provide quality care to patients when the goal of the practice owner is to make their Maserati payments. This is a microcosm of how the entire American corporate healthcare system works. Profits over patients.
I have a curiosity about how much you make as a non-specialist? Before the disability what was your yearly or monthly income after taxes and loan repayments, and how many hours did you work for that?
Thank you for being primary care. There’s an enormous lack of PCP care. I live in Maine . Unfortunately I have some serious health issues ( cervical dystonia, Parkinson’s, 3 TBI , I see neurologist therapist PT twice a week, postulate psoriasis of my palms and soles 2 back surgeries… on and on) I’m disabled now , I worked since I left home at 14. It took me 4 drs before my current PCP to even look at my feet. The soles of my feet were covered in sores ( almost like I walked on coals) she was the one when interviewing me to see if I could be a patient who finally would look at my feet. She had never seen such a thing and sent me straight away to dermatologist. My psychiatrist in the same group left for private practice. I have to pay become I just can’t switch providers during what’s happening personally. The UNHC could not tell me what if anything they will reimburse me. Very confusing paperwork I’m still waiting.
My mom passed June 2020 ( not Covid) my oldest sister and I would switch back and forth she would stay 4 days, I 3 ( I lived 2 hours away with 2 sons one a senior in HS) she was in hospice from January to June . We had little support ( understandably with the pandemic).
Telehealth is a lifesaver as well living in Maine and therapy if there is bad weather. Also even my dermatologist when I was healing from my second back surgery in April this year.
Thank you for all this information and I’m going to watch again because I lost much of it while typing out the comment.
It’s so hard. My dad is a retired pathologist who is 88. He got covid last September (2023) he was in the hospital for a month. I thought I would lose him then. My last living parent.
It's sad that everything written in this essay is actually heartening for me, a psych RN for the last 37 years. Heartening because I feel a little less alone. The moral injury cannot be overstated. The concern about MD suicides is appreciated. As are the lives of all the RNs and allied health professionals who show up every day to help people with their healing gifts while spending increasing amounts of energy trying to adapt to the ick in our pond. The depression in health care workers is well-known. Many have died. Thank you Amber Hull and all the others here who are looking for more productive coping behaviors with the slimmest of hopes that something somehow shall change, ignoring again that it is unlikely to be anytime soon. Make stout your hearts.
Medicine, a lay vocation in spiritual terms, is focused properly on the healing and furtherance of the human existence through the remedy of human afflictions.
Doctors and other healthcare professionals have a clear window into a shocking problem in America. Many choose to shutter and drape that window.
We see afflictions of the human body in which human life dwells. In curing there is liberation.
Looking through that window, I see an ever increasing contempt for humanity in our societies. Although societies are constructed by humans, we seem to favor the control of the living by inhuman constructs.
Please pause with me and see Chaplin’s speech from the Great Dictator. For some reason, it makes some people uneasy and angry even still.
Since we have been trained to become bored and uneasy after mere seconds, do something revolutionary. Sit in a quiet room, and let Chaplin talk for the eternity of three minutes, quieting the selfish chatter of your mind.
He speaks of “machine men with machine minds.” Most likely, Brian Thompson was this sort of man. He was murdered recently as CEO of United Healthcare.
But these women and men are but hostages of the machine. Shooting them kills the meat, not the machine. In this way, shooting him in the body only re-enacts the death of humans caused by a wicked, non living entity.
This is the crux of the problem-machines, or humans? One more human has died to feed the machine and the helpless anger that humans have for it.
But we can subjugate the machines, corporations, non-human entities. Humans shall rule or fall extinct.
I spend so much time explaining the diagnoses of specialists! Specialists who get paid exponentially more than I do.
I recently sent an infant to an allergist for what was confirmed to be a peanut allergy. The midlevel "provider" gave the family a prescription for an EpiPen but didn't bother to educate them about anaphylaxis or removing all peanut-containing products from the house.
I know and respect a good PCP when I hear of them. Unfortunately like the rest of the country Maine has a real shortage. It took me 3 drs to even look at my feet. I so appreciate my PCP !
I am so glad to discover you here and read this and hopefully much more! I am so lucky; I had just tried to finish a piece by a hack named Aaron something and was feeling ill at heart. His opinion is that health insurance companies most certainly don’t cause this horrible health care problem, they operate on quite thin margins and their profits are reasonable, almost too small! Thier are the middle man and the scape goat and besides they are so deeply wrapped into investment funds and retirement funds etc…hand wringing bs. I was wondering if he was trying to tell his readers that they should be grateful for the hard and thankless work health insurers do. His numbers were a study in misleading inaccuracy as well. Thank goodness he was a mere unsubscribe away. (Better than the Easy Button!)
I am hoping in your writing you identify something you may not have considered. What can we, John Q Public do about it?
Shooting executives may be quite satisfying for some, especially those that have lost loved ones to care that was denied. I have to admit it’s a pleasant yet unsatisfying fantasy. The reality of it is we all want these bastards to know what they have done in the most visceral way possible.
I know I want them alive. I want them to see the results of EVERY ONE of their denials. I want them to figure out how to juggle costs of living with premiums, co-pays, deductibles, networks, referrals…I want them to experience the grief and anguish of those who’ve lost a loved to a preventable cause for profit.
I want them to burn with shame. And I want this system gone.
I agree that the shooter is long gone . No video of him getting on any of the buses there nor of him leaving . If he did leave on a bus he did it under a different ID. I’m sure he’s in a different country by now. All the executives must sweating bullets. 🎻
When I was in solo private practice (a long time ago) I worked with an attorney who would help my patients file "bad-faith business practice" lawsuits against insurance companies who had denied payment of their claims. In a short time, the companies learned that it was less expensive to pay what I had billed, rather than fight a lawsuit. I don't know if the same tactic would work today. After all the company mergers, and after "managed care" became the norm, the health insurance industry is able to wield incredible power over both patients and their doctors. Isn't it about time for American physicians to unionize?
I would love to see some multi-billion dollar, class-action lawsuits against United, Cigna, Aetna, Humana. Basically every financial services business standing between physicians and their patients.
It's been heartening to see more residents and even some attending physician groups constructing labor unions. Practicing one of the greatest forms of service to humanity shouldn't be this hard.
Also, I deeply appreciated the article you posted about moral injury in medicine.
Thank you, as always, for your thoughtful contributions!
Glad the lawsuits helped. I've seen many comments in relation to the shooter along the lines of "I'm not happy about this. I don't want to live in a lawless society. Health insurers may be terrible but they are following the law." And I thought really? That seems improbable. Do they have no contractual obligations? Can they just deny claims willy nilly? No one to answer to for misrepresentation? Like when a representative assures you yes if you go get glasses at walmart they will be covered and then they are not covered and some other representative says well sorry that person was wrong.
There are certain businesses that are nuisance corporations. Verizon. Comcast. Customer dissatisfaction is guaranteed due to the way they handle the sales (bait and switch) and billing (unexpected fees) and customer support (the run around). That is the first thing I thought of when this news broke. The price of annoyance. The price of frustration.
If you reminded people that just 50 short years ago, hospitals were non-profit organizations usually founded by good citizen donors and supported by charities and the community, most wouldn’t believe you.
I wish we could return to this.
California is talking about creating a state-level public (non-profit) bank and insulin production capability, and already has a non-profit earthquake insurance system. Kaiser-Permanente is a non-profit health insurer/provider. States as the laboratory for democracy indeed!
On many occasions, I had to be the person who told 20+ year old patients with brain tumors that the best (> efficacious/ less toxic) chemotherapy was not approved by his/her policy. I would actually document the name of the physician who I had peer to peer discussion in the patient medical chart. Needless to say, this is the most heartbreaking part of my job not to be able to provide the best therapy when I know it works!
My best friend/roommate from residency is a pediatric neuro-oncologist at Stanford. Cancer is The Emperor of All Maladies (see Siddhartha Mukherjee) and an incredibly expensive condition to treat.
I've seen countless GoFundMe accounts attempting to fund cancer treatment and life expenses. The salt in the wound is that these accounts are taxed; so the IRS takes a cut of the funds that families are scrambling to raise as a result of an inadequate social safety net.
And the reason for denial is often the unavailability of Phase 3 Randomized Clinical Trial data on very rare neurological conditions. In those circumstances, we are relying on a patient assisted programs administered directly by manufacturers but there are no guarantees, and the process takes time. Meanwhile, the
disease is progressing…
I so appreciate all you do and bringing to light, sharing your stories, and the horrors of the reality. Fear is how much worse it will get.
Thank you for your kind words! I share your concern.
This has to be priority one for the U.S. public. I guarantee the profit-making, insanely expensive healthcare is causing more harm to your life than immigration ever will!
I spoke with 2 US physicians about emigration this week. One is a family medicine doc who left the country in 2023 to practice in Canada. One is an anesthesiologist considering leaving to practice abroad.
Your story is a remarkable example of how our healthcare system actually works! The most interesting part for me is your theory of the the motivation behind the assassination - send a warning to those who might testify regarding the selling off stocks issue! Seems too frequently our members of Congress are caught selling off stocks because of insider information! You have undertaken a most worthwhile project! I’m going to reread to more fully all you have said! Congratulations and much luck doing what you see as a great need in this country! I just wish things could change so the escape to other countries by medical professionals would stop! You are so needed right here now! You must know I’m serious!
I'm a retired physician/psychiatrist/addictionist/stress researcher and recovered alcoholic-addict. I concur totally with the critique of the American medical industry, the worst medical care system in the developed world. I could write a book! Wait a minute, I did write a book: "Stress R Us", which is available for free from the Stanford e-library as a PDF. I have Medicare at 79yo and a supplemental policy, for $400/mo., and can only get care from a nearby family medicine residency program. I've survived a 15mo LONG COVID episode and 18mo's. of prostate cancer diagnosis and treatment, including chemical castration, on top of the symptoms of LONG COVID. BTW, I nearly died from cardiac involvement with LONG COVID, which left most of my organs scarred, but was 90% improved after two Pfizer vaxs. Did I mention that I wrote a free online book on stress diseases and the history of stress medicine? Thanks for your efforts! Have a blessed day and know that you are not alone! Gregg Miklashek, MD
Thank you for sharing your story! I
think a lot of chronic disease has roots in the stress of living in a violent system without a social safety net. Epigenetics and stress hormones, combined with the toxic crap in our food supply, predisposes the human body to profound cellular damage.
It's obvious to me why Americans have a lower life expectancy than most of the developed world.
You're welcome and thanks for your efforts! My lifelong research and study has informed my understanding of the role of the chronic stress hormone "cortisol", with all its catabolic functions, worse with age, and the overactive sympathetic branch of the ANS wearing down the parasympathetic stabilizing reaction to the point where the stress response just drives on unopposed. Then, "stress diseases" result. It's all in "Stress R Us". Have a blessed day and evening! You are not alone and neither am I. Gregg
As a general pediatrician for the past 20 years, I can totally relate. I love my career and certainly didn’t choose pediatric medicine for the $$. Yet every day, I’m asked to see patients in 20 minutes and cover every aspect of their physical and mental health and development in that time. And God forbid if a parent brings up a concern at their child’s wellness visit, as the Optum billers will attach an additional “sick visit” charge to the bill that insurance typically won’t cover! And don’t even get me started on the whole “mid-level” issue…..
I so relate to all of this!
Before my injury, I worked in a clinic that required me to schedule patients every 10 minutes. It didn't matter if the kid had non-verbal autism; was a suicidal teenager with a plan; was a baby who spent the first 3 months of their life in the NICU. I was required to schedule 6 patients per hour. No wonder I was always running an hour late.
It's impossible to provide quality care to patients when the goal of the practice owner is to make their Maserati payments. This is a microcosm of how the entire American corporate healthcare system works. Profits over patients.
I have a curiosity about how much you make as a non-specialist? Before the disability what was your yearly or monthly income after taxes and loan repayments, and how many hours did you work for that?
Thank you for being primary care. There’s an enormous lack of PCP care. I live in Maine . Unfortunately I have some serious health issues ( cervical dystonia, Parkinson’s, 3 TBI , I see neurologist therapist PT twice a week, postulate psoriasis of my palms and soles 2 back surgeries… on and on) I’m disabled now , I worked since I left home at 14. It took me 4 drs before my current PCP to even look at my feet. The soles of my feet were covered in sores ( almost like I walked on coals) she was the one when interviewing me to see if I could be a patient who finally would look at my feet. She had never seen such a thing and sent me straight away to dermatologist. My psychiatrist in the same group left for private practice. I have to pay become I just can’t switch providers during what’s happening personally. The UNHC could not tell me what if anything they will reimburse me. Very confusing paperwork I’m still waiting.
My mom passed June 2020 ( not Covid) my oldest sister and I would switch back and forth she would stay 4 days, I 3 ( I lived 2 hours away with 2 sons one a senior in HS) she was in hospice from January to June . We had little support ( understandably with the pandemic).
Telehealth is a lifesaver as well living in Maine and therapy if there is bad weather. Also even my dermatologist when I was healing from my second back surgery in April this year.
Thank you for all this information and I’m going to watch again because I lost much of it while typing out the comment.
I’m so sorry for the loss of your dad.
It’s so hard. My dad is a retired pathologist who is 88. He got covid last September (2023) he was in the hospital for a month. I thought I would lose him then. My last living parent.
It's sad that everything written in this essay is actually heartening for me, a psych RN for the last 37 years. Heartening because I feel a little less alone. The moral injury cannot be overstated. The concern about MD suicides is appreciated. As are the lives of all the RNs and allied health professionals who show up every day to help people with their healing gifts while spending increasing amounts of energy trying to adapt to the ick in our pond. The depression in health care workers is well-known. Many have died. Thank you Amber Hull and all the others here who are looking for more productive coping behaviors with the slimmest of hopes that something somehow shall change, ignoring again that it is unlikely to be anytime soon. Make stout your hearts.
Medicine, a lay vocation in spiritual terms, is focused properly on the healing and furtherance of the human existence through the remedy of human afflictions.
Doctors and other healthcare professionals have a clear window into a shocking problem in America. Many choose to shutter and drape that window.
We see afflictions of the human body in which human life dwells. In curing there is liberation.
Looking through that window, I see an ever increasing contempt for humanity in our societies. Although societies are constructed by humans, we seem to favor the control of the living by inhuman constructs.
Please pause with me and see Chaplin’s speech from the Great Dictator. For some reason, it makes some people uneasy and angry even still.
https://youtu.be/J7GY1Xg6X20?si=f3_FfxO37-KyIAS4
Since we have been trained to become bored and uneasy after mere seconds, do something revolutionary. Sit in a quiet room, and let Chaplin talk for the eternity of three minutes, quieting the selfish chatter of your mind.
He speaks of “machine men with machine minds.” Most likely, Brian Thompson was this sort of man. He was murdered recently as CEO of United Healthcare.
But these women and men are but hostages of the machine. Shooting them kills the meat, not the machine. In this way, shooting him in the body only re-enacts the death of humans caused by a wicked, non living entity.
This is the crux of the problem-machines, or humans? One more human has died to feed the machine and the helpless anger that humans have for it.
But we can subjugate the machines, corporations, non-human entities. Humans shall rule or fall extinct.
That is the enormity of what we face.
On time . I so wish that my neurologist has more time. He never does.
My PCP spends the time explaining to me what is going on ( even about what my specialist tell me)
I spend so much time explaining the diagnoses of specialists! Specialists who get paid exponentially more than I do.
I recently sent an infant to an allergist for what was confirmed to be a peanut allergy. The midlevel "provider" gave the family a prescription for an EpiPen but didn't bother to educate them about anaphylaxis or removing all peanut-containing products from the house.
I know and respect a good PCP when I hear of them. Unfortunately like the rest of the country Maine has a real shortage. It took me 3 drs to even look at my feet. I so appreciate my PCP !
“fully grasp”
Edit: Noah Smith, not Aaron (whatever it was) was the author of the article mentioned.
I am so glad to discover you here and read this and hopefully much more! I am so lucky; I had just tried to finish a piece by a hack named Aaron something and was feeling ill at heart. His opinion is that health insurance companies most certainly don’t cause this horrible health care problem, they operate on quite thin margins and their profits are reasonable, almost too small! Thier are the middle man and the scape goat and besides they are so deeply wrapped into investment funds and retirement funds etc…hand wringing bs. I was wondering if he was trying to tell his readers that they should be grateful for the hard and thankless work health insurers do. His numbers were a study in misleading inaccuracy as well. Thank goodness he was a mere unsubscribe away. (Better than the Easy Button!)
I am hoping in your writing you identify something you may not have considered. What can we, John Q Public do about it?
Shooting executives may be quite satisfying for some, especially those that have lost loved ones to care that was denied. I have to admit it’s a pleasant yet unsatisfying fantasy. The reality of it is we all want these bastards to know what they have done in the most visceral way possible.
I know I want them alive. I want them to see the results of EVERY ONE of their denials. I want them to figure out how to juggle costs of living with premiums, co-pays, deductibles, networks, referrals…I want them to experience the grief and anguish of those who’ve lost a loved to a preventable cause for profit.
I want them to burn with shame. And I want this system gone.
The timing of your comment was so crazy! I was reading that exact article as you were typing this comment!
I didn’t finish reading it.
I agree that the shooter is long gone . No video of him getting on any of the buses there nor of him leaving . If he did leave on a bus he did it under a different ID. I’m sure he’s in a different country by now. All the executives must sweating bullets. 🎻