An Unsympathetic Death

Last week, United Healthcare CEO Brain Thompson was murdered in New York City on his way to a conference of investors in his American health insurance company. To say that the public has been unsympathetic would be grossly understating the sentiment. It has sparked widespread discussion in the United States over the troublesome private health care system in the country — the same one that conservative governments have been quietly working hard to bring back to Canada.

On the face of it, it’s hard to be sympathetic to the death of a man who has made himself wealthy denying medically necessary care to his clients. Were there to be a public manhunt for those responsible for every medically avoidable death, there would be little else in the news.

The numbers speak for themselves. Reddit user TA-MajestyPalm took public data from the US government to produce this chart on the rate of claims denial by health insurance provider, showing that United Healthcare in particular denies a full third of claims, more than any other provider in the country.

TA-MajestyPalm posted this chart to Reddit from government data. Shared with permission.

If you are lucky enough to get health insurance, which in the United States almost always requires you to be employed to get, you have an only slightly better than even chance of getting the medical treatment you need, if you can have the visits needed to determine what that is approved in the first place. Studies done over the years — none recent, presumably because nobody has a financial interest in gathering the data — have shown that somewhere between 26,000 and 45,000 Americans die each year as a direct result of not having health insurance, in all cases higher than the country’s famously high murder rate. That does not count the deaths of those who have it, but who are unable to use it.

The Affordable Care Act — the famous Obamacare that Trump wants to repeal — has improved coverage somewhat, though 25 million Americans still don’t have any health insurance at all, but the act does not force health insurance companies to approve claims. Health insurance claim denials have been steadily rising ever since.

At its core, healthcare has no business being a user-pay private for-profit industry. Most developed countries have public healthcare because we see health as a fundamental human right. I’ll never forget an interview I heard on CBC radio as a kid where Montreal-area homeless people were interviewed about their lives, and one of them commented that at least he had his health card. Universal access, in practice, requires equality of access. If some can buy their way to access, it necessarily reduces access for those who cannot afford to do so. By forcing everyone into the public system, the system has to be robust enough for everyone as the decision makers themselves must participate in the system they control.

Over the past roughly thirty years, the door has been cracked open to user-pay private health care in Canada, and provinces have been jumping into it whole hog. Quebec is leading the country on doctors who ‘choose not to participate’ in the health care system and bill patients directly, with the inevitable consequences of a collapsing public health system which, in turn, drives demand for user-pay healthcare. It is far from the only province doing so and our much vaunted universal healthcare system in Canada is under significant pressure to fail.

If you are trusting Pierre Poilievre to take the reins of the country next year and save our health care system, think again. The government of Stephen Harper made no attempt to protect the public health system and much of the structural failures that we have seen were set in motion on his watch. Trudeau has spent most of his 9 years in office trying to improve the health care system but the die has been cast and provinces are not receptive to the needed improvements — and no federal government has the courage of their convictions or the use of their powers under the Canada Health Act to financially pressure provinces into compliance.

Canada’s public health system is in a very sad state. We don’t train enough doctors or nurses, we don’t allow interprovincial migration of credentials, we don’t do enough to recognise foreign credentials, and we aren’t doing enough to fix any of it. If you are willing to pay up front, however, access to medical services is increasingly fast and efficient.

Culturally, we normalise private user-pay health care from a young age. As I have relearned songs for young kids for my youngest, I was frustrated to note the words to the nursery rhyme “Miss Polly had a dolly”. The oft-sung story talks of a sick child requiring a doctor’s visit, at the end of which the doctor says he’ll be back in the morning “with his bill bill bill,” ingraining the expectation that seeing a doctor will cause direct financial outlay.

When Brian Thompson was killed last week, the shooter left messages scratched directly into the bullets and shell casings believed to read “delay” “deny” “depose”, a thinly veiled reference to the book “Delay, Deny, Defend” on insurance industry practices that have ended the social contract to actually provide insurance.

The alleged shooter, Luigi Mangione, was captured in an Altoona, Pennsylvania McDonald’s after an employee there called in a tip. The social media reaction has been to review-bomb that McDonald’s (“rats everywhere”) and there’s a common theme around the Internet wishing New York prosecutors good luck finding 12 New Yorkers who aren’t angry at the health insurance industry for the jury.

20 years ago last week Tommy Douglas was named the “Greatest Canadian” ever to have lived for having driven the creation of Canada’s universal public healthcare system. In the face of bubbling anger against a system designed to literally sell American lives for profit, Canada would be well advised to seek ways to dramatically and rapidly rebuild our dying source of pride rather than joining our southern neighbours in bankrupting their people for the simple act of staying alive.