the “healthcare” industry (thread includes entire film “Sicko” for free)

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  • #153712
    Avatar photozn
    Moderator

    from Quora (David Marshall)

    A decade ago, I worked for UHC for about a year. The culture made me uncomfortable. I worked in claims appeals. This would entail a claim that has been denied initially when filed by the provider. It would then go to a claims adjuster to review before coming to us on appeal.

    Accuracy was stressed in training. However, once we graduated to the floor after a 6-week class (ours turned into about 8 due to holidays, etc.) It became quickly apparent that accuracy took a back seat to working claims quickly. We were given a quota to work 80 claims per day. Bonuses were awarded based on accuracy and percentage worked above the quota. Coming out of training they checked 4 claims per month for accuracy. However, once you reached quota that number dropped to 1 per month, if I remember correctly. And once you hit above a certain percentage of quota, they no longer checked claims for accuracy.

    Do you see the problem here? For someone like me who understood that the claims assigned to me represented real people’s lives, I wanted to make sure my claims were worked with the highest level of accuracy. I didn’t have a single month where I wasn’t at 100% accuracy. However, they stayed on me and some others on our team because we worked about 60–80 claims per day. That number represented us going through their Standard Operating Procedures carefully. However, we had people who regularly worked 200 or more claims per day. They knew they wouldn’t be checked for accuracy. Even worse, they were rewarded financially for working that many claims, as were the team managers and those above them. I had a colleague from class who was considered a superstar because he was hitting these crazy numbers. He told me he just denied a claim without looking at it and moved on to the next one. He also said a manager told him they only checked the claims in which we paid out.

    God knows how many claims were denied in error with this system. But, the system worked in favor of the company. Our team manager wouldn’t check this guy’s work, because it put money in his pocket, too, when he turned in 200 claims per day. Likewise, the call center managers didn’t rock the boat either because they profited from the denials.

    There is something called a corrected claim. These were claims that needed a correction, often in favor of the provider. I can’t tell you how many times UHC changed the rules for corrected claims while I was there. There was one week in which they changed the policy three times. These frequent procedural changes occurred so often to maximize the benefit in the company’s favor. Never once did the new criteria favor the providers asking to be paid.

    I was never so happy to leave a company in my life.

    #153714
    Avatar photozn
    Moderator


    .

    #153715
    Avatar photozn
    Moderator

    from Quora (Franklin Veaux)

    Why are Americans still against universal healthcare after decades of abuse from health insurance companies?

    Because they’ve had decades of slick, highly polished propaganda from insurance company marketers.

    I’ll give you an example:

    When you talk to someone who’s strongly opposed to universal health care, one of the arguments you’ll likely hear—I’ve heard this argument trotted out over and over again—is that insurance company profits are quite small, typically between 2% and 3.3%.

    That makes people believe that health insurance companies only add a tiny percentage to healthcare costs: two or three percent.

    Wrong. Wrongo Wrongo wrong wrong wrong.

    This is the Minnetonka headquarters of UnitedHealth:

    The cost of this building is not included in their profits.

    The cost of paying every person who works in this building is not included in their profits.

    The cost of the thousands of other buildings they own and the 440,000 people they employ (yes, seriously, 440,000 people) is not included in their profits.

    The cost of their investments is not included in their profits. When you send your insurance premium in, that money doesn’t sit in a bank account. The insurance companies invest it in for-profit enterprises. For example UnitedHealth is a huge landlord, with over a billion dollars’ worth of rental housing in its portfolio, administered by a large network of subsidiaries you probably have no idea are associated with a health insurer.

    In 2023, UnitedHealth posted total revenue of $371,600,000,000 and paid out $308,428,000,000 in medical claims, for a difference of $63,172,000,000.

    That’s sixty-three billion dollars just one insurance company brought in that did not go to paying for healthcare.

    So no, private for-profit insurance does not add only 2% to healthcare costs.

    But their propaganda makes it sound like it does, and a lot of Americans believe that it does.

    And that’s not even counting the ridiculous made-up horror stories about wait times and such in places with universal healthcare. Those stories are obviously absurd, but most Americans never travel abroad so they have no idea how ridiculous the lies are that they’re swallowing.

    • This reply was modified 1 month, 2 weeks ago by Avatar photozn.
    #153762
    Avatar photozn
    Moderator

    from quora: Susanna Viljanen
    ·

    Why aren’t more people showing empathy towards the UnitedHealth CEO who is as murdered? Why are people defending the suspect?

    Because people in the US are sick and tired of the American profit-oriented health care and paying through the nose – and even more so with the insurance industry, which they see as a legalized racket.

    What we know is that:

    The murder is pre-meditated and definitely targeted. The murderer arrived with a bus which had left at Atlanta, GA, using a fake identity, and stayed in a hostel in NY, using another fake identity
    He prowled the victim for ten minutes before shooting.

    He used an unconventional weapon.
    The casings found at the site were signed “deny”, “defend” and “depose”, referring to a book about abuses of the insurance industry
    The murderer escaped just in a way we were taught in the military: leaving fake tracks, using multiple vehicles, using diverted routes. His tracks go cold in the Central Park.
    His backpack has been found – full of Monopoly money

    It’s been over three days now. It is likely his identity will never be resolved as the tracks have gone cold. He is most likely away from the NYC already – perhaps escaped abroad.
    What we know also is that United HealthCare (UHC) has been the most ardent insurance company to reject insurance claims, and Brian Thompson has been suspected on fraud and insider trading. He has also implemented a deeply flawed AI to handle the insurance claims.

    It is personal. My estimation is someone whose insurance claims have been rejected by UHC and who has a fatal disease – or a loved one of someone whose insurance claims have been rejected. He is not a professional, but likely to have previous gun handling experience and at least rudimentary experience on guerrilla warfare tactics. He has a sick sense of humour (the signed cartridges, the backpack full of Monopoly money) and he wanted to mock and harass both the medical insurance industry and NYPD. It is likely we will see similar antics in the next days.

    I do not think the case is about a triangle drama – or a competiting insurance company. It may also be the murderer is a disgruntled employee of the UHC – someone thoroughly morally disgusted on being a part of what they see as a legalized racket. Who might want Thompson dead?

    Anyone, who or whose loved one has died, become moribund, or left permanently crippled, or gone bankrupt due to rejected insurance claims. Any corporate employee, who is disgusted on working in a racket not unlike Mafia. Anyone, who is sick and tired by being screwed by the profit-oriented medical care and the legalized fraud of the insurance industry. Anyone, who has medical debt. Anyone forced to pay 10 to 100 times more of medicines than EU citizens – and does not have an access to Mexico or Canada for medicines. Anyone with a pre-existing condition. If we narrow down only to those whose claims have been turned down by UHC, we can narrow the pool of suspects down to 8.1 million people.

    NYPD initially offered a 10,000 USD reward for any clues leading to apprehension. Now the reward has been raised to 50,000 USD – but the posters have been defaced and torn off. Seemingly the New Yorkers do not want the murderer to get caught.

    Brian Thompson is seen as the bad guy. He implemented a deeply flawed AI to handle the insurance claims, rejecting one third of the claims, and it was found the AI got wrong in 90% of the cases.

    But even worse and more unethical was found. The AI was found to be optimized to find cases where the company would gain the biggest profits by denying the claims and where the patient would be too weak to protest and raise a lawsuit against the company, and where actual immoral practices would produce an arbitrage. AI actually kills people. Brian Thompson has been seen as the guy who presses that black button which kills someone – and brings him million dollars.

    Physical violence is the last resort of the poor and the downtrodden, and in a country so immersed in firearms, something like this was bound to happen sooner or later. It happened sooner. I sincerely hope we will learn something from this.

    The murderer is now fifth day on the loose. Each day means diminishing chances of him ever getting caught. It is likely he has already escaped the country and is out of the reach of justice – many countries refuse to cede wanted criminals in countries which have death penalty. Some 50% of all murders in the US go unsolved anyway.

    #153772
    Avatar photowv
    Participant

    They caught him, i see. Sigh.

    A tweet, i read:

    “Wild that the McDonald’s employee who snitched on Luigi Mangione probably can’t even afford healthcare.”

    w
    v

    #153816
    Mackeyser
    Moderator

    I don’t believe they got the guy.

    You don’t grow a unibrow in a day.

    As mentioned in Minority Report, you never find an orgy of evidence.

    He’s in so much pain he has to kill the CEO of United Healthcare, but he sits on a bus from Georgia and lays in wait? Has no one who set this up ever ridden a bus for more than an hour?

    He’s pissed and goes out of his way to hide his identity and not be caught on camera using multiple fake identities (the guy used to lead an AI undergrad group at Stanford), but he takes off his mask and flirts with a McDonalds employee AFTER photos are released to the media?

    Either he’s the stupidest smart guy in America who can flirt while in immense pain or this is all bullshit.

    I’m going with bullshit.

    Sports is the crucible of human virtue. The distillate remains are human vice.

    #153822
    Avatar photozn
    Moderator

    #153838
    Avatar photoZooey
    Moderator

    And that’s not even counting the ridiculous made-up horror stories about wait times and such in places with universal healthcare.

    And ignores wait times here. My hernia surgery was approved in April, and I waited until in late October for the procedure. Just saying.

    something like this was bound to happen sooner or later. It happened sooner.

    I’d say later, myself. But I’m the guy who, in the 80s, said the easiest way to inflict a bunch of terrorist damage would be to fly a plane into a target building. So maybe I’m just an unfulfilled and gifted criminal mastermind.

    If they indeed have the actual guy, he was either resigned to getting caught, or intended to get caught from the beginning. I guess there is more to the story, but it sure seems strange that he did everything professionally…except dispose of incriminating evidence – you know – the MOST obvious precaution any moron criminal would do. More to come, I guess.

    #153839
    Avatar photowv
    Participant

    #153899
    Avatar photoZooey
    Moderator

    Fun fact.

    Listening on the commute to 9ers radio, and they had a bit on picking a few games this weekend, and Philly/Pitt came up, and one of the guys got distracted by the battle for PA which reminded him of the following:

    Luigi’s mom filed a Missing Persons report for Luigi when he dropped out of contact for, like, 6 months or something. When that happens, police departments around the country get notified just in case.

    Some SFO cop made the connection between the photo of Luigi and the missing persons photo, and reported his observations, making Luigi a suspect.

    How all this fits with the subsequent arrest and the McDonalds story he did not say, but I thought that was interesting.

    #153994
    Avatar photozn
    Moderator

    A Manifesto Against For-Profit Health Insurance Companies
    I hereby give you my Oscar-nominated Documentary on the Killer Health Insurance companies like United HealthCare —SICKO — for FREE… and let’s end and replace this so-called “health care system” NOW

    Michael Moore, https://www.filmsforaction.org/articles/a-manifesto-against-forprofit-health-insurance-companies/?fbclid=IwY2xjawHOkqZleHRuA2FlbQIxMAABHZQa23jGWprRV3Gx2brUtM1ggv2UfhP19-PzdIz_ayVn0PM7NOJXlqPXQw_aem_xEmZvKr2vWUJWtK6vnx5cQ

    It’s been three days since Luigi Mangione’s manifesto was discovered in his backpack explaining why he assassinated the CEO of United HealthCare.

    In Mangione’s manifesto, he said that he was not the “most qualified person to lay out the full argument” against our for-profit healthcare industry. Apparently, to Mangione, one of those qualified people — is me. In his manifesto, he references how I’ve “illuminated the corruption and greed,” implying folks should go to my work to understand the complexity — and the power-hungry abuse — within our current system.
    It’s not often that my work gets a killer five-star review from an actual killer. And thus, my phone has been ringing off the hook which is bad news because my phone doesn’t have a hook. Emails are pouring in. Text messages. Requests from many in the media. The messages all sound something like this:
    “Luigi mentioned you in his manifesto. That people should listen to you. Will you come on our show, or talk to our reporter and tell them that you condemn murder!?”

    Hmmm. Do I condemn murder? That’s an odd question. In Fahrenheit 9/11, I condemned the murder of hundreds of thousands of innocent Iraqi people and the senseless murder of our own American soldiers at the hands of our American government.

    In Bowling for Columbine, I condemned the murder of 50,000 Americans every year at the hands of our gun industry and our politicians who do nothing to stop it.

    In my 35 years as a filmmaker, have I said or done anything that has implied I condone murder? As a teenager during the Vietnam War, I was required to register for the draft at the local draft board. There was a box on the form asking me if I had a problem with killing Vietnamese people. Actually, it just asked me to check the box if I was going to file for Conscientious Objector status — meaning, if given the opportunity, would I swear that I would never kill a Vietnamese person. I checked the box. Throughout my adult life, I have repeatedly stated that I’m a pacifist. In fact, I have never struck another human in my life. Not even on the playground. I was taller and bigger than the other boys so they mostly left me alone. Usually I was the one who would try to stop the bullies from picking on the smaller kids. When they’d start swinging at me, I would wrap my arms around them, pinning their arms to their sides in my “human straitjacket” and not letting them go until they stopped.

    Here’s a sad statistic for you: In the United States, we have a whopping 1.4 million people employed with the job of DENYING HEALTH CARE, vs only 1 million doctors in the entire country! That’s all you need to know about America. We pay more people to deny care than to give it. 1 million doctors to give care, 1.4 million brutes in cubicles doing their best to stop doctors from giving that care. If the purpose of “health care” is to keep people alive, then what is the purpose of DENYING PEOPLE HEALTH CARE? Other than to kill them? I definitely condemn that kind of murder. And in fact, I already did. In 2007, I made a film – SICKO – about America’s bloodthirsty, profit-driven and murderous health insurance system. It was nominated for an Oscar. It’s the second-largest grossing film of my career (after Fahrenheit 9/11). And over the past 15 years, millions upon millions of people have watched it including, apparently, Luigi Mangione.

    After the killing of the CEO of United HealthCare, the largest of these billion dollar insurance companies, there was an immediate OUTPOURING of anger toward the health insurance industry. Some people have stepped forward to condemn this anger.
    I am not one of them.

    The anger is 1000% justified. It is long overdue for the media to cover it. It is not new. It has been boiling. And I’m not going to tamp it down or ask people to shut up. I want to pour gasoline on that anger.
    Because this anger is not about the killing of a CEO. If everyone who was angry was ready to kill the CEOs, the CEOs would already be dead. That is not what this reaction is about. It is about the mass death and misery — the physical pain, the mental abuse, the medical debt, the bankruptcies in the face of denied claims and denied care and bottomless deductibles on top of ballooning premiums — that this “health care” industry has levied against the American people for decades. With no one standing in their way! Just a government — two broken parties — enabling this INDUSTRY’s theft and, yes, murder.
    And now the press is calling me to ask, “Why are people angry, Mike? Do you condemn murder, Mike?”
    Yes, I condemn murder, and that’s why I condemn America’s broken, vile, rapacious, bloodthirsty, unethical, immoral health care industry and I condemn every one of the CEOs who are in charge of it and I condemn every politician who takes their money and keeps this system going instead of tearing it up, ripping it apart, and throwing it all away. We need to replace this system with something sane, something caring and loving — something that keeps people alive.

    This is a moment where we can create that change.

    But instead, what are we doing? What are our “leaders” doing? What is the Democratic Party doing?

    This is what they are doing — THIS is why people are angry. Listen to an everyday American on TikTok:

    And here is a perfect example of what the young man in that video is talking about — at a press conference this week, Pennsylvania Governor Josh Shapiro repeatedly grabbed the spotlight to say… this:

    Shapiro wasn’t alone. After last week’s killing — which was just one more gun death in an unending sea of American gun deaths — our Democratic leaders all chimed in to say, “In America, we don’t solve our problems and our ideological disputes with violence!” and that there’s “no place for political violence” in America.

    No place for political violence? America’s entire history is defined by political violence. We slaughtered the Native people who already lived here. We enslaved and slaughtered the African people our Founding Fathers kidnapped and brought here. We — to this day — force Women in our country to give birth against their will. 77 MILLION AMERICANS just voted in November to approve Trump mobilizing the U.S. Military to round up and forcibly remove immigrants, dead or alive, from our country. We spent $8 TRILLION in the last 20 years bombing and slaughtering people in the Middle East. We are spending billions and billions of dollars right now to bomb and kill and starve and exterminate women and children in Gaza… and you, our leaders, are telling us there’s no place for political violence in America?

    People across America are not celebrating the brutal murder of a father of two kids from Minnesota. They are screaming for help, they are telling you what’s wrong, they are saying that this system is not just and it is not right and it cannot continue. They want retribution. They want justice. They want health care. And they want to use their money to live — not to throw it away each month into a black hole of health insurance premiums only to discover that when the time finally comes to use their insurance, when the leg breaks or the car crashes or the gun accidentally goes off, their health insurance company is there not to help them but to deny their claim, bankrupt them with deductibles and copays, and give them the runaround until their spirit is broken and they just give up and wait to die.

    But the politicians and the pundits and the headlines aren’t telling you that. Just like they aren’t telling you the truth about this crime. They’re so busy telling you not to riot and not to participate in an uprising against their advertisers and campaign funders that they won’t tell you what this really is — a RICH ON RICH crime! Luigi, a young rich man with a couple of Ivy League degrees, scion of a family that owns 2 of the biggest country clubs in Maryland and who is in line to inherit a chain of nursing homes — in other words, scion of a family that’s enriched themselves off a broken healthcare system by bilking retirees and their families in their end-of-days — this young, rich man with an ax to grind against another multi-millionaire, a CEO facing a Justice Department anti-trust investigation, as well as accusations of bilking tax payers in Medicaid/Medicare schemes and of participating in illegal insider trading.

    On Monday, the mainstream media was breathlessly reporting about Luigi’s “manifesto.” On Tuesday, though the manifesto was leaked, the mainstream media refused to publish it. By Wednesday, with the whiff of a perfectly choreographed PR move, the mainstream media stopped calling it a “manifesto” — now it was “a letter” or “a confession” or “rantings.” Some of the words were “indecipherable”! It wasn’t a “manifesto,” it was “nonsense”! Clearly the health insurance companies were immediately spending millions of dollars on publicists and lobbyists to convince each of the networks to send out a memo to their anchors and reporters banning the word “manifesto” in the desperate hope that the American public would not be inspired to rise up, not with violence, but with the immense power they already hold in their own hands. Because the numbers don’t lie. There are only 800 billionaires in this country, 6 million millionaires and 160 million of you reading this right now who are living from paycheck to paycheck and literally cannot afford the rent. For God’s sake, don’t call what he wrote a “manifesto” because the one mistake the rich have made is that those 160 million working class people were taught, free of charge, to read.

    I don’t know.

    When Lyndon Johnson used the manufactured Gulf of Tonkin incident to launch the Vietnam War, his address to the nation was 546 words long. LBJ’s manifesto ended with the pledge that America’s “mission is peace.” That mission ended in the pointless deaths of 58,220 American soldiers and 4 million people in Southeast Asia.

    When George W. Bush addressed the nation on the night of his “shock and awe,” his manifesto was 578 words. In it, he promised that “The people [we] liberate will witness the honorable and decent spirit of the American military.” George’s words killed nearly 5,000 American servicemembers and countless thousands of Iraqis.

    One hundred and sixty-three years ago, half our country, desperate to keep enslaving people, launched the Civil War, leading to President Abraham Lincoln’s manifesto — the Gettysburg Address… which is just 262 words long.

    Luigi Mangione’s manifesto? It’s also 262 words long.

    But don’t get me wrong. No one needs to die. In fact, that’s my point. No one needs to die – No one should die because they don’t “have” health insurance. Not one single person should die because their “health insurance” denies their health care in order to make a buck or Thirty Two Billion Bucks.

    These insurance corporations and their executives have more blood on their hands than a thousand 9/11 terrorists. And that’s why they are scrubbing their executives’ profiles from their websites and putting up fences around their headquarters. Because they know what they have done. You can’t be the CEO of a company where you knowingly deny care to people — often leading to their deaths — and not have people mad at you, people hate you, people who have no pity for you because you have no pity for them.

    But I have a solution. No one has to kill anyone. And it doesn’t cost anything. I have a solution that does not involve any violence. Unless violence to you means us taking money out of your rich effing pockets, unless violence to you means you can’t send your kids to USC or UPenn or buy a third vacation home or a fourth Tesla or a fifth Land Rover or another yacht.

    The solution is simple. Throw this entire system in the trash, dismantle this immoral business that profits off the lives of human beings and monetizes our deaths, that murders us or leaves us to die, destroy it all, and instead, in its place, give us all the same health care that every other civilized country on Earth has:

    Universal, free, compassionate, and full of life.

    Give us Scotland. Give us Uruguay. Give us Taiwan. Give us Canada or give us death! Just go ahead and deny us all now the care that we will someday need. Or give us Canada and let us get busy curling.

    And now, what I would like is for everyone reading this to watch my movie, SICKO, and then, when it’s over, join me in condemning this murderous health insurance system. Here it is… YOU can watch it right here, right now, for FREE (and please, please share this with your friends and family):

    #154000
    Avatar photoZooey
    Moderator

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