Tiffany, Sigh-D on Nostr: The UHC CEO thing has brought up a ton of stuff for me, both as a professional and a ...
The UHC CEO thing has brought up a ton of stuff for me, both as a professional and a person living with 2 "pre-existing conditions", 1 of these since before the ACA. I read an article yesterday that attributed the mass "gee, that's terrible" reaction of Americans to this event being due to an increasing trend of nihilism. While there may be some nihilists out there, I disagree wholeheartedly. Below is why, if you decide to read my long winded reasoning.
Before being involved in a lawsuit against UHC, I knew the healthcare landscape was bad. But it's way worse than you can probably imagine. MAGA types have to work, and I could see them being drawn to jobs with health insurance companies because of the fundamental lack of empathy necessary to do what they do. Good people leave because they can't take it, and you have this toxic cesspool that I suspect exists now in a lot of these companies.
We focus our attention on the insurance companies, but it's not just them. It's the consolidation of hospitals under private equity. I worked for an academic medical center from 2005-2023 and watched the enshittification. The "suits" reproduced like a gremlin thrown in a swimming pool. They shifted to an RVU system, which basically turned medicine into a factory with MDs being paid based on productivity metrics. In direct correlation was the increasing burnout and cynicism amongst the physicians, nurses, and staff. Then COVID hit, and any cracks were just blown wide open and we are where we are today.
Seeking healthcare if you have anything remotely complex going on has never been easy, and I recognize this isn't unique to the U.S., but I'd estimate at least half of the mental health work I do is trying to help people manage the anxiety related to engaging with the system and then dealing with insurance hassles. I try not to add to the gaslighting they've likely experienced already by trying to "reframe their thinking" (a common psychological tool) because their perceptions are 100% accurate. So it's a lot of "yeah...I know. It's terrible." while trying to instill some sense of meaning and hope in other areas of their life.
I also accept about 7 major insurance plans in my mental health practice, which I've run since 2012. The bullshit insurance pulls regarding reimbursement has gotten exponentially worse. They all mess with you, delaying payment by making arbitrary changes to coding what seems to happen every 6 months now. But UHC is definitely a major offender. Today, I have about $10,000 in outstanding claims with UHC plans across 15 patients. For a small operation like mine, that's a lot of coin. And now going into 2025, we face a repeal of the ACA.
Personally, I've lived with Crohn's disease since 2002 and I picked up another awesome diagnosis, Eosinophilic Esophagitis, in 2016. Both require really expensive medications (at least in the US) that eventually stop working for around half of people who take them. So then you have to switch, which puts you into prior authorization hell. Or you have to do some combination of expensive treatments and insurance is like absolutely not. At present, I'm waiting on prior authorization for an iron infusion, which is ridiculously expensive. This is something I've had about 3 times now and was always quickly approved, but I've never gotten one under my current insurance plan. My guess is they're taking their time so I'll have to get it in January when my deductible resets and it'll be on my tab. But I kind of understand why insurance is balking at these treatments, which have been driven up by hospital consolidation and private equity nonsense. With the return of the Orange Shitler administration, I expect my medications to eventually be denied even though they've been covered thus far.
So my indifference to the UHC CEO being murdered has nothing to do with nihilism. I desperately want it to be different. Abject cynicism based on a decade of these experiences? Absolutely.
Some receipts, because academic me just won't die 😂 :
https://www.propublica.org/topics/health-insurance
https://journals.lww.com/academicmedicine/abstract/2003/07000/effects_of_performance_based_compensation_and.8.aspx
https://www.jpeds.com/article/S0022-3476(21)01161-6/fulltext
Before being involved in a lawsuit against UHC, I knew the healthcare landscape was bad. But it's way worse than you can probably imagine. MAGA types have to work, and I could see them being drawn to jobs with health insurance companies because of the fundamental lack of empathy necessary to do what they do. Good people leave because they can't take it, and you have this toxic cesspool that I suspect exists now in a lot of these companies.
We focus our attention on the insurance companies, but it's not just them. It's the consolidation of hospitals under private equity. I worked for an academic medical center from 2005-2023 and watched the enshittification. The "suits" reproduced like a gremlin thrown in a swimming pool. They shifted to an RVU system, which basically turned medicine into a factory with MDs being paid based on productivity metrics. In direct correlation was the increasing burnout and cynicism amongst the physicians, nurses, and staff. Then COVID hit, and any cracks were just blown wide open and we are where we are today.
Seeking healthcare if you have anything remotely complex going on has never been easy, and I recognize this isn't unique to the U.S., but I'd estimate at least half of the mental health work I do is trying to help people manage the anxiety related to engaging with the system and then dealing with insurance hassles. I try not to add to the gaslighting they've likely experienced already by trying to "reframe their thinking" (a common psychological tool) because their perceptions are 100% accurate. So it's a lot of "yeah...I know. It's terrible." while trying to instill some sense of meaning and hope in other areas of their life.
I also accept about 7 major insurance plans in my mental health practice, which I've run since 2012. The bullshit insurance pulls regarding reimbursement has gotten exponentially worse. They all mess with you, delaying payment by making arbitrary changes to coding what seems to happen every 6 months now. But UHC is definitely a major offender. Today, I have about $10,000 in outstanding claims with UHC plans across 15 patients. For a small operation like mine, that's a lot of coin. And now going into 2025, we face a repeal of the ACA.
Personally, I've lived with Crohn's disease since 2002 and I picked up another awesome diagnosis, Eosinophilic Esophagitis, in 2016. Both require really expensive medications (at least in the US) that eventually stop working for around half of people who take them. So then you have to switch, which puts you into prior authorization hell. Or you have to do some combination of expensive treatments and insurance is like absolutely not. At present, I'm waiting on prior authorization for an iron infusion, which is ridiculously expensive. This is something I've had about 3 times now and was always quickly approved, but I've never gotten one under my current insurance plan. My guess is they're taking their time so I'll have to get it in January when my deductible resets and it'll be on my tab. But I kind of understand why insurance is balking at these treatments, which have been driven up by hospital consolidation and private equity nonsense. With the return of the Orange Shitler administration, I expect my medications to eventually be denied even though they've been covered thus far.
So my indifference to the UHC CEO being murdered has nothing to do with nihilism. I desperately want it to be different. Abject cynicism based on a decade of these experiences? Absolutely.
Some receipts, because academic me just won't die 😂 :
https://www.propublica.org/topics/health-insurance
https://journals.lww.com/academicmedicine/abstract/2003/07000/effects_of_performance_based_compensation_and.8.aspx
https://www.jpeds.com/article/S0022-3476(21)01161-6/fulltext