Tag Archives: healthcare

Interpreting Mangione.

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            Polls in 2024 revealed that more than three-quarters (78 percent) of respondents believed that the United States “is headed in the wrong direction”; and that over half (55 percent) say that our political and economic system needs major changes.[1]  However, only one-fifth (20 percent) as yet think that violence may be required to reform the situation.  That’s still a large share compared to most bygone times. 

            In light of these reports, the reaction to the story of Luigi Mangione is interesting.[2]  Mangione is accused of murdering Brian Thompson, CEO of UnitedHealthcare (UHC).[3]  Mangione immediately became a media sensation and, to some, a folk hero.[4]  Some 124,000 “laughing face” emojis were posted in the Comments section of UHC’s on-line statement about Thompson’s murder.                                              

This idolization of a guy who shot his victim in the back stuck in the craw of lots of decent people.  Matthew Continetti spoke for many when he wrote that the murder tested “America’s ability to distinguish right from wrong” and “far too many Americans have flunked.”[5]  As do we all, Ingrid Jacques found the inhumanity of the response “alarming to witness” and the Washington Post found the response evidence of a “sickness” in society.[6]

What to make of the murder itself?  Seemingly not a “random act of violence.”[7]  The early investigation of the murder produced evidence of careful planning.  The man accused of the killing remains a puzzle.  In the absence of anything beyond police leaks and gleanings from internet searches, people assigned their own preferred meaning. 

Thus the Wall Street Journal wondered if Mangione had adopted “the populist theme of blaming seemingly distant and faceless corporations for social ills.”[8]  Most commonly, commentators immediately assumed that it is related only to problems with health care costs.  Explanations appeared of how health insurers are merely the surface of a much more complicated problem.  What about Oxycontin?  What about Boeing’s planes and space vehicles? 

Or they posit that “congressional gridlock” lies at the root of high health costs.  What if “Government is [just] the entertainment division of the military-industrial complex”?[9]  What if NOT fixing the problems is just what big money donors want…and get?[10]  Regarding another case, the Washington Post argued that tolerating antisocial behavior can lead to vigilantism.”[11]  Is that going too “populist”? 

[1] “The way we were in 2024,” The Week, 27 December-3 January 2024, p. 26. 

[2] “Mangione: Why did he become a folk hero?” The Week, 27 December 2024-3 January 2025, p. 19. 

[3] A loving husband and father, who reportedly made $10.2 million. 

[4] Not the first: The hanging of the abolitionist John Brown, Virginia, 1859; Nick Cave – The Ballad of Jesse James – YouTube and The Highwaymen Chasing scene the Gang 🌟

[5] Matthew Continetti in National Review, quoted in “Mangione: Why did he become a folk hero?” The Week, 27 December 2024-3 January 2025, p. 19. 

[6] In USA Today, quoted in “Health insurance: A CEO’s murder and an explosion of rage,” The Week, 20 December 2024, p. 6. 

[7] Like, say, a mentally disturbed guy with “a record as long as a CVS receipt” (stole that from a “Law and Order” episode) setting fire to a sleeping person on a NYC subway car. 

[8] Quoted in “Suspect in CEO murder raged against ‘parasites’,” The Week, 20 December 2024, p. 5. 

[9] Attributed to Frank Zappa, but who knows. 

[10] For example, Leaked emails show what Clinton told executives in private | PBS News 

[11] “Daniel Penny: A hero or a murderer?” The Week, 27 December-3 January 2025, p. 18. 

Prologue to a Diary of the Second Addams Administration 13.

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            The Agenda: Why does health care cost so much? 

One theory is that, traditionally, medicine could not really do much for the sick and injured.  For almost all of human history, science and medicine knew nothing of many things.  Anesthesia and antiseptics for example, or what was a “normal” blood pressure or heart rate.  “Doctors” could be “real” or they could be “quacks” and you couldn’t tell the difference.  Surgeons could lop off arms or legs with a fair chance that the patient would survive.  They could do nothing about deep puncture wounds to the thorax.  They could administer heroic doses of laxatives and they could “bleed” patients to restore the balance of humors in the body.  As for psychiatry, Ben Franklin once helped out his sister by paying for her disturbed son to be chained up in a farmer’s barn to keep him from harm. 

Then, from the mid-19th Century onward, a medical revolution occurred.  It was just as dramatic—and probably more important—than the various political revolutions that have enlivened journalism over the same period.  Invasive surgery became safe and commonplace.  Drugs treated many diseases.  Vaccination warded off a host of terrible killers.  Then, in the second half of the 20th Century, still greater marvels appeared.  However, these ones were vastly more costly than the earlier innovations.  Organ transplants and fertility treatments, for example, are very costly.  Chronic illnesses in a population with an extending life-span is a new development.  In sum, modern medicine is just really expensive.  The best solution is to socialize the costs through government taxation and payments to providers. 

Another theory is that none of this is the real explanation for high health costs.[1]  It isn’t ALL medical costs that are so high.  It is only AMERICAN medical costs that are so high.  On a per capital basis, health care is about twice as expensive as it is in other advanced countries (i.e. Western Europe, Japan).  European doctors with comparable education and skills earn about half of what American doctors earn.  Members of the administrative hierarchy in hospitals and medical networks earn high salaries.  Medical tests, surgeries, and prescription drugs are far more expensive in the United States than they are elsewhere. 

According to this second theory, if you want more affordable medicine, you’re going to have to take it out of the incomes of the health profiteers.  This means everyone from your GP to the pharmaceutical companies.  Trying to compress incomes to cut costs for consumers (patients) will involve battling powerful entrenched interest groups, everyone from the American Medical Association to Big Pharma. 

In all of this, the health insurance industry plays the Bad Guy.  They’re the ones who interact with customers/consumers/patients.  Often they bring bad news.  Some charge is denied, or you still haven’t exhausted your out-of-pocket obligations, or you need to get your doctor to re-authorize some prescription that you’ve been taking—and will be taking—for years.  In truth, health insurers make a profit that is less than half of the average profit for corporation on the S&P 500. 

It is interesting that none of this has come up in discussion of Secretary of Health and Human Services nominee Robert F. Kennedy, Jr.[2]  What could/will Trump force through? 

[1] “The reason health care is so costly,” The Week, 27 December-3 January 2024, p. 14. 

[2] “RFK Jr. softens positions amid Senate scrutiny,” The Week, 27 December-3 January 2024, p. 4. 

Prologue to a Diary of the Second Addams Administration 11.

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            The Agenda: Entitlements.  The financing systems for Social Security and Medicare/Medicaid have been crumbling for some time.  Exhaustion of the funding sources looms.  What to do?  For the Democrats, the standard answer has been “Make the rich pay their ‘fair share,’[1] then spend the money like a drunken sailor.”  For Republicans, the standard answer is “Dump the dependency-fostering bureaucratized systems in favor of sensible market-based solutions; you know, like Boeing and Wells Fargo.” 

            The Republican favorite, “Medicare Advantage” plans, are private health insurance plans that can be chosen by customers as an alternative to regular Medicare.  “Advantage plans” cover hospitalization and surgery, visits to doctor, prescription drugs, and vision, dental and hearing care.  They also limit out-of-pocket spending.[2] 

How do they do this?  They strive to be more efficient and cost-saving than regular Medicare.  For one thing, members are offered a more limited pool of network doctors to consult.  No insisting on the doctor whose manner or reputation you prefer.[3]  For another thing, they require prior authorization by the company for many treatments and services.  Insurance companies often refuse authorization for things that they regard as CYA or treatment-padding.[4]  Beyond these “sensible, market-based solution,” the plans are also accused of “up-coding” procedures.  That is, they turn whatever was done into something higher on the scale, the bill the government for the more costly thing.  Then there is the complaint that they deny services recommended for patients by doctors.  On the one hand, they increase the money paid by the government; on the other hand, they dodge around providing costly procedures. 

Then there is the touchy question of end-of-life spending.  Seventy percent of Americans die from a one or more chronic diseases.  The last few years of life often involve treatments for those chronic diseases.  This makes chronic diseases “the leading drivers of health care costs.”[5]  Almost 950,000 Americans die of heart disease or stroke every year; and more than 600,000 die from cancer.  Shedding end-of-life patients by denying them desired coverage could be good for the bottom line of Advantage Plans by pushing them to shift to Medicare.   

            The new administration may actually try to carry out a sweeping overhaul of entitlements.  They’re going to start with Medicare.  President-Elect Donald Trump has nominated Dr. Mehmet Oz to head the Center for Medicare and Medicaid Services (CMS).  Oz has a track-record of having supported the expansion of “Medicare Advantage” plans.  He also “criticized the drug industry over high prices” during his 2022 Senate campaign.  Will the new administration sustain, and build on, the Biden administrations negotiation of drug prices? 

            Leaving things just the way they are doesn’t seem like a good choice. 

[1] “Fair share” is never defined beyond my beloved sister-in-law’s “More, we’ll tell you when to stop.”  Honest. 

[2] “Dr. Oz: Expanding Medicare’s private option,” The Week, 6 December 2024, p. 33.

[3] This is a big issue for many people, but if you get hurt in a car wreck or have a heart attack, you go to the nearest ER.  Nobody says “I want to see MY doctor and I’ll wait until they’re available—don’t slip on the blood pooling on the floor.”  Why should it be different with an annual visit? 

[4] See, for example, Nicholas Bakalar, “Overtreatment is Common, Doctors Say,” NYT, 6 September 2017; Ryan Levi and Dan Gorenstein, “When routine medical tests trigger a cascade of costly, unnecessary care,” NPR, 14 June 2022, When routine medical tests trigger a cascade of unnecessary care : Shots – Health News : NPR 

[5] Fast Facts: Health and Economic Costs of Chronic Conditions | Chronic Disease | CDC