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飞书用户90592024年12月29日修改
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whole system healthcare system American healthcare system entire American healthcare system whole case own pain whole thing healthcare industry broken system AI system tiered system systemic issues United Health Care many Americans United Healthcare chronic pain
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说话人 1 00:00
Welcome back to the deep dive. Today we're diving deep into a story that's gripped America, the assassination of United Health Care CEO Brian Thompson.
说话人 2 00:09
Yeah, it's fascinating how this event has just brought everything to the surface, all these tensions within the American healthcare system. I mean, this isn't just about one man's a death, right? It's about a system that leaves millions, literally millions, feeling trapped and desperate. You might.
说话人 1 00:23
Be thinking, okay, corporate intrigue sounds intense, but this one's got twists. You would believe. We're gonna untangle this whole web looking at the crime itself, the public's reaction, which was surprising, and the systemic issues that this whole thing, this whole event reveals. Ready to dive in?
说话人 2 00:41
Absolutely. Let's get started.
说话人 1 00:43
All right. So December 4th, Thompson's in New York City, big investor meeting, leaving his hotel, the Hilton Midtown. We're on 6.45 in the morning when.
说话人 2 00:52
A gunman disappears out of nowhere, basically, and shoots him multiple times.
说话人 1 00:58
And get this, the weapon was a 9 millimeter silenced pistol. The shooter escaped on a bicycle. I mean, talk about a scene straight out of Hollywood. But.
说话人 2 01:06
Here's where it gets really interesting, disturbing, even the shell casings at the scene, they were engraved with the words delay, deny and.
说话人 1 01:15
Depose. Chilling, right. And the public reaction was immediate and really unexpected instead of the usual shock and warning, there was this outpouring of support are the shooter online. People were actually cheering for the assassin. It got so bad that United Healthcare had to disable comments on all their social media.
说话人 2 01:35
Yeah, it really shows you how much frustration, anger Americans have towards the healthcare system. Yeah, especially towards these big insurance companies like United.
说话人 1 01:43
Healthcare. And speaking of United Health Care, let's talk about the giant in the room, right? We're talking about the largest health insurance company in the US, okay, and the second largest globally.
说话人 2 01:52
A financial powerhouse. Revenue last year, $281 billion, market value exceeding 500 billion.
说话人 1 01:59
But here's the catch. A big portion of that profit, yeah, it comes from their high claim denial rate. It's actually notorious. We're talking about 32%. One in three claims gets rejected.
说话人 2 02:09
Which, I mean, of course, it explains the public's reaction to Thompson's death, right? A lot of people see United Healthcare as like the face of the problem. This whole system that feels rigged against them, profit over patients.
说话人 1 02:21
And it's not just united, is it? The entire American healthcare system is a mess. The costs are astronomical. It's true.
说话人 2 02:28
The average cost for just hospitalization, $22,500. And a simple appendic to me, 30,000. You combine these crazy costs with the insurance company's constant fight to deny claims, it's an unbelievable burden on patients. It's David.
说话人 1 02:44
Versus Goliath, where patients always feel powerless. But let's get into the specifics. How do these insurance companies avoid paying out claims? We've all heard the horror stories.
说话人 2 02:54
Right? I mean, there's the obvious stuff, convoluted procedures, mountains of paperwork, processing times that feel like forever. But one of the most controversial is the prior authorization.
说话人 1 03:04
System. Prior authorization, yeah. The bane of doctors and patients everywhere. Could you, I can explain how it works for those who might not be familiar.
说话人 2 03:11
So prior authorization means doctors have to get pre approval from the insurance company before they can give certain treatments. On paper, it sounds reasonable, making sure only necessary treatments are covered. Right. But in reality, it just causes delays and complications.
说话人 1 03:27
Delays that can be devastating for.
说话人 2 03:29
Patients. Exactly. There is a study by the American Medical Association, a third of doctors reported prior authorization delays caused serious health problems for their patients. People's lives are at risk because of red tape. It's.
说话人 1 03:43
Infuriating. And it's not like it's a secret. These practices are exposed all the time. There was even that book, remember, back in 2010, Delay, deny, depose, why insurance Companies don't pay claims.
说话人 2 03:54
Yeah, the title, it's pretty spot on. Delay, deny, depose, just like those shell casings. It feels like our assassin was sending a message. No doubt.
说话人 1 04:02
All right. Let's shift gears a little. Back to Brian Thompson. What was his legacy, his impact at United Health Care? He was there for 20 years, worked his way up to CEO in 2021.
说话人 2 04:11
And during his time, there's this clear correlation between his leadership and their denial rates and profits going up. Of course, where were the.
说话人 1 04:20
Numbers? Paint is a picture.
说话人 2 04:21
Okay, so 2020 before Thompson denial rate was 10.9%. Profits were about 12 billion. By 2022, under Thompson, the Nile rate had more than doubled, 22.7% profits. Sixteen billion.
说话人 1 04:35
Talk about a motive. But it gets worse, right? Thompson had some controversial plans in the works.
说话人 2 04:40
He wanted to deny coverage for visits at non critical hospitals like he wanted to restrict coverage to just the most severe cases, potentially leaving a lot of patients in the lurch.
说话人 1 04:49
Okay, so what defines a non critical hospital and why was this so controversial? Well.
说话人 2 04:54
To Thompson, a non critical hospital was any hospital that wasn't equipped to handle the most life threatening emergencies, you know, like a tiered system where only certain hospitals would be covered for visits. It was controversial because it put the burden on the patients, right, to figure out how sick they're and choose the right hospital, potentially delaying care. And for people in rural areas or with limited access to specialized hospitals, it could be a matter of life and death.
说话人 1 05:23
Sounds disastrous. Yeah, forcing patients to make these split second decisions in a panic. That wasn't all, was it? He was also pushing for value based care.
说话人 2 05:32
Yes, value based care. Sounds good, doesn't it? Yeah, but I, as with a lot of things in healthcare, the details matter.
说话人 1 05:38
So what does value based care actually mean and what does it mean for the patients?
说话人 2 05:43
Basically, it's about shifting focus from how many services are provided to the out come. Sounds good, right? Sure. The idea is to incentivize providers to be more efficient and effective. So reduce unnecessary procedures, hospital readmissions, that kind of thing. Sounds.
说话人 1 05:57
Good, but what is the catch?
说话人 2 05:58
The worry is that it could lead to skimping on care or delaying care to save money. Right. Insurance companies are still businesses. They want to maximize profit.
说话人 1 06:07
So under the guise of value, patients might actually get less care. Exactly. It's a slippery slope. We've got this CEO pushing for policies that put profit first and then he gets assassinated. And a lot of people are, well, relieved.
说话人 2 06:23
It's complex and, well, unsettling, but it really shows you how much mistrust there is and resentment towards the healthcare industry and people at the top like Thompson.
说话人 1 06:34
Right? Like when people are pushed to the edge, when they feel like the systems fail them, they're gonna look for any sign of hope, any sign of, I don't know, payback. And in this case, that hope came in the form of a bullet and a man on a bicycle.
说话人 2 06:48
It's a reflection of a system that's in crisis. It's lost the trust of the people it's supposed to help. Yeah, but it goes beyond like human gatekeepers. They're using AI now too. Algorithms.
说话人 1 06:57
Right. Artificial intelligence. To like automate claim denials. It's like they're taking the human element out of healthcare.
说话人 2 07:03
Exactly. They have this tool called NH predict. It basically automates claim denials, especially for post acute care rehab services, skilled nursing facilities, stuff like.
说话人 1 07:14
That. So what's their justification for using AI for this? Do they say it's more efficient or accurate?
说话人 2 07:20
That's what they say that AI can, you know, analyze all this data, make objective decisions. But there was a Senate report found super high denial rates connected to this AI system. And it raises some serious concerns about algorithmic bias, wrongful denials. So instead.
说话人 1 07:37
Of human error, now we've got machines making these decisions.
说话人 2 07:40
And they're not even necessarily good decisions. There have been lawsuits against United and Sigma actually for using this algorithm saying any predict has like a 90% error rate, which leads to, you guessed it, wrongful denials and people getting hurt.
说话人 1 07:54
90%. That's crazy. It's scary to think that people's healthcare is being determined by an algorithm that's wrong most of the time. It.
说话人 2 08:01
Really is. We can't just blindly trust these machines, especially when it comes to healthcare. I.
说话人 1 08:05
Mean, how many people just give up when they get tonight, just figure it's a loss cause?
说话人 2 08:11
Most people, unfortunately, the appeal rate for claims denials, it's point one %. People are tired. They don't have the energy to fight these huge companies.
说话人 1 08:20
That's heartbreaking. So with all this resentment toward the healthcare system, it's no surprise Thompson's death got such a, well, let's say a unique response. It sparked this whole Robin Hood narrative, right?
说话人 2 08:33
People were calling the assassin a hero, someone who finds finally stood up to these corporate bullies.
说话人 1 08:38
And it wasn't just talk. People were sharing their own stories online. Of other struggles with the healthcare system.
说话人 2 08:44
It was like a collective venting session for all those who felt ignored and silenced. And then.
说话人 1 08:48
The media frenzy when they finally caught the guy nine days after the shooting.
说话人 2 08:53
Adam McDonald's, someone tipped them off. And when they arrested him, they found a three page manifesto, all handwritten, denouncing the healthcare industry and a ghost gun assembled from parts he got on the black market.
说话人 1 09:07
A ghost gun, untraceable? Yeah, this guy was serious. But here's the twist. His name is Luigi Mangione, and he's not exactly what you picture when you think assassin.
说话人 2 09:19
Not at all. He's 26 years old, went to like the best schools, Gillman, then university of Pennsylvania.
说话人 1 09:24
Comes from a wealthy family. Has connections. A cousin who's a Republican delegate, had a great job, software engineer, a true car and no criminal record. Not.
说话人 2 09:34
Your typical, you know, sick to the mankind of guy.
说话人 1 09:37
Right. So what would drive someone like that to do something so drastic?
说话人 2 09:41
Well, the media dug into his past, found out he had back surgery recently and he was dealing with chronic pain.
说话人 1 09:48
His Goodreads account showed he was really struggling with it, too, reading tons of books about pain management. There was even a suggestion that he might have had Spandy Lois thesis, which is like a really painful spinal condition.
说话人 2 09:59
So it seems like his own experiences with the healthcare system probably facing those delay, denied, opposed tax 's first hand that fueled his anger.
说话人 1 10:07
But there's more. His Goodreads account also showed he was reading Ted Kasinsky. The Anna Bomber, specifically this manifesto, Industrial Society and its future, which.
说话人 2 10:19
Is all about the negative effects of technology and industrialization.
说话人 1 10:23
And he didn't just read it. He wrote this long review agreeing with some of Kansinsky's more radical views, like he said violence is a necessity for survival and that corporations don't care about people.
说话人 2 10:35
So it's possible that in a way he was being radicalized both by his own pain and these anti establishment ideas. He saw Thompson as a symbol maybe of a broken system. And.
说话人 1 10:47
Then there's that handwritten manifesto that they found when they arrested him. He went off about United Healthcare practices and how they hurt Americans.
说话人 2 10:54
Yeah, it was powerful. He talked about their market value going up while life expectancy in America is going down. Right.
说话人 1 11:00
Is this feeling that corporations are putting profit fits over people, shareholder value over human lives.
说话人 2 11:05
Exactly. It's like he was channeling the anger of so many Americans. Right, who feel trapped.
说话人 1 11:10
But there's one more thing, this substack post that popped up after Mangene was arrested.
说话人 2 11:16
Oh, yeah, the homeopathic complex and its consequences. LM's final word by someone called LM Publication. So.
说话人 1 11:25
What's in this post? Is it connected to Manjoni?
说话人 2 11:28
We can't say for sure. But the similarities between what's in the post and what we know about Manjoni, they're pretty striking. It talks about the author's mother and her struggle with , which is, it causes terrible nerve pain. Sounds.
说话人 1 11:43
Awful. And I'm guessing United Healthcare was involved.
说话人 2 11:45
Absolutely. They were denied coverage for treatments. Expert consultations were limited, long wait times for prior authorizations, the whole nine yards. Another.
说话人 1 11:54
Classic example.
说话人 2 11:55
Yeah, and it gets really personal. The author talks about their own chronic back pain, just like manjunie. And then they say they promised insurance but broke their promise. To my mother, these companies have made billions off the pain, suffering, death and cries of millions of Americans in the night. They don't think anyone will stop them. And then they say something about taking warlike action to defend their life.
说话人 1 12:16
Disturbing. So we don't know for sure if LM is Man Joni, but their.
说话人 2 12:20
Story, it shows what so many Americans are going through, this frustration with the healthcare system. It's like.
说话人 1 12:26
A story of desperation.
说话人 2 12:27
Right? Feeling like you have no other choice.
说话人 1 12:30
And the public's reaction to Mangane, it's surprising to say the.
说话人 2 12:34
Least. Instead of condemning him, people are supporting him, calling him a hero, someone who finally fought back against corporate greed. Free Luigi is trending.
说话人 1 12:44
Everywhere. And it's not just online. There are protests, demonstrations all over the country. People are demanding affordable healthcare, transparency from insurance companies.
说话人 2 12:53
It's like, in a way, Manjini accidentally started a movement by tapping into all this anger and frustration that's been building for years. Like an.
说话人 1 13:02
Accidental revolutionary.
说话人 2 13:03
Exactly. And the media is playing effect fascinating role in this, too. They're talking about Mangana's background, his education, his success. It's like they're saying, look, if this guy was driven to this, imagine what everyday Americans are feeling.
说话人 1 13:15
Right. It ships the focus away from blaming Mangeney and toward the system.
说话人 2 13:21
And it's putting pressure on politicians and policymakers to finally do something about healthcare in this country.
说话人 1 13:28
It's amazing, right? This one event sparked this whole national conversation about healthcare. It's not just a policy debate anymore. It's personal. It's a story that everyone can connect with.
说话人 2 13:40
And you see how Minjuni's case has kind of exposed the cracks in our society, right? This gap between the rich and the poor, the privileged and everyone else is struggling.
说话人 1 13:50
Yeah, like he ripped off the Band Aid and showed this wound has been festering for who knows how long.
说话人 2 13:56
And the irony is on the same day Thompson is assassinated, Anthem Blue Cross Blue Shield, they announce they're reversing their policy to limit anesthesia coverage. Talk about.
说话人 1 14:06
Bad timing. It's like they suddenly realized, oh, people are angry.
说话人 2 14:11
Total damage control, trying to put out a fire that's been burning for years.
说话人 1 14:15
But will it lead to real change or is this just a temporary fix? That's the.
说话人 2 14:18
Question, isn't it? Real change needs more than just surface level adjustment. So.
说话人 1 14:24
What are the solutions? What are people saying? There.
说话人 2 14:26
Are a lot of ideas out there. Some want stricter regulations on insurance companies so they can't just deny claims and put profits over patients make sense. Others say we need to expand government programs like Medicare as a safety net for those who can't afford private insurance. And then there's the single payer system idea base, get rid of private insurance completely, everyone's covered.
说话人 1 14:49
A lot to think about. Each approach has its pros and cons for sure. But one thing's for sure, things can't stay the same. The American healthcare system needs to change. We need a system that puts people first, not profits. A system that makes sure everyone has access to quality care. It's.
说话人 2 15:07
About shifting our mindset, recognizing that healthcare is a right, not a privilege.
说话人 1 15:12
In this whole case, the story of Thompson and Manjoni, it really highlights that. It's a wake up call we can't ignore all the people who are struggling with this system that feels designed to take advantage of.
说话人 2 15:22
Them, it makes us think about our values, right, and what kind of society we want to live in. It.
说话人 1 15:27
Challenges us to do better, to fight for a system that works for everyone.
说话人 2 15:31
And as we wrap up, it's important to remember this isn't just about two men. It's about a system that's failing millions. It's a.
说话人 1 15:38
Story that demands our attention, our action.
说话人 2 15:42
It reminds us that we have the power to change things, to demand better healthcare.
说话人 1 15:46
For all. So keep learning, keep thinking and keep the conversation going. Until next time.