I became a physician to protect people’s health. But in the past year, my uveitis clinic — where I treat blinding eye disease, for which expensive, cutting-edge treatments are often a last-ditch effort to save patients’ vision — has become more of a therapy session than a treatment center.
Patients are crying, helpless and frustrated, begging for me to do something — anything — to get their medications approved. I have little left to offer: Instead, I’m crying with them, wringing my hands, telling them I’m simply a puppet in a profit-driven system with no control over the puppet master.
It’s a ubiquitous American nightmare, as evidenced by the mostly unified response to the recent murder of Brian Thompson in Manhattan. Thompson was CEO of UnitedHealthcare, the largest private health insurance company in the United States. Since Thompson’s death, his company has come under scrutiny for denying 32% of its claims, and for its alleged use of artificial intelligence to systematically deny patients care, despite a reported 90% error rate in evaluating claims — while its own profits swell. The bullets reportedly used in the killing were emblazoned with the words “deny,” “defend,” and “depose,” referencing the tactics used by insurance companies to avoid covering patients’ care. With fury and frustration boiling over, some have even celebrated UnitedHealthcare CEO’s killer as a national hero.
In the days since the shooting, Americans across the political spectrum have been trading grim stories: medical bills in the hundreds of thousands of dollars, cancer patients denied surgeries for being “not medically necessary,” families dealing with bills and denied claims while grieving the loss of their parents or children.
We’ve reached a watershed moment that is forcing those in power to address — or at least acknowledge — the health care system that has failed us. Still, the death of one man is unlikely to lead to the necessary health care reform Americans deserve, even if he seems to represent the whole of the rapacious insurance industry.
Of course, vigilantism can be destructive. But such behavior is also inevitable when the public feels they have been exploited endlessly, left helpless with no recourse or bureaucracy. As physicians, we don’t have to compromise our humanity by mocking one man’s death; instead, we can show more humanity than UnitedHealthcare or its CEO ever did by calling for a health care system that recognizes all life as precious.
It’s time to hold our government responsible for keeping the multi-trillion dollar medical industrial complex accountable for its profit-driven agenda. In particular, medical professionals like myself have a duty to stand up and demand better for our patients.
Physicians must call out abusive health care system
While a true health care revolution has been overdue for decades in America, the denial of medications over the past nine to 12 months has reached truly criminal levels. Access to accurate data about insurance denial rates remains limited; still, my personal experience has seen a disturbing uptrend, with access to vision-saving drugs being denied in about 75% of patient cases.
My gut reaction is not alone. A 2024 Experian Health survey found that 73% of health care providers noted an increase in denials, compared to 42% from two years ago. This 31% uptick in concern was exacerbated by a 25% drop in confidence levels that using automation and artificial intelligence would help patients get the timely treatments they need.
In his Pulitzer Prize-winning book The Social Transformation of American Medicine, Princeton sociology and public affairs professor Paul Starr explains how American physicians in the 1900s were opposed to not only the socialist medical practices taking over Europe, but also corporate enterprises and their profit-gouging middlemen in the United States. The transformation from a competitive to a corporate practice occurred slowly and was multi-factorial, but physicians fought for their autonomy and were staunchly against commercialism in medicine.
It wasn’t until the 1980s, when the number of physicians quickly outgrew the aging population, that finances became a zero-sum game for practicing physicians. Along with the chain reaction of events that had begun at the turn of the century, opening up licensing and care to non-physicians as well as a growing public distrust, intensified the turmoil within the health care system.
The race to make more money — a lot more money — has led large health care systems and hospital administrators to condone predatory and silencing practices. Inflating hospital bills and then suing patients and garnering their wages for not making the payments; making billion dollar deals with big pharmaceutical companies and payers; contractually forbidding pharmacists to give patients certain information; the list goes on. To make matters worse, special laws have been passed to exempt the mysterious middlemen from anti-kickback laws, as surgeon and public policy researcher Marty Makary notes in his book The Price We Pay.
Physicians are conditioned to work like machines. We’re taught to keep our heads low, obey authority, pay homage to the hierarchy and compartmentalize our emotions. Some of this conditioning is necessary to provide expert, unbiased care; otherwise, walking patient after patient through their health care journeys can lead to vicarious trauma that is mentally and physically debilitating. We, too, are human.
But the price we’ve paid as a profession has been far too high, and the moral injury incurred at the hands of the medical-industrial complex can no longer be sustained. The humility and fortitude expected from clinicians and patients does not mean we should remain silent.
It is time for us all to speak up. We must demand not only transparency about cost, but accountability from our lawmakers to value health instead of supporting a parasitic system that profits from disease.