DENY, DELAY, DEFEND, or, why most Americans hate health insurance companies, and what we can do about that

 

DENY, DELAY, DEFEND, or, why most Americans hate health insurance companies, and what we can do about that

 

Under normal circumstances, most poor, working class and middle class Americans would be horrified by the spectacle of an early morning commuter being shot in the back by a random armed stranger and mortally wounded on the way to a work meeting.

 

But Brian Thomson was no ordinary commuter – nor was his (alleged) assailant Luigi Mangione (or, as he was dubbed on Tik Tok, “The Adjuster”) an ordinary gunman

 

We don’t know all the facts yet, but, based on published accounts in the media, Mangione was an affluent and well educated young man, from a well off family – but he reportedly suffered a debilitating back injury, around the same time his grandmother fell ill and passed away.

 

These  personal tragedies would be devastating enough… but, of course, the insurance industry made things worse, as they always do – a tragedy that’s drearily familiar to pretty much anybody in America who isn’t rich enough to have indemnity coverage and is forced to rely on managed care for profit health insurance for their medical needs

 

The vast majority of Americans have a horror story of the predation of the insurance companies – inflicted on them, or somebody they love – or, for those who are healthcare workers, they’ve had to witness the needless suffering of their patients due to that industry

 

What’s Brian Thompson have to do with any of that?

 

He was the CEO of the largest private for profit health insurance company in the United States – United  Healthcare. That company is notorious for systematically denying care to the people covered by it’s insurance

 

They even have an internal slogan for how to do that – DENY (deny coverage) DELAY (delay appeals of that denial) DEFEND (come up with a good sounding reason for not paying for the health coverage their policyholders are entitled to)

 

Of course, if you delay coverage long enough… sometimes the policyholders die

 

These practices are widespread in the health insurance industry – UHC is just the most extreme – this may be why Mangione targeted Thompson

 

The mass reaction to the murder – ESPECIALLY online in social media – was immediate and vocal

 

Tens of millions of poor, working class and middle class Americans looked to the initially unknown gunman as an outlaw folk hero – he didn’t have a name at first, so folks called him “The Adjuster” – once police named a suspect, Luigi Mangione was hailed by many as striking a blow against the oppressive and exploitative insurance industry

 

It didn’t matter that he shot a man in the back in cold blood in an act that can, to be honest, be accurately described as terrorism and assassination

 

As some people pointed out, about 36,000 Americans die every year from being denied medical care by the insurance companies  - their lives taken by a few keystrokes rather than the double action of a suppressor equipped 9mm auto, but deaths equally wrongful (yet perfectly legal, and unpunished)

However, the assassination of a CEO didn’t stop those unalivings… hell, they didn’t even slow them down!

The investors meeting at the Hilton New York went on without Thompson – as he died alone with strangers in a Manhattan emergency room, his colleagues continued the work of enriching the shareholders of UHC at the expense of poor, working class and middle class patients

 

Within hours, an ad was posted on Linkedin seeking Thompson’s replacement

 

Beyond the many very valid moral arguments against individual terrorist violence, this is a brutally practical one – IT DOES NOT WORK

 

The sad thing is, despite living in a strong democracy with broad rights of assembly, expression and protest, the great majority of Americans really don’t have a viable avenue to resist oppression and exploitation by the insurance companies

 

America’s political spectrum is narrowed into two pro capitalist political parties – a far right one and it’s center right competitor.

 

These parties have their social base among the top 20% of Americans, but ultimately serve the billionaires, who’s interests are put above everyone else

 

Private health insurance  has been a bipartisan project from the beginning – and over the years premiums have been allowed to increase while it’s gotten easier and easier for them to deny care to their customers – with the full support of the entire political spectrum

 

We don’t have a workers party in this country – not even a pro capitalist  one, let alone a party that fights for working class power and a worker-run economy and government – so there is no counterbalance to the money power, in health coverage or in anything else

 

As for the labor unions, their leadership is openly allied to  the insurance industry that preys on us!

 

Unions pioneered private health insurance in the 1940s – one of the reasons that the draconian Taft Hartley Act, which so heavily restricts worker organizing, strikes and workplace freedom of speech, has long gone unresisted by the labor leadership is because that law  let them get in the health insurance industry.

 

American labor unions have allowed 94% of private sector workers to be denied any kind of representation at work.. but for the 6% of private sector workers and 34% of public sector workers they do represent – the main function of the labor unions is serving as insurance brokers, middlemen between the employers and the insurance companies

 

For most of the 10% of Americans who have a union at work, their main interaction with their union is with the Welfare Fund – the joint labor management trust fund (“Taft Hartley Funds” as they are known in private sector unions) that deals with the insurance companies – represented tangibly by those little plastic cards in our wallets with the logo of our union side by side with the logo of Allstate, or Blue Cross, or Cigna… or United Healthcare (or one of its many subsidiaries)

 

For those with union insurance, when you get denied care… your union signed off at it

 

Case on point, the infamous Copays – that cash up front you have to pay when you seek care? That was pioneered by a union health plan

 

Specifically, the United Mine Workers of America/Bitumenous Coal Operators Association Welfare Fund.

 

Back in 1948, the UMWA and the BCOA set up a network of small joint union management run hospitals in the coal mining towns of America – areas where miners and their families had long suffered from medical neglect.

 

When these hospitals were set up, miners and their families saw them as a godsend, and immediately sought out the healthcare they had long  been denied

 

The leaders of the miners union, the mine owners association and their  insurance carriers saw this as a problem – how dare those miners actually use the coverage that their labor paid for!

 

So, in the 1950 UMWA/BCOA national agreement, the union and the companies agreed that miners would have to pay a fee to access care in the hospitals that their labor had paid for

 

The explicit intent was to get the miners to make less doctor visits – and it worked – then as now copays discourage working class people from seeking out the medical care they need

 

Other insurance carriers and Taft Hartley funds followed their lead and now the copay is general and normalized

 

(I once had the experience of being brought into the hospital in an ambulance and – while literally strapped to a gurney being pushed by paramedics – before I even spoke to a  nurse or doctor I had a billing clerk with a portable computer terminal demanding to see an insurance card – upon running the card, she asked me “would you like to pay your $200 copay now?”)

 

Far from defending us from the depredations of the insurance companies, the unions are on the side of our tormentors!

 

That’s for the small fraction of our class who even have a union, of course

 

In this context, the public acclaim for the murderer of an insurance executive makes sense – as ineffective as his act of terror was, it’s not like there’s any actual effective resistance to the insurance industry being proposed

 

So, as has become the default in our society where the affluent are well organized and the working class majority are individualized and atomized, we get to be passive spectators and cheerleaders to the well publicized deeds of celebrities – bystanders, not actors, witnesses, not participants

 

So, what to do?

 

We need a working class party that leads a nonviolent mass struggle for power for our class and ultimately for the replacement of our capitalist system with a society where the working class runs the economy, the government and the society in the interests of the great majority

 

That working class party needs to build a new labor union movement -  unions that organize the entire workforce, defend our rights on the job, using our rights to peacefully protest, petition and strike, at work and in the community, not as junior partners with management and the Democratic Party but as zealous advocates for our class interests as workers

 

One of the key demands of this workers party and these new labor unions should be the abolition of private health insurance and the expansion of Medicaid and Medicare to cover every person residing and/or working in the United States

 

We need this to happen sooner rather than later