Thread by @moetkacik

The murder of the UnitedHealth CEO by a guy who underwent spinal fusion surgery for debilitating pain has unleashed a furious debate about US health care, most of it dumb
Thankfully I found a whistleblower suit filed by a surgeon UHC hired to deny spinal fusion surgery coverage..

But first: the predictable chorus of obtuse propagandists saying it's vulgar to villainize insurers which after all "barely generate profits", reminds me of a book I've found invaluable for demystifying this shit.
The author was a Mafia reporter. US health care is a crime scene

Cook's book introduced me to the world of unnecessary hysterectomies, which became a scourge soon after unions began negotiating Blue Cross coverage. But hysteretomy isn't so profitable today. Spinal fusion, on the other hand, can rake in up to $250K/pop
prospect.org/health/2024-12…

For more than a decade Cincinnati surgeon Atiq Durrani performed unnecessary spinal fusions & other procedures on more than 500 patients without so much as consulting their MRIs.
He told them that if they didn't go under the knife THEIR HEADS WOULD FALL OFF

But Ohio has strict malpractice caps, and few medmal lawyers as a result. The one atty who sued on Durrani has 580 clients. A surgeon who worked as an expert witness on the case told me powerful hospitals imposed a conspiracy of silence.

Expert witness went to work for UHC utilization review. He believed spine surgery outcomes are much iffier than hip/knee procedures, but many surgeons over-perform them for $.
He wanted to save patients from future Durranis.

He soon encountered a surgeon who appeared to be misdiagnosing degenerative disc disease as spondylolisthesis (Luigi's disease) to fast-track patients to spinal fusion.
And in a peer review meeting, the surgeon admitted it -- and said (on tape!) that if UnitedHealth denied the claim he would intentionally botch the less-expensive surgery so that the patient would require spinal fusion to fix it.

Did I mention this guy was about to sell his practice to a private equity firm?

The expert witness surgeon was aghast, but when he took his evidence to his overlords at UnitedHealth, they.... made him take de-escalation training.
Meanwhile, Durrani fled to Lahore, where he is...currently performing unnecessary surgeries.

The irony is that the whole policy framework that begat UnitedHealth (which @hayrook calls the "capitation consensus") was built around the 1970s idea that the solution to health care was an esoteric system of bribing doctors not to do unnecessary surgery economicliberties.us/wp-content/upl…

This was a bad idea because performing unnecessary surgeries is gruesome & evil & most doctors were not doing it, bc most doctors are not primarily motivated by greed.

(UnitedHealth knows this better than anyone, because it started in the 80s as a secret subcontractor of the Hennepin County Medical Society HMO. Year after year it imposed pay cuts on participating doctors, who went along bc they wanted care to be more affordable. Then in 1984 the company submits SEC filings to IPO, and the doctors learn UnitedHealth is taking a 17% cut off the top of their earnings, and they're steaming. They had no idea the HMO was even allowed to turn a profit -- because it wasn't! The state legislature had explictly outlawed for-profit HMOs 10 years earlier with just this scenario in mind! But then as now, UnitedHealth did not give a fuck about laws.)

This week I wrote about Insight, a MI-based medical empire on a hospital buying spree. It's a dumpster fire: hospitals owe millions to Israeli loan sharks, cant buy TP, weekly health inspections..
And workers say they're doing 100s of unnecessary surgeries prospect.org/health/2024-12…

How do such abuses persist against the backdrop of radical austerity reflected by UHC's reported 32% denial rate?
Because UHC's biz model is symbiotic w/ (ahem) medical entrepreneurs, like this FL primary care doc who just sold his house for $27 million therealdeal.com/miami/2023/11/…

A deepdive into the multitude of recent UHC whistleblower suits shows how much of its biz involves funnelling kickbacks to providers willing to 1)scam patients into signing up w/ UHC & 2)fraudulently diagnose said patients with diseases they don't have.
prospect.org/health/2024-12…

At a certain point those kickbacks got so $$$ UHC started just buying physician practices, surgery centers & staffing agencies en masse & bringing it in house. @matthewstoller has a great survey of UHC's internal conflicts today thebignewsletter.com/p/its-time-to-…

Meanwhile, check out the Medical Loss Ratios listed for various California insurance plans. MLR is essentially the percentage of an insurer's premiums it spends on care. 78.7% for certain UHC plans! As compared with 94-97% at Kaiser. I know we all agree that Luigi Mangione is a deranged weirdo who would never do anything rational, but given that he was not himself a UHC policyholder, do you wonder if there's a reason he went after them, of all health insurers?