70
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Family sues over adult son's fatal asthma attack after US insurance company removed medication from coverage
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- Authors
- Corrinne Hess
- Published
- Jan 31 2025
- Word count
- 578 words
I don't understand how UHC gets away with not covering asthma inhalers. I've got UHC through work too and they don't cover my inhaler either. Fortunately my pharmacy has its own "coupon" plan that gives it to me at a more reasonable price, but (excuse my French) what the fuck is UHC good for if they're not going to cover basic-ass necessary life saving shit like asthma inhalers?
Explaining to my parents why the reaction to the UHC CEO's murder among millennials and zoomers mostly ranged from indifferent to celebratory was kind of depressing. I explained situations exactly like this to them, and their response was more or less that he was just doing his job and the free market should sort it out. When I tried to explain that the free market is what optimized for this outcome they just dropped the conversation rather than acknowledge the problem.
They have never had to live with this kind of shitty health insurance, so they don't prioritize fixing it at the voting booth. Then they act surprised when, eventually, people start resorting to violence to try and affect change that has been so desperately needed for decades.
I've taken to saying "Free market did sort him out. Sold the guy he crossed a gun."
This gets equal horror from the boomers and a combo for 2nd Amendment types.
This is the kinda thing that has honestly radicalized me more than any other social issue in the past decade or so. It's so incredibly easy for insurance companies to just not exist anymore if we have politicians who actually gave a shit about anything other than their own pockets. There are parasites all the way up the chain that are draining the lifeblood out of the American people. Every single aspect of the current healthcare system is completely broken, not least of which the extraordinary prices that you have to pay for things if you aren't lucky enough to have coverage. And now we're approaching a system where we don't have enough doctors and nurses to actually perform life saving procedures so people are having to wait weeks or even months to get their problems addressed.
Especially when I've gotten a taste of this bullshit first hand when my Doctor prescribed a new medication for me and the insurance company denied it 4 times in a row leading to me having to go off my meds for over a month until I was able to get a new prescription for my old medicine because I couldn't get coverage for the new stuff.
Many many people forget that disability is the identity that most people will acquire at some point in their lives, because otherwise you died first. Complex or expensive medical issues are just one of the ways that can show up.
People are satisfied with their healthcare until they get screwed over. Or see someone they love screwed over. I've watched the doctor's office fuck up prescriptions too many times for my partner, myself. And BCBS no longer covers one of my diabetes meds. So... Yeah.
On the other hand, his Medicare+ Medicaid supplement generally takes good care of him. So get paralyzed if you want people to not make you prove you're in pain or need physical therapy. (Don't get paralyzed)
I’ve said it before. But at this point it would be a massive improvement to ban any form of paid health insurance. Don’t even expand Medicare or Medicaid. Almost everyone will save money. Without the racket in place hospitals and pharmacies can charge reasonable cash prices for care. Money that would have gone to premiums can go into a savings account.
This should even make the “free market” nut jobs salivate. What sounds better than paying a low cash price with transparent pricing? Shop around without worrying about secret negotiated insurance “discounts” (which in reality are cash anti-discounts).
People with disabilities and major surgeries? Nursing home residents?
Wheelchairs that cost more than cars? Medicaid funded personal assistants and home renovations?
It just trades one "rich people can afford health care" problem for another "only healthy people can afford health care" problem.
When you can't afford to keep the money in savings because your furnace breaks you get the free market choice to asphyxiate instead of getting that breathing treatment at the hospital.
Also, the whole "shop around" teaearlgraycold proposes completely misunderstands how medical care works. If you are having an emergency you simply can't afford to "shop around".
Say you get severe chest pains and are worried you are having a heart attack. Are you gonna open up a bunch of hospital websites and spend half an hour comparing price lists? Then travel 7 hours to a hospital in another city because they offer a better deal?
You aren't buying a phone, you can't "shop around". The free market is good for many things, but not for healthcare.
Exactly, it's the perspective of someone with minimal health care needs, often young and healthy folks, who would typically save money by paying a cash price. Which is fine until it isn't.
You can shop around if it's just an annual visit and a med check. Not so much for an emergency or urgent care visit or even when you need a specialist and don't live in a well off area.
I struggle to cover my copay alone for physical therapy when they've wanted me to come 3x a week. If my copay is prohibitive, it's not gonna be more accessible if I'm paying for the entire visit
As I entered my 50s, my determining where I live was more and more driven by 'and where can I qualify for partially-subsidized health coverage', because I'd straight-up die without my meds. Even so, and with coverage, if I wasn't paranoid about refills not getting done on time, and purposefully under-taking my dosages, I'd have run out several times the past year alone due to how long the system takes to process things. And I'm one of the lucky ones that can be mobile, and can still work. Many, many other folks are stuck where they are, and it's scary.
I manage my partner's pain meds, because present "in pain" him doesn't think about future "will still be in pain" him. I've become very familiar with the regular fuck ups of the doctor's office, the pharmacy, insurance, etc. as well as the rules for when they'll fill. Knowing the regular pharmacists helps but inevitably we need every pill I save because something happens. Oh and then remote supply pharmacy is a whole other thing. And this is all with Medicare and fewer arguments about coverage than before.
Even today, I sat at the pharmacy waiting for a fill because we now live out of town and there's freezing rain.
Yeah anything but better than perfection leads you to have to deal with pain, side effects and even more frustration.
I'm not in health care so I can't think of appropriate examples but cancer treatment and surgery are beyond expensive. Many people who receive expensive care are sick enough that they will never work again.
Also many people work at jobs where food and rent and transportation take nearly all of their paycheck, if they can even afford housing.
If you are interested, I suggest reading Nickled and Dimed on not getting by in America by Barbara Erenreich.
At the moment it is illegal for emergency services to deny life saving care to indigent people. The system has to cover the cost of their care somehow, so hospitals shift costs.
I love this
In a different thread today I learned about this book - the Authoritarians
I believe the book sheds light on the kind of attitudes and reactions your parents showed. (I am not a psychologist and I could be wrong.)
What makes you think that they're meant to be "good for" anything?
Insurance companies and pharma companies have been playing games with asthma inhalers for decades. I can't say what I'd like to say on Tildes, but IMO it is completely unsurprising that people feel the way they do about health insurers.
UHC in particular.
Hence an indifferent or supportive response from many to Luigi Mangione
For anyone reading this that has a prescription insurance won't cover, check GoodRx.
In case it helps anyone, GoodRx offers prescription discounts on lots of medications that insurance doesn't cover. The discount can be enormous. Please tell others about them. Maybe it can save lives.
No association with them. I've just used them. The website lists the meds and the prices they get at different pharmacies.
US medical insurance is a fucking nightmare. Every human deserves better than this.
Ask at the pharmacy counter, and check Cost Plus drugs (Mark Cuban's online pharmacy) too. That last one won't work if it's a controlled substance though.
Shareholders. They're good for shareholders. Our system is broken.
UHC claims that Walgreens was obligated to notify patient's physician of alternatives still covered under the plan.
Plaintiffs allege that UHC violated a required 30 day notice period, creating a medical emergency.
Everyone is complicit.
I'm furious that UHC didn't inform him over that 30-day period. I've had this exact experience last year with Anthem/Carelon over a medication. They told me they sent me a 30-day notice, and I still haven't gottne it.
I hope his family can get some reform for everyone in his name.
They suck at communication. Brings to mind POSIWID: the purpose of a system is what it does. No/very late communication is the same as denying service.
That’s the first thing I thought of too. It’s manufactured layers of complexity for the sake of business, not health.
And these are the layers we know about. Nobody challenges the prescription monopoly/racket.
At one point I had a view into some of the internal machinations of the VA health system. It is as hamstrung and inefficient as is written about. But it’s also the closest model for how socialized healthcare might be pursued here in the US.
Which is why the VA has been constantly attacked and undermined and rendered ineffective. I’m firmly of the belief that there is a soft pipeline/micro economy of leaks and journalists designed to ensure that every misstep the VA takes makes it into the news. To ensure we are always of the belief that socialized healthcare isn’t possible.
The truth is every single other developed country has done it to one extent or another more successfully than the US. For one reason; money. Examples of how to improve healthcare are literally surrounding us globally.
The death and pain and suffering are by design.
edit: fixed a run-on sentence/
Absolutely. We could absolutely have had socialized healthcare, but those at the top of the capitalist system won't let that happen.
Of course it's United HealthCare. Of course.
I recently read a short story by Cory Doctorow that seems spot-on relevant here: Radicalized - specifically the 3rd of the 4 short stories which is about the inhumanity of healthcare here in the US. Definitely recommend it as a read, or as a listen especially since Wil Wheaton is the voice actor for it.
Printed in full on the American Prospect.
https://prospect.org/culture/books/2024-12-09-radicalized-cory-doctorow-story-health-care/
I read this yesterday due to this thread, and I can’t stop thinking about it. My wife had Stage 2 Breast Cancer last year, and I had already been radicalized against for-profit healthcare. I struggle to think what my mental state would be post-Luigi if we hadn’t had good health insurance and access to good healthcare.
Thank you kindly. I should have thought of that.
At what point do you also start holding your own employer responsible for providing health insurance through the company with supposedly the highest denial rate in the industry?
I think that's a big issue. I think job benefits bundling should be banned. Just pay me money appropriate for the position, then let me spend that money on whatever I need. Between me and my company, our incentives just aren't that aligned on things like insurance and retirement plans. It's inefficient to have my employer be a middle man in these important transactions involving my health and future.
Except the way our insurance system is rigged, you'd be even more screwed, buying your own insurance without having a larger organization to (maybe?) give you a little leverage on pricing.
The whole "employment providing insurance" thing is a scam.
I don't think there's much gained by "group buying" insurance plans. For one, that's a bit dependent on how large of a company you're working for. Second, price is often not the most important aspect, as shown by this incident. If people all had to buy their own insurance, company reputation would start to matter more, and poor coverage would actually move the needle on number of customers buying that insurance. If the family in this story could have clicked "unsubscribe" the moment the coverage for the inhaler dropped, the insurer would definitely think twice about dropping this kind of coverage.
This is, of course, thinking about it from a practical perspective of what could possibly be done. I think it's preferable to have a model where the government provides basic health insurance for everyone, but I don't think that is politically possible in the US in the near future.
I disagree, they'd absolutely drop the coverage of medication for someone medically fragile who is likely to be expensive. Chronic conditions are not money makers. Even without that, businesses are not inherently rational decision makers only making the best "free market" decisions. Too many business owners were quite happy to not take the money of someone the wrong color, or are outspoken about denying business to Muslims or what have you
I guess that all depends on the laws surrounding the whole thing. Whether you are allowed to deny coverage based on pre-existing conditions, race, religion, etc. Aside from that, people may experience that kind of discrimination when trying to find a job, and that even further highlights why essential services shouldn't be tied to employment.
My understanding is that it's currently illegal for insurance providers to do what you suggested, but I haven't bought my own insurance in about 15 years, so I'm not really familiar with the system.
But the idea that switching to a "free market" option, which removes the grouping of healthy people with sick people would make this cheaper for disabled people or more accessible. If I want to subtly press certain people out of my insured pool, I just need to stop covering certain meds, like in this case. We already know they do these things to save money over saving lives, because their goal is the former, not the latter. And if you have chronic medical issues, no insurance company is incentivized to cover you as an individual.
Your idea only works for someone with minimal health issues who is a "good bet" insurancewise. The regulations you mention wouldn't be sufficient because, currently, they're associated with the Marketplace + employer options. Insurance Company A wouldn't be pricing "expensive" customers at the bulk employer rate, pricing them out of their care instead.
At the level of regulation that would be required, you're just offering government plans via private companies, IMO. But this hurts older folks, people with chronic conditions, families with small kids, and lower income families alike.
All the things you mention still exist, they just get transferred to whether you can get a job or not. It's not a good system if an employer is disincentivized to hire you if you will be an extra cost to them on the insurance side. Then instead of one problem you have two problems: insurance and employment. Not everyone is working for a large corporation that won't care about extra benefit costs. Roughly 40% of employees work for small businesses (<100 employees).
Your hypothetical about subtly pressing certain people out of the pool doesn't just apply to my suggestion. It's the subject of this entire discussion, so it's already reality. Someone lost coverage and lost their child despite "group buying".
I'm not suggesting a switch to a "free market" solution, it's already a market based solution, just that your employer is an extra middleman who makes things less efficient. As for your last comment, yeah I am suggesting trending towards government provided insurance, as I mentioned in a comment above. I don't mind if it takes an intermediate step that is similar to the original obamacare to get there.
Our current system is awful, I've been specific about this. But if you're just saying create a universal marketplace and mandate coverage, sure, great, but without stricter regulation and enforcement of that than what we have currently, I'm saying it's a net negative. I have chronic conditions, my partner's are much more severe, if he'd not been on Medicare he wouldn't have had the capacity to shop around, and if he was being actively denied treatment, switching insurance isn't something he's going to be physically capable of doing either.
I feel like you are treating this suggestion like a "give a computer programmer instructions on how to make a peanut butter and jelly sandwich game," where you only perform the most literal interpretation of the instructions and nothing more. In general, you can poke holes in any suggestion about a complex system if you assume the people implementing it don't put any framework around it.
So, in this scenario, what if you assume the most obvious holes are plugged, unless you feel there is a significant structural reason why it can't happen? You say "without stricter regulation ... it's a net negative," but I haven't opposed such a thing so I feel like you're strawmanning me. What if we did have that?
I'm really not strawmanning, this is based on my life. But I see zero movement towards effectively regulating insurance companies and the individual costs for chronically ill people and their families are almost certainly going to remain too high and make them uninsurable
Having to figure out which plan covers all your meds and doctors is exhausting as things are. The amount of regulation that is IMO required to make what you propose functional would be essentially the equivalent of nationalizing healthcare. Maybe if everyone has to sell on the same marketplace and meet minimum criteria and all this... Maybe? But if you can stop covering my meds anyway, will I find a provider that I can afford who covers all my meds and my doctors? Who actually has therapists and not just lists of "fake" providers (no longer working there, remote only, etc.)? The extreme version of this is no longer covering an expensive chemo drug, which means all the cancer patients go to another provider. Or don't have the energy and time to figure that out. But Provider A that cuts the drug off their list absolutely saves money.
This is based on being the caretaking partner of a physically disabled person and having chronic conditions of my own. My experiences with healthcare are such I believe individual plans are likely to perpetuate discrimination in insurance against people with chronic conditions, not improve it.
If I steelman your idea with unspoken regulations, it becomes nationalized healthcare run by private companies which IMO is the worst version of nationalized healthcare.
Putting in a word for Mark Cuban CostPlus Drug Company here. My prescription insurance changed recently, and I got to learn the current pharmacy list price of one of my meds, generic hydroxychloroquine... $280 for a three month supply. Another is nearly $1000/month. My insurance is through UHC. And yes, it's an OptumRx price list.
Hydroxychloroquine is one of the WHO essential medicines (as is the common asthma inhaler drug albuterol), and among the cheapest generics globally. On the CostPlus site, hydroxychloroquine is $14 for a 90-day supply. Albuterol inhalers are $46. The only drawback is that drugs without a generic equivalent, opiates, many biologics (including insulin), and rarer drugs aren't available.
Critical medicines ought to have zero out of pocket costs, but the CostPlus pricing is transparent, free from gouging middlemen, and far more affordable if you need them. [If you need rage fuel, take a browse at the list prices compared to the CostPlus generic drug prices - sometimes thousands of dollars differential.]