Wednesday, December 11, 2024

AI, Medical Debt and the Murder of Brian Thompson

Someone shot dead is rare but not unusual: About 46 people are murdered every day in the United States by someone with a gun, according to Gun Violence Statistics. In a country with more than 337 million people, it’s unlikely it’ll happen to you.

But if an upper crust 50-year-old white male is gunned down on New York City’s Sixth Avenue, in the heart of swanky midtown Manhattan, it’s a very different story. The usual gun victim in the United States is black, a Native American or an Alaska Native, statistics say.

 

Brian Thompson was, by some accounts, a mild-mannered individual, approachable, likeable and a solid colleague, too. His murder is a tragic, criminal event that can never be justified. 

 

On the video recording his death, he was stalked, shot and killed around 6:45 a.m. on Wednesday, Dec. 4th.

 

Two days ago, 26-year-old Luigi Mangione was picked up at a McDonald’s in Altoona, Pa., after a customer spotted what they thought was someone looking very similar to the man who killed Thompson. He’s been charged with murder.

Given Thompson’s title, CEO of UnitedHealthcare, the health insurance arm of UnitedHealth Group, the courtroom hosting this trial could very well take on a very different tone other than a murder trial. Besides arguing over the obvious – did the police pick up the right man? – other issues could arise.

 

What’s At Stake

 

“Delay,” “deny” and “depose” were written on the casings of the bullets that are thought to have been used in Thompson’s murder, police say. Add to what’s also been reported, and there’s every chance this could turn into a show trial about health insurance, maybe even the medical industry. 

 

As with another high-profile trial in New York City, involving a former Marine, defense attorneys will need to work hard at gaining a jury’s sympathy if they hope for any leniency should their client be convicted – and this approach might work.

 

Recent numbers on the amount of medical debt Americans carry are staggering. 

 

Two months ago, the Consumer Financial Protection Bureau reported that 100 million Americans are carrying about $220 billion in medical debt, and it may not be their fault.

 

“Medical billing is often riddled with errors, including inflated or duplicative charges, fees for services the patient never received, or charges already paid,” said CFPB Director Rohit Chopra in the news release reporting the $220 billion in medical debt. “The CFPB is taking action to ensure that Americans are not unfairly chased by debt collectors over unsubstantiated or invalid medical bills.”

 

Every year, about 530,000 bankruptcies in the United States are due to medical costs, according to the National Library of Medicine.

 

Looking Under The Hood

 

A U.S. Senate report, published about eight weeks ago, puts UnitedHealth Group in a bad light. Looking at the claims of senior citizens in the Medicare Advantage program, the U.S. Senate Permanent Subcommittee on Investigations found that in 2019, UnitedHealthcare “issued an initial denial to 8.7% of the post-acute care prior authorization requests it received; by 2022, it denied 22.7% of all such requests.”

 

The report also says UnitedHealthcare tested “Machine-Assisted Prior Authorization (MAP)” to determine the care that would be covered or not covered. Was this an AI program? 

 

Emails seeking clarification and comment from UnitedHealth Group about this report weren’t immediately returned. Telephone calls seeking a response from U.S. Sen. Richard Blumenthal’s office (D-Conn.), who chairs the Senate Subcommittee, weren’t returned either.

 

The report said, “The minutes for the Utilization Management Program Committee (UMPC) (an internal UnitedHealth Group committee) described MAP generally and noted that while it was ‘never a valid source to justify approval or denial of a case,” it was a ‘tool’ that ‘points the clinician to significant sources of primary evidence’ used in evaluating a prior authorization request. When Committee members asked ‘whether the software creates the potential risk of bias, ‘they were told that the doctor or nurse reviewing the case was responsible or verifying that ‘the primary evidence is acceptable.’”

 

The UMPC committee “while discussing the auto authorization model, expressed concern about the costs of ‘increasing manual review rates’ in the UnitedHealthcare division responsible for Medicare Advantage plans,” the report says.

 

“Taken together,” the report says, “these documents suggest that (1) UnitedHealthcare was evaluating the use of automated prior authorization procedures; (2) the company knew from testing that at least one of these automation technologies resulted in an increase in the share of those requests being denied; (3) this model was associated with less time spent evaluating prior authorization requests; and (4) the company was interested in reducing the money it spent on human reviewers of cases for the group covering Medicare Advantage plans.”

 

The Senate Subcommittee’s conclusion might be the most damning part:

 

“Medicare Advantage has grown rapidly in recent years and is, as of 2023, larger than Traditional Medicare. Despite the enormous growth in enrollment, some two dozen health systems have announced over the past year that they will stop accepting Medicare Advantage beneficiaries, with hospitals and providers overwhelmingly citing frustration with prior authorization. Prior authorization was one of the tools given to insurers participating in the program to help them prevent harmful or unnecessary medical services, but as HHS (U.S. Department of Health & Human Services) OIG (Office of the Inspector General) and others have warned, the structure of Medicare Advantage can incentivize companies to use the process to deny care to which patients are entitled.”

 

Another report, from The Commonwealth Fund, published in August, details a recent survey of Americans and their issues with being denied coverage from their health insurer. 

 

Does exasperation and indignation over health insurance justify Brian Thompson’s murder? Of course not!

 

But with hundreds of millions of Americans feeling the weight of medical debt, and a sizable amount unable to pay it, Luigi Mangione might very well receive a sympathetic hearing from a compassionate jury and, quite possibly, a lesser sentence if convicted. 

Sunday, November 24, 2024

Ten Solutions to Unity


The election is over, and like the cocktail parties of decades ago, when alcohol and cigarettes were consumed freely and too often, some of us are still recovering, lamenting that there's unlikely anything to glide us through the next four years – at least without a prescription.

Before you know it, the American electorate, fickle as it is, will likely dispatch many of today's leaders from either side of the aisle for the next flavor of the day.

 

What's disturbing during political campaigns of late is that some people think their views furnish them with an element of superiority. In contrast, others are certain theirs keep them grounded, in touch with the common folk, the regular Joes and Josephines. 

 

But that's nothing compared to what's even more disconcerting.

 

It's the separation. The echo chambers. The refusal to engage with those whose views are different. And when we do, often anonymously, it's not a civilized exchange as it is an effort to demean someone in a digital boxing ring.

 

We can beat a retreat with coloring books and Crayons – maybe even to another country, as some mentioned after Nov. 5th – banishing ourselves so we're "safe" from views we find hideous and threatening, or we can pull out a relic that might just save us.

 

I recall the 1970s and 1980s, when the cocktail party was de rigueur for socializing long before there was anything called the internet, a smartphone or an echo chamber, which holds us hostage to our views.

 

Perspectives other than our own – whether political, economic, social or theological – can be angering, no doubt, which is all the more reason for some lubrication.


 

There isn’t a problem we can’t solve while throwing back one, many or all of the 10 solutions to common ground: Whiskey, brandy, vodka, rum, gin, tequila, wine, beer or ale. Throw in the 10th solution – cigarettes – and this is a winner.

 

As the Canadian Club trickles across the rocks, the martini is being shaken, or we’re helping someone – whose views we’re convinced are completely contrary to our own – light their cigarette, we'll discover what political scientists already know: We're a version of purple.

 

Few of us, in fact, are hardened Democrats and Republicans, which means, despite whatever fears we may have, this cocktail party should go off without a fight. Maybe a boisterous debate or two but without fisticuffs. 

 

As the great Tom Lehrer once crooned, "shake the hand of someone you can't stand/You can tolerate him if you try."

 

And if you're doing so while consuming your favorite booze, it'll be easier and, hopefully, a friendlier exchange.


Smoke 'em if you got 'em!




Sunday, June 23, 2024

The Kid with It All


About six months after my 18th birthday, my parents’ forewarnings came to pass. I worked an unpaid internship at a Texas newspaper, the San Antonio Light, where my dad was the assistant CEO. Early one evening, about three weeks into it, I was speaking with one of the newspaper’s oldest and longest-serving 
reporters, Frank Trejo.

 

Unlike many reporters who spent a life writing nearly every story carried out by car thieves, murderers, rapists, serial killers, cops gone bad, run-of-the-mill thugs, and politicians incapable of telling the truth, Frank wasn’t cynical. He was a happy-go-lucky man and, on this particular evening, dispensing advice to make me better in my chosen profession. I devoured his words like a famished kid and even took notes because that’s what good rookies do: Listen to those who’ve come before them.

 

Across the newsroom, eyeing the conversation, was another man. The fact that he couldn’t hear it didn’t matter. He was about 10 years older than me and about 45 years younger than Frank. Life was different for him; authority figures weren’t to be trusted. 

 

“Hey, Trejo!” he screamed across the newsroom, standing behind a five-foot-tall partition where his pens, paints, paper and drawing board were kept for his editorial cartoons. “Are you trying to get a promotion – or a raise!?”

 

As much as the incident pissed me off – and I never mentioned it to my old man – this was exactly what my parents warned me about: People were going to look at me, the son of a prominent executive, and issue judgment because I was following Dad’s footsteps.

 

To be the child of a highly successful executive is no easy path to travel, especially if you’re following them into their chosen career. It’s quite treacherous. As my parents warned me, all eyes are on that person. 

 

They endure hushed voices as their colleagues issue biased, harsh, and, often, unfair convictions not only about their abilities and their work but also about what they wear, how they speak, and how they conduct themselves -- something they themselves likely never endured, especially with such furor. 

 

One of the best lines I ever heard about my intent was six years later, during my first week in the circulation department, now called consumer sales, of a gritty tabloid newspaper, the Chicago Sun-Times, where my dad was the CEO. I suggested to one of the department’s mid-level executives, who was overseeing my entrĂ©e into the department, that I spend my first weekend shadowing one of the division managers so I could improve my understanding of how the paper was distributed and sold. 

 

Nick Manzi called down to the city circulation manager, asking if there was anyone I could tag along with. 

 

“What the hell does he want to do that for?” Ian Clark barked. 

 

“He wants to work,” Nick replied.

 

Soon it was arranged, and I met the division manager at 6 a.m. on Sunday. We spent the day traveling in the city and around the greater Chicago area, visiting various retail outlets, newsstands and both airports, seeing how the paper was presented. We spoke with a few store clerks and managers, too. 

 

I learned a lot that day: One of the reasons people purchased the Sun-Times instead of the Chicago Tribune was because it was far easier to read on a standing-room only El train into the Loop, where many of the city’s businesses were located. It also had the best sports coverage. And winning local teams helped sell copies – big time! 

 

These lessons continued when I worked during the morning’s wee hours, filling the newspaper’s sales boxes – now artifacts from a bygone era – around the city, including those adjacent to Cabrini Green. I delivered copies in sub-zero temperatures, even blizzards, and retain harrowing memories of traveling on the Kennedy Expressway, with about a foot of snow on the ground and more falling, at 1 a.m. to get to a suburb, Wheeling, doing 360s on the highway as I drove one of the newspaper’s 1980s Chevrolet Caprices, which, in those days, were large, heavy, four-door gas guzzlers.

 

“You’ll have to work harder than the next guy,” Dad said before I joined the paper. “And you need to understand it better than everyone, too.”

 

Joan Kane, Dad’s executive assistant, provided even more cutting advice: Consider yourself a public figure, she said.

 

I picked up the hint.

 

Hunter Biden, the president’s younger son, fills me with empathy. Living in a fishbowl isn’t easy. He had no more control over his dad’s career than I had over my dad’s and the steps he took to ascend to the top of his profession.

 

Joe Biden did what was best for Joe Biden and, perhaps, as he contemplated each campaign, he thought about his family. Of course, this is something only those within the Biden inner circle will know. 

 

But it’s a lesson. You can be incredibly successful, as the president is, but if your young are ensconced in legal issues, become front page news, or can’t seem to get a handle on their demons, that says something about the parenting.

 

It’s unfair. It’s harsh. It’s as unforgiving as what any child endures when following their parents into their profession or living in a fishbowl.

 

As these stories about Hunter’s legal woes, personal failings, and drug and alcohol abuse come to pass, there are likely many who wonder, me included, what kind of father Joe Biden was to him. Was he there for those critical moments when Hunter was much younger or during the teenage years, sometimes filled with danger and trepidation? What lessons did he impart, and what nurturing did he provide when Hunter was younger and into adulthood?

 

Parenting never stops. I know. I've got two in college. 


As children grow up, they need their parents less. They’re making their way and their name in the world. But when the child is front-page news, and the articles are centered on legal woes and, sometimes questionable business affairs, some of it is a reflection on the parents. 

 

Did Joe Biden set up his kid?

Friday, June 07, 2024

Alzheimer's and the Health of Public Officials


Years ago, when covering Massachusetts public schools and the state’s education department for Bay State Parent, a monthly magazine, I had my own run-in when writing about the health of a public official. Instead of it being the governor, or even the president of the United States, it was the Bay State’s education commissioner. Mitchell Chester wielded a lot of power, overseeing the state’s K-12 public schools. 
 

If the teachers’ unions weren’t taking issue with him, it was the parents and others who thought they knew better than he about the best way to educate kids. I interviewed him a few times, and I always found him quite pleasant.

 

In fact, I often thought if the state board of education – to whom he reported – really wanted to sell what the Department was doing – pushing standardized testing, especially Common Core – they should have put on him on the road, doing more public speaking around the Commonwealth. He made a strong case for standardized testing -- “the system needs feedback" -- and he always did it with a smile. He was very engaging.

 

Tragically, back in 2017, he was diagnosed with cancer. The Department didn’t make the news public, but the board of education allowed Chester so much time away from the office they appointed one of the Education Department’s top leaders “acting commissioner.” The appointment and Chester’s health were kept out of the public eye.

 

Then, one Friday afternoon, an incontrovertible source called me. This individual had a lengthy professional history with the Massachusetts Department of Elementary and Secondary Education. They had worked alongside Chester for years and had also served, for many years, on the state’s board of education before retiring. They knew the state’s education Department quite well, and many in the Department fed them documents that weren’t supposed to be seen by the public; this source shared them with me. 

 

They didn’t make the Department look so good, showing that it was being supported, on occasion, financially by the Bill & Melinda Gates Foundation so it could enact certain policies – mostly to do with Common Core – they wouldn’t need to be run by the legislators on Beacon Hill for funding. (Talk about a threat to democracy!)

 

Of course, I wrote about it, and that put me on the Department’s well, let's say, "bad list." Not that I cared, of course. 

 

When I heard about the cancer diagnosis, it was a huge story. The Massachusetts Teachers Association knew something was wrong with him, too. As I recall, they were getting it from their members, plus, likely, the rumor mill. 

 

On Monday, I spoke again with my source. As on Friday, they confirmed their source was someone no one expected -- the acting commissioner. I quizzed the source about details about how the discussion came about and mentioned that this better be true. They swore it was. As for the details about their talk, it was surprising and somewhat comedic.

 

Of course, Bay State Parent’s editor and I were in touch on this issue with many phone calls. We saw this as a huge story that needed to be reported.

 

On Monday morning, I also called the state Education Department’s spokesperson. After we exchanged pleasantries, I asked her about the commissioner’s health, telling her what I knew. She promptly went into a 15-minute tirade, screaming that I was the worst reporter she ever met. I replied, saying the sources were solid and she had until 3 p.m. to provide a statement; otherwise, I said, we would update our website with the story -- as is. 

 

She provided a statement. We had a scoop. The commissioner died three weeks later. 

 

So, if a state education department can be highly defensive about its leader’s health, imagine what the Biden White House is going through. It has lots to lose, so they’re being as protective as possible about the president’s health. I’m not a Joe Biden fan. I’m not a Donald Trump fan. As a voter, I feel like that great social commentator and comedian Tom Lehrer once remarked, a "Christian Scientist with an appendicitis."

 

The WSJ’s story on the president’s health was likely as good and objective as could be expected. They quoted both sides. Could it have been better? I think so. But there’s always an editor – no matter if the media outlet sides with the left or the right – driving their reporters to get the story as quickly as possible.

 

As for Biden’s mental acuity, I’ll say this:  His actions, particularly the way he speaks, are reminiscent of the way my mother was just before she was diagnosed with Alzheimer’s. 

 

It’s important to keep in mind that President Reagan underwent the same scrutiny about his health during his re-election campaign in 1984, which Democrats were all too happy to discuss and push. His first debate appearance against former Vice President Mondale didn’t go so well, and it was thought he was in decline. Reagan acquitted himself in the second one, saying he wasn't about to take advantage of Mondale’s “youth and inexperience.” 

 

It generated several laughs, and Reagan waltzed into victory.

 

Imagine if the Biden campaign did the same.