...to Patients After the CEO was Murdered | May, 2025
https://medium.com/@hrnews1/blackrock-is-suing-unitedhealth-for-giving-too-much-care-to-patients-after-the-ceo-was-murdered-4af185038a62
The mind reels....
Back in 2009, Sarah Palin coined the term "death panels" to describe legislation that would have reimbursed doctors through Medicare for appointments discussing end of life plans, advanced directives and so forth with elderly patients.
https://en.wikipedia.org/wiki/Death_panel
The term stuck. Most people had no idea what the legislation actually proposed. People were revolted. The people were clear:
- all care should be covered no matter how expensive
- premiums must be kept to a reasonable level
- doctors should not talk about end of life with elderly people
And then Obama made the devil's bargain promising that the government would not negotiate on drug costs because without that provision, the Affordable Care Act was dead in the water.
Now here we are. Instead of some sort of rational triage, we have triage by attrition - deny as many claims as possible and hope that most people who are denied will not have the time and energy to fight you.
So I kind of agree with the article, but one way or another, we have to have a discussion about costs. As a general rule, we as a society hate having these hard discussions, but we can't put it off forever.
For my part, I have a lot of trouble deciding which razor blade to buy, so I'm not saying that *I* would be good at having these discussions. But I wish someone was rather than using default denial as your rationing system.
>would be good at having these discussions
Neither are the doctors.
I'm 75 and seem to have comorbidities stacking up like cord wood. I tell the doctors to cut to the chase and not skirt around discussing -say- whether a procedure will last as long as I likely have left. (Just give me the bullets!) No, they'll sidestep it every time.
So I tell them I'm gaming the system. For instance, I'll get my diabetes diet & meds good enough but I don't see the need to worry much about long-term ramifications. If I were 25, yeah. 75, meh.
Interesting. Probably because you are cogent and asking the question.
When it looked like my MIL would die (but didn't) and looked like my FIL would die (and did) last summer, I was in the ER when it looked like things would go south. In the first case, my wife with power of attorney was there. With my FIL, I was solo - the only family within 2000 miles.
In both cases the doctors were super jittery and careful about the conversation. When I basically said, "Look, this is a 91yo with lots of comorbidities. We're not doing anything extreme here right?" There was this palpable look of relief and the doctor went straight into, "If we don't get the next IV in, our next stop is the resuscitation room. We will have 1 minute to decide. So what are we going to do?"
I talked to an anesthesiologist friend who has spent a lot of time in the ER and a lot of time watching people die with family around. He explained that the doc's first question was to test whether I am a reasonable, rational person or not. He then said something like, "Your answer told him you were in the 10% who is going to make the rational decisions here."
Basically, he was saying that after years of being yelled at, told you don't care, told "you're just giving up on him," etc etc, most doctors are very very reticent to have those conversations.
So the problem I had was that I was in the 10% of rational family members. The problem you have is that you are in the 1% of patients with comorbidities who are rational about the situation and they have just been burned too many times by getting lulled into believing the person is rational and then having someone lash out when they hit a triggering question.
Heh! They'd freak if I told them that -rather than enduring a slow, grinding death- I'd buy a ticket to Switzerland and climb into one of their little futurist gas chamber pods. ...Then the docs would write me up as being severely depressed and suicidal.
<cultural> That reminds me. My daughter once told me that black families will not sign a DNR order for her nursing home patients even if mama is suffering terribly.
>> write me up as being severely depressed
My sister had a co-worker back in the 1980s who had shaky English and was from a foreign country (somewhere). One day he didn't show for work. When he came in few days later, he explained that they had asked him what he would do if [some bad thing - like his wife had cancer or died or he had cancer] and he said, "I would kill myself." Apparently, in his native language it is a common idiom for, "I would be really sad." Anyway, they locked him up on suicide watch and wouldn't let him out for two days.
2018: Goldman Sachs asks in biotech research report: 'Is curing patients a sustainable business model?
https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html
I remember that. If you're a drug company and you could create a pill that in a single dose would outright cure some type of cancer, could you afford to bring it to market? At what price per dose?
>> single dose would outright cure
Aside from the need to recoup development costs, I don't see a problem.
If a single dose cured me of something awful, I'd eventually get something else and then the pharms could probably sell me drugs for that.
Dead consumers don't buy products.
>Dead consumers
They want patients to live. Dying kills the cash flow.
The National Spinal Cord Foundation started in the 70s-80s with the goal of funding research for curing paralysis. As it grew legs, corporate sponsors (medical equipment, wheelchairs, etc) came onboard and provided more funding. But -Surprise!- the goal morphed to care.
> Aside from the need to recoup development costs
That's the problem. Remember threads on here that everything is becoming a subscription? Drugs are the best, most profitable subscription business in history (maybe next to rent).
Something like 50,000,000 Americans take statins and will deposit money in the drug companies' bank account for 30, 40, even 50 years.
Lipitor costs $600/month[1]. Call it $7000/year. Over 40 years, that's $280,000.
Logically, if someone came up with a pill to cure high-cholesterol, that should be worth more than Lipitor, but would people pay $300,000 for a single dose? I think it would be a hard sell in the US.
In Canada, it might not be so hard because people will be on the same "insurance plan" for life, so patient and insurer incentives align even on very expensive preventative care that won't realize the full savings for decades.
In the US, the company might spend $300,000 to cure you from high cholesterol and next year your employer switches insurance, so the new company is the one who realizes the cost savings. Incentives here often do not align, which I think makes the one super expensive pill very hard to sell.
> Dead consumers don't buy products.
Healthy consumers don't buy drugs. That's the problem with curing people.
Of course, I 100% agree with you in principle about how it *should* be, I'm just more pessimistic than you with respect to how the accountants at drug companies run the numbers.
I'm not arguing that we should not do this. I'm more arguing that I think for-profit drug companies LOVE drugs that people take every day for life. Drugs that cure things quickly might have to come from the not-for-profit sector as did the first big breakthroughs in antibiotics and vaccines. Once antibiotics and vaccine technology was proven, it was easier for for-profit drug companies to work on variants that push that tech forward.
>> Healthy consumers don't buy drugs
True, but few people stay in full health forever.
Create a drug that saves me from disease X and eventually you'll be able to sell me drugs for Y and Z.
>> In Canada, it might not be so hard
In Canada we treat health care as a right, not a profit center. Our average life expectancy is significantly longer for both men and women than our counterparts in the US, even though we spend a significantly smaller portion of our GDP on health care costs. More of what we pay goes to actual care rather than admin overhead.
It's also worth noting that health care costs are the leading cause of personal bankruptcy in the US. For Canadians that's not even on the radar.
You can think of me as your friend with benefits!
>> health care costs are the leading cause of personal bankruptcy in the US
We're Number 1! We're Number 1!
>> friend with benefits!
:)
Some drugs are made with grants from the US government, but drug companies still charge people a lot of money for them. If my tax dollars are used for the R and D, shouldn't people in the US be charged less for those drugs?