Sick Unto Death

The United Health Care Assassination

Freakshow fans, I know we are in the midst of witnessing the establishment of the greatest Cabinet of corrupt, lunatic, malformed curiosities ever brought under one roof in human history - and that therefore you expect your Freakshow guide to keep touring the tent.

But the wild incident in midtown Manhattan yesterday demands our attention this week. It clarifies what’s really at stake in America. It is the trailer to a must-watch thriller, the ongoing blockbuster series called The Scandal of American Healthcare.

The assassination of health insurance CEO Brian Thompson outside the New York Hilton at dawn, while undeniably horrifying and tragic, especially for his friends and family, feels like lancing a boil. Rage and macabre glee course through the sewer of social media. So much cheering of the assassin on Xitter and Threads. As one wag put it, Thompson’s was the most celebrated death since Kissinger’s. Civilized hand-wringing over this spectacle of heartlessness is being drowned out by orders of magnitude.

Why? Yes, we’re a flinty lot (see my post-election Freakshow on that national trait here). But one reason for our flintiness is that most Americans live with the total or near-total absence of the most fundamental pillar of human security. I’m not talking about guns. I am talking about health care.

The sleight of hand that circus-barker-crowned-King Donald pulls every time he blames brown people coming over the border for the miseries and panics of average Americans is a sick, slick trick from the old Republican playbook. Reagan plied it first and most effectively at the dawn of the new anti-progressive era, gulling middle America into voting for its own extinction by blaming welfare queens for their unhappiness.

Sadly the trick works just as well almost a half century later. Blaming immigrants is a reliably crowd-pleasing diversion from the real problem: the abomination of private, for-profit, market-driven health care. One huge reason Americans are so stressed out and mad is the sheer difficulty of achieving and maintaining access to what should be a basic human right.

Chemo? Or a roof over your family?

Meanwhile, health care profiteering is obscene. Did you know United Health Care hauled in $371 billion in revenue last year? Did you know United Health Care has the highest claim denial rate in the already flinty American insurance industry? (At 32%, four and half times higher than Kaiser, with the lowest rate.) Did you know United Health Care’s C-suite was under DOJ investigation for insider trading? Thompson was one of several senior executives at UnitedHealthcare who sold stock after an antitrust investigation that had not yet been made public, according to a Crain’s New York Business report from April.

Of course, United Health Care blows hundreds of millions on political donations and lobbying to keep things just the way they are.

I am sure Brian Thompson was a nice midwestern guy and his family did not deserve to lose him. But the company he runs is not far from the faceless death panels that conservative shills have warned about for years - and still do every time any credible attempt at national health care is brought up (no one really does that in Washington anymore except the sidelined cranks, of course).

Did you know that United Health Care uses AI to deny claims and then refuses to explain the decisions to patients or doctors because their “tool” is "proprietary”? Ars Technica broke that story in detail last year, and it’s hideous. The machine has a 90 percent error rate! Talk about faceless death panels.

The company’s AI “tool” determines how long the company should cover a stroke victim’s rehabilitation, or a geriatric’s physical therapy after a fall, or any of the myriad needs of the old and infirm. The tool - not the doctor or nurse or patient advocate - determines how much care they “need.” The machine was designed to be absent any human touch that might - god forbid - inject a drop of profit-cutting compassion, the milk of human kindness or even medical common sense into the cold dead algorithm.

When this was reported in November last year, I may have missed it because at the time our family was distracted, dealing with our mother’s last days of life. She was 93, failing after years of valiantly living independently. We had just moved her into an expensive assisted living situation, draining her teachers’ pension bank account of tens of thousands of dollars monthly on rent and shifts of three different caretakers. Almost none of it was covered by Medicare or insurance.

Mom died with almost no money left. But she was one of the lucky ones. She was almost broke. Most people don’t even have that luxury. Many Americans are forced to decide between care, chemo, or a roof over their heads.

Sadly, we’re used to it. We don’t expect any more because we don’t know any other way. I’ve had the chance to see this appalling system from the outside, from places where this is not how people live. Once seen, it is impossible to unsee.

I had one baby in New York City and one in Paris. Both pregnancies and births were without incident. In the USA, the bill ran into the high $20,000s. And I was in the hospital for exactly one night. In Paris, the entire saga, from the first ultrasound to the French standard practice pour les mamans of being cared for in a hospital bed and fed three-course meals for the baby’s first five days, was in the lower four figures.

But there was also something else: in France (and in other European countries with national health care where I have lived, Norway and Italy) doctors are like techs. They dress and act like orderlies, or government employees (which technically many are) and not like people with enough stash on the side to own ski chalets or tropical hideaways.*

Returning to the rural U.S. after our European residencies, it was always shocking to see how unhealthy our neighbors were, how they lived almost without any care, getting sick from preventable metabolic maladies, suffering cancers whose cures were bankrupting them. In rural upstate New York, doctors are few and far between. Their scarcity doesn’t mean they cost any less.

They have no idea how different life is in countries with socialized medicine. In America, if you get sick, you’re really on your own. In most of the rest of the world, you will not see coffee cans on gas station checkout counters for families with sick relatives, and certainly not “gun bingo” charity fundraising nights (see a recent freak show here for more on this all-American diversion.)

In the next four years, Trump and MAGA Republicans will continue to attack the meager shreds of what passes for a healthcare net that Americans do enjoy. These people have been fighting savagely against national healthcare for decades, leaving the United States almost alone in the world without such a program.

Remember when Obama first proposed the ACA? The opposition sent armed men to menace and march around health care town halls at which the policy was being discussed. We didn’t know it then, but we were witnessing the early days of the now openly fascist backlash to progressive gains.

When the ACA passed, insurers were forced to cover people with pre-existing conditions, but hardly more than that. Even so, Republicans poured money and political and legal capital into destroying it. They and their legal minions in red states filed at least 40 lawsuits trying to kill or maim the law. In his first term, Trump sabotaged it in half a dozen ways.

In 2021, in a surprise ruling, the red Supremes definitively threw out a challenge, entrenching the ACA in American life.

The loathing that MAGAs and their corporate donors harbor for the ACA is rooted in fear of an additional “entitlement.” The ACA is far from a workable national health care plan, but it cracked open a door to socialized medicine and therefore is anathema to the giant beast of profiteering health insurers and other entities that grift and steal from the most desperate Americans at the most desperate points in their lives.

These profiteers and their political tools understand that once “entitlements” — like Social Security and Medicare - are enjoyed by many, they must be pried from the cold, angry hands of the public, even from conservatives who benefit from them as much as the poor.

Back to the assassin’s trail. He apparently left bullet casing engraved with the words “delay” and “deny” - a clear indication of a motive that may have crossed the minds of untold millions of Americans, waiting for hours on hold on 1-800 lines, whose needs are so unimportant compared to the bottom line that the company hands off the job of divvying up care to a machine.

The assassin will most likely be caught. Meanwhile, the crime begs for armchair sleuthing. Was this a “professional” job? The silencer on the gun, the apparent advance knowledge of which door the victim was going to use, and when he would arrive. NYPD thought the killer seemed to understand the web of surveillance cameras on the streets of New York. But: he reportedly fled on an electric Citibike (my preferred mode of transport in Manhattan too!) which gives him a decidedly Antifa flavor.

Soon enough, he will be trapped. Or not. Either way, we will be back to the Cabinet of Curiosities next week.

*Yes, I know there are also many private-only doctors working in Europe who do rake it in. But they are not the norm.

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AUTHOR’S NOTE: Troubled times demand both awareness and laughter. If you’re looking for something short and clever to divert you from our real-life dystopia for a few hours, click here and order a copy of my new (and first) novel, Zero Visibility Possible. The book is a funny dark satire about American gun violence, the media and disinformation, and the political uses of public trauma. Early readers called the book “a stick of dynamite” (Greg Olear) and “dark, witty and obsessively readable” (Rick Wilson). Buy one and I will gift you a one-year PAID subscription to the American Freakshow. Just DM or email me the receipt.