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I Was a Health Insurance Executive. What I Saw Made Me Quit. (www.nytimes.com)

submitted 2 days ago by [email protected] to c/[email protected]

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One story that we couldn’t keep out of the press and that contributed most to my decision to walk away from my career in 2008 involved Nataline Sarkisyan, a 17-year-old leukemia patient in California whose scheduled liver transplant was postponed at the last minute when Cigna told her surgeons it wouldn’t pay. Cigna’s medical director, 2,500 miles away from Ms. Sarkisyan, said she was too sick for the procedure. Her family stirred up so much media attention that Cigna relented, but it was too late. She died a few hours after Cigna’s change of heart.

Ms. Sarkisyan’s death affected me personally and deeply. As a father, I couldn’t imagine the depth of despair her parents were facing. I turned in my notice a few weeks later. I could not in good conscience continue being a spokesman for an industry that was making it increasingly difficult for Americans to get often lifesaving care.

One of my last acts before resigning was helping to plan a meeting for investors and Wall Street financial analysts — similar to the one that UnitedHealthcare canceled after Mr. Thompson’s horrific killing. These annual investor days, like the consumerism idea I helped spread, reveal an uncomfortable truth about our health insurance system: that shareholders, not patient outcomes, tend to drive decisions at for-profit health insurance companies.

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[–] [email protected] 4 points 1 day ago (1 children)

From nearly all ethical standpoints this murder was unethical and unjust.

Really? I definitely don't agree with that. The starting base that you're likely missing is that this man is directly responsible for the preventable deaths of thousands to hundreds of thousands of people. He joined UHC as the CEO in 2021, so has had some time to work and adjust the company. Since he joined, he has changed their policy and implemented measures to deny additional claims (see, chatbot rejecting peoples claims), causing their denial rate to skyrocket to ~30%. Source is here in the XLS files the government provides. UnitedHealtcare claims it pays 90% of claims but hasnt actually provided data showing that.

Since his company posted enormous, increasing profits in every year he was CEO, and the denial rates, I'd argue he's led the company to deny healthcare claims.

Some easy ethical frameworks where this is acceptable?

Utilitarianism - you could argue that killing him has caused companies to back off other healthcare cuts (see BlueCross and their anaesthesia cuts). The ripples it has caused are likely to impact what decisions CEOs of other healthcare organizations make regarding patient care and denials.

Natural law theory essentially argues that law and morality are separate. An example that might be clearer is slavery - I'd argue killing a slaver is morally correct, because I believe that slavery is immoral, even is slavery is legal in that country. I believe that healthcare should not be a for-profit industry, and that denying people care to prioritize "line goes up" is immoral. Those who are making the decisions to do that are thus directly contributing to the preventable deaths of countless people.

Rousseau talks about the social contract theory, and basically says if a government approves immoral actions (which I count for-profit healthcare as), they forfeit their legitimacy, and thus people have the right to rebel.

Retribuutivism by Kant argues punishment should be proportional to the crime. If you accept that he is responsible for deaths (not legally responsible, but morally), then this is definitely moral, though its worth noting Kant though murder is a serious, irreversible action and recommended other options before murder.

I could keep going, but those are the easy ones.

[–] [email protected] 0 points 6 hours ago* (last edited 6 hours ago)

Yet those companies will probably just postpone these policies until the public has cooled off of the topic.

Rule utilitarianism states that "an action is right as it conforms to a rule that leads to the greatest good". Murder as a general is right. The reason is that this murder is just a short-term thing that doesn't undo all the deaths that have happened. The general abidance to rule of law without self-justice is worth way more than any single person dying in nearly all cases.

In the categorical imperativ Kant argues that you should "Act only according to that maxim whereby you can at the same time will that it should become a universal law." If it became a universal law that you could kill anyone you deemed evil this would end in a worse result for everybody. Thus it cannot be wanted.

The family and friends around him mourn and the new CEO seems like he is not about to roll over and accept every health insurance claim. The death is dividing citizens which believe he is a hero while others believe he is a murderer. The responsibility off of all those unneeded deaths are claimed by not only the CEO but also by legislators who didn't account for universal healthcare. It is on the sitting government and parties for not supporting change. It is on the employer partly for not buying a higher premium package that includes more things or choosing a different company with a smaller denial rate. It is on the individual employee inside UH denying claims. It is on upper management like Brian Thompson and the people around him who are at fault for making this worse. And then there's the stakeholders that don't press on more ethical practices. Then its also on Americans voting against parties that wish to change the healthcare system in a beneficial way for everybody.

As the head of a company Brian Thompson also had the responsibility to steer it in an ethical way which it seems he did not do. His death has sparked public debate which is a good thing. This does not necessarily mean choosing a murder was the right way of doing things that optimizes utility for everybody.

The only statement you made was about Utilitarianism. Every other argument built on that. Retribuutivism for example is a legal concept and the punishment is not chosen by a person but written down in law.

I also agree with the sentiment that law and morality are different from each other but I do still not see this murder as morally right. UH is just one of many healthcare insurers and if the problem was solved legislatively it would benefit everyone.

I appreciate you approaching my statement from a logical standpoint and not just slinging insults at me like some other people. I believe we do not have to share the same view to get along or have an interesting conversation.